The Evolution and Sustainability of Environmental Health Services in the Azraq Refugee Camp, Jordan: A Qualitative Study.

The Syrian civil war displaced more than half of the Syrian population, including over 660,000 registered refugees who fled to neighboring Jordan. Environmental health services (e.g., water, sanitation, hygiene, and solid waste management) are critical for refugee health. Still, they may strain resources in host communities and must evolve in protracted crises. We studied environmental health services in the Azraq refugee camp in Jordan to identify the stakeholders and their roles in service provision, assess stakeholder communication and coordination, and evaluate sustainability. We conducted 25 interviews with stakeholders involved in environmental health service provision. We found that non-governmental and United Nations organizations had well-defined responsibilities, but the roles of donors, the Jordanian government, refugees, and the host community needed clarification. Conflicting standards and mismatched donor expectations with on-the-ground needs sometimes created challenges for coordinated and efficient service provision. The basic needs of refugees were generally met and services improved somewhat over time, but political obstacles and inadequate resources complicated the path toward sustainable services. Early incorporation of sustainability in planning and increased efforts to build the capacity of refugees to contribute and take ownership of environmental health services will likely enhance long-term environmental health service provision and development outcomes.