19 November 2023, Damascus, Syria¬ – WHO and the Syrian Ministry of Health recently completed a joint evaluation of the country’s main disease surveillance system, the Early Warning, Alert and Response System (EWARS). Throughout the crisis in Syria, EWARS has been instrumental in detecting outbreaks of measles, cholera and other diseases and preventing their further spread. Health facilities across Syria submit weekly surveillance data to the Ministry of Health in Damascus for consolidation, analysis and response.

The EWARS mission team meets with local health officials in rural Damascus.
Photo credit: WHO/WHO Syria

The evaluation team, comprising experts from the WHO Regional Office for the Eastern Mediterranean, WHO Country Office in Syria and national counterparts, assessed 46 health facilities and laboratories in 13 Syrian governorates. The team’s preliminary findings indicate that EWARS is working effectively, with high levels of timeliness, completeness and acceptability – particularly at field level.

The team recommended that the list of diseases under surveillance is revised to include case definitions, and that disease thresholds are reviewed. It also recommended efforts to strengthen staff capacity, data quality and feedback loops.

Dr Iman Shankiti, Acting WHO Representative in Syria, said that the evaluation was timely: “The last evaluation of EWARS dates to 2017. This recent assessment is critical to help us ensure that EWARS remains agile and fit for purpose. We are committed to work with the Ministry of Health to strengthen EWARS and make it even more effective.”

Dr Sherein Elnossery, of the Infectious Hazards Prevention and Preparedness unit at the Regional Office, said that EWARS is a lifeline for people in Syria in the face of ongoing conflict and uncertainty. “EWARS has proven to be resilient, even in the face of the devastating earthquake that hit the country this year. By providing early warnings of outbreaks and emerging threats, it helps to save lives and protect the health of communities. I am proud to be part of the team working to strengthen this vital system.”

WHO will use the mission recommendations to develop a plan to strengthen EWARS and further increase its capacity to detect and respond to disease outbreaks and emerging threats.