Turkmenistan and the WHO, a Delicate Dance

“From the scientific point of view, it’s unlikely that the virus is not circulating in Turkmenistan,” a WHO senior emergencies officer, Catherine Smallwood, told the BBC in November, referring to the novel coronavirus. As the BBC report notes: “Smallwood’s comments represent the first public challenge by the WHO to Turkmenistan’s claim” that the country has not seen a single case of COVID-19.

Since the start of the COVID-19 pandemic in 2020, Turkmenistan has remained one of just a few countries that have officially registered no cases of the disease, no trace of the virus. Most of the others are small Pacific Island states; North Korea is also in the group.

The case of Turkmenistan highlights the position international institutions like the World Health Organization find themselves in – and find themselves harshly criticized for. When asked by the BBC if Turkmenistan was providing false data, Smallwood – who led a WHO delegation to Turkmenistan in July 2020 – demurred. She said the WHO could not “call into question whether a country is acting in the spirit of the International Health Regulations.” Smallwood emphasized that it was important to “build a dialogue” and pointed to Turkmenistan’s policy evolution with regard to mask-wearing as positive developments.

Early in the pandemic, Turkmen authorities issued fines to those wearing face masks, claiming that they were “trying to create a panic,” as one Turkmen told The Diplomat in August 2020. That policy reversed following the WHO’s visit in July, with masks mandated and social distancing encouraged. There were always reasons for the policies but never the truth: Turkmen authorities justified the mask mandate by citing toxic dust.

The WHO officials’ recent comments, as the BBC titled its article, “cast doubt” on Turkmenistan’s claims. But did anyone outside of Turkmenistan seriously believe those claims? The answer is no; but less is known about what those inside Turkmenistan, the people directly affected by the government’s policies and claims, believe. It’s hard to imagine how lying about the reality of the pandemic can lead to anything but confusion.

It’s hard to also fathom how the WHO could criticize Turkmenistan as sharply as many would hope and also continue to work with the country.

While the Turkmen government has maintained its COVID-free claims, it has also engaged with initiatives to access vaccines, received a $20 million World Bank loan to address the health and social impacts of the pandemic, and was the first country in the world to mandate that all adults be vaccinated.

Although a planned second mission to Turkmenistan by the WHO never happened, the organization’s engagement with the country has continued.

In August 2021, the WHO held a training course in Ashgabat focused on “new guidelines and technologies for the systematic collection of epidemiological data relating to influenza, acute respiratory infection (ARI) and COVID-19.” This followed the delivery of new laboratory equipment specifically to expand testing capacity for COVID-19.

According to the WHO, in 2020-21 Turkmenistan received around $2.8 million in supplies and equipment “to ensure that health agencies are prepared for the spread of acute respiratory infections, including COVID-19.”

In October, WHO Regional Director for Europe Hans Kluge did visit Turkmenistan to address a forum on infectious disease control. Kluge highlighted the importance of primary care and the need to invest in health care infrastructure.

According to the WHO’s press release about the visit, Kluge “also underlined that transparent communications are vital at all levels, from the community up.”

An organization like the WHO engages in a difficult and delicate dance to maintain workable relations with a government as autocratic, insular, and eccentric as Turkmenistan’s. But at the end of the day the WHO has to deal with Turkmenistan as it is, as difficult as that may be – and leave the much-deserved sharp critiques for others to make.