Conditions for health care
All registered temporary protection beneficiaries, whether residing in the camps or outside the camps, are covered under Türkiye’s General Health Insurance (GSS) scheme and have the right to access health care services provided by public health care service providers.[1] The health care services are no longer free of charge following a legal amendment of 25 December 2019 and they have to pay a contribution fee determined by the Ministry of Interior Affairs to access primary and emergency health care services and medicines.[2] This does not apply to vulnerable groups, however. The practice of contribution fees is different in each province with no uniform application. Reimbursement is not foreseen in the law.
Persons who are eligible for temporary protection but have not yet completed their registration have only access to emergency medical services and health services pertaining to communicable diseases as delivered by primary health care institutions.
Temporary protection beneficiaries are only entitled to access health care services in the province where they are registered. However, where appropriate treatment is not available in the province of registration or where deemed necessary for other medical reasons, the person concerned may be referred to another province.[3]
The “income test” to assess means classifies the beneficiary according to the level of income. Persons in the “G0” class have health care premiums covered entirely, while individuals in categories “G1”, “G2” and “G3” proportionally cover some of their health care costs.[4]
Scope of health care coverage
Under the Turkish health system, differentiation is made among primary, secondary and tertiary public health care institutions. Health stations, health centres, maternal and infant care and family planning centres and tuberculosis dispensaries that exist in each district in each province are classified as primary healthcare institutions. State hospitals are classified as secondary health care institutions. Research and training hospitals and university hospitals are classified as tertiary health care institutions.
Temporary protection beneficiaries are entitled to spontaneously access initial diagnosis, treatment and rehabilitation services at primary health care institutions. These providers also undertake screening and immunisation for communicable diseases, specialised services for infants, children and teenagers as well as maternal and reproductive health services.
Temporary protection beneficiaries are also entitled to spontaneously approach public hospitals in their province. Their access to medical attention and treatment in university and research and training hospitals, however, is on the basis of a referral from a state hospital.[5] In some cases, state hospitals may also refer a beneficiary to a private hospital, where appropriate treatment is not available in any of the public healthcare providers in the province. In such a case, the private hospitals are compensated by the GSS scheme and the beneficiary is not charged.
As a rule, referrals to university hospitals and private hospitals are only made for emergency and intensive care services as well as burn injuries and cancer treatment. This is confirmed in practice in various cities where temporary protection beneficiaries cannot access the research and training hospitals without a medical doctor referral. Costs are not covered by the State promptly, however.[6]
97 million medical services, more over 3 million inpatient treatments, and 2,6 million procedures were delivered to Syrian beneficiaries in primary, secondary, and tertiary public health institutions up until March 2022. In addition, 754,000 Syrian babies were born in these public health institutions.[7] Among foreign women who had children in 2023, Syrian mothers were in the first place with 6,425 babies.[8]
Temporary protection beneficiaries’ access to secondary and tertiary health care services is conditional upon whether the health issue in question falls within the scope of the Ministry of Health’s Health Implementation Directive (SUT). For treatment of health issues which do not fall within the scope of the SUT or for treatment expenses related to health issues covered by the SUT, which however exceed the maximum financial compensation amounts allowed by the SUT, beneficiaries may be required to make an additional payment.
Free health care coverage for registered temporary protection beneficiaries also extends to mental health services provided by public health care institutions. A number of NGOs are also offering a range of psycho-social services in some locations around Türkiye with limited capacity. For instance, Türk Kızılay runs community centres providing services on health and protection. (Find more information in Reception Conditions: Healthcare)
With EU funding, in the frame of the “Improving the Health Status of the Syrian Population under Temporary Protection and Related Services Provided by Turkish Authorities” (SIHHAT-1) and (SIHHAT-2) projects, 190 Migrant Health Centres (Göçmen Sağlığı Merkezi) were established for migrants, especially targering Syrian beneficiaries of temporary protection in 32 provinces. Syrians can approach these centres as primary health care institutions. Migrant Health Centres employ 4,000 staff including 787 Syrian doctors, 1149 nurses, 34 dentists.[9] The EU-funded SIHHAT project supported and developed primary health care services to increase access to health services. The project mainly focuses on reproductive health, mental health and psychosocial support, immunization, mobile health services, cancer screening, and health literacy training. In 51 Migrant Health Centres; in addition to primary health care services, internal medicine, gynecology and obstetrics, pediatrics, oral and dental health services, laboratory, x-ray and psychosocial support services are also provided under the Strengthened Migrant Health Center structure. 10 Community Mental Health Centres and over 100 hospitals offer healthcare solutions in migrants’ native languages, with 4,000 health workers[10]. In 2022, over 7 million primary healthcare consultations were conducted in these facilities. Between 2017 and October 2023, these centres provided more than 33 million medical consultations and 9 million doses of vaccine were administered in these centres. The project also improved health infrastruc ture by constructing two new state hospitals in Dörtyol Hatay and Kilis[11].
In addition, the “Strengthening Health Care Infrastructure for All (SHIFA)” project aims to construct migrant health centres and provide medical equipment, maternity, health kits and capacity building with EUR 90 millions of support.[12] The project plans the construction or rehabilitation of primary health care facilities in 120 different locations across the country, with a significant focus to the earthquakes-affected zone. The third steering committee meeting was held in January 2023.[13]
In addition, NGOs have operated projects aimed at enhancing vulnerable groups’ access to health care. Doctors of the World (DDD) has been actively providing emergency response in Türkiye and northwest Syria from the onset of the eartquake. Supported by the MdM International Network, they have delivered comprehensive healthcare services, including primary health care, medicine distribution, sexual and reproductive health care, dignity and hygiene kits, mental health and psychosocial support, protection, case management, and support for secondary health care facilities. DDD has also operated mobile medical units for hard-to-reach areas and established a women and child-friendly safe space to assist the most vulnerable populations[14]. DDD implemented several projects in the affected areas in collaboration with international organisations:
A post-emergency response and reconstruction project which is funded by Agence française de Développement (AFD) and Fondation de France, started at the beginning of January 2024 aims to assist populations in Hatay province affected by the February 2023 earthquakes. The ongoing project focuses on providing primary health services, protection, and psychosocial support to the most vulnerable groups. Initially, DDD will deliver emergency response through mobile teams and “safe spaces” for confidential consultations, ensuring access to hard-to-reach areas. In the second phase, the project will transition to post-emergency response, incorporating capacity-building activities to gradually transfer services to local authorities[15].
Within the scope of a partnership between UNFPA Türkiye and DDD, another project on Provision of Sexual and Reproductive Health (SRH) services through Mobile SRH Medical Teams in Hatay Türkiye was completed between July 2023 and December 2023. The project offered both static and mobile sexual and reproductive health (SRH) services to the most vulnerable women and girls in Hatay province, including refugees, pregnant women, and lactating mothers[16].
Funded by IOM and PRM, DDD implemented a humanitarian project on primary healthcare services through Mobile Medical Units (MMUs) in Hatay province to restore the pre-earthquake healthcare system by deploying mobile medical teams to remote areas lacking regular access to primary healthcare. The project’s objectives were to provide timely and life-saving health and nutrition assistance to earthquake-affected populations, enhance community resilience, and support the rapid resumption of essential health services in underserved communities. The project included triage, outpatient consultations, management of communicable and non-communicable diseases, maternal and child health, nutrition services, immunizations, referrals, and health education[17].
Another project aimed to enhance the resilience of earthquake-affected communities in Türkiye by improving their physical and psychological health, particularly focusing on women and children. In response to mass displacement from cities like Antakya and Iskenderun to rural areas with less damage, DDD deployed mobile medical units (MMUs) to hard-to-reach locations and new displaced camps. These MMUs, comprising medical and support personnel, provided medical screenings, psychosocial support, and various health services. Key activities included primary healthcare consultations, sexual and reproductive health services, antenatal and postnatal care for pregnant and lactating women, and other essential nursing services[18].
Medication costs
According to SUT, persons covered by the general health insurance scheme are expected to contribute 20% of the total amount of the prescribed medication costs. The same rule also applies to temporary protection beneficiaries, while the rest was previously covered by AFAD.
Obstacles to access in practice
Syrians with temporary protection registrations in different provinces face several limitations in accessing the public health system[19]. These individuals are required to pay for their medications. Increased measures to check IDs and control refugee movements have heightened fears of leaving their homes to access healthcare or psychosocial support from NGOs. Previously, they could use migrant health centres even without an active ID, but now many avoid leaving their homes, due to the increased police control, hindering their access to health services[20].
In some provinces, the petitions for the injunction decision to access healthcare for children submitted by parents without active IDs are not accepted, blocking their access to court services and healthcare. While efforts are made to ensure healthcare access for children and those with chronic illnesses, obtaining health reports for children and adults with disabilities can take a long time, and families struggle to keep up with the process[21]. Finding appointments can also be challenging.
Seasonal agricultural workers, particularly in İzmir (Torbalı), suffer from poor living conditions, lacking hygiene. Some of them may be reluctant to access hospitals because they are not registered in the province they work in. This situation especially causes delays in vaccinations, and increases in scabies cases[25]. Two mobile medical units from Médecins du Monde Türkiye delivered primary health care and sexual and reproductive health services to 4,000 Syrian seasonal workers in the rural areas within the scope of the project “Provision of health protection and resilience of at-risk Syrians and undocumented migrants”[26]. These services included preventive and curative care for common illnesses and postnatal care.
People who entered Türkiye from Syria with an emergency travel document can be referred to hospitals in Istanbul after arriving through Hatay or Kilis, especially following the earthquake. However, this referral needs to be renewed periodically, requiring them to return to their initial entry point. This process poses challenges as they may face health problems or have childcare responsibilities that hinder their ability to travel[27]. Additionally, they incur medical expenses that cannot be covered due to a lack of social security, and it is difficult to find institutions that will cover these costs. Without access to their ID, they are expected to receive treatment and then return. As a result, some may choose to return to their home country.
Vulnerable and marginalised groups, such as sex workers, face greater obstacles to accessing services, such as information on sexual health, due to the fact that they perform sex work informally, frequently through intermediaries – who, in some instances, are perpetrators of discrimination and violence – and under harsh working conditions. Since 2018, UNFPA has provided multiple services to sex workers, LGBITQ+, and persons living with HIV, through its implementing partners, Positive Living Association and Red Umbrella Sexual Health and Human Rights Association, in five cities.[28] The regulation on charging a contribution rate to Syrians refugees imposes a serious barrier to access to health but it is rarely applied to vulnerable groups.[29]
A research[31] identified the most significant barriers to accessing mental health services as language difficulties and a lack of information about available services, and service providers and policymakers echoed these concerns, citing low awareness of mental health issues, daily living challenges, and language and cultural barriers as key obstacles. Another study[32] also included other major challenges in accessing healthcare such as discrimination, and stigmatization, despite these issues, they reported satisfaction with the mental health services, particularly psychiatric nursing care.
Challenges faced by children with disabilities, particularly after the earthquake, include limited access to special education and services, fees to access education services, lack of participation in decision-making and policy implementation, and limited targeted programming[33].
The impact of the earthquakes:
Around 7000 TPB lost their lives, and around 4000 were injured[34]. According to Turkish authorities, more than 2,306 bodies were sent to Syria from the border within the first 10 days after the earthquake[35].
After the earthquake, the healthcare system was significantly affected due to damaged hospitals, loss of personnel, a high number of injured individuals, and increased health problems caused by the disaster. The earthquakes caused trauma and directly impacted the health of people living in the area. Refugees face numerous challenges due to their status or lack of active ID cards. There has been a noticeable increase in the number of disabled individuals, leading to difficulties in accessing healthcare services. Refugees with disabilities face specific challenges, such as difficulties accessing physical therapy centres and issues faced particularly by children using prostheses, as it requires frequent adjustments in the prostheses[36]. Services for persons with disabilities are severely lacking, heightening their vulnerability[37].
Refugees living in accommodation centres encounter physical barriers in reaching hospitals, exacerbated by the distance of these centres from city centres and the financial strain of public transport[38]. Additionally, inadequate hygiene, clean water, and food in camps pose significant health risks for residents. In urgent health situations, such as cancer or pregnancy, hospitals still require an active ID, creating additional barriers for refugees in the region. To activate their IDs, the provincial immigration administration demands a health report. However, to obtain this health report, they need an active ID, which further complicates access to healthcare. The same issue arises when obtaining a disability report for refugees. In cases of extreme urgency, such as pregnancy, with the support of NGOs, refugees manage to access healthcare[39].
Under the scope of “Project Facilitating Health Services to Earthquake Victims in Türkiye” implemented by ASAM, in the provinces affected by the earthquake, particularly Hatay, primary healthcare services are provided in Container Health Clinics and Mobile Health Clinics. Within the scope of the project, support for container clinics is provided to ensure the supply of all medical consumables and the proper storage of materials in healthy conditions[40]. Médecins du Monde Türkiye implements similar project through their mobil service units and at least 10,000 services were provided between January-April 2024, including primary health care, sexual and reproductive health, mental health and psychosocial support[41]. In collaboration with Relife International, MUDEM assists people with disability in Malatya, by providing wheelchairs, walking aids, glasses, hearing devices, and other medical needs[42].
Within the framework of the EU-supported “Sıhhat” project, there are 2 Syrian doctors (1 General Practitioner, 1 Gynecologist), 2 Syrian nurses, and 1 Turkish dentist working in the Temporary Shelter Center in Adıyaman. Additionally, psychosocial support activities are carried out in the field (with personnel support provided in Adıyaman Center and Kâhta District, as well as in Besni and Gölbaşı districts)[43]. Accessing to basic health care in the temporary shelter areas is very crucial, especially for vaccinations, pregnancy etc., due to the transportation problems.
[1] Article 27 TPR.
[2] Article 27(1)b as amended by Regulation no.30989.
[3] Selin Siviş, ‘Who is (un)deserving? Differential healthcare access and the interplay between social and symbolic boundary-drawing towards Syrian refugees in Turkey’, 2021, available here
[4] isvesosyalguvenlik, ‘Gelir Testinde G0 – G1 – G2 – G3 Ne Demek ?’, 2018, available here
[5] Selin Siviş, ‘Who is (un)deserving? Differential healthcare access and the interplay between social and symbolic boundary-drawing towards Syrian refugees in Turkey’, 2021, available here
[6] Information provided by a stakeholder, May 2023.
[7] Ministry of Health, ‘Avrupa Bölgesi Göç ve Sağlık Yüksek Düzeyli Toplantısı İstanbul’da Gerçekleştirildi’, March 2022, available in Turkish here
[8] NTV, “Türkiye’de doğum yapan Suriyeli anne sayısı azaldı”, 17.05.2024, available here
[9] AA, ‘Bakan Koca: Ayrım yapmaksızın göçmenlerin sağlık ihtiyacına ilişkin ortak bir yol izlemek hepimizin asli görevi’, 17 March 2023, available in Turkish here
[10] Sihhat Project, Instagram, available here
[11] European Commission, Türkiye 2023 Report, 8.11.2024, available here
[12] CEB, CEB approves € 250 million loan to the Republic of Türkiye and establishes Disaster Prevention and Recovery Fund, 24 April 2023, available here
[13] Ministry of Health, ‘3rd Steering Committee Meeting of SHIFA Project’, 9 February 2023, available here
[14] Doctors of the World Türkiye Programme, available here
[15] Doctors of the World, Eartquake Response Projects, available here
[16] Ibid.
[17] Ibid.
[18] Ibid.
[19] Information provided by stakeholders, March – April 2024.
[20] Information provided by a stakeholder, March 2024.
[21] Information provided by a stakeholder, May 2023
[22] Information provided by a stakeholder, May 2023.
[23] Information provided by a stakeholder, May 2023.
[24] Cagla Aydin, ‘Boğaziçi Üniversitesi Sosyal Politikalar Forumu Üyesi Nihal Kayalı: “Türkiye’nin Suriyeli mülteciler için sağlık çalışmaları övgüye değer ama problemler de var”’, 2022, available in Turkish here
[25] Information provided by a stakeholder, March 2024.
[26] Dünya Doktorları, 2023, Provision of health protection and resilience of at-risk Syrians and undocumented migrants in Turkey, available here
[27] Information provided by a stakeholder, March 2024.
[28] Information provided by a stakeholder, June 2023.
[29] Information provided by a stakeholder, May 2023.
[30] Information provided by a stakeholder, May 2023.
[31] Kiliç C, Kaya E, Karadağ Ö, Üner S. Barriers to Accessing Mental Health Services Among Syrian Refugees: A Mixed-Method Study. Turk Psikiyatri Derg. 2024 Summer;35(2):87-94. doi: 10.5080/u27044.
[32] Öztürk et al, 2023, “Syrian refugees’ experiences while receiving mental health services and psychiatric nursing care: A qualitative study” Journal of Advanced Nursing, 80 (4).
[33] Ulusal Koruma Çalışma Grubu, Ortak 3RP Koruma Sektörü Çalıştayı, 2-3 Ağustos 2023 & Information shared by a stakeholder in April 2024.
[34] AA, 2023. “Bakan Soylu: 11 Bölgede 57 Bin Enkazın 50 Bini Bitti.” 22 April 2023, available here, & Information provided by a stakeholder, April 2024
[35] BBC News, Kahramanmaraş depremi: Türkiye’deki Suriyeli depremzedeler yakınlarının cenazelerini Suriye’ye gönderiyor – BBC News Türkçe, available here
[36] Information provided by a stakeholder, April, 2024.
[37] Ibid.
[38] Kirkayak Kültür, February 2024, “We started from zero, we returned to zero again…”, available here
[39] Information provided by stakeholders, March – April, 2024.
[40] ASAM, Türkiye’deki Depremzedelere Sağlık Hizmeti Sunulmasının Kolaylaştırılması Projesi – SGDD-ASAM, available here
[41] DDD, LinkedIn, available here
[42] Information provided by a stakeholder, April 2024.
[43] Türk Tabipleri Birliği & Sağlik ve Sosyal Hizmet Emekçileri Sendikasi Şubat 2023 Depremleri 1. Yil Raporu, 2024, available here