The first step was taken as early as January 6, with the set-up of the Operation Centre and Science Council within the framework of the Ministry of Health to draw up guidelines for COVID-19. Since then, a number of measures have been adopted including halt of flights first from Asia and then various other countries depending on the number of cases. Initially, travellers returning to Turkey were being advised to self-isolate and quarantine themselves for 14 days at home, but later quarantine became compulsory. Schools, cafes, restaurants and any venues people could come together in large numbers are closed down since March 10th. People over the age of 65, under the age of 20 and individuals with chronic disease are banned to go out of their homes. On March 20th, with a circular order from the Ministry of Health, all private hospitals and research hospitals of private universities with specific infrastructure were designated as pandemic hospitals along with public ones. From the beginning of April, periodic curfews over the weekends in 31 cities as well as inter-country travel restrictions are in place, and wearing mask in public spaces is mandatory.

The Ministry of Health has the sole authority over the execution of public health policies in addition to its regular responsibilities of planning and providing healthcare. Its affiliated institutions are Pharmaceutical and Medical devices Institution, Public Health Institution, Public Hospitals Institution and General Directorate for Borders and Coastal Health. While the Turkish Public Health Association is accountable for the primary healthcare delivery, Public Hospitals Institute of Turkey oversees the hospitals and inpatient facilities providing care services. The governance and regulation of the healthcare sector are highly centralized even though these four agencies were created a decade ago with the goal of fuller autonomy independence over time.

There are several controversies regarding the measures taken against COVID-19 in Turkey and most of these are directed towards the lack of an economic support package that can help employees to stay at home. Initially, the government was criticized for not responding quickly particularly in cancelling the sporting events and banning prayer gatherings in mosques. Also, people returning from Umrah and various European countries where the pandemic was already widespread were only told to self-isolate without further checks. This is claimed to be one of the reasons of seeing virus in remote locations as the travellers were scattered all over the country, and some of them did not obey the self-isolation recommendations. Over the last weeks, partial curfews over the weekends and holidays became the centre of debate. A number of public health experts raised concerns about the ineffectiveness of these measures, especially given the household structure in Turkey where dependent and working family members live together. Moreover, there are some worries that stepwise approach would be delaying the peak of contagion, and stricter quarantine orders including working population are needed to restrain the spread of the virus.

Imaged credit: Enghin Akyurt via Pexels.

As mentioned before public health governance in Turkey is centralized and none of the social partners or professional organizations was consulted before the Scientific Advisory Board was established. A number of medical associations including Turkish Medical Association (TTB), which represents nearly 80% of physicians in the country, do not have any members in the Board. Similar concerns were voiced about the composition of the Board, particularly the inclusion of only one public health expert. The number of board members was later increased, and currently there are six public health specialists. Together with trade unions and few other professional organizations, TTB, launched a signature campaign on 31 March to enforce emergency measures asking for social protection for workers nationwide. The doctors belonging to TTB have been demanding that works should be terminated immediately during the pandemic in all sectors except those providing basic, compulsory and urgent goods and services. There are different views on why these measures are not recommended by the Scientific Board, and the exclusion of social partners and medical professionals who are openly critical of the government is a commonly stated reason. Devolution of authority and involvement of local stakeholders would reduce the bureaucratic hurdles, and allow the responsible agencies to develop more proper responses to the local needs.

Another point of debate is the opacity of the decision making in the Scientific Board and to what extent their role is purely advisory. Given the centralization of governance in Turkey and concentration of power in the hands of the President, it is argued by various social partners that mismanagements are inevitable due to prioritizing economic goals over health and not engaging in any dialogue with the larger societal groups. Some the most visible issues with centralized jurisdiction were observed in relation to the testing procedure and distribution of medical supplies to healthcare workers. In the first weeks of the pandemic, all COVID-19 tests were processed in Ankara and centrally administered, which considerably reduced the number of tests done and lengthened the time needed to get the results. Eventually, test centres were multiplied and now they exist in most of the metropolitan areas. Similarly, medical supply shortages were rampant at the beginning despite the claims of the Ministry of Health that the government has the adequate stock of masks and protective gear. This was also linked to the central government’s insistence of managing all the affairs from Ankara such as overseeing all the tests and distribution of medical supplies. Partly to respond to these criticisms, Pandemic Boards were founded under the chairmanship of city governors in April. However, professional organizations such as TTB and healthcare sector unions are still excluded.

COVID-19 pandemic certainly intensified the discussions over the relationship between the local and central governments in Turkey.

COVID-19 pandemic certainly intensified the discussions over the relationship between the local and central governments in Turkey. Since the electoral defeat of the governing party, the Justice and Development Party (Adalet ve Kalkınma Partisi – AKP) in major cities in the local elections in March 2019, the central government is trying to increase its grip on the municipalities. But during the pandemic conflicts escalated and reached a peak when the donation campaigns and various social assistance programs embarked on by the mayors
of Istanbul, Ankara, Izmir, all from the main opposition party, and other metropolitan areas were halted. These municipalities are already heavily constrained in their fiscal resources, and the government further limits their financial capacity by not letting them to borrow from the public banks or obtain funds from the public investment agencies. To provide, at least minimal safety nets, to the local residents during the pandemic, a number of the mayors from the metropolitan areas launched campaigns to collect in-kind and monetary donations. Shortly after, the President also announced a nationwide donation campaign and requested the well-off citizens to support their less privileged compatriots. However, the central government was not tolerant towards the local attempts, and right after the President’s announcement, emergency assistance programs undertaken by the local administrations were deemed as illegitimate. Paradoxically, while initiatives by the mayors from the opposition parties were stopped, several AKP mayors in Central Anatolian cities are able to maintain their social assistance packages and continue to distribute in-kind and cash benefits. Hence, the dispute between the central and local governments during the pandemic in Turkey is another manifestation of the ruling party’s attempt to suppress opposition and demonstrates the problems with extremely centralized governance structures.

Additionally, the Turkish government is not coordinating and communicating with the local authorities regarding the development and implementation stages of pandemic measures. For example, mayors of Istanbul, Ankara and Izmir were not notified about the weekend curfew for 11-12 April that was declared only few hours before and caused confusion and panic among the citizens. Although these cities host more than a quarter of Turkey’s population, the local administrations were not given any information ahead of time to organize public transport, food supplies and other necessities that would avoid further complications during lockdown. While the more recent weekend lockdown was announced in advance, still the municipalities were left out of the decision making process entirely. According to some estimates more than two million individuals have lost their jobs in Turkey since the beginning of the pandemic, and people are much worried about their livelihoods and economic prospects. The political clashes and the barriers erected by the national government against municipalities’ efforts would lead to public resentment and deterioration of confidence in policy makers, which can significantly hamper the effectiveness of crisis management and citizens’ willingness to abide by the public health measures.

In Turkey, governance of the pandemic and the ensuing reactions cannot be isolated from the political transformation the country has been going through over the last two decades.

In Turkey, governance of the pandemic and the ensuing reactions cannot be isolated from the political transformation the country has been going through over the last two decades. But, this is also not unique to Turkey as less democratic governments everywhere are seizing the pandemic as an opportunity to expand their power and focus more on perceptions and political consolidation rather than minimizing public health risks and offering safety nets.