After the February 6 earthquakes, we share an interview with Zerrin Oğlağu and Neşe Yorguner, volunteer psychiatrists who went to Adıyaman and Hatay.
How did you decide to be among the volunteer psychiatrists from the Psychiatric Association of Turkey going to Adıyaman and Hatay?
Zerrin: I have been interested in and working in the field of individual and mass trauma since the first years of my assistantship. I had previously worked in the field during the Hopa events, the explosions in 2015, COVID-19 and the Van earthquake. Therefore, when I heard the news of the February 6 earthquake, I can say that it did not take me long to decide to go. The Psychiatric Association of Turkey, which has been working in the field of disaster and trauma since the 99 earthquake, had already started working from the first hours, so I reached out to the coordinators in this field and submitted my request to go.
The first days of disasters are actually the days when more vital and basic needs must be met, and it is then that our duty starts. In other words, people must first be pulled out of the wreckage, the lost ones must be buried, living and sheltering areas must be created, clothing and food must be provided, and then the mental needs must be met. But in this process, more than a month after the earthquake, we see that these things have still not been fully realized. For this very reason, we can say that mental needs cannot be postponed any longer.
It was with these motives that I set out to reach Adıyaman on February 16, because psychiatrists, like all other health professionals living and working in the city, were actually earthquake victims and had to leave the city with all their losses.
Neşe: Although I had decided to volunteer on the first day, the painful news from the region caused me to worry about not being able to cope with the stories I would encounter in a mental sense. But then I realized that not being there, watching from afar, created a greater helplessness and strain, and I decided to go. I am glad I went.
What would you like to say about the gap between your assumptions on the way to the earthquake zone and the reality you encountered?
Zerrin: Before I went, of course I was expecting that the gap between what was shown in the mainstream media and what actually happened would be huge, but I could not have foreseen that the destruction in Adıyaman would be so massive. Because the destruction started from the point you entered the city and it was not possible to live in the buildings that were still standing. The only way to get around the city was by private car and there was not a single open shop.
There were many tent cities, large and small, and with dispersed settlements, and hot meals and necessities were distributed both there and at central points in the city. In terms of tent supply, Adıyaman did not seem to be in a very bad situation. However, it was very cold at night and the efficiency of the tents in this sense was quite low. Of course, what I am saying here only covers the city center and the first weeks because I did not have the opportunity to go to the districts and villages and I know that things are not so organized there. Moreover, just in the past few days, we have seen how sloppy and unplanned the existing tent cities have been set up. With the rainfall, which had been warned much in advance, there were very obvious problems in the tents and there was no space for people to shelter.
The most basic and unmet needs of people seemed to be toilets and showers. It is almost impossible to maintain the cleanliness of existing toilets in places of mass settlements, and this was the case there. Shower cabins, on the other hand, seemed quite dysfunctional for the use of women and children, both in terms of their location and size. This is why I was hearing that a large number of the women I spoke to were going into their damaged homes for these needs.
Primary health care and women’s health services were very limited. The city’s obstetrics and gynecology hospital was serving in a field hospital tent because it was damaged, and as I said, there was no public transportation and therefore no possibility for poor women to reach a doctor. Most of the family health centers were closed because they were damaged, and there were no dental services. I can add that all these services were provided by the volunteers of the Turkish Medical Association, who were present in the field from the first days and worked with both fixed and mobile units.
Within days, of course, family health centers started to open in tent cities, and very basic services such as pregnancy follow-up and vaccination became more accessible. My guess is that the situation is better now.
Another outstanding issue, of course, is the lack of organization. There was massive disorganization in state-based services. Even different ministries could not coordinate among themselves, for example. In terms of civil society organizations, I have to say that only some (!) of them were allowed to enter the tent cities. The sociocultural and political climate did not allow for the presence of some volunteers in the field.
Neşe: The earthquake zone was physically much worse than what I saw on the screen, especially Antakya. In addition to the magnitude of the destruction, the smell of corpses in the city made the gravity of the situation even more evident. When I saw the region, I understood better why it is said “like an atomic bomb was dropped”.
On the other hand, being in contact with the people affected by the earthquake in the region, being able to accompany them through their difficulties, and meeting health workers and volunteers from NGOs from all over Turkey made me feel good mentally. Instead of the feeling of helplessness and frustration that I was worried about at the beginning, I felt more optimistic than I expected.
One of the things that particularly struck me about the people affected by the earthquake in the region was the very different conditions people were living in. For example, one group was staying in ship guesthouses anchored in Iskenderun Port, another group was staying in container cities, another group was staying in tent cities, another group was staying in their cars or in their houses that had not yet been checked for damage because they could not even find a tent. Some unfortunately slept on the ground in the park with a blanket they could find. We know that inequality of opportunity leads to secondary traumatization. Unfortunately, we will see more of the wounds this has caused to people in the region in the future.
Women and LGBTI+s are considered among the “disadvantaged” groups in disasters. Were there any situations related to being “disadvantaged” that you have observed that pose a high risk for mental health, what are they?
Zerrin: Unfortunately, women, children, LGBTI+s, migrants and the poor are disadvantaged groups in all traumatic life events. During my time in Adıyaman, I did not have any LGBTI+ applications, but this may be due to the short duration of my work and the reservations about applying due to the general conservative attitude of the city. However, what we know from other cities is that LGBTI+s face different challenges ranging from being blamed for the earthquake to housing problems, from increased domestic violence to sexual violence.
I described the inadequacy of women’s health services in the previous question, but it is worth emphasizing again. Those who stayed in Adıyaman after the earthquake are mostly poorer people and it is very difficult for them to access health institutions. How will they go to the maternity hospital? How will routine pregnancy and postnatal check-ups be done? Many pregnant women were rescued from under the wreckage or had walls and furniture collapsed on them, who will they go to? How will contraceptives, medicines and termination of pregnancy services be accessed? All these questions are still very much unanswered.
First of all, after such traumatic life events, women’s monthly bleeding cycles are very disrupted. There is a lot of unexpected and prolonged bleeding. Let us remember the demands for clean underwear and pads, which were more prominent in the first days. It was not easy for women to demand these, especially in a closed society like Adıyaman. Let’s say they found them, it was very difficult to find a healthy, clean, accessible and safe toilet. It is possible to say that during the design of the tent cities, the toilets were quite far away and unsafe to reach at night, which especially affected women and girls. Under these conditions, how can women and girls bathe in safety? How is it possible to protect mental health when every moment and every area of life is under such a sense of insecurity and threat of danger?
Another important consequence of this sudden change in living spaces, living in a small space like a tent and in crowded groups, is the increase in women’s care labor and the frequency and severity of male violence against women. It is possible to predict that we will hear about this more frequently over time.
Neşe: As far as I could observe, hygiene was a big problem especially for women. The low number of public toilets per person posed a great risk in terms of cleaning difficulties and infection. Apart from that, shower facilities were very, very limited. In some tent cities where refugees were staying, there were no toilets or even washbasins, let alone showers.
Another problem was security. I heard that women were forced by their husbands to have sexual intercourse and that they felt helpless because they had nowhere to go in that environment. It can be said that the feeling of loss of control created by the disaster is likely to be deepened by such incidents and that the impact of the trauma is likely to create greater psychological consequences.
Women’s organizations continued to work and stand in solidarity during the disasters. Were there Women’s Tents, Women’s Health Units in the regions you were in? Could you tell us a little about the contacts you experienced in the name of women’s solidarity?
Neşe: In Antakya, I came across the examination tents of obstetrician-gynecologists, tents of women’s organizations such as Mor Dayanışma [Purple Solidarity], and tents of physician friends from the women’s commission of the Turkish Medical Association. Seeing these in the midst of all that poverty made me feel like seeing a loved one. There must be other non-governmental organizations making efforts that I have not seen, the efforts of each and every one of them are very valuable.
Zerrin: I was in Adıyaman from the 10th day of the earthquake, so the women’s tents had not yet formed, but feminist women were in the field and were working. For example, I met my feminist women friends from Istanbul in a cemevi in the city center and I can say that it was very good for me personally to see them there. Because in the post-disaster chaos, services are tried to be produced without considering all disadvantaged groups, but mostly women, and this is always missed. The presence of organized women was refreshing in this respect. Afterwards, fixed women’s tents started to be set up anyway.
What do you think awaits us in the coming months in terms of women’s and LGBTI+s’ mental health after the earthquake? What can we do to support each other’s mental well-being and what should we avoid doing?
Neşe: We know that discrimination and security problems increase during times of natural disasters, and that people need more social support than ever to cope with loss, destruction and trauma. It is necessary to be careful not to deepen the difficulties experienced by LGBTI+s, who are already among the groups that are most discriminated against in society, in the presence of such a chaotic process.
To give a few examples; many people were displaced from their homes in the earthquake region. One of the most important needs in this period is to be able to settle in safe shelters. Especially LGBTI+s, when they become homeless or settle in new places, may face discrimination due to their gender identity and sexual orientation and may experience more security problems. In other words, this is a period of greater challenges for disadvantaged groups in terms of settling in a new place where they can feel safe. It should also be kept in mind that access to medicines, medical supplies and social support are also important needs during this period. It is imperative to ensure that these people can access the social support and health services they need as much as others without being discriminated against, and to provide them with the housing opportunities they can feel safe in.
If these are not provided, secondary traumatization can lead to more intense post-traumatic stress disorder, depression and other psychological problems.
Zerrin: We can predict that all mental illnesses emerging after the earthquake; primarily post-traumatic stress disorder, major depression and anxiety disorders will be more common in disadvantaged groups. In addition to these, we can say that women and LGBTI+s will be at risk of domestic violence, sexual violence and being forced into early marriage. It should be added that all these mental strains will also increase the risk of suicide.
The only way to support our mental health in this period is solidarity. Both in the earthquake zones and in the cities of migration… Solidarity will be good for both the earthquake victims and those who follow what is happening from outside/remote.
Do you have anything to add?
Zerrin: In the aftermath of traumas/disasters of this magnitude, not only the peoples of the region but actually all witnesses are affected. Especially in the first periods, there is an intense desire and behavior to help among everyone, which is a very good thing. Over time, however, sending aid diminishes. However, this is a process that needs to be thought and planned in a much longer term. I would like to say this firstly for the state service, but also for civil society. The most important agenda for the coming years should be the earthquake.
Neşe: I think the impact of the volunteers of non-governmental organizations who can properly witness what happened in the midst of such a major disaster and keep the feeling of solidarity alive is very important. It is very valuable for the people there to know and recognize the difficulties they are experiencing, and to make them feel that the problems experienced will be tried to be solved even if they are not solved immediately. There is a lot of work to be done, but I think this work can be overcome with solidarity.
How can they reach you for support?
Neşe: The support chain of Psychiatric Association of Turkey volunteers continues in the earthquake zone. Although I cannot be there today, I know that my friends with similar feelings are continuing the duty. If people affected by the earthquake in the region have difficulties in coping, they should definitely apply to the areas where volunteer psychiatrists are located. Maybe not every problem can be solved in this process, but I am sure they will do their best.
Zerrin: The Psychiatric Association of Turkey has started to provide volunteer services that can be accessed online, and the Istanbul Psychosocial Solidarity Network, of which it is a component, is taking individual and group applications. It is possible to apply to these resources to work on earthquake trauma.
PAT Online Support: https://tpdruhsaldestek.psikiyatri.org.tr
For the original in Turkish / Yazının Türkçesi için
Translator: Gülcan Ergün
Proof-reader: Müge Karahan
