costs were slightly higher than those paid by refugees outside camps. A similar pattern is evident for IDPs, as well. Almost all of their visits are to government-run hospitals or doctors in private clinics (which are outside camps), suggesting that camp residents incur significant costs to treat more serious health issues, but not for preventive care.<sup>11</sup> More than 97 percent of Syrian refugee households in the Jordan sample reported that a family member had visited a health facility or provider in the last year. Among camp households, more than 80 percent of the most recent visits were to hospitals, whereas outside camps, refugee households sought care in hospitals (40 percent), primary health clinics, and private clinics. In the Jordan sample, refugees outside camps reported using public (41 percent) and private (39 percent) health care providers. In contrast, inside camps in Jordan, refugees said that they mostly use health care facilities provided by the UN or a nongovernmental organization (NGO). Out-of-pocket costs (doctor’s fees, diagnostics, and other expenses) related to the last visit varied greatly: almost all camp respondents reported having incurred no costs, whereas three-fourths of out-of-camp respondents reported paying, on average, JD 60 (Jordanian dinars), and one-fourth reported incurring no out-of-pocket costs. Camp residents were also more likely to report receiving assistance from someone outside their household to cover the costs of the visit, with two-thirds reporting receiving help, primarily from the UN and NGOs, compared with only one-third of out-of-camp residents.

Our survey included questions about perceived changes in service provision, asking respondents to compare the overall quality of services in 2010 and 2015. The analysis compares two similar individuals living in slightly different localities in terms of density and describes whether those living in areas relatively more affected by the influx are more likely to say that health services have worsened. One concern is that Syrian refugees or IDPs might choose a location based on the quality of service provision, sorting into localities that would have experienced relative improvements even without the influx. If this were the case, estimates would be biased toward zero, even if the influx has negatively affected the provision of services. All specifications account for differences in population size, in an attempt to proxy for characteristics that would be associated with the different trends. In Kurdistan, it is also possible to account for differences in the structure of service provision, including information on the use of public health services in 2012. Despite the large overlap in the use of private and public health providers, we find no evidence that the influx negatively affected perceptions about health services in 2015 compared to 2010 (tables 1-3).

# **5. Education Services**

Overall enrollment rates among Syrian children aged 5-15 are highest in our Jordan sample (figure 4). In Jordan, roughly two-thirds of all school-age refugee children are enrolled in schools.<sup>12</sup> In Kurdistan, a similar share of refugee children living in camps is enrolled, while enrollments are much lower among the out-of-camp population. Among IDPs, girls attend school at lower rates than boys, both in camp and non-camp settings.

> 11 Irregular payment of salaries to public sector health workers has also affected the delivery of health services in Kurdistan.

> 12 Our survey coincided with the announcement in August 2016 that all children in Jordan under age 18 are allowed to enroll in school. This rescinded a provision barring any child who was out of school for three years from returning to school.

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