Jordan Report

Refugee crisis deteriorates

The Syrian refugee crisis in Jordan is deteriorating. More aid is desperately needed to help the refugees meet basic needs of shelter, food and healthcare. Middle East Health reports.

The Government of Jordan, NGOs and the United Nations continue to call on the International Community for financial assistance as the refugee crisis in Jordan deteriorates.

In particular, Jordan’s healthcare system has come under enormous strain as the country struggles to provide healthcare to the massive Syrian refugee population who have fled the war in neighbouring Syria and taken shelter within the Kingdom. According to the UNHCR, as of 28 August, the organisation had registered 629,000 Syrian refugees in Jordan. In May the ICRC estimated there were 680,000 Syrian refugees in the Kingdom with 85% of them living in host communities.

Now in its fifth year, the refugee crisis has affected not only the Syrian refugees but also their host communities in Jordan. The influx of refugees has overstretched Jordan’s infrastructure and public services, increasing the demand on housing, food, energy, water and sanitation.

Abdul Latif Wreikat, Minister of Health, told the Jordan Times in July that the cost of providing health services for the Syrians currently in Jordan will reach JD30 million (about US$42 million) this year: a figure that is likely to expand as more displaced people cross into the Kingdom over the northern border.

In November 2014 the Jordanian government announced that all Syrian refugees, whether registered or not, would have to pay for health care at Ministry of Health facilities. “We provide all needed health services and medication to Syrians who are currently in Jordan, which puts more pressure on the country’s health system,” Wreikat said. He said the ministry has vaccinated 25,000 Syrian children at a cost of JD800,000.

He added that many of the Syrians who came to Jordan require care for chronic diseases such as cancer, diabetes, cardiovascular disorders and high blood pressure. Along with the Jordanian Government there are many NGOs operating in the country in an effort to relieve the plight of the refugees. They include, among many others, Médecins Sans Frontières (MSF), CARE International, the International Committee of the Red Cross (ICRC) and The International Medical Corps.

As well as living among host communities, many refugees are housed in refugee settlements. The Zaatari refugee settlement alone houses some 80,000 registered refugees, according to the UNHCR. And the Azraq refugee settlement is now home to more than 22,000 Syrians.

Life for more than half a million refugees living outside of camps in Jordan has become increasingly tough. The latest survey found 86% of these people live below the Jordanian poverty line of 68 JOD (about US$95) per capita per month. Faced with such pressures, increasing numbers are moving to camps from urban areas. With Zaatari at capacity, the number of urban refugees seeking shelter in Jordan’s second camp, Azraq, increased fourfold in the first six months of this year with 3,658 people returning there from urban areas, compared to just 738 in the second half of 2014. This trend is driven by increasing vulnerability of urban refugees in Jordan whose savings are depleted after years in exile, and who are unable to find secure legal livelihoods. Those living in Amman, in particular, are trying to survive in one of the most expensive cities in the Middle East. Most have already seen the value of their monthly WFP food vouchers being cut in recent months and now face the prospect of losing them entirely.

ICRC support

In an effort to address the humanitarian needs of Syrian refugees in Jordan, the International Committee of the Red Cross has continued providing the newly arriving Syrians, who stay initially at four ICRC-supported transit facilities in the north-eastern border area, with often daily essential assistance, including three cooked meals per day, drinking water, blankets, mattresses, hygiene items and basic medical supplies.

In cooperation with the Jordan Red Crescent Society (JRCS), the ICRC continues to provide monthly cash assistance to Syrian refugees living in host communities, since the refugees gradually use up their savings and other resources.

In Zaatari and Azraq refugee camps, the ICRC provides free international phone calls for thousands of Syrians, so they can restore contact with their families inside Syria and elsewhere. In the first half of his year, the ICRC says:

• The Jordanian Royal Medical Services have provided health care to Syrian refugees at four ICRC-supported health posts in Hadalat, Rukban, Bustana and Tal Shehab.

• Through the ICRC-run medical facility at Raba’a Al Sarhan Registration Centre in Mafraq, some 6,450 Syrian refugees received medical screening, some 1,520 of the refugees benefited from clinical services, and around 540 of the Syrians were transferred by ambulance to other health facilities.

• Basic first aid training sessions were held for Syrian refugees in three locations: 37 sessions for 1,145 individuals in Zaatari camp, four sessions for 120 people in Azraq camp and one session for 45 participants n Cyber City camp.

• A course on pre-hospital care and another on first aid and stabilization were held for 52 Syrian health-care providers involved in the management of casualties from the Syrian conflict.

In April CARE International voiced its concern about the deteriorating health situation of Syrian refugees in Jordan and called on the international community to share the burden with the Government of Jordan. According to an assessment by CARE, Syrian refugees, living outside of camps in Jordan, are increasingly unable to pay for medical treatment and access health services.

Since November 2014, Syrian refugees have had to pay fees to use Jordan’s public health facilities and have no free health access anymore, as the costs of this service became increasingly unbearable for the Jordanian government.

Some of the findings of CARE’s assessment:

• Three out of ten families reported that they could not access health services when needed during the last six months. For most, the reason was that services are too expensive and they could not cover the costs. “Many refugees are telling us that they are rather consulting pharmacies to receive the medication that they think they need to treat their condition, as they cannot afford to go to the doctor. However, often their condition deteriorates afterwards,” says Salam Kanaan, CARE country director in Jordan.

• Half of pregnant women do not have money to pay for ante-natal care, and 60% of mothers with newborns could not afford post-natal care, heightening the risk of health problems for them and their babies. At the same time, the health conditions of Syrian refugees are deteriorating as they face increasingly unhealthy living conditions, for example damp rooms and lack of finances to secure heating in the winter.

• CARE has also found that refugees are expressing a high need for psychosocial and psychological support. “The memories of war, the loss of family members and the constant struggle to survive causes high levels of anxiety. Parents are telling us that their children have forgotten how to speak or are bed-wetting,” says Kanaan.

In June CARE International issued a report, “Five Years into Exile”, which notes that Syrian refugees in Jordan continue to face immense and increasing challenges leading to grave concerns about their vulnerability and protection. The report points to reduced levels of assistance and access to services, lack of sustainable livelihoods, and complicated registration procedures as factors contributing to deepening hardship for the refugees.

“We are seeing growing evidence that after five years of conflict, an increasing number of Syrian refugees have exhausted their means of subsistence. At least two in three families live in poverty. We fear that without scaling up international assistance, the spiral of deepening poverty will accelerate with lasting impact on both refugees and local communities,” says Kanaan.

Strikingly, half of the 1,300 Syrian families interviewed said their overall situation had deteriorated over the last year. Inability to pay rent remains their top concern, with 8 out of 10 families worried about housing; 6 out of 10 lack money to buy enough food, an increased share since last year, as a result of the World Food Programme’s reducing food support.

“While the numbers of Syrian refugees coming into Jordan has decreased this year, there is no end to their displacement in sight,” Kanaan says. “The protracted nature of this crisis demands that we seek longer term solutions. We must address the need for sustainable livelihoods. We seek solutions that will benefit both refugee and host communities. This requires a stronger international commitment to funding. But we must also see the mutual benefits and opportunities available in opening up some work sectors, or creating less complicated procedures for registration of refugees.”

Do not forget this crisis – WFP

Ertharin Cousin, Executive Director of the United Nations World Food Programme (WFP), concluded a visit to Jordan and Lebanon on 13 August by calling upon the international community to continue supporting Syrian refugees displaced in neighbouring countries and appealing to the world not to forget this crisis.

Major funding shortfalls forced the agency to cut food assistance by up to 50%. During her four-day visit, Cousin met with Syrian refugees and government officials, bringing attention to the plight of millions facing extreme hardship as a result of these cuts.

“I met young Syrians who because of the conflict may never realize their incredible potential. This conflict robs them of their education, their childhoods and their dreams,” said Cousin.

“The conflict is pushing families below the poverty line, into desperation. “For affected populations in Syria and refugees around the region, WFP food assistance provides stability,” she said. “To provide this assistance, we rely on the generosity of the international community. We simply cannot let them down.”

Since the beginning of the year, WFP has faced critical funding shortages that forced it to reduce the level of the assistance it provides to some 1.5 million Syrian refugees in Jordan, Lebanon, Turkey, Iraq and Egypt.

Families are taking extreme measures to cope with their difficult circumstances, including removing their children from school so that they can work, incurring large debts and cutting back on the nutritional value and quantity of the food they eat.

Cousin acknowledged the heavy burden host countries carry. She visited shops where refugees benefit from WFP’s electronic voucher programme (e-cards). Through its e-cards, WFP supports over half a million Syrian refugees in Jordan and 770,000 in Lebanon.

The programme has generated income for host communities by injecting over US$1.1 billion into the local economies of the five neighbouring countries. The programme has also created thousands of local jobs in the food retail sector.

Zaatari camp – three years on

Ariane Rummery, UNHCR spokesperson, speaking at press briefing in Geneva on 28 July 2015, said: “The Zaatari camp in Jordan was established on 29 July 2012 amid huge inflows at that time of refugees from Syria. The camp was set up in nine days, and has grown in large stages since. Initially there were problems with electricity for lighting and for refugees to charge their mobile phones – the sole means by which they could keep in touch with families back in Syria and elsewhere.

“Today Zaatari is a sprawling, bustling home to around 80,000 Syrians. Prefabricated shelters including family compounds have largely replaced the lines of tents that were initially there.

More than half the population are children, presenting challenges not just on how to provide schooling and restore abruptly halted educations in Syria, but also in investing for the future. 1 in every 3 children is not attending school. There are also some 9,500 young people in the camp aged between 19-24 who need skills training and, like their older counterparts, need livelihood opportunities too. Some 5.2% of these were at university in Syria but had to drop out due to the conflict, while just 1.6% successfully graduated. More opportunities must be found for this generation and the millions of other refugees around the region in similar predicaments: They are the future of Syria,” Rummery said.

Dramatic increase in Syrian patients wounded by barrel bombs – MSF

At a surgical project in northern Jordan, Médecins Sans Frontières (MSF) reports seeing a huge spike in the number of cases of Syrians wounded by barrel bombs.

Over three days in the last week of June, the MSF Ramtha Emergency Surgical Programme received 34 Syrian wounded, some of whom were stabilized by MSF medical teams and referred to other hospitals. The rest continue to receive surgical and rehabilitative treatment in the facility, where MSF works in close collaboration with the Jordanian Ministry of Health to provide medical care to Syrian patients, less than five kilometres from the Syrian border.

“More than 70% of wounded we receive suffer from blast injuries, and their multiple wounds tell their stories,” said Renate Sinke, Project Coordinator of MSF Ramtha Emergency Surgical Programme.

MSF and many other organisations have been calling repeatedly for an end to the bombing of populated areas inside Syria. These calls have had no impact. Patients of all ages continue to arrive at the MSF facility in large numbers with injuries that they said were caused by barrel bombs dropped by helicopters on residential areas and health structures in south Syria.

There have been reports of health facilities coming under attack in Dara’a governorate in July, which has led an to increasing number of Syrian patients taking the risk of a long, hazardous trip to cross the Jordanian border to seek medical care that has become extremely difficult to receive in their home country.

Dr Muhammad Shoaib, Medical Coordinator of MSF in Jordan, said: “A significant proportion of patients we receive have suffered head injuries and other multiple injuries that cannot be treated inside southern Syria as CTscans and other treatment options are limited.”

Many hospitals inside Syria suffer from limited capacity to deal with complex injuries. They lack the manpower and medical expertise, or lack the necessary equipment due to damage or destruction from bomb attacks.

MSF upgrades hospital in Irbid

MSF have upgraded their healthcare facility in Irbid, northern Jordan, according to a statement issued by the organisation in May. At the facility MSF can now provide complicated deliveries including C-sections and improved neonatal care. The upgrade also included a development in the mental health support program which is reaching out to Syrian mothers and children in refugee communities in the north of Jordan.

Marc Schakal, MSF’s Head of Mission in Jordan said: “More than half of the children followed by the MSF mental health team in Irbid have witnessed one or more distress factors – the killing of a loved one, the destruction of a home, physical or psychological abuse. The mothers of these children are also being supported by MSF as they struggle to look after their children, in most cases alone due to the death or absence of the father. We are offering them a range of services – individual therapy, group therapy, dyadic therapy, group support and parental guidance.

“Access to mother and child care, as well as mental health care, is very difficult for Syrian refugees here in Jordan, and we are trying to fill some of this gap which, but more needs to be done,” Schakal added.

Since the project started in October 2013, it has provided over 20,991 obstetrics/gynaecology consultations, 18,082 paediatric consultations, 3,089 deliveries and 389 neonatology admissions.

The project has become even more important due to the increased pressure on Jordan’s health system and following the Jordanian authorities’ announcement in November 2014 that all Syrian refugees, whether registered or not, would have to pay for health care at Ministry of Health facilities.

 Date of upload: 12th Sep 2015


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