Presentations at the American Public Health Association (APHA) Conference, Session: Displaced Populations and Refugee Health. There are an estimated 17,000 Palestine Refugees from Syria (PRS) registered with The United Nations Relief and Works Agency (UNRWA) in Jordan, they are the most marginalized—one-third lack legal documents; most cannot find jobs, and live in fear of deportation. Concerned that PRS will over-stay, Jordan has prevented their entry since April 2012, and formally announced its non-admittance policy to PRS in January 2013. This qualitative assessment is the first such study to focus exclusively on PRS and to understand issues of access to maternal and child health services, prevention and treatment of diabetes and hypertension, and factors preventing access to hospitalization.

1. Understanding the Lived Experiences of
Palestine Refugees from Syria (PRS)
Residing in Jordan
Kumkum Amin: Associate Director, John Snow, Inc.
Akihiro Seita: Director of Health Programme, UNRWA
Anne Austin: M&E Advisor, John Snow, Inc.
​APHA: November 7, 2017

2. Disclosure Statement
No personal financial
relationships with commercial
interests relevant to this
presentation existed during the
past 12 months.

3. Purpose of
Assessment
1. Better understanding of health
issues affecting PRS, in particular:
​ - MCH including sick baby care
​ - NCD consultations, treatment
2. Provision of hospitalization
​ support - who, where, how much
​ paid
3. Formulation of advocacy strategy
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4. Methodology
• Qualitative assessment
• Groups selected from UNRWA database
- Women with children <2 years old
- Wo/men diagnosed with diabetes and/or hypertension
- At least one family member hospitalized in past 12
months
• Social Workers invited participants based on "script"
• Consent form read in Arabic; hard copy provided
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5. Profile of
Participants
• 104 individuals, 18 groups, 3 cities
• 80% live outside camps in Jordan
• 84% did not know each other
• Average years in Jordan: 4.0 (ranging
from 1-6 years)
• Average number of children: 3.2
(ranging from 1-7)
• All participants have extended family
in Syria
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6. Life in Syria • More "beautiful and simple" life
• Most owned their home
• No discrimination as Palestinians
• Did not have to be rich to save money
• Education was free
• Families went on Friday picnic outings
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7. Life in Jordan • Difference between "heaven & hell"
• Expensive (rent, water, electricity), hard
to survive
• Men cannot find jobs
• "Syrians" better off – receive more
support, work permits
• Children struggle in school; require
parental engagement
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8. Overview • Multiple definitions of PRS through inter-
marriage (Syrian wo/men married to PRS,
or PRJ living in Syria)
• Strong identification with Syria – "that
was our country, our home"
• No future seen in Jordan - "we should
have stayed and died in Syria”
• Most would like to return to Syria but
believe that "Syria is no more"
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9. Overview • Participants likely never asked for
opinions before
• In every men’s group at least one
person cried
• Most experienced discrimination, even
from PRJ
• Consider their situation as worst of
both worlds – no support from UNHCR
and charities, yet charged high prices
and discriminated for being Syrian
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10. Postpartum Depression Case
​A 30-year old woman arrived in Amman 14 months
ago with husband and 3 children (and had a 4th
child in Jordan). She knows no one, does not leave
the house, and wants to return to Syria where her
parents are still living. She has tried to kill herself
and her children on more than one occasion, so her
husband prevents her from leaving the house. She
was allowed to attend the meeting in the
expectation of receiving money.
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11. Women with children U2: General
​• Pregnancy seen as “mistake”; wished to abort
​• Almost all received ANC; choice of facility depended on
​ proximity to residence (mostly UNRWA HC)
​• Hospital experience varied by type of delivery
​• Choice of hospital through UNRWA referral, family
​ experience, self-referral, private provider
​• PNC primarily focused on child, not mother
​• All children were immunized, and all but one child
​ was registered
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12. Hospitalization Case
​A 44-year old man who is not working and not
following any regimen for his diabetic condition
arrived at the hospital "almost dead". Since his
wife is not working, his 13-year old son, who is
out of school and working, paid USD 180 for his
hospital stay, which was not presented to
UNRWA for reimbursement.
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13. Hospitalization - General
​• All hospitals received mixed reviews
​• Deliveries reimbursed easily, other cases vary
​• No reimbursement for private hospital
​• Self or family member unable to access care
​ due to high cost of consultation and hospitalization
​• “Disc” and vision problems quite common, and
​ going untreated
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14. NCDs - General
​• Most diagnosed with co-morbidity
​• Diagnosed at private facility in Syria; at UNRWA
​ in Jordan – largely focused on medication
​• Lifestyle/diet learnt from family; others with disease;
​ own research; infrequently from doctor
​• Only 2 have self-monitoring device for blood sugar; most
​ unaware of device
​• Ill-health causes families to rely on children’s earnings
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15. UNRWA Services - Strengths
​• UNRWA’s cash assistance valued; social workers
​ highly respected – "alive because of UNRWA"
​• Receive ANC visit reminder; “keep order”
​• Trust health centers for ANC, immunization, FP
​• Those with no recourse to health care outside
​ are grateful to UNRWA for services
​• Availability of drugs generally good
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16. Observations
• Limited systematic internal feedback system, and
open communications (social workers know families
intimately, many issues have been communicated
by them but no formal mechanism to gather
feedback and communicate decisions)
• PRS could benefit from support groups to connect,
engage, and manage their health issues
• Staff might consider increasing contact time with
PRS to better understand the whole person
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17. Conclusion
“Syrians have the UNHCR, we have no one.”
- What will UNRWA’s role be in the 21st century?
- Who will advocate on behalf of PRS with the
GOJ for work permits, education, resettlement to
3rd country…?
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18. THANK YOU!
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