By Yaseen al-Mubarak

AMMAN- After the initial shock of Ahmad al-Shahadat’s cancer diagnosis, his family had little time to process before receiving a second piece of distressing news: the cost of treatment would far outstrip their financial means.

Al-Shahadat, 54-year-old, was a Syrian refugee who lived in Irbid province in northern Jordan. He was diagnosed with cancer of the small intestine, a rare form of the disease, which requires “an urgent surgery to remove the affected part,” his son Muhammad told Syria Direct.

At the request of the doctor, Muhammad visited several hospitals in Irbid to review his father’s surgery options. He found that his family could not afford the operation, as its cost “ranged from five to ten thousand Jordanian Dinars ($7,052-$14,000),” and his family had already borrowed “two thousand Dinars ($2,820) to pay the costs of tests and analysis.”

In April, the Jordanian Ministry of Health announced that Syrian refugees receiving treatment at government hospitals and health centers would pay the same fees as uninsured Jordanians, where before they were treated as if they were insured Jordanians.

Many refugees have found the new cost of medical treatment in Jordan to be too high, so much so that it has pushed some to return to Syria and seek treatment there. The reopening of Naseeb-Jaber Syrian-Jordanian border crossing in October 2018 has helped facilitate these returns.

In April, al-Shahadat decided to return back to Syria. There, he underwent “surgery to remove the tumor, which did not cost more than 550 Jordanian Dinars [around $775],” at al-Mujtahid hospital in Damascus, according to Muhammad. The cost of the surgery was 10 percent of what it would have cost in Jordan.

Unfortunately, al-Shahadat died just days after the operation.

Mahmud Sadaqa, a Jordanian activist and a medical aid volunteer who works with both Jordanians and Syrian refugees, confirmed that “the cost of treatment in Jordan for some diseases is high” and affects Jordanians and Syrian refugees alike.

“The cost of heart and cancer operations is oppressive for both Jordanians and Syrians,” he told Syria Direct,

“Syrian refugees get assistance for cancer and other treatments via [humanitarian] organizations or individual initiatives, however, not all cases [can receive treatment].”

In June, The World Bank approved a “$200 million project to support the Government of Jordan, maintaining the delivery of critical primary and secondary health services to poor uninsured Jordanians and Syrian refugees at Ministry of Health facilities.”

Medical costs forcing returns

As the Syrian government encourages refugees to return—simplifying documentation procedures to do so—the number of returnees remains low. According to UNHCR, just 27,000 Syrian refugees in Jordan have returned to Syria since the opening of the border crossing in October 2018. The current number of Syrian refugees in Jordan sits at 657,000.

However, the high cost of medical treatment has caused some Syrians to return home where they otherwise would have been reluctant to do so, as the country has yet to recover from eight years of civil war and the risk of arrest by Syrian security services remains an issue for many.

This was the case with Muhammad al-Ahmad, a 31-year-old who fled to Syria in 2013 and currently studies at a Jordanian university and works at night to support his wife and two children.

During his wife’s pregnancy, they discovered that one of the twins “suffers from Anterior Plagiocephaly [a fusion of skull bones in infancy which produces a variety of health problems, including facial disfiguration and vision problems].”

By the time his son was four-month-old, it became apparent that he was suffering from fluids in the brain, a condition which requires multiple surgeries to fix, costing around seven thousand Jordanian Dinars (around $9,870). Al-Ahmad could not afford the operations as, in his words, “I barely cover my family’s daily expenses.”

Al-Ahmad sought help from humanitarian organizations in Jordan but received no assistance, telling him that “they don’t cover those types of operations.”

With little options left, al-Ahmad began to think about treating his child in Damascus, despite such a move having been “unimaginable” to him just months before due to the security risks it would expose his family to, especially due to his wife having left Syria “illegally”.

According to a Syrian who works as a volunteer helping people to get medical care in Jordan: “The question of treatment in Syria is not easy for Syrian refugees. Patients get shocked by the changes that took place as a result of the war, in addition to the regulations and bylaws in force in Jordan concerning Syrian refugees leaving.”

Any patient who wants to receive treatment in Syria needs a “document that permits them to enter Jordan again. However, in emergency cases, patients are unable to wait for the re-entry document, which takes at least 15 days, placing before them two options: Either a hasty departure which could bar them from returning [to Jordan], or waiting and bearing whatever results from the [subsequent] decline in their health,” she told Syria Direct.

Medical support for Syrians drawing down

While talking to Syria Direct on phone, the Syrian volunteer was in al-Bashir public hospital in Amman accompanying an elderly Syrian woman with breast cancer.

The woman was unable to afford the cost of the chemotherapy she needed. Private individuals were able to put together the 160 Jordanian Dinar ($225) necessary to cover the woman’s first chemo dose; however, “there are no funds to cover further treatment [and] there is no humanitarian organization to take on this case,” the Syrian volunteer said.

“This elderly woman has no option other than returning to Syria to get treatment, where the cost of chemo treatment dose is no more than eight thousand Syrian Pounds (around $15.50), or only ten Jordanian Dinars.”

Furthermore, in spite of her advanced age and sickness, she has to travel by herself, according to the Syrian volunteer, as her son will not be able to go with her because of security concerns.

According to the Advocacy Manager of the Syrian American Medical Association (SAMS), Dr. Mohamad Katoub, the association covers “the medical side in Jordan in two ways: clinics, which work on a permanent basis, or through medical missions which bring foreign specialists to Jordan for several days.” He noted that SAMS “does not provide support for surgeries, [because] there are no donors which cover them.”

In general, Syrians in Jordan are finding it increasingly difficult to obtain medical care as donor states draw down their funding to Syrian refugee programs.

Humanitarian organizations have been reducing their presence in Syria’s neighboring countries, choosing to redirect their resources into Syria itself, encouraged by Damascus’s statements indicating the war is ending and that it is safe for refugees to return.

This report is part of Syria Direct’s Connecting Communities through Professional Engagement Project in partnership with the Australian Embassy to Jordan's Direct Aid Program.

The report was originally published in Arabic and translated into English by Will Christou