Disasters and Public Health
Disasters caused by a natural phenomenon or human activity have been increasing across the world every passing year. According to the World Disasters Report, the most substantial increase has been observed in climate and weather-related disasters (floods, extreme weather events, storms, etc.), followed by geophysical and biological disasters.1 The same goes for the disasters that occurred in Türkiye in 2021. Storms and precipitation events that affected Istanbul and nearby areas in the first months of the year were followed by extreme precipitations that affected Artvin, Düzce, Rize, and nearby areas.2 Widfires that started in the Manavgat region in July were followed by wildfires in Adana, Marmaris, Mersin, and Osmaniye; 299 wildfires occurred between 28 July and 12 August 2021 in 54 cities located in the Mediterranean, Aegean, and South-East Regions.2 3 It is estimated that 160 thousand hectares of areas were affected by fires in 2021 where the greatest wildfires occurred in the history of Türkiye.4 Right after the wildfires, extreme precipitations occurred in Bartın, Kastamonu, and Sinop, and accordingly flood and landslide disasters led to many losses of lives and properties. In the last months of the year, unfavorable weather conditions, and heavy winds affected the whole country, especially the Marmara Region. When analyzing earthquake statistics for 2021, it can be observed that moderate earthquakes (5.0-5.9) occurred in Bingöl, Düzce, Elazığ, Erzurum, Konya, Kütahya, Malatya and Van.2 5
It would not do justice if we just look at the numbers of people who lost their lives or were injured, or the buildings damaged or destructed, as disasters have direct and indirect negative effects on society and public health services. The physical, psychological, and social health of individuals may worsen and many difficulties may arise, such as the loss of opportunities related to nutrition, shelter, and access to safe drinking water; failure in controlling outbreaks, chemical pollution, and wastes; infrastructure damages on water, electricity, sewage, transportation, and communications; and service infrastructure damages- especially on health services.6 7 Although these problems might be encountered in most disasters, each disaster might lead to different kinds of problems depending on its dynamics. The flood disasters that occurred in 2021 have the potential to cause all these problems, wildfires may cause the numbers of PM10 and PM2.5 pollutants to increase, and the pollution of air, earth, and underground water resources may lead to burns and heat-strokes.6 8 These problems faced in the acute stage are followed by much more severe and irrevocable problems related to the destruction of habitats and ecosystems, and the loss of cultural and social heritage, and production resources.
When we take into consideration that disasters occur due to the combination of dangers and vulnerabilities, we can say that there is a direct correlation between the current state in the pre-disaster period, preparedness, and risk reduction activities.9 This entails global and individual level action. Aimed to be achieved by the United Nations Member States by 2030, 17 Sustainable Development Goals, directly or indirectly related to disasters, address what needs to be done to build disaster resilient societies and to prevent the losses caused by disasters. It is aimed to reduce disaster risks and the ratio of losses of lives and properties in the GDP, develop good agricultural practices, create urban and residential area planning that prioritizes disaster resilience, improves disaster resilience activities intended for disadvantageous groups, and climate change responses with the help of national level activities such as the Disaster and Emergency Presidency’s (AFAD) National Disaster Response Plan (TAMP) and Guidelines for Climate Change and Disasters.10 Reducing disaster risks and improving resilience is only possible if this matter is prioritized in all policies and institutional goals, and if community engagement is ensured.
Migration and Public Health
Still affected by the pandemic, 2021 was a year in which migrations continued to increase across the world. Wars, crises, and conflicts (Sudan, Syria, Yemen), serious economic and political uncertainty (Afghanistan, Venezuela), and climate and weather-related disasters (China, Philippines, India) caused millions of people to leave their homes. Migrations increased despite restrictions to prevent in-country or intercountry border mobility, the number of international migrants increased from 272 million to 281 million according to data from the World Migration Report (2022), which was published in the last month of the year. 26.4 million of the 89.4 million displaced people were refugees and 4.1 million were asylum seekers, and the number of internally displaced people reached 55 million. While the great majority of internally displaced people left their homes due to conflicts and violence, 7 million people were displaced due to disasters. Wildfires in France, Spain, and Greece led to the displacement of 23,000 people.11
On the 10th anniversary of the uncertainty in Syria, Türkiye continues to host the most refugees in the world. The Türkiye-Syria migration corridor is the second biggest intercountry corridor (following the US-Mexico corridor).11 3,735,701 Syrian citizens with temporary protection status are in Türkiye as of December 2021. 51,559 people are in temporary refuge centers, while the remaining 3.6 million people are settled mostly in big cities especially Adana, Gaziantep, Hatay, Istanbul, and Şanlıurfa. As of 2021, the number of irregular migrants was recorded as 154,766. The highest number of the origins of irregular migrants are respectively Afghanistan, Syria, Pakistan, Somali, Uzbekistan, Iraq, Turkmenistan, Bangladesh, Iran, and Palestine.12
Migration is a field of study for public health with its impacts on individual and community health. Migrant communities mostly come from places where the health infrastructure is damaged and preventive health services like vaccinations are interrupted due to long-lasting crises, and they experience poor sanitation on the route and face challenges to access health services in the country they arrive. Worsened health indicators have multiple causes such as changes in lifestyle and malnutrition, having difficulties in accessing essential services and necessary services for monitoring and treatment of current chronic diseases. Psychological issues related to traumas and the adaptation process, working in less secure jobs, frequent accidents and injuries, poor housing, and working conditions cause migrants’ state of health to worsen. All these problems faced before, during, and after migration, left migrants vulnerable to health issues in the country they arrive.13 According to the right to health and principles of universal health coverage, migrants need to be provided with essential health services regardless of their status to maintain and improve the health of both migrants and society.
When studies on migrants in Türkiye are analyzed, it can be observed that psychological issues, prenatal care and other reproductive health services, and mother-infant health problems are among the most highlighted topics. One study highlighted that depression, anxiety, and post-traumatic stress disorder are prevalent among Syrians under temporary protection, and the life conditions after displacement play a role in this.14 Syrian women are at risk in terms of inadequate prenatal care, adolescent pregnancy, and adverse pregnancy outcomes, and early labor and prematurity are frequently seen in newborns.15 16 In 2021, when the pandemic still has an impact on our lives, studies on the problems faced by migrants during the pandemic period have also been published. According to a study, economic problems resulting from COVID-19 measures disproportionately affected Syrians under temporary protection.17 According to a study published by the Turkish Red Crescent and the International Red Cross and Red Crescent Federation on migrant access to vaccinations, 72.1% of 624 migrants receiving service from one of the 16 community centers in 15 provinces got the first dose. It is highlighted that 68.2% of all the vaccinated (307 people, 49.2% of the total participants) got the second dose, and 1.3% of them got the third dose. Hospitals, primary care clinics, and migrant health centers are the first three places where vaccinations are administrated.18
Taking action against the causes of migration and preventing irregular migration are the initial steps towards combatting health issues caused by migration. Migration should be managed by all parties and in coordination with each other, also with an approach that considers human dignity. Many internationally acknowledged texts such as the Geneva Convention and the Sustainable Development Goals were significant steps to eliminate risk factors and regulate legal processes regarding migrations. Within the framework of the “Target 3.8 Universal Health Coverage Principles” under the Sustainable Development Goals, the goal is to ensure access for everyone, regardless of their legal status, to quality essential health services, essential medicines, and vaccines.19 Within the scope of the Global Compact for Safe, Orderly and Regular Migration, UN Member States, including Türkiye, adopted goals to increase their efforts to protect the fundamental rights and freedoms of all migrants, to eliminate discrimination, to provide migrants with fair employment opportunities, to prevent migrant trafficking, to ensure migrant access to essential services and to promote their social adaptation process.20 Migration processes should be managed in global cooperation, to prevent climate-related problems, disasters, economic, social, political uncertainties on which migrations are based, adverse health impacts and social outcomes related to migrations with an approach prioritizing actions to prevent crisis and conflicts.
1. IFRC. (2020). World Disaster Report. https://kizilayakademi.org.tr/wp-content/uploads/2021/11/dunyaAfetRaporu_TR_web.pdf
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2. AFAD. (2021 18 December). https://www.afad.gov.tr
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3. Ministry of Agriculture and Forestry, General Directorate of Forestry (2021 13 August). Tüm orman yangınları kontrol altında. https://www.ogm.gov.tr/tr/haberler/tum-orman-yanginlari-kontrol-altinda
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4. Istanbul Technical University (2021 12 August). İTÜ-UHUZAM orman yangınlarının bıraktığı hasarı uydudan tespit etti. https://web.cscrs.itu.edu.tr/itu-uhuzam-orman-yanginlarinin-biraktigi-hasari-uydudan-tespit-etti/
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5. Boğaziçi University. (2021 18 December). Boğaziçi üniversitesi kandilli rasathanesi ve deprem araştırma enstitüsü bölgesel deprem-tsunami izleme ve değerlendirme merkezi. http://udim.koeri.boun.edu.tr/zeqmap/hgmmap.asp.
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6. Güler, Ç. (2012). Su baskınlarında alınacak toplumsal ve bireysel önlemler. G. Çağatay Çevre Sağlığı, Çevre ve Ekoloji Bağlantılarıyla (c:2, ss:1311-1326) içinde. Yazıt Yayıncılık
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7. Shoaf, Kimberley & Rottman, S.J. (2000). Public health impact of disasters. Australian Journal of Emergency Management. 15. 58-63
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8. Finlay, S. E., Moffat, A., Gazzard, R., Baker, D., & Murray, V. (2012). Health impacts of wildfires. PLOS Currents Disaster, 4 https://doi.org/10.1371/4f959951cce2c
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9. Altıntaş, H. (2012). Afetler ve Afet Tıbbı. C. Güler & L. Akın (Eds.), Halk sağlığı temel bilgiler (c: 2, ss: 1107:1111). Hacettepe University Publications
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10. TR Presidency Strategy and Budget Office (2019). Sürdürülebilir kalkınma amaçları değerlendirme Raporu.
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11. McAuliffe, M. and A. Triandafyllidou (2021). World migration report 2022. International Organization for Migration
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12. Directorate of Migration Management (2021 18 December). Düzensiz göç. https://www.goc.gov.tr/duzensiz-goc-istatistikler
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13. WHO. (2018) Report on the health of refugees and migrants in the WHO European Region. World Health organisation
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14. Acarturk, C., McGrath, M., Roberts, B. (2021). Prevalence and predictors of common mental disorders among Syrian refugees in Istanbul, Turkey: a cross-sectional study. Social Psychiatry and Psychiatric Epidemiology 56, 475–484, https://doi.org/10.1007/s00127-020-01941-6
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15. Silahli, N., Baris H. E., Qutranji, L., Ozek, E., Boran, P. (2021) The differences in perinatal outcomes between refugee and resident mother–infant dyads: A retrospective study in Turkey between 2013 and 2018, Health Care for Women International, 1-14, https://doi.org/10.1080/07399332.2021.1954648
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16. Vural T., Gölbaşı C., Bayraktar B., Gölbaşı H., Yıldırım A. (2021). Are Syrian refugees at high risk for adverse pregnancy outcomes? A comparison study in a tertiary center in Turkey. The Journal of Obstetrics and Gynaecology Research. 2021 Apr; 47(4),1353-1361. https://doi.org/10.1111/jog.14673
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17. Elçi, E., Kirisçioglu, E. & Üstübici, A. (2021). How COVID‐19 financially hit urban refugees: evidence from mixed‐method research with citizens and Syrian refugees in Turkey. Disasters, 45, S240-S263. https://doi.org/10.1111/disa.12498
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18. Kızılay. (2021 20 December). Türkiye’deki göçmenlerin aşılanma durumu: III. anket sonuçları https://reliefweb.int/sites/reliefweb.int/files/resources/3.%20A%C5%9F%C4%B1lama%20Anket%20Sonu%C3%A7lar%C4%B1-d%C3%BCzeltme.pdf
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19. TR Presidency Strategy and Budget Office (2019). Sürdürülebilir kalkınma amaçları değerlendirme Raporu.
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20. Directorate of Migration Management. (2018 12 December). Küresel göç mutabakatı hakkında basın açıklaması https://www.goc.gov.tr/kuresel-goc-mutabakati-hakkinda-basin-aciklamasi
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