TURKEY

Returning To A Syrian War Zone, To See A Dentist

Syrian doctors can't get licenses to practice in Turkey, leaving millions of new refugees fighting to find care

TURKEY
Patients wait to see a doctor at a clinic in Istanbul, Turkey. — Vocativ
May 18, 2016 at 5:49 PM ET

Hundreds of Syrians line up every evening at 5:30pm on a sidewalk in Istanbul’s Fatih district, spilling onto the street and causing a traffic jam. Most are mothers toting children, hoping to see a doctor at one of the city’s only clinics that offers them medical care. Every evening since last November, Bezmialem Foundation University Fatih clinic transforms into a facility for Syrians run by the charity Doctors Worldwide Turkey.  Seven Syrian doctors and a handful of nurses treat more than 300 patients a day. 

The facility can only offer basic services like blood tests, x-rays, and advice on what kind of medicine to get, but doctors and patients say many more such clinics and more resources need to be devoted to meet the needs of nearly 3 million Syrian refugees in Turkey. With no end in sight for the war, a central point of concern is whether or not Syrians can find a place to call home in Turkey.

At the clinic’s registration desk, men and women form separate lines waiting to register themselves and get assigned to the appropriate medical specialist. In order to receive care, they must present a Turkish kimlik, an identification card they receive after registering with authorities as Syrian refugees, in order to qualify for temporary protection in Turkey.

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Syrian refugees who have a kimlik can theoretically receive free medical care in Turkish public hospitals, but the facilities are often overcrowded and the doctors and staff do not speak Arabic or English, making it difficult or nearly impossible for patients to communicate.

“I see around 50 patients in 4 hours, compare that to what a Turkish doctor might deal with, say 50 patients in 8 hours,” says Zakaria Sallan, a pediatrician who came to Turkey two years ago from Damascus. “We need more clinics like this, but one problem is we Syrian doctors cannot get medical licenses here,” he says.

In order to practice in Turkey, physicians educated abroad must pass a series of exams to obtain a license, but currently the Turkish Ministry of Health does not, as a policy, allow Syrian doctors to obtain this license. “Turkish officials usually need an official body in the country the physician is coming from to certify their background, but for Syria, no such link exists since the start of the war,” explains Sallan. “And our Syrian leaders [for the refugee population in Turkey] don’t seem to care about solving this problem, they are not trying to cooperate with Turkish authorities to develop a system. If you solve the problem of licensing for Syrian doctors, all our other problems will be solved as well.”

Because the Bezmialem Clinic is technically a humanitarian facility, the doctors there cannot write proper referrals to Turkish hospitals, and the prescriptions they write are only accepted at a handful of nearby pharmacies where the workers overlook laws that require proper licensing for the scripts.

To cater to the demand for medical care, private clinics have sprung up around Istanbul where Syrian doctors without local licenses provide medical care. At the nearby Noor Clinic, a schedule on the wall lists days you can see an orthopedic specialist, a gynecologist, a dentist, an optician, a neurosurgeon, and other specialists. The clinic sees about 200 patients a day, and more than 27 Syrian physicians are on hand. A pharmacy inside the clinic is stocked with basic medicines so the patients do not have to go to Turkish pharmacies except for a handful of tightly controlled drugs.  Patients pay only 15 TL ($3) to be seen by a doctor and small fees for tests.

Muhammad, 26, waits to see a pediatrician for his eight-year-old son, who has had a fever for a few days now.  He declined to give his full name because he still has family in Syria. “I came here because it is cheap and because in my experience the Turkish hospitals don’t care if you are a Syrian. They see you as a refugee and not as a person.” 

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Muhammad says the situation has gotten so desperate some Syrians go back to the war zone to get medical treatment.  His 21-year-old brother went to a Turkish dentist last August to have a tooth removed. The next day his cheeks and his eyes were all swollen up. “So he went to the emergency room at a Turkish hospital and the doctor didn’t even examine him really, he gave him an injection and didn’t explain what it even was.” The swelling got worse, and over ten days Muhammad’s brother visited two government emergency rooms but got little attention, so he finally decided to return to a rebel-controlled area in Aleppo to see a doctor there. “He convinced some Turkish border guards at Bab al Hawa [border crossing] to let him through,” Muhammad explains, “and it took him a month to find a doctor in Aleppo, but he did, and he eventually returned to Turkey.”

“That’s the medical system here for us, my brother had to go back to Aleppo to get a simple thing like an infected tooth looked at.”

“At a Turkish hospital, first you need a kimlik, and even if you have one, the main problem is translation, sometimes they are not even trying to translate,” explains Hassan, a former anesthesiologist now moonlighting as a dermatologist at the Noor Clinic. “And there is a big disconnect between Syrian patients and Turkish doctors. For many simple problems they [Syrians] go to a Turkish hospital and they don’t treat them well, or they don’t give proper attention, and the problem gets much worse, even for simple things.”

Dr. Sallan, the Syrian pediatrician at the Bezmialem Clinic offers the example of a seven-month-old baby boy he recently treated. The child, named Ahmet, belonged to a family that had lived in Istanbul for two years, and came to see Sallan when the child had problems breathing. “It was a very clear problem, the child was malnourished because of a metabolic condition from birth, and he was suffering from hepatomegaly [an expanded liver].”

The family was too poor to go to a private clinic, so Sallan advised them to go to a public Turkish emergency room. The emergency room physicians though, told Ahmet’s family to simply give the baby more milk, so a few days later the father brought the child back to Sallan. “I told him the child needs glucose, he needs oxygen, and he needs to be constantly monitored. I don’t have anything to give to your child, take him again to an emergency room.” It took three tries before Ahmet was finally admitted into a Turkish government hospital, says Sallan.  “They kept him for three weeks, and every day the father would come visit me to tell me how the baby was doing. Then one day he came to tell me the baby died.”

“That baby’s condition was a clear well known problem, and it only got worse because he was not given proper attention,” Sallan says. 

“Out of say a hundred good cases, I see ten where [Turkish hospitals] don’t give proper attention. That’s a big number.  Someone should go and investigate the doctor who examined that baby that eventually died.”