Jordan is one of the world’s largest refugee-hosting countries relative to population. It shelters more than 3 million migrants and refugees, including more than 1.3 million Syrians, along with Iraqis, Palestinians, Yemenis and others. This influx has placed considerable strain on Jordan’s national health system, which must balance the needs of citizens with those of displaced populations. The challenge has grown increasingly political, raising questions of equity, inclusion and national identity.

Policy Evolution and the 2019 Reform

Jordan’s refugee health policy has evolved through a complex interplay of humanitarian priorities and national politics. Since 2012, the country’s Ministry of Health has collaborated with international partners, including UNHCR, WHO, UNICEF and bilateral donors, to integrate refugees into existing public health services, rather than establishing parallel systems. This model sought to ensure sustainability while maintaining the state’s control over its health infrastructure.

In April 2019, Jordan introduced a major policy change: Syrian refugees registered with UNHCR were permitted to access public health care at the “noninsured Jordanian rate,” effectively restoring access to government facilities after a period of reduced subsidies. This measure reflected an attempt to balance national cost constraints with humanitarian obligations and international diplomacy.

According to analyses by researchers, this decision was influenced by shifts in both domestic politics and global funding flows. Initial momentum for refugee inclusion, strong during the early years of the Syrian crisis, began to decline as fiscal pressures intensified and political attention shifted. Jordan’s leadership weighed the costs of long-term refugee care against concerns about public resentment and donor fatigue.

Donor Politics and the Multi-Donor Trust Fund

To sustain health-service delivery for refugees and vulnerable Jordanians, the government established the Jordan Response Plan (JRP) framework and a Health Sector Working Group. These bodies coordinate with the Jordan Health Fund for Refugees (JHFR), a multi-donor trust fund managed by the World Bank and the Ministry of Planning and International Cooperation. This mechanism pools donor contributions from the European Union (EU), Canada, Germany and other countries to support public health facilities that treat refugees.

The fund represents a hybrid model where humanitarian assistance and national systems converge, blurring traditional lines between emergency relief and development aid. Such arrangements also reveal how refugee health policy in border-host states is inherently political. International partners influence policy through funding priorities, while Jordan’s government uses refugee-health initiatives to strengthen diplomatic ties and demonstrate regional stability. Researchers argue that this dynamic reflects “policy integration by necessity,” a balancing act between sovereignty and donor expectations.

Equity and Inclusion in Practice

Despite the use of inclusive policy language, access remains uneven. Studies of Syrian and Palestinian refugees in Jordan show that health care equity depends heavily on legal status, registration and location. Refugees registered with UNHCR generally qualify for subsidized public health services. However, unregistered or urban refugees often face high out-of-pocket costs.

Research also finds that gender, chronic illness and camp residency shape who can obtain care. For example, while camp-based refugees may receive consistent primary care from NGOs, urban refugees struggle with costs for hospital care and medicines. The WHO’s 2023 review noted that health service utilization among refugees is constrained by both financial and administrative barriers, even where policies formally allow for inclusion.

This disparity underscores how refugee health is as much a political question of belonging as a technical challenge. When governments define access tiers by citizenship or registration, they reaffirm boundaries of national identity, determining who is seen as part of the social contract and who remains outside it.

Health Care as Diplomacy and Strategy

Jordan’s refugee health policy has also become a form of regional diplomacy. By maintaining access for Syrians and cooperating closely with international agencies, Jordan projects stability and reliability to donors and neighboring states. The World Bank and WHO both highlight Jordan as a leading example of a country “integrating refugees into national systems” within the Eastern Mediterranean Region.

This approach aligns humanitarian and strategic interests: providing health care prevents disease outbreaks, reduces social tensions and supports regional security. It also strengthens Jordan’s leverage in international negotiations, where hosting millions of refugees positions the country as a key partner for the West.

Lessons for Other Border-Host States

Jordan’s effort illustrates that refugee health policy is not solely a humanitarian issue but a political ecosystem involving ministries, donors and citizens. Effective inclusion relies on sound fiscal planning, effective diplomatic management and public trust. When handled strategically, as in Jordan’s integration model, health care for refugees can enhance both human security and state resilience.

For other border-hosting nations, the Jordanian case offers three takeaways:

1. Integrate refugee care into existing national systems rather than creating separate structures.
2. Align donor funding mechanisms with government priorities to ensure sustainability.
3. Recognize that equitable access to health care reinforces social cohesion and prevents instability.

Providing health care to refugees, therefore, is not only a moral responsibility but also a strategic investment in regional peace and long-term system resilience.

– Clara Garza

Clara is based in Los Angeles, CA, USA and focuses on Global Health and Politics for The Borgen Project.

Photo: Flickr