Almost six years into the conflict in Syria, the high number of Syrian refugees seeking shelter in Jordan has put considerable pressure on the country's health system. In November 2014, the Jordanian Health Ministry decided it would no longer provide free health care to refugees. Since then, registered Syrian refugees have had to obtain legal documentation from the Interior Ministry to receive health care from public health facilities at subsidized rates.
Today, two clinics managed by Doctors Without Borders/Médecins Sans Frontières (MSF) in Jordan's Irbid Governorate are seeing more patients than ever for noncommunicable diseases. These include diabetes, hypertension, asthma, cardiovascular diseases, and chronic obstructive pulmonary disease, which are among the most common causes of death in Jordan and the surrounding region.
"Treating noncommunicable diseases is as important as treating a gunshot wound," said Marjan Besuijen, MSF project coordinator. "The difference is that noncommunicable diseases can go unnoticed for years, which is why we refer to these diseases as 'silent killers.'"
A total of 3,700 patients are receiving free treatment and follow-up care for diseases such as diabetes and hypertension in MSF's clinics, which were opened two years ago. Run in collaboration with the Jordanian Health Ministry and the Arabian Medical Relief Society, these clinics help people who have no other access to essential medical care and assist the Jordanian health system in coping with the health needs of large numbers of Syrian refugees. Currently, 69 percent of the clinics' patients are Syrian refugees and 31 percent are Jordanians in need of health care.
"There is a high incidence of noncommunicable diseases among Syrians, and getting treatment for these diseases is unaffordable for many, particularly given the high cost of drugs in Jordan," said Dr. Shoaib Muhammad, MSF medical coordinator.
More needs to be done to help vulnerable Syrians and Jordanians access quality health care, such as reducing the prices of essential medicines in Jordan and encouraging other organizations to help people with noncommunicable diseases.
As accessing health care has become increasingly difficult for Syrians in Jordanian host communities, many have considered moving to official refugee camps, where medical care is provided.
"Many Syrians end up exhausting their life savings to pay for long-term medical care, while others are forced to search for alternative means to access much-needed but expensive medical treatment," Besuijen said.
In addition to running two clinics in Irbid, MSF medical teams have been making home visits for patients who are unable to come in for appointments due to physical disability or financial constraints, among other reasons. Since April 2016 MSF has also been providing patients with comprehensive psychosocial support, to help alleviate mental health problems caused by stress, psychological trauma, and the war in Syria. Teams have carried out more than 1,600 psychosocial support sessions since April.
"My house was bombed, and I lost my property and my livelihood due to the war in Syria," said Muwaffaq Mreish, a 51-year-old Syrian refugee. "I suffered a heart attack because of what I had experienced. To help me overcome this ordeal, the doctor encouraged me to attend psychosocial support sessions. As a result, I've become psychologically stable and have overcome my fears of suffering another health complication."
Given the number of patients with noncommunicable diseases, MSF launched a second similar project in Ramtha District in March 2016.
MSF's project in Irbid has provided more than 44,000 medical consultations, including home visits, to Syrian and Jordanian patients over the past two years.
The closure of Jordan's borders with Syria in June 2016 affected MSF's ability to treat war-wounded Syrians at Ramtha hospital, and forced the closure of its post-operative care facility in Zaatari camp earlier this month.
MSF continues to monitor the health needs of Syrian refugees in Jordan, particularly in terms of access to specialized care, in order to adapt its response and provide medical care to those in need, working alongside the Jordanian Health Ministry.