Driving to Zerqa, Jordan second-largest city, about 40 miles north of the capital of Amman, is a bit like traveling back in time.

Leaving the spotless streets of Amman, you pass towns and villages almost devoid of greenery, for there is a severe water shortage in this Middle Eastern kingdom. The farther from Amman you go, the older the houses and the poorer the people.

The apparent prosperity of Amman does not seem to have touched Zerqa; many roads are unpaved and deeply pockmarked, especially in the city refugee camps. Without yards in which to play, children scamper in the dirty streets, barely avoiding traffic. Even in the relentless July heat, jobless young men gather at midday outside neighborhood coffeehouses.

Twenty-five percent of Zerqa population is unemployed; the vast majority of these are males under the age of 30. Illiteracy, particularly among Zerqa women, is high; prospects are generally bleak.

It is no coincidence that the Pontifical Mission for Palestine established a mother-and-child clinic almost two decades ago in one of Zerqa poorest neighborhoods. At the Mother of Mercy Clinic, which is administered by the Franciscan Missionaries of the Divine Motherhood, thousands of local women receive some of the best pre- and postnatal care Jordan has to offer.

“The Pontifical Mission serves poor areas and Zerqa is certainly one of them,” explains Dr. Ibrahim Ghabeish, one of the clinic two staff physicians. “We treat bedouin from the deserts and people from Zerqa itself. We serve the surrounding Palestinian refugee camps and even patients from the nearby industrial city of Rosafa.”

Dr. Ghabeish says the clinic provides care to Jordanians who would almost certainly fall through the cracks of the nation overextended and costly health care system. Only an estimated 10 percent of Jordanians actually have health insurance.

“The Pontifical Mission has served the people here and in Palestine for many years,” explains the physician, who was born and reared in the West Bank. “As a Palestinian, this is important to me. I feel that someone is helping my people.”

Fifty years after Pope Pius XII established the Pontifical Mission as a relief agency to provide Palestinian refugees with food, clothing, shelter and education, it continues to aid refugees. Yet while the agency goal to help the needy has remained basically the same since its foundation, the scope of its projects – especially with regard to health care – has broadened considerably.

The Pontifical Mission was established in 1949 soon after the partition of Palestine and the subsequent Arab-Israeli war, when hundreds of thousands of Palestinians fled or were forced from their homes. Most relocated to nearby Jordan, Lebanon, Egypt and Syria, or to the West Bank and Gaza Strip. The latter two were under Jordanian and Egyptian control, respectively, until Israel captured them in June 1967. With its headquarters in Beirut the Pontifical Mission established local committees to aid refugees in these areas, as well as in Israel.

It was not until the cataclysmic 1967 Arab-Israeli war displaced hundreds of thousands more Palestinians – a large percentage of whom flooded into Jordan – that the Pontifical Mission decided to open a full service office in the kingdom.

Ra’ed Bahou, Pontifical Mission Regional Director for Jordan and Iraq, says that in the months following the 1967 war, the Pontifical Mission was “almost purely a relief service” preoccupied with “providing food, medicine, clothing, tents, blankets and drinking water” to refugees.

“But after a year or two,” he adds, “people began to realize they couldn go back. Gradually our objectives changed.”

One of these objectives was to move from short-term, crisis-intervention medicine into long-term, preventative health care. This emphasis on “wellness” can be seen at the Zerqa clinic, where pregnant women and new mothers wait in air-conditioned comfort to be examined. The work of the clinic is sustained by the great generosity of Kinderhilfe Bethlehem, a German-Swiss Catholic charitable organization. Originally founded to operate Caritas Baby Hospital in Bethlehem, today Kinderhilfe supports mother-and-child programs throughout the Middle East.

“This is primarily a health clinic,” says nursing Sister Caroline of the Franciscan Missionaries of the Divine Motherhood, the religious congregation that operates the clinic for the Pontifical Mission. Pointing to one of the waiting rooms where several young mothers nurse their babies, she continues.

“We reserve two days a week for vaccinations. And we encourage women to come to the clinic soon after they give birth. They and their newborns receive a full exam. We do blood work on the mothers and take their blood pressure to detect problems early on. When a woman comes in for a pregnancy test and is found positive, we open a file right away. From then on, she’ll come for regular examinations.”

From the age of two months, infants receive vaccinations against diphtheria, tetanus, whooping cough, polio and hepatitis B. Measles shots are given at nine months. The clinic also works with UNICEF during its yearly vaccination drive.

When the clinic first opened in 1985, Sister Caroline recalls, “we saw a lot of polio and measles. Now, if we see such cases – and this is extremely rare – the babies come from remote areas.” These days, she notes, “we see a difference in the children’s health. The government is no longer reluctant to provide vaccines and mothers are more aware. We used to have to go to their houses and ask them to come. Now they make appointments and keep them.”

Much of the parent health education comes from the clinic. While waiting their turn, parents watch videos on everything from breast-feeding to hygienic food preparation to the implications of fever and diarrhea. A small statue of the Virgin and Child sits atop the television set.

A vital service provided by the clinic is on-site counseling. “We help mothers when they have problems at home,” says social worker Maryam Kassem. “Sometimes this is the reason they come to us and not to another clinic.”

Noting that Jordanian society leans toward the traditional and insular, Kassem, a devout Muslim, notes that “sometimes a woman will have a problem with her husband or mother-in-law. Sometimes the husband drinks or there is abuse. It important for a woman to have a place to turn for help.”

Amal Yousef Momoni, mother of four, says she prefers the clinic to other facilities and therefore walks a half hour each way for its services. We sit in her brother modest stone house near the facility.

“I’ve been to other clinics but this one is better,” she says. “The army hospital is closer, but to be seen I have to go early in the morning and wait till three or four in the afternoon. Here, everything is orderly, and there no wasta,” she adds, referring to the Arab word for favoritism.

“That right,” says Kassem, also at the house. “At our clinic there no favoritism between people, whether they are from one tribe or the other, or between Muslims and Christians. Here we’re all people.”

This philosophy is evident at two large-scale health projects at the Italian Hospital in Amman and its counterpart in the southern city of Kerak. These facilities are owned and funded by the Italian Catholic missionary society ANZMI and administered by the Comboni Missionary Sisters. The philosophy was also the driving force at the Marqa Clinic near Amman, which the Mission recently passed to private hands.

Every Wednesday, almost 200 men, women and children of every age converge on the Italian Hospital in one of Amman poorest areas. According to Mrs. Suhad Haddad, the Pontifical Mission Sponsorship Program Coordinator, a large percentage of the patients are Iraqi refugees, both Christian and Muslim.

“Many are in the country without residency permits; if found, they may be sent back across the border.” They are therefore not entitled to work permits or health care at government hospitals, she says. “In addition, there are many foreign workers, such as the ones from Sri Lanka, who don know where else to go for help.”

Regardless of their background, Amman poor know they will not be turned away from the Wednesday clinic. The clinic, which began as an outreach program of the Pontifical Mission Amman office, moved to the Italian Hospital in 1997. Subsidized by the Pontifical Mission, this social service program offers a fresh helping of hope each week to Amman poor.

Everyone who enters the clinic doors is evaluated by a nursing sister. The majority are referred to physicians, who may prescribe medication or schedule a meeting with one of the hospital specialists.

“We get a lot of medical, surgical and pediatric cases,” says Dr. Adnan Al Saidi, a clinic physician. “We see hypertension, diabetes, epilepsy, heart disease, cancer. The children come in with ear infections, stomach problems, tonsillitis.”

“The Pontifical Mission clinic plays a vital role in helping the poor,” says Sister Vivana, the hospital Director of Nurses. She stresses, however, that assistance does not end there. Walking through the maternity ward, she stops at an incubator holding a tiny but otherwise healthy two-pound baby. “The Mission helps us buy equipment like incubators, cots and laboratory items, depending on what most needed.”

The Pontifical Mission also saves lives by subsidizing procedures and operations. “People knock on my door, saying, ‘Sister, I have no one to turn to,’” says Sister Vivana. She recalls one compelling case: “An Iraqi woman desperately needed a hysterectomy – she was bleeding heavily. She had little money and the government hospital wouldn take her. We provided a bed and the Mission paid for most of the operation.”

Sister Vivana only regret is that the Pontifical Mission cannot do more. “We would like to open a neonatal intensive care unit but lack funding and equipment. If one of our doctors sees a baby in distress, we have to send it to another hospital.”

Standing outside the Italian Hospital clinic, Raymond Daud, an Iraqi Christian, talks to his 10-year-old son Alain, who needs a tonsillectomy. Asked how he learned of the clinic, he says, “We heard about it before moving to Jordan. People in our community move back and forth between countries. They tell us where we should live in Amman and where to go for medical care.”

Although he declines to speak of his life in Iraq, Daud does reveal that he is unemployed. “There is no work here. We have lived on charity since we arrived,” he says, eyes downcast. “We have relatives in Canada and Australia and would like to emigrate.”

One pregnant woman, a housekeeper with four other children and an unemployed husband, prefers not to give her name. She does volunteer information about her condition. “My baby is very weak,” she says. “I might need an operation. I pray the baby will be able to hold on a few more months.”

Although she could have gone to a local government hospital, this woman had two compelling reasons to go to the clinic. “I probably would have had to wait, perhaps weeks, for an appointment,” she says. “Here, there are very good doctors and the sisters take good care of me.”

Another factor was cost. “My operation will cost about $500. The hospital will give me room and board and the Pontifical Mission will pay $150. Another organization will contribute, and I’ll pay the rest.”

Suhad Haddad says that whenever possible it is preferable for a patient to bear some of the costs. “People are proud and want to feel like they are contributing to their own welfare. It gives them a feeling of self-worth,” she says.

This policy extends to the Italian Hospital in Kerak, a desert city of 60,000 residents; another 140,000 people live in nearby mountain towns and villages. Plagued with unemployment and low literacy rates, this region is one of the least developed in Jordan.

“The Pontifical Mission is a good partner,” says hospital Director Dr. Fawaz Awabdeh. “It helps with 20 to 30 cases a month.”

“A month ago,” he recalls, “a woman came to us with a gallstone. She’d already been to the government hospital, which gave her an appointment for a month later. It was clear the operation had to happen right away.”

Following a procedure the hospital and the Pontifical Mission had worked out long ago, a sister sat down with the woman and asked her how much she could pay. “She really didn have anything,” says Awabdeh, “so the hospital covered the room and the Pontifical Mission paid the rest. If the Mission weren here, we’d be in trouble.”

Back in his Amman office, Ra’ed Bahou believes that words like these sum up why the Pontifical Mission still has work to do.

“We’re still relevant, even after 50 years,” he asserts. “Life in the Middle East is constantly changing. First there was the 1948 war, then the 1967 war, then the Lebanese war. All created refugees. In 1991 the Gulf War displaced another 300,000 people.”

“Today,” he says, “the problems are mainly economic. Even our middle class can afford to pay $500 for surgery.”

Making a mental list of all the things the Pontifical Mission does for the people of Jordan, Ra’ed Bahou says with a smile, “We’re helping about 100,000 people a year. That a pretty important mission.”

Michele Chabin is a freelance journalist based in Jerusalem.