What the 2023 Türkiye earthquakes taught about crush injury and after

Two studies published in 2026 look back at the health consequences of the February 2023 Kahramanmaraş earthquakes in Türkiye from different distances: one at the acute struggle to deliver life-saving treatment in the rubble, the other at how the disaster's health burden was distributed across the years that followed [s1][s2].

Why crush-syndrome timing is the whole problem

Crush syndrome develops when muscle tissue is compressed for a prolonged period, as when a person is trapped under a collapsed building [s1]. When the pressure is released, damaged muscle releases its contents into the bloodstream, which can trigger acute kidney injury and become life-threatening [s1]. Early fluid therapy — ideally begun before or as the patient is freed — is critical to reducing that risk [s1]. In a disaster, the first study notes, the setting itself often works against delivering that treatment on time [s1].

What the responders described

The study used a qualitative phenomenological design, conducting in-depth interviews with 20 emergency medical service personnel who worked during the acute phase of the earthquakes, and analysing the transcripts with dedicated software [s1].

Responders described three points at which crush-syndrome treatment could begin: during extrication, after rescue at the scene, and inside the ambulance [s1]. Against those opportunities, they identified five barriers that delayed early fluid therapy for high-risk patients: crowd density, media interference, inadequate search-and-rescue training, a lack of scene safety, and resource shortages [s1].

The through-line is that the obstacles were operational rather than clinical [s1]. Responders recognised the urgency of early treatment; what stood in the way was the environment in which they had to deliver it — chaotic, unsafe and under-resourced scenes where reaching a trapped patient with an intravenous line was the hard part [s1]. The authors argue for integrating health-care professionals into search-and-rescue teams, improving inter-agency coordination, and ensuring scene safety, so that fluid therapy can start earlier [s1]. They frame these as disaster-preparedness measures specific to crush syndrome rather than general emergency planning [s1].

The burden that outlasted the rescue

The second study widens the lens. This ecological analysis compared the health burden of Türkiye's 1999 and 2023 earthquakes using Global Burden of Disease data, examining deaths, disability-adjusted life years, years of life lost and years lived with disability across 19 age groups [s2]. It recorded 17,981 deaths attributed to the 1999 earthquake and 53,054 to the 2023 event [s2].

The burden was not shared evenly. Females consistently bore a higher share: the female-to-male death rate ratio was 1.63 in 1999 and 1.42 in 2023, with the disparity peaking among women aged 15 to 34, whose death rates ran three to four times higher than men's [s2]. The gap in long-term disability widened over the two decades — the female-to-male ratio for years lived with disability rose from 1.69 to 4.50 [s2]. While the mortality disparity stayed relatively stable across 24 years, the disability inequality worsened significantly [s2].

Reading the two together

The studies are different in kind, and each has clear limits. The first is a qualitative account from 20 responders, not a measurement of patient outcomes, and it cannot say how many patients each barrier affected [s1]. The second is an ecological study built on modelled Global Burden of Disease estimates, which describe populations rather than individuals and carry their own uncertainty [s2].

The two death counts are not directly comparable as a measure of severity, since they reflect different earthquakes, different building stock and different populations, and both rest on modelled estimates rather than a single official register [s2]. What they establish between them is that the health toll of a major earthquake has two phases that require different responses. The acute phase turns on operational logistics — getting fluid therapy to trapped patients fast enough to prevent kidney failure [s1]. The long phase turns on who carries the lasting disability, which the second study argues means monitoring must move beyond mortality counts and disaster policy must attend specifically to young women [s2]. Neither is captured by a single headline death toll. The first study's operational fixes and the second's call for sex-disaggregated, disability-aware monitoring are complementary rather than competing: one shortens the interval to treatment in the rubble, the other widens the frame over which the health system tracks who was harmed and for how long [s1][s2].

Sources

• [s1] "Barriers delaying treatment in cases at risk of crush syndrome in major disasters: Kahramanmaraş earthquake experience," Journal of Nephrology, 28 August 2026. https://doi.org/10.1093/joneph/aajag021
• [s2] "The gendered burden of natural disasters: Evidence from two catastrophic earthquakes in Türkiye," Social Science & Medicine, 26 June 2026. https://doi.org/10.1016/j.socscimed.2026.119540