WHO Syria, Week 48, November 24 -30 November 2018 General developments & political & security situation • President al-Assad issued Decree No. 360 of 2018 stipulating for a Cabinet reshuffle which included a change of 9 ministers including the Minister of Interior, Water Resources, Domestic Trade and Consumer Protection, Tourism, Education, Higher Education, Public Works and Housing, Communications and Technology, and the Minister of Industry. • The 11th round of Syria peace talks in the Astana format is scheduled to start in the Kazakh capital on 28 November. • North East Syria: Dozens of reported civilian casualties as military operations resume against the last remaining areas under ISIL control. • Idleb/Northern Hama: intensified hostilities result in civilian casualties and displacement. On 26 November, the Abu Dhour crossing point in south rural Aleppo opened for the civilian movement in one direction, from NSAGs to GoS areas. Most of the people crossing are women and children; they are returning to their original villages in Hama, Idleb (Sinjar), and south rural Aleppo. In total: 280 families / 1,327 individuals (including 367 children). An estimated 60 percent of people crossing went to rural Hama, 10 percent to Sinjar area, while the rest headed for Aleppo (south rural and city). Area in Hama is being covered by WHO partner. • Hama: Deteriorating humanitarian situation in Northeast and East Hama. North East Syria: Ar Raqqa city security concerns. Northern Aleppo: Improved shelter and wash facilities in IDP camps in the Tal Rifaat Enclave. East Ghouta: Improved humanitarian access but access to health care and water remain insufficient. Yarmouk camp: Residents allowed returning. • Ministry of Health’s AIDS Program: “Ministry provides free treatment to patients living with AIDS and conducted scan of 15,000 people to investigate new infections in conflict-affected areas.” • Medical Doctors Syndicate’s President: “6,000 doctors left due to crisis, and more than 4,000 private clinics damaged … there are no funds to compensate affected doctors.” • “Deir Ez-Zor hospitals suffer lack of specialized service in neurosurgery, vascular surgery and anesthesiology.” OVERVIEW KEY HEALTH ISSUES Acute Jaundice Syndrome in Aleppo and Dara’a governorates –please see below. Suspected chemical exposure or unknown hazard in Aleppo city, Aleppo governorate, November 24, 2018 - WHO has received unconfirmed reports of patients arriving in health facilities in Aleppo city with symptoms that may be consistent with exposure to chemical agents. WHO is not involved in the process of verifying the alleged perpetrators, or the cause of the event. As a health agency, WHO concern is with the health dimension of the reported event. WHO has previously prepositioned supplies and conducted training of health workers to prepare for such events and now activating emergency procedures to assist in the public health response if needed. WHO Syria is in direct contact with the hospital managers in Aleppo and the Directorate of Health of Aleppo. As of morning 25 November, based on the information received, patients have been discharged from the hospitals. Access to Menbij –only one health service provider from Qamishli side. Access to massive displacement in Deir-ez-Zor governorate - due to ongoing fights against ISIS – Hajin area. Deir-ez-Zor: Support DoH in development of plans to increase access to health services by local population, including rehabilitation of PHC centers, strengthening EPI coverage microplans; enable more services by mobile teams; regular provision of medicines, consumables and medical equipment for DoH facilities; continue the support to the national Al Assad hospital; provide the required medical equipment for newly rehabilitated hospital wards on 3rd and 4th floors; provide support to Ath-Thawra PHC center (rehabilitation and equipment) considering its 24/7 functionality; support for 1 the setup of the ambulance center in Mayadin area as located between Abu Kamal and DeZ cities; focused support to routine vaccination in east and west side of the governorate; prioritizing response to PHC centers with the largest catchment areas. Ar Raqqa (Tabqa health facilities): Set up of nutrition stabilization center; enhancement of vaccination coverage; establishment of immunization point; enhanced continuous capacity building of staff; provision of hospital beds (75) and regular health supplies; strengthening lab and x-ray capacity; operationalize dialysis machines and water purification unit; find solutions for oxygen generating unit. Southern Syria: Daraa – functionalizing 65 (58%) partially functioning and 24 (21%) non-functioning PHC centers. Quneitra- functionalizing 22 (37%) partially functioning and 13 (22%) non-functioning PHC centers. KEY GAPS & CHALLENGES Key areas where humanitarian actors from within Syria face access challenges remain and are the focus for scaled up advocacy and programming efforts: Dara’a and Quneitra: Regular and sustained access to formerly NSAG-held areas in the south remains challenging for Syria based partners due to security concerns, administrative impediments, UXO contamination and extensive infrastructure damages. Eastern Ghouta: Humanitarian and commercial access, as well as civilian movements, has improved, with variations in access to locations inside the area: Duma and Zamalka continue to be considered by the UN as hard-to-reach due to restrictions on humanitarian access and civilian movement. Northern Rural Homs: Since May 2018, when the Government of Syria and non-state armed groups reached a local ‘reconciliation’ agreement, access to some areas was limited. Since September 2018, however, access for the UN and INGOs to the area has improved following a blanket authorization provided by the Governor. Deir-ez-Zor and Ar-Raqqa city: Ongoing fighting and insecurity, shifting front lines and landmine/ contamination remain key challenges to scaling up the response, particularly to some rural areas of southern Deir-ez-Zor. Contamination and growing insecurity have also constrained further efforts by UN agencies in Ar-Raqqa City. Menbij: Humanitarian partners from within Syria have sought to address unmet humanitarian needs in Menbij through the Inter-Agency convoy modality. However, an ongoing challenge has been gaining acceptance for SARC due to the presence of the Kurdish Red Crescent in the area. As result, emergency assistance has only been provided on a few occasions by partners (including health sector) in Qamishli based on ad hoc requests from the Governor of Hassakeh. Afrin: Humanitarian partners from within Syria have also sought to address unmet humanitarian needs in Afrin through the Inter-Agency convoy modality. However, challenges relate to the ongoing presence of the Turkish Red Crescent in the area and pending Government approvals. Rukban: a humanitarian convoy was successfully completed in November 2018, providing humanitarian assistance to some 50,000 people and carrying out a vaccination campaign for over 5,000 children. However, the convoy took a year of negotiations and efforts are underway to dispatch a second convoy in December 2018. OPERATIONAL UPDATES 20- 25 November – WHO HQ technical mission for “Syria Health Diplomacy Project: Contributing to Social Cohesion through Health”. An adapted approach to meet the demands of a changing context while to contribute to improving social cohesion, by strengthening and enhancing the Syrian Public Health System’s capacity to deliver a package of 2 adapted emergency response and long-term interventions that serve the most vulnerable in all 270 sub-districts of Syria: Workforce: Grow & capacitate a new generation of Syrian Health Professionals; Services: Restore, strengthen, and protect health services; People & Minds: Expand capacities to address MHPSS as well as disabilities. 1. Coordination: • Conducted health sector meeting in Damascus. • Updated list of public health facilities for reconstruction /rehabilitation across Syria 28 November 2018, Syria hub. Produced Health Cluster Bulletin for November. 2. Information and planning: • Developed infographics of summary of key performance indicators for Q3 and Q1-Q2 2018 (across Syria; North-east Syria; North-west Syria; Southern Syria). • Developed 4W (WHO and Health Sector) snapshots for October 2018. • Monitored a weekly update on shift of control, functionality status of public HFs, and control areas for regained areas in the south of Syria. • Completed the analysis of health sector Syria performance against 2018 HRP indicators (based on WoS health sector 2018 HRP severity scale). • Updated assessment registry for WHO. • Data processing and analyzing for producing Neonatal resuscitation infographic - October 2018 for nutrition programme. Developed infant home caring data entry tool. • Participated in the second regional workshop on Development of National eHealth Strategies, Beirut, Lebanon. 3. Health operations: Northern Syria response: • Afrin response: 2 national NGO mobile teams continue to be deployed in area of Afrin displacement. PHC, MHPSS services, nutrition screening activities are provided by MMTs. • Eastern rural Aleppo response: 2 national NGOs mobile teams continue to be deployed in eastern rural Aleppo, in addition to 1 WHO-supported PHC in Dier Hafeir run by a national NGO. 1 MMT also serves Debsi Afnan (western rural Ar-Raqqa). • NW response: 2 WHO-supported MMTs are deployed in Tal Ad-Damman, Al-Boudier and surrounding areas. PHC, MHPSS services, nutrition screening activities