In desert camp along Jordan border, doctor says ‘sick patients are more likely to die than get better’

Three times a week, Dr. Ghaith Homsi, 45, hitches a ride from a truck driver to a makeshift clinic in a desert settlement on the Jordanian border.

The clinic lies about 250km northeast of Amman, where 75,000 Syrians are now stranded in two desert camps between the Syrian and Jordanian borders, with limited access to clean water, food and medical care.

Beginning in mid-2014, Syrians began fleeing eastern, Islamic State-controlled Syria to this barren no-man’s land. They set up camp with the goal of eventually entering Jordan. Homsi, who fled to Rukban this January after the Islamic State seized his village in east Homs, took up residence directly outside the camp.

The residents of Rukban and Hadalat, two camps located 50km apart along an earthen berm that demarcates the Jordanian-Syrian border, never intended to settle in this demilitarized zone.

More than two years later, piles of trash and sewage are growing, and disease is spreading.

But no one is leaving. In June, after a truck bomb killed seven Jordanian border guards, Amman declared the Rukban-Hadalat area a “closed military zone,” cutting off aid deliveries and preventing displaced Syrians from entering Jordan as refugees.

Since the June closure, the Jordanian government has allowed one aid delivery—food and hygiene kits delivered by crane—to the settlements, the World Food program reported in August. The UN is currently negotiating with Jordanian officials to move the camp a few kilometers from the border and resume humanitarian operations in the camp, Amnesty International reported last month.

For now, residents survive on limited UNICEF water deliveries, or retrieve water from puddles beneath water tanks. Sometimes they lug their dusty plastic jugs to an artesian well 45 minutes away by car, where Homsi and his family live.

 The tent where Homsi receives patients. Photo courtesy of Ghaith Homsi.

After outside medical services were cut off, Homsi, who studied medicine at Baath University in Homs and ran a private clinic there before the war, began working in the Rukban camp.

Since the end of August, Homsi has seen 18 infants die from jaundice, a symptom of hepatitis. In addition, 10 pregnant women and eight premature newborns died from medical complications.

“I feel frustration and despair because I can’t do my work as a doctor and serve my fellow Syrians in this desert,” Homsi says.

Q: Describe the medical situation in Rukban. What happened after Jordan closed its borders?  

There are absolutely no outside medical services here, ever since the Jordanian border closed in June. Before the attacks, the Red Cross ran a medical point equipped with supplies. Red Cross members would visit camp residents twice a week. After the June explosions, the supplies from the Red Cross medical point were stolen.

[Ed.: On June 21, 2016 a car bomb exploded near a military outpost in Rukban, killing seven Jordanian soldiers and injuring others, Amnesty International reported.]

The border attack had a devastating impact on residents because food and medical aid stopped coming in.

Q: How do residents receive medical treatment without the services provided by outside organizations?

Thirteen nurses, who are also camp residents, set up medical tents for residents. There are also several pharmacies, also located in tents. Although we’re using these tents as an alternative, the medical situation is still very bad because we don’t have the necessary medicine or tools to diagnose patients. This limits what we can do. Sick patients are more likely to die than get better.

Q: Tell me more about your work. What does an average day look like?

I visit Rukban three times a week, or less, depending on the weather. I hitch a ride with water truck drivers who come to the artesian wells to get water for the camp. I get to the pharmacy around 8am.

My medical assistant, a longtime friend, owns the pharmacy. It operates as both a pharmacy and clinic. I examine some patients in the clinic and others in their tents.  I see residents who suffer from chronic diseases and children who have diarrhea. Sometimes patients give me a small amount of money, depending on their financial situation.

I head home around 7pm by hitching a ride with someone who has a motorcycle.

The medical burden falls on the 13 nurses who live in the camp, since I’m not there every day.

Q: Which tools do you use to diagnose patients? What happens to residents you can’t treat?

We have stethoscopes, thermometers, a blood pressure monitor and small surgical tools.

We can’t perform surgery, even cesarean sections. Women who need cesarean sections are transported to Tabqa, but the majority of them die on the way. So far 10 women have died since the borders closed in June.

[Ed.: Homsi says that residents go to Tabqa, a city under Islamic State control, because all other roads out of Rukban to other cities in Syria are closed. “No one would go to Tabqa if there were medical treatment here, since everyone in this camp is against Islamic State,” he explained.]

Also, eight premature infants have died because they needed incubators, which we don’t have. Dialysis and cancer patients are just waiting to die since we can’t provide them any treatment.

 A makeshift pharmacy in Rukban. Photo courtesy of Ghaith Homsi.

Q: Which sicknesses are widespread in the camp? How do you handle them?

The most common sicknesses are intestinal swelling, diarrhea, diabetes, vitamin deficiency, high or low blood pressure, the flu as well as stomach and kidney disease.

I think that rates of jaundice among newborns are higher because of unsanitary water and malnutrition. In addition, when a newborn has jaundice, we can’t immediately diagnose him because we don’t have the tools to measure the level of bilirubin in his blood. Nor do we have the medial tools to treat him. As a result, more than 18 children have died from jaundice since the end of August.

[Ed.: Neonatal jaundice occurs when bilirubin, a yellow pigment formed in the liver by the breakdown of hemoglobin, builds up in an infant’s blood, causing the skin to yellow. Untreated, it can lead to brain damage, according to a fact sheet by the Centers for Disease Control and Prevention.]

We do the best we can do. We can only detect sickness and provide emergency aid since we have limited supplies and medicine. We’re unable to provide complete medical care.

[Ed.: Homsi and the 13 other nurses in the camp have been unable to counter a hepatitis outbreak in the camp, caused by unsanitary living conditions, Amnesty International reported in September.]

Q: What do you say to a sick person whom you are unable to help?

The people in the camp know I have no ability to give anything to them. I am unable to give them anything because there are no supplies for diagnosis.

Sometimes I go on visits to the sick people to their tents—this includes disabled people and newborn babies. I tell them to forgive me because I can’t do anything to help them.

Everything is extremely difficult, but the hardest situation was with a woman who had waited 15 years for a child. We found out it would be a difficult birth and she needed a cesarean section. She was taken to Tabqa, but she died on the way. She died before she realized her dream.

Q: How does being unable to treat patients affect you?

I feel frustration and despair because I can’t do my work as a doctor and serve my fellow Syrians in this desert. Whenever I examine a patient I tell myself: the people of my country fled bombs fearing death, only to find it here.

Q: What medicine do you have at the camp and what do you need?

We have only some first aid medicine and a few painkillers.

The medicine we do have comes from Tabqa, Raqqa and Dumayr.

[Ed.: Homsi explained that camp residents buy products from Bedouin tribes that are connected with other cities in Syria. Dumayr is located in the eastern Qalamoun mountain range, roughly 38 kilometers northeast of the Syrian capital. Tabqa and Raqqa, cities in Islamic State territory, lie more than 500km north of Rukban camp.]

Q: Tell us about yourself. Why did you come to Rukban?

I studied medicine at Baath University in Homs. Before the revolution, I had a clinic in Bab al-Darib in Homs and worked at private hospitals in the city.

After the revolution began, there were many demonstrations, clashes and arrests. I fled to the east Homs countryside and opened a private clinic in al-Qaryatayn. I treated residents in the town, but fled at the end of 2015 after IS seized the town.

I arrived at the Jordanian border with my wife and two boys in January 2016. I went to the Jordanian border, rather than another regime-controlled town in Syria because while I was working in Qaryatayn, the Security Branch investigated me several times. They accused me of medically treating “terrorists,” or helping the rebels.

I decided to go to Jordan in January 2016 with my family.  After a few days in the camp my wife refused to stay any longer because of the bitter cold. We have two boys, a six and eight-year-old.

We heard from residents that we’d have to wait at least four months before we could enter Jordan. So we registered to enter and then went to an area about 45 min away from Rukban, called “Artesian.” It’s named for a group of artesian wells that provide water for regime areas.  My family and I have here for nine months.

[Ed.: Homsi explained that a guard who is stationed by the wells has several apartments there.  Although the area is in regime territory, it is not heavily regulated so he has lived there without incident.]