HeRAMS Bi-Annual Report

HeRAMSBi-Annual ReportJanuary - June 2020

Public Hospitalsin the Syrian Arab Republic

World Health Organization Health Resources and Services Availability Monitoring System Syrian Arab Republic

HeRAMSBi-Annual ReportJanuary - June 2020

Public Hospitals in the Syrian Arab Republic

This is to acknowledge that the data provided in this report is a product of joint collaboration between the World Health Organization, Ministry of Health, and Ministry of Higher Education in the Syrian Arab Republic. The report covers the months of January to June 2020.

© World Health Organization 2020Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).

Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”.

Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization.

Suggested citation. [Title]. Cairo: WHO Regional Office for the Eastern Mediterranean; 2020. Licence: CC BYNC-SA 3.0 IGO.

Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see http://www.who.int/about/licensing.

Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-partyowned component in the work rests solely with the user.

General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.

The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.

All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.

Contents

Introduction

Executive summary

1. Completeness of hospitals reporting 2. Functionality and accessibility of the public hospitals 2.1 Functionality status of the public hospitals

2.2 Density of the public hospitals

2.3 Accessibility to public hospitals

3. Accessibility to public hospitals

4. Infrastructure patterns of the public hospitals 4.1 Level of damage of the hospitals’ buildings

4.2 Analysis of the inpatient capacity

4.3 Water sources and functionality status

4.4 Availability of electricity generators

5. Availability of health human resources 5.1 Availability of medical staff by category and affiliation

5.2 Availability of medical doctors by affiliation (MoH vs. MoHE hospitals)

5.3 Availability of medical doctors by gender (MoH vs. MoHE hospitals)

6. Availability and utilization of the health services 6.1 General clinical services

6.2 Surgical and trauma care

6.3 Maternal health services

6.4 Child health

6.5 Nutrition

6.6 Communicable diseases services

6.7 NCDs (non-communicable diseases)

6.8 Rehabilitation services

6.9 Mental health

7. Availability of medical equipment

8. Availability of medicines & medical supplies

9. Conclusions and recommendations

1

1

3

44

7

8

8

1010

14

15

17

1821

23

25

2729

31

38

41

42

43

44

47

48

49

51

52

Abbreviations

CEmOC Comprehensive Emergency Obstetric Care

CS Caesarean Sections

DoH Directorate of Health

ESKD End Stage Kidney Disease

HeRAMS Health Resources & Services Availability Monitoring System

HIS Health Information System

HRP Humanitarian Response Plan

ICT Information and Communication Technology

ICU/ CCU Intensive Care Unit / Critical Care Unit

IDPs Internally Displaced People

MoH Ministry of Health

MoHE Ministry of Higher Education

NCDs Non-communicable Diseases

OCHA United Nations Office for the Coordination of Humanitarian Affairs

WHO World Health Organization

HeRAMS | Bi-Annual Report | January - June 2020Public Hospitals1

HeRAMS is a global health information management tool (for mapping, collection, collation and analysis of information on health resources and services) that aims to provide timely, relevant and reliable information for decision-making. It is used to guide interventions at the primary and secondary care levels, measure gaps and improve resource planning, ensure that actions are evidence-based, and enhance the coordination and accountability of WHO and other health sector partners.

HeRAMS in Syria is a World Health Organization (WHO) project that aims at strengthening the collection and analysis of information on the availability of health resources and services in Syria at health facility level. A team of national health staff from all governorates was formulated for HeRAMS reporting, and different data collection mechanisms were introduced to address the shortage of timely and relevant information. The main HeRAMS tool for collecting data is a questionnaire that assesses the functionality status, accessibility, health infrastructure, human resources, availability of health services, equipment and medicines at primary and secondary care level.

Regular assessment to monitor the impact of the crisis on the health facilities functionality, accessibility, condition status, availability of resources and services, has been conducted using HeRAMS (Health Resources & services Availability Monitoring System) tool. The report provides descriptive and trend analysis for the situation of public hospitals in all 14 governorates of Syria [including Ministry of Health (MoH) and Ministry of Higher Education (MoHE) hospitals (a total of 113 hospitals)].

Despite the challenging security situation and protracted crisis, in addition to the wide disruption of the Health System, implementation of HeRAMS has been successfully institutionalized and strengthened in public health facilities since 2014.

Completeness of hospitals’ reporting remained 100%, where all 113 public hospitals: 100 (MoH) hospitals and 13 (MoHE) hospitals reported to HeRAMS by end of June 2020.

Functionality status of the public hospitalsBy the end of June 2020, and out of the 113 assessed public hospitals [MoH & MoHE], 50% (56) were reported fully functioning, 26% (30) hospitals were reported partially functioning (i.e., shortage of staff, equipment, medicines or damage of the building in some cases), while 24% (27) were reported non-functioning.

Accessibility status of the public hospitalsBy the end of June 2020, 79% (89) hospitals were reported accessible, 8% (9) hard-to-access, and 13% (15) were inaccessible.

Introduction

Executive summary


Infrastructure of the public hospitalsBy the end of June 2020, 43% (49) hospitals were reported damaged [10% fully damaged and 33% partially damaged], while 57% (64) of public hospitals were reported intact.

Analysis on inpatient capacity in functional hospitals has shown shortage of beds at varying degrees, across all governorates.

Assessing the availability of water sources at functional public hospitals indicated that 37.2% (32) are using main pipelines, 9.3% (8) are mainly using wells, 51.2% (44) are using both (main pipeline and well), while 2.3% (2) are using other sources of water.

Electricity power is widely disrupted nationwide and majority of public hospitals are dependent on generators’ power. According to HeRAMS assessment 31% (27) of functional public hospitals across Syria are in need for electrical generators, mainly reported from 11 governorates: Damascus, Rural Damascus, Aleppo, Lattakia , Homs, Hama, Al-Hasakeh, Deir-ez-Zor, Dar’a, As-Sweida, and Quneitra.

Human resources for health The general practitioner (0.2%) and emergency physician (0.3%) were the lowest proportion of health staff in public hospitals, followed by dentists (0.6%), pharmacists (0.7%), midwives (4.7%), laboratory (5.1%), specialists (12.6%), resident doctors (23.5%), and nurses (52.4%).

Trend analysis of available number of medical doctors, nurses, and midwives during 2020 has shown slight increase. In functional public hospitals the number of medical doctors [general practitioner, specialists, emergency doctors, resident doctors, dentists] has slightly increased by 1% in June 2020 compared to January 2020, similarly the number of nurses has slightly increased by 1%, while the number of midwives has slightly decreased by 2%.

Analysis of proportions of medical doctors [general practitioner, specialists, emergency doctors, resident doctors, dentists] working at MoHE hospitals versus MoH hospitals has shown that 26% of medical doctors work in MoHE, while 74% are in MoH hospitals.

Analysis of availability of medical doctors by gender has shown that lowest proportion of female to male medical doctors is in Ar-Raqqa governorate (17%).

Availability and utilization of health services As a result of disrupted healthcare delivery and non-functionality of the hospitals, limited provision of health services was observed across governorates, even within functional hospitals. Detailed analysis on services’ availability and utilization throughout 2020 by category (i.e., General Clinical Services, Surgical and Trauma care, Child Health, Nutrition, Maternal & Newborn Health, Communicable Diseases, Non-communicable Diseases, and Mental Health) is provided at governorate level.


The completeness of reporting from public hospitals across Syria remained at 100%, where all the 113 public hospitals: 100 Ministry of Health (MoH) Hospitals and the 13 Ministry of Higher Education (MoHE) hospitals continued to report to HeRAMS in June 2020.

The distribution of public hospitals by affiliation [MoH & MoHE], per governorate is shown in Figure 1.

The following sections provide descriptive and trend analysis on the functionality status, accessibility, and infrastructure of the public hospitals, availability of resources & services, and available equipment and medicines by the end of June 2020.

The provided analysis supports informed decision making, better planning and allocation of resources, and contributes to significant and focused humanitarian response by WHO and health sector partners.

Figure 1: Distribution of public hospitals by affiliation, per governorate

1. Completeness of hospitals reporting

8

14

11

4

67

16

65

7

4

7

4

1

7

1

4

01

0 0 0 0 0 0 0 0 0

15 15 15

4

7 7

16

65

7

4

7

4

1

0

2

4

6

8

10

12

14

16

18

Damascus Rural Damascus

Aleppo Idleb Lattakia Tartous Homs Hama Al -Hasakeh Deir-ez-Zor Ar-Raqqa Dar'a As -Sweida Quneitra

Total MoH Hospitals Total MoHE Hospitals Total Public Hospitals

Availability of medical equipment Analysis of availability of essential and specialized equipment was measured across all functional public hospitals [MoH & MoHE], in terms of functional equipment out of the total available equipment in the hospital. The produced analysis provides good indication of the current readiness of the hospitals to provide the health services, and also to guide focused planning for procurement and distribution of equipment and machines, to fill-in identified gaps that were observe even within the functional public hospitals.

Availability of medicines and medical supplies Availability of medicines and medical supplies at hospitals’ level was evaluated based on a standard list of identified priority medicines and medical supplies for duration of one month.

The key identified gaps of medicines and consumables at functional hospitals include the:Cancer related medicines (83%), Hepatitis vaccine (77%), Tetanus shot (73%), Medicines affecting the blood (73%), etc.


The following sub-sections provide analysis on the functionality and accessibility status of the public hospitals at governorate level.

2.1 Functionality status of the public hospitals

Functionality of the public hospitals was defined and assessed at three levels;

• Fully functioning: a hospital is open, accessible, and provides healthcare services with full capacity (i.e., staffing, equipment, and infrastructure).

• Partially functioning: a hospital is open and provides healthcare services, but with partial capacity (i.e., either shortage of staffing, equipment, or damage in infrastructure).

• Non-functioning: a hospital is out of service, because it is either fully damaged, inaccessible, no

available staff, or no equipment.

Figure 2: Functionality status - June 2020

2. Functionality and accessibility of the public hospitals

Fully Functioning

Partially Functioning

Non-Functioning

56

30

2750%

26%

24%

By the end of June 2020, and out of the 113 assessed public hospitals [MoH & MoHE], 50% (56) were reported fully functioning, 26% (30) hospitals were reported partially functioning (i.e., shortage of staff,equipment, medicines or damage of the building in some cases), while 24% (27) were reported non-functioning [Figure 2].

The hospitals reported partially functioning or non-functioning are in 12 out of a total 14 governorates (86% of governorates). Detailed analysis on the functionality status of the MoH and MoHE hospitals at governorate level is presented in [Figure 3] and [Map 1]. All public hospitals in Idleb were reported out of service.


Figure 3: Number and percentage of the public hospitals by functionality status, per governorate, June 2020

0

0

0

1

1

5

7

8

3

12

5

6

7

1

0

3

3

5

3

5

4

2

1

3

0

1

0

0

4

4

1

1

1

6

4

5

0

0

1

0

0

0

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Idleb

Deir -ez-Zor

Ar -Raqqa

Dar'a

Al -Hasakeh

Homs

Aleppo

Rural Damascus

As-Sweida

Damascus

Hama

Lattakia

Tartous

Quneitra

Fully Functioning Partially Functioning Non-functioning

Map 1: Distribution and functionality status of public hospitals, June 2020


56 56 55 55 55 56

29 29 30 30 30 30

28 28 28 28 28 27

0

10

20

30

40

50

60

Jan 2020 Feb 2020 Mar 2020 Apr 2020 May 2020 Jun 2020

Fully Functioning Partially Functioning Non-functioning

Figure 4: Trend analysis of functionality status of public hospitals, January to June 2020

Slight variation of functionality status of public hospitals has been observed during 2020 [Figure 4].


2.2 Density of the public hospitals

Hospitals density reflects the total number of hospitals relative to population size (based on OCHA HRP

2020), which helps measure physical access to outpatient health care services. Comparing with Sphere

standards for hospitals (250,000), five governorates (Aleppo, Rural Damascus, Hama, Al-Hasakeh, and

Deir-ez-Zor) are over the standard density reference; due to high number of population against the

available functioning public hospitals [Figure 5] and Map 3.

Map 3: Density of the public hospitals per governorate, June 2020

Figure 5: Density of the public hospitals per governorate, June 2020

360,162

312,772

266,997 257,766 253,181231,989

173,801 170,498146,332 132,361 121,948

105,122 94,851

238,203

-

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

Aleppo Rural Damascus

Hama Al -Hasakeh Deir-ez-Zor Ar-Raqqa Lattakia Dar'a Homs Tartous Damascus Quneitra As -Sweida Syria

Sphere standards for hospitals (250,000)


Figure 6: Accessibility status - June 2020

Yes

Hard to access

No

89

9

15

79%

8%

13%

2.3 Special cases

The following public hospitals have been considered as non-functioning, but are providing health services by non-MoH staff with no information available, where data is being collected by cross-border partners:

1. “Idleb National Hospital” in Idleb: partially damaged, providing health services by non-MoH staff since 2015.

2. “Ibn Seina Hospital” in Idleb: partially damaged, providing health services by non-MoH staff since 2015.

Accessibility to public hospitals is defined at three levels:

• Accessible: a hospital is easily accessible for patients and health staff.

• Hard-to-reach: a hospital is hardly reached, due to security situation or long distance.

• Inaccessible: a hospital is not accessible because of the security situation, or a hospital is accessible only to a small fraction of the population, or military people (inaccessible to civilians).

By the end of June 2020, 79% (89) hospitals were reported accessible, 8% (9) hard-to-access, and 13% (15) were inaccessible [Figure 6]. Distribution of public hospitals by accessibility status is presented in Map 4 , while more details are provided at governorate’s level in Figure 7.

3. Accessibility to public hospitals


Figure 7: Accessibilty status of the public hospitals per governorate, June 2020

09

45

312413

1377741

02

11

031

01

00000

44

11

100

31

00000

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

IdlebAleppoHamaDar'a

Ar -RaqqaDamascus

Al -HasakehHoms

Rural DamascusLattakiaTartous

Deir -ez-ZorAs-Sweida

Quneitra

Yes Hard to access No

Map 4: Accessibility to public hospitals [MoH & MoHE], June 2020

Trend analysis on accessibility to public hospitals [MoH & MoHE] from January to June 2020, is presented

in Figure 8.


Figure 8: Trend analysis of accessibility to public hospitals, January to June 2020

89 89 88 87 88 89

9 9 10 11 10 9

15 15 15 15 15 15

0

20

40

60

80

100


Yes Hard to access No

Figure 9: level of damage - June 2020

4. Infrastructure patterns of the public hospitals

Fully damaged

Partially damaged

Not damaged

11

38

6457% 33%

10%

The following sub-sections provide analysis on the infrastructure patterns of the public hospitals, in terms of building condition, inpatient capacity, water sources, availability of ambulances, and electricity generators, all summarized at governorate level.

4.1 Level of damage of the hospitals’ buildings

The level of damage to hospital buildings was measured at three levels: • Fully damaged: either, all the building is destroyed, about 75% or more of the building is destroyed,

or damage of the essential services’ buildings. • Partially damaged: where part of the building is damaged. • Intact: where there is no damage in the building. Analysis of the level of damage provides good indication on the potential costs for reconstruction.

By the end of June 2020, 43% (49) hospitals were reported damaged [10% fully damaged and 33% partially damaged], while 57% (64) of public hospitals were reported intact [Figure 9]. Distribution of public hospitals by level of damage is presented in Map 5, while more details are provided at governorate’s level in Figure 10.


Map 5: Level of Damage of the Hospitals’ buildings, by governorate [MoH & MoHE], June 2020

It is essential to cross-analyze the infrastructural damage of the public hospitals in relation to the functionality status (i.e. provision of services). Some hospitals have resiliently continued to provide services regardless of the level of damage of the building and by optimizing intact parts of the building or in a few cases operating from other neighboring facilities. The national figures translate as follows:

Out of the 38 partially damaged hospitals, 16 hospitals were reported partially functioning and 18 out of service (non-functioning), while 4 hospitals (Ebn Khaldoun Psychiatric hospital in Aleppo, As-Salameyeh National hospital in Hama, As-Suqailbeyeh National hospital in Hama, and Al-Bairouni hospital in Rural Damascus) were reported to be fully functioning providing all services with full staffing capacity.

Out of the 11 fully damaged hospitals, 7 were reported non-functioning while 4 hospitals have opted for innovative ways to continue providing health services to populations in need through partially functioning from other nearby temporary locations and provide health services with limited staff capacity and resources. More details of the 4 hospitals are available in the HeRAMS database.

Then again, hospitals with intact buildings (64 hospitals) does not directly reflect full functionality, only 52 of the 64 intact hospitals are fully functioning, while 10 are partially functioning, and two hospitals are not functioning, due to limited access of patients and health staff to the facilities resulting from the dire security situation as well as critical shortage of supplies.


11 11 11 11 11 11

38 38 38 38 38 38

64 64 64 64 64 64

0

20

40

60

80


Fully damaged Partially damaged Not damaged

0

1

0

5

1

1

2

1

0

0

0

0

0

0

4

5

6

3

7

2

6

1

1

1

2

0

0

0

0

1

1

7

7

3

8

3

3

6

13

7

4

1

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Idleb

Deir -ez-Zor

Dar'a

Aleppo

Rural Damascus

Hama

Homs

Al -Hasakeh

Ar -Raqqa

Lattakia

Damascus

Tartous

As-Sweida

Quneitra

Fully damaged Partially damaged Not damaged

Figure 10: Number and percentage of the public hospitals by level of damage, per governorate, June 2020

Figure 11: Trend analysis of public hospitals’ level of damage, January to June 2020

Trend analysis on condition of the public hospitals (level of damage of the building) from January to June 2020 is presented in Figure 11.

The tables below list the hospitals, which reported fully damaged (buildings), in addition to the list of hospitals that are operating from different location (s) given that the original building is fully damaged or partially damaged.


Table 1: The list of hospitals with reported fully damaged buildings

Table 2: Special cases of hospitals which reported fully damaged (buildings), and operating partially from other locations

Table 3: Special cases of hospitals which reported partially damaged (buildings), and operating partially (limited provided health services) from other locations

AffiliationDistrictProvinceHospital Name#

MoHDuma Rural DamascusRural Damascus specialized hospital – Duma 1

MoHThe fourthAleppoZahi Azraq general hospital2

MoHE'zazAleppoE'zaz national hospital3

MoHThirdAleppoOphthalmology hospital4

MoHThirdAleppoChildren hospital5

MoHAl-QusayrHomsAl-Qusayr general hospital6

MoHAl-QuabuHomsTaldaw hospital7

MoHMuhardehHamaHelfaya hospital8

MoHAl-HasakehAl-HasakehChildren hospital9

MoHAl-MayadinDeir-ez-ZorModern Medicine hospital10

MoHEThe fourthAleppoAl-Kindi university hospital11

New locationAffiliationConditionTypeDistrictProvinceHospital name#

Ar-Razi hospitalMoHFully damagedGeneralThe fourthAleppoZahi Azraq general hospital1

Ar-Razi hospital + Al-Bassel Heart Institute

MoHFully damagedSpecializedThirdAleppoOphthalmology hospital2

Ar-Razi hospital + Maternity hospital

MoHFully damagedSpecializedThirdAleppoChildren hospital3

New medical center in Al-hasakah

MoHFully damagedSpecializedAl-HasakehAl-HasakehChildren hospital4

New locationAffiliationConditionTypeDistrictProvinceHospital name#

Qara Municipal MoHPartially damaged

GeneralAl-NabakRural Damascus

Al-Bassel-Qara hospital1

Al-Assad hospitalMoHPartially damaged

SpecializedDeir-ez-ZorDeir-ez-ZorChildren and Obstetrics hospital2

Al-Assad hospitalMoHPartially damaged

SpecializedDeir-ez-ZorDeir-ez-ZorAl-Furat hospital3

The information above could guide focused rehabilitation activities for hospitals’ infrastructure, which could improve functionality status of hospitals to reach fully functional level, especially for partially functional hospitals that need small scale of rehabilitation.


Figure 12: Comparison of inpatient capacity (original vs. available) in functional hospitals per governorate, June 2020

Figure 13: Percentage of available number of beds in functional hospital versus the original inpatient capacity, June 2020

2,840

2,203 2,096 1,958

1,186 1,160810 792 720 670 558 410

200

3,246

1,698 1,557 1,631

1,111 998

317

767588 535

232 231 133

DamascusRural Damascus Aleppo Lattakia Tartous Dar'a Deir -ez-Zor Hama Ar -Raqqa Homs As-Sweida Al -Hasakeh Quneitra

Original No. of Beds Available No. of Beds

114%

97% 94%86% 83% 82% 80% 77% 74%

67%56%

42% 39%

84%

Damascus Homs Tartous Hama Rural Damascus

As -Sweida Al -Hasakeh Lattakia Aleppo Quneitra Ar-Raqqa Deir-ez-Zor Dar'a Overall

% of available beds /Total original beds

4.2 Analysis of the inpatient capacity

The inpatient capacity has been analyzed in terms of the total number of beds available in functional hospitals by end of 2020 compared to the original number of beds in these hospitals pre-crisis or the maximum inpatient capacity) [Figure 12].

Reduced inpatient capacity (shortage of beds) was observed in all governorates at varying degrees. This may be correlated to the upsurge in usage of beds in functional hospitals, as direct implication of the crisis on the overstretched public health sector. The number 114% in Damascus illustrates that some hospitals have expanded their operational capacity to meet the increase needs of provision health services. Figure 13 illustrates the proportion of available beds in functional hospitals versus the original inpatient capacity at governorate levels.


Figure 15: Main sources of water, June 2020

Figure 14: number of hospital beds (including ICU)/10,000 Population in public hospitals, June 2020

Main Pipeline, 32, 37%

Main Pipeline

and Well, 44,

51%

Well, 8, 9%

Other, 2, 3%

4.3 Water sources and functionality status

Availability of water sources at public hospitals was assessed using a standard checklist of main types of water sources (i.e., main pipeline, well, or both (main pipeline and well)).

By the end of June 2020 and out of 86 functional public hospitals, 37% (32) are using main pipelines, 9% (8) are mainly using wells, 51% (44) are using both (main pipeline and well), while 3% (2) are using other sources of water [Figure 15].

The lowest percentage (39%) of available beds in functional hospital versus original inpatient capacity is observed in Dar’a governorate, mainly reported from Jassem hospital, Nawa hospital, and the national hospital.

The follow figure shows the number of hospital beds (including ICU)/10,000 Population, given that the benchmark is greater than 10 health staff per 10,000 population (Inter-Agency Standing Committee (IASC) Standards).

The national levels in addition to eight governorates (Hama, Rural Damascus, Al-Hasakeh, Aleppo, Homs, Deir-ez-Zor, Dar’a, and Ar-Raqqa) are below benchmark in [Figure 14].

18

15

14

1312

7

5 5 5

43 3 3

6

0

2

4

6

8

10

12

14

16

18

20

Damascus As -Sweida Lattakia Quneitra Tartous Hama Homs Rural Damascus Al -Hasakeh Aleppo Ar-Raqqa Dar'a Deir-ez-Zor Grand Total

Number of hospital beds (including ICU)/10,000 Population

Inter-Agency Standing Committee (IASC) Standards: 10 hospital beds


Figure 17: Functionality status of the water sources at functional public hospitals, June 2020

14

11

8

7

7

7

5

5

3

2

2

1

1

0

2

3

0

0

0

1

0

1

2

3

0

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Damascus

Aleppo

Homs

Rural Damascus

Lattakia

Tartous

Hama

Dar'a

Deir -ez-Zor

Ar -Raqqa

As -Sweida

Al -Hasakeh

Quneitra

Fully Functioning Partially Functioning

Functionality status of the water sources was measured at three levels; fully functional, partially functional, and not functional. Figure 17, provides details on functionality status of water sources at functional hospitals, (86/113) per governorate.

Figure 16: Distribution of water sources/ types at functional public hospitals, per governorate, June 2020

0

0

0

0

1

2

2

3

3

4

5

5

7

9

5

4

0

2

1

1

12

1

5

2

2

0

0

0

0

1

3

0

0

0

0

1

0

3

0

2

0

0

0

0

0

0

0

0

0

0

0

0

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Aleppo

Hama

Al -Hasakeh

Quneitra

Dar'a

Deir -ez-Zor

Ar -Raqqa

Damascus

As -Sweida

Rural Damascus

Tartous

Homs

Lattakia

Main Pipeline Main Pipeline and Well Well Other

Detailed analysis on distribution of water sources at functional public hospitals is presented at governorate level on [Figure 16].


4.4 Availability of electricity generators

Availability of electricity generators continued to be highly demanded with the current situation, where electricity power is widely disrupted and majority of public hospitals are dependent on generators’ power. Availability of electrical generators at functional hospitals was measured by assessing the functional out of the total existing generators in the hospital.

Figure 18: Hours of availability of electricity (from all sources) on average during the day in functional hospitals, June 2020

24.0

22.2

24.0 24.0 24.0 24.0 24.0 24.0 24.0 24.0

22.3

24.0 24.0

23.7

21.0

21.5

22.0

22.5

23.0

23.5

24.0

24.5

Damascus Rural Damascus Aleppo Lattakia Tartous Homs Hama Al -Hasakeh Deir -ez-Zor Ar -Raqqa Dar'a As-Sweida Quneitra Syria

Figure 19: Percent of hospitals in need for generators out of total functional hospitals, June 2020

100%

64%

50% 50%

40% 40%

33% 33%

20% 20%14%

0% 0%

31%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Quneitra Aleppo Al -Hasakeh As-Sweida Rural Damascus

Hama Deir-ez-Zor Dar'a Damascus Homs Lattakia Tartous Ar -Raqqa Total

The percent of hospitals in need for electricity generators out of the total functional hospital is summarized at governorate level [Figure 19].

31% (27) of functional public hospitals across Syria are in need for electrical generators, mainly reported from 11 governorates: Damascus, Rural Damascus, Aleppo, Lattakia, Homs, Hama, Al-Hasakeh, Deir-ez-Zor, Dar’a, As-Sweida, and Quneitra.


5. Availability of health human resources

Availability and trend of health human resources were analyzed across all public hospitals [MoH & MoHE] considering the following scopes:

• Comparative and trend analysis of medical staff by category (i.e., doctors, nurses, midwives)

• Trend analysis of availability of medical doctors by affiliation; MoH vs. MoHE hospitals

• Trend analysis of availability of medical doctors by gender, per governorate

The proportion between different categories of health staff, among the total functional (fully and partially) MoH and MoHE hospitals (86/113), by the end of June 2020, is as follows: The general practitioner (0.2%) and emergency physician (0.3%) were the lowest proportion of health staff in public hospitals, followed by dentists (0.6%), pharmacists (0.7%), midwives (4.7%), laboratory (5.1%), specialists (12.6%), resident doctors (23.5%), and nurses (52.4%); [Figure 20].

Figure 20: Proportion of health staff in hospitals, June 2020

General Practitioner 0.2%

Specialist12.6%

Emergency Physician 0.3%

Resident Doctor 23.5%

Dentist 0.6%

Nurses52.4%

Laboratory5.1%

Midwives4.7%

Pharmacists 0.7%


Table 4: Availability of human resources of functioning public hospitals, per governorate, June 2020

Oth

ers

Tec

hnic

ians

Uni

vers

ity*

Pha

rmac

ists

Mid

wiv

es

Labo

rato

ry

Nur

ses

Den

tist

Res

iden

t Do

ctor

Em

erge

ncy

Phys

icia

n

Oth

er

Spec

ialis

ts

Neu

rolo

gica

l su

rger

y

Gen

eral

su

rger

y

Ort

hope

dic

su

rger

y

Gen

eral

Pr

actit

ione

r

Gove

rnor

ate

2,9531,324551791513933,720422,676158052053450Damascus

89045713116891381,276456642255312412Rural Damascus

1,054332208159014995131,2725430539303Aleppo

Idleb

1,145501250322431522,571411,20818500850414Lattakia

1,605925246281212382,40932562204201060384Tartous

43772370142341581,6329189162385373113Homs

806736130132391511,5313662112351946304Hama

16114624237402902740623746Al-Hasakeh

296262100109835587330380221Deir-ez-Zor

12111321128152450024622278Ar-Raqqa

23315024548354060730401571Dar'a

58730680494561,0061122211821373As-Sweida

2267011316101093964371320Quneitra

10,5145,9431,7672221,4991,61816,7041807,492983,3107136826859Grand Total

* Health workers in the hospitals who hold university degrees (engineer, law, trade and economics .......)


The availability and level of medical staffing (by category and gender) in public hospitals a, as is summarized at governorate’s level in Map 6. The categories of staff included in the map are: general practitioner, specialists, emergency doctors, resident doctors, dentists.

Map 6: Availability of medical doctors in functional public hospitals, by end of Jun2020, per governorate


5.1 Availability of medical staff by category and affiliation

The availability medical staff in functional public hospitals is analyzed by category [i.e., medical doctors1, nurses, and midwives] and affiliation [MoH vs. MoHE hospitals], as follow:

i. Trend analysis of medical doctors [a total of general practitioner, specialists, emergency doctors, resident doctors, dentists]:

The number of medical doctors in public hospital has slightly increased by 1% in June 2020 (11,846 compared to January 2020 (11,702).

Figure [21] shows the trend analysis of reported medical doctors during 2018 and 2019, in functional public hospitals.

10,37110,185

10,319 10,327 10,317

10,799

11,19611,319 11,286

11,090 11,194

11,484

11,702 11,63611,370 11,355

11,53711,846

9,000

9,500

10,000

10,500

11,000

11,500

12,000

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

2019 2020

Figure 21: Trend analysis of number of doctors (a total of general practitioner, specialists, emergency physicians, resident doctors, and dentists) in public hospitals during 2019 and 2020

ii. Trend analysis of nurses:

The number of nurses in public hospital has slightly increased by 1% in June 2020 (16,704), compared to January 2020 (16,484).

Figure [22] shows trend analysis for the reported number of nurses during 2019 and 2020.


Figure 22: Trend analysis of number of nurses in public hospitals during 2019 and 2020

16,16016,389

16,323

16,243

16,509

16,767

16,880

16,72616,643

16,899

16,769

16,618

16,48416,547

16,443

16,247

16,350

16,704

16,000

16,100

16,200

16,300

16,400

16,500

16,600

16,700

16,800

16,900

17,000


2019 2020

Figure 23: Trend analysis of number of midwives in public hospitals during 2019 and 2020

1,478

1,5081,515

1,490

1,5371,545 1,542 1,544

1,510

1,519

1,540 1,541

1,534 1,536 1,537

1,522 1,523

1,499

1,460

1,470

1,480

1,490

1,500

1,510

1,520

1,530

1,540

1,550


2019 2020

iii. Trend analysis of midwives:

The number of midwives in public hospital has slightly decreased by 2% in June 2020 (1,499), compared to January 2020 (1,534).

Figure [23] shows trend analysis for the reported number of midwives during 2019 and 2020.


Figure 24: Proportions and numbers of key staff work in MoH vs. MoHE hospitals, June 2020

583,223

95

5,224151 12,728 1,308 1,291

1 3

2,26829 3,976 310 208

0%10%20%30%40%50%60%70%80%90%

100%

General Practitioner

Specialist Emergency Physician

Resident Doctor

Dentist Nurses Laboratory Midwives

MoHE

MoH

However, MoHE hospitals are located in four governorates (Damascus, Rural Damascus, Aleppo, and Lattakia), they serve the whole country. A comparison between the total available medical-related staff in MoH vs. MoHE hospitals is shown in [Figure 25].

5.2 Availability of medical doctors by affiliation (MoH vs. MoHE hospitals)

Analysis of proportions of medical doctors [general practitioner, specialists, emergency physician, resident doctors, dentists] working at MoHE hospitals versus MoH hospitals in June 2020 has shown that 26% (3,095) of medical doctors (general practitioner, specialists, emergency physician, resident doctors, dentists) work in MoHE, while 74% (8,751) are in MoH hospitals.

2% out of total general practitioner (59) work in public hospitals are in MoHE hospitals; 20% out of total specialists (4,017) work in public hospitals are in MoHE hospitals; 3% out of total emergency physician (98) work in public hospitals are in MoHE hospitals; 30% out of total resident doctors (7,492) are in MoHE hospitals; 16% out of total dentist (180) work in public hospitals are in MoHE hospitals and 23% out of total the nurses & midwives (18,203) are in MoHE hospitals. Details on proportions and numbers of key staff work in MoH vs. MoHE hospitals, by end of June 2020, are presented in [Figure 24].


Figure 26: Number of nurses and midwives per doctor in public hospitals, June 2020

8.0

4.1

3.6 3.53.1

2.2 2.1

1.6 1.6 1.51.1

0.90.6

1.5

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

Deir-ez-Zor As -Sweida Dar'a Homs Ar-Raqqa Tartous Al -Hasakeh Hama Rural Damascus Lattakia Damascus Quneitra Aleppo Grand Total

Number of nurses and midwives per doctor

MoH benchmark (2)

The follow figure shows the number of nurses and midwives per doctor, given that the benchmark is at least 2 nurses and midwives for each doctor (MoH, 2011).

The national levels in addition to six governorates (Hama, Rural Damascus, Lattakia, Damascus, Quneitra, and Aleppo) are below or equal benchmark in [Figure 26].

The follow figure shows the number of health staff (doctors, nurses and midwives) per 10,000 population, given that the benchmark is greater than 22 health staff per 10,000 population (Inter-Agency Standing Committee (IASC) Standards).

The national levels in addition to eight governorates (Hama, Homs, Deir-ez-Zor, Rural Damascus, Aleppo, Dar’a, Al-Hasakeh, and Ar-Raqqa) are below or equal benchmark in [Figure 27].

Figure 25: Comparison of the medical staff of MoH vs. MoHE hospitals, June 2020

0 11

3 4 0 1 0 0

52

8

22

7

27

0 49

2

39

5

58 2

34

10

7

15

4 5 15

0 0 0 3

1,7

70

49

2

52

8 66

4 90

6

74

74

4

54

4

23

2 3 33

19

2 0 8

1,4

78

95

4

58

9

1,5

21

2,2

42

32

2

36

2

1,0

50

54 89

59 16

3

97

0 31 80

0

500

1,000

1,500

2,000

2,500

Damascus Rural Damascus Aleppo Lattakia Damascus Rural Damascus Aleppo Lattakia

MoH MoHE

General Practitioner Specialist Emergency Physician Resident Doctor Dentist Nurses Midwives Pharmacists


Figure 27: number of health staff (doctors, nurses and midwives) per 10,000 population in public hospitals, June 2020

Figure 28: Proportion of Doctors (a total of Specialists, Emergency Physicians, Resident Doctors, Dentists), by gender, per governorate, June 2020

2263 520 987 1090 713 325 677 9856

72

76176

83

1393 351 800 780 433 213 432 6027

15

5192

63

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Aleppo Lattakia Tartous Homs Hama Al -Hasakeh Deir-ez-Zor Ar-Raqqa Dar'a As -Sweida Quneitra

Male Female

5.3 Availability of medical doctors by gender (MoH vs. MoHE hospitals)

By analyzing the proportion of male to female doctors (a total of: general practitioner, specialists, emergency physician, resident doctors, dentists), lowest proportions are seen in Ar-Raqqa governorate (24%). [Figure 28].

20.0

12.415.4

7.1

13.9

8.33.7

1.1 2.8 4.51.2 1.3 1.5

5.8

20.3

26.0 21.1

26.510.4

11.5

11.2

7.3 4.1 2.4

4.0 3.5 2.8

8.2

0.81.3

2.0

2.5

1.5

1.8

1.6

1.40.3 0.2

0.5 0.4 0.4

0.7

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

Damascus Tartous Lattakia As -Sweida Quneitra Hama Homs Deir-ez-Zor Rural Damascus Aleppo Dar'a Ar-Raqqa Al -Hasakeh Grand Total

Health Staff /10,000 Population

Doctors Nurses Midwives

Inter-Agency Standing Committee (IASC) Standards: health staff > 22


Figure 29: Percentage of functioning public hospitals without medical staff (gaps), June 2020

65.1

65.1

61.6

30.2

16.3

1.2

.0

0 10 20 30 40 50 60 70 80 90 100

Practitioner

Dentist

Emergency Physician

Midwives

Resident Doctor

Specialist Doctor

Nurses


Figure 30: Availability of health services in the functional public hospitals, June 2020

30%

32%

56%

60%

60%

63%

65%

65%

72%

73%

74%

76%

77%

78%

79%

82%

86%

86%

87%

89%

93%

93%

94%

94%

94%

Cancer treatment services

Management of severe acute malnutrition with complications

Rehabilitation services

Medical evacuation

Acute psychiatric inpatient unit

Comprehensive abortion care

Waste management

Management of children diseases

(CEmOC) Comprehensive emergency obstetric care

Treatment of diabetic complications

Communicable diseases services

Burn patient management

Trauma services

Emergency surgery

End Stage Kidney Disease (ESKD) treatment

Cardiovascular services

ICU services

Blood bank service

Management of diabetes

Hypertension services

Elective surgery

Sanitation availability

Emergency services

Imaging service

Safe water availability

**Detailed information on availability of services per governorate is available in the HeRAMS database.

The workload and utilization of the health services were analyzed in terms of the total estimated serviced people in all functional public hospitals during January and June 2020 per governorate [Figure 31]. In 2020, the total estimated caseload in functional public hospitals is 2,945,140.

6. Availability and utilization of the health services

The availability of core healthcare services is monitored through HeRAMS at hospital’s level, considering a standard list of health services (including: General Clinical Services, Surgical and Trauma care, Child Health, Nutrition, Maternal & Newborn Health, Communicable Diseases, Non-communicable Diseases, and Mental Health).

Analysis of availability of health services has been conducted across all functional public hospitals [MoH & MoHE]: (86/113). As a result of disrupted healthcare delivery and non-functionality of hospitals, limited provision of health services was observed across governorates, even within functional hospitals [Figure 30].


Figure 31: Estimated caseload of functional public hospitals (outpatient consultations and emergency cases), January to June 2020

556,560

387,398348,336

318,361 308,840

248,940207,227

133,531 118,639 117,858 116,429

55,01028,011

0

100,000

200,000

300,000

400,000

500,000

600,000

Damascus Lattakia Homs Aleppo Tartous Hama Rural Damascus

Ar-Raqqa Dar'a Al -Hasakeh As -Sweida Deir-ez-Zor Quneitra

621,035 639,985 666,941623,091

571,808615,054

718,432

616,927651,993 656,810

592,783 591,390 610,267 613,503

501,222

277,122

358,035

584,991

200,000

300,000

400,000

500,000

600,000

700,000

800,000

Jan 2019 Feb 2019 Mar 2019

Apr 2019 May 2019

Jun 2019 Jul 2019 Aug 2019

Sep 2019 Oct 2019 Nov 2019

Dec 2019

Jan 2020 Feb 2020 Mar 2020

Apr 2020 May 2020

Jun 2020

Estimated caseload

Figure 32: Trend analysis of estimated caseload in public hospitals, January 2019 to June 2020

Most of healthcare services had a remarkable drop in April 2020; due to lockdown as part of COVID-19 response and then got back to previous level.

The proportion of workload of functional hospitals per governorate is provided on Figure 31.

Detailed analysis on utilization of the core health services is provided on the following sub-sections, including:

1. General Clinical Services (Outpatient, Inpatient, Laboratory, Blood bank services, Imaging services)2. Surgical and Trauma care 3. Maternal health services [normal deliveries, caesarean sections, and CEmOC]4. Nutrition 5. Child Health6. Communicable diseases7. Non-communicable diseases8. Mental Health


Damascus19%

Lattakia13%

Homs12%

Aleppo11%

Tartous10%

Hama8%

Rural Damascus7%

Ar-Raqqa5%

Dar'a4%

Al -Hasakeh4%

As-Sweida4%

Deir -ez-Zor2%

Quneitra1%

Figure 33: Proportions of workload during 2020, per governorate

Figure 34: The number of Outpatient and Inpatient in public hospitals, June 2020

78,486

40,463 37,13433,087 29,800

23,97819,566

15,4819,720

6,239 4,504 3,383 2,811

11,6096,704 4,713 5,912 7,596 9,202 10,456

1,978 1,9655,295 3,016 2,362 786

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

Damascus Lattakia Homs Aleppo Tartous Hama Rural Damascus

Ar-Raqqa Deir-ez-Zor As -Sweida Dar'a Al -Hasakeh Quneitra

Outpatient services Inpatients services

6.1 General clinical services

The following sections provide analysis on the utilization of health services in functional public hospitals at governorate level.

i. Outpatient and inpatient

The number of outpatients to inpatients was assessed at a hospital level, and the total numbers reported in December 2019 were summarized and analyzed at governorate level [Figure 34].


Figure 35: Trend analysis of outpatient and Inpatient in public hospitals, January 2019 to June 2020

299,928332,437 339,352

319,570

269,881302,713

385,016

283,295

335,992 337,732297,979 295,934 307,513 307,667

242,832

92,187134,399

304,652

75,695 74,028 76,116 75,215 71,857 77,734 88,560 77,537 80,129 76,002 67,685 70,628 71,466 69,988 62,710 45,788 49,43071,594

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

450,000

Jan 2019 Feb 2019 Mar 2019 Apr 2019 May 2019 Jun 2019 Jul 2019 Aug 2019 Sep 2019 Oct 2019 Nov 2019 Dec 2019 Jan 2020 Feb 2020 Mar 2020 Apr 2020 May 2020 Jun 2020

Outpatient services Inpatients services

Trend analysis of total reported numbers of outpatient and Inpatient from functional public hospitals [MoH & MoHE], for six months (January to June 2020), is presented in [Figure 35]. In 2020, the total reported outpatients are 1,389,250 while the inpatients are 370,976.

Figure 36: The number of patients received services in laboratories, blood bank, and imaging services in public hospitals, June 2020

548,259

136,567

197,091

287,473

236,273

87,843

214,824

17,446

30,182

14,678

32,133

72,391

12,098

5,228

939

1,477

2,546

1,108

937

3,120

524

240

257

278

493

141

45,457

12,769

33,914

24,849

29,053

16,623

25,650

8,639

4,348

3,417

9,633

9,189

2,793

0

100,000

200,000

300,000

400,000

500,000

600,000



Laboratory services Blood bank service Imaging service

ii. Laboratories, blood bank, and imaging services

The number of patients received services in hospitals’ laboratories, blood bank, and imaging departments was assessed at a hospital level, and the total number of cases from January to June 2020 analyzed at governorate level [Figure 36].

Trend analysis of number of patients received services in hospitals’ blood banks and imaging departments, from January to June 2020, is presented in [Figure 37]. In 2020, the total reported patients received services in blood banks are 93,948 [of note: the total number of blood bags and products in 2020 are 169,116], while patients received imaging services are 1,192,563 [of note: the total performed service (X-Ray, MRI, and CT Scan pictures) in 2020 are 1,495,680].


Figure 37: Trend analysis of number of patients received services in blood banks and imaging services in public hospitals, January 2019 to June 2020

17,603 17,076 17,614 17,669 17,467 18,970 18,023 18,896 17,128 15,954 15,935 16,549 17,673 18,099 15,209 12,246 13,43317,288

31,154 32,386 32,412 33,898 34,467 33,163 34,606 31,828 31,363 30,902 28,550 31,118 31,973 32,458 29,941 22,196 23,918 28,630

238,820 238,596 252,011233,370 218,780 221,219

257,383233,577

254,295 262,962235,441

303,905

230,587 247,115

201,362

127,510159,655

226,334

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

Jan 2019 Feb 2019 Mar 2019 Apr 2019 May 2019

Jun 2019 Jul 2019 Aug 2019

Sep 2019 Oct 2019 Nov 2019

Dec 2019 Jan 2020 Feb 2020 Mar 2020 Apr 2020 May 2020

Jun 2020

Blood bank service Blood bags and products Imaging service

1,846,3211,872,7401,976,1871,924,265

1,714,390

1,878,963

2,112,496

1,869,0671,990,5161,931,187

1,837,2131,937,965

1,873,8311,839,575

1,570,613

1,057,7161,209,226

1,887,258

1,000,000

1,200,000

1,400,000

1,600,000

1,800,000

2,000,000

2,200,000

Jan 2019 Feb 2019 Mar 2019 Apr 2019 May 2019

Jun 2019 Jul 2019 Aug 2019 Sep 2019 Oct 2019 Nov 2019 Dec 2019 Jan 2020 Feb 2020 Mar 2020 Apr 2020 May 2020

Jun 2020

Laboratory services

6.2 Surgical and trauma care

The surgical and trauma care services is assessed at hospitals’ level. Descriptive analysis is conducted at governorate’s level for the number of reported emergency cases, and surgeries (elective and emergency).

iii. Emergency cases reported in emergency departments

Figure 38 presents the total number of cases in emergency departments, reported during December 2019 from functional public hospitals at governorate level.

Figure 38: The number of reported cases in emergency department in public hospitals, June 2020

44,705

37,048

31,194 29,814 28,37424,972

17,967 16,352 15,852 15,84712,935

3,052 1,940

05,000

10,00015,00020,00025,00030,00035,00040,00045,00050,000

Damascus Lattakia Tartous Aleppo Homs Hama Dar'a As -Sweida Al -Hasakeh Rural Damascus

Ar-Raqqa Quneitra Deir-ez-Zor


Figure 39: Trend analysis of number of reported cases in emergency department in public hospitals, January 2019 to June 2020

320,368306,689

326,739

302,873 301,476312,053

332,815 333,126315,282 318,284

294,167 294,678301,901 305,107

257,725

184,790

223,296

280,052

180,000

200,000

220,000

240,000

260,000

280,000

300,000

320,000

340,000

360,000

Jan 2019

Feb 2019

Mar 2019

Apr 2019

May 2019

Jun 2019

Jul 2019

Aug 2019

Sep 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Feb 2020

Mar 2020

Apr 2020

May 2020

Jun 2020

Emergency services

Trend analysis of total number of cases in emergency departments in functional public hospitals [MoH & MoHE], from January to June 2020, is presented in [Figure 39]. In 2020, the total number of cases in emergency departments are 1,552,871.

iv. Emergency and elective surgeries

The number of emergency surgeries to elective surgeries was assessed at a hospital level, and total numbers were summarized and analyzed at governorate level [Figure 40].

During June 2020, the highest workload of elective surgeries is reported from Al-Assad university hospital in Damascus (1,126), followed by Tishreen university hospital in Lattakia (810), Damascus MoH Hospital (Al-Mojtahid (791), Hama national hospital (719), Dermatology and Venereology university hospital in Damascus (716), Al-Mouwasat university hospital (690) in Damascus, Ar-Razi MoH hospital in Aleppo (640), Children university hospital in Damascus (622), and Al-Bassel Heart Institute in Damascus (510).

While the highest workload of emergency surgeries is reported from Al-Bassel hospital in Tartous (2,002), followed by National hospital in Lattakia (892), National hospital in Ar-Raqqa (442), Zaid Ash-Shariti hospital in As-Sweida (440), Al-Mouwasat MoHE hospital (359), Hama national hospital (310), Tishreen university hospital in Lattakia (281), Aleppo university hospital (251), Damascus MoH Hospital (Al-Mojtahid (220)).


Figure 40: The number of emergency surgeries vs. elective surgeries in public hospitals, June 2020

5,516

1,867 1,7351,344 1,343

1,106757 591 501 499 275 144 65

844535

1,341795

111

2,356

166458

156481

131 109 160

1,000

2,000

3,000

4,000

5,000

6,000

Damascus Aleppo Lattakia Hama Homs Tartous Rural Damascus

Ar-Raqqa Dar'a As -Sweida Al -Hasakeh Quneitra Deir-ez-Zor

Elective surgery Emergency surgery

By analyzing the percent of total emergency surgeries to elective surgeries during June 2020, the highest percent across different governorates is reported in Tartous, As-Sweida, Ar-Raqqa, and Lattakia governorates.

Across all reported functional public hospitals, 32% of surgeries are emergency while 68% are elective [Figure 41].

Trend analysis of total number of elective and emergency surgeries reported in functional public hospitals [MoH & MoHE], from January to June 2020 is presented in Figure 42. In 2020, the total reported emergency surgeries are 42,459 while the elective surgeries are 67,588.

8% 13% 18% 20% 22% 24%32% 37% 43% 44% 44% 49%

68%

32%

92% 87% 82% 80% 78% 76%68% 63% 57% 56% 56% 51%

32%

68%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Homs Damascus Rural Damascus

Deir-ez-Zor Aleppo Dar'a Al -Hasakeh Hama Quneitra Lattakia Ar-Raqqa As -Sweida Tartous Total

% Emergency surgery % Elective surgery

Figure 41: Percentage of total emergency surgeries to elective surgeries in public hospitals per governorate, June 2020


6,546 6,601 7,243 7,016 7,958 7,870 7,911 8,124 8,048 7,690 7,307 7,546 7,382 7,683 7,6805,499

6,716 7,499

15,094 15,46116,791 16,609

14,483 14,574

20,535

15,554

19,216 18,830

15,652 15,941 15,050 14,560

11,977

4,2775,981

15,743

0

5,000

10,000

15,000

20,000

25,000

Jan 2019

Feb 2019

Mar 2019

Apr 2019

May 2019

Jun 2019

Jul 2019

Aug 2019

Sep 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Feb 2020

Mar 2020

Apr 2020

May 2020

Jun 2020

Emergency surgery Elective surgery

Figure 42: Trend analysis of number of patients received emergency surgeries and elective surgeries in public hospitals, January 2019 to June 2020

With note that increasing of the number if elective surgeries during June 2020 was due to desire of people to perform elective surgeries after the month of fasting in Ramadan (May 2020).


Figure 43: The number of patients received ICU services in public hospitals, June 2020

Figure 44: Trend analysis of number of patients received ICU services in public hospitals, January 2019 to June 2020

1,304

944

724 704

515416

323 314197 147 142

75 67

0

200

400

600

800

1,000

1,200

1,400

Damascus Hama Aleppo Lattakia Homs As -Sweida Ar-Raqqa Tartous Dar'a Rural Damascus

Quneitra Deir-ez-Zor Al -Hasakeh

6,569

5,9006,253

5,839 5,875 5,9806,372

5,773 5,9816,224

5,908 5,9706,214 6,203

5,328

3,672

4,635

5,872

3,0003,5004,0004,5005,0005,5006,0006,5007,000

Jan 2019

Feb 2019

Mar 2019

Apr 2019

May 2019

Jun 2019

Jul 2019

Aug 2019

Sep 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Feb 2020

Mar 2020

Apr 2020

May 2020

Jun 2020

ICU services

v. ICU services

Figure 43 presents the total number of patients received ICU services reported during June 2020 from functional public hospitals at governorate level.

Trend analysis of total number of patients received ICU services reported in functional public hospitals [MoH & MoHE], from January to June 2020 is presented in Figure 44. In 2020, the total reported total number of patients received ICU services are 31,924.


Figure 45: The number of patients received trauma services in public hospitals, June 2020

2,552

2,147

465 458300 241 156 121 60 57 36 21 21

0

500

1,000

1,500

2,000

2,500

3,000

Hama Damascus Aleppo Homs Dar'a Lattakia Ar-Raqqa Rural Damascus

Tartous As -Sweida Al -Hasakeh Deir-ez-Zor Quneitra

vi. Trauma services

Figure 45 presents the total number of patients received Orthopaedic/trauma ward for advanced orthopaedic care reported during June 2020 from functional public hospitals at governorate level.

Trend analysis of total number of patients received trauma services reported in functional public hospitals [MoH & MoHE], from January to June 2020 is presented in Figure 46. In 2020, the total reported total number of patients received trauma services are 34,481.

Figure 46: Trend analysis of number of patients received trauma services in public hospitals, January 2019 to June 2020

6,031 6,098

7,322 7,1396,776

7,115

8,452

7,521

8,9698,187

7,746

6,122 6,1836,609

6,003

3,850

5,201

6,635

3,500

4,500

5,500

6,500

7,500

8,500

9,500

Jan 2019

Feb 2019

Mar 2019

Apr 2019

May 2019

Jun 2019

Jul 2019

Aug 2019

Sep 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Feb 2020

Mar 2020

Apr 2020

May 2020

Jun 2020

Trauma services


Figure 48: Trend analysis of number of patients received burn patient management in public hospitals, January 2019 to June 2020

1,3141,403

1,240

1,076 1,131

1,380

1,1441,223 1,201 1,248

851

1,0601,163

1,310

1,026

833964

1,568

500

700

900

1,100

1,300

1,500

1,700

Jan 2019

Feb 2019

Mar 2019

Apr 2019

May 2019

Jun 2019

Jul 2019

Aug 2019

Sep 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Feb 2020

Mar 2020

Apr 2020

May 2020

Jun 2020

Burn patient management

Figure 47: The number of patients received burn patient management in public hospitals, June 2020

629

353

186113 87

53 40 34 28 25 10 7 3

0

100

200

300

400

500

600

700

Ar-Raqqa Tartous Homs Dar'a Damascus Al -Hasakeh Aleppo Lattakia Hama Deir-ez-Zor Quneitra As -Sweida Rural Damascus

vii. Burn patient management

Figure 47 presents the total number of patients received burn patient management reported during June 2020 from functional public hospitals at governorate level.

Trend analysis of total number of patients received burn patient management reported in functional public hospitals [MoH & MoHE], from January to June 2020 is presented in Figure 48. In 2020, the total reported total number of patients received burn patient management are 6,864.


Figure 49: Number of functioning hospitals providing CEmONC services/ 500,000 Population, June 2020

4.8

4.0

2.92.7

2.4

2.1

1.5 1.5 1.4

1.1

0.70.5

0.3

1.2

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

Quneitra As -Sweida Dar'a Tartous Homs Lattakia Hama Al -Hasakeh Ar-Raqqa Rural Damascus Deir-ez-Zor Damascus Aleppo Grand Total

Number of functioing hospitals providing CEmONC Services/ 500,000 Population

Inter-Agency Standing Committee (IASC) Standards: 1 hospital

6.3 Maternal health services

Analysis of availability and utilization of maternal health services was conducted considering three scopes:• Number of functioning hospitals providing CEmONC services/ 500,000 Population, June 2020• Utilization of service (caesarean sections (CS) vs. normal deliveries); June 2020 summary figures by

governorate• Percentage of CSs to normal deliveries, June 2020• Trend analysis of the monthly normal deliveries vs. caesarean sections, January to June 202

i. Number of functioning hospitals providing CEmONC services/ 500,000 Population

The follow figure shows the number of functioning hospitals providing (CEmOC) Comprehensive Emergency Obstetric Care (i.e., BEOC + caesarean section + safe blood transfusion) services/ 500,000 Population, given that the benchmark is at least 1 hospital providing CEmONC services (Inter-Agency Standing Committee (IASC) Standards).

Three governorates (Deir-ez-Zor, Damascus, and Aleppo) are below benchmark in [Figure 49].

ii. Utilization of service (caesarean sections vs. normal deliveries)

The numbers of caesarean sections performed at public hospitals (in June 2020) versus the normal deliveries have been analysed at governorates’ level [Figure 50].

The highest numbers are reported from Obstetrics and Gynecology MoHE hospital in Damascus [normal deliveries are 409 while CSs are 513], followed by Az-Zahrawy hospital in Damascus [normal deliveries are 530 while CSs are 205], Gynecology MoHE Hospital in Aleppo [normal deliveries are 340 while CSs are 296], Ath-Thawrah National hospital in Ar-Raqaa [normal deliveries are 349 while CSs are 139], Al-Assad hospital in Hama [normal deliveries are 285 while CSs are 178], Maternity hospital in Ar-Raqaa [normal deliveries are 290 while CSs are 155], and Maternity hospital in Aleppo [normal deliveries are 245 while CSs are 111].


Figure 51: Percentage of caesarean sections to normal deliveries in public hospitals, June 2020

35% 35%46% 48% 48% 52% 55% 57% 59% 62% 65% 68% 68%

54%

65% 65%54% 52% 52% 48% 45% 43% 41% 38% 35% 32% 32%

46%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Tartous Lattakia Homs Hama Deir -ez-Zor Rural Damascus

As-Sweida Damascus Aleppo Quneitra Al -Hasakeh Dar'a Ar-Raqqa Total

CSs % Normal deliveries %

939

639585

465 437

314253 251 220 196

158 141 130

718

294

407

508

207

295

138

290

408

162

296

15480

0

100

200

300

400

500

600

700

800

900

1,000

Damascus Ar-Raqqa Aleppo Hama Dar'a Rural Damascus

Al -Hasakeh Homs Lattakia As-Sweida Tartous Deir -ez-Zor Quneitra

Normal deliveries CSs

Figure 50: The No. of normal deliveries and caesarean sections (CSs) performed at public hospitals, June 2020

iii. Percentage of CS to normal deliveries

The highest figures of caesarian sections in June 2020 are reported in Deir-ez-Zor (154 CSs compared to 141 normal deliveries), Lattakia (408 CSs compared to 220 normal deliveries), Homs (290 CSs compared to 251 normal deliveries), Hama (508 CSs compared to 465 normal deliveries), and Tartous (296 CSs compared to 158 normal deliveries).

Across all reported functional hospitals in June 2020, 46% (3,957) of deliveries are CSs while 54% (4,728) are normal deliveries. Details on percent of CSs to normal deliveries per governorate in June 2020, is provided in [Figure 51].


530

314245

110

409340

110

205

295

111

336

513

296

72

0

100

200

300

400

500

600

Damascus Rural Damascus Aleppo Lattakia Damascus Rural Damascus Aleppo Lattakia

MoH Hospitals MoHE Hospitals

Normal_deliveries CSs

7,027

6,372 6,5526,227

5,824 5,819 6,0116,429

5,8915,368

4,8815,303 5,225

4,9234,507

4,1314,499

4,7285,187

4,6614,995

4,608 4,483 4,4714,742

4,458 4,430 4,3293,981

4,247 4,1793,720

4,0133,564 3,506

3,957

3,0003,5004,0004,5005,0005,5006,0006,5007,0007,500

Normal deliveries CSs

Jan 2019

Feb 2019

Mar 2019

Apr 2019

May 2019

Jun 2019

Jul 2019

Aug 2019

Sep 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Feb 2020

Mar 2020

Apr 2020

May 2020

Jun 2020

Figure 52: Trend analysis of the monthly numbers of normal deliveries vs. caesarean sections in public hospitals, January 2019 to June 2020

Figure 53: Comparison of MoH & MoHE hospitals workload of normal deliveries vs, CSs, June 2020

iv. Comparison of MoH and MoHE hospitals workload of normal deliveries vs. CSs:

Trend analysis of the monthly numbers of normal deliveries vs. caesarean sections reported from the MoH & MoHE hospitals, from January to June 2020 is shown in Figure 52. In 2020, the total reported normal deliveries are 28,013 while the caesarean sections are 22,939.

v. Comparison of MoH and MoHE hospitals workload of normal deliveries vs. CSs:

Comparison analysis between MoH and MoHE hospitals that provide Obstetrics & Gynecology services across four governorates is shown in [Figure 53].


626 600

265

160

69 58 28 12 7 5 20

100

200

300

400

500

600

700

Hama Rural Damascus

Damascus Homs Aleppo Lattakia As -Sweida Tartous Quneitra Dar'a Al -Hasakeh Deir-ez-Zor Ar-Raqqa

3,8083,536 3,521

3,206 3,149

3,595 3,514

3,176 3,246

2,8132,652

3,257 3,1973,326

2,627

1,667

2,163

1,832

1,500

2,000

2,500

3,000

3,500

4,000

Jan 2019

Feb 2019

Mar 2019

Apr 2019

May 2019

Jun 2019

Jul 2019

Aug 2019

Sep 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Feb 2020

Mar 2020

Apr 2020

May 2020

Jun 2020

Management of children diseases

Figure 54: Number of children with severe diseases in public hospitals, June 2020

Figure 55: Trend analysis of reported cases of severe children diseases in public hospitals, January 2019 to June 2020

6.4 Child health

Management of severe children diseases (such as acute respiratory diseases, Meningitis, blood diseases cancer, etc…) are assessed at hospitals level. Figure 54 shows the distribution of total reported cases of management of children classified with severe or very severe diseases (parenteral fluids and drugs, oxygen) by governorate.

The high reported figures in Hama, Rural Damascus, Damascus, Homs, and Aleppo are due to the high numbers of IDPs, and also availability of MoHE referral hospitals for children in some of these areas.

Trend analysis of reported cases of severe children diseases from January to June 2020, is presented in [Figure 55]. In 2020, the total reported cases of severe children diseases are 14,812.


38

30

2018

1210

7 7 7 63 2 1

0

5

10

15

20

25

30

35

40

Deir-ez-Zor Aleppo Lattakia Hama Dar'a Al -Hasakeh Damascus Ar-Raqqa As -Sweida Homs Tartous Rural Damascus

Quneitra

7383

69

93 96

123135

86 92 9587 88 86

67 71 77

104

161

0

20

40

60

80

100

120

140

160

180

Jan 2019

Feb 2019

Mar 2019

Apr 2019

May 2019

Jun 2019

Jul 2019

Aug 2019

Sep 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Feb 2020

Mar 2020

Apr 2020

May 2020

Jun 2020

Management of severe acute malnutrition with complications

Figure 56: The number of children with severe acute malnutrition with complications in public hospitals, June 2020

Figure 57: Trend analysis of number of children with severe acute malnutrition with complications in public hospitals, January 2019 to June 2020

6.5 Nutrition

Monitoring of cases in stabilization centre for the management of severe acute malnutrition with medical complications, with availability of ready-to-use therapeutic foods and dedicated trained team of doctors, nurses, and nurse aids, 24/7 is systematically conducted at public hospitals level; Figure 56 demonstrates the number of cases reported in June 2020, at governorate level.

The high reported figures in Deir-ez-Zor , Aleppo , Lattakia, Hama, and Dar’a, due to the high numbers of IDPs.

Trend analysis of reported cases of severe acute malnutrition from January to June 2020, is presented in [Figure 57]. In 2020, the total reported children with severe acute malnutrition are 566.


841

412315 297 286

12831 27 23 17 13 9 0

0

100

200

300

400

500

600

700

800

900

Hama Aleppo Ar -Raqqa Tartous Damascus Deir -ez-Zor As -Sweida Al -Hasakeh Lattakia Rural Damascus

Dar'a Homs Quneitra

2,5062,692

2,832

2,484

2,2332,113

2,5472,365

2,203 2,2812,070

2,523

2,258

3,109

2,558

1,9061,791

2,399

1,5001,7001,9002,1002,3002,5002,7002,9003,1003,300

Jan 2019

Feb 2019

Mar 2019

Apr 2019

May 2019

Jun 2019

Jul 2019

Aug 2019

Sep 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Feb 2020

Mar 2020

Apr 2020

May 2020

Jun 2020

Communicable diseases services

Figure 59: Trend analysis of number of patients received communicable diseases in public hospitals, January 2019 to June 2020

Figure 58: The number of patients received communicable diseases in public hospitals, January to June 2020

6.6 Communicable diseases services

Management of severe and/or complicated communicable diseases (such as meningitis, measles, SARI, others) are assessed at hospitals level. Figure 58 shows the distribution of total reported cases of communicable diseases services by governorate.

Trend analysis of reported patients received communicable diseases from January to June 2020, is presented in [Figure 59]. In 2020, the total reported patients are 14,021.


467

312

482

1,37

4

472

1,17

4

52 16 358

280 31

2

87 80634

60 354

193

142

192

53 4 0 96 8 15 0630

459

937

2,37

7

486

1,26

0

69 523

89 374

523

343

91

1,94

1

102 2,34

1

3,26

7

519

824

1,09

5

39 33 80 104

477

781,13

6

160

655

690

391

219

449

215

75 334

108

117

30

2,67

3

21,0

76

674

311

415

479

943

0 0 0 0 398

0

2,11

6

75 330

776

471

0 1,51

1

8 100

0 304

321

0

0

5,000

10,000

15,000

20,000

25,000



Management of diabetes Treatment of diabetic complications Hypertension Cardiovascular services End Stage Kidney Disease (ESKD) treatment Cancer Rehabilitation services

Figure 60: The number of NCDs’ consultations in public hospitals, June 2020

6.7 NCDs (non-communicable diseases)

NCDs were assessed through HeRAMS by checking the availability and utilization of services at hospitals level. The majority of high reported figures of NCDs (Diabetes, Treatment of diabetic complications, Hypertension, Cardiovascular, Kidney, and Cancer diseases) are from Damascus hospitals.

Among all NCDs during 2020, Cancer patients’ consultations are the highest reported figures, mainly in Damascus, Rural Damascus (has one cancer specialized hospital). It worth mentioning that cancer is treated at secondary and tertiary levels only, while other NCDs (diabetes and hypertension, etc…) usually managed at primary and secondary care levels, unless patients develop complications.

Cardiovascular consultations are the second highest reported figures during 2020, mainly in Lattakia (has one cardiovascular specialized hospital), Damascus (has two cardiovascular specialized hospitals), and Aleppo (has two cardiovascular specialized hospitals, Homa, Hama, and Tartous [Figure 60]


5,2955,623 5,685 5,643 5,733 5,641

6,356

5,0915,413

4,888 4,6924,346

4,691 4,8414,203

2,642 2,695

5,466

2,035 2,137 2,153 2,1251,735 1,807 1,789 1,637 1,804 2,025 1,811 1,843 1,804 2,045

1,624

596 758

1,751

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

Jan2019

Feb2019

Mar 2019

Apr 2019

May 2019

Jun2019

Jul2019

Aug 2019

Sep2019

Oct2019

Nov 2019

Dec 2019

Jan2020

Feb2020

Mar 2020

Apr 2020

May 2020

Jun2020

Management of diabetes Treatment of diabetic complications

7,591

8,543 8,4968,232

7,7777,516

9,146

8,1328,499

7,9837,652

7,9678,333

9,193

7,735

4,818

5,518

8,161

4,5005,0005,5006,0006,5007,0007,5008,0008,5009,0009,500

Hypertension

Jan2019

Feb2019

Mar 2019

Apr 2019

May 2019

Jun2019

Jul2019

Aug 2019

Sep2019

Oct2019

Nov 2019

Dec 2019

Jan2020

Feb2020

Mar 2020

Apr 2020

May 2020

Jun2020

Figure 61: Trend analysis of total monthly number of NCDs’ consultations reported in public hospitals, January 2019 to June 2020

The monthly trend of reported NCDs’ consultations at functional public hospitals from January to June 2020 is shown in [Figure 61].

In 2020, the total reported NCDs’ consultations are as follow:

• Diabetes: 24,538• Diabetic complications: 8,578• Hypertension: 43,758• Cardiovascular: 52,005• ESKD: 25,320 [of note: the total performed ESKD Sessions in 2017: 184,477]• Cancer: 136,550


4,190

3,9634,049 4,089

4,1774,041 4,094

4,1824,252

4,120

4,855 4,883

4,226 4,2564,164

4,0064,089

4,579

3,500

3,700

3,900

4,100

4,300

4,500

4,700

4,900

5,100

End Stage Kidney Disease (ESKD) treatment

Jan2019

Feb2019

Mar 2019

Apr 2019

May 2019

Jun2019

Jul2019

Aug 2019

Sep2019

Oct2019

Nov 2019

Dec 2019

Jan2020

Feb2020

Mar 2020

Apr 2020

May 2020

Jun2020

18,07217,487

18,47219,132

15,022

17,356

21,242

17,227

22,62523,695

20,16021,033

24,452

22,50321,411

22,240

18,975

26,969

14,000

16,000

18,000

20,000

22,000

24,000

26,000

28,000

Cancer

Jan2019

Feb2019

Mar 2019

Apr 2019

May 2019

Jun2019

Jul2019

Aug 2019

Sep2019

Oct2019

Nov 2019

Dec 2019

Jan2020

Feb2020

Mar 2020

Apr 2020

May 2020

Jun2020

11,66712,211 12,178

11,304

9,8229,288

11,436

9,052

11,55112,032

10,51511,214 11,133

11,605

9,168

3,840

5,359

10,900

3,6004,6005,6006,6007,6008,6009,600

10,60011,60012,60013,600

Cardiovascular services

Jan2019

Feb2019

Mar 2019

Apr 2019

May 2019

Jun2019

Jul2019

Aug 2019

Sep2019

Oct2019

Nov 2019

Dec 2019

Jan2020

Feb2020

Mar 2020

Apr 2020

May 2020

Jun2020


Figure 62: The number of rehabilitation services in public hospitals, June 2020

2,116

1,511

776

471330 321 304

100 75 8 0 0 00

500

1,000

1,500

2,000

2,500

Damascus Hama Lattakia Tartous Aleppo As -Sweida Dar'a Deir-ez-Zor Rural Damascus

Al -Hasakeh Homs Ar-Raqqa Quneitra

6.8 Rehabilitation services

Rehabilitation services and assistive device provision, including post-operative rehabilitation for trauma-related injuries are assessed at hospitals level. Figure 62 shows the distribution of total reported cases of rehabilitation services by governorate.

Trend analysis of reported patients received rehabilitation services from January to June 2020, is presented in [Figure 63]. In 2020, the total reported patients are 30,344.

7,6458,620

7,9807,076 6,864 7,192

9,226

6,336

9,7779,166

7,3656,799

7,4098,183

5,032

1,772 1,936

6,012

0

2,000

4,000

6,000

8,000

10,000

12,000

Rehabilitation services

Jan2019

Feb2019

Mar 2019

Apr 2019

May 2019

Jun2019

Jul2019

Aug 2019

Sep2019

Oct2019

Nov 2019

Dec 2019

Jan2020

Feb2020

Mar 2020

Apr 2020

May 2020

Jun2020

Figure 63: Trend analysis of number of rehabilitation services in public hospitals, January 2019 to June 2020


Figure 64: The number of psychiatric inpatients in public hospitals, June 2020

Figure 65: Trend analysis of number of psychiatric inpatient cases in public hospitals, January 2019 to June 2020

378

286

460 0 0 0 0 0 0 0 0 0

0

100

200

300

400

Rural Damascus

Aleppo Damascus Lattakia Tartous Homs Hama Al -Hasakeh Deir -ez-Zor Ar -Raqqa Dar'a As -Sweida Quneitra

Psychiatric inpatient

782803

816

780

735756 761 750

710697

675 675 664647

680

627 631

710

600

650

700

750

800

850

Jan 2019

Feb 2019

Mar 2019

Apr 2019

May 2019

Jun 2019

Jul 2019

Aug 2019

Sep 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Feb 2020

Mar 2020

Apr 2020

May 2020

Jun 2020

Psychiatric inpatient

6.9 Mental health

Inpatient care for management of mental disorders by specialized health-care providers are assessed at hospitals level. Figure 64 shows the distribution of total reported cases of Psychiatric inpatient by governorate.

The key figures of Psychiatric inpatient during June 2020 are reported from Rural Damascus (Ibn-Sina Psychiatric MoH hospital (366 cases), followed by Aleppo (Ibn-Khaldoun MoH hospital (286 cases).

Trend analysis of monthly reported number of psychiatric inpatients in public hospitals [MoH & MoHE] from January to December 2018 is shown in [Figure 65]. In 2020, the total reported psychiatric inpatients cases are 3,959.


The availability of different types of essential and specialized equipment and supplies was assessed at hospital level, based on a standard checklist2.

In its ninth year of crisis, Syria’s hospitals (have a remarkable improvements) are still suffering from shortages and/or malfunction of medical devices/ equipment to provide secondary care services. In insecure governorates, medical devices are either destroyed, burned, or malfunctioned, while in safe areas the medical devices are overburdened by increased numbers of people (actual numbers of people in the area, in addition to IDPs and patients /injured people from surrounding areas).

Maintenance of malfunctioned devices remains a concern, due to non-availability of spare parts, accredited agent to provide maintenance support, or difficulty of accessibility in many cases.

Analysis of availability of essential and specialized equipment was measured across all functional public hospitals [MoH & MoHE] (86/113), in terms of functional equipment out of the total available equipment in the hospital. The produced analysis provides good indication of the current readiness of the hospitals to provide the health services, and also to guide focused planning for procurement of equipment and machines, to fill-in identified gaps.

Gaps on essential and specialized equipment and machines were observed, even within the functional public hospitals. Further details are provided on [Figure 66] and [Figure 67].

7. Availability of medical equipment

73%

84%

84%

85%

85%

85%

86%

88%

88%

88%

90%

93%

93%

93%

94%

94%

96%

97%

Autoclave

Dry_Sterilizer

Weighing Scale for infants

Ambu bag (Paediatric and Adult)

Fetoscope

Pulse Oximeter

Oxygen Station

Weighing Scale for adults

Operating_tables

Delivery_table

Suction machine

Vaginal examination set

Length Measurement Device

Oxygen cylinders

Weighing Scale for children

Height Measurement Device

Minor Surgical sets

Nebulizer

Figure 66: Percentage of functional essential equipment/ total available equipment in functional public hospitals, June 2020

2 A more detailed list of essential equipment is available upon request.


Figure 67: Percentage of functional specialized equipment/ total available equipment in the functional public hospitals, June 2020

69%

70%

74%

78%

79%

79%

80%

81%

82%

83%

83%

83%

84%

89%

95%

MRI machine

Cardiotocography (Monitoring of fetalheart frequency)

CT Scan

Incubator for new born

Portable X-Ray

X -Ray

Anaesthesia machines

Ventilators – Adult

ECG

Renal Dialysis machine

Ultrasound

Ventilators – Paediatric

DC Shock machine/ Defibrillator

ICU/CCU Monitors

Major surgical sets


Based on the priority medicines list agreed by MoH and WHO, WHO has managed to address the gaps of medicines identified at all levels of health care.

More details on availability of medicines and medical supplies at governorate level are available in HeRAMS database.

17%

23%

27%

27%

31%

35%

42%

46%

46%

59%

62%

65%

66%

67%

69%

70%

73%

74%

76%

78%

78%

80%

81%

83%

91%

91%

Cancer related medicines

Hepatitis vaccine

Tetanus shot

Medicines affecting the blood (anti-anemia medicines, heparin, warfarin, etc.,)

Psychotropic medinas (i.e., antipsychotics, antidepressants, antiepileptic and anxiolytics)

Dermatological preparations/topical (Burns, and anti-infective, etc...)

Antidotes for Poisoning

Specific antibiotics for multi –resistant bacteria/infectious diseases

Delivery related medicines (i.e., Oxytocin , … )

Dialysis consumables

Medicines acting on respiratory system (e.g., medicines of Asthma, H1N1 ARI… like salbutamol …)

Anti -diabetic preparations (especially Insulin)

Anaphylactic shock

Antibiotics for Children

Cardiac and /or Vascular Drugs (Anti -hypertensive Drugs, Diuretics, …)

Gastrointestinal

General Anaesthetics

Albumin

Preoperative medication

Local Anaesthetics

Anti -allergic including Steroids

Antibiotics for Adults

IV Fluid

Analgesics, antipyretics, non -steroidal anti-inflammatory Medicines

Serums

Antiseptics

Figure 68: Availability of medicines and medical supplies for one month in the functional public hospitals, June 2020

Availability of medicines and medical supplies at hospitals’ level was evaluated based on a standard list of identified priority medicines (driven from the national Essential Medicine List), and medical supplies for duration of one month [Figure 68].

8. Availability of medicines & medical supplies


Slight variation of functionality status of public hospitals was observed throughout 2020. For example, 27 hospitals were reportedly out-of-service in June 2020 compared to 28 in January of the same year. Similarly, access to the public hospitals has no changes throughout 2020 with 15 hospitals reportedly non-accessible during 2020. Functionality status of hospitals was highly affected by the dire security situation and limited access by health staff and patients as well as critical shortages of supplies.

Levels of damages of the hospitals’ buildings directly affected the functionality status and provision of health services; however, some hospitals have resiliently continued to provide services regardless of levels of damage to the building and by utilizing intact parts of the building or operating from other neighboring facilities in a few cases. Rehabilitation of the damaged hospitals’ infrastructure, in addition to provision of supplies and medical equipment will significantly improve functionality of hospitals, readiness and provision of essential health services at secondary care level.

Slight improvement of the available number of medical staff (doctors, and nurses) with slight decreasing of the available number of midwives throughout 2020 was observed. However, increased capacity building activities and training courses of the national health staff will help in improving technical capacity of healthcare providers and filling gaps in certain areas.

Limited functionality and accessibility to public hospitals in addition to large displacement of people have greatly overburdened the few functional public hospitals’ resources. Increasing provision of specialized medical machines, as well as medicines and supplies especially for NCDs (such as cancer treatment, as observed the highest consultations among other NCDs) provides an affordable alternative compared to the high cost of healthcare in the private sector.

Furthermore, the crisis aggravated the inequalities among regions, leaving many people deprived of the minimum level of health services. HeRAMS can help in directing the interventions of different players to the most vulnerable groups and those with the greatest needs, and in assessing the efficiency of interventions.

Conducting a qualitative survey on provision of health services from the populations’ point of view and another survey on COVID-19 impact, using HeRAMS data as a baseline, will help in concretely measuring the impact of the crisis and COVID-19 on public health sector in terms of responsiveness of hospitals and quality of provided services.

9. Conclusions and recommendations

Documents

HeRAMS Bi-Annual Report