“DÜNYA DOKTORLARI GROWING SOLIDARITY IN TÜRKİYE AND SYRIA AFTER DEVASTATING EARTHQUAKES”

Months after the devastating earthquakes that hit Türkiye and Syria on FEBRUARY 6, 2023, Dünya Doktorları (DDD)/Médecins du Monde (MdM) Türkiye continues to stand in solidarity with earthquake-affected people in the region, fighting for their right to health and access to humanitarian assistance, despite insufficient funding.

Seven months after the massive earthquakes struck southeastern Türkiye and northwestern Syria, citizens continue to need urgent humanitarian assistance to cope with its brutal aftermath. Nearly 60,000 people were killed and 5 million internally displaced as a result of the earthquake.

In Türkiye alone, 156,321 buildings were affected by 25,000 aftershocks from earthquakes measuring 7.8 and 7.6 on the Richter scale. According to World Bank figures, material losses are estimated at more than 34 billion dollars, equivalent to 9% of Turkey’s Gross National Income.

The town of Afrin, on the other side of the Syrian border, was one of the hardest hit cities in Syria. In addition to 7,400 buildings in the predominantly Kurdish town, 32 hospitals and 50 health facilities belonging to various NGOs that had to suspend their activities in the region were also damaged by the earthquake.

In the days following the February 6 earthquakes, one of the deadliest of the last century, many countries rushed to help the disaster victims by sending rescue teams and humanitarian aid. However, it seems inevitable that, in addition to the aid in the days following the disaster, the affected areas will continue to be supported with reconstruction and health services in the following months.

HUMANITARIAN ASSISTANCE to 15,000 people IN four months

In this context, the work on the ground by the doctors of DDD/MdM Türkiye, chaired by Hakan Bilgin, is of great importance. Seven months after the earthquake, the needs of the affected population are still great, while international funding to mitigate the effects of the earthquake is dwindling. “We are trying to help as many people as we can, but the funds and resources we have are very limited,” says Mustafa, one of the organization’s doctors.

Mustafa explains that a significant part of the work of an NGO, such as DDD/MdM Türkiye, is driven by donations and funding, so the biggest challenge they face at the moment is their dwindling main source of funding. But despite the challenges, DDD/MdM Türkiye’s mobile medical units have been able to provide health care to nearly 15,000 people in four months.

“It is disappointing that we are not reaching our potential due to the lack of necessary funding, so we cannot offer more,” Mustafa adds.

However, DDD/MdM Türkiye itself was also directly affected by the earthquake. The organization lost four staff members in the earthquake: Syria Program Coordinator, a laboratory technician, a security guard and a midwife. Those left behind had to suffer psychologically and physically, while the DDD/MdM Türkiye’s office in Antakya, located in one of the hardest-hit cities in Türkiye, was badly damaged.

Despite the challenges and risks, DDD/MdM Türkiye offered all the tools at its disposal to facilitate rescue and relief efforts. In addition to its own medical team, it also received support from volunteer and trainee doctors and nurses, as well as from other country offices of the Médecins du Monde International Network.

Türkiye IS one of the world’s largest refugee HOSTING COUNTRIES WITH nearly 4 MILLION REGISTERED refugees. In Istanbul alone, ACCORDING to OFFICIAL data, there are an ESTIMATED 640,037 IRREGULAR or undocumented MIGRANTS.

Due to the high number of staff working for DDD/MdM Türkiye, a new accommodation center had to be opened in the Altinozu district of Hatay. While the immediate needs of those affected by the earthquake have been met through mobile medical units and a safe space, the organization warned of the critical state of sanitation services in the region and the potential for post-earthquake issues such as the spread of infectious diseases, the challenges faced by pregnant women, psychological needs and the increased risk of community-based violence. In this sense, an area for psychological and gynecological services was set up to ensure the safety of women and children, as 25,000 births were expected in the affected areas of Türkiye in the month following the earthquake, although this is not always easy to control.

DDD/MdM Türkiye’s efforts and hard work have yielded significant results. At the primary health care level, the organization has conducted 16,028 medical examinations, providing 92% of patients with the necessary medication. Of the people served by the organization, 63% are women and 25% are refugees. In addition, due to the success of its earthquake response, DDD/MdM Türkiye is currently co-leading the Health Coordination Group with the World Health Organization (WHO).

PSYCHOLOGICAL support

In terms of psychological assistance, so far, DDD/MdM Türkiye has provided mental health and psychosocial support services to 5,706 earthquake survivors. The most common problems experienced by earthquake survivors supported by the organization’s psychologists and clinical psychologists include earthquake trauma (50%), acute stress (15%), behavioral disorders (5%) and depression (5%).

DDD/MdM Türkiye is also providing services in earthquake-affected areas of Syria such as Afrin and Idlib with two mobile health units and setting up a level 3 field hospital. DDD/MdM Türkiye was one of the first humanitarian organizations to respond to the earthquake in Hatay and one of the most active.

However, even though the whole world came to the aid of the earthquake victims, Syria did not receive as much aid as its northern neighbor due to the state of war in the country and the sanctions imposed on the Syrian government.

Therefore, the health infrastructure in Syria is also very fragile. Before the earthquake, the number of health workers in the country was already insufficient due to internal conflicts: Doctors and nurses had been targeted during the war and many had chosen to flee the country.

DÜNYA DOKTORLARI/MédecIns du Monde Türkiye IN refugee CRISIS

Part of the good management and work of DDD/MdM Türkiye during the earthquake is due to the organization’s extensive experience in dealing with different challenges.

The organization is also playing a key role in the protection and access to health care for refugees in Türkiye. Türkiye is one of the world’s largest refugee hosting countries with nearly 4 million registered refugees. In Istanbul alone, according to official data, there are an estimated 640,037 irregular migrants.

Many of the country’s refugees, asylum seekers and migrants live in poverty and work in labor-intensive sectors such as construction, textiles and agriculture. Many of them lack legal documentation, which prevents them from accessing basic services such as healthcare and education.

For this reason, different civil society organizations in the country provide primary health care, including sexual and reproductive health, to more than 12,000 migrants in their areas each year. DDD/MdM Türkiye focuses particularly on the social protection of seasonal workers in rural areas and irregular migrants in urban areas.

Children, as always in such conflicts and crises, are among the most affected. To this end, DDD/MdM Türkiye is developing programs to integrate them into local schools, including children with special needs.

MAIN OBJECTIVES

DDD/MdM Türkiye has set two overall goals for its work in Türkiye:

1. To provide a safe environment for refugees and asylum seekers through the protection and promotion of rights and services.
2. To increase access to health, social and legal services in accordance with the laws and regulations of the Republic of Türkiye. To this end, the organization focuses on seasonal workers’ access to primary health care, sexual and reproductive health, and mental health and psychosocial support services.

In addition to its offices in Türkiye, DDD/MdM Türkiye has eight health centers operating in northwest Syria. This allows them to monitor and control health services in the region. Located in Aleppo and Idlib provinces, these centers provide primary health care services and support primary health care, mental health and psychological wellbeing, and sexual and reproductive health. The medical teams in Syria are also tackling malnutrition, which has been present in the region due to the 12-year war, and conducting vaccination campaigns. The association has laboratories equipped to conduct PCR tests to diagnose COVID-19, especially during the pandemic.

Even before the earthquake that devastated southeastern Türkiye, Bilgin was working in Hatay to help thousands of displaced Syrians fleeing the brutal war that began more than a decade ago. DDD/MdM Türkiye was founded in 2015 and has since reached more than 35,000 people every month throughout the war in the neighboring country.

Adding to the devastation and horror of war is the desolation of this natural disaster, which has killed more than 60,000 people in both countries. There is of course sadness and concern about all this, but Bilgin refuses to be overwhelmed by these problems. “Seven months after the earthquake, while much of the international aid has been withdrawn, he knows that the people still living in Antakya (Hatay), on the Syrian border, need him and humanitarian organizations like him. This is no easy task, of course, when the financial resources and funds that ensure the continuation and effectiveness of services are dwindling. Despite a very uncertain future, the important thing is not to give up,” says Bilgin: “A minimum health infrastructure needs to be in place to meet the needs of the population.”

While there were about a dozen hospitals in Hatay before the earthquake, after the earthquake there was only a private hospital in Reyhanlı and one in Dörtyol, about 50 kilometers away. The number of homeless citizens is in the thousands. Buildings have collapsed and those still standing are so badly affected that they too are being demolished and will have to be rebuilt because they are dangerous to live in.

Seven months after the earthquake, the fear has not gone away: “In light of what happened, there is a general fear among people about the coming of summer and what winter will bring…” According to Bilgin, the problem is not only that there was an earthquake that killed thousands of people and destroyed everything, but also the aftermath. For example, insufficient water and lack of access to clean water.

Bilgin refuses to give a pessimistic picture and reflects on the potential health problems or diseases that could result from the earthquake. Given how difficult it is to access health care in the region, he and his health and logistics team are working hard to get people treated as soon as possible. “Our goal and the reason we are working so hard is to get health services here as soon as possible so that people can hold on to life,” he says.

Many doctors have died or left the city.

But the problem is not only due to a lack of infrastructure. Due to the war in Syria and now the earthquake, many doctors have left the region in search of safety, Bilgin says. There are not enough vehicles or personnel. “In this border region of Syria, before the war, there were 3.5 doctors per 1,000 people, compared to 1 in Türkiye in general and 0.86 per 1,000 in Antakya. Now the average is 0.2 or 0.3 doctors per 1,000 people. Not only has the number of medical staff been drastically reduced, but those that remain are struggling to care for patients because there is no infrastructure to do so.”

And this situation exists in Syria as well as in the affected Turkish region, Bilgin said, adding, “There was already a shortage of medical staff before the war. Many doctors and nurses died during the war, and a significant number of them had to leave the country.”

“Although the need is high, it is almost impossible to recruit doctors and health personnel due to the war conditions. This is one of the biggest challenges we face,” he noted.

Increased costs

In the face of this situation, building these infrastructures, equipping them with medical equipment and finding the right staff, both on the Syrian and Turkish side, are becoming major challenges. This is something the organization is slowly achieving thanks to the private donations it receives, mostly from the Turks themselves, who have shown great solidarity. The war between Ukraine and Russia has also caused the price of everything to rise. “Something that was worth 1,500 or 2,000 dollars before the earthquake is now worth 5,000 or 6,000 dollars. And this is not something that depends on us. This is the market, this is how the market works. If you find them (the necessary materials and equipment)! That was also a problem, especially in the first days and the first weeks…”

Bilgin emphasizes that these infrastructures are neither complex nor require high quality engineering. “What we need are small one-story buildings where we can receive people,” he says, noting that the most urgent thing for them is access to professional health workers.

UNCERTAIN FUTURE

Atalayar, together with Hakan Bilgin, had the opportunity to witness the streets of Antakya (Hatay), the destruction, the chaos, the machines used to demolish the buildings that are still standing but not habitable, the sadness in the air and at the same time the desire to rise again. “In Antakya, people are tired, lost in thought….and desperate. Their jobs and businesses have been destroyed, their savings have disappeared in an instant, their lives have been turned upside down in a matter of minutes…. And these people lost everything in one day. Therefore, they cannot see any future for now,” Bilgin said, adding that they are planning to open a school for 300 children.

Another issue that worries him the most is the children, who will grow up with the trauma of witnessing the terrible destruction caused by the earthquake and who are a generation that has experienced terrible things… For this reason, the team of DDD/MdM Türkiye also includes pediatricians and psychologists. Bilgin reminds us that the people in Antakya had a good, quiet, quality life before the earthquake, mostly upper middle class, with nice cars, nice houses, jobs and incomes, and in just a few hours, very painfully, they found themselves living in containers.

Dr. Mustafa is grateful for life; thousands of people were not as lucky as his family

The story of Dr. Mustafa, DDD/MdM Türkiye’s Program Coordinator, is a story of resistance, survival and dedication to others… While still carrying the deep scars of the war in Syria, Mustafa also witnessed the horror of the earthquake that struck Hatay on February 6 after he moved to Türkiye. His life was spent with those who needed him.

Dr. Mustafa is from Aleppo Governorate of Syria. Three years after the start of the war in Syria, like many Syrians, he moved to the border region. Like many others, he left behind a whole life to start a new one with his family. But on the morning of February 6, he, his wife and six-year-old daughter experienced the terrible earthquake in Türkiye.

As a doctor, he decided to help the most vulnerable. First, he joined DDD/MdM Türkiye’s medical operations in Syria to support the urgent needs of Syrian refugees. She started from scratch. Her second son, now one year old, was born here in Türkiye.

FIRST war, then earthquake

Despite everything, Dr. Mustafa thanks life once again. Because he knows that thousands of people are not as lucky as he, his wife and his surviving children. And he remembers other children, his daughter’s friends, their parents, neighbors, relatives, acquaintances, who are not as lucky as they are. He wonders how he will tell his daughter that her friends, the twins, are dead.

He knows that his family is safe, even though they are not together, and that he and the DDD/MdM Türkiye team have saved many people. These days, Dr. Mustafa’s different responsibilities or tasks include coordinating all the mobile units that go out every day to do field surveys to help people, analyzing the current situation on the ground, predicting possible problems and diseases that may arise according to the conditions in each area. He has been working to provide aid first to refugees/IDPs and now to those affected by the earthquake.

“After the earthquake, we first had to move to another city, we moved our families to safer places and we stayed here to support the people of Türkiye and Syria affected by the earthquake. We get up in the morning and communicate with our teams to see how the activities are going,” he tells Atalayar.

On the Syrian side, Dr. Mustafa works in 8 clinics providing primary health care. He says that after the earthquake there was an increase in trauma cases and they helped stabilize the patients and although some clinics were damaged, they were able to reopen them in a short time.

On the Turkish side, Dr. Mustafa started helping all the injured in the Antakya area shortly after the earthquake. He recalls that in the early days there were many wounded and it was a difficult time as there were not enough facilities to provide them with the necessary medical attention in the face of a disaster of this magnitude. For this reason, DDD/MdM Türkiye’s Izmir and Istanbul teams were mobilized and involved in the operations in Hatay for a while.

Like Bilgin, the Founding President of DDD/MdM Türkiye, Dr. Mustafa told Atalayar that securing funding and financing is one of the biggest challenges they face because these resources are very limited and there are so many people in need of the services provided.

“Because we are a health NGO, there are constraints and there are doubts about what we can and cannot do. But we have already proven that we have the necessary experience and will,” Mustafa says, adding that they need more resources to continue this work: “Let’s not forget that the area is in ruins and needs new facilities, even prefabricated ones, sanitary equipment, medicine and people to help them.”

Like many other professionals, Dr. Mustafa wanted to stay in the region and contribute to respond to the needs of the people there. But he explains how difficult it was to first experience this terrible disaster and then to see the whole city, buildings, hospitals, businesses, destroyed… “It is not easy but people have to be resilient and not be afraid to ask for support. There are people, including us, who are trying to support the people in the area, to be in solidarity with them, so we are asking for help and we are helping and we continue to be in solidarity with them.”

REBUILDING the CITY and LIVES

Syrian and Turkish citizens are slowly trying to rebuild their lives. Living in containers or moving to other cities is very difficult and inconvenient. Dr. Mustafa believes that people will gradually return because they are from here.

“This is something very difficult to understand, I don’t know how to explain it, I am Syrian. I had to leave my city. Now when I have the opportunity to go to Syria, I try to go every time. But it is not for me, it is for my family and my children, for their safety. It is my home, something you are attached to.”

It is really hard to listen to him describe, almost in tears, the experiences of his friends, colleagues and neighbors in Antakya who have lost everything and are now homeless, living in the temporary containers they have managed to set up.

“They are talking about the destruction of Antakya (Hatay) almost in tears, with their throats knotted, but at the same time they are determined to rebuild the city and their lives, to get back on their feet. Where will they live again, they are not thinking of moving to another city,” says Mustafa.

“As the media shows, everyone knows how the earthquake destroyed everything, how it destroyed the lives of tens of thousands of citizens, but unless you go and walk the streets and see that this place is now a ghost town, not a single building is left, everything is destroyed… you cannot really understand it. You have to survive, especially if you have a family and children… Adults can understand this, but you cannot explain it to children,” concludes Dr. Mustafa.

On the Syrian side, the ddd/MdM Türkiye team, headed by Hakan Bilgin, is working as a polyclinic in three centers. Mobile medical units go to the camps established after the earthquake; and at the same time, the field hospital, which is almost a reality and will have operating rooms and sufficient equipment to provide good health services, is nearing completion.

On the Turkish side, they have established an operations center in Antakya (Hatay) where they organize daily work, coordinate different mobile teams, provide consultancy, visit those in need, take care of children, and provide psychological support. Approximately 30 km from this command center is the Altınözü camp, built with containers and tents for the association’s staff to stay and rest.

MUST Level 3 FIELD HOSPITAL

This center, built from containers in the Syrian town of Jandairis, has an operating room, so even major surgeries can be performed.

But what is important is that more than a hundred health workers are also transported to the area. The hospital was established to provide health services to earthquake victims. Hakan Bilgin says that with the refugee crisis affecting the entire northern and northeastern Syria region, what was done was to bring hospitals together to provide better medical care.

After the earthquake, a clinical unit with a capacity of eighty beds and two operating rooms was also established as part of the field hospital.

DDD/MdM Türkiye’s three clinics in the Afrin region of Syria have between 300 and 500 consultations a day. One of the biggest problems they face is access to clean water. So they are trying to put in water tanks to have more water sources. They are drilling to find water, although it is not easy, and they are purifying the water to prevent it from being harmful to health. The facility also has a small area with washing machines for washing not only hospital gowns but also medical gowns.

Everything is very basic and in the early stages of development, but hygiene is not compromised. DDD/MdM Türkiye says that all hospitals in the region are overcrowded and they can only cope to some extent.

The central hospital in Afrin, about 20 km away, is directly supported by the Turkish government’s Ministry of Health. More than 750,000 people are currently receiving treatment there. Medical staff say DDD/MdM Türkiye’s aim is to provide people with access to healthcare and to treat as many people as possible.

One person, one story

Cemal has been working with DDD/MdM Türkiye for many years. He was in his home in Antakya with his wife and children during the earthquake. They were living on the 12th floor. They lost everything but survived. Cemal lost more than 200 friends and relatives, including his colleagues from the organization, in this earthquake.

They tell with great sadness how they got together for dinner a few days before the earthquake, took photos of that moment, and now the colleagues and doctors in that photo are no longer there, they are victims of the earthquake.

Cemal knows the area well and is a great professional. He gets emotional while telling his story, but he continues, helping others as much as he can and working hard.

Ferit is the logistics manager responsible for the Turkish region of DDD/MdM Türkiye. He went to the US in 2009 but returned to his country in 2011. Like Cemal, he has been working with the organization for many years. He remembers being at home with his wife and child on the night of the earthquake. When the shaking started and seemed to be going on, they thought death was coming. The building they were living in collapsed. They managed to get out, but they realized at that moment that their other neighbors were not so lucky.

It is heartbreaking to listen to all these testimonies. They had everything and suddenly they lost everything. They no longer know how to get out of this situation. Ferit does not hesitate to do his part in this great chaos that has engulfed the city.

Need for PSYCHOLOGICAL support

Özlem is a sexual and reproductive health consultant. She works with the DDD/MdM Türkiye team, and is responsible for pregnancy, family planning and pregnancy follow-up.

In her interview with Atalayar, she talks about the many miscarriages caused by the earthquake. Not to mention the number of women who lost their lives and babies. It is no longer just a matter of giving birth; providing the care a woman who gives birth needs in the following days is also quite complicated but vital. Moreover, their homes are in ruins. It is not easy, and there are no emergency services. Özlem, who says that there is a lot of suffering, also talks about the abuse in the camps, which is not easy to control and in which women remain silent.

They will need a lot of psychological support now and in the future. The team starts working at 8:30 a.m. after the first meeting to coordinate and organize the activities. The center also has a pharmacy, and they get the medicines they need from there. They do their work in the camp around 10:00 a.m. They also provide psychological and psychosocial support. Around 16:00, they return to the operation center and regroup, share their experiences and organize the next day’s work.

They do not forget the little ones either; that is why they have created some areas for the children to leave this experience behind and do the things they did before everything happened: playing, drawing, laughing and sharing…

In short, they support them in order to distance themselves from the reality they have to live in for a while. With the support of psychologists, nurses and pediatricians in these areas, they forget everything for a while and have fun, and they also receive the health care they need.

Doctors, nurses, psychologists, assistants, drivers, cleaners… They all do their jobs within the organization, they all act with the desire to help others and to be in solidarity with them, and each of them has their own “backpack” where they carry their personal experiences, stories, sorrows and pains. Yes, they have losses and uncertainties about what will happen in the future, but they also have the strength and willpower that comes from knowing that they are doing what they have to do.

What people here experience and witness is not easy. Everything is ruined, there are no opportunities to work, not enough resources, and thinking about the future is stressful. But at least DDD/MdM Türkiye teams are determined not to leave them alone, and this determination can sometimes change many things.