Situation updates: Turkey and northern Syria: May–June 2018: situation report # 3

PAGE 1 1 Figures to be confirmed by partners in the field 2 Health Cluster estimate based on Humanitarian Needs Overview 2017 3 Health Cluster estimate based on Humanitarian Needs Overview 2017 4 Data from April 30, 2018 to June 16, 2018 (epidemiological weeks 18 -24)for all EWARN-covered areas in Syria Situation report # 3 MAY-JUNE 2018 SYRIA CRISIS Turkey update: O Refugee Health Programme O Cross-border operations FOR THE REPORTING PERIOD 3.5 MILLION SYRIAN REFUGEES WERE LIVING IN TURKEY 99 000 HEALTH CONSULTATIONS WERE PROVIDED TO SYRIANS IN REFUGEE HEALTH TRAINING CENTRES1 3.7 MILLION PEOPLE WERE IN NEED OF HEALTH CARE2 THERE WERE 2.3 MILLION INTERNALLY DISPLACED PEOPLE3 3 ATTACKS ON HEALTH CARE WERE VERIFIED KEY FIGURES HIGHLIGHTS REFUGEE HEALTH PROGRAMME IN TURKEY Under the whole-of-Syria approach, WHO and its health partners provide medical services to Syrian refugees in Turkey and to populations in northern Syria from Turkey Refugee Health programme • 350 Syrian refugees finished training as community health support staff to provide home care and social services to older and disabled Syrians in Turkey.  250 Syrian and Turkish doctors were trained in mental health and psychosocial support.  63 Syrian nurses underwent the theoretical stage of the adaptation training to serve in the Turkish health system while 218 Syrian doctors and nurses completed the practical stage. Cross-border operations  People in Afrin have limited access to primary and mental health care services and essential medicines. There are also insufficient numbers of health care workers, vaccines and secondary health care services. Additional funding is urgently needed to respond to this acute emergency.  Cutaneous leishmaniosis remains a pressing concern in Aleppo and Idleb governorates, especially in camps and remote areas of the region.  Although at a lower scale, the measles epidemic remains a point of concern. 4132 cases were identified in May and June. 4 WHO plans another campaign for children 5-15 in Idleb and Aleppo governorates to help close the vaccination gap.  WHO reached more than 781 000 children in the 2nd round of the polio immunization campaign conducted in Idleb, Aleppo and Hama governorates. 12 WHO HEALTH EMERGENCY STAFF 70 HEALTH SECTOR WORKING GROUP PARTNERS (INCLUDING DONORS) 3.5 MILLION REFUGEE POPULATION 7 WHO-SUPPORTED REFUGEE HEALTH TRAINING CENTRES 95% % FUNDED OPERATIONS IN 2018 21 300 000 US$ REQUESTED FOR OPERATIONS CROSS-BORDER OPERATIONS TO NORTHERN SYRIA 23 WHO HEALTH EMERGENCY STAFF 96 HEALTH CLUSTER PARTNERS 4.6 MILLION ESTIMATED POPULATION 438 HEALTH FACILITIES SUPPORTED BY WHO PARTNERS 82 FUNCTIONING HOSPITALS SUPPORTED BY WHO PARTNERS 47% % FUNDED OPERATIONS IN 2018 43 500 000 US$ REQUESTED FOR OPERATIONS Sabah is one of the 350 Syrian refugees that WHO trained as community health staff for the provision of home care to other older and disabled Syrian refugees in Turkey. During the training, Sabah visited bed-ridden patients in their homes under the supervision of health staff from Turkey’s Ministry of Health. Photo credit: WHO/Rocio Lopez PAGE 2 5 Data for all 2018 until June 23, 2018 (epidemiological weeks 1 -25)for all EWARN-covered areas in Syria Refugee Health Programme Health needs, priorities and gaps  Language and cultural barriers remains a major obstacle to the provision of health care services for Syrian refugees, especially at the secondary and tertiary levels.  The mental and psychological consequences of conflict and displacement among the refugee population still place high burdens on refugees’ health and household expenditures. Conflict-related injuries, the long-term disruption of Syria’s health system and the poor or insufficient management of chronic conditions have left behind large numbers of refugees with disabilities. WHO and health sector actions Leadership and partner coordination  WHO continued to support Turkey’s Ministry of Health and worked closely to the relevant national authorities to ensure alignment of objectives at all levels of the programme. WHO also maintained its role as the leading agency of the health sector working group and the MHPSS sub-working group involved in the refugee health response in Turkey under the Regional Refugee and Resilience Plan 2018- 2019. Health expertise and technical operations  63 Syrian nurses underwent the theoretical stage of the adaptation training aimed at qualifying Syrian health professionals to work within the Turkish health care system while 84 Syrian doctors and 134 Syrian nurses completed the practical stage of the training. During this on-the-job training, they provided consultations to other Syrians in 7 WHO-supported refugee health training centres across the country.  250 Syrian and Turkish primary health care doctors were trained in early diagnosis, management, treatment, basic counselling and proper referral for a range of low-intensity mental health conditions. These trainings support the increasing mental health needs of the Syrian population in Turkey.  350 Syrian refugees were trained as community health support staff to provide home care and social services to older and disabled refugees. The training consisted of 4 weeks of theoretical learning and 2 weeks of practical training in palliative care units and 7 WHO-supported refugee health training centres across Turkey.  83 Turkish-Arabic interpreters were trained to serve as patient guides to Syrian refugees in several health facilities across Turkey. Cross-border operations to northern Syria Situation update  In May, more than 100 000 people moved from rural Damascus and Homs governorate into north- western Syria. People arrived mostly to northern and central Idleb and northern Aleppo.  Between 150 000 and 250 000 are estimated to remain in Afrin district. Small numbers of IDPs returned to Afrin district in the last days of May prior to the closing of the Tanab-Ibbin crossing on 26 May 2018. Public health concerns  Cutaneous leishmaniosis remains a pressing concern in Aleppo and Idleb governorates, especially in camps and remote areas of the region. The only NGO working in this field reduced its services, resulting in a significant gap to accessing the necessary care.  The measles epidemic continued to affect the northern governorates of Syria. A total number of 14 857 suspected cases of measles have been identified in 2018.5 The main governorates affected include Raqqa, Deir Ez Zor, Idleb and Aleppo. PAGE 3 6 Data from April 30, 2018 to June 16, 2018 (epidemiological weeks 18 -24)for all EWARN-covered areas in Syria 7 Referrals took place in 28 out of the 35 trained health facilities in the network. Health needs, priorities and gaps  In Afrin, a needs assessment showed a lack of essential medicines, medical staff and specialized services. Mental health care and physical rehabilitation services are not available at all. Overcrowded locations, including camps, and lack of hygiene in several IDP sites pose some increased risk of potential outbreaks.  Mental health remains a point of concern in north-western Syria due to the weak referral system, lack of integration of mental health services at primary care health level and lack of professionals properly trained and qualified to respond to the needs of the affected population.  In north-western Syria, war-wounded or injured patients are in need of physical rehabilitation services. WHO is working with 15 humanitarian partners that are providing services for people with disabilities, to improve referral mechanisms between trauma care and physical rehabilitation.  The destruction of Kafr Zeita hospital at the beginning of May created a large gap in northern Hama countryside for primary and secondary health care services. Other health facilities in Hama and Idleb require strong support to continue running.  Additional funding is needed in order to continue polio vaccination campaigns in 2018 and 2019 and bridge the immunity gap against polio virus among children in north-western Syria. WHO and health sector actions Leadership and partner coordination  WHO led regular coordination meetings with the health cluster and mental health and psychosocial support (MHPSS) partners to identify gaps and response priorities. In May, in response to the ongoing population displacement in north-western Syria, partners scaled up from 70 to 100 mobile clinics to reach communities in remote locations. According to a mapping exercise in June, MHPSS care is provided in 77 medical facilities run by 17 partner international NGOs.  WHO conducted two orientation workshops for Health Cluster partners, WHO staff and other UN agencies, in the prevention of aid diversion, sexual exploitation and abuse. Information and planning  Attacks on medical facilities continued. In May and June, a total of 12 attacks on health were recorded in all Syria, resulting in four deaths and eight injuries among health personal and patients.  Through surveillance system for the early detection, prevention and control of diseases, the Early Warning Alert and Response Network (EWARN) identified 42 cases of acute flaccid paralysis. The number of new polio cases remains 0 for 2018.6 Health expertise and technical operations  Primary health care (PHC): WHO completed training in referral mechanisms for 35 out of 46 health facilities of the model PHC network in Idleb governorate to ensure integrated health services at the primary health level. In May and June 3128 referrals were conducted.7  Mental health and psychosocial support: 14 psycho-social experts were trained as trainers for other health workers operating in Syria. 63 psycho-social workers in Azzaz and Idleb were trained in psychological first aid, case management and referral pathways for mental health and gender-based violence. 21 doctors and midwives in Azzaz-Jerablus received refresher training on mhGAP. In June, a mental health needs assessment was conducted in Idleb by partner NGOs (results to be shared in July).  Immunization: Routine immunization for children under 5 years old continued in 84 out of total established 86 centres in Idleb, Hama and Aleppo governorates. In June, 47 vaccinators were trained in north-western Syria in basic routine immunization practices, data collection and health information systems. PAGE 4 FUNDING STATUS OF APPEALS for 2018 NAME OF APPEAL REQUIRED FUNDS FUNDED % FUNDED WHO Turkey Regional Refugee & Resilience Plan (3RP) 2018-2019 US$ 21 300 000 US$ 20 315 000 95% WHO 2018 Cross-border operations from Turkey US$ 43 500 000 US$ 20 300 000 47% DONORS - Refugee Health Programme European Civil Protection and Humanitarian Aid Operations, the Bureau of Population, Refugees, and Migration of the United States Department of State, KfW Development Bank, EU Trust Fund and the governments of the People’s Republic of China, Kuwait and Norway. DONORS - Cross-border operations UK Department for International Development, European Civil Protection and Humanitarian Aid Operations, United Nations Office for the Coordination of Humanitarian Affairs pooled funds, the United States Agency for International Development and the governments of Japan, Norway and Sweden. The second of four polio immunization campaigns planned for 2018 was conducted, reaching more than 781 000 children in Idleb, Aleppo and Hama governorates.  Trauma management: WHO trained 22 Syrian surgeons to perform life-saving procedures such as tracheotomy and management fatal bleeding. Another 16 Syrian doctors were trained to serve as trainers for trauma management to other health care workers operating in northern Syria. Operational support and logistics  Cross-border deliveries filled 5 truckloads of medicines and medical supplies worth more than USD 320 600. The overall shipment, consisting of 369 000 treatments, included specialized emergency kits, essential medicines, burn dressings, lice and scabies treatments and other key supplies to support immunization campaigns. In June, about 80% of supplies were distributed to 140 health facilities and 54 mobile units serving IDPs and host communities in the governorates of Idleb, Hama, Latakia and Aleppo. RESOURCE MOBILIZATION Contacts Refugee Health Programme Cross-border operations Altin Malaj, Annette Heinzelmann, Refugee Health Coordinator, malaja@who.int Emergency Operations Manager, heinzelmanna@who.int Rocio Lopez Inigo, Lieke Visser Communications & Advocacy Consultant, lopezr@who.int Communications Officer, visserl@who.int Deniz Akkus, Communications Officer, akkusd@who.int For more information, please visit http://www.euro.who.int/en/syria-crisis © World Health Organization 2018