ACMC 3rd Medical Report

hgjr
Dr. Fadi HAKIM
Vice-president of ACMC
March 13, 2014
Third Medical report
Aleppo city medical council

Aleppo City Medical Council
ACMC Third medical report © All rights reserved
2
Table of contents
Preface ..........................................................................................................................................................4
Evolution in numbers of medical services presented in our hospitals .........................................................5
Annual number of surgeries performed in our hospitals .............................................................................6
Annual count of surgeries classified by type ................................................................................................6
Overview of our hospitals.............................................................................................................................7
M01 Hospital.............................................................................................................................................7
Some landmarks through the evolution of the medical work..............................................................9
Annual work Statistics at M01 ............................................................................................................10
M02 Hospital...........................................................................................................................................11
Some landmarks through the evolution of the medical work............................................................13
Some ambitions and projects to be supported in M02..........................................................................14
Annual work Statistics at M02 ............................................................................................................14
M03 Hospital...........................................................................................................................................16
Annual work statistics at M03.............................................................................................................18
M10 Hospital...........................................................................................................................................19
M10 under attack................................................................................................................................21
Annual work statistics at M10.............................................................................................................22
Overview of our PHC centers......................................................................................................................23
Dental clinics...........................................................................................................................................24
Some landmarks through the evolution of the dental care project DCP............................................24
Some ambitions and ideas to be supported.......................................................................................25
Annual work statistics at DCP .............................................................................................................25
N1 Medical point.....................................................................................................................................26
N2 Medical point.....................................................................................................................................27
N3 Medical point.....................................................................................................................................28
N4 Medical Point.....................................................................................................................................29
N12 Medical point...................................................................................................................................31
N13 Medical point...................................................................................................................................32

3
N14 Medical point...................................................................................................................................34
PHC statistics overview...............................................................................................................................35
Most common diagnosis.....................................................................................................................36
Central Warehouses performance..............................................................................................................37
Percentage of medicines and supplies to the hospitals .........................................................................37
Percentage of medicines and supplies over the medical points ............................................................38
Major suppliers of medicines and supplies for ACMC in 2013 ...............................................................39
Referral system – Disaster response system ..............................................................................................40
Activity for prevention of chemical attacks................................................................................................41
Training and development..........................................................................................................................42
1- First aids for beginners ...................................................................................................................43
2- Emergencies for intermediate students .........................................................................................43
3- Emergencies for advanced students...............................................................................................43
Adminstrative restructuring and improvements........................................................................................44
Long term strategy and vision for the future..............................................................................................44

4
Preface
This is the third formal update of ACMC medical report, one of our important internal and
external reports that illustrates the achievements of our collective work.
This version comes with some modifications, first it comes in English language, after the demand
of our public relations offices, it would be more convenient to publish directly in English because we
intend to share it with our international partners
This version comes after a complete year of medical work; therefore, we are able for the first
time to speak about our annual workload volume, and other global issues through the next pages.
The third point is about our statistic teams, they have become more and more precise in their
work, and therefore I am much more confident than before in the accuracy of numbers mentioned in
the report.
In the end, I thank the effort of all the persons who participate in the preparation this report,
and all of these unsung heroes of ACMC, their work is the real topic that we are discussing through
these pages.
We are ready to receive your remarks and questions on the following emails:
management@acmc-sy.org
public_relations@acmc-sy.org
All other suggestions to enrich this article are also welcomed.
President of ACMC Vice-president of ACMC
Dr. Abdul-Aziz Al-ADEL Dr. Fadi HAKIM
Thursday, March 13, 2014

5
Evolution in numbers of medical services presented in our hospitals
Our annual work volume in our hospitals is estimated at 69253 medical service, M01 and M10
are majorly concerned with war injuries, while M02 and M03 are concentrated on Cold medicine and
non-war related injuries , in times of crisis or intensity of military operations like in December 2013 ,
numbers of M02 drop out to match those in military-injuries concerned hospitals , because we prioritize
these injuries on other non-urgent conditions.
0
2000
4000
6000
8000
10000
12000
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
M10
M8
M3
M2
M1

6
Annual number of surgeries performed in our hospitals
10340 surgical intervention has carried out in our hospitals till the end of December, we witnessed an
increase with percentage of M03 due to the activation of the obstetric department, and the increase of
accuracy in the documentation M10 continues to increase its volume, leaving M02 slightly less than its
share in the last report which was around 52%.
Annual count of surgeries classified by type
The following diagram explains how important the amount of orthopedic surgery in our
hospitals was, orthopedist were most of the time in the ORs for 16h straight. In addition, vascular
surgery was very necessary, at the beginning of the year, only one vascular surgeon was working in M01
and covering for the whole city, by the time; our general surgeons learned how to do vascular, and
thereby we have now 5 surgeons with vascular surgical capabilities.
Neurosurgery was a real catastrophe, with absence of a CT. Scan our neurosurgeon was
paralyzed, which explains the drop in number of this type of surgeries, we made more than 15 referral
per week to outside Aleppo only for making the diagnosis, now the CT is finally mounted in M02 and we
are having an important activity of neurosurgeries, although, we need more specific surgical instruments
and a surgical microscope.
Obstetric and pediatric surgeries are underwent in M02 and recently M03 , our only pediatric
surgeon is located in M02 , so why we registered the surgeries out there, but in so many cases , general
or urologic surgeon are performing pediatric surgeries also. We did not count them in the last year and
considered them as general or urologic.
M1
18%
M2
47%
M3
12%
M10
23%
NUMBER OF SURGICAL INTERVENTIONS
BY HOSPITAL

7
Overview of our hospitals
M01 Hospital
M01 was the second operating hospital within the liberated area in Aleppo neighborhoods after the
bombing of Al-Shifa hospital, M01 underwent sever conditions and had received many injuries in a time
when no organized structure or resources were available.
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
M1 M2 M3 M10
Neuro Surgery
Gynecologic Surgery
ophthalmologic Surgery
urologic surgery
orthopedic surgery
Vascular surgery
general surgery

8
The hospital is adopted and supported by SEMA (Syrian expatriate medical association – Saudi Arabia), and
was heavily supported by UOSSM (Union des organisations syriennes de secours médicaux – France) with medical
supplies as for all of our hospitals.
A full coverage of ICU drugs and salaries were provided by DSV (Deutsch-Syrischer Verein - Germany)
General Informations
Number of Floors5
Number of Rooms7
Number of Beds20
Number of Ambulance Cars3
Number of Operation Rooms2 + 1 for ortho. Surg.
Number of ICU Beds3
Facility Equipment
ER Equipmentyes
Laboratory Equipmentyes
X-Ray Equipment ( simple X ray )yes
OR Equipment ( Diathermy , C-arm , Suction)yes
ICU Equipmentyes
Staff and Specialties
Total Medical Staff38
Total Specialists6
General Surgeons2
Orthopedist2
Pediatrician1
Vascular Surgeons1
Total Residents6

9
General surg.2
Orthopedic surg.2
Esthetic surg.1
vascular surg.1
Doctor M.D.1
Medical Students4
Pharmacy Student1
Medical Assistants29
Nurses4
Anesthesia technicians10
ICU technicians4
Paramedics2
Operation Room Assistants4
X-Ray Technicians2
Laboratory Technicians3
Physiotherapist1
Non-Medical Staff34
Ambulance Driver5
Some landmarks through the evolution of the medical work
- Many medical devices has been introduced to the medical work such as ventilators, Diathermy,
OR suction.
- New ambulance vehicles from our partners
- Many important surgeons from around the world had visited us and helped saving lives
- The ICU unit was running through Tele-medicine, we had specialists out-side Syria monitoring
the status of every patient and supervising the treatment courses of them.

10
Annual work Statistics at M01
Total
patients
No of
operations
Vascular
surgery
Urologic
surgery
Orthopedic
surgery
General
surgery
ICUOrtho
clinic
Chest
tube
ER
Jan19413822393438832NANA1875
Feb8291243813332619NA15575
Mar13963189932113418NA141019
Apr231122133812611NA21385
May198812213313961NA321233
Jun182219136314283161313469
Jul36131313321624321129211663
Aug32321834611192331126321262
Sep39681823261822121336141138
Oct244726032013957321247332159
Nov21012263361155220978311830
Dec17401721921216830609491402
Jan1728239263111514875301420
Feb96519930410164218918742
0
50
100
150
200
250
300
350
Chest tube
ICU
General surgery
Orthopedic surgery
Urologic surgery
Vascular surgery

11
M02 Hospital
M02 is the largest operating hospital within the liberated area in Aleppo neighborhoods, it is
considered besides being an advanced trauma center as the biggest provider of non-war related
services, such as gynecologic and obstetrical surgery, pediatric surgery, and cold medicine.
Services in this hospital are free of charge in all war- related injuries, or in ERs, while low fees are
imposed for cold medicine to cover the operational cost of the hospital, which stills not fully adopted by
any NGOs.
Syria Relief is financing the salaries of the doctors in Pediatrics and gynecology departments.
USSOM is the major provider of the supplies, and has provided through its trauma committee an
important help to cover the financial deficit of salaries in the last quartile of the fiscal year.
As in M01, full coverage of ICU drugs and salaries were provided by DSV (Deutsch-Syrischer Verein -
Germany)
Number of Floors5
Number of Rooms14
Number of Beds38
Number of Operation Rooms2 + 1 ortho. + 1 Gync.
Number of ICU Beds2

12
Facility Equipment
ER Equipmentyes
ICU Equipmentyes
Total Specialists9
General Surgeons1
Orthopedist1
Pediatrician3
Gynecologist2
Urologist1
Neurosurgeon1
Total Residents2
General surg.1
Orthopedic surg.1
Doctor M.D.4
Pharmacist2
Medical Assistants37
Nurses7
ICU technicians2
Midwifes3
X-Ray Technicians2
Pediatric Nurse3

13
artificial limbs technician1
pharmacy assistant1
Surgical assistant3
ER Nurse2
Incubator's Nurse2
Obstetric nurse1
Physiotherapist3
Non-Medical Staff37
Ambulance Driver7
accountant1
Documenter2
receptionist1
security5
Repair/Maintenance Workers3
Cooks2
Janitors16
- The introduction of the CT scan in the hospital
was a major step, it is the only running CT
device in the whole liberated area, now it is
working but without appropriate output
terminals (no printer or CD writer), still, it
saves many lives and prevented referring
patients in dangerous conditions at night or
during roads blockages.
- The activation of Hemodialysis center , funded
by an independent NGO , it has provided
about 200 dialysis session per month

14
- Many medical devices has been introduced to the medical work such as ventilators, Diathermy,
OR suction , incubators , obstetric chairs , Echo devices specially from ONSUR-OSSEMI (Italy)
- New ambulance vehicles from our partners specially form Al-Fatiha Global (United Kingdom)
- Many important surgeons from around the world had visited us and helped saving lives
- The ICU unit was running through Tele-medicine, we had specialists out-side Syria monitoring
the status of every patient and supervising the treatment courses of
them.
Some ambitions and projects to be supported in M02
- Creation of a new-born ICU unit , because no one is yet created in
Aleppo
- The renovation of the old ER department
- The activation of the 5th
OR room to do neurosurgeries , which
require specialized medical equipment
- The activation of the Cardio-department with necessary equipment
to make catheter diagnosis , and other procedures
Annual work Statistics at M02
Total
patients
No of
operations
without
childbirth
Neuro-
Surgery
Urologic
surgery
Orthopedic
surgery
General
surgery
ENTICUNatural
birth
CaesareanChest
tube
ER
Jan595204NA511252NANA530NANA
Feb790226NA410277NANA439NANA
Mar480333NA2115086NANA2155NANA
Apr3100303NA3856108NANA3863NA1862
May3608298NA4698112NANA8742NA2263
Jun3440416NA47168116NANA11185NA2234
Jul3669626NA109229288NA14915362503013
Aug4135905NA142368395NA40162103583549
Sep4017290NA1393184NA166575343050
Oct2281263NA5266118271911191541168
Nov4835349NA2675223252512481234333
Dec2351230NA15921111235123902192034
Jan2788295NA13101181011192851272016
Feb2229227454849802278371071901

15
July and August were from the quietest months from military point of view, which explains the
significant increase in our numbers of surgeries (non-war related) M02 hospitals during these 2 months.
In Jan and Feb 2014, it is the opposite situation, because of the TNT barrels attack period; cold surgeries
are almost stopped in hospital to prioritize war injuries and to keep a strategic reserve of medical
supplies for them.
0
500
1000
1500
2000
2500
M02 Surgical Stats
Caesarean
Natural birth
ICU
ENT
General surgery
Orthopedic surgery
Urologic surgery
Neuro-Surgery

16
M03 Hospital
M03 is the first line hospital in Aleppo for treating eye-related traumas and surgeries, and the only
hospital performing ophthalmologic surgery in liberated Aleppo , although the hospital in not a real
comprehensive trauma center like our other hospitals , it improves its gynecologic department to be at
50% of M02 hospital in a matter of 2 months , we expect more growing in this department , also , it has
an incubators ward equipped with 6 incubators .
Number of Floors2
Number of Rooms9
Number of Beds15
Number of Operation Rooms2
Facility Equipment
ER Equipmentyes
Laboratory Equipmentno
ICU Equipmentno

17
Total Specialists4
Pediatrician1
internal medicine1
ophthalmologist2
Total Residents1
internal medicine1
Doctor M.D.1
Medical Assistants9
Nurses1
Paramedics1
Midwifes2
X-Ray Technicians1
Operation Room Assistants1
Incubator's Nurse1
Obstetric nurse1
Non-Medical Staff7
accountant1
Documenter1
receptionist2
Janitors3
- The PHC clinics also had witnessed a great momentum, especially in pediatrics, internal medicine,
and ophthalmologic consultations of course.
- The activation of a new surgical ER department

18
- Multiplication of the number of incubators in the hospital
- Introduction of new medical equipment such as oxygen generators for incubators, Autoclave MdM
(Médecins du Monde– France)
- activation of the Hemodialysis center by a private donor , this center was active before M02 center
, it works with 6 devices 3shifts per day , the number of beneficiaries exceeds 400 patient per month.
Annual work statistics at M03
Total
patients
No of
operation
s without
childbirth
Urologic
surgery
Ophtalmol
ogic
surgery
General
surgery
haemodialysisNatur
al
birth
CaesareanGynecology
Surgery
ER
Mar2006054015NANANANA160
Apr3921129584218NANANA262
May4745033314103NANANA321
Jun7761012972118NANANA557
Jul1177122089331182NANA937
Aug1248241211432NANA988
Nov1148270114914563144209977
Dec3101525100454970137166
Jan389840840NA35620282
Feb363960960NA5100265
0
200
400
600
800
1000
1200
1400
1600
1800
2000
Mar Apr May Jun Jul Aug Nov Dec Jan Feb
ER
Gynecology Surgery
Caesarean
Natural birth
haemodialysis
General surgery
Ophtalmologic surgery

19
M10 Hospital
M10 hospital was created by ACMC to cover the need for a strong trauma center in the eastern
neighborhoods of Aleppo, while we did not have enough staff at the time; we did what we were calling
ironically a (mitosis) to our staff in M01 to operate the hospital! Afterwards many other volunteered
doctors and assistants came in and the mitosis was completely successful.
This hospital is the second trauma center in Syria in terms of Trauma work activity after Doma field
hospital – Damascus.
The hospital is fully adopted by SAMS (Syrian American medical society – United States) , while UOSSM
provides generous supplies as usual.
Number of Floors4
Number of Rooms5
Number of Beds21
Number of Operation Rooms3
Number of ICU Beds3

20
Facility Equipment
ER Equipmentyes
ICU Equipmentyes
Total Specialists6
General Surgeons2
Urologist1
Anesthesia Specialist1
ENT Specialist1
Total Residents5
General surg.2
Orthopedic surg1
internal medicine1
Neuro Surg.1
Medical Assistants4
total medical staff except doctors16
Paramedics2
X-Ray Technicians2
Surgical assistant5
Non0Medical Staff28
Ambulance Driver4
accountant1

21
security6
Documenter2
receptionist2
Janitors11
Repair/Maintenance Workers2
Cooks2
- The creation of the ICU unit with three beds by SAMS, and link it via telemedicine to the
monitoring unit as n M01 and M02.
- Many specialized equipment for urologic surgery has been provided.
- Al-Fatiha Global and other partners provided ambulance vehicles.
M10 under attack
In the 7th
of February 2014,
the hospital was targeted by a
fighter-jet missile, 2 patients were
killed and some staff had minor
injuries, the destruction reached
almost all parts of the hospital: ICU
is 100% damaged and un-reparable ,
the X-ray device is broken , the C-
Arm also , the ORs , and general
destruction in patient’s wards.
One week after the hit, the surgeons were operating in a very difficult condition, persisting to
continue their duty no matter how dangerous or difficult it is.

22
Annual work statistics at M10
Total
patients
No of
operation
ENTUrologic
surgery
Orthopedic
surgery
General
surgery
vascular
surgery
Neuro
Surgery
Chest
tube
ICUER
Feb117117NA152NA01NA108
Mar58675NA113228400NA501
Apr1672226NA1713069100641494
May2123401NA2021113337612NA1864
Jun1995311NA1617410120821NA1780
Jul1833229NA22144392442011631
Aug2015174NA51115711026311777
Sep2297329NA2515113320430362033
Oct2333263NA21151856017372111
Nov2139248NA71359016029411900
Dec1852354NA3915614811413271665
Jan13561301250621601081341156
Feb11492671018851244003867929
0
50
100
150
200
250
300
350
400
450
Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan
2014
Feb-14
ICU
Chest tube
Neuro Surgery
vascular
surgery
General
surgery
Orthopedic
surgery
Urologic
surgery
ENT

23
Overview of our PHC centers
The first concern of Aleppo City medical council was to focus on war related injuries, this priority
was obvious in the first half of the year 2013, by time and the longevity of the crisis, PHC appears to be
as much important as war injuries.
We have noticed by daily practice how important was to cover this important gab for the
community.
leishmaniasis lesions , pediatrics and gynecology , chronic diseases ( HT , Diabetes Type I & II ,
Epilepsy , ENT , ophthalmologic , and dental , were all important fields to be covered.
Our strategy to support the PHC points was to:
- Provide medicines and supplies in collaboration with partners
- Provide financial cover for the running cost , and partial support for the mass of salaries
- To cumulate accurate statistics from the medical points (which was absent in the beginnings) so
that these medical points could be presented to NGOs to be supported.
Our efforts has let us to:
a. Get our N4 medical point to be adopted by the EU ( European union) project of PHC
centers
b. Our N1, N2,N14 medical points are adopted by MdM by all necessary amount of
medicines and supplies

24
Dental clinics
Dental care has been always an absent element in any serious plan of PHC project, because of the
common idea that dental treatment are very expensive.
The idea was very challenging, but the need for dental treatment was very important, se we have
decided to initiate a low cost treatment, and still presenting all sorts of treatment from restorative
dentistry to endodontics, and not simply extractions.
The project has ten working dentists (2 specialists), the total amount of treatment sessions exceeds
11000 session.
Six dental clinics are actually running, and they are distributed in five distinct neighborhoods in
Aleppo:
1- D1 (2 dental chairs) - part of N04 medical point
3- D3 (2 dental chairs)
4- D4 (1 dental chairs)
Some landmarks through the evolution of the dental care project DCP
- Introduction of new dental chairs by the help of SAMS
- Introduction of new equipment ( ultra-sonic scalers , apex locators , panoramic x-ray device)
- First project in ACMC completely documented since day 1 , we have accurate patient record
about all of our patients
- Support from individual dentists in Saudi Arabia and from Austria to the project in the last year.
- Launch of oral care & caries prevention campaign within elementary schools

25
Some ambitions and ideas to be supported
- To find a sponsor to adopt the project with salaries and dental materials supplies
- To support the prescribed medications to the population
- Provide IT support to the clinic to move from paper archive to more organized practice
management software
Annual work statistics at DCP
0
500
1000
1500
2000
2500
Evolution in dental care sessions per month
D6
D5
D4
D3
D2
D1

26
N1 Medical point
N01 is the first medical point supported by the council; staff includes an internal medicine specialist, a
gynecologist, and medical assistants.
Presented services:
- General & internal consultations
- Minor cases ambulance ( simple wounds , class I burns , Bandages )
- Gynecology consultations
- Anti-leishmaniasis
- Pharmacy
Total
patients
internal
medicine
Dressingleishmaniasisdiabetesgynecologypediatric
Jun83111847021026NA525
Jul1040102189320835170
Aug1121132652308143183
Nov13831880NA301315NANA
Dec93419201350366117290290
Jan516425NA78729087
Feb708383603170234125

27
N2 Medical point
N2 medical point was also from the first medical points adopted by the medical council; it
provides specialized pediatric consultation thanks to the two pediatricians in it, gynecology, and other
services.
Presented services:
- Pediatric consultations
- Pharmacy
- Lab
0
500
1000
1500
2000
2500
Jun Jul Aug Nov Dec Jan -14 Feb-14
Total patients
internal medicine
Dressing
leishmaniasis
didbetes
gynecology
pediatric

28
Total
patients
internal
medicine
DressingleishmaniasisdiabetesGynecologyPediatricophthalmology
Jul1750NA1253NANA122375NA
Aug1500NA746NANA76678NA
Oct12001582760420NA24052020
Nov7561382965200NA21836015
Dec1612207114503609570237450
Jan12007807854205524022020
Feb89561578528085011035
N3 Medical point
This medical point is the external clinics of
M02 hospital; it is located in an adjacent
independent building, and presented various
sorts of medical services.
- Internal & general consultations
- Minor cases ambulance ( simple
wounds , class I burns , Bandages )
- Orthopedic clinic
- ENT consultations
0
500
1000
1500
2000
2500
Jul Aug Oct Nov Dec Jan-14 Fab - 14
Total patients
internal medicine
Dressing
leishmaniasis

29
- Ophthalmologic consultation ( now transferred to M03 external clinics)
- Dental consultations via the included D2 dental clinic
- Physiotherapy sessions and artificial limbs
Total
patients
internal
medicine
Dress
ing
PhysiotherapyOrthopedic
clinics
ENTophthalmology
Apr3461900201120900210750
May3461900201164900210750
Jun1240349420147386224260
Jul2217450332173412332224
Aug230329462684165626131
Nov1223478269328NA269NA
Dec553103198265NA198NA
Jan353121109100019NA
N4 Medical Point
This medical point is located in a strategic area in the liberated neighborhoods; it is an elected point to
be adopted by the European union PHC centers, it provided through the last year the following services :
- general consultations
0
100
200
300
400
500
600
700
800
900
1000
Apr May Jun Jul Aug Nov Dec Jan
internal medicine Dressing Physiotherapy Orthopedic ENT ophthalmology

30
- Orthopedic clinic
- Ophthalmologic consultation ( now transferred to M03 external clinics)
- Dental consultations via the included D1 dental clinic
- Pharmacy
- Lab
- Vaccines ( brought from regime held territories)
Total
patients
internal
medicine
DressingleishmaniasisOrthopedic
clinics
pediatricophthalmology
Jul601NA941565826121
Aug689NA1548950752150
Sep62483225422330352919100
Oct47154053952115391725101
Nov4768383398265034130386
Dec23851641321497358950

31
N12 Medical point
This medical point is now out of service because of the lack in financing , and the leakage of medical care
providers after the TNT barrels drop by the regime jets.
Presented services through the course of the last year:
- general consultations
- Pharmacy
- Lab
- Diabetes clinic
- Vaccines ( brought from regime held territories)
0
500
1000
1500
2000
2500
3000
3500
Jul Aug Sep Oct Nov Dec Jan Feb
internal medicine
Dressing
leishmaniasis
Orthopedic
pediatric
ophthalmology

32
Total
patients
internal
medicine
leishmaniasisENTpediatric
Mar32222494NA403325
Apr36892886NA538265
May33072658NA416233
Jun26992073NA437189
Jul480617942954NA284
Aug26311508330524269
N13 Medical point
0
500
1000
1500
2000
2500
3000
3500
Feb Mar Apr May Jun Jul Aug
internal medicine
leishmaniasis
ENT
pediatric

33
N13 has been established in the last part of the last year, it is located in the far east of the city in a very
crowded population, and it presents the following services:
- Internal & general consultations ( internal medicine specialist)
- Pharmacy
- Dental consultation (via its included D6 clinic )
Total
patients
internal
medicine
Dressingleishmaniasisdiabetespediatric
May10391355552163265
Jun147113575855131275
Jul1978156551338173256
Aug2199179901402219309
Sep2471364661295124649
Oct2162381571172NA552
Nov28704711641512NA723
Dec273106263845963NA
0
200
400
600
800
1000
1200
1400
1600
May Jun Jul Aug Sep Oct Nov Dec
internal medicine
Dressing
leishmaniasis
didbetes
pediatric

34
N14 Medical point
N14 is located in a neighborhood in the northeastern part of the city, the population is very poor
and a considerable number of IDPs are in the area, the region was it by scud missile in the mid of the
year 2013. The point provide the following services:
- Internal & general consultations ( internal medicine specialist)
- Pharmacy
- Lab
- Dental consultation (via its included D6 clinic )
Total
patients
internal
medicine
Dressingleishmaniasis
Jun147447576645
Jul130450857543
Aug95639463478
Sep1506460142454
Oct1022453109574
Nov1427451109710
Dec573373214735
0
100
200
300
400
500
600
700
800
Jun Jul Aug Sep Oct Nov Dec
internal medicine
Dressing
leishmaniasis

35
PHC statistics overview
The statistics of the first months of year 2013 in the medical points was unavailable, due to the
lack of personnel , logistics, and informatics equipment, this problem was solved only in the last quartile
of the year 2013, the presented numbers only reflects a partial amount of the real work volume.
Medical
point
Total
patients
internal
medicine
DressingleishmaniasisdiabetespediatricophthalmologygynecologyENTPhysiothe
rapy
N165338139162115436241380NA892NANA
N2891364306744168023526371401476NANA
N31481135952356NANANA21152088NA1381
N419406127414919496NA8114608NANANA
N122035413413NA3284NA1565NANA2318NA
N13144632883120085547733029NANANANA
N14826231147704139NANANANANANA
Total927423884814182286961632167252863445623181381
It is also good to know that some services were not well presented because of the lack in
medical providers (specially in gynecology and dermatology).
Many medicines specially those for the chronic diseases (HT , Diabetes .. ) were not enough
served via our pharmacies.
35%
13%26%
1%
15%
3%4%2%1%
Treatment's distribution profile in ACMC PHC centers
internal medicine Dressing Leishmaniasis Diabetes pediatric
Ophthalmology Gynecology ENT Physiotherapy

36
It is one of the most important projects and sights for the year 2014 to avoid these problems.
Most common diagnosis
While this list is not built statistically but more on the reflections of the doctors, all of the following
reports of ours will be very accurate , thanks to the incorporation of a new software with full details
about the diagnostics and therapies.
Common medical conditions
Upper Respiratory tract infections
Pneumonia
Hepatitis A
gastrointestinal infections , diarrhea
Gastric ulcer ,
Vitamins deficiency , Iron deficiency
Anemia
Mal nutrition
typhoid fever
Brucellosis
Diabetes mellitus
blood hypertension
Degenerative arthritis
Impetigo
Dermal Leishmaniasis
Pediculosis
Scabies

37
Central Warehouses performance
Central warehouses at ACMC are the organizing body for the logistic chain of : receiving,
distributing, and storaging all medical supplies and medicines sent to ACMC hospitals and medical
points.
Now the warehouses are using management software to run out their work, we have
introduced internet connection to all secondary warehouses at the hospital, and the next step is to link
them all through a network to create a real-time database, this would help to determine more
accurately our needs of medicines and supplies.
Reporting system has become more accurate, and the documentation of shipments has become
mandatory.
Percentage of medicines and supplies to the hospitals
Prices as estimated in USD according to the corresponding exchange rate at each month
HospitalM 1M 2M 10M 3Monthly Total
July19,533.6816,432.3319,196.801,417.2356,580.04
August9,015.7514,592.1010,528.004,242.4138,378.26
September10,102.259,909.799,083.332,790.5394,958.30
October28,208.0519,422.7718,911.907,205.6073,748.32
November25,616.7216,941.1520,057.994,442.0767,057.92
December10,802.1819,765.4017,148.892,380.59235,764.54
January21,133.6328,291.1227,548.866,139.4283,113.03
February20,652.0424,467.9923,639.182,764.1871,523.39
Total sum145,064.30149,822.64146,114.9531,382.03390,400.96

38
As you can see , our hospitals consumption rate is high , which goes with the important work
volume , it is also important to mention that the support values are in some months are lesser than our
real need.
Percentage of medicines and supplies over the medical points
Point Name July August September October November December January February Total Sum
Dental Clinics $31.49 $235.66 $616.66 $584.05 $40.96 $13.00 $161.20 $165.00 $1,848.02
M09 $646.12 $909.99 $2,091.01 $0.00 $0.00 $0.00 $0.00 $0.00 $3,647.12
M2 - Kidney $36.96 $1,085.26 $68.00 $237.00 $0.00 $0.00 $118.00 $20.00 $1,565.22
M3 - Kidney $27.00 $618.79 $738.33 $1,250.66 $93.33 $0.00 $0.00 $0.00 $2,728.11
N01 $0.00 $0.00 $0.00 $401.43 $121.73 $444.42 $1,904.65 $1,209.85 $4,082.08
N02 $506.66 $2,726.62 $1,749.92 $1,090.46 $812.09 $1,415.90 $2,174.65 $1,373.35 $11,849.65
N03 $0.00 $0.00 $294.22 $131.16 $115.73 $122.63 $212.80 $0.00 $876.54
N04 $886.66 $2,339.33 $1,627.29 $2,709.99 $960.63 $1,249.26 $478.10 $608.65 $10,859.91
N05 $135.43 $1,669.33 $839.53 $742.66 $1,007.56 $631.86 $679.00 $61.80 $5,767.17
N06 $214.17 $98.66 $1,117.23 $231.99 $1,457.00 $0.00 $497.90 $0.00 $3,616.95
N12 $3,820.07 $10,821.66 $382.99 $0.00 $0.00 $0.00 $0.00 $0.00 $15,024.72
-
10,000.00
20,000.00
30,000.00
40,000.00
50,000.00
60,000.00
70,000.00
80,000.00
90,000.00
JulyAugustSeptemberOctoberNovemberDecemberJanuaryFebrurary
Medical supplies expences during the second half of 2013 in
USD
M 1 M 2 M 10 M 3

39
N13 $0.00 $0.00 $1,749.56 $25.99 $1,343.76 $520.36 $1,658.00 $481.00 $5,778.67
N14 $0.00 $0.00 $0.00 $1,194.96 $1,617.76 $1,017.52 $2,633.10 $1,708.66 $8,172.00
N16 $0.00 $262.66 $189.16 $285.99 $236.76 $0.00 $205.00 $640.85 $1,820.42
N17 $405.36 $2,358.00 $2,087.82 $1,091.93 $0.00 $0.00 $0.00 $0.00 $5,943.11
Total Grand $6,709.92 $23,125.96 $13,551.72 $9,978.27 $7,807.31 $5,414.95 $10,722.40 $6,269.16 $83,579.69
We did not listed all the beneficiary medical points in the table; therefore, the real number of
supplies cost distributed to the medical points is higher.
The new strategy in distributing supplies and medicines is based on the accurate statistics of
medical workload in the point, of its financial transparency.
In the next year, only accredited medical points will benefit from most of our support , which
are: N01, N02, N03, N04, N13, and N14.
Other points are encouraged to raise their capacity to join our recognized ones.
Major suppliers of medicines and supplies for ACMC in 2013
 UOSSM is our strategic partner for the delivery of medical supplies and hospital medicines (
more than 50% of our supplies ).
 DSV is the major supporter for ICU drugs
 MdM is now the major supplier of surgical sutures, PHC drugs.
 SAMS is the major supporter with medical devices and equipment
 Many other NGOs has helped providing us with supplies such as :
o SEMA
o Al-Fatiha Global
o Hammer forum
o Syrian relief and development
o Preston for Syria
o Life line from Malaysia
o Medicines sans frontiers
o Karlsruhe Hilft Syrien
o Syria Der
o Kuwait patient’s help fund
o Syrian national council

40
o Mairie de Metz – France
o Syrian British medical society
Referral system – Disaster response system
The need for an integrated response
team to refer patients and transfer tem form
the accidents sites was very important,
especially after the bombing with TNT barrels
over the city.
The council has already 13 working
ambulance vehicle, provided by many
partners notably Al-Fatiha global.
The newly created of Aleppo health
directorate possess 15 ambulance vehicle, as
we have decided to part of it, a meeting has
conducted to the unification of all ambulance
vehicles under one command. Now all
vehicles in Aleppo city follow the orders of the
central emergency command, they have
communication with civil defense team to
coordinate when pulling injured from under
the collapsed building.
All vehicles are connected via radio
headpieces, we can now decide which
hospital is crowded and to which hospital we
can refer cases, moreover, the referring to
hospitals in turkey is now more organized , we
can made less trips per day thanks to this
coordination ( which means less maintenance to the vehicles )

41
Activity for prevention of chemical attacks
The council has started its interest in the
prevention of chemical strikes immediately after the
chemical attack in Khan-Alasal (Aleppo countryside)
on 14 March 2013 ,
First response was to establish 3 points of
decontamination.
Communications has been made with MSF and other
NGOs, for providing technical and scientific support
and logistics (such as protective suits, gas masks,
and tents of high quality.)
A specific protocol has been approved and adopted
to deal with any attack.
The CBRN-TF ( chemical biological radiological
nuclear task force ) at ACU ( assistance coordination
unit )
Our staff had intensive theoretical and practical
courses on treatment protocols in case of chemical
incident.
A good coordination with the Canadians and the
French in fields of getting consultations and
collecting data via the responsible of the project.
Three simulations maneuvers was carried out in our
hospitals.
in each hospital , two response teams are created ,
every team covers one shift in way that 24/24 a
trained team is ready to work in case of chemical
attacks .

42
We received significant quantities of atropine and other drugs form ACU , MdM , they were distributed
to hospitals
Training and development
The medical staff assisted too many training courses and sessions in the last year
ACLS (advanced cardio-vascular life support)
It took place in Killis city- Turkey, the total
number of attending persons was 50 trainee.
The outcomes was to form 2 teams for
Cardiopulmonary resuscitation (CPR) or Code blue
teams in M01 and M08
PALS (Pediatric advanced life support)
Five trainees from our pediatric departments
attended this course.
ATSU (apprentissage de technique de médicine
d’urgence)
Ten ER nurses had participated in this course in April 2013; the course is running regularly in Bab
Al-Hawa every 2 months.
The course was repeated recently in February 2014 in M02 hospital, it was a good success with
the presence of 20 trainee
ATMG
This training course was realized with
collaboration of UOSSM, intensive workshops for 2
days, we have the pleasure of guesting a French
trainer doctors in Aleppo, the number of trainees
exceeds 30 persons.
Course for anesthesia technicians
Five of our anesthesia technicians attended
this course
Creation of nursing school in Aleppo
One of the most permanent problems we are facing is the lack of medical care providers.

43
As a solution, comes the idea of creating a permanent center in Aleppo to train and teach
medical skills.
The school is established in M02 hospital (in a hall of the inactivated ICU !) in july 2013 , and the
school started teaching 3 levels :
1- First aids for beginners
- Basic anatomy
- sterility and disinfection
- hand washing
- taking and reading vital signs
- evacuation from risk environments
- basic emergency skills
- injections administration ( IV – IM )
- psychological support
2- Emergencies for intermediate students
- background about infectious diseases
- basic prescriptions and medications
- wounds suturing techniques
- airways openings
- bandages
- splints and casts
- dealing with burns of class I and II
- putting and removing urinary catheters
- patient evaluation
- triage
- ethics and moral considerations
3- Emergencies for advanced students
- head and spinal cord injuries
- soft tissues injuries
- bleeding and shock management
- tracheotomy
- IV solutions
- CPR
- Child delivery emergencies
- EKG interpretation

44
More than 300 student has been graduated from the 3 levels, some of them went directly to cover our
needs for nurses in the hospitals.
Adminstrative restructuring and improvements
The need to have an independent adminstrative body to manage and direct the huge work volume
in the hospitals , and to carry on all the non-medical related problems such as documentation , , public
relations , informatics and communications , human resources , Maintenance , supply chains. All this led
to create the M17; the central direction of ACMC.
We make Reunions and meetings at the level of the adminstrative staff such as documenters and
accountant in order to harmonize the efforts and increase productivity.
Also, we make meeting of ACMC board for discussing the strategy and the major orientations in
ACMC medical policy.
All data about medical activity, finical documents and statistics is now organized in the central
archive at ACMC direction, the local Lan with special permissions and firewalls is now set for the bureau
officers, in order to help them in taking decisions.
On more local scale, in every hospital, a board of direction has to be established, this board makes
meetings to solve problems and suggest improvement for the work, a copy from these meeting has to
be sent the central direction at M17
To provide more work that is organized and efforts, a support for the adminstrative offices with
funds is necessary; this is why we urge our partners not to focus only on the needs in terms of medical
supplies, but to consider also the need to support and finance human resources and adminstrative
issues.
Long term strategy and vision for the future
The council has played an important role in the last year serving the medical sector in Aleppo,
but now we in the administration believe that we need to act more globally and think about the

45
coordination with all active medical care providers on the ground, this is why we have signed the act of
creation of Aleppo health directorate.
We are willing to merge in this new entity, to help it and to support it performing its function in
medical sector not only in the city, but also in Aleppo countryside.
We also went through the election of the council of free Aleppo governorate, ACMC chairman is
now the head of Aleppo health office.
The coordination between Aleppo health directorate and Aleppo health office is very high,
specially that both responsibles are former ACMC, we share the same vision and the new work strategy
is to distribute responsibilities as follows:
- Aleppo health directorate is the executive part, the real responsible and follower of the medical
sector issues and needs.
- Aleppo health office is more to communicate with NGOs , coordinate the efforts , collet data
and prepare plans according to the population needs
This is our future vision for the medical work in Aleppo , it will be presented trough the next general
assembly of ACMC.
End of report

ACMC 3rd Medical Report

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