DW is a member of the UK Department of Health Critical Care Contingency Planning Working Group. The other authors declare that they have no competing interests. Avian influenza outbreak in Turkey through health personnel's views: a qualitative study BACKGROUND: Avian influenza threatens public health worldwide because it is usually associated with severe illness and, consequently, a higher risk of death. During the first months of 2006, Turkey experienced its first human avian influenza epidemic. A total of 21 human cases were identified, 12 of which were confirmed by the National Institute for Medical Research. Nine of the cases, including the four fatal ones, were from the Dogubeyazit-Van region. This study aims to evaluate the efforts at the avian influenza outbreak control in the Van-Dogubeyazit region in 2006 through the experiences of health personnel. METHODS: We conducted in-depth interviews with seventeen key informants who took active roles during the avian influenza outbreak in East Turkey during the first months of 2006. We gathered information about the initial responses, the progress and management of the outbreak control, and the reactions of the health professionals and the public. The findings of the study are reported according to the topics that appeared through thematic analysis of the interview transcripts. RESULTS: Following the first suspected avian influenza cases, a Van Crisis Coordination Committee was formed as the coordinating and decision-making body and played an important role in the appropriate timing of decisions. The health and agriculture services could not be well coordinated owing to the lack of integrated planning in preparation for outbreak and of integrated surveillance programs. Traditional poultry practice together with the low socio-economic status of the people and the lack of health care access in the region seemed to be a major risk for animal to animal and animal to human transmission. The strengths and weaknesses of the present health system – primary health care services, national surveillance and notification systems, human resource and management – affected the inter organizational coordination during the outbreak. Open communication between the government and the public played an important part in overcoming difficulties. CONCLUSION: Although there were problems during the avian influenza outbreak in Turkey, the rapid responses of the central and regional health authorities and the performance of the health workers were the key points in controlling the epidemic. The lessons from this outbreak should provide an opportunity for integrating the preparation plans of the health and agricultural organizations, and for revising the surveillance system and enhancing the role of the primary health care services in controlling epidemic disease. Developing successful strategies based on knowledge and experience may play a valuable role in delaying an avian influenza pandemic. The highly pathogenic Avian Influenza A (H5N1) virus has caused more than ten outbreaks worldwide and many related human fatalities have occurred since 1997. A total of 258 laboratory-confirmed cases have been reported in South East Asia, North Africa and Europe by the World Health Organization (WHO) and 154 people with confirmed avian influenza died between 2003 and 2006 [1,2] . Most patients have similar features; they are children, they have a history of close contact with poultry or wild birds, and they live in some of the poorest areas of the world. The human cases in Turkey and Azerbaijan were the first confirmed reports of human avian influenza infection outside Asia and Africa. This was alarming not only for Turkey but also for the European Union and other countries. After considering the epidemiological and laboratory evidence, WHO has maintained its pandemic alert at Phase 3 (of 6), indicating that the new influenza strain causes human infections with no or very limited human to human transmission [3] .