As conflict affects Syria's health sector, many sick and injured seek treatment outside

ZA'ATRI REFUGEE CAMP, Jordan, February 21 (UNHCR) - Mustapha* sits on a foam mattress inside a green hospital tent trying to contain his pain. Burns have shrunk the skin on his legs, leaving them bent at a 45-degree angle. Moroccan doctors at a field hospital in Jordan's Za'atri camp have kept his body clear of infection. Soon he will be transferred to another facility to undergo plastic surgery and the hope is that he will walk again.

The 41-year-old Syrian refugee's hazel eyes well up as he recounts the evening when his house in Dara'a was set ablaze during the conflict. He remembers the ear-splitting explosion that rocked his house. The walls of the living room buckled beneath a loud and shifting orange flame. His motorbike glowed with fire. "My clothes were on fire and my body was burning," he said. "I was very surprised that it burned so quickly."

There was no doctor available in Dara'a to tend to his injuries. And so Mustapha's young son gathered a group of men from the neighbourhood to help transport him across the border. At 10am on January 23, they put him in a car and headed towards Jordan. After three hours, they stopped and put their friend on a mattress, which six men hoisted onto their shoulders before heading across the fields and eventually reaching the border.

Others in the hospital here lie next to Mustapha. There is a man with a heart disorder. Another patient suffers from a collapsed lung. The ward is filled, even as a long line stretches to the hospital gate with others seeking medical care. Like Mustapha, many have crossed the border injured or sick.

Staff at the Moroccan hospital in Za'atri have seen more than 93,000 cases since the camp was opened in July last year. And while the hospital is fully equipped with everything from a dental clinic to two surgical theatres and an x-ray room, the increased number of refugees fleeing the border has meant that the facility is working overtime.

Jordan says it has received more than 320,000 Syrians since the conflict erupted in March 2011. They arrive in numbers approaching anywhere between 1,700 to as many as 4,000 each night. Many of are in need of medical treatment.

In partnership with Jordan, UNHCR has worked vigorously to coordinate the response to the crisis. A primary health care coordination centre is expected to open in Za'atri in the coming days. "We're making sure that everyone is working together and taking advantage of the vast resources available in the camp," says Ann Burton, who heads the UNHCR health unit in Jordan.

Meanwhile, the refugee agency is urging its partners to increase the number of general practice physicians with the 10 health partners who work in Za'atri. UNHCR health experts and other doctors believe the breakdown of health services in many parts of Syria has meant they are seeing increasing numbers of refugees with complex medical problems, which is straining the resources available for health care in Jordan.

So far, UNHCR and its partners have staved off epidemic disease. All children aged under 15 are offered a measles vaccination. Each new arrival to the camp is screened for health problems to determine if any are in need of immediate referral to available services.

But while all of the camp health indicators are below emergency thresholds, UNHCR experts are particularly concerned about children. The newly born are the most vulnerable, Burton notes. "We see the same range of health problems in newborns as you would see anywhere, including congenital abnormalities, pre-term birth and low birth weight, and neonatal infections," she says, adding: "We are able to manage many of these in the camp health services, but for more complicated cases we need to refer to the Ministry of Health services."

Burton's Geneva-based colleague, Chris Haskew, says there are inevitably some fatalities and when these do occur, "UNHCR works with the Ministry of Health and its partners to investigate the causes and to look for any preventable factors."

Doctors working in Za'atri are keenly aware of the often violent circumstances under which refugees have fled Syria. Despite the large number of patients who receive treatment, the staff make a point of listening to their stories.

"The majority have lost someone and the impact of this experience is very important," says Bouaiti Elarbi, a doctor at the Moroccan hospital. "They are frustrated, they feel anxiety. They need people to listen to them. We have seen that when we give more time to patients, their mood will change."

Meanwhile, in the hospital's delivery room, 22-year-old Leila* has just given birth to her second child, via Cesarean section. Baby Nara's* grandmother, Noor,* holds the child in her arms and gives thanks that mother and daughter are both healthy.

Leila's other child, Reena,* suffers from epilepsy. Her husband Ali* fled Syria out of the fear he would be killed. The safety of the baby also was part of the decision to leave as the family was concerned that the local hospital might become engulfed in the conflict in Dara'a. When Leila arrived in Jordan she was wracked with nerves and the doctors in Za'atri opted for a Caesarean out of concern for her safety and that of the child.

The thoughts inside Leila's mind conflict with each other. She beams at the sight of her newborn. And she is thankful that for the first time in many months she can sleep at night. And yet the past claws at her. It denies her even the joy of celebration. "Would I lie and tell you I am happy," Leila says. "I am not happy at all. After all we have been through, I am very sad. What will be the future of my child?"

* Names changed for protection reasons.

By Greg Beals in Za'atri Refugee Camp, Jordan