2014 Syrian Arab Republic Humanitarian Assistance Response Plan (SHARP)

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SYRIAN ARAB REPUBLIC HUMANITARIAN ASSISTANCE RESPONSE PLAN 2014 from school, reducing quality and quantity of foods consumed, residing in crowded and unclean shelters, begging, child labour and other risky income-generating activities to cope with the crisis. The Joint FAO/WFP Crop and Food Security Assessment Mission (CFSAM) in July 2013 found agricultural workers engaged in disruptive coping mechanisms, such as the sale of household assets and livestock, and in some cases of forced early marriage and temporary work for armed groups. WFP beneficiaries increasingly report resorting to begging in order to survive – from 5 to 9 percent in March to May 2013. 11 Given the declining capacity of host communities to cope with the crisis themselves let alone support displaced people, secondary and additional displacement is expected. Increased disruption of health and social services The crisis has disrupted the capacity of the government and private health centers and clinics in affected areas to provide basic health and social services to the population, contributing to increased mortality and morbidity, higher risk of outbreak of communicable disease, increased risk from vaccine-preventable diseases, increased vulnerability to mental health and psychosocial distress and disorders and incidence of malnutrition and decreased child and reproductive health outcomes. Extreme stress on infrastructure systems and severe deterioration of urban functionality have left many towns and large parts of cities without markets and social and public services. These systemic disruptions have also become a cause of further displacement. If the crisis continues, the current health situation is anticipated to deteriorate further and significantly disrupt vaccination coverage rates. Interruption to the regular distribution of vaccines, increased wastage due to difficulties in maintaining the cold chain and access constraints have reduced vaccination coverage rates and increased vulnerability to communicable diseases such as polio and measles. As of November 2013, 17 cases of polio of foreign origin were confirmed in Deir-ez-Zor governorate, one case in rural Damascus and one in Aleppo, marking the first time since 1999 that polio has been reported in Syria. Previously, a polio-free country due to its effective polio eradication programme employing a routine immunization system, Supplementary Immunization Activities (SIAs) and an Acute Flaccid Paralysis (AFP) surveillance system, the immunization rates have dropped and, currently, there is widespread circulation of the wild polio virus in the country. According to a Ministry of Health (MoH) report in October 2013, 64 percent of public hospitals and 38 percent of public healthcare centres are either damaged or out of service due to the crisis. Forty-nine percent of primary healthcare centres which provided reproductive healthcare services are reported as not functional in the affected governorates. Eight of the 23 health centres operated by UNWRA across Syria have been forced to close due to crisis-related damage or insecurity, and a further 7 are working on reduced hours. A disruption to fuel and electricity has forced many hospitals to operate on reduced capacity or to close, despite an increased caseload of patients. There remains a critical shortage of life-saving medicines and medical supplies, including medicines needed for treatment of chronic diseases. 12 Prior to the crisis, Syria met 90% of the demand for medicines with domestic production. Substantial damage to pharmaceutical plants has led to a 65-70 percent decline in domestic production while unilateral economic and financial sanctions limit substantially the importation of medicines and medical supplies. Dispatching humanitarian medical supplies, when they are available, to areas in which there is presence of armed groups is challenging. The health workforce has been significantly reduced as many numbers of doctors are outside of Syria. 13 Affected governorates lack qualified medical expertise particularly for trauma, anesthesia and specialised laboratory personnel. For those health workers that have remained, it is difficult and dangerous to report to duty under the current circumstances, with a significant number of public health workers from the public system reportedly directly affected by crisis (127 killed and 111 injured). According to the Ministry of Education (MoE) 14 , approximately 3,004 schools have been damaged or destroyed and 1,068 schools are being used as shelters for displaced persons, while other schools cannot be reached by the MoE. The MoE estimates at least 1.9 million children have dropped out of school since the onset of the crisis, approximately 1.1 million of whom remain in Syria (UNHCR Syria Regional Refugee Response). For much of 11 FAO/WFP: Joint Crop and Food Security Assessment Mission to the Syrian Arab Republic, July 2013. 12 WHO Regional Situation Report: Syrian Arab Republic, Jordan, Lebanon, Iraq Issue 14, 24 April-23 May 2013. 13 According to the Office of the Prime Minister, September 2013. 14 Government of Syria, Ministry of Education, October 2013. 15
SYRIAN ARAB REPUBLIC HUMANITARIAN ASSISTANCE RESPONSE PLAN 2014 2013, 76 out 118 schools in Syria supported by UNRWA were closed due to damage or insecurity, while a further 10 operated as emergency shelters for displaced Palestine refugees. As a result, only 35 percent of Palestine refugee children regularly accessed school in the first half of 2013; though encouragingly, this number rose to over 60 percent at the beginning of the new semester in 2013. UNRWA has been granted the use of 41 government buildings in safer areas as alternative school locations. The Ministry of Water Resources (MoWR) estimates a decline of approximately 40 percent in clean water available in the country overall, but in some cases, water production has dropped down to zero percent (production for a limited number of days and at certain times), contributing to the overall decline in health conditions as people depend on unsafe water sources. In Al-Hassakeh, the interruption of the power supply to water treatment plant was directly correlated with incidence of diarrhea cases in Al Shadadeh village. The availability of safe and clean water is severely limited in areas where extensive damage has occurred to the water and sanitation infrastructure, such as Aleppo, Ar-Raqqa, Damascus, Deir-ez-Zor, Homs, Idleb and Rural Damascus. An estimated 35 percent of water treatment plants have been damaged while the national production of water treatment chemicals has come to a halt. Most water utility/feeder establishments depend upon provision of the chemicals needed for potable water production by humanitarian actors. Lower efficiency at water treatment plants has increased the level of discharge of untreated wastewater which is associated with high risk of ground and surface water contamination. The MoWR warns of an eminent environmental disaster related to the safe breakdown of waste water management and hospital waste disposal. Meanwhile, solid waste disposal and collection has been disrupted across the country, and in particular in large cities. In parts of Aleppo, Deir-ez-Zor, Homs, Idleb and Rural Damascus, solid waste management has emerged as a huge public health concern due to lack of garbage collection. Scope of the crisis and demographic profile of the affected population The UN estimates 9.3 million people are in need of humanitarian assistance inside Syria, more than 6.5 million of whom are internally displaced. 15 Close to half of the people remaining in Syria (44% of an estimated 21.3 million people) require humanitarian aid, a 37 percent increase since April 2013. Internally displaced persons, host communities, and other communities are directly impacted by the crisis, as are at least 270,000 Palestine refugees. The magnitude of humanitarian needs are mainly concentrated within active crisis zones, areas of large scale displacement, and final destination/receiving areas. Areas that are currently hosting displaced populations are experiencing increasing strain on public and basic facilities. Some IDPs are concentrated in areas with limited or no crisis-related damage and with some level of urban functionality to enable access to basic social services, health and markets. Internally displaced families who have lost their income sources, the urban poor who are mainly dependent upon markets, subsistence farmers, small-scale herders, casual labourers and petty traders are the among the most affected groups. 1 SHARP 2012 (Jun- 2012) Number of people in need (in millions) 37% increase since April 2013 2.5 SHARP 2012 (Sep- 2012) 4 SHARP 2013 (Dec- 2012) 6.8 SHARP 2013 (Apr- 2013) 9.3 SHARP 2014 (Sep- 2013) People are expected to continue to move away from areas that have experienced significant, damage and deteriorated basic and health services, to seek safety and assistance elsewhere. In parallel, the number of people in need inside Syria is expected to increase as the concentration of population overwhelms local basic and health services capacity, access to food and water decreases and alternative livelihood opportunities become less. 15 The planning figures represent estimates derived from triangulation across a number of sources. 16
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2014 Syrian Arab Republic Humanitarian Assistance Response Plan (SHARP)

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