WHO Press conference on Syria 23 March 2021

To organise this press briefing regarding the health situation in Syria, we have heard from Jans and OCHA comments he made about attacks on health facilities that took place in last couple of days.

We have been informing you about the situation in Syria for the last 10-10 years and unfortunately we are marking this very sad milestone these days.

So we wanted ahead of ahead of the Brussels 5 conference that will take place on 29th.

We wanted to get you the latest about a situation in Syria when it comes to the health situation, when it comes to COVID, when it comes to WTO activities and our needs and gaps.

So with with us, we have Doctor Ajmal Maktimova.

She is our representative and head of mission in Syria.

She is today calling us from Aleppo.

We have also Doctor Mahmoud Daher, who is head of WHO field office in Gaziantep, Turkey, where whereas there's he's today calling from Istanbul.

But normally he's basic in based in Gaziantep and is looking to work in the areas in the northwestern part of the country.

Just for your information, if you are looking at the names that are with us, we have 3 colleagues who are joining us and participating.

So just for if you see some unknown names, we have Gualek Sultanova and Nohal Arabi from our office in in Syria, as well as our head of news and emergencies, Marcia Paul, who is online with us.

So with this, this, this this briefing is not embargoed.

And I will give a floor immediately to Doctor Ajamal Maktimova, our representative in Syria, who will give her opening remarks.

Ajamal, please, the floor is yours.

Thank you so much for that Tarek, and I would like to thank our esteemed participants for valuable partnership and your interest in work of WTO in Syria.

Syria, one of WTO's 194 member states, and it remains one of the world's complex, most complex humanitarian emergencies.

2020 has been a year of logic, a tragic loss, and we were all compellingly reminded of the importance of investing in public health and global health security.

March 2021 marks the first case of COVID-19 in Syria reported, as well as it marks 10 years since the start of the ongoing crisis.

Today we are witnessing more lives and livelihoods lost as Syria enters the third wave of COVID-19 while with crippled capacities of public health to cope and continued hostilities.

I have joined Syria ten months back and have witnessed that the year 2020 pushed the country as well as its people to even deeper devastation.

Economy driven further down.

We're witnessing half of work age population is now unemployed, hundreds of thousands of job lost since the beginning of pandemic.

Remittances on which millions of Syrians rely have halved to regional and economic contraction.

The Syrian pound is virtually in it's free fall having lost 78% of its value since last year and the price increase of average food basket equals increased to 236%.

Communitarian needs are increasing 21% increase in people in need for humanitarian assistance.

Over 12 million people, which is more than half of the population are in need of health aid, especially those people who are living in camps, in camp like settlements.

We have over 200 partners on the ground and W Church has been and continues to be present in Syria.

Throughout these difficult times, we have worked hand in hand with our partners for coordinated efforts for COVID-19 preparedness and response against nine response pillars, enhancing laboratory and surveillance capacity, infection prevention and control, points of entry, case management and most importantly, maintaining essential health services.

Little over half of health facilities are functioning in the ranks of healthcare professionals are severely depleted and this presents special challenge given the fragility of National Health system to respond to public health challenges.

We continue operating in one of the most complex environments in some of the challenges we've continued facing expanding public health measures and achieving behaviour change, protecting health workers security and access in in ensuring continuity of essential health services as well as establishing reliable supply chains.

For every word I stated in as challenge, I would give you examples, but let me share with you the picture which did not let me or kept me awake throughout the night which I witnessed yesterday here in Aleppo Hospital.

Men, women and children in the emergency department receiving treatments in overcrowded rooms, no masks, no distancing.

Mothers with their children side by side with penetrated wounds, abdominal wounds due to artillery strikes that were launched on the Mother's Day 2 days ago.

A5 year and seven-year old boys with over 35% of bodies burned whose parents rushed them from neighbouring Mid Beach, making a six hour detour instead of a straight route of one hour, which is no longer possible due to hostilities.

I kept awake thinking if these boys make it out alive.

While W2 made the fight against COVID-19 pandemic its major priority all over the globe, W2 in Syria its role as a provider of last resort and responded to an exacerbated humanitarian emergencies remains.

We remain on the front line to prevent, detect and respond to between the prone diseases, to maintain basic health services and to provide routine vaccination to children.

As a result of these dedicated efforts, not a single outbreak of vaccine preventable diseases were reported across Syria in 2020.

Non communicable diseases remain one of the major causes of mortality and morbidity and COVID-19 makes those people even more vulnerable.

Access to essential medicines have been severely compromised due to economic constraints hence double HR, sustained provision of life saving medicines to patients with diabetes, kidney diseases and failure cancer alongside with COVID-19 patients.

We have to sustain also and in fact increase mental health and psychological services, integrating it in facilities and various schools, as mental health and psychological well-being have been heavily impacted by COVID and its economical impact.

Despite the pandemic, W should maintain its public health programmes on nutrition, on tuberculosis as well as disability, trauma, burns and injuries.

We continue advocating as widely as possible to facilitate access to humanitarian assistance, especially to the most vulnerable.

We use all modalities in our whole of Syria approach to deliver humanitarian assistance in aid, medicines and medical supplies to all in need.

As we enter 2021, we cherish the same hopes.

We cherish the same aspirations as people in Syria.

We hope that our collective efforts and pandemic.

We hope to see peace in Syria and we want a better future for its people.

COVID-19 vaccines offer hope that the first of our goals is within our reach.

We work together with COVID Kovacs facility and with other partners and we put all our efforts to make vaccines available throughout Syria, prioritising **** risk groups based on equity, transparency and solidarity.

We would like to thank and continue working with our partners and we would like to thank media for their interest in Syria, for their interest in well-being of Syrian people in partnership with WHO to support our work on the ground throughout this very challenging times.

[Other language spoken]

Thank you very much, Doctor Maktimova, for sharing your thoughts, but also your impressions from from Aleppo Hospital.

I'll give a floor now to Doctor Daher who will tell us more about the situation in northwestern part of the country and WTO response.

[Other language spoken]

And thanks to Doctor Akzimel for this very important words about the situation in in Syria as a whole.

I just want to compliment the picture from the northwest Syria side, a region of the country that is out of the control of the government of Syria, which we, as the video show trying under the whole of Syria structure.

We work together in order to reach all population in in northwest Syria, 4 point 4.2 million population are living there.

They are not reached by any authorities and they they they are relying on the international community and the provision of humanitarian assistance and including the healthcare services.

Out of 500 or more healthcare facilities, only 423 are functional and almost 45% are relying on the supply chain of pharmaceutical that we are providing as WHO we complement our country office in reaching all Syrian population and all localities and IDB camps.

Out of the 4.2 million population, there are 2.6 million living in IDB camps and internally displaced people.

I mean, and the 4.8 million were considered are people in need for humanitarian assistance.

WHO has also expressed the concern about the increased attacks on healthcare services as mentioned by Doctor Abdimal and previously by OSHA on the tragic incidents that are happening in in the in the in Syria in general and in northwest Syria.

We have witnessed the attack on a hospital that has been reported to WHO.

This hospital, which is in Javan Saman district of Aleppo, was providing 500 and seven 5700 outpatient consultations, the 375 hospital admissions and 160 major surgeries per month to the population in northwest Syria.

This hospital now is out of order and not functioning and they have to evacuate.

This situation continues and show the fragility of the health system that is prevailing in in the northwest Syria.

We work with the international community, with the UN system in order to continue to provide healthcare services to the entire population there.

But we are waiting for and we are working under the United Nations Security Council resolution, which will be until the 9th of July 21, where we are uncertain about the continuity.

And for that reason, we are working with all partners in order to make sure that the humanitarian assistance can continue.

Although the situation since the 9th of July 2020, there are 21,260 confirmed cases of COVID-19 WR show have escalated, has escalated its work in order to make sure that the preparedness of the health system that already overstretched and the fragile health system can be ready to receive the number of patients with COVID-19.

We contributed to the functionality of nine COVID-19 dedicated hospitals and more than 30 community care treatment centres for moderate and mild cases of COVID-19.

We contributed also to the establishment of three laboratories to be able to detect and to confirm cases with COVID-19.

Out of the 21,260 COVID-19 cases, there have been 411 death IS, which contributed 1.93% of the total incidence of COVID-19.

That shows the amount of the investment that the international community led by WHO to respond to the COVID-19 situation in northwest Syria.

Yet the situation is in need of all our effort in order to contribute to the humanitarian assistance, including the healthcare services in Northwest Syria.

And we hope that this would continue under the United Nations Security Council resolution.

I will stop here and I will be able to respond to specific answers.

[Other language spoken]

Thank you very much, Doctor Daher.

So before we start with questions, I would just like to inform you that as a side event as part of the Brussels Conference on supporting the future of Syria and the region, WTO, UNICEF and Norway are organising tomorrow, 24th of of March at 11:00, side events entitled Improving the response to COVID-19 while tackling humanitarian needs in Syria.

We will be happy to send you the link for the registration.

And if there are any questions, our speakers can probably say more about the event itself.

[Other language spoken]

First question is Byram Altour from Anadolu news Agency.

Byram, thank you very much Tarek for taking my question.

I have a short one.

Actually.

Millions of Syrians special oppositions were trapped in Idlib in the northwest of the country.

So my question I am just wondering if who plans?

Deliver COVID-19 vaccines to the region via COVAX facilitation.

[Other language spoken]

Thank you, Byram, who would like to take this one.

I would give Mahmoud, but probably mentioned that Syria is 1 of 92 countries which is eligible for advanced market commitment supported by Kovacs and we are receiving first allocation of 3% coverage of population through cross-border support from Gaziantepar as well as from Damascus.

And I would give the floor to my colleague Mahmoud to answer the details for Northwest.

[Other language spoken]

And yes, thanks for the question.

On Northwest Syria, we are planning together with UNICEF, we have put plans for the for to reach out 20% of the population in Northwest Syria.

That will include the all the areas that is cannot be reached by our country office in Damascus and we will reach it out from our cross-border operation.

We have been working with the COVAX facility in order to make sure that we will get these vaccines.

We also were informed that 224,000 doses will be coming in the next couple of weeks and hopefully in April we can start kick, kick off our vaccination, COVID-19 vaccination to the beginning with healthcare workers and frontline workers and going to the other categories that were prioritised by the COVAX facility.

Thank you very much.

Just to remind journalists to click on raise hands so we can see who is having a question.

[Other language spoken]

Yes, Thanks, Eric.

Well, Bairam asked my, my, my question first, but maybe I, I can ask you a bit more details about the, the, the overall numbers just to make sure how many people were contaminated, contaminated by COVID-19 overall in Syria and how many in Idlib in northwest and.

[Other language spoken]

Deaths basically in again overall Syria and in Italy because it seems like it's a bit confusing the figures just like you mentioned 200 and two 224,000 doses.

[Other language spoken]

For the entire country, not only northwest Syria, right?

[Other language spoken]

Thank you for the question gentlemen.

Currently as we speak, the total recorded number of cases PCR confirmed is less than 50 thousand 47,966 and the way how it is distributed in Northwest Syria, we're talking slightly more than 21,000 in North East Syria more than 9000.

And in government controlled Syria more than 17,000.

I'm giving you rough figures because I have figures for 19th of March.

And if we look at the case fatality ratio, the highest case fatality is under government controlled territory.

Meaning that out of 100 people, 6.7 or around 7 people would likely die out of reported cases.

And while overall case fatality is 4.5, case is northwest Syria is 3 in northeast Syria 3.9.

When we speak about Kovacs delivery of vaccines against COVID, we are talking about two routes of delivery one when we are WHO and being self working with Minister of Health to distribute to the population and the government controlled territory and northeast and the population in the northwest 4.2 million population in the northwest through cross-border.

So northwest received from or is receiving I would I have to correct myself?

We're hoping maybe in 2-3 or four weeks we will be receiving AstraZeneca, Serum Institute of India vaccines, 224,000 doses for northwest Syria, 3% of people, mainly health workers and we are receiving 912,000 doses for the rest of Syria through Damascus.

This 912,000 and 224 are mainly targeting health workers and some proportion of it will go also to cover elderly population.

These are our primary target highest population as we get additional 17% coverage from our or quantities from for AstraZeneca from Quebecs.

We are hoping to by end of December 2021 to cover 20% of the population across Syria and that population will be health workforce, elderly people above 55 and 16 years of old as well as those with common.

So we're hoping by this to make a contribution towards a combating pandemic globally.

[Other language spoken]

You want to do you want to add something?

Yeah, well, just to confirm back the numbers from Northwest Syria, 21,260 cases were confirmed since the 9th of July, out of which 411 died, which make the case fatality rate 1.93.

The, as Doctor Ajman mentioned, the vaccine will arrive also through the cross-border for Northwest Syria and we will receive, as mentioned by both of us, 224,000 doses for the 1st 3% of the population and then it will be complemented by 17% over.

Thank you very much, Doctor Daher.

So Byram, it has a follow up question, Byram.

[Other language spoken]

Clarify about the number the doctor gave.

[Other language spoken]

1000 those will arrive to Syria.

[Other language spoken]

Did you mean that you will send 70% of those vaccines to the northwest of the country?

No, no, no, sorry.

The total number for northwest Syria for 20% of the population is is going to be 1.6 million doses only for northwest Syria.

I'm talking, I mean, Doctor Ajamal might, might talk about the entire country, but the part of northwest Syria will, will, is a plan to receive 1.6 million out of which we receive now 224,000 doses for the 1st 3%.

I hope that this is clear from my side, the treasure.

Maybe you want to?

Probably let me put it this way, if you take a rough estimated population of entire Syria as 20 million, we're hoping by end of December to cover 5 million population.

Those who will be **** risk 2020% of the population will be approximately 5 million.

So currently we have received our we are going to receive our first batch of vaccines and it is AstraZeneca, which means that we have to make 2 doses care one person to be vaccinated and protected.

So 224,000 from Basante for Northwest, a **** risk group and 912,000 for the remaining, again on the **** risk group, it will mean 912,000 will cover only 456,000 people and we're talking about health workers and some elderly people.

This is our phase one and phase one we're hoping to end by start end of April and hopefully end by first weeks of June.

And then hopefully, we will receive another batch of vaccine allocation to cover the remaining 17% of the targeted 20% of the population.

I hope it's clear overall.

Maybe just also to mention that this is a global target to cover at least 20% of the population across the globe with call against to protect against COVID and to halt and combat COVID pandemic.

[Other language spoken]

Oh, there is a, there is a one question that's basin and I think that's from AP in Beirut basin.

[Other language spoken]

I have a question please for Jamal about you said that there are 17,000 cases in government health parts of Syria and do you believe that the real number is much higher than that?

And we're we're also hearing that hospitals, some hospitals are full with patients.

Is, is Syria Gov witnessing an increase Bison was broken.

So I don't know Jamal, if you have understood both of his questions.

[Other language spoken]

I do believe that the real numbers are much, much higher.

The virus is not behaving differently in Syria.

In fact, we are not aware of what kind of variant of the virus we are dealing with because of the laboratory capacity is weak.

But as WHO we have sent samples for sequencing to understand, since in neighbouring countries there are already both UK and South African variants, we believe the current wave, the 3rd wave, is due to possible mutation of the virus.

And in Damascus, you are absolutely right, we are having 100% bed, bed occupancy 100% used.

Some of the patients are being referred to government level.

This situation is yet didn't reach Aleppo where I am speaking with you today.

Normally when we look into EPIC curve, it takes about two to four weeks for reaching reaching other government.

We have witnessed our epidemiological curve shows increase in the new cases over the week of 11 and 12 respectively for approximately 42%, which means that we are going into the very steep curve.

And I have no reason to believe that you know, the the situation of recorded cases is real.

It is only for our epidemiological kind of thing and analysis, but in no way it's a real picture.

We have seen much more this we have seen much more people with COVID-19.

[Other language spoken]

Thank you very much, Jamal.

[Other language spoken]

I'm not seeing any further questions.

Well, there is one more we have.

[Other language spoken]

I'm just trying to follow up on my colleague's question in the Northwest.

If we can also get from Doctor Mahmoud just a bit of an overview of the situation in terms of we've seen no cases, almost no cases in the Northwest in the last few days and the hospitals seem to be at not not overcrowded.

So I'm wondering if that's the if, if you can explain the situation in in the Northwest, if, if that's a curve and there if there are concerns that the peak in the north in the government areas may impact the situation in, in the Northwest.

And one last adding to that, I understand there are a number of health facilities or vaccination centres that are not receiving funding and may be useful in the vaccination campaign.

If you can clarify that.

I'm not, I'm not sure I have the full picture here.

[Other language spoken]

Well, for the first part of your question regarding the COVID-19 situation in the last couple of weeks or even 4 weeks, we, you are right.

We are receiving a few cases per day.

Some days we didn't report any case, even the the care has gone sharply down.

There is no clear reasoning for that.

Maybe it's, it's a normal, how do you call it?

It's a normal evolution of the situation in northwest Syria vis A vis the the outbreak.

We have seen only during the months of August to December, the peak of the outbreak.

But that doesn't mean that the COVID-19 is over from North Syria.

We still have cases there.

And we probably, as you mentioned, we will see an impact of the third wave that is happening in other territories that will reach there either from from those who are trafficking between Turkey to Northwest Syria or even across the line between the districts of Syria.

So we are not complacent and we are continuing to do the testing on a daily basis and the three laboratories that are there.

However, we see the positivity rate has gone down, which means that we are not missing too many of the cases.

Regarding the funding for health facilities and the structure of healthcare services, we work with the around the 50 partner organisations to provide healthcare services under the coordination of the healthy cluster that WHO is leading in northwest Syria.

There are we have seen jobs in funding healthcare services in the last few months compared to 20/20/2020, we received the for the health sector good funding to respond to the COVID-19.

But since the beginning of the of the year, the funding situation not only for The Who but for the entire health sector is facing troubles.

And for this, as colleagues mentioned, we will also we have on the side of the Brussel conference, the side event that we will also talk about the funding situation for, for the whole country, in fact including Northwest Syria.

We work with the partners in order to find the filling the gaps.

As last resort, WR show has repurposed some of the funding available funding in order to continue the critical functions of the of those self-care facilities.

Thank you very much both.

So I should probably wait now 2 seconds to see if there is anyone else raising hand.

I was wondering if I can hear the share the screen.

I'm not sure who was speaking this, but.

This is Jamal and I wanted to share the screen to show the epic curve to make it easier to understand if possible.

If not, then it is fine.

I'm not sure our colleagues would be able to do that while while managing this, but we will be happy to.

[Other language spoken]

We have activated the.

Function.

You can share the screen.

[Other language spoken]

We can see right here we see the picture which we have peer PCR tests.

This is something which we report, which we report.

However, this is only indication of the real picture, maybe just an outline for us to understand where we are.

You see there are three distinct waves in blue colour which is government controlled territory.

And over the past weeks we have seen that the numbers have increased even superseding the numbers which have been in December.

The blue colour, although the numbers are less than for example in green colour for Northwest because of capacity to test, because of testing strategy, we have very limited number of laboratories across the country.

Still it shows what we are facing.

We're facing the 3rd wave which has been close to the second wave which also suggests it might be due to new variant.

We have seen also the new wave coming up in the North East of the country while the same might happen in the northwest, apparently because of the normal life of the of the virus or outbreak.

So I really wanted to show you this and I'd like to again emphasise the capacity of the country to test is not sufficient.

And we continued beefing that capacity up.

Currently, we were able to provide in 2028 laboratory PCRS to make it work.

This year, we have provided additional 3 PCRS and we three more PCRS are on the way.

One gene expert machine is in North East Syria and we are really hoping to have those means on the ground to be able to understand where we're in terms of COVID, which still continues to be very, very dangerous.

[Other language spoken]

Thank you for sharing this and thank you for making it possible.

Sarah, do you have a follow up question or it's all hand?

[Other language spoken]

You said there were, we've, we've seen the troubles of the financing and we've repurposed some of our funding.

If you can just give a brief example or two on, on where that funding has been most felt.

Thank you and and also sorry.

And also you said we're, we're, we're taking care for to we're taking on measures necessary to make sure that it doesn't move over from the government areas.

Is there is there like closure of borders or like limited movement or is there something that you can also give us as an example of how you?

No, the last I didn't say we we are not.

We don't have powers on the ground to restrict people.

This is always for governments in fact to do, but what we are doing is enhancing the risk communication and community engagement, the pillar which is talking to the population, trying to explain, it's trying to enhance public education about the outbreak.

Now in regards to the funding, funding we as I mentioned, there will be an appeal by WHO, but we, we have seen some facilities that could have not been function functional because of lack of the direct support to the implementing partner.

And usually WHO as a provider of last resort under the healthy cluster would receive all these requests.

And then we'll first of all, we'll try to arrange and coordinate between the donor community and the direct implementation partner.

However, if we fail to do so or or donors will not be available to support directly, then WHO will step in?

There have been few Primary Health care centres that lately we they have exhausted funding and they didn't receive direct funding.

About six of them.

We are working on also one of the hospitals that cease to receive direct funding for the population and we talked with one of our donors last in the last year and we continue to support the hospital at the moment.

Currently we are engaged with 45 healthcare facilities out of 170 Primary Health care centres.

I mean sorry, 45 Primary Health care centres.

And as I mentioned, we contribute to 1/3 more or less of the.

Supply system in the entire health facilities, which means that the 426 functional healthcare facilities would receive supplies through the supply system.

That WHO is providing more details, I assume that Doctor Ajmal and myself will be providing also in the side event brief and in the appeal The Who is going to issue on the funding situation for 21.

Maybe if I may also add Sarah to the question which you raised, our most pressing needs currently if if we look into last year we our funding for double HO to target millions of people have been funded half of what we have requested this year.

And currently as we speak, most pressing need while we're awaiting for the arrival of vaccines and we're talking about two, 3-4 weeks maximum, we need budget to cover operational costs.

And those operational costs are mobile clinics and services, training, provision of an administration of those vaccines, surveillance, dealing with side effects.

And if we look into initial 3% of the vaccine which we are receiving, those which I mentioned 224,000 and 912,000, in order to implement and vaccinate people, we need currently $7,000,000 before end of June.

But to reach our target of covering 20% across Syria, we need 38 million U.S.

[Other language spoken]

And I'm not talking about what we continue doing.

I'm not talking about medicines, I'm not talking about other supplies.

I'm not talking about working with local injurers or international injurers to provide services.

I'm only talking about cost of vaccination.

COVAX is giving vaccines free of charge, but we need cost of operationalization and administration of those taxes.

What Doctor Mahmoud was mentioning?

We are now reprioritizing our available funding in order to advance to be able to implement and meet our target to combat pandemic, to save lives, to avert this.

[Other language spoken]

Thank you very much Jamal and Mahmoud.

Again looking for any questions.

I can't see any with this.

We will, we will conclude.

I will thank our speakers.

Audio file will be available.

Our colleagues from Eunice can make it ready for any other questions.

Just don't hesitate to contact us here in in the media team and we will liaise with our offices in the Gaziantep and Damascus provide you any clarification you may need.

With that, have a wonderful day and stay safe.