guide to healthcare

Turkey Will Now Let Syrian Doctors Treat Refugees Legally

After working illegally in their new country of residence, select MDs will get accredited.

Daniel Shkolnik

YUCEL ZORLU / LEJOURNAL/AP

Waiting at the border between Lebanon and Syria, Dr. M was asked by a police officer to step aside. He was led away from his wife and young son and sat down in front of a high-ranking Lebanese officer with decorations studding his shoulders. The officer was speaking angrily into his phone: "He did what? … He did that? ... Well then we'll have to punish him. … Yes, he's sitting right here in front of me."

"They've caught us," thought the doctor. "It's over."

Then the officer turned to Dr. M and asked for a pediatric consultation. His wife was on the other end of the phone at wit's end with their troublesome son.

It's now been four years since Dr. M made it out of Syria with his family. Today he provides primary and pediatric care in the Fatih neighborhood of Istanbul. The clinic he works in feels like a regular doctor's office: bright, clean—its door even stands open onto the street. At first glance, you wouldn't be able to tell the whole operation is illegal.

Syrian doctors, unable to gain accreditation in the Turkish medical system, have set up unofficial clinics to treat fellow Syrians. There are an estimated 40 such clinics in Istanbul alone, and the one in which Dr. M works, consisting of about 30 doctors and 30 nurses and other employees, is one of the largest.

The Turkish Ministry of Health has, up until now, turned a blind eye to these clinics, allowing them to operate in the shadows to help ease strain on Turkish medical facilities under the influx of refugees. But these Syrian clinics are always under threat of crackdown. In the past, Turkish government officials have appeared on the doorstep of Dr. M's clinic with a simple message: 'You can keep working, but if we hear any complaints, we'll shut you down.' Xenophobic neighbors have bitched about noise before (and even some disgruntled patients, about care) resulting in the police or municipality shutting clinics down. That's what happened to Dr. M's previous clinic, which was just down the street from his current space. Unfazed, he and the other doctors picked up stakes and moved down the street to continue their work.

Others have not been so steadfast. Dr. M knows of Syrian doctors who, losing hope of ever working legally again, have gone into textile or farm work. Other refugee doctors fled to Europe, where a clear accreditation processes exists. Dr. M says he's thought about it himself, but says, "There's no safe way to Europe. … Should [my family and I] get in a boat to Greece and go like thieves in the night? I have two small kids, what if I lose one of them [in the passage]?"

So Dr. M has continued to practice off the books in Turkey, earning about a fifth of what Turkish doctors do, all the while hoping a path to legal employment would one day emerge. Last year, it seemingly did.


Watch on VICE: Inside Assad's Syria


In 2016 the Turkish Ministry of Health, financed by the World Health Organization, finally opened an accreditation program for integrating Syrian doctors into the medical system. Of the roughly 1,200 Syrian doctors in Turkey applying to enter the program, Dr. M is among the first 25 to have passed all the hurdles.

Dr. M and his cohort are at the front of the line to become legal doctors in Turkey. Their fate will be a canary in the coal mine for all other Syrian doctors currently applying in hopes of working legally within the system.

If they are brought on board, the doctors will work in Migrant Health Centers (MHC) providing medical care in areas of the country with the highest Syrian populations. Many doctors are eager for the opportunity to come out of the shadows and provide their fellow Syrians with appropriate lab tests, prescription drugs, medical records and statistics, and—particularly important for their Syrian patients—access to prosthetic limbs; all things these Syrian doctors have been working without.

Best of all, it will be free for the refugees. Those Syrians registered with Turkey's Disaster & Emergency Management Authority (AFAD) have "temporary protection" status and are allowed free healthcare at public Turkish hospitals. Yet many choose to see Syrian doctors in clinics such as these either because of Turkish-Arabic language barriers or because about a third of Syrians have for various reasons not yet been registered and so don't have proper documentation to be treated at public hospitals. Right now it costs 15-20 TL (about four to six dollars) to be seen at Dr. M's clinic. Negligible by US standards, but money that not all refugees can spare.

Turkey deserves genuine praise for the humanitarian weight it's taken on during the Syrian crisis, taking in more than three million Syrians—far more than the EU and US combined. And while delayed, all signs now point to an honest effort on the part of the Turkish government to get Syrian doctors into existing MHCs and significantly expand the MHC network.

"Since this program began they kept all their promises," Dr. M says, describing the past year's rigorous accreditation process, which included three separate stages of training and testing. "But [actually getting hired] is the final hurdle."

Dr. M is putting his faith in this program and in Turkey. After four years of scraping by, he is determined to build a proper life for himself and his family. And he's optimistic. When he first arrived, he was told by officials, "Don't ever think that you'll work as a doctor. The best thing you can dream of in Turkey is to be a translator."

Promisingly, as of May 18th, the Turkish MOH has called doctors in Ankara, Turkey's capital, and Kilis, a city on the border with Syria, extending an invitation to work legally in the promised MHCs—the first such invitations to Syrian doctors. Dr. M hopes he too will soon receive such a call.

Being a doctor in Turkey, even illegally, has been far better than practicing in Syria. Dr. M recalls how Syrian President Bashar al-Assad systematically targeted doctors and hospitals found treating the opposition, to the point some doctors would go against their Hippocratic oath out of fear. "You couldn't trust any patient. If someone came to you with a wound, you couldn't tell what side he's from. If the government found out he was from the opposite side, they would come and kill you."

He had many colleagues die in prison for treating opposition fighters or government agents posing as opposition. Their bodies, like many others, were never returned and their families were made to sign a death certificate that they died in a "traffic accident."

To that end, Dr. M has not forgotten the openness Turkey has shown Syrian refugees. Recep Tayyip Erdoğan, he says, ironically ended up being far better for Syrians than the EU, US, or even their Arab neighbors.

On the condition that the MHCs live up to their promise, there could be much to be lauded about the effort. Not only would they address refugees' physical needs but also psychological ones. Part of the training Dr. M and other doctors have already received from the MOH prepares them to screen patients for psychological trauma and redirect them to the appropriate resources. This is something Dr. M considers essential for Syrians, many of whom are still struggling to come to grips with the psychological violence of what's happening to them.

The collective psychological damage in the Syrian community is enormous. Dr. M has encountered many patients who live in denial, believing they will return home any day. Some spend countless hours watching TV in hopes of hearing news the war is over. Many Syrians, including Dr. M himself, carry deep-seated feelings that the world abandoned them to Assad's slaughter. Given how the international community has responded over the last six years, it's hard to disagree with him.

For the doctor, psychological damage cuts especially close to home. During the first two years of the war, his three-year-old son went mute. He sat in the corner and would say only one thing: "Please my god, protect me and my family." After leaving Syria, it took more than six months before he started speaking again. Even now, he asks questions that are difficult for his father to hear. Upon seeing the aftermath of a car crash in Istanbul, the seven-year-old asked his father, "Did Assad do that?"

Update: A previous version of this story states that Dr. M is among the first 25 to have passed all the hurdles, but the correct number of doctors being considered is 125.

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Lede image: YUCEL ZORLU \u002F LEJOURNAL\u002FAP

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