Uzbekistan 1998

Environmental disaster affects health International staff: 9 National staff: 25 This region is the setting for one of the world's greatest environmental disasters, but the implications for human health are largely overlooked. With the introduction by the former Soviet Union of a cotton industry into an inappropriate environment and poor water management practices in general, an environmental disaster has occurred: the drying up of the Aral Sea and gross deterioration of water, land and air qualities further upstream. This region, including areas of Turkmenistan and Kazakhstan, has one of the highest levels of anaemia in the world and possibly the worst TB situation in Europe and Central Asia. Acute respiratory infections (ARIs) and diarrhoeal diseases are the main causes of morbidity and mortality among children. While international attention targets the environment, MSF targets five million people in the Aral Sea region. The focus is on TB patients in Muynak and Kungrad, where MSF implements a DOTS pilot programme, and on reducing life-threatening complications for anaemic pregnant women during delivery in the districts' maternity hospitals. The team also works with health staff responsible for diagnosing, treating and monitoring ARI and diarrhoeal diseases. Improvements are being made in water supplies and sanitation in the health facilities. MSF implements an epidemiological data system to improve Ministry of Health disease monitoring and health information systems. Operational research is beginning to promote greater understanding and acknowledgement of the health implications of this disaster for the region's populations.