Dealing with the psychological aftershocks of the Türkiye earthquakes: why mental health and psychosocial support are so desperately needed

The scale and impacts of the February 2023 earthquakes in Türkiye and Syria have created almost unimaginable psychological stressors for individuals who survived the disaster. From being caught up in the quakes and often injured, to seeing their
homes badly damaged or destroyed and their cities flattened and emptied, to losing friends, family members and colleagues – the mental health effects on communities are immense. 

Doctors of the World/Médecins du Monde – Türkiye recently carried out a post-quake needs assessment in more than 10 sub-districts of the Antakya, Defne and Samandağ districts. In the assessment, 35% of respondents reported that at
least 1 member of their family had died. 

Although the assessment interviewed a modest number of people, the percentage that reported symptoms of psychological distress and shock was considerable. Symptoms included a tendency to burst into tears, fits of rage and appetite changes –
and nearly all reported changes in their sleeping patterns, often punctuated by horrific recollections of the traumatic experience they had been through.  

The mental trauma continues well after the quakes 

And the nightmare does not stop. Since the first 7.8 earthquake struck on 6 February, over 10 000 aftershocks of varying magnitudes have been registered. Residents, rescue teams and other responders have been living in a permanent state of fear, each
rumble bringing new terror and uncertainty. 

Presently, hundreds of thousands of people are living in temporary camps, sleeping in their cars, or having to seek shelter in insecure or unsanitary accommodation. Access to clean water remains an issue for many. 

While weather conditions may have improved, the change in temperature now brings about new challenges, with tents and mobile hospitals overheating and forcing people out into the open. In less than a month’s time, temperatures in the area could
climb to over 40° C, creating additional physical and mental stressors. 

Health-care workers and other responders also psychologically affected 

According to Dr Akfer Karaoglan Kahilogullari, a mental health expert at the WHO Country Office in Türkiye based in Ankara, many health-care workers in the quake-affected areas also became first responders, working to pull people out of the rubble
of destroyed buildings and jeopardizing their own safety to try to help. Despite often losing family members and homes themselves, they carry on working long hours to treat survivors.  

“Many are continuing in their caring roles because they want to help their communities at a time of national crisis, but in doing so they may be postponing their own grief and adding to their own trauma through dealing with so much death and
injury.”  

She adds that other frontline helpers working in the devastated areas, such as police officers, army personnel, teachers, faith leaders and international responding teams also need psychosocial support because of the indescribable things they are
witnessing on a daily basis. 

A complicated situation with no easy answers 

Dr Yagmur Gok is a 25-year-old doctor who graduated just 4 months ago. When the first quake struck, she scrambled with 2 other doctors to get patients out of their hospital in Gaziantep, then worked to manage the needs of survivors with a range of
injuries. When not on duty, Dr Gok is also now volunteering as an interpreter with an emergency medical team run by UK-Med and Turkish medical staff. 

“People are in shock right now. They are taking care of their physical health and basic needs, but the psychological effects will come later. Thinking about where they’re going to live and how they’re going to earn a living is concerning
people right now. And they simply don’t know what to do,” she explains. 

Dr Karaoglan Kahilogullari agrees: “Secondary trauma is everywhere. The whole country is either directly or indirectly affected, so the mental health needs are truly unprecedented. There is also a high volume of complicated grief – with
so many people struggling to come to terms with their loss, unable to bury their dead or perform the important religious rites that are part of their culture for saying goodbye to a loved one. Some don’t even have a body to bury, which makes
the grieving process that much harder.” 

Recently, WHO Director-General Dr Tedros Adhanom Ghebreyesus and WHO Regional Director for Europe Dr Hans Henri P. Kluge visited some of the areas most affected by the earthquakes and met Dr Esra Pacaci from Türkiye’s Ministry of Health.
She explained to them the scale of the problem: “Many people have lost not just 1 person but many people, as well as accommodation and their livelihoods. Kids are especially traumatized. But the psychologists we have here are helping out
a lot. As a nation we are keen to help each other out so that people don’t feel left out or alone.” 

How is WHO helping? 

To date, WHO has trained over 900 Ministry of Health staff in psychological first aid, and provided online support to 180 psychosocial workers deployed by the Ministry of Health and Ministry of Family and Social Services. 

As Dr Karaoglan Kahilogullari explains, WHO is also playing an important part in coordinating all the different partners responding to the crisis: “Having had offices in the country for many years, WHO has been able to build a trusted relationship
with the Government, health authorities, professional associations and nongovernmental organizations. They value our expertise and respect our coordinating role for bringing everyone together to respond to the emergency.”

War, armed conflict, and other man-made or natural disasters such as the Türkiye and Syria earthquakes cause profound distress, and can in some cases ignite or inflame existing mental health conditions. Although most people will recover without
help, an estimated 1 in 5 people will have a mental health condition in the next 10 years. This makes good-quality mental health and psychosocial support essential for the recovery of those caught up in emergency situations.  

The need for more support 

WHO has so far released more than US$ 16 million from its Contingency Fund for Emergencies to support those affected by the Türkiye and Syria earthquakes, but with almost 26 million people impacted, there is a dire need for more funding.  

With that in mind, WHO has launched a flash appeal for US$ 84.57 million to meet the immediate response needs across both Türkiye and the whole of Syria for the next 3 months. This will focus on: 

• ensuring access to the most vulnerable and affected populations; 
• providing immediate trauma care for injured people as well as post-trauma rehabilitative care; 
• providing essential medicines, emergency kits and supplies to fill urgent gaps; 
• preventing and controlling disease outbreaks, including by strengthening disease surveillance; 
• increasing access to mental health and psychosocial support; 
• coordinating the international health response, including the dispatch of Emergency Medical Teams where requested; and
• ensuring access to essential health services, particularly for women, children, older people and those living with noncommunicable diseases.