Since establishing its presence in the region in July 1997, MSF runs a number of health projects primarily focusing on control and treatment of tuberculosis. MSF remains the only international humanitarian medical organisation based in the Aral Sea Area. . Although there is a great deal of ongoing research and development, the international community must act now on health and humanitarian issues within the Aral Sea Area.
Sir - One disaster resulting in water scarcity requiring urgent international attention, but neglected by almost everyone, including by you in your Sept 29 editorial,1 is the shrinking of the Aral Sea.
The Aral Sea disaster has evolved over decades through irresponsible Soviet exploitation of desert rivers in Central Asia to increase cotton and rice production. The slow course of events has not helped to publicise the plight of the local population, and has resulted in a gradual disengagement by the few international agencies working on one of the largest environmental disasters in the world.
Central Asia has been affected by acute drought for more than two years. In the region immediately surrounding the Aral Sea, half the grain and fodder crop, and all the rice failed in 2000. According to the United Nations, 100,000 farming families in western Uzbekistan have no stable source of income because of failed harvest, loss of productive assets, and inability to plant through lack of water. Anecdotal evidence suggests accelerated economic out-migration.
The current drought has been accentuated by political wrangling between countries sharing water resources of the two main rivers that fed the Aral Sea, which have now run dry.
Drinking water in the region is inadequate. Piped water is rare in rural areas, and intermittent at best. Alternative water sources include open canals, which may harbour chemical contamination (river salt, pesticides and fertilisers) and pathogenic microbes from uncontrolled sewage disposal. In 2000, WHO reported an increased frequency of diarrhoeal disease in Muynak, once a peninusla town, now 120 km from the receding sea, as well as the potential for more serious illness such as cholera.2
Hand pumps are the standard response of government and developmental agencies, whereas more sustainable solutions such as desalinators powered by renewable energy sources are ignored. However, these solutions are far from satisfactory. Water from shallow aquifers (extracted by hand pumps) reaches salinities of 3-5 g/L, three times the WHO accepted limit.3
Consumers have little possibility of desalinating such water. In one area, a third of bore holes tested by Médecins Sans Frontières (MSF) within two years of their construction were far short of their projected depth because of mismanagement or early silting. 19% were abandoned, mostly because of mechanical failure or the delivery of unpalatable water.4
Serious health issues have emerged in the area, probably because of socioeconomic upheaval. The incidence of infectious diseases such as tuberculosis, hepatitis, and respiratory and diarrhoeal disease are among the highest in the former Soviet Union.5
Through environmental-health research, MSF is advocating for increased sustainable investment.5 The need for meaningful action after years of talk is evident. There is a common saying in the region that if every expert brought a bucket of water, the Aral Sea would be filled again. After years of international presence and millions of dollars reportedly spent to bolster water security in the area, many of the 4 million people living in the region still lack safe and palatable water.
Ian Small, Dennis Falzon, Joost van der Meer, Nathan Ford and Ross Upshur
Médecins Sans Frontières, Aral Sea Programme, PO Box 333, 700 000 Tashkent, Uzbekistan; and Departments of Family and Community, and Public Health Services, University of Toronto, Ontario, Canada
1 Editorial. Nor any drop to drink. Lancet 2001; 358: 1025.
2 Vliet HCAM. Emergency and humanitarian assistance in Uzbekistan: report for assessment of impact of drought on communicable disease situation and health. Geneva: WHO, 2000.
3 Magnusson J. An assessment of the drinking water situation in Karakalpakstan, Central Asian Free Exchange and Lifewater International. August 1994.
4 Den Boogard W, Reed B, Oudman M. Urgent human needs: rural water supply and health education in Aral Sea region: evaluation report. UZB/95/Q05/5Q/99, 1999.
5 Small IB, Van der Meer J, Upshur REG. Acting on an environmental health disaster: the case of the Aral Sea. Environ Health Perspect 2001; 109: 547-49. [PubMed]