herams report january - june 2015 · 2015-11-30 · herams report january - june 2015 (public...

HeRAMS Report January - June 2015

(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 2015.

HeRAMS| Public Hospitals Report, Jan to Jun 2015, Health Information Management Unit, WHO, Syrian Arab Republic Page 1 of 35

Table of Contents

Executive summary ............................................................................................................................................ 5

1. Completeness of Hospitals Reporting ........................................................................................................ 7

2. Functionality and accessibility of the Public Hospitals ............................................................................... 7

2.1 Functionality Status of the Public Hospitals ........................................................................................ 7

2.2 Accessibility to public hospitals ........................................................................................................... 9

3. Infrastructure Patterns of the Public Hospitals ........................................................................................ 11

3.1 Level of Damage of the hospitals’ buildings ...................................................................................... 11

3.2 Analysis of the inpatient capacity ...................................................................................................... 14

3.3 Water sources and functionality status ............................................................................................. 15

3.4 Availability of electricity generators .................................................................................................. 16

4. Availability of Health Human Resources .................................................................................................. 17

5. Availability and Utilization of the Health Services .................................................................................... 20

5.1 General Clinical services .................................................................................................................... 21

5.2 Surgical and Trauma care .................................................................................................................. 22

5.3 Maternal health services ................................................................................................................... 24

5.4 Child Health ....................................................................................................................................... 26

5.5 Nutrition ............................................................................................................................................ 27

5.6 NCDs (non-communicable diseases) ................................................................................................. 28

5.7 Mental Health .................................................................................................................................... 29

6. Availability of Medical Equipment ............................................................................................................ 30

7. Availability of Medicines & Medical supplies ........................................................................................... 32

8. Conclusions and Recommendations ........................................................................................................ 34

Cover photo credit: WHO/Syria


List of Figures

Figure 1: Distribution of public hospitals by affiliation, per governorate 7

Figure 2: Functionality Status- June 2015 7

Figure 3: Number and percentage of fully functioning, partially functioning, and non-functioning public hospitals in Syria, June 2015

8

Figure 4: Trend analysis of functionality status of public hospitals, January to June 2015 9

Figure 5: Accessibility status- June 2015 9

Figure 6: Accessibility status of the public hospitals [MoH & MoHE] per governorate, June 2015 9

Figure 7: Trend analysis on accessibility to public hospitals, January to June 2015 10

Figure 8: Level of Damage - June 2015 11

Figure 9: Number and percentage of hospitals [MoH & MoHE] by level of damage, June 2015 12

Figure 10: Trend analysis of public hospitals’ level of damage, January to June 2015 12

Figure 11: The number of emergency beds vs., total number of beds in functional hospitals [MoH & MoHE], per governorate, June 2015

14

Figure 12: The percent of assigned emergency beds by total number of bed at functional hospitals, June 2015 14

Figure 13: Main sources of water, June 2015 14

Figure 14: Distribution of water sources/ types at functional public hospitals, per governorate, June 2015 15

Figure 15: Functionality status of the water sources at functional public hospitals, June 2015 15

Figure 16: Percent of hospitals in need for generators out of total functional hospitals [MoH & MoHE], June 2015 16

Figure 17: Proportion of health staff in hospitals, June 2015 17

Figure 18: Proportions and numbers of key staff work in MoH vs., MoHE hospitals, June 2015 18

Figure 19: Comparison of the medical staff of MoH vs., MoHE hospitals, June 2015 18

Figure 20: Proportion of doctors (a total of Specialists, Emergency Physicians, Resident Doctors, Dentists), by gender, per governorate, [MoH & MoHE], June 2015

19

Figure 21: Availability of health services in the functional public hospitals [MoH & MoHE], June 2015 20

Figure 22: Estimated workload of functional public hospitals (outpatient consultations and emergency cases), January to June 2015

20

Figure 23: Proportions of workload from January to June 2015, per governorate 21

Figure 24: The number of outpatient and inpatient in public hospitals [MoH & MoHE], June 2015 21

Figure 25: Trend analysis of outpatient and inpatient in public hospitals [MoH & MoHE], January to June 2015 21

Figure 26: The number of patients received services in laboratories, blood bank, and imaging services, in public hospitals [MoH & MoHE], June 2015

22

Figure 27: Trend analysis of number of patients received services in blood banks and imaging services, in public hospitals [MoH & MoHE], January to June 2015

22

Figure 28: The number of reported cases in emergency department, in public hospitals [MoH & MoHE], June 2015 22

Figure 29: The number of reported cases of mass casualties, in public hospitals [MoH & MoHE], June 2015 23

Figure 30: The number of emergency surgeries vs., elective surgeries in public hospitals [MoH & MoHE], June 2015 23

Figure 31: Percentage of total emergency surgeries to elective surgeries in public hospitals [MoH & MoHE] per governorate, June 2015

24

Figure 32: Trend analysis of number of patients received services in blood banks and imaging services, in public hospitals [MoH & MoHE], January to June 2015

24

Figure 33: The No. of normal deliveries and caesarean sections (CSs) performed at public hospitals [MoH & MoHE], June 2015

25

Figure 34: Percentage of caesarean sections to normal deliveries, all public hospitals [MoH & MoHE], June 2015 25


Figure 35: Trend analysis of the monthly numbers of normal deliveries vs., caesarean sections, public hospitals

[MoH & MoHE], June 2015

26

Figure 36: Comparison of MoH & MoHE hospitals workload of normal deliveries vs., CSs, June 2015 26

Figure 37: Number of children with severe diseases in public hospitals [MoH & MoHE], June 2015 26

Figure 38: Trend analysis of reported cases of severe children diseases in public hospitals [MoH & MoHE], January

to June 2015

27

Figure 39: The number of children with severe acute malnutrition with complications in public hospitals [MoH &

MoHE], June 2015

27

Figure 40: Trend analysis of number of children with severe acute malnutrition with complications in public

hospitals [MoH & MoHE], January to June 2015

27

Figure 41: The number of NCDs’ consultations in public hospitals [MoH & MoHE], June 2015 28

Figure 42: Trend analysis of total monthly number of patients with NCDs reported in public hospitals [MoH &

MoHE], January to June 2015

28

Figure 43: The number of outpatient psychiatric cases vs., the number of inpatients in public hospitals [MoH &

MoHE], June 2015

29

Figure 44: Trend analysis of number of outpatient psychiatric cases vs., the number of inpatients in public


29

Figure 45: Percentage of functional essential equipment/ total available equipment in functional public hospitals


30

Figure 46: Percentage of functional specialized equipment/ total available equipment in the functional public

hospitals [MoH & MoHE], June 2015

30

Figure 47: Availability of and medical supplies for one month in the functional public hospitals [MoH & MoHE],

June 2015

32

List of Tables

Table 1: The list of hospitals with reported fully damaged buildings 14

Table 2: Special cases of hospitals with reported fully damaged buildings, and operating partially from other

locations

14

Table 3: Special cases of hospitals with reported partially damaged buildings, and operating partially (limited

provided health services) from other locations

14

List of Maps

Map 1: Distribution and functionality status of public hospitals [MoH & MoHE], June 2015 8

Map 2: Accessibility to public hospitals [MoH & MoHE], June 2015 10

Map 3: Level of damage of the hospitals’ buildings, by governorate [MoH & MoHE], June 2015 12

Map 4: Level of medical staffing in public hospitals, by end of June 2015, per governorate 17

Map 5: Percent of functional specialized equipment/ total available equipment in functional public hospitals [MoH

& MoHE], June 2015

31

Map 6: Percentage of available medicines in functional public hospitals [MoH & MoHE], June 2015 33


Abbreviations

CEmOC Comprehensive Emergency Obstetric Care

CS Caesarean Sections

DoH Department of Health

ESKD End Stage Kidney Disease

HeRAMS Health Resources & Services Availability Mapping System

HIS Health Information System

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

WHO World Health Organization


Executive summary

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 Mapping System) tool. The report provides descriptive analysis for the

public hospitals in all 14 governorates of Syria [including Ministry of Health (MoH) hospitals 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 during 2014 and 2015. Key achievements include expansion of the system to cover

MoHE hospitals; improved national HIS capacity through regular workshops and trainings; strengthened

operational capacity of HIS units in all governorates, through supplying of ICTs means; developed database

system and standardized reporting channel, tools and protocols.

Completeness of Hospitals’ reporting remained 100%, where all 99 (MoH) hospitals and 14 (MoHE) hospitals

reported to HeRAMS by the end of June 2015.

Functionality status of the public hospitals:

By the end of June 2015, and out of the 113 assessed public hospitals [MoH & MoHE], 41% (46) were

reported fully functioning, 32% (36) hospitals were reported partially functioning, while 27% (31) were

reported non-functioning. All public hospitals in Idleb were reported out of service.

Accessibility status:

By the end of June 2015, 59% (67) hospitals were reported accessible, 17% (19) hard-to-access, and 24% (27)

were inaccessible

Infrastructure of public hospitals:

By the end of June 2015, 42% (48) hospitals’ building were reported damaged [12% fully damaged and 30%

partially damaged], 55% (62) of public hospitals were reported intact, while the infrastructure of three public

hospitals were unknown.

Assessing the availability of water sources at functional public hospitals indicated that 40% (33) are using

main pipelines, 6% (5) are mainly using wells, while 50% (41) are using both (main pipeline and well).

Electricity power is widely disrupted across the country and majority of public hospitals are dependent on

generators' power. According to HeRAMS assessment 40% (33) of functional public hospitals across Syria are

in need for electrical generators, mainly reported from 10 governorates: Quneitra, Aleppo, Deir-ez-Zor,

Dar’a, Rural Damascus, Hama, Homs, Ar-Raqqa, Damascus and Lattakia.

Human Resources:

The emergency physicians remain the lowest proportion of health staff in public hospitals (0.3%), followed

by dentists (1%), pharmacists (2%), Midwives (5%), Laboratory personnel (7%), specialists (14%), resident

doctors (19%), and nurses (52%).

Analysis of proportions of medical doctors [specialists, emergency doctors, resident doctors, dentists]

working at MoHE hospitals versus MoH hospitals has shown that 32% of medical doctors work in MoHE,

while 68% are in MoH hospitals.


Availability and Utilization of Health Services

Analysis of availability and utilization of health services was conducted across all functional public hospitals

[MoH & MoHE]. 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. Detailed

analysis on services’ availability and utilization throughout the first half of 2015 by category (i.e., general

clinical services, trauma care, nutrition, child health, NCDs, and mental health) is provided at governorate

level.

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 consumable at functional hospitals include the tetanus shots (87%),

hepatitis vaccine (82%), affecting blood (62%), antidotes for poisoning (61%), dermatological preparation

(59%), delivery related medicines (52%), dialysis consumable (50%) and antibiotics for multi-resistant

bacteria (49%).


1. Completeness of Hospitals Reporting

The completeness of reporting from public hospitals across Syria remained at 100%, where all the 99

Ministry of Health (MoH) Hospitals and the 14 Ministry of Higher Education (MoHE) hospitals continued to

report to HeRAMS in June 2015.

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

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

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 2015.

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.

2. Functionality and accessibility of the Public Hospitals

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).

Not functioning: a hospital is out of service, because it is

either fully damaged, inaccessible, no available staff, or no equipment.

By the end of June 2015, and out of the 113 assessed public hospitals [MoH & MoHE], 41% (46) were

reported fully functioning, 32% (36) hospitals were reported partially functioning, while 27% (31) were

reported non-functioning [Figure 2].

15 15 14 14

9 8

7 6 6

5 4 4

3

1

11

8

13 14

9

6 7

6 6 5

4 4 3

1

4

7

1 0 0

2

0 0 0 0 0 0 0 0 0

2

4

6

8

10

12

14

16

Aleppo Damascus RuralDamascus

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

Total Public Hospitals Total MoH Hospitals Total MoHE Hospitals

Fully Functioning:

41% (46)

Partially Functioning:

32% (36)

Non-functioning:

27% (31)

Figure 2: Functionality Status- June2015


The hospitals reported partially functioning or non-functioning are in 12 out of a total 14 govrnorates (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 fully functioning, partially functioning, and non-functioning public hospitals in

Syria, June 2015

Map 1: Distribution and Functionality status of public Hospitals [MoH & MoHE], June 2015

0

0

1

1

3

1

5

5

4

10

2

7

6

1

0

3

3

3

6

1

8

4

1

5

1

1

0

0

4

1

5

3

7

3

2

5

1

0

0

0

0

0

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

Idleb

Ar-Raqqa

Dar'a

Deir-ez-Zor

Homs

Al-Hasakeh

Aleppo

Rural Damascus

Hama

Damascus

As-Sweida

Lattakia

Tartous

Quneitra

Fully Functioning Partially Functioning Non-functioning


Since beginning of the year, June 2015 was the worst month with regards to functionality of the hospitals, 31

hospitals were reported out of service compared to 19 in January 2015 [Figure 4].

The increase of the number of non-functioning hospitals in June 2015 is an indication for the direct impact of

the deteriorating security situation in Ar-Raqqa governorate ([i.e., Tal Abyad hospital becomes non-

functional], Al-Hasakeh governorate [i.e., two hospitals become non-functional: Al-Hasakeh national

hospital, and the Children hospital, during the last 10 days of June].

Figure 4: Trend analysis of functionality status of public hospitals in Syria, January to June 2015

2.2 Accessibility to public hospitals

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 2015, 59% (67) hospitals were reported

accessible, 17% (19) hard-to-access, and 24% (27) were inaccessible [Figure 5]. Distribution of public

hospitals by accessibility status is presented in Map 2.

The number of inaccessible hospitals increased from 24 by end of May to 27 by end of June (those are

Tal Abyad hospital in Ar-Raqqa governorate, Al-Hasakeh national hospital, and the Children hospital in

Al-Hasakeh governorate).

Figure 6: Accessibilty status of the public hospitals [MoH & MoHE] per governorate, June 2015

53 53 50 50 49

46 41 40 40

37 36 36

19 20 23

26 28 31

0

10

20

30

40

50

60

Jan 2015 Feb 2015 Mar 2015 Apr 2015 May 2015 Jun 2015

Fully Functioning Partially Functioning Non-functioning

0

6

6

7 4

4

3

11 3

5 8

6 3

1

0

7

3

2 0

3

0

4 0

0 0

0 0

0

4

2

5

7 5

0

2

0 1

1 0

0 0

0

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

Idleb

Aleppo

Rural Damascus

Homs

Dar'a

Deir-ez-Zor

Al-Hasakeh

Damascus

Ar-Raqqa

Hama

Lattakia

Tartous

As-Sweida

Quneitra

Yes Hard to access No

Yes: 59% (67)

Hard to access:

17% (19)

No: 24% (27)

Figure 5: Accessibility status- June 2015


Map 2: Accessibility to public hospitals [MoH & MoHE], June 2015

Trend analysis on accessibility to public hospitals [MoH & MoHE] from January to June 2015, is presented in

Figure 7.

Figure 7: Trend analysis on accessibility to public hospitals, January to June 2015

78 77 74 73 70 67

18 19 20

18 19 19

17 17 19

22 24 27

0

10

20

30

40

50

60

70

80

90


Yes Hard to access No


3. Infrastructure Patterns of the Public Hospitals

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.

3.1 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 2015, 42% (48) hospitals were reported damaged [12% fully damaged and 30% partially

damaged], while 55% (62) of public hospitals were reported intact. The level of damage of three hospitals

was unconfirmed due to escalating security situation: Tal Abyad hospital in Ar-Raqqa governorate, Al-Bassel-

Tadmor and Al-Bassel-Sokhneh hospitals in Homs governorate [Figure 8]. Distribution of public hospitals by

level of damage is presented in Map 3.

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 34 partially damaged hospitals, 18 hospitals were reported partially functioning and 15 out of

service (non-functioning), while one hospital (Yabroud, Rural Damascus) was reported to be fully

functioning providing all services through salvaging medical equipment from the damaged section of the

hospital with full staffing capacity.

Out of the 14 fully damaged hospitals, 10 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 (62 hospitals) does not directly reflect full functionality, only

45 of the 62 intact hospitals are fully functioning, while 14 are partially functioning and 3 hospitals are

not functioning all together, 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.

Fully damaged: 12% (14)

Partially damaged: 30% (34)

Not damaged: 55% (62)

No Report: 3% (3)

Figure 8: Level of Damage - June 2015


Figure 9: Number and percentage of hospitals [MoH & MoHE] by level of damage, June 2015

Trend analysis on condition of the public hospitals (level of damage of the building) from January to June

2015 is presented in Figure 10.

Figure 10: Trend analysis of public hospitals’ level of damage, January to June 2015

Map 3: Level of Damage of the Hospitals’ buildings, by governorate [MoH & MoHE], June 2015

0

0

1

5

2

4

1

0

1

0

0

0

0

0

3

4

6

5

2

4

5

2

1

1

1

0

0

0

0

0

2

4

3

7

8

3

4

7

14

6

3

1

1

0

0

0

0

0

2

0

0

0

0

0

0

0

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

Ar-Raqqa

Idleb

Dar'a

Rural Damascus

Deir-ez-Zor

Aleppo

Homs

Al-Hasakeh

Hama

Lattakia

Damascus

Tartous

As-Sweida

Quneitra

Fully damaged Partially damaged Not damaged No Report

14 13 14 14 14 14

32 32 34 33 33 34

67 68 65 66 64 62

0 0 0 0 2 3 0

10

20

30

40

50

60

70

80


Fully damaged Partially damaged Not damaged No Report


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:

# Hospital Name Province District Affiliation

1 Rural Damascus specialized hospital – Duma Rural Damascus Duma MoH 2 Harasta general hospital Rural Damascus Harasta MoH 3 Al-Mleha hospital Rural Damascus Harasta MoH 4 An-Nashabeyeh hospital Rural Damascus An-Nashabeyeh MoH 5 Darayya general hospital Rural Damascus Darayya MoH 6 Zahi Azraq general hospital Aleppo The fourth MoH 7 E'zaz national hospital Aleppo E'zaz MoH 8 Children hospital Aleppo Third MoH 9 Al-Qusayr general hospital Homs Al-Qusayr MoH 10 Helfaya hospital Hama Muhardeh MoH 11 Maternity and Paediatric specialized hospital Deir-ez-Zor Deir-ez-Zor MoH 12 Alfurat general hospital Deir-ez-Zor Deir-ez-Zor MoH 13 Jassem general hospital Dar'a Nawa MoH 14 Al-Kindi university hospital Aleppo The fourth MoHE

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

other locations:

# Hospital name Province District Type Condition Affili-

ation

New location

1 Zahi Azraq general hospital Aleppo The fourth General Fully damaged

MoH Al-Razi Hospital in Aleppo city

2 Children hospital Aleppo Third Specialized Fully damaged

MoH Ar-Razi hospital and Maternity hospital

3 Maternity and Paediatric specialized hospital

Deir-ez-Zor Deir-ez-Zor Specialized Fully damaged

MoH Al-Assad autonomous hospital (MoH)

4 Alfurat general hospital Deir-ez-Zor Deir-ez-Zor Specialized Fully damaged

MoH Al-Assad autonomous

hospital (MoH)

Table 3: Special cases of hospitals which reported partially damaged (buildings), and operating partially

(limited provided health services) from other locations: # Hospital name Province District Type Condition Affili-

ation New location

1 Martyr Basil al-Assad in Deir Atia/Qalamoun Autonomous hospital

Rural Damascus

Al-Nabak General Partially

damaged

MoH Deir- Atia Health Centre

2 Qaara/ Qalamoun Autonomous hospital

Rural Damascus

Al-Nabak General Partially

damaged

MoH One floor in Qara Municipal (they moved

the functional medical equipment to the

new location)

3 Ebn Khaldon Aleppo The third Specialized Partially

damaged

MoH The administrative departments and

outpatient clinics are operating in Al-

Furqan area, while inpatient units are in

the main location of the hospital in

Dweireena area (recently rehabilitated

partially [ongoing project])

4 Ophthalmology hospital

Aleppo Third Specialized Partially

damaged

MoH Part of the hospital operating from Al-

Razi hospital, while the other from the

Obs. & Gyn. Hospital in Aleppo

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.


3.2 Analysis of the inpatient capacity

The inpatient capacity was analyzed in terms of the total number of beds within the functional hospitals (82)

and the proportion assigned as emergency beds1.

The number of beds assigned for emergency cases vs, total number of beds by governorate is illustrated

below [Figure 11].

Figure 11: The number of emergency beds vs., total number of beds in functional hospitals [MoH & MoHE], per

governorate, June 2015

The inpatient capacity has been improved in certain hospitals, as in impact of beds donations by WHO and

other partners in certain governorates (i.e., Damascus, Aleppo, Rural Damascus, Hama, As-Sweida).

The highest percent of emergency beds (out of total available beds) is reported in Ar-Raqqa, Dar’a, Homs

Damascus, Lattakia and As-Sweida governorate [Figure 12].

Figure 12: The percent of assigned emergency beds by total number of bed at functional hospitals, June 2015

1 The beds assigned for emergency is part of the total number of beds in the hospital

3,228

1,378 1,306 1,284 1,073 959

562 327 313 287 222 180 133

292 80 69 94 34 34 40 36 48 18 11 22 7

Damascus Aleppo RuralDamascus

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

Available No. of Beds Emergency No. of Beds

15%

12%

11%

9%

7% 7% 6%

6% 5% 5% 5%

4% 3%

7%

Ar-Raqqa Dar'a Homs Damascus Lattakia As-Sweida Al-Hasakeh Aleppo RuralDamascus

Quneitra Deir-ez-Zor Hama Tartous Total

% of emergency beds /Total available beds


3.3 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 2015 and out of 82 functional public

hospitals, 40% (33) are using main pipelines, 6% (5) are

mainly using wells, while 50% (41) are using both (main

pipeline and well) [Figure 13].

Detailed analysis on distribution of water sources at

functional public hospitals is presented at governorate level

on [Figure 14].

Figure 14: Distribution of water sources/ types at functional public hospitals, per governorate, June 2015

Functionality status of the water sources was measured at three levels; fully functional, partially functional,

and not functional. Figure 15, provides details on functionality status of water sources at functional

hospitals, (82/113) per governorate.

Figure 15: Functionality status of the water sources at functional public hospitals, June 2015

0

0

0

0

1

2

3

3

3

5

5

5

6

13

5

2

0

0

1

4

0

0

10

1

3

2

0

0

0

1

0

1

2

0

0

0

0

1

0

0

0

0

0

3

0

0

0

0

0

0

0

0

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

Aleppo

Hama

Al-Hasakeh

Quneitra

Deir-ez-Zor

Dar'a

Rural Damascus

Ar-Raqqa

As-Sweida

Damascus

Tartous

Homs

Lattakia

Main Pipeline Main Pipeline and Well Well Other

13

10

8

6

6

5

4

3

3

3

2

1

2

1

0

3

0

0

5

0

1

0

0

0

4

0

2

0

0

0

0

0

0

0

0

0

0

0

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

Damascus

Aleppo

Lattakia

Rural Damascus

Tartous

Hama

Homs

Ar-Raqqa

Dar'a

As-Sweida

Al-Hasakeh

Quneitra

Deir-ez-Zor

Fully Functioning Partially Functioning No Report

Main Pipeline: 40% (33)

Main Pipeline

and Well: 50% (41)

Well: 6% (5)

Other: 4% (3)

Figure 13: Main Sources of Water, June 2015


3.4 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. The percent of hospitals in need for electricity generators out of

the total functional hospital is summarized at governorate level [Figure 16].

40% (33) of functional public hospitals across Syria are in need for electrical generators, mainly reported

from 10 governorates: Quneitra, Aleppo, Deir-ez-Zor, Dar’a, Rural Damascus, Hama, Homs, Ar-Raqqa,

Damascus and Lattakia [Figure 16].

Figure 16: Percent of hospitals in need for generators out of total functional hospitals [MoH & MoHE], June 2015

100%

77% 75% 75%

56%

40%

33% 33%

27%

13%

0% 0% 0%

40%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Quneitra Aleppo Deir-ez-Zor Dar'a RuralDamascus

Hama Homs Ar-Raqqa Damascus Lattakia Tartous Al-Hasakeh As-Sweida Total


4. Availability of Health Human Resources

Availability of health human resources was analyzed

across all public hospitals [MoH& MoHE] considering the

following scopes:

Analysis of proportions of medical-related staff

(doctors, nurses, midwives, and pharmacists)

Analysis of proportions of available health human

resources; MoH vs., MoHE hospitals

Analysis of available human resources by gender, per

governorate

Trend analysis of distribution of medical doctors

(Specialists, Emergency Physicians, Resident doctors,

and Dentists), per governorate

Analysis of proportions of medical-related staff (doctors, nurses, midwives, and pharmacists):

The proportion between different categories of health staff, among the total functional (fully and partially)

MoH and MoHE hospitals (82/113), by the end of June 2015, is as follows: the emergency physicians remain

the lowest proportion of health staff (0.3%), followed by dentists (1%), pharmacists (2%), Midwives (5%),

Laboratory personnel (7%), specialists (14%), resident doctors (19%), and nurses (52%); [Figure 17].

The availability and level of medical staffing in public hospitals is summarized at governorate’s level, as

shown in Map 4. The categories of medical staff included in the map are: specialists, emergency physicians,

resident doctors, and dentists.

Map 4: Level of medical staffing in public hospitals, by end of June 2015, per governorate

Specialist 14%

Emergency Physician

0.3%

Resident Doctor

19%

Dentist 1%

Nurses 52%

Laboratory 7% Midwives

5%

Pharmacists 2%

Figure 17: Proportion of Health Staff in Hospitals, June 2015


Analysis of proportions of available health human resources; MoH vs., MoHE hospitals:

Analysis of proportions of medical doctors [specialists, Emergency doctors, resident doctors, dentists] working

at MoHE hospitals versus MoH hospitals has shown that 32% (3,338) of medical doctors (specialists and

resident doctors) work in MoHE, while 68% (6,958) are in MoH hospitals (percentage is calculated out of total

medical doctors in MoH & MoHE).

Details on proportions and numbers of key staff work in MoH vs., MoHE hospitals, by end of June 2015, are

presented in [Figure 18].

The drop of the reported health staff by end of June is a direct impact of increased number of non-functional

hospitals since end of 2014, which is due to the security situation (i.e., 89 functional by end of 2014 vs., 82 by

end of June 2015). Health staff in many affected areas have been displaced, relocated / reassigned to DoHs, or

missing in certain cases.

Figure 18: Proportions and numbers of key staff work in MoH vs., MoHE hospitals, June 2015

Out of a total Specialists work in public hospitals (4,299), 20% (839) are in MoHE hospitals, out of a total

5,537 resident doctors 45% (2,480) are in MoHE hospitals, and out of a total 16,850 nurses & midwives, 24%

(4,064) are in MoHE hospitals.

Fleeing of specialized medical staff out of the country because of the crisis situation has been a major

concern. Comparison of the availability of medical staff by end of June 2015 versus end of December 2014,

for the common functional public hospitals during both periods (a total of 77 hospitals), has shown drop of

the number of specialists from 4,316 by end of December 2014 to 4,198 by end of June 2015.

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 19].

Figure 19: Comparison of the medical staff of MoH vs., MoHE hospitals, June 2015

3,460

87

3,057

354

11,619 1,510 1,167

839

2,480

19

3,879 435 185

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Specialist EmergencyPhysician

Resident Doctor Dentist Nurses Laboratory Midwives

MoHE

MoH

53

7

145 32

2 547

42

9

54

226

130

10 2 8 14 0 0 0 0

1,1

92

17

0 315

29

1

1,0

19

66

72

2

67

3

52

17 29 78

12

1 1 5

1,4

33

60

9

924

1,3

90

2,2

88

335

418

838

316

83

83 14

4

225

32 11

9

59

43 58 117

194

10

0

0 29 56

0

500

1,000

1,500

2,000

2,500

Damascus Rural Damascus Aleppo Lattakia Damascus Rural Damascus Aleppo Lattakia

MoH MoHE

Specialist Emergency Physician Resident Doctor Dentist Nurses Midwives Pharmacists


Analysis of available human resources by gender, per governorate:

By analyzing the proportion of male to female doctors (a total of: Specialists, Emergency Physicians, Resident

Doctors, Dentists), lowest proportions are seen in Al-Hasakeh, Deir-ez-Zor and Ar-Raqqa governorates,

[Figure 20].

Figure 20: Proportion of Doctors (a total of Specialists, Emergency Physicians, Resident Doctors, Dentists), by gender,

per governorate, [MoH & MoHE], June 2015

2243 305 1058 1095 790 293

544 111 121 143 54 205 92

1008 150 565 643 332 145

198 28 28 34 15 66 30

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Damascus RuralDamascus

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

Male Female


5. 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, Non-communicable Diseases, and Mental Health).

Analysis of availability of health services has been conducted across all functional public hospitals [MoH &

MoHE]: (82/113). 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 21].

Figure 21: Availability of Health Services in the functional Public Hospitals [MoH & MoHE], June 2015

**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 2015 [Figure 22].

Figure 22: Estimated workload of functional public hospitals (outpatient consultations and emergency cases), January

to June 2015

11%

31%

36%

39%

57%

69%

70%

72%

75%

80%

81%

81%

86%

87%

90%

90%

Acute psychiatric inpatient unit

Outpatient psychiatric care

Cancer treatment services

Management of severe acute malnutrition with complications

Management of children diseases

(CEmOC) Comprehensive emergency obstetric care

Emergency surgery

ICU services

Mass casualty management

Cardiovascular services

Blood bank service

End Stage Kidney Disease (ESKD) treatment

Elective surgery

Imaging service

Emergency department services

Solid waste management

655,008

481,520

388,513 346,821

299,609

244,514 227,339

172,633

112,618 79,382 72,784 60,358 45,623 26,703

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

Damascus Lattakia Aleppo Homs Tartous Hama Al-Hasakeh RuralDamascus

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


The proportion of workload of functional hospitals per governorate is provided on Figure 23.

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 Health

6. Non-communicable diseases

7. Mental Health

5.1 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

June 2015 were summarized and analyzed at governorate level [Figure 24].

Figure 24: The number of Outpatient and Inpatient in public hospitals [MoH & MoHE], June 2015

Trend analysis of total reported numbers of Outpatient and Inpatient from functional public hospitals [MoH

& MoHE], for six months (January to June 2015), is presented in [Figure 25].

Figure 25: Trend analysis of Outpatient and Inpatient in public hospitals [MoH & MoHE], January to June 2015

63,549

49,836

32,092 27,934

23,533 19,457

16,507

7,662 5,616 5,194 4,731 4,150 1,358

17,974

7,396 4,221

7,724 2,688

6,101 7,095

84 5,220 4,321 833 1,969 306

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

Damascus Lattakia Aleppo Tartous Homs Hama RuralDamascus

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

Outpatient services Inpatients services

202427

255271

304016 277312

259927 261619

59459 62492 70066 66221 65928 65932

0

50000

100000

150000

200000

250000

300000

350000


Outpatient services Inpatients services

Damascus 20%

Lattakia 15%

Aleppo 12% Homs

11%

Tartous 9%

Hama 8%

Al-Hasakeh 7%

Rural Damascus 5%

As-Sweida 4%

Deir-ez-Zor 3% Ar-Raqqa

2%

Dar'a 2%

Idleb 1% Quneitra

1%

Figure 23: Proportions of workload from January to June 2015, per governorate


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 2015 analyzed at

governorate level [Figure 26].

Figure 26: The number of patients received services in laboratories, blood bank, and imaging services, in public


Trend analysis of number of patients received services in hospitals’ blood banks and imaging departments,

from January to June 2015, is presented in [Figure 27].

Figure 27: Trend analysis of number of patients received services in blood banks and imaging services, in public


5.2 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, mass causalities, and surgeries (elective

and emergency).

iii. Emergency cases reported in emergency departments

Figure 28 presents the total number of cases in emergency departments, reported during June 2015 from

functional public hospitals at governorate level.

Figure 28: The number of reported cases in emergency department, in public hospitals [MoH & MoHE], June 2015

514,416

69,493

185,726 182,824 174,915

90,970

250,066

18,339 21,290 2,660 7,699 54,456

12,925 7,371 812 5,495 1,995 1,956 611 1,771

317 98 1,201

124 426 115 41,300

11,109 21,454 23,475 27,356 12,119 21,972 7,641 1,562 3,631 2,241 9,253 1,351 0

100000

200000

300000

400000

500000

600000



Laboratory services Blood bank service Imaging service

23289 23395 26857 24598 23848 22292

156912 171621

194439 184184 186069 184464

0

50000

100000

150000

200000

250000


Blood bank service Imaging service

47,373

32,560 29,723

25,259 25,171 24,468

14,853 14,844 14,445

6,482 3,621 3,308 2,814

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

50,000

Damascus Lattakia Homs Hama Aleppo Tartous Al-Hasakeh RuralDamascus

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


iv. Mass causalities

Figure 29 presents the total number of mass causality cases, reported during June 2015 from functional

public hospitals at governorate level.

Figure 29: The number of reported cases of mass casualties, in public hospitals [MoH & MoHE], June 2015

v. 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 30].

During June 2015, the highest workload of elective surgeries is reported from Al-Assad university hospital/

Lattakia (1,304 surgeries), followed by Damascus MoH Hospital (Al-Mojtahid: 1,124 surgeries), Al-Bassel

Heart Institute in Damascus (920), Al-Assad university hospital in Damascus (919 surgeries), Ar-Razi MoH

hospital in Aleppo (864), and Al-Mouwasat university hospital (847).

While the highest workload of emergency surgeries is reported from Al-Bassel hospital in Tartous (2,083),

followed by Zaid Ash-Shariti hospital in As-Sweida (1,011) due to security reasons, then Al-Mouwasat MoHE

hospital (546), Lattakia National hospital in Lattakia (525), and Ar-Razi MoH hospital in Aleppo (412),

*Of note, the highest number of functional public hospitals is in Damascus, of which 14 out of 15 hospitals

provide elective surgeries, except Ibn-Roshd hospital for Mental Health.

Figure 30: The number of emergency surgeries vs., elective surgeries in public hospitals [MoH & MoHE], June 2015

By analyzing the percent of total emergency surgeries to elective surgeries during June 2015, the highest

percent of emergency surgeries across different governorates is reported in Tartous, As-Sweida, Dar’a, and

Quneitra governorates. Across all reported functional public hospitals, 31% of surgeries are emergency while

69% are elective [Figure 31].

In Tartous, the highest figures are reported from Al-Basil surgical hospital, which is the biggest hospital in

Tartous, located in the south eastern part of the governorate and adjacent to Hama and Homs. The location

of this hospital is also very close to the highway, and majority of the road incidents are received there.

6,034

840 539 487 456 349 300 225 180 152 76 57 39

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

Hama Aleppo Damascus Quneitra Dar'a Ar-Raqqa Al-Hasakeh Tartous As-Sweida RuralDamascus

Lattakia Deir-ez-Zor Homs

6,359

3,044

1,987 1,633

1,411 1,220 1,087 798 764

294 105 90 89

1,019 973 698

1,147

2,312

85 374

1,063

78 251 146 24 149

0

1000

2000

3000

4000

5000

6000

7000

Damascus Lattakia Aleppo Hama Tartous Homs Ar-Raqqa As-Sweida RuralDamascus

Al-Hasakeh Dar'a Deir-ez-Zor Quneitra

Elective surgery Emergency surgery


In As-Sweida, the number of emergency surgeries is relatively high because of emergency cases received

from surrounding in-secure areas.

In Dar’a and Quneitra, the high percent of emergency surgeries is due to the escalating security situation;

emergency surgeries are given higher priority than cold surgeries.

Figure 31: Percentage of total emergency surgeries to elective surgeries in public hospitals [MoH & MoHE] per

governorate, June 2015

Trend analysis of total number of elective and emergency surgeries reported in functional public hospitals

[MoH & MoHE], from January to June 2015 is presented in Figure 32.

Figure 32: Trend analysis of number of patients received services in blood banks and imaging services, in public


5.3 Maternal health services

Analysis of availability and utilization of maternal health services was conducted considering three scopes:

Utilization of service (caesarean sections (CS) vs., normal deliveries); June 2015 summary figures by

governorate

Percentage of CSs to normal deliveries, of June 2015

Trend analysis of the monthly normal deliveries vs., caesarean sections, January to June 2015

i. Utilization of service (caesarean sections vs., normal deliveries)

The numbers of caesarean sections performed at public hospitals (in June 2015) versus the normal deliveries

have been analyzed at governorates’ level [Figure 33].

The highest numbers are reported from Damascus hospitals (i.e., Obs. and Gyn. MoHE Hospital [normal

deliveries are 574 while CSs are 472] followed by Al-Zahrawi MoH Hospital [normal deliveries 363 while the

CSs are 108 case).

7% 9% 14% 21% 24% 26% 26%

41% 46% 57% 58% 62% 63%

31%

93% 91% 86% 79% 76% 74% 74%

59% 54% 43% 42% 38% 37%

69%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Homs RuralDamascus

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

% Emergency surgery % Elective surgery

7213 6596 8020 7899 8601 8319

13161

15176

17290 16260 16589

18881

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000


Emergency surgery Elective surgery


Figure 33: The No. of normal deliveries and caesarean sections (CSs) performed at public hospitals [MoH & MoHE],

June 2015

ii. Percentage of CS to normal deliveries

The global norm for the percentage of CS to normal deliveries is 5% to 15%. Based on [Figure 34], 12

governorates are above the threshold.

The highest reported figures of caesarian sections are in Lattakia and Tartous, which are due to cultural

preferences, where the pregnant women opt for cesarean sections for several reasons, such as:

Reducing the pain associated with childbirth

Choosing a fixed date for delivery, in relation to other social occasions

Similar reasons for high CSs are in Hama governorate, in addition to security constraints in certain areas.

In Aleppo and Rural Damascus the high numbers of CSs are due to the fact that majority of the pregnant

women prefer to do caesarean sections, because of the security situation and hassles they could go through

if they opted for normal delivery.

In Aleppo, the high figures of CSs were reported form Obstetrics and Gynecology hospital of MoHE (87) and

Maternity hospital of MoH (46) in Aleppo city.

In Rural Damascus, the high figures of CSs were reported from Al-Qutayfeh hospital MoH (104), Al-Qalamun

hospital MoH (93), and Al-Bassel-Yabroud hospital MoH (41).

Across all reported functional hospitals, 41% of deliveries are CSs while 59% are normal deliveries. Details on

percent of CSs to normal deliveries per governorate in June 2015, is provided in [Figure 34].

Figure 34: percentage of caesarean sections to normal deliveries, all public hospitals [MoH & MoHE], June 2015

937

850

538

413

312 269 247 233

179 174 142

54 33

580

189

580

54

238 238

159

345

133

426

57 29 37

0

100

200

300

400

500

600

700

800

900

1000

Damascus Ar-Raqqa Hama Al-Hasakeh RuralDamascus

Homs As-Sweida Tartous Aleppo Lattakia Dar'a Quneitra Deir-ez-Zor

Normal_deliveries CSs

29% 40%

47% 48% 53% 57% 57% 61% 62% 65% 71%

82% 88%

71% 60%

53% 52% 47% 43% 43% 39% 38% 35% 29%

18% 12%

0%

20%

40%

60%

80%

100%

Lattakia Tartous Deir-ez-Zor Hama Homs RuralDamascus

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

Normal deliveries % CSs %


iii. Trend analysis of the monthly numbers of normal deliveries vs., caesarean sections

Trend analysis of the monthly numbers of normal deliveries vs., caesarean sections reported from the MoH

& MoHE hospitals, from January to June 2015 is shown in Figure 35.

Figure 35: Trend analysis of the monthly numbers of normal deliveries vs., caesarean sections, public hospitals [MoH

& MoHE], January to June 2015

iv. 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, has shown higher workload for the MoHE Hospitals mainly in Damascus

governorate (Al-Tawleed [Obstetrics and Gynecology] hospital for MoHE); [Figure 36].

Figure 36: Comparison of MoH & MoHE hospitals workload of normal deliveries vs., CSs, June 2015

5.4 Child Health

Management of severe children diseases (such as acute respiratory diseases, Meningitis, blood diseases

cancer, etc) are assessed at hospitals level. Figure 37 shows the distribution of total reported cases of

children with severe diseases by governorate.

Figure 37: Number of children with severe diseases in public hospitals [MoH & MoHE], June 2015

5633

4871 5364

4887

4161 4381

3469 2982

3577 3314 3111 3065

0

1000

2000

3000

4000

5000

6000


Normal_deliveries CSs

363 312

82

161

574

97

13

108

238

46

359

472

87 67

0

100

200

300

400

500

600

700


Aleppo Lattakia Damascus RuralDamascus

Aleppo Lattakia

MoH Hospitals MoHE Hospitals

Normal_deliveries

CSs

715

617 600

374

231 226 191 168

112 66 59

0 0 0

100

200

300

400

500

600

700

800

Tartous Hama Damascus As-Sweida Aleppo Quneitra RuralDamascus

Homs Lattakia Dar'a Al-Hasakeh Deir-ez-Zor Ar-Raqqa


The high reported figures in Tartous, Hama, Damascus, and As-Sweida 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 2015, is presented in

[Figure 38] below.

Figure 38: Trend analysis of reported cases of severe children diseases in public hospitals [MoH & MoHE], January to

June 2015

5.5 Nutrition

Monitoring of cases of severe acute malnutrition with complications is systematically conducted at public

hospitals level; Figure 39 demonstrates the number of cases reported in June 2015, at governorate level.

Figure 39: The number of children with severe acute malnutrition with complications in public hospitals [MoH &

MoHE], June 2015

The high reported figures in Damascus, Hama, and Lattakia are due to the high numbers of IDPs.

Trend analysis of reported cases of severe acute malnutrition from January to June 2015, is presented in

[Figure 40] below.

Figure 40: Trend analysis of number of children with severe acute malnutrition with complications in public hospitals

[MoH & MoHE], January to June 2015

2901 3119

3758 3751 3633 3359

0

500

1000

1500

2000

2500

3000

3500

4000


Management of children diseases

13

10 9

7 6 6

3 3

0 0 0 0 0 0

2

4

6

8

10

12

14

Damascus Hama Lattakia Deir-ez-Zor Aleppo Al-Hasakeh RuralDamascus

Dar'a Tartous Homs Ar-Raqqa As-Sweida Quneitra

44

65

56

41

80

57

0

10

20

30

40

50

60

70

80

90


Management of severe acute malnutrition with complications


5.6 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, Hypertension, Cardiovascular, Kidney and

Cancer diseases) are from Damascus hospitals.

Among all NCDs, Cancer patients’ consultations are the highest reported figures, mainly in Damascus, Rural

Damascus (has one cancer specialized hospital), and Lattakia (has one cancer specialized hospital) public

hospitals, where cancer referral hospitals are located. 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 were high in Damascus (has two cardiovascular specialized hospitals), Lattakia

(has one cardiovascular specialized hospital), Aleppo (has two cardiovascular specialized hospitals), Tartous,

and Homs in June 2015 [Figure 41].

Figure 41: The number of NCDs’ consultations in public hospitals [MoH & MoHE], June 2015

*ESKD: End Stage Kidney Disease

The monthly trend of reported NCDs’ consultations at functional public hospitals from January to June 2015

is shown in [Figure 42].

Figure 42: Trend analysis of total monthly number of NCDs’ consultations reported in public hospitals [MoH &

MoHE], January to June 2015

The numbers of cancer’s consultations has been increased noticeably from 12,538 in January to 15,889 in

June 2015. The high numbers were reported mainly from Al-Bairouni MoHE hospital in Rural Damascus

(7,534), which is the biggest cancer specialized hospital.

642 198 156

642

122

916

20 25 34 0

38 72 55

1151

301 452 161 171

901

27 347

37 54 34 40 63

3876

207

1135

2376

899 775 328

96 25 98 12 270 73

905

104 271 372 316 128 365

130 40 50 132 25

3351

7534

1783

2808

35 135 171 0 3 0 0 69 0

0

1000

2000

3000

4000

5000

6000

7000

8000



Diabetes Hypertension Cardiovascular ESKD Cancer

3247 3425

3778 3583

3266 2920

4805 5468 5567 4931 4980

3739

9774 10600

11883

10940 10486 10170

3593 3613

3319 3032 3074

2838

12538

14101 13966 14514

15303 15889

0

2000

4000

6000

8000

10000

12000

14000

16000

18000


Diabetes Hypertension Cardiovascular ESKD Cancer


5.7 Mental Health

Availability and utilization of mental health services were assessed through HeRAMS by checking the

outpatient and inpatient services at hospitals level and the number of patients. Summary of the total

reported consultations (outpatient) and inpatients at public hospitals, per governorate level is shown in

[Figure 43].

The reported figures of outpatients are disaggregated as follow:

Aleppo: Ibn-Khaldoun mental health specialized hospital/ MoH (4,228 cases), Zahi Azraq MoH hospital

(10 cases)

Damascus: Ibn-Roshod mental health specialized hospital/ MoH (491 cases), followed by Al-Mojtahid

[Damascus MoH Hospital] (255 cases), Al-Mouwasat MoHE hospital (231 cases), and Children MoHE

hospital (19 cases).

Rural Damascus: Al-Bairuni MoH hospital (53 cases), Ibn-Sina Psychiatric MoH hospital (33 cases) which

is a mental health specialized hospital, Al-Qalamoun MoH hospital (26 cases), and Yabroub MoH hospital

(23 cases).

Lattakia: national MoH hospital (103 cases), Al-Assad MoHE hospital (20 cases)

Homs: Karm Allouz MoH hospital (75 cases), Al-Basil MoH hospital [Al-Zahra’] (20 cases) and MoH Mobile

hospital (12 cases).

Dar’a: Ezraa hospital (16 cases)

The reported figures of inpatients are disaggregated as follow:

Aleppo: Ibn-Khaldoun MoH hospital (105 cases).

Damascus: Ibn-Roshod hospital (491 cases), followed by Al-Mouwasat MoHE hospital (15 cases).

Rural Damascus: Ibn-Sina Psychiatric MoH hospital (440 cases).

Lattakia: national MoH hospital (6 cases).

Figure 43: The number of outpatient psychiatric cases vs., the number of inpatients in public hospitals [MoH &

MoHE], June 2015

Trend analysis of monthly reported number of outpatient psychiatric cases vs., the number of inpatients in

public hospitals [MoH & MoHE] from January to June 2015 is shown in [Figure 44] below.

Figure 44: Trend analysis of number of outpatient psychiatric cases vs., the number of inpatients in public hospitals

[MoH & MoHE], January to June 2015

4,238

996

135 123 107 16 0 0 0 0 0 0 0 105 506 440

6 0 0 0

50010001500200025003000350040004500

Aleppo Damascus RuralDamascus

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

Outpatient psychiatric care Psychiatric inpatient

3,025

3,647

4,347 4,896

5,235 5,615

849 881 866 967 1,017 1,060

0

1000

2000

3000

4000

5000

6000


Outpatient psychiatric care Psychiatric inpatient


6. Availability of Medical Equipment

The availability of different types of essential and specialized equipment and supplies was assessed at

hospital level, based on a standard checklist2.

In its fifth year of crisis, Syria’s hospitals 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] (82/113), 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 45] and [Figure 46].

Figure 45: Percentage of functional essential equipment/ total available equipment in functional public hospitals


Figure 46: Percentage of functional specialized equipment/ total available equipment in the functional public


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

70%

80%

86%

87%

87%

87%

89%

89%

90%

91%

92%

92%

93%

96%

96%

97%

Nebulizer

Ambu bag (Paediatric and Adult)

Sterilizer/ Autoclave

Suction machine

Delivery_table

Pulse Oximeter

Weighing Scale for adults

Weighing Scale for infants

Height Measurement Device

Operating_tables

Light source (flashlight acceptable)

Oxygen cylinders

Fetoscope

Minor Surgical sets

Length Measurement Device

Vaginal examination set

46%

68%

72%

75%

77%

78%

78%

79%

82%

84%

84%

85%

85%

86%

97%

MRI machine

Cardiotocography (Monitoring of fetalheart frequency)

CT Scan

Ventilators – Adult

X-Ray

Portable X-Ray

Renal Dialysis machine

Incubator for new born

Ultrasound

DC Shock machine/ Defibrillator

ECG

Anaesthesia machines

ICU/CCU Monitors

Ventilators – Paediatric

Major surgical sets


Analysis of availability of specialized equipment [Figure 46] has highlighted many gaps and urgent needs for

equipment and machines at different governorates; such as:

MRI machines: main gaps are in Damascus, Aleppo, Lattakia, Tartous, Homs, Hama, Al-Hasakeh, Deir-

ez-Zor, Ar-Raqqa, Dar'a, As-Sweida, Quneitra hospitals.

Cardio-topography (Monitoring of fetal-heart frequency); main gaps are in Damascus, Rural

Damascus, Al-Hasakeh, Dar'a, Quneitra hospitals.

CT scanners: main gaps are in Rural Damascus, Deir-ez-Zor, Dar'a hospitals.

Ventilators for adults: main gaps are Rural Damascus, Deir-ez-Zor, Ar-Raqqa hospitals.

X-Ray machines: main gaps are in Deir-ez-Zor and Dar’a hospitals.

Portable X-Ray: main gaps are in Aleppo, Al-Hasakeh, Ar-Raqqa hospitals.

Renal dialysis machines: main gaps are in Dar’a and Al-Hasakeh hospitals.

Incubator for new born: main gaps are Rural Damascus, Dar'a, Quneitra hospitals.

Map 5: Percent of functional specialized equipment/ total available equipment in functional public hospitals [MoH &

MoHE], June 2015


7. Availability of Medicines & Medical supplies

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 47].

The key identified gaps of medicines and consumable at functional hospitals include the tetanus shots (87%),

hepatitis vaccine (82%), affecting blood (62%), antidotes for poisoning (61%), dermatological preparation

(59%), delivery related medicines (52%), dialysis consumable (50% and antibiotics for multi-resistant bacteria

(49%).

Figure 47: Availability of medicines and medical supplies for one month in the functional public hospitals [MoH &

MoHE], June 2015

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 care. One example is the increased availability of serums and IV fluids on

the hospitals level after WHO continuous efforts to provide this item on a larger scale during last year.

Percent of available medicines in functional public hospitals, by governorates, are visualized in Map 6.

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

Database.

13%

18%

38%

39%

41%

48%

50%

51%

61%

63%

67%

67%

73%

73%

74%

77%

79%

80%

80%

84%

84%

85%

87%

89%

Tetanus shot

Hepatitis vaccine

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

Antidots for Poisoning

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

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

Dialysis consumables

Specific antibiotics for multi –resistant bacteria / infectious diseases

Antibiotics for Children

Anti-diabetic preparations (especially Insulin)

Anaphylactic shock

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

IV Fluid

Gastrointestinal medicines

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

Albumin

Preoperative medication

General Anesthetics

Antibiotics for Adults

Anti-allergic including Steroids

Antiseptics

Local Anesthetics

Analgesics, antipyretics, non-steroidal anti-inflammatory Medicines

Serums


Map 6: Percentage of available medicines in functional public hospitals [MoH & MoHE], June 2015


8. Conclusions and Recommendations

Rehabilitation of the damaged hospitals’ infrastructure is highly needed to improve functionality of

hospitals and availability of essential health services at secondary care level.

Provision or maintenance of electricity generators for hospitals in need (identified in the HeRAMS

database) could result in significant improvement of availability of services

Increasing provision of NCD medicines (especially for cancer treatment), as it was observed that

cancer consultations are the highest among other NCDs.

Increasing provision of specialized medical equipment and machines, in addition to spare parts (in

certain cases) will improve readiness of hospitals’ secondary and tertiary levels of care, and

accordingly fill-in the highlighted gaps and urgent needs reported at different governorates.

Conducting a qualitative survey on provision of health services to measure the impact of the crisis on

the population across the country, using HeRAMS data as a baseline.

Increasing supply of ICTs means for health districts and reporting facilities especially in hard-to-reach

and inaccessible areas, to improve timeliness & completeness of reporting, quality of data, and flow

of information.


© World Health Organization 2015. All rights reserved. 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.

WHO-EM/SYR/012/E

herams report january - june 2015 · 2015-11-30 · herams report january - june 2015 (public...

Documents