Standing #WithRefugees: Helping Jordan with the Provision of Health Services to Syrian Refugees

March 15, 2017. She looked at me curiously, sipping on her juice box. Her pink sweater in contrast to her anemic pallor. If it had not been for the drip in her right arm, she could be any five year old child. Except she was not. She was a refugee, one of the more than 650,000 Syrians that Jordan has been hosting since the start of the war. Exactly six years ago, the civil war in Syria had started a couple of miles away. Six years later the war continued. It was all this girl had seen in her lifetime.

We met in a crowded pediatric hospital in Irbid, Jordan near the Syria border. She patiently waited for her monthly blood transfusion, critical to treat her severe sickle cell anemia.  The cost of her treatment was only affordable because the Government of Jordan was paying a large part of the bill. Our team from the World Bank, Islamic Development Bank, and Global Concessional Financing Facility were there on a joint mission to prepare an emergency health project in response to the crisis. We were there to understand how to maintain her access to health care.

The Syrian crisis has impacted the health of both refugees and host communities. As a result of the war, mortality and morbidity has sharply increased. Diseases which were close to elimination—polio, leishmaniasis, measles, tuberculosis-- have reared their ugly heads. And new health concerns have emerged. Mental health, communicable diseases, non-communicable diseases—all have increased in the last six years—with deadly consequence.

The Government of Jordan has mounted a generous response. From 2012-2014, they provided free health care to all Syrian refugees. When this became financially unsustainable, they continued to pay almost 80 per cent of the cost of care and still provide free care for a subset of conditions-- antenatal visits, vaccinations, and treatment of communicable diseases. They understand that if one person is sick, the entire community can get sick. Disease is the ultimate leveler—it respects no boundaries and transcends nationality.

However, continuing to provide these services at such a low cost is also unsustainable. But who will pay the bill? When care moved from being free to being subsidized three years ago, the number of Syrians being able to afford health services in Jordan halved. One in six refugees stated that cost was the greatest barrier to accessing health care, one in five households faced catastrophic spending due to health care costs, and one in two Syrian refugees with chronic conditions stated that they could not access medicines and other services. If the subsidy is further reduced, it is clear that more refugees will be unable to access care. Six years in, the humanitarian crisis has become a development one. And so a development response is required.

Recognizing that host countries like Jordan and Lebanon, which have taken in the bulk of the 5 million Syrian refugees are performing a global public good, the World Bank, United Nations, Islamic Development Bank, and bilateral donors set up the Global Concessional Financing Facility last year (see video). This facility uses grant money to buy down the interest on loans to transform them into credits. Thus one dollar raised by the facility, allows Jordan to access up to four dollars on concessional terms. Our project uses this new mechanism to assist the Government of Jordan in continuing to provide these lifesaving services. At the same time that our team was in Jordan, another set of colleagues was deployed to Lebanon to prepare a similar emergency project to help the Government respond to the health care needs of refugees and host communities.

June 20, 2017. Today is World Refugee Day and that little girl in the pink sweater remains in my thoughts. In the three months since I met her, our agile team has prepared, appraised, negotiated, and now just approved a project to support the Government of Jordan in the provision of critical primary and secondary health care services for poor uninsured Jordanians and Syrian refugees. We use a results based financing mechanism to reimburse the Government for the cost of providing care to these beneficiaries based on independently verified records of utilization and expenditure. The project will cover almost 3.5 million health visits over the next two years. In addition, we are working with the Government of Jordan to create a more sustainable and resilient health care system.  The project will provide technical assistance and capacity building to increase the efficiency of the health system. Our aim is to provide more health for the same amount of wealth in the medium to long term.

The project is US$150 million in total-- US$36 million from the World Bank, US$34 million from the CFF, and US$79 million from the Islamic Development Bank. As a result, our impact is fivefold greater than if we had prepared this project alone. Our team had staff from seventeen nationalities based in five different countries working 24/7-- truly a “World” Bank effort. We worked as one team, towards one goal—supporting the government to delivery critical health services for the most vulnerable.
And that little girl in the hospital on the Jordan-Syria border? She will be able to continue getting her blood transfusions every month at subsidized rates. Continue surviving. And one day, maybe even thriving, despite the war that rages on next door.