By Attila Kulcsar
HelpAge International is currently collaborating with Handicap International on its response to the Syrian refugee crisis in Jordan. We are using our joint expertise to identify the needs of the most vulnerable, including older people and people with disabilities, to ensure their access to essential relief services, and to look at the best ways of providing further assistance to them.
(c) Jamal Saidi
The conflict in Syria has exposed the population to unprecedented levels of violence. In Jordan, the number of refugees arriving daily has dramatically increased over the last month. A reported 50,000 individuals are waiting at the border to cross; with 1,500 more arriving each day. There are currently about 313,000 refugees either registered or awaiting registration inside Jordan, with an estimated additional 87,000 refugees unregistered.
Many Syrian refugees are leaving the camps to move to urban areas, joining thousands of other refugees who are already living in cities along the northern border between Syria and Jordan. This group - estimated at about 75% of the refugee population - is relying heavily on the support of their Jordanian neighbours.
Need for more services for older people
Pascale Fritsch, HelpAge's Emergencies Health and Nutrition Advisor recently met Syrian refugees living in cities in northern Jordan and found a clear need for community services for older, disabled and other vulnerable people, with more work required to train community health workers, volunteers and home-based carers.
The main refugee camp in the north of Jordan, Za'atari camp, hosts over 144,000 refugees - more than half of them having arrived during February 2013. The camp is overcrowded and a lack of access to food has been reported. People over 60 make up around 3% of the camp population, which suggests older people are unwilling or unable to leave Syria. However, this figure has risen from 2% in the last month confirming reports that increasing numbers of older people are fleeing, as they are no longer able to tolerate the violence in Syria.
UNHCR data from Za'atri camp shows that, while 3% of the refugees are aged 60 and over, they account for 7% of the acute health conditions and 21% of chronic health conditions, such as diabetes and high blood pressure. This indicates older refugees are disproportionately at risk and in need of humanitarian assistance. However medical facilities in Za'atari camp are increasingly overburdened.
Urban communities are overwhelmed
Refugees who have illegally moved from the camp do not have identity papers and are not eligible for help provided by UNHCR, such as emergency cash assistance, clothes, bedding, food vouchers, free healthcare and schooling for children. Overall, the situation of refugees who live in urban areas is much worse than for those in camps. Outreach activities are essential to locate and support them.
Amnah is 85 and left Syria six weeks ago. She now lives in Mafraq in northern Jordan. She said: "We only stayed in the camp for five days because it was so overcrowded. I left to live with my son. In the coming days, I will move to a flat in another city where I'll be closer to the hospital and health services."
Amnah is not yet registered with UNHCR, so has no access to free healthcare. Handicap International will help her to register and has already provided her with a wheelchair. Next week, a therapist from the organisation will provide her with physiotherapy sessions.
These urban communities are fast becoming overwhelmed by the influx of new inhabitants and their services overburdened. This has led to high rents and difficulties in finding accommodation. Rental assistance is one of the most urgent needs, with many Syrian families unable to meet rents and threatened with eviction or forced to live in sub-standard housing.
Most refugees enter Jordan at unofficial border crossings and - because their identity documents are retained by the Jordanian authorities - they are unable to work, meaning they are struggling to obtain enough resources for rent and food.
Fatma, 75, arrived in Jordan a month ago. She said: "We have no income, as we are not allowed to work in Jordan. The rent for the flat is 250JD (US$353) a month, including electricity and water and gas tanks for the heater cost 10JD (US$14). To stay warm, we use one per week."
High rates of chronic health conditions
Older people have specific health needs for the unusually high rates of chronic disease such as cardiovascular and respiratory diseases and diabetes that, according to the World Health Organization, affect older people in Syria.
Ms Fritsch said: "Access to medical care for urban refugees is a major concern. Despite the commitment of the Jordanian authorities to grant access to services to the Syrian refugees, not all health services are provided for free. The facilities that are free reportedly do not have the capacity to deal with the influx of patients. The main challenges regarding health services for older people are distance, lack of medicine, user fees and ceiling of health assistance per year."
HelpAge, in partnership with Handicap International, is planning to strengthen our assistance to older, disabled and other vulnerable refugees living in the urban areas of Jordan and Lebanon, notably in terms of access to housing, electricity and heating, clothing, food and healthcare.