Displaced Syrians at a workshop organized by medical volunteers affiliated with a Turkish-registered Syrian relief organization aimed at spreading awareness of Covid-19 at a camp near the Syrian town of Atme close to the border with Turkey in Idlib province on March 16, 2020. Photo: AFP / Aaref Watad

The Covid-19 pandemic is, of course, creating monumental problems across the world. But Turkey has an additional challenge: It is host to the largest contingent of refugees anywhere on the globe today.

According to the Norwegian Refugee Council, there are 4.3 million Syrian refugees in Turkey, adding to the nation’s burden of providing well-being and health care for all. How Turkey manages to protect the millions of refugees in the country will have a direct and profound impact on how well it serves its own people. Right now, the case doesn’t look good.

Let’s start with vaccine distribution, the topmost issue on people’s minds. There is, quite simply, no plan yet on vaccinating the millions of refugees in Turkey. While questions about this have been posed in parliament, a response from the Health Ministry is still pending.

To be fair, the vaccination program for Turks themselves is also in disarray. Ankara agreed on a deal for 50 million doses of the CoronaVac vaccine from China. Nearly 40 million were supposed to be delivered by the end of January. That did not happen.

By January 23, only 3 million doses had been delivered and 1.2 million citizens vaccinated in a population of 82 million. (As of Sunday, Turkey had a total of 2.48 million infections and nearly 26,000 deaths from Covid-19.)

Leaving alone the inadequacy of supplies, the biggest problem from a health-management perspective is the apparent bifurcation of the inoculation program between Turks (too little, too slow) and refugees (thus far, apparently non-existent).

It is blindingly obvious that the coronavirus that causes Covid-19 does not discriminate between Turks and Syrians. If the refugees, amounting to more than 5% of all people living on Turkish soil, are not included in an immediate and comprehensive plan for vaccination, there is the very grave peril that the virus will embed itself even more firmly in the community, seeding more infections.

In this regard, an important statistic to bear in mind is that more than 98% of refugees actually live outside the camps – that is to say, they are integrated into the general Turkish population.

This underscores one of the few things that are clear from the pandemic: A comprehensive plan of infection control is necessary. For you can’t separately consider one group of people for vaccination and exclude or delay such provision for another when they live together in the same space.

Then there is the economic issue. Poverty has a direct impact on health outcomes. To put it starkly, impoverished people do not eat well enough – or even just eat enough. This weakens their immunity to a host of diseases. Their susceptibility to illnesses weakens them, and if they also fall ill from Covid-19, their chances of recovery is further compromised.

In May last year, the Danish Refugee Council found that 74% of Syrian refugee households were in danger of falling into poverty. That was nine months ago. The situation today can be surmised to be worse.

Of those Syrians eligible to work in Turkey, the Economic Policy Research Foundation of Turkey (TEPAV) reported in December that 36.5% had been let go – which in the punishing circumstance of the pandemic economic crisis might not seem as bad as it could be. But because more than 90% of Syrians who work do so in the informal sector, the number of workers who have been laid off is likely to be high.

With the worsening economic condition and a scarcity of jobs, refugees have had to rely more heavily on welfare. But Turkey, which was already in an economic crisis before the pandemic hit, has barely enough resources for its own citizens, let alone Syrian migrants. In fact, last March it even had to launch a public campaign to raise donations to support low-income Turks.

TEPAV says only 5.5% of Syrians are eligible for the government’s special Covid-19 support, while Syrians registered under temporary protection status receive 120 Turkish lira (US$16 under the official exchange rate) a month under the emergency social safety net program. But they are excluded from the cash assistance program from the Ministry of Family, Labor and Social Services, which disburses 1,000 lira per household each month.

Estimates are that Turkey might be able to return to a state of normalcy by mid-2022 – if the vaccination rollout goes to plan. But clearly, it has already hit a significant bump.

There is still time to compensate, of course. However, these calculations don’t take account of the variable represented by the millions of Syrian refugees. If they continue to be left out of plans for inoculation, if they are allowed to fall deeper into health-draining poverty, then the challenge will be all the greater for Turkey to reach the state of herd immunity required for a return to life as usual.

This article was provided by Syndication Bureau, which holds copyright.

Alexandra de Cramer

Alexandra de Cramer is a journalist based in Istanbul. She reported on the Arab Spring from Beirut as a Middle East correspondent for Milliyet newspaper. Her work ranges from current affairs to culture, and has been featured in Monocle, Courier Magazine, Maison Francaise and Istanbul Art News.