Uzbekistan's health nightmare

By Rory Mulholland in Urgench, Uzbekistan, BBC News, Sunday, 12 August 2001, 01:19 GMT 02:19 UK

The Soviet Union came to an abrupt end a decade ago, but on Makhtumkuli collective farm in southeastern Uzbekistan not much has 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.

So the 11,000 people who call Makhtumkuli 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 statistics today are shocking. A survey last year in the southeastern province of Khorezm, in which Makhtumkuli lies, revealed that three out of every four children are sick.

Poor drinking water

The decline began decades ago, when 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 arrogant and foolish agricultural policy has combined with a severe drought.

The illnesses prevalent today are largely due to the decline in the quality of drinking water, which is a result of the worsening ecological situation, and to a general decline in living and nutritional standards due to the current drought.

Irgash and Bekzod look perfectly healthy as they play with a wheelbarrow in the garden of their home on Makhtumkuli farm.

But the brothers both have goitre. This is a swelling of the thyroid gland in the neck.

Neurological defects

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.

Yet goitre is just one of a long list of complaints 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.

Failing health

Rates of hepatitis, diarrhoeal diseases, acute respiratory infections, gallstone diseases, and anaemia have all shot up.

In Khorezm, it is estimated that 60% of women of child-bearing age are anaemic, as are roughly the same percentage of children under three.

Last year's health survey of nearly half a million children in the province concluded that only 23% could be considered in full health. And child mortality rates have also risen.

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.

Crumbling infrastructure

The drought has brought the crumbling health system in Uzbekistan into sharp focus.

Funding per head of population is around $2.50 a year.

With this money the authorities have to fund an enormous number of health staff in institutions around the country.

They are 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 medical workers, faced with ever shrinking budgets, are less and less likely to be able to properly treat children like these.