The Syrian Arab Republic is experiencing a protracted political and socio-economic crisis that has resulted in a severe deterioration of living conditions because of the civil war that started in 2011. Up to 90% of the population is estimated to live below the poverty line, and at least 12.4 million people are in dire need of health assistance. As the crisis enters its tenth year, 6.7million people remain internally displaced and million people have fled the country as refugees. Hospitals are in a state of disrepair, requiring extensive maintenance and rehabilitation to provide a minimum level of essential health service delivery. The eruption of COVID-19 in the country on 22 March 2020 has further augmented the crisis.
The Routine Immunization Programme experienced a setback during the lockdowns from March to May 2020, which affected vaccination coverage due to domestic travel restrictions, cessation of all mobile routine immunization activities, and the suspension of mass immunization campaigns. But the Syrian Ministry of Health (MoH) maintained the Expanded program immunization (EPI) in primary health care units (PHC) throughout all this period, with special emphasis on physical distancing for the staff as well as the use of personal protective equipment (PPE).
With strong support from the WHO Country Office (WCO), MoH strengthened EPI activities after the lockdown, starting with a set of trainings for core staff in health and vaccination centres. The trainings coveredCOVID-19 case identification, investigation, reporting and follow up. WCO facilitated capacity building activities in all governorates,with 622 EPI team participants benefitting from increased knowledge.In addition, WHO organized induction and refresher trainings for vaccinators on the surveillance of vaccine-preventable diseases to boost early detection and response. To measure teams’ use of and adherence to WHO guidelines on distancing, use of PPE,and COVID-19 awareness-raising, WHO developed a monitoring tool. Further, WCO provided training on the Vaccine Management System (vSSM) for national and governorate EPI staff and MoH information management department. Also, WCO conducted a series of advocacy meetings for the private sector, NGOs, the Syrian Arab Red Crescent (SARC), and the academia,for ramping up vaccine-preventable disease surveillance,to monitor disease occurrence within the community.
In collaboration with WHO, Syrian Ministry of Health organised two rounds of National Immunization Days – one national and one sub-national polio campaigns in July and October 2020 respectively. As a result, more children especially in high-risk areas, like the camps for internally displaced people received polio vaccination. Additionally, WHO supports nationwide routine immunization in the Syrian Arab Republic and integration of vaccination in a comprehensive package of health services to increase vaccination coverage in the north-east of the country.
National Immunization Week Round 1 was conducted in June 2020, when 79039 children were vaccinated. Round 2 took place in November 2020. Together with repeating the multi-antigen approach of round 1, it provided an extra injectable polio vaccine for all children aged 3to 23 months, irrespective of previous vaccination history, to protect against vaccine-derived polio. 64 293 children were vaccinated in this round.
WCO supported MoH to strengthen supervision of vaccination campaigns at all levels from national to governorate to districts, with a special focus for the hard-to-reach and newly accessible population, like the people living in IDP camps. Furthermore, WCO was the implementing technical partner of MoH in the process of remapping communities and new settlements that is done regularly to follow population movement. The vaccination plan in the north-east of the country focuses on mapping high-risk areas with low routine immunization performance and developing special strategies to close gaps, training new vaccinators and providing on-the-job refresher courses for existing vaccinators. All these activities are aimed at ensuring outreach to vulnerable populations and hard-to-reach communities.
WHO aims to reach all populations across the country and those groups of people that are in hard-to-reach areas, e.g. camp and camp like settings and across differing control areas. This includes the three governorates in the north-east: Hassakeh,Deir ez-Zor and Raqqa.
In Deir ez-Zor governorate, the governorate is heavily affected due to several years of continued hostilities and civil unrest. With two Polio outbreaks in 2013 (37 NSL1) and 2017 (74 cVDPV2), WHO supported MoHboth technically and financially; the two outbreak were effectively dealt with and MoH was able to successfully end both after series of quality Polio campaigns. MoH conducted four Periodic Intensification of Routine Immunization (PIRI) rounds in 2020 (three of which were post-lockdown) and three special activities for nomadic populations –with around 3500 children under 5 years of age vaccinated (all were multi-antigen vaccination operations). WCO provided technical support –with a field presence in these particularly sensitive geographical areas –as well as financial support to cover all EP Iand polio activity operational costs, which include the transport of vaccines and personnel. More specifically, the PIRI actions in the northeast of the country, which faces a deficit of Primary Health Centers and vaccination sites, enabled reaching almost 40 000 children, who received all eligible vaccines. This this had a substantial impact on the reduction of the risk of communicable diseases, especially polio and measles.
Capacity strengthening for the Polio National Laboratory (NPL) was another major initiative for the health system in the Syrian Arab Republic. The country has a robust surveillance system for polio that was consistently able to track any deviation and guide response actions. In 2017it added environmental sampling to increase detection capability. With a major contribution from WCO, NPL became a referral laboratory capable of performing the most sophisticated polio tests.Currently, the National Polio Laboratory is accredited by the WHO as one of the referral laboratories in the EMRO region. Accreditation provides formal confirmation that the laboratory has the capability and the capacity to detect, identify and promptly report wild and vaccine-derived polio viruses that may be present in clinical and environmental specimens. WCO funded all supplies and equipment required by the NPL and supported capacity building for senior NPL staff through internal and external workshops, in coordination with the WHO Regional office.
The national programmes upported by WHO prioritizes capacity building at the national and the subnational level, innovative solutions for hard-to-reach areas located in the Autonomous Administration of North and East Syria (NES), like the periodic intensification immunization activities.
Photo caption: Polio immunization campaign supported by WHO.
Photo credit: WHO
