Economic Research Forum (ERF)

Syrian refugees in Jordan: healthcare and food security

1875
Ensuring the health and food security of the 1.3 million Syrians seeking refuge in Jordan is critical for protecting this vulnerable population now as well as securing their future. This column reports research showing that despite food assistance programmes, they face high rates of food insecurity. In addition, low rates of health insurance among refugees are likely to create barriers to healthcare, although refugees do ultimately access care when needed.

In a nutshell

As of 2016, 75% of Syrian refugees in Jordan did not have health insurance.

Syrians have high rates of food insecurity, particularly in refugee camps.

Policy-makers need to take action to improve access to health insurance and food security for this vulnerable population; without action, Syrians will be at increased risk of suffering, illness and shortened lifespans.

Among the 1.3 million Syrian refugees in Jordan, struggles with health and hunger may endanger an already vulnerable population. The latest evidence indicates that their health and wellbeing are at risk and need additional support.

We know that food insecurity not only harms human health but also hinders economic growth (Barrett, 2002). Likewise, access to healthcare is not only critical for human development but it is a fundamental human right. When refugees lack health insurance or struggle with food security, this puts an already vulnerable population further at risk and limits their potential and development.

Policies in Jordan for refugees’ healthcare and food security

Before receiving most health and food services, Syrian refugees in Jordan must register officially with the United Nations High Commissioner for Refugees (UNHCR) (Salemi et al, 2018). Once they have registered with the UNHCR, they can apply for a Ministry of Interior (MOI) service card.

This service card allows refugees to access Jordanian public health facilities. Initially, care was free for refugees, then at a subsidised cost, paying the same rate as uninsured Jordanians, but as of January 2018, that subsidy has ended (Amnesty International 2016; Dupire 2018). This cost is likely to be a barrier for refugees (Doocy et al, 2016). Refugees without an MOI card face difficulty accessing care (Amnesty International, 2016; Norwegian Refugee Council, 2016).

Likewise, it is only after registration and with an MOI card that refugees can potentially receive food aid from most sources, including the World Food Programme (WFP).

The WFP also screens refugees for eligibility, based on need, before they can receive food support (World Food Programme, 2015, 2016). For example, to be eligible, a family’s per capita expenditure per month needs to be under 68 Jordanian dinars, or they must have other ‘vulnerable characteristics’, such as being in a camp or a household that is at least two thirds children.

Few Syrian refugees have health insurance

Health insurance is not readily accessible for Syrian refugees in Jordan. Lack of health insurance may be a barrier to receiving care as well as increasing the financial challenges of paying for care.

The majority (75%) of Syrian refugees in Jordan do not have any form of health insurance coverage (Figure 1), according to the 2016 Jordan Labor Market Panel Survey (JLMPS). In contrast, the majority of Jordanian citizens have insurance and only a low percentage (39%) of Jordanians are not insured. Among Syrian refugees, cost is a major barrier to seeking care (Doocy et al, 2016), and those without insurance will face higher out of pocket costs.

Figure 1:
Health insurance (percentage), Jordanians and Syrian refugees aged 6+, 2016

Source: Krafft et al, 2018

As a result of low insurance coverage and cost barriers in public facilities, Syrians rely more on charity care, pharmacies or forgoing care when ill. While, as of 2016, 73% of Jordanians report that they go to public hospitals or clinics when they need care, only 44% of Syrians do so. Refugees use private hospitals and clinics at a similar rate as Jordanians (19%) and are likely to pay high costs of care as a result (Doocy et al, 2016).

There are more Syrians who report not going anywhere when sick (8%) than Jordanians (5%). Syrian refugees are more likely to use pharmacies (10%) than Jordanians (2%), which are likely to offer a more limited range of services than clinical facilities. Another key source of care for Syrian refugees are international organisations and NGO facilities (18%).

Figure 2:
Healthcare source (percentage), Jordanians and Syrian refugees aged 6+, 2016

Source: Krafft et al, 2018

Syrian refugees struggle with food security

Although the WFP and other organisations assist Syrian refugees, many still struggle with food insecurity. While some refugees are registered with ration cards and receive food vouchers, others may not receive food assistance.

We consider Syrian refugees who report eating less in the last 12 months due to scarcity of food to be food insecure (See Krafft et al, 2018, for a detailed investigation of different measures of food security). Even when they have food support, there is substantial food insecurity among Syrians.

Food insecurity is high in host communities and especially refugee camps. Figure 3 shows the percentage of Syrian refugees aged 15-59 who ate less by whether they received food support (food vouchers or ration cards). The refugees that are the most food insecure (74%) are the Syrians with no food support in camps.

Among Syrians with food support, Syrians in the camps have the highest rate of food insecurity (68%). In host communities, rates of food insecurity are lower (25% with food support, 27% without), but still concerning. While food support is reducing food insecurity, it is not preventing food insecurity. The additional purchasing and livelihoods opportunities outside the camps appear to be important in reducing food insecurity.

Figure 3:
Food insecurity: ate less (percentage) by receipt of food support, Syrian refugees aged 15-59 in host communities versus camps, 2016

Source: Krafft et al, 2018

Reducing food insecurity and increasing health insurance coverage of refugees

Since the WFP is the primary programme battling hunger among the Syrians in Jordan, the funding of the WFP is critical for ensuring food security among refugees. Unfortunately, the WFP faces funding shortfalls, which has led to cuts in food support at times (Bellamy et al, 2017). As a result, even Syrian refugees who qualify for assistance are not receiving the support they need.

In addition, unlike other programmes that receive consistent funding, the WFP is funded by governments, companies and individuals on an entirely voluntary basis (World Food Programme, 2018). Finding more consistent and reliable funding for the WFP will help reduce hunger within the refugee population. The financing of food programmes, like the WFP, needs to be made a priority because food is a basic need for survival and critical for human development.

Improving Syrians’ access to healthcare in Jordan is important to protect refugees’ human rights and wellbeing. Syrians who have access to public health facilities may face unaffordable costs. These barriers limit Syrian refugees’ access to medical assistance.

Policy-makers must address the fact that the vast majority (75%) of the Syrian refugee population has no form of health insurance in Jordan and pays out of pocket for health services. Not having health insurance leaves a vulnerable population at high financial and health risk from health shocks.

Further reading

Amnesty International (2016) ‘Living on the Margins: Syrian Refugees in Jordan Struggle to Access Health Care’.

Barrett, Christopher (2002) ‘Food Security and Food Assistance Programs’, in Handbook of Agricultural Economics, edited by Bruce L. Gardner and Gordon C. Rausser.

Bellamy, Catherine, Simone Haysom, Cailtlin Wake and Veronique Barbelet (2017) ‘The Lives and Livelihoods of Syrian Refugees in Turkey and Jordan: A Study of Refugee Perspectives and their Institutional Environment in Turkey and Jordan’, Humanitarian Policy Group, Overseas Development Institute.

Doocy, Shannon, Emily Lyles, Laila Akhu-Zaheya, Ann Burton and Gilbert Burnham (2016) ‘Health Service Access and Utilization among Syrian Refugees in Jordan’, International Journal for Equity in Health 15(108): 1-15.

Dupire, Camille (2018) ‘Regularisation Campaign for Syrian Refugees Raises Healthcare Access Concerns’, The Jordan Times (April 2).

Krafft, Caroline, Maia Sieverding, Colette Salemi and Caitlyn Keo (2018) ‘Syrian Refugees in Jordan: Demographics, Livelihoods, Education, and Health’, ERF Working Paper No. 1184.

Norwegian Refugee Council (2016) ‘Securing Status: Syrian Refugees and the Documentation of Legal Status, Identity, and Family Relationships in Jordan’, Norwegian Refugee Council.

Salemi, Colette, Jay Bowman and Jennifer Compton (2018) ‘Services for Syrian Refugee Children and Youth in Jordan: Forced Displacement, Foreign Aid, and Vulnerability’, ERF Working Paper No. 1188.

World Food Programme (2015) ‘World Food Programme Beneficiary Targeting for Syrian Refugees in the Community,’ Al-Jubaiha, Rasheed District.

World Food Programme (2016) ‘WFP Jordan Situation Report # 13’.

World Food Programme (2018) ‘Funding and Donors‘.

Tags: , , , ,

Most read

Trust in Lebanon’s public institutions: a challenge for the new leadership

Lebanon’s new leadership confronts daunting economic challenges amid geopolitical tensions across the wider region. As this column explains, understanding what has happened over the past decade to citizens’ trust in key public institutions – parliament, the government and the armed forces – will be a crucial part of the policy response.

Qatarisation: playing the long game on workforce nationalisation

As national populations across the Gulf have grown and hydrocarbon reserves declined, most Gulf countries have sought to move to a more sustainable economic model underpinned by raising the share of citizens in the productive private sector. But, as this column explains, Qatar differs from its neighbours in several important ways that could render aggressive workforce nationalization policies counterproductive. In terms of such policies, the country should chart its own path.

Small businesses in the Great Lockdown: lessons for crisis management

Understanding big economic shocks like Covid-19 and how firms respond to them is crucial for mitigating their negative effects and accelerating the post-crisis recovery. This column reports evidence on how small and medium-sized enterprises in Tunisia’s formal business sector adapted to the pandemic and the lockdown – and draws policy lessons for when the next crisis hits.

Economic consequences of the 2003 Bam earthquake in Iran

Over the decades, Iran has faced numerous devastating natural disasters, including the deadly 2003 Bam earthquake. This column reports evidence on the unexpected economic boost in Bam County and its neighbours after the disaster – the result of a variety of factors, including national and international aid, political mobilisation and the region’s cultural significance. Using data on the intensity of night-time lights in a geographical area, the research reveals how disaster recovery may lead to a surprising economic rebound.

Qatar’s pursuit of government excellence: promises and pitfalls

As Qatar seeks to make the transition from a hydrocarbon-based economy to a diversified, knowledge-based economy, ‘government excellence’ has been identified as a key strategic objective. This column reports what government effectiveness means in terms of delivery of public services, digitalisation of services, and control of corruption – and outlines the progress made to date on these development priorities and what the country needs to do to meet its targets.

The impact of climate change and resource scarcity on conflict in MENA

The interrelationships between climate change, food production, economic instability and violent conflict have become increasingly relevant in recent decades, with climate-induced economic shocks intensifying social and political tensions, particularly in resource-constrained regions like MENA. This column reports new evidence on the impact of climate change on economic and food production outcomes – and how economic stability, agricultural productivity and shared water resources affect conflict. While international aid, economic growth and food security reduce the likelihood of conflict, resource scarcity and shared water basins contribute to high risks of conflict.

A Macroeconomic Accounting of Unemployment in Jordan:  Unemployment is mainly an issue for adults and men

Since unemployment rates in Jordan are higher among young people and women than other groups, unemployment is commonly characterised as a youth and gender issue. However, the majority of the country’s unemployed are adults and men. This suggests that unemployment is primarily a macroeconomic issue challenge for the entire labour market. The appropriate response therefore is coordinated fiscal, monetary, structural and institutional policies, while more targeted measures can still benefit specific groups.

The green energy transition: employment pathways for MENA

The potential employment impacts of green and renewable energy in the Middle East and North Africa are multifaceted and promising. As this column explains, embracing renewable energy technologies presents an opportunity for the region to diversify its economy, mitigate the possible negative impacts of digitalisation on existing jobs, reduce its carbon footprint and create significant levels of employment across a variety of sectors. Green energy is not just an environmental imperative but an economic necessity.

Global value chains, wages and skills in MENA countries

The involvement of firms in production across different countries or regions via global value chains (GVCs) can make a significant contribution to economic development, including improved labour market outcomes. This column highlights the gains from GVC participation in terms of employment quality in Egypt, Jordan and Tunisia. Given the high unemployment, sticky wages and wide skill divides that are common in the MENA region, encouraging firms to participate in GVCs is a valuable channel for raising living standards.

Tunisia’s energy transition: the key role of small businesses

Micro, small and medium-sized enterprises (MSMEs) play a critical role in Tunisia’s economy, contributing significantly to GDP and employment. As this column explains, they are also essential for advancing the country’s ambitions to make a successful transition from reliance on fossil fuels to more widespread use of renewable energy sources. A fair distribution of the transition’s benefits across all regions and communities will secure a future where MSMEs thrive as leaders in a prosperous, inclusive and sustainable Tunisia.