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Syrians build health care network in Turkey

Informal health centres are treating thousands of Syrian refugees in Turkey, easing the pressure on local hospitals.

Last updated: 01 Sep 2014 08:37
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Health centres have been set up in abandoned buildings in southern Turkey to treat Syrian refugees [Reuters]

Kilis, Turkey - On a dusty, shadeless hilltop in the Turkish border town of Kilis, Syrian mothers, toddlers, and elderly cram into a makeshift medical centre housed in an abandoned bakery. Some 500 patients will seek treatment here today, though officially the centre does not exist.

Known as Syria Polyclinic 1, the facility is part of an informal network of medical centres that have cropped up in Kilis to treat the nearly 80,000 Syrian refugees that now reside in and around the town.

"Over the last two years, [the number of Syrian refugees] has [reached] nearly the same as the number of Turks here in Kilis," Dr Mohammed Assaf, general director at Syria Polyclinic 1, told Al Jazeera. "The [Turkish] state hospital and clinics cannot cope."

We started this clinic because the need was becoming so big. The number of Syrians in Kilis started growing, and room in the camps was running out.

- Dr Mohammed Assaf, general director at Syria Polyclinic 1 in Kilis

Like many smaller Turkish border towns, the influx of newcomers into Kilis has far exceeded the capacity of local infrastructure and services. "We started this clinic because the need was becoming so great. The number of Syrians in Kilis started growing, and room in the camps was running out," Dr. Assaf explained.

"In this way, we are helping reduce the pressure on the Turkish [health] centres."


RELATED: Syrians in Turkey push for coexistence


There are three more polyclinics in Kilis that treat Syrians specifically, each seeing between 200 and 400 patients per day. In addition, the city hosts three post-operative centres, a mental health clinic, physical therapy facilities, a vaccination centre, and a facility supported by the government of Saudi Arabia that provides high-quality prosthetics for a legion of new amputees.

The centres provide primary health services, prenatal care, and rehabilitation and psychosocial support for Syrians suffering from the trauma of war and who continue to require basic health care.

Syrian residents of Kilis are not the only ones seeking care in Turkey. Given the town's proximity to the border with the Syrian city of Aleppo - the site of some of the war's most intense fighting - and that nearly half of Syria's public health care system has been destroyed as a result of the conflict, many of those receiving treatment still live inside Syria.

This includes individuals injured while fighting among the numerous armed groups in Syria. Fighters are able to receive treatment since neither the Syrian clinics nor Turkish centres require proof of identity before providing care, especially in emergency situations.

Adnan Abdul Ghafer, a construction worker originally from Deir Hafer, a small village outside Aleppo, has been travelling between Syria and Turkey for over a year receiving treatment for injuries he suffered from a barrel bomb attack on a street near his home. "I don’t remember what happened after the bombing, but I woke up at the hospital in Kilis with no hand and no sight in my left eye," Abdul Ghafer told Al Jazeera.

"Deir Haffa is under the control of the Islamic State group, and there are no [public] medical services now. It’s just private hospitals and they are butchers - they are very expensive. People only go there when they have no option. In Turkey, everything has been free, I just pay for transportation when I come every two months," Adnan said.

Each facility is required to have at least one Turkish doctor on staff, and monthly reports are required on the number of patients seen and the types of illnesses treated. The centres are also forbidden from treating Turkish citizens, and doctors and nurses are not allowed to perform any invasive procedures.

"The NGOs want this position [to be providing health services]. We decided to coordinate with them because this is the easiest way, I think, to find a solution, as they are professionals and they have a lot of resources," a member of the Kilis governorate, who did not have authority to comment, told Al Jazeera.


RELATED: Syrian war transforms Turkish border towns


One of the greatest beneficiaries of this parallel health care system has been the Kilis State Hospital, where the added pressure of Syrians' medical needs over the last two years had brought the hospital to a near breaking point. "We do not deny anyone who comes seeking treatment… but our hospital was built for a population of 100,000," Dr Halil Ibrahim Toptan, general director at the hospital, told Al Jazeera.

Witness - Syria: No strings

"Since March 2012, we have treated 350,000 Syrian patients at our hospital. Today, we are seeing between 2,000 and 3,000 patients per day."

A recent report released by the Turkish government stated that Turkey has spent $100m on health care for Syrians, who receive services free of charge and pay a fraction of the price for pharmaceuticals. In total, Turkey is reported to have expended $3.5bn in aid, mainly through its Disaster and Emergency Management Presidency (AFAD), for the nearly one million Syrians that have poured into the country.

Although there are officially more than 1.3 million Syrians who have taken refuge in Turkey since the war in Syria began, the actual figure may well be higher than 1.5 million, as many Syrians are not registered. Only 220,000 of these refugees currently live in 22 refugee camps, while the rest are in various provinces across Turkey.

Turkish citizens, especially in the cities where the influx of Syrians has been greatest, often complain about the impact that the high number of refugees has had on the quality of care that they are able to receive.

"There are many Turkish people who are upset about all the services the Syrians are getting," Mehmet K, a resident of the nearby city of Gaziantep, told Al Jazeera. "Doctors and patients are complaining because there is not enough time to see all the patients. The doctors have to work double, and many Turks are mad that the Syrians are able to get treated whenever they want even though they are not the ones paying taxes," Mehmet said.

Yet with resources running low, and limited space in the camps, those Syrians who are forced to find shelter in urban settings, like Kilis, are all the more vulnerable. "Turkey’s humanitarian outreach, while morally right and in line with international principles, remains an emergency response," a recent report by the International Crisis Group concluded. "The influx puts pressure on local infrastructures and creates social tensions … Turkey’s open door policy has its limits."

Last year, the Turkish ministry of health decided to allocate $6.9m to expand the Kilis State Hospital, according to Toptan, the general director. The number of beds is expected to double to 400 by the end of 2014, and the number of health professionals will increase by 50 percent.

While the expansion is expected to decrease the day-to-day pressure on the hospital, some doctors point out that this will not help to resolve the strain in critical times, such as during heightened clashes in Aleppo.

"The state hospital will still be small compared to the need. If there is a really big crisis in Aleppo or fighting among the armed groups there, the hospital cannot accommodate the waves of injured, and they send them to hospitals in Gaziantep or elsewhere," Dr Valantina Sbahi, a gynecologist from Aleppo who works in a field clinic inside Syria, told Al Jazeera.

Sometimes patients who were treated at the state hospital are discharged but they have no place to go to finish their recovery, maybe because they have no home or because it is too dangerous to return. We let them stay here longer.

- Dr Mouhannad Abdulqader, Malteser-IBC health centre

"The expansion will help Kilis [hospital] perform better, but it will not reduce the greatest pressure."


RELATED: Syria's conflict raises Turkey tension


In the meantime, the hospital and its satellite clinics in Syrian refugee camps continue to rely on the support Syrian doctors and volunteers operating hand-in-hand with relief organisations.

At a post-operative care centre run jointly by Malta’s humanitarian aid arm, Malteser, and the Turkish International Blue Crescent (IBC), a staff of 18 Syrian doctors and nurses treat recovering Syrian patients that the state hospital cannot accommodate. "There are not enough beds at the state hospital. Sometimes they release the patient too soon just to make room for others," Dr Mouhannad Abdulqader, general administrator of the Malteser-IBC centre, told Al Jazeera.

"Nine months ago when we opened, we had to fight with the [state] hospital to send the patients to us. They didn’t understand what we were doing," Dr Abdulqader said. "We were going there and telling them, 'Give us the patients!' Now... they are begging us to take patients."

According to Cristina Carino, technical advisor at the Helsinki Citizens Assembly, a Turkish NGO that runs a clinic in Kilis funded by Doctors Without Borders-Spain, the network of Syrian-focused clinics and care centres has kept the Turkish health care system from collapsing.

"If everyone was going to the hospital, no one could work, and the Syrians couldn’t get services," she said. "We are all just trying to cooperate as much as possible."

"Here we have to deal with the social situation too," Dr Abdulqader added. "Sometimes patients who were treated at the state hospital are discharged but they have no place to go to finish their recovery, maybe because they have no home or because it is too dangerous to return. We let them stay here longer."

Follow Danya Chudacoff on Twitter: @DanyaChudacoff

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