The Impact of Syrian Refugee on Jordanian National Security

Introduction

The adoption of the 1951 refugee convention is considered one of the most significant achievements in the humanitarian field. It has clearly addressed the refugee problem as ‘’a matter of concern to the international community and must be addressed in the context of international cooperation and burden-sharing’’.¹ As a country surrounded by intractable conflicts, Jordan has shared in bearing the burden on behalf of the international community as it has always been a safe haven for refugees and forced migrants throughout its history. In addition to receiving Palestinians since the exodus of 1948, Jordan has also hosted refugees from Lebanon during the 1975-1991 civil war, Iraq since the 1991 Gulf War and after the Anglo-American invasion in 2003, and most recently Syrian refugees since the escalation of the conflict since 2011.

The magnitude of the impact of Syrian refugees on Jordan as a host community has generated political, economic, social, as well as security challenges that demanded immediate and sufficient response regionally and globally.

A Jordanian census performed in November 2015 showed that there are about 1.4 million Syrian refugees residing in the country's different governorates, as of May 2017, there were 659,246 registered Syrian refugees in Jordan,²  meaning that more than 50% of Syrian refugees in Jordan are unregistered.

The majority of the refugees in Jordan live in the local communities rather than refugee camps Total urban, per urban and rural population (518,044) consist of 79% of the Total Syrian refugees register with UNHCR, as shown by table 1.

Table 1. Registered Refugees by Region in Jordan as of May 2017

Source: UNHCR, The UN refugee Agency, Syrian Regional Refugee Response. Inter-agency information sharing portal, as of May 1, 2017.

The refugees whom live in camps –Zaatari, MargeebAlfhood, and Azraq, within Jordan total (141,202), consist of 21%, which had added a large strain on the country's infrastructure, particularly towns in northern Jordan adjacent to the Syrian border.³ And table (2) shows the Syrian Refugees live in Camps.

Table 2. Registered Refugees by Camps in Jordan as of May 2017, Source: gathered information by the Author

Table 3. Budget Requirement for Sectors Affected by Refugees Crisis.

Sources: The Jordan Response Plan for the years 2014-2019 Gathered by the authors.

Problem Statement

Forced immigrant implications for host communities are diverse. Therefore, it should be taken into consideration the host communities’ economic, social, political, and infrastructure status when addressing those implications. The Syrian refugee crisis has placed financial, social, and institutional strains on Jordan as a host community. It is in the light of this that Syrian refugees might be considered as a threat to the socio-economic, political stability of the kingdom and most importantly internal and national security.

Research Questions

The study answers the following question: What are the impacts and implications of Syrian refugees on Jordan’s security and stability?

National Security Definition:

Security is generally defined as the freedom of any danger or threat. According to the Institute for Security and Open Methodologies (ISECOM) in the OSSTMM 3, security provides "a form of protection where a separation is created between the assets and the threat." These separations are generically called "controls," and often include changes to the asset or the threat.⁴ So it is a state’s ability to maintain its sovereignty and independence by identifying potential threats and elements crucial to its survival.

A typical definition of security has been a source of debate especially from a realist view of security which considers the state as the main actor, and survival as its main objective, thus seen as a "derivative of power''⁵ and simplifies the complex concept of security as almost a "synonym for power".⁶Therefore, the concept of security emphasizes the use of force and military power to counter external threats and ensure the survival of the state.

The concept of security has developed after the cold war, because potential threats were not only of traditional military kind, but also of economic, political, social, environmental nature.

Samuel Makinda defines security as “the preservation of the norms, rules, institutions and values of society”⁷ He states that all the institutions, principles and structures associated with society, including its people are to be protected from “military and non-military threats”.⁸

The United Nations Office for the Coordination of Humanitarian Affairs (OCHA) expanded the definition of security calls for a wide range of security areas:⁹

1.    Economic: creation of employment and measures against poverty.

2.     Food: measures against hunger and famine.

3.    Health: measures against disease, unsafe food, malnutrition and lack of access to basic health care.

4.    Environmental: measures against environmental degradation, resource depletion, natural disasters and pollution.

5.    Personal: measures against physical violence, crime, terrorism, domestic violence and child labor.

6.    Community: measures against inter-ethnic, religious and other identity tensions.

7.    Political: measures against political repression and human rights abuses.

Joseph J Romm, states that the phrase ‘’national security’’ was not commonly used until World War II, and 1947 National Security Act, which established the National Security Council.¹⁰

Arnold Wolfers noted that national security remains an ambiguous symbol since it can mean different things to different people, and there is no universally agreed upon definition of the term.¹¹

Harold Brown, U.S. Secretary of Defense from 1977 to 1981 in the Carter administration defined national security as the ability to preserve the nation's physical integrity and territory; to maintain its economic relations with the rest of the world on reasonable terms; to preserve its nature, institution, and governance from disruption from outside; and to control its borders.¹²

Barry Buzan classifies sectors of security analysis as follows: military security, political security which is the organizational stability of states, systems of government and ideologies that give them legitimacy.

Economic security meaning access to the resources, finance and markets necessary to maintain adequate levels of welfare and state power. Societal security is concerned with sustainability, within satisfactory levels conditions of evolution of traditional patterns of language, culture, customs, religious and national identity, and environmental security.¹³

According to a new report by the United Nations Higher Commission for Refugees (UNHCR), Jordan is the second largest refugee-hosting country in the world when compared to the size of its population.¹⁴ The massive impact of Syrian refugees on the kingdom can only be understood within the framework earlier proposed by Buzan. The five sectors of politics, economy, military, society and environment will be examined to assess those five sectors as components of Jordan’s national and internal security.

There is no doubt that Jordan has faced significant external and internal threats to its national security. A country with poor resources and directly influenced by the push and pull factors of regional politics and players due to its location. Surrounded by Israel, Syria, Iraq, and Saudi Arabia, Jordan struggles in maintaining stability and security. It is both a blessing and a curse for Jordan to share the burden of the Arab-Israeli spillover, the waves of refugees from Iraq and Syria and refugees from different Arab states. However, those pressing issues attracted foreign aid and support for Jordan, boosting its role as a key player in the region and maximizing its security. But Jordan today faces more challenges than ever, and unless an adequate immediate response is provided, its national security can be subject to more serious threats, especially after the Syrian refugee influx.

Socio-Economic Impacts of Refugees

Hosting a large number of Syrian refugees has added to the negative economic effects and put public services under pressure, the camps has further aggravated the kingdom’s already poor infrastructure and scarce resources. As Jordanians increasingly feel the impact on their daily lives, and security concerns grows, the increase in unemployment rates, as well the rightful access for all citizens to quality public services, education and health facilities Jordanians have found themselves confronted with additional competition from Syrians in local job markets, with a dangerous increase in child labor, which added pressure on local wages and caused food, fuel, rent and in some cases, water price inflation.

The Syrian refugees have flooded the local labor market and affected the chances of the local residents, especially the lower classes, where most workers are unskilled, to earn a respectable living. These refugees intensify the competition for jobs, and prompt both higher rents and lower wages than what was previously paid to Jordanian employees. Social cohesion between Syrians and host communities has deteriorated and the Syrian crisis become progressively politicized (EUI 02/2015).

One of the challenges that face Jordan as a host community for Syrian refugees is responding to their needs which place an enormous pressure on the kingdom’s poor infrastructure, economic, institutional and natural resources. This sudden increase in the population means more demand and competition for access to public utilities, schooling, health services, infrastructure and jobs.

Also, the quality and availability of education and health care have declined as overburdened facilities have struggled to cope with the significant increase in numbers of students and patients. Schools are overcrowded, even though a double-shift system has been introduced in which Jordanians are taught in the mornings and Syrians in the afternoons. People wait a very long time before receiving medical attention. Local water shortages have also increased. Municipalities lack sufficient capacity and funding to deliver and maintain essential services for the tens of thousands of new residents, the arrival of whom has created a need to build new roads, expand the electricity infrastructure and collect much more waste.9

Another reason for Jordan’s burgeoning trade deficit is the closing of trade routes between Jordan and Syria. Syria is an essential trade route for Jordan for imports and exports. Closing this trade route impacts negatively on many trade agreements between Jordan and countries in the region, and hence on Jordan’s economy, and is forcing the Jordanian government to seek commercial alternatives.

The cost of hosting refugees with scarce international aid impacts the kingdom’s services sectors, like education, health, water, energy and housing. Increasing pressure on public finances and affecting the quality of northern governorates could exacerbate vulnerabilities for the poorest segments of the Jordanian population, specially the competition in the job market and the high level of unemployment among Jordanian youth.

Since the outbreak of the crisis, Jordan coordinated with UNHCR to deal with the Syrian Refugee situation, the first waves of Syrian refugees were welcomed and hosted by Jordanian families in bordering towns, especially Ramtha. But with the increase in the influxes, Syrians were seen occupying public parks and spaces. In the meantime, Al Za’atari Camp was established in Mafraq.¹⁵

Perhaps one of the challenging stages for both refugees and the host country is employment and social integration. While hopes remain for some refugees to return to their homes after the end of the conflict, the Syrian blood shed scenario is unlikely to reach an end. Support from international organizations at the beginning of the conflict was sufficient, but now since the highest percentage of refugees live outside camps, they need to find jobs and a stable income. This in return fuels frustration and anger among Jordanian youth who suffer from unemployment and face competition from Syrian labor that is willing to work for a modest wage.

The impacts of the refugee presence in a host country can be both positive and negative.¹⁶It all depends on factors related to the state’s economy, policy, demography, geography and so on. A refugee situation can benefit and harm the host country altogether. For this reason, Jordan released the Jordan Response Plan Document to create balance between supply and demands of refugee and vulnerable Jordanian community needs.

Generally speaking, the refugee presence in hosting countries may impact ethnic balance of hosting areas, or lead to social conflict, and hinder the deliverance of social services. It has been a misconception that Syrian refugees seem to benefit from access to resources that may not be available for the host community members. This is only because the host community itself lacks the same resources as the refugees, especially in northern governorates which represent the largest refugee receiving community.

One of the social challenges facing Jordan’s economy is poverty. The presence of Syrian refugees would force the government to double its efforts in combating this phenomenon. The competition on financial resources which were directed towards vulnerable Jordanian communities and the popular sympathy with the Syrian issue led many to extend their support to the Syrians at the expense of Jordanians. It is strongly believed that it has had an impact on efforts made by civil society organizations and individuals in combating poverty.¹⁷

Table (4) Financial Requirement for the Protection Sectors

Sources: The Jordan Response Plan for the years 2014-2019 Gathered by the authors.

Direct Budget Support

The JRP 2017–19 plan seeks to address the needs and vulnerabilities of Syrian refugees and Jordanian people, communities and institutions affected by the crisis through the above mentioned 12 sectors. However, income losses and budgetary costs which burden the Jordanian economy cannot be addressed through the implementation of the intervention. The table below shows the major sectors that require direct budget support to compensate for the additional costs and losses resulting from the Syria crisis.

Table (5) Direct Budget Support

Sources: The Jordan Response Plan for the years 2017-2019 Gathered by the authors.

Political and Security Impacts

In some cases, refugees may not have a significant impact on the host community’s political or security situation. However, in Jordan’s case, while the kingdom is a part of a coalition that targets terrorist groups and combats extremist radical ideologies, a threat to its internal and external security is likely to occur. Since Jordan maintained an open border policy to Syrian refugees fleeing the war. According to Salehyanthe influx of refugees from neighboring countries can destabilize neighboring countries in certain cases. Refugee flows may cause international disputes between sending and receiving countries. First by constituting a negative externality borne by receiving states, and these states may launch military actions to block their borders, threaten and even invade the sending state to prevent further flows. Second, the sending states may violate the sovereign territory of the receiving state in order to target political and/or ethnic rivals that have fled across the border. Moreover, such conflicts are more difficult to resolve through bargaining because promises to end refugee-producing human rights violations and attacks against dissidents are not credible¹⁸

While such an impact was not clearly visible in the Syrian refugee case in Jordan. Fear of attacks at the Syrian-Jordanian borders urges the kingdom to maximize its border security and abandon the open border policy to avoid incidents similar to Al-Rukban camp bombing in January 2017.¹⁹

The War Against ISIS

The Islamic State, also known as Daesh, Isis, or ISIL, emerged in 2013 as an extension of Al Qaeda. Since then, ISIS has conquered significant parts of Syria and Iraq, declared a Caliphate in 2014 andbecame notorious for extreme savagery and brutality.

Since joining the U.S. led international coalition against Isis, Jordan has become increasingly involved in the fight against the Islamic state and terrorism targeting the kingdom. However, the release of a video in February 2015 showing captured Jordanian pilot Moath Al-Kasasbeh being burned alive, further fueled the Jordanian public against Isis. The people demanded ‘’revenge’’

And in response, the Jordanian government executed two convicted terrorists and carried out a series of air strikes in Syria in the days following the release of the video.²⁰

As Jordan seeks to secure its borders against Isis, the kingdom has concerns regarding the threat Isis poses as an ideology and a terrorist group. The fear of smuggling terrorists among Syrian refugees crossing the borders or taking advantage of Jordan’s fragile economy and domestic instability as well as spreading extremist jihadi ideology in the name of Islam. Jordan had faced terrorism before Isis in 2005, when members of Al-Qaida carried out deadly suicide attacks in Amman, killing 57 people.²¹The danger Isis poses to Jordan is not military wise. The Jordanian Army is well trained and can defend the external threat. However, the real danger comes from the ideological fear that is trans-boundary. In one of his published articles in AlGhad newspaper Mohammed Abu Rumman, wrote “the real danger of [ISIS] is not external, it is internal."²²Radical ideology often targets middle class, camp residents living in remote areas far from the capital. What Jordan needs right now is countering extremist thought by adopting effective approaches even when dealing with returned Jordanian jihadis from Syria.

Local Governance and Municipal Services

The local governance and municipal services plan of the JRP seeks to enhance the capacity and responsiveness of local administrations through a resilience-based approach that assists municipalities in coping with and recovering from the impact of the Syrian crisis. It also focuses on service delivery performance, solid waste management, investment in infrastructure, social cohesion, and cross-sector cooperation.

The JRP plan pays special attention to the most affected areas in the kingdom, mostly northern governorates which are likely to be tension-prone areas. Social cohesion interventions mobilize activities that foster tolerance, co-existence and cooperation. The procurement of solid waste machinery and equipment will be employed to handle additional waste production. Rapid planning and coordination on the other hand will speed up the recovery of affected areas, while the construction of sanitary cells will serve only as an emergency response. The plan encourages financial independence of municipalities; therefore, it aims at improving the performance of existing revenue collection to increase the overall revenue flow, and eventually introducing alternative approaches.

Capacity building interventions will help municipalities and the wider local administration structure in Jordan in planning and responding to the needs of citizens and refugees, with a special focus on gender, youth and persons with disabilities. Finally, participatory approaches to planning and budgeting as well as better information management and coordination are essential for fostering efficient local government responses.²³

Education Challenges

Since the 1980's Jordanian government has invested heavily in the education system, enabling it to perform well in comparison with other middle-income countries and the Middle East and North Africa region. However, the Syria refugees having a profound impact on the education sector by flow of Syrian refugees into Jordanian cities and villages, in particular on public schooling.

The Syria crisis continues to have a profound impact on Jordan’s education sector, and in particular on public schooling. During the school year 2015/2016, there were 236,304 school-aged Syrian boys and girls registered as refugees.

Out of 659,246 Syrian refugees in Jordan, some 236,304 are school-aged children (117,306 boys; 118,998 girls).²⁴ By the end of the 2015/2016 school year, 145,458 Syrian refugee children were enrolled in public schools in camps and host communities, an increase of 16,104 students (12 percent) compared to the previous academic year.²⁵ With an increase of 875 per cent compared to the 2011/2012 year.²⁶ In the school year 2014/2015 Syrian students are enrolled in public schools 226,486 school-aged Syrian boys and girls registered as refugees, including 129,354²⁷ who were enrolled in public schools in camps and host communities. The number of Syrian students during the year 2011 7,337, compared with 44,022 in 2012 and, 111,589 by the end of 2013 whereas Jordanian students numbered 1.7 million, in 6,355 schools.

Meanwhile, around 170,000 Syrian refugee children have been enrolled in public schools for the school year 2016/2017.²⁸ A total of around 90,846 Syrian children registered with UNHCR remain out of formal education, a figure that substantially increases to 118,840 children when calculations are based on the 2015 Census data.²⁹ Many refugees’ households cannot cover the cost of education due to their increasingly fragile financial situation, with children living in northern and eastern regions being particularly affected.

Around 47 percent of schools are crowded (as of 2015/2016), up from 36.6 percent in 2012/2013.³⁰ As part of efforts to improve quality of education, an intensive planning exercise was conducted at school camps to decongest classrooms, the result of which was a 50 percent decrease in the teacher-student ratio by the start of 2015/2016 school year. In order to create an educational opportunity for Syrian Children into public schools, double shift were introduced in 98 schooled year in 2013-2014, in addition to another 102 schools in the year 2016-2017. Also, there is a plan to added four school complexes in camps to accommodate refugee children.

Table 6. Syrian Refugees enrolled in public educations

Sources: Ministry of Education Statistics the years 2011-2018.

The Syrian crisis created a burden on the treasury of the Hashemite Kingdom of Jordan, by carrying a large part of the education expenses. As the number of Syrian students in the public schools increased reaching approximately 130 thousand Syrian students during the 2015-2016 academic year, where the numbers of students in the classrooms increased in an unprecedented manner, reaching more than seventy students per classroom in some cases. This state was accompanied by a shortage of educational staff, both teachers and administrators. To solve this problem, the Ministry of Education started applying two shifts (a morning and evening shifts) in more than a 100 public schools, which put pressure in the general infrastructure of the sector (The Ministry of Education, 2016).

The burdens of the education sector has been assessed in the 2016 Syrian asylum crisis plan which had been prepared by the Ministry of Planning and International Cooperation for a total of $249,638,101 or a total of approximately two hundred and five million dollars ( Ministry of Planning and International Cooperation, 2016). As for the higher education, the Syrian students represent (%16.4) of the total number of foreign students in the Jordanian universities, which makes the approximate total of Syrian students in the Jordanian universities 6670 students, and the number of foreign students 40598 student. The majority of these students enroll in medical and engineering majors, in addition to that these refugee students after graduating from the universities constitutes another source of unemployment in the Jordanian market, which is already suffering from increasing unemployment, and especially for the female refugee population (Ministry of Planning and International Cooperation, 2016).

Most of the Syrian students who are in school suffer from financial hardships as refugees, and are looking for sources to finance their studies, there are some organizations which provide some scholarships for the Syrian students. This has led relief organization such as the UNHCR to play an important role in mobilizing international support in addition to coordinating the relief efforts and assistance to meet the refugee needs (Al-Khasawneh, 2016). Another problem had emerged, the issue of certificates, during this year more than 250 Syrian high school degrees and 50 university degrees were forged, which pushed the Ministry of Education and Scientific Research to request all Jordanian Universities to provide them with the Syrian High school documents in addition to the Bachelor degree certificates in the Jordanian universities, which the students were accepted upon, in order to ascertain their validity, as it became clear that there are some websites found on the social media which tempt Syrian refugees, sending them false high school certificates as well as forged university degrees (Ministry of Higher Education, 2016). The following table shows the number of registered Syrian students in the Kingdom's schools (a comparison between the years 2013/2014, 2014/2015 and 2015/2016).

Energy Challenges

Jordan is one of the world’s most energy insecure countries. Jordan imports more than 97 percent of its energy from international markets at international prices, energy imports accounted for 13 percent of gross domestic product (GDP) in 2015.³¹ Energy imports for the year 2016, increased to 18 percent of gross domestic (GDP).

The need for fuel increased after Egyptian gas was cut off, following the revolution of 25 January 2011; this prompted power plants to return to the use of heavy fuel and diesel to generate electricity, which was becoming increasingly necessary as a result of the high population growth caused by the Syrians refugees in Jordan. This raised the electric loads in Jordan to record levels that reached 2800 megawatts, compared with the normal load, which did not exceed 2500 MW before the Syrian refugees.³²

During the period 2011- 2015, the total accumulative governmental subsidies for petroleum and electricity products reached USD 7.1 billion.³³ The total residential electricity consumption rose significantly from 5548 gigawatts (GWh) in 2011 to 6,938 GWh in 2015. The consumption of liquefied petroleum gas (LPG) increased from 370,000 tons in 2011 to 420,000 tons in 2015. As per the latest statistics, electricity consumption in the northern governorates (those mostly affected by the Syria crisis) showed an additional increase of 2.3 percent compared to other governorates in Jordan.³⁴

The sudden influx of population growth due the increasing number of refugees has led to an increasing demand on the energy sector. The Syria crisis has exacerbated long-standing structural challenges in the energy sector in terms of supply, demand and management. Securing a sustainable energy pathway for Jordan is more critical today than ever.³⁵

Over 80% of refugees are settling in rural and urban areas of Jordan, contributing to an increase of total residential electricity consumption from 5548 GWh in 2011 to 6,938 GWh in 2015.³⁶ Consumption of light petroleum gas (LPG) has increased from 370,000 in 2011 to 420,000 tonnes in 2015.³⁷ Latest available statistics show that electricity consumption in the northern governorates, where most of the refugee population lives, have increased by 2.3% compared to other governorates in Jordan.³⁸

The greatest difficulty Jordan has faced since 2009 is with the supply of energy, and the situation has worsened in the last seven years, with the constant influx of Syrian refugees who have spread throughout Jordan, to the point that their numbers exceeded the numbers of native citizens in some places, not to mention the refugee camps that have been established on the outskirts of some cities. Syrian refugees now constitute nearly Fourteen percent of the population of Jordan.³⁹

According to the Jordanian Ministry of Energy and Mineral Resources, the cost of imported energy amounted to approximately 4.08 billion JOD (about 17 percent of GDP), at a time when the ministry estimates that the demand for oil and gas is going to increase by 5.5 percent by 2020, that is, about 12.5 million metric tons in oil equivalent, an increase of 50 percent over last year see table below.

Demand for electricity is expected to increase by 6.4 percent by 2020, to 28 giga watts, an increase of 75 percent from last year.

Sector assistance in camps is focused on delivering adequate energy to every household for the purposes of cooking and refrigerating food, lighting and heating homes, lighting streets, charging electronics, and washing clothes. In urban areas, interventions should focus on utilizing safe RE&EE technologies at the household level.⁴⁰

Table (7)

Source: The Jordan Response Plane for the Syria Crisis 2017-2019

Health Challenges

Jordanian health services have also been under a great deal of pressure, as those services are provided by privet and public sector, in hospitals and health centers across the kingdom, to all Syrian refugees who enter its territories. The demand for health services from Syrian refugees in Jordan continues to place acute pressure on the national health system, posing risks to the population's health status and social stability.

Meeting the basic living needs of Jordan’s citizens and the new population has become increasingly difficult for a country already poor in resources. The Government of Jordan and the Jordanian people are committed to assisting Syrians and others Refugees. The Ministry Of Health (MOH) has spent an at least US$15 million on care to refugees between January and April, 2013, but every year Jordan government spent every year more than 200 million dollar a year. During the same period, only $5 million was provided in direct support to the MOH by UN agencies.⁴¹

The Ministry of Health has deployed its personnel in camps and other areas where Syrians are concentrated, so that it may deal on a first hand basis with the diseases appearing among the refugees, by taking all the necessary measures for the prevention of communicable diseases.

About 80% of Syrian refugees are residing among host Jordanian communities. Only 21% of the Syrian refugees reside in camps, which started in early 2012; the largest camp is Zaateri, with an estimated population of (80,000).In the camps, UNHCR and other partners, with the support of the Jordanian Ministry of Health (MOH), provide health and humanitarian support. However, for the larger proportion of refugees outside the camps, not all needs can be adequately addressed. The Jordanian MOH provides full access to health services for the Syrians outside camps along with the local Jordanian population. Additionally, some non-governmental organizations and private sector practitioners also deliver services to Syrian refugees outside the camps.

For example, During the year of 2013 the Ministry of Health have revealed the emergence of 24 diseases: such as 1748 cases of chronic diarrhea, 642 of hepatitis A, 529 of scabies, 491 of chicken pox, 86 of measles, 102 of tuberculosis, 80 of cutaneous leishmaniasis, 77 of female sterility, 26 of non-epidemic meningitis, 23 of typhoid and paratyphoid, and 19 of hepatitis B. Syrian refugees using Ministry of Health Hospitals by the year 2013 (80097) Syrian Refugees admitted to MOH Hospitals, 9168, where as the Syrian Refugees who required surgeries at MOH Hospitals, 2646. Also, Syrian refugees using MOH health centers (132432) see table below.

The Syrian refugee crisis and the health situation in Jordan after 2011

The influx of Syrian refugees into the Jordanian territory and their stay in camps which had been especially established for them, in addition to the inadequate availability of health supplies led to the spread of many epidemics and conic and non-chronic diseases. Consequently , the health sector in the Kingdom provided all preventative health services for the refugees, in addition to providing awareness and all of the services provided by the Ministry of Health to the Jordanian citizen without any discrimination (Government of Jordan and the United Nation,2013), in addition to that all of the treatment services were provided to the Syrian refugee patients free of charge until the month of November 2014, for the high cost of treatment led to the change in the mechanism of dealing with them, where they were treated like uninsured Jordanians, which provides them with 80% subsidized health services and some services were still provided free of charge such as: MCH services, Thalassemia patients and vaccination ( Ministry of planning and International Cooperation, 2016).

The Syrian refugee patients are treated in the hospitals and health centers of the Ministry of Heath as uninsured Jordanians, and are charged directly, as for the Syrian refugee patients who are suffering from mental illnesses, alcohol and drug addiction, drug poisoning, snake or scorpion sting, AIDS, chronic blood diseases, Septic thalassemia, sickle cell anemia, genetic immunodeficiency, immunodeficiency, cystic fibrosis, and the diseases of children under 6 are treated the treatments of the capable Jordanian. In addition to that the Jordanian government took a series of measures to improve the Syrian refugees treatment in the health sector, some of which ( Government of Jordan and United Nation, 2013):

Raising the capabilities of those working with the Syrian refugees through training them and providing therapeutic and counseling guides.

coordinating with the international organizations to provide treatment and material assistance

Helping with forming mobile field teams as to reach all of the refugees in all areas.

Assisting and coordinating with other governmental and non-governmental bodies to provide necessary assistance such as civil status, for the purpose of obtaining birth certificates or logistical help such as providing aids to persons with special needs.

Providing all elements of first aid, which includes: vaccination in accordance to the national immunization program in addition to the implementation of vaccination campaigns of their own, because of their non -compliance with the program in their countries since the crisis, in addition to that providing epidemiological services and follow up, treatment of contagious diseases and the prevention of those diseases, monitoring treating the diseasing prevalent among them, discovering and wiping out the congregations for some diseases such as tuberculosis and the other diseases, furthermore the full supervision of school health in their schools, environmental supervision and the monitoring of drinking water and sewage, providing all publications and family planning methods , the follow-up of Women's and children's heath work, and finally conducting various educational and health awareness workshops in the various activities aimed at them. The following table shows the health situation and the health services provided to Syrian refugees for 2015-2016, within and outside of the camps.

Table 9.

Source: The health situation outside of camps until 31/6/2016, and the health situation within camps until 30/9/2016.

Moreover, Services are overstretched. For example, the Mafraq Government Hospital—the closest hospital to Zaateri camp—has 16 neonatal incubators: two of these incubators are used by Jordanians, two by other internationals, and 12 by Syrian refugees. There has also been a huge increase in surgical care demand. Surgical operations for Syrian refugees done in MOH facilities have increased rapidly (from 105 operations in January, to 622 in March 2013).

This is aggravated by high healthcare expenditure and the prevalence of non-communicable diseases (NCDs) among refugees. Similar trends for admission of Syrians to MOH facilities has been observed, reflecting the rapid influx of refugees into the country. Surgical and trauma care needs include amputations, burn care, acute surgical conditions (eg, accidents, falls) that affect those exposed to conflict, as well as treatment for weapons-related wounds, disabled, war-wounded, and older refugees also present significant challenges, particularly as war-related injuries require costly surgical treatment and lengthy rehabilitation. More than half of Syrian households suffer from severe or high health vulnerability,⁴²while around one-third of Jordanian children under below five years of age are anaemic, and vitamin A and iron supplementation is alarmingly low among this age group.⁴³ Low tetanus toxoid vaccination coverage among women of reproductive age (TT1 65 percent overall and TT2 coverage 20 percent) poses serious public health risks and concerns regarding protection of women and their newborn infants from tetanus.⁴⁴Meanwhile, the humanitarian situation at the north-eastern border is of increasing concern.

Jordan remains at risk of infectious disease outbreaks, including polio, measles, H1N1 and Middle East respiratory syndrome corona virus (MERS-CoV). Around one third of the Jordanian population do not have access to universal health insurance coverage.⁴⁵

Furthermore, according to Ministry of Health officials in Jordan, there have been 13 cases of mumps, 13 of food poisoning, 8 of nonpulmonary tuberculosis, 7 of H1N1 flu, two of typhus, two of acute flaccid paralysis, two of brucellosis (Maltese fever), one of whooping cough, one of rubella (German measles), one of alopecia (hair loss) and one case of gonorrhoea.

As a result of the increase of the Jordan Populations became clear that there is a need for an additional 2,886 hospital beds and 22 comprehensive medical centers in Jordan, with 69 per cent of additional hospital bed capacity and 83 per cent of additional comprehensive health centre capacity required to meet the need of the demand by the Jordanian people and refugees health system. There are shortages of human resources for health, particularly in nursing and medical specialties, with variable availability across the country. The MOH identified a need for an additional for the year of 2016 1,022 doctors and 866 nurses in Jordan.⁴⁶

Conclusions

Jordan faced challenges in security, economic, social and Energy and Educations aspects before refugees crisis, but with the existence of the refugees in Jordan this has increased the challenges and problems faced by Jordan and has a negative impact on the mentioned aspects before. It is clear that the Syrian crisis and refugees have had an effect Jordan.

The humanitarian spill-over of the crisis in Syria has resulted in severe burdens for the host countries especially these countries have limited resources. The international community to step up to the challenge and be more active and forthcoming in burden sharing.

The truth is that the international support to the governments and the host communities has been minimal in relation to the needs. Due to the protracted character of this crisis, this support needs to massively increase.

International community have to move beyond short-term humanitarian responses for Syrian refugees and start to address the immediate to long-term, structural, economic and development impact this crisis is having on the countries hosting them as well. What is happening in Syria will have profound implications for neighboring states for years to come. The Jordanian fears the situation will get even worse. International community must large-scale commitments incorporating humanitarian and emergency development support. This would include the involvement of international financial institutions.

References