Overview of qualitative themes
| Major themes | Subthemes | Illustrative quotes |
| Grief reactions | Emotional reactions including intense emotional pain, guilt, emotional numbness, loneliness and despair. | ‘…municipal workers tried very hard to pull my daughter out of the rubble, but hours later they reached her dead body and said that the only way to get her out was to cut her into three pieces. There are no words to express my pain…(crying). I begged them to take her out in one piece, then the workers hugged me and cried, promised to take her out in one piece and finally gave her to me in one piece. Wishing to die, I hugged the dead body of my beautiful daughter and stayed with her for hours…’ (P8, bereaved man) |
| Cognitive reactions including emptiness, disbelief about death and dreams regarding the deceased. | ‘All I feel is a great emptiness. I’m not even sure if I’m dreaming or if I’m dead. The other day I looked at my phone book and realised that most of my loved ones were dead. Not one, not two. Most of our loved ones are no longer alive.’ (P11, bereaved woman) | |
| Behavioural reactions including alcohol use and avoidance of reminders that the person is dead. | ‘I’ve been drinking more alcohol since the earthquake. Otherwise, it is very difficult to bear this pain. Sometimes I drink until three in the morning.’ (P6, bereaved man) | |
| Physical reactions including loss of appetite and insomnia. | ‘After the earthquake, there was not a single day that I could sleep comfortably. I wake up three or four times a night. When I feel like I can’t breathe, I wake up, sit down and smoke a cigarette…’ (P1, bereaved woman) | |
| Coping with grief | Making sense of the death | ‘After all, this disaster came from God. His plans are bigger than anything I can imagine. That’s why I thank God every day.’ (P5, bereaved woman) |
| Reconstruction of meaning | ‘Life is not always a bed of roses. Sometimes there are rough roads, the important thing is to overcome the rough roads. Time heals… Time is the cure for everything. Time heals…’ (P4, bereaved woman) | |
| Disrupted grieving | Disruption to mourning rituals | ‘ …No one could wash their deceased; our water was cut off and we slept with our deceased until the authorities gave us a mass grave. In the mass grave they opened big graves, and all the dead were buried on top of each other…’ (P11, bereaved woman) |
| Unfinished business | ‘…I’m so sorry I couldn’t hug her and tell her how much I love her. I’m so sorry I couldn’t save her (crying).’ (P3, bereaved man) | |
| The loss of memories | ‘…The earthquake not only took away our houses, roads and neighbourhoods, but also our memories. This place is no longer like the city where I was born and raised.’ (P6, bereaved man) | |
| Impact of grief on chronic disease | Increased metabolism problems Increased cardiovascular problems | ‘After the earthquake, my illnesses increased, I swear, they did not decrease at all, they increased. I feel much more tired and weak after the earthquake. I had blood pressure, now it is always high. My blood sugar goes up and down.’ (P3, bereaved man) |
| Moving forward | Being strong for others | ‘I have two more children and a wife for whom I am responsible. I also have close friends and relatives. I must be stronger for them. After all, life still goes on.’ (P8, bereaved man) |
| New activities such as gardening or knitting | ‘After the earthquake, we planted rocket, garlic and lettuce with the neighbours. Gardening makes us happy. If I didn't have new hobbies, I would keep thinking about the same things in my head. This is how I try to forget.’ (P10, bereaved man) | |
| Support from others | ‘Here we cook together with the neighbours in the tents. We set a big table together and eat together. We are trying to get through these days by supporting each other.’ (P7, bereaved woman) | |
| Positive future thinking | ‘Women from Hatay (earthquake region) are strong and hardworking. We will make Hatay what it used to be. Whatever happens, we have not given up hope for the future.’ (P2, bereaved woman) | |
| Unmet needs | Basic needs | ‘…Water remains a significant issue here: it is constantly cut off, and we are unable to access clean drinking water. There is no means of transport from one place to another. It has been nine months since the earthquake, but our transport and water problem are still not solved.’ (P7, bereaved woman) |
| Bereavement support needs | ‘Our psychology is very bad, but there are not enough doctors here and there is nowhere we can get support… There are still bodies under the rubble that have not been found. So, there is a dead smell everywhere. Recently, we heard that someone whose entire family died in the earthquake attempted suicide out of grief. We are all alone here with our grief.’ (P8, bereaved man) | |
| Medical needs | ‘Hospitals and pharmacies were destroyed in the earthquake. Many people here could not access their medicine. We still don’t have a hospital. Tents were set up for the medicines sent by volunteers, and volunteer pharmacists tried to help us as much as possible.’ (P8, bereaved man) | |
| Support needs with financial | ‘Many businesses were destroyed in the earthquake. People became unemployed. The shopping centre where my children work was also destroyed. I am very worried about my children. Although ten months have passed since the earthquake, they could not find a job.’ (P11, bereaved woman) |