Public Health Crisis in Turkmenistan

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.

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.

In 2004, President Niyazov ordered the dismissals of an estimated 15,000 health care workers, replacing skilled professionals in most instances with military conscripts. In February of 2005, Niyazov suggested closing all hospitals outside of the capital Ashgabat.

In light of these facts, OSI's Public Health Program and the Turkmenistan Project gathered a group of experts to discuss the international reaction to the deteriorating public health situation in the country. Speakers included:

• Dr. Martin McKee, co-director of the European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, and co-author of the OSI-funded study "Human Rights and Health in Turkmenistan" (2005).
• Lucy Ash, presenter for BBC Radio World Current Affairs and Crossing Continents, Radio 4 s main foreign affairs documentary strand. Ash traveled to Turkmenistan in 2005 and produced rare field-based coverage of health concerns there.

Summary

Turkmenistan's health care system is in a ruinous state, in which "the oath of allegiance [to President Saparmurat Niyazov] has replaced the Hippocratic Oath," according to a leading Western analyst.

Martin McKee, co-director of the European Centre on Health of Societies in Transition at the London School of Hygiene and Tropical Medicine, said the laws of the black market have taken hold of Turkmenistan's health-care system, forcing people to pay for treatment that until recently was virtually free. In addition, doctors, seeking to bolster their meager salaries, often resort to carrying out unnecessary treatments. While the quality of health care has declined across Central Asia and the Caucasus following the 1991 Soviet collapse, McKee drew a clear distinction between developments in Turkmenistan and those elsewhere in the former Soviet Union. Whereas the health care networks in most former Soviet states "collapsed" amid the chaos associated with the transition from communism to market-related economic systems, Niyazov wantonly "destroyed" Turkmenistan's medical infrastructure, McKee said during a public presentation January 27 at the Open Society Institute (OSI) in New York.

McKee was a co-author of a 2004 report, titled Human Rights and Health in Turkmenistan, which detailed the decline of the country's health care system. Niyazov has steadily curtailed government support for health-care professionals since the country gained independence in 1991. Perhaps his most notorious move came in 2004, when he ordered the dismissal of an estimated 15,000 skilled health-care workers and replaced them with military conscripts. In early 2005, the mercurial Turkmen leader mentioned that all hospitals outside the capital Ashgabat would be closed. Given the restrictions on movement inside the country and the country's tightly controlled press, outside experts have had difficulty in determining the extent to which the hospital-closing plan has been carried out.

The lack of basic care, McKee stated, "makes diabetes and hypertension fatal where they needn't be." Many patients who gain access to a doctor become victims of what is tantamount to extortion, McKee added. For example, he said that it is common for a woman bringing in a child for a routine check-up to be forced to undergo a gynecological exam herself, for which high fees are charged. The tests are unnecessary, McKee contended, and serve only to augment doctors' incomes.

The Turkmen government has engaged in a wide-ranging effort to conceal public-health information from outside scrutiny. Accordingly, the government has tightly guarded basic public health statistics—such as those concerning the prevalence of disease, as well as mortality rates. Lucy Ash, a reporter for the British Broadcasting Corp. and one of the few Western journalists to have done on-the-ground reporting in Turkmenistan in recent years, also spoke at the OSI event, which was co-sponsored by the Turkmenistan Project and the Public Health Program. Ash related horror stories concerning health care. Operating surreptitiously in Ashgabat while visiting on a tourist visa in October, Ash visited one hospital and witnessed patients being treated with unsanitary instruments and bandages. "We've heard of specialists getting referrals, and telling the patients to come back in two years," Ash added.

Ash also conveyed anecdotal evidence that suggested child mortality is rapidly rising. She said that in one area of Turkmenistan, over 12 percent of children die before they reach age five. According to World health Organization data from 2002 shows life expectancy for men in Turkmenistan to be roughly 51 years, and 57.2 years for women. Ash also interviewed female sex workers and found that many are intravenous drug users. This fact would suggest that Turkmenistan is vulnerable to an epidemic of HIV/AIDS.

Buttressing the alarming view of Turkmenistan's health-care crumbling infrastructure is the fact that so-called health tourism for Turkmen citizens is booming. Many Turkmen travel to neighboring Uzbekistan to seek medical treatment, sometimes taking considerable risks to cross the border illegally. Niyazov himself appears to have shunned the Turkmen health care system when seeking medical treatment. According to various media reports, Niyazov has brought teams of German doctors to Turkmenistan to treat him for a variety of illnesses.

Unless steps are undertaken immediately to reverse existing trends, Turkmenistan stands to experience a public health catastrophe in the not-so-distant future. "We're losing a generation of educated people," McKee said. "The consequences will be tragic."