In June 2013, a simplified early warning, alert, and response network (EWARN) disease surveillance system was established in Northern Syria. This system has been managed and coordinated by the non-governmental organization, the Assistance Coordination Unit (ACU) since it was established in another part of the country. The current EWARN system operates in 280 sentinel sites across two governorates (Idleb, and Aleppo). EWARN has both an immediate alert reporting function and weekly and weekly reporting mechanism for 13 high-priority syndromes, in addition to weekly reporting.

This EWARN system has been evaluated three times since it was established with the last evaluation completed in 2018. It is recommended that an early warning system in humanitarian settings should be evaluated every 12-18 months; however, due to the COVID-19 pandemic routine activities were either suspended or delayed and the system has not been assessed in over four years. Most disease surveillance systems were overwhelmed by the COVID pandemic, and EWARN was further stressed by the major earthquake that affected parts of Northern West Syria in February 2023.

WHO in collaboration with US-CDC has recently completed a mission (between 17 to 23 September 2023) to support North West Syria’s evaluation of the Early Warning Alert and Response Network (EWARN), the only functioning disease surveillance system in the northern part of the country (Syria).

The evaluation team adapted the WHO EMRO published EWARN evaluation protocol as the guiding document, which uses a mixed methods approach. The evaluation was partly on site (EWARN central office in Gaziantep) and partly remote (District Level Officers, Field Level Officers, Health facility staffs and data tools) as there was no access for the evaluators to go into North Syria.

• Conducted a desk review of all current standard operating procedures, field manuals, protocols, and other operational documents

• Review various registers from a selected number of facilities, weekly reports and database;

• Conducted interviews with key staff at all levels, Central, Governate and field staff at sentinel sites, and other reporting agencies using both face-to-face interviews and remote using calls for staff inside Syria

• Reviewed laboratory reporting forms, registers, and standard operating procedures for selected priority diseases

• Assessed attributes for selected priority diseases: COVID-19, measles and acute watery diarrhea (cholera).

The rapid EWARN evaluation was completed, and initial results and following preliminary recommendations were shared with the WCO-Gaziantep team in a debriefing session.

• Strengthen EWARN implementation through a better-coordinated approach utilizing available structures, such as a health cluster approach

• Ensure implementation of the standard/ unified case definitions across the EWARN reporting health facilities for the EWARN syndromes

• Review/ update the list of the priority disease and alert and outbreak thresholds

• Involve all the relevant stakeholders and develop/ adapt a standard/ unified data recording and collection tool to collect harmonized information from all the health facilities implementing EWARN

• Develop/update and implement supervision, monitoring, and evaluation plan and ensure gap analysis and feedback mechanism

• Enhance the laboratory testing/confirmation and rationalize it by developing and implementing a “surveillance testing strategy” according to the prevailing situation