The Realization of the Right to Health for Refugees in Jordan

Heus, Katharine; Sartawi, Thamer

doi:10.1007/978-94-6265-014-5_7

Katharine Heus⁵ &
Thamer Sartawi⁵

1533 Accesses
1 Citations

Abstract

This chapter presents an assessment of the realization of the right to health for refugees in Jordan. A host to Palestinian, Iraqi, and Syrian refugees, Jordan has one of the highest densities of refugees per capita of any country in the world. The central aim of this contribution is to assess where primary responsibility for the realization of the right to health for these acutely vulnerable subgroups lies, both in theory and in practice. This is done through an analysis of the health status, core obligations, and the accessibility, availability, acceptability, and quality of care framework. It is found that while in theory primary responsibility lies with the Government of Jordan, in practice the international community has assumed a greater role in realizing the right to health across each of the main refugee communities. In particular, the United Nations Relief and Work Agency and the United Nations High Commission for Refugees have assumed a central role in realizing the right to health for refugees in Jordan. We posit that this Government of Jordan to United Nations responsibility-shift has resulted in the entrenchment of parallel social protection structures that has led to the creation of multiple UN “surrogate states.” While providing access to key services, these parallel structures exacerbate fragmentation in the Jordanian health system, compromising the realization of the right to health for both refugees and non-refugees alike. Integration of these parallel service structures into the Jordanian health system is proposed as a potential avenue for advancing the realization of the right to health for all residents in Jordan, including refugees.

Katharine Heus is a Graduate at the Global Public Health Unit, School of Social and Political Sciences, University of Edinburgh. Thamer Sartawi is a Medical doctor, Holder of MSC Global Public Health Unit, School of Social and Political Sciences, University of Edinburgh.

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Notes

1.
World Bank (n.d.): Jordan Country Profile http://www.worldbank.org/en/country/jordan [last accessed: 2 October 2013]. Patterson 2007 offers an overview of the Kingdom of Jordan in his comprehensive assessment of the right to health in Jordan.
2.
Jordan is often portrayed as a safe haven for refugees in the Middle East and North Africa region; see Chatelard 2010 and Patterson 2007.
3.
World Bank (n.d.) Jordan Country Profile http://www.worldbank.org/en/country/jordan [last accessed: 2 October 2013].
4.
ESCWA Demographic Profile of Jordan (n.d) http://www.escwa.un.org/popin/members/Jordan.pdf [last accessed: 2 October 2013].
5.
Ibid. Furthermore, UNHCR estimates that Jordan currently hosts 600,000 Syrian refugees, constituting 10 % of the Jordanian population, see Koren 2013.
6.
UNHCR Global Report 2012b, p. 84.
7.
United Nations International Committee on Economic, Social and Cultural Rights (ICESCR) 1976 Article 12.
8.
United Nations CESCR 2000 General Comment No. 14: The Right to the Highest Attainable Standard of Health (herein: General Comment 14).
9.
Ibid.
10.
General Comment 14, para 12(a).
11.
General Comment 14, para 12(b).
12.
General Comment 14, para 12(c).
13.
General Comment 14, para 12(d).
14.
Kagan 2012 offers an interesting assessment of the proliferation of UN surrogate states in the MENA region. He recognizes that UN surrogacy has arisen in Jordan, and proposes that this has been particularly acute in response to the Palestinian and Iraqi refugee crises.
15.
Hunt and Backman 2008, p. 82.
16.
World Bank 2012: Country Cooperation Strategy 2012–2015, p. 2.
17.
Jordanian Department Of Statistics 2011.
18.
WHO 2013 Global Health Expenditure—Jordan National Expenditure on Health 1996–2011.
19.
Ekman 2007.
20.
Jordanian Ministry of Health 2011—Jordan National Health Strategy 2008–2012.
21.
Ibid.
22.
Ibid.
23.
Ibid.
24.
World Health Organization 2009—Country Cooperation Strategy for WHO and Jordan 2008–2013 http://www.who.int/countryfocus/cooperation_strategy/ccs_jor_en.pdf [Last accessed: 2 October 2013].
25.
Ibid.
26.
Ibid.
27.
NCHR 2010, UNDP 2013, p. 78.
28.
UNHCR 2010.
29.
Backman et al. 2008, p. 2064, NCHR 2010, Patterson 2007, pp. 2–3, UNDAF 2007, p. 11.
30.
UNDP 2013.
31.
Patterson 2007.
32.
Patterson 2007.
33.
Davis 2012.
34.
UN 1951, Protocol Relating to the Status of Refugees.
35.
Refugees of the 1948 war were granted Jordanian citizenship and are the exception here as the categorization of refugees as foreigners largely applies to those who sought refuge to Jordan after 1954.
36.
See Zaiotti 2006 for a broader discussion of refugee policy in the Middle East.
37.
U.S. Committee for Refugees and Immigrants 2009.
38.
Backman et al. 2008, Human Rights Watch (HRW) 2006.
39.
General Comment 14, para 33; WHO (n.d.) Human Rights-Based Approaches Note further outlines the duty to “respect, protect, fulfill” the right to health, while Meier and Fox 2010 offer an interesting discussion of this duty in regards to international obligations.
40.
ICESCR 1976, Article 12, para 1.
41.
General Comment 14, para 34.
42.
Toebes 2013, p. 133.
43.
General Comment 14, para 35.
44.
General Comment 14, para 36. Much of this discussion emerged from the commentary offered by B. Toebes—for a full discussion see: Toebes 2013.
45.
ICESCR Article 2, para 3.
46.
Hunt and Backman 2008.
47.
General Comment 14, para 33.
48.
Hunt 2006, p. 1. A special thanks to B. Toebes for her comments, guidance and insights on this matter.
49.
ICESCR Article 2, para 1.
50.
Toebes 2013, p. 133.
51.
Toebes 2013, p. 134.
52.
United States Department of State: Human Rights Report Jordan 2010.
53.
Toebes 2013, p. 136.
54.
Ibid, p. 134.
55.
General Comment 14, para 18.
56.
UN CESCR 2009 General Comment 20: Non-discrimination in economic, social and cultural rights (Herein: General Comment 20).
57.
General Comment 20, para 10(b).
58.
General Comment 20, para 10(b).
59.
General Comment 14, para 18.
60.
General Comment 14, para 19.
61.
General Comment 14, para 30.
62.
Hunt and Backman 2008, p. 84.
63.
General Comment 14, para 12.
64.
Hunt and Backman 2008, p. 84.
65.
General Comment 14, para 43.
66.
General Comment 14, para 43 a–f.
67.
Hunt and Backman 2008, p. 85.
68.
Ibid.
69.
Patterson 2007.
70.
Sincere thanks to Stefanie Jensen for her comments and insights regarding non-nationals, and to Obi Nnamuchi for his editorial support and assistance with the discussion around the finitude of resources.
71.
Rempel 2006.
72.
Ibid.
73.
Al Abed 2004: This categorization of the 6 groups of Palestinians is done in addition to east banker Jordanians who lived on the east bank of the Jordan River before 1948. They are referred to as being Jordanians of Jordanian origin, in contrast to the 1948 Palestinian refugees who are more widely referred to as Jordanians of Palestinian origin.
74.
Ibid.
75.
Law No. 6 of 1954 on Nationality (last amended 1987) http://www.refworld.org/docid/3ae6b4ea13.html [Last accessed: 3 October 2013].
76.
Al Abed 2004.
77.
Al Abed 2004.
78.
Pérez 2011, p. 1034.
79.
Ibid. Gaza was under Egyptian administration during the 1948 and 1967 wars in Palestine, and Gaza inhabitants held Egyptian legal documents. During the 1948 war Gazan's who fled to the West Bank as well as refugees of the 1967 war originally from Gaza were not given Jordanian citizenship status as they already possessed Egyptian legal documents. Accordingly, Jordan classified these refugees as foreigners—a status that has persisted for 46 years even though these refugees are eligible for citizenship under Jordanian Law due to their prolonged residence in Jordan.
80.
Ibid, p. 1036.
81.
Ibid, p. 1045.
82.
Ibid, p. 1036—the notion of a substitute homeland “Watan Badil” claim is only put forward with regards to the 1967 Gaza refugees, however, it is interesting to note that such claims have not been put forward with regards to the 1948 refugees.
83.
Ibid, p. 1037.
84.
Ibid, p. 1036.
85.
Pérez 2011, p. 1036.
86.
UNRWA Medium Term Strategy 2010–2015, p. 9.
87.
Ibid.
88.
UNRWA's consolidated Eligibility and Registration instructions (CERI) (n.d.) http://www.unrwa.org/userfiles/2010011995652.pdf [Last accessed: 2 May 2013].
89.
Ibid.
90.
Ibid.
91.
Article 1D of the 1951 Refugee Convention states that the “convention shall not apply to persons who are at present receiving from organs or agencies of the United Nations other than the United Nations High Commissioner for refugees protection or assistance.” Since Palestinians receive assistance from a UN body (UNRWA), they are excluded from UNHCR mandate. See: http://www.unhcr.org/4ca34be29.pdf [Last accessed 3 October 2013] and Bocco 2009.
92.
Bocco 2009—the resolution was updated in 2004 in the General Assembly, further strengthening UNRWA's mandate to attend to the needs of Palestinian refugees.
93.
UNRWA: http://www.unrwa.org/etemplate.php?id=86 [Last accessed: 2 October 2013].
94.
Ibid.
95.
UNRWA 2010b.
96.
Riccardo et al. 2012.
97.
Ibid, p. 5. For example, with regards to infant mortality for Palestinian refugees in Jordan is 22.3/1000 compared to 18.4/1000 for the Jordanian population.
98.
Ibid, p. 11.
99.
Leaning et al. 2011, p. 9, Yach et al. 2004, Adeyi et al. 2007.
100.
Leaning et al. 2011.
101.
Toebes 1999, p. 665.
102.
Jordanian Ministry of Health 2011—Jordan National Health Strategy 2008–2012.
103.
UNRWA 2013, Health in Jordan. Available at: http://www.unrwa.org/activity/health-jordan [Last accessed: 12 October 2013].
104.
Lapeyre et al. 2011, pp. 105.
105.
Ibid.
106.
Ibid.
107.
World Health Organization 2009—Country Cooperation Strategy for WHO and Jordan 2008–2013 http://www.who.int/countryfocus/cooperation_strategy/ccs_jor_en.pdf [Last accessed: 2 October 2013].
108.
Ibid.
109.
Ibid.
110.
Lapeyre et al. 2011, pp. 100–105.
111.
Hunt and Backman 2008, p. 85.
112.
UNRWA Medium Term Strategy 2010–2015.
113.
World Health Organization 2009—Country Cooperation Strategy for WHO and Jordan 2008–2013 http://www.who.int/countryfocus/cooperation_strategy/ccs_jor_en.pdf [Last accessed: 2 October 2013].
114.
Ibid.
115.
Ibid.
116.
Hunt and Backman 2008, p. 85.
117.
Ibid.
118.
UNRWA ‘Health in Jordan’ Summary: http://www.unrwa.org/activity/health-jordan [last accessed: 6 October 2013].
119.
Hunt and Backman 2008, p. 85.
120.
See: UN (n.d.) http://www.un.org/en/strengtheningtheun/accountability.shtml [last accessed: 6 October 2013].
121.
As UNRWA's funding has decreased over the past years from 100 USD per refugee to 60.6 USD per refugee, the organization is under substantial financial pressure to perform and deliver services for refugees with only limited means. UNRWA Medium Term Strategy 2010–2015, p. 3.
122.
Lapeyre et al. 2011, pp. 100–105, UNRWA Medium Term Strategy 2010–2015, p. 41.
123.
Bocco 2009, p. 234.
124.
Rosenfeld 2009.
125.
Bocco 2009.
126.
Kagan 2012.
127.
Takkenberg 2009.
128.
Jordan Ministry of Health 2011.
129.
Bocco 2009, p. 234.
130.
Ibid.
131.
Devi 2007, p. 1815, Bettis 2010, p. 262, Doocy et al. 2011, p. 273.
132.
Bettis 2010, p. 262, Chatelard 2010, Kenyon Lischer 2008.
133.
UNHCR 2013 http://www.unhcr.org/pages/49e486426.html.
134.
Crisp et al. 2009: 1, Bettis 2010: 262, International Organization for Migration 2009, as cited in Kenyon Lischer 2008, p. 95.
135.
Fafo 2007, p. 3. Figures listed here are based on synthesis of UNHCR, NGO and Government data. Furthermore, Chatelard 2010 suggests that the actual number is probably closer to 1 million, whereas Davis 2012 suggests that, at the peak of the crisis, the number was between 400,000 and 750,000. Finally, data presented by the U.S. Committee for Refugees and Immigrants 2009 World Refugee Survey estimates the figure is closer to 450,000 refugees from Iraq. Conflicting estimates of the total number of Iraqi refugees in Jordan make it quite difficult to ascertain an example number, and so instead the wide range proposed here will be accepted.
136.
International Crisis Group 2008 Middle East Report No. 77, p. 14.
137.
Crisp et al. 2009, p. 9.
138.
Ibid.
139.
UNICEF, WHO and Johns Hopkins 2009, HRW 2006.
140.
Ibid.
141.
UNHCR 2010 Global Report Jordan, Crisp et al. 2009, Chatelard 2010.
142.
UNHCR and GOJ MOU 1998. For a more detailed discussion see: HRW 2006.
143.
HRW 2006.
144.
UNHCR and GOJ MOU 1998.
145.
HRW 2006, p. 10.
146.
Kenyon Lischer 2008, p. 65.
147.
Davis 2012.
148.
See HRW 2006, p. 5 for a discussion of camps in the Iraqi refugee crisis.
149.
Ibid, p. 6.
150.
UNHCR Global Report Jordan 2010.
151.
Ibid.
152.
Martin and Taylor 2012.
153.
Leaning et al. 2011 p. 7, United States Committee for Refugee and Immigrations 2009, p. 2.
154.
Mowafi and Spiegel 2008, p. 1713.
155.
Crisp et al. 2009.
156.
HRW Silent Treatment 2006 offers an extensive discussion of the difference between the number that have been registered with UNHCR, and the number of Iraqis present in Jordan (pp. 6–9). Significantly, as stated in this report, the GOJ does not recognize the UNHCR asylum-seeker cards that the Refugee Commission has issue to some Iraqis in lieu of refugee status.
157.
Guterras and Spiegel 2012, p. 673.
158.
Crisp et al. 2009, p. 4.
159.
Mateen et al. 2012, Fafo 2007, Davis 2012, p. 4, Doocy et al. 2011.
160.
Davis 2012 has undertaken a comprehensive assessment of urban refugees in Amman and the complexities around mainstreaming healthcare. Furthermore, the Iraqi refugee population in Jordan is not the only urban refugee population to speak of and Guterras and Speigal 2012 offer an interesting overview of adapting health responses to urban environments.
161.
Crisp et al. 2009. Furthermore, the Jordanian refugee population was found by Crisp et al. to be on average of higher socioeconomic status than those who sought refuge in Syria and Lebanon. Davis 2012, p. 9; International Crisis Group 2008: Middle East Report No. 77, p. 13.
162.
Davis 2012, p. 9.
163.
Devi 2007, p. 1816, UNICEF, WHO, Johns Hopkins Joint Assessment 2009.
164.
Mateen et al. 2012, p. 446.
165.
UNICEF, WHO, Johns Hopkins Joint Assessment 2009, p. 21, Mateen et al. 2012.
166.
Crisp et al. 2009.
167.
Davis 2012, p. 4.
168.
UNICEF, WHO and Johns Hopkins 2009, Devi 2007.
169.
Crisp et al. 2009.
170.
Devi 2007, Davis 2012.
171.
UNICEF, WHO and Johns Hopkins 2009.
172.
Davis 2012, p. 9.
173.
UNICEF, WHO and Johns Hopkins 2009.
174.
Ibid, p. 15.
175.
HRW 2006, p. 64.
176.
UNICEF, WHO and Johns Hopkins 2009.
177.
Ibid.
178.
Ibid.
179.
HRW 2006.
180.
UNHCR Jordan Country Profile 2013.
181.
HRW 2006.
182.
Mowafi and Spiegel 2008.
183.
Bocco 2009.
184.
Davis 2012.
185.
Hunt and Backman 2008, p. 85.
186.
General Comment 14, para 3.
187.
Crisp et al. 2009, p. 10.
188.
Davis 2012.
189.
Davis 2012.
190.
Davis 2012, p. 10.
191.
Ibid.
192.
Ibid.
193.
Crisp et al. 2009.
194.
The Jordan Times (15 September 2013) Jordan Hosts 2130 Syrian Army Defectors. Available at: http://jordantimes.com/jordan-hosts-2130-syrian-army-defectors----majali.
195.
UNHCR 2013.
196.
Ibid.
197.
UNHCR Global Report Jordan 2010.
198.
Kagan 2012.
199.
General Comment 14, para 33.
200.
For a discussion of accountability and the realization of the right to health—see Yamin 2008.
201.
Kagan 2012, p. 311, Slaughter and Crisp 2008.
202.
Kenneth 2004.
203.
Kagan 2012, p. 316.
204.
Ibid.
205.
Bocco 2009, p. 234.
206.
Kagan 2012, p. 308.
207.
Ibid, p. 309.
208.
Ibid.
209.
Ibid.
210.
Ibid.
211.
Kagan 2012, p. 311, Hathaway 2007.
212.
Ibid.
213.
Hunt and Backman 2008, p. 89.
214.
WHO 1978 Declaration of Alma-Ata, WHO 2008: Primary Health Care (Now More than Ever), Rifkin and Walt 1986.
215.
Buse and Harmer 2007, England 2007, Ranson et al. 2007, p. 30.
216.
Clear examples of GPPHP include the GAVI Alliance, which provides immunizations (www.gavialliance.org) and also The Global Fund to Fight AIDS, TB and Malaria, which attempts to provide access to necessary medication (www.theglobalfund.org).
217.
Balbanova et al. 2010, Buse and Harmer 2007, Kagan 2012.
218.
Balbanova et al. 2010, Buse and Harmer 2007.
219.
Balbanova et al. 2010.
220.
Buse and Harmer 2007.
221.
Ibid.
222.
Ibid.
223.
OECD Paris Declaration on Aid Effectiveness 2005, OECD Accra Agenda for Action 2008, Sridhar 2009, WHO Aid Effectiveness and Health 2007.
224.
UNHCR 2009—Facilitating the Transition http://www.unhcr.org/4a8030d69.pdf [last accessed: 14 October 2013], Martin and Taylor 2012.
225.
Vergeer et al. 2009, World Health Report 2008, Freedman 2005.
226.
Godfrey and Mursal 1990 as cited in Rowley et al. 2006.
227.
Kunz 1990 as cited in Rowley et al. 2006.
228.
Van Damme 1998, as cited in Rowley et al. 2006.
229.
Rowley et al. 2006, p.162.
230.
UNFPA 2013, UN News Center 2013.
231.
UNHCR 2012a Participatory Assessment; CARE Jordan Baseline Assessment 2012.
232.
ICESCR 1976.

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School of Social and Political Sciences, University of Edinburgh, Edinburgh, EH8 9AD, UK
Katharine Heus & Thamer Sartawi

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Katharine Heus
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Faculty of Law, Constitutional and International Law, University of Groningen, Groningen, The Netherlands
Brigit Toebes
Law, Irish Centre for Human Rights, Galway, Galway, Ireland
Rhonda Ferguson
Institute of Social Sciences, Belgrade, Serbia,Institute of International Law, Graz, Austria
Milan M. Markovic
Faculty of Law, Dept of Public and Private Law, University of Nigeria, Enugu Campus, Enugu, Nigeria
Obiajulu Nnamuchi

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Heus, K., Sartawi, T. (2014). The Realization of the Right to Health for Refugees in Jordan. In: Toebes, B., Ferguson, R., Markovic, M., Nnamuchi, O. (eds) The Right to Health. T.M.C. Asser Press, The Hague. https://doi.org/10.1007/978-94-6265-014-5_7

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