Uzbekistan is a top destination for Turkmen health tourists

Eurasia Insight September 21 Turkmenistan's health care system is in such disrepair that many Turkmen citizens are traveling to neighboring Uzbekistan to seek treatment. Most Turkmen "health tourists" come from Tashauz and Lebab provinces, situated along the Uzbek frontier. For its part, Uzbekistan is experiencing profound social and economic discontent, underscored by the Andijan massacre in May. But for increasingly desperate Turkmen citizens, Uzbekistan offers the only viable option for the treatment of serious illnesses. Turkmenistan's totalitarian leader Saparmurat Niyazov has gutted his country's health-care system In 2004, for example, Niyazov ordered the dismissal of approximately 15,000 health-care workers. And in February, he called for the closure of hospitals and clinics outside of the capital Ashgabat. "Every year the situation is getting worse," said Tadjigul Begmedova, the director of the Turkmenistan Helsinki Foundation. Anecdotal evidence suggest that dozens of Turkmen citizens - many of them ethnic Uzbeks -- are crossing the border daily with the intention of seeking treatment, said Begmedova, who is presently based in Bulgaria. Those crossing the border officially often say they are visiting relatives, but once in Uzbekistan, they head directly to hospitals in Bukhara, Khashkadarya, Khiva and elsewhere. Other Turkmen take the chance of entering Uzbekistan illegally. "The number of Turkmen patients has skyrocketed compared to past years," says Shukhrat Ilyasov, head of the surgery department of the Karshi Emergency Medical Care Department. Not only are Turkmen going to Uzbekistan to be patients, Begmedova added. Hundreds of Turkmen doctors have moved to Uzbekistan to practice medicine, many of them doing so on a quiet, "agreed-upon" basis. Even some Turkmen students are now in Uzbekistan studying medicine at higher-education institutions, she said. Travel restrictions implemented after a summit meeting between Niyazov and Uzbek leader Islam Karimov in late 2004 are complicating efforts by Turkmen citizens to obtain prolonged medical care in Uzbekistan. In particular, Niyazov has mandated that Turkmen citizens can spend only three days per month in Uzbekistan. The rule is primarily designed to discourage shuttle-trading of oil and gas products. Some Turkmen said that even before Niyazov's recent moves to dismantle the health-care system, they preferred the quality of Uzbekistan's medical care. "There was a diagnostics center in our provincial capital [in Turkmenistan]," said a Turkmen patient at a clinic in Karshi, speaking on conditions of anonymity. "But many physicians left and there was no qualified staff left at the center." Beyond mandated staffing cuts at Turkmenistan's health-care facilities, some Turkmen doctors have lost their jobs for failing to pass a test administered to all state employees, in which they must prove their knowledge of the Ruhnama, the spiritual guide reputedly penned by Niyazov. "It's absurd, but doctors must know the Ruhnama in order to treat patients," Begmedova said. According to Khayitbay Dustchanov, an official at Uzbekistan's Khorezm Province Healthcare Department, eight Turkmen citizens were registered as undergoing medical treatment recently in Urgench, the provincial capital. Local experts believe that official statistics vastly undercount the actual number of Turkmen patients. Many Turkmen conceal their identity by using relatives' documents to gain admission to Uzbek medical facilities. "We have to do so," explained Gulbakhor, a Turkmen citizen. "Only emergency health care is provided free of charge for foreign citizens at Uzbek hospitals. Regular medical care costs tremendous money." It is not unusual for diagnostics and the initial stage of treatment for a variety of illnesses to cost over $100 for foreigners, a sum that is beyond the reach for most Turkmen. Gulbakhor, for example, said his household's monthly income was roughly $20. "This is why I have to undergo treatment under my [Uzbek] relative's documents," Gulbakhor said. Ilyasov, the health-care worker in Karshi, said Uzbek authorities often carried out document checks at Uzbek hospitals and clinics, adding that if Turkmen are caught, they are liable to be deported immediately. According to several Uzbek emergency care physicians, authorities have instituted a rule that if a potential patient's documents do not seem to be in order, the suspect must be immediately reported to local police. "We cannot do it [check documents] when a patient arrives in critical condition," said one physician. "Sometimes, we have to hide them [critically ill Turkmen patients] or register them under different names."