Turkmenistan has reported no cases of coronavirus – why?

As the Covid-19 map fills up with more and more red circles, several countries still haven't registered a single case of infection. One of these is the most repressive states in the world - Turkmenistan. Many experts are concerned that its government may be hiding the truth, which could disrupt attempts to end the pandemic.

Turkmenistan

While the rest of the world world is battling the novel coronavirus, Turkmenistan is holding a mass cycling rally to mark World Health Day on Tuesday. In contrast to other countries going in lockdown, this sovereign country in Central Asia claims to have zero coronavirus cases. But can we trust the figures provided by a government renowned for censorship?

“Official health statistics from Turkmenistan are notoriously unreliable,” said Professor Martin McKee from the London School of Hygiene and Tropical Medicine, who has studied the Turkmen healthcare system.

“For the past decade they have claimed to have no people living with HIV/Aids, a figure that is not plausible. We also know that, in the 2000s, they suppressed evidence of a series of outbreaks, including plague.”

Many in Turkmenistan are fearful of even suggesting of COVID-19’s possible presence in the country. “My acquaintance who works in a state agency told me that I shouldn’t say that the virus is here or that I heard about it, otherwise I may get into trouble,” said a resident of the capital Ashgabat, who asked to remain anonymous.

In February, Turkmen hospitals did have posters about coronavirus but they were removed

The role of the government of Turkmenistan

Authorities in Turkmenistan are, however, working on tackling a possible coronavirus outbreak. Sources say that they are discussing a plan of action together with UN agencies in the country. The UN Resident Coordinator, Elena Panova, told the BBC that this plan included country level coordination, risk communication, case investigation, laboratory diagnostics and other measures.

When asked whether the UN trusted the official figures showing Turkmenistan had no confirmed Covid-19 cases, Ms Panova avoided giving a straight answer. “We are relying on official information because this is what all countries are doing,” she said. “There is no question of trust because that’s the way it works.”

Ms Panova further explained that early measures on restricting travel might have contributed to lack of confirmed cases. Indeed, Turkmenistan closed most of its land border crossings over a month ago. It also cancelled flights to China and some other countries in early February. Infact, it started diverting all international flights from the capital to Turkmenabat in the north-east, where a quarantine zone was created.

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However, some residents confirm that people were able bribe their way out of the zone and avoid two weeks of isolation in a tent. Ms Panova admitted that everyone arriving in the country and those showing symptoms were being tested for Covid-19. However, there are no exact figures of how many tests were conducted a day or how many test kits Turkmenistan had overall. “What we understand in talking to government officials is that they have sufficient tests.”

But how ready is their health system to deal with a coronavirus outbreak?

“We don’t know,” Ms Panova admitted. “We’ve been told that they have a certain level of preparedness and we don’t doubt it… as the hospitals here are very well equipped.” “However, if there is an outbreak that’s a huge pressure on the health system like in any other country. So, irrespective of how much you’ve prepared, it usually is insufficient. That’s why we’re already talking to them about procuring ventilators, and also other types of equipment.”

Surprisingly, there is some sense of awareness of the outbreak among the public. Movement between cities has been restricted and those who enter Ashgabat must now have a doctor’s note. Markets and offices are being fumigated with smoke from a type of grass called yuzarlik, used in herbal remedies. Turkmen President Gurbanguly Berdymukhamedov announced that burning it would ward off the virus – despite there being no evidence.

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However, unlike the rest of the world, daily life in Turkmenistan continues unfettered. Cafes and restaurants remain open. Crowds gather for weddings. Nobody wears protective gear. It appears that the country is in denial of accepting the deadly contagion as a threat to their wellbeing.

Why might that be? The World Health Day mass cycle may provide an explanation.

President Berdymukhamedov is the biggest star and centerpiece of the annual event. An image of health is part of his cult of personality. State TV regularly shows him lifting weights in the gym, or cycling on his bike. He is promoting of “health and happiness” campaigns, which show state employees wearing identical uniforms and performing morning exercises.

The whole purpose is portray the picture of a healthy and happy, thanks to the president. Mr Berdymukhamedov proclaimed his presidency as the “era of might and happiness”. And an outbreak of Covid-19 could expose his hollow messages.

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The Turkmen government might try to conceal an outbreak for this reason; even if it puts the citizens at a risk of infection. And that is what worries Professor McKee. “We have seen how the COVID-19 infection moved rapidly from China to all parts of the world. In this globalised economy that we now live in, every country is only as secure as the weakest country in the world,” he said.

“Even if other countries manage to get the epidemic under control, there is a risk of continued seeding of infections from those countries that have failed to. It seems that Turkmenistan may well be another example.”

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