Country of origin information report Turkey March 2009

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25 Medical issues
Overview of availability of medical treatment and drugs
25.01 The Human Development Report has published the human development index (HDI) which looks beyond GDP to a broader definition of well-being. The HDI provides a composite measure of three dimensions of human development: living a long and healthy life (measured by life expectancy), The UN Development Programme’s 2007/2008 Country Factsheet on Turkey noted that the country’s Human Development Index (HDI) was 0.775, which gave Turkey a rank of 84th out of 177 countries:

HDI value	Life expectancy at birth (years)	Adult literacy rate (% ages 15 and older)	Combined primary, secondary and tertiary gross enrolment ratio (%)	GDP per capita (PPP US$)
84. Turkey (0.775)	85. Turkey (71.4)	69. Turkey (87.4)	108. Turkey (68.7)	66. Turkey (8,407)

[35a]
25.02 The World Health Organisation’s (WHO) ‘European health for all database (HFA-DB)’, last updated in July 2008, recorded the presence of 1,205 hospitals with a bed capacity of 196,667 in 2006. The database also informed that there were 158.98 people per physician; a total of 116,014 physicians in the same year. [37d]
25.03 On 21 February 2005, the Turkish Daily News reported that a law to transfer ownership of Social Security Authority (SSK) hospitals to the Health Ministry had come into effect over the weekend:
“The law also transfers health facilities owned by Postal and Telecommunications General Directorate (PTT) and Ziraat Bank to the ministry. SSK hospitals will from now on be run like other state-owned medical facilities. SSK members will still have to obtain referrals from their local hospital for treatment at university hospitals… Numerous political parties, nongovernmental organizations and labor groups criticized the government decision to transfer the hospitals to the Health Ministry. Those opposing to the law said the government intended to privatize the health sector, with many people only getting the treatment they could afford. The government decision is a small part of the social security reform process currently under way to ease the burden on taxpayers. Despite being owned by the SSK, hospitals are a drain to the state because of the huge losses they incur.” [23f]
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25.04 A June 2007 Pharmaceutical Pricing and Reimbursement Information report commissioned by the European Commission, Health and Consumer Protection Directorate-General and the Austrian Ministry of Health, Family and Youth recorded:

“… In general, access to health care has improved since 2004 with radical changes in the provision side. In the past, the Social Insurance Organization (SSK) had its own hospitals with restricted access to its members and in many cases low standard facilities. In 2005, as part of the ongoing reforms, the competence of these facilities were transferred to the Ministry of Health (MoH) and all MoH hospitals were opened to the SSK members increasing the opportunities of access. Second, access to prescriptions was also improved after allowing SSK enrollees to obtain pharmaceuticals from private pharmacies. In the past, the SSK members were only allowed to buy pharmaceuticals from their hospitals’ pharmacies. After the transfer of these hospitals to the MoH, the SSK beneficiaries also started to purchase their prescriptions from private pharmacies as well. Last but by no means the least, in the past, the Green Card Scheme for the poor covered only in patient care hence excluded outpatient care and prescriptions. In 2005 the scheme was extended to cover all health care expenditures easing access of the poorest segments of the society.” [75] (p6)
Pharmacies
25.05 The Yellowpages.com website provides a list of Pharmacies (Eczanes) or Nöbetçi Eczane in Turkey accessed 30 January 2009; http://www.yellowpages.com.tr/search_results.php?yp=c2VhcmNoX2tleXdvcmRzPSZzZWFyY2hfZGlyPUFsbCZjaXR5X2lkPUFsbCZhcmVhX2lkPUFsbCZkaXN0cmljdF9pZD0mc2VhcmNoX2xhbmd1YWdlPSZzZWFyY2hfbW9kdWxlPWNhdGVnb3J5JmFjdGlvbj1zaG93bGlzdCZzdGFydD0wJmNvbXBvbmVudF9pZD0yOTA1JmxldHRlcj1h [82]
Hospitals
25.06 The US State Department’s Consular Information Sheet on Turkey dated 1 November 2006, and current at 18 July 2008, stated:
“Turkish hospitals vary greatly. The new, private hospitals in Ankara, Antalya, and Istanbul have modern facilities and equipment, numerous U.S.-trained specialists, and international accreditation. However, they still may be unable to treat certain serious conditions. … Those planning to remain in Turkey for a prolonged period of time should consider bringing or securing a supply of necessary chronic medications (e.g., heart medications, birth control pills) to cover them while they are in the country, as certain medications are difficult to obtain in Turkey. Nursing care and diagnostic testing (including mammograms) meet American standards at specific institutions in the larger cities. Health care standards are lower in small cities in Turkey in comparison to bigger cities such as Ankara, Istanbul, Izmir, and Adana.” [5f]
25.07 The Foreign and Commonwealth website provides a list of Hospitals for Turkey;

Ankara

Hacettepe Üniversitesi Tıp Fakültesi Sıhhiye – Ankara Tel: [phone]

Numune Hastanesi Sıhhiye – Ankara, Tel: [phone] (50 lines)

Ankara Üniversitesi İbni Sina Hastanesi Dışkapı – Ankara, Tel: [phone] (120 lines)

Ankara Üniversitesi Tıp Fakültesi Cebeci – Ankara, Tel: [phone]

Gazi Üniversitesi Tıp Fakültesi Araştırma ve Uygulama Hastanesi Beşevler – Ankara, Tel: [phone]

Istanbul

Bakırköy Psychiatric Hospital, Bakırköy, Istanbul, Tel: [phone]

Taksim İlk Yardım (Emergency) Hospital Sıraselviler Caddesi Taksim, Istanbul

Tel: [phone]

Florence Nightingale Hospital Abide Hürriyet Caddesi 290, Çağlayan Şişli

Istanbul, Tel: [phone]. www.florence.com.tr

Izmir

Atatürk Devlet Hastanesi, Basın Sitesi 35360, İzmir, Tel: [phone]

Ege Üniversitesi Hastanesi Bornova, İzmir. Tel: [phone]

Denizli Pamukkale Universitesi Hastanesi, Denizli. Tel: [phone]

[4t]
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HIV/AIDS – anti-retroviral treatment
25.08 The Turkish Ministry of Health (MoH) Country Report of January 2008, accessed via the UNAIDS website, recorded that “Turkey is among low prevalence countries in Central Europe for HIV/AIDS. The first case of HIV infection was reported in 1985, and by the end of June 2007, a total of 2,711 cases had been identified. The rate of increase for the reported number of HIV/AIDS cases has been more over the last three years (about 300 reported new cases annually) and the estimated prevalence is 3,700 cases out of a population of over 70 million.” [39a] (p3)
25.09 On the subject of funding for treatment, the Ministry of Health (MoH) Country Report of January 2008 recorded that “In Turkey PLHA [people living with HIV/AIDS] have same rights with other patients. The Government of Turkey provides with ART services including treatment for opportunistic infections. For PLHA not having any medical insurance, green card provides with ART treatment as for any other disease…In 2006, 685 PLHA have been taking ART. In 2007 it is estimated that around 800 PLHA have taken ART in Turkey.” [39a] (p11)
25.10 The BIA News Center article published 1 December 2008, noted that “In the last seven years, the HIV/AIDS cases have reached twice the intitial number. According to the figures of the Ministry of Health, while there were total of 158 HIV cases in 2000, this number rose to 376 in 2007. The total number of the cases since 1985 has become 2920. The ages of the three hundred registered cases are not known. There are 118 cases under the age eighteen. 470 of the cases are in the 30-34 age intervals. 892 of the 2920 HIV/AIDS cases are women.” [102s]
25.11 The same Bianet article further adds that “The government pays the cost of the HIV/AIDS treatment in Turkey. Thanks to the support that comes from the Global Fund, ‘HIV/AIDS Prevention and Support Project’ could be launched.” [102s]
Cancer treatment
25.12 As recorded in the World Health Organisation’s (WHO) Impact of Cancer for Turkey 2005: “In 2005 cancer killed approximately 52,000 people in Turkey, 37,000 of these people were under the age of 70.” [37b]
25.13 The International Observatory on End of Life Care website, dated 2006, stated that:
“Turkey is an area where supportive care with hospice/ palliative care is linked to the development of other services, particularly within hospital based oncology units… There are no specialist palliative care services in Turkey. Medical oncology units and departments of algology (pain) at major hospitals in the country provide pain control and symptom relief. Oncologists and pain specialists in seven hospitals report actively working to establish the concepts of palliative care... The majority of cancer patients are treated in university hospitals that support units with pain specialists and medical oncologists… Some specialist cancer state hospitals such as the Dr Ahmet Andicen Oncology Hospital and Demetevler Oncology Hospital will provide pain relief and symptom management. No information, however, is currently available about the development of palliative care services in the state hospital system or the development of training in the 57 medical schools around the country. There are around 30 specialist ‘pain centres’ and 20 medical faculties with departments of algology in Turkey. There are no reported activities for paediatric palliative care.” [33] (Current palliative services)
25.14 The same website also noted that:
“Individual physicians (and their colleagues) have reported active involvement in developing the concepts of palliative care within departments and units in three main areas of the country; in Ankara, a pain specialist at Hacettepe University Hospital, three oncologists, one at Başkent University Hospital, one in the Gulhane Military Academy, (GATA) and one at Gazi University Hospital; in Istanbul, a pain specialist at the Istanbul University Medical Faculty and two oncologists at the Marmara University Medical Faculty; there is one pulmonary specialist developing concepts of palliative care at the Pamukkale University Medical School, Denizli. Medical and nursing professionals have also expressed interest in palliative care at Ankara University Faculty of Medicine.” [33] (Current palliative services)

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25.15 The World Health Organisation (WHO) report on ‘Strengthening cervical cancer prevention in Europe’ of May 2007 noted:
“In Turkey, cancer of the cervix is the eighth leading cause of cancer in women and the age-standardized incidence rate is relatively low (4.5 per 100 000 women). There are several arguments against the introduction of HPV [Human papillomavirus] vaccines in Turkey …‘Guerrilla marketing’ of HPV vaccines gives the impression that their introduction is a high priority. In Turkey, however, introducing organized screening is considered much more important and more feasible at the moment. It is essential that WHO policies are country-based and take the different scenarios into account.” [37e] (p22)
Kidney dialysis
25.16 The website Globaldialysis. Com provides a list of all Dialysis centres in Turkey.

http://www.globaldialysis.com/centres/country/eurasia-and-central-asia/turkey.html [50]

Tuberculosis (tb)
25.17 The World Health Organisation (WHO) states “Tuberculosis (TB) is a contagious disease. Like the common cold, it spreads through the air. Only people who are sick with TB in their lungs are infectious. When infectious people cough, sneeze, talk or spit, they propel TB germs, known as bacilli, into the air. A person needs only to inhale a small number of these to be infected.” [37c] The WHO country profile 2006 provides key indicators, notification and treatment outcome data. See link attached. [37c]
http://www.who.int/globalatlas/predefinedreports/tb/PDF_Files/tur.pdf
25.18 A January 2008 article on Todayszamen.com reported:
“Although Turkey has long been committed to activities to counter tuberculosis and has achieved great success in the last few years in fighting against the disease, experts have said it continues to pose a threat to the society as hundreds of people contract tuberculosis each year. There has been a significant increase in the number of services to fight tuberculosis in the past two to three years, yet we cannot say that it will be eradicated in the short term, said Ali Rıza Erdoğan, the secretary-general of the Ankara-based Federation of National Associations of the Fight against Tuberculosis (TUVSDF) in a phone interview with Today’s Zaman.” [24a]
25.19 The same 2008 Todayszamen article continued:
“TUVSDF Chairman Dr. Ferit Koçoğlu, in an interview with the Anatolia news agency, noted there are some 20,000 people with tuberculosis in Turkey, around 13,000 of whom are male patients. …Almost 88 out of every 100 cases of tuberculosis can be treated in Turkey because we have waged a successful fight against this disease. There are many volunteer doctors and nongovernmental organizations that battle tuberculosis. They continue their struggle against this ailment under unfavorable conditions,’ he noted… The [Directly Observed Treatment Short Course (DOTS)] project has made health officials accessible to 89 percent of all tuberculosis patients, with 85 percent of these patients being treated.” [24a]
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Deaf and hearing impaired
25.20 In a letter to the Country of Origin Information Service from the British Embassy in Ankara, dated 27 March 2007, about services for children who are deaf or whose hearing is impaired, in the province of Izmir it was noted that:
“We are aware of at least one state-funded school for deaf children in the city of Izmir. This provides education from pre-school level up to 8th grade:
“Tülay Aktaş İşitme Engelliler İlköğretim Okulu

Mevlana Mahallesi, 373/2 Sokak

No:6/1, Bornova - IZMIR

Tel: [phone]

Fax: [phone]

Email: [e-mail]

“There is no secondary school for the deaf and hearing impaired in the province. At present children have the choice between being assisted to attend a normal secondary school or attending a specialist school in one of the neighbouring provinces in the Aegean region? Pre-school education is also available. We are aware of two state-funded specialist toddler groups in Izmir itself, in the Carsi and Konak districts. Provision is likely to be much more limited outside of the main towns, as in the UK.

To access these services a child’s parents must first submit documentation to the local Directorate of Education confirming that his or her hearing is impaired. A state hospital will usually be able to provide a suitable report.” [4n]

25.21 The International Deaf Children’s Society (IDCS) published an article in March 2004 by Mary C Essex, who specifically looked at the Turkish special education system for the deaf people, and it noted that:
“The Ministry of Education estimates having 58,351 students with disabilities in elementary, middle scholl and high school. This is well below the WHO estimate of people with disabilities.
Percentages of Disabilities in Turkey

Disability	Total	Percentage
Deaf	8,666	15%
Vision	1,555	3%
Physical	656	1%
Mental	44,970	77%
Autistic	419	.007%
Other	2,085	3%
Total	58,351	0.8%

There are four Deaf education teacher training programs in Turkey and these are located in the cities of:

• 
  Bolu, Abant Izzet Baysal University
  
• 
  Eskisehir, Anadolu University
  
• 
  Samsun, Ondokus Mayis Universitesi
  
• 
  Trabzon Karadeniz Teknik Universitesi
  

There are 47 elementary schools and 14 high schools for the Deaf throughout Turkey… The Ministry of Special Education has more information about the Deaf education curriculum and other information about their services available in Turkish.” [28]

See section 21 - Disability
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Mental health
25.22 As recorded in the World Health Organisation’s (WHO) Department of Mental Health and Substance Dependence Mental Health Atlas 2005, the country has disability benefits for persons with mental disorders: “After being approved by a mental health board as a chronic mental health patient, the patient can benefit from the social security services… Mental health is part of the primary health care system. Actual treatment of severe mental health is available at the primary level… Mental health in primary care is available in only some provinces… Regular training of primary care professional [sic] in the field of mental health is present and the approximate number of personnel trained over the last two years totalled 3,000.” [37a] (Section on Mental Health Financing)
25.23 The WHO Mental Health Atlas 2005 further states that there are 1.3 psychiatric beds per 10,000 population, one neurosurgeon, one neurologist, one psychologist and one social worker per 100,000 population. [37a] (Section on Mental Health Financing)
25.24 The Foreign and Commonwealth Office contacted Hacettepe University Hospital Psychiatric Department in April 2002 and confirmed that antipsychotic and antidepressant medication is available in Turkey. [4b]
25.25 The WHO Mental Health Atlas 2005 recorded that “The following therapeutic drugs are generally available at the primary health care level:

Carbamazepine,

Ethosuximide,

Phenobarbital,

Phenytoin,

Sodium valproate,

Amitriptyline,

Chlorpromazine,

Diazepam,

Fluphenazine,

Haloperidol,

Lithium,

Biperiden,

Carbidopa and

Levodopa.” [37a] (Section on Therapeutic Drugs)
25.26 The WHO Mental Health Atlas 2005 continued:
“The mental health department was established within the Ministry of Health in 1983 with the primary tasks of improving mental health services, development and dissemination of preventive mental health services, integration of mental health with primary care, community education and protection of the community from harmful behaviours. The means of achieving these aims were through determination of standards, training programmes, data collection, research, creation of counselling and guiding units, creation of psychiatric clinics in state hospitals, assigning proper tasks to personnel, developing rehabilitation facilities, carrying out public education through the help of media, educating the public on harmful behaviour, and taking care of those who succumb to those behaviours.” [37a] (Section on Other Information)
25.27 The US Department of State Country report on Human Rights Practices 2007, published 11 March 2008, noted that “The Ministry of Health operated eight mental health hospitals in seven different provinces. There were two private mental health hospitals in Istanbul. The government reported that it operated 45 boarding care centers and 22 daycare centers that provided services to physically and mentally challenged individuals.” [5g] (Section 5 – Persons with Disabilities)
25.28 A Mental Health Economics European Network (MHEEN) report of January 2008 recorded that there was virtually no social care or community care provisions for the mentally ill in Turkey. [22] (p9) It further added that: “although psychiatric care is almost entirely provided in nine psychiatric hospitals and there are virtually no social care homes or community-based services, there has also been a slight decrease from 4140 beds in 1990 to 3777 in 2004. … there are now some beds available in psychiatric wards in general hospitals but figures are difficult to obtain and the only data available are for 2003 when there were 1876 beds, and for 2004 when there were 2467 beds.” [22] (p8)
25.29 As noted in a report by the Mental Disability Rights International (MDRI) entitled ‘Behind Closed Doors: Human Rights Abuses in the Psychiatric Facilities, Orphanages and Rehabilitation Centers of Turkey’ (released on 28 September 2005):
“There is no enforceable law or due process in Turkey that protects against the arbitrary detention or forced treatment of institutionalized people with mental disabilities. There are virtually no community supports or services, and thus, no alternatives to institutions for people in need of support. As a result, thousands of people are detained illegally, many for a lifetime, with no hope of ever living in the community. Once inside the walls of an institution, people are at serious risk of abuse from dangerous treatment practices. In order to receive any form of assistance, people must often consent to whatever treatment an institution may have to offer. For people detained in the institution, there is no right to refuse treatment. The prison-like incarceration of Turkey’s most vulnerable citizens is dangerous and life-threatening.” [90]
25.30 The European Commission 2008 Progress report, published 5 November 2008, acknowledged that: “As regards mental health, progress has been made in the field of electroconvulsive therapy which is implemented in hospitals in line with medical standards and respecting patients' rights… (p22) The lack of data and research on persons with a disability and on conditions of care for mentally ill persons is preventing informed policy-making. Community based services are not sufficiently developed as an alternative to institutionalisation, and resources continue to be limited in relation to needs. There is an ongoing problem of insufficient general medical care and treatment in mental health hospitals and rehabilitation centres.” [71d] (p22-23)
25.31 The US State Department (USSD) 2007 report published 11 March 2008 mentioned that “In February [2007] a public prosecutor opened an investigation into reports of abuse at the Ekrem Tok Mental Hospital in Adana. The Ministry of Health and Adana Provincial Health Directorate also began investigations. The investigations were opened after Star TV aired a program that showed patients at the hospital complaining about electro-shock treatment, beatings, and abuse. According to the program, patients were subject to beatings and violence for performing religious prayers, for not eating, or for not cleaning their plates after a meal. Hurriyet reported that a patient died of a drug overdose in the facility in August 2006. Police arrested two staff members, Huseyin Hatipogul and Nusret Er, for mistreating patients.” [5g] (Section 5 – Persons with Disabilities)
See also Section 21.01 Disability