HeRAMS Annual Reportapplications.emro.who.int/docs/COPub_SYR_Jan_Dec_2015_EN_166… · HeRAMS|...
Transcript of HeRAMS Annual Reportapplications.emro.who.int/docs/COPub_SYR_Jan_Dec_2015_EN_166… · HeRAMS|...
This is to acknowledge that the data provided in this report is a product of joint collaboration between the
World Health Organization, Ministry of Health, and Ministry of Higher Education in the Syrian Arab Republic.
The report covers the months of January to December 2015.
HeRAMS Annual Report
January - December 2015
Public Hospitals in the Syrian Arab Republic
HeRAMS| Public Hospitals’ Annual Report for 2015, Health Information Management Unit, WHO, Syrian Arab Republic Page 1 of 37
Contents
Executive summary ............................................................................................................................................ 5
1. Completeness of Hospitals Reporting ........................................................................................................ 7
2. Functionality and accessibility of the Public Hospitals ............................................................................... 7
2.1 Functionality Status of the Public Hospitals ........................................................................................ 7
2.2 Accessibility to public hospitals ........................................................................................................... 9
3. Infrastructure Patterns of the Public Hospitals ........................................................................................ 11
3.1 Level of Damage of the hospitals’ buildings ...................................................................................... 11
3.2 Analysis of the inpatient capacity ...................................................................................................... 14
3.3 Water sources and functionality status ............................................................................................. 15
3.4 Availability of electricity generators .................................................................................................. 16
4. Availability of Health Human Resources .................................................................................................. 17
4.1 Availability of medical staff by category and affiliation .................................................................... 18
4.2 Availability of medical doctors by affiliation (MoH vs. MoHE hospitals) .......................................... 19
4.3 Availability of medical doctors by gender (MoH vs. MoHE hospitals) .............................................. 20
5. Availability and Utilization of the Health Services .................................................................................... 21
5.1 General Clinical services .................................................................................................................... 22
5.2 Surgical and Trauma care .................................................................................................................. 23
5.3 Maternal health services ................................................................................................................... 26
5.4 Child Health ....................................................................................................................................... 28
5.5 Nutrition ............................................................................................................................................ 28
5.6 NCDs (non-communicable diseases) ................................................................................................. 29
5.7 Mental Health .................................................................................................................................... 31
6. Availability of Medical Equipment ............................................................................................................ 32
7. Availability of Medicines & Medical supplies ........................................................................................... 34
8. Conclusions and Recommendations ........................................................................................................ 36
Cover photo credit: WHO/Syria
HeRAMS| Public Hospitals’ Annual Report for 2015, Health Information Management Unit, WHO, Syrian Arab Republic Page 2 of 37
List of Figures
Figure 1: Distribution of public hospitals by affiliation, per governorate 7
Figure 2: Functionality Status- December 2015 7
Figure 3: Number and percentage of the public hospitals by functionality status, per governorate, December 2015 8
Figure 4: Trend analysis of functionality status of public hospitals, January to December 2015 9
Figure 5: Accessibility status- December 2015 9
Figure 6: Accessibility status of the public hospitals per governorate, December 2015 9
Figure 7: Trend analysis of accessibility to public hospitals, January to December 2015 10
Figure 8: Level of Damage - December 2015 11
Figure 9: Number and percentage of the public hospitals by level of damage, per governorate, December 2015 12
Figure 10: Trend analysis of public hospitals’ level of damage, January to December 2015 12
Figure 11: The number of emergency beds vs. total number of beds in functional hospitals, per governorate, December 2015
14
Figure 12: Percentage of available number of beds in functional hospital versus the original inpatient capacity, December 2015
14
Figure 13: Main sources of water, December 2015 15
Figure 14: Distribution of water sources/ types at functional public hospitals, per governorate, December 2015 15
Figure 15: Functionality status of the water sources at functional public hospitals, December 2015 15
Figure 16: Percent of hospitals in need for generators out of total functional hospitals, December 2015 16
Figure 17: Proportion of health staff in hospitals, December 2015 17
Figure 18: Trend analysis of number of doctors (a sum of Specialists, Emergency Physicians, Resident Doctors, Dentists) in public hospitals during 2015
18
Figure 19: Trend analysis of number of Nurses in public hospitals during 2015 18
Figure 20: Trend analysis of number of midwives in public hospitals during 2015 19
Figure 21: Proportions and numbers of key staff work in MoH vs. MoHE hospitals, December 2015 19
Figure 22: Comparison of the medical staff of MoH vs. MoHE hospitals, December 2015 20
Figure 23: Proportions of doctors (a total of Specialists, Emergency Physicians, Resident Doctors, Dentists), by gender, per governorate, December 2015
20
Figure 24: Availability of health services in the functional public hospitals, December 2015 21
Figure 25: Estimated caseload of functional public hospitals (outpatient consultations and emergency cases), January to December 2015
21
Figure 26: Proportions of workload from January to December 2015, per governorate 22
Figure 27: The number of outpatient and inpatient in public hospitals, December 2015 22
Figure 28: Trend analysis of outpatient and inpatient in public hospitals, January to December 2015 22
Figure 29: The number of patients received services in laboratories, blood bank, and imaging services in public hospitals, December 2015
23
Figure 30: Trend analysis of number of patients received services in blood banks and imaging service in public hospitals, January to December 2015
23
Figure 31: The number of reported cases in emergency department in public hospitals, December 2015 23
Figure 32: The number of reported cases of mass casualties in public hospitals, December 2015 24
Figure 33: The number of emergency surgeries vs. elective surgeries in public hospitals, December 2015 24
Figure 34: Percentage of total emergency surgeries to elective surgeries in public hospitals per governorate, December 2015
25
Figure 35: Trend analysis of number of patients received services in blood banks and imaging services in public hospitals, January to December 2015
25
HeRAMS| Public Hospitals’ Annual Report for 2015, Health Information Management Unit, WHO, Syrian Arab Republic Page 3 of 37
Figure 36: The No. of normal deliveries and caesarean sections (CSs) performed at public hospitals, December 2015
26
Figure 37: Percentage of caesarean sections to normal deliveries in public hospitals, December 2015 27
Figure 38: Trend analysis of the monthly numbers of normal deliveries vs. caesarean sections in public hospitals,
December 2015
27
Figure 39: Comparison of MoH & MoHE hospitals workload of normal deliveries vs. CSs, December 2015 27
Figure 40: Number of children with severe diseases in public hospitals, December 2015 28
Figure 41: Trend analysis of reported cases of severe children diseases in public hospitals, January to December
2015
28
Figure 42: The number of children with severe acute malnutrition with complications in public hospitals,
December 2015
28
Figure 43: Trend analysis of number of children with severe acute malnutrition with complications in public
hospitals, January to December 2015
29
Figure 44: The number of NCDs’ consultations in public hospitals, December 2015 29
Figure 45: Trend analysis of total monthly number of patients with NCDs reported in public hospitals, January to
December 2015
30
Figure 46: The number of outpatient psychiatric cases vs. the number of inpatients in public hospitals, December
2015
31
Figure 47: Trend analysis of number of outpatient psychiatric cases vs. the number of inpatients in public
hospitals, January to December 2015
31
Figure 48: Percentage of functional essential equipment/ total available equipment in functional public hospitals,
December 2015
32
Figure 49: Percentage of functional specialized equipment/ total available equipment in the functional public
hospitals, December 2015
32
Figure 50: Availability of and medical supplies for one month in the functional public hospitals, December 2015 34
List of Tables
Table 1: The list of hospitals with reported fully damaged buildings 13
Table 2: Special cases of hospitals with reported fully damaged buildings, and operating partially from other
locations
13
Table 3: Special cases of hospitals with reported partially damaged buildings, and operating partially (limited
provided health services) from other locations
13
List of Maps
Map 1: Distribution and functionality status of public hospitals [MoH & MoHE], December 2015 8
Map 2: Accessibility to public hospitals [MoH & MoHE], December 2015 10
Map 3: Level of damage of the hospitals’ buildings, by governorate [MoH & MoHE], December 2015 12
Map 4: Availability of medical doctors in functional public hospitals, by end of December 2015, per governorate 17
Map 5: Percent of functional specialized equipment/ total available equipment in functional public hospitals,
December 2015
33
Map 6: Percentage of available medicines in functional public hospitals, December 2015 35
HeRAMS| Public Hospitals’ Annual Report for 2015, Health Information Management Unit, WHO, Syrian Arab Republic Page 4 of 37
Abbreviations
CEmOC Comprehensive Emergency Obstetric Care
CS Caesarean Sections
DoH Directorate of Health
ESKD End Stage Kidney Disease
HeRAMS Health Resources & Services Availability Mapping System
HIS Health Information System
ICT Information and Communication Technology
ICU/ CCU Intensive Care Unit / Critical Care Unit
IDPs Internally Displaced People
MoH Ministry of Health
MoHE Ministry of Higher Education
NCDs Non-communicable Diseases
WHO World Health Organization
HeRAMS| Public Hospitals’ Annual Report for 2015, Health Information Management Unit, WHO, Syrian Arab Republic Page 5 of 37
Executive summary
Regular assessment to monitor the impact of the crisis on the health facilities functionality, accessibility,
condition status, availability of resources and services, has been conducted using HeRAMS (Health
Resources & services Availability Mapping System) tool. The report provides descriptive and trend analysis
for the situation of public hospitals in all 14 governorates of Syria [including Ministry of Health (MoH) and
Ministry of Higher Education (MoHE) hospitals (a total of 113 hospitals)].
Despite the challenging security situation and protracted crisis, in addition to the wide disruption of the
Health System, implementation of HeRAMS has been successfully institutionalized and strengthened in
public health facilities during 2014 and 2015.
Completeness of Hospitals’ reporting remained 100%, where all 99 (MoH) hospitals and 14 (MoHE) hospitals
reported to HeRAMS by end of December 2015.
Functionality status of the public hospitals
By the end of December 2015, and out of the 113 assessed public hospitals [MoH & MoHE], 43% (49) were
reported fully functioning, 31% (35) hospitals were reported partially functioning, while 26% (29) were
reported non-functioning.
Accessibility status of the public hospitals
By the end of December 2015, 60% (68) hospitals were reported accessible, 18% (20) hard-to-access, and
22% (25) were inaccessible.
Infrastructure of the public hospitals
By the end of December 2015, 42% (48) hospitals were reported damaged [13% fully damaged and 29%
partially damaged], while 55% (62) of public hospitals were reported intact while the infrastructure of three
public hospitals were unknown.
Analysis on inpatient capacity in functional hospitals has shown shortage of beds at varying degrees, across
all governorates.
Assessing the availability of water sources at functional public hospitals indicated that 40% (34) are using
main pipelines, 7% (6) are mainly using wells, 49% (41) are using both (main pipeline and well), while 4% (3)
are using other sources of water.
Electricity power is widely disrupted nationwide and majority of public hospitals are dependent on
generators' power. According to HeRAMS assessment 40% (34) of functional public hospitals across Syria are
in need for electrical generators, mainly reported from 11 governorates: Quneitra, Aleppo, Deir-ez-Zor,
Dar’a, Rural Damascus, Al-Hasakeh, Hama, Damascus, Homs, Lattakia and Tartous.
Human Resources for Health
The emergency physicians remain the lowest proportion of health staff in public hospitals (0.3%), followed
by dentists (1%), pharmacists (1%), Midwives (5%), Laboratory personnel (7%), specialists (15%), resident
doctors (17%), and nurses (54%).
Trend analysis of available number of medical doctors and nurses during 2015 has shown consistent decline. In functional public hospitals the number of medical doctors [specialists, emergency doctors, resident doctors, dentists] has decreased by 11% in December 2015 compared to January 2015, similarly the number of nurses and number of midwives has decreased by 9% and 13%, respectively .
HeRAMS| Public Hospitals’ Annual Report for 2015, Health Information Management Unit, WHO, Syrian Arab Republic Page 6 of 37
Analysis of proportions of medical doctors [specialists, emergency doctors, resident doctors, dentists]
working at MoHE hospitals versus MoH hospitals has shown that 31% of medical doctors work in MoHE,
while 69% are in MoH hospitals.
Analysis of availability of medical doctors by gender has shown that lowest proportions of Female to Male
medical doctors are in Al-Hasakeh, Deir-ez-Zor and Ar-Raqqa governorates.
Availability and Utilization of Health Services
As a result of disrupted healthcare delivery and non-functionality of the hospitals, limited provision of health
services was observed across governorates, even within functional hospitals. Detailed analysis on services’
availability and utilization throughout 2015 by category (i.e., general clinical services, surgical & trauma care,
maternal healthcare, child healthcare, nutrition, NCDs, and mental health) is provided at governorate level.
Availability of Medical Equipment
Analysis of availability of essential and specialized equipment was measured across all functional public
hospitals [MoH & MoHE], in terms of functional equipment out of the total available equipment in the
hospital. The produced analysis provides good indication of the current readiness of the hospitals to provide
the health services, and also to guide focused planning for procurement and distribution of equipment and
machines, to fill-in identified gaps that were observe even within the functional public hospitals.
Availability of Medicines and Medical Supplies
Availability of medicines and medical supplies at hospitals’ level was evaluated based on a standard list of
identified priority medicines and medical supplies for duration of one month.
The key identified gaps of medicines and consumables at functional hospitals include the hepatitis vaccine
(87%), tetanus shots (85%), medicines affecting the blood, such as heparin (58%), antidotes for poisoning
(57%), specific antibiotics for multi-resistant bacteria (57%), dermatological preparation (57%), delivery
related medicines (51%), dialysis consumables (49%), Albumin (35%), etc.
HeRAMS| Public Hospitals’ Annual Report for 2015, Health Information Management Unit, WHO, Syrian Arab Republic Page 7 of 37
1. Completeness of Hospitals Reporting
The completeness of reporting from public hospitals across Syria remained at 100%, where all the 99
Ministry of Health (MoH) Hospitals and the 14 Ministry of Higher Education (MoHE) hospitals continued to
report to HeRAMS in December 2015.
The distribution of public hospitals by affiliation [MoH & MoHE], per governorate is shown in Figure 1.
Figure 1: Distribution of public hospitals by affiliation, per governorate
The following sections provide descriptive and trend analysis on the functionality status, accessibility, and
infrastructure of the public hospitals, availability of resources & services, and available equipment and
medicines by the end of December 2015.
The provided analysis supports informed decision making, better planning and allocation of resources, and
contributes to significant and focused humanitarian response by WHO and health sector partners.
2. Functionality and accessibility of the Public Hospitals
The following sub-sections provide analysis on the functionality and accessibility status of the public
hospitals at governorate level.
2.1 Functionality Status of the Public Hospitals
Functionality of the public hospitals was defined and
assessed at three levels;
Fully Functioning: a hospital is open, accessible, and
provides healthcare services with full capacity (i.e.,
staffing, equipment, and infrastructure).
Partially functioning: a hospital is open and provides
healthcare services, but with partial capacity (i.e.,
either shortage of staffing, equipment, or damage in
infrastructure).
Not functioning: a hospital is out of service, because it
is either fully damaged, inaccessible, no available staff,
or no equipment.
15 15 14 14
9 8
7 6 6
5 4 4
3
1
11
8
13 14
9
6 7
6 6 5
4 4 3
1
4
7
1 0 0
2
0 0 0 0 0 0 0 0 0
2
4
6
8
10
12
14
16
Aleppo Damascus RuralDamascus
Homs Dar'a Lattakia Deir-ez-Zor Tartous Hama Al-Hasakeh Idleb Ar-Raqqa As-Sweida Quneitra
Total Public Hospitals Total MoH Hospitals Total MoHE Hospitals
Figure 2: Functionality Status- Dec 2015
Non-Functioning
29
Partially Functioning
35
Fully Functioning
49 26%
31%
43%
HeRAMS| Public Hospitals’ Annual Report for 2015, Health Information Management Unit, WHO, Syrian Arab Republic Page 8 of 37
By the end of December 2015, and out of the 113 assessed public hospitals [MoH & MoHE], 43% (49)
were reported fully functioning, 31% (35) hospitals were reported partially functioning, while 26% (29)
were reported non-functioning [Figure 2].
The hospitals reported partially functioning or non-functioning are in 12 out of a total 14 govrnorates (86%
of governorates). Detailed analysis on the functionality status of the MoH and MoHE hospitals at
governorate level is presented in [Figure 3] and [Map 1]. All public hospitals in Idleb were reported out of
service.
Figure 3: Number and percentage of the public hospitals by functionality status, per governorate, December 2015
Map 1: Distribution and Functionality status of public Hospitals, December 2015
0
0
1
1
3
5
2
7
4
10
2
7
6
1
0
4
3
3
5
4
2
6
1
5
1
1
0
0
4
0
5
3
8
5
1
2
1
0
0
0
0
0
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Idleb
Ar-Raqqa
Dar'a
Deir-ez-Zor
Homs
Rural Damascus
Al-Hasakeh
Aleppo
Hama
Damascus
As-Sweida
Lattakia
Tartous
Quneitra
Fully Functioning Partially Functioning Non-functioning
HeRAMS| Public Hospitals’ Annual Report for 2015, Health Information Management Unit, WHO, Syrian Arab Republic Page 9 of 37
Constant deterioration of functionality status of public hospitals has been observed during 2015; 29
hospitals were reported out-of-service in December 2015 compared to 19 in January 2015, while June
marked a record high of 31 non-functional hospitals [Figure 4].
Figure 4: Trend analysis of functionality status of public hospitals, January to December 2015
2.2 Accessibility to public hospitals
Accessibility to public hospitals is defined at three levels:
Accessible: a hospital is easily accessible for patients and
health staff.
Hard-to-reach: a hospital is hardly reached, due to security
situation or long distance.
Inaccessible: a hospital is not accessible because of the
security situation, or a hospital is accessible only to a small
fraction of the population, or military people (inaccessible
to civilians).
By the end of December 2015, 60% (68) hospitals were reported accessible, 18% (20) hard-to-access,
and 22% (25) were inaccessible [Figure 5]. Distribution of public hospitals by accessibility status is
presented in Map 2.
Figure 6: Accessibilty status of the public hospitals per governorate, December 2015
53 53 50 50 49
46 46 46 47 48 49 49
41 40 40 37 36 36 37 37 36 36 35 35
19 20 23
26 28
31 30 30 30 29 29 29
0
10
20
30
40
50
60
Jan 2015 Feb 2015 Mar 2015 Apr 2015 May 2015 Jun 2015 Jul 2015 Aug 2015 Sep 2015 Oct 2015 Nov 2015 Dec 2015
Fully Functioning Partially Functioning Non-functioning
0
6
6
6
4
4
2
11
5
8
6
5
4
1
0
2
7
3
0
3
1
4
0
0
0
0
0
0
4
8
2
5
5
0
0
0
1
0
0
0
0
0
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Idleb
Homs
Aleppo
Rural Damascus
Dar'a
Deir-ez-Zor
As-Sweida
Damascus
Hama
Lattakia
Tartous
Al-Hasakeh
Ar-Raqqa
Quneitra
Yes Hard to access No
Figure 5: Accessibility status- Dec 2015
Hard to access
20
22%
Yes 68
No 25
18%
60%
HeRAMS| Public Hospitals’ Annual Report for 2015, Health Information Management Unit, WHO, Syrian Arab Republic Page 10 of 37
Map 2: Accessibility to public hospitals [MoH & MoHE], December 2015
Trend analysis on accessibility to public hospitals [MoH & MoHE] from January to December 2015, is
presented in Figure 7.
Figure 7: Trend analysis of accessibility to public hospitals, January to December 2015
78 77 74 73
70 67 68 69 68 68 68 68
18 19 20 18 19 19 19 19 20 20 20 20
17 17 19
22 24
27 26 25 25 25 25 25
0
10
20
30
40
50
60
70
80
90
Jan 2015 Feb 2015 Mar 2015 Apr 2015 May 2015 Jun 2015 Jul 2015 Aug 2015 Sep 2015 Oct 2015 Nov 2015 Dec 2015
Yes Hard to access No
HeRAMS| Public Hospitals’ Annual Report for 2015, Health Information Management Unit, WHO, Syrian Arab Republic Page 11 of 37
3. Infrastructure Patterns of the Public Hospitals
The following sub-sections provide analysis on the infrastructure patterns of the public hospitals, in terms of
building condition, inpatient capacity, water sources, availability of ambulances, and electricity generators,
all summarized at governorate level.
3.1 Level of Damage of the hospitals’ buildings
The level of damage to hospital buildings was measured at
three levels:
Fully damaged: either, all the building is destroyed, about
75% or more of the building is destroyed, or damage of
the essential services’ buildings.
Partially damaged: where part of the building is damaged.
Intact: where there is no damage in the building.
Analysis of the level of damage provides good indication on the
potential costs for reconstruction.
By the end of December 2015, 42% (48) hospitals were reported damaged [13% fully damaged and 29%
partially damaged], while 55% (62) of public hospitals were reported intact. The level of damage of three
hospitals was unconfirmed due to escalating security situation: Al-Bassel Tadmor, Al-Bassel Al-Qaryatein and
Al-Bassel Sokhneh hospitals in Homs governorate [Figure 8]. Distribution of public hospitals by level of
damage is presented in Map 3, while more details are provided at governorate’s level in Figure 9.
Map 3: Level of Damage of the Hospitals’ buildings, by governorate [MoH & MoHE], December 2015
It is essential to cross-analyze the infrastructural damage of the public hospitals in relation to the
functionality status (i.e. provision of services). Some hospitals have resiliently continued to provide services
Figure 8: Level of Damage - Dec 2015
Not damaged
62
55%
Partially damaged
33
Fully damaged
15
No Report 3
29%
13% 3%
HeRAMS| Public Hospitals’ Annual Report for 2015, Health Information Management Unit, WHO, Syrian Arab Republic Page 12 of 37
regardless of the level of damage of the building and by optimizing intact parts of the building or in a few
cases operating from other neighboring facilities. The national figures translate as follows:
Out of the 33 partially damaged hospitals, 17 hospitals were reported partially functioning and 14 out of
service (non-functioning), while two hospitals (Yabroud in Rural Damascus, and Ebn Khaldoun Psychiatric
hospital in Aleppo) were reported to be fully functioning providing all services through salvaging medical
equipment from the damaged section of the hospital with full staffing capacity.
Out of the 15 fully damaged hospitals, 10 were reported non-functioning while 5 hospitals have opted
for innovative ways to continue providing health services to populations in need through partially
functioning from other nearby temporary locations and provide health services with limited staff
capacity and resources. More details of the 5 hospitals are available in the HeRAMS database.
Then again, hospitals with intact buildings (62 hospitals) does not directly reflect full functionality, only
47 of the 62 intact hospitals are fully functioning, while 13 are partially functioning and 2 hospitals are
not functioning all together, due to limited access of patients and health staff to the facilities resulting
from the dire security situation as well as critical shortage of supplies.
Figure 9: Number and percentage of the public hospitals by level of damage, per governorate, December 2015
Trend analysis on condition of the public hospitals (level of damage of the building) from January to
December 2015 is presented in Figure 10.
Figure 10: Trend analysis of public hospitals’ level of damage, January to December 2015
0
1
0
5
2
1
4
1
1
0
0
0
0
0
4
6
3
5
2
5
4
1
1
1
1
0
0
0
0
2
1
4
3
7
7
3
4
7
14
6
3
1
0
0
0
0
0
3
0
0
0
0
0
0
0
0
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Idleb
Dar'a
Ar-Raqqa
Rural Damascus
Deir-ez-Zor
Homs
Aleppo
Al-Hasakeh
Hama
Lattakia
Damascus
Tartous
As-Sweida
Quneitra
Fully damaged Partially damaged Not damaged No Report
14 13 14 14 14 14 15 15 15 15 15 15
32 32 34 33 33 34 33 34 34 34 34 33
67 68 65 66 64 62 62 62 61 61 61 62
0 0 0 0 2 3 3 2 3 3 3 3 0
10
20
30
40
50
60
70
80
Jan 2015 Feb 2015 Mar 2015 Apr 2015 May 2015 Jun 2015 Jul 2015 Aug 2015 Sep 2015 Oct 2015 Nov 2015 Dec 2015
Fully damaged Partially damaged Not damaged No Report
HeRAMS| Public Hospitals’ Annual Report for 2015, Health Information Management Unit, WHO, Syrian Arab Republic Page 13 of 37
The tables below list the hospitals, which reported fully damaged (buildings), in addition to the list of
hospitals that are operating from different location (s) given that the original building is fully damaged or
partially damaged.
Table 1: The list of hospitals with reported fully damaged buildings:
# Hospital Name Province District Affiliation
1 Rural Damascus specialized hospital – Duma Rural Damascus Duma MoH 2 Harasta general hospital Rural Damascus Harasta MoH 3 Al-Mleha hospital Rural Damascus Harasta MoH 4 An-Nashabeyeh hospital Rural Damascus An-Nashabeyeh MoH 5 Darayya general hospital Rural Damascus Darayya MoH 6 Zahi Azraq general hospital Aleppo The fourth MoH 7 E'zaz national hospital Aleppo E'zaz MoH 8 Children hospital Aleppo Third MoH 9 Al-Qusayr general hospital Homs Al-Qusayr MoH 10 Helfaya hospital Hama Muhardeh MoH 11 Children hospital Al-Hasakeh Al-Hasakeh MoH 12 Maternity and Paediatric specialized hospital Deir-ez-Zor Deir-ez-Zor MoH 13 Alfurat general hospital Deir-ez-Zor Deir-ez-Zor MoH 14 Jassem general hospital Dar'a Nawa MoH 15 Al-Kindi university hospital Aleppo The fourth MoHE
Table 2: Special cases of hospitals which reported fully damaged (buildings), and operating partially from
other locations:
# Hospital name Province District Type Condition Affili-
ation
New location
1 Zahi Azraq general hospital Aleppo The fourth General Fully damaged
MoH Ar-Razi hospital
2 Children hospital Aleppo Third Specialized Fully damaged
MoH Ar-Razi hospital + Maternity hospital
3 Children hospital Al-Hasakeh Al-Hasakeh Specialized Fully damaged
MoH Al-Hasakeh National hospital
4 Maternity and Paediatric specialized hospital
Deir-ez-Zor Deir-ez-Zor Specialized Fully damaged
MoH Al-Assad hospital
5 Alfurat general hospital Deir-ez-Zor Deir-ez-Zor Specialized Fully damaged
MoH Al-Assad hospital
Table 3: Special cases of hospitals which reported partially damaged (buildings), and operating partially
(limited provided health services) from other locations: # Hospital name Province District Type Condition Affili-
ation New location
1 Martyr Basil al-Assad in Deir Atia/Qalamoun Autonomous hospital
Rural Damascus
Al-Nabak General Partially
damaged
MoH Deir- Atia Health Centre
2 Qaara/ Qalamoun Autonomous hospital
Rural Damascus
Al-Nabak General Partially
damaged
MoH One floor in Qara Municipal (they moved
the functional medical equipment to the
new location)
3 Ophthalmology hospital
Aleppo Third Specialized Partially
damaged
MoH Part of the hospital operating from Al-
Razi hospital, while the other from the
Obs. & Gyn. Hospital in Aleppo
The information above could guide focused rehabilitation activities for hospitals’ infrastructure, which could
improve functionality status of hospitals to reach fully functional level, especially for partially functional
hospitals that need small scale of rehabilitation.
HeRAMS| Public Hospitals’ Annual Report for 2015, Health Information Management Unit, WHO, Syrian Arab Republic Page 14 of 37
3.2 Analysis of the inpatient capacity
The inpatient capacity has been analyzed in terms of the total number of beds available in functional
hospitals by end of 2015 compared to the original number of beds in these hospitals pre-crisis or the
maximum inpatient capacity) [Figure 11].
Figure 11: Comparison of inpatient capacity (available vs. maximum) in functional hospitals per governorate,
December 2015
Reduced inpatient capacity (shortage of beds) was observed in all governorates at varying degrees. This may
be correlated to the upsurge in usage of beds in functional hospitals, as direct implication of the crisis on the
overstretched public health sector. Figure 12 illustrates the proportion of available beds in functional
hospitals versus the original inpatient capacity at governorate levels.
Figure 12: Percentage of available number of beds in functional hospital versus the original inpatient capacity,
December 2015
The lowest percentage (25%) of available beds in functional hospital versus original inpatient capacity is
observed in Dar’a governorate, mainly reported from the national hospital [the current number of beds are
14, while the original hospital capacity is 60 beds].
3,500
2,455 2,429
1,917
1,160 1,107
675 670 660 630 618 610
200
3,146
1,532 1,772
1,352
917 1,062
311 485 507
155 239 413
133
Damascus Aleppo Lattakia RuralDamascus
Hama Tartous Homs Al-Hasakeh As-Sweida Dar'a Deir-ez-Zor Ar-Raqqa Quneitra
Original/Max. No. of Beds Available No. of Beds
96% 90%
79% 77% 73% 72% 71% 68% 67%
62%
46% 39%
25%
72%
Tartous Damascus Hama As-Sweida Lattakia Al-Hasakeh RuralDamascus
Ar-Raqqa Quneitra Aleppo Homs Deir-ez-Zor Dar'a Overall
% of available beds /total original beds
HeRAMS| Public Hospitals’ Annual Report for 2015, Health Information Management Unit, WHO, Syrian Arab Republic Page 15 of 37
3.3 Water sources and functionality status
Availability of water sources at public hospitals was assessed
using a standard checklist of main types of water sources (i.e.,
main pipeline, well, or both (main pipeline and well)).
By the end of December 2015 and out of 84 functional public
hospitals, 40% (34) are using main pipelines, 7% (6) are mainly
using wells, 49% (41) are using both (main pipeline and well),
while 4% (3) are using other sources of water [Figure 13].
Detailed analysis on distribution of water sources at functional
public hospitals is presented at governorate level on [Figure
14].
Figure 14: Distribution of water sources/ types at functional public hospitals, per governorate, December 2015
Functionality status of the water sources was measured at three levels; fully functional, partially functional,
and not functional. Figure 15, provides details on functionality status of water sources at functional
hospitals, (84/113) per governorate.
Figure 15: Functionality status of the water sources at functional public hospitals, December 2015
0
0
0
1
1
2
3
3
4
4
5
5
6
13
5
0
3
0
1
3
0
3
0
10
1
2
0
0
1
0
0
1
3
0
1
0
0
0
0
0
0
0
0
3
0
0
0
0
0
0
0
0
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Aleppo
Hama
Quneitra
Al-Hasakeh
Deir-ez-Zor
Dar'a
Rural Damascus
As-Sweida
Homs
Ar-Raqqa
Damascus
Tartous
Lattakia
Main Pipeline Main Pipeline and Well Well Other
13
10
8
6
6
5
4
4
3
3
2
1
2
1
0
3
0
0
4
0
1
0
2
0
4
0
2
0
0
0
0
0
0
0
0
0
0
0
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Damascus
Aleppo
Lattakia
Rural Damascus
Tartous
Hama
Homs
Ar-Raqqa
Al-Hasakeh
As-Sweida
Dar'a
Quneitra
Deir-ez-Zor
Fully Functioning Partially Functioning No Report
Main Pipeline, 34, 40%
Main Pipeline
and Well, 41, 49%
Well, 6, 7%
Other, 3, 4%
Figure 13: Main Sources of Water, Dec 2015
HeRAMS| Public Hospitals’ Annual Report for 2015, Health Information Management Unit, WHO, Syrian Arab Republic Page 16 of 37
3.4 Availability of electricity generators
Availability of electricity generators continued to be highly demanded with the current situation, where
electricity power is widely disrupted and majority of public hospitals are dependent on generators' power.
Availability of electrical generators at functional hospitals was measured by assessing the functional out of
the total existing generators in the hospital. The percent of hospitals in need for electricity generators out of
the total functional hospital is summarized at governorate level [Figure 16].
40% (34) of functional public hospitals across Syria are in need for electrical generators, mainly reported
from 11 governorates: Quneitra, Aleppo, Deir-ez-Zor, Dar’a, Rural Damascus, Al-Hasakeh, Hama, Damascus,
Homs, Tartous and Lattakia [Figure 16].
Figure 16: Percent of hospitals in need for generators out of total functional hospitals, December 2015
100%
77% 75% 75%
56%
50%
40%
27% 25%
17% 13%
0% 0%
40%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Quneitra Aleppo Deir-ez-Zor Dar'a RuralDamascus
Al-Hasakeh Hama Damascus Homs Tartous Lattakia Ar-Raqqa As-Sweida Total
HeRAMS| Public Hospitals’ Annual Report for 2015, Health Information Management Unit, WHO, Syrian Arab Republic Page 17 of 37
4. Availability of Health Human Resources
Availability and trend of health human
resources were analyzed across all public
hospitals [MoH & MoHE] considering the
following scopes:
Comparative and trend analysis of medical
staff by category (i.e., doctors, nurses,
midwives)
Trend analysis of availability of medical
doctors by affiliation; MoH vs. MoHE
hospitals
Trend analysis of availability of medical
doctors by gender, per governorate
The proportion between different categories of health staff, among the total functional (fully and partially)
MoH and MoHE hospitals (84/113), by the end of December 2015, is as follows: the emergency physicians
remain the lowest proportion of health staff in public hospitals (0.3%), followed by dentists (1%),
pharmacists (1%), Midwives (5%), Laboratory personnel (7%), specialists (15%), resident doctors (17%), and
nurses (54%); [Figure 17].
The availability and level of medical staffing (by category and gender) in public hospitals a, as is summarized
at governorate’s level in Map 4. The categories of staff included in the map are: specialists, emergency
physicians, resident doctors, and dentists.
Map 4: Availability of medical doctors in functional public hospitals, by end of December 2015, per governorate
Specialist 15%
Emergency Physician
0%
Resident Doctor 17%
Dentist 1%
Nurses 54%
Laboratory 7%
Midwives 5%
Pharmacists 1%
Figure 17: Proportion of Health Staff in Hospitals, December 2015
HeRAMS| Public Hospitals’ Annual Report for 2015, Health Information Management Unit, WHO, Syrian Arab Republic Page 18 of 37
4.1 Availability of medical staff by category and affiliation
The availability medical staff in functional public hospitals is analyzed by category [i.e., medical doctors1,
nurses, and midwives] and affiliation [MoH vs. MoHE hospitals], as follow:
i. Trend analysis of medical doctors [a total of specialists, Emergency doctors, resident doctors,
dentists]:
The number of medical doctors in public hospital has slightly decreased by 11% in December 2015 (9,455
compared to January 2015 (10,586).
Figure [18] shows the trend analysis of reported medical doctors from January to December 2015, in
functional public hospitals.
Figure 18: Trend analysis of number of doctors (a total of Specialists, Emergency Physicians, Resident Doctors, and
Dentists) in public hospitals during 2015
ii. Trend analysis of Nurses:
The number of nurses in public hospital has slightly decreased by 9% in December 2015 (14,892), compared
to January 2015 (16,450).
Figure [19] shows trend analysis for the reported number of nurses from January to December 2015.
Figure 19: Trend analysis of number of Nurses in public hospitals during 2015
1 A total of specialists, Emergency doctors, resident doctors, and dentists
10,586
10,801 10,819 10,742
10,519
10,296 10,280 10,266 10,154 10,160
9,909
9,455
8500
9000
9500
10000
10500
11000
Jan2015
Feb2015
Mar2015
Apr2015
May2015
Jun2015
Jul2015
Aug2015
Sep2015
Oct2015
Nov2015
Dec2015
16,450 16,696
16,293
15,972 15,753
15,498 15,614 15,548
15,324 15,339
14,933 14,892
13500
14000
14500
15000
15500
16000
16500
17000
Jan2015
Feb2015
Mar2015
Apr2015
May2015
Jun2015
Jul2015
Aug2015
Sep2015
Oct2015
Nov2015
Dec2015
HeRAMS| Public Hospitals’ Annual Report for 2015, Health Information Management Unit, WHO, Syrian Arab Republic Page 19 of 37
iii. Trend analysis of Midwives:
The number of midwives in public hospital has slightly decreased by 13% in December 2015 (1,319),
compared to January 2015 (1,516). The drop is mainly observed in Deir-ez-Zor governorate.
Figure [20] shows trend analysis for the reported number of midwives from January to December 2015.
Figure 20: Trend analysis of number of midwives in public hospitals during 2015
4.2 Availability of medical doctors by affiliation (MoH vs. MoHE hospitals)
Analysis of proportions of medical doctors [specialists, emergency doctors, resident doctors, dentists]
working at MoHE hospitals versus MoH hospitals in December 2015 has shown that 31% (2,952) of medical
doctors (specialists and resident doctors) work in MoHE, while 69% (6,503) are in MoH hospitals.
20% out of total Specialists (4,228) work in public hospitals are in MoHE hospitals; 43% out of total resident
doctors (4,798) are in MoHE hospitals; and 25% out of total the nurses & midwives (16,211) are in MoHE
hospitals. Details on proportions and numbers of key staff work in MoH vs. MoHE hospitals, by end of
December 2015, are presented in [Figure 21].
Figure 21: Proportions and numbers of key staff work in MoH vs. MoHE hospitals, December 2015
1,516
1,490
1,464 1,445 1,441
1,352 1,376
1,362 1,346 1,348
1,302 1,319
1150
1200
1250
1300
1350
1400
1450
1500
1550
Jan2015
Feb2015
Mar2015
Apr2015
May2015
Jun2015
Jul2015
Aug2015
Sep2015
Oct2015
Nov2015
Dec2015
3,382
90
2,713
318
10,994 1,410 1,142
846
2,085
21
3,898 379 177
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Specialist EmergencyPhysician
Resident Doctor Dentist Nurses Laboratory Midwives
MoHE
MoH
HeRAMS| Public Hospitals’ Annual Report for 2015, Health Information Management Unit, WHO, Syrian Arab Republic Page 20 of 37
However, MoHE hospitals are located in four governorates (Damascus, Rural Damascus, Aleppo, and
Lattakia), they serve the whole country. A comparison between the total available medical-related staff in
MoH vs. MoHE hospitals is shown in [Figure 22].
Figure 22: Comparison of the medical staff of MoH vs. MoHE hospitals, December 2015
A comparative analysis for the number of medical doctors [specialists, emergency doctors, resident doctors,
dentists] working in MoH hospitals between June and December 2015, has shown a drop of 386 (3,338 in
June compared to 2,952 in December 2015); similarly, a drop of 455 (6,958 to 6,503) in MoHE hospitals.
This could be interpreted as fleeing of specialized medical staff out of the country in some cases, and
relocation / reassignment of medical staff to DoHs/ health centres on other cases, based on functionality
status of the hospitals, and security situation in the area.
4.3 Availability of medical doctors by gender (MoH vs. MoHE hospitals)
By analyzing the proportion of male to female doctors (a total of: Specialists, Emergency Physicians, Resident
Doctors, Dentists), lowest proportions are seen in Al-Hasakeh, Deir-ez-Zor and Ar-Raqqa governorates
[Figure 23].
Figure 23: Proportion of Doctors (a total of Specialists, Emergency Physicians, Resident Doctors, Dentists), by gender,
per governorate, December 2015
55
5
14
8 26
2
53
5
43
4
58
22
5
12
9
10 3 7 14 0 0 0 0
96
1
18
0
26
0
26
4
91
4
15
70
2
45
4
47
13 42 81
12
1 0 8
1,4
38
62
8
61
1
1,4
19
2,2
17
31
7
37
9
98
5
30
8
89
68 13
8
13
1
20 1
11
11
7
32
68 99 1
95
96
0 29 52
0
500
1,000
1,500
2,000
2,500
Damascus Rural Damascus Aleppo Lattakia Damascus Rural Damascus Aleppo Lattakia
MoH MoHE
Specialist Emergency Physician Resident Doctor Dentist Nurses Midwives Pharmacists
1907 288 963 908 817 297 503
152 23 140 40 186 84
1026 130 535 577 344 145 212
31 6 36 17 62 26
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Damascus RuralDamascus
Aleppo Lattakia Tartous Homs Hama Al-Hasakeh Deir-ez-Zor Ar-Raqqa Dar'a As-Sweida Quneitra
Male Female
HeRAMS| Public Hospitals’ Annual Report for 2015, Health Information Management Unit, WHO, Syrian Arab Republic Page 21 of 37
5. Availability and Utilization of the Health Services
The availability of core healthcare services is monitored through HeRAMS at hospital’s level, considering a
standard list of health services (including: General Clinical Services, Surgical and Trauma care, Child Health,
Nutrition, Maternal & Newborn Health, Non-communicable Diseases, and Mental Health).
Analysis of availability of health services has been conducted across all functional public hospitals [MoH &
MoHE]: (84/113). As a result of disrupted healthcare delivery and non-functionality of hospitals, limited
provision of health services was observed across governorates, even within functional hospitals [Figure 24].
Figure 24: Availability of Health Services in the functional Public Hospitals, December 2015
**Detailed information on availability of services per governorate is available in the HeRAMS Database.
The workload and utilization of the health services were analyzed in terms of the total estimated serviced
people in all functional public hospitals during January and December 2015 per governorate [Figure 25]. In
2015, the total estimated caseload in functional public hospitals is 6,334,010.
Figure 25: Estimated caseload of functional public hospitals (outpatient consultations and emergency cases), January
to December 2015
11%
31%
35%
41%
55%
65%
71%
73%
74%
76%
79%
80%
83%
85%
87%
91%
Acute psychiatric inpatient unit
Outpatient psychiatric care
Cancer treatment services
Management of severe acute malnutrition with complications
Management of children diseases
(CEmOC) Comprehensive emergency obstetric care
Emergency surgery
Mass casualty management
ICU services
Cardiovascular services
End Stage Kidney Disease (ESKD) treatment
Blood bank service
Elective surgery
Imaging service
Solid waste management
Emergency department services
1,321,953
981,599
747,374
647,939 636,004
505,247 442,229
353,249
228,053 147,274 117,196 106,870
53,400 45,623
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
Damascus Lattakia Aleppo Homs Tartous Hama Al-Hasakeh RuralDamascus
As-Sweida Ar-Raqqa Deir-ez-Zor Dar'a Quneitra Idleb
HeRAMS| Public Hospitals’ Annual Report for 2015, Health Information Management Unit, WHO, Syrian Arab Republic Page 22 of 37
The proportion of workload of functional hospitals
per governorate is provided on Figure 26.
Detailed analysis on utilization of the core health
services is provided on the following sub-sections,
including:
1. General Clinical Services (Outpatient,
Inpatient, Laboratory, Blood bank services,
Imaging services)
2. Surgical and Trauma care
3. Maternal health services [normal deliveries,
caesarean sections, and CEmOC]
4. Nutrition
5. Child Health
6. Non-communicable diseases
7. Mental Health
5.1 General Clinical services
The following sections provide analysis on the utilization of health services in functional public hospitals at
governorate level.
i. Outpatient and inpatient:
The number of outpatients to inpatients was assessed at a hospital level, and the total numbers reported in
December 2015 were summarized and analyzed at governorate level [Figure 27].
Figure 27: The number of Outpatient and Inpatient in public hospitals, December 2015
Trend analysis of total reported numbers of Outpatient and Inpatient from functional public hospitals [MoH
& MoHE], for twelve months (January to December 2015), is presented in [Figure 28]. In 2015, the total
reported outpatients are 3,005,756 while the inpatients are 804,649.
Figure 28: Trend analysis of Outpatient and Inpatient in public hospitals, January to December 2015
54,319
41,288
32,596
24,038 21,356
15,724 12,625
6,280 6,105 4,299 4,281 1,600 1,389
17,808
6,215 4,626 7,555
2,472 5,166 5,331
2,620 5,180 41
4,485 413 731
0
10,000
20,000
30,000
40,000
50,000
60,000
Damascus Lattakia Aleppo Tartous Homs Hama RuralDamascus
Al-Hasakeh Ar-Raqqa Deir-ez-Zor As-Sweida Quneitra Dar'a
Outpatient services Inpatients services
202,427
255,271
304,016 277,312
259,927 261,619 235,079
280,021
240,309 226,524 237,351 225,900
59,459 62,492 70,066 66,221 65,928 65,932 66,669 77,664 71,806 70,769 65,000 62,643
0
50000
100000
150000
200000
250000
300000
350000
Jan 2015 Feb 2015 Mar 2015 Apr 2015 May 2015 Jun 2015 Jul 2015 Aug 2015 Sep 2015 Oct 2015 Nov 2015 Dec 2015
Outpatient services Inpatients services
Damascus 21%
Lattakia 15%
Aleppo 12% Homs
10%
Tartous 10%
Hama 8%
Al-Hasakeh 7%
Rural Damascus 5%
As-Sweida 4%
Ar-Raqqa 2%
Deir-ez-Zor 2%
Dar'a 2%
Quneitra 1%
Idleb 1%
Figure 26: Proportions of workload during 2015, per governorate
HeRAMS| Public Hospitals’ Annual Report for 2015, Health Information Management Unit, WHO, Syrian Arab Republic Page 23 of 37
ii. Laboratories, blood bank, and imaging services
The number of patients received services in hospitals’ laboratories, blood bank, and imaging departments
was assessed at a hospital level, and the total number of cases from January to December 2015 analyzed at
governorate level [Figure 29].
Figure 29: The number of patients received services in laboratories, blood bank, and imaging services in public
hospitals, December 2015
Trend analysis of number of patients received services in hospitals’ blood banks and imaging departments,
from January to December 2015, is presented in [Figure 30]. In 2015, the total reported patients received
services in blood banks are 275,016 while patients received imaging services are 2,145,212 [of note: the
total performed service (X-Ray, MRI, and CT Scan pictures) in 2015 are 3,005,823].
Figure 30: Trend analysis of number of patients received services in blood banks and imaging services in public
hospitals, January to December 2015
5.2 Surgical and Trauma care
The surgical and trauma care services is assessed at hospitals’ level. Descriptive analysis is conducted at
governorate’s level for the number of reported emergency cases, mass causalities, and surgeries (elective
and emergency).
iii. Emergency cases reported in emergency departments
Figure 31 presents the total number of cases in emergency departments, reported during December 2015
from functional public hospitals at governorate level.
Figure 31: The number of reported cases in emergency department in public hospitals, December 2015
45
7,0
59
68
,65
1
17
0,0
67
15
8,1
37
16
8,7
61 8
1,5
79
19
7,6
36
10
5,9
69 1
3,1
66
2,4
61
10
,63
3
48
,75
7
19
,91
9
6,8
52
36
2
4,9
30
2,6
98
1,9
76
61
1
1,6
65
87
8
20
26
1 91
37
0
11
0
40
,97
1
8,0
43
22
,80
9
22
,62
3
21
,97
3
10
,13
0
19
,44
8
8,3
99
1,3
60
83
2
1,7
05
9,1
89
1,2
50
0
50000
100000
150000
200000
250000
300000
350000
400000
450000
500000
Damascus RuralDamascus
Aleppo Lattakia Tartous Homs Hama Al-Hasakeh Deir-ez-Zor Ar-Raqqa Dar'a As-Sweida Quneitra
Laboratory services Blood bank service Imaging service
23,289 23,395 26,857 24,598 23,848 22,292 20,934 23,079 23,026 22,221 20,653 20,824
156,912 171,621
194,439 184,184 186,069 184,464 174,944 191,674
177,433 178,225 176,515 168,732
0
50000
100000
150000
200000
250000
Jan 2015 Feb 2015 Mar 2015 Apr 2015 May 2015 Jun 2015 Jul 2015 Aug 2015 Sep 2015 Oct 2015 Nov 2015 Dec 2015
Blood bank service Imaging service
48,272
37,355
30,155 29,550 29,402 25,140
22,667
15,188 13,007
5,867 3,577 3,109 1,269
0
10,000
20,000
30,000
40,000
50,000
60,000
Damascus Lattakia Al-Hasakeh Homs Aleppo Tartous Hama RuralDamascus
As-Sweida Ar-Raqqa Dar'a Quneitra Deir-ez-Zor
HeRAMS| Public Hospitals’ Annual Report for 2015, Health Information Management Unit, WHO, Syrian Arab Republic Page 24 of 37
iv. Mass causalities
Figure 32 presents the total number of mass causality cases, reported during December 2015 from
functional public hospitals at governorate level.
Figure 32: The number of reported cases of mass casualties in public hospitals, December 2015
v. Emergency and Elective surgeries:
The number of emergency surgeries to elective surgeries was assessed at a hospital level, and total numbers
were summarized and analyzed at governorate level [Figure 33].
During December 2015, the highest workload of elective surgeries is reported from Damascus MoH Hospital
(Al-Mojtahid: 983 surgeries), followed by Al-Assad university hospital in Damascus (817 surgeries), Al-Assad
university hospital/ Lattakia (817 surgeries), Aleppo university hospital (794 surgeries), Hama national
hospital (789 surgeries), Ar-Razi MoH hospital in Aleppo (732), Al-Bassel Heart Institute in Damascus (663),
and Al-Mouwasat university hospital (625).
While the highest workload of emergency surgeries is reported from Al-Bassel hospital in Tartous (2,004),
followed by National hospital in Lattakia (574), then Al-Mouwasat MoHE hospital (494), and Ar-Razi MoH
hospital in Aleppo (351), As-Salameyeh national hospital (307), Hama national hospital (295), and Zaid Ash-
Shariti hospital in As-Sweida (259).
*Of note, the highest number of functional public hospitals is in Damascus, of which 14 out of 15 hospitals
provide elective surgeries, except Ibn-Roshd hospital for Mental Health.
Figure 33: The number of emergency surgeries vs. elective surgeries in public hospitals, December 2015
2,237
922
641 531 496
187 185 128 82 77 30 29 11
0
500
1,000
1,500
2,000
2,500
Hama Dar'a Aleppo Quneitra Damascus RuralDamascus
Homs Al-Hasakeh Tartous Ar-Raqqa Deir-ez-Zor Lattakia As-Sweida
5,064
2,327 1,973
1,473 1,093
732 652 579 430 165 88 44 6
907 1,153
645 984
2,326
284 55 67 204 222 132 32 2
0
1000
2000
3000
4000
5000
6000
Damascus Lattakia Aleppo Hama Tartous As-Sweida RuralDamascus
Homs Al-Hasakeh Ar-Raqqa Quneitra Dar'a Deir-ez-Zor
Elective surgery Emergency surgery
HeRAMS| Public Hospitals’ Annual Report for 2015, Health Information Management Unit, WHO, Syrian Arab Republic Page 25 of 37
By analyzing the percent of total emergency surgeries to elective surgeries during December 2015, the
highest percent of emergency surgeries across different governorates is reported in Tartous, Quneitra , Ar-
Raqqa , Dar'a, and Hama governorates. Across all reported functional public hospitals, 32% of surgeries are
emergency while 68% are elective [Figure 34].
In Tartous, the highest figures are reported from Al-Basil surgical hospital, which is the biggest hospital in
Tartous, located in the south eastern part of the governorate and adjacent to Hama and Homs. The location
of this hospital is also very close to the highway, and majority of the road incidents are received there.
In Ar-Raqqa, the number of emergency surgeries is relatively high because of emergency cases received
from surrounding in-secure areas.
In Hama, the number of emergency surgeries is relatively high because of emergency cases received from
surrounding in-secure areas (Rural Hama, Idleb, and Rural Lattakia).
In Dar’a and Quneitra, the high percent of emergency surgeries is due to the escalating security situation;
emergency surgeries are given higher priority than cold surgeries.
Figure 34: Percentage of total emergency surgeries to elective surgeries in public hospitals per governorate,
December 2015
Trend analysis of total number of elective and emergency surgeries reported in functional public hospitals
[MoH & MoHE], from January to December 2015 is presented in Figure 35. In 2015, the total reported
emergency surgeries are 96,766 while the elective surgeries are 196,401.
Figure 35: Trend analysis of number of patients received emergency surgeries and elective surgeries in public
hospitals, January to December 2015
8% 10% 15% 25% 25% 28% 32% 33%
40% 42%
57% 60% 68%
32%
92% 90% 85% 75% 75% 72% 68% 67%
60% 58%
43% 40% 32%
68%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
RuralDamascus
Homs Damascus Aleppo Deir-ez-Zor As-Sweida Al-Hasakeh Lattakia Hama Dar'a Ar-Raqqa Quneitra Tartous Total
% Emergency surgery % Elective surgery
7,213 6,596 8,020 7,899 8,601 8,319 8,219
9,395 8,152
9,646
7,693 7,013
13,161
15,176
17,290 16,260 16,589
18,881
15,796
19,400
16,927 15,957 16,338
14,626
0
5000
10000
15000
20000
25000
Jan 2015 Feb 2015 Mar 2015 Apr 2015 May 2015 Jun 2015 Jul 2015 Aug 2015 Sep 2015 Oct 2015 Nov 2015 Dec 2015
Emergency surgery Elective surgery
HeRAMS| Public Hospitals’ Annual Report for 2015, Health Information Management Unit, WHO, Syrian Arab Republic Page 26 of 37
5.3 Maternal health services
Analysis of availability and utilization of maternal health services was conducted considering three scopes:
Utilization of service (caesarean sections (CS) vs. normal deliveries); December 2015 summary
figures by governorate
Percentage of CSs to normal deliveries, of December 2015
Trend analysis of the monthly normal deliveries vs. caesarean sections, January to December 2015
i. Utilization of service (caesarean sections vs. normal deliveries)
The numbers of caesarean sections performed at public hospitals (in December 2015) versus the normal
deliveries have been analyzed at governorates’ level [Figure 36].
The highest numbers are reported from Maternity hospital in Ar-Raqqa [normal deliveries are 1,500 while
CSs are 355]. Of note, the maternity hospital in Ar-Raqqa is the only reported provider for delivery services in
the governorate, after closure of the maternity specialized centre in the city in addition to the high cost of
delivery in private centres, which is unbearable cost for the residing population
The high figures reported in Damascus hospitals are from the Obs. and Gyn. MoHE Hospital [normal
deliveries are 567 while CSs are 468] followed by Al-Zahrawi MoH Hospital [normal deliveries 391 while the
CSs are 103 case.
Figure 36: The No. of normal deliveries and caesarean sections (CSs) performed at public hospitals, December 2015
ii. Percentage of CS to normal deliveries
The global norm for the percentage of CS to normal deliveries is 5% to 15%. Based on [Figure 34], 12
governorates are above the threshold.
The highest figures of caesarian sections in December 2015 are reported in Lattakia (478 CSs compared to
272 normal deliveries) and Tartous (442 CSs compared to 311 normal deliveries), which are due to cultural
preferences, where the pregnant women opt for cesarean sections for several reasons, such as:
Reducing the pain associated with childbirth
Choosing a fixed date for delivery, in relation to other social occasions
In Homs, Rural Damascus, and Aleppo the high numbers of CSs are due to the fact that majority of the
pregnant women prefer to do caesarean sections, because of the security situation and hassles they could go
through if they opted for normal delivery.
Across all reported functional hospitals in December 2015, 37% (3,524) of deliveries are CSs while 63%
(5,880) are normal deliveries. Details on percent of CSs to normal deliveries per governorate in December
2015, is provided in [Figure 37].
1702
958
717 659
325 311 280 272 240 226
85 70 35
386
571
115
611
291
442
165
478
217 180
28 40 0
0
200
400
600
800
1000
1200
1400
1600
1800
Ar-Raqqa Damascus Al-Hasakeh Hama RuralDamascus
Tartous As-Sweida Lattakia Homs Aleppo Dar'a Quneitra Deir-ez-Zor
Normal_deliveries CSs
HeRAMS| Public Hospitals’ Annual Report for 2015, Health Information Management Unit, WHO, Syrian Arab Republic Page 27 of 37
Figure 37: percentage of caesarean sections to normal deliveries in public hospitals, December 2015
iii. Trend analysis of the monthly numbers of normal deliveries vs. caesarean sections
Trend analysis of the monthly numbers of normal deliveries vs. caesarean sections reported from the MoH &
MoHE hospitals, from January to December 2015 is shown in Figure 38. In 2015, the total reported normal
deliveries are 63,185 while the caesarean sections are 39,635.
Figure 38: Trend analysis of the monthly numbers of normal deliveries vs. caesarean sections in public hospitals,
January to December 2015
iv. Comparison of MoH and MoHE hospitals workload of Normal Deliveries vs. CSs:
Comparison analysis between MoH and MoHE hospitals that provide Obstetrics & Gynecology services
across four governorates, has shown higher workload for the MoHE Hospitals mainly in Damascus
governorate (Al-Tawleed [Obstetrics and Gynecology] hospital for MoHE); [Figure 39].
Figure 39: Comparison of MoH & MoHE hospitals workload of normal deliveries vs, CSs, December 2015
36% 41% 52% 53% 53% 56%
63% 63% 64% 75% 82% 86%
100%
64% 59% 48% 47% 47% 44%
37% 37% 36% 25% 18% 14%
0%
0%10%20%30%40%50%60%70%80%90%
100%
Lattakia Tartous Hama Homs RuralDamascus
Aleppo Damascus As-Sweida Quneitra Dar'a Ar-Raqqa Al-Hasakeh Deir-ez-Zor
CSs % Normal deliveries %
5,633
4,871 5,364
4,887
4,161 4,381
5,290
5,941 5,742 5,837
5,198
5,880
3,469 2,982
3,577 3,314 3,111 3,065
3,314 3,621
3,169 3,321 3,168 3,524
0
1000
2000
3000
4000
5000
6000
7000
Jan 2015 Feb 2015 Mar 2015 Apr 2015 May 2015 Jun 2015 Jul 2015 Aug 2015 Sep 2015 Oct 2015 Nov 2015 Dec 2015
Normal_deliveries CSs
391
325
77
226
567
149
46 103
291
54
429 468
126
49
0
100
200
300
400
500
600
Damascus Rural Damascus Aleppo Lattakia Damascus Rural Damascus Aleppo Lattakia
MoH Hospitals MoHE Hospitals
Normal_deliveries CSs
HeRAMS| Public Hospitals’ Annual Report for 2015, Health Information Management Unit, WHO, Syrian Arab Republic Page 28 of 37
5.4 Child Health
Management of severe children diseases (such as acute respiratory diseases, Meningitis, blood diseases
cancer, etc…) are assessed at hospitals level. Figure 40 shows the distribution of total reported cases of
children with severe diseases by governorate.
Figure 40: Number of children with severe diseases in public hospitals, December 2015
The high reported figures in Tartous, Quneitra, Damascus, Hama, and As-Sweida are due to the high
numbers of IDPs, and also availability of MoHE referral hospitals for children in some of these areas. While in
Quneitra it was due to bad weather condition.
Trend analysis of reported cases of severe children diseases from January to December 2015, is presented in
[Figure 41]. In 2015, the total reported cases of severe children diseases are 40,232.
Figure 41: Trend analysis of reported cases of severe children diseases in public hospitals, January to December 2015
5.5 Nutrition
Monitoring of cases of severe acute malnutrition with complications is systematically conducted at public
hospitals level; Figure 42 demonstrates the number of cases reported in December 2015, at governorate
level.
Figure 42: The number of children with severe acute malnutrition with complications in public hospitals, December
2015
681
540 478
422 374
265
122 92 80 77
47 0 0
0
100
200
300
400
500
600
700
800
Tartous Quneitra Damascus Hama As-Sweida Aleppo Homs Lattakia Dar'a RuralDamascus
Al-Hasakeh Deir-ez-Zor Ar-Raqqa
2,901 3,119
3,758 3,751 3,633 3,359
3,545 3,777
3,210 2,929 3,072 3,178
0
500
1000
1500
2000
2500
3000
3500
4000
Jan 2015 Feb 2015 Mar 2015 Apr 2015 May 2015 Jun 2015 Jul 2015 Aug 2015 Sep 2015 Oct 2015 Nov 2015 Dec 2015
Management of children diseases
12 11
8 7
3 3
0 0 0 0 0 0 0 0
2
4
6
8
10
12
14
Lattakia Hama Al-Hasakeh Damascus RuralDamascus
Aleppo Tartous Homs Deir-ez-Zor Ar-Raqqa Dar'a As-Sweida Quneitra
HeRAMS| Public Hospitals’ Annual Report for 2015, Health Information Management Unit, WHO, Syrian Arab Republic Page 29 of 37
The high reported figures in Lattakia, Hama, Al-Hasakeh, and Damascus are due to the high numbers of IDPs.
Trend analysis of reported cases of severe acute malnutrition from January to December 2015, is presented
in [Figure 43]. In 2015, the total reported children with severe acute malnutrition are 807.
Figure 43: Trend analysis of number of children with severe acute malnutrition with complications in public
hospitals, January to December 2015
5.6 NCDs (non-communicable diseases)
NCDs were assessed through HeRAMS by checking the availability and utilization of services at hospitals
level. The majority of high reported figures of NCDs (Diabetes, Hypertension, Cardiovascular, Kidney and
Cancer diseases) are from Damascus hospitals.
Among all NCDs, Cancer patients’ consultations are the highest reported figures, mainly in Damascus, Rural
Damascus (has one cancer specialized hospital), and Lattakia (has one cancer specialized hospital) public
hospitals, where cancer referral hospitals are located. It worth mentioning that cancer is treated at
secondary and tertiary levels only, while other NCDs (diabetes and hypertension, etc…) usually managed at
primary and secondary care levels, unless patients develop complications.
Cardiovascular consultations were high in Damascus (has two cardiovascular specialized hospitals), Lattakia
(has one cardiovascular specialized hospital), Aleppo (has two cardiovascular specialized hospitals), Tartous,
and Homs in December 2015 [Figure 44].
Figure 44: The number of NCDs’ consultations in public hospitals, December 2015
*ESKD: End Stage Kidney Disease
44
65
56
41
80
57
80 85 83 83
89
44
0
10
20
30
40
50
60
70
80
90
100
Jan 2015 Feb 2015 Mar 2015 Apr 2015 May 2015 Jun 2015 Jul 2015 Aug 2015 Sep 2015 Oct 2015 Nov 2015 Dec 2015
Management of severe acute malnutrition with complications
727
214 128
391
74
739
55 24 57
0
24 76 74
1212
325 520
70 195
318
72
993
28 58 46 38 85
3399
200
1272
2663
822 630
391
135 21
320
16
427
92
843
113 289
399 346 110
344 190
16 53 40 119 25
2606
4470
919
2688
32 174
512
0 2 0 0 132
0
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Damascus RuralDamascus
Aleppo Lattakia Tartous Homs Hama Al-Hasakeh Deir-ez-Zor Ar-Raqqa Dar'a As-Sweida Quneitra
Diabetes Hypertension Cardiovascular ESKD Cancer
HeRAMS| Public Hospitals’ Annual Report for 2015, Health Information Management Unit, WHO, Syrian Arab Republic Page 30 of 37
The monthly trend of reported NCDs’ consultations at functional public hospitals from January to December
2015 is shown in [Figure 45].
In 2015, the total reported NCDs’ consultations are as follow:
Diabetes: 36,481
Hypertension: 52,648
Cardiovascular: 127,659
ESKD: 36,719 [of note: the total performed ESKD Sessions in 2015: 279,283]
Cancer: 167,933
Figure 45: Trend analysis of total monthly number of NCDs’ consultations reported in public hospitals, January to
December 2015
The high numbers were reported mainly from Al-Bairouni MoHE hospital in Rural Damascus (4,468), which is
the biggest cancer specialized hospital.
3,247 3,425
3,778 3,583
3,266 2,920 2,604
2,861 2,937 2,778 2,499 2,583
4,805 5,468 5,567 4,931 4,980
3,739 4,343
3,564 3,568 3,784 3,939 3,960
9,774 10,600
11,883
10,940 10,486 10,170 9,953
11,264 10,370
10,871 10,960 10,388
3,593 3,613
3,319 3,032 3,074
2,838 2,932 2,821
2,850 2,927 2,833 2,887
12,538
14,101 13,966 14,514
15,303 15,889
13,957
15,713
12,865
14,138 13,414
11,535
0
2000
4000
6000
8000
10000
12000
14000
16000
18000
Jan 2015 Feb 2015 Mar 2015 Apr 2015 May 2015 Jun 2015 Jul 2015 Aug 2015 Sep 2015 Oct 2015 Nov 2015 Dec 2015
Diabetes Hypertension Cardiovascular ESKD Cancer
HeRAMS| Public Hospitals’ Annual Report for 2015, Health Information Management Unit, WHO, Syrian Arab Republic Page 31 of 37
5.7 Mental Health
Availability and utilization of mental health services were assessed through HeRAMS by checking the
outpatient and inpatient services at hospitals level and the number of patients. Summary of the total
reported consultations (outpatient) and inpatients at public hospitals, per governorate level is shown in
[Figure 46].
The high figures of outpatients in Aleppo are reported from Ibn-Khaldoun mental health specialized
hospital/ MoH (4,334 cases) and Zahi Azraq MoH hospital (52 cases), while in Damascus high reporting is
received from Ibn-Roshod mental health specialized hospital/ MoH (407 cases), followed by Al-Mojtahid
[Damascus MoH Hospital] (222 cases), Al-Mouwasat MoHE hospital (173 cases), and Children MoHE hospital
(36 cases).
The key figures of inpatients are reported from Damascus (Ibn-Roshod hospital (407 cases), followed by Al-
Mouwasat MoHE hospital (14 cases); Rural Damascus (Ibn-Sina Psychiatric MoH hospital (400 cases); and
Aleppo (Ibn-Khaldoun MoH hospital (130 cases)).
Figure 46: The number of outpatient psychiatric cases vs. the number of inpatients in public hospitals, December
2015
Trend analysis of monthly reported number of outpatient psychiatric cases vs. the number of inpatients in
public hospitals [MoH & MoHE] from January to December 2015 is shown in [Figure 47]. In 2015, the total
reported outpatient psychiatric cases are 61,788 while the psychiatric inpatient cases are 11,673.
Figure 47: Trend analysis of number of outpatient psychiatric cases vs. the number of psychiatric inpatient cases in
public hospitals, January to December 2015
4,386
838
150 129 74 26 0 0 0 0 0 0 0 130 421
8 0 400
0 0 0 0 2 0 0 0 0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Aleppo Damascus Lattakia Homs RuralDamascus
Dar'a Tartous Hama Al-Hasakeh Deir-ez-Zor Ar-Raqqa As-Sweida Quneitra
Outpatient psychiatric care Psychiatric inpatient
3,025
3,647
4,347
4,896 5,235
5,615
5,071
6,460
5,866 5,989 6,034 5,603
849 881 866 967 1,017 1,060 1,051 1,069 979 999 974 961
0
1000
2000
3000
4000
5000
6000
7000
Jan 2015 Feb 2015 Mar 2015 Apr 2015 May 2015 Jun 2015 Jul 2015 Aug 2015 Sep 2015 Oct 2015 Nov 2015 Dec 2015
Outpatient psychiatric care Psychiatric inpatient
HeRAMS| Public Hospitals’ Annual Report for 2015, Health Information Management Unit, WHO, Syrian Arab Republic Page 32 of 37
6. Availability of Medical Equipment
The availability of different types of essential and specialized equipment and supplies was assessed at
hospital level, based on a standard checklist2.
In its fifth year of crisis, Syria’s hospitals are still suffering from shortages and/or malfunction of medical
devices/ equipment to provide secondary care services. In insecure governorates, medical devices are either
destroyed, burned, or malfunctioned, while in safe areas the medical devices are overburdened by increased
numbers of people (actual numbers of people in the area, in addition to IDPs and patients /injured people
from surrounding areas).
Maintenance of malfunctioned devices remains a concern, due to non-availability of spare parts, accredited
agent to provide maintenance support, or difficulty of accessibility in many cases.
Analysis of availability of essential and specialized equipment was measured across all functional public
hospitals [MoH & MoHE] (84/113), in terms of functional equipment out of the total available equipment in
the hospital. The produced analysis provides good indication of the current readiness of the hospitals to
provide the health services, and also to guide focused planning for procurement of equipment and
machines, to fill-in identified gaps.
Gaps on essential and specialized equipment and machines were observed, even within the functional public
hospitals. Further details are provided on [Figure 48] and [Figure 49].
Figure 48: Percentage of functional essential equipment/ total available equipment in functional public hospitals,
December 2015
Figure 49: Percentage of functional specialized equipment/ total available equipment in the functional public
hospitals, December 2015
2 A more detailed list of essential equipment is available upon request.
73%
86%
86%
87%
89%
90%
90%
91%
91%
92%
93%
93%
94%
95%
96%
98%
Ambu bag (Paediatric and Adult)
Sterilizer/ Autoclave
Suction machine
Delivery_table
Pulse Oximeter
Weighing Scale for adults
Operating_tables
Minor Surgical sets
Weighing Scale for infants
Light source (flashlight acceptable)
Height Measurement Device
Fetoscope
Oxygen cylinders
Length Measurement Device
Nebulizer
Vaginal examination set
53% 69% 70%
73% 74% 74%
79% 80% 82% 83%
85% 85%
87% 88%
95%
MRI machine CT Scan
X-Ray Renal Dialysis machine
Ventilators – Adult Cardiotocography (Monitoring of fetalheart frequency)
Portable X-Ray Ultrasound
ECG Incubator for new born
DC Shock machine/ Defibrillator Anaesthesia machines
Ventilators – Paediatric ICU/CCU Monitors Major surgical sets
HeRAMS| Public Hospitals’ Annual Report for 2015, Health Information Management Unit, WHO, Syrian Arab Republic Page 33 of 37
Analysis of availability of specialized equipment [Figure 49] has highlighted many gaps and urgent needs for
equipment and machines at different governorates; such as:
MRI machines: main gaps are in Damascus, Aleppo, Lattakia, Tartous, Homs, Hama, Al-Hasakeh, Deir-
ez-Zor, Ar-Raqqa, Dar'a, Quneitra hospitals.
Cardio-topography (Monitoring of fetal-heart frequency); main gaps are in Damascus, Rural
Damascus, Al-Hasakeh, Dar'a, Quneitra hospitals.
CT scanners: main gaps are in Rural Damascus, Deir-ez-Zor, Ar-Raqqa, Dar'a hospitals.
Ventilators for adults: main gaps are Rural Damascus, Deir-ez-Zor, Ar-Raqqa, Dar'a hospitals.
X-Ray machines: main gaps are in Deir-ez-Zor and As-Sweida hospitals.
Portable X-Ray: main gaps are in Aleppo, Al-Hasakeh, Ar-Raqqa hospitals.
Renal dialysis machines: main gaps are in Rural Damascus, Dar’a, Al-Hasakeh hospitals.
Incubator for new born: main gaps are Homs, Dar'a, Quneitra hospitals.
Map 5: Percent of functional specialized equipment/ total available equipment in functional public hospitals,
December 2015
HeRAMS| Public Hospitals’ Annual Report for 2015, Health Information Management Unit, WHO, Syrian Arab Republic Page 34 of 37
7. Availability of Medicines & Medical supplies
Availability of medicines and medical supplies at hospitals’ level was evaluated based on a standard list of
identified priority medicines (driven from the national Essential Medicine List), and medical supplies for
duration of one month [Figure 47].
The key identified gaps of medicines and consumable at functional hospitals include the hepatitis vaccine
(87%), tetanus shots (85%), affecting blood (58%), antidotes for poisoning (57%), antibiotics for multi-
resistant bacteria (57%), dermatological preparation (57%), delivery related medicines (51%), dialysis
consumables (49%), Albumin (35%), etc.
Figure 50: Availability of medicines and medical supplies for one month in the functional public hospitals, December
2015
Based on the priority medicines list agreed by MoH and WHO, WHO has managed to address the gaps of
medicines identified at all levels of healthcare.
Percentages of available medicines in functional public hospitals, by governorates, are visualized in Map 6.
More details on availability of medicines and medical supplies at governorate level are available in HeRAMS
Database.
13%
15%
42%
43%
43%
43%
49%
51%
65%
65%
67%
68%
71%
74%
77%
79%
79%
81%
82%
85%
85%
87%
88%
89%
Hepatitis vaccine
Tetanus shot
Medicines affecting the blood (anti-anemia medicines, heparin, warfarin, etc.,)
Antidots for Poisoning
Specific antibiotics for multi –resistant bacteria / infectious diseases
Dermatological preparations/ topical (Burns, and anti-infective, etc...)
Delivery related medicines (i.e., Oxytocin , … )
Dialysis consumables
Albumin
Medicines acting on respiratory system (e.g., medicines of Asthma, H1N1 ARI… like salbutamol …)
Anti-diabetic preparations (especially Insulin)
Antibiotics for Children
Gastrointestinal medicines
Anaphylactic shock
Cardiac and /or Vascular Drugs (Anti-hypertensive Drugs, Diuretics, …)
Preoperative medication
IV Fluid
Antibiotics for Adults
General Anesthetics
Local Anesthetics
Antiseptics
Analgesics, antipyretics, non-steroidal anti-inflammatory Medicines
Serums
Anti-allergic including Steroids
HeRAMS| Public Hospitals’ Annual Report for 2015, Health Information Management Unit, WHO, Syrian Arab Republic Page 35 of 37
Map 6: Percentage of available medicines in functional public hospitals, December 2015
HeRAMS| Public Hospitals’ Annual Report for 2015, Health Information Management Unit, WHO, Syrian Arab Republic Page 36 of 37
8. Conclusions and Recommendations
Constant deterioration of functionality status of public hospitals was observed throughout 2015. For
example, 29 hospitals were reportedly out-of-service in December 2015 compared to 19 in January of
the same year, while June marked a record high of 31 non-functional hospitals. Similarly, access to the
public hospitals deteriorated throughout 2015 with 25 hospitals reportedly non-accessible at the close
of the year compared to 17 at the beginning of the year in January 2015. Functionality status of
hospitals was highly affected by the dire security situation and limited access by health staff and
patients as well as critical shortages of supplies.
Levels of damages of the hospitals’ buildings directly affected the functionality status and provision of
health services; however some hospitals have resiliently continued to provide services regardless of
levels of damage to the building and by utilizing intact parts of the building or operating from other
neighboring facilities in a few cases. Rehabilitation of the damaged hospitals’ infrastructure, in addition
to provision of supplies and medical equipment will significantly improve functionality of hospitals,
readiness and provision of essential health services at secondary care level.
Consistent decline of the available number of medical staff (doctors, nurses and midwives) throughout
2015 was observed, and interpreted as fleeing of specialized medical staff out of the country in some
cases, and relocation / reassignment of medical staff to DoHs/ health centres in other cases, based on
functionality status of the hospitals, and security situation in the area. Increased capacity building
activities and training courses of the national health staff will help in improving technical capacity of
healthcare providers and filling gaps in certain areas.
Limited functionality and accessibility to public hospitals in addition to large displacement of people
have greatly overburdened the few functional public hospitals’ resources. Increasing provision of
specialized medical machines, as well as medicines and supplies especially for NCDs (such as cancer
treatment, as observed the highest consultations among other NCDs) provides an affordable alternative
compared to the high cost of healthcare in the private sector.
Conducting a qualitative survey on provision of health services from the populations’ point of view, using
HeRAMS data as a baseline, will help in concretely measuring the impact of the crisis on public health
sector in terms of responsiveness of hospitals and quality of provided services.
HeRAMS| Public Hospitals’ Annual Report for 2015, Health Information Management Unit, WHO, Syrian Arab Republic Page 37 of 37
January - December 2015
© World Health Organization 2015. All rights reserved. The designations employed and the presentation of the material in this publication do not
imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory,
city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border
lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that
they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and
omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the
World Health Organization to verify the information contained in this publication. However, the published material is being distributed without
warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event
shall the World Health Organization be liable for damages arising from its use.
WHO-EM/SYR/026/E
HeRAMS Annual Report
January - December 2015 Public Hospitals in the Syrian Arab Republic