Attitudes of Healthcare Workers toward Refugee & Migrant Populations in Turkey

• In Event: The Politics of Refugee and Migrant Admission and Integration in Turkey

Abstract

Recent research on refugee integration has highlighted the importance of street-level bureaucrats (SLBs) like doctors, nurses, and social workers in supporting healthcare access for refugees, as well as shaping public attitudes and behaviors toward refugees. These frontline providers have considerable discretion in how they implement state policies, they are gatekeepers to critical health services, and the public health centers they administer often serve members of the host society and refugees alike. This research draws on 60 in-depth interviews with healthcare workers from about 20 health facilities in Turkey, which hosts one of the largest numbers of Syrian refugees in the world, to investigate the factors that shape SLBs’ attitudes and discretionary behaviors related to refugee patients. Our preliminary analysis shows three major themes emerging from these interviews. First, health workers characterized the state of the current health system in Turkey as stressed and over-burdened, something that certain respondents attributed to government-provided public health benefits for Syrian refugees. In this context of high demand and relatively limited resources, they also acknowledged that they can and sometimes do engage in discretionary behaviors vis-à-vis patients within the boundaries of professional values and norms. In many cases these behaviors were a direct response to the systemic pressures faced by frontline staff, and instances of both positive and negative discretion were reported. Second, our interviews suggest that these pressures and corresponding discretionary behaviors are not experienced evenly: healthcare workers in specific practice areas, such as obstetrics/gynecology and pediatrics, encountered a larger number of refugee patients relative to other areas of medical care and thus felt more acute strain in their day-to-day work. Third, despite acknowledging the toll on public resources and associated pressures, some of the health workers we spoke with also alluded to the positive aspects of interacting with different refugee patients. Specifically, several of the physician specialists noted that because of the variety of patients, they were able to gain more experience than they otherwise would and thus were able to build new skills and developing professionally. Overall, this research highlights the importance of examining and understanding the attitudes of SLBs within efforts to support equitable health service delivery and broader inclusion for refugee populations.

Authors

• Burcu Pinar Alakoc, University of Chicago

• Alan Zarychta, University of Chicago

• Emel Ozdora, Bilkent University