Access to Healthcare and Tensions in Jordanian Communities Hosting Syrian Refugees

Status:	Published 1 August 2013 - 31 March 2014
Funded
Methodology:	Data collection started, Data collection finished
Methodology description:	REACH, with support from the British Embassy in Amman, undertook a large assessment in Jordanian host communities focusing on prioritization of needs, vulnerabilities and tensions that have emerged as a result of the Syrian refugee crisis. The assessment was undertaken over a six month time period between August and March 2014 and included a series of data collection and analysis exercises. First, a desk review was conducted to outline the broad challenges, needs and priorities in Jordan as a result of the Syrian refugee crisis. The findings from this desk review informed the methodology for a key informant assessment in 446 communities in the six northern governorates of Ajloun, Balqa, Irbid, Jarash, Al Mafraq and Zarqa.18 Findings from the key informant assessment were then used to select the 160 host communities most at risk of high tension and insecurity, which were identified based on having the lowest level of resilience.19 REACH then undertook a community-level assessment of Jordanians and Syrians living in these 160 communities from December 2013 until early March 2014. Administration of questionnaires and eight focus group discussions (FGDs) with on average 6 participants per group were undertaken in each of these communities. During the targeted assessment phase 7,158 individual questionnaires were completed and 1,280 FGDs with Jordanians and Syrians. In addition, REACH hosted six participatory workshops with local government representatives from the six sampled governorates during January and February 2014. The aim of these workshops was to gain a better understanding of perceptions, challenges and needs of local government institutions in providing support to host communities and incoming refugees. In particular, these workshops sought to identify the priority sectors in each governorate to inform programming around social cohesion and resilience. They thereby complemented the community-level data collection to illustrate a comprehensive and nuanced perspective of vulnerabilities and challenges to resilience in Jordanian host communities.
Sampling:	Random
Sampling size:
Target population:	Displaced - Refugees and Asylum Seekers, Urban / Rural Population, Host Communities, Non-Displaced - Host
Target settlement:	Privately hosted, Individual accommodation (not hosted)
Measurement:	Community, Individual, Other

Access to Healthcare and Tensions in Jordanian Communities Hosting Syrian Refugees

Status:	Published 1 August 2013 - 31 March 2014
Funded
Methodology:	Focus Group Discussion, Community Key informant
Methodology description:	REACH, with support from the British Embassy in Amman, undertook a large assessment in Jordanian host communities focusing on prioritization of needs, vulnerabilities and tensions that have emerged as a result of the Syrian refugee crisis. The assessment was undertaken over a six month time period between August and March 2014 and included a series of data collection and analysis exercises. First, a desk review was conducted to outline the broad challenges, needs and priorities in Jordan as a result of the Syrian refugee crisis. The findings from this desk review informed the methodology for a key informant assessment in 446 communities in the six northern governorates of Ajloun, Balqa, Irbid, Jarash, Al Mafraq and Zarqa.18 Findings from the key informant assessment were then used to select the 160 host communities most at risk of high tension and insecurity, which were identified based on having the lowest level of resilience.19 REACH then undertook a community-level assessment of Jordanians and Syrians living in these 160 communities from December 2013 until early March 2014. Administration of questionnaires and eight focus group discussions (FGDs) with on average 6 participants per group were undertaken in each of these communities. During the targeted assessment phase 7,158 individual questionnaires were completed and 1,280 FGDs with Jordanians and Syrians. In addition, REACH hosted six participatory workshops with local government representatives from the six sampled governorates during January and February 2014. The aim of these workshops was to gain a better understanding of perceptions, challenges and needs of local government institutions in providing support to host communities and incoming refugees. In particular, these workshops sought to identify the priority sectors in each governorate to inform programming around social cohesion and resilience. They thereby complemented the community-level data collection to illustrate a comprehensive and nuanced perspective of vulnerabilities and challenges to resilience in Jordanian host communities.
Sampling:	Random
Sampling size:
Target population:	Displaced - Refugees and Asylum Seekers, Urban / Rural Population, Host Communities, Non-Displaced - Host
Target settlement:	Privately hosted, Individual accommodation (not hosted)
Measurement:	Community, Individual, Other

In Jordan, few comprehensive studies have been conducted to provide an in-depth understanding of the key drivers of host community tensions. To address this information gap, this multi-sectoral REACH assessment aimed at identifying where tensions have emerged across northern Jordan as a result of the Syrian refugee crisis, and how they could be mitigated through social cohesion and resilience programming. In the shift from humanitarian relief to long-term development, the assessment aims to promote and inform the mainstreaming of a ‘Do No Harm’ approach in the response provided to conflict-affected populations residing in Jordanian host communities. Sectors assessed included: education, external support, healthcare, livelihoods, municipal services, shelter and water.

Main Findings

REACH found health care to be a major source of tension in Jordanian host communities that were estimated to be at relatively high risk of tension at the time of assessment. Key findings include:  More Syrians (66%) than Jordanians (57%) reported adequate access to health care services in their community.  When asked to rate challenges confronting health care in the community, both Jordanian and Syrian respondents expressed heightened perceptions of urgency, with ‘Very Urgent’ the most commonly cited response.  64% of Jordanians and 56% of Syrians perceived access to health care as a cause of tension in their community.  The majority of Jordanians (60%) indicated overcrowded health care centres as a driver of health-care related tension. This was also the most commonly cited reason among Syrians (39%).  More Jordanians (26%) than Syrians (21%) cited uneven access to health care as a reason for tension. Meeting the health care needs of both Jordanians and Syrians living in the host communities presents Jordan’s health sector with a definitive challenge. Currently the national health system is encumbered with overcrowded health care facilities, a lack of qualified medical staff and shortages in supply.3 Furthermore, outbreaks of communicable diseases such as polio and measles have posed a threat to the health of host community populations, despite being stymied by emergency vaccination campaigns.4 Findings in this report suggest that overstretched health care services are likely to be contributing to heightened levels of tension and negative perceptions between Jordanian and Syrian groups in host communities. Additionally, these findings call attention to a range of issues obstructing even and adequate access to health care across the northern governorates.