Experiences of women relocated due to the february 2023 earthquake in Turkey: a qualitative study

Abstract

Background

Women are disproportionately affected by disasters due to their vulnerability and limited access to resources. The purpose of this study is to investigate the health concerns and experiences of women who relocated to a different city following the February 2023 earthquake in Turkey.

Methods

Data was collected using a constructivist qualitative research design. Between May 1 and July 1 2023, interviews were conducted with female participants who relocated to a different city after the February 2023 earthquake in Turkey. The collected data underwent qualitative content analysis, adhering to the Standards for Qualitative Research Reporting (SRQR). The study utilized Graneheim and Lundman’s content analysis method to analyze the interview data. Interviews were transcribed. The transcripts were analyzed in the qualitative research software package ATLAS.ti 9.

Results

In the study, 32 women aged 19–43 years were interviewed. The results revealed four distinct categories and 10 sub-categories derived from the interviewees’ narratives. These four categories were physiological needs, safety concerns, need for love and belonging, and self-realization.

Conclusions

It was concluded that individuals who experience disasters face multiple hardships, especially related to these categories. Therefore, it is crucial to focus on the issues and requirements of survivors, particularly women belonging to vulnerable groups. One should not overlook the fundamental needs of women in service delivery.

Background

Disasters are environmental phenomena, which include volcanic eruptions, floods, epidemics, hurricanes, and earthquakes not caused by human actions [1]. Earthquakes are unforeseeable natural disasters that have been documented since the existence of the planet. Due to the severe devastation, they cause, earthquakes endanger many lives and have fatal consequences [2]. Furthermore, earthquakes can result in long-lasting physical, psychological, and social effects [3].

An earthquake with a magnitude of 7.8 struck Turkey on February 6, 2023 at 04:17 local time in the Pazarcık district of Kahramanmaraş province. This earthquake stands as the largest in Turkey since the Erzincan earthquake in 1939. The earthquake and its aftershocks worsened the humanitarian situation [3]. The World Health Organization (WHO) reported that approximately 46,000 deaths and over 108,000 injuries occurred due to the disaster that impacted 9.1 million people, leading 2.7 million to become homeless and relocate. The WHO prioritized providing emergency health services to the displaced population to ensure continuity of care and support for the disrupted health system. Within the displaced population, priority has been given to caring for disadvantaged groups, such as women, children, and older adults [3].

Earthquakes have a direct impact on people’s physical health [4]. Injuries, fractures and other serious health problems occur during and after earthquakes, and serious injuries and even deaths can occur in collapsed buildings. In addition, earthquakes negatively affect women’s mental health [5,6,7]. They cause anxiety, stress, and trauma for many women [1]. Particularly in the aftermath of an earthquake, adverse conditions such as homelessness, poor nutrition and hygiene, and mourning for deceased loved ones can lead to a variety of health problems. The resulting negative effects can last for a long time [8]. Disasters, including earthquakes, cause extensive devastation, affecting not only the physical infrastructure but also individuals’ health and well-being. Research indicates that disasters result in significant psychological trauma, physical injuries, and long-term socio-economic impacts [4]. While the effects of earthquakes on general health are well-documented, there remains limited attention on how these disasters disproportionately affect women, especially in terms of reproductive health, mental health, and socio-economic stability.

Studies have shown that women face various health problems post-earthquakes, including early pregnancy loss, stillbirths, preterm births, and urinary tract infections. For example, the 2008 Chinese earthquake was associated with increased rates of pelvic fractures and inflammation among women [9]. Furthermore, women are more likely to experience post-traumatic stress disorder after earthquakes [9, 10]. Natural disasters, women are often part of the more vulnerable population [9, 11].

Studies of earthquakes usually rely on quantitative and descriptive methods [12,13,14]. However, qualitative studies provide a valuable opportunity to describe experiences, interpretations, and perspectives, as well as to better understand the cultural and social context surrounding them. A qualitative study that explores the experiences of women who relocated to a different city after Turkey’s February 2023 Earthquake will provide health professionals, policy providers, and intervention groups with comprehensive information. Thus, this study aims to investigate the health concerns and experiences of these women.

Methods

Aim

This study aims to investigate the health concerns and experiences of women, who had to relocate to a different city due to the February 2023 earthquake in Türkiye.

Design

The study used a qualitative research design with a constructivist paradigm as it involved generating new knowledge about the health concerns, experiences and problems of women who moved to a different city after the earthquake in Turkey in February 2023. Constructivist qualitative research is often used to explore participants’ subjective experiences and perspectives about the phenomenon at hand and to construct meaning. Semi-structured interviews were used in which participants were invited to express their views and experiences regarding the health concerns and problems of women who moved to a different city after the February 2023 earthquake in Turkey. Study data were collected through face-to-face interviews using a descriptive form consisting of nine questions focusing on women’s socio-demographic, gynecological and obstetric information, as well as a semi-structured form consisting of nine open-ended questions.

Information Form: This form was developed by the researchers and included age, marital status, employment status, income status, pre-earthquake city of residence, post-earthquake place of residence, chronic disease, reproductive system disease, presence of cancer, number of children and experience of death of first-degree questions such as relatives.

Semi-structured Interview Form: A semi-structured interview form was used in the study to explore the aims of the research, to explore experiences in more depth and to guide the interviews. The semi-structured interview included nine open-ended questions. Before the study, the interview questions were administered to two earthquake-affected and displaced women outside the study group to assess their clarity and comprehensibility.

Each session was comprehensively documented using a tape recorder, and detailed notes were taken on the interview form. The data was methodically described employing the qualitative research checklist (SRQR) [15].

Participants

This study was conducted between May 1, 2023 and July 1, 2023 with women who were affected by the February 2023 earthquake in Turkey and had to migrate to a different city. The study was conducted in a training and research hospital in Sakarya province. The study included 32 women aged 19–43 who had to migrate from different cities after the earthquake and applied to the institution where the study was conducted (Table 1). The number of participants was determined based on the data saturation principle [16]. After the interview with the 30th participant, it was observed that no new information was obtained from the interview. We interviewed 2 more participants and no new information was obtained regarding the research. We decided to end the interviews after we perceived that we had collected sufficient data and reached data saturation.

Table 1 Descriptive information

Data collection

This study was conducted between May 1, 2023 and July 1, 2023. Volunteer women, who were affected by the February 2023 earthquake, had to relocate to a different city, expressed a desire to discuss their earthquake experiences and women’s health issues, and possessed communication skills were included to the study. Eligible women were identified through a pre-screening process and invited to participate in the study via email containing information about the research. After obtaining informed consent from the participants, the dates and times of the interviews were scheduled. The interviews took place face-to-face at the healthcare facility utilizing a semi-structured form to collect data. The interviews were conducted in a quiet and isolated interview room in the organization where the study was conducted, paying attention to the privacy and comfort of the participants. The interview environment was free from external distractions. The time of the interview was determined according to the preferences of the participants. The participants were informed about the purpose of the study, that the interview was completely confidential and that the information they provided would only be used for research purposes. It was stated that they could leave the study according to their wishes. Audio recordings were made with a voice recorder and note-taking method after obtaining the consent of the participants.

The researchers who conducted the interviews (Y.Ç.Ş., D.S.G.) have an academic background in the field of gynecology and obstetrics and have experience and studies in qualitative research methods. They also specialize in women’s health and post-traumatic psychosocial support. Audio recordings were made to capture changes in the interviewees’ expressions, behaviors, and nonverbal responses throughout the interview process. In order to minimize bias, one researcher conducted the interviews while the other participated as an observer. During the interviews, techniques such as questioning, repetition, and responding were used to facilitate uninterrupted and nonjudgmental in-depth communication. After the interviews, regular team meetings were held to evaluate the interview processes and share experiences.

The interviews were conducted using some general questions (Table 2). An interview guide was specifically developed for this study. The interview guide consisted of open-ended questions about the women’s health problems and experiences during the earthquake. The interviews with participants lasted a minimum of 23 min, a maximum of 36 min, and an average of 26 min.

Table 2 Interview questions

Ethical considerations

Ethical committee approval and institutional permission were obtained prior to the study (No: E-71522473-050.01.04-241664-109/27.03.2023). Participants were informed that participation was voluntary and voice recordings would be made. They were also informed that they could withdraw at any time if they felt uncomfortable, and the data would be kept confidential and only used for the purpose of the study. Verbal and written consent was obtained from all participants.

Data analysis and reporting

The study utilized Graneheim and Lundman’s content analysis method to analyze the interview data [17]. The initial step involved transcribing the voice records, resulting in a 72-page raw data document. The narratives were read carefully several times to fully understand their content. Following this, sentences in these narratives were meticulously identified for contextual clues and thematic connections. The identification process involved examining shared concepts, emotions, or events that demonstrated thematic relevance. Next, codes were created to represent condensed units of meaning. These codes were statements that captured the essence of the content and served as a way to categorize and organize the data. Similar codes were then clustered into categories, resulting in ten subcategories and four categories that comprised the emerging findings. Finally, the subcategories and categories were distilled to create coherent subthemes and overall themes. The categories, subcategories, and codes are shown in Table 3. All researchers discussed the analysis, and in cases of disagreement, a consensus was reached by taking a different view. The transcripts were analyzed in the qualitative research software package ATLAS.ti 9 (Scientific Software Development GmbH, Berlin, Germany).

Table 3 Categories, sub-categories, and examples of codes

Rigor

The study followed the criteria of Guba and Lincoln: credibility, transferability, dependability, and confirmability [18]. The fact that the researchers were from different disciplines such as women’s health and disease nursing and midwifery enriches the study. The first author was the main analyst of the study but did not participate in the interviews, which provided a more objective perspective on the data. Techniques such as long-term data interaction, sufficient time for data collection and analysis, and member checking contributed to credibility. For member checking, the interviews were read several times by the research team and after coding, the interviews were checked with two of the participants and asked to verify the accuracy of the text. The confirmability of the results was supported by the use of quotations to illustrate the basis of the study findings. During the coding sessions, all authors were involved in a discussion about the interpretation of the data, thus providing a basis for auditing to increase reliability. In addition, to indicate the accuracy of the data analysis, some sections of the interview transcripts were sent to two psychologists and one social worker with codes and categories, and their approval was obtained. To ensure reliability, two independent researchers were involved in analyzing the data and discussing the results until a consensus was reached. Transferability was supported by detailed descriptions of the research process, and confirmability was ensured by accurate, direct quotes from the interviews. Transferability of the research findings was strengthened through purposeful sampling and in-depth interviews. In addition, maximum diversity in sample was used and direct quotes were included to provide more comprehensive and complete information. Confirmability was maintained by keeping a careful record that included the original notes, transcription, and analysis.

Unlike many other studies, this qualitative analysis examines the health issues and experiences of women who relocated after the earthquake. The study aims to provide valuable information for developing interventions that can address the problems faced by these women. Some of the researchers conducting the study worked in the institution where the participants received service, which provided them with the opportunity to observe them, which contributed to the complete and accurate acquisition of information.

Findings

Sociodemographic profiles

Table 1 presents the descriptive information of the participants. The mean age was 29 years and the majority were married, unemployed, with an income lower than their expenses, coming from the province of Kahramanmaraş and had lived in a tent for a minimum of two weeks after the earthquake. Moreover, the majority did not have any chronic or reproductive system diseases, were not diagnosed with cancer, did not have children, and had lost at least one first-degree relative.

Based on participant expressions, we identified 10 subcategories that fell into four main categories: inadequate meeting of physiological needs, safety concerns, need for love/belonging, and Self-realization. Table 3 presented the subcategories for each category.

Inadequate meeting of physiological needs

Physiological needs are the needs that must be met for an individual to continue living biologically. These include breathing, eating, drinking, sleeping, resting and sheltering. The inadequacy of meeting physiological needs is the most basic level of human needs and is a priority for individuals to continue their lives. When these needs are not met, people’s health is at risk.

Nutritional and Hygiene Needs; Access to clean water and adequate nutrition resources becomes limited due to logistical problems after a disaster. This situation poses serious health risks, especially for pregnant and breastfeeding women. Food inadequacies, difficulties in accessing clean water, and food security problems can also be counted. After disasters, infrastructure destruction, inadequate shelters and deterioration of hygienic conditions make it difficult for individuals to meet their basic evacuation needs. This can lead to serious physical, psychological and social problems, especially for women. Difficulty accessing toilets, anxiety about not being able to maintain hygiene during and after toilet use, and privacy issues.

For three days, I think no one could reach anything. It was insufficient because at that moment everyone was trying to remove the debris in some way and the aid could not be distributed. Maybe it came, but we didn’t see it. We hardly ate anything for three days (P18).

We took shelter in my grandparents’ house because their house was detached. There was no electricity, no water, no food. The conditions were very harsh (P27).

We took shelter in cars. We needed water and food. We went to the gas stations but they were looted. The bakeries gave one loaf of bread. It was not enough for families of ten. We tried to feed the children the first. We tried to cook food in the back of the car. We went home scared and cooked lentil soup; I still remember its taste (P1).

These statements reveal the difficulties experienced in meeting basic needs in the post-disaster period. Women feel a greater burden, especially due to their additional responsibilities such as family and childcare.

I was very anxious so I had to use the bathroom more often than usual. I needed to go all the time. At first, we tried going to places where no one could see us, but it didn’t work. I felt ashamed, but there was nothing I could do. Then, we found a youth center at the entrance of Islahiye. We went there after hearing that the building was secure. We walked there for around two hours. Just taking care of our bathroom needs made us feel better. (P30)

I couldn’t eat or drink for several days due to stress. Actually, I didn’t need to. My bathroom habits changed. I used to go to bathroom easily every day but could only do so on the eighth day following the earthquake. (P23)

These statements show the physical and emotional barriers women face when meeting their toilet needs. The distance and unsafe nature of toilets has caused women to encounter situations that endanger their health. It also reveals the psychological burden that women experience due to the lack of privacy in temporary shelters after disasters.

Sleep and Shelter Problems: Traumatic events such as earthquakes directly affect the physical and psychological health of individuals. One of these effects is disruption of sleep patterns. Women may experience serious sleep problems in the post-earthquake period due to recurrent fears, inadequate physical conditions and symptoms of post-traumatic stress disorder (PTSD). Fear that the earthquake will happen again, fear of death, inability to create a suitable sleeping environment and post-traumatic stress disorder (PTSD) are some of these. Women also experience housing problems after the earthquake and this is one of the main problems affecting women’s physical and emotional health. Women and their families are often forced to seek temporary shelter because their homes have been damaged, destroyed or are unsafe. This situation brings many problems such as loss of privacy, safety concerns and adverse weather conditions.

I was sleeping during the earthquake; there is no such fear. My heart raced. We tried to get out of the house. Since that day, I can’t close my eyes without remembering the incident, which has caused insomnia (P 19).

This statement reflects the constant alertness experienced by women due to fear of a recurrence of the earthquake. Such chronic fears disrupt sleep patterns and increase both physical and psychological fatigue.

The earthquake had a significant impact on my personality and behavior. Even when there is no earthquake, I constantly think one is happening, causing me to wake up frequently. I believe that an earthquake could occur unexpectedly, causing everyone I know to vanish instantly (P10).

Imagine a place where there are maybe a hundred people, we are in the gym, you want to go to sleep and try to forget what happened, there are people talking in their sleep, there are people chatting, but you can never sleep (P16).

The conditions of temporary shelters prevent women from resting physically, which leads to long-term health problems. It is clear that women need a quality sleep environment.

Following the earthquake, the most pressing concern was finding a safe place to stay. Shelter was a major issue due to severe weather conditions caused by heavy snowfall. Dressing appropriately was also a challenge as many people were caught outside in their pajamas. Those with cars sought refuge in their vehicles while others were left out in the cold (P 28).

This statement reveals how adverse weather conditions make women’s daily lives difficult and threaten their health. It emphasizes that temporary shelters should be designed to withstand weather conditions.

Following the earthquake, the most pressing concern was finding a safe place to stay. Many were unable to return to their homes and lacked proper shelter. The weather was really bad. Although winter usually lasts for less than 10 days, it felt like all of the bad weather happened during that time period (P 5).

After the earthquake, we had nowhere to go as the roads had cracked and transportation was nearly impossible, even to our closest relatives. It took us three weeks before we were finally able to get on a bus and go to a completely unfamiliar city (P3).

In this sense, women who are forced to migrate not only experience a physical displacement, but also lose their social support networks and face the challenge of starting over in a new place. This is a process that challenges their psychological resilience.

Health and Women’s Health Needs: One of the most critical problems for women after the earthquake is the lack of access to health services. This situation increases both physical and psychological health problems and seriously affects women’s quality of life. These disruptions in access to health services may cause women to neglect or ignore their health needs. These include severe damage or destruction of health centers after the earthquake, staff shortages due to earthquake-related losses in health personnel, the idea that health services should be prioritized for individuals with more serious medical needs, and lack of access to medical resources. Such situations negatively affect women’s physical and mental health and lead to neglect of basic hygiene needs and reproductive health services. In particular, inadequate delivery conditions, lack of access to sanitary pads and insufficient medical resources are priority problem areas for women.

Hospitals couldn’t work. There was a hospital where I did my internship. The upper floors of the hospital had collapsed, the walls had exploded (P8).

Most of the hospitals had collapsed. I was very anxious because I was pregnant; I was worried about my baby. Four days after the earthquake, a tent city was established, there was a doctor, there was an ultrasound and I went there. There were long queues. The ultrasound showed that there was no problem with my baby (P 24).

I was cancer and I couldn’t access medication, I couldn’t talk to my doctor, the operators weren’t working. I wanted to get myself checked but the hospitals were packed and there were wounded and dead people everywhere. It was a horrible sight; I couldn’t even ask about my condition (P32).

This statement reflects how health services were prioritized after the earthquake and how women’s health issues were often deprioritized.

I lost my 28-week-old twin babies after the earthquake. I was already at risk for a premature birth, but we were 28 weeks old at the doctor’s control. I could hardly conceive anyway; they were conceived with in vitro fertilization. At the time of the earthquake, we were able to leave the house unharmed, but I could not leave that city for three days. There were no hospitals available, and my water broke. It usually takes two hours to get to Niğde, but with the earthquake, it was impossible. We barely made it there within eight hours, and upon arrival, we were informed that labor had already begun and a caesarean section was necessary. Although the building did not collapse on me, can it be said that I was not trapped under the rubble? (P31).

This statement clearly highlights the lack of access to safe birth services and the difficulties women face.

I took a risk by going into my house, risking my life, to buy clothes and pads that I needed, despite the possibility of another earthquake. I was menstruating. Now I question whether it was a wise decision. Either way, I prefer not to remember. (P6).

It happened at the same time as my menstrual cycle following the earthquake. I realize it was a bodily function, but there were no sanitary pads, no clean underwear to change into, and no water to wash ourselves. We had a bad odor, which made me hesitant to interact with others. Unfortunately, there were no hygiene products available for about a week (P 14).

Failure to meet basic hygiene needs increased health risks and created psychological distress for women.

Women’s Fear of Stigma: In the post-earthquake crisis environment, women face significant difficulties in expressing their physical and emotional needs. The basis of these difficulties is the fear of stigma and gender-based discrimination in society. Women tend to hide their needs due to fear of stigma. The fact that women’s needs are ignored, especially in mixed areas or in aid processes where men are at the forefront, further deepens this problem.

You can’t take the pads off very often. It stinks, it runs down your legs. I think I had a urinary tract infection at the time. There was a great need for pads. I cut my clothes, my undershirt and used them. People other than women cannot understand. I was very shy and embarrassed around men (P11).

This statement clearly reflects how women remain silent due to fear of stigmatization and the difficulty they experience in expressing their needs.

The aid was also given to women, but when the aid was distributed, there were big, huge men at the front. They had priority and we couldn’t get the aid (P20).

This quote highlights the discrimination women face in aid distribution processes and reveals gender-based inequality.

I have stage three breast cancer and I had a check-up coming up. No hospital, no equipment, no access to my doctor (P29).

Safety concerns

After a disaster like an earthquake, women’s physical needs can be threatened, but also their safety. In such crises, the crowded and mixed nature of shelters makes it difficult for women to feel safe. The necessity to be together with strangers and the fear of being disturbed can create a constant feeling of insecurity in women. This situation makes women more vulnerable, especially in communal living spaces after an earthquake.

A lot of people came after the earthquake. But you don’t know them, maybe they want to help, but you can’t trust them, you are afraid. You spend time side by side with people you don’t know, I am not used to that, but I had to (P2).

Economic and Resource Concerns: The economic problems women face after an earthquake can pose major obstacles to rebuilding their lives. The loss of property, loss of income sources and inadequate financial assistance have a particularly profound impact on women who are economically vulnerable. These problems leave women unable to meet their basic needs, feeling uncertain about their future and at risk of losing their long-term economic independence. One of the important difficulties women face after an earthquake is the lack of resources. This situation is related to the lack of both human and material resources. While the lack of human resources manifests itself in the absence of sufficient health personnel and disaster specialists, the lack of material resources means the inability to provide the financial support needed to improve living conditions in disaster areas. In addition, improper management of material resources and gender inequality in the provision of assistance lead to inadequate responses to women’s post-disaster needs. These inadequacies can negatively affect women’s health, safety and economic independence.

I had everything. It was gone in an instant. I gave my whole life to build that house. Now it is just a big wreck (P25).

Before the earthquake, I was a shopkeeper. My shop was under our house. Now I have neither a home nor a job. All we could do was save our lives (P7).

Aid is coming, but it is not enough to sustain our lives, let alone cover our losses (P8).

When the aid came in after the earthquake, some got tents and some did not. For example, we got ours much later. It was so cold in the first days that even the tent was very valuable (P13).

Help is coming but we haven’t seen it yet. They usually reach the entrance of the city or an area near the center. We realized this situation much later. We can’t get out of the rubble, my husband is under the rubble, my children are with me, but we needed a lot (P26).

This quote states that aid should be provided by taking gender inequality into consideration, and draws attention to the fact that neglecting women’s basic hygiene and health needs is a factor that increases gender inequality.

Moral and Health Safety Issues: Moral problems refer to situations that are frequently encountered in the aftermath of natural disasters such as earthquakes, especially in areas of debris and in emergencies, and that result from the disruption of social order. Material theft in areas of debris includes unethical actions taken by people with the basic instinct of survival in the chaotic environment created by the disaster. Such behaviors may be part of the trauma caused by the disaster and may reflect the moral collapse in society. Another moral problem is the looting of health centers. After an earthquake, basic health resources such as medicines, medical supplies, and even hygiene products in health centers may be stolen, sometimes with the instinct of survival and sometimes with opportunism. This situation may negatively affect the difficulties in maintaining social order in the initial stages of the disaster and access to health services. Problems about health safety included microorganisms in tap water, garbage and sanitation problems due to the presence of toilets and corpses in public areas.

We watched over the rubble. There were officials who took note of the valuables, but then there were thefts (P9).

You can do anything in this apocalypse. The pharmacies were looted, it was very cold, my children had fever, there was no doctor, no medicine. So, I stole an antipyretic. I can’t forget it, but I had to do it (P21).

I don’t think kidnapping is real, it’s an urban legend. In this situation everyone is tense, if it happened and it was realized, everyone would rise up and lynch the thief. Let me put it this way, one of my cousins is 14 months old and her mother was pulled out of the rubble. She was in the rubble, and when the baby was pulled out, people took her right to the hospital. Now you can’t see the name of the building because it was demolished, they took the child away. The child disappeared and we searched for Gizem for 20 days. They told us that Gizem was in a hospital in Ankara. We searched all over Ankara. There is absolutely no record of Gizem. The child is 14 months old and cannot speak. Thank God, we finally found Gizem in a hospital in Istanbul (P4).

There was absolutely no water, the streets were cracked, the pipes burst. In some places, sewage water was mixed with tap water. We tried to use bottled water all the time, but they give us the water in grains. You have to use it for both drinking and cleaning (P9).

We couldn’t remove the bodies. Bodies were everywhere, some had no arms, some had no torso. You freeze, you don’t know if it’s real at that moment, garbage, rubbish, all side by side. There is no water, no house (P15).

Privacy Issues: Privacy is the need to protect personal space and not to be violated by others without permission. After a disaster, this privacy can often come with the loss of personal space, the sharing of basic living spaces with others, and in some cases, the violation of women’s rights to privacy regarding their bodies and private lives.

We have a village house, or rather, my grandfather had built a small house next to the garden. After the earthquake, when our house collapsed, there was no place to stay, so we went there. My uncles and cousins came as well. We tried to live in that house with sixteen people. When we wanted to change our clothes, men would come out and it was very difficult to have privacy (P9).

In the early days, there was a gas station nearby. The bathroom doors were broken, and in that environment, you try to get what you need, even if you are embarrassed. You want privacy, but who are you going to ask in that situation? (P12).

Need for love/belonging

Individuals who can satisfy their need for security through social activities that provide a sense of belonging, such as forming a family or gaining a place in society, create opportunities for community groups to contribute to community development. We identified one subcategory through participant expressions. Being cared for by others involved increased cooperation between friends or neighbors, while strengthening family unity entailed reconciling resentful relatives, taking responsibility for the well-being of family members, and fostering a sense of happiness and gratitude for their existence.

My two uncles did not talk to each other. Their relationship has improved a bit after the earthquake, so we are actually more connected to each other (P12).

Our family has all gone somewhere, but the sulks have reconciled. We are more connected. We feel the need to call each other more. We are more united. When we go back to our hometown, I will never neglect my relatives, I will not say that I will see them later because I had this job. I want to see them often (P20).

“My mother is sick. Her knees are bad and she has run out of synovial fluid. She has arthritis, meniscus, diabetes, toxic goiter, high blood pressure. She was a person in need of care under normal conditions. We always took care of her. That day my mother became healthier than all of us and supported us. She was very cold-blooded, taking care of us and guiding us. I don’t know what kind of strength and wisdom suddenly appeared. My mother brought us together as a family. She forgot her pain and sickness. I don’t understand how that happened. May God keep her in our lives (P 17).

After the earthquake, my neighbors pulled me and my children out of the rubble. May God be with them. If there is any help, they would take it for us. They share their bread (P22).

Self-realization

Self-realization refers to an individual’s pursuit of maximizing their own potential, developing their skills, and living up to their ideal self-image. As a self-improvement necessity, there is no saturation point and needs increase in relation to the level of satisfaction Women affected by the earthquake exhibited a tendency for accepting reality and problem-solving. The problem-solving aspect comprised backing local organizations and devising solutions for personal and societal needs. On the other hand, accepting reality involved acknowledging the earthquake and the supremacy of a divine entity.

I am also an earthquake survivor, but I was never pessimistic, it was already an earthquake. I tried to organize the help that came. I cooked in the tents. It even felt good to help (P17).

It is from God, there is nothing to do. Thank God we have faith. I wish it had not happened, but it did. May God never let anyone suffer like this (P21).

Discussion

This study focused on the experiences of women in Turkey after the February 2023 earthquake. Among vulnerable populations, women, children, and the elderly are most affected by disasters [19, 20]. Women are especially vulnerable due to their increased risk sensitivity, limited access to resources and opportunities, and heightened vulnerability in disaster situations [21, 22].

Women experience a multitude of physical and psychological health challenges in the aftermath of earthquakes. The challenges faced by women may an inability to meet their basic physiological needs, a lack of access to menstrual hygiene products, complications during prenatal, intrapartum, and postnatal care, discontinuation of treatment for chronic illnesses, inadequate safety measures, anxiety around childcare, and earthquake-related losses.

Inadequate meeting of physiological needs

Physiological needs are the primary needs that must be met in order for an individual to maintain a healthy life. In this study, it was observed that women assumed responsibilities such as cooking and taking care of the family, which are social roles imposed by the society immediately after the earthquake. However, they were worried because they did not have access to the food and cooking utensils they would use for cooking, and they tried to cook for their husbands and children in their damaged homes, risking all kinds of dangers. In addition, difficulties in accessing toilets and their inability to maintain hygiene increased their stress and anxiety. Needs such as toileting, hand washing, and providing underwear are essential. They are basic physiological needs and play an important role in preventing health problems. In addition, the fact that they had to live on the streets because their houses were damaged or destroyed to the extent that they could not stay in them, or that they had to use the same environment with people they did not know at all, caused women to have difficulty sleeping or to migrate from their places of residence. Our study results have shown that the most basic problem experienced by women after earthquakes is related to physiological needs such as nutrition, shelter, and sleep. Similar needs have been reported in other studies. Participants in the study conducted by Abbasian et al. (2023) reported poor and unfavorable living conditions, including a lack of facilities for washing clothes and dishes, difficulty sleeping at night due to cold and inadequate conditions, and untimely and unequal distribution of aid [23]. Budhathoki and colleagues (2018) identified the primary needs of earthquake survivors as food, shelter, water, clothing, and access to information about families or relatives [24]. A qualitative study conducted on Iranian women struck by an earthquake in 2017 revealed that women encountered issues with accessing restrooms and changing clothes due to insufficient clothing options. Moreover, the fear of being stigmatized hindered them from expressing their needs openly. The distribution of aid was biased towards men and individuals with influence [25].

Hou and Wu (2020) found that after the Wenchuan earthquake, women assumed gendered social roles for care, such as cooking, taking care of the elderly and children staying at home [20]. According to the results of the studies, it has been shown that women assume more gender-based traditional roles after devastating earthquakes and that these responsibilities increase their anxiety and cause them to become more vulnerable.

The women who participated in the study stated that not only the houses were damaged after the earthquake, but also the institutions providing health services were damaged. In this situation, pregnant women worried about themselves and their babies, those with chronic diseases had problems in accessing medication and doctors, and those in menstruation had problems in meeting needs such as hygienic pads. Issues related to women’s health that were identified by participants consisted of limited access to medical resources, challenges in procuring sanitary pads, unsuitable birth conditions, lack of follow-up for health, and difficulty in acquiring medications. According to Harville and Do (2016), the Haiti earthquake resulted in increased preterm birth rates and reduced average birth weights of infants [26]. Women, who survived the Nepal earthquake were unable to access sanitary pads, which was considered as an urgent necessity and basic need [24]. Similarly, women affected by the Iran earthquake reported that the most pressing health needs were access to toilets and bathrooms, as well as a lack of underwear and sanitary napkins. They also noted that women’s health needs were not adequately addressed after the earthquake, particularly in rural areas [25]. A comparison of contraception methods before and after the 2009 Sumatra earthquake reveals that modern contraception usage decreased after the earthquake, and there was an increase in the rate of stillbirths [27].

The amount of qualitative research concerning women’s experiences during earthquakes is limited. Our findings align with those of existing studies. However, despite differences in cultural and societal contexts, the primary needs of women during earthquakes, such as nutrition, sleep, and hygiene challenges, are universal. In addition, research indicates that women may perceive neglect of their health needs, potentially contributing to future health problems [25, 28]. Furthermore, in numerous societies, women are expected to bear the burden of meeting essential survival needs, such as water, food, and heating, which can add to their workload [22, 29].

Women’s physiological needs and health issues are important priority areas that require attention. Although needs like shelter, food, and clothing are easier to articulate, women’s health concerns and hygiene requirements are often left unaddressed due to fear of social stigma, cultural reservations, and shame, resulting in neglect. Therefore, logistics staff and healthcare professionals who offer assistance during earthquakes should take these types of concerns into account when designing and carrying out interventions.

Safety concerns

Another result of our study is the security concerns of women who have experienced earthquakes. The presence of unknown individuals who arrive to provide assistance after an earthquake, having to share sleeping arrangements, restrooms, and incidents such as theft and kidnapping of infants and children at the disaster site have made women feel insecure. In addition, financial losses raise future security concerns for women. Similar security concerns have been expressed in other studies. In the study conducted by Abbasian et al. (2023), earthquake survivors expressed that they lacked shelter during rainy or snowy days, lost their belongings, and had difficulty rebuilding, causing anxiety during their efforts to survive [23]. Yoosefi Lebni et al. (2020) found that the influx of outside volunteers to assist after the earthquake altered the established social environment in the villages of women and contributed to a sense of insecurity, as these individuals were unfamiliar with the situation. Consequently, women refrained from going outside [25]. Turkish women who participated in Ayata et al.‘s (2023) study, which was conducted after the 2023 earthquake, expressed feelings of unsafety while residing in tents or outside. They described various situations that contributed to their insecurity, including difficulties with using toilets in complete darkness and needing to enter damaged buildings for privacy to change underwear or pads. Additionally, they felt under threat of harassment and violence [30]. Women participants in the study by Demirci and Avcu (2021), who survived the 2020 earthquake in Turkey, reported safety concerns such as exposure to verbal violence, theft in their building, and economic losses [31]. Similarly, the 3rd Month Earthquake Report of the Turkish Medical Association addressed post-earthquake security concerns. It noted that safety measures for women are insufficient in temporary settlements, where some locations do not have separate toilets and showers, and these facilities are often situated far from residences. Additionally, living quarters lack secure doors, creating an environment that does not promote trust or privacy, and which may cause women to feel unsafe [32].

Earthquakes are complex events that involve geophysical, biological, economic, social, and cultural factors. Planning after a natural disaster should be interdisciplinary and address women’s health concerns. The study’s results demonstrate that women’s safety is a crucial issue following an earthquake. Hence, post-disaster planning should account for the experiences of women and their safety concerns. In addition, Crisis and Disaster Management teams at district, provincial, and relevant ministry levels should receive expert support from those experienced in addressing the unique vulnerabilities, needs, and health concerns of women.

Need for love/belonging

The participants in the study stated that the losses caused by the earthquake strengthened the ties within the family, ended the existing resentments and tried to do their best to help each other. In the aftermath of the earthquake, individuals exhibited an increased propensity for cooperation with friends, neighbours and relatives, with the objective of ensuring their survival. This phenomenon resulted in the resolution of existing resentments and the consolidation of interpersonal relationships. Similarly, Ahmadi et al. (2018) found that sharing feelings and experiences with neighbors helped earthquake survivors cope with the aftermath of the disaster and make future plans [33]. In the context of an earthquake, individuals typically seek support from their immediate social circle, characterised by familiar and trusted individuals, in order to experience a sense of safety and to share the burden of losses. Consequently, these relationships merit attention and support. Therefore, these relationships should also be supported by professional assistance units.

Self-realization

The women affected by the earthquake accepted their situation, safeguarded their families, and tackled challenges while striving to improve their abilities to manage the process and reach their full potential. Various factors affect this effort. The belief in a higher power and the desire to help others within society provided individuals with the motivation to persevere through their post-earthquake lives. Similar to our results, Yoosefi Lebni et al. (2020) discovered that women coped with the disaster by praying, aiding those less fortunate, and sharing their experiences [25]. Women in Ekanayake et al.‘s (2013) study stressed the significance of self-motivation and maintaining a positive mindset in moving forward and overcoming distress [34]. In addition, Ekanayake et al. (2013) found that holding religious beliefs and seeking support from others can aid in managing the emotional trauma and destruction experienced by women in the aftermath of a traumatic event [34].

In the post-earthquake period, women in the vulnerable group played an important role in minimizing the devastating effects of the earthquake for their families and society. This situation led women to realize their power to manage themselves, their families, society and the process in the best way. Therefore, in such disasters, policy makers, health service providers and disaster response organizations need to improve their planning and practices to support women.

Strengths and limitations

This study fills an important gap in the literature, as the relationship between women’s health and the effects of natural disasters is a relatively understudied area. By focusing on women’s health, the study contributes to a better understanding of post-disaster needs and offers a new perspective for shaping health policies. The qualitative research method is an appropriate approach to deeply understand the experiences of the participants. This study provides a rich data set on the difficulties, coping mechanisms and needs of the women. Using the participants’ own words allowed the findings to be presented in a meaningful and contextual way.

The study drew attention to a group that is often overlooked by focusing on the physical, emotional and social difficulties experienced by women after the disaster. The strict application of ethical rules during the interview processes, respect for the privacy of the participants and sensitivity to their needs strengthened the ethical standards of the study. The study addressed not only the physical effects on women’s health, but also the psychosocial and economic effects. This provides a comprehensive perspective for understanding the holistic effects of disasters on women.

The study findings not only provide an academic contribution, but also offer concrete recommendations for policy makers, health service providers, and civil society organizations regarding post-disaster women’s health. The findings also emphasize the importance of gender-sensitive policies in post-disaster interventions. The implementation of standardized interview plans, the establishment of trust with participants, and the use of a systematic approach in data analysis increased the reliability and validity of the study’s findings. The study addressed post-disaster women’s health at both the individual level (e.g., health needs and psychological effects) and the societal level (e.g., deficiencies in service provision). This allows the findings to be placed in a broader context.

The study was conducted with women who were directly affected by the effects of the earthquake, had to migrate, and agreed to participate in the study. This may have ensured that only women from a specific social and psychological context participated in the study. Not all groups may have been adequately represented. This limitation limits the generalizability of the findings to the entire female population.

There are difficulties in migrating after an earthquake and in a new settlement. Post-earthquake conditions and migration made the interview process difficult and emotionally challenging for some participants. It was important for the researchers to have expertise in post-traumatic communication to manage this process.

Conclusions

Earthquakes have devastating effects on women who lose their families and homes. Natural factors such as physiology, multiple social roles, cultural differences, care burdens such as marriage and child rearing, and being a vulnerable group indicate that women are a group that requires focus in disasters. Therefore, government aid agencies and community-based organizations should make plans to support women. Policy makers should develop a national disaster management plan that includes women’s special health needs in response to natural disasters. It is recommended that mobile health units that will provide prenatal care, delivery services, and psychosocial support after a disaster be expanded. The establishment of women-friendly centers should be encouraged to increase women’s access to health services in disaster areas. Special training programs focusing on women’s health after a disaster should be prepared for health service providers and health workers. Continuous training should be organized to increase their skills in recognizing and managing disaster-related psychological problems such as post-traumatic stress disorder (PTSD). Gender-sensitive service protocols should be developed to ensure women’s privacy and safety in disaster areas. Disaster response organizations should prepare and distribute emergency aid kits that will meet hygiene and post-natal care needs. Safe and women-friendly areas should be created in temporary shelters. Collaboration should be made with local governments to facilitate women’s access to health services after a disaster. At the individual level, the needs of women and their families, such as nutrition and shelter, should be met, and access to services that will support health needs and family relationships should be facilitated. Clinics, group communication and help lines should be provided for psychological care. Policy makers and civil society organizations have important duties in such natural disasters. Due to the gendered nature of disaster vulnerability, mechanisms should be created to ensure that women’s medical, economic and security needs, as well as aid resources, are allocated fairly and non-discriminatorily. It is believed that developing such policies will help reduce the negative impact of large-scale natural disasters on women.