As part of the Southern Responses to Displacement project, the research team has been examining responses developed by differently-positioned states (including host states) as well as by municipal and local-level actors, and of course refugees themselves. While Syrians registered under a Temporary Protection ID in Turkey can access free healthcare services through the Turkish public healthcare system, in this piece I reflect on the inclusion/exclusion of Syrians not only from accessing healthcare services provided by the Turkish host state, but also the barriers to Syrian health-workers themselves working in medical settings in Turkey. In so doing, I offer reflections from our research and from my own observations, as a public health specialist, of Syrians’ interactions with the public health system in Turkey, as they relate both to state-provided services and the potential for refugee-led responses to displacement.
Syrian refugees and healthcare in Turkey
At the beginning of Syrians’ displacement to Turkey (2011–2012), public hospitals were the primary healthcare providers for refugees from Syria. In our recent participatory and writing workshops in Istanbul and Gaziantep, our participants expressed their satisfaction with both the quantity and quality of these services. They recalled that during the first few years of displacement, healthcare was provided to literally everyone. Although some expensive specialized medications and services required out-of-pocket payments, even Syrians without a Temporary Protection ID—or any form of ID—could receive primary, secondary, and even tertiary care for free. Critical cases were even transferred from Syria to Turkey for treatment.
In our workshops, our Syrian participants unanimously acknowledged the high quality and accessibility of healthcare for those under Temporary Protection status. They noted that Turkey’s healthcare system is well-functioning and practical for its citizens and they expressed gratitude for their access to it. They spoke not only about public hospitals but also about what they called “المستوصفات” in Arabic, referring to the Turkish Aile Sağlık Merkezleri (Family Health Centers). These centers provide vaccines, maternal and child-care, basic blood tests, and general practitioner consultations with referrals. They serve both Turkish citizens and Syrians with Temporary Protection IDs, and were described by our participants as providing good-quality services.
As noted above, public hospitals and family health centers were repeatedly praised by our Syrian participants. However, they highlighted a major issue: inequality in access. In practice, many Syrians are deprived of these essential, life-saving services.
The primary issue lies in geographic restrictions—Syrians can only access healthcare in the province where their Kimlik (Temporary Protection ID) was issued. Those who move to other cities, often for work, face serious difficulties. Many are unable to transfer their Kimlik due to bureaucratic restrictions imposed by Göç İdaresi İdaresi (General Directorate for Migration Management), leaving them without healthcare access.
Additionally, undocumented Syrians who have not obtained Temporary Protection status face even greater challenges. Seeking medical care at a hospital or clinic risks exposing them to authorities, potentially leading to deportation. This fear also affects Syrians whose Kimlik is registered in a different city from where they currently live. For example, a Syrian with a Gaziantep Kimlik who moves to Istanbul for work is not eligible for healthcare in Istanbul and may face deportation if identified by authorities.
The Mental and Physical Toll of Administrative
From a public health perspective, the stress caused by these restrictions has severe consequences. Many Syrians dealing with Kimlik issues experience psychosomatic symptoms—chronic stress, anxiety, and even physical manifestations and ailments. A friend of mine once shared how a simple administrative error with her Kimlik—which left her unable to update her registered address—resulted in months of distress. She developed severe stomach pain, which she believed was not due to a physical condition but rather the psychological burden of knowing she couldn’t access healthcare if needed.
As a public health specialist, I see an urgent need for further research on how these administrative barriers impact the well-being of Syrian refugees in Turkey. A well-functioning healthcare system should promote equity and reduce harm. However, despite its high quality, the current system unintentionally exacerbates public health concerns by fostering uncertainty, fear, and stress among vulnerable populations. Addressing these systemic issues is crucial to ensuring that healthcare serves its intended purpose: to provide support rather than contribute to additional hardship.
The Language Barrier
Another challenge in the Turkish public healthcare system for Syrians is the language barrier in public hospitals. This issue was not solved by appointing qualified, trained translators. Instead, Syrian Turkmens were hired, many of whom lacked formal training in medical translation. Participants shared that when a Turkish doctor spoke multiple sentences, the translator would often translate only a few words, leading to significant gaps in communication. As a result, many Syrian parents had to rely on their children—who had studied in Turkish schools—to translate during medical appointments.
Syrian Healthcare Workers in Turkey
Before 2017, Syrian healthcare workers were not allowed to practice medicine in Turkey. Certain professions, including medicine, are legally restricted to Turkish citizens. Even if foreign doctors pass the required exams and complete the necessary paperwork, they are still prohibited from working in these fields.
This restriction, coupled with the lack of a clear and transparent pathway to Turkish citizenship, was extremely frustrating for Syrian healthcare workers. It led to the emergence of an unregulated, underground Syrian healthcare system in cities with large Syrian populations. It also pushed many Syrian doctors to migrate to European countries, particularly Germany. Those who remained in Turkey were forced into unfair working conditions, taking on jobs that paid less and were outside their fields—such as teaching English or Turkish, working in NGOs, or even doing daily labor.
In 2017, the EU, WHO, and the Turkish Ministry of Health introduced the Migrant Health Centers program, allowing Syrian doctors to practice medicine in Turkey. When the program was announced, it sparked hope. Syrian healthcare professionals dreamed of practicing their careers and regaining their dignity, while Syrian patients hoped to receive regulated healthcare services in Arabic. But the reality fell short of these expectations.
The program trained around 1,000 Syrian doctors and 600 Syrian nurses. Most doctors were specialists, but they were only allowed to practice general medicine in the Migrant Health Centers. Only pediatricians, gynecologists, and internal medicine specialists were permitted to practice in their expert fields—but even then, they had no access to essential tools or equipment.
In our participatory workshops in 2025, our participants complained about the quality of care in these centers, particularly about the attitude of Syrian doctors toward Syrian patients. When we investigated why this was the case, participants cited low salaries as compared to Turkish doctors, a lack of medical equipment, and the impact of the presence of Turkish supervisors (whose role is to monitor the work of Syrian doctors), as contributing factors.
My mother, an anesthesiologist and Syrian refugee in Gaziantep since 2015, attended the training but ultimately could not continue. She told me it was not just the issues that our participants mentioned—it was something deeper. She felt that Syrian doctors were not truly integrated into the Turkish system. Instead, the program reinforced a sense of discrimination and separation.
Comparing the Experiences of Syrian Doctors in Turkey and Germany
Since we began conducting interviews with Syrians in Turkey under the Southern Responses to Displacement project in 2020, participants have frequently compared the experiences of Syrians in Turkey and Germany.
One major difference is financial support—in Germany, refugees receive monthly stipends until they learn the language, which did not happen in Turkey. Another key distinction is the clear pathway to citizenship, which is not available in Turkey in a clear, fair and organized way. Approximately 238,000 Syrian refugees out of more than 3.2 million Syrian refugees in Turkey received Turkish citizenship on an exceptional basis. However, there were no criteria or specific steps to follow in order to receive it, and individual Syrian refugees did not have the right to apply for citizenship directly themselves. Instead, some Syrian refugees received a text message inviting them to be interviewed at the Governor’s Office, and in turn then some of these people were granted citizenship while others were not, without understanding why some people received it while others did not.
A particularly interesting comparison with Germany is job opportunities for Syrian healthcare workers there.
The integration of Syrian healthcare workers presents a compelling comparison. In Germany, Syrian doctors, dentists, and pharmacists have the opportunity to thrive. Upon acquiring German language skills and passing equivalency exams, they gain access to education and employment opportunities equal to German professionals, receiving equal salaries and being included in the German healthcare system. This inclusion has been mutually beneficial, addressing Germany’s healthcare workforce shortages and providing Syrians with stable careers.
In contrast, Syrian doctors in Turkey are only allowed to work in Migrant Health Centers MHCs. While these centers offered employment opportunities for Syrian doctors, the latter’s roles were confined to serving within the MHCs, preventing their integration into the broader Turkish healthcare system. Additionally, Syrian doctors in Turkey receive lower salaries compared to their Turkish counterparts, reflecting a disparity in compensation.
The decision to restrict Syrian healthcare professionals to MHCs and offer them lower salaries appears to stem from Turkey’s broader policy framework toward Syrian refugees. By designating Syrians as temporary guests, Turkey has implemented policies that emphasize temporariness and limit full legal or social integration. This approach is evident in the employment restrictions and the lack of a clear pathway to citizenship. While the establishment of MHCs aimed to address immediate healthcare needs and provide employment, it inadvertently reinforced the notion of temporariness and segregation from the national healthcare system.
Missed Opportunities and Paths to Inclusive Practices
Reflecting on these policies raises critical questions about missed opportunities. Fully integrating Syrian doctors into Turkey’s healthcare system, offering them equal salaries and opportunities, could have been advantageous for both the Turkish healthcare sector and members of the Arabic-speaking refugee community. This would not only alleviate workforce shortages but also facilitate social cohesion and economic contributions from the refugee population. The current approach, however, serves as a constant reminder to Syrians of their provisional status in Turkey, influencing their long-term integration prospects and overall well-being.
While I originally aimed to write about healthcare services in Turkey, which participants described as high-quality, I find myself hoping that the Turkish government will address the concerns of Syrian refugees regarding barriers to inclusive and equal access to the healthcare system, including with regards to language.
Host states can implement practical solutions by allowing Syrians to work and contribute to the system and community where they live. Encouraging and enabling refugees to lead responses to the challenges faced by refugees would benefit both host and refugee communities.
For example, eliminating language barriers in healthcare would support effective communication and understanding of medical information, which is crucial to uphold the “do no harm” principle in humanitarian responses.
Moreover, facilitating proper documentation for all Syrians would enable them to access high-quality, lifesaving services. This should be prioritized even after the fall of Assad regime, as many Syrians, particularly from the younger generations, now consider Turkey home. Improving their current and future living conditions—including healthcare access and employment opportunities—should be facilitated in the place they feel they belong.
Southern Responses to Displacement 