Introduction
Food security is defined as a multidimensional concept encompassing availability, accessibility, utilization, and stability over time. 1 The United States Department of Agriculture (USDA) describes food security as consistent and reliable access to sufficient quantities of food for an active, healthy life. 2 Food safety prevents hazards that compromise health and is essential for sustaining food security and well-being. 3 Access to sufficient, nutritious, and safe food plays a critical role in sustaining life and promoting health. 4 Food (in)security is one of the most common and vulnerable issues faced by disaster victims due to the effects of disasters. 5 Disasters damage infrastructure and disrupt food production and supply chains. 6 , Reference Aydın, Yüceer and Ulugergerli 7 Therefore, it is essential to stock food with a long shelf life, requiring little or no cooking, water, or refrigeration, while also meeting special dietary needs, being low in salt and spices, and being sufficient for at least three days. 8
In areas affected by disasters, a large number of people can become dependent on food provided by aid organizations or distributed through soup kitchens.Reference Kalyoncu Atasoy, Kurt and Beckerman-Hsu 9 While food aid provided to people affected by disasters is crucial for the protection of health and life, the shock and trauma caused by disasters can alter the dietary patterns of disaster victims, placing them at a disadvantage.Reference Aydın, Yüceer and Ulugergerli 7 , Reference Gupta, Motarjemi and Lelieveld 10 , Reference Cherry 11 Therefore, ensuring that food reaches disaster victims safely is of utmost importance.Reference Saggu, Tomer and Kumar 12 –Reference Güden and Borlu 14
In the acute phase of disasters, food scarcity, and in the later phase, inadequate and unbalanced nutrition, are primary causes of potential health issues.Reference Güden and Borlu 14 Failure to recognize nutritional problems and low nutrition awareness in the post-disaster period can increase morbidity and mortality rates.Reference Dewi, Khomsan and Dwiriani 13 Malnutrition, recurrent infections, contaminated food, and limited access to essential resources further exacerbate the vulnerability of already at-risk populations. Rapidly assembling and dispatching food aid to the disaster area and focusing on the content and safety of the aid are crucial for disaster victims.Reference Aydın, Yüceer and Ulugergerli 7 , Reference Saggu, Tomer and Kumar 12 In this regard, food security principles must be adhered to and implemented to ensure food security post-disaster.Reference Gupta, Motarjemi and Lelieveld 10
Emergency food products are defined as highly energy-dense, convenient food specially designed for crises. These foods are designed to be ready-to-eat, shelf-stable, transportable, culturally acceptable, and, most importantly, to meet the nutritional needs of disaster victims.Reference Saggu, Tomer and Kumar 12 In Türkiye, the Turkish Red Crescent (KIZILAY) and the Disaster and Emergency Management Authority (AFAD) are the main public providers of food assistance in disasters. KIZILAY also coordinates short- and long-term nutrition services.Reference Kalyoncu Atasoy, Kurt and Beckerman-Hsu 9
On February 6, 2023, 2 earthquakes with magnitudes of 7.7 and 7.6 occurred, centered in Kahramanmaraş, Türkiye. These earthquakes affected 11 provinces, resulting in 53,537 fatalities, 107,213 injuries, and damage to a total of 2,618,697 buildings.Reference Durmaz Yurt and Yeniçırak 15 Following the disaster, due to the prioritization of rescue operations and a lack of full comprehension of the disaster’s magnitude, significant issues arose regarding shelter and nutrition.Reference Aydın, Yüceer and Ulugergerli 7 In some regions affected by the earthquake, issues emerged related to food safety inspections, safe food access, and drinking water accessibility.Reference Çakır, Mercan and İçyer 16 Indeed, a study conducted after these earthquakes reported that one of the problems related to the emergency food and nutrition environment was food safety.Reference Kalyoncu Atasoy, Kurt and Beckerman-Hsu 9 Indeed, the lack of food safety, difficulties in food accessibility, and inadequate intake of nutrients are significant indicators of food insecurity. In disasters where the priority is addressing urgent needs, there is a significant lack of scientific studies globally that focus on emergency nutritional conditions following natural disasters. For these reasons, this study aimed to examine the food safety and food access status impacting food (in)security among earthquake victims in Kahramanmaraş and Hatay during the 14th-18th days following the Kahramanmaraş-centered earthquake and to determine their relationship with the victims’ nutritional status.
Method
Study Design
This descriptive and cross-sectional study was conducted between February 20 and 24, 2023 (the 14th-18th days of the earthquake) in Kahramanmaraş and Hatay, Türkiye. The study population consisted of earthquake victims aged 18 years and older residing in Kahramanmaraş Central District and Hatay Antakya. Using the unknown population proportion formula in Epi Info 7.2.5.0 StatCalc Program, the minimum sample size was calculated as 270 (P = 0.50, α = 0.10). During data collection, a total of 209 individuals who were not pregnant, volunteered to participate, and were aged 18 years or older were reached. The participation rate for earthquake victims recruited using a non-probability sampling method was determined to be 77.4%. Further details on the study area and affected population are provided in the Supplementary Document.
Data Collection
Data were collected face-to-face using an interviewer-assisted response method, employing a 24-Hour Food Consumption Form and a Descriptive Form developed by the researchers based on literature.Reference Dewi, Khomsan and Dwiriani 13 , Reference Kirsch, Leidman and Weiss 17 , Reference Inoue, Nakao and Kuboyama 18 For the Descriptive Form, an initial item pool was created following a narrative review of national and international guidelines and survey tools used in disaster and emergency settings; overlapping or unclear items were removed, the remaining items were grouped thematically, and the draft form was refined through discussion and consensus within the research team.
The data collection process took approximately 50-60 minutes per participant. Before the main data collection process, a pilot study was conducted to assess the comprehensibility, cultural appropriateness, and applicability of the questionnaire forms. In this pilot, the forms were administered face to face by members of the research team to a convenience sample of 18 earthquake-affected adults living in the study area, using the same interviewer-assisted procedure planned for the main survey. After completing the forms, pilot participants were briefly debriefed and asked to comment on unclear wording, sensitive questions, survey length, and overall burden. Based on participant feedback from the pilot study and field notes, minor revisions were made to the questionnaire by consensus.
The detailed descriptions of the Descriptive Form, 24-Hour Food Consumption Form, and study variables, including data collection procedures, categorization criteria, and methodological strategies to minimize recall bias, are provided in the Supplementary Document.
Study Analysis
A range of statistical tests, including descriptive statistics, normality tests, comparative tests, and multivariate logistic regression analysis, were applied. A full description of the statistical methods and detailed analyses can be found in the Supplementary Document.
Ethical Approval
To conduct the study, ethical approval was received from Kırklareli University Rectorate, Scientific Research and Publication Ethics Board (E-35523585-199-111976).
Results
Table 1 presents the descriptive characteristics of earthquake victims. The mean age was 42.75 ± 14.70 years (Median: 42), and 52.6% were female. Most victims (78.5%) resided in Kahramanmaraş, and 83.3% lived in tent cities. Among participants, 4.3% were trapped under debris, 75.6% had relatives rescued, and 71.3% lost at least one close contact. Food safety concerns were reported by 31.6%, while 56.5% faced food inaccessibility in the initial days.
Distribution of descriptive characteristics of earthquake victims
BMI: Body mass index, MFS: mass feeding services.
Food safety concerns were higher among women (P = 0.014), individuals under 40 (P = 0.001), those with higher education (P = 0.000), unmarried individuals (P = 0.049), white-collar workers (P = 0.016), and those without chronic diseases (P = 0.026). Dissatisfaction with food quality, portion sizes, and mass feeding services (MFS) also increased food safety concerns (P <0.05) (Table 2).
Comparison of earthquake victims’ characteristics based on food safety and food access status
*P <0.05, **P <0.01,***P <0.001. †Proportions refer only to those who responded “Yes.”
BMI: Body mass index, MFS: Mass feeding services.
Food access difficulties were more frequently reported by men (62.6%) than women (50.9%). Those with unchanged appetite, dissatisfaction with MFS, and employed men were more likely to report food access issues (P <0.05) (Table 2).
Water, fiber, polyunsaturated fats, vitamins A, C, E, folate, potassium, calcium, magnesium, iron, and zinc intake were significantly lower than NRV (P <0.05). Conversely, phosphorus intake was significantly higher (P <0.001) (Table 3).
Comparison of nutrient intakes of earthquake victims by gender and age groups with national reference values (NRVs)
*P <0.05, **P <0.01, ***P <0.001. †Low active total energy expenditure, 50th percentile.
PF: Polyunsaturated fat.
For both genders, energy intake (except ≥70 years) (P <0.01) and protein intake (except ages 18 and ≥70) (P <0.01) were below NRV, while sodium levels (except ≥70 years) were significantly higher (P <0.001). Among women, cholesterol (except ≥65 years) (P = 0.000), vitamin B1 (except 18 years) (P = 0.000), vitamin B2 (except 18 years) (P = 0.000), and vitamin B6 (except 18 years) (P < 0.001) were significantly lower than NRV. Among men, carbohydrate intake was significantly higher than NRV (P = 0.002), whereas vitamin B1 (P = 0.000), vitamin B2 (P = 0.000), and vitamin B6 (P <0.001) were lower than NRV (Table 3).
Table 4 presents the comparison of food safety and access by nutrient intake and gender. No significant difference was found between nutrient intake and food safety (P >0.05). Among women, fat (P = 0.020), sodium (P = 0.007), and calcium (P = 0.014) intake were significantly higher in those without food access. No significant difference was observed between food access status and nutrient intake among men (P >0.05).
Comparison of nutrient intakes by food safety and food access status of earthquake victims based on gender
*P <0.05, **P <0.01.
CHO: Carbohydrates, PF: polyunsaturated fat.
The multivariate logistic regression analysis of food safety and access to food by gender among earthquake victims is presented in Table 5. Models created using the Enter method explained 12.7-51.5% according to Nagelkerke R 2. Among female participants, the perception of unhealthy food, inadequacy of MFS, and dissatisfaction with the meals served increased the risk of food insecurity by 3.461 times (odds ratio [OR], 95% confidence interval [CI]: 1.245-9.623), 4.134 times (OR, 95% CI: 1.351-12.648), and 3.413 times (OR, 95% CI: 1.186-9.818), respectively (P <0.05). No statistically significant relationship was found between food safety and age, educational level, occupation, employment status, chronic disease presence, and vitamin E levels among women (P >0.05).
Multivariate logistic regression analysis of food safety and food access status by gender among earthquake victims
*P <0.05, **P <0.01.
1Omnibus Tests of Model Coefficients: P <0.05, Hosmer and Lemeshow Test: P >0.05. Nagelkerke R2: 0.4572; 0.5153; 0.2434; 0.1275. Reference groups (0): food safety (adequate), food access (accessed), age (<40), education level (high school or lower), marital status (married), children (yes), occupation (blue-collar), employment status (no), presence of chronic disease (no), appetite status (unchanged), perception of healthy food (yes), sufficiency of portions (yes), access to sufficient utility water (yes), adequacy of mass feeding services (MFS) (yes), satisfaction with food (yes), presence of food-related symptoms (no).
Men with an associate degree or higher had a 20.724-fold higher risk of perceiving food insecurity (OR, 95% CI: 2.290-187.548) (P = 0.007). Additionally, among male participants, the perception of unhealthy food posed a 12.446-fold increased risk of food insecurity (OR, 95% CI: 2.601-59.565) (P = 0.002). No statistically significant differences were observed between food safety and age, marital status, presence of children, occupation, portion adequacy, access to sufficient drinking water, adequacy of MFS, satisfaction with meals, presence of foodborne symptoms, folate levels, and vitamin C levels among men (P >0.05) (Table 5).
Women without sufficient access to drinking water had a 2.631-fold higher risk of lacking access to food compared to those with adequate water access (OR, 95% CI: 1.069-6.473) (P = 0.035). No statistically significant differences were found between food access status and appetite change due to the earthquake, portion adequacy, adequacy of MFS, protein levels, fat levels, sodium levels, calcium levels, phosphorus levels, and zinc levels among women (P >0.05) (Table 5).
Among men, those employed in income-generating jobs before the earthquake had a 2.666-fold higher risk of lacking food access than those unemployed before the earthquake (OR, 95% CI: 1.055-6.735), and those who were dissatisfied with the meals provided had a 2.811-fold higher risk of lacking food access compared to those who were satisfied (OR, 95% CI: 1.162-6.801) (P <0.05) (Table 5).
Limitations
From a survey methodology perspective, several limitations should be noted. First, this cross-sectional survey relied on self-reported data collected at a single point in time, which makes it difficult to establish cause-and-effect relationships between food safety, food access, and nutritional status. Second, participants were recruited through a non-probability, volunteer sampling approach during the acute phase of the disaster. This method may have led to coverage error and selection bias, as individuals who were able to access and complete the survey during the crisis may differ from those who did not respond, limiting the generalizability of the findings to all survivors of the 2023 Kahramanmaraş earthquake. Third, as in many survey studies, there is a risk of nonresponse and response bias, and food-related symptoms and experiences may have been under- or over-reported due to stress or social desirability. Fourth, all variables, including food-related symptoms and nutritional status indicators, were based on self-report, and the 24-hour recall method used to assess food consumption may have introduced recall and representativeness bias in an unstable post-disaster setting where daily intake can vary greatly. In addition, potential confounding factors could not be fully controlled because of the extraordinary field conditions
Discussion
In this study, approximately one-third of the earthquake victims reported inadequate food safety, and more than half reported being unable to access food in the initial days following the earthquake. Women were more likely than men to perceive food insecurity, while men were more likely to experience challenges in food access. Similar findings have been documented in previous disaster studies. 19 , 20 In a study involving 6451 individuals in Japan after the Great East Japan Earthquake and Fukushima Disaster, participants expressed concerns regarding food security (47.3%), natural disasters (69.5%), and radiation (53.5%).Reference Sugimoto, Shinozaki and Naruse 21 Women were 1.70 times (1.38-2.10) more concerned about food security, 1.74 times (1.39-2.19) about natural disasters, and 1.67 times (1.35-2.06) about radiation compared to men. Likewise, following the 2008 Sichuan Earthquake, women in affected areas were significantly more attentive to health, nutrition, and food and water security than those in unaffected regions.Reference Xu, Li and Bai 22 In disaster-stricken areas, infrastructure disruptions, damage to electricity and water systems, and logistical failures hinder food supply chains, affecting both victims and relief efforts.Reference Aydın, Yüceer and Ulugergerli 7 , Reference Nekouie Moghadam, Amiresmaieli and Hassibi 23 , 24 Although similar findings have been observed across these studies, the variety of disasters, geographical differences, emergency and disaster preparedness programs, and economic conditions of the countries involved suggest that these factors also influence disaster response rates. Additionally, as data in this study were collected in the acute phase (days 14-18 post-earthquake), the victims’ priorities and recent losses may account for some differences in findings.
The findings of this study indicate that age was not associated with food safety for either female or male participants. A study conducted in Piura, Peru, after the 2021 earthquake found that food insecurity was not determined by gender but was associated with age.Reference Valladares-Garrido, Zapata-Castro and García-Vicente 25 Similarly, a study involving 251 disaster victims following Hurricane Harvey (2017) found that food insecurity decreased with age, regardless of gender.Reference Fitzpatrick, Willis and Spialek 26 While the association between education and food safety perception among men aligns with the literature, it should be noted that 80% of women in our sample had only basic education, and 20% were illiterate. The fact that women were already disadvantaged before the earthquake may have significantly influenced the findings of this study.
The results of this study reveal that the risk of perceiving inadequate food safety was 20.7 times higher among men with an associate degree or higher, whereas women’s educational status was not associated with food safety. Educated individuals generally prefer more diverse and nutritious diets, and the failure of post-disaster food distribution to meet these expectations may heighten perceptions of food insecurity.Reference Loofbourrow and Scherr 27 , Reference DeBate, Himmelgreen and Gupton 28 Similarly, following the Great East Japan Earthquake and Fukushima Disaster, university graduates were reported to have greater concerns about food security. 19 In contrast, a study conducted in Piura, Peru, following the 2021 earthquake, found no association between education level and food insecurity among victims.Reference Valladares-Garrido, Zapata-Castro and García-Vicente 25 Although the association between education and food safety perception among men aligns with the literature, it should be noted that 4 out of 5 women in the sample had only basic education, and 1 in 5 was illiterate, indicating that this group was already disadvantaged before the earthquake. This pre-existing disadvantage may have influenced the findings of this study.
In this study, women’s employment and work status, as well as men’s employment status, were not associated with food safety. However, the risk of lacking food access was found to be 2.7 times higher among employed men. This aligns with findings from the 2010 Haiti earthquake, where camp residents reported greater economic and food security challenges than neighborhood residents.Reference Kirsch, Leidman and Weiss 17 Likewise, following the 2021 Piura earthquake, higher-income individuals experienced lower food insecurity risks.Reference Valladares-Garrido, Zapata-Castro and García-Vicente 25 In the assessment conducted 4 months after the Nepal earthquakes, groups whose primary livelihoods depended on agriculture, agricultural labor, and low-skilled daily work reported lower food consumption scores compared to those in high-skilled and skilled labor sectors. 19 Employed men are typically the primary income providers for their families, which means they bear a greater economic burden. After an earthquake, job loss intensifies this burden, making food access more difficult due to reduced income. Men who are not employed in income-generating jobs may already have lower economic expectations, and therefore might feel the impact of income loss less acutely during crises.Reference Coats, Humble and Johnson 29 , Reference Holston, Stroope and Greene 30 Consequently, unemployed men may have a better understanding of where and how to access essential resources after a disaster due to their previous experience with food insecurity, which could provide them with an advantage. This context might explain the findings of this study, as this factor could have conferred an advantage to these individuals.
The findings of this study indicate that women’s employment and work status, as well as men’s employment status, were not associated with food safety. In a study conducted after the Great East Japan Earthquake and Fukushima Disaster, married couples were 1.38 times (1.20-1.59) more concerned about food safety, 1.30 times (1.12-1.52) about natural disasters, and 1.53 times (1.33-1.77) about radiation; living with children was shown to affect anxiety levels.Reference Sugimoto, Shinozaki and Naruse 21 Independent of anxiety levels, a study conducted after the 2021 earthquake in Piura, Peru, found that food insecurity among victims was not associated with living alone or household size, even with the impact of the coronavirus disease 2019 (COVID-19) pandemic.Reference Valladares-Garrido, Zapata-Castro and García-Vicente 25 Similarly, a study conducted with Hurricane Harvey victims in Texas in the fall of 2017 found no association between the number of children and food insecurity.Reference Fitzpatrick, Willis and Spialek 26 These studies support the findings of this study.
This study’s results highlight that inadequate mass feeding services (MFS) elevated the risk of food insecurity by 4.1 times for women, while no significant association was observed for men. Additionally, MFS inadequacy was not associated with food access among women. Similar challenges have been reported in past disasters. In Harris County, Texas, food depot access was severely disrupted after floods, particularly due to road network failures, limiting emergency food aid distribution.Reference Casellas Connors, Safayet and Rosenheim 31 After Cyclone Pam, it was reported that nutritional principles highlighted in disaster situations were insufficiently followed, and there were challenges in providing sustainable and healthy food aid, with inadequate consideration of public health needs and food preferences.Reference Wentworth 32 These findings indicate that food access is particularly limited in the initial days after disasters, with food distribution systems lacking in speed and effectiveness. Similar to the difficulties reported following the Harris County flood and Cyclone Pam, similar deficiencies in the effectiveness and sustainability of food aid were observed in Türkiye’s Kahramanmaraş and Hatay earthquakes, aligning with the food security issues reported by victims.
In this study, the perception of unhealthy food increased the risk of food insecurity by 3.5 times for women and 12.5 times for men. The primary risks to the food supply chain during natural disasters relate to monitoring and ensuring food safety.Reference Perdana, Onggo and Sadeli 33 Disruptions in the food supply chain in disaster-affected regions can lead to issues in the distribution, storage, preparation, and access to food.Reference Toland, Wein and Wu 34 Following Japan’s 2011 Tohoku earthquake, logistical issues and unplanned deliveries led to spoilage of fresh produce.Reference Zhu, Wang and Regan 35 Following Türkiye’s 1999 Izmit and 2002 Afyon earthquakes, problems with expired canned goods, improper storage, inadequate refrigeration, hygiene issues among service personnel, and dishwashing problems were reported. The preliminary observation report by the Union of Chambers of Turkish Engineers and Architects (TMMOB) on the Kahramanmaraş-centered earthquakes also noted that unresolved risks in local gathering areas were directly reflected in the disaster area.Reference Çakır, Mercan and İçyer 16 These issues are supported by the literature and are thought to be related to our findings.
In this study, dissatisfaction with the meals served increased the risk of food safety by 3.4 times for women, while this was not a significant factor for men. In disaster situations, it is crucial to consider food storage, preservation, ease of preparation, and cultural acceptability.Reference Wien and Sabaté 36 According to the comprehensive report prepared by the Chamber of Food Engineers on this earthquake in Türkiye, it was reported that aid was distributed unevenly across the region, leading to varying amounts of food distribution among victims.Reference Kalyoncu Atasoy, Kurt and Beckerman-Hsu 9 In a study involving disaster survivors from Vermont, North Carolina, and Oklahoma perceptions of food security varied widely. While some defined it as “always having something in the pantry,” “healthy eating,” or “food the family enjoys,” others associated it with affordability, locally grown food, and the ability to dine out. These variations suggest that meal satisfaction in disaster settings may influence perceptions of food security.Reference Clay, Koyratty and Rogus 37 Notably, another finding of this study was that portion inadequacy was not a determinant of food safety for men and food access for women might also stem from these differing perceptions.
In this study, lack of sufficient drinking water was not associated with food safety among men but increased the risk of food access issues by 2.6 times among women. In a study by Valladares-Garrido et al.Reference Valladares-Garrido, Zapata-Castro and García-Vicente 25 examining food insecurity in the Piura region of Peru after the earthquake and during the COVID-19 pandemic, it was reported that lack of access to electricity, toilets, or running water increased the likelihood of food insecurity. Water is fundamental to food security, as lack of access to water increases the level of food insecurity.Reference Jiao 38 This issue complicates basic needs such as food cleaning, cooking, and hygiene, directly affecting victims’ access to reliable and nutritious food. 39 These findings explain the increased risk of food access issues among women, although demographic factors may account for the differences observed among men.
In this study, the presence of chronic illness in women and foodborne symptoms in men were not associated with food safety. Additionally, changes in women’s appetite did not significantly impact food access. Ensuring access to safe and nutritious food is crucial for both physical and mental well-being in post-disaster periods. Nutrient-dense food provided in emergency shelters supports health and recovery.Reference Kalyoncu Atasoy, Kurt and Beckerman-Hsu 9 A study with disaster-surviving women in East Azerbaijan found that dietary changes after disasters affected both psychological and overall health.Reference Janmohammadi, Daneshzad and Alipour 40 In Ishinomaki, Japan, disaster victims in temporary shelters experienced nutrient deficiencies due to limited fresh fruits and vegetables, leading to increased gastrointestinal symptoms. About a quarter of the 236 respondents reported reduced food intake one month post-disaster.Reference Inoue, Nakao and Kuboyama 18 Another study reported that disaster victims experiencing food insecurity adjusted their diets by reducing portion sizes, skipping meals, or not eating for an entire day.Reference Bell, Scott and Visram 41 In another study, it was shown that women with high earthquake-related stress exhibited decreased healthy eating behaviors, while those with high emotional eating tendencies showed a propensity for overeating.Reference Kuijer and Boyce 42 Limited food variety, prolonged shelter stays, and disruptions in social life can exacerbate food insecurity, leading to stress, depression, and nutritional deficiencies.Reference Tsuboyama-Kasaoka, Ueda and Ishikawa-Takata 43 , Reference Doğru and Ede 44 These issues further increase the risk of health complications related to inadequate energy and nutrient intake.Reference Bell, Scott and Visram 41 , Reference Tsuboyama-Kasaoka and Purba 45 This discrepancy from the findings of this study may be due to the study design. Since face-to-face interviews were conducted at a single point in time, acute issues that developed later could not be recorded. This underscores the need for longitudinal studies to better capture the long-term effects of food insecurity in disaster settings.
This study found that earthquake victims had significant nutrient deficiencies, with most intake levels below National Reference Values (NRVs). Water, energy, protein, polyunsaturated fats, fiber, and key vitamins and minerals, including vitamins A, C, E, folate, potassium, calcium, magnesium, iron, zinc, and B vitamins, were lower than recommended. However, phosphorus and sodium levels were elevated. However, nutrient intake was not significantly associated with food safety or food access for either gender. Lack of access to food post-disaster can lead to deficiencies in meeting nutritional needs.Reference Quijada Robles and Benavidez 46 In Malatya, Türkiye, following the February 6, 2023, earthquake, food aid lacked essential nutrients such as protein, fiber, and vitamin C, while sodium levels exceeded recommendations.Reference Kalyoncu Atasoy, Kurt and Beckerman-Hsu 9 These shortages illustrate how emergency food systems often fail to meet victims’ nutritional needs. Similar deficiencies have been observed in disaster-affected regions worldwide. In La Punta, Ecuador, 57% of families relied on plant-based vitamin A sources, while 96% obtained iron from animal-based foods.Reference Herrera-Fontana, Chisaguano and Villagomez 47 Similarly, after the Great East Japan Earthquake, food in temporary shelters primarily consisted of carbohydrate-rich items such as rice balls, bread, and instant noodles, leading to persistent micronutrient deficiencies for at least a month post-disaster.Reference Tsuboyama-Kasaoka and Purba 45 , Reference Tsuboyama-Kasaoka, Hoshi and Onodera 48 A study in Athens, Greece, found that despite equal food distribution in evacuation areas, elderly victims had lower intake, and nutritional needs remained unmet.Reference Magkos, Arvaniti and Piperkou 49 These findings highlight the need to reform emergency food aid strategies by incorporating nutrient-dense, culturally appropriate meals. Future disaster response should prioritize balanced dietary interventions, ensuring that aid meets the specific nutritional needs of vulnerable populations, particularly the elderly and individuals with pre-existing health conditions.
Conclusions
The objective of this study was to examine food safety, food access, and their relationship with nutritional status among adult survivors of the 2023 Kahramanmaraş earthquake in Kahramanmaraş and Hatay during the early post-disaster phase. This objective was met. The findings indicate that perceived food safety and reliable access to nutritionally adequate meals are essential yet vulnerable components of disaster response. Emergency nutrition planning should ensure culturally appropriate, nutritious food, safe drinking water, and adequate hygiene, supported by the involvement of trained nutrition and food professionals in organized mass feeding services.
Supplementary material
The supplementary material for this article can be found at http://doi.org/10.1017/dmp.2025.10294.
Data availability statement
Data will be made available on request.
Acknowledgements
This work was supported by the Scientific and Technological Research Council of Turkey (TUBITAK) 1002-C Natural Disaster Focused Field Study Emergency Support Program (Project code: 5200101).
Author contribution
MAC: Muhammet Ali Çakır; YM: Yeliz Mercan; NCI: Necattin Cihat İçyer; FB: Fatih Bozkurt.
Conceptualization: MAC, YM, NCI, FB; data curation: MAC, YM, NCI, FB; formal analysis: MAC, YM; investigation: MAC, YM, NCI, FB; methodology: MAC, YM; resources: MAC, YM, NCI, FB; supervision: MAC, YM, NCI, FB; writing—original draft: MAC, YM; writing—review and editing: MAC, YM.
Competing interests
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
