HEALTH CLUSTER BULLETIN OCTOBER 2020 Fig: Independent Doctors Association observing 10 October - World Mental Turkey Cross Border Health Day 2020 in NWS (IDA) Emergency type: complex emergency Reporting period: 01.10.2020 to 31.10.2020 12 MILLION* 2.8 MILLION 3.7 MILLION 25**ATTACKS PEOPLE IN NEED OF HEALTH PIN IN SYRIAN REFUGGES AGAINST HEALTH CARE HEALTH ASSISTANCE NWS HNO 2020 IN TURKEY (**JAN - OCT 2020) (A* figures are for the Whole of Syria (All figures are for the Whole of Syria) HIGHLIGHTS ▪ Social services providers such as in health and 131 HEALTH CLUSTER MEMBERS education continue to be at risk for COVID-19. At 42 IMPLEMENTING PARTNERS REPORTING 1 month ends’ 12.2% of the total positive cases were MEDICINES DELIVERED TREATMENT COURSES FOR COMMON doctors, nurses and midwives. And the cases of 311,249 DISEASES students increased by a 12-fold and teachers over FUNCTIONAL HEALTH FACILITIES HERAMS 4 times since the re-opening schools in September. FUNCTIONING FIXED PRIMARY HEALTH ▪ World Mental Health Day was observed 10 Oct., 161 CARE FACILITIES with the overall objective of raising awareness of FUNCTIONING HOSPITALS mental health issues around the world and 65 mobilizing efforts in support of mental health. The 78 MOBILE CLINICS 2 Day provided an opportunity for all stakeholders HEALTH SERVICES working on mental health issues to talk about their 808,613 CONSULTATIONS DELIVERIES ASSISTED BY A SKILLED work, and what more needs to be done to make 9,143 ATTENDANT mental health care a reality for people worldwide. 13,917 REFERRALS ▪ As per HeRAMS Q3 2020, out of total functioning 896,455 MEDICAL PROCEDURES health facilities reported from Northern Syria, the 34,572 TRAUMA CASES SUPPORTED distribution per governorate is as follows; in the 472 NEW CONFLICT RELATED TRAUMA CASES NWS 222 (56%) in Idleb and 156 (39%) in Aleppo VACCINATION governorates; and 18 (4.5%) from NES (Al-Hasakeh, 9,895 CHILDREN AGED ˂1 VACCINATED3 Ar-Raqqa, Deir-ez-Zor) governorates. ▪ Health Cluster partners observed the Oct 15 Global MENTAL HEALTH SERVICES Handwashing Day with theme “Hand Hygiene for 11,435 MENTAL HEALTH CONSULTATIONS All.” The theme followed the global initiative calling on all of society to scale up hand hygiene, DISEASE SURVEILLANCE especially through handwashing with soap. SENTINEL SITES REPORTING OUT OF A 469 ▪ The Syria Cross-Border Humanitarian Fund (SCHF) TOTAL OF 480 announced the launching of the 2020 Second WOS HEALTH HRP & COVID-19 2020 FUNDING $US4 Standard Allocation (SA2). This allocation aims to HRP RECEIVED $121.3 M (27.4% funded) prioritize interventions that address critical and COVID19 IN 2020 $69.4 M (43.9% funded)

life-saving gaps in the response to COVID-19 and the most urgent winterization needs of people, prioritizing underserved and high-needs areas.

1 Supplies were cross border delivered by the WHO Gaziantep Hub and distributed to implementing health cluster partners in northwest Syria. 2 Figures reported and updates are from 1 – 31 October 2020. 3 Routine immunization with pentavalent vaccine (5 in 1 vaccine) 4 Source: OCHA Financial Tracking System, Syrian Arab Republic Humanitarian Response Plan (HRP 2020) as of 31 October 2020. https://fts.unocha.org/ 1

Situation Update:

The Northwest Syria continue to be the most active armed conflict frontline in Syria. Regular bombardment of frontline communities in southern Idleb continue to challenge the March agreed ceasefire. Civilians and humanitarian health actors were again vulnerable for violation and hostility. In Al Bab city, a VBIED exploded leaving behind 22 civilians deaths including 3 children and one woman. More than 118 civilians were injured, this is the second large-scale incident in the past two months. In addition, a VBIED detonated under unknown circumstances in Al-Bab city and three health cluster implementing NGO’ staff working in COVID-19 referrals network were wounded. The driver was seriously injury and required transfer to Turkey for medical care, while the vehicle has severely damaged.

A STATEMENT (see right insert) was released by Kevin Kennedy, Regional Humanitarian Coordinator for the Syria Crisis, on Violence Impacting Aid Workers in North-West Syria. As well, “the United Nations Resident Coordinator and Humanitarian Coordinator for Syria, Mr. Imran Riza, and United Nations Regional Humanitarian Coordinator for the Syria Crisis, Mr. Kevin Kennedy, strongly condemn the horrific bombing that has reportedly killed and injured dozens of civilians in Al Bab, northern Syria. On 6 October, a bomb blast from a truck was reported near a bus station in Al Bab city. Early reports indicate that more than a dozen civilians were killed in the attack and up to 40 were injured”5.

In addition to volatile armed conflict, the COVID-19 pandemic continues to spread, and livelihoods opportunities are in declined. Devaluation of the Syrian pound and crop prices within the region have further immiserated agriculturalists and communities with a heavy reliance on agriculture-dependent industries6. Regarding the pandemic, the number of COVID-19 cases in northwest Syria continued to increase from 1,072 cases to 5,382, in one-month period. In parallel, the testing capacity was boosted to reach 25,000 tests by end of October. Forty-two COVID-19 associated deaths have been reported in northwest Syria, while 3,065 cases are reportedly active, and 2,275 people recovered. The testing capacity has increased through the 4- polymerase chain reaction (PCR) machines in three functional laboratories in NWS. Health partners plan to add two more laboratories in action with surveillance capacity.

A worrisome trend continued to be the number of cases among medical health care workers (HCWs) which is reported at 12.2% of the total positive cases. The affected clinical staff include doctors, nurses and midwives; staff critical in the delivery of health services. Also, there is a significant increase of positive cases among students and teachers. In September, 19 students and 36 teachers were reported COVID-19 positive, by the end of October 254 students and around 196 teachers were infected; In September, 19 students and 36 teachers were reported COVID-19 positive, and then by the end of October, 254 students and around 196 teachers were infected. This significant increase came as a result of re-opening schools in September, coinciding with a peaking number of COVID-19 cases thru the NWS. To mitigate the outbreak, all stakeholders including local authorities must work together. A challenging work continues to be ahead.

5 OCHA,https://www.humanitarianresponse.info/sites/www.humanitarianresponse.info/files/documents/files/6_october_statement_on_civilian_casualties_al_bab_en.pdf 6 COAR https://coar-global.org/2020/09/30/the-economy-of-war-in-syria-armed-group-mobilization-as-livelihood-and-protection-strategy/ 2

Public health risks, priorities, needs and gaps

• The security situation remains a challenge and a risk for heath implementing partners. • The limited man power in the health sector workforce continues to be a greater challenge as health care workers continue to be disproportionally infected through northern Syria. • Under a dire economic situation threatening the daily living of the most vulnerable people in NWS and the COVID-19 outbreak is imposing a heavy challenge for health partners to mitigate the spread of the virus, especially in crowded places such as IDPs camps, while trying to maintain the continuity of lifesaving public health care services. • Several members of the EPI vaccination teams were reported positive for SARS-CoV-2 causing a disruption in services and temporary decrease in the vaccination activities. There is a need to increase the testing through the revised testing strategy to include at risk HCWs. • Preventive measures such as the use of masks, keeping social distancing and avoiding crowdedness are an implementation challenge. Furthermore, there is a resistance to be referred to COVID-19 dedicated facilities such as CCTCs despite the rigorous effort by health partners to fight the stigma and to understand the services provided. • Triage and IPC measures in 250 health facilities were found not satisfactory as 35% has the triage and IPC measures not followed. There is a need at the field level for implementers partners to hold responsibility and claim ownership of the recommended measures. • The caseload of Visceral Leishmaniasis has dramatically increased with more than doubling of cases this year compared to the last 2 years. • Tuberculosis Multi Drugs Resistance (MDR) cases have been identify in NWS requiring a treatment care strategic revision.

Health Cluster Coordination and Service Delivery

As for coordination during the end of October, two virtual bi-weekly Health Cluster meetings were held and attended by an average of 82 stakeholders. In addition, Health Cluster WGs and the COVID-19 Taskforce continue to meet regularly and there are well represented by health cluster partners and members.

During the first week of October, the Gaziantep Health Cluster successfully elected a new co-coordinator from the Syrian NGO Independent Doctors Association (IDA). The process was smooth and transparent with the health partners and resulted a successful election after previous two unsuccessful trials. Furthermore, as the health cluster’s team was encountering a gap for an Information Management Officer, as gap was created by the departure of the WHO IMO and a seconded stand-by partners (SBP) from the Global Health Cluster surge support, IDA graciously seconded a national IMO colleague to support the cluster. The support will mainly be for COVID-19 response while the Information management officer continues supporting regular tasks such as the monthly 4Ws reporting, HeRAMS data collection and analysis, infographics, and support for Technical Working Groups. The NWS COVID-19 Dashboard was kept up-to date and accessible for the general public. The Health Cluster Coordinator continuous to monitor the Surveillance Against the Health Care WHO SSA tool.

The Health Resources Availability Monitoring System (HeRAMS) Q3 2020 (July -September) report was issued with 56 implementing health cluster partners (managing and supporting agencies) reporting a baseline data of 577 health facilities supported by the Turkey based Heath Cluster partners. This figure represents an increased when compared to 550 health facilities in Q2 of this year. Of the 577 health facilities, 396 are reported to be functional facilities, a significant increase when compared to 370 in prior quarter. The breakdown of the functioning health facilities is as follows: • 65 (16.4%) Hospitals • 161 (40.5%) fixed PHCs • 51 (13%) specialized care centres • 78 (20%) mobile clinics • 41 (10%) others health facilities

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As of December 2019, and during Q1 2020, circa 80 health facilities temporarily or permanently suspended services in NWS, mainly due to the ongoing armed conflict. Many of these facilities relocated and/or resumed services as of the end of Q1 and Q2 2020, and by the end of Q3 (September 2020) there was a remarkable increased in ‘new’ health facilities including; 2 hospitals, 9 PHCs, 2 specialized care centres and 16 mobile clinics – as per use/agree classification. Out of total functioning health facilities reported from Northern Syria, the distribution per governorate is as follows; in the NWS, 222 (56%) in Idleb and 156 (39%) in Aleppo governorates; and 18 (4.5%) from Northeast Syria (Al-Hasakeh, Ar-Raqqa, Deir-ez-Zor) governorates.

By the end of October, as seen in the monthly 4Ws indicators’ summary table in the next page, majority of the tracked indicators have reached about 75% of the year targets. The graph to the right shows a remarkable increase in the provision of mental health consultations for new cases and cumulative for new and follow cases. In October alone, there was a 29% increase of new patients who received mental health consultations. Also, mental health services were boosted under the COVID-19 response making new cases and follow- up cases the highest so far this year and overpassing the yearly targets.

Another positive and significant improvement in service delivery is seen in the provision of physical rehabilitation services, with an 89% reached of the year target in new patients receiving care and over 100% coverage in therapy sessions. Although these indicators are encouraging, it should be noted that the year target was conservative as it was based in the prior conservative reached people with disabilities.

There are a good number of articles in circulation that state that the expected disability prevalence in conflict- affected countries is between 18-20%. A disability survey in 2018 from non-Government Syria controlled populations (camps in Jordan and Lebanon, as well as three governorates in N Syria) that showed a prevalence of disability ranging from 21 up to a 44%.

The admissions to hospitals ICU beds (see graph to the right) recorded an increase of 34%; a boost came out of as counting the admissions of COVID- 19 cases to these facilities. As per the same rational, appears that the COVID-19 cases had boosted the total number of referrals and the referrals inside Syria, as dedicated ambulances are supporting this response. The cumulative number of referrals inside Syria overpassed the year target at 127%, and the total number of referrals was 115%. As a synergy, Turkey continues to limit the transfer of cross border patients, as consequence more cases are referred with available healthcare providers.

As for the Health Sector at the Whole of Syria level, please see below extract infographic as of 13 October for Q2 reporting the number of hospitals providing CEmONC, Surgeries/trauma services and Blood Bank services.

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During the month of October and so far during this year, the Health Cluster service delivery is summarised in the cumulative monthly 4Ws indicators as per below table:

Table 1: Health Cluster NWS monthly & cumulative indicators for January to October 2020- Disclaimer: figures may change due to late inputs by partners and data cleaning 5

Health Cluster Technical Working Groups For secondary health care, SDI Harim General Hospital and Partners Update conducted 2,898 medical consultations, including 497 trauma consultations, 58 major surgeries, 10,871 health services (including lab services), BAHAR Organization (BO) is supporting four hospitalizations and treatment courses for 2,898 primary healthcare center, one secondary health care facilities, three mobile clinics (2,643 consultations), beneficiaries. And Save the Soul Hospital for Maternal and one Tuberculosis care center (92 consultations) in and Child Health in Salqin served 3,567 medical Afrin. Also, two EPI centers are supported and consultations, 235 vaginal and C-sections deliveries provided 9,438 vaccination services. and 10,765 medical services including laboratory and MHPSS consultations. During the month of October, the PHCs provided 7,430 primary healthcare interventions. Al-Salam Hospital provided 3,813 consultations, meanwhile 27 caesarians sections, and 91 normal deliveries were performed in both primary and secondary health facilities. The dialysis center in Afrin provided a total of 514 dialysis sessions.

Al Resala Foundation (RF) provided health services through two primary health care centers (PHCs) in Afrin and Shamarin (Al Resala camp), in addition to two mobile clinics serving Al-Manarah camp in Al Dana, Bulbul, and Sharan.

Fig: SDI- Physical rehabilitation session in action for a child The Global Hand-washing Day (15 October) was celebrated in the time of the COVID-19 pandemic and The Swasia Center for Orthotic, Prosthetics, and awareness activities raised to children and adults on Physiotherapy, in Afrin provided its services for 41 the importance of hand-washing and how to do it. As patients, 39 Assistive devices for 27 patients, 544 part of the Infection and Prevention Control (IPC) physical rehabilitation therapy sessions for 172 activities, the health facilities were disinfected in patients and 169 mental health sessions for 128 line with the WHO recommendations. patients. Lastly, the Tal Abiyad Physical Rehabilitation Center provided 120 Assistive devices for 83 patients and 270 physical rehabilitation therapy sessions for 135 patients. Other services include the SDI supported Afrin Blood Bank delivered 884 blood units and other blood components for the patients in Afrin’s health facilities.

The NGO through outreach interventions, two mobile clinics supported 10 communities in Salqin sub- district, Harim, providing 2,351 medical consultations for 1,949 beneficiaries, 3,534 health and nutrition

Fig: Al Resala Foundation- IPC application in health facilities services including MHPSS services. 238 household’s visits were conducted by CHWs teams. Lastly, on Social Development International (SDI) COVID-19 response, nine rapid response teams in continues providing primary, secondary, and tertiary Harim and Afrin covered 25 communities with raising health care services to vulnerable people in NW Syria, awareness session. applying IPC measures as the COVID-19 pandemic unfolds. SDI as well provides needed services to The VIOLET Foundation: supported Al-Amal people with disabilities. Maternity Hospital in Azzaz provided gynecology and obstetrics health care services, as well as As for primary health care services, the Al-Hakeem pediatric services. In October, the hospital provided PHC center in Afrin, provided 2,492 medical 2,058 maternal and pediatric health services to consultations for 6,731 beneficiaries. women and children. 6

Violet supported hospital attended 1,099 children Under the Risk Communication and Community consultations with 116 children admitted, out of Engagement (RCCE) pillar of the COVID-19 response, which 24 children required intubation. In total 843 awareness sessions were held for 4,575 beneficiaries. women visited the hospital seeking reproductive The NGO distributed; 150,000 surgical masks, 6,500 health services. Total number of deliveries during Oct face shields, 1,700 gowns for health facilities and was 128 (76 normal deliveries and 52 C-sections). 2,837 hygiene kits. Furthermore, on IPC measures, 17 Also, 45 minor and major surgeries where conducted facilities were disinfected out of which 10 are health at the hospital during same period. Furthermore, a facilities in addition to 61,000 m2 of public areas team of 10 CHWs is connected to the hospital through 41 teams. providing its neighborhood communities health- related messages. MENTOR Initiative supports 71 health facilities in NWS and runs 8 leishmaniasis mobile treatment clinics The Foundation as well supports vaccination activities (4 in Idleb governorate, 1 in Afrin, 2 in Azaz and 1 in and a total of 1,039 children below 5 y/o (523 boys, west rural Aleppo) covering 72 different mobile clinics 522 girls) were vaccinated through Mhambel and Al point locations. In October, two Visceral leishmaniasis Sheikh Bahr EPI centers. In addition, 105 women out (VL) cases were detected out of the 47 total cases of of which 58 were pregnant were vaccinated with 2020. The total number is more than the double tetanus toxoid. Both teams of Muhambel and Al compared to the previous year. Sheikh Bahr center participated in the OPV campaign (Oct 10-15) led and coordinated by Syria Immunization Group (SIG).

Violet as an active partner of the ambulance referral networks supports five ambulance stations in Idleb and Aleppo governorates which transferred 1,132 medical cases.

On COVID-19 response, three CCTCs are operating in Idleb, Ariha and Kafer Takharim. In October, the centers admitted 1,067 patients out of which 246 were positive including 38 medical personnel. The As for Cutaneous leishmaniasis (CL) 2,573 new cases number of patients referred to home quarantine were were reported, 45% female and 55% Male, were 996 and 49 to COVID-19 designated hospitals. diagnosed and offered treatment in addition to 31,562 total consultations. Out of the cases diagnosed, 69% were children. So far as for 2020, 28,202 cases of CL had been diagnosed and treated as per the above graph.

SHAFAK Organization (SO) continue supporting two dialysis centers in Idleb and Qah as well providing lithotripsy sessions to patients in Idleb center. In addition, six PHC centers are serving the population in NWS: Arshaf, Ziyadeh, Kafr Ghan , Jineh and Akhtarin centers in Aleppo and Harbanoush in Idleb.

The CeMONC supported facility continue to provide pediatric, RH and GBV services in Idleb until end of 2020. A pediatric ICU was activated and as well the Ariha surgical unit was reactivated with laboratory and referral services. IDPs are still a concern and they are served through two mobile clinics and 18 rapid response teams (Integrated health, protection and nutrition) focusing on COVID-19 awareness. Fig: VIOLET- COVID-19 activities in CCTS 7

IHH Humanitarian Relief Foundation (İnsani A series of human interest stories were published in Yardım Vakfı) in coordination with Turkish WHO EMRO website regarding chronic diseases, authorities distributed medical masks and women health system response and the health of IDPs. hygiene pads to Darkoush Hospital and Sarmada treatment center. In addition, 1,000 baby milk boxes Sexual and Reproductive Health (SRH) TWG: delivered at Sham Children’s Hospital in Sarmada and The Post-Natal Care (PNC) service guidance was 300 cartons of milk. In Zarzour Health Center delivered prepared and shared with SRH partners. The guidance medical masks and medicines. is highlighting the importance of the PNC visits, some key statistics about newborn death, preventive care On prosthesis and orthosis, 14 artificial limbs were practices and routine assessments during the visits. A provided for IDPs women, children and men from Al- distribution of 373 RH kits and 49,000 bulk items was Hidaya camp, Ataa 2, Atma camp and Al-Rahel camp. made to cover the needs of 500,000 women till the The physical therapy department in Sarmada provided end of 2020. In October 2020, there had been no 422 physical rehabilitation sessions during the month. maternal death from the data received form 21 partners in 57 reporting health facilities. Mental Health and Psycho-Social Support (MHPSS) TWG: on 10 October World Mental Health Another public health Day (WMHD), WHO hosted, for the first time, an awareness campaign held in online global advocacy event on mental health. The October was the International event was opened by the WHO Director-General and Breast Cancer Awareness participated by National and International leaders and Month (Pink October) marked celebrity guests to talk about what can all do to in countries across the world. improve the mental health and how to help assuring The campaign helps to the quality mental health care is available to everyone increase attention and support for the awareness, who needs it. In NWS, under the MHPSS WTG health early detection and treatment as well as palliative care cluster partners observed the day as well. of this disease.

On Pink October, cluster partners such as SDI launched awareness campaigns (insert photo below) in all its supported fixed centers, mobile clinics providing health advises on breast cancer signs, causes, treatment methods and how to conduct self- examination and early detection.

The BCAM awareness campaign activities were held in 22 camps, 16 communities, four PHC centers and some women's centers (see insert photo below)

Fig: Al Resala Foundation and IDA in World Mental Health Day, October 10 through Afrin, Harim, Salqin, Al-Dana and Maaret Masrin sub districts. In observance, Al Resala Foundation conducted awareness sessions under the slogan #My Mental The campaign targeted Health is Important. The awareness sessions were approximately 3,426 raised in a full week the health facilities and mobile women, in addition to clinics, in which 34 females and 15 males participated, dissemination of text with the application of strict IPC measures. As well SDI awareness messages conducted awareness campaign about suicide from the SRH TWG via prevention following IPC measures in health facilities, 35 WhatsApp groups. households and camps.

As well, under the hashtag #Pink October, Al Resala Furthermore, WHO published a story to shed light on Foundation in its RH supported clinics provided health the importance of investing in mental health service awareness sessions to women on the importance of provision in NWS and supported health partners in early screening for breast cancer including self- organizing and creating an advocacy video. manual examination for early detection 8

COVID-19 Task Force (TF): the taskforce to reach a total of 26,028 tests. Three testing continues the implementation of the COVID-19 laboratories are fully functional with an additional PCR preparedness and response plan with all the health machines, increasing the average of daily testing from cluster partners addressing the key pillars of the below 500 tests daily to above 1,000 tests. This was a response. significant benchmark achievement this month.

Coordination: besides the established coordination On Case Management, six new COVID-19 Community with the implementing health cluster partners, local Treatment Centers (CCTC) were added to the Syrian and Turkish acting health authorities, there is a response to have a total of twenty CCTCs functional continue interaction with non-health actors and with a capacity of 1,110 beds. The CCTC aim is to clusters to assure a comprehensive multi-sector managed mild cases with minor dependency to approach. One the common non-health interventions medical care such as provision oxygen therapy. For been addressed is the establishment of quarantine moderate to severe cases, eight hospitals (out of 9) centers for travelers and suspected but not positive are functional with a capacity of 615 beds. These key cases. In addition, Early Recovery Cluster actions such indicators as well are part of the NWS COVID- as cash for work initiatives is been pursued in the 19 Dashboard as seen in below snipped section. fabric masks production.

The Health Cluster team on behalf of the NWS COVID- 19 Taskforce with information from the Disease Surveillance Network maintains and daily update the COVID-19 Response Tracking Dashboard for the NWS. In addition, a summary update in English, Arabic and Turkish as seen below is shared daily with all stakeholders.

The Risk Reduction and Community Engagement (RRCE) pillar WG is working with the communities and the social media to increase the awareness in the need for quarantine and or isolation measures. In addition, there is the ongoing need for behavioral change in wearing masks, social distancing and limiting social gatherings.

Epidemiology, Surveillance and Laboratories: As of the ending of October, 5,660 cases have been confirmed as SARS-CoV-2 positive out of 26,028 tests. There had been 278 new cases on the last day of the month (October) in the North West of Syria. The cases are in (Aleppo 77–Idleb 201). There were 2,450 recovered patients and 42 related death to COVID-19 reported, with 3,155 active cases.

During the reporting period, confirmed COVID-19 cases in northwest Syria drastically increased from 1,072 in September to 5,660 confirmed cases. This significant increase was synergistically proportional with the increase of testing capacity from 11,000 tests Fig: VIOLET- COVID-19 RCCE activity, Visual awareness session in action 9

Monitoring of violence against health care Plans for future response: events & dates:

➢ Health Cluster Meetings: 5 and 19 November

➢ SCHF SA2 2020: The envelope for this allocation is tentatively set at US$ 13 million and open to eight clusters; CCCM, Education, ERL, FSL, Health, Protection, Shelter/NFI and WASH. Specific information on prioritized activities and locations are detailed in the allocation strategy paper. Please note that this amount is indicative to inform the reviews and subsequent Fig: Attacks on Healthcare trends in Syria Jan 2019- Oct 2020 (WHO WoS) recommendation of projects. The final decision

will be based on the quality of the proposals As attacks trends at the Whole of Syria level continue received, the extent to which they correspond to to decrease (see above graph); in October, ZERO the allocation strategy and alignment with the attacks were reported on the WHO Surveillance strategic objectives of this allocation. Due to the System for Attacks on Healthcare (SSA). As 31 October limited funding available, final funding decisions 2020, a cumulative total of 25 attacks were reported will take into consideration ongoing interventions in the SSA for Syria, of which 14 were recorded in the (funded by SCHF or other donors) and strong NW Syria, specially Idleb governorate where the prioritization related to the latest population armed conflict continues to be at the frontline. figures, severity of needs, and critical gaps.

The deadline for submission of proposals will be 13 November 2020, 17:00 hours. All proposals must be submitted online via the GMS only. Fig: SSA Dashboard screenshot as of 31 October 2020 (http://ssa.who.int/)

➢ Kick-off of the Humanitarian Program Cycle (HPC) Although not reported attacks, a VBIED detonated o November deadline for input to 2021 under unknown circumstances in Al-Bab city and Global Humanitarian Overview (i.e. three staff from SRD, working in COVID-19 referral estimated 2021 PiN, HRP target; plus 2020 project were wounded. The driver was serious injured reach in Q1-Q3) with unstable condition and transferred to Turkey for o OCHA joint inter-sectoral analysis (series further medical care. of mini-workshops), including analysis by

humanitarian condition + development of The above describe event is coming after another inter-sector severity/PiN and inter-sector incident reported in September resulting a loss of a chapter Turkish Red Cross staff. The Health Cluster raises the voice again to the conflict’s party to respect lives of ➢ Master's Training on Perinatal Depression to be civilian, humanitarians and especially health care held 10-13 December 2020 workers.

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