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Entrance to the Niyazov Medical Center in Ashgabat, one of Turkmenistan's top medical facilities, June 2020. © 2020 Chronicles of Turkmenistan

(Berlin) Turkmenistan authorities are jeopardizing public health by denying an apparent outbreak of the coronavirus, Human Rights Watch said today. Officials claim there are no Covid-19 cases, silence health workers, and do not promote social distancing and other preventative measures.

The Turkmen government should urgently gather and publicize data about the course of the disease in the country, make testing widely available, and stop censuring health workers.

“Every minute that Turkmenistan’s government conceals the truth about Covid-19 in the country, it’s putting lives and health in danger,” said Rachel Denber, deputy Europe and Central Asia director at Human Rights Watch. “The authorities should stop this reckless denial and urgently adopt appropriate public health measures.”

Turkmenistan has an extremely repressive government that severely restricts access to information and free expression. It has a dangerous record of concealing information or remaining silent about developments that are vitally important, such as natural disasters, major accidents, social unrest, bad economic news, and epidemics.

The World Health Organization (WHO) is expected to send representatives to Turkmenistan in early July 2020, after seeking since at least April to visit the country. Turkmenistan should allow the WHO to conduct its visit fully in line with the organization’s terms of reference and should immediately start carrying out WHO recommendations and guidelines for Covid-19 prevention and data collection, Human Rights Watch said.

Starting in February and March, Turkmenistan took some steps to protect against the spread of the virus, including limiting entry to the country and raising awareness about handwashing and other hygiene measures. However, until April, state media and high-level government officials were mostly silent about the situation. The authorities have not promoted any social distancing measures and instead have held
mass public events. They have sought to silence medical workers and others from speaking out about the impact of the virus in the country.

Turkmenistan is one of very few countries worldwide that claims it has no cases of Covid-19. Others include North Korea, Kiribati, Tonga, and several other island states. The Turkmen government’s denial of a single Covid-19 case is so insistent that the Foreign Ministry
publicly repudiated a June 23 alert published on the US embassy’s website that acknowledged there were “no official reports of positive Covid-19 cases,” but noted “reports of local citizens with symptoms consistent with Covid-19.” The Foreign Ministry called the statement “distorted,” “baseless,” and “fake.”

The Turkmen government routinely retaliates against independent reporting inside the country. However, several organizations based in Europe with reliable sources inside Turkmenistan have reported widely about the spread of Covid-19 there. A steady stream of reports of people reporting symptoms consistent with Covid-19 began appearing in late March and early April. Radio Azatyk, the Turkmen-language service of the US government-funded Radio Liberty, told Human Rights Watch that by May, reports of an outbreak of pneumonia, which is one complication of severe Covid-19, had grown widespread.

By mid-June, there was evidence that this outbreak was out of control. An employee with Turkmenistan’s Center for the Prevention and Treatment of Infectious Diseases told Radio Azatyk that the outbreak was “serious, [with] some patients com[ing] in extremely serious condition,” and with fatalities.

In Ashgabat, the capital, by June 10 the entire main infectious disease hospital had been overwhelmed by “pneumonia-like” cases and was placed under quarantine, Radio Azatlyk reported. A health worker at this hospital was able to call his family to inform them that the quarantine could last as long as 28 days, during which staff were required to live and work at the hospital.

Many of the reported cases of infections are of health workers. The Rights and Freedoms of Turkmen Citizens, a Prague-based independent group that is in regular contact with doctors in the country, reported that doctors as a rule must supply their own personal protective equipment, including masks and gloves. A local source told Human Rights Watch that starting in the past few days, “[Some]
hospitals are supplying doctors with masks and gloves, they don’t have to buy them.”

The Turkmen Initiative for Human Rights, an independent group that operates from Vienna, reported on June 23 that six health workers at one of the country’s top hospitals had symptoms consistent with Covid-19.

Around June 15,
two doctors at Ashgabat’s infectious disease hospital had died, reportedly with symptoms consistent with Covid-19. Several doctors and nurses reportedly tested positive for the virus at a clinic in Ashgabat.

Turkmen News, an independent outlet based in the Netherlands, reported on June 15 that the infectious disease hospital in Turkmenabad, the capital of the eastern province of Lebap, had 34 patients with acute pneumonia, which their source told them was an unprecedented number of simultaneous cases. Four days earlier, the National Security Ministry had cordoned off the hospital.

An unnamed health official told Radio Azatlyk that “several people with suspected Covid-19 symptoms,” among them a doctor, were admitted to Lebap’s general hospital in mid-June.

There are scattered reports of potential Covid-19 infections and deaths in other parts of the country, including the death of a
doctor in Balkanabat, in western Turkmenistan. Another doctor told Radio Azatlyk’s reporter that although the doctor was not tested, the fast onset of his death and the damage to his lungs strongly indicated Covid-19.

There appears to be some unspoken acknowledgment that the country is in a health crisis, Human Rights Watch said. On June 15, according to Turkmen News, the Health Ministry ordered all staff from several government agencies in Lebap province to come to work in masks citing, as Turkmen News told Human Rights Watch, the
 “current epidemiological situation and the need to prevent respiratory diseases.” Several construction sites in Ashgabat have been shuttered. The authorities without explanation ordered public sector employees in Mary region, in southern Turkmenistan, to “undergo mandatory general medical checkups.”

The Turkmen government should prioritize informing people about recognizing symptoms of Covid-19 and protecting themselves from the disease, rather than forcing people to undergo mandatory checkups that violate their privacy rights, Human Rights Watch said.

Testing in the country appears to be very haphazard, and people have little information about accessing it. The media reported in late April that the health minister said Turkmenistan has 30,000 test kits and was ordering 40,000 more. But Rights and Freedoms said there was a dire lack of tests and of testing reagents, chemicals and equipment needed for testing. The group told Human Rights Watch about a woman who died at home of Covid-19 in June after testing positive. Her family was able to obtain a test because they had the connections and financial means to do so, whereas many others who cannot pay may face barriers to testing.

Radio Azatlyk told Human Rights Watch that a major hospital in Turkmenabat that had previously been testing patients had recently stopped doing so for unknown reasons.

Turkmen authorities pressure health workers into silence about Covid-19. Reports indicate that workers in the Ashgabat infectious disease hospital who were required to live and work at the facility for at least two weeks were also not allowed to use their phones. Rights and Freedoms described a doctor who was sent for a 25-day shift in the quarantine facility in Lebap province; her son told the group that his mother was not allowed to take her phone with her.

Rights and Freedoms earlier reported that doctors and junior medical personnel in four of the country’s five regions said they are not allowed to take their cell phones into work with them. A member of staff in an Ashgabat clinic told the group that doctors and nurses had to sign a nondisclosure statement. The Turkmen Initiative reported that in mid-April, security forces had detained a doctor working in a quarantine facility and questioned him for two days after he forgot to leave his cell phone in the locker before entering the facility.

Rights and Freedoms also said that doctors have been pressured not to make pneumonia diagnoses or even to list key pneumonia symptoms as the patient’s primary symptoms. Turkmen authorities should immediately cease this practice and allow doctors to make appropriate diagnoses, Human Rights Watch said. In line with WHO recommendations, they should test patients with pneumonia for the virus causing Covid-19 and report the cases to the WHO.

“Turkmenistan’s government has no time to lose in addressing the pandemic,” Denber said. “It needs to urgently and fundamentally depart from the repressive way it’s handling this crisis so that it can protect its citizens.”

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