Doctors Warned This Turkish Hospital Was Unsafe. Then the Earthquakes Hit.

İSKENDERUN, Turkey – Anxious onlookers followed the stretcher with their eyes as a crane lifted it out of the rubble of the city’s state hospital.

Covered in a blanket, the person on it was small, just a boy, rescuers said. By the time he was pulled out almost three days after Monday's earthquakes, he was dead. They carried him around the campfires in the yard and into the makeshift morgue next door, where body bags awaiting identification covered the floor.

“Everyone on the hospital lawn is hoping for that one miracle to be their kin,” Nazli Danis, a product manager for a tech startup in Istanbul, told VICE World News.

She would have to keep hoping. Her mother Tulin had been keeping the family's ailing grandmother Keriman Garbioglu company overnight when the six-storey hospital building collapsed. Tulin had phoned Danis’s aunt just after the earthquake, but the line was silent when the aunt picked up. Was she still alive somewhere under the broken concrete and metal?

“The magnitude of the pit I feel in my stomach changes. Right now it's heavy,” Danis said.

More than 22,000 people have died following the earthquakes in Turkey and Syria, while at least 12,000 buildings have been destroyed or damaged. Visiting the region hit by the quakes, President Recep Tayyip Erdoğan, who is up for re-election in May, has said “it is not possible to be prepared for such a disaster.”

The sheer number of structures that collapsed, however, including critical infrastructure such as hospitals, administrative centres and schools, has raised questions about the government’s construction policies. Turkey lies on two major fault zones, in one of the world's most seismically active regions, with a long history of earthquakes. On Monday, two hospitals were levelled and another two damaged in the Hatay region, which includes Iskenderun, and even the local headquarters of the Disaster and Emergency Management Authority was reportedly destroyed.

“Two things have to stay strong in this kind of situation: hospitals and disaster response buildings. But in this case they both failed,” Mucip Ozgur, an Istanbul-based civil engineer, told VICE News.

“There is more damage and destruction of public buildings than should be possible or acceptable,” Taner Yuzgec, head of the Turkish Chamber of Civil Engineers, told local media after visiting Hatay on Wednesday.

Several new buildings also fell, such as a 16-story apartment block in Iskenderun, even though they were erected after a devastating 1999 earthquake prompted building code reforms. While the two earthquakes on Monday had large magnitudes of 7.8 and 7.5, experts have said better construction and reinforcement of structures could have reduced the damage. 

“This many buildings should not have been destroyed,” Haluk Sucuoğlu, a professor of earthquake engineering at Middle East Technical University, said on Halk TV. “These risks had to be reduced … Our risks are the same today as in the 1999 earthquake.”

Block A was at one point slated to be demolished, Koray Tanin, Iskenderun branch head of the Turkish Chamber of Architects, told the Turkish independent news site Diken. Instead, it continued to serve orthopaedics, pulmonary medicine and urgent care patients.

As a result, at least 12 patients and two nurses were trapped inside Block A after the earthquake hit, VICE World News learned from relatives on the ground. The real number is likely much higher, as dozens of people have been waiting day and night by the campfires in the hospital yard. In addition to several bodies, volunteer rescuers have pulled four people out who were blue from cold but alive. One of them soon died of her injuries.

“This [hospital] building should have been abandoned,” Suzan Sahin, a member of opposition party CHP who represents Iskenderun and the rest of the Hatay region in Turkey's national assembly, told VICE World News. “We knew that this was a risky building, and there could be problems in an earthquake.”

The Turkish government vowed not to be caught off guard. A reform of the building codes mandated thicker support columns and better-quality concrete in new structures. These buildings should be better able to withstand tremors than the old stock; only a small percentage would be expected to collapse, according to Kit Miyamoto, a Los Angeles-based engineer who has consulted on earthquake rebuilding in countries including Turkey.

Existing structures are a thornier issue. Ankara introduced an “earthquake tax” that would go on to raise some $17 billion to reinforce public buildings. Many techniques can be employed, like spring systems to cushion the foundation, shock absorbers to reduce sway or simply extra layers of concrete to increase strength. 

While more than 50 hospitals and 1,200 schools have been strengthened or rebuilt in Istanbul, according to the presidential office, southeastern Turkey was neglected, though it also lies on a major fault line.

“The Turkish government has been preparing for an Istanbul earthquake for quite a while,” Miyamoto said. “On the southern border, they haven't had an earthquake for 400 to 500 years, quite a long time ago, so if there's nothing happening, people aren't going to spend 5 percent of the value to retrofit a building.”

Even as the government has spent billions of dollars to improve resilience, it has allowed more than half of Turkey’s buildings to remain not up to code. In 2018 it instituted a “zoning amnesty” under which irregularities in private buildings could be waived, including violations of earthquake norms. Each waiver can earn the state thousands of dollars in fees. 

These amnesties give a pass to potentially unstable buildings and promote “lax behaviour” on new projects, with developers confident they can get an exemption later, said Yigit Ergecen, an Istanbul-based architect.

Much of this week’s destruction can be blamed on the greed of construction firms and the government, said Pelin Pınar Giritlioglu, a professor of urbanisation and environmental studies at Istanbul University. Some 140,000 thousand zoning amnesty applications had previously been made in the hard-hit Hatay and Gaziantep regions, and the total number of substandard buildings is much higher, she said.

“Ever since the zoning amnesty was issued, we have been asking what will happen to these structures in an earthquake,” Giritlioglu said. “We got the answer with this earthquake. That's why I'm so angry.”

When asked for comment, the Iskenderun hospital director's office told VICE World News to contact the district administration. The man who answered the phone at the district administration said he was not authorised to comment, but could not say who would be. A request for comment sent to the district administration email address on Thursday had not been answered at time of publication.

An orthopaedic specialist at the hospital, who asked for his name to be withheld, said some sort of “steel construction” had been done in block A a few years ago, but Ergecen, the Istanbul architect, said he could see no steel reinforcement of the concrete structure in multiple photos of the rubble. 

Earthquake-vulnerable buildings are a problem not just in Turkey, but also around the world, according to Miyamoto, the LA-based engineer. Seismic retrofitting is costly, time-consuming and often unpopular. For instance, California's deadline to upgrade or replace hospitals for earthquake safety was pushed back from 2008 to 2020, and 23 facilities are still not in full compliance.

“Every government is probably failing right now,” Miyamoto said. “I don't know a single government that's doing that. Even in California we cannot fix all those hospitals.”

But as she waited for her mother to be pulled out of the rubble, Nazli Danis said Turkey lagged behind in protecting against natural disasters like earthquakes. She has been sourcing orbital grinders, floodlights and thermal cameras to help the mostly volunteer rescue effort.

“You have natural events in Japan, the Philippines, everywhere,” she said, “and you don't see these kinds of casualties.”