The study, published in the journal Environmental Geochemistry and Health, was led by Serdar Çetinkaya and colleagues at the University of Health Sciences in Ankara, with additional participation from Lokman Hekim University. The team sampled municipal drinking water from all 11 districts of Kahramanmaraş Province at two time points: roughly 18 months after the earthquakes, in August 2024, and again at roughly 24 months, in February 2025. This two-timepoint design allowed the researchers to look not just at a single snapshot of contamination but at whether post-earthquake exposure patterns were persisting, shifting, or resolving over time.

The analytical backbone of the study was inductively coupled plasma mass spectrometry, or ICP-MS, a technique capable of detecting trace elements at concentrations down to parts per trillion. Water samples were analyzed in triplicate, and the team validated their measurements with matrix spike-recovery experiments, the raw data for which are included in the paper’s supplementary materials. The target analytes included the classic toxic metal(loid)s of environmental health concern: arsenic, lead, cadmium, chromium, and several others that can leach into groundwater from natural mineral deposits or from damaged and disturbed infrastructure.

The headline result is, on its face, reassuring. Every measured concentration of every trace element remained below the guideline values set by the World Health Organization and by Türkiye’s national drinking-water regulation, TS 266. When the researchers compressed their multi-element dataset into a Water Quality Index, a composite score that summarizes overall water quality on a scale where lower is better, the values ranged from just 3.1 to 13.4, well within the range considered excellent for drinking purposes. By conventional single-element standards, the tap water of Kahramanmaraş passed the test.

But the story becomes considerably more complicated when the team moved from individual contaminants to cumulative risk. Using both deterministic calculations and probabilistic Monte Carlo simulations, a statistical technique that runs thousands of hypothetical exposure scenarios by varying input parameters such as water consumption rates, body weight, and contaminant concentrations, the researchers estimated the aggregate non-carcinogenic and carcinogenic hazards facing adults and children in each district. The results revealed substantial spatial heterogeneity across the province, and they singled out one group as consistently the most vulnerable: children.

In up to four districts per sampling campaign, the cumulative hazard index for children exceeded the safety threshold of 1, the point at which estimated non-carcinogenic exposure crosses the level regulators consider acceptable. Arsenic was by far the largest contributor, accounting for approximately 76 percent of the total cumulative non-carcinogenic risk. This finding matters because arsenic is a well-established human carcinogen with a long list of additional toxic effects, and because children consume more water per unit of body weight than adults, amplifying their dose from any given concentration.

The carcinogenic risk calculations produced an even more striking pattern. Deterministic estimates of lifetime cancer risk exceeded the benchmark of 1 in 10,000, a widely used screening threshold, in 21 of the 44 district-period-population combinations analyzed. The exceedances clustered consistently in three districts: Afşin, Türkoğlu, and Elbistan. Notably, Afşin and Elbistan sit atop the Afşin-Elbistan lignite coal basin, a region whose coals are known from earlier geological studies to be enriched in trace elements, providing a plausible geological context for arsenic-rich groundwater in those areas.

Here the study delivers one of its most important and most easily misread findings. The apparent carcinogenic risk exceedances do not reflect a deterioration in the actual arsenic concentrations measured in the water, all of which remained below the WHO and Turkish guideline value of 10 micrograms per liter. Instead, they are driven largely by a regulatory change: in January 2025, the US Environmental Protection Agency’s Integrated Risk Information System, or IRIS, adopted a substantially higher oral cancer slope factor for inorganic arsenic, raising it from 1.5 to 32 per milligram per kilogram per day. That more-than-twentyfold increase in the toxicity parameter means that the same measured concentrations now translate into far higher estimated cancer risks than they would have under the old factor. The exceedances, in other words, are a product of updated toxicology meeting persistent low-level contamination, not of worsening water quality.

The Monte Carlo simulations, which account for uncertainty and variability in exposure parameters, identified the same three districts as recurring screening-level hotspots, lending statistical robustness to the spatial pattern. The authors are careful, however, about what their data can and cannot prove. Because the study lacks a pre-earthquake baseline and a comparable control area outside the earthquake zone, direct causal attribution to the seismic event is not possible. The findings are consistent with the hypothesis that major earthquakes can reshape drinking-water exposure patterns long after the immediate disaster period, a phenomenon documented in other seismic settings, including the 2016 Kumamoto earthquake in Japan and the Amatrice-Norcia sequence in central Italy, where hydrogeochemical changes in groundwater have been observed before and after major quakes. But consistency is not proof.

What the study does establish is methodological and practical. It is the first province-wide assessment of post-earthquake drinking-water quality and health risk following the 2023 Türkiye earthquakes, and it demonstrates why single-contaminant, single-timepoint compliance testing is insufficient in post-disaster settings. A water supply can meet every individual regulatory limit and still produce cumulative hazard indices above 1 for the most sensitive populations when multiple trace elements are considered together over years of consumption. The authors argue that post-disaster water management should incorporate cumulative, probabilistic, and long-term monitoring, with particular attention to districts like Afşin, Türkoğlu, and Elbistan where arsenic-driven risk persists. For the residents of Kahramanmaraş, the message is nuanced: their water is, by every conventional measure, safe to drink. Yet the invisible arithmetic of chronic, low-dose exposure, weighted by the newest and most conservative toxicological assessments, suggests that the true health legacy of the 2023 earthquakes may still be unfolding, quietly, one glass of water at a time.

Subject of Research: Post-earthquake drinking-water quality and health risk assessment in Kahramanmaraş Province, Türkiye

Article Title: Post-earthquake monitoring of drinking-water quality and health risk in Kahramanmaraş Province, Türkiye: a two-timepoint screening assessment

Article References: Çetinkaya, S., Aydin, H., Çetin, M., Macit, E., & Erdem, O. (2026). Post-earthquake monitoring of drinking-water quality and health risk in Kahramanmaraş Province, Türkiye: a two-timepoint screening assessment. Environmental Geochemistry and Health, 48(15), Article 621. https://doi.org/10.1007/s10653-026-03517-w

Image Credits: AI Generated

DOI: 10.1007/s10653-026-03517-w

Keywords: drinking water, arsenic, earthquake, Kahramanmaraş, health risk assessment, ICP-MS, Monte Carlo simulation, water quality index, trace elements, Türkiye, Environmental Geochemistry and Health, post-disaster monitoring

The research, conducted by Ayşenur Gündüz of Erciyes University, Dicle Gözüm of the Turkish Ministry of National Education, and Sümeyye Öcal of Kütahya Dumlupınar University, focused on the experiences of the people who actually ran these spaces: volunteer play facilitators. Children affected by large-scale disasters face elevated risks of psychosocial distress and developmental disruption, and child-friendly spaces have become a standard component of humanitarian response worldwide. Yet, as the authors note, rigorous qualitative evidence about how such interventions are implemented in practice, and how they are perceived by those delivering them, has remained strikingly limited. Their study set out to fill that gap by listening closely to the facilitators themselves.

The methodological design was deliberately grounded and practical. Using a qualitative descriptive approach, the researchers selected ten voluntary play facilitators through purposive sampling from a larger pool of sixty-five facilitators who worked in seventeen child-friendly playrooms set up in temporary accommodation centers in Kayseri province. Data were collected through semi-structured online interviews, allowing participants to describe their experiences in their own words, and the resulting material was analyzed using content analysis, a technique that systematically codes textual data to identify recurring themes and patterns. Ethical approval was obtained from the Erciyes University Social and Human Sciences Ethics Committee, and all participants were adults who provided written informed consent before taking part, in line with the Declaration of Helsinki.

The findings paint a vivid picture of what these playrooms actually did for the children who used them. Facilitators consistently perceived the playrooms as safe environments that supported children’s wellbeing, development, peer interaction, and—perhaps most importantly—their return to daily routines. In disaster psychology, the restoration of routine is considered a cornerstone of recovery: predictable structure helps children regain a sense of control and normalcy after the chaos of a catastrophic event. The playrooms provided exactly that, offering scheduled, familiar activities in a protected setting where children could simply be children again, rather than displaced survivors of a disaster.

Equally striking was the level of engagement the spaces generated. Participants highlighted the high degree of involvement not only from children but also from their parents, suggesting that the playrooms functioned as more than childcare. By giving children a structured, supportive environment, the spaces indirectly relieved pressure on caregivers who were themselves coping with loss, displacement, and the logistical burdens of life in temporary accommodation. The authors conclude that volunteer play facilitators perceived the playrooms as valuable settings for supporting children directly and families indirectly—a dual benefit that multiplies the impact of a relatively low-cost intervention.

The study also scrutinized the preparation of the volunteers themselves, and here the picture was more nuanced. Facilitators judged their training to become play facilitators as sufficient in general terms, but they advised that future preparation should go deeper in three specific areas: child mental health, psychological first aid, and play interventions. This recommendation carries real technical weight. Psychological first aid is an internationally recognized early intervention approach designed to reduce initial distress and foster adaptive coping, while targeted play interventions can help children process traumatic experiences nonverbally. Volunteers without formal grounding in these areas may struggle to recognize signs of post-traumatic stress or to respond appropriately when a child’s play reveals deep distress, making training a critical quality-control point for any future deployment.

Implementation, the facilitators reported, was far from frictionless. The study documented several practical difficulties clustered around four domains: the physical setting, materials, administration, and the voluntary delivery of services. Makeshift spaces in temporary accommodation centers inevitably pose challenges—heating, lighting, noise, safety, and privacy are hard to guarantee in emergency structures. Supplies of age-appropriate play materials could be inconsistent, and coordination among the various institutions involved added administrative complexity. The reliance on volunteers, while essential to scaling the response, also raised questions about continuity, burnout, and the sustainability of a service delivered by people without professional status or long-term commitments.

From these experiences, the participants constructed a clear vision of the ideal playroom: a space that is safe, accessible, aesthetically conducive, and developmentally appropriate, and that is equipped with suitable play materials. Each element of that definition maps onto established principles of child-centered design in early childhood education. Safety and accessibility address physical protection and inclusion; aesthetic quality signals care and normalcy to children in destabilized circumstances; developmental appropriateness ensures that activities match children’s cognitive, social, and emotional stages rather than merely keeping them occupied. The finding underscores that in disaster settings, the details of environment design are not cosmetic—they are therapeutic.

The Kayseri case also illuminates the institutional architecture behind the response. The playrooms operated within a network that included the Turkish Ministry of Youth and Sports, the Ministry of National Education, Guidance and Research Centers, and structures aligned with the international Child Protection Working Group, the coordinating body for child protection in humanitarian emergencies. The authors emphasize that inter-institutional collaboration, alongside appropriate physical environments and trained facilitators, is essential for the successful implementation of child-friendly playrooms. In other words, a playroom is not just a room with toys; it is the visible endpoint of a supply chain, a training pipeline, and a coordination framework that must all function together under emergency conditions.

The broader significance of the study lies in its contribution to a thin evidence base. Post-disaster psychosocial interventions for children are widely deployed, but implementation research—especially qualitative work capturing the perspectives of frontline deliverers—remains scarce. By documenting what facilitators experienced in Kayseri, the researchers have produced findings that can inform future disaster preparedness and child protection practices, both in Türkiye, which sits in one of the world’s most seismically active regions, and internationally. The lessons are deceptively simple: invest in volunteer training that includes child mental health and psychological first aid; plan physical spaces with children’s developmental needs in mind; secure materials and administration before the next crisis rather than during it; and treat play not as a diversion but as a legitimate, evidence-informed component of disaster response. For the children of the Kahramanmaraş earthquakes, a room with blocks and a trusted adult may have been one of the most effective therapies available—and for the next disaster, the study offers a blueprint for making sure that therapy is delivered well.

Subject of Research: Child-friendly playrooms as post-earthquake psychosocial support for children following the 2023 Kahramanmaraş earthquakes in Türkiye

Article Title: Playrooms as a post-earthquake psychosocial support service: case of Kayseri province

Article References: Gündüz, A., Gözüm, D., & Öcal, S. (2026). Playrooms as a post-earthquake psychosocial support service: case of Kayseri province. BMC Psychology. https://doi.org/10.1186/s40359-026-05719-4

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05719-4

Keywords: child-friendly spaces, playrooms, psychosocial support, disaster response, earthquake, Kahramanmaraş, Kayseri, children's mental health, psychological first aid, play facilitators, qualitative research, Türkiye