In the middle of the Jordanian desert, a city of white corrugated-steel buildings stands in the dust. Azraq refugee camp opened in 2014 to ease overcrowding in Zaatari, Jordan’s other refugee camp. However, life in the camp has never been easy for the 42,000 Syrians who live behind its chain-link fences.
“At first, there was no electricity at all. People were using candles at night,” says Dr Ahmad Zghool, an International Medical Corps Health Coordinator who has been involved with the camp since its inception. “Clean water was an issue—people needed to transport it using jerry cans. And the toilets were shared between 50 people, or sometimes up to 100.”
“That’s not to mention what the people went through before reaching the safety of the camp. After coming from a warzone and then sitting at the border—sometimes for as long as a month—there was so much assistance that they needed.”
International Medical Corps has been on the ground providing services to Syrian refugees in the camp since day one. Over the past 10 years, our interventions have changed the lives of the people who live there.
Healthcare
Early on, when fewer people lived in the camp, International Medical Corps operated the camp’s only primary healthcare clinic, while the Red Cross managed the camp hospital. But when greater numbers of refugees started entering the camp in 2015–16 and were housed in Village 5—a secured part of the camp without access to either the clinic or the hospital—we needed to act fast.
“It was one of our biggest challenges yet,” Dr Ahmad says. “Thousands of people entered the camp in just a few weeks. We started deploying staff in tents, identifying people who had urgent health needs like diabetes, hypertension and more.” The team worked around the clock to provide the urgently needed care to new arrivals.
Eventually, we developed Village 5’s field clinic to the point where it became a permanent primary healthcare clinic offering comprehensive services, including outpatient consultations, reproductive health services, vaccinations, mental health services, nutrition and more.
In addition to providing services at the camp’s two comprehensive primary healthcare clinics, we took over management of the camp hospital in 2015 and have run it ever since. Today, it has an emergency department, maternity ward and operating theatre. We also provide dental, laboratory analysis and X-ray services. In early 2017, we added a 16-bed paediatric ward to the hospital to care for sick children on-site, so they no longer had to be transported out of the camp—and away from their families—for treatment.
Over the years, we’ve worked with the camp community to improve the speed and effectiveness of care and increase coordination between the primary healthcare centres and the hospital.
Maternity Ward
The maternity ward is another example of how dramatically the camp has changed over the last decade. When the camp opened, it didn’t have maternity facilities. Women were transported to a hospital across the desert when they showed signs of going into labour—meaning they gave birth in an unfamiliar place, far away from their families.
This wasn’t a sustainable solution. When Dhiba, a Syrian refugee who had just moved to the camp in 2014, went into labour, the team decided that her case was too urgent to send her away from the camp. Instead, they had to deliver her baby girl in the 24-hour-clinic. Amnah was the first baby born in Azraq camp.
Today, International Medical Corps doctors and midwives deliver about 90 babies a month in our fully equipped maternity ward. We have the facilities to care for expectant mothers, make normal deliveries, and provide comprehensive emergency obstetric and neonatal care.
Last year, these facilities meant the difference between life and death for 33-year-old Fatima. When she arrived at the hospital with intense labour pains, the team found that her baby was in complete breech. The umbilical cord was compressed, cutting off the baby’s blood and oxygen supply; the team needed to act immediately to save the baby’s life.
Dr Mohamed Altaher led a team of midwives and performed an emergency C-section to deliver the baby boy successfully. Then, when Fatima started haemorrhaging, the doctor stabilised her condition with blood transfusions and helped her make a successful recovery.
“International Medical Corps’ timely intervention saved my life and my baby’s,” said Fatima, thanking the team.
MHPSS and Protection
The Syrian families living in the camp have endured immense hardship, having to leave behind their homes, livelihoods and communities because of the conflict. Even once they’ve reached the safety of the camp, mental health conditions such as anxiety, depression and post-traumatic stress disorder can continue to make their lives miserable.
We integrated mental health and psychosocial support (MHPSS) into our services from the start. When people first arrive at the camp, our case managers are ready to provide psychological first aid. Our team of psychiatrists, psychologists, mental health nurses and case managers also provide various mental health services and run psychosocial activities in the camp.
We also have provided gender-based violence (GBV) prevention and response services, and child protection services—closely integrated with our MHPSS services—since the beginning of the camp’s operation. We’ve built safe spaces for women and girls to provide recreational activities, as well as GBV awareness-raising, reproductive health campaigns and psychosocial support.
The programme made a huge difference for Rufayda, a 38-year-old mother of seven who was among the first to enter the camp after the bombing of her suburb in Damascus. Caring for her husband, who had been brutally beaten at the border checkpoint, and bitterly missing her home, Rufayda was so miserable she could barely speak.
When an International Medical Corps case manager met Rufayda and encouraged her to attend mental health sessions, she gradually started to adapt to camp life. After a year, she had made new friends and even started running tailoring workshops at the Women’s and Girls’ Center.
“This has completely changed my life. I have become famous in the camp!” Rufayda told our team.
Today, we continue to lead the camp’s MHPSS services and provide child protection programmes to safeguard young people in the camp.
Nutrition
Although the camp has a supermarket where refugees can spend food vouchers and receive a free allocation of bread, many of the residents have found it difficult to get a nutritious diet that aligns with Syrian traditions and tastes.
In 2016, we led a Cost of the Diet study to investigate this. We found that although most of the households in the camp had access to a nutritious diet in theory, many weren’t getting this because of issues around cost, lack of refrigeration facilities and preferences for Syrian foods over more nutritious—but less traditional—meals.
To help, we run three nutrition clinics in the camp. Our approach includes a therapeutic feeding programme for children suffering from acute malnutrition, an infant and young-child feeding program to help mothers give their babies the best start in life and educational campaigns to teach refugees about healthy eating.
Manar, a 31-year-old mother of five, is one of the refugees whose life has been transformed by our nutrition team. Manar was struggling with anaemia, and her breastfeeding son’s health was also suffering as a result. However, after learning from our team about iron-rich foods and how to improve iron absorption by avoiding caffeine with meals, Manar improved her whole family’s diet and nutrition.
The programme inspired Manar to educate others, so she got involved with the campaign to deliver this knowledge to her community.
“International Medical Corps was able to provide a service that was never presented to us as mothers before,” Manar told our team. “It made a positive impact on my family’s life.”
Fighting COVID-19
When COVID-19 began spreading around the globe, we needed to move swiftly. People live in close proximity in the camp, so managing the spread of the virus was essential.
To manage infections, we set up a COVID-19 treatment centre and a 50-patient isolation facility in the camp. We trained camp personnel, screened people’s temperatures as they entered the camp, carried out random PCR tests and spread awareness about how to prevent COVID-19.
We of course continued our other services, following updated infection-prevention-and-control guidelines. We even stepped up our MHPSS services to help people cope with the stress of the pandemic.
When vaccines became available in Jordan, we worked closely with the Ministry of Health to roll them out. We trained community health volunteers to raise awareness about vaccines’ importance and register people to receive them. We provided pre-vaccine health checks, helped vulnerable people get to the vaccination centres and provided follow-up care.
Working amid the uncertainty of the pandemic was a challenge, but our brave teams persisted. “Our response to COVID-19 was fast and competent—it’s one of the things I’m most proud of from the past 10 years,” says Dr Ahmad.
Training and Capacity-Building
Of course, no matter where we work, International Medical Corps aims to help local people build their own capacity to respond to crises. In Azraq camp, we provide training for local teams and have started handing over management of some of our services to partner organisations so they can continue providing sustainable services in years to come. We still run the hospital and some health services, and provide MHPSS, nutrition and child protection interventions, but we have handed over management of some of our GBV and health services to local partners.
To help refugees rebuild their lives, we’re also providing work and training opportunities within the camp. Through roles such as lab technician assistant, nutrition counsellor, hospital maintenance worker and community health volunteer, we give Syrian refugees skills and experience to help them get jobs and build a new life.
For Akram, a 45-year-old Syrian refugee who works as a cleaner at the camp hospital, the work has dual benefits. “I don’t want to sit at home doing nothing—I want to be an active member of the community,” Akram said. “Plus, this work provides me and my family with an income that supports us.”
For others, the training and work in the camp has helped them move to other jobs in the camp or in Zarqa and Mafraq, the closest cities to Azraq.
A Better Future for Syrian Refugees
Although other countries’ crises have occupied the headlines in recent years, the Syrian civil war continues. Families have remained in the camp for many years; younger children have lived their entire lives there. Many can’t leave or get work permits, and there’s little hope of being able to return to Syria in the near future.
Life is hard for the residents of Azraq camp. It would be even harder without the services that International Medical Corps and our partners provide. Our staff have seen their work’s immense impact in Azraq camp.
“As a doctor working in a humanitarian setting, I see a huge amount of appreciation, and I feel relieved that I can help. It’s so important that people continue to fund the services and activities we provide in Azraq camp so we can continue helping refugees,” says Dr Ahmad.
“Without these facilities, they would be alone in the middle of the desert.”
To support our work in refugee camps and in responding to crises around the world, donate to International Medical Corps today.