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Turk Arch Pediatr
Turk Arch Pediatr
Turkish Archives of Pediatrics
2757-6256
Turkish Pediatrics Association

10.5152/TurkArchPediatr.2024.28625
tap-59-5-429
Editorial
The Devastating Impact of the Earthquake Doublet: An Alarming Increase in Child Mortality
Sayılı Uğurcan 1http://orcid.org/0000-0002-5925-2128

Cansu Çulpan Hazal 2http://orcid.org/0000-0001-9244-3818

Erginöz Ethem 1http://orcid.org/0000-0002-2338-4014

1 Department of Public Health, İstanbul University-Cerrahpaşa Cerrahpaşa Faculty of Medicine, İstanbul, Türkiye
2 Altındag District Health Directorate, Ankara, Türkiye
Corresponding author:Uğurcan Sayılı ક ugurcan.sayili@iuc.edu.tr
Cite this article as: Sayılı U, Cansu Çulpan H, Erginöz E. The devastating impact of the earthquake doublet: An alarming increase in child mortality. Turk Arch Pediatr. 2024;59(5):429-431 .

9 2024
01 9 2024
59 5 429431
15 6 2024
11 7 2024
2024 authors
2024
authors
https://creativecommons.org/licenses/by-nc/4.0/ Content of this journal is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

This study received no funding.
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pmcChildren of all ages, especially those under the age of 5, are among the most vulnerable groups of the population during disasters, and emergency conditions such as air pollution, coronavirus disease-2019 pandemic, and earthquakes have a damaging effect on children’s health.1-3 Earthquakes are among the most devastating natural disasters that occur as a result of geological processes and cause widespread destruction, loss of life, and long-lasting societal and economic impacts. Tragically, children are often the most vulnerable victims, with earthquakes disproportionately affecting their health and well-being.4-6

During or immediately after earthquakes, children may be killed or injured due to massive destruction. Structural collapses, being trapped under debris, and inadequate emergency medical intervention are the main causes of child deaths.5,7 Additionally, the death or injury of their parents, or their separation from their parents, may lead to situations where they are unable to provide their own care and survive.8

In studies, concerns are expressed about the increase in child mortality rates during disasters, both compared to previous years and other age groups. In the 2011 Great East Japan Earthquake and Tsunami, the mortality rate among children younger than 10 years was 6.4 times greater than that before and after 2011.9 Also, a survey in Indonesia following the 2005 tsunami revealed that the mortality rate for children aged 0-9 years was greater than that for all other age groups.10

On February 6, 2023, an earthquake doublet with moment magnitudes of 7.8 and 7.5 occurred 9 hours apart, affecting a large area, including south-central Türkiye, and having devastating effects. One year later, the Ministry of Interior reported that 53  537 people lost their lives during the earthquake, 38 901 buildings were destroyed, and 200 401 were severely damaged.11

On June 14, 2024, the Türkiye Statistical Institute released the Death Statistics of 2023 and reported that 45 784 Türkiye citizens lost their lives due to the earthquake doublet.12 The mortality data reflect the dramatic effect of the earthquake, especially on children. Remarkably, mortality due to “external causes of injury and poisoning” increased from 3.9% in 2022 to 12.3% in 2023 in the population and from 5.4% in 2022 to 17.0% in 2023 in the 0-14 age group. In the 3 provinces most affected by the earthquake, Adiyaman, Hatay, and Kahramanmaraş, mortality due to “external causes of injury and poisoning” was 3.8%, 2.9%, and 4.7% in 2022, respectively, and reached 74.8%, 70.1%, and 67.9% in 2023, respectively. Furthermore, the infant mortality rate and under-five mortality rate, which were 9.2 and 11.2 per thousand, respectively, in 2022, increased to 10.0 and 14.5 per thousand, respectively, in 2023. The rate is strikingly high in the 3 provinces that suffered the greatest devastation from the earthquake. The infant mortality rates in Adiyaman, Hatay, and Kahramanmaraş were 23.0, 20.8, and 20.3 per thousand, respectively, in 2022 and reached 23.0, 20.8, and 20.3 per thousand, respectively, in 2023. The under-five mortality rates in 2022 were 11.8, 13.0, and 11.4 per thousand in Adiyaman, Hatay, and Kahramanmaraş, respectively, and increased to 82.8, 67.9, and 65.3 per thousand, respectively, in 202312 (Table 1).

In addition to mortality due to “external causes of injury,” morbidity was also encountered during the earthquake. In Malatya, one of the cities affected by the earthquake doublet, almost a fifth of child patients admitted to the emergency department with crush injuries required limb amputation.13

Besides the death toll caused by physical destruction, earthquakes can cause large numbers of deaths, especially in vulnerable groups such as infants and children, as a consequence of reduced access to health services, difficulties with clean water and shelter, increased food insecurity, disruption of childhood vaccination, and increased communicable diseases.9,14,15 If appropriate measures are not taken, these disruptions can create ideal conditions for the outbreak of infectious diseases that can disproportionately affect infants and children.16 The 2015 earthquake in Nepal provided a striking example of the devastation that earthquakes can have on child health. Following the 7.8 magnitude earthquake, Kanti Children’s Hospital in Kathmandu saw a significant shift in inpatient disease patterns among children without traumatic injuries. The most frequent diagnoses were respiratory illnesses, gastrointestinal disorders, and neurological disorders, which were mostly related to the disruption of basic services and sanitation infrastructure.4 In Islahiye, a district affected by the 2023 Kahramanmaraş earthquake doublet, respiratory diseases, diarrhea, and vector-borne infections due to poor conditions started to occur within the first 2 weeks after the disaster. The incidence of norovirus and rotavirus infections, as well as Cryptosporidium, Giardia, and many enteric diarrheal infections started to increase as a result of damaged canalization systems and sanitation systems.17 On the other hand, in Adana, where the earthquake caused less damage and the healthcare system was not disrupted for diabetes patients, enhanced glycemic control was observed in children with type 1 diabetes using continuous glucose monitoring.18 It shows that the negative health effects of disasters on patients with chronic diseases can be reduced when there is no disruption in health services and when effective health services are provided. Hence, the prompt and efficient restructuring of health services, enhancement of hygiene and sanitation practices, and provision of shelter and proper nutrition are imperative measures to safeguard the health of children following an earthquake. Particularly, the preservation of breastfeeding is vital as it is the safest way of feeding and reduces the risk of infectious diseases and mortality in emergencies. Even though mother and infant are separated from each other, donor human milk should be considered as an alternative.19

Disasters possess both short- and long-term consequences, as well as direct and indirect health effects. However, it is important to be prepared for the unexpected and to have disaster planning, especially for vulnerable groups such as children.20 The devastating impact of earthquakes on human life was once again demonstrated by the statistics of the 2023 earthquake in Türkiye. These data also show that vulnerable populations, such as infants and children, often bear the heaviest burden of destruction. Natural disasters, including earthquakes, can have far-reaching consequences on the health and well-being of these young individuals, often leading to increased mortality rates. It is vital that society and governments consider the special needs of children in their disaster management plans.

Table 1. Infant Mortality Rate and Under-Five Mortality Rate by Year for Türkiye and the Provinces Most Affected by the Earthquake

The Under-Five Mortality Rate (Per 1000)	
Place	2018	2019	2020	2021	2022	2023	
Türkiye	11.4	11.4	10.7	11.4	11.2	14.5	
Adiyaman	13.3	14.2	12.1	14.0	11.8	82.8	
Hatay	12.2	13.1	12.2	11.8	13.0	67.9	
Kahramanmaraş	13.8	13.0	13.1	12.7	11.4	65.3	
The Infant Mortality Rate (Per 1000)	
Place	2018	2019	2020	2021	2022	2023	
Türkiye	9.3	9.3	8.7	9.3	9.2	10.0	
Adiyaman	10.7	11.4	9.8	12.3	10.8	23.0	
Kahramanmaraş	11.6	10.5	10.1	10.2	9.0	20.8	
Hatay	10.0	10.9	10.1	9.1	10.7	20.3	

Declaration of Interest: H.C.C. and E.E. are the statistical editors of the Turkish Archives of Pediatrics. However, they did not have any assignments in the process for this article.
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