WHO Syria, Week 33, August 2018

Transcription

1 WHO Syria, Week 33, August 2018 General developments & political & security situation The security situation across the country remains volatile and unstable with the main hot spots in the governorates of As-Swieda, Deir Ez-Zor, Aleppo, and Idlib. In the northwest, following another week of increased violence; hostilities exacted a heavy toll on the civilian population. At least 134 people, including many children, were reportedly killed last weekend in Idleb, Hama and Aleppo Governorates. The conflict reportedly resulted in damage to the Ma ret An-Nu man National hospital, which impacted emergency services for two days. A Statement by Panos Moumtzis, Regional Humanitarian Coordinator for the Syria Crisis, on Civilian Casualties in Northwest Syria was issued over the reported deaths. In northeastern Syria, the UN voiced its concern about the safety and protection of civilians in rural Deir-Ez-Zor Governorate where fighting in Hajin and Dashesha reportedly displaced more than 20,000 people (4,630 families) since July after conflict between the Syrian Democratic Forces (SDF) and the Islamic State of Iraq and the Levant (ISIL). Internally displaced people have reportedly settled in makeshift camps in the Governorate and are in urgent need of humanitarian assistance. While humanitarian organizations are able to access some displacement camps, other camps have yet to receive humanitarian assistance. In southwestern Syria SAA continued its operation against ISIL positions in the east and north east rural As- Suwayda. OVERVIEW KEY HEALTH ISSUES Health response to multiple and simultaneously evolving emergency situations across the country: WHO is currently responding to ongoing emergency needs in the southwest and preparing for a potential response to increased hostilities northwest Syria. Continued disruption to health services across the country, including the severe interruptions in services occurring during and after localized military offensives or truce agreements. Ongoing and increased risk of disease outbreaks across the country, particularly in vulnerable areas such as NES. KEY GAPS & CHALLENGES Urgent funding for Damascus hub scale-up of emergency operations in Northwest Syria. Attacks on health care facilities, health workers and patients must cease. The targeting of health facilities means that injured people, including children, have practically no access to health care. Humanitarian convoys bearing all essential life-saving and life-sustaining supplies must be allowed to proceed immediately to provide medical assistance across conflict lines and to newly accessible areas. Scale up of operations is required for UN partners in Ar-Raqqa city. UN approval to commence operations in Ar Raqqa has been obtained. OPERATIONAL UPDATES 1. Coordination: A regular bi-weekly Health Working Group meeting was conducted in Damascus. Issues of follow up and priorities include: situation and response in the southern Syria (response, needs, gaps and constraints); review of health situation and service provision in Ar-Raqqa city; health sector contingency operational plan for north-west Syria; health service availability in Arbin and Zamalka (eastern Ghouta), preparations for the visit to Syria of the Emergency Relief Coordinator, Mr Mark Lowcock, submission of mandatory 4W inputs, disease surveillance and response, vaccination, outcomes of the meeting with MOSAL on pending project proposals, reproductive health. Health sector strategy for SHF standard allocation is developed. Health sector preparedness and operational plan for north-west Syria is developed. 1

2 2. Information and planning: Infographic for profile of public health centres in NSAG areas of North West Syria, based on HeRAMS Q Jointly produced a report of health situation in Ar-Raqqa city, as of August 2018, by conducting a site visit to Ar-Raaq city to assess the capacity and preparedness of the five private hospitals using a standard HeRAMS tool to assess the availability of human resources, health services, equipment, medicines, and priority health needs Conducted a pilot assessment in five governorates by HIS-FPs to test the monitoring tool from statistical perspective on representative samples for public and NGOs health facilities Daily update on shift of control, functionality status of public HFs, and control areas for regained areas in south Syria Developed maps on: IDP camps in Quneitra; Current situation and functionality of public health facilities in Hama; HTR locations for WHO bi-monthly plan delivering medicines and supplies, as of 08 Aug 2018; Number of children screened, half1 2018; Drinking water status of uncontrolled groundwater wells in the East Ghouta (01 August 2018); Drinking water status of uncontrolled groundwater wells in East Ghouta, as 1 Aug Health operations: Northern Syria response: Afrin Response: No major changes in the situation as 26,494 families/138,807 individuals remain displaced from Afrin. 7 NNGOs mobile teams (WHO-supported) continue to be deployed in area of Afrin displacement. With a capacity of health workers providing essential health care services in Tall Refaat and surrounding Villages. furthermore, 2 Static medical points in Nubl and Zahra continue to be supported by WHO. WHO supports the provision of specialist and STHC health care services through an active referral pathway. In the past week, 44 cases were referred successfully to Al-Zahraa filed Hospital including obstetric deliveries outpatient consultations provided in the last week to Afrin IDPs through NGOs facilities supported by WHO. Eastern rural Aleppo response 6 NNGOs mobile teams (WHO-supported) continue to be deployed in eastern rural Aleppo. 12 specialist and 22 health workers provide essential services in Dier Hafier, Maskanieh, AL-Khafseh and surrounding Villages. WHO supports the provision of STHC health care services through an active Referral pathway, 36 cases referred successfully to Aleppo from eastern rural Aleppo. Planned scale up: 1 Static medical point in Dier Hafier supported by WHO will be starting to provide primary health care services NW response readiness: Last updated population figures 2,987,716 people are currently living in the NSAG-controlled areas of Idleb, western Aleppo, Northern Hama and Eastern Latakia. WHO Response plan is in place and to be reviewed in next 10 days. Preparedness actions in progress across strategic objectives. Coordination with DoH and SARC is in place and an outline of the response plan was shared. An urgent need of medical supplies identified, current stock is reviewed and replenishment is underway. 3 MOUs are to be activated in favor the expected scenarios in NWS, and 6 MMTs were prepared for any emergency intervention in Northwest Syria (NWS). In addition, 2 static points are planned to be active in NWS areas. Trauma and rehabilitation services will be scaled up through two mobile medical teams will be deployed through the partnership with YBY NGO (including distribution of different kind of assistive devices). STHC health care services will be enhanced to Aleppo hospital for advance health care services, Coordination with SARC were took place to insure smoothly patients transportation. Aleppo regular program follow-up: Nutrition and child health: Following up the NGOs response in Afrin IDPs locations and Aleppo. 2 SAM and 7 MAM cases in Aleppo and Afrin IDPs locations. Coordination with UNICEF supported mobile teams is in place TB/HIV: A field visit was conducted to Fafin camp to follow up the 12 recently diagnosed TB cases in the site. As a joint team from DoH and WHO met local health authority and agreed on steps to enhance coordination. 2

3 Mental Health: Ibn Khadloun provided 76 specialized MHPSS services through mobile clinic and the specialized team. 8 mhpss doctors working in 4 NNGOs provided 385 MHPSS services in Afrin displacement locations. 666 MHPSS and medical services have been provided in the GOPA community center (WHO-supported) Latakia response: Replenished Aleppo hub with 6 cholera Kits Delivered nutritional therapeutic items to Al-berr hospital in Homs and Al-Taalouf hospital in Aleppo Supported medical screening that was conducted by Lattakia DOH teams for IDPs in Al-Basset. Developed preparedness and response action plan for WHO NWS Response. Damascus, Rural Damascus As of 1 August 2018, 6,850 individuals from East Ghouta remained in 7 IDP Shelters. Over 33,000 individuals have now returned to their communities. IDPs from Herjelleh site were moved to Dweir site (1700 individuals), currently only two families remain at the Herjelleh site. East Ghouta response in numbers from 15 March 12 August 2018: 17 delivered shipments containing 797,841 medical treatments delivered accounting for 74 tons of health supplies. 48 EWARS sentinel sites reporting surveillance information, with 488 reports produced and 33 alerts investigated and responded to. 58 field assessment missions to shelters (IA and WHO) conducted by WHO staff 34 nutrition surveillance DoH mobile teams supported by WHO (with operational costs), 12 were operational in the past week. 18 malnourished children have been hospitalized in stabilization centres. 17 educational nutrition sessions have been conducted by WHO-supported NGOs (activity stopped since 16 July). 13 WHO-supported NGOs deployed for the response, with 5 NGOs operating in the past week through 9 mobile teams. 337,904 patients have been assisted by national NGOs including 7,459 in the past week. 9 MHPSS mobile teams deployed, with 4 operating in the past week, and 71 static medical points provide integrated MHPSS services. 14,836 basic psychological interventions have been provided to people. 2,813 patients hospitalized in public hospitals. 51,854 children under 5 vaccinated (polio and EPI), including 815 in the past week. WHO has supported 32 DoH mobile teams. South Syria (Dar a, Quneitra, Sweida) On 16 August, a United Nations/ Syrian Arab Red Crescent inter-agency team delivered nutrition, health, water, hygiene and sanitation and other non-food humanitarian assistance for 7,500 people and conducted a rapid needs assessment in Busra al-cham in Dara a, southern Syria. It included WHO hemodialysis sessions, insulin and other NCD medicines to support health facilities in the area. WHO has conducted an assessment of level of damage for public health facilities across Dar a and Quneitra governorates. The findings are being analyzed. Five health centers are ready to be re-opened in rural Quneitra. 11 health centers need to be rehabilitated. In Quneitra, 4 DOH mobile teams has provided services to 23 locations since 30 July. In Nab e As-Sakher, rural Quneitra, increased cases of acute diarrhea were reported. Water samples were taken in the town and sent to the national public health laboratory. The mobile clinic affiliated to the Quneitra Health Directorate is present in the area to treat patients and report any new cases. Reports from mobile teams in Quneitra suggest that many IDPs previously sheltering in exposed conditions near Brega and Saida have now returned to their homes. Three mobile units through two NGOs partners are ready to provide medical services in rural Quneitra, but awaiting government approval. WHO and health authorities are on alert following an announcement of returning Syrian refugees (approximately 30 families) from Zaatari camp in Jordan to Dar a through Nassib crossing to Jbab shelter. Currently there has been no update on their movement or date of return. 3

4 SARC has wound down their emergency response in SW Syria as of 8 August. South Syria WHO response in numbers from 17 June 15 August 2018: 9 WHO delivered shipments containing 313,278 medical treatments delivered accounting for 63 tons of supplies. DoH Dar a and Quneitra teams have provided more than 35,660 primary health care consultations in IDP shelters, crossing points and newly accessible areas. 20,386 patients have been assisted by WHO-supported NGOs through 2 fixed points and 3 mobile teams. 729 referral cases to Dar a and Damascus health facilities.12 referral cases to Quneitra facilities. 21,725 children under-five were screened for vaccination. Vaccination coverage is high as routine immunization had continued across southwest Syria despite the conflict. 21,581 children under five years have been screened for nutritional status in Dar a and Quneitra with 340 identified as MAM or SAM cases. 185 surveillance sentinel sites in the 3 southern governorates report to EWARS program. In Dar a the completeness of reporting 57%, and timeliness 100%. In Quneitra the completeness of reporting is 55%, and timeliness 100%. 80 mental health professionals 200 health workers provide integrated mental health support. In addition to a group of 25 community psychosocial support workers is ready to support. Homs response/ Northern Rural Homs: Coordination Conducted assessment and follow up visits to Ras Alain and Tal tamr hospitals; field visit to Alhol camp to follow up medicines availability considering chronic medications survey s results; field visits to the Armenian charity at Al- Hasakah and Al-Qamishly to follow up the ongoing services. Pharmacy and STHC program Delivered to Altabka hospital 2,168 treatments of anesthetics, antibiotics and chronic medications. Delivered to a health actor 8,731 treatments of anti-infectives, chronic medications, plasma substitute, vitamins to support primary care and emergency centers in Alareesha camp, Alhol camp, Ein Issa camp, Amuda, Arraqqa, Tal tamr, Altabka and Alkasra districts and cities. Delivered 2 cholera kits -equipment and renewable- to Alkasra hospital. Distributed 22 personal protective equipment to Allulua and Alhekma hospitals in Alhasaka Delivered 100 length and weighing scales to Alhasaka DOH to support nutrition program National NGOs coordination: GOPA, 9 medical mobile teams, Armenian charity and Al-Hikmah private hospital are the ongoing WHO s partners. Started nutrition surveillance at Ain Issa camp after the team was trained in coordination with UNICEF. Transferred 8 cases from Al-Mabrouka camp to the hospitals. Annex 7 contains number of beneficiaries of partners in NES. 4. Technical Expertise (See Annex 2 for capacity building activities this week) Non-Communicable diseases / Primary healthcare Bimonthly dispatching plan for Jul-August & Sep-October is finalized targeting HTR & newly accessible areas under PHC/NCD program to deliver life-sustaining health supplies including NCD medications, Glucose meter, strips and NCD guidelines; targeting several health partners functioning at SW,NW, and NES ( DOHs, NGOs, & SARC). Prepositioning of NCD complete kits in Aleppo Hub as preparedness plan for NW response. Shipment of medical & nonmedical equipment is under process to support 2 DOH PHCs rehabilitated by WHO under Japan fund namely Al Khaldya & Maasranyia health centres. Replenishment for Qamishly Hub with PHC and NCD Kit 1 a, PHC medications, NCD guidelines, Insulin vials to cover NES needs for diabetic patients including Raqqa city. Capacity building workshops / NCD programme under JPRM fund in cooperation with MOH as follows: - Strengthen the MOH capacity for data entry using the established Electronic Registry for Diabetes program, August targeting 25 trainees. 4

5 - Strengthening the capacity of DOH Rural Damascus staff in terms of malnutrition screening among Elderly people, August ;20 trainees. - Health System Integrative workshop : Primary health service standards focusing on communicable & NCDs, 20 trainees, August in cooperation with Centre for Strategic Health Studies / MOH. Immunization: During Phase 1 of the sub-national measles campaign in July 2018, the final number of vaccinated children was 160,106. A total of 1,142,155 children from 7-71 months old were vaccinated across 7 governorates. Surveillance officers and EPI managers from 13 governorates gathered in Damascus for two-day workshop (13-14 August) to review the surveillance indicators at governorate level and to develop mitigation plan according to the result of risk assessment of the first half of National Environmental Surveillance Committee met on 9 Aug to discuss the expansion of environmental surveillance plan in relation to readiness of the polio lab. Regional Coordinator for Polio labs, has undertaken a mission to the Polio Laboratory in Damascus, Syria, during the period August 2018,for the following objectives: - Annual Accreditation for the National Polio Laboratory - Containment: to work with National Polio Containment Coordinator for the report of completion of GAPIII Mental health program: Site visits were conducted to 5 PHC and community health centers in Damascus, Rural Damascus and As-Sweida a to follow up on the implementation of mhgap programme. The WHO mental health professionals provided the needed technical support to 16 health professionals previously trained on mhgap-intervention Guide. Nutrition and child health: Conducting a Meeting with MOH to evaluate Nutrition program for the first semester 2018 in and finalize the plan for the nest semester in Damascus. Following up to our response in Al Quneitrah, a nutrition screening was conducted for 2371 children under 5, detecting 27 moderate acute Malnutrition and 7 severe acute Malnutrition. Following up to our response in Dar a, nutrition screening was conducted for 912 children under 5, detecting 6 moderate acute Malnutrition and 13 severe acute Malnutrition. Responding to gaps in nutrition response in NES. Secondary health care program: Delivered about 21,870 treatments of essential and lifesaving medicines to different public health facilities and NGOs in Aleppo, Al Hasskeh, Ar-Raqa- As-Sweida, Homs and Daraa that will meet the health needs of diabetic patients and those in critical care in the intensive care and operating theatre. Advanced the rehabilitation project for the Childrens Hospital in Damascus. Started data collecting of patients views and experiences of cancer care in Tishreen Hospital Lattakia which is one of the oncology facilities targeted in the cancer assessment study. Completed the first bimonthly distribution plan to HTR areas for Sep-Oct. Trauma: 45 PPEs, personal protective equipment, for dealing with chemical exposure were to hospitals in NES as follows : 13 to Al Hassakeh DOH, 9 to Al Hekmeh hospital, 23 to Al Qamshili National hospital Medical supplies were distributed to SARC and an NGOs in Homs in favor of IDPs from Foah and Kefraya in Hesia Shelter as follows: trauma medicines (20,500 treatment), 3 burn kit (30 burn cases) and 6 wheel chair for children and adult were distributed to Homs SARC Trauma medicines (1200 treatment) and 1 burn kit were distributed to Al Hadi NGO in Homs. Disease surveillance and response: 5

6 See EWARS bulletins at Strengthening disease surveillance systems in Syria: After more than 6 years of implementing EWARS in Syria, it is needed to strengthen the initial already existing routine surveillance, for this purpose, a meeting was conducted this week by WHO regional office consultants and MoH stakeholders, the aim of this meeting was to provide technical support and help MoH to integrate the early warning alerts and response system (EWARS) into the national routine surveillance system. Acute bloody Diarrhea in Deir-ez-Zor As of 12 August 2018, 699 cases, including 12 deaths, of acute diarrhea in Deir Ezzor Governorate have been reported since week 10. The lab results of testing 5 new specimens at WHO reference were positive for E. coli for the 5 specimens. PCR detection of Stx1 and Stx2 genes showed negative results for O 157: H7. WHO and UNICEF on the 6 August has initiated implementing of a campaign to distribute of aqua-tables and raising the awareness of approximately 20,000 households in 20 villages located in the eastern bank of Euphrates River in Deir Ezzor. The campaign will be implemented up till the end of September, the main objectives are: - Secure safe drinking water to households by distributing aqua-tables to households in the affected areas and other villages along the Euphrates valley in Al Husseniyeh district. - Provide health education to household level in the affected areas and scaling up the hygiene promotion activities including: Increase awareness about hygiene practices especially hand washing and water preservation. - Promote the knowledge of cleaning water tanks, and educate households on how to use chlorine tablets (including what to do if the smell of chlorine is strong). Emphasize on the importance of using, and how to use ORS, and encourage community to report and referral of cases of acute diarrhoea immediately to the nearest health facilities. The first phase of this intervention was to conduct two days training for 102 local volunteers on the usage of aquatablets and main health education messages. The field workers were provided with 200,000 aqua-tabs, 20 boxes of brochures, and 200 awareness posters. Typhoid cases in Areesha camp, in Al Hassakeh: An increase of suspected Typhoid cases has been reported from Areesha Camp since week 30, the cumulative number of cases between 30 and 32 is 153. In week 32 the number of suspected cases was 86. All cases were tested by Widal (results above 1/40). On 6 August, specimen were delivered to the microbiology reference lab in Damascus for additional testing, the lab results were negative for salmonella typhi, more laboratory tests are needed to identify the causative agent. An awareness raising campaign is needed in order to enforce health awareness and hygiene measures. Active TB case finding: WHO in collaboration with the National Tuberculosis Program and others health partners are working to strengthen the surveillance and detection of TB among vulnerable population, active case findings activities has been initiated in 11 governorates in the 25th of July, 17 confirmed cases among Afrin IDPs in rural Aleppo have been detected. Estimated number of IDPs in these camps is 10,000 individuals. For this purpose and due to high number of patients reported from one location, tent to tent modality was implemented in this camp to investigate all IDPs and identify any suspected TB case inside the camp. A plan to screen the high risk villages is being prepared by TB control program. All confirmed cases are receiving treatment and were registered in the program. WASH: Coordination on the future activities between WASH, EWARS and HIS was held to ensure that current WASH activities with regards to water quality monitoring continue uninterrupted after the departure of the current WASH Technical Officer, and to ensure that roles and responsibilities of various persons involved in the water quality monitoring program or interested in its findings and results are clearly defined. National NGO coordination: 4 mobile medical teams (2 in Hama and 2 in Lattakia) are under preparation for rapid response for NWS; 6

7 4 mobile medical teams in Al Qunaitera are pending for government approval to start their activities in providing essential health care; A new MoU was queued for clearance to support the delivery of essential package of services in AL Hassakeh NES. Third monitoring party visits to 2 NGOs (1 in Al Hassakeh and 1 in Damascus). The full list of MOUs is in Annex 1. External Relations and Communications: Communicating officially with MoH concerning the Ministerial Meeting on UHC, 3 5 September 2018, Oman. Coordination with MoFA to speed up the arrangements to provide clearance for shipping 20 Mobile Clinics to support the health services provided through WHO partners (MoH, SARC and NGOs). Press Release on Southwest Syria response. Preparing short videos, photos, and humanitarian stories to be published on the occasion of the World Humanitarian Day 2018, #NotATarget. Arranging for the handing over ceremony of medical equipment procured under the Japanese grant. The ceremony will be attended by WR and officials from MoFA, MoH, MoHE as well as Lattakia governor, 30th August Following up on WHO-Syria Twitter account, posting several tweets about WHO interventions and health response. Operational support and logistics: Dispatched 7.8 tons of medical supplies, health kits, printing materials covering 9 governorates (Aleppo, Al-Hasakeh, Deir Ez-Zor, Damascus Rural Damascus, Daraa, As-Sweidaa, Ar-Raqqa and Homs). The recipient included 4 MoH facilities, 1 MoHE facility, 4 Non-governmental hospitals, 22 NGOs, KRC and SARC. The total number of treatments is 69,917 treatments and 40 trauma cases. The dispatched supplies included: Mental health, PHC, STHC and EWARS medical supplies delivered to KRC Al-Hasakeh and MoH - Al-Tabaqa Hospital Ar-Raqqa. 23 different types of PPE kits, 140 bottles of Alcohol hand rubs and 138 bottles of antiseptic hand soap solution delivered to MoH Qamishli national hospital Al-Hasakeh. 1 pneumonia kit A, 1 burn dressing kit and different types of EWARS, mental health, PHC, STHC, nutrition and trauma medical supplies delivered to Homs DOH in Hesyia to support the IDPs from Faoa & Kafrya. 1 vial of Octagam 10 g in 200 ml delivered to Aleppo university hospital. 2 different types of cholera kits, 9 PPE kits, and therap milks delivered to 4 non-governmental hospitals in Deir Ez- Zor, Al-Hasakeh, Homs and Aleppo. Different types of insulin vials and penfils, 13 devices of Accu-chek and different types of EWARS, mental health, nutrition, PHC, STHC & trauma medical supplies and printing materials were delivered to 22 NGOs in Aleppo, As- Sweidaa, Damascus, Rural Damascus, Homs and Daraa. 8 devices of Accu-chek, 3 Burn dressing kits, 1 pneumonia kit A, 2 IEHK supplementary kits, 1 hot air sterilizer, 1 portable X-Ray, 3 adult and children wheelchairs and different types of EWARS, mental health, nutrition, PHC, STHC and trauma medical supplies delivered to SARC branches in Aleppo, Homs, Rural Damascus. RESPONSE PRIORITIES NWS/Afrin, Eastern Ghouta and South Damascus, Rural Homs, North-East Syria and Southwest Syria. Annex 1: Current WHO agreements with national NGOs No update in week 33. Annex 2: WHO supported capacity strengthening (30 activities for 740 participants) Date # participants Details/Field Program 7

8 12-14/08/ Disability Management Training course in Damascus Disability 11-13/08/ Final findings of EWARS evaluation in Damascus EWARS 12-14/08/ Training on using use Pediatric medicines in Damascus EWARS/ GF 12/08/ HeRAMS follow up workshop at hospital level in Damascus HIS 12-16/08/ International classification of Disease in Aleppo HIS 13/08/ HeRAMS follow up- at hospital level in Damascus HIS 13-15/08/ Improve utilizing and investing the collecting HeRAMS data using office program in Damascus HIS 14/08/ HeRAMS follow up- at hospital level in Damascus HIS 12-13/08/ Mental health GAP-intervention guide -Refresher for MOH in Aleppo MH 12-16/08/ Group counseling for NGOs from Damascus& R. Damascus in Damascus MH 12-16/08/ Mental health GAP-intervention guide phase 1 for MoH in Lattakia MH 12-16/08/ Mental health GAP-intervention guide phase 1 for NGOs in Lattakia MH 12-16/08/ School mental health program for MoE in Lattakia MH 11-16/08/ Integrated management childhood illness (IMCI) program in Hama Nutrition 12-14/08/ Midterm evaluation for nutrition programe in Damascus Nutrition 12-14/08/ Nutrition program midterm evaluation in Damascus Nutrition 15-17/08/ Expansion with nutrition stabilization centers inline with the new indicators in Damascus Nutrition 12/08/ Measles follow-up committee in Damascus PHC 13-14/08/ Activate the vaccination surveillance & reporting program in Damascus PHC 15/08/ Polio Follow-up Committee in Damascus PHC 13-15/08/ Leadership and strategic management in Hama SHC 13-15/08/ Leadership and strategic management in Damascus SHC 13-15/08/ Leadership and strategic management in Lattakia SHC 14-16/08/ Infection control in Damascus SHC 14-16/08/ Rational Use of Medicines in Damascus SHC 11-13/08/ Major incident medical management support MIMMS in Tartous Trauma 12-14/08/ Adults Life Support ALS in Aleppo Trauma 12-14/08/ Pediatrics Life support EPLS in Damascus Trauma 14-16/08/ Major incident medical management support MIMMS in Damascus Trauma 15-19/08/ War Wounded Injuries Management WWIM in Damascus Trauma Annex 3: outpatient consultations provided to Afrin IDPs Not provided in week 33. 8

9 Annex 4: Nutrition activities for Aleppo-Afrin IDPs Not provided in week 33. Annex 5: WHO Supported Health services in Aleppo city Not provided in week 33. Annex 6: WHO Supported Health services in Homs # of N of beneficiaries, Second month, 1-14 August 2018: Area Provision of medical consultations medicines surveys conducted by the malnutrition team Hashmiya Ein Talbisah Sabil Ghurnata Kafr laha Tal daw Tal Dahab Al Wasata Ramadi Hasyia Tayba Zafarani Total Total N individual psychological sessions 298 Annex 7: WHO Supported Health services in NES Governorate Area # of outpatient consultations # of beneficiaries reached with the medicines # of secondary health consultations # of trauma referrals # of Mental Health Psychosocial Services Hasakah city center Al-Qamishly city Al-Hasakah Al-Areesha camp Al-Hol camp Al-Mabrouka camp Al-Kasrat / Madan Ain Issa camp Al-Raqqa Al-Karama/Alhamrat Al-Jurneah Al-Safsafa Aleppo Manbij Dier Ezzour Abu Khashab camp Dier Ezzour city Sub-total: