Turkmenistan is vulnerable to a "grave" public health crisis, thanks in large part to the totalitarian practices of President Saparmurat Niyazov's regime, according to a recently published report. Since 1991, the Turkmen government has made drastic cutbacks in the healthcare system, while discouraging the compilation and distribution of data that could help contain the spread of deadly diseases. The report says "prompt" international action could mitigate the brewing public health crisis.
Public health conditions in Turkmenistan could be described as alarming, and most signs point to the continuing decay of the quality of life in the country. According to the most recent estimates, Turkmen citizens had an average life expectancy of 62.7 years in 2002, the lowest expected lifespan in Europe and Central Asia. The typical European Union resident, by contrast, lived an average of 16 years longer than Turkmen citizens. Meanwhile, infant mortality in Turkmenistan was estimated at 16 times greater than in EU member states, with roughly 76 out of every 1,000 Turkmen babies born failing to survive for one year.
Niyazov is notorious for establishing a personality cult in Turkmenistan that has sought to seal citizens off from outside influences, drastically restricting basic rights in the process. [For background see the Eurasia Insight archive]. In building a totalitarian system, Niyazov has allowed Turkmenistan's public health infrastructure to crumble, according to the report, titled Human Rights and Health in Turkmenistan. "In recent years, the health care system has been dismantled," it stated.
In 2004, Niyazov ordered the dismissals of an estimated 15,000 healthcare workers, replacing skilled professionals in most instances with military conscripts. In February of this year, Niyazov suggested closing all hospitals outside of the capital Ashgabat. While it remains unclear whether comprehensive government action will be taken to implement Niyazov's stated preference, the Human Rights organization Amnesty International expressed concern that "presidential statements have in the past in many cases been sufficient to result in ad hoc enforcement."
Compounding the dangers for Turkmen citizens has been the government's far-reaching efforts to conceal health statistics from the public, the report said. Turkmenistan's Ministry of Health and Medical Industry in 2004 reportedly issued secret instructions prohibiting healthcare workers from publicly discussing infectious diseases, including tuberculosis, measles and hepatitis. "The potentially devastating consequences of secrecy and denial in Turkmenistan were illustrated in the summer of 2004, when several sources reported a concealed outbreak of the plague," the report's policy brief said.
The report was published in April by the European Center on Health and Societies in Transition and the London School of Hygiene and Tropical Medicine. Financial support for the report was provided by the Network Public Health Programs of the Open Society Institute in New York. The report is an attempt to provide a comprehensive look at public health conditions in Turkmenistan, a state in which "almost total censorship" exists.
Given the drastic decline of the quality of health care, combined with the government's penchant for secrecy, the potential for a catastrophic epidemic in Turkmenistan is high, the report suggests. Drug use in the country is widespread and rising, according to international estimates. For example, the United Nations Office on Drugs and Crime estimated that the use of opiates experienced a 17-fold increase in Turkmenistan from 1991-2002. The agency added that approximately 1 percent of the country's inhabitants could be considered regular users of injected, or hard drugs. Such drug-use patterns have been associated with the rapid spread of HIV/AIDS, although the Turkmen government insists that there of almost no cases of the deadly disease in the country.
"Drug use, in particular heroin, has become very common, with some observers suggesting that the government is either complicit in the trafficking of drugs, or turning a blind eye to the drug crisis," the report stated. "In the wake of this increased drug use, sex work and suicides are reported to have risen markedly." An estimated 70 percent of "young sex workers" in Ashgabat are reportedly heroin addicts, a sign that HIV/AIDS could experience explosive growth in Turkmenistan in the coming years.
The report characterized the international response to Turkmenistan's public health crisis as inadequate, in large part because of Turkmen government resistance. But the reluctance of Western governments to challenge Niyazov also appears to be a significant factor. "The rich gas and oil reserves of Turkmenistan, combined with its strategic geographical position [bordering Afghanistan and Iran] ... have so far worked as impediments to international pressure for improving the country's human rights record," the report said.
The report called on the Turkmen government to take immediate steps to establish a comprehensive framework for the provision of health care in the country, taking concurrent action to reverse the damage already done to the health-care infrastructure and to make a firm commitment to report vital statistics in a public and timely fashion.
Containing a potentially disastrous public health crisis in Turkmenistan would also require the international community to make "more profound interventions," the report stated. Among the recommendations for the international community, the report urged that:
The United Nations establish a special rapporteur for human rights issues in Turkmenistan.
The European Union review its assistance to Turkmenistan provided under the TACIS program, "in view of the human rights and public health situations in the country."
The United States should designate Turkmenistan as a country of "particular concern," unless Ashgabat achieves "measurable, sustained improvements in compliance with religious freedom guarantees."
All international "actors and donors" should agree on "health and human rights benchmarks" that could be used in determining "the provision of external assistance" to Turkmenistan.
"Under the current dictatorship, the prospects for the health of the people in Turkmenistan are bleak," the report said. "An improvement will require recognition of the scale of the current health crisis, both domestically and internationally."
"Ultimately, however, sustained improvements hinge on the democratization of the country," the report added. "It will take many years to overcome the disastrous legacy of the current regime."