Health and mortality

According to the World Health Organization (2006, http://www.who.int/countries/tjk/en/), life expectancy in Tajikistan was sixty-three years in 2004, sixty-two years for males and sixty-four years for females. Healthy life expectancy at birth was 53.1 years for males and 56.4 years for females in 2002. Under-five child mortality was 120 deaths per 1,000 live births for males and 115 per 1,000 live births for females in 2004. Data on infant mortality vary by source. Existing birth and death records are not considered reliable in Tajikistan. However, in January 2005 IRINnews.org reported that infant mortality rates appear to be going up in the northern provinces of the country. The article cites estimates for 2003 from both the United Nations Children's Fund (UNICEF) and the U.S. Agency for International Development (USAID). According to UNICEF, the infant mortality rate was ninety-two deaths per 1,000 live births, but USAID's rate was 112.1 deaths per 1,000. Tajikistan's health ministry chief believed the numbers could actually be three or four times higher.

As in the other Central Asian republics, HIV/AIDS cases are on the rise in Tajikistan because of the country's geographical location on the trafficking route and because of an increase in intravenous drug use and prostitution. In fact, if the number of HIV cases continues to increase at its 2005 rate, experts say the number could double every thirteen months ("Tajikistan: Donors Call on Country to Strengthen Battle against HIV/AIDS," February 23, 2006, http://www.aegis.com/news/IRIN/2006/IR060259.html). Besides its role in the drug trade, Tajikistan has many citizens who temporarily migrate abroad—mostly to Russia—for work. Increasingly, these migrant workers become infected abroad and bring the disease back to Tajikistan, where they spread HIV.

Turkmenistan

Turkmenistan is considered the most closed society in the former Soviet bloc. In July 2004 the last international radio outlet to broadcast in the country—Russia's Mayak radio station—was cut off by Turkmenistan's authoritarian government, leaving the Turkmen people with no access to outside information. According to an article from the Power and Interest News Report (PINR; "The Erosion of Political Institutions in Turkmenistan," December 30, 2004, http://www.pinr.com/report.php?ac\=view_report&reportid=250&language_id=1), as of 2006 Turkmenistan and North Korea were the only countries in the world to retain their Stalinist regimes, meaning that they were ruled by dictators who control every aspect of their societies. The PINR lists many problems with the Turkmen government:

documented human rights violations, forced resettlement of ethnic minorities, rigid press censorship, high unemployment, a drug epidemic among the youth, widespread corruption, a declining educational system …, vast symbolic building projects (including an ice palace in the desert), isolation of the country from the rest of the world, collapsing public health (including reported cases of plague), and a political system in which no opposition to the government is tolerated.

Although exact figures are difficult to obtain because Turkmenistan does not have an established poverty line and what calculations the government does keep are not widely available, poverty is believed to be high and human development indicators low despite the potential for national wealth because of the country's huge oil and natural gas reserves. Turkmen president Saparmurat Niyazov has ruled Turkmenistan since independence in 1991, but in 1999 he declared himself "president for life" and adopted the title "Turkmenbashi," which means "father of all Turkmen."

According to Bernd Rechel and Martin McKee's report Human Rights and Health in Turkmenistan (April 2005, http://www.lshtm.ac.uk/ecohost/projects/turkmenistan%20files/Turkmen%20report.pdf), Turkmenistan has evolved to become the most oppressive of all the former Soviet republics. The Turkmen government controls all media and communications and refuses to report health data to the World Health Organization or development information to the United Nations. In March 2003 the Turkmen government imposed a ban on the issuance of exit visas to its citizens, preventing them from leaving the country. Threats of trade sanctions from the United States caused the Turkmen regime to abandon the exit visa ban in January 2004, although the government maintains a blacklist of people not allowed to travel.

Because of this atmosphere, the United Nations has been unable to research and publish a human development report on Turkmenistan since the 1990s. As of early 2006 the country was on uneasy terms with the World Bank because it refused to report its international debt, so all statistics related to poverty are speculative and based on data that are in most cases ten years old. Rechel and McKee, however, deduce from the information available in the World Bank's 1998 Living Standards Measurement Survey that urban unemployment in Turkmenistan was approximately 50% in 2003, and rural unemployment about 70%. In 1998 an estimated 44% of Turkmen lived below the international poverty line of $2 per day. Rechel and McKee note that "there is anecdotal evidence that the economic situation has deteriorated considerably since then."

Like all other statistics about the country, information on the health and education status of the Turkmen people is of dubious accuracy; the last time the country reported health data to the World Health Organization was in 1998. In February 2006 EURASIANET.org reported in "Turkmenistan Vulnerable to Public Health Catastrophe" (http://www.eurasianet.org/departments/recaps/articles/eav020606.shtml) that health care in Turkmenistan since independence has been deliberately targeted by President Niyazov, who has officially denied the existence of contagious diseases such as AIDS in the country, leaving citizens with no real options for medical aid. When they are able to see a doctor, extortion is not uncommon because the medical system is essentially a black market: for example, a parent taking her child in for a doctor visit might be forced to undergo testing herself so that the doctor makes more money. In 2004 Niyazov dismissed 15,000 health care professionals and replaced them with untrained military conscripts (people who have been drafted into the military involuntarily) to cut down on government spending. In 2005 he announced that all hospitals outside the capital city of Ashgabat would be closed indefinitely. In 2002 the World Health Organization (2006, http://www.who.int/countries/tkm/en/) estimated that the mortality rate was 51.6 years for men and 57.2 years for women. The child mortality rate for those under five years old had risen from ninety-seven per 1,000 live births in 1990 to 103 per 1,000 in 2004, as reported by UNICEF; an estimated 11,000 Turkmen children under five years old died in 2004 (http://www.unicef.org/infobycountry/Turkmenistan_statistics.html).

In late 2005 the Turkmen government began cutting benefits to about 100,000 of the country's 400,000 people, mostly the elderly, who receive government pensions. Other government benefits have been cut by 20%, according to IRINnews.org ("Turkmenistan: Pension Cuts Begin to Bite," February 6, 2006, http://www.irinnews.org/report.asp?ReportID=51553&SelectRegion=Asia&Select Country=TURKMENISTAN). This move was expected to push thousands of older people into almost instant poverty. IRINnews.org notes that unemployment in Turkmenistan is believed to be as high as 80%.

Uzbekistan

Uzbekistan is the most populous of the Central Asian republics, with 25.8 million people—36.7% in urban areas and 63.3% in rural, according to the UNDP's "Country Sheet: Uzbekistan" (2006, http://hdr.undp.org/statistics/data/countries.cfm?c=UZB). Poverty in Uzbekistan is not generally as dire as in some of the other Central Asian republics. The country is the fourth-largest producer of cotton in the world and the seventh-largest producer of gold; in addition, it has large reserves of gas and oil. However, rising unemployment, a government crackdown on civil liberties, and economic policies that many observers consider disastrous have put Uzbekistan on the brink of total disarray.

According to "Country Sheet: Uzbekistan," in 2003 Uzbekistan ranked 111 out of 177 countries on the Human Development Index, ahead of Kyrgyzstan's 109 and Tajikistan's 122, but behind Kazakhstan's 80 and Turkmenistan's 97. As in all the other Central Asian republics, life expectancy decreased in Uzbekistan between 1990 and 2003, from 69.17 to 66.68 years. The UNDP's Central Asia Human Development Report: Bringing Down Barriers—Regional Cooperation for Human Development and Human Security (2005, http://hdr.undp.org/docs/reports/regional/CIS_Europe_CIS/Central_Asia_2005_en.pdf) states that in 2003, 47% of Uzbekistan's population lived below the international poverty line of $2.15 per day, compared to a high of 74% in Tajikistan and a low of 21% in Kazakhstan. Yet, Uzbekistan's annual economic growth lagged behind that of all the other Central Asian republics, at around 7.5%.

As in all the Central Asian republics, HIV and AIDS pose a risk not just to the physical health but also to the economy of Uzbekistan. In "A Silent Killer Threatens Central Asia" (December 28, 2004, http://www.eurasianet.org/departments/civilsociety/articles/pp122804.shtml), Antoine Blua states that the projected long-term loss in economic growth in Uzbekistan because of HIV and AIDS infection could total 21% by 2015. However, unlike the rest of Central Asia, the cause of the burgeoning epidemic in Uzbekistan is not so much intravenous drug use as a huge increase in prostitution since independence in 1991. According to Gulnoza Saidazimova in the article "HIV Infections Build in Uzbekistan as Prostitution Rises" (December 29, 2004, http://www.eurasianet.org/departments/civilsociety/articles/pp122904.shtml), Uzbekistan's large population, high unemployment—especially among women—and role as a major transit stop for truck drivers throughout the republics has caused an increasing number of women to turn to prostitution to earn a living. With an average monthly income in the country at just $15, condoms to prevent HIV and antiretroviral drugs to treat it are too expensive for prostitutes to afford.

Of further concern to the international community is the potential for widespread unrest in the region if Uzbekistan should become even more unstable. A government crackdown on civil liberties began after armed protesters stormed a prison in the city of Andijon in May 2005 to free twenty-three men accused of membership in an extreme Islamic group. Government troops were sent to stop the insurgency, but eyewitness accounts say they fired indiscriminately into crowds of people, killing as many as 1,000 Uzbek citizens; since then, the International Crisis Group has called leadership in Uzbekistan one of the most repressive regimes in the world. With political refugees from Uzbekistan fleeing to other Central Asian republics, especially the already-fragile Kyrgyzstan, the entire region could, according to some observers, fall into total disarray. The United States and the European Union both condemned the May 2005 government massacre and have since cut off nearly all ties to Uzbekistan. After the events of May 2005, Uzbek leaders halted the activities of at least 60% of nongovernmental organizations in the country. With aid groups forced to close facilities and leave the country, the Uzbek people have become even more vulnerable to the effects of poverty.

According to the International Crisis Group's Policy Briefing "Uzbekistan: In for the Long Haul" (February 16, 2006, http://www.crisisgroup.org/home/index.cfm?id=3952&l=1), the ruling party's economic policies have been disastrous for the Uzbek people. Although the country is the world's second biggest exporter of cotton (which is used mostly to produce blue jeans for the U.S. and European markets), the rural farmers—mostly women and children—who grow and cultivate it are essentially slave labor, with all the revenues going to the small but powerful upper class. Unrest has continued since the Andijon uprising despite the government's increase in the minimum wage to $9 a month. A growing number of Uzbeks are leaving the country for Russia and Kazakhstan to work as illegal, and therefore unprotected, temporary laborers.

3. http://www.undp.kz/userfiles/File/angl.pdf

4. http://www.refi.su/help_53.htm

5. http://www.undp.kz/projects/files/26-21888.htm

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