By Lisa Peppler
It is not widely known that medical migration is one of the most important parts of the Turkish-German relationship, as well as a central part of the medical history in both countries. Today’s strong transnational network between physicians in Turkey and Germany was established between the 1930s and 1970s by two groups of migrant physicians: the first were mostly Jewish physicians from Nazi Germany who went into Turkish exile in the 1930s and 1940s; the second group were their Turkish students who came to Germany for specialist training as of the 1950s. In 1964, 18% of Turkish medical school graduates were working abroad, many of them (832 of 2284) in the Federal Republic of Germany, followed by the USA (607).[i]
At that time, the West German healthcare system was increasing its resources due to strong economic growth. New hospitals were built and provision of healthcare was expanded. As a result, a so-called lack of doctors emerged that could only be met by the immigration of foreign physicians. Therefore, Turkish migrant doctors had promising career opportunities. Some of these physicians and their families are still living in Germany today, and in many cases their children became doctors as well.
Through 29 semi-structured interviews with physicians of Turkish origin and three expert interviews with presidents of Turkish German medical associations, I have analysed patterns of this migration as it has changed through time.[ii] In the following post I will show that today‘s transnational network is based on longstanding professional relationships between German and Turkish physicians, which have been developed through German-Turkish as well as Turkish-German medical migration.
German Physicians in Turkish Exile since 1933
Since the Law for the Restoration of the Professional Civil Service in 1933, Jewish physicians were forced to leave Nazi Germany. At the same time, the president of the young Turkish Republic, Mustafa Kemal Atatürk, initiated Western-oriented changes in Turkish higher education. It was the president’s Jewish dentist, Sami Günzberg, who warned him about Hitler’s anti-Semitism and suggested the idea of extending invitations to the so-called German exile physicians to bring greater development to modern Turkey.[iii] This German-Turkish medical migration was part of a broader wave of migration of around 180 scientists from various disciplines, including economics, history and natural sciences, who also brought their families and assistants to Istanbul and Ankara with them.[iv] In 1936, these migrant scientists comprised two thirds of the teaching staff at İstanbul Üniversitesi,[v] and sixteen physicians became directors of institutes and clinics of the medical faculty.[vi] Following Islam scientist Hüseyin Ağuiçenoğlu, this movement started a new phase of Turkish medicine which flourished in subsequent years.[vii]
Many of these exiled physicians became leading figures in Turkish medicine. Their situation was characterized by freedom of research and generous financial support. Additionally, they earned twice as much as their Turkish colleagues and were exempt from taxation.[viii] The Kemalist belief in science and technical progress was based on Atatürk‘s idea that these were central reasons for Western modernity in contrast to Ottoman ‘backwardnes’. Therefore Turkish authorities provided particular financial resources for medical technological developments, such as machines for nuclear medicine. In this way, the radiologist and head of the Institute of Radiology, Friedrich Dessauer, was able to establish a state-of-the-art center for radiotherapy.[ix]
Besides these generous conditions, the situation at İstanbul Üniversitesi was nevertheless difficult because of disputes about competences and responsibilities. The German physicians were confronted with suspicion from their Turkish colleagues and assistants because some of their former Turkish colleagues – who had disagreed with the Kemalist reforms – had been forced to leave the University. These vacancies had been filled by the German expatriates.[x] Additionally, the German physicians were compelled to give their lectures and publish their studies in the Turkish language, and hence were dependent on Turkish assistants for translation.[xi]
What tended to distinguish the physicians from other scientists in Turkish exile was their intimate contact with the Turkish population for study purposes. The best-known surveys were conducted by the pediatrician Albert Eckstein, who headed up the pediatric division of Nümne hospital in Ankara. On behalf of the Turkish Ministry of Sanitation, Eckstein conducted comprehensive studies in Anatolia to establish healthcare for infants and children in these provinces.[xii]
Leaving Turkey, moving to Germany after 1945
Most of these German scientists who had moved to Turkey subsequently left a few years after the Second World War ended. Some moved to North America during the war itself, while others moved back to Germany after 1945.[xiii] They tended to maintain relations with Turkey and cultivated lasting friendships, professional networks and scientific cooperations.[xiv] One of the re-migrants was the above-mentioned Albert Eckstein in 1950, who returned to Germany accompanied by his Turkish assistant, Gül Pala. She might have been the first Turkish physician to come to Germany after 1945, and 60 years later her son, Dr Pala, told me her story in an interview.[xv] She completed her specialist medical training in Hamburg and several other German cities under the teaching of famous pediatricians of that time. She then moved back to Turkey in 1953 where she worked as a pediatrician in her own practice. In 1961, she was offered an interesting job at the World Pediatrics Congress in Istanbul. Her former teacher, the pediatrician Jean Baptiste Meyer, invited her to his chair at a German University so she moved back to Germany, but this time she brought her husband and son. In the years that followed, she was active in pediatric neurological research and development. Smiling, Dr Pala (a general practitioner) told me that he treats elderly patients in his practice in Germany today who had been patients of his mother in Turkey when they were young. These patients are part of the German population of Turkish background who migrated in the course of the German Turkish Recruitment Agreement from 1961 and settled in Germany.
Turkish Physicians in West Germany since 1961
1961 was a key year not only for Turkish-German migration generally, but also for medical migration in particular. The new Constitution gave Turkish citizens official permission to leave the country for employment abroad.[xvi] Many physicians took the chance to leave Turkey to work and receive specialist medical training in Western countries. Another interviewee, Dr Levent, whose father was a student of the exile physicians in Istanbul, talked about the pro-European attitude in the University:
They all said to the students back then, the generation of my father, ‘you are European, you have to go to Europe, do your specialist medical training […] in Germany […] and come back to your home country afterwards.’ This was more or less a direct request […] Yes, this actually was the main reason. Well, I know a lot of them, that’s why a lot of Turkish physicians came to Germany.[xvii]
One of the main reasons that most of the physicians migrated to the Federal Republic of Germany was the so-called Wirtschaftswunder (economic miracle). This general economic growth affected the healthcare system in the 1960s and 1970s. Its expansion was characterized by increased financial resources as well as high differentiation of the healthcare services. Therefore, Germany had a great need for practitioners as well as specialists to ensure medical supply. The news of this opportunity circulated among physicians in Turkey, as DrT Schmidt recalls:
It was said, well, one does not get a job confirmation from England, not from other countries anyway. But the Germans […] they have a lack of doctors now, so one just came to Germany.[xviii]
Many Turkish physicians moved to the Rhine-Ruhr area where huge hospitals had been built since the 1950s. These clinical centers needed medical specialists for scientific research, particularly in the growing field of developing medical devices and applications.[xix] Other migrant physicians found work in underserved rural areas, like Dr Bilgens father:
Back then, my father initially wanted to move to the US, but he didn’t find a job there immediately, he had also applied for a job in Germany and promptly got a confirmation from Germany and then he thought, go to Germany for five years first and you can still go to America afterwards. And … well … we are still here today. [laughing][xx]
Because of their exceptional need for physicians, German authorities created special allowances for foreign doctors to work in rural areas – although usually a license to practice medicine was bound to German citizenship until 2012.
Transnational networks between physicians from Turkey and Germany
In the 1970s some migrant physicians went back to Turkey, but many of them stayed in Germany with their families. Through personal relationships and professional cooperation between Turkish and German physicians in both countries, a transnational network was established. From this time until the present, this professional network was instutionalized in the form of around twelve associations with different priorities. One key example is the German Turkish Physicians Association, which was founded in 1973 to strengthen scientific exchange between the medical faculties of Istanbul and Gießen.[xxi] Another example is the Association of Turkish Doctors, founded in 1970 to support members with migration related or professional aspects. Over time, their activities focused more on their aim of treating Turkish patients in Germany, which is why they changed the name to the Turkish German Medical Association in 2004.[xxii] The associations were founded to sustain the Turkish German professional network beyond the individual personal relationships between friends and colleagues. In this way, the Turkish German relations in medicine have already lasted among generations of medical students and physicians until today. It remains to be seen how the currently difficult relationship between the pair of countries will affect Turkish German medical migration in the future.
Dr. phil. Lisa Peppler is a cultural scientist from Goettingen, Germany. Her recently published dissertation “Medizin und Migration” (Medicine and Migration) is on Turkish German medical migration and positioning processes of (post-)migrant physicians in Germany. She received a scholarship from the postgraduate program History of Generations in Goettingen, Germany. Currently, she is working on medical migration and diversity in healthcare. Twitter: @LisaPeppler (German and English)
[i] Cf. Oğuzkan, Turhan. „The scope and nature of Turkish brain drain“ In Turkish workers in Europe 1960-1975. A a socio-economic reappraisal. (Social, economic and political studies of the Middle East, 19) Edited by Nermin Abadan-Unat, 74-103. Edition ed. Leiden: Brill, 1976, p. 82.
[ii] Cf. Peppler, Lisa. Medizin und Migration. Deutsche Ärztinnen und Ärzte türkischer Herkunft – eine soziokulturelle Mikroskopie. (Göttinger Studien zur Generationsforschung, 23) Göttingen: Wallstein, 2016.
[iii] Cf. Güçlü, Yücel. ‟Turkish-German Relations from Montreux to the Second World War.“ The Turkish Yearbook of International Relations 29 (1999): 49-82, p. 52.
[iv] Cf. Bozay, Kemal. Exil Türkei. Ein Forschungsbeitrag zur deutschsprachigen Emigration in die Türkei (1933-1945). (Fremde Nähe, 15) Münster/Hamburg: Lit, 2001, p. 43.
[v] Cf. ibid., p. 40.
[vi] Cf. Terzioğlu, Arslan. Beiträge zur Geschichte der türkisch-islamischen Medizin, Wissenschaft und Technik, 2. (Analecta Isisiana, 24b) Istanbul: Isis, 1996, p. 258.
[vii] Cf. Ağuiçenoğlu, Hüseyin. ‟Die Mediziner als Avantgarde der politischen Umgestaltung seit der Tanzimat-Periode.“ In Einheit und Vielfalt in der türkischen Welt. (Turcologica, 69) Edited by Hendrik E. Boeschoten and Heidi Stein, 319-332. Edition ed. Wiesbaden: Harrassowitz, 2007, p. 321.
[viii] Cf. Hillebrecht, Sabine. ‟Freiheit in Ankara. Deutschsprachige Emigrantenkinder im türkischen Exil.“ Exilforschung. Ein internationales Jahrbuch 24 (2006): 198-214, p. 200.
[ix] Cf. Ebert, Andreas D. and Arin Namal. „Wilhelm Gustav Liepmann (1878-1939). Vertreibung vom ersten Lehrstuhl für Soziale Gynäkologie an der Berliner Universität ins Exil an die Universität Istanbul.“ In Geschichte der Berliner Universitäts-Frauenkliniken. Strukturen, Personen und Ereignisse in und außerhalb der Charité. Edited by Matthias David and Andreas D. Ebert, 238-250. Edition ed. Berlin: de Gruyter, 2010, p. 243.
[x] Cf. Strohmeier, Martin. „Der zeitgeschichtliche und politische Rahmen der türkischen Universitätsreform und die Rolle der deutschen Wissenschaftsmigranten.“ In Deutsche Wissenschaftler im türkischen Exil. Die Wissenschaftsmigration in die Türkei 1933-1945. (Istanbuler Texte und Studien, 12) Edited by Christopher Kubaseck and Günter Seufert, 67-75. Edition ed. Würzburg: Ergon, 2008, pp. 70-71.
[xi] Cf. Hillebrecht 2006: Freiheit in Ankara, p. 200.
[xii] Cf. Kröner 1988: Die Emigration deutschsprachiger Mediziner, p. 92. The picture of Eckstein’s article is taken from Dogramaci, Burcu. Fotografieren und Forschen. Wissenschaftliche Expeditionen mit der Kamera im türkischen Exil nach 1933. Marburg: Jonas Verlag, 2013, p. 129.
[xiii] Cf. Widmann, Horst. Exil und Bildungshilfe. Die deutschsprachige akademische Emigration in die Türkei nach 1933; mit einer Bio-Bibliographie der emigrierten Hochschullehrer im Anhang. Frankfurt am Main: Lang, 1973, pp. 168-171.
[xiv] Cf. Bozay 2001: Exil Türkei, p. 105.
[xv] Cf. Interview with Dr Pala, 10 Jun 2010. His mother’s name is anonymized, like all interviewees.
[xvi] Cf. Benedict, Peter et al. “Introduction (Part Three).” In Turkey. Geographic and Social Perspectives. (Social, Economic and Political Studies of the Middle East, 9) Edited by Peter Benedict et al., 237-240. Edition ed. Leiden: Brill, 1974, pp. 238-239.
[xvii] Interview with Dr Levent, 5 Dec 2007.
[xviii] Interview with Dr.T Schmidt, 22 Jun 2011. Dr.T means, that she received her doctorate of medicine in Turkey.
[xix] Cf. Lindner, Ulrike. Gesundheitspolitik in der Nachkriegszeit. Großbritannien und die Bundesrepublik Deutschland im Vergleich. (Veröffentlichungen des Deutschen Historischen Instituts London, 57) München: Oldenbourg, 2004, p. 109.
[xx] Interview with Dr Bilgen, 2 Apr 2008.
[xxi] Cf. Interview with Prof Dr Erol Düren, 20 Jul 2011.