Since the war in Syria began, half a million Syrian refugees have come to Jordan. According to the UN High Commissioner for Refugees (UNHCR), between 1500 and 3500 Syrian refugees are now arriving each day. Jordan shares history, culture, and a long open border with Syria. Jordan provides access to preventative and curative services to Syrian refugees (appendix
Over 70% of Syrian refugees are residing among host Jordanian communities. Only 30% of the Syrian refugees reside in camps, which started in early 2012; the largest camp is Zaateri, with an estimated population of 120 000. In the camps, UNHCR and other partners, with the support of the Jordanian Ministry of Health (MOH), provide health and humanitarian support. However, for the larger proportion of refugees outside the camps, not all needs can be adequately addressed. The Jordanian MOH provides full access to health services for the Syrians outside camps along with the local Jordanian population. Additionally, some non-governmental organisations and private sector practitioners also deliver services to Syrian refugees outside the camps.
Most of the refugees' demand is located in the four northern governorates, and in Amman where specialty care can be found. A joint rapid health assessment led by the Jordanian MOH and WHO is currently underway to better determine facility capacity and service utilisation patterns in the most affected governorates.
Services are overstretched. For example, the Mafraq Government Hospital—the closest hospital to Zaateri camp—has 16 neonatal incubators: currently, two of the incubators are used by Jordanians, two by other internationals, and 12 by Syrian refugees. There has also been a huge increase in surgical care demand. Surgical operations for Syrian refugees done in MOH facilities have increased rapidly (from 105 operations in January, to 622 in March). Similar trends for admission of Syrians to MOH facilities has been observed, reflecting the rapid influx of refugees into the country. Surgical and trauma care needs include amputations, burn care, acute surgical conditions (eg, accidents, falls) that affect those exposed to conflict, as well as treatment for weapons-related wounds.
Cancer treatment requires labour-intensive efforts by providers as well as expensive medication and therapies. The cancer burden among Jordanians already strained MOH's budgets and workforce. The public hospital system provided care for 134 Syrians with cancer in 2011. This rose to 188 cases in 2012, and is expected to rise above 600 cases this year. This represents a 14% rise in the number of patients treated. This additional Syrian burden greatly affects Jordan's efforts to improve cancer control.
Thanks to the Jordanian MOH's vigilance and support from WHO, UNICEF, and other partners, to date no major infectious disease epidemics have occurred, but outbreaks appeared and risks are increasing. Without additional support to prevent and respond to such outbreaks inside and outside the camps, Jordan's health sector will suffer not just the immediate loss of life and health among Syrians and Jordanians, but will also see a major erosion of the gains Jordan has made over decades of investment in health and health systems (appendix
The people and Government of Jordan are committed to assisting Syrians. The MOH has spent an estimated US$53 million on care to refugees between January and April, 2013. During the same period, only $5 million was provided in direct support to the MOH by UN agencies.
We need support from the international community to respond to the many health needs of Syrian refugees. $180 million are needed to expand and upgrade ten existing facilities in the northern governorates to cope with the massive demand on health care posed by the Syrian refugees. Additionally, we urgently need a boost to the MOH's expenditure on health proportional to the numbers of refugees; it should be around $135 million for 2013 and readjusted for 2014 and beyond.
Jordan is committed to continuing to care for refugees from Syria and other countries, but the system is dangerously overstretched. Excessive demands on our health system pose risks to our health status and social stability. We are committed to the health of both Syrians and Jordanians. We invite the international community to join us and assist in this effort.
MMM is Minister of Health and Minister of Environment, Jordan. We declare that we have no conflicts of interest.