TÜRKİYE, ALMANYA VE YUNANİSTAN’DA MÜLTECİLERE YÖNELİK HASTANE ÖNCESİ SAĞLIK HİZMETLERİNİN KARŞILAŞTIRMALI ANALİZİ

Öz

Amaç: Bu çalışma, Türkiye, Almanya ve Yunanistan’da ulusal politikaların mültecilere ve sığınmacılara sunulan acil sağlık hizmetlerini nasıl etkilediğini belgeleyen bir dizi araştırmayı eleştirel bir bakış açısıyla bir araya getirmektedir. Acil sağlık hizmetlerine erişimin sosyal bağlamını oluşturan politikalar, yerel hizmet yapıları ve göçmenlerin anlatılarına kadar uzanan çeşitli faktörleri analiz etmek için sosyo-ekolojik bir çerçeve kullanılmıştır. Gereç ve Yöntem: Eleştirel Yorumlayıcı Sentez (CIS) yöntemini içeren yenilikçi, karma yöntemli bir sistematik derleme gerçekleştirilmiştir. PRISMA kılavuzlarına uygun olarak, PubMed, Web of Science, EMBASE ve Cochrane Library veritabanlarında çok aşamalı bir literatür taraması gerçekleştirilmiştir. Literatür, Google ve ilgili akademik kuruluşların veri havuzları kullanılarak yapılan gri literatür taramasıyla desteklenmiştir. Bulgular: Önemli bir bulgu, katı sosyal yardım sistemlerinin birinci basamak sağlık hizmetlerine erişimi kısıtladığı ve bu durumun acil sağlık hizmetleri tek gerçekçi alternatif olarak tercih edilmesine yol açtığıdır. Göçmen Sağlık Merkezleri de, temel erişimi iyileştiren ancak sıkı ulusal tıp lisanslama düzenlemeleri nedeniyle eğitimli tıp uzmanlarının mesleki becerilerinin körelmesine yol açan paralel bir sağlık sisteminin oluşmasına katkıda bulunmaktadır. Dil engelleri, sınırları geçen sığınmacılar ve mülteciler için güvenli triyajın önündeki kritik bir engeldir. Dahası, güvencesiz yasal statü ve sınır dışı edilme tehdidi, mültecilerde ciddi psikolojik acil durumlara ve fiziksel somatizasyon travmasına yol açabilir. Sonuç: Kısıtlayıcı idari ve caydırıcı politikalar, birçok mülteci ve sığınmacıyı, sağlık hizmetlerine erişimin tek birincil noktası olarak acil sağlık hizmetleri kullanmaya zorlamakta ve bu da hasta güvenliğini ve sistem verimliliğini tehdit etmektedir. Sürdürülebilir acil sağlık hizmeti sunumu, ev sahibi ülkelerin, savunmasız grupların dışlanmasına yol açan idari engelleri ortadan kaldırmasını ve ulusal sağlık hizmetleri içine uygun kültürel ve dilsel kapasiteleri entegre etmesini gerektirmektedir.

Anahtar Kelimeler

• Hastane öncesi acil sağlık
• mülteciler
• sağlık hizmetlerine erişim
• sağlık politikası

COMPARATIVE ANALYSIS OF PREHOSPITAL HEALTH SERVICES FOR REFUGEES IN TÜRKİYE, GERMANY AND GREECE

Öz

Objective: This study critically synthesises a body of research that documents how national policies affect emergency health service delivery to refugees and asylum seekers in Türkiye, Germany and Greece. A socio - ecological framework is used to analyse a range of factors from policies to local service structures to migrant narratives that create the social context for accessing emergency health. Material and Methods: An innovative, mixed - methods systematic review that incorporated a Critical Interpretive Synthesis (CIS) was undertaken. Following PRISMA guidelines, a multi stage literature search of PubMed, Web of Science, EMBASE and the Cochrane Library databases was conducted. The literature was supplemented by grey literature searched using Google and relevant academic organisational repositories. Findings: A major finding is that rigid welfare systems restrict access to primary healthcare, driving demand for emergency medical services as the only realistic alternative. Migrant Health Centres also contribute to a parallel healthcare system which improves basic access but leads to the deskilling of trained medical professionals owing to tight national medical licensing. Language barriers are a critical barrier to safe triage for asylum seekers and refugees crossing borders. Moreover, insecure legal status and the threat of deportation can precipitate serious psychological emergency and physical somatisation trauma in refugees. Conclusion: Restrictive administrative and deterrence policies force many refugees and asylum seekers into using emergency medical services as the only primary point of access to care, threatening patient safety and system efficiency. Sustainable emergency health service delivery requires host nations to eliminate administrative barriers that exclusion of the vulnerable implies and integrate appropriate cultural and linguistic capacities within their national health services.

Anahtar Kelimeler

• Prehospital emergency health
• refugees
• healthcare access
• health policy

Kaynakça

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