The impact of violence across northwest Syria, combined with reduced donor funding and economic collapse, has meant inadequate and uneven provision of health care for Syrians, particularly women and girls. In response to the violence, providers have been forced to leave or relocate beyond the line of fighting, leaving many unable to reach the care they need. This not only impacts civilian access to services, but also increases demand on the service providers in safer areas, undermining the quality of care. The devastating earthquakes which struck southeast Türkiye and northwest Syria in early February 2023 further limit the already precarious access to health care detailed in this report.
UDER contributed to this research to raise awareness of the ongoing plight of Syrians and to inform policy change. While health actors, including UDER, have worked to fill the gaps in health care provision, the current approach to the crisis in Syria is inadequate. Urgent changes are needed to protect the right to health for populations in northwest Syria and ensure access for those who require medical care.
This report reflects the SRH concerns of those living and working in northwest Syria. It establishes a record upon which policymakers, donors, and health actors, including humanitarian organizations, may rely in addressing the crisis of SRH in northwest Syria. It provides core recommendations for the United Nations Security Council, United Nations member states, donors, health actors, and the coordination architecture. The report is available in English, Arabic and Turkish.
The Harim PHC Network, coordinated by Relief Experts Association (UDER) and supported by The World Health Organization (WHO) consists of 60 health facilities offering access to services of diverse complexity and according to capacity (in mobile units and primary health centres, among others). As part of the network activities, UDER procures medical equipment needed by 60 health facilities to ensure the availability of resources necessary to provide health services according to the standard protocols. This approach serves towards progressive development of a joint procurement, distribution and monitoring system. Partners supporting these health facilities participates in the technical evaluation of the equipment. After the equipment is delivered to the UDER’s warehouse in NWS, partners are contacted to receive the equipment and deliver them to health facilities. This video shows the equipment distribution process to the UOSSM organization, including checking, loading and paperwork.
WHO, together with the Relief Experts Association (UDER) as implementing agency, has bolstered the provision of primary health care services in northwest Syria by rendering the facilities in the towns of Sarmada, Tarmanin, Daret Azza and Zarzour fully operational. During the project – supported by the United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA) and its Syrian Cross-border Humanitarian Fund (SCHF) – 174,374 medical consultations were provided through the 4 health facilities (132% of the targeted 131,893), including for 98,064 internally displaced persons in the area. A total of 127,276 patients (equating over 159% of the targeted 80,000) were screened for temperature measurements.
Thanks to a bespoke multi-donor funding approach, via ECHO, FCDO and USAID/BHA, WHO together with health partners, initiated an integrated service delivery network in Harim, Idleb Governorate to implement the EHSP by improving the capacity and coordinating the operations of participating health facilities with the overall specific objectives of increasing access to health services for displaced and host populations in the region and ensuring efficient service delivery. The Harim Network, coordinated by Relief Experts (UDER) with the support of WHO, consists of 60 health facilities. UDER recruits the network technical team of 8 technical staff, dedicated to follow up on a set of priority health areas and process related components covered by the Network (non-communicable diseases, reproductive health, community health, pharmaceuticals and stock management, infection prevention and control, health information system, referral, and complaint and feedback mechanisms). The team visits all 60 health facilities every month. In these visits, the technical team meets with the facility staff, checks the practices against the standard protocols and provides on-job coaching and training. This video highlights a field supervision visit to the PHC center in Kafr Arouq, supported by HIHFAD.
In this webinar, Relief Experts Association hosted four Syrian public health experts to talk to medical workers in Syria about the COVID-19 vaccination campaign. The aim was to provide medical workers with up-to-date information about COVID-19 spread, public perceptions v.s scientific evidence about the vaccination and the vaccination campaign which will be launched by the Syria Immunization Group in May 2021 in northwest Syria.
The presentation can be found here and the recording of this webinar is published below.
Under the COVID-19 Preparedness and Response Plan (PRP) for NWS 34 COVID-19 Community Treatment Centers (CCTC)s were established as a solution for COVID-19 patients and contacts who cannot manage home-isolation. While these centers were prepared with a capacity of 1,700 beds, people didn’t utilize the services of these centers at an optimal rate. As the centers employ over 1,713 medical and non-medical staff members, it was important to understand this under-utilization and derive a set of recommendations for these centers to be better utilized. Deploying 49 surveyors from its community health worker network, UDER interviewed a sample of 991 participants representing all of northwest Syria (NWS) to assess their knowledge and perceptions of the participants in relation to COVID-19 and CCTCs. The results of this survey were presented to the NWS COVID-19 taskforce, and the recommendations were discussed with NGOs managing CCTCs to ensure that they were practical and feasible, and this included:
1. As the two most common reasons for not moving to a CCTC by COVID-19 patients were being able to manage their cases at home and the mild symptoms that didn’t make it necessary for them to visit a CCTC, there is a need to correct this misinformation by explaining that CCTCs are needed not only to manage mild or moderate COVID-19 cases, but to also isolate self from others to avoid spreading the infection in the community. Staying at home if infected is only an option if patients can fully isolate themselves.
2. As the third most common reason for not moving to a CCTC by COVID-19 patients was having to stay home and take care of children, it is recommended to advocate to provide conditional cash assistance and/or food baskets for families of patients in CCTCs to compensate for their time spent in CCTCs and ensure that their families’ basic needs are addressed. COVID-19 patients who visited the CCTCs reported staying less days on average than the standard 14-day period, which might be an indicator that some patients discontinued their stay. It is recommended to raise the awareness of the visitors and provide them with adequate instructions and information about the importance of their stay until the appropriate time of discharge.
3. Since most COVID-19 patients did not visit CCTCs, it is necessary to re-share the set of instructions to follow during self-isolations with all patients. Follow-up on patients who chose home-isolation is a must to ensure that they follow the isolation instructions. This can be done by community health workers (CHW)s.
4. Although the services at CCTCs were positively rated in general, and that only a small percentage of participants heard bad things about the centers, it is recommended to improve the services to the maximum extent possible and to introduce recreational activities to encourage patients to move to CCTCs for the full isolation period, while ensuring a commitment to infection-control and medical instructions.
The full report can be downloaded through the following link:
In November 2020, UDER completed a wide assessment of community health programs in northwest Syria. The assessment was done with the help of 23 NGOs implementing community health projects in northwest Syria, and it lasted for 5 months. The result of this assessment can help organizations and donors looking to improve community health programming in northwest Syria by considering the following recommendations:
CH roles and responsibilities
While there was a common understanding of the CHW role in each organization, participant NGOs demonstrated different understanding and structures of the CH Supervisor and Team Leader roles and responsibilities. All NGOs should be encouraged to follow the structure identified in the CHWG SOPs: CHWs to deliver health-related activities directly to the community and households, CHW Team Leaders for a maximum of 10 CHWs (5 teams) each, and dedicated CH Supervisors. Also, many NGO respondents reported that the CH Working Group is less active now than before. It is recommended that the Group is reactivated and regular meetings should be held to guide and organize all NGO CHW activities.
CHW scope of work
Participant NGOs demonstrated different type of service delivery and scope of work. All NGOs should be encouraged to follow the CHWG SOPs and provide CH services according to all the 6 modules (Basic Module, Family Health Module, Nutrition Module, NCD Module, CD Module, and Healthy Lifestyle Module) instead of focusing only on nutrition and COVID-19, in a community-based setting with well-established linkages to health facilities, instead of providing the CH services from the facilities only. As clarified in the CHWG SOPs, the community members should receive community health services through outreach visits by CHWs to reduce accessibility obstacle due to transportation and travel distance and to maximize the coverage of the health system by active community engagement. As for the services that the CHWs provide, the collected data specifically identified a lower reporting of follow-up visits for the same households. All NGOs should focus more on these follow-up visits, and guide their CHW teams to revisit the household as recommended in the SOPs (at least once every 2 or 3 months).
CHW selection and recruitment
The dissatisfied community members mentioned that CHWs are not from the same community, and the responses of other participants and CHWs confirmed this. The first criteria for selecting community health workers in the CHWG SOPs is being a member of the targeted community and being recruited from within his/her community. All NGOs reported that they do the recruitment process independently and they should consider this aspect in their future CHW recruitment processes.
CHW Training
According to the CHWG SOPs, each CHW must complete a training and successfully pass the evaluation by the end of it, then undergo a refresher training every three months. Around half of the CHWs working in northwestern Syria are not trained on the comprehensive package and the six-module training curriculum and many respondents reported the lack of qualified trainers and the necessity to review the contents and update its information, especially with relation to COVID-19 materials. The CH Working Group is encouraged to consider updating the package and reviewing its contents according to the suggestions mentioned in the report. ToT training covering COVID-19 and all the 6 modules (Basic Module, Family Health Module, Nutrition Module, NCD Module, CD Module, and Healthy Lifestyle Module) should be reconducted to qualify more trainers who can visit Syria and provide the training for the CHWs.
CH Supervision
According to the CHWG SOPs, CHWs should be supervised through field visits and on the job coaching, with weekly meetings or visits to discuss and evaluate the work plans. The participant NGOs reported conducting supervision or regular evaluation to CHWs, but they are encouraged to follow the CHWG SOPs in this aspect, especially regarding conducting the supervision visits on weekly-basis and coordinating with local community representatives.
CHW data collection and reporting
Data collection and reporting is an essential part of the CHWs work, with a detailed process flow clarified in the CHWG SOPs. The participant NGOs confirmed submitting the required reports, but data collection and reporting tools varied significantly between NGOs, although most of them expressed their interest to change to an electronic system. However, donors have strict rules about procuring tablets and tools required to do this upgrade. The key informants requested from the donors to provide solutions and make it easier to procure electronic tools. The CH Working Group should also work on developing a standardized electronic system, which could enhance the reporting from all NGOs managing CH projects.
CHW linkages with the health system
According to the CHWG SOPs, one of the main objectives of CHWs is to maximize the coverage of the health system. Since not all NGO CHWs are linked to health facilities, there is an area for improvement in this aspect. First, a comprehensive map of services should be developed to identify all types of services in northwestern Syria. Second, the coordination between CHWs and health facilities in the area they cover should be enhanced, with more focus on follow-up visits to referred community members.
Community coverage and feedback
The general community feedback about CHWs was found to be satisfactory and positive, with a significant exception related to low follow-up visits by CHWs. A high percentage of community members and leaders recognized CHWs as helpful, considered their information and services to be useful, and requested to continue supporting these projects and increase their coverage. As recommended in a previous section, more focus on follow-up visits is important as well.
We started a campaign with local health directorates to distribute reusable fabric facemasks to vulnerable people in northwest Syria. With additional funds we believe that we will now go beyond 1.5 million masks which represents 35% of the population, but this is still far from reaching a comfortable point during the combat against COVID-19.
As of 9 November 2020, our teams completed the distribution of 853,312 facemasks. This is while 8,388 people were infected and over 87 have died to COVID-19 in an area where less than 120 ICU beds are ready to receive patients in critical condition, and almost all of these ICU beds are already full. The needs are still too big for any organization to cover, but we are confident that all actors are doing the best that they can to prevent a disaster from happening in northwest Syria.
A young boy in a fabric facemask – an IDP camp in northwest Syria.
استضافت منظمة خبراء الإغاثة اللقاء الأول مع الأطباء السوريين في المشافي والمنشآت الصحية في شمال غرب سوريا لشرح تفاصيل آخر التطورات في خطة فريق عمل استجابة كوفيد-19، مع توضيح للأدوار المختلفة للفاعلين في هذه الخطة وأهمها دور الأطباء، خط الدفاع الأول.
وقد تم التخطيط لعقد عدة لقاءات بشكل دوري، يطرح في كل منها عنصران أو أكثر من عناصر خطة الاستجابة الثمانية وهي: إدارة الحالة، الترصد، المختبرات، نقاط العبور، ضبط العدوى، التنسيق، التواصل المجتمعي، والدعم العملياتي، وبمشاركة الأطباء السوريين المشاركين في تنفيذ هذه الخطة والمطلعين على آخر تطوراتها وتطورات سير الوباء في شمال غرب سوريا.
تم تخصيص اللقاء الأول لعرض المحاور التالية:
ملخص عن خطة استجابة كوفيد-19 في شمال غرب سوريا.
تحديث حول خطة عمل الترصد والإنذار المبكر والمختبرات الخاصة بكوفيد19.
تحديث حول بروتوكول إدارة الحالة ومسار المريض ودور العناصر المختلفة ضمن النظام الصحي.
أسئلة وأجوبة.
تم عقد هذا اللقاء يوم الجمعة 25 أيلول، الساعة التاسعة مساءً بتوقيت سوريا على منصة زووم وبدعوة عامة لجميع الأطباء في شمال غرب سوريا وتركيا والمهتمين بشأن المنطقة، وبمشاركة المتحدثين:
د. ياسر الفروح، من برنامج الإنذار المبكر، إيوورن، ممثل مكون الترصد والإنذار المبكر: للحديث عن عملية الترصد الوبائي وعمل المخابر.
د. محمد العيسى من الجمعية الطبية السورية الأمريكية، سامز، ممثل مكون إدارة الحالة: للحديث عن نظام الفرز، مشافي العزل، بروتوكولات مسار المريض والتدريبات، وغيرها).
د. هاني طالب، من منظمة خبراء الإغاثة، ممثل مكون التواصل المجتمعي والإبلاغ عن المخاطر: للحديث عن خطة الاستجابة العامة، وكمنسق للجلسة.
لمشاهدة مجموعة اللقاءات التي استضافتها المنظمة حول خطة الاستجابة تحميل العرض التقديمي أو سماع التسجيل، يرجى اتباع هذا الرابط.
المبدعون التالية أسماؤهم وأعمالهم حصلوا على تقدير لجنة التحكيم ضمن الأعمال التي وصلت إلى المرحلة النهائية من التقييم، ونشكرهم على مساهماتهم الرائعة وعلى منحهم الثقة لنا لعرض مشاركات بعضهم
إضافة إلى كل من المبدعين محمد نور محفوظ حذيفة الشحاد نصار نصار
نقدم شكرنا الخالص لكل من ساهم في هذه المسابقة وأمضى وقتاً في البحث عن المعلومات واستعراض الأفكار والتصميم والمونتاج. لقد ساهمتم حقيقة في تحقيق هدف هذه المسابقة وهو نشر مزيد من الوعي حول أهمية إجراءات الوقاية وخاصة ارتداء الكمامات لحماية أهلنا من وباء كوفيد19. نحن، فريق خبراء الإغاثة، نشكركم من أعماقنا ونتمنى أن يبقى سيل أفكاركم متدفقاً في سبيل مساعدة أهلنا وحمايتهم ونرجو أن تعلمونا في حال وجود أي أفكار لديكم تعزز مفهوم الوقاية، وسنسعد بدراستها ونشرها على فرق التوعية وبكل السبل المتاحة لنا نرحب بأي اقتراحات لديكم أو رسائل أو فيديوهات ترغبون في مشاركتها مع الناس حول التعامل مع كوفيد19 بشكل أفضل على الإيميل feedback@reliefexperts.org
تم الانتهاء من عملية التقييم النهائي من قبل لجنة تحكيم مؤلفة من 56 فرداً من سيدات ورجال يمثلون فئات مختلفة من المجتمع. نشكر لهم وقتهم وحرصهم على تقييم الأعمال المشاركة بشكل عادل. تم استلام أكثر من 100 فيديو من أشخاص مبدعين يتجلى مجهودهم الواضح في تصميم وتنفيذ هذه الأعمال وحرصهم على نشر المعلومات حول أهمية إجراءات الوقاية من كوفيد19، وقد تم ترشيح 12 فيديو منها بناء على وضوح الفكرة التحفيزية بعيداً عن الطرح التقني الممل، ملاءمة المحتوى للسياق السوري، عدم وجود أخطاء علمية ولغوية كبيرة، وكون المحتوى أصيلاً لم يتم نقله من مصدر آخر تم التواصل مع أصحاب الفيديوهات ال12 المرشحة وإعلامهم بنتيجة التقييم، ونقوم الآن بالحصول على الموافقات اللازمة من أصحاب الفيديوهات قبل إعلان النتائج ونشر الأعمال الفائزة والأعمال التي وصلت إلى المرحلة النهائية نشكر من كل قلبنا كل من شارك في هذه المسابقة على إبداعهم ومبادرتهم، فهذا حقيقة من نطمح إليه وهو أن نشجع المبادرات من أصحاب القضية أنفسهم على تغيير واقعهم نحو الأفضل، بأيديهم لا بأيدي آخرين، وقد أبهرنا مستوى الإبداع والأفكار المميزة التي وصلتنا على الرغم من قلة الإمكانيات وصعوبة الظروف، وهو ما يجعلنا على يقين أن الشعب السوري لن تنكسر عزيمته مهما ضاقت الظروف سيتم الإعلان عن الأسماء والأعمال عبر هذه الصفحة في الساعة العاشرة من مساء يوم الإثنين 28 أيلول 2020 بإذن الله
شكرا لكم على تفاعلكم الرائع مع المسابقة، لقد وصلنا عشرات الأفلام والمقاطع المصورة والأفكار المميزة. اكتملت مرحلة استقبال المشاركات وسنبدأ الآن بالفرز الأولي والتواصل مع أصحاب المشاركات التي سيجري ترشيحها إلى التقييم النهائي من قبل لجنة التحكيم قبل تاريخ 25 أيلول 2020. نظراً لوجود عدد كبير من المشاركات فنحن نقدم خالص اعتذارنا عن التواصل مع من لم يتم ترشيحه، غير أننا نشجع الجميع على الاستمرار في الإبداع في خدمة أهلنا وحمايتهم، ولعل إحدى أفكاركم تكون سبباً في حماية مئات الآلاف. نتمنى التوفيق للجميع بإذن الله
تعلن منظمة خبراء الإغاثة عن مسابقة لاستقبال أفضل فيديو مصور أو بالصور المتحركة يروج لفكرة استخدام الكمامات كوسيلة أساسية للوقاية من مرض كوفيد-19. يجب أن يبنى الفيديو على فكرة أصيلة، مميزة، مرتبطة بالمجتمع السوري، مقبولة دينياً واجتماعياً. لا حدود لمستوى الإبداع في هذا المجال فالهدف تحفيز أهلنا على ارتداء الكمامات والإسهام في إزالة العوائق الاجتماعية التي تمنعهم من ارتدائها. ترسل الفيديوهات المصورة مع إثبات لملكية منتج الفيديو في موعد أقصاه الساعة العاشرة ليلاً من 20 أيلول 2020 إلى الإيميل facemask-syr@reliefexperts.org
يتم اختيار 3 فائزين من قبل لجنة تحكيم بناءً على تقييم الأثر التحفيزي للفيديو المقدم الجائزة الأولى 1000 دولار | الجائزة الثانية 500 دولار | الجائزة الثالثة 400 دولار
يمكن إرسال الفيديو إما عبر الإيميل أو برفع الملف إلى وحدة تخزين سحابية كغوغل درايف وإرسال الرابط إلى الإيميل المذكور في الأعلى. سيتم نشر الفيديوهات التي تحقق أفضل تقييم عبر هذه الصفحة، كما ستعتمد بشكلها الحالي أو بعد تطويرها في حملة التوعية المجتمعية التي تقوم بها المنظمة. فيما يلي أمثلة مميزة عن فيديوهات تحفيزية يتم استخدامها في العالم لدعم نفس الفكرة. هذه الفيديوهات للاطلاع على مفهوم التحفيز المقصود. يرجى الانتباه إلى حقوق النشر الخاصة بأصحابها وإلى كونها مختلفة عن السياق الموجود في سوريا. هذه الفيديوهات لا تعبر بالضرورة عن وجهة نظر منظمة خبراء الإغاثة The National Anthem of Pakistan As Sung Through Face Masks Hands. Face. Space You Can Still Smile Staying Safe At Home Snowday We are compassion
An acknowledgement note from Janudiyeh local council for UDER’s work
From time to time, we get overwhelmed by the gratitude and satisfaction that some of the people that we serve like to show. This time, we were surprised by these notes of acknowledgement from two of the communities that we work with in Idleb, Syria.
In our return, we thank you, our success partners – the people of Syria, for encouraging us to keep going, and making a difference.
A thanks letter from Idleb University for UDER’s work on COVID-19
A community health worker during an interview in Idleb
In July 2020, Relief Experts Association conducted a public survey on the use of face masks in the context of COVID-19 in NW Syria. The survey aimed at providing valuable information from northwest Syria on how people look at face masks as a preventive measure against COVID-19, and what practices they are adhering to in this regard. The survey was done through face-to-face interviews with 767 randomly selected individuals from 9 districts across northwest Syria.
The survey concluded that: 1. As the knowledge among survey participants about face masks was inadequate, increasing the public awareness-raising campaigns and activities promoting the proper use of non-medical (fabric) face masks by the community could be helpful during this pandemic. The campaign may have more focus on people (particularly women) above 50 years of age due to the higher gaps in their knowledge compared to the below 50. In many areas, women above 50 showed lower levels of knowledge compared to men, while in the Syrian context, their role in raising children is more important.
2. Since the most common reason for participants’ who didn’t wear face masks outside their homes was inability to afford buying one, providing face masks and distributing them to the population for free is expected to increase the practice significantly, especially that people seem to have a positive attitude towards wearing them. This can be combined with a campaign to educate the population on making home-made facemasks to overcome supply limitations.
3. Wearing a Niqab by Muslim women in NW Syria is a common practice and perceived by many participants as an alternative to face masks, although there is no proof that niqabs are effective as face masks. Specific guidelines from the Centers for Disease Control and Prevention recommend that cloth masks must fit “snugly” on the sides of the face, but not all niqabs are tight-fitting. The resources of Corona Awareness Team of NW Syria don’t currently include any specific instructions about niqabs, although they include a broader document named “Public advisory on the use of fabric facemasks”, therefore a clear set of guidelines should be developed for the use of niqabs as facemasks and included in CAT NW Syria resources.
4. In some areas, female participants reported less adherence to optimal practices or lower levels of knowledge. This may not necessarily translate into better practices applied by male respondents, but could also be associated with social norms and the desire to report self-adherence to best practices. These results are best interpreted when practices are observed in daily life.
5. The stigma around wearing face masks in public seem to be preventing a significant part of the population in NWS from wearing face masks, and could even be a reason for not following other preventive measures. More effort by educational campaigns and the media can be dedicated to reducing this stigma and this can be supported by public figures who present themselves wearing masks and following preventive precautions.
