Who cares for the nine million displaced people of Syria?

“Zaatari camp is considered the fourth biggest city in Jordan,” a volunteer medical coordinator who had recently been working there told me last week. She was speaking from the Paris headquarters of Doctors of the World. The charity asked us to keep its volunteers’ identities confidential as healthcare professionals and facilities have been targets for violence. Just inside the border, the Zaatari refugee camp began only a year and a half ago but has exploded to a population of well over 100 000 Syrian men, women, and children. The charity Doctors of the World manages and staffs two medical centres in the camp and one in a nearby town. “This situation is new for Jordan and overwhelming,” according to a volunteer pharmacist. Each centre has two general practitioners, four nurses, one psychologist, and a pharmacist and provides free primary care and drugs. Doctors of theWorld is also helping the Jordanian Ministry of Health train staff to respond to outbreaks of infectious disease. “In the summer the biggest fear was cholera as there were cases of bloody diarrhoea. It’s particularly dangerous in a closed community because it’s so contagious,” she said. But no outbreak came. “The fear now is polio, which Jordan has not seen for many years, with 10 confirmed cases.” Vaccination campaigns are taking place, she confirmed. She also said that refugees’ pre-existing illnesses are being neglected: “Diseases like diabetes and hypertension are quite a challenge. In an emergency context nobody thinks about non-communicable disease. No one thought the crisis would last this long. “We have to move from thinking about health emergencies to think about post-war, the long term, and not just about outbreaks and communicable disease but about people who already have health problems,” she added. Zaatari’s residents are also experiencingmental health problems: “Post-traumatic stress disorder and depression are quite common in the camp, especially for children, who often suffer from enuresis because they don’t always know how to express themselves. “Some people don’t want to be thought of as refugees,” she continued. If refugees do not register as such they are often denied care through Jordan’s secondary care system. “When we want to refer patients, if they are registered it’s simple: they can see any specialist. Unregistered refugees are treated as foreign, though, and have to pay, but many don’t have the money. There are no barriers to registration, but the problem is stigma. “Secondary and tertiary care are the responsibility of the Jordanian Ministry of Health and a big burden so maybe NGOs [non-governmental organisations] should think about this and not just support primary care.” Difficult conditions