Look, we're warning you now. When the earthquake comes, it is late.
Turkey is an earthquake country. No one does not know this anymore. But the issue is not to accept the earthquake reality, but to be prepared for it. In terms of the health system, we are not fully prepared.
The 2023 Kahramanmaraş earthquakes showed this to all of us. The Ministry of Health went to the field, UMKE went to the field, field hospitals were established, volunteers rushed to the region. There was a great mobilization. We cannot deny this. But at the same time, coordination failed, there were problems in the distribution of equipment, and guidance was not established.
This is what the field observations of the Turkish Medical Association wrote. There were serious coordination weaknesses in the first hours. In fact, the first 6-12 hours of an earthquake are the most critical time period in terms of survival.
If it is not clear who will go where at those hours, if there is an overcrowding at one point and a gap in another, if a health worker reaches the field and receives the answer “you are not needed here”, we are no longer talking about the fault of individual people, but directly about a system deficit.
Every minute lost is another minute over the critical period. And that loss could be your relative or mine.
The picture described by medical personnel on the ground was not simple. The organization was disjointed, task boundaries were unclear, coordination was lacking. There were good intentions but not the same level of organization. Good intentions are not enough to save lives in a disaster. Order is needed. It requires authority. A pre-established command structure is required.
Moreover, the earthquake does not only hit the patient. It also hits the physician, the nurse and the technician. On the one hand, the health worker tries to reach the patient who is pulled out of the rubble, on the other hand, he cannot reach his own family, he is sleepless for hours, he is hungry, he has to make decisions in uncertainty. Under such a burden, the quality of decision-making decreases. This is not a weakness, but a human limit.
This is what the World Health Organization has been saying for years. Systems that exceed human capacity collapse. The issue is not only the number of ambulances, the number of tents, the number of equipment. It is about building a structure that takes into account the limits of human endurance.
Today we have regulations. We have UMKE. We have hospital disaster plans. There is a framework on paper. But the real question is not what is written on paper, but what actually works when the destruction starts. Because as the earthquake grows, as the simultaneous destruction increases, even the best plan can fall apart under the load. Sometimes the problem is not a lack of planning, but that the plan starts to collapse in the face of real disaster.
This is precisely what worries me as a physician. Coordination is still fragile. There is no guarantee of first hour performance. Protection mechanisms to sustain health workers are insufficient. Especially in medium-sized cities, this fragility is even more evident. Because resources are limited, spare capacity is scarce and alternative opportunities are narrower.
That is why we have to speak clearly. Before a major earthquake strikes, a crisis management system with a single command, clear authority and instant data must be established in the field of health. It is not credible to say “we are ready” without a common coordination infrastructure where everyone is looking at the same information and can see where the teams are and what they are doing.
Demonstration exercises will not close this gap. There should be simulations that really challenge the field, test communication, and show the build-up and collapse in advance. Simply calling health workers to duty and then leaving them to their own endurance is not a solution either. Rest, rotation and psychological support must be planned from the beginning. Critical equipment and mobile health capacity should be placed in the right locations before the earthquake, not after. Medium-sized cities should be particularly strengthened. Because it is often right there that the first major rupture occurs.
In the next earthquake, saying “we intervened” will not console anyone. The main issue is to intervene in time, to intervene in the right place, to intervene in the right way.
Today, let us put our hands on our conscience and say. Turkey's health system knows about the earthquake. But it still cannot provide the assurance to manage the first hours of an earthquake perfectly.
And if there is no assurance in disaster management, there is no preparedness.