WHO press conference Health in Syria

Well, good morning, everyone.

Thank you very much for joining this press briefing that is organised by WHO but is hosted by our colleagues at the UN in Geneva.

So I would really first like to thank Enrique, Jean, Marc and others who will be helping us, Francois as well who will be helping us technically to do this this briefing.

As as we have noted in in our media advisory, we would like to talk to you this morning about a health situation in Syria.

And for that we have two WHO guests with us today from Syria.

We have our WHO representative, Doctor Akjamal Maktimova.

And in Cairo, in Egypt, we have Doctor Rick Brennan that most of you probably know and remember from the time when he was here in Geneva.

Right now he works as a regional director for emergencies in our regional offices for Eastern Mediterranean in Cairo.

So I will give a floor first to Doctor Maktimova, who is who is joining us from Syria and then for her opening remarks and then Doctor Brennan, we'll speak and then we will open the floor for questions.

So if it's possible now to give a floor to to to Doctor Agdemal?

[Other language spoken]

Good morning, everyone.

We can hear you very well.

[Other language spoken]

Right, I'm in international civil service for over 22 years and Siri is my 10th duty station.

I joined Syria country office 7 weeks back.

My first UN job was in Turkmenistan and I moved to work in UNFP in Lao PCR, moving to W 20 PR, Korea, India, Bangladesh, Maldives, Nepal, Yemen and Oman.

I am a medical doctor with master's degrees in Health Systems management from London School of Hygiene and Tropical Medicine and also International affairs from Fletcher School of Law and Diplomacy, Tufts University.

And my values and Call of Duty made me to travel in the midst of pandemic from Oman to my former duty station to Syria.

As Syria entered it's tense year of conflict, on top of the brunt of humanitarian crisis, Syrian people are experiencing epidemiological and health impacts related to COVID as well as regional economic crisis impacting their livelihoods.

This week I am greeting you from the historic city of Aleppo.

[Other language spoken]

Any war is meant to destroy and this war has not been an exception.

Throughout my Rd travel from Damascus to Homs, Tuhama and to Aleppo, it's been heartbreaking to have witnessed complete destruction of many health facilities including a 400 bed hospital in Holmes, A600 bed brand new Eastern Aleppo Health Complex along with its state-of-the-art medical equipment which used to host nursing school, polyclinic and three specialised hospitals.

This is a case across Syria as per WTO most recent estimates and we did it in March.

Less than half of all public hospitals and health centres are still functional, the rest being either partially functional or totally destroyed.

Some governorates and populations are being affected the most.

The example is NE Syria where I am going to travel tomorrow.

Out of 16 public health hospitals, only one is fully functional, 3 are partially functional, others are not functional.

Hospitals are being affected the most.

In the past decade, the number of hospital beds has dropped by 43%.

In some government.

It's less than three beds per 10,000 population is available.

I would like to give you international standard of 10 beds required of pure 10,000 population.

In addition, over half of healthcare forces fled the country since the conflict began.

The remaining medical staff struggled to cope with the overwhelming health needs while continuously surviving the threats of being kidnapped or targeted for killing.

We need to invest in health system to serve people and their needs.

1/3 of approximately 20 million Syrian population is internally displaced.

Over half, it's about 2012 million are in need for healthcare.

Those who are displaced are facing a protection and poverty crisis.

Millions of displaced have lost their livelihoods and are taking on debt and increasingly unable to meet their basic needs due to impact of regional economic crisis and the impact of COVID-19.

They face increased risk of child labour, gender based violence, early marriage and other forms of exploitation.

Displaced people in camps or camp like situations may not be in a position to practise regular hand washing, physical distancing or other health measures.

Compared to war and starvation.

And I would like to give you example, 9 million people in Syria are now considered food insecure up to 9.3 million, which is an increase of 1.4 million in the past six months only compared to war and starvation, the pandemic seems benign to many Syrians.

This wrong impression may be due to the fewer numbers of COVID cases detected so far and announced by Ministry of Health.

As of today, there are 248 confirmed cases, mainly in rural Damascus, which is being affected the most and 9 deaths.

Another 5 cases are recovered in northeast Syria and one death in northeast Syria.

These numbers are partly due to Syria being a country less open to international travel, but mainly a result of its inadequate laboratory testing capacity and local surveillance capabilities, lack of equipment, supplies and regions.

For WTO to provide epidemiological evidence, generate predictions and mitigate risks, we need more data, and our first step is to build up and strengthen testing capacity.

I acknowledge there is a delicate balance between protecting the economy and introducing public health measures.

It becomes an ethical dilemma in Syrian context when we speak about those for whom it means to lose livelihoods.

More than 90% of the population in Syria living on the poverty line, compared to 28% in 2010.

Humanitarian needs are worsening in the context of COVID-19.

The measures adopted to combat COVID-19 have affected the livelihoods of most individuals across the globe.

Due to dire economic situations, the consequences of Syrian people for Syrian people would be devastating.

Many have lost their livelihoods, both inside the country but also for those who have been providing remittances from outside the country.

The outbreak can really deepen the humanitarian needs.

And while the numbers are small, there are no reassurances that COVID-19 will behave differently in Syria.

And we have seen it across the world, We have seen it across the region and also in neighbouring countries like Iraq and Turkey are the examples of **** transmission levels.

However, for Syria, we believe there is a chance to respond, scale up public health measures.

WHO with partners is putting all our efforts for mitigation measures.

Humanitarian community join efforts with health professionals in Syria.

I met extraordinary professionals this week.

Doctors, nurses, midwives, field vaccinators determined to serve caught up in protracted crisis in Aleppo National Lab.

The staff is determined to work around the clock to maximise the number of tests if only extraction kits, reagents and consumables were in place to scale up COVID-19 testing.

I met medical students who volunteered to serve should their hands be needed at the front line to support COVID-19 patients due to search of cases.

Civil society is organising itself and rendering its services in cooperation with local health authorities and international partners.

While travelling, I have observed the work of five local Ng OS whom WG has a long standing partnership with.

I have visited A hemodialysis centre operated by Sunduk Al Afiya NGO in homes which served 160 patients suffering from kidney failure.

It's about 2/3 of patients which used to be prior to be served by the National Hospital before its destruction using 22 functioning hemodialysis machines.

These services are provided free of charge.

These are 5 of 23 Ng OS WS is currently supporting and working with to deliver health services through 7 Primary Health centres, 23 mobile teams, 20 static medical points Only In March over 94,000 patients were seen.

Over 1400 referrals to specialised services were supported.

We are all caught in this crisis that needs political solution.

We do have we don't have tools for political solutions as publisher but neither we are mandated to resolve political crisis.

But we are determined to support Syrian people, to protect public health and to serve vulnerable.

Over to you.

Thank you very much, Doctor Maktimova.

I will now turn to Doctor Rick Brennan, who is again our Regional Director for Emergencies for Eastern European, so for Eastern Mediterranean region.

Sorry, Doctor Brennan.

Thanks very much, Tariq, and thanks very much, Akhtimal, for that wonderful overview of the issues.

I've been working on the Syria crisis for over 8 years now, and I think that everything that needs to be said has essentially been said.

And you've heard a lot now from from from Achmal.

You know, we're all familiar with the **** levels of violence the Syrian people have been subjected to for the better part of a decade.

The lack of political progress, the recurrent assaults on the Syrian people, the enormous suffering, but the incredible resilience as well.

But I do think we're, we are moving into a new phase of, of the crisis.

And I think that Arjmal has captured some of those key new developments.

Well for you, the, the, the economic crisis is really adding an enormous new burden to the, the coping capacities of the Syrian people.

We, you know, you've heard the figures around food insecurity and people going hungry.

Now these these are developments that that we haven't seen really on this scale before.

Also now the the ****** of COVID, you know, adds a new layer of complexity to the public health risks, the humanitarian needs and, and the socio economic threats that that the Syrian people face.

And I think actor Miles said it well.

You know, we've only had 248 cases in the country thus far, but we can take no comfort in that.

That's, you know, other countries in the region.

The number of cases has got off to a slow start.

And we've seen in more recent times a real acceleration.

So we've seen this in Iraq.

[Other language spoken]

And we can fully expect that we'll have a similar development in Syria as well.

So as was said, we still have an opportunity to mitigate the worst of the outbreak in Syria and we really do need to collectively scale up our efforts with the local health authorities, local health workers to to try and blunt the acceleration of the outbreak that we know is coming.

We can do that most effectively by scaling up the effective public health measures that we know work, the disease surveillance, the testing, the isolation, the case management, the contact tracing and the community engagement and communications.

With the current economic climate, we we really want to avoid some of the the lockdown measures that can bring just another level of social and economic pain to the Syrian people.

So we have, you know, what we see as WHO that we have an important role to work with health authority and with our partners to, to address this very significant new public health risk.

Archmal has given you a real ground eye view for and what she's seen recently.

And I, I've visited Syria on quite a few occasions over the last eight years.

In fact, we're if things go to plan, there'll be another group of us going back next week.

And I think that what has really one of the lasting images for me about Syria is the enormous resilience and resourcefulness of the Syrian people.

And you see that on both sides of the conflict.

I've worked closely with, with medical staff and nursing staff on both sides of the conflict and the other deep distance those people, their absolute commitment to, to serving their people.

The extreme, you know, extreme resourcefulness of, of being able to live to deliver and care and provide extraordinarily **** levels of service for complicated conditions, for bad burns, for the chronic diseases that, you know, the renal dialysis and so on.

That their ability to deliver under enormous strains and to keep doing it year in and year out.

After 8 years, I have enormous respect.

And, you know, we often talk about the need for us to, to reflect on our common humanity.

And I think seeing that resilience and that commitment and dedication of healthcare workers on both sides of the conflicts, that's, that gives me hope that we can still tap into that, that sense of, of common humanity and this idea that, that the, that health can promote and contribute to, to some in some way, in some modest way to rethinking the underlying causes of our conflict and, and, and, and pushing us towards some sort of agreement and peace process.

I, I, I think that we have a modest role to play there.

So it's an incredibly challenging circumstance.

We've got new risks and new burdens with the economic decline and, and the ****** of COVID.

What do we need to do?

Well, we still need to maintain our all modalities approach to the delivery of humanitarian assistance.

It's a shame that eight years in there is such still such a dependence on humanitarian aid.

But the reality is there is and we have to continue to deliver.

So for us to do so.

Secondly, we need, we need the, the funding, we need our donors to continue to be generous.

We've got the pledging conference on June the 30th, the ministry of the pledging conference.

We need the donors to step forward for us.

Thirdly, we need to, as Ajmal has said and I've just said, we need to accelerate our, our preparedness for the and response to the COVID outbreak.

And finally, I think, you know, again, we really need the change of heart.

You know, eight years of conflict will give creates cynicism and division and hardness of heart.

And it's pretty hard to overcome that.

But we've got to appeal to the best of our humanity and hope that the people who do have a chance to make the political decisions that can bring some peace and stability to the country will make those decisions.

Thanks for the opportunity to speak with you today.

Many thanks, Doctor Brennan for for for this.

I will now invite journalists to ask their questions.

As I have not been doing this before on Zoom, I don't know really how where I'm going to see the hands being raised.

Hi, Tariq, this is Lauren.

I've been unmuted.

So I assume that that means that I can start to ask my question.

OK, then, then I will do that way as I hear someone starting I I just left questions coming, please.

Lauren, thank you very much.

Thank you for the.

[Other language spoken]

You mentioned that the the number of COVID cases are still very low in Syria, but you tend to say that it might be an underreported because of the the lack of testing capacities and the broader, broader lack of capacities.

Has the virus reach alo camp and do you fear that there might already be maybe thousands of cases there?

[Other language spoken]

So I let Doctor Brown or Doctor Jamal to reply.

Doctor Jamal, do you want to take that?

There are no reports from alcohol camps, but as I mentioned, majority of reports are coming from rural Damascus.

There are 9 governorates currently affected but there are no reports from alcohol camp.

OK, if Doctor Graham, you want to add something, please, please just jump in.

No, I, I, I, I think Aptamal's said that we, we have no evidence of any cases in alcohol camp.

And if there were thousands of cases as the question, as the as as was asked, we would certainly be aware of it.

But no, no evidence of any cases in fact.

I, I, I might just add 11 observation that we've, we have for camps generally across our region is that there have been very, very few cases in refugee or IDB camps.

And that's in large part because of, of good, good management, good preventative work and also because of the reduced movement in and out of camps.

So we know that camps represent a **** risk should the virus be introduced, but we have not had any major outbreaks in any camp across our region to date.

And again, that's that's because of some good management and reduction in movements in and out of camps.

And also the, the situation in Syria in terms of COVID, it's unfolding and it starts and we're observing cluster of cases which are being closed and controlled and contacts traced there.

The health personnel is doing it's best to get with WH and partners to trace contacts and isolate.

So currently it is still possible to keep it under control, but as cases will grow, it is going to be increasingly difficult and it's going to stretch already stretched health system.

[Other language spoken]

So I understand that it's really open for participants to jump in when they want.

[Other language spoken]

Thank you very much, Mr Tarek.

This is Byramat.

From Anatole.

Agency Mr Brennan, I have a question on El Ho campus, but I just followed up my colleague.

[Other language spoken]

Any chance to?

Enter that camp, we have access that enter the El Ho.

[Other language spoken]

Week A Human Rights **** Commissioner Michelle Bachelet expressed her deep concern overall human situation.

In the camp.

So what is the latest health situation?

And please tell me.

If he.

Entered the company before.

[Other language spoken]

I'm not sure I, I, I got the whole question, but current status in the camp, we're always concerned about the conditions in our whole camp.

We, we know that the stresses and strains that the residents there have been under.

As we mentioned, I think that there's with respect to COVID, there's been a lot of efforts taken to prepare for, for COVID.

So the disease surveillance being strengthened.

There are different committees in the camp that are, you know, promoting all the measures that, that the, that the residents can take to protect themselves.

We've strengthened the health services there.

There is a process to take samples and and and transport them to the laboratory as required.

But it's always difficult in alcohol it it's a difficult operating environment.

I think that what HealthPartners have demonstrated through a real commitment to, to scale up access to essential health services, the main, if you look at the health indicators in the camp that they meet international standards, which is a pretty remarkable effort given the austerity of the environment.

So it's not an ideal environment, it's not an ideal situation with with regard to healthcare, but we have, we, we have met, we continue to meet international standards there.

And as I mentioned, I think the appropriate steps have been taken for preparedness for for the very closely.

[Other language spoken]

Next question if any Taric, I just I have, I asked this question if Mr Branan had a chance to, you know, visit that.

Camp and I couldn't.

I couldn't get the answer, please.

[Other language spoken]

Doctor Branan.

The question was, did you have opportunity to to visit the camp yourself?

[Other language spoken]

I am going to commercially tomorrow and I'm expecting to have access to camp.

Our office sub office 22 sub office in commercially is having regular access to camp.

There are 65,000 displaced people and there is work with partners with multiple partners to support those people in need.

I'm sorry, Terika, I was having trouble with my mute button.

But so it's great that Jamal is going and it's great that we have staff going there.

I personally have never visited Al Hulk.

[Other language spoken]

Any other questions?

[Other language spoken]

Just wondering those figures that you've reported the, the national, the national figures, can you clarify, I may have not caught it in the beginning, Can you clarify whether they include cases and surveillance work underway in areas not controlled by the government?

[Other language spoken]

Yes, if I may, as I mentioned, as of today, there are 248 cases which are under government controlled area and five cases which are recovered in Northeast, one death in Northeast and 9 deaths otherwise.

So all together 10 deaths.

There is no reported cases in Northwest area.

So we have full picture across all territories and Double Cho is advocating for unified reporting from all territories.

Thank you for this clarification.

Any other questions?

Yes, hi, it's Nina Larson from AFPI.

Just wanted to follow up on that.

How how confident are you that you're you're getting proper reporting because there isn't AI mean what kind of.

[Other language spoken]

Have over the different.

Areas the areas that aren't under government control.

For instance.

[Other language spoken]

There are double chose primary bread and butter is health information including surveillance.

There are over 12181 surveillance evors sites, Sentinel sites and we are getting information not only related to COVID but also we are able to detect in a spark in cases or suspected cases of COVID.

If with those kind of triangulations which we are doing in epidemiology did not match, we would have suspection or suspecting certain outbreaks which are not reported.

Current situation, I would say good confidence information is correct.

Of course across the globe countries and there are studies which are done that current even level of reporting across the globe could be one in 10 cases.

And Syria might not be an exception.

There might be more cases than what we're it's being reported.

But the WTO is working with all those Sentinel sites to get information on potential outbreaks and also cases.

We have also rapid response teams, so we are working on the ground to understand the situation.

Rick, would you like to mention about the territories which are not necessarily accessed from this site?

[Other language spoken]

And well, I think you've, I think you've captured it well, who does court these, these, these surveillance sites and for the detection of infectious diseases.

And we also do what's called right now active surveillance as well.

Not only do we have these sites that collecting information, we've got teams going out into, into the camps and into the small vulnerable communities actively looking for disease also.

And then we've also supported the laboratory capacities and we're looking to further expand that.

So in Northwest Syria, we have one functional lab right now supported by WHO, but we're expanding that capacity.

There'll be another 2 coming online.

There's a lot of samples being taken across, across the border into Turkey from some parts of Northwest Syria.

Ajmal and the team there are, there's a one or two functioning labs up in the northeast.

Ajmal and the team are also working to expand that capacity.

So I, I, you know, actor Miles made the point that the official numbers represent a likely underestimate of the true numbers.

And that's not unique to Syria at all.

It's, it's, you've heard the CDC and the US come out and say we're probably only going, picking up one in 10 cases.

It's the nature of the disease.

But what we do know in Syria, though, is that we are we we don't have an explosive outbreak.

[Other language spoken]

The health, the health facilities are not overwhelmed.

And so This is why we're saying we still have an opportunity to scale up our preparedness to blunt and mitigate the worst of of the outbreak.

[Other language spoken]

Doctor Brennan, I understand that we have Peter Kenny who would like to ask question as well.

[Other language spoken]

Yes, I'm asking a question for Anna Dooloo English.

And I would like to know specifically if you can give us any information about the cases in Idlib itself.

[Other language spoken]

So COVID-19 cases, I'm sorry.

And I mean, I mean, COVID-19 cases, yes, there's there's been no cases to date in Idlib in the northwest.

And as we mentioned, where we are strengthening the disease surveillance and the testing capacity there.

You may have heard of, you know, talk of Turkish policemen coming in and bringing the disease.

That hasn't been the case.

They they did not actually cross the border.

So to date, no cases in the Northwest, but we are watching the situation very, very closely because we, you know, because we know that the risks for rapid transmission of the disease are **** there because of the conditions on the ground.

And and therefore all the disease surveillance measures and the preparedness and prevention measures are very much in place.

But we're watching it very, very closely and we remain very concerned.

[Other language spoken]

Maybe Lauren would like to have one more question.

[Other language spoken]

What is the situation in terms of PPE throughout the country?

Maybe I will take this question.

PPE, The situation overall in terms of providing PPE, providing diagnostic and testing equipment and supplies and regions in terms of providing equipment and supplies and medications for case management.

We have not reached our targets.

And I have been travelling and have seen that the while we as double churn HealthPartners have provided over the past six months significant numbers, they have been distributed, but it is not enough.

It is not sufficient in public health laboratory here in Aleppo.

I have seen actually the, the, the, the potential gap, not potential gap, it is going to be gap because those PPS are going to be used extensively day in and day out and they are going to the, the, the, the level and stock is going to expire very soon.

So we're going to, we are speaking about the number of days or weeks when those PPS will will be utilised and we will not have.

So we need to ensure uninterrupted supply chain which is not easy.

And as double show, while we have provided initial PPE supplies, we're focusing now on testing capacity and also on capacity for case management because we are expecting numbers and we are expecting big numbers as it was a case in scenario in other countries.

And PPE is still something which we have to also prioritise, but we need support.

And for COVID, so far we have received less than 50% of pledges and and what we have requested from donors, unfortunately, we also have to prioritise and have balance across those needs.

PPE is not being prioritised in laboratories and healthcare settings but I have not seen myself that masks and are being used in other settings other than healthcare settings.

Even in healthcare settings, what I have witnessed crowds of patients in the facilities which are and there there is no use use of masks and even among some of the some of the health medical personnel because of the lack of PPE.

Thank you very much.

Are there any other questions Not being informed that there is anyone else asking, but please come in if we still have a few minutes if needed.

[Other language spoken]

I don't know Doctor Brennan and Doctor Doctor Jamal, do you want to have a final word before we conclude?

Maybe I would like to, yes, maybe I would like to add what I have witnessed and it is again related to overall economic situation and also it relates to certain restrictions.

And as I mentioned, we have caught in political crisis, but when we speak about global public health reasons, global public health imperative, it is necessary perhaps to reassess impact of restrictions, some of the political restriction sanctions made on medical equipment, on supplies for maintenance of that medical equipment and medications when it reduces the ability of health system to respond to outbreak.

We are nobody is safe until we are all safe.

So I said UNSG Security Secretary General has called in May for global halt of military actions as well as ease of sanctions of humanitarian operations.

I would like to really request that for medical reasons, in order to respond to for COVID crisis, it is important to perhaps reassess the situation.

Doctor Brenana, last word.

Well, I'd just like to thank everyone for your interest today.

I think we've, I think actually Miles covered the main issues.

I, you know, we, we, we remain disappointed that there's still such a dependence on humanitarian assistance in Syria.

Nonetheless, we as an organisation and our partners, we're absolutely committed to the Syrian people, but we're dependent on the, on the donors stepping up at next week's pledging conference.

And we will certainly play our part in support of, of the Syrian people and their incredible resilience.

We, we just hope that the donors do likewise.

But we know that there's a lot of demand on humanitarian budgets right now.

But the Syrian people, we cannot forget them.

And we hope the donors deliver.

[Other language spoken]

Thank you very much.

Thank you very much, Doctor Brennan, and thank you, Doctor Jamal from Syria.

We will all be following the the the conference next week and we all hope that it will be successful.

I wish to thank all journalists who were with us this morning and then we will stay in touch.

If you have any questions on WH operations in Syria, you can contact me or some of my colleagues and we will be happy to to help.

Wish everyone a very nice day.

Thank you for your time.

[Other language spoken]