The Coronavirus Meets Authoritarianism in Turkey

In a public address on Monday night, the Turkish President, Recep Tayyip Erdoğan, stated, “Turkey is a country where production must continue and the cogs must keep turning under every circumstance and every condition.” Turkey, where more than two hundred people have died from the new coronavirus, has one of the world’s fastest-growing outbreaks, but Erdoğan has resisted urgent action, calling only for a “voluntary quarantine” for most of the country. Opposition politicians have called for harsher measures against the coronavirus, including the types of lockdowns that have gone into effect around the world, but they have been increasingly besieged and marginalized in recent years, as Erdoğan has extended his power and thrown his rivals in prison. Last week, Turkey arrested hundreds of people for “provocative” posts about the outbreak on social media. Medical professionals who have urged harsher measures have issued apologies after being arrested.

I recently spoke by phone with Emrah Altindis, a professor of biology at Boston College who has been studying the epidemic in Turkey, where he is from. He is also one of the editors of the book “Authoritarianism and Resistance in Turkey: Conversations on Democratic and Social Challenges.” During our conversation, which has been edited for length and clarity, we discussed how Erdoğan’s privatization of the medical system affected coronavirus preparation, how the Syrian refugee crisis has changed Turkish society, and the dangers of an outbreak in Turkey’s prisons.

Can you give us your overview of the coronavirus in Turkey right now?

Let’s start with the numbers. The first case in Turkey was detected on March 11th. This was later than in most countries. And the first death happened on March 17th. And as of today, March 31st, we have lost two hundred and fourteen people. And the number of cases that are confirmed is 13,531. If you compare these numbers to other countries’ after they had a hundred cases detected, Turkey has the biggest rate of increase in the number of cases in the world right now. So it means that it is really very serious.

We have some hope with the mortality rate. As you know, it is very high in Spain and in Italy. But in Turkey, if these official numbers are true—and some people question them, because there is no transparency—but, if these numbers are true, then the rate is less than in Italy or Spain.

Is there a theory about why the virus spread so quickly in Turkey even though, as you say, the first case was relatively late?

I think that in the world there are two different ways to contain the pandemic right now. Two successful models. One is South Korea, which did mass testing. And they were able to do twenty thousand tests per day. As of March 20th, South Korea did more than three hundred and fifty thousand tests. But in Turkey the number of tests that we have today is just ninety-two thousand, and the population of Turkey is eighty million. This is one of the reasons.

The other model that’s worked is in Wuhan, in China, and, right now, in California and France, and also in Boston, which entails stopping non-essential business. But Turkey hasn’t stopped. They closed restaurants and schools, but working-class people have to go to work every day. [More than forty small villages and towns in Turkey are under quarantine, but, as of Thursday, that was not true of any cities, including Istanbul, which has had the greatest number of covid-19 cases.] These people are carrying the virus to the people who are in the high-risk groups, and, as working-class people in Turkey go to work every day, they will bring the virus back home to their parents, grandparents, and people with chronic diseases such as diabetes, hypertension, chronic lung disease, or kidney disease. And so we will not be able to stop this transmission.

One more thing: as of today, we have more than thirteen thousand cases, but this is really the tip of the iceberg, because these thirteen thousand people were largely infected two, three weeks ago. The incubation time for the virus to show symptoms is approximately six days. They showed the symptoms, and then they went to hospital, but, meanwhile, this virus transmission continued, and these people infected many, many more people. It will be worse in the next two weeks.

Do you have a sense of why the Erdoğan government did neither mass testing nor universal shelter-in-place measures, and why the President seems to be more interested in talking about the economy than serious social-distancing and shelter-in-place measures?

Yeah, there are two different theories. The first one is that he says that the Turkish economy cannot manage a lockdown. This is one theory—that they are not able to do it. The other theory is about herd immunity. They already told people over sixty-five or with chronic diseases that they are at risk. And they have never talked about this, but there could be a hidden herd-immunity agenda there. This is a one-man regime right now. He decides.

On February 24th, the Turkish Minister of Health, Fahrettin Koca, who is a medical doctor, gave an interview to one of the most famous journalists in Turkey, Ahmet Hakan, and he said that Wuhan and Italy did a great job by locking down. And he said that, when there was a case in Qom, in Iran, he called the health minister of Iran, and he said it’s time to have a lockdown, but then Iran admitted to him that they didn’t lock down the city, and that’s why it spread. So he is aware of the fact that locking down the streets is a way to stop the infection. Unfortunately, one man decides, and, somehow, they cannot convince him to lock down the cities. Today, Ekrem Imamoğlu, the mayor of Istanbul, which is a huge city; the population of Istanbul is sixteen million—

He is an opposition politician, yes?

Yes, so, in Turkey, we have today three great cities: Ankara, the capital; Izmir; and Istanbul. And these three cities all have mayors from the opposition. And one-third of the population of Turkey lives in these big three cities. But we don’t have a system like you have in the United States. So, right now, the California governor can decide to lock down the whole state. But in Turkey this is not the case, and the Istanbul mayor was trying. He understood that we needed to lock down the city to be able to control the infection.

And there is another problem. The Health Minister said several days ago, when then the number of the cases was just six thousand, that sixty-three per cent of our intensive-care units are full. Right now we have more than thirteen thousand cases, and he says that we are just about to fill all our capacity, and the surge is coming.

There were a lot of sectors of Turkey, including journalism, academia, and politics, which were hollowed out, and in which people were sent to jail, after the failed coup attempt against Erdoğan. How much was this the case in the scientific and medical fields?

So, first of all, we can compare Turkey to the European Union and O.E.C.D. countries. Italy has 2.5 times more medical doctors and nurses per thousand people compared to Turkey. Or, when you compare Turkey with any other O.E.C.D. country, it has fewer medical doctors and nurses per person. After this coup attempt, many people lost their jobs in many sectors. And this also includes many medical doctors and nurses, and many academics, as well. And, in addition to this, for instance, many academics—and I’m one of them—signed a petition in 2016 to ask for peace in the Kurdish question. Several professors in the medical schools also lost their jobs from that. This has an effect also on our response, but there are also structural problems.

There have also been reports that doctors who have spoken out about the threat of the coronavirus in the last few weeks had been arrested and then, in some cases, recanted their statements under pressure. Is that something that you’ve heard about?

Yeah. Turkey has a good history of medical doctors’ organizations. The Turkish Medical Association represents eighty-four per cent of the Turkish medical doctors. And from the first day they have been asking to be a participant of the process of fighting this pandemic. And, unfortunately, the Turkish government doesn’t coöperate with them. They had been asking for transparency in the process, and there is no transparency. And from the first day they have been trying to have enough P.P.E. in the hospitals. According to the Turkish Medical Association, we have a hundred medical professionals that are in Istanbul and seventy-five medical professionals in Izmir who are already infected. But this is not the only problem.

There was an infectious-disease doctor, and she was giving an internal seminar for the other medical professionals in Ankara University Hospital. And she said the cases were being underreported, and that we have to be really careful and we have to protect ourselves. And someone recorded it. A medical doctor was trying to educate other medical doctors and nurses to tell them that this is serious, but then she ended up having to apologize to the public. And this happened again two days ago. A professor who is the head of a university in Izmir said that the cases are increasing, and that the situation is more serious than in Italy. And, again, he needed to apologize. Since 2013, oppression in Turkey has unfortunately become our normal living condition.

Turkey has been a place where a lot of refugees have come from North Africa, from other places, but especially from Syria after the civil war, which displaced millions of people. How much has that strained Turkey’s medical system in the past several years?

So, it is a general rule that infectious diseases always affect the weakest in the society—poor people, working-class people, refugees, the people in prisons. So, in Turkey, we have approximately four million refugees. Turkey and the E.U. had an agreement several years ago, and these people stayed in Turkey. But in the last three weeks, even in the Turkish media, I haven’t seen anything about refugees. And of course these groups will be hit very hard by this pandemic.

The population of Turkey is already eighty million. So you are adding four million people, and it means hundreds of thousands of new potential patients to your system. The medical system is one of the best medical systems in the Middle East—I’m not saying that it is a bad medical system. What I am saying is that it is not as strong as those in the E.U. or in other O.E.C.D. countries, but, in addition to this, there has been the privatization of the hospitals. The Erdoğan government has made several changes and privatizations that weakened the system, as well.

What were they, and why did they occur?

This is a model that is coming from the United States, actually, that exports it to other countries. We didn’t have private insurance in Turkey, but, in the last ten years, people started to have private insurance. We had very few private hospitals in Turkey. Right now we have so many private hospitals, and, unfortunately, the Turkish Health Minister is the C.E.O. of one of the main private hospital chains in Turkey. So they started to see health as a commodity to make money. Health became a service, as we have here in the United States. This did not used to be the case. Health was a right in Turkey—for everyone. And everyone was covered. Right now it is still much better than America, in terms of coverage. But, still, it is not enough. And it is weaker.

What have your friends who are doctors in Turkey been saying to you recently?

I have talked to many medical doctors. First of all, they have been complaining about the equipment, the P.P.E., and about the lack of transparency. For example, they do tests today, and the results come in four days, but they want to get the results the same day, and they’re very concerned about the violence that will come from the patients’ relatives. Just before the pandemic, the Turkish Medical Association was planning to organize a very big meeting in Ankara to protest violence against medical professionals. And right now they’re worried that, as the intensive-care units will be full soon and the people will be so stressed, there will be many more deaths, which might lead to an increase in the violence.

But their main concern is the P.P.E. and working conditions. And the Turkey Medical Association’s main concern is transparency and how the Turkish government is managing the process.

Do you have a sense of why Erdoğan has reacted the way he has? Some leaders of his ilk have not taken this seriously, but others, such as Narendra Modi or Xi Jinping, have, whatever you think of them or their methods.

I was hoping that, after I saw this interview with the Minister of Health, that they would take this seriously. They have been following what is going on in the world, and I was hoping to see some lockdowns of infected cities. They closed down schools and universities, but there is not a city in Turkey that is locked down or quarantined yet. And the second thing is that the number of the tests were so low. We are really not ready for this pandemic. And if we cannot protect our health professionals from the virus in the next two weeks, we will lose people who are fighting this virus. I was hoping to see more, because we have had some time, Turkey and the United States, but, unfortunately, the government didn’t see the tsunamis coming to us. A tsunami is coming to our cities.

There are many similarities between Trump, Erdoğan, Bolsonaro. And, unfortunately, they also have a role. This is a historical moment, and in the future historians will write about this, and I think that this will be one of the factors: Was there an authoritarian leader in the country or not?

Thank you so much for talking.

Can I make one more point? In Turkey, we have approximately three hundred thousand people in prison. Of these people, many of them are over sixty, and many have chronic conditions. In addition to this, Turkey is one of the top countries that imprisons journalists, politicians, students, lawyers. So right now, in these very crowded prisons, there’s a huge risk that we might have infections, and it might kill many people. And you saw in the news in New York, which has three people per a thousand infected. In Rikers, there are twenty-seven people in a thousand that are infected. This can cause massive deaths in prison, so we have to think about these people in prison, as well. We need reform. And in Turkey they have been talking about this, but they are excluding all political prisoners.

What do you mean, “excluding all political prisoners”?

The government has been talking about reform in the prison system because of the pandemic. So they are talking about freeing people. Some people who stole money or sold some drugs can be free soon. But not the journalists, not the members of the parliament, not the mayors, not the lawyers who are in prison because of politics. According to the Turkish state, they’re terrorists.

This has been discussed because in Iran they made the reform and freed eighty-five thousand people after they started to see how many people died in prison. And Turkish prisons are known to be quite crowded, and the health conditions are really bad. It’s the same in the United States. So, in the United States and in Turkey, and in any country that has so many people in prison, there’s a very serious risk that these people will die.

By: Isaac Chotiner

Isaac Chotiner is a staff writer at The New Yorker, where he is the principal contributor to Q. & A., a series of interviews with major public figures in politics, media, books, business, technology, and more.

Source: The New Yorker