WHO Syria: SITUATION REPORT Weeks 17-18; 26 April – 09 May, 2019

I. General Development, Political and Security Situation

 More than ever before, there was intensification of hostilities throughout northern Hama and southern Idlib governorates; with shelling, airstrikes and active fighting in and around over 50 villages in northern rural Hama and southern Idlib.  The escalation of bombardments resulted in deaths and casualties, and sending civilians fleeing in all directions.  An estimated 152 210 individuals were displaced during the reporting period  There is huge concerns about further escalation in the coming weeks.  Severe fuel shortages in government-controlled areas continued; resulting in long queues at petrol stations, with people waiting for up to 6 hours to buy a limited quantity of gasoline. Prices on the black market have more than doubled.

II. Key Health Issues a) Due to the hike in hostilities around northern Hama and southern Idlib, about 15 health structures have been hit and they have all suspended health services. This will negatively impact a minimum of 30,000 medical consultations on a monthly basis. b) With more than 150,000 people already displaced; there is the enormous task of urgently providing humanitarian health assistance for the displaced population. c) The health sector Syria hub is equally concerned about the safety and protection of 157 public health facilities in NSAG controlled areas in addition to field facilities supported by XB partners. d) Statement, 3 May 2019 - WHO condemns the attack on three health facilities in northwest Syria on 28 and 30 April. The attacks resulted in damage to infrastructure, putting the vital facilities out of service. e) Statement, 7 May 2019, WHO Condemns Multiple Attacks on Health Facilities in Northwest Syria. Since 29 April, in just nine days, twelve health structures have been hit. f) In Al Hol camp:  The humanitarian situation in Al Hol continues to be challenging. In total, the camp population is now 73 393 people (21 586 families), with the vast majority being women and children. Around 70 per cent of the camp population is under the age of 18 with 65 percent under the age of 12.  Multiple specific protection needs remain with a direct impact and links to health sector responses.  Crude mortality rates remain within emergency sphere standards of 1.0/10,000/day. As of 28 April 2019, 286 deaths had been registered in 2019, a CMR of 0.5 deaths/10,000/day is weak. g) In Rukban:  The total number of people who have left Rukban is 11,393 out of 41,700 residents. Some of them have been hosted in in Arts Institute in Bayada. SARC provided them NFIs, food, and male & female protection kit for both.

III. Operational & Technical Updates

a) Coordination

Page 1 of 3 1. Ad Hoc HTF meeting on Idleb was conducted to a) Appraise HTF members of the deleterious humanitarian situation in Idleb and its potential consequences; and b) Discuss and agree the need to ensure that parties to

the crisis exercise restraints especially in the de-escalation and de-militarized area in order to protect civilians 2. The health sector was constantly briefed on the latest attacks on health care in northwest Syria, including the release of a WHO statement. 3. Conducted a national health sector coordination meeting in Damascus with a focus on: health situation in Al Hol camp; situation in northwest Syria; fuel crisis and potential impact on health; critical health sector funding priorities; standard allocation, SHF; scale-up response in southern Syria; MoH request to support reconstruction of hospitals and PHC centers; Rukban and Global Health Cluster survey on capacity of national NGOs, etc. 4. Health cluster bulletin for April was produced. 5. 4W snapshots for health sector and WHO Syria performance in March 2019 were disseminated. Process in place to enhance further 4W health sector snapshot. 6. EWARS Bulletin for Syria, week 16 was disseminated. 7. Conducted operational follow up on Al Hol camp issues, including updated mapping of health sector composition, gaps and challenges, priority response areas, dissemination of EWARS bulletin for Al Hol camp. 8. Briefed partners on WHO preparedness levels during the ad hoc TC on north-west Syria. 9. Participated in the Whole of Syria Health Cluster Second Quarterly Inter-Hub Meeting of Health Cluster Coordinators and Information Management Officers, 1-2 May 2019, Beirut, Lebanon. 10. Plans concluded for the upcoming quarterly WoS WHO meeting in Beirut, 13-14 May.

b) Non-Communicable diseases/Primary health care a. Continued follow up for oral health project in eastern Ghouta in rural Damascus; 20,700 total oral health care services provided in cooperation with Ministry of Education. b. Dispatched a second shipment of dental supplies to MEO in support of Eastern Ghoota oral health project. c. Replenished Homs Hub with life-saving PHC/NCD medicines and supplies in support of Hajin IA convoy to cover health needs of IDPs from Derz Zour. d. Supported Health charity in Qutaifa working in rural Damascus by providing medical equipment (2 examination beds, 1 Oxygen Concentrator & 1 pulse oximeter). e. Supported Al-Asad hospital in Deir Ezzor with two operating ceiling lights. f. The total number of PHC treatments courses provided to date 63 926.

c) Trauma a. Updated the ToR of trauma and physical rehabilitation sub-sector working group (waiting for a reply from WCO level). b. Proposed a project to support the dissemination of optimal Health Care of severe injuries caused by ERW, UXOs and Landmines (awaiting a reply from WCO level). c. One workshop was conducted in close coordination with Aleppo DoH on ventilator management. d. The first conference of Cardio surgery was conducted in closed coordination with the Ministry of Higher Education. e. A field visit was made to the eastern part of rural Aleppo.

d) Immunization a. National Immunization Week: The National Immunization week took place in the Syrian Arab Republic from 21-30 of April 2019 in all 14 Governorates (accessible areas). Children under the age of 5 were screened for the completeness of their routine immunization vaccination. An estimated 247 728 children under the age of 5 years are expected to have dropped out of the routine immunization program. 232 934 children were vaccinated of which 99 959 were considered drop-outs. The campaign in Raqqa and Der ez Zor (considered as high-risk localities) was successfully completed, with 31 221 and 10 264 children under the age of 5 being reached, respectively, including 361 children in Ein Issa camp in Tal Abiad. th b. National Immunization Technical Advisory Group (NITAG) meeting was conducted on the 8 ofPage May. 2 of 3 The meeting discussed three essential topics; namely: o Maintaining the 2 doses of IPV in the Routine Immunization Schedule of Syria; o Necessity of vaccinating children against Mumps (hence the use of MMR is essential);

o Vaccinating children with DTP + Hib + HEP B (PENTA vaccine) with 4 doses during their first 18 months of life.

e) Mental Health a. Technical approval was granted for family well-being centers with Shabab Charity NGO to work in rural Damascus, with 2 MHPSS mobile teams, Archbishopric of Syriac Catholic Center Mar Assia and St. Ephrem Patriarchal Development Committee in Al Hasakeh. b. Four family well-being centers are active in DEZ: 2044 beneficiaries, HAMA 1540, NES and Latakia. c. Developing special training materials and agenda for KHTWA NGO for people with artificial limps and their families. 32 medical doctors were nominated for the training course, including 5 medical doctors working in UNRWA. d. The MHPSS questionnaire was revised according to WHO-UNHCR MHPSS toolkit in the assessment tools and protocol for the assessment of the health situation and services in Al-Hol camp. e. Two days of training were conducted; 35 NGO volunteers were trained on communication skills and PFA by two MH experts. f. The GBV plan for 2019 was finalized according to the latest update through coordination with EMRO GBV FP g. The strategic plan for psychotropic medication procurement 2019 was developed. h. 11 MHPSS MMUs are active in Aleppo for NWS response with integrated MHPSS services (1124 services) i. 3 MHPSS mobile teams for Aleppo DoH and Ibn Khaldoun Mental Hospital were included in the NWS preparedness plan; referrals with MHPSS partners to be updated. j. The entire NES MHPSS response in camp has been mapped, with the number of MHPSS workers to be 34; services provided in ANNEX to be scaled up, MHPSS NES response to be added to the whole MHPSS services activities in emergency response areas across the country and shared with emergency lead officer.

f) Nutrition and Child Health a. Data collected on nutrition surveillance from 13 governorates, with a total of 69 138 services conducted and 1172 global acute malnutrition cases detected. b. Currently reviewing the essential new born care training package with MOH. c. Completed data collection of AL HIkmeh SC for April 2019: 118 Admissions, 139 discharges, and 6 deaths.

g) Secondary Health Care a. Participated in a two-day training session at EMRO on WHO quality assurance policy for the procurement of essential medicines and other health products. b. Procured 2000 hemodialysis sessions to be distributed to Afia Fund NGO in Homs, which will enable over 132 kidney failure patients to have continuous dialysis treatment. c. Distributed 10 360 treatments of essential and life-saving medicines, in addition to supplies needed for hemodialysis treatment for kidney failure patients, to public hospitals and health facilities in Damascus, Aleppo and Homs. d. Delivered 4 hemodialysis machines and 2 steam sterilizer devices to Al Assad hospital in Dierr-Ar-Zour and Al Tabqa hospital in Ar-Raqqa.

h) Disease Surveillance and Response and WASH a. During the reporting period, an average of 1080 sentinel sites out of 1300 functional sentinel sites reported to EWARS with an average of 83% timeliness. b. Three suspected HIV cases were reported in week 16 among Syrian males aged between 25 and 35 years old in Ar-Raqqa. The blood specimens from all the cases were collected and tested for IgM ELISA at an HIV reference laboratory. However, none of the results were definitive. PCR tests are to be performed for confirmatory diagnosis. WHO supports treatment for individuals who are HIV positive through the National HIV Programme. Page 3 of 3

c. MoH and WCO SYR participated in an inter-country workshop on the transition toward new policies and treatments of DR TB and LTBI in Pakistan to assist countries in the process of operationalization of the new guidelines and development of country plans for transition and implementation. d. Leishmania medicines (25,000 vials of Meglumine antimoniate) were successfully delivered by air shipment to WHO hub to support the needs of NES. e. WHO delivered Genexpet kits for 2800 tests to TB reference laboratories. 20 Olympus binoculars functioning on solar power were delivered to MoH a to be distributed to 20 peripheral TB labs in all governorates to support direct TB sputum tests. Equipment was delivered to MoH to activate microbiological culture in Homs TB lab. f. A meeting was conducted with health directorate of Al-Hassekeh in order to coordinate detection, identification and response to outbreaks. WHO followed up on the distribution and prepositioning of 118 cholera kits and CD.

i) Information and Planning a. Developed and disseminated infographics for key performance indicators for March 2019 covering WoS, Northeast Syria, Northwest Syria, and Southern Syria. b. Developed and disseminated 4Ws (WHO and Health Sector) snapshots for March 2019. c. Developed and disseminated health Profile for health facilities in NSAG areas of North West Syria. d. Produced and disseminated HeRAMS annual report 2018 of the public Health Centres in Syria. e. Provided HeRAMS indicators of Damascus hub to WoS f. Participated in Whole of Syria Inter-hub HCC/IMO Meeting 1-2 May, Beirut, Lebanon. g. Produced and disseminated narrative report on the health situation in Deir-ez-Zor governorate (areas under government control) in April 2019 h. Conducted site visits to UNRWA health centres in Damascus, Dar’a, Aleppo, Homs, Hama, & lattakia governorates to train staff on collecting HeRAMS data for Q1 2019 as part of HeRAMS expanding coverage to non-public health facilities. i. Provided (4Ws_Health_Syria_Mar2019) to WoS using the ‘ActivityInfo’ standard template based on the new HRP indicators 2019.

j) National NGO Coordination a. TPM conducted three field visits to one NGO in Damascus, one NGO in Al Hasakeh and one NGO in Deir Ez- zor. b. A one-day field mission was conducted in Saqba, Hamourieh and Ein Terma in Eastern Ghouta, where WHO is supporting static medical points. c. The consultancy assignment to conduct public health assessment in Al-Hol camp is in process; the tools have been finalized, followed by two days of training on the tools in addition to training on communication skills. Pre-test is scheduled to take place on 9 May 2019 followed by 5 to 7 days of assessments.

k) External Relations and Communications a. Official communication opened with MoH on o WHO’s provided airlift medical supplies (nearly 4 tons) to boost the medical services available at Al Qamishli National Hospital. o Preparation for the 72nd World Health Assembly (20-28 May 2019). b. Conducted a field visit to Aleppo Governorate to follow up on WHO's response and attend the official opening ceremony of the national conference on enhancing the capacity of specialists and resident doctors in the field of emergency surgery and cardiovascular surgery in Aleppo from 1-3 May 2019 together with the Minister of Higher Education and senior representatives of Aleppo University Hospital. c. Followed up with MoH in preparation for conducting specialized training courses to enhance the Page 4 of 3 interpersonal communication skills of health promoters and IEC health workers at MoH and WHO supported NGOs. d. Visited select PHC centres to provide visibility materials on the occasion of the national immunization days.

l) Supplies and Logistics a. Dispatched 20.7 tons of medical & nutritional supplies, equipment, health kits and printing materials – covering 7 governorates (Al-Hasakeh, Raqqa, Deir Ez-Zor, Damascus, rural Damascus, Aleppo & Homs). The recipients included 5 MoH facilities, 2 NGOs, 2 non-governmental hospitals & SARC. Total number of treatments is 104 538 with 200 trauma cases. The dispatched supplies included: b. 2 steam sterilizers, 3 haemodialysis machines and 2 operating ceiling light modules with O2, which were delivered to MoH central warehouse in Damascus in support of Al-Asad hospital in Deir Ez-Zor. c. 1000 bottles of sodium chloride, 14 different types of cholera kits, 70 plastic containers and 3500 sachets of ORS were delivered directly to Deir Ez-Zor DoH. d. 750 haemodialysis sessions were delivered to kidney hospital in Aleppo. e. 2 Italian emergency kits (B), 3 pneumonia kits (A), 5 sphygmomanometer adult cuff, 7 plastic containers, 1 NCD kit, 2 IEHK supplementary kits and various types of EWARS, PHC & STHC medical supplies and printing materials were delivered to Homs DoH. f. PHC, STHC & mental health medicines were delivered to MoH central warehouse in Damascus. g. 1 Haemodialysis machine was delivered to Al-Tabqa national hospital in Raqqa. h. 120 cans of F-100 therap. Milk and 144 cans of F-75 therap. Milk were delivered to Al-Hekma hospital in Al- Hasakeh. i. 1 autoclave device, 1 oxygen finger oximeter, 1 oxygen concentrator, 2 examination beds and 2 NCD kits were delivered to 2 NGOs in Damascus & rural Damascus Governorate. j. 40 wheelchairs for adults, 10 wheelchairs for children and various EWARS, PHC & STHC medical supplies were delivered to SARC branch in Aleppo.

IV. WHO Response in Hotspot Areas

a) North West (Aleppo, Homs & Latakia)

i) Aleppo a. Number of WHO supported mobile Medical teams in rural areas is 9 MMTs in additional to 2 static medical points, as follows: o 4 MMTs in rural east Aleppo NWS (2 ASLSS NGO, 2 AL-Beer NGO) in addition to 1 PHC in Dier Hafier; o 3 MMTs in rural north Afrin (IDP’s response), (1 YBY NGO, 2 AL-Ihsan NGO) in addition to 2 static medical points in Fafin Camp and Al-Asser Camp; o 2 MMTs in rural south Aleppo (2 AL-Taalouf NGO). b. The first surgical conference (WHO and MoHE) was conducted at Aleppo University hospital in 1-3 May 2019 c. Joint technical meeting (Health, WASH) was conducted, with participation by DoH, Aleppo Municipality, UNICEF, OCHA, UNDP, ICRC, SARC, and WHO, to discuss CL in Aleppo, in general, and Fafin (Afrin displacement area) in particular. o WHO continues to address the CL outbreak in coordination with the national leishmaniasis control programme by enhancing surveillance, providing medicines, and conducting vector control and risk communication activities. d. Follow up on 56 identified TB cases in Fafin area: 15 completed treatment, 4 drop outs, 37 under treatment. e. WHO supported: a) Ibn Khaldoun psychiatric hospital - 4563 consultations; b) Mental Health directorate – 186 consultations; c) University neurological clinic – 125. f. WHO supported 3 health facilities through the regular program in Aleppo City, as follows: o 1 PHC in Jabal Samman (Agiuor); o 2 trauma and physiotherapy centres in Jabal Samaan (east Aleppo). g. WHO supported the distribution of 54 mobile aids in rural north Aleppo (Afrin IDPS) through the implementation partner Yadan Biyad NGO in addition to 1058 trauma and rehabilitation services.Page 5 of 3 h. WHO helped 4 MMTs prepare to respond to 5000 students coming from HTR area to do their exams at the end of May. i. MHPSS team supported the activities of Medical teams; 1124 MHPSS services were provided throughout the reporting period.

ii) Homs a. 9 NGO and 8 SARC centres continue to report to EWARS. b. The National immunization week campaign was organized during 21th to 31th of April to vaccinate all dropout children under 5 years old. In total, 5935 children were vaccinated, and 2647 dropout children were vaccinated in Rastan district. Among them, 139 children had totally dropped out from routine immunization. c. Two trained health workers from DOH provided basic counselling and psychological first aid in individual sessions, identifying needed cases to be referred to psychiatrist. During the reporting period, eight PSS group sessions, 29 Individual sessions, and six cases were referred to psychiatrist. d. High energy biscuits and Plumpy'Doz™ were distributed to all children under 5 years old. e. DOH MMT, with WHO support, is providing health services in the shelters as well as the areas of the returnees with free medicine.

iii) Latakia

20 Surgical Supply Kits (100 patients/10 days) have been delivered to Latakia warehouse. Each kit is composed of 115 different hospital supplies and consumable items that are required to perform surgical operations and treat patients.

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

i. Al Hol camp

 Coordination

 Conducted 2 health working group meetings in Al-Hol camp. The meetings discussed the health situation updates, EWARS system updates, the internal referral mechanism and updates of health map of services.  Participated in 2 of the regular coordination meetings of Al-Hol camp.  Conducted two meetings with Al-Hikmah and the operational desk group of Al-Hol camp to discuss the procedures and the options related to referrals.  Plan developed to conduct death case analysis meetings on a weekly basis in Al-Hol camp.  Collaboration established with WASH sector to improve the overall WASH services in the camp; and with protection sector to ensure the registration of new births.

 Immunization

 The response at Al-Hol Camp is still occurring on a daily basis, and the number of teams was decreased from 2 to 1 due to a slowing of new influxes and small number of newly arrivals.  National Immunization Week in Ar-Raqqa Governorate (except Tal Abiad district) was conducted during 22th to 30th of April 2019.

 Communicable diseases and surveillance and WASH

 WHO mobile team continues to support Al Ahsakeh DOH to provide treatments to the new arrivals as an emergency response in phase 5.  Through the early warning alert and response network (EWARS); i. Morbidity has been effectively reported from eight medical points in the camp. It showed that the most common causes of morbidities are acute diarrhea, Influenza-like illness, scabies and lice. Page 6 of 3 ii. There are alerts of suspected TB cases, acute diarrhea and other cases in Al-Hol camp among the newly arrived families. The investigation and follow-up of the cases are ongoing.

iii. Acute diarrhea cases have shown high morbidity, with 496 cases in epidemiological week 17 and 343 cases in week 18. Also, the number of bloody diarrhea cases increased to 27 in week 17 before falling to 14 in week 18, compared with 25 in week 15 and only one case in week 16. iv. Six suspected measles cases were reported; three cases in week 17 and three in week 18. Samples from all the cases have been collected and tested at the referral laboratory. All the samples tested negative for measles. v. Five suspected TB cases were reported in week 18. All the cases have been followed up by DoH FP and linked for treatment with the DoH. vi. In total, 15 leishmaniosis cases were reported during the reporting period.  Water quality monitoring continued, and the results were within the normal range.

 Mental Health

 12 health workers provided Psychological First Aid (PFA) and counselling  MhGAP services are provided through the functioning medical points in the camp.

 Nutrition and child care:

 In total, 25 children with SAM complications were admitted to the WHO-supported Al-Hikma Hospital stabilization center; 24 cases were discharged and one patient died.  In Al-tabqah stabilization center, 17 children are under treatment. Among the two newly admitted cases, one case was discharged and one case is still under treatment.

 Pharmacy and Secondary Health care:

 Conducted a field visit to Allulua Hospital in Al-Hasakah to follow up on the delivered equipment.  Presented and discussed recent dispatched shipments to Al-Hasakah DOH in a meeting with Al-Hasakah health director and explored remaining needs and further support requirements.  Conducted a monitoring visit to a partner warehouse to check the managment of health commodities.  A dialysis machine provided to the newly re-established hemodialysis department in Altabka hospital.  Additional NCD kits and dialysis-related medicines requisitions shared with WCO the NES needs of more.

ii. Elsewhere in NES

 Conducted a field visit to Al-Mabrouka camp to follow up on the implementations of WHO partners; two meeting took place (with camp management and the other health actors).  Mechanism established with UNHCR and other humanitarian actors to submit the relocation plan of Al- Mahmoudli camp.  During the reporting period, an increase of suspected mumps cases was reported through EWARS in Ar- Raqqa, Areesha camp and Ain Essa camps. Leishmaniosis cases have also increased in Abu-Khashab camp and in Menbej.  One AFP case was reported in Ain Essa camp and is under investigation.

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V. Annexes

Annex 1: Current WHO agreements with national NGOs

Governorate Location of current of ongoing MOUs # of ongoing # of MOUs in MOUs preparation Damascus Al Zahera 1 3 Rural Damascus Qutaifeh - Douma - Harasta and Al Tal 2 6 Lattakia Lattakia city- Al Baset - Saqubeen- Qnanas and Al Ramel Al Janoubi 1 1 Dara'a Dara'a , Al Laja'at, Al Yarmouk 1 1 Qunaitera Qunaitera 1 Homs Old Homs, Al Ghassani and Ayoun Al Wadi 1 5 Hama Hama city, Souran, Moardes ,Taybet alemam, Alsawa'aek 1 ,Alhashimyaa , ean albad, Jarjesah ,tal kartal,tellef ,herbenafsah,maardeften and alzarah. Aleppo / Efrin Nabul - Zanairta - Mayasah - AL-Mogambo - Burj Al-Kaaf -Al-Zouk - 2 3 Response Tall Refaat - Kafar Naya - Al-Zyara - Deer Jmal - Ihras - Kashtaar - Al-Ukaibeh - Kherbat AL-Hayat - Tal Jbeen - Ibeen - Sheikh said - Salah AL-Deen - Al-Mshatia - Bostan AL-Zahra - Al-Villat - Menbej - Agior , Deir Hafer and surrounding villages ((Babiri -Upper Babiri , Babiri -Lower Babiri , Rasm Elbokhar , Kayariyieh , Big Habbuba , little Habobieh , Southern Rasm Elharmal ) NES Deir- Ez-zor - Ar Raqqa city - Al Hasakeh. 5 6 Total 14 26

Annex 2: No. of healthcare services provided by national NGOs

NGO Health Locations # of outpatient # of patients # of SHC # of MHPSS # of facility consultations received services services Trauma and PHC services assistance with provided Rehabilitation medicines Services ALEPPO Response Al-Ber & Mobile Hazaza , Zubayda , Tal Ayub , 652 410 0 369 0 AL-Ihsan team 1 Akula , Southern Rasm Elharmal , Little Hmeimeh Al-Ber & Mobile Um Arkileh , Halabiyeh , 789 355 0 856 0 AL-Ihsan team 2 Dikwaneh , Tal Sabeen , Kaskis , Rasm Elkhabbaz ASLSS Mobile Babiri - Lower - Upper Babiri , 771 464 5 294 0 team 3 Maskanieh , Kayariyeh , Mufliseh , Rasm Elabed ASLSS Mobile Mahdum , Abu Maqbara , 465 379 6 70 0 team 4 Rasm Elkhamis , Um Adae Ajami , Abu Hanaya , Atireh , Mufliseh Total 2677 1608 11 1589 0 Afrin IDPs Response Mobile Kafr Naya - Abin, Kafen, Burj Al-Ihsan 436 200 0 171 0 Team 5 AL-Kaas, Hardening Mobile Tenib - Znarita , Mayasa , Al-Ihsan 200 90 0 118 0 Team 6 Zyara , AL-Zahraa Static SCC Al-Asser Camp 399 312 5 458 0 Point 1 Static YBY Fafin 855 396 6 65 0 Point 2 Mobile Deer Jmal, Babnis , Qaramel YBY 362 521 5 312 0 team 7 ,Wahshieh , Al-Alousheh Total 2252 1519 16 1124 0 South Rural Al- Mobile Hadher, Abtin, Wdeihi, 157 128 0 63 3 Taalouf Team 8 Haddadin Al- Mobile Blaas, Big Oweinat, Tall Ed- 159 152 2 85 Page 38 of 3 Taalouf Team 9 dama Total 475 280 2 148 6

Annex 3: WHO supported capacity strengthening (supported 31 activities for 798 participants)

Date # of Details/Field Program participants 26-27/04/2019 25 Psychological First Aid "PFA" and Self-care strategies for MoE health workers Damascus MH 26-30/04/2019 25 Ventilator management for MOH Health workers in Damascus Trauma 27-30/04/2019 25 Basic Trauma Life Support MOH Health workers in Qunitera Trauma 28/04 - 01/05/2019 25 Non-Communicable Diseases workshop for Medical staff (NGO & Private sector) in Al Hassakeh NCD 28/04/2019 275 11 Evaluation meeting on peripheral level regarding new born care at home programme for Child Health Health villages volunteers in Damascus, R. Damascus, As-Sweida, Quniterah, Hama, Homs, Deir Care Ezzor, Aleppo, Lattakia and Tartous 28-29/04/2019 30 MoH Network Evaluation workshops to support the National Health Information System for HIS MoH in Damascus 01-02/05/2019 27 Communication and Psychosocial support DoH + NGO Health workers in Lattakia NGOs 01-05/05/2019 50 2 Ventilator management activities for MOH Health workers in Damascus Trauma 01-05/05/2019 25 Ventilator Management for MOH Health workers in Aleppo Trauma 04-11/05/2019 20 Integrated Management of Childhood Illness (IMCI) for MoH doctors in Damascus Child Health Care 04-05/05/2019 30 MoH Network Evaluation workshops to support the National Health Information System for HIS MoH in Damascus 05-06/05/2019 26 Primary health care programmes : Quality control measures for MoH & NGO Health workers in NGOs Qunaitera 05-08/05/2019 25 Non Communicable Diseases for Medical staff (NGO & Private sector) in Al Hassakeh NCD 06-10/05/2019 25 War Wounded Injuries Management Trauma 07-11/05/2019 35 Assessment of The Health Situation and Services in Al Hol IDP Camp and assessment tools for NGOs/ MH NGO Health workers in Qamishli 07-09/05/2019 25 Neonatal resuscitation for MoH Health workers in Damascus Child Health Care 07-09/5/2019 30 Improve utilizing and investing the collecting HeRAMS data using office program for MoH in HIS Damascus 07-09/05/2019 25 Low Back Pain for MoH health workers in Damascus Disability 07-11/05/2019 25 Ventilator Management for MOH Health workers in Tartous Trauma 08-10/05/2019 25 National disease surveillance officers on timely outbreak investigation and response for EWARS MOHresponse teams in Tartous and Lattakia in Homs 26-27/04/2019 25 Psychological First Aid "PFA" and Self-care strategies for MoE health workers Damascus MH 26-30/04/2019 25 Ventilator management for MOH Health workers in Damascus Trauma 27-30/04/2019 25 Basic Trauma Life Support MOH Health workers in Qunitera Trauma 28/04 -01/05/2019 25 Non-Communicable Diseases workshop for Medical staff (NGO & Private sector) in Al Hassakeh NCD 28/04/2019 275 11 Evaluation meeting on peripheral level regarding new born care at home programme for Child Health Health villages volunteers in Damascus, R. Damascus, As-Sweida, Quniterah, Hama, Homs, Deir Care Ezzor, Aleppo, Lattakia and Tartous 28-29/04/2019 30 MoH Network Evaluation workshops to support the National Health Information System for HIS MoH in Damascus 01-02/05/2019 27 Communication and Psychosocial support DoH + NGO Health workers in Lattakia NGOs 01-05/05/2019 50 2 Ventilator management activities for MOH Health workers in Damascus Trauma 01-05/05/2019 25 Ventilator Management for MOH Health workers in Aleppo Trauma 04-11/05/2019 20 Integrated Management of Childhood Illness (IMCI) for MoH doctors in Damascus Child Health Care 04-05/05/2019 30 MoH Network Evaluation workshops to support the National Health Information System for HIS MoH in Damascus 05-06/05/2019 26 Primary health care programmes : Quality control measures for MoH & NGO Health workers in NGOs Qunaitera 05-08/05/2019 25 Non Communicable Diseases for Medical staff (NGO & Private sector) in Al Hassakeh NCD 06-10/05/2019 25 War Wounded Injuries Management Trauma 07-11/05/2019 35 Assessment of The Health Situation and Services in Al Hol IDP Camp and assessment tools for NGOs/ MH NGO Health workers in Qamishli 07-09/05/2019 25 Neonatal resuscitation for MoH Health workers in Damascus Child Health Care 07-09/5/2019 30 Improve utilizing and investing the collecting HeRAMS data using office program for MoH in HIS Damascus 07-09/05/2019 25 Low Back Pain for MoH health workers in Damascus PageDisability 9 of 3 07-11/05/2019 25 Ventilator Management for MOH Health workers in Tartous Trauma 08-10/05/2019 25 National disease surveillance officers on timely outbreak investigation and response for EWARS MOH response teams in Tartous and Lattakia in Homs

Annex 4: WHO supported health services in northern and eastern Hama and northern Homs

Medical Medicines Consultations Eastern Hama

Shelters Dier balba 2 shelters 203 190

Al kosour shelter 76 45 Al bayada 2 shelters 277 187

Sub Total 556 422 Areas of returns Shamseen 67 62 Mheen 72 65 Hasyaa industrial 95 84 Al soukhna 180 155 Sub Total 414 366 Northern Homs Area Provision of Medicine medical consultation 2 locations in Alholeh 298 298 5 locations in Rastan 357 357 5 locations in Talbiseh 422 422 Total 1077 1077

Area Provision of medical PSS Individual PSS group consultation with free sessions sessions medicines 10 locations in Sinjar sub district –Idleb 391 23 16 Governorate 10 locations in Hamrat district –east Hama 307 12 10 Governorate 10 locations in Hur Benafseh district- west 279 13 19 south Hama Governorate Total 977 48 45

Eastern rural Hama villages Al- Hamraa 680 129 555 district (20 locations)

Northern Hama(20 locations) 781 116 338 Health center Abi Alfidaa 456 133 270 Total 1917 378 1163

# of outpatient # of SHC Hearing Medical District Commune/Village/Town consultations services aids glasses PHC services Alghassani Homs city 1,302 151 6 0 Fairouza. Eastern Homs 452 21 1 8 Ayoun Alwadi. Western Homs 63 9 1 3 Total: 1817 181 8 11

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Annex 5: WHO Supported Health service in NES

Governorate Area # of # of # of referrals # Referral of # of trauma # of first aids # of Mental outpatient beneficiaries for treatment referrals and Health consultations reached with secondary for children emergency Psychosocial the health with SAM services in Services medicines services the camps Al-Hasakeh Hasakeh city 827 654 11 1 0 0 4 center Al-Mabrouka 681 672 12 0 0 148 0 camp Ras Al-Ain city 278 273 10 0 0 0 129 Al-Areesha 568 463 19 2 32 25 113 camp Al-Hol camp / 822 822 47 19 126 535 364 Phase 1 Al-Hol camp / 1197 1112 0 0 12 232 1006 Annex Al-Hol camp / 350 350 0 0 4 262 311 Reception area Al-Hol camp / 448 338 0 0 0 117 160 Phase 5 Al-Hol camp/ 799 685 0 0 11 0 33 phase 7 Ar-Raqqa Ar-Raqqa city 487 332 0 0 0 0 593 Al-Jurneay + Al- 35 24 0 0 0 0 22 Mansoura Al-Tabqa 173 90 0 0 0 8 30 Ain Issa camp 1192 1094 0 0 0 130 174 Al-Twehenah 896 896 0 0 0 18 55 camp Al-Karama 540 502 0 0 0 38 84 Al-Kasrat 453 386 0 0 0 16 63 Aleppo Menbej 810 810 0 0 0 23 77 Deir-ez-Zor Al-Jerzi 677 549 1 0 0 109 139 Abu Khashab 839 834 0 0 0 34 215 camp Deir-ez-Zor city 857 602 0 1 0 0 0 Total: 12 929 11 488 100 23 185 24 724 3568

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