<p>The total number of cases reported was 2499 between 2017 and 2021. There was an obvious rise in cases by 30% in 2019 and 2020. All cases had the same seasonal distribution, being highest in cold months. The most affected age group was 5-&lt;15 years and cases were higher among females 57%. The majority of cases were unvaccinated (56%) and 86% of vaccinated cases take three doses. Overall, IR was 36.2/ 100000 population and it was significantly higher in conflict governorates (42 vs 22, p&lt; 0.001). The overall case fatality rate (CFR) was 7.4%. It was significantly higher in 2020 (23.3% vs 7.7%, p&lt; 0.001), among &lt;5 years (12.3% vs 6.6%, P&lt; 0.001) and patients with zero dose vaccination (11.9% vs 6.7%, p= 0.001) compared to the relevant groups.</p>