On February 6, 2023, a devastating Mw 7.8 earthquake struck Turkey and Syria, causing widespread destruction and loss of life. The earthquake's epicenter was west of Gaziantep, with a shallow focal depth. A subsequent Mw 7.5 earthquake occurred 100 km further north. The immediate impact included massive structural damage to buildings and infrastructure, resulting in tens of thousands of casualties and millions affected. However, an emerging threat is the potential for a public health crisis due to infectious diseases. This study investigates the risk factors that could lead to outbreaks of infectious diseases in the affected regions, leveraging field data collected by the authors in the aftermath of the disaster, along with insights from existing literature on similar events in Turkey and globally. The goal is to provide actionable insights for scientists, health professionals, and disaster management personnel to effectively prevent, control, and manage the risk of infectious disease outbreaks in the post-disaster context. The study adopts a multi-hazard approach that has become increasingly relevant in disaster response given the complexity of overlapping crises. The approach recognizes the interconnectedness of various hazards and their compounding effects on public health.

Previous earthquakes in Turkey, such as the 1999 Izmit (Mw 7.6) and the 2011 Van (Mw 7.1) earthquakes, resulted in outbreaks of infectious diseases. The Izmit earthquake led to outbreaks of gastrointestinal infections, largely attributed to water and food contamination due to damaged infrastructure and disrupted sanitation. Hepatitis A and E infections increased in children living in post-earthquake camps. The Van earthquake demonstrated similar patterns. The study references existing research highlighting increases in diarrheal diseases, hepatitis A and E, and skin infections following these earlier events, underscoring the vulnerability of populations in the aftermath of major seismic events. Prolonged residence in temporary settlements was linked to higher rates of giardiasis and enterobiasis. Wound infections, often hospital-acquired, were prevalent and were frequently caused by resistant Gram-negative bacteria like Acinetobacter baumannii.

The research methodology involved a combination of post-event field surveys and a review of existing literature. The authors conducted field surveys in the earthquake-affected areas shortly after the event, collecting data on the impact on buildings and infrastructure (including health facilities), water and electricity supply networks, and the effectiveness of initial response efforts. The surveys covered major cities like Kahramanmaraş, Nurdagı, Gaziantep, Osmaniye, Adana, Iskenderun, and Antakya. Data related to the damage to health infrastructure, disruption of essential services, and the conditions in emergency shelters were gathered. This field data was then integrated with information from existing literature, particularly focusing on infectious disease outbreaks following past earthquakes in Turkey. This combined approach allowed for a more comprehensive understanding of the risk factors associated with the emergence of infectious diseases in the 2023 earthquake-affected region and informed recommendations for disaster management.

The 2023 earthquakes in Turkey and Syria created numerous risk factors for infectious disease outbreaks. Significant damage to health facilities, including the collapse of hospitals, reduced the availability of medical personnel and increased the time required for medical care. Disruptions to roads hampered transportation of the injured. Severe winter weather conditions further complicated rescue and relief efforts and the survival of those displaced. Damage to water and sanitation systems resulted in a lack of access to safe drinking water and increased risks of gastrointestinal infections. Widespread displacement and overcrowding in emergency shelters created ideal conditions for the transmission of respiratory and other infectious diseases. The pre-existing fragile health system in Syria, weakened by years of conflict, the COVID-19 pandemic, and a recent cholera outbreak, exacerbates the situation. Existing literature highlighted the increased incidence of measles outbreaks in conflict-affected areas of Syria and Turkey. The disruption of existing disease surveillance and health care programs, such as immunization or vector control programs, further elevated the risks. The combination of damage to infrastructure and healthcare systems coupled with poor sanitation, overcrowded shelters and the harsh winter weather created a perfect storm for the propagation of infectious diseases. The study also identifies specific examples of previously documented infectious diseases outbreaks after earthquakes in similar contexts, drawing parallels with the current situation to reinforce the urgency and gravity of the issue. The lack of access to essential services such as clean water, proper sanitation and adequate shelter, combined with the existing health vulnerabilities of the population, dramatically increased the likelihood of infectious disease transmission.

The findings highlight the urgent need for a multi-pronged approach to mitigate the risk of infectious disease outbreaks in the aftermath of major earthquakes. Establishing robust disease surveillance systems is crucial for early detection and response to outbreaks. Preventive measures, such as ensuring access to clean water and sanitation, improving shelter conditions (including addressing overcrowding and providing adequate heating), distributing personal protective equipment, and implementing vaccination campaigns, are essential. The study emphasizes that effective disaster preparedness and response plans must integrate public health considerations to prevent infectious disease outbreaks. The challenges are greater in regions experiencing multiple overlapping crises, such as war, economic instability, and existing health vulnerabilities. The authors propose and discuss several preventative measures, drawing upon previous experiences and best practices, to reduce the likelihood and severity of outbreaks.

The 2023 Turkey-Syria earthquakes created a significant risk for infectious disease outbreaks. Effective disease surveillance, improved sanitation and hygiene, and the timely provision of essential supplies and services are crucial for mitigating this risk. A multi-hazard approach incorporating lessons learned from past disasters is essential for future preparedness and response. This highlights the critical need for comprehensive and integrated disaster preparedness strategies that actively address public health risks alongside the immediate challenges of rescue, relief, and recovery.

The study relies on field observations and existing literature, limiting the scope of quantitative data analysis. The rapidly evolving situation in the affected areas also posed challenges in data collection and analysis. Future research should focus on longitudinal studies to track the long-term health impacts of the earthquakes and the effectiveness of implemented interventions.