WHO Syria, Weeks 5-6, 1 – 14 February 2019 General developments & political & security situation The security situation in the East of Syria is assessed as tense and unstable, mainly on the frontlines of Hajin pocket (ISIL) in the far South East rural of Deir Ez-Zour, where the fighting intensified between the SDF fighters, backed by US and ICF airstrikes, and ISIL. Meanwhile, the threat of a Turkish military operation against SDF/YPG is on hold. The military situation in the Northern area remains volatile and tense. While Idlib governorate is still witnessing a series of IED related incidents. The security situation in the central area remains volatile and unstable. The main hot spots remain north rural Hama and East Rural Homs. Military offensives by SAA are ongoing against NSAGs positions in north rural Hama and against ISIL positions in the deserted areas of Eastern Homs with no change in the areas of control. The situation in the Southern area was relatively calm but unpredictable. Tension is still witnessed between GoS and reconciled NSAGs in Daraa governorate. OVERVIEW KEY HEALTH ISSUES Key Dates and Events coming up for HPC Syria TDG, 4-5 February in Istanbul HNO published, 15 February Senior Officials Meeting (SOM), 21 February HRP finalized & shared with GoS, 9 March Brussels III Conference, first week of April (date TBC) Convoy to Rukban: On 6 February, a joint UN/SARC convoy bringing emergency life-saving assistance to over 40,000 displaced people, the majority of whom are women and children, reached Rukban makeshift settlement near the Jordan border. The inter-agency convoy, the second convoy that deployed from within Syria, consists of 133 trucks (118 with humanitarian assistance and 15 with logistical supplies), more than 300 UN and SARC staff and volunteers. It is delivering humanitarian supplies that had been identified as critically needed following the assessment completed during the previous convoy which took place in November 2018. These include food, medicines and medical equipment, items for the cold winter months, shelter materials, dignity kits for women and girls, as well as nutrition, education supplies and children’s recreational kits. The delivery and distribution of the humanitarian assistance are monitored closely by UN and SARC teams to ensure that it is delivered fairly and equitably to civilians in need in addition to conducting distribution and post-distribution surveys. Since the first convoy was not able to target all children in the camp, vaccinations points have been set up inside the camp where an estimated 10,000 children under five-years-of-age will be immunized, including the 5,100 children that were vaccinated during the first convoy who will receive booster vaccination. As of 14 February, the operation is well underway with most materials offloaded, and distributions and vaccination advancing well. The operation is expected to last approximately until 14 February. Health supplies delivered by WHO were offloaded at Sham health clinic after completion of assessment of all other reported health points in the camp (9.6 tons for more than 75,000 treatments). The shipment contained lifesaving and life-sustaining medicines, including NCD medicines, standard health kits, supplies, wheelchairs and a generator. Response to Al Hol camp: The UN and humanitarian partners continue to scale up the response efforts in Al Hol camp providing life-saving assistance to new arrivals in the reception and screening areas including ready to eat ration, mattresses and blankets, tents, winterization and hygiene kits. The response also includes the presence of 24-hour medical and protection response teams in the reception areas to quickly identify the most vulnerable and provide urgent assistance, especially to unaccompanied or separated children, and those who are in need of immediate medical 1 assistance. Since the beginning of December, a total of 54 children and adults has died either en route or shortly after arriving in the camp. Vaccination: The National bOPV campaign has started this week (10-14 February 2019) targeting 2,774311 children (0- 59 months) in all governorates, except Idlib (details are below). KEY GAPS & CHALLENGES Shortage of hemodialysis session in the south and north-west of Syria is reported. Al Hol camp response: o Assess IDPs before they reach Al-Hol camp o Provision of health services in Annex (foreigner’s families) o Active referral system with needed ambulances o Transportation of cold cases to referral hospitals in Al-Hassakeh (including specialized consultation, Lab analysis, and advanced health services) o Risk of disease outbreaks related to harsh winter season, unsafe water, poor sanitation and hygiene, overcrowding, and poor vaccination coverage o Mental health and psychosocial conditions, in addition to gender-based violence o Sustain the life-saving medicines, NCDs treatments OPERATIONAL UPDATES 1. Coordination: Close follow up on planning and response to the emergency situation in and around Al Hol camp in Hassakeh governorate. Regular health sector updates are being circulated through the email list. Participated in the WoS Health Cluster/IMO meeting in Beirut, 11-13 February. A presentation was shared on the implementation strategy of health sector Syria hub. Worked with IM to finalize a set of indicators for WHO Syria and WoS WHO KPI snapshots for 2019. Worked with the WoS health team on the update of consequence of underfunding for health sector. Updated the list of health sector organizations involved in or planning reconstruction/physical rehabilitation of health facilities and their equipping across Syria in 2019. Updated with the support of sub-national sectors (Aleppo, Lattakia/Tartous, Homs/Hama, NES) information on coverage by mobile medical teams and health points across the country. Reviewed, revised and returned for editing drafts of health sector projects. A total of 20 projects were reviewed with the estimated amount of 70,931,471 USD. 7 projects are requested to reduce budgets. 5 projects are rejected. 8 projects have maintained the originally requested budgets. A total of 15 projects are recommended for next stage. Took part in the technical meeting with representatives of MoFA and line ministries on HNO and HRP. The line ministry has agreed with the reflected health sector priorities. Submitted 10 WoS WHO projects (health, nutrition, WASH) under 2019 HRP. The projects will undergo the review and vetting process at the WoS level. Project Title Damascus Gaziantep Iraq Total for 2019 Trauma and Disability 15,920,500 6,460,000 875,000 23,255,500 Secondary Health Care 41,925,550 8,540,000 - 50,465,550 Primary Health Care 19,286,000 9,720,000 2,820,000 31,826,000 Immunization 4,800,000 6,620,000 - 11,420,000 EWARS/N 4,922,000 2,985,000 - 7,907,000 Mental Health 3,595,000 2,665,000 6,260,000 2 Health Information System 3,630,900 645,000 4,275,900 Coordination 2,450,000 950,000 3,400,000 Total For Health Projects 96,529,950 38,585,000 3,695,000 138,809,950 Nutrition 1,045,000 60,000 1,105,000 WASH 1,000,000 1,000,000 TOTAL 98,574,950 38,645,000 3,695,000 140,914,950 70.0% 27.4% 2.6% Worked with the technical officers on finalization of their 2019 PMDS and alignment with GPW 13 objectives. Followed on day to day updates and next steps for the mission in Rukban camp (offloading and distribution of health supplies; coordination on the ground). 2. Information and planning: Developed infographics of summary of key performance indicators for 2018 (across Syria; North-east Syria; North- west Syria; Southern Syria). Developed 4W (WHO and Health Sector) snapshots for 2018. Provided 4Ws consolidated figures on delivered assistance by WHO in January 2019. Developed a draft for Summary of WHO key performance indicators 2019, Whole of Syria. Updated WHO key performance indicators 2019, Syria. Conducted site visits to MoH hospitals (Hama National hospital, Al-Assad Medical Complex) in Hama to assess the prior needs as part of strengthening the national health information systems at secondary care level. Participated in WoS health cluster and IMO meeting in Beirut, 11-13 February. Participated in the IMWG meeting to discuss 4Ws 2019 at OCHA. Conducted health assessment visits in Al Mabrouka and Al Hol camps in NES. 3. Health operations: Northern Syria response: Menbij Convoy: UN and SARC informed the KSA that after the KSA approval to send humanitarian convoy to Menbij, MoFA also approved the convoy to Menbij to be implemented by SARC. The draft list of items has been shared with KSA to be channeled to a local relief committee that will be coordinating with SARC teams. Following-up proposed evacuation of mental health patients’ from Azzaz to Aleppo facility, Aleppo team has been in touch with Aleppo SARC branch. SARC expressed the readiness to facilitate the transportation upon approval of all parties. In addition, Aleppo team met with Ibn Khaldoun mental hospital management in Aleppo, the hospital currently provides services to 210 inpatients and capable to receive up to 300 residents. If and when necessary, WHO Aleppo team will scale up its assistance to the hospital to meet the increased needs with new patients. 6 cases of TB in Fafin area during reporting period with a total number is 48 and all of them are on treatment. Ongoing coordination with SARC to find the best feasible solution to deliver TB medicine for TB cases in Western rural of Aleppo. Expanding EWAR reporting SSs in Aleppo, as 4 SSs start to report through EWARS electronic system. Two ongoing MOUs with two national partners. 11 MMTs are deployed: 4 in eastern rural of Aleppo, 3 in southern rural and 4 in Afrin IDPs response.