The Doctor Won’t See You Now
Refugees in Turkey depend on illegal medical centers, but the Syrian physicians who run them are fleeing
FOUR MONTHS after Dr. Rami opened the doors of his illegal medical clinic in Istanbul, he has yet to find enough doctors to staff it. An Arabiclanguage poster at the entrance says the clinic provides pediatric care, dentistry and a pregnancy unit. He still hasn’t crossed out that last service, despite the fact that his Syrian gynecologist and obstetrician both left Turkey just after the clinic opened in February—traveling across the Aegean Sea to Greece and then on to Germany.
Rami and his seven colleagues are all refugees from Syria, where dozens of hospitals have been bombed and doctors have been shot at and kidnapped during the past five years of war. But for most refugee doctors in Turkey, the only way to practice medicine is to find employment in an illegal clinic like Rami’s. Rami, an eye surgeon who fled his hometown of Deir Ezzor in eastern Syria four years ago, estimates Syrians have set up about 100 such facilities across the country, and there are five in Fatih, Istanbul’s historic heart.
In May, when I visited, Rami and his colleagues were putting the final touches on the cramped apartment in Fatih they had transformed into a well-equipped health center. The smell of fresh paint hung in the corridors, and there was a pile of discarded tiles at the bottom of the stairs. Rami—who asked Newsweek not to publish his last name out of fear Turkish authorities would arrest him—says his Syrian neurologist left before the clinic even opened. He doesn’t blame his fellow doctors for leaving Turkey, usually for Europe. “If Syrian doctors have a chance to go to any other country, they go,” he says. “We are unlicensed. At any moment, the municipality can come and close us down. If this happens, I will either return to Syria or take the boat to Europe.”
Syria’s health care system was once one of the best in the Middle East, and its doctors were among the highest-paid professionals in the country. In Turkey, if a Syrian doctor wants to work legally, he or she has to go through a lengthy bureaucratic vetting process. First, the Turkish Education and Health ministries must approve a doctor’s medical certificate—but to do so, they need their Syrian counterparts to confirm its authenticity. The Syrian government rarely responds to such requests, and even if a doctor overcomes this hurdle, he or she then needs to apply for a work permit.
In January, Ankara introduced work permits for Syrians, but five months later, just 3,800 Syrians have received permits.
In the meantime, illegal clinics are springing up across Turkey. While the country offers free health care to Syrian refugees, that applies only to the 2.7 million registered with the authorities. Many more are thought to be unregistered.
“They come here because Turkish hospitals don’t treat Syrians fairly and because we speak their language,” says Abdullah, the manager of another clinic in Istanbul. (He also asked that
his last name be withheld.) Husna al-muhamed, a woman lining up to see a Syrian psychologist at Abdullah’s clinic, says her 5-year-old has not been able to walk or speak since their home in Aleppo was bombed in February by Russian or Syrian government jets. “I went to a Turkish hospital for help, and they told me to accept my son like this,” she tells Newsweek.
For now, the Turkish state appears to tolerate the many makeshift centers run and owned by Syrians. Officials from the Ministry of Health declined to comment, but Abdullah says the government permits the clinics to run because they relieve the burden on Turkey’s health services. “They turn a blind eye because we only treat Syrians. Refugees treating refugees,” he says.
“Turkey could benefit from Syrian doctors,” he continues. (Turkey’s health minister has said that the country needs an additional 30,000 doctors to staff its hospitals.) “But they’re making it hard for us to work [legally].”
One exception to the work permit rule is made for Syrian doctors employed by nonprofit organizations providing medical care to refugees. At Bezmialem University Hospital in Fatih, 10 Syrian doctors and nurses take over from their Turkish colleagues at 5 p.m. every day. Arwa al-rajeh, the hospital’s gynecologist, used to have her own clinic in Aleppo. When the front line inched closer, she began treating women in her home, but she left when her son narrowly escaped an airstrike. In November, she began working at Bezmialem. “The women here couldn’t believe that there was finally a Syrian doctor treating them,” she says. “It makes such a difference, the language especially.”
Although the majority of the doctors in illegal clinics treat only fellow refugees, some also help Turks who do not have health insurance. The Fatih clinics charge patients a flat fee of 20 liras (about $7)—the price of a takeout pizza in Turkey. Several neighborhood pharmacists accept prescriptions issued by Rami’s clinic and even sell discounted drugs to Syrians.
Turkey’s medical associations worry about the many unregulated doctors. “It’s a problem. None of them have had any medical education in the past five years,” says Selcuk Erez, the head of the Istanbul branch of the Turkish Medical Association, which represents 80 percent of Turkey’s doctors. “I’m sure there are some who work with fake diplomas as well.”
Doctors like Rami say there’s a simple way to make sure Syrian doctors in Turkey are qualified. “If they wanted to, they could solve this easily. Just test us, have us sit for an exam,” says Rami. “All staff here are real doctors.”
Real doctors or not, they can hardly get by. Rami has spent his life savings buying second- hand equipment for his clinic. He secretly performs eye operations at a private Turkish hospital to earn money on the side. Ayman, a doctor who works in Abdullah’s clinic, does not earn enough to pay his son’s kindergarten fees.
“We get paid maybe 20 percent of what a Turkish doctor gets. Most of my colleagues left. They went to Germany, Iraq, Saudi; one works in a textile factory here,” Ayman says. “And those that haven’t left yet are thinking of running away.”
“TURKEY COULD BENEFIT FROM SYRIAN DOCTORS, BUT THEY’RE MAKING IT HARD FOR US TO WORK.”