It is hard to believe today that there was once a rich natural environment around the Aral Sea – with beautiful forests providing sites for sanatoria and children’s camps – or that its fish earned half of the region’s income. This wonderful picture has now been replaced by a ships’ cemetery, and the seabed by a desert. More than 150 plant species have become extinct; the variety and numbers of fish have been severely reduced; about 35 bird species have changed their migration patterns; and six mammal species have declined.

The sea was also important in maintaining the balance of the region’s climate. The last 30 years have seen an increasing number of dust storms, a greater difference between night and day temperatures, and hotter summers.

Massive pollution by insecticides, herbicides and defoliants used in the cotton industry, along with large-scale irrigation of the crop, have led to chronic environmental degradation and health damage. Water withdrawals from the two rivers supplying the sea – the Amu-Darya and the Syr Darya – did much to cut the size of the sea by more than half, from 64,500 to 30,000 square kilometres, exposing over 30,000 square kilometres of salty contaminated sediments. Strong winds disseminated these, spreading a white powder over the region and subjecting the whole ecosystem to their toxic components. High levels of DDT and other organochlorine compounds appeared in the soil, air and water – and at every level of the food chain. The region seems to have suffered further pollution from factories and industries upstream and to have been contaminated by the testing and production of chemical weapons on the sea’s Vosrozhdenye Island.

The republic of Karakalpakstan – whose 1.5 million people live around the delta of the Amu-Darya – is believed to be the most polluted area, posing a serious risk both to its peoples’ health and to that of future generations.

Local people should have an opportunity to decide about their health, their environment, their life and their future

Polluted and unsafe drinking water is an urgent and major problem. Water quality began to deteriorate in the 1970s, in parallel with environmental degradation. Now 65 per cent of piped water in Karakalpakstan does not meet chemical standards for drinking water and 35 per cent falls below bacteriological ones. It is thought that some 150,000 tonnes of toxic chemicals have entered the Amu-Darya river in the last ten years alone. Its waters are highly contaminated with organic and inorganic substances, including nitrogen, phosphorous, pesticides, phenols, organochlorine compounds and minerals. The situation is much the same in Kazakhstan on the other side of the sea.

The impact of the crisis on health is only now beginning to emerge. The people of the area suffer from general bad health, partly due to the breakdown of the health care infrastructure since the Soviet Union fell apart. There are repeated outbreaks of infectious diseases and average life spans are dropping dramatically, as in most of the newly independent states.

Health in the Aral Sea region, however, is also declining in parallel with the worsening ecological situation. Over the past 15 years, local scientists have reported increasing rates of maternal and infant morbidity and mortality, anaemia, kidney and liver diseases, allergies, cancer, mental disorders, tuberculosis, birth abnormalities, miscarriages, and complications during pregnancy and childbirth. Average life expectancy in Kzyl-Orda, in Kazakhstan, has declined from 64 to 51.

Women and children are the most vulnerable. Maternal and infant morbidity and mortality are significantly higher in Karakalpakstan and Kzyl-Orda than in other parts of Uzbekistan and Kazakhstan. Official statistics show, for example, that maternal mortality in Karakalpakstan in 1998 was 60.6 per 100,000 live births – and infant mortality 24.3.

An investigation of some 5,000 women of reproductive age in Karakalpakstan has shown that:

• 87-99% have anaemia.

• 90% have complications during pregnancy and childbirth.

• 30% have kidney diseases in pregnancy.

• 15% have a miscarriage.

• 23% have thyroid pathology, mainly goitre and hyperthyroidism, probably due to iodine deficiency.

The blood, endocrine and immune systems are all affected. Anaemia, which has been on the increase for the last 15 to 18 years, is found in almost all women – teenagers and both pregnant and non-pregnant women. It is the main concern and the region’s greatest health problem. As pregnancy develops it gets worse: about 70 per cent of pregnant women in Karakalpakstan have it severely by the third trimester – and the situation is similar in Kzyl-Orda. Most women with severe anaemia have complications during pregnancy and delivery, including haemorrhage. Some 86.9 per cent of newborn babies are also anaemic. Untreated anaemia in pregnancy and young children poses a high risk of many other diseases, and leads to weak immune systems and the risk of brain damage.

Investigations by local scientists suggest that anaemia in the region is linked with chemical pollution. The rate of birth abnormalities – another serious consequence of pollution – is also increasing. One in every 20 babies is now born with abnormalities, a very high rate.

Pesticide effects
Other investigations have shown significantly high levels of organochlorine pesticides (such as DDT and hexachlorocyclohexane) in the plasma of pregnant women, and in cord blood, in Karakalpakstan and Kazakhstan. These substances were detected in every sample of the women from Karakalpakstan. They pose high risks for both mothers and their babies; the effects include changes in reproduction and foetal development, disturbance of endocrine function, neurobehavioural changes, soft tissue cancers, dermatological damage, immunosuppression and changes in liver function.

Due to the severe pollution of all natural resources in the Aral Sea region, it is believed that the entire population has been chronically exposed to harmful chemicals for a long time. This, in combination with economic and medical/social factors, could be responsible for the high levels of disease, reproductive pathology, maternal and infant morbidity, and for the shortening of life expectancy. The massive contamination of the environment in the Aral Sea region, the high rate of reproductive pathology, the susceptibility of the local population to negative environmental factors, and our inability to realistically evaluate the long-term consequences, all call for global attention.

Center PERZENT – The Karakalpak Center for Reproductive Health and Environment – is a national non-governmental organization that has worked to improve the health of mothers and children in the region for eight years. Its activities include: a research programme on the linkages between environmental factors and health; developing a community-based reproductive health clinic for women; an organic farming and a healthy nutrition programme; providing educational activities on health and the environment; and supporting women’s and children’s initiatives. The activities reach more than 10,000 people, with more than 200 people working in different districts. There have been some positive changes in people’s lives and behaviour, but there are difficulties in developing local organizations and providing activities for local people.

Indeed the situation is worsening, even though international agencies and institutes have also been involved in the Aral Sea crisis for decades, several hundred conferences have been held and several hundred millions of dollars spent, and there have been so many declarations and promises.

For Karakalpakstan, the year 2000 was one of the most dramatic of the last 70. There was almost no water in this part of the Amu-Darya river: 95 per cent of the rice harvest and about 70 per cent of the cotton harvest perished – and drinking water became very scarce. The prognosis for the coming years is uncertain. The fate and future of 1.5 million people in Karakalpakstan is at risk if the problem of regulating and distributing water is not solved urgently. But there is no coordinating body to do this in Central Asia, nor to monitor water supplies and health in the disaster area.

Experimental zone
One of the roots of the problem is that local communities have never been involved in assessing needs, planning, decision-making, monitoring or evaluation. There are so many Aral Sea programmes, organizations and experts around the world; they come regularly, and replace each other, with no real outcomes for the local people. We have become an experimental zone for investigation and model implementation. Helping this region has become a profession for many organizations. Local people become dependent on them, yet have almost no chance of involvement in the decision-making process. Just as it was decided to grow cotton, use pesticides, and divert rivers for irrigation, so it has now been decided to let the Aral Sea die. No one asked the local people for permission, or sought their opinion.

During the workshop a Steering Committee was created to develop and implement a Plan of Action to provide practical help on improving health and conducting research on identifying pollution sources and the effect of the environment on human health. An international team of scientists is being created to bring this about.