In 2013, Syria has plunged into a real civil war for longer months. The conflict has already caused more than 70.000 victims, mainly civilians, more than 4 million people would be in need of assistance, in particular medical assistance, inside the country with many wounded, 2 million people displaced and 1.2 million houses damaged or destroyed. Meanwhile, many people have fled the country to neighbouring countries. In April 2013, no less than 1 million Syrians are registered as refugees in Jordan, Lebanon, Turkey, Iraq and Egypt, according to the United Nations Refugee Agency. Thousands of other refugees live in these countries without being registered, as such they are living in precarious conditions and with no sources of income; these populations are in immediate need for free access to health.
Assisting refugees in the village of Qah
With the increasing number of internally displaced persons (more than 2 million according to the UN) and the upsurge in violence, Doctors of the World opened a primary healthcare center in Qah, in northwestern Syria. 5,000 Syrians have already congregated in the village, where Doctors of the World receives hundreds of patients per day, mostly women and children.
"The main pathologies encountered by physicians are conditions related to the living conditions of these people during their many displacements. They have often left in haste, leaving behind everything they owned, which makes them even more vulnerable,” says Joël Weiler, general coordinator of Médecins du Monde/Doctors of the World.
With the onset of winter, Doctors of the World began distributing blankets, soap and plastic sheeting to ensure better living condition. Water supply and wastewater disposal systems are being implemented, and hygiene kits are being distributed to reduce the risk of infectious diseases in the camp.
Syrians have also taken refuge in neighboring countries, and the UN estimates that that there will be 720,000 refugees by the end of the year. In Jordan, Doctors of the World is present in the town of Ramtha, in King Abdullah Park and in the camp in Zaatari, which now has 35,000 Syrian refugees. Doctors of the World brings primary and mental healthcare to these vulnerable populations in conjunction with the Jordanian Ministry of Health. In the Bekaa Valley in Lebanon, Doctors of the World, in partnership with the Lebanese organisation Amel, to support and supply medicine to two health facilities where 1,000 consultations are conducted each month.
see : http://appelsyrie.medecinsdumonde.org/EN/
Camp de Zaatari
In April 2013, Jordan counts more than 420 000 Syrians registered or awaiting registration with the United Nations Refugee Agency. As for the Jordanian government, it estimates the number of Syrians living in Jordan at around 500 000. Most of them are from Deraa - a city located few kilometres away from the Jordanian borders, this city is known to be the birth place of the Syrian uprising - and Homs, a city located in the centre of Syria particularly affected by the conflict.
Médecins du Monde provides aid to the Syrian refugees in Jordan through three primary health care centres, in cooperation with the Jordanian Ministry of Health
IN ZAATARI CAMP
Opened since August 2012, Zaatari camp receives the majority of Syrians that entered the country illegally.
Previous system made the Syrians go through transit sites before a bailout system would allow them to live in the Jordanian communities. With the bailout system restricted and the number of the Syrians who fled to Jordan increasing dramatically in the last months, the number of refugees in Zaatari camp which is located in a desert area in northern Jordan has reached over 120 000 in April 2013.
The stress caused when fleeing Syria and the harsh living conditions in the camp make the population living there even more vulnerable, especially regarding their health status.
MdM runs a primary health care centre in Zaaatari camp, in which free medical consultations and drugs are provided to the refugees as well as psychosocial counseling. 4200 free medical consultations have been carried out in this medical centre in March 2013. The main pathologies are respiratory infections, skin diseases and wounds caused by accidents; which reflect the negative impact of the living conditions inside the camp on the refugees’ health status.
IN THE BORDER CITY OF RAMTHA
Ramtha is one of the first Jordanian cities that received major influxes of the Syrians fleeing the violence, especially the population of Deraa, a city located only few kilometres away from the Jordanian borders. The ever existing socioeconomic linkages between the two cities allowed the reception of the Syrian refugees by Jordanian families, while some others were able to rent private accommodations in the city. Despite this fact, access to medical treatment for the refugees remains limited due to their scarce resources and the overloaded medical facilities in Jordan.
As such, MdM opened a primary health centre in downtown Ramtha in July 2012 for the Syrian refugees and also for the vulnerable Jordanians. Free medical consultations as well as free medicines are provided in this primary health care centre by a medical team, which includes two doctors, nurses, a pharmacist and a midwife. The team ensures the follow up of pregnant women and people with chronic diseases and immunizations; over 2600 free consultations have been carried out in this health centre in March 2013.
IN KING ABDULLAH PARK CAMP
Located near Ramtha, King Abdullah Park camp hosts around a thousand Syrian refugees living mainly in fixed caravans. MdM supports the Jordanian Ministry of Health medical staff working in this primary health centre both financially and technically as well as by providing medicines and medical equipment.
MdM has also an ambulance, for all the refugees living in the Ramtha area, which transfers severe and urgent cases such as women in labour, from MdM PHCs to the Ministry of Health hospitals in the region.
MdM also supports Syrian psychologists and psychiatrics both financially and technically, with a presence of a mental health expert of Médecins du Monde.
Testimony of a Syrian doctor, who arrived to Jordan in 2011 - collected by Médecins du Monde in May 2012
“I have participated in Syria in urgent medical activities for the wounded people during clashes, but following a two months jail term, I have decided to come to Jordan and I was able to cross the borders legally.
At present, I work with a team of psychologists, most of them are Syrians, and we bring psychosocial and psychiatric treatments to Syrian families. We also provide trainings for volunteers who would want to help these families.
Syrian refugees suffer together from psychological traumas, linked to what they have witnessed back in Syria and the way they fled the country, and they also suffer from treatment breaks for those who have chronic pathologies.
About 40% of children that we have examined showed symptoms of post-traumatic stress, fear of dark and aggressiveness.
More than anything, Syrian people want to return to normal daily life, work and send their children to school. Syrian kids are authorised to join the Jordanian schools, but it is not as simple as it seems, because the school programmes are very different.
When we arrived to Jordan, we thought our stay was going to be temporary, only few months and we will return home, but now it’s nearly one year since we first came and the situation back in Syria keeps getting worse.”
Providing care for Syrian refugees in the Bekaa Valley
Thousands of Syrians have taken refuge in the north of the country and in the Bekaa Valley. Doctors of the World supports and supplies medicines to three health centers close to the Syrian border. Free consultations and primary healthcare are provided to Syrian refugees and destitute Lebanese. Visits are also made to villages where refugees have settled.
Doctors of the World supports two health facilities in the Bekaa Valley, and El-Ain and El-Qaa, which are 8 kilometers from the Syrian border. The El-Ain center is part of Amel, a Lebanese organization that has been partners with Doctors of the World for over thirty years. In both the centers supported by Doctors of the World, Syrian refugees and extremely vulnerable Lebanese have access to free primary and reproductive healthcare, health education, and malnutrition screenings. Nearly 1,000 consultations are conducted month at each of the centers. Additionally, a first-aid training was delivered in the five villages of the Bekaa.
In the region, a supply of medical and surgical kits are being prepared in the event that we are permitted to provide humanitarian aid elsewhere in Syria.
Testimonies Baptiste Hanquart, MdM General Coordinator in Lebanon - December 2013
Impact of the extreme weather conditions on the Syrians refugees in the Lebanon
'Winter storm Alexa brought temperatures below normal. However it is not an exceptional phenomenon in Lebanon at this time of year. But the impact on the ground is heavy because the country’s infrastructures cannot cope with the situation. The problem is the same almost every year, except that, this winter, it strongly affects hundreds of thousands of Syrian refugees who are poorly accommodated and particularly vulnerable to cold.'
'Unfortunately, some heating systems are made available to the refugees at the last moment while the distribution of aid is complicated and slowed by the bad weather conditions. Roads are cut off at the mountain passes and vehicles can only go through at certain times of the day.'
'Despite these obstacles, the distribution of aid takes place, with considerable efforts from the Lebanese state, as in Arsaal where the distribution of 1,000 shelter kits was permitted. On Tuesday, an MdM team present in Aarsal assessed the health situation as under control even if gaps remain in terms of adapted housing and heating.'
Testimonies Al Ain, Lebanon – April 2013
Financial barriers to healthcare access
'I live with part of my family in an encampment of eighteen tents. When I was eight months pregnant, I was stung by a scorpion and had to be taken to hospital. We had to pay 100,000 Lebanese pounds [some 50 euros] so I could be taken care of. That’s a lot of money for me, but I had no choice. I had to pay. It was either that or I was going to die.
Today, my baby suffers from bowel problems. We took him to hospital, and he spent a day there, but then we couldn’t afford the costs so we went back home. We were told that he needed an 800,000 Lebanese pounds [over 400 euros] operation 15% of which we had to pay ourselves. We can’t afford it, we don’t have that kind of money’.
Noor, a 25 year-old Syrian woman living with her 3 young children in an encampment near Al Ain, North Bekaa
‘Everything is considerably expensive here so we try to manage to get the basics even if we lack everything.
I live off four food coupons. I sell two of them to buy milk for my newborn twins. There is a pharmacy which sometimes gives me milk or lets me pay later.
This winter, we didn’t have enough blankets for everyone, so we gave the only ones we had to the children.
We bake our own bread as it is cheaper than buying it. We can only afford to buy some flour and then use a small oven we built to cook the bread’.
Noor, a 25 year-old Syrian woman living with her 3 young kids in an encampment near Al Ain, North Bekaa
‘We don’t feel ashamed. Come and see the conditions we live in!’
Noor, a 25 year-old Syrian woman living with her 3 young kids in an encampment near Al Ain, North Bekaa
March 20 th
Psychosocial activities for Syrian children in Jordan
Health education for children in MdM Primary Health Care Center in Zaatari camp
“Most of the children we met were having hallucinations, visions and flashback memories. Some were experiencing a lack of taste or a continuous smell of blood in their noses. A lot of them were afraid at night or having nightmares that they would carry with them throughout the day.
So we decided to implement a programme to help these children deal with their psychological distress and trauma, through group therapy. It proved difficult to find participants: most of the children were so traumatised that group therapy would have caused them more harm than good. When meeting the families of the children, we also realised that the parents needed therapy as much as their children.”
Heba, Syrian psychologist volunteering for the organisation Syria Bright Future, supported by MdM in providing mental health and psychosocial services to Syrian regugees in Jordan.
6 March 2013
From Syria to Jordan…a young Syrian mother tells about her journey
Ramtha, Jordania - MdM health center - 2013
Cécile Génot / MdM
« A checkpoint was set up just behind my house in Dera’a. The military used to regularly shoot people who tried to avoid the checkpoint and take another road. My brother-in-law was shot dead at that checkpoint
So, with my husband, we decided to leave and go to Jordan. The journey is long, weary, and scary too…You never know how it is going to end, whether you will be able to make it to the other side of the borders or be captured by the army. Me and my husband we hold valid passports so we thought to cross the borders legally, but before reaching to our destination we had to come through countless numbers of military checkpoints. Every time we were stopped, military men would ask people to get off the bus and get it thoroughly searched, then they would turn to the passengers to check and question them one by one. This was the scariest part: if you don’t tell them what they want to hear, it is enough reason for them to detain you.
Once we passed the borders, we were taken to Zaatari camp. The living conditions there were unbearable. With the dust and the cold, my son was continuously sick and I was spending all my time in the waiting lines of health care centres so that we could see the doctor. After two months, it was no longer tenable. We asked to be sponsored and bailed out of the camp but our request was turned down. So we paid some guardians so they would let us leave and we went to Ramtha to settle.
Here, life remains difficult, everything is expensive but I feel safe. When we go to sleep, we don’t have to fear missiles or visits from the security forces, that’s already a good point ».
Jasmine, a young Syrian woman, who has been living in Ramtha for few months with her husband and her son.
Testimonies Syrian refugees living in Zaatari camp – Jordan – February 2013
« My father is still in Dera’a. He told me: ‘If I have to live in a camp, I prefer to stay in Syria’. As for me, I left to accompany the children of my brothers and sisters, to protect them and keep them safe in Jordan. Also, I had just been called to serve in the army, I would have been obliged to kill people and I couldn’t accept that. So I didn’t have a choice, either I had to join the army or I had to flee.
In the camp, life is difficult. Security is an ongoing concern, in particular theft. There must always be at least one person in the tent, if not, you can be sure that everything will have disappeared when you come back. »
Mohammad, young Syrian refugee who has been living in Zaatari camp for a few months with his nieces and nephews
« We arrived in Jordan eight months ago but it feels like eight years. We don’t know what the future will bring. We could die here or we could go back to Syria. »
Ibrahim and Hanadi, a couple of Syrian refugees living in Zaatari camp
« It’s normal to see a lot of sick people in here, people with cold, people with fever. It’s because of the cold. In my tent, we are five and we only received five sheets, not even proper blankets and we don’t have heaters either. »
Rasha, 15 years old, young Syrian girl living in Zaatari camp, bringing her little brother to MdM healthcare centre