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FM AMCONSUL ISTANBUL
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UNCLAS SECTION 01 OF 03 ISTANBUL 000203 
 
SIPDIS 
SENSITIVE 
 
DEPT FOR EUR, EUR/SE AND CA/OCS 
 
E.O. 12958: N/A 
TAGS: SENV CASC KFLU PREL AMGT TU
SUBJECT: LESSONS LEARNED FROM THE H1N1 OUTBREAK IN TURKEY 
 
REF: STATE 54435 
 
ISTANBUL 00000203  001.2 OF 003 
 
 
¶1. (SBU) Summary:  An Amcit transit passenger  was Turkey's 
first confirmed H1N1 case.  His mother, a green card holder 
(LPR), also tested positive for the virus.  Subsequently six 
more confirmed H1N1 cases have been announced by the 
Government of Turkey (GOT) including an additional U.S. 
citizen and a Turkish national recipient of a State 
Department grant.  Close coordination among Mission Turkey's 
three posts (Ankara, Istanbul and Adana) as well as the 
Bureau of Consular Affairs and the EUR Turkey Desk enabled us 
to support the Amcit family while in quarantine, ensure their 
timely release and facilitate their onward travel.  This case 
highlighted inadequacies on the part of the GOT, most notably 
communication gaps between GOT agencies in Ankara and field 
offices in Istanbul and an unwillingness to engage with 
consular officials on the details of the quarantine. 
Turkey's sensationalist media exacerbated communication 
problems and made preserving the privacy of the Amcit 
patients very difficult.  End Summary. 
 
Background on Amcit H1N1 Case 
----------------------------- 
 
¶2. (SBU) A U.S. legal permanent resident (LPR) mother and her 
five adult U.S. citizen children -- all of Kurdish descent 
and former asylees from northern Iraq -- were quarantined in 
Turkey for seven days from May 14-22 after the mother and her 
26 year-old son tested positive for the H1N1 virus. A thermal 
camera at the Istanbul airport determined that the Amcit had 
a fever upon arrival on Thursday, May 14. The entire family 
was then taken by ambulance to a nearby hospital where they 
were held until eventual release. The Amcit tested positive 
the same day, and the mother two days later on Saturday, May 
¶16. Other than the infected son's fever, which dissipated 
within 24 hours, none of the other family members exhibited 
symptoms during quarantine. All six family members were 
released after the two infected individuals were retested and 
tested negative on Thursday, May 21. 
 
The Challenge of Obtaining Accurate and Timely Information 
--------------------------------------------- ------------- 
 
¶3. (SBU) Turkish authorities said that they followed 
international H1N1 quarantine and treatment guidelines. 
However, they were unable to internally coordinate, 
communicate and execute an effective bureaucratic response. 
Specifically, the consulting physician and hospital 
administration at the designated quarantine site had little 
to no say in the treatment and decision making process. 
Instead, they fed regular treatment and condition updates to 
the Istanbul Crisis Center and to Ministry of Health 
headquarters in Ankara, which then in theory decided. 
However, as days passed, the lack of communication and 
coordination at all levels became apparent as hospital 
officials would ask ACS Istanbul for news from the capital 
because they weren't aware of the latest developments and/or 
plan of action. On numerous occasions the Turkish authorities 
gave information to ACS Istanbul that was different from 
firsthand information provided by the quarantined patients 
and also different from what the media was reporting.  As a 
result, Mission Turkey spent a great deal of time 
triangulating to ascertain accurate and timely information, 
and diplomatically encouraging various Turkish authorities to 
coordinate amongst themselves. 
 
Regular E-Mail SITREPs 
---------------------- 
 
¶4. (SBU) Consulate General Istanbul learned of the family's 
detention on Friday, May 15 shortly after close of business 
via a telephone call one of the patients made to Post's duty 
officer.  Initial information gathering and case developments 
occurred over the following weekend. Istanbul consular duty 
officer and consular section chief drafted and sent e-mail 
SITREPs, usually two per day, to keep Embassy Ankara as well 
as interested parties in Washington (State/Ops, CA, EUR and 
the NSC) informed. By sending regular dispatches through 
 
ISTANBUL 00000203  002.2 OF 003 
 
 
Friday, May 22, Istanbul's limited consular staff were free 
to concentrate on assisting the family and actively 
monitoring the situation instead of responding to individual 
inquiries. 
 
Supporting Quarantined Individuals 
---------------------------------- 
 
¶5. (SBU) Despite assurances by hospital administration, the 
quarantined family did not initially receive sufficient 
accommodations and care.  In Turkey, the general practice is 
for family and friends to supplement the very basic 
accommodations and supplies provided to patients at Turkish 
government hospitals.  Our traveling family had no such 
support base, and Consulate staff was prohibited from 
visiting the quarantined family.  The family complained of 
unclean accommodations, lack of shower facilities, 
insufficient food and water, and the absence of 
English-speaking hospital staff.  Consulate staff immediately 
raised these issues with hospital management and were assured 
that changes would be made.  On day three, when confronted 
with specific details describing the insufficient 
accommodations and care, the head of epidemiology for the 
Ministry of Health admitted that treatment and care of the 
patients suffered because the Ministry prioritized tracking 
down all other passengers on the same flight as the two 
infected individuals.  Only after a diplomatic note detailing 
the poor level of support being provided by the hospital was 
sent by Embassy Ankara to the Turkish Ministry of Foreign 
Affairs were most of the matters addressed. 
 
¶6. (SBU) The quarantined family had a local prepaid mobile 
phone number they used to communicate with Consulate staff 
and family back in the United States. Without that lifeline, 
information dissemination and coordination would have been 
exponentially more difficult, especially given that a 
Consular visit was not possible, the hospital phones could 
not dial out, and Turkish authorities did not provide 
accurate and timely information. 
 
Managing Media Attention 
------------------------ 
 
¶7. (SBU) The two infected family members were the first two 
confirmed cases of H1N1 virus infection in Turkey. On Friday, 
May 15, the media started a 24-hour vigil outside the 
hospital where the family was being quarantined.  By 
Saturday, May 16, the story was on the front page of most 
major newspapers in Turkey and the lead story for the Turkish 
cable news channels. Involving the public affairs section 
from the very beginning helped manage the intense level of 
media scrutiny and enabled consular section staff to focus on 
their core responsibilities.  The quarantined family wanted 
as little media coverage as possible, and as self-identifying 
Kurds from northern Iraq, were concerned about public 
perception in Turkey.  Consular Istanbul and Public Affairs 
Istanbul earnestly protected the family's privacy and 
communicated the family's wishes to all relevant Turkish 
authorities.  However, detailed biodata for several family 
members leaked to the media and was in circulation by Sunday, 
May 17.  PAS Istanbul was able to convince some media outlets 
to refer to the patients using initials rather than full 
names. 
 
¶8. (SBU) After the two infected family members tested 
negative for the virus on Wednesday night, May 20, Turkish 
authorities informed Post on the morning of May 21 that the 
patients were free to leave the hospital and depart Turkey. 
However, while no longer white hot, the story continued to 
draw steady media attention, including a collection of 
reporters and cameras camped outside the hospital.  Consulate 
staff worked quickly to formulate and execute an exit 
strategy.  Istanbul  worked with Turkish Airlines contacts to 
re-issue at no charge the family's airline tickets for onward 
travel from Istanbul to the Turkish city of Diyarbakir. 
Consulate staff picked up the family at the hospital and 
accompanied them to Istanbul International airport. 
 
 
ISTANBUL 00000203  003.2 OF 003 
 
 
¶9. (SBU) Due to the intense media attention, Mission Turkey 
sent a diplomatic note in advance of the movement to the 
airports requesting the use of the Istanbul airport VIP 
lounge for the family's departure.  Doing so reduced, but did 
not eliminate, media access to the group and prevented an 
unwanted scene in a public airport area.  Consulate Adana 
also requested VIP lounge access for the family upon arrival 
at the Diyarbakir airport, thereby again avoiding the media 
and allowing Consulate Adana staff to better assist the 
family in making their onward journey by private vehicle to 
northern Iraq. 
 
GOT Response to Subsequent H1N1 Cases 
------------------------------------- 
 
¶10. (SBU) According to Turkish public health officials there 
have been eight confirmed H1N1 cases in Turkey since the 
outbreak began.  ACS Ankara in monitoring the case of an 
Amcit archeologist based in the Aegean province of Aydin who 
contacted a local hospital after experiencing flu symptoms 
following a trip to the United States.  He is a confirmed 
H1N1 case and is due to be released from quarantine on June 
¶6.  Ankara ACS has spoken to him by telephone and he is 
comfortable and being well-treated.  As in the Istanbul 
cases, Turkish health authorities did not report the 
quarantine of an Amcit to the embassy; ACS Ankara learned of 
this case through press reports.  Embassy Ankara brought this 
omission to MFA's attention with a request for better 
coordination.  We learned on June 3 that an Education and 
Cultural Affairs grantee had tested positive for H1N1 upon 
her return to Turkey from New York City.  She had traveled to 
the United States as part of the Carnegie Hall exchange 
program and was detected by the thermal camera screening 
process at Istanbul's Ataturk International Airport.  She is 
currently in quarantine at the same Istanbul facility where 
the Amcit family of six had been held.  Her fellow program 
participants have been identified and are under observation 
(but not in quarantine.) 
 
Summary and Comments 
-------------------- 
 
¶11. (SBU) Mission Turkey's experience with the H1N1 outbreak 
has been primarily through an American citizen services lens. 
 However, this case highlighted communication breakdowns 
within the GOT that are likely to reoccur in future emergency 
situations (pandemic outbreaks, aviation or natural 
disasters) and underscored the need for close coordination 
among all elements of the USG to compensate for deficiencies 
on the Turkish side.   Double and even triple tracking of 
requests (for instance in Istanbul with local authorities, in 
Ankara with the central government and with the Turkish 
Embassy in Washington) proved necessary to acquire the 
multiple sets of permission needed to finally get the family 
on the move on May 21.  Access to mobile computing devices 
(i.e. blackberries) was crucial throughout the quarantine 
period and enabled consular officers at remote locations such 
as the hospital and airport to provide accurate, real time 
information to officers working on this case with senior 
officials in Ankara and Washington and to Consulate Adana 
staff on the road in South Eastern Turkey. 
WIENER