1. 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

2. Jordan: In the Middle of the Arab World

3. 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

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

5. 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

6. Distribution of total Refugee pop. by Governorate

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

8. 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

9. The Impact of Syrian Refugees on Jordan

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

11. 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

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

13. 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

14. 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).

15. 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.

16. Mental Health Problems Among Displaced Syrian Population

17. 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

18. 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.

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

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

21. 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

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

23. 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….

24. 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)

26. 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

27. 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

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

29. 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

30. Thank you