Syrian Refugee Inflows, Health-Care Access, and Childhood Vaccination in Turkey

Abstract

This study explores the impact of the arrival of Syrian refugees in Turkey on access to health-care resources and subsequent changes in infectious disease rates among native children. Employing a distance-based instrument, it finds that native children living in regions that received large inflows of Syrian refugees experienced an increase in their risk of catching an infectious disease compared to children in less affected regions. In contrast, there is no evidence of significant changes in the incidences of noninfectious diseases such as diabetes, cancer, or anemia. The findings also reveal that the number of health-care professionals and hospital beds per capita declined in provinces that received large refugee inflows. This study also documents a decrease in native children’s probability of being fully vaccinated in provinces that received large refugee inflows. Although contact with potentially infected refugees may increase disease spread among natives, the migration-induced supply constraints in health-care access may also worsen health outcomes in host countries.

Can refugees improve native children's health?: evidence from Turkey

“…Our paper also sheds light on the mechanisms that drive possible health impacts of refugees. Existing studies emphasize the transmission of diseases such as malaria in Africa (Dagnelie et al, 2023), or other vaccine-preventable diseases (e.g., chickenpox and tuberculosis) and sexually transmitted diseases (e.g., syphilis) in Latin America (Ibáñez et al, 2021), and/or overburdened healthcare resources (Tatah et al, 2016;Aygün et al, 2021;Erten et al, 2022). Against these channels, we highlight the role of another mechanism through which immigration can affect health outcomes: the labor market channel and the associated mother's time allocation.…”

“…Particularly, in the case of children, the combined impact of such factors is likely to induce a deterioration in health outcomes during early stages of life. On the other hand, the refugee inflow may boost the welfare of the host population and accelerate local economies through increased demand, the flow of financial/humanitarian aid from intergovernmental organizations, and infrastructural improvements (Aygün et al, 2021;Erten et al, 2022). Delving into whether the benefits outweigh the costs is ultimately an empirical question, as these channels work in unique directions and the magnitude of their effects is largely unknown.…”

“…However, their estimates report no evidence of an impact on the Turkish natives' mortality outcomes. Erten et al (2022), in turn, mainly concentrate on the vaccination outcomes of native children in addition to the prevalence of infectious/non-infectious diseases among native children. Their benchmark results document a drastic reduction in the probability of being fully immunized against hepatitis B, tuberculosis, and measles.…”

“…Due to multicollinearity (Variance Inflation Factor (VIF)=70, well above the rule-of-thumb of 10, it leads to severe serial correlation), survey years are used instead of year of birth for time indicators. We therefore introduce 5 region-specific time trends and alternatively, 5 region-year fixed effects following Erten et al (2022). We also assess the sensitivity of our results to the use of more disaggregated subnational divisions in Section 5.2.…”

“…where η sc denotes the shortest travel distance (measured in kilometers using Google Maps) from each origin Syrian governorate s to a Turkish province c. As noted by Erten et al (2022), there are six border crossing points from Syria to Turkey, two in Hatay and the other four in Gaziantep, Kilis, Sanliurfa, and Mardin provinces. Therefore, choosing between these border crossing points are contingent upon the Syrian individuals' governorate of residence and the intended province of arrival in Turkey.…”