Week 17, 20 - 27 April 20182018

General developments & political & security situation  Al-Yarmouk Camp: SAA military operation against ISIL and AL-Nusra presence in South of Damascus has continued for the seventh day following the failure of negotiations to halt fighting and evacuate ISIL fighters and Al-Nusra out of Tadamoun, Al-Yarmouk Camp, Al-Hajar Al-Aswad and Al-Qadam.  Eastern Qalamoun, Rif Damascus/ S Homs - The last phase of NSAGs evacuation from East Qalamoun was concluded according to several reports. About 38 buses were observed gathering in Al-Rehaibeh point and carrying more than 1,500 NSAGs fighter along with their family members and civilians who are not willing to stay in the area.  Rural Deir Ez-Zor; The security situation in the ISIL pocket in Eastern rural Deir Ez-Zor is still tense with reports of internal confrontations among them.  S Rural Idlib/ W Rural Aleppo; A new ceasefire agreement was announced between HTS, SLF and Souqour Al- Sham to halt the fight in the NSAGs territories in Idlib and West rural Aleppo. SAA and RF warplanes bombarded NSAGs positions in the towns of Hobiet, Abdien, Barsah, Ma'aret Hurmah and Tal Al-A’as in rural Idlib  Aleppo Govt: An increase in military activities was witnessed between SAA and NSAGs located in the West of Aleppo city since the beginning of this week.  Rural Homs & Rural Hama; AC/IAF: SAA continued its military operation against NSAGs located in the north rural of Homs and South countryside of Hama with a slight decrease in the level of clashes on the ground.

OVERVIEW

KEY HEALTH ISSUES  Afrin: Acute Diarrhoea, upper respiratory infections, and Lice are the most reported communicable diseases among Afrin IDPs. Increasing in reporting of measles suspected cases, particularity from Afrin displacement area was reported in week 15-16. Samples were taken from 4 locations (Fafin town, Fafin camp, Ihres, Tal Refaat). In response to suspected measles cases 1450 children are vaccinated with MMR.  East Ghouta: Increased incidence of acute diarrhea, upper respiratory tract infections, reproductive health. Decreasing number of people remaining in shelters.

KEY GAPS & CHALLENGES  Afrin: - Newly accessible areas require a higher number of equipped mobile clinics/ambulances to improve access to primary health care services. - Suboptimal referral system and approval delays for patients with chronic health conditions. - Limited health care for patients with TB and leishmaniosis. - Family planning activities to be enhanced with distribution of contraceptives, reproductive health kits. - A potential for increase of vector-borne diseases across the shelters. - Further heath supplies required to increase availability of essential medicines.

 East Ghouta: - Lack of clarity on hospitalization of patients outside the shelters and within Eastern Ghouta. - Remaining populations in East Ghouta communities still inaccessible to most health partners.

OPERATIONAL UPDATES

1. Coordination:

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 Regular national health sector meeting in Damascus: Violence against health care; Response to eastern Ghouta and Afrin displacement; Results of Syria Humanitarian Fund for eastern Ghouta and Afrin response; Health sector assessment registry, 2018; Health Cluster Gaziantep and Health Sector Syria hubs monthly snapshots; 2017 End of Year report (Periodic Monitoring Report); Area based preparedness and response plans; May-June 2018 IA convoys; reproductive health update.  Coordination at WoS level on: - Coordination on vaccination and disease surveillance, especially in NES. - Ar-Raqqa City Strategic Response Plan (preliminary estimates required for health sector funding is 16,850,000 USD.)  Developing inputs on the coverage of WHO activities in HTR and besieged areas.  Initiating an exercise for key health agencies on Afrin and eastern Ghouta response, jointly with Aleppo hub, with the objective to enhance response in Afrin as not being current sufficient under the current situation.  Upon the request of Qamishli AHCT, developed NES health sector preparedness and response plan for inter- sector plan.  Meeting of sector coordinators with the RC/HC on 2019 HNO/HRP (including mapping of sectoral assessments, HRP Costing and proposed way forward) and SSG outcomes.  Developed and shared with OCHA a preliminary list of health sector activities under the Southern Syria Preparedness Plan.

2. Information and planning:  Produced: - 4 infographics of key indicators for March 2018 (English/Arabic), across Syria; North-east Syria; North- west Syria; Southern Syria). - Health sector 4Ws snapshot for March 2018 across Syria. - Draft HeRAMS summary report Q1 2018 of the public hospitals in Syria.  Provided: - Key indicators of HeRAMS Syria for the global HeRAMS.org platform. - Syria Information product catalog and WHO Assessment Registry 2018 to WHE-EMRO. - Key information on public health facilities in NES to Qamishli hub for NES response.  Developed maps: - Functionality of public health centres in Rural Damascus, Aleppo, and Al-Hasakeh, Apr 2018; - Current situation and functionality of public health facilities in Eastern Ghouta (Rural Damascus) as of 17 April 2018; - istribution of the NGOs health facilities in Homs governorate.

3. Health operations:

East Ghouta response  Daily narrative of the health sector response maintained and Inputs provided for weekly OCHA.  Assessment missions to the shelters resumed on 25 April.  Planned health assessment for 25 public health facilities in East Ghouta under planning with MOH and SARC.  Support to 60 medical mobile teams, mobile health units and medical points have been mobilized, including: - 25 medical mobile teams by 13 national NGOs are in shelters providing almost 30,000 outpatient consultations per week. - 23 medical mobile teams from DoH Rural Damascus (estimated 200 health workers) providing health care on a daily basis in shelters and beyond. 15,000 consultations are provided during a week. - 6-8 teams of trained community psychosocial support workers providing basic psychological interventions, educational and recreational activities. People with mental health conditions received psychological and /or

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pharmacological interventions. People in need for medical assistance were identified and referred by the MHPSS teams to receive the needed health care and medicines in the shelters. An estimated 2,800 people benefit weekly from this program. - 3-4 nutrition surveillance and nutrition screening teams are on the ground. 3 stabilization centers are functioning.  38 EWARS sentinel sites are supported.  1193 injured and critically ill patients referred to Damascus hospitals and under health monitoring.  Vaccination activities within the Global Vaccination Week (22-30 April) –estimated 5,000 children covered.  A total of 11 shipments completed with health supplies, 50 tons or 600,000 medical treatments to SARC and DoH Rural Damascus, including the first batch of 30 wheelchairs for distribution by SARC.

Defined follow up points for the health sector for East Ghouta:  Develop clarity among the health workers on the ground on hospitalization of patients outside the shelters and within eastern Ghouta. There are many people who have stayed in different locations across eastern Ghouta and in need of continuous health care (at PHC and secondary levels). o Organizations to work closely through DoH medical teams and centers established inside the shelters and eastern Ghouta for hospitalization. o DoH medical teams are present in IDP shelters and reach areas outside the shelters, such as Kafr Batna, Ein Tarma, Arbin, Saqba, Zamalka, Hazzeh, Harasta, and Douma. o 3 DoH PHC centers were opened in Saqba, Hazzeh and Ein Tarma. Requests for hospitalization should come from and via these 3 PHC centers and any other locations where DoH will open its fixed presence. o SARC and health partners’ objectives are to roll out and enhance service provision inside Eastern Ghouta which will minimize eventually the number of people in need hospitalization in Damascus hospitals. o Use of private hospitals for referrals of patients not currently being considered.  Considering the decreased number of people remaining in shelters, SARC objective is to have 1 assigned ambulance per 3 shelters (depending on the size of population).  Setting up additional Emergency Health Points in shelters (currently established 3 by SARC): SARC plan to establish additional Emergency Health Points (EHP) only in shelters with more than 4,000 people.

Aleppo response:  An estimated 137,070 people remain displaced from Afrin in the Tall Refaat area, Nabul and Zahraa, Fafin, and surrounding villages. Afrin IDP registration is progressing slowly, and all IDP numbers remain estimates. Reportedly, IDPs are not able to cross check points on the streets leading to Afrin district.  Disease surveillance & immunization: - Increasing in reporting of measles suspected cases, particularity from Afrin displacement area was reported in week 15-16. Samples were taken from 4 locations (Fafin town, Fafin camp, Ihres, Tal Refaat). In response to suspected measles cases 1450 children are vaccinated with MMR. - Routine vaccination program active in Nabul, Zahraa, Deir Jmal, kafar Naya, and Meskan DoH point. - 10,067 children have been vaccinated with oral polio vaccine (OPV), 634 with inactivated polio vaccine (IPV)  Essential outreach services: - 26 medical mobile teams, health units and medical points that have been mobilized: 5 DoH donated mobile clinics, 5 SARC mobilized mobile clinics, 8 mobile medical teams by NGOs, 2 DoH PHC centers ,3 SARC PHC, 1 NGO PHC, 1 dialysis center, and 1 local hospital. - 8 WHO-supported and NGO-managed mobile medical teams are active in Nabul, Zahraa, Tall Refaat and surrounding villages. The teams, consisting of 40 health care workers working round the clock to respond to growing health care needs. - 1 WHO-supported static health point is also operational in Nabul, with four specialist doctors, 3 nurses and 3 health workers providing primary health services to an estimated 30,000 IDPs accommodated in collective shelters and host communities. 3

- One doctor and 2 technicians supported by WHO are activated in Nabul dialysis centre operated by SARC . - WHO supports the referral system for Afrin IDPs in Al-Zahraa Filed Hospital, 30 cases received STHC services including obstetrics deliveries (SARC ambulances are facilitated patients’ transportation)  Hospitalization of critical cases - Coordination with DoH and SARC is ongoing to facilitate medical evacuations. Approval was received from MoFA to facilitate medical evacuations for IDPs who fled from Afrin and are currently in Nabul, Zahraa and surrounding villages to the city of Aleppo. - SARC - supported by WHO- facilitates the referral system to Zahraa local hospital through 4 active ambulances. To date, 53 patients have been supported though this system, including obstetric cases.  Shipments: 1 shipment of Anti-D Immunoglobulin delivered to SARC.  Health services for IDPs through public health facilities as follows: # of # of patients # of # of Health outpatient received Partner District SHC trauma facility consultations assistance services patients PHC services with medicines Al-Ihsan Mobile Burj Al-Kaaf & Al-Zouk 701 701 3 team Mobile Al-Ihsan Kishtaar 221 218 2 team

Mobile Al-Ihsan Al-Ukaiba 258 77 team

Mobile Ibeen 415 415 1 Al-Ihsan team

Mobile Al-Ziyara 139 129 4 Al-Beer & Al-Ihsan team

Mobile Deer Jmal 80 39 Al-Beer & Al-Ihsan team

Mobile Kafr Naya 67 102 Al-Beer & Al-Ihsan team

Mobile Nabul 58 36 2 Al-Beer & Al-Ihsan team

PHC Al-Ihsan Nabul 1131 1131 Sub total 3225 2987 12 0

 Response Pipeline: - 12 additional medical mobile teams to be deployed next week, through 3 national NGOs Each team will consist of the following: 2 doctors (General Doctor/ Internist / paediatric ), 1 nurse and 2 health workers.

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The total No of WHO supported mobile medical teams in Nabul, Zahraa, Tall Refaat and surrounding villages will be raised to 20 mobile medical teams. - Coordination with active health sector partners to map of health services provided by mobile medical teams. - 4 agreements are in the pipeline with 4 NGOs.

Aleppo Regular Program:  Coordination: Sub-national HWG conducted in 24th April, enhancement of Afrin response was key agenda item.  Immunization: “Protected Together” National Immunization Week in Aleppo is being implemented by 81 mobile teams (34 teams in the city and 47 teams in rural Aleppo) will fan across the governorate to reach around is 88690 U5 children. The campaign will emphasize the routine vaccination campaign also it will provide polio vaccines OPV.  NNGOs support:

# of # of patients # of # of # of outpatient received traum # of people Commune/Village/T SHC Partner District consultatio assistan a MHPS with own servic ns PHC ce with patien S disabili es services medicin ts ty es

Al-Ihsan Jabal AL-Mogambo 1579 1334 4 2 13 0 PHC Samaan Al-Ihsan Jabal Sheikh said 536 536 8 1 0 0 PHC Samaan Al-Ihsan Jabal Salah AL-Deen 528 528 7 0 0 0 PHC Samaan Al-Ihsan Jabal Al-Mshatia 766 606 7 0 14 0 PHC Samaan Al-Ihsan Jabal Bostan AL-Zahra 0 0 0 171 0 0 PHC Samaan Al- Jabal Old Shahbaa 178 114 0 6 0 0 Beer PHC Samaan Jabal GOPA Al-Villat 0 81 52 0 185 26 Samaan Sub-total: 3587 3199 78 180 212 26

Northeast Syria (Al-Hassakeh; Ar Raqqa; Deir-ez-Zoir) response:  Health information: NES health sector 4W snapshot for March; Map of Typhoid case distribution in Alhole IDP camp; conducted site visits to some areas in Ar-Raqqa (Maadan and Al Thawara) to assess resource availability, health services, supporting agencies, infrastructure monitoring and rehabilitation potential; assess the health profile of public health facilities.  Pharmacy and secondary/tertiary health care: - Monitoring visit to a partner health point in Ein Issa camp to check medicines availability, dispensing and managing. 80-85% of essential medicines are available, good practices in managing the stock and dispensing medicines to patients.

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- Monitoring visit to a supported health actor in Al Areesha camp, pervious delivered shipments covered the qualitative and quantitative needs. - Visit to Al-Hassakeh DOH to follow up on the last delivered shipment, rehabilitation works and identify other needs.  Immunization: - National vaccination week to support routine immunization program as well as polio and measles vaccines have been started on 22nd April.  Disease surveillance: - Typhoid outbreak responses in Al Houl camp: Number of population in the camp is 15798 individuals, total number of suspected cases till 18th April is 1116. No death due to Typhoid fever has been reported.

Homs response:  A separate weekly report is being produced  EWARS weekly reports & tally sheets collected.  One suspected case (male, 9m) of AFP from HTR northern area admitted in the hospital in Homs, samples were taken for lab analysis by DoH team.  Health assessment in HD Quseer (AlHouz, Alnaem villages) done with coordination with SARC and DOH Homs.  Vaccination week started at 22/4 and will be for 7 working days, till 30/4. The campaign will emphasize the routine vaccination campaign also it will provide polio vaccines OPV.  Total number of vaccinated children at first 3 days is: 44,903 with OPV, and 1538 children with routine vaccination (630 children in Tadmour area), including 120 totally drop-out  Follow up Wash project with DOH Homs in Quseer (AlHouz, Alnaem villages) water samples were taken from the schools, PHCs, houses tanks.  The number of the beneficiaries of Albir NGO- WHO partner in Homs is shown below:

# of outpatient # of Commune / Village / # of SHC Partner District consultations PHC trauma Town services services patients

Albir Alhamra clinic Homs city 2519 117 39

Albir AlWaer clinics Alwaer 1335 110 35

Albir Fruqlus Fruglus village 240 68 49

Albir Qareteen Qareteen village 360 75 26

Albir Hamediyah Homs city 2208 94 24

Lattakia response:  Dispatched 10,700 serums in favor of Al-Mwassat hospital in Damascus  In order to support the IDPs in Homs shelters; dispatched 19,400 bottle of Permethrin 1% shampoo  Replenished Aleppo Hub with 15 Tons of medical health supplies.  Prepared a shipment on the ground to be dispatched to Al-Qamishlli hub.

4. Technical Expertise

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Non-Communicable diseases / Primary healthcare  6 workshops with 162 trainees in cooperation with MOH Center of Strategic Health Studies: Management of Health Facilities, Hospital Management, and Health Economics & Public health.  2 NCDs workshops to enhance medical staff capacity for better control & treatment of Chronic Respiratory Diseases according to standard guidelines; total trainees 50.  Followed up with MOH to finalize updating NCDs guidelines adopting WHO standards.  Advocating Training workshops on monthly reporting at As As-Sweida governorate 28-30 April.  Supported Primary health care Conference in Homs governorate conducted on 13th of Apr to 15th of Apr 2018. The conference highlighted the achievements of 2017 in whole Syria and in collaboration with UN agencies (UNFPA, UNICEF, and WHO. The conference lasted for three days and included more than 200 participants from over all Syria to discuss the plans and strategies of work in addition to the challenges during 2018.

Immunization: During the national immunization week 22-30April, MOH in coordination with WHO and UNICEF will conduct the following activities  National Immunization week: it is annual activity to reach the EPI defaulters. The target is 81,533 children 0-59 months. UNICEF has special communication activities through TV, Radio, orientation sessions with physicians and other community leaders, MOH has several meetings with other ministries and all MOH departments. WHO is printing message on T-Shirts for the children in IDP camps and in Raqqa city who are recently back to their city after long time. The national immunization week has started in all governorates except Deir-ez-Zor  bOPV sNIDs: 366.159 children under 5 were vaccinated in the first three days in the targeted governorates: Damascus, R Damascus, As-Sweida, Hasakah, Deir-ez-Zor ,Ar-Raqqa and Aleppo( 44% of the total target),As for Deir-ez-Zor the campaign is postponed till next Saturday due to logistic and administrative challenges, WHO focal point in Deir-ez-Zor is coordinating with the local authority to facilitate the implementation of the campaign next Saturday 28 April. As for Ar-Raqqa, 84817 were vaccinated with bOPV in the first three days in addition to 6622 children vaccinated wit IPV  Measles campaign has started in 3 governorates (Rural Damascus, Ar-Raqqa and Hasakah ),47816 children were vaccinated against measles the first three days.  393,642 children under 5 were screened for their vaccination status in different governorates, drop out children were vaccinated in line with the national vaccination schedule

Mental health program:  Three trainings on mhGAP Intervention Guide were conducted to about 70 health professionals working at PHC and community health centers in Damascus, Rural Damascus and Hama/Musiaf. The participants were form MOH and several NGOs.  25 community psychosocial support workers received trainings on Basic Counseling. The trainees work in the WHO-supported family wellbeing community centers in Aleppo. Training was conducted on the WHO School Mental Health Programme (SMHP) to 25 school counselors working in different schools in Rural Damascus.  Meeting was conducted with the management of Syria Pulse NGO to follow up on the process of establishing two family well-being community centers with mobile teams in Deir Ez-Zor governorate.

Nutrition and child health:  A stabilization centre for the management of complicated cases of severe acute malnutrition, using WHO guidelines, was established in Al Hikmah Hospital private in Al Hassakeh Governorate by training 25 doctors. While the training was ongoing, cases were identified and treatment initiated.  Survey data concerning the neonatal resuscitation program in March 2018 received from 23 hospitals in 8 governorates for more than 3676 new-borns:  54.6 % were caesarean,  13.8 % were premature babies,  311 new borne received neonatal resuscitation, 7

 179 were admitted in new borne section,  21 deaths were recorded.

Secondary health care program:  Finalized translation of the study tool to be used in assessment of patients' views on cancer care. The mentioned tool will be tested in Albyroni Hospital and to be modified later according to the findings.  Delivered approx. 3,391 treatments of life-saving and essential medicines: IV fluids and Anti D to SARC Aleppo and MOHE hospital in Damascus.  Continued preparations for activities to be implemented on the World Hand Hygiene Day on 5 May, 2018.

Trauma:  Procured locally 30 adult wheelchairs and delivered them to SARC to be distributed to persons in need in the IDP shelters. Another shipment of 300 adult wheelchairs and 100 children wheelchairs expected within weeks.  As a part of Afrin response, WHO dispatched 10 IEHK kits (sufficient for 100,000 treatments) to Aleppo to be further distributed to our implementing partners (SARC and DOH).  As a part of the daily coordination, conducted a meeting with SARC medical director to follow up on the proposal of refereeing patients from IDP shelter and from the newly regained areas. The director stated that at the moment this is not possible. A further discussion with the authorities is required on this issue.  Conducted a technical meeting with the director of Disability and Physical Rehabilitation Centre in MOH to discuss the proposal of establishing a National Register for persons with disabilities in collaboration with the Central Council for Persons with Disabilities Affairs. As a result, WHO will receive an official request from MOH requesting a detailed support regarding this Register.

Disease surveillance:  Measles in NES: A Slight decrease in suspected Measles cases has been noticed in weeks 14 and 15. The increase in Measles cases has been reported in Syria since the beginning of 2018. The number of reported cases in 2018 from week 1- 15 is 1863, compared with 700 cases reported in the same period in 2017. Cases were reported mainly from 3 governorates: Raqqa (812), Hassaka (722) and Dier Ezor (146). Number of confirmed Measles till week 15 is 130, of which 53 in Hassaka, 19 in Raqqa, 16 Aleppo, and 6 in Dier Ezor.  Typhoid in Alhole camp in Al Hassakeh: The increase of the number of suspected Typhoid cases has been reported since week 8 and peaked in week 13. 1116 cases were reported from weeks 1- 15. Control measures to containment the outbreak have been undertaken by all involved partners, as result; a decline in cases has been noticed in week 14 and 15.  Hepatitis A in Daraa: increase in Hepatitis A cases has been reported in week 15 from Daraa governorates, 30 cases were reported from the areas Tafas, Bosra, Sanamin and Izraa. Rapid response team in Daraa DoH will investigate the cases and check the quality of drinking water.  On 26 April a case of acute watery Diarrhea was reported in Dier Ezzor, the case is female, 30 years old, complains from fatigue and sever acute diarrhea with dehydration, the patient has not improved by antibiotics and serums, and has referred to Alassad hospital. WHO focal point in Dier Ezor will investigate the case in the hospital and collect stool samples to be shipped to the reference lab in Damarcus.

WASH  Field visit undertaken to Douma in East Ghouta to assess status of healthcare facilities and needs for rehabilitation. 8

 Water quality monitoring teams managed by SARC set-up in 8 camps for East Ghouta IDPs after training and provision of support equipment and reagents by WHO.  Water quality monitoring in NES camps in progress.  Coordination with SARC in Aleppo is underway for monitoring drinking water quality in temporary shelters in Afrin area.  Water quality monitoring of groundwater wells in Aleppo in progress. Over 950 wells monitored to date.  Water quality monitoring in Homs for reservoirs and groundwater wells in progress.  Upgrading water supply and storage system of St Louis hospital in Aleppo. Contract implementation will start on Sunday 28 April 2018.  Medical waste trucks for Damascus Waste Directorate are being shipped after obtaining necessary approvals.  Procurement of 450 medical waste bins for DoH Aleppo. Product ready for shipping since 22 February 2018. MoFA approval obtained.

National NGO coordination:  A field mission to Daraa was conducted to visit the Charity And Social Service Society – NGO.  NGOs inputs for the Standardized indicators for 4 response scenarios for March /2018 were submitted.  Summary report on the main findings of the conducted field visits to 11 NGOs has been submitted.  Two SARC injured cases received life-saving surgical intervention under WHO support.

External Relations, Coordination and Communications:  Circulated draft 2 of Q1 donor update for review and comments  Tweets about WHO interventions and health response, concentrating on covering the Syrian participation in the World Immunization Week (22-30 April 2018). “Protected Together, Vaccines Work”.  Several meetings with MOH & MOI to follow up on the media campaign materials (TV, Radio and Newspapers hits) broadcast on the occasion of the National Immunization Week in Syria.  Coordination with MOHE for the final preparation concerning the WHO - Bambino Gesù Hospital joint mission to the paediatric hospital in Damascus and the joint upcoming visit to Aleppo.  Preparing advocacy media materials to demonstrate the upcoming WHO Global Annual Campaign on Hand Hygiene dated on 5th May 2018.  Follow up with MOH to conduct two training courses on combating smoking as scheduled in the joint Collaboration Program 2018-2019.

Operational support and logistics:  Dispatched 17.5 tons of medicines, vaccines and printing materials, covering 3 governorates (Damascus, Rural Damascus and Aleppo). The recipients included 3 MoH facilities, 1 MoHE facility and SARC.  The total number of treatments is 30,420. The dispatched supplies included: - 25 vials of Anti-D immunoglobulin (Human) delivered to SARC in Aleppo. - Different types of mental health medicines delivered to SARC warehouse in rural Damascus to support the IDPs from Eastern Ghouta in the shelters. - 1,900 vials of Anti-Rabies vaccine delivered to MoH central warehouse in Damascus. - Different types of IV fluids delivered to MoHE – Al-Mowasat hospital in Damascus. - 52,385 ampoules of Meglumine antimonite 1.5 g/5 ml delivered to MoH central warehouse in Damascus in favor of Leishmaniosis control program.

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- 14,499 ampoules of Water for injection 5ml delivered to MoH central warehouse in Damascus in favor of TB program. - Different types of polio posters delivered to MoH central warehouse to support this week polio campaign. - Different types of AIDS printing materials delivered to MoH central warehouse in favor of HIV control program. - 3 IEHK supplementary kits, 3 different types of cholera kits, 1 tabletop centrifuge PLC-026, 1 spectrophotometer, 1 water bath model WNB 14 MEMMERT, 1 Fresenius hemodialysis machines - model 4008S, 1 BeneHeart R12 12-channel, 1 M7 diagnostic ultrasound device, 20 Mercurial Sphygomometer + stethoscope sphygmomanometer adult cuff, 1 portable X-Ray machine - model: DIG-360 Dongmun, 2 sphygmomanometers, 1 biological microscope standard set CX23 and different types of mental health, PHC, STHC and trauma medicines & consumables delivered to SARC Aleppo as a response for the IDPs from Afrin.

Capacity support (details): Supported 14 training events for 361 participants: # Date Details/Field Program participants 22- School mental health program for MoE Rural Damascus in 25 MH 26/04/2018 Damascus 22- Mental health GAP intervention guide refresher for MOH of 25 MH 23/04/2018 Hama/Msiaf in Hama 22- Improve utilizing and investing the collecting HeRAMS data using 28 HIS 24/04/2018 office program for MoH staff in Damascus 22- 25 First Aid and Basic Life Support “FA&BLS” in Damascus Trauma 24/04/2018 22- 25 Disability Management training course in Damascus Trauma 24/04/2018 22- Mental health GAP intervention guide phase 2 for MOH of 25 MH 26/04/2018 Damascus in Damascus 22- 25 Basic counseling for NGOs Aleppo in Aleppo MH 26/04/2018 24- Investment of the Ministry of Health Observatory for Human 28 HIS 26/04/2018 Resources in Damascus 24- 30 HeRAMS for SARC in Damascus HIS 26/04/2018 25- Mental health GAP intervention guide phase 1 Part 1 for NGOs of 25 MH 26/04/2018 Damascus, Rural Damascus and Daraa in Damascus 25- 25 Immediate Life Support “ILS” in Damascus Trauma 27/04/2018 26- 25 Rational use of medicines in Hama SHC 28/04/2018 28- 25 Electronic data entry for nutrition surveillance in As-Sweida NUT 30/04/2018

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28- 25 Monthly report training in As-Sweida PHC 30/04/2018 nutrition surveillance and MUAC assessment activities nominated 22 NUT from three national NGOs in Aleppo

RESPONSE PRIORITIES - Afrin, Eastern Ghouta, North-East Syria - Planned interagency convoys May-June 2018: Requested Requested Areas target areas Damascus and 1 Duma 70,000 1 Rural Damascus 2 Yarmuk, Hajar Aswad 6,000 1 Bait Jan (Bait Jan, Mazraet Beit Jin, Maghar Elmir) + 3 Betime, Beit Saber and Kafr Hoor 19,500 1

4 Yalda, Babela, Beit Sahem (YBB) ** 61,000 1

5 Jirud, Nasriyeh, Atna 47,500 1 Daraa 6 Mahjeh 22,000 1 7 Masmiyyeh (Masmiyyeh,Um Elqosur, Sharae) 14,500 1 8 Shaqraniyeh, Sweimreh 7,000 1 9 Ankhal & Jasim 55,000 1 Idleb 10 Foah and Kafraya* 8,200 1 Hama Tlul Elhomor (Dlal, Aidon, Almzira'a, Tlol Alhumer, Alzitona, Jmalt, Brighid, Alnezaryah, Aldminah, Alkantra, Aljomaqlia, Alshankiah, Zor 11 Alasi, Alamarah, Taksis) * 8,750 1

12 Harbanifse sub-district (Aqrab, Telf, Kherbet Eljame)* 18,000 1 Homs Talbiseh: (Talbiseh, east Farhania, west Farhania, Alsa'an, Alwasata, 13 Almkarmiah, AlHashmia)* 84,000 1 14 Al Houla (Taldu + Kafr Laha) * 71,000 1 Ar-Rastan: Ar-Rastan, Ghrnata, EzAldien, Abo Hmama, Alblan, Alken, 15 Alzafrana, Dier Foll, Almajdl, Tibo * 107,500 1 16 Dar Kabira, Ghanto, Tir Maallah* 40,250 1 Aleppo 17 Afrin ( Kafr Janna Raju Yakhur ) 50,000 1 18 Menbij 50,000 1 Big Orem (Qanater, Little Orem, Kafr Taal, Oweijel, Shiekh Ali, Kafr 19 Aleppo, Western Kafr Jum, Kfer Naha) 40,000 1 Al-Tareb area (Tuwama, Abzemo, Kafr Karmin, Maaret Atareb, Sahra, Tadil, Kafr Amma, Andan, Kafer Hamrah, Marat Al-Artiq, Khan Asal, Yaqed Eladas, Kafr Bssin, Babis, Hayyan, Haritan, Abin Semaan Kafr 20 Thoran, Batbu, Jeineh, Babka, Kafr Naseh Elatareb) 80,000 1 860,200 20

* Joint UN/ICRC/SARC request

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