Introduction
On February 6, 2023, 2 earthquakes measuring 7.7 and 7.6 (Mw) occurred at 04:17 and 13:24 local time, with epicenters in the Pazarcık and Elbistan districts of Kahramanmaraş.1 The earthquakes had a significant impact on the 11 provinces. This was Türkiye’s most destructive recorded earthquake,1, 2 prompting a global humanitarian response involving the World Health Organization (WHO) and United Nations (UN) partners.3 The earthquakes have exerted a widespread impact on the natural and built environment in southeastern Türkiye and northwestern Syria.Reference Çetin, Ilgaç and Can4 This has resulted in significant losses, with tens of billions of dollars in material damage to the economy, social infrastructure, valuable historical sites, and the tragic loss of tens of thousands of lives.3, Reference Ni, Sun and Somerville5
Undoubtedly, earthquakes have numerous devastating effects, especially on health and the economy.Reference Kahraman6 The most substantial damage to structures and infrastructure was observed in the provinces of Hatay, Kahramanmaraş, Gaziantep, Malatya, and Adıyaman. These provinces, constituting 81% of the total estimated damage, are home to approximately 7.4% of Türkiye’s total population.2 The earthquakes impacted 9.1 million people, displaced nearly 3 million individuals, resulted in the loss of 50,783 lives, and led to the collapse or severe damage of at least 298,000 buildings. Over 216,000 individuals migrated from the earthquake-affected provinces to other regions in Türkiye.7 Evacuees faced temperatures of –5°C to –19°C. Heavy snowfall led to road closures, impeding search and rescue efforts and delaying the delivery of aid to the affected areas on the same day.Reference Bayram, Rastgeldi Dogan and Şahin8–Reference Hussain, Kalaycıoğlu and Milliner10.
The earthquake resulted in significant losses in health infrastructure and the workforce. The Minister of Health of the Republic of Türkiye reported on February 20 that the Ministry of Health personnel in the affected region totaled around 140,000, comprising 74,000 health care workers (HCWs) and 47,000 other personnel. Approximately one in every 8 personnel from the Ministry of Health of the Republic of Türkiye was deployed to the earthquake zone.11 Given the catastrophic nature of the disaster, the Health Emergency Coordination Center identified the impacted areas, activated the National Medical Rescue Team (UMKE) nationwide, and dispatched UMKE vehicles and ambulance teams to the region. A total of 12,749 UMKE members and 112 health personnel were deployed to the earthquake zone, while an additional 26,353 HCWs were assigned to health facilities within the affected area.2 The Turkish Medical Association has reported disruptions in the planning of units for HCWs who voluntarily and officially went to the region. This includes challenges in providing transportation and accommodation facilities, leading to HCWs staying in unsafe, damaged buildings.12
In the earthquakes that wrought extensive destruction in Türkiye, creating a significant demand for emergency health care, the pivotal role played by HCWs in the disaster area cannot be overstated. Consequently, it is crucial to engage in discussions and share the experiences of these HCWs who delivered essential services in the affected region. There are studies in the literature on HCWs and volunteers who took part in the February 6 Kahramanmaraş earthquake.Reference Salik, Şahin and Uslu13–Reference Yanık and Ediz19 Previous studies mainly focused on nurses or emergency teams, highlighting psychosocial and organizational challenges during the response phase. However, limited research has explored how HCWs from different backgrounds experienced the process before, during, and after their service in the disaster zone. The aim of this study is to explore the multidimensional experiences of physicians, nurses, and UMKE members who participated either voluntarily or by assignment, focusing on their experiences before, during, and after their service in the disaster zone.
Methods
Research Design
A phenomenological design was used to explore HCWs’ perceptions and experiences during and after the earthquake. To ensure a comprehensive understanding of disaster and emergency response, semi-structured interviews were conducted with HCWs between November and December 2023. These interviews facilitated a rich dialogue, allowing participants to articulate their thoughts and feelings in their own words. Ethical approval was obtained (Süleyman Demirel University; 14.11.2023/E-87432956-050.99-625915).
Recruitment Strategy and Participants
The process of identifying participants in this research was crucial. According to the Grand National Assembly of Türkiye, a total of 11 provinces were affected by the earthquake.1 The study group for this research was determined using maximum variation sampling, a type of purposeful sampling method. In this study, to ensure maximum variation, interviews were conducted with at least one HCWs from each of the provinces affected by the earthquake. As criteria for participant selection in the scope of the research, HCWs who were not present there during the earthquake but later voluntarily went there or were assigned were considered. The participating HCWs in the study were physicians, nurses, and UMKE members. UMKE is a medical rescue team composed of health care personnel. The time of arrival in the earthquake zone varied among participants; some reached the area immediately after the disaster, whereas others were assigned or volunteered to go up to 2 weeks later. The participants were residing and working in different cities across Türkiye prior to deployment, yet they shared the common experience of providing health care services in the earthquake zone.
All participants provided informed consent after being clearly informed verbally and in writing about the study’s aims, risks, and confidentiality. Participation was voluntary, with the option to withdraw at any time without consequences. While some interviews were conducted face-to-face in participants’ workplaces, some were carried out online via secure video-conferencing platforms (Zoom or Microsoft Teams) due to participants’ geographical distance from the researcher and workload constraints. This approach ensured flexibility and accessibility while maintaining the confidentiality and ethical standards of the study. This research includes a total of 18 participants, comprising 10 physicians, 5 nurses, and 3 members of the UMKE (Table 1). Among these participants, 8 chose to volunteer, while 10 were assigned to work in the earthquake zone. On average, participants fulfilled their duties in the earthquake zone for approximately 15.5 days. While the inclusion of 18 participants may initially seem limited, phenomenological research often prioritizes depth over breadth.
Descriptive characteristics of the participants
At the beginning of the study, no participant number was determined by scaling to ensure data saturation. Considering the relevant criteria, the interviews were concluded by the researchers’ mutual decision that sufficient data saturation was achieved. In phenomenological studies, ensuring data saturation in a similar manner, in other words, repeating the data within the scope of the research, seems sufficient for this process.Reference Daher20, Reference Gündüz21 When the data obtained after each interview were examined, the inability to obtain more themes and categories was associated with similar responses from participants. This process was reached by consensus of the researchers involved in the interviews and analyses. The aim was to achieve data saturation, code saturation, and thematic saturation while striving to avoid false saturation.
Efforts were made to establish a diverse participant pool that reflects the target population’s characteristics. Additionally, all participants were individuals who voluntarily agreed to take part in the study. This ensured that responses were provided willingly and without coercion, enhancing the data’s reliability.
Data Collection
A semi-structured interview form was developed as the main data collection tool. Following its initial design by the researchers, six experts from various fields (nursing management, psychology, medicine, health management, and disaster management) reviewed the form. Experts noted that two questions could be interpreted differently and provided recommendations to enhance clarity and better capture participants’ experiences. Based on this feedback, the form was revised accordingly. The final form consisted of 2 parts: demographic questions (e.g., age, gender, profession) and questions exploring participants’ experiences before, during, and after their time in the earthquake zone.
Data Generation and Analysis
Five interviews were conducted face-to-face, while 13 were carried out online. The interviews continued without a pilot interview. Prior to each interview, participants received an informed consent form explaining the research’s purpose. The choice for online interviews was driven by the geographical diversity of participants across different provinces. Face-to-face interviews occurred in quiet settings, often in cafes chosen by the participants. Even if different interviews were selected, special care was taken to ensure that the participants had a place where they could feel comfortable, especially for online interviews, and that they were held for as long as they wanted. Online interviews were conducted with participants via video chat on the dates and times they requested, and all interviews were recorded with their consent. In this way, it was possible to reveal the meaning of the participants’ experiences of the relevant phenomenon.
The interviews were conducted by two researchers (the first and second authors). The second author conducted the interviews, while the other reviewed the interviews and prompted participants for any missing details. Both authors completed a qualitative research and analysis methods course during their master’s and doctoral education and have authored articles and book chapters on qualitative research methods. Both authors are male and have no connection with the participants. Interviews lasted 27-80 minutes (mean: 42 minutes). All interviews were recorded. Face-to-face interviews were audio-recorded, while others were video-recorded. After the recordings were transcribed, participants were sent a message asking if they had any areas they would like to change, but no negative feedback was received from any participants. In cases where additional information was needed, second interviews were conducted with the same individuals. The coding process occurred after each interview, and data collection continued until sufficient saturation was reached. The decision to conclude the data collection process was made when it was observed that previous codes were being reiterated instead of generating new ones, indicating that the saturation point had been reached. After the researchers determined that data saturation had been achieved, 2 analysts trained in qualitative research analyzed the transcripts using Braun and Clarke’s thematic analysis approach.Reference Braun and Clarke22
Coder Agreement
Researchers independently coded the texts and identified themes and subthemes using the NVivo 14 software. To enhance reliability, a Jaccard coefficient analysis was employed to measure agreement between the coders. Jaccard coefficient analysis is one of the methods that can be used in qualitative research in the literature. Although this process is not a necessity in qualitative analysis, it is thought that it can increase the reliability dimension of the research.Reference Kuiken and Miall23–Reference Amarat, Baş and Akbolat26 The analysis results indicated a compliance rate, represented by the ratio of the Jaccard coefficient analysis result for the themes and categories determined by the researchers, at 0.85.
Results
Based on the data, researchers identified 3 periods, 8 themes, and 32 categories (see Table 2). These were aligned with frequently mentioned patterns in the interviews. Some themes and categories appeared across multiple periods.
Periods, themes, and categories
Period 1. Pre-arrival Experiences
After the earthquake occurred, the participants experienced some emotional symptoms and talked about organizational processes during the time between deciding to go to the earthquake zone or learning that they were assigned to work in the earthquake zone and going to the duty zone.
Among the emotional symptoms expressed by the participants before going to the earthquake zone, the most prominent ones were uneasiness, panic, anxiety, and fear. In the general organization theme, information about the trip, uncertainty, the area of duty, and transportation were among the prominent categories. Except for those who volunteered for duty in the earthquake zone, participants dispatched to the region as HCWs highlighted a lack of coordination in various processes. Specifically, some participants were unaware of the duration of their duty, others were uncertain about the items they should bring, and there was confusion about when they would arrive in the disaster zone:
….I found out the day before I left that I was going to the earthquake zone, so I was naturally alarmed…. (P4)
….No information was given. I was only told that I was assigned to Adıyaman and that I would go to the earthquake zone. The date of my departure was not given clearly…. (P2)
I was a bit anxious because I saw what people went through in the earthquake there on social media, in print media. I spent that one day getting ready in a panic. I can say that I went to the earthquake zone a little bit nervously. (P2)
Period 2. Experiences in the Earthquake Zone
Participants shared their observations, feelings, and thoughts in the earthquake zone under 6 themes: physical symptoms, emotional symptoms, basic needs, health care organization, health care delivery, and other services.
Participants reported experiencing profound tiredness and lack of sleep, largely attributed to the overwhelming patient load in the earthquake zone, compounded by continuous hospital duties and aftershocks. On an emotional level, participants expressed shock, fear, helplessness, and sadness as they witnessed the severity of the earthquake. However, there was also a sense of satisfaction among participants in providing crucial health services to those affected by the earthquake. The participants’ feeling of fear differs slightly from their experiences before going to the earthquake zone. This difference is associated with the change in the cause of fear. The occurrence of aftershocks during the time when most of the participants were on duty, the collapse of damaged buildings around them, and the lack of isolators in some hospitals caused them to experience a fear of earthquakes. The subsequent emotional symptoms included shock and helplessness. Upon reaching their duty stations and witnessing the stories of the people and the condition of the city, participants were initially shocked, followed by a sense of helplessness.
In the theme of basic needs experienced by participants in the earthquake zone, some individuals reported challenges in securing accommodation, leading them to stay in tents they had brought with them. Additionally, variations arose among participants, with some facing heating issues in their lodgings while others did not encounter such problems. Nevertheless, the prevailing issue for the majority of participants was the difficulty in finding a hygienic environment to fulfill their toilet and bathroom needs.
Participants expressed a mix of positive and negative experiences regarding the organization of health care services. On the negative side, they highlighted issues such as HCWs arriving in the earthquake zone without proper orientation to the designated hospitals, a shortage of allied health personnel, challenges in recording health procedures, and imbalances in the distribution of HCWs across hospitals. Some hospitals had an excess of HCWs, while others faced a shortage, indicating a problem in the allocation of assigned health personnel. According to the participants, the overcrowding issues could have been prevented, and the distribution of resources in the region could have been improved. On a positive note, everyone agreed that there were no problems with the availability of medical supplies. Participants also mentioned that the transportation of referred patients happened quickly and smoothly.
In the theme of health care delivery, the experiences of the participants reveal that HCWs and earthquake survivors worked together with incredible superhuman devotion, sacrifice, solidarity, and cooperation to heal the wounds. In addition, participants stated that in some hospitals, they encountered an excessive patient load during the health care delivery process. This situation is thought to be related to the problem in the distribution of HCWs in the health service organization process. Participants also conveyed that, as part of other services, food and clothing aid were provided.
…Because you are severely physically exhausted from working hard and being constantly busy with patients due to your job and not being able to go home. Spending time in a hospital environment is a tiring process. (P1)
…for example, we barely slept for the first 3 nights. It was the 3rd day when we slept. (P3)
The buildings seemed to crumble in the palm of someone’s hand. I really couldn’t believe it. I couldn’t believe they were able to get people out there. This is such a destruction that I saw the floors merge. So, I saw that the mezzanine floor was flat. So, it was really scary. (P11)
There were constant earthquakes. You are getting ready to rest completely, and your patients are becoming a little more stable. At that moment, an earthquake occurs, and your psychology is turned upside down, and you cannot sleep. (P17)
Frankly, there was no health organization in the earthquake area. From the moment we first went to the hospital, we knew that we would only work in the emergency room in that hospital. (P13)
The management was actively working on this issue in great detail, for example, they immediately connected us with the team we would take over and we were able to take over the patients. (P1)
Period 3. Post-departure Experiences
The participants’ experiences after leaving the earthquake zone were collected under 2 themes: emotional symptoms and the process of returning to routine work. Many participants continued to meet with both their patients and colleagues after their return. Many of the stories they experienced here left deep marks on them, and this brought great sadness. They expressed concern for those left behind and subsequently felt guilty for returning. Although they were pleased and proud of helping the earthquake victims in the earthquake zone, they stated that they felt the need to get psychological support because they witnessed all these processes. While they stated that they did not have the opportunity to rest during the routine return to work, they were grateful when they compared their current working conditions with the working conditions in the earthquake region.
When I returned, I felt guilty. Because I came back early. My team stayed three or four days after me, and I returned earlier than they did. I wonder if I could have done more if I had stayed? I felt guilty for arriving early. (P3)
Discussion
The study involved in-depth interviews with HCWs to examine HCWs’ experiences. The insights derived from these interviews hold the potential to contribute significantly to policymakers, health managers, and researchers. The information can aid in enhancing the coordination of post-earthquake health services, addressing the emotional and psychological challenges faced by HCWs, understanding the needs of the disaster-affected community, and preparing for potential future disasters. This qualitative study identified 8 themes across 3 periods, with emotional symptoms present throughout. The presence of emotional symptoms across all periods highlights the emotional burden on HCWs, particularly uneasiness, anxiety, and fear before deployment. Prior studies confirm similar emotional responses among both HCWs and disaster victims.Reference Salik, Şahin and Uslu13, Reference Düzgün, Polat and Hakverdi̇oğlu Yönt27–Reference Köksal, Mert and Aslan34 It is observed that participants undergo both similar and distinct emotional symptoms while in the earthquake zone and after leaving the area. Emotions such as helplessness, sadness, and shock align with findings from previous studies,Reference Çetinkaya Özdemir, Semerci Çakmak and Ziyai17–Reference Yanık and Ediz19, Reference Zhou, Wu and An35 while satisfaction is a less-explored dimension in the literature. One relevant study pertains to the satisfaction of military physicians providing humanitarian aid.Reference Oravec, Artino and Hickey36 Upon leaving the earthquake zone, it became evident that some participants were able to cope with certain emotions (such as anxiety, sadness, guilt), while others still struggled to manage these feelings. Consistent with prior research, participants emphasized the need for post-disaster psychological support.Reference Zhou, Wu and An35, Reference Uwishema37–Reference Kanadli, Aşkar and Sazak39
Before arrival, HCWs reported distress due to unclear logistics and role assignments. Likewise, disaster response teams lacking clear pre-arrival protocols face greater psychological strain and are less operationally effective.Reference Hugelius, Becker and Adolfsson40 These uncertainties cause distress among HCWs even before they arrive in the disaster area.
HCWs were caught unprepared due to the lack of information regarding where they would be stationed, where they would stay, and their needs, resulting in issues related to basic necessities. It is known that HCWs in earthquake-affected areas face challenges arising from environmental factors such as hygiene, cold weather, and shelter.Reference Salik, Şahin and Uslu13, Reference Hussein41 In our study, the lack of food and cold-resistant clothing, particularly among the first response teams, is perceived as a negative issue. It was stated that similar problems were encountered in studies on the earthquake in Türkiye in 2023.Reference Genc42, Reference Segev, Suliman and Gorodetzer43 The magnitude of disasters may delay the fulfillment of humanitarian needs like electricity, potable water, and food in the affected area, impacting both earthquake victims and HCWs. Therefore, HCWs assigned to the earthquake zone must be informed about the conditions and deployed according to a specific plan.
Another theme that emerged from the experiences in the earthquake zone is the physical symptoms experienced by HCWs. Kıymış and YüceReference Kıymıs and Yüce44 stated in their research that the earthquake in Türkiye resulted in sleep disorders and depression among HCWs. In addition, Kuday et al.Reference Kuday, Özcan and Çalışkan45 emphasize the need to improve working conditions, stating that long working hours and insufficient sleep cause difficulties for HCWs during disaster response.
The next finding encompasses general assessments of health care delivery and health care organization in the earthquake zone. Organizational challenges are known to arise in disasters, particularly in earthquakes.Reference Abdi, Vaisi-Raygani and Najafi46–Reference Parlak, Güney and Akkaya50 Initial emphasis will be placed on positive aspects or what HCWs did right. Participants noted that supply issues were largely avoided through the use of local warehouses and military/civilian air transport. Functional local pharmacies also supported the distribution process. Volunteer Pharmacists’ dispensing medications without prescriptions. Moreover, to enhance accessibility, field pharmacies were established alongside field hospitals in the region.51, Reference Uzun, Gülpınar and Iqbal52
The second positive development is associated with the continuous and efficient transportation of earthquake victims who sought assistance at hospitals or field hospitals in the region, facilitated by military or civilian airplanes. This seamless process is a notable and significant advancement for the local population, particularly given the challenges in organizing the health structure following the earthquake. Another positive action is the rapid initiation of the specialist recruitment process within the Ministry of Health in the region, and the sufficient number of specialists. Participants emphasized that collaboration between HCWs and earthquake victims contributes to the smooth and uninterrupted operation of the health care system. Following these positive developments, inadequate orientation has emerged as a significant problem. Health care services rely heavily on teamwork and necessitate high coordination.
Participants expressed that they faced challenges in performing their duties with the desired efficiency due to a lack of orientation in the institutions where they were deployed. They state that better results could have been obtained if they had been able to exchange information about the hospital with their colleagues who served before them before they took over the hospital. Orientation is highlighted as a crucial variable for adaptation during the commencement of HCWs, who noted poor distribution and lack of orientation, leading to inefficiencies. The primary issue with this process could be attributed to partial problems in the organization. It is suggested that the lack of coordination among these teams might lead to potential inefficiencies, including wasted time and resources. Ardagh et al.Reference Ardagh, Richardson and Robinson53 in New Zealand, the earthquake at Christchurch Hospital demonstrated that the unbalanced distribution of HCWs caused similar problems. The malfunctioning of health care record systems prevented accurate patient documentation. Finally, it was noted that a shortage of auxiliary HCWs and difficulties in their geographic distribution could lead to disruptions in time management.
This study adds to the growing body of disaster and health management research by taking a comprehensive, phase-based look at HCWs’ experiences before, during, and after serving in the earthquake zone. Including physicians, nurses, and UMKE members brings together multiple professional perspectives and highlights how emotional, organizational, and practical factors intersect in complex disaster settings. Unlike many studies that focus solely on the immediate response or a single professional group, this research reflects both the positive and challenging aspects of providing care in crisis conditions. In doing so, it offers a more complete picture of what HCWs face and points toward strategies that can strengthen preparedness and support in future disasters.
Limitations
Despite yielding important findings, this study is not without limitations. First, participants included physicians, nurses, and UMKE members who cared for earthquake victims. However, the exclusion of other HCWs limits the scope of the study. Including a broader range of HCWs in future research could provide a more holistic perspective on the HCWs experiences and health care system’s response to disasters. Second, while some findings possess universal relevance, the Turkish cultural context may influence specific results. For example, the processes of social solidarity and mutual aid may have affected health care organization and the motivation of HCWs. Additionally, Türkiye-specific laws and regulations may have influenced the organizational process. Therefore, the findings of the research may be applicable to certain cultures, which could limit the generalizability of these results. Finally, some of the interviews with the participants were online and the impact of the lasting events that remained in their minds should not be ignored, as some time has passed since the event.
Conclusion
This study provides a consolidated view of HCWs’ experiences during the February 6, 2023, earthquakes in Türkiye, encompassing the pre-arrival, in-zone, and post-departure periods. Across these periods, emotional symptoms were a recurrent theme, while organizational factors consistently shaped the conditions of care. Notably, participants also described effective practices such as collaboration with survivors and teams, generally adequate supplies, and timely patient transfers, indicating assets that can be reinforced rather than rebuilt from scratch in future responses.
In light of these results, several actions should be prioritized. Systematic pre-arrival briefings must be organized to clarify the scope of duty, duration, and logistics. Orientation and handover processes between teams should be structured and clearly defined. Staff deployment needs to be planned more equitably, considering regional needs. In addition, psychological support should be provided to HCWs before, during, and after their service to reduce emotional strain. Future research should involve other professional groups such as emergency medical service personnel, psychologists, and technicians to broaden the understanding of interdisciplinary collaboration. Comparative and longitudinal studies across different disaster contexts are also needed to assess the effectiveness of briefing, orientation, and emotional support programs and to inform the development of evidence-based disaster preparedness and response policies. Strengthening these strategies will enhance both system resilience and the well-being of those serving on the front lines of disaster care.
Acknowledgments
The authors express their sincere gratitude to the unsung heroic health care workers who provided health care in the affected areas during the February 6 earthquakes in Türkiye, and special appreciation to the dedicated contributors whose invaluable contributions significantly enriched this study. We respectfully commemorate our citizens who lost their lives in the earthquake and offer our condolences to their families.
Author contribution
The first author designed the study. The first and second authors collaboratively carried out interviews and analyzed the data. The second author obtained ethics committee approval. The third and fourth authors arranged participant appointments, wrote the introduction and discussion sections, and helped edit the manuscript. All other stages were accomplished through collaboration among all authors.
Funding statement
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Competing interests
No conflict of interest has been declared by the author(s).
