Iraqi Refugees & the Mental Health Crisis in Jordan

Iraqi refugees in Jordan face the triple threat of isolation, insecurity, and inadequate resources – all contributing factors to the high rates of mental illness and distress found within the population. Many of the Iraqi refugees in Jordan have been exposed to considerable trauma and generalized violence in their home country. Upon entering Jordan, they face an existence characterized by an ambiguous legal status, high unemployment, and feelings of societal alienation. The marginalization of the Iraqis can lead to a loss of identity, chronic stress, and depression. Unfortunately, those who do seek counseling find that care comes with high costs and is severely limited by a lack of mental health services.

Estimates for the number of Iraqis currently residing within Jordan range from approximately 450,000 to 750,000. Of this population, roughly seventy-seven percent (77%) entered between 2003 and 2007. Approximately seventy-six percent (76%) of the current population originated in Baghdad and fled to Jordan after violence escalated following the United States invasion of Iraq. The largest waves of migration occurred after the outbreak of the war in 2003 and then again after the bombing of the holy Shi’a Al Askariya shrine in Samarra in February of 2006.

According to the report by International Organization for Migration (IOM) titled, “Assessment on Psychosocial Needs of Iraqis Displaced in Jordan and Lebanon,” over fifty percent (50%) of the 138 Iraqi families interviewed in Jordan displayed eight (8) or more indicators of distress in their new lives. The report notes that over twenty-one percent (21%) of the respondents in Jordan were exposed to trauma in Iraq in the form of kidnapping, torture, rape, and/or being witness to the assassination of friends and family members. For those with a history of trauma, there is a corresponding high rate of depression and anxiety characterized by panic attacks and obsessive thoughts of death.

Mental distress among the Iraqis is further aggravated by their status in Jordanian society. Iraqis in Jordan are not recognized as refugees by the Jordanian government. Officially, Iraqis are considered the “guests” of Jordanians – a term that alludes to the Arabic concepts of hospitality and duty but which also distinguishes them from the Palestinian refugees that Jordan has hosted since 1947. Jordan has never signed The 1951 UN Convention and Protocol relating to the Status of Refugees which establishes the obligations of host nations to provide legal protections and services to asylum seekers. Although Jordan is considered a friendly host nation for Iraqis, the Jordanian government has never passed legislation defining the legal status or protections of Iraqis within its borders. Iraqis entering Jordan usually do so on three (3) to six (6) month visas rather than through an appeal for asylum. Once their visas expire, Iraqis are essentially illegal residents in Jordan. According to the working-paper, “Jordan as a transit country: semi-protectionist immigration policies and their effects on Iraqi forced migrants,” published online through the United Nations High Commissioner for Refugees (UNHCR) website, Iraqi refugees live in fear of deportation to Iraq. Therefore, they do not necessarily seek the assistance of UNHCR by registering as refugees. As of 2008, the UNHCR had only registered 52,192 Iraqi refugees in Jordan.

Iraqi refugees are regularly denied work permits by the Jordanian government due to their status. Consequently, most Iraqi refugees’ livelihoods in Jordan are dependent on intermediate and short-term labor opportunities, cash transfers from abroad, and through selling goods or services. According to the report, “Iraqis in Jordan: Their Number and Characteristics” produced by the Norwegian Research Institute FAFO, approximately seventy percent (70%) of the Iraqi refugees in Jordan are of working age, but only thirty percent (30%) are currently in the labor market. Of those that are working, approximately thirty percent (30%) are self-employed. This contradicts wildly with the information known about the education levels of Iraqi refugees – forty-six percent (46%) arrived in Jordan with a Bachelor’s degree.

Widespread unemployment and economic insecurity has not only marginalized the Iraqis within Jordanian society – it has also altered the traditional gender roles, family relationships, and concepts of identity. These issues have been further stressed by the segmenting of families across borders and regions due to the security system, leading to increased anxiety, sadness, and loneliness in many families. Women are taking on greater roles in households in which husbands are absent or unable to find work. Approximately one-quarter of women participating in focus groups facilitated by the International Organization on Migration (IOM) reported incidents of domestic abuse in 2008. These compounding factors have increased feelings of isolation, alienation, and high levels of status-related insecurity among the Iraqi refugee population.

Perhaps the most complicated issue affecting the mental health of displaced Iraqis is the question of their future. There are seemingly three possible solutions to the Iraqi refugee crisis in Jordan – the first option is resettlement in a third country such as the United States, Canada, New Zealand, Australia or many nations in Western Europe. Resettlement is conducted through UNHRC and IOM and is an unlikely solution for the vast majority of refugees. To put the possibility of resettlement into context, the United States resettled approximately 7,000 Iraqis in 2007 out of total population of approximately 4 million worldwide. The second option for Iraqi refugees is full integration into Jordanian society—an option made nearly impossible due to the current legal and legislative policies held by the Jordanian government. The final option is voluntary return to Iraq – one that approximately 300 to 400 individuals have attempted with the aid of UNHRC within the past two years. This option is obviously dependent upon the security situation within Iraq as well as the economic and social opportunities it is able to offer its citizens in the next several years.

Given the many contributing factors affecting the mental well being of displaced Iraqis, a case can be made for providing these individuals with free mental health screenings and counseling within the first several months of their transition to Jordan. Unfortunately, Jordan is plagued by a severe shortage of mental health services available for Iraqis. In the public health system, the picture for mental health services is bleak –Jordan has only a few counselors, approximately three (3) to five (5) clinical psychologists, twenty-four (24) psychiatrists, a total of thirty (30) outpatient clinics, and 450 hospital beds for mental illness (IOM). The obvious short-term solution would be providing services through implementing partners. However, among the NGOS, only a few are able to offer mental health services and even then what is offered is not comprehensive or meant to be long-term. CARE, Mercy Corps and World Vision currently provide basic but limited counseling to the Iraqi communities. The International Rescue Committee has plans to develop a mobile unit for basic counseling and the World Health Organization (WHO) is developing trainings for specialized counseling for health professionals. Likewise, the International Medical Corps is offering training in mental health practices for general practitioners.

The mental health crisis among displaced Iraqis must be addressed through strong international support in the form of increased funding for trained mental health professionals, greater access to care facilities, extended outreach efforts by NGOs, and fuller integration of the Iraqi population into their host country. The International Organization for Migration report notes that any effort should not to seek to medicalize the issue within the population, but rather to integrate culturally appropriate solutions that allow for the reengagement of Iraqis into society. To do this, implementing partners will need to engage the community itself in finding solutions which can retain the traditions and integrity of the home and lives that they have left behind. If the crisis is not adequately and appropriately addressed, Jordan will likely be left bearing the social, economic, and security consequences for many years to come.