Earthquakes in Turkiye and northern Syria: natural disasters compound existing suffering for the most vulnerable
On 6th February 2023, earthquakes of a high magnitude (7.8 on the Richter scale)
struck southern Turkey, just 50 miles from the Syrian border. Over 60 aftershocks were recorded, including a major one measuring 7.5 magnitude. A further 6.4 magnitude earthquake struck the region again on February 20th, causing even more damage to already devastated areas. The death toll has now surpassed 50,000(1), with expectations that the true number is much higher as many have still not been rescued from under the rubble. Of further imminent concern is the freezing weather, which further endangers survivors who have now been displaced from their homes and require urgent shelter.(2)
Image: Shutterstock. Turkey and Syria Earthquake 2023. A devastating magnitude 7.8 earthquake struck the Turkish province of Kahramanmaras
What are the most affected areas in Syria?
In northern Syria, these earthquakes present an additional stressor on top of many others which include the protracted conflict, outbreaks of communicable diseases including most recently the ongoing cholera outbreak, economic crises, attacks on healthcare and related infrastructure, forced displacement and the politicisation of humanitarian aid.(3)
Among the most devastated areas are those under opposition control in northwest Syria where around 4.5 million people reside, of whom more than 60% are internally displaced from elsewhere in Syria. Risks both now and in the future include further disruption to an already devastated health system; rising poverty rates (which already exceed 90%;) increased burden on the health system due to chronic injuries and interrupted care for communicable (including the ongoing cholera outbreak, measles among others) and non-communicable diseases; protection concerns related to children including exploitation and early marriage; effects on sexual and reproductive health as well as effects on mental health.(4)
The devastating impacts of the recent earthquakes in Syria are likely to exacerbate the pre-existing healthcare pressures created by the ongoing conflict of twelve years and the COVID-19 pandemic. Prior to the earthquakes, it has been estimated that a third of hospitals within Syria are entirely non-functional.(5) It is estimated that 55 healthcare facilities were directly affected by the earthquakes.(6) Of even greater concern is that the Syrian government continued to shell areas in northwest Syria which had already been affected by the earthquakes.
The need for medical supplies and products have increased far beyond the country’s supply capacity and population’s demand. From gauze to insulin to blood products to body bags, the affected populations face further deprivation - having already battled this in the context of sanctions affecting trade and access to humanitarian aid. Furthermore, systematic targeting of healthcare facilities in the war has created severe breakdowns in efficient and effective service access and delivery.
Why was aid to northwest Syria delayed in the aftermath of the earthquakes?
More concerning is that northwest Syria is essentially besieged with, at the time of the first earthquakes, only Bab Al Hawa border crossing open to allow aid from Turkey to Syria. In 2014, the UN Security Council had passed resolutions for cross-border aid after it became clear that aid donated to Damascus (under government control throughout the conflict,) would not be distributed cross-line to areas outside of its control. This resolution had been subject to twelve monthly then six monthly renewals with challenges and vetos by allies of the Syrian government including Russia and China. As such, the initial four border crossings have dwindled to only one border crossing over that time. In January 2023, the resolution to keep Bab Al Hawa border crossing - a key lifeline for health and humanitarian aid to the 4.5 million people in northwest Syria - was passed with renewal in six months.(7)
In the immediate aftermath of the earthquakes, emergency providers - mainly the White Helmets - were left to dig through the rubble of destroyed buildings, often with bare hands and little search and rescue equipment as the virtually no aid trickled through Bab Al Hawa. This left people under the rubble for many hours leading to further injuries and suffering and the deaths of others. This compounded the trauma and neglect felt by the population in this area. It was only on 13th February 2023 that two further border crossings to northwest Syria were opened to allow essential health and humanitarian aid to enter the area - by which time, many who could have survived had died. In contrast, aid flowed to government areas through Damascus though the greatest need was in northwest Syria.
The UN has been heavily criticised for not responding more efficiently to help those who were suffering. International bodies including the UN are mandated to work with the sovereign state - something which is increasingly problematic given the complexity of current armed conflicts and crises. However, in emergencies such as this, mechanisms to deliver aid directly to areas of need are essential. Lawyers and judges have also reiterated that in the case of border crossings, there is no legal mandate which disallows the delivery of emergency aid to these areas. It is unclear how much suffering would have been averted for already vulnerable populations if international mechanisms had acted faster.
What about Turkey?
Turkey has suffered with decades of economic difficulty and instability, although there were signs that this had started to stabilise over the last 6 months. Turkey also hosts the largest number of refugees worldwide - with an estimated 3.8 Syrian refugees living within Turkey, with around 1.7 million of these in the areas worst affected by the earthquakes.(8) In both Syria and Turkey, a large proportion of people who have lost their homes will already have been displaced multiple times causing further suffering and psychological traumas
The situation in Turkey differed due to AFAD and the ability to deliver aid without the same restrictions as were faced in northwest Syria. However the response in Turkey was also criticised for a lack of timeliness and poor coordination. In addition, the state of buildings including illegal construction practices or a lack of enforcement meant that buildings collapsed more readily - whether immediately or with aftershocks - in a known earthquake susceptible zone.
What should UK health professionals do?
The United Kingdom’s Foreign, Commonwealth and Development Office announced on the 8th February following the first earthquake that the UK will send medical aid as well as vital items such as tents and blankets to meet the needs of up to 15,000 people. Medical teams including those with surgical capabilities are being deployed to provide emergency treatment in addition to a 77 person rescue team currently on the ground to help find survivors.
Urgent action is required from healthcare professionals within the UK to the evolving crisis through coordinated efforts in the provision of medical supplies which are rapidly depleting in the region. Some individuals have started campaigning to hospital trusts to gather equipment to be sent to the region. The essential needs will be fuel, vital medications, surgical kits, orthopaedic supplies as well as management of infectious diseases outbreaks such as cholera. Financial aid to trusted organisations would enable the purchase of materials and supplies within Turkey and Syria which are locally available.
The UK has a strong network of healthcare professionals through its Royal College membership which have previously written statements in response to the war in Ukraine. Given the urgency of this crisis, we call on the Academy of Medical Royal Colleges and the individual colleges including the RCP, RCS, RCGP and all others to issue statements of support, and to consider ways in which they can directly assist in this emergency, whether it be with financial aid, direct assistance from medical professionals or other remote support.
The Syrian British Medical Society has listed a range of easy actions that can be taken by UK healthcare professionals here.
reliefweb.int. (n.d.). Syria/Turkey Earthquakes Situation Report #7, March 8, 2023 - Syrian Arab Republic | ReliefWeb. [online] Available at: https://reliefweb.int/report/syrian-arab-republic/syriaturkey-earthquakes-situation-report-7-march-8-2023.
Syria earthquake aid held up as millions suffer in freezing conditions. (2023). The Guardian. [online] 13 Feb. Available at: https://www.theguardian.com/world/2023/feb/13/syria-earthquake-aid-held-up-as-millions-suffer-in-freezing-conditions.
msf.org.uk. (n.d.). Syria-Turkey earthquakes. [online] Available at: https://msf.org.uk/issues/syria-turkey-earthquakes [Accessed 14 Apr. 2023].
Geddes, L. 14/02/2023. 5 ways in which earthquakes can threaten our health. [online] Available at: https://www.gavi.org/vaccineswork/5-ways-which-earthquakes-can-threaten-our-health.
reliefweb.int. (n.d.). Türkiye and Syria: IRC warns of worsening public health crisis in northwest Syria following earthquake - Syrian Arab Republic | ReliefWeb. [online] Available at: https://reliefweb.int/report/syrian-arab-republic/turkiye-and-syria-irc-warns-worsening-public-health-crisis-northwest-syria-following-earthquake [Accessed 14 Apr. 2023].
Doctors Without Borders (2023). Earthquake in Turkey and Syria: What is MSF doing? [online] Doctors Without Borders - USA. Available at: https://www.doctorswithoutborders.org/latest/msf-responds-overwhelming-medical-needs-following-earthquakes-turkey-and-syria.
press.un.org. (n.d.). Adopting Resolution 2672 (2023), Security Council Renews Cross-Border Aid Operations into North-West Syria for Six Months, Requests Special Report on Humanitarian Needs | UN Press. [online] Available at: https://press.un.org/en/2023/sc15168.doc.htm.
UNHCR (n.d.). Türkiye-Syria earthquake. [online] UNHCR. Available at: https://www.unhcr.org/uk/turkiye-syria-earthquake.html.