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Overwhelming Mercy

Catholic health care initiatives in Jordan confront crisis

By the middle of the morning, the Mother of Mercy Clinic is already crowded. Built on the grounds of Zerqa’s Latin parish of St. Pius X, the clinic has little by way of a waiting area. Benches and chairs, packed with women in Muslim headscarves, line the clinic’s narrow, winding corridors. A few women wear niqabs, the face covering popular in some Arab countries. Some carry infants. And always the clinic is at capacity.

“It is not possible to receive any patients who come after 9:30,” explains Sister Najma, the clinic’s administrator and a member of the Dominican Sisters of St. Catherine of Siena, a religious community based in Iraq. “We already have the number we can see.”

Yet the atmosphere remains calm, peaceful. At the front desk, the staff interviews new arrivals, pulling colorful folders containing patient files from the carefully ordered shelves behind the desk.

The clinic has served the Hashemite Kingdom of Jordan for more than 30 years. In that time, it has built up an impressive reputation.

“The most important thing is cooperation,” Sister Najma says. “Patients now are used to us, and that’s what encourages them the most. It’s very sweet. The reception, how we talk, how we treat them — it’s not like other clinics. We are like a family. That’s why they’re comfortable coming back.”

Run by the sisters and funded by CNEWA, the clinic offers a range of services to Jordan’s needy. While the staff treats injuries and common ailments, it focuses on prenatal and maternity care — a major demand in a country with a young and growing population. With only two doctors, two laboratory technicians and a handful of nurses and staff, Mother of Mercy manages to see between 100 and 130 patients a day. Patients of all creeds and ethnicities come from Zerqa — a sprawling, poverty-ridden city populated mainly by Jordanians of Palestinian ancestry — and from the impoverished industrial areas that surround it. They also travel from more distant northern cities, such as Mafraq, Jerash and Irbid. They are drawn by the clinic’s reputation for treating patients with respect, and by the affordable cost of its care.

“Some groups or families, they come here and they don’t pay, because they’re poor. Sometimes we just charge them small amounts of money,” says Sister Najma. “There are a lot of poor people in Zerqa. There are poor immigrants, some of whom are from Bangladesh, and some from Egypt. Egyptian workers come as well,” she adds.

As with other Catholic health care facilities in Jordan, Mother of Mercy charges patients on a sliding scale, offering free service to those most in need, says Ra’ed Bahou, CNEWA’s regional director for Jordan and Iraq. But even its base fees are much lower than Jordan’s burdened state-run hospitals.

Right now, the demand for affordable care in Jordan is enormous.

Jordan is on the brink of a health care crisis. The tiny kingdom’s aging health infrastructure has long been in need of an overhaul, but recent events in the region have exacerbated an already-difficult situation. The economic boom that Jordan experienced after the U.S. invasion of Iraq in 2003 has come to a grinding halt. Capital and investment have fled, and jobs are scarce. Economic stress tends to cause people to fall back on public health care services, but the government has been facing a budget crisis of massive proportions. Rounds of austerity measures have increased the price of fuel and basic goods, pounding hard an already weary population. Exacerbating matters, in the past decade Jordan has absorbed massive waves of new refugees — first from Iraq and now Syria.

Since early 2011, more than half a million Syrians have found refuge in a country with a population of barely more than six million. Hundreds of people arrive every day, many of whom come with severe injuries, long-term health issues or both. Many women arrive pregnant — some of whom, married at a young age, are barely more than children themselves.

Early in the crisis, the kingdom offered all Syrian refugees free health care in the public system. But as the demand for care grew, it came close to bringing the system to its knees. In March, Dr. Yaroub Ajlouni, president of the Jordan Health Aid Society, reported that the health system in northern Jordan — where many Syrian refugees live — was on the verge of collapse. Beds were unavailable in the public hospitals, intensive care unit spaces and incubators were full, drugs in short supply. Since then, Dr. Ajlouni and other aid workers say the kingdom has relieved some of the crowding, quietly scaling back the amount of health care refugees can access, implementing new restrictions and asking international organizations to carry more of the burden. The crisis has affected everyone.

Sister Najma says the Mother of Mercy Clinic sees few refugees — perhaps 10 or 15 a day — but demand for its services is constantly growing, and the clinic is struggling to keep up with the increase. Part of this is because space is limited, Mr. Bahou explains, and part of it is that the same economic factors squeezing Jordanians are also putting pressure on private health care providers. “It’s getting tight, because we cannot increase the budget anymore,” says Mr. Bahou.

“We’re trying to keep the budget as it is and absorb the higher cost of maintenance and utilities.

“We have many generous donors, but it’s not easy,” says Mr. Bahou. “We’re managing with the amount we’re receiving — we don’t have a problem — but it’s very tight. Every penny we spend, it should be used very reasonably.”

Things are not yet dire — the clinic is slated for renovation this year, funded in part by the U.S. Eastern Lieutenancy of the Equestrian Order of the Holy Sepulchre of Jerusalem. But Sister Najma says the pressure on the sisters is growing, and there is no room to treat more patients.

“Definitely, the economy here is really difficult because of the increase in fuel and gas prices,” she says. Complicating matters further is a shortage of water. “Even for us, the water we get from the municipality isn’t enough; we have to buy our own, and it’s very expensive.” And more and more of the charitable donations that used to help the clinic are being diverted to the Syrian crisis, she adds.

Even in the face of immense public health challenges, the Mother of Mercy Clinic forges ahead with its mission, which is as much spiritual as charitable.

“We cannot talk about spirituality in our work,” says Sister Najma. “What we do and how we do it shows our spirituality.

“We are sisters. We’ve devoted our whole lives to helping people. This is our work, this is our message.”

And the message has gotten through. Though the clinic serves people of all faiths, the vast majority of its patients are Muslims. In the past, Mr. Bahou says, there were tensions between Christians and Muslims in Zerqa, but the clinic spread a message of good work that crosses religious boundaries. Now, he says, people come up to the sisters in the street and hug them.

“Sometimes, when we are in the supermarket, or about town, a woman wearing the hijab, or the niqab, she will say, ‘Oh, hi, sister,’” says Sister Nahla, who assists in the clinic. “Even if we can’t see her face, she knows us, and she hugs us. They are kind people.

“Our mission here is for everyone,” adds Sister Nahla. “If you go to a hospital, sometimes they will include ‘religion’ in your file. We don’t have that kind of stuff here. Just the name and the age is what we need to know.”

Aisha comes from the tiny town of Busra al Harir, in southern Syria’s Dera’a province. For seven months, she has been living with her husband and three children in a prefabricated trailer in the sweltering Zaatari refugee camp — located near Jordan’s border with Syria — that is now home to more than 120,000 Syrians. It is a hard life. The World Food Program distributes dry rations every 15 days, but they include no vegetables, meat or milk. Anything extra costs money, but the prices in the camp’s sprawling market are high, and there are few jobs available. Water delivered via tanker is drinkable, but tastes foul and there are constant shortages. Hygiene is a problem, and the camp is littered with trenches of stagnant water and open sewers where camp residents have tried to construct their own toilets.

The camp has several hospitals and numerous clinics run by aid agencies and foreign governments, but they are crowded to capacity. When Aisha’s son, Nuh (a form of “Noah”), fell sick with vomiting and severe diarrhea, she says the camp hospitals could not help him. Her neighbor’s newborn daughter, Majd, was similarly sick. Unable to get help in the camp, Aisha obtained a temporary pass that allowed her two days to visit a hospital outside the camp. She could not afford a taxi, so she and her neighbor walked for three hours through the desert to the nearby town of Mafraq. From there, a Jordanian woman took pity on them and brought them to the Italian Hospital in Jordan’s capital, Amman.

As Amman has grown, its historic city center has fallen into disrepair. The city’s wealthy and powerful residents have moved west, into new districts packed with luxury hotels, restaurants and shopping malls. The old downtown area, nestled in a valley that once boasted the city’s main water source, has fallen into decline. The city’s first buildings are now home to bargain-basement souks (marketplaces) and coffee shops, surrounded by low-income neighborhoods of raw concrete and exposed reinforcement bars.

The Italian Hospital sits in the heart of downtown Amman, its blue logo looming over an empty lot where men sell used furniture and the winding alleys known locally as “the thieves’ market.” It is the oldest hospital in Amman, a private Catholic institution that has served the city since 1926. Now it has become a go-to destination for many of Amman’s most vulnerable denizens.

A large number of the hospital’s clients are refugees — thanks in part to another CNEWA project that provides supplementary funding for both refugees and poor Jordanians.

“Today, I saw more than 100 Syrians in the hospital,” says the hospital’s project manager, Mazen Smeirat. “Today!”

Syrian patients occupy 10 of the hospital’s 80 beds, he says, and their number continues to grow. Most of them come from low-income neighborhoods on the nearby hills, from Ashrafiyeh and Hashimi, Hay Nazzal and Jofeh.

Barely one-fifth of Jordan’s half a million Syrian refugees live in Zaatari. Most Syrians live in Jordan’s cities, living in groups in run-down rented apartments, working illegally for pittance wages and seeking charitable assistance wherever they can get it. And there are also tens of thousands of Iraqis, who fled their own civil war five or even ten years ago and do not dare go home. They come to the Italian Hospital because they simply cannot get treatment in the public system, where waiting lists can be months long.

Their health needs are legion, explains Dr. Khalid Shammas, the Italian Hospital’s medical director. There are everyday injuries and war wounds, acute illnesses and chronic conditions. Concerns include influenza, infections, hypertension, diabetes and, of course, deliveries — the hospital’s entire second floor has become one large maternity ward.

The hospital treats as many as it can.

“We do not make any discrimination in this hospital,” the doctor says. “All the patients — private patients, insured patients, charity patients — see the same rooms, the same doctors.”

But the needs are immense, and the patients just keep coming.

No single source of support can cover the need. To stay afloat, Dr. Shammas says they draw from the hospital’s own funds, “from Caritas, from CNEWA, from the International Refugee Trust [in London].” For those they still cannot treat, they find some other hospital. “Everything together, we help the people.”

When Aisha and her neighbor finally arrived in Amman, the sickly Nuh and Majd were suffering from amoebic dysentery, perhaps carried by flies or picked up from the dirty pools in the camp, explains pediatrician Dr. Saba Ghawi. Nuh was severely malnourished, a consequence of the parasites and the poor quality of food available to his family.

“He was very thin,” Dr. Ghawi says.

Four days later, the two children lie in their beds in a clean, sunlit hospital room. Nuh still has splints on both his arms where the hospital had given him intravenous feeding, but he is well fed and smiling, laughing with his mother. Next to him, Majd sleeps peacefully, her dark hair peeping out from wrapped blankets. Their mothers are smiling and chatting, relieved.

But their future remains grim. The children are ready to be discharged, and that means returning to the harsh and unsanitary conditions of the camp. With no end in sight to the conflict in Syria, Aisha and tens of thousands of mothers like her may be forced to remain in Jordan for months, years — perhaps decades. The scale of the crisis underway is scarcely imaginable — both in its effects on the refugees, and on the countries that have been generous enough to accept them.

The aid will never be enough. But every gift, even the smallest, can help save young lives like Nuh and Majd’s — at least for one more day.

Nicholas Seeley covers the Middle East from Jordan. His reporting has appeared in The Christian Science Monitor and Foreign Policy. He has just published an e-book about daily life in the Za’atari refugee camp, A Syrian Wedding.

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