WHO : SITUATION REPORT Weeks 26 – 27 (22 June - 4 July), 2019

I- General Development, Political and Security Situation

 The security situation within the country remains volatile and unstable. The main hot spots remain As-Swieda, Al- Hassakah, Deir Ez-Zor, , and governorates.  The reporting period witnessed a new wave of Israeli attacks on military positions around the capital, . According to state media, the Syrian Air Defenses intercepted hostile missiles fired by Israeli warplanes from the Lebanese airspace towards some of the military positions in the surroundings of Damascus city. Four civilians were killed and twenty-one were injured in town, South-west rural Damascus as the glass of the houses was shattered due to the pressure which resulted from the Israeli airstrikes.  There are still remaining pockets of ISIL in the Eastern area which continued their asymmetric attacks against SDF as well as SAA on the other bank of the Euphrates river. SAA military operations are still taking place against NSAGs held towns in Idlib, Hama, and Aleppo Governorates while the armed conflict continued between Kurdish forces and Turkish backed NSAGs at several battlefields in North rural Aleppo.  Three civilians were killed and seven others were wounded in a terrorist explosion of a motorbike bomb in Qanawat street of As -Swieda city. The motorbike bomb which was parked on Kanawat street was remotely detonated , claiming the lives of three citizens and wounding seven others.  A new batch of returning families arrived in Jlaighim corridor in the Syrian Desert coming from Al-Rukban makeshift camp in South-east rural consisting of 741 people (182 males, 208 females, and 351 children and infants), bringing the total number of people who left Rukban to 15,569 people (37.3%) out of the 41,700 residents.  A number of displaced families returned from Jordanian refugee camps through Nassib border crossing to be transported later to their areas of permanent residence which have been liberated from terrorist groups.  The Syrian and Russian coordination committees on the return of displaced Syrians asserted that tens of thousands of displaced Syrians returned to their areas which have been liberated from terrorist groups.  The overall situation remains unstable in the Northern area. SAA airstrikes and ground shelling continue against NSAGs held towns, mainly in South rural Idlib, while the situation in Aleppo is still affected by the ongoing armed conflict between multiple warring sides.

II- Key Health Issues

 The three million people in Idlib (majority of whom are civilians) in addition to the injured and more than 353,000 that were displaced since April require urgent access to health care services .  The intensity of hostilities especially in Hama, Idlib, Aleppo and Ar-Raqqah is reportedly outweighing health response capacities in the areas. Local humanitarian actors are using their limited capacity to respond to the IDPs’ most urgent needs. However, the large number of IDPs, shortage of funds and the instability of the security situation are severely hampering the response.  Twelve static medical points, 18 medical mobile teams, two vaccination teams, a leishmaniasis team and three maternity clinics are providing daily health care services to Al Hol camp inhabitants.  Eight mobile medical teams and a fixed medical clinic are providing health care services at the Foreign Annex in Al- Hol camp; however, the Annex still lacks round-the-clock services.

Page | 1

 The three new field hospitals in Al-Hol camp lack safe blood supplies and, therefore, have limited capacity to perform surgical operations. WHO and the hospital managers are negotiating with the blood bank in Al-Hasakeh national hospital to secure regular supplies of blood. Two of the hospitals are operating round the clock and have a combined total of 46 beds. The third hospital, with five-beds, is open daily from 8.30 a.m. to 5 p.m. The hospitals provide emergency health care, laboratory and X-ray services, obstetrics and emergency surgery. Each hospital has incubators for infants and a two-bed intensive care unit (ICU) for short stays. Patients who need to stay more than two days in the ICUs are referred to hospitals in Al-Hasakeh.  Water samples were randomly collected from water tanks in Al-Hol camp and analyzed at the national laboratory in Al-Hasakeh governorate. The results confirmed that most of the samples were contaminated with E-coli. WHO has delivered over 150 000 chlorine tabs to the camp to sterilize water and reduce the risk of waterborne diseases.

III. WHO Response

1) Non-Communicable diseases & Primary health care

 Facilitated three capacity building trainings on NCDs topics (Chronic respiratory Diseases & electronic registry for Diabetes) under JPRM fund; targeted MOH staff with a total of trainees 75.  Prepared and followed up on the celebration of the Thalassemia World Day in cooperation with MoH .The objective of the ceremony was to launch the Thalassemia Project for the alleviation of the disease burden, to highlight the cost-effective & feasible preventive measures, and underline the importance of sustainable and affordable antenatal care, pre-marriage counselling and testing to reduce diseases burden in Syria in addition to MOH call for commitment to the agreed multisectoral strategic approach to develop, implement and monitor action plan to tackle the disease and to stop having new-born babies with Thalassemia by 2025.  Attended Strategic Framework meeting to review & discuss: A). Strategic Framework Progress reporting – end of 2018; B). challenges and way forward; C). Feedback on lessons learnt from planning and reporting of the current Strategic Framework.  In close coordination with MOH counterparts and EMRO; continued following up on the arrangements for the Primary Health Care Measurement & Improvement Initiative /PHCMI workshop to be held between 30 July till 1 August 2019 in Cairo, including the national consultant to be accountable for PHC strategic planning, improvement actions, PHC indicators and the regular reporting on the PHC improvement progress at the national level.  Finalizing the oral health project in Eastern . A total of 4250 school students were reached with a total of oral health services 20,700, health promotion sessions for 97 teachers and 4250 students in addition to 12,450 preventive services.  The final batch of caravans was received in NES, with a total of 14 prefabricated clinics to be activated in NES camps to provide basic PHC health care & MH services.  Supported Al Qamsilhi Hub with 7 electricity generators in favor of the newly received caravans located in IDPs camps in Hassakeh & governorates (Al Hol ,Al-Mahmoudli new camp , Ain Issa, Abu Khashab , Al- Areesha & Mabrouka ).  Coordinated & followed up on the installation of dental equipment in favor of two PHCs affiliated to DOH Aleppo: Khaldya & Maasarnaya health centers.  Dispatched 18 NCD kits of Insulin vials of different types to NGOs working in EG in rural Damascus, SARC Aleppo & Aleppo Hub, in addition to the following medical devices: 15 Digital & manual sphygmomanometer devices, 9 glycosometer devices,5 Digital thermometers, 4 Nebulization devices, 4 Pulse Oximeter, 1 Portable Oxygen Concentrator ,2 Water bath and medical consumables to Homs & Aleppo Hubs and 1 Steam Sterilizer with 80 Liter Capacity in favor of Jub Jandali PHC in Homs.  The total number of treatment under PHC/NCD program is 74,651 during the reporting period.

Page | 2

2) Trauma  About 100 health workers were trained on trauma and disability in three governorates (Rural Damascus, Tartous and Damascus) .  The following deliveries (23,778 treatments of trauma medicines and medical kits) were made during the reporting period:

o 4 first aid kit delivered to Al Qutaifah Health Charity in Rural Damascus, Association For Poor Charity in Damascus and SARC in Damascus. o 1 Basic kit and 1 supplementary kit delivered to AL-Ber & Al-Ihsan NGO in Aleppo o 1 Basic kit and 1 supplementary kit delivered to SARC in Aleppo o 5 medical equipment (Gastrointestinal Fiberscope, Patient Monitor device, Diagnostic Ultrasonic system, Infant incubator) delivered to Ar-Raqqa National Hospital, KRC Al-Hol Camp, Alhasaka Health Authority, and Dierzzor Health Authority o 1758 treatments of antibiotics, anesthetics medicines, and analgesics delivered TO AL-Ber & Al-Ihsan in Aleppo, SARC Aleppo, Tall Abiad National Hospital, Al-Tabqa National Hospital in Ar-Raqqa, KRC Al- Hol Camp and Dierzzor Health Authority.  Conducted a joint mission (MOH and WHO) to Hama Governorate to assess the health situation in the area, and explore the existing capacity of functioning hospitals in Hama governorate and recommend the most suitable trauma and critically-ill referral pathways. The following hospitals were visited and assessed: o Al Salamiah National Hospital. o Hama National Hospital. o Al Assad Hospital. o Al Hayat private hospital in Muhardeh. o Al Suqailbia National Hospital o Misiaf National Hospital.

 The Trauma and disability officer in Aleppo Hub conducted a mission to Al Qamishly as follows: o A field visit to Al Hol camp to follow on the issues related to trauma management and operated surgeries in the three field hospitals SARC - ICRC, MSJM - UNFPA and KRC hospitals. o A coordination meeting has been conducted with the UNDP in Al to discuss the issues related to the artificial limbs project in Al Qamishli. o A Field visit to the artificial limbs workshop supported by UNDP in Al Qamishli. o Field visits to Al Hol camp have been suspended since 3/7/2019 due to the security situation in the camp.

3) Immunization  The final agreement between the DOH Aleppo and Kurdish authority to resume the EPI vaccination activities in Ein Arab district of Aleppo governorate and Tal Abyad district of Raqqa governorate has reached to the MOH for getting approvals.  Based on the request of the Ministry of Health, WHO regional office and Country office are conducting a comprehensive EPI review and data quality assessment of the different components of the EPI; The overall objectives are to determine the status of the immunization programme and data quality in Syria at National, and sub national levels with regards to strengths and weaknesses and opportunities for further improvement to enable the programme achieve national goals for EPI. Ten experts are currently on the ground to conduct the review at selected governorates in Syria. They will be assisted by national MOH officers from other governorates; the WHO focal points will also facilitate the field work with local DOH staff; the activity is funded in Full by EMRO. Initially, a national workshop is currently ongoing (3-5 July 2019) attended by PHC directors, EPI officers, surveillance officers from all governorates to finalize the EPI review formats and assign the teams to the designated governorates;  GAVI support for the year 2019-2020. The Ministry of Health is still reviewing the draft Partner Framework Agreement (PFA); the proposed Teleconference between the GAVI and the MOH is postponed this week.

Page | 3

 Measles committee meeting held at the Directorate of Public Health (MOH) highlighted the situation of the Measles in the country. There is a decrease in number of confirmed Measles cases this year compared to the previous years due to the strengthening of EPI activities and the timely outbreak response efforts.  WHO, based on MOH request, did provide the reprint of the EPI and AFP surveillance field guides for distribution in newly accessible areas.  WHO procured an electron microscope for the National Polio laboratory (NPL) based on the official request of the MOH  Field mission to Al Hassakeh governorate was executed by the PTL and Admin Officer to acquaint themselves with the quality of EPI/Polio services; this entailed visit to Al Hassakeh health authority and field visits to Al Hassakeh, Al Qamishli districts and Al Hol camp. The EPI team is making effort to vaccinate all eligible children based on the available resources. The Environmental sampling activity for the Polio Eradication endeavor is maintained and followed timely. The EPI manager has agreed to strengthen the EPI activity by adding one new vaccination site at Phase one of Al Hol camp to cope with the increasing number of children and maintain the continuity of the activity.  Visit of the Polio/EMRO finance officer 23-27 June 2019 to review the payment modalities of the field staff and maintain the compliance of the country office as planned; in that regard: a. Review Q3 AFP surveillance and made sure of the availability of the funds timely b. Review of the advance payment modality for hard to reach area and developed a draft Memo for the approval of DAF  The ministry received the WHO EMRO invitation for the Regional EPI managers meeting which will be held in Amman (16-19 September 2019) to update the country EPI managers on the newly developed EPI monitoring and evaluation tools as well as the improvement of the EPI data quality.

4) Mental Health

 MHPSS services delivered by NGOs through Four Active family wellbeing centers as follow: HAMA with Al-Bir Hama NGO, Lattakia, with Syrian Association for Children with Special Needs NES in Al-Hassakeh/ Al-Hol camp with, Archbishopric of Syriac Catholic Center Mar Assia DEZ with Syrian Pulse NGO,

 MHPSS services delivered on community level in Qunaitra, Rural of Damascus, Aleppo and Al-Hassakeh through agreement with local NGOs.  2 procured caravans received, to be posed as field family center in Al-Hol camp to ensure that service provision respect privacy and more appropriate for beneficiaries.  In the pipeline" 2 projects with NGOs in DEZ and Al-Hol camp have been technically cleared.  MH Psychotropic items distributed to different destinations and further detailed plans across WHO HUBs in place to cover the partner's needs.  First MH referral case from NES/Al-Hol camp to Aleppo – Ibn khadloun mental hospital succeeded after intensive coordination and advocacy efforts with health local partners and authorities.  Coordination meeting with MOH/ MH department new director to ensure the sustainability of services delivery across the country, increase the UHC for MH services by adding new facilities in the coming capacity building activities, and to ensure distributing the psychotropic to active PHCs that provide mhGAP services.  Following up with GAZ HUB MH to jointly finalize the planning and preparation to conduct a mhGAP training course in NES for health partners as MHPSS TWG NES finalized assessing and analyzing the current available human resources for the training. The training could take place in July-August.

Page | 4

 MHPSS TWG on WCO level has been conducted with more than 25 participants from national and international partners, co-chaired by IMC and UNHCR, outcomes are:

o First MHPSS TWG work plan for 2019 has been developed with IMC and shared with partners, aiming to enhancing MHPSS across the country by: digitalizing referral pathways, mapping human resources, assessing the needs in capacity building and exchanging capacity building activities between the leading agencies in this field. o MHPSS M&E tool, to be adapted to Syria context and aligned with the global work frame. o Central preparedness plan for NWS emergency response to be developed, o Assess MHPSS services provision in GBV projects.  Delivering MHPSS services to students coming to GoS from HTR for the final exam through MoE community workers and psychologists trained on counselling and SMHP prgoramme.  Continuous providing of MH capacity building activities and supportive supervision sessions for partners in many governorates on MH programme "mhGAP, Counselling, SMHP".  Supporting SARC with printed materials on mhGAP programme.  Developing IEC materials on GBV with GBV FP at EMRO to target communities through the WHO Family Centers, particularly in NES, with potentially adding materials to target schools.

5) Nutrition and Child Health  Activating the IMCI in Al Hol camp; the number of beneficiaries is 1200.  Conducting training for the medical and nursing staff in Al Hol camp , the field hospital and Al Hayat Hospital on receiving and handling severe acute malnutrition cases .  Treating 13 cases of severe acute malnutrition in Al Hayat hospital with no death cases reported.  Attending the regional workshop on trans-fat acid limitation to create new national guidelines and standards for processed food in Syria.

6) Secondary Health Care

 Developed a check list of the main criteria of essential and support services to be filled by the field hospitals in Al- Hol camp and analyzed the collected data to get clarity on the type of services provided, capacity and preparedness of each hospital and type of services could be managed inside the camp and the ones that should be referred outside the camp due to unviability of the needed services.  Worked closely with Al Qamishli team in developing the distribution plan for all the supplies available in Qamishli warehouse to be delivered later to different health actors in Hassakeh, Raqa ,Deir ez Zour and Eastern Aleppo, In addition to NGOs and field hospitals operating in Al-Hol Camp.  Conducted a site visit to Tabaqa hospital to follow up the installation of the Oxygen generator that will enable the hospital to activate the intensive care unit, ventilators and incubators.  Followed up the mission’s preparation of RO consultants scheduled from 3- 7 August,2019 to monitor the progress of work at the children hospital and to confirm and certify the acceptance tests related to the rehabilitation project.  Joined Al Qamishli team in screening CVs to select the best candidate for APW in Al-Hol Camp.

Page | 5

7) Communicable Diseases, Surveillance & WASH : Communicable Diseases/Surveillance  A meeting with UNICEF WASH to review/harmonize the WASH activities in Al Hol camp to respond to the increase of acute diarrhea cases in the camp. The recommendations include to conduct investigation of the cases and to standardize the water quality monitoring methodology among the partners.  A two- day meeting was organized by WHO to review the draft national AMR action plan. The participants included stakeholders of animal health and environmental issues. The work plan will be endorsed officially by MoH and the implementation will be initiated in July.  The updated national TB guideline was finalized in Arabic.  Indoor residual spraying campaign to respond to the increase of leishmaniasis cases in Aleppo had been conducted in the priority neighborhoods/areas where the prevalence of leishmaniasis exceeds 1%. 11 locations were covered in Aleppo city by the reporting period. The number of beneficiaries is 51 196 including 10 277 households.  The EWARS bulletin for Q1 2019 was drafted and to be finalized for distribution.  A ToT training on the new TB guideline was conducted and emphasized the importance of the new child medicines regimen.  The GenExpert system at the TB reference lab was upgraded, new generation of TB testing of body fluids is now available.  Following up with on installing solar microscopes and direct sputum tests kits in 22 TB central and peripheral labs.  Following -up on the leprosy case with direct observation of treatment in Al Hol camp. MoH leprosy programme manager examined the case and her contacts confirmed the fact that no other cases were found.  Suspected TB cases in Al Hol camp: Eight suspected TB cases were detected during the reporting period. All cases were investigated by TB program in Al-Hasakeh. The cases were referred to TB specialist center for the laboratory diagnosis. The total number of TB confirmed cases in the camp is 30, of which one case recovered and 29 cases are still under treatment.  Suspected HIV case in Raqqa: Two suspected cases were reported from Ar-Reqqa. The samples were taken and investigated. The both cases were found to be negative for HIV/AIDs at the national laboratory.  Regular laboratory screening for diarrhea cases in Al-Hol camp: A field mission was conduct by lab technicians from the reference public health laboratories in Damascus to conduct a regular monitoring for diarrhea cases in Al-Hol camp and identify the etiology of disease. The stool samples were collected from diarrhea cases and laboratory analysis for cholera, E-coli, salmonella, and rotavirus will be conducted.  Communicable disease response in Al Hol camp: A joint WHO and MoH mission was conduct to Al-Hol camp to assess the health situation and identify the health needs in the area of surveillance and communicable diseases. During this mission, WHO supported training workshop for health care workers on the following interventions: 50 health care workers were trained on EWARS and active surveillance of diarrhea and water borne diseases 10 health care workers on leishmaniasis case management and active case detection, 9 health care workers on TB active case finding, and 10 health care workers on HIV voluntary counseling services.  Leishmaniasis response in Al-Hol camp: WHO continues to support the leishmaniasis medical points in Al-Hol camp operated by DoH in Al Hol camp. In total, 360 suspected leishmaniasis cases were registered during the reporting period. Among them, diagnosis of leishmaniasis was confirmed for 19. In total, 1155 leishmaniasis cases have received treatment since March 2019.

WASH  The water quality monitoring visits were conducted in Rural Damascus, Aleppo and Al-Hol camp.  WHO provided 150 150 chlorine tablets to Al-Hol camp for NGO to conduct water chlorination.  23 900 oral rehydration salt sachets were dispatched to Deir-ez-Zor Health authority, in addition to five community cholera kits and 20 000 ORS to East of Deir-ez-Zor.

Page | 6

8) Information and Planning  Joint technical meetings by HIS team and counter partners in MoH (Directorate of Planning and International Cooperation) to follow up IM transition from emergency to early recovery context (Primary Health Care Information System, Secondary Health Care Information System, CRVS (Civil Registration and Vital Statistic) for deaths and births modules, Health Indicators Database).  Joint technical meeting with HeRAMS-HQ staff in Geneva for discussing HeRAMS Syria / Country Model.  Conducted a field visit to Aleppo to follow up on installing the network infrastructure, and to follow up on the Secondary Health Care Information System (SCIS) with MoHE (Aleppo university hospital, University Cardiovascular Surgical hospital, Obstetrics and Gynecology Hospital).  Prepared proposed work plan jointly with MoH for CRVS (Civil Registration and Vital Statistic) for deaths and births modules.  Participated in HeRAMS external evaluation workshop, 24 - 26 June 2019, Geneva.  Attended webEx WHO/EMRO - Results measurement framework - Phase 2 - Reporting tool's workshop with the CO/DOs  The following information products were published and distributed: o 4Ws (WHO and Health Sector) snapshots for May 2019.HeRAMS Summary UNRWA Health Centres Report Q1 2019 in Syria. o HeRAMS Summary NGOs Health Centres Report Q1 2019 in Syria. o HeRAMS health profile of reported health facilities in Al Hol camp for May 2019. o Statistical analysis of Household tool as part of the Assessment of the Health Situation and Services in Al Hol IDP Camp. o In-house HeRAMS evaluation tool and analytical report of the recent evaluation conducted in June 2018 on a 181 sample representing the health partners contributing to HeRAMS-Syria, using statistical approaches.  Monitored a weekly update on shift of control, functionality status of public HFs, and control areas for NSAG areas of North West Syria.  Provided (4Ws_Health_Syria_May2019) to WoS using the ‘ActivityInfo’ standard template based on the new HRP indicators 2019.  Provided full package of SARA Syria 2017: (Data collecting tools, Final Report, Key findings, Data) to EMRO as part of Regional analysis of health facility.

9) National NGO Coordination  The second phase of the IDPs health situation assessment at Al Hol camp was completed. Data entry and data analysis were finalized and report writing is under progress.  6 field visits were conducted by the TPM to partner NGOs in Rural Damascus, Lattakia, Al Hasakeh and Deir Ez Zor.  Damascus and Rural Damascus: o 1 PHC center in Al Zahera run by Nour Foundation for Relief and Development continues to provide the essential package of health care services to affected host community and IDPs. o 1 PHC center in Al Qutaifeh and 4 MMTs runs by Al Qutaifah Health Charity operating in Eastern Ghouta (Douma and Harasta) maintain the provision of the essential health care services to the host community, IDPs and returnees to eastern Ghouta.  In Homs; field monitoring visit to Albir Hama NGO – Abi Alfidaaa medical center- was conducted by Homs officer to follow up the implementation of health project supported by WHO  South Syria: 3 MMTs by Charity And Social Service Society Organization continue to provide the essential primary health care services in Dar'a governorate including Dar’a,Tassil, Shaqraniyeh, Sharae, Bweidan, Masmiyyeh, Barraq (Masmiyyeh), Bali and Northern Karim.  3 project proposals were submitted for approval to strengthen the provision of primary health care services in areas with severity scale above 4 in Aleppo, Al Hol and Deir Ez zor.  In collaboration with HIS unit, HeRAMS Summary NGOs Health Centres Report Q1 2019 was developed..  NGOs support team inputs for upcoming exhibition brief for country offices were submitted;  # of NGO partners is 21 – Annex 7

Page | 7

10) External Relations and Communications  Conducting a field visit to Aleppo governorate to follow up on the WHO supported activities on strengthening the health response in Aleppo governorate and related preparedness to NWS and NES areas.  Communicating officially with MoH concerning the upcoming sixty-sixth session of the World Health Organization Regional Committee for the Eastern Mediterranean, Tehran – Iran 14-17 October 2019.  Developing a success story on a mental health patient who was evacuated from Al-Hol camp to the mental health hospital in Aleppo with WHO support: http://www.emro.who.int/syr/syria-news/who-supports-the-evacuation-of-a-mental-health-patient-from-al- hol-camp.html  Preparing two visibility stories for the upcoming RC66 Exhibition focusing on innovation action on public health that is distinctive on the national level (Country Success Stories and Innovations).  Providing visibility coverage on the occasion of the Thalassemia World Day 2019.  Attending the UNCG meeting, the discussions were on the preparation for the upcoming World Humanitarian Day 2019, and on finalizing the UN Communication strategy and work plans.  Posting several tweets on WHO-Syria Twitter account about WHO interventions and health response: WHO Syria (@WHOSyria) | Twitter

11) Training and capacity building During the reporting period, 661 participants benefitted from 20 WHO-supported capacity strengthening activities (Annex 2).

12) Operational Support and Logistics Operational support and logistics:  Dispatched 47 tons of medical & nutritional supplies, equipment, health kits prefab caravans and printing materials to 7 governorates. The recipients included 10 MoH facilities, 12 NGOs, 1 non-governmental hospitals, 3 non-governmental PHC centres SARC, KRC & others.  The total number of treatments of delivered medicines and supplies to the end users is 199,907 and 20 trauma cases. The dispatched supplies included: - 14 NCD kits -1030 Tab acyclovir-2 Patient Monitor devices-Portable Oxygen Concentrator delivered to KRC – Al-Houl camp at Al-Hasakeh. - 4.6 million Of CHLORINE, 1 g (NaDCC 1.67g), tablet were delivered to Deir Ezzor DOH directly. - 3 Electricity Diesel Generator 5 KVA were delivered to DOH Qunitera directly to support the PHC centres. - 1 Semi-Automatic Spectrophotometer were delivered to DoH Al-Khaldya PHC. - 1 Semi-Automatic Spectrophotometer and list of dental health supplies were delivered to DoH Al-Maasranya PHC in Aleppo. - 10000 Ethyl Al cohol 75%, 1 litter bottles were delivered directly to MOH central. - 200 Thalassemia Guideline were delivered directly from the supplier to MoH - Directorate of Communicable & NCD to support the national day. - List of psychotropic medicines were delivered to MOH central WH. - 2000 vial EPOTIN, Recombin.Human Erythropoietin, 4000IU/ml- 3000 Furosemide 20mg/2ml-600 Heparin Sodium 1000IU/m l -40 Fresenius PL1 and 2000 0.9% Sodium were delivered to Qamishli National Hospital. - List of wash supplies were delivered to Aleppo Water and Wastewater Establishments - Drinking water Laboratory in Aleppo in favour of MOLA.  Diagnostic Ultrasonic system -3000 Doxycyline Hyclate Tablets-1 Digital Ultrasonic Diagnostic imaging System-490 Heparin Sodium 1000IU/m l were delivered to NGPHCC Al Hasaka Health Authority.  10 NCD kits-2 Infant incubator-6000 insulin syringe-23900 Oral Rehydration Salt BP 20.5 grams were delivered to NGPHCC Dierzzor Health Authority.

Page | 8

 2 IEHK basic in addition to list of PHC medicines were delivered to SARC Aleppo and Damascus.  800 Ranitidine Injection-300 Salbutamol sulphate -4 NCD kits-300 IRON SUCROSE, 20 mg/ml,-3000 Furosemide 20mg/2ml,2000 EPOTIN, recombin.human erythropoietin, 4000IU/ml,--480 Amoxicillin + clavulanic acid for injection 1.2 g were delivered to NGH Tall Abiad National Hospital.  5000 Atracurium besylate 25mg/ml were delivered to NGH Alhekma Hospital.  6 NCD kits -600 Enohep-2 Haemodialysis Machine-1 Set composed of Colofiberscope- in addition to list of STHC and trauma medicines were delivered to NGH Ar-Raqqa National Hospital  15 NCD kits -15 Cholera -2 IEHK basic – 2 IEHGK supplementary -5 KIT, PNEUMONIA Type B in addition to wide list of PHC medicines were delivered to 14 NGO’s partner in Aleppo-Damascus-Rural Damascus and AL HAssakeh governorate to support the health situation in the area.

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 (Aleppo, Homs & Latakia)

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

1. Political/Security Situation

Political Headlines:

 The Iraqi Popular Mobilization Units (PMU) have withdrawn their units from Al-Bukamal city east of Deir Ez- Zor governorate.  According to Al-Watan, the PMU’s withdrawal from Al-Bukamal was carried out in full coordination with the SAA, which took control of the abandoned positions. Earlier this month, a tribal meeting was held in Al- Bukamal to form local forces to protect the city and assist the SAA. During the meeting several tribal leaders stressed that the army’s allies should be replaced by local forces.  A Raqqa tribal leader was assassinated in an attack claimed by ISIL.  According the Syrian Observatory for Human Rights (SOHR), A senior tribal leader from the Bu Assaf clan, Ubaid Khalaf al-Hassan, was found dead in his home on Tuesday in a village near Tel Abyad.

Security situation: The security situation in the NES area is still volatile and unpredictable.

 Deir Ezzor Governorate: In a continuation of the trend of violence against SDF positions the security situation on the eastern bank of the Euphrates remains complicated. The SDF-held area appears to be infiltrated by multiple ISIS cells that carry out attacks on civilian and SDF targets on a constant basis.

 Also in SAA controlled Area , Clashes broke out between SAA and ISIL sleeper cells in the desert of AlMayadin city. In the same context, ISIL sleeper cell attacked an SAF SAA patrol in the desert of Boqruss village South East Deir Ezzor city, while SAA combing operation continued on Kabajb Axis on the southwest of Deir Ezzor city searching for ISIL presence.

Page | 9

 Ar Raqqa Governorate:

During the last two weeks 5 IEDs and 1 Landmine was reported in Ar-Raqqa governorate (Rural Ar-Raqqa, Ar- Raqqa city, Al-Thawrah city)

 Al Hasakah Governorate:

- During the last 15 days: 2 IEDs went off in Qamishli city and Zerkan village respectively north of Al Hassakeh.

 Al Hol camp: Al Hol camp is still a disturbing place. It has more than 70 thousands of refugees, IDPs and Families of foreign jihadists. The camp is witnessing many security incidents and violence as demonstrations, 2 Stabbed with knives incidents and verbal assault and throwing stones against humanitarian workers/NGOs and vehicles.

Coordination:

 Conducted a meeting with HCT Damascus to discuss the general humanitarian situations in Al-Hol camp and the main gaps.  Conducted the regular health working group meeting twice in Al-Hol camp, the meetings discussed:

o Updates on the general health situations. o The analyzing of EWARS weekly updates. o Updates on the three field hospitals functionality. o Weekly mortality analyzing.

 Participated in the regular coordination meetings of Al-Hol camp, where many crosscutting issues related to the health were raised to the other sectors. The main issue was WASH interventions and enhancements.

 Conducted a training on the referral mechanism within Al-Hol camp to ensure the appropriate links between all the health actors on the ground .The meeting was postponed to the next week.  Followed up closely with the WASH sector in the water quality in the camps and in Al-Hol camp in particular, following the WASH sector alarming on the water quality of the ice in the camp. The health sector advocated to stop dealing with the same ice resources.  Coordinated with MSJM/UNFPA field hospital and allocated a space to start activities of WHO surgical team within the hospital as a part of the current ongoing process. The team will provide surgical consultations and triage to support the functionality of the field hospital.  Finalized the analyzing of the availability of services within the three field hospitals in Al-Hol camp based on a designed checklist that was distributed to the field hospitals . It has been agreed to keep the analyzing updated on a weekly basis.  Conducted a meeting with CADUS team on the ground to discuss the enhancement requirements and the ways forward to approach comprehensive services within KRC/SARC hospital.

 Conducted a meeting with UNDP to discuss the needs in the camps regarding the people in need for assistive devices.  Conducted a joint visit to Al-Hol camp with UNFPA team to follow up and assess the RH services provision in the camp.  Conducted a field visit to Al-Hol camp jointly with the HCT representative ; a meeting was conducted with the three field hospital.  A meeting was in place with a team of MoH, which is in a visit to NES; a field visit with them was conducted to Al-Hol camp to follow up the health system, medical points, field hospitals and the leishmaniosis team.

Page | 10

Response:

Vaccination:

 2 vaccination teams are working on a daily basis in Al-Hol ; about 13,149 children have been vaccinated since 9th of December 2018 till May 30th 2019.

EWARS & CDs& Water quality:

 In coordination with AlHasaka – DoH, Leishmania treatment mobile team supported by WHO provided treatment to the camp residents in phase 5.  The Early warning system is ongoing effectively within the camp. During the reporting period medical points provided reports for the epidemiologic weeks 25 and 26.  During the epidemiological week 25 of 2019, 90.9% of the reporting sites in Al-Hol camp disease surveillance data was provided through the early warning alert and response system (EWARS), with 100% timeliness among those sites providing data.  A total of 7065 consultations were recorded in eight health facilities in the camp in week 25.  The leading causes of morbidity among all age groups remained acute diarrhea (52.5%) and influenza-like illnesses (41.6%).  Upward trends for both AD and ILI cases have been observed.  In total, 1047 cases of acute diarrhea were reported in week 25 , a slight increase of 5% over the previous week. WHO’s response activities include provision of medical supplies and improving water quality in the camp.  Transferred samples of HIV from Al-Raqqa to Damascus for the ref. laboratory  Various trainings were conducted on TB, HIV and Leishmaniosis for the medical staffs.  56 water samples been collected from various water resources and the analysis results were;  1 sample collected from the water truck was drinkable and with no bacterial contamination  21 samples collected from the water tanks were drinkable and with no bacterial contamination.  1 sample collected from the water tanks was non-drinkable and with bacterial contamination.  13 samples collected from the water jerry cans were drinkable and with no bacterial contamination.  16 samples collected from the water tanks were non-drinkable and with bacterial contamination.  4 samples collected from the ice were non-drinkable and with bacterial contamination.  Based on the above results, 9 samples were collected and raised to advanced level of analyzing within the reference laboratory of the general water company ; the results showed that the samples are non-drinkable with bacterial contamination ratio.

Mental health:

 23 health workers provided PFA and counseling.  Mh-GAP services were provided through the functioning medical points in the camp.  A Woman with Mental health disorder was successfully referred to Ibn Khaldon hospital in Aleppo in coordination with UNHCR and Aleppo hub.

Nutrition and child care:

 4 training sessions were provided to Syria Al-Yamama NGO in Al-Hol camp on IMCI methods.  Conducted a training for the medical staff who will operate in MSJM/UNFPA field hospital in Al-Hol camp as part of the establishment of a new SC there.  240 children were screened in Al-Mawadda association medical point; 14 of them were SAM, 10 MAM, and the cases were referred to the specialized centers for more follow up.  At Al-Tabqa hospital 4 children were admitted ; 2were discharged and 2are still under treatment.  IMCI medicines were received and distributed. Page | 11

Pharmacy and Secondary Health care:

 Conducted a field visit to Al-Kasra area in Dier Ez-Zor. WHO team met with the health authority of Dier Ez-Zor eastern Euphrates river to follow upon health projects. Al-Kasra hospital was visited later to assess the needs and possibility to establish hemodialysis service.  Coordinated to conduct a workshop on Infection control in Qamishli hospital which will target health workers in the hospital, Al-Hassakeh DOH, Al-Hikmah and Al-Hayat hospitals.  Conducted a field visit to Al-Tabqa hospital to monitor the installation of provided Oxygen generating plant, and other delivered medical supplies.  Delivered around 31,000 treatments of essential medicines to NGOs partners and other health actors operating in NES.

HIS activities:

 Conducted field visits to the private hospitals in Hassakeh and SARA tool was applied to the below private hospitals: Al-Hikmah, Dar Al-Shifa, Al-Hayat, Farman and Al-Salam hospital.  Collected the monthly data related to the health facilities of Al-Hol camp.  Conducted a field visit to the available health facilities; the HeRAMs model was applied.

NGOs coordination in NES:

 New plan is in place to remobilize the operating medical teams according to the needs to ensure the continuity of health services.  The needed approvals to restart the advanced health services provision in Al-Hikmah hospital.  Kicked off a new MoU with Mar Assia Al-Hakim center;l the MoU includes establishing one static medical point, one mobile team and one community center.  Coordination is in place to ensure at least a one ORS corner per each phase in Al-Hol camp.  Conducted a special checklist tool to monitor the developments of the three hospitals within Al-Hol camp.  Conducted a meeting with NGO in Qamishly to discuss the coming plans in NES.  Continued the advocacy to apply the 24/7 services in the annex in Al-Hol camp,  Two meetings were in place with three NGOs in Hassakeh to discuss the pipelined MoUs.  The relocation process of Al-Twehenah camp residents to Al-Mahmoudli camp is ongoing ; WHO has started a static medical point in Al-Mahmoudli new camp; two caravans became in place and there is a medical team that consists of: internist, gynecologist, pediatrician, 2 nurses, paramedic and MHPSS processor; WHO is committed to continue supporting the both locations Al-Twehenah and AL-Mahmoudli camps .  Conducted a field visit to the WHO-supported Al-Hayat Private hospital in al-Hassakeh city to follow up the ongoing activities and provided the technical administrative and financial support and advices.

Annex 3 shows the number and type of services provided in NES (22nd June-4th July 2019)

Page | 12

North West (Aleppo, Homs & Latakia)

1) Aleppo

Security Situation

 Violence in northwest Syria has continued unabated since the beginning of May and is putting civilians at risk, violence in areas directly affected by conflict is driving displacement into densely-populated areas.  A further escalation of violence, triggering waves of displacement and provision of humanitarian assistance.

Service provision

 1 ongoing MOUs with WHO implementing partners (Health promotion).  7 MMTs are WHO supported in rural areas and are functioning as follows: a) 4 MMTs in east rural of Aleppo (2 ASLSS NGO, 2 AL-Beer NGO) in addition to 1 PHC in Dier Hafer. b) 3 MMTs in north rural (Afrin IDPs response), (1 CCS, 2 AL-Ihsan NGO)  Total No of health services provided through MMT is 4523

WHO response for student coming from HTR areas:

 4 WHO partners are responding to the health needs of more than 6,500 students who arrived in Aleppo from HTR areas (mainly from & Al-Bab) to take their national exams .  DoE assigned 23 locations as an accommodation sites for the students in 8 neighbourhoods in Aleppo.  WHO supported MMTs provide their health services through two shifts ( Daily and night shifts ) During the night shift there are WHO supported 4 ambulances for emergency cases.  The Total No of Health services provided for students is 5025 services.  65 cases were transported to Public and private hospitals in corporation with SARC Aleppo branch ; 13 cases were admitted to Hospitals before they were discharged after one or two days.  WHO coordinated with SARC Aleppo branch in order to transport one case that was admitted to AL-Razi hospital to AL-Tayha crossing point.  The exam finished and all students returned back to their homes.

Communicable Diseases

 Followed up on 61 identified TB cases in Fafin area (28 completed treatment, 2 dropouts, 33 under treatment)  Aleppo DoH continuing the insecticide spraying campaign as a part of the vector control of Leishmaniasis supported by WHO as 25 days were completed and 55 days remain ,the Campaign finishes at the end of September. 11 neighbourhoods have been completed in Aleppo city and 20 remaining in Aleppo city ; 114 workers in Aleppo city and 56 workers in rural Aleppo are working in this campaign.  Aleppo DoH will start a TB survey in Al-Shiekh Maksoud neighborhood on the 10th of July supported by WHO targeting around 11.000 families

Mental Health  WHO supported: a) Ibn Khaldoun psychiatric hospital - 3571 consultations; b) Mental Health directorate – 123 consultations;  8 individual supportive supervision sessions were conducted for training doctors on mhGAP working for NGOs.

Page | 13

 5 individual supportive supervision sessions were conducted for training psychologists on SMHP working for MoE.  The MH refereed case from Al-Hol camp succeeded to reach Aleppo with the support of Aleppo team efforts, and close coordination with SARC; the mental health ibn khadloun hospital is providing proper and dignified services for the patient and now she is stabilized..  A meeting has been conducted with Ibn khadloun hospital to identify current psychotropic needs,; a list has been sent to them to specify the quantity of each item.  A meeting has been conducted with MH director at DoH level to set the agenda of capacity building activities in Aleppo for Q3-Q4.  2 psychotropic shipments have been received in Aleppo warehouse ; a distribution plan is in place to include 6 NGOs working in NWS field and also other facilities that provide MH specialized services.  20 reported cases from HTR students benefited from MHPSS interventions through training psychologists on SMHP from MoE. Annex 1 shows the number and type of services provided in Aleppo (22nd June-4th July 2019)

2) Homs

 HERAMS: Joint monitoring visit with MOH representative was conducted to Alwaleed hospital in Alwaer area and Baba Amer PHC to assist the quality of the data entry in the system.

 WHO response for student coming from HTR areas ( Idleb, Raqaa) to Hama city: Around 9,600 students arrived to Hama from Idleb, Raqaa, hard- to-reach rural rural Hama to take their national exam. 4,330 of them stayed in 18 shelters.  2 partners (DOH, Albir Hama) have provided health services to the students through 2 mobile teams.

1. Health situation

 The total number of treatment under PHC/NCD program is 206 medical consultations,21 individual PSS sessions, including 177 medical prescriptions were provided for returnees from Rukban camp who have recently returned to Homs governorate.  192 children under 5 years from the last arriving 2 groups were vaccinated by mobile teams supported by WHO.  Primary health services: DOH MMT with WHO support provided health services in the shelters with free medicines. The Total No of the medical consultations for the period 18-30/6 /2019 was 133: (Annex 5)  4 mobile health teams from DOH Homs supported by WHO provided health services (medical consultations and medicines) in northern Homs area. The total N of health services is 985 (Annex 6).  3 mobile health teams from DOH Hama supported by WHO provided health services in rural Hama and Sinjar sub-district in Idleb Governorate. The total number of health services was 952 (Annex 7).

NGOs activities  Albir Hama NGO health project: Provided services from one fixed health point and 2 mobile health teams in Hama city and villages across eastern and northern Hama. The total No of beneficiaries during the period was 3266 and 1315 PSS consultations (Annex 8).  Orthodox Association for Helping the Poor health project: Provided health services through 3 fixed health points in Alghasaniya old Homs city, Fairouza village in east Homs, Ayoun Alwadi in Mesyaf Hama district. The total number of beneficiaries was 1205 (Annex 9).

Capacity building:  Facilitated 3 trainings in Homs and Hama governorates with 75 participants (Annex 2).

Page | 14

3) Lattakia

Situation Update:  The Russian air defence detected and downed several drones in the vicinity of Hmeimim airbase in south rural Latakia.  NSAGs targeted with rockets , shells and snipers shelling SAA positions in Ain Ghazal axis and Jabal Al Turkmanin North-east rural Latakia; m several casualties were reported.  Back and forth fights continued in Kabanitown north of Lattakia governorate, accompanied by SAA/RF artillery shelling and airstrikes.

Coordination:  Conducted HWG coordination meeting; discussed 2018 health achievements, 2019 main HRP objectives and targeted PiN, last updates on IDPs influx movement towards the coastal area, in addition to health updates from all partners. NGO:  Assessed SACSN work performance in the three supported health centres along with Venture evaluation & monitoring company  Total beneficiaries from 22th June to 4th of July:

Clinics Ramel Squbben HC Qnenas HC Mobile team 1 Mobile team 2 Jnoubi HC Internal 200 293 349

Pediatrics 527 375 284

gynecology 263 242 347

PSS support 89 11 55

Total 1079 921 1035 213 209

Field assessments:

 Participated in a field assessment mission to Sinjar area to assess 4 selected locations to be used as collective shelters in case of any IDPs movement from Idlelb. ( separate report was developed )

EWARS:

 4 AJS reported cases, 5 SM cases, 5221 ILI cases, 443 AD reported cases.  Completion of reports reached 96%

Capacity building:

Supported the following trainings and workshops:  Integrated Management of Childhood Illness (IMCI )  Expansion on training regarding nutrition surveillance + IYCF counselling

Logistics:  Dispatched 2 tons of medical health supplies to Aleppo  Received 284 NCD Kits at Lattakia warehouses ( medicines, renewables and equipment )  Supported NGO with 8 glucose test devices.

Page | 15

IV. Key Operational Challenges

EPI The final agreement between the DOH Aleppo and Kurdish authority to resume the EPI vaccination activities in Ein Arab district of Aleppo governorate and Tal Abyad district of Raqqa governorate has reached the MOH for getting approvals.

PHC/NCD  MOFA approval is still pending MOH feedback for Al Hol response under SHF /OCHA.  Shortage of PHC/NCD items at free stocks.  NCD kits under OFDA is not received yet :26 NCD 1a & 33 NCD 1b /Insulin.

Communicable Diseases/EWARS/WASH  Tracking the shipment and dispatching of related items to the end users, especially in NES governorates.  Delay in releasing payments for field workers in Deir Ezzor and Hassaka

Trauma Care  Lack of fund allocated for capacity building has affected the number of trained health workers on trauma topics.

Secondary Health Care  Due to security reasons on roads, 4 trainees from Deir-ez-Zor and Raqaa did not manage to participate in the training workshop.  Limited number of trainers to conduct training in Hasskeh. As a result, 2 trainers from WHO staff must organize and conduct the training during the 3 days .  The long distance (85 km) that the trainers should travel, during the time of training, from Qamishli to Hassakeh where the training was conducted is 85 km.

Operational support and Logistics  No approval as per MOFA’s letters to deliver any health supplies to NES through road transportation. The only possible way to deliver supplies is through airlift which is very expensive  The MOH and MOFA approval process to approve import of supplies sometimes takes 1-3 months which affects procurement using short-term funds especially if the awards are close to expire.  WHO is obliged to deliver supplies to MOH central WH directly as per MOH instructions, which makes it difficult to follow up on the redistribution to the end user in different governorate . However, some of the supplies are approved to be delivered directly to DOH.

HIS  Timeliness of HeRAMS reporting by health partners.  Shortage of fund to cover the activities of CRVS (Civil Registration and Vital Statistic) for deaths and births modules. WHO will collaborate with UNFPA to cover some activities.

Page | 16

V. Key Health Actions for the Next 2 Weeks

Secondary Health Care  Assess the field hospitals at Al-Hol Camp.

Communicable Diseases/EWARS/WASH  Laboratory screening of diarrhea cases in Al-Hol camp.  Dispatch additional chlorine tabs and covers for water tanks to reduce the risk of contaminated water.  Activate DoH medical point of in Al Hol camp. The medical point will provide general consultations for cases of infectious diseases including diarrhea and water-borne diseases and respiratory infections in addition to HIV voluntary counseling services and TB health care.  Syria’s contribution in the Global Antimicrobial Resistance Surveillance System (GLASS).

HIS  Conduct joint technical meetings by HIS team and counter partners in MoH (Directorate of Planning and International Cooperation) to follow upon IM transition from emergency to early recovery context (Primary Health Care Information System, Secondary Health Care Information System, CRVS (Civil Registration and Vital Statistics ) for deaths and births modules, Health Indicators Database).  Conduct a field visit to Al-Bairouni hospital (MoHE) to follow-up the process of cancer registry project.  Conduct a mission to Tartous to monitor HeRAMS implemented in health facilities affiliated to MoH and SARC.  Produce regular information products: HeRAMS report for private hospitals in Al Hasakah Q1 2019; Summary of (WHO, WHO-WoS) key performance indicators snapshot for June 2019 and others.

PHC  following up with MoH concerning the Primary Health Care Measurement & Improvement Initiative /PHCMI workshop to be held between 30 July till 1 August 2019 in Cairo.  Surge mission to Al Qamishli is scheduled on 14-27 July 2019.

EPI  GAVI support for the year 2019-2020; the Ministry of Health is still reviewing the draft Partner Framework Agreement (PFA);  the EPI field assessment will start on 06-12 July 2019.  Procurement of Supplies for the National Polio Laboratory (Based on MOH official request) is in progress.

Mental Health  Follow up with HUBs and MoH/ MH directorate  Follow up with Idleb DoH/ MoH-MH directorate.  Follow up with WHO-sub office in Al-Qamishli to facilitate the training courses for the health workers.

Trauma Care  Trauma kits and supplies will be distributed to Hama, Homs and Aleppo.  Coordinate with the field hospitals in Al Hol camp and the blood bank in Al-Hasakeh to secure regular supplies of blood and blood products.  Six trauma and disability training courses will be conducted in several governorates.

Page | 17

NGO Team  Maintain close follow up with EMRO/ BFU unit to clear the rest of the submitted LOAs.  Finalize and submit the listed under preparation LOAs.  Finalize conducting financial and technical closure of 3 LOAs.  Review and clear 3 due progress reports.  Complete phase 2 and phase Draft report is in process and will be shared with the technical officers and stakeholders for review and feedback.

------

KEY CONTACTS:

Representative Elizabeth HOFF [email protected] Health Cluster Coordinator Azret Stanislavovich KALMYKOV [email protected] Emergency Team Lead Isiaka Stevens ALO [email protected] Communications Officer Yahya BOUZO [email protected]

Page | 18

V. Annexes

Annex 1 No of health services provided by NGOs

NGO Health Location # of # of # of # of MHPSS # of Facility outpatient patients SHC services Trauma an consultatio received service provided d ns PHC assistance s Rehabilitat services with ion medicines Services East rural of Aleppo 1 Al-Ber Mobile Hazaza , Zubayda , 652 410 0 369 0 & AL- team 1 Tal Ayub , Akola , Ihsan Southern Rasm Elharmal , Little Hmeimeh 2 Al-Ber Mobile Um Arkileh , 789 355 0 415 0 & AL- team 2 Halabiyeh , Ihsan Dikwaneh , Tal Sabeen , Kaskis , Rasm Elkhabbaz 3 ASLSS Mobile Babiri - Lower - 609 465 0 128 0 team 3 Upper Babiri , Maskanieh , Kayariyieh , Mufliseh , Rasm Elabed 4 ASLSS Mobile Mahdum , Abu 1395 880 12 185 0 team 4 Maqbara , Rasm Elkhamis , Um Adae Ajami , Abu Hanaya , Atireh , Mufliseh 3445 2110 12 1097 0 AFRIN 1 Al-Ihsan Mobile Kafr Naya - Abin , 436 200 0 171 0 Team 5 Kafen , Burj AL- Kaas , Hardening 2 Al-Ihsan Mobile Tenib - Znarita , 200 90 0 118 0 Team 6 Mayasa , Zyara , AL-Zahraa 3 SCC Static Point Al-Asser Camp 795 680 195 25 1 4 YBY Static Point Fafin 415 396 6 65 0 2 5 YBY Mobile Deer Jmal , Babnis , 362 521 5 169 0 team 7 Qaramel ,Wahshieh , Al- Alousheh

Page | 19

2208 1887 11 718 25 South Rural 1 Al- Mobile Hadher , Abtin , 832 744 0 82 0 Taalouf Team 8 Wdeihi , Haddadin 2 Al- Mobile Blaas , Big Oweinat 785 717 0 95 0 Taalouf Team 9 , Tall Ed-dama 1617 1461 0 177 0

Annex 2: WHO supported capacity strengthening (supported 20 activities for 661 participants)

Date No of Detailed title Venue Program particip ants meeting to discuss basic neonatal care 22/06/2019 15 PHC building Damascus national guide Integrated Management of Childhood 22-29/06/2019 20 National hospital Lattakia Illness (IMCI) Integrated Management of Childhood AL ASSAD medical 22-29/06/2019 20 Hama Illness (IMCI) center Obstetrics and 22-28/06/2019 25 Ventilator management Aleppo Gynecology Hospital Mental Health GAP-Intervention Guide PH1 23-27/06/2019 25 MoH premises Damascus for MoH doctors from R. Damascus The importance of switching to routine 25-26/06/2019 25 DOH in Damascus Damascus surveillance Rehabilitation of anterior cruciate ligament 23-25/06/2019 25 Ibn Nafice Hospital Damascus injury Improve utilizing and investing the Strategical study 23-25/06/2019 30 collecting HeRAMS data using office Damascus center program Expansion on training regarding nutrition 23-27/06/2019 25 surveillance clinics + Infant and Young Child PHC building Lattakia Feeding (IYCF) counselling National disease surveillance officers on 25-27/06/2019 25 DOH in Al Swieda As-Sweida timely outbreak investigation and response 25-27/06/2019 25 Neonatal resuscitation programme(NRP) Homs DoH Homs R. 25-27/06/2019 25 Neonatal resuscitation programme(NRP) AL NABEK hospital Damascus 27/06/2019 100 Thalassemia World Day Hall Damascus HeRAMS online workshop at governorate 28/06-1/07/2019 30 MoH premises Aleppo level 29-30/06/2019 26 Communication and Psychosocial support DOH Hama National disease surveillance officers on 29-30/06/2019 25 Pharmacists Unit Hama timely outbreak investigation and response 30/06/2019 20 Measles follow-up committee PHC department Damascus

Page | 20

30-02/07/2019 25 Laboratory diagnosis of Leishmaniosis DOL in Damascus Damascus Teams and adaptation of the instruments 01-02/07/2019 30 PHC department Damascus for EPI/DQA team Teams and adaptation of EPI & DQA 03-05/07/2019 120 Damarose Hotel Damascus instruments

Annex 3: No and Types of services provided in NES (22 June-4 July 2019 )

PHC services SHC services Trauma services

# of # Referral of # of First # of Mental # of # of referrals treatment aids and Health beneficiaries # of Governorate Area for for children emergency outpatient reached with trauma secondary with Severe services in Psychosocial the referrals health Acute the camps consultations medicines services Malnutrition Services Hassakeh city 0 0 650 415 3 33 0 center Al-Mabrouka 0 207 880 880 31 10 257 camp 0 0 Ras Al-Ain city 518 518 29 0 0

Al-Areesha 1 78 786 695 2 0 103 camp Al-Hol camp / 8 182 938 931 3 12 127 Al-Hassakeh Phase 1 Al-Hol camp / 4 0 290 566 566 0 243 Annex Al-Hol camp / 0 0 77 754 742 0 108 Phase 6 Al-Hol camp/ 0 0 22 425 425 0 56 phase 7 Al-Hol camp/ 0 0 0 118 543 543 157 phase 8 Al-Raqqa city 385 236 0 0 0 0 406 Al-Jurneay + 0 0 0 21 68 45 23 Al-Mansoura Al-Tabqa 63 58 0 0 0 11 23 Al-Raqqa Ain Issa camp 2289 2289 0 0 0 214 205 Al-Twehenah 0 0 0 18 1039 1039 83 camp Al-Karama 824 803 0 0 0 53 122 Al-Kasrat 823 823 0 0 0 9 71 Aleppo Manbij 830 823 0 0 0 16 111 Dier Ezzour Hajin 893 449 0 0 0 116 99

Page | 21

Al-Busayra 270 270 0 0 0 48 72 Al-Jerzi 1012 634 0 0 0 44 112 Abu Khashab 0 0 0 35 1168 1168 469 camp Dier Ezzour 0 0 0 0 792 626 0 city Sub-total: 16518 14978 72 9 55 1560 2847

Page | 22

Annex4: Provision of Medical Consultations

# of beneficiaries from 18-30/6 2019 Area Provision of medical consultations Medicines Dier balba shelter 33 30 Al kosour shelter 46 22 Al bayada shelter 44 36 Total 123 88

Annex 5: Number of beneficiaries for the period 19-30/6 /2019 in Northern Homs district

Provision of medical Area medicines consultations 290 258 3 locations in Al-holeh

248 189 5 locations in Rastan 447 423 5 locations in Talbiseh

Total 985 870

Annex 6: Health Services Provision

Provision of medical PSS PSS Area consultations with Individual group sessions free medicines sessions Rural Hama and Sinjar sub district (Idleb Governorate) 10 locations in Sinjar sub district –Idleb 352 23 12 Governorate 10 locations in Hamrat district –east Hama 298 15 17 Governorate 10 locations in Hur Benafseh district- west 302 12 16 south Hama Governorate Total 952 50 45 Hama city and villages across eastern and northern Hama Eastern-northern rural Hama villages 1652 64 402 Al- Hamraa district (20 locations) Northern Hama (20 locations) 1198 56 265 Health center Abi Alfidaa 416 75 453 Total 3266 195 1120

Page | 23

Annex 7: List of current WHO agreement with national NGOs (by NGO)

# of ongoing # of MOUs in Governorate Location of current of ongoing MOUs MOUs preparation 1 Damascus Al Zahera

Rural Damascus Qutaifeh - Douma - Harasta - Al Tal - Yalda 5 1

Lattakia city- Al Baset - Saqubeen- Qnanas and Al 1 Lattakia Ramel Al Janoubi Dara'a Dara'a , Al Laja'at, Al Yarmouk 1 1 Qunaitera Qunaitera 1

Old Homs, Al Ghassani and Ayoun Al Wadi 2 1 Homs Hama city, Souran, Moardes ,Taybet alemam, Alsawa'aek ,Alhashimyaa , ean albad, Jarjesah ,tal 1

Hama kartal,tellef ,herbenafsah,maardeften and alzarah. Agior , Deir Hafer , Rural villages of Aleppo city ((Babiri -Upper Babiri , Babiri -Lower Babiri , Rasm Aleppo Elbokhar , Kayariyieh , Big Habbuba , Little Habobieh 2 1 , Southern Rasm Elharmal ). Hananou , AL-Martini , Tal Refaat and surrounding villages

NES Deir- Ez-zor - Ar Raqqa city - Al Hasakeh. 7 3

Total 21 7

Annex 8: Health Service provision in Alghasaniya old Homs city, Fairouza village in East Homs, & Ayoun Alwadi in Mesyaf Hama district.

Commune/Villa # of outpatient consultations PHC # of SHC District #Trauma patients ge/Town services services

Alghassani Homs city 745 10 6 Fairouza. Eastern Homs 331 6 1 Ayoun Alwadi. Western Homs 129 2 1 Total: 1205 18 8

Page | 24