Addressing population stratification and health disparities in Türkiye: integrating forensic and legal frameworks

Population stratification due to migration can result in discrimination and microaggressions that affect both patient care and healthcare workers’ well-being. Türkiye hosts millions of refugees and asylum seekers, creating new cultural and social challenges within healthcare. This study aimed to measure the degree of awareness of equitable care practices among hospital managers and physicians in Istanbul’s private hospitals and to evaluate how forensic and legal medicine considerations are integrated into serving migrant patients. Using a specialized questionnaire, 210 executive-level healthcare managers and clinicians from 125 private hospitals in Istanbul were surveyed. Embedded within the questionnaire were items on forensic medicine obligations, including mandatory reporting of violence/abuse, medicolegal documentation of injuries, and referral pathways. Frontline clinicians (physicians and nurses) reported higher levels of burnout associated with increased population stratification. Hospital administrators advocated for specific budget allocations and service revisions to meet migrant needs. Despite a general recognition of disparities, only 45% of respondents were aware of mandatory reporting laws, and fewer than 22% knew of standardized forensic documentation protocols. Most hospitals lacked clear forensic referral mechanisms for abuse or trafficking cases. Migration-driven population changes exacerbate inequities and highlight critical gaps in medicolegal awareness within private hospitals. Integrating forensic medicine protocols, offering targeted training, and establishing clear referral pathways may help protect vulnerable patients and reduce legal and ethical risks for healthcare institutions.