UZBEKISTAN: ALARM AT RISE IN CANCER CASES  Medical staff complain of shortage 
of specialist care, medicines and hospital beds.  By Bakhtior Rasulov in 

ease passage of constitutional amendments.  Pavel Dyatlenko in Bishkek

community to act.  By Asyl Osmonalieva in Bishkek

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Medical staff complain of shortage of specialist care, medicines and hospital 

By Bakhtior Rasulov in Tashkent

Doctors in Uzbekistan say cancer treatment facilities are failing, with poor 
provision for early diagnosis, inadequate hospital facilities, and medicines 
that are unobtainable in the state healthcare system and unaffordable on the 
open market. 

The warnings come at a time when a leaked internal report says the incidence of 
cancer is rising dramatically in this Central Asian state. 

The report, based on a study conducted last year, showed a leap in the number 
of people with cancer – in the first half of 2009, 17.9 per cent more than in 
the same period of 2008. Over the five years from 2003 to 2008, the incidence 
of cancer increased from around 14 cases to 25 per 100,000 of the population. 

The study drew comparisons with other countries around the world, where it said 
the annual growth rate ranged between six and 8.5 per cent.

The Uzbek health ministry says that in 2009, there were 90,000 people with 
cancer, about a third of one per cent of the population. 

The internal report was based on data collected by doctors from all over 
Uzbekistan. The highest rates of cancer were discovered in Fergana, Bukhara and 
Khorezm regions. 

Khorezm lies close to the Aral Sea, which has dried up over several decades, 
causing harmful dust in the air and other environmental problems. The study 
made a link between the Aral disaster and cancer rates, although it did not 
place the sea’s location – Karakalpakstan – among the regions with the highest 
incidence, while Fergana, one of the top three, is a long way away from the sea.

A more general cause was, said the report, the use of harmful pesticides on 
cotton plantations, where much of the work is done by hand by adults and often 

A number of experts expressed concern that almost nothing was being done to 
prevent cancer or detect the early signs among children, young women, and 
people who work with chemicals or other hazardous materials. 

Uzbekistan’s state health system appears to be in no shape to cope with such a 
high, and rising, incidence of the disease

One cancer specialist in the capital Tashkent, who was involved in the study, 
summed up what he saw as the main problems, “a lack of highly-trained experts 
and inadequate state funding for cancer centres”. 

Nationwide, this doctor said, “There are only 1,104 beds for cancer patients. 
People have to wait their turn for months on end.” 

According to a haematologist also from Tashkent, “The majority of cancer 
sufferers are admitted in the final stages of the disease. They cannot be 
treated, and we’re simply forced to watch them die.”

A doctor involved in gathering data for the report said Uzbekistan should have 
at 30 large cancer clinics instead of the current 19, and also hospices where 
the terminally ill could receive qualified care.

In addition to the inadequate number of specialised medical centres, many forms 
of treatment are in short supply. A health ministry adviser said the lack of 
radiotherapy and other treatment was causing “a lot of deaths”. 

The cost of medicines used to treat cancer or alleviate the symptoms is a focus 
of many complaints. 

The Tashkent cancer specialist said the health ministry had refused a request 
to buy in 1,000 bottles of an advanced drug known as MabThera to be dispensed 
by state doctors. 

At 6,000 US dollars a bottle on the open market, the drug was beyond the reach 
of people who might considering buying it themselves, since the average wage in 
Uzbekistan is between 70 and 80 dollars a month.

“Doctors say that the combined treatment including modern chemotherapy and new 
drugs helps one recover,” said a 39-year-old woman who has stomach cancer. “But 
such drugs aren’t available here and I don’t have money to buy them abroad.” 

Officials say the problems are exaggerated. Bakhtior Niozmatov, first deputy 
prime minister of Uzbekistan and the country’s chief doctor insists that state 
funding is adequate and the system is getting better all the time, with drugs 
and treatment methods available.

“Every year, several million soms [upwards of one million US dollars] is 
allocated to purchase of drugs for those who need cancer treatment,” he said.

“A wide-ranging programme is under way to prevent serious diseases, including 
cancers. Last year a haematological stem cell transfer centre opened… now it’s 
become much easier to treat serious forms of leukaemia.”

That will be little consolation to one woman, who told how she had brought her 
son to Tashkent the hundreds of kilometres from Navoi to Tashkent in hope he 
would get better treatment. 

“For the last six months, we haven’t been able to get the medicines we need 
even though we have an official prescription from the cancer centre,” she said. 
“They say there aren’t any drugs. But the drugs they do have get divided up 
among those who’re able to pay over the odds, and they don’t have to wait in 
the queue.

“Our 27-year-old son is simply melting away before our eyes, and there’s 
nothing we can do to save him.”

Bakhtior Rasulov is the pseudonym of a journalist in Uzbekistan.


Parliament devises compromise to ease passage of constitutional amendments.

Pavel Dyatlenko in Bishkek

Kyrgyzstan’s parliament has been forced to rethink plans to change the rules on 
who steps in if the head of state cannot continue in office.

Deputies were forced to reconsider the reform, which was proposed by President 
Kurmanbek Bakiev, after the country’s constitutional court rejected it on a 

At the moment, should the president step down unexpectedly, for example due to 
illness, the constitution says the speaker of parliament can fill in as head of 
state until an election is held. If for some reason the speaker cannot do it, 
the prime minister is next in line. 

President Bakiev wanted to change this to a system where the choice of interim 
replacement would fall to the Presidential Institution, a new administrative 
structure which he unveiled late last year, but which has yet to come into 

Doing so would have reduced the certainty that the temporary president was in 
some way a representative of the public, like the speaker or prime minister, 
since the Presidential Institution – made up of non-elected executives – might 
make some other choice.

The bill, which consists of a package of changes to the constitution to bring 
it into line with governance reforms announced by the president last October.

Tasked with checking the legality of the amendments, the constitutional court 
ruled on the emergency appointment issue on January 21, rejecting it on the 
grounds that the Presidential Institution is an advisory rather than a 
decision-making body, and consequently lacks the authority to pick a temporary 
head of state. 

Court chairwoman Svetlana Sydykova said this provision needed revision, and 
sent the bill back to parliament.

This created a dilemma for a legislature that is dominated by the president’s 
party Ak Jol, as members now had to get their leader’s reform package through 
while at the same time accommodating the court’s objections.

Ak Jol members came up with a new arrangement designed to kill both birds with 
one stone. The parliamentary committee tasked with redrafting the bill produced 
a proposal to that would, as Bakiev wants, abolish the automatic delegation of 
power to the speaker or premier. Instead, a new entity called the State Council 
will be set up, and it will be its job to appoint an interim president. 

The details have yet to be worked out, and separate legislation will be needed 
to constitute the new body. 

It is known, though, that the State Council will include the prime minister, 
the speaker as well as members of the Presidential Institution. In remarks made 
on February 2, opposition parliamentarian Roza Otunbaeva indicated that the 
latter were likely to include the head of the president’s office, his 
communications chief, the State Adviser for Defence, Security and Law and Order 
and the director of the Central Agency for Development, Investment and 
Innovation. These last two posts were created as part of Bakiev’s governance 
reforms and give the Presidential Institution strategic oversight of security 
and economic policy and planning.

Placing such an important decision in the hands of a narrow group of unelected 
officials would be a major change to the constitutional system.

The Presidential Institution includes some elected officials like the president 
himself, who acts as its chairman, and the speaker of parliament. The cabinet 
is represented by the prime minister and foreign minister, but the rest of the 
Presidential Institution’s members are directly appointed by the head of state. 

The net result is to place more power in the president’s hands at the expense 
of the prime minister and his cabinet. Under his control, the Presidential 
Institution has wide-ranging powers, including some that previously belonged to 
the government, for example foreign policy and control over security and 
economic policymaking. 

In turbulent times, it is important to have clear legal procedures in place for 
the transfer of power, so that this happens promptly and effectively. The 
current system, where the leadership role temporarily goes to one of two 
officials, is simple and logical and has stood the test of time. 

It was put to the test during the “Tulip Revolution” of March 2005, when 
mounting popular unrest put an end to the rule of the then president Askar 
Akaev. He left the country, his prime minister resigned, and Kyrgyzstan seemed 
to be facing a parliamentary vacuum as the old legislature’s mandate was 
expiring and the new one had yet to form.

At that critical moment, the speaker of the old parliament was able to step in 
as head of state for less than 24 hours and facilitate the appointment of a 
prime minister. The latter post went to Bakiev, who ex officio assumed the role 
of interim president until he was elected to the job in July 2005. 

This experience, of a system that worked under stress, is one that should be 
remembered when the terms of the new constitutional arrangement are being 
worked out.

The next stage now is for President Bakiev to approve the proposed State 
Council, after which the entire package of changes can be put to a vote in 
parliament. Once that happens, the bill will get its second hearing in three 
months’ time, after which it could become law.

Pavel Dyatlenko is an expert at the Polis Asia Centre, a think-tank in Bishkek.


Violent attacks prompt media community to act.

By Asyl Osmonalieva in Bishkek

A wave of brutal attacks on Kyrgyz journalists has sparked alarm among 
journalists and local and international media watchdogs

Media representatives have also expressed concern about what they say is the 
Kyrgyz authorities’ failure to investigate crimes against journalists and to 
bring those responsible to account.

According to the Association of Journalists in Kyrgyzstan, at least 58 
journalists from Kyrgyzstan have been attacked over the last four years. 

The Kyrgyz interior ministry, meanwhile, says that between 2005 and 2009, there 
were 28 reported cases of attacks on journalists, 23 of which led to criminal 
cases. In the other five cases it was decided not to prosecute.

The latest attack on a journalist from Kyrgyzstan involved Gennady Pavlyuk, who 
died in hospital on December 22 after he was thrown out of a tall building with 
his hands tied behind his back.

Pavlyuk was on a visit to Almaty, the financial capital of neighbouring 
Kazakstan. Kazak police said they were treating the case as murder. 

The Kazak TV station KTK has reported that the officers from the Kyrgyz 
National Security Service had a meeting with Pavlyuk in the Almaty apartment in 
Almaty from which later he fell to his death. The press office of the Kyrgyz 
security service denied the allegations, dismissing them as disinformation.

Pavlyuk’s supporters and campaigners have linked his death to his work in 
Kyrgyzstan, where he was setting up a website.

The leader of opposition party Ata-Meken, Omurbek Tekebaev, told Radio Free 
Europe/Radio Liberty that he and Pavlyuk had met shortly before the latter’s 
death to discuss plans for the website project.

Tekebaev insisted that atameken.kg was to be an independent website, not an 
official party mouthpiece as some media have reported, the RFE/RL website said.

"I think this is a politically motivated crime," he was quoted as saying. "It's 
yet another attack in order to restrict freedom of speech in Kyrgyzstan."

Tekebaev also said Pavlyuk had recently published several articles and 
interviews in which he criticised the Kyrgyz authorities, “explaining the real 
meaning of their newly initiated reforms".

Akmat Alagushev from the Media Representative Institute in Kyrgyzstan, a 
non-government group, said the country’s law-enforcement agencies needed to 
solve crimes involving attacks on journalists. 

“Freedom of expression in this country will depend on how crimes are 
investigated and how those responsible are punished,” he said, adding that 
impunity would hinder any improvement in journalists’ safety.

The Committee to Protect Journalists, a New York-based watchdog group, has 
taken up the Pavlyuk case. Its Europe and Central Asia programme coordinator, 
Nina Ognianova, said in a statement, “This investigation will not succeed 
without bilateral cooperation. We call on Kazak investigators to coordinate 
efforts with their Kyrgyz counterparts, and we urge the government of 
Kyrgyzstan to assist to the fullest extent.”

Asked to comment on the number of attacks on Kyrgyz journalists, presidential 
spokesman Ilim Karypbekov told IWPR the authorities support freedom of 

“We are building a state on principles of democracy and freedom of expression,” 
he said. “We have an interest in seeing that the safety of journalists is 
assured and that all attacks on representatives of the media are resolved.”

Karypbekov said all attacks on journalists were being dealt with by law 
enforcement agencies, and the president’s communications department was 
watching how this was being handled. 

“We try to inform the public about the progress of investigations and, at the 
same time, we urge all interested parties to join efforts to solve the 
problem,” he said. “We await a response from the media community and we are 
hoping above all for constructive proposals and solutions, instead of 
accusations directed at the authorities.”

The death of Pavlyuk was the third incident involving journalists working in 
Kyrgyzstan in December alone.

Alexander Yevgrafov, a correspondent for Russia's Rosbalt news agency in 
Bishkek, was beaten up in the Kyrgyz capital earlier in the month.

Days later, an envelope carrying a threatening message and a bullet casing from 
a Kalashnikov was sent to the Osh Shami newspaper in the southern Kyrgyz city 
of Osh.

Others have been murdered. Freelance journalists Alisher Saipov and Almaz 
Tashiev were killed in 2007 and 2009, respectively.

Saipov, a prominent journalist working in Osh, was shot dead in the street by 
an unidentified gunman. An ethnic Uzbek, he was the founder of an 
Uzbek-language newspaper called Siyosat known for its critical coverage of 
human rights in neighbouring Uzbekistan. 

Tashiev, a freelance journalist who worked for a number of news organisations 
including the Kyrgyz-language newspaper Agym, was beaten by a group of 
policemen when he went to a police station to obtain a new passport. 

No one was brought to justice for these murders.

Other recent attacks include those on Syrgak Abdyldaev, a correspondent for the 
Reporter newspaper, the victim of a multiple stabbing in March 2009; Kayrat 
Birimkulov, a reporter for the state broadcaster, who was assaulted; NBT 
television journalist Gulmira Umetalieva, who was injured and had her camera 
broken; and political commentator Alexander Knyazev, who was mugged and had his 
notebook and money stolen.

At least six journalists have left the country since 2005 to seek political 
asylum abroad because they feared for their lives. 

According to the head of the Association of Journalists, Marat Tokoev, the most 
worrying trend is the brutal character of the attacks.

“I can’t say that the number of attacks is on the increase but what is 
definitely changing is the manner in which they are done... Attacks are 
becoming more brutal and cynical, and as a result journalists end up in 
hospital or even die,” he said.

Tokoev said that his organisation was working with experts from the 
Organisation for Security and Cooperation in Europe, OSCE, and with lawyers, 
police and journalists to uncover the real number of attacks and find out 
whether they were connected to the victims’ work.

The situation prompted the OSCE centre in Bishkek to make journalists’ safety 
one of its priorities for 2010.

In an interview with IWPR, Lilian Darii, deputy head of the OSCE centre in 
Bishkek, said the organisation “aims to contribute to an environment in which 
journalists can perform their crucial work responsibly and safely, without fear 
of reprisal or intimidation”.

She said the OSCE mission planned to provide legal assistance to journalists 
and to support public debate on the issue.

“The OSCE therefore renews its calls on the Kyrgyz government to address the 
current situation, which the OSCE representative for the media has described as 
a crisis,” said Darii.

Tokoev welcomed the OSCE statement making the safety of journalists a priority, 
but said the problem could only be solved if all the parties involved joined 

“What’s needed to withstand the pressure and the threat to journalists is to 
unite and work together,” he said.

Asyl Osmonalieva is an IWPR-trained journalist in Kyrgyzstan.

This article was produced under IWPR’s Building Central Asian Human Rights 
Protection & Education Through the Media programme, funded by the European 
Commission. The contents of this article are the sole responsibility of IWPR 
and can in no way be taken to reflect the views of the European Union.

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