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Providing care under canvas in Turkey and Syria

Providing care under canvas in Turkey and Syria

Two months after earthquakes razed south-eastern Turkey and north-western Syria, British GPs are among the aid and humanitarian workers on the frontline. Sally Howard reports

More than 50,000 people have died from the two major earthquakes that hit south-eastern Turkey and north-western Syria in early February this year.

The largest for many years in the region, the earthquakes measured 7.8 and 7.5 on the magnitude scale and centred around the southern Turkish cities of Gaziantep and Kahramanmaraş. 

In the three weeks that followed, more than 10,000 aftershocks were recorded, razing buildings across a swathe of the region – including parts of Syria under the control of anti-government rebels.

An estimated 2.2 million people have been displaced across both nations, and their medical needs are huge. Many are suffering from immediate trauma, respiratory illnesses, and mental health problems. 

To aid recovery efforts and support victims, British volunteer and military GPs have travelled to the region, mainly Turkey, where healthcare facilities have either been destroyed or are unsafe to access and physicians working in the Turkish universal healthcare system are overstretched. 

British GPs on the ground

Dr Bryony Pointon, a locum GP from Chichester, is one of the volunteers. She is at a non-emergency ‘type 1’ field hospital in Türkoğlu in Gaziantep, which is run by the NGO UK-Med. There are 18 NHS workers volunteering at the tented polyclinic alongside a Turkish emergency response team. 

Speaking to Pulse between shifts, Dr Pointon – who has also worked with UK-Med in the disaster emergency response in Ukraine – says that the unique challenge of the earthquakes is the lack of infrastructure. The reason why a field hospital had to be set up in Gaziantep is because the local hospital and its equipment, including X-ray and diagnostic equipment, had been damaged. 

‘When we are deployed as humanitarian doctors, we usually take over local buildings or hospitals,’ she says. ‘However, because of the effects of the earthquake and risk of aftershocks, no buildings are safe to enter, so we have had to operate fully in tented conditions.’ 

Dr Pointon says that UK-Med trains medical volunteers in such conditions, ‘but there are definite challenges, not least the lack of privacy for sensitive patient consultations’. She provides care to around 100 patients a day, many of whom are parents worrying about their children’s health.

‘We are seeing a lot of coughs, colds and diarrhoea as well as patients who cannot get access to medication such as insulin, as it is trapped inside their homes, which are not safe to enter,’ says Dr Pointon. She adds that additional British GPs are soon to arrive at the field hospital but that the aim is to hand over the facility to the Turkish healthcare system in the coming weeks.

An MOD-run ‘type 2’ field hospital, staffed by troops from 16 Medical Regiment and the RAF’s Tactical Medical Wing, operates alongside the non-emergency field hospital in Gaziantep. It comprises an operating theatre, high-dependency unit and beds for in-patient care. 

Lt Col Kate Clay is a general medic from the MOD’s 16 Medical Regiment, who arrived in Türkoğlu a week after the earthquakes. 

‘A lot of the health needs in the community are due to their living conditions following the devastation of the earthquakes, such as infected wounds requiring debridement, infectious diarrhoea, scabies and respiratory tract infections,’ she says. ‘There has also been a reduction in maternal care and deterioration of chronic health conditions, such as hypertension, diabetes, COPD and asthma due to loss of medications, medical infrastructure and clinicians.’

Two hundred kilometres west of Gaziantep, in the Turkish port city of Iskenderun in Hatay Province, the general hospital collapsed, killing tens of patients. 

From a camp in the province, Dr Shirley Smith, a retired British GP volunteer with disaster response charity RE:ACT, tells Pulse that she arrived there in the immediate aftermath of the earthquakes.

As the local hospital was inaccessible, Dr Smith says that her role was to support the humanitarian effort, supplying food, water and shelter and treat immediate trauma.

‘We have seen lots of distressed people and people without homes who are living in tents that are being provided by the Turkish state,’ she says. ‘Food supplies and water supplies are sufficient and [the state] is providing medical care, with charities helping out until Turkey can manage on its own.’ 

Dr Smith adds that even though two months have passed since the earthquakes, locals and aid workers still prefer to live in tents because of the risk of aftershocks.

Dr Pointon says that the rise in temperatures after the earliest days of the aftermath, when temperatures plummeted to -7 degrees overnight, has been helpful for tent-dwelling survivors. However, she worries about the medium-term health impacts of living in these environments.

With semi-permanent shelter slow to come, many of the millions of displaced survivors, who include 1.7 million Syrian refugees who were living in southern Turkey, have fled to other regions.

‘Hygiene is a challenge in tented encampments, making the spread of infectious disease a constant risk. There will be long-term mental health issues in the population as well, which we’re only just beginning to see in the psychological first aid we are able to do.’

Helping from home

British GPs are also helping those affected by the earthquakes from the UK.

GP partnership Modality has encouraged staff and patients to donate what they can to support the earthquake victims. Their funding drive raised £920 for the Disasters Emergency Committee appeal to help with first response and emergency shelter. It has raised £88 million so far.

Meanwhile, Dr Amir Khan, a Yorkshire GP and best-selling author of The Doctor Will See You Now, announced that he would donate his performer fee and ticket sales income from his six-date May ‘Doctor in the House’ tour to victims of the Turkey-Syria earthquake.

Syria: A tougher terrain

A greater issue for medical and emergency responders has been Syria, particularly reaching the rebel-held northwest where healthcare infrastructure has collapsed and border access routes into the region from Turkey are controlled by President Bashar al-Assad of the Arab Socialist Ba’ath Party.

Speaking in Aleppo in February, Dr Richard Brennan, regional emergency director of the WHO Eastern Mediterranean Region, said that Syrian survivors were of principal concern; while humanitarian aid and healthcare responses were functioning in Turkey, ‘only 51% of Syria’s healthcare services are fully functioning, and a further 25% are only partially functioning after 12 years of civil war [in Syria]’.

Prior to the earthquakes, Syria was suffering outbreaks of measles and cholera as well as high levels of Covid circulation. Data is poor on the level of healthcare access in north-western rebel-held areas, which include north-western Aleppo, northern Hama and Latakia governorates, where healthcare is principally provided by NGOs in mobile healthcare units. 

Médecins Sans Frontières (MSF) has nearly 500 staff members working in the affected regions of north-western Syria and had been treating patients in the cholera outbreak when the earthquake struck. The health NGO has launched mobile clinics in Jinderis, Aleppo governorate, to care for displaced people and has supported 32 hospitals with distributed emergency kits, trauma kits, medical supplies and laboratory equipment, medicines, laboratory and medical consumables. 

MSF is also supplying psychological first aid to survivors. In February, the NGO announced that two of its medical staff members had been found dead under the rubble.

UK-Med is looking for staff for overseas postings. Click here to learn more