Since the start of the conflict in Syria in 2011, Turkey has granted temporary protection status to over 3.6 million Syrian refugees. The legal status provides access to basic social rights, including free access to state healthcare. Despite this right to state care, Syrian-run healthcare providers have emerged, persisted, and formalized in urban centers over time. Why do refugee-run providers persist even as the state expands free Arabic-language healthcare services for refugees? Drawing on interviews with Syrian doctors, clinic managers, and patients, this paper explains how and why Syrian refugee-run healthcare providers continued to operate, first as humanitarian organizations and later, in some cases, as private clinics. It finds that Syrian patients that perceive state services as inadequate or hostile to migrants continue to seek out alternative providers. At the same time, many Syrian doctors eschew what they see as low pay, low dignity employment in state Migrant Health Centers and instead undertake lengthy equivalency processes to work as private providers. Finally, informal organizations that emerged to meet Syrian refugees’ healthcare demands formalize over time by privatizing, subsequently marketing their services to a broader swath of patients. These patients include a variety of migrant groups as well as medical tourists from around the world seeking low-cost care. Providers that once targeted the most vulnerable refugees gradually start serving a broader but wealthier patient base. I argue that as precarious migrant organizations institutionalize, they increasingly serve professional interests. This exacerbates inequality in access to care among local refugees while integrating professional classes into transnational economic exchange that bolsters the host state economy.