Perceptions and evaluations of women who experienced the February 2023 Türkiye earthquake: "Everything was so difficult and scary..."

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Gulengul Mermer¹, Renginar Ozturk Donmez, Aynur Çetinkaya This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7082863/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 16 You are reading this latest preprint version Abstract Background: Women, with more vulnerabilities and less access to resources, are often seen as victims of natural disasters. The present study aimed to describe the perceptions and evaluations of women who experienced the February 2023 earthquake in Türkiye. Methods: Thirteen volunteer earthquake-affected women of reproductive age were included in the study, which was planned in the phenomenological design. The research data were collected by the researchers using the face-to-face interview technique along with a semi-structured questionnaire. Content analysis was conducted in analyzing data. As a result of women’s perceptions and evaluations, a three-stage process model created with in vivo coding was reached. The first stage includes the theme of "Difficult and Scary" as "Very difficult to explain, where words fail." The second stage was titled "After the earthquake..." and included the subthemes were “Failure to meet basic needs," "Lack of coordination and injustice in distribution," "Psychological trauma, exhausting," "Emotional state reactions," "Weather conditions," "Safety problems," "Failure to meet primary toilet and bathroom needs," "Death, moral loss," "Communication problems," and "Physical health problems." The third stage of women's statements for the present time was titled "It is very difficult to start everything from scratch" and includes the theme of "Building the future." Effective disaster preparation is required to reduce women's vulnerability to disasters and enhance the level of damage reduction. Türkiye earthquake qualitative research woman perception Figures Figure 1 Introduction Earthquakes are deadly natural phenomena that have existed on our planet since the existence of life. Earthquakes are important since they are unpredictable, can lead to extensive destruction in a wide area, threaten many lives, and have deep and lasting effects on the mind and development of human beings [1, 2]. Türkiye is located in a geographical zone that is considered "high-risk" in terms of earthquakes on the Earth [3]. The latest earthquakes are the two earthquakes that occurred within nearly 10 hours in Kahramanmaraş on February 6, 2003, in Türkiye. The first was of 7.8 magnitude in the Pazarcık district of Kahramanmaraş, and the second was of 7.6 magnitude in the Elbistan district of Kahramanmaraş. These two consecutive earthquakes affected an area of 108,812 square kilometers covering 11 provinces (Kahramanmaraş, Hatay, Gaziantep, Osmaniye, Malatya, Adana, Diyarbakır, Şanlıurfa, Adıyaman, Kilis, and Elazığ provinces) and were recorded as the largest earthquakes in the history of Türkiye according to the surface wave magnitude scale and the second biggest earthquakes recorded in Anatolia after the North Anatolia earthquake in 1668 They are also the second deadliest earthquakes in the world since the 2010 Haiti earthquake, which killed more than 220,000 people. According to the released data, 46,104 people lost their lives in the earthquake, 105,505 people were injured, and 13.5 million people were directly affected [4]. Especially in earthquakes in developing countries, the necessary resources cannot be adequately supplied to provide appropriate services to survivors [5]. Pre-existing hierarchies and inequalities in access to resources and opportunities may make certain groups, such as women, children, ethnic minorities, and those living in rural areas, more vulnerable in case of earthquakes [6, 7]. A person's response to natural disasters is largely affected by their cultural, social, and economic background [8]. Sociological and ethnographic research results have also shown that natural disasters exacerbate gender and social inequalities. The negative effects of social, economic, political, and ecological conditions on each other worsen the vulnerability of women and limit their capacity to cope with difficulties in emergencies [9,10]. Women, with more vulnerabilities and less access to resources, are often seen as victims of natural disasters [11]. The recent earthquakes in Türkiye have caused significant damage to infrastructure, leaving many pregnant women without access to essential healthcare services [12]. According to the United Nations Population Fund (UNFPA), there are currently more than 226,000 pregnant women in Türkiye among earthquake survivors who need immediate access to reproductive healthcare [13]. In their study, Yoosefi Lebni et al. (2020) revealed the post-earthquake experiences of Iranian women living in rural areas as neglect of their health needs, tension in family and marital relations, gender inequality in the assistance provided, feeling insecure, ignoring the dominant culture of the region, fear of stigmatization, and need to hide for grief [11]. In another study, women were found to be less likely than men to receive relevant post-disaster assistance, including financial support, healthcare services, and other types of social aid [14]. (One of the professional requirements for nurses is to determine the needs of individuals at risk in the prevention, preparation, response and recovery stages of disaster management and to take appropriate initiatives. Earthquake studies have generally been studied using quantitative and descriptive methods [15–18]. However, qualitative studies provide a valuable opportunity to describe individuals’ experiences, interpretations, and perspectives and to better understand the surrounding social and cultural context. A qualitative study examining the perceptions and experiences of women who experienced the earthquake after the February 2023 Earthquake in Türkiye would provide comprehensive information to health professionals, intervention groups, and policy makers. Therefore, this study aims to investigate women’s perceptions and evaluations of earthquake experiences. Methods Aim The present study aimed to describe the perceptions and evaluations of women who experienced the Kahramanmaraş-centered earthquakes on February 6, 2023, in Türkiye. Design and participants The research was designed as a phenomenological study, one of the qualitative research designs. Phenomenology is a qualitative research method that enables individuals to express their understanding, feelings, perspectives, and perceptions about a phenomenon or concept and is used to express how they experience this phenomenon [19]. The study group of this qualitative research comprised women who experienced the consecutive Kahramanmaraş-centered earthquakes on February 6, 2023. The snowball/chain sampling method, one of the purposive sampling methods, was used as the sampling method. The reason for using non-random sampling techniques is that such studies involve an effort to explore and understand rather than to test a hypothesis. The selection of individuals who would form the sample and the interviews with the individuals were continued until a saturation point suitable for the study’s purpose was reached. Since the objective was to improve knowledge, the selection was ended when no new information was obtained from the sample group (n=13). The inclusion criteria determined for the sampling included being a woman between the ages of 15-49, being in Izmir for temporary accommodation, being able to speak Turkish, and volunteering to participate in the research. The semi-structured interview technique was employed in data collection. In-depth individual interviews were conducted with the participants determined by purposive sampling, and the number of participants was determined according to theoretical saturation (data saturation). In qualitative research, the sampling criterion is theoretical saturation, and it shows that saturation is reached when there is no new code in interviews and that researchers can interrupt the interview process and no longer need to enlarge the sample size [20]. In this study, the saturation level was reached in the 11th participant, and the study was completed with 13 participants. Table 1 contains the descriptive characteristics of the sample. Table 1 Descriptive characteristics of the sample Participant No Age Place of residence * Province of current residence due to the earthquake Damage to the house Loss Participant 1 28 Gaziantep Gaziantep Undamaged No loss Participant 2 25 Adana Ankara Heavily damaged No loss Participant 3 35 Malatya İzmir Slightly damaged Lost siblings, nieces and nephews, and cousins Participant 4 49 Antakya Mersin Destroyed Lost the daughter Participant 5 40 Hatay İzmir Slightly damaged No loss Participant 6 44 Şanlıurfa İzmir Slightly damaged No loss Participant 7 42 Gaziantep Gaziantep Heavily damaged No loss Participant 8 22 Gaziantep İzmir Destroyed No loss Participant 9 21 Gaziantep Gaziantep Heavily damaged No loss Participant 10 48 Gaziantep Gaziantep Destroyed Lost second-degree relatives Participant 11 23 Hatay İzmir Heavily damaged Lost second-degree relatives Participant 12 23 Hatay Antalya Heavily Damaged Lost friends Participant 13 22 Hatay Eskişehir Heavily damaged Lost the cousin * A state of emergency was declared in the following 11 provinces affected by the February 6 earthquakes in Türkiye: Adana, Adıyaman, Diyarbakır, Gaziantep, Hatay, Kahramanmaraş, Kilis, Malatya, Osmaniye, Şanlıurfa, and Sivas. Data collection Semi-structured questions, prepared by the researchers by reviewing the literature and shown in Appendix 1, were used in data collection [3,9,15,21]. No interview guide from a previous study was used, and the questions were evaluated for content by consulting expert opinions. It is stated that expert opinions significantly contribute to the validity of data collection tools in qualitative research [22]. In present study, expert opinion was obtained from the fields of public health nursing, psychiatric nursing, obstetrics and gynaecology nursing, and surgical diseases nursing for the questions in the form that would guide the interview. Moreover, data analysis was started simultaneously with the data collection. All interviews were recorded with a voice recorder. The statements of the two participants who did not allow voice recording were recorded in writing. To capture the rich life experiences of women, the interview form was a pilot study of four women in April for the clarity and functionality of the questions, and the necessary revisions were made to two questions. Pilot study data were not included in the data analysis in the research. A researcher conducted the interviews to gain the women's trust and create a desire to participate in the study. The interviews were held between May 12, 2023, and August 27, 2023. For the interviews, a student who was studying in the Faculty of Nursing of Ege University and met the inclusion criteria of the study was selected by the snowball sampling method. The student was considered the starting point of the study. After this participant was interviewed, women who experienced the Kahramanmaraş-centered earthquake and came to Izmir for temporary shelter were reached. Permission was obtained for the interviews, and the participants approved the audio recording. The sentence " First of all, thank you for allowing me to turn on the audio recorder " was noted down. An in-depth interview was held after the consent. After each interview, the researchers started to analyze and encode the data to guide subsequent interviews. The interviews were conducted in the most appropriate environment and time for the interviewees. Thematic content analysis was performed through the transcription of the records. Data analysis In the research, the analysis phase was carried out at the same time as the data collection phase. The analyses were performed simultaneously with the start of the initial interviews. All interviews were recorded using an audio recorder, and the contents were transcribed one-to-one. Moreover, all material was reviewed several times for an accurate understanding. The data were analyzed using the NVIVO 12 Pro software. Content analysis was conducted to collect and interpret similar data within the scope of certain concepts and themes. This process was conducted in the form of preliminary reading, coding qualitative data, reaching themes, organizing data, interpretation and reporting [22, 23]. Handling coding used in the data analysis of the study. A list of codes was created (43 codes) and the codes were systematically grouped into women's post-earthquake perceptions and evaluations based on three main themes: Difficult and Scary, Basic needs and support, Building the future. To ensure coding reliability, interview recordings from five women were independently checked for coding consistency by the lead author. All codes in the selected interview recordings were compared and inconsistencies/disagreements were discussed until consensus was reached. Then, the codes were given their final form. All authors took part in the analysis of the data. For some themes, in vivo coding, which is included in the qualitative research methodology of the embedded theory, was carried out as the inductive coding process. In vivo coding involves creating a theme label by directly using the code obtained from the data, in other words, the participant's statements [24]. When presenting the findings, the abbreviation "f" was used for the frequency numbers indicating the citation. The qualitative content analysis performed in the study is a powerful process that involves different research methods used to analyze textual data and aimed at initiating the introductory meanings of the concept. It is also a systematic classification and coding method. The main purpose of this method is to satisfactorily understand the phenomenon researched [20]. Validity and reliability In the study, participant confirmation and expert opinion in data analysis and coding stages were taken for validity and reliability, and direct quotations were frequently included in the report. All the researchers have a qualitative data analysis certificate. The interviews were conducted by a single researcher. Validity was assessed on the basis of one researcher (public health nurse, first author) collecting the data and all authors working on the analysis of the data [25]. Responses were coded separately by two coders and a single code list was created based on the consistency of the coding. These codes were categorized by content analysis with the words written by the authors to create themes and three themes were obtained [26]. Ethical considerations Permission was obtained from the Scientific Publication Ethics Committee of Ege University to carry out the study (Date: 27 April 2023, Number: 05/10). The participants were given a detailed explanation of the study and volunteered to take part in the study, and a written informed consent form was obtained from the participants. The participants were informed both in writing and verbally that they could leave the interview at any time. Meanwhile, the participants were told that a code would be determined for each participant, that code would be used during the writing phase of the research, and their real identities would be kept confidential. For example, the abbreviation "P5" was used in the quotes of Participant 5. Furthermore, all participants were informed that the interviews would be recorded with a digital audio recorder to conduct the interviews more appropriately, and these audio recordings would be listened to/read by only two experts/researchers other than the interviewer for credibility and internal consistency. The study was conducted in accordance with the principles of the Declaration of Helsinki. Findings In this qualitative study on the perceptions and evaluations of women who survived the Kahramanmaraş-centered earthquake disaster, Türkiye, on February 6, 2023, and were interviewed in the 3rd and 6th months after the disaster, data analysis was performed with content analysis following in-depth individual interviews (n=13) using a semi-structured interview form. The themes reached in the form of process from women’s statements and their relationships are presented visually in Figure 1. The theme labels and frequency numbers reached for the post-earthquake process expressed by the participating women are as follows: Theme 1 label is "Difficult and Scary". "Difficult" (f:48) and "Scary" (f:31) subthemes were included in the first stage, which was titled " Very difficult to explain, where words fail, " created with in-vivo coding from the quotes of 49-year-old Participant 4, who stated that she lived in the center of Antakya and lost her daughter in the earthquake. The statement of 48-year-old Participant 10 from Gaziantep province, " Everything was very difficult and scary, " was moved to the title due to its relationship with other categories and because it was a summary description explaining the first stage of the process. Theme 2 label is "Basic needs and support". The themes in the next stage " After the earthquake… ", which were reached through in-vivo coding from the statements of five participants (participants 5, 6, 7, 10, and 13), were "Failure to meet basic needs" (f:56), "Psychological trauma, exhausting" (f:27), "Emotional state reactions" (f:26), "Weather conditions" (f:16), "Safety problems" (f:16), "Failure to meet primary toilet and bathroom needs" (f:12), "Death, moral loss" (f:9), "Communication problems" (f:7), and "Physical health problems" (f:5). In this process, 5 participants expressed that their needs were met through aid and support, 2 participants expressed that their needs were met late, and 6 participants expressed that their needs were not met. The participants who expressed that they were not satisfied at this stage of the process referred 42 times to the theme of "Lack of coordination and injustice in distribution" for aid and support. Theme 3 label is "Building the future". Regarding the earthquake-affected women's statements for the present time, the subthemes of "Presence of social support" (f:23), "Future planning" (work problem, financial loss, housing) (f:19), and "Request for state support" (f:5) were included in the stage titled " It is very difficult to start everything from scratch " belonging to 40-year-old Participant 5, who stated that she lived in Hatay. THEME 1. Difficult and Scary This theme includes the first phase describing the first moment of the earthquake; “Very difficult to explain, where words fail.” Of the citations made by the earthquake-affected women when describing their life experiences, 23% consisted of the words “difficult” and “scary” regarding the first stage. The participants used the word "difficult" 48 times and "scary (fearful, anxious, worrying)" 31 times. Some of the participant quotations with reference to the first stage are presented below: "The most difficult thing was the fears we experienced psychologically… Our house was not heavily damaged in the earthquake, but we could not go into our house due to the fear we had. In other words, our biggest problem was the fear of another earthquake if we entered the house ." P1, 28 years old, Gaziantep. " We were all worried about a new earthquake… The fear of a new earthquake made everyone nervous, and this caused people to be on pins and needles all the time. It was very difficult to meet basic needs. Parents could not even send their children to school with a fear of an earthquake. Therefore, it was a difficult process for everyone, including university students, in terms of education ." P8, 22 years old, Gaziantep. “… In fact, I think everything was difficult, we were homeless at first, and the weather conditions were very difficult. There was no toilet or shower for a long time, so it was all difficult. " P6, 44 years old, Şanlıurfa. " The most obvious concern is the fear of death. Of course, we survived as a family, but we experienced great fears in the slightest earthquakes. " P5, 40 years old, Hatay. THEME 2. Basic needs and Support This theme, which was mentioned most by the participants and constituted 63% of all references, includes the second stage; It includes statements made by the participants such as “ After the earthquake… ” These are failure to meet basic needs, psychological trauma, exhausting, emotional state reactions, weather conditions, safety problems, failure to meet primary toilet and bath needs, death, moral loss, communication problems, physical health problems, and lack of coordination and injustice in distribution. More than half (63%) of the citations made by women when describing their perceptions and evaluations about the earthquake consisted of statements and themes describing this stage. Some of the participant quotations describing this stage are as follows: "Our basic needs were water, food, and clothes. Because it was cold, we needed socks and blankets. The hardest part was the cold weather. The weather conditions were terrible. We waited for hours and days in the cold and even spent a day on the roads and at the airport to leave the city. I had a temporary paralysis on part of my face because of the cold. Even children were waiting in the cold. I was quite affected ... [by the earthquake] We still have aftershocks, and this has affected our psychology very badly. The trauma we experienced caused anxiety in some of us and increased the worries in others." P9, 21 years old, Gaziantep "We have dealt with many difficulties, both material and immaterial. My father couldn't get paid because he couldn't work, and this forced us a lot during this period and afterward. Additionally, the most difficult thing was to constantly face the fear of earthquakes after the earthquake and to meet the basic needs such as food, sleep, bathing, cleaning, etc. in the same place with many people." P8, 22 years old, Gaziantep. "[Still] the bathroom and toilet problem is our biggest problem ." P4, 49 years old, Antakya " Our main problems after the earthquake were the WC, shower, and accommodation, in other words, there was no place to sleep. They were very difficult and bad days . My behavior changed a lot, I had extremely difficult days [psychologically ], I couldn't sleep for 5 days, I had panic attacks and shortness of breath. " P10, 48 years old, Gaziantep. " Our house was heavily damaged, so we could not enter our house. We couldn't get our stuff. In the harsh conditions of winter, cold, rainfall, and in the heat of summer, we had a difficult time being bitten by animals, and we are still having a difficult time ." P11, 23 years old, Hatay. “I cannot sleep comfortably at night, sometimes I am sleepless, and it affects my whole life. " P7, 42 years old, Gaziantep. " We slept in our cars for a week after the earthquake. There was no electricity, no water, and we were trying to reach our relatives while charging our phones at other relatives' places. " P3, 55 years old, Malatya. " We feel very sad and helpless ." P6, 44 years old, Şanlıurfa. " We went out right after the earthquake, not having a car to put our heads in made it very difficult for us in cold and rainy weather. Although we did not think of food at that moment, we would get hungry after a while. It was a big problem that there was no help for food and drink, stores and markets were looted, security was troublesome... My personality, unfortunately, changed, and I think my anxiety increased. I remember death more often, I didn't want to see four walls at first, I thought I shouldn't have a social life. After the city changed, I didn't go out for a while, I condemned myself. We felt very bad psychologically... After being left homeless, we would find it enough even if our basic needs were met. However, after a while, it was difficult to reach them, and the water problem continues. " P13, 22 years old, Hatay. Participant 13 expressed her decision to leave the city she lived in as follows: “…It [earthquake] was felt much more severely due to the soil structure of Hatay. While running, my family and I fell down the stairs, the stairs collapsed, my father's leg was broken, and many of us had bruises and injuries on different parts of our bodies. We were in shock. The fact that there were even bigger aftershocks after the earthquake, the view we saw in daylight, the desperation of people, and the late arrival of aid put us in an incredibly fearful situation. Then we decided to leave Hatay, we are now in Eskişehir." Moreover, Participants 1 and 8 stated the following on the subject: "I did not receive much help because there was no major destruction in the area where I lived, but I believe there was no coordination in the distribution of the aid." P1, 28 years old, Gaziantep. "Our most basic needs, such as tents and materials to be used for heating, were not met. Except for the first two days of the earthquake, our needs, such as food, bread, and water, were met on other days. But during the first two days, we could not reach any of the basic needs such as food, bread, water, and fuel. Furthermore, aid could not reach people in need and was unconsciously distributed to people who did not need it." P8, 22 years old, Gaziantep. THEME 3. Building the future The statements that were mentioned least by the participants regarding the last phase after the earthquake were about building the future. Women about the final stage of the earthquake disaster; “ It is very difficult to start everything from scratch. ” These are presence of social support, future planning, and request for state support. The stage with the lowest citation rate (14%) for the earthquake-affected women is the final stage titled " It is very difficult to start everything from scratch ." Some quotes from the participants who referred to the categories at this stage are as follows: " It's very difficult to start a role, everything, from scratch. I plan for the future a lot . In fact, if I had had the state on my side, if I had accessed my relatives, I would have been [felt] safer… I would have coped more easily. My friends helped me the best. " P5, 40 years old, Hatay. " Our adaptation process to the city we live in is difficult. We had a lot of financial difficulties. Our car was damaged in the earthquake, and its repair was very costly. We had to buy new items because we moved into the new house and saved few of our belongings." P12, 23 years old, Hatay. "In fact, of course, I would like to have my losses with me. Then, I wish a lot of psychological support had been provided. My greatest helper was to feel the presence of good-hearted people. " P3, 55 years old, Malatya. " A social state does this for its people. If it were a social state, I would not live with possibilities. If I received food, health, accommodation, and psychological support, I would cope better. My greatest helper... It's good to know that people are supporting us, but our greatest helper is ourselves." P2, 25 years old, Adana. Discussion Recent studies have revealed that damages caused by natural disasters are observed more in women, children, and ethnic minorities due to social and economic inequalities [ 11 , 15 , 27 – 29 ]. In the present study, which focused on the perceptions and evaluations of women 3–6 months after the February 6, 2023 earthquakes in Türkiye, which are defined as the disaster of the century, the statement " very difficult to explain, scary," which refers to the process and is mentioned in the title, is a summary and is related to all the categories reached. In this study, the statements of failure to meet basic needs, lack of coordination, injustice in distribution, and psychological trauma were the most mentioned subcategories in the category of " after the earthquake " by earthquake-affected women. Since the earthquakes occurred in February and the night temperature dropped below zero, the basic need expressed by earthquake-affected women was the need for blankets and clothes to protect themselves from the cold. In the earthquakes in Van province of Türkiye in 2011 and Nepal in 2015, the need for blankets and tents was stressed by earthquake victims [ 2 , 30 ]. In a study, a 41-year-old woman, an earthquake victim, expressed the most important needs as "... the most important and necessary things for us at that time were food, tarpaulin, and blankets ". In the studies, in the first phase after the earthquake, the need for accommodation, food, and clothing emerged for earthquake victims, as Maslow stated in the hierarchy of basic needs. In emergencies such as earthquakes that concern large groups of people, it has been considered quite important and a priority for institutions to plan and prepare for needs such as tents, warm clothes, and food. The lack of communication and coordination is often stressed in the literature as one of the biggest problems in disaster response worldwide [ 31 ]. In a publication where experiences in the region were shared with the leaders of women's communities after the February 6, 2023 earthquake, it was stated that a lack of coordination was frequently experienced, as emphasized by the women in our study. For example, it was reported that the incidents of skin irritation increased as a result of washing laundry with hands, creams and medications were not considered for their treatment, contraceptive pills were not provided for women who used oral contraceptives before the earthquake, the need for underwear was not met for women while providing clothing support, and it was not taken into account at the logistics stage [ 32 ]. In the qualitative study conducted by Yoosefi Lebni et al. (2020) with earthquake-affected women in Iran in 2012, a theme emerged, indicating that the needs of men were prioritized in the list of needs, and the needs of women remained in the background [ 11 ]. Governments and non-governmental organizations should further include gender frameworks in their plans for disaster relief interventions. Individuals may suffer deep despair and posttraumatic stress disorder after the earthquake due to the loss of family members and financial losses. After the 2011 Van earthquake in Türkiye, the rate of stress disorder was found to be 35.5% in individuals over the age of 15 after the earthquake. Being a woman was determined as one of the risk factors [ 33 ]. The stress rate was determined to be 11.9% in individuals who survived the 2016 Kumamoto earthquake in the world. When the variables predicting stress were examined, stress was 1.33 times more common in women than men, and those living in common areas such as tents were 2.44 times more stressed than those living in their homes [ 33 ]. In our qualitative study, psychological trauma, exhausting (f:27), and emotional state reactions (f:26) of women after the earthquake were the second most mentioned subcategory following the subcategory of failure to meet basic needs , which received 56 citations, with a total of 53 citations. The study conducted with earthquake-affected women in Iran found that women were emotionally affected but could not express this [ 11 ]. After the earthquake, it is important to prevent suicidal attempts, particularly among women, with social, economic, and cultural effects and to raise awareness of this issue. A study revealed that after the February 6, 2023 earthquake, women experienced safety problems at night due to the lack of appropriate structures to meet their toilet need [ 32 ]. In our study, the safety problem was mentioned 16 times, and toilet and bathroom needs were mentioned 12 times by women in the category of "after the earthquake..." Due to their need for privacy, women entered damaged buildings to meet their toilet needs. To meet their needs, they had to re-experience life-threatening situations [ 32 ]. Earthquake victims can try to avoid the reminders of the earthquake, experience some health problems, and constantly visualize it in their minds and dreams. People may also fear that their relatives or themselves may die suddenly [ 29 ]. In our study, female earthquake victims referred to the category of " very difficult to explain... " 48 times. The term " difficult " was defined by earthquake-affected women for "another earthquake," "fear of death, scary," and it was mentioned 79 times in total. The study by Yoosefi Lebni et al. (2020) elucidated that it became an obsession for Iranian earthquake-affected women to experience the fear that there will be another earthquake [ 11 ]. In this category, the participants also put emphasis on the difficulty of "displacement," "disruption of education," and "weather conditions." Although Türkiye is referred to as an earthquake country, post-earthquake experiences have shown that both individuals and institutions are not so prepared. Undoubtedly, the magnitude of the earthquake and its wide geography have contributed to this. In some provinces affected by the earthquake, many neighborhoods and even most of the city have been completely destroyed. The total number of deaths announced is 50,783. At least 15.73 million people and 4 million buildings were affected, and 345 thousand buildings collapsed [ 4 ]. Thus, as emphasized by earthquake-affected women in our study, a large population had to be displaced, and the education of individuals/their children was disrupted. The education of 9% of university students in Türkiye was disrupted. In our study, the final stage created from the statements of earthquake-affected women was " Starting everything from scratch. " At this stage, the cited subcategories were the difficulty in planning the future, the request for state support, and the importance of social support. After the 2011 Van earthquake in Türkiye, the risk factors in earthquake victims over the age of 15 diagnosed with post-traumatic stress disorder were determined as having accommodation problems, being unemployed, experiencing financial difficulties, and experiencing temporary relocation, which indicates future planning [ 33 ]. After the 2013 Lushan earthquake in China, it was observed that the effective predictors at health levels for earthquake survivors were the amount of perceived social support, financial loss, and fear they experienced after the earthquake. When the gender factor was added to the regression model, it was found that the effect of the gender factor reduced the effect of other factors and being a woman was more decisive than other variables [ 5 ]. Post-earthquake adaptation of individuals who have experienced earthquakes is facilitated by social support, economic status, and public support. Previous studies have revealed that receiving social and state support after the earthquake positively affects individuals' health perceptions [ 27 , 30 , 34 ]. It was elucidated that emergency rescue efforts were properly provided after the earthquake that occurred in Nepal in 2015, but there were difficulties in strategic planning, provision and distribution of aid [ 35 ]. As emphasized by the women in our study, it should be ensured that an aid registration system is developed among the stakeholders, and national policy developments are systematically monitored. Earthquakes pose a threat to all individuals living in society. However, gender inequality causes women's vulnerability to increase and their resilience to decrease. In this context, the basic needs of women in earthquakes also differ. More scientific studies are needed to reveal these different needs. It is recommended that researchers conduct academic studies that include the psychological, social and economic difficulties experienced by women in earthquakes and to reduce the burden of roles caused by gender inequality on women. Limitations The researchers of this study are female academic nurses. The subject has been attempted to be addressed with sensitivity by women who have a profession based on altruism. Since the earthquake-affected participants were selected using purposive sampling methods, some perspectives may not be represented. The research findings emerged from the perceptions and evaluations based on the experiences of individuals who experienced the earthquake approximately 3–6 months ago. The data obtained from the participants are based on their statements. Moreover, the present study was conducted on Turkish women. Therefore, the translation of the concepts mentioned by the participants, which belong to Turkish culture, into English can be considered a limitation of the study. Conclusions This study reports the perceptions and evaluations of women who survived the Kahramanmaraş-based earthquakes on February 6, 2023, in Türkiye and were interviewed 3–6 months after the earthquakes. The earthquake-affected women describe the earthquake moments, the period after the earthquakes, and the present time. The statement " Very difficult to explain, where words fail," which was obtained from women's life experiences and perceptions, is a descriptive summary and points to a difficult and scary process from a woman's perspective, indicating the need for all kinds of support by emphasizing the problems such as failure to meet the basic needs, and lack of coordination and injustice in distribution. As in the world, effective disaster preparedness is required in Türkiye to reduce vulnerability to disasters and increase the level of not being harm. One of the most important questions to be answered now is "How can support for earthquake-affected women be increased?" Abbreviations UNFPA United Nations Population Fund Declarations Ethics approval and consent to participate Permission was obtained from the Scientific Publication Ethics Committee of Ege University to carry out the study (Date: 27 April 2023, Number: 05/10). The participants were given a detailed explanation of the study and volunteered to take part in the study, and a written informed consent form was obtained from the participants. The participants were informed both in writing and verbally that they could leave the interview at any time. Meanwhile, the participants were told that a code would be determined for each participant, that code would be used during the writing phase of the research, and their real identities would be kept confidential. For example, the abbreviation "P5" was used in the quotes of Participant 5. Furthermore, all participants were informed that the interviews would be recorded with a digital audio recorder to conduct the interviews more appropriately, and these audio recordings would be listened to/read by only two experts/researchers other than the interviewer for credibility and internal consistency. The study was conducted in accordance with the principles of the Declaration of Helsinki. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare no competing interests. Funding None. Authors' contributions G.M. and R.Ö.D. provided the conceptual framework and designed the study. G.M. conducted the interviews and A.Ç. performed initial data analysis. G.M., R.Ö.D., and A.Ç. collaborated on further data analysis, writing the manuscript, interpretation, and drafting the manuscript. All authors reviewed and approved the final manuscript . Acknowledgements We would like to thank all women for participating in the study. References Kahraman S A. Comprehensive Health Economic Analysis of the 2023 Turkey Earthquake. Disaster Med. Public Health Prep. 2023;17(e503): 1–4. Karki J, Matthewman S, Grayman JH. Rahat-Sahayog (relief support): examining disaster emergency response in the aftermath of the Nepal Earthquake 2015. Disaster Prev. Manag. 2022; 31(5): 494-507. Disaster Emergency Management Presidency (DEMP) Disaster Management and Natural Disaster Statistics in Turkey. 2018. Accessed April 22, 2023. https://www.afad.gov.tr/kurumlar/afad.gov.tr/35429/xfiles/turkiye_de_afetler.pdf. World Health Organization (WHO) 2023. Office for Europe. Türkiye earthquake: external situation report no.5. Accessed April 25, 2023.https://apps.who.int/iris/handle/10665/366587. Shang F, Kaniasty K, Cowlishaw S, Wade D, Ma H, & Forbes D. The impact of received social support on posttraumatic growth after disaster: The importance of both support quantity and quality. Psychol. Trauma: Theory Res. Pract. Policy. 2022; 14(7):1134. Ruwanpura KN.Temporality of disasters: the politics of womens livelihoods ‘after’the 2004 tsunami in Sri Lanka. Singap. J. Trop. Geogr. 2008;29(3):325–40. Neumayer E, Plümper T. The gendered nature of natural disasters: the impact of catastrophic events on the gender gap in life expectancy, 1981–2002. Ann. Assoc. Am. Geogr. 2007; 97(3):551–66. Blain LM, Galovski TE, Robinson T.. Gender differences in recovery from posttraumatic stress disorder: a critical review. Aggress Violent Behav. 2010; 15(6):463–74. Austin KF, McKinney LA. Disaster devastation in poor nations: The direct and indirect effects of gender equality, ecological losses, and development. Social Forces. 2016; 95(1): 355-380. Sohrabizadeh S, Tourani S, & Khankeh H R. Women and health consequences of natural disasters: Challenge or opportunity? Women & Health, 2016; 56(8):977–993. Yoosefi Lebni J, Khorami F, Ebadi Fard Azar F, Khosravi B, Safari H, & Ziapour A.Experiences of rural women with damages resulting from an earthquake in Iran: a qualitative study. BMC Public Health. 2020; 20: 1-13. Uwishema O. Addressing the effects of the earthquakes on Türkiye’s health-care system. Lancet.2023; 401:727. Goodyear S. 2023.Hundreds of thousands of pregnant women need help in earthquake-torn Turkey, Syria. CBC, 20 February 2023, https://www.cbc.ca/radio/asithappens/turkey-syria-earthquakes-pregnant-1.6754582. Bradshaw S, Fordham M. Double disaster: Disaster through a gender lens. In Hazards, Risks, and Disasters in Society (pp. 233-251). Academic Press. 2015. Yamamoto K et al. Changes in the proportion of anemia among young women after the Great East Japan Earthquake: the Fukushima health management survey. Sci. Rep. 2022; 12(1):10805. Demirchyan A, Petrosyan D, Armenian HK. Rate and predictors of postpartum depression in a 22-year follow-up of a cohort of earthquake survivors in Armenia. Arch Women Ment Health .2014;17(3):229–37. Campbell DW, Campbell JC, Yarandi HN. Violence and abuse of internally displaced women survivors of the 2010 Haiti earthquake. Int. J. Public Health.2016;61:981-992. Budhathoki SS et al. Menstrual hygiene management among women and adolescent girls in the aftermath of the earthquake in Nepal. BMC Women's Health.2018; 18, 1-8. Tekindal M, Uğuz Arsu Ş. Nitel araştirma yöntemi olarak fenomenolojik yaklaşimin kapsami ve sürecine yönelik bir derleme. Ufkun Ötesi Bilim Dergisi.2020 20(1):153-72. Özsoy S. Nitel Araştırma. Hemşirelik alanından örnekler. Çukurova Nobel Tıp Kıtapevi. Ankara: 93, 2021. Wu Z, Xu J, He L. Psychological consequences and associated risk factors among adult survivors of the 2008 Wenchuan earthquake. BMC Psychiatry.2014; 14(1):126–37. Sundler AJ, Lindberg E, Nilsson C, & Palmér L. Qualitative thematic analysis based on descriptive phenomenology. Nurs Open. 2019; 6(3):733-739. Bengtsson M. How to plan and perform a qualitative study using content analysis. Nurs Plus Open.2016; 2: 8-14. Zamawe F. Implication of using nvivo software in qualitative data analysis: evidence-based reflections. Malawi Med J.2015; 27(1): 13–15. Leung L.Validity, reliability, and generalizability in qualitative research. J Family Med Prim Care 2015; 4(3):324–327. Buus N, Perron A. The quality of quality criteria: Replicating the development of the Consolidated Criteria for Reporting Qualitative Research (COREQ). Int J Nurs Stud. 2020;102: 103452. Koç M, Yalçin S. Crisis intervention in disasters: the work of the ministry of family and social services in the Kahramanmaraş earthquake. Int. J. Soc. Work. 2023; 3(2):93-105. Özer E, Şen YÇ, Güler DS, & Güvenç G. Experiences of women relocated due to the february 2023 earthquake in Turkey: a qualitative study. BMC Women's Health, 2025; 25(1):21. Yıldız MI et al. Preventive and therapeutic mental health care after the earthquake-expert opinion from the Psychiatric Association of Turkey. Turkish J Psychiatry. 2023; 34(1): 39. Zare M, Saeedi A, Kamranzad F, Pishnamazi P. An overview of disaster management during the april 25, 2015, Mw7. 8 Nepal earthquake. Journal of Disaster and Emergenc Research . 2020;3(1):7-27. Yates S. Emergency knowledge management and social media technologies: A case study of the 2010 Haitian earthquake. Int. J. Inf. Manag. 2011;31(1):6–13. Ayata G, Kapdan Ö, Ozan Ö, Gürbüz N, & Onuk B. Deprem bölgesinde kadin olmak. Reflektif Sosyal Bilimler Dergisi.2023; 4(2): 403-417. Boztaş MH et al. Post traumatic stress disorder among adults in the aftermath of 2011 Van-Ercis earth-quake in Turkey. Turkish J Clin Psy. 2019; 22:380-388. Ide-Okochi A, Samiso T, Kanamori Y, He M, Sakaguchi M, & Fujimura K.Depression, insomnia, and probable post-traumatic stress disorder among survivors of the 2016 Kumamoto earthquake and related factors during the recovery period amidst the COVID-19 pandemic. Int. J. Environ. Res. Public Health. 2023; 19(7): 4403. Cook AD, Shrestha M, Htet ZB. An assessment of international emergency disaster response to the 2015 Nepal earthquakes. t. J. Disaster Risk Reduct. 2018;31: 535-547. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7082863","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":501127664,"identity":"5ab8e2af-1c43-417c-8505-c82f811c8e9d","order_by":0,"name":"Gulengul Mermer¹","email":"","orcid":"","institution":"Iğdır University","correspondingAuthor":false,"prefix":"","firstName":"Gulengul","middleName":"","lastName":"Mermer¹","suffix":""},{"id":501127670,"identity":"fbfe7157-cbaa-4630-9da3-d4ce7033e78e","order_by":1,"name":"Renginar Ozturk Donmez","email":"data:image/png;base64,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","orcid":"","institution":"Ege University","correspondingAuthor":true,"prefix":"","firstName":"Renginar","middleName":"Ozturk","lastName":"Donmez","suffix":""},{"id":501127673,"identity":"219cd722-b2f1-4e32-8543-e08526e31a42","order_by":2,"name":"Aynur Çetinkaya","email":"","orcid":"","institution":"Manisa Celal Bayar University","correspondingAuthor":false,"prefix":"","firstName":"Aynur","middleName":"","lastName":"Çetinkaya","suffix":""}],"badges":[],"createdAt":"2025-07-09 10:38:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7082863/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7082863/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89367559,"identity":"ef9fcb60-e89b-4454-9adc-4114bca39192","added_by":"auto","created_at":"2025-08-19 09:30:37","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":84206,"visible":true,"origin":"","legend":"\u003cp\u003eTheme labels and frequency numbers defining the process* reached on women's perceptions and evaluations after the earthquake (n=13)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e*Note: In Figure 1, the use of colour is especially preferred in conceptual visual presentation. The black filling colour symbolizes the women’s negative experience statements in which they had difficulty, and the gray filling colour symbolizes that they moved away from the negative life experience slightly more. The white filling colour shows a positive evaluation with clear statements. In the figure, the sizes of the visual boxes were used according to the number of citations received by the categories and in line with the analysis results. The dashed line indicates that there is no definite relationship regarding the process.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7082863/v1/19f373bca4f53aa969ed38f5.png"},{"id":89370409,"identity":"065780bc-c4d8-4068-8ce7-d61e700c492a","added_by":"auto","created_at":"2025-08-19 10:02:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":644660,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7082863/v1/08479bf1-91a7-4e81-b498-05321db3a2f1.pdf"},{"id":89367560,"identity":"155633a4-fed0-43dd-a492-4d7007cff67a","added_by":"auto","created_at":"2025-08-19 09:30:37","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":18008,"visible":true,"origin":"","legend":"","description":"","filename":"Interviewform.docx","url":"https://assets-eu.researchsquare.com/files/rs-7082863/v1/fa6d74641e0c156b0b0078c1.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Perceptions and evaluations of women who experienced the February 2023 Türkiye earthquake: \"Everything was so difficult and scary...\"","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEarthquakes are deadly natural phenomena that have existed on our planet since the existence of life. Earthquakes are important since they are unpredictable, can lead to extensive destruction in a wide area, threaten many lives, and have deep and lasting effects on the mind and development of human beings [1, 2]. T\u0026uuml;rkiye is located in a geographical zone that is considered \u0026quot;high-risk\u0026quot; in terms of earthquakes on the Earth [3]. The latest earthquakes are the two earthquakes that occurred within nearly 10 hours in Kahramanmaraş on February 6, 2003, in T\u0026uuml;rkiye. The first was of 7.8 magnitude in the Pazarcık district of Kahramanmaraş, and the second was of 7.6 magnitude in the Elbistan district of Kahramanmaraş.\u0026nbsp;These two consecutive earthquakes affected an\u0026nbsp;area of 108,812 square kilometers covering 11 provinces (Kahramanmaraş, Hatay, Gaziantep, Osmaniye, Malatya, Adana, Diyarbakır, Şanlıurfa, Adıyaman, Kilis, and Elazığ provinces) and were recorded as the largest earthquakes in\u0026nbsp;the history of T\u0026uuml;rkiye according to the surface wave magnitude scale and the second biggest earthquakes recorded in Anatolia after the North Anatolia earthquake in 1668 They are also the second deadliest earthquakes in the world since the 2010 Haiti earthquake, which killed more than 220,000 people. According to the released data, 46,104 people lost their lives in the earthquake, 105,505 people were injured, and 13.5 million people were directly affected\u0026nbsp;[4].\u003c/p\u003e\n\u003cp\u003eEspecially in earthquakes in developing countries, the necessary resources cannot be adequately supplied to provide appropriate services to survivors [5]. Pre-existing hierarchies and inequalities in access to resources and opportunities may make certain groups, such as women, children, ethnic minorities, and those living in rural areas, more vulnerable in case of earthquakes [6, 7]. A person\u0026apos;s response to natural disasters is largely affected by their cultural, social, and economic background [8]. Sociological and ethnographic research results have also shown that natural disasters exacerbate gender and social inequalities. The negative effects of social, economic, political, and ecological conditions on each other worsen the vulnerability of women and limit their capacity to cope with difficulties in emergencies\u0026nbsp;[9,10]. Women, with more vulnerabilities and less access to resources, are often seen as victims of natural disasters [11]. The recent earthquakes in T\u0026uuml;rkiye have caused significant damage to infrastructure, leaving many pregnant women without access to essential healthcare services\u0026nbsp;[12]. According to the United Nations Population Fund (UNFPA), there are currently more than 226,000 pregnant women in T\u0026uuml;rkiye among earthquake survivors who need immediate access to reproductive healthcare\u0026nbsp;[13]. In their study, Yoosefi Lebni et al. (2020) revealed the post-earthquake experiences of Iranian women living in rural areas as neglect of their health needs, tension in family and marital relations, gender inequality in the assistance provided, feeling insecure, ignoring the dominant culture of the region, fear of stigmatization, and need to hide for grief\u0026nbsp;[11]. In another study, women were found to be less likely than men to receive relevant post-disaster assistance, including financial support, healthcare services, and other types of social aid\u0026nbsp;[14]. (One of the professional requirements for nurses is to determine the needs of individuals at risk in the prevention, preparation, response and recovery stages of disaster management and to take appropriate initiatives.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEarthquake studies have generally been studied using quantitative and descriptive methods [15\u0026ndash;18]. However, qualitative studies provide a valuable opportunity to describe individuals\u0026rsquo; experiences, interpretations, and perspectives and to better understand the surrounding social and cultural context. A qualitative study examining the perceptions and experiences of women who experienced the earthquake after the February 2023 Earthquake in T\u0026uuml;rkiye would provide comprehensive information to health professionals, intervention groups, and policy makers. Therefore, this study aims to investigate women\u0026rsquo;s perceptions and evaluations of earthquake experiences.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eAim\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present study aimed to describe the perceptions and evaluations of women who experienced the Kahramanmaraş-centered earthquakes on February 6, 2023, in T\u0026uuml;rkiye.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDesign and participants\u003c/p\u003e\n\u003cp\u003eThe research was designed as a phenomenological study, one of the qualitative research designs. Phenomenology is a qualitative research method that enables individuals to express their understanding, feelings, perspectives, and perceptions about a phenomenon or concept and is used to express how they experience this phenomenon [19]. The study group of this qualitative research comprised women who experienced the consecutive Kahramanmaraş-centered earthquakes on February 6, 2023. The snowball/chain sampling method, one of the purposive sampling methods, was used as the sampling method. The reason for using non-random sampling techniques is that such studies involve an effort to explore and understand rather than to test a hypothesis. The selection of individuals who would form the sample and the interviews with the individuals were continued until a saturation point suitable for the study\u0026rsquo;s purpose was reached. Since the objective was to improve knowledge, the selection was ended when no new information was obtained from the sample group (n=13). The inclusion criteria determined for the sampling included being a woman between the ages of 15-49, being in Izmir for temporary accommodation, being able to speak Turkish, and volunteering to participate in the research.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe semi-structured interview technique was employed in data collection. In-depth individual interviews were conducted with the participants determined by purposive sampling, and the number of participants was determined according to theoretical saturation (data saturation). In qualitative research, the sampling criterion is theoretical saturation, and it shows that saturation is reached when there is no new code in interviews and that researchers can interrupt the interview process and no longer need to enlarge the sample size [20]. In this study, the saturation level was reached in the 11th participant, and the study was completed with 13 participants. Table 1 contains the descriptive characteristics of the sample.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 1 Descriptive characteristics of the sample\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eParticipant No \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eAge \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003ePlace of residence *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eProvince of current residence due to the earthquake\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eDamage to the house\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eLoss\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eParticipant 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eGaziantep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eGaziantep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eUndamaged\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eNo loss\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eParticipant 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eAdana\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eAnkara\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eHeavily damaged\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eNo loss\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eParticipant 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eMalatya\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eİzmir\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eSlightly damaged\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eLost siblings, nieces and nephews, and cousins\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eParticipant 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eAntakya\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eMersin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eDestroyed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eLost the daughter\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eParticipant 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e40\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eHatay\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eİzmir\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eSlightly damaged\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eNo loss\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eParticipant 6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eŞanlıurfa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eİzmir\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eSlightly damaged\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eNo loss\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eParticipant 7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eGaziantep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eGaziantep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eHeavily damaged\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eNo loss\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eParticipant 8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eGaziantep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eİzmir\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eDestroyed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eNo loss\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eParticipant 9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eGaziantep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eGaziantep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eHeavily damaged\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eNo loss\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eParticipant 10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eGaziantep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eGaziantep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eDestroyed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eLost second-degree relatives\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eParticipant 11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eHatay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eİzmir\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eHeavily damaged\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eLost second-degree relatives\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eParticipant 12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eHatay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eAntalya\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eHeavily Damaged\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eLost friends\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eParticipant 13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eHatay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eEskişehir\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eHeavily damaged\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eLost the cousin\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e* A state of emergency was declared in the following 11 provinces affected by the February 6 earthquakes in T\u0026uuml;rkiye: Adana, Adıyaman, Diyarbakır, Gaziantep, Hatay, Kahramanmaraş, Kilis, Malatya, Osmaniye, Şanlıurfa, and Sivas.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSemi-structured questions, prepared by the researchers by reviewing the literature and shown in Appendix 1, were used in data collection [3,9,15,21]. \u0026nbsp;No interview guide from a previous study was used, and the questions were evaluated for content by consulting expert opinions. It is stated that expert opinions significantly contribute to the validity of data collection tools in qualitative research [22]. In present study, expert opinion was obtained from the fields of public health nursing, psychiatric nursing, obstetrics and gynaecology nursing, and surgical diseases nursing for the questions in the form that would guide the interview. Moreover, data analysis was started simultaneously with the data collection. All interviews were recorded with a voice recorder. The statements of the two participants who did not allow voice recording were recorded in writing.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo capture the rich life experiences of women, the interview form was a pilot study of four women in April for the clarity and functionality of the questions, and the necessary revisions were made to two questions. Pilot study data were not included in the data analysis in the research.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA researcher conducted the interviews to gain the women\u0026apos;s trust and create a desire to participate in the study. The interviews were held between May 12, 2023, and August 27, 2023. For the interviews, a student who was studying in the Faculty of Nursing of Ege University and met the inclusion criteria of the study was selected by the snowball sampling method. The student was considered the starting point of the study. After this participant was interviewed, women who experienced the Kahramanmaraş-centered earthquake and came to Izmir for temporary shelter were reached. Permission was obtained for the interviews, and the participants approved the audio recording. The sentence \u0026quot;\u003cem\u003eFirst of all, thank you for allowing me to turn on the audio recorder\u003c/em\u003e\u0026quot; was noted down. An in-depth interview was held after the consent. After each interview, the researchers started to analyze and encode the data to guide subsequent interviews. The interviews were conducted in the most appropriate environment and time for the interviewees. Thematic content analysis was performed through the transcription of the records.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the research, the analysis phase was carried out at the same time as the data collection phase. The analyses were performed simultaneously with the start of the initial interviews. All interviews were recorded using an audio recorder, and the contents were transcribed one-to-one. Moreover, all material was reviewed several times for an accurate understanding. The data were analyzed using the NVIVO 12 Pro software. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eContent analysis was conducted to collect and interpret similar data within the scope of certain concepts and themes. This process was conducted in the form of preliminary reading, coding qualitative data, reaching themes, organizing data, interpretation and reporting [22, 23]. Handling coding used in the data analysis of the study. A list of codes was created (43 codes) and the codes were systematically grouped into women\u0026apos;s post-earthquake perceptions and evaluations based on three main themes: Difficult and Scary, Basic needs and support, Building the future. To ensure coding reliability, interview recordings from five women were independently checked for coding consistency by the lead author. All codes in the selected interview recordings were compared and inconsistencies/disagreements were discussed until consensus was reached. Then, the codes were given their final form. All authors took part in the analysis of the data.\u003c/p\u003e\n\u003cp\u003eFor some themes, in vivo coding, which is included in the qualitative research methodology of the embedded theory, was carried out as the inductive coding process. In vivo coding involves creating a theme label by directly using the code obtained from the data, in other words, the participant\u0026apos;s statements [24]. When presenting the findings, the abbreviation \u0026quot;f\u0026quot; was used for the frequency numbers indicating the citation. The qualitative content analysis performed in the study is a powerful process that involves different research methods used to analyze textual data and aimed at initiating the introductory meanings of the concept. It is also a systematic classification and coding method. The main purpose of this method is to satisfactorily understand the phenomenon researched [20].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eValidity and reliability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the study, participant confirmation and expert opinion in data analysis and coding stages were taken for validity and reliability, and direct quotations were frequently included in the report. All the researchers have a qualitative data analysis certificate. The interviews were conducted by a single researcher. Validity was assessed on the basis of one researcher (public health nurse, first author) collecting the data and all authors working on the analysis of the data [25]. Responses were coded separately by two coders and a single code list was created based on the consistency of the coding. These codes were categorized by content analysis with the words written by the authors to create themes and three themes were obtained [26].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePermission was obtained from the Scientific Publication Ethics Committee of Ege University to carry out the study (Date: 27 April 2023, Number: 05/10). The participants were given a detailed explanation of the study and volunteered to take part in the study, and a written informed consent form was obtained from the participants. The participants were informed both in writing and verbally that they could leave the interview at any time. Meanwhile, the participants were told that a code would be determined for each participant, that code would be used during the writing phase of the research, and their real identities would be kept confidential. For example, the abbreviation \u0026quot;P5\u0026quot; was used in the quotes of Participant 5. Furthermore, all participants were informed that the interviews would be recorded with a digital audio recorder to conduct the interviews more appropriately, and these audio recordings would be listened to/read by only two experts/researchers other than the interviewer for credibility and internal consistency. The study was conducted in accordance with the principles of the Declaration of Helsinki.\u003c/p\u003e"},{"header":"Findings","content":"\u003cp\u003eIn this qualitative study on the perceptions and evaluations of women who survived the Kahramanmaraş-centered earthquake disaster, T\u0026uuml;rkiye, on February 6, 2023, and were interviewed in the 3rd and 6th months after the disaster, data analysis was performed with content analysis \u0026nbsp;following in-depth individual interviews (n=13) using a semi-structured interview form. The themes reached in the form of process from women\u0026rsquo;s statements and their relationships are presented visually in Figure 1. The theme labels and frequency numbers reached for the post-earthquake process expressed by the participating women are as follows:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTheme 1 label is \u0026quot;Difficult and Scary\u0026quot;. \u0026quot;Difficult\u0026quot; (f:48) and \u0026quot;Scary\u0026quot; (f:31) subthemes were included in the first stage, which was titled \u0026quot;\u003cem\u003eVery difficult to explain, where words fail,\u003c/em\u003e\u0026quot; created with in-vivo coding from the quotes of 49-year-old Participant 4, who stated that she lived in the center of Antakya and lost her daughter in the earthquake. The statement of 48-year-old Participant 10 from Gaziantep province, \u0026quot;\u003cem\u003eEverything was very difficult and scary,\u003c/em\u003e\u0026quot; was moved to the title due to its relationship with other categories and because it was a summary description explaining the first stage of the process.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTheme 2 label is \u0026quot;Basic needs and support\u0026quot;. The themes in the next stage \u0026quot;\u003cem\u003eAfter the earthquake\u0026hellip;\u003c/em\u003e\u0026quot;, which were reached through in-vivo coding from the statements of five participants (participants 5, 6, 7, 10, and 13), were \u0026quot;Failure to meet basic needs\u0026quot; (f:56), \u0026quot;Psychological trauma, exhausting\u0026quot; (f:27), \u0026quot;Emotional state reactions\u0026quot; (f:26), \u0026quot;Weather conditions\u0026quot; (f:16), \u0026quot;Safety problems\u0026quot; (f:16), \u0026quot;Failure to meet primary toilet and bathroom needs\u0026quot; (f:12), \u0026quot;Death, moral loss\u0026quot; (f:9), \u0026quot;Communication problems\u0026quot; (f:7), and \u0026quot;Physical health problems\u0026quot; (f:5). In this process, 5 participants expressed that their needs were met through aid and support, 2 participants expressed that their needs were met late, and 6 participants expressed that their needs were not met. The participants who expressed that they were not satisfied at this stage of the process referred 42 times to the theme of \u0026quot;Lack of coordination and injustice in distribution\u0026quot; for aid and support.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTheme 3 label is \u0026quot;Building the future\u0026quot;. Regarding the earthquake-affected women\u0026apos;s statements for the present time, the subthemes of \u0026quot;Presence of social support\u0026quot; (f:23), \u0026quot;Future planning\u0026quot; (work problem, financial loss, housing) (f:19), and \u0026quot;Request for state support\u0026quot; (f:5) were included in the stage titled \u0026quot;\u003cem\u003eIt is very difficult to start everything from scratch\u003c/em\u003e\u0026quot; belonging to 40-year-old Participant 5, who stated that she lived in Hatay.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTHEME 1. Difficult and Scary\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis theme includes the first phase describing the first moment of the earthquake;\u003cem\u003e\u0026nbsp;\u0026ldquo;Very difficult to explain, where words fail.\u0026rdquo;\u0026nbsp;\u003c/em\u003eOf the citations made by the earthquake-affected women when describing their life experiences, 23% consisted of the words \u0026ldquo;difficult\u0026rdquo; and \u0026ldquo;scary\u0026rdquo; regarding the first stage. The participants used the word \u0026quot;difficult\u0026quot; 48 times and \u0026quot;scary (fearful, anxious, worrying)\u0026quot; 31 times. Some of the participant quotations with reference to the first stage are presented below:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;The most difficult thing was the fears we experienced psychologically\u0026hellip; Our house was not heavily damaged in the earthquake, but we could not go into our house due to the fear we had. In other words, our biggest problem was the fear of another earthquake if we entered the house\u003c/em\u003e.\u0026quot; P1, 28 years old, Gaziantep.\u003c/p\u003e\n\u003cp\u003e\u0026quot;\u003cem\u003eWe were all worried about a new earthquake\u0026hellip; The fear of a new earthquake made everyone nervous, and this caused people to be on pins and needles all the time. It was very difficult to meet basic needs. Parents could not even send their children to school with a fear of an earthquake. Therefore, it was a difficult process for everyone, including university students, in terms of education\u003c/em\u003e.\u0026quot; P8, 22 years old, Gaziantep.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u0026hellip;\u003cem\u003eIn fact, I think everything was difficult, we were homeless at first, and the weather conditions were very difficult. There was no toilet or shower for a long time, so it was all difficult.\u003c/em\u003e\u0026quot; P6, 44 years old, Şanlıurfa.\u0026nbsp;\u0026quot;\u003cem\u003eThe most obvious concern is the fear of death. Of course, we survived as a family, but we experienced great fears in the slightest earthquakes.\u003c/em\u003e\u0026quot; P5, 40 years old, Hatay.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTHEME 2. Basic needs and Support\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis theme, which was mentioned most by the participants and constituted 63% of all references, includes the second stage; It includes statements made by the participants such as \u0026ldquo;\u003cem\u003eAfter the earthquake\u0026hellip;\u003c/em\u003e\u0026rdquo;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThese are failure to meet basic needs, psychological trauma, exhausting, emotional state reactions, weather conditions, safety problems, failure to meet primary toilet and bath needs, death, moral loss, communication problems, physical health problems, and lack of coordination and injustice in distribution.\u003c/p\u003e\n\u003cp\u003eMore than half (63%) of the citations made by women when describing their perceptions and evaluations about the earthquake consisted of statements and themes describing this stage. Some of the participant quotations describing this stage are as follows:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;Our basic needs were water, food, and clothes. Because it was cold, we needed socks and blankets.\u003c/em\u003e \u003cem\u003eThe hardest part was the cold weather. The weather conditions were terrible. We waited for hours and days in the cold and even spent a day on the roads and at the airport to leave the city. I had a temporary paralysis on part of my face because of the cold. Even children were waiting in the cold.\u003c/em\u003e \u003cem\u003eI was quite affected\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cem\u003e... [by the earthquake] We still have aftershocks, and this has affected our psychology very badly. The trauma we experienced caused anxiety in some of us and increased the worries in others.\u0026quot;\u0026nbsp;\u003c/em\u003eP9, 21 years old, Gaziantep\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;We have dealt with many difficulties, both material and immaterial. My father couldn\u0026apos;t get paid because he couldn\u0026apos;t work, and this forced us a lot during this period and afterward. Additionally, the most difficult thing was to constantly face the fear of earthquakes after the earthquake and to meet the basic needs such as food, sleep, bathing, cleaning, etc. in the same place with many people.\u0026quot;\u003c/em\u003e P8, 22 years old, Gaziantep.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026quot;[Still] \u003cem\u003ethe bathroom and toilet problem is our biggest problem\u003c/em\u003e.\u0026quot; P4, 49 years old, Antakya\u003c/p\u003e\n\u003cp\u003e\u0026quot;\u003cem\u003eOur main problems after the earthquake were the WC, shower, and accommodation, in other words, there was no place to sleep. They were very difficult and bad days\u003c/em\u003e. \u003cem\u003eMy behavior changed a lot, I had extremely difficult days [psychologically\u003c/em\u003e], I \u003cem\u003ecouldn\u0026apos;t sleep for 5 days, I had panic attacks and shortness of breath.\u003c/em\u003e \u0026quot; P10, 48 years old, Gaziantep.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026quot;\u003cem\u003eOur house was heavily damaged, so we could not enter our house. We couldn\u0026apos;t get our stuff. In the harsh conditions of winter, cold, rainfall, and in the heat of summer, we had a difficult time being bitten by animals, and we are still having a difficult time\u003c/em\u003e.\u0026quot; P11, 23 years old, Hatay.\u003cem\u003e\u0026nbsp;\u0026ldquo;I cannot sleep comfortably at night, sometimes I am sleepless, and it affects my whole life.\u003c/em\u003e\u0026quot; P7, 42 years old, Gaziantep. \u0026quot;\u003cem\u003eWe slept in our cars for a week after the earthquake. There was no electricity, no water, and we were trying to reach our relatives while charging our phones at other relatives\u0026apos; places.\u003c/em\u003e\u0026quot; P3, 55 years old, Malatya. \u0026quot;\u003cem\u003eWe feel very sad and helpless\u003c/em\u003e.\u0026quot; P6, 44 years old, Şanlıurfa.\u003c/p\u003e\n\u003cp\u003e\u0026quot;\u003cem\u003eWe went out right after the earthquake, not having a car to put our heads in made it very difficult for us in cold and rainy weather. Although we did not think of food at that moment, we would get hungry after a while. It was a big problem that there was no help for food and drink, stores and markets were looted, security was troublesome... My personality, unfortunately, changed, and I think my anxiety increased. I remember death more often, I didn\u0026apos;t want to see four walls at first, I thought I shouldn\u0026apos;t have a social life. After the city changed, I didn\u0026apos;t go out for a while, I condemned myself. We felt very bad psychologically... After being left homeless, we would find it enough even if our basic needs were met. However, after a while, it was difficult to reach them, and the water problem continues.\u003c/em\u003e\u0026quot; P13, 22 years old, Hatay.\u003c/p\u003e\n\u003cp\u003eParticipant 13 expressed her decision to leave the city she lived in as follows:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u0026hellip;It [earthquake] was felt much more severely due to the soil structure of Hatay. While running, my family and I fell down the stairs, the stairs collapsed, my father\u0026apos;s leg was broken, and many of us had bruises and injuries on different parts of our bodies. We were in shock. The fact that there were even bigger aftershocks after the earthquake, the view we saw in daylight, the desperation of people, and the late arrival of aid put us in an incredibly fearful situation. Then we decided to leave Hatay, we are now in Eskişehir.\u0026quot;\u003c/p\u003e\n\u003cp\u003eMoreover, Participants 1 \u0026nbsp;and 8 stated the following on the subject:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;I did not receive much help because there was no major destruction in the area where I lived, but I believe there was no coordination in the distribution of the aid.\u0026quot;\u003c/em\u003e P1, 28 years old, Gaziantep.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cem\u003e\u0026nbsp;\u0026quot;Our most basic needs, such as tents and materials to be used for heating, were not met. Except for the first two days of the earthquake, our needs, such as food, bread, and water, were met on other days. But during the first two days, we could not reach any of the basic needs such as food, bread, water, and fuel. Furthermore, aid could not reach people in need and was unconsciously distributed to people who did not need it.\u0026quot;\u003c/em\u003e P8, 22 years old, Gaziantep.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTHEME 3. Building the future\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe statements that were mentioned least by the participants regarding the last phase after the earthquake were about building the future. Women about the final stage of the earthquake disaster; \u0026ldquo;\u003cem\u003eIt is very difficult to start everything from scratch.\u003c/em\u003e\u0026rdquo; These are presence of social support, future planning, and request for state support. \u0026nbsp;The stage with the lowest citation rate (14%) for the earthquake-affected women is the final stage titled \u0026quot;\u003cem\u003eIt is very difficult to start everything from scratch\u003c/em\u003e.\u0026quot; Some quotes from the participants who referred to the categories at this stage are as follows:\u003c/p\u003e\n\u003cp\u003e\u0026quot;\u003cem\u003eIt\u0026apos;s very difficult to start a role, everything, from scratch. I plan for the future a lot\u003c/em\u003e. \u003cem\u003eIn fact, if I had had the state on my side, if I had accessed my relatives,\u0026nbsp;\u003c/em\u003eI would have been [felt]\u003cem\u003e\u0026nbsp;safer\u0026hellip; I would have coped more easily. My friends helped me the best.\u003c/em\u003e \u0026quot; P5, 40 years old, Hatay.\u003c/p\u003e\n\u003cp\u003e\u0026quot;\u003cem\u003eOur adaptation process to the city we live in is difficult. We had a lot of financial difficulties. Our car was damaged in the earthquake, and its repair was very costly. We had to buy new items because we moved into the new house and saved few of our belongings.\u0026quot;\u0026nbsp;\u003c/em\u003e P12, 23 years old, Hatay.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;In fact, of course, I would like to have my losses with me. Then, I wish a lot of psychological support had been provided. My greatest helper was to feel the presence of good-hearted people. \u0026quot;\u003c/em\u003e P3, 55 years old, Malatya.\u003c/p\u003e\n\u003cp\u003e\u0026quot;\u003cem\u003eA social state does this for its people. If it were a social state, I would not live with possibilities. If I received food, health, accommodation, and psychological support, I would cope better. My greatest helper... It\u0026apos;s good to know that people are supporting us, but our greatest helper is ourselves.\u0026quot;\u003c/em\u003e P2, 25 years old, Adana.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eRecent studies have revealed that damages caused by natural disasters are observed more in women, children, and ethnic minorities due to social and economic inequalities [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In the present study, which focused on the perceptions and evaluations of women 3\u0026ndash;6 months after the February 6, 2023 earthquakes in T\u0026uuml;rkiye, which are defined as the disaster of the century, the statement \"\u003cem\u003every difficult to explain, scary,\"\u003c/em\u003e which refers to the process and is mentioned in the title, is a summary and is related to all the categories reached. In this study, the statements of failure to meet basic needs, lack of coordination, injustice in distribution, and psychological trauma were the most mentioned subcategories in the category of \"\u003cem\u003eafter the earthquake\u003c/em\u003e\" by earthquake-affected women. Since the earthquakes occurred in February and the night temperature dropped below zero, the basic need expressed by earthquake-affected women was the need for blankets and clothes to protect themselves from the cold. In the earthquakes in Van province of T\u0026uuml;rkiye in 2011 and Nepal in 2015, the need for blankets and tents was stressed by earthquake victims [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. In a study, a 41-year-old woman, an earthquake victim, expressed the most important needs as \"... \u003cem\u003ethe most important and necessary things for us at that time were food, tarpaulin, and blankets\u003c/em\u003e\". In the studies, in the first phase after the earthquake, the need for accommodation, food, and clothing emerged for earthquake victims, as Maslow stated in the hierarchy of basic needs. In emergencies such as earthquakes that concern large groups of people, it has been considered quite important and a priority for institutions to plan and prepare for needs such as tents, warm clothes, and food.\u003c/p\u003e\u003cp\u003eThe lack of communication and coordination is often stressed in the literature as one of the biggest problems in disaster response worldwide [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. In a publication where experiences in the region were shared with the leaders of women's communities after the February 6, 2023 earthquake, it was stated that a lack of coordination was frequently experienced, as emphasized by the women in our study. For example, it was reported that the incidents of skin irritation increased as a result of washing laundry with hands, creams and medications were not considered for their treatment, contraceptive pills were not provided for women who used oral contraceptives before the earthquake, the need for underwear was not met for women while providing clothing support, and it was not taken into account at the logistics stage [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. In the qualitative study conducted by Yoosefi Lebni et al. (2020) with earthquake-affected women in Iran in 2012, a theme emerged, indicating that the needs of men were prioritized in the list of needs, and the needs of women remained in the background [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Governments and non-governmental organizations should further include gender frameworks in their plans for disaster relief interventions.\u003c/p\u003e\u003cp\u003eIndividuals may suffer deep despair and posttraumatic stress disorder after the earthquake due to the loss of family members and financial losses. After the 2011 Van earthquake in T\u0026uuml;rkiye, the rate of stress disorder was found to be 35.5% in individuals over the age of 15 after the earthquake. Being a woman was determined as one of the risk factors [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. The stress rate was determined to be 11.9% in individuals who survived the 2016 Kumamoto earthquake in the world. When the variables predicting stress were examined, stress was 1.33 times more common in women than men, and those living in common areas such as tents were 2.44 times more stressed than those living in their homes [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. In our qualitative study, psychological trauma, exhausting (f:27), and emotional state reactions (f:26) of women after the earthquake were the second most mentioned subcategory following the subcategory of \u003cem\u003efailure to meet basic needs\u003c/em\u003e, which received 56 citations, with a total of 53 citations. The study conducted with earthquake-affected women in Iran found that women were emotionally affected but could not express this [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. After the earthquake, it is important to prevent suicidal attempts, particularly among women, with social, economic, and cultural effects and to raise awareness of this issue.\u003c/p\u003e\u003cp\u003eA study revealed that after the February 6, 2023 earthquake, women experienced safety problems at night due to the lack of appropriate structures to meet their toilet need [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. In our study, the safety problem was mentioned 16 times, and toilet and bathroom needs were mentioned 12 times by women in the category of \u003cem\u003e\"after the earthquake...\"\u003c/em\u003e Due to their need for privacy, women entered damaged buildings to meet their toilet needs. To meet their needs, they had to re-experience life-threatening situations [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eEarthquake victims can try to avoid the reminders of the earthquake, experience some health problems, and constantly visualize it in their minds and dreams. People may also fear that their relatives or themselves may die suddenly [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In our study, female earthquake victims referred to the category of \"\u003cem\u003every difficult to explain...\u003c/em\u003e\" 48 times. The term \"\u003cem\u003edifficult\u003c/em\u003e\" was defined by earthquake-affected women for \"another earthquake,\" \"fear of death, scary,\" and it was mentioned 79 times in total. The study by Yoosefi Lebni et al. (2020) elucidated that it became an obsession for Iranian earthquake-affected women to experience the fear that there will be another earthquake [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn this category, the participants also put emphasis on the difficulty of \"displacement,\" \"disruption of education,\" and \"weather conditions.\" Although T\u0026uuml;rkiye is referred to as an earthquake country, post-earthquake experiences have shown that both individuals and institutions are not so prepared. Undoubtedly, the magnitude of the earthquake and its wide geography have contributed to this. In some provinces affected by the earthquake, many neighborhoods and even most of the city have been completely destroyed. The total number of deaths announced is 50,783. At least 15.73\u0026nbsp;million people and 4\u0026nbsp;million buildings were affected, and 345 thousand buildings collapsed [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Thus, as emphasized by earthquake-affected women in our study, a large population had to be displaced, and the education of individuals/their children was disrupted. The education of 9% of university students in T\u0026uuml;rkiye was disrupted.\u003c/p\u003e\u003cp\u003eIn our study, the final stage created from the statements of earthquake-affected women was \"\u003cem\u003eStarting everything from scratch.\u003c/em\u003e\" At this stage, the cited subcategories were the difficulty in planning the future, the request for state support, and the importance of social support. After the 2011 Van earthquake in T\u0026uuml;rkiye, the risk factors in earthquake victims over the age of 15 diagnosed with post-traumatic stress disorder were determined as having accommodation problems, being unemployed, experiencing financial difficulties, and experiencing temporary relocation, which indicates future planning [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. After the 2013 Lushan earthquake in China, it was observed that the effective predictors at health levels for earthquake survivors were the amount of perceived social support, financial loss, and fear they experienced after the earthquake. When the gender factor was added to the regression model, it was found that the effect of the gender factor reduced the effect of other factors and being a woman was more decisive than other variables [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Post-earthquake adaptation of individuals who have experienced earthquakes is facilitated by social support, economic status, and public support. Previous studies have revealed that receiving social and state support after the earthquake positively affects individuals' health perceptions [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. It was elucidated that emergency rescue efforts were properly provided after the earthquake that occurred in Nepal in 2015, but there were difficulties in strategic planning, provision and distribution of aid [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. As emphasized by the women in our study, it should be ensured that an aid registration system is developed among the stakeholders, and national policy developments are systematically monitored.\u003c/p\u003e\u003cp\u003eEarthquakes pose a threat to all individuals living in society. However, gender inequality causes women's vulnerability to increase and their resilience to decrease. In this context, the basic needs of women in earthquakes also differ. More scientific studies are needed to reveal these different needs. It is recommended that researchers conduct academic studies that include the psychological, social and economic difficulties experienced by women in earthquakes and to reduce the burden of roles caused by gender inequality on women.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe researchers of this study are female academic nurses. The subject has been attempted to be addressed with sensitivity by women who have a profession based on altruism. Since the earthquake-affected participants were selected using purposive sampling methods, some perspectives may not be represented. The research findings emerged from the perceptions and evaluations based on the experiences of individuals who experienced the earthquake approximately 3\u0026ndash;6 months ago. The data obtained from the participants are based on their statements. Moreover, the present study was conducted on Turkish women. Therefore, the translation of the concepts mentioned by the participants, which belong to Turkish culture, into English can be considered a limitation of the study.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study reports the perceptions and evaluations of women who survived the Kahramanmaraş-based earthquakes on February 6, 2023, in T\u0026uuml;rkiye and were interviewed 3\u0026ndash;6 months after the earthquakes. The earthquake-affected women describe the earthquake moments, the period after the earthquakes, and the present time. The statement \"\u003cem\u003eVery difficult to explain, where words fail,\"\u003c/em\u003e which was obtained from women's life experiences and perceptions, is a descriptive summary and points to a difficult and scary process from a woman's perspective, indicating the need for all kinds of support by emphasizing the problems such as failure to meet the basic needs, and lack of coordination and injustice in distribution. As in the world, effective disaster preparedness is required in T\u0026uuml;rkiye to reduce vulnerability to disasters and increase the level of not being harm. One of the most important questions to be answered now is \"How can support for earthquake-affected women be increased?\"\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eUNFPA \u0026nbsp; \u0026nbsp;United Nations Population Fund\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePermission was obtained from the Scientific Publication Ethics Committee of Ege University to carry out the study (Date: 27 April 2023, Number: 05/10). The participants were given a detailed explanation of the study and volunteered to take part in the study, and a written informed consent form was obtained from the participants. The participants were informed both in writing and verbally that they could leave the interview at any time. Meanwhile, the participants were told that a code would be determined for each participant, that code would be used during the writing phase of the research, and their real identities would be kept confidential. For example, the abbreviation \u0026quot;P5\u0026quot; was used in the quotes of Participant 5. Furthermore, all participants were informed that the interviews would be recorded with a digital audio recorder to conduct the interviews more appropriately, and these audio recordings would be listened to/read by only two experts/researchers other than the interviewer for credibility and internal consistency. The study was conducted in accordance with the principles of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eG.M. and R.\u0026Ouml;.D. provided the conceptual framework and designed the study. G.M. conducted the interviews and A.\u0026Ccedil;. performed initial data analysis. G.M., R.\u0026Ouml;.D., and A.\u0026Ccedil;. collaborated on further data analysis, writing the manuscript, interpretation, and drafting the manuscript. All authors reviewed and approved the final manuscript\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank all women for participating in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eKahraman S A. Comprehensive Health Economic Analysis of the 2023 Turkey Earthquake. Disaster Med. Public Health Prep. 2023;17(e503): 1\u0026ndash;4.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKarki J, Matthewman S, Grayman JH. Rahat-Sahayog (relief support): examining disaster emergency response in the aftermath of the Nepal Earthquake 2015. Disaster Prev. 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Social Forces. 2016; 95(1): 355-380.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSohrabizadeh S, Tourani S, \u0026amp; Khankeh H R. Women and health consequences of natural disasters: Challenge or opportunity? Women \u0026amp; Health, 2016; 56(8):977\u0026ndash;993.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eYoosefi Lebni J, Khorami F, Ebadi Fard Azar F, Khosravi B, Safari H, \u0026amp; Ziapour A.Experiences of rural women with damages resulting from an earthquake in Iran: a qualitative study. BMC Public Health. 2020; 20: 1-13.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eUwishema O. Addressing the effects of the earthquakes on T\u0026uuml;rkiye\u0026rsquo;s health-care system. Lancet.2023; 401:727.\u003c/li\u003e\n \u003cli\u003eGoodyear S. 2023.Hundreds of thousands of pregnant women need help in earthquake-torn Turkey, Syria. CBC, 20 February 2023, https://www.cbc.ca/radio/asithappens/turkey-syria-earthquakes-pregnant-1.6754582.\u003c/li\u003e\n \u003cli\u003eBradshaw S, Fordham M. 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Work. 2023; 3(2):93-105.\u003c/li\u003e\n \u003cli\u003e\u0026Ouml;zer E, Şen Y\u0026Ccedil;, G\u0026uuml;ler DS, \u0026amp; G\u0026uuml;ven\u0026ccedil; G. Experiences of women relocated due to the february 2023 earthquake in Turkey: a qualitative study. BMC Women\u0026apos;s Health, 2025; 25(1):21.\u003c/li\u003e\n \u003cli\u003eYıldız MI et al. Preventive and therapeutic mental health care after the earthquake-expert opinion from the Psychiatric Association of Turkey. Turkish J Psychiatry. 2023; 34(1): 39.\u003c/li\u003e\n \u003cli\u003eZare M, Saeedi A, Kamranzad F, Pishnamazi P. An overview of disaster management during the \u0026nbsp;april 25, 2015, Mw7. 8 Nepal earthquake. Journal of Disaster and Emergenc Research . 2020;3(1):7-27.\u003c/li\u003e\n \u003cli\u003eYates S. Emergency knowledge management and social media technologies: A case study of the 2010 Haitian earthquake. Int. J. Inf. Manag. 2011;31(1):6\u0026ndash;13.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAyata G, Kapdan \u0026Ouml;, Ozan \u0026Ouml;, G\u0026uuml;rb\u0026uuml;z N, \u0026amp; Onuk B. Deprem b\u0026ouml;lgesinde kadin olmak. Reflektif Sosyal Bilimler Dergisi.2023; 4(2): 403-417.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eBoztaş MH \u0026nbsp;et al. Post traumatic stress disorder among adults in the aftermath of 2011 Van-Ercis earth-quake in Turkey. \u0026nbsp;Turkish J Clin Psy. 2019; 22:380-388.\u003c/li\u003e\n \u003cli\u003eIde-Okochi A, Samiso T, Kanamori Y, He M, Sakaguchi M, \u0026amp; Fujimura K.Depression, insomnia, and probable post-traumatic stress disorder among survivors of the 2016 Kumamoto earthquake and related factors during the recovery period amidst the COVID-19 pandemic. Int. J. Environ. Res. Public Health. 2023; 19(7): 4403.\u003c/li\u003e\n \u003cli\u003eCook AD, Shrestha M, Htet ZB. An assessment of international emergency disaster response to the 2015 Nepal earthquakes. t. J. Disaster Risk Reduct. 2018;31: 535-547. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Türkiye earthquake, qualitative research, woman, perception","lastPublishedDoi":"10.21203/rs.3.rs-7082863/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7082863/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Women, with more vulnerabilities and less access to resources, are often seen as victims of natural disasters. The present study aimed to describe the perceptions and evaluations of women who experienced the February 2023 earthquake in Türkiye.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Thirteen volunteer earthquake-affected women of reproductive age were included in the study, which was planned in the phenomenological design. The research data were collected by the researchers using the face-to-face interview technique along with a semi-structured questionnaire. Content analysis was conducted in analyzing data. As a result of women’s perceptions and evaluations, a three-stage process model created with in vivo coding was reached. The first stage includes the theme of \"Difficult and Scary\" as \"Very difficult to explain, where words fail.\" The second stage was titled \"After the earthquake...\" and included the subthemes were “Failure to meet basic needs,\" \"Lack of coordination and injustice in distribution,\" \"Psychological trauma, exhausting,\" \"Emotional state reactions,\" \"Weather conditions,\" \"Safety problems,\" \"Failure to meet primary toilet and bathroom needs,\" \"Death, moral loss,\" \"Communication problems,\" and \"Physical health problems.\" The third stage of women's statements for the present time was titled \"It is very difficult to start everything from scratch\" and includes the theme of \"Building the future.\" Effective disaster preparation is required to reduce women's vulnerability to disasters and enhance the level of damage reduction.\u003c/p\u003e","manuscriptTitle":"Perceptions and evaluations of women who experienced the February 2023 Türkiye earthquake: \"Everything was so difficult and scary...\"","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-19 09:30:33","doi":"10.21203/rs.3.rs-7082863/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-08-23T14:36:46+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-20T05:13:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-15T21:04:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"334135795475452021636434930364615956221","date":"2025-08-15T20:10:20+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-14T06:06:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"35618893209758610733190475390868341077","date":"2025-08-13T15:15:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-12T14:22:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"317436196266714024273048404955238238427","date":"2025-08-12T12:04:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"136285073239014842174066995357211392693","date":"2025-08-11T17:41:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"42710559150535585682407243033533613232","date":"2025-08-11T10:01:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"162411846863463102196858668355110141726","date":"2025-08-11T09:56:29+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-11T09:52:17+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-06T07:50:26+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-21T07:24:25+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-18T12:51:46+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2025-07-18T12:42:16+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bc286c8e-aedd-426f-8a20-979fc3565f54","owner":[],"postedDate":"August 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-08-19T09:30:33+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-19 09:30:33","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7082863","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7082863","identity":"rs-7082863","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}