HEALTH CLUSTER BULLETIN Community health workers give medical advice on reproductive health, nutrition

July 2017 and immunization in the camps for internally displaced people camps in northern and eastern . Photo: Independent Doctors Association Cross Border

Emergency type: complex emergency Reporting period: 01.07.2017 to 31.07.2017

12.8 MILLION 700 000 6.3 MILLION 4.54 MILLION IN NEED OF CHILDREN <5 INTERNALLY BESIEGED AND HEALTH ASSISTANCE DEPRIVED OF VACCINE DISPLACED HARD-TO-REACH (All figures are for the Whole of ) HIGHLIGHTS HEALTH SECTOR

 In July 2017, seven verified incidents of 58 HEALTH CLUSTER PARTNERS violence against the health care MEDICINES DELIVERED1 infrastructure were reported, resulting in 41 450 TRAUMA CARE TREATMENT COURSES the deaths of at least three people, including HEALTH CARE FACILITIES RECEIVED one health worker. 183 ESSENTIAL MEDICINES  A few health care facilities in Idleb FUNCTIONAL HEALTH FACILITIES governorate have temporarily suspended FUNCTIONING FIXED PRIMARY 169 HEALTH CARE FACILITIES services due to the clashes between non- state armed groups. 84 FUNCTIONING HOSPITALS 76 MOBILE CLINICS  A primary health care network in Saraqeb, HEALTH SERVICES Idleb governorate, was launched on 15 July 926 657 CONSULTATIONS 2017. DELIVERIES ATTENDED BY A SKILLED 8 056 ATTENDANT  195 doctors, nurses, midwives, data entry staff and management staff from three 10 725 REFERRALS hospitals, three primary health care centres VACCINATION

and three medical centres were trained on 2 21 986 CHILDREN AGED ˂5 VACCINATED the data entry and analysis within the District Health Information System, and CAPACITY BUILDING provided with accounts in the system. 3 416 HEALTH CARE WORKERS TRAINED  An ambulance system project was launched in Aleppo governorate. DISEASE SURVEILLANCE SENTINEL SITES REPORTING OUT OF A  Idleb governorate received 63 ambulances. 495 TOTAL OF 512  The Health Cluster developed priorities for FUNDING $US4 second Standard Allocation of Humanitarian 90.3 RECEIVED 77.2% not covered Pooled Fund in 2017. MILLION IN 2017

1 Supplies were delivered by the WHO Turkey Hub and distributed to health cluster partners in northern Syria. 2 Routine immunization with pentavalent vaccine. 3 Medical staff and community health care workers. 4 Source: OCHA Financial Tracking System, Syria Humanitarian Response Plan 2017.

A Situation update 20000 In July, clashes erupted between non-state armed groups in Bab al- 17500 Hawa, al-Atareb, Dana, Armanaz, Harem, Saraqeb, and Kafr 15000 Nabel (Aleppo and Idleb governorates). As a result, a few health care 12500 facilities in Idleb governorate have temporarily suspended their services, 10000 including the hospital in Kafar Nebull. 2016 7500 2017 Following these incidents, movement through Celvegozu-Bab al-Hawa 5000 crossing was temporarily limited for non-humanitarian goods. The 2500 corridor for humanitarian aid and some categories of people is not 0 affected. 18 19 20 21 22 23 24 25 26 27 28 29 30 Displacements from and within Ar- governorate continued, with May June July estimated 215 678 people have been displaced since 1 April, and some B other 45 486 – since 1 June. Up to 25 000 people are estimated to be 360 remaining inside Raqqa city. Currently, 14 of 24 Ar-Raqqa 320 5 280 neighbourhoods are abandoned or almost abandoned , access to health 240 care is extremely limited, represented only by informal health care 200 points, typically clinics established in personal homes and not staffed by 160 medical professionals, providing only the most basic of medical services. 2016 120 2017 80 Public health risks, priorities, needs and gaps 40 Communicable diseases 0 18 19 20 21 22 23 24 25 26 27 28 29 30 The incidences of influenza-like illness (ILI) and severe acute respiratory May June July infection (SARI) observed among the affected population are within the seasonal baselines. An overall seasonal decline in the number of C 32000 reported ILI and SARI has been observed since the beginning of March, 28000 with a slight increase in ILI cases in mid-July. Fig. 1 shows the trends in 24000 ILI, SARI, diarrhoeal diseases and leishmaniasis. 20000 The trend in diarrhoeal diseases shows a decrease in comparison to 16000 the same period in 2016. More than 50% of the reported cases are in 12000 the group aged <5 years. In addition to the regular update of the 8000 2016 cholera risk scale map, the Early Warning, Alert and Response Network (EWARN) team is monitoring any conversion in children aged >5 years 4000 2017 to those aged <5 years as a warning sign of a possible cholera outbreak. 0 18 19 20 21 22 23 24 25 26 27 28 29 30 Needs and gaps May June July Local health providers report a shortage of medical supplies. The D tuberculosis (TB) centres in Idleb, Al-Maara and Maret Hurma are 2100 running out of anti-TB drugs; the available medicines will cover 1800 approximately one month’s treatment for the patients currently 1500 enrolled. Two dialysis centres in Aleppo governorate are facing 1200 shortages in consumables. 900 Seven health care facilities in Idleb are at risk of discontinuing their 2016 services owing to lack of funding6. 25% health facilities are damaged, 600 7 2017 23% of the facilities are non-functioning or partially functioning . 300 37.6% of the functioning facilities works without/with interrupted 0 electricity services, 26% of comprehensive health centres are not 18 19 20 21 22 23 24 25 26 27 28 29 30 providing basic laboratory services, 37% of the facilities are not May June July providing primary injury care, and only 11% of the facilities provide physical rehabilitation services. Almost half of the hospitals and the Fig. 1. Trends in the priority diseases for weeks 18–30 of 2017 comprehensive health centres do not provide Comprehensive A – ILI; B – SARI; C – diarrhoeal diseases Emergency Obstetric Care. Only 50% of the facilities provide (acute bloody diarrhoea, acute diarrhoea outpatient treatment of acute malnutrition. Only 18% of the total and acute watery diarrhoea); D – leishmaniasis. health facilities provide mental health services. Source: EWARN.

5 Third rapid assessment on the humanitarian situation in Ar-Raqqa city, REACH Initiative, July 2017. 6 Odai hospital in Saraqeb, Ar-Rahma hospital, Green Idleb primary health care (PHC) centre, Armanaz and PHC centres, Tarmala Women and Children hospital. 7 Health Resources Availability Mapping System (HeRAMS) survey, June 2017.

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Health Cluster action Health Cluster coordination The Health Cluster conducted two coordination meetings in July. Among the issues discussed were: measles outbreak In Idleb and Alleppo, strengthening routine immunization by expansion of fixed Cluster partners of immunization centres and improving outreach services, funding Turkey hub are present in status for the Health Cluster and its impact on health assistance; 10 governorates, 45 status of Cluster Coordination Performance Monitoring; response to districts, 99 sub-districts cVDPV2 outbreak in Deir Ez Zour and post-campaign independent and 275 communities in monitoring. northern Syria providing In addition, an ad-hoc meeting on Eastern Gouta was held on 12 of support to 355 health July, where the overall situation and challenges were assessed, and care facilities, including the mapping of the services will be further reviewed in order to identify the gaps in health services and develop an action plan to 76 mobile clinics address the gaps. In light of the evolution of the situation in Ar-Raqqa city, the Inter-sector group has developed a specific response plan. The Ar-Raqqa City response plan outlines a 10-step phased-response to meet the needs of the estimated 10,000-25,000 civilians remaining in the city. On 15 July, Primary Health Care network comprised of 11 PHC facilities at four levels of care8 facilities in Saraqeb was launched9. It is estimated that coordination of referral services through the Network will allow increasing accessibility to health care services by 30%. Support to health service delivery Up to June 34 primary health care facilities In July Health Cluster partners has provided 926 657 outpatient consultations and supported 26 721 hospital admissions. 7 244 established services people living with disabilities were supported with rehabilitation expanded programme of services. routine immunization Routine immunization. The expanded programme of routine immunization was revitalized in four additional health centres in northern Syria, making a total of 34 operational centres by the end of July. Emergency care. An ambulance system project was launched in Aleppo governorate in collaboration with Qatar Red Crescent. In Find out more addition, Hand in Hand for Syria has provided 63 ambulances to Idleb governorate. Central ambulance system in Idleb governorate will be https://www.facebook.com/ coordinated through the Technical Working Group under the Health healthclusterturkeyhub Cluster umbrella.

Doctor is performing routine examination of a child in northern Syria A child receives care after suffering from the heat wave in northern Syria Photo: Independent Doctors Association Photo: Union of Medical Care and Relief Organizations

8 five Mobile Primary Health Care (PHC) units, three PHC fixed units, two PHC centres and one Comprehensive PHC centre 9 in coordination with Union of Medical Care and Relief Organizations (UOSSM), Physicians Across Continents (PAC), Syria Relief and Development (SRD), Hand in Hand for Syria (HiH), Syrian American Medical Society Foundation (SAMS).

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From January to June 2017,

69 verified incidents of violence against health care infrastructure were reported

Health workers are being trained on management of chemical exposure cases Photo: WHO

Monitoring of violence against health care Capacity building In July 2017, eight reported incidents of violence During July 2017, Health Cluster partners have against the health care infrastructure were trained in total 416 health staff in various topics, reported: seven were verified and one is in the namely: process of verification. The seven verified attacks  preparedness and medical management of resulted in temporary closure of one hospital in chemical incidents; and three hospitals in Idleb governorate;  first aid and emergency management of war killing of at least three people, including one injuries; health worker, and injuring at least 15 people,  gender based violence; including three health workers.  reproductive health, antenatal and postnatal In total, from January to July 2017, 69 verified care, infant and young child feeding; incidents of violence against the health care  management of noncommunicable diseases; infrastructure were reported. For more details, see  health information management. the Monitoring violence against health care mid- Also, 56 health care providers and community year report, 2017. health workers were trained to provide routine immunization services in Idleb and Assessments, information and planning governorate, and other 40 received training on adverse reactions. Health Cluster in currently conducting the Salary Scale Survey, in order to develop a unified salary An advanced medical training on chemical incident package for health care providers. management was conducted during July for 29 health care professionals, including medical doctors, In order to identify the gaps in medical waste nurses, ambulance and civil defence workers. management system a mapping of available incinerators per governorate was conducted. WHO in collaboration with Sustainable International According to the mapping, 38 incinerators are Medical Relief Organization (SIMRO) conducted a available in Idleb governorate and 31 – in Aleppo training course on the District Health Information System (DHIS) within the pilot project on governorate. implementation of the DHIS system in Syria. 195 In addition, WHO/Health cluster trained four doctors, nurses, midwives, data entry staff and health partners on HeRAMS and 4Ws. The training management staff from nine health care facilities course mainly focused on how to manage, report were trained on the data entry and analysis, and and analyse information using the online tool. were provided with accounts in the system. Data entry will be launched on 1 of August 2017. Plans for future response The Health Cluster developed priorities for HPF second Standard Allocation 2017. The priorities are: (1) to support access to primary health care through Essential Package of Primary Health Services; (2) to support prevention and control of communicable diseases; (3) to strengthen and expand District Health Information System that is accurate: (4) to enhance capacity development of health workforce and balancing the skill mix at facility; (5) to support secondary health care including trauma care.

https://www.humanitarianresponse.info/en/operations/stima/health Contacts

Dr Annette Heinzelmann Dr Jamshed Tanoli Dr Abd Arrahman Alomar Dr Ganna Radysh Emergency Coordinator Health Cluster Coordinator Health Cluster Reports Officer World Health Organization World Health Organization National Co-Lead World Health Organization Mobile: +90 530 011 4948 Mobile: +90 530 238 8669 Mobile: +90 538 052 9213 Mobile: +90 538 544 2944 Email: [email protected] Email: [email protected] 4 Email: [email protected] Email: [email protected]