TURKMENISTAN: DOCTORS WITHOUT BORDERS STILL

1. (SBU) We met December 21 with Tim Baerwald and Silvia De
Weerdt, Head of Mission and Medical Coordinator,
respectively, for Medecins Sans Frontieres (MSF - Doctors
Without Borders). Baerwald and De Weerdt are in Ashgabat for
a six week-period to try to conclude negotiations on an
agreement on multiple-drug resistant TB and thereby extend
MSF's work in Turkmenistan. Negotiations on this agreement
have been ongoing since late 2008. The other projects MSF
had been working on ended in September.



2. (C) Baerwald and De Weerdt said MSF decided to issue a
press release on the organization ending its medical
activities in an effort to attract further international
support to keep them in the country. MSF is the only
international humanitarian NGO in Turkmenistan. The item
that is preventing reaching an agreement is that the
Turkmenistan government does not want MSF to work directly
with patients. However, MSF's mandate requires that it not
only have direct access to patients, but that it also provide
public reports on its findings. MSF wants to continue its
work, because medical needs in the country are high, Baerwald
said, especially in regard to multi-drug resistant TB.



3. (C) Baerwald met with Deputy Chairman for Health and
Education Hydyr Saparlyev, who was resistant to their
proposals. Following that meeting, MSF received a diplomatic
note, asking it to provide technical assistance to the
Turkmenistan government. MSF has rejected that proposal,
because it would not involve patient access. Saparlyev's
office then referred MSF to the Ministry of Health for
further discussions. Nevertheless, MSF has yet to receive a
response to the letter it sent formally requesting a meeting
with the Minister of Health.



4. (C) COMMENT: In our view, the departure of MSF will be a
shame. They have done good work on health in a country which
has sorely needed assistance in that area. Nevertheless, we
hold out little hope that they will reach agreement with the
Turkmen. In fact, it seems to us that the request for
technical assistance is the official Turkmen response,
designed to keep MSF here, without violating Turkmen
redlines. The Turkmen government does not want foreigners
working directly with patients, observing illness, and then
reporting the extent of health problems in the country. The
government response to the recent H1N1 outbreak was to
declare it did not exist in the country. Doctors are loathe
to report incidence of serious illness (or even treat some
patients with serious illness) for fear that they will be
blamed when unpleasant statistics are reported for their
hospitals. This fact we learned from MSF sources.



5. (C) COMMENT CONTINUED: It is likely that the Deputy
Chairman's referral of MSF to the Minister of Health, his
subordinate, is a dodge. The Minister of Health has less
power than his boss. Given that there is little room to give
on both sides, we doubt that the request for the meeting
comes through before the six-week clock runs out on this
couple's TDY or if it does, that it brings any change. END
COMMENT.
CURRAN