Strong criticism over proposed hospital closures

A proposed measure by Turkmen President Saparmurat Niyazov to close down all hospitals outside the Turkmen capital, Ashgabat, has drawn sharp criticism from outside observers and activists. "The president's order to close hospitals outside of the capital is shocking even by the regime's own abysmal standards," Erika Dailey, director of the Open Society Institute's Turkmenistan Project, told IRIN on Wednesday from the Hungarian capital, Budapest. "I have not heard of policies this unapologetically retrogressive come out of Turkmenistan in a long while." "Such moves by the Turkmen authorities will only further restrict the rights of Turkmens to healthcare," Tajigul Begmedova, head of the Turkmen Helsinki Foundation, told IRIN from the Bulgarian Black Sea port of Varna, noting the high costs of clinics were already far beyond the financial means of most citizens. "It is clear that these moves won't bring any good for people's health. On the contrary it will only worsen the situation with regard to healthcare," she maintained. During a meeting with local officials on Monday, a government spokesman announced that Niyazov – otherwise known as Turkmenbashi the Great - had ordered the closure of all hospitals in the reclusive Central Asian state except those in the capital. "Why do we need such hospitals?" the BBC reported him as saying. "If people are ill, they can come to Ashgabat." But for the country's 5 million inhabitants, the move will only exacerbate the state's already deteriorating healthcare system. Prior to the collapse of the Soviet Union in 1991, Turkmenistan had one of the least well-resourced healthcare systems in the Soviet Union, according to Dailey. However, following independence, the situation went from bad to worse and health standards declined further as a result of budget cutbacks, a brain drain and inadequate medical education and training. "But Turkmenistan's health crisis is distinct and worse because it is the only government in the region that has deliberately dismantled the remaining infrastructure without budgetary justification," Dailey said, citing a decision in 2004 to lay off 15,000 healthcare professionals and replace them with army conscripts. "Can you imagine any other government calling unskilled, semi-literate 18-year-olds giving inoculations and delivering babies "healthcare?" she asked. According to the activist, Niyazov routinely fabricated healthcare statistics and had even prohibited doctors from diagnosing communicable diseases, such as tuberculosis and HIV/AIDS. "The government deliberately puts its head in the sand and deprives citizens access to treatment. As the HIV/AIDS epidemic spreads throughout the region, the human toll could be enormous," she warned, a concern Begmedova shared as well. "We monitor the healthcare system in Turkmenistan and our findings sadly suggest that health services in the country do not even meet those standards that existed during Soviet times, not to mention international norms. People are not provided with the comprehensive health services they need," she explained. Although it remained unclear whether the president's comments would result in a presidential decree or otherwise be codified as law and there was presently no indication of how or whether the president's will on this issue would be enforced in practice, the legalities in a lawless state were largely beside the point, Dailey said. "Bureaucrats have in the past enforced off-hand statements of the president as if they had the force of law. The president's comment last year that gold teeth were unsanitary resulted in bureaucrats checking students' teeth as they entered schools and sending them back petrified if they had them," she said. Asked what needed to be done, Begmedova called on the international community to raise the alarm, warning of possible humanitarian consequences if it failed to do so. "The international community could assist the people in need if only the authorities agreed to it. But the official policy of Ashgabat is that they do not accept that such problems exist and everything is fine according to them. But hiding all these facts only aggravates the situation." Dailey, however, was more forthright, calling for a stronger reaction to Monday's announcement in keeping the order from being implemented. "The international community can also play a constructive role by helping create opportunities to keep the medical and health professions alive in Turkmenistan through scholarships, study tours, conferences. Only strong and sustained multilateral pressure on the dictatorship can send the message that, for once, it has gone too far," she said.