North West Syria Needs Assessment

(A Visual Analytics Report)

20 / 03 / 2018

2

Contributors

3

Idleb nowadays in Syria is the most IDPs-crowded place. When it comes to human-life related

needs and missed responses, no words can describe it. Therefore, we relied on the visuals to

express and reveal them. As been told, a visual should be aesthetically pleasing, thought-

provoking, communicative, and most importantly informative to decision-making.

Here you, and we are.

4

Table of Contents

▪ EXECUTIVE SUMMARY ............................................................................... 5

▪ SURVEY METHODOLOGY AND CONTEXTUAL BACKGROUND ....................... 5

▪ POPULATION AND DEMOGRAPHIC CHARACTERISTICS ................................ 6

▪ SECTOR-BASED ANALYSIS AND VISUAL ANALYTICS ................................... 13

• FOOD SECURITY EVALUATION ............................................................................. 13

• SHELTERS SITUATION ......................................................................................... 18

• NON-FOOD ITEMS NEEDS ................................................................................... 22

• WASH CONDITIONS ........................................................................................... 26

• EDUCATION ASSESSMENT ................................................................................... 30

• PROTECTION ESTIMATION................................................................................... 33

• HEALTH ISSUES MODES ...................................................................................... 35

• NUTRITION CONDITIONS .................................................................................... 39

▪ OVERALL CONCLUSION ............................................................................. 43

▪ CHALLENGES ............................................................................................ 44

▪ RECOMMENDATIONS ............................................................................... 44

5

▪ Executive Summary The results of the 2018 January North West Syria Needs Assessment (NWSNA) revealed

that 85% of the IDPs in Idleb governorate are food-insecure, 90% of them have issues

with their shelters, 85% of them have various problems with non-food items, over 90%

of the children of the displaced did not receive any education services, and vastly varying

classes of health problems impacting the IDPs, for instance respiratory infectious disease

was the most concerning class for all IDPs, in addition to overload cases of child diarrhea.

In summary, overcrowded settings, lack of shelter, more than 54% of the children don’t

have access to vaccination, the majority of population are getting just 2 meals a day (risk

for malnutrition due to the low calories intake), third of the population are IDPs, the

communicable and non-communicable diseases are the highest morbidities while the

war-related cases and heart diseases are the main cause of mortality, the hospitals are

the most common places to get the health services, the average distance for the health

facility is 5.7 km which is about the standards but details about the distribution are

needed, inadequate medical supplies, and interrupted nutrition practices and

interrupted WASH services.

▪ Survey Methodology and Contextual Background The main source of data for the NWSNA analysis was from original data (Key informants)

collected through a digital poll (Through KOBO). The survey was designed to present an

estimate that is representative at a sub-districts level, concentering largely the IDPs. In

addition, the survey divided to be a multi-sectoral approach developed by several NGOs.

The survey was not intended to be a concrete statistical study, yet it essentially to bear

marks on diverse segments impacting the IDPs.

This overflow of the IDPs, started in the middle of October 2017, GoS forces backed by

its allies' militias had launched a military ground offensive against what were OAGs-held

territories of Hama eastern and Aleppo southern countryside. The offensive forces

managed to advance within the area passing Al-Hejaz railway in Idleb province and

capturing wide areas in Idleb eastern and southeastern countryside after

controlling Hama eastern and Aleppo southern countryside. This ground attack

alongside with the heavy GoS/GoR aerial bombardment prompted a huge IDPs wave

towards the northern and western countryside of Idleb province.

6

▪ Population and Demographic Characteristics 1. The total counted population is 3,328,615. A nested tree-map below displays the

spreading of the people in Idleb and a few of Aleppo small towns. This map holds the

cumulative estimate of the population including the host communities and the IDPs. As

demonstrated Idleb city, Atareb, Dana and Maaret Tmasrin holds the most total

population.

Figure 1: population per sub-district

7

Map 1: distribution of population on north of Syria

2. Demographically-based, amplified information covering the sub-district-segmented

circulation of settled IDPs, the host communities’ population, IDPs in informal

settlements, and more specific an estimation of the number of reported IDPs last 30 days

before beginning the military operations.

8

Figure 2: Idleb (Total IDPs means the settled IDPs excluding the IDPs in last 30 days and

those at informal settlements)

9

Figure 3: Harim (Total IDPs means the settled IDPs excluding the IDPs in last 30 days

and those at informal settlements)

10

Figure 4: Jisr-Ash-Shugur (Total IDPs means the settled IDPs excluding the IDPs in last

30 days and those at informal settlements)

Figure 5: Al Ma’ra (Total IDPs means the settled IDPs excluding the IDPs in last 30 days

and those at informal settlements)

11

Figure 6: Ariha (Total IDPs means the settled IDPs excluding the IDPs in last 30 days and

those at informal settlements)

Figure 7: Jebel Saman (Total IDPs means the settled IDPs excluding the IDPs in last 30

days and those at informal settlements)

12

Figure 8: As-Suqaylabiyah (Total IDPs means the settled IDPs excluding the IDPs in last

30 days and those at informal settlements)

3. The table below shows the sub-districts-based percentage of settled IDPs and IDPs in last

30 days and those at informal settlements out of all population.

Sub-District Population IDPs Percentage

Atareb 296160 49%

Ehsem 225957 36% Armanaz 74099 61%

Janudiyeh 88909 55%

Badama 29713 68%

Bennsh 61495 12%

Teftnaz 72031 57%

Haritan 36374 24%

Heish 112464 54%

Daret Azza 166032 16%

Dana 286725 89%

Darkosh 103700 55%

Saraqab 30947 84%

Sarmin 36891 35%

Salqin 171483 53%

Madiq Castle 139971 29%

Qourqeena 94685 49%

Kafr Takharim 89684 7%

Kafr Nobol 265835 31%

Mhambal 79624 32%

Idleb 314458 35%

Ariha 219699 42%

Jebel Saman 20874 88%

Jisr-Ash-Shugur 86491 32%

Harim 43489 78%

Jebel Saman 216509 42%

Maaret Tamsrin 282189 41%

Table 1: proportion of IDPs out of All total population

13

▪ Sector-based Analysis and Visual Analytics In this report, we fundamentally analyzed the data based on a visual analytics-inference

approach, in order to simplify the subject and back the decision-maker with a specific

conclusion.

• Food Security Evaluation Key-findings:

▪ 85% of the IDPs have “NO” regular food supports.

▪ The insecurity rate of IDPs food needs to be reached 65%.

▪ “ZERO” functionality of bakeries according to 58% of the people.

1. 14% of the IDPS consume only 1 meal daily, 55% of the IDPs consume regular two meals,

and 31% of them consume 3 meals.

Figure 9

2. Casual labor forms 26% of the food sources for the IDPs, followed by acquiring from the

main shops by 22%, equally followed by borrowing and purchasing from roadside

vendors, and others like sheep farming.

14

Figure 10

3. Mostly no sides in the field providing any type of food support which has been reported by 85% of the IDPs. While 13% remarks that they get provided by some-side unusual support.

Figure 11

15

4. Close to 42% received partial food rations as separate food items, although 24% received full food rations, yet 19% did not receive any food portions.

Figure 12

5. 65% of the IDPs received utterly and collectively “ZERO” food supports. In contrast, 30% received “One” time food support, and 4% received two food supports.

16

Figure 13

6. Multiple measurements below describe and parametrize the markets and bakeries situations, which is -inferentially- accessible conditionally, where the markets are accessible almost 92% yet the food coverage averagely 44%.

Parameter Measure

Coverage percentage of IDPs food needs

out of the total need for the displaced in

the last 7 days.

65% of the IDPs have “NO” food needs

converge. In addition to averagely 44% for

whom were covered.

The regularly still and accessible open food

markets to customers and suppliers.

It is predominantly “YES” by 92%.

Main food commodities available in

sufficient quantities in the nearest

market?

It is predominantly “YES” by 90%.

Basic food commodities still and accessible

comparing to the last year prices (based

on the people judgments)

It is “YES” by 56% and “NO” by 44%.

17

Functionality status of bakeries in the

area/community

It is “YES” by 40% and “NO” by 60%.

Table 2: Measurement of markets and bakeries parameters

The last four parameters have been represented in the following unified chart.

Figure 14: Markets and bakeries

7. The price of the foods largely increased between 10% to 30% according to 53% of the people, in addition to less than 10% price increase according to 31%.

18

Figure 15

8. “ZERO” functionality of bakeries according to 58% of the people, and “ONE” functional bakery -per community- according to 28% of them.

Figure 16

Sector mini-Analysis

Idleb governorate due to the overflow of IDPs is characterized by widespread diverse needs, food insecurity, and malnutrition. Multiple and simultaneous clashes worsened the vulnerability of families where they confined to absolute scarcity and hunger. In addition, thousands of people continue to displace resulting limit access to basic food needs. Ongoing inner conflicts in the area, economic downturn, and unemployment increasing rate make Idleb one of the most food-insecure governorate in Syria.

• Shelters Situation Key-findings:

▪ 90% of the assessed communities have problems with their shelters.

▪ Most IDPs reside in unfinished buildings.

1. In the region of 90% of the assessed communities there were several problems with the

shelters.

19

Figure 17

2. Over-crowdedness houses essentially in Ariha, Harim and Idleb sub-districts was the

main shelter problem. In addition to expensively priced shelters mainly in Ariha and

Harim. Moreover, unavailable shelters are a major problem which was mainly in Harim

and Idleb.

Figure 18

3. Most IDPs, largely by 62%, reside in unfinished buildings especially in Ariha, Harim and

Idleb. In addition to 25% of IDPs reside in non-residential or public buildings especially in

Harim and Ariha. The other residents remain in hosting, tents, rental houses, hangars

and outdoors.

20

Figure 19

4. The percentage of IDPs sharing shelters with other families ranges between 46% in Idlib

district and 27.6% Jisr-Ash-Shugurin district. The Average of the percentages in all

districts is 36.6%.

5. In most sub-districts, there are a huge lack of rental houses, where it can be reached to

60%, especially in Ariha-Harim -Jisr-Ash-shugur.

Figure 20

6. The average of houses rents is 14802 SYPs. The chart below shows the average for each

district.

21

Figure 21

7. The total collective centers are 273. The proportion of non-functional collective centers

to the total center is 45%.

8. Almost 30% are the coverage percentage of IDPs shelter needs out of the total needs.

9. The total transit centers are 66. The proportion of non-functional transit centers to the

total center is 38%.

10. 16% of the communities have received a shelter-related support such as tents, free

houses, free hosting, cash money and a land for establishing the camps.

22

Figure 22

Sector mini-Analysis

Most sub-districts have seen a major increase in the shelter issues. In the light of

additional IDPs, it is obvious that the shelters mostly over-crowded, intensifying other

forms of needs and make the shelters open to damages. Across all sub-districts, the

overflow needs to increase the un-availableness and minimized-functionality of the

shelters.

• Non-food Items needs Key-findings:

▪ Zero “Availableness” of blankets in the markets, which increased the need over

96%.

▪ Sarmin, Kafr Takharim, and Janudiyeh sub-districts have “Zero” non-food items

converge, which determine their security as almost zero.

1. There are multiple problems with needed non-food items according to 85% of

the people.

Figure 23

2. The utmost concern for non-food needs is the safety and security of markets. The

two charts below show the most important needs and concerns.

23

Figure 24

Figure 25

3. The chart below shows the most NFI needs as a percentage, which shows an over

96% needs for blankets, fuel for heating and cooking, and mattresses.

24

Figure 26

4. The graph below confers the availableness situation of the non-food items needs

in the markets. Which proves that there is a tremendous urgency for blankets.

Figure 27

5. Cash is so far the most preferred model of support, followed by 16% who prefer

some any sort of materials.

25

Figure 28

6. The graph below shows the percentage of each supports modality. The blankets

top the list by 77%.

Figure 29

7. Sarmin, Kafr Takharim, and Janudiyeh sub-districts have “Zero” non-food items

converge, which determine their security as almost zero. Ehsam, Saraqab, and

Arhia sub-districts have a very low converage.

26

Figure 30

Sector mini-Analysis

The survey found a mixed pattern on availability of non-food items. Blankets are far

needier than other types of non-food items. General insecurity has its shadow on the

markets, which make the supply irregular and event-oriented. Specifically, access to fuel

for heating and cooking is one of the factors influencing the utilization of food and the

rate of mortalities, which in turn impact the health and nutrition issues.

• Wash conditions Key-findings:

▪ Camps in all communities, mostly have no bathrooms. Numerically, the un-

availableness can reach 97% peak.

▪ Kafr Takharim sub-district has difficulties in reaching the water considering that

they need 181 minutes of walking.

1. Over 58% of the population in all community acquiring their drinking water from the

water trucks, followed with a definite decrease into 16% who accessing the water from

the nearby water networks.

27

Figure 31

2. As shown, IDPs obtaining the drinking water from the water truck, increasingly over

63% compared to the total population. Additionally, the IDPs second source of water was

the nearby borehole.

Figure 32

3. Similarly, non-drinkable water usually purchased from the water truck by 59% of the

population, in addition to the borehole, over 16% of the population.

28

Figure 33

4. The mode of the distance that the people have to travel to get water is 19 minutes of walking, but Kafr Takharim has difficulties in reaching the water considering that they need 181 minutes of walking.

Figure 34

5. Bar of soaps and tubes of toothpaste were the most items been distributed to the IDPs.

In contrast, plastic garbage bags and water purification tablets were the least distributed

items.

29

Figure 35

6. The coverage percentage of IDPs needs for hygiene kits in the Idleb area sub-districts

were almost zero, while bennsh and mhambal have the most.

Figure 36

7. Sanitation concerns, such as open defection and sewage flowing onto the streets were

issued by 51% and 24% of the population respectively.

30

Figure 37

8. Camps in all communities, mostly have no bathrooms. Numerically, the un-

availableness can reach 97% peak.

Figure 38

Sector mini-Analysis

Accessing to safe drinkable water appears to be a major challenge for the IDPs because

they depend mostly on water truck, which in turn depends on the circumstances of the

area and the fuel availability and price. Despite the fact that the majority of the sub-

district have improved water sources, they are not getting enough water because of

constant interruptions. Among IDPs, lack of access to improved sanitation facilities has a

fear of health-related consequences.

• Education assessment Key-findings:

▪ Over 90% of the children of the displaced HHs did not receive any education

services.

▪ The average coverage of the education services is 39%.

1. Over 90% of the children of the displaced HHs did not receive any education

services, while only 10% of the children receive such services.

31

Figure 38

2. Madiq castle, Hweijeh, Armanaz, Aljib sub-districts have the least coverage

percentage (30%) for the education needs of IDPs out of the total. Out of all, the

average coverage is 39%.

32

Figure 39

3. There are no major barriers to access the education services in the communities

according to 49% of the people, in addition to a great lack of education availability

according to 19%.

33

Figure 40

Sector mini-Analysis

Despite the considerable variation, mostly amid the IDPs, across all assessed sub-

districts, yet the data shows clearly, the utmost need for the education services. IDPs are

struggling with a variety of issues which create barriers to their enrolment on any type

of education system, each formal and informal. The drop seen of attendance

relied somehow on the unreliability or the ill-advised evaluation of the educational value

among IDPs.

• Protection estimation Key-findings:

▪ Missing or separated children were the main problems with safety or child

welfare according to 52%.

1. 78% of the population did not see any problems with safety or childcare, while

17% saw several protection problematics.

34

Figure 41

2. Missing or separated children were the main problem with safety or child welfare

according to 52%. In addition to the violence against boys and girls.

Figure 42

Sector mini-Analysis

IDPS considered as vulnerable gatherings or at-risk groups, yet the protection concerns

influenced all alike groups such as the host communities and particularly the children. In

35

estimated area, there are numerous complications associated to protection, such as

missing children throughout the evacuations or the violence facing boys and girls, in

addition to the improper estimation of the incorrectness of child recruitment into armed

forces.

• Health Issues modes Key-findings:

▪ Respiratory Infectious Diseases were the most common health issues.

▪ The hospital was the most common type of health facility where the IDPs are

treated.

▪ Charges at the facilities are mostly “FREE” by 95%, in addition to the free-

medicine by tiny decrease down to 82%.

1. Respiratory Infectious Diseases were the most common health issues according to their

flow in the community. In contrast, Acute Jaundice Syndrome was the less common

health issue.

Figure 43

2. According to the population estimation, less than 15% signified that there were death

cases registered recently among the IDPs of informal settlements.

36

3. The hospital was the most common type of health facility where the IDPs are treated,

which followed by the clinic.

Figure 44

4. Charges at the facilities are mostly “FREE” by 95%, in addition to the medicine by small

decreased down to 82%, as shown below.

Figure 45

37

Figure 46

5. The mobile clinics mostly visiting the communities “ONE” time every week, yet two big

communities have been visited almost daily.

Figure 47

38

6. Vaccination teams occasionally visit the informal settlements. Considering that 58% was

the rate of visiting.

Figure 48

7. The table below shows the average cost of medicine and the average distance of the

facilities from the IDPs.

Parameter Average

How far is the facility from IDPs residence? 5.7 KM

How much money does transportation cost from

IDPs residence to the closest free health facility?

(SYPs)

1,135

How much money does transportation cost from

IDPs residence to the closest paid health facility?

(SYPs)

2,311

How much money does the medical check cost in

private clinics? (SYPs)

1,436

What is the average spending on medicine by a

HH per month?

5,400

What is the average IDP income per month?

(SYPs)

18,875

Table 3

39

8. War-related injuries complications are the most death cause among assessed

communities, in addition to the heart diseases which forms 39% of all death causes.

Figure 49

Sector mini-Analysis

The evaluated communities, particularly the IDPs, face multi-dimensional healthcare

challenges as a result of series of the long-term structural and crisis-oriented problems.

There are several circumstances and conditions that depended on the vulnerability of

tens of thousands to diverse disease groups, frequently the respiratory infectious

diseases and child diarrhea. The predisposing factors incorporate the prevailing

instability, conflicts, and food-insecurity and periodic power interferences. On the other

hand, war-related injuries complications and heart diseases are the largest death causes

for both the IDPs and the host communities.

• Nutrition conditions Key-findings:

▪ Identified problems for 68% in feeding babies of 0 to 5 months.

▪ No distribution of milk products for 96% of the IDPs.

40

1. Identified multi-problems facing 68% in feeding babies of 0 to 5 months

Figure 50

2. No support for non-breastfed babies of 0 – 5 months ranked as the first main problem.

In contrast, poor hygiene for feeding non- breastfed ranked as the least problem.

Figure 51

41

3. Different -which will be detailed later- problems identified in feeding young children of

6 to 23 months for 65%.

Figure 52

4. Unsuitableness of the food for young children of 6 – 23 months ranked as a main

problem, in addition to insufficient food (by quantity).

42

Figure 53

5. The distribution of the milk products has been very needy. The chart below proof that

there is no distribution for 96% of the people.

43

Figure 54

6. In case of distributed milk products, the channels were mostly by a local medical facility

or a mobile medical team.

Figure 55

Sector mini-Analysis

This mini-survey concentrated mostly on the child nutrition statuses, in particular for two

age groups: 0 – 5 months and 6 – 23 months. Through ranking the nutrition difficulties

facing these groups, it is wrap-up by two main determinants. The first determinant is the

availability of the food especially the milk products, which is in extent summarized by its

unsuitableness and the second determinant is its quantity insufficiency.

▪ Overall Conclusion Continued armed conflicts and instability, coupled with inadequate response to needs,

the assessed communities need standpoint is far from promising. In addition to poverty,

which was already increasing prior to the conflict crisis. The area faces multi-dimensional

difficulties, large IDPs growth correlated with disabilities great rate, long-lasting effects

of the food, fuel have all increased the number of people affected by food insecurity and

health-related issues, which in turn characterized the area with a tremendous scale of

mortality.

44

▪ Challenges o It takes a lot of effort to assemble reliable and detailed data, especially which

population-related.

o Multi-partners work commonly lack robust coordinating and well-made

assessment designing and planning.

▪ Recommendations o PHC is the most needed services for better provision of the health services and

decrease the work load on the hospitals.

o Integrating the nutrition activities within all PHCs, especially the IYCF.

o Expanding the routine vaccination especially for the IDPs and the crowded

settings.

o Immunization coverage survey maybe useful.

o Re-distribution of the PHCs to insure better access to the essential health

services.

o PSS as an essential PHC component is highly needed especially for children.

o More medical supplies are needed, most important are the protocols and

guidelines.

o Supply chain management.

o Medical waste management is a critical issue, as there are many people are living

in open settings or informal settlements.

o NCD management is needed in both PHCs and hospitals.

o Maintain the continuing supporting secondary healthcare aids such as trauma

services.

o Establishing and developing serviceable referral pathways.

o Broadening in numbers and functionalities of the rehabilitation and

physiotherapy centers.

o Shaping a Community Health Workers (CHW) unit as a central component of the

response dynamics particularly in the overcrowded camps and communities.

o An integrated approach that incorporates a mixture of interventions,

management and surety nets needs to be generated in the course of improving

the food and nutrition security of many poor and at-risk IDPs and host

communities.

o Education missions, accurate information-spreading and advocacy campaigns

and activities are demanded at all levels to address the gaps in knowledge,

attitudes and opinions.

o Once an HH is displaced, it becomes unsafe and helpless. Therefore, emergency

food aid and livelihoods help for anew displaced people are an utmost necessary.

45

o Market-based provision to enhance access to food. In addition to the support of

bakeries.

o Prioritize the inclusion of education in the humanitarian response to the newly

IDPs. In addition to correcting-the-thoughts activities initiating regarding

education among them.

o Expanding in quantity and enhancing the quality of the shelters, in addition to

completing the unfinished buildings.

o Provision of additional lavatories in large overcrowded camps. In addition to

repair of bathing facilities.