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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.
Background
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.
Results
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.
Conclusions
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.
Publications
- 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.
[Full
text]
- 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.
[English
version]
[Russian
version]
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