hospital beds in this remote mountain capital are
occupied by victims of a typhoid outbreak which is
reported to be spreading rapidly.
The government was urged to
act more than a week ago, but appears to have done
little beyond making a single radio broadcast to
alert people. Critics say it was anxious to avoid
unwelcome publicity during the Central Asian Games,
which ended here on Monday. Diplomats say they have
been warned to keep their children away from school.
Typhoid, a water-borne infection, has been virtually
endemic in Tajikistan for a decade or more.
In the nine months to the end
of September, 545 cases were diagnosed in hospitals
in Dushanbe. From 1 to 19 October, 235 new cases
were confirmed, and now there are 530 suspected
cases. Typhoid causes vomiting, stomach cramps and
diarrhoea - it can kill the old, the young and those
who are already weakened, though many Tajiks have
developed a degree of resistance to it. The city's
water system is so out-of-date and antiquated that
it has proved impossible so far to eradicate typhoid
from the water supply. Tess Dobek works for MVV, the
German partner of the city water company in an
ambitious World Bank-funded plan to bring the supply
up to modern standards.
She said: "The authorities
here were quite unprepared. They had no emergency
plan to cope with an outbreak, nor any stocks of
emergency medicine. "We appealed to the Ministry of
Health eight or 10 days ago to warn people, but it
fell on deaf ears. So we spent $1,000 dollars on
Sources have told BBC News
Online that the government's reticence is explained
by the Asian Games. One Western diplomat said his
doctor had advised him against sending his children
to school or kindergarten, for fear of catching
typhoid. The doctor said there were large numbers of
children affected, and the disease was "rampant". A
government commission set up to identify the cause
of the outbreak was due to hold its first meeting on
22 October. Professor Khamdam Rafiev holds the chair
of epidemiology at Tajikistan's state medical
He said 38% of those affected
by typhoid in Dushanbe were children, 11% were of
pre-school age, and 35% were "housewives,
pensioners, poor and homeless people".
Professor Rafiev told BBC
News Online: "For every typhoid case that is known
officially, you can reckon there are 10 more out
there somewhere who we don't know about.
"Medical staff have been
going from house to house in parts of Dushanbe
asking whether the residents are suffering from
typhoid, and advising them to boil their water.
"The Health Ministry says
water should be boiled for 50 minutes. But apart
from the sole radio broadcast, there appears so far
to have been no use of the mass media to alert
In Tajikistan as a whole, it
is estimated that 85% of the population lives below
the poverty line. The average gross domestic product
per head is $188, making it one of the world's
Workers for the city water
company earn about 70 somoni ($22) a month. The
minimum amount needed to survive in Dushanbe is
estimated at $40 a month.
Professor Rafiev said
Tajikistan would like to buy 300,000 doses of an
anti-typhoid vaccine developed by the former Soviet
Union, but could not afford the $3m they would cost.
In August, Tajikistan hosted
an international conference, the Dushanbe Fresh
Water Forum, at an estimated cost of $1m.
He said "dysentery and a
whole bouquet of diseases" were widespread in the
capital: "We have been facing an epidemic of typhoid
and hepatitis for the last 10 years. We don't know
when this typhoid outbreak will stop."
Outside the capital the
situation varies widely, with some towns and
villages enjoying pure water and others no supply at
One village, 30 km (18 miles)
from Dushanbe, home to 2,500 people, went for almost
two years without any supply, forcing people to
drink from irrigation channels whose water was
polluted with pesticides and fertilisers.
A German charity has now
provided an $800 pump to ensure the village's
There are plans to fit every
house in Dushanbe with water meters over the next
year or so, to try to cut consumption, which can
reach 2,000 litres per head per day, something like
10 times the amount reckoned to be sufficient