According to AFAD, Turkiye’s Disaster and Emergency Management Authority, the energy released during each earthquake is reportedly equivalent to 132 atomic bombs, and the affected area is 110 000 square kilometres, writes DR FATIMA HENDRICKS.
ON early Sunday morning, February 5, 2023, while on a working visit to Istanbul, Turkiye, a friend sent me a message asking if I had felt the 4,5 magnitude tremor overnight. Little did I know, that it was just the beginning of a series of events that would define Europe witnessing the worst natural disaster in a century. In the past 100 years, more than 20 earthquakes have occurred in Turkiye but none as deadly as the two massive earthquakes that hit on February 6, 2023. A 7,7 magnitude earthquake rocked Kahramanmaras at 4:17am in the wee hours of Monday morning, followed by a 7,6 magnitude earthquake in Elbistan at 1:24pm in the afternoon.
Turkiye is surrounded by strike-slip or sideways sliding fault zones. The earthquakes resulted in five broken segments on the east Anatolian fault line and a forty-metre-deep rift forming in Hatay. According to AFAD, Turkiye’s Disaster and Emergency Management Authority, the energy released during each earthquake is reportedly equivalent to 132 atomic bombs, and the affected area is 110 000 square kilometres. The earth’s crust moved 7,5 metres post-earthquakes and there have been more than 5 700 aftershocks since February 6, with magnitudes as high as 6,7 on the Richter scale. Some buildings and people that may have survived the first quake, perished in the second quake due to the quick succession.
The affected regions in Turkiye include Kahramanmaras, Hatay, Gaziantep, Adiyaman, Osmaniye and Malatya. Upon learning about the earthquakes, I was moved to action to see how I could assist as an occupational therapist. The role of occupational therapy in disaster management is an emerging and rapidly developing area of specialisation that brings together understanding of occupations (things that people do everyday), occupational disruption and its impacts on physical and mental health.
Learning that the airports at the epicentre were closed, I booked a flight to Kayseri with the intent of driving to reach the quake-hit region. Due to the snowstorm that came in from Siberia, the flight was cancelled. I then booked a flight to Konya, and that too was cancelled because of a snow blizzard. Eventually, I was offered a spot with the Gift of The Givers Search and Rescue team number 3 that was deployed to the province of Hatay on Friday, February 10. We flew from Istanbul to Adana with a member of the medical assessment team, Dr Asad Bhorat, and the South African Police Service’s (SAPS) K-9 unit under the leadership of Brigadier Vimla Moodley. Five K-9 dogs accompanied us on the flight and flew on Turkish Airlines in business class, a sight to behold.
The teams, under the leadership of Dr Ahmed Bham, consisted of Search and Rescue South Africa (Sarza), Medi Response, Free State Department of Health, Limpopo Department of Health, Northwest Department of Health, Life Hospital Group, The SA Red Cross Air Mercy Service (AMS), Netcare 911, and Cape Peninsula University of Technology Department of Emergency Medical Care. The diverse team from across South Africa comprised 47 team members, and five dogs from the K-9 unit.
According to Mevlut Cavusoglu, the Turkish Foreign Minister, offers of support were received from 102 countries, and we saw international team after team (some with their K-9s), disembark with state-of-the-art equipment and leave to set up their operational camps and deploy into the affected areas.
The sheer scale of the cataclysmic destruction is hard to describe in words. As we drove across the country towards Antakya, one of Turkiye’s cultural centres, we were met with building after building of collapse. We saw the different categories of building collapses including debris heaps where the floors, columns and walls had collapsed into a heap, or an overturn where part or all of the building had fallen on its side. We also saw buildings where the floors had collapsed on top of each other like pancakes and other buildings that looked like a fallen stack of dominoes, where columns and walls had collapsed into an incline.
Whatever the formation, we witnessed people sitting outside the collapsed buildings, in the bitter cold, some in shock, dazed, numb, while others were busily trying to assist with others’ needs as they waited for news of loved ones from under the rubble. Interwoven in the rubble, street upon street, was a vast museum of artifacts from full lives, children’s toys, clothing from closets, kitchen utensils, family albums. Parked in the surrounding area were abandoned cars, some crushed by fallen debris from the buildings and others dusty but intact, without their drivers, who were likely deceased and others amongst people who were displaced.
The first earthquake occurred at a time when people are at their most vulnerable, fast asleep in their beds. Earthquakes are sudden and the least predictable type of natural disaster. Taha Erdem, a young 17-year-old Turkish teen recalled how suddenly and quickly the earthquake decimated his building. He said there were violent tremors, and a few seconds later the building collapsed. He recalled that by the time he jumped out of bed and ran to the door, the building was already collapsing all around him. He recorded a farewell video message, widely viewed on social media, while trapped under the rubble preparing for death. He was subsequently rescued from underneath the rubble, one of approximately 8 000 rescued from the rubble. More than 216 000 survivors have been evacuated from southern Turkiye. 105 000 buildings across Turkiye have been destroyed or damaged and 50 000 buildings have collapsed or are severely damaged. Those who managed to escape from the buildings, were left with just the clothes on their backs.
The relief team combed through sites searching for life in survivable voids created by spaces under concrete beams or stairwells. Some voids were large enough to move or crawl in, while other voids were much smaller with tighter spaces for any movement. Specialist sound and visual equipment was used to pass through gaps to listen and watch for movement, searching for life in the rubble. Thermal imaging equipment was also used by some teams to detect body warmth, creating a digital image of the human body, making it easy to locate those trapped. Sound signaling using tapping accompanied by ‘stop, quiet’ whistles were commonplace when listening for signs of life.
The SAPS K-9 unit played a pivotal role in detecting life. Warrant Officer Tinalia Gouws and her sniffer dog Donna, and Warrant Officer Martin Bann with his sniffer dog Optimus, part of the SAPS K-9 unit, were instrumental in finding an 80-year-old woman alive after eight days under the rubble. The South African K-9s are able to detect both live human and dead person’s scents, distinguishing them from other dogs that can only detect one type. Similarly, a 52-year-old man was discovered alive. Fifteen bodies were recovered to give the families closure. Importantly, the relief team marked where bodies were and as a result the Turkish teams are working on recovering over 200 bodies. Red balloons colour the demolished sites, representing the child, mother or father that once lived there.
The extent of human suffering and losses are mammoth, as whole families were wiped out. It was not uncommon to meet parents who had lost multiple children, and dozens of family members. Not just families but neighbours and neighbourhoods were destroyed as if to challenge whether people once lived there. As the relief team recovered the bodies of a woman’s children from a building, makeshift tomb, the unnamed woman expressed deep anger amidst her excruciating grief, blaming the building contractor and building inspectors for poor quality building material and the flouting of building regulations.
Building contractors have been arrested across Turkiye, as they tried to flee the country because current construction techniques should have been able to withstand earthquakes of this magnitude, however building regulations were bypassed. In addition, construction amnesties have been in place which provide legal amnesty for buildings without the required safety certificates. Hence, there are moves towards the establishment of an Earthquake Crimes Investigation bureau to investigate the building supply chain from materials to contractors and permits.
Turkiye hosts the largest number of the world’s refugee population, estimated to be at 3,6 million people. A large number of Syrians who were displaced by the war, are experiencing secondary or tertiary displacement by the earthquake, reliving the trauma of losing everything, including loved ones, and having to start over. I spoke to a Syrian family whose home was bombed, and who fled to Turkiye. They rebuilt their lives in Hatay, but were once again displaced to the tent city after having everything destroyed in a fresh wave of displacement from the earthquake.
They expressed the sentiment that camp living was not a viable life, and yearned for a return to Syria, referencing the rising xenophobia against Syrians. Despite their dire situation, the family invited us for tea into their AFAD tent, with such hospitability and incredible grace; scenes that were oft repeated and reported upon by all those who came into contact with the affected peoples.
Amongst the most vulnerable in the earthquakes are people with disability, large scale newly disabled, people with mental illness, children and the elderly. It is of critical importance to have disability-inclusive disaster management responses because in displacement situations, the needs of people with disability are often neglected. Those that are most affected are also those that are most forgotten. The newly disabled – people with amputations, and new injuries require disability access as temporary infrastructures are built, like transport, information, communication and the surrounding environment. Importantly, disability-inclusive programmes for prosthetics and orthotics, targeted rehabilitation to address functional limitations and a focus on mental health and well-being will need to be firmly established in the upcoming weeks.
Amidst the many stories of relief, hope and despair, mental health practitioners are called to assist survivors, grieving families and personnel on the ground. The affected communities risk major depression, anxiety, post-traumatic stress disorder, sleep disorders, and substance abuse. Symptoms to be on the lookout for include trauma related alterations to arousal and reactivity such as hypervigilance to sound and touch, irritability, loss of sleep, difficulty concentrating. Other physical symptoms of trauma include fatigue, eating disturbances and decreased immunity.
Emotional symptoms include shock, anger, guilt, confusion, grief, nightmares, withdrawal and reliving the event over in the mind, resurfacing the physiological reactions experienced during the earthquake, intense fear, flashbacks, and nightmares.
Affected individuals may also experience separation anxiety from family, fearing that they may be killed in subsequent tremors. There is an urgent need to address mental health challenges in both children and adults. Early intervention is key in mitigating psychological disturbances and re-establishing routines. Some people are still afraid to enter buildings, while others live in cars/vans where they take turns to sleep. They report that even though they are standing still, they feel that the ground is shaking, and are triggered by sights and sounds around them that play the earthquake scenes over and over again in their minds.
In terms of reestablishing housing, constructed makeshift shelters with bed sheets, blankets, plastic tarpaulin, were scattered along pavements and amidst the bitter cold, people were burning anything for fuel, including plastic.
Local water is contaminated, there are fuel shortages, and electricity is patchy. There are generally no working toilets, no showers with running water, and if there are, they are inaccessible for people with disability. Overall, the basic needs for self-care and hygiene are overwhelming. In addition, children are at risk for human trafficking and gender-based violence, given that so many are now orphans.
Meanwhile, personnel working on the ground are at risk from the trauma of what they have witnessed as wounded healers. It is important to recall that these same personnel were on the front line of the COVID-19 pandemic not too long ago, and still in recovery from that trauma.
We had the opportunity to visit a large field hospital, and saw Turks pull together in service of their people, amidst a very trying time. Attention is now being turned towards preventing infectious diseases like COVID-19 and waterborne diseases, as well as secondary incidents that can threaten health, such as fire and flooding.
Pre-earthquake challenges of a fragile employment market, rising inflation and xenophobic tensions are now exacerbated. Tensions between Turks and Syrians in the camps were palpable given the competing for sparse resources, and politicized anti-refugee sentiment. In the Hatay stadium tent city, Syrians were provided bus transport and transferred to other Turkish cities, in an attempt to diffuse the situation.
In terms of global foreign interests, Turkiye plays a crucial role around in the eastern Mediterranean and the world in foreign policy, with significant regional impacts, especially in the current Ukraine and Russia conflict. Turkiye will require sustained aid from the international community with their rebuilding efforts, as the financial damage of the Turkiye earthquake is estimated to be $84bn USD.
We encountered many heroes during our brief time there. We met Alleve, a volunteer nurse who worked round the clock to support the international teams with little resources. We met a Georgian young man who had sold his car to buy supplies to bring across into Turkiye. We met Dr Osamah, a Syrian orthopedic surgeon who had lived under siege for eight years in Syria who had turned a room in his home in Syria into a makeshift operating theatre.
Then there was the widely publicised Azerbaijani man who loaded his old car with mattresses and drove to Turkiye. Suffice to say, we met remarkable heroes at each step along the way, ordinary people doing the extra ordinary, to lean on each other at a most difficult time.
Within the remarkable Gift of the Givers team the camaraderie was strong, each looking out for each other, in the practice and lived experience of ubuntu. We can easily and proudly claim to be the most diverse and talented team deployed from around the world.
The Gift of the Givers team worked co-operatively with other international teams, especially the Omani, Chinese and Turkish teams.
In the words of the founder, Dr Imtiaz Sooliman: ‘When we work together for the purpose of humanity, there is always success’.
This profound moment in time offers many spiritual moments for tadabbur, tafakkur and tadhakkur. We are chillingly reminded of Surah Az-Zalzalah, the Earthquake from the Quran Al-Kareem, where Allah Ta’ala describes how the earth will be split asunder. Earthquakes have been used as punishments, blessings, and to teach lessons. I had the opportunity to perform two janaazah salaahs, one in an Adana masjid built in 1548, and the other salaah in Ayasofya. The Imams reminded the jama’ah that The Holy Prophet (SAW) said in a hadith narrated by Malik, Ahmad, Bukhari, and Muslim that those who die in a natural disaster are considered martyrs. Therefore, they were not just bodies under rubble, but rather honoured shuhada/martyrs.
On a sobering note, we are reminded in the Holy Quran that the day of resurrection will not come until the earthquakes happen frequently. Just as the earthquake came suddenly, so too will the Day of Judgment, come upon them suddenly, while they perceive it not. Given rapid climate change, and this promise of increased earthquakes, preparedness for future earthquakes of this scale, will take on a new heightened significance.
Strikingly, we observed the concept of sabr/patience as an active doing word, and jihad/struggle personified, as people galvanized together in selfless servitude, caring more about the well-being of others than their personal selves. Resilience research indicates that through community connectedness, working together and spirituality, there can be communal healing to the collective trauma experienced.
Hope springs eternal, like in Haiti, where a survivor was pulled out 27 days later, and in Bangladesh 17 days later after a factory building collapse. Many families are praying for such miracles for their loved ones, like the man who was pulled out after 13 days, defying the odds. It is disturbing that Syria has received very little aid and requires a dedicated article to unpack the extent of human misery unfolding there. Act by donating, advocating and volunteering.
Dr Fatima Hendricks is an occupational therapist living in Cape Town. She formed part of the Gift of the Givers disaster relief team who travelled to Turkiye to assist the victims of the recent earthquake.
- This article was updated on February 21, 2023 at 16h50 to include a quote from Dr Imtiaz Sooliman, founder of the Gift of the Givers Foundation.