Jordanian Hospitality and Wadi Rum

Wadi Rum, Jordan

Bedouin in the desert, Wadi Rum
Bedouin in the desert, Wadi Rum

Jordanian hospitality is renowned. It is impossible to meet anyone without being offered tea, coffee or even snacks. My driver and fixer, Moh’d insisted that I come to his house for lunch. He has lived in his well-kept, 3 room apartment for 20 years, raising 5 kids (2 still living with him). His wife (Rhonda) made chicken, rice, salad and fresh juice. She followed lunch with Nescafe Cake, nuts coffee AND tea. Rhonda capped it off with gifts for my daughter and wife. Their generosity was incredible. These are humble people of modest means, and they rolled out a spread fit for a visiting dignitary. I was truly honored.

Moh'd- my fixer- and his family
Moh’d- my fixer- and his family

 

Mansaf is one of the classic Jordanian dishes served to celebrate new guests. Mansaf is lamb cooked in a fermented yogurt called jameed and served on a large platter with rice and a tasty lemon juice- yogurt mix sauce. If you’re gutsy, or a local, you eat with your right hand, mashing the rice, meat and yogurt into a golf ball sized morsel and throwing it down the hatch.

A huge plate of Mansef in Irbid at the Specialty Hospital
A huge plate of Mansef in Irbid at the Specialty
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Hospital

 

In Irbid, the CEO of the Specialty Hospital and his team treated me to a lunch of Mansef and lemon juice with lime. Great people, excellent conversation and good insights on the future of healthcare in Jordan.

Mansef in Irbid- don't mind the skepticism
Mansef in Irbid- don’t mind the skepticism

 

As I entered Wadi Rum, Jordanian hospitality remained in full effect. Samir Al Mujet, my Bedouin guide insisted on lunch at his house prior to our jeep trip. A plate full of goat, and a few photos of his 9 kids later, and I was off in the back of the Hilux into the desert.

Al Mujet and 2 of his 9 children in Wadi Rum
Al Mujet and 2 of his 9 children in Wadi Rum

 

T.E. Lawrence once described Wadi Rum as “Vast, echoing and God-like“. Despite a burgeoning tourist trade with a couple of hundred “jeeps” and an expanding network of “Bedouin” camps, there remains truth to Lawrence’s observations. The views are incredible a difficult to capture in any film format ( I now have even more respect for Jimmy Chin and my friend Alyssa Everett’s ability to convey amazing landscapes). Here are a few amateur attempts.

 

Wadi Rum Sunset Panoramic
Wadi Rum Sunset Panoramic

 

Callaway and the caravan
Callaway and the caravan

 

Selfie on the Jabal above our camp in Wadi Rum
Selfie on the Jabal above our camp in Wadi Rum

 

The day ended with music, $7 dollar Amstel, and a restive- not restful- night of sleep. There is nothing like Arabian wedding music, middle of the night oil trains, and a 4am call to prayer to rattle your subconscious and provoke some head scratching dreams. I awoke at 0415 and wandered out to the edge of the camp to get a view of the night sky. Even with the scant light pollution from my camp, the stars were amazing, and the night still. It was the first time in a great while that I could appreciate true silence- even the camp generator had cycled off. I forgot how important silence can be for our minds, and how unnerving it can be. Think about it the next time you are watching a movie- rarely does the drama of the scene carry the moment, there is almost always music. Somehow, this seems to create a sense that, like John Cusack in “Say Anything”, our lives should and must have a soundtrack.

I can’t wait to come back, spend a little more time and share this with Jenny and Elizabeth. Ellie’s adventuresome spirit will fit right in out here in the desert!

IMG_4518 IMG_4521

 

David Callaway,
Director Operational and Disaster Medicine, Carolinas Medical Center, Charlotte NC

Eisenhower Fellow (2014)

 

Petra

 

Obelisk at High Place of Sacrifice, Petra
Obelisk at High Place of Sacrifice, Petra

 

58 minutes until departure from Amman. The past 72 hours have been a whirlwind of meetings, travel and amazingly beautiful scenes.

My body is aching from the steps and hills of Petra. My mind is reeling as I try to process 14 days of high level meetings on healthcare, innovation, security and the refugee crisis, sojourns into two of the most beautiful places on earth (Petra and Wadi Rum), and my looming to do list when I return home. Not too mention, I am having my standard pre-travel jitters as I prepare for my 14 hour flight to Chicago.

So, briefly on Petra. It is incredible. I am not going to summarize the guide books and give some abbreviated history- here are two sources BROWN and NATGEO. Wiki has a pretty good overview also. What I would say if you are planning a visit, would be to consider something like:

NOTE: The hike out can be a little bit of a bear if you have been going for a while, so save water and food.

Day 1: Leave Amman and get to Petra in the evening. Spend the night at one of the hotels with a great view of the mountain range.

Day 2: Up at 5:30 and start Petra at 6:30am. This will beat many of the crowds and give you some time during the cooler morning hours. I’d do about 4-5 hours. Start deep. It is easy to get caught by all of the beauty and action immediately upon entering Petra. Do the High Place of Sacrifice and hike back into some of the marked areas further back. Cycling back

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out and then grab one of the dialy treks to Wadi Rum or get a driver to take you over there (about 90 minute drive). I’d do an afternoon Jeep excursion- usually about 2-3 hours and catch sunset in Wadi Rum. Spend the night in one of the tent camps (they are all pretty well outfitted). I stayed at Jabal Rum Camp which has showers, bathroom, and parties all night. Tents have a small light. It is comfortable, but if you’re like me and want to get away, find a smaller camp deep inside the Rum.

Day 3: Wake up and catch the sunrise at Wadi Rum. Don’t worry, the 0415 call to prayer or the 0500 train should wake you up. Sunrise is incredible. Take your time, eat some breakfast, maybe even a morning hike. Then head back to Petra. Hit Petra in the afternoon and catch the more famous sites, usually closer to the entrance and with a few more people. It gets hot. You can buy food and whatever to drink at multiple spots, but I’d bring some of your own. Then, head back to the hotel, take a shower and eat. Return at 8pm for the 8:30 Petra at night candle light tour. I didn’t get to do it, but it looks amazing. When you are done, get a good night’s rest and head back to Amman on the AM of Day 4- you don’t really want to drive the highways at night. Drivers are “Majnoon” (Crazy).

Petra Siq entrance into the Treasury
Petra Siq entrance into the Treasury

 

 

Petra Treasury
Petra Treasury

 

Obligatory selfie in front of the Treasury
Obligatory selfie in front of the Treasury

 

Petra, High Place of Sacrifice
Petra, High Place of Sacrifice

 

Thanks to everyone for all of the support. Will be posting some shots from Wadi Rum and a variety of culminating thoughts- hey, I have to use the 14 hour flight for something!

 

Tragedy at Circle 2 Reem Shawarma

So, I have been enjoying my every other day Shawarma from the hole in the wall Reem Shawerma, Circle 2 just a block from the Intercontinental.  A small shwarama runs about a buck, sodas are JD 0.4 ($0.75) as opposed to JD 5 at my hotel (yes $7 Pepsi).  So, I know the risk of street food, but these guys looked OK and everyone said they were solid.

 

Reem Shawarma Circle 2

Reem Shawarma Circle 2

So the staff breakdown is Register guy- speaks English.  Lamb Cutting guy wears no gloves and has a solid grease burn on his left hand.  Next is Bread Cutting guy who also throws in the tomato, sauce and meat.  Finally, is the closer- he adds some spices, wraps the shawarma and throws it in a bag.  This will be important later.

Lamb Cutting guy with Bread cutting guy to his right

Lamb Cutting guy with Bread cutting guy to his right

 

So here I am today, back from the hot, barren hellish landscape of Azraq and looking to get my shawarma on.  I get to Reem, no line- sweet.  I put in an order for 3- $2 dollars well spent.  They are washing the floors, so the guys are standing outside, their gloves still on.  OK, whatever.  Then Closer greats a guys on the street- gloved hand to random, nasty street guy hand.  Alright, my gut has seen worse.  A few seconds pass, and my old pal the Closer puts his hand on the lip of the garbage can- the inner lip.  Well, you can image in the inner monologue- not many words, but colorful.

So Closer comes back in grabs a bunch of bread and spices and begins, well closing.  I grab Register man and give him the two hands to the side palms up, eyebrows raised universal sign for WTF?!?!  I point to the hands tell him to change his gloves.  They look at me and put on a second pair of gloves.  I think my “no glove, no love” comment flew by them.

By now a crowd is standing outside Reem #2 (from now on ‘The Deuce’) .  They begin to say, “yes, good.” and “yes, glove”.  So, I don’t feel too bad until I catch two sideways glances from Bread Cutting guy and Closer.  Then, for a moment my view of the food is blocked.  I hear some laughing and begin to feel like Will Farrel after taking the Animal tranq dart to the next in Old School.  I catch them by surprise when the try to give my order to someone else, and we reconcile the order.  They try to give me a different bag, only raising my suspicion that The Deuce’s special sauce may live up to the name (sorry, but you knew it was coming).

So, I walk home, 3 shawarmas in a bag and two sodas- the only consolation is that soda at my hotel costs 10x (yes) the price at The Deuce.  So, I ditch the shawarmas, drink my soda, and am now ready to head back out into the city to find food… Insha’ Allah.

IMG_6025

Za’atari Camp

Za’atari Camp

Za'atari Camp
Za’atari Camp

 

Remember this name: Kilian Tobias Kleinschmidt. We’ll get back to him.

In March 2011, Syria began its descent into the violent chaos of civil war. The rate of the massive displacement of Syrians into peaked in 2012 (estimated at 3000-4000 people/ day) but continues to this day (down to about 300-400/ day). People cite a variety of reasons for this trend including tightened border security and the fact that the main crossings were closed, shifting people to the far northeast corner of Jordan (See prior post).

The Jordanians, ever gracious hosts to their displaced neighbors- be them Palestinians (1948, 1967), Iraqis (1991, 2005), Egyptians and Syrians (1982, 2011)- launched a hybrid response model that included refugee camps and integration into local communities. The GoJ partnered primarily with UNCHR through the Jordanian Ministry of Planning and International Cooperation (MoPIC) to manage this complex strategy. By mandate and agreement, UNCHR has the lead for management and daily operations of refugee camps within Jordan. The largest and arguable most famous camp is Za’atari.

Za’atari Camp is about 220 hectare of barren desert located in the Mafraq Governate, northeastern Jordan- about 10km east of the city of Mafraq and 15km south of the Syrian border. The camp is “divided” into 12 zones, which really have developed organically. Za’atari functions as one of the major refugee registration areas and has hosted upwards of 120,000 Syrians (Ref. ACTED 2014), making it at one time Jordan’s 4th largest city. Estimates as of May 2014, have the population at around 106,000. When Za’atari was born, it was only a “smattering of tents dotting the landscape”. There were no paved roads or electricity. Today, it is a sprawling urban center- businesses, crowds, action, gangs, hustle… energy. Industrious Syrians have figured out ways to pirate electricity to power the homes, businesses and cell phones. One reporter with about 10 years on the ground here said, “These are middle class people, like anywhere, they view electricity as a human right.” The result is an electricity bill for UNHCR that varies between $700,000- 1,000,000 USD/ month.

Pirated electricity
Pirated electricity

Power Line

High power lines
High power lines

 

UNOSAT has an excellent map illustrating the evolution of Zaatari over the past 3 years.

Za’atari: The bare bones

  • 220 hectares in Mafraq, 6 miles (10k) east of the city of Mafraq
  • Built over
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    a large aquifer (unclear if camp planners knew this at the time, but creating significant issues now)

  • Population: 110- 120k (60k pediatrics)
  • Reportedly 2nd largest refugee camp globally behind (Dadaab in Northern Kenya)
  • 4th largest city in Jordan
  • Estimated 1,000 businesses line Za’atri’s streets.
Za'atari housing
Za’atari housing

 

Thriving economy
Thriving economy

But, population size alone doesn’t tell the entire story. An estimated 90% of the occupants in Zaatari are from Dara’a Syria, an agrarian area often considered the “birthplace of the Syrian uprising”. They are proud of their country, resilient and skillful- maybe even crafty. Free Syria flags are common.

Za'atari compound with Free Syria Flag
Za’atari compound with Free Syria Flag

 

There are an estimated 1,000 shops and small businesses scattered across the camp- the two main souks or market streets are the now famous Champs de Elysee and the newer “5th Avenue”. Hey, they are giving ‘Mad Men’ a run for their money. There is significant trade with Mafraq, the closest Jordanian city. You can get whatever you want in Za’atari- refrigerators, ice cream, dishwashers, clothes, food, fruit, cement, corrugated steel, you name it. For JD 20, you can hire one of the bands of kids to move your caravan to basically wherever you want in the camp. The Syrians have combined tents and caravans to create a variety of housing compounds, courtyards and businesses. There is even a small internet café.

 

Za'atari- kids wait for ice cream
Za’atari- kids wait for ice cream

 

Za’atrai though is schizophrenic. For all of the hustle, entrepreneurship, and action, it is still a refugee camp. Life is hard. For the medical people, it is like an anticholinergic overdose:

Hot as a hare, blind as a bat, dry as a bone, red as a beet, mad as a hatter.

Open black water (e.g. poop) runs from shelters, past restaurants and along the street. One of the WASH guys told me 300 kids go to the clinics daily with some form of skin condition, mostly from exposure to, well shit… and probably some piss. Robert (a young Dutch guy) and Tom (a super experienced Aussie) are doing a great job driving innovation in this sphere and getting community buy in to divert “grey water” into small community or household gardens. Sanitation- remember the old adage that “indoor plumbing has saved more lives than all doctors in history”? Probably still some ongoing truth in that.

IMG_0387

 

In his piece, City of the Lost, David Remnick wrote, “In Za’atari, the dispossession is absolute. Everyone has lost his country, his home, his equilibrium. Most have lost a family member or a close friend to the war. What is left is a kind of theatrical pride, the necessary performance of will. ‘This place is a graveyard for camels,’ a refugee in his thirties named Ahmed Bakar told me one morning. “Camels can’t even live here. But Syrians can.”

It is an interesting observation. Since I only talked with a couple of Syrians- one outside the camp who had been in country for 4 days and one in the camp who tried to steal my camera- I don’t know if I have the exposure to comment. I have to imagine it is true, and the potential to have a lost generation of Syrian youth is dangerously real. The UNHCR and other groups are working to avert this disaster, but mindsets need to change. Survival is not the goal- growth, strengthening and resilience are now critical. If the Syrians are ever to return home, they must have knowledge, skills, and the mindset to rebuild their communities. This requires fighting every potential driver of institutionalization. This requires education, job training, advanced education, family support, and working with local (Jordanian and Syrian) partners to build a vision of the future.

So, back to Kilian. Early in my trip, Ambassador Jones (US Ambassador to Jordan) listened to my EF and professional elevator pitch and told me that I needed to meet with Kilian Kleinschmidt- the “Mayor of Za’atari”. “Kilian is a guy who is thinking like you, and he is executing”. A packed schedule and logistics were not in my favor. Then, last night I met with Nick Seeley- author and reporter for Christian Science Monitor. Nick is smart, passionate and well tattooed American ex-pat with over a decade of experience in Jordan. Nick, also graciously listened to my impassioned argument that we need to do things differently- align disaster response, humanitarian assistance and development, engage the private sector, foster innovation… renewable energy baby. “Dave”, said Nick, “you need to meet Kilian; he is a revolutionary.”

So it was as I stood in the UNHCR compound having essentially served a “no knock warrant” on their technical team, arriving with 30 minutes notice. As I waited in the shade, two guys stood next to me chatting. “Hell, I thought…”

“Hey, my name is Dave. What’s up?”

“I am Kilian. This is Gavin.”

And so began one of the most interesting 40 minute conversations I have had on disaster response, humanitarian aid, innovation, and battling against static paradigms. Amongst other things, Kilian has been pushing the solar farm idea and has decided to set up an “innovation team” within the UNHCR compound. This team will be comprised of technical experts, Syrians from the camp, and possibly some “outsiders”. I am hoping that the Division of Operational and Disaster Medicine and OMI are part of this team. In the past 10 days, I have met an amazing group of local entrepreneurs, heads of industry and visionaries. Perhaps, contributing to this Innovation Team will be part of the Eisenhower Fellowship legacy in Jordan.

 

 

 

 

 

Evolution of Za’atari Camp

Za’atari Camp Shelters

Amman: A little culture between meetings

Amman Citadel

Jabal al Qala’a in Amman, Jordan.

 

Spring blossoms
Spring blossoms

 

 

Amman Castle
Amman Castle

From (http://www.art-and-archaeology.com/jordan/amman/citadel.html)

The Hill of the Citadel (Jabal al-Qal’a) in buy generic cialis online the middle of Amman was occupied as early as the Neolithic period, and fortified viagra cialis levitra trial pack during the Bronze Age (1800 BC). The generic cialis ruins on the hill today are Roman through early Islamic. The name “Amman” comes from “Rabbath Ammon,” or “Great City of the Ammonites,” who settled in the region some time after 1200 BC. The Bible records that King David captured the city in the early 10th century BC; Uriah the Hittite, husband of King David’s paramour Bathsheba, cialis + viagra was killed here after the king ordered him to the front line of battle.

In ancient times, Amman with its surrounding region was successively ruled by the then-superpowers of the Middle East: Assyria (8th buy viagra no prescription canadian pharmacy 24 hr review century BC), Babylonia (6th century), the cialis online purchase Ptolemies, the Seleucids (third century BC), Rome (1st century BC), and the Umayyads (7th century AD). Renamed “Philadelphia” after himself by Ptolemy II Philadelphus, the city was incorporated into Pompey the Great’s province of Syria, and later into the province of Arabia created by Trajan (106 AD). As the southernmost city of the Decapolis, Philadelphia prospered during viagra en las canadian pharmacy meds farmacias Imperial times due to its advantageous location alongside Trajan’s new trade and administrative road, the Via Nova Traiana.

generic viagra

 

Juxtaposition
Juxtaposition

 

When Transjordan passed into Arab rule in the 7th century AD, its Umayyad rulers restored the city’s original name of Amman. Neglected under the Abbasids cialisdosage-storeonline and abandoned by the Mamlukes, the city’s fortunes did not revive until the late 19th century, under the Ottoman empire. Amman became the http://cialis4dailyusedosage.com/ capital of the Emirate of Transjordan in 1921, and of the newly-created Hashemite Kingdom of Jordan cialis4dailyusedosage.com in 1947. Greater Amman (the core city plus suburbs) today remains by far the most important urban area in Jordan, containing over half of the country’s population or about 3 million out of 5 million people.

Innovation in the Jordanian Health Sector

May 25, 2014

Dead Sea, Jordan
Dead Sea, Jordan

 

“The system should be restless”.

Alright, you have my attention.

“We need an explosion to change the paradigm of how we deliver health. But, it must be a controlled explosion. We need victors of change who speak the language of innovation, science, health and business to spark this change, harness the power and direct the energy”.

There is a disconnect between education and modern health. The problem is that to change attitudes and beliefs, we cannot rely on lectures and powerpoint. Adults are different than children.

“How do fanatics create a following? How do they convince someone of the validity of suicide? They use dialogue learning- engagement, mental challenging of preconceived notions, and steering- but not driving- of the student through the intellectual argument”.

This does not imply the fanatic’s argument is correct, just that they have figured out a way to fundamentally change the way some people see the world. This sounds like mentorship. Sometimes, I think that we rely too heavily on the perceived inherent strength of the argument- i.e. “of course this makes sense”. Agreement with a principle and commitment to devote energy to execute are very different things.

This conversation with Dr. Al Bashir at Istishari Hospital in Amman started my day. Istishari Hospital is a 108- bed private hospital in upscale Amman, complete with cardiac cath labs, neurosurgical capabilities, IVF and an small emergency department that sees about 1000 patients/ month (they admit 100- 75 to the ICU!!). Istishari was recently in the news when they hosted French cardiac surgeons to perform a host of gratis surgeries on pediatric Syrian refugees with congenital cardiac defects. I was able to see four of these kids (the other 8 had already been discharged).

My conversation with Dr. Al Bashir flowed from clinical care quality to financial reform to water conservation and, my favorite, the integration of clean energy technology into the delivery of health care. Istishari spends about 25% of its annual budget on its power bill- lighting, medical equipment and HVAC. An audit showed that about 15% of this went to lighting so they swapped to LEDs. They are also working on expanding their grey water system (essentially targeted treatment and recycling of water- e.g. laundry water treated and routed to toilets) and integrate conservation measures as part of their SOP. A USAID energy audit in 2010 suggested energy conservation measures (ECM) could result in a reduction of 12.3% from the total energy and water consumption, i.e. 55,158 JD/yr (Note in 2010, fuel prices were < 25-50% of current prices)

 

Dr. Al Bashir in the resuscitation bay of the Emergency Department at Istishari Hospital in Amman
Dr. Al Bashir in the resuscitation bay of the Emergency Department at Istishari Hospital in Amman

 

When I brought up solar, I got the same answer that I have heard all week- the current regulatory system makes integrating solar difficult and the State- owned electricity company in Amman (JEPCO) opposes large scale solar projects. Also, according to EDAMA (a non profit renewable energy consortium), in 1990 20% of homes in Jordan used Solar Water Heaters. By 2010, this number dropped to 11.8%. I haven’t been able to dig too deeply into the true regulations, but this is the feeling

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in the energy sector and health sector.

To their credit, there is movement on many fronts to drive wind, solar and biofuels. The Energy Ministry recently inked deals for its 12th solar farm (totally USD 560 million in investments)- The two 10mW farms in southern Jordan will contribute to the estimated 2500 new jobs created by the solar market in Jordan. This is great news- and the efforts should be accelerated.

As mentioned before, there are several factors that lower the barrier to market entry for renewables in Jordan and that suggest Health Care should lead the way in a cross- sector

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collaboration.

  1. Jordan lacks any fossil fuel resources
  2. Jordan imports 96% of its energy (19.5% of its GDP)
  3. Jordan’s domestic energy consumption is rising about 7%/ year
  4. The average daily irradiance is 5-7 kWh/m2 (this is pretty high)
  5. The health sector is a major consumer of energy and water (4% in the US- data tough to find in Jordan given the sectored system)

One comment struck me- “We need space to maneuver, it is very difficult on shoe string budgets and in times of economic stress”. There is truth in the observation that tight times can result in contraction of services and R&D. However, crisis can also spark and drive innovation. From my observations, Jordan’s health sector is historically strong, but facing tremendous strain from a decade of economic challenges acutely worsened by the Arab Spring and the massive influx of Syrian refugees. There exists an opportunity to capitalize on this crisis to build infrastructure, improve systems and build community resilience (i.e. Jordanians, Palestinians, Syrians, etc.) in Jordan. The Gulf Cooperation Council (GCC) is rumored to be offering USD 5 billion for projects (they require the proposal submitted to them and they deliver- apparently), UNHCR is running two major refugee camps that are essentially major metropolitan areas with all requisite public services, USAID has major HA/DR and development projects underway in the health and energy sector. Alignment of resources and laser focus projects that provide both immediate relief and set the stage for long term sustainability are critical.

Today, I head north. As with many countries (especially in the Middle East), there exists a distinct difference between the capital and the country side. It will be interesting to have these conversations with doctors, nurses and community leaders who have seen massive population changes in the past 2 years.

The socio economic impact of the Syrian crisis on Jordan

May 25, 2014

The socio- economic impact of the Syrian crisis on Jordan is complex and must be taken in the context of decades of Jordanian response to external strife and hosting of refugees (1948

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and 1967 Palestinians, 1982 Syrians, 1991 and 2003-5 Iraqis and now 2011-14 Syrians).

It is worth a scan of this report from Khalid W. Al Wazani. Focus on the summary points but realize, every analysis on this crisis is limited by the accuracy of the source data.

Hamza Hospital, Amman (public hospital)
Hamza Hospital, Amman (public hospital)

Syrian Crisis Overview: Maps and Charts

May 23, 2014
Amman, Jordan

After a great day with Moh’D at Wadi Mujib and the Dead Sea, I thought I’d throw out a few overview images to put the Syrian refugee crisis in perspective.

BORDER CROSSINGS:

Border crossings were initially informal and largely unregulated. Then in 2012 through early 2014, the border was sealed and tightly controlled at Ramtha. Again, for 2 years,

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Jordan essentially took everyone (up to 3,000/ day). When Syrians cross the border, they are generally picked up by the Jordanian Armed Forces (JAF) or IOM and taken to Raba’ Al Sarhan for registration, vaccination, food, basic medical care and ultimately transfer to the Camp (initially Zaatari and now Azraq).

Bordres 2

Now, there are only about 300 Syrians per day crossing into Jordan. The main entry point being moved to the far north- eastern border-so far out, my Jordan Tourism Map cuts off before the area. The process remains the same, but the logistical train is now much, much longer. Syrians travel for up to 2 weeks to get to the East and cross. They are often dehydrated and weak. When they cross, ICRC provides initial stabilization, the JAF must drive them hundreds of Km west to Mafraq area and Raba’ Al Sarhan, and then transport them back to the east to Azraq Camp.The refugees are taken to Bustana (“Garden”) collecting point run largely by ICRC.

map-bustana-z

Bustana= Garden. Somehow, must be lost in translation
Bustana= Garden. Somehow, must be lost in translation
ICRC assisting incoming refugees
ICRC assisting incoming refugees

The impact on Jordan is staggering. Though Jordan was suffering economic challenges prior to the Syrian crisis (from the Arab Spring largely reducing export options and driving up fuel prices), the last 2 years have accelerated the crumbling of their economy, social services and healthcare. The most recent UNHCR refugee numbers are shown below. Note, this only includes REGISTERED refugees- this is critical as GoJ and other researchers suggest an additional 500,000 non registered Syrian refugees in Jordan.

Refugee numbers

The United Nations, for all of its faults and limitations, is working hard to protect both the Syrians and the vulnerable Jordanian populations. They are also striving to modernize their data collection and analytics (though still largely using paper surveys and somewhat traditional data analysis/ reporting). A good overview can be found at UNHCR.

I met yesterday with Salma Jaouni, CEO for the Health Care Accreditation Council (HCAC). Coincidently, an fellow HKS Mid- Career. And, wouldn’t you know it, she gave me one of the best references yet to explain the socio-economic impacts of the Syrian crisis on Jordan (just published that day!). Not being an economist- macro, micro, behavioral or otherwise- some of the material is lost on me. However, here are some highlights:

1. Total benefit to Jordan economy (2011-13): JD 4.1 Billion ($USD 5.86 Billion)
2. Total cost to Jordan economy (2011- 13): JD 5.8 Billion ($USD 8.3 Billion)
3. Gap: JD 1.7 Billion (USD 2.42 Billion) or 20% of the Jordanian GDP
4. International community covering 75% through “Committed” though not necessarily delivered funds.
5. USAID estimated healthcare cost burden from Syrian utilization of Jordanian Healthcare system is JD 24.35 million (USD 34.79 million) between 2011-2012.

With those uplifting numbers I leave you with this cheerful adios from the gorgeous Wadi Mujib.

wadi small waterfall

Game Changer: Renewable Energy and Healthcare in Crisis

What does it cost to provide healthcare? Depends who you ask and what you count. Staff salaries- sure. Medications and supplies- yep. Power and water? Maybe, unless you have a subsidized system or you are unable to get granular data on usage in a place such as Zaatari Refugee Camp. The UN reportedly pays 750,000- 1,000,000 USD/ month for electricity in Zaatari Camp. A month.

From the NYT, the evolution of Zaatari Zaatari and below an image of the camp.

Zaatair
Zaatair

Notice anything? It is in the middle of the friggin desert in one of the top 5 driest and sunniest countries in the world. Oh, there is a little wind there as well.

Back of the envelope calculations over Turkish coffee put the cost of a 20mW solar farm that could power Zaatari and potentially expand to power nearby Mafraq at about $22 million (now there are issues of linking to the grid -v- direct power to Zaatari, durability etc.). This means in about 22 months (heck call it two years) the solar farm would be paid off- 2 year payback is unheard of in the US solar market. If the crisis ends before then (which I fear it will not), the farm can be used to power Mafraq. The UN cites financial regulations, direct relief priorities and donor preferences as barriers to being able to invest in innovative solutions. “The UN can’t float bonds” one person told me (NOTE: I am not a finance guy and rely on my wife to keep us out of debt). But, let me run this potentially common sense idea by you:

1. UN and International donors identify that sustainable energy is a requirement for mission success. They also acknowledge that trucking in fuel on a daily basis to run generators is not a cost effective long term solution (frankly short term either in my opinion). Relief and development priorities are aligned to reflect the critical integration of cross sector solutions.

2. UN and donor nations partner with Jordanian private sector and appropriate GoJ leaders to create an innovative solution to drive solar/wind energy integration into both the National Response Plan and the future Jordanian energy plan.

3. Jordan convenes a stakeholder meeting including IO, GoJ, energy sector, private sector, international experts, USAID, DFID, etc. to address barriers to implementation- I bet you a dollar it is mostly politics and inertia.

Potential benefits: Local jobs (addressing issues of the burgeoning unemployment in Jordan), seed funding for local high tech, clean energy industry in Jordan (expanding Jordan’s knowledge based economy), development of local expertise in renewable energy that can be exported across the region, decreased national electricity costs (this will reduce financial strain being experienced by local Jordanians), UN dollars being spent on electricity can be redirected to support critically underfunded projects, and finally reduction of high carbon output fuel source utilization.

One company of innovative forward thinkers is Clean Energy Concepts. The Managing Partner, Maher Matalka has experience in health care an clean energy. He seems to have the knowledge, experience, mindset, and optimism to drive ideas like this forward. But, success requires all of the clean energy companies to come to the table, it requires aid/relief organizations to break out of their silos, and it requires the GoJ to create the proper incentives. I think the USAID Jordanian team is working in this direction, but could also be critical partners in funding this type of cross sector, out of the box solution.

Eisenhower Fellowship Jordan: Health and Syria

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May 22, 2014
Amman, Jordan

I apologize for the delay in blogging. I now know why I could never be a reporter; I have difficulty sitting through meetings (no surprise to all who know me), I do not write quickly, I frequently go off on rants and I am easily distracted. So it is this morning, four days into the trip and I will blame my delinquency on Fox News and CNN. But, perhaps not in the way you think. I have actually been watching “the news”. In the US, I have written off our reported “News” industry as an entertainment clown show. If I want to get piercing insights into the hypocrisy of our leaders, I turn to Jon Stewart. Imagine my surprise, when I switched to CNN and didn’t see any reporting on the disappearance of Malaysian flight whatever. And, on Fox, they were actually reporting international stories of interest, rather than vomiting nonsensical, overtly hypocritical ideology. Still, I turned to BBC because, well, it’s the BBC.

On the ground in Amman, life appears to be rolling forward like it does in any major metropolitan area of several million people. Rush hour is madness (more or less throughout the day), the markets are packed, Range Rovers battle with the occasional donkey for street space, and people are dealing with human issues- work, family life, school for their kids, etc. However, conversations quickly and, frankly pretty easily, turn to concerns about money.

Official statistics are difficult to find, but here are some comments with general references from my conversations:

1. “Jordan’s population has doubled in the last 10 years” (GoJ Official, cab driver, and University Professor). The current reported population in about 6.4 million (The most recent statistics are from 2012) with official growth rates for past decade are between 2-3.8% (http://www.dos.gov.jo/dos_home_e/main/Demograghy/2012/2-6.pdf). The challenge to these numbers is it is unclear whether they include the approximately 1 million Iraqis who have entered the country since 2005 and they almost certainly do not include the 600,000- 1.3 million Syrians who have immigrated (or been displaced since 2011). So, call the population closer to 8-10 million.
2. “Petrol prices are too high”. True. At least a 21% increase since the Arab Spring secondary to instability in Egypt- one of Jordan’s main fuel suppliers.
3. “Jordanians cannot afford rent.” Rent and housing prices have skyrocketed by all accounts since 2005. The average Jordanian blames the displaced Iraqis who tended to be wealthy and were able to purchase homes/ apartments at elevated prices (note most of the sellers were Jordanians) and the Syrians who are “able” to put several families into small spaces and therefore landlords are demanding more money. Hard to tell the root causes. Some analysts do fear that the UNHCR cash distribution programs outside of the camps is creating a false economy and worsening the situation. Others counter that since Syrians cannot legally work, some economic crisis mitigation tactics are needed.
4. “The hospitals are full. Even private hospitals are short on beds.” I have heard some variation of this from people at the Shawarma shop, the MoH personnel, private hospital leadership and even USG staff. King Abdullah and the Prime Minister have mandated that Syrians registered with the UNHCR will be treated like Jordanians, specifically in terms of healthcare provision. This means largely free primary care, significantly discounted medications, and low cost hospitalization at public hospitals. The resulting burden on the health care system is immense. Again, think about the drama in the United States regarding adding 15 million (out of 330 million citizens) new “insured” patients onto the books. In Jordan, we are talking about perhaps an immediate 10-20% increase people to be covered. MoH leadership says the issue is not number of primary care doctors or nurses (though I suspect there are significant issues with matching staff and volume nation- wide), the issues are medications, supplies and physical space (More on this later).

My understanding continues to grow throughout the trip (amazing that I am only 4 days in). This is largely because of the excellent work of my in country team (Dima, Ruba and Moh’D) and the willingness of leaders to meet with me to have frank open discussions. This access is a true testament to the values, mission and strength of the Eisenhower Fellowship. Complex challenges require innovative, cross sector thought. The EF has helped to create this

environment, pulling together leadership from International Organizations (e.g. UNHCR, WHO, and the ICRC), NGOs (e.g. International Medical Corp, Save the Children, and MSF), government leaders (e.g. Ministry of Health) and the private sector (e.g. Private Hospital Association, EDAMA, Hakeem, etc.). Solving this short term crisis and leveraging the lessons learned to propel Jordan forward will require active engagement from all of these sectors. For my part, I just hope that I can help facilitate introductions and hopefully spark some game changing discussions.

Dr. Abdel Razzaq Shafei and Dr Riyad Okour Directors of Health Economics and Health Planning
Dr. Abdel Razzaq Shafei and Dr Riyad Okour Directors of Health Economics and Health Planning

The current President of the Eisenhower Fellowship, Ambassador John Wolf, recently quoted President Eisenhower in an email to our community. Sitting in Amman, fatigued from 4 days of poor sleep, but well caffeinated (still), I found the quote to be both sobering and inspiring.

“We pray that peoples of all faiths, all races, all nations, may have their great human needs satisfied; that those now denied opportunity shall come to enjoy

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it to the full; that all who yearn for freedom may experience its spiritual blessings; that those who have freedom will understand, also, its heavy responsibilities; that all who are insensitive to the

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needs of others will learn charity; that the scourges of poverty, disease and ignorance will be made to disappear from the earth, and that, in the goodness of time, all peoples will come to live together in a peace guaranteed by the binding force of mutual respect and love.

With that, I am off to another day of conversations and problem solving.

Guess what we did next?
Guess what we did next?

Those who society abandons, we defend.