Challenges in access to healthcare of Syrian refugees in Türkiye: The case of Mardin

The right to health is a fundamental human right, regardless of migratory status. Access to healthcare is also crucial for refugees, since they are already traumatized by conflict, civil wars, and associated poor living conditions. In the early years of the mass migration flows, Turkish government took an emergency response towards Syrian "guests" who were in dire need for protection. Later on, under the temporary protection scheme, Syrians' access to healthcare was redesigned from a short-term humanitarian emergency to a longer-term service provision that started to include Syrian medical professionals into the frame. Currently, there are over 3.5 million Syrians under temporary protection living in Türkiye. However, access to routine and/or specialized healthcare services for refugees in Türkiye still remains challenging. The main aim of this thesis was to understand what problems are being encountered by Syrians under temporary protection (SuTP) in access to healthcare services, their expectations from healthcare in Türkiye, and what the current system provides. Fieldwork was carried out in the Mardin province in two state hospitals - one in the city center and one in Kızıltepe district of the city, and a migrant health center also located in Kızıltepe. Mixed methodology was adopted for the research. In addition to 128 surveys carried out among 35 male and 93 female respondents, 13 in-depth face-to-face interviews with Syrian patients and six key informant interviews with Turkish medical personnel were conducted. Although almost all the survey participants and interviewees noted that they were able to access to healthcare in Türkiye, they mentioned that they had a myriad of problems in accessing to healthcare services. They underlined the problems of language barrier, procedural problems (i.e. number of appointments to be taken from the hospital, limitations by legal status and common knowledge about healthcare system), discrimination, economic difficulties, and difficulty in transportation. Other than the problems faced by Syrian patients, interviews with Turkish medical personnel indicated structural challenges in the health system. The findings of this research can be grouped under two categories as obstacles and facilitators to access to healthcare. Accordingly, Syrian patients identify bilingual patient guides as facilitators, albeit they have very limited access to their services. Language can be seen both as an obstacle and a facilitator. Obviously, language barrier limits the patients' understanding of their medical condition as well as required steps for a treatment. Yet, the levels of satisfaction of Arabic and Kurdish speaking Syrians from the healthcare services are usually based on the language skills of the host community. Arabic speaking Syrians living in Mardin find relatively easy access to healthcare in Mardin due to the main ethnicity in Mardin being Arabs. The same can be said for Kızıltepe where the local community is mainly Kurdish. Therefore, language and ethnic similarities act as a facilitator enabling Syrians to overcome language barrier in their access to healthcare services. It also indicates that belonging to same ethnicity and sharing a common language result in overall easier adaptation and better social cohesion. Another major obstacle takes place due to structural problems of the health system. Turkish medical personnel already overburdened are usually left alone to take care of Syrian patients. Although SIHHAT project was devised as a facilitator by creating refugee health centers for Syrians to access to healthcare, these centers often operate either as small clinics or rather for referring patients to nearby state hospitals. Furthermore, difficulties that medical personnel face may increase the risk of malpractice. This translates into medical personnel being reluctant to treat Syrian patients, which in turn understood generally as discrimination and shaming by patients.