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  • Reports on Sexual & Reproductive Health

    Photo By: The IRC/Gerald Martone

    Reproductive Health for Syrian Refugees in Zaatri and Irbid Jordan

    An Evaluation of the Minimum Initial Service Package (MISP)

    Reproductive Health for Syrian Refugees in Zaatri and Irbid Jordan thumbnail

    Despite the steady influx of refugees into Jordan that has strained the resource capacity of this humanitarian emergency response, the agencies that provide RH services have been able to implement the MISP for the most part, although there is need for some improvement. In this setting, the study team found some challenges, such as balancing the increasing demands for services while maintaining quality and managing information flow among multiple stakeholders. 

    Key Findings

    • Key informants were aware of the five MISP objectives . However, there was very limited understanding of the additional priorities of the MISP such as ensuring contraceptives are available to meet the demand; treatment for sexually transmitted infections (STIs) is available to people presenting with symptoms; antiretrovirals (ARV) are available to current users; and menstrual hygiene supplies are available.
    • A number of key elements to support implementation of the MISP were in place, including a dedicated lead agency to support MISP implementation within the health sector, a focal point for RH coordination, regular RH coordination meetings in Amman and Zaatri camp, and RH kits and supplies, and funding for MISP implementation were noted. However, key informants reported that RH coordination was insufficient for the urban areas; not all key stakeholders participated in coordination; protocols for care for survivors of sexual violence were incomplete or STIs did not exist; and that key informants would like UNFPA to share the information that it collects from stakeholders among stakeholders.
    • Syrian refugee women discussed security fears that they had in relation to using the latrines at night due to a lack of lighting. While services existed to manage sexual violence (SV), they were limited, and community and provider knowledge of the services was low.
    • Safe blood transfusion practices and standard precautions were in place; however, condom distribution was limited.
    • Clinical services to prevent excess maternal and newborn morbidity and mortality were in place and utilized.
    • Planning was underway for expanding to have more comprehensive RH services.
    • Baseline data collection and routine monitoring of RH indicators were limited.
    • In terms of additional priorities to the MISP, modern methods of family planning was available (although condom distribution limited), syndromic treatment for people presenting with symptoms of STIs was not available, the situation of continuing ARVs for refugees already on ARVs was unknown and menstrual hygiene supplies were insufficient.
    • Although there was a high level of specialty clinical care available, primary care clinics and outreach to the community was limited.
    • Refugee women and adolescent girls that participated in the FGDs perceived clinical services negatively and they complained about not being included in the humanitarian relief response.
    • MISP contingency plans were established but not activated. Jordan has undertaken some activities on disaster risk reduction although it was unclear if there have been initiatives to address health and RH.
    • Barriers to MISP implementation included a lack of adequate staffing in urban areas and of clear RH protocols, particularly on care for survivors of SV, and management of STIs); less focus by the RH working group in Amman on urban populations compared with the camp population; and lack of capacity to implement the MISP contingency plan.

    Key Recommendations

    There are a number of interventions that can be implemented immediately and include the following:

    • Strengthen coordination in Amman to address the RH needs of urban refugee populations; facilitate the participation of key stakeholders such as the MOH, WHO, local NGOs, unfunded partners and inter-agency protection and gender-based violence (GBV) working groups in both Amman and Zaatri meetings; address RH protocols, particularly, finalize the clinical care for SV survivors protocol; identify STIs management and protocols for referral of and caring for person living with HIV (PLHIV); improve data collection and use of data for action; and support information, education and communication (IEC) campaigns on the benefits to seeking care and the availability, location and hours of services in both urban areas and Zaatri refugee camp.
    • Improve free condom distribution with sensitivity to cultural norms.
    • Scale up the availability of clinical care for survivors of SV at service delivery sites and consider integrating the protocol into the Family Protection Department where forensic doctors are available and could be trained.
    • Strengthen community outreach, participation and services along with information and education, including for adolescents and people with disabilities, by utilizing existing IEC campaign resource materials on the MISP and family planning, and ensuring all service delivery is physically accessible and inclusive of people with disabilities.
    • Improve the health care environment with adequate staffing, particularly female doctors and by addressing the interactions between health care providers and Syrians so that Syrian women feel comfortable while seeking care. Advocate for Syrian health care providers to be involved in providing health care services to the refugees.
    • Modified: Thursday, December 15, 2016
    • Published: