Türkiye’de Bulunan Suriyeli Sığınmacıların Ulusal Sağlık Sistemi Üzerine Etkisinin Değerlendirilmesi

Abstract

Due to turmoil and internal armed conflict in Syria which started on 15th of March 2011, millions of people took refuge and flooded in neighboring countries such as Turkey, Lebanon, Jordan and Iraq. Refugees preferred Turkey as the priority because of several reasons such as its longest border with Syria, being more reliable than other neighboring countries, probabilities to cross to Europe. In reference to UNHCR, The Republic of Turkey is the country that hosting largest number of Syrian refugees by 3,632,622. Turkey initiated comprehensive programs and systems in many areas in order to protection, education, health, labor, shelter, humanitarian aid through both public organizations and NGOs. Health, which is one of the most important needs of refugees who were obliged to leave their homeland with the fear of death, states in the Universal Declaration of Human Rights that "Everyone has the right to a standard of living adequate for the health of himself and of his family, including food, clothing, housing and medical care and necessary social services" The aim of the study is assessing the services which were received by Syrian Refugees in between the years 2011-2017 and assessing its impact on National Health System. This research is a descriptive and cross-sectional epidemiological study. The research was carried out between July 2017 and June 2019. Qualitative and quantitative methods were used together. In qualitative research method, document analysis was conducted and MAXQUDA qualitative data analysis program was used for data analysis. Between 2011 and 2017, the legislation on asylum seekers was examined under the titles of scope, access, utilization and administrative arrangements of health services. Quantitative data consists of two parts. Firstly, data on 112 emergency health services records in Emergency Health Automation System (ASOS) between 2011-2017, secondly data on hospitals, family medicine and community health centers between 2011-2014 from Net Decision Support System (NKDS) another data obtained from the Decision Support System (KDS) between 2015-2017 years. The Big Data size that used is 89 GB. ORACLE SQL Developer program was used for the analysis of the data and the frequency analyzes of the person, place and time characteristics of the health services that the Syrian Refugees (SS) received between 2011 and 2017 were revealed. EMS was intervened to 16,009,524 cases. 34,973,029 examinations were performed in the NHS during this period. The number of drugs which prescribed is 31.685.468. 9.7% 112 cases in EMS occurred in December, %26.8 in winter, and most cases were in 2017. According to the type of call, 47.4% of the cases reached to Call Center by Phone. 76.9% of total cases applied due to medical reasons, 7.3% due to traffic accidents and 6.1% due to other accidents. 66.6% of the cases resulted in transport to hospital, 13.9% between hospitals, 22.7% rejection of tranport and 3.6% on-site intervention. 1.2% of the cases (187.661) were left as ex in place, 0.1% resulted in transport as ex to morgue. The number of Syrians using air ambulance vehicles is 7,357. The most airborne ambulance station carrying the sick or injured is the Air17 helicopter ambulance in Çanakkale. According to ICD10 diagnostic codes, 52.9% accidents, 14.5% symptoms, signs and abnormal clinical and laboratory findings are not classified elsewhere, 7.8% circulatory system diseases, 7.1% injuries, poisoning and some consequences of external causes. Approximately 35 million people from the NHS have benefited from hospital services. About 40% of NHS beneficiaries are under 18 years of age. The proportion of those under 5 years of age is 15.8%. 55.8% of the beneficiaries are women. 33.4% from Mediterranean Region, 29.2% from Southeastern Anatolia Region and 19.0% from Marmara Region. The provinces that benefited the most from health services were Şanlıurfa with 18.7%, Gaziantep with 15.8% and Hatay with 15.1%,. First three districts are Kilis Center, Sehitkamil Gaziantep and Suruc Sanliurfa. December and November are the months when Syrians applied mostly for the health care. According to the types of Instutitions, 44.0% of the applications were made to public hospitals, 15.0% to family medicine, and 13.3% to training hospitals, the utilization of dental hospitals is 4.3%. According to the outpatient clinics, the top ten outpatient clinics that Syrians benefited the most were emergency medicine, family medicine, public health, pediatrics, gynecology and obstetrics, internal medicine, dentistry, ENT, ophthalmology, orthopedics and traumatology. 85,763 people benefited from intensive care services and 1050 Syrians from burn intensive care unites. Syrians have applied for 1.727.344 times of dental policlinic examinations. Dental and maxillofacial surgery (8,9%), pediatric dentistry (2,0%), restrorative dental treatment (1,1%), prosthetic dental treatment (0,2%), oral tooth and jaw radiology (0.2%), endodontics (0.2%), periodontology (0.2%), orthodontics (0.1%). According to the ATC code groups of the drugs, the most common drug groups were respiratory system with 19.2%, gastrointestinal system and metabolism with 17.1%, and systemic antiinfectives with 15.6%. Family medicine and emergency medicine are the most commonly prescribed polyclinics. As a result, it was found that the service provided to the Syrian refugees from the National Health System was not different from that provided to normal Turkish citizens. It was also found that there are access to health services such as burns, cancer, which require high cost and special care. It is determined when evaluated under key headings by WHO's recommandation of "Review of the Health System Capacity for Crisis Management Tool" that Turkey's National Health System, in order to the leadership and governance, health workforce, health care financing, immunization, medicine and technology, health information systems and the provision of health services; is a resilient sytem that focuses on human being without discrimination, agile, fair, exemplary and sustainable.

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