Ethnography under Authoritarianism: Notes from Medical Anthropological Fieldwork

What is perceived today as “living in an unknown moment” with global pandemics and ecological disasters has long become the “new normal” that structures everyday life at the margins of Europe and the Middle East, particularly in places with rising authoritarian regimes. As scholars working in and on Turkey, for instance, we have witnessed or experienced firsthand several moments of crisis over the recent years. We have seen the collapse of peace negotiations between the Turkish state and the Kurdistan Worker's Party (Partiya Karkeren Kurdistane; PKK) in 2015 and the resulting surge in state violence in Turkey's Kurdistan, the 2016 coup attempt against the Justice and Development Party (Adalet ve Kalkınma Partisi; AKP) government by the Gülen movement, and the long-standing suppression, criminalization, and incarceration of dissent affecting, among others, students, politicians, journalists, and academics.¹ These divergent yet interlinked moments of crisis have reshaped and often complicated, if not completely stopped, our research as ethnographers of Turkey. These moments of crisis have also pushed us to develop creative strategies and analytics to continue our fieldwork and provided opportunities to hone our research questions and methodologies in more nuanced ways.

These strategies have included building solidarity and intentional collaborations with our colleagues and interlocutors, relocating fieldwork to the diaspora or online venues, and dividing long-term fieldwork into short-term, consecutive, or cyclical field visits, similar to what has recently been conceptualized as patchwork ethnography.² The multiple temporalities of disruptions have proved once and again that ethnographic resilience is essential for researchers, especially in prolonged moments of crisis. On the other hand, the discourse of resilience often puts the burden on individuals, particularly those already marginalized and precarious, rather than on institutions of power, such as departments, universities, professional associations, and funding agencies. The resilience discourse individualizes the dynamics of flexibility and adaptation by leaving larger structures that make resilience possible or impossible unaddressed.³ In most cases, however, resilience becomes possible through material and other forms of support provided to researchers by external structures and processes.

How can we respond to changing conditions at our field sites as ethnographers amid rising authoritarianism and in moments of (ethnographic) crisis? How can we draw on the experience of scholars working in and on Turkey to inform our future research practices better? What are the broader structural conditions that make flexibility and adaptation, thereby ethnographic resilience, possible for researchers? Drawing on my dissertation research regarding medical institutions in Turkey between 2014 and 2017, I reflect on these questions in this article and discuss how ethnographic disruptions push researchers to develop creative strategies and open new analytic possibilities rather than hindering research processes. Drawing on feminist scholarship, I argue for approaching these disruptions not “as . . . problem[s] to overcome” but as “constitutive element[s] of the answers [we are] looking for” as researchers.⁴

My dissertation focused on the sociopolitical implications of reproductive surveillance in Turkey through a case study of a controversial public health surveillance tool known as GEBLIZ (Gebe, Bebek, Lohusa İzlem Sistemi; Pregnancy, Newborn, and Postnatal Monitoring System). I conducted preliminary research in 2014 in state-run health clinics to observe who was monitored, by whom, how, and to what end in the midst of selective state pronatalism. One of the striking findings of this research was that the implementation of GEBLIZ pushed nurses, largely low-ranked, feminized healthcare professionals, into becoming the technicians behind the system's massive data collection. Although nurses felt increasingly estranged from their profession, they nonetheless used GEBLIZ, mostly to collect information on urban poor mothers and Kurdish women due to class-based and ethno-racialized (and racist) discourses of reproductive othering. By contrast, middle-class Turkish women who could afford private health care were often allowed to choose with whom and under what conditions they shared their personal information.⁵ In 2016, I planned to continue this research and include hospitals in my design for the second leg of my fieldwork.

When I was ready to embark on fieldwork in May of 2016, the country had already begun a downward spiral following the last national parliamentary elections in June and November 2015, respectively. In the aftermath of those elections, political violence in the Kurdish regions had gradually increased, and suicide bomb attacks by ISIS had claimed many lives in different parts of the country. By the summer of 2016, governmental repression, fear, and uncertainty accelerated remarkably with the coup attempt on June 15 and the consequent declaration of the state of emergency (olağanüstü hal). This state of emergency suddenly turned the already existing witch hunt for leftist activists into a vast political crackdown on dissident civilians, politicians, and journalists across the country. Hundreds were put in jail, and thousands of others were dismissed from their duties and banned from leaving the country. Political divides and distrust among different sections of society grew deeper.

Given the political situation, I was unsure whether I could start my fieldwork as planned, because receiving research permission and gaining access to state-run hospitals seemed impossible under such circumstances. I also was among the Academics for Peace who had signed a petition condemning the Turkish state violence in the Kurdish regions and asked for the resumption of peace negotiations, which later led to a severe backlash from President Recep Tayyip Erdoğan and resulted in the persecution of academics and dismissal from university positions.⁶ Of course, I was in a relatively privileged position as a Turkish person and someone affiliated with a North American institution. However, I witnessed friends, colleagues, and former professors in Turkey getting fired, put into jail, or leaving their jobs, field sites, and families under exile conditions.

Right before I was about to embark on an investigation of reproductive surveillance and GEBLIZ, alongside some other signatories of the Academics for Peace petition, I was put under scrutiny and found myself under state surveillance. The group lawyers notified us that our names were on a list prepared by the Turkish police and prosecutors in Ankara, and we would be called to testify as part of a criminal investigation, being accused of “propaganda for a terrorist organization.” Around the same time, I also was receiving notifications constantly from a website I signed up for, which indicated that my name was being Googled in Ankara by several different people. I was unsure if this was a coincidence, but I thought it was to collect information about the signatories of the Academics for Peace petition for the pending investigation. I consulted with the lawyers to get advice on possible scenarios if I decided to continue with my research and brainstormed with friends and colleagues about strategies to protect myself, such as closing my social media accounts and not booking late flights because landing after business hours would make it hard to reach the lawyers and ask for help.

Authoritarianism thrives on fear. In the aftermath of the recent political developments in Turkey, the constant threat of persecution and the growing uncertainty have created a climate of fear for many members of the society, including students, faculty, and other public officials.⁷ One of the common narratives I heard during my fieldwork about GEBLIZ pointed to a similar atmosphere of fear regarding medical institutions. People were not sure whether they were monitored, how, or by whom, creating fear and anxiety, especially among young, single women, who were often afraid of using publicly funded sexual and reproductive health services, especially abortion related services, due to the ongoing stigma and criminalization surrounding the procedure. Although abortion is technically legal for up to ten weeks of pregnancy in Turkey, women fear that their medical histories, without their consent, may be recorded and shared with third parties under the auspices of GEBLIZ, which might negatively affect their safety.

The news of a pending criminal investigation and the uncertainty of who would be part of it and under what conditions had a similar effect. Anxiety and fear affected us as researchers who were planning to embark on fieldwork in Turkey but had to reconsider and recalibrate plans for different reasons. While considering my options, I received a great deal of support from my graduate department and external funding agency. From the start, they both assured me that they would support my decision and extend my funding if I decided to postpone my research. These institutional supports alleviated at least some of the anxiety as they gave me more flexibility in my research plan and design. After careful consideration, I decided to travel to Turkey and begin my fieldwork in October 2016 rather than wait for an uncertain and perhaps never-arriving change in the political climate. Under the shadows of a pending criminal investigation, I started research—but then other disruptions intervened.

In 2014, during preliminary fieldwork, I was able to secure a research permit from the administrative committee under the Istanbul Provincial Directorate of Health (İstanbul İl Sağlık Müdürlüğü) to conduct participant observation and interviews in state-run health clinics in Istanbul. In 2016, the first place I visited when I started my fieldwork was a well-known, state-run maternal and child health hospital in Istanbul, because I was planning to include hospitals in my research in addition to health clinics. Without any prior connections, I visited the hospital to contact the person responsible for the ethical clearance for outside researchers, whose name and room number I found among the scattered information on the hospital website. I entered the room with “ethics committee” (etik kurulu) written in big letters on its door. A male officer was sitting at one of the desks, and the other desk was empty. I approached his desk and asked the officer in my friendliest voice, “Are you Cemal Bey?” He paused momentarily and said, “He is not here anymore. I am taking care of the applications now instead of him.” I told him I wanted to apply for a research permit but could not reach their office by phone or email to get information. There was not enough information on the website, and I had seen Cemal Bey's name there.

The man was hesitant to talk with me at first; it seemed he did not want to give too much information or did not know what to say. He asked whether I was a doctor or a nurse and what kind of research I would do. After learning that I was a graduate student in anthropology studying in the United States, he said that the application must be made together with a specialist from the hospital and that external researchers were not accepted. I asked if this was a rule specific to hospitals, because another health care institution had previously granted me a permit to conduct research as an external researcher. He said yes and told me that if I found someone from the hospital to collaborate in my research, my application would be considered. He passed through the other door in the room and went into the inner room, then brought a file from inside and sat down again. While opening the file, he said that the ethics committee had not been able to meet for a while. Before July 15, the committee would meet twice a week, but then the meetings were disrupted, and they had not met for a while. He continued that if I could find another institution at which to conduct my research, it would be better for me. He added that the applications submitted to the hospital's ethics committee would not be returned for about five or six months. As we talked, there was a quiet tension in the air; he seemed cautious about giving information, and I was uneasy and did not want to ask too many questions. I asked if he could send the forms to my email address; he took my address and said that someone else also came in the morning and that he would email both of us.

I never received that email. This was the first of many similar encounters during my research with state-run hospitals. From there on, unanswered or promised-but-never-sent emails and never-answered or never-returned phone calls from state officials became the new routine of my fieldwork.

I was able to access the very same hospital through other means later, however. With the help of a nurse-midwife working there, who was generous enough to respond to my cold email inquiring about access without any previous contact, I conducted participant observation and interviews in birthing classes, known as Pregnancy Schools (Gebe Okulları), organized for expecting parents, particularly for pregnant women. With the contacts I made there, I received access to other medical settings to conduct further research. However, I also encountered different types of ethnographic disruptions in those places. During one of the birthing classes, I met with a nurse-midwife working at another major training and research hospital. She mentioned that I could talk with healthcare providers working at the family planning clinic at their hospital, but the clinic had closed two years ago. Apparently, while the Eurasia Tunnel was being built, cracks appeared in the hospital building. Later, due to the construction of the parking lot next door, the cracks got bigger, and some parts of the hospital, where the family planning clinic was, became unusable. I asked her if those parts of the hospital were repaired later. She said yes and added, “Some clinics were relocated or reopened later, but the family planning clinic was never reopened. We still provide some of the family planning services such as intrauterine devices and tubal ligations, but abortion services are halted indeterminately.”

Getting access to official clinical settings has always been challenging for medical anthropologists in Turkey as elsewhere. Picking sensitive research topics such as family planning and abortion or not having powerful allies in these settings to overcome the hurdle of “political patronage” were among some of the reasons for this challenge.⁸ The broader political developments of recent years, particularly the increasing government surveillance over public officials and offices, deepened this challenge and made it even more difficult to access public medical institutions as an ethnographer. However, the roadblocks we face during our encounters with these institutions can also provide important insights into the workings of the “state.”⁹

For instance, the closure of the ethics committee after the attempted coup on 15 July 2016 gave the state the perfect excuse to deny access to outside researchers and control the narrative about state institutions and services for local and global public audiences. In the aftermath of the coup attempt, the government had already suspended all research permits for an unforeseeable time and announced new regulations for permission procedures to strictly control research processes. But not even having an ethics committee to apply to in the first place and not knowing when the committee would start operating again created an extra step of difficulty and uncertainty for my research, and ultimately, I had to change my research location. Similarly, the construction issues in the hospital mentioned above became an excuse for the government to close the family planning clinic and restrict an important reproductive healthcare service, abortion, without making any legislative changes. Although abortion is still legal in Turkey, it is technically inaccessible for reasons such as the dismantling of otherwise functional clinics and doctors afraid of being criminalized by the Ministry of Health if they performed abortions. All these examples show that the state implements alternative techniques to govern individuals and populations, even if making direct changes to control them and their behaviors becomes impossible at times.

When I returned to the United States in 2018 after my fieldwork, people celebrated me as being resilient for carrying out and completing fieldwork under such dire conditions. After all, according to them, I successfully navigated uncertainties in the political climate, a pending criminal investigation, and challenges in accessing field sites. It was true; I had to develop a certain kind of ethnographic flexibility and learn to let go of certain parts of my fieldwork. But I was able to do that for two main reasons: one, the legal and emotional support that I received from the solidarity networks created among the Academics for Peace and their allies in Turkey and abroad, and second, the encouragement from my graduate program and funding agency, who both assured me that they would support me financially and in other ways if I decided to postpone my fieldwork or prolong my graduate studies.

Ethnographic resilience is essential for researchers to overcome adversities, especially in extended moments of crisis. However, the discourse of resilience often puts the responsibility and burden on individuals, particularly those already marginalized and precarious, rather than on institutions of power. Being flexible and adaptable, on the other hand, is predicated on broader conditions, such as how many material or other types of support structures one has access to, rather than individual circumstances.¹⁰ It is crucial to make visible and learn from different forms of individual resilience. But it is more critical to hold accountable our disciplines and institutions so that they create the conditions that make individual resilience possible, rather than, for instance, imposing traditional forms of fieldwork, linear and restrictive timelines of degree completion and funding, or competitive academic structures. In the face of rising authoritarianism and ongoing ethnographic disruptions, disciplinary and institutional support for ethnographers working in contentious political contexts, particularly those who are underrepresented, is more critical than ever. Only with the help of these support structures can we mitigate current and future ethnographic disruptions.