SAN FRANCISCO/NEW YORK - Al Ameen, a 33-year-old Iraqi refugee with hemophilia A, a genetic disorder that prevents proper blood clotting, has been living in Jordan awaiting medical care in the United States for two years. His condition is so advanced, his doctors have told him, that only a handful of facilities in the world can treat him.
Already worried that his application would not be approved in time to get the treatment he needs, the United States' four-month halt of the resettlement of refugees has convinced him he will never be accepted.
"I'm going to die here by myself," Al Ameen said in a phone interview on Sunday. "Where do people expect all the refugees to go? We have nowhere to go."
President Donald Trump's executive order last Friday has sowed panic and uncertainty among refugees who need urgent medical care, some of whom had prioritized applications, according to aid workers.
Al Ameen, who asked that his last name not be disclosed because he fears attacks on his relatives still in Iraq, said his condition has deteriorated in recent months. He lives in Jordan alone, is barely able to move and is covered by bruises.
The four-month U.S. ban on accepting refugees could mean as many as 800 people needing medical treatment will be denied entry, said Karen Monken of HIAS, a Maryland-based refugee assistance organization formerly known as Hebrew Immigrant Aid Society. Before the halt, about 200 refugees with significant medical issues were being resettled in the United States each month on average, she said.
Trump administration officials say the 120-day ban is temporary and needed so that a new vetting system can be put in place, which they say will prevent terrorist attacks. The order singles out Syrian refugees and suspends their admission until "sufficient changes have been made" to the refugee program. The executive order allows exemptions on a case-by-case basis.
The White House did not immediately respond to a request for comment on refugees in need of urgent medical care.
DOCTORS' APPOINTMENTS MADE
Under the system in place before the temporary halt, after refugees register with the United Nations and undergo initial assessment and interviews, the strongest candidates are referred for resettlement, aid workers and U.N. officials said. Those referred to the United States tend to be the most vulnerable - including single mothers, children and people with medical conditions that require sophisticated treatment.
U.S. State Department guidelines provide that refugees with serious life-threatening medical conditions can move to the front of the line for expedited processing. The fast-track process from referral to arrival in the United States typically takes around eight to ten weeks or several months.
The normal processing time for refugees is between 18 to 24 months, according to the State Department. Lawyers say individual refugee cases, though, can often drag on for years longer.
HIAS' Monken said her organization had been expecting the arrival of several refugees with medical conditions to the United States in the coming weeks who had already started planning their doctors' appointments and finding apartments.
One Syrian woman in her 20s, who is deaf and mute, was supposed to arrive in New York in early February and her case is now on indefinite hold, Monken said. An Iraqi family with a 5-year-old son who has congenital heart disease was also due to arrive in Michigan in coming months.
"We see intense medical needs, especially from Syrians, because their trauma is so fresh, including recent shrapnel wounds and lost limbs," said Monken.
Officials at the United Nations agency that handles refugees, UNHCR, are still trying to understand the breadth and implications of the executive order. The UNHCR said it could not provide a specific number of how many refugees with medical needs would be affected by the U.S. ban.
UNHCR's Larry Yungk, a senior resettlement officer in Washington, said they are speaking with State Department officials and trying to learn which cases might be exempt from the ban.
"There are still a lot of unknowns," said Yungk.
Since the halt was announced on Friday U.N. officials and attorneys for refugees have also worked to identify emergency cases that could be sent to other countries. But the prospects are not promising.
Canada and several European nations where U.N. officials would normally reroute cases, including Sweden, Norway and Germany, have already taken record numbers of refugees in recent years. The Minister’s Office for Immigration, Refugees and Citizenship in Canada did not immediately respond to a request for comment.
"We've informed (the State Department) that there's limited capacity to resettle these other cases," said Yungk, the UNHCR official. "There's no way to compensate for all the U.S. placements."
'LOST HOPE' FOR DAUGHTER
One Syrian mother, who requested anonymity for fear of retribution against her family, said in a telephone interview on Sunday that she had completed interviews with UNHCR and hoped her 15-year-old daughter would be accepted for resettlement and surgery in the United States.
She said the girl, who was also born with a birth defect, was imprisoned in Syria by government forces with other children four years ago. The girl was tortured, leaving her with severe injuries to her hands and jaw, according to her mother.
She was hospitalized in Jordan and received hand surgery there but the surgery made her condition worse, her mother said. The girl lost much of the movement in her hand and now needs a more complex operation.
"I've lost hope that I'll be able to get treatment for my daughter," said her mother.
Another refugee needing urgent U.S. medical care is Mohammad Alkhaled, a six-year-old Syrian boy living in Jordan, according to Jayne Fleming, a New York-based lawyer who works with refugees. Fleming said she was working on getting the boy expedited resettlement in the United States before the halt.
In October, Alkhaled was diagnosed with Ewing Sarcoma, a type of cancer that forms in bone or soft tissue. Earlier this month, Fleming contacted David Tishler, a pediatric oncologist at Children's Hospital Los Angeles and asked him to review scanned copies of Alkhaled's medical records.
"Where he is they have very little experience treating cancer, they don't have the resources," said Tishler. He said that particular strain of cancer requires a year of intensive chemotherapy in addition to surgery and radiation, which is extremely expensive.
In cases where the disease is localized, patients with the full course of treatment have a 70 to 75 percent chance of being alive in five years and many survive for much longer, said Tishler.
"Without getting additional therapy, he is going to die," Tishler said.
(Additional reporting by Bushra Shakhshir in Amman; Editing By David Rohde and Mary Milliken)