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1 Week 18, 28 April

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1 Week 18, 28 April Week 18, 28 April – 3 May 2018 General developments & political & security situation In rural Homs, following a period of intensified fighting, a temporary truce was reportedly reached on 17 April to allow for ten days of negotiations. However, military confrontations resumed and the situation has evolved rapidly. The state of negotiations for a local agreement cannot be determined at this stage. On 29 of April an agreement reached between GoS and Tahrir Al-Sham (HTS) to evacuate up to 5,000 individuals from Kafrayaa and Fouaa besieged villages in rural of Idleb, synchronized with evacuation of HTS fighters and their families from Yarmouk camp for Palestinian refugees in southern of Damascus to Idlib. OVERVIEW KEY HEALTH ISSUES Expanded health operations in East Ghouta and Aleppo. Preparedness for health responses in South Damascus, Rural Homs and South Syria. Outbreak of bloody diarrhoea Deir Ezzor Governorate. Increased cases of measles and leishmaniosis across northern Syria. KEY GAPS & CHALLENGES Unsafe water and poor hygiene practices among displaced people in shelters increase the risk of water- and foodborne and vector borne diseases. Remaining populations in East Ghouta and Afrin communities still inaccessible to most health partners. Uncertainty and rapidly evolving security situation across the country. OPERATIONAL UPDATES 1. Coordination: Developed health cluster bulletin for April 2018. Continued technical discussions with SARC on public health assessment across eastern Ghouta. Locations of key sites have been agreed. A NV is to be submitted by WHO to MoFA. Updated information is provided for Health Security Council meeting in Geneva. Updated health sector information is provided to RC/HC office on the assistance to Moudamiya, Rural Damascus. Finalized information on present health sector response to Afrin and eastern Ghouta with the main objective to enhance further response for Afrin displacement. Prepared the update of health sector coverage of north-east Syria (Al Hassakeh, Ar Raqqa and Deir-ez-Zoir governorates). 2. Information and planning: Produced: - HeRAMS annual report 2017 of the public health centres in Syria. - Narrative report of site visits to some areas in Ar-Raqqa (Maadan and Al Thawara) to assess resource availability, health services, supporting agencies, infrastructure monitoring and rehabilitation potential; assess the health profile of public health facilities. - 4 infographics of summary of key indicators for 1st quarter 2018, across Syria; North-east Syria; North- west Syria; Southern Syria). 1 Provided: - One HeRAMS follow up workshop in Aleppo university hospital for 28 MoHE participants. - One training on Management of the drug information system in Damascus for 28 MoH participants. - HeRAMS online application Hospital dataset was updated to meet the dataset version 5. - New feature has been developed on the WHO-Syria-Portal Registry module Developed maps: - Distribution of public and SARC health facilities at Eastern Ghouta as of 1 May 2018; - Current situation and functionality of public health facilities in Al-Yarmouk city, as of 01 May 2018; - Functionality of public health facilities in Northern Homs, as of 1 May 2018; - Distribution of the Al Afia fund Charity – Homs facilities/NGO, 2018; - Number of children screened, Feb&Mar2018; Stabilization centers, Apr 2018; - Distribution of health facilities for Armenian Catholic Church (NGO) in Al-Hasakeh, as of Apr 2018; - Functionality of public health facilities in Deir-ez-Zor governorate. 3. Health operations: East Ghouta response Interagency visits to shelters resumed with WHO visiting all 8 shelters once between 26 April – 2 May. The total IDP population in the eight shelters remained stable around 44,000. Women, children and men over 55 years of age can leave the shelter but many families decide to stay together as they are destitute and do not want to be separated of their men who can only leave after security clearance is obtained. Health sector partners, including 11 national NGOs supported by WHO continue to run mobile clinics and mobile health units in all shelters with continued high numbers of patient contacts per day with an average of 100 - 200 patient contacts per day. 2 WHO NNGOs partners obtained permission to run mobile clinic services in selected areas inside East Ghouta. Negotiations for further access by other NNGOs is ongoing. WHO supports up to 60 medical mobile teams, mobile health units and medical points, including: o 27 medical mobile teams by 11 national NGOs in shelters providing almost 22,000 outpatient consultations in week 17 (average daily consultation of 116 per day per team). o 23 medical mobile teams from DoH Rural Damascus (estimated 200 health workers) providing health care on a daily basis in shelters with almost 13,000 consultation in week 17 and an additional 5480 consultation in eight locations inside of East Ghouta. A total of 11,575 children were vaccinated in 8 community locations while all children in shelters were covered with vaccines in the previous weeks, in week 17 268 children were vaccinated in the shelters. 8 WHO-supported teams of trained community psychosocial support workers provided basic psychological interventions to an average 178 persons / day. A daily average of 144 children participated in educational and recreational activities during which children with emotional and behavioral problems are identified to receive further psychological interventions. Teams also provided psychological and/or pharmacological interventions to an average 25 persons / day in shelters by the accompanying psychiatrist or trained psychologists. 4 nutrition surveillance and nutrition teams started screening in newly accessible areas in East Ghouta. 3 stabilization centers are functional in Damascus hospitals, 0 children from East Ghouta were admitted. 38 EWARS (An early warning and response system) sentinel sites are supported. A total of 1320 injured and critically ill patients referred to Damascus hospitals and under health monitoring since mid-March. Since mid-March a total of 11 shipments completed with health supplies, 50 tons or 600,000 medical treatments to SARC and DoH Rural Damascus. 2 The approved WHO, SARC and MoH public health assessment is pending. In agreement with SARC an updated plan to visit in five days all 25 public health structures as well as seven SARC health structures in East Ghouta has been presented to MOFA for further approval. Aleppo response: Situation update: An estimated 137,070 individuals remain displaced from Afrin district to the Tall Refaat, Nabul, Zahraa and Fafin areas. At the same time, it is estimated that as many as 50,000 people are still in Afrin city and an additional 100,000 in rural Afrin. SARC +4 NGOs registered 10’616 families/53’311 IDPs in Tal Rifaat sub district. In aadetion to estimated 10’000 families/60’000 IDPs are is Zabul and Zahraa sub districts. Currently, IDP movements are free between the reception areas, while no return or onward movement has been permitted. Reportedly, the local administration is planning to relocate the IDPs families from Nabul and Zahraa to Tal Refaat and surrounding areas. Disease surveillance &immunization: Acute Diarrhoea, upper respiratory infections, and Lice are the most reported communicable diseases among Afrin IDPs. Decreasing suspected measles cases during week 17. IDPs sites were targeted through the national immunization days, as 4065 U5 children were OPV vaccinated and 7’989 U5 children were routine immunized Furthermore, 700 mosquito nets were distributed in Fafin camp Essential outreach services: (see annex) 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 10 mobile medical teams are supported through three national NGOs ( Al-Ihsan , SCC/ Society for children cancer, Yadan Biyad ). In addition to one static point in Nabul. One doctor and 2 technician supported by WHO are activated in Nabul dialysis center operated by SARC . Through coordination between SARC and national NGOs active in Afrin response, WHO support referral system for Afrin IDPs in Zahraa local Hospital, 128 cases received STHC services including 59 deliveries, SARC ambulances are facilitated patients’ transportation. Mental health and disability: 12 social workers are working for Al-Berr & Al-Ihsan, Al-Ihsasn and YBY NGOs; 423 mhPSS services were provided during reporting period (physiological first aid, basic psychosocial support services, and counselling) 8 WHO mhGAP trained doctors (NGOs) and 4 WHO mhGAP trained doctors (DoH) have been deployed in mobile medical teams and fixed PHC to the IDP sites; 255 mhGAP consultations were provided during reporting period Hospitalization of critical cases Approval was received from MoFA to facilitate medical transportation for IDPs who fled from Afrin and are currently in Nabul, Zahraa and surrounding villages to the city of Aleppo. Several cases are being transported via SARC to Aleppo University hospitals based on approval of local authorities to facilitate the transportation of critical/emergency cases Daily coordination between SARC and WHO to facilitate the hospitalization in Public facilities and/or NGO supported referral system (if needed) Ongoing coordination between SARC, DoH, and WHO to establish an active mechanism to transport critical
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