On February 6, 2023, a 7.8 Richter scale strong earthquake struck southwestern Türkiye and areas in northwest Syria. According to WHO, 1 the earthquake killed around 50 000 and injured more than 100 000 in Türkiye alone. One of the worst affected areas was Türkoğlu, a district of Kahramanmaraş Province. National authorities identified it as an area for international support, as the district hospital, normally serving the district with a population of 80 000, was partly destroyed and out of use. The United Kingdom (UK) Emergency Medical Team (EMT), the front line of the UK’s response to humanitarian crisis overseas, set up an EMT Type 1 (equivalent to an outpatient health center) in Türkoğlu, adjacent to the damaged hospital. The UK EMT also later deployed mobile clinics to areas around Türkoğlu to serve displaced populations residing in temporary centers. The deployed EMTs adhered to set EMT standards as outlined by WHO, whereby a Type 1 EMT should be capable of providing emergency and outpatient care during daylight hours. 2 The UK EMT was staffed by a national and international workforce on rotational basis. A Turkish EMT Type 1, Ulusal Medikal Kurtarma Ekibi (UMKE), was already established at the site in Türkoğlu. UMKE and the UK EMT worked side by side for the duration of the deployment, coordinating patients between the 2 facilities based on needs and resources.
Narrative
Earthquakes have both direct and indirect effects on health and health care services. Direct/immediate effects cause trauma and destruction of health facilities, while indirect effects may negatively affect health and exacerbate noncommunicable diseases (NCDs) due to increased vulnerability and disruption of existing health services, as well as loss of shelter, lack of access to safe water, hygiene, etc.Reference Mavrouli, Mavroulis and Lekkas 3 Studies following earthquakes have reported outbreaks of infectious diseases—mainly gastrointestinal, dermal, and respiratory diseases—as a result of extensive population displacement and lack of basic hygiene.Reference Kouadio, Aljunid and Kamigaki 4 Trauma, mainly limb injuries and wounds, are the most common type of direct health effect of earthquakes. For every deceased person, it is estimated that around 3 become injured. 5
Following the initial surge of trauma, the dominating burden of diseases (BoD) after major earthquakes will, depending on context, be NCDs. The indirect effects may further lead to the exacerbation of NCDs by the interruption of access to medications, and the fact that immediate needs like shelter and food are prioritized over health care.Reference Ghazanchaei, Khorasani-Zavareh and Aghazadeh-Attari 6
A total of 7048 medical records were collected from those seeking care at a UK EMT Type 1 fixed facility in Türkoğlu and from the mobile clinics visiting the surrounding areas. Patient records were filed after each consultation by clinicians, and a daily WHO Minimum Data Set (MDS) template compiling the results was reported to the EMT Coordination Cell. 7 -Reference Benin-Goren, Kubo and Norton 9 The WHO MDS template was designed and developed by WHO in order to ensure standardized reporting from EMTs deployed to disasters in any country, and systematic reporting is mandatory from any deployed EMT deployed.Reference Benin-Goren, Kubo and Norton 9
The collected records reflect patients’ visits between February 8, 2023 and April 20, 2023. The UK EMT did not use more than the required WHO MDS template as a reporting mechanism of collected patients’ data. The descriptive analysis was conducted using Power BI to visualize the data that was collected manually and entered into an excel sheet. All the secondary data used were totally de-identified. An IRB approval (number E-72321963-300-215498) was obtained from the Social and Human Science Ethics Committee at Kahramanmaras Sutcu Imam University in Türkiye.
The aim of this report from the field is to describe types of medical conditions presented to primary health care Type 1 facilities in the first weeks after an earthquake.
The descriptive data are presented in Table 1.
Table 1. The distribution of cases based on medical conditions, sex, age, and months
A predominant number of medical conditions were reported and labeled as “other diagnoses” (4833, 72%) and not all those “other conditions” were reported by UK EMT clinicians or by the data manager. Upper respiratory tract infections and musculoskeletal pain were the most commonly reported within this category, 836 (17%) and 687 (14%) respectively. The MDS format is more appropriate for trauma cases rather than primary care patients.
Consultation cases (not necessarily related to the earthquake) were mainly reported during the month of March 2023, occurring in 3953 (59%) of patients visiting during that month. Communicable diseases were highly prevalent during the month of February and accounted for 1825 (27%) of cases seen within the UK EMT facility.
This field report has some methodological concerns. Data is facility-based and count each case as a new patient. Results may not be generalizable to the entire affected area. Moreover, it is not clear if the presentation of conditions across the 3 months is due to an increase in cases, or if people with trauma started to visit hospitals and other health care facilities close to the affected area. Moreover, an additional national study is necessary for accurate nationwide BoD assessment, as the data presented in this report does not fully capture the actual disease burden in Türkoğlu.
Discussion
This study shows that the medical cases treated by UK EMTs outpatient clinic in Türkoğlu from a week after the earthquake to 3 months after, were predominantly non-trauma related, countering the common belief that earthquake-related medical needs are dominated by trauma. The main BoDs will rapidly dominate primary health care needs.Reference Çağıran 10 A major event like an earthquake entails destruction of infrastructure and displacement of a significant number of the population. The living conditions in temporary informal tented settings will increase vulnerability and risk worsening existing medical conditions and spreading of infectious diseases.Reference Najafi, Rezayat and Beyzaei 11 A recent study conducted in Türkiye following the earthquake confirmed that fragile infrastructure, weather, and living conditions contributed to infectious disease spread.Reference Mavrouli, Mavroulis and Lekkas 3
In addition, during an emergency crisis, communities might not be equipped with the right knowledge on how to prevent and treat certain diseases, resulting in increased spread of communicable diseases.Reference Maddah, Salvi, Vadi and Mohammad 12
As mentioned in the systematic review by Najafi, Rezayat, and Beyzaei et al., respiratory infections increase after earthquakes.Reference Najafi, Rezayat and Beyzaei 11 This is confirmed in Türkoğlu following the earthquake where cases of infectious diseases were raised. This increase might be due to harsh weather, seasonal infections, overcrowding, and poorly-ventilated spaces.Reference Mavrouli, Mavroulis and Lekkas 3 , Reference Najafi, Rezayat and Beyzaei 11 The increased occurrence of respiratory diseases during winter is attributed to several factors. These include the influence of weather on virus survival, changes in behavior such as increased indoor crowding, and alterations in individuals’ susceptibility to diseases.Reference Nichols 13 Additionally, physiological elements like day length affecting influenza morbidity, exposure to cold increasing susceptibility, and seasonal changes in vitamin D levels are considered contributory factors.Reference Nichols 13 Furthermore, infants and unvaccinated children are especially vulnerable to respiratory infections regardless of the presence of other risk factors.Reference Najafi, Rezayat and Beyzaei 11
Other medical conditions that are noticed after natural disasters are skin diseases, such as scabies. However, skin diseases seem to be part of the major BoD on a national level for a certain age category (5-17 years) specifically, and are on the lower end of the spectrum of BoD for the remaining age categories. 14 Similar to a previously conducted meta-analysis, our results speculate the prevalence of dermal conditions occurring after the earthquake.Reference Najafi, Rezayat and Beyzaei 11
Chronic diseases, and specifically NCDs, are among the top BoDs in Türkiye. 14 However, data about the several NCDs—besides hypertension and diabetes—are not registered within UK EMT Type 1 records following an earthquake. Continuous surveillance is advisable, as most people will be affected by medication scarcity and displacement, in addition to the focus on treating acute diseases following the disaster.Reference Suneja, Chandler and Schlegelmilch 15
Therefore, EMTs should have a more context-adapted data management system that allows for more data gathering, stratified by different sociodemographic factors, leading to better analysis of post-disaster health care. Also, strategies where primary health care capacity is strengthened are equally needed, optimizing facilities for disaster response.Reference Fuady, Pakasi and Mansyur 16
Data availability
Data are available upon reasonable request.
Acknowledgements
Thanks to UK Foreign, Commonwealth and Development Office for funding the deployment.
Author contribution
DM and GI drafted the initial manuscript and adjusted it based on other author’s suggestions. RMT helped drafting part of the results’ section. NA, MB, DW, AM, and DAT helped with the entry of patients’ records and consultations information into the system, and cleaning the data whenever necessary. Both RV and JVS overviewed the manuscript separately and revised it.
Funding statement
Not applicable.
Competing interest
The authors have no conflicts of interest to declare.
Ethical standard
This study was approved by the Social and Human Science Ethics Committee at Kahramanmaras Sutcu Imam University (number E-72321963-300-215498).
Open access
