Professor Muntaha Gharaibeh Secretary General Jordanian Council Jordan Impact of Refugees on the Health Care System in Jordan: Implications for Health Professor Muntaha Gharaibeh Secretary General Jordanian Council Jordan

Jordan: In the Middle of the Arab World

Background: The Jordanian Health System Jordan is recognized for its advanced health care system: one of the best in region Total population in 2015 is 6,823,000 Accessibility to health care system is high Medical Tourism Very strong nursing and medical education Nursing and midwifery are well regulated

Refugee status In Jordan Total number of refugees in Jordan until June 2014 is 2.5 million (Iraq, Libya, Yamen, Syria)

Status of Syrian Refugee Total number of Syrian refugees in Jordan is 1.5 million constitute about 25% of the total population, of those; 85% of Syrian refugee are outside the camps, living in communities, and not registered with UNHCR. The number of refugee registered with the UNHCR is estimated to be 637.000

Distribution of total Refugee pop. by Governorate

Number of Refugee Camps Refugees are located in 5 main camps, Al Zatari (the largest) All are near the Syrian Boarders

Distribution of refugees according to age and gender (UNHCR, 2014 ) Percentage Age distribution F M 8.9 9.3 18.2 0-4 10.1 10.6 20.7 5-11 6.7 7.1 13.8 12-17 23. 7 20.2 43.9 18-59 2 1.4 3.4 60+ 48.6 51.4 100% Total 53% of the refugees are under the age of 18 years

The Impact of Syrian Refugees on Jordan

Reduction in health index by 12 points human development index in 2014

The change in population pyramid 2014 3.3 million Jordanian males .53 million Syrian males 3.1 s million Jordanians female and .57 million female Syrians Source : UNHCR and JORDAN Annual Statistics Report 2014

Infectious diseases between Jordanians and Syrian refugees 2013-2014 Syrian Refugees Jordanians Disease 13 5 TB /100,000 51 3 Measles /million 158 Liechmania /million

Number of refugee children being immunized inside camps and outside MOH Response Measles Polio vaccine All 10 vaccines in the national immunization program Number of Syrian Children 541,315 799,769 1,341,084

Primary Impacts of the Syrian Crisis on the Health Sector Include: The immediate increase in the prevalence and risk of diseases among Jordanian host communities; Increased demand for health services, infrastructure and medicines, with negative financial consequences; A projected reversal in some of the most important indicators achieved by country (MDGs achievements).

IMC’s Reports on Mental Health shows that…. Syrian refugee in Jordan has the highest rates of sever emotional disturbances than those in Lebanon and turkey with limited resources for diagnoses and treatment.

Mental Health Problems Among Displaced Syrian Population

Human Resources In Health: Jordan Status Before and with Refugees Ratio for 10,000 population With refugees, 2014 before 2013 22.8 29.4 Physicians 36.1 44.8 Nurses in all categories

Health Burdens Caused by Refugees Increased demand for services Occupancy rate in hospitals, especially in the North province reaching 100%. Increased workload by 9-15% at PHC Increased medical disposables and non-medical Exchange by about 35%. Increased demand for medical equipment and surgical interventions Increased consumption of drugs.

Increased burden on human resource with shortage of human resources. Increased vaccination campaigns more than once at a high cost and human resource efforts.

Jordan has developed its National Resilience Plan for 2014-2016 Jordan Response Jordan has developed its National Resilience Plan for 2014-2016 To mitigate the impact of Syrian Crisis on Jordan and Jordan Host Communities For all sectors including Health

Government Response Cabinet Decree of 16 May 2012: Syrian refugees granted free access to national health care services for all outside camps After 4 years of the Syrian conflict and In 2015 refugees outside camps are treated as Jordanians with no insurance at MOH services

Humanitarian response Role of international organization WHO, UNFPA, UNDP, UNHCR direct and indirect interventions Technical and financial assistance to strengthen health care system

Challenges For Nursing And Midwifery: The new emergence diseases of the refugees: How to ensure safe nursing practice? The increased on daily workload and patient/nurse ratios are not/can not be maintained . Shortage of Nursing specialization workforce such as mental Health, pediatric and maternal care….

Regulation of Health care Professionals Majority of international organizations are hiring Jordanian nurses and physicians who are already licensed to practice under Jordanian Public Health Law Doctors without borders are totally employing Jordanians HCP who are under the umbrella of Humanitarian Aid are working inside camps and are already licensed as humanitarian HCP (French, UAE, Morocco, Bahrein …and more)

Syrian Nurses and midwives who moved to Jordan are seeking jobs in the private sector and some are hiring them without any type of available documentation …very few

The conflict has reached its 5th year Things are getting worse & No signs of political settlement or solution…. No lights at the end of the tunnel

How can you regulate in crisis situations… How can you regulate in crisis situations…. do we know how or do we have to….

Since the Future is not clear…. Do we need to prepare nurse for humanitarian and health of refugee….(short courses, curriculum modifications,,,)? Strategize for refugee health and integrate in our health care system? Establish regulatory mechanisms of new health categories?… Are these political or human right issues or professional issues

Thank you