“Such things have always happened. It's part of destiny's plan.” The reaction of Recep Tayyip Erdoğan, Türkiye's President, to the devastating earthquakes that struck Türkiye and Syria on Feb 6, betrays a dangerous sense of fatalism, if not an active effort to deflect responsibility. As of Feb 14, the earthquakes have caused more than 35 000 deaths, and injured many more. As the chances of finding survivors under the rubble diminish, a second catastrophe is looming. The widespread destruction of buildings and infrastructure has left more than a million people homeless in Türkiye and displaced 5 million in Syria. These people need urgent shelter from freezing temperatures, food, clean water, and medical care. Earthquakes are natural disasters. They cannot be prevented and some harm is inevitable. But the human cost can be mitigated by effective preparation, response, relief, and rebuilding—if those in positions of responsibility are willing to do so.
Erdoğan is at least partly right. Türkiye is earthquake-prone. The 1999 İzmit earthquake killed more than 17 000 people, largely because of building construction that led to a pancake model of progressive collapse. Stricter building regulations were introduced but poorly enforced, enabling a construction boom with deadly consequences. Several Turkish building constructors have been arrested, but for many victims, it is too late. Erdoğan has rightly been under intense criticism as a result.
In a World Report in this issue, Turkish doctors speak of the lack of emergency preparation and their efforts to care for people despite the disorganisation of the immediate response, including insufficient medical equipment and supplies. Many health workers have been killed and others have anxiety or post-traumatic stress disorder. Türkiye is asking much of its health workforce. Surgery, trauma care, and treatment of crush injuries are in high demand. WHO has warned of increasing infectious diseases, hypothermia, mental ill health, and respiratory illnesses aggravated by cold weather. Essential medicines such as insulin, provision of renal dialysis, prevention of infectious diseases, and psychological and mental health support are all needed. Yet the government has been at loggerheads with the medical community for some time, and poor working conditions have led many to emigrate. 2023 is an election year in Türkiye. Erdoğan's years in power have been tumultuous, characterised by increasing authoritarianism. But the earthquakes and their aftermath could be the events that define his legacy.
In Syria, the earthquakes are playing out against a wholly man-made disaster. 12 years of civil war have driven the country to collapse. Early aid could not reach the most affected opposition-held areas in northern Syria because of the government's initial insistence that either one badly damaged border crossing was used or aid be routed through Damascus. The Syrian Government, along with Russian support, has destroyed health facilities of its own people in targeted attacks. National water infrastructure has been devastated, leading to unsafe water and poor sanitation. A cholera outbreak that began in September, 2022, has caused almost 80 000 cases. WHO has warned of a further increase in cases, along with respiratory illnesses, leishmaniasis, physical and mental trauma, disability, and secondary wound infections. Peter Ford, the former UK ambassador to Syria, has described the “callousness” of blanket EU and US sanctions that harm the health and wellbeing of Syrians. An opportunity now exists for the international community to re-invigorate discussions to address the dire impacts of the war and bring an end to this protracted crisis.
A global and regional emergency response to the earthquakes is now underway. WHO has launched an appeal for US$43 million. 5200 volunteers from the International Red Cross are taking part in the rescue operations in both countries. Field hospitals are being built. 3·7 million refugees live in Türkiye, many close to the epicentre of the earthquakes, and they have been disproportionately affected. Effective coordination among many international partners is required to ensure that relief, including appropriate and timely medical services, is provided to those most in need. The vulnerability of neonates, children, and older people deserves specific attention.
The response in the coming days and weeks will decide the health and wellbeing of millions of people in the region. Recovery will take decades. Success or failure will depend on political decisions and commitments—acts of humanity, not acts of God. As Turkish doctors who have spoken to The Lancet, such as Bulut Ezer, know: “If natural disasters aren’t properly managed, they turn into artificial disasters. We could have saved so many more people...We’ve not been prepared for this at all.”
© 2023 REUTERS/Alamy Stock Photo