Practicing in exile: Syrian healthcare professionals working in informal outpatient clinics in Istanbul
| Published date | 01 June 2022 |
| Author | Aral Sürmeli,Yesim Yasin,Tuana Umay Tolunay,Inci User,Pinar Topsever |
| Date | 01 June 2022 |
| DOI | http://doi.org/10.1111/imig.12906 |
188
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International Migration. 2022;60:188–208.
wileyonlinelibrary.com/journal/imig
Received: 20 Jul y 2020
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Revised: 24 May 2021
|
Accepted: 4 July 2021
DOI: 10.1111/imig.12906
ORIGINAL ARTICLE
Practicing in exile: Syrian healthcare professionals
working in informal outpatient clinics in Istanbul
Aral Sürmeli1 | Yesim Yasin1 | Tuana Umay Tolunay2 | Inci User3 |
Pinar Topsever4
© 2021 The Author s. Internationa l Migration © 2021 IOM
1Departme nt of Public Health , Acibadem
Mehmet Ali Aydin lar University S chool of
Medicine, At asehir Istanbu l, Turkey
2National Ins titutes of Health , National
Cancer Inst itute, West Bethes da, MD, USA
3Departm ent of Sociology, Aciba dem
Mehmet Ali Aydin lar University S chool of
Arts and S ciences, Atasehi r Istanbul, Turkey
4Deparment of Fa mily Medicine, Acib adem
Mehmet Ali Aydin lar University S chool of
Medicine, At asehir Istanbu l, Turkey
Correspondence
Yesim Yasin, Depart ment of Public Healt h,
Acibadem Meh met Ali Aydinlar Unive rsity
School of Medi cine, Icerenkoy Maha llesi,
Kayisdagi C addesi No 32, 34752, Atase hir
Istanbul , Turkey.
Email: yesim.yasi n@acibadem.ed u.tr
a.surmeli@medak.org.tr
Funding Information
This study is f unded through Aci badem
Mehmet Ali Aydin lar University S cientific
Research Proj ects Committ ee (ABAPKO) for
10,000 Turkish L iras in 2017, with decree
number 20 16/05/08.
Abstract
Turkey hosts the lar gest proportion of Syria n refugees
worldwide. Although Syrian refugees e njoy similar rights
to health as Turkish citizens, some barriers can limit ac-
cess to healthcare in practice. The healthcare needs of the
Syrian popul ation led to t he emergence of "informal" clin-
ics oper ated by Syrian healt hcare professionals w hom the
Ministry of Health does not authorize to practi ce in Turkey.
This qualit ative study explores the views of 22 healthcare
professionals working in s uch clinics about health provi-
sion for Syrian refugees. Fo cus groups and in- depth inter-
views were transcribed and thematically coded. Language
and c ultural barrie rs, ill- effects of immigr ation, insecurit y
concerning living conditions and expected lawful contri-
bution to health services emerged as themes. Participants
suggested that formal authorization to practice in Turkey
for the Syr ian healthcare work force would be a good step
towards caring for the Syr ian population in Turkey.
KEYWORDS
barriers to acce ss to healthcare, infor mal outpatient clinics ,
Istanbul, li censing, Syrian healthc are professionals, Syrian
refugees, Turkey
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189
PRACTICING IN EXILE
INTRODUCTION
According to data from UNHCR (The UN Refugee Agency), some 5.6 million individuals have fled Syria, resulting
in one of the most signif icant humanitarian cr ises to have occurred since the end of World War 2 (UN HCR, 1951).
Turkey, which borde rs Syria, had adopted an op en- door policy towards Syrian refugees and became h ost to the
greatest number of refugees in t he World (UNHCR, 2020). In the in itial phase, the majority of refugees were
received into camps. Within t he last few years , however, this situatio n has been comple tely reversed. Acco rding
to current statistics, less than 2% of the Syrian population in camps or temporary shelters within five cities (MoI,
August 2020). The most dramati c rise in absolute n umbers took place in Istanbul. Istanbul har bors the highest
number in Turkey with 497.775 Syrian refugees , followed by Gaziantep, Hatay an d Sanliurfa (MoI, 2020 ).
The movement to urban settlement s led to demogra phic changes and an increasing need to provide healthcare
in the initial phase. To meet this demand, the Turkish Ministry of Health (MoH) reorga nized the primary healthcare
system. In the summer of 2014, the first migrant outpatient clinic began operating at the Community Healthcare
Center in the Gazios manpasa district of Ist anbul by the MoH. The total nu mber of such clinics is now 180, spre ad
out ove r 29 ci ties, but 32 based in Is tanbul (Hei nrich Böll Stiftung, 2020). Re gistered Syria n refugees have, in
theory, enjoyed the same rights as Turkish citizens in terms of access to pro bono healthcare since 2014, with the
intr oduct ion of Tempo rary Pr otect ion Stat us (Art icle 27) (Bilece n & Yurtse ven, 2018 ; Kaya & Kı raç, 2016 ). In prac-
tice, however, they face nu merous obstacles, t he most important of wh ich is the language barrie r.
In par tnership wi th the WH O, Turkey was one of t he first countries t o implement the polic y of integr ating
Syrian ref ugee health professionals wi thin the he alth workforce , starting on a pil ot basis as early as in 2014, in
the province of Gazia ntep (WHO, 2014). This approach has led to th e formation of migrant healt h centers staffed
with Syrian health profe ssionals providing primar y- care ser vices for the Syrian population in Turkey. Although the
exact nu mber of Syrian d octors residing in Turkey is unknow n, since 2015, t heir numbers have been decrea sing
(Erdogan, 2014). In line with it s policy, t he government has star ted implement ing an acc reditation pr ogram for
Syrian d octors and nurses designed to enable licensing, al lowing Turkey to use t his trained medical workforce
(Goksel, 2018). The firs t cohort of licensed Syrian doctor s and nurses has already starte d working in primary care,
providing healt hcare to the Syrian popula tion.
Hosting t he largest prop ortion of Syrian refugees, Turkey has been facing a tremendous chall enge regarding
providing we lfare services , like healthca re. In response to the unmet healthcare ne eds of the Syria n population,
"informal" out patient clinics oper ated by Syrian healthcar e professionals have emerge d. The local health a uthori-
ties tolerated them in Istanbul. In the transition p eriod from informally licensed to formally licensed practice (be-
tween 2014 and 2017), some Syria n healthcare profession als adopted a proactive appr oach to bridge the de facto
gap in healthcare for the Syrian population . They came up with the pragmat ic solution of running outpatient clinics
in urban neighborhoods with large numbers of Syrian inhabita nts. Two main factors were driving this action: in
the first place, un registered Syrian refugees wer e not entitled to receive any public serv ices. Secondly, it was only
possible to gain access to hea lthcare service s in the city w here the refugee has been initially registered. For t his
reason, many Syrians who resided in Istanbul but had initially bee n registered in a different town in Turkey we re
excluded from th ese services (Woods & K ayali, 2017).
Under Turkish legislation, non- Turkish health professionals need to apply for a license to practice medicine in
Turkey; hence the clinics wer e unofficial and unregist ered (TMA, 2017). To the best of the auth ors’ knowledge, at
the beginning of 2017, there were over 40 such clinics in Istanbul, mainly situ ated in and around a city district with
large refugee group s. As far as the authors are aware, when t he idea for this study was conceived, th ere had been
no study explicitly investi gating the perspectives of Syrian health profession als on the short comings of the Turkish
healthcare system regarding t he provision of healt h services for th e Syrian population. Given the lack of ver ified
facts conce rning such clinics, the mo st fruitful way to investig ate the phenomenon proved to b e interviewing the
clinic workforce, who have firsthand experience of the situation. Therefore, this qualitative study aims to under-
stand Syrian heal th professionals’ views about the hea lthcare system in Turkey in general, investi gate any barriers
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