Dr Özgür Deniz Değer is sitting in his office in Van, a predominately Kurdish city in eastern Turkey, when I ask him if he’s worried about speaking to me. “Of course,” he says.
At the start of the pandemic, as the-then head of the Van Medical Chamber, he twice criticised the health ministry. In March, he said precautions hadn’t been taken early enough. Then in May, he tweeted the health minister, asking how many health workers had been infected.
Twice, he was called by the police to provide a statement, and questioned on “threats to create fear and panic among the people” – a crime in Turkey, punishable by two to four years in prison. “There is always a risk of being punished when you do something that displeases those in power.”
It’s a reminder that in Turkey, everything – including a pandemic – is political. Not least in the country’s south-east, its predominantly Kurdish regions, still marked by an ongoing conflict.
During the lockdown in May, gunmen shot and killed two aid workers in rural Van as they delivered aid. The Defence Ministry blamed the “treacherous attack” on the PKK (the Kurdistan Workers’ Party). Forty-three people were arrested in response, including members of the HDP (People’s Democratic Party), the pro-Kurdish group that in recent years has come to dominate elections in the south-east.
The cycle of violence and arrests continues. As Crisis Group reports, more than 5,000 people have died since the collapse of Turkey’s peace process in 2015, including 552 civilians.
Any fears that the south-east, with all its challenges, would be the worst hit by COVID-19 were initially misplaced. As Turkey enforced its rolling lockdowns and restrictions from March to June, it was its big cities to the west where the virus seemed to spread the most. Back in the summer, Health Minister Fahrettin Koca referred to Istanbul as “Turkey’s Wuhan”.
Yet as Turkey started to open up, cases began to rise higher in the Kurdish regions than in any other part of the country. “The increase in the number of patients in Van almost doubled compared to the last month,” Koca admitted on a visit to the city last month.
Dr Hüseyin Yavıç, the new head of the Van Medical Chamber, is one of the many experts who believe things are much worse than that. “They mention cases around 1,500 [nationally]” he tell me. “Our own figures are very different. Just in Van alone, every day, there are 400 new cases. And in Urfa, Diyarbakir and those places, it will be a lot more.” The population of Van province is just over one million. The population of Turkey is over 82 million.
What’s more, Dr Yavıç says, Van’s health services are becoming overwhelmed. “The numbers increased, the pandemic hospitals are full, the intensive care units are full, completely full,” he explains. “When it’s possible…if their [COVID] symptoms are not too serious, they send them home.”
Turkey’s health ministry has consistently denied playing down the full scale of the pandemic, while denying that any intensive care units are full. Part of the discrepancy, at least, may be because doctors are reporting those they diagnose with COVID – from scans or clinical findings – while the health ministry only counts those who test positive with a PCR.
Ali is a young shopkeeper from Van who contracted COVID-19 in late July, after lockdown measures had been eased. Barbers and malls had long opened, communal prayers resumed, and the over-65s, for weeks the subject of a curfew, were free to roam the streets again at all hours.
Suffering from a persistent cough, losing his sense of smell, and feeling a heaviness in his chest, Ali was referred to Van’s regional hospital. “There was a queue of 400 to 500 people, all the way down the street,” to the pandemic polyclinic. After a CT scan, the doctor diagnosed him with COVID – without a PCR test – and he was sent home, where he lives alone. Though now recovered, he says every night he went to sleep, “afraid he might die”.
Few else in Van, though, seem to feel the same, despite the rising cases. “The young just don’t fear it,” Nurten Sağlam tells me, the district head of Bahçıvan, as we tour the neighbourhood. And there are a lot of young people in Van province: 65 percent of the population are under 29. Bahçıvan is in the centre of Van city. Just an hour away lies the Iranian border. As we walk through its central market, you can see plenty of clinking of çay glasses and people shaking hands. But almost no masks.
Sağlam tries to remind a large group of young men sitting close to each other that they should be socially distanced, but they just laugh dismissively. Sağlam is part of the track and trace team in Bahçıvan, a district of 9,000 that only had three to four cases throughout April. Now, she tells me, she is personally checking in on 20 households.
Further on, we pass kebab stalls, barbers, and a tailors selling wedding dresses. “The weddings are the worst,” she says – a common complaint.
“All here love the halay,” a local journalist later tells me – a dance, performed especially at weddings, that’s main requirements involves holding hands, forming a ring, and stepping to the music.
Kurdish weddings can often have up to 1,000 guests, lasting three days straight. As the country opened up again over the summer – peak wedding season – many have blamed the ceremonies for spreading the virus over the southeast. Eventually, 14 provinces introduced restrictions, limiting ceremonies to just one hour, and banning food and drink.
But there are questions, too, about whether it is entirely fair to shift the blame onto individual choices or cultural practices. Dr Yavıç believes the blame really falls on policy decisions, such as reopening too soon despite “the statistics saying the pandemic wasn’t under control.”
The government should have done more to support people financially, Dr Yavıç tells me. “If people have economic losses, they won’t stay at home,” he says. “People in some way will go out and they’ll work.” Especially in Van, one of the poorest provinces in Turkey, with a GDP per capita that is roughly a third of the national average.
Then, of course, there are the region’s politics to complicate matters. As Turkey’s war on the terror-listed PKK has rolled on, one notable effect in the last eighteen months has been the removal of elected HDP mayors all over the southeast. Of the 65 elected in March 2019, as few as 15 are still standing. Many of those removed have been detained, charged, or convicted on terror charges. As President Erdoğan said of the party in February, “everything they do constitutes a crime.’”
Yet the pro-Kurdish HDP has denied any links with the PKK, and repeatedly condemned its violence. Earlier this year, Human Rights Watch declared that “removing, detaining, and putting on trial local Kurdish politicians as armed militants with no compelling evidence of criminal activity seems to be the Turkish government’s preferred way to wipe out political opposition.”
Last year, Van too had its mayor removed – on the same day as two other predominantly Kurdish cities, Mardın and Diyarbakır – with all three replaced by government-appointed trustees. And the top-down politics this has entailed has affected the work of Van’s doctors. Trustees, for example, have the power to ban all public events across their province for weeks at a time.
As a result, Dr Yavıç says, the police have prevented the Van Medical Chamber from making public statements. Neither has the provincial medical board been able to meet since the pandemic began. “There’s no unity, there’s no process in society to cooperate, there’s no transparent sharing of information,” he tells me. “from our perspective, it makes dealing with this for us much harder.’
Most strikingly, in Van and elsewhere, it’s in an environment that has seen some doctors actively investigated for speaking out. For it’s not solely Dr Değer who has been summoned to the police. Members of medical chambers in Mardin and Şanliurfa – also in the southeast – have been interrogated. Both Amnesty International and Human Rights Watch have condemned the cases, which are still ongoing.
Opposite Dr Değer’s clinic, in Van city centre, is Lokman Hekim Hastanesi, a large, glassy hospital with a pleasant café at its front. Opened in 2010 – and one of two new hospitals built in the province since 2002 – it is perhaps a fitting symbol for a government that, in healthcare at least, seems to provide with one hand, and silence with the other. For, in its early years especially, Erdoğan’s AKP government did transform Turkey’s health service: a universal insurance system was introduced; access to doctors was substantially increased; and hundreds of hospitals, public and private, were built across the country. And, for one reason or another, Turkey’s death rates throughout the pandemic have remained impressively low. True to form, this week, Health Minister Koca pledged to build six hospitals urgently, across the south-east, to tackle the region’s growing epidemic.
But one wonders if more couldn’t be done to take the people with them. For their own part, despite the fear, Van’s doctors themselves will keep trying, to be heard both by the government and the people, too. “Because if we don’t do it,” asks Dr Değer “who will?”