The effects of dictatorship on health: the case of Turkmenistan
Reported, January 10, 2012
Turkmenistan is a country in Central Asia that, initially reluctantly, became independent as a consequence of the collapse of the former Soviet Union in 1991. The energy-rich and largely desert country, covering an area approximately as large as Spain, has a population of about 5 million people, the majority of which lives in rural areas. In terms of human rights, Turkmenistan provides one of the worst examples of post-Soviet development. The country has become increasingly totalitarian and its human rights violations 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 authoritarian rule by former president Saparmurat Niyazov on the health of the country’s population, however, has so far attracted little international attention.
Political context
Turkmenistan is a one-party state, which was dominated for 21 years by president Saparmurat Niyazov, until his unexpected death, on 21 December 2006, from heart failure. Niyazov’s rule began in 1985 when he became party secretary of the then Turkmen Soviet Socialist Republic. He emerged from the collapse of the Soviet Union as president of the now independent Turkmenistan, where he established one of the most oppressive regimes of any former Soviet republic. He surrounded himself with a bizarre personality cult and became president for life in 1999. On 11 February 2007, Gurbanguly Berdymukhammedov, the former Minister of Health, was, as had been widely predicted, elected as the new president of the country. In the pro forma elections, only candidates of the ruling party were allowed, and Berdymukhammedov allegedly gained 89% of the vote, with a participation of 98.65% of voters.
Turkmenistan has been described as one of the world’s most repressive and closed countries. There are no opposition parties or independent trade unions and the government controls the media and censors all newspapers and access to the internet. According to the Annual Worldwide Press Freedom Index, created by Reporters Without Borders, in 2006, Turkmenistan ranked among the two worst violators of press freedoms among 168 countries, surpassed only by North Korea. Civil society activists have faced persecution and imprisonment and the government prevents all but a few non-governmental organisations from working. Prisoners are subject to torture, routine beatings, food deprivation and overcrowding, often leading to death. There have also been politically motivated beatings and incarceration in psychiatric facilities to silence perceived dissidents .
The political system of the country has also left its mark on the educational system, which has markedly deteriorated in recent years. In 2002, mandatory education was reduced from 10 to 9 years, while the number of students in higher education has dropped dramatically.
Do the profound human rights violations in Turkmenistan have an impact on the health of the people living there? Recent research has shown a surprisingly close association between the extent of political freedom and several measures of population health, after adjusting for economic factors. However, the precise nature of the impact of dictatorship on health is difficult to quantify, as health is influenced by a large number of factors, including the socioeconomic situation, housing, nutrition, drinking water, lifestyle and access to health services.
Health impacts of human rights violations in Turkmenistan are most obvious in the imprisonment, torture and beatings of perceived opponents of the regime, and the incarceration of part of the population in unsanitary and overcrowded penal colonies. As in the Soviet period, psychiatry is being abused for political purposes, with perceived opponents of the regime being confined to psychiatric institutions. The suppression or deportation of religious and ethnic minorities, and the demolition of private homes to make way for grandiose presidential projects also directly impact on health and well-being. The impoverishment of the population, while the leadership is amassing great private fortunes, also has consequences for health, affecting access to the essentials for life, such as nutrition, and to basic health services. There are credible accounts of how impoverishment and lack of opportunities are leading to increasing sex work, domestic violence and drug use. The suppression of civil society, the growing isolation of the country and the general climate of fear, repression and corruption are likely to contribute to deteriorating population health, as are the violations of the right to education .
This paper explores in more detail three ways in which the dictatorship in Turkmenistan has impacted negatively on the health of the population living there. It first describes how the regime has pursued a policy of secrecy and denial, which sees the “solution” to health care problems in concealment rather than prevention. The paper then explores the complicity of the regime in drug trafficking, which has led to widespread drug use in Turkmenistan and also impacts on the health and well-being of people in the destination countries of the international drug trade. The paper concludes by describing how the regime has neglected the health care system in recent years and seeks to gauge the extent of the health crisis in the country.
Have the human rights violations in Turkmenistan contributed to the health crisis experienced by the country? Focusing on three areas where the implications are most apparent, our paper strongly suggests that this is the case.
Although Turkmenistan has sought international assistance in the fight against HIV/AIDS and the spread of avian influenza and has also reported some health data to the international community, it still seems to cling to the previous policy of secrecy and denial. The data on HIV/AIDS, which fail to capture a single case in the country in recent years, are the most obvious example for this policy. The denial of health problems in the country is likely to lead to their persistence or escalation.
In terms of drug trafficking, the true extent of the involvement of the Niyazov regime in the drug trade from Afghanistan may only now become apparent. The new president Berdymukhammedov raised the previously taboo topic of drug abuse in his election campaign and promised to eradicate the trafficking of drugs from Afghanistan. Only time will tell whether he can muster the political support in the higher echelons of the regime to follow these words with actions.
The worrying decline in health services in Turkmenistan in the last years of the Niyazov regime has been noted by several international agencies. It has also become a topic in the presidential election campaigns in early 2007 and Berdymukhammedov promised to invest in the health sector. As he has been Minister of Health in the crucial period, however, these promises have to be treated with some scepticism.
Despite the abject record of Niyazov’s regime, its plentiful energy resources and collaboration in the so-called “war on terror” meant that critique by the major powers was muted. After we published our report in 2005, we briefed the main UN agencies, the European Union, the UK Foreign and Commonwealth Office and the US State Department, and although there was much support by desk staff, politics prevailed.
After Niyazov’s death, the main concern of the major powers was one of regional stability and secure energy supply, and human rights concerns once again played a secondary role. The strategic importance of the inauguration of Berdymukhamedov as Turkmenistan’s new president in February 2007 was underscored by the presence of Russian Prime Minister Mikhail Fradkov and US Assistant Secretary of State Richard Boucher, as well as senior delegations from Iran and China. Human rights groups have argued that the limited pledges of the new president are not enough, and that instead of giving the new leadership the benefit of the doubt, the international community should be pressing for change . Indeed, Berdymukhammedov has emphasized repeatedly that he would continue the policies of Niyazov . Beginning the post-Niyazov era with a blatantly falsified election is certainly not an encouraging sign.
Credits:Bernd Rechel and Martin McKee.European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
More Information:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1948003/?tool=pubmed