Policy Memo: Effects of Syrian Refugees on the Jordanian Health Sector


Jordan’s role as an open economy makes it vulnerable to the political, economic, and social upheaval within the region. The revolutionary wave that swept the Arab world, beginning in late 2010, has significantly impacted Jordan. The country has suffered widespread economic hardships as a result of the political turmoil in the region. Apart from economic shocks, the Kingdom “has a tradition of hospitality towards asylum-seekers and refugees.”[6] Since 2006, Jordan has been home to a large number of Iraqi refugees. Currently, the number of Iraqi refugees in Jordan remains stable at around 29,000.[7] Since March 2011, Syrians have also fled their country due to events seeking refuge in Jordan.[8] In the last two years, Jordan has witnessed a significant increase in the number of refugees, leading to strains on many vital sectors of the country as Jordan overstretches itself to accommodate its neighbors. The UN Refugee Agency (UNHCR) estimates that the total number of Syrians in Jordan will exceed 1 million before the end of 2013, which will constitute almost 17% of Jordan’s total population.[9]

I.     Introduction

Jordan maintains an open-door policy for the Syrian refugees fleeing unrest in their country. According to a news release issued by the International Red Cross, the refugees cross the borders with nothing and depend on the host country for water, food and shelter as soon as they arrive.[1] The Kingdom must provide health care to its own citizens, as well as over 550,000 Syrian refugees in addition to other living necessities.[2] The large number of refugees has placed a large economic burden on the country. Jordan cannot continue to support this large and still increasing number of refugees without international financial support.

    II.     Country Overview

The Hashemite Kingdom of Jordan occupies in a strategic location in the Middle East. The small country shares its borders with the following countries (listed in alphabetical order): Egypt, Iraq, Israel, Lebanon, Saudi Arabia and Syria. According to The World Bank, Jordan is an upper middle-income country with a population of 6.4 million.[3] Around 80% of the population is urban. The country “ranks as the world’s fourth poorest country in terms of water resources.”[4] Jordan has developed strong relationships with its neighbors due to its role as an open economy in the region. Jordanian policymakers strive to create the demographic of a well-educated, young population to build a dynamic, knowledge based economy.”[5]

  III.     Summary

Jordan’s role as an open economy makes it vulnerable to the political, economic, and social upheaval within the region. The revolutionary wave that swept the Arab world, beginning in late 2010, has significantly impacted Jordan. The country has suffered widespread economic hardships as a result of the political turmoil in the region. Apart from economic shocks, the Kingdom “has a tradition of hospitality towards asylum-seekers and refugees.”[6] Since 2006, Jordan has been home to a large number of Iraqi refugees. Currently, the number of Iraqi refugees in Jordan remains stable at around 29,000.[7] Since March 2011, Syrians have also fled their country due to events seeking refuge in Jordan.[8] In the last two years, Jordan has witnessed a significant increase in the number of refugees, leading to strains on many vital sectors of the country as Jordan overstretches itself to accommodate its neighbors. The UN Refugee Agency (UNHCR) estimates that the total number of Syrians in Jordan will exceed 1 million before the end of 2013, which will constitute almost 17% of Jordan’s total population.[9]

  IV.     Background of the Problem

In 2011, there were around 1,000 Syrian refugees in Jordan as of September 2013 there were over 550,000 Syrian refugees in the country.[10] Hospitals in Jordan are facing a catastrophe as they must accommodate an influx of around 70,000 Syrian refugees a month.[11] Health services are readily available to the Syrian refugees who live in the Zaatari refugee camp. The camp is located in the northern region of the country, less than 20 km from the Syrian border, near Mafraq.[12] However, only around 25% of the Syrian refugees in Jordan live within the camp. The other 75% live in urban areas, placing a significant burden on the country’s health system.[13] Most of the Syrian refugees have settled in the north, the poorest region of Jordan.

    V.     Main Actors 

i.         National

  • Foreign Ministry under Nasser Judeh
  • Health Ministry under Ali Hiasat
  • Interior Ministry under Hussein Majali
  • Ministry of Health and Ministry of the Environment under H. E. Dr. Mujalli Mhailan
  • Ministry of Planning under Ibrahim Saif
  • General Budget Department under Mohammah Hazaimeh
  • The Civil Service Bureau
  • Jordan National Red Crescent Society

ii.         International

  • The World Bank
  • The United Nations Refugee Agency
  • The United Nations High Commissioner for Refugees (UNHCR)
  • Medecins Sans Frontiers
  • Caritas Internationalis
  • World Health Organization (WHO)
  • The Red Cross
  • The Red Crescent
  • The International Rescue Committee (IRC)

  VI.     Main Issues 

i.         Camp Refugees vs. Urban Refugees

Within the Zataari camp, the medical staff is witnessing an increase in diarrhea and respiratory infections, reflecting “the precarious living conditions of the refugees in this overcrowded camp”[14] Claudia Truppa, a doctor for Medecins sans Frontiers, said. Furthermore, an increase in dehydration cases occurred over the summer of 2013 as a result of the lack of water availability within the region. Healthcare facilities continue to be insufficient for the camp’s large population.

Outside of the camp, the number of Syrian refugees in Jordan’s public hospitals has experienced an increase of almost 250% from January 2013 to March 2013, while the number of Syrians requiring surgical procedures outside the camp increased by almost 600%.[15] Syrians with chronic diseases require long-term, more expensive treatment, placing additional burdens on Jordan’s health sector. Jordan’s Ministry of Health estimates that there will be around 676 Syrian cancer patients in Jordan, representing a 14% increase in Jordan’s total cancer disease population.[16]

ii.         Outbreak of Diseases

A majority of diseases, which had been completely eliminated or were of low prevalence in Jordan, have been discovered among the Syrian refugee population. As of June 2013 77 cases of measles were discovered in Jordan, with the majority recorded among Syrian refugees. Before the measles cases surfaces, Jordan had been measles-free for almost 20 years.[17] According to the Jordan Times, the Health Minister, Hiasat, reported 95 cases of tuberculosis and 8 cases of HIV/AIDS discovered among the Syrians.[18] Rotavirus, one of the most common causes of severe diarrhea among children, is currently responsible for around 46% of hospital admissions of Syrian children.

iii.         Vaccination Campaign and Other Key Services

In October 2013, a nationwide vaccination campaign, supported by UNICEF, was launched covering all those under the age of 20 in Jordan, regardless of nationality to reduce the outbreak of diseases among the population.[19] The targeted group was vaccinated against DTP, hepatitis, measles and polio. UNICEF, through the Jordanian Ministry of Health, distributed over 1 million measles vaccinations, 600,000 polio vaccinations, and 500,000 vitamin A drops.[20] The vitamin A drops were given to reduce morbidity in acute respiratory infections and diarrhea among children. The WHO monitored the mass immunization campaign and provided logistical and technical support to the Jordanian Health Ministry.

The IRC is also running several counseling centers as well as several centers designed to assist women and girls who have been sexually attacked in Syria’s conflict, offering confidential counseling and clinical referrals for these victims.[21]

iv.         Economic Strain & Funding

As Jordan continues to accommodate the large influx of Syrian refugees, economic support from the international community is a necessity. In 2012 alone, The Government of Jordan incurred over 226 million US dollars in providing services and basic needs to Syrian refugees.[22] Jordan’s health sector is subsidized governmentally. Over the past few years, international organizations such as the WHO, UNHCR and World Bank have also subsidized the health sector due to the economic strain of providing health care for Syrian refugees. The pressure is beyond the health sector’s capabilities to continue to provide services for refugees, Jordan’s Health Minister stated in February 2013.[23] Conditions have not improved in subsequent months, despite a 150 million US dollar loan from the World Bank[24] and 5 million US dollars from the WHO[25] in 2013. The monetary support funded the vaccination campaign as well as public and private Jordanian hospitals. The total amount of funds by donors spent in the protection and support of Syrians in Jordan is 850 million US dollars, according to the UNHCR in late November 2013.[26] The influx of Syrian refugees increases daily, at almost 70,000 a month, without continued international financial support Jordan will not be able to keep accepting new refugees.

v.         Increase in Medical Staff

In order to avoid staff shortages, Health Minister, Hiasat, told the Jordan Times in October 2013, that the ministry was in the process of appointing 600 physicians and nurses.[27] The ministry appointed the Civil Service Bureau to appoint more nurses, while doctors who had applied to the bureau were to be directly appointed to hospitals with staff shortages. Economic support is not only needed to provide medical supplies, but also needed to fund newly appointed physician and nurse salaries.

vi.         Public Opinion

The increase in Syrian refugees raises tensions among the Jordanian population as resources in Jordan continue to be stretched. An article written in April 2013 from British newspaper, The Guardian, discusses how Syrian were once welcomed into Jordan “as guests and brothers,” but are now seen as “a curse” according to a Syrian refugee living in Jordan.[28] The anti-Syrian sentiment has increased largely due to the massive influx of refugees in urban areas, where Jordanians must now compete for jobs against Syrian refugees, who employers can appease with low-salaries. Reports of young school children getting into fights in Marfaq, a region with a large Syrian refugee population, reveal how tensions between Jordanians and Syrians have trickled down into schoolyards. If large numbers of Syrian refugees continue to enter Jordan, Jordanians will continue to feel threatened; threats of violence against Syrians have been echoed throughout the Jordanian public.

vii.         Security

As economic strains increase and Jordan continues to suffer the impact of a continuous increase in Syrian refugees, the security of Jordan is being threatened. Not only has public opinion taken on violent sentiments, but the stability of Jordan is also being directly impacted by the large influx of refugees. The UN High Commissioner for Refugees, Guterres, and Jordanian officials have discussed having border management put into place that incorporates Jordan’s security needs.[29] Although Jordan has continued to maintain an open-door policy towards Syrian refugees, it cannot continue to do so without international financial support. Furthermore, Gutteres called on European and Gulf Arab states to host Syrian refugees. If the world society does not step up to host refugees, border management discussions must be conducted in a way that protects Jordan’s needs and stability.

  1. Recommendations

In comparison to the international community, Jordan’s resources are meager. In order for Jordan to continue its humanitarian efforts to the Syrian refugees, the world’s community must play a larger role. Countries within the region can no longer bear the burden of hosting Syrian refugees alone. At Geneva II in October 2013, Kristalina Georgieva, the European Union’s commissioner for humanitarian affairs and crisis response, stated: “We in Europe must not only keep our hearts and wallets open, but also our borders.”[30] Jordan has been placed in a difficult position and now must make a decision regarding whether or not to continue to accommodate Syrian refugees, and if so, how?

  1. Jordan has continued to maintain an open-door policy towards Syrian refugees fleeing their own country, but as tensions have increased and resources have thinned in urban areas, this policy is being criticized. Jordan can only continue to house refugees in camps.
  1. To control the outbreak of diseases from spreading among the general population more vaccination campaigns must be launched.
  1. The global community, not only through international organizations, but also countries, must contribute larger financial investments in order for Jordan to maintain the continued influx of refugees.
  1. In order to support new medical staff that must be increased, Jordan must receive international monetary support.
  1. To quell public anti-Syrian sentiments, Jordan must prevent Syrian refugees from settling in urban areas and disrupting the Jordanian job market.
  1. Jordan must control borders and decrease the new influx of Syrian refugees so that they may go to other countries, decreasing the burden of Syrian refugees on Jordan.
  1. More efforts should be made by the international community to end conflict in Syria and allow for the resettlement of Syrian citizens in Syria under a stable government.

 

[1] Jordan: Cash Assistance For Syrian Refugees Beset By Mounting Needs.

International Committee of the Red Cross, November 23 2013.

[2] Lama Jamal Al-Absah, “Hosting Syrian Refugees Costs Jordan $1 Billion,” Al-Dustur (Amman, Jordan), September 9, 2013.

[3] “Jordan Overview,” The World Bank.

[4] “Jordan Overview,” The World Bank.

[5] “Jordan Overview,” The World Bank.

[6] “2013 UNHCR Country Operations,” UNHCR.

[7] “2013 UNHCR Country Operations,” UNHCR.

[8] Riham Fakhuri, “1,000 Syrian Refugees in Jordan Receive Assistance,” Al-Ra’y (Jordan), September 27, 2011.

[9] “Jordan Says Health Services Overstretched To Capacity, Seeks Urgent Support.”

World Health Organization. June 16, 2013.

[10] Al-Absah, “Hosting Syrian Refugees Costs.”

[11] Nadia Gilani, “Syrian Refugee Crisis Leaves Jordan On Verge Of A ‘Catastrophe,'” Metro (London), October 28, 2013, http://metro.co.uk.

[12]”Syrian Refugees in Jordan: The Limits of Assistance,” Medecins Sans Frontieres, May 30, 2013.

[13] “Jordan Says Health Services,” World Health Organization.

[14] “Syrian Refugees in Jordan,” Medecins Sans Frontieres.

[15] “Jordan Says Health Services,” World Health Organization.

[16] “Jordan Says Health Services,” World Health Organization.

[17] Khetam Malkawi, “Jordan Health Sector ‘Ready’ for Syrian Crisis Emergency,” Jordan Times (Amman, Jordan), September 2, 2013.

 

[18] Khetam Malkawi, “Syrian Refugees Placing Huge Burden on Healthcare Sector,” Jordan Times (Amman, Jordan), October 1, 2013.

[19] Malkawi, “Jordan Health Sector ‘Ready.'”

[20] Mass Measles and Polio Immunization Campaign Starts in Jordan (Amman: UNICEF, April 17, 2013).

[21] Megan Rowling, “Syrian Refugees Struggle to Access Healthcare in Jordan,” Thomas Reuters Foundation, January 17, 2013.

[22] “Response Plan for the Government of Jordan.” Working plan, January 2013.

[23] “Syrian Refugees Burden Jordan’s Health Sector,” Xinhua General News Service (China), February 13, 2013.

[24] “Jordan, World Bank sign 150m-doallar Loan Deal,” Petra (Amman, Jordan), July 28, 2013.

 

[25] “$5 million from WHO to Health Ministry,” Petra (Amman, Jordan), August 3, 2013.

[26] Khetam Malkawi, “Syrian Refugee Hosts ‘Should Not be Taken for Granted,'” Jordan Times (Amman, Jordan), November 29, 2013.

[27] Malkawi, “Syrian Refugees Placing Huge.”

[28] Taylor Luck, “Influx of Syrian Refugees Raises Tensions in Jordan as Resources are Stretched,” The Guardian, April 23, 2013.

[29] Khitam Malakawi, “Jordanian King, UNHCR Chief Discuss Syrian Refugees 28 November,” Jordan Times (Amman, Jordan), November 29, 2013.

[30] Nick Cumming-Bruce, “Countries Agree to Special Quotas for Syrian Refugees,” The New York Times, October 1, 2013.

 

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