Roosevelt Institute | Cornell University

Implementing Cost-Effective and Sustainable Vaccination Programs in Jordan Amidst the Syrian Refugee Crisis

By Viktoria CatalanPublished December 22, 2020

As hundreds of thousands of Syrian refugees migrate to and reside in Jordan, the Jordanian government faces a dwindling budget and is becoming less able to afford its refugees’ healthcare nee
As hundreds of thousands of Syrian refugees migrate to and reside in Jordan, the Jordanian government faces a dwindling budget and is becoming less able to afford its refugees’ healthcare needs. To begin overcoming this financial instability, Jordan should allocate its funds towards immunizing the Syrian refugee population via nationwide vaccination programs. This cost-effective approach would ultimately eradicate the current prevalence of communicable diseases and provide Jordan greater financial flexibility to accommodate the surge of incoming refugees.

Conflict and violence in Syria have led to the largest current humanitarian crisis, namely the displacement of about 11 million refugees, over 600,000 of which now reside in Jordan. Despite Jordan having the highest healthcare system ranking in the Middle East, the continuing surge of Syrian migrants restricts Jordan’s ability to finance access to adequate health care for refugees. Although Jordan has supplied refugee camps with generalized medical treatments, only 17% of Syrian refugees actually reside in these camps. Meanwhile, those living outside the camps remain undocumented and spend 60% more on health care than non-insured Jordanians. These discriminatory costs even apply to refugee children who are born in Jordan but whose parents are undocumented. In addition, most Syrian refugees lack health insurance, experience cultural barriers, and face a high cost of living while attempting to assimilate into Jordanian society. Until receiving approval for medical relief, refugees outside of camps are required to pay out-of-pocket for medical treatments and services and primarily rely on temporary care from NGOs and international donors. To overcome this surge in healthcare costs and dependence on outside funding, Jordan should begin to allocate its funds towards immunizing its Syrian refugee population. Launching full vaccination programs nationwide, particularly for influenza, measles, and polio, would prevent further onset of disease and quickly allow Jordan to sustain itself financially. 

Although Jordan provides health services to refugee camps, such as Za’atari (the largest in the nation), health care accessibility and quality can improve. A cross-sectional study looking into Za’atari’s refugees’ satisfaction with Jordanian health care shows that 75% did not receive sufficient care, and 43% predicted that their health condition(s) would worsen. Nonetheless, considering that its borders are still open, Jordan appears committed to assimilating Syrians into the Jordanian health system. Until 2014, both primary and secondary healthcare services were free of charge. However, because hundreds of thousands of Syrian refugees have moved to Jordan, the government can no longer provide financial assistance without also struggling to maintain its national security. For instance, the cost to house about 120,000 people in Za’atari is at least $500,000 a day, and such large costs cause Jordan to increasingly block Syrian refugees’ access to generalized care. Despite Jordan’s provision of primary care, its inability to provide higher-cost secondary care prevents refugees from having chronic and preventable conditions addressed. Though the government does not actively resist assisting refugees, the immense financial strain of healthcare makes it difficult to provide consistent coverage for all. 

Given the complexities of Jordanian healthcare amidst the Syrian refugee crisis, what should Jordan prioritize addressing? Some researchers argue that chronic diseases are the leading cause of mortality among Syrian refugees in Jordan and should therefore be urgently addressed. However, acute conditions are the primary impairment causing Syrian refugees to seek care. While Syrian refugees’ prevalence of chronic diseases (primarily diabetes, hypertension, cardiovascular diseases, respiratory diseases, etc.) is 29%, the prevalence of communicable diseases (the highest being influenza) is 42.9%. Although almost all Jordanian children below the age of 5 have received at least one vaccination for a communicable disease, only 50,000 Syrian children residing in Jordan have completed the full 10-vaccine program. Therefore, Jordan should prioritize launching full vaccination programs, beginning with the highly-prevalent influenza. Furthermore, because measles and polio are so close to being eradicated worldwide and may otherwise spread drastically in Jordan, the Jordanian healthcare system should also address these two diseases in their vaccination programs.  

Due to its willingness to provide healthcare services to Syrian refugees, the Jordanian government continues facing a dwindling budget. Addressing chronic diseases right away would require long-term health programs and specialized technologies, leading to a short-term increase in medical costs. In turn, Jordan would have to tighten its annual budget even further and limit providing health care to its more vulnerable populations, including refugees. Additionally, decades of research would be required to fully understand the impact of such technologies and programs, making this approach further unfeasible. Instead, funds should be directed towards services that will improve healthcare within a shorter period of time and in a more cost-effective manner. An immediately-impactful initiative would be for Jordanian healthcare providers to initiate sustainable vaccination campaigns for measles, polio, and influenza across Jordan, focusing on the immigrant and refugee youth population. Rather than treating incurable diseases via impractical medicinal trials, a greater effort should be made to prevent individuals from contracting these diseases in the first place. Although vaccination campaigns would still be costly, spending on the community as a whole would lead to less money spent per capita, leading to less spending overall. The resulting funds that are saved could then be allocated towards addressing other prevalent health conditions among Syrian refugees, including the development of smoking-prevention programs, reproductive health programs, water and sanitation facilities, and mental health services.

While some assert that Jordan should continue utilizing international donations to finance refugee health services, this approach overlooks the long-term goal of Jordanian self-sufficiency in healthcare. Jordan should invest in training staff in its local health systems to implement the aforementioned campaigns and accommodate the surge of incoming Syrian refugees. While international organizations should continue their financial assistance, Jordan should also begin funding most of its own cost-effective healthcare programs and administrative training. This funding can be achieved by having the public sector, private sector, and NGOs specific to Jordanian causes mutually prioritize the pressing economic concerns in the healthcare system and collectively allocate their resources towards eradicating them.