WHO Syria: SITUATION REPORT Weeks 30 – 31 (19 July – 1 August), 2019 I. General Development, Political and Security Situation (22 June - 4 July), 2019 The security situation in the country remains volatile and unstable. The main hot spots remain Daraa, Al- Hassakah, Deir Ezzor, Latakia, Hama, Aleppo and Idlib governorates. New Israeli offensive hit Syrian targets in rural Damascus, Qunaitera and Daraa. IEDs exploded in the Southern neighborhoods of Damascus, the capital. Deadly bomb attacks hit the governorates of Aleppo, Daraa at least five people, mostly army soldiers, have been killed in these attacks. Escalation of violence caused lots of destruction in populated areas of the northwestern Syrian governorate of Hama; over 100 rockets and mortar shells fell in the towns of Joreen and Rassif causing huge material damage to the dwellings of the inhabitants of the area. The population of Rukban camp in southeast Syria has dwindled to a quarter of the estimated 40,000 who used to live there five months ago. A new batch of returning families arrived in Jlaighim corridor in the Syrian Desert coming from Al-Rukban makeshift camp in South-east rural Homs. A new wave of Indirect Artillery Fire attack (IAF) was reported in some parts of Aleppo city where 12 projectiles were registered in different neighbourhoods. Tension was escalating at Al-Hol camp during the reporting period; crowds were chanting several political and racial slogans against political authorities II. Key Health Issues Response to Al Hol camp: 196 inhabitants more left the camp to their original homes in Deir-ez-Zor governorate, reducing the total number of the camp inhabitants to 70 285. WHO-supported health teams screened 98 children and diagnosed 7 children with severe acute malnutrition and 7 children with moderate malnutrition. All of the diagnosed children were referred to the outpatient center. Eight children with severe acute malnutrition were referred to the WHO-contracted Al-Hikmah private hospital for treatment. Three children were cured and discharged while the rest are still under treatment. Several training sessions were conducted targeting Al-Hassakeh DoH –affiliated medical staffs and other health teams focusing on different health issues like leishmaniasis, TB, HIV and severe acute malnutrition. WHO has distributed three prefabricated caravans to be used as family wellbeing centers which enables WHO- supported metal health intervention teams to provide social support services as well as individual and mass listening sessions. Moreover, WHO-supported surgical teams and health workers from Al-Hasakeh Directorate of Heatlh (DoH) were enrolled in several heath training sessions to enhance emergency care and provision of essential health services in the camp. The newly established static health point in Phase 5 started operating and providing health services to the camp’s inhabitants. III. WHO Response Non-Communicable diseases & Primary health care: Page | 1 Represented WCO at the Extended Pillars’ Group Meeting under the Strategic Framework to present WHO presentation under pillar 1 is shared with RCO. As a follow up of the WHO/UNICEF joint Session during the UNICEF MENA Regional Management Team meeting, a joint meeting was held with UNICEF OIC for health and nutrition program to elaborate on the WHO/UNICEF joint action plan to advocate PHC at community level in coordination with MOH counterparts. Carried out surge mission to Al Hol IDP camp in Hassakeh between 23-27 July to follow up on the health response in the camp Coordinated with PHCMI national expert in MOH and UNICEF to strengthen joint WHO and UNICEF support fort MOH under the Joint Regional PHC Partnership to enhance UHC at community level. Under PHC fund and in order to expand outreach basic PHC services, a total of 8 mobile clinics have been received and will be donated to local NGOs in NES and SARC. Trauma Trained 100 health workers on trauma and disability related topics in three governorates (Homs, Al Hasakah and Damascus). Conducted a joint meeting between WHO focal persons for disability and engineering with their counter parts in MoH at the premises of the Rehabilitation and Artificial limbs Centre to discuss the ongoing support to MOH in the field of physical rehabilitation. This included finalizing the preparation of the upcoming 2-week mission to Syria of an international expert in prosthetics and orthotics (P&O) in order to enhance the capacity of MOH technicians through implementing advanced P&O training course. The topics of the training courses are identified as 1) Trans femoral prosthesis with ischial rainal containment design, and 2) knee ankle foot orthosis. The discussion also included the provision of a 45 sq container to the Rehabilitation and Artificial limbs Centre to be used in the workshop for manufacturing prosthetic devices. Supported public health facilities and health partners with 328,766 treatments and the management of 3,825 trauma cases in addition to the delivery of 22 medical devices needed in health facilities, especially in emergency unit, operating theater and intensive care unit. The details of distribution are as follows: 40,000 treatments of IEHK supplementary kits to Ain Al-Arab (Kobani) Hospital in Aleppo. 39,465 treatments of trauma medicines and IEHK medical kits to Alhasaka Health Authority, Alhayat Hospital, Alhekma Hospital, Al-Mawadda NGO and Souria Alyamama NGO in addition to 1025 trauma cases via Surgical and trauma kits) to health partners in Al Hassakeh; Al-Mawadda NGO, Souria Alyamama NGO, KRC, Qamishli National Hospital, Alhasaka Health Authority and Alhekma Hospital. Immunization Following the finalization of the comprehensive field EPI review and data quality assessment of the different components of the EPI in Syria lead by the WHO Regional Office team, an EPI improvement plan workshop was conducted on (17-18 July 2019) where representatives of all 13 governorates involved gathered to identify the points of strength of their program and way forward to fill the gaps. Each governorate team presented their draft improvement plan based on their local needs. MoH are to set the exact target population and include all marginalized and special population (Nomads, IDPs, refugees, etc…) for equity purposes; update the field guides for VPDs and conduct quality trainings to build capacity of service providers for better documentation, data compilation and analysis. WHO and UNICEF reiterated their commitment to supporting the efforts of the Ministry of Health for the improvement of VPD vaccination activities The EPI accelerated implementation of Routine Immunization in Der Ez Zor (eastern Euphrates districts) started on 17 July up to 03 August 2019. (35) vaccination teams are mobilized by DOH Der Ez Zor up to date reached 36,561 children. MOH provides vaccines and teams while WHO supports technical and operational costs and UNICEF supports the social mobilization component. The initial reports highlighted that the local population demands continuous vaccination services for their children Meeting with the Director of Primary Health Care department and the National EPI manager to discuss: The dates of the Supplementary Immunization Activities (SIAs) are set for NID October 13-17 and SNID November 17-21, 2019. The target has not changed much since the February round at the country level; hence Page | 2 the targeted population is set at 2.8 million children under the age of 5 years. GAVI Performance Engagement Framework (PEF) is almost finalized, pending the approval of the Cabinet Due to the high population demand for vaccination in the Eastern Euphrates part of Der Ez Zor; DOH are revising the targeted population figure for the under 1 year of age to dispatch appropriate supplies on the ground to close the immunity gap in this high risk area. Plans: a) Follow up on the GAVI proposal with HE the Deputy Minister of Health due on 04 August 2019 b) A new request to WHO for urgent procurement of laboratory supplies for the National Polio Laboratory (NPL) is under process. The Polio Expert Review Committee Meeting at central EPI department in Damascus reviewed the documents of 27 non Polio AFP cases and all were discarded based on the provided documents and field investigations . Mental Health MHPSS services were delivered by NGOs through: Five 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 Syria Catholic Center Mar Assia and Al-Yamama, Dez with Syrian Pulse NGO, Integrated MHPSS services were delivered on community level in Qunaitra, Rural Damascus, Aleppo, Homs and Al-Hassakeh through agreement with 10 local NGOs. The procured caravans are positioned in Al-Hol camp and are active as field family centers providing MHPSS services, raising awareness session, providing psychological counselling " individual and group " and psychiatric consultation . Psychotropic medications were delivered to different partners in Aleppo, basically Ibn khadloun hospital for their new out-patient clinic in the hospital. Following-up with MOH/ MH director on two main issues: Global survey on progress on SDG health target 3.5 (2019), and the rehabilitation proposed by MoH/ MH directorate for having a training hall to cover the need in MoH trainings, supported by WHO. Coordinating with GZT HUB MH and MHPSS NES TWG to jointly conduct a mhGAP training course in NES for health partners. The training will be roll-out modality rather than ToT, with joint training for MHPSS workers on the ground. Finalized M&E MHPSS Global framework to be implemented in Q3-Q4 for MHPSS partners and projects managers for WHO NGOs partners in the week of August; the first workshop will be for NGOs partners in Damascus in the first week of August. Capacity building activity took place in Aleppo for 25 community workers in CARITAS Aleppo, with discussion to widening collaboration with Damascus office as CARITAS is supporting MHPSS projects in EG.