Press Release by the Republican People's Party Scientific Advisory Committee on Health Policies

IT IS ALSO NECESSARY TO PREPARE FOR EXTRAORDINARY SITUATIONS IN TERMS OF HEALTH MANAGEMENT!

Starting from February 6, 2023, the earthquakes we are experiencing in recent days have caused significant human losses and suffering that is very difficult to be relieved of and have overwhelmed us all with great sorrow. We are sending condolences to our nation.

As the Scientific Advisory Committee on Health Policies of the Republican People's Party, in light of the earthquakes centred in Pazarcık and Elbistan in Kahramanmaraş province, we would like to share our approach and suggestions for solutions to health problems that may arise in extraordinary situations, based on the stages recommended by the World Health Organization.

At the national level, emergency response preparation should set out to achieve the following strategic objectives:

- operational readiness to respond to situations,

- a health system,

- 'One Health' approach on the interface and

- 'Whole State' and 'Whole Society' approaches including democratic mass organizations, civil society organizations and volunteers.

First of all, we would like to express clearly that the emergency readiness of our country has been very inadequate; the Pazarcık and Elbistan earthquakes have turned into an unnatural disaster that violated the right to life of people and caused extraordinary destruction and deaths that the intensity of the earthquakes cannot explain. An earthquake, as it is known, is a violent and sudden tremor of the earth caused by the movement between tectonic plates along a fault line in the earth's crust. What transforms an earthquake from a natural phenomenon into a disaster is the societal process that central and local governments are primarily responsible for ignoring this violent and sudden tremor.

One of the essential dimensions of this process is the field of health. The failure to establish a resilient health system in our country and the bitter cost of continuing to provide services in earthquake-resistant hospitals have been revealed by the health workers and patients who lost their lives in the collapsed hospitals. The Ministry of Health and local administrators are directly responsible for the deaths of health workers and patients trapped under the rubble of collapsed public and private hospitals in Antakya and İskenderun.

In extraordinary situations, health management should function in four main phases:

Health Management and Risk Mitigation,

Be,

and

Prevention and Risk Mitigation

Preventing the adverse health effects of a possible earthquake and reducing the risk is only possible with a robust health system and earthquake-specific health programs. As the World Health Organization emphasizes, the most critical condition for preventing all-natural events, including earthquakes, from turning into unnatural disasters and catastrophes is to take precautions against disasters and ensure risk reduction in advance. There is sufficient scientific knowledge on precautions against earthquakes and risk mitigation. The problem in our country is that scientific knowledge is not appreciated, and the precautions and risk mitigation indicated by science still needs to be implemented.

A 'Strategic Risk Assessment' should guide risk-informed programming to accelerate action to prevent, prepare for and mitigate risks associated with a particular hazard and its health consequences before an earthquake strikes.

The Pazarcık and Elbistan earthquakes have painfully demonstrated the tragic consequences of complacency in prevention and risk reduction. In this context, it is urgently necessary to formulate realistic disaster management plans involving all stakeholders nationwide. On the other hand, the Pazarcık-Elbistan earthquakes indicate that such a plan is impossible with the current functioning and capacity of the Disaster and Emergency Management Presidency (AFAD) under the Ministry of Interior. Furthermore, our observations in the earthquake zone indicate no coordination between AFAD and the Ministry of Health but instead a conflict of authorities. For this reason, a health earthquake structure in which the Ministry of Health, local administrations, health professional organizations, speciality associations and civil initiatives can work together on the health problems that will be caused by possible earthquakes in our country, especially the Marmara/Istanbul earthquake, should be implemented.

Readiness

Country-level readiness means that all sectors and systems are prepared to manage risks at national and local levels in communities, rural and urban environments, health facilities, laboratories, emergency departments and the health system in general.

Readiness is a fundamental prerequisite for effective response and includes:

Assessing hospitals and all health facilities for safety and functionality.

Establishing an excellent laboratory network.

Setting up systems for disease surveillance.

Using disaster-specific software.

Engaging communities for risk communication.

Ensuring the sustainability of health service delivery in the face of an extraordinary emergency should be well-planned. All buildings in which health facilities provide services should first be risk assessed for their seismicity. In addition, retrofitting or reconstruction steps to prevent the collapse of health institutions, as was the case in Antakya and Iskenderun, as well as the pre-determination of the health team from outside the earthquake zone to replace the health workers who will be affected by the earthquake and ensuring their transportation at the time of the disaster, are vital. Unfortunately, the Pazarcık/Elbistan earthquakes revealed the inadequacy of the public authority on these two critical topics.

Intervention

Effective emergency intervention immediately after an earthquake strike means implementing life-saving health interventions to ensure that the affected population has timely access to quality health services. This mitigates the health impact of the earthquake emergency, ensures public safety, enables people's needs to be met, and ultimately saves lives.

During the intervention, life-saving health interventions should be carried out in collaboration with health partners to ensure timely access to quality health services without leaving anyone from the affected population behind, use timely registration and identification practices, and provide pre-positioned primary health care services.

In the aftermath of an earthquake or any other natural disaster, instead of a hospital-based health service provision, as is presently practised in the earthquake region, a primary care-based health organization based on temporary settlement units should be designed, and hospital-based services should support this organization.

Regular and planned visits and follow-ups should be organized for the people living in tents and containers, especially the elderly, pregnant women, infants and disabled people, by providing on-site health care services.

The primary health care service activity to be organized should not be considered only in its curative dimension; on the contrary, it should be supported by a mobile laboratory team to be established, especially on water control, sanitation and waste management. Similarly, an active surveillance system should be implemented to detect possible epidemics in temporary settlements early.

In the post-disaster intervention period, an approach considering vulnerable groups may be subjected to social exclusion mechanisms, such as children and the elderly, pregnant women and those with chronic diseases, or the disabled, migrants, and LGBTIQs should be implemented.

All aspects of health determinants should be considered at every moment of the disaster. In addition, psychosocial support should be provided to those affected by the earthquake or those who go to the earthquake zone for support, starting from the search and rescue phase.

Domestic and wild animal life, agricultural basins and wetlands should be protected by approaching the health field holistically from a "single health" perspective.

Special planning should be undertaken for issues such as asbestos exposure during the removal of rubble, which may profoundly impact individual and public health.

Recovery

The recovery stage includes the precautions and measurements taken after an earthquake to bring the area back to normal. It is a time to learn from the experience and build better; it is an opportunity to strengthen health systems for the future. After the devastating effects of the earthquake have begun to subside, the recovery phase is about ensuring that the health system continues to function and, as a result, rebuilds better for the future.

In this stage, the approach should be that no one will be safe unless everyone is safe. In this phase, health services shift from emergency risk management to routine services and rehabilitation. Therefore, it is essential to establish a resilient health system based on primary health care services.

Healthcare workers exposed to the earthquake should be allowed and supported to overcome the psychological, physical and economic trauma they have experienced. In addition, they have experienced secondary trauma due to fulfilling their duties in intense, stressful and prolonged working conditions and environments after the earthquake to take care of themselves and their families and to cope with their pain. Therefore, healthcare workers should be assigned to these regions by rotation.

The physical and mental conditions of health workers (including those working in private hospitals) in the earthquake zone should be assessed to determine whether they are fit to provide health services, and the healthcare workforce planning in the country should be reconsidered in the context of the data obtained. Furthermore, arrangements should be made to prevent any loss of rights regarding the personal rights of health workers in the earthquake zone.

Health workers' needs and working conditions in the earthquake zone should be evaluated regardless of whether their duty is in Ministry of Health hospitals or university hospitals. Furthermore, arrangements should be made to ensure that health profession students' theoretical and practical training is not interrupted.

The current conditions of hospitals (including private hospitals), family health centres and community health centres in the earthquake zone should be assessed to determine whether they are suitable for providing health services. Cooperation should be established with relevant institutions and organizations to reconstruct health facilities and retrofit existing buildings. Work should be started as urgently as possible to assess the earthquake resistance of all health institutions in the country and to carry out the necessary reinforcement works.

The needs of the injured survivors of the earthquake should be determined, and the necessary units and functioning should be established, especially in major cities (needs for materials such as orthotics/prosthetics for those who lost their arms or legs, rehabilitation programs, etc.). The co-payments for health services, outpatient physician and dentist examinations, outpatient prosthetics and orthotics, outpatient medication and assisted reproduction method treatment, which we aim to abolish entirely in the health system we will establish as CHP, are currently applicable in the health system, should not be taken from citizens who have experienced the earthquake even after the SoE period. On the contrary, they should be given priority in the central appointment system.

Diagnosis-treatment processes regarding infectious diseases (cholera, scabies, etc.) that emerged/may emerge in the earthquake region, as well as what needs to be done to prevent and control epidemics - not limited to the earthquake region - should be shared with the social and health workers throughout the country. In addition, monitoring systems that will ensure close and strict tracking of the relevant diseases should be established, and the data gathered should be shared rapidly.

Measures should also be taken to ensure the education system is not negatively affected during recovery. In this context, face-to-face education, suspended in universities after the Kahramanmaraş earthquakes, should be resumed immediately. Face-to-face education will allow students to benefit from crucial social support resources such as socialization and being together with their peers in overcoming their trauma. Face-to-face education will also ensure students' right to quality education is not violated.

It is known that the traumatic effects of all disasters that cause great destruction, especially earthquakes, persist for a long time. However, on the other hand, such major traumas can also allow societies to realize the problems they have overlooked, overcome prejudices about differences and feel that solidarity is a healing that heals everyone's wounds. Undoubtedly, which of these aspects will evolve depends on the political power of the country's approach to the disaster, its ability to unite and integrate the society, to self-criticize and democratize its administrative structure by feeling responsible for the destruction. For this reason, the way to recover from the Pazarcık / Elbistan earthquake, which has become a humanitarian disaster, is to heal each other's wounds with solidarity, liberate the country we live in, and democratize the political power of the country.

To ensure readiness for all kinds of emergencies at national and international levels, there is a need for a common, efficient and coordinated multi-sectoral approach that includes measures specific to all hazards. The Republican People's Party is ready to realize this approach.

Republican People's Party Scientific Advisory Board on Health Policies