30 August 2021, Damascus – The conditions under which people are born, grow, live and age, as well as the forces and systems that shape the conditions of daily life, have an enormous impact on health outcomes. These non-medical factors are called the social determinants of health.

They include economic policies and systems, development agendas, social norms, social policies and political systems, all of which greatly influence health inequities. Peace and conflict, income and social protection, job security, education, food security, housing, social inclusion, and access to affordable social services – all influence equity and have an adverse or positive impact on health. Overall, the lower a person or community’s socioeconomic standing, the worse their health.

WHO strives to build back a fairer and healthier future for the people of Syria by providing the most vulnerable with lifesaving services. WHO addresses broader determinants of health through collaboration with social and economic sector partners in a bid to reduce social inequities, protect health rights and build resilient communities.

“The 2030 Agenda for Sustainable Development emphasizes the interconnectedness of social, economic, and environmental concerns, highlighting the importance of addressing the social determinants of health. Prevention is more cost-effective than treatment and health promotion must be an be integral part of healthy cities, villages and settlements if we are to achieve the Sustainable Development Goals,” said Dr Akjemal Magtymova, Head of Mission and WHO Representative in Syria. “Investment, policy and legislation that address emerging health threats at the community level and empower local governments to act quickly will ensure Syrians are better protected.” 

Social determinants of health have been top of the agenda during discussions between the WHO Representative and line ministries in Syria this week. Meetings were held with the Ministers of Local Administration and Environment, Information, Higher Education and Scientific Research, Education, as well as Social Affairs and Labour. WHO will collaborate with ministries on safe school reopening and health education, waste management and safe water, sharing evidence-based information, and strengthening the research and academic curriculum on health as key intersectoral interventions that will positively influence the population’s health. 

Dr Magtymova called on each sector to unite efforts to ensure quality services under their mandate and reconfirmed WHO’s commitment to partners to achieve better health outcomes for all.   

Summary

On 15 August 2021 Syria received the second batch of COVAX-facilitated AstraZeneca (AZ) vaccines with support from Sweden, amounting to 174 720 doses, 79% of which will be administered by the national immunization programme in Government-controlled areas and northeast Syria, and approximately 21% in northwest Syria through Gaziantep. 

This follows the allocation criteria used for the distribution of the first batch of COVAX AZ vaccines (256 800) The first dose vaccine campaign in northwest Syria started on 1 May 2021 and is still ongoing with 49 130 people covered so far, while the campaign in the rest of the country was completed as of 30 June with 101 751 people vaccinated with the first dose. 

The campaign for the second dose was launched on 13 July in Government-controlled areas and on 25 July in northeast Syria. In northwest Syria, the second dose vaccination campaign will start on 21 August. 

Vaccination strategies

Two different vaccination strategies are applied in various parts of the country. In northwest Syria, the first batch of vaccines was used for the first dose vaccination, while in Government-controlled areas and in northeast Syria (where vaccination is administered as part of the national immunization programme) the total quantity of available vaccines from the first batch were equally split into two parts to roll out the first and the second dose vaccination accordingly. The second batch of the vaccines is going to help expand the coverage and high-risk target populations. 

Priority groups

As per the National Deployment and Vaccination Plan, the vaccination priority groups include high-risk population groups such as: 1) health workers; 2) the elderly; and 3) people with co-morbidities. 

Challenges

As in all countries, COVID-19 vaccination has been a novel process in Syria and several challenges were faced since the onset of the vaccination campaign. 

As of August 2021, vaccines supplied under COVAX ensures the vaccination of less than 1% of the population of Syria. In addition, bilateral donations add a further 2% to the vaccination rate, still Syria risks not reaching the national target of 20% by December 2021. 

Due to lack of knowledge and public trust in the COVID-19 vaccine coupled with limited demand creation efforts, initially there was a visible hesitancy among the target population – even among health workers - to accept a COVID-19 vaccine. While the national promotional campaign was suspended at the start of the COVID-19 vaccination campaign, with more vaccines becoming available, with community-level efforts for demand generation, with more people receiving vaccines without severe side-effects, public confidence in vaccines has gradually increased. 

Joint efforts and way forward 

WHO and partners reached out to health care workers at health facilities and through medical syndicates to increase vaccine uptake and confidence.

WHO and its partners – GAVI and UNICEF – worked together to secure the second batch of COVAX-facilitated vaccines in August and expecting consequent batches in the near future, with the estimated COVAX vaccines available to cover approximately 6% of the population. 

12 August 2021, Damascus, Syria – WHO welcomes a new donation from the Kuwait Fund For Arab Economic Development to support health care for all people in need in Syria. This new contribution of US$ 3 million comes at a critical time as the health system faces shortages in resources due to sanctions and is overwhelmed by the ongoing COVID-19 pandemic.

“Kuwait has been a long-standing partner to WHO in our work to save the lives of the Syrian people. We are grateful for this generous contribution that has come as a major step towards reviving the availability of health care services to all people in need, and supports WHO’s commitment to alleviate the immense suffering of the Syrian people,” said Dr Akjemal Magtymova, WHO Representative and Head of Mission in Syria.

Gaps in local production of medicines within Syria have left significant shortages in much needed essential medicines, especially for patients with chronic conditions. Noncommunicable diseases are now the highest cause of morbidity in Syria, accounting for 45% of all deaths in the country. This new funding will enable WHO to increase access of vulnerable people to life-saving treatment for noncommunicable diseases, including asthma and chronic pulmonary conditions, cancer, cardiovascular disease, diabetes and kidney failure.

With this generous support, WHO will also continue strengthening the COVID-19 response, as well as support the national immunization programme in the implementation of COVID-19 vaccination campaigns targeting high-risk groups, including internally displaced people and host communities.

Part of the funds will also be used to purchase 5 fully equipped ambulances that will boost national efforts to strengthen the management of trauma cases, increase access to health care services, and facilitate transportation and referral of emergency cases among internally displaced people and host communities to the nearest health facility. As the crisis enters its eleventh year, 6.1 million people remain internally displaced and are at increased risk of infectious diseases due to limited access to safe water and sanitation, overcrowding and other risk factors. In Syria today, there are cases of epidemic-prone diseases like acute diarrhoea, leishmaniasis, and suspected hepatitis.

As of June 2021, only 47% of public hospitals are fully functioning, resulting in access to health services to millions being crippled. Shortages of trained health workers are very visible on the ground, as a result of more than a decade of war, and a declining economic situation.

“Syria is experiencing a protracted political and socioeconomic crisis that has resulted in a severe deterioration of living conditions. The scale, severity and complexity of humanitarian needs remain extensive. The health system has taken a devastating blow as a direct result of the crisis and aggravated by the sanctions coupled with the ongoing COVID-19 pandemic. Long-standing partners to WHO, such as the Government of Kuwait, help WHO ensure that health care services to all vulnerable Syrians continue uninterrupted, and help us fulfil our common vision of universal health coverage and health care for all by all,” added Dr Magtymova.

WHO is in the process of rehabilitating Daraa tuberculosis centre, planned for completion by the end of 202112 August 2021, Damascus, Syria – In response to ongoing conflict in Daraa, south Syria, WHO is working with the Ministry of Health and local health partners to respond to urgent health needs. 

“Escalating conflict in Daraa has resulted in significant population movement and increased health needs among an already vulnerable population. WHO has delivered essential supplies and is working with partners to make sure that urgently needed health services are being provided to all those who need them,” said Dr Akjemal Magtymova, WHO Representative and Head of Mission in Syria.

On 2 August, WHO delivered more than 7.6 tons of essential medicines and supplies to Daraa National Hospital and Daraa Health Authority. The shipment includes surgical and trauma kits and medical supplies, intravenous fluids and anesthetics, which are enough to provide almost 88 000 treatment courses, as well as support 830 trauma cases. 

Together with Al-Nour Foundation, WHO is supporting a mobile clinic that provides diagnostic services, laboratory, and radiology referrals. Five WHO-supported mobile medical teams are providing health services for displaced people and communities, and WHO is planning to deploy an additional 2 mobile teams, as well as health experts to identify the health needs of people living in shelters. Six ambulances previously donated by WHO in 2020 and 2021 to Daraa Health Authority are on the ground supporting referral services.

New waves of displaced people seeking shelter in schools and mosques, coupled with a volatile security situation in areas such as Dara Al Balad are creating challenges to the health response in the area. Damage to the essential dialysis water tanks in Daraa National Hospital has led to the dialysis department being out of service. 

WHO is actively working to restore non-functional and partially functional health facilities to ensure continued access to health care by people in the area. With the generous support of a number of donors, WHO is in the process of rehabilitating 2 primary health care clinics, a tuberculosis centre, and Nawa National hospital – all planned for completion by the end of 2021. When fully functional, these facilities will provide essential health care services to an estimated 1.025 million people living in the Daraa governorate.