During the week of 16 December 2018, two babies under the age of six months passed away in al-Rukban refugee camp due to freezing temperatures and lack of necessary supplies. The United Nations International Children’s Emergency Fund (UNICEF) asserts that the lack of readiness in the camp, which is located in an inhospitable area in the desert, puts the lives of more than 45,000 Syrian refugees in danger. UNICEF calls for the states involved in the camp management to take action to improve the camp’s conditions.

Jordan has previously sealed the borders connecting al-Rukban to its territories after attacks carried out by Islamic State (IS) fighters, who were presumably present in the camp on Jordanian soil. With countries continuously placing the camp’s responsibility on their counterparts, the refugees inside continue to struggle.

The United States (US) has created a 55-km wide region around al-Rukban camp area to establish al-Tanf base, where it deploys around a thousand military personnel and continues to train its local Syrian allies. Russia and the Syrian government cite the US presence in the area as the reason for their inability to deliver aid into the camp, while Jordan maintains that since the camp lies on Syrian territories, it remains to be the Syrian government’s responsibility. Russia continues to accuse the US of disrupting aid delivery into the camp, with the US accusing the former of doing the same. Last December, Russia called for the withdrawal of the US from the region and for transparency in the aid delivery process, with the United Nations (UN) considering the dispatch of another convoy to the camp in order to evaluate the situation inside.

Now, with the Trump administration’s decision to withdraw troops from the region just last month, the Syrian rebel groups operating in the area have voiced their willingness to lay down their weapons and work on a reconciliation roadmap with the Syrian authorities. This means that camp residents might finally be able to receive the aid they are in urgent need of.

Defenders for Medical Impartiality (DMI) calls on the Jordanian authorities to facilitate the movement of camp residents and aid, and calls on the US to swiftly carry out their withdrawal from the region. DMI also echoes UNICEF’s call for all sides concerned to facilitate humanitarian access to reach refugees in need in al-Rukban and elsewhere in Syria, especially children, and support the safe and voluntary return of displaced people.

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In 2014, a number of Syrian refugees encamped to the remote area of al-Rukban located near the extreme northeast of Jordan. Four years later, in October 2018, the United Nations International Children’s Emergency Fund (UNICEF) estimated that the population of the camp had reached 45,000, 80% of whom are women and children. However, this number is said to be declining due to the complete lack of infrastructure which has contributed to its deteriorating healthcare system and cases of severe malnutrition. As a result, UNICEF Regional Director for Middle East and North Africa, Geert Cappelaere, urged critical action to save the lives of the thousands of children who are settled there.

Recently on 10 October 2018, a five-day-old boy and a four-month-old girl died in al-Rukban due to the lack of medical care. This has sparked international coverage regarding the severity of the living conditions at the camp. Although the UN refugee agency runs a clinic on the Jordanian side of the border, it is not always accessible to the residents of the camp.

This humanitarian crisis is not a new occurrence but the current siege imposed by the Syrian Army has intensified its severity. In 2016, dozens of displaced Syrian children died of disease due to lack of humanitarian aid and medical supplies. The encampments are makeshift, and lack the proper infrastructure necessary to provide services which are needed for survival, such as waste management, sanitation, and proper water delivery systems. Additionally, the camp’s only clinic is failing to provide even the most basic of needs. “It can’t even be called a clinic,” says Ali, a camp resident who helps run a local Facebook news page. “The two people running it are a midwife and a medical student who never graduated. It often goes out of service due to a lack of supplies.” Dr. Jalal al-Zoubi, a Jordanian doctor who monitors the clinic said that the medical staff cannot even make proper diagnoses for their patients. The only staff members are nurses, making it harder to obtain exact diagnoses, or any precise statistics regarding the health of children in the camp.

Since the beginning of July 2018, health conditions have worsened in al-Rukban refugee camp, with children registering multiple conditions, including malnutrition and food poisoning. The negative impact of the poor health situation is magnified by the significant rise in costs of medicine and Jordan’s refusal to allow patients into its territory for treatment. According to a nurse who works in one of the medical posts at the camp, diseases including gastrointestinal infections and acute diarrhea are very prevalent. The number of children infected with severe diarrhea reached 25%, while other children also suffer from dehydration, in addition to the spread of lung disorder, acute bronchitis and urinary tracts infections (UTIs) among the camp’s displaced residents. The camp also lacks the ability to determine the type of bacteria causing the diseases, as well as the ability to cure several cases, such as burns, fractures and myocardial infarctions.

According to a Syrians for Truth and Justice’s (SJT) anonymous source, cases of suffocation are widespread among children and the elderly. Chest allergies are very common due to the severe dust storms that are prevalent in that area. Moreover, SJT states that due to high temperatures, the desert environment, the spread of insects, and the lack of cooling devices and food preservation, the health situation at the camp has further deteriorated.

The exact rules of procedure for granting residents of al-Rukban camp access to Jordanian medical centers are undetermined. Some sources from within the camp state that the guards located at the Jordanian border prevent patients, even those with medical reports confirming the deterioration of their health, from entering Jordan to receive adequate treatment. “Only the patient with the most severe emergencies (on the verge of death) is allowed to enter Awon Point. But despite the seriousness of the patient’s health condition and his desperate need to enter a hospital and intensive care, he is not allowed to enter Jordan for treatment.” Other sources claim that although entry into the medical post is difficult, patients are eventually granted access. “The patient might wait days in order to enter the medical point, but eventually enters in case he/she has a medical report illustrating his/her condition”. Other sources argue that only patients escorted by a mediator from Jaysh al-Ashaer, a faction of the Free Syrian Army that is made up of mostly tribes of the Lajat Plain backed by Jordan, are granted entry. “The soldier at the point tore the medical report and prevented my entry on the pretext of congestion and he expelled us. If you have a mediator with connections to Jaysh al-Ashaer faction, then you can enter, otherwise you have to wait days and weeks until you are allowed”.

The deteriorating conditions in the camp are a product of the conflict unfolding around it. In recent months, the Syrian Army has tightened restrictions on goods coming in and out of the area, preventing local aid groups from accessing it. In the beginning of 2018, Jordan allowed an aid shipment from the UN to pass through its border, but has since said that all aid to the area must come from the Syrian side of the border. Ever since a deadly attack killed seven border guards on 21 June 2016, humanitarian assistance, which was already limited, stopped completely when the Jordanian authorities closed off the camp’s border. The camp residents have been living without aid for ten months and do not have access to medicine, not even painkillers.

Defenders of Medical Impartiality (DMI) acknowledges the recent humanitarian efforts made by the joint agency operation of the UN and Syrian Arabic Red Crescent (SARC), however, the overall humanitarian access to the informal desert camp remains wholly inadequate and temporary.

DMI calls on the Syrian Army to lift its siege of the camp and allow the entry of food, aid deliveries, and relief workers, and on the Jordanian government to grant the residents of the camp access into Jordan’s medical points and medical centers to receive comprehensive medical care needed for their survival. The camp population is in need of regular and consistent aid to meet their critical and urgent needs which cannot be addressed with infrequent deliveries. DMI also calls for more international awareness on the severity of the issue and raises the issue to the international community to establish comprehensive, sustainable plans to set up a solid infrastructure that can withstand the harsh desert conditions and the increasing needs of its residents, including water sanitation and distribution networks, proper medical facilities and supplies and shelter.