Syria: At the onset of the third year
Prior to the crisis, Syria had a very strong public health base and its health indicators were amongst the best in the region (e.g. maternal and infant mortality; life expectancy; high ratio of health professionals including specialized medical doctors per inhabitant; good nutrition status of the population; excellent hygiene practices etc.)
The effects of the crisis on the public health sector were not felt for several months thanks to the strong health infrastructure including water and sanitation and availability of large reserves of medicines and medical supplies.
Since the beginning of the conflict the health system was severely disrupted in terms of health care infrastructure, workforce, and availability of essential medicines and supplies, imposing an ever growing threat to the provision of health care.
More than one-third of the public hospitals are out of service and almost 1 in 10 of the public health centres. In Aleppo, only four hospitals out of 11 are functional.
Hospitals and health centres that are operating are overburdened with patients: for example, the main referral hospital in Lattakia receives a new emergency patient every 32 seconds (this hospital covers referrals from Aleppo, Homs and Idlib).
Similarly Al Berony referral hospital in Damascus is receiving 20 times more emergency patients now than before the conflict began.
The lack of fuel and electricity has forced many hospitals to operate with reduced capacity.
Internally Displaced Persons in collective accommodation are among the most vulnerable as they cannot afford medical services and medicines they need.
Damage to civilian water and sanitation infrastructure is particularly severe in Rural Damascus, Idlib, Deir-ez-Zor, Homs, Aleppo, and Al-Raqqa, and per-capita availability of water supply has decreased to one third of pre-crisis levels (from 75 litres to 25 litres per person per day).
Deteriorating conditions in collective centres are of a particular concern with unsanitary conditions due to the lack of toilets (with a range of 1 toilet per 50 people to 1 toilet per 70 people).
Many health professionals have fled the country. Affected governorates are lacking qualified medical expertise, particularly for trauma, anaesthesia and specialized laboratory personnel.
Many health care workers are unable to report to duty, contributing to grave staffing shortages in hospitals and other health facilities. In Damascus, Aleppo and Homs, at least 70% of the health providers live in rural areas and therefore frequently unable to access their work place due to irregular public transportation and blocked and unsafe roads.
There are critical shortages of life-saving medicines including anaesthesia, antibiotics, serums and intravenous fluids, as well as those needed for the continuous treatment of chronic diseases, especially haemodialysis services and insulin.
With the substantial damage to pharmaceutical plants, local production of medicines has been reduced by 90%. Prior to March 2011, 90% of medicines in Syria were locally produced.
Additionally, the main government storage for imported medicines, which included most of the required needs for the first quarter of 2013, has been destroyed. Medicine prices on the black market have skyrocketed and are not available to the majority of the population, especially in the rural areas where communities are traditionally economically worse off than in the cities.
The Early Warning and Response System (EWARS) reports frequent cases of diarrhea. An increasing number of typhoid cases are being reported in Derezzor, Homs and Hama.
An increasing number of suspected hepatitis A cases can be attributed to the deterioration of sanitation and hygiene. There is an outbreak of Leishmaniasis (skin disease) in several governorates including Hama, Hassakeh and Derezzor. With the forthcoming summer months, the health situation is expected to deteriorate further, with potential water-borne disease outbreaks presenting real risks.
In collaboration with the health authorities, WHO and health sector partners have in 2012 reached over 2 million people with health care support.
WHO has been using a multi-pronged approach to ensure that the medical products reach those in need, in both government and in opposition-controlled areas, and that those critical services are accessible to those in need.
Since May 2012, WHO has distributed medical supplies for basic health care to cover the needs of 1.7 million people in affected areas.
Polio and measles vaccination campaigns have reached 1.5 million children vaccinated against polio and 1.3 million children vaccinated against measles in 2012.
WHO has established innovative partnerships with 20 local NGOs to provide basic health services and/or referral services for secondary and tertiary care.
WHO initiated its support to outreach health care provision through 6 mobile clinics and 10 mobile teams in highly affected areas in Rural Damascus, Aleppo and Homs.
Over 2012, WHO conducted several trainings to strengthen disease surveillance, immunization programs and health information systems. NGOs with WHO support have trained internally displaced Syrian volunteers in first aid, psychosocial support, and basic stress and trauma coping mechanisms for children.
Health experts from Syria and pharmaceutical experts and health professionals from WHO and Jordan met in Amman this month to address critical shortages in medicines and medical supplies inside Syria, resulting in an updated Essential Medicines List for the entire country.
WHO has evaluated the needs for the next 12 months in terms of essential medicines, medical supplies, medical consumables and estimated that these will require a minimum of US$ 900 million. A list of the most urgently-needed and life-saving items has also been developed, containing 168 items (92 urgently needed essential medicines, 33 cancer medicines) and estimated the costs at US$ 467 million for 2013.
Funding WHO has demonstrated capacity to effectively respond to the increasing health needs of the Syrian population including the severe shortage of medicines, medical supplies across the country. However because of lack of funding, WHO is now having to decline provision requests for critical life-saving interventions
WHO has received only 12% of required US$ 48.5 million for the current period (January to June 2013)
For this reason it is difficult to meet objectives set at the beginning of the year. These objectives include:
Delivery of medicines, medical supplies and equipment to meet the trauma care needs of an estimated 735 000 people in Damascus, Rural Damascus, Al Raqqa, Aleppo, Idlib, Hamah, Homs, Swieda and Quintera;
Supporting health authorities to complete the second phase of the polio and measles immunization campaigns for up to 1.6 million children;
Providing medical supplies and care for 4 million people and materials to support 3500 haemodialysis patients;
Providing essential medicines, supplies and equipment to support services for non-communicable disease treatment with a priority for life-saving medicines such as diabetes, cancer and cardiovascular conditions.