The dozens of bustling people and the swirling dust make it hard to see very far down the main street that runs through Zaatari, the largest Syrian refugee camp in Jordan. The road is lined with ramshackle stalls made of corrugated steel, pieces of aluminum and planks of wood. These little shop stalls display plastic-mannequin heads modeling hijabs, piles of fly-covered vegetables and stacks and stacks of World Food Program boxes. “Not for sale” read the sides of the boxes, but here on the street their contents are spilled out, sorted, and sold. There is a mechanic shop where men are welding and tinkering. There is a barber. There are several restaurants. Young boys push wheelbarrows full of things they have purchased or things they have received from the UN. Shopkeepers yell prices at the passers by. They call it the Champs-Élysées, this street full of shops and people, this marketplace where thousands of displaced Syrian refugees strive for a bit of normalcy by selling goods, bartering, and chatting with neighbors.
The reproductive health clinic stands just off of this street. Early in the morning, before the thick summer heat sets in, the women step through the gate that divides the clinic from the chaos of the Champs-Élysées. Sometimes men wander in.
“No men allowed!” shouts the midwife through the open door of the portable tin building, or “caravan,” that houses the clinic. “No men! This clinic is only for women!” she shouts, waving her arms wildly back and forth.
Three caravans belong to the clinic. One serves as a makeshift waiting room for the dozens of women waiting to be seen. The second caravan houses a desk, an exam bed and a tiny bathroom. It is here that the midwife registers each of the women, gives out birth control, pregnancy tests, and consults on breast feeding. If women need to see a doctor for any reason, if, for instance, they are pregnant and need an ultrasound, the midwife sends them on to the third caravan where a doctor sits at a desk next to an exam table with an ultrasound machine powered by a generator. All of the staff at the clinic are Jordanian.
I spend most of my days working in the little clinic with the midwife.
“They call me ‘Mama Munira’,” she tells me, on my first day. “Sometimes they tell me they feel like my children, but sometimes they are very angry with me because I cannot give them what they want. It is very hard work.”
I hear tenderness in her voice as she speaks of the refugees. Sometimes the tenderness turns to anger when the women cluster around her door, fighting to be seen first. Or when they peek through the windows as she examines a patient.
“It cannot be this way,” she says. “How can I have a proper conversation with a patient if there are so many others listening and watching? The patient must have privacy.”
Exasperated, she tries to create an ordered system. One of the Syrians, a former patient, is in charge of keeping track of the women in the order they came through the gate, and directing them to wait in the caravan behind the clinic until it is their turn.
I assist Munira each day by helping her take down patient information and counseling the women on how to properly take their birth control pills. Sometimes the women laugh because my Arabic spelling is not very good and they have to correct me when I write their names. They want to know who this ajnabieh, or foreigner is. I explain that I am a medical student volunteer from America. I tell them that I grew up in Jordan, just a few kilometers from where the camp now stands.
Our first patients today are two sisters, each carrying a baby on her hip. They are dressed in black robes and black head coverings with silver sequin detailing on the edges. They smile shyly at Munira as they explain to her that they have come for some type of birth control. I ask them for their refugee cards. Each produces a little white card with a serial number on it. These cards allow them access to food rations, housing, and free healthcare and medications in the camp. They also serve as an identification card, made necessary by the fact that many refugees have lost official documentation in the chaos leaving Syria and entering Jordan. Munira pulls out a glass case that shows the different birth control products she has on hand. She points to each one of them and explains how they work. She points out the IUD, the DepoProvera injection, the two different types of pills and the package of condoms.
The sisters decide that they would like to use the condoms. They begin to giggle as Munira asks them if they know how to use them. As the giggling continues, she unwraps a condom and demonstrates its use. They promise to go home and explain it all to their husbands. I give each of the women a blue card with their names, serial numbers, the date, and the item they received from us. If the women return to us, they can give us this card and we will know what form of birth control we have given them in the past and that they have already been counseled on its proper use. When the two sisters leave us they are still giggling a little.
The next patient is a pretty girl of 16. Her hijab perfectly matches the teal of her outer robe. Her makeup is immaculate. She has been married for a little more than a year. She has one baby at home and has come today for a pregnancy test. She is one of many teenage girls in the camp who are wives and mothers.
“Ya habeebti (oh, my darling),” says Munira to our patient, “Do you want another baby when you have one so young at home?”
The girl shakes her head. “No, but my husband wants one.”
When asked, the Syrian women tell me that marriage between the ages of 15 and 18 is common and expected in Syria. They also say girls are married even younger in the camp. Here, the social structure that existed in Syria is almost entirely broken down. In the midst of a fragmented society, women are not surrounded by a large protective extended family. They live in very close quarters to men who are not related to them. There is little security in the camp, and much fear of rape. Therefore, many parents feel that they need to protect their daughters by marrying them off as soon as possible. Because the family’s former social structure has been broken, the family may no longer have the option to marry a girl to a relative or someone they know well.