Origin-Country Disease Burden Profiles of Refugees and Migrants in Türkiye and Inequality in Air Pollution Exposure among Syrians: An Ecological Analysis of Global Burden of Disease 2023 Data from a Public Health Nursing Perspective

Abstract

Aim: This study aimed to compare the disease burden profiles of the main countries of origin of refugees and migrants in Türkiye (Syria, Afghanistan, Iraq, and Iran) with that of Türkiye, and to determine whether exposure to fine particulate matter (PM2.5) among Syrians under temporary protection differs from that of the host population, based on their provincial settlement pattern.
Methods: This was an ecological secondary data analysis. For the origin-country profile, GBD 2023 estimates on the morbidity gap, human resources for health, meningitis, breast cancer, and air pollution were used. For the exposure analysis, provincial area means for all 81 provinces calculated from GBD 2023 gridded PM2.5 estimates (0.1°×0.1°) were linked with the provincial distribution of Syrians under temporary protection reported by the Presidency of Migration Management (1 May 2025) and provincial populations from the TurkStat Address-Based Population Registration System (2024), which excludes persons under temporary protection. Population-weighted mean provincial-level exposures were compared between Syrians and the host population; uncertainty intervals of the GBD estimates were reported.
Results: In all four countries of origin, the proportional morbidity gap, meningitis incidence, and PM2.5 exposure were higher than in Türkiye. In Syria, the proportion of life lived in poor health was 16.7% (Türkiye: 14.4%), meningitis incidence was 4.4 times higher, and under-5 meningitis mortality was 2.8 times that of Türkiye. In Afghanistan, under-5 meningitis mortality was 37 times that of Türkiye, while nurse and midwife density was less than half. Breast cancer mortality among women aged 55 years and older increased by 45–112% between 1990 and 2023 in Syria, Afghanistan and Iraq. Within Türkiye, The population-weighted mean provincial PM2.5 level for Syrians under temporary protection was 27.4 µg/m³, 12.5% higher than that for the host population (24.4 µg/m³). Of Syrians, 40.0% lived in provinces in the most polluted quintile, compared with 17.5% of the host population. The proportion of Syrians living in provinces where PM2.5 exceeded 35 µg/m³ was 2.5 times that of the host population.
Conclusion: The main countries of origin of refugees and migrants in Türkiye have a higher burden of both communicable and non-communicable diseases than Türkiye, and Syrians under temporary protection are concentrated in the provinces with the highest estimated PM2.5 levels. These ecological, provincial-level findings do not describe individual exposure or health status, but they can guide needs assessment. Completing vaccination status, improving access to chronic disease and cancer screening, providing culturally sensitive health education, and reducing environmental risks are priority areas for public health nursing.