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The agree­ment struck between the Euro­pean Union and Turkey con­cern­ing “migrants” is accom­pa­nied by sums paid by the Euro­pean side. In oth­er words, entry into Europe by migrants, by sea or by land, main­ly through Greece, has been sub-contracted.

Not only if this agree­ment vil­lain­ous and inhu­man, with the “migrant” being treat­ed like mer­chan­dise, but the ques­tion also aris­es over how they are “treat­ed” in Turkey and by Turkey. We know they serve as an exchange cur­ren­cy and a means of per­ma­nent black­mail exploit­ed unashamed­ly by Turkey. We know that migrants of Syr­i­an ori­gin are also exploit­ed at will and sub­ject­ed to dai­ly racism.

But what about the fun­da­men­tal right to health care?

A reportage by Arif Koşar for Duvar. With pho­tos by Vedat Yal­vaç.


In Turkey dur­ing the pan­dem­ic, migrants can­not ben­e­fit from health ser­vices, can­not even go to the hos­pi­tal for fear of expul­sion or because of lack of money.

N.A. a 34 year old Moroc­can, afflict­ed with COPD (Chron­ic obstruc­tive pul­monary dis­ease) and five-months preg­nant, Yaku­ba S. who arrived in Turkey as a polit­i­cal refugee from Gam­bia, and Younes A., a Moroc­can in Turkey for work pur­pos­es in order to pro­vide care for his moth­er suf­fer­ing from can­cer, testify.

Access to health ser­vices, already rel­a­tive­ly prob­lem­at­ic for Turk­ish cit­i­zens, is ren­dered even more dif­fi­cult for migrants. The Coro­na pan­dem­ic has muti­plied these obstacles.

On paper, health is con­sid­ered one of the fun­da­men­tal human rights but it is often restrict­ed by the Right to cit­i­zen­ship. Once tak­en into account pri­va­ti­za­tions, third par­ty pay­ments, ser­vices and the treat­ments not cov­ered, for pop­u­la­tions in a pre­car­i­ous posi­tion who make up the major­i­ty of cit­i­zens, this right is almost total­ly inac­ces­si­ble. And when it comes to unde­clared migrants, it becomes almost impos­si­ble. On the one hand, the fear of being expelled, on the oth­er, illnesses.

Health with indebtedness

N;A. is a 34 year old Moroc­can. She arrived in Turkey two years ago and con­tract­ed a reli­gious mar­riage. Sub­ject­ed to vio­lence by her hus­band and fol­low­ing the fil­ing of a com­plaint, famil­ial dis­tanc­ing was pro­nounced imme­di­ate­ly, accord­ing to Law 6284 and the Istan­bul Con­ven­tion. She sep­a­rat­ed from her com­pan­ion. Five-months preg­nant and afflict­ed with Chron­ic obstruc­tive bron­chop­neu­mopa­thy (COBD), she now lives alone and with the need for reg­u­lar med­ical con­trols and treat­ments. Despite this fact, she faces anoth­er issue when she goes to the hos­pi­tal. “I have lan­guage issues. I under­stand very lit­tle Turk­ish. I received a twelve day treat­ment at the hos­pi­tal, and received shots. When I left the hos­pi­tal with my sis­ter, I was pre­sent­ed with a bill and told I must pay 4 000 Turk­ish lira (approx­i­mate­ly 610 euros). I did not under­stand their expla­na­tions but I signed the doc­u­ment they put before me. They informed me that nei­ther me nor my sis­ter could leave Turkey before this bill was paid.”

Dur­ing the inter­view, she has long cough­ing spells. She has trou­ble breath­ing. We take a break and con­tin­ue lat­er, then, anoth­er break. She must be put under assist­ed breath­ing every four hours. Yet, N.A. can­not go the the hos­pi­tal, nei­ther for the reg­u­lar fol­low-up on her preg­nan­cy, nor for her ill­ness. Because she has “a debt toward the State”. She has been told she will not receive treat­ment as long as she has not paid off her debt. She has no mon­ey to do so, nor to buy her medicine.

Poverty connects with health issues…

Her preg­nan­cy gives her crav­ings: “in the street when I see foods like fruits that give me crav­ings, I look the oth­er way. Some­times, it’s unbear­able but I tell myself ‘you have no mon­ey, you must not buy it”. I walk on by. I hope this won’t harm my baby.”

With her ill­ness, she must live in spa­cious well ven­ti­lat­ed spaces, but she lives in a base­ment apart­ment where, until very recent­ly, she had no fur­ni­ture. She strong­ly insist­ed that we sit on the few chairs that she owns. Thanks to the sol­i­dar­i­ty from the HDK’s Migra­tion and Refugee Coun­cil, she was pro­vid­ed with a fridge, a wash­ing machine, a stove and a few oth­er items. But the orga­ni­za­tion does not have unlim­it­ed means. In her con­di­tion, she is forced to turn to pri­vate hospitals.

But if the pub­lic hos­pi­tal is barred because of her debt, N.A. can­not afford pri­vate hos­pi­tals. And she is for­bid­den from return­ing to her coun­try because she signed a doc­u­ment acknowl­edg­ing her indebtedness…She no longer knows what to do. The vise­hold gen­er­ates a heavy depres­sion. Wor­ried for her baby and for her­self, she says: “I think of every­thing. I even think of death.” She is afraid her baby will be tak­en from her because of her ill­ness. “I think about that 24 hours a day. I don’t see how to escape this sit­u­a­tion and I cry con­stant­ly”, she says. Her voice is sad, she cries.

The fear of expulsion

Con­cern­ing lack of access to health ser­vices, N.A. if not the only one, unfor­tu­nate­ly. Yaku­ba S. who arrived in Turkey from Gam­bia request­ing polit­i­cal asy­lum, shares the same apart­ment with 17 oth­er migrants. He lost his job with the pan­dem­ic. He also says hos­pi­tals request astro­nom­i­cal amounts for health care. “For a surgery, the hos­pi­tal demand­ed 5 650 dol­lars. We are from Gam­bia, we don’t have 5 650 dol­lars to hand over, just like that. It is not easy at all.” Equal­ly resigned when he must go to the hosp­tial Yaku­ba prefers to stay away, in order not to run the risk of expulsion.


Younes A. (Pho­to : Vedat Yalvaç)

Younes A., a Moroc­can, came to Turkey in order to work and help his moth­er suf­fer­ing from can­cer. He has lost his job and his main demand is a job. He also prefers not to seek health care for fear of expul­sion. “In the Magreb, when we had a head ache, we bought a lemon. We cut it in half to apply it against our tem­ples and with, trust in Allah, we wait­ed. We do the same thing over here,” he says.

Migrant solidarity group “Tarlabaşı Dayanışma”

In gen­er­al, migrants and refugees reside in the town’s poor­est quar­ters. Kadir Bal, spokesper­son for Tar­labaşı Dayanış­ma, a group act­ing in sol­i­dar­i­ty in Tar­labaşı but also in oth­er neigh­bor­hoods, under­lines the exis­tence of three bar­ri­ers to health care for unde­clared migrants: “The first is finan­cial. For exam­ple, a hos­pi­tal ser­vice billed 5 or 10 Turk­ish lira to a Turk­ish cit­i­zen, is billed 50 or 100 Turk­ish lira in their case. The sec­ond is the lan­guage bar­ri­er, hav­ing trou­ble express­ing one’s self is a prob­lem. The third is the fear of depor­ta­tion. For these rea­sons, health is some­thing con­stant­ly pushed down the line here and treat­ment becomes a con­stant effort lim­it­ed to recu­per­at­ed out-dat­ed antibiotics.”

Kadir Bal, spokesper­son for Tar­labaşı Dayanış­ma. (Pho­to : Vedat Yalvaç)

Lack of funds and despair

Mehmet Yer­alan, alias “Mehmet from Urfa”, a mem­ber of the Tar­labaşı Dayanış­ma is one of the wit­ness­es to the dif­fi­cul­ties the migrants have get­ting health care and to the open wounds thus gen­er­at­ed: “One migrant with kid­ney prob­lems came to see me. He was in need of dial­y­sis. Each ses­sion cost approx­i­mate­ly 400 Turk­ish lira (some 50 euros). He needs dial­y­sis three times a week. How can this broth­er from Africa pay 1 200 Turk­ish lira a week? Once or twice, he man­aged to gath­er this sum by doing the rounds of his friends. But he needs treat­ment every week… We were able to help him once but the hos­pi­tal no longer accepts him, say­ing ‘we can’t treat him for free’ What did we do? We had the boy wait with us until there was a low­er­ing in his hemo­glo­bin. Once the diminu­tion was averred we called an ambulance…We had no oth­er solu­tion. The ambu­lance arrived and he was tak­en in as an emer­gency. That time, we man­aged to have him dial­ized that way. Lack of funds, despair…”


Mehmet Yer­alan, mem­ber of the Tar­labaşı Dayanış­ma. (Pho­to : Vedat Yalvaç)

Clandestine clinics

Göç­men Dayanış­ma Derneği (Migrant Sol­i­dar­i­ty) inter­venes in order to sup­port access to health care for migrants, be they declared or not. Its coor­di­na­tor Özgür AktÜkün draws atten­tion to the fact that migrants encounter count­less vital prob­lems both in their access to health ser­vices and dur­ing their treat­ment. Accord­ing to Aktükün, although the right to health is defined as a fun­da­men­tal right with no dis­crim­i­na­tion accord­ing to cit­i­zen­ship, eth­nic ori­gin, belief or gen­der, it is lim­it­ed in fact by the “Cit­i­zen­ship Right”. It is not some­thing that can be set aside sim­ply by say­ing “that’s the way the leg­is­la­tion works. “Because of this, if you are from Ugan­da and can­not obtain a pro­tec­tion sta­tus as a can­cer patient, you will die in this country.”

Özgür Aktükün, coor­di­na­tor of social ser­vices for the Göç­men Dayanış­ma Derneği. (Pho­to : Vedat Yalvaç)

Nei­ther Turk­ish nation­al­i­ty, nor inter­na­tion­al pro­tec­tion or the sta­tus of tem­po­rary pro­tec­tion resolve the prob­lem of access to health care, espe­cial­ly for the des­ti­tute. And when deal­ing with unde­clared migrants, the prob­lems increase. “If the per­son is in an irreg­u­lar sta­tus, he or she has no pos­si­bil­i­ty what­so­ev­er of ben­e­fit­ing from any free health care.” Aktükün con­tin­ues: “We must dis­cuss exist­ing ten­sions between the frame­work of uni­ver­sal human rights and the Cit­i­zen­ship Law of States and the Rights of strangers. Because that ten­sion trans­forms into severe ill­ness­es and even death.”

Accord­ing to Aktükün, irreg­u­lar migrants have oth­er prob­lems that go beyond the amounts of mon­ey required for health care. “Since they are unde­clared, they are clan­des­tines. The costs are a sec­ondary issue, real­ly, because there is also the prob­lem of secu­ri­ty. When a clan­des­tine sol­lic­its a State admin­is­tra­tion, even if it is an admin­is­tra­tion deal­ing with health, this lat­ter must alert author­i­ties. This holds true for pri­vate hos­pi­tals. Migrants in an irreg­u­lar sit­u­a­tion can­not go there. This is the rea­son why clan­des­tine health cen­ters and med­ical work­ers have mul­ti­plied in Turkey, offer­ing their ser­vices par­tic­u­lar­ly to clan­des­tine migrants, who are total­ly out­side con­trol structures.”

This reportage is also avail­abe as a video (in Turk­ish). Real­ized by Vedat Yalvaç.

Head­line pho­to: N.A. at home… (Pho­to: Vedat Yalvaç)

Translation by Renée Lucie Bourges 
*A word to English-speaking readers: in all instances where the original text is in Turkish or Kurdish, the English version is derived from French translations. Inevitably, some shift in meaning occurs with each translation. Hopefully, the intent of the original is preserved in all cases. While an ideal situation would call for a direct translation from the original, access to information remains our main objective in this exercise and, we hope, makes more sense than would a translation provided by AI…
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