health sector bulletin january 2020 dialysis machine …...the border crossings of al-ramtha and of...
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PAGE 1
HEALTH SECTOR BULLETIN
JANUARY 2020
Dialysis Machine in Al Tabaqa National Hospital – Photo by WHO
SYRIAN ARAB REPUBLIC Emergency type: Level 3 Emergency
Reporting period: 01-01-2020 to 31-01-2020
HIGHLIGHTS HEALTH SECTOR
A total of 277 Health Facilities are supported by Health
Sector Partners in 14 governorates.
WHO dispatched 82.5 tons of medical & lab supplies,
printing material, vehicles & generators - covering 9
governorates The shipments are sufficient to provide more
than total number of treatments is 650,223 and 1,295
trauma cases
As a part of the contingency response plan for the evolving
situation in NWS, five WHO supported implementing
partners deployed 11 medical teams to provide integrated
health care services The teams are covering more than 40
villages in the south and north rural Aleppo governorates.
WHO supported Ministry of Health on preparedness and
response activities for 2019-nCoV outbreak. WHO
provides technical support to strengthen surveillance,
laboratory capacity, entry screening, Infection Prevention
and Control as well as risk communication.
Security Council renewed resolution 2165 (2014), for a
period of six months, that is, until 10 July 2020, excluding
the border crossings of Al-Ramtha and of Al Yarubiyah.
UNICEF reached 2308 household in Al Hol Camp with
information on health, nutrition and WASH while UNHCR
assisted more than 2300 IDPs and around 4000 refugees.
71
HEALTH SECTOR PARTNERS
KITS DELIVERED TO HEALTH FACILITIES/PARTNERS
02 IEHK SUPPLEMENTARY KITS
12 TRAUMA A & B KITS
12 NCD KITS
SUPPORTED HEALTH FACILITIES
277 HEALTH FACILITIES
HEALTH ACTION
1,301,323 MEDICAL PROCEDURES
948,790 TREATMENT COURSES
Number of deliveries attended by
skilled attendant Number of
deliveries attended by skilled
attendant
23,484 TRAUMA CASES
VACCINATION
36,020 PENTA 3
EWARS
1,257 REPORTING SITES
FUNDING $US
445 M REQUESTED FOR 2020
12 M PIN of Health Assistance
11.4 M Targeted with Health Interventions
3.4 M IDPs
445 Funds required
146,200
Returnees
PAGE 2
Public health risks, priorities, needs and gaps
The ongoing conflict, violence and displacement have grave public health consequences with increased
morbidities, mortalities and disabilities among affected and vulnerable population. The most affected are children,
women and elderly people.
Despite challenges, Ministry of Health and humanitarian partners continue to assist people in need where access is
possible with focus on collective shelters and IDP camps delivering essential health services.
With the deplorable condition of the health facilities and inadequate clean water, there is a likelihood of a rise in the
communicable diseases. In the face of high levels of displacement and accompanying threats to physical and mental
Situation update
The security situation remains unstable and volatile, with the main hot spots in Al-Hasakah, Ar-Raqqah, Aleppo,
Latakia, Hama and Idlib governorates. Hundreds of thousands of people in northeast and northwest Syria are at
risk amid ongoing violence. The civilians continue to pay a very high price.
The Eastern region is still subject to several escalations across the three governorates. Ras A-Ain Axis witnessed
escalation between the Turkish forces/SNA and the SAA/ Russian forces. Where, intense Turkish/SNA artillery
shelling targeted SAA positions in the vicinities of Abu Rasin and Tal Tamer towns, the shelling expanded to
several villages such as Tal Tawel, Tal Ward, Khrbat Al-Sha'ir and Umm Al-Kef. Reportedly, the attack resulted in
several casualties among SAA, moreover, a large IDPs movements were noticed in the targeted area such as Abu
Rasin town, Kasra and Daher Al Arab villages.
As of 29 January and since 1 December 2019, nearly 390,000 people have fled from their homes, mainly from
southern Idleb and western Aleppo governorates, mostly escaping hostilities by moving to urban centers and IDP
camps in northwest Idleb. Most of the people displaced in northwest Syria since 15 January have been displaced
multiple times before, with each new displacement introducing new risks and intensifying existing vulnerabilities.
The population of Al Hol is 66,101 people (18,208 HHs); comprising of 46 per cent Iraqis (30,724), 39 per cent
Syrians (25,780) and 15 per cent third country nationals (TCNs) (9,597).
The access to primary health care services in Al Hol Camp has improved with 15 static medical points, eight medical
mobile teams and three field hospitals functioning. Specialist services are also available through three delivery
clinics, two HIV and TB clinics, and two static and two mobile teams for vaccinations and leishmaniosis. Five health
actors are supporting Areesha Camp, while six health actors with seven health facilities are active in Al-Mahmoudli
camp.
The total number of people who left Rukban transiting through Homs shelters remains at 19,054 people. People
have been temporarily accommodated in five collective shelters in Homs (Mahmoud Othman in Al-Qusour, Baraa
Ibn Malek in Deir Baalba, and Abdul Rahman Shattoor, the Teachers Institute and Art Institute in Al Bayada).
As of 20 January, shelters reportedly empty. After leaving the shelters, an estimated 3,230 families are now settled
in Homs Governorate of whom 801 returned to their areas of origin (532 Mahin, 204 Al-Qariatein and 65 Palmyra),
and 179 families settled in Hama Governorate.
UN Inter-Agency Mission was conducted during end of January for four days to seven sites - Al Zohouryeh village,
Deir Baalba neighborhood, Shamsin, Industrial Hassya , Mahin, Qaryatein and Foruglus (Malaha area) area – to
assess the availability of services and gaps. The main needs are essential medicines, wheelchairs, ambulance in
Qareteen city, vaccination in camps and reproductive health services in Deir Baalba neighborhood. The health
partners have been advised to address the needs.
PAGE 3
well-being, surveillance and response capacity for epidemic-prone diseases, as well as immunization services, must
be maintained and strengthened.
Communicable diseases
EWARS and epidemiological updates at national level
Surveillance performance:
A total of 1118 out of 1257 active reporting sites (88.9%) in all 14 governorates of Syria reported through
early warning alert and response system (EWARS) with 92.3 % of timeliness.
One reporting site was newly recruited in Al-Hasakeh.
Total number of consultations was 1 538 781. 50.2% of the cases were among females and 42.3% were
among children under 5 years.
Out of the 1 538 781 total consultations, a total of 214 996 EWARS notifiable cases were reported.
Morbidity:
The leading causes of morbidity among all age groups were influenza-like illnesses, and acute diarrhoea. The
breakdown was as follows:
Influenza-like illness (ILI): 135 967, accounting for 63.2% of total cases. Most cases reported from Aleppo,
Deir-ez-Zor and Tartous.
Acute diarrhoea (AD): 47 545 (22.1% of total cases), most reported from Deir-ez-Zor, Aleppo, and Idleb.
Acute jaundice syndrome (AJS): 2 371 most reported from Deir-ez-Zor, Ar-Raqqa, and Idleb.
Sever acute respiratory infections (SARI): 2 358, most reported from Tartous, Hama and Damascus.
Suspected measles (SM): 157, most reported from Ar-Raqqa, Homs and Aleppo.
Acute flaccid paralysis (AFP): 22, most reported from Damascus, Hama, and Aleppo.
For the “other diseases” category 25 876 cases were reported, with the most reported cases is
leishmaniasis of cases (11 861), most reported from Deir-ez-Zor, Aleppo, and Idleb
8.4%
3.2%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3
Per
cen
tage
Week Number
Proportional Morbidity of top 5 diseases among the total consultation( week 4,2019 - week 3,2020)
ILI AD LSH LIC SCA
PAGE 4
EWARS and epidemiological situation in Al-Hol camp
Surveillance performance:
Total number of reporting site is 24.
Average completeness of reporting 79.7%, and average timelines is 59.6%.
Total number of consultations were 43 512. 57.4% of the cases were among females and 52.5% were
distributed among children under 5 years.
Morbidity:
Out of the 43 512 total consultations, 8 182 EWARS notifiable cases were reported.
The leading causes of morbidity among all age groups were influenza-like illnesses (63.6%/5 200) then
acute diarrhoea (21.7%/1 776).
4 suspected measles was reported, two of them were under five years old, and the other two were above
five years’ old
Zero cases of AFP reported.
Public health responses
2019-nCoV
As of end of January, no suspected case of 2019-nCoV were reported in Syria.
WHO supported MoH on preparedness and response activities for 2019-nCoV outbreak. WHO provides
technical support to strengthen surveillance, laboratory capacity, entry screening, IPC measurement, as
well as risk communication. Daily follow up on SARI cases and entry screening are in place. WHO has also
supported them developing passenger location cards for points of entry and investigating forms for
suspected 2019-nCoV. WHO has provided MOH with PPE (500 medical masks(N95), 10,000 surgical masks,
200 goggles, 10,000 gloves, etc.) 50 stethoscope and pulse oximeter for each, and 4,000 nasopharyngeal
swabs for laboratory testing.
Between 2 and 3 February, a joint meeting with MOH and WHO was conducted in Damascus. WR and the
Deputy Minister attended. More than 50 MOH officers participated and discuss the preparedness and
response plan, investigation, and laboratory procedure. During the meeting, MOH agreed on SoP in entry
screening.
Acute diarrheal cases
An increase of acute diarrhea cases was reported from 8st of January 2020 in Tal Maskan and Bitariye in
Rural Damascus. Between 8 and 18 of January 2020, a total of 190 (U5yrs:78, above 5yrs: 112) cases with
no associated death were reported. The symptoms were acute diarrhea. The severity of diarrhea ranges
mild to moderate. On 9 January, three samples of water network from Tal Maska and tested. The results
showed all sample had no residual chlorine and identified fecal contamination (E. coli + fecal coliform) in
all three samples. The water in the network was sterilized after the analysis immediately.
An increase of acute diarrhea cases was reported from 31st of December 2019 in Ashrafia Al-Wadi and
Jdeideh Al-Wadi in Rural Damascus. From 31 of December till 11 of January 2020, a total of 882
(U5yrs:199, above 5yrs: 683) cases with no associated death were reported though EWARS. The common
symptoms were acute diarrhea and vomiting. The severity of diarrhea ranges mild to moderate. Coliform
contamination was found in water samples collected from both neighborhoods. E.Coli was detected in
water samples from Jdidet el-Wadi. A laboratory analysis of human stool sample detects norovirus and
campylobacter. The contaminated water sources were sterilized, and the use of the contaminated water
source was banned.
PAGE 5
Suspected measles
According to MOH, during 2019, a total of 1221 suspected cases reported and among them 27 cases were
tested positive for measles.
There is one confirmed case of measles reported from Aleppo on 15th of January. The case was child with
8 months old. DoH in Aleppo conducted local vaccination activity of MMR vaccines with vitamin A and 38
children in the neighborhood were vaccinated.
Influenza
An increase of proportional morbidity of influenza-like illness (ILI) and severe acute respiratory infection
(SARI) has been observed. This trend is in line with the seasonality of the diseases considering that the
same trend was observed in the previous two years.
Between 1 January and 6 February, a total of 103 samples were collected from SARI cases admitted to ICU
and tested at the influenza reference laboratory. Among them, 23 cases tested were positive for influenza
(2 cases were influenza type A H1N1, 18 cases were influenza type A(not subtyped), and 3 cases were type
B)and 22 cases were negative, while test results of 58 cases were pending.
Cutaneous leishmaniasis
Between week 1 and 3 in 2020, a total of 6178 suspected cutaneous leishmaniasis were reported and most
reported from Deir-ez-Zor, Aleppo and Idleb in December. Specifically, in Deir-ez-Zor, a significant
increase of suspected cutaneous leishmaniasis has been observed since mid of October.
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728293031323334353637383940414243444546474849505152
Per
cen
tage
Week Number
Proportional morbidity of influenza-like-illness (ILI) cases among total consultations( week 1-52,2018,2019,2020)
2018 2019 2020
344349
363
0
200
400
600
800
1000
1200
20
19,
42
01
9,5
20
19,
62
01
9,7
20
19,
82
01
9,9
20
19,
102
01
9,11
20
19,
122
01
9,13
20
19,
142
01
9,15
20
19,
162
01
9,17
20
19,
182
01
9,19
20
19,
202
01
9,21
20
19,
222
01
9,23
20
19,
242
01
9,25
20
19,
262
01
9,27
20
19,
282
01
9,29
20
19,
302
01
9,31
20
19,
322
01
9,33
20
19,
342
01
9,35
20
19,
362
01
9,37
20
19,
382
01
9,39
20
19,
402
01
9,41
20
19,
422
01
9,43
20
19,
442
01
9,45
20
19,
462
01
9,47
20
19,
482
01
9,49
20
19,
502
01
9,51
20
19,
522
02
0,1
20
20,
22
02
0,3
Nu
mb
er o
f ca
ses
Week Number
Number of severe acute respiratory infection cases ( week 4,2019 - week 3,2020)
PAGE 6
From 21-22 January 2020, a training workshop on cutaneous leichmaniasis case management and early
detection and treatment was conducted in Al-Hassakeh. 25 health workers were trained to respond to the
severe increase of cutanious leishmaniasis cases from east countryside of Deir-ez-Zor.
Tuberculosis
WHO delivered three GeneXpert systems and testing cartridges to the National TB Programme. The
delivered system will contribute to scaling up the TB laboratory up to more than 60% of their capacity. The
related kits will cover testing of 2400 sputum samples plus 1200 body fluid samples. Also 45,000 Vit B6
was secured to support multi drug resistant patient from side-effects of TB medicine.
2 mobile clinics for TB diagnosis and case management started working in Aleppo and Deir-ez-Zor. 4
villages were visited in Deir-ez-Zor, 70 contact tracing were examined (25 TB suspected cases and no case
was confirmed), and TB medicines for 7 TB patients were delivered.
Mental Health and Psychosocial Services
The number of mental health consultations provided by health actors stands at 28,091.
There is continue scaling up MHPSS services in NES in coordination with partners and Qamishli hub.
Health facility Functionality
According to HeRAMS June 2019 report, out of 111 hospitals, 58 (52%) are fully functioning, 27 (24%) partially
functioning and 26 (24%) are non-functioning. Out of 1808 Public health centers, 833 (46%) are functioning, 389
(22%) partially functioning and 586 (32%) are non-functioning.
Availability of health staff
Pharmacists represent (1%) of the total health staff at centers’ level, along with resident doctors (2%) followed by
general practitioners (4%); laboratory (6%); Specialists (7%); dentists (10%); midwives (12%); and nurses (58%).
Health Sector Action
Health Sector Coordination and service delivery
During this month, two regularly scheduled health sector coordination meetings were held on 7 and 28 January and
were attended by national Syrian NGOS, international NGOs, SARC and observers.
The health sector partners delivered health services and the cumulative monthly indicators (December)
are summarized in the below table.
1326
9551046
924
0
200
400
600
800
1000
1200
1400
1600
4 5 6 7 8 9 10111213141516171819202122232425262728293031323334353637383940414243444546474849505152 1 2 3
Nu
mb
er o
f ca
ses
Week Number
Figure 9: Number of suspected Leishmaniasis cases in in Deir-ez-Zor (week 4,2019 - week 3, 2020)
PAGE 7
HRP Indicator 2019 (Per Month) November
Med
ical
pro
ced
ure
s
1.1.1 Number of outpatient consultations provided 1,242,362
1.1.2 Total number of trauma consultations supported 23,484
1.1.3 Number of mental health consultations supported 22,649
1.1.4 Number of physical rehabilitation sessions
supported 2,376
1.1.5 Number of vaginal deliveries attended by a skilled
attendant 4,769
1.1.6 Number of caesarean sections supported 4,024
1.1.7 Number of cases referred for treatment (between
levels of care, cross-line and cross-border) 1,659
Child Health
36,020 children were immunized for Penta 3
Reproductive Health
Skilled birth attendants conducted 4,769 normal deliveries while 4,976 mothers underwent caesarean sections.
Health Cluster Partners Updates – November 2019
Health Cluster Partners continued supporting health service delivery across the country. Some of the highlights
are;
World Health Organization
Continued support with operational cost to sustain field
activities for the four medical mobile teams to cover
basic PHC services for Al Rukban returnees.
55,175 treatments of life-saving medicines delivered to
Damascus MOH, MOHE Central, Aleppo (Gyn/Obs
hospital, SARC), Hama (Al Br Hama NGO).
5 ambulances delivered to the Readiness & Emergency
Unit at MOH as part of the NW and the south response
(Aleppo, Hama, Homs, Daraa, Qunitra). 1 ambulance
delivered to the Aleppo university hospital, MOHE.
175 field workers from the Ministry of Electricity trained on first aid and basic trauma life support in three governorates (Lattakia, rural Damascus and Damascus). Two diesel generator (5KVA) were delivered to Qunetra
governorate. And two ultrasound machines model DC-N3
were delivered to Al-Khaldyeh & Al-Massaranyeh PHC
centers.
Two surgical tables donated to MoH Alwaleed hospital in
Hama governorate.
Interagency Mission Hama assessing needs of Rukhban arrivals
PAGE 8
UNHCR
During January an estimated 23,682 IDPs,
and 3916 refugees & asylum seekers assisted
to access basic package of primary health
care services through 13 PHCs supported by
UNHCR in Damascus, rural Damascus, Homs,
Hama, Aleppo and Al Hasakeh. Services
included medical consultations,
investigations. Treatment courses were
provided to an estimated 12,895 IDPs and
3390 refugees & asylum seekers
794 IDPs with critical medical conditions and
286 refugees in need for secondary care were
referred by UNHCR partners to hospitals and
received free of charge secondary care
services.
Estimated 9895 PoCs reached by community
based health activities through 19 health
points in community centers in Hasakeh,
Aleppo, rural Aleppo, rural Hama, rural
Homs, Tartous, rural Tartous, Qunetra , rural
Daraa and rural Damascus. In
details, 3674 received basic Medical
consultation, while 6221 PoC participated
and benefited of health promotion and
disease prevention activities conducted by
community health workers inside and
outside the community centers.
UNHCR primary health care service
UNICEF
C4D works on integrated community engagement
and awareness initiatives in Al Hol camp with ST, and
Ehram. The achievements were;
65 sector leaders and community services
committees were trained on Communication
skills and key messages (Vaccine & IYCF,
diarrhea and leishmania) in coordination
with camp management. Our goal was to
activate the community committees to take
their role as active actors in their community
in addition that after this training, each
sector leaders conducted ten awareness
session for Community leaders in their
sector.
The child and adolescent committees that
were formed by the camp management were
targeted by training them in theaters
focusing on their rights to the vaccine as well
as on Hygiene promotion, ten theaters were
performed by 25 children and 15 adolescents
from the camp.
2,308 households were reached with
comprehensive information on Health,
Nutrition, and WASH, and 42 mother
sessions conducted.
The basic messages were drawn in 16
kitchens in eight sectors in Al Hol camp.
UNICEF: Painting on kitchens
PAGE 9
Plans for future response
Plan to conduct vetting of HRP 2020 projects
Ensure health sector readiness and preparedness for COVID -19
Planning to conduct Cluster coordination performance monitoring during 1st Q 2020
Finalizing health sector component of HNO and HRP 2020
CONTACTS
Damascus
national
level
Aleppo
sub-national level
Homs
sub-national level
Lattakia/Tartous
sub-national
level
Qamishli
(north-east Syria):
sub-national level
Coordinators
Dr Jamshed Tanoli
Health Sector
Coordinator
Dr Kady Fares
Head of WHO
sub-office
Dr Nadia Aljamali,
Head of WHO
sub-office
Mr Hamza Hasan
Head of WHO
sub-office
Dr Khaled Al Khaled
Head of WHO sub-office
Information Management Unit
Mr Mutasem Mohammad, Information Management Officer, WHO Syria, [email protected]
Mr Ayman Al Mobayed, Information Management Officer, WHO Syria, [email protected]