Why International Medical Volunteers should *NOT* travel to Turkey to provide medical assistance right now.
Since the devastating earthquake less than 48 hours ago, Doctors Worldwide’s team in Türkiye - otherwise known as Yeryüzü Doktolari [Doctors Worldwide in Turkish] mobilised immediately and arrived at the epicentre on the same day to provide emergency relief and medical aid. Our teams are in Kahramanmaraş, Hatay, Gaziantep, Mersin and Adıyaman, and so far we have provided much needed hygiene kits for families living out in the streets, as well as food, water and medication. Two tents, medical equipment and a mobile vehicle to provide safe medical/primary care have also arrived from Istanbul in hard hit cities like Kahramanmaras, and a large truck of further supplies [as of Tuesday 8th February]. Our teams of Turkish medical volunteers consisting of internists, paediatricians, nurses, pharmacists, orthopaedic specialists, neurosurgeons and general surgeons are also enroute/arrived to provide medical care, with mobile clinics and rotas being established amongst our 20,000+ Turkish medical volunteers. Our teams have also been carrying out assessments to determine immediate medical needs as well as mid to long term recovery plans. We are one of the few if not the only medical NGO currently operating on the grounds at the epicentres from day one [at the time of writing this article 8/2/23]. Harsh snow storms and freezing cold weather along with traffic jams into the region continue to hamper efforts, particularly due to the scale of the disaster.
Whilst all this has been happening in the last 48 hours, here in the UK, concerned and well intentioned medical volunteers have been requesting to go to Türkiye through DWW UK to provide medical care and relief, and we have already heard of a number of healthcare workers fundraising large sums to go out on their own.
At the current time our formal position is that there is no requirement for such deployments and we are actively discouraging any informal international medical volunteers from travelling to Türkiye. Some of these potential volunteers who have been actively pushing for deployments with the best of their intentions have found it difficult to appreciate our current position.
We have put together a brief list of reasons based on our 20 years of experience responding to disasters on why we discourage international medical volunteers from travelling and delivering medical care in Türkiye as part of the earthquake response:
- Clear guidelines on the deployment of international medical teams - Based on the reviews of previous large scale disasters such as the South Asian Tsunami in 2004 and the Haiti Earthquake of 2010, there are clear international and WHO-approved criteria of the type and specification of international medical teams required for deployment in response to major disasters. Such teams have clear remits based on the expected patient and injury burden, have trained together and have the prerequisite skills to respond to such emergencies. If you have not had any such training or induction before, you should not be volunteering as part of immediate response teams.
- Key clinical priorities - In any earthquake disaster, the initial focus is on search and rescue, followed by management of injuries, including crush syndrome and infections which require high-level surgical and intensive care with renal support. Such specialised skills are outwith the scope of the general field medical volunteer. The reality is that in Türkiye, patients have already begun to be evacuated to hospitals in other cities as per national plans.
- Legal permission to practise medicine in Türkiye - without explicit permission from the relevant government bodies in Türkiye it is illegal for a physician to practise even in a disaster such as this. Safeguarding of patients and to ensure no harm comes to patients is rooted in this, and we should never accept any less. Doing so otherwise would risk your good standing and licence to practise in your own country, e.g. the GMC.
- Language barrier, culture and communication - international physicians who are not fluent in Turkish may compromise the safety of patients and the quality of care being delivered, especially as they are unable to communicate and conduct consultations with patients in Turkish, and are unfamiliar with local cultural norms, thus missing vital cues, information and opportunities for diagnosis. Documentation, IT systems and patient records will likely be in Turkish adding to the complexities. It is not acceptable to assume or insist on speaking and writing in English for the benefit of a foreign deployed medic over a Turkish medic. The use of local residents as non trained medical interpreters is unsafe and will limit the delivery of effective care.
- 20,000 strong healthcare volunteers - Doctors Worldwide Turkey has a volunteer database of over 20,000 Turkish healthcare workers, who are better suited to deliver medical care not only because they can do so in the language of the affected people, but crucially because they are familiar with the local health system and they understand the local referral pathways.
- The Turkish healthcare workers have the expertise and skills - appreciating the sovereignty and autonomy of the local medics who know what they are doing is part and parcel of the ethos and principles of DWW. To overlook this has worrying undertones of western superiority complex.
- Scale up and surge response is possible within the first 24 hours when local medical teams are deployed, therefore being able to provide medical care within the critical window. International medical volunteers will need time to adjust and understand the conditions and medical set up, all the while costing valuable time and impacting lives.
- Standards and medical equipment - healthcare teams need to abide by rigorous standards and will require a large pool of medical resources and equipment to ensure operational delivery as well as clinical care can be met - not only is there a massive initial outlay of cost, but there is also the ongoing procurement and supply chains [and cold chains] to consider - imagine trying to save a baby and you did not have the right paediatric IV lines because you forgot or did not consider it - experienced medical teams have the logistics and standards in place to ensure this does not happen.
- Cost and self-sufficiency - sending clinicians from overseas is a significant financial burden. Not only can donor money be better spent on utilising local staff and resources, but there are additional costs burdens to consider such as accommodation, flights, meals, safety equipment etc. An ill-prepared clinician travelling to Türkiye may find themselves coming straight back, all the while having wasted funds that could have been better utilised by giving it to established medical organisations. Please dont think this is rare, it happens multiple times.
- When deployment becomes necessary - If and when appropriate, reputable medical organisations will make specific requests/call outs for skills that are needed based on thorough needs assessments, coordination and context analysis. Then a deployment becomes both needed and integrated. This will ensure the most relevant utilisation of a clinician’s time and ability.
The scenes of devastation and suffering are difficult to process and the immediate human reaction is to want to help. You can show solidarity by supporting your Turkish colleagues who are already responding and continue to remain available to serve the needs of the victims of this disaster. You can demonstrate your sincerity by being willing to respond to the calls for assistance when they are made specific to your skills and abilities and being flexible in your approach when called to do so. The best way to help right now is to donate to reputable organisations who are established and have the necessary compliance and accountability levels in place to ensure every donation reaches the right places, whilst ensuring the highest level of integrity and putting the quality and safety of medical care for every patient at the core of our response. Those who have been impacted by this disaster need your support, but they don’t need you to be there to deliver it. Our teams are fulfilling that responsibility in the best way that is possible currently, and we welcome you to support our efforts.
Donate to Doctors Worldwide’s Turkey Earthquake response here.