Refugees in Jordan: Rumbles of change?

Mike is in Jordan, where he’s part of an Médecins Sans Frontières / Doctors Without Borders (MSF) project that provides free non-communicable disease care to vulnerable people.

Irbid has a reputation as one of the safest projects that MSF runs: we are 20 km from the Syrian border, in a big city where there is not a lot of tension (though a recent football match in which another local town lost and blamed the referee did create some chaos and damage).

I’ve no doubt that the overall situation for us as international workers with MSF is not going to change much but there do seem to be some new elements making things worse for the population we are serving.

Our project is not big enough to offer non-communicable disease care to all the refugees and vulnerable Jordanians who live locally. There are, according to a study done relatively recently, thousands more people who suffer from non-communicable diseases (conditions such as diabetes or heart disease) who we do not have the resources at present to support.

 It has become more obvious that the war in Syria is active and not that far away

So, when it slowly leaked out in late February that from the beginning of this year the Jordanian government has changed their policy on how much refugees will have to pay for their care in the Jordanian health care system, the impact on the families we see was enormous.

While MSF services are always free of charge, the prices for access to care in the state-run system have increased about eight-fold (more for some services). In a population of whom about 85% are already living below the poverty line, this is an enormous increase.

It has raised questions in our project of how we could respond. Should the project seek to expand what we do so that chronic disease care is available to more refugees (knowing that having a member of the household who has a chronic disease is a permanent drain on the income of each of these families)?

Or should we be looking to expand into offering other services for the many destitute families (full primary health care services, mother and child health programmes etc.)?

In the end though we know that this is not a decision for us.The answer depends on money and donations, and even on the rival interest of the world’s population on different disasters - Eastern Ghouta or the Rohinga, which is worse?

At the same time, from the beginning of the year it has become slightly more obvious that the war in Syria is active and not that far away.

smoke rises in the sky over the Syrian mountains

Archive photo of smoke in the sky over northern Syria. Photo: MSF

On one of my trips out of town onto the plains outside Irbid I could, to the north, see plumes of black smoke appearing on the horizon in Syria… there are other things it could have been I suppose but it definitely was not natural. I checked the following day and there were reports of bombings in about the right area to fit what I’d seen.

I’ve also heard gunshots in Irbid recently and even stumbled across some people shooting in the street too. The couple standing there in black tie and a flowing white dress made it clear that the shots were traditional celebrations that accompanied the wedding happening nearby. I guess the military post only 200 m away didn’t respond because they had heard the constant hooting of cars as the bride and groom arrived only a short while before the two volleys of shots. (As I walked past the house the next morning I noticed that all the cartridges had been neatly tidied up… though once accepted as ‘normal’ to have gunshots for celebrations it has now been denounced by the king and is illegal.)

I’ve chosen to be here and could leave and I’m safe and well. The refugee population we serve are suffering more and struggling badly.

On one or two nights recently I’ve woken to repeated bouts of distant, almost continuous rumbling which last for several minutes. It doesn’t sound like thunder and two am is an odd time to take on industrial work. The next morning, when I look at my app which tells me what is happening in the Eastern Mediterranean (LiveUAMap) I find that there is a correlation between my rumbles in the nights and reports of bombings etc. in Dara’a or other relatively nearby town in Syria.

Day-to-day though the signs of all this are that when I get to the meetings at the start of the clinic day there is still a colleague’s voice piping up and asking whether anybody has anything to say about security changes, and, apart from the fallout from football referees’ decisions, there is normally no response.

I remind myself that where I worked in Sheffield there were occasional gunshots and I know that I’m very safe where I am, and that the organisation I’m working for regularly monitors the risks both formally and informally.

I’ve chosen to be here and could leave and I’m safe and well. The refugee population we serve are suffering more and struggling badly. They face a poor choice: staying here in increasing poverty and with the traumatic damage they brought with them, or returning to Syria. Like the chronic diseases they and their Jordanian cousins suffer from, the plight of the refugees here is not exciting or newsworthy, but slowly and grindingly harsh and painful.