Case presentation for MSc GUH oral exam

1. Mhd Samer Alkarkoukly
Freiburg | May 22nd, 2018
A potential Cholera
outbreak in Syria

2.  Introduction to Syria Crisis.
 Introduction to Deir Ezzor Crisis
 Potential Cholera Outbreak
 Objectives Tree & Planned Activities
Outline:

3. Entering the seventh year of the crisis, the scale, severity, and complexity of
needs across Syria remain overwhelming. Some 13.1 million people in Syria
require humanitarian assistance (UN OCHA, 2017).
Introduction to Syria Crisis:

4.  4th biggest city in Syria.
under siege for 3 years till end
of 2017.
Siege and military operations
have resulted in a devastating
impact on the different
aspects of life including food
security, livelihoods, water
and sanitation systems, civil
infrastructure,
communication, education
and health.
Introduction to Deir Ezzor Crisis
(LiveUmap, 2016)

5. 19,023
18,344
12,682
7,700
5,662
6,794
6,567
11,097
6,115
5,662
3,850
3,850
1,359
2,718
01-04
05-09
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65+
Age Group (Years)
Distribution of the population
per age groups in Deir Ezor cityCity population in 2017 is 111 K people.
Children under 5 years: 17.4%
Health Services:
• 2 of the 3 public hospitals in the city are
fully damaged and not functioning.
• 13 physicians (1.2 per 10,000 persons).
• 100 nurses (9 per 10,000 persons).
Introduction to Deir Ezzor Crisis
(OCHA, 2017)

6. Low availability of
safe drinking water
Decreased
capacity to
provide
safe water
Damage of
water
pumping
systems
Destructio
n of
transport
channels
Destructio
n of
sewage
systems
Low
availability
of
electricity
damage of
governorate
electricity
generators
damage of
electricity
cables
low
availability of
fuel
Low
community
knowledge
of
household
water
treatment
Decreased
capacity of
treatment
Low
availability
of health
facilities
Destructio
n of
hospitals
Low
accessibilit
y of health
facilities
long
distance to
the only
hospital in
the city
High costs
of
transportat
ion to the
hospital
High costs
of the
private
health
services
Low
availability
of health
workforce
Migration
of health
work force
to safe
places
Low wages
of health
staff
the
previous
low level of
security
Low
availability
of
medication
s
the
previous
siege of
the city
Low
knowledge
of
managing
cholera
outbreak
within
physicians
Transmition of an
outbreak from
Iraq
Uncontrolled
borders
Movement of
refugees back
to Deir Ezzor
city
High probability of
disease transmition
within community
Low
community
knowledge
of cholera
transmitio
n and
prevention
Potential Cholera Outbreak:
Causes:
 Recurrent cholera outbreaks in Iraq.
 Low availability of safe drinking water.
 Damage of sewage systems due to military
operations.
 Low availability of health services, health
facilities, health staff and medications.
 Poor knowledge of cholera symptoms,
transmition and prevention behaviours among
communities.
 Low quality surveillance system.

7. Objectives Tree & Planned Activities:
To reduce the probability of
cholera outbreak and to
reduce the morbidity and
mortality
To prevent the transmition of
the outbreak from Iraq
To provide safe drinking water
To provide the effective
treatment of cholera cases
To enable the local
community to take preventive
actions

8. Objectives Tree & Planned Activities:
• Implement health check-up for the refugees coming back from
Iraq
• Provide electricity generators and fuel for the water pumping
system
• Awareness campaign for the local community on household
water treatment
• establishing community health centers in each neighborhood
• Training for the community volunteers to detect and manage
cholera cases
• Recruit the needed health workforce from other governorates
• Providing the needed IV fluids and antibiotics
• Training for the physicians and nurses on cholera management
• Awareness campaign for the community of cholera transmition
and prevention

9. References:
• LiveUmap, 2016. Map of Syria. [Online]
Available at: https://syria.liveuamap.com/en/time/02.05.2016
[Accessed 21 May 2018].
• OCHA, 2017. Final Pop IDPs Returnees Data for HNO 2018, Damascus:
United Nation Office for Coordination of Humanitarian Affairs.
• UN OCHA, 2017. Humanitarian Needs Overview 2018, Damascus, Syria: UN
OCHA.

10. Thank you
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