EMERGENCY RESPONSE TO COVID-19 in Mixed Migration Context in Bosnia and Herzegovina SITUATION REPORT #44 / 25 January 2021 Reporting Period: 11 - 25/01/2021 http://drc.ba/covid19_resources WEEKLY HIGHLIGHTS UPDATES: 120,143 cases of COVID-19 confirmed in BiH, 4,593 deaths and 92,542 recovered patients.1 8 PoCs exhibiting symptoms and 8 PoCs exhibiting COVID-19-like symptoms monitored by PHC and DRC medical isolated in teams in TRCs: 5 in TRC Miral and 3 in TRC Blazuj. reception facilities 12 new PoCs exhibiting COVID-19-like symptoms referred to symptomatic isolation in reception centers: 4 in TRC Miral, 1 in TRC Sedra and 7 in TRC Blazuj. 489 PoCs screened in 111 PoCs referred to preventive isolation in reception facilities. reception facilities 489 PoCs screened for COVID-19 symptoms: all new arrivals to temporary reception facilities in BiH during the reporting period. In addition, 1,184 PoCs 1,184 PoCs underwent screening procedure within the provisional camp Lipa. screened in out-of- site locations 66 PoCs monitored in preventive isolation by DRC Medical Officers (65 in TRC Miral and 1 in Sedra). 0 new PoCs 18 PoCs tested for COVID-19. All results confirmed negative. confirmed positive for COVID-19 CUMULATIVE: KEY DEVELOPMENTS AND CHALLENGES In the provisional camp Lipa – accommodating around 900 PoCs stranded on the 33 PoCs positive site after the closure of the former ETC Lipa – health concerns have been critical for for COVID-19 days due to the sub-standard conditions of the site. In addition to infectious and communicable diseases (primarily scabies), the most common health issue among 63,178 COVID- the population (single males) is related to respiratory tract infections (common cold, 19 screenings in sore throat, pneumonia and bronchitis). Additionally, performing emergency health reception facilities care in precarious hygiene and sanitary conditions at the site, coupled with the impossibility of establishing measures preventing the spread of COVID-19 within the 1 Official statistics for Federation of BiH, Republika Srpska and Brcko District and in out-of-site site (and lack of specific diagnostic tests), makes it very difficult for medical locations professionals to respond properly to either identification or treatment of COVID-19 cases. The situation is additionally complicated by a number of service providers 391 PoCs tested working at the site and not following basic Infection Prevention and Control (IPC) for COVID-19 measures for COVID-19, such as wearing a mask, practicing hand hygiene and maintaining physical distance. There is a strong possibility that the virus itself will be introduced into the population of PoCs by service providers who do not comply with measures imposed by relevant health authorities. It is necessary to implement all necessary IPC measures, including establishment of isolation areas, as well as referral pathways for COVID-19 cases, at the Lipa site. DRC, coordinating its activities with PHC, maintains daily monitoring of PoCs with symptoms related to COVID-19. Attempts to refer COVID-19 symptomatic patients from Lipa to TRC Miral have largely been unsuccessful, due to the overcrowding of the Miral facility. Accommodation capacities in general in TRCs are reaching maximum, making it necessary to accommodate PoCs inside areas that are intended for isolation (preventive and symptomatic). This could additionally jeopardize public health of the general population in already overpopulated TRCs. A total of 107 PoCs were discharged from preventive isolation in all TRCs in BiH, and 23 PoCs from symptomatic isolation, upon the expiry of isolation and monitoring periods. In the same period, 3 PoCs left preventive and 1 PoC left symptomatic isolation on their own will, opening a public health risk. PREVENTIVE ISOLATION OVERVIEW 80 67 60 40 35 19 20 13 13 11 6 7 7 5 8 8 3 0 1 0 3 0 2 0 1 1 1 0 3 0 0 3 0 0 0 2 0 0 0 2 0 11-Jan 12-Jan 13-Jan 14-Jan 15-Jan 16-Jan 18-Jan 19-Jan 20-Jan 21-Jan 22-Jan 23-Jan # of PoCs referred to isolation area (new arrivals/ pushbacks/ exposed to COVID-19) on the date of reporting* Discharged from preventive isolation Left preventive isolation 2 SYMPTOMATIC ISOLATION OVERVIEW 8 7 6 6 4 4 3 3 3 3 2 2 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11-Jan 12-Jan 13-Jan 14-Jan 15-Jan 16-Jan 18-Jan 19-Jan 20-Jan 21-Jan 22-Jan 23-Jan # of PoCs referred to isolation, exhibiting symptoms of COVID-19 on the date of reporting** Discharged from Symptomatic isolation Left Smytomatic Isolation Outreach response: o PoCs in out-of-site locations are provided with medical assistance by DRC and RC teams visiting the sites, delivering First Aid and performing medical screening of PoCs for COVID-19 symptoms. o DRC medical teams, with direct engagement of PHC Bihac medical team, are performing medical consultations for PoCs accommodated in the tented Lipa site. o Transfers from PoCs from out-of-site locations to TRCs without prior coordination seriously jeopardize preventive COVID-19 measures in TRCs. A case in point is the transfer of PoCs from Bosanska Bojna to TRC Sedra on Friday 22 January: due to the lack of prior information and coordination of the transfer, the PoCs transferred from outreach locations did not go undergo medical entry screening in TRC Sedra, and simply mixed with the general population. OPERATIONAL PREPAREDNESS AND RESPONSE COVID-19 Response in TRCs in BiH: o Capacities for preventive and symptomatic isolation in TRCs in BiH have been preserved. At the moment, a total of 123 beds in TRCs in USC are available for preventive isolation, while a total of 202 beds are at disposal of POCs with COVID-19 symptoms. 3 OVERVIEW OF DESIGNATED ISOLATION AREA (COVID-19) 25 JANUARY 3500 3205 3000 2500 2000 1500 1078 1000 755 369 500 305 0 30 0 50 54 20 28 6 41 10 0 Usivak Blazuj Miral Borici Sedra Current no of PoCs in TRC Isolation for Preventive monitoring Isolation for COVID-19 expressed symptoms o In line with COVID-19 testing procedures for the local population, PoCs exhibiting mild or moderate symptoms are not tested, but frequently monitored in isolation areas by both PHC and DRC medical staff. MoH and PHIs are informed on a daily basis on the conditions of these patients. o Security of isolation areas needs to be improved in order to establish better compliance with COVID-19 preventive measures, since several beneficiaries left isolation during night hours. Coordination with authorities and health actors: o As per request of Ministry of Health, Labor and Social Policy of USC, as well Service for Foreign Affairs, DRC has shared a minimum of preconditions that must be met in order for the medical team to start working on new tented Lipa site in full capacity, including all the challenges that the core medical team is facing at the moment. o Weekly Health SnapShot for new tented Lipa site is being shared with relevant authorities and actors, in order to identify key health concerns and develop further activities, as well as to mitigate public health risks for the population accommodated there and service deliverers attending the site. o Due to a suspect case of diphtheria inside TRC Blazuj, that resulted in death, under joint coordination of DRC, IOM, PHC Sarajevo, following the recommendations of Public Health Institute of Sarajevo Canton, a mass screening for signs and symptoms of diphtheria, as well further actions (isolation, treatment, disinfection) was conducted on Wednesday 13th of January. Since diphtheria is transmitted in a similar way to COVID19, compliance with all recommended IPC measures is beneficial for prevention of transmission of both infections. o Due to limited capacities of symptomatic and preventive isolation in Una-Sana Canton, as well overstretched health systems lacking specialized diagnostic equipment (Cantonal Hospital not yet fully operational for this purpose), the immediate needs for diagnostic of population of migrants and asylum seekers related to COVID-19 are not being met in the last several weeks. DRC has launched additional 4 PCR testing of PoCs accommodated in preventive and symptomatic isolation areas of TRCs in USC, engaging a private health care actor through the IcSP project “Addressing COVID-19 challenges within the Migrant and Refugee Response in the Western Balkans.” Measures related to humanitarian staff: o Humanitarian staff working in the reception centers should continuously self-monitor2. In case humanitarian staff have been in contact with persons confirmed positive for COVID-19, they should inform their health provider and follow the suggested measures. Staff exhibiting COVID-19 like symptoms, including fever, should suspend their presence from the reception centers until fully recovered. Additionally, information should be shared with DRC medical teams, to ensure contact tracing and mitigating the risk of spread of COVID-19 infection. MEASURES ANNOUNCED BY BIH AUTHORITIES Following the request from the Ministry of Education of USC, Crisis Board of USC has announced that epidemiological situation has not yet improved to the point that some IPC measures could be alleviated. http://vladausk.ba/v4/files/media/pdf/60094cd345b608.80980887_Krizni%20stab- Zakljucak%20za%20obrazovanje.pdf Federal Ministry of Health has extended the current COVID19 related order for additional 2 weeks. https://covid19.fmoh.gov.ba/uploads/files/Naredbe_170121- d0e8533887bc4e592a783c20300e6974235bd5ac.pdf Federal Ministry of health has shared the plan of immunization for the population of Bosnia and Herzegovina. http://www.fbihvlada.gov.ba/bosanski/aktuelno_v2.php?akt_id=9052 Federal Ministry of health is reviewing the possibility of importation of Russian and Chinese vaccine, as well direct procurement from Pfizer, due to delay in delivery of vaccine against COVID19 through COVAX system.