Rescue workers continue to comb through the rubble of collapsed buildings across Turkey and Syria in the wake of a devastating earthquake that struck the two countries on February 6. More than 36,000 people have been confirmed dead in what is one the strongest earthquakes to hit the region in the past century. As search-and-rescue missions continue and recovery begins, a handful of RAND researchers shared some of their initial thoughts:
- Shelly Culbertson is a senior policy researcher who focuses on forced displacement, post-conflict stabilization, and disaster recovery. She has led multiple studies about refugees and is associate director of the Disaster Research and Analysis Program at the nonprofit, nonpartisan RAND Corporation.
- Aaron Clark-Ginsberg is a behavioral/social scientist at RAND who has been researching disasters for more than 10 years. His projects span the disaster gamut, with a recent focus on three primary areas of inquiry: disasters and community, disasters and health, and disasters and measurement.
- Howard J. Shatz is a senior economist at RAND and a professor at the Pardee RAND Graduate School. He specializes in international economics and economics and national security. His RAND research has included stabilization and reconstruction in post-conflict countries.
- James A. Schear is an adjunct senior political scientist at RAND. Early in his career, he worked at the United Nations, supporting implementation of the 1991 Gulf War cease-fire resolutions and, shortly thereafter, as an advisor to U.N. missions in Cambodia and former Yugoslavia.
- Krishna Kumar is vice president, International; Distinguished Chair in International Economic Policy; and a senior economist at RAND. He is also a professor at the Pardee RAND Graduate School, where he teaches economic development.
- Mahshid Abir is a senior physician policy researcher at RAND. Also a practicing emergency physician, her research evaluates the continuum of acute care delivery, including pre-hospital, emergency, inpatient, and ambulatory care, with a focus on policy-related issues pertaining to utilization, quality, efficiency, and acute care outcomes.
- Jay Balagna is an assistant policy researcher at RAND and a Ph.D. fellow at the Pardee RAND Graduate School. His research focuses on disaster risk reduction and risk creation. His RAND research has included disaster and emergency management topics both domestically and around the world.
- Jessie Riposo directs the Disaster Management & Resilience Program (DMR) within the RAND Homeland Security Research Division, and is a senior operations researcher at the RAND Corporation. She focuses on developing and maintaining the capabilities required to conduct research and analysis in support of disaster management.
What are some of the main considerations for starting the recovery process?
Shelly Culbertson: After the immediate response efforts that include rescuing people, addressing injuries and health care, uniting families, putting out fires, clearing rubble, and getting basic services back up again, longer-term recovery processes will need to start. Recovery may include developing plans, managing financing for massive capital infrastructure investment, coordinating among national and local governments along with international donors, rebuilding homes and public infrastructure, developing improved standards, and many more steps. A long list of activities needs to happen as part of recovery. I would highlight a few key lessons learned about these recovery steps from RAND's work on other disasters in the United States and internationally.
First is that recovery takes a long time, much longer than people who have experienced a disaster want it to take or expect. Depending on the severity of the disaster, it can take 5, 10, 15 years to do much of the needed rebuilding. For instance, recovery projects from Hurricane Katrina are winding down after 15 years. Much of the recovery rebuilding from Hurricane Sandy in the northeast of the United States took about eight years. Five years after Hurricanes Irma and Maria, Puerto Rico has only been able to spend a small portion of disaster resources on rebuilding.
Recovery takes a long time, much longer than people who have experienced a disaster want it to take or expect.
Shelly CulbertsonShare on Twitter
Next, there are a lot of capacities that are needed to manage recovery.
Reconstruction could require capital investment of many billions of dollars, and national and local governments will likely be responsible for managing these processes. And they may face challenges in finding the staffing and those with the skills to oversee these projects, a huge workforce needed to undertake rebuilding, and the significant amounts of money along with government and private-sector financing mechanisms.
And third, authorities could seek to emulate successful past recoveries that have built opportunity into the recovery process by using the recovery process to mitigate future risk, for example, by improving building codes and standards, and to invest in the local economy and workforce.
Aaron Clark-Ginsberg: First is rebuilding and providing humanitarian support in conflict contexts without clear governance. There are major humanitarian access problems and it can be difficult to know who to work with. Second is Syria is effectively forgotten. The United States does not allocate sufficient international aid to the Syrian people, nor do other countries. And third, many international NGOs and other key humanitarian players have lost a lot of staff in the quake. They are dealing with grief while also working to organize a response. Shockingly, the organization I collaborate with lost 27 of its staff. It's like the Haiti earthquake all over again.
What challenges are being faced in getting assistance to Syria?
Howard Shatz: While assistance from numerous countries is piling into Turkey, helping Syria presents a far more difficult problem. The greatest damage occurred in parts of Syria that are governed in part by Turkey and Turkish-linked rebel groups, and in part by the designated terrorist group Hayat Tahrir al-Sham (HTS), an offshoot of al-Qaeda.
There may be options for delivering aid. First, these areas have in place experienced disaster workers on the ground, the Syria Civil Defense, known as the White Helmets. The United States is among many countries that support this organization. Second, Turkey is apparently willing to allow international aid convoys, but is grappling with the disastrous consequences of the earthquake in its own country. One option might be airdrops of supplies to the White Helmets, coordinated in advance. This could include lifesaving food, water, medicine, and shelter, such as insulated tents.
Second, countries willing to aid Syria could declare an equivalent of force majeure on the U.N. limitation of only one border crossing, move additional aid to Turkey (perhaps through the Port of Iskenderun), and then using all available crossings.
Third, countries could channel aid via the Kurdistan Region of Iraq through the Kurdish-led Autonomous Administration of North and East Syria. Doing so would involve negotiating crossing of lines of control with either Turkish-led groups or with the Syrian government.
A fourth option could be cooperating with the government of Bashar Assad and moving aid through government-held territory, but this is likely the worst of the options because Western aid providers will have no control over how much aid actually gets to the earthquake-stricken areas, and Assad and his network will surely take their cut.
Finally, Syria is one of the most heavily sanctioned countries in the world. However, in almost no cases do sanctions stop humanitarian relief. And to ensure that this is not the case, the U.S. Treasury issued a general license authorizing for 180 days “all transactions related to earthquake relief that would be otherwise prohibited by the Syrian Sanctions Regulations.”
What about Turkey?
James Schear: Turkey faces a “congested access” problem. Syria is more prone to this, to be sure; but Turkey's air, sea, and overland transit routes are getting swamped by a huge influx of relief and recovery aid. Their initial “first come, first served” approach for clearing flights just didn't work. There also seems to be a need to engage with Turkey regarding safe rebuilding practices. Turkey may need to start with viable habitability assessments for buildings that are still up but fragile. Then, there's the challenge of monitoring and enforcement of building codes as well as seismic retrofitting of existing structures before the next big quake.
How is the United States helping and what are its reasons for doing so?
Jay Balagna: There are a few dozen FEMA Urban Search and Rescue (US&R) Task Forces scattered around the nation, two of which also serve as US&R components of the USAID's Disaster Assistance Response Teams. These teams have been used in emergencies across the country and deployed internationally since the 1980s, and both were sent to Turkey last week. They represent the spear tip of the American emergency management field's contribution to humanitarian response and global “disaster diplomacy.” As Howard Shatz points out, this international outreach is often complicated by the political realities on the ground, but we have seen the best examples of how it can succeed in previous disasters in the same region.
A pair of earthquakes in 1999—one centered near Izmit, Turkey, and the other just weeks later near Athens, Greece—saw the exchange of rescue task forces that not only saved Turkish and Greek lives, but warmed relations between tense international rivals. While responders from many countries, including from the United States, assisted after both earthquakes, it was the task forces from each neighbor that were the first to pledge support and show up on-scene. The exchange drove not only a rapprochement, but the beginning of a wide range of disaster risk reduction activities shared between the two. In a period of heightened tensions between Turkey and its NATO allies, the U.S. US&R teams follow in that same tradition, responding to humanitarian needs in the short term and hopefully warming relations in the long term.
How big will the economic impacts be?
Jessie Riposo: Current estimates of the economic impact from the disaster include nearly $70 billion in housing losses and another $10.4 billion in economic loss. These preliminary estimates likely fall short of total damages as it can take months to fully assess and establish the total cost of recovery. These costs appear to be driven by the poor construction of many properties, which may lead to legal action, and serve a stark reminder of the importance of implementing more-resilient building codes and standards. As Turkey takes steps to rebuild, they must consider how they will enforce more-rigorous adoption and adhesion to safe building practices.
Are relief efforts complicated by the West's strained relationship with Russia over its invasion of Ukraine?
Shatz: Some potential relief options may require some type of negotiation with Russia. Any airlift will go over Syrian airspace, which Russia de facto controls. And one risk of breaking the U.N. resolution on border crossings is that when it comes time to renew it in July, Russia might not agree, effectively closing all border crossings to northern Syria. This places countries in a dilemma—is it better to ensure aid now, in the wake of a massive disaster, at the cost of aid later? Given Russia's intransigence, there is no easy answer.
What about all the refugees in the region?
Krishna Kumar: Given that the affected areas are densely populated with Syrian refugees, they should be included and involved in the reconstruction efforts. A recent RAND study found that refugees are eager to contribute to the local economy even during normal times. During this extraordinary time, they are likely to be even more willing to work, especially since many of their own are affected. However, many legal and regulatory impediments are placed in their way of working. Turkey could suspend all restrictions on the kinds of jobs Syrian refugees can do and accept help in recovery and reconstruction from all. The above study also found that it was hard to match refugees to jobs given their informal nature. Turkey should use all available technologies such as a mobile app to match workers—refugees and nationals—to jobs, if needed on a task-by-task basis as is the norm for gig jobs.
Children are especially vulnerable to traumatic effects of disasters and can experience anxiety, depression, and posttraumatic stress disorder.
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How should the needs of vulnerable populations be addressed?
Mahshid Abir: As seen in prior earthquakes such as those in Haiti, Bam, Iran, and others, children, pregnant women, older adults, and those with mental health diagnoses are particularly vulnerable in the aftermath of these events. Many will not have access to their medicines, including those for chronic diseases such as asthma and diabetes and psychiatric medicine leading to acute exacerbations of these conditions. Obstetric/gynecologic and mental health needs are particularly pronounced in the few weeks after these events, making access to care from generalists, nurses, OB/Gyn providers, and mental health experts critical during that timeframe. All care could be provided in a culturally competent manner, and relief teams could ensure sensitivity to local religious practices and use interpreters to communicate with earthquake victims whenever possible. Children are especially vulnerable to traumatic effects of disasters and can experience anxiety, depression, and posttraumatic stress disorder. In war-torn Syria, the earthquake can compound prior traumatic experiences. Disaster relief teams may need to work with local health care providers and community stakeholders to ensure a safe and supportive environment for impacted children as soon as possible.
How will renal failure from crush injuries among earthquake victims be addressed?
Abir: Given that building materials used in both Turkey and Syria include bricks, stone, mortar, and steel, one of the highest risks for those rescued from the rubble under collapsed buildings are musculoskeletal crush injuries. Such injuries can lead to renal failure requiring emergency dialysis to prevent fatal electrolyte abnormalities among the victims. Concurrent with search-and-rescue efforts, plans for either transferring mobile dialysis units to the impacted area and/or arranging transfer of patients to facilities in the region with the capacity and capability to conduct emergent dialysis should be made.