WHO Syria: SITUATION REPORT Weeks 26 – 27 (22 June - 4 July), 2019 I- General Development, Political and Security Situation The security situation within the country remains volatile and unstable. The main hot spots remain As-Swieda, Al- Hassakah, Deir Ez-Zor, Hama, Aleppo and Idlib governorates. The reporting period witnessed a new wave of Israeli attacks on military positions around the capital, Damascus. According to state media, the Syrian Air Defenses intercepted hostile missiles fired by Israeli warplanes from the Lebanese airspace towards some of the military positions in the surroundings of Damascus city. Four civilians were killed and twenty-one were injured in Sahnaya town, South-west rural Damascus as the glass of the houses was shattered due to the pressure which resulted from the Israeli airstrikes. There are still remaining pockets of ISIL in the Eastern area which continued their asymmetric attacks against SDF as well as SAA on the other bank of the Euphrates river. SAA military operations are still taking place against NSAGs held towns in Idlib, Hama, Latakia and Aleppo Governorates while the armed conflict continued between Kurdish forces and Turkish backed NSAGs at several battlefields in North rural Aleppo. Three civilians were killed and seven others were wounded in a terrorist explosion of a motorbike bomb in Qanawat street of As -Swieda city. The motorbike bomb which was parked on Kanawat street was remotely detonated , claiming the lives of three citizens and wounding seven others. 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 consisting of 741 people (182 males, 208 females, and 351 children and infants), bringing the total number of people who left Rukban to 15,569 people (37.3%) out of the 41,700 residents. A number of displaced families returned from Jordanian refugee camps through Nassib border crossing to be transported later to their areas of permanent residence which have been liberated from terrorist groups. The Syrian and Russian coordination committees on the return of displaced Syrians asserted that tens of thousands of displaced Syrians returned to their areas which have been liberated from terrorist groups. The overall situation remains unstable in the Northern area. SAA airstrikes and ground shelling continue against NSAGs held towns, mainly in South rural Idlib, while the situation in Aleppo is still affected by the ongoing armed conflict between multiple warring sides. II- Key Health Issues The three million people in Idlib (majority of whom are civilians) in addition to the injured and more than 353,000 that were displaced since April require urgent access to health care services . The intensity of hostilities especially in Hama, Idlib, Aleppo and Ar-Raqqah is reportedly outweighing health response capacities in the areas. Local humanitarian actors are using their limited capacity to respond to the IDPs’ most urgent needs. However, the large number of IDPs, shortage of funds and the instability of the security situation are severely hampering the response. Twelve static medical points, 18 medical mobile teams, two vaccination teams, a leishmaniasis team and three maternity clinics are providing daily health care services to Al Hol camp inhabitants. Eight mobile medical teams and a fixed medical clinic are providing health care services at the Foreign Annex in Al- Hol camp; however, the Annex still lacks round-the-clock services. Page | 1 The three new field hospitals in Al-Hol camp lack safe blood supplies and, therefore, have limited capacity to perform surgical operations. WHO and the hospital managers are negotiating with the blood bank in Al-Hasakeh national hospital to secure regular supplies of blood. Two of the hospitals are operating round the clock and have a combined total of 46 beds. The third hospital, with five-beds, is open daily from 8.30 a.m. to 5 p.m. The hospitals provide emergency health care, laboratory and X-ray services, obstetrics and emergency surgery. Each hospital has incubators for infants and a two-bed intensive care unit (ICU) for short stays. Patients who need to stay more than two days in the ICUs are referred to hospitals in Al-Hasakeh. Water samples were randomly collected from water tanks in Al-Hol camp and analyzed at the national laboratory in Al-Hasakeh governorate. The results confirmed that most of the samples were contaminated with E-coli. WHO has delivered over 150 000 chlorine tabs to the camp to sterilize water and reduce the risk of waterborne diseases. III. WHO Response 1) Non-Communicable diseases & Primary health care Facilitated three capacity building trainings on NCDs topics (Chronic respiratory Diseases & electronic registry for Diabetes) under JPRM fund; targeted MOH staff with a total of trainees 75. Prepared and followed up on the celebration of the Thalassemia World Day in cooperation with MoH .The objective of the ceremony was to launch the Thalassemia Project for the alleviation of the disease burden, to highlight the cost-effective & feasible preventive measures, and underline the importance of sustainable and affordable antenatal care, pre-marriage counselling and testing to reduce diseases burden in Syria in addition to MOH call for commitment to the agreed multisectoral strategic approach to develop, implement and monitor action plan to tackle the disease and to stop having new-born babies with Thalassemia by 2025. Attended Strategic Framework meeting to review & discuss: A). Strategic Framework Progress reporting – end of 2018; B). challenges and way forward; C). Feedback on lessons learnt from planning and reporting of the current Strategic Framework. In close coordination with MOH counterparts and EMRO; continued following up on the arrangements for the Primary Health Care Measurement & Improvement Initiative /PHCMI workshop to be held between 30 July till 1 August 2019 in Cairo, including the national consultant to be accountable for PHC strategic planning, improvement actions, PHC indicators and the regular reporting on the PHC improvement progress at the national level. Finalizing the oral health project in Eastern Ghouta. A total of 4250 school students were reached with a total of oral health services 20,700, health promotion sessions for 97 teachers and 4250 students in addition to 12,450 preventive services. The final batch of caravans was received in NES, with a total of 14 prefabricated clinics to be activated in NES camps to provide basic PHC health care & MH services. Supported Al Qamsilhi Hub with 7 electricity generators in favor of the newly received caravans located in IDPs camps in Hassakeh & Raqqa governorates (Al Hol ,Al-Mahmoudli new camp , Ain Issa, Abu Khashab , Al- Areesha & Mabrouka ). Coordinated & followed up on the installation of dental equipment in favor of two PHCs affiliated to DOH Aleppo: Khaldya & Maasarnaya health centers. Dispatched 18 NCD kits of Insulin vials of different types to NGOs working in EG in rural Damascus, SARC Aleppo & Aleppo Hub, in addition to the following medical devices: 15 Digital & manual sphygmomanometer devices, 9 glycosometer devices,5 Digital thermometers, 4 Nebulization devices, 4 Pulse Oximeter, 1 Portable Oxygen Concentrator ,2 Water bath and medical consumables to Homs & Aleppo Hubs and 1 Steam Sterilizer with 80 Liter Capacity in favor of Jub Jandali PHC in Homs. The total number of treatment under PHC/NCD program is 74,651 during the reporting period. Page | 2 2) Trauma About 100 health workers were trained on trauma and disability in three governorates (Rural Damascus, Tartous and Damascus) . The following deliveries (23,778 treatments of trauma medicines and medical kits) were made during the reporting period: o 4 first aid kit delivered to Al Qutaifah Health Charity in Rural Damascus, Association For Poor Charity in Damascus and SARC in Damascus. o 1 Basic kit and 1 supplementary kit delivered to AL-Ber & Al-Ihsan NGO in Aleppo o 1 Basic kit and 1 supplementary kit delivered to SARC in Aleppo o 5 medical equipment (Gastrointestinal Fiberscope, Patient Monitor device, Diagnostic Ultrasonic system, Infant incubator) delivered to Ar-Raqqa National Hospital, KRC Al-Hol Camp, Alhasaka Health Authority, and Dierzzor Health Authority o 1758 treatments of antibiotics, anesthetics medicines, and analgesics delivered TO AL-Ber & Al-Ihsan in Aleppo, SARC Aleppo, Tall Abiad National Hospital, Al-Tabqa National Hospital in Ar-Raqqa, KRC Al- Hol Camp and Dierzzor Health Authority. Conducted a joint mission (MOH and WHO) to Hama Governorate to assess the health situation in the area, and explore the existing capacity of functioning hospitals in Hama governorate and recommend the most suitable trauma and critically-ill referral pathways. The following hospitals were visited and assessed: o Al Salamiah National Hospital. o Hama National Hospital. o Al Assad Hospital. o Al Hayat private hospital in Muhardeh. o Al Suqailbia National Hospital o Misiaf National Hospital. The Trauma and disability officer in Aleppo Hub conducted a mission to Al Qamishly as follows: o A field visit to Al Hol camp to follow on the issues related to trauma management and operated surgeries in the three field hospitals SARC - ICRC, MSJM - UNFPA and KRC hospitals. o A coordination meeting has been conducted with the UNDP in Al Qamishli to discuss the issues related to the artificial limbs project in Al Qamishli. o A Field visit to the artificial limbs workshop supported