Earthquake death tolls are a basic statistical measure of the capability of a country to manage seismic risk. The extremely high Turkish death toll of 50,000 from the Kahramanmaraş earthquake doublet of 6 February 2023 is the product of a cascade of detrimental factors. These need to be explained if lessons from this disaster are to be learned. This is the purpose and objective of this paper, which is a contribution to the interdisciplinary Frontiers research topic on integrated perspectives on the 2023 Turkey and Syria earthquakes: advancing understanding and preparedness across earth sciences, engineering and public health. This paper covers these three disciplines by focusing on casualties, and identifying crucial aspects of earth sciences and engineering which contributed to the high death toll. First, there was a surprising combination of multiple fault segment ruptures, and a high level of ground motion relative to the risk-based Turkish code, indicative of the under-representation of the M7.5+ earthquake doublet event in the national probabilistic seismic hazard model. This combination of fault segment ruptures was missing from all seismic source models. Furthermore, the capability of buildings to cope with strong ground motion was much reduced by informal construction methods, which eroded the margin of safety needed to avoid building collapse. The extent of building code non-compliance was widely underestimated in seismic risk models. Non-compliance is often hard to identify, but construction amnesties make non-compliance more transparent and trackable. The disastrous outcome of the Kahramanmaraş earthquake doublet of 6 February 2023 has drawn global attention to systemic building code non-compliance, and the open official acceptance of informal housing. To demonstrate that this key systemic risk is far from being just a Turkish problem, notably in Istanbul, the challenge of Italian informal housing is highlighted within the context of international building code non-compliance.