HEALTH SECTOR BULLETIN FEBRUARY 2021 WHO-delivered medical supplies in Syria SYRIAN ARAB REPUBLIC Emergency Type: Level 3 Emergency Reporting Period: 1-28 February 2021 12.4 M 11.6 M 6.7 M $ 618 336,200 Targeted with health PIN of health assistance IDPs Funds required Returnees interventions HIGHLIGHTS HEALTH SECTOR As of 28 February 2021, the Ministry of Health 70 HEALTH SECTOR PARTNERS COVID-19 reported cases in Syria have reached 15,588 including 1027 deaths and 9,801 KITS DELIVERED TO HEALTH FACILITIES/PARTNERS recoveries1. The first confirmed case was 15 IEHK BASIC & SUPPLEMENTARY KITS declared on 22 March 2020 and the first death on 9 TRAUMA KITS 29 March 2020. 5 CHOLERA KITS Minister of Health declared the Government’s SUPPORTED MOBILE HEALTH UNITS approval of the COVID-19 vaccine application 127 MOBILE HEALTH UNITS/TEAMS through the COVAX facility. HEALTH ACTION The Syrian Arab Republic is allocated 912,000 705,651 MEDICAL PROCEDURES doses of the AstraZeneca AZD1222 vaccine 529,389 TREATMENT COURSES An online Cluster coordination performance 23,748 TRAUMA CONSULTATIONS monitoring survey was conducted. The response Number of deliveries attended by skilled VACCINATIONattendant Number of deliveries attended by rate was 70%. skilled attendant WHO dispatched 208 tons of health supplies 30,862 PENTA 3 (medical, WASH and lab supplies, kits, equipment EWARS etc.) to MOH, MOHE, and non-governmental 1,361 REPORTING SITES organizations). FUNDING $US IDPs departure to Manbij, has taken place on 21 Feb 2021.The number of IDPs who left Al Hol 618 M REQUESTED WOS IN 2021 camp is 102 families/336 individuals. 1 Currently, there are 17, 240 confirmed cases of COVID-19 including 1153 associated deaths as of 21March 2021. PAGE 1 SITUATION UPDATE As the Syrian crisis enters its 11th year, the scale, severity and complexity of humanitarian needs remain extensive. This is the result of continued hostilities in localized areas, new and protracted displacement, spontaneous returns and sustained erosion of communities’ resilience during more than nine years of crisis. Syria is still one of the biggest and most complex crises globally. The Syrian crisis has generated more than six million refugees and displaced further six million Syrians inside their own country. Health needs in Syria are already significant. Thousands of children are suffering from severe malnutrition. Thousands more are suffering from cancer, diabetes and other chronic conditions for which treatment is limited. In 2021, more than 12.4 million people (out of the total estimated population of 20 million) require health assistance. COVID-19 has aggravated the situation further. In February health authorities announced 1540 confirmed cases, as compared 2,614 in January, 3,547 in December, 2,159 in November, 1,528 in October, 1,435 in September, 2,008 in August, 478 in July, 157 in June and 79 confirmed cases in May 2020. All indicators point out to the disease occurrence across the communities in the country. The health sector agencies continue supporting interventions to suppress the transmission of the virus through risk communication and community engagement; procurement and distribution of medical supplies, personal protective equipment’s; supporting COVID-19 clinical readiness; supporting case management and maintaining essential health care services and system. PUBLIC HEALTH RISKS, PRIORITIES, NEEDS AND GAPS The ongoing conflict, violence and displacement have had grave public health consequences with increased morbidities, mortalities and disabilities among affected and vulnerable populations. The most affected are children, women and elderly people. Despite challenges, the Ministry of Health, WHO as well as humanitarian partners continue to assist people in need where access is possible, with a focus on vulnerable people, by delivering essential health services and supporting referrals. The first confirmed case of COVID-19 was announced on 22 March 2020. As of 28 February 2021, the number of reported cases in Syria has reached 15,518 including 1027 deaths and 9,801 recoveries. The areas of concern are densely populated, notably Damascus/Rural Damascus, Aleppo and Homs, in addition to those living in camps and informal settlements in Northeast Syria (NES), collective shelters throughout the country. Populations living in low-capacity settings face enhanced vulnerabilities in the COVID-19 context. Persons who are homeless or displaced, whether internally or as a refugee or asylum-seeker, as well as those who are stateless and migrants with tenuous legal status, face additional compounding risk factors, which may dramatically increase the risks they face in the context of the COVID-19 pandemic. It is important to recognize the extent to which the COVID- 19 outbreak may affect people differently according to their age, sexual orientation and gender identity, ethnicity, disability, education, employment, displacement, migration status and other socio-cultural attributes. COVID-19 testing is taking place in six laboratories in Damascus, Rural Damascus, Aleppo, Homs and Lattakia governorates. One GeneXpert machine is functioning at the health centre located at the Syrian-Lebanese border, mostly for returnees, another GeneXpert machine was donated by WHO to Al Qamishli National hospital. PAGE 2 There are 32 quarantine centres with 5,182-bed capacity; 86 hospitals with 956 ICU beds; and 22 designated isolation hospitals with 1,090 beds and 214 ICU beds. ASSESSMENTS An inter-agency field assessment mission including WHO, WFP, FAO, UNICEF, UNFPA and OCHA was conducted to Darayya –Rural Damascus. The health center is delivering the following services: maternal health, general clinic, first aid and minor surgeries and recently the immunization services are provided twice a month. Furthermore, the center has a pharmacy that provides some medicines for free, such as antibiotics, antipyretic, diabetic and hypertension medications. About 900 visits to the center are recorded per month. Needs Support the center with health professionals. Provide medicines, equipment, and an ambulance. Proper health care waste management system Referral system for emergency cases Gaps: Lack of electricity, accumulation of rubbles and wastes, unavailability of a well-functioning sewerage network, disturbed communication network. All these can undermine the health situation and aggravate any health emergency. Specific health professionals are needed based on priority, gynaecologist, Internists, paediatrician, endocrinologists, emergency physician, ophthalmologists, dentists, etc. There is a gap in some specific cardiovascular and diabetic medicines, shortage of antibiotics and antipyretics and flu palliative medicines. Medical devices and equipment from different categories, first aid and surgery consumables. No obstetric delivery service is available. No ambulance is dedicated for this city, the center is using nearby ambulances either from Sahanaya or other health facilities in the health area based on operation center at the ambulatory system. EWARS and epidemiological updates at national level (week 5-8,2021) Surveillance performance: A total of 1,140 out of 1,361 active reporting sites (84%) in all 14 governorates of Syria reported through early warning alert and response system (EWARS) with 94% of timeliness. Out of the 766,105 total consultations, a total of 107,563 EWARS notifiable cases were reported Morbidity: The leading causes of morbidity among all age groups were influenza-like illnesses, and acute diarrhoea (Figure 1). The breakdown was as follows: Influenza-like illness (ILI): 67,172 accounting for 62% of total cases. Most cases reported from Deir-ez-Zor, Aleppo and Rural Damascus, the average number of ILI case per week was 16,793. Acute diarrhea (AD): 22,053 (21% of total cases), most reported from Aleppo, Deir-ez-Zor and Al-Hasakeh. PAGE 3 Severe acute respiratory infection (SARI): 1,490 case were reported. Acute jaundice syndrome (AJS): 2,184 most reported from Deir-ez-Zor, Ar-Raqqa and Aleppo. Suspected measles (SM): 47, most reported from Al-Hasakeh and Idleb. Acute flaccid paralysis (AFP): 10, reported from Damascus and Aleppo. Suspected COVID-19: 2,648. Most reported from Tartous, Hama and Aleppo. For the “other diseases” category 11,019 cases were reported, with the most reported cases is Leishmaniasis (5,328), Lice (1,534) and Scabies (1,419). Figure 1: Proportion of Morbidity of top 5 diseases among the total consultation between week 1 and week 8 0.12 0.10 0.08 0.06 0.04 0.02 0.00 1 2 3 4 5 6 7 8 AD LSH AJS ILI EWARS and epidemiological situation in Al-Hol camp (week 5-8,2021) Surveillance performance: Total number of reporting site is 17. Average completeness of reporting 64%. Total number of consultations were 2,583 Out of the total consultations, 2,484 EWARS notifiable cases were reported. 57.9% of the cases were among females, and 44.93% were distributed among children under 5 years. Morbidity: The leading causes of morbidity among all age groups were influenza-like illnesses (48.28%/1,247). Then acute diarrhea (32.91%/850) 7 suspected measles cases were detected in Al hol camp in December, all cases were investigated, and no positive measles case was reported PAGE 4 COVID-19 updates 28 February: Situation: - As of 28 of February 2021, 15,588 cases - in 13 governorates as figure (2, 3). Of them MoH reported 9,801 cases, the recovery rate is 62.8% - Number of COVID-19 deaths is 1,027 and CFR= 6.6%. COVID-19 deaths. - Cases distribution by gender is 56% male and 44% female. The average age is 51 (ranging from 1 to 108), figure (4). - A decrease in cases reported in February by 41% compared with January cases. Figure (5). - 169 cases (1.1%) are travel related cases, 791 cases (5.1%) are contacts of confirmed cases, and 14,628 cases (93.2%) are community infection. - The number of confirmed COVID-19 cases among health workers increased to 604 in mainly in Damascus hospitals, Lattakia, and Aleppo and Rural Damascus. 25 HWs deaths were reported among positive COVID- 19 cases.