ACMC 3rd Medical Report

hgjr

Dr. Fadi HAKIM

Vice-president of ACMC

March 13, 2014

Third Medical report

Aleppo city medical council

Aleppo City Medical Council

ACMC Third medical report © All rights reserved

2

Table of contents Preface .......................................................................................................................................................... 4

Evolution in numbers of medical services presented in our hospitals ......................................................... 5

Annual number of surgeries performed in our hospitals ............................................................................. 6

Annual count of surgeries classified by type ................................................................................................ 6

Overview of our hospitals ............................................................................................................................. 7

M01 Hospital ............................................................................................................................................. 7

Some landmarks through the evolution of the medical work .............................................................. 9

Annual work Statistics at M01 ............................................................................................................ 10

M02 Hospital ........................................................................................................................................... 11

Some landmarks through the evolution of the medical work ............................................................ 13

Some ambitions and projects to be supported in M02 .......................................................................... 14

Annual work Statistics at M02 ............................................................................................................ 14

M03 Hospital ........................................................................................................................................... 16


Annual work statistics at M03............................................................................................................. 18

M10 Hospital ........................................................................................................................................... 19


M10 under attack ................................................................................................................................ 21

Annual work statistics at M10............................................................................................................. 22

Overview of our PHC centers ...................................................................................................................... 23

Dental clinics ........................................................................................................................................... 24

Some landmarks through the evolution of the dental care project DCP............................................ 24

Some ambitions and ideas to be supported ....................................................................................... 25

Annual work statistics at DCP ............................................................................................................. 25

N1 Medical point ..................................................................................................................................... 26

N2 Medical point ..................................................................................................................................... 27

N3 Medical point ..................................................................................................................................... 28

N4 Medical Point ..................................................................................................................................... 29

N12 Medical point ................................................................................................................................... 31

N13 Medical point ................................................................................................................................... 32



3

N14 Medical point ................................................................................................................................... 34

PHC statistics overview ............................................................................................................................... 35

Most common diagnosis ..................................................................................................................... 36

Central Warehouses performance .............................................................................................................. 37

Percentage of medicines and supplies to the hospitals ......................................................................... 37

Percentage of medicines and supplies over the medical points ............................................................ 38

Major suppliers of medicines and supplies for ACMC in 2013 ............................................................... 39

Referral system – Disaster response system .............................................................................................. 40

Activity for prevention of chemical attacks ................................................................................................ 41

Training and development .......................................................................................................................... 42

1- First aids for beginners ................................................................................................................... 43

2- Emergencies for intermediate students ......................................................................................... 43

3- Emergencies for advanced students ............................................................................................... 43

Adminstrative restructuring and improvements ........................................................................................ 44

Long term strategy and vision for the future .............................................................................................. 44



4

Preface

This is the third formal update of ACMC medical report, one of our important internal and

external reports that illustrates the achievements of our collective work.

This version comes with some modifications, first it comes in English language, after the demand

of our public relations offices, it would be more convenient to publish directly in English because we

intend to share it with our international partners

This version comes after a complete year of medical work; therefore, we are able for the first

time to speak about our annual workload volume, and other global issues through the next pages.

The third point is about our statistic teams, they have become more and more precise in their

work, and therefore I am much more confident than before in the accuracy of numbers mentioned in

the report.

In the end, I thank the effort of all the persons who participate in the preparation this report,

and all of these unsung heroes of ACMC, their work is the real topic that we are discussing through

these pages.

We are ready to receive your remarks and questions on the following emails:

[email protected]

[email protected]

All other suggestions to enrich this article are also welcomed.

President of ACMC Vice-president of ACMC

Dr. Abdul-Aziz Al-ADEL Dr. Fadi HAKIM

Thursday, March 13, 2014

mailto:[email protected]

mailto:[email protected]



5

Evolution in numbers of medical services presented in our hospitals

Our annual work volume in our hospitals is estimated at 69253 medical service, M01 and M10

are majorly concerned with war injuries, while M02 and M03 are concentrated on Cold medicine and

non-war related injuries , in times of crisis or intensity of military operations like in December 2013 ,

numbers of M02 drop out to match those in military-injuries concerned hospitals , because we prioritize

these injuries on other non-urgent conditions.

0

2000

4000

6000

8000

10000

12000

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

M10

M8

M3

M2

M1



6

Annual number of surgeries performed in our hospitals

10340 surgical intervention has carried out in our hospitals till the end of December, we witnessed an

increase with percentage of M03 due to the activation of the obstetric department, and the increase of

accuracy in the documentation M10 continues to increase its volume, leaving M02 slightly less than its

share in the last report which was around 52%.

Annual count of surgeries classified by type

The following diagram explains how important the amount of orthopedic surgery in our

hospitals was, orthopedist were most of the time in the ORs for 16h straight. In addition, vascular

surgery was very necessary, at the beginning of the year, only one vascular surgeon was working in M01

and covering for the whole city, by the time; our general surgeons learned how to do vascular, and

thereby we have now 5 surgeons with vascular surgical capabilities.

Neurosurgery was a real catastrophe, with absence of a CT. Scan our neurosurgeon was

paralyzed, which explains the drop in number of this type of surgeries, we made more than 15 referral

per week to outside Aleppo only for making the diagnosis, now the CT is finally mounted in M02 and we

are having an important activity of neurosurgeries, although, we need more specific surgical instruments

and a surgical microscope.

Obstetric and pediatric surgeries are underwent in M02 and recently M03 , our only pediatric

surgeon is located in M02 , so why we registered the surgeries out there, but in so many cases , general

or urologic surgeon are performing pediatric surgeries also. We did not count them in the last year and

considered them as general or urologic.

M118%

M247%

M312%

M1023%

NUMBER OF SURGICAL INTERVENTIONS BY HOSPITAL



7

Overview of our hospitals

M01 Hospital

M01 was the second operating hospital within the liberated area in Aleppo neighborhoods after the

bombing of Al-Shifa hospital, M01 underwent sever conditions and had received many injuries in a time

when no organized structure or resources were available.

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

M1 M2 M3 M10

Neuro Surgery

Gynecologic Surgery

ophthalmologic Surgery

urologic surgery

orthopedic surgery

Vascular surgery

general surgery



8

The hospital is adopted and supported by SEMA (Syrian expatriate medical association – Saudi Arabia), and

was heavily supported by UOSSM (Union des organisations syriennes de secours médicaux – France) with medical

supplies as for all of our hospitals.

A full coverage of ICU drugs and salaries were provided by DSV (Deutsch-Syrischer Verein - Germany)

General Informations

Number of Floors 5

Number of Rooms 7

Number of Beds 20

Number of Ambulance Cars 3

Number of Operation Rooms 2 + 1 for ortho. Surg.

Number of ICU Beds 3

Facility Equipment

ER Equipment yes

Laboratory Equipment yes

X-Ray Equipment ( simple X ray ) yes

OR Equipment ( Diathermy , C-arm , Suction) yes

ICU Equipment yes

Staff and Specialties

Total Medical Staff 38

Total Specialists 6

General Surgeons 2

Orthopedist 2

Pediatrician 1

Vascular Surgeons 1

Total Residents 6



9

General surg. 2

Orthopedic surg. 2

Esthetic surg. 1

vascular surg. 1

Doctor M.D. 1

Medical Students 4

Pharmacy Student 1

Medical Assistants 29

Nurses 4

Anesthesia technicians 10

ICU technicians 4

Paramedics 2

Operation Room Assistants 4

X-Ray Technicians 2

Laboratory Technicians 3

Physiotherapist 1

Non-Medical Staff 34

Ambulance Driver 5

Some landmarks through the evolution of the medical work

- Many medical devices has been introduced to the medical work such as ventilators, Diathermy,

OR suction.

- New ambulance vehicles from our partners

- Many important surgeons from around the world had visited us and helped saving lives

- The ICU unit was running through Tele-medicine, we had specialists out-side Syria monitoring

the status of every patient and supervising the treatment courses of them.



10

Annual work Statistics at M01

Total patients

No of operations

Vascular surgery

Urologic surgery

Orthopedic surgery

General surgery

ICU Ortho clinic

Chest tube

ER

Jan 1941 382 23 93 43 88 32 NA NA 1875

Feb 829 124 38 13 33 26 19 NA 15 575

Mar 1396 318 99 32 11 34 18 NA 14 1019

Apr 231 122 13 3 81 26 11 NA 21 385

May 1988 122 13 3 13 96 1 NA 32 1233

Jun 1822 191 36 3 14 28 3 1613 13 469

Jul 3613 131 33 2 16 24 32 1129 21 1663

Aug 3232 183 4 6 111 92 33 1126 32 1262

Sep 3968 182 32 6 18 22 12 1336 14 1138

Oct 2447 260 32 0 139 57 32 1247 33 2159

Nov 2101 226 33 6 115 52 20 978 31 1830

Dec 1740 172 19 2 121 68 30 609 49 1402

Jan 1728 239 26 3 111 51 48 75 30 1420

Feb 965 199 30 4 101 64 21 89 18 742

0

50

100

150

200

250

300

350

Chest tube

ICU

General surgery

Orthopedic surgery

Urologic surgery

Vascular surgery



11

M02 Hospital

M02 is the largest operating hospital within the liberated area in Aleppo neighborhoods, it is

considered besides being an advanced trauma center as the biggest provider of non-war related

services, such as gynecologic and obstetrical surgery, pediatric surgery, and cold medicine.

Services in this hospital are free of charge in all war- related injuries, or in ERs, while low fees are

imposed for cold medicine to cover the operational cost of the hospital, which stills not fully adopted by

any NGOs.

Syria Relief is financing the salaries of the doctors in Pediatrics and gynecology departments.

USSOM is the major provider of the supplies, and has provided through its trauma committee an

important help to cover the financial deficit of salaries in the last quartile of the fiscal year.

As in M01, full coverage of ICU drugs and salaries were provided by DSV (Deutsch-Syrischer Verein -

Germany)


Number of Floors 5

Number of Rooms 14

Number of Beds 38


Number of Operation Rooms 2 + 1 ortho. + 1 Gync.




12

Facility Equipment

ER Equipment yes




ICU Equipment yes



Total Specialists 9

General Surgeons 1

Orthopedist 1

Pediatrician 3

Gynecologist 2

Urologist 1

Neurosurgeon 1

Total Residents 2

General surg. 1

Orthopedic surg. 1

Doctor M.D. 4

Pharmacist 2


Nurses 7


ICU technicians 2

Midwifes 3

X-Ray Technicians 2


Pediatric Nurse 3



13

artificial limbs technician 1

pharmacy assistant 1

Surgical assistant 3

ER Nurse 2

Incubator's Nurse 2

Obstetric nurse 1

Physiotherapist 3

Non-Medical Staff 37

Ambulance Driver 7

accountant 1

Documenter 2

receptionist 1

security 5

Repair/Maintenance Workers 3

Cooks 2

Janitors 16


- The introduction of the CT scan in the hospital

was a major step, it is the only running CT

device in the whole liberated area, now it is

working but without appropriate output

terminals (no printer or CD writer), still, it

saves many lives and prevented referring

patients in dangerous conditions at night or

during roads blockages.

- The activation of Hemodialysis center , funded

by an independent NGO , it has provided

about 200 dialysis session per month



14

- Many medical devices has been introduced to the medical work such as ventilators, Diathermy,

OR suction , incubators , obstetric chairs , Echo devices specially from ONSUR-OSSEMI (Italy)

- New ambulance vehicles from our partners specially form Al-Fatiha Global (United Kingdom)

- Many important surgeons from around the world had visited us and helped saving lives

- The ICU unit was running through Tele-medicine, we had specialists out-side Syria monitoring

the status of every patient and supervising the treatment courses of

them.

Some ambitions and projects to be supported in M02 - Creation of a new-born ICU unit , because no one is yet created in

Aleppo

- The renovation of the old ER department

- The activation of the 5th OR room to do neurosurgeries , which

require specialized medical equipment

- The activation of the Cardio-department with necessary equipment

to make catheter diagnosis , and other procedures

Annual work Statistics at M02

Total patients

No of operations

without childbirth

Neuro-Surgery

Urologic surgery

Orthopedic surgery

General surgery

ENT ICU Natural birth

Caesarean Chest tube

ER

Jan 595 204 NA 5 112 52 NA NA 5 30 NA NA

Feb 790 226 NA 4 102 77 NA NA 4 39 NA NA

Mar 480 333 NA 21 150 86 NA NA 21 55 NA NA

Apr 3100 303 NA 38 56 108 NA NA 38 63 NA 1862

May 3608 298 NA 46 98 112 NA NA 87 42 NA 2263

Jun 3440 416 NA 47 168 116 NA NA 111 85 NA 2234

Jul 3669 626 NA 109 229 288 NA 149 153 62 50 3013

Aug 4135 905 NA 142 368 395 NA 40 162 103 58 3549

Sep 4017 290 NA 13 93 184 NA 16 65 75 34 3050

Oct 2281 263 NA 52 66 118 27 19 111 91 54 1168

Nov 4835 349 NA 26 75 223 25 25 124 81 23 4333

Dec 2351 230 NA 15 92 111 12 35 123 90 219 2034

Jan 2788 295 NA 13 101 181 0 111 92 85 127 2016

Feb 2229 227 45 4 84 98 0 22 78 37 107 1901



15

July and August were from the quietest months from military point of view, which explains the

significant increase in our numbers of surgeries (non-war related) M02 hospitals during these 2 months.

In Jan and Feb 2014, it is the opposite situation, because of the TNT barrels attack period; cold surgeries

are almost stopped in hospital to prioritize war injuries and to keep a strategic reserve of medical

supplies for them.

0

500

1000

1500

2000

2500

M02 Surgical Stats

Caesarean

Natural birth

ICU

ENT

General surgery

Orthopedic surgery

Urologic surgery

Neuro-Surgery



16

M03 Hospital

M03 is the first line hospital in Aleppo for treating eye-related traumas and surgeries, and the only

hospital performing ophthalmologic surgery in liberated Aleppo , although the hospital in not a real

comprehensive trauma center like our other hospitals , it improves its gynecologic department to be at

50% of M02 hospital in a matter of 2 months , we expect more growing in this department , also , it has

an incubators ward equipped with 6 incubators .


Number of Floors 2

Number of Rooms 9

Number of Beds 15

Number of Operation Rooms 2

Facility Equipment

ER Equipment yes

Laboratory Equipment no



ICU Equipment no



17



Total Specialists 4

Pediatrician 1

internal medicine 1

ophthalmologist 2

Total Residents 1

internal medicine 1

Doctor M.D. 1


Nurses 1


Paramedics 1

Midwifes 2

X-Ray Technicians 1

Operation Room Assistants 1

Incubator's Nurse 1

Obstetric nurse 1

Non-Medical Staff 7

accountant 1

Documenter 1

receptionist 2

Janitors 3


- The PHC clinics also had witnessed a great momentum, especially in pediatrics, internal medicine,

and ophthalmologic consultations of course.

- The activation of a new surgical ER department



18

- Multiplication of the number of incubators in the hospital

- Introduction of new medical equipment such as oxygen generators for incubators, Autoclave MdM

(Médecins du Monde– France)

- activation of the Hemodialysis center by a private donor , this center was active before M02 center

, it works with 6 devices 3shifts per day , the number of beneficiaries exceeds 400 patient per month.

Annual work statistics at M03

Total patients

No of operations without childbirth

Urologic surgery

Ophtalmologic

surgery

General surgery

haemodialysis Natural

birth

Caesarean Gynecology Surgery

ER

Mar 200 60 5 40 15 NA NA NA NA 160

Apr 392 112 9 58 42 18 NA NA NA 262

May 474 50 3 33 14 103 NA NA NA 321

Jun 776 101 2 97 2 118 NA NA NA 557

Jul 1177 122 0 89 33 118 2 NA NA 937

Aug 1248 24 1 21 1 43 2 NA NA 988

Nov 1148 270 11 49 1 45 63 144 209 977

Dec 310 152 5 10 0 45 49 70 137 166

Jan 389 84 0 84 0 NA 35 62 0 282

Feb 363 96 0 96 0 NA 5 10 0 265

0

200

400

600

800

1000

1200

1400

1600

1800

2000

Mar Apr May Jun Jul Aug Nov Dec Jan Feb

ER

Gynecology Surgery

Caesarean

Natural birth

haemodialysis

General surgery

Ophtalmologic surgery



19

M10 Hospital

M10 hospital was created by ACMC to cover the need for a strong trauma center in the eastern

neighborhoods of Aleppo, while we did not have enough staff at the time; we did what we were calling

ironically a (mitosis) to our staff in M01 to operate the hospital! Afterwards many other volunteered

doctors and assistants came in and the mitosis was completely successful.

This hospital is the second trauma center in Syria in terms of Trauma work activity after Doma field

hospital – Damascus.

The hospital is fully adopted by SAMS (Syrian American medical society – United States) , while UOSSM

provides generous supplies as usual.


Number of Floors 4

Number of Rooms 5

Number of Beds 21


Number of Operation Rooms 3




20

Facility Equipment

ER Equipment yes




ICU Equipment yes



Total Specialists 6

General Surgeons 2

Urologist 1

Anesthesia Specialist 1

ENT Specialist 1

Total Residents 5

General surg. 2

Orthopedic surg 1

internal medicine 1

Neuro Surg. 1


total medical staff except doctors 16


Paramedics 2


X-Ray Technicians 2

Surgical assistant 5

Non0Medical Staff 28

Ambulance Driver 4

accountant 1



21

security 6

Documenter 2

receptionist 2

Janitors 11

Repair/Maintenance Workers 2

Cooks 2


- The creation of the ICU unit with three beds by SAMS, and link it via telemedicine to the

monitoring unit as n M01 and M02.

- Many specialized equipment for urologic surgery has been provided.

- Al-Fatiha Global and other partners provided ambulance vehicles.

M10 under attack

In the 7th of February 2014,

the hospital was targeted by a

fighter-jet missile, 2 patients were

killed and some staff had minor

injuries, the destruction reached

almost all parts of the hospital: ICU

is 100% damaged and un-reparable ,

the X-ray device is broken , the C-

Arm also , the ORs , and general

destruction in patient’s wards.

One week after the hit, the surgeons were operating in a very difficult condition, persisting to

continue their duty no matter how dangerous or difficult it is.



22

Annual work statistics at M10

Total patients

No of operation

ENT Urologic surgery

Orthopedic surgery

General surgery

vascular surgery

Neuro Surgery

Chest tube

ICU ER

Feb 117 117 NA 1 5 2 NA 0 1 NA 108

Mar 586 75 NA 11 32 28 4 0 0 NA 501

Apr 1672 226 NA 17 130 69 10 0 6 4 1494

May 2123 401 NA 20 211 133 37 6 12 NA 1864

Jun 1995 311 NA 16 174 101 20 8 21 NA 1780

Jul 1833 229 NA 22 144 39 24 4 20 1 1631

Aug 2015 174 NA 5 111 57 1 10 26 31 1777

Sep 2297 329 NA 25 151 133 20 4 30 36 2033

Oct 2333 263 NA 21 151 85 6 0 17 37 2111

Nov 2139 248 NA 7 135 90 16 0 29 41 1900

Dec 1852 354 NA 39 156 148 11 4 13 27 1665

Jan 1356 130 1 2 50 62 16 0 108 134 1156

Feb 1149 267 10 18 85 124 40 0 38 67 929

0

50

100

150

200

250

300

350

400

450

Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan2014

Feb-14

ICU

Chest tube

Neuro Surgery

vascularsurgery

Generalsurgery

Orthopedicsurgery

Urologicsurgery

ENT



23

Overview of our PHC centers

The first concern of Aleppo City medical council was to focus on war related injuries, this priority

was obvious in the first half of the year 2013, by time and the longevity of the crisis, PHC appears to be

as much important as war injuries.

We have noticed by daily practice how important was to cover this important gab for the

community.

leishmaniasis lesions , pediatrics and gynecology , chronic diseases ( HT , Diabetes Type I & II ,

Epilepsy , ENT , ophthalmologic , and dental , were all important fields to be covered.

Our strategy to support the PHC points was to:

- Provide medicines and supplies in collaboration with partners

- Provide financial cover for the running cost , and partial support for the mass of salaries

- To cumulate accurate statistics from the medical points (which was absent in the beginnings) so

that these medical points could be presented to NGOs to be supported.

Our efforts has let us to:

a. Get our N4 medical point to be adopted by the EU ( European union) project of PHC

centers

b. Our N1, N2,N14 medical points are adopted by MdM by all necessary amount of

medicines and supplies



24

Dental clinics

Dental care has been always an absent element in any serious plan of PHC project, because of the

common idea that dental treatment are very expensive.

The idea was very challenging, but the need for dental treatment was very important, se we have

decided to initiate a low cost treatment, and still presenting all sorts of treatment from restorative

dentistry to endodontics, and not simply extractions.

The project has ten working dentists (2 specialists), the total amount of treatment sessions exceeds

11000 session.

Six dental clinics are actually running, and they are distributed in five distinct neighborhoods in

Aleppo:

1- D1 (2 dental chairs) - part of N04 medical point


3- D3 (2 dental chairs)

4- D4 (1 dental chairs)



Some landmarks through the evolution of the dental care project DCP

- Introduction of new dental chairs by the help of SAMS - Introduction of new equipment ( ultra-sonic scalers , apex locators , panoramic x-ray device) - First project in ACMC completely documented since day 1 , we have accurate patient record

about all of our patients - Support from individual dentists in Saudi Arabia and from Austria to the project in the last year. - Launch of oral care & caries prevention campaign within elementary schools



25

Some ambitions and ideas to be supported

- To find a sponsor to adopt the project with salaries and dental materials supplies - To support the prescribed medications to the population - Provide IT support to the clinic to move from paper archive to more organized practice

management software

Annual work statistics at DCP

0

500

1000

1500

2000

2500

Evolution in dental care sessions per month

D6

D5

D4

D3

D2

D1



26

N1 Medical point

N01 is the first medical point supported by the council; staff includes an internal medicine specialist, a

gynecologist, and medical assistants.

Presented services:

- General & internal consultations

- Minor cases ambulance ( simple wounds , class I burns , Bandages )

- Gynecology consultations

- Anti-leishmaniasis

- Pharmacy

Total patients

internal medicine

Dressing leishmaniasis diabetes gynecology pediatric

Jun 831 1184 70 210 26 NA 525

Jul 1040 1021 89 320 8 35 170

Aug 1121 1326 52 308 1 43 183

Nov 1383 1880 NA 301 315 NA NA Dec 934 1920 1350 366 117 290 290

Jan 516 425 NA 7 87 290 87

Feb 708 383 60 31 70 234 125



27

N2 Medical point N2 medical point was also from the first medical points adopted by the medical council; it

provides specialized pediatric consultation thanks to the two pediatricians in it, gynecology, and other

services.

Presented services:

- Pediatric consultations




- Pharmacy

- Lab

0

500

1000

1500

2000

2500

Jun Jul Aug Nov Dec Jan -14 Feb-14

Total patients

internal medicine

Dressing

leishmaniasis

didbetes

gynecology

pediatric



28

Total patients

internal medicine

Dressing leishmaniasis diabetes Gynecology Pediatric ophthalmology

Jul 1750 NA 1253 NA NA 122 375 NA

Aug 1500 NA 746 NA NA 76 678 NA

Oct 1200 1582 760 420 NA 240 520 20

Nov 756 1382 965 200 NA 218 360 15

Dec 1612 2071 1450 360 95 702 374 50

Jan 1200 780 785 420 55 240 220 20

Feb 895 615 785 280 85 0 110 35

N3 Medical point This medical point is the external clinics of

M02 hospital; it is located in an adjacent

independent building, and presented various

sorts of medical services.

- Internal & general consultations


- Minor cases ambulance ( simple

wounds , class I burns , Bandages )



- Orthopedic clinic

- ENT consultations

0

500

1000

1500

2000

2500

Jul Aug Oct Nov Dec Jan-14 Fab - 14

Total patients

internal medicine

Dressing

leishmaniasis



29

- Ophthalmologic consultation ( now transferred to M03 external clinics)

- Dental consultations via the included D2 dental clinic

- Physiotherapy sessions and artificial limbs

Total patients

internal medicine

Dressing

Physiotherapy Orthopedic clinics

ENT ophthalmology

Apr 3461 900 201 120 900 210 750

May 3461 900 201 164 900 210 750

Jun 1240 349 420 147 386 224 260

Jul 2217 450 332 173 412 332 224

Aug 2303 294 626 84 165 626 131

Nov 1223 478 269 328 NA 269 NA

Dec 553 103 198 265 NA 198 NA

Jan 353 121 109 100 0 19 NA

N4 Medical Point This medical point is located in a strategic area in the liberated neighborhoods; it is an elected point to

be adopted by the European union PHC centers, it provided through the last year the following services :

- general consultations



0

100

200

300

400

500

600

700

800

900

1000

Apr May Jun Jul Aug Nov Dec Jan

internal medicine Dressing Physiotherapy Orthopedic ENT ophthalmology



30



- Orthopedic clinic

- Ophthalmologic consultation ( now transferred to M03 external clinics)

- Dental consultations via the included D1 dental clinic

- Pharmacy

- Lab

- Vaccines ( brought from regime held territories)

Total patients

internal medicine

Dressing leishmaniasis Orthopedic clinics

pediatric ophthalmology

Jul 601 NA 9 415 65 826 121

Aug 689 NA 15 489 50 752 150

Sep 6248 322 542 2330 35 2919 100

Oct 4715 405 395 2115 39 1725 101

Nov 4768 383 398 2650 34 1303 86

Dec 2385 164 132 1497 3 589 50



31

N12 Medical point This medical point is now out of service because of the lack in financing , and the leakage of medical care

providers after the TNT barrels drop by the regime jets.

Presented services through the course of the last year:

- general consultations





- Pharmacy

- Lab

- Diabetes clinic

- Vaccines ( brought from regime held territories)

0

500

1000

1500

2000

2500

3000

3500

Jul Aug Sep Oct Nov Dec Jan Feb

internal medicine

Dressing

leishmaniasis

Orthopedic

pediatric

ophthalmology



32

Total patients

internal medicine

leishmaniasis ENT pediatric

Mar 3222 2494 NA 403 325

Apr 3689 2886 NA 538 265

May 3307 2658 NA 416 233

Jun 2699 2073 NA 437 189 Jul 4806 1794 2954 NA 284

Aug 2631 1508 330 524 269

N13 Medical point

0

500

1000

1500

2000

2500

3000

3500

Feb Mar Apr May Jun Jul Aug

internal medicine

leishmaniasis

ENT

pediatric



33

N13 has been established in the last part of the last year, it is located in the far east of the city in a very

crowded population, and it presents the following services:

- Internal & general consultations ( internal medicine specialist)




- Pharmacy

- Dental consultation (via its included D6 clinic )

Total patients

internal medicine

Dressing leishmaniasis diabetes pediatric

May 1039 135 55 521 63 265

Jun 1471 135 75 855 131 275

Jul 1978 156 55 1338 173 256

Aug 2199 179 90 1402 219 309

Sep 2471 364 66 1295 124 649

Oct 2162 381 57 1172 NA 552

Nov 2870 471 164 1512 NA 723

Dec 273 1062 638 459 63 NA

0

200

400

600

800

1000

1200

1400

1600

May Jun Jul Aug Sep Oct Nov Dec

internal medicine

Dressing

leishmaniasis

didbetes

pediatric



34

N14 Medical point

N14 is located in a neighborhood in the northeastern part of the city, the population is very poor

and a considerable number of IDPs are in the area, the region was it by scud missile in the mid of the

year 2013. The point provide the following services:

- Internal & general consultations ( internal medicine specialist)



- Pharmacy

- Lab

- Dental consultation (via its included D6 clinic )

Total patients

internal medicine

Dressing leishmaniasis

Jun 1474 475 76 645

Jul 1304 508 57 543

Aug 956 394 63 478

Sep 1506 460 142 454

Oct 1022 453 109 574

Nov 1427 451 109 710

Dec 573 373 214 735

0

100

200

300

400

500

600

700

800

Jun Jul Aug Sep Oct Nov Dec

internal medicine

Dressing

leishmaniasis



35

PHC statistics overview The statistics of the first months of year 2013 in the medical points was unavailable, due to the

lack of personnel , logistics, and informatics equipment, this problem was solved only in the last quartile

of the year 2013, the presented numbers only reflects a partial amount of the real work volume.

Medical point

Total patients

internal medicine

Dressing leishmaniasis diabetes pediatric ophthalmology gynecology ENT Physiotherapy

N1 6533 8139 1621 1543 624 1380 NA 892 NA NA

N2 8913 6430 6744 1680 235 2637 140 1476 NA NA

N3 14811 3595 2356 NA NA NA 2115 2088 NA 1381

N4 19406 1274 1491 9496 NA 8114 608 NA NA NA

N12 20354 13413 NA 3284 NA 1565 NA NA 2318 NA

N13 14463 2883 1200 8554 773 3029 NA NA NA NA

N14 8262 3114 770 4139 NA NA NA NA NA NA

Total 92742 38848 14182 28696 1632 16725 2863 4456 2318 1381

It is also good to know that some services were not well presented because of the lack in

medical providers (specially in gynecology and dermatology).

Many medicines specially those for the chronic diseases (HT , Diabetes .. ) were not enough

served via our pharmacies.

35%

13%26%

1%

15%

3%4%2%1%

Treatment's distribution profile in ACMC PHC centers

internal medicine Dressing Leishmaniasis Diabetes pediatric

Ophthalmology Gynecology ENT Physiotherapy



36

It is one of the most important projects and sights for the year 2014 to avoid these problems.

Most common diagnosis

While this list is not built statistically but more on the reflections of the doctors, all of the following

reports of ours will be very accurate , thanks to the incorporation of a new software with full details

about the diagnostics and therapies.

Common medical conditions

Upper Respiratory tract infections

Pneumonia

Hepatitis A

gastrointestinal infections , diarrhea

Gastric ulcer ,

Vitamins deficiency , Iron deficiency Anemia

Mal nutrition

typhoid fever

Brucellosis

Diabetes mellitus

blood hypertension

Degenerative arthritis

Impetigo

Dermal Leishmaniasis

Pediculosis

Scabies



37

Central Warehouses performance

Central warehouses at ACMC are the organizing body for the logistic chain of : receiving,

distributing, and storaging all medical supplies and medicines sent to ACMC hospitals and medical

points.

Now the warehouses are using management software to run out their work, we have

introduced internet connection to all secondary warehouses at the hospital, and the next step is to link

them all through a network to create a real-time database, this would help to determine more

accurately our needs of medicines and supplies.

Reporting system has become more accurate, and the documentation of shipments has become

mandatory.

Percentage of medicines and supplies to the hospitals

Prices as estimated in USD according to the corresponding exchange rate at each month

Hospital M 1 M 2 M 10 M 3 Monthly Total

July 19,533.68 16,432.33 19,196.80 1,417.23 56,580.04

August 9,015.75 14,592.10 10,528.00 4,242.41 38,378.26

September 10,102.25 9,909.79 9,083.33 2,790.53 94,958.30

October 28,208.05 19,422.77 18,911.90 7,205.60 73,748.32

November 25,616.72 16,941.15 20,057.99 4,442.07 67,057.92

December 10,802.18 19,765.40 17,148.89 2,380.59 235,764.54

January 21,133.63 28,291.12 27,548.86 6,139.42 83,113.03

February 20,652.04 24,467.99 23,639.18 2,764.18 71,523.39

Total sum 145,064.30 149,822.64 146,114.95 31,382.03 390,400.96



38

As you can see , our hospitals consumption rate is high , which goes with the important work

volume , it is also important to mention that the support values are in some months are lesser than our

real need.

Percentage of medicines and supplies over the medical points

Point Name July August September October November December January February Total Sum

Dental Clinics $31.49 $235.66 $616.66 $584.05 $40.96 $13.00 $161.20 $165.00 $1,848.02

M09 $646.12 $909.99 $2,091.01 $0.00 $0.00 $0.00 $0.00 $0.00 $3,647.12

M2 - Kidney $36.96 $1,085.26 $68.00 $237.00 $0.00 $0.00 $118.00 $20.00 $1,565.22

M3 - Kidney $27.00 $618.79 $738.33 $1,250.66 $93.33 $0.00 $0.00 $0.00 $2,728.11

N01 $0.00 $0.00 $0.00 $401.43 $121.73 $444.42 $1,904.65 $1,209.85 $4,082.08

N02 $506.66 $2,726.62 $1,749.92 $1,090.46 $812.09 $1,415.90 $2,174.65 $1,373.35 $11,849.65

N03 $0.00 $0.00 $294.22 $131.16 $115.73 $122.63 $212.80 $0.00 $876.54

N04 $886.66 $2,339.33 $1,627.29 $2,709.99 $960.63 $1,249.26 $478.10 $608.65 $10,859.91

N05 $135.43 $1,669.33 $839.53 $742.66 $1,007.56 $631.86 $679.00 $61.80 $5,767.17

N06 $214.17 $98.66 $1,117.23 $231.99 $1,457.00 $0.00 $497.90 $0.00 $3,616.95

N12 $3,820.07 $10,821.66 $382.99 $0.00 $0.00 $0.00 $0.00 $0.00 $15,024.72

-

10,000.00

20,000.00

30,000.00

40,000.00

50,000.00

60,000.00

70,000.00

80,000.00

90,000.00

JulyAugustSeptemberOctoberNovemberDecemberJanuaryFebrurary

Medical supplies expences during the second half of 2013 in USD

M 1 M 2 M 10 M 3



39

N13 $0.00 $0.00 $1,749.56 $25.99 $1,343.76 $520.36 $1,658.00 $481.00 $5,778.67

N14 $0.00 $0.00 $0.00 $1,194.96 $1,617.76 $1,017.52 $2,633.10 $1,708.66 $8,172.00

N16 $0.00 $262.66 $189.16 $285.99 $236.76 $0.00 $205.00 $640.85 $1,820.42

N17 $405.36 $2,358.00 $2,087.82 $1,091.93 $0.00 $0.00 $0.00 $0.00 $5,943.11

Total Grand $6,709.92 $23,125.96 $13,551.72 $9,978.27 $7,807.31 $5,414.95 $10,722.40 $6,269.16 $83,579.69

We did not listed all the beneficiary medical points in the table; therefore, the real number of

supplies cost distributed to the medical points is higher.

The new strategy in distributing supplies and medicines is based on the accurate statistics of

medical workload in the point, of its financial transparency.

In the next year, only accredited medical points will benefit from most of our support , which

are: N01, N02, N03, N04, N13, and N14.

Other points are encouraged to raise their capacity to join our recognized ones.

Major suppliers of medicines and supplies for ACMC in 2013

UOSSM is our strategic partner for the delivery of medical supplies and hospital medicines (

more than 50% of our supplies ).

DSV is the major supporter for ICU drugs

MdM is now the major supplier of surgical sutures, PHC drugs.

SAMS is the major supporter with medical devices and equipment

Many other NGOs has helped providing us with supplies such as :

o SEMA

o Al-Fatiha Global

o Hammer forum

o Syrian relief and development

o Preston for Syria

o Life line from Malaysia

o Medicines sans frontiers

o Karlsruhe Hilft Syrien

o Syria Der

o Kuwait patient’s help fund

o Syrian national council



40

o Mairie de Metz – France

o Syrian British medical society

Referral system – Disaster response system

The need for an integrated response

team to refer patients and transfer tem form

the accidents sites was very important,

especially after the bombing with TNT barrels

over the city.

The council has already 13 working

ambulance vehicle, provided by many

partners notably Al-Fatiha global.

The newly created of Aleppo health

directorate possess 15 ambulance vehicle, as

we have decided to part of it, a meeting has

conducted to the unification of all ambulance

vehicles under one command. Now all

vehicles in Aleppo city follow the orders of the

central emergency command, they have

communication with civil defense team to

coordinate when pulling injured from under

the collapsed building.

All vehicles are connected via radio

headpieces, we can now decide which

hospital is crowded and to which hospital we

can refer cases, moreover, the referring to

hospitals in turkey is now more organized , we

can made less trips per day thanks to this

coordination ( which means less maintenance to the vehicles )



41

Activity for prevention of chemical attacks

The council has started its interest in the

prevention of chemical strikes immediately after the

chemical attack in Khan-Alasal (Aleppo countryside)

on 14 March 2013 ,

First response was to establish 3 points of

decontamination.

Communications has been made with MSF and other

NGOs, for providing technical and scientific support

and logistics (such as protective suits, gas masks,

and tents of high quality.)

A specific protocol has been approved and adopted

to deal with any attack.

The CBRN-TF ( chemical biological radiological

nuclear task force ) at ACU ( assistance coordination

unit )

Our staff had intensive theoretical and practical

courses on treatment protocols in case of chemical

incident.

A good coordination with the Canadians and the

French in fields of getting consultations and

collecting data via the responsible of the project.

Three simulations maneuvers was carried out in our

hospitals.

in each hospital , two response teams are created ,

every team covers one shift in way that 24/24 a

trained team is ready to work in case of chemical

attacks .



42

We received significant quantities of atropine and other drugs form ACU , MdM , they were distributed

to hospitals

Training and development The medical staff assisted too many training courses and sessions in the last year

ACLS (advanced cardio-vascular life support)

It took place in Killis city- Turkey, the total

number of attending persons was 50 trainee.

The outcomes was to form 2 teams for

Cardiopulmonary resuscitation (CPR) or Code blue

teams in M01 and M08

PALS (Pediatric advanced life support)

Five trainees from our pediatric departments

attended this course.

ATSU (apprentissage de technique de médicine

d’urgence)

Ten ER nurses had participated in this course in April 2013; the course is running regularly in Bab

Al-Hawa every 2 months.

The course was repeated recently in February 2014 in M02 hospital, it was a good success with

the presence of 20 trainee

ATMG

This training course was realized with

collaboration of UOSSM, intensive workshops for 2

days, we have the pleasure of guesting a French

trainer doctors in Aleppo, the number of trainees

exceeds 30 persons.

Course for anesthesia technicians

Five of our anesthesia technicians attended

this course

Creation of nursing school in Aleppo

One of the most permanent problems we are facing is the lack of medical care providers.



43

As a solution, comes the idea of creating a permanent center in Aleppo to train and teach

medical skills.

The school is established in M02 hospital (in a hall of the inactivated ICU !) in july 2013 , and the

school started teaching 3 levels :

1- First aids for beginners

- Basic anatomy

- sterility and disinfection

- hand washing

- taking and reading vital signs

- evacuation from risk environments

- basic emergency skills

- injections administration ( IV – IM )

- psychological support

2- Emergencies for intermediate students

- background about infectious diseases

- basic prescriptions and medications

- wounds suturing techniques

- airways openings

- bandages

- splints and casts

- dealing with burns of class I and II

- putting and removing urinary catheters

- patient evaluation

- triage

- ethics and moral considerations

3- Emergencies for advanced students

- head and spinal cord injuries

- soft tissues injuries

- bleeding and shock management

- tracheotomy

- IV solutions

- CPR

- Child delivery emergencies

- EKG interpretation



44

More than 300 student has been graduated from the 3 levels, some of them went directly to cover our

needs for nurses in the hospitals.

Adminstrative restructuring and improvements

The need to have an independent adminstrative body to manage and direct the huge work volume

in the hospitals , and to carry on all the non-medical related problems such as documentation , , public

relations , informatics and communications , human resources , Maintenance , supply chains. All this led

to create the M17; the central direction of ACMC.

We make Reunions and meetings at the level of the adminstrative staff such as documenters and

accountant in order to harmonize the efforts and increase productivity.

Also, we make meeting of ACMC board for discussing the strategy and the major orientations in

ACMC medical policy.

All data about medical activity, finical documents and statistics is now organized in the central

archive at ACMC direction, the local Lan with special permissions and firewalls is now set for the bureau

officers, in order to help them in taking decisions.

On more local scale, in every hospital, a board of direction has to be established, this board makes

meetings to solve problems and suggest improvement for the work, a copy from these meeting has to

be sent the central direction at M17

To provide more work that is organized and efforts, a support for the adminstrative offices with

funds is necessary; this is why we urge our partners not to focus only on the needs in terms of medical

supplies, but to consider also the need to support and finance human resources and adminstrative

issues.

Long term strategy and vision for the future

The council has played an important role in the last year serving the medical sector in Aleppo,

but now we in the administration believe that we need to act more globally and think about the



45

coordination with all active medical care providers on the ground, this is why we have signed the act of

creation of Aleppo health directorate.

We are willing to merge in this new entity, to help it and to support it performing its function in

medical sector not only in the city, but also in Aleppo countryside.

We also went through the election of the council of free Aleppo governorate, ACMC chairman is

now the head of Aleppo health office.

The coordination between Aleppo health directorate and Aleppo health office is very high,

specially that both responsibles are former ACMC, we share the same vision and the new work strategy

is to distribute responsibilities as follows:

- Aleppo health directorate is the executive part, the real responsible and follower of the medical

sector issues and needs.

- Aleppo health office is more to communicate with NGOs , coordinate the efforts , collet data

and prepare plans according to the population needs

This is our future vision for the medical work in Aleppo , it will be presented trough the next general

assembly of ACMC.

End of report

Documents

ACMC 3rd Medical Report