Coordination-related ethical challenges in large-scale earthquake response: a cross-sectional survey of field and institutional personnel involved in the 2023 Kahramanmaraş earthquake response, Türkiye

Sustainable disaster response depends not only on technical and logistical capacity but also on coordination arrangements that support human dignity, fairness, accountability, and public trust. The 6 February 2023 Kahramanmaraş earthquakes created a complex multi-actor response environment in which personnel reported both operational and ethical challenges. Aim This study aimed to identify coordination-related ethical challenges self-reported by personnel involved in field operations or institutional support and coordination after the earthquakes and to examine whether reporting of these challenges varied according to demographic, professional, and deployment characteristics. This descriptive cross-sectional survey incorporating exploratory associational analyses included 417 of 2,309 personnel involved in search-and-rescue, health, support, and institutional coordination roles. Data were collected using a 30-item Ethical Issues Assessment Form developed from national and international disaster-response frameworks and refined through expert review. Descriptive statistics and chi-square or exact procedures, as appropriate, were used for analysis. Among 956 selections for coordination difficulties, information-flow disruption accounted for 28.5%, inefficient resource use for 25.5%, uncertainty in assignments for 24.5%, and overlapping authority for 21.5%. Resource insufficiency was reported by 145 of 344 respondents (42.2%). Inefficient resource use was associated with volunteer-related problem type ( p = 0.002; BH-FDR q = 0.035). No other comparison remained below q = 0.05 after adjustment across the 16 exploratory associations. The findings indicate that self-reported coordination difficulties and ethical concerns were interrelated in this large-scale earthquake response. Although the cross-sectional and retrospective design does not permit causal inference, the results point to the importance of clearer role and authority structures, transparent resource governance, reliable information-sharing arrangements, and structured volunteer management in disaster preparedness and response.