: HEALTH CLUSTER BULLETIN DECEMBER 2016

Photo credit: Qatar Red Crescent

414 health facilities Highlights operationally supported in 145 districts o From the onset of the AWD/cholera outbreak on 6 October until 20 December 406 surgical, nutrition and 2016, a cumulative number of 11,664 mobile teams in 266 districts AWD/Cholera cases and 96 deaths were reported in 152 districts. Of these, 5,739 97 general clinical and (49%) are women, while 3,947 (34%) are trauma interventions in 73 children below 5 years.* districts o The total number of confirmed measles cases in Yemen from 1 Jan to 19 December 541 child health and nutrition 2016 is 144, with 1,965 cases pending lab interventions in 323 districts confirmation.** o A number of hospitals are reporting shortages in fuel and medicines/supplies, 341 communicable disease particularly drugs for chronic illnesses interventions in 229 districts including renal dialysis solutions, medicines for kidney transplant surgeries, diabetes 607 gender and reproductive and blood pressure. health interventions in 319 o The Health Cluster and partners are working districts to adopt the Cash and Voucher program on 96 water, sanitation and a wider scale into its interventions under hygiene interventions in 77 the YHRP 2017, based on field experience districts by partners who had previously successfully implemented reproductive health services. 254 mass immunization interventions in 224 districts *WHO cholera/AWD weekly update in Yemen, 20 Dec 2016 ** Measles/Rubella Surveillance report – Week 50, 2016, WHO/MoPHP

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Situation Overview

The ongoing conflict in Yemen continues to undermine the availability of basic social services, including health services. Increasing needs for conflict-related trauma injuries, non-communicable diseases, and maternal and child health services are placing a strain on a weakened health system. Import interruptions and the closure of air and sea ports have resulted in shortages in essential medicines and medical supplies. Since September 2016, government employees, including health staff, have not been receiving regular salaries, resulting in shortages of staff reporting to work at public health facilities. On the other hand, most Yemeni citizens are not able to afford health services from the private sector.

SPECIAL FEATURE: Cholera Response The AWD/cholera outbreak has affected 15 of Yemen’s 23 governorates, with Al Jawf recently reporting confirmed cholera cases. However, the danger of spread is still present, as other governorates remain at high- risk of infection transmission, due to the conflict situation, as well as population movement. From the onset of the outbreak on 6 October until 20 December 2016, a cumulative number of 11,664 AWD/cholera cases were reported, with 96 associated deaths. Of these, 157 stool samples from 741 patients tested positive for Vibrio cholera.1 The overall attack rate during Epidemiological Week 51 in 2016 (18-24 December) was 4.9 per 10,000 populations, compared to 4.3 in the previous week, indicating that the outbreak has not declined. For more information, see WHO’s latest cholera situation update.

Call for NGOs to support AWD/cholera response

The Integrated Health/WASH and AWD/cholera taskforce has updated the Cholera Response Plan to ensure adequate integration of interventions. OCHA Yemen has opened a funding window, the Second Reserve Allocation of the Yemen Humanitarian Pooled Fund (YHPF), calling for NGOs to apply and support the cholera response. Both clusters have finalized and shared the Gap Analysis and Standard Operating Procedures (SOPs) with OCHA to guide agencies on the geographical priorities and immediate interventions needed to be included in their proposals, based on existing needs and gaps in the 15 affected governorates. Funding is scheduled to be made available to selected agencies in early January 2017, with a project duration of three months.

Health cluster AWD/cholera response activities

Abs Development for Women & Children (ADO) distributed 850 hygiene kits in the two districts ( district of Hjah governorate and Al Luhia district of governorate. The total number of beneficiaries is 725 persons (309 male and 416 female). Additionally, 69 health education sessions were conducted in the two districts.

Building Foundation for Development (BFD) reached 46,690 beneficiaries in Amran district, Amran (874 men, 410 women, 24,473 boys and 20,933 girls) through cholera health awareness activities in 50 schools targeting both students and teachers. The campaign included posting educational materials, distributing brochures, and conducting role-play activities in classrooms and during morning assembly.

Khadijah Foundation for Development (KFD) reached 2,292 individuals (171 men, 234 women, 171 boys and 170 girls) by conducting 16 sessions of Focus Group Discussions, 31 sessions of counselling and distributing 330 IEC materials in Modhaikihra district (). The purpose of these activities was to raise awareness mainly on cholera, safe motherhood, and other public health related issues. In addition, 508 households (577 men, 674 women, 491 boys and 454 girls) were reached through distribution of 508 hygiene kits and 1,016 jerry cans.

1 WHO cholera/AWD weekly update in Yemen – 20 December 2016

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National Foundation for Development and Humanitarian Response (NFDHR) opened two cholera treatment centres in Hospital and Sharyah Al Wafa’a Health Centre in Al Baydah governorate. The two centres are functional 24/7 and are receiving and treating all cases of AWD/cholera.

Action Contre la Faim (ACF) in close collaboration with MoPHP and WHO has reached 1,041 patients with acute watery diarrheal treatment (300 men, 371 women, 217 boys and 153 girls) through Al Thowra DTC in Al Hawk District of Hodeidah Governorate. Out A physician treating a patient at the new cholera treatment of which 646 cases were treated with suspected centre in Mukayras Hospital - Photo-credit: NFDHR cholera2, the majority coming from Al Hawk, Al Hali and Al Mina districts. Dehydration status upon admission in the month of December was mild-28.8% (300), moderate-47.8% (498) and severe-23.3%. On discharge, 15% (156) patients left the treatment centre without completing full rehydration therapy, 83.7% (871) patients cured, 1.3% (14) patients were transferred to other medical facilities. Public health risks, priorities, needs and gaps The number of confirmed measles cases in Yemen from the beginning of 2016 until 19 December is 144, while the number of suspected measles cases is 3,417. The vaccination profile of the suspected cases show that zero dose cases were heavily distributed in Sa’ada, Al Jawf, Shabwa, Al Hudaydah and Amran governorates. 61% of measles cases received no vaccination. The affected age group is mainly children under 15 years, with a greater number below the age of five. Four measles outbreaks have been declared since the beginning of 2016.

A number of hospitals are reporting shortages in fuel and medicines/supplies, for chronic illnesses including renal dialysis solutions, medicines for kidney transplant surgeries, diabetes and blood pressure.

Health Cluster Action Coordination The second leg of the YHRP 2017, i.e., uploading of projects by humanitarian agencies on the Online Project System (OPS) has been completed on 21st December 2016. Currently, there are 78 projects uploaded under the Health Cluster, including those by UN agencies, international and local NGOs. The total amount is USD 364,657,776. The Cluster provided guidance and support to agencies during the project uploading phase. Projects submitted online are to be vetted by clusters/OCHA and the final list of projects will be published by mid-January 2017.

HEALTH RESPONSE Health service delivery Abs Development for Women & Children (ADO) reached a total of 8640 people through mobile & fixed clinics providing primary health care services, including treatment of common and infectious diseases: 4285 people (689 men, 1,870 women, 844 boys and 882) girls were reached through two mobile teams in () and Al Luhia district (Al Hudaydah), and 4,355 people (950 men, 1829 women, 819 boy, 757 girl) were reached through two fixed clinics in Al Zuhra and Al Luhia districts (Al Hudaydah) 55 patients were referred to hospitals for tertiary care services including surgical intervention & blood transfusions.

Building Foundation for Development (BFD) reached 4,372 beneficiaries (968 women, 224 men 1,585 boys and 1,595 girls) through supporting one mobile team and five health facilities in Harf Sufian and Hubor Zolima districts (Amran). The fixed and mobile teams provide epidemiological services, including Integrated Management of Childhood Illnesses (IMCI) services; nutrition services; maternal, newborn and child health

2 Suspected cholera case definition in areas with confirmed cholera case is any person with Acute Watery Diarrhea; Suspected cholera case definition in the area without confirmed cholera cases is any person with Acute Watery Diarrhea and severe dehydration with or without vomiting or any death related to AWD

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services; and Communication for Development (C4D) services. In Mareb, BFD reached 4,560 beneficiaries (1,739 women, 260 men, 1,282 boys and 1,279 girls) through supporting two mobile teams and four health facilities in Harib and Al Abedia districts. BFD also delivered medicines, reproductive health kits and medical equipment to health facilities in the two districts.

Handicap International (HI) donated specialised rehabilitation equipment for health facilities to be able to offer quality services to beneficiaries. By the end of December, HI will support the establishment of a rehabilitation unit at the inpatients department in Al Thawra hospital. On a daily basis, HI provides devices such as wheelchairs and crutches to persons with injuries and disabilities in Al Thawra hospital, Al Jumhuri hospital and the Prosthesis and Physiotherapy Centre. International Medical Corps (IMC) supported 97 health facilities in five governorates (Sana’a, , , Al Dahale’e and Lahj) In addition, a total of 24 mobile teams are also being supported. IMC referred 213 people for secondary and tertiary health care in Sana'a. Intersos - Humanitarian Aid Organization (INTERSOS) is currently managing nine mobile clinics, five of which are in Governorate (Bani Hushaysh and Hamdan districts) providing a total of 5,241 consultations, and four in (Buraiqa and Dar Saad districts) providing a total of 6,460 consultations. Qatar Red Crescent (QRC) is supporting the provision of primary health care services including immunization, reproductive health services, childbirth, emergency services, surgeries, and distribution of medicines in 22 May Health Centre in Al Mudaffar district (Taiz). As of 22 December, 2,301 consultations have been provided. Action Contre la Faim (ACF) reached a total of 547 children (300 male, 247 female) with primary health services in Jabal Ras, Al Khokah, Al Garahy and Al Munira districts of Hodeidah Governorate through two mobile teams.

Trauma care Through an ongoing project on health and child protection which is funded by the Humanitarian Pooled Fund, Abs Development for Women & Children (ADO) has treated 35 children affected by war and conflict in by providing them with secondary health care and rehabilitation services.

International Medical Corps (IMC) supported health facilities in Taiz and Ibb, as well as mobile teams in Ibb, treated a total of 73 patients for trauma injuries.

Khadijah Foundation for Development (KFD) provided 305 disabled people in Modhaikihra district (Ibb) with physiotherapy sessions under the supervision of medical specialists, experts and qualified health staff. These services, provided free of charge, are the only such services available in the governorate. Immunization International Medical Corps (IMC)-supporting health facilities and mobile teams provided 5,438 vaccinations (measles, polio, pentavalent and pneumococcal) to children under-one and 6,203 vaccinations to children under-twelve in six governorates. Tetanus toxoid vaccinations were provided to 1,046 pregnant and lactating women in six governorates.

Intersos - Humanitarian Aid Organization (INTERSOS) supported the immunization of 4,125 children under five in Aden against measles, polio, and other antigens, in addition to 1,649 children in Sanaa. Nutrition Abs Development for Women & Children (ADO) admitted 6035 children under five for follow up and 844 new cases suffering from moderate acute malnutrition in 42 fixed health facilities in three districts (Boraa, Alkanawes, Almeghlaf) in . 34 cases suffering from severe acute malnutrition (SAM) were referred to the SAM programme in Al-Qnawis and Meglaf district.

International Medical Corps (IMC) admitted and treated a total of 744 children under five suffering from severe acute malnutrition without complications and 3,174 moderate acute malnourished children in six

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governorates (Amran, Sa`ada, Al Bayda, Aden, Lahj and Abyan) through its supported health facilities and mobile teams.

Four mobile teams run by Intersos - Humanitarian Aid Organization (INTERSOS) in Aden supported by 24 community health volunteers who screened 1,598 children for malnutrition and detected 251 severe acute malnutrition cases. Of these, 12 complicated cases were admitted to hospital and 239 cases were enrolled into the outpatient therapeutic programme (OTP). In Sana’a, five mobile teams were supported by 30 community health volunteers who screened 1,469 children for malnutrition and detected 68 severe acute malnutrition cases, which were all enrolled into the OTP programme. INTERSOS also supported three referral hospitals: Al Sadaqa Hospital (Aden) and Zaid Hospital and 22 May Hospital (Sana’a) with medicines and equipment.

Action Contre la Faim (ACF) organized six days of training on inpatient management of severe acute malnutrition for ACF staff and MoPHP nurses from Hays hospital. A total of 22 staff including eight MoPHP nurses attended the training in Al Hudaydah governorate facilitated by ACF experts (read the detailed report here). In December, ACF treated 20 severely malnourished children with medical complications in Hays stabilization centre. Communicable disease control and surveillance In the six governorates targeted by International Medical Corps (IMC), medical consultations were provided through supported health facilities for 2,504 children (1,653 acute respiratory infections, 843 diarrhoea, eight measles). Additionally, 6,282 consultations (5,166 acute respiratory infections and 1,109 diarrhoea and seven measles) were provided through mobile teams.

In response to the measles/rubella outbreak, the World Health Organization (WHO) provided the following: o Technical support to develop microplans /proposals, Monitoring & Evaluation and tOPV-bOPV Switch Plan. o Technical support to develop the Joint Reporting Form and the Annual Progress Report. o Financial support for operational costs for 2 rounds of outreach activities. o Financial support for establishing operation rooms at the central and governorate levels for three months to ensure vaccine safety at all vaccine stores and service points, and to follow up the functionality of health facilities in conflict areas. o 78 electricity generators to ensure uninterrupted temperature control for vaccine storage. o 143 battery-free solar-refrigerators during 2016 for district vaccine stores. Reproductive health Abs Development for Women & Children (ADO), supported by UNFPA, distributed 139 clean delivery kits to pregnant women through fixed and mobile health services in Hajjah and Al Hudaydah governorates.

International Medical Corps (IMC) supported the provision of 1,124 safe deliveries in six governorates (Amran, Sa`ada, Al Bayda, Aden, Lahj and Abyan), and 3,757 women received antenatal care services. Additionally, one woman in Sana’a received emergency obstetric care and one woman was treated for injuries resulting from domestic violence. Also in Sana’a, nine people were provided with pre/post-HIV test counselling.

Through the support of Intersos - Humanitarian Aid Organization (INTERSOS), 426 pregnant women in Aden and 633 mothers in Sanaa accessed antenatal care services. 353 women in Aden and 780 women in Sanaa accessed post-natal care services. INTERSOS distributed reproductive health kits to 10 health facilities in Aden. United Nations Population Fund (UNFPA) mobile teams provided reproductive health services for 26,000 people in the governorates of Al-Dahale’e, Al Jawf, Amran, Ibb, Sa’ada and Taiz. In , three mobile teams provided integrated reproductive, maternal, and new-born health services covering 3 districts and supporting 2 hospitals (Al-Naser and Motherhood). UNFPA is supporting the MoPHP in conducting an assessment that will include short term and long term interventions to establish a functional reproductive health supply chain management system. A 3-day training course was held on minimum initial service package for reproductive health in Taiz and Ibb Governorates, targeting 50 reproductive health coordinators. A total of 808 beneficiaries (634 female, 174 male) were reached with services to address gender-based violence in December, with the highest being for psychosocial support services (593), followed by health service.

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Despite the staggering economic and humanitarian situation currently facing Yemen, to sustain the gains made in maternal and new-born health, UNFPA is supporting the MoPHP to develop a new reproductive, maternal and new-born health and advocacy strategy (2017-2012) with a costed five-year Action Plan. Through a participatory process involving extensive consultations with health officials, UN agencies (UNFPA, WHO, UNICEF), professional bodies and national and international NGOs, the new strategy will also aim to ensure that the urgent reproductive health needs during emergencies are adequately strategized, with a special section on reproductive health in humanitarian situations.

Action Contre la Faim (ACF) reached a total of 584 pregnant and lactating women with reproductive health services in Jabal Ras, Al Khokah, Al Garahy and Al Munira districts of Al Hudaydah Governorate.

Noncommunicable diseases and Mental Health Handicap International (HI) provided direct psychological first aid and group sessions (psychoeducational activities covering the impact of injuries on psychosocial well-being; positive coping mechanisms and resilience. Since March, more than 5,000 persons with injuries and their caregivers received direct Psychological First Aid and group sessions by specialized social workers in Al Jumhuri hospital, Al Thawra hospital and the Prosthesis and Physiotherapy Centre in Amanat Al Asimah.

International Medical Corps (IMC) provided mental health and psychosocial support services to 275 people in six governorates where they are operational (Amran, Sa`ada, Al Bayda, Aden, Lahj and Abyan).

International Youth Council – Yemen (IYC-Y) continued their interventions in Jabal Habashi district (Taiz), through THE provision of health services to more than 100 vulnerable people with chronic illnesses including cardiovascular diseases, diabetes, renal conditions, psycho-social disorders and physical disabilities. In December, IYC-Y provided medicines for chronic illnesses to 100 individuals (55 women and 45 men).

Khadijah Foundation for Development (KFD) provided 20 individuals with optometry services, and 17 individuals were provided audiogram services in district (Ibb). Water, sanitation, hygiene, and environmental health International Medical Corps (IMC) provided a total of 2,672,000 litres of water through water trucking to hospitals and internally displaced persons in Lahj, Amanat Al Asimah, Sana’a, Ibb and Taiz governorates. In addition, a total of 47,796 individuals were reached with hygiene promotion messages in Taiz, Ibb, Lahj, Al Dahale’e and Sana’a. IMC also conducted a health facility rapid WASH assessment in 5 hospitals in Lahj (Tur Al Baha Hospital, Radfan Hospital, Al Musaimeer Hospital, Al Shat Hospital, Ras Al Arah Hospital). IMC also conducted a health and nutrition assessment in three districts in Lahj (Al Musaimeer, Al Had, Al Qabaitah). Health education and capacity-building Abs Development for Women & Children (ADO) conducted training for 18 health workers on mental and post- surgical psychosocial support in nine districts of Hajjah Governorate. Action Contre la Faim (ACF) organized a five-day training course for field supervisors and workers in Al Hudaydah facilitated by MoPHP trainers. A total of 18 ACF staff received the training facilitated by MoPHP trainers for improved quality of health care services through mobile clinics for childhood illnesses. In addition, ACF experts facilitated a two-day training course for 12 staff members on the provision of reproductive health services following standard national guidelines.

International Medical Corps (IMC) conducted five rounds of trainings on infant and young child feeding, family planning, community management of acute malnutrition and on water useage, targeting a total of 164 participants (19 male, 145 female).

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Handicap International (HI) trained 41 nurses from Al Thawra hospital and 19 nurses from Al Jumhouri hospital (in Amanat Al Asimah) on the methodology of rehabilitation for nurses at hospital level. The training included: rehabilitation methodology in emergency settings; gait training and use of mobility devices; rehabilitation management for war injuries: amputation, fractures, spinal cord injuries, hemiplegia, peripheral nerve injuries and burns; and psychological first aid. Intersos - Humanitarian Aid Organization (INTERSOS) conducted 4,113 health education sessions facilitated by community health volunteers, reaching 14,362 people. An additional 380 sessions were conducted in Sana’a reaching 4,893 people. The health sessions covered topics such as immunization, cholera prevention, Infant and Young Child Feeding (IYCF), childhood illnesses (preventive behaviour and care), acute malnutrition prevention and care and other public health issues. The sessions targeted women, men, children, and parents. In addition, 13,371 information materials on education & communication on cholera prevention, immunization, malnutrition and other public health topics were distributed in Aden and Sana’a.

Funding As part of the 2016 Yemen Humanitarian Response Plan, the Health Cluster required US$182 million. To date, US$ 88.7 million (49%) has been received.

Contributions to this month’s edition The following organizations contributed to the December 2016 issue of the health cluster bulletin:  Abs Development for Women & Children (ADO)  Action Contre la Faim (ACF)  Building Foundation for Development (BFD)  Handicap International (HI)  International Medical Corps (IMC)  Intersos - Humanitarian Aid Organization (INTERSOS)  International Youth Council – Yemen (IYC-Y)  Khadijah Foundation for Development (KFD)  National Foundation for Development and Humanitarian Response (NFDHR)  Qatar Red Crescent (QRC)  United Nations Population Fund (UNFPA)  World Health Organization (WHO)

Contacts: Alexandra Simon-Taha, [email protected], [email protected], +967 739712220 Kamal Olleri, [email protected] / [email protected], +967 736300337 Syed Haider Ali, [email protected], +967 730000378

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Annex 1: Health Cluster Partners

Partner Name Partner Type

1 Abs Development for Women & Children (ADO) National NGO 2 Action Contre la faim (ACF) International NGO 3 Adventist Development and Relief Agency (ADRA ) International NGO 4 Al-Atta Institution for Social Development and Charity (AISDAC) National NGO 5 Charitable Society for Social Welfare (CSSW) National NGO 6 Handicap International (HI) International NGO 7 Human Appeal International (HAI) International NGO 8 Humanitarian Aid and Development Organization (HAD) International NGO 9 Humanitarian Forum Yemen (HFY) National NGO 10 International Committee of the Red Cross (ICRC) Observer agency 11 International Medical Corps UK (IMC UK) International NGO 12 International Organization for Migrants (IOM) UN agency 13 International Rescue Committee (IRC) International NGO 14 International Youth Council - Yemen (IYCY) National NGO 15 Intersos - Humanitarian Aid Organization (INTERSOS) International NGO 16 Islamic Relief Yemen (IRY) International NGO 17 Life Maker Meeting Place Organization (LMMPO) National NGO 18 Médecins Du Monde (MDM) International NGO 19 Medicines Sans Frontiers (MSF) - France Observer agency 20 Medicines Sans Frontiers (MSF) - Holland Observer agency 21 Medicines Sans Frontiers (MSF) - Spain Observer agency 22 Medicines Sans Frontiers (MSF) - Switzerland Observer agency 23 Mercy Corps (MC) International NGO 24 Ministry of Public Health and Population (MoPHP) Government 25 Nahda Makers Organization (NMO) National NGO 26 National Foundation for Development and Human Rights (NFDHR) National NGO 27 Norwegian Refugee Council (NRC) International NGO 28 Partner Aid (PA) International NGO 29 Première Urgence - Aide Médicale Internationale (PU-AMI) International NGO 30 Qatar Charity (QC) International NGO 31 Relief International (RI) International NGO 32 Sama Al Yemen Development Foundation (SAMA) National NGO 33 Save the Children Fund (SC) International NGO 34 Society for Humanitarian Solidarity (SHS) National NGO 35 SOUL for Development (SOUL) National NGO 36 United Nations High Commission for Refugees (UNHCR) UN agency 37 United Nations International Children's Educational Fund (UNICEF) UN agency 38 United Nations Population Fund (UNFPA) UN agency 39 World Health Organization (WHO) UN agency 40 Yemen Family Care Association (YFCA) National NGO 41 Yemeni Development Network for NGOs (YDN) National NGO 42 Yemen Red Crescent Society (YRCS) Observer agency

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