Urban Refugees in Amman: Mainstreaming of Healthcare
Mainstreaming of refugees into host country health, education and social service programs presents unique challenges in urban areas. Even when governments are open to such mainstreaming, refugees experience numerous barriers to utilization of mainstream programs while host communities find that often limited resources are stretched thin while accommodating a new population in need of services. To respond to these challenges, the UN High Commissioner for Refugees (UNHCR) adopted policy guidelines in 2009 that set out new approaches for addressing the needs of urban refugees. The guidelines specified that if the goals were to be achieved:
An appropriate resource base will be required, coupled with effective cooperation and support from a wide range of other actors, especially those host governments and city authorities in the developing world that so generously host the growing number of urban refugees. In this respect, UNHCR encourages states to respect and give practical meaning to the principle of international solidarity and responsibility-sharing.
In 2011, UNHCR promulgated specific guidance regarding the health services to refugees in urban areas, recommending that refugees be mainstreamed into the primary health care system of host countries to the fullest extent possible. The health guidelines further recommended referral of urban refugees with chronic diseases and tertiary health problems (at least to the extent of available financial resources) to host country medical specialists or, in rare cases, to third countries for medical resettlement.
This report is based on field research that took place between December 2010 and January 2012 that examined the mainstreaming of Iraqi and other refugees in Amman into the Jordanian health care system.1 Unlike many other host countries, Jordan has explicitly encouraged refugees to use its primary health care system while working with the UNHCR to transition refugees from a nascent parallel system of refugee-specific services that had been established soon after Iraqi refugees arrived in Jordan in large numbers. That Jordan has embarked on a policy of mainstreaming is all the more noteworthy because Ministry of Health officials repeatedly emphasize that Jordan is a country with limited resources and believe that the health and education sectors are already aggravated by the influx of newcomers. As discussed in further detail below, the government has been able to pursue health mainstreaming through collaboration with the UNHCR and World Health Organization (WHO), particularly in support of hospital-based services; its openness to working with nongovernmental organizations funded through UNHCR, which has allowed for the pooling of health related resources; and generous support from the United States to strengthen the mainstream health care system. Without this continued support, the Government of Jordan holds that it cannot be expected to provide free and subsidized services for Iraqis or other refugees.