Refugee health: Lessons learned from Jordan in response to the refugee crisis

Za’atari Refugee Camp, Mafraq, Jordan

Registered Syrian Refugees in Jordan August 2014

Jordan613,252

Za’atari Camp79,562

Azraq Camp

11,443

King Abdullah Park & Cyber City Camps

1,180

Host Communities

521,067

Age Demographics

Host Communities: North

Host Communities: Central

Host Communities: South

Za'atari Camp

Azraq Camp

Other Camps

Iraqi and Other Refugees in Jordan

• Approx. 28,000 Iraqi refugees living mainly in Amman, Zarqa, Irbid, and Mafraq• Approximately 4,350 Sudanese, Somali, and other refugees in Jordan, living

mainly in small communities in Amman.• Non-Syrian refugee groups in Jordan are generally older populations (registered)

Percentage of registered refugees between 18-59 (UNHCR, June 2014)

22% Syrian

55.5% Iraqi

67.9% Other

Division Refugee Populations in Jordan

Syrian

Iraqi

Somali, Su-danese, other

Major Health Problems for Syrian Refugees

Non-communicable, chronic diseases

(NCDs)

Hypertension, diabetes,

cardiovascular disease, asthma

Communicable diseases, acute

illness

Polio, measles, other severe contagious

diseases

Infections, parasites, skin conditions, gastro-

intestinal issues, seasonal illness

Conflict-related or other injuries,

wounds, disabilities

Women’s health issues

Reproductive health issues,

HIV/STDs

Health Intervention CHALLENGES

Discrimination against refugees, refusal of service

Documentation requirements

prevent access to services

Distance and cost of transport to health centers

Lacking awareness of rights and

available healthcare services

Care-seeking practices are reactive, not preventative

Lack of education on health risks

and healthy lifestyle practices

Refugee mistrust of healthcare

system in Jordan

Lack of follow-up after initial treatment

Lack of women’s access to healthcare system and health

education

Lacking supply of medications,

medical equipment, number of facilities,

qualified staff

IRD health interventions address

all of these issues.

The IRD Strategy

• Community-level health referral system

• Awareness of health services

• Education and preventative self-healthcare

Empowerment and self-management of refugees

• Medical supplies and equipment

• MoH staff training• Vaccination and health

education campaigns

Building capacity of existing host country institutions

NGO/Aid Partners (UNHCR, UNICEF)

Community Health

Workers (CHWs)

MoH

Key IRD Health Partners

IRD Health Intervention AchievementsOver the last 4 years, IRD has implemented two health interventions

for Syrian and Iraqi Refugees and achieved significant outcomes.

47,538 home visits

91,659 referrals to

MoH centers (1,500

monthly)

32,549 patients served

53 health education and 2 vaccination

campaigns supported

70,000 (approx ).

campaign beneficiaries

1,449 MoH healthcare

staff trained

26 MoH centers served

IRD Health Intervention Achievements

20% refugee beneficiaries surveyed using MoH clinics

• Baseline study (2010)

93% refugee beneficiaries surveyed using MoH clinics

• Endline study (2014)

More Endline Data• 71% patients said

service was better than expected

• 97% of patients said they would visit MoH clinics again

• 95% of patients were satisfied with MoH clinics services

Challenges/Lessons Learned

Delays in obtaining required approval of program action plan from government ministries caused delays in implementation

Periodic turn-over in the health director position over the life of the program caused some confusion

Intensive and time-consuming administrative, financial, and follow-up procedures for equipment donation

Security-related delays in program activity in certain areas (Ma’an, Karak)

Barriers to provision of subsidized services to Iraqi refugees due to changes in internal MoH regulations

Limited capacity of some local partners to complete technical/financial reports

Limited funding to address additional needs

Future Steps

Continue and enhance effective collaboration with MoH, including capacity-building for staff and provision of equipment and supplies

Increase number of partnerships MoH health centers throughout Jordan in order to serve increasing number of refugees in Jordan’s governorates

Provide more feedback to MoH on quality of services based on refugee patient exit interviews collected by CHWs

Train and involve refugees as peer-to-peer educators in promoting national health education campaigns

Work with more local organizations targeting at-risk groups to ensure that none are left out of healthcare access

Work toward building coalition of national and international agencies that serves refugees in Jordan in order to strengthen collaboration.