HEALTH SERVICES IN ISTANBUL DURING THE REPUBLICAN PERIOD

In parallel with the formation of the state during the Republican period, health organizations took their place among other organizations established in the provinces. When examining the first years of the Republic, the efforts to rapidly form an organization and train medical personnel are striking. During this process, health services were sometimes combined with social welfare, social security, and even with municipal services. Moreover, during the organizational process, these institutions could sometimes take the place of one another. Unfortunately, there is no information or study that has regularly classified or recorded this formation. Here, the health services in Istanbul will be discussed in general, while keeping in mind the lack of studies, scattered documents and the dearth of a common memory of these institutions.

HEALTH DIRECTORATES IN ISTANBUL

Provincial Directorate of Health

The directorates of Vilayet Sıhhiye (provincial health services) and Muaveneti Ictimaiye (social welfare), what are known as health directorates today, were established in the provinces. Within this period, the organization of sağlık müdürlüğü-hükûmet tabipliği (health directorate/government physician), which was adopted in the era of the Second Constitutional period, was the basis for these institutions and the goal was to make health services available throughout the country. With the Umumi Hıfzısıhha Kanunu (Public Health Law) was enacted in 1930, doctors began to be employed in provincial, district and sub-district centers. The primary duty of government doctors was to protect public health. The Istanbul Health Directorate, which served as the Sıhhıye Umum Müdürlüğü (Directorate of Public Health) before the Republic, began to offer services as the Istanbul Sıhhat ve Ictimai Muavenet Müdürlüğü (Istanbul Directorate of Public Health and Welfare) after the foundation of the Republic. Being the responsible institution, this directorate carried out important duties during this period, including the management of state hospitals, the control and license of all health institutions, the performance of primary healthcare and environmental health services.

Provincial Directorate of Social Security

In order to obtain social security and healthcare institutions services, provincial directorates also carried out activities under the Ministry of Labor. After the Social Security Institution was established, the Istanbul Provincial Directorate of Social Security took on these tasks.

Public Health Directorate

After Law Number 663 Sağlık Bakanlığı ve Bağlı Kuruluşlarının Teşkilat ve Görevleri Hakkında Kanun Hükmünde Kararnâme (Decree Law concerning the Organization and Duties of the Ministry of Health and Its Affiliates), which was passed in 2011, as in all other provinces, the Health Directorate in Istanbul was divided into two; the İstanbul İl Sağlık Müdürlüğü (Istanbul Provincial Directorate of Health) and the İstanbul Halk Sağlığı Müdürlüğü (Istanbul Public Health Directorate). Inpatient health services, diagnostic and treatment centers, medical professions, oral and dental health, pharmacies, medical devices and biomedical and medical services in cases of emergency and disaster fell under the responsibility of the İl Sağlık Müdürlüğü. Departments of family medicine, public health, cancer, non-communicable diseases and departments concerned with chronic diseases, obesity, diabetes and metabolic diseases, as well as mental health, smoking and other addictive substances, child welfare, adolescent health, women’s health and sexual health, communicable diseases, immunization services, environmental health and worker’s health all fell under the Halk Sağlığı Müdürlüğü.

Following the withdrawal of the Allies from Istanbul in 1923, the Beynelmüttefikin Sıhhiye Kontrol İdaresi (Inter-allied Health Control Administration) was abolished with the Treaty of Lausanne and was substituted by the Hudut ve Sahiller Sağlık Genel Müdürlüğü (General Directorate of Border and Coastal Health). This institution, which has been known by different names throughout this period, still provides services in Karaköy, as the Türkiye Hudut ve Sahiller Sağlık Genel Müdürlüğü (Turkish General Directorate for Border and Coastal Health). During the first stage of this directorate, its duty was to provide health control for the ports of Istanbul and the Straits; in addition there were the Galata and Kavak coastal health centers and the Kavak and Tuzla quarantine stations. Additionally, the Emraz-ı Sariye (fever hospital) and port laboratory in Istanbul also worked under this directorate. Today, there are a number of health units that offer services for the protection of public health at border control points, in ports and within transit points of airports.

THE ISTANBUL MUNICIPALITY AND HEALTH

The Belediye Kanunu (municipal law), which was prepared during the Republican period to reorganize municipal services, came into effect in 1930. This law set out the duties of municipalities concerning the protection of public health; these included: food, beverage, animal welfare, hygiene, service industry, mercantile procedures, education and maintenance of the poor, including medication, shelter and clothing, funeral and burial procedures, breastfeeding centers and maternity hospitals, medical care and emergency departments, pharmacies, veterinary hospitals and the establishment of county hospitals. Moreover, the Umumi Hıfzısıhha Kanunu (public health law), which came into effect in the same year, put some duties related to public health and assistance under the control of the municipality.

The Istanbul Belediyesi Sıhhat İşleri Müdürlüğü (Istanbul Municipality Directorate of Sanitary Affairs) carried out the duties that these laws had given it. First, in Saraçhane, a building was constructed for the Belediye Kimyahanesi (municipal chemistry laboratory), which had been operating in different locations. Afterwards, a fire station in Fatih and a veterinary hospital near Atpazarı were constructed. In addition to the animals that were used for municipal cleaning and transportation services, other animals that were owned by the public were also treated at this hospital. The Sultanahmet madrasa was converted into a dormitory for street children (1929). The İskoç Mektebi (Scottish School) in Galata became the Çocukları Kurtarma Yurdu (rehabilitation center for children). Haseki Hospital, Cerrahpaşa Hospital and Zeynep-Kamil Hospital were renovated and new additions were constructed. Dispensaries that offered outpatient care and diagnostic services were opened in Kasımpaşa, Eyüp, Kadıköy and Üsküdar. In 1932, the Istanbul Mıntıkası Sıhhat Murakabe Merkezi (Istanbul Territorial Health Supervisiory Service) was established and consisted of a healthcare team which offered medical advice in neighborhoods that had a large density of underprivileged residents. The Belediye Kanunu also meant that the Vakıflar Umum Müdürlüğü (General Directorate of Foundations) was no longer responsible for graveyards within city limits. In order to build modern cemeteries outside the city rather than investing in traditional graveyards and tombs, which until that time had been established within neighborhoods next to houses and near mosques, the department of cemeteries was established in 1933.

In 1931, a committee established by the City Council determined that the number of beds available in hospitals in the Istanbul Municipality was 740. At that time, considering the population, a more appropriate number of beds in Istanbul should have been 7,000. With this in mind, a five-year health plan was prepared for Istanbul. As there was no bacteriology laboratory in the city, the municipal bacteriology laboratory was launched in 1932.

In 1959, the following medical institutions were included in the Istanbul Municipality: Beşiktaş, Edirnekapı, Üsküdar and Süleymaniye health centers; Sarıyer and Zeytinburnu dispensaries; dispensaries for venereal diseases in Üsküdar, Beyoğlu, Tophane and Galata; chief-physician offices in Adalar, Bakırköy, Beşiktaş, Beykoz, Beyoğlu, Eminönü, Eyüp, Fatih, Kadıköy, Sarıyer, Şişli, Üsküdar and Zeytinburnu; local physician offices in Anadoluhisarı, Beylerbeyi, Beyazıt, Burgaz, Heybeliada, Kısıklı, Kızıltoprak, Küçükpazar and Taksim. In addition, sıhhi imdat teşkilatı (emergency organizations) were established in 11 neighborhoods, with a maternity hospital in Büyükada.

Apart from duties concerning public health, the municipality was also responsible for the management of Cerrahpaşa, Haseki, and Beyoğlu Hospitals and the venereal disease hospital, which had been under the control of the municipality before the Republic, as well as the management of Zeynep-Kamil Hospital, which was transferred to the municipality immediately after the establishment of the Republic. All of the hospitals in Istanbul that were under the management of the municipality were transferred to the Ministry of Health in accordance with a protocol between the minister of health and the mayor, signed in 1982. Later on however, this became a matter of dispute and the implementation was cancelled; the ministry and the municipality were able to settle this conflict in 2004.

Today, the Istanbul Metropolitan Municipality does not offer inpatient treatment services. A limited number of medical centers offer outpatient services. Although the first ambulance system, Hızır Acil, carried out important services in Istanbul, but lost its importance after the Ministry of Health extended the 112 Emergency systems throughout the country. In 2003, Hızır Acil was integrated into the Ministry of Health. Today, the municipality aims to offer services that target women’s health and family health. Moreover, throughout Istanbul, the municipality offers home care and health services for those in need.

Darülaceze (Almshouses)

The darülaceze were first established in 1895 by Abdulhamid II; until 2013 approximately 100,000 people were housed in these institutions. The darülacezes and hospitals which existed on the premises of the darülacezes served under various ministries and sometimes under the şehremaneti (city council) during the Ottoman State. During the Republican era, the darülaceze was completely transferred to the Istanbul Municipality in keeping with a decision passed by the council of ministers in 1924. Within the structure of the darülaceze the following facilities were available: seven departments for the needy, a polyclinic, kindergarten, rehabilitation center with a library, bakery, a kitchen large enough to cook for 3,000 people, a slaughter house, an icehouse that could preserve the meat of the animals that had been slaughtered for one year, a laundry room and other facilities as needed by the institution. The darülaceze, which continued its activities under Istanbul Metropolitan Municipality until 1998, was transferred to the Ministry of Internal Affairs by a court decision in 1998. It is still in operation under the Ministry of Family and Social Policies.

After a court decision in 1998, the darülaceze was transferred to the Ministry of Internal Affairs, the Istanbul Metropolitan Municipality in Kayışdağı opened a new darülaceze. This new darülaceze was the largest nursing home in Turkey. It was established on 151 acres of land and can house up to 1,000 people. The new darülaceze meets the social and basic needs of the residents. Areas within the campus, such as a gymnasium, library, social activities center, café, gardens, hobby spaces and small zoo offer rehabilitation services for the residents.

Hospitals

When the Republic of Turkey was established, it inherited 86 hospitals and 6,437 beds from the Ottoman State. Of these hospitals, those that had a large number of beds, in particular, the largest ones, were located in Istanbul. A rough observation can give an estimate that there were some city centers in which not even one hospital existed. In 1924, in order to serve as an example, numune hastaneleri, which embodied all the contemporary areas of specialization in medicine, were established in Ankara, Erzurum, Diyarbakır and Sivas. Haydarpaşa Hospital in Istanbul started to operate as the Haydarpaşa Numune Hospital.

In addition to Haseki Hospital, Bezmialem Vakıf Gureba Hospital, Zeynep-Kamil Hospital, the Municipal Hospital of Beyoğlu, Şişli Etfal Hospital and Süleymaniye Hospital, hospitals which are still actively operating today, other hospitals that served minority groups also offered services to the residents of Istanbul.

According to the data, during the first years of the Republic, 554 doctors, 69 pharmacists, 4 nurses, 560 health officers and 136 midwifes were employed by the Sıhhiye ve Muaveneti İctimaiye Vekaleti (Ministry of Health and Social Welfare). It would not be unreasonable to suppose that most of these people were working in Istanbul, the capital city of the Ottoman State.

Haydarpaşa Numune Hospital

Haydarpaşa Hospital served as the Istanbul faculty of medicine from 1908 to 1933. Later, the faculty of medicine was transferred to the ministry of education and the hospital was transferred to the ministry of health. This hospital led the way in many areas, including the foundation of reanimation, plastic and reconstructive surgery clinics in Turkey, as well as some important operations, like kidney and liver transplants.

Haseki Hospital

The wife of Suleyman the Magnificent, Hürrem Haseki Sultan, had Koca Sinan build a complex in 1539; this complex included a hospital, known as Haseki Hospital. Until 1878, the management of the hospital was under the waqf established by Hürrem Haseki Sultan. After that year, it was transferred to the şehremaneti. With the addition of new pavilions during the Republican period, Haseki became a large modern hospital. In the 1930s the name of the hospital, Türkiye Cumhuriyeti Istanbul Şehremaneti Haseki Nisa Hastanesi (Turkish Republic Istanbul Haseki Women’s Hospital), was changed to Haseki Kadınlar Hastanesi (Haseki Women’s Hospital).

When the faculty of medicine in Haydarpaşa was transferred to the European side, as part of the University Reform of 1933, some of the clinics of the faculty were placed in Haseki Hospital. When the university clinics were shifted to Cerrahpaşa with the foundation of the Cerrahpaşa faculty of medicine in 1967, these clinics once again came under the auspices of the Istanbul Municipality. The Haseki Hospital was transferred to the Ministry of Health according to a protocol that went in implementation in 1982.

Bezmialem Vakıf Gureba Hospital

In 1843 Bezmialem Valide Sultan, the mother of Sultan Abdülmecid established the Bezmialem Vakıf Gureba Hospital; later this became the Bezm-i Alem Gureba-i Müslimin Hospital. Having been managed by a waqf, the hospital was transferred to the Sıhhat Vekaleti (Ministry of Health) in 1926. After 1933, some clinics of the Istanbul medical faculty were located in this hospital, with the hospital being transferred once again to the general directorate of waqfs in 1956. In 1962, the Çapa clinics which belonged to the hospital were transferred to Istanbul University. In 1989, Bezmialem University was founded as part of the Vakıf Gureba Hastanesi, but the university was disincorporated in the same year in accordance with a report from the Cumhurbaşkanlığı Devlet Denetleme Kurulu (presidential state supervisory committee). Later, the management of the hospital was transferred from the Vakıflar Genel Müdürlüğü (General Directorate of Waqfs) to the Sosyal Sigortalar Kurumu (Social Security Institution) and then to the Ministry of Health. Finally, the hospital was returned to the Vakıflar Genel Müdürlüğü in 2005. The Vakıf Gureba Hospital was transferred to Bezmialem Vakif University in 2010 and is now known as the Hospital of the Bezmialem Vakif University medical faculty.

Zeynep Kamil Hospital

The daughter of Muhammed Ali of Egypt and her husband Yusuf Kamil Pasha constructed this hospital on their private property in 1862, in order to provide free services for patients. The hospital was transferred to the Istanbul Municipality in 1933 and in 1935 it was transformed into a maternity hospital. The Istanbul Municipality, in keeping with an agreement drawn up in 1982, assigned the management of the Zeynep-Kamil Hospital to the Ministry of Health.

Şişli Hamidiye Etfal Hospital

Constructed by Abdulhamid II as a children’s hospital, this facility opened under the name of Hamidiye Etfal Hastane-i Alisi (Hamidiye Children’s Hospital) in 1899. During the Republican period, this hospital became known as Şişli Etfal Hospital and this was put under the administration of the ministry of health and social welfare. The clinics of the Istanbul University medical faculty, which were transferred to the Etfal Hospital after the university reform of 1933, continued to operate until they were moved to Cerrahpaşa Hospital in 1949. The main building was demolished in 1968, and the current hospital was constructed. Only the clock tower remains from the original structure.

Süleymaniye Maternity Hospital

As a continuation of the Süleymaniye Darüşşifa (hospital), which offered services from the 16^thcentury, the Süleymaniye Maternity Hospital played an important role in the field of gynecological health from 1927 on, operating as a specialty hospital. Although it served in a building that belonged to the waqf, it was assigned to the administration of the ministry of health. In the 2000s, the hospital location of the hospital was changed, and the historical buildings were assigned to the waqfs once again.

Cerrahpaşa Hospital

This hospital was first opened by the municipality in Takiyüddin Paşa Mansion in Cerrahpaşa. In 1912, the hospital was expanded with additional buildings. After the university reform act of 1933, some clinics of the Istanbul faculty of medicine were brought here. The hospital continued to expand under the control of the university. Later on, the clinics in Haseki and Bakırköy were also moved here. The university took over the Çapa Clinics from the Vakıf Gureba in 1967 and in 1969 took over Cerrahpaşa Clinics from the municipality.

Beyoğlu Belediye Hospital

These health services, which were organized as hospitals under different names and in different places for the purpose of fighting cholera in 1865, were brought to their present location in 1948 and took the name of the Beyoğlu Belediye (county) Hospital. Like other county hospitals, it was transferred to the ministry of health in accordance with a 1982 protocol. The facility was transformed into an ophthalmic hospital in 2000, and still operates, under the name of Prof. Dr. N. Reşat Belger Beyoğlu Göz Eğitim ve Araştırma (ophthalmic teaching and research) Hospital.

Deri ve Tenasül Hastalıkları Hospital

This hospital was established in 1908 as Emraz-ı Zührevi (venersal disease) Hospital, and operated under the Istanbul security directorate in Beyoğlu Kuledibi. Later, the hospital was transferred to Hasköy and then to Cankurtaran. Having operated for several years under the Istanbul Municipality, the hospital, like all other municipal hospitals, was transferred to the ministry of health in accordance with a 1982 protocol. In 2009, the hospital vacated the building that belongs to the municipality and now operates out of a building near Bakırköy Lepra Hospital.

Bakırköy Ruh ve Sinir Hastalıkları Hospital

The Istanbul Emraz-ı Akliye ve Asabiye (mental health) Hospital was established when the Topbaşı Bimarhanesi (mental hospital), located in the Atik Valide Complex in Üsküdar, was moved to the Reşadiye Barracks in Bakırköy. The removal began in 1924 and was completed probably in 1927; the Toptaşı Bimarhanesi was closed down. This hospital played a pioneering role in the field of psychiatry throughout the Republican period, and offers services not only to the residents of Istanbul, but to people from all over Turkey. The hospital was named after Mazhar Osman, who established the hospital and acted as its first head physician.

Minority Hospitals

Various minority foundations have played an active role in education, social welfare and health services throughout Istanbul, a city that hosts a population from various religious and ethnic backgrounds. Below are the main hospitals that were established by minority groups, which continued to exist during the Republican period and which operate as private hospitals today:

Austria Sen Jorj Hospital

During the cholera epidemic of 1872, some nuns from Austria provided health services in a location near Galata Tower. Later, in 1893, the first pediatric clinic of Turkey was opened here, with the help of an Istanbul doctor. The facility became a hospital after an ophthalmic clinic and polyclinics were added. The Austria Sen Jorj (St. George) Hospital has grown with the addition of new buildings and still continues to offer services.

Balat Or-Ahayim Jewish Hospital

The Balat Or-Ahayim Jewish Hospital was established with a decree by Sultan Abdulhamid II and with the help of some benefactors; it first started to operate as a small health care center in 1898, later developing into a hospital. In the 1920s, with the help of donations from Sir Elly Kadoorie, a Baghdad businessman, new buildings were added; it was after this date that the hospital started to operate as a modern hospital. Having undergone renovations, the Balat Or-Ahayim Jewish Hospital is still offering health services today.

Surp Agop Armenian Catholic Hospital

In 1831, at the request of the Armenian Catholic community, the sultan gave a decree ordering the construction of the Surp Agop church and hospital began in Pangaltı. The construction was completed in 1837 and with constant improvements, the hospital became a modern, high-capacity health institution. The Surp Agop Hospital has been offering services since the beginning of the Republican period.

French Lape Hospital

After the Crimean War in 1857, Sultan Abdülmecid assigned a property to the Filles de la Charité in Şişli; at this time, the property was located outside the city. In addition, the sultan gave a large amount of money to the nuns as a sign of his gratitude for their services in the army’s mobile hospitals. The hospital, called La Paix in commemoration of the nuns, was constructed and began operations. After 1877, the Lape Hospital became a psychiatric hospital. During the period when Doctor Mazhar Osman was the chief physician, the institution functioned as a teaching hospital and today continues to offer services in the same field.

Istanbul Balıklı Rûm Hospital

Balıklı Hospital, or Yedikule Hospital as it was formerly known, was established in 1753 by the guild of grocers to treat Greek Ottoman citizens who suffered during epidemics. Other Greek Ottoman hospitals, the Gemicilerin Hospital in Galata and the Veba Hospital in Beyoğlu, were brought under a single management in 1794. Having undergone various changes until today, the hospital continues to serve as a general hospital within its campus in Yedikule.

Yenikapı Surp Purgiç Armenian Hospital

Under the leadership of the pioneers of the community, the Yenikapı Surp Purgiç Armenian Hospital was established in 1832 according to a decree from Sultan Mahmud II. In spite of the financial and administrative difficulties that the hospital has encountered throughout its history, it has survived until today.

Istanbul University Hospitals

Known as the Darülfünun-i Osmani during the period shortly after the promulgation of the Republic, the university became known as Istanbul Darülfünunu (school of science) in 1924 according to Law Number 493.

When the Istanbul Darülfünunu was closed down in 1933, to be replaced by Istanbul University according to Law Number 2252, the faculty of medicine was transferred from the buildings in Haydarpaşa to the European side. The central administration of the medical faculty and the liberal arts faculty were transferred to former Ministry of War building, located in Beyazıt and used today as the Rector’s Office of Istanbul University. The clinics were assigned to hospitals in Şişli Etfal, Haseki, Cerrahpaşa, Gureba and Bakırköy.

After the transfer from Haydarpaşa to the European side, the medical faculty spread over a larger area. This caused some difficulties both for students and for the administration. In 1951, the faculty of medicine was removed from the Şişli Etfal and Bakırköy Psychiatric hospitals. Thus, the faculty of medicine was centered around the Çapa and Cerrahpaşa clinics.

When the number of students increased, in 1967 the faculty of medicine at Istanbul University was divided into the Istanbul faculty of medicine and the Cerrahpaşa faculty of medicine. In the same year, the university purchased Çapa clinics, which were a continuation of the Vakıf Gureba Hospital. In 1969, the Cerrahpaşa clinics, which had been owned by Istanbul Municipality from their establishment onwards, were taken over from the municipality. Since that time, the Çapa and Cerrahpaşa campuses have been offering services as the faculty hospitals of Istanbul University.

The Struggle against Tuberculosis in Istanbul and Sanatoriums

At the beginning of the Republic, tuberculosis prevailed in metropolises, particularly in Istanbul. In order to combat the disease, which created a significant problem during the Republic’s first years, the Istanbul Directorate of Health first opened the Istanbul Vilayeti Verem Savaş Dispanseri’ni (Istanbul Provincial Dispensary for Combating Tuberculosis) in 1923. Later on, the dispensaries of Gebze, Ağva, Kemerburgaz, Sarıgazi, Ömerli and Zekeriya were opened. Later, the Istanbul Verem Savaş Dispanseri began to open dispensaries in poor neighborhoods.

During the truce period, an attempt to open a sanatorium in Heybeliada for the treatment of tuberculosis patients failed. When the Republican administration was established, the government dealt directly with this problem. Thus, the Heybeliada Sanatorium came into service in 1924, after which the minister of health, Refik Saydam, put other such facilities into operation. Moreover, Baltalimanı Kemik ve Mafsal Veremi Hospital (bone and joint tuberculosis) (1944), Yedikule Tuberculosis Hospital (1949), Koşuyolu Tuberculosis Hospital (1951) and Haydarpaşa Tuberculosis Hospital (1953) treated patients. As tuberculosis was brought under control over time, these hospitals were converted into hospitals treating chest diseases.

Heybeliada Sanatorium

Opening with 50, Heybeliada Sanatorium later became a modern institution when additional buildings were made; the number of beds increased to 700. Although Heybeliada Sanatorium continued to operate as a Thoracic Surgery and Chest Diseases Hospital, the personnel and medical equipment were transferred to Süreyyapaşa Chest and Cardiovascular Diseases Hospital in 2005 due to the low number of patients at Heybeliada, the result of transportation difficulties to the island.

Yediküle Göğüs Hastalıkları Hospital

Being put into service in 1950 as a tecrithane (quarantine) with 300 beds, Yedikule Verem Hospital later became a full-fledged chest disease hospital. With the opening of the thoracic surgery clinic at the beginning of the 1980s, the hospital continued to serve as the Yedikule Göğüs Hastalıkları ve Göğüs Cerrahisi (chest diseases and thoracic surgery) Hospital.

Süreyyapaşa Göğüs Hastalıkları Hospital

This hospital started to operate under the SSK (Social Security Institution) in 1951 as a health facility with 20 beds; it quickly improved and become a sanatorium. In 1961, the Süreyyapaşa Hospital became a hospital specializing in chest diseases, and also treated patients with lung diseases other than tuberculosis. In 1995, the hospital became known as the SSK Süreyyapaşa Göğüs Kalp ve Damar Hastalıkları (chest and cardiovascular diseases) Hospital. In 2005, the hospital was transferred to the ministry of health, as were all other SSK hospitals. In October 2005, Heybeliada Göğüs Hastalıkları Hospital and in May 2006, Beykoz Çocuk Hastalıkları (pediatric) Hospital were incorporated into this facility.

PTT Hospital

In 1945, after World War II, tuberculosis was widespread; at this time, the general directorate of the PTT (Post, Telegraph and Telephone company) opened a sanatorium to treat tuberculosis patients who worked for the PTT. Later this institution took on the status of a hospital with the addition of internal and external disease services. In 2005, the hospital was transferred to the ministry of health and continues to operate as the Fatih Sultan Mehmet Eğitim ve Araştırma (teaching and research) Hospital.

Baltalimanı Kemik Hastalıkları Hospital

In 1943, the Mustafa Reşid Paşa Palace in Baltalimanı was given to the ministry of health in order to be turned into a hospital “for patients with bone tuberculosis.” A year later, the hospital started to function as bone tuberculosis hospital and in 1955 became known as the Baltalimanı Kemik Hastalıkları (bone disease) Hospital. The hospital still treats patients in this field today.

THE UNIFICATION OF PUBLIC HOSPITALS

In keeping with the Ottoman heritage, most hospitals in Istanbul served under the administration of the Istanbul Municipality. The minister of health, Dr. Refik Saydam left his mark on the health policies of the Republican period and had the foresight that hospitals should be managed by local administrations. Numune (model) hospitals, which were constructed by the central government in large cities, were planned to serve as models for local administrations. Although some rare municipalities outside Istanbul had hospitals, hospital services were not introduced by municipalities throughout country.

Later, the ministry of health abandoned this policy and adopted the policy of uniting public hospitals under the ministry of health. Although in the 1960s, as part of the “socialization in healthcare,” a legislative regulation was passed to unite hospitals managed by other public corporations under the ministry of health, the implementation of this regulation cannot be seen. The hospitals that were under the auspices of the Istanbul municipality were transferred to the ministry of health in accordance with a protocol introduced under the 1980 military government.

The SSK, established in 1946, began to offer health services to its members in 1952. The hospitals and other healthcare organizations that were owned by the SSK, which were opened principally in Istanbul and in the provinces by the ministries of transportation, internal affairs and national education, were transferred to the ministry of health in keeping with a law passed in 2005. In 2005, as a part of the reconstruction of the ministry of health, all hospitals that belonged to the ministry were brought under the Türkiye Kamu Hastaneleri Kurumu (Institution of Turkish Public Hospitals).

In 2012, following the decree of Law Number 663, the Kamu Hastaneleri Birlikleri (Union of Public Hospitals) was established in association with the Türkiye Kamu Hastaneleri Kurumu in five different areas of Istanbul. The unions and the hospitals are as follows:

Istanbul Beyoğlu Public Hospital Union

Okmeydanı Research and Teaching Hospital
Şişli Hamidiye Etfal Research and Teaching Hospital
Prof. Dr. N. Reşat Belger Ophthalmic Research and Teaching Hospital
Metin Sabancı Baltalimanı Bone Disease Research and Teaching Hospital
Gaziosmanpaşa Taksim Research and Teaching Hospital
Eyüp State Hospital
Kağıthane State Hospital
Sarıyer İstinye State Hospital
Sarıyer Ismail Akgün State Hospital
Beşiktaş Sait Çiftçi State Hospital
İl Özel Idaresi Oral and Dental Diseases Hospital

Istanbul Fatih Public Hospitals Union

Haseki Research and Teaching Hospital
Istanbul Research and Teaching Hospital
Yedikule Chest Diseases Research and Teaching Hospital
Süleymaniye DKH Research and Teaching Hospital
Arnavutköy State Hospital
Bayrampaşa State Hospital
Lütfiye Nuri Burat State Hospital

Istanbul Bakırköy Public Hospitals Union

Bağcılar Research and Teaching Hospital
Bakırköy Dr. Sadi Konuk Research and Teaching Hospital
Bakırköy Prof. Dr. Mazhar Osman Research and Teaching Hospital for Mental and Neurological Diseases
Istanbul Mehmet Akif Ersoy Cardiovascular Research and Teaching Hospital
Kanuni Sultan Süleyman Research and Teaching Hospital
Physical Therapy and Rehabilitation Research and Teaching Hospital
Başakşehir State Hospital
Büyükçekmece State Hospital
Çatalca İlyas Çokay State Hospital
Dr. Necmi Ayanoğlu Silivri State Hospital
Esenyurt State Hospital
Silivri Ceza Infaz Kurumu (Penal Institution) State Hospital
Lepra Dermatological and Venereal Diseases Hospital
Istanbul Dermatological and Reproduction Diseases Hospital
Bahçelievler Oral and Dental Healthcare Center
Güngören Oral and Dental Healthcare Center

Istanbul-Anatolian Side Northern Public Hospitals Union

Fatih Sultan Mehmet Research and Teaching Hospital
Haydarpaşa Numune Research and Teaching Hospital
Ümraniye Research and Teaching Hospital
Siyami Ersek Cardiothoracic Surgery Research and Teaching Hospital
Zeynep-Kamil Gynecological and Pediatric Diseases Research and Teaching Hospital
Istanbul Medeniyet University Göztepe Research and Teaching Hospital
Erenköy Physical Therapy and Rehabilitation Hospital
Usküdar State Hospital
Beykoz State Hospital
Şile State Hospital
Ataşehir Oral and Dental Healthcare Center
Beykoz Oral and Dental Healthcare Center
Çekmeköy Oral and Dental Healthcare Center
Göztepe Oral and Dental Healthcare Center
Sancaktepe Oral and Dental Healthcare Center

Istanbul-Anatolian Side Southern Public Hospitals Union

Kartal Dr. Lütfi Kırdar Research and Teaching Hospital
Süreyyapaşa Chest Diseases and Thoracic Surgery Research and Teaching Hospital
Marmara University Pendik Research and Teaching Hospital
Kartal Koşuyolu Yüksek Ihtisas Research and Teaching Hospital
Kartal Yavuz Selim State Hospital
Pendik State Hospital
Tacirler Eğitim Vakfı Sultanbeyli State Hospital
Yakacık Maternity and Pediatric Diseases Hospital
Istanbul Meslek Hastalıkları (career-linked diseases) Hospital
Maltepe State Hospital
Tuzla State Hospital
Maltepe Ceza Infaz Kurumu (penal institution) State Hospital
Kartal Oral and Dental Healthcare Center

PRIVATE HOSPITALS IN ISTANBUL

It has been difficult for public health investments to keep in pace with the population growth of Istanbul, a city that is home to an important proportion of the population of Turkey. A solution to this problem had been addressed within the dynamics of the market in Istanbul, a city with a vibrant financial life. Private investments have attempted to fill in the gaps in public healthcare. In this respect, an important number of private hospitals offer services in Istanbul. The private hospitals are for the most part new, with most having been opened within the last 20 years (except for those that belong to minority groups). In particular, the changes in the health system over the last ten years and the fact that the SSK obtains services from private hospitals has facilitated a rapid increase in private hospitals both in terms of number and capacity. In 2013 there were 152 private hospitals actively operating in Istanbul. More than 1% of inpatient bed availability is fulfilled by private hospitals in Istanbul. In addition to hospitals, several private medical centers, polyclinics, and private health offices play an important role in providing health services in Istanbul.

UNIVERSITY HEALTH INSTITUTIONS

Today, in addition to state universities, foundation (private) universities also occupy important place in education. It is also striking that half of the foundation universities in Turkey are in Istanbul. The dentistry and medicine faculties in these universities play an important role in health services and most offer services within their own hospitals. Recent applications have meant that cooperation between universities and hospitals has developed. In this respect, it has become difficult to categorize a health institution as merely a state hospital, university hospital or private hospital. The faculties that provide health education and offer services in this field within Istanbul are listed below in alphabetical order (this list was updated on the 23^th September 2020):

Medical Faculties of State Universities

İstanbul Medeniyet University Medical Faculty
İstanbul University Istanbul (Çapa) Medical Faculty
İstanbul University Cerrahpaşa Medical Faculty
Marmara University Medical Faculty
Sağlık Bilimleri University Hamidiye Medical Faculty and Hamidiye International Medical Faculty

Medical Faculties of Foundation Universities

Acıbadem Mehmet Ali Aydınlar University Medical Faculty
Altınbaş University Medical Faculty
Bahçehir University Medical Faculty
Beykent University Medical Faculty
Bezmialem Waqf University Medical Faculty
Biruni University Medical Faculty
Demiroğlu Bilim University Medical Faculty (Şişli Florence Nightingale Hospital)
Haliç University Medical Faculty
İstanbul Aydın University Medical Faculty
İstanbul Kemerburgaz University Medical Faculty
İstanbul Medipol University Medical Faculty and International Medical Faculty
İstanbul Okan University Medical Faculty
İstinye University Medical Faculty
Koç University Medical Faculty
Maltepe University Medical Faculty
Üsküdar University Medical Faculty
Yeditepe University Medical Faculty
Yeni Yüzyıl University Medical Faculty

Dentistry Faculties of State Universities

İstanbul Medeniyet University Dentistry Faculty
İstanbul University Dentistry Faculty
Marmara University Dentistry Faculty
Sağlık Bilimleri University Dentistry Faculty

Dentistry Faculties of Foundation Universities

Altınbaş University Dentistry Faculty
Bahçeşehir University Dentistry Faculty
Beykent University Dentistry Faculty
Bezmialem University Dentistry Faculty
Biruni University Dentistry Faculty
İstanbul Aydın University Dentistry Faculty
İstanbul Kent University Dentistry Faculty
İstanbul Medipol University Dentistry Faculty
İstanbul Okan University Dentistry Faculty
Maltepe University Dentistry Faculty
Yeditepe University Dentistry Faculty
Yeni Yüzyıl University Dentistry Faculty

PRIMARY HEALTH CARE SERVICES

In 1961, health services were reorganized according to Law Number 224, Sağlık Hizmetlerinin Sosyalleştirilmesi Hakkındaki Kanun (Law on the Socialization of Health Services). In particular, health centers, designed to offer primary health services, were expected to include extensive personnel who would offer preventative and therapeutic services. The socialized health services that started in Muş in 1963 were only able to cover one-third of the country by the beginning of the 1980s. After the 1980s, it was decided that socialization was to be spread throughout the whole country, but this was not possible to implement, even in Istanbul. Giving primary health services to the public through a limited number of health centers - limited with respect to Istanbul’s population – was not possible. Although there was an attempt to fulfill the needs by means of private polyclinics and medical centers, the services remained inadequate, as these institutions focused mainly on therapeutic health services.

In the early 2000s, the number of health centers and primary care physicians available to provide primary health care services was quite insufficient. In 2000, the number of health centers was 209 and in 2002, this number had only risen to 217. Thanks to the efforts of the Directorate of Health and with the support of the county municipalities, this number increased to 335 in 2003 and by the end of 2009, it had reached 552, in keeping with the goal of offering one health center for every 20,000 people. As part of the Devlet Hizmeti Yükümlülüğü (Civil Service Obligation), which consisted of appointing primary care physicians for compulsory service, the number of health centers reached 604 and the number of commissioned doctors reached 2,100 in 2010.

In 2010, the application of “family practice” was put into effect and 762 family health centers, 3,125 family physicians and 3,090 medical personnel began to provide primary health services. Today, there are approximately 900 family health centers and more than 3,500 family physicians. In every district, public health centers have been opened in order to carry out preventative health services and to monitor family physicians.

ISTANBUL PHYSICIAN ADMINISTRATORS

The first physician administrator in Istanbul during the Republican period was Emin Erkul (1924-1928); he took office after Haydar Yaluğ, who had been a local administrator in Istanbul when the Republic was proclaimed.

According to the Belediye Kanun of 1930, a law that united Istanbul municipal and provincial services, the Şehremaneti (city council) was abolished and the term şehremini (mayor) became a thing of the past. After Muhittin Üstündağ, the first person to act both as mayor and governor, Lütfi Kırdar (1938-1949) and Fahrettin Kerim Gökay (1949-1957) successively became governor-mayors who were also physician administrators for Istanbul in the Republican period.

In 1956, the municipality and governorate were divided. Mayors were elected by the Istanbul City Council. After May 27, 1960, mayors were appointed to office. According to the Constitution of 1961, among the mayors who took office after local elections starting from 17 November, 1963 onwards, only Fahri Atabey (1968-1973) was a physician.

During the Metropolitan Municipality period that began in 1984, Nurettin Sözen (1989-1994) was the only mayor to also be a physician.

PHARMACIES

In the first years of the Republic, pharmacies were only found in the larger cities and were not available in most of the provinces and districts. In 1924, there was approximately 300 pharmacies in Istanbul.

In Law 964, Eczacılar ve Eczahaneler Hakkında Kanun (Law on Pharmacists and Pharmacies), enacted in 1927, it was stated that new pharmacies could not be established until the surplus of pharmacies was reduced to a predetermined number, which would be in accordance with the population; the existing pharmacies could not be transferred or sold if they continued to operate in the same location. Moreover, those that were closed down could not be reopened. In accordance with this law, 90 pharmacies in Istanbul were closed down and 18 pharmacies were relocated.

However, this law did not attain the expected results; the number of pharmacies in Istanbul in 1949 was over 150, although there were no pharmacies in most of the provinces and districts. According to a law enacted in the same year, the pharmacists who opened a pharmacy for five years in those provinces and districts that had no pharmacy would be granted the right to open a pharmacy wherever they wished.

With Law Number 6297, Eczacılar ve Eczaneler Hakkında Kanun (Law on Pharmacists and Pharmacies), which was passed in 1953, the restriction on pharmacies that had been imposed from 1927 came to an end. In Istanbul, the number of pharmacies before this law was 156. After this new law was passed, the number doubled within six years (348 pharmacies in 1959) and reached 5,169 in 2011.

With a law enacted in 2012, the restriction of one pharmacy for every 2,500 people was imposed.

ISTANBUL HEALTH ORGANIZATION TODAY

The Decree Law Number 663, which rearranged the Ministry of Health, gave rise to a reorganization of Istanbul health organizations after 2011. Being restricted in terms of its authority, the provincial directorate of health, which represents the ministry of health in the provinces, has undertaken the duty of controlling health policies, particularly with regard to the duties of coordination and supervision. The Directorate of Health also carries out the control and licensing of pharmacies and private health institutions.

Some of the duties which had previously been carried out by a single institution were now divided; a separate provincial directorate of public health was established in order to monitor family physicians and carry out public health services. Thus, both primary and preventative health services, as well as health promotion were managed by a separate organization. As stated above, physicians and other medical officials, serving in more than 3,000 family health centers, today provide primary health services. Also, the directorate of public health is implementing preventative health services through community health centers that have been opened in every district.

In accordance with the Decree Law Number 663, the hospitals under the ministry of health were removed from the ministerial administration in 2012 and came under the public hospital institution. This institution manages state hospitals via the unions of public hospitals, which were established throughout the entire country. There are five unions of public hospitals, in the areas of Bakırköy, Beyoğlu, Fatih, Anatolian South and Anatolian North, in Istanbul.

By 2011, there were 214 treatment institutions with inpatient bed availability. 52 of these were under the ministry of health and there were 30,219 hospital beds in Istanbul. 15,310 beds were in ministry of health hospitals, with 4,270 beds were in university hospitals and 10,539 beds in private hospitals. At the present time, the number of private hospitals is 152. In addition to these, there are a large number of private medical centers and polyclinics.

In 2012, while 25.2 hospital beds were available for every 10,000 people throughout Turkey, this number was 22.2 in Istanbul. Taking the hospitals of the ministry of health into consideration, today 16.3 beds are available for every 10,000 people throughout Turkey, while this number is 15.4 in Istanbul. It is clear that the total number of hospital beds in Istanbul is below the country’s average. In addition to this insufficiency, Istanbul receives patient applications from throughout the country, as well as from its own population, particularly for secondary and tertiary health institutions. Thus, the number of patients who apply to health institutions in Istanbul is increasing incrementally. Moreover, in recent years there have been applications to teaching hospitals from Middle Eastern and European countries. This increases the responsibilities of Istanbul and deepens the supply deficit in health services.

The fact that the number of the sickbeds of the hospitals of the Ministry of Health is below the average of the whole country shows the insufficiency of investments in this area. In spite of the many state hospitals that have been recently constructed, this gap has not yet been filled. Istanbul has attempted to fill this gap which has appeared over the years with investments from the private sector. This is why the dynamics of the private sector manifest itself in Istanbul more than they do throughout the rest of the country. The policies developed in favor of public health in Istanbul are due to the fact that in Istanbul the balance between state and private in the health sector differs from that in the rest of the country.

Although there is a considerable amount of data about the health indicators of the entire country, concerning the sector volume, public expenditures and out-of-pocket expenditures, there are limited sources providing information specifically about Istanbul, despite the fact that it plays host to a large proportion of the Turkish population and despite its unique qualities in terms of social and economic life. There is not sufficient data about the history of Istanbul health institutions even in Istanbul-related sources. Some information has been received via personal connections with the authorities of some institutions. Taking Istanbul as one among other provinces of Turkey and evaluating it from this respect is not a realistic approach. According to 2012 data provide by the SSK, 24% of payments that the SSK has made to private hospitals for health services, 6.5% of the payments that the Ministry of Health made to the state hospitals, 35% of payments made to research and teaching hospitals and 11% of payments made to university hospitals were from Istanbul. Additionally, 18% of payments made to pharmacies originated in Istanbul.

Having a population larger than that of most European countries and with a volume incommensurably greater than other cities in Turkey in terms of economic and social life, Istanbul needs to be studied with respect to these points.

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