The Al-Zattari Experience

As UK paediatric trainees, we are very fortunate to be part of a college that actively and passionately advocates for the rights of child refugees both in the UK and internationally.  In Katy’s recent report on this year’s RCPCH conference, it was interesting but a little disappointing to hear about the UK government's involvement in the Dubs amendment and how only 350 of the potential 3000 unaccompanied children were given refuge in the UK before being abandoned due to lack of capacity. 


Being ever aware of the large number of children who are displaced due to war and conflict, I decided that I wanted to use my medical skills and help in whatever way I could.  Last month I found myself spending 10 days of my annual leave in Jordan, home to 1.4 million Syrian refugees and host of the largest refugee camp outside of Africa with the Syrian American Medical Society on their July Mission.


I had found out about the Syrian American Medical Society (SAMS) through word of mouth.  With an interest in international child health, I was very interested to hear about this American NGO that regularly arranges medical relief missions to Syria and its neighbouring countries.  I was even more happy to hear that they really needed paediatricians and you didn’t need to be American, Syrian or even an Arabic speaker to apply. Historically they are a non-profit organisation set up by a group of American doctors. Since the Syrian conflict began in 2011, their focus has been directed towards meeting the needs of the healthcare crises of refugees. They have been working in the Al-Zaatari refugee camp for over three years, providing medical care to Syrian refugees displaced by the ongoing crisis. The camp, currently hosting 80,000 registered refugees (of which half are children) is so vast that it has now become Jordan’s fourth largest city. SAMS are in the process of establishing their own medical care facility within Al-Zaatari for both primary and secondary care.


I recruited fellow @bttb member Smiti, who also has a keen interest in international child health to join me. Our trip gathered interest from colleagues, friends and family and before long we were fundraising and managed to raise an unexpected amount of donations for SAMS.


We arrived at 5 a.m in Amman greeted by the beautiful Jordanian sunrise and a SAMS volunteer called Muhammad who was himself a Syrian refugee. Later that same day we met our fellow SAMS volunteers. Having already communicated with the 60 strong team via Whatsapp it was great to put faces to the names.  Our group was made up of key SAMS organisational staff from both Jordan and America, as well as paediatricians, interventional cardiologists, ophthalmologists, dentists, physiotherapists, counsellors, pharmacists, anaesthetists and a small army of translators who were often local or American medical students as well as children of the SAMS staff. Some of us were first timers volunteers whilst some were returning. We all had one thing in common- the need to give back a little bit towards humanity.


We were briefed on what would be a busy week ahead. There were 4 paediatricians in the group, which meant over the course of the next six days we would be conducting 4 individual paediatric clinics in various outreach centres in Jordan including within the Zaatari refugee camp. The satellite clinics are situated in various cities around Jordan, some up to 2 hours of travel from Amman. They were identified as towns and cities where there were a significant population of Syrian refugees.


Our days were long, starting with a 5.30 am wake up, followed by breakfast, a quick visit to the makeshift pharmacy to pick up supplies hen onto to the bus by 7.30am. By the time we arrived, there was already a queue of ptatients waiting to see a doctor.  Some would have had to travel a fair distance to access the free medical clinics.


Altogether, we saw close to 900 children in 6 days. Most of the children came with minor coughs and cold that did not need any intervention other than gentle reassurance. Recurring themes were chest infections, fungal infections and poor appetite.  Some older children presented with nocturnal enuresis – likely a symptom of the trauma they had experienced in war-torn Syria.  It was hard to hear some of their stories of the war but overall the children were very sweet, funny and playful.  There was the occasional frustrating and heart-breaking case in which we had little to offer, such as the child with stage II neuroblastoma whose parents had run out of money to pay for chemotherapy, or the child who had at some point in their life underwent open heart surgery exhausting the families’ finances to the point they could no longer buy food. However there was one success story that will always be a reminder for me whenever I wonder if I was making any difference at all; A 6-month old girl presented to us with a cleft palate and lip. Her parents had been tirelessly spooning in milk to provide her with the nutrition she required. In the UK, children like her would be managed by a specialist team with knowledge and access to clever feeding devices and the hands of a skilled surgeon. We highlighted her case to the mission leader ,who through her contacts with other charities found someone who could surgically fix the deformity. At the time of writing this, she has already received her first surgery and I know this will make a world of difference to her and her family.


The highlight of the trip was working in the Al Zataari camp itself. The clinics, and the "houses" were temporary structures resembling portakabins arranged in straight rows and columns. Each family is allocated one unit along with an outdoor kitchen, latrine and a water tank. The clinic rooms were pretty basic. There are facilities for laboratory tests including urine dip testing, full blood counts, biochemistry and INR; although their availability depends on the availability of reagents and staff. The emergency room was not different from the emergency room I experienced in a Ugandan district hospital not too long ago – a couple of worn out beds and a shelf housing cannulas, fluid bags and a portable oxygen supply device. 


From the heavily guarded entrance of the camp heading towards the clinic, we would pass what is known as the "Champs d Elysses" of the camp; the main street running through lined with various shops including barber shops, small cafes and clothing shops. There were both primary and secondary schools as well as playgrounds and hospitals. In the words of one of the refugees I had the pleasure to speak to - "Life has to go on; this is the only life our children know and we want to give them a life as close to normal as possible."


Apart from paediatrics, the dental, ophthalmology and cardiology teams performed a significant number of tooth extractions, cataract surgeries, squint repairs, stent insertions and angioplasties. The illuminating fact recognised by the surgeons was the efficiency in which they were able to perform the procedures; reaching up to 15 a day, triple the amount in an average day at work. These procedures were performed in a private hospital in Amman; hence they had access to the facilities required in pre and post operative care.


In the time outside of work, we had the opportunity to immerse ourselves in day to day life in Amman. We had a couple of dinners with the whole SAMS team in a restaurant and on one of the evenings we had the honor of having dinner in the home of an American Jordanian doctor. We were humbled by the hospitality of his family and by then understood that dinners in Jordan usually equate to 5 course meals, meat feasts and desserts swimming in syrup.


We ended the trip tired and sleep deprived. As doctors, we both wish we could do so much more. This may sound cliched but there is so much that we take for granted back in the UK- as simple as a bottle of iron supplement, nappies, even milk -  that can mean survival for these refugee children. Personally, I wonder whether my 10 day trip made a difference at all; I know it is just a drop in the ocean and that it is not solving the root of the problem. As long as Syria remains at war; everyday she will claim another child as her victim. 


However Jordan made a difference to us. The lessons learnt and the inspiration gained from those 10 gruelling days will live on within us. We hope to raise awareness amongst our colleagues and medical fraternity in general and inspire those with an interest in global health and humanitarian work to pursue their interest and provide an extra pair of much required hands! With the ongoing arrival of refugees into the UK, the post-war consequences, both medical and psychological, are more relevant than ever before. For example, a quaint village in Narbeth in West Wales is now home to a family of 7 Syrian refugees. This really is everybody’s responsibility.


For more information of the Syrian American Medical Society (SAMS), do visit their website. They have presence in Jordan, Turkey, Lebanon and Greece. Their missions are between 10 to 30 days long. They are flexible so can be done during periods of annual leave.


For an insight into life in Al-Zataari camp, the UNHCR Youtube channel has a series called "A day in the life: Za'atari" that's well worth a watch...

Dr Munirah Mazlan