Almost 12 million Syrians need humanitarian assistance, and Turkey alone hosts at least 3.6 million refugees from the war-torn country. Such large groups of migrants posed huge challenges to health services.

Meanwhile, as refugees became more settled, Turkey needed to think about how refugees can integrate into society through work.

But Turkey's government found a way to both strengthen its healthcare services for refugees and help shape the future of its workforce — retrain Syrian doctors to work in the Turkish healthcare system. Not only do more refugees have care that meets their needs as a result, but some of them have a brand new route to work in their host country.

Establishing a healthcare infrastructure

In 2011, refugees began migrating to Turkey from Syria. By 2013, they were in the hundreds of thousands. By 2015, there were more than a million refugees. By 2016, this had tripled. In cities in Southern Turkey, the number of Syrian patients was matching the number of Turkish patients in its health centres.

“Syrian patients soon overstretched national health services,” said Dr Santino Severoni, Coordinator of Public Health and Migration for the World Health Organisation (WHO).

On top of treating the influx of new patients’ health problems, which may have been worsened by long stints in insecure accommodation, cultural and language barriers can also play a huge part of eating into doctors’ capacity. Reports were coming back from the field that longer-term integration was required.

In Turkey, each person is given a family physician. Patient empowerment is central to the Turkish medical system, with a big focus on primary care. So when the Turkish Ministry of Health established migrant health centres to strengthen the health infrastructure for refugees, they were established with this in mind.

"To transfer qualifications, Turkey created its own accreditation mechanism to be used in humanitarian disasters."

The WHO has provided support to seven of its Refugee Health Training Centres in seven Turkish provinces since mid-2016.

In 2017, the WHO’s initiative helped establish a network of 178 Migrant and Refugee Health Centers across the country where linguistic and culturally-sensitive services for the Syrian population are offered free of charge. By September 2019, the network was completed and it now covers over 30 Turkish provinces.

Some 600,000 consultations have taken place and the program has led to increased access to health services for almost 20,000 refugees and migrants.

But the centres don’t just offer health services to refugees — they also train Syrian health professionals to become doctors in Turkey. Over 2,200 Syrian doctors and nurses have now completed their training.

The future of the Turkish workforce

Beyond its impact on the immediate welfare of sick refugees, the scheme is creating job opportunities for migrants. Some 1,300 Syrians have been hired by Turkey’s Ministry of Health.

"The training aims to adapt the Syrian health professionals into the new setting in Turkey"

To transfer qualifications, Turkey created its own accreditation mechanism to be used in humanitarian disasters.

The Turkish Higher Education Council worked alongside the Ministry of Health to delegate authority to the Ministry so that it could approve Syrians’ medical qualifications. The Ministry established its own committee to interview health workers for positions.

In replicating the program, Severoni suggested policymakers should figure out what makes doctors and nurses tick — “address the language, cultural, financial, burn-out [factors] and motivation of health professionals”.

How to train your doctor

There’s an effort to help the Syrian medics settle in Turkey, but not change their entire approach to care. “The training aims to adapt the Syrian health professionals into the new setting in Turkey,” said Severoni.

The training includes a one-week theoretical course and six weeks of on-the-job experience, where Syrian doctors and nurses are posted in WHO-supported healthcare centres across Turkey.

In 2018, the training was expanded to include training in basic computer skills, health information systems, language and community health. Without basic knowledge of the national health data systems, confidential information risked being left insecure.

Participants can then work in the Ministry’s national health centres, caring for Turkish and Syrian patients alike. These new healthcare workers can deliver culturally sensitive health consultations and strengthen refugee access to quality health services.

The program’s considered dual approach — supporting the careers of refugees, while developing a culturally sensitive Turkish healthcare system — means it does more than show refugees the country cares. Turkey shows refugees they belong. — Emma Sisk