HumanitarianResponse



WHO Libya biweekly operational update1-15 May 2020General developments: political & security situation“The overall security situation in Libya witnessed series of different incidents influenced by the protracted armed conflict. Associated with the sustained use of new military hardware, sophisticated Air Defence Systems (ADS) and infiltration of foreign fighters/mercenaries across the porous borders, sea and air powered by some of the international partners. Determinedly, increasing civilian casualties, properties destruction and civilian displacement.”2 May, Tripoli – WHO urges the health authorities in Libya to remain vigilant in the face of the serious health threat posed by COVID-19 in the country. Following Aguila Saleh’s initiative and Haftar’s declaration, Prime Minister al-Sarraj welcomes all political initiatives calling for a peaceful solution to the Libyan crisis. House of Representatives members in Tripoli set conditions for resumption of political talks and High Council of State calls for redoubling military efforts. 10 May, armed group opened fire inside the intensive care unit in Al-Jalla hospital in Benghazi. Indiscriminate shooting. Panic between health workers. Doctors and nurses were assaulted. Medical equipment in ICU ward was damaged, including 7 respirators, monitors, ultrasound machine and other life-saving devices. Transferring all urgent cases to Benghazi Medical Center.13 May - A joint statement (OCHA, UNHCR, UNICEF, UNFPA, WFP, WHO, IOM) on Libya: Conflict and the COVID-19 pandemic present a significant threat to life in Libya May – As a result of continuous military activities around Tripoli city, the building (dermatology department, ENT department) of the Tripoli central hospital was hit by shrapnel of the ongoing shelling of the area close and around the hospital. The hospital is one of the city's main and largest health facilities, including the oldest?trauma center. The shelling caused infrastructural damage to few hospital’ buildings. No casualties were reported.Out of 100 registered incidents the western region registered the highest and continues to be the country’s hotspot region. Irrespective of all these, the UN still maintains its minimum presence in Tripoli and Benghazi and missions/movements are allowed on a case-by-case basis. Meanwhile, the UNSMIL flight have been put to a provisional hold to Misrata and Benina Airport with the advent of the COVID-19. Libya has closed its land and airports including enacting curfew hours as a precautionary measure. The UN flights to Mitiga Airport are still being impacted for anticipation of artillery shelling and lack of acquisition of deconfliction clearance, as a result the suspension of air operations in the airport remained. OPERATIONAL UPDATESFollowing the reported emergency needs as a result of fighting around Al Watiya base, WHO delivered 2 trauma kits to each of three hospitals where dozens of dead and injured people were brought, Al Zental hospital, Al Rujban hospital, Al Riyaina hospital. 10 May, Tripoli - WHO delivers essential health supplies to Tarhouna, Libya, where 200 000 remain trapped due to ongoing hostilities part of the emergency response following the conflict around Tarhouna area, WHO delivered 5 NCD kits, 3 trauma kits, 1 surgical kit, 1 cholera and 2 IEHK kits to Bani-Waleed hospital. Additional 6 NCD kits, 3 trauma kits, 1 surgical kit, 5 IEHK and 1 cholera kits were delivered to Tarhouna hospital. COVID-19 responsePillar 1: Coordination WHO Libya bi-weekly (30 April – 13 May) COVID-19 update was prepared. Participated in a UNDP-led on line meeting of UN framework to compile assessments carried out on the socio-economic impact of COVID-19. Participated in the bimonthly technical coordination EMRO IMST and CO focal points meeting with agenda related to case management, procurement, communication and infection prevention control. Participated 2 meetings on 4th and 12 May on surveillance, RRT and case investigation, 1 meeting on led by the MoH.Continued to provide technical support to the COVID 19 advisory committee in the municipalities: Tobruk, Musaed, and Bir Bir Al Ashhab.Attended the meeting of COVID advisory committee and follow up on the implementation of the preparation and response micro plan in Tobruk. Facilitated two Video Conference meetings between COVID-19 team members with MTI to establish a link with French experts in different fields. The training needs were identified by Al Baida Hospital team and the capacity building and experience sharing activities will start next week.Pillar 2: Risk communication and community engagement (RCCE)The RCCE group where WHO is a member has completed a behavioural risk assessment for COVID-19.WFP has completed the distribution of WHO COVID 19 education and awareness material to families reciving food assistance in all areas of the country.Pillar 3: Surveillance, rapid response teams and case investigationParticipated in the National Steering Committee meeting and recommended that the testing strategy be expanded to include patients with influenza-like illness or severe acute respiratory infection, as well as migrants in the south and prisoners in Libyan jails and detention centres. WHO has also stressed to the MoH to develop a clear guideline on use of RDT.Submitted research proposal on sero epidemiology and genomic sequencing to the WHO Regional Office for technical support and collaboration on behalf of the Benghazi School of Public Health. Discussed and requested further technical advice with WHO Regional Office on the issues affecting low reporting rate of COVID 19 cases and no case has been reported during second week of May. Pillar 4: Points of entryRaised the concern of lack of coordination by the Egyptian to enable PCR testing for Libyans inside Egypt prior to their repatriation to Libya. Participated in weekly NCDC technical steering committee to discuss return of Libyan outside Libya particularly from Egypt, Turkey and Tunisia, follow up, quarantine and in community.Conducted field visits to the quarantine in the three municipalities, where the returnees from Egypt have been isolated in Tobruk. Pillar 5: National laboratorySent 100 PCR kits (500 tests) and 24,000 viral transportation media with swabs to the NCDC laboratory.Met with the NCDC, Sabha Medical Center and Sabha Crisis committee on the operationalization of the RT PCR and the Sabha.Dispatched Nasopharyngeal Swabs for COVID 19 with VTM distributed to the RRTs in Sabha, Ashshatti, Murzuk, Wadi Etba, Um Al Araneb, Tragen, Al Gatroun, Ubari and Ghat. Facilitated the transportation of 60 extraction kits from NCDC Tripoli to? COVID 19 laboratory in Benghazi.Followed up with NCDC/ surveillance administration preparation for population survey in four municipalities in Tripoli which targeted 3500 specimen will start on 17 May 2020, the purpose of this step to enhance detection rate and to detect asymptomatic cases.Pillar 6: Infection prevention and controlWHO/EMRO has reviewed Libya’s national IPC guidelines and recommended adding a summary annex on special IPC precautions, including disinfectant for environmental cleaning and its preparations and concentrations. The guidelines have been approved by the national Technical Advisory Committee and endorsed by the office of the Prime Minister.Conducted virtual awareness sessions about COVID 19, mode of transmission and general prevention precautions, answer to public questions and concerns in Tobruk.Pillar 7: Case managementThe national case management guidelines for COVID-19 have been reviewed by the WCO and EMRO, approved by the Technical Advisory Committee and endorsed by the Office of the Prime Minister.Conducted a simulation exercise on the triage and referral mechanisms between the triage clinic and the isolation centre in Sabha.Conducted a meeting with the head of the medical teams who will work in the isolation centers and draft a plan for operationalization of the center together with the respiratory clinic in Sabha.Pillar 8: Operational support and logisticsThe Libyan authorities has been informed by WHO on the establishment of the global Supply Chain portal, providing the national authorities an opportunity to procure COVID-19 supplies. Pillar 9: Maintaining essential health servicesWHO country and regional office provided inputs to the second draft of the “Essential Health Services” document. The purpose of the document is to provide coordination and operational guidance on preparing a continuity plan for maintaining good quality, equitable essential health care services including sexual, reproductive, maternal, newborn, child, and adolescent health (RMNCAH) services during the pandemic. Convened TC with RMNCAH focal point of MoH with regard to development of COVID-19 and pregnancy/ childbirth protocols.Convened TC with Regional Advisor for Primary and Community Health Care with regard to Essential Health Services (EHS) component of the response plan for COVID-19 and the Regional Paper on Role of Primary Health Care in COVID-19.Has been continuously following up along with UNICEF with the EPI programme administration and NCDC TCO on the proper resumption of immunization activities including concerns of vaccine shortages.Met with the head of Primary Health care administration in Sabha and discuss about the precaution of the training needed to their staff to reestablishing? the immunization services in Sabha. Shared with MoH the recently published violence against women and COVID-19 guidance Arabic version with infographics.Convened meeting with representative from the National Planning Council and discussed training activities to support community health worker roles against COVID-19. LeadershipConducted a teleconference with the Libyan Prime Minister and other high-ranking officials, Tripoli, Libya, 13 May 2020. Participants: Ms Elizabeth Hoff (WHO Representative in Libya) and Mr Fayez Mustafa al-Sarraj (Chairman of the Presidential Council of Libya and Prime Minister of the Government of National Accord (GNA)), with the participation of Mr Mohammed Haitham (Deputy Minister of Health) and D. Khalifa Bakkoush (head of the COVID-19 National Scientific Committee). Concerns raised by WHO:Need for endorsement of national COVID-19 response planFacilitation of approvals for importation of health suppliesRelease of salaries and provision of PPE to health workersVaccine shortagesGlobal COVID-19 Supply Chain PortalNeed to strengthen the coordination between NCDC and WHONFR from the meeting shared with EMRO senior management. Prepared and issued two Press Releases (10 May on Deliveries to Tarhouna and 12 May on Deliveries of Health Supplies across the country)Prepared and issued Health Response to COVID-19 in Libya Update #6 Opened Case Management Meeting on Cutaneous Leishmaniasis online courseAttended weekly diplomatic briefings led by the SRSG and provided update on the heakth situation in Libya including on COVID-19Prepared proposals and donor reports for submission Briefed the German Ambassador on the potential for strengthening the health cooperation with municipalities (through a decentralized model in line with the political dialogues).Reviewed and submitted WHO input to a CN on health diplomacy (drafted by UNDP and UNSMIL).CoordinationPrepared health sector situation report on COVID-19 in Libya covering 1-14 May 2020.Prepared the overview of the capacity building activities to be supported by health sector organizations in May-June 2020. ?Prepared a fact sheet on the latest update on impact of conflict on health in Tarhouna municipality.Work in progress to evaluate preliminary findings of health sector assessment at a community level. Joined WHO Represntative in the teleconference with the Libyan Prime-Minister. Reviewed project proposals developed by UNSMIL on COVID-19 response. Provided comments into the final version of joinr WHO/UNICEF/IOM project proposal for EU on COVID-19. Followed up on identification of needs for support with standard health kits by the Government of Italy.Provided weekly inputs to UNSMIL weekly report. In continuous dialogue with OFDA team on health sector situation. Updated ECHO and DFID teams on the situation in Tarhouna. Provided comments to the proposed concept note on health diplomacy. HEALTH OPERATIONSSub-office BenghaziFacilitated and supervised the delivery of medical supplies, Tobruk Medical Center, Mother and Childhood Center, Bab Derna, three hospitals (Ashhab, Al-Bardi, and Jaghboub), and the Al-Manara Policlinic and Omar Al-Mukhtar, polyclinic in three municipalities (Tobruk, Bir Al-Ashhab, Musaad, and Jagboub southeastern Libya)Followed up with the NCDC reviewing the country fourth round of the Tripartite Country AMR Self-Assessment Survey.In coordination with the Health Services Directorate and Tobruk Medical Center, organized and facilitated a scientific day for health care workers. Arabic translation and post WHO activity on WHO official pages on social media (FB. And twitter) and follow up the comments and inbox.Trainings on the implementation of the Minimal Health Service Package (MHPS) conducted between 7-14 May in Benghazi, Al Baida, Ejdabiya, Tobrouk, and Al Marj. More than 60 General Practitioners (GPs) from the 25 PHCs attended the trainings. This training was mplemented in collaboration with Directorate of PHC and facilitated by University consultants. The advanced On-line ToT course on case management of leshmaniasis facilitated by EMRO and HQ based experts will be concluded on 16th May. The trainees are five Libyan dermatologists who are the core team of the national control NCDC program. Medical supplies provided by WHO were delivered on 10th May to Al Baida Hospital and the Primary Health care Directorate. The supplies included 40 IEHK basic units, 5 supplementary kits, and 3 NCD1a kits.Distributed? medical supplies including IEHK and NCD kits, including insulin, to Benghazi Medical Center and Benghazi health Services directorate, Al Briga General hospita, Sirt General Hospital.Coordinated four scientific meetings between experts from France (MTI) in fields of Virology, ICU, and laboratory expert with Consultant Medical Committee CMC in Benghazi,Al Bayda General Hospital and Tobruk Medical Center.Emergency Medical Teams supported 14 health facilities providing primary and secondary health care services across the country with 849 surgical intervention and 2,336 specialized consultations, as below:S.NoTeamSpecialtiesDuty stationsMajorsurgeryMinorsurgeryConsultation1Alzintan EHTOrthopedicChest & TB? Alzintan GH1192152Tarhouna EHTAnesthesia, Orthopedic, Nuero Surgery, Vascular Surgery, Burns surgeryTarhouna GH24180243Misrata EHTAnaesthesia Orthopedic? General SurgeryVascular SurgeryMisrata medical Center35489664?Al Jofra EHT?Anesthesia General SurgeryHounAl Afia GH18321065Benghazi MMTPediatricCardiology Gynecology GPAl Majori PCTawergha IDPs CampsSidi Khalifa polyclinic--6376Ejdabia MMTPediatricInternal medicineDermatology GPTawergha IDPs clinic Abu Shaala PHC Ejdabia Diabetic center--3107Tarhouna MMTEndocrinologyGastroenterologistGynecologyDermatology Tarhouna PCSuk Alahad PHCAl khdra polyclinic--189Dermatology only8Sabha EHTAnesthesiaSabha Medical Center15--9Ghat EHTPediatric , GP, GynecologyBerket PHC ?--70210Leishmania MMTDermatology Tawergha GHNCDC Misrata--87Total:6392102,336Sub-office SabhaParticipated in the meeting of the consultancy committee in the south and provide the needed technical support.Met with the Mayor of Al Bawanees municipality and the head of the health services administration to discuss the situation of the health facilities located in the municipality.EMT in Sabha Medical Center and in Berket PHC in Ghat continued their work in provision of the medical services.Dispatched the following supplies from the contingency stock in Sabha: Lab reagents to Ubari General Hospital, Sabha Diabetic Center and Al Bawaness Health Services administration; IEHK Basic unit dispatched to Um Al Araneb Rural Hospital (3 Kits), Hay Abdulkafi polyclinic (2 Kits), Sabha Golden polyclinic (3 Kits) and Al Bawaness Health services administration (3 Kits); NCD Kit module 1c dispatched to Um Al Araneb Rural Hospital in addition to IVF, 80 bottle sodium chloride 0.9% and 80 bottle dextrose 5% . Facilitated and supervised the delivery of medical supplies to Sabha Medical Center, Sabha Health Services Administration, Sabha Golden Polyclinic, Hay Abdulkafi Polyclinic, Al Gurtha PHC in Sabha, Bergen PHC in Ashshatti, Murzuk General Hospital, Tragen General Hospital, Murzuk Health Services Administration, Ubari General Hospital, Ubari Health Services Administration, Berket PHC in Ghat. ?Tuberculosis and EOC Working with PHEOC/NCDC and the technical unit to complete the communication software and the power generator installation.Identifying the urgent needs and responses to the IDPs mass movements due to Tripoli clashes and the clashes at the surrounding areas.Conducted health situation assessment for Gasr AlAkhyar Municipality.Conducted health situation assessment for Tarhouna Municipality. Disseminated WHO Guidance on disability considerations during COVID-19 and regional report on assistive technology.Primary Health CareConvened meeting with MoH-ICO and HRH department to set an action plan regarding capacity building activities for health worker. Followed with MoH Libya reproductive and maternal health country data review and response 2020 as a response to the Regional Office request. Participated on the first virtual workshop of Primary Health Care Measurement and Improvement (PHCMI) initiative and prepared and presented a power point presentation on Libya measurement phase of the PHCMI initiative. Prepared delivery chain mapping (DCM) and other necessary documents in regard to finalization of contribution agreement with DfID for supporting two-year MHPSS project.Finalized the ToRs of national positions which will be recruited under the newly approved two-year MHPSS project.Convened TC with ECHO to discuss the implementation progress of ECHO supported project on “Support emergency and basic health services for conflicted affected population in Libya”. Prepared the first draft of the final project report for project on “Provision of emergency life-saving health services for people affected by Tripoli clashes”.Participated in TC on MHPSS updates and plans organized by NMH department of Regional Office.EPI/AFP/ Measles surveillance programFollowing up the recommendations on SL3 and transportation of pending stool samples that have been collected through the routine surveillance , the collection of stool samples from index cases No 008 and it’s 3 contacts (brothers) were successfully collected, stored and ready to be shipped along with other 19 stool samples from the routine surveillance that already stored in Tripoli and pending for transportation. The possibility of special flight to transport these samples that have stored both in (Tobruk and Tripoli) including number 034-043 AFP cases to the Pasteur Polio lab in Tunis are being coordinated and monitored with and national AFP surveillance officer through DG of MoH and NCDC. As per WR request and coordination, a concept note on EPI with proposed budget of USD 3,295,600.00 was developed, finalized and raised to Italian government. The objective of this proposal is to strengthening National Immunization Program and increasing effectiveness of immunization service delivery in Libya.TC between VPI/EMRO and Libya country POL/Immunization team in the context of COVID-19 pandemic was held and joined by Libya focal person at EMRO. The meeting has discussed the situation of implementation of routine vaccination services in terms of service delivery, vaccination campaign, surveillance of vaccine-preventable diseases (VPDs), immunization staff and required technical support.POL/EPI Technical Officer consultant participated in the regional POL weekly TC, where above issue of vaccine shortage in certain municipalities have been highlighted and issue of pending transport of AFP stools to Pasteur Institute Laboratory, Tunis due to flight issues- it is expected to be arranged by NCDCConsolidated and disseminated AFP/Measles weekly epidemiological update report (Epi week 18 and 19).3 AFP cases reported during the last two weeks from 2 districts, Al-akhdar (2) and Benghazi (1). Stool specimens from suspected case of AFP have collected and being monitored to be delivered to Pasteur Polio lab in Tunis. Summary AFP indicator performance as on Epi week 19, 2020Total AFP cases reported as on EPI-Week 19, 2020 = 43Early detection and notification within 7 days of paralysis in 2020 = 40 (93%) Early investigation within 48 hours from date of notification in 2020 = 43 (100%) Annualized Non-Polio-AFP rate = 4.7/100,000 U15 years Children% of Stool adequacy for the reported week (Epi-week 19) = 34 (100%) and stools of 9 AFP cases are still pendingProcurement and Logistic Dispatched medical supplies (81 tons or 389 cubic meters) to over 50 health facilities around the country. 20 trauma kits, 749 different IEHK kits, 1 surgical kit, 6 cholera kits, 71 different modules of NCD kit. Recipients include: TRIPOLITripoli NCDCSabhaSabha Golden polyclinic SabhaSabha Health Services AdministrationSabhaHay Abdulkafi PolyclinicSabhaSABHA MEDICAL CENTERSabhaSabha-Algurdha PHCSabhaMSO Fezzan (contingency stock)SabhaBergin Alshate-Bergin PHCBani waleedBani waleed HospitalTarhouna Tarhouna Hospital Zentan Al Zentan HospitalAl Rujban Al Rujban HospitalAl RiyainaAl Riyaina HospitalAl BeidaAl Bayda Hospital Al BeidaAl Baida Primary Health Care DirectorateBENGHAZIBenghazi Medical CenterBENGHAZIBenghazi health service directorate DERNADerna HospitalDERNADerna Primary Health Care DirectorateAljabal AlkhdarAl Gobba General HospitalAljabal AlkhdarGandola Rural HospitalAljabal AlkhdarMartouba HospitalAljabal AlkhdarOmar Al Mukhtar Rural HospitalAljabal AlkhdarSousa Rural HospitalBENGHAZIAlmajore polyclinicAl Briga Al Briga HospitalAl Briga Breiga rural hospitalUBARIUbari general hospitalUBARIUbari Health Services AdministrationTraghanTragen General HospitalMURZUQMurzuk General HospitalSabhaSabha Medical CenterMsillataMisillata HospitalALKHOMUSAlkhomus HospitalMsallata Misillat PHC adminstrationZlitenMajer PHCTOBRUKTobruk Medical CenterTOBRUKAl-Mukhtar PHC TOBRUKAl Manara PCTOBRUKAlmanara PCTOBRUKBab Derna Maternity CenterTOBRUKAl Bardi HospitalTOBRUKBir Alashhab PHCTOBRUKGagboub HospitalTawarghaTawergha HospitalMisrata Misrata Diabetic centerMsallata Misrata PHC adminstrationTripoliHai-Almujahideen,AbuslimTripoliAbuslim Trauma HospitalQasr akhiarAlamirien PHCAl BreigaBreiga rural hospitalsSIRTESirt hospital Purchase requests for procurement of blood bags and blood reagents (in below table) submitted and relevant PO issued in favor of Tobruk blood bank in the east with ETA in June/July.Description UOMQTY1Blood bag single 450ml with 16G needle gauge, needle guard protector, holder and sampling bag with CPDA anticoagulant WHO GMP Certified & CEEach60002Blood bag triple 2 satellite bag 450ml platelets 5 days with 16G needle gauge, needle guard protector, holder and sampling bag. CPDA anticoagulantEach18003Blood bag double with satellite bag 450ml, 16G needle gauge, needle guard protector, holder and sampling bag. CPDA anticoagulanEach18014EIA HEP C (Innotest HCV Ab IV) , ser/pl, box-480Box of 48055EIA HEP B (Murex HBsAg Version 3) , HBsAg, ser/pl, box-480Box of 48056TEST, BLOOD GROUPING, Anti A, 10ml, dropper, bottleEach2007TEST, BLOOD GROUPING, Anti B, 10ml, dropper, bottleEach2008TEST, BLOOD GROUPING, RHESUS Anti D, 10ml, dropper, bottle?Each200KEY GAPS & CHALLENGESLow reporting of COVID-19 cases for LibyaClosure of airports and seaports prevent importation of COVID-19 procured suppliesEnhancing WHO role to support capacity building events across the country (a separate guidance note is developed for CO staff). RESPONSE PRIORITIESStock of COVID-19 supplies at global level and WHO Libya request Monitoring on the implementation of the COVID-19 OCR workplans and related activitiesFinalization of all administrative formalities for hiring of identified international staff. ................
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