Mike is a doctor from the UK, who’s recently arrived at the MSF project in Irbid, a city in the north of Jordan, close to the border with Syria…
Quite a lot of my first few days has been spent having briefings. Clearly the ones on security or HR in MSF are not that appropriate or interesting in a blog, but possibly it’s helpful to look at why there is an MSF project here in Irbid? I’ll explain it as I understand it, based on my personal reading before arrival and information from various sources in and out of the organisation since arrival here.
Inside the MSF / Doctors Without Borders project in Irbid. Photo: N'gadi Ikram
Jordan has a long history of being a place of refuge, and there are many Palestinians here who are or were refugees. Indeed a high proportion of the Jordanian population are Palestinian … though as the definition of “Palestinian” is complex (as historically the concept of “Palestinian” predates that of “Jordanian”) I’m going to avoid numbers or proportions.
My current understanding is that since the flaring of the conflicts in Syria there are now about five million internally displaced Syrians (people who have had to flee their homes, but are still in Syria) and another five million who have become refugees (living outside the country).
Jordan has a long history of being a place of refuge
About two million Syrian refugees have gone to Turkey, 1.4 million to Lebanon and between 0.65 and 1.2 million to Jordan (depending on whether you look at numbers of registered refugees only, or include non-registered refugees also). These figures will vary depending on where you look or who you listen to.
One understanding might be that initially Jordan may not have had especially stringent border controls and it may have been easier for refugees to come either into camps (with initially lighter restrictions on movement in and out of the camps) or to move into rented accommodation with support from family or friends (being “bailed” by them). Though all those I’ve talked to have emphasised that Jordan is a very legally led country and that there is a strong tradition of applying due processes in a systematic way.
Refugees in the rented sector have minimal restrictions on their movement I’m told, whereas the more recent additions to the camps (more of whom may have come from areas closer to the formerly Daesh / IS controlled areas) have less choice but to live in the more tightly restricted camps.
For the 80% of Syrian refugees who live outside camps, the relative freedom comes with major costs
For the 80% of Syrian refugees who live outside camps, the relative freedom comes with major costs: rent and utility bills. There are very few possibilities of earning money for most of them as with approximately 18% national unemployment in Jordan there are no easily available work permits for Syrian refugees. (So, for example, very few Syrians are employed in the MSF projects because it is so difficult to do this.)
The Syrians who have work are reported to be often working in building work or the food industry or agriculture, all of which used to be areas where Egyptians often worked, but which have tended to be less popular with Jordanians.
So, refugees living outside the camps have much greater vulnerability and less ease of access to health services and probably to other services too, making them an important group for MSF to reach out to. And those who are without the right papers from the Ministry of the Interior and UNHCR are, I think, even more vulnerable as they have no rights at all to most health care. (There are different papers for those who are registered in camps from those “bailed” by family / friends etc to live outside the camps).
The high prevalence of diabetes and heart disease makes working in non-communicable diseases really important
In addition to these difficulties, the interplay of depression / post-traumatic stress disorder and the high prevalence of diabetes, heart disease and chronic breathing problems in the Syrian population makes working in non-communicable diseases really important… Which is why the MSF project I’m joining is here, reaching out to the most vulnerable of the 20% of Syrian refugees in Jordan who are in the Irbid area. We also ensure that (in line with national requirements) 30% of our patients are vulnerable Jordanians.
In the patients we see in our clinics we have a very skewed sample of the local population, as our caseload reflects those who are refugees and have most chronic disease. So, our patients are 60% women, and only about 7.5% are between 16 and 40 (with just 2.1% younger than this).
Looking at illnesses we find that 60+% of our patients have a form of diabetes, 25% have a form of cardiovascular disease (angina or strokes mostly) and 67% have hypertension with some damage as a result of this… (and 62% are obese).
Given the prevalence of diabetes and the recent World Diabetes Day I have attached here a link to some diabetic stories and pictures which come from the project.