Week 21, 19-25 May 2018 General developments & political & security situation On 22 May, a convoy of an estimated 400 people from Yarmouk arrived in Madiq Castle in northern Hama Governorate, following a local agreement reached between parties. This development renders the whole of Damascus and Rural Damascus governorates under GoS control. From 15 - 22 May, over 8,000 of the some 44,000 displaced people in IDP collective sites in Rural Damascus reportedly returned to eastern Ghouta. They have been displaced since March when military operations resulted in mass displacement. According to Syrian media, the Syrian Minister of Health’s intervention at WHA71 called for lifting the unilateral economic measures on Syria that affect the health of its people … on the occupied Golan, he stressed that despite Syria's repeated demands, Israeli occupation authorities deliberately deprive the area of health facilities, to pressure its population to leave; also noting the continued suffering of Syrian prisoners in Israeli jails that lack the minimum standards of hygiene and health care …. He noted that over 7 years of war, Syrian health institutions continued providing free services, which exceeded 40 million services, at a cost of about 81 billion SYPs in 2017. OVERVIEW KEY HEALTH ISSUES Health response to multiple and simultaneously evolving emergency situations across the country: Cases of measles across the country, leishmaniasis in northern Syria and acute diarrhea in NE Syria. An estimated 137,070 individuals remain displaced from Afrin district to the Tall Refaat, Nabul, Zahraa and Fafin areas. In East Ghouta, about 44,000 IDPs remain in eight shelters, and an estimated population between 100 and 140,000 in the communities that remain largely inaccessible to health assistance. Approximately 35,648 people have evacuated Northern Homs through Rastan exit point since 7 May 2018 towards Idlib governorate. A total of 150,000 people in rural Homs remain in areas inaccessible to health assistance. KEY GAPS & CHALLENGES Lack of information or access to areas recently regained by GoS. Little known about the status of public health care facilities in the areas occupied by the Turkish government and the Kurdish Self-Administration. OPERATIONAL UPDATES 1. Coordination: No update. 2. Information and planning: Produced HeRAMS snapshot for April 2018 for public hospitals across Syria; Flash update # 29 for monitoring violence against a medical mobile clinic donated by WHO to an NGO in Deraa (12 May 2018). Site visit to WHO-Homs hub to provide technical support in HIS issues and to develop response monitoring indicators for Northern Rural Homs. New maps: - Current situation and functionality of public health facilities in Southern Damascus (Al-Yarmouk city) along with control areas, as of 21 May 2018; - Distribution of health facilities for Syria Pulse in Deir-ez-Zor , May 2018. 1 - Distribution of health facilities for Al-Ihsan Charity (NGO) in Aleppo, May 2018. 3. Health operations: Aleppo Afrin response: Situation update Returns into Afrin district have increased. From 21-24 May 2018 up to 600 vehicles carrying IDP families from various displacement locations (Tal Refaat, Fafin, and surrounding areas) crossed into Afrin city. All IDPs crossed from Ibin village (under GoS) – Inab (under NSAGs) – Maryamayn then to Afrin. The crossing point opened after an agreement between the Afrin local council and Turkish forces to strengthen the position of Afrin Local council (supported by Turkey). The limitation of movement for IDPs remains a key concern. IDP movement only between reception areas. These limitations of movement mean that displaced people continue to be prevented from moving forward to areas where they would potentially have better access to services and humanitarian assistance. Disease surveillance &immunization: Acute Diarrhoea, URIs, and Lice are the most reported diseases among IDPs. Continuous decreasing in reporting of measles suspected cases in week 20. 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 NGOs Activities >50,000 bed nets are in pipeline, and preparedness for vector control is ongoing (4 months starts in June). NGO activities 13 WHO Supported mobile teams are operated through 5 national NGOs. 1 fixed PHC is supported in Nabul, in addition to the support of referral system to the local hospital in Zahraa town (in total 143 patients who received STHC services including 46 obstetric deliveries) 3336 outpatient consultations were provided, as the service is available on daily basis. In addition to 84 services were provided to people with special needs. Nutrition activities: 10 WHO supported nutrition surveillance teams running activities in Afrin IDPs sites. 835 children under 5 years screened during this week, 10 SAM cases were registered and began treatment. Mental Health 890 MHPSS and medical services have been provided through the 13 WHO Supported mobile teams Medical transportation for critical cases Ongoing coordination between SARC, DoH, and WHO to enhance the mechanism to transport critical cases. 7 critical cases were transported by SARC to Aleppo University Hospital, including severe fractures, people with cancer and renal failure. Response to student from HTR for national exam: 3042 students from HTR areas reached Aleppo for the final exams, accompanied by 400 parents, hosted in 16 collective shelters in Aleppo city. WHO responds to the health needs of students through partnership with 5 national NGOs response to the health needs of resident students. East Ghouta response No update. Homs response: Response to Northern Rural Homs On 17 May 2018 the 9th (final) convoy of evacuees from NRH (from Al‐Houla) entered Idleb and western rural Aleppo through Al‐Madik castle crossing point. Evacuation of the NSAGs from the northern countryside of Homs and southern countryside of Hama is now completed. The collective total number of evacuees was 35,648 individuals between 7 - 17 May. 2 Nutrition screening was conducted for 50 children <5, detecting 24 moderate and 2 severe acute Malnutrition cases, 13 pregnant and 17 lactating women were screened, detecting 14 moderate malnutrition cases. Inside NRH, DOH teams vaccinated 227childern with routine vaccination program (193 of them dropout) in 3 points: Dar Kabira, Rastan and AlGanto. Access to other health actors not yet provided. WHO dispatched shipment of medicine and Permethrin 1% Shampoo to SARC Homs, to cover needs of mobile clinic which provided health services to Northern Homs area. Routine program Participation in IA mission for humanitarian assessment for Alqareeten town. HIS field visits conducted to Fairoze and Zeidal PHC (in eastern Homs area). Annex 4 for number of beneficiaries of Albir NGO- WHO partner in Homs. Lattakia response: Prepared two shipments to be dispatched to Douma and YBB in the upcoming IA convoys. Prepared shipments to replenish Homs, Aleppo and Al-Qamishlli stocks. Northeast Syria (Al-Hassakeh; Ar Raqqa; Deir-ez-Zoir) response: Coordination Follow up: diarrhea cases in Zghair and Al-Kasra in Dier Ezzour with NES health actors; WASH sector in water quality control issues in camps. Coordination meetings with the directorate of the DOH in Al-Hasakah with the MH technical officer to discuss the current situation of MH services in the governorate; the governor of Al-Hasakah to provide the needed facilitations; IRC to discuss the collaboration pathways in terms of Mental health Acute diarrhea in Dier Ezzor Acute diarrhea cases have been reported to WHO from Deir Ezzor Governorate in north eastern Syria since 26 April. Several villages on the eastern bank of the Euphrates have reported cases. o 28 cases including 5 deaths have been reported to WHO from health facilities. o As per update on 23 May 2018, KRC reported 353 cases and 0 deaths of acute diarrhea. The laboratory results of (18) stool samples tested by MoH indicated that E. coli as the predominant etiology, while lab tests to identify E. coli O157:H7 were negative. The laboratory results of (14) stool samples tested by Kurdish Red crescent were negative for shigellosis and salmonella. Water quality disinfection programme is in progress in Husseiniya district east of Euphrates River in the Governorate of Deir Ezzor. As of 22 May, 41, 677 chlorine tablets have been consumed, chlorinating approximately 83,000 liters of water distributed by 9964 water tankers with capacities varying between 5 and 10 cubic meters. Further details in outbreak sitrep. Pharmacy and STHC program: Delivered 4 tons of kits, medicines and equipment to Al-Kasra hospital northern Deir Ezzor, the supplies support different health needs in areas located eastern the river and respond to the high number of water- born infectious cases, providing in total supplies for 61,330 treatments and 200 trauma cases. Delivered 4 tons of kits, medicines and equipment to Al-Taqba hospital in Ar-Raqqa to complete rehabilitation works and expand hospital services, providing supplies for 62,271 treatments and 225 trauma cases. National NGOs coordination: St. Ephram committee in coordination with three NGOs, GOPA and Al-Hikmah private hospital are WHO’s current partners. 2 health working group meetings in both of Al-Mabruka camp and Ain Issa camp with all the health actors, the meetings addressed the last health situation updates, gaps and the action points. Conducted a field visit with MH technical officer to follow up service provision (GOPA and St.Ephrem committee). 4. Technical Expertise 3 Non-Communicable diseases / Primary healthcare Under Biennium program 2018-2019; advocated 2 PHC/NCDs workshops In cooperation with MOH as follows: - “Diabetic Foot management & approaches for Diabetic Elderly People “workshop 12-14 in Damascus, targeting doctors in MOH. Total number of trainees 25. - Tobacco Control TOT workshop 19-21 May in Homs, targeting doctors & directors of Tobacco control program in DOHs from Aleppo, Tartous, Hama , Homs & Latakkia.