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A promise of tomorrow: The effects of UNHCR and UNICEF cash assistance on Syrian refugees in Jordan

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Executive summary

Despite the generous hosting by the Government and people of Jordan of Syrian refugees, more than 650,000 registered Syrian refugees in the country, continue to face a highly uncertain future. They cannot go home, given the ongoing conflict and insecurity in Syria; many of the most vulnerable struggle to find suitable employment that would enable them to support themselves and their families while in Jordan; around 80% reside outside of the camps amongst the host community; and the United Nations (UN) cash assistance programmes that enabled them to make ends meet are increasingly jeopardised by budget cuts.

Unfortunately, while refugees’ options are heavily restricted, their needs are not. With their savings exhausted, assets already sold, and borrowing and debt on the rise, despite recently improved access to work opportunities, UN social assistance programmes are helping tens of thousands of registered refugee families make ends meet on a daily basis. It is against this background that our research is set.
This study aimed to find out what effects the United Nations High Commissioner for Refugees (UNHCR) and United Nations Children’s Fund (UNICEF) cash assistance has had on beneficiaries’ lives. It had the following objectives: (1) to evaluate beneficiary spending patterns and their effect on family well-being; (2) to evaluate the efficiency, effectiveness and accountability of cash assistance provided by UNHCR and the Child Cash Grant (CCG) provided by the UNICEF; and (3) to evaluate the complementarity of (as well as gaps in) programming by UNICEF, UNHCR and the World Food Programme (WFP) in targeting the most vulnerable groups.

Methods

Our mixed-methods study included a literature review as well as one round of quantitative data collection and two rounds of qualitative data collection. The quantitative findings were collected through household surveys completed by respondents in 2,114 randomly selected households spread across four governorates (Amman, Irbid, Mafraq and Zarqa) between December 2016 and March 2017. In order to explore the effects of different types of cash assistance, as well as to ascertain how they complement one another, respondent households were selected from six groups of social assistance beneficiaries – i.e. those receiving:
1. UNHCR cash assistance, UNICEF CCG, plus full-value WFP vouchers;
2. UNHCR cash assistance, UNICEF CCG, plus half-value WFP vouchers;
3. UNHCR cash assistance plus full-value WFP vouchers;
4. UNHCR cash assistance plus half-value WFP vouchers;
5. WFP full-value vouchers and no cash assistance;
6. WFP half-value vouchers and no cash assistance.

In addition, where possible, household-level changes were assessed by comparing households’ vulnerability status at the time of UNHCR’s first home visit – undertaken as part of the Vulnerability Assessment Framework (VAF) in 2014-2016 – with findings from the Overseas Development Institute (ODI) survey undertaken in 2016-2017.

The two rounds of qualitative data collection were undertaken in December 2016 and May 2017. They covered the same four governorates as the quantitative work. In order to engage with a wide array of stakeholders, qualitative researchers visited urban and semi-rural communities, including informal tented settlements, and used focus group discussions (FGDs) (with adults and children separately), key informant interviews (KIIs) and case studies.

Key findings

Our primary research found that refugee households remain highly vulnerable. Most have expenditures that exceed their reported incomes – in some cases quite dramatically – and are living in overcrowded conditions that exacerbate health risks. Many children, especially older adolescents, remain out of school, and good nutrition is impossible for the majority. Refugees’ psychosocial wellbeing is poor and their opportunities for socialisation and participation limited, especially for women. Fortunately, our research found that UN cash assistance is broadly making lives better – especially when it is combined with full-value WFP vouchers.

Here, we summarise our findings, organised (as in the body of the report) by domain.

Household income and expenditure

Cash assistance is critical but does not fully meet basic expenditure needs

Our research confirmed that the vast majority of refugee households are living below the Jordanian poverty line. On a monthly basis, across our entire sample, median household expenditure exceeds median household income by 20 Jordanian Dinar (JOD) (285 vs 265 JOD). We also found that expenditures are rising over time. On a monthly basis, for example: rent is now a median of 10 JOD higher than it was at UNHCR baseline (findings compiled from first home visits in 2014-2016); expenditure on utilities has risen from 20 JOD to 35 JOD; health costs are up from 15 JOD to 29 JOD; education expenditures are up from 9 JOD to 35 JOD; and transport costs have doubled from 10 JOD to 20 JOD. In some cases, cost increases are likely positive – e.g. rising spending on education reflecting children’s improving access to school. In other cases, such as health care, rising costs likely reflect households’ shrinking access to free and reduced-price services. Our research found that UN cash assistance is critical to helping households meet their expenditure needs. Indeed, over 50% of participants reported UN cash assistance being their sole source of income. Households receiving all three UN types of assistance – UNHCR cash assistance, the UNICEF CCG and full-value WFP vouchers – have median incomes that exceed their median expenditures (370 JOD vs 321 JOD). This is not the case for households receiving only WFP vouchers (a median of 180 JOD vs 248 JOD).

WFP vouchers play a key role in household survival

Critically, our research found that full-value WFP vouchers are a necessary package component. Households that receive both forms of cash assistance but only half-value vouchers spend more each month than they bring in (a median of 300 JOD vs 260 JOD). Effects are particularly visible on a per capita basis: median income for those that receive all three cash assistances is 58 JOD (vs 51 JOD in expenditures). Those receiving no cash, only full-value vouchers, have median expenditures that far exceed their incomes (65 JOD vs 45 JOD). Those receiving both of the cash transfers but only half-value WFP vouchers have median per capita incomes of 64 JOD – and median per capita expenditures of 70 JOD.

Research participants reported that cash had helped them meet a range of household expenses. For example, 92% of respondents said that cash assistance had helped them to pay the rent and 40% that it enabled them to pay utilities or move to a better house. About one-fifth also reported improvements in debt-load, ability to buy clothes for children, and ability to give children an allowance. The UNICEF CCG was felt to be particularly important for improving children’s well-being. Nearly four-fifths of beneficiaries said that the CCG had helped them buy clothes and shoes for their children and over half reported buying more food and accessing more health care as a result of the grant.

The majority of female respondents reported that they control spending (ranging from 67% on food and toiletries to 85% on water, sanitation and hygiene (WASH)). Just over two-thirds reported that cash has helped give women a greater say in household expenditure.

Employment opportunities

Cash assistance is not a springboard to employment**

While our qualitative work suggests under-reporting, only 18% of survey respondents reported earned income from wages in the past year, and only 15% across all assistance categories earned income from self-employment. Respondents living in Amman were far more likely to report earned income (29% from wages and 31% from self-employment) than those living in Irbid (2% from wages and 0.4% from self-employment). We also found that fathers were more likely to earn an income than mothers, and that when women work, it is mostly homebased self-employment (or domestic service), due to social norms that constrain their mobility outside the home. While survey respondents told us that few children were engaged in child labour – and very few children earned an income – our qualitative work suggests a different reality. Indeed, we found that most adolescent boys appear to work – sometimes for long hours in exploitative conditions and almost always for very low pay.

Despite the 2016 Jordan Compact, which promised to open 200,000 work opportunities for Syrians and ease the permit application process, only half of survey respondents knew they could get a work permit. Of those, only 20% had applied for one. Those who had not applied found the process overwhelming, were too ill to work, or – in the case of women – reported that work was not socially acceptable. In FGDs, refugees also told us that Syrians remain locked out of the most desirable jobs and are often exploited when they undertake work.

Our research found that cash is not a springboard to employment. Indeed, those receiving cash are less likely to report income from wages or income from selfemployment than those not receiving cash – regardless of the cash assistance package. Differences are quite large: for example, only 11% of those receiving UNHCR cash report income from self-employment – vs 23% of those not receiving UNHCR cash. A partial explanation could be that agencies target the most vulnerable for cash assistance, including those who are unable to pursue full employment due to factors including disabilities, single headed female households and the trauma effects of conflict. In addition, those that are receiving cash might be afraid to report earned income because they fear losing access to cash assistance. It is also possible that the cash assistance is working as designed and is helping families avoid the need to have their sons engage in child labour.

Coping mechanisms

Cash assistance is helping families avoid harmful coping strategies

Refugee households employ a wide variety of coping mechanisms to help make ends meet. Most survey respondents, for example, reported eating less expensive food (75%), reducing accommodation costs (73%), reducing food intake (72%), and borrowing (60%). Very few, however, admitted to using the types of coping strategies that they perceive will be frowned upon. For instance, only 1% said they have sent their children to work in the past month, only 3% said they had married their daughters to reduce expenditure, and only 5% said they had pulled children out of school. Our qualitative work suggests very considerable under-reporting.

Our research found that cash assistance is helping families avoid dangerous coping strategies. When asked what strategies they had been able to avoid because of cash assistance, half of respondents reported eating cheaper food, eating less food or reducing housing costs. Nearly 45% said they had been avoiding going further into debt. Similarly, whereas 26% of households had pulled a child out of school due to financial reasons at the UNHCR baseline (2015), only 5% of ODI’s sample had done so.
A similar pattern was seen in regard to borrowing money – the frequency of which declined from 79% to 26%.

Shelter and living conditions

Cash assistance is improving access to housing

Our research found that the living conditions of Syrian refugees are overall quite poor. While 95% of our respondents were living in permanent housing – as opposed to informal tented settlements (ITS) – crowding remains extreme due to supply constraints. We found a median of 3.7 people sharing a single bedroom, up from 2.5 at UNHCR baseline, probably due to the subdivision of already small spaces. Households receiving larger assistance packages, which tend to be poorer and have more members, have higher crowding ratios – as do those living in urban areas. About one-fifth of families are still sharing toilets (down from 30% at baseline), 12% had run out of water at least once in the past month (down from 20% at baseline), and only 76% of homes were connected to the public sewer (up from 69% at baseline). Nearly all, however, had electricity (96%), a TV (90%) and a refrigerator (85%).
Interestingly, most households (62%) understood the constraints to adequate shelter well enough to report being ‘satisfied’ with their housing, regardless of conditions.

Our qualitative work found that some groups of refugees were far more vulnerable than others. For example, those living in ITS tended to have dangerously unhygienic WASH conditions. Similarly, girls and women and those with disabilities were often far more affected by bad housing conditions than boys and men and those without disabilities – because they were largely confined to home.
Our research found that cash assistance is improving Syrian refugees’ access to housing, with over 90% of respondents reporting that cash was helping them to pay rent and 40% that it had helped them move to better housing. Only 27% of those receiving all three types of UN cash assistance, for example, reported that they cannot pay in full for rent, compared to 52% of those receiving only WFP vouchers. Findings are similar for households’ ability to pay for electricity, fuel and heat.

Furthermore, while 72% of those receiving only WFP vouchers reported that their housing is bad – and 26% reported that they are not satisfied with their housing – rates for those also receiving UNHCR and UNICEF cash assistance modalities were notably lower, at 58% and 19% respectively. Indeed, when asked to identify how the cash assistance had contributed most to their family’s wellbeing, 26% of survey respondents said ‘better housing’.

Food consumption and nutrition

Cash assistance is enhancing household food consumption as are full value

WFP food vouchers Our research found that Syrian refugees living in Jordan, especially those in informal tented settlements, are highly vulnerable to food insecurity. Over half of the survey respondents (55%) reported having experienced a food shortage in the past month. Indeed, the average number of food shortage incidences in the past month was 8.5 (median 5). Larger households, those headed by women and those in Amman were especially likely to experience food shortages.
In addition, 70% of respondents admitted to skipping at least one meal in the past week due to lack of money, and 60% reported having reduced either the frequency or size of meals. When asked how many meals their family had consumed yesterday, 73% of respondents said two and 10% said only one. Over 60% of adults had restricted their own food intake so that children could eat more.

Our research found that cash assistance is helping refugee families eat more and higher-quality (i.e. proteinrich) food on a more regular basis. While noting that the value of WFP vouchers in 2017 is half what it was in 2015 – a reality which has hit even families receiving cash assistance hard – those benefiting from both UNHCR cash and the UNICEF CCG are less likely to experience a food shortage (51% vs 57% of those receiving only full-value WFP vouchers). They are also less likely – on a weekly basis – to forgo meat (27% vs 38%), eggs (10% vs 13%) and dairy (14% vs 20%), and more likely to have an acceptable food consumption score (90% vs 82%) and be able to pay for drinking water.
Unsurprisingly, full-value WFP vouchers are also critical to household food security. Across both cash beneficiary groups (those receiving both UNHCR and UNICEF cash assistance and those receiving only UNHCR cash), households receiving full-value vouchers are more food secure than those receiving half-value vouchers.

Education

Cash assistance is supporting greater spending on schooling and improved academic performance but is not linked to a significant increase in enrolment

Our quantitative survey found that despite the commitment of the Jordanian government, UN bodies and nongovernmental organisation (NGO) partners, school-aged Syrian refugees still face considerable barriers to education. Overall, 20% of children under the age of 18 remain out of school, with younger children far more likely to be in school than older adolescents (90% for those under 12 vs 48% for those over 16). Girls have higher enrolment rates and lower truancy rates than boys at all ages, possibly reflecting boys’ greater involvement with child labour. Children in Mafraq and those living in smaller households were less likely to attend school than their peers in other governorates and in larger households (70% vs just over 80%), due to greater needs for transportation and child labour respectively. Respondents reported that the primary reasons that children were out of school had to do with lack of space (38%), inability to pay for transportation (33%) and inability to pay for school-related costs (30%).

Our qualitative work highlighted a variety of other issues with refugee children’s access to schooling. For example, many adolescents are out of school because they are now too old to attend regular school. After years out of the classroom, they are now so over-aged that they are required to attended informal rather than formal school (per government regulations). Parents and children also reported rampant bullying (especially of boys), sexual harassment for girls, and concerns about educational quality that are partially attributable to overcrowded classrooms but also seen by refugees themselves as evidence of teachers’ under-commitment to Syrian students.

Our research found that outside of a small minority of children – mostly younger students who had not been out of school for long – cash was not able to facilitate a return to the classroom. Enrolment rates, while slightly higher in 2017 than at UNHCR baseline (80% vs 75%, probably due to supply expansion), were the same regardless of UN assistance package. Our qualitative work suggests that for adolescent girls, it is largely social norms around their purity that keep them out of school, while for adolescent boys, it is their families’ need for their wages.

On the other hand, for children who are enrolled in school, cash assistance helps their families spend more on education (56 JOD/month vs 39 JOD/month, comparing students living in households receiving the complete UN assistance package with those receiving only full WFP vouchers). Most parents (60%) also reported that their children’s academic performance improved since beginning to receive cash assistance.

Health care

Cash assistance does not lead to greater spending on adult health care but does lead to improvements in spending on child health

Poor health and limited access to health care are common among Syrian refugees. We found that just over one-third of households had at least one member with a chronic illness and 19% had a child who had been sick within the past two weeks. In addition, 7% had at least one member – most often a child – with a disability. Due to the implementation of user fees by the Jordanian government in 2014, the majority of refugee households (61%) struggle to afford health care. We also found that healthcare spending doubled from baseline, which may be linked to increased assistance provided by UNHCR cash for health programming.1 Respondents told us that the costs of transportation and medication were particularly prohibitive and often prevented them accessing even ostensibly free care. Our qualitative work found that those living in informal tented settlements were especially likely to be unhealthy (due to living conditions) and deprived of health care (due to geographic isolation).
While one-quarter of respondents reported that cash assistance had enabled them to access health care, we found no expenditure evidence of this– at least for adults.

Cash beneficiaries are no more likely to report spending on health care, and do not have higher median health care spending than those who do not receive cash assistance. There is, however, some evidence that cash beneficiaries do access more care for their children. Almost half (46%) of households receiving both the UNICEF CCG and UNHCR cash assistance reported spending money on children’s health care, compared to only 20% of those benefiting from full-value WFP vouchers only. Notably, access to full-value WFP vouchers also appears to improve children’s access to health care, even when families are also receiving cash – probably because it frees up money that would otherwise have been spent on food.

Social capital and participation

Cash assistance has only a limited effect on social participation although it was found to improve intra-household relationships due to reduced stress levels

Our research found that on the whole, Syrian refugees have limited opportunities for socialisation and participation. Three-quarters of adult survey participants reported that they had not taken part in a single social event in the past six months, primarily because they could not afford to or did not have the time. Women were particularly isolated, as they not only have heavy caretaking responsibilities but are also generally confined to home unless they have a chaperone. Just over half of women told us that they are not allowed to leave home alone. Our qualitative work echoed our quantitative findings. We found refugee women to be almost completely isolated and struggling with conflict- and poverty-related stress and anxiety. Many told us that the research interview was the first time they had shared their experiences and feelings with anyone.

We also found that Syrian children and adolescents have little time to socialise and play. Parents told us that even younger children do not play outside much, because of fears for their safety. Over one-quarter (28%) told us that their children under the age of 12 are never allowed to play outside. Based on our qualitative work, most children appear to spend their days watching TV. Older children and adolescents, especially girls (who face heavy restrictions on their mobility), also have limited recreational opportunities. Three-quarters had not had a single social opportunity in the past week. Not only do they lack the financial resources to afford social experiences, such as trips to the market to buy sweets with friends, but they face increasing bullying from peers when they do go out.

Our research found that cash assistance is primarily helping refugee families by reducing their stress and thus improving intra-household relationships. Given the many other demands on income, we found little evidence that cash is improving opportunities for extra-familial socialisation and participation, largely because the amount is insufficient to cover competing expenditure priorities. Critically, however, we also found no evidence that cash is fomenting jealousy or exacerbating tensions between refugees and host communities. Adolescents reported more engagement with peers due to cash assistance, primarily the result of their having pocket money to spend with friends. UNICEF’s Makani centres emerged in our research as critical to improving adolescents lives, and especially adolescent girls’ lives. They not only provide a safe space where they can be with friends, and make new Jordanian friends, they also provide the opportunity to learn life skills and practice speaking up for themselves.
A further alternative is provided by UNHCR funded Community Support Committee (CSC) which offer numerous training opportunities and social activities.

Psychosocial well-being

Cash assistance had helped adults and children feel less stressed, but they also needed psychosocial support

Our research found extreme levels of trauma and stress among Syrian refugees, with nearly three-quarters of adult respondents reporting that their psychosocial well-being was bad because of the war and nearly 40% saying their overall quality of life was bad or very bad. Only 12% reported that their lives were good – with no differences between men and women or rural and urban respondents. Our qualitative work found that many, if not most, refugees have been traumatised by the combination of violence and poverty and that gender relations in particular have been turned upside down by the war. Many men, unable to provide for their families, feel emasculated and are responding by further restricting the lives of their wives and daughters.

Children and adolescents’ psychosocial well-being is also generally poor. Composite scores on the KIDSCREEN Quality of Life (QoL) tool are substantially below international averages, especially on friendships. Qualitative work highlights why: first, as noted above, many children (especially girls) are almost entirely socially isolated; second, adolescents in particular face growing violence in the community and at school.

Research participants overwhelmingly agreed that cash assistance is improving their well-being, with 96% agreeing that it had improved family well-being and 66% that it had improved children’s well-being. Nearly nine in ten said that it had reduced stress and over half said that it had improved their feelings of control. Fourfifths of adolescents said that their lives were better in Jordan than they were in war-torn Syria, and two-thirds believed that cash assistance was in part responsible for improvements. Overall, 31% of adults and 42% of adolescents reported that cash assistance had made children’s lives ‘a lot’ better, with younger teens and women more optimistic than older teens and men. Adults and children alike told us that while cash assistance had helped them feel less worried and stressed, they also needed psychosocial support.

eneficiary perspectives on cash assistance programme implementation

Overall, beneficiaries were satisfied with the cash transfer mechanisms but were less satisfied with the narrow scope of beneficiary-programme implementer interaction

While beneficiary perceptions of the UNHCR and UNICEF cash assistance programming were very positive overall, we found limited awareness of programme targeting and accountability mechanisms. Most beneficiaries had limited understanding of how the cash assistance was targeted, and a sizeable minority (30%) thought targeting was unfair. Families also had little understanding of the exact benefit amounts, and while they knew the main sources of funding, they had gaps in understanding as to how these were allocated. Overall, the process through which beneficiaries receive the cash assistance was reported to work well and most were satisfied with it. Although our qualitative work found some initial frustrations with the iris scan recognition system, there was an acknowledgement that other mechanisms were more liable to fraud or exploitation.

Beneficiaries were generally satisfied with the way they were treated by agency staff, although there was dissatisfaction with the level and scope of interaction, particularly the limited nature of home visits, which beneficiaries felt made it difficult for staff to really understand their struggles.
Finally, only half of all respondents were aware of a complaints system and many doubted that submitting a complaint would change anything. There were also repeated complaints about inability to get through to the UNHCR telephone helpline, with many people giving up before their call was answered.

Conclusions and recommendations

Our findings highlight a number of ways in which UN cash assistance programming could be strengthened to more effectively tackle the multi-dimensionality of poverty and vulnerability. First, it is critical to work towards a crosssectoral and joint stakeholder roadmap in implementing the more detailed recommendations below. While being clear about what the proposed theory of change is in terms of improving outcomes across different wellbeing domains, it is essential that the larger social protection framework ensure an integrated approach, with linkages to complementary programming if the services needed go beyond the specific remit of the implementing agency.
Only with a coordinated response will the multiple vulnerabilities of refugees be sustainably addressed; indeed, one of the overarching recommendations from our research is to invest in a broader, longer-term social protection system, led by the government, with support from UN agencies, donors and NGOs/CSOs.

Second, as part of this roadmap, it will be important to identify a clear sequencing of recommendations, including quick wins. Clearly, all of these different vulnerabilities need to be factored in but it is also clear that those receiving the full package (and thus the larger amount of cash) are better able to meet their basic expenditure needs. In addition to these material needs, our study highlights one other area that requires much greater investment: tackling the psychosocial and social capital challenges that are unique to the refugee experience.

And in this regard, it is urgent to invest in a cash-plus approach. One example highlighted in the report, which could serve as an important model for future investigation and investment, is UNICEF’s integrated social protection package of services for children, adolescent and youth though Makkani and cash transfer programme. This tackles educational, protection, skillsbuilding and psychosocial and social cohesion objectives in an integrated package.

More specifically, our research findings point to the following recommendations which both resonate and build on recommendations identified in the secondary literature:

Income and employment

• Explore setting up a referral pathway involving Syrian community leaders, teachers, health workers and other local service providers to link families who have working children with partners offering cash assistance and with Makani centres.

• Invest in public awareness campaigns to explain the work permit process and set up centres where refugees can get practical help to apply.

• Advocate for changes in labour law currently linking the work permit to a single employer and explore an alternative, transferable permit (not specific to a location or employer) for certain professions in certain sectors.

• Advocate for the extension of the types of work Syrian refugees can legally do and extend the validity of work permits to more than a year.

• Offer entrepreneurship and skills building training, with a specific focus on youth and women.

• Monitor the enforcement of labour law (protection) regulations and set up referral mechanisms to report and address abuses in the workplace.
Coping strategies • Establish two-way processes to communicate clearly with beneficiaries about when and for how long they will receive cash assistance.

• Develop clearer links with UNICEF’s Makani programme and create a database of the most vulnerable adolescents and their families.

• Invest in social networking opportunities within refugee communities and with host communities. This could include working with the new UNICEF Hajati cash transfer facilitators to make phone calls and home visits for children who have dropped out of school and who will have a concrete entrypoint for engaging with vulnerable households.

• Continue promoting and funding community based organisations and their refugee support functions, such as currently undertaken by UNHCR funding 24 CSCs across Jordan.
Shelter • Prioritise cash-for-shelter provisions for refugees living in informal tented settlements, targeting WASH improvement in particular.

• Set minimum standards for landlords renting out living spaces and monitor the enforcement of housing arrangements.

• Facilitate negotiations between landlords and refugees and help provide legal aid support for housing contracts.
Food security and nutrition • Link the neediest households and individuals with WFP’s emergency food programming.

• Provide cash-for-food services / and health referrals for children.

• Provide food assistance and nutritional supplements to particularly vulnerable refugee populations, especially those living in informal tented settlements and vulnerable children attending the second school shift.

• Advocate for reinstatement of the full-value WFP voucher through increased donor support.
Education • Consider introducing a programme component that provides awareness-raising and support to beneficiary families to ensure that their children are in school.

• Raise awareness among parents of importance of educating children, to those whose children are currently out of school as well as those at risk of dropout.

• Provide free transport for girls to get to school.

• Invest in teacher training (including use of non-violent disciplinary methods).

• Invest in training counsellors and other forms of psychosocial support for children, particularly those who have experienced extreme trauma.

• Monitor all out-of-school refugees and make recommendations on referrals.

• Improve access to education for children in families living in informal tented settlements.

• Invest in informal education as well as schemes to attract adolescents back into formal education.

• Monitor and enforce equal treatment and opportunities within the double-shift system.

• Invest in sport and other recreational initiatives to bring together Syrian and Jordanian children.
Health • Advocate to donors to provide funding coverage for all refugee paediatric visits (at a minimum for those under 6 years) psychosocial and mental health services.

• Ensure a functioning referral system for refugees with emergency and chronic health issues including disabilities to access cash for health services.

• Explore the feasibility of cash assistance that encourages regular health checksfor the children, particularly the most vulnerable infants and young people.

• Invest in providing information, referrals, menstrual hygiene support, and affordable maternal health care and sexual and reproductive health (SRH) services for refugee women and girls.

• Build a cadre of health workers able to provide specialist psychosocial services to refugees, and where possible involve refugees in this training given they will have direct experience and could also benefit from the employment opportunity.

• Provide specialised services to vulnerable refugee populations for conditions not covered by the Jordan Health Aid Society (JHAS) system.
Participation and social capital • Link vulnerable and isolated women and girls with UNICEF’s Makani programme, UNHCR’s community based organisations and other safe space initiatives.

• Set up women’s support groups (targeting Syrian and other refugee populations and Jordanian women) that provide recreational, employment and saving opportunities in safe spaces, mindful of the need to provide transport and consider safety.

• Scale up the Makani programme to include more systematic outreach and support for caregivers and adults, encouraging government to gradually take on more of the management and referrals between Makani centres and other public service providers.

• Facilitate fora where male refugees can connect with men from other refugee populations and host communities and offer recreational, livelihoods and saving opportunities.
Quality of life and psychosocial well-being • Scale up cash assistance to support the most vulnerable families, focusing on households with people with disabilities, female-headed households, and children in households with large families.

• Develop indicators to measure psychosocial well-being (of cash assistance beneficiaries and the wider refugee population) and link these to households’ Vulnerability Assessment Framework (VAF) scores.

• Set up a clear and rapid referral pathway for particularly vulnerable cases with partners providing psychosocial and mental health services.

• Offer combined recreational services for refugees and host communities, investing in safe spaces and recreational service programming for women and girls, and separate activities for men and boys, to help integrate Syrian refugees with host communities and other refugee populations.
Strengthening cash assistance programming and implementation • Improve overall accountability framework for cash assistance • Invest in more face-to-face communication activities to give Syrian refugees the opportunity to ask questions and give feedback about the cash assistance programme.
If the current enumerator cadre are unable to fulfil this role then consider introducing a social work cadre or retraining/ skilling up the enumerator cadre.

• Make information more readily available in print, audio and web-based formats.

• Provide clear information on the time it takes to process applications for cash assistance for eligible households, and explain what applicants can do if the stipulated time is exceeded.

• Ensure that beneficiaries are aware of complaints mechanisms.

• Ensure that the UNHCR telephone helpline is much more accessible and efficient in resolving beneficiary queries • Provide information on the cash assistance programmes to parents of children attending Makani centres.

• Invest in capacity-building of social workers, volunteers and programme implementers to help them understand the multifaceted aspects of vulnerability.

• Organise awareness and capacity-building sessions on gender equality, intra-family violence, and psychosocial service provision for beneficiaries and programme implementers.

• Strengthen community involvement in programme decision-making, governance and accountability, setting up regular forums to promote information exchange and solicit beneficiary views about the programme.