WHO : SITUATION REPORT (7 March – 7 April 2020).

I. General Development, Political and Security Situation

✓ As of 7 April 2020, The Ministry of Health (MOH)in the Syrian Arab Republic announced a total of nineteen confirmed cases of COVID-19, three of which have recovered, and two are reported dead. ✓ The security situation remains unstable and volatile, with the main hot spots are in rural and Ar-Raqqah . Relative calm prevailed over the frontline axis between SAA and NSAGs in the rural areas of Idlib and while sporadic SAA ground shelling targeted NSAGs in western rural and northern rural . ✓ The Turkish Army established a new observation point in western rural Idlib and continued dispatching reinforcement convoys to its military positions within the .

II. Highlight of WHO key achievements for February 2020

• 50% #of public hospitals are either partially functioning or non-functioning as assessed by HeRAMS. • 53% % of public health centers are either partially functioning or non-functioning as assessed by HeRAMS. • 346,047 # of delivered treatment courses were provided. • 57 Total weight (tons) of regular deliveries across the country including IA convoy. • 95% # of sentinel sites submitting weekly surveillance reports. • 98,087 # of children under 5 were screened. • 23 # of national NGOs as implementing partners. • 81,428 # of PHC outpatient consultations were provided by WHO partners.

Highlights of attacks on health care 1 Jan - 31 Mar 2020 at WoS level

• 11 Total Attacks • 10 Killed (of which 0 Health care providers) • 35 Injured (of which 5 Health care providers) • 10 Attacks impacted health facilities (This is not equal to the number of health facilities attacked as repeat incidents can occur or one attack incident could impact multiple health facilities)

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III. WHO Response

Non-Communicable diseases & Primary health care: PHC activities: ✓ An Online training was conducted on PHCMI initiative targeting focal points at MOH and WCOs. Three sessions were conducted per week for two weeks “Progression Model “.

Capacity building: ✓ COVID-19 response: PHC Directorate held a 2-day TOT training to focus on case definition, triage, RRts roles, IEC materials and case management at PHC level. Similar trainings are to be conducted at health district

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levels targeting management, physicians, RRTs, surveillance staff, with a total number of trainees of 10 per training. Medical Mobile Teams /MMTs: ✓ Continued support with operational cost to sustain field activities for the four medical mobile teams to cover basic PHC services for Al Rukban returnees towards eastern rural areas and Kuser district in in addition to IDPs and returnees’ movement from east-south Idleb towards rural Hama including Sanjar district and the two announced humanitarian corridors for civilians to exit NSAGs controlled areas towards GoS control areas including Hobait town ,south of Idlib and Abu Al-Dohur sub-districts in east Idlib.The total number of provided consultations in Homs and Hama is 4950 & 6603 respectively. ✓ Due to schools’ suspension, the Oral health project covered till mid-March in EG schools; targeting students with dental examination, prevention and treatment measures along with health promotion sessions for both students and teachers. So far, a total of 1390 students were reached with health promotion sessions, and 5857 oral health services were provided including promotion, preventive and management interventions in addition to 36 teachers covered with health promotion activities.

Rehabilitation of health centers:

✓ Under a Russian fund, minor rehabilitation work is to be implemented for 8 PHCs along with medical equipment to be supplied to three governorates: Homs, Qunitera and . So far, three health centers in northern rural Homs are under tendering process (Ter Mala, Kafernan and Jaborin). ✓ Under a Japanese fund, two PHC centers in Aleppo are to be rehabilitated ; tender is in process.

Trauma ✓ Trained 350 health workers on trauma and disability related topics in seven governorates (Deir–ez-Zor, Daraa, Qunitra, Aleppo, Tartous, rural , and Damascus). This included a specialized training course on Immediate Life Support and Management of Patients on Ventilator in Al Zabadani Hospital (the isolation center for COVID 19 patients). The targeted group for this course is health professionals (doctors, nurses and anesthesia technicians) working in ICU and emergency departments in the hospital in addition to first responders from the ambulatory and emergency directorates in Damascus and Rural Damascus. This training will be repeated in Al Zabadani and in Damascus Hospital before expanding the training to cover other governorates next month. ✓ A field mission to Al- Qamishly was conducted between 9-12 March, with the participation of the Health Emergency Officer in EMRO and the WHE team Leader in their first visit to NES to have a firsthand observation on WHO response in the field and provide guidance and support to the sub-office in terms of health operations in NES. This included a field visit to IDP camps to follow up on WHO supported health services including those provided to field hospitals providing secondary services. The WHO team attended a health coordination meeting in the camp to discuss ways of enhancing the health response. The team also conducted site visits to the WHO-contracted referral hospitals in Al Hasakeh city (Al Hikmeh and Al Haya ), WHO-contracted NGOs, DOH, Qamishli Hospital and the Governor of Al Hasakeh.

Immunization ✓ In coordination with MOH, UNICEF reviewed the final draft of the comprehensive multi plan year cMYP 21-23 for the final endorsement of HE the Minister of Health. ✓ Working on the finalization of the Gavi Programme Support Rational 21-23 (PSR) together with the MOH and UNICEF partners for the endorsement of HE the minister and Gavi board. ✓ The EPI services are still being provided at fixed sites as well as the outreach and mobile vaccination activities whenever possible within the current worldwide COVID-19 pandemic taking into consideration respect of the local situation in Syria. ✓ In support to the EPI activities and for the protection of the service providers and users during the current COVID-19 worldwide pandemic, EPI department in WHO, has developed a plan to procure PPEs for PHC vaccinators and Surveillance workers enough for 6 months 3

✓ The Acute Flaccid Paralysis Surveillance is maintained and closely monitored through coordination with the Polio cell at MOH; the indicators meet the globally set targets despite a slower progress since the outbreak of the COVID-19 pandemic; MOH is making efforts to sustain the Polio surveillance performance through virtual meeting/communication with field staff.

Mental Health

✓ Several communications with MoH/ MHD for MHPSS interventions for COVID response, with consideration to three areas: developing a national guideline for MHPSS considerations and interventions, to be adapted and published by MoH with technical support by WHO and MHPSS TWG. ✓ Support quarantine sites are to be more friendly observing spaces during staying of patients , with focus on developing case management to provide MHPSS services in site or remotely, and to continue MHPSS training for main programme such as mhGAP, PFA and PM+. Special focus is to be laid on supporting health frontline workers. ✓ Developing a plan to provide MHPSS online services for people living with HIV by providing MHPSS orientation sessions and develop counselling methodology adapted to COVID19 with full coordination with HIV unit in WCO, MOH relevant counterparts. ✓ conducted 6 orientation sessions for more than 125 health and community workers about COVDi19 from different NGOs across the country in addition to two PFA trainings for COVID19 response for different NGOs. ✓ 23,907 MH consultations were provided at community level through partnership with 11 NGOs in 84 different locations as part of emergency response in areas across the country, ✓ Mental health specialized hospital and psychiatric ward needs for laboratory equipment were assessed and a procurement process is to take place accordingly to cover the needs targeting 3 mental health hospitals and Almost psychiatric ward in MoHE in collaboration with MHPSS partners ✓ Engagement actively in NES campaign for COVID19 from MHPSS component perspective through IEC capacity building activities for 233 volunteers on PFA and MHPSS key messages. ✓ Engagement with Faffin camp/ Affrin response area through an orientation session for 25 doctors working in the Faffin field hospital. ✓ MHPSS workers in 9 different locations with 5 NGOs are engaged in providing up to 10k MHPSS services in NES emergency response area.

Nutrition and Child Health ✓ Following up on the IMCI program to review the actual data coming from 201 HC on respiratory infections (no changes are noticeable compared with January 2020 ) . ✓ Data analysis of nutrition surveillance for February 2020 with 858,434 services. ✓ Data collection of hospitalized severe acute malnutrition cases in 25 stabilization centers for all 2019 with 79 admissions ; the higher number is in Aleppo ( 25 admissions ).

Secondary Health Care ✓ In coordination with WCO HIS team, a meeting was held with MOH to support installation and training on CanReg 5 system at public hospitals and central cancer registry unit in addition to providing operational support. ✓ Finalizing the cancer form for new registered cases. ✓ Coordinating with Al Qamishli hub to carry out training on triage, IPC measures, waste management and case management for NES medical staff working at hospitals. ✓ Supporting the installation of X-Ray machines in two public hospitals in Damascus and rural Damascus ( Mujtahed & Kalamoon). ✓ The total number of treatments for STHC programme is 81,860.

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Communicable Diseases, Surveillance and WASH EWARS and epidemiological updates at national level (week 10,2020-week 13,2020) Surveillance performance: • A total of 1156 out of 1273 active reporting sites (90.9%) in all 14 reported through early warning alert and response system (EWARS) with 92.7 % of timeliness. • 9 newly recruited as following: (6) Deir-ez-Zor ,(2) Al-Hasakeh, and (1) • Total number of consultations was 952 154. 50.7% of the cases were among females and 41.6% were among children under 5 years. • Out of the 952 154 total consultations, a total of 136 436 EWARS notifiable cases were reported. Morbidity: The leading causes of morbidity among all age groups were influenza-like illnesses, and acute diarrhoea (Figure 1) . The breakdown was as follows: • Influenza-like illness (ILI): 91 303, accounting for 66.9% of total cases. Most cases reported from Aleppo, Tartous and Lattakia. There is a decrease of the number of cases by 20.0% compared to the reporting number of ILI cases during the previous 4 weeks (115 667) (Figure 2). The average number of ILI case per week was 22 989. • Severe acute respiratory infection (SARI): 2262 case were reported, which decreased by 23.5% compared to the reporting number of SARI during the previous 4 weeks (2793) (Figure 3). The average of weekly number of reporting was 565. • Acute diarrhoea (AD): 26 278 (19.3% of total cases), most reported from Deir-ez-Zor, Idleb, and Aleppo. • Acute jaundice syndrome (AJS): 1414 most reported from Deir-ez-Zor, Idleb, and Ar-. • Sever acute respiratory infections (SARI): 2 238, most reported from Hama, Tartous and Aleppo. • Suspected measles (SM): 118, most reported from Ar-Raqqa, Idleb, and Al-Hasakeh. • Acute flaccid paralysis (AFP): 26, most reported from Homs, Ar-Raqqa, and Damascus. • For the “other diseases” category 14 697 cases were reported, with the most reported cases is leishmaniasis of cases (5118) , most reported from Aleppo, Deir-ez-Zor, and Idleb • From week 1 till week 13, there were two measles confirmed cases reported from each Hama and Dara’ in February. No confirmed measle cases ware reported in March.

Figure 1: Proportional morbidity of top 5 diseases among the total consultation between week 12,2019 and week 13,2020 12.0% 10.0% 8.0% 6.0%

4.0% Percentage 2.0% 0.0% 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 2 4 6 8 10 12 Week Number

ILI AD LSH LIC SCA

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Figure 2: Number of ILI cases (week 12,2019 and week 13 2020) 35000 30000 25000 20000 15000 10000 5000

Numbercase of 0

week 1,2019 week 3,2019 week 5,2019 week 7,2019 week 9,2019 week 1,2020 week 3,2020 week 5,2020 week 7,2020 week 9,2020 week

week 39,2019 week week 11,2019 week 13,2019 week 15,2019 week 17,2019 week 19,2019 week 21,2019 week 23,2019 week 25,2019 week 27,2019 week 29,2019 week 31,2019 week 33,2019 week 35,2019 week 37,2019 week 41,2019 week 43,2019 week 45,2019 week 47,2019 week 49,2019 week 51,2019 week 11,2020 week 13,2020 week WEek number

Figure 3: Number of SARI cases (week 12,2019 and week 13 2020) 1200 1000 680 800 650 494 600 438 400

Numbercase of 200

0

week 1,2019 week 3,2019 week 5,2019 week 7,2019 week 9,2019 week 1,2020 week 3,2020 week 5,2020 week 7,2020 week 9,2020 week

week 11,2019 week 13,2019 week 15,2019 week 17,2019 week 19,2019 week 21,2019 week 23,2019 week 25,2019 week 27,2019 week 29,2019 week 31,2019 week 33,2019 week 35,2019 week 37,2019 week 39,2019 week 41,2019 week 43,2019 week 45,2019 week 47,2019 week 49,2019 week 51,2019 week 11,2020 week 13,2020 week Week number

EWARS and epidemiological situation in Al-Hol camp (week 10,2020-week 13,2020) Surveillance performance: • Total number of reporting site is 22. • Average completeness of reporting 100.0%, and average timelines is 94.3%. • Total number of consultations were 26 633. 58.2% of the cases were among females and 52.1% were distributed among children under 5 years. Morbidity: • Out of the 26 633 total consultations, 5 327 EWARS notifiable cases were reported. • The leading causes of morbidity among all age groups were influenza-like illnesses (74.4%/3 963) then acute diarrhoea (15.9%/848). • 8 suspected measles was reported, four cases were above five years old, and the other four were under five years old • Zero cases of AFP reported.

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COVID-19 Situation: • Syria declared its first case on 22 March 2020. As of 31 March 2020, the number of reported cases in Syria has reached 10, including 2 deaths (CFR: 20.0%). Among 10 cases, 5 cases were imported case and the rest of the cases do not have any travel history. Those non-travel related cases were reported from Damascus (3) and Rural Damascus (2). • Among these 10 cases, 60.0% are male and 40.0% are female. The average age of those infected is 49.0 (ranging from 19 to 75). Comorbidities is high among the confirmed cases (48.5%); the most common morbidity factors are diabetes and cardiovascular diseases (Fig.4).

Figure 4: Confirmed case of COVID-19 in Syria by week

6 5 4 3 2 1 0 Number of case

Date of reporting

confirmed case Death

Responses: WHO has supported MOH to rapidly detect, diagnose, and prevent the further spread of the virus in line with IHR (2005): 1. Country-level coordination, planning, and monitoring

2. Surveillance, rapid response teams, and case investigation • Early warning alert and response system (EWARS) covers severe acute respiratory infection (SARI) which is one of the case definitions of COVID-19. 1269 sentinel sites report cases through EWARS system across all 14 governorates. In addition of EWARS, WHO supported MOH to establish active by surveillance officers in 13 governorates and collect any alerts of suspected cases of COVID-19 from private and public health facilities • WHO supported several MOH workshops on surveillance, sample collection and referral (8-19 March), case investigation and IPC measures (17-19 March) and response activities and case management (29-31 March) for a total of 125 MOH surveillance officers in 14 governates.

3. Points of entry • MOH has implemented health measures for travelers such as temperature screening and monitor the travel history at 14 points of entry in Damascus, Rural Damascus, Homs, Tartous, Dara’, Deir-ez-Zor, Lattakia, and Qamishili. With support of WHO, MOH has developed the protocol of entry screening and passenger location cards. Each PoE equips a medical center and one ambulance with medical personnel. WHO provided MOH with 700 electronic infrared thermometers and a thermographic scanner camera for temperature screening which was equipped at the Damascus International Airport as well as IEC materials including 40 roll up banners.

4. National laboratories • WHO supports rehabilitation of CPHL to establish a designated laboratory for COVID-19 in the whole 3rd floor of CPHL, fixed 2 air-conditions and 4 laboratory fridges and procured additional 2 air-conditions and 2 laboratory fridges. By end of March, WHO delivered to the central public health laboratory with 50 screening kits (4,800 reactions), 4 confirmatory testing kits (384 reactions), 4,000 laboratory swabs for sample collection, 30 extraction kits (1,500 reactions) and 5 PCR machine as well as PPE, and additional laboratory supplied/equipment and testing kits are in pipeline. 7

5. Infection prevention and control • WHO conducted training workshops for 3 UN clinic staff members in Damascus on 19 March, and 25 SARC first responders in Aleppo on 25 March on IPC measures. Also, WHO procured PPE (6,000 reusable heavy- duty aprons, 151,000 gloves, 715 goggles, 20,400 gowns, 610,000 surgical masks, 2,275 medical masks,600 coverall and 10,000 headcovers) and 2,850 alcohol hand-rub and delivered to MOH, CPHL and health partners.

6. Case management • WHO conducted a training workshop on case management for 30 HCWs in Damascus on 16 March as well as a series of the joint MOH/MOE one day training workshop for 50 physicians on quarantines and case management in Tartous (25 March), and Damascus (26 March). • Also, WHO support SARC on case management and trained 100 healthcare worker on IPC and case management in Damascus (21-22 March, 28-29 March). • WHO donated one portable x-ray, 3 respiratory ventilators, 4 intensive care beds, 130 fingertip pulse oximeters, 130 sphygmomanometer and stethoscopes to MOH and other partners.

Influenza • The average proportional mobility of ILI ranges 9.3 to 9.8% between week 10 and 13 which is below the proportional mobility of ILI during the same period in 2019 (Figure 5). The upward trend of f SARI was observed during the reporting period (Figure 6). • From week 1 to week 11 in 2020, a total of 258 SARI case admitted in ICU including 42 deaths were tested for influenza. Among them, 92 cases were influenza type A (not subtyped), 2 cases were H1N1, and 6 cases were influenza type B. Among 42 death cases, 22 cases were positive for influenza (21 cases were type A, one case was type B). Most of the cases reported from Lattakia (50, 19.4%), Rural Damascus (43, 16.7%), and Damascus (37, 14.3%) .

FIgure 5: Proportinal morbidity of ILI by week (2018,2019,2020) 15.0%

10.0%

5.0% Percentage 0.0% 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728293031323334353637383940414243444546474849505152 Number of week

2018 2019 2020

FIgure 6: Proportinal morbidity of SARI by week (2018,2019,2020) 0.40%

0.30%

0.20%

Percentage 0.10%

0.00% 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 Week number

2018 2019 2020

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National NGO Coordination ✓ Under The Global Program of Work (GPW 13) health the World Work Program emergencies objective “Health emergencies rapidly detected and responded to” ,WHO is strengthening timely access and provision of the essential package of health care services at the community level in NES and NWS. ✓ Health emergency response in NES ( Al Hasakeh, Ar-Raqqa and Deir Ez Zor): through 8 rolled out medical mobile teams and 11 fixed health facilities, the essential package of health care services were delivered to 99,513 beneficiaries. Al Hole camp, Areesheh camp, Al Hasakeh collective shelters, Tal Tamer collective shelters, Karama, camp, Ein Issa , were covered.

Health Emergency Response in NES

# of cases referred for specialized treatment

# of mental health consultations supported

# of outpatient consultations 0 10,000 20,000 30,000 40,000 50,000 60,000

Host Community IDPs Refugees / Asylum Seekers Returnees

✓ In terms of Health Emergency response in NWS ( Aleppo, Hama and Idleb) and through 15 rolled out medical mobile teams and 5 fixed health facilities, the essential package of health care services was delivered to 46,045 beneficiaries.

Health Emergency Response in NWS

# of delivery # of cases referred for specialized… # of mental health consultations supported # of treatment courses delivered to… # of outpatient consultations

0 5,000 10,000 15,000 20,000 25,000 30,000

Host Community IDPs

✓ In addition, under the GPW 13 objectives of “Universal health coverage and healthier population’’28,787 benefited from the essential package of health care services through 11 fixed health facilities provided to affected areas with focus on high health severity scaled ones. ✓ In response to COVID-19, WHO strengthened its implementing partners with the essential PPEs and IEC materials. ✓ In the same context, more than 230 volunteers received online orientation training on COVID-19 , Mental Health and Psycho-Social Support (MHPSS). Basic interventions under NES cross-sectoral awareness campaign were implemented targeting Al Hol, Al Mahmoudi and Al Areshha camps as well as some collective shelters in NES including those in Ar-Raqqa & Deir ez-Zour governorates.

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External Relations and Communications

✓ Submitting a modification request to ECHO for the reallocation of the remaining fund from the NES XB action to COVID-19 preparedness and response in NES from DAM hub. ✓ Contributing to the WoS CERF application for COVID-19 preparedness and response. ✓ Contributing to the WoS proposal to USAID for additional funding support for COVID-19 preparedness and response. ✓ In March, WHO conducted, in cooperation with MOH, five workshops on risk communication for more than 125 journalists and IEC professionals in the governorates of Damascus, Hama, Lattakia and Aleppo. ✓ In collaboration with WHO, MOH continues to disseminate responsive, and consistent messaging through TV, radio and social media platforms to raise awareness and promote the observation of preventive measures. ✓ WHO and MOH have developed 16 kinds of information, education and communication (IEC) materials with different key messages and distributed more than 642,100 posters/flyers to MOH, MOHE, MOE and other health partners. ✓ WHO held a meeting with the UN communication group and conducted awareness sessions for UN staff members in various UN agencies as well as for NGOs. ✓ In cooperation with MOH, MOI and UNICEF, TV & radio spots were developed to raise awareness in the community on the need to observe preventive measures to face COVID-19. ✓ Posting several tweets on WHO-Syria Twitter account about WHO interventions and health response: WHO Syria (@WHOSyria) | Twitter.

Training and capacity building ✓ During the reporting period, 1433 participants benefitted from 62 WHO-supported capacity strengthening activities.

Operational Support and Logistics:

✓ Dispatching 91.8 tons of medical, nutritional, WASH, ICT & lab supplies and printing material covering 12 governorates (except Idleb & Tartous). The recipients included 40 MoH facilities, 8 MoHE facilities, MoE, MoSA, 26 NGOs, INGO, 2 NGPHCs, 24 NGHs KRC, 4 SARC branches, 8 camps, UNRWA & others. ✓ it is expected that these supplies will cover 600,029 treatments and 675 trauma cases.

IV. WHO Response in Hotspot Areas

The following sections describe the security and health situation including WHO response in the hotspot areas in Syria. It is subdivided into:

1. Northeast Syria (Al-Hasakeh; Ar-Raqqa, Deir-ez-Zor), and 2. North West Syria (Aleppo, Homs & Latakia)

Northeast Syria (Al-Hasakeh; Ar-Raqqa, Deir-ez-Zor)

COVID-19 response:

✓ In the context of response to COVID-19 and ASMT recommendations WHO/UNDSS conducted an assessment of the quarantine area for UN International staff and allocated isolation rooms for confirmed cases if any in Al Hikmah Hospital.

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Health sector coordination:

✓ Conducting the weekly health sector coordination meeting in Al-Hol camp; the main discussed issues were on COVID19 response. ✓ A COVID-19 subcommittee was established per each camp and settlement to ensure the appropriate response and meet the required needs. ✓ A multi sectoral coordination meeting was in a place to discuss the isolation areas in the camps; deadlines were stated per each sector. ✓ Coordination was made between WHO, UNICEF and UNHCR to start an awareness campaign covering the IDPs settlements in the camps and informal settlements. ✓ Several meetings with the health authorities in NES discussed the levels of COVID-19 Case management.

Al-Hol camp:

✓ The available health services in the camp are as follows : 15 static health points, eight mobile teams, three delivery clinics, three hospitals, two HIV clinics, one static point and one mobile team for Leishmaniosis. ✓ The camp administration suspended the referral of the cold cases and kept the referrals to the hospitals outside the camp to the critical cases only. ✓ Mobilizing 50 volunteers for the awareness campaign of COVID-19; the mentioned volunteers are supported by WHO, UNICEF and UHHCR. ✓ Continuing the activities in the annex and exerting efforts to develop key messages in various languages as per the needs of the residents there. ✓ Conducting awareness sessions covering the health sector partners and the partners from the other sectors. ✓ Discussions with the camp admin and the other relevant actors on the establishment of the isolation area in the camp; contributions of each sector were discussed and agreed upon. ✓ Establishing a specialized COVID-19 health committee to lead ,in particular ,the response to COVID-19. ✓ During this period, 19 health medical points reported in addition to the 3 field hospitals. ✓ The total consultations are 23,943 reported from medical points and 1210 consultations were reported by the 2 field hospitals as MSJM not functioning. ✓ The most common conditions reported were ILI with 4333 followed with Acute Diarrhoea 815 ✓ Overall diarrhea cases decreased in number comparing with summertime (about 3% out of all consultations ) On the other hand, the ILI increased to reached about (15-24%) comparing with about 6% or 7% last October. ✓ 9 suspected SARI cases were reported and followed by DOH, RRT.

NGOs coordination:

✓ Through the 3 supported NGOs ,2 mobile teams, 5 static points and 2 community centers are operating in Al- Hol camp. ✓ Conducting a meeting with Al-Hayat hospital and AL-Hikmah hospital to discuss the challenges and the ways forward to enhance the referral processes from the various locations including the camps and the collective shelters.

Deir ez Zor

✓ Deir ez Zor governorate has been identified as one among highest cutaneous leishmania endemic areas in Syria. DoH in DeZ has requested support from WHO to implement campaign activities to treat cases from the eastern area of the river. DoH has established 5 medical points at river ferries where people cross the river coming from the eastern bank of the Euphrates. ✓ During the reporting period ,the medical points at the river ferries have recorded 2625 new cases of CL coming from located at eastern area of the Euphrates river. 2555 cases have received local treatment while 70 cases required intramuscular treatment with antimony injections. The total number of cured cases was 11

1006 with a cure rate of 38.32%.

North West (Aleppo, Homs, Lattakia)

1- Aleppo: NGOS: Coordination and Community engagement activities : ✓ A meeting was conducted with DoH and two national NGOs ( Al-Ihsan , ASLLS ) aiming to Follow up on the national NGOs readiness and response to COVID-19. ✓ A Field visit was conducted to the NGOs ( Al-Ihsan , ASLLS ) which aimed to assess the locations of quarantine and the isolation centers run by national NGOs : Omar Hospital ( ASLSS NGO ) in Al- Maadie and Hanano compound ( YBY NGO ). ✓ WHO supported eight national implementing partners with PPEs equipment including hand and surface sterilizers , surgical Masks and IEC materials covering the needs of medical staff in 15 PHCs and 11 MMTs. ✓ A field visit was conducted on 29-03-2020 jointly by SARC Aleppo, Fafin Camp and Fafin field Hospital in addition to a meeting with local health authorities and the camp management. ✓ Currently, WHO supports 4 MMTs 1 SMP through 3 Implementing partners ( CCS , AL-Ihsan , AL-Taalouf ).

✓ A team consisting of 2 doctors , 4 MHPSS service providers from WHO supported volunteers only started their activities of Home visits for MH patients in corporation with Ibn Khaldon MH team. ✓ WHO supported 6 medical mobile teams in addition to 3 Static medical points throughout four WHO Implementing partners ( AL-Ihsan , CCS , SYC and Health promotion ) to enforce access and timely delivery of essential package of health care services including medical consultations on internal and chronic diseases, child health and MHPSS services. TB/HIV Programme ✓ Two fully equipped mobile clinics for treating TB started working in Aleppo and Deir Ezzor. The TB staff provided awareness sessions and examinations of TB cases . ✓ The number of prisoners who were screened through the mobile clinic in Aleppo is 2232 with 12 awareness sessions. The number of suspected cases is 517 (20 Female and 497 Male, 1> 14 and 515 < 14).The number of confirmed cases (by sputum and X-Ray) is 5 TB cases ✓ The number of people who were examined through the mobile clinic in Deir Ezzor is 3815 with 16 awareness sessions. The number of suspected cases is 389 (115 Female and 207 Male, 67 > 14).The number of confirmed cases (by sputum and X-Ray) is 3 TB cases. The clinic in Deir Ezzor provided treatment to 6 TB previously registered cases in the mentioned areas . Trauma ✓ One (HAZMAT Management and evacuation of the buildings) training has been conducted in close coordination and cooperation with Aleppo DoH. ✓ Al Razi hospital and Aleppo University Hospital are still providing a full range of trauma management services for civilian trauma injuries and war injuries through a close and full support from WHO in Aleppo. ✓ SARC is still providing the first aid and pre-hospital care for civilian trauma and ERWs injuries.

Mental Health : WHO supported: • Ibn Khaldoun psychiatric hospital –outpatient clinic providing consultations in hospital location with a full range of services for 235 in-patients in the hospital in addition to several assessments and preparations for medevac of asylum patients. • Mental Health directorate – Zahi Azrak Hospital out-patient provided psychiatric consultations, mhGAP consultations on PHC level, psychological services, raising awareness session and consultations on community level by trained psychologists.

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• In response to the current NWS emergency, and in line with MHPSS preparedness plan updated recently , integrated MHPSS services were delivered to the community through the supported NGOs in the city, the emergency areas, and HTRs, wherein, 9 MHPSS teams embedded with MMTs are functioning in NWS . 2- Homs Coordination: ✓ Regular meetings with Homs and Relief committee, to discuss the preparedness, response plan and all updates for COVID-19 in addition to AHCT , ASMT regular meeting. ✓ The response plan for Homs and Hama prepared and shared with both governorates.

COVID-19 related activity: ✓ Assessment field visits were conducted to all quarantine and isolation centers in Homs and Hama ( 2 quarantine centers in Homs and 3) in Hama , 2 Hospitals as main isolation centers ).

Center name Quarantine / Quarantine ICU Beds Governorate Isolation Beds Damascus Al Dweir Health Centre Quarantine Baba Amar Health Centre Quarantine 9 Al Mutanqel University Hospital (the same of 250 Homs Homs University Dorm) Quarantine Ibin Al Waleed Hospital Isolation 18 5 Sharia Centre Quarantine 11 Muhsen Haj Hussein Centre Quarantine 12 Hama General Commission of Hama National Hospital Isolation 24 17 General Commission of El Assad Medical Hospital Isolation 12 5 Hama University Dorm Quarantine 250

✓ 131 individuals were quarantined in Homs ( at present 44 ) and total 348 in Hama in home quarantine ( at present 48) ✓ PPEs were dispatched to DOH Homs ( 70 bottles hand rub solution 500 ml, gloves 100, mask n 95 100 surgical mask 100 boxes) ✓ Printing materials were dispatched to DOSA Homs ( 2000 posters and 12000 brochures ) to support awareness activities implemented by 12 NGOs with 240 volunteers and 8000 posters to DOH, DOE and LNGOs Hama . ✓ 2 awareness sessions for (25 participants in each ) DOE school health workers, in Homs and Hama were conducted . ✓ 10 awareness sessions to the health workers in all Hama general hospitals were conducted .

Rukban returnees: ✓ The total number of people who left Rukban transiting through Homs shelters is 19467 People arriving in Homs in 36 phases: ( 29% Women, 26% Men, 34% children ,11% infants) . As of 04 April, the shelters are reportedly empty.

The second destination situation update: ✓ Deir Ba’alba: Zhoriya camp (541) families most of them are originally from countryside; health services are provided by SARC mobile clinics and NGO MMT supported by WHO on a weekly basis.

✓ Deir Ba’alba: Helalya: (103) families most of them are originally from Palmyra countryside; health services are provided by SARC mobile clinic on a monthly basis and NGO MMT supported by WHO on a weekly basis. DOH PHC is accessible ( 1 km) ✓ Shamseen: (110) families were in the tents but they were moved to Hasya and other areas . 13

✓ Hasya Industrial city (103) families originally from AL-Amor mountain and rural Palmira; there are DOH clinics in the area and NGO MMT supported by WHO on a weekly basis providing primary health services. ✓ Mheen: (410) families , DOH PHC but with for nurses and doctor only twice a week; there is no pharmacy in the and two mobile clinics (SARC& SFPA& Bear NGO) offer consultations and medicine for patients. ✓ Quaryateen: (231) families from Rukban, witha total population of 2400 families, DOH hospital was partially rehabilitated , providing primary and emergency health services.

Primary health care: ✓ WHO-supported 2 medical mobile teams in Hama to cover health needs in north-eastern Hama , and in south-west Hama (total provided medical consultations were 3392 and 89 PSS services were provided during the reporting month ). ✓ And supported 2 medical mobile teams in Homs to cover health needs in the second Rukban destination ( east ) and Quseer district ( 1907 medical consultations were provided and 78 children were screened for malnutrition ). ✓ National NGOs’ Coordination: WHO-supported 4 mobile medical teams (including PSS services) in Hama governorate to provide primary health services in south Idleb District ( Sinjar area), east north area (Alhamra district) , south Hama area : 6496 medical consultations and1632 PSS services were provided) 3 mobile medical teams (including PSS services) in provided primary health services in north Homs district and east district: 1390 medical consultations and 1018 PSS services were provided. 3- Latakia Coordination: ✓ A regular meeting with DOH emergency committee at DOH was conducted to update COVID-19 development and discuss main needs. ✓ Conducting a joined meeting with SARC & ICRC to highlight SARC first aid role in transporting COVID suspected cases.

Under COVID-19:

✓ Conducting awareness sessions to UN agencies and NGOs partners in Latakia, where IEC materials and WHO guidelines were distributed in addition to PPEs. ✓ Conducting an interagency field assessment mission to the quarantine and isolation centers in Latakia and Tartous. ✓ Conducting field visits to all public and private hospitals in Latakia to strengthen the surveillance reporting system and disseminate IEC materials, in addition to WHO protocols and guidelines on COVID-19 ✓ 7 RRTs have been activated in Latakia for each health district and at governorate level and 9 RRTS in Tartous governorate. ✓ 4 Active surveillance teams are activated in Latakia and Tartous to be deployed in the most reported SARI cases in hospitals. ✓ Disinfecting two collective shelters in Latakia that host around 100 families mainly displaced from NES of Syria.

NGOs

✓ Distributing IEC materials (brochures, posters, flyers) to NGOs partners in Latakia and Tartous. ✓ Conducting awareness sessions to SACSN, CCA, SFPA NGOs ✓ Supporting health services during the report timeline: Ramel Jnoubi Center Squbeen Center Qnenas Center 1940 657 1076

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V. Annexes

Annex 1: The dispatched supplies included: - 1,170,000 tablets of chlorine sachets and different types of medical consumables related to COVID-19 response were delivered to 8 camps at Aleppo, Al-Hasakeh, Raqqa and Deir Ez-Zor governorates. - 5,000 ampoules of MEGLUMINE ANTIMONIATE 1,5 g/5ml were handed over to Mentor INGO at Al- Hasakah governorate. - 1 Doppler ultrasonic scanner, 10,400 vials of insulin and different types of PHC & mental health medicines were delivered to KRC Al-Hasakah. - 30 infrared thermometer and flayers related to spreading awareness of COVID-19 were handed over to ministry of education. - 4 desktops were handed over to Damascus, kidney surgical, SARC & Al-Basel MoH hospitals in Damascus. - 5 sphygmomanometers, 10 fingertip oximeter and different types of medical consumables related to COVID-19 response were delivered to Al-Waleed hospital at Homs governorate. - 4 portable oxygen concentrators & 2 ICU beds were delivered to Al-Deware center for isolation of suspected COVID-19 cases. - 5000 vials of Heparin sodium, 1 adult ventilator, 1 patient monitor, 1 ICU bed, 1 hospital stretcher, 2 adult wheelchairs, 150 hospital absorbent sheets, 10 fingertip oximeter, 5 sphygmomanometer + stethoscope and different types of medical consumables related to COVID-19 response were delivered to Aleppo DoH. - 4 PPE kits were delivered to Al-Haffeh centre for isolation of suspected COVID-19 cases. - 1 desktop with 2 printers and UPS were handed over to Al-Lulua hospital at Al-Haskah governorate. - 3 Spectro Humalyzer with filters and different types of ICT equipment were delivered to Damascus, As-Sweida. rural Damascus & Daraa DoHs. - 2 surgical kits, 3 ventilators and different types of medical consumables & printing materials related to COVID-19 response were delivered to MoH central warehouse. - 1,100,000 capsules & 14,998 bottles of rifampicin were delivered to MoH central warehouse in favour of zoonotic disease program. - Different types of medical consumables related to COVID-19 response were delivered to Deir Ez-Zor DoH. - 2 desktops, 6 printers, 2 UPS, 3000 insulin syringes, 300 vials of anti-rabies, 25 UNI-Gold HIV kits and different types of medical consumables related to COVID-19 response were delivered to Al-Hasakah DoH. - 4,875 tablets of chlorine (aqua tab) were delivered to the health education authorities at Al-Hasakah governorate. - 5 mother/child/infant scales, 4 portable baby/child/adult L-H measuring system and different types of EWARS, Trauma, PHC, & STHC medicines were delivered to Homs DoH. - 1 Defibrillator were handed over to hospital in Lattakia. - Different types of trauma, PHC, STHC & EWARS medicines were delivered to Lattakia DoH. - 3 real time PCR system, 2 roto-gene Q6 plex platforms and 87 different types of COVID-19 screening kits & medical consumables were delivered to public health labs in Damascus. - Different types of lab kits were delivered to public health labs – polio & molecular biology labs.

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- 1 digital thermographic camera with stand were put in standby at Damascus international airport to help the local authorities to screen the suspected COVID-19 cases. - 750 HIV UNI-Gold kits were delivered to MoH central warehouse in favour of HIV program. - 22 syringe pumps were delivered to MoH central warehouse in favour of public hospitals. - 2 monitor patient devices 1 defibrillator, 2 neonatal incubators and 1 syringe pump were delivered centrally in favour of children hospital in Lattakia. - ICT and office equipment were handed over to MoH communicable and non-communicable disease department. - Artificial limbs were delivered to physical rehabilitation centre. - 120 transport tubes were delivered to TB & microbiology labs. - ICT equipment and different types of medical consumables related to COVID-19 response were delivered to Qamishli national hospital. - Different types of medical consumables related to COVID-19 response were delivered rapid response team DoH Al-Hasaka. - 2 neonatal incubator, 1 infant warmer, 1 syringe pump, 10 fingertip oximeter, 5 sphygmomanometer and different types of medical consumables related to COVID-19 response were delivered to Aleppo university hospital. - 1 desktop were delivered to MoHE – Al-Moasat hospital in Damascus. - 2 patient monitor devices were delivered to MoHE - Assad university hospital in Damascus. - 2 syringe pump, 4 neonatal incubators, 1 infant warmer, 1 desktop, 2 patient monitor devices and 1 defibrillator were delivered to children hospital in Damascus. - Cancer medicines and different types of medical consumables & printing materials related to COVID- 19 awareness and response were delivered to MoHE central warehouse. - Different types of medical consumables related to COVID-19 response were delivered OB/GYN Hospital in Aleppo. - 4 PPE kits and different types of PHC medicines were delivered to hospital. - Different types of medical consumables & printing materials related to COVID-19 awareness and response were delivered to ministry of social affairs. - Different types of ICT equipment and medical supplies were delivered to 26 non-governmental hospitals and PHC centres at Al-Hasakah & Raqqa governorates. - 15 infusion pumps, 20 syringe pumps, 20 otoscopes, 8 portable oxygen concentrators, 2 sphygmomanometers + Stethoscopes, 9 doppler ultrasonic devices, 20 nebulizers, 1apheresis transfusion machine, 2 portable x-ray systems, 2 oximeters, 2 electro diagraph ECG (BeneHeart R12), 3 steam sterilizers, crutches, walkers and different types of PHC, STHC & EWARS medical supplies were delivered to 26 NGOs at Damascus, Rural Damascus, Aleppo, Homs, Hama, Lattakia, Qunaitra & Deir Ez-Zor. - 1 desktop, 2 printers and 1 UPS were delivered to emergency center at Al-Hasakah governorate. - 50 infrared thermometer scanner, 4 ventilators and different types of medical supplies consumables & printing materials related to COVID-19 awareness and response were delivered to SARC. - 66,000 tablets of mebendazole 500 mg & 10,000 sachets of ORS were Delivered to UNRWA

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Annex 2: WHO supported capacity strengthening (supported 62 activities for 1433 participants)

Estimated Start date End date No of Detailed title Governorate Program (DD/MM/YYYY) (DD/MM/YYYY) participants

COVID-19 test for 24/03/2020 26/03/2020 15 referral laboratory Damascus CD workers COVID-19 awareness for doctors at schools- 25/03/2020 25/03/2020 25 Tartous CD Health directorate level COVID-19 awareness 25/03/2020 26/03/2020 25 for ambulances health Aleppo CD workers in Aleppo Orientation sessions "prevention and 25/03/2020 25/03/2020 25 Al-Hasakeh CD control of coronavirus" IEC professionals will be conducted to raise awareness among the 26/03/2020 26/03/2020 25 community on the Damascus CD personal preventive measures concerning the COVID-19 2 activities "COVID- 19 awareness for 26/03/2020 26/03/2020 50 doctors at schools- Damascus, Lattakia CD Health directorate level" Orientation sessions "prevention and 26/03/2020 26/03/2020 25 Al-Hasakeh CD control of coronavirus" COVID-19 test for 27/03/2020 29/03/2020 15 referral laboratory Damascus CD workers COVID-19 awareness 28/03/2020 29/03/2020 25 for SARC front line Damascus CD health worker

COVID-19 case 29/03/2020 31/03/2020 50 Damascus CD management

COVID-19 awareness for doctors at schools- 29/03/2020 29/03/2020 25 Hama CD Health directorate level COVID-19 awareness 29/03/2020 30/03/2020 25 for health workers at Aleppo CD private hospitals

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COVID-19 test for 30/03/2020 01/04/2020 15 referral laboratory Damascus CD workers TOT training on early case detection, early referral, and 30/03/2020 30/03/2020 25 Al-Hasakeh CD management of suspected cases of COVID-19. COVID-19 awareness for doctors at schools- 31/03/2020 31/03/2020 25 Homs CD Health directorate level

COVID-19 awareness 31/03/2020 31/03/2020 25 Aleppo CD for teachers

2 activities "PFA+MHPSS Different governorates across 31/03/2020 01/04/2020 40 response for MH the country COVID19+Self and other care strategies" Mental Health GAP- Intervention Guide 01/03/2020 02/03/2020 25 Damascus MH Refresher for MoH doctors Mental Health GAP- Intervention Guide 03/03/2020 04/03/2020 25 Damascus MH Refresher for MoH doctors

Ventilator 05/03/20020 09/03/20020 25 Damascus Trauma Management

Mental Health GAP- Intervention Guide 05/03/2020 07/03/2020 25 Homs MH PH2 for MoH forensic doctors Mental Health GAP- Intervention Guide 08/03/2020 09/03/2020 25 Aleppo MH Refresher for Aleppo- Medair 2 activities "Mental Health GAP- 08/03/2020 12/03/2020 50 Intervention Guide Damascus, Tartous MH PH2 for MoH doctors" Psychological First Aid (PFA) and Self- 08/03/2020 10/03/2020 30 Aleppo MH care strategies for NGOs Mental Health GAP- Intervention Guide 10/03/2020 11/03/2020 25 Aleppo MH Refresher for MoH doctors

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Mental Health GAP- Intervention Guide 12/03/2020 13/03/2020 25 Aleppo MH Refresher for NGOs doctors 2 activities "Mental Health GAP- Idleb,Lattakia,Damascus+R. 15/03/2020 19/03/2020 50 Intervention Guide MH Dam. PH 1&2 for MoH doctors" COVID19 orientation with MHPSS Basic Aleppo, Damascus, 21/03/2020 21/03/2020 10 MH response for Hassakeh, Latakia, Homs Managers 2 activities "COVID19 orientation with Different governorates across 31/03/2019 31/03/2019 40 MHPSS Basic MH the country response+ self and other care strategies" 2 activities "COVID19 orientation with Different governorates across 01/04/2020 01/04/2020 40 MHPSS Basic MH the country response+ self and other care strategies" COVID-19 awareness for doctors at schools- 01/04/2020 01/04/2020 50 Damascus & Aleppo CD Health directorate level COVID19 orientation with MHPSS Basic Different governorates across 02/04/2020 02/04/2020 20 MH response+ self and the country other care strategies

COVID-19 awareness 02/04/2020 02/04/2020 25 Aleppo CD for policemen

COVID19 orientation with MHPSS Basic 03/04/2020 03/04/2020 70 NES MH response+ self and other care strategies COVID19 orientation with MHPSS Basic 04/04/2020 04/04/2020 63 NES MH response+ self and other care strategies COVID19 orientation with MHPSS Basic 05/04/2020 05/04/2020 50 NES MH response+ self and other care strategies COVID-19 awareness for road 05/04/2020 05/04/2020 25 Aleppo CD transportation workers COVID19 orientation with MHPSS Basic 06/04/2020 06/04/2020 54 NES MH response+ self and other care strategies

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COVID-19 awareness 06/04/2020 07/04/2020 25 for doctors- private Aleppo CD clinics COVID19 orientation with MHPSS Basic Different governorates across 07/04/2020 07/04/2020 25 MH response+ self and the country other care strategies 2 activities "PHC programs COVID-19 07/04/2020 08/04/2020 50 coordination with Damascus CD health directors at MoH " Damascus, Aleppo, Hama, Homs, Tartous, Lattakia, Al COVID-19 Rapid 07/04/2020 07/04/2020 96 Hassakeh, Deir Ezzour, CD response Daraa, ArRaqqa, Qunaitera, AsSwaida Immediate Life Support and 07/04/2020 11/04/2020 25 Damascus Trauma Ventilator Management

Annex 3: List of current WHO agreements with national NGOs

# of ongoing # of MOUs in Governorate Location of current of ongoing MOUs MOUs preparation Damascus Damascus city 1 3 Rural Yalda- - Douma - , , 4 2 Damascus Hammura

Lattakia city- Al Baset - Saqubeen- Qnanas and Al 2 1 Lattakia Ramel Al Janoubi Baath - Um Batna - Ofania - Jbata Elkhashab - Khan - Qahtaniyyeh () - Majdolieah and Nabe 1 Qunaitera Elsakher Hama city, Souran, Moardes ,Taybet alemam, Alsawa'aek ,Alhashimyaa , ean albad, Jarjesah ,tal 1 2 Hama kartal,tellef ,herbenafsah,maardeften and alzarah. Homs , Ar-Rastan and Mahein 1 3 Akramiye ,Al-Hader,Tal Qerah , Babinis , Um - Haoush , Taiena , Al-Alousheh Farm , Hassin , Oqayba , Aleppo 2 2 Wahshiyeh Farm, Abtin, Wdeihi, Haddadin, Blaas, Tall Ed-daman, baradah and Menbje Al Hasakeh: Al Hasakeh city, Al Hole camp, Areesheh camp, Tal Tamer. NES Ar Raqqa: Karama, Mahmudli camp , Kisret Elsheikh 8 3 Jomaa and Ein Issa. Deir Ez Zor: Deir-ez-Zor city Total 20 16

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