Washington Report on Middle East Affairs, September 1999, pages 28-29

Central Asia

Shrinking of Aral Sea Causes Regional Health Crisis

By Lucy Jones

Crumbling, windswept guest houses, a boarded-up seafront cinema and a few crumpled metal placards showing ice cream and fish are all that is left of Moynaq’s past life as northern Uzbekistan’s foremost spa town.

As pale ragged children watch their mothers buy food in sparsely stocked stores, it is impossible to imagine a time when this town was a thriving vacation resort.

Soviet tourists once flocked to Moynaq to swim in the Aral Sea’s salty waters, famed for healing skin diseases, and to sunbathe on pristine beaches. Children from far away cities were bused in to under-canvas summer camps to breathe the sea air and eat fresh fish.

Today Moynaq overlooks a glistening salty plain, now a graveyard of rusting hulks of stranded fishing vessels. The sea is 70 miles from the promenade and impossible to see with the naked eye.

The Aral Sea has shrunk by 75 percent of its volume and half its surface area since 1960 as a result of the Soviet government’s diversion of its source rivers to irrigate central Asia’s cotton fields.

This has produced such devastating consequences for the inhabitants here that doctors have likened the area to a war zone.

“The Aral Sea disaster is not just about the death of an incredible sea, which is criminal. It’s also about 5 million people living in an environment which is degraded due to the same processes that killed the sea,” said Ian Small, head of the Doctors Without Borders’ (DWB) Aral Sea Program based in the Uzbek capital, Tashkent.

“You’ve got the climate change, the dust storms, the death of the fisheries, but also due to the same process of over-irrigation, you’ve got the salinization of the land and water,” he added.

Tuberculosis in the Aral Sea basin, which spans parts of Uzbekistan, Kazakhstan and Turkmenistan, is epidemic. There are an estimated 400 cases per 100,000 people in some towns, an incidence unmatched elsewhere in Central Asia and Europe.

Anemia rates are among the highest in the world, with more than 95 percent of pregnant women suffering from a deficiency in red blood cells.

As a result of a dramatic rise in birth deformities in Dashkhovuz, northern Turkmenistan, the region’s 10 hospitals have set up special wards for babies with birth defects.

Respiratory infections are the main cause of death among children. Cancer, hepatitis, diarrhea and kidney diseases are widespread. There have been reports of an outbreak of plague in Aralsk, a former fishing port in Kazakhstan, now 20 miles from the sea.

Not surprisingly, life expectancy has dropped—by almost five years over a decade in some places—to 62 years for women and 59 for men.

The disappearance of the Aral Sea is believed to be directly linked to the region’s health crisis. Dust storms rage for up to 60 days a year, spreading toxic residue and salt left behind by the sea. These particles are thought to be a possible cause of respiratory diseases and cancers. (When the sea eventually dries up, an estimated 15 billion tons of salt will be released into the atmosphere.)

The drinking water contains upward of six grams of salt per liter, a level four times higher than the World Health Organization standard. This has been related to the prevalence of kidney disease.

High levels of pesticide contamination are alleged to affect the human body’s ability to absorb iron, causing anemia. (An alternative thesis, however, links the high rates of anemia to dietary deficiencies.)

People have also had to adapt to a drastic change in climate. Over the last four decades, summers have become hotter and shorter, and winters cooler, with temperatures ranging between plus 120 degrees and minus 70 degrees Fahrenheit.

“A climate change doesn’t necessarily affect the spread of disease, but it makes life a lot more difficult,” said Darin Portnoy, a Western TB specialist working for DWB’s project in Moynaq. “People are staying inside for longer periods of time. They’re in enclosed conditions where they spread disease to others.”

Before June of this year it appeared as if matters could not get more depressing. But then they did when Uzbek government officials revealed that barrels of the anthrax bacteria had been buried on Vozrozhdeniye Island, situated in the Aral Sea, when Uzbekistan was part of the U.S.S.R.

While Mikhail Gorbachev, the former Soviet head of state, was publicizing his glasnost and perestroika campaigns and forming ties with the West, Washington was gathering intelligence suggesting that the Soviet Union, contrary to its treaty pledges, was producing chemical weapons.

In 1988, at a point when the U.S. was demanding the inspection of Soviet chemical facilities, scientists in the Siberian city of Sverdlovsk were ordered to transfer hundreds of tons of anthrax into giant stainless-steel canisters and pour bleach into them to kill the bacteria.

The deadly cargo was then transported to the Aral Sea island which, until 1992 when the military left for good, had been the Soviet Union’s open-air testing site for biological weapons.

However, the bleach failed to destroy the anthrax bacteria completely. Tests on soil samples show that some of the spores are still alive. And because the Aral Sea is shrinking, the now-deserted island is growing, from 77 square miles to 770 at the last count, meaning it will soon be connected to the mainland. The fear is that the buried anthrax bacteria could be transported to Uzbek and Kazakh territory by lizards and birds. Anthrax, characterized by lesions in the lungs and external ulcers, is transmitted from animals to humans though contact.

Uzbekistan and Kazakhstan, which share ownership of the island, have asked the United States for help in assessing the site’s danger, since Russia has not delivered on Boris Yeltsin’s 1992 pledge to close and decontaminate the site.

As well as degrading the environment and the health of a population, the desiccation of the Aral Sea has resulted in thousands of people losing their livelihoods. Fish processing used to be the leading industry in Moynaq, a town of 25,000. The cannery at one time preserved not only fish from the Aral Sea but from waters as far away as Kaliningrad, St Petersburg and Vladivostok.

Today the factory operates sporadically. Fishermen no longer can afford the gasoline to drive to the sea’s edge. In any case, fish stocks have been depleted and what is left is of bad quality. Stocks from elsewhere stopped arriving after the collapse of the Soviet Union.

“We used to process around 23,000 tons of fish per year. Last year we didn’t process any. This year, we’ll process about 1,500. We’ve laid off around two-thirds of our employees,” said Daulbay Kudriniazov, director of the fish cannery in Moynaq.

Unemployment, combined with the instability following Uzbekistan’s declaration of independence in 1991, means living standards have plummeted. This is particularly relevant to the rise in the region’s tuberculosis rates.

“People don’t eat as much fish as they used to. They exist mainly on bread, rarely eating meat or vegetables. If we had an adequate diet, then maybe we would be able to cope,” said Beldvig Rheimov, head of Moynaq’s tuberculosis hospital.

With Western help, Uzbek doctors are adopting a method of TB treatment pioneered by the World Health Organization. Known as DOTS—Directly Observed Treatment Short Course—this places the emphasis on patients finishing a course of therapy.

This is a start but there is still a long way to go. Medicines are in short supply, even though Uzbekistan says it now manufactures four of the five standard drugs needed to treat TB. Hard medical data are inadequate and clean water and good sanitation are minimal.

Most alarming of all, drug-resistant strains of tuberculosis are on the increase, a result of sufferers who stop taking their drugs when they feel better, but before they are cured. TB thus transmutes into a drug-immune form, which can be passed on by the bacilli in a sneeze. Exactly how many people have drug-resistant TB is unknown. Uzbek officials say 17 percent, but Western sources put the figure nearer to one in three.

If this is true, then the worst may be still to come. Hospitals have yet to separate the patients who are not resistant to treatment from the rest, although they are starting to do so. There is also a monetary question. Non-resistant TB costs $50 to cure; the drug-resistant variety costs 20 times as much, which is well beyond the means of this Central Asian republic.

The Uzbek government has gone some way in recognizing the plight of the people in Moynaq. It has provided food for hospital patients, medicines and children’s clothes, which, coupled with international assistance, allows this profoundly poor region to limp along.

But there is little in the way of a grassroots movement lobbying the government for profound change, partly because many Uzbeks are afraid to speak out. Their president, Islam Karimov, runs a hard-line regime intolerant of all forms of opposition.

Most attention to the Aral problem continues to come from outside. The United Nations labeled the Aral Sea “an ecological disaster area.” There have been countless doctorates and reports written about the catastrophe by academics and environmentalists from all corners of the world. Locals have a saying: “If every specialist coming to the Moynaq brought a bucket of water, the sea would be filled again.”

Under the auspices of the Organization for Security and Cooperation in Europe, the Interstate Council for the Aral Sea and the International Fund for the Aral Sea are starting to galvanize the five states of Central Asia and Russia into cooperation to lessen the impact of the catastrophe. However, this process has so far been slow and produced few results.

The crux of the matter is the Uzbek government’s lack of interest in diverting the Aral Sea’s sources—the Sry-Darya and Amu-Darya rivers—away from the cotton fields.

Cotton production dominates the Uzbek economy. In the cotton harvesting season, school children, students and even some government employees are sent to the fields to join the farmers to make sure the crop is picked on time. Uzbekistan’s institutes are cotton-related, as is much of the country’s industry and exports.

“It’s not as if they can wake up tomorrow and say ‘to hell with cotton, let’s start doing computer microchips,’” said Small of the DWB project. “They inherited this cotton monoculture installed by Moscow.”

In Kazakhstan there has been an attempt to reclaim the Aral Sea’s waters. In Aralsk, the poorest region in Kazakhstan, the regional government and local people raised enough money to build a 10-mile dam across the mouth of the Sry-Darya river.

So far nine million cubic meters of water have been reclaimed, which although not enough to restore the fishing industry, has covered the seabed close to the town, reducing the noxious clouds of salt.

This is a start. But unless drastic measures are taken, degradation of the environment will continue, making it increasingly difficult for towns like Moynaq to survive. An estimated 100,000 people have been displaced from the region due to the Aral disaster, a number the United Nations Committee for Refugees says could threaten security in the region.

“It’s hard to know how anyone will be able to live here in 10 or 15 years unless we find some way to get water,” said Amanbay Mambtskalderov, the head doctor of Moynaq’s general hospital.

At the present rate, the Aral Sea is likely to shrink to less than a quarter of its size by 2015. If this happens, which seems likely, the towns in the region will die as well as the sea.

Lucy Jones is a free-lance journalist based in Tashkent.