Situation Desperate in Earthquake-Stricken Turkey and Syria

Ute Eppinger

February 17, 2023

Several hospitals in Turkey and northern Syria were among the thousands of buildings destroyed by the first 7.8 magnitude earthquake in the early hours of February 6. The earthquake struck the southeast of Turkey around the city of Gaziantep and the northwest of Syria. The cities of Aleppo, Homs, and Hama were affected, as well as the Idlib region. The Turkish government has declared a state of emergency in 10 cities. Strong aftershocks are still being felt regularly.

The massive quakes have claimed the lives of more than 41,000 people as of February 16, and more than 40,000 are reported to be injured. It is still difficult to comprehend the full extent of the destruction.

According to the World Health Organization (WHO), up to 23 million people could be affected by the aftermath of the earthquake. "It's a race against time. With every passing minute, every passing hour, the chances of finding survivors falls even lower," said Tedros Adhanom Ghebreyesus, PhD, WHO director-general, on February 7. The WHO has activated its network of medical emergency teams and sent medical charter flights with aid supplies to both countries from its logistics center in Dubai.

But freezing temperatures, ongoing aftershocks, ruined streets, huge piles of rubble and meter-deep craters, and massive damage to power supplies, communication, and other infrastructure continue to make access and search-and-rescue operations difficult.

To make matters worse, millions of civil war refugees from Syria are living in the earthquake zone on both sides of the border. According to the United Nations (UN) Refugee Agency, 1.7 million internally displaced people in northwestern Syria are living in hazardous conditions in camps. The number of refugees immediately affected by the earthquakes is still unclear.

Tragic News

Multiple countries are sending aid, and the European Union (EU) has already mobilized more than 1200 emergency personnel. The German contingent includes personnel from Médecins Sans Frontières ("Doctors Without Borders"), International Search and Rescue (ISAR) Germany, and the Federal Agency for Technical Relief (THW). Aid workers from the Turkish Red Crescent and the Syrian Arab Red Crescent (SARC) were on location immediately after the first earthquake to help people.

The German Red Cross (DRK) is in contact with its counterparts on the ground to coordinate humanitarian aid; the Federal Foreign Office is also giving 500,000 euros to support the DRK emergency aid in Turkey and Syria. German Chancellor Olaf Scholz has promised further aid.

"The news continuing to come in from Turkey and Syria is tragic. We have lost one colleague, and many of our staff have lost members of their families in the earthquakes. My heart is with everyone affected, and MSF staff are working around the clock to provide support," tweeted Christos Christou, MD, president of Médecins Sans Frontières (MSF). "We are looking for more ways that we can provide support to people in this desperate situation."

The Turkish Red Crescent's pioneer team — 467 full-time and 733 volunteer helpers — started on February 6 with five mobile kitchens, 77 catering trucks, 1903 tents, and 26,929 blankets in the Kahramanmaras region, the epicenter of the earthquake.

The Hatay province, located between the Mediterranean Sea and the Syrian border, is currently the worst-affected region in Turkey with 870 casualties. Official reports indicate that around 1500 buildings were destroyed by the earthquake in this densely populated province.

"Our teams have been deployed across the country after a strong earthquake hit over 10 provinces and the regions in the south and southeast of Turkey," tweeted Kerem Kinik, MD, PhD, president of the Turkish Red Crescent. The organization itself announced, "We are traveling on to the tent sites in Pazarcik, the epicenter of the earthquake. We are continuing to provide food assistance for those in Gaziantep affected by the earthquake."

Idlib Without Assistance

While thousands of international helpers have already reached the disaster zone in Turkey, getting help to the zones in northern Syria remains difficult. The roads to the only open border crossing, Bab al-Hawa, are damaged, which delays the delivery of humanitarian aid, reported the UN.

Syria has been in the grip of a civil war for the last 12 years. So, in northern Syria, a region in which access to healthcare and the humanitarian situation were already critical, this earthquake has been devastating. The Syrian government has promised help, but in the Idlib region, which is under the control of the Islamic State (IS) rather than the government, people cannot rely on government assistance. They depend on foreign aid.

"This region has no government, it is practically a no man's land, and it is not mentioned in Syrian state media. The death toll there is still unknown," reported Falah Elias, reporter and moderator at German broadcasting institution Westdeutscher Rundfunk Köln (WDR). The parents of Elias live on the edge of the disaster zone in northwestern Syria.

"Emergency call for doctors! We need your help in Idlib," tweeted Shajul Islam, MD, a British emergency doctor who worked at St. Bart's Hospital in the United Kingdom and has lived and worked in the Idlib region for several years. "The most critical patients from the entire region have been rushed to us all in one go. We need your support right now to cover their medical treatment."

The doctor shared the story of little Mustafa, who was pulled out of the rubble together with his three siblings. "He only sustained light injuries, but his sister is in our ICU fighting for her life." Islam also described a baby who was pulled out from under the rubble and is now in the hospital. There is no sign of any of the baby's family members.

Situation Is "Catastrophic"

MSF, which has assisted the population in northern Syria since 2009, has provided support to 23 health facilities across the Idlib and Aleppo governorates by donating emergency medical kits and sending medical staff to reinforce their teams. "The region's health facilities are overwhelmed, medical personnel in northwestern Syria are working around the clock to respond to the huge numbers of wounded arriving to the facilities," reported Sebastien Gay, MSF head of mission in Syria.

"We were able to mobilize all of our local medical teams in Syria in the first few hours. Rapid action is essential in the acute phase. There will also be a longer-term medical requirement, due to the aftermath," said Gay. The needs are very high in northwest Syria, as this earthquake adds a dramatic layer for the vulnerable people here who are still struggling after many years of war, said Gay.

"From the first hours of the disaster, our teams have treated around 200 wounded people. We have received 160 casualties in facilities and clinics that we run or support in northern Idlib. Our ambulances have also been sent to assist people," Gay added.

Christian Katzer, general director of MSF Germany, described the situation in northwestern Syria as "catastrophic" on the news show Tagesthemen. The extent of the damage in the region has led to the destruction of hundreds of houses and made thousands of people homeless.

"We received the sad news today that one of our colleagues did not survive and that his body had been pulled out from the ruins of his home in Idlib. Another of our colleagues — we have more than 500 based in northern Syria — has lost relatives. The situation is complex," said Katzer. Already under an extreme amount of pressure because of the war, the health system was also affected: several hospitals were destroyed by the earthquake.

Although snow has fallen, people largely remain outside due to the fear of further aftershocks. During an interview, Marcus Bachmann of MSF Austria pointed out that even before the earthquake, the health infrastructure in northern Syria was hardly in the position to guarantee primary healthcare. The earthquake has exacerbated the situation dramatically. "Since the roads are destroyed, many of the injured are arriving much later to the clinic, meaning that fighting infected wounds becomes a priority. We are seeing lots of septic patients as a result."

The Austrian division wants to first rectify the lack of health infrastructure by using inflatable field hospitals. According to Bachmann, these facilities have the advantage of being able to become fully functioning operating theaters within just a few hours. "We are in the position to bring these field hospitals to the earthquake zone," said Bachmann.

Lifting Sanctions?

The Syrian Arab Red Crescent has mobilized 3000 volunteers for deployment. "We do not differentiate between any of the Syrian people. We are the Syrian Arab Red Crescent for all Syrian people," emphasized the president of the organization, Khaled Hboubati. He also added, "We are ready to send an aid convoy through the cross line to the stricken areas in the Idlib region [in northern Syria]. If they [the opposition] open a road for us, we will go. We have no problem with this."

In a press conference broadcast via Syrian state television, Hboubati called for the West to lift sanctions and to provide aid. "Following this earthquake, the time has come," said Hboubati. He appealed to "every EU country to lift the economic sanctions against Syria." He also called for the United States Agency for International Development "to provide help to the Syrian people." After a war in Syria that has now lasted more than a decade, President Bashar al-Assad and his government are still being ostracized by the West. This complicates international aid efforts.

Katzer confirmed that MSF is still finding access to the northwest part of Syria extremely difficult, since there is only one open border crossing between Turkey and Syria. "The international community must not forget the people in northern Syria," said Katzer.

MSF continues to be in close contact with the local authorities in northwestern Syria and the authorities in Turkey so that they can expand their support there to where it is most needed. The organization is currently assessing the situation and requirements in Idlib, northern Aleppo, and southern Turkey to scale up aid accordingly, since the number of dead and injured people increases by the hour.

This article was translated from the Medscape German edition.

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