Ouzbékistan

Histoires vécues

Uzbekistan: Health has rapidly deterioriated in a land where much has stayed the

© July 2001/UZB008/Rory Mulholland

Staff at the health centre on Mahtumkuli collective farm, in Khorezm province, southeastern Uzbekistan.

The Soviet Union came to an abrupt end over a decade ago, but on Mahtumkuli collective farm not many things have changed since the days of communism. The state still owns the land, the farmers and their families are still told what crops to grow, and they still hand over their harvest to the farm management. Theoretically, they can leave and try to make a new life for themselves elsewhere. But for that you need money, and that's a commodity in short supply in this part of Uzbekistan. So the 11,000 people who call Mahtumkuli their home carry on much as they did before capitalism supposedly arrived here. There has, however, been rapid change in one vital aspect of their lives - their health. The decline began decades ago, when the Soviet planners began turning this arid land into a primary producer of cotton, a crop that demands huge quantities of water. It has accelerated over the past two years, when this agricultural policy has combined with a severe drought.

The statistics today are shocking. A survey last year in the south-eastern oblast, or province, of Khorezm, in which Mahtumkuli lies, revealed that three out of every four children are sick. Their illnesses are largely due either to the decline in the quality of drinking water, which is a result of the worsening ecological situation, or to a general decline in living and nutritional standards due to the current drought. Most families have vegetable gardens which supplied them with a range of fresh fruit and vegetable. But the lack of rain has meant they've been able to grow little or nothing there over the past two years. Those who can afford it buy their greens from the market. But most can't, so they go without.

Irgash and Bekzod look perfectly healthy as they play with a wheelbarrow in the garden of their home on Mahtumkuli farm. But the brothers both have goitre. This is a swelling of the thyroid gland in the neck. "When I cough sometimes it's really sore," says Irgash, who's twelve years old.

© UNICEF /Uzbekistan/ July 2001/UZB009/Rory Mulholland

Irgash (right) and his brother Bekzod live on Mahtumkuli collective farm in Khorezm province, southeastern Uzbekistan. They both have goitre, caused by iodine deficiency.

But the more serious impact of goitre is that it causes severe neurological defects in children. It stems from a lack of iodine, which most people in the developed world get from their salt. Iodine deficiency is considered the main preventable cause of mental deficiency in children. As well as causing clinical forms of mental retardation, it decreases the mental capacity of the whole nation. In Uzbekistan, rates of goitre have tripled in many provinces.

A generation under threat

"This has enormous implications on the whole country and will have very serious implications for the future if not stopped now," says Dragoslav Popovic, a UNICEF health and nutrition expert.

UNICEF has provided iodization machines for some salt producing plants in Uzbekistan, and is lobbying the government to legislate to ban the production of non-iodised salt. Yet goitre is just one of a long list of illnesses that are on the increase both here in Khorezm and in neighbouring Karakalpakstan, an autonomous republic within Uzbekistan. The drought in these two provinces has magnified and compounded existing health issues. Rates of hepatitis, diarrhoeal diseases, acute respiratory infections, gallstone diseases, and anemia have all shot up. In Khorezm it's estimated that 98 per cent of women of fertile age are anemic, as are 50 per cent of children under fourteen. Last year's health survey of nearly half a million children in the oblast concluded that only 23 per cent could be considered in full health. And child mortality rates have also risen. A UNICEF study puts them at double the figures provided by the government.

A robust health infrastructure is needed to handle such an alarming situation. But robust is not a word that could be used to describe Uzbekistan's ailing medical facilities.

"The drought unveiled the whole problem of the health system in Uzbekistan, which is possibly one of the most stretched systems in the whole of the former Soviet Union," says Dragoslav Popovic. "Funding per head of population is around two and a half dollars a year. With this money they have to fund an enormous number of health staff in numerous health institutions around the country. They're working in extremely difficult conditions. In most hospitals, for example, there is no running water."

It was thanks to the abundance of highly qualified medical staff that Irgash and Bekzod's goitre was detected when their mother, who also suffers from the complaint, took them in for a routine check-up. But these medical workers, faced with ever shrinking budgets, are less and less likely to be able to properly treat children like these.