NJOG 2008 May-June; 3(1): 3 - 9 New concepts in pathogenesis and management of polycystic ovarian syndrome: Insulin resistance and role of insulin sensitizers Rashmi Prasad Yadav National Academy of Medical Sciences, Bir Hospital. AbstractPolycystic ovarian syndrome (PCOS) is classically characterized by the clinical triad of androgen excess,anovulation infertility and obesity. Anovulation occurs due to functional ovarian and/or adrenalhyperandrogenism. The etiology and patho physiology of PCOS is unknown .Proposed theories includeexcess of gonadotropins; the effect of which is amplified by disturbances in intrinsic regulatory peptides, suchas inhibin or extrinsic regulatory peptides, such as insulin or insulin like growth factor ( IGF). For over 25years insulin resistance has been known to be associated with PCOS. Improvement in insulin resistance withthe use of insulin sensitizers, such as metformin and thiazoldinediones (TZDs) have been seen to be associatedwith better ovulation and reduced testosterone levels in patients with PCOS.
25 JULY– 8 AUGUST 2013: SYRIA, JORDAN, LEBANON, IRAQ AND TURKEY SITUATION IN NUMBERS In Syria
In Syria, UNICEF provided a 500 KVA electrical generator for the water treatment plant #of children affected in Deir ez Zour City to ensure continuous provision of treated water to 250,000 people during times of power outages, with UNICEF facilitating the safe transportation and 6,800,000
installation of the generator, as well as provision of spare parts. # 0f people affected (OCHA April 2013) Despite the challenging situation in Homs, UNICEF has continued with supply and
service delivery in some of the worst affected areas – including in Al Waer, supplying
essential WASH and nutrition items as well as providing life skills and remedial Outside Syria
education for children in the area. In Jordan, UNICEF and partners have provided structured psychosocial support to #of registered refugee children and 70,280 children and adolescents (47 per cent male & 53 per cent female) in refugee children awaiting registration camps and host communities with 6,943 of these children and adolescent receiving more focused and more specialized case management services. 1,895,831
The health and hygiene promotion team in Domiz Camp in Iraq finished a second # of registered refugees and persons round of hygiene message promotion. While many factors contribute to the incidence awaiting registration
of diarrheal disease cases – the latest decrease of diarrheal cases from 13 per cent in (UNHCR, 6 August 2013)
June to 5.5 per cent at the end of July can at least partially be attributed to the work of
the health and hygiene promotion teams.
Syria Appeal 2013*
US$ 110.46 million
Regional Appeal 2013*
UNICEF's Response with partners US$ 360.19 million
29 July 2013 marked the first anniversary of Za'atari refugee camp in Jordan. One year *January – December 2013 after Za'atari camp was carved out of the desert in northern Jordan to host refugees fleeing Syria, it is now housing more than 120,000 people – half of them children. The site has become the fourth largest city in Jordan and is also the world's second largest refugee camp behind Dadaab in eastern Kenya. In Za'atari School 1, summer activities continue with remedial education in the morning session and recreational activities in the afternoon session. Some 500 students attend the sessions each day. As part of the Back to School Campaign for 20,000 children in Za'atari Camp, School 1 undertook a "Talking Walls" activity, encouraging children to come to the school and participate in drawing and writing messages on school walls. UNICEF provides over 4 million litres of water a day to Za'atari, meeting the needs of all camp residents. Collection of sewage from Zaatari camp is running smoothly with average 1,400m3 collected daily. The immunization of newly-arrived Syrian refugees against measles and polio and provision of vitamin A in Za'atari Camp continues. SYRIA CRISIS BI-WEEKLY HUMANITARIAN SITUATION REPORT Estimated Affected Population
(Estimates calculated based on initial figures from (*)
OCHA April 2013. The rest of the figures are calculated based on CBS demographic distribution of 2011 and on UNOHCHR figures
Total Affected Population
Children Affected (Under 18) Pregnant women (estimate: On 2 August, UNICEF Executive Director released a statement on the life- 5% of the total population) threatening situation of displaced women and children in Homs, highlighting Total Displaced Population some 400,000 civilians are now displaced in the district of Al Waer, and calling on (a proportion of the above) all parties to facilitate immediate safe access to displaced families to provide Children Displaced (estimated: 46 % of the with life-saving assistance. population is children) Despite the challenging situation in Homs, UNICEF has continued with supply and service delivery in some of the worst affected areas – including in Al Waer, supplying essential WASH and nutrition items. UNICEF participated in a joint assessment mission to Al-Qamishli and Al-Hasakeh cities in the north east of the country; UNICEF is preparing accordingly to scale up its response in the region, beginning with water and sanitation. A delay in issuance of permits for supplies to be dispatched to several hard to reach areas caused some missions and convoys to be either cancelled or delayed. UNICEF, in coordination with local partners, has reached over 158,000 children with access to learning programmes since the beginning of this year in all 14 governorates. Situation Overview and Humanitarian Needs The cost of living has almost tripled nationwide. The significant rise in prices, which is due to the rapid depreciation of the local currency, continues to impact living conditions especially in the worst affected areas where access to markets has been greatly reduced due to rampant insecurity. The Ministry of Education (MoE) reported on the education situation in Syria last week including: a total of 3,004 schools are partially damaged or completely destroyed countrywide and 931 schools are used as shelters for internally displaced persons (IDPs) as of July 2013 (unpublished MoE data as of July 2013). This indicates that 18 per cent of Syria's 22,000 schools are affected and the estimated property loss reaches US$ 567 million. An estimated 2.8 million children have dropped out of basic education in 2013. More than half of them remain out of school inside Syria, in particular those who have been displaced. Some children have lost months of schooling, while others have missed a whole school year or more. In Aleppo, while humanitarian needs, especially for food, water and shelter, are very severe, limited improvement was observed during the last UNICEF mission in terms of electricity and general hygiene in Aleppo city. Prices have tripled or quadrupled, impacting the provision of basic supplies and households' purchasing power. Families are struggling to provide their children with basic supplies including bread, vegetables and fruits, milk, yogurt and eggs. Thus, there are risk factors for malnutrition, and symptoms were observed such as poor feeding practices and a high number of children with diarrhea. Spaces for children to play were reported also as extremely limited. Psychosocial support to traumatized people, especially children, is highly needed. In Homs, the security situation continued to be very tense. Mortars, rocket fire and daily clashes were reported especially in Al-Waer, Dablan, Zahara and Wadi Al-Dahb making it difficult to reach populations in need within this area. While UNICEF response in Homs was hindered by the security situation, in cooperation with local partners, UNICEF continued to provide essential humanitarian assistance to children and women in need in accessible areas.
SYRIA CRISIS BI-WEEKLY HUMANITARIAN SITUATION REPORT Tartous governorate continues to record a steady inflow of displaced persons from other governorates. The 21 shelters, inhabited by only a small fraction of the displaced caseload, are extremely overstretched and can no longer absorb more people. The water, sanitation and hygiene conditions remain dire with protection concerns requiring immediate attention. In Lattakia, the situation in the three shelters continues to deteriorate. The needs within the Sports facility, currently inhabited by some 800 families, are growing and require immediate attention. WASH, protection and education gaps are reported. There is an urgent need to step up efforts to address these gaps. In response, UNICEF (WASH and Child Protection sections) sent a mission to Lattakia on 5 August to initiate interventions. Programme Response WASH In Deir ez Zour, UNICEF provided a 500 KVA electrical generator for the water treatment plant in Deir ez Zour City to ensure continuous provision of treated water to 250,000 people during times of power outages, with UNICEF facilitating the safe transportation and installation of A Hygiene promotion session in a school in Hessia, Homs ,
the generator, as well as provision of spare parts. UNICEF, 2013
In addition to helping to make sure that public water systems continue to provide safe water for the wider population, UNICEF is also providing specific assistance to displaced people. IDPs are scattered throughout the country, often living in harsh conditions in collective shelters where water-borne diseases can spread quickly. Below is a snapshot of UNICEF's response for over 3,000 IDPs over the reporting period. Despite very limited access to affected areas in rural Homs, UNICEF and its partners were able to provide 15 litres of water per person per day, trucked to 380 persons in Talbiseh. The water trucking project aims at reaching a total of 1,130 beneficiaries. Inside the city of Homs, despite the challenging situation in the district of Al-Waer, UNICEF partners were able to deliver over 1,000 adult and baby hygiene kits on 7 August. Additionally, a hygiene promotion campaign in Hasia area of rural Homs was launched benefitting 100 children. The campaign is accompanied by the distribution of hygiene kits and soap to 490 women and children. Furthermore, 120 IDPs were provided with access to safe drinking water in Salamiyeh in Hama. In Aleppo, in cooperation with a local NGO, UNICEF was able to provide 1,020 IDPs with access to safe water and sanitation in seven different IDP shelters, including the largest – that of the university campus. In Tartous, UNICEF and SARC conducted a hygiene promotion campaign Recreational activities in a shelter in Tartous, UNICEF
in two IDP shelters. A total of 112 children and 65 women were provided with hygiene awareness messages; 792 bars of soap were provided to the participants. Child Protection UNICEF's Child Protection programme conducted a preliminary assessment in four IDP shelters in Tartous hosting 411 families which included 770 children aged from 0 to 18 years old. The preliminary results of the assessment highlighted cases of child labor, early marriage, psychological disorders (PTSD) and unaccompanied children. SYRIA CRISIS BI-WEEKLY HUMANITARIAN SITUATION REPORT As part of efforts to build the capacity of local organizations on issues related to child protection, a training session was held in Tartous on the Convention on the Rights of the Child, and Child Protection in Emergencies. This training session is the first step of the Child protection training series which are going to take place in Lattakia and Homs, with the aim of building national capacities on child protection matters. Essential psychosocial support services continue to reach over 61,917 children with the support of UNICEF and local partners. During the reporting period, psychosocial support was provided to 1,100 children in Damascus, Rural Damascus, Dar'a and Quneitra. Additionally, 140 volunteers were trained on psychosocial support and child protection activities in Aleppo and Damascus. Education: UNICEF continues to support school club activities in Dar'a, Rural Damascus, Lattakia, Tartous, Hama, Homs, Quneitra and Damascus in coordination with the MoE (148,840 children) and other education NGO partners (10,111 children). A total of 457 school clubs (out of a goal of 1,000 school clubs for 2013) are providing pedagogical and psychosocial support to 158,951 children (50 per cent girls). UNICEF also supported Danish Refuge Council (DRC) to install blast film at 5 schools to provide 3,842 students with safer learning environments. Moreover, UNICEF, in partnership with SARC Talbiseh, provided 7,641 students with remedial catch-up education activities at 38 centres in Homs. Education supplies were also distributed for 23,000 children during the reporting period with 140 recreational kits benefiting 13,000 children in Talbiseh, Homs governorate, and Aleppo; 200 school supplies benefiting 8,000 students in Talbiseh in Homs governorate; 1,000 school bags for 1,000 students in Aleppo; and 25 school supply kits for 1,000 students. Furthermore, UNICEF, in cooperation with a local NGO, continues to support 2,255 adolescents with life skills, vocational, computer and English training courses in two Adolescent Friendly Spaces in Al-Waer and Al-Hamra area in Homs. In Rural Damascus, UNICEF continues to provide learning and vocational training courses to 357 adolescents and young persons in Jaramana area. Additionally, 5,500 adolescent students continue to receive remedial classes in Al-Waer area in Homs. UNICEF is supporting life skills and vocational awareness to benefit 215 adolescents in the affected areas of Aleppo city; also two training courses were conducted to benefit 50 young volunteers on life skills, such as counseling and peer support, in Aleppo. Health & Nutrition Accessibility to some affected areas is still a challenge while the health situation continues to deteriorate as the violence spreads, especially in Homs, Aleppo, and Rural Damascus. The Health situation in Homs is of particularly concern as IDP children and women are trapped in the current escalated violence. The 51 mobile medical teams in the 14 governorates and the fixed centres in Damascus, Rural Damascus and Quneitra have been able to reach 182,896 children with medical check-ups since the beginning of this year. The target is to reach 570,000 IDP children by the end of this year. UNICEF continues to dispatch health supplies to governorates for almost 22,000 people. Supplies dispatched during the reporting period include 3,000 bottles of lice shampoo distributed in Tartous and Aleppo for the benefit of 3,000 children, in addition to 500 cooking stoves in Tartous for 500 IDP families, 369 first aid kits for 3,690 IDPs and diarrhea kits sufficient to treat 1s,200 cases of diarrhea. UNICEF has provided SARC and Ministry of Health (MoH) facilities with 1,000 boxes Plumpy Doz to benefit 9,750 children and 3,000 cartons of high energy biscuits to prevent the further deterioration of the nutrition situation of 15,000 children in Lattakia and Tartous. Additionally UNICEF has trained ten new partners in Homs on the detection of malnutrition, appropriate use of nutrition supplements and referral of severely malnourished cases. UNICEF has provided with 166 boxes of Plumpy Doz and 28 boxes of high energy biscuits reaching 1,500 children in Deir ez Zour city health centres during routine immunization sessions as well as among IDP shelters. SYRIA CRISIS BI-WEEKLY HUMANITARIAN SITUATION REPORT Inter-Agency Collaboration and Partnerships
A WASH joint assessment mission was undertaken to Al-Qamishli and Al-Hasakeh cities from 23 - 26 July. UNICEF and WFP
participated in the mission. Following to the mission, UNICEF is working to scale up its programmes in these areas.
Supply and Logistics
UNICEF successfully dispatched the following items:
In Damascus, UNICEF dispatched 20 inter-agency emergency health kits (IEHKs) to the Ministry of Health benefiting 20,000 persons.
In Hama, UNICEF dispatched the following items to the Directorate of Health: 2,300 Permethrin shampoo bottles benefiting 2,300
people; 1,000 energy biscuits boxes for 40,000 children; 500 first aid kits for 5,000 persons; and 500 cooking stoves for 2,500 people.
UNICEF dispatched the following items to a local NGO: 8,500 blankets for 17,000 people; and 832 baby hygiene kits benefiting 832
In Homs, UNICEF dispatched the following items to SARC branch in Homs: 30 emergency kits (IEHK) benefiting 30,000 persons, 520
recreational kits for 52,000 children, 245 school supplies benefiting 9,800 children, 50 boxes of school stationary benefiting 12,500
In Tartous, UNICEF dispatched 2,000 Permethrin shampoo bottles benefiting 2,000 persons to SARC branch in Tartous.
SYRIA CRISIS BI-WEEKLY HUMANITARIAN SITUATION REPORT Lebanon
Total number of registered and unregistered refugees:
671,270 (UNHCR August 6, 2013)
UNICEF has commenced equipping Primary Healthcare Centres to Registered
monitor and treat malnutrition, with micronutrients, therapeutic Refugees
foods and portable equipment for measuring malnutrition distributed to implementing partner International Orthodox Christian Charities. Total Affected
PU-AMI has conducted WASH assessments for thirty of the sixty informal tented settlements in Akkar. These assessments will Children
determine follow-up interventions appropriate to each settlement to Affected
ensure that all beneficiaries receive the components of the comprehensive WASH package suited to their needs. Children 0-4
436 women and girls have attended activities at four Women and Girls Community Centres in the past two weeks. Overall, 5,857 women and girls have benefitted from GBV interventions supported by UNICEF in 2013. Situation Overview and Humanitarian Needs A total of 558,874 refugees are currently registered with UNHCR, of which more than 50 percent are children. An additional 112,396 Syrians have been in contact with UNHCR to be registered, bringing the total to 671,270. The number of Palestinian refugees from Syria in Lebanon is 92,000 individuals. Programme Response WASH UNICEF partner Action Contre La Faim (ACF) distributed sixty 1,000 litre water tanks and sixty water filters to 485 beneficiaries in the Bekaa Valley. They also constructed 36 latrines, benefitting 870 people. PU-AMI has conducted WASH assessments for thirty of the sixty informal tented settlements in Akkar. Two tented settlements were assessed in a joint visit with the UNICEF WASH team. One of the settlements, Miniara, has been in existence for two years, while refugees arrived in the other, Haret Al Jadida, a year ago. Neither of these settlements has received external assistance for water, sanitation or hygiene to date. These assessments will determine follow-up interventions appropriate to each settlement to ensure that all beneficiaries receive the components of the comprehensive WASH package suited to their needs. Child Protection In the past fortnight, UNICEF partner Intersos had 335 children attend activities in Child Friendly Spaces in Arab Salim and Bent Jbeil, as well as 344 children attend Child Smart Bus mobile activities in Nabatiyeh and Tyre. Activities included making cards for Eid, awareness sessions about the five senses, cooking classes for traditional dishes and awareness sessions on non-violent communication. This brings the cumulative total for children provided access to psychosocial support services to 51,325 this year. Also in the past fortnight, 436 women and girls have attended activities for survivors of gender based violence (GBV), and for those at risk of GBV, at the four Women and Girls Community Centres run by International Rescue Committee (IRC). A further 115 women and girls have benefitted from IRC's outreach activities. These activities include social therapy workshops to increase networks among girls, improving their coping skills and encouraging greater help-seeking among survivors of violence. Overall, 5,857 women and girls have benefitted from GBV interventions supported by UNICEF in 2013. Children play at Intersos' Child Friendly Space in
SYRIA CRISIS BI-WEEKLY HUMANITARIAN SITUATION REPORT Over the reporting period, Intersos and IRC distributed 2,023 UNICEF-funded hygiene and dignity kits. UNICEF has provided capacity training to fieldworkers, social workers, teachers and animators from ten implementing partners operating in Zahle, Qoybayat, Baalbek, Tripoli and Burj Albarajneh. The sessions encouraged coordination between partners, enhancing communication skills and increasing fieldworkers' awareness of their own stress and stress management techniques. Further, 27 social workers and case managers were trained on GBV case management, and 21 hygiene promoters from the WASH sector were trained on GBV referral and mainstreaming in WASH. Five religious leaders, including one woman, have been identified to raise awareness on GBV issues, including sexual abuse and child marriage. A Friday Speech has been developed with the five religious leaders, with a pilot sensitization campaign through mosques to start in Tyre after Ramadan. Education To date, UNICEF and implementing partners have assisted 34,527 children into schools and learning programmes, provided 36,333 children with access to psychosocial support in education and provided 24,861 children with non-formal and informal education services. Based on 42 per cent of registered refugees being between 4 and 14 years of age, there are over 280,000 refugee children who need access to education in Lebanon. With government estimates at 1.2 million refugees in the country, this number could be more than 400,000, which is more than the entire public school student population in Lebanon. UNICEF is gearing up for a Back to School programme that aims to bring 174,000 children into classrooms for the new school year. UNICEF implementing partners are continuing community outreach to identify out-of-school children affected by the Syria crisis. Out-of-school children are being supported through the summer education programme, as well as receiving material assistance to enroll in school in the beginning of the 2013/2014 academic year in October. In partnership with the Ministry of Education and Higher Education (MEHE) Centre for Education Research and Development, UNICEF has developed an Accelerated Learning Programme (ALP) curriculum of core competencies to harmonize the delivery of ALP across all agencies. These programmes are being run between July and September 2013 to help streamline children into formal education in the new school year. Nutrition Five doctors and an official from the Ministry of Public Health (MOPH) have been provided training on the management of acute malnutrition in children under five years of age. This brings the number of healthcare providers trained to 38. Participants were trained on supplementary feeding and outpatient therapeutic feeding, as well as infant and young child feeding in emergencies. Community outreach in Al Marj tented settlement
UNICEF has commenced equipping Primary Healthcare Centres to monitor and treat malnutrition, with micronutrients, therapeutic foods and portable equipment for measuring malnutrition distributed to implementing partner International Orthodox Christian Charities. Inter-Agency Collaboration and Partnerships The number of Palestinian Refugees from Syria (PRS) is estimated to have reached 92,000 individuals, following a rapid increase in the number arriving at the beginning of July. The majority are living inside camps across the country, with the influx concentrated within large camps (Ein El-Helweh, Rashidiyeh, Beddawi and Nahr el-Bared camp). The number of these refugees attending UNRWA schools has increased to 4,285 PRS students, 9 per cent more than last month. All new arrivals are now being enrolled in special classes, with UNICEF-supported summer learning classes scheduled to run until September for PRS who have been out of school during the school year. SYRIA CRISIS BI-WEEKLY HUMANITARIAN SITUATION REPORT The Child Protection in Emergencies Working Group (CPiEWG) conducted three field workshops in Bekaa, South and North Lebanon and a national workshop in Beirut during as part of a consultative process to develop a CPiEWG national strategy 2013-2014. More than 80 child protection actors from the Ministry of Social Affairs, UN agencies, international and national NGOs participated in the discussions. Communication for Development (C4D) 5,000 cartoon posters on scabies for children are being widely distributed by the MOPH, the Ministry of Social Affairs, MEHE and all national and international NGOs. Supply and Logistics In the past fortnight, the following supplies have been distributed to implementing partners: 50 water tanks (1,000 litre) 516 cooking stoves 2,600 hygiene kits to Ministry of Social Affairs' Social Development Centres (one kit provides for a family of five) 2,600 baby kits to Ministry of Social Affairs' Social Development Centres
SYRIA CRISIS BI-WEEKLY HUMANITARIAN SITUATION REPORT Highlights Drilling of the first borehole in Azraq camp is completed. Total number of registered refugees and pending registration:
Installation of water and sanitation facilities is progressing 512,281 (UNHCR August 6, 2013)
according to schedule. Registered
7,989 Syrian refugee children are participating in summer Refugees
catch-up classes to enable their return to school in the fall. Total Affected
1,054 mothers and 463 children under five visited the four Children Affected
UNICEF/Save the Children Jordan (SCJ) Infant and Young Child (Under 18)
Feeding (IYCF) caravans in Za'atari and EJC camps. Children Under
UNICEF partners Un Ponte Per and Jordan Women's Union Five
Children 6 to 23
have recorded 3,027 visits by children at 16 Child Friendly Spaces in host communities in 7 Governorates in North and Pregnant women
Situation overview and humanitarian needs Some 257,153 Syrian refugees have crossed into Jordan since 1 January 2013, bringing the total number of Syrians now registered or awaiting registration with UNHCR to 512,281. The Government of Jordan estimates there are now over 600,000 Syrians in the country, of which over half are children. Since 10 July, arrivals have dropped markedly, averaging less than 100 refugees each night, as compared with over 500 arrivals per night in June. Programme Response WASH UNICEF and partners' work to prepare WASH infrastructure at Azraq camp continues at a steady pace. Some 21km of pipes have been laid in all villages and the 19 water storage tanks with a combined capacity of 1.69 million litres (sufficient capacity for over 56,000 people at 30 litres/person/day) have been installed. Forty-nine tap stands/water collection points have been installed. For sanitation facilities, over 2,100 latrine pits have been dug, 611 septic tanks delivered to site and 186 wash units (toilets and showers) are ready to serve 2,790 people at a ratio of 1:15. The first Azraq borehole was drilled to a final depth of 500 metres and had an initial promising yield on 1 August. Next actions involve borehole development and water quality testing. The electricity connection to this borehole has also been completed; the system is being flushed and cleaned and should be ready for use by next week (after the Eid holiday). Azraq Camp is expected to open on 1 September. Collection of sewage from Zaatari camp is running smoothly with average 1,400m3 collected daily. Azraq borehole draws water on 1 Aug 2013(UNICEF/Jordan
SYRIA CRISIS BI-WEEKLY HUMANITARIAN SITUATION REPORT Fifty-four team members from UNICEF partners Relief International and ACTED received training on hygiene promotion to implement activities at King Abdalla Park (KAP), Cyber City (CC), Ramtha and Irbid Camps. Child Protection: UNICEF supports 65 Child and Adolescent Friendly Spaces (42 in camps and 23 in host communities) which provide psychosocial support to children. A further 10 playgrounds and multipurpose courts providing recreational activities are supported in Za'atari, KAP, Emirates Jordanian Camp (EJC) and CC. During the reporting period, seven more spaces have been added in three governorates in host communities with the approval of an agreement between UNICEF and INTERSOS/JOHUD by Jordanian Government. Agreements have been finalized with Mercy Corps, International Medical Corps (IMC) and International Rescue Committee (IRC) to establish child protection interventions in Azraq refugee camp. Under one such agreement, IMC will establish and operate two Adolescent Friendly Spaces to provide specialized structured psychosocial support activities. Additionally, IMC provide case management services to children identified as having suffered harm or who are at risk of abuse, violence and exploitation. Under a separate agreement, IRC will be responsible for setting up operations in Azraq for the management of cases of unaccompanied and separated children. UNICEF/Mercy Corps will operate ten Child Friendly Spaces in Azraq for children 6 -14 years old, and four Adolescent Friendly Spaces for children 15 -18 years old. Additionally, JCO Representative joins a basketball game in Za'atari
Mercy Corps will construct eight playgrounds in Azraq. UNICEF and partners have provided structured psychosocial support to 70,280 children and adolescents (47 per cent male) in refugee camps and host communities with 6,943 of these children and adolescent receiving more focused and more specialized case management services. UNICEF/IRC/IMC has identified and registered 480 unaccompanied and 542 separated Syrian children since January 2013 in refugee camps and host communities. During the same period 202 children have been reunited with their families. A further 91 unaccompanied children are receiving family-based or appropriate alternate care. These children are followed up with very regularly by case workers. UNICEF and partners (Un Ponte Per and Jordan Women's Union) have recorded 3,027 visits by children at 16 Child Friendly Spaces in host communities in seven Governorates in North and Central Jordan. Activities have been focusing on traditional games, health and nutrition, environment and hygiene. Social mobilizers have also stared working with communities to form community based child protection committees (CPCs). One CPC has already been formed. Education In Za'atari School 1, summer activities continue with remedial education in the morning session and recreational activities in the afternoon session. Some 500 students attend the sessions each day. As part of the Back to School Campaign, UNICEF's Education and Communication teams had their first session with 35 Imams in the old mosque of Za'atari camp on the importance of education. It was led by Imam Yahya (Clergy Beyond Borders based in Washington DC) organized by UNICEF/SCJ. The main objective was to have closer engagement with the Imams around the issue of education in Za'atari. SCJ created teams of teachers and students in Za'atari School 1 for "Talking Walls" activity as part of "Back-to-School" campaign, Boys at school in Za'atari camp. (UNICEF/Jordan2013/Malhas)
SYRIA CRISIS BI-WEEKLY HUMANITARIAN SITUATION REPORT encouraging children to come to the school and participate in drawing and writing messages on school walls. In total, the Back to School campaign will target 20,000 children in Za'atari and 60,000 children in host communities. The total number of registered students for catch-up classes in the Za'atari and EJC camps has increased to 3,965 bringing the total number in both camps and host community settings into 7,989. The number of registered students for informal education in Za'atari Camp and host community are 483 and 2,491 respectively bringing the total number of registered students for informal education to 3,294. UNICEF and the Ministry of Education (MoE) have collaborated to map the absorption capacity of schools with the highest concentration of Syrian students. Schools accommodating large numbers of refugees were classified into three main categories: severely overcrowded, overcrowded and crowded. Accordingly, a meeting was held between UNICEF and MoE to agree on the actions and measures needed to identify the schools that need to be double-shifted and those which may require additions of prefabs in order to be able to accommodate the increasing numbers of Syrian students. The UNICEF-MoE meeting delved into specific concerns regarding 70 severely overcrowded schools in Irbid governorate which require immediate double-shifting to accommodate students. The total number of Syrian and Jordanian students (51 per cent Syrian) who received remedial education in host communities through UNICEF/Madrasati was 4,024 (52 per cent female). As for the academic progress, based on students' scores in their own schools and entry tests, 70 per cent of the Jordanian and Syrian students demonstrated improvements in taught subjects across all grades, while the parents gave the same feedback, in particular the level of literacy and numeracy in Arabic and English. Health The immunization of newly-arrived Syrian refugees against measles and polio and provision of vitamin A in Za'atari and EJC camps continues, conducted by IOM with UNICEF technical support. Measles vaccination is provided to refugees aged 6 months to 30 years, polio (OPV) to children 0-59 months, and vitamin A supplementation to children aged 6-59 months. Since IOM has started vaccinating new arrivals (16 April), 43,214 children (six months to 15 years of age and adults 16 – 30 years) have been vaccinated against measles and 12,702 children (0-5 years) against polio. In addition, 11,724 children (6-59 months) were provided with vitamin A supplements. During the last two weeks, 267 children under five years old visited the eight Oral Rehydration Therapy corners established in Za'atari. The majority were cases of watery diarrhoea with no dehydration, while five were referred to health facilities and Diarrheal Treatment Units (DTUs) for further assessment. A total of 150 Oral Rehydration Solution (ORS) sachets were distributed to children after a demonstration of how to make ORS and dissemination of key messages on how to prevent diarrhoea, importance of hand washing, personal hygiene and environmental sanitation issues.
Nutrition During the last two weeks, 1,054 mothers and 463 children under five visited the four UNICEF/Save the Children Jordan
(SCJ) Infant and Young Child Feeding (IYCF) caravans in Za'atari and EJC camps. In addition, 2,174 nutritional snacks were distributed
to children under 5 and lactating mothers. Through this project, UNICEF/SCJ provides nutritional support and guidance, including
breastfeeding promotion, complementary child feeding, one-to-one counselling and health education sessions for pregnant/lactating
women in the camp. In addition, the preparation for establishment IYCF caravan in four identified locations in Azraq camp is on-going.
Monitoring and Evaluation
UNICEF is in the process of strengthening its team of Field Monitors, bringing the total number of field monitoring staff to five by the
end of August 2013. The Field Monitors track activities of UNICEF and its partners by carrying out regular service delivery spot checks
and collecting feedback from beneficiaries through focus group discussions. They can also respond rapidly to specific monitoring
requests from UNICEF's programme sections, e.g. for special initiatives such as immunization campaigns or for supply chain
SYRIA CRISIS BI-WEEKLY HUMANITARIAN SITUATION REPORT Communications for Development (C4D) UNICEF provided a C4D workshop in Amman for 25 implementing partner staff involved with the Back to School campaign. UNICEF and SCJ organized a public meeting with all Imams in Za'atari camp to mobilize support for the Back to School campaign. UNICEF supported training of a ‘core group of peers' consisting of 30 refugee children involved in the Back to School Campaign in Za'atari camp. Supply and Logistics In the reporting period, UNICEF received 210 pieces of school furniture for use in Azraq schools.
Winterization UNICEF Jordan is preparing for the coming winter months to support Syrian children up to 5 years old in refugee camps.
Basic winter clothes and apparel items for 37,800 children are being procured through regional tendering process. Additional 38,000
thermal blankets will be procured as well. The estimated time of arrival of these items are expected by early October 2013.
SYRIA CRISIS BI-WEEKLY HUMANITARIAN SITUATION REPORT Highlights The total number of persons of concern registered with UNHCR in July Total number of registered refugees and pending
totalled 987 - the lowest number since March 2012. registration: 160,335 (UNHCR August 8, 2013)
Dara Shakran camp is due to receive the first group of refugees – 50 families Registered
The Memorandum of Understanding (MOU) with Directorate of Water Outskirts Duhok (DoWOD) has been signed and the Directorate of Water Affected
has formed a water cell inside Domiz camp which will be responsible for the Population
operation, maintenance and development of the water system for the Children
Situation Overview and Humanitarian Needs Children 0-4
The situation in Domiz and Al-Qaim remains stable. However, the number of refugees entering northern Iraq from Syria has decreased dramatically as a result of the closure of the Sehela border crossing between Syria and Iraq (Dohuk Governorate). The total number of new registrations with UNHCR for July totalled 987 - the lowest number since January 2012. As of 8 August, there are a total of 160,335 persons of concern registered with UNHCR. Children under 18 represent 38.7 per cent (62,050) of the population and children four and under comprise 14.6 per cent (23,409). Ninety-six per cent of Syrians are located in Kurdistan, northern Iraq. After reaching a high of over 100,000, the number of persons of concern in Dohuk region has now dipped to 99,424. However, the number of persons of concern residing in Erbil and Suleimaniyeh regions continues to increase slightly, and has now reached 40,146 and 15,104 respectively. Al-Qaim continues to trend toward depopulation for the seventh consecutive month with 367 refugees electing to return to Syria in July, leaving a total registered population of 5,079 from a peak of 8,955 in January 2013. Programme Response WASH Western Iraq UNICEF started relocating and storing all WASH items from the old camps 1 and 2, to the new camp in Al-Obedy, and refugees received additional water storage tanks. With the new phase of hygiene promotion campaigns, UNICEF's implementing partner, AFAKR, carried out a competition for the cleanest tent and gifts were distributed to the winners. Northern Iraq A Memorandum of Understanding (MOU) with Directorate of Water Outskirts Duhok (DoWOD) has been signed and the Directorate has formed a water cell inside the camp to be in charge of the operation, maintenance and development of the water system for the whole camp. DMC has already allocated space for the office. The DoWOD has also finalized the distribution plan for water trucking and are discussing with IRC to finalize the monitoring system by recruiting the required number of monitors. DoWOD is finalizing a bill of quantities (BOQ) for installing water metres to measure the amount of water pumped to the different phases of the camp and a BOQ for connecting communal water tanks in transit 2 to a sustainable water source through water pipes.
SYRIA CRISIS BI-WEEKLY HUMANITARIAN SITUATION REPORT KURDS, with UNICEF support, is continuing work with the water network for transit 4 and 7. The camp is moving ahead with relocating some refugees to another part of the camp to allow for the completion of work in transit 7. Norwegian Refugee Council (NRC) has started the water quality project funded by UNICEF to monitor water quality from the source to the household level. Communication has started with authorities to agree on reporting forms. NRC, with UNICEF funds, has started an assessment to install an additional 80 latrines, 200 bathing facilities and 10 communal water tanks in transit 2. A management plan for the trucks undertaking the de-sludging of septic tanks and pit latrines has been drafted. Qandil has been requested to start implementing the plan and to provide feedback to the Sanitation Technical Working Group about its efficiency. Additionally, materials for messages on water conservation have been developed by the hygiene promotion group and will be discussed with the communities through focus group discussions to ensure messaging and imaging is positively perceived. In Dara Shakran, construction of the water supply system is well underway with infrastructure 20 per cent complete. Four boreholes are completed but connection to some of the piped system has not yet started. The construction of household sanitation facilities and on-site disposal systems are also well underway - infrastructure is 10 per cent complete. The camp is due to receive people on 15 August and that infrastructure will be ready to receive some 50 families. Dara Shakran Camp is planned for 15,000 people. Child Protection Western Iraq The Child and Youth Friendly Space (C/YFS) continues providing various indoor recreational and psychosocial support activities to children and adolescents aged from 3 - 17 years. Activities include chess and other games; football and volleyball; and educational activities like improving Arabic and English languages skills, calligraphy and story-telling. The space is also providing sewing and knitting activities for 36 girls and computer courses for 71 boys and girls. The process of establishing a new Child Friendly Space outside the camp for Syrian refugee children in the host community is ongoing. Northern Iraq UNICEF Goodwill Ambassador Pau Gasol plays
IRC in partnership with UNICEF has completed six days of case management training basketball with children in Domiz Camp in
Iraq. UNICEF Iraq-2013/Bruere
attended by 16 child protection workers from ACTED and UNICEF/DoLSA CPU. A total of 1,720 visits by children aged 4 - 17 were made to the all Child and Youth Friendly Spaces in Domiz camp; 632 participated in the ACTED CFS/YFS and 771 boys and 459 girls attended the UNICEF/DoLSA centre activities. Education Western Iraq The school is now the only space available for entertainment for families in the camp and during Ramadan and it has been used as a theatre. Summer school continues in the new camp with 50 children attending. An exhibition will be organized in the coming weeks to display the arts and crafts developed by the children. UNICEF, in coordination with UNHCR and the Directorate of Education of Al-Qaim, is leading a back to school campaign to ensure that children attending Grades 1-9 return for the new academic year. SYRIA CRISIS BI-WEEKLY HUMANITARIAN SITUATION REPORT Northern Iraq Approximately 1,400 children are participating in the summer activities in Kar and Qamishlu schools, including courses on fine art and sport activities. Catch-up classes are still ongoing in Jyian School where 1,400 students are receiving remedial education. Rehabilitation of Jiyan School is now complete, benefitting 1,450 students. The NRC assessment report on the education status of refugees in urban areas is finalized and has been shared with all education partners. The methodology included phone interviews and focus group discussions. The findings show that only 10 per cent of students in urban areas are receiving education. Health and Hygiene Promotion Western Iraq Seven women from the camp gave birth during the reporting period. A UNICEF facilitator visited the families and provided the mothers with messages about exclusive breast feeding and the importance of immunization. All babies received the BCG vaccine and are now included in the routine immunization programme. In terms of numbers in the camp, there are 30 pregnant women, 166 children under 2 years of age and 269 between 2 and 5 years of age. The Directorate of Health (DoH) continues to provide immunization services through two immunization sessions per week as well as health promotion through an outreach team. Islamic Relief Worldwide (IRW) are providing curative services. There were 44 children included in the routine immunization programme for the last three weeks. A team from EPI /MoH will visit Al-Obey camp and Al-Qaim after Eid to monitor the immunization status of children under the age of 5. Northern Iraq Expanded Programme of Immunisation (EPI) services continue to run smoothly in Domiz Camp. From 20 - 27 July the vaccination team of the DoH reached 449 newcomers to the camp between the ages of 6 months and 25 years with Measles, Mumps and Rubella vaccinations and an additional 20 persons were provided with measles vaccine alone. One hundred and thirty six children under the age of 5 were reached with the full expanded programme of immunization according to the Iraqi schedule. Seven pregnant women and 88 women of child bearing age received Tetanus Toxoid vaccination in the same week. At the time of publishing this report the data for the week from 28 July to 1 August was not yet made available by the UNICEF's implementing partner. The health and hygiene promotion team finished a second round of message distribution through tent to tent visits in the camp over the past month. The messages were related to diarrheal disease prevention and to mother and child health care. While many factors contribute to the decrease and rise of diarrheal disease cases – the latest decrease of diarrheal cases in Domiz Camp from 13 per cent in June to 5.5 per cent at the end of July can at least partially be attributed to the hard work of the health and hygiene promotion teams from IRW and MSF. The UNICEF led health and hygiene promotion working group is making progress in formulating key messages around responsible water use in the camp through coherent inter-agency messaging using camp-specific messages on posters and banners as well as through SMS services and a public announcement system. Nutrition Western Iraq Twelve children under 5 years of age were monitored for growth in July. As a part of the prevention of anemia programme among women, 25 pregnant women received visited the health centre and got ferrous folic acid. In addition, 17 breastfeeding women and 10 children under five years of age received vitamin A. UNICEF, in collaboration with the DoH, plans to conduct training on infant and young child feeding after Ramadan for health workers in Al-Qaim. SYRIA CRISIS BI-WEEKLY HUMANITARIAN SITUATION REPORT Northern Iraq World Breast Feeding Week from 1 - 7 August was officially opened with a ceremony at the newly established UNICEF-funded Baby Hut in Domiz Camp. The Baby Hut functions as a centre for pregnant women and mothers of newborn babies in which education and support on infant and young child feeding practices are being offered. The close proximity to UNICEF funded EPI services and the sexual and reproductive health clinic of MSF Switzerland enable the women in Domiz Camp to receive comprehensive services for themselves and their babies. SYRIA CRISIS BI-WEEKLY HUMANITARIAN SITUATION REPORT Turkey Highlights Total number of registered refugees and pending
Ongoing activities are taking place in the Child Friendly Spaces (CFSs) registration: 434,814 (UNHCR August 8, 2013)
that have been established in 16 of the 20 camps. Youth workers are Registered
continuing to mobilize youth volunteers through registration activities, Refugees
and have begun to plan activities for youth and children in the camps. The art activities that were piloted in Osmaniye and Adana camps last Total Affected
week will continue to be rolled out to the other camps. Children
Situation Overview and Humanitarian Needs Affected (under
On 30 July, the Disaster and Emergency Management Presidency (AFAD) of the Government of Turkey reported that the total number of Syrians registered and accommodated in 20 camps in 10 provinces is 201,120, including 507 Syrians receiving medical treatment in hospitals. Local officials informed UNHCR that the admissions from the Jarablus border will resume again soon. Reportedly there is a group of approximately 1,000 Turkmen IDPs identified living on the border in Jarablus who will be admitted and sent to Malatya container site. As reported in the national media, there are continued fights between the opposition groups in northern Syria in Ras-Al Ayn and Tel Abyad across the Turkish border towns of Ceylanpinar and Akcakale. UNHCR Field Teams continue to be in close contact with the local officials to follow up the possible influx to the Turkish borders. Programme response Child Protection and Youth Ongoing activities are taking place in the CFSs that have been established in 16 of the 20 camps. Eight of the CFSs are located in tents purchased and distributed through UNICEF, four will be in containers (as they are container camps) with temporary spaces set up in the eight camps where tents have not been erected. The youth workers are continuing to mobilize youth volunteers through registration activities, and have begun to plan activities for youth and children in the camps. The art activities that were piloted in Osmaniye and Adana camps last week will continue to be rolled out to the other camps. Education Meetings were held during the reporting period with the researcher undertaking the Turkey portion of the regional education study to gain a better understanding of the teaching and learning situation of Syrian refugee children in the five Syria crisis affected countries (Jordan, Lebanon, Turkey, Iraq and Egypt) together with the development of recommendations for policies and strategies in relation to the curricula used for teaching and to the accreditation of learning. The study was initiated by UNICEF Middle East and North Africa Regional Office for the five concerned countries to address the challenges related to teaching and accreditation for Syrian refugee children. The study will provide a valuable tool for concerted advocacy, policy development and active engagement for improving education programmes benefitting Syrian refugee children. Supply and Logistics The majority of supply needs over the period continued to be in preparation for the establishment of the CFSs in camps. The main items for procurement have been air conditioning systems, laptops and mobile phones for youth workers, recreational kits and materials, furniture and sign boards. SYRIA CRISIS BI-WEEKLY HUMANITARIAN SITUATION REPORT In addition to supplies for CFSs, 80,000 pairs of shoes have been procured and will be distributed to children in the camps in collaboration with a back-to-school campaign planned for the end of August. The shoes have been given to the Turkish Red Crescent Society to distribute, and will be distributed according to an agreed distribution plan. SYRIA CRISIS BI-WEEKLY HUMANITARIAN SITUATION REPORT Funding Status In millions of US Dollars * The total amount includes funds that are currently being allocated to country offices.
** This includes multi-country technical support.
On 7 June UNICEF, together with other UN agencies and partners, launched its revised appeal requirements for the Syria Crisis. As
detailed in the above table, UNICEF's total funding requirements from January to December for Syria have increased by 61% to
$110.46m. For neighbouring countries, UNICEF total funding requirements have now reached $360.19m representing a 183% increase.
Next Situation Report: 22 August 2013
For further information, please contact:
Syria Hub Coordinator
Regional Chief of Communication
UNICEF MENA Regional Office UNICEF Middle East and Northern Africa Mobile: +962 (0) 79 6835058 Mobile: + 962 (0) 79 5904740 UNICEF Syria Cri
UNICEF Syria Crisis Facebooena
UNICEF Syria and Syrian Refugees AppeaUNICEF Syria Cri
A Weekly FAX from the Center for Substance Abuse Research CESAR FAX Buprenorphine Series March 31, 2003 to December 15, 2014 (updated January 9, 2015) Center for Substance Abuse Research University of Maryland 4321 Hartwick Road, Suite 501 College Park, MD 20740 301-405-9770 (phone) 301-403-8342 (fax) CESAR is pleased to provide this compilation of CESAR FAX issues focusing on buprenorphine. While research indicates that buprenorphine is an effective drug for treating opioid dependence, we feel that the potential for its nonmedical use and related unintended consequences may be going unnoticed. The most recent CESAR FAX issues on buprenorphine were designed to highlight indicators of the increased availability, diversion, and misuse of buprenorphine. CESAR will continue to monitor the diversion and abuse of buprenorphine and report on developments as they arise.