Al-Zaatari Prison!

Oops, did I say prison in the title. That should have said camp. Al-Zaatari camp is located about 1-1.5 hours northeast of Amman depending on traffic. It is situated near the Syrian border east of a town called Al-Mafrak and a military base. It is a fenced area that started with few tents and now bustles with many caravans (POD storage units now used for human housing) and tents that provide a sanctuary to many Syrians. The number has been fluctuating. Some says that it houses +180,000 Syrian refugees. I have heard that it dropped recently to about 120,000 people.

The camp is the home of all of those refugees who cross the borders without a passport or illegally. The other fortunate ones who cross with a passport are allowed to live in other areas of Jordan. If a refugee ended up housed in here he or she cannot get out unless a Jordanian sponsor him or her. Few pay for that sponsor and few smuggle out. Through out this mission, I have seen few patients that were initially in Al-Zaatari and then were bailed out by a Jordanian relative.

You get to the camp by turning right just before the Syrian border, south of ‘Jaber’. The road takes you east of Al-Mafrak and then you take another right toward the area. I am not sure if the road before you get to the camp is meant to be a dirt road or is currently undergoing construction. The camp itself can be seen in the horizon but when you get near by it is hidden behind recently planted trees. There are two checkpoints to enter the camp and many soldiers.

There is an armored vehicle on the main entrance and photography is not allowed near or inside the camp. The tiny road filled with people and kids walking in and out takes you to another check point were you see another set of soldiers (some hiding in civilian clothing) who check your approval papers again. You will need a permit and a valid passport to enter. After we got in, we rearranged our vans so that the psychiatry team went in one van and the medical and optometry team went in another.

We travelled on a dirt road around the camp and then entered what seems to be Al-Zaatari main road. There are multiple shops on both sides, shops of all kinds: clothing, shoes, food, mobile technology, and even bridal shops. People were everywhere and kids were everywhere. They jumped on vans back bumper to get free rides or may be they were just having fun. There are areas of the camp that look like a sea of tents but others that are now made of caravans. I am not sure what determine where people live or if it is a matter of short term versus long term stay.

The alley that took us to the clinic has caravans on each side. Each group of caravans is blessed with a water tank that gets filled on a regular basis. Our clinic area was spread across the two sides of the alley. There is a pharmacy with very limited resources and two clinic areas. We set up quickly the Optometry clinic in one room and the Family Medicine in another and the Internal Medicine in a third. We paired up each non-Arabic speaking physician with an Arabic-speaking physician (in addition to their interpreters).

The room I shared with Dr. Green, the great Cardiologist from Seattle, was a 15x25 rectangle with no ventilation. It has one paper-shaded window on each side. There was an exam table at the end and one desk. Dr. Green took the exam table and I took the desk. Which meant that he will write without support and that my exam table is a wooden bench. There was an air conditioner in the pharmacy and after an hour they brought us a fan. I don't know what was better; survive the clinic without ventilation or trying to catch all the flying papers the fan blew away.

Dr. Green coined the term 'the physician's lounge' describing a room that has a toilet hole in the ground, a primitive shower and a stove to boil water for tea or coffee. The couch was made of a rear car seat. Needless to say, we avoided eating or drinking anything there that day but I am sure if you keep going to that clinic every day you will become numb. We learned that this clinic houses an Ob/Gyn clinic and a neurosurgery clinic during the week. The ladies who were triaging for us were Syrian nurses who are themselves refugees.

It didn't take long to realize that the cases are either too simple to even be seen by a physician or too complicated for our very limited resources. We did what we needed to do to see patients. I saw kids, checked blood pressures, measured weights and calculated doses. By four o'clock our clinic was done but the optometry clinic had about sixty patients waiting. We went in to see what we can do to help and soon enough a cardiologist, a nephrologist and an attorney were prescribing reading glasses. Seeing a smile on the face of a grandma after she was reading clearer with her new frame was the most rewarding event to me that day.

There are other clinics in Zaatari. There is the Moroccan, the Saudi, and the Emirates clinics and probably others. Each clinic has different resources and I have no doubt that patients are shopping around. They all try to tell you that they were stable on the medications they were taking in Syria but in the camp they get whatever are available that day. I am sure that there are many resources provided to the camp by several agencies, governments and individuals but the lack of coordination, and the chaotic nature of the process is only creating a fractionated health care system for these poor people.

There was a silver lining though because one patient came to me with a health care passport book that was issued by the UNHCR and should contain her medical history. It took about three years for this idea to come about and hopefully, if the various organizations are unable to keep records of the patients, the patients themselves will. This is an issue that needs reinforcing.

I have heard about two other refugee camps in Jordan. One is Al-Rajehi camp on the Syrian border for the defectors from the Syrian army and the other is called Cyber City. Cyber City is supposed to house Syrian Refugees of Palestinian origin such as those who used to live in Al-Yarmouk camp in Damascus. Though I did not see it, I was told that it was more prison-like than Al-Zaatari with enhanced security and snipers on multiple observation towers.

There are some who believe that the Syrian revolution was a revolution to reclaim the dignity of the Syrians. The things that I saw today and through out this week make me doubt that this is what the Syrians accomplished so far.