All available 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.

Water works

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 The city's water system is so out-of-date and antiquated that it has proved impossible so far to eradicate typhoid from the water supply.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 medicines ourselves."

All levels

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 university.

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".

Vaccine shots

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 people."

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 poorest countries.

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.

No supplies

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 all.

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 supply.

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 globally.

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