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Women Respond to a Shrinking Aral Sea

Karakalpakstan,  UZBEKISTAN
Karakalpakstan is a semi-autonomous republic in Uzbekistan with an area of 165,300 sq. kilometers (half the size of Italy and four times larger than the Netherlands) and a population of 1.5 million. Karakalpakstan lies in the delta area of the Amur Darya river and the Aral Sea.

The Aral Sea, once one of the world's largest inland freshwater seas, is now a shrinking sea due to unsustainable water use. The local population used to live on fishing, commercial shipping, rice growing or cattle herding, but the ongoing Aral Sea crisis has dramatically affected the health and livelihoods of the 35 million inhabitants of the region. Doctors and NGOs in the region say that there is a strong link between the environmental crisis and the health problems of women and children living in the region. Local women and children suffer from menstrual disorders, anemia, liver diseases, cancer and birth defects. Infant mortality is said to be the highest in the former Soviet Union (40 to 60 deaths per 1,000 live births in Karakalpakstan compared with 19 per 1,000 in Russia and between 7-12 per 1,000 in Europe). Birth defects are also on the increase (27 per 1,000 in Karakalpakstan compared with 3-5 per 1,000 in Europe). There has been a clear destruction to the region’s economy. The Aral Sea has shrunk to almost half its orginal size, which has led to the loss of livelihoods of an estimated 40,000 - 60,000 fishermen and fish-processing workers in the area. Karakalpakstan is now the poorest region in Uzbekistan and the area hardest hit by the Aral Sea crisis.

Cause of the Environmental Crisis
The arrival of Soviet developers in the 1930s heralded the destruction of the age-old system of rice-field irrigation and water pricing and the installation of a wasteful, large-scale irrigation system. Under the Soviet economic system, the entire region along the Amu Darya River (Kyrgyzstan, Turkmenistan and Uzbekistan) was designated for the production of cotton. To ensure the productivity of the cotton agro-industry, large quantities of water were needed to irrigate the fields. Thus, the Amu Darya river was dammed at several places along the river, diverting water that would have ordinarily gone into the Aral Sea, to irrigate cotton fields instead.

In the 1960s it became apparent that the dams and large-scale irrigation projects were drawing too much water from the Amu Darya river (which feeds into the Aral Sea), as the sea was beginning to dry up. The large cotton monoculture developed by the Soviet regime is the main reason for the dying of the Aral Sea.

Cotton production also led to toxic pollution of the region. Pesticides like DDT and lindane were used to maximize the total yield of cotton. Defoliants containing dioxin were used to make it possible for mechanical pickers to harvest the crop. The use of DDT and lindane has now been banned, however defoliants and other pesticides are still being used. The entire population continues to be exposed to chemicals. Often, pesticides are sprayed from airplanes, which fly over villages and cotton field workers, many of whom are women. These chemicals have entered the food chain where they bio-accumulate and are transferred from fatty foods, such as oil and milk, to women who then transfer the chemicals to their children through their womb and breast-milk.

Reports recently published by the World Bank, the Japanese International Development Agency (JICA) and UN agencies testify to the immense environmental pollution problem in the area, particularly water pollution and water mismanagement. At the UN international meeting on Urgent Human Needs, held in Tashkent in January 1994 an Uzbek government representative observed that 150,000 tons of toxic chemicals had entered the water over the last 10 years and that these would continue to pollute soil and water supplies. The report from the 1995 UN conference on the Aral Sea states, "Once a prime source of potable water, ground water is no longer suitable for drinking in most areas."

A 1996 JICA report attributed deterioration of water quality to the discharge of mineralized water into rivers, highly contaminated with organic and inorganic substances (nitrogen, phosphorus, pesticides, phenols, etc.). The defoliants (used on the cotton fields) polluted underground and river water which was used as drinking water in the downstream areas. In addition ground water was also used for irrigation, leading to underground salt deposits, thus exacerbating the salinification of the soil. The 1996 JICA report describes increasing aridity, as salt crystallized on the dry bed of the sea and on the agricultural land due to surface water evaporation. Salt dust blown over the surrounding area, caused damage to agricultural land and adverse effects on people’s health. More than 40% of cultivated land has suffered salt damage.

The inefficient irrigation system installed by the Soviets eventually caused declining cotton yields and infertile agricultural land. Furthermore, the region was affected by pollution from upstream, particularly from heavy metals used in mining and metalworking industries. In the Pamir mountains, dams and large industrial sites include chromium plants, which emit waste into the Amu Darya river and chemical and biological weapons factories in Kongrad and Muniak, two towns in Karakalpakstan, that tested their weapons in the Aral Sea. This toxic inheritance probably continues to pollute the area.

Impact of the Environmental Crisis
The Aral Sea case is a prime example of how unsustainable water management can lead to an economic and human disaster. The local people see more and more community members becoming ill or dying. They see their environment becoming increasingly hostile as salt crusts on the land thicken, fewer trees grow old, the growing season is shorter and harvests are lost. They see the places they used to swim in the sea when they were young, covered by sand. There are no more fish and the animals and plants are disappearing. They notice how they have less and less water and how bad it tastes.

The women of Karakalpakstan are worst hit by the environmental crisis, because women traditionally bear the burden of caring for ill family members. Often it is the women who are wrongly blamed for illnesses. Two studies (Crosslinks 1994, Binnies 1996) blamed the high level of anemia, diarrhea and consequent increase of morbidity and mortality, indirectly on women for not cooking adequately for their families and not providing their children with a balanced diet and clean water. Many women in Karakalpakstan work in the kolkhozes (state farms) or are in the service sectors (doctors, nurses, schoolteachers, etc.) In their spare time women try to grow some food in their gardens, if they have them and if they can find sufficient water, which is becoming increasingly difficult.

Health effects on women and children in Karakalpakstan:
   Maternal mortality rates are 3 to 4 times higher than the national average;
  99% of women and 90% of children suffer from anemia;
   90% of women have complications during pregnancy and deliveries;
   16% of pregnant women have miscarriages;
   30%of pregnant women have kidney diseases;
   there is a high level of certain elements (Mn, Cr, and Cd) in pregnant women’s blood serum;
   there is a low level of essential elements (Fe, Zn) in pregnant women’s blood serum
   Breast milk contains lindane and DDT;
   Frequency of birth defects is 5 times higher than in most of Europe;

A 1995 UNDP report stated that the average infant mortality rate was 4.48%, the highest in Uzbekistan, which has an average infant mortality rate of 3%. In 1996, a JICA report found infant mortality rates to be 10% in some areas. This report also found that 6.49% of children below the age of 14 years suffer from skin diseases and that children are prone to water borne diseases such as diarrhea and acute respiratory illness.

Health effects on general population of Karakalpakstan:
    Viral hepatitis has increased from 62.4 per 1,000 to 94.8 per 1,000 in the past 19 years;
    Incidence of tuberculosis is 1.5 times greater than before;
    Liver cancer incidence has increased 5 times in the last 10 years; and
    Skin disease is twice the national level affecting 9.83% of the general population.

The effects of environmental pollution on people are being played down by government and international agencies. According to these agencies, the causes of health problems are lack of hygiene and poor diet, rather than environmental pollution. The population of the Aral Sea region and particularly women and children, generally suffers from poor health. Part of this is due to a breakdown in the health care infrastructure since the dissolution of the Soviet Union. There are repeated outbreaks of infectious diseases and average lifespans are declining dramatically. This phenomenon is seen in most of the newly independent states; however, Karakalpakstan and other regions bordering the Aral Sea have been particularly hard hit. Poor drinking water quality is assumed to have contributed to documented increases of certain morbidities such as hepatitis, kidney failure, birth defects and spontaneous abortions (Ataniyazova 1994, Abdirov 1993).

Anemia is often disregarded since almost 50% of the world’s population suffers from it, but policy makers must examine the severity of the problem, not just the occurrence. One out of seven women in Karakalpakstan suffers from severe hemorrhage (bleeding) during pregnancy which is the main cause of maternal death (they bleed to death, so to say). A World Bank report (Binnies 1996) relates hemorrhaging directly to severe anemia. Severe anemia is also found in 60% of newborn babies. The same 1996 World Bank report relates severe anemia in newborns to increased fetal morbidity and mortality, impaired language and motor development and impaired coordination.

Frequent pregnancy and poor diet were considered to be the causes of anemia among Central Asian women. Thus, programs designed to address anemia have been directed at regulating the number of births, proper diet and iron supplementation. However, Dr. Oral Ataniyazova's research has shown that the high frequency of anemia among women in Karakalpakstan is independent of pregnancy and age. The study reveals a high frequency of anemia in women who were not pregnant (92%), teenage girls (87%) and among newborn babies (85%). This research has shown that environmental factors such as high mineralization of drinking water have led to anemia amongst women in the Aral Sea region.

Effects on the climate and economy:
The drying up of the Aral Sea and water pollution have led to economic decline in the region, through loss of resources and productive labor. The Karakalpak tourism industry along the Aral Sea shore was abandoned in the 1980s. It is estimated that some 40-60,000 fisher people have lost their livelihoods. While fishing and related activities once provided 50% of the region’s income, large fish canning industries now have hardly any fish to process. Species extinction is taking place with almost 40 fish species in the Aral Sea having become extinct. The former fish catch of 40,000 tons a year has declined to zero. The mutagenic activity of the water is 1.5 times higher than in Moscow. Great numbers of other species (i.e., mammals, birds) have also become extinct.

Under the Soviet system the entire region specialized in growing cotton, which was then exchanged for wheat and other goods from other areas of the Soviet Union. This specialization is increasingly problematic for the newly independent states of the Aral Sea Basin. The quality of Aral Sea Basin cotton is low, because it has short fibers. Although cotton exports still make up most of the country's income, cotton sales are declining and the Uzbek government has to import three million tons of wheat to feed it’s people.

The greatest effects of the Aral Sea crisis are expected to hit the agricultural sector of Karakalpakstan, where local climate changes and increased salinity are starting to take their toll. The agricultural output of the region has already declined by 20-30% due to soil salinity, climate change and reduced labor productivity stemming from health problems. As a result of the shrinking Aral Sea, the Karakalpak region suffers increasingly from climate change. The climate of the Aral Sea basin used to be tempered by the moderating influence of the enormous water body. Now, temperature changes are wider and more abrupt, resulting in shorter growing seasons and higher probability of harvest loss.

Response to the Environmental Crisis
Response by Governments and International Agencies
The enormity of the ecological crisis in the Aral Sea basin became more visible following the dissolution of the Soviet Union. It also became increasingly clear that no country acting alone could stop the destruction and an interregional effort of all the riparian states - Uzbekistan, Kazakhstan, Turkmenistan, Kyrgyzstan and Tajikistan - was necessary. The Heads of State of the five riparian countries came together to form the Executive Committee of the Interstate Fund for the Aral Sea (ICAS). Each country contributed to this fund, for activities to improve the Aral Sea problems. The five countries also asked the UN and the World Bank for assistance.

In January 1994, the Aral Sea Basin Program was set up in cooperation with the World Bank, UNEP and UNDP. The objectives of the program were to:
       Stabilize the environment of the Aral Sea basin;
       Rehabilitate the disaster zone around the sea;
       Improve the management of the international waters of the Aral Sea basin; and
       Build the capacity of the regional institutions to plan and implement the above programs (ASBP progress
       report No. 2, p.1).

The program included seven sub-programs divided into 19 projects. The cost of implementing these planned projects was estimated at US $470 million. The money came from donor countries including Japan, Germany, the Netherlands and Kuwait (progress report No.3, p. 1).

There was a great deal of hope and optimism in 1994, it was the first time that these five newly independent states had established international relations independent of Moscow. The governments of the five countries believed that their problems were the problems of the world and that the world community would help them solve this crisis. In this state of euphoria, the heads of state of the Aral Sea riparian countries declared themselves committed to sustainable development and signed the Nukus Declaration on September 1995 at an UN International Conference on Sustainable Development of the Aral Sea Basin (ICAS) held in Nukus. The state leaders acknowledged the need to "Preserve the quality of life for our peoples, without compromising the life of future generations by encouraging and supporting initiatives aimed at improvement of health, income generation and preservation of cultural heritage" (UN ICAS final report, p.20). They also committed themselves to human development stating, "As representatives and supporters of the new democratic countries of Central Asia, we are committed to achieving the participation of our peoples and NGOs in the overall economic process and in the solution of their problems." (UN ICAS final report, p.21)

Several million dollars have already been spent on feasibility studies by the World Bank and more than 131 foreign missions and delegations have visited the Aral Sea area, discussed the problems, and published articles and reports. However, no epidemiological studies have been done to look at the links between the chemical pollution of the region and the health disorders. In 1997, several World Bank reports stated that it had been shown that there were no health problems resulting from agrochemicals in Karakalpakstan. The World Bank bases this conclusion on the 1996 JICA study on water quality of urban drinking water reservoirs. But the JICA report only measured treated drinking water; it did not look at untreated water used in rural areas or at other sources of chemical intake such as cotton oil, used for cooking, or milk. More than half of the test sites in the JICA report are not those closest to the Aral Sea. Other measurements are also inconsistent and show major mistakes. For example, chemical tests for lindane and the DDT breakdown product DDD are indicated in milligrams per liter, or in grams per liter, whereas they probably meant to write one-millionth of a gram per liter, as these pesticides are usually measured.

The World Bank health project’s final report focuses entirely on the bacteriological health problems in the region. It states that chemical pollution is not a problem and that if water was indeed chemically polluted, "experience shows that in such incidents the water usually becomes undrinkable owing to unacceptable taste, odor and appearance and is not consumed." (Aral Sea Program 5 project no. 1 Uzbekistan Water Supply Sanitation and Health Project Final Report Health Aspects, p.5). What is omitted is that when people have nothing other than polluted water to drink, they will have to drink it, and that is what is happening in Karakalpakstan. In rural areas people even use water from the irrigation drainage ditches for drinking water.

In 1997, a change in strategy occurred. It became clear that the health dimension bothered officials at the World Bank. World Bank officials wanted to get on with their work and look for economic projects that would promise a return on investment from which to start paying back the interests on the loans. The World Bank officially appeared all too willing to accept the outcomes of JICA water tests, a few fish analyzed for pollutants, and a graduate student's study on the causes of anemia. The World Bank transferred the responsibility for the program to a 2-person team in Tashkent, and decided to reduce the number of programs and to focus primarily on the agricultural program to improve cotton production. Health projects were integrated into the water supply program. After spending around US $2 million, donor countries seem uninterested in giving more funds to relieve pressing human needs. The UN agency which was supposed to focus on the human needs issues, the UNDP office in Tashkent, is busy with internal problems and is in the process of being reorganized.

In Fall 1997, the heads of state of the five riparian countries came together and, following recommendations from the World Bank, decided that the sea should be left to die since there was no longer a chance of saving it. Trying to save the Aral Sea would mean making economic sacrifices that were deemed too great. This decision was taken without any input from the affected populations. It could mean that some of the populations living closest to the Aral Sea, like the Karakalpaks, will now have to leave their towns and villages. A representative of Doctors Without Borders in Tashkent remarks, "Isn't it just incredible that five years and $13 million dollars later we are still trying to find out what pollutants exactly occur in the drinking water of the Aral Sea region?" The region still does not have a good hospital; there is no diagnostic center to identify diseases; and no toxicological laboratory where environmental hazards can be studied.

NGO Response
In most countries, women are society's most experienced and important natural resource managers. In Karakalpakstan women do most of the agricultural work, supply water, care for the ill and try to grow sufficient food for their families. Environmental degradation has added to women's low status in society by increasing their burdens in an environmentally vulnerable region. Their children are at increased risk of disease from unsafe water, nutritional deficiencies and lack of knowledge about prevention. A 1997 UNICEF report on a children's right to sustainable development states, "Environmental problems are social problems and the time women spend each day with the ramifications of environmental decline is time lost to their own development and that of their children and the wider community. Sustainable development cannot be isolated from implementing the rights of women to sustainable livelihood and equal opportunities for education, training, technology, access to credit and decision making."

With the premise that sustainable development is not possible without the direct participation of women, the NGO Center-Perzent has initiated a number of projects in Karakalpakstan. These projects incorporate women's perspective into the research and analysis of the crisis as well as directly involve them in programs such as health education and organic food farming. The following initiatives are being undertaken by Center-Perzent in collaboration with international networks.

Center-Perzent conducts research to assess the quality of environment and human health in the Aral Sea region. In collaboration with the NGO ECOLOGIA, Center-Perzent has engaged the public in monitoring water quality, made recommendations on how to improve household water quality and developed several workshops with local authorities and physicians on water quality and health problems.
In collaboration with the Russian Scientific Center of Obstetrics and Gynecology, Center-Perzent is investigating the epidemiology of reproductive pathology and reproductive toxicity. In collaboration with the Laboratory of Ecology and Evaluation at the Russian Academy of Sience, Center Perzent investigated the level of pesticides in food, soil, water andnursing women’s breast milk in Karakalpakstan. In cooperation with World Resources Institute, Center-Perzent is developing an investigation on reproductive health indicators. This project covers several countries including Brazil, Mexico and Uzbekistan. Center-Perzent is also receiving assistance from an international team of experts to carry out research in the Karakalpak region and to identify problem areas, thus reducing the population’s exposure to contaminants.

Education and Community Awareness
There is a need for enhanced community participation, self-sufficiency, and empowerment in Karakalpakstan. Center-Perzent has chosen a strategy of education, information and training as the central components of moving towards this goal. In its first year of existence Perzent brought out a series of five booklets on women's health, providing basic information on hygiene, diet, the functioning of a woman's body, ways of contraception, the needs of pregnant women and how to take care of newborn babies. The booklets were printed in the Karakalpak language and distributed in hospitals. The NGO also publishes a women's newsletter, as well as booklets on "a safe childhood" and the relationship between health and environment.

Center-Perzent has an environmental education program for 200 children in Nukus schools. It established an ecological club “Shagala” for children and has an environmental librasy open to the public. In collaboration with Save the Children Fund, Center-Perzent has a program which provides water filters to kindergartens and environmental educational programs for pre-school children.

Since 1996 Center-Perzent has been running a ‘women, health and environment’ project with Women in Europe for a Common Future and partners in Russia and the Ukraine. As part of this project a group of 20 women from five towns in Karakalpakstan have been trained on basic health and health and environment issues. They are now conducting workshops for women in their communities and run a 'health-desk' where people can come for advice and information.

It is crucial for education and information projects to be interactive, and not to use a top-town approach. Often women have a lot of knowledge of the local environment and resources that has been handed down through the generations. The key is to revitalize that knowledge to improve the current situation.

Community Projects Build Self Sufficiency
Center-Perzent has recently set up the project ‘Sustainable Chimbay,’ a self-help, organic vegetable and fruit farming program to improve women’s and children’s diet and avoid further contamination. The local authorities in the town of Chimbay provided 20 hectares of land for the organic farm.

The goal is to use the vegetables and fruits from this farm in meals served at the school, thereby improving the health of the children. Another part of the harvest will be used to improve the women’s diet, particularly pregnant women. If the harvest is good, the families of participating women will consume the surplus food and sell the rest. The income from the sales will be used for the target group's most serious needs, such as securing additional food, repairing the kindergarten's heating system, building a hand pump, filtering drinking water and obtaining medicines and syringes for the children's clinic. The project also includes plans of capacity building training for women who work on the farm. The training sessions will look at methods of organic farming and methods to reduce exposure to pollution and improve personal health including hygiene, diet and water purification.

The main aim of the Sustainable Chimbay project is to show that organic farming is a viable alternative to pesticide intensive farming. It will improve the diet of children and families in Chimbay and offer income-generating opportunities for women farmers and the staff at the training center. The project will become a training and education center for surrounding farming communities. Thus the "kindergarten-farm" will gradually become a demonstration farm where local farmers and Kolkhoz directors can see how different crops can be cultivated with good yields using organic methods. Furthermore, the demonstration farm can serve as an experimental center to test new species of plants which can regenerate the soil, adapt to saline soils and require less water. Also, the cultivation of organic cotton in rotation with other crops will hopefully become a pilot project in this demonstration center.

For the last 50 years the local population has been conditioned against undertaking any individual action. All responsibility for society’s well being was the domain of the state. The local population appears to think that someone will come and solve all the problems for them. Local communities need to realize that they possess the power to improve their environment and their lives. It is in this context that projects promoting self-sufficiency, like the organic farm in Chimbay, take on a greater significance.

Recommendations for Action
Based on the experience in the Aral Sea region, the following recommendations are made:

Make Women’s Health a Priority
Women and children are the main victims of the Aral Sea crisis and they cannot be expected to bear the increasingly high cost of health care. Therefore, we call on donors of international aid and credit projects to create a special fund with grants to pay for health care and monitoring programs, using a gender differentiated approach with special attention to the health impact on women and children.

Make Environmental Health a Priority
The Aral Sea case shows that there is a need to create a training program for staff of the World Bank and other international agencies on the links between health and the environment. In addition and parallel to existing expertise on bacteriological health issues, expertise is needed in toxicology and epidemiology. Therefore, we call on donors of international aid and credit projects to engage environmental health experts and dedicate funds for research on environmental health effects, as well as funds for practical projects working on ways to reduce this impact.

Increase Funding to Women's NGOs
"National and local NGOs are at the cutting edge of the environmental movement and no government or international agency can afford to ignore their critical contribution," according to a 1997 UNICEF report. In countries with a history of authoritarian rule, NGOs are often the only ones trusted by communities. NGOs with strong participation of women can motivate and mobilize communities to understand the health and other harmful effects of their activities and show how this can be changed. The World Bank and other international agencies working in Uzbekistan have made some attempts at working with NGOs but the proportion of funds dedicated to working with NGOs is a fraction (0.25%) of total funds spent. Therefore, we call on donors of international aid and credit projects to set apart at least 5% of total funds for grants to community-based NGO projects, with specific attention to the participation of women.

Create an International Independent Assessment Committee
The responses to the Aral Sea problem have been marked by the misallocated expenditures of funds. To prevent further misallocation, an International Independent Assessment Committee should be created to monitor and assess the international programs on the Aral Sea, involving local and international scientists and NGO representatives.

Create a UN Fund for Ecological Disaster Zones
Environmental pollution and resource mismanagement of fresh water bodies like the Amu Darya river and Aral Sea can cause the devastation of a region and its people. The UN should develop international agreements to avoid the devastation of one region's livelihoods by pollution from other regions. The UN has a role to play that is similar to its peace keeping function.

Beyond developing international conventions, the UN needs to assist the affected people in cleaning and regenerating their region. How can such regions repay loans if their resources have been severely damaged and are increasingly unproductive? We call on the UN to create a fund for grants to pay for clean-up, resource regeneration and health care in ecological catastrophe areas like the Aral Sea Region.

Integrate Agricultural, Environmental and Health Policies
After five years and such high expenditures, there still has not been any scientific analysis of the contaminants in the air, soil, water and food of the Aral Sea region. The World Bank and UNDP need to integrate their research, for example, the agricultural department has data which the health department has not looked at.

Governments must ensure that policies and programs to fulfill people’s basic needs such as clean water and their right to know what is harmful to their health. It is inappropriate to place trust in a trickle-down approach and more attention must be given to UNICEF’s recommendations and utilizing a bottom-up approach that involves women’s NGOs.

Humanitarian Aid
International agencies, including the World Bank, UNDP and UN, need to create a fund for humanitarian aid to this region. Above all, international agencies need to treat the Aral Sea Basin with the same urgency that they would treat a war or earthquake zone. The Aral Sea region is an environmental disaster area in need of immediate assistance.

Case Prepared by:
Center-Perzent is an NGO based in Nukus, the capital of the semi-autonomous republic of Karakalpakstan in Uzbekistan. The goal of Perzent (a Karakalpak word meaning "progeny") is to unite the strengths of organizations and progressive people seeking to improve the status and health of women and children by empowering local women's groups.

Contact: Dr. Oral Ataniyazova
P.O. Box 27
Nukus-12, Karakalpakstan, Uzbekistan
Tel: (7-361) 227-5517; Fax: (7-95) 251-7617

Women in Europe for a Common Future, an NGO based in the Netherlands, networks women working on environment and health in Western and Eastern Europe and the Newly Independent States. Its primary aims are to link European women’s organizations and networks that promote sustainable development and to strengthen their decision-making power in environmental and health policies.

Contact: Sascha Gabizon
P .O. Box 12111
3501 AC Utrecht, The Netherlands
Tel: (31-30) 231-0300; Fax: (31-30) 234-0878



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