Abstract: The Syrian population influx has dislocated a significant number of people (6.7 million of people outside the Syrian borders, 6.5 million of people among the different provinces of Syria). The biggest group among this moving population between borders has integrated into the Turkish society, and economy. From the macro and micro perspectives, the health system integration is significantly graded by the Syrian population. We will focus on the early age group, among the refugees, as their health vulnerabilities, and health improvements will create much larger effects throughout their lifetime. What we aim in this paper is to bring forward an objective micro-level outcome that will allow us to measure two things that was crucial in the life cycle of the refugee population: the war effect which will create a push factor for them to start moving, and an integration effect which will measure the time-continuous, and time-discrete increase in their health outcomes, as a result of relatively cost-free integration into a more developed health system. The Demographic Health Survey (DHS) 2018 data that we utilize gives us an empirical advantage for identification for two reasons; it differentiates the health outcome of children, in multi-child families depending on where they were born, which we will call an intra-Syrian effect, and it allows us to compare the situation of the Syrian children vis-a-vis the average child health outcomes in the society they are integrating into (what we call the inter-Syrian effect). The results suggest that Syrians remain underneath the Turkish average, for many early child development, and vital health access, however, after integration significant positive developments occur, in terms of compensating for the negative war effect, and in terms of the second effect (integration/adaptation effect) that they have started to converge to the Turkish average, as they have spent more years in Turkey. Özet: 2011 yılında Suriye’de başlayan iç savaş ile birlikte 6.7 milyon Suriyeli ülke sınırları dışına çıkmak zorunda kalmıştır, aynı zamanda yaklaşık 6.5 milyon Suriyeli de ülke içinde farklı bölgelere göç etmek durumunda kalmıştır. Ülke sınırları dışına çıkmak zorunda kalan Suriyeli göçmenlerin çok büyük bir bölümü Türkiye’ye göç etmiştir ve tamamiyle Türk sağlık sistemine entegre olmuştur. Bu çalışma, Türk sağlık sistemine entegre olan Suriyeli nüfusun yaşam boyunca sağlık kırılganlığı ve sağlık gelişimi açılarından önemli etkiler gösteren erken yaş grubunu ele almıştır. Bu çerçevede, çalışmanın temel amacı göç eden Suriyeli nüfusun entegre oldukları Türk sağlık sistemi içerisinde mikro seviyede sağlık çıktılarındaki değişikliği ölçmek ve değerlendirmektir. Çalışma, Demographic Health Survey (DHS) 2018 veri setini kullanmaktadır; kullanılan veri seti çalışmaya iki önemli avantaj sağlamaktadır; birincil olarak, kullanılan veri seti erken yaş grubunun sağlık çıktılarını diğer yaş gruplarından demografik özelliklere göre ayrıştırmaktadır, ikincil olarak da, savaş nedeniyle ülkelerinden göç eden Suriyeli çocukların sağlık çıktılarının Türkiye’de entegre oldukları toplumun ortalama sağlık çıktıları ile karşılaştırılmasını sağlamaktadır. Çalışmanın sonuçları göstermektedir ki, Suriyeli nüfus erken çocukluk gelişimi ve önemli yaşamsal göstergelerde Türk nüfusunun gerisinde kalmıştır. Diğer yandan, Suriyeli nüfusun Türk sağlık sistemine entegrasyonu ile birlikte oldukça olumlu gelişmeler meydana gelmiştir; Suriyeli nüfusun Türkiye’de geçirdiği zamanın artmasına parallel olarak sağlık çıktılarının Türk nüfusunun ortalamasına yaklaşarak iyileştiği gözlemlenmiştir.

Anahtar Kelimeler:

Forced migration, refugees, health care system, health care demand, health care access, health resilience, child mortality, antenatal care, postnatal care

ACCESS TO HEALTHCARE SERVICES AMONG SYRIAN REFUGEES IN TURKEY

The Syrian population influx has dislocated a significant number of people (6.7 million of people outside the Syrian borders, 6.5 million of people among the different provinces of Syria). The biggest group among this moving population between borders has integrated into the Turkish society, and economy. From the macro and micro perspectives, the health system integration is significantly graded by the Syrian population. We will focus on the early age group, among the refugees, as their health vulnerabilities, and health improvements will create much larger effects throughout their lifetime. What we aim in this paper is to bring forward an objective micro-level outcome that will allow us to measure two things that was crucial in the life cycle of the refugee population: the war effect which will create a push factor for them to start moving, and an integration effect which will measure the time-continuous, and time-discrete increase in their health outcomes, as a result of relatively cost-free integration into a more developed health system. The Demographic Health Survey (DHS) 2018 data that we utilize gives us an empirical advantage for identification for two reasons; it differentiates the health outcome of children, in multi-child families depending on where they were born, which we will call an intra-Syrian effect, and it allows us to compare the situation of the Syrian children vis-a-vis the average child health outcomes in the society they are integrating into (what we call the inter-Syrian effect). The results suggest that Syrians remain underneath the Turkish average, for many early child development, and vital health access, however, after integration significant positive developments occur, in terms of compensating for the negative war effect, and in terms of the second effect (integration/adaptation effect) that they have started to converge to the Turkish average, as they have spent more years in Turkey.

Keywords:

Forced migration, refugees, health care system, health care demand, health care Access, health resilience, child mortality, antenatal care, postnatal care,

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Akresh R, Verwimp P, and Bundervoet T. 2012. Civil War, Crop Failure, and Child Stunting in Rwanda. Economic Development and Cultural Change. Vol. 59, No. 4, pp. 777-810.
Akresh R, Lucchetti L, Thirumurthy, H. 2012. Wars and Child Health: Evidence from the Eritrean-Ethiopian Conflict. Journal Development Economics. Vol. 99(2):330-340. doi: 10.1016/j.jdeveco.2012.04.001.
Bundervoet T, Verwimp P, and Akresh R. 2009. Health and Civil War in Rural Burundi. The Journal of Human Resources. Vol. 44, No. 2, pp. 536-563.
Chetty R, Hendren N. 2018. The Impacts of Neighborhoods on Intergenerational Mobility I: Childhood Exposure Effects. The Quarterly Journal of Economics, Volume 133, Issue 3, Pages 1107–1162, https://doi.org/10.1093/qje/qjy007.
Guha-Sapir D, Gijsbert W. 2004. Conflict-related mortality: an analysis of 37 datasets. Disaster, 28(4), 418–428.
Hacettepe University Institute of Population Studies (HUIPS). 2019. 2018 Turkey Demographic and Health Survey. Hacettepe University Institute of Population Studies, T.R. Presidency of Turkey Directorate of Strategy and Budget and TÜBİTAK, Ankara, Turkey.
Hamill A, Houston P. 2000. War and children’s mortality. Childhood, 7(4), 401–419.
Hargreaves JR, Collinson MA, Kahn K, Clark SJ, Tollman SM. 2004. Childhood mortality among former Mozambican refugees and their host in rural South Africa. International Journal of Epidemiology, 33(6), 1271–1278.
Hynes M, Sheik M, Wilson HG, Spiegel P. 2002. Reproductive health indicators and outcomes among refugees and internally displaced persons in post emergency phase camps. JAMA, 288(5), 595–603.
Khawaja M. 2004. The extraordinary decline in infant and childhood mortality among Palestinian refugees. Social Science and Medicine, 58(3), 463.
Madi HH. 2000. Infant and child mortality rates among Palestinian refugee populations. Lancet, 356(9226), 312.
Maystadt JF, Hirvonen K, Mabiso A, and Vandercasteelen J. 2019. Impacts of Hosting Forced Migrants in Poor Countries. Annual Review of Resource Economics.
Minoiu C and Shemyakina O. 2012. Child Health and Conflict in Côte d'Ivoire. The American Economic Review Vol. 102, No. 3.
Mipatrini D, Balcılar M, Dembech M, Ergüder T, and Ursu P. 2019. Survey on the health status, services utilization and determinants of health: Syrian refugee population in Turkey (No. WHO/EURO: 2019-3472-43231-60591). World Health Organization. Regional Office for Europe.
O’Hare BA, Southhall DP. 2007. First do no harm: the impact of recent armed conflict on maternal and child health in Su-Saharan Africa. Journal of the Royal Society of Medicine, 100(12), 564–570.
Serdan GG. 2009. The Effects of the War in Iraq on Nutrition and Health: An Analysis Using Anthropometric Outcomes of Children. SSRN Electronic Journal. DOI:10.2139/ssrn.1359161.
Singh K, Karunakara U, Burnham G, Hill K. 2005a. Using indirect methods to understand the impact of forced migration on long-term under-five mortality. Journal of Biosocial Science, 37, 741–760.
Singh K, Karunakara U, Burnham G, Hill K. 2005b. Forced migration and under-five mortality: a comparison of refugees and hosts in North-western Uganda and Southern Sudan. European Journal of Population, 37, 741–760.
Solis-Soto MT, Paudel D, and Nicoli F. 2020. Relationship between vaccination and nutritional status in children: Analysis of recent Demographic and Health Surveys. Demographic Research, 42(1):1–14.
Verwimp P, Van Bavel J. 2005. Child survival and fertility of refugees in Rwanda. European Journal of Population, 21(1), 271–290.
Winfred AA, Agadjanian V. 2009. Forced migration and child health and mortality in Angola. Social Science and Medicine. 70 (2010) 53–60.
World Health Organization (WHO). 2006. WHO Child Growth Standards: Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: Methods and development. Geneva: WHO.