Friday, December 22, 2006

Woken up yesterday morning by a series of SMS messages – colleagues with the benefit of time differences had already heard the news from Ashgabat that Saparmurat Niyazov, the president of Turkmenistan, had died. Apart from a general interest in current affairs why, you might ask, should anyone want to share this news about the leader of a far away country with me? Some time ago, with my colleague Bernd Rechel, we tried to understand what was happening to the health of the population of Turkmenistan. Our problem was that the Turkmen government had stopped sending health data to the WHO in 1998. What data did emerge was barely credible, such as the admission that there were 2 (two) cases of HIV infection in the country, despite its location on the edge of the region with the fastest spreading epidemic in the world, despite the presence of a thriving sex industry, and despite the existence of extensive drug trafficking, with credible evidence that senior members of the regime were involved in it.
At that time Turkmenistan mainly attracted attention in the international media as a figure of fun (remember, this was before Borat drew attention to Kazakhstan). We occasionally saw pictures of the golden statues depicting himself that were adorning Ashgabat, or heard about his injunctions against beards, music on car radios, and gold tooth fillings. Indeed, there seemed no end to his eccentricities, including renaming much of the country after himself, or rather his adopted name Turkmenbashi, or leader of the Turkmens, and what he didn’t name after himself he named after his family – he was orphaned as a child. He published his thoughts in a book entitled the
Ruhnama, which soon became required reading for all Turkmens. It is worth looking at for an insight into his deranged thinking. Yet there was a sinister side to his regime that was not reported. After a failed assassination attempt (or at least that was how it was portrayed – there is credible evidence that it was a setup) he launched a purge against opponents, or at least those he imagined to be opponents. Those unlucky to be caught up in his purges were tortured and many fled into exile. He then launched a sustained attack on the health and education systems, and indeed anything he didn’t understand. Other casualties were opera and ballet, which he described as “unnecessary”. Universities and the Turkmen Academy of Sciences were closed. His attack on health care was also severe. All hospitals outside the capital were closed and health workers were sacked, to be replaced by untrained military conscripts. We summarised all of this in a book, which we wrote by searching for snippets of news from the growing émigré sources, as well as information from some people who were working within the country in various organisations. We described a country in which outbreaks of serious contagious disease, including plague, were suppressed. Anyone seeking health care had to pay for it, often incurring catastrophic expenses. Health workers themselves struggled to survive. Many nurses drifted into sex work. Doctors demanded that women wanting immunisations for their children prove they were suitable mothers by undergoing internal examinations, which of course they had to pay for. Inevitably, Turkmenbashi was unwilling to share the privations being suffered by his compatriots. He knew he had heart disease and each year he flew in a group of German doctors to check him out.
After we published the book, Lucy Ash and Sian Glaesnner, two BBC reporters, went to Turkmenistan, posing as tourists. The
programme they made was horrifying, allowing Turkmen people to recount the experience of everyday life. Shortly afterwards I went with Lucy and Sian to describe our findings to UN agencies in New York and to the State Department and USAID in Washington. We were accompanied by a Turkmen former journalist who described a graphic example of field epidemiology, in which he counted the growing number of gravestones for infants in a local cemetery. A number of international agencies used our work to exert pressure on the Turkmen government but there was little they could do when the leading western and ex-Soviet governments were unprepared to act.
So where now for Turkmenistan? The omens are not good. His deputy, Gurbanguly Berdymukhamedov, has been given the job of arranging the funeral and is acting prfesident, even though this is actually a departure from the procedure set out in the constitution. He is a former dentist and, in addition to being deputy prime minister, served as minister of health. Formally, he is ineligible to stand as president when the position is decided in a few months, although the constitution in Turkmenistan seems to be somewhat flexible. Another one to watch is Agageldy Mamedgeldyev, the defence minister. Unfortunately, neither has a reputation suggesting that they will depart from the policies of their predecessor. There is, however, another possibility, that Turkmenistan will fall victim to the tribal tensions that are just underneath the surface. Tragically, the precedents of what happens when a strong leader leaves the scene, in Iraq or Yugoslavia for example, are not encouraging.
One can only hope for a better 2007 for the people of Turkmenistan. Unfortunately I’m not optimistic.

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