Strangers in a new land: Evaluating the diagnostic effectiveness of the Turkish health system in the context of Syrian refugees

Abstract

In this chapter, we investigate the factors contributing to the higher rates of underdiagnoses among Syrian refugees at the start of their integration into the Turkish health system. Using an extensive dataset of over 10 million electronic health records (E.H.R.), we analyse the probability of underdiagnoses and its impact on subsequent health outcomes. Our analysis employs a detailed regression model with a rich set of regressors; including patient age, time of the day, hospital role, severity score, and utilization levels of doctors and MR machines. Our main findings reveal that patients who experienced underdiagnoses during their first visit had significantly higher subsequent severity scores compared to those who were not underdiagnosed. These results highlight the critical need for accurate and timely diagnosis to prevent worsening health conditions, especially for vulnerable populations like refugees. From the perspective of sustainable refugee integration, our findings underscore the importance of providing adequate resources and training to healthcare providers to address the unique challenges faced by refugees. From the perspective of general health system performance, the study emphasizes the systemic improvements needed to enhance diagnostic accuracy and equity in healthcare delivery across the nation. © 2025 selection and editorial matter, Dilek Başar and Selcen Öztürk.