Humanitarian Assistance Response Plan (1 January - 30 June 2013) 19 December 2012

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1 Government of the Syrian Arab Republic Humanitarian Assistance Response Plan (1 January - 30 June 2013) 19 December 2012 Prepared in Coordination with the United Nations System

2 TABLE OF CONTENTS 1. EXECUTIVE SUMMARY... 1 Table I. Summary of requirements and funding by sector... 6 Table II. Summary of requirements and funding by RESPONSE PLAN Strategic objectives for humanitarian assistance response Needs and response summary Sector response plans Food Non Food Items (NFIs) and Shelter Health Water, Sanitation and Hygiene (WASH) Education Livelihoods Community Services Coordination Logistics and Emergency Telecommunications Staff Safety Services ROLES AND RESPONSIBILITIES ANNEX I. LIST OF PROJECTS BY SECTOR Table III. Detailed list of projects by sector ANNEX II. ACRONYMS AND ABBREVIATIONS... 49

3 1. EXECUTIVE SUMMARY The events in Syria since March 2011 have resulted in significant humanitarian needs that have now spread to many areas of the country, and have further grown since the drafting of the revised Humanitarian Assistance Response Plan (HARP) in September The Government of Syria, in collaboration with UN agencies, is launching a new HARP for the period from 1 January 2013 to the end of June This plan will serve around four million people, as estimated by the UN, that have been directly or indirectly affected by the current events including the drought, among them two million who have left their homes because of the current situation. As under the previous plans, the directly affected populations include those injured during the events, families who lost their breadwinners or left their home areas as well as relatives, friends and communities hosting them. The indirect effects of the current events threaten a second major category of Syrians due to multiple effects of the current events. These include primarily: the aggravation of poverty; damage to housing and infrastructure including water and power utilities, schools, medical and other social service facilities, industrial and agricultural infrastructure (including fertilizer production and pharmaceutical industry); shortages of fuels, which affect the whole economy, including electricity and water supplies as well as transportation; disruptions to telecommunications; a rapid shrinkage of the private sector and most importantly the informal sector that employs a large proportion of the population leading to livelihood losses and rising unemployment, including in industry, agriculture and tourism; unsafe movement on major routes in the country and across borders is hindering internal and external transit and trade and inflating prices; the rising costs of imports due to devaluation of the local currency. The effect of economic sanctions is further aggravating the situation, in particular as international transactions become more difficult for both the public and the private sectors. Sanctions also significantly affected the import of fuel derivatives, which created shortages in the local market and resulted in the increase of prices of diesel and heating oil, as well as overall living costs for families. The need for humanitarian assistance in affected areas is increasing in order to save lives and to avoid a large segment of the Syrian population falling into destitution and seeing a further decline in their health, psychological and nutritional status. All humanitarian assistance is, and will continue to be, delivered with full respect to the sovereignty of the Syrian Arab Republic during the implementation of this Response Plan. Decisions on strategic or logistical issues including field office locations should be done after formal consultations with the government in order to receive the clearance and accreditation. This revised Response Plan will be implemented according to UN General Assembly Resolution 46/182, titled Strengthening of the Coordination of Humanitarian Emergency Assistance of the United Nations and the Guiding Principles in its annex. The priority needs differ from one area to another: in the directly affected areas, life-saving measures including food assistance, water supplies, nutrition and emergency medical services and non-food items are the priority and need scaled-up support. Support to the government in the rehabilitation and reconstruction of critical infrastructure and vital services is required in a number of locations. Adequate alternative shelter arrangements are urgently needed for those that left their homes as a result of the current events and are currently staying in schools and other public facilities with limited sanitary facilities. Until affected people are able to safely return home, they are in need for additional assistance, including food, mattresses and bedding, kitchen and hygiene sets, clothes, baby supplies and other basic items. Many have lost their sources of income and require cash assistance and income-generating activities in order to cover their immediate requirements for a minimum standard of living. The increasing number of 1

4 families who lost their primary income earner requires particular attention in order to avoid the resorting to negative coping strategies. Adequate sanitary conditions and access to clean water are crucial in these temporary settings to avoid the outbreak of diseases. As host communities resources are becoming increasingly exhausted, they need additional support, including through the provision of food and non-food items. Schools, medical facilities and other public infrastructure and services in indirectly affected areas need to be upgraded or rehabilitated in order to cope with the additional number of people and needs. Access to education is critical for the children affected by the events. The Ministry of Education (MoE) has encouraged the enrolment of all children affected. The generosity of the school principals has been remarkable, but challenges remain. The figures provided by the Ministry in fact show that some governorates have very low attendance rates, because schools have been targeted or are hosting people that left their homes. Full attention should be given to cases of most affected children. Those affected by the on-going events, in particular children and women require access to psychosocial support to cope with their negative experiences. Once the situation allows for the return of those that have temporarily left their homes, the restoration of livelihoods and the reconstruction or rehabilitation of homes and infrastructure is critical for their sustainable reintegration. Direct cash assistance may be needed, particularly for those that have left their homes because of the current events for a considerable period of time and have lost their means of livelihoods and income as a result of the events. The Syrian Arab Red Crescent (SARC) has been designated as the leading national provider of humanitarian relief and through its thousands of trained and committed volunteers has provided the bulk of humanitarian assistance to date. SARC s own analysis states that humanitarian needs are growing daily and that its capacity has to be further enhanced to respond to these needs. More can be done to ensure more regular and predictable supplies to SARC and to further build its capacity. To date, most relief items have been purchased in-country. While this continues to be the preferred approach, other complimentary options may have to be explored, especially because essential supplies, like for example medicines are less available compared to the situation before to the current events. Purchases inside the country will also be affected by inflationary pressures. The participation of other international and national NGOs and community-based organizations, as reiterated by the participants of the joint Humanitarian Group Meeting that was held on 5 November 2012 in Damascus, has proven be very beneficial. The UN agencies welcome the willingness of the Government of Syria to support the expansion of local stakeholder s efforts to strengthen the response to the growing needs. Under the Humanitarian Assistance Response Plan, the UNCT and its partners in collaboration with SARC and under the leadership of the Government of the Syrian Arab Republic have significantly scaled up their activities and there is an urgent need for more humanitarian assistance to reach those in need. Humanitarian activities include, inter alia: the monthly distribution of food for 1.5 million people in all 14 governorates; provision of basic household and winter items and cash assistance to those who have left their homes because of the current events; rehabilitation of communal shelters, with a particular focus during the winter, the delivery of water and hygiene support to and the upgrading of sanitation facilities in communal centres housing people that had to; provision of additional health and education services; commencement of a country-wide measles and polio vaccination campaigns; and, provision of livelihood support to poor affected farmers and herders. As there is a threat from explosive remnants of war (ERW), in particular for people that have left or return to their homes, as well as aid workers, SARC volunteers, risk awareness and risk-reduction activities need to be prioritized to avoid casualties. 2

5 UNRWA, with the support of the General Authority for Palestine Refugees in Syria (GAFAR), has continued to provide multi-sector humanitarian assistance to the Palestine Refugees in Syria, also affected by the current events. This Response Plan builds on the findings of recent sectoral assessments undertaken by concerned ministries (e.g. Ministries of Education, Social Affairs and Labour, Agriculture and Agrarian Reform, and local administration) and UN agencies, including through field missions to affected governorates. It aims at adequately responding to the increased humanitarian needs of the population directly and indirectly affected by the current events in Syria from January 2013 to end of June In terms of the most urgent needs, the 2013 Response Plan considers the following four categories of the affected population, in order of severity: People located in or near areas subject to armed activities. Affected populations who have moved to other areas. Host families and communities. Poor people in urban and rural areas suffering from the multiple effects of the current events, including the impact of economic sanctions. This Humanitarian Assistance Response Plan aims at supporting the Government of Syria s efforts in providing humanitarian assistance to the affected populations. It will cover the period from 1 January 2013 until the end of June The financial requirements amount to $519,627, In recent months, the current events have been affecting an increasing number of people across larger portions of the country while the economic decline, aggravated by economic sanctions, is now being felt by all Syrians alike. Although no new comprehensive needs assessment has been conducted recently, sector needs assessments, combined with the figures provided by the Government, give an indication of the actual number of people affected and in need of humanitarian assistance. Additional sector needs assessments are on-going, jointly with the different governmental counterparts and their findings will be used to respond to the identified growing needs. The June 2012 Rapid Access to Food Needs Assessment (JRFSNA), conducted by the Ministry of Agriculture and Agrarian Reform (MoAAR), is currently being updated and will be completed in the second half of December The Ministry of Local Administration (MoLA) and UN and local partners are conducting assessments of collective shelters hosting affected people who have left their homes because of the current events. An assessment for the WASH Sector, in collaboration with the Ministry of Water Resources (MoWR) is also under-way. Recent data from the Ministry of Health (MoH) show that 35% of hospitals and approximately 10% of health centres are reported as damaged. The emergency transport system is affected by a shortage of available ambulances as over 40% of the total available ambulances have been damaged. Patients as well as health care workers face problems reaching health facilities as a result of the on-going events. Assessed shortages of life-saving medicines (including for noncommunicable diseases), personnel and medical equipment indicate that additional assistance in the Health Sector are required in order to meet the increasing needs, especially the needs of those injured during the events as well as those with chronic diseases that require uninterrupted treatment and medication. The combined effects of economic sanctions, currency fluctuations, 1 All dollar signs in this document denote United States dollars. Funding for this Plan should be reported to the Financial Tracking Service (FTS, which will display its requirements and funding on the current appeals page. 3

6 and unavailability of hard currency, fuel shortages, and increases in operational costs have adversely affected the production of medicines and pharmaceutical products. Recent data from the Ministry of Education show that about 2,000 schools and other public buildings are currently hosting people that left their homes, often in overcrowded and inadequate sanitary conditions. UNRWA is mandated to provide services to 525,525 Palestine refugees living in Syria. UNRWA is also the core providing support for the escalating needs of Palestine refugees as a result of the current events in Syria. UNRWA works with the support of the General Authority for Palestine Arab Refugees in Syria. In November 2012, UNRWA undertook a comprehensive assessment of humanitarian needs of Palestine refugees in Syria. This assessment found that nearly 360,000 people or up to 90,000 families require humanitarian support. This surpasses the previous planning figure in the 2012 HARP of 225,000 Palestine refugees affected by the current events. The general situation throughout Syria is compounding the humanitarian needs of Palestine refugees. Food remains a critical priority for all, and NFIs needed included in particular: mattresses, blankets, quilts, and hygiene kits are needed. Affected refugees are expected to face difficulties during the winter season in Syria, as many of them are no longer able to afford warm clothes, blankets and quilts. Anticipated areas of concern include the limited availability of fuel for heating and the plight of refugees whose homes have been damaged. UNRWA has also received requests for emergency cash assistance from over 90,000 families in Syria. Based on UN findings and analysis of the situation, it is considered that around four million people are in need of humanitarian assistance, whether they are affected directly or indirectly including those affected by the drought. The revised Response Plan foresees projects in all 14 governorates of the country. Therefore, and in order to maintain a level of flexibility to respond to the emerging situation, the concerned government bodies, in association with all parties participating in the Response Plan, will fine-tune figures and locations of people in need of humanitarian assistance as well as the type of assistance required during the implementation of the Response Plan. The Government of Syria and the UN continue to explore arrangements to facilitate and increase the delivery of humanitarian assistance in order to deliver efficient and adequate assistance, administrative procedures to approve the cooperation with local associations have been simplified and streamlined. Monitoring and reporting mechanisms have been put in place to enable standardized reporting of the assistance and achievements under the Humanitarian Assistance Response Plan. Contributions to humanitarian assistance under the Response Plan should be provided in a way that is not to the detriment of resources made available for international cooperation for development. The main four objectives of the Humanitarian Assistance Response Plan, according to the findings of the needs assessment and analysis of the economic and social situation, are the following: Provide relief supplies (food/nutrition, medicines and medical equipment, NFIs, water and sanitation, and shelter) and appropriate emergency services to those most directly affected by the current events. Provide assistance to people who left their homes as a result of the current events and to communities hosting them. Support the Government in the rehabilitation and reconstruction of critical infrastructure and vital public services affected by the currents events through rapid repairs. 4

7 Address humanitarian needs of the poor who are mostly affected by the current situation in order to avoid their further destitution. This Response Plan incorporates 61 projects in ten sectors (each focal point is in charge of presenting its project) to be coordinated by the following Programme Management arrangements: 1. Steering Committee, chaired by the Vice-Minister for Foreign Affairs and Expatriates (or whomever he delegates), with the membership of the Regional Humanitarian Coordinator (RHC). 2. The Ministry of Foreign Affairs and Expatriates is the Government focal point in charge of the supervision of implementation of humanitarian projects and coordination of the various sectors in an effort to avoid duplication, ensure coordination of programme data of all projects, evaluation of humanitarian needs, submission of regular reports on projects implementation, including evaluation reports. 3. One focal point representing the Government for each of the sectors of the Response Plan, who will closely coordinate with the lead agency of the UN sectoral working groups. The RHC will jointly organize with the Ministry of Foreign Affairs, regular meetings of the Humanitarian Working Group, which is a forum composed of the Government of Syria and the humanitarian community: UN, international and local NGOs, SARC, IFRC and ICRC established to discuss implementation of humanitarian activities within Syria. 5

8 Table I. Summary of requirements and funding by sector Sector Requirements $ Food 196,896,716 NFIs and Shelter 110,771,867 Health 81,905,133 WASH 43,417,139 Education 23,024,800 Livelihoods 19,670,111 Community Services 20,547,692 Coordination 9,438,752 Logistics and Emergency Telecommunications 5,500,000 Staff Safety Services 8,454,837 GRAND TOTAL 519,627,047 Table II. Summary of requirements and funding by Original Appealing agency Requirements $ FAO 34,850,000 ORHC 4,950,000 UNDP 45,101,953 UNDSS 3,244,000 UNFPA 12,000,000 UNHCR 82,925,000 UNICEF 68,438,800 UNMAS 5,305,025 UNRWA 75,087,822 WFP 139,259,447 WHO 48,465,000 GRAND TOTAL 519,627,047 Compiled by OCHA on the basis of information provided by appealing organizations as of 19 December. 6

9 2. RESPONSE PLAN 2.1 Strategic objectives for humanitarian assistance response This Humanitarian Assistance Response Plan takes stock of the achievements made by the Government of Syria and the humanitarian partners during It highlights strategic priorities and sectoral response to address the needs of the affected population, based on sector needs assessments and analysis. Further updates to the information to assess the needs will be required. It provides a focused and time-bound strategy to support national efforts to meet humanitarian needs in Syria from 1 January 2013 to 30 June The four main objectives of the Response Plan are to: Provide relief supplies and appropriate emergency services to those most directly affected by the current events. Provide assistance to people who left their homes as a result of the current situation and to communities hosting them. Support the Government in the rehabilitation and reconstruction of critical infrastructure and vital public services affected by the currents events through rapid repairs. Address humanitarian needs of the poor who are most affected by the current situation to avoid their further destitution. Assumptions and principles for implementation Humanitarian action will be conducted in accordance with UN General Assembly Resolution 46/182 and the Guiding Principles contained in its Annex, under the overall leadership of the Government of the Syrian Arab Republic and in full respect of the state sovereignty and territorial integrity and the recognized principles of humanity, impartiality and neutrality. The adequate response to all identified needs requires availability of funding by donors, flexibility in terms of free access to all affected populations as well as to the objectives and priorities of the projects. The supervision of the implementation of the Response Plan is the responsibility of the Programme Management as provided for in this Response Plan. Humanitarian actors under the Response Plan require streamlined procedures for the issuance of visas and for the different aspects of the implementation of the response. A significant strengthening of the capacity of the SARC and local NGOs participating in the implementation of the Plan, as well as a scale up in the activities of international NGOs and UN agencies. This includes the formation of sectors working groups and of inter-sector coordination. The establishment of joint UN field presences with SARC local branches in the most affected regions to enable rapid and efficient delivery of assistance. Some costs of the programme management activities, as well as administrative costs related to the implementation of the Response Plan in sectoral coordination including training courses and human resources capacity-building, for those in charge of the implementation and administration, are part of this Response Plan. Where local markets for goods and services permit, response projects will endeavour to procure supplies and labour from local communities and businesses to promote trickle-down economic benefits to the local communities. 7

10 Staff safety of UN personnel is a key prerequisite for the implementation of the Response Plan and requires sufficient resources and close liaison with the relevant Government bodies. 2.2 Needs and response summary Recognizing that needs identified and assistance required will vary from location to location and situation to situation, in agreement with the Government of Syria, the UNCT has identified the following sectors as the most urgent and wide-ranging in scope: Food NFIs/Shelter Health and medical care (including nutrition) WASH Education Livelihoods and economic stabilization Community services Rehabilitation and reconstruction of critical infrastructure and vital utility services Coordination Logistics and emergency telecommunications Staff safety 8

11 2.3 Sector response plans Food Main Government bodies responsible: Ministry of Agriculture and Agrarian Reform, and General Authority for Palestinian Refugees in the Syrian Arab Republic Supporting represented in Syria: WFP Participating UN agencies: WFP, FAO, UNRWA Food items are generally available in areas where markets are functioning. However, in some areas, access to food is becoming an issue due to sharp increases in food prices and rising unemployment resulting from economic sanctions and increase in international food prices. The current events in Syria have affected almost all aspects of national food production and family access to food, including rain fed and irrigated crops, livestock and poultry farming. Farmers have suffered from high prices, a lack of availability and/or accessibility of farming inputs and fuel. Fuel shortages have affected the functioning of irrigation systems, transportation of commodities and other services relevant to food production. In addition, the deteriorating security situation and the resulting population migration have contributed to a lack of casual labourers available for planting and harvesting on farms. Fertilizers and seeds have become scarce and all agricultural subsectors have been significantly impacted. Family access to food status is under immense strain due to growing unemployment, rising prices and population movements. Prolonged drought conditions stretching back five years, coupled with the adverse impact of the on-going current events have particularly exacerbated agricultural production and availability of food, most significantly in the north-east. The June 2012 JRFSNA conducted by the MoAAR, FAO, and WFP concluded that up to 3 million people were exposed to food shortages and at real threat of complete erosion of their sources of income. The recommendations of the assessment clearly delineated food and farming inputs as urgent and necessary life-saving assistance to 1.5 million people. Findings of WFP and FAO monitoring missions confirm that coping strategies are already severely eroded. Many people have exhausted their food stocks in the context of high urban and rural unemployment. Life is increasingly difficult for a growing proportion of the population. The number of people who have migrated to other areas within Syria continues to increase. FAO and WFP are particularly concerned about the access to food situation of people who have moved from their homes. Both agencies have supported the MoAAR to begin an update of the JRFSNA in November Rice and sugar are still subsidized throughout the country: 1kg of each for every person monthly, but both commodities are available on a limited and first-come first-serve basis. Subsidized rice still sells at 12 Syrian Pounds (SYP) and sugar at 10 SYP per kilo, yet most people pay the normal shop (private) prices of 70 SYP per kg for rice and 65 SYP per kilo for sugar. Bread continues to be subsidized but now sells at around SYP per kilo instead of 7.5 SYP per kilo earlier in the year. In recent months, food shortages have been reported in some markets in relatively stable areas of the country, including Damascus. Staple commodities are still available in cities, but in the past year, prices have risen by 80 to 100% in some areas. Bread is a key source of concern: many bakeries have been destroyed or face fuel shortages. Subsidized bread is no longer available in some areas of the country. Poor families are therefore obliged to seek bread in other areas and to pay SYP per kilo, rather than the SYP cost of Government-subsidized bread. Similarly, shortage/lack of farming and livestock inputs and interruption in agricultural services 9

12 have been reported, causing concern that the next planting season will result in much lower planted areas than in a normal year. From January to June 2013, WFP plans to continue to provide food rations to 1.5 million people in 14 governorates in Syria. This will consist of a general food ration of staple commodities, which aims to meet about two-thirds (or 1,200 kcal per person per day) of the dietary requirements of a family of five people. The ration includes staple food items such as rice, bulgur, pasta, lentils, sugar, iodized salt, vegetable oil and canned goods (beans and fish). If funding permits, complementary items such as tea and tomato paste will also be added. Items selected are relatively easy to cook, as many affected families have difficulties with cooking fuel. SARC will handle distribution and local charities. WFP also plans to provide ready-to-eat-supplementary food to meet potential gaps in the diets of children under three as a supplementary ration. UNICEF and MoH will provide technical guidance for the geographic coverage and targeting strategy of affected children. The target number of children will be 50,000 across the country. During the same period, FAO plans to provide humanitarian assistance to 50,000 families (approximately 400,000 people) in the form of seeds and other essential crop inputs as well as animal feed to enable the most affected small farmers and herders to restore their farming activities and/or sustain the remaining small herds which represent the only source of family income and access to food sources. Sectoral objectives Provide adequate and appropriate food to people affected by the current events until they are able to ensure a stable and sufficient food status. Support and strengthen SARC's capacities to assess and respond to food needs. Provide seeds/farming inputs and animal feed/livestock inputs to poor families affected by the on-going current events to restore/sustain their source of income, family access to food and minimize population movement. Strategy and proposed activities Identify affected population in rural and urban areas. Provide food and farming/livestock inputs to populations affected by the current situation. Expected outcomes A - Identified affected populations receive adequate and appropriate food assistance to save lives and livelihoods. B Identified affected farming and herding families receive adequate crop and livestock inputs to continue/restore local food production and family access to food. The total funding requirements to implement projects within the sector amount to $196,896,

13 Projects Government body Ministry of Agriculture and Agrarian Reform World Food Programme Project title Emergency Food Assistance to People Affected by Unrest in Syria Save lives and support livelihoods of affected people through provision of emergency food assistance. Beneficiaries 1,500,000 people in need (male:765,000; female:735,000) Participants SARC and participating international INGOs and local NGOs Project code SYR-13/F/57198 Budget ($) 133,759,447 Government body Ministry of Agriculture and Agrarian Reform Food and Agriculture Organization of the United Nations Project title Emergency response to restore/sustain access to food to small livestock herder families affected by the on current events To enable small poor herders affected by the current events, to sustain the remaining of their herds and sustain/restore the families food security and to reduce displacement through the provision of animal feed under humanitarian life-saving and sustaining packages Beneficiaries 320,000 people (40,000 poor families) Participants MoAAR, participating international and local NGOs Project code SYR-13/A/57229 Budget ($) 19,000,000 Government body Ministry of Agriculture and Agrarian Reform Food and Agriculture Organization of the United Nations Project title Emergency assistance in support of the poor small farmers affected by the on-going current events To restore and/or sustain families access to food, and reduce population movement of small farmers who lost their crops and/or farming assets, totally or partially, through the provision of life-saving/sustainable humanitarian assistance. Beneficiaries 80,000 people ( poor families) Participants MoAAR and participating international and local NGOs Project code SYR-13/A/57227 Budget ($) 8,000,000 Government body General Authority for Palestinian Refugees in the Syrian Arab Republic United Nations Relief and Works Agency Project title Food assistance for affected Palestine refugees Save lives and support livelihoods of affected Palestine refugees through provision of emergency food assistance. Beneficiaries 360,000 people (89,740 families) Participants UNRWA Project code SYR-13/F/57201 Budget ($) $19,146,629 Government body General Authority for Palestinian Refugees in the Syrian Arab Republic United Nations Relief and Works Agency Project title Provision of cash assistance for food Support the livelihoods of affected Palestine refugees through the provision of one-time cash assistance for food at a rate of $42 per person/six months Beneficiaries 360,000 people (89,740 families) Participants N/A Project code SYR-13/F/57199 Budget $16,990,640 11

14 2.3.2 Non Food Items (NFIs) and Shelter Main Government body responsible: Ministry of Social Affairs and Labour, Ministry of Local Administration, municipalities Supporting represented in Syria: UNHCR Participating UN agencies: UNICEF, UNDP, UNHCR, UNRWA, UNFPA The Syrian population has shown its strong and traditional generosity and solidarity with people who fled areas affected by the events by opening their homes and sharing resources. Hospitality is extended and assistance provided by host families, local communities, religious and local charitable and community organizations. However, previously robust networks and support mechanisms are coming under increasing pressure in view of the limited and depleting resources of host families and local communities. Many Syrians and host communities are in urgent need of basic family NFIs such as mattresses, blankets, hygiene kits and kitchen sets. Host families are experiencing shortages of such items due to limited financial capacity and the additional demands of their guests. Some families have rented houses in less affected areas, but are finding it difficult to continue to pay rent due to the depletion of their savings and resources. In some areas people and charity organizations are renting houses for those that have left their homes. Under the overall coordination of the MoSAL for non-food item distribution, SARC is a key in the national response in the provision of domestic items with inputs from the ICRC, the IFRC, UNHCR, and other UN agencies and community-based organization (CBOs). For NFI distribution in Syria in 2013 the inter-agency response (excluding IFRC and ICRC) under the SHARP will aim at providing full NFI assistance to 1,500,000 people. Collective shelters and public buildings used as shelters are in need of repairs and adjustments to provide adequate, hygienic and safe living conditions. There is also an emphasis on the first quarter of 2013 on ensuring shelters are winterized against the cold. Host families might have to make smaller adjustments to their homes in order to accommodate their guests. Similarly, many homes have been damaged or destroyed and are in need of rehabilitation or reconstruction. Syrians who have left their homes often express a strong desire to return to their homes and the provision of shelter grants and vouchers for rehabilitation / reconstruction will support them to successfully return and reintegrate. MoLA oversees the national response supporting people in collective shelters and is responsible for coordinating all related rehabilitation works and provision of equipment (water tanks, heating systems, solar systems, stoves and other items). s Provide basic NFIs for those that have left their homes and for their host families. Improve shelter, including rehabilitation and coordination and support to management of collective shelters. Provide cash assistance and/or building materials for affected families to meet shelter and other immediate non-standard domestic needs and recurrent family expenses. Strategy and proposed activities Expand outreach and delivery of NFIs with SARC as the lead and involving more registered local and international NGOs, CBOs and charities. Prioritize procurement of locally produced items goods will be sourced internationally when not available in terms of quantity, quality and time. 12

15 Strategic placement of warehouses and pre-positioning of NFI. Improve monitoring and reporting on distribution and engagement with donors for provision of more resources. Increased rehabilitation and management of communal shelters through direct implementation and partners. Provide cash assistance to affected families for recurrent needs and housing repairs. Provide cash support for improvements, rehabilitation and reconstruction of individual shelters of affected populations willing to return. Expected outcomes Immediate shelter and basic domestic needs are met for people who left their homes and host families. Syrians who have left their homes found temporary and adequate shelter (especially in communal shelters). People willing to return home are supported to rehabilitate and restructure their dwellings. The total funding requirements to implement projects within the sector amounts to $110,771,867. Note: UNICEF and UNFPA have HARP 2013 projects relating to the NFI and Shelter Sector however, these two agencies will be submitting under other sectors, and will attend NFI coordination meetings to share / receive information. Projects Government body Ministry of Social Affairs and Labour United Nations High Commissioner for Refugees Project title Provision of non-food items (NFI) s To provide basic NFIs for those who left their homes and for host families Beneficiaries 200,000 Syrian families (1,000,000 people) Participants SARC, participating international and local NGOs Project code SYR-13/S-NF/57234 Budget ($) 54,841,067 Government body General Authority for Palestinian Refugees in the Syrian Arab Republic UN Agency United Nations Relief and Works Agency Project title Provision of NFIs for affected Palestine refugees s Provision of NFI supplies to affected refugee families and children Beneficiaries 99,557 (22,124 families) and 30,861 children Participants N/A Project code SYR-13/S-NF/57210 Budget ($) $6,683,353 Government bodies Ministry of Social Affairs and Labor, Ministry of Local Administration, municipalities UN Agency United Nations Development Programme Project title Basic domestic items (NFIs) Provide NFIs to affected populations and hosting families Beneficiaries 500,000 people (100,000 families) Participants SARC, and participating international and local NGOs Project code SYR-13/S-NF/57205 Budget ($) 10,000,000 13

16 Government body Ministry of Local Administration UN Agency United Nations High Commissioner for Refugees Project title Rehabilitation of communal shelters To ensure that accommodation in the collective shelters meets minimum standards set down by MoLA Beneficiaries Total 100,000 (20,000 families) 54,000 people (10,800 families) in 180 collective shelters, with others benefitting from WASH and rapid repairs where necessary Participants MoLA, MoSAL, SARC, international and local NGOs, CBOs and charities Project code SYR-13/S-NF/57236 Budget ($) 6,634,000 Government body Ministry of Local Administration United Nations High Commissioner for Refugees Project title Financial assistance for shelter and family needs Provide cash assistance to support multiple shelter and family needs, that are not covered by standard NFI distribution and shelter projects Beneficiaries 200,000 people (40,000 families) Participants MoLA, Governorates, SARC, participating international and local NGOs Project code SYR-13/S-NF/57235 Budget ($) 10,393,266 Government body General Authority for Palestinian Refugees in the Syrian Arab Republic United Nations Relief and Works Agency Project title Shelter assistance for affected Palestine refugees Families provided shelter assistance subsidies for three months Beneficiaries 99,557 people (22,124 affected families) who left their homes Participants N/A Project code SYR-13/S-NF/57215 Budget ($) 11,173,726 Government body General Authority for Palestinian Refugees in the Syrian Arab Republic United Nations Relief and Works Agency Project title Shelter repairs assistance for affected Palestine refugees Minimal temporary shelter assistance for families whose shelters have been affected Beneficiaries 2,696 families Participants N/A Project code SYR-13/S-NF/57217 Budget ($) 1,556,375 Government bodies Ministry of Local Administration United Nations Development Programme Project title Cash assistance for housing repairs Provide cash assistance to affected population for immediate housing repairs. Beneficiaries Up to 1,500 families Participants Ministry of Housing, Municipalities, participating international and local NGOs Project code SYR-13/S-NF/57207 Budget ($) 2,000,000 Government body General Authority for Palestinian Refugees in the Syrian Arab Republic United Nations Relief and Works Agency Project title Provision of emergency cash assistance for non-food items Support affected Palestine refugees by providing two-time cash assistance at a rate of $150/family/three months to purchase heating fuel and necessary NFIs Beneficiaries 99,557 people (22,124 affected families) Participants UNRWA and BEMO bank (ATM cards) Project code SYR-13/S-NF/57218 Budget ($) 7,490,080 14

17 2.3.3 Health Main Government body responsible: Ministry of Health Supporting represented in Syria: WHO Participating UN agencies: UNDP, UNICEF, UNHCR, UNRWA, UNFPA, WHO The current events in Syria have caused serious disruption of the health system. It has severely affected the health care infrastructure, the health workforce and the availability of essential medicines and supplies. According to government statistics, almost 35% of hospitals and approximately 10% of health centres are reported as damaged. The emergency transport system is also affected due to shortage of available ambulances - over 40% of the total available ambulances are targeted or damaged. Lack of access to health care facilities due to the current events and severe shortages of medicines are among the main obstacles to the provision of health care. The worsening insecurity is also preventing many health care workers from reporting to duty, contributing to severe staffing shortages in hospitals and other health facilities. Many doctors have left the country, e.g. over 50% of the medical doctors have left Homs. In Damascus, Aleppo and Homs at least 70% of the health providers live in rural areas and therefore frequently cannot reach their work place due to irregular public transportation, blocked and unsafe roads. MoH lead the management of health systems throughout Syria, the main stakeholder in the Health Sector and health care service provider. In addition to the MoH, and under its supervision, the SARC is actively providing specialized medical services, primary healtch care (PHC) services and referral services in most governorates. The Ministry of Higher Education (MoHE) with its network of teaching hospitals is also an important health care provider. Prior to the current situation, over 51% of health expenditure was out-of-pocket, going mainly for costs of medicines and hospitalization in the private sector. In the current situation of socio economic deterioration and the consequent reduction in the number of operational public health facilities, the private sector is being used by the minority that can afford it whilst most people are relying on the remaining under-resourced public health services. Before the current events started in March 2011, more than 90% of medicines in Syria were locally produced. The combined effects of economic sanctions, currency fluctuations, and unavailability of hard currency, fuel shortages, and increases in operational costs have adversely affected the production of medicines and pharmaceutical products. 2 In affected areas there is a critical shortage of life-saving medicines e.g. Insulin is not available in a number of areas. There are more than 430,000 registered diabetic patients in Syria out of which 40,000 are children with insulin dependent diabetes. In Al Raqqa, the Director of Health reported that before the influx of people who left their homes because of the current events three months ago, there were 10,300 patients registered with diabetes. At the end of October 2012, the number of registered diabetic patients was 21,000. Even when limited medicines and supplies are available, their equitable distribution is difficult due to the current situation. Based on the request from Health Sector partners and MoH a list of essential medicines has been developed to cover the needs. Due to the current events reaching reproductive health care poses sometimes challenges in affected areas. An increasing number of pregnant women are requesting an elective C-section as they are worried that they will not be able to reach clinics and hospitals in time for their delivery. In Al Raqqa an average of 45% of all deliveries are C-section (prior to the current events

18 %). 2 The two maternity referral hospitals in Damascus are also reporting a doubling of the C- section rates over the last few months. 3 Similarly, the current situation has created challenges in implementing the national immunization programme. The shipment of vaccines has been complicated due to the current events. There are difficulties in maintaining the cold chain which is resulting in destroyed vaccines. The national vaccination coverage for the first quarter of 2012 dropped from 95% to an estimated 80%. The rate has almost certainly deteriorated further since then. There are shortages of vaccination vehicles. Many vaccination /supply vehicles have been targeted and damaged or affected (117 of 157 damaged are out of service). 1 The Early Warning and Response system is gaining momentum with increasing coverage. Prior to the current situation, according to the 2009 Family Health Survey, 9.3% of children under five were suffering from wasting, and 23% from stunting. 4 According to a study the MoH conducted in 2007, 22.3% of children under five had anaemia. 5 Older studies have also demonstrated deficiencies in vitamin A and iodine. 6 In 2007 a study conducted on prevalence of anaemia, demonstrated that 44% of women of childbearing age and 57.2% of pregnant women suffered from anaemia. 5 The study concluded that nutrition has been much neglected. The prolonged current events has resulted in growing unavailability of food, unhygienic living conditions, and overcrowding, inaccessible or limited health care services and reduced immunization coverage for children under five. These combined factors may have serious implications on the nutritional status of children under five and pregnant and lactating women (PLW). It has been difficult to conduct relevant studies to determine whether malnutrition has increased since the onset of the current events. However, based on the studies referenced above, a nutritional assessment to areas with large populations who have left their homes because of the current events and areas affected by drought are required to gather sufficient data to evaluate the situation. There are reports of growing mental health needs due to the current events. Mobile clinics report an increasing number of people seeking assistance for affected family members. Prior to the current events there were a limited number of psychiatrists in Syria. The MoH has asked the support of WHO in undertaking an assessment of the mental health needs in affected governorates. There are a number of psychosocial support programmes, especially among people who have left their homes because of the current events, initiated by the humanitarian community. There is, however, a concern that when people with mental problems have been identified, they are not receiving the required expert follow up as there is no proper referral system in place for mental disorders, including for post-traumatic stress disorder (PTSD). The Health Sector Working Group is playing an instrumental role in coordinating health response activities, joint work plans and indicators for monitoring the effectiveness of the response that are currently being developed. The Health Sector response has improved over the last six months, the partnerships with NGOs has increased. Health Sector assessments have been carried out in affected areas. Efficient approaches for monitoring and evaluation is being utilized, for example teleassessments will be used to verify the implementation of activities, distribution of medicines and supplies. Also to ensure that statistics on disease morbidity and mortality are timely shared with MoH and partners. 2 Joint Assessment Mission Report to Ar-Raqqa, September, Field Visit to Maternity Wards in Damascus, November, Family Health Survey, PAPFAM, Iron Deficiency Anemia Study, MoH, Vitamin A deficiency Study, MoH,

19 Health sector objectives To support effective and efficient delivery of life-saving emergency health care (medical, surgical, maternal, child health etc.) at all levels of health facilities in directly and indirectly affected areas. To facilitate population s access to essential primary and secondary health care (preventive and curative) including support for chronic diseases, reproductive health, infant and child health, nutrition, and mental health services. Strategy for achieving the objectives i) Coordinate Health Sector response by working with MoH, MoHE, NGOs and CBOs. ii) Implement through LNGOs to fill gaps in service delivery, in close cooperation with MoH. iii) Distribute essential medicines and supplies to health facilities and to implementing partners. iv) Deliver standardized package of essential of quality health care services (preventive and curative) by implementing partners. v) Regular supply essential medicines and supplies through a functioning supply chain with emergency medical stockpile at regional level. vi) Update information on health needs and service availability through on-going integrated assessment missions with relevant UN partners (WHO, UNICEF, UNFPA, WFP and UNHCR) in close cooperation with MoH. vii) Effective approach for monitoring service delivery and remote activities using participating NGOs/CBOs. viii) Standardize systems for reporting by implementing partners. ix) Build the capacity of Ministry and implementing partners staff. x) Advocacy with international and national stakeholders to respect and support for health humanitarian principles. xi) Mobilize resources for health. Specific objectives Support the delivery of essential health care including: trauma care, PHC, reproductive and child health and nutrition services, management of chronic illness, mental health services, management of acute malnutrition, inclusive of immunizations. Support emergency services including ambulances. Fill priority gaps for essential medicines, medical equipment and supplies. Establish functional mechanism for psychosocial support and timely referral for management of mental health problems. Strengthen Early Warning System for outbreaks of disease and public health emergencies. Strengthen management of malnutrition through treatment, provision of essential nutrition supplies, raise awareness and community outreach activities. Strengthen the nutrition surveillance system. Inform and coordinate the Health Sector response through consistent availability of up-todate information on health needs, Health Sector response capacities, and gaps. Pave the way for revitalization and early recovery of health services, and restoration of health facility services in affected areas, while ensuring Health Sector readiness for emergency response. 17

20 Expected outcomes Patients have access to essential health services including the required medicines, vaccines and supplies. Priority gaps in Health Sector are identified jointly with the MoH and addressed through networks such as mobile clinics and outreach activities including nutritional teams. Health Sector capacity to respond to acute needs strengthened through the establishment of emergency stockpiles. Emerging health problems including possible outbreaks detected early and contained through a strengthened surveillance system. Patients have access to mental health services and psychosocial support. Capacities built of health care providers, including to deliver nutritional services and management of acute malnutrition and infant and young child feeding. Health Sector response is effectively monitored and activities adjusted as appropriate. Coordinated health response and minimum duplication. Early recovery assessment and recovery strategy in place. Damaged health facilities are rehabilitated and fully operational. The total funding requirements to implement projects within the sector amounts to $81,905,133 Projects Government body Ministry of Health United Nations Children's Fund Project title Children in most affected communities have access to basic health and nutrition care s To improve access for children and mothers in most affected communities to basic health care (management of childhood illnesses, pneumonia and diarrhoea, newborn care, health education and promotion) along with adequate training and supplies. Maintain children s immunization coverage, with measles and polio campaign and increased support to routine immunization. Prevent deterioration of children s nutrition status and support cases of malnutrition. Support the resumption of public health centre services to provide regular immunization and nutrition services especially for children who have left their home because of the current events and lactating mothers. Beneficiaries 563,000 affected children have access to health care (13.4%) 1,400,000 children with improved access measles and polio vaccination 268,000 with access to nutritional services 26,000 children with moderate acute malnutrition 6,150 children with SAM Participants SARC, MoH, participating international and local NGOs, PHCs, polyclinics Project code SYR-13/H/57237 Budget ($) 15,878,800 18

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