102184 Turkey’s Response to the Syrian Refugee Crisis and the Road Ahead WORLD BANK – DECEMBER 2015 The International Bank for Reconstruction and Development / The World Bank 1818 H Street, NW Washington, DC 20433 All rights reserved First published December 2015 Disclaimer: This volume is a product of the staff of the International Bank for Reconstruction and Development/The World Bank. The findings, interpretations, and conclusions expressed in this paper do not necessarily reflect the views of the Executive Directors of The World Bank or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries. Copyright Statement: The material in this publication is copyrighted. 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Photos credits: Flckr Libray - Russell Watkins/Department for International Development Cover Design and Text layout: Duina Reyes-Bakovic Acronyms and Abbreviations AFAD Disaster and Emergency Management Authority AFKEN Disaster Management System CBEs community-based education DGMM Directorate General of Migration Management EYDAS Electronic-based Aid Distribution System GIS Geographic Information System GoT Government of Turkey IDPs internally displaced persons MoH Ministry of Health MoNE Ministry of Education NGO nongovernmental organization ReDAT Refugee Doctor Adaptation Training SuTP Syrians under Temporary Protection TEC temporary education center TP Temporary Protection UN United Nations UNHCR United Nations High Commissioner for Refugees WHO World Health Organization Background/Acknowledgements The Government of Turkey and the World Bank are working in partnership on a program of technical assis- tance that aims to identify and mitigate the impact of Syrians under Temporary Protection (SuTPs) on Turkish hosting communities. This paper was written by Holly Benner, Arzu Uraz, Joanna de Berry, and William Wise- man of the World Bank, with valuable contributions from Zeynep Darendeliler and Elif Yukseker. The paper was produced under the guidance of Johannes Zutt (World Bank Country Director, Turkey) and Mariam Sher- man (Director for Operations, Eastern Europe and Central Asia, World Bank). Funding for the work was avail- able under the “Turkey Regional Development and Vulnerability” Program co-led by the Social Development and Urban Development teams of the World Bank and financed by SIDA. TURKEY’S RESPONSE TO THE SYRIAN REFUGEE CRISIS AND THE ROAD AHEAD  1 Turkey’s Response to the Syrian Refugee Crisis and the Road Ahead Today, global leaders face the greatest movement of The GoT’s non-camp approach was driven by the scale peoples since World War II—nearly 60 million are dis- of the crisis. As a result, the GoT’s approach diverges placed as refugees or internally displaced around the from the way in which hosting countries commonly world. Forced displacement situations are often pro- respond to refugee situations—by directing refugees tracted and unresolved; only 126,800 refugees were into camps supported by humanitarian agencies. Ex- able to return to their home countries in 2014—the perience shows that when refugees are supported in lowest number in 31 years. With no end in sight to the becoming socially and economically self-reliant, and conflicts producing the largest refugee flows, it is in- given freedom of movement and protection, they are more likely to contribute economically to their host creasingly clear that humanitarian responses must be country. They are also more likely to be able to under- paired with development interventions that can begin take a successful return process. Integrating support to respond to the scope, long-term nature, and socio- for refugees into mainstream government service pro- economic impacts of this global crisis. vision can be more cost effective and sustainable than Turkey now hosts the largest refugee population in the setting up parallel delivery channels. However, this ap- proach also creates challenges for both SuTP and host- world (see Figure 1). The Government of Turkey (GoT) ing communities, which include socioeconomic pres- estimates the total number of registered Syrians under sures such as deficits in housing and service delivery, Temporary Protection (SuTPs) at 2,225,147.1, 2 Facing a joblessness, and the potential for social tensions.  record influx of displaced, the GoT is setting a global precedent for a refugee response with two unique fea- The objective of this policy brief is to collate existing tures: publically available material on the situation of SuTPs (i) A non-camp approach. Only 12 percent of the total number of SuTPs are living in tents and temporary shelters;3 the rest are settled in ur- Figure 1. Major refugee-hosting countries ban areas, where they seek their own accom- modation and work opportunities. (in millions) (ii) A government-financed approach. By Septem- Turkey ber 2015, the GoT had spent an estimated $7.6 Pakistan Top-3 billion on its response to Syrian refugees. 30%* Top-4 Lebanon Islamic 41%* Rep. of Iran Ethiopia Top-10 1  See http://www.haberturk.com/gundem/haber/1130284-nu- Jordan 57%* man-kurtulmus-turkiyede-kayitli-2-milyon-225-bin-147-suriyeli-var. Kenya 2  The largest concentrations of refugees are in Istanbul (20 per- Chad cent of the total refugee population), and the southern provinces Uganda of Gaziantep (14 percent), Hatay (12 percent) and Sanliurfa (10 percent). Fifty one percent of all refugees are children under 18 China years of age (AFAD, 2013). 0.00 0.25 0.50 0.75 1.00 1.25 1.50 1.75 3  See https://www.afad.gov.tr/TR/IcerikDetay1. Source: UNHCR 2014 Global Trends in Forced Displacement aspx?ID=16&IcerikID=848. 2 Turkey’s response to the crisis also includes much Figure 2. Displacement in the 21st century more than the government-led legal framework and support. It involves many acts of individual kindness at (in millions) the local level, whereby Turkish families and civil soci- 60 ety organizations have made donations and extended help to their new Syrian neighbors. One survey (HUGO, 50 2014) across a large sample in 18 provinces indicates 40 that 31 percent of Turkish respondents had made a personal financial contribution in support of Syrian 30 refugees. 20 The GoT’s Response 10 To operationalize the TP guidelines, different Turkish ministries have completed the subsidiary legal ar- 0 ‘00 ‘02 ‘04 ‘06 ‘08 ‘10 ‘12 ‘14 rangements to implement the measures. These guar- antee registered SuTPs access to health care, educa- Refugees and asylum-seekers Internally displaced persons tion, social services, and the labor market. Psychosocial People Newly displaced during the year* support and rehabilitation services are also prioritized for groups with special needs, such as children, women, Source: UNHCR 2014 Global Trends in Forced Displacement and the elderly. Those holding a TP identification card can secure access to electricity, water, communication services and are able to open bank accounts. Some of in Turkey and to summarize: (i) the strategy and prin- these remain subject to approval. For example, regu- ciples of Turkey’s unique response to its displacement lating access to the labor market through work permits crisis; (ii) the challenges in managing the socioeco- is being discussed with the Council of Ministers. nomic dimensions of displacement; and (iii) remaining critical policy issues and the road ahead for Turkey, as A cross-sectoral collaboration has been established well as implications for other countries’ refugee re- among Turkish ministries in order to respond to the di- sponse efforts. verse needs of the SuTPs. The Disaster and Emergency Management Authority (AFAD) coordinates the emer- gency response, with the involvement of the Ministries 1. Turkey’s Response to the of Interior, Foreign Affairs, Health, Education, Agricul- Syrian Displacement Crisis— ture and Forestry, Transportation, Family and Social Strategy and Principles Policies, Labor, Social Security and Finance; the Turkish Armed Forces; the Presidency of Religious Affairs; the Turkish Red Crescent Society; and the Undersecretary The GoT defined its response to the arrival of refugees of Customs. Since the Law on Foreigners and Interna- from Syria through the 2013 “6458: Law on Foreigners tional Protection came into force in April 2014, the Di- and International Protection,” which defined a Tem- rectorate General of Migration Management (DGMM) porary Protection (TP) regime for the Syrian refugees. has become the sole institution responsible for pro- The TP Regulation was prepared pursuant to Article tection and asylum issues. The recent nomination of a 91 and put into force on 22 October 2014. It sets out chief advisor to the Prime Minister on SuTP response is how TP status is issued and the specific provisions for bolstering the coordination needed for a comprehen- admission, registration and exit while under tempo- sive inter-agency response. rary protection in Turkey. It also outlines the rights and responsibilities of those under temporary protection; The GoT has also continuously adapted to the chang- regulates the TP identification process; services to be ing nature of the crisis and the needs of SuTP commu- provided to persons under TP; and outlines the coordi- nities already residing in Turkey. Authorities have, for nation between national, local and international agen- example, shifted from emergency response to long- cies involved in the response. The TP extends to all Syr- term planning. While organizations such as AFAD and ian refugees whether or not they are registered. the Turkish Red Crescent Society were initially tasked TURKEY’S RESPONSE TO THE SYRIAN REFUGEE CRISIS AND THE ROAD AHEAD  3 Map 1. SuTP camps and refugee centers Source: UNHCR, 2015 with SuTP reception and assistance, a broader set of data. This registration was conducted under the coor- agencies are now involved in managing a more holistic dination of DGMM. To support the registration process, and long-term approach. a “Temporary Protection Module” was launched on 30 November 2015 in the GöçNet system to consolidate In an effort toward more strategic planning, the GoT all biometric data on SuTP into one data base, facili- has also increasingly involved international organiza- tating access to the information by different ministries. tions and civil society groups with experience in pro- AFAD has developed an electronic-based aid distribu- tracted refugee response settings (Icduygu, 2015, p. 9). tion system—Elektronik Yardım Dağıtım Sistemi (EY- For example, in 2015 the United Nations High Commis- DAS)—that matches SuTPs in need with those provid- sioner for Refugees (UNHCR) cooperated closely with ing assistance, so as to facilitate a speedy response. the Turkish authorities to build DGMM’s capacity and to develop a new asylum system. While UNHCR will Camp policies continue to work on case management, it will start a phased handover of registration and refugee sta- The GoT has also taken a progressive approach to the tus determination fully to DGMM. Community-based relatively limited number of SuTPs (over 250,000) re- organizations and nongovernmental organizations siding in 25 camps across 10 provinces in Turkey (see (NGOs) have provided invaluable local-level support Map 1).4 The camps are all managed and financed by for SuTPs, including setting up community centers and Turkey through AFAD. While AFAD utilized UNHCR offering legal advice, translation services, and psycho- camp guidelines, the GoT designed its own approach. social care. The GoT has utilized innovative technologies in track- ing SuTP movements and trends. Turkey has just fin- 4  See https://www.afad.gov.tr/TR/IcerikDetay1. ished registering almost all of the SuTPs with biometric aspx?IcerikID=848&ID=16, accessed October 14, 2015. 4 The camps are staffed by Turkish government em- proach is increasingly recognized as having significant ployees, with some NGO involvement in supporting limitations, especially for longer-term development roles. When the first waves of Syrians began arriving prospects (UNHCR, 2014b). Integrating support for in Turkey, within 24 hours the Turkish government had refugees into mainstream government service provi- set up an emergency tent camp for them in southern sion can be more cost effective than setting up large- Hatay Province. Moreover, in less than four years, the scale camps and parallel humanitarian service delivery Turkish government has shouldered the financial and channels. This is particularly true in the case of situa- management responsibility of 25 camps in provinces tions of protracted displacement. This approach also along its 500-mile border with Syria. The camps aim to offers the potential benefit of more broadly building offer a better standard of shelter and services and have the capacity of national and local institutions. been recognized for their cleanliness, safety, mainte- nance, power lines, schools, and other services and Emerging global evidence increasingly shows that giv- amenities (McClelland, 2014). UNCHR has declared the ing refugees the freedom to live outside of camp set- Turkish-led and Turkish-financed camp management tings, providing opportunities for social and economic as “emergency response of a consistently high stan- self-reliance, and protecting rights is more likely to re- dard” (UNHCR, 2015). However, there are growing con- sult in economic benefits for host countries (UNHCR cerns regarding the finances and support needed to 2014b). Refugees who are self-sufficient are also more sustain the camps at the same standard of quality and likely to be able to undertake a successful and sustain- services. able return process to their home countries, when the situation allows (World Bank, 2015b). AFAD has also established a Disaster Management System (AFKEN) which allows all the camps and tem- Indeed, preliminary observations of the impact SuTPs porary disaster centers to be managed, standardized, have on the Turkish economy show some potential and monitored in one holistic system that is GIS-based. positive trends. Syrians arriving with assets have in- Through AFKEN, the GoT can monitor the capacity sta- vested in Turkey: in 2014, 1,222 out of 4,249 foreign- tus of the camps, integrate with MERNIS (the central- owned businesses in Turkey were established by ized population management system), and manage Syrians. In Gaziantep, Mersin, and Hatay, 122 Syrian- aid distribution, supply stocks, and personnel. owned companies were registered in 2013, and the es- timated initial capital invested in these companies was Recognizing the potential challenges faced by SuTPs TL 39 million (Brookings Institution and USAK, 2013). residing in the camps, AFAD has also taken measures Syrians have also started up (mainly unregistered) mi- to improve SuTP self-sufficiency and quality of life. croenterprises, particularly cafes and restaurants. The GoT has ensured that Syrians are represented by their own community leaders within the camps and in Further gains come from the expansion of local mar- discussions with camp managers.5 Syrian teachers are kets in areas with high SuTP concentration; receipt of hired in camp-run schools. Electronic food vouchers, or remittances from within Syria during the early years e-cards, are being distributed to simplify life for SuTPs of the conflict; and the benefits of government SuTP and enable them to go into shops and buy food. expenditures for local suppliers and SuTPs’ labor con- tribution. Implications of the GoT’s Response Nevertheless, the strains of hosting SuTPs are felt es- pecially in cities in the southeast of Turkey. Tensions The two key characteristics of the Turkish response—a from Turkish communities relate to competition over non-camp, government-financed approach—strongly jobs, rising rent prices, strains on municipal services differentiate it from many refugee-hosting countries, and infrastructure, and cultural differences with SuTPs. where the tendency is to direct refugees into camps Perception surveys show mixed attitudes—Turkish supported by external humanitarian agencies. This ap- families recognize the humanitarian imperative to respond to SuTPs and show much generosity toward them; yet they are also deeply concerned about the 5  Statement of President of AFAD: https://www.afad.gov.tr/TR/ social consequences of the presence of SuTPs in their HaberDetay.aspx?ID=5&IcerikID=4710 accessed on October 16, communities. 2015 TURKEY’S RESPONSE TO THE SYRIAN REFUGEE CRISIS AND THE ROAD AHEAD  5 2. Socioeconomic Pressures Figure 3. Socioeconomic pressures—displacement of Displacement: Turkey’s response Approach, Lessons Learned, and Challenges Welfare Housing & The key challenge facing the GoT is to mitigate the po- tential negative impacts of hosting SuTPs while build- Municipal ing on the positive contributions refugees can make. Services The following section provides an assessment of the Labor GoT’s response and continuing challenges in manag- Market & Syrians and Host ing the socioeconomic dimensions of displacement. Skills Communities This includes a focus on the most common issues faced by both displaced and host communities in a Social development-oriented response effort, including in- cohesion come, welfare, and employment; pressures on housing Education & and services; and social tensions/community relations Health (see Figure 3). In each of these areas, the GoT has complex decisions ahead on whether and how to extend benefits and in- crease investments for both SuTP and host communi- ties. alizing formal access to the labor market by issuing work permits is awaiting approval by the Council of Socioeconomic Challenges, Lessons, and Ministers. In absence of this, only SuTPs with residence Considerations Moving Forward permits can apply for work permits. Work permits are difficult to obtain. To date 6,858 Syrians have been granted work permits. Therefore, SuTPs mainly work in Income and employment. Surveys consistently the informal sector and in low-skill jobs such as sea- show that SuTPs in southeast Turkey have been rely- sonal agricultural work, construction, manufacturing ing on savings, selling assets (for example, jewelry), or textiles, and waste picking and sorting. Some have and remittances as their greatest source of household also been absorbed into the service industry. income. However, as these assets and savings are de- pleted, there is increasing demand for employment While SuTPs were initially concentrated in Turkey’s opportunities (STL, 2014; IMC, 2014).6 Data on current southeastern provinces, the search for better liveli- employment rates among SuTPs is sparse. One survey hood opportunities has been a key factor in their suggested that the rates of refugee households hav- spread across the country, mostly to areas of seasonal ing at least one working member were 61 percent of agricultural work or metropolitan cities. An assess- refugees in Urfa; 16 percent in Hatay; and 30 percent ment in Istanbul found that the majority had arrived in Kilis (STL, 2014). in the last six months, suggesting that the flow may be increasing (IMC/ASAM, 2014). As noted above, Turkey passed additional legal guide- lines for foreigners under temporary protection in October 2014 that provides SuTPs access to the labor market7. However, secondary legislation for operation- rary Protection Regulation provides legal guarantee for the right to work as an indispensable element of social life. It has the provision that all SuTP, whose registration procedures have been completed 6  Refugees report that the transaction costs of these remittances and who have been granted a Temporary Protection ID Card, can from Syria are increasing with the deterioration of mobile phone apply to the Ministry of Labor and Social Security to obtain working networks and banking systems. permits in sectors, business lines and geographical areas to be 7  The binding Article titled ‘Access to Labor Market’ of the Tempo- determined by the Council of Ministers. 6 There are reports of SuTPs working under exploitative education, and increase in average wages (Del Carpio, conditions in the informal sector; these include long Wagner, and Triebe, 2015). Nevertheless, the wide- hours, unsafe conditions, lack of guaranteed payment, spread perception and experience of Turkish workers and low wages. One survey states that average wages seems to indicate increased competition over jobs and for refugees were TL 5.6/day in Hatay and TL 14/day in a lowering of wages. Further investigation is required Urfa (STL, 2013); another gives the average monthly in- on this issue. come from employment for refugees in Gaziantep as TL 406/month (IMC, 2014). The current net minimum Education. The GoT has put forth an enormous effort wage in Turkey is TL 1000.54/month.8 to provide education options for SuTPs. The Turkish ap- proach to school provision for SuTPs has taken three Since their displacement from Syria, there have been main forms: (i) integrating Syrian children into the significant changes in SuTP labor force participation Turkish education system; (ii) allowing community- trends. Without work permits, few are able to gain based education (CBE) programs run from within the formal employment in their previous professions. In Syrian community; there is a range of curriculum used addition to legal status, lack of Turkish language skills in these CBEs, with the most popular being the Libyan poses another primary barrier to entering the labor curriculum and religious education (Refugee Studies market. Refugees often experience humiliation over Centre, 2014); and (iii) facilitating Syrian children to lowering their job positions and being unable to carry attend SuTP-designated temporary education centers on a previous profession (SREO, 2013). (TECs), which are supervised by the Ministry of Educa- tion (MoNE). These have Turkish senior administration Access to employment is also a potential flashpoint be- but are staffed by Syrian teachers, with education pro- tween SuTPs and Turkish host communities. One sur- vided through a modified version of the Syrian curricu- vey of Turkish workers who were newly unemployed lum developed by the Syrian Commission of Education found that, depending on location, between 40 and under the Syrian Interim Ministry of Education. Some 100 percent of those who had lost their jobs attributed TECs have been instituted by setting up a double-shift it to the presence of Syrians and increased competition arrangement in Turkish school buildings, while others in the labor market (ORSAM, 2015a). Another survey operate in municipal buildings or in the camps. found that 56 percent of Turkish respondents felt that MoNE estimates that there are 589,500 school-age Syr- “Syrians take our jobs” (HUGO, 2014).9 Tensions seem ian children in Turkey and that up to 250,000 Syrian to particularly center on wage levels. The influx of Syr- children are enrolled in school; an additional 137,650 ians into the labor market has apparently driven down plan to be enrolled by the end of the 2015–2016 school wages for both Syrians and Turks. year (a rise in enrollment rate from around 40 percent The full impact of the presence of Syrian refugees on to 60 percent). MoNE has asked all provincial director- ates to register Syrian children of preschool and first- the labor market has yet to be analyzed. Three stud- year primary school age in the Turkish schools, though ies point to some positive trends: (i) Syrians may be this will take time. MoNE is therefore planning to open filling an unmet need for unskilled labor rather than an additional 60 temporary education centers to ad- displacing the labor force (ORSAM, 2015a); (ii) the pres- dress immediate capacity constraints, using the tem- ence of Syrians may have a tempering effect on the in- porary education centers as a interim solution. MoNE migration of Turkish nationals to the refugee hosting has also begun to provide Turkish preparatory courses areas, which mitigates changes in the labor market at public education centers (Halk Egitim Merkezi) to (IZA, 2015); and (iii) there is widespread displacement facilitate the transition of Syrian children into Turkish in the informal labor market of Turkish informal work- schools. Increasing access to the Turkish systems will ers by SuTP informal workers—women are particularly be formalized through a MoNE Circular currently un- affected. However the outcomes of this displacement der preparation. are seen to be generally positive for Turkish workers with greater formalization of jobs, extended time in Inside the camps, school enrollment rates have been high (around 86 percent), but much lower outside the camps. Recent enrollment rate increases can be tied to GoT efforts to open up more places within the Turk- 8  For the period of July 1, 2015 – December 31, 2015. ish education system. Yet several challenges persist in 9  This rose to 69 percent in the border regions. increasing SuTP enrollment, sustaining attendance, TURKEY’S RESPONSE TO THE SYRIAN REFUGEE CRISIS AND THE ROAD AHEAD  7 and ensuring quality instruction. The most pressing in- rising housing costs (both rent and utilities) at the low- clude: (i) the high degree of mobility of the SuTP popu- er end of the housing spectrum. There is a projected lation, which results in school dropout; (ii) high levels housing supply lag of an estimated nine years, and of psychosocial trauma, which disrupts concentration; rent/utilities share of household expenditures has in- (iii) difficulties in retaining Syrian teachers—most are creased by over 10 percent over the last few years for unable to register for work permits and are paid mod- the lowest deciles of the income spectrum. The pres- est stipends; (iv) the lack of quality control of services sures on housing and municipal services introduced provided through CBE; and (v) overcrowding, damage, by SuTPs have likely had a sharp impact on low-income and disruption to Turkish schools where double shifts Turkish households (World Bank, 2015a, 2015b). May- are in place. In addition, there is a large unmet demand ors in host communities in the country’s southeast for the provision of vocational, remedial, and higher now highlight the growing number of street children, education among SuTP adolescents (Refugee Studies the inadequacy of housing supply, the strain on mu- Centre, 2014). nicipal services, and the need for improved infrastruc- ture services and social safety nets. Housing and municipal services. Outside the camps, the initial wave of Syrians were put up in host house- The quality of the housing stock utilized by refugees holds, building upon their existing social, cultural, or has also been raised as a concern, with one rapid as- economic networks in Turkey. Over time this pattern sessment reporting that only 25 percent of respon- has changed, with new arrivals increasingly finding dents have access to heating and only 35 percent have their own places to live; many who had originally lived easy access to toilets and shower facilities (Alliance with host families have moved into their own accom- 2015, 2014). Another survey suggested that 84 percent modation (Ozden, 2013; STL, 2014). of refugee families surveyed in Hatay, Urfa, and Kilis live in a single-room dwelling (STL, 2014). AFAD (2013) The most extensive assessment of refugees living out- figures put the number of people per dwelling at 8.6 side of camps (AFAD, 2013)10 found that 75 percent of people per unit, with 32 percent of dwellings housing SuTPs live in houses or flats, while 25 percent live in more than one family and the average dwelling size informal settlements or makeshift arrangements. Most being 2.1 rooms, all of which suggests significant over- of those who live in houses or flats rent these units crowding. (STL, 2014). One survey from Gaziantep suggested that refugees are on average paying TL 178/month While there are legal difficulties in property owner- in rent. There is a widespread perception that rental ship, the SuTP population has access to formal rent prices have almost doubled in provinces along the contracts under the TP regime. However, there are border and housing has become scarcer due to high anecdotal reports of some exploitation occurring; for demand.11 There are currently no quantified market example, stories of landlords demanding that SuTPs assessments, but figures commonly cited in Gazian- make six-month cash rent payments in advance of ac- tep reported that over the last two years, the price of cess, and evicting them on short notice. Some Syrian a TL 600/month apartment has increased to TL 1,000/ refugees have reported being discriminated against month (SREO, 2013). For Kilis, the increase has been by landlords who refuse them as tenants on grounds more dramatic, with a TL 300/month apartment now of their large family size, perceived noisiness, and cul- reportedly costing up to TL 1,000/month (Brookings tural practices. However some Turkish families have Institution and USAK, 2013). Surveys consistently con- conversely complained that they find it harder to find a clude that along with rising food prices, rising house rental property because landlords can make cash more prices are the largest contributor to the inflation that readily from Syrians, who are prepared to fit larger has been experienced in the refugee-hosting regions numbers of people into smaller spaces. along the border (ORSAM, 2015b; IZA, 2015). Health. Under the TP regime, registered SuTPs are Even before the arrival of SuTPs, Turkey experienced entitled to free health care at Turkish facilities from their initial day of arrival in Turkey. A number of World Health Organization (WHO) and Ministry of Health (MoH) assessments in southern Turkey in 2014 illus- 10  This covered 1,500 households. trate the strong effort of the MoH to provide SuTPs with 11  Some areas of the southeast were experiencing a housing free access to all health services. As of October 2014, shortage prior to the refugee crisis. about 250,000 Syrian refugees received inpatient care; 8 more than 200,000 patients were operated on; almost the impact of SuTPs have on communities, services, 150,000 births occurred; and over 6 million consulta- and security pervades the southeast of Turkey. These tions took place (3RP, n.d.). Refugees in the community tensions seems to be most commonly articulated in receive free primary and inpatient health services. In- concerns over increasing rents, decreasing wages, creasing numbers of non-registered refugees can ac- increasing job competition, longer waiting times for cess emergency care, after which they need to register hospital services, and the rise of polygamy and crime in order to obtain further health support. As a result, (Brookings Institution and USAK, 2013; ORSAM, 2015a; clinics and hospitals in affected areas report an addi- HUGO, 2014). But how far these underlying concerns tional patient load of 30 to 40 percent. Local hospitals translate into active social tension is difficult to gauge. have been enlarged and equipped to cover the current There have been several well-publicized incidents of and most acute needs. The GoT has also developed in- violence between Syrians and Turks. There are also formation campaigns, including communication ma- anecdotal reports of Syrian children being harassed, terials in Arabic on disease prevention and available discriminated against, and bullied. However, surveys heath care services. suggest that the majority of Syrians think they are well treated by their Turkish hosts; 66 percent of respon- The GoT has also worked closely with the WHO and dents in Gaziantep reported having a good or very other international institutions to conduct regular good relationship with their hosting community (IMC, mapping and needs assessments to improve SuTP 2014). In another perception survey, only 20 percent of access to essential health services. This has included Syrian respondents reported having “social problems quick response treatments as needed—for example, a with Turks,” while 37 percent reported having good vaccination campaign in Suruç district was organized Turkish friends (SABR Center, 2015). Strikingly, only following the influx of about 190,000 Syrian refugees. 25 percent reported feeling they were discriminated Along with the Turkish University of Gaziantep, WHO against in mainstream government service provision. also completed the Refugee Doctor Adaptation Train- ing (ReDAT) modules in Turkish and Arabic to help However, as the situation becomes more protracted, Syrian doctors understand Turkish standard operating there are signs of increasing tensions and frustra- procedures, treatment guidelines, and referral struc- tion. In a new survey from the German Marshall Fund tures. (October 2015),12 81 percent of Turkish respondents reported that they “do not think Syrian immigrants Some Turkish users report facing increased wait times integrate well.” When asked about Turkey’s policies to- and overcrowding in health centers caused by SuTPs ward SuTPs, 68 percent of respondents wanted more (Ozden, 2013). However, indications are that take-up restrictive policies; 73 percent said the existing SuTPs of Turkish health care by SuTPs is still less than the full should be asked to go home, whereas 17 percent said demand. There are reports, for example, that SuTPs it depended on the circumstances, and only 8 percent are reluctant to access the free health care because said they should be offered legal status in Turkey. As of of an inability to communicate their health concerns October 2015, the Ministry of Family and Social Policy in Turkish and the need for a translator to accompany had started preparations to launch a child protection them to appointments. The GoT has worked to provide program together with UNICEF. In addition, psychoso- translators to assist in health care provision, but has cial assistance and family training programs have been not been able to fully meet the scale of demand. One offered to 25,000 SuTPs living in camps, and will be ex- survey states that only 60 percent of refugees outside tended to SuTPs living in cities. camps are using the Turkish health services, and that 54 percent have difficulty accessing medication (AFAD, One factor that contributes to social tension is the 2013). As of October 2015, all registered SuTPs have lack of information regarding the benefits that SuTPs been assigned a foreign national ID number to enable receive, which at times creates misunderstanding and additional access to medicines from all pharmacies contracted with the Turkish government health insur- ance provider (SGK). However, many Syrians continue to self-medicate or seek medical advice from those 12  Survey released in October 2015; see http://www.gmfus.org/ they know who were trusted medical health practitio- sites/default/files/TurkeySurvey_2015_web1.pdf. The fieldwork was ners in Syria. conducted via face-to-face interviews with 1,018 respondents from 16 selected provinces and 125 neighborhoods through a multi- Social tensions and vulnerabilities. Concerns about stage stratified sampling scheme. TURKEY’S RESPONSE TO THE SYRIAN REFUGEE CRISIS AND THE ROAD AHEAD  9 frustration. At the town or province level, SuTPs may For Turkey—Critical Policy Questions and the have access to some social assistance and services Road Ahead provided by the governorate, the municipality, social solidarity foundations, and NGOs. These services vary As Turkey has incrementally shifted to longer-term across localities and may not extend to host communi- planning and development-oriented response, the ties. There is a need for a transparent framework and GoT remains committed to the principle of treating plan on SuTPs’ rights and entitlements that is coordi- SuTPs as protected “guests” that will be well prepared nated with and communicated to host communities. to return home once the conflict in Syria ends. Three key policy questions should then guide next steps: Implications for GoT Policymaking ■■ How to mitigate the potential negative socioeco- nomic impact of the refugee presence on host A theme across these areas is the need for more reli- communities? able and extensive information on both SuTP and host ■■ How to maximize the social and economic ben- community populations in order to provide a better- efits of the refugee presence for host communities targeted and better-informed policy response. It is also and the Turkish economy as a whole? clear that while each dimension—employment, edu- cation, health, housing, and municipal services—has ■■ How to support SuTPs to be self-reliant until they are able to return? distinct challenges and barriers to progress, there is a need for a more comprehensive integrated approach. Based on the challenges and lessons outlined in Sec- tion 2, the following are key issues to address in man- The GoT will also need to consider how to best invest aging socioeconomic pressures: in and support municipal leaders and institutions at the front line of the response effort. Local leadership Labor and Employment. As the GoT moves ahead will often have the best knowledge of community dy- in considering work permits for SuTPs, the key policy namics and challenges, and would benefit from being questions are: (i) how to introduce the work permit given sufficient space and support to design response system with maximum gains for the Turkish labor mar- efforts tailored to municipal-level needs. Channels for ket; and (ii) how to mitigate any negative impacts on municipal authorities to inform national-level planning Turkish communities through strengthening systems and policymaking based on lessons learned, progress, to support vulnerable Turkish workers. Additional data and evolving challenges would also be beneficial. and analysis are needed to quantify the skills among SuTPs, to understand what they bring to the Turkish labor market and the current and potential impact of 3. Critical Policy Questions and SuTP workers on the Turkish labor force. Policy and le- the Road Ahead gal measures are also needed to promote employment opportunities and to provide training and services to The surge of refugees streaming into Europe has drawn help SuTPs integrate into the Turkish labor market the world’s attention to the issue of displacement. It based on identified unmet demands. has demonstrated the global nature of the crisis and Education. The initial policy question for the GoT in has raised difficult questions on how best to man- regards to education is whether to keep three systems age an effective national and international response. in place for educating SuTP children (integration into The Turkish experience offers a progressive approach Turkish schools, TECs, and CBE) or to prioritize one that makes significant progress in tackling both the over another. This decision will have to be informed by humanitarian and developmental dimensions of the the educational preferences among SuTPs that could challenge. The following section highlights the critical continue to increase school enrollment rates. The GoT policy questions that lie ahead for Turkey in deepening also needs to consider strengthening support mecha- its response, and points to lessons from the Turkish ex- nisms—such as Turkish language classes and psycho- perience that may be salient for international actors in social support—that facilitate SuTP children’s entry considering a more effective strategy commensurate into the Turkish education system. Finally, more data with the scale, scope, and protracted nature of the dis- is needed on the skills, capacity, and training demands placement crisis. for Syrian teachers that can lead to increased regular- 10 ization of their work and support for the young SuTP ian staff and will utilize GoT and NGO resources for ser- population. vice provision. Housing. To effectively address the challenges facing Social cohesion. With such a large movement of peo- SuTPs and host communities in securing adequate ple and changing dynamics at the community level, it housing, the GoT needs to quantify the current hous- is a testament to the Turkish people and the SuTP pop- ing conditions of SuTPs, particularly the vulnerabilities ulation that there have not been widespread issues associated with living in poor conditions. There also with social tension, violence, and conflict. However, as needs to be an in-depth assessment of the impact the situation becomes more protracted and socioeco- of SuTP housing and utility demand on Turkish com- nomic pressures mount, investments should be made munities as a baseline to design mitigation measures, to promote continued tolerance and positive relations including on housing affordability. The GoT could con- between SuTPs and Turkish hosts. A key issue is to im- sider additional measures to respond to SuTP hous- prove communication to Turkish hosting communities ing needs, such as vouchers, rental subsidies, and in- regarding SuTP entitlements, as well as broader bene- creased social housing to respond to availability and fits and improvements to municipalities. Hosting com- affordability concerns. munities need to see and experience benefits from SuTPs’ presence and from the programs that support Municipal services. Turkish municipalities are bear- them. Policies should be pursued and communicated ing the brunt of the burden of the SuTP presence, with that increase the living standards and situation of both local institutions and communities at the front line of refugees and hosts. There is also a need to work more the SuTP response effort. A policy decision needs to be systematically with security and justice institutions to made on whether and how to give municipalities more ensure fair and nonviolent resolution to disputes when financing and institutional support to extend their ser- they emerge. vices in line with the population increases caused by SuTPs. Finally, enhanced coordination is needed be- By hosting and supporting the largest refugee popula- tween municipalities and NGOs that deliver services tion in the world, the GoT is providing a “global good.” to SuTPs to maximize the effectiveness of support to The effective management of the refugee crisis in Tur- SuTPs and host communities. key reduces the potential for continued displacement to Europe and beyond, and avoids further insecurity Health. The key policy question for the GoT is what and destabilization across borders. Recognizing the is preventing the SuTP population from more fully preventative power of a successful Turkish-managed accessing health care, with potential impacts on the response effort, international actors should scale up health and well-being of both SuTPs and Turkish host- their support to the GoT to signal joint accountability. ing communities. There is a need to strengthen sup- New international financing offered to Turkey should port mechanisms—such as translators—that facilitate focus on supporting and supplementing what Turkey SuTPs’ access to Turkish health care. At present these is already doing. The GoT’s response, which has strong support systems are being provided by NGOs, and potential for development gains, should be applaud- are overwhelmed. There may also be more creative ed and reinforced; there should not be a new debate solutions regarding how the SuTPs approach their on humanitarian response or a reversal of progress health care needs. These could include identifying made in offering Syrian refugees unique protections, Syrian health care professionals, their skills, and sup- employment, and a non-camp and more sustainable port needs to increase the quality and organization of approach to managing their lives in Turkey. That said, health care provided informally from within the Syr- the UN and other humanitarian actors do have an im- ian community. A directive issued by the Ministry of portant role to play in humanitarian and protection Health in November 2015 has already begun to extend mandates, such as organizing SuTP resettlement and health care services, including the establishment of protecting those in transit. As the GoT considers addi- secondary-level health centers that will provide outpa- tional national and international financing, this should tient, laboratory, radiology, emergency, and minor sur- also include support for strengthening data collection gical operation services, as well as specialized health and technical engagement at the sectoral level along- centers that provide mental health, physical therapy, side projects across sectors such as education, health, and rehabilitation services. These centers are designed job creation and skills development, social protection such that health care will be provided primarily by Syr- and social cohesion, capacity building for municipal TURKEY’S RESPONSE TO THE SYRIAN REFUGEE CRISIS AND THE ROAD AHEAD  11 institutions, housing support, and private sector de- include giving refugees the opportunity to se- velopment. cure their own homes, livelihoods, and services to maximize self-reliance during their displacement Lessons from Turkey—Implications for the period and equipping refugees for a successful re- International Response to Displacement turn home if and when conditions allow. The Turk- ish response to SuTPs is well placed to illustrate The forced displacement crisis poses a substantial the longer-term challenges and impacts of this arrangement, including how to ensure notice and threat to development progress globally. Refugees and protection of the vulnerable who may not have internally displaced persons (IDPs) represent almost 1 the resources and assets to cope in this context. percent of the global population and often (though not always) end up being among the poorest, most ex- ■■ Understanding socioeconomic pressures on cluded, and most vulnerable. They are overwhelmingly host communities. There is a need to recognize hosted in developing countries, where they are often the socioeconomic pressures displacement puts viewed as an additional burden on already stressed na- on host communities, including across a range of tional systems and poverty reduction efforts. However, key sectors—housings, employment and liveli- the Turkish experience also points to an alternative hoods, education, health, municipal services, and approach with the potential for the displaced to open intercommunal relations; investments should be new markets and trading opportunities, enhance a designed to relieve these pressures and ensure workforce, support national and local systems for ser- the spread of benefits to host communities. This vice delivery, and energize private sector development will include lessons on how municipalities can be and entrepreneurship. supported to deliver a refugee response. ■■ Managing host–refugee tensions. There is an The Turkish experience has the potential to inform opportunity to learn how to prevent social ten- and create invaluable lessons on several emerging sions through intercommunal interaction and principles in considering a more sustainable and de- trust building. velopment-oriented response that can maximize the benefits and minimize the socioeconomic risks of dis- There is still significant effort and evidence needed placement: to define a successful “development response” to the ■■ Strengthening national and local institutions forced displacement crisis, despite calls for a new para- to respond to displacement crises. The advan- digm that would combine humanitarian and develop- tage of national ownership over a response to ment efforts. What is clear is that the complexity, scale, a displacement crisis is that it puts the hosting and protracted nature of the crisis requires creative government in the driver’s seat and emphasizes approaches that maximize the potential benefits and strengthening existing national and local re- minimize the risks to countries bearing the hosting sponse efforts and institutions instead of intro- burden for the rest of the world. The May 2016 World ducing parallel external delivery channels. The Humanitarian Summit offer key forums in which to Turkish example has the potential to illustrate how further such discussions. Lessons from Turkey’s unique to implement this approach. hosting experience should figure centrally in defining the way forward. ■■ Maximizing refugees’ self-reliance. 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