Jordan

HEALTH AND WELFARE

A child patient at King Hussein Medical Center, Amman

Factors affecting the standard of living for the average citizen were difficult to assess in early 1989. Information was scanty. Living conditions varied considerably according to region, kind of settlement, social position, and fortune of war. At the high end of the spectrum, well-to-do city dwellers appeared to enjoy all the amenities of modern life. In cities, basic public services such as water, sewage, and electricity were sufficient to meet the needs of most residents. Nevertheless, mounting pressure on these services, particularly the demand for water, rose steeply during the 1980s and was bound to increase as the urban population continued its high rate of growth. World Health Organization (WHO) figures indicated that, in the mid-1980s, the urban population had a 100-percent rate of access to safe water within the home or within 15 minutes walking distance; in rural areas the figure was 95 percent. Adequate sanitary facilities were available to 100 percent of the urban population and to 95 percent of the rural population. The rural poor, however, generally lived in substandard conditions. Homes in some villages still lacked piped water. At the bottom were the poorest of the refugees, many living in camps with minimal services. Open sewage ran through dusty, unpaved streets. During the late 1970s and the 1980s, electricity was gradually extended to nearly all rural areas.

Diet was generally adequate to support life and activity. Average daily caloric intake for adults in the 1980s was 2,968 (117 percent of the requirement), and protein intake was 52.5 grams, 115 percent of the daily requirement. Nonetheless, nutritional deficiencies of various kinds reportedly were common.

The number of health care personnel increased so that by the mid-1980s Jordan had a surplus of physicians. The "brain-drain," or emigration from Jordan of skilled professionals, apparently peaked in 1983, after which the number of physicians started a gradual climb. According to the WHO, in 1983 Jordan had 2,662 physicians. In 1987 the Jordan Medical Association reported a figure of 3,703, of whom 300 were unemployed. In the early 1980s, the medical college of the University of Jordan started to graduate students, further increasing the numbers. Fewer opportunities for physicians became available in the Gulf states and Saudi Arabia because of the recession in these countries.

In 1987 the Ministry of Health and the Jordan Medical Association, concerned about high unemployment among physicians, put forth various suggestions. These included opening more clinics in rural areas and assigning physicians to schools, colleges, and large industrial concerns.

Other health care professions showed moderate increases; the number of government-employed dentists, for example, increased from 75 to 110. Pharmacists, a profession increasingly entered by women, nearly tripled in number from thirty-eight in 1983 to ninety-six in 1987. Government-employed nurses increased from 292 to 434 over the same period (see table 4, Appendix).

In the early 1980s, Jordan had thirty-five hospitals, of which about 40 percent were state run. A number of other health facilities scattered throughout the country included health centers, village clinics, maternal and child care centers, tuberculosis centers, and school health services. In 1986 government health expenditures represented 3.8 percent of the national budget.

Medical care services were distributed more evenly than in the past. Previously most health professionals, hospitals, and technologically advanced medical equipment were located in major urban areas, such as Amman, Irbid, Ar Ramtha, Az Zarqa, and As Salt. People in smaller villages and remote rural areas had limited access to professional medical care. With the focus on primary health care in the 1980s, the WHO commented that treatment for common diseases was available within an hour's walk or travel for about 80 percent of the population. The expense and inconvenience of traveling to major urban areas did, however, hinder rural people from seeking more technologically sophisticated medical care.

The WHO reported a general decrease in the incidence of diseases related to inadequate sanitary and hygienic conditions. A reduction in the incidence of meningitis, scarlet fever, typhoid, and paratyphoid was noted, while an increase was registered in infectious hepatitis, rubella, mumps, measles, and schistosomiasis. In the mid-1980s, only one reported case of polio and none of diphtheria occurred. Childhood immunizations had increased sharply, but remained inadequate. In 1984 an estimated 44 percent of children were fully immunized against diphtheria, pertussis, and tetanus (DPT); 41 percent had received polio vaccine; and 30 percent had been vaccinated against measles. Cholera had been absent since 1981. Jordan reported its first three cases of acquired immuno-deficiency syndrome (AIDS) to the WHO in 1987.

The most frequently cited causes of morbidity in government hospitals, in descending frequency, were gastroenteritis, accidents, respiratory diseases, complications of birth and the puerperium, and urogenital and cardiovascular diseases. Among hospitalized patients, the most frequent causes of mortality were heart diseases, tumors, accidents, and gastrointestinal and respiratory diseases.

Traditional health beliefs and practices were prevalent in urban and rural areas alike. These practices were the domain of women, some of whom were known in their communities for possessing skills in treating injuries and curing ailments. Within the family, women assumed responsibility for the nutrition of the family and the treatment of illness.

Local health beliefs and practices were important not only for their implications in a family's general state of health but also in determining when, and if, people would seek modern medical care. Local beliefs in the efficacy of healers and their treatments prevented or delayed the seeking of medical care. For example, healers often treated illness in children by massages with warm olive oil, a harmless procedure but one that often delayed or prevented the seeking of medical care.

Modern medicine had made tremendous inroads, however, into popular knowledge and courses of action. People combined traditional and modern medical approaches. They sought modern medical facilities and treatments while simultaneously having recourse to traditional health practitioners and religious beliefs. Infertility, for example, was often dealt with by seeking the advice of a physician and also visiting a shaykh for an amulet. In addition, traditional cures such as "closing the back" were used. In this cure, a woman healer rubbed a woman's pelvis with olive oil and placed suction cups on her back. This acted to "close the back"; an "opened back" was believed to be a cause of infertility.

The acceptance of modern health practices and child care techniques was closely related to household structure. A study by two anthropologists noted that younger, educated women encountered difficulties in practicing modern techniques of child health care when they resided in extended family households with older women present. The authority in the household of older women often accorded them a greater voice than the mother in setting patterns of child care and nutrition and in making decisions on health expenditures.

Discrimination on the basis of gender in terms of nutrition and access to health care resources was documented. In a study conducted in the mid-1980s, the infant mortality rate for girls was found to be significantly higher than for boys. It was also noted that male children received more immunizations and were taken to see physicians more frequently and at an earlier stage of illness than girls. Girls were more apt to die of diarrhea and dehydration than males. Malnutrition also was more common among female children; boys were given larger quantities and better quality food. In addition, more boys (71 percent) were breast-fed than girls (54 percent).

In the 1980s, government efforts to improve health were often directed at women. In the summer, when outbreaks of diarrhea among infants and children were common, commercial breaks on television included short health spots. These programs advised mothers how to feed and care for children with diarrhea and advertised the advantages of oral rehydration therapy (ORT) to prevent and treat the accompanying dehydration. The WHO noted that the use of ORT helped lower the fatality rate among those children hospitalized for diarrhea from 20 percent in 1977 to 5 percent in 1983.

During the 1980s, the Ministry of Health launched an antismoking campaign. Posters warning of the dangers to health could be seen in physicians' offices and in government offices and buildings. Success was slow and gradual; for example, cigarettes were less frequently offered as part of the tradition of hospitality.

Social welfare, especially care of the elderly and financial or other support of the sick, traditionally was provided by the extended family. Nursing homes for the elderly were virtually unknown and were considered an aberration from family and social values and evidence of lack of respect for the elderly. Social welfare in the form of family assistance and rehabilitation facilities for the handicapped were a service of the Department of Social Affairs and more than 400 charitable organizations. Some of these were religiously affiliated, and the overwhelmingly majority provided multiple services. UNRWA provided an array of social services, such as education, medical care, vocational training and literacy classes, and nutrition centers to registered refugees.

Government expenditures on social security, housing, and welfare amounted to 8.6 percent of the budget in 1986. Social security was governed by the Social Security Law of 1978, which was being applied in stages to the private sector. As of 1986, all establishments employing ten persons or more came under the law's provisions. Ultimately the law will apply to all establishments employing five or more persons. The employer contributed 10 percent of salary and the employee contributed 5 percent, and the contribution covered retirement benefits, termination pay, occupational diseases, and work injuries. The plan was for medical insurance to be included eventually under the social security contribution. In April 1988, the Social Security Corporation covered 465,000 workers employed by approximately 7,000 public and private establishments.

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Adequate published research in East Bank society and culture remained limited as of the late 1980s. Richard T. Antoun's books, Arab Village: A Social Structural Study of a Transjordanian Peasant Community and Low Key Politics: Local Level Leadership and Change in the Middle East, describe a village and its surroundings in the northwest corner of the East Bank. Peter Gubser's book, Politics and Change in Al-Karak, Jordan: A Study of a Small Arab Town and Its District, describes a town and its environs in west-central Jordan in which tribal organization was still significant. Gubser also has published a very general book, Jordan: Crossroads of Middle Eastern Events, on Jordanian history, politics, society, and economy. More recent research studies were: Linda Layne's "Women in Jordan's Workplace" and "Tribesmen as Citizens: `Primordial Ties' and Democracy in Rural Jordan"; Seteney Shami and Lucine Taminian's Reproductive Behavior and Child Care in a Squatter Area of Amman; Nadia Hijab's Womenpower: The Arab Debate on Women at Work; Ian J. Seccombe's "Labour Migration and the Transformation of a Village Economy: A Case Study from North-West Jordan"; Lars Wahlin's "Diffusion and Acceptance of Modern Schooling in Rural Jordan"; and Laurie Brand's Palestinians in the Arab World: Institution Building and the Search for State. These works provide background to a variety of social issues in Jordan such as tribalism, health behavior, women and work, labor migration, education, and the Palestinians in Jordan. No recent work, however, deals in a comprehensive fashion with the social changes and emerging social forms in Jordan in the 1980s. (For further information and complete citations, see Bibliography).

Data as of December 1989

Jordan - TABLE OF CONTENTS