Elif N. Özmert, MD, PhD,a​ Orhan Derman, MD, PhD,a​ Aysun Bideci, MD,​b Nurullah Okumuş, MD,​c KoraySyrian Boduroğlu, MD, ChildrenPhD,​a Sevcan Bakkaloğlu, MD, inb​ Enver : Hasanoğlu, MD,​d Errol Alden,A MDModele of Action for National Pediatric Societies

The Syrian Civil War, which has refugee infants have been born been ongoing since March 2011, in Turkey. Not only is there an has forced nearly 11 million increase in the number of patients people from their homes. Of those to be seen, but a resurgence of ∼ remaining in , 13.5 million infectious diseases has been people, including 6 million brought into the country. For children, need humanitarian example, cutaneous leishmaniasis, assistance as a result of having reported in 16 new cases in fled their homes, enduring province in 2010, aDepartment of Pediatrics, Faculty of Medicine, Hacettepe University, hostilities, and experiencing increased to 104 new cases in , Turkey; bDepartment of Pediatrics, Faculty of Medicine, Gazi c limited access to food, health1 2013 and afterward4 declined to University, Ankara, Turkey; Department of Pediatrics, Faculty of care, and other basic needs. 11 in 2015. To combat the spread Medicine, Yıldırım Beyazıt University, Ankara, Turkey; dTurkish National Pediatric Society, Ankara, Turkey; and eDepartment of Pediatrics, Furthermore, >3.4 million Syrians of disease, additional vaccination Uniformed Services University of Health Sciences, Bethesda, Maryland have fled to Turkey since the campaigns against poliomyelitis start of the conflict. The Turkish and measles have been organized Dr Özmert organized and provided training, organized, created, and delivered the workshop, and drafted the government gave an immediate for both refugees and Turkish manuscript; Drs Derman and Bideci organized and provided response with an open-door children in cities with high training, organized, created, and delivered the workshop, and policy and offered temporary refugee populations. critically reviewed the manuscript; Drs Okumuş, Hasanoğlu, protection status. Currently, and Boduroğlu organized the training, organized, created, Refugees in Turkey have been 9% of the refugee population and delivered the workshop, and critically reviewed the provided accommodation, manuscript; Dr Bakkalo lu organized the training, organized, are living in 26 temporary ğ nutrition, and health services, created, and delivered the workshop, and critically reviewed protection shelters, and the as well as education and and revised the manuscript; Dr Alden organized, created, remaining 91% have integrated psychosocial support. However, and delivered the workshop and critically reviewed and into the communities in cities revised the manuscript; and all authors approved the final there is still much to be done to across the country. Half of the manuscript as submitted and agree to be accountable for all İ prevent a lost generation. It is aspects of the work. Syrian refugees are living in the well known that adult medicine following 4 major cities: stanbul 5 DOI: https://​doi.​org/​10.​1542/​peds.​2018-​0539 Ş ı begins in pediatrics,​ so pediatric and 3 other cities near the border Accepted for publication Jul 23, 2018 societies should not just endeavor (Hatay, anl , and Gaziantep). to protect and cure children today Address correspondence to Elif N. Özmert, MD, PhD, In some provinces near the Syrian Department of Pediatrics, Faculty of Medicine, Hacettepe but must also support them to border, the percentage of Syrian University, 06100 Sıhhiye, Ankara, Turkey. E-mail: nozmert@ achieve a healthful and productive hacettepe.edu.tr refugees has reached 50% of the adulthood. Pediatricians have current total population of the PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). 2,3​ an obligation to advocate for province. ‍ Copyright © 2019 by the American Academy of Pediatrics resources and services for The influx of Syrian refugees children, emphasizing that if FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to has increased the burden on children are not served now, disclose. the health care system. As of society will pay the price later

August 2017, 953 466 surgeries, in rising violence, out-of-control To cite: Özmert EN, Derman O, Bideci A, et al. Syrian 1 143 393 hospitalizations, and health care costs, and squandered Children in Turkey: A Model of Action for National Pediatric 25 919 750 outpatient clinic human potential. It is a crucial Societies. Pediatrics. 2019;143(2):e20180539 services have been provided to role of pediatric societies to refugees, and 224 750 Syrian advocate for children, families, Downloaded from www.aappublications.org/news by guest on October 6, 2021 PEDIATRICS Volume 143, number 2, February 2019:e20180539 MONTHLY FEATURE and pediatricians. As part of this been conducted partly through Pediatric Congress in in advocacy, they should also play a the financial support of the collaboration with the IPA and IPAF. role in research, policy-making, International Pediatric Association The speakers included were from and the education of pediatricians, Foundation (IPAF). To date, 10 Turkey, the IPA, Save the Children, prioritizing those child health issues meetings have been conducted and the International Association with the greatest impact on children involving 2000 physicians. The for Adolescent Health. Participants and societies. problems of Syrian children have included representatives from the also been discussed in every pediatrics societies of Jordan, Iraq, The International Pediatric National Pediatric Congress held Kosovo, and Azerbaijan; 24 branches Association (IPA) has a mission to annually since 2013. Additionally, of TNPS; and pediatricians and help children in disaster through the TNPS has provided training to nurses from the cities with a large education, advocacy, and convening refugee mothers and adolescents Syrian population. The workshop policy makers, corporate leaders, living in the Cevdetiye Temporary report can be found on the TNPS and nongovernmental organizations 8 Protection Center regarding health Web site. (NGOs). However, national societies and psychosocial issues, again with should also take action to cope the financial contribution of IPAF. A particularly innovative aspect with this exceptional challenge to The main health topics discussed of the model of action was the the health care system and health 6 were breastfeeding, newborn health, development of a social awareness of children. To the best of our growth and development, vitamin campaign designed to increase knowledge, Turkey is currently and/or mineral supplementations, social support to refugee hosting the largest number of vaccinations, and common infectious children and families in Turkey refugee families and children in diseases. The topics were identified in collaboration with the media. the world. To address this, the as a result of interviews with Famous artists and football players real-world action model of the mothers and local health providers. (28 in total) gave unifying messages Turkish National Pediatric to the host communities about No assessment was made about the “ Society (TNPS) in Turkey that these children and families and results of the education sessions ” was adopted and implemented on either health care providers or emphasized the tagline everything to support the children of war is families. However, feedback from starts with love. presented here in the following health providers emphasized that 3 parts: (1) education for health As always, none of the aspects of having the support of TNPS made workers, families, and adolescents; this action plan were conducted them more confident. (2) research; and (3) social by a single organization. Key awareness raising. After so many years refugees implementing partners for the spend in a foreign country under TNPS for this set of activities were While governments often are the temporary protection, education (1) the Turkish governmental major authority to deliver and and psychosocial needs have come bodies (Disaster and Emergency organize health services, pediatric up as priority topics. A research Management Presidency, Ministry societies can help develop the study conducted by TNPS on of Health), (2) international capacity and the knowledge of adolescents living in the Cevdetiye associations (IPA) and foundations service providers. To ensure camp revealed that anxiety, (IPAF) and other international NGOs the appropriate education of depression, negative self-concept, (Save the Children, International pediatricians during the acute hostility, and Global Severity Index Association for Adolescent Health), phase of the disaster, the TNPS has scores in the refugee group were and (3) the media. The Turkish regularly planned local trainings significantly above the cutoff points government has spent >30 billion since 2012 for pediatricians, family for pathology. Scores for hostility dollars to support refugees in physicians, and general practitioners and somatization were highest in Turkey. However, there remains in the region. The training modules the group that had been at the camp a lot for communities, NGOs, and address important pressing topics 7 for >4 years. This type of research all the world to do to protect the for refugee children, including the is essential to provide evidence children of war. management and prevention of to support program and policy communicable diseases, current As highlighted in the letter by development. “ 9 issues in the vaccination of refugee Bhutta (IPA president) et al,​ children, management of acute To further address these issues, we express our strongest “ ” malnutrition, and psychosocial TNPS organized an international condemnation of the failure of ” issues in children under difficult Refugee Mental Health workshop warring factions globally to protect circumstances. Trainings have during the 61st Turkish National the rights of women and children,​ Downloaded from www.aappublications.org/news by guest on October 6, 2021 2 ÖZMERT et al ü “ ” ABBREVIATIONS ’ and we extend this to include Kemal Atat rk), no lost generation “ ” families and fathers. National (United Nations Children s Fund), pediatric societies are urged to take and everything starts with love IPA: International Pediatric action locally to ensure a bright (TNPS). Association future for any child affected by IPAF: International Pediatric With several years into the conflict conflict or disaster. Association Foundation in Syria, it is time to think beyond NGO: nongovernmental For all children affected by war, the urgent concerns of safety, “ organization terrorism, and conflict, let us act with nutrition, and health to the more ” TNPS: Turkish National Pediatric the following 3 mottos: peace at complex long-term needs of the Society home, peace in the world (Mustafa children. FUNDING: The Turkish National Pediatric Society and International Pediatric Association Foundation funded the trainings and workshop activities. POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

REFERENCES 1. United Nations High Commissioner for 4. Özkeklikçi A, Karakuş M, Özbel Y, Töz 7. Derman O, Akgül S, Ataman E, et al. The Refugees. Syria emergency. Available at: S. The new situation of cutaneous rise of a hostile adolescent population: www.​unhcr.​org/​syria-​emergency.​html. leishmaniasis after Syrian civil war in the Syrian refugee problem. Adolesc Accessed April 2, 2018 Gaziantep city, Southeastern region of Psychiatry. 2017;7(2):83–88 2. Disaster and Emergency Management Turkey. Acta Trop. 2017;166:35–38 8. Turkish National Pediatric Society. Presidency of Turkey. Current status at 5. Van Niel C, Pachter LM, Wade R Jr, Felitti Çocuk ve Ergen Perspektifi ile welcome centers: temporary reserve VJ, Stein MT. Adverse events in children: Mülteci Akıl ve Ruh Sağlığı Çalıştayı center reports. Available at: https://​ predictors of adult physical and mental Raporu. Available at: https://​ www.​afad.​gov.​tr/​tr/​2374/​Barinma-​ conditions [published correction appears millipediatri.org.​ tr/​ cocuk-​ ve-​ ergen-​ ​ Merkezlerinde-​Son-​Durum. Accessed in J Dev Behav Pediatr. 2014;35(9):581]. J perspektifi-ile-​ multeci-​ akil-​ ve-​ ruh-​ ​ January 23, 2018 Dev Behav Pediatr. 2014;35(8):549–551 sagligi-calistayi-​ raporu/​ .​ Accessed July 3. United Nations High Commissioner 6. Goldhagen JL, Kadir A, Fouad FM, 4, 2018 for Refugees. Syria regional refugee Spencer NJ, Raman S. The Budapest 9. Bhutta ZA, Keenan WJ, Bennett S. response: Turkey. Available at: http://​ declaration for children and youth on Children of war: urgent action is data.​unhcr.​org/​syrianrefugees/​country.​ the move. Lancet Child Adolesc Health. needed to save a generation. Lancet. php?​id=​224. Accessed January 23, 2018 2018;2(3):164–165 2016;388(10051):1275–1276

Downloaded from www.aappublications.org/news by guest on October 6, 2021 PEDIATRICS Volume 143, number 2, February 2019 3 Syrian Children in Turkey: A Model of Action for National Pediatric Societies Elif N. Özmert, Orhan Derman, Aysun Bideci, Nurullah Okumus, Koray Boduroglu, Sevcan Bakkaloglu, Enver Hasanoglu and Errol Alden Pediatrics originally published online January 15, 2019;

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Downloaded from www.aappublications.org/news by guest on October 6, 2021 Syrian Children in Turkey: A Model of Action for National Pediatric Societies Elif N. Özmert, Orhan Derman, Aysun Bideci, Nurullah Okumus, Koray Boduroglu, Sevcan Bakkaloglu, Enver Hasanoglu and Errol Alden Pediatrics originally published online January 15, 2019;

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Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. Pediatrics is owned, published, and trademarked by the American Academy of Pediatrics, 345 Park Avenue, Itasca, Illinois, 60143. Copyright © 2019 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 1073-0397.

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