Jordan

2.8.2.1 Geography

Jordan is situated within the Middle East, bordered with Syria, Iraq, Israel and Saudi Arabia and covers a territory of 89,328 kilometres squared (UNDATA, 2017). It is predominately a desert plateau with temperatures that reflect this demographic of mild winters and hot summers. It is home to the Dead Sea, the lowest point on earth, resting at 431 metres below sea level (Central Ingelligence Agency, 2017). The geographical site of Jordan is documented as being inhabited since the Stone Age and hosts some wonders of ancient civilisation including the UNESCO World Heritage site of Petra. Yet the Jordan of today is very much a modern land.

2.8.2.2 Demographics and population

The population of Jordan is 7,505,000 (UNDATA, 2017), although this is a variable figure due to the influx of refugees from Syria over the past few years (Central Ingelligence Agency, 2017). Of this population 83 percent live in urban areas, principally because the

55 country is largely desert (World Health Organisation, 2016a). Nearly half of the population is concentrated in the capital city of Amman and more than 70 percent are reportedly under the age of 30 (United Nations, 2017)with 33.7% aged 0-14 years of age and in contrast over the age of 60 making up only 5.5% of the population (UNDATA, 2017) . The population in Jordan has steadily increased due to a fertility rate of 3.3% (UNDATA, 2017) plus the movement of refugees driven by regional crises which has resulted in many seeking refuge in Jordan. Such mass population movement has brought with it many challenges, in particular the provision of healthcare and has impacted on the social and economic makeup of a country. Despite these challenges, the past ten years have been a period of successful educational and health reforms in Jordan (The World Bank, 2017c). One of the major challenges facing Jordan is a scarcity of water (United States Library of Congress, 2006), due to natural water sources diminishing making it one of the most water deprived nations in the world (World Health Organisation, 2017b).

The population of Jordan is mainly Arab, with a minority population (2%) of Armenian and Circassians. The official language is Arabic, spoken in various dialects. Jordan is unique within the Middle East as English is widely spoken as a second language. The main religion is Sunni Muslim with a minority population (2.2%) of Christians (Central Ingelligence Agency, 2017).

Jordan is classified as an upper middle income country where life expectancy at birth is 72/76 (male/female) (World Health Organisation, 2017a), which has been steadily growing over the past decades. Neonatal mortality is recorded as being 11 deaths per 1,000 live births with under 5 mortality standing at 18 deaths per 1,000 live births (World Health Organisation, 2016a), making it one of the lowest in the region.

Tourism is essential to the Jordanian economy, with many being attracted by the large number of ancient sites and antiquities. This is of particular importance as Jordan has no natural resources and limited other exports (United Nations, 2017).

2.8.2.3 Healthcare provision in Jordan

Health expenditure per capita in Jordan has been placed at being 61 US dollars (2014) (World Health Organisation, 2017a). The health workforce as per 2016 data stands at being 22.2 physicians, 20.7 nurses and midwives, 7.1 dentists and 13.5 pharmacists per 10,000 population (World Health Organisation, 2016b). This puts Jordan as a leader in workforce

56 per capita in the region. Healthcare in Jordan is delivered by three main providers (Al Hadidi, 2014);

1. Public sector which consists of the Ministry of Health (MOH), the Royal Medical

Services (RMS) and two university hospitals; the Jordan University Hospital (JUH) and the King Abdullah the Second University Hospital (KAH). The MOH has overall responsibility for the maintenance of public health, supervision of public and private health sectors, the management of medical training and the maintenance of health insurance programme. Primary, secondary and tertiary care services are provided by the MOH (31 hospitals, 375 primary care centres).

The RMS is mainly responsible for the provision of secondary and tertiary care with 12 hospitals accounting for 20% of hospital beds (2013) in Jordan. The healthcare

responsibilities of the RMS predominately cover military (active and retired) and security personnel and their families. Their hospitals are known for providing

particularly specialised treatment and high quality care. They are also well versed in the provision of field hospitals. The university hospitals take patients from other sectors, provide care for university employees and their dependants and are teaching centres (Al Hadidi, 2014).

2. Private sector. Like the public sector, they provide primary, secondary and tertiary

services through a number of hospitals (33% of all hospital beds), clinics and centres. They are strongly high tech focused and attract many from medical tourism (Al Hadidi, 2014).

3. Not for profit organisations including the United Nations Relief and Welfare Agency

(UNRWA) who are responsible for the provision of all aspects of primary healthcare to Palestinian refugees and assists them in navigating to secondary and tertiary care. The King Hussein Cancer Foundation (KHCF) provides comprehensive care to Jordan but also to other countries in the Middle East (Al Hadidi, 2014).

In 2012 the WHO reported the 10 main cause of death in Jordan as being; ischaemic heart disease, stroke, diabetes mellitus, road injury, hypertensive heart disease, kidney disease, preterm birth complications, congenital anomalies, lower respiratory infections, colon and rectum cancers with the top two leading the ranking for the past 12 years (World Health Organisation, 2015a). Non communicable diseases are clearly increasing and becoming a new focus to be addressed.

57 As Jordan is a relatively small country, which not only has limited natural resources, it also, like many other countries has limited human resources too resulting in a shortage of healthcare professionals (Al Hadidi, 2014).