By Justyna Alsamawi – Volunteer, International Medical Corps, Jordan
Of the world’s 10.5 million refugees, only one-third live in traditional camps settings. Since the 1950s, the trend for refugee movement has shifted increasingly toward urban settings, due in part to the hope for increased employment opportunities, ability to remain anonymous and greater self-sufficiency. Despite these potential gains, “urban refugees” lack natural social support networks, suffer from isolation within the host population, and are more vulnerable to acts of sexual and gender-based violence and exploitation. In large cities, migrants and refugees, many of whom have experienced loss and been exposed to extraordinary events, are difficult to identify and reach with humanitarian services including primary and mental health care.
Jordan, a primarily urbanised country, has long been a key destination for refugees. Palestinian, Iraqi, Sudanese, Somali, and, most recently, Syrian refugee groups constitute the most vulnerable urban populations in Jordan. Though they face a range of health and protection needs, reaching and assisting urban refugees, especially those not registered with the UN Refugee Agency, can be challenging. Addressing the mental health and psychosocial support (MHPSS) needs of urban refugees requires effectively integrating mental health practices into primary health care systems, the commitment of well-trained health practitioners, and strong coordination at the national and local levels.
To address these challenges, the Psychosocial Services and Training Institute in Cairo in affiliation with the American University in Cairo organised a workshop entitled “A Growing Challenge: Psychosocial and Mental Health Support for Refugees and Migrants living in Urban Settings”. This three-day conference in April 2012 was held in Cairo, one of the largest urban settings for migrants and refugees. Representatives of international non-governmental agencies from more than 20 countries and regions, including Egypt, the West Bank, Syria, Sudan, Libya, Ethiopia, Kenya, Hungary, Canada and the United States attended the conference.
International Medical Corps’ Jordan mission was represented at the conference by Sawsan Moh’d Sa’aada, Case Management Team Leader, whose presentation “International Medical Corps Interventions to Build Initiatives with Jordanian National Governments for MHPSS of Refugees and Migrants in the Urban Context” sparked great interest among the international audience. Ms. Moh’d Sa’aada’s presentation highlighted International Medical Corps’ work with the Jordanian Ministry of Health (MoH) and Jordan Health Aid Society (JHAS), which International Medical Corps has worked to build the capacity of in the field of MH education.
International Medical Corps-Jordan’s MH e-learning training for health practitioners, currently being developed, was of particular interest to the audience. Mental Health E-learning training – an interactive educational platform on mental disorders and needed interventions –is designed specifically for health practitioners in Jordan at the national (MoH) and local (JHAS) level.
“MH E-learning is a more sustainable and consistent way of training Jordanian health practitioners that could be ongoing and accessible at any time and for everyone, regardless of his or her current field location in Jordan,” said Ms. Moh’d Sa’aada. “Through this initiative, practitioners will be able to respond to MHPSS needs of urban refugee and migrant communities scattered across Jordan efficiently and in a timely manner.”
According to Ms. Moh’d Sa’aada, this conference was a great platform for international agencies working with urban refugees to share innovative interventions and approaches to respond to the MHPSS needs of these vulnerable communities.
Just 22 hours after the devastating 7.0-earthquake hit in January 2010, International Medical Corps’ Emergency Response Team was on the ground in Haiti providing medical care to survivors. Our doctors and nurses were able to mobilise on an unparalleled scale to provide 24-hour emergency care to the acutely injured at the Hôpital de l’Université d’État d’Haiti (HUEH), a 700-bed hospital in Port-au-Prince. HUEH was badly damaged in the earthquake and many local health care professionals were missing. We were able to save thousands of lives through emergency and trauma care in the critical days following the earthquake.
At the height of emergency operations at the hospital, International Medical Corps treated approximately 1,000 patients per day. Our early entry also gave us the foundation to rapidly expand our operations to 15 mobile clinics throughout Haiti to provide critical services. Through the hospital and mobile and fixed clinics, International Medical Corps teams provided more than 110,000 patient consultations during the first year following the emergency.
When reports of acute diarrhoea emerged from the north of Haiti in October 2010, International Medical Corps doctors and nurses immediately deployed to the region providing emergency relief for the growing cholera crisis. Our network of rapidly constructed cholera treatment centres, supported by 820 community health volunteers to educate communities on how to prevent and identify cholera, meant that more than 30,000 cholera patients received life-saving treatment within the first year following the outbreak.
International Medical Corps was among the first organisations to enter Libya once the conflict began in February 2011, providing emergency medical care to casualties from the fighting and support to hospitals with medical staff and supplies. Among the first challenges our Emergency Response Teams encountered was a chronic shortage of nurses, as thousands of foreign nurses had fled the country. In partnership with the Jordan Health Aid Society, International Medical Corps immediately deployed volunteer nurses to health centres across eastern Libya moving them to towns and cities throughout the country as access permitted. Volunteer nurses trained the local counterparts while working alongside them.
At the country’s borders and within Libya, we supplied those displaced by the fighting with essential relief items, including blankets, bottled water and food. Recognising the danger posed by communicable diseases, our sanitation and hygiene specialists constructed latrines and washing stations in transit camps along the Tunisia borders.
As the fighting went on International Medical Corps worked as close to the front line as possible, providing emergency treatment to those injured in the conflict, and medicines and supplies to besieged towns and cities. In Misurata, inaccessible by road, we evacuated nearly 500 injured civilians by boat. International Medical Corps’ mobile field hospitals treated the wounded from battles in Tripoli, the Western Mountains, Bani Walid, Sabha, Jufrah and Qaddafi’s hometown of Sirte.
International Medical Corps mobilized an emergency response in Mali in January 2013 after rebel armed forces from the north began moving south, triggering French military intervention. In Timbuktu, which had spent months under the control of armed Islamist rebel our team were amongst the first international organisations to arrive and found pillaged clinics, missing medical personnel and damaged health infrastructure.
We immediately began supporting eight strategically targeted health clinics in remote areas around Timbuktu, where the Malian Ministry of Health has been unable to maintain adequate services to local communities. By providing medicines, training staff and recruiting qualified doctors and nurses, we can ensure local people will now have access to basic primary and secondary health care for the first time in months
True to our mission to build self reliance, International Medical Corps is also already training community health workers to go out to local markets and spread essential hygiene, reproductive health and nutrition messages. We are also working to rehabilitate clinics damaged during the conflict, by building or repairing latrines, water systems, solar panel systems and other infrastructure repairs, enabling health workers to have stable and well-equipped facilities to help the people of Mali.
Basanti, a young mother of two in Nepal, returned home from fetching water for her family to find her 8-month old son Bishal had fallen into the open cooking fire. Basanti was in shock, but she wrapped her baby in blankets and ran for help. No one in their village or at the local health post knew what to do so she had to travel more than six hours by bus to seek emergency care at the closest hospital. The district hospital could only stabilize Bishal and wasn’t able to treat his wounds properly. As a result, his little fingers contracted into a fist as the burned skin contracted and “healed” over the coming year, making it impossible for him to use his hand. His cheek, lips and eyelid also contracted and tightened, threatening his vision.
After selling part of their farm to pay for transportation to Kathmandu, Basanti sought further treatment for her baby. However, two hospitals in the nation’s capital could not help either. Adding to Basanti’s struggles, her husband abandoned the family, leaving her alone to care for Bishal and his four-year-old sister.
Thankfully, Basanti heard about the surgical care available through ReSurge International, our trusted partner with a 43-year history of serving burn victims. Dr. Rai, ReSurge’s Outreach Director in Nepal, and his team restored Bishal’s eyelid and his hand will soon be surgically repaired as well.
Even though it took more than a year for him to get appropriate treatment, Bishal is one of the lucky ones. Thousands of children never get the care they need to live a normal life after a disabling burn.