Türkiye earthquake: external situation report no.2: 20–26 February 2023

1. EVENT OVERVIEW Priority concerns The priority concerns in the areas affected by the earthquake are: • ensuring access to the most vulnerable and affected populations; • immediate trauma care for the injured and post-trauma rehabilitative care; • provision of essential medicines, emergency kits and supplies to address urgent needs; • prevention and control of disease outbreaks, including through strengthening disease surveillance; • access to mental health and psychosocial support; and • ensuring access to essential health services, particularly for women, children, the elderly and those living with noncommunicable diseases. WHO actions • In Türkiye, WHO continues to support the government-led response, working in close coordination with the Türkiye Ministry of Health (MoH) and the Disaster and Emergency Management Authority (AFAD). • From 26 February to 2 March, the WHO Director General, the WHO Regional Director for Europe and the WHO European Regional Emergency Director visited Türkiye to discuss the earthquake response. • WHO is the lead for the Health and Nutrition Sector under the inter-agency coordination cell managed by the United Nations (UN) Office for the Coordination of Humanitarian Affairs (OCHA) established in Ankara, with the first meeting held on 21 February. • As of 26 February, the Emergency Medical Team Coordination Cell (EMTCC) in Türkiye has overseen the work of 32 approved international emergency medical teams (EMTs) from more than 20 countries. EMTs have carried out a total of 15 389 medical consultations in the most affected areas. As of 26 February, there are 18 active EMTs working on the ground. • As of 26 February, WHO has delivered 23.8K kg of supplies to the MoH, worth over USD$ 221 000. • WHO has released a flash appeal for immediate funding totalling US$ 84.5 million, of which US$ 50.8 million has been requested for Türkiye. Türkiye earthquake external situation report no.2: 20 – 26 February 2023 2.2M 9.1M 44K 108K 2 External situation report no.2 2. SITUATION UPDATE On 6 February 2023, a 7.8 magnitude earthquake struck at 04:17 local time with its epicentre located in the Pazarcık district in Kahramanmaraş province, Türkiye. This is the highest magnitude earthquake recorded in Türkiye since 1939 and it was followed by around 9136 aftershocks. The earthquakes directly affected 11 provinces within Türkiye: Adana, Adıyaman, Diyarbakır, Elazığ, Gaziantep, Hatay, Kahramanmaraş, Kilis, Malatya, Osmaniye, and Şanlıurfa. Ten of these have declared a state of emergency. Approximately 15 million people (according to the 2021 census) live in these provinces, including over 1.7 million Syrian refugees and around 4.6 million children. More than 44 374 people have been reported to have been killed across Türkiye as of 27 February, with over 108 000 injured. Overall, UN OCHA has reported that potentially 9.1 million people have been affected by the earthquakes. More than 520 000 individual units in 164 321 buildings either collapsed or were heavily damaged in Türkiye, including at least 15 hospitals. The collapse and damage of buildings generated high levels of debris and 116 to 210 million tons of rubble. In Türkiye, 2.2 million people have left the area, of whom 528 146 people have been evacuated and relocated by Turkish authorities. Of those who remain, around 1.9 million people are living in tents and temporary shelters. To meet the urgent shelter needs, Turkish authorities have set up 335 382 tents that were shipped by ministries as well as other national and international partners. The Government of Türkiye has declared a level four alert to appeal for international aid, in addition to a state of emergency for three months in the 10 most affected provinces. Emergency services in Türkiye rushed to search for survivors trapped under many collapsed buildings and as of 25 February, AFAD reports that three international urban search and rescue teams remain active on the ground from two countries. On 20 February, at 20:04 local time, Defne District in Hatay Province was struck by the largest registered aftershock of 6.4 magnitude. This was followed by a 5.8 magnitude quake three minutes later. Six people were reported to have been killed and 294 injured as a result of the aftershock, and 10 more buildings collapsed. In addition, 95 patients from Hatay Mustafa Kemal University Hospital were transferred to Adana and Dörtyol hospitals. Teams from WHO making observations in the field to collect data for the rapid field assessment © WHO 3 External situation report no.2 The Minister of Health announced that 448 health workers died and 528 health workers were injured in the earthquake. In addition to active hospitals in the earthquake-affected region of Hatay, 25 field hospitals have been set up and are operating in five of the affected provinces and 110 emergency response units have been established. In 11 of the affected cities, the number of active service beds is 22 153 (44% occupancy), with 3374 intensive care beds (65% occupancy). Within the scope of mobile health services, health services have been provided to more than 50 000 patients in 76 districts and 1512 villages of Kahramanmaraş, Hatay, Malatya and Adıyaman. In Adıyaman, active service bed capacity is at 25% and intensive care bed capacity is at 50%. International emergency medical support teams reported seeing many pediatric patients with burns as well as a mix of mental health needs, including panic disorders, acute anxiety, depression and grief caused by loss of life, and fear of new earthquakes and collapse of buildings. The MoH reports that risks related to possible communicable diseases in the disaster area seem to be under control with the establishment of a surveillance early warning system. Additional sources have reported infectious diseases such as outbreaks in Antakya. 3. WHO ACTIONS TO DATE Leadership and coordination • WHO continues to support the government-led response, working in close coordination with the MoH and AFAD. • From 26 February to 2 March, the WHO Director General, the WHO Regional Director for Europe and the WHO European Regional Emergency Director visited Türkiye to discuss the earthquake response. Health operations • WHO supported the Government of Türkiye to carry out a rapid health services and needs assessment in the affected provinces between 12–22 February. Following the assessment, the WHO team is preparing a mission report highlighting the population’s health needs in the earthquake-affected areas to guide the implementation of WHO response activities and support the development of a recovery strategy. • In addition to the field-level needs assessment, WHO held bilateral discussions with the public health directorate and the MoH to identify needs and to assess laboratories, surveillance capacities and systems in four of the affected provinces. • In collaboration with the MoH, WHO continues to support a cholera contingency and preparedness plan due to ongoing outbreaks in neighboring countries (Syria and Lebanon), which may pose a risk for onward transmission. Health sector coordination • WHO is the lead for the Health and Nutrition Sector under the UN OCHA-managed inter-agency coordination cell managed by the United Nations (UN) Office for the Coordination of Humanitarian Affairs (OCHA) which was established in Ankara, with the first meeting held on 21 February. • In addition to the Health and Nutrition Sector, there are eight other sectors that make up the coordination cell under the humanitarian country team: Shelter; Water Hygiene and Sanitation (WASH); Food Security; Protection; Early Recovery; Temporary Settlement Support; Education; and Logistics and Emergency Telecommunications. 4 External situation report no.2 Fig.1. Türkiye: Emergency Medical Teams deployed the earthquake affected provinces, as of 26 February 2023 Operational partnerships • WHO’s EMT initiative was activated to provide essential health care for the injured and the most vulnerable affected by the disaster, in response to a request for international assistance issued by the Government of Türkiye on 6 February. The EMTCC has scaled up, with additional surge mobilized from the EMT Secretariat and Turkiye Country Office staff under MoH leadership and using WHO capacity. As of 26 February, the EMTCC in Türkiye has overseen the work of 32 approved international EMTs from more than 20 countries. EMTs have carried out a total of 15 389 medical consultations in the most affected areas. Currently there are 18 active EMTs working on the ground. • The EMTCC has also been coordinating effectively with other operating partners (UN OCHA, non- governmental organizations, international non-governmental organizations) on the ground following the earthquake, with information flows streamlined to optimize operational outcomes. • A call has been disseminated through the Global Outbreak Alert and Response Network (GOARN) for rapid response mobile laboratories, following a formal request from the MoH. Five laboratories have come forward to support Turkiye. Risk communication • WHO continued to provide technical support to the MoH for public health advice on hand hygiene, rabies and tetanus vaccinations, use of bottled water, food safety and protection against airborne diseases. • WHO extended the post-earthquake public advice to mental health messages and developed food safety tiles for digital media that will be shared soon. 5 External situation report no.2 Emergency communications • From 26 February to 2 March, the WHO Director General, the WHO Regional Director for Europe and the WHO European Regional Emergency Director visited Türkiye to support the government-led response. The visit included a meeting with Belgium’s Ambassador to Türkiye Paul Huynen, and Minister of Health Dr Fahrettin Koca and his team, and a visit to a reception centre where they met frontline responders and earthquake survivors. They also visited the B-FAST EMT. The Director General participated in a press conference hosted by the Minister of Health. WHO Regional Director for Europe, Dr Hans Kluge, has posted about the trip here. • A video highlighting the Belgian team's field hospital in Kırıkhan can be viewed here. • Yagmur, a 25-year-old doctor, was on duty in a local hospital when the earthquakes struck. Now, she spends her free time volunteering between shifts so that people can get the medical help they need. Hear her story here. • WHO headquarters has produced this video on how the Japanese EMT, with the support of WHO, addresses urgent healthcare needs in Türkiye. • Medical teams from around the world joined forces with the National Medical Rescue Team (UMKE) and Turkish authorities to support rescue operations and ensure access to health care for those affected by the earthquakes. Watch here. • A series of video diaries by Senior Emergency Officer Dr Catherine Smallwood can be viewed here. • Dr Gerald Rockenschaub, Regional Emergency Director, talks about the massive mobilization of emergency medical teams in Türkiye to save lives. High-level visit of WHO Director General and WHO Regional Office for Europe Director to Türkiye © WHO 6 External situation report no.2 Supplies and logistics • As of 26 February, WHO has delivered 23.8K kg of supplies to the MoH, worth more than USD$ 221 000. The main supplies delivered include trauma and emergency surgery kit (TESK) and interagency emergency health kit (IEHK) modules, pneumonia kits and blood supplies. Resource mobilization • WHO has released more than US$ 16 million from the Contingency Funding for Emergencies, including US$ 3 million within hours of the disaster. WHO has released a flash appeal for immediate funding totaling US$ 84.5 million, of which US$ 50.8 million has been requested for Türkiye. • The UN in Türkiye has issued a flash appeal for preliminary estimated funding for immediate and urgent health needs, amounting to US$ 1 billion. The preliminary appeal includes the requirements of UN agencies and non-governmental organizations. In the health sector an estimated US$ 118 million is required. 4. KEY NEXT STEPS As part of the WHO regional concept of operations, WHO will work to consolidate the response in the affected areas. This includes providing support to the MoH by: • leading the health and nutrition sector coordination in Türkiye; • carrying out in-depth health needs and health facility damage assessments; • supporting water hygiene and sanitation in affected areas and health facilities; • enhancing community engagement and listening to guide the response; • supporting the transition of EMT service delivery to disrupted health system support; • supporting health service provision to displaced populations to allow continuity of care, especially for women, children, elderly people and those with noncommunicable diseases; • strengthening and extending mental health services; and • reinforcing early warning and surveillance for infectious hazards. Emergency medical teams from around the world have worked tirelessly to save lives and rebuild the health care system © WHO © World Health Organization 2023. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license. Document number: WHO/EURO:2023-7145-46911-68571