Health emergencies biweekly Bulletin, 11-24 January 2024

WHO Regional Office for the Eastern Mediterranean Health emergencies biweekly bulletin 11–24 January 2024 WHO-EM/CSR/729/E WHO Regional Office for the Eastern Mediterranean | Health emergencies biweekly bulletin Page 2 Public health events and emergencies dashboard 11–24 January 2024 *Signals followed-up: Signals are data and/or information detected that represent a potential acute risk to human health. Signals followed-up are signals for which confirmation is requested and/or for which official government websites and reports are continuously monitored for further information. **Events: An event is defined by article 1 of the International Health Regulations (2005) as “a manifestation of disease or an occurrence that creates a potential for disease”. This can include events that are infectious, zoonotic, food safety-related, chemical, radiological or nuclear in origin and which are transmitted by people, vectors, animals, goods/food or the environment. ***Grading: Grading is an internal WHO process that triggers WHO emergency procedures and activities for the management of the response. More information on WHO grading, according to the Emergency Response Framework Multiple occurrences of the same graded emergency across different countries and territories are considered a single emergency. For instance, COVID-19 is a graded emergency in all 22 countries and territories of the WHO Eastern Mediterranean Region, but it counts as just one emergency when calculating the total number of graded emergencies in the Region. 55 3 0 0 5 0 4 83 0 19 Grade 2Grade 3 Signals followed-up* Grade 1 New events** Protracted 3 Closed events Protracted 2 Ongoing events Protracted 1 Total graded emergencies *** Public health events and emergencies dashboard Public health events and emergencies map Yemen: cholera outbreak Eastern Mediterranean Region: strengthening risk assessment capacities for targeted health emergency response Ongoing public health events and emergencies Contents 2 4 3 5 6 WHO Regional Office for the Eastern Mediterranean | Health emergencies biweekly bulletin Page 3 Public health events and emergencies map WHO Regional Office for the Eastern Mediterranean | Health emergencies biweekly bulletin Page 4 BACKGROUND Cholera is an acute diarrhoeal disease caused by the bacterium Vibrio cholerae, which most often infects people via ingestion of contaminated water or food. Cholera has the potential to be fatal within hours if not treated promptly. It mainly affects individuals who lack access to safe water and sanitation. Factors such as conflict, unplanned urbanization, and climate change amplify susceptibility to cholera. In Yemen, cholera is endemic. The worst reported cholera outbreak to date occurred from 2017 to 2020. On 19 October 2023, about 480 immigrants arrived in Shabwah governorate, southern Yemen, from the Horn of Africa. They temporarily settled in three unofficial refugee camps in the Al-Mostawatena area of Ataq district. On 22 October, the International Organization for Migration and international nongovernmental organizations working in the area of the migrant camps alerted WHO to an increase in suspected cholera cases in Shabwah. After seven weeks, cholera was confirmed in nine governorates of south and east Yemen: Abyan, Aden, Al Hudaydah, Al Mahrah, Al Mukalla, Hadramout, Lahj, Shabwah and Taiz. From 2 January 2023 to 24 January 2024, the south and east of Yemen reported 4081 suspected cholera cases, Yemen: cholera outbreak Cholera mainly affects individuals lacking access to safe water and basic sanitation. Photo credit: WHO/T. Pietrasik including 14 deaths, giving a case fatality ratio of 0.35%. Culture tests to confirm cases are not performed regularly in Yemen except in a few governorates. Rapid diagnostic tests are, however, generally available and conducted routinely. From 16 October 2023 to 24 January 2024, 474 specimens were collected, of which 119 samples were confirmed as Vibrio cholerae O1 Ogawa serotype (positivity rate: 25%). Additionally, 67 cases out of 302 tested positive using rapid diagnostic tests. WHO RESPONSE • A cholera task force and a public health emergency operations centre were launched, and response actions were coordinated based on epidemiological analysis by WHO and the Health Cluster. This resulted in the formulation of a cost-effective, scenario-based multisectoral cholera response plan. • The Health Cluster is working with WHO to coordinate the response with the WASH (Water, Sanitation and Hygiene) Cluster, inter-cluster coordination mechanisms, and Health Cluster partners and working groups. • WHO supports national surveillance and active case finding along migration routes and in high-risk areas, as well as rapid response team activities to address affected governorates. • WHO activated zero reporting in all governorates, aiming to reach cholera-free governorates. • WHO distributed 11 000 rapid diagnostic tests to southern governorates. • WHO has pre-positioned cholera kits and intravenous fluids and delivered them to Yemen’s Ministry of Public Health and Population for distribution. • WHO supported the revision and printing of cholera case management guidelines and protocols, trained health workers on cholera case management in southern governorates and supported the ambulance referral system in Aden governorate. • WHO and the WASH Cluster are collaborating to orient WASH activities in line with the evolving situation, as informed by epidemiological data. • In coordination with the Ministry of Public Health and Population and the United Nations Children’s Fund (UNICEF), WHO is leading the development of a proposal to the International Coordination Group on Vaccine Provision to vaccinate people in districts with culture-confirmed cases. The plan proposes the distribution of 1.2 million doses to 10 target districts in the six high-risk governorates. WHO Regional Office for the Eastern Mediterranean | Health emergencies biweekly bulletin Page 5 BACKGROUND WHO RESPONSE Timely and effective risk assessment and outbreak investigation are important to control diseases and prevent and manage public health emergencies. Adopting a standardized risk assessment approach is therefore vital during epidemics and pandemics to mitigate health emergencies. It leads to better outcomes as it ensures that timely, sufficient and effective mitigation measures are effectively implemented to minimize the negative impacts of public health events while efficiently managing resources. To strengthen the response to disease outbreaks and public health emergencies, WHO is working to strengthen risk assessment tools in every country and territory of the Eastern Mediterranean Region to enhance their capacity to perform their own risk assessments. In 2024, WHO will initiate a pilot phase to introduce a new risk assessment tool in a selected country to refine and validate the country’s risk assessment tools, ensuring their practical applicability and effectiveness. WHO also provides trainings in countries and territories to enhance their capacities to conduct rapid risk assessments and public health situation analyses. The first such training was conducted in 2023 in Morocco, followed by another training in Gaziantep, Türkiye. The latter was for health professionals from the northwest of the Syrian Arab Republic engaged in the implementation of the early warning, alert and response network, and was coordinated by the WHO Regional Office for the Eastern Mediterranean and the WHO Field Presence Office in Gaziantep. Eastern Mediterranean Region: strengthening risk assessment capacities for targeted health emergency response Training on risk assessment and outbreak investigations in the northwest of the Syrian Arab Republic, conducted in Gaziantep. Photo credit: WHO/WHO Field Presence Office in Gaziantep One of the training presentations given by the WHO expert in Morocco. Photo credit: WHO/M. Ismaili The trainings to date have provided health professionals with the knowledge and skills to address health risks and acute public health emergencies in a more timely and effective manner. As part of WHO’s continued efforts in this area, more trainings will be provided in 2024 to strengthen health emergency response in the Region. WHO Regional Office for the Eastern Mediterranean | Health emergencies biweekly bulletin Page 6 Ongoing public health events and emergencies As at 24 January 2024 Last updateDate of startbDeathsCasesWHO gradeaEventHazardMember State/territory 28-Dec-2322-Sep-2193203 901 Afghanistan Complex Emergencies, Protracted 3 Acute watery diarrhoea (AWD) BiologicalAfghanistan There were 2395 cases of AWD with dehydration and one associated death during week 50 of 2023. Cases were reported from 138 districts, which represents a stabilization in the number of suspected cases. Since the start of 2023, 5912 rapid diagnostic tests have been conducted among AWD cases with dehydration. Since the start of the outbreak, 203 901 cases and 93 deaths have been reported. 20-Dec-2324-Feb-207965229 590COVID-19, Protracted 3COVID-19BiologicalAfghanistan As at 9 December 2023, 229 590 cases and 7965 deaths had been reported. A total of 1 340 648 polymerase chain reaction (PCR) tests had been conducted by the same date. 17-Dec-231-Jan-2300Polio (cVDPV), Grade 2 Circulating vaccine- derived poliovirus type 2 (cVDPV2) BiologicalAfghanistan No new cases of cVDPV2 were reported in 2023. The last date of a reported onset was 27 March 2020. 10-Dec-2330-Aug-21NANA Afghanistan Complex Emergencies, Protracted 3 Civil unrestSocietalAfghanistan In 2023, no major casualties or displacements were observed. Civil unrest events increased in the country in 2023. 21-Dec-233-May-231141234 Afghanistan Complex Emergencies, Protracted 3 Crimean-Congo haemorrhagic fever BiologicalAfghanistan Between 1 January and 16 December 2023, 1234 suspected Crimean-Congo haemorrhagic fever cases were reported from 26 provinces, with 114 associated deaths reported from 15 provinces. The figure reported in week 50 of 2023 is almost four times the reported figure for the whole of 2022. 28-Dec-2314-Aug-2211141 Afghanistan Complex Emergencies, Protracted 3 DengueBiologicalAfghanistan Since January 2023, 1391 suspected cases of dengue and one death have been reported. In week 50 of 2023, 33 suspected cases of dengue were reported from Nangarhar province. A total of 860 samples were collected in 2023, of which 310 were confirmed as dengue. Since the start of the outbreak, 1141 cases and one death have been reported. 4-Dec-2325-Sep-2301609 Afghanistan Complex Emergencies, Protracted 3 MalariaBiologicalAfghanistan No new malaria cases have been reported since week 44 of 2023. From 4 July to 28 October 2023, 1609 confirmed malaria cases were reported: 1303 were confirmed by a laboratory and 306 were confirmed by rapid diagnostic tests. 28-Dec-2319-Apr-216424 995 Afghanistan Complex Emergencies, Protracted 3 MeaslesBiologicalAfghanistan Since January 2023, 24 995 suspected measles cases and 64 deaths have been reported, giving a case fatality ratio of 0.3%. Of these cases, 17 789 cases (71.2%) were children aged under 5 years and 11 782 cases (47.1%) were females. Since the start of the outbreak, 23 284 cases and 64 deaths have been reported. 17-Dec-2316-Mar-2306 Afghanistan Complex Emergencies, Protracted 3 Wild poliovirus type 1 (WPV1) BiologicalAfghanistan Wild poliovirus is endemic in Afghanistan. Six human cases were reported in 2023. 20-Dec-2324-Feb-201536696 614COVID-19, Protracted 3COVID-19BiologicalBahrain As at 9 December 2023, 696 614 COVID-19 cases and 1536 deaths had been reported. A total of 10 578 766 PCR tests had been conducted by the same date. 20-Dec-2318-Sep-2202Mpox, Protracted 2MpoxBiologicalBahrain As at December 2023, two mpox cases had been reported, with no deaths. a Grading is an internal WHO process that triggers WHO emergency procedures and activities for the management of the response. More information on WHO grading, according to the Emergency Response Framework Global graded emergencies: COVID-19 and mpox Regional graded emergencies: circulating vaccine-derived poliovirus (cVPDP) Multi-regional graded emergencies: dengue, cholera and the Greater Horn of Africa drought and food insecurities b Date of start: The date the health event is created in the Event Management System (EMS). WHO Regional Office for the Eastern Mediterranean | Health emergencies biweekly bulletin Page 7 Last updateDate of startDeathsCasesWHO gradeEventHazardMember State/territory 20-Dec-2318-Mar-2018915 690COVID-19, Protracted 3COVID-19BiologicalDjibouti As at 9 December 2023, 15 690 cases and 189 deaths had been reported. A total of 319 153 PCR tests had been conducted by the same date. 29-Nov-2321-May-23NANA Greater Horn of Africa Drought and Food Insecurity, Grade 3 DroughtClimatologicalDjibouti It is estimated that about 11% of the population of Djibouti is acutely food insecure. 30-Nov-231-Jan-23035 795UngradedMalariaBiologicalDjibouti As at 30 November 2023, 35 795 confirmed malaria cases had been reported, with no associated deaths. 18-Dec-2326-Jun-22NA12UngradedMeaslesBiologicalDjibouti As at 15 February 2023, 12 suspected measles cases had been reported, two of which were confirmed. 20-Dec-2316-Feb-2024 830516 023COVID-19, Protracted 3COVID-19BiologicalEgypt As at 2 December 2023, 516 023 COVID-19 cases had been reported, with 24 830 deaths. A total of 12 645 544 PCR tests had been conducted by the same date. 20-Dec-2327-Sep-2203Mpox, Protracted 2MpoxBiologicalEgypt As at 20 December 2023, three mpox cases had been reported, with no deaths. The most recent case was reported on 12 December 2022. 20-Dec-2324-Feb-2025 3752 465 545COVID-19, Protracted 3COVID-19BiologicalIraq As at 20 December 2023, 2 465 545 COVID-19 cases had been reported, with 25 375 deaths. A total of 19 550 473 PCR tests had been conducted by the same date. 17-Dec-2321-Apr-221402144 Iraq Crimean-Congo Haemorrhagic Fever, Grade 2 Crimean-Congo haemorrhagic fever BiologicalIraq From 1 January 2023 until the end of week 49 of 2023, Iraq reported 2144 suspected cases of Crimean-Congo haemorrhagic fever, with 140 deaths, giving a case fatality ratio of 7%. Of the total suspected cases, 584 were confirmed. 17-Dec-2319-Apr-23NA893 Iraq Complex Emergencies, Protracted 2 MeaslesBiologicalIraq As at week 23 of 2023, 893 suspected measles cases had been reported. 22-Jan-2419-Feb-20146 7777 626 022COVID-19, Protracted 3COVID-19BiologicalIran (Islamic Republic of) As at 13 January 2024, 7 626 022 COVID-19 cases had been reported, with 146 777 deaths. 17-Dec-2311-Dec-2210134425UngradedMalariaBiologicalIran (Islamic Republic of) As of 2022, malaria cases have shown an increasing trend, with 4425 reported cases, of which 1013 were locally transmitted. The reported cases were primarily concentrated around the border area in Sistan and Baluchestan province of the Islamic Republic of Iran and Balochistan of Pakistan, an area currently facing a malaria outbreak. The surge in cases is attributed to increased cross- border movement due to flooding in Pakistan, political issues in Afghanistan and illegal trade and fuel smuggling activities. 17-Dec-238-Jun-21332UngradedMeaslesBiologicalIran (Islamic Republic of) In 2022, a measles outbreak was reported in the Islamic Republic of Iran, despite the disease having been eliminated in the country in 2019. Since the outbreak began, 32 cases and three associated deaths have been reported. The outbreak, especially in the Sistan and Baluchestan province, is linked to the ongoing measles outbreak in neighbouring Pakistan. 20-Dec-2318-Aug-2201Mpox, Protracted 2MpoxBiologicalIran (Islamic Republic of) As at 20 December 2023, only one mpox case had been reported, with no deaths. 20-Dec-232-Mar-2014 1221 746 997COVID-19, Protracted 3COVID-19BiologicalJordan As at 9 December 2023, 1 746 997 COVID-19 cases had been reported, with 14 122 deaths. A total of 17 201 885 PCR tests had been conducted by the same date. Ongoing public health events and emergencies As at 24 January 2024 WHO Regional Office for the Eastern Mediterranean | Health emergencies biweekly bulletin Page 8 Last updateDate of startDeathsCasesWHO gradeEventHazardMember State/territory 20-Dec-2311-Sep-2201Mpox, Protracted 2MpoxBiologicalJordan As at 20 December 2023, only one mpox case had been reported, with no deaths. 3-Jan-2424-Feb-202570666 551COVID-19, Protracted 3COVID-19BiologicalKuwait As at 9 December 2023, 666 551 COVID-19 cases had been reported, with 2570 deaths. A total of 8 455 743 PCR tests had been conducted by the same date. 20-Dec-2322-Feb-2010 9471 239 904COVID-19, Protracted 3COVID-19BiologicalLebanon As at 9 December 2023, 1 239 904 COVID-19 cases had been reported, with 10 947 deaths. A total of 10 696 009 PCR tests had been conducted by the same date. 30-Nov-234-Jul-230337UngradedMeaslesBiologicalLebanon Since March 2023, Lebanon has reported higher numbers of monthly measles cases than at any time since 2019. From week 1 to week 4 of 2023, 260 cases (125 laboratory-confirmed, 135 epidemiologically linked and clinically compatible) and no deaths were reported. Baalbek-Hermel governorate reported the highest attack rate: 15 cases per 100 000 population, and 75% of the cases were unvaccinated. 20-Dec-2320-Jun-22027Mpox, Protracted 2MpoxBiologicalLebanon As at 20 December 2023, 27 mpox cases had been reported, with no deaths. 24-Jan-242-Sep-18NANA Libya Complex Emergencies, Protracted 2 Armed conflictSocietalLibya A state of emergency was announced by the government on 2 September 2018 and there have been on-and-off conflicts since then, and into 2024. Since August 2023, however, no major armed conflicts have been reported. 24-Jan-2425-Mar-206437507 269COVID-19, Protracted 3COVID-19BiologicalLibya From 3 January 2020 to 22 January 2024, 507 269 confirmed COVID-19 cases and 6437 deaths (case fatality ratio: 1.3%) were reported to WHO. 24-Jan-2412-Sep-235898NALibya Tropical Storm, Grade 2Cataclysmic stormMeteorologicalLibya On 11 September 2023, heavy rains and flooding hit Libya, which caused extensive damage, especially in Derna city, displacing more than 44 800 residents and leading to 5898 fatalities. Emergency response teams used 182 sentinel sites for daily data sharing from the flood-hit areas. 25-Jan-2416-Mar-2311962 Libya Complex Emergencies, Protracted 2 MeaslesBiologicalLibya A measles outbreak has been spreading in Libya since early 2023, affecting six districts. Sabha has been the most affected district. As at week 49 of 2023, 1962 suspected measles and rubella cases had been reported, among which 251 measles cases and 196 rubella cases were confirmed, with one associated death. 20-Dec-233-Mar-2016 2981 277 956COVID-19, Protracted 3COVID-19BiologicalMorocco As at 9 December 2023, 1 277 956 COVID-19 cases, with 16 298 deaths, had been reported. A total of 13 068 242 PCR tests had been conducted by the same date. 4-Dec-2310-Sep-23NANAMorocco Earthquake, Grade 2EarthquakeGeologicalMorocco On 9 September 2023, Morocco was hit by an earthquake measuring 6.8 on the Richter scale, with numerous aftershocks recorded. Over 320 000 people were exposed to the eathquake's destructive force. The city of Marrakesh, one of the most severely affected areas, reported considerable damage. According to the Moroccan Ministry of Interior, 1037 deaths and 1204 injuries were reported, including 721 critical injuries. 20-Dec-232-Jun-2203Mpox, Protracted 2MpoxBiologicalMorocco As at 20 December 2023, three mpox cases had been reported, with no deaths. 24-Jan-247-Oct-2325 700NA Israel/occupied Palestinian territory Hostilities, Grade 3 Armed conflictSocietalOccupied Palestinian territory As at 24 January 2024, hostilities in the occupied Palestinian territory had killed 25 700 and injured 63 740 people. About 1.7 million people have been internally displaced. As at 22 January, just 15 of the 36 hospitals in the Gaza Strip were functioning and these were only partially operational. Ongoing public health events and emergencies As at 24 January 2024 WHO Regional Office for the Eastern Mediterranean | Health emergencies biweekly bulletin Page 9 Last updateDate of startDeathsCasesWHO gradeEventHazardMember State/territory 29-Jan-2412-Mar-205708703 228COVID-19, Protracted 3COVID-19BiologicalOccupied Palestinian territory As at December 2023, 703 228 COVID-19 cases, with 5708 deaths, had been reported. A total of 3 477 872 PCR tests had been conducted by the same date. 20-Dec-2324-Feb-204628399 449COVID-19, Protracted 3COVID-19BiologicalOman As at 9 December 2023, 399 449 COVID-19 cases and 4628 deaths had been reported. A total of 3 737 036 PCR tests had been conducted by the same date. 20-Dec-2327-Feb-2030 6561 580 631COVID-19, Protracted 3COVID-19BiologicalPakistan As at 9 December 2023, 1 580 631 COVID-19 cases and 30 656 deaths had been reported. A total of 31 656 354 PCR tests had been conducted by the same date. 7-Dec-2317-Apr-22NA145Multi-region Cholera, Grade 3CholeraBiologicalPakistan From January to November 2023, there were 145 confirmed cholera cases, with most of the cases reported from Sindh province (113 cases). 17-Dec-2312-Nov-1900Polio (cVDPV), Grade 2 Circulating vaccine- derived poliovirus type 2 (cVDPV2) BiologicalPakistan Zero cVDPV2 cases were reported in 2022 and 2023, and the number of cVDPV2-positive environmental samples in 2022 and 2023 was also zero. 7-Dec-2312-Nov-23419Ungraded Crimean-Congo haemorrhagic fever BiologicalPakistan On 3 November 2023, nosocomial Crimean-Congo haemorrhagic fever infection was reported from the intensive care unit at Sandeman Provincial Hospital, Quetta, affecting 12 intensive care unit health workers. As at 20 November 2023, 19 positive cases had been reported – of which 18 were health workers – including 4 deaths. 30-Nov-234-Sep-23NA319Multi-region Dengue, Grade 3DengueBiologicalPakistan In week 34 of 2023, 319 confirmed dengue cases were reported. Most of the cases were reported from Faisalabad, Lahore, Multan and Rawalpindi. 14-Dec-232-Nov-2355611UngradedDiphtheriaBiologicalPakistan Since 2022, there has been an ongoing transmission of diphtheria in Pakistan. The number of cases surged in week 33 of 2022. A similar pattern was observed in 2023. As at week 45 of 2023, 611 suspected diphtheria cases had been reported, with 55 deaths, giving a case fatality ratio of 9%. Children aged above 5 years accounted for 488 cases (79.9%), while 123 cases (20.1%) were children aged under 5 years. 31-Dec-231-Jan-194084001UngradedHIV/AIDSBiologicalPakistan As at 31 December 2022, 4001 cases of HIV/AIDS had been registered in the three hospitals in Larkana since 2019, with 408 deaths (case fatality ratio: 10%). 7-Dec-2323-Sep-22NA2 036 831UngradedMalariaBiologicalPakistan By the end of October 2023, 1 959 896 confirmed malaria cases had been reported (1.75 times as many cases as reported in the same period of 2022, which totalled 1 115 820 ). As at the first week of November 2023, 2 036 831 confirmed malaria cases had been reported. 24-Jan-2426-Jan-21NA13 628UngradedMeaslesBiologicalPakistan Between week 1 and week 43 of 2023, 13 628 measles cases were reported, with 4801 cases aged 9–24 months (35%) and 4182 cases (31%) aged 25–60 months. 20-Dec-2321-Apr-2307Mpox, Protracted 2MpoxBiologicalPakistan As at 20 December 2023, seven mpox cases had been reported, with no deaths. 15-Jan-2416-Mar-2306Ungraded Wild poliovirus type 1 (WPV1) BiologicalPakistan Six cases were reported in 2023, compared with 20 cases in 2022. 24-Jan-241-Mar-20690514 524COVID-19, Protracted 3COVID-19BiologicalQatar From 3 January 2020 to 29 January 2024, 514 524 confirmed COVID-19 cases were reported, with 690 deaths, giving a case fatality ratio of 0.1%. Ongoing public health events and emergencies As at 24 January 2024 WHO Regional Office for the Eastern Mediterranean | Health emergencies biweekly bulletin Page 10 Last updateDate of startDeathsCasesWHO gradeEventHazardMember State/territory 20-Dec-2325-Jul-2205Mpox, Protracted 2MpoxBiologicalQatar As at 20 December 2023, five mpox cases had been reported, with no deaths. 20-Dec-233-Mar-209646841 469COVID-19, Protracted 3COVID-19BiologicalSaudi Arabia As at 9 December 2023, 841 469 COVID-19 cases, with 9646 deaths, had been reported. A total of 45 484 848 PCR tests had been conducted by the same date. 20-Dec-232-May-23014 055Multi-region, Dengue Grade 3DengueBiologicalSaudi Arabia As at December 2023, 14 055 confirmed dengue cases had been reported, with no deaths. 12-Dec-235-Nov-128582200Ungraded Middle East respiratory syndrome (MERS) BiologicalSaudi Arabia Since the first report of MERS in Saudi Arabia in 2012, a total of 2200 human cases have been reported, including 858 deaths. 20-Dec-2317-Jul-2208Mpox, Protracted 2MpoxBiologicalSaudi Arabia As at 20 December 2023, eight mpox cases had been reported, with no deaths. The most recent case was reported on 30 August 2022. 24-Jan-2416-Mar-20136127 334COVID-19, Protracted 3COVID-19BiologicalSomalia From 3 January 2020 to 29 January 2024, 27 334 confirmed COVID-19 cases, with 1361 deaths (case fatality ratio: 5%), were reported to WHO. 24-Jan-248-Feb-18181401Multi-region Cholera, Grade 3CholeraBiologicalSomalia As at 21 January 2024, 1401 cholera cases had been reported, with 18 associated deaths. The Banaadir region of Somalia has seen a noticeable increase in the number of reported cholera cases since the start of 2024. Beletweyn is the district with the highest number of reported cases, accounting for 34% of the total cases. 24-Jan-2418-Aug-20NA0Polio (cVDPV), Grade 2 Circulating vaccine- derived poliovirus type 2 (cVDPV2) BiologicalSomalia In 2023, five confirmed cVDPV2 cases were reported out of 408 acute flaccid paralysis cases, and seven isolates from the environment tested positive for cVDPV2. No acute flaccid paralysis or new cVDPV2 cases have been reported from Somalia in 2024. 24-Jan-245-Oct-23NA668Multi-region Dengue, Grade 3DengueBiologicalSomalia As at 30 November 2023, 1863 suspected dengue cases had been reported, of which 668 cases tested positive. WHO Somalia’s response included the distribution of rapid diagnostic tests to scale up case confirmation, with a plan to procure reverse transcription–polymerase chain reaction (RT-PCR) kits; and deployment of community health workers and social mobilizers. 24-Jan-242-Jun-22118NA Greater Horn of Africa Drought and Food Insecurity, Grade 3 FloodsClimatologicalSomalia As at 10 December 2023, 2.48 million people across the country had been affected by the heavy rains and floods, according to the Somali Disaster Management Agency, with 899 000 people displaced and 118 deaths. 24-Jan-249-Mar-22NA928 Somalia Complex Emergencies, Protracted 3 MeaslesBiologicalSomalia As at 21 January 2024, 928 suspected measles cases had been reported. The regions reporting the most cases were Banaadir (230), Gedo (131) and Lower Shabelle (116). 20-Dec-2322-Jan-2112 501NA Sudan Conflict and Complex Emergency, Grade 3 Armed conflictSocietalSudan The conflict in Sudan has led to significant displacement, with 6.88 million people internally displaced and 1.45 million externally displaced as at December 2023. Conflict-related fatalities totalled 12 501, with 26 051 injuries, by the same date. About 24.7 million people require humanitarian assistance, with 11 million urgently in need of health care. Disease outbreaks are widespread. About 70% of health facilities in conflict-affected areas are non-functional. Dialysis is crucial for over 9000 patients. Food insecurity affects 17.7 million people, including 3.4 million children with acute malnutrition. WHO has dispatched over 1190 tonnes of supplies, launched 21 mobile clinics, and trained more than 14 000 health workers in case management and over 120 in psychological first aid. Ongoing public health events and emergencies As at 24 January 2024 WHO Regional Office for the Eastern Mediterranean | Health emergencies biweekly bulletin Page 11 Last updateDate of startDeathsCasesWHO gradeEventHazardMember State/territory 20-Dec-2315-Mar-20504663 993COVID-19, Protracted 3COVID-19BiologicalSudan As at 9 December 2023, 63 993 COVID-19 cases and 5046 deaths had been reported. A total of 479 278 PCR tests had been conducted by the same date. 17-Dec-2310-May-232006882Multi-region Cholera, Grade 3CholeraBiologicalSudan Since the start of the armed conflict in Sudan on 15 April 2023, cholera cases have risen. As at 9 December 2023, 6882 suspected cholera cases and 200 deaths had been reported. 17-Dec-2310-Aug-2000Polio (cVDPV), Grade 2 Circulating vaccine- derived poliovirus type 2 (cVDPV2) BiologicalSudan No new cVDPV isolates were reported in week 49 of 2023. As at December 2023, zero cVDPV2 cases had been reported in Sudan, compared with one case in 2022. There were also zero cVDPV2- positive environmental samples in 2023, compared with one such sample in 2022. 17-Dec-2320-Oct-21555525Multi-region Dengue, Grade 3DengueBiologicalSudan Since week 44, 2023, 5525 dengue fever cases were reported, with 55 deaths with a case faility ration of 0.99% and attack rate of 3.9/10 000. Forty-four localities in 10 states have reported dengue cases. Gedaref state reported the highest share of cases (58%), followed by North Darfur (17%), North Kordofan (13%) and Kassala (7%). 10-Dec-2321-May-23NANA Greater Horn of Africa Drought and Food Insecurity, Grade 3 DroughtClimatologicalSudan Prolonged dry spells and crop failures across 14 states in Sudan are affecting more than 5.6 million people. Over 22 million people – half of the Sudanese population – live in the 115 affected areas, and 3.1 million people need short- to long-term assistance. An increase in localized conflicts has triggered population displacement, which has led to acute food insecurity at levels higher than usual. 14-Dec-239-Oct-222151 467 006 Sudan Conflict and Complex Emergency, Grade 3 MalariaBiologicalSudan As at 10 November 2023, 1 467 006 malaria cases had been reported, with 215 deaths. 11-Dec-231-Aug-211074039 Sudan Conflict and Complex Emergency, Grade 3 MeaslesBiologicalSudan Measles cases continue to be reported from 12 states in Sudan, reaching 4039 cases and 107 deaths by 11 December 2023, giving a case fatality ratio of 2.65%. In addition, suspected cholera cases reported from South Kordofan and Gedaref states reached 562, with 18 deaths (case fatality ratio: 3.2%), with 162 cases from Gedaref. Darfur, Khartoum and Kordofan states are still largely deprived of meaningful access by Health Cluster partners, specifically in Central, South and West Darfur states. 20-Dec-2331-Jul-22119Mpox, Protracted 2MpoxBiologicalSudan As at 20 December 2023, 19 mpox cases and one death had been reported. The most recent case was reported on 5 April 2023. 24-Jan-2427-Jun-18NANA Syrian Arab Republic Complex Emergencies, Protracted 3 Armed conflictSocietalSyrian Arab Republic The security situation within the Syrian Arab Republic remains unstable. 24-Jan-2423-Mar-20316357 423COVID-19, Protracted 3COVID-19BiologicalSyrian Arab Republic As at 9 December 2023, 57 423 COVID-19 cases and 3163 deaths had been reported. A total of 202 513 PCR tests had been conducted by the same date. 24-Jan-242-Mar-2029 4231 153 361COVID-19, Protracted 3COVID-19BiologicalTunisia As at 9 December 2023, 1 153 361 COVID-19 cases and 29 423 deaths had been reported. A total of 5 013 383 PCR tests had been conducted by the same date. 20-Dec-2329-Jan-2023491 067 030COVID-19, Protracted 3COVID-19BiologicalUnited Arab Emirates As at 20 December 2023, 1 067 030 COVID-19 cases and 2349 deaths had been reported. 12-Dec-2310-Jul-2301Ungraded Middle East respiratory syndrome (MERS) BiologicalUnited Arab Emirates On 10 July 2023, a 28-year-old male MERS-CoV case was reported in the United Arab Emirates. Investigation revealed no camel or sick person contact. Immediate actions included contact tracing, incident reporting and notifying relevant authorities, prioritizing public health without disclosing personal data. Ongoing public health events and emergencies As at 24 January 2024 WHO Regional Office for the Eastern Mediterranean | Health emergencies biweekly bulletin Page 12 Last updateDate of startDeathsCasesWHO gradeEventHazardMember State/territory 20-Dec-2325-May-22016Mpox, Protracted 2MpoxBiologicalUnited Arab Emirates As at 20 December 2023, 16 mpox cases had been reported, with no deaths. The most recent case was reported on 24 July 2022. 20-Dec-2310-Apr-20215911 945COVID-19, Protracted 3COVID-19BiologicalYemen As at 9 December 2023, 11 945 COVID-19 cases and 2159 deaths had been reported. A total of 329 592 PCR tests had been conducted by the same date. 17-Jan-2411-Jul-1747159 490Multi-region Cholera, Grade 3CholeraBiologicalYemen From 2 to 13 January 2024, the south and east of Yemen reported 3940 suspected cholera cases, with 13 associated deaths, giving a case fatality ratio of 0.33%. Of the suspected cases, about 36% (1411 cases) were children aged under 5 years. Since the start of the outbreak, 159 490 cases and 47 deaths have been reported. 17-Dec-2329-May-2000Polio (cVDPV), Grade 2 Circulating vaccine- derived poliovirus type 1 (cVDPV1) BiologicalYemen As at 17 December 2023, there was no evidence of cVDPV in the country. The Global Polio Eradication Initiative and regional and country counterparts and partners are supporting the local public health authorities in field investigation and field monitoring. The most recent case was reported on 31 January 2020. 17-Dec-2330-Nov-2103Polio (cVDPV), Grade 2 Circulating vaccine- derived poliovirus type 2 (cVDPV2) BiologicalYemen As at 12 December 2023, three cVDPV2 cases had been reported in Yemen in 2023. 18-Dec-2329-Mar-2139649 498 Yemen Complex Emergencies, Protracted 3 MeaslesBiologicalYemen As at December 2023, 49 498 suspected measles cases and 396 deaths had been reported. The main hot spots are Saada (11.3% of cases), Taiz (8.3%), Al Bayda (8.1%) and Aden (7.3%). North Yemen accounts for 61.3% of reports and 33% of deaths. Ongoing public health events and emergencies As at 24 January 2024 WHO Health Emergencies Programme WHO Regional Office for the Eastern Mediterranean Monazamet El Seha El Alamia Street Extension of Abdel Razak El Sanhouri Street P.O. Box 7608 Nasr City, Cairo, 11371, Egypt For more information and queries, email: emrgowhebulletins@who.int WHO country office contributors Regional Office contributors Editorial advisory group Yemen: Christopher Lane Public health intelligence: Farida Abougazia Tarek Awad Aura Corpuz Mona Elbarbary Ali ElKony Rana Elzahar Abdelrahman Khalifa Basant Mohamed Sara Morsy Jeremias Naiene Geographic information system: Ramy Ahmed Hanem Mohamed Basha Design: Zena Harb Editing: Lisa Drysdale Paiman Akbar Rick Brennan Aura Corpuz Sarah Eissa Mona Elbarbary Sherein Elnossery Farida Mahgoub Basant Mohamed Shaza Mohammed Thomas Mollet Muhammad Tayyab Data and information are provided by Member States through WHO country offices. Situations are evolving and dynamic, therefore the figures stated herein are subject to change. © World Health Organization 2024 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).