On 6 February 2023, several massively destructive earthquakes struck 10 provinces in southern Türkiye. These were followed by thousands of aftershocks. As well as facing immediate danger from the earthquakes themselves, people in the affected areas faced many other health threats, such as the impact of cold and hypothermia in the wintry conditions. Risks also included further injury from damaged buildings, hygiene problems due to damaged water and sewage systems, and the ongoing individual and public health challenges experienced by displaced people living in temporary settlements and tents.
In addition to instigating search and rescue efforts and working to ensure health services and care for those affected by the earthquakes, WHO at regional and country levels worked with the country’s Ministry of Health (MoH) to develop, test and deliver health messaging to affected communities on approximately 30 topics. These included protection from cold and hypothermia, safe water use, food hygiene, vaccination (rabies and tetanus) and advice on mental health.
“The sense of collaboration and close cooperation between our ministry and WHO are of vital importance in terms of protecting and promoting health, both in Türkiye and in the Region,” commented Serkan Karavus, of the General Directorate of Health Promotion at the Turkish MoH.
Gerald Rockenschaub, WHO Regional Emergency Director echoes the importance of this collaboration. “The partnership with the Turkish MoH has been exemplary during the most acute phase of the earthquake response and thereafter. We have come together, bridging international and national expertise to develop and disseminate life-saving health information and advice to the people who need it most.”
Social and community listening
As soon as the earthquakes struck, the MoH and WHO developed public health messages on priority topics. Serkan Karavus explains: “The messages we determined as a result of regular meetings we held with WHO as a stakeholder since the first day of the disaster were instrumental in mitigating the harm to people’s health caused by the earthquake. Making use of WHO’s institutional knowledge and experience in crises and emergencies contributed to our efforts greatly”.
To inform message development, taking into account people’s risk perceptions and evolving health information needs, WHO/Europe conducted regular social listening – a key facet of risk communication, community engagement and infodemic management (RCCE-IM). Using digital platforms which analyse online posts and conversations, they sought to identify health information needs and voids as well as perceptions on the ground and to understand how WHO and the MoH could offer support.
The team identified key words relating to topics of immediate health concern, such as food and water safety and skin diseases, and translated them into Turkish and Arabic (to reflect the large numbers of Syrians affected by the earthquake). Information voids and trending searches were detected by using software which analyses the popularity of information that people are searching for online every day.
One of the main and enduring topics detected was mental health. Shocked and grieving citizens and health workers, as well as people working in emergency services, reported a big impact on their mental health. With input from mental health specialists and working closely with local experts, WHO developed messages in a culturally appropriate and contextually relevant way.
WHO developed visually appealing social media tiles, conducted rapid online message testing, adapted the messages, and finally disseminated them through social media and other channels accessed by end-users. Within the first month, these tiles reached 27 million people with targeted mental health advice to help protect their well-being and facilitate access to specialist services where needed.
Leveraging community assets
To bridge the information gap created by the destruction of communication infrastructure (such as television and internet masts) during the earthquakes, the MoH and WHO plan to deploy a mobile health communication vehicle to the earthquake-hit region. Such vehicles enable health and social workers to deliver health information and advice right to where people are sheltering, including advice on breastfeeding, how to ensure food and water safety, what to do in case of headlice and scabies, and how to cope during extreme heat.
The MoH and WHO are also training community members in Hatay province to support breastfeeding mothers, and to encourage pregnant women, new mothers or those who have stopped breastfeeding, to breastfeed their babies. This intervention aims at enhancing community members’ communication skills so that they can listen, understand and support mothers who might already be breastfeeding, or who are hesitant about starting.
Taking stock from RCCE-IM preparedness
“Communicating risks based on people’s perceptions and needs, and engaging communities to develop, test and deliver public health advice is at the core of accessing health services. As such, this is an essential public health intervention in emergencies from preparedness to response," says Cristiana Salvi, Regional Adviser for RCCE-IM at WHO/Europe.
As a key partner of the MoH in Türkiye, in the year prior to the earthquakes, WHO/Europe ran two intensive RCCE-IM trainings, coupled with simulated emergencies, to test participants’ skills in real time. This helped to build the capacity of emergency responders in the Region.
“The most salient [feature of RCCE-IM is] being proactive (preventive) and keeping communities engaged and at the centre of the solution,” said Serkan Karavus, who participated in the trainings. “Within the margins of these 2 trainings, the content, knowledge and experiences presented with the participation of distinguished experts from the WHO regional and country offices helped us immensely in the activities we conducted during the earthquake period.”
In addition, as part of long-term emergency preparedness, WHO/Europe has established the first ever Technical Advisory Group (TAG) on RCCE-IM to solicit expert advice on acute and long-term RCCE-IM needs in the Region. The TAG includes 18 experts from public health, academia and civil society, including from Türkiye. During the earthquakes, WHO/Europe was able to receive rapid advice from the TAG’s Turkish expert who was embedded into the RCCE-IM response strategy.