Tuesday, October 23, 2007

"Marhabah" from Amman, Jordan

Hello, all.

I am in Jordan , where an estimated 600,000 Iraqis have fled the violence in their homeland, streaming across the border in hopes of finding a safer existence. Many of them have leveraged everything they have to secure visas and get their families onto flights out of Iraq .

By the time these refugees make their way to a major city like Amman , they have little money or economic prospects and limited access to health care. Most have also suffered the loss of a family member.

Yesterday I toured health clinics in a low-income area of East Amman , where large numbers of Iraqis have settled and where International Medical Corps is working to provide them with primary and mental health care services.

Their stories are heartbreaking. Repeatedly I heard the same phrase: “I have lost everything.”

One man morosely recounted the bombing that hit his home four months ago, killing one young daughter and paralyzing the other. His wife, who witnessed everything, has been so distraught she can scarcely leave the home. He has come to this particular clinic, which is funded by the UNHCR and run by the Jordan Red Crescent, to appeal for the expensive surgeries for his surviving daughter.

Injuries related to conflict are just part of the painful equation; these refugees have inadequate primary care and nutrition for their children, little or no reproductive or antenatal care, and many suffer from neglected chronic diseases like diabetes and high blood pressure for which they cannot afford care or medication.

At another clinic operated by the Jordan Red Crescent and French Red Cross, a little Iraqi girl was brought in by a father clearly fearful about her worsening condition. She was extremely frail, unresponsive and her pallor ashen. Her father described how hard life has been since fleeing Iraq . He is out of work and unable to afford care for his family. This clinic is literally their only lifeline.

But in addition to those seeking help at these facilities, there is an enormous population not being reached at all because they are simply unable to travel. IMC is targeting this population, planning to bring comprehensive primary and mental health services to them directly through mobile medical units.

IMC is just getting started here. The influx of refugees has been so vast and so rapid that we repeatedly discover whole new “gap” areas – suffering that is going either unnoticed or underserved. All of it is putting increasing strain on the local population, particularly among the poor who are in need of similar services.

Aside from the physical needs, these people have huge emotional needs that are largely being ignored. This is an oft-neglected area, and therefore one where IMC is taking the lead, integrating clinical mental health into primary care services.

The refugees we’re working with have been subjected to years of low-level warfare and large-scale regional conflicts, depriving them of basic life needs, and exposing them to trauma, depression and stress. This is to say nothing of those with pre-existing mental health disorders that aren’t being diagnosed or treated. For these refugees, the prospect of long-term recovery really hinges on their ability to recover emotionally as well.

One woman I met from Baghdad tearfully recounted how her brother was killed, forcing her to flee with her husband and four children. And yet she is effusively grateful for the care she is receiving at this clinic. On this day, she has brought in her young son, who has a bad cold – and she has discovered the happy news that she is pregnant.

I am astonished once again by the resilience of people who have endured relentless violence and crushing personal loss. For the man at the UNHCR clinic whose daughter was killed, and who faces losing his only other child, the outlook was grim. A Jordan Red Crescent representative explained to him that the hospital likely could not approve such expensive surgeries for one child, when so many others are in need. He gazed down, thought about this for a moment, then turned to me and offered a striking statement: “Maybe you tell people about the situation here - it might not save my daughter but it might save others.”

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