Earthquakes in Turkey and Syria – Collaboration is needed to mitigate long-term health risks

Irva Nur Sinar, MD, intern in Pediatrics 1, Ola Abbara, Consultant in Infectious Diseases and Acute Medicine, Co-Chair of Education and Training, Syrian British Medical Society, and Co-Chair, Syrian Public Health Network, UK 2, Ebru Yilmaz, Consultant in Emergency Medicine31Mid and South Essex Foundation Trust Trust, Essex, UK2Im Imperial NHS Healthcare Trust, London, UK3Turkish Ministry of Health, Gaziantep, TurkeyTwitter @cinarervanur @AulaAb

In both countries, Erva Nur Senar and his colleagues say, the response has been inadequate

The catastrophic earthquakes that struck southeastern Turkey and northern Syria on February 6, 2023 left a humanitarian crisis in its wake. As of March 1, 2023, the death toll in Turkey has risen to 45,089, and 6,000 deaths have been reported in Syria. Northwest Syria, where border restrictions have hampered search and rescue efforts. Much of the immediate devastation is evident, but without careful mitigation of it, the people of these two countries will face malign long-term damage to their health.

The repercussions of these earthquakes will be shaped by the fact that first responders and healthcare workers in both countries have been directly affected by the earthquakes. They have experienced trauma, loss and forced displacement along with the wider population, which has taken a high psychological toll. As local authorities and international actors respond to this crisis, the provision of psychosocial support – culturally and linguistically appropriate and free when used – is essential and urgent. To meet these needs, mental health and psychosocial services should be integrated with primary care, which itself needs to be strengthened in both countries. For healthcare providers experiencing impaired mental health in the aftermath of earthquakes, investing in telepsychology interventions may be a useful strategy for reaching them and providing care.

In Turkey, a country already experiencing a severe economic crisis, the immediate and long-term effects of the earthquakes on the health system will be extensive. Responding to the immediate healthcare needs of the population, including physical injuries and trauma, as well as recovering from the disruption caused by routine services will increase demand on the remaining infrastructure. Residents have raised concerns about the potential spread of communicable diseases due to the overcrowded accommodation, damaged water infrastructure (including sewage and drinking water), and interrupted food supplies. 8 This threatens the provision of healthcare services and could hinder the country’s recovery from this disaster. As such, coordination between authorities and humanitarian organizations to provide water, sanitation and hygiene, shelter and immediate health care is essential.

Relief efforts must focus on the most vulnerable, bearing in mind that some groups are at risk of being left behind. About 1.7 million (of the 3.8 million) Syrian refugees in Turkey live in areas affected by earthquakes. 9 Even before the earthquake, reports emerged of Syrian refugees facing growing discrimination and resentment. 10 Unfortunately, this current crisis has exacerbated these sentiments in some areas, Syrians reported being evicted from emergency shelters or subjected to verbal abuse. 11 Authorities and humanitarian organizations must ensure that all health care and aid provided is fair and non-discriminatory, but must also recognize special needs. who are the most vulnerable.

For Syria, these earthquakes are an additional disaster for a country that has already faced multiple and intersecting challenges in recent years, including protracted armed conflict, infectious disease outbreaks (such as the ongoing cholera and measles outbreaks), economic crises, and attacks on health care and related infrastructure, and forced displacement of large parts of the population 121,314

Northwestern Syria is one of the regions most affected by both these crises and earthquakes. This area includes about 4.5 million people living under opposition control who have relied almost entirely on humanitarian aid delivered across the border since 2014. Most of the local and international humanitarian organizations that contribute to the WHO are led by the Health Cluster that oversees and coordinates the delivery of aid to the northwest. Syria and is based in Gaziantep, Turkey – one of the provinces hardest hit by the disaster. As a result, the devastation in Gaziantep disrupted immediate relief efforts, contributing to the delay and disorganization of the immediate response.15

The use of only one border crossing for aid and relief efforts – and the fact that this was underutilized in the immediate aftermath of the earthquakes – also hampered the response.16 On 13 February 2023 only two more border crossings were opened – during which time many people died in Absence of immediate support 17 However, this emergency arrangement will only keep the additional borders open for three months. As the continuing toll of this disaster, the international community must ensure that border crossings are extended in number and duration to ensure that essential health and humanitarian aid reaches those who need it most.

The response of the authorities as well as the international community has been limited on both sides of the Syrian-Turkish border. Anger has spread in both countries over the inadequate responses to the earthquakes and there will be a need to restore confidence. Given the scale of the disaster, coordination and cooperation of relief efforts must be improved between authorities and humanitarian organizations to meet the immediate and long-term needs of those affected. Only then will people be able to rebuild and recover what they have lost.

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