Al-Rukban refugee camp is all but forgotten to the world, sequestered in the dusty no-man’s land on the edge of the Syrian side of the Syrian-Jordanian border. The camp was initially formed in 2014 as Internally Displaced Persons (IDPs) fled violence from fighting between opposition groups and the Syrian regime, but were denied entry into Jordan due to perceived security concerns. The flow of IDPs into al-Rukban continued until the camp’s population peaked at 75,000 residents in 2016. Today, the population hovers somewhere between 10,000 and 13,000 residents, depending on the source of the estimate.
Starting in 2018, humanitarian conditions in the camp began to degrade severely, after Jordan declared it would no longer allow aid deliveries to the camp via its territory, and Damascus began cracking down in earnest on smuggling routes into the camp. This all but choked off the flow of goods—with the exception of three crossline aid deliveries Damascus permitted into the camp in the last two years. The last aid delivery, a joint UN-Syrian Arab Red Cross (SARC) mission was sent in February 2019, two years ago. Currently, no non-governmental organizations (NGOs) officially operate in the camp, and those working there unofficially do so on an extremely limited scale.
As a result, residents have adopted a variety of ad-hoc strategies to cope with and improve their living conditions. Some of these require the intervention of external actors—friends and family abroad or NGOs working through local agents in the camp. Virtually all aid projects are unofficial, working through the black market.
This study provides a general overview of the humanitarian situation in al-Rukban, specifically the healthcare sector, the availability of basic goods and the methods by which they are obtained, and the public services available in the camp.
The information provided in this study is based on interviews conducted by OPC with al-Rukban camp residents, their relatives, the heads of two clinics in al-Rukban, medical and humanitarian workers who focus on al-Rukban and who have conducted aid projects in the camp, and United Nations needs assessments.
The study will conclude with a set of policy recommendations directed toward responsible governments, as well as NGOs seeking to undertake aid projects in al-Rukban.
The Healthcare Sector
The healthcare system within the camp is scarce at best. When asked about his clinic’s medical capacity, the response of the head nurse of a clinic in al-Rukban is revealing: “Healthcare system? There is no healthcare system. There is nothing here.” The camp has no doctors, only nurses with basic-to-no training, and this same nurse said the camp’s pharmacies are “completely empty of drugs.”
As a result, a number of diseases and afflictions have become endemic to al-Rukban, exacerbated by malnutrition, poor water quality, and particulates inherent to the sandy environment. Common maladies include: Leishmania, unidentified rashes (especially among children), respiratory diseases due to constant unfiltered exposure to sand particulates and fumes from trash and plastic burnt for warmth, stunted growth due to malnutrition, and post-traumatic stress disorder.
At one time there were also camp residents who suffered from chronic diseases which required frequent intervention, like dialysis or the administration of insulin, but most have left to regime-held territory in search of more consistent medical care.
To treat these diseases, residents previously relied on a UNICEF-run clinic on the Jordanian side of the border, which provided basic medical care and referred more specialized cases to hospitals within Jordan. However, the clinic was shut indefinitely in mid-March 2020 due to COVID-19 concerns.
In the absence of the UNICEF facility, the camp is serviced by three clinics, with varying levels of equipment available in each.
The first (unnamed) clinic is the newest of the three and was opened in July 2020 with anonymous funding from a private individual in the camp. The clinic has equipment to perform surgeries, take x-rays, and has two ICU beds with one respiratory device between them. The clinic is staffed by seven nurses, two of whom had certificates prior to displacement; the other five were trained at the US-run al-Tanf garrison in 2018.
Since opening however, the financial patronage has dried up, leaving the clinic with no medicine to prescribe treatment. Currently the clinic can only provide diagnoses and check vitals.
The second clinic in the camp is a mobile clinic run by a group which calls itself the “Palmyra Tribal Council.” This clinic has surgical and anesthesia equipment, and an ultrasound device. The clinic is made up of two nurses—at least one had experience prior to their displacement—and the clinic’s manager, Shihab al-Shukri, who has also taken on a medical role. It is unclear what training al-Shukri has beyond a 45-day course he took in the fall of 2020 over Zoom.
The “Palmyra” clinic successfully performed a c-section on a woman on November 30, 2020. The team of nurses performed the operation with the assistance of a gynecologist, a general doctor, and a surgeon advising over Zoom. This clinic also has an open communication channel with the al-Tanf garrison, although it is unclear to what extent.
The third clinic, known as the “Sham Clinic,” is the worst equipped of the three. It has only two nurses as staff, and it is unclear what medical capacity is available, other than devices to measure blood pressure. The clinic is also associated with Maghawir al-Thawra (MaT), the US-backed opposition group serving as the local partner force of the International Coalition to Defeat ISIS forces in al-Tanf.
All three clinics, regardless of the equipment available, are extremely limited in the services they can provide their patients. Most can diagnose medical conditions but cannot medically intervene, due to either a lack of knowledge or a lack of equipment. The severe shortage in medicine also means that even if the attending nurse does know the proper drug treatment to prescribe, the necessary medicine is usually not in stock. Specialized medicine (e.g., anything other than Panadol, a brand of over-the-counter acetaminophen) must be smuggled in, an expensive and time-consuming process.
Basic Goods Growing Increasingly Expensive
The prices of basic goods in al-Rukban have been steadily rising since Jordan stopped allowing aid deliveries via its territory two years ago. Like the rest of Syria, the economic crisis and severe depreciation of the Syrian pound has contributed to a sharp increase in prices.
There are acute shortages of many goods in the camp, especially fresh fruit and vegetables. Those goods which are available are quite expensive.
Unable to afford food, many residents suffer from some form of malnutrition, and an unknown number have died from starvation. According to the last update issued by the UNICEF clinic in March, nearly 100% of the children under 5 who went to the clinic were malnourished, in addition to the other diseases which brought them to the clinic in the first place.
To cope with the food shortage, camp residents have begun engaging in widespread small-scale subsistence farming. Yields are quite low—as crops are grown in small plots around tents and houses—and seeds need to be smuggled into the camp each season, making farming an expensive endeavor. Productivity is limited by the fragmentation of agricultural plots; instead of concentrating crops in one large field where growing can be coordinated on behalf of the camp, each family is left to initiate and manage their own produce, with varying levels of success.
Though cultivation in the arid soil of al-Rukban is no easy feat, several crops have been successfully grown, including cucumbers, mulukhiyah (jute mallow), okra, eggplant, and tomatoes. Most residents have no prior experience in agriculture—one resident who spoke to OPC was previously a mechanical engineer and was struggling to farm efficiently—and have been forced to learn on the fly.
Farming has thus been a process of trial and error, with residents testing out different seeds and techniques, then pooling their experiences together to learn and maximize their future productivity. The process is lengthy and expensive, as seeds and equipment must be brought in. The lack of technical expertise is also a large obstacle. To that end, a Turkey-based NGO which asked to remain anonymous, began cooperating with some residents in al-Rukban in early December to provide technical expertise from agricultural experts over Zoom.
For foodstuffs they cannot grow by themselves, camp residents rely on smugglers to bring them from government-held Syrian territory into the 55-kilometer al-Tanf zone. However, due to the regime’s clampdown on smuggling routes into the camp, there has been a drastic drop in the smugglers willing to traverse the desert and risk arrest at the hands of the Syrian government soldiers who guard their side of the al-Tanf deconfliction zone. Prior to 2018, there was a route that ran from the camp to the city of Ar Raqqah that made ferrying goods into the camp a relatively simple process, creating a large market for smugglers in the camp.
Now, there are just three smugglers al-Rukban residents feel they can rely on, limiting the volume of goods flowing into the camp. The price of goods has also risen; increased scrutiny by the Syrian military means more bribes must be paid along the way, and these costs are passed along to the camp residents. The virtual monopoly smugglers hold on goods brought into the camp allows them to raise prices as they see fit, an arrangement which leaves the residents feeling exploited, but with no other alternative.
Compounding the problem is that, in general, smugglers prefer to be paid in US dollars—though both US dollars and Syrian pounds are in circulation in the camp. Those residents who have access to US dollars have been largely insulated from the recent depreciation of the Syrian pound, whereas those dealing in Syrian pounds have suffered from the rapid inflation in prices. In fact, when the change in price over the last two years for the goods listed in the previous chart is calculated in real US dollars, many of the goods (rice, tomatoes, and bread) have either decreased dramatically in price since 2018, or increased (but at a much lower rate).
This means that those residents who are able to pay smugglers in US dollars, either in person at the camp or via a third-party intermediary outside of the camp, have far more purchasing power than those dealing solely in Syrian pounds.
Most of the US dollar supply in the camp comes from members of MAT. The fighters are paid in US dollars by the American forces at al-Tanf garrison. They then spend them at the local market in al-Rukban, creating a limited supply of US dollars, concentrated primarily in the hands of merchants and MAT members.
MAT “receives” the smugglers once they enter the al-Tanf deconfliction zone, unloading their goods or directing them to al-Rukban, affording them a large degree of control over goods entering the camp. Residents interviewed by OPC complained that the higher-ups of MAT freely abuse this power, taking a cut of all incoming goods for themselves and their families.
There are virtually no public services available in al-Rukban, save for water supplied from across the border in Jordan. In order to make up for the gap in missing services, residents have turned to ad-hoc, short-term solutions. For example, due to the shortage of fuel, residents burn trash and blankets to keep themselves warm or cook their meals.
The one public service available is a free water supply, which is fed to al-Rukban via a pipeline from a Jordanian military base on the other side of the border.
The water-supply project is run by UNICEF, which operates a reverse-osmosis water treatment facility that cleans the water before sending it via pipeline some two kilometers away, to water tanks just in front of the earthen berm marking the border between Syria and Jordan. The water tanks then pipe the water a short distance away to outlets on the Syrian side of the border.
The water outlets are still a few kilometers from the camp, so residents must transport their personal water tanks to the outlets via mule-drawn carts—unless they are one of the few residents who have access to a car or fuel.
Residents of al-Rukban ferry water from water spigots to their homes via mule-drawn carts. (24-06-2020)
Still, despite a steady supply of water to the camp, in recent months, children have had mysterious rashes appear on their skin, something which residents claim is caused by contaminated water. Theoretically, if the reverse osmosis treatment plant is working properly, the water that comes out of the pipeline should be potable and free of contamination. However, residents say the water that reaches them is already contaminated.
A UN OCHA spokesperson denied any water contamination issues, telling OPC that “the water supply system treats water to WHO standards,” and that “there have been no contamination events since the system construction, with regular water quality te
Still, residents and activists insist there is indeed some form of contamination present; after a water purification project was carried out in the camp this summer, providing purified water to 1,000 families for two weeks via chlorine tablets smuggled in, the rashes temporarily disappeared from the afflicted children. Due to a lack of medical attention in al-Rukban, it’s impossible to assess the true cause of these rashes or if indeed the water is contaminated—as well at what point any contamination is occurring.sting undertaken throughout the treatment process and system to ensure quality.”
Internet and cellular data is available in the camp, though it is relatively expensive. Internet is distributed throughout the camp via routers which hook up to a Turkish satellite. Those who own the routers sell internet access to residents for $0.25 every three days. OPC asked for more information about this internet system and exactly which Turkish company is supplying it, but was unable to reach those responsible for the arrangement.
There is no electrical grid in al-Rukban, nor any distribution system within the camp. Residents who have car batteries rig up power-diversion systems from them to charge their phones and other electronics, as well as to provide light at night.
Power siphoned off a car battery in the home of a resident of al-Rukban.
A minority in the camp have access to solar power panels or generators, though the latter requires scarce and expensive fuel. According to one resident’s rough estimate, only about 20% of the camp has enough electricity to power lights in their tents or homes at night. The other 80% of the camp has nothing, though occasionally they can charge their phones when their neighbors allow them to do so.
Neighboring states and states involved in Syria should do the following:
Lift the siege on al-Rukban and allow aid to be delivered to the camp by opening former smuggling routes, allowing the UN and SARC to conduct crossline aid deliveries from regime-held Syria, and by sending aid to al-Rukban camp via Jordanian territory.
Re-open the UNICEF clinic in Jordanian territory.
In the case that the UNICEF clinic is not re-opened, US forces should more consistently allow emergency cases into its military hospital at al-Tanf base.
Allow a doctor into al-Rukban to perform a healthcare needs assessment of the residents, whether a US doctor or otherwise.
Establish and enforce anti-corruption measures for MAT to ensure they do not pilfer deliveries of goods to al-Rukban or otherwise abuse their leverage over camp residents.
NGOs seeking to improve humanitarian conditions in al-Rukban camp should consider the following:
Consider launching services over the internet. Internet access is available in al-Rukban camp and communication with the outside world is consistent. Willing NGOs can take advantage of this and launch projects from a distance. Some examples of such projects might be tele-education for children, psychological counseling, technical advising for engineering and agricultural projects, and virtual doctor visits.
Carry out proper monitoring and evaluation processes. Despite the unofficial nature of aid initiatives in al-Rukban, procedures should be put in place to ensure that aid is actually delivered to those in need, rather than being hoarded by middlemen. Key to this is sustained relationships with a number of trusted local agents within the camp.
Consult with local civilians to provide needs assessments before launching new initiatives. Many small-scale projects have proved extremely effective in al-Rukban, due to their highly targeted nature, such as the water purification project implemented this summer. Talking directly with key informants in the camp will help identify needs and make projects more targeted and effective.