Right to health at stake for Syrian refugees in Jordan

Chiara Lozza

Sharing borders with Palestine, Syria, and Iraq, Jordan has been deeply affected by the crises that have torn the neighboring countries apart and is today home to 760,360 refugees, half of them children, the second country in the world with the highest share of refugees compared to its population – 89 refugees per 1,000 inhabitants. To get a sense of the scope of the situation, consider that Germany, the European country with the highest share of refugees, is currently hosting 17 refugees per 1,000 inhabitants.

Although the refugee population in Jordan comprises 57 different nationalities, 97% of refugees come from Syria and Iraq, with 672,438 persons fleeing the conflict that has been ravaging Syria for eight years. If Jordan offers them a shelter, refugees find themselves forced to cope with a dire situation, with the vast majority struggling to survive in conditions of poverty (85% of refugees live with less than $3 per day) and heightened vulnerability.[1] In particular, more than half of Syrian households present severe or high health vulnerability[2].

In 2012, the Government of Jordan decided to grant registered Syrian refugees free access to healthcare services. However, this policy was reversed in 2014 and, since then, Syrian refugees outside camps have been required to pay the same rate as non-insured Jordanians, a subsidized rate that might be affordable for non-vulnerable households, but represents a heavy burden for most refugees. Jordan’s Response Plan 2018-2020 provides a clear, albeit gloomy, picture of the situation, estimating that more than one third of all Syrian refugees living outside camps could not afford needed medicines or health services in 2017.

The situation further worsened in March 2018, when the Government decided to cancel the provision of subsidized healthcare services for Syrian refugees. Under the new regulation, Syrian refugees are required to pay the same rate as foreigners, with fees that are up to five times those paid by non-insured Jordanians. This change in policy reflects the strain under which the country and its national health system currently are, due to the sustained flow of refugees generated from the Syria crisis, with direct healthcare costs for Syrian refugees estimated at over €100 million annually for the years 2018-20.

Following the adoption of the new regulation, a worrisome trend has been observed among Syrian refugees, namely the tendency to resort less and less to health services because of the increased fees, which make even basic medical treatment unaffordable for most. This phenomenon, in turn, may encourage recourse to unsafe practices such as home deliveries, with the consequence of further aggravating Syrian refugees’ vulnerability.

The right of every person, irrespective of his or her status, to physical and mental health is a fundamental human right, inscribed in a number of international instrument, from the Universal Declaration of Human Rights to the Convention on the Rights of the Child. Refugees, as human beings, enjoy such an inalienable right, which States have a duty to protect, even more so as refugees find themselves in a situation of specific vulnerability. The international community has historically recognized this obligation and recently reaffirmed its commitment to ensure that all migrants enjoy access to basic health services in the Global Compact for Migration, adopted in December 2018.

This is therefore the time for both the Jordanian Government and the international community to meet their commitments in terms of refugees’ human rights. With increased support from international donors, who in 2018 only funded 72% of the total amount requested by UNHCR, the Government shall strive to ensure that Syrian refugees are not deprived of their basic human rights, thus living up to its generous response so far. In the long term, such an approach would not only respond to an ethical imperative but also create the conditions for sustainable development, as “the right to health has a vital role to play in tackling poverty and achieving development – it lies at the heart of our struggle for a fairer, more humane world”

[1] UNHCR Jordan Factsheet, October 2018, http://reporting.unhcr.org/sites/default/files/UNHCR%20Jordan%20Fact%20Sheet%20-%20October%202018.pdf.

[2] Jordan Response Plan 2018-2020, https://static1.squarespace.com/static/522c2552e4b0d3c39ccd1e00/t/5a84036708522971785025b6/1518601080546/JRP2018_2020+%28final%29.pdf.

[3] Opening remarks of Paul Hunt, UN Special Rapporteur on the Right to the Highest Attainable Standard of Health to the London launch of the ‘call to action’ on the right to health, 9 December 2005.