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Uzbekistan - Health and safety
With Dr Felicity Nicholson
Comprehensive travel insurance should be high on your list when you contemplate travelling to Uzbekistan. Choose a policy that includes medical evacuation (Medevac) and make sure you fully understand any restrictions: it is not uncommon for insurance companies to exclude certain activities (including mountaineering and skiing) from cover. Leave a copy of the policy documents at home with someone you trust, and keep a copy of your policy number and the emergency contact number on you at all times. Your GP or a specialised travel clinic will be able to check your immunisation status and advise you on any additional inoculations you might need. It is wise to be up to date on tetanus, polio and diphtheria (now given as an all-in-one vaccine, Revaxis, that lasts for ten years), and hepatitis A. Immunisations against meningitis and rabies may also be recommended depending on the duration of your stay and the sort of activities you will be undertaking.
Hepatitis A vaccine (Havrix Monodose or Avaxim) comprises two injections given about a year apart, though you will have cover from the time of the first injection. The course typically costs £100 and, once completed, gives you protection for 25 years. T e vaccine is sometimes available on the NHS. Hepatitis B vaccination should be considered for longer trips (two months or more) and by those working in a medical setting or with children. The vaccine schedule comprises three doses taken over a six-month period, but for those aged 16 or over it can be given over a period of 21 days. T e rapid course needs to be boosted after one year. A combined hepatitis A and B vaccine, ‘Twinrix’, is available, though at least three doses are needed for it to be fully effective. The newer injectable typhoid vaccines (eg: Typhim Vi) last for three years and are about 85% effective. Oral capsules (such as Vivotif) may also be available for those aged six and over. Three capsules taken over five days last for approximately three years but may be less effective than the injectable version.
Typhoid vaccines are particularly advised for those travelling in rural areas and when there may be difficulty in ensuring safe water supplies and food. A meningitis vaccine (ideally containing strains A, C, W and Y) is recommended for all travellers, especially for trips of more than four weeks. A single dose of the meningitis Menveo vaccine costs around £65. Rabies is not particularly prevalent in Uzbekistan but vaccination is highly recommended for those travelling more than 24 hours from medical help or who will be coming into contact with animals as there is unlikely to be treatment available within the country. Although the vaccination does not protect completely against rabies, it reduces the amount of post-exposure treatment required and gives you a longer period in which to find help. Three doses of the vaccine need to be administered over a 21-day period and will cost a total of £100–150 depending on the brand of vaccine used. There is a small risk of tick-borne encephalitis, a viral infection spread by infected ticks, which is most common between April and September. If you intend to go trekking in forested areas during these months, then it would be wise to get immunised. The vaccine is not readily available in the UK, but can be obtained on a named-patient basis from some travel clinics. However, even if you are unable to get the vaccine there are some sensible precautions you can take such as wearing long-sleeved tops and trousers with socks tucked into boots. The risk of malaria is low in Uzbekistan, so there is no need to take antimalarials. While pharmacies in Uzbekistan are numerous, especially in the main cities, and some are well equipped, you should still pack a first-aid kit (a comprehensive kit is essential for trekkers and others visiting remote areas) and any prescription medicines you require.
Travel clinics and health information
A full list of current travel clinic websites worldwide is available on www.istm.org. For other journey preparation information, consult www.travelhealthpro.org.uk (UK) or http://wwwnc.cdc.gov/travel/ (US). Information about various medications may be found on www.netdoctor.co.uk/travel. All advice found online should be used in conjunction with expert advice received prior to or during travel.
The UK’s Foreign and Commonwealth Office (FCO) generally considers Uzbekistan to be a safe place for foreigners to travel. They regularly update their travel guidance, and the latest advice for Uzbekistan is available online at www.fco.gov.uk. The FCO advises caution when travelling to border areas, in particular the border between Uzbekistan and Afghanistan, as there is a threat of land mines. These regions can also be flashpoints for inter-ethnic violence, as was seen in the Fergana Valley in July 2010. Such violence is not typically targeted at tourists, but there is a risk of being caught up in the upheaval There is also an underlying threat from terrorism. Attacks could be indiscriminate, including in places visited by tourists. Security has been increased at airports and railway and metro stations as a result of the bombing at Moscow Airport in January 2011, with an increased police presence and the introduction of X-ray machines. You are expected to show your passport when entering metro stations, and the use of cameras (including camera phones) is prohibited. Some visitors have been victims of petty crime, particularly mugging and pickpocketing, and a high number of visitors experience low-level corruption from traffic police and other officials. The latter is irritating more than dangerous, and can often be averted by requesting a receipt or refusing to hand over documents or cash on the street. Ask to be taken to the police station instead. Uzbekistan is seismically active, and there is therefore a risk of earthquakes. On 20 July 2011 an earthquake measuring 6.2 on the Richter scale hit Batken, just across the Uzbek border with Kyrgyzstan, and tremors were felt in Tashkent. A number of deaths and injuries were reported.
Uzbekistan is generally a safe country for women to travel in, and there are no specific legal or cultural restrictions imposed on women (either locals or foreigners). The social conditions of women improved significantly during the Soviet period, and the enrolment of women in education and in the workplace remains high.
Women should, however, exercise the usual personal safety precautions. Particular caution should be taken when hailing taxis: in Tashkent, phoning for a cab, or getting the establishment you are in to do this for you, is probably a safer option.
Unaccompanied women may receive unwanted attention in bars and clubs but this is usually deflected with a few terse words. If the harassment continues, alert the management or leave the premises and find a more pleasant alternative. Try to avoid physical confrontation, as alcohol-fuelled violence and being tailed home are not uncommon. Domestic violence is high in Uzbekistan, as it is across central Asia. There have been suspected cases where ‘date rape’ drugs have been used; keep a close eye on your drink, and do not accept drinks from strangers. You should dress modestly, especially in conservative rural areas and in the Fergana Valley where religious sentiments often run high.
Homosexuality is illegal in Uzbekistan and Article 120 of the country’s penal code punishes voluntary sexual intercourse between two men with up to three years in prison. Sexual intercourse between two women is not mentioned in the code.
Many people in Uzbekistan are deeply conservative, especially when it comes to the issue of sexuality, and homosexuality is still often seen as a mental illness (a hangover from the Soviet period). Muhammad Salih, leader of the People’s Movement of Uzbekistan, said publicly in 2012: ‘I support a civilised way of isolating gays and other sick members of society so that they could not infect healthy people with their disease.’ Sadly, his views are widely shared. Homosexuals in Uzbekistan regularly experience harassment, including from the police; gay-friendly establishments are heavily monitored by the police and are often forced to close; and police detention and the threat of prosecution are regularly reported.
If you are travelling with a same-sex partner, you should refrain from public displays of affection and be exceptionally cautious when discussing your relationship with others: it is often simplest to allow others to assume you are simply travelling with a friend. Double rooms frequently have twin beds, so asking for one room is unlikely to raise eyebrows in any case.
Travelling with a disability
Travellers with disabilities will experience difficulty travelling in Uzbekistan. Public transport is rarely able to carry wheelchairs, few buildings have disabled access, and streets are littered with trip hazards such as broken paving, uncovered manholes and utility pipes. Hotel rooms are often spread over multiple floors without lifts and assistance from staff is not guaranteed. If you have a disability and are travelling to Uzbekistan, you would be advised to travel with a companion who can help you when the country’s infrastructure and customer service fall short.
Travelling with children
This is relatively easy given Uzbeks’ focus on family life. Children are welcomed in restaurants and shops but you may have difficulty manoeuvring pushchairs in and out of buildings and along broken pavements.
Nappies, baby food and other similar items are available in supermarkets and larger stores, but you are unlikely to find European brands. There have been a number of scandals in recent years relating to the potentially toxic content of Chinese-made baby milk powder and, as many of the brands involved are for sale on shop shelves in Uzbekistan, you should stay on the safe(r) side and purchase Russian or European-made brands instead. The quality control is slightly higher. Journeys by car and public transport are often long and uncomfortable, and food supplies erratic, which may deter families with younger children travelling beyond Tashkent and the main tourist sites. Ensure you stock up with plenty of snacks before leaving a town, and take plenty of entertainment options along for the ride.