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.