Residents in the Tajik Capital Confront Typhoid Outbreak

When the United Nations Office for the Coordination of Humanitarian Affairs recently announced a typhoid outbreak in Tajikistan, it was telling the world what residents of the Tajik capital already knew. At least 500 people have contracted typhoid in Dushanbe, according to media reports. Despite the severity of the outbreak, Ministry of Health officials have been slow to respond, downplaying the threat posed by typhoid.

"Typhoid is raging in the capital of Tajikistan," said a commentary published by the Asia-Plus news agency. "The facts speak for themselves, no matter how hard officials in all medical structures, from polyclinics and hospitals to top officials in the Health Ministry, have tried to conceal this information."

Following the July 19 UN announcement, the Tajik Ministry of Health forbid all public clinics and hospitals from disclosing information on how many people had contracted the viral disease. An Asia-Plus report on August 1 put the toll at 500. Three of the victims have reportedly died from the disease. Some political analysts have started to deem the spreading epidemic a larger threat to socio-political and economic stability than the possible incursion of extremist fighters from across the Uzbekistan border.

On July 25, the Russian newspaper Meditsinskaya Gazeta cited reliable sources in reporting that a typhoid epidemic was raging in Tajikistan. The article contained an implicit warning to Russians about the typhoid threat. Following publication of the article, the Ministry of Health revealed that 1,700 medical personnel were working to protect Dushanbe's population from the disease. Health officials also said the outbreak likely began in the Bokhtar district two months ago, with contaminated water the suspected cause.

Throughout the summer, rumors concerning typhoid have spread among Dushanbe residents like the disease itself, fed in large part by the government's reluctance to publicly discuss the epidemic. Ministry of Health officials have tended to decline interview requests.

On August 5, First Deputy Health Minister Asomiddin Latipov described reports of a typhoid epidemic as "exaggerated," Asia-Plus reported. Though some doctors say this information is rightly confidential, the policy of nondisclosure has raised worries among civil-liberty watchdogs. Some argue that the Law on State Secrets, which dates from 1996, requires officials to share information about health and environmental conditions. But the statute seems ambiguous. "The legal status of intelligence that does not constitute a state secret remains undetermined," the Moscow-based Center for Journalism in Extreme Situations said in a commentary.

The last major outbreak of typhoid in Tajikistan occurred in 1997, which was blamed on a lack of clean drinking water. That outbreak sickened 8,901 people and killed 95 over a six-month period, according to the Morbidity and Mortality Weekly Report. Conditions have changed little since then. Most of the city districts are short of water; and tap water often contains plenty of sediment. "Look what we have to drink," said resident Sayeeda Vohidova. "Mud flows from the taps, instead of water." Vohidova says she prohibited her three children drinking tap water, but claims she could not watch them. As a result, she says, her six-year-old Shahzod fell ill with typhoid. Vohidova claims that Shahzod was the third child in her apartment house to develop the virus in July.

Another sign that Dushanbe residents are grappling with – or at least worried about – a typhoid epidemic is found in city drug stores, where residents have bought up medicines used to treat acute intestinal diseases. Pharmacists says most buyers referred to their need to treat typhoid when they bought the medicine. Bahrom Odinayev, one Dushanbe pharmacist, told EurasiaNet that many customers come into drug stores unsure of what specific medicine they require, an indication that many are treating themselves at home, rather than following a doctor's advice.

This illustrates a dangerous epidemiological trend. Typhoid death rates run high among people who cannot afford professional healthcare. Such people have few options. Police officers are guarding the city's three hospitals that treat infectious diseases. These facilities have received medication from international agencies, including UNICEF and the World Health Organization. Those who cannot get into the hospitals depend on thrice-weekly visits from territorial medical personnel and public service announcements. Citizens who asked for anonymity say that they have heard of the city authorities banning the sale of soda and soft ice cream during the summer, on the grounds that these treats could help spread typhoid.