慈濟傳播人文志業基金會
Free Clinics for Syrian Refugees

More than 600,000 Syrian refugees currently live in Jordan. Given the uncertain future of the Syrian civil war, they don’t know when, if ever, they will be able to return to their home country. It has been more than seven years since the war started, and outside assistance for them has dwindled with passing time. In addition to other problems, refugees have had a tough time getting medical care. Tzu Chi volunteers offer them free clinics.

Located in a desert and encircled by barbed wire fences, the Azraq refugee camp is a community of 40,000 residents.

These Syrian refugees who do not live in a refugee camp work on a farm to support themselves. The work, picking tomatoes, was temporary, with a daily wage of eight to ten U.S. dollars. Tzu Chi volunteers visited the farm to see if they could help the refugees in any way.

In July 2018, Tzu Chi volunteers provided five free clinics for Syrian refugees and needy people in Jordan.

Under the scorching sun, the Azraq refugee camp in northern Jordan is shrouded in dead silence. One wouldn’t expect that tens of thousands of Syrians live within the camp, but the barbed wire fences that run along the perimeters are cruel reminders of their sad situation. Fleeing their homes and the violence of the Syrian civil war, they have become virtual prisoners in another country.

While the Syrian civil war has dragged on year after year, assistance from all sides for Syrian refugees has receded like a waning tide. In early 2017, the United Nations ceased assisting Syrian refugees living outside a refugee camp. Refugees in Jordan started to be treated just like any other foreigners. The registration fee for a hospital visit alone costs ten American dollars, and that doesn’t include the cost of medicine.

Towards the end of 2017, the Syrian government announced that refugees could return to Syria, but that they would need to live in refugee camps on the national borders.

In June 2018, fighting resumed in southwestern Syria, forcing many people to flee their homes and attempt to escape to neighboring Jordan. However, they were not allowed to cross the border. They couldn’t go back to the unrest and fear in their hometowns, but they couldn’t go forward either. About 60,000 Syrians were caught in a bind, stuck in the scorching desert heat at the border.

Residents in Ramtha, Jordan, tried to help the refugees by giving them whatever daily necessities they could. The Jordanians squeezed the necessities through gaps in the barbed wire fences to the refugees. The Syrians ran the risk of their bodies or arms being injured by the barbed wire in their rush to reach out and receive the proffered goods.

Despite an appeal from the United Nations High Commissioner for Refugees (UNHCR), the Jordanian government in July 2018 refused to temporarily take in more Syrian refugees. Jordan made it plain that it had no intention of reopening its border crossings with Syria.

A little boy sat in the examination chair of Dr. Zou Mu-fan (鄒牧帆), a doctor of traditional Chinese medicine (TCM). The boy had been injured in a traffic accident, and he limped because of a stiff left leg.

The treatment tools in the TCM area—for cupping therapy and acupuncture, for example—unnerved the boy. The last straw was when Dr. Zou began to insert an acupuncture needle in him. At that point, the boy began to wail and struggle, and his mother tried to hold him down.

“Dr. Zou, stick the needle in my arm to show him that it doesn’t hurt, and then he won’t be afraid,” volunteer Hong Xiu-mei (洪琇美) said urgently, offering her arm. Several other volunteers did the same, sticking out their arms. All the volunteers there just wanted to help make sure that the little boy would be treated and receive some relief for his injuries.

This scene kicked off a free clinic provided by Tzu Chi at the Tarabot Social Center in Amman, the capital of Jordan, in July 2018.

Patients seek medical help at the Tzu Chi free clinic in the Azraq refugee camp.

Back again

In the winter of 2016, Tzu Chi had held free clinics at the Quran & Hadith Science Center in Mafraq and at the Azraq refugee camp. Though volunteers served a large number of people, they really would have liked to do more.

Their wishes were fulfilled in July 2018. Volunteers from Taiwan and the United States once again traveled to Jordan to treat patients in five large-scale clinics at the Tarabot Social Center, the Quran & Hadith Science Center, and the Azraq refugee camp. Services were offered in internal medicine, surgery, pediatrics, gynecology, and TCM. Twenty-four hundred Syrian refugees and needy Jordanians were served by the end of the final clinic.

Before the 2018 trip to Jordan, Dr. Ye Tian-hao
(葉添浩), of Taiwan, thought back to the trip in late 2016. As images of the previous visit flashed through his mind, he recalled warming the diaphragm of his stethoscope before applying the instrument to a patient’s chest. To this day he remembers the beat of the patient’s heart that he heard through his stethoscope. With these thoughts in his mind, he began packing the equipment and instruments he wished he had taken to Jordan in 2016.

Later, Ye and his wife, Chen Hong-yan (陳紅燕), a pharmacist, tried to hail a cab to take them to the Taiwan High Speed Rail station in Zuoying, Kaohsiung. They were surrounded by their luggage and black metal trunks of medical equipment, including an abdominal ultrasound machine, an electrocardiogram (ECG), an automated external defibrillator (AED), and a pulse oximeter. It’s no wonder the first cab driver refused to take them: Their luggage was too bulky and way too heavy. Another cab driver kindly called a van taxi for them, but the delay caused them to miss their train.

The couple finally arrived in Taoyuan, but then the vehicle taking them to the Taoyuan International Airport got stuck in a traffic jam caused by a heavy downpour. Finally, after a lot of hassle, the couple joined other Tzu Chi delegates at the airport.

Ye’s instruments would come in handy to help him and his fellow physicians better care for the refugees. The ultrasound machine could help physicians in OB/Gyn, internal medicine, or even dermatology make more rapid and accurate diagnoses. The ECG machine would be indispensable for cardiologists. The pulse oximeter could provide an extra layer of information should anybody faint (a number of people did faint during a 2017 free clinic in Mexico). Though Ye prayed that nobody would need the AED, he wanted to have it ready to serve should the need arise.

Ye knew that a one-time free clinic could not solve patients’ problems once and for all, but he could at least give them the best service he could while he was there. That’s why he was determined to take these instruments to Jordan, regardless of their weight.

Now, finally at the airport, Ye was ready to start an 8,200-kilometer (5,095-mile) journey to Jordan.

Tzu Chi volunteers shuttle Syrian refugees by bus to the free clinic at the Quran & Hadith Science Center in Mafraq. These refugees live in tents in Mafraq in the desert near the border.

Order! Order!

People swarmed to the free clinic held in the Quran & Hadith Science Center. Everyone seemed very tense, crowding around the sign-in area, making the small, stuffy space seem even smaller. Maybe they were afraid of missing this chance to see a doctor.

The crowd appeared on the verge of erupting into chaos. In response, Dr. Lee Yi-kung (李宜恭), head of the emergency department at Dalin Tzu Chi Hospital in southern Taiwan, asked Mohammad Khwaileh, a volunteer interpreter, to interpret for him. He told the crowd that everyone had to come to him first. He would triage and assign each patient to the appropriate clinic, depending on the patient’s complaint and the patient load at each clinic. He had learned this approach for handling a large crowd when he volunteered in a free clinic in Mexico in December 2017 after the country had been struck by multiple earthquakes.

Besides performing triage, Lee prescribed medicines for patients who had minor problems. The frequently-prescribed medicines were within easy reach, and he could hand them over right away. Though he didn’t know Arabic, he looked intently at every patient while listening to Mohammad. He paid close attention to their facial expressions and movements, which also helped him make judgments. His aplomb calmed people down. It wasn’t too long before the sign-in area calmed down, and patients sat quietly in the waiting area.

Off in the dental clinic, a young man sat in a dental chair, his uneasiness obvious despite his effort to suppress and disguise it. Instead of treating him straightaway, Dr. Hsia Yi-jan (夏毅然) gently said to him, “You haven’t eaten, have you?” Without waiting for a response, he gave the patient some biscuits he had brought from Taiwan and asked him to eat them first. The dentist was concerned that the patient might become dizzy from low blood sugar when he pulled his tooth. The young man was surprised at first, but he did as he was told.

After treatment, the patient asked the interpreter to relay a message to Dr. Hsia: “Because of Tzu Chi, I was finally treated like a person.” The patient’s words made Hsia’s eyes moist with tears. “Master Cheng Yen tells us to respect patients,” Hsia said. “A patient’s response makes everything I do here worthwhile.”

The ultrasound and ECG machines that Dr. Ye had taken so much trouble to bring to Jordan were in great demand. A long line of patients at the gynecology clinic and physicians from different specialties waited for their turns to use the machines.

Ye worked all day operating on patients. His operating room consisted of nothing more than a small table and a plastic chair in a corner of the internal medicine clinic, but the makeshift facilities didn’t seem to bother him at all. He squatted down to inject anesthetics into his patients. He excised from a patient a sarcoma that had hindered him from walking normally. He removed bloody gauze and closed incisions. Lots of people moved around, but they all slowed down and tried to make as little noise as possible when they walked by this surgical area, as they knew that serious medical care was underway.

 

Dr. Ye Tian-hao (left) and Dr. Jian Zai-xing serve a patient together.

The Azraq refugee camp

The winds blew across the desert near the Azraq refugee camp, raising sand and giving everything a pale yellow tinge. There was silence all around, despite the fact that about 40,000 Syrian refugees were living here.

As the Syrian civil war ground on, outside aid dwindled. Every month, the camp gave each refugee 20 Jordanian dinar (US$28) in vouchers, but that was barely enough to buy the barest essentials to exist. The refugees needed all the help they could get.

After negotiation, the Tzu Chi free clinic delegation was allowed to use one of the facilities belonging to the International Medical Corps (IMC) as the venue for the free clinic for the refugees at the camp. The space the Tzu Chi delegation could use was the administrative center of a small hospital housed in shipping containers. It was limited and cramped, but doctors made do the best they could.

The IMC is a contractor for the UNHCR. Together, the IMC and the Jordan Hashemite Charity Organization provide medical care for residents in the third and fourth zones of the refugee camp. The United States cut off its financial support for the IMC in 2016, leaving it with a diminished capacity to serve. Only one or two internal medicine doctors were left to provide 24-hour coverage. A few packages of medicine sparsely occupied the shelves in the dimly illuminated pharmacy.

Refugees lined up to see the doctors on the day of the free clinic. Some in the line wore IMC vests, indicating that they worked for the IMC. They were there to seek medical care, too. Their embarrassment was apparent, as they sought help from volunteer doctors from other countries in, of all places, their own hospital. The look on their faces explained the tight spot their hospital was in.

A soldier dressed in a camouflage uniform sat like an obedient child in front of Wu Sen (吳森), a TCM doctor. As Dr. Wu inserted acupuncture needles in him, the soldier felt his stiffness and aches disappear. His earlier uneasiness about this ancient Chinese treatment technique turned into awe, and he looked with admiration at the 76-year-old doctor.

An aching lower back had bothered Hla Fhasan Musa for some time. On this day, he had pedaled a bike for three kilometers (two miles) in the hot sun to reach the clinic (the Azraq refugee camp stretches 15 kilometers [over nine miles]). Dr. Hong Qi-fen (¡x١Ò*Þ) examined him and determined that he had urethral stones, a condition that could not be treated with the limited equipment at the hospital. Hong consulted with his fellow physicians about what medicines to prescribe for the patient to alleviate his suffering. 

Pediatrician Lin Yu-ying (林玉英) examines a child at the free clinic at the Quran & Hadith Science Center.

 Hla Fhasan Musa and his two wives had fled Syria and ended up in this refugee camp in Jordan. They had been here for 240 days. Though he and his family no longer had to worry about their safety, he felt stifled by their confinement in the camp. Now at the free clinic, the attention of several doctors prompted him to tell them of his every pain and discomfort. Dr. Hong tried his best to help him, and he prescribed medicines based on his complaints. Afterwards, with the prescriptions in his hand, Hla Fhasan Musa mused, “What am I going to do when you’re gone?”

Naima Alali waited anxiously at the dental clinic. Her daughter, Sarah, had had a toothache for more than a year. She had been in excruciating pain day and night; sometimes the pain was so bad it made her throw up.

Naima Alali had taken Sarah to the camp hospital several times for treatment, but they were turned away each time. Though the hospital had dental equipment, there were no dentists around to operate it. Now the free clinic from Taiwan would offer dental care. Naima was hopeful that her little girl would get relief.

“Have you eaten?” Dr. Li Ming-ru (李明儒) asked Sarah. He had noticed that the little girl looked pale. Sarah shook her head, her thin, raised shoulders seemingly bespeaking her helplessness and fear. Li gave her some biscuits and waited for her to finish eating them. Then he quickly pulled out the tooth that had tormented her for so long.

Biting down on a cotton ball to stop the wound from bleeding, Sarah was still in a bit of shock, but her mother looked relieved. Looking at the volunteers who had accompanied the two of them every step of the way, Naima Alali said, “I can’t even begin to express how nice you’ve been to us. I can only thank you for your medical expertise and tender care.”

Two and a half years ago, Naima Alali and six family members came to Jordan to flee the fighting in their native Syria. The war had destroyed their home and killed her younger brother. She and her family were now safe in the refugee camp, but that came at a price: Every child of hers was malnourished, victims of dwindling aid.

“If I could, I would return to Aleppo,” said Naima Alali. “Even though my home is in ruins, I’d pitch a tent there. That’s where I can really call home.” She was blind in her right eye, but her longing to go home loomed brightly in her left eye.

The afternoon ticked away, but the stream of patients waiting to be seen remained steady. The sign-in had to close at 3:30, and the volunteers had to exit the camp promptly at 4:00, when power would be cut off.

Throngs of people were still gathered outside the administrative center of the IMC hospital as closing time neared, hoping for a chance to see a doctor. The hospital staffers explained to the crowd at the top of their lungs that the clinic would be closed soon. Their explanations seemed to fall on deaf ears, though; the crowd continued to grow bigger and, worse, restless. The staffers could only fight their way through the crowd back into the administrative center and close the doors behind them.

People banged on the door and begged the workers to let them in. On the other side of the door, volunteer doctors shed tears over their inability to help more patients. 

Though sharing no common tongue, a mother and a doctor can communicate adequately through an interpreter to help a about a meaningful treatment for her child.

 Mafraq

Mafraq, one of the governorates of Jordan, is located to the northeast of the capital city of Amman. Bordering Syria to the north, the governorate is largely in a desert. Some Syrian refugees escaped here several years ago. They put up tents in the midst of the endless sand and scraped together what they could to live on, waiting for the day when they could return to Syria. They were still waiting, their tents now worn and shabby. What’s worse, the landowner could ask them to leave at any time, forcing them to move again. As big as the desert was, they could not find a spot to really call home. Living on the fringe of society, they were all but forgotten by the world.

But Tzu Chi volunteers did not forget them. The volunteers shuttled the refugees by bus from their homes to the free clinic at the Quran & Hadith Science Center. It took six round trips to transport all the participants from that area to the clinic.

The Quran & Hadith Science Center, located in Mafraq, was founded by the Jordan Relief Organization in a rented house. The center offered courses in subjects including the Quran, science, math, and English to Syrian refugee children ranging from six to 14 years of age.

On the day of the free clinic, the center was packed with a large number of patients. Jian Zai-xing (簡再興), a family medicine doctor from Yilan, northeastern Taiwan, wore many hats that day, at times helping in the pediatric clinic, at times helping in surgery. He had a way with patients; his enthusiastic smile and easy-to-understand facial expressions and hand gestures quickly won them over. For example, one woman was comfortable enough with Jian to pull down her stockings to show him a problem that had bothered her for a long time: a swollen leg. This was all the more remarkable given that Arabic women are usually very conservative around males.

A man sitting near Chien Sou-hsin (簡守信), superintendent of Taichung Tzu Chi Hospital, smiled at him. Dr. Chien smiled back, but before he could utter a word, the man hugged him and kissed him on the cheeks. Chien didn’t know what to make of all this until he saw the chubby boy beside the man—the scars on the boy’s round face took Chien back to 2016, when he had first seen the boy at a Tzu Chi free clinic in Jordan. The boy had come to that clinic, and Chien had treated the shrapnel wounds on his face.

This was a warm reunion, a nice surprise. Who would have thought that their paths would cross again?

In the TCM clinic, Ali sat quietly in a chair as Dr. Wu Sen treated him with acupuncture. He stared ahead, the melancholy expression in his eyes a stark contrast to the bright sunlight splashing into the courtyard.

Ali’s life lately had been almost too rough for him to bear, to have any hope. He suffered from chronic back pain, and his child was afflicted with a contracture as a result of injuries in a traffic accident. An impoverished refugee, Ali had been unable to tend to their medical needs. A few days before the clinic, his son, a student at the center, brought home an announcement about this free event. A slight glimmer of hope flashed through Ali’s mind, and they decided to go.

Ali used to work in construction in Syria before he and his family fled to Jordan in 2013. To make a living, he peddled beverages and bottled water, which he carried around on his shoulder. The heavy burden day in and day out over an extended period had resulted in his back pains.

Remembering the better days in Syria had made the current toil that much more unbearable for Ali. The seemingly never-ending civil war in his homeland had all but dashed his hope of ever returning there. He had lost heart and was in total dejection.

Now in the clinic, Dr. Wu administered acupuncture on Ali, who had not expected much in the way of relief. To his great and pleasant surprise, however, he began to feel his tight muscles relaxing and his back pain diminishing. He looked at Dr. Wu with appreciation. The gray-haired doctor patted him on the shoulder and urged him to be strong. 

 

 

Most patients coming to the Tzu Chi free clinics were women with children. An abdominal ultrasound machine from Taiwan offered more precise diagnosis for the female patients.

During this trip to Jordan, Wang Zhi-min (王智民), a pharmacist from Tainan, southern Taiwan, met Lugain Omer, an eight-year-old Syrian girl. Though it was their first meeting, the girl had been on Wang’s mind for some time.

Lugain had been diagnosed at age four with a severe deficiency in growth hormone. There were injections on the market for her condition, but the family could not afford them. They sought help from the UNHCR and all the aid organizations that they could find, but none of them was able to help.

A Jordanian dentist, Zaid B. Al-Vitae, told Tzu Chi about the family’s situation. In response, the Jordan Tzu Chi chapter began providing medical assistance to the girl in early 2018.

As fate would have it, Wang learned about Lugain’s story. He found a supplier of the hormone injection that would sell the medicine for a lower price, and he bought a year and a half’s worth of injections. Wang then asked volunteer Chen Chiou Hwa (陳秋華) to take the medicine back to Jordan when Chen visited Tainan from Jordan in April 2018.

When Wang met Lugain in Jordan, the girl, now 112 centimeters (3’7”) tall, stood shyly in front of Wang. She didn’t know that the man in front of her had purchased the hormone injections for her, and Wang said nothing about that. He was glad the girl had grown taller and stronger and that she was even taking a Taekwondo class. He stayed by her side like a father when she drew pictures. He couldn’t stop himself from saying to the girl, “Make sure that you grow taller than me!”

Dr Jian Zai-xing asked himself at the beginning of the free clinic mission, “What is the meaning of a free clinic? What can I do to really benefit the refugees?” His questions were answered when he met a refugee who had come to one of the free clinics. The man had been unable to straighten his arm due to a contracture caused by a gunshot, but he was able to do so after treatment. This episode helped Jian see the value of the clinic. “A free clinic gives the patients not just medical care but also hope,” Jian said. “The refugees really need people to care about them, and we do really care.”

November 2018