Türkiye earthquake: external situation report no.8: 17–30 April 2023

1. EVENT OVERVIEW Priority concerns The priority concerns in the areas affected by the earthquake are: • access to mental health and psychosocial support; • ensuring access to health care services for the most vulnerable and affected populations; • post-trauma rehabilitative care; • water and sanitation services; • prevention and control of disease outbreaks, including through strengthening disease surveillance; • ensuring access to essential health services, particularly for women, children, the elderly and those living with noncommunicable diseases; and • enhancing the provision and accessibility of reproductive health services. WHO actions • In Türkiye, WHO continues to support the government-led response, working in close coordination with the Türkiye Ministry of Health (MoH), the Ministry of Family and Social Services (MoFSS) and the Disaster and Emergency Management Authority (AFAD). • WHO, with other United Nations (UN) agencies and humanitarian partners, laid down the strategic and operational priorities moving forward in order to improve outcomes for affected populations. • WHO has provided training in psychological first aid for children to 1476 staff from the MoFSS. WHO also reached a total of 1325 MoH and MoFSS staff who attended online “Ask the Expert” sessions on mental health and psychosocial support (MHPSS). Additional face-to-face support for social care workers was provided in Kahramanmaras and Hatay. • As of 2 May, WHO had delivered over US$ 1.1 million of supplies including for scabies and lice treatment, laboratory supplies for malaria and cholera, modules of trauma and emergency surgery kit (TESK), interagency emergency health kit (IEHK) and pneumonia kits. • As of 30 April, the Emergency Medical Team (EMT) Coordination Cell has been transitioned and,post- emergency response, has been under the UMKE, the national medical rescue team, and the MoH. Currently there are only two international EMTs still present in Türkiye. • Through the Protection from Sexual Exploitation, Abuse and Harassment (PSEAH) Network and the interagency mechanism, WHO has developed various communication and awareness materials endorsed by the MoH in Türkiye. The PRSEAH focal points are in the field conducting risk and need assessments in five provinces (Gaziantep, Sanliurfa, Hatay, Mersin and Adana). • 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. As of 30 April, 18% of required funds have been received by WHO. 3M 9.1M 50K Türkiye earthquake External situation report no.8: 17–30 April 2023 >3M 2 External situation report no.8 2. SITUATION UPDATE Nearly three months after the devastating earthquakes that struck the Kahramanmaraş province in Türkiye on 6 February and 20 February, a state of emergency remains in place for the 11 provinces directly affected by the earthquakes where 50 339 people lost their lives, including more than 7300 foreign nationals. According to the authorities, close to 70 000 Syrians were issued authorizations to temporarily exit to Syria after the earthquake. Based on United Nations High Commissioner for Refugees (UNHCR) estimates, as of 20 April, some 16 000 Syrians have returned to Türkiye. To date, there have been more than 29 600 aftershocks, and nearly 311 000 buildings were damaged throughout the region. Removal of debris is almost complete in the 11 affected provinces. The Government of Türkiye is leading the earthquake response , coordinated through the AFAD with the Turkish Red Crescent (TRC). The UN and humanitarian partners continue to provide relief operations in Türkiye, in support of the response by the Government of Türkiye. Since 6 February, over 216 000 people from affected areas have been relocated to other provinces within Türkiye. According to the Ministry of Interior, about 20% of those affected by the earthquakes who migrated to other cities have returned, possibly due to financial constraints and the high cost of living in the hosting provinces. The Shelter Sector Türkiye reported that over 3 million people were identified as sheltered in various types of settlements including tents, formal shelters, containers and collective shelters, of whom close to 2 million are in informal settlements. UNHCR has also observed an increase in returns of refugees to the affected provinces, citing similar reasons. To meet the needs of the returning population, authorities are attempting to strengthen shelter capacity through temporary accommodation. On 20 April, a severe storm and tornado in Pazarcık district of Kahramanmaraş meant that tents and containers sheltering earthquake-affected people in both informal and formal settlements were blown away and damaged, exposing some to harsh weather conditions. Reports have shown that one person died and 44 were injured in the storm. Fig.1: Distribution of population in temporary settlements in the earthquake-affected provinces, as of April 2023 ©WHO 3 External situation report no.8 It is estimated that the number of babies expected to be born in the earthquake zone within one month is approximately 14 400 and the number of pregnant women is 130 000. According to the MoH, 23,678 babies have already been born in the disaster area since 6 February, and newborns have been screened and vaccinated. As of 20 April, UNFPA had distributed dignity and maternity kits to over 15 000 individuals, including women, girls, young people and other vulnerable groups. An additional 4 800 life-saving reproductive health commodities have been distributed to affected populations. Based on the report from 11 April, UN agencies and humanitarian partners had supported more than 4.2 million people. More than 71 000 medical consultations have been provided and 42 (EMTs were deployed to provide life-saving health services. Sexual reproductive health services have been provided to 6800 people through six stationary and 11 mobile units, providing 2100 reproductive health supplies, while 13 300 people have received dignity kits and maternity kits. Building on previous experiences in the country, humanitarian actors continued to put impacted community members at the centre of the response by strengthening accountability to affected populations, including through two-way communication and community engagement. The international humanitarian community continues to support the government in providing immediate assistance to the affected population, including through the direct contribution of in-kind relief items for onward distribution. In a collaborative effort, humanitarian partners are delivering relief items such as food, medical supplies, shelter, hygiene and dignity kits, and WASH assistance, among other essential needs. According to a recent analysis, access to services remains limited in the provinces of Kahramanmaraş (On İki Şubat) and Hatay (Arsuz, Defne, Samandağ and Hassa). The potential health impact of severe weather conditions andsafe access to water, hygiene and sanitation remain a concern. UNFPA reported that more than 5.5 million people have been provided with health-care services in the earthquake zone since 6 February. As a means of increasing access to health care, 1064 family health centres were activated as of 23 March, and 176 primary health care units were put into service in tents and container cities in the earthquake-affected provinces. However, women and girls continue to have unaddressed, sector- specific needs. Psychosocial support for children is urgently needed, along with information about MHPSS referrals, and training and sensitization on preventing violence against women and children. © WHO Collapsed buildings in earthquake affected areas in Türkiye Access to health services 4 External situation report no.8 WHO ACTIONS TO DATE Leadership and coordination • WHO continues to support the government-led response, working in close coordination with the MoH and AFAD. • WHO continues to develop long-term operational planning to provide consistent support to the MoH around ensuring the continuity of essential health services for rehabilitation, primary health care, expanding MHPSS services within the affected population and providing timely Risk Communication and Community Engagement (RCCE) to affected populations in line with current health needs. Health sector coordination • WHO, along with UNICEF, continues to lead health and nutrition sector coordination in Gaziantep as well as in the four hubs in Hatay, Kahramanmaras, Adiyaman and Malatya. • WHO conducted a key MHPSS stakeholders' coordination meeting to identify current needs and challenges in the field and has now developed a joint roadmap for MHPSS for the next 3 months. Among the identified activities are establishing coordination mechanisms at provincial level, conducting needs analysis and access studies for the different groups, identifying resources, strengthening areas of self-help and social support, advocacy with service users involved in decision-making processes, and monitoring and eval Health operations • WHO has provided training in psychological first aid for children to 1476 staff from the MoFSS. WHO also reached a total of 1325 MoH and MoFSS staff who attended online “Ask the Expert” sessions on MHPSS. Additional face-to-face support for social care workers was provided in Kahramanmaras and Hatay. • WHO is working on the procurement of containers to be used as mental health-care centres in Adiyaman, Hatay and Kahramanmaras, the provinces most affected by the earthquake, in response to a request for international assistance issued by the Government of Türkiye on 6 February, • WHO, with the AFAD, coordinated EMT deployments to provide life-saving emergency health care for the injured and the most vulnerable affected by the disaster. As of 30 April, the Emergency Medical Team © WHO As part of the rapid field assessment the team from WHO visited UK-MED field hospital), in Kahramanmaras province 5 External situation report no.8 Coordination Cell has been transitioned and, post-emergency response, has been under the UMKE, the national medical rescue team, and the MoH. Most international EMTs have now left the country with only one still operating within Hatay province. Protection from Sexual Exploitation, Abuse and Harassment (PSEAH) • WHO continues to develop and translate PSEAH community messages and posters, and disseminate them through PSEAH Network partners. Information has been shared regarding consolidated PSEAH Network messaging and training materials that are now available to UN members, and uploaded to ReliefWeb for others to access. • Through the PSEAH Network and the interagency mechanism, WHO has developed various communication and awareness materials endorsed by the MoH in Türkiye. The PSEAH focal points are in the field conducting risk and need assessments in five provinces (Gaziantep, Sanliurfa, Hatay, Mersin and Adana). The Gaziantep hub provided orientation and information sessions to the pharmaceutical and MHPSS technical working groups and health cluster members. The sessions aimed to strengthen the principle of zero tolerance within the provision of care and services, and were attended by over 150 people. Risk communication, community engagement and infodemic management (RCCE-IM) • Overall, the WHO RCCE team, in collaboration with the health promotion department of the MoH, developed and disseminated health messages that included prevention of foodborne and waterborne diseases, breastfeeding, MHPSS, chronic diseases and asbestos. WHO Regional and Country Offices also provided insights through social listening. • Public health advice reached 48 million individual accounts on social media channels in March. • The Health Promotion Department of the MoH and the WHO Country Office collaborated to develop a distribution plan for printed materials containing public health advice for earthquake-affected provinces. • The WHO Country Office created a concept note for the deployment of a mobile health communication vehicle, which will be utilized by the MoH to facilitate risk communication activities and coordinate community engagement efforts. • The WHO Country Office finalized RCCE planning for the earthquake response and commenced its implementation. Supplies and logistics • WHO has delivered over 308 000 supplies to the MoH, worth more than US$ 1.1 million. Supplies delivered include: o modules of trauma and emergency surgery kit (TESK), interagency emergency health kit (IEHK) and pneumonia kits; o laboratory reagents and treatments for scabies and lice; 5000 cholera and 5000 malaria rapid test dipsticks; o reproductive health medicines and instruments delivered to 10 provincial health directorates, reaching 5500 individuals. Resource mobilization • WHO has released more than US$ 16 million from the Contingency Funding for Emergencies, of which US$ 1.4 million was allocated to the WHO Türkiye Country Office for the emergency response. 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. As of 21 April, 18% of required funds have been received by WHO. • The UN in Türkiye has issued a flash appeal amounting to US$ 1 billion to assist 5.2 million people affected by the devastating earthquakes. The appeal includes the initial financial requirements of UN agencies and NGOs. As of 27 April, only 30.3% had been funded (US$ 303.6 million). In the health and nutrition sector an estimated US$ 118 million is required, of which only 14% has been funded (US$ 16.4 million). 6 External situation report no.8 3. KEY NEXT STEPS 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; • enhancing community engagement and listening to guide the response; • 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 *Please note that as of 30 April the Türkiye earthquake situation report will be published on a monthly basis. ©WHO UMKE National Emergency medical teams worked tirelessly to save lives in Türkiye © World Health Organization 2023. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license. © WHO Document number: WHO/EURO:2023-7145-46911-69358