03 Aug 16 15 Jan 18

'A state of paralysis': A Canadian MSF nurse on the struggle to provide care to Syrians trapped on the Jordan border

Mariko Miller
Infirmière canadienne de MSF
« Les Syriens ont fui une guerre civile horrible qui perdure. Bon nombre ont vu des membres de leur famille mourir de façon traumatisante, les infrastructures réduites à néant et leur pays en pleine destruction. Tout ça pour se retrouver au Berm, où l’aide humanitaire n’arrive pas. »

Mariko Miller is a Canadian nurse currently working for Doctors Without Borders/Médecins Sans Frontières (MSF) in Jordan, helping deliver medical care to refugees fleeing the war in neighbouring Syria. She wrote the following post in response to the humanitarian emergency taking place on the Syrian/Jordan border in which tens of thousands of people are stranded without access to essential needs.

By Mariko Miller

I am part of an MSF medical team in a small Jordanian town about 70 kilometres from both the Syrian and Iraqi borders. We are working in an area known as “the berm,” where we had been providing medical care to a stranded population of Syrian refugees in a desert belt between the Syrian and Jordanian borders. Since a suicide bombing at the same border over one month ago, the Jordanian border has been indefinitely closed, and our project to provide emergency medical care has been in a state of paralysis.

While the name of our organization suggests unrestricted access across borders to provide care for the most vulnerable populations, the reality can be more complicated. In our work, access is something that often is the result of careful political negotiations, and our widely known commitment to impartiality, neutrality and independence. In the case of the berm, access is an extraordinarily complex issue, and the political and structural barriers in place for us highlight the limitations of humanitarian aid in the face of protracted conflict, when a lack of international political commitment has abandoned this desperate and terrified population.

Aid agencies struggling to gain access to people in need

The berm refers to a two-kilometre stretch of desert between the Syrian and Jordanian borders. It is a devastatingly unsustainable place to live, devoid of water sources, agriculture, food sources and even shade. It is a rocky desert land where the terrain make latrine-building a challenge, and where extreme dust storms can unexpectedly hit amid 45-degree heat.

The berm is frequently referred to as a refugee camp, but it is not an established camp. The majority of current residents are women and children who have fled bombs and aerial strikes from elsewhere in Syria. They seek asylum, but many are afraid of deportation (and separation from family). The rumoured presence of various Syrian rebel factions, armed gangs, and IS in the berm has prompted Jordan to close its borders from potential security threats, and aid agencies have been left struggling with the challenges of overcoming issues of access and ensuring our own security.

Since June 21, there has been limited water distribution and no food distribution (or medical care), and the complexities of distribution to an estimated population of over 80,000 stranded people through a single service entrance is a logistical nightmare.  Perceived ethical issues of sanctioning aid to an impossible living environment where people can’t sustainably survive independent of it, nor seek asylum or secure safety, raise difficult questions. But the risks of doing nothing are horrific.

A humanitarian emergency

Jordan has already accepted a huge burden of refugees from the Syrian conflict along with Turkey and Lebanon, and currently over 650,000 Syrian refugees have been absorbed in Jordan.  Globally, over 85 per cent of all refugees are absorbed by developing countries, reflecting a disappointing response by high-income countries with better capacity. The need for a long-term solution for the berm is glaring, but currently the desperation for food, water and medical care remains an immediate emergency.

From the rooftop of the MSF house in Ramtha, our sister project along the north-western border, you can see the smoke, and hear the explosions, the barrel bombs and mortar shells through the night. The proximity of war has a more urgent impact on my understanding of crisis. The container I sleep in vibrates with the explosions, and images of people fleeing dance in my mind. 

Syrians have fled an ongoing horrific civil war, many having witnessed the traumatic deaths of family members, the damage to infrastructure and the destruction of their country, only to arrive to the berm for help — to a place where aid can’t be delivered. In desperation and for survival, some are even returning to Syria knowing that the risks of IS, aerial strikes, attacks from rebel factions and continuous food insecurity are obvious realities. There is no longer any sense that humanitarian spaces can guarantee protection; and in many places — from Syria to Afghanistan to Yemen — we have seen international humanitarian law and the rules of war routinely flouted.

MSF has a Jordanian team of nurses, doctors, midwives and pharmacists who had been working at the berm and who are now currently on standby in case access to the berm is given. They speak of the human beings at the centre of this crisis and the deplorable conditions of the berm. Over 22 days of limited mobile clinical hours, they treated over 3,500 patients. Their commitment and extended hours of gruelling work has been beyond impressive; their sheer humanitarianism and readiness has been remarkable, and their generosity and empathy are inspiring.

We remain hopeful. We are hopeful that we will be given access and that we will be able to return and provide emergency medical care to this displaced population. We remain vocal that more commitment must be made by the international community to respond to this humanitarian crisis.

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