Scabies Outbreak in Hatay Following the Devastating 2023 Turkish Earthquake

On February 6, 2023, twin earthquakes of 7.8 and 7.5 Moment magnitude (Mw) struck southeastern Turkey, affecting 11 provinces and constituting one of the most destructive natural disasters in the country's history. Hatay, one of the most severely affected provinces, faced a disruption of hygiene and healthcare infrastructure, known to increase ectoparasitic infestations such as scabies [1]. This study aimed to evaluate the change in scabies incidence before and after the 2023 Turkey earthquake. All patients diagnosed with scabies at the Hatay Mustafa Kemal University Dermatology Outpatient Clinic between February 6, 2021–February 6, 2023 (pre-earthquake), and April 6, 2023–February 6, 2025 (post-earthquake), were retrospectively analyzed. The two-month post-earthquake gap (February–April 2023) reflects the disruption of hospital infrastructure, during which patients were managed in temporary facilities and medical records could not be maintained. Diagnoses were based on clinical and dermoscopic criteria. Demographic data were retrieved from medical records. Comparative analyses were performed using chi-square and Mann–Whitney U tests, with p < 0.05 considered significant. This study received ethical approval from the Ethics Committee of Hatay Mustafa Kemal University (30.04.2025-39). During the pre-earthquake period, 4.97% of 48,986 patients at our dermatology outpatient clinic were diagnosed with scabies (n = 2434); although total outpatients slightly decreased to 45,655 post-earthquake, scabies diagnoses rose to 13.01% (n = 5938), reflecting a true increase in cases rather than an artifact of reduced clinic access. A statistically significant increase in the proportion of scabies diagnoses was found between the two periods (p < 0.001). In the post-earthquake period, the likelihood of receiving a scabies diagnosis was found to be 2.86 times higher according to the odds ratio (Figure 1). The mean age was 33.4 ± 20.5 years before and 31.7 ± 22.1 years after the disaster. Regarding the male/female ratio (1183/1251 in the pre-earthquake and 2979/2959 in the post-earthquake group), no statistically significant difference was found between the two periods (p = 0.202). In contrast, the age distribution shifted, with cases in patients under 18 increasing from 21.8% (n = 530) to 32.5% (n = 1931) (p < 0.001). The 10.7 percentage point rise indicates a substantial increase in scabies among children following the earthquake, likely due to their dependence on caregivers for hygiene and post-disaster conditions such as sharing bedding in overcrowded shelters and disrupted schools, which facilitate close contact and the spread of scabies. Additionally, the proportion of patients residing in Antakya, the province's central district, rose from 59% (n = 1436) to 66% (n = 3919), reflecting the concentration of displaced populations in temporary settlements (p < 0.001) (Figure 2). Similar findings were reported following previous disasters, including the 1999 Marmara earthquake and 2005 Northern Pakistan earthquake, where overcrowded living conditions and limited access to clean water and hygiene products were linked to a rise in the incidence of scabies [2-4]. In Turkey, the treatment of scabies is conducted in accordance with the guidelines published by the Turkish Society of Dermatology [5]. This guideline emphasizes the importance of proper sanitation measures during treatment, such as bathing with clean water and changing into clean clothes and linens. Following a major earthquake, limited access to clean water and disrupted hygiene conditions hinder the proper implementation of treatment protocols. Our findings highlight the need for a modified treatment approach tailored to extraordinary circumstances that significantly alter living conditions. In conclusion, the Kahramanmaraş Earthquake led to a marked increase in the incidence of scabies. Following the widespread destruction of residential infrastructure, many were resettled in overcrowded shelters with an interrupted water supply, directly contributing to the observed rise in infectious diseases, compounded by limited access to sanitation, clean water, and personal hygiene. These observations underscore the importance of implementing public health strategies and adapting treatment protocols post-disaster to prevent scabies outbreaks. The authors have nothing to report. The authors declare no conflicts of interest. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.