Health aspects of the drought in Uzbekistan 2000-2001: World Health Organization Regional Office for Europe Emergency Preparedness and Response Programme Technical Field Report Series, July 2001 Summary Since spring 2000, an unusual drought has underreporting and unreliable medical affected Central Asia. The lack of rainfall and statistics. melting of glaciers has greatly reduced the To date, the decreased availability of water water flow of the Amu Darya River. This has has had no major impact on the resulted in the reduced availability of water for communicable disease situation in Uzbekistan. drinking and irrigation, which has led to Nevertheless, given the critical gaps at the severe crop failure. In Uzbekistan, the SES, compounded by malnutrition and drought has primarily affected the regions of environmental changes, communicable Khorezm and Karakalpakstan, particularly the disease surveillance must be given a high districts located downstream of the Amu priority. Darya River (flowing to Uzbekistan from Another major concern is the nutritional Tajikistan). Approximately 13 million people status of the population and the prevention of have been affected, out of which some six famine and poverty. Malnutrition, especially million are children under 14. among children, is a serious health problem Due to the water shortage, most of the crops in Uzbekistan, which has been aggravated by in the affected areas have failed. The the drought. The underlying factors include Republic of Karakalpakstan, with a population inadequate infant feeding, early weaning, of 1.5 million, suffers particularly severely, as inappropriate weaning foods, the introduction its economy relies heavily on agriculture. of breast milk substitutes, poor maternal Joint coordinated actions of national and nutrition and inadequate caloric intake, at international organizations helped prevent least in some regions of the country. An in- serious negative impacts on the health of the depth surveillance project is now being population of the drought affected areas. implemented to define the extent of the Many organizations have sent expert health problems related to nutrition. missions to the area (for example, UNICEF, Priority actions should include strengthening WHO, WFP/FAO, UNDP, US Embassy/USA). water quality control; supporting PHC The supply of drinking water has been the services through the supply of essential drugs main focus of attention. The drinking water and equipment, and the training of health supply problem is acutely serious in the workers; strengthening the communicable Bukhara and Navoi regions and in disease surveillance system and nutritional Karakalpakstan. As a result of the lack of surveillance; health awareness campaigns for clean drinking water and sanitation, the general population on the most important Uzbekistan bears one of the highest burdens symptoms of ARI and diarrhoeal diseases in of ill health in the region. children requiring me dical assistance; and a Moreover, drinking water quality control is further strengthening of interagency one of several weak chains. The district coordination in the health sector. laboratories of sanitary epidemiological This report reviews the current health stations (SES) lack qualified staff, reagents situation in northern Uzbekistan, focusing on and modern equipment. In addition to new communicable diseases, nutrition, the water equipment and staff training, the disease situation and the health-related relief actions surveillance system needs to be improved. of international agencies. The existing system is characterised by 2 The general situation Of the 15 newly independent states that raise concern both internally and with the emerged from the break-up of the Soviet neighbouring countries of Afghanistan, Union in 1991, Uzbekistan is the third largest Kyrgyzstan and Tajikistan. in terms of population and fourth largest in land area (447 000 km²). Uzbekistan, the most populous republic in Central Asia, has a population approaching 24 million, with an estimated birth rate of 21.3 per thousand. By 2025, Uzbekistan will have an estimated population of 34.7 million people. More than 48% of the population are 16 years of age or under. Population growth has an impact on every aspect of life in the country. The heavy use of agro-chemicals, the diversion for irrigation of huge amounts of The Amu Darya River is 40-45% of its normal water from the two rivers that feed the capacity in the lower stretches. region (Amu Darya and Sir Darya) and poor The main indicators of quality of life (Table 1) drainage systems have caused enormous place the country close to the average for health and environmental problems in recent eastern Europe but well below that of years, as exemplified in the Aral Sea disaster. industrialised countries. Regional instability and security continue to Table 1. Basic health and socio-economic indicators on Uzbekistan (1998) Source: UNDP Population (millions) 23.9 GDP per capita (PPP $) 2 829 Infant mortality rate (IMR) 21.9 Birth rate (per 1 000 population) 23 Mortality rate (per 1 000 population) 5.8 Life expectancy 70.3 Maternal mortality (per 100 000 live births) 9.6 Human Development Index 0.697 The country is not homogeneous as far as the quality of life is concerned. Karakalpakstan and Khorezm, the areas most affected by the drought, have the lowest average per capita income and two of the highest infant mortality rates. In Karakalpakstan the most affected rayons were said to be the rayons at the lower end of the Amu-darya River, (Bozatau, Karauzyak, Kegeyli, Kungrad, Kanlikol, Muynak, Nukus, Takhtakopir, Shoumanay, Chimbay) and the A barren rice field in Uzbekistan. desert zones of the Tortkoul and Ellikkala 3 rayons, a total population of approximately The health status in Uzbekistan is 378 000. characterized by a "double burden" of disease In Khorezm Oblast, rayons south of Urgenc, at that includes a legacy of acute communicable the edge of the desert (Kosh-Kupir, Khiva, diseases and conditions related to Yangi-Arik, Gurlen and Shavat), were the reproduction and childhood, compounded by most affected, a total population of about chronic non-communicable diseases. The 320 000. health status of the population is affected by a wide range of risk factors, particularly high Due to low crop yields, food availability was rates of fertility, inadequate systems for adversely affected in a wide area and the food water and sanitation, high rates of smoking, situation is becoming increasingly critical. alcohol drinking and poor diet. Reduced income resulting from agricultural activities also affected the income of the Intestinal and parasitic infections are population considerably, and this will likely widespread, especially acute diarrhoeal lead to widespread impoverishment. This will diseases in areas lacking safe water and affect nutrition, the carrying over of stocks of sanitation. Diarrhoeal diseases are the third rice and wheat for planting during the next major cause of death in children under one. season and, among other things, the ability to pay for medical services. Low water levels also affected the availability of fodder for livestock, and farmers consequently have started to sell their cattle. This led to an increase of prices on the market, as reflected in UNICEF and MSF-Holland reports. The socio-economic, technological, demo- graphic, environmental and epidemiological changes that are now taking place pose The severe impact of the drought can also be found unprecedented health challenges for in the Uzbek regions upstream on the Amu Darya Uzbekistan. Recent economic shocks have River. affected the functioning of the Uzbek health Currently, only 54% of the urban and 3% of system in terms of its affordability, efficiency the rural populations enjoy access to sewage and quality. The economic transition and networks; the remainder relying on on-site worsening fiscal constraints have led to sanitation, usually unlined pit latrines. This, shortages of medical supplies and equipment. in conjunction with high groundwater tables Historically, the health care system in (caused by poor irrigation) and poor Uzbekistan has been comprehensive and sanitation and hygiene practices, leads to a extensive but has lacked modern medical high bacteriological contamination of water technology and approaches. Current and food. The impact of this in terms of problems exist with the delivery of routine or waterborne disease outbreaks is evident, basic health care, which is continually particularly in the regions of Khorezm, plagued by institutional problems. Karakalpakstan, Bukhara and Kashkadarya. The water situation One of the most urgent problems is the low levels in the canals in a significant area, this access to safe drinking water, especially in had an impact on the groundwater levels. rural areas. Overall, a third of the population Water levels in shallow wells already started to of the republic have drinking water which does fall in June 2000, at a rate of 1 m per month. not meet quality standards. As water shortage And while the groundwater level had resulted in very low to nearly depleted water previously been at 10-15 m, these levels have 4 now decreased so much, that many artesian shortage, water had to be brought in by wells do not function any more. Moreover, as tankers. a result of anthropogenesis activity, 40% of Below, the two figures show that the level of known fresh groundwater is unsuitable for rainfall in 1999 and part of 2000 are below drinking. To compensate for the severe water average for the period reported. Rainfall Recorded by Climate Stations in Karakalpakstan Rainfall for Kungrad Rainfall for Nukus Weather Station Weather Station 1200 1000 800 1000 1000 500 800 600 800 0 600 600 -500 400 400 (mm) 400 -1000 200 200 Total Rainfall 200 -1500 0 Regression (mm) Regression (mm) Total Rainfall (mm) 0 -200 0 -2000 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 Total Year Total Year Regression Regression Source: UNICEF Mission Report Drought Assessment on Health, Water, Sanitation and Hygiene in Uzbekistan and Turkmenistan.