Türkiye experienced several watershed events in public health in 2023, some yielding positive and others negative outcomes. The earthquakes that struck on 6 February 2023, centered in Kahramanmaraş’s Pazarcık and Elbistan districts, respectively, rattled ten other surrounding provinces, leading to what would become dubbed the disaster of the century. These two earthquakes left an excess of 50 thousand people dead, 120 thousand injured, 2 million homeless, and 5 million internally displaced. Coming closely on the heels of the COVID-19 pandemic, this catastrophe constituted the most significant public health challenge to Türkiye in 2023. According to the Risk Management Index (INFORM), earthquakes rank among the foremost risks for the country, with a potential earthquake in the Marmara region posing a potentially existential threat to Türkiye’s most populous city of Istanbul and public health at large.
Emergency situations, disasters, accidents, injuries, and both communicable and non-communicable diseases have resulted in untold numbers of deaths, disability, and healthcare expenditures in 2023. On the other hand, however, new health policies, screening programs, and government-funded initiatives aimed at preserving and improving health have had a positive impact on public health in Türkiye. Nevertheless, non-communicable diseases remain the leading cause of death in Türkiye, in line with global trends. Coronary heart disease, cerebrovascular diseases, cancer, and chronic respiratory diseases make up roughly eighty-five percent of all deaths in Türkiye. Given its global impact, the COVID-19 pandemic reaffirms the continued importance of communicable diseases in public health.
Disasters and Emergencies
Earthquakes
The two earthquakes measuring Mw 7.7 and 7.6 that struck Kahramanmaraş at 4:17 a.m. and 3:24 p.m. on 6 February were the two most impactful events of 2023 in Türkiye. These earthquakes and their aftershocks left 50,783 dead, 107,204 injured, and 301 thousand buildings either destroyed or damaged. The 2023 Parliamentary Investigation Commission Report submitted to the Grand National Assembly of Türkiye estimated the total damage to be 148.8 billion USD, corresponding to %9 of Türkiye’s GDP for 2023. The first of these two earthquakes was the most powerful to strike Anatolia since the 1668 North Anatolia earthquake and the strongest in the history of the Turkish Republic. Then, a mere two weeks later, two more earthquakes of Mw 6.4 and 5.8 struck Hatay’s districts of Defne and Samandağ on 20 February, leaving 6 people dead and another 562 injured.
Floods
Türkiye experienced a total of 8,279 weather- and climate-related natural disasters between 2010 and 2021. The most prevalent of these were storms, accounting for 2,645 incidents, followed by severe rainfall and floods with 2,486 incidents. Given Türkiye topographical conditions, floods continue to pose a significant public health risk to the country’s inhabitants. For instance, the 2023 Turkish floods of 15 March resulted in 17 deaths in Şanlıurfa and 4 in Adıyaman while an additional 3,154 individuals suffered damage to their residences, businesses, vehicles, and personal belongings. Several months later during the initial days of Cyclone Daniel in September 2023, flood claimed the lives of 6 people in Kırklareli and 2 in Istanbul.
Wildfires
Türkiye’s Minister of Agriculture and Forestry reported that 1,022 wildfires occurred in the first seven months of 2023, resulting in 6,900 hectares of damaged land. Of this area, 5,800 hectares were destroyed in just 18 wildfires, 17 of which occurred in July. More recently, the 26 October wildfire in Kastamonu’s Tosya district left 47 homes uninhabitable.
Global Warming and Climate Change
Surpassing the previous record set in 2016 for hottest eleven-month average temperature by 0.13°C, 2023 found itself as hottest calendar year on record. The EU’s Copernicus Climate Change Service announced that November 2023 had set a global record for the hottest November ever recorded, with an average surface air temperature for the month at 14.22°C, which exceeded the 1991–2020 temperature average by 0.85°C.
According to data from the Turkish State Meteorological Service, Türkiye experienced its warmest December in the past fifty-three years in 2023. The lowest temperature, −21.3°C, was observed in Van, while the highest was recorded in Sinop at 27.4°C. The average nationwide temperature for December rose 3.5°C, increasing from 4.8°C between 1991 and 2020 to 8.3°C in December 2023.
October–December 2023, Israel’s War on Gaza
Since 7 October, Israel has subjected Palestine’s Gaza Strip to an incessant carpet bombing campaign that has killed at least 37,765 people, injured or maimed at least 86,429, and trapped countless others under the rubble of destroyed buildings, many of whom are presumed dead. On 13 October, Türkiye sent eight cargo planes full of medication, medical consumables, medical equipment, and generators. Then, after receiving the necessary permissions, fifty-one containers full medical supplies and emergency generators, along with twenty fully equipped ambulances, departed from Izmir’s Port of Alsancak on 10 November on a cargo ship bound for Occupied Palestine. Gaza’s sole hospital specialized in treating cancer, the Turkish–Palestinian Friendship Hospital, itself built by Türkiye, was hit during an Israeli airstrike. The hospital has since been illegally seized by the Israeli army and used as a military base during its continued attack on the civilian population of Gaza. With the hospital no longer able to provide lifesaving services, the Turkish government began transporting cancer patients to Türkiye for continued treatment. In addition to the Syrian Civil War, the Russo-Ukrainian War, and the Second Nagorno-Karabakh War, all of which have affected Türkiye in terms of food supply, communicable diseases, and migration, Israel’s war on Gaza is a particularly precarious situation with the potential to embroil the wider region in instability and unrest.
Communicable Diseases
New Coronavirus Disease (COVID-19)
Statistics published by Türkiye’s Ministry of Health reveal that 102,174 people died from COVID-19 related complications as of March 2023, after which month no new data was published. A total of 43,801 new cases and 231 deaths were reported in January, 15,811 new cases and 95 deaths in February, and 31,054 new cases and 85 deaths in March.
Influenza
The COVID-19 pandemic had a profound impact on global health and social life from 2020 to 2021. Measures like mask-wearing, physical distancing, enhanced hygiene practices, improved ventilation, and reduced social mobility implemented during the pandemic also contributed to a decline in influenza cases. As these measures were relaxed, however, influenza cases began to increase globally. Outpatients complaining of flu-like symptoms (e.g., fever, fatigue, muscle aches, headaches, coughing, and respiratory distress) to their family physicians tested positively for influenza at increasing rates beginning in October and peaking in December. This trend is expected to decrease gradually from January to April 2024.
Figure 1 Outpatients Testing Positive for Influenza at Family Clinics
HIV/AIDS
The rise in HIV positivity poses a critical challenge in effective infectious disease management in Türkiye. From 1985 until 8 November 2023, 39,437 HIV-positive cases and 2,295 AIDS cases were confirmed through HIV screening. Of these cases, 81.5 percent were men, 18.5 percent were women, and 16.1 percent were foreign nationals of either gender. A total of 1,728 new cases were reported between 1 January 2023 and 8 November 2023, including 1,677 HIV-positive and 51 AIDS cases. Among these, 84.2 percent were male, 15.6 percent were female, and 11.6 percent were foreign nationals of either gender. Individuals aged 25 to 29 exhibited the highest number of positive cases. An upward trend in HIV-positive cases has been observed in the last decade, rising from 3,220 in 2016 to 5,591 in 2022. Public awareness campaigns, public service announcements, community health education, and efforts to enhance health literacy are needed to reverse this trend.
Accidents and Injuries
Traffic Accidents
Türkiye’s Traffic Statistics Bulletin for December 2023 reported a total of 555,668 accidents over the year, resulting in 2,984 fatalities and 354,323 injuries. Drivers were found to be at fault in 249,776 incidents, pedestrians in 25,340 incidents, vehicle issues in 3,148 incidents, road conditions in 940 incidents, and passengers in 1,754 incidents. While running red lights resulted in 7,030 fatal or injury-causing accidents, alcohol use was found to be a factor in 1,712. Excessive speed resulted in 2,208 accidents and illegal parking in 1,247. Official accident figures show that traffic accidents caused 167 deaths in Ankara, ninety-seven in Bursa, 157 in Istanbul, and 125 in Izmir. Though mostly preventable, traffic accidents continued to be a leading cause of death and disability among adolescents and young adults in 2023.
Addiction Prevention and Intervention Efforts
An integral partner in the fight against addiction, Türkiye’s Green Crescent significantly expanded its efforts in 2023. The inauguration of two new Green Crescent Consultancy Centers this year brought the total number of centers to 107, ensuring nationwide accessibility to their services across all provinces. Additionally, two 40 bed rehabilitation centers were opened in the provinces of Bursa and Diyarbakır. The Green Crescent organized numerous educational workshops, events, and competitions throughout 2023 as part of its efforts to prevent addiction in Türkiye. Among these was the Türkiye Addiction Prevention Program, in which 14 million students and 3 million adults received education on addiction prevention. Another was the Intervention to Addiction at School Training Program, the Green Crescent, which provided assistance to 6,380 students who either had used or were currently using tobacco, alcohol, or narcotics. These programs effectively supported students in completely quitting or reducing their use of addictive substances. Under the Green Crescent Life Skills Training Program, 264 facilitators were trained to lead workshops teaching students how to refuse addictive substances, make effective decisions without succumbing to peer pressure, and manage their emotions. A total 115 thousand students participated in these workshops over the course of this program. Additionally, 110 nationwide sports clubs ran programs to promote healthy lifestyles among young people and to deter them from using addictive substances.
New Developments
Family Dentistry
‘The Community “Family Dentistry” application was launched as a pilot program in Eskişehir, Karabük and Kırşehir provinces in 2022 and is expected to be widespread in 20 provinces in 2024. In this context, it aims to prevent and control tooth decay and risk factors before health problems arise. As a result of the application, approximately 10,000 children were reached in 42 family dentistry units. It is aimed to gradually implement the application in 81 provinces by the end of 2028, covering the entire population. In this context, it has become possible to facilitate access to services and to conduct regular dental check-ups for children between the ages of 0-12. Families who were informed about the applications participated in oral and dental health awareness training.
The family dentistry practice is expected to make a very positive contribution to the oral and dental health of the society with the oral and dental health services currently provided by 131 Oral and Dental Health Centers, 32 Oral and Dental Health Hospitals / Training and Research Hospitals and 820 State Hospitals under the Ministry of Health with 9,950 units and 11,588 dentists in a total of 983 units.
Hıfzıssıhha-Türkiye Vaccine and Biotechnological Product Research and Production Center
Vaccine production is a vital preventive healthcare service for all nations, crucial for immunization against infectious diseases. The COVID-19 pandemic brought to light the importance of not only domestic vaccine production but also the availability of medical supplies for public health, as evinced by reports of countries seizing masks and disinfectants to protect their own citizens. These and other events underscored the need for national self-sufficiency in vaccine production.
A significant step forward in this regard is the establishment of the Hıfzıssıhha-Türkiye Vaccine and Biotechnological Product Research and Production Center at the end of 2022, spearheaded by Türkiye’s Ministry of Health. Situated near Ankara Esenboğa Airport, this state-of-the-art facility spans 50 thousand square meters and is equipped with advanced smart building technology. As its name implies, this center was designed to develop and produce a wide range of vaccines and biotechnological products. As the largest facility of its kind, it will serve as a hub for the development of vaccines and genetic products, such as the Turcovac COVID-19 vaccine and various inactivated, mRNA, intranasal, and adenovirus vaccines.
1 BBC News Türkçe. (2023). Hatay merkezli depremler: 6 kişi hayatını kaybetti, 562 kişi yaralandı https://www.bbc.com/turkce/articles/cglrzkl8418o.amp
2 EM-DAT- The international disaster database. (2023). Public EM-DAT. https://public.emdat.be/data
3 Kısa Dalga Haber. (2023). 2023’ün ilk yedi ayında 1022 orman yangını çıktı https://kisadalga.net/haber/detay/2023un-ilk-yedi-ayinda-1022-orman-yangini-cikti_77269
4 TRT Haber. (2023). Kastamonu’da köy yangını: 47 ev küle döndü https://www.trthaber.com/haber/turkiye/kastamonuda-koy-yangini-47-ev-kule-dondu-807106.html
5 Climate Change Service. (2023). Copernicus: November 2023 – Remarkable year continues, with warmest boreal autumn. 2023 will be the warmest year on record https://climate.copernicus.eu/copernicus-november-2023-remarkable-year-continues-warmest-boreal-autumn-2023-will-be-warmest-year
6 ALAIN News Türkçe. (2024). Türkiye’de 2023 Aralık ayı, son yarım yüzyılın en sıcak ayı olarak belirlendi https://tr.al-ain.com/article/turkiye-aralik-2023-sicaklik-rekoru
7 T.C. Sağlık Bakanlığı. (2023). Türkiye, Gazze’ye yardım ve tıbbi estek malzemeleri göndermeye devam ediyor https://www.saglik.gov.tr/TR-100110/turkiye-gazzeye-yardim-ve-tibbi-destek-malzemeleri-gondermeye-devam-ediyor.html
8 T.C. Sağlık Bakanlığı. (2023). Gazze için yapılan yardımlarının en büyüğü yola çıktı https://www.saglik.gov.tr/TR-100857/gazze-icin-yapilan-saglik-yardimlarinin-en-buyugu-yola-cikti.html
9 T.C. Sağlık Bakanlığı. (2023). Gazze Türk-Filistin dostluk hastanesi yakınına yapılan saldırıya ilişkin açıklama https://www.saglik.gov.tr/TR-100503/gazze-turk-filistin-dostluk-hastanesi-yakinina-yapilan-saldiriya-iliskin-aciklama.html
10 T.C. Sağlık Bakanlığı. (2023). Gazzeli 68 hasta, 61 refakatçi ile birlikte tedavileri için ülkemizdeler https://www.saglik.gov.tr/TR-101247/gazzeli-68-hasta-61-refakatci-ile-birlikte-tedavileri-icin-ulkemizdeler.html
11 T.C. Sağlık Bakanlığı. (2024). COVID-19 Bilgilendirme Platformu https://covid19.saglik.gov.tr/
12 T.C. Sağlık Bakanlığı. (2024). Haftalık İnfluenza (Grip) Sürveyans Raporu, 2023/52. Hafta (25-31 Aralık 2023) https://grip.saglik.gov.tr/depo/influenza-raporu/2024/Haftalik_Influenza_Grip_Surveyans_Raporu_2023_52._Hafta_9c351.pdf
13 T.C. Sağlık Bakanlığı. (2024). HIV/AIDS İstatistikleri. https://hsgm.saglik.gov.tr/depo/birimler/bulasici-hastaliklar-ve-erken-uyari-db/Dokumanlar/Istatistikler/hiv-aids-2023.pdf)
14 Emniyet Genel Müdürlüğü. (2023). Trafik İstatistik Bülteni, Ülke Geneli (Aralık-2023) https://www.trafik.gov.tr/istatistikler37
15 Yeşilay. (2023). Bağımlılıkla Mücadele Merkezi https://www.yesilay.org.tr/tr/
16 Anadolu Ajansı Haber. (2023). “Aile Diş Hekimliği” uygulaması 2024’te 20 ile yaygınlaştırılacak https://www.aa.com.tr/tr/saglik/aile-dis-hekimligi-uygulamasi-2024te-20-ile-yayginlastirilacak/3050538#
17 Sağlık-Der. (2023). Türkiye Sağlık Raporu 2023 https://www.saglikder.org.tr/upload/raporlar/2023_SAGLIK_RAPORU.pdf
18 Anadolu Ajansı Haber. (2021). Türkiye’nin ‘aşı ve biyoteknoloji üssü’ 2022 yılı sonunda hizmete alınacak https://www.aa.com.tr/tr/saglik/turkiyenin-asi-ve-biyoteknoloji-ussu-2022-yili-sonunda-hizmete-alinacak-/2462019