As Jordan grapples with the influx of Syrian refugees, the provision of health care in refugee camps has become a crucial issue, involving various political actors. This case study explores the depth of the crisis and the intricate roles these actors play in managing health care services.
Background of the Crisis
Origins and Scale
- Syrian Civil War: Starting in 2011, conflict in Syria led to a massive displacement of people.
- Refugee Influx: Jordan, a neighbouring country, became a primary refuge for fleeing Syrians.
- Numbers: Over 660,000 Syrian refugees are registered in Jordan; unofficial estimates are higher.
Refugee Camps in Jordan
- Main Camps: Za'atari, hosting around 80,000 refugees, and Azraq, with approximately 40,000.
- Living Conditions: Camps vary, but many refugees live in temporary shelters or tents with limited amenities.
Health Care Challenges
Immediate Health Concerns
- Trauma: Many refugees arrive with war-related injuries and psychological trauma.
- Chronic and Communicable Diseases: High prevalence of conditions like diabetes, hypertension, and respiratory infections.
Systemic Challenges
- Resource Stretching: Jordan's health system, already facing its own challenges, is stretched thin.
- Cultural and Language Barriers: These barriers complicate the delivery and effectiveness of health care.
Role of Political Actors
Jordanian Government
- Policy Development and Implementation: Played a pivotal role in setting up camps and initially providing free health care.
- Capacity and Resource Management: Struggled with the strain on national health care resources and infrastructure.
United Nations Agencies
- UNHCR: Primarily responsible for coordinating the international response, including health care.
- WHO: Focuses on disease surveillance, health system support, and emergency response coordination.
International and Local NGOs
- Medical NGOs: Organizations like Médecins Sans Frontières (MSF) provide direct health services, including mental health support.
- Local NGOs: Engage in community outreach, health education, and facilitating access to health care services.
Donor Countries and Agencies
- Financial Aid: Essential for maintaining health services, though often subject to political considerations and donor fatigue.
- Influence on Health Priorities: Donor preferences can shape the health care agenda, sometimes at odds with ground realities.
Health Care Provision in Camps
Primary Care and Specialised Services
- Facilities: Include hospitals, primary health care centres, and mobile clinics.
- Services Provided: Range from basic health care and vaccinations to specialised services like dialysis and cancer treatment.
Mental Health and Psychosocial Support
- Growing Need: Increasing recognition of the mental health toll of war, displacement, and camp life.
- Provision: Includes psychological counselling, support groups, and psychiatric services, though availability is often limited.
Reproductive Health
- Maternal and Child Health: Prenatal and postnatal care, safe delivery services, and child health services are critical.
- Family Planning: Access to contraception and family planning advice is part of the health provision.
Assessment of Political Actor Roles
Effectiveness and Coordination
- Inter-agency Collaboration: Essential but challenging; varying mandates and resources of actors can lead to fragmented service provision.
- Capacity Building: Training and support to local health care workers have been critical in enhancing service delivery.
Challenges
- Funding Gaps: Lead to service cuts, particularly affecting non-life-threatening but chronic conditions.
- Access Barriers: Including policy changes restricting refugees' access to free health care services outside camps.
Innovations and Adaptations
- Telemedicine: Used to overcome resource and specialist constraints.
- Community Health Workers: Refugees trained to provide basic health care and health education within their communities.
Sustainability and Future Strategies
Long-Term Health Needs
- Chronic Diseases: Increasing focus on managing non-communicable diseases prevalent among the ageing refugee population.
- Mental Health: Recognition of the need for long-term mental health services.
Integration with National Health Care
- Collaboration with Jordanian Health System: Proposals to integrate refugee health care more closely with the national system to improve sustainability and resilience.
- Health Care as a Human Right: Ongoing debates about the extent to which health care should be provided to refugees as part of Jordan's international obligations and humanitarian ethos.
The Syrian refugee crisis in Jordan presents a complex scenario where health care provision is not just a medical challenge but also a political and social one. The intricate interplay among the Jordanian government, international and local NGOs, UN agencies, and donor states and organisations reflects the multifaceted nature of managing health in humanitarian settings. The effectiveness of these endeavours depends on coordination, resource availability, and adaptability to the evolving needs of refugees, highlighting the importance of developing sustainable, long-term strategies for refugee and host community health.
FAQ
Local NGOs play a pivotal role in supporting health care among Syrian refugees in Jordan. They are often more agile and better able to understand and adapt to the local context compared to larger, international organisations. These NGOs facilitate access to health care services, provide community-based health education, and work to bridge cultural and linguistic gaps. They also play a critical role in supplementing basic health care needs, such as distributing hygiene kits, offering first aid, and providing informal psychological support. Their community-level engagement enables them to identify unmet health needs and work towards addressing them, often serving as a vital link between refugees and larger health care providers.
The Syrian refugee crisis in Jordan has had a substantial influence on global health policy, highlighting the need for more responsive, sustainable, and flexible health systems in crisis situations. This crisis demonstrated the importance of integrating mental health and psychosocial support into humanitarian healthcare responses, recognising the long-term nature of displacement. It underscored the necessity for international collaboration and funding in addressing health crises in refugee situations. Additionally, it pushed global health policy towards greater inclusion of refugees in national health plans and promoting the concept of health care as a universal right, regardless of citizenship or refugee status.
The Jordanian government has made several adaptations to its health care policies in response to the Syrian refugee crisis. Initially, it offered free health care to Syrian refugees, but as the financial burden grew, it imposed restrictions and fees for services to manage resources better. The government has worked with international donors and organisations to secure funding and build healthcare capacity. Efforts have been made to integrate refugee health needs into national health planning and services, aiming to ensure sustainability. Moreover, the government has explored public-private partnerships and innovative solutions like telemedicine to enhance health care provision amidst the challenges posed by the refugee influx.
The influx of refugees poses significant impacts on the host country's population and resources. In Jordan, the Syrian refugee crisis has put a strain on the health system, leading to longer wait times, resource reallocation, and increased competition for limited medical supplies and services. This situation can sometimes foster resentment or social tension among local communities who may feel their own access to healthcare is being compromised. Furthermore, the additional load on health infrastructure accelerates the wear and tear of facilities and depletes financial and human resources, challenging the government's capacity to maintain quality health care for both refugees and its citizens.
Cultural and language barriers significantly impact the efficiency and effectiveness of health care delivery in refugee camps. Most Syrian refugees speak Arabic, but dialectical and cultural differences can still lead to misunderstandings or miscommunications with healthcare providers, especially those from international organisations who might not be fluent in Arabic or familiar with Syrian cultural contexts. Such barriers can lead to distrust or reluctance among refugees to seek medical help, misdiagnosis, or inappropriate treatment plans. Addressing these barriers requires cultural sensitivity training for health workers, employing interpreters, and involving community leaders to facilitate better communication and understanding.
Practice Questions
International organisations play a crucial role in managing health care crises in refugee settings, exemplified by the Syrian refugee situation in Jordan. The UNHCR, for instance, coordinates international responses, ensuring that the refugees' basic health needs are met. Organisations such as WHO monitor and control disease spread, crucial in crowded camps. However, their effectiveness is often hampered by funding limitations and bureaucratic hurdles. Despite these challenges, their presence is indispensable for providing structured and professional health care services in crises, particularly where the host country's resources are overwhelmed, as was the case in Jordan.
The Jordanian government faced multifaceted challenges in providing health care to Syrian refugees. Initially, Jordan opened its borders and camps like Za'atari and Azraq, offering free health services. However, as the refugee population swelled, it strained the national health infrastructure, already grappling with limited resources. The government had to balance the needs of its citizens against those of refugees, leading to policy shifts like restricting free health services for refugees due to financial constraints. These challenges underscore the difficulties in sustaining a compassionate response in the face of prolonged humanitarian crises, emphasising the need for international support and sustainable solutions.
