ECOHOST contributors: Bernd Rechel, Martin McKee
This study was undertaken in late 2004 and early 2005 by ECOHOST, with funding from the Open Society Institute, New York. It provides an in-depth analysis of the impact of the dictatorship in Turkmenistan on the health of the country’s population and outlines what should be done at national and international level to prevent a further deterioration of health in Turkmenistan.
Turkmenistan is located in Central Asia and has a population of about 5 million people. The country stands out among the successor states of the former Soviet Union for its widespread abuses of human rights. Turkmenistan’s president Saparmurat Niyazov has established a dictatorship that recalls many of the excesses of the Stalinist era. While the regime’s violations of human rights have been condemned by the United Nations (UN), the Organisation for Security and Cooperation in Europe (OSCE) and the European Parliament, the impact of the dictatorship on the health of the country’s population has so far failed to attract international attention. However, there are many signs that the country now faces a serious health crisis.
Our study examined the direct and indirect effects on health of the dictatorship in Turkmenistan. There are a number of human rights violations with obvious health implications, such as the habitual imprisonment, torture and beatings of perceived opponents of the regime, the suppression or deportation of religious and ethnic minorities, the incarceration of part of the population in unsanitary and overcrowded penal colonies, or the demolition of private homes to make way for grandiose presidential projects. The health care system has been essentially demolished in recent years; in March 2004, 15,000 health workers were dismissed and replaced by military conscripts, and in February 2005, the President ordered the closure of all hospitals outside the capital Ashgabat.
Estimated life expectancy in Turkmenistan, at 62.7 years at birth in 2002, is the lowest in any country in Europe and Central Asia and more than 16 years lower than the average of the 15 countries constituting the European Union before May 2004. Worryingly, the government has banned the official diagnosis of certain communicable diseases, raising the prospect of major outbreaks going unreported. The potentially devastating consequences of secrecy and denial were illustrated in the summer of 2004, when informal sources reported an outbreak of plague.
Drug use, in particular heroin, has become very common and commentators have argued that this reflects either complicity by senior officials in the trafficking of drugs or, at least, turning a blind eye to the drugs crisis. In the wake of the increased drug use, sex work and suicides are reported to have risen markedly.
As in the Soviet period, psychiatry is being abused for political purposes, with perceived opponents of the regime being confined to psychiatric institutions. The Turkmen government has also failed to address major environmental problems. While a large part of the population does not have access to safe drinking water, scarce resources are being wasted in the construction of artificial lakes and rivers, which are likely to compound existing problems of desertification.
The international community has so far failed to respond adequately to the health crisis in Turkmenistan. UN organisations, including UNICEF, UNDP, UNFPA and WHO, have maintained their country presence, but their actions have been confined by the Turkmen government, which has been resistant to foreign involvement. More profound interventions are urgently necessary to prevent a further deterioration of the health of the Turkmen population. Improvements require the recognition of the scale of the current health crisis, both domestically and internationally, a sustainable allocation of state resources to the health sector, and more carefully conditioned foreign assistance programmes. Ultimately, however, sustained improvements hinge on the democratisation of the country.
Human rights and health in Turkmenistan
Rechel, B., McKee, M.
The publication contains an in-depth study of the impact of the dictatorship in Turkmenistan on the health of the country’s population and includes chapters on human rights, the economic and social situation, health, health care and the reaction of the international community.
[Ful text : Turkmen health report]
Human rights and health in Turkmenistan. Policy Brief
Rechel, B., McKee, M.
This brief summarises the findings of the detailed report and outlines what can be done at national and international level to prevent a further deterioration of health in Turkmenistan.