Translation from Turkish by translators for justice
Prof. Dr. Cem Terzi*
The following report covers the top items of urgency that need to be addressed based on day-long observation and volunteer work at Suruç State Hospital.
1- The dreaded street clashes in Kobanê have started, resulting in a significant surge in the number of injuries and casualties. Around 10 corpses have been brought to the hospital today. The number of heavily injured who were treated here and then referred to either Şanlıurfa or Diyarbakır is around 60. Notably, injured civilians have been admitted in the evening. We might encounter a more severe situation tomorrow and in the upcoming days.
2- It is of utmost importance that as a community of physicians, we should call out to political authorities both in Turkey and around the world to take action in order to prevent a massacre in Kobanê. In this respect, an initiative by Turkish Medical Association (TTB) and the Union of Health and Social Service Workers (SES) should have priority over any healthcare they will provide.
3- A field hospital should urgently be established between the border and Suruç, including an operation room and an intensive care unit. This is the only way some of the injured could survive. As an example; an 18-year-old individual with femoral fracture died of hemorrhage during transporation. Some of the casualties could have been saved if on-site treatment could be provided.
4- It is apparent that we are going through a state of emergency in healthcare terms. A crisis center should be established immediately. This center should coordinate the healthcare capabilities in Ankara, Suruç, Şanlıurfa and Diyarbakır; and in more complicated cases requiring advanced treatment, such as microsurgery due to loss of limb, patients should be airlifted to Ankara, İstanbul and İzmir.
5- Even though calls for help for volunteer physicians and healthcare professionals have received responses; this situation could only be dealt with through a general mobilization of the Ministry of Health’s resources. Any effort in which the Ministry of Health does not assume chief responsibility will therefore fall short. This point should be made absolutely clear to the Ministry officials. On the other hand, the volunteer physicians and healthcare professionals from TTB and SES play a major role in establishing communication between local teams, patients and their families. It is mandatory that the Ministry of Health cooperate with these two health organizations.
6- At the moment, the shortage of physicians and health workers at Suruç State Hospital has been overcome thanks to volunteers; however, in a couple of days many will have to return to their posts. Therefore, volunteering physicians and health workers from both the Ministry of Health and from TTB and SES should arrive here as of 9th October. Otherwise there will be serious chaos.
7- Suruç State Hospital does not have a thoracic surgeon. Many patients with thoracic trauma have sought our help. Thoracic surgery specialists should definitely be sent here. There is no thoracotomy kit available in the hospital and it needs to be provided urgently.
8- There is only one ventilator available in Suruç State Hospital. Some of the patients leave the operation theatre intubated. There is an urgent need for a ventilator.
9- Many patients are referred to Şanlıurfa Training and Research Hospital, which is 45 minutes away. The intensive care unit and bed capacity of this hospital has been filled as of tonight and no other patients can be allowed in. Transportation to Diyarbakır takes three and a half hours; which results in an insupportable loss of time. Therefore, all hospitals in Şanlıurfa, including private ones, should be made available while triage is managed by an expert team.
10- We are unable to treat cases of traumatic brain injury in Suruç; all such patients are sent to Şanlıurfa. Only one of the five brain surgeons employed worked throughout the holiday period. There is also a shortage of operation equipment and medical supplies necessary for brain surgery. Special support is needed. A craniotomy drill, dura mater substitutes etc. should be provided immediately.
11- Here is a list of specialists and healthcare professionals needed in the area in the upcoming days:
a) a brain surgeon
b) a thoracic surgeon
c) a general surgeon
d) a cardiovascular surgeon
e) an orthopaedist
f) an anaesthetist
g) an emergency medicine specialist
h) an anaesthetic technician
i) a radiologist
j) a plastic surgeon
k) general practitioners or emergency medicine specialists with ambulance experience to be recruited in patient referrals
12- Unfortunately, patient transportation between the border gate and Suruç State hospital is hindered with constant problems that cost invaluable time. The local administration needs to be contacted so that such problems can be eliminated and not only 112 ambulances but also municipality and other vehicles could be used for transfer.
13- Traffic safety is not provided on the roads. There have been two traffic accidents during patient transfers today, adding to the number of trauma admissions to Suruç State Hospital. Road safety should be maintained as a matter of urgency.
14- It may be necessary to establish a temporary blood transfusion center in Suruç county. Today a significant number of blood transfusions took place without any setbacks, but major issues may emerge in the upcoming days.
15- The city of Gaziantep may also be incorporated into patient coordination efforts.
16- In Suruç, there are around 10 physicians from Kobanê. These professionals could prove crucial for establishing communication with patients if they could serve in Suruç and Şanlıurfa state hospitals.
17- Amara Cultural Center is currently being used as a policlinic and infirmary for immigrants staying in camps. A makeshift pharmacy has been set up here. The physical conditions are far from appropriate. Major issues in healthcare services provision primarily in hygiene, crop up.
18- There is an infirmary within walking distance on the Kobanê side of the border, where two physicians are treating patients. Apart from that, there are no functional hospitals or health centers. During our conversation at the border, the physician on duty asked for prednisolone, adrenaline, a surgery kit and local anaesthetic. This example illustrates the serious need for medication and supplies in Kobanê. In order to meet these needs, an official network should be established.
* Prof. Dr. Cem Terzi, President of European Surgical Association, Member of Dokuz Eylül University School of Medicine, Volunteer Physician of TTB and SES Health Organizations