SITUATION REPORT #44 / 25 January 2021 Reporting Period: 11 - 25/01/2021

EMERGENCY RESPONSE TO COVID-19 in Mixed Migration Context in Bosnia and Herzegovina

SITUATION REPORT #44 / 25 January 2021 Reporting Period: 11 - 25/01/2021 http://drc.ba/covid19_resources

WEEKLY HIGHLIGHTS UPDATES:  120,143 cases of COVID-19 confirmed in BiH, 4,593 deaths and 92,542 recovered patients.1 8 PoCs exhibiting symptoms and  8 PoCs exhibiting COVID-19-like symptoms monitored by PHC and DRC medical isolated in teams in TRCs: 5 in TRC Miral and 3 in TRC Blazuj. reception facilities  12 new PoCs exhibiting COVID-19-like symptoms referred to symptomatic isolation in reception centers: 4 in TRC Miral, 1 in TRC Sedra and 7 in TRC Blazuj. 489 PoCs screened in  111 PoCs referred to preventive isolation in reception facilities. reception facilities  489 PoCs screened for COVID-19 symptoms: all new arrivals to temporary reception facilities in BiH during the reporting period. In addition, 1,184 PoCs 1,184 PoCs underwent screening procedure within the provisional camp Lipa. screened in out-of- site locations  66 PoCs monitored in preventive isolation by DRC Medical Officers (65 in TRC Miral and 1 in Sedra). 0 new PoCs  18 PoCs tested for COVID-19. All results confirmed negative. confirmed positive for COVID-19

CUMULATIVE: KEY DEVELOPMENTS AND CHALLENGES  In the provisional camp Lipa – accommodating around 900 PoCs stranded on the 33 PoCs positive site after the closure of the former ETC Lipa – health concerns have been critical for for COVID-19 days due to the sub-standard conditions of the site. In addition to infectious and communicable diseases (primarily scabies), the most common health issue among 63,178 COVID- the population (single males) is related to respiratory tract infections (common cold, 19 screenings in sore throat, pneumonia and bronchitis). Additionally, performing emergency health reception facilities care in precarious hygiene and sanitary conditions at the site, coupled with the impossibility of establishing measures preventing the spread of COVID-19 within the

1 Official statistics for Federation of BiH, Republika Srpska and Brcko District

and in out-of-site site (and lack of specific diagnostic tests), makes it very difficult for medical locations professionals to respond properly to either identification or treatment of COVID-19 cases. The situation is additionally complicated by a number of service providers 391 PoCs tested working at the site and not following basic Infection Prevention and Control (IPC) for COVID-19 measures for COVID-19, such as wearing a mask, practicing hand hygiene and maintaining physical distance. There is a strong possibility that the virus itself will be introduced into the population of PoCs by service providers who do not comply with measures imposed by relevant health authorities.  It is necessary to implement all necessary IPC measures, including establishment of isolation areas, as well as referral pathways for COVID-19 cases, at the Lipa site. DRC, coordinating its activities with PHC, maintains daily monitoring of PoCs with symptoms related to COVID-19.  Attempts to refer COVID-19 symptomatic patients from Lipa to TRC Miral have largely been unsuccessful, due to the overcrowding of the Miral facility.  Accommodation capacities in general in TRCs are reaching maximum, making it necessary to accommodate PoCs inside areas that are intended for isolation (preventive and symptomatic). This could additionally jeopardize public health of the general population in already overpopulated TRCs.  A total of 107 PoCs were discharged from preventive isolation in all TRCs in BiH, and 23 PoCs from symptomatic isolation, upon the expiry of isolation and monitoring periods. In the same period, 3 PoCs left preventive and 1 PoC left symptomatic isolation on their own will, opening a public health risk.

PREVENTIVE ISOLATION OVERVIEW 80 67 60

40 35 19 20 13 13 11 6 7 7 5 8 8 3 0 1 0 3 0 2 0 1 1 1 0 3 0 0 3 0 0 0 2 0 0 0 2 0 11-Jan 12-Jan 13-Jan 14-Jan 15-Jan 16-Jan 18-Jan 19-Jan 20-Jan 21-Jan 22-Jan 23-Jan

# of PoCs referred to isolation area (new arrivals/ pushbacks/ exposed to COVID-19) on the date of reporting* Discharged from preventive isolation Left preventive isolation

SYMPTOMATIC ISOLATION OVERVIEW

8 7 6 6 4 4 3 3 3 3 2 2 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11-Jan 12-Jan 13-Jan 14-Jan 15-Jan 16-Jan 18-Jan 19-Jan 20-Jan 21-Jan 22-Jan 23-Jan

# of PoCs referred to isolation, exhibiting symptoms of COVID-19 on the date of reporting** Discharged from Symptomatic isolation Left Smytomatic Isolation

 Outreach response: o PoCs in out-of-site locations are provided with medical assistance by DRC and RC teams visiting the sites, delivering First Aid and performing medical screening of PoCs for COVID-19 symptoms. o DRC medical teams, with direct engagement of PHC Bihac medical team, are performing medical consultations for PoCs accommodated in the tented Lipa site. o Transfers from PoCs from out-of-site locations to TRCs without prior coordination seriously jeopardize preventive COVID-19 measures in TRCs. A case in point is the transfer of PoCs from Bosanska Bojna to TRC Sedra on Friday 22 January: due to the lack of prior information and coordination of the transfer, the PoCs transferred from outreach locations did not go undergo medical entry screening in TRC Sedra, and simply mixed with the general population.

OPERATIONAL PREPAREDNESS AND RESPONSE

 COVID-19 Response in TRCs in BiH: o Capacities for preventive and symptomatic isolation in TRCs in BiH have been preserved. At the moment, a total of 123 beds in TRCs in USC are available for preventive isolation, while a total of 202 beds are at disposal of POCs with COVID-19 symptoms.

OVERVIEW OF DESIGNATED ISOLATION AREA (COVID-19) 25 JANUARY 3500 3205 3000 2500 2000 1500 1078 1000 755 369 500 305 0 30 0 50 54 20 28 6 41 10 0 Usivak Blazuj Miral Borici Sedra Current no of PoCs in TRC Isolation for Preventive monitoring Isolation for COVID-19 expressed symptoms

o In line with COVID-19 testing procedures for the local population, PoCs exhibiting mild or moderate symptoms are not tested, but frequently monitored in isolation areas by both PHC and DRC medical staff. MoH and PHIs are informed on a daily basis on the conditions of these patients. o Security of isolation areas needs to be improved in order to establish better compliance with COVID-19 preventive measures, since several beneficiaries left isolation during night hours.

 Coordination with authorities and health actors: o As per request of Ministry of Health, Labor and Social Policy of USC, as well Service for Foreign Affairs, DRC has shared a minimum of preconditions that must be met in order for the medical team to start working on new tented Lipa site in full capacity, including all the challenges that the core medical team is facing at the moment. o Weekly Health SnapShot for new tented Lipa site is being shared with relevant authorities and actors, in order to identify key health concerns and develop further activities, as well as to mitigate public health risks for the population accommodated there and service deliverers attending the site. o Due to a suspect case of diphtheria inside TRC Blazuj, that resulted in death, under joint coordination of DRC, IOM, PHC Sarajevo, following the recommendations of Public Health Institute of Sarajevo Canton, a mass screening for signs and symptoms of diphtheria, as well further actions (isolation, treatment, disinfection) was conducted on Wednesday 13th of January. Since diphtheria is transmitted in a similar way to COVID19, compliance with all recommended IPC measures is beneficial for prevention of transmission of both infections. o Due to limited capacities of symptomatic and preventive isolation in Una-Sana Canton, as well overstretched health systems lacking specialized diagnostic equipment (Cantonal Hospital not yet fully operational for this purpose), the immediate needs for diagnostic of population of migrants and asylum seekers related to COVID-19 are not being met in the last several weeks. DRC has launched additional

PCR testing of PoCs accommodated in preventive and symptomatic isolation areas of TRCs in USC, engaging a private health care actor through the IcSP project “Addressing COVID-19 challenges within the Migrant and Refugee Response in the Western Balkans.”

 Measures related to humanitarian staff: o Humanitarian staff working in the reception centers should continuously self-monitor2. In case humanitarian staff have been in contact with persons confirmed positive for COVID-19, they should inform their health provider and follow the suggested measures. Staff exhibiting COVID-19 like symptoms, including fever, should suspend their presence from the reception centers until fully recovered. Additionally, information should be shared with DRC medical teams, to ensure contact tracing and mitigating the risk of spread of COVID-19 infection.

MEASURES ANNOUNCED BY BIH AUTHORITIES

Following the request from the Ministry of Education of USC, Crisis Board of USC has announced that epidemiological situation has not yet improved to the point that some IPC measures could be alleviated. http://vladausk.ba/v4/files/media/pdf/60094cd345b608.80980887_Krizni%20stab- Zakljucak%20za%20obrazovanje.pdf Federal Ministry of Health has extended the current COVID19 related order for additional 2 weeks. https://covid19.fmoh.gov.ba/uploads/files/Naredbe_170121- d0e8533887bc4e592a783c20300e6974235bd5ac.pdf Federal Ministry of health has shared the plan of immunization for the population of Bosnia and Herzegovina. http://www.fbihvlada.gov.ba/bosanski/aktuelno_v2.php?akt_id=9052 Federal Ministry of health is reviewing the possibility of importation of Russian and Chinese vaccine, as well direct procurement from Pfizer, due to delay in delivery of vaccine against COVID19 through COVAX system. http://www.fbihvlada.gov.ba/bosanski/aktuelno_v2.php?akt_id=9061

MEDIA REPORTING

1. Bosnia reports 100 new coronavirus cases and 18 fatalities Bosnian health officials reported 100 new Covid-19 cases on Monday, along with 18 virus-related fatalities. https://ba.n1info.com/vijesti/najnoviji-podaci-za-bih-100-novozarazenih-covidom-19-18-smrtnih-ishoda/

2 The Federal Institute for Public Health has made available the online self-assessment test on COVID-19, available at https://www.zzjzfbih.ba/covid-19/ 5

2. Sarajevo Hospital ready to take all Responsibilities related to Vaccination General Hospital “Prim. Dr. Abdulah Nakas” is ready to take on all the responsibilities related to the vaccination of the citizens of Sarajevo Canton, against Covid-19, as well as for the treatment of patients who would experience possible side effects. ”Vaccination teams have been formed in the health institution, and the staff are being made available to the citizens of Sarajevo Canton in full capacity, so that the upcoming immunization process against Covid-19 goes smoothly, because the vaccine is the most important ally in ending the pandemic and returning to normal lifestyle,” is stated from General Hospital. Sarajevo Hospital ready to take all Responsibilities related to Vaccination - Sarajevo Times 3. Germany to donate 50 ventilators to BiH Given the still very high number of people infected with coronavirus and the extreme pressure on the health system, the Government of the Federal Republic of Germany decided to donate 50 ventilators and 10,000 pulse oximeters worth a total of €530,000 to hospitals throughout Bosnia and Herzegovina, German Embassy to BiH said Thursday. Germany to donate 50 ventilators to BiH - N1 (n1info.com) 4. Bosnia to receive only 4-5,000 coronavirus vaccines, Minister says. Bosnia will receive between 4,000 and 5,000 anti-coronavirus vaccines in January, Bosnia's Civil Affairs Minister Ankica Gudeljevic told N1 on Thursday. “We still don't know the exact number of vaccines, but according to my information, we'll receive between 4,000 and 5,000 doses,” she said. Bosnia to receive only 4-5,000 coronavirus vaccines, Minister says - N1 (n1info.com) 5. Skin conditions and no utilities as migrants suffer in Bosnia camp Migrants at a camp in northwestern Bosnia have complained of respiratory and skin diseases after spending days in makeshift tents and containers amid freezing weather and snow blizzards, aid workers said on Monday. Bosnia has faced sharp criticism for leaving around 1,000 people without shelter after a fire gutted most of the camp on December 23rd. Authorities initially said they would move the migrants to another location but they ended up setting up military tents at the site instead. The Lipa site has also lacked basic facilities such as electricity or running water, with migrants left to light fires for days to protect themselves from the cold. Many migrants at the camp said they have not showered for a long period of time, while some have washed outside despite the freezing temperatures. On Monday, doctors set up medical tents for health examinations at the camp, handing out medicines and medical advice. An emergency response team from the Danish Refugee Council have helped the triage the migrants over the past few days, finding cases of scabies and pediculosis.

Others presented with persistent coughs and temperatures, both symptoms of coronavirus, but lack of testing supplies means medical teams have been unable to diagnose illnesses with certainty. Bosnia has struggled with the influx of thousands of people who are trying to reach Western Europe through the Balkans. From Bosnia, migrants first aim to reach neighbouring the European Union member state Croatia before moving on toward wealthier EU nations. Skin conditions and no utilities as migrants facing bleak winter in Bosnian camp | Euronews 6. FBiH Government adopts Vaccination Plan against COVID-19 The Government of the Federation of BiH adopted the Vaccination Plan against COVID-19 in the Federation of BiH at today’s session in Sarajevo and instructed the FBiH Ministry of Health and the Institute of Public Health of FBiH to implement it, each within its competences. FBiH Government adopts Vaccination Plan against COVID-19 - FENA.NEWS 7. Federation of BiH presented the Vaccination Plan ” Vaccines will be free and voluntary for all citizens, and vaccination will be based on the principles of fairness and equality “, said Davor Pehar, director of the Public Health Institute of the Federation of Bosnia and Herzegovina, presenting the Vaccination Plan in FBiH. He added that officials in the cantons were given plans, and made lists of people to be vaccinated. “These are primarily health workers and health care staff, residents of social institutions for the elderly, as well as employees who work in those institutions, then people with chronic diseases, and people employed in important public services,” said Pehar. Federation of BiH presented the Vaccination Plan - Sarajevo Times 8. Citizens of BiH still without official Information about Vaccines The citizens of Bosnia and Herzegovina still do not have official information about vaccines that should come to our country in the coming period. For now, the promotion of vaccination is taking place behind closed doors, and the authorities say that a detailed plan will be presented soon. In the meantime, citizens are educating themselves, on social networks and the Internet. A video intended to inform the public how to properly greet each other during the BH pandemic is presented to the public by the leaders of the Federal Institute of Public Health, via social media, 15 days ago. And nothing would be disputable if the pandemic had not erupted for almost a year. And an even bigger task is yet to come – the promotion of immunization. As we don’t have a vaccine yet – and we’re late there, BHRT writes. Citizens of BiH still without official Information about Vaccines - Sarajevo Times 9. Verica Recevic, DRC Program Manager about health needs and health services provided for migrants ZAJEDNO DO BOLJIH RJEŠENJA | RTVUSK.ba

10. EC Vice-President Sefcovic says Western Balkans will get vaccines European Commission Vice-President Maros Sefcovic told Radio Free Europe on Tuesday that the European Union General Affairs Council affirmed the partnership with the Western Balkan countries in sharing coronavirus vaccines. He told the video conference that the European Commission is trying to secure coronavirus vaccines for the countries of the region through its member states individually and through the COVAX initiative. Sefcovic said that the EU has just started the inoculation campaign and that the Commission is coordinating member states who want to donate vaccines from the joint EU procurement. Sefcovic confirmed that that the EU will make sure that an adequate share of vaccines is secured through COVAX for its partners. EC Vice-President Sefcovic says Western Balkans will get vaccines - N1 (n1info.com) 11. Health Centers in Republika Srpska getting ready for Immunization Process Health centers in Republika Srpska, where vaccination against coronavirus will be carried out, say that they are forming teams to treat it. The Health Center Banja Luka, stated for Nezavisne that they are currently in the process of preparing for the upcoming vaccination against Covid-19 Health Centers in Republika Srpska getting ready for Immunization Process - Sarajevo Times 12. Pehar: Pfizer vaccines will be the first to arrive in FBiH Director of the FBiH Institute of Public Health Davor Pehar said today in Sarajevo that the first vaccines against Covid-19 in FBiH should arrive at the end of this, or the beginning of next month. These will be Pfizer vaccines, and the public health institutes in FBiH are ready to start the vaccination process. Pehar: Pfizer vaccines will be the first to arrive in FBiH - FENA.NEWS 13. Bosnia will start Procurement of Russian and Chinese Vaccines Zoran Tegeltija, Chairman of the Council of Ministers of BiH, said after a meeting with entity prime ministers Fadil Novalic and Radovan Viskovic in Sarajevo, that the pandemic is a global issue and thus the procurement of vaccines should be viewed, and that BiH will start direct procurement of vaccines from Russian manufacturers and vaccines coming from China. “We have agreed on the purchase of vaccines through Covax, you know the distribution and that we have paid the full amount, but we still do not have vaccines. It is good that the vaccine appeared in the world much earlier than expected, and what is not good is that neither system the vaccine signed by BiH has not yet begun to be distributed, “ Tegeltija said. “Deadlines are the end of January or the beginning of February. Today, the situation will be much clearer through the help of joint procurement through the EU system. And today, we will have information on when,” he added, Nezavisne writes. Bosnia will start Procurement of Russian and Chinese Vaccines - Sarajevo Times 14. EU, UNDP help Hospitals in Bosnia with 100,000 BAM

In the past four days, the Delegation of the European Union in BiH delivered a total of 253,725 surgical masks, N95 / FFP2 protective masks and protective gowns to the Cantonal Hospital in Gorazde, the Brcko District, the Posavina Canton Public Health Institute, as well as to Civil Protection of Zenica-Doboj Canton, and the Civil Protection of the Central Bosnia Canton in Travnik. The total value of the delivered equipment which was done in partnership with the United Nations Development Program (UNDP) in BiH is 107,061 BAM. In order to ensure the personal protection of medical professionals and employees in emergency services, a total of 1,100,000 surgical masks, 110,000 N95 / FFP2 protective masks and 50,000 protective gowns will be delivered to institutions in Banja Luka, Bihać, Brčko District, Goražde, Livno, Mostar, Orašje, Travnik, Tuzla and Zenica by the end of January 2021 with the support of the European Union. The equipment was procured through the “COVID-19 Pandemic Response” project implemented by the United Nations Development Program (UNDP) for which the European Union provided a total of 7 million euros. EU, UNDP help Hospitals in Bosnia with 100,000 BAM - Sarajevo Times

Stay informed – find the latest information from WHO or related sources: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/ https://www.who.int/emergencies/diseases/novel-coronavirus-2019 https://www.epi-win.com/

We thank you for your responsible behavior in the interest of your own health, but also in the interest of the health of all the citizens of Bosnia and Herzegovina.