Metropolitan Municipality of Bursa Research and Projects Department Healthy Cities Project Office

Study Executives Nalan FİDAN Emel İRGİL Handan TÜRKOĞLU

Prepared for Publication By Ercüment Yılmaz Mehtap Taşkıran Emine Ot

Graphic Design Burak TAŞKIN

Cover Design Talha BIYIK

Published by

0224 251 18 00

ISBN 978-605-61689-2-5

BURSA CITY HEATH PROFILE 2011 SECTION I...... 7

THE NAME OF GREEN“ BURSA”...... 8 BURSA THROUGHOUT THE HISTORY...... 12 GENERAL INFORMATION ON BURSA...... 14 GEOGRAPHICAL LOCATION...... 14 CLIMATE...... 14 DISTRICTS...... 14

SECTION II ...... 16

1. POPULATION ...... 17 1.1. POPULATION DENSITY...... 17 1.2. DISTRIBUTION OF POPULATION ACCORDING TO AGE AND GENDER...... 17 1.3 POPULATION AND MIGRATION...... 19 1.4. BIRTHS...... 22 1.4.1. FERTILITY...... 22 1.4.1.1. SPATIAL DISTRIBUTION OF FERTILITY...... 22 1.5. DEATHS...... 24 1.5.1. DEATHS ACCORDONG TO AGE AND GENDER...... 24 1.5.2 INFANT DEATHS...... 26 1.5.3. REASONS OF DEATH...... 26 1.6. POPULATION PROJECTIONS...... 28

2. HEALTH...... 31

2.1. HEALTH SERVICES...... 31 2.2. PRESENTATION OF HEALTH SERVICES...... 32 2.2.1. DENTAL HEALTH...... 34 2.2.2. WOMEN HEALTH SERVICES...... 34 2.2.3. INFANT HEALTH SERVICES...... 35 2.2.3.1 VACINE COVERAGE RATE FOR BABIES AND INFANTS (MEASLES, RUBELLA, MUMPS VACCINE)...... 36 2.2.4. EMERGENCY HEALTH SERVICES...... 36 2.2.4.1. DISTRIBUTION OF NUMBER OF CASES BY YEARS AND BY MONTHS...... 36 2.3. DISEASES...... 38

index 2.5. MEDICINE AND PHARMACEUTICS...... 43 02 BURSA CITY HEALTH PROFILE 3. FACTORS HAVING EFECT ON LIFE STYLE ...... 44

3.1 TOBACCO...... 44 3.2 ALCOHOL CONSUMPTION...... 45 3.3 NARCOTIC CONSUPTION...... 45 3.4 SPORTS...... 47 3.5. DISABLED PEOPLE...... 49 3.6. CONDITIONS FOR HOUSING...... 51

4. SOCIO-ECONOMICAL SITUATION...... 53

4.1 EDUCATION...... 53 4.1.1. METROPOLITAN MUNICIPALITY FREE VOCATIONAL COURSES...... 54 4.2 ECONOMY, EMPLOYMENT AND DISTRIBUTION OF INCOME...... 56 4.2.1 EMPLOYMENT...... 56 4.2.2 DISTRIBUTION OF INCOME AND EXPENSES...... 59 4.2.3 EKONOMİ...... 59

5. CULTURE AND TOURISM...... 60

5.1 HISTORY OF BURSA...... 60 5.2 SYMBOLS OF BURSA...... 60 5.3 MUSEUMS AND RUINS...... 61 5.4 MOSQUES AND TOMBS ...... 62 5.5 KHANS...... 62 5.6 CASTLES AND BRIDGES...... 63 5.7 MUSEUMS ...... 64 5.8 CINEMAS AND THEATRES...... 64 5.9 LIBRARIES ...... 64 5.10. CULTURE AND ARTISTIC ACTIVITIES...... 66 5.11. TOURISM...... 66 index 03 BURSA CITY HEALTH PROFILE 6. INFRASTRUCTURE AND ENVIRONMENT...... 68

6.1. WASTE WATER TREATMENT FACILITIES...... 68 6.2 DRINKING WATER SOURCES...... 69 6.2.1. DOĞANCI DAM (% 82)...... 69 6.2.2. FOUNTAIN SOURCES (% 12)...... 69 6.2.3. UNDERGROUND WATER (%12)...... 69 6.3. SOLID WASTE MANAGEMENT...... 73 6.3.1. ERECTION AND MONITORING OF DISPOSAL AREAS...... 75 6.3.2. COLLECTION AND STORAGE OF WASTE BATTARIES...... 75 6.4. SPECIAL WASTE MANAGEMENT...... 75 6.4.1. ERECTION AND MONITORING OF DISPOSAL AREAS ...... 75 6.4.2. COLLECTION AND STORAGE OF WASTE BATTARIES...... 75 6.4.3. STUDIES ON WASTE OIL CONTROL MANAGEMENT ...... 75 6.4.4. STUDIES ON WASTE VEGETABLE OIL CONTROL MANAGEMENT...... 75 6.4.5. STUDIES ON EXPIRED TIRES CONTROL MANAGEMENT...... 75 6.4.6. STUDIES ON PACKAGING WASTES CONTROL MANAGEMENT...... 76 6.4.7. STUDIES ON HAZARDOUS AND INDUSTRIAL WASTE MANAGEMENT...... 76 6.5. CONTROLS AND AUDITS ON AIR AND NOISE POLLUTION ...... 76 6.5.1. NOISE POLLUTION ...... 76 6.5.2. AIR POLLUTION CONTROL ...... 76 6.5.3. DOĞALGAZ KULLANIM BİLGİLERİ ...... 77

7. CITY PLANNING...... 78

7.1. UPPER SCALE PLANNING AND 1/100000 SCALE 2020 ENVIRONMENT PLAN...... 78 7.2. 1/100000 SCALE BURSA CITY ENVIRONMENT PLAN...... 78 7.3. 1/25000 SCALE LAND USE PLANS...... 79 7.3.1. 1/25000 SCALE CENTRAL PLANNING ZONE LAND USE PLAN...... 80 7.3.2. 1/25000 SCALE WEST PLANNING ZONE LAND USE PLAN...... 80 7.3.3. 1/25000 SCALE MUDANYA PLANNING ZONE LAND USE PLAN...... 80 7.3.4. 1/25000 SCALE GEMLİK PLANNING ZONE LAND USE PLAN...... 80 7.3.5. 1/25000 SCALE NORTH PLANNING ZONE LAND USE PLAN...... 81 7.3.6. 1/25000 SCALE EAST PLANNING ZONE LAND USE PLAN...... 81 index 04 BURSA CITY HEALTH PROFILE 7.4. URBAN TRANSFORMATION PROJECTS...... 81 7.4.1. URBAN TRANSFORMATION PROJECT AREAS...... 82 7.4.1.2. SANTRALGARAJ URBAN TRANSFORMATION PROJECT...... 82 7.4.1.3. SANTRALGARAJ KENTSEL DÖNÜŞÜM PROJESİ...... 82 7.4.1.4. YALOVA HIGHWAY URBAN TRANSFORMATION PROJECT...... 82 7.5.GREEN FIELDS, SPORTS FIELDS AND RECREATIONAL PROJECTS...... 82 7.5.1. BURSA STADIUM...... 83 7.6. PROJECTS FOR CONSERVATION AND SUSTENANCE OF HISTORICAL AND CULTURAL HERITAGE ...... 84

8. TRANSPORTATION AND PUBLIC TRANSPORTATION...... 87

8.1. ROAD, SEA AND AIR TRANSPORTATION...... 87 8.1.1. ROAD TRANSPORTATION...... 87 8.1.2. SEA TRANSPORTATION (BURSA FAST FERRY STATION)...... 88 8.1.3. AIR TRANSPORTATION (YENİŞEHİR AIRPORT)...... 89 8.2. PEDESTRIAN AND BICYCLE TRANSPORTATION...... 90 8.2.1. BICYCLE TRANSPORTATION...... 90 8.2.2. PEDESTRIAN TRANSPORTATION...... 90 8.2.3. TRANSPORTATION FOR THE DISABLED...... 90 8.2.4. EDUCATION AND TRAINING ON TRANSPORTATION...... 91 8.3. PUBLIC TRANSPORTATION SYSTEM UTILISATION RATES...... 92 8.3.1. THE NUMBER OF VEHICLES AND PASSENGERS IN BURSA PUBLIC TRANSPORTATION.... 94 8.3.2. WALKING DISTANCES IN PUBLIC TRANSPORTATION...... 94 8.4. CAR PARK UTILISATION...... 94 8.4. RAIL SYSTEMS...... 95 8.4.1. BURSARAY ROUTES...... 95 8.4.2. GENERAL ASSESSMENT ON STATION POINTS...... 96

9. SOCIAL SERVICES...... 97

9.1.SOCIAL WELFARE SERVICES:...... 98 9.1.1. EDUCATIONAL SETS AID: ...... 98 9.1.2. SUPPLIES AID...... 98

9.1.3. FUEL (COAL) AID...... 98 index 05 BURSA CITY HEALTH PROFILE 9.1.4.PUBLIC SOUP- KITCHEN SERVICES...... 98 9.1.5. PROPERTY AIDS...... 99 9.1.6. SOCIAL AIDS DISTRIBUTION CENTERS...... 99 9.2. SERVICES FOR THE DISABLED:...... 99 9.3. CHILDREN AND YOUTH SERVICES: ...... 101 9.3.1.İGEP (DOMESTIC MIGRATION INTEGRATION PROJECT)/CHILDREN CENTER...... 101 9.4. FAMILY AND ADULT SERVICES ...... 105 9.4.1. WOMEN’S SHELTER PROJECT ...... 105 9.4.2.SHELTER HOUSE SERVICE ...... 107

10. SECURITY ...... 108

10.1. CRIME AND VIOLENCE...... 108 10.2. DISASTERS...... 108 10.3. TRAFFIC ACCIDENTS...... 109

SECTION 3 ...... 110

RESULT AND ASSESSMENT ...... 111

ACKNOWLEDGEMENTS...... 112

REFERENCES ...... 113

06 BURSA CITY HEALTH PROFILE Section I

07 BURSA CITY HEALTH PROFILE The name of green “Bursa” Bursa, besides its unique harmony of green and blue, thanks to the opportunity for housing many ci- vilisations though out the history, it incorporates a rich historical heritage as well. Bursa is a city which is well blended with economical and social integrity, natural beauties, healing spring waters, summer and winter tourism facilities. For being located between Asia and Europe, Bursa which is highly influen- ced by both Asian and European culture, bears the signs of history of Hittite, Lydia, Phrygia, Romans, Byzantium, Seljuk and Ottomans. Each spot carries the traces of history. Your journey to the past begins at the very first step in our city.

Our city also takes the pride in and assumes the responsibility for being a city which played an important role for the establishment of “Healthy Cities Association” for the develop- ment, adaptation and implementation of “Healthy Cities” movement in Turkey which is maintained and developed in 6 Regional offices of World Health Organisation around the world in 66 countries, 220 world cities and 55 European cities by leading the agg- regation of the cities which attach importance to the issue.

We , Non Governmental organisations, public institutions and establishments and all the stakeholders living in the city, being aware of our responsibility within this scope and working in harmony, are trying to maintain the sustainable deve- lopment and sustainable health and to embrace people with equal rights by minimizing the variabilities. We all are aware that a city heath profile is the qualitative and quantitative definition of the health of the persons living in a city and the factors having impact on those. Therefore, we have an objective of fulfilling our duty for standing up for health, determining the priorities and to establish reliability and acceptability.

I would like to present my acknowledgements to everyone who contributed into the preparation of Bursa Health Profile with an intention to build our road map in order to see the potential of Bursa ideally and for our development in our way which we set off with the belief that a healthy city is a healthy man. Our city is our health.

Recep ALTEPE Mayor of Bursa Metropolitan Municipality President of Healthy Cities Association 08 BURSA CITY HEALTH PROFILE World Health Organisation Healthy Cities Project is a global movement which only in Europe involves thirty national network and one thousand and four hundred cities which are members of those networks. WHO Healthy Cities Network where the membership is renewed according to the criteria which are renewed every five years is now at Phase V which includes the period between 2009-2013. Member cities are performing studies in a new phase as they did in other phases.

Maybe the most important among those studies for the identification of the health situation of the city population is the Healthy City Profile. City Health Profile is a tool which leads the way for the improvement of the health of a city. This profile which we prepared with the updated statistical data therefore is a mirror of the he- alth status of Bursa. Bursa Health Profile which was prepared for Phase IV that was published in 2005 was not only a source for Metropolitan Municipality but also for other establishments and led the way for the studies performed.

Within this context, information contained within this book unfurls how the City He- alth Profile which was prepared before was indeed influential and the development in Bursa. The data contained in this publication in all areas from health to educa- tion, transportation to culture, physical and social areas will display the present situation and will light the way for and become a source for our future plans and projects as well. We present our acknowledgements to Mr Recep Altepe, Mayor of Bursa Metropolitan Municipality; Members of Advisory Board of Healthy Cities Mrs. Assc Prof. Emel İrgil, Academician from the University of Uludağ Faculty of Medici- ne, Public Health Department and Prof Dr. Handan Türkoğlu from İstanbul Technical University Head of City and Regional Planning Department, all the departments partnering to Healthy City Project in Metropolitan Municipality of Bursa and Go- vernorship of Bursa, Provincial Directorate of Health, Provincial Directorate of Se- curity, Provincial Directorate of Culture and Tourism, Bursa Chamber of Commerce and Industry, Bursa Büyükşehir Belediyespor Club, Bursa General Directorate of Water and Sewage Administration, Bursa Şehir içi Doğalgaz Dağıtım Ticaret ve Ta- ahhüt A.Ş. (BURSAGAZ) and Bursa Ulaşım-Toplu Taşım İşletmeliği San. ve Tic. A.Ş. (BURULAŞ) who contributed and supported us for introducing the profile we have prepared with this belief. With my best wishes for a healthy life in a healthy Bursa

Nalan FİDAN Metropolitan Municipality of Bursa Head of Research and Projects Department Manager of Healthy Cities Association 09 BURSA CITY HEALTH PROFILE City Health Profile is a follow-up of the profiles which were prepared be- fore. City Health Profiles are used to measure the sustainable activities of the World Health Organisation Healthy Cities Project in terms of qua- lity and quantity. They are intended for the comparison of the past and today of cities. This profile was prepared with an intention to determine and examine all the indicators concerning health and health related is- sues.

While preparing the City Health Profile, data were obtained from a num- ber of organisations concerning Bursa. During the assessment of such data it was revealed that particularly some of the data concerning health were not fully reliable. While data were being assessed, those issues were pointed out. Furthermore, the system for the execution of health services was sub- ject to amendment in September 2009 in Bursa. In the forthcoming years, it will be observed what kind of changes will be required on the health criterion subject to the Family Physician system which began to be implemented. With this system, where everyone is registered and can reach to services, we expect that certain health situations, which shouldn’t exist in the fourth largest of city of Turkey such as vaccine pre- ventable diseases, will be improved.

We consider that this profile which was prepared by the common effort and data of all the stakeholders in our city will play a significant role for the planning and implementation of the future of Bursa. Moreover, this is a source where all the data regarding Bursa is accumulated. We hope that the profile will help us to create an environment for a healthier Bursa after the problems determined are resolved in the future...

Doç. Dr. Emel İrgil University of Uludağ, Faculty of Medicine, Public Health Department Member of Advisory Board of Healthy Cities

010 BURSA CITY HEALTH PROFILE The quality of the environment we live in have an impact on our health and happiness. Quality of Life, according to World Health Organisation (WHO) is defined as a perceptual assessment shaped by expectations related to cultural structure and a values system associated with goals, life standards and concerns for life. On the other hand, it is known that the quality of life is a complicated and broad notion which is shaped in association with many factors such as the physical health, psychologi- cal health, freedom level, social relations and interaction with the main characteristics of the environment lived in.

The conditions required for the composition of a healthy environment and a healthy society are defined by World Health Organisation as a cle- an and safe environment, providing the participation and control of civil society concerning subjects related with the health and welfare of the society, meeting the basic needs as food, water, housing, safety, labour and income for the society in general, making the control concerning the public health and health services accessible by all segments of society and improvement of level of health in general and reduction of diseases. So in order to determine to what extent all these are provided, it is so cru- cial for the policies to be developed by the decision makers to prepare a profile on these subjects which have direct impact on our health and to monitor this profile by years. It is clear that it is required and helpful to prepare a settlement profile for the determination of current status of the municipalities which are members of Healthy Cities Association and to give healthy decisions for the future.

Prof. Dr. Handan Türkoğlu Head of City and Regional Planning Department, Istanbul Technical University, Faculty of Architecture Healthy Cities Association Member of Advisory Board

011 BURSA CITY HEALTH PROFILE Bursa throughout the history

012 BURSA CITY HEALTH PROFILE The Bythians and their relatives Thynians who were li- ceramics, coins of the Byzantium Era, the richest among ving at the side of Strymon in Tracia in VII. Century BC co- all in our country, are exhibited in Bursa Museum of Arc- uld not withstand the attacks of Skyths so therefore they haeology. Bursa has always been a city which persisted migrated to Northeast Anatolia and settled in these land its development as an industrial and agricultural center where life started approximately 5000 years ago. They throughout the history. named these fruitful lands as Bythinia and although they extended their borders in a short time, they could not In 2005, Metropolitan Municipality of Bursa has become avoid falling under domination of Lydians who had po- the first and unique metropolitan municipality holding a werful armed forces in VI century BC in the territory. The quality certificate. Bursaspor which is the football team Lydian King Kroisos in 546 BC left the territory after being of the city has become the champion in Turkcell Super defeated by the Persians and thus the territory was invol- League in 2009-2010 season. ved in the boundaries of the Persian Empire until 453 BC.

The ancient sources indicate Prusias I. (232-192 BC) as the founder of Bursa. When Hannibal, the Carthaginian King, lost the war against the Roman Empire, he then had to take refuge with his soldiers to Prusias I. With the positive impression of being welcomed as a victorious commander and having been shown respect, Hannibal caused his soldiers to build a city. And he named the city as Prusias and gave it as a present. Bursa which is gradually developing through its path along its journey throughout the history has a special place in the history for being the first capital of the Ottoman State. As a result of the periods passed through and cultural changes and interactions, a number of works which were built in either the Roman, Byzantium or Ottoman and Republic Periods made material contribution for shaping the city. Bursa besides being a city of history and culture also has the characteristic of being a center for healing as well. The hot springs and baths which are shown among the cha- racteristic buildings of the Roman Era still continue to be used today. The thermal and health tourism of our city also hosts our guests who come to recover their health and perpetuates cultural sharing. Bursa which is known for its natural beauties also embodies a value like Uludağ which occupies a significant place in winter tourism and known as Olympus, the mountain of gods in the ancient era. The natural beauties, water falls, caves and aut- hentic Ottoman Villages of the districts of Bursa may be listed among the places to be discovered. Today, grave steles and various pieces of architectural work of arts, 013 BURSA CITY HEALTH PROFILE General information on Bursa

014 BURSA CITY HEALTH PROFILE SURFACE AREA 11.043 km² POPULATION Address Based Population Registration System Results, 2010 2.550.645 (Turkish Statistical Institute(TUİK) Address Based Population Registration System (ADNKS) Census Results (2009)) PROVINCIAL TRAFIC CODE 16 GEOGRAPHICAL LOCATION Bursa which is located at 40°C longitude and between 28-30°C latitudes at the southeast of Marmara Sea is the fo- urth largest city in Turkey with its population of 2.550.645 persons according to (Turkish Statistical Institute(TUİK) Address Based Population Registration System (ADNKS) Census Results (2009)). Bursa is surrounded by Bilecik, Adapazarı at the east; İzmit, Yalova, İstanbul and Marmara Sea at the North, Eskişehir, Kütahya at the South and Balı- kesir at the west. CLIMATE Bursa, with its elevation of 100 mts from sea level typically has a mild climate. However, the climate may vary depen- ding on the regions. You can meet the mild and genial climate at the North whereas at the south you face the harsh climate of Uludağ. The hottest months are July and August and coldest months are Ferbruary and March. As of the observations carried out for a period of 52 years the average amount of rain is 706 mms. The average relative humi- dity of the city is 69%. DISTRICTS The districts of Bursa are Nilüfer, Yıldırım, Osmangazi, Büyükorhan, Gemlik, Gürsu, Harmancık, İnegöl, İznik, Karaca- bey, Keles, Kestel, Mudanya, Mustafakemalpaşa, Orhaneli, Orhangazi and Yenişehir.

Table: Population of Metropolitan Municipality of Bursa and affiliated municipalities in 2009

Belediye Toplam Nilüfer 269.371 Mudanya 49.805 Kestel 37.282 Gürsu 52.333 Gemlik 90.834 Yıldırım 602.505 Osmangazi 752.155 Büyükşehir Belediyesi 1.854.285 Reference : www.tuik.gov.tr 015 BURSA CITY HEALTH PROFILE Section II

016 BURSA CITY HEALTH PROFILE 1. POPULATION 1.1. Population Density According to (Turkish Statistical Institute (TUİK) Address Based Population Registration System (ADNKS) Census Results (2009)) the population of Bursa is 2.550.645 persons. The population at the city, districts, towns and villages are included in the total population.

Table 1.1. Development of Bursa Population (2007-2009) BURSA city City/District Centers Towns / Villages 2007 2.439.876 1.979.999 459.877 2008 2.507.963 2.204.874 303.089 2009 2.550.645 2.249.974 300.671 Reference: www.tuik.gov.tr

Table 1.2. Population based on districts (2009)

Gemlik 90.834 İnegöl 161.541 İznik 22.574 Karacabey 51.907 Keles 3.681 Mudanya 49.805 Mustafakemalpaşa 57.097 Orhaneli 7.934 Orhangazi 54.319 Yenişehir 29.275 Büyükorhan 3.285 Harmancık 4.076 Nilüfer 269.371 Osmangazi 752.155 Yıldırım 602.505 Gürsu 52.333 Kestel 37.282 Total 2.249.974

Note: When the population is determined according to city, districts, villages and streets: the administrative affiliation, legal personality and name changes which were made by the National Address Data Base (UAVT) intended for the settlement areas were taken into consideration by General Directorate of Popu- lation and Citizenship Affairs in accordance with the relevant legislations and administrative registers. (TUİK) Address Based Population Registration System data base- www.tuik.gov.tr 017 BURSA CITY HEALTH PROFILE 1.2. Distribution of population according to age and gender

According to 2008 data of Provincial Directorate of Health 23,34% of the population within the boundaries of Metropolitan Municipality of Bursa is under 15. When it is considered that this value was 22,9% according to 2007 data, it is obvious that there is an increase in the number of young population within this one year period. Besides the increase in the number of young population, when it is compared to Health Profile 2005, it is also seen that the number of elderly population is increasing.

Table 1.3. Distribution of Population according to age within the Borders of Metropolitan Municipality of Bursa 2007 2008 BURSA Population % Population % Population between 0 - 364 days 36426 1,52 38158 1,68 Population between 1 - 4 Years old 135614 5,64 134619 5,92 Population between 5 – 9 years old 184213 7, 67 173557 7, 64 Population between 10 - 14 Years old 193840 8,07 181891 8,00 Women population between 15 - 49 Years old 670635 27, 91 633314 27, 87 Population over 45 years old 660962 27, 5 0 626729 27, 5 8 Population over 65 years old 183179 7, 62 169345 7, 45 Reference: Provincial Directorate of Health, www.bsm.gov.tr

In 2008, 23,2% of the population is under 15 and 7,4% is over 65 years old (an aggregate of 30,6%) In this case, Bursa has a mature population structre. The rate of dependent population in Bursa is 30,6%. According to 2002 data, the rate of dependent population in Bursa was specified as 31%. When the distribution of population within the borders of Metropolitan Municipality of Bursa is examined, it can be seen that male and female population made a very close progress within the years. Table 1.4. Distribution of Population within the boundaries of Metropolitan Municipality of Bursa according to gender 2003 2004 2005 BURSA Population % Population % Population % Male 1097842 50,05 1126782 50,49 1146833 49,99 Female 1095791 49,95 1104697 49,51 1147399 50,01 TOTAL 2193633 100,00 2231479 100,00 2294232 100,00 2006 2007 2008 BURSA Population % Population % Population % Male 1170424 50,05 1200820 49,97 1133406 49,87 Female 1168282 49,95 1202386 50,03 1139249 50,13 TOTAL 2338706 100 2403206 100,00 2272655 100,00 Reference: Provincial Directorate of Health, www.bsm.gov.tr 018 BURSA CITY HEALTH PROFILE 1.3 Population and Migration While Bursa was receiving migration from the Balkans, Caucasus and Russia starting from the 19th century, it then started to receive domestic migration with the advantages created in the city by the industrialization movement in 1960’s.

Between 1927 and 1965, the population of Bursa almost doubled. Since the foreign migration that started at those times created the majority of the increase, the population of Bursa grew by 3,5 times within the same period of time. Between 1950-2008, the population of Bursa city grew by 4,5 times and population of the towns grew by 15 times. The rate of migration received, rate of emigrants, net migration and net migration rate as of 2000 was given in Table 1.5

Table 1.5. The rate of migration received, rate of emigrants, net migration and net migration rate, 2000

Permanent Residence in Resident population in Migration Received Emigrants Net migration Net migration 2000 2000 rate (per mille) BURSA 1933732 180171 94846 85325 45,12 Reference : www.tuik.gov.tr

When the reason for migrating from the places previously lived was asked to emigrants within the scope of studies performed under Support Project for the Solution of Ecnomical and Social Integration Problems of İstanbul, İzmir, Ankara and Bursa as being the Significant cities receiving migration (Domestic Im- migration Integration Project-İGEP) majority of which was financed by the European Union, general family issues (migration of parents, marriage etc) come to the forefront. When more substantial reasons are examined, hope for finding a job becomes prominent. More than one fourth of the said group stated that they migrated since themselves or family members were seeking for a job. This is followed by change of job / appointment for himself or family members, seeking for better life conditions and safety reasons.

Diğer 7,80

Güvenlik Endişesiyle (Kendi İsteği 2,00 Dışında)

Güvenlik Endişesiyle (Kendi İsteği) 2,00

İşsizdi/İş Bulamıyordu 3,10

Anne/Babanın İş Araması 4,70

Eşinin Yanına Gitmek 6,50

Evlilik 1 6,60

Daha İyi Bir Yaşam 6,90

Eşinin İş Araması 8,40

Anne/Babanın Yanına Gitmek 9,40

İş Değişikliği/Tayin 9,70

İş Aramak için 11,10

Anne/Babanın Göç Etmesi 19,60

0,00 5,00 10,00 15,00 20,00 25,00 019 BURSA CITY HEALTH PROFILE Persons born in Bursa are concentrated in the city texture formed before 1960 and vicinities such as Demirtaş, Mudanya, Gemlik, Çalı, Kayapa, Akçalar, Hasanağa and Görükle which are involved in the ju- risdiction of metropolitan municipality. In 2000 half of the population living in Metropolitan Municipality of Bursa were born in Bursa.

Map 1.1. Concentration status of the persons born in the city Reference: İGEP Supply Demand and Needs Assessment Report

Persons who were born outside Bursa are concent- rated at the part of the city which was developed after 1975. Yıldırım district at the east and west side of Mudanya highway at the west are the regions where those groups are mostly concentrated. In 2000, data of which was shown by the map, appro- ximately 1/3 of the city population and 40% of the population living in the metropolitan municipality were born in cities other than Bursa.

Map 1.2. Concentration status of the persons born outside the city Reference: İGEP Supply Demand and Needs Assessment Report 020 BURSA CITY HEALTH PROFILE Graphic 1.2. Population growth rate in Bursa city and villages

Reference: İGEP Supply, Demand and Needs Assessment Report

According to interurban migration rates of TUİK, net migration rate of Bursa was above 6% between 1975-80 and 1985-90. Net migration between those years met 30% of the periodical population growth. Between 1980-85 and 1995-2000 this rate was around 27-28%. In this case, migration received from the rural parts of Bursa has a significant share in the fast population growth of Bursa between 1980-85 besides the migration received from other cities.

Table 1.6. Bursa City - Net Migration and Net Migration Rate

1965-1970 1970-1975 1975-1980 1980-1985 1985-1990 1995-2000 Net Migration* 52.370 (4) 58.720 (3) 47.430 (4) 83.640 (3) 85.320 (5) Net Migration Rate (Per thousand)** 23,72 (7) 57,89 (4) 61,0(4) 41,1 (4) 61,6(6) 45,1(6) Population growth 82.380 113.750 186.850 175.520 279.120 299.540**

* Statements in parenthesis indicated the position in Turkey ranking. ** Calculated according to 1995 population estimate.

Reference: DPT (State Planning Institute) , Domestic Migration in Turkey and Characteristics of Emigrants 1965-2000; TUİK

According to Address Based Population Registration System data, while the growth in city population between 2007-2008 was 68.080 net migrations in one year was stated as 35.600. In this case, approximately half of the population growth originated form migration and if this tendency continued Bursa will continue to be one of the top migration places.

021 BURSA CITY HEALTH PROFILE 1.4. Births 1.4.1. Fertility

The change in the fertility level was examined according to child/women ratio (the number of children between 0-4 ages per 1000 women between 15-49 ages). According to Provincial Directorate of Health data for 2009 the ratio of child / women is 271. When the previous Bursa Health Profile is examined, it is seen that this rate was 290 in 2000 and 551 in 1960. This indicates that there is a remarkable decrease in the fertility level. In the last 46 years, approxima- tely 55% decrease was determined in the fertility level. Population per house in Bursa shows a downward trend since 1966 until today. While this downfall may be subject to the decrease of the fertility level, it may also be due to the transformation from the traditional family type to nuclear family as well.

Table1.7. Number of houses Table 1.8. Population per house in the in the last 14 years last 14 years

Number of BURSA BURSA Population per house Houses 1996 410419 1996 4,58 1997 438941 1997 4,40 1998 465120 1998 4,28 1999 482920 1999 4,25 2000 499616 2000 4,21 2001 523336 2001 4,05 2002 538068 2002 4,00 2003 550977 2003 3,98 2004 563071 2004 3,96 2005 576438 2005 3,98 2006 599730 2006 3,90 2007 630534 2007 3,81 2008 634535 2008 3,58

Reference: Provincial Directorate of Health, www.bsm.gov.tr

1.4.1.1. SPATIAL DISTRIBUTION OF FERTILITY

In the map which indicates the concentration of live birth data in the city it is seen that the fertility is lower than that of the city in general in the city Center and streets where mid-high income groups live such as Kükürtlü, Çekirge, İhsaniye and Ataevler. The streets where highest fertility rate can be seen are Ulus, Mevlana, Yavuzselim Değirmenönü and Karapınar in Yıldırım District and Ülkü Street in Mudanya which has a rural character where agricultural production continues. 022 BURSA CITY HEALTH PROFILE Map 1.3. Spatial Distribution of Fertility in Bursa Reference: İGEP Needs Assessment Report While in 2009, a total of 32.891 births were in hospitals, the number of births without any medical assistance was only 109. This number decreased significantly since 1997. In our time, the decrease in the rate of births without medical assistance shows that the practices threatening health during birth were precluded in the society.

Table1.9. The spatial distribution of births within Bursa in the last 13 years

Other medical Births without medical Hospital Physician Midwife TOTAL personnel personnel assistance 2009 32.891 7 41 28 109 33.076 The majority of births in our city are realized 2008 33.989 18 27 2 110 34.146 at the hospitals and with the assistance of 2007 31.064 9 61 24 99 31.257 medical personnel. However, although it is 2006 28.094 7 102 29 73 28.305 getting gradually lower within the years, 2005 27.15 6 43 123 40 101 27. 4 63 births without the assistance of medical 2004 25.459 56 248 111 163 26.037 personnel are still realized. This is due to 2003 23.626 6 326 50 198 24.206 the lack of access to medical services in the 2002 25.092 30 593 77 353 26.145 societies coming with migration although 2001 23.621 11 661 273 316 24.882 the maternal and infant health services are 2000 21.752 10 771 251 292 23.076 widespread. Such services shall be focused 1999 23.057 29 937 231 330 24.584 on particularly at the regions with degraded 1998 23.173 10 1.354 72 376 24.985 socio economical situation. 1997 23.076 16 1.489 253 483 25.317 Reference: Provincial Directorate of Heath, www.bsm.gov.tr 023 BURSA CITY HEALTH PROFILE 1.5. Deaths 1.5.1. DEATHS ACCORDONG TO AGE AND GENDER

In 2009 the total number of deaths was 7.591. Whe compared to the previous years, the decrease in the number of early deaths is evident.

Table1.10. The number deaths according to age and gender in the last 13 years

SUBJECT 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 0-7 days M 65 58 61 54 60 71 83 103 118 105 118 148 151 0-7 days F 46 32 44 48 47 46 54 55 58 64 81 108 111 8-28 days M 17 12 11 24 10 19 22 11 19 18 25 33 43 8-28 day F 19 19 17 12 11 14 12 14 24 24 34 23 32 29-364 days M 38 47 50 45 37 64 51 75 92 91 96 129 135 29-364 days F 54 38 30 27 40 43 44 78 61 82 77 126 114 1-4 years old M 21 19 11 35 29 36 33 34 44 39 52 45 42 1-4 years old F 18 12 19 27 17 28 30 30 32 28 45 39 44 5-9 years old M 9 11 13 18 15 14 13 23 24 15 27 31 40 5-9 years old F 6 10 11 12 10 4 9 9 14 13 15 13 15 10-14 years old M 5 12 10 13 13 14 11 9 18 21 26 28 33 10-14 years old F 3 3 5 13 10 10 8 12 11 8 21 16 10 15-24 years old M 37 63 55 67 43 73 66 51 65 72 88 77 90 15-24 years old F 31 14 30 34 31 36 29 21 37 33 58 44 48 25-44 years old M 172 222 179 276 223 237 221 250 264 254 292 281 273 25-44 years old F 113 125 139 183 171 121 108 136 127 133 155 129 141 45-49 years old M 205 267 251 367 300 232 211 226 215 218 258 206 227 45-49 years old F 123 130 122 244 240 131 131 124 109 88 129 105 125 50-64 years old M 1.050 1.149 1.061 1.350 1.091 978 983 927 890 910 869 916 858 50-64 years old F 627 706 675 813 805 681 582 536 530 510 568 546 540 65+ years old M 2.610 3.085 2.967 3.027 2.668 2.557 2.341 2.279 2.318 2.193 2.082 2.054 2.097 65+ years old F 2.322 2.697 2.675 2.851 2.459 2.420 2.239 2.115 1.997 2.104 1.989 1.847 1.875 TOTAL 7.591 8.731 8.436 9.540 8.330 7.829 7.281 7.118 7.067 7.023 7.105 6.944 7.044 F: Female / M: Male Reference: Provincial Directorate of Health, www.bsm.gov.tr The number of infant and child deaths decreased in 2009. Similarly the number of adolescent and adult deaths also decreased. On the contrary, the deaths in the group in 65+ population continue as expected. Even though the number of deaths was discreetly recorded statistically, there may be some troubles for determination of the number of infant deaths. Realization of births without medical assistance in our city bring into mind that there may be some births which were never recorded and therefore when some of those babies pass away they may not be entered into death records. Therefore, it is obligatory to determine all the pregnant’s and the pregnant monitoring shall be implemented in place and properly in terms of frequency and quality. 024 BURSA CITY HEALTH PROFILE The vital statistics for which changes by years are shown in Tablo 1.12 are the registered data of Bursa population.

Tablo1.11. Vital Statistics regarding Health in Bursa

SUBJECT 2004 2005 2006 2007 2008 2009 Mid-year population 2.231.479 2.294.232 2.338.706 2.403.206 2.272.655 2.399.844 Population density 205 212 216 222 210 220 General Gender Ratio * 101,99 99,85 100,18 100,13 99,49 99,72 Early Neonatal Death Rate 4,47 3,88 3,66 3,34 2,62 3,33 Late Neonatal Death Rate 1,26 0,76 1,27 0,89 0,09 1,08 Neonatal Death Rate 5,74 4,64 4,85 4,23 3,52 4,41 Post Neonatal Death Rate 4,09 2,79 2,53 2,54 2,47 2,76 Crude abortion rate 0,61 0,56 0,57 0,81 1,53 1,69 Abortion rate 14,77 13,17 13,04 17,18 28,29 33,66 Crude birth rate 11,7 12,01 12,16 13,08 15,12 13,89 General Fertility rate 41,62 42,58 43,37 46,88 54,26 50,12 Crude death rate 3,5 3,63 4,08 3,51 3,84 3,16 Infant death rate (0-11 months) 9,83 7,44 7,38 6,78 5,99 7,17 Death rate between 0 – 4 years old 41 30,13 28,51 28,81 27,14 36,62 Death rate over 45 Years old 893,98 907,92 906,92 918,80 920,17 913,85 Maternal death rate ** 30,61 14,51 14,06 15,90 17,46 24,00 Natural Population Growth Rate 11,63 8,38 8,08 9,57 15,12 10,73 Stillbirth rate 6,46 5,48 4,32 6,14 6,52 7,41 Annual live birth rate 26.130 27.560 28.441 31.438 34362 33334 Annual Mortality Number 7.829 8.330 9.540 8.436 8731 7591

Calculated (*) per 100 / (**) per 100.000 / others per 1000. Reference: Provincial Directorate of Health, www.bsm.gov.tr

025 BURSA CITY HEALTH PROFILE 1.5.2 Infant Deaths

Turkish Population and Health Research (TNSA) data for 2008 shows that the infant death rate in Turkey is 17 per thousand. As a consequence of studies of Provincial Directorate of Health for prevention of infant deaths, the rate of infant deaths was reduced from 16,64 per thousand to 7,44 per thousand in 2006. However, the births without medical personnel assistance and probable infant deaths in recent years indicate that more precautions shall be taken in this respect. It is considered that infant deaths may be prevented besides monitoring the pregnancies and enabling births to be realized under healthy conditi- ons also by informing the individuals on family planning which is one of the issues brought forth by the population increase due to migrations.

Tablo1.12. Status of infants in Bursa for the last 9 years

SUBJECT 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 Carried forward from previous 38.985 37.704 35.511 36.233 34.510 32.972 33.515 35.583 34.699 35.963 year Determined 3.489 2.799 3.227 3.000 3.232 3.417 2.919 2.468 5.419 4.502 Coming from other regions 44.703 9.353 10.682 5.118 4.678 5.099 4.842 3.854 5.134 5.358 Live birth 33.334 34.362 31.438 28.441 27.560 26.130 24.258 26.186 24.905 23.068 Infant deaths 239 206 213 210 205 257 266 336 372 384 Leave the region 45.826 8.834 10.705 5.845 4.266 4.548 4.515 4.230 5.316 6.105 Became a child 36.899 36.167 32.236 31.226 29.276 28.303 27.781 30.010 28.886 27.703 Year end infant presence 37.547 39.011 37.704 35.511 36.233 34.510 32.972 33.515 35.583 34.699 Number of stilbirths 247 224 193 123 151 169 158 205 190 202

Reference: Provincial Directorate of Health, www.bsm.gov.tr

33.334 babies were born and 239 of them died in 2009. When new determined infants, infants coming with migration and live births and infants who became a child and left the region and infant deaths are taken into consideration, the number of infants at the end of the year is 37.547.

1.5.3. Reasons of death

The number of deaths in Bursa in 2008 is 11.297 according to data of Provincial Directorate of Health. According to the Death Statistics 2008 published by Turkish Statistical Institution the reasons for deaths are as follows. As can be seen from the table the rate of deaths in other types of cardiac diseases and from illnesses classified as carcinoma including tumors of lymphatic and hematopoietic (blood forming) tissues is high.

026 BURSA CITY HEALTH PROFILE Table 1.13. Reasons for Deaths in Bursa (2008)

Reason for A BC C death(UHS-8) Total 11 297 6 368 4 929 1. Cholera - - - 2. Typhoid - - - 3. Bacillary dysentery amoebiasis - - - 4. Enteritis and other diarrheic illnesses 5 4 1 5. Respiratory system tuberculosis 25 21 4 6. Other types of tuberculosis including after-effects 70 33 37 7. Plague - - - 8. Diphtheria - - - 9. Whooping cough - - - 10. Streptococcal angina and scarlet fever - - - 11. Meningococcus infections 104 54 50 12. Acute poliomyelitis - - - 13. Variola - - - 14. Measles - - - 15. Typhus and other rickettsia illnesses - - - 16. Marsh fever - - - 17. Syphilis and types 8 6 2 18. All other infection and parasitic illnesses 12 5 7 19. Carcinoma including tumors of lymphatic and hematopoietic (blood forming) tissues 1 941 1 335 606 20. Benign tumors and tumors with undefined nature 2 - 2 21. Diabete mellitus 266 166 106 22. Avitaminoses and other lack of nutritions 13 7 6 23. Anemia 7 6 1 24. Meningitis 4 2 2 25. Acute rheumatism - - - 26. Chronical rheumatic heart illness 32 15 17 27. High blood pressure 245 90 155 28. Heart diseases due to lack of blood (ischemic) 573 379 194 29. Other types of heart diseases 3 192 1 616 1 576 30. Cerebro vacular illnesses 1 354 647 707 31. Influenza - - - 32. Pneumonia 101 52 49 33. Bronchitis, emphysema, asthma - - - 34. Gastric ulcer - - - 35. Appendicitis - - - 36. Intestinal obstruciton and hernia 13 4 9 37. Liver cirrhosis 91 49 42 027 BURSA CITY HEALTH PROFILE 38. Nephritis and nepherosis 3 1 2 39. Prostatic hyperplasia 5 - 5 40. Abortion 2 - 2 41. Other complications of pregnancy, birth and puerperium. Birth without mentioning complications 5 - 5 42. Congenital anomaly 73 39 34 43. Birth trauma, painful birth and other anoxia and hypoxia situations 3 2 1 44. Other reasons of Perinatal mortality 117 70 47 45. Symptoms and improperly defined situations 979 574 405 46. All other disases 1 614 932 682 47. Motor vehicle accidents 159 114 45 48. All other accidents 148 109 39 49. Suicide and self-injury 42 30 12 50. All other external reasons 23 14 9 A: Total / B: Male / C: Female Reference:TUİK data 1.6.Population Projections

Since total fertility rate in West and Southwest Anatolia lowered considerably in recent years, the natural growth rate of population decelerated notably if the migration is not taken into consideration. Consequently, the reason for the population growth in large cities is migration. For the projections, the total net migration of Bursa Metropolitan in 2008 was assumed to have a share of %70 compared to the whole city. The projections were based on four scenarios which are net migration value decrease by approximately 50% between 2008 and 2020 (Scenario 1), net migration rate slightly increases (Scenario 2), rapidly increasing (scenario 3) and very rapidly increasing (Scenario 4). In the third and fourth scenarios, the decisions of the existing plan had influence for the determination of net migration tendencies. Accordingly, Scenario 3 and Scenario 4 are aligned with the 2020 population estimates of 1/5000 and 1/25000 Land Use Plans respectively in terms of approximate values.

028 BURSA CITY HEALTH PROFILE Table 1.14. Population Projection of Bursa Metropolitan Based on Age Group Composition

2008 2010 2015 2020 1.SCENARIO – LOWERING MIRGRATION Population 1.813.000 1.901.000 2.100.000 2.261.000 Annual Net Migration 25.100 23.700 18.100 12.500

2.SCENARIO- SLIGHTLY INCREASING Population 1.813.000 1.905.000 2.159.000 2.437.000 MIGRATION Annual Net Migration 25.100 27. 20 0 32.200 37.300 3.SCENARIO – RAPIDLY INCREASING Population 1.813.000 1.912.000 2.209.000 2.593.000 MIGRATION Annual Net Migration 25.100 30.800 42.900 62.100 4.SCENARIO - VERY RAPIDLY INCREA- Population 1.813.000 1.917.000 2.316.000 2.925.000 SING MIGRATION Annual Net Migration 25.100 35.600 70.900 106.200 Reference: İGEP Supply, Demand and Needs Assessment Report Turkish Statistical Institute(TUİK) Address Based Population Registration System (ADNKS) Census Results for 2009 mostly comply with Scenario 1 and 2. Although the numbers of migrations are not announced yet, decrease in population growth between 2008-09 in Bursa Metropolitan indicates that the net migration within this period is lower than that of the previous period. 029 BURSA CITY HEALTH PROFILE Table 1.15. Bursa City and Bursa Metropolitan ADNKS Population Data

2007 2008 2009 Bursa City 2.440.000 2.508.000 (2,8) 2.551.000 (1,7) Bursa Metropolitan 1.721.000 1.813.000 (5,4) 1.854.000 (2,3) Share of metropolitan in the total population of the city %70 %72 %72

Note: Statements in parenthesis indicates the population growth according to the previous year. Reference: İGEP Supply, Demand and Needs Assessment Report

Table 1.19. Address Based Population Registration System Central District Populations 2007 2008 07-08 Increase % 2009 08-09 Increase % GEMLİK 90.487 90.592 0,1 90.834 0,3 MUDANYA 46.352 47.178 1,8 49.805 5,6 NİLÜFER 239.056 257.248 7,6 269.371 4,7 OSMANGAZİ 723.681 739.909 2,2 752.155 1,7 YILDIRIM 574.303 592.373 3,1 602.505 1,7 GÜRSU 47.180 50.085 6,2 52.333 4,5 KESTEL 34.723 36.067 3,9 37.282 3,4 METROPOLITAN 1.721.059 1.813.452 5,4 1.854.285 2,3 Reference : TUİK data

030 BURSA CITY HEALTH PROFILE 2. HEALTH 2.1. Health Services

Bursa Field Research conducted within the scope of Support Project for the Solution of Economical and Social Integration Problems of İstanbul, İzmir, Ankara and Bursa as being the Significant cities receiving migration (Domestic Immigration Integration Pro- ject-İGEP) majority of which was financed by the European Union revealed that Bursa citizens were satisfied with the quality of health services in general. However, the as- sessments in the most disadvantageous parts of the city are not as much positive as others. For example, while in other layers this rate is 93% and 89% where there is health care center in the vicinity, this rate falls down to 84% in the disadvantageous layers. While 72% of the persons at those layers take benefit of the health care center services 61% of them think that they have to wait at the queue too much. The rate of persons who consider the number of medical personnel to be insufficient is 44% in this layer which has the highest rate. This group is the least satisfied group with 44% from health care center services. İGEP Corporate Capacity Research, in a manner to confirm the circumstance, revealed that the number of local health service units is insufficient according to the population they serve. In Yıldırım there is one health care center per 21.553 persons where as this number is per 16.919 persons in Osmangazi, 16.923 in Nilüfer and 17.740 in Gürsu. The standard of Ministry of Health is one health care center per 12.000 persons. Thus there is a need for new health care centers in these districts to comply with this standard. Also the implementation of the standards foreseen in the family physician system that started in October 2009 in Bursa shall be pushed to the forefront.1

The field research revealed that on-site vaccination, health screening and family plan- ning activities are extremely limited. Only 12% of the household stated that there was a vaccination campaign at their streets. The rate of persons who stated that there was heath screening at their streets was only 4% and the number of persons stating that family planning services were given is 9%, 3% and 5% respectively from the highest la- yer to the lowest layer. These values indicate that preventive health care services can only be given limitedly and even though such services are rendered these services did not reach the public and localized. There is a need to provide preventive and basic health services on-site as much as possible by generating budget facilities with suf- ficient amounts. Today from time to time public establishments, local governments, relief organizations and voluntary associations arrange campaigns to perform health screening in the particularly identified areas. It is important to establish mechanisms which will convert these activities into regular, systematic and coordinated activities. And how far these needs could be met with the family physician system will be indica- ted with the data to be obtained in the forthcoming years. 031 BURSA CITY HEALTH PROFILE 2.2. Presentation of Health Services

Health services include all of the services rendered to protect and improve health, to provide treatment to patients and to heal the injured people. These services are classified as preventive health services and curative health services. Furthermore, these services are classified into three as as 1.stage Health Services, 2.stage health services and 3.stage rehabilitative heath services during the presentation of the service. The 1st stage involves the healthcare organisations for out patients without beds; the second stage involves the healthcare organisations for inpatient treat- ment with bed and third stage involves the health care organisations which offer bed and high medical technology.

In Bursa health services are provided basically by family healthcare centers, tuberculosis dispensaries, state hospitals and university hospitals all of which are monitored by the Ministry of Health. Polyclinics and healthcare establishments with or without bed which are monitored by the municipality also render health services. 2009 data for the number of healthcare organisations providing health services are given below. As fas as Health Profile 2009 is considered, we can observe from the indicators, the direct proportion of the increase of the health services to the increase of Bursa population.

Table2.1. Fundamental Information on Health in Bursa for 2009

SUBJECT NUMBER Number of Hospitals 32 Family Healthcare Centers 152 Family Physician Units 731 Number of MIH/FP Centers 2 Number of dispensaries 9 Total number of beds (Actuasl) 5597 Number of beds per 10.000 persons 22 Bed occupancy rate (%) 75 Number of physicians 3670 Population per physician 695 Number of dentists 720 Number of nurses 3639 Number of midwifes 1756 Number of pharmacies 800 Number of Pharmaceutists 892 Reference: Provincial directorate of health, www.bsm.gov.tr

032 BURSA CITY HEALTH PROFILE As of October 2010, Family Physician System began to be implemented in Bursa. There are a total of 152 Family Healthcare Centers. When compared to 2000, it is seen that until 2007 the number of beds per 10.000 patients increased and afterwards in 2008 there is a downward trend even though slightly. While the number of beds per 10.000 persons in Turkey is 28,4 this number is 24 in Bursa. There are a total of 476 pcs dialyser in Bur- sa out of which 112 pcs belong to the Ministry of Health, 30 pcs belong to University of Uludağ and 3334 pcs to private centers. The number of population per physician is 720. There is a direct relation between utilisation from health services and being registered to social security system. In Bursa 637.342 (26,12% of population ) employed and 351.924 (14,42% of population) retired persons are sheltered under social security system. The number of depen- dent population which the persons involved in the social security system shall take care is 1.531.197.

Table2.2. Total number of beds (Actual)

SUBJECT 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Total number of beds (Actual) 3.929 3.969 4.635 4.479 4.665 5112 5932 5906 5772 5597 Reference: Provincial Directorate of Health, www.bsm.gov.tr The number of beds which was around 4000 in our city in the year 2000 achieved 5600 in 2009.

Table2.3. First Stage Study Outcomes

Policlinic Services 2009 2008 2007 Number of Consultations 8.119.798 7.071.813 5.858.197 Number of persons send to Health Organisation 55.549 49.602 108.208 Rate of Sending (%) 0,68 0,70 1,85 Minor surgical operations 17.853 13.100 12.878 Number of classic autopsy 44 43 64 Number of judicial reports 3.870 5.985 7.134 Certificate of death 1.378 1.462 1.269 Reference: Provincial Directorate of Health, www.bsm.gov.tr While the number of consultations in first stage is close to 6 million, this number exceeded 8 millions in 2009. At the same time, in 2009 the number of persons sent to hospitals decreased by fifty percent compared to 2007. The chain of transfer between the organisations being removed highlights the decrease in the number of persons send to hospitals. The number of increase in consultations shows that healthcare organisations are frequently used by the public. While the number of consultations in first stage was 2,4 in 2007 it became 3,2 in 2009.

Table 2.4. Bursa City Health Personnel SPECIALIST PRIMARY TOTAL NUMBER OF DENTISTS PHARMACEUTIST HEALTH OFFICER NURSE MIDWIFE PHYSICIAN CARE PHYSICIAN PHYSICIANS

1.500 1.707 3.207 455 696 1.452 2.561 1.292

Reference: Provincial Directorate o f Health, www.bsm.gov.tr 53,2 % of the physicians working in Bursa are practising physicians. In line with the general situaiton in our country, the number of specialist physicians also increased in our city. 033 BURSA CITY HEALTH PROFILE 2.2.1. Dental Health

According to WHO health is not only the situation without illness or injury but being fully well bodily, psychologically and socially. Taking advantage of the highest level of health which is achievable is one of the fundamental rights of being a human irrespective of race, religion, political belief, economical and social conditions. Dental health is one of the issues which the developed countries overemphasize for the individuals to have access to their rights on health equally and within the best reasonable period of time.

In our country, according to a research caused to be performed by the Ministry of Health 47,11% of the public has not consulted a dentist within the last year and the rate of population who never visited a dentist in their lifetime is 12,5%.

In Bursa, as mentioned in below tables, the dental health examinations have been gradually reducing since 2007. The increase in the treatment indicates that the individuals act more passively compared to previous years for not having visited any health care organisations without having any health problems. However, while, in the below table, the number of decayed teeth was 534 in 2009 such number was determined to be 15.442 in 2006.

Table 2.5. Dental Health Information covering last 13 years

SUBJECT 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 Number of examinations 4.706 4.865 12.950 14.793 11.850 11.545 5.109 5.618 4.861 3.437 Number of students screened during school screenings 1.744 1.865 2.387 5.631 1.338 158 1.234 1.683 1.414 1.344 Number of decays specified between 12 to 45 years old 534 743 9.472 15.442 2.109 853 823 1.362 1.543 297 The number periodontal diseases specified 197 59 621 745 465 230 136 182 119 126 Number of treatments 3.003 1.772 4.857 5.968 4.754 224 944 1.243 685 639 Number of pulls 620 608 3.112 3.059 4.724 1.770 2.055 1.748 1.403 1.145 Number of transfers 251 119 767 1.286 1.229 1.560 2.917 2.536 2.964 1.180 Fluorine application 1.213 853 2.733 2.550 0 35 51 65 5.453 30.494

Reference: Provincial Directorate of Health, www.bsm.gov.tr

2.2.2. Women Health Services

The rate of married women between ages 15-49 using contraceptive modern methods in Bursa is 42,7%

Table 2.6. Follow-up on women for the last 10 years

SUBJECT 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 Pregnant 168.081 174.354 131.033 98.832 85.655 92.709 75.593 82.301 92.234 83.274 Puerperant 53.419 57.261 48.887 39.838 38.434 36.201 66.188 31.716 33.132 30.369 Between 15-49 years old 610.850 729.441 564.425 441.769 426.481 403.335 353.190 424.910 424.156 355.492

Reference: Provincial Directorate of Health, www.bsm.gov.tr 034 BURSA CITY HEALTH PROFILE Table2.7. Maternal and Infant Health Data of the Health Directorate for 2007,2008 and 2009

Number of Pregnancy Average Number Baby Average Number of Child Average Number Women Average Wo- pregnancy Follow-up pregnancy of babies Follow-up baby children follow-up Child of women follow-up men follow-up follow-up (0-11 follow-up (1-4 years Follow-up between between between 15- Months) old) agrees 15-49 49 years old 15-49 years old 2007 34828 131033 3.76 37678 263709 7, 0 0 132672 268815 2.03 670635 564425 0.84 2008 38579 174354 4.52 38985 321266 8.24 135940 37104 4 2.73 633314 729441 1.15 2009 38071 168081 4.41 37547 308834 8.23 142981 341948 2.89 665074 610850 0.92

Reference: Provincial Directorate of Health

2.2.3. Infant Health Services It is observed that the number of children in Bursa increased in 2009 compared to the previous years. These data indicate that the services performed on children education and development shall ve enhanced.

Table 2.8. Status of Children SUBJECT 2009 2008 2007 2006 2005 Carried forward from previous year 135.940 132.770 134.904 136.014 136.400 Determined this year 11.579 4.981 4.893 3.827 2.892 Arrivals from other regions 154.515 18.978 25.253 10.542 6.979 Who became a child thesis years 36.899 36.167 32.236 31.226 29.276 The number of infant deaths this year 39 31 30 62 47 Number of children who left the city 162.982 22.059 29.410 12.993 9.052 Juvenescent 32.931 34.768 35.076 33.650 30.434 The number of children at year-end 142.981 136.038 132.770 134.904 136.014

Reference: Provincial Directorate of Health, www.bsm.gov.tr

Table 2.9. Child and Infant Follow-ups for the last 10 years

KONU 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 Infant 308.834 321.266 263.709 208.124 216.423 205.101 156.635 164.851 170.624 165.487 Child 341.948 371.044 268.815 220.278 228.839 187.245 170.818 182.221 156.763 163.051

Reference: Provincial Directorate of Health, www.bsm.gov.tr

035 BURSA CITY HEALTH PROFILE 2.2.3.1 VACINE COVERAGE RATE FOR BABIES AND INFANTS (MEASLES, RUBELLA, MUMPS VACCINE)

Table 2.10. The rate of vaccination in babies in 2008, at least five health care centers

Health Care Centers 2006 2007 2008 Beyazıt Health Care Center 52,27 54,46 66,31 Hacivat Health Care Center 47,22 74,29 71,59 Gemlik Manastır Health Care Center - 63,08 73,72 Ortabağlar Health Care Center 58,62 97,31 76,04 Gemlik No:1 Health Care Center 40,43 73,04 77,57

Reference: İgep Supply, Demand and Needs Assessment

The table above was prepared based on the 5 health care centers where the infant and child vaccination rates were minimum in 2008. It is observed that the rate of vaccination by years is increasing in Beyazıt Healthcare Center. However, in order to make an assessment, the target population shall also be taken into consideration. The target population of Beyazıt Healthcare Center which was 336 in 2007 fell back to 282 in 2008. The target popula- tion numbers of Hacivat Healthcare Center are 396, 420 and 447 respectively. Therefore, it can be assumed that vaccination rate in Hacivat Healthcare Center increased compared to 2006. What is interesting in the table is that while the rate of vaccination in Ortabağlar Healthcare Center in 2006 was only 58,62% then increased up to 97,31% in 2007 and fell down to 76,04 % in 2008. The target population of Ortabağlar Healthcare Center by years is 348, 372 and 576 and the number of healthcare personnel is 9.14 and 16 respectively. It can be determined that the rate of increase in the number of healthcare personnel increased the rate of vaccination and the population growth in 2008 could not be met by increasing the number of personnel working at the healthcare centers and the number of personnel became insufficient. What kind of a course will the immunization rates after the family physicians system started will follow in Bursa shall be discreetly evaluated.

2.2.4. Emergency Health Services 2.2.4.1. DISTRIBUTION OF NUMBER OF CASES BY YEARS AND BY MONTHS Table2.11. Distribution of cases by moths YEAR JAN FEB MAR APR MAY JUNE JUL AUGUST SEP OCT NOV DEC 1997 422 425 424 467 555 594 545 456 471 550 550 597 1998 566 565 686 762 818 980 1.018 1.003 915 998 911 889 1999 856 1.023 1.354 1.148 1.268 1.306 1.356 1.449 1.237 1.191 1.247 1.340 2000 1.387 1.081 1.326 1.335 1.426 1.485 1.599 1.426 1.359 1.385 1.599 1.453 2001 1.403 1.199 1.385 1.284 1.568 1.691 1.675 1.545 1.448 1.430 1.314 1.413 2002 1.602 1.418 1.533 1.515 1.731 1.659 1.700 1.533 1.432 1.644 1.361 1.723 2003 1.882 1.436 1.549 1.659 1.930 1.944 2.072 1.944 1.764 1.735 1.629 1.920 2004 2.197 2.071 2.000 2.025 2.252 2.351 2.601 2.387 2.412 2.171 2.322 2.388 2005 2.491 2.328 2.694 2.676 2.363 3.012 3.342 3.389 2.956 2.814 3.018 2.802 2006 3.085 2.710 3.054 3.093 3.338 3.194 3.276 3.477 2.917 3.111 3.244 3.250 2007 3.278 2.993 3.458 3.456 3.987 4.027 4.093 4.301 3.572 3.784 3.497 3.586 2008 3.718 3.453 3.951 3.991 4.512 4.623 4.775 4.901 3.912 4.450 4.148 4.200 2009 4.376 4.205 5.110 5.253 5.911 6.261 6.193 5.955 5.261 5.948 5.957 6.162 Reference: Provincial Directorate of Health, www.bsm.gov.tr 036 BURSA CITY HEALTH PROFILE Table 2.12. Average Number of cases in total and by months

YEAR TOTAL CASES MONTHLY AVERAGE 1997 6.056 505 1998 10.111 843 1999 14.775 1.231 2000 16.861 1.405 2001 17.355 1.446 2002 18.851 1.571 2003 21.464 1.789 2004 27.177 2.265 2005 33.885 2.824 2006 37.749 3.146 2007 44.032 3.669 2008 50.634 4.220 2009 66.592 5.549

Reference: Provincial Directorate of Health, www.bsm.gov.tr

Since 1997, a notable increase for both the total and monthly calls for emergency health services can be observed. Beside the increase of the population and the number of emergency services, these high averages could be achieved as a result of increases for emergency service calls with the consideration of citizens that they can receive faster service from emergency services

Table 2.13. Monthly Distribution of Carbon monoxide Intoxications determined in our city in 2008

MONTH Number of Applications Outpatient Treatment Inpatient Treatment Number of deaths January 129 68 59 2 February 103 35 66 2 March 131 47 82 2 April 13 9 3 1 May 0 0 0 0 June 0 0 0 0 July 0 0 0 0 August 0 0 0 0 September 0 0 0 0 Carbon monoxide intoxications which occur in winter October 0 0 0 0 time as a result of geographical and climatic conditions November 107 49 56 2 of our city is a significant issue. Warnings and trainings December 45 20 23 2 in this respect shall be regarded because there are citi- TOTAL 528 228 289 11 zens who die for this reason. Reference: Provincial Directorate of Health, www.bsm.gov.tr 037 BURSA CITY HEALTH PROFILE 2.3. Diseases

Table 2.14. Information Form between January 2009 and December 2009 Concerning the Notifiable Diseases

Acute Bloody Whooping Cough Brucellosis Gonorrhea HepatitisA Hepatitis B Diarrhea Possible Definitive Possible Definitive Definitive Definitive Definitive Definitive Case Case Case Case Case Case Case Case M 8 1 1 1 0-11 F 8 1 months T 16 1 1 1 M 17 1 1 1 1-4 Years F 22 1 1 1 old T 39 1 1 2 2 M 11 1 6 1 5-9 Years F 9 1 7 old T 20 1 13 1 M 13 1 5 2 10-14 F 8 4 Years old T 21 1 9 2 M 10 1 1 4 15-19 F 15 1 Years old T 25 1 1 5 M 8 3 9 3 10 20-29 F 15 2 3 4 18 Years old T 23 5 12 7 28 M 9 7 11 1 13 30-44 F 18 4 7 10 Years old T 27 11 18 1 23 M 21 6 7 7 45-64 F 30 5 8 2 Years old T 51 11 15 9 M 10 3 4 1 16 1 65+ Years old F 17 2 5 16 1 T 27 5 9 1 32 2 M 107 2 1 20 35 39 TOTAL F 142 1 13 23 33 T 249 3 1 33 58 72 Reference: Provincial Directorate of Health 038 BURSA CITY HEALTH PROFILE Tablo 2.14. Information Form between January 2009 and December 2009 Concerning the Notifiable Diseases (continued)

Rabies Risk- MENINGOCOCCAL DISEASE Syphylis Anthrax Typhoid Hepatitis C Mumps Measles Contact Definitive Case Possible Case Definitive Case Definitive Case Possible Case Definitive Case Definitive Case Definitive Case Possible Case Definitive Case Possible Case M 1 1 0-11 F 1 1 months T 2 1 1 M 20 1 14 3 2 1-4 Years F 10 8 2 old T 30 1 22 5 2 M 66 1 1 1 13 7 2 5-9 Years F 36 1 14 5 2 old T 102 2 1 1 27 12 4 M 97 1 1 7 2 10-14 F 24 1 1 1 5 1 Years old T 121 1 2 12 3 M 87 1 2 15-19 F 25 1 1 Years old T 112 3 M 110 11 1 1 1 2 20-29 F 29 5 1 5 1 2 Years old T 139 16 1 6 3 2 M 115 21 1 2 30-44 F 41 12 1 4 Years old T 156 33 1 5 2 M 107 16 2 45-64 F 54 6 4 Years old T 161 22 2 4 M 40 1 1 1 65+ Years old F 24 1 T 64 2 1 1 M 643 3 1 49 1 4 4 40 12 4 TOTAL F 244 1 1 24 3 1 14 29 10 3 T 887 4 2 73 1 3 5 18 69 22 7 Reference: Provincial Directorate of Health

039 BURSA CITY HEALTH PROFILE The most common notifiable disease in Bursa in 2009 has been “Rabies Risk-Contact”. This is followed by acute bloody diarrheal. Observance of whooping cough, mumps and measles which are among vaccine preventable diseases indicates that there is a setback in the immunization services and that they shall be reorganized.

Table 2.15. Information Form Concerning Non-Notifiable Diseases in 2009 Gender Asthma diseases Age Groups Bronchiolitis Pneumonitis Acute Angina Acute tract infection tract Acute Sinusitis Acute tive pulmonary pulmonary tive Acute Tonsillitis Acute chronic obstruc- chronic Acute Bronchitis Acute A cute Laryngitis A cute Acue otitis media otitis Acue Upper respiratory respiratory Upper

0 Years M 9298 316 5103 2599 249 2504 692 154 160 924 Old F 8520 265 4301 2136 193 1897 490 103 67 793

1-4 Years M 48261 6298 41200 36847 1971 15906 1939 855 2371 5167 Old F 45277 5336 38840 31644 1601 12445 1560 570 1246 4394

5-9 Years M 32891 11515 36353 34133 1465 10778 965 455 2034 2486 Old F 31679 10076 35201 31580 1312 9106 796 354 1294 2351

10-14 M 21940 10141 26809 20791 1079 5627 448 188 849 1196 Years Old F 21850 10108 26644 19681 978 4626 367 153 649 1347

15-24 M 23164 13547 29639 15048 869 5448 380 193 5 612 990 Years Old F 30306 16604 381161 18750 1334 5761 379 192 12 837 1743

25-44 M 20095 14311 30773 15147 998 8345 433 383 1125 1753 1531 Years Old F 53386 33413 76327 31434 2755 16172 895 577 1638 4476 4187

45-64 M 21810 11118 30260 10142 1087 11255 616 582 10271 3378 1215 Years Old F 39585 19870 52898 17653 1958 18003 966 647 6593 6526 2122

65+ Years M 10323 3439 10697 3459 407 7503 388 537 16183 3356 357 Old F 13856 4168 14346 4465 564 8970 419 528 9571 3934 484 M 187782 70685 210834 138166 8125 67366 5861 3347 27584 14513 13866 TOTAL F 244459 99840 286718 157343 10698 76980 5872 3124 17814 19029 17421 T 432241 170525 497552 295509 18823 144346 11733 6471 45398 33542 31287

Reference: Provincial Directorate of Health 040 BURSA CITY HEALTH PROFILE Table 2.15. Information Form Concerning Non-Notifiable Diseases in 2009 (continued) Fever Gender Obesity binaptic Varicella Anaemia Diabetes Pressure Diarrheal Age groups Age SCervicits Rachitism High Blood Blood High malnutrition Thalassemia thyromegaly Scarlet Fever Scarlet Acute Rheumatic Rheumatic Acute Febrile Convulsions Febrile protein-energy protein-energy Iron deficiency deficiency Iron Other hemoglo- Other

0 M 2 9 68 3 11 1068 1703 17 3 2 YEARS OLD F 2 4 75 6 14 1038 1362 12 5 1-4 M 22 109 1184 16 17 45 3991 12013 21 64 6 13 7 YEARS OLD F 24 87 1181 17 12 22 3541 10220 2 23 61 3 6 2 5-9 M 27 58 1887 28 11 5 2418 5870 8 24 391 16 15 7 YEARS OLD F 26 37 1728 28 9 1 2325 4989 4 64 407 22 27 6 10-14 M 43 1 398 4 4 1323 4556 22 44 422 53 41 11 YEARS OLD F 52 398 6 3 2441 3314 2 11 109 567 65 12 5 15-24 M 50 85 1 2 1492 6890 322 187 826 51 13 9 YEARS OLD F 108 79 1 1 14393 4988 624 641 978 1338 83 29 14 25-44 M 64 38 2161 4939 15113 982 8424 77 8 4 YEARS OLD F 310 34 1 3 34332 7131 2394 36165 6094 16013 356 42 30 45-64 M 120 5 3 2939 4256 132497 2494 59642 232 9 10 YEARS OLD F 420 6 1 14889 5613 599 263096 9280 94597 507 36 9 65+ M 64 3 1 2708 2274 120478 1557 35303 116 1 5 YEARS OLD F 113 3 1 6297 2758 214077 4017 59829 185 6 4 M 392 177 3668 52 38 61 18094 42501 0 268440 5326 105075 553 100 53 TOTAL F 1055 128 3504 53 36 37 79256 40375 3619 513996 20577 172817 1221 158 70 T 1447 305 7172 105 74 98 97350 82876 3619 782436 25903 277892 1774 258 123

Reference: Provincial Directorate of Health While among the epidemic diseases acute angina, upper respiratory tract diseases and acute tonsillitis were most common in Bursa in 2009, high blood pressure and diabetes are the most common reason among the non-infectious diseases for people to seek medical treatment. 041 BURSA CITY HEALTH PROFILE 2.4. Training Studies

Table 2.16. Central Districts Healthcare Centers Maternal and Infant Health Public Training Studies

Hygiene and Environmental Health (01) Maternal Health and Family Planning (04) 2006 2007 2008 2006 2007 2008 Osmangazi 1235 1685 2394 Osmangazi 2760 3615 2097 Yıldırım 1134 1658 1263 Yıldırım 2032 2515 1921 Nilüfer 351 285 429 Nilüfer 905 802 775 Mudanya 480 428 369 Mudanya 864 714 569 Gemlik 189 281 510 Gemlik 606 616 432 Gürsu 0 12 66 Gürsu 20 29 24 Kestel 38 61 308 Kestel 307 399 306 Total 3427 4410 5339 Total 7494 8690 6104

Nutrition (02) Protection Against Epidemic Diseases, Vaccination and Responsibles (05) 2006 2007 2008 Osmangazi 2376 3234 4668 2006 2007 2008 Yıldırım 1776 2678 2296 Osmangazi 2022 2526 3230 Nilüfer 749 802 1119 Yıldırım 1730 218 1522 Mudanya 724 672 739 Nilüfer 706 810 817 Gemlik 488 558 655 Mudanya 447 425 467 Gürsu 16 16 137 Gemlik 454 468 413 Kestel 291 472 796 Gürsu 7 19 67 Total 6420 8432 10410 Kestel 207 248 662 Total 5573 4714 7175 Child Health and Childhood Diseases (03) Reference: Provincial Directorate of Health, www.bsm.gov.tr 2006 2007 2008 Osmangazi 1832 2097 3205 It can be observed that the public training works performed by the healthcare centers are gradu- Yıldırım 1447 1921 1539 ally increasing. When a comparison is made on district basis, it is apparent that during all the 3 Nilüfer 701 775 939 years more persons were trained in Osmangazi District. However, as mentioned before Osmangazi Mudanya 587 549 567 is a district where the highest number of healthcare centers are available and the most populated among the central districts. When the number of persons trained per healthcare center as of 2008 Gemlik 384 432 491 is considered, it is seen that Osmangazi is ranked in 3rd place after Kestel and Mudanya in terms Gürsu 15 24 83 of the number of persons trained per healthcare center. As far as the ratio of the persons to the Kestel 250 306 762 number of population is concerned it can be seen that Mudanya has the highest rate after Kestel. Total 5216 6104 7586

042 BURSA CITY HEALTH PROFILE Table 2.17. Public Training Works on Healthcare Center Basis in 2008 in Central Districts

Number of Healthcare DISTRICT Total Education Number of persons trained per healthcare center District Population Centers Osmangazi 17716 44 403 710.590 Yıldırım 8682 23 377 517.274 Nilüfer 4360 13 335 236.918 Mudanya 2921 7 417 59.069 Gemlik 2565 8 321 53.219 Gürsu 477 3 159 89.472 Kestel 3328 5 666 40.919 TOTAL 40049 103 389 1.707.461

Reference: iGEP, Supply, Demand and Needs Assessment

2.5. MEDICINE AND PHARMACEUTICS

Table 2.18. Number of Pharmacies in Bursa SUBJECT 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Number of Pharmacies 645 647 661 664 678 713 746 753 771 800 Number of Pharmaceutics 685 687 722 730 772 786 812 850 868 892 Reference: Provincial Directorate of Health, www.bsm.gov.tr

The number of pharmacies in Bursa which was 645 in 2000 increased upto 800 in 2009.

043 BURSA CITY HEALTH PROFILE 3. FACTORS HAVING EFECT ON LIFE STYLE 3.1 Tobacco

According to the outcomes of Global Adult Tobacco Research held in Novem- ber 2008, while 27,4% of individuals at or above 15 years old consumed to- bacco every and 3,8% consumed tobacco occasionally, 15,9% declared not to use tobacco for the time being and 52,8% declared that they are life long non-smokers. When the tobacco consumption is examined in gender ba- sis, the rate of men consuming tobacco is 43,8% while this rate is 11,6% for women. It is observed that tobacco consumption is more common among men than women. When the gender differentiation is examined in terms of non-smokers, 30% of men declared to be life long non-smokers where as this ratio for women is 74,8%.

According to World Health Organisation (WHO) data, smoking habits starts between 15-19 years old with a rate of 40%. Globally in the whole World app- roximately 45% of the population above 15 years old severely suffer from smoking addiction. Since it was calculated that the number of deaths due to smoking in Turkey in the last 40-50 years could be over 10 million, this habit is accepted as a critical public health issue.

According to WHO data, the smoking habit in the world between 1970-85 increased with an average of 7,1%. While it showed a dramatic increase in Asia, Latin America and Africa, it is becoming less in North America and Eu- rope. The increase in Turkey is about 10%. Smoking cigarettes is the reason for 30% of all the cancer originated deaths and 90% of all the lung cancers. Smoking prevalence in Europe is around 40% and 1 per 6 deaths is due to cigarette-originated diseases.

WHO, starting from 1998, is celebrating 31st of May as “World No Tobacco Day” by organizing various activities.

044 BURSA CITY HEALTH PROFILE Table 3.1. Table of Cigarette Related Diseases Number of Cases 2009

Ocak Şubat Mart Nisan Mayıs Haz. Tem. Ağus. Eylül Ekim Kasım Aralık

Ischemic Heart Dis. 3875 3887 3937 4364 3458 3502 3295 3195 2768 3465 2944 4050 Cardiac Insufficiency 1309 1206 1341 1298 1027 1170 1035 935 812 1027 928 1145 Asthma 3156 2998 3251 2942 2619 2559 2002 2157 2032 2557 2812 3483 Chroınic Bronchitis 911 1021 910 718 711 652 581 539 549 596 753 991 Emphysema 50 36 47 53 54 42 29 34 39 64 47 48 Cerebovascular Disease 523 431 512 491 564 551 499 498 430 532 458 587 Lung Cancer 394 332 369 341 380 321 289 324 262 286 339 552 Laryngeal Cancer 143 104 131 127 115 106 134 119 122 135 108 119 Bladder Cancer 230 258 277 274 244 234 256 248 250 256 207 267 Prostate Cancer 200 158 210 192 191 183 192 158 191 228 198 214

Reference: Provincial Directorate of Health

3.2 Alcohol Consumption

Data for alcohol consumption is very limited in Bursa. The number of applications due to alcohol addiction complaint to Bursa Provincial Directorate of Health Mental Health and Social Diseases Department in 2009 is only 19.

3.3. Narcotic Consumption

According to Bursa Provincial Directorate of Security data, the information concerning the substance-use is as follows:

EDUCATION STATUS

Among the individuals who were subject to criminal actions due to nar- cotics in 2009, 7% were literate, 37% graduated from primary school, 20% graduated from secondary school, 19% graduated form high school and 4% graduated from the university. 13% were illiterate.

Secondry School High School University Not literate Literacy Primary school

045 BURSA CITY HEALTH PROFILE DISTRIBUTION ACCORDING TO OCCUPATIONAL GROUPS

In 2009, among the persons who were taking drugs, 38% were freelancers, 26% were artisans, 25% were unemployed and 11% were involved in other occupational groups. Other Artisan Freelancer Unemployed

DISTRIBUTION ACCORDING TO AGE GROUPS

Among the drug users in 2009, 2% were between 11-15 years old, 10% were between 16-18 years old, 31% were between 19-25 years old, 34% were between 26-35 years old, 15% were between 36-45 years old and 8% were at or above 46 years old. .Between 11-15 .Between 16-18 .Between 19-25 .Between 26-35 .Between 36-45 .Between 46 + .Between

FUNDEMENTAL REASONS STIMULATING DRUG ADDICTION

According to Turkey data, among the reasons stimulating drug addiction first rank is hold by curiosity by 42% followed by family issues by 16%, 13% perso- nal issues, 27% affected from friends and 2% done it for fun purposes. For fun For .Friends Curiosity .Family Issues .Family Personal issues Personal

046 BURSA CITY HEALTH PROFILE Within the scope of fight against drug addiction, the following studies were implemented in 2009 and 2010 and still continue to be implemented by Bursa Provincial Directorate of Security.

• A Local Action Plan was prepared covering 2009-2012 in our city in line with the National Strategy Instrument prepared by TUBIM and started to be implemented with the approval of the governorship.

• Brochures concerning the drug addiction are published and distributed to students and parents. Also promotional materials were printed and dist- ributed in this respect.

• Awareness and consciousness raising conferences intended for public establishments and institutions, parents, students, NGO’s and private sec- tor employees are being held.

• Support was given to Domestic Migration Integration Project (IGEP) initia- ted by Bursa Metropolitan Municipality.

• A website was activated to establish efficient communication with the public and to cause them be properly informed. (www.maddebagimliligi16. com).

• Awareness raising programs were prepared at the local media by the Pro- vincial Contact.

• Stands were established at various activities and our citizens were given consciousness raising information’s. 3.4 Sports

When the statistics obtained on sports are examined, it is seen that the capacity of sports clubs in Bursa is not sufficient when compared to the average in Turkey. Therefore, the existing capacity shall be increased in order to make public health planning without ignoring the positive effect of sports on public health.

047 BURSA CITY HEALTH PROFILE Table 3.2. Statistical Regional Units Classification and number of sports clubs according to type Sports Clubs

Total Youth Sports Club Establishment’s Clubs Specialized Sports Club School Sports Club Military Sports Club Turkey 8.593 5.636 1.181 615 1.148 13 Bursa 329 290 6 14 18 1

Reference: TUİK,2007

Table 3.3. Number of licenced and active athletes under supervision of a federation according to Statistical Region Units classification

Licenced Athletes Active Athletes TOTAL MALE FEMALE TOTAL MALE FEMALE Turkey 1.262.891 910.831 352.060 209.436 152.785 56.651 Bursa 57.756 47.609 10.147 8.200 6.156 2.044

Reference: TUİK,2007

Bursa Büyükşehir Belediyespor continues to work with an intention to cause the children to spend their time in a healthy environment and to keep away from harmful habits and to become a competitor sportsman by taking the basic training ata club and to become socially beneficial individuals in terms of sentiments, physical and mental health and to raise strong, resolute, participative and responsible sportsman under the supervision of trainers who are expert in their fields.

Table 3.4. Number of Athletes in Bursa Büyükşehir Belediyespor Club according to Branches

Licenced Without licence Wrestling 336 50 Athleticism 313 40 Basketball 289 100 Table Tennis 80 14 Tennis 70 63 Karate 279 70 Swimming 110 50 Water polo 100 50 Cycling 93 0 Volleyball 42 110

Total: Activities and trainings continue with 2259athletes. Reference: Bursa Büyükşehir Belediyespor 048 BURSA CITY HEALTH PROFILE 3.5. Disabled People

As specified in the regulations of Metropolitan Municipality of Bursa, studies and projects are implemented in order to determine the statistical data of the disabled persons living within the borders of Bursa either by purchasing services or by the own resources of the municipality, to remove all the physical barriers ( particularly the Municipality and Public Establishments Service buildings) so as to enable them to live without any need for an assistant or a com- panion and to realize proper architectural and urban arrangements and to take all required measurements in this respect.

BUKART was provided free of charge to a total of 17.120 disabled citizens and 1322 companions by Metropolitan Municipality of Bursa Transportation Depart- ment in Bursa. Also a total 87 lower -floored buses suitable for use by the disabled serve in different destinations interchangeably.

Table 3.5. Establishments Providing Service to the Disabled in Bursa

Name of Center Capacity Number of beneficials Personnel Location

Yenice Care, Rehabilitation and Family Consultancy Cen- 60 21 40 Mümin Gençoğlu mah. Yenice/İnegöl ter Day / Night

Nursing Home Physiotherapy Unit, Spastic 168 177 53

Reference: İGEP Supply, Demand and Needs Assessment

In the reformatories of Turkish Social Service and Children Protection Institution the disabled children and youngsters are provided accommodation together with other children and youngsters.

Ministry of National Education (MEB) provides the disabled education in special schools for the disabled. The hearing-impaired children are able to receive education in 48 primary schools in Turkey. Two of these schools are in Bursa as Duyum Primary School for Hearing Impaired and İbn-i Sina Primary School for Hearing Impaired. Furthermore, there are 15 vocational high schools intended for hearing impaired in Turkey an done of the Nilüfer Vocational High Schools for Hearing Impaired provides education in Bursa. Sight disabled children may receive education in 16 primary schools however there is no school in Bursa providing service to sight-impaired students under the supervision of the Ministry of National Education.

In Turkey, wide trainable mentally retarded children receive education in 67 and in Bursa there are 3 schools. Trainable mentally retarded children between 6-14 years old receive education in Mithat Enç Primar School and Work School, Nilüfer Work School and Yıldırım Rüveyde Dörtçelik Primary School. Educable mentally retarded children receive education in 121 schools in Turkey and 3 in Bursa. In nationwide, there are 5 establishments under the supervision of Mi- nistry of National Education which provide education to mentally retarded adults whereas there is no establishment in Bursa providing education in this field.

Autistic childred are provided education nationwide in a total of 23 centers monitored by the Ministry of national Education and in Bursa at Baha Cemal Zağra Autistic Children Education Center in Osmangazi District. While in Turkey-wide there are 3 Orthopaedic Primary Schools and 2 Vocational High Schools mo- nitored by MBE, in Bursa there is no school providing education to orthopedically handicapped children. Furthermore, in Bursa one hospital primary school is providing education. The list of schools monitored by the Ministry of National Education providing education to disabled children in Bursa is given below. 049 BURSA CITY HEALTH PROFILE Table 3.6. School for the Disabled in Bursa Monitored by MEB

Name of Center Number of beneficiaries Personnel Location Nilüfer Vocational High School for Hearing Impaired 197 22 Fethiye Mah,Nilüfer Duyum Primary School for Hearing Impaired 144 25 Nilüfer University of Uludağ Faculty of Medicine Hospital Primary School 77 3 Nilüfer Mithat Enç Primary School and Work School for the Trainable Mentally Retarded 162 21 Fethiye Mah,Nilüfer Nilüfer Work School for Trainable Mentally Retarded 217 35 Nilüfer İpek Education Practice School and Work Training Center Educable Mentally Retarded 142 26 Fethiye Mah,Nilüfer Yıldırım Rüveyde Dörtçelik Primary School Educable Mentally Retarded between 6-14 105 10 Şükraniye Mah,Yıldırım Years old Samanlı Education Practice School and Work Center Educable Mentally Retarded 55 4 Yıldırım BTSO Baha Cemal Zağra Autistic Children Education Center 111 28 Osmangazi İbn-İ Sina Primary School for Hearing Impaired 71 15 M.Kemal Paşa

Municipality of İnegöl Bursa Special Directorate of Administration Practice School and 51 6 İnegöl Work Center Educable Mentally Retarded Total 1336 195 Fethiye Mah,Nilüfer

Reference: İGEP Supply, Demand and Needs Assessment

050 BURSA CITY HEALTH PROFILE 3.6. CONDITIONS FOR HOUSING

According to the study carried out in 2000 for the last time, when the data of Turkish Statistical Institute is examined, it is seen that the number of house- holds and housing situation in Bursa indicates a better position in terms of higher standards of house inventory when compared to Turkey in general. Most of population almost 84% live in 3 or 4 –room houses.

Table 3.7. Number of households according to the number of rooms of the house

CITY Total number Number of rooms Unknown of households 1 2 3 4 5+ Total 15 070 093 242 082 1 443 730 5 607 870 6 126 409 1 628 587 21 415

Bursa 545 391 4 003 35 551 218 280 237 816 49 404 337

Reference: 2000 year general census, Turkish Statistical Institution, www.tuik.gov.tr

Table 3.8. Ease of use of houses

Toilet Konutun Dışında % Yok % Bilinmeyen % In the house % Outside the house % None % Unknown % 488 658 86,60 55 792 10,23 885 0,16 56 0,01 Bath 6 067 1,11 7 441 1,36 116 0,02 In the house % Outside the house % None % Unknown % 531 767 97,50 6 067 1,11 7 441 1,36 116 0,02 Kitchen Konutun Dışında % Yok % Bilinmeyen % In the house % Outside the house % None % Unknown % 534 011 97,91 4 272 0,78 6 981 1,28 127 0,02 Mains Water In the house % Outside the house % None % Unknown % 526 068 96,46 9 878 1,81 9 274 1.70 171 0,03

Reference: General Census for 2000, Turkish Statistical Institution, www.tuik.gov.tr

When houses are examined in terms of ease of use, it is observed that toilets are located in approximately 90% of the houses. The houses where toile’s are located outside are generally in rural areas. 1,36 % of the houses (7447 houses) do not have a bathroom, 1,28% (6981 houses) do not have a kitchen and 1,70% (9275 houses) do not have mains water connection. In general, it is seen that the houses are suitable in terms of ease of use. 051 BURSA CITY HEALTH PROFILE Table 3.9. House according to the type of heating used for the last 2 years

2007 2008

Home % Home % Coal 254861 40,42 202008 31,84 Firewood 91185 14,46 64289 10,13 Petroleum Products 2246 0,36 3766 0,59 Natural Gas 280514 44,49 357 56,40 96 56,40 0,27 1456 0,23 Electricity 1704 0,27 1456 0,23 Other 24 0,00 5120 0,81 TOTAL (Houses) 630534 100,00 634535 100,00

Reference: Turkish Statistical Institution, www.tuik.gov.tr

Table 3.10. Number of house holds according to the ownership of houses

Bursa Turkey

Total number of households 545 391 15070093 Landlord 353 275 10 290 843 % 65 68 Tenant 143 638 3 604 367 % 26 24 Lodging inhibiter 6 335 310 347 % 1 2 Non home owner and rent-free inhibiters 39 081 730 065 % 7 5 Other 2 798 125 452 % 1 1 Unknown 264 9 019

Reference: General census for 2000, Turkish Statistical Institution, www.tuik.gov.tr

Table 3.11 Population per house for the last 9 years BURSA 2000 2001 2002 2003 2004 2005 2006 2007 2008 Population per house 4,21 4,05 4,00 3,98 3,96 3,98 3,90 3,81 3,58

Reference: Bursa Provincial Directorate of Health, www.bsm.gov.tr 052 BURSA CITY HEALTH PROFILE 4. SOCIO-ECONOMICAL SITUATION

4.1 Education

According to data of Provincial Directorate of Health 4,7% of the population in Bursa is illiterate. This ratio is even higher compared to the city population par- ticularly in areas which receives migration and that we qualify as disadvan- tageous. Fall down of the illiterate population from 5,38% in its 2007 level to 4,7% in 2008 indicates the improvement in the education level and that the individuals become more conscious and support development. The literacy courses opened according to the needs of the regions within the body of Pro- vincial Directorate of National Education, free of charge SBS (level determina- tion exam) courses, vocational courses intended for women, cultural, social and sportive activities organized with the support of local governments and NGO’s can be assumed as the drivers of improvement in educational levels.

Table 4.1. Population According to Educational Status of Bursa

2005 2006 2007 2008 Population % Population % Population % Population % Under or above school age 237538 10,35 236504 10,11 241652 10,06 225668 9,93 Illiterate 117549 5,12 128392 5,49 129334 5,38 108452 4,77 Literate 224452 9,78 225866 9,66 226046 9,41 243580 10,72 Primary Sch. 964839 42,05 948598 40,56 949794 39,52 69412 38,26 Secondary Sch. 325909 14,21 334103 14,29 347282 14,45 306329 13,48 High Sch. 310008 13,51 334522 14,30 363603 15,13 359870 15,83 University 113937 4,97 130721 5,59 145495 6,05 159344 7,01 TOTAL 2294232 100,00 2338706 100 2403206 100,00 2272655 100,00

Reference: Provincial Directorate of Health, www.bsm.gov.tr

053 BURSA CITY HEALTH PROFILE Table 4.2. Information Concerning I. and II. Phase Literacy Courses and Trainees in Central Districts, 2007-2008

Central Number of Number of Total Number of Trainees Number of Trainees Total Number of I. Number of II. TOPLAM Districts courses I. courses II. number of in I. Phase in II. Phase Phase Trainees Phase Trainees Phase Phase courses completing the completing the course course MFMF MFMF Gemlik 2 2 4 21 31 29 13 94 17 22 17 12 68 Gürsu - 2 2 - - 8 12 20 8 12 - - 20 Kestel 2 3 5 1 51 6 50 108 1 47 6 47 101 Mudanya 3 3 6 3 28 8 20 59 3 28 8 20 59 Nilüfer 8 5 13 73 52 46 38 209 64 49 44 38 195 Osmangazi 36 10 46 92 616 103 128 939 36 478 96 118 728 TOTAL 51 25 76 190 778 200 261 1429 129 636 171 235 1171 Yıldırım - - 65 233 841 - - 1074 - - - - -

Reference: İGEP Supply, Demand and Needs Assessments Report

As far as the number of literacy courses opened concerned it is seen that the courses concentrate in Yıldırım (65) and Osmangazi (46) Districts. Similarly, maximum participation to I and II. Phase courses was realized in Yıldırım and Osmangazi Districts. While mainly women attended I. Phase courses and there is a much balanced distribution between men and women in the II. Phase courses. It is seen that a total of 1429 persons attended the courses which con- sisted of 73% by women and 27% by men. This is an expectable outcome when the fact that the rate of illiteracy is higher in women population than that of men population. Moreover, 82% of the attended in other words 84% of women and 77% of men completed the courses. When compared to other courses, it is observed that the rate of completion of the courses for women is only higher than that of men in literacy courses.

4.1.1. Metropolitan Municipality Free Vocational Courses

Metropolitan Municipality of Bursa renders Vocational Course Services for our citizens residing within its jurisdiction particularly for groups under risk (disab- led, women, unemployed etc) to give them knowledge, skills and qualities and to contribute their domestic economies.

054 BURSA CITY HEALTH PROFILE Metropolitan Municipality of Bursa Artistic and Vocational Courses (BUSMEK) is an adult organization acting under the heading of common-public education supplementary to formal education.

BUSMEK; launched forth its journey in education with objectives to give Bursa citizens skills in arts, to provide their vocational and social development, to equip them with contemporary information and to enliven the traditional arts that faded into oblivion and to enable their adaptation to social life. The headli- nes of the general educations provided in BUSMEK can be listed as Vocational and Technical Educations, Handicrafts, Music Education, Fashion Design, Tur- kish Islamic Arts, Health and Sports, Special Educations, Visual Arts and Com- puter Training and Language Trainings.

Anyone who have completed elementary education age can be enrolled to BUSMEK which shall continue to operate under supervision of Metropolitan Municipality of Bursa without any upper age limits.

BUSMEK 2009-2010 Academic Year

23.795 persons applied to Metropolitan Municipality of Bursa Artistic and Vocational Courses in 2009-2010 Academic Year.

Besides the educations provided in 12 course centers and Fomara Sports Center, there are also courses opened in the Nursing Home and H Type Punish- ment and Execution Establishment.

In BUSMEK 2009-2010 Academic Year 8275 trainees received education in 71 classes with 233 groups in 74 branches.

5328 persons were entitled to receive certificates during the educations given in 2009-2010 Academic Year.

In 2009-2010 academic year, 6 seminars intended for teaching staff in the BUSMEK organizational structure and our trainees. 055 BURSA CITY HEALTH PROFILE Table 4.3. Statistical Data Concerning BUSMEK 2009-2010 Academic Year

Course Center Course Center Name 2009-2010 2009-2010 2009-2010 2009-2010 2009-2010 Num- 2009-2010 District Nr. Of preregistrations Nr of classes Nr of branches Number of groups ber of trainees Nr of Trainees re- opened opened opened starting educa- ceiving certificate tion OSMANGAZİ ALACAHIRKA-PRISON 1869 6 14 30 963 670 OSMANGAZİ HÜRRİYET 1418 5 15 17 384 288 OSMANGAZİ MERİNOS-GLASS WORK- 9929 16 36 104 272 1748 SHOP OSMANGAZİ BAŞARAN 704 3 8 8 317 225 OSMANGAZİ SPORTS CENTER 1355 1 3 14 539 0 OSMANGAZİ (TOTAL) 15275 31 173 4932 2931 YILDIRIM HOCATAŞKIN 1123 4 9 27 554 459 YILDIRIM VATAN-NURSING HOME 448 5 3 6 212 143 YILDIRIM (TOTAL) 1571 9 33 766 602 NİLÜFER ATAEVLER VADİKENT 1103 4 8 20 498 376 NİLÜFER BEŞEVLER 1278 5 8 21 548 328 NİLÜFER (TOTAL) 2381 9 41 1046 704 KESTEL KESTEL 926 4 7 9 156 108 GÜRSU GÜRSU 634 5 6 15 306 163 MUDANYA MUDANYA 1243 6 9 32 398 481 GEMLİK GEMLİK 1765 6 9 24 671 339 GRAND TOTAL 23795 71 74 327 8275 5328

Reference: Social Services Department

Economy, Employment and Distribution of Income

4.2.1 Employment

According to Turkish Statistical Institution data, the employment is concentrated in industry sector in TR41 Region which includes Bursa, Eskişehir and Bile- cik. TR41 region has the highest rate of employment in Industry Sector with a rate of 42,16%. Industry sector ranks in number one for female employment with a rate of 35,1% and for male employment with a rate of 45,1% .

056 BURSA CITY HEALTH PROFILE Graphic 4.1: İBBS, Distribution of employment according to 2. Level and education Reference: Tuik data

Kaynak : TÜİK

Table 4.2. İBBS, Sectoral distribution of employment according to 2. Level and economical activities / Reference: Tuik

Reference : TÜİK 057 BURSA CITY HEALTH PROFILE Graphic 4.3: Employment in Bursa according to economical activities (1970-2000) Reference: TUİK A study concerning to what extent the migration driven by the industrialization movement has at- tained the employment opportunities which it see- ked in Bursa has not been met. However, it is out of Services Construction question that Bursa has a nation wide high position Industry in terms of manufacturing industry and provided a Agriculture, Livestock significant employment capacity. The agricultural and Forestry sector lost its significance in the city starting from 1950’s. While its share in employment was 63% in 1970, this rate fell down to 34% by 2000. This level is still above the EU average. However, as far as the fertile lands of Bursa is concerned, it seems impos- sible for the short-mid term to lower the employ- ment in the sector to EU level (3-4%).

According to the “Socio-economic Development Performance of Cities” compilation of State Planning Institution (DPT) published in 2003 which included the data for 2000, Bursa

Ranks second following İstanbul by providing 28% of industry sector employment

Ranks fourth after İstanbul, İzmir, Kocaeli with its 7% share in the added value of manufacturing sector

Ranks seventh in the country with its 12% share in the commerce sub sector total employment.

Ranks fourth in the country with its 3,5% share of the businessmen in the total employment

Ranks fourth in the country with its 14% share of the paid women in the total employment.

Ranks fourth following İstanbul, Ankara, İzmir with 500.000 insured persons paying premium to social security institutions.

Table 4.4. Bursa Insurance Registries - 2007

Insured Persons with monthly income Total with dependents Rate to General Population % Active/Passive

SSK 481.083 223.592 1.533.425 62,9 2,2 Bağkur 121.267 66.879 505.465 20,7 1,8 Retirement Fund 58.435 79.066 284.678 11,7 0,7 TOTAL 660.785 369.537 2.323.568 95,2 1,8

058 BURSA CITY HEALTH PROFILE Informal employment which is one of the greatest impediments before a sustainable social security system also blocks the unemployment problem. Con- sequently, various sanctions shall be exercised for the duly execution of the insurance registries. Efforts shall be made to increase women employment. Required amounts of funds shall be allocated for secondary education and vocational education so that investments aimed for future may be realized.

4.2.2 Distribution of Income and Expenses

There are various approaches for the definition of poverty. Economical definitions generally take income or consumption as a base and take also social indicators such as life expectancy, infant death rates, nutrition, share of food in household budget, literacy and schooling rate, access to health services into consideration. Depending on how the poverty threshold is specified, two definitions ” absolute poverty “ and “ relative poverty” are widely acclaimed. The measurements made according to the income required for the procurement of basic needs to survive are named as “absolute poverty “ and assuming a certain level of the average income in the society as a threshold is named as “relative poverty”. François Bourguignon, the head economist of World Bank between 2003-2007 who assumed relative poverty as the equivalent of social deprivation or relative deprivation is in the opinion that economical growth ori- ented policies shall be at the forefront at the (under developed) countries where a remarkable portion of the population is in the borders of absolute poverty whereas policies intended to restore income distribution shall be prominent at the (developing) countries where relative poverty is dominant. (Bourguignon 1999) Fights against poverty brought also forward the debates that it will not be sufficient for the solution of the problem when only the definition of poverty is focused on. At this point, measurement of “depth”, “density” and “duration” of poverty is an obligation for the establishment of preferences among the methods of intervention and fight. (World Bank 1997) According to the report of Turkish Statistical Institution based on its studies performed in 2008, while average annual disposable income per household in Turkey was 19.328 TL average annual equivalent household disposable income was 8.372 TL. İstanbul region is the region with highest average annual equivalent household disposable income with 11.881 TL. This is followed by East Marmara Region including Bursa with 9.852 TL average income. The region with minimum average is Southeast Anatolia Region with 4193 TL.

In the study with following data conducted by Turkish Statistical Institution in 2008, it is seen that there is a reduction in the number of poor’s in TR4 East Marmara Region involving Bursa, Eskişehir, Bilecek, Kocaeli, Sakarya, Düzce, Bolu and Yalova compared to previous years.

Table 4.5. Number of poor’s and rate of poverty per region according to relative poverty limit (calculated for Turkey) based on income

TR4 East Marmara Poverty Threshold (TL) Number of Poors (Thousand) %

2006 2007 2008 2006 2007 2008 2006 2007 2008 Poverty Risk %50- 2 351 3 013 3 146 370 340 310 3,0 3,2 2,8 Poverty Risk %60- 2 822 3 616 3 775 722 648 568 4,3 4,2 3,5 Reference: TÜİK, 2007 and 2008 Income and Life Conditions Research 4.2.3 Economy Bursa is a city prominent with its character of being a textile center. Approximately 60.000 persons are employed in around 8.000 establishments which are active in textile sector. 8 of the 11 synthetic yarn plants established in Turkey are situated in Bursa. Again, as far as synthetic yarn manufacturing is con- cerned Bursa occupies 75% of the total capacity of the country. Besides weaving also agriculture is a remarkable economical value. Also olive growing is an activity which maintains importance still today. However even this production is maintained with small volume, peaches and chestnuts grown in Bursa are among the tastes known by the whole country. However, gradually agriculture loses its economical importance while Bursa is on its way to gain a industrial city identity. Another branch of industry in Bursa which is as much important as textile is the automotive industry. Two automobile giants at the city center Tofaş-Fiat and Oyak Renault are the main reason for also the development of automobile side industry. We can say that automotive sector is vital for Bursa.

059 BURSA CITY HEALTH PROFILE 5. CULTURE AND TOURISM

5.1 History of Bursa

In Bursa mainly historical artifacts of the foundation period of the Ottoman State take place and this is because Bursa was the first capital of the Ottoman State. Bursa is a historical treasure with its every piece. It also embodies an exceptional cultural and historical heritage with the spatial and architectural characteristics of Byzantium, Ottoman and the Republic Era. Bursa which is the only city the name of which is mentioned with green and a city worth to see with its mosques, castles, lakes, churches, parks, tombs, khans, bridges, hot springs and many others and it bears the importance of being a bridge between the Asian and European civilizations.

Symbols of Bursa

Bursa, besides its historical character, has a rich cousine culture lasting for many years. Bursa cousine created by this culture is well known with many meals and desserts which it gave away to Turkish cousine. İskender Kebaph, İnegöl Maetballs, Kemalpaşa Dessert, pideli kebap (kebaph with pitta), ceviz- li lokum, tahinli pide (pitta with tahini), hosmerim and candied chestnut are leading the tastes which are remembered with Bursa. Furthermore, Bursa is a city which is prominent with redbuds, Karagöz shadow plays, silk industry, silk and peaches. Bursa, besides the meal symbols, also benefits the privilege of being situated at the skirts of Uludağ which is one of the places one may remember when winter sports is mentioned.

Uludağ

Geological structure of Uludağ which was formed by the emerging and soli- dification of the magma coming from depths of the earth through breaks and cracks is generally formed by extrusive granite rocks. Todays’ form of the mo- untain is due to impacts of the tectonic movements and different erosions. Uludağ with its elevation of 2.543 mt from Bursa plain is the highest point in the Marmara Region. Aras Waterfall and the traces of glaciers are interesting characteristics of the goemorphological structure of Uludağ. The first telfer in Turkey is the telfer operating between the Bursa city center and Uludağ Natio- nal Park which has become one of the symbols of Bursa.

Uludağ is covered with snow between December to May and the thickness of snow up to 3,95 mt makes it so convenient for skiing and Uludağ is one of the most important winter sports center with its high quality snow. 060 BURSA CITY HEALTH PROFILE 5.3 Museums and Ruins Ottoman House Museum

Museum of Archaeology The wooden house in Muradiye Street just opposite the Murad II. Social Complex In the museum where works of arts of bears the traces of 17th century in terms of plan and ornaments and is one of the Bythnyia and Mysia regions are exhi- oldest and most beautiful houses in Bur- bited also there are some works of art sa which is still remain standing. It was belonging to the period from 3000 BC opened to visits under the name “Otto- till late Byzantium Era. The terra-cotta man House Museum” as being a sample cases, coins, stone works of art and of an ancient Bursa house. glass works of art are exhibited toget- her in four saloons. Mudanya Armistice House Museum Turkish - Islamic Arts Museum The wooden building where the TBMM Go- (Green Madrasah) vernment signed the armistice treaty on 11th September 1922 belongs to early The Green Madrasah located at the city 19th century period. The building which center is also known as Sultaniye Mad- was renovated afterwards was opened as rasah. The madrasah in which many a museum monitored by the municipality known scholars were raised was built in 1937 and then became a museum mo- by Architect Hacı İvaz Pasha between nitored by the Ministry of Culture in 1959. 1414-1424 together with the Green Social Complex. In the building which İznik Museum today used as a museum, mines, ceramic wooden, engravings, guns, It was built as a hospice in remembran- manuscripts, Islamic coins, Islamic ce of Nilüfer Hatun, the mother of Sultan epigraphs and headstones and ethnog- Murad I. in 1388 and opened to visit as a museum in 1960. It is one of the most raphic materials from the 12th century beautiful examples of 14th century Otto- till 20th century are being exhibited. Ti- man Architecture. In the museum various ling decorations of the complex is less works of arts from the prehistorically era than that of the mosque and the tomb. till Ottoman period collected around İznik are exhibited. Atatürk Museum İznik Ayasofya Museum This building where Atatürk accommo- dated during his various visits to Bursa The church at the town center of İznik was presented to him and Atatürk bes- which was built on 4th century was resto- towed the building to the Municipality red in 11th century after the earthquake of Bursa in 1938. The building was and was transformed into a mosque by converted into a museum and on 29th Orhan Gazi in 1331. Today it is open to October 1973, on the 50th anniversary visits as a monument-museum. The 7th of the Republic, it was opened for visits. Ecumenic (spiritual) consul which is sig- The two-floor building which was built nificant for the Christians was held here. entirely of wooden materials at the turn There are some freaks of the Byzantium period and at the floor there are mosaics of 19th century is one of the most att- consisting of geometrical patterns. Altar, ractive civil architecture examples of minaret, inscriptions on the walls and the the era and the wooden structure and restoration of the arch inside which indi- internal design was preserved simi- cate the transformation of the church into larly. a museum are considerably notable. 061 BURSA CITY HEALTH PROFILE İznik Tile Furnaces Green Tomb

This is the area where ancient tile fur- It was built by the order of Çelebi Sultan naces stand. Excavations still continue. Mehmet, son of Yıldırım Bayezid, in 1421. The building which then became a symbol İznik Roman Theatre of Bursa is located at a place which enab- les to be seen from all points of the city. It is located at the southwest of İznik. There are 8 sarcophaguses in the tomb Ut is also named as Eski Saray (Old belonging to Çelebi Sultan Mehmed and his sons Şehzade Mustafa, Mahmut and Palace) and was built in there Roman Yusuf and his daughters Selçuk Hatun, period. There are long cradle vaulted Sitti Hatun Ayşe Hatun and her nursema- galleries. Excavations still continue. id Daya Hatun.

Mosques and Tombs Osmangazi Tomb During the siege of Bursa, Osman Gazi Ulu Camii showed his son Orhan Gazi the domed building in the city and bequeathed to be This is the most majestic mosque buried there. This domed building which which is able receive the highest num- today is at the entry of Tophane Park be- ber of community inside. It was built by longs to Mesihi’s chapel. After the conqu- the order of Sultan Yıldırım Bayezid bet- est of Bursa, the chapel was converted ween1398-1400. All the front facades into a mosque and Osman Gazi was buri- are made of cut stones. Ulucami is one ed there. of the oldest mosques of the Turkish Islamic society. Over the entry door of Orhangazi Tomb the minaret the statement “This is built by Yıldırım Bayezid Khan on 804 (Gre- It is at the entry of Tophane Park. The gorian Calendar 1402) “ is inscribed in tomb has a square design where there Ottoman Turkish with gilt. are 3 windows on each facades.

Emir Sultan Mosque and Tomb 5.5. Khans Koza Khan Emir Sultan Mosque was built by the order of Hundi Fatma Hatun, daughter It was built by the order of Bayezid II in of Yıldırım Bayezid, to the name of her 1492 to create income for the mosques husband Emir Sultan possible during and madrasahs in İstanbul. There are 95 the reign of Çelebi Sultan Mehmed rooms being 50 at the upper floor and 45 (1366-1429). It is located at the east of at the bottom floor. The portal at the north Bursa next to the Emir Sultan graveyard made of a large stone with embossed de- among the cypress and plane trees. corations has a magnificent view. Today it is the center for the famous Bursa silk trading.

062 BURSA CITY HEALTH PROFILE Pirinç Khan Irgandı Bridge

Pirinç Khan was built by the order of Irgandı Bridge is bridge in Bursa whe- Sultan Bayezid II in 1508 in order to re the craftsmen performed traditional generate income for his foundations handicraft works. It was built in 1442. in İstanbul. There are 38 rooms at the There are three other bridges similar to bottom floor and 48 at the upper floor. Irgandı Bridge in the world. Those are The signs of hex decagonal fountain in Osman Bridge in Lovech Bulgaria, Pon- the original court are still visible today. te Vecchi Bridge in Florence Italy and Rialto Bridge in Venice Italy. Geyve Khan İnkaya Plane Tree It was built in the XVth century by Hacı İvaz Pasha to generate income for the Inkaya Plane tree is a natural wonder Green Mosque and was given to Çelebi which is known as the oldest plane Mehmed as a present. Khan is at the tree in Turkey. It is also most renowned Demirkapı Bazaar in Bursa. It was also among the monumental trees in Bursa. called Lonca Khan in the past. The two- It is on the way to Uludağ at Inkaya Vil- floor khan has 26 rooms at downstairs lage which is one of the first villages of and 30 rooms at upstairs. Ottoman State. Its height is 35 mts and the diameter is 9,2 mts. The tree which 5.6 Castles and Bridges is 600 years old has branches which are as large as a tree with a thickness Bursa Castle of 3-4 mts.

The construction of the castle started during the Bithinian Era, then was res- tored by the Romans, Byzantium’s and in the Ottoman Empire period various times as and when required. A majority of the cyclopean blocks on the castle walls are the coloumns, sarcophagus pieces, graveyard steles, statue bases and honorary epigraphs of the Roman Era. Castle walls of Bursa which was captured from Byzantium in 1326 were reinforced with three corner bastions.

Abdal Bridge

Abdal Bridge is a historical bridge built over the Nilüfer River connecting Acem- ler and Hürriyet Streets together and also known as Acemler Bridge. The brid- ge was built by a trader named Abdal Çelebi in 1669. The mid part is slightly over road level and has lancet arches. 063 BURSA CITY HEALTH PROFILE 5.7 Museums

Table 5.1 Museums according to Statistical Region Classification, 2008

Total Archaeology and History Ethnography and Anthropology General

Bursa 8 3 4 1

Reference:TUİK,2008

5.8 Cinemas and Theatres Theatre is one of the most significant braches of art which personalises and develops identities of human beings. In 2008 the number of State Theatres in Bursa is only 1.

Table 5.2. The number libraries, number of books received by and taken from the library and the number of books at year-end according to Statistical Region Units Classification, 2008.

Number of seats Number of films shown Number of audiences Number of cinema halls Total Domestic Filmes Foreign Films Total Domestic Filmes Foreign Films Turkey A 1.514 212.155 21.003 9.455 22.548 31.132.231 16.166.153 14.966.078 Turkey B 1.037 145.628 20.375 6.095 14.280 23.409.186 11.776.345 11.632.841 Turkey C 477 66.527 11.628 3.360 8.268 7.723.046 4.389.808 3.333.237 Bursa A 55 9.485 1.125 380 745 1.325.103 792.482 532.621 Bursa B 30 5.681 535 185 350 822.368 518.984 303.381 Bursa C 25 3.804 590 195 395 502.735 273.495 229.240

Reference:TUİK,2008

064 BURSA CITY HEALTH PROFILE Table 5.3. The number of theatre halls, seats, plays performed, shows and audiences according to Statistical Region Units Classification.

Number of theatre Number of Number of plays performed Number of shows Number of audiences halls seats Total Copyright Translation Total Copyright Translation Total Copyright Translation

Turkey 204 70.924 2.122 1.818 304 14.410 13.177 4.233 3.380.214 2.466.373 913.841

Bursa 1 342 10 5 5 299 141 158 61.219 33.422 27.797

Reference:TUİK,2008

5.9 Libraries

There are 20 public libraries in Bursa. The number of works received by those 20 libraries in 2008 is 324.076. Taking into consideration that Bursa is the fourth largest city in Turkey, it is evident that the number of books available are insufficient when compared to Turkey in general.

Table 5.4. The number libraries, number of books received by and taken from the library and the number of books at year-end according to Statistical Region Units Classification, 2008

Number of libraries Total Purchased Transfer from other Donation Withdrawn Transfer other libraries 2008 Year End Number libraries of Titles Turkey 1.156 791.955 628.277 123.655 306.884 67.213 13.662.483 Bursa 20 16.131 9.979 5.989 3.609 - 324.076

Kaynak: TUİK,2008

065 BURSA CITY HEALTH PROFILE 5.10. Culture and Artistic Activities

The following cultural activities which are included in the main objectives of Bursa Metro- politan Municipality were performed in 2009

International Bursa Festival (12th June -05th July 2009)

23.rd International Altın Karagöz Folk Dances Contest (7th- 12th July 2009)

Ramadan and Sufism Days (21th August – 11th September 2009)

14th. International Youth and Children Theatre Festival (19th-24th October 2009)

4th. International Bursa Silk road Film Festival (14th-22nd November 2009)

13th. International Bursa Dummy and Karagöz festival (7-12 Aralık 2009)

Literature Days (18th-19th December 2009)

Mollafenari Symposium (4th-6th December 2009)

5.11. Tourism

The first thing that comes into ones mind in Bursa as a new business field is tourism. The historical and natural values of the region are capable of being a ba- sis for a large scale tourism activity. Bursa has all the values required for winter and summer, religious tourism, health and natural tourism. So if the planning and application programme which was implemented in 1970’s for Antalya region aimed to improve tourism is applied similarly covering the whole region however focused on Bursa city, this will enable tourism to become a sector which will create the second highest number of employment after industry. It is crucial that tourism development planning is implemented taking the protection of historical and natural values, social and environmental effects and finan- cial requirements during the implementation stage into consideration.

066 BURSA CITY HEALTH PROFILE Table 5.5. Capacity Breakdown of Operating and Investment Facilities in Bursa ( 07 / 2010 ) CENTER 8 FACILITIES 972 ROOMS 1979 BEDS DISTRICTS 2 FACILITIES 46 ROOMS 90 BEDS ULUDAĞ 3 FACILITIES 359 ROOM 754 BEDEK TOTAL 13 FACILITIES 1377 ROOMS 2823 BEDS ACCOMMODATION WITH OPERATION CERTIFICATE FACILITIES CENTER 27 FACILITIES 1886 ROOMS 3859 BEDS DISTRICTS 16 FACILITIES 578 ROOMS 1196 BEDS ULUDAĞ 13 FACILITIES 1189 ROOMS 2540 BED TOTAL 56 FACILITIES 3653 ROOMS 7595 BEDS Reference: Governorship of Bursa Provincial Directorate of Culture and Tourism Table 5.6. The number foreigners having entered or exit according to the city which monitors the port of entry and exit and to transportation mode.

2005 2006 2007 A B A B A B Bursa Transportation Mode 3.658 3.341 3.847 4.891 2.105 2.512 Center Air way 3.312 3.026 3.519 4.570 1.718 2.093 Gemlik Sea 343 314 304 304 361 385 Mudanya Sea 3 1 24 17 26 34 Reference: TUİK / A. Foreiners entered B.Foreigners exit

Table 5.7. Citizens going abroad according to age groups and gender in Bursa 2009 (Resident in Bursa)

Total Age Group and Gender / 15-24 General Total M F A B Bursa 371.492 241.160 130.332 17.341 10.098

Table 5.8. Number of overnight stays of the foreign visitors according to the city accommodated and type of accommodation Type of Accommodation Total Hotel Motel Holiday Village Pensions Camp/Caravan Bursa 3.747.113 576.389 28.965 6.333 9.710 1.830 067 BURSA CITY HEALTH PROFILE 6. INFRASTRUCTURE AND ENVIRONMENT 6.1. WASTE WATER TREATMENT FACILITIES

Bursa East and West Waste Water Treatment Facilities – Hamitler Leachate Treatment Facility

Bursa East Waste Water Treatment Facility was projected to operate in two stages being the first stage to be capable of 240.000 m3/day in 2020 and and in second stage 320.000 m3/day in 2030. Bursa West Waste Water Treatment Facility was projected to operate in two stages being the first stage to be capable of 87.500 m3/day in 2020 and and in second stage 175.000 m3/day in 2030. In those facilities where advanced biological treatment processes are imple- mented, also nitrogen and phosphorous removal can be done. Both facilities were completed and commissioned in April 2006.

Hamitler Leach ate Treatment Facility will be implemented in two phases. The facility was projected to be capable of treatment of filtrate water in two phases first in 2020 with a capacity of 500 m3/day and in 2030 with a capacity of 1.000 m3/day. The first phase was completed in 2004 and is operating.

Table 6.1 East and West Waste Water Treatment Facilities Raw Waste Water Flow rates and Pollution Loads

East Waste Water Treat- West Waste Water Treat- Parameter Unit ment Facility (DAAT) ment Facility (BAAT) Parameter Unit 1.Phase 2.Phase Average Project Flow Rate (Dry Air) m3 /day 240,000 320,000 Average Project Flow Rate (Dry Air) m3 / day Dry Air Peak Flow Rate m3 / day 351,200 468,300 Dry Air Peak Flow Rate m3 / day Raw Weather Peak Flow rate m3 / day 597,500 796,600 Raw Weather Peak Flow rate m3 / day BOİ5 kg/ day 64,000 85,300 BOİ5 kg/ day AKM kg/ day 64,000 85,300 AKM kg/ day Ammonia (as N) kg/ day 10,800 14,400 Ammonia (as N) kg/ day Phosphorus (as P) kg/ day 2,640 3,520 Phosphorus (as P) kg/ day Reference: BUSKİ data 068 BURSA CITY HEALTH PROFILE Table 6.2 East and West Waste Water treatment Facility Refined Exit Water Characteristics

Parameter Concentration ( mg/lt) Min. Removal Efficiency (%)

Biochemical Oxygen Need (BOI5) 25* 70-90*

Chemical Oxygen Need (KOİ) 125* 75*

Total suspended solid matter 35* 90*

Total Nitrogen (N) 10* -

Total Phosphorus (as P) 3 - Reference: BUSKİ data / * Directive 91/271/EEC dated 21.05.1991 of European Union Council

Bursa Hamitler Leach ate Treatment Facility is aimed to refine the leachates originating from Hamitler Solid Waste Regular Storage Area with high pollution load and to prevent the leach ate to contaminate the soil, under ground and ground water sources. For this purpose, it is aimed to keep the monthly exit water average Chemical Oxygen Need value below 3000 mg/l and highest consecutive 3 days exit water average Chemical Oxygen Need value below 3200 mg/l for the raw filtrates received at Hamitler Leach ate Treatment Facility and for which raw leach ate characteristics are given in Table 6,3.

Table 6.3: Hamitler Leachate Treatment Facility Raw Leach ate Pollution Concentrations Parameter Concentration (mg/lt) BOI5 15,000 KOİ 30,000 AKM 1,500 Reference: BUSKİ data

6.2 Drinking Water Sources

6.2.1. Doğancı Dam (% 82) It is constructed over Nilüfer River 3 kms away from Doğancı Village at the source. • Reservoir Capacity: 43 million m3 • Active capacity: 25 million m3 • Annual water reception capacity: 115 million m3

6.2.2. Fountain sources (% 12) Fountains in Bursa originate from Uludağ and its foothills. There are 145 fountains. It is possible to generate 15 million m3/year water from fountain sources.

6.2.3. Underground Water (%12) During July to November when there is less rain and the water level of Doğancı Dam falls drastically due to depletion of snow reserves in Uludağ, underground water sources are activated. There are a total of 42 water-wells being 16 at Acemler, 10 at Arabayatağı, 15 at hacıvat and 1 local. 069 BURSA CITY HEALTH PROFILE Table 6.4. Active Deep Drinking Water Wells Summary Table

ACTIVE DEEP DRINKING WATER WELLS SUMMARY TABLE Well group Number of wells Total productivity (m3/h) Total Productivity (m3/gün) Acemler 16 1.782 42.768 Arabayatağı 10 1.080 25.920 Hacivat 15 1.368 32.832 Local wells 1 29 696 TOTAL 42 4.259 102.216 Reference: 2009 BUSKİ data

070 BURSA CITY HEALTH PROFILE Table 6.5. Local Water Wells WATER QUALITY REPORT LABORATORY: BUSKİ,TÜBİTAK, FOOD CONTROL LABORATORIES

LIMIT VALUE

FEBRUARY 2005 PARAMETERS UNIT APRIL 2005 TS-266 2009 MINISTRY OF HEALTH

ph 6.5-9.5 6,5-9,5 7,51 COLOUR mg/l 20 - 0 TURBIDITY ntu 5 1 0,17 TOTAL HARDNESS Fr0 - - 15,5 TOTAL IRON mgFe/l 0,2 0,2 0,02 TOTAL MANGANE mg/l 0,05 0,05 0,013 CHLORIDE mgCl/l 250 250 3,1 SUPLHATE mgSO4/l 250 250 27 NITRATE mgNO3/l 50 50 0,8 NITRITE mgNO2/l 0,5 0,5 0.000 AMONIUM mgNH4/l 0,5 0,5 0,00 CONDUCTIBILITY µs/cm 2500 2500 318 ORGANIC SUBSTANCE mgO2/l 5 5 2,37 SODIUM mgNa/l 200 200 6,15 ALLUMINIUM mgAl/l 0,2 0,2 0,048 FLUORIDE mgF/l 1,5 1,5 0,10 FREE CHLORIDE mg/l 0,5 0,5 0,5 BORON mgB/l 1 1 < 0,1 TOTAL CYANIDE µgCN/l 50 50 < 0,01 ANTIMONY µgSb/l 5 5 < 5 ARSENIC µgAs/l 10 10 1,35 COPPER µgCu/l 2000 2000 < 5 MERCURY µgHg/l 1 1 < 1 CADMIUM µgCd/l 5 5 < 5 CHROME µgCr/l 50 50 < 5 LEAD µgPb/l 10 25/10 < 5 NICKEL µgNi/l 20 20 < 5 SELENIUM µgSe/l 10 10 < 5 COLIFORM BACTERIA 100ML/ADET 0 0 0 SMELL - - - Proper TASTE - - - Proper

Reference: BUSKİ Drinking Water Treatment Facility / * Facility Exit Value. 071 BURSA CITY HEALTH PROFILE 6.2.4. Bursa Drinking Water Projection for 2040

2005

S.SAYGI 110 million m3/year

ULUDAĞ 15 million m3/ year

YAS 20 million m3/ year

TOTAL 145 million m3/ year

UNTIL 2014

S.SAYGI + NİLÜFER 170 million m3/ year

ULUDAĞ 15 million m3/ year

YAS 25 million m3/ year

TOTAL 210 million m3/ year

UNTIL 2022

S.SAYGI + NİL + GÖLBAŞI 225 million m3/ year

ULUDAĞ 15 million m3/ year

YAS 20 million m3/ year

TOPLAM 260 million m3/ year

UNTIL 2040

S.SAYGI + NİL + GÖLBAŞI 225 million m3/ year

ULUDAĞ 15 million m3/ year

ÇINARCIK 145 million m3/ year

TOPLAM 385 million m3/ year

072 BURSA CITY HEALTH PROFILE 6.3. Solid Waste Management

6.2.1.6.2.1. Citywide Disposal of Solid Was- tes and Construction of Solid Waste Storage Facilities

In our city 1810 tons/day solid wastes are generated by the settlement areas and en- terprises are collected by Osmangazi, Yıldı- rım, Nilüfer, Mudanya, Gürsu, Kestel and Zey- tinbağı Municipalities and brought to regular storage area at Geçit.

City Solid Waste Storage Area is 156,18 ha and 83,09 of this area is allocated for dum- ping. In the area which consists of 4 side valleys (X,Y,Z,T) and a main valley according to its final project, constructions are done in stages according to the requirement.

Constructions at Phase I constituting 40 ha of the area (entire of X and T valleys) Pha- se II (a part of main valley) and Phase III (a Graphic 6.1. Amount of wastes stored between 1995-2009 part of main valley) were completed but the construction for the remaining parts are not realized yet. Waste storage processes are completed in the valleys taking place in Pha- se I and continue in the main valley since October 2000 for which Phase II and III are completed.

Domestic wastes, medical wastes and un- harmful solid industrial wastes are accepted in a controlled manner and those wastes are laid and compressed on a surface where im- permeability is ensured and then disposed by covering earth. The cost of wastes accep- ted to the storage area except domestic was- tes are collected on daily or monthly basis after being weighed in line with the income tariff. In 2009, 661.320,90 tons of wastes are stored and waste disposal cost with an amount of 1.881.560 TL was collected from the accepted industrial wastes. The waste storage area is operated by a contractor as a Reference: 2009 Environmental Protection Branch Directorate data result of a tender. 073 BURSA CITY HEALTH PROFILE 6.2.3. Sterilization of the medical wastes at the sterilization facility after being col- lected from the medical establishments under a certain programme with medical waste vehicles by virtue of Medical Waste Control Regulation.

Bursa Medical Waste Sterilization facility is constructed in the City Solid Waste Sto- rage Area monitored by the Metropolitan Municipality on a 2000 m2 area and star- ted operation on 26.07.2008.

Medical wastes produced by the medial establishments in Bursa are collected with containers separate form its source with licenced vehicles by virtue of Medical Was- te Control Regulation yat came into effect after being published in the Official Ga- zette dated 22.07.2005 with nr: 25883 and brought to the Sterilization Facility. The wastes are sterilized under high temperature and pressure at the facility and the operations are electronically recorded and all parameter are monitored. Sterilized wastes are stored at the City Solid Waste Storage Area. A total of 2.486,77 tons of wastes were collected from medical establishments and disposed in 2009.

Graphic 6.2. medical waste amounts between 1996-2000 Reference : 2009 Environmental Protection Branch Directorate data

074 BURSA CITY HEALTH PROFILE Special Waste Management Environment and Forestry. Within the scope of the regulation which was revised in 2008, waste motor oils produced by the workshops of the Met- 6.3.1. Erection and monitoring of disposal areas ropolitan Municipality are again started to be given to PETDER.

Within the scope of “Excavation Earth, Construction and Debris Wastes 6.3.4. Studies on Waste Vegetable Oil Control Management Control Regulation” that came into effect upon publication in the Official Trainings were given at the pilot schools and collecting containers were gi- Gazette dated 18th March 2004 with nr: 25406, disposal areas are cons- ven for the separate collection of vegetable wastes from other wastes and tructed and licenced. As of the end of December 2009 43 Excavation Earth, to prevent environmental damages within the scope of Waste Vegetable Oil Construction and Debris Wastes Storage Area were licenced in the city. The Control Regulation dated 19.04.2005 with number: 25791 issued by the number of areas licenced in 2009 is 5. These licenced areas are regularly Ministry of Environment and Forestry. Restaurants, industrial cousines, audited. hotels, motels, catering services and refectories which produce vegetable wastes that have applied to our Municipality were directed to licenced col- 6.3.2. Collection and Storage of Waste Battaries lecting and recovery companies.

Our efforts to collect the batteries separately continue within the frame 6.3.5. STUDIES ON EXPIRED TIRES CONTROL MANAGEMENT of provisions of Waste Batary and Accumulators Control Regulation issu- It is prohibited to directly or indirectly to give the expired tires of vehicles ed by the Ministry of Environment and Forestry dated 31.08.2004 with nr: which are non-utilizable into the receiving environment and waste storage 25569. A protocol was executed with Battery Importers Association which areas in a manner which would damage the environment within the scope is the authorized establishment by the Ministry and battery containers, of the provisions of Expired Tires Control regulation issued by the Ministry cardboard boxes, banners and brochures supplied by the association of Environment and Forestry dated 25.11.2006 with nr: 26357. were distributed to street headmen, schools, shopping centers, hospitals, work places, sites etc. in the 7 central districts Osmangazi, Nilüfer, Yıldırım, Studies were made to establish a system for the Expired Tires collection Gemlik, Gürsu, Kestel and Mudanya) In 2009, a total of 3.550 kgs waste transportation system in Bursa with the Ministry and Tire Industrialists As- batteries were delivered to the association. sociation and 21 tons of expired tires produced by our municipality were given to the licenced companies. All the waste tire producers including public establishments and organizations were caused to contact with the licenced companies.

6.3.3. Studies on Waste Oil Control Management

Coordination studies were conducted by our municipality in order to es- tablish a system for the collection, transportation, recovery and removal of the waste motor oils within the scope of provisions of Waste Oil Cont- rol Regulation issued by the Ministry of Environment and Forestry dated 30.07.2008 with nr: 26952. Waste motor oils which bear the risk to create environmental pollution and collected by PETDER are evaluated by ma- king of use of their energy by the enterprises licenced by the Ministry of 075 BURSA CITY HEALTH PROFILE 6.3.6. Studies on Packaging Wastes Control Management

Separate collection and evaluation of packaging waste which became a legal obligation by virtue of the Packaging Wastes Control Regulation that came into effect with the Official Gazette dated 30.07.2004 with nr: 25538 and also which started with voluntary practices in our city for the fist time, continue to be done within the jurisdiction of our metropolitan municipality since 1995. With the given regulation the Metropolitan Municipalities were given the authority to coordinate and the District and First Stage Municipalities were given the authority to grant temporary working permits and to prepare a packaging wastes management plan by working together with the licenced collection and classification facilities. In line with this, glass, paper – cardboard, metal and plastic etc packaging wastes and being collected by the licenced companies which have agreements with the relevant municipalities from the houses, work places, business organisations, pubic establishments and organizations. You can have access to the list of packaging waste classification facilities which were licenced or granted temporary operation certificate by the Ministry of Environment and Forestry through website www.atikyonetimi.cevreorman.gov.tr and also the number of facilities are given in the below table.

Table 6.6. Number of facilities which have temporary working permit or licenced by the Ministry of Environment and Forestry in Bursa

LICENCED FACILITIES BURSA WITHIN BORDERS OF METROPOLITAN MUN. Recovery Facility 12 10 Collection Classification Facility 16 12 Reference:2009 Environmental Protection Branch Directorate data 6.4.7. STUDIES ON HAZARDOUS AND INDUSTRIAL WASTE MANAGEMENT The establishments bear the responsibility of disposal of production wastes generated by their plants. Waste producers which bring wastes to our storage area are required to provide waste analysis reports from accredited laboratories by virtue of the Hazardous Waste Control Regulation and accordingly wastes which are hazardous are not accepted in the City Solid Waste Storage Area and the producers of the waste are required to dispose of the waste in accordance with the respective regulation. The wastes which are not hazardous are accepted to the City Solid Waste Storage Area in consideration of a fee charged in accordance with the income tariff. Wastes that are accepted into our Storage Area are checked and monitored by our laboratory.

6.4. CONTROLS AND AUDITS ON AIR AND NOISE POLLUTION 6.4.1.Noise Pollution Metropolitan Municipality of Bursa, based on the Environment Law Nr: 2872, conducts either scheduled or unscheduled or complaint-based audits to check whether the principles of this regulation are complied with or not, at the noise sources within the borders of municipalities other than Osmangazi, Yıldırım and Nilüfer, and when required with the support of establishments and organisations authorized within the scope of the relevant legislation and apply administrative sanctions in case of violation. The municipality delivers the results of the audits within its ju- risdiction to the Provincial Directorates of Environment and Forestry. 6.4.2. Air pollution Control Audits on air pollution originating from warming are conducted and relevant documents are recorded and delivered to relevant organizations. In cases when fines shall be applied in accordance with the circular of Ministry of Environment and Forestry Nr: 2006/19, punitive action is taken. Domestic and industry originated air pollution is determined and precautions are taken. 076 BURSA CITY HEALTH PROFILE 6.4.3. INFORMATION ON NATURAL GAS CONSUMPTION

In 2009, Bursagaz sold 403 million m3 of natural gas to domestic consumers, 71 million m3 to eligible customers and 12 million m3 to non-eligible industrial con- sumers. Among the domestic consumers 11% consists of official customers, 20% commercial customers and 69% home consumers.

Table 6.7. BURSAGAZ Information on Natural Gas Consumption 2009

Subscriber Consumption Consumption Number of Gas Users Type Amount Rate (BBS) Domestic 276.496.330 69% 464.381 Official 44.347.692 11% 27.194 Commercial 81.845.128 20% 30.394 Total 402.689.150 100% 521.969

Subscriber Type Consumption Consumption Rate Number of Gas Amount Users (BBS) Non-eligible 12.285.206 15% 50 Industry Eligible Customer 71.198.299 85% 52 Total 83.483.505 100% 102 Reference: Bursagaz 2009 data

077 BURSA CITY HEALTH PROFILE 7. CITY PLANNING

7.1. UPPER SCALE PLANNING AND 1/100000 SCALE 2020 ENVIRONMENT PLAN

In our country planning hierarchy is defined as follows:

REGIONAL PLAN ENVIRONMENT PLAN CITY ENVIRONMENT PLAN (Based on Regions and Basins (Metropolitan/Provincial Municipa- Min. Env. And For.) lity and Special Prov. Adm.

MASTER LAND USE PLAN (Municipality/Special Provincial ) Administration) IMPLEMENTATION LAND USE PLAN (Municipality/Special Provincial Administration) Reference: Town Planning and Urbanism Department Provincial Planning Branch Directorate 2010

Environment Plan mentioned in the above scheme is the 1/100000 scale 2010 En- vironment Plan within the borders of Bursa. The plan which was prepared based on the protocol executed between the Metropolitan Municipality of Bursa and the Public Works and Settlement Directorate and with the coordination and contributions of, ot- her than the establishments appointed by the law, Local Representatives based on participation, was approved by the Ministry of Public Works and Settlement. The aim of the plan is to negotiate and balance the Protection and Development Principles and to ensure a sustainable development. 7.2. 1/100000 SCALE BURSA CITY ENVIRONMENT PLAN

When examined in terms of urbanism and planning principles, upper scale plans sig- nifies the role of the city within the country and the region. While enabling utilization from the natural resources of the city within the frame of sustainable development principles and reflection into physical environment, they are plans arranging the spatial organization of urban functions and providing ecological balance. Upper scale plans are the plans which lead the lower scale plans and enable the protection uti- lization balance for the area which require immediate intervention. 1/100.000 plan which is hierarchically at the top above all plans in our city signifies which regions require lower scale plan and which regions shall be used with what purpose and thus monitor the development of the city. 078 BURSA CITY HEALTH PROFILE Plan preparation process is a stage which will activate and associate the foreseen to be achieved in the entire process; planning decisions which will enable the access to objectives with the en- • Preparation of common design and action environment participatively vironment and which includes identification of relevant players and estab- and in coordination lishments and legal tools and organization and coordination of the sources. • The participants having learned the participation method and from each other. After the sectoral analysis and synthesis are completed, information on • The participants getting stronger by obtaining individual, corporate and/or which parts of the city are suitable for settlement and to which direction and synchronization skills under which conditions the city shall be developed, which thresholds are es- • Probing and sharing the value judgements sential, shall be made available to the decision maker and offers regarding • Experiencing democratic dialogue and participative management environ the management of those shall be submitted. Amendment of the Metropo- ment litan Municipality Law and adoption of Law Nr: Nr: 5216, Municipal Law nr: • Across-the-board compromise 5393 and other authorities in particular the planning, the effect of Special Efforts by the Metropolitan Municipality of Bursa and Bursa Special Provinci- Provincial Administrations Law Nr: 5302 on the plan and its implementation, al Administration continue with an intention to prepare the environment plan developments and amendments on the physical environment (in complian- with a participative approach. ce with/non-complaint with the plan decisions) together with the extension of the responsibility area of the Metropolitan Municipality of Bursa 10 times 7.3. 1/25000 SCALE LAND USE PLANS with a radius of 30 kms in the period after the approval date of the plan and population growth, industrialization, Law Nr: 5403 on the soil conservation In the 1/100000 scale 2020 Environment Plan, 6 sub-planning zones were and land utilization and classification of agricultural lands, requirement to established based on the economical, social, demographical and cultural de- reflect the fundamental changes such as soil council on the existing plan velopments in Bursa Metropolitan area. The necessity to prepare 1/25000 and obtaining the numeric plans in harmony with the Geographical Informa- lower scale plans was inserted in the provisions of 1/100000 scale 2020 tion System with the support of satellite images and updated data upon the Environment Plan by the Metropolitan Municipality of Bursa. According to improvement of technological facilities caused the necessity to rediscuss the provisions of this plan, 1/25.000 scale environment plans in five zones the 1/100.000 scale 2010 Bursa Environment Plan and constituted the rea- within the borders of the municipality was prepared and approved. Metropo- sons for the preparation of 1/100.000 scale Bursa Environment Plan. litan Municipality of Bursa, targeting the 1/100.000 scale Environment Plan, in April 2005 started the preparation of 1/25.000 scale Environment Plans With a participative approach, while the 1/100.000 scale Bursa Environment for Central Planning Zone, West Panning Zone, Mudanya Planning Zone, North Plain is developed, it will be realized with a system which was never practi- Planning Zone, Gemlik Planning Zone, East Planning Zone, Alaçam (Ululdağ) ced in Turkey by implementing all the stages of the plan with the participa- Planning Zone with an intention to “ creating a sustainable and habitable tion of the relevant groups and handling the plan with all the stakeholders environment and protection of agricultural, touristic and historical identity, with a participative approach and preparation of the plan by providing mutual enabling the protection utilization balance and to obtain the healthy deve- solutions and with design charred method which is new in the global urban lopment and growth objectives in line with the planning principles determi- planning. ned according to the sectoral development objectives within the scope of the development policy of Turkey”. While the environment plan is developed, with a participative planning app- Central Planning Zone and West Planning Zone Environment Plans were roach, the information produced and implementation of all the stages of the approved on July 2006 and and Mudanya, Gemlik, East and North Planning plan with the participation of all the relevant stakeholders are the two ob- Zones Environment Plans were approved on November 2006. Alaçam (Ulu- jectives adopted by the municipality. Thus, the participants shall be able to dağ) Planning Zone Environment Plan could not be prepared since the zone produce information intended for common action taking their experiences is within the jurisdictions of Ministry of Environment and Forestry, Ministry as a base; identifying the problems of Bursa and to jointly find solutions to of Culture and Tourism, Cultural and Natural Heritage Preservation Board and these problems and make commitments to take the future of Bursa to a bet- the Metropolitan Municipality of Bursa and lack of coordination between the ter situation than that of today and to improve their democratic governance authorized establishments. skills. Furthermore, the following objectives adopted by the municipality are 079 BURSA CITY HEALTH PROFILE 7.3.2. 1/25000 SCALE WEST PLANNING ZONE LAND USE PLAN While the plans decisions are taken, taking the decisions for the upper scale planning into consideration, new housing and business areas were formed in the West Planning Zone for it being the development direction of Bursa. Lake of Uluabat and its surroundings and Çayırköy Plain was preserved; small in- dustrial areas were formed in different locations for the decentralization of the contaminating industries within the city.

Planning Area : 19.791 ha. Population : 401.600 persons Housing Area : 2269 ha. Business Areas (Trade + Industry) : 1380 ha.

7.3.3. 1/25000 SCALE MUDANYA PLANNING ZONE LAND USE PLAN While the plans decisions are taken, taking the decisions for the upper scale planning into consideration; in Mudanya Planning Zone decisions bringing the historical and touristic identity forward were taken, special product areas were preserved and Agricultural Organized Industrial Zones were prepared intended for these areas.

Planning Zone : 13.146 ha. Population : 174000 persons Housing Area : 1768 ha. Business Areas (Trade + Industry) : 204 ha.

7.3.4. 1/25000 SCALE GEMLİK PLANNING ZONE LAND USE PLAN While the plans decisions are taken, taking the decisions for the upper scale planning into consideration; in Gemlik Planning Zone, storage and packaging 7.3.1. 1/25000 SCALE CENTRAL PLANNING ZONE LAND USE PLAN areas intended for the development of port activies were formed, new indust- When the plan decisions were taken, the decentralization of the settlement rial zones were not formed, existing airport was improved, historical identity centre was taken as a base in the Central Planning Zone taking the upper sca- of Umurbey was preserved and new housing areas were formed taking the le plan decisions into consideration, service sector was improved, existing seismicity character of the area into consideration. Special product areas industrial zones in Gürsu and Kestel was not enlarged, social facilities were were preserved and Agricultural Organized Industrial Zones were prepared improved and density was not increased in the existing planned zones. intended for these areas. Planning Area : 44.421 ha. Planning Zone : 17.142 ha. Population : 2.248.300 persons Housing Area : 9363 ha. Population : 228.605 persons Business Zones (Trade Industry) : 3985 ha. Housing Area : 1262 ha. Business Areas (Trade + Industry) : 944ha.

080 BURSA CITY HEALTH PROFILE 7.3.5. 1/25000 SCALE NORTH PLANNING ZONE LAND USE PLAN Urban Transformation is the production of projects and practices where ur- ban development is reconsidered socially, economically and environmen- While the plans decisions are taken, taking the decisions for the upper sca- tally and for transforming the impaired or disfunctionalized city parts and le planning into consideration; in North Planning Zone, planning decisions problematical areas into healthy and habitable spaces. Urban transformati- which would create an attraction center was not taken. Existing settlements on is the elimination of the problems which impair the texture of a city. were improved taking the year 2020 as a target and special product areas were preserved. Almost 70% of the house inventory in Bursa is in the unlicensed constructi- on status and 80% of these buildings, differing from other metropolises, are Planning Zone : 10.647 ha. illegal buildings on shared plots instead of shanty houses. At the eastern and Population : 63.945 persons northern parts of the city such constructions are highly common, the sub- Housing Area : 421 ha. standard housing areas are extensively densed at both sides of narrow stre- Business Areas (Trade + Industry) : 78 ha. ets with rare social facilities. Furthermore, impaired areas become gradually more at the city center. In these unhealthy urban spaces which constitute 7.3.6. 1/25000 SCALE EAST PLANNING ZONE LAND USE PLAN almost 70% of the city texture, Urban Transformation is used as a helpful tool.

While the plans decisions are taken, taking the decisions for the upper scale Metropolitan Municipality of Bursa adopted a Urban transformation unders- planning into consideration, in North Planning Zone; rural developments are- tanding which is not only the transformation of the physical environment but as and business areas where there is no contaminating activities takes place to be handled with social and cultural aspects and having the basic princip- were formed in consideration of the water basins and the characteristics of les of a health city the area. Equal sharing Planning Zone : 5.406 ha. Transparency Population : 20.025 persons Rightful management Housing Area : 97 ha. Consensus and participation Business Areas (Trade + Industry) : 231 ha. and shapes the future of Bursa by creating healthy living spaces with trans- 7.4. URBAN TRANSFORMATION PROJECTS formation projects implemented on a 200 ha area which is socio-culturally, economically and physically impaired. Metropolitan Municipality of Bursa which paves its way for establishing a modern and a healthy city with urban transformation projects, historical he- ritage preservation and sustenance projects, recreational projects, sports facility projects aims to generate the highest level of living spaces for its citizens and a high quality life for everyone in line with the sustainable de- velopment principles. It is intended to cause the development areas have habitable environments and integration of any kind of urban services with the spaces constituted thereof, enabling participation to large scale reinfor- cement and implementation process adapting the same principles for the constructed areas and not to ignore the city aesthetics and visual images.

Metropolitan Municipality of Bursa continues its efforts seeking solutions for the processes which have negative impact on the city and city life naturally, socially, economically and culturally. These projects aim to create higher quality environments, urban transforma- tion, reinforcement, preservation of historical and cultural heritage and reha- bilitation of the environment. 081 BURSA CITY HEALTH PROFILE 7.4.1. URBAN TRANSFORMATION PROJECT AREAS

7.4.1.2. Sıcaksu Urban Transformation Project

19,8 ha area known as Leather Manufacturers Area and which served le- ather industry for long years lost its function since the industrial facilities moved to other places and has become a place of impairment at the city center. The project primarily aims to prevent environmental pollution due to evacuated and destructed buildings which has become an impairment area at the city center and to clean up the transformation area.

7.4.1.3. Santralgaraj Urban Transformation Project

The project area of 12 ha involves Hocahasan, Ahmetpaşa, Çırpan, Ulu and Kırcaali streets. The area involves a retail trade which evolved parti- cularly due to the light rail system station and unplanned constructions and dated building stock. The project to be implemented will enable the existing trade system to continue under a renewed shelter and also will be developed in a manner to include modern office units which Bursa seriously needs. The efforts on the project continue.

7.4.1.4. Yalova Highway Urban Transformation Project

Project includes an area with a lenght of approximately 2739 kms with 160 ha surrounded by Nilüfer River at the north, and İzmir-Ankara high- way at the south. Yalova Highway was announced as an Urban Transfor- mation and Development Area since urban areas in required amounts could not be obtained with the public improvement works and illegal ho- usings could not be prevented and activites which impair city hygiene continue in this area. Efforts on the project still continue. GREEN FIELDS, SPORTS FIELDS AND RECREATIONAL PROJECTS

In order to support the identity of Bursa which inscribed its name “Gre- en Bursa” into history with golden letters sports areas and recreational projects are being implemented. The objective is to increase the green fields in Bursa in general by 2.500.000 m2. Thus while the green field per capita was 1,87 m2 according to 2004 data, this figure will be increased up to 7,32 m2 per capita as a result of the on going project studies.

082 BURSA CITY HEALTH PROFILE Taking into consideration the interaction of physical environment with social health and its importance to create healty societies and the need to develop healthy generations in order to develop a healthy future; the studies continue with an objective to built Regional sports complexes in 3 central districts A swimming pool for each district A sports area for each street Sheltered sports halls for 20 schools with an intention to serve each point of the city and the city will gain a total of 100 ha sports facilities at the end.

7.5.1. Bursa Stadium

In Bursa Stadium which was designed in accordance with UEFA standards, the objectives were enlarged and redesigned to be built on a 400.000 m2 area with a capacity of 43.000 spectators as an outcome of the accomplishments of Bursaspor. The stadium is projected with modern architecture concept desig- ned in form a crocodile which is the symbol of Bursaspor will involve special watching points for the disabled will become a living center with environmental planning’s.

083 BURSA CITY HEALTH PROFILE PROJECTS FOR CONSERVATION AND SUSTENANCE OF HISTORI- PROJECTS FOR CONSERVATION AND SUSTENANCE OF HISTORICAL CAL AND CULTURAL HERITAGE AND CULTURAL HERITAGE

Deep-rooted history, cultural heritage and “Living Museum City” identity of Historical Bazaar and Khans Region Urban Design Project (Osmangazi) Bursa which housed many civilizations for centuries are reshaped with res- Application to UNESCO List of World Cultural Heritage for Historical Bazaar toration projects. When the projects which will raise the historical texture of and Khans Region (Osmangazi) Bursa are completed a substantial bridge will have been built between the Restoration of Historical Bursa City Walls (Osmangazi) past and the future of the city. Metropolitan Municipality of Bursa accomp- Kütahya Khan Restoration Project and Kütahya Khan Vicinity Reinforce- lishes the project with broadest scope ever implemented to make Bursa a ment Project (Osmangazi) living, active city of history .Metropolitan Municipality of Bursa which produ- ced 250 projects in the last year in order to reveal the historical and cultural Eskişehir Khan Restoration Project (Osmangazi) heritage also continues its efforts on concept projects to bring the historical Emir Khan Survey – Restitution Projects (Osmangazi) bazaars and khans region where no efforts were made for the last 25 years İpek Khan Survey – Restitution -Restoration Projects (Osmangazi) into open. The projects by Metropolitan Municipality of Bursa concerning the Emirsultan Bath Restoration Project (Yıldırım) preservation of historical and cultural heritage and establishment, renewal Mahkeme Bath Restoration Project (Osmangazi) and restoration of social facilities, parks and recreational areas are given as Tahirağa Bath Restoration Project (Mudanya) follows: Hamamlıkızık Bath Restoration Project (Yıldırım) Davutpaşa Bath Restoration Project (Osmangazi) Kayhan Bath Restoration Project (Osmangazi) Muallimzade Bath Restoration Project (Yıldırım) Hasanbey Bath Restoration Project (Mudanya) Cık Cık Bath Restoration Project (Osmangazi) İncirli Bath and SMO Building Restoration Project (Yıldırım) Reyhanpaşa Bath Restoration Project (Yıldırım) Çandarlı İbrahimpaşa Bath Restoration Project (Osmangazi) Fabrika-İ Humayun Restoration Project (Osmangazi) Çobanbey Old Plant Buildings Restoration Project (Yıldırım) Yeşil Poor House Simple Renovation Project (Yıldırım) Çukur Mescid Restoration Project Emirsultan Feyzullahpaşa Mescidi Restoration Project (Yıldırım) Yıldırım Mosque Minarets Reconstruction (Yıldırım) Kiremitçi Sinan Bey Mosque Restoration Project (Osmangazi) Yaylacık Village Mosque Restoration Project (Nilüfer) Yahudilik Synagogue Survey and Repairment of Annxes (Osmangazi) Fidyekızık Konak Restoration Project (Yıldırım) Barakfakıh Registered Building Restoration Project (Kestel) Boyacıkulu School Restoration Project (Yıldırım) Gürsu Water Mill Restoration Project (Gürsu) SMO Building Opposite Ördekli Bath Restoration Project (Osmangazi) Hünkar Mansion Annexes Reconstruction Project (Yıldırım) Mudanya Old Olive Bazaar Design Project (Mudanya) Muradiye Head Stones Outdoor Museum (Osmangazi) Akçalar Aktopraklık Archeopark Project (Nilüfer) Gemlik City Walls Restoration Project (Gemlik) 084 Kestel Castle Environmental Planning and Cafeteria Project (Kestel) BURSA CITY HEALTH PROFILE 085 BURSA CITY HEALTH PROFILE SOCIAL FACILITY PROJECTS Yıldırım (Mimar Sinan) Women Clubhouse Project (Yıldırım) Yıldıztepe One-Day Facility Project (Mudanya) Atatepe Social Facilities Project (Gemlik) Zoo Africa Cafe and New Construciton Projects Kestel Sports and Disabled Clubhouse Project Narlı Social Facilities (Gemlik) Özlüce Mosque Cafeteria and Environment Planning Projects (Nilüfer)

PARKS AND RECREATIONAL AREA PROJECTS Hüdavendigar City Park Project (Osmangazi) Botanikpark Climbing Park Project Bakacak Environmental Planning Project River Restoration Project at the back of Şevket Yılmaz Hospital Beşevler Su Deposu City Park Project Tekel Building and Vicinity Urban Design Project Kurşunlu Kumsaz Regional Park Project Gemlik Square Restoration Project Gemlik Çarşı River Restoration Project Mollafenari, Üç Kuzular, Somuncubaba Mosques Environmental Planning Projects Ertuğrul Gazi Street Water Reservoir Environmental Planning Project Karabalçık Village Square Restoration Project (Osmangazi) Gölbaşı Recreational Area Project Karıncadere Park Area Restoration Project Gökdere Kurtuluş Street Restoration Project Namazgah Park Urban Design Project Children Play and Recreational Park next to Food WholeSellers Market (Nilüfer) Soğukpınar Village Park Project Zeytinlik Mosque Environmental Planning Project (Osmangazi) Yunus Emre Street Park Project (Yıldırım) Kültürpark Gaziakdemir and Çakaldere Entries Road Project (Osmangazi) Güzelyalı Municipality Service Building Area Restoration Project Yerkapı Urban Design and Yokuş Street Restoration Project Altıparmak-SGK square Urban Design Project 086 BURSA CITY HEALTH PROFILE 8. TRANSPORTATION AND PUBLIC TRANSPORTATION 8.1. ROAD, SEA AND AIR TRANSPORTATION

8.1.1. ROAD TRANSPORTATION Road network in Bursa consists of freeways, state roads, city roads under the supervision of Highways 14th Regional Directorate and the main traffic arterial roads and side roads under the supervision of Metropolitan Municipality of Bur- sa. 80% of the roads are of urban road quality. Since a part of the interurban roads are occupied by the parking cars, the roads operate inefficiently. There are no pavements at the majority of the side roads in the city due to unplanned cons- tructions. Some of those are narrow roads with a width of 4 mts and have a slope of more than 10%. There is a freeway within the borders of Bursa destined from Ankara to İzmir. There are connections to Bursa orbital motorways and main traf- fic arterial roads at five connection points. Taking the existing settlement status of Bursa, main arterial road which is East_West axis pass through Nilüfer, Osman- gazi and Yıldırım. This axis at the same time is used for Ankara-İzmir direction. There are two main road connections from this East-West axis through north. One of them is destined for Mudanya through Northwest direction. The other reaches to Kocaeli and İstanbul through Gemlik and Yalova in the northeast direction.

Another axis which starts from Osmangazi goes to Uludağ which has the most significant infrastructure for winter sports in our country and located at the south of the city center. This road is extensively used particularly in winter time. The immediate orbital motorway passes through Osmangazi and Yıldırım Districts. This road is directed from East to West and relieves the interurban traffic. Cont- rary to Ankara-İzmir motorway, immediate motorway does not have underpas- ses but signalized cross-roads.

In Bursa city center Cumhuriyet Street, Cemal Nadir Street, Atatürk Street and İnönü Street operate as one way roads. Also in many small streets between the- se streets at the center the traffic moves one-way.

087 BURSA CITY HEALTH PROFILE 8.1.2. SEA TRANSPORTATION (BURSA FAST FERRY STATION)

Sea transportation in Bursa is provided from the Mudanya Güzelyalı Station. For long years sea transportation of Bursa passenger and vehice traffic was provided through Güzelyalı Seaport. Expeditions were launched in İstanbul – İmralı – Gemlik - Mudanya direction with the passenger ferries of Maritime Lines till 1997 and İstanbul Deniz Otobüsleri A.Ş. (IDO) started regular trips thereafter. The trip from İstanbul to Mudanya with passenger boats which lasted for almost 4 hours was reduced down to 75 min with fast ferries. Bursa Ferry Station is designed suitable for 4 ferries with lengths respectively 59,9 mts and 86,6 mts and width 17,5 and 24 mt respectively. Station car park has a capacity for 500 cars. The fast ferry expeditions are organised by IDO from Güzelyalı to Kadıköy-Kabataş and Yenikapı. Fast ferries with a capacity of 225 vehicles and 1200 passengers serve in the İstanbul-Bursa direction.

İDO Fast Ferry Destinations (İDO) The durations of Bursa-Kadıköy-Kabataş fast ferry expeditions; Kabataş-Bursa: 2 hours; Kadıköy-Bursa 1h 15 min. Bursa Fast Ferry station There are public transportation vehicles serving from Bursa fast ferry station to city center, Bursaray Organized Industry Area, Bus terminal and to univer- sity according to the expeditions of IDO. 088 BURSA CITY HEALTH PROFILE 8.1.3.AIR TRANSPORTATION (YENİŞEHİR AIRPORT)

In the airport located 10 kms at the west of Yenişehir District, the utilization area of the terminal is 5600 m2 including domestic and international open public spaces and has a passenger capacity of 1.500.000 passengers/year. It also has a cargo building with 9460 m2 closed area and 8 chilling rooms with a capacity of 115 m3 each and a car park with an area of 10.000 m2.

On 21.05.2001 the Council of Ministers issued a decree with nr: 2001/2444 to declare Bursa-Yenişehir Airport as a permanent passenger entry-exit air border check point. Thus Yenişehir airport was allowed for international air traffic. Flights to Ankara by Anadolu Jet which is a subsidiary of THY was started on 02.04.2010 and the airport serves to domestic scheduled flights with bilateral flights scheduled four times a week (Monday, Wednesday, Thursday, Saturday). Thus there are indirect flights to all cities with transfer in Ankara and to some international points.

Besides, once a week (Tuesday) there is a bilateral flight to Dusseldorf Öğer Tur with airplanes of Germania Fluggesellschaft since 30.03.2010.

Borajet started scheduled domestic flights on 20.07.2010 and thus direct flights to four domestic points to Adana, Şanlıurfa, Samsun and Trabzon and also to Skopje. On 02.08.2010 Lufthansa started bilateral Munich flights three times a week and thus it is possible to have indirect flight oppor- tunity to many points outside the country with Lufthansa through Munich.

Other than the aforementioned flights; VIP flights, military flights, parachute flights, pilot training flights, business flights, ambulance flights etc. are frequently made from the airport since it was first established. Transportation from Yenişehir Airport to the City: Transportation from the airport to the city is provided by public transportation vehicles. Also Airport Taxi and Airport pick-ups serve for 24 hours for private use. Public Transportation Vehicles serve with line number 80 for 9 tours a day destined from the airport to the Interurban Bus Terminal.

089 BURSA CITY HEALTH PROFILE 8.2. PEDESTRIAN AND BICYCLE TRANSPORTATION Concerning the solution for the transportation and other problems of our disabled citizens; car parks for the disabled, markings intended for giving in- 8.2.1.BICYCLE TRANSPORTATION formation at the pavements and other facilities. In 23 Bursaray Stations 70 elevators intended for there disabled were With the bicycle tracks built by the Metropliatn Municipality on İzmir High- built. way and Mudanya Road and the bicycle tracks built on either single or on both sides of the roads with a width over 10 mts constructed by Municipality Ramps and elevators intended for the disabled were built on the newly of Nilüfer, a bicycle path of 59 kms was constructed in Nilüfer. projected footbridges. (Terminal Footbridge, Footbridge in front of Anatolian High School, Acemler Footbridge, Nilüfer Carrefour Footbridge, Merinos Footb- Among the Bursa Light Rial System stations, K.Sanayi, Ataevler, Beşevler, ridge). FSM, Nilüfer, Karaman, İhsaniye, ESentepe, Hamitler, Organize Sanayi, Acem- 85 low-based public transportation vehicles serve for the disables citizens ler has bicycle parking points and also bicyle parking points are planned for in 38 lines. It is planned to purchase all new buses suitable for the disabled. the BLRS III Phase stations. Within the scope of article four of “METROPOLITAN MUNICIPALITY OF BURSA PUBLIC TRANSPORTATION VEHICLES TRANSPORTATION CARDS IMPLEMENTATI- 8.2.2.PEDESTRIAN TRANSPORTATION ON REGULATION” prepared according to law nr: 4436; a total of 6891 free- pass for the disabled (with 40% disability rate) and 1559 free pass were The pavements in the city center can not be built sufficiently wide due to the given to escorts of the disabled (with disability rate of 50% or more) as of extensive historical texture, narrow streets of the old city and extensive ho- November 2010. usings. Extensive pedestrian traffic can be observed particularly on streets and squares allocated for pedestrian traffic. It is planned to allocate Cumhu- riyet Street for tramcar and pedestrian traffic.

8.2.3.TRANSPORTATION FOR THE DISABLED

Metropolitan Municipality conducts all the required studies to prevent the disabled citizens not to face any difficulties at the traffic and transportati- on. Studies to transform the pavements and transportation vehicles eligible for use by the disabled citizens rapidly continue. Some of the studies are as follows: Signalized cross-roads equipped with sound alarm system intended for the disabled citizens: 106 Altıparmak Emniyet, 107 Altıparmak, 108 Altıpar- mak Arap Şükrü, 105 Zafer Plaza, 147 Cemil Nadir Yaya, 102 Fevzi Çakmak Yaya, 116 Çekirce cad. İntam, 117 Çekirge cad. Karagöz, 121 Zübeyde Hanım, 148 Cumhuriyet cad. Yaya, 149 İnönü Cad. Yaya, 103 Şehreküstü Meydanı, 201 Setbaşı, 202 Yeşil, 151 Adliye Yaya, 316 FSM Bulvarı Hastane, 109 Stad- yum, 155 Haşim İşcan Yaya, 261 Eşrefiler cad. Yaya, 162 Kapalıçarşı Yaya.

090 BURSA CITY HEALTH PROFILE 8.2.4. EDUCATION AND TRAINING ON TRANSPORTATION Private Public Transport Vehicles to be operated by private or legal entities Metropolitan Municipality of Bursa; has prepared the “Private Public Trans- being awarded the tender for performing public transport by our municipality portation Vehicles Regulation” in order for the public transportation services and/or their sub contractors. in the adjacent area and which are implemented by private sector other than Private Public Transport Vehicles having working permit registered with its own enterprises serial M from the municipality operating based on the decision of the metro- Be clean , technical and economical politan municipal council dated 07.08.2002 with nr. 161. Be integrated under the management, operation and supervision Private Public Transport Vehicles having working permit registered with organisation serial M from the municipality operating based on the decision of the metro- politan municipal council dated 07.08.2002 with nr. 162 Be in coordination with the public transport services given by Public Trans- portation Branch Directorate Legal Supports of this regulation are: To specify under which conditions and how those vehicles operate, rela- Metropolitan Municipalities Law Nr: 5216 tions between the entrepreneurs and the corporations benefiting from those services, authorities and responsibilities of the establishments and organi- Municipal Law Nr: 5393, zations which will execute and audit the application. High way Traffic Law Nr: 2918, Misdemeanour Law Nr: 5326, Law Nr: 4736 and attached bylaws (Cards with reduced rate or free of charge) Free Travel Cards Regulation, Decisions of the Metropolitan Municipal Council dated 07.08.2002 with nr: 161 and 162 Decision of Provincial Commission of Traffic dated 23.10.2002 with nr: 121, 02.04.1986 tarih ve 10553 sayılı Bakanlar Kurulu’nun Ticari Plakaların verilmesine ilişkin Usul ve Esaslar Hakkındaki Kararı

EĞİTİM: Özel Toplu Taşıma Araçlarında çalışan sürücüler belediye tarafından belir- lenecek ve önerilecek eğitim programına katılmak zorundadırlar. Bu eğitimle- re katılmayan sürücüler işletici araçlarında çalıştırılamaz. Araç sürücüleri, yılda 6 kez Belediye tarafından düzenlenecek eğitim se- minerin en az 3’ üne katılmak zorundadır.

“Private Public Transportation Vehicles Regulation” includes Council of Ministers Decree Concerning the Procedures and Principles for Granting the Commercial Licence Plates dated 02.04.1986 date with nr 10553 091 BURSA CITY HEALTH PROFILE TRAINING:

Drivers of the Public Transport Vehicles are obligated to attend the training programmes to be specified and offered by the municipality. The drivers failing to attend such courses are prohibited to work at these vehicles. The derivers shall attend at least 3 out of 6 training seminars to be organized by the municipality. At the end of the training seminar, the owner and driver of the vehicles will be subject to an exam. The drivers accomplishing the exam will be granted a Vehicle Driver Identity Card which will be valid for 5 years.

SUPERVISION: The vehicles of the operator shall be subject to audits by the following authorities in accordance with this regulation Transportation Department Public Transport Brach Directorate Municipal Police Department Auditing Branch Directorate The operators failing to comply with the provisions of this regulation and subject to monetary fines and points reduction penalty and the drivers are sub- ject to points reduction penalty During the audits, the operator who is in default may be subject to verbal or written warnings by the authorities at any time. The operator in breach of this term of reference shall be subject to monetary and point reduction penalties according to penalty scheme at the same time.

8.3. PUBLIC TRANSPORTATION SYSTEM UTILISATION RATES The table and graphic for all types of transportation including interim public transport data are as follows in general:

Table 8.1. Average Daily Passenger Distribution between November 2009- October 2010

TOTAL DAILY PASSENGER DISTRIBUTION Number of Vehicles Number of passengers Passenger% BursaRay 48 143.936 8 Bus 736 356.542 20 Minibus 1.034 206.800 11 Service 2.699 215.920 12 Services with route permit 1.011 50.550 3 Dolmush 702 70.200 4 Taxi 783 15.660 1 Private Cars 213.697 747.938 41 TOTAL 220.662 1.807.547 100 092 BURSA CITY HEALTH PROFILE 45%

40%

35%

30%

25%

20%

15%

10%

5%

0% Bursaray OtobüsBus MinibüsMinibus ServiceServis GüzergahService İzin Bel. DolmuşDolmush TaksiTaxi PrivateÖzel Araç Cars with routeServis permit

Reference: (Metropolitan Municipality of Bursa Transportation Department)

093 BURSA CITY HEALTH PROFILE 8.3.2. WALKING DISTANCES IN PUBLIC TRANSPORTATION

Distances between each Bursaray station is about an average of 1 km. The locations of stations are specified according to the areas of usage around, the structure of streets and existing usable lands. In practice, the distance between the stations is a function of ava- ilability of areas of usage and ease of access to the settlement in the vicinity and the lowest limit is about 600-800 mts. between the stations. The distances between the stops of rubber-wheeled vehicles is ab out 300-500 mts depending on the intensity of pas- sengers and physical conditions.

8.4. OTOP CAR PARK UTILISATION

In line with the intensive private car usage in Bursa city center the- re is a huge need for car parks. Roadside parking lots at the city center are operated by BURBAK A.Ş. which is monitored by the Metropolitan Municipality. Furthermore, there are car parks which serve as open and multi-storey car parks operated by private en- terprises.

094 BURSA CITY HEALTH PROFILE 8.5. RAIL SYSTEMS Public transportation with rail system is performed with Bursaray which is in the body of BURULAŞ. The data concerning the average daily number of passen- gers for Bursaray Public Transport System between November 2009-October 2010 are given as follows:

Table 8.2. Public Transport Data with Rail System

Annual Daily Average Number of reserve BURSARAY ENTERPRISE Number of Stations Number of vehicles Total Number of Vehicles Number of Passengers vehicles (week-days) BURSARAY 23 45 3 48 143.936

Reference: Metropolitan Municipality of Bursa Transportation Department

8.5.1. BursaRay Routes

Bursaray / Light Rail System Stage I which is operated is about 21,88 kms and starts from Organized Industry Zone on the road to Mudanya and intersects at Mudanya Road Cross-Roads with the route coming from Küçük Sanayi and then continues through Acemler, Sırameşeler, Merinos, Şehreküstü, Demirtaşpaşa, Gökdere, Davutdede, Duaçınarı, Yüksek İhtisas Hastanesi and ends at Arabayatağı Station.

The I Stage of Bursaray which is operated has three main lines: North Line starts from Mudanya Crossroad and goes through Mudanya which is about 4,8 kms consisting of 5 stations, 2 open-close tunnel pass crossroads, 2 ramps, 1 overpass with bridge.

West Line starts from Mudanya crossroads and goes through University of Uludağ with a length of 5,32 kms consisting of 5 stations, 2 open- close tunnel pass crossroads, 2 ramps, 1 overpass with bridge. East Line, starts from Mudanya crossroads and goes through Ankara Highway with a length of 12,49 kms consisting of 13 stations ( 4 underground and 9 at-grade ) and 1 overpass with bridge.

095 BURSA CITY HEALTH PROFILE 8.5.2. GENERAL ASSESSMENT ON STATION POINTS

Locations of Stations There are 23 stations in the system and 5 of these are underground and others are at-grade stations. The total length of two – line route is 21,88 kms and there are no at grade crossings in the system and therefore a privileged road for use of cars is allocated. There are 5 stations in İzmir Line at Küçük Sanayi, Ataevler, Beşevler, Fatih Sultan Mehmet and Nilüfer. There are 5 stations on Mudanya Line at Organized Industry, Hamitler-Fethiye, Esentepe, İhsaniye and Karaman. When the two lines combine on Ankara Highway route there are stations at Acemler, Paşa Çiftliği, Sırameşeler, Kültürpark, Merinos, Osmangazi, Şehreküstü, Demirtaşpaşa, Gökdere, Davutdede, Duaçınarı, Yüksek İhtisas Hastanesi, Arabayatağı.

On-goning investmens and planned investments for Bursa Light Rail System Bursa Light Rail System Project is a project constructed in stages. Stage I of BLRS is completed and operated and Stage II construction works continue. At this stage the existing BursaRay line which is on İzmir Highway with the lst station at Küçük Sanayi will be extended to the University of Uludağ. The length of the line is approximately 6,6 kms and there are additional 6 stations assumed on the line. Moreover, in Stage II the existing LRS line will be extended for about 2,5 kms from its last station at Organized Industry 1050 Konutlar on Mudanya Road and there are 2 additional stations are planned in this route. The length of railway platform is abut 120 mts and passenger platform has a width of 8,3 mts. Elevators for the disabled are planned for each station in Stage II.

BLRS (East) Light Rail System Line III starts from the existing Arabayatağı Station and ends at Kestel District. This new planned line which has a length of 7,08 kms will pass through the corridor allocated on the mid referee of Bursa-Ankara Highway. There are 7 stations foreseen for BLRS III East Line. The stations are planed at-grade and locations were chosen considering the crossroads, ramps, bridges, important settlements, streets and public establishments. Stations are underpass type and the entries are designed according to location of the stations. The length of the platforms are 120 mts and the width of passenger platforms is 8,3 mts. There are disabled elevators foreseen in the stations.

096 BURSA CITY HEALTH PROFILE 9. Social Services

Metropolitan Municipality of Bursa executes its duties for systematic and scheduled services for the elimination of mone- tary, moral and social deprivations arising out of the personal and environmental problems of the individuals and families or which arise out of their control; prevention and solution of social problems, improvement of their life standards, within the borders of its jurisdiction. The services rendered within this scope

Social Welfare Services Services for the Disabled Children and Youth Services Family/Adult Services

097 BURSA CITY HEALTH PROFILE 9.1. Social Welfare Services:

This includes the social welfare services and the assistance or cooperation of persons and organizations which will contribute to such services intended for persons who are in poverty and fail to meet basic needs and have difficulties to maintain their lives even at the lowest level or who suffered from natural disasters such as fire, earthquake, floods; prisoners, refugees and emigrants, as far as is allowed by the sources.

9.1.1. Educational Sets Aid: In 2010-2011 education year, 16750 needier students were granted education set aids (school bags and stationeries) with the cooperation in distribution by Provincial Directorate of National Education.

9.1.2. Supplies Aid The supplies are distributed in routine and collectively in Ramadan taking the needs of our citizens into consideration. In 2010, a total of 23.640 families’ received supplies aids which were brought to their homes.

9.1.3. Fuel (Coal) Aid In 2009-2010 winter period fuel (coal) aid was granted to a total of 7.237 families who fail to meet their requirements. In 2010-2011 winter period fuel (coal) aid will be granted to a total of 8.000 families who fail to meet their requirements. The distributions continue.

9.1.4. Public Soup- Kitchen Services During Ramadan, a total of 120.000 persons with a daily average of 4.000 were given iftar meals at the public soup-kitchen established in the Fevzi Çakmak multi storey car park. 48.000 citizens benefited from the iftar soups given at Kent Meydanı, Emirsultan Meydanı, Orhangazi Park, University of Uludağ and Merinos Park.

098 BURSA CITY HEALTH PROFILE 9.1.5. Property Aids

Since 2010, the families in need were given 81 pcs baby biscuits ( with an amo- unt of a food package), baby diapers, milk, 70 triple couches, 5 single couches, 14 carpets, 10 single beds, 3 twin beds, 3 twin bed base, 7 single bed-base, 1 twin sponge bed, 2 child bedsteads, 2 child beds, 21 ovens, 37 refrigerators, 1 refrigerator repairment, 10 washing machines, 1 washing machine repairment, 2 televisions, 1 electric water heater, 4 stoves, 2 bed stands, 1 vanity mirror, 1 two-wing wardrobe, 2 single–wing wardrobe, 2 large gas-filled tubes, 2 small furnaces, 4 drum heaters, 6 stove pipes, 1 stove elbow pipe, 1 dining table, 1 set of cookware’s, 1 set of dining plates, 1 set of cutlery were delivered.

9.1.6.Social Aids Distribution Centers

On site cloth, shoe, food etc. aids are realized at the addresses of our citizen who are in need within the scope of the center.

9.2. Services for the Disabled:

With the services for the disabled, it is aimed to reinforce the assistance and support to the disabled persons who live within the boundaries of the metropo- litan Municipality and to ease the adaptation of the disabled into social life and to create a social structure which will encourage the protection of their rights. The disabled citizens are given priority in the social services and monthly co- ordination meetings are held with the disabled associations within the scope of services for the disabled. The studies to prepare a Bursa Disabled Inventory are going on. In the future period, it is planned to make studies on establishing a Disabled Service Center.

The disabled citizens have priority to get their food, fuel, educational materials and various aids in-kind (assistance devices, tools and equipments) within the scope of Social Welfare Services. In 2010;

1.000 food packages were personally delivered against signature at the resi- dential addresses of the disabled.

099 BURSA CITY HEALTH PROFILE 800 families which have a disabled member were given coal aids.

46 battery-operated wheelchairs, 1 battery, 9 manual wheel-chairs, 1 ma- nual wheelchair for children, 1 cerebral pulsy pushchair, 1 patient toilet chair, 1 pair of polyethylene mold, 2 air-beds, 2 patient beds, 3 eyeglasses, 3 batteries for hearing instrument, 20 probes and 20 probe bags, 3 pairs of orthopedically shoes, 1 pair of orthopedically shoe sole, 1 pair of varsity sock, 38 patient di- apers / wet wipes / towel napkins, 1 orthopedically adjustable child seat with table, 1 chargeable battery compartment, 1 blood metering rod were given and maintenance of 1 battery-operated wheelchair and repairment of 2 battery-ope- rated wheelchair and 1 double arm prosthesis were done by us.

7 coordination and assessment meetings were held with public establish- ments and Non-Governmental Organisations in 2010.

The studies on the preparation of a Bursa Disabled Inventory which started in 2007 still continue.

The efforts on the Preparation of Bursa Disabled Inventory was started on No- vember 2007 with an aim to determine the number of the disabled in 7 central districts of Bursa (Osmangazi, Nilüfer, Yıldırım, Gürsu, Kestel, Mudanya, Gemlik) and to compose a database of the socio-demographical information including data on disability classification, age, gender, education, income, occupation and communication. It is aimed to plan the Services for the Disabled based on scientific and statistical information as a result of the need assessment to be executed based on this database.

In order to extend this study for thr preparation of Disabled Inventory to wi- der masses announcement materials such as leaflets, banners, bill-boards and overpass coverings were used at the beginning of 2010.

Within the scope of studies for the preparation of Bursa Disabled Inventory in 2009-2010 1526 disabled citizens completed the Disabled Social Research Form and registered and 4584 disabled persons were registered from the begin- ning of the study.

0100 BURSA CITY HEALTH PROFILE 9.3. Children and Youth Services: It is aimed to protect the bodily and mental health’s, to support the cultural improvements of and to educate and to give skills to the children and young- sters residing within the boundaries of the Metropolitan Municipality of Bursa. A Children Center was opened on 04th March 2009 within the scope of “ EU Financial Cooperation Support Project for the Solution of Socio-Economical Problems Originating From Migration”.

9.3.1.İGEP (Domestic Migration Integration Project)/Children Center

IGEP which is based on EU Accession Framework is a project which aims to provide technical support for the socio-economical integration problems in the large cities which receive intensive domestic migration Ankara, İzmir, Bursa ve İstanbul). The project, focuses particularly on the socio-economical integration for the long term planning of the services rendered by the Metropolitan Municipaliti- es, and aims to make the required capacity increase for the execution of their duties. What is important is the improve the strategically planning process at Metropolitan Municipality level however the point of focus is not to prepare a full Strategically Action Plan for all the sectors in the municipalities. The objective of planning activities is to support the improvement of the socio-economical and environmental conditions of the groups who are less integrated with the society in the metropolis or who are most disadvantageous.

At the same time, the project aimed to make an intervention in the social life by establishing pilot “child centers” which aim to serve the children who are most affected and live at the streets and/or work with properly trained personnel. 1st component of the project “Strategically Action Planning and Opera- tional Programming” studies including in the scope of the enhancement of the capacities of the municipalities were executed by the Work Groups with coordination of Project Coordination Unit established within the metropolitan Municipality.

By virtue of participative approach and except the corporate plans of the respective organizations, it was aimed to establish a multi sectoral plan intended for the solution of “migration, urban poverty and integration and participation to work groups from the relevant units of the metropolitan Municipality, Go- vernorship, Special Provincial Administration, District Municipalities, NGO’s and universities was ensured. The work groups composed within the 1st component of Project;

1. Social Services and Health 2. Employment and Income Generation 3. Education and Culture 4. Urban Services and Environment 5. Coordination and Governance between Sectors

Work groups which convened for the first time in 25th-26th June 2009 initially worked as an opinion exchange platform and enabled the sharing of the offers on the subjects concerning the project at technical level. Work Groups were considered as platforms that have different duties and activities. For each activity, the representatives of public establishments and other stakeholders were separately grouped and they completed their duty to establish a Strategically Action Plan for Bursa. The project ended in June 2010. A Strategically Action Plan was prepared in 1st component “Capacity Improvement” and 20 personnel received education on various subjects and maps of the disadvantageous groups were prepared and the needs analysis of Bursa was made. 2nd component of the project has foreseen a specimen child center aiming particularly the children working or under risk to work at the streets.

0101 BURSA CITY HEALTH PROFILE Since the time the center was opened, 2147 children were registered.

Children Center Service Headlines: Protective and Preventive Activities Social Awareness and Introduction of the Center Physco-Social Guidance Intended for the Child and Family, Consultancy and Support Services Health Services Self Care Services ( Feeding and Cleaning Services) Education Support Services (School Etüt Desteği - Bilgisayar - İngilizce) Social Welfare Services Intended for Child and the Family Social and Cultural Activities (Music - Handicrafts – Drawing – Theatre Chess – Folk Dances – Picnic and Travels etc.) Sports Activities (Football - Basketball – Taekwondo – Table Tennis - Sports Tournaments)

0102 BURSA CITY HEALTH PROFILE Below activities were performed since 2009: Social research was performed for 120 families. Participation to Bursa Region State Symphony Orchestra Concert and Ballet Performance was provided. 19th May Commemoration of Atatürk, Youth and Sports Day activities were performed in front of the Children Center. City Museum was visited in the 18 – 24th May Museums Week. Academic personnel commissioned at University of Houston Social Services Institute visited our center in May. A seminar was held on “Waste materials and Recycling” within the scope of activities for June 5th Environment Day. Support for “Children of Love” was given within the scope of activities organized by the governorship. Model Plane Making Workshop was done by Turkish Aeronautical Association Children Center Sports Festival was organized within the scope of sports activities. “School Reports Festival” was organized after the schools were closed for summer. 109 kids learned their blood groups as a result of Blood Group Determination studies within the scope of health activities. The center was introduced to teachers at the schools around the center within the scope of cooperation with the schools in the vicinity. “Hygiene Training” seminar in October and “Swine Flu” seminar in November was held within the scope of health activities. University of Uludağ Animal Hospital was visited on 4th October Animal Protection Day. “Children Rights” seminar was held intended for Children Rights. As of October, Drama trainings’ started to be given on Saturdays. These activities ended as of May 2010. “Fire Training and Exercise” was performed in October. Participation was provided to “14th International Bursa Children and Youth theatres Festival” on 24th October 2009. 29th October Republic Day Ceremony was performed. 10th November, Commemoration of Atatürk Programma was organized. On 11th November 2009, Regina de DOMİNİCİ, Assistant for UNICEF Turkey representative made a visit to Childen Center. Participation was provided to “4th International Silk Road Film Festival” between 14-22th November 2009. “Children Rights Day” programme intended for Children Rights was organized on 20th November 2009. Barbering service was given to boys for two months between October-November. Children Center basketball field started operation as of December. Participation was provided to 13th International Bursa Karagöz, Puppet and Shadow Plays Festival” between 07-12th December 2009. Participation to “Social Working Symposium with Children and Youth under risk” was provided on 16-17th December 2009 within the scope of “Support Project for the Solution of Migration originated Social and Economical problems in Ankara, Bursa, İstanbul and İzmir” A visit to children center was made with the participation of Prof. Dr Sevil ATAUZ and Prof. Dr. Suna TANELİ and the experts which came from İstanbul, İzmir and Ankara within the scope of “Support Project for the Solution of Migration originated Social and Economical problems in Ankara, Bursa, İstanbul and İzmir” Hünkar Köşkü Museum visit was made with the participation of approximately 100 children. 0103 BURSA CITY HEALTH PROFILE Zoo visits were made at suitable times during the year. Photograph training was given to 15 children working at the streets by BUFSAD and a photograph exhibition was held in Artist Şefik Bursalı Art Gallery in March 2010. Tiling training was given to 15 children working at the streets by BUSMEK and a tile exhibition was held in Artist Şefik Bursalı Art Gallery in May 2010. A visit to the Children Center was made with the participation of Paul de Vitte, Belgium Ambassador and his wife. Children Center Chorus attended the 23rd April Children Festival programme organized by Zoo Management. 18 children attended Wire Car Course which was organized with the cooperation of BEGEV-BUTGEM in July 2010 within the scope of “We Raise the En- gineers of the Future” Project. Approximately 250 children found the opportunity to be trained on swimming, basketball, volleyball, wrestling in the 2010 summer courses with the cooperation of Belediyespor. Participation was provided to the activities organized by the Governorship within the scope of Fighting against Child Labor day on 12th June 2010. 14 children registered to Children center attended the Youth Camp traditionally organized each year by City Volunteers between 15/07/2010 – 22/07/2010. A total of 97 children attended the zoo visit made on 03-04.08.2010. 26 children registered to Children Center, 17 parents and 2 personnel attended the Blue Tor Public Trips in the Gulf on 06/08/2010. 44 families registered to Children Center were given 44 food packages from the aid package distributed during Ramadan. “Emergency Aid and First Aid” seminar intended for the personnel of Children Center was held by Dr Nurten Türksoy who is commissioned at Sanitary Affairs Department on 16/09/2010. A total of 60 children registered at the children center participated basketball, volleyball, tennis and karate courses in the scope of the Büyükşehir Belediyespor “Winter School” programme on 06/11/2010. Winter Schools will continue at weekends until 09.01.2011. A seminar on “Mouth and Dental Health” was held by dentist İnci Güçüşten on 23/11/2010. A total of 120 children participated the seminars organized at the Children Center Seminar Hall with the support of Chamber of Dentists due to Mouth and Dental Heath Week. “World Children Rights “Programme organized by Children Rights Provincial Adults Committee was held on 26/11/2011 in Merinos Atatürk Congress and Culture Center Orhangazi Hall. The children center attended the programme with the Children Center Chorus. A seminar on “Children Rights in Islam” was held in Children center seminar hall on 29/11/2010. Seminar was given by Provincial Assistant Mufti Suzan Yıldırım and 30 families participated. On 30/11/2010 international news channel Euronews which was reporting news on the EU projects shouted a programme at the Children Center. Children center continues it activities with 1 sociologist, 1 Child Development Expert, 1 Computer Operator, 1 Nurse, 2 Cleaning Personnel, 5 Security Personnel.

0104 BURSA CITY HEALTH PROFILE 9.4. Family and Adult Services The aim is to protect the entirety of the family and to improve social welfa- re, enforcement of potential of the adults to become an individual and to enable their social alignments and protection, support and reinforcement against economical, social, cultural and physiological problems.

9.4.1. WOMEN’S SHELTER PROJECT Women Shelter construction made with the cooperation of Ministry of In- ternal Affairs and General Directorate of Local Administrations is comple- ted. Furnishing process continues. The secrecy and being kept confiden- tial of the building which was established in Bursa/Nilüfer District is so important. Target of the project; 1. Component: Construction of eight separate women shelters projected to serve at best conditions in eight cities (Ankara, Antalya, Bursa, Eskişe- hir, Gaziantep, İstanbul, İzmir, Samsun).

2. Component: Monitoring the manufacturing process of constructions

3. Component: Furnishing of the women shelters in a manner to meet the needs of the women and children who will live there.

4. Component: “Project for Improvement of Protection Services Intended for Women”: Commissioning the shelters which are ready to operate with the special trained personnel, improvement of sheltering services inten- ded for women in aforementioned cities and to improve delicacy of the public.

0105 BURSA CITY HEALTH PROFILE Parties of the Project; Women Shelter Project is executed by the Ministry of Internal Affairs General Directorate of Local Administrations with the financial support of European Union and technical support of United Nations Population Fund.

The architectural project was realised by the Ministry of Internal Affairs by receiving consultancy from United Nations Population Fund and three women associations specialized on women consultancy center’s and women shelter services. Tender for construction was realized by Under secretariat of Trea- sury, Central Finance and Contracts Unit. “Improvement of Protection Services Intended for Women Project” which is the fourth component of the project is executed by the Project Coordination Unit constituted by United Nations Population Fund – UNFPA. This Coordination Unit is commissioned in Ankara at the Ministry of Internal Affairs head office. All the organizations offering services intended for women who suffer from violence shall benefit from the educations to be given in the scope of the project. Duration and Budget of the Project; Total budget of the Women Shelter Project. is 11,8 million Euro. Approximately 20% of this budget intended for construction, building audits and furnis- hings is allocated from the budget of the Ministry of Internal Affairs. Project Partners; The project is executed by the General Directorate of Local Administrations and Metropolitan Municipality of Bursa with the financial support of European Union. Metropolitan Municipality of Bursa shall be responsible for the operation of Women Guesthouse. Services given by the Women Shelter with a capacity of 20 women (also children can accommodate, the number of children is not included in the given figure)

1. Health Services 2. Feeding Services 3. Social Welfare Services 4. Personal care Services 5. Psycho-Social Support Services 6. Socio-Cultural Services 7. Preschool Education Services 8. Guidance and Consultancy Services 9. Educational Services (Reading-Writing-Vocational Education etc), 10. Security Services 11. Monitoring and Assessment

0106 BURSA CITY HEALTH PROFILE 9.4.2.Shelter House Service: Such like every year, in November 2010 a women shelter was put into servi- ce at the Refectory next to Former Rural Services Provincial Building on the highway to Ankara by the Metropolitan Municipality of Bursa intended for the accommodation of our citizens who are homeless and aggrieved at the streets. All kinds of support are granted for meeting the daily requirements of individuals at the women shelter which shall serve till the end of winter. 220 persons benefited from the shelter house and 178 persons stay in the shelter for the time being. The service is given 24 hours a day with 1 ambu- lance, 1 private car, and 23 personnel being 1 shelter house responsible, 1 worker, 1 nurse, 12 security personnel, 6 cleaning personnel, 1 municipal police at the shelter house. The shelter house which operated from Decem- ber 2009 till March 2010 last year served 477 persons.

0107 BURSA CITY HEALTH PROFILE 10. SECURITY 10.1. CRIME AND VIOLENCE Various measurements are taken to prevent crime and violence. The existing rate may be reduced with studies to diminish the psychological factors and awareness educations and the welfare and security of the society may be improved. The below table indicates the 2009 data concerning the types of crime and violence cases in Bursa. When those data are considered, it is seen that the rate of crimes against property is high. It may be possible to reduce crime and violence by eliminating the impairments of economical conditions and inequalities of income distribution

Table 10.1. Distribution According to Type of Crime in Bursa (2009)

Crimes against property 13999 Crimes against individuals 15751 Crimes against society 3888 Crimes against nation and state 533 Crimes to be followed -up 6901 GENERAL TOTAL 41072

Reference: Provincial Directorate of Security

10.2. DISASTERS Between2005-2009; there were 19.088 fire and salvage cases reported in Bursa. 5085 of those are bushfires set by unidentified persons on purpose and 1989 of them are solid waste fires (intended for destruction)

0108 BURSA CITY HEALTH PROFILE Graphic 10.1. Fire Statistics for Bursa between 2005 -2009 / Reference: Metropolitan Municipality of Bursa Fire Department

Kaynak: Bursa Büyükşehir Belediye Başkanlığı İtfaiye Dairesi Başkanlığı

10.3. Traffic Accidents

10.2 Traffic accidents and outcomes in Bursa (Fatal, Injurious accidents) Total Traffic Officers Gendarmerie Total Traffic Officers Gendarmerie Total Traffic Officers Gendarmerie 3879 3112 767 132 90 42 5991 4787 1204 Reference: Turkish Statistical Institution, adapted from Traffic Accident Statistics, Highway publication

10.3 Dead, injured drivers and passengers and pedestrians in Bursa according to gender ( Fatal, injurious, material damage accidents, 2008) Total acci- Material damage Number of Number of Number of Fatal accidents Injurious accidents Number of death dents accidents injured death injured 41790 78 3034 38678 90 4787 37 1806 Reference: Turkish Statistical Institution, adapted from Traffic Accident Statistics, Highway publication

10.4. Traffic accidents and outcomes according to settlement in Bursa (Fatal, injurious accidents] Total In-site Off-site Number of acci- Number Number of Number of Number Number of Number of Number Number of dents death injured accidents death injured accidents death injured Bursa 3112 90 4787 2583 45 3677 529 45 1110 Reference: Turkish Statistical Institution, adapted from Traffic Accident Statistics, Highway publication 0109 BURSA CITY HEALTH PROFILE Section III

0110 BURSA CITY HEALTH PROFILE It is inevitable that the planning and development activities of this city RESULT AND ASSESSMENT which incorporates many characteristics such as illegal settlements Bursa is a city which has a fast growth rate of population. The rate of po- which is a result of rapid migrations, the richness’s of historical, cultural pulation below 15 and over 65 years old which we call “dependent po- heritage and natural values and being one of the most important indust- pulation” to the total population is 30,6%.The population has a dynamic rial regions in Turkey, shall be prepared taking those into consideration. It structure for it being a city which receives migration. The assessments is seen that the planning activities in Bursa are fulfilled with a hierarchic, made by years indicate an evident reduction in the rate of fertility. participative and systematic approach according to the urban develop- ment and strategically development objectives of the city. Growth of the population mainly due to migration brings economical and social problems to the forefront. A decrease in the rate of infant and child The earthquake which happened in 1999 in our country revealed the im- mortality can be seen by years. “Other types of cardiac diseases” is ran- portance to make the urban planning’s in order to increase the resistance ked in the first place for reasons of death. The population per physician of settlements and to reduce the risk of disasters, effective use of natural in Bursa is 720. An increase in the total number of beds is seen by years. sources and sustenance of ecological, economical and social sustainabi- An improvement, may be not sufficient, is observed during the monito- lity and the necessity to make the urban planning’s to involve renewals. ring of pregnant, babies, children and women aged between 15-49 years Metropolitan Municipality of Bursa plans the city with an upper scale old. The outcomes of the family physician system will be examined at the planning process which will include all these approaches. next profile. Immunization rates are not at desired levels. Family physici- an system which is said to give importance to personal protective servi- Urban transformation practices intended to improve the economical, so- ces is expected to increase this level. Health service planning intended cial, physical and environmental conditions ah the illegally settled and for emigrant societies shall be made. Data concerning substance-use are impaired urban areas with exhaustive and integrated approaches, imp- insufficient in our city. A board consisting of all the establishments in the rovement and urban renewal activities intended for the revival of cultural city was formed for this purpose and efforts to prepare the profile of al the heritage shall be fulfilled. youth living in the city are launched. Subjects such as environmental pollution control, waste management, It is required to increase the number of sports facilities which enable clean water supply, sustainable transportation, access to health servi- participation of all the society. Disabled citizens shall be determined ces, preservation of historical environment, employment, access to rec- and their opportunities for education, working and decarceration shall be reational and social services, security which are among the characteris- improved. Efforts shall be made to maintain and increase the number of tics to become a healthy city were approached within the scope of this courses opened. profile. Improvement on all the issues directly concerned with health is crucial for the development of living conditions in Bursa. As can be understood from the evaluations that Bursa has a structure which benefits sophisticated transportation opportunities such as land, Bursa which is above the Turkey averages in terms of urbanization, an- air, sea and rail transportation. However, it is so crucial to complete the nual growth rate of population, ratio of employees in the industry to the study which will plan the short, mid and long term strategies and deve- total employment, is an industrialized city which contributes to Turkish lopments of this transportation within the frame of “Transportation Mas- economy with its strong economy and employment capacity. ter Plan”. In this sense, it is known that Metropolitan Municipality of Bursa gave a start to its studies on “Transportation master Plan” with 2030 pro- Bursa which is among the important cities in terms of tourism potential jections. and variety; is a tourism city which has a promising future with winter tourism, health tourism, religious tourism, historical and cultural tourism, It is so important that the city develops in the scope of a healthy urban tableland tourism and sea tourism. It is a city of agriculture with its uni- planning frame for becoming a healthy city. que nature and inherent products. Bursa has a long history of planning. The natural values it has, caused In brief, Bursa is a developing city. Tradition and future is melt down in the Bursa to be under spotlights throughout the history and to receive in- same pot. It develops by realizing its changes. The developments in Bur- tensive migration during the urbanization period. Within the frame of sa, the current status of the city, health policies and restructuring efforts 1/100000 scale Environment Plan prepared in a participative process in require the development of an integrated development and health policy. 1998, it was foreseen to preserve and use the natural sources within the Therefore, this City Health Profile shall make remarkable contributions to principles of sustainable development. make Bursa a healthier and a habitable city. 0111 BURSA CITY HEALTH PROFILE ACKNOWLEDGEMENTS

We hereby present our acknowledgements for their contribution for the preparation this profile. • Governorship of Bursa Provincial Directorate of Health • Governorship of Bursa Provincial Directorate of Security • Governorship of Bursa Provincial Directorate of Culture and Tourism • Bursa Chamber of Commerce and Industry (BTSO) • Metropolitan Municipality of Bursa Social Services Department • Metropolitan Municipality of Bursa Municipal Police Department • Metropolitan Municipality of Bursa Cultural and Social Affairs Department • Metropolitan Municipality of Bursa Fire Department • Metropolitan Municipality of Bursa Transportation Department • Metropolitan Municipality of Bursa Research and Projects Department • Metropolitan Municipality of Bursa Environmental protection and Monitoring Department • Bursa Büyükşehir Belediyespor Club • General Directorate of Bursa Water and Sewage Works Administration (BUSKİ) • Bursa Şehir içi Doğalgaz Dağıtım Ticaret Ve Taahhüt A.Ş.(BURSAGAZ) • General Directorate of Bursa Ulaşım-Toplu Taşım İşletmeliği San. ve Tic. A.Ş. (BURULAŞ)

0112 BURSA CITY HEALTH PROFILE REFERENCES 1. http://www.bto.org.tr/sunular/30122009rapor.pdf, date of access: 17.01.2011 2. Social Services and Disadvantageous Persons in Bursa: Supply, Demand and Need / Social, Economical and Spatial Aspects 3. Data obtained from Bursa Provincial Directorate of Health 4. Data obtained from Bursa Provincial Directorate of Health 5. Data obtained from Bursa Provincial Directorate of Health 6. Data obtained from Bursa Provincial Directorate of Health 7. Data obtained from Bursa Provincial Directorate of Health 8. Data obtained from Bursa Provincial Directorate of Health 9. Data obtained from Bursa Provincial Directorate of Security 10. Data obtained from Metropolitan Municipality of Bursa, Cultural and Social Affairs Department 11. Data obtained from Bursa Provincial Directorate of Culture and Tourism 12. Metropolitan Municipality of Bursa, City Health Profile and Health City Indicators, 2005 13. Data obtained from Metropolitan Municipality of Bursa, Social Services Department 14. Data obtained from Bursa Provincial Directorate of Security 15. Data obtained from Metropolitan Municipality of Bursa, Fire Department 16. Turkish Statistical Institution (TUİK) internet website http://www.tuik.gov.tr, Date of access: 17.01.2011 17. Turkish Statistical Institution (TUİK) Tourism Statistics,2009 18. Turkish Statistical Institution (TUİK) Sports Statistics, 2007 19. Turkish Statistical Institution (TUİK) National Education Statistics Common Education 2008/’09 20. Turkish Statistical Institution (TUİK) Death Statistics, City and District Centers,2008 21. Ministry of Health Health Statistics Almanac, 2008 22. Address Based Population Registration System (ADNKS) Census Results (2009)) 23. State Planning Organisation, Domestic Migrations and Qualities of Emigrants in Turkey 1965-2000; TUİK 24. General Census Results for 2000, Turkish Statistical Institution, www.tuik.gov.tr, Date of access: 17.01.2011 25. Bursa Provincial Directorate of Health internet website: http://www.bsm.gov.tr/, Date of access: 17.01.2011 26. Bursa Chamber of Physicians website www.bto.org.tr, date of access: 17.01.2011 27. http://www.saglik.gov.tr, date of access: 17.01.2011 28. http://tr.wikipedia.org/wiki/Bursa, date of access: 17.01.2011 29. http://www.bursa.bel.tr/?baslik=bursa-tarihi&bolum=sayfa&id=514, date of access: 17.01.2011 30. Turkish Statistical Institution (TUİK) Migration Statistics, http://www.tuik.gov.tr/VeriBilgi.do?tb_id=38&ust_id=11, Date of Access: 17.01.2011 31. Domestic Migration Integration Project (İGEP) Supply, Demand and Need Assessment Report 32. From Prussia to Bursa, Silk City of Civilization, 3.rd edition, İstanbul, December 2006

0113 BURSA CITY HEALTH PROFILE Etüd Projeler Daire Başkanlığı Bursa Büyükşehir Belediyesi Acemler Yerleşkesi B Blok K:1 Osmangazi / BURSA / TURKEY

Tel : 0224 234 00 87 - 253 23 99 Fax : 0224 235 34 70 www.bursa.bel.tr Notes :...... Notes :......