8.6 M PEOPLE IN NEED 5.63 M TARGET 3.1 M DISPLACED 268,000 RETURNEE HIGHLIGHTS EWARN. **reported by health facilities ***subject to field verification

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1 UIMS Al Qaim PHC in Anbar 8.6 M PEOPLE IN NEED 3.1 M DISPLACED 5.63 M TARGET 268,000 RETURNEE HIGHLIGHTS - The Iraq humanitarian pool fund (IHPF) 2015 is in process. Eight projects were submitted to the IHPF. The health cluster has been allocated 100 % of the requested amount. - The Health cluster has developed the Cholera preparedness plan for effective response to any emerging outbreak of cholera among the vulnerable affected people in Iraq. - Health cluster partners provided 83,257 consultations to affected people, including 989 referrals, 7,799 hospitalizations and 13 surgical operations. - The health cluster responded to emergency needs of IDPs from Anbar conflict including WHO donation of 2 Mobile Medical Clinics (MMCs), 10 ambulances, and six Mobile Medical Teams (MMTs) delivering essential health services to IDPs. 51 HEALTH CLUSTER PARTNERS 5.8 M COVERAGE POPULATION MEDICINES STOCK AVAILABLE HEALTH FACILITIES 7,800 TRAUMA KITS A & B ITALIAN EHKS/IEHKS 2,531 TOTAL HEALTH FACILITIES 197*** HEALTH FACILITIES AFFECTED DISEASES EWARN 15 7,625 2,088 FUNDING $US TOTAL DISEASES ALERTS REPORTED AND INVESTIGATED NO. OF HOSPITL ADMISSIONS NO. OF BIRTHS ASSISTED BY A SKILLED ATTENDANTANT BIRTHS BY CESAREAN SECTION 65 REPORTING SITES (CURRENT) 60 M FUNDING REQUIRED **reported by health facilities ***subject to field verification

2 Humanitarian Situation and Public Health Risks The overall humanitarian situation in Iraq remained unchanged, although slight increases in the number of Internally Displaced Peoples (IDPs) and a geographical shift in humanitarian needs was reported. The security situation in Al-Ramadi and other major towns in Anbar governorate remains fluid. Approximately 100 families were reported to have been newly displaced from Habbariya and Kassra (28 and 50 km north of Nukhaib, respectively), with Primary Health Care (PHC) facilities closed in both areas. In contrast, over 1500 displaced families in Salahuddin governorate returned to their home town of Tikrit between the 23 rd and 29 th of June. To assist resettlement, the Federal Ministry of Health resumed rehabilitation work for Tikrit s Salah Al-Din General Hospital. During this same reporting period (week 26), Erbil governorate in KRG recorded the arrival of 907 new families, of which 823 families were from Anbar and 84 from Ninewa governorates. Due to increased security risks in Anbar province, two further PHC facilities were closed in Habbariya and Kassra cities. Even still, Anbar Department of Health (DoH) was able to support Faris Alrabi, Khlidiyiah and Al Nukhaib health sectors with two consignments of medical supplies and pharmaceuticals. This was complimented by one ton of medical provisions given to the WHO clinic managed by United Iraqi Medical Society (UIMS). The Federal Ministry of Health (FMoH) successfully mobilized two mobile clinics from Basrah DoH to Amiriyat Al Falluja, but Senone Hospital and PHCs in Siniar and Nenewa continue to report shortages in medical supplies, healthcare workforce and funding concerns restricting service delivery in liberated areas. Collaboration between Ninewa DoH and German International cooperation (GIZ), is seeing the establishment of a new PHC facility in Kebirto IDP Camp in Dohuk governorate, KRG, to be operational within three weeks. In the last week of June, three cases of malnutrition were reported amongst IDPs in Numanyhea district in Wassit governorate; these cases were referred to Numanyhea Hospital for nutritional rehabilitation. Finally, Qustapa camp for Syrian Refugee reports indicate a shortage in medicines for chronic disease treatment, and highlight the diagnosis and treatment of 12 cases psychological disorders by Un Ponte Per (UPP). Ten deliveries were reported in May with another 11 pregnancies registered in this reporting week. Public Health Priorities, Needs and Gaps Public Health Priorities: Enhancing local capacities to reduce the risk, prepare for, detect and respond to outbreak of diseases among the conflict affected population. Ensure improved access to essential package of life-saving health care services, including essential reproductive health (RH) and the Minimum Initial Service Package (MISP) to most vulnerable groups of boys, girls, men and women among affected population. Ensure maximum level of vaccinations by thorough monitoring of immunization coverage and launching of immunization mass campaigns. 2

3 Maintaining stable maternal and child mortality rates through ensuring minimum emergency obstetric and child health services for the IDPs and other affected communities. Needs and Gaps Compromised access to essential lifesaving package of health care services in hard to reach, conflict affected and armed group (AG) controlled areas. Inadequate health related human resources, leaving tangible gaps in the availability of female health workers and medical staff in remote areas. Inadequate national and local capacities, including access and security constraints in expanding the reach of surveillance systems to ensure early detection, response and management of communicable disease outbreaks. Interrupted chain of supply of essential medicines and vaccination, resulting in a low coverage of routine vaccination among children under five. Inadequate or lack of life-saving maternal and child health care services, including Basic and Comprehensive Emergency Obstetric, Neonatal and Child (EmONC) care and Antenatal Care (ANC) services. Inadequate or lack of essential drugs and medical supplies for management of common diseases, particularly for non-communicable diseases (NCD). Communicable Diseases Number of reporting sites: During July, 62 reporting sites including 9 Refugee, 40 Internally Displaced People s (IDP) camps and 13 mobile clinics submitted timely and complete weekly reports. Total number of consultations were 60,688, with 47% male and 53% female (male=28,765 and female=31,923). Leading causes of morbidity in the camps: During July, acute respiratory tract infections (ARI) (n=19,748), acute diarrhea (n=5,485) and skin diseases (n=2,695) were the leading cause of morbidity in all the camps. The figure for acute diarrhea has increased in trend during the summer months. The proportion of Acute Diarrhea in IDP camps has gradually decreased 1% per week since week 27 (week %; week %) whilst the opposite trend is seen in refugee camps with a 2% increase since last week (week %; week %). ARI reports show a general decreasing trend attributed to the summer months, with upper ARI in weeks 27/28 (89%) and 28/29 (84%) decreasing by 5%. Although lower ARI showed an increase of 5% between weeks 27/28 (11%) and weeks 28/29 (16%). 3

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5 Partners Report Health & Nutrition-IDP Crisis: UNICEF July 2015 Health and Nutrition response activities to the IDP crisis in Iraq in July continued to focus on neonatal care services, growth monitoring and nutrition screening for children under 5, and routine measles vaccination for children 0-12 months through PHC and other facilities located in or adjacent to IDP camps in priority governorates (Baghdad, Diyala, Basra, Ninewa, Kirkuk, Sulaymaniyah, Dahuk and Erbil). In July, UNICEF in close collaboration with the Ministry of Health (MoH) reached 1,066 children with new-born care services, helping new mothers and infants navigate their first weeks together. Growth monitoring services reached 2,326 children in July, screening them for signs of malnutrition. Those who were detected with malnutrition received relevant information, supplies and appropriate referral. For each newborn screened, the mother receives complementary counseling on infant and young child feeding, ensuring that caregivers are informed about children s nutritional needs and how to meet them. As reported in June, vaccination continues to be a priority for UNICEF and the MoH, given the high numbers of measles cases reported in the first half of especially in and around Baghdad Governorate. 19,592 children received routine measles vaccination, with ongoing collaboration between UNICEF and the DoH at governorate level. The majority of children reached with measles vaccine was in Baghdad governorate and came from displaced populations who are considered to be at high risk. UNICEF and the Nutrition Research Institute (NRI) screened 1,750 children for malnutrition in Laylan and Yahyawa IDP camps in Kirkuk. Six teams consisting of two health workers and one supervisor were used in the screening exercise. The data is being analyzed by NRI, and used to strengthen UNICEF and partners existing response to child nutrition. An additional 2,000 IDP children from Anbar were included in a similar assessment carried out in Aliyawa and Saad camps in Diyala in July. UNICEF dispatched nutrition supplies to the MoH for response to IDP nutrition and health needs in selected PHCs and hospitals. Supplies included supplementary and therapeutic food (6,300 cartons), anthropometric equipment (200 height measuring instruments, 100 portable baby/child measurement sets, 80 electronic baby scales and 60 manual breast pumps). The supplies also included 15 interagency emergency health kits ( IEHK2011 ), each estimated to cover 10,000 people s medical needs for up to three months. Adequate monitoring of health and nutrition activities, and quality assurance of facilities and service delivery points led by government counterparts, remains a concern for UNICEF. Consistent and focused monitoring is critical to ensure that women, children and families receive quality services that meet their needs. Lack of access to populations in need remains a concern for health and nutrition actors, including UNICEF. Insecurity significantly affected delivery of critical services, particularly in areas of Anbar Governorate. Lack of funding for the IDP response remains of grave concern for UNICEF and health partners. With limited resources, UNICEF-supported capacitybuilding on neonatal care and newborn services will be seriously affected, as will the current nutrition and disease prevention programmes, including provision of essential health supplies to high priority areas. 1 According to WHO, there were 603 confirmed measles cases by July 2013, as compared to 976 by July Baghdad Governorate remains the most heavily affected Governorate. (WHO, IRAQ: Measles cases evolution (January to July ) lab-confirmed-cases-from-january-to-july&Itemid=626&lang=en 5

6 Médecins du Monde (MdM) Continuing its interventions in Dohuk governorate (running PHCs in Dawodia and Chamiskhu camp), Medicine du Monde (MdM) also started to implement activities in Kirkuk governorate on July 2015, in order to responsd to the high number of IDPs and vulnerable host communities. MdM put in place 2 mobile clinics in the East of the governorate, targeting Daquq and Kirkuk districts. Mobile clinics are supporting the PHC facilities in Badawa and Khalobaziani, due to the increased number of people in need. Better collaboration with MoH staff is ensuring all incoming patients are attended to; IDPs and vulnerable host communities. Consultations, antenatal and post-natal cares are conducted by medical doctors regularly. Picture: Médecins du Monde Medical consultation in Badawa Coordination has also been increased with other international and local partners, working across governorates. A potential partnership with FUAD has been discussed and will be implemented to facilitate referral of IDPs to specialist medical doctors and so increased their access to healthcare system. IOM health response During July 2015, 5 IOM mobile medical teams (MMT) in Erbil, Sulymaniyah, Duhok and Kirkuk conducted 3336 PHC consultations amongst IDPs and host communities. Furthermore, IOM static clinic in Shekhan Camp (Duhok) received 2630 patient visits. From all the above mentioned cases, 231 cases were referred for further investigation or treatment to secondary or tertiary health facilities. A total of 69,637 PHC consultations have been recorded since the beginning of IOM is supporting the National Tuberculosis (TB) Program with one mobile team in each of Erbil, Duhok, Sulymaniah and Kirkuk governorates. Mobile teams have supported 283 confirmed TB cases in KRI by providing transportation assistance and directly observed treatments (DOT) for each of the cases. 57 contact relatives were traced, and a further 122 TB presumptive cases were screened (by X-ray and/or sputum). 6

7 WHO response updates: WHO, as health cluster lead, has been working very closely with health partners to respond to health needs. The following were identified as the most pressing health needs: 1. Ensuring access to essential life-saving health care and supporting the provision of primary health care (PHC) services, including mental health and non-communicable diseases. 2. Supporting the early detection of and response to communicable diseases. 3. Supporting maternal and nutritional health services in locations with identified gaps. 4. Supporting referral services through providing equipment, kits and personnel to secondary and tertiary health facilities to ensure continuum of care for complicated cases. In addition to its on-going effort in supporting the Ministry of Health with respect to the above mentioned health needs, the following were achieved during the month of July: Two Mobile Medical Clinics (MMCs) donated by WHO with support from the Kingdom of Saudi Arabia to the FMoH, 10 ambulances, and six Mobile Medical Teams (MMTs) are still delivering essential health services to the new displaced population in Anbar governorate. Anbar DOH, temporally performing from Baghdad, has, moreover, distributed 34 permanent and resident doctors to Ameryiaht Alfalluja General Hospital with additional eight male/female doctors relocated to support Habbanyiah tourist city PHC facility. An additional 50 medical staff including dentists and pharmacists were also deployed to Faris Alarabi health sector in the governorate. A second PHC facility named Al Razi was opened in Tikrit, capital of Salah Aldin governorate this reporting week after the operation of Ibn Rushid centre earlier in June. Salah Aldin DOH supported the newly opened centre with medicines and supplies to respond to the health needs of returning civilians. Salah Aldin DoH has also been granted the FMoH approval on the budget raised to rehabilitate Salah-Aldeen. Baghdad Al-Karkh DoH representatives visited Dahaa Alrawi IDP camp in Al Khadhraa district, west of Baghdad. The camp accommodates 109 families, medically served by a mobile medical team with ambulance deployed by the Al- Khadhraa PHC facility. Drinking water and sanitation services are available. EPI was also administered children below the age of five living in the camp. WHO health partners held an emergency meeting with the management of Arbat Hospital in Sulaimaniya governorate, KRG. The provision of secondary health services delivery to IDPs and Syrian Refugees was assessed to prepare for required action. The WHO lead Health Cluster coordinated a meeting for the health actors including UN agencies, governorates DoHs and NGOs to discuss the Cholera and Avian flu preparedness plans put in place in anticipation of any seasonal outbreak. A set of recommendations were made focusing on renting tankers for transporting drinking water to IDPs, performing stool swab tests for each watery diarrheal case, distributing aquatabs to displaced populations in areas where no pipe water is available and ensuring daily monitoring of residual chlorine levels in areas surrounding PHC facilities. 7

8 A team from Diyala DoH conducted a visit to Saad IDP camp in Baquba, the largest city of Diyala governorate. The visit aimed at assessing the availability of drinking water in the camp, measuring the level of chlorine in the water supply to the camp, and following up on the medical, laboratory, and vaccination activities. Educational session was also given to camp residents on the use of ice blocks for cooling purposes only. Environmental negative indicators were identified and a note submitted to relevant authorities for treatment. The surveillance unit in Basra DoH has joined the EWARN system as of last week and are applying it to the Basra IDP camp alongside other sentinel sites across the governorate. United Medical Institute of Science (UIMS) response updates: WHO response updates: In Ameriyat Al-Fallujah, UIMS supported by WHO, continue to provide primary health services for IDPs in Al-Salam PHC. Managed by UIMS and located inside the IDP camps, this facility conducted 5524 consultations throughout July. Physical examinations, laboratory and pharmaceutical services alongside the dental and specialist care are provided across morning and night shifts. Weekly EWARN and general reporting was provided to WHO. Domoah delivery room in Ameriyat Al-Fallujah, supported by UNFPA and managed by UIMS, continues to provide services to IDPs. July reports showed 311 consultations and 7 successful natural deliveries. The other PHC facility managed by UIMS is Al-Amal, located in Al-Nakheeb IDPs camp. Supported by WHO, this facility reported 1462 consultations during July and continued reporting in to the EWARNs and WHO directly. Although the security situation in Al-Qaim remains tense, UIMS continues to manage the PHC facilities in Al-Obeidi camp for Syrian refugees in Al-Qaim. Supported by UNHCR, this facility reported 290 consultations in July. Although internet connectivity has been an issue, weekly reporting has been maintained to WHO. 8

9 Health Cluster Coordination The health cluster in Iraq has been working within the Iraq humanitarian response program framework along with national and international health partners towards maximizing access to life-saving essential health services for affected population. This is coupled with mitigation and contingency preparations for and responding to public health risks. The following coordination activities were undertaken by health cluster along with health partners during the month of July: Regular Health Cluster meetings were conducted at the national level as well as subnational level in Erbil, Dohuk and Sulaimanyiah as technical working groups, including medical referrals and nutrition conducted their regular meetings at the national level. The cluster actively participated in the contingency planning led by HCT through contribution of health cluster inputs into the planning process. Played an active role in the Inter-Cluster Coordination mechanism at the national as well as sub-national levels. Participated and represented the cluster partners in the Humanitarian Pooled Fund allocation process and developed health cluster response plan and priority projects for consideration by the IHPF panel led by the humanitarian coordinator. Facilitated the initiative for inter-cluster coordination in Kirkuk and activation of health sub-national cluster led by Medair on behalf of health cluster Facilitated and contributed to health cluster cholera preparedness plan and engaging the WASH cluster. Produced up to date weekly monitoring reports, 3Ws maps and cluster snapshots on the achievements, needs and gaps in the health cluster. The cluster provided inputs to weekly humanitarian sitreps and monthly dashboard produced by OCHA. IMC representative in the cluster was endorsed as Cluster Co-Coordinator. 9

10 Stock of Essential Medicines and Available (WHO) No Description Unit form Erbil Total Stock 29/6/ IDDK (Diarrhoeal Support Module) Sulaymaniyah Total Stock 29/6/2015 Kit Kits 4.00 Kits Dahuk Total Stock 29/6/ IDDK (Diarrhoeal Basic Module) Kit Kit Kits 1.00 Kits 3 IDDK (Diarrhoeal Infusion Module) Kit Kits 4 IDDK (Diarrhoeal ORS Kit Kits 5.00 Kits Module) 5 IEHK BASIC (Medicines) Kit Kits Kits 2600 Kits 6 IEHK SUPPLEM.UNIT (Boxes 1 to 30) Kit 8.00Kits 2.00 Kits 7 NSTITUTION KIT WITH 4 FILTERS Kit Kits KITS Kits 8 TRAUMA KIT A Kit 6.00Kits 1.00 Kits 9 TRAUMA Kit B (Support for Kit A) Kit 11.00Kits 3.00 Kits 10 ALUMINIUM HYDROXIDE tab 34,600.00Tablet Oral 11 SALBUTAMOL tab 489, Tablet Oral 4 mg 12 SALBUTAMOL Aerosol 3, Aerosol Inhalation Aerosol Inhalation 0.5% in 20 ml 13 SALBUTAMOL Aerosol 4, Aerosol Inhalation 100 mcg 14 ATENOLOL tab 2,265,000.00Tablet Oral 50 mg 15 ATENOLOL tab 2,123, Tablet Oral 100 mg 16 CAPTOPRIL tab 1,415, Scored Tablet Oral 25 mg 17 DIGOXIN tab 86, Tablet Oral 250 μg 18 GLIBENCLAMIDE tab 4,149, Tablet Oral 5 mg 19 OXYTOCIN Injection 3, Ampoule Injection 10 IU in 1-ml 20 ADHESIVE TAPE->Silkplast adhesive tape SURGICAL SUPPLIES 9,400.00Units 10,000.00Units 21 BANDAGE crepe SURGICAL SUPPLIES 58, Units 31,440.00Unit 22 Zinc Oxide Tape SURGICAL SUPPLIES 11, Units 8,640.00Units 10

11 Funding Update The table below shows funding requirements for the Health Cluster from 1 July to 31 December 2015, planned to respond to the health needs of 5.63 Million IDPs and host communities Funds requested Funds received Funding gap Health Cluster 60 Million 35.7 FundFunds million 59% Editorial Dr. Mohammad Dauod Altaf, Health Cluster Coordinator, Iraq Abdulrahman Raheem, National Health Coordinator, WHO Zubin Malhotra, Communications and IM, WHO Dr. Sangar Rashid Perdawed, Health Coordinator, IOM altafm@who.int raheemab@who.int zmalhotra@immap.org sperdawed@iom.int See also the cluster website: 11