Since the beginning of October, 235 cases have been officially confirmed, medical authorities report. An additional 530 hospitalized patients are suspected of having the disease, and the number of unofficial cases is thought to be several times greater. According to Professor Khamdam Rafiev, chief of epidemiology at the State Medical University, the city's hospitals are full. The Asia-Plus news agency reported October 24 that one person has died as a result of typhoid.
The outbreak comes just weeks after Tajikistan's President Emomali Rahmonov hosted an international forum in connection with the United Nations Year of Freshwater. During the forum, the Tajik President called for improved management of regional water resources. [For additional information see the Eurasia Insight archive].
The government's delay in publicly declaring a health crisis has fueled frustration among international aid workers. "We told the authorities several days ago that they needed to notify the public, but it fell on deaf ears," said Tess Dobek, a consultant with MVV, a private German concern contracted by the city to operate and improve its water utility under a World Bank project.
Children and the poor are especially vulnerable to typhoid, which can be fatal if not properly treated. According to Professor Rafiev, children make up half of the reported cases in Dushanbe so far. Experts believe the typhoid crisis started in mid-September, when source water from the Varzob River, which supplies half of the city's population, was not treated with chlorine before it entered the municipal system. During the same period, flash floods swept communal waste into the river. Dushanbe's crumbling infrastructure significantly raises the risk of epidemics, such as the recent typhoid outbreak, according to Rafiev. "The quality of the water is so low that it cannot be used for drinking or bathing, but the population has no choice," he said.
"There is actually no filtration of the water taking place," added Djahon Ziyaev, who chairs a special commission under the auspices of the Ministry of Nature Protection that is investigating the typhoid outbreak. Another problem, according to a number of sources, is that the city's current method of disinfecting the water is ineffective
According to Bakhrom Mamaladiev, chairman of the city's Committee on Environmental Protection, officials have found that the bacteria level in Dushanbe's drinking water far exceeds safe limits. To make matters worse, Dushanbe's per capita water consumption is believed to be almost 10 times higher than Western European averages. This forces the city to waste precious resources trying to purify an excessively large quantity of water.
Fixing existing problems will not be easy, experts say. A complicating factor is that the city's water system is interconnected, so that clean water from groundwater sources is mixed together with contaminated water. A $17 million World Bank project is designed to help untangle and update Dushanbe's drinking water supply network. Roughly $70 million will be needed to fully improve the system, authorities say.
Dushanbe has been frequently hit by epidemics in recent years. A typhoid outbreak in 2002, for instance, reportedly left three people dead and made over 500 ill. [For background see the Eurasia Insight archive]. A major outbreak in 1997 sickened 8,901 and claimed 95 lives over a six-month period. Despite these outbreaks and an ongoing pattern of illness, progress in addressing the issue is slow. "The authorities are very much unprepared," says MVV's Dobek. "There is no emergency response plan and no medication."
John Bennett is an independent consultant and freelance journalist specializing in environmental affairs.