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From 2011 to 2014, when Syrians attained the status of persons under temporary protection, their healthcare needs were overseen by the so-called Directorate for Disaster and Emergency Management (AFAD). However, until this status was introduced, refugees' access to medicine and treatment was very limited, except in emergency cases. The Turkish Ministry of Health created the Chief Directorate for Migrant Health Services under the Public Health Institute, which was to take over all responsibilities related to healthcare for migrants, especially Syrians living under temporary protection. In November 2015, a circular No. 9648 entitled "Basics for providing health services to persons living under temporary protection" was issued. This made the Ministry of Health responsible for all primary and preventive care, diagnosis, treatment, immunization, environmental hygiene, reproductive and women's health, child and adolescent health, and the fight against communicable diseases, epidemics, and tuberculosis. Syrians living under temporary protection now have access to all healthcare, including mental health, in all public institutions free of charge. [1]
Due to the growing complexity of humanitarian crises worldwide and their health risks, the WHO member states established a new Health Emergencies Program at the World Health Assembly in 2016. [2] Within the "Whole Syria" approach and this new WHO program, an emergency operations team was established in Turkey, operating both from the main office in Ankara and from the emergency office established in 2013 in the border town of Gaziantep. The two main directions of this team were aimed at ensuring a coordinated response to the Syrian crisis: through cross-border operations in northern Syria from Gaziantep and by responding to the health needs of refugees in Turkey. [3]
The World Health Organization (WHO) closely cooperates with the Turkish Ministry of Health in providing culturally and linguistically sensitive health services for Syrian refugees. The WHO branch in Turkey:
- supports 7 refugee health training centers where Syrian doctors and nurses undergo workplace training and also provide health services for Syrian patients
- prepares Arabic-Turkish interpreters to serve as guides for patients at various levels of healthcare
- provides further medical education to Turkish and Syrian healthcare workers in diagnosing and treating mental health, such as depression, anxiety, and post-traumatic disorders
- provides training and staff to care for the health of the Syrian community and provide home care for elderly and disabled Syrians
Since the WHO Refugee Health Program began, nearly 2,000 Syrian healthcare workers have been trained in 7 refugee health training centers to work in 178 refugee health centers throughout Turkey. The Turkish Ministry of Health has already hired more than half of them to provide healthcare services to Syrian refugees. [4]
However, other types of hospitals also emerged in Turkey. First, there were clinics within NGOs that also provided healthcare to unregistered residents. After 2015, they did not get a new registration due to a new circular regulating the activities of NGOs, but continued to operate with the tacit consent of the state. Furthermore, small private clinics began to appear all over Istanbul around 2015. These clinics, run by Syrians and hidden in apartments and commercial buildings, operated without any attempt to register with state agencies. Many Syrian doctors worked at both types of these clinics. [5]
However, the language barrier remains the main obstacle to accessibility and provision of healthcare for Syrian refugees, which complicates even informing about existing health services and vaccination.[6] Some doctors also see the language barrier at state providers as the main reason for the operation of the mentioned unofficial clinics. This barrier is present in all aspects of seeking care, including navigating the bureaucracy of the Turkish recommendation-based system and misunderstandings and risks of discrimination by Turkish medical staff. These concerns also appeared in interviews conducted by Nihal Kayali with Syrian patients. One 38-year-old woman described a traumatic experience to her, after which she believes she was subjected to an unnecessary cesarean section, describing the suffering as "violent" and "inhuman." However, due to the language barrier, there was no way to inform the patient of the reasons for this scar-leaving procedure. Moreover, she noted that even if she would like to use the free care, she now prefers to go only to Syrian clinics where she has to pay fees but avoids the risk of another negative experience in a Turkish hospital. [7]
The COVID-19 pandemic has put even more pressure on Turkish infrastructure and basic services, which were already overloaded due to the Syrian refugee crisis. [8] However, while before 2019, Turkish hospitals were places that unregistered refugees avoided, during the COVID-19 pandemic, they opened their doors to them to curb the spread of the virus. In April 2020, the Turkish government ordered that everything related to the treatment and prevention of the virus, including protective equipment, testing, and treatment, be available for free regardless of registration status. However, some NGOs report that refugees fearing deportation to Syria still avoid state healthcare, and others fear that a positive COVID-19 test could result in their eviction or job loss. Therefore, they continue to seek care from unofficial providers. [9]
Conclusion
The Syrian refugee crisis posed significant challenges to Turkey's healthcare infrastructure. While efforts have been made by both the Turkish government and international organizations like WHO to ensure that healthcare is accessible to Syrians, linguistic and cultural barriers persist. The presence of unofficial clinics, while offering a solution, also indicates that a portion of the refugee community remains hesitant about accessing official healthcare services. The COVID-19 pandemic further strained the system but also saw some positive changes, with health services opening up to unregistered refugees to mitigate the spread of the virus. However, the fears of deportation and potential ramifications of a positive COVID-19 diagnosis indicate an ongoing mistrust in the system. It underscores the importance of continued efforts towards integration, trust-building, and addressing the specific needs and concerns of the refugee population in the host country's healthcare landscape.
[1] BILECEN, B. Temporarily protected Syrians’ access to the healthcare system in Turkey: Changing policies and remaining challenges. Migration Letters [online]. 2.1.2018,
[2] Health-emergency-to-reponse-in-Syria-WHO-Turkey.pdf
[3] Health-emergency-to-reponse-in-Syria-WHO-Turkey.pdf
[4] https://www.euro.who.int/en/health-topics/health-emergencies/syrian-crisis/health-services-for-syrian-refugees-in-turkey
[5] KAYALI, N. Syrian Refugees Navigate Turkey’s Shifting Health Care Terrain. Reliefweb [online]. 24.11.2020
[6] DEJONG, J, H. GHATTAS, H. BASHOUR, R. MOURTADA, Ch. AKIK a A. REESE-MASTERSON. Reproductive, maternal, neonatal and child health in conflict: a case study on Syria using Countdown indicators. BMJ Global Health [online]. 2017
[7]KAYALI, N. Syrian Refugees Navigate Turkey’s Shifting Health Care Terrain. Reliefweb [online]. 24.11.2020
[8] Humanitarian Situation Report No. 40. UNICEF Turkey [online]. 2020
[9]KAYALI, N. Syrian Refugees Navigate Turkey’s Shifting Health Care Terrain. Reliefweb [online]. 24.11.2020
