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ABSTRACT
The history of the Fergana Valley in 1917-1924 is characterized by famine, increasing epidemics, war, and the collapse
of the national economy due to the policy of military communism of the Soviet authorities. These factors forced the
people to go through a whirlwind of unprecedented difficulties. In the Fergana region, epidemics of perspiration,
malaria, cholera, influenza, and plague spread and the spread of syphilis, tuberculosis, smallpox, and other infectious
diseases intensified in the conditions of increased famine. As a result, a major health crisis occurred in the region.
KEYWORDS
Soviet power, public health, famine, epidemics, new economic policy, malaria, cholera, sweating disease.
INTRODUCTION
The February Revolution and the October Coup d'état
in Russia in 1917 had an impact on Turkestan and
started a new era of Russian colonial policy. After the
February Revolution, power passed to the Provisional
Government. The Turkestan Committee, approved by
the Provisional Government on April 7, 1917, continued
the colonial policy in Turkestan. The Provisional
Government did not want to change the policy of the
Russian Empire towards Turkestan. For this reason, the
management staff was left almost unchanged. After
the October coup of 1917, on November 1, 1917, the
Soviet power was established in Tashkent. The Soviet
Research Article
HISTORY OF THE HEALTH CARE SYSTEM OF THE COUNTRY OF
TURKESTAN IN 1917-1924: ON THE EXAMPLE OF THE FERGANA REGION
Submission Date:
June 20, 2023,
Accepted Date:
June 25, 2023,
Published Date:
June 30, 2023
Crossref doi:
https://doi.org/10.37547/ajsshr/Volume03Issue06-18
Rukhiddin Kh. Patkhiddinov
Doctoral Student, Namangan State University (Namangan, Uzbekistan)
Journal
Website:
https://theusajournals.
com/index.php/ajsshr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
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authorities established state control over the health
care system, as well as over other areas of society. In
1918-1921, the Soviet government implemented a
number of positive changes in the health care system.
In particular, the training of medical staff from the local
population was started, the production of several
types of medicines was started in Turkestan itself, the
total number of treatment places increased by turning
part of the military infirmaries into hospitals and
increasing the number of treatment places in the
existing hospitals. However, the measures taken were
not enough due to the increase of famine and
epidemics in Fergana region. Following the
announcement of the New Economic Policy in 1921, in
1922 health care costs were transferred to local
budgets. As a result, health care facilities fell into a
difficult situation.
Materials and methods. The article uses scientific
research published in the Soviet era and the years of
independence, materials of the National Archives of
Uzbekistan and the State Archives of Fergana region,
news published in the newspapers "Izvestiya TurTsIK",
"Krasnaya Fergana".
The research was conducted based on the principles of
objectivity and historicity, using the methods of
analysis, synthesis and logic.
Discussion. The February Revolution of 1917 in Russia
also had a great impact on the Turkestan region. The
Bolsheviks, who came to power, began to seize cotton
and food products and livestock from the peasants
without any payment, based on the policy of military
communism. As a result, arable land was reduced and
famine began. Together with the famine, epidemics of
malaria, cholera, and perspiration sicknesses spread in
the country, and the spread of smallpox, skin diseases,
and stomach diseases intensified. In this situation, the
provision of medical assistance by the state to the
population was not sufficient at all. The horrors of
famine and epidemics in the Fergana Valley during the
years of Soviet power in Uzbekistan were not covered.
The establishment of Soviet medicine in the region was
positively evaluated in the works of Soviet-era
researchers, A.I. Pogosyants, M. Makhmudov and
other researchers. An opportunity to objectively
approach the issue appeared in the studies created
after Uzbekistan gained independence. The issues of
famine in the region were highlighted in the studies of
V. Semenyuta and M. Rakhmatov, the achievements
and problems of the Soviet healthcare system were
shown while in the studies of G. Mominova and G'.
Karomov.
Results. During the reign of the Russian Empire,
Fergana region was specialized in cotton cultivation.
The grain needed for the region was imported from the
central regions of the Russian Empire. But when the
First World War began, food prices rose and famine
began in Fergana province. During the terrible winter
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of 1917-1918, the population was killed here like flies...
there was no one to collect the corpses, their remains
from dogs and wolves were found at every step, the
remains of the poor people were collected only in 1919.
[Semenyuta: 7]. N.Khojaev, who studied the issue of
food supply to the population with the support of the
Turkestan Central Executive Committee, said at the
government meeting: "The villagers were satisfied
with different types of grass and weeds, because of
this there are deaths, especially among children." In
Fergana region, 35-40 percent of the population,
including 60 percent in Margilon uyezd, 50 percent in
Kokand uyezd, are facing famine [Mo‘minova: 61]. The
famine that began in 1917 in Fergana region left behind
a great complication in 1918-1919. As a result of the
measures taken, the number of famines in 1920
decreased significantly. However, in 1921 - 1923, the
famine in the valley continued on a larger scale.
[Rakhmatov: 83] In the winter of 1921 and March 1922,
hunger and devastation intensified. Not only in
villages, but also in cities and large settlements, one
could see cases of people begging for bread. In 1921-
1923, as a result of people eating various things,
especially plants, various diseases and deaths among
children increased. In 1921-1922, as a result of famine
and malnutrition, skin, eye and stomach diseases, as
well as malaria due to the climate, increased. According
to accounting books, more than 1 million people died in
Fergana region in 1917-1923 due to famine, disease and
war.[ NA Uz, 108: 200-201] As a result, the population
of Fergana region dropped from 2,700,000 before the
First World War to 1,600,000.
Malaria, cholera, and perspiration epidemics occurred
in Fergana region under conditions of increased
famine. Due to the fact that hospitals were located in
cities, the inner regions of uyezds were cut off from
medical care. As a result, local health departments and
the People's Commissariat of Health of Turkestan did
not have accurate statistics on the spread of infectious
diseases in the region. The cited statistical data
indicated only the regions where hospitals were
located and the number of people who applied to the
hospital. As a result of the lack of hospitals and
available treatment facilities, the majority of the local
population did not seek medical care. In 1922, only 11.4
percent of the population in Fergana region applied to
state medical institutions.[ NA Uz, 1821: 125]
There was a lack of hospitals, dispensaries, medical
staff and medicine to establish a health care system in
Fergana region. The Soviet government initially tried to
solve the shortage of medical personnel by recruiting
medical personnel from among the prisoners of war
sent to Turkestan and training medical personnel from
the local population. In particular, on March 25, 1917, by
the order of the Intendant of the Turkestan military
district, paramedics who were prisoners of war were
provided with allowances and made equal to the rank
of junior paramedics. [NA Uz , 1: 24] On April 14, 1919,
Health Committee of Turkestan published the list of
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foreign doctors in "Izvestia" newspaper and decided
that all pharmacies could be given medicines based on
their prescriptions. [NA Uz, 138: 146] However, the
shortage of medical personnel increased due to the
return of foreign doctors to their homeland and the
death of medical personnel due to epidemics. If
medical staff fell ill, there was no reserve staff to
replace them. 25 percent of medical workers died
during the epidemics as a result of the harsh working
conditions of medical workers and insufficient material
support. [NA Uz, 17: 2] For example, during the
sweating epidemic, 50% of medical workers got sick
from sweating, and 25% of them died. The fact that the
death rate of patients from other professions was 8-9
percent indicates that the financial situation of medical
workers was difficult.[10] According to the letter of
Fergana regional health department to Turkestan
People's Commissariat of Health on August 2, 1921,
several hospitals were left without doctors due to the
departure of foreign doctors from the region and the
death of several medical workers. In particular, only 16
doctors worked in 32 hospitals and 28 outpatient clinics
operating in Fergana region. Due to the shortage of
doctors and experienced medical assistants, the
provision of medical care to the population was
transferred to inexperienced medical assistants
trained during the military era, gradually causing
dispensaries and even hospitals to cease functioning.
There were no doctors left in hospitals belonging to
large enterprises such as Kyzylkiya, Chimyon, Suyukta,
Santo. There was only one doctor and two medical
assistants in the 110-bed surgical hospital in Kokand.
One doctor had to fulfill the duties of chief, consultant,
and ordinator. Although the Fergana Regional Health
Department requested to send doctors many times,
the Turkestan People's Commissariat for Health did not
fulfill these requests. The 3 doctors sent on September
5, 1921 also returned a month later. [NA Uz, 159: 79] As
of March 30, 1921, there was a city hospital with 100
beds, a women's hospital with 20 beds, a therapist's
hospital with 60 beds, a maternity hospital with 30
beds, a hospital for ear, throat, and nose diseases with
40 beds, barracks for infectious diseases with 55 beds,
and a children's hospital with 40 beds. In the city of
Kokand, 10 doctors were required for the regional
health department, 7 for hospitals, 3 for sanitary-
epidemiological control, 3 for schools, and 2 for
sanitary-educational work, out of a total of 18 doctors.
[NA Uz, 190a: 1420]
On June 6-9, 1921, the shortage of doctors was noted
at the meeting of healthcare departments of the
Turkestan region, which was held in Tashkent. The
situation was especially difficult in Fergana region and
Mirzachul district. The shortage of medical personnel
could be eliminated only by attracting doctors from the
center.
[Izvestiya,
1921:
135]
Russian
health
commissioner, Semashko promised to send 150
doctors to Turkestan, but 15 doctors were sent from
the center. [Izvestiya, 1921: 154]
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Some of the medical workers in Fergana region were
forced to engage in other professions due to poor
financial conditions. Owing to the shortage of medical
personnel, the Soviet government decided to forcibly
return them to the medical field. Pursuant to the order
No. 290 of the Turkcommission of the All-Russian
Central Executive Committee and Turkestan Council of
People's Commissars dated December 27, 1921, the
Fergana Regional goverment made a decision on
January 23, 1922 to return all medical personnel to
medical institutions regardless of their position. [SA
FR, 140: 1]
The main difficulties in the organization of health work
arose due to insufficient funds allocated to the sector,
insufficient material and technical base. It was noted at
the meeting of health departments of the Turkestan
region on June 6-9, 1921 that the health care system in
the Turkestan region was in a difficult situation.
Hospitals were in disrepair, and there was a serious
shortage of farm inventories. The situation in the
Fergana Valley was extremely difficult. As a result of
the lack of fuel for the baths, the itch disease increased.
The number of sanitary workers was very small, and
those who were there left because of the workload.
Due to the lack of fuel supply to hospitals, the places
could be reduced twice during the autumn-winter
season. [NA Uz, 41: 15]
Following the announcement of the new economic
policy in 1921, medical institutions were transferred to
local budgets. After the transition to local funding, it
soon became clear that local governments were
against allocating funds for public health needs, even
at the behest of party and state leaders. At the
beginning of politics, Semashko, the head of the health
department, sent a telegram to all regional executive
committees, asking for special tax breaks for health
departments, but to no avail. Due to the
implementation of the new economic policy and the
transition of all budgetary organizations to self-
financing, local medical organizations had to pay for
electricity, fuel, transport, fodder and other services,
which placed an insurmountable burden on health
departments. Because the budget funds for 1921 did
not allocate credits for these expenses. In early 1922,
the Turkestan Health care Committee was faced with
the impossibility of implementing expansion plans and
created a reduction scheme that included the partial
reintroduction of fees for certain types of medical
services. The new health commissioner, Nikolay
Gelfgot warned the Soviet National Economy
Committee that a sharp reduction in minimum services
to the population could increase epidemic diseases,
endemic diseases of the local population, "social
diseases" (tuberculosis, venereal diseases), and at the
same time lead to "degeneration" of the population.
[Cavanaugh: 169 -170 pages] In all regions, medical
institutions were seriously reduced due to the fact that
the possibilities were not taken into account when
transferring them to the local budget. During the first
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two and a half months of 1922, the Fergana Health
Department received no help from higher authorities.
As a result, medical workers began to leave their jobs.
Although it was provided with some money in April, it
did not last long. Medical workers were not adequately
supplied with food: 50 percent of the designated flour
and 30 percent of rice were given, nothing else. [NA
Uz, 92: 277] As of May 1, 1922, the health department of
Namangan district owed employees 1,280,000,000
rubles. As a result, some of the medical workers did not
go to work, and some of them were kept by the 100
million rubles given to the department. In Margilan
uyezd, due to non-payment of salaries during the first
three months of 1922, medical workers went hungry
and cases of patients' belongings were stolen. There
was a serious lack of inventory in hospitals. 75 percent
of the beds were unusable, and there was no spare.
Medical workers in Osh uyezd were in a difficult
situation due to non-payment of salaries for 3 months.
The hospital in Gulchin was about to be closed, but it
was financially supported by the initiative of the
population. [NA Uz, 138: 131]
In Fergana region in June-July 1922, only a few uyezds
were able to provide funds for hospitals. If the
executive committees of Osh, Namangan, and
Margilan districts did not refuse to provide funds, in
practice, hospitals were not given funds at all. From
October 1, 1922, the hospitals were cut off from the
state food supply, which aggravated the situation.
Cases of medical workers' strikes increased. [NA Uz,
138: 106] The greatest reduction in medical facilities
occurred from June 1, 1922 to January 1, 1923. During
this period, rural district medical institutions decreased
by 51.6%, and urban medical institutions decreased by
44.6%. The population per place was 379 people in 1922,
and 1270 people on January 1, 1923. [NA Uz: 416: 149]
In the Soviet era, health care was viewed as a
secondary issue in Turkestan. Limited funds were
allocated to health care. In particular, 327,701 rubles,
i.e. 5% of the total budget, were allocated to the
Turkestan SSR from the state budget of the 1923-1924-
economic year. In the same period, 1,572,034 rubles,
10.5% of the total budget, were allocated to the health
sector from the local budgets of 5 regions of
Turkestan. Due to lack of attention, health care in the
country has gone backwards instead of progressing.
Only in 1923-1924, hospital beds in the country
decreased from 3,492 to 2,359, that is, by 32.5 percent.
In rural areas, hospitals shrunk by 40 percent. In 1923-
1924, the number of district hospitals in villages
decreased from 64 to 36, and the number of beds in
them decreased from 648 to 380. Fergana region had
18,000 inhabitants per place. There were no sanitary
organizations for preventive purposes in the entire
Turkestan SSR. Also, special medical care was
completely absent in uyezds. Syphilis, eye diseases and
women in labor were left to their own devices. Despite
the limited number of district hospitals in the villages,
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the qualifications of medical personnel serving in them
were low. Many hospitals were run by medical
assistants due to low pay. [NA Uz, 443: 229]
On April 27, 1923, the plenum of the Fergana
government came to the conclusion that health care in
the region is in an extremely difficult situation. A
number of measures are proposed to improve the
situation. In particular, in order to attract specialist
doctors to Fergana region, their salaries would be
increased to the maximum. In his letter to the
Turkestan Healthcare Committee dated May 14, 1923,
he asked to send experienced pediatricians,
ophthalmologists, therapists, bacteriologists and
sanitary doctors to work in Fergana region, and a
monthly salary of 60-70 gold rubles was set for the
doctors. [NA Uz, 389: 17-18] But due to financial
difficulties, this decision was not fully implemented. In
April 1924, reductions were made among medical
workers in Fergana region. Although the reduction was
carried out, the financial situation of the medical staff
did not change at all. The efforts of the Soviet
authorities to train medical personnel from the local
population did not bring any results. In October 1923,
there were no representatives of the local population
among the medical workers in the Fergana region. Only
two people were trained for clerical work. [SA FR, 10:
42-46]
By 1923, a number of problems had accumulated in
medical institutions. In all hospitals, patients were fed
wrongly, patients were not properly triaged, and
medical histories were filled superficially. One of the
main reasons for the chaos in the economic-
management and treatment-sanitary side of medical
institutions was the lack of management capacity of
the heads of uyezd health departments, district
hospitals and the Osh uyezd-city hospital were
managed by medical assistants, while the uyezd
hospitals were managed by young, inexperienced
doctors.
CONCLUSION
The increase in famine and epidemics in Fergana region
led to a health crisis. Although the Soviet authorities
implemented organizational and structural changes in
the health care system, the provision of medical
services to the population was not improved. Hospitals
were destroyed in the fighting between the Red Army
and the armed resistance movement in the province,
and there was a serious shortage of medical staff,
medicine, and medical supplies. This caused the death
of 40 percent of the population of the Fergana region.
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