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History of healthcare in Karakalpakstan in 1917
–
1924
Medetbay TORENIYAZOV
1
Nukus State Pedagogical Institute
ARTICLE INFO
ABSTRACT
Article history:
Received May 2025
Received in revised form
15 June 2025
Accepted 25 June 2025
Available online
15 July 2025
This article examines the early development of the
healthcare system in Karakalpakstan between 1917 and 1924, a
period marked by the Russian Revolution, Civil War, and the
establishment of Soviet administration. Drawing upon archival
materials, published research, and contemporary accounts, the
paper outlines the state of medical services prior to Soviet rule,
the impact of political upheaval, and the first measures to
organize public health infrastructure in the region.
2181-
1415/©
2025 in Science LLC.
DOI:
https://doi.org/10.47689/2181-1415-vol6-iss6/S-pp501-505
This is an open access article under the Attribution 4.0 International
(CC BY 4.0) license (https://creativecommons.org/licenses/by/4.0/deed.ru)
Keywords:
Karakalpakstan,
healthcare history,
Russian Revolution,
public health,
Soviet medicine,
Central Asia.
1917
–
1924-
yillarda Qoraqalpog‘istonda sog‘liqni saqlash
tarixi
ANNOTATSIYA
Kalit so‘zlar
:
Qoraqalpog‘iston,
sog‘liqni saqlash tarixi,
Rossiya inqilobi,
jamoat salomatligi,
sovet tibbiyoti,
Markaziy Osiyo.
Ushbu maqolada Rossiya inqilobi, fuqarolar urushi va sovet
boshqaruvining o‘rnatilishi bilan bog‘liq 1917–
1924-yillarda
Qoraqalpog‘istonda sog‘liqni saqlash tizimining dastlabki
rivojlanishi ko‘rib chiqiladi. Maqolada arxiv materiallari, nashr
etilgan tadqiqotlar va zamonaviy ma
’lumotlarga asoslanib,
Sovet hokimiyatigacha bo‘lgan davrda tibbiy xizmatning holati,
siyosiy inqilobning ta’siri va mintaqada sog‘liqni saqlash
infratuzilmasini tashkil etish bo‘yicha birinchi chora
-tadbirlar
bayon etilgan.
1
Assistant teacher, Nukus State Pedagogical Institute.
Жамият
ва
инновациялар
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Общество
и
инновации
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Society and innovations
Special Issue
–
06 (2025) / ISSN 2181-1415
502
История здравоохранения в Каракалпакстане в 1917–
1924 годах
АННОТАЦИЯ
Ключевые слова:
Каракалпакстан,
история здравоохранения,
Российская революция,
общественное
здравоохранение,
советская медицина,
Центральная Азия.
В данной статье рассматривается раннее развитие
системы здравоохранения в Каракалпакстане в период с
1917 по
1924 год, ознаменованный Российской
революцией, Гражданской войной и установлением
советской администрации. В работе, основанной на
архивных материалах, опубликованных исследованиях и
современных
сообщениях,
описывается
состояние
медицинского обслуживания до советской власти, влияние
политических потрясений и первые меры по организации
инфраструктуры общественного здравоохранения в
регионе.
INTR
О
DU
С
TI
О
N
At the beginning of the 20th century, Karakalpakstan was an economically
underdeveloped and medically underserved territory within the Amu Darya region,
administered successively by the Khanate of Khiva and later by the Russian Empire. The
collapse of imperial governance in 1917, followed by the Russian Civil War and the
establishment of Soviet power, transformed nearly all aspects of social life, including
healthcare. This period laid the groundwork for the gradual institutionalization of Soviet-
style medical services in the Karakalpak region.
M
А
T
Е
RI
А
LS
А
ND M
Е
TH
О
DS
Before the Bolshevik Revolution, healthcare in Karakalpakstan was extremely limited.
The region had no developed hospital infrastructure.
Medical services were largely provided by feldshers (medical assistants),
traditional healers, and itinerant practitioners.
Epidemic diseases such as smallpox, malaria, typhus, and tuberculosis were
widespread.
Maternal and child mortality rates were among the highest in Central Asia.
Under the Russian Empire’s
Turkestan Governorate-General, only sporadic efforts
were made to expand modern medicine into peripheral areas like Karakalpak
settlements along the lower Amu Darya.
R
Е
SULTS
А
ND DIS
С
USSI
О
N
In the early 1920s, Soviet authorities began introducing more structured
administrative measures in the Karakalpak territories to overcome the fragmented and
largely traditional healthcare practices inherited from the Khiva Khanate and the Russian
Empire. A notable milestone was the creation of dedicated health sections (zdravotdely)
within local revolutionary committees, which were tasked with coordinating sanitary
efforts and distributing scarce medical supplies.
By 1922, the People’s Commissariat of Health of the Khorezm People’s Soviet
Republic began regular reporting on morbidity rates, which was a significant step
forward compared to earlier periods when no systematic epidemiological records were
kept. These reports consistently highlighted malaria, typhus, trachoma, and smallpox as
the leading causes of mortality. In response, health departments prioritized three main
directions:
Жамият
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Combating epidemic diseases:
➢
Large-scale disinfection of wells and irrigation canals, often supervised by
sanitary doctors dispatched from Tashkent.
➢
Quarantine measures during outbreaks of typhus and relapsing fever, which
were frequent in 1921
–
1923 due to poor nutrition and population movements.
➢
Distribution of quinine for malaria, though supplies were often insufficient.
Organizing maternal and child healthcare:
✓
The first maternity care points (roditelskiye punkty) were established in Nukus
and nearby settlements to address extremely high maternal mortality rates.
✓
Midwives trained in Tashkent were sent to Karakalpak villages to provide both
delivery assistance and basic hygiene instruction.
Expanding feldsher-midwife stations:
Feldsher stations functioned as the primary medical units providing first aid,
vaccinations, and health education.
By the end of 1924, more than 10 such stations had been set up across populated
areas along the lower Amu Darya, despite chronic understaffing.
Another important aspect was the emphasis on health propaganda. Health workers
conducted lectures at red yurts
–
mobile educational units intended to reach nomadic
and semi-nomadic Karakalpak communities. These red yurts distributed posters and
pamphlets in Karakalpak and Uzbek languages, explaining the benefits of vaccination and
elementary rules of personal hygiene. For many rural residents, this was their first
encounter with modern public health information.
At the same time, Soviet administration faced deep-rooted mistrust among the
local population. Some traditional healers and religious leaders opposed vaccination
campaigns, believing them to be harmful or sacrilegious. Archival correspondence
between Khorezm health officials and the Commissariat of Health of Turkestan ASSR
frequently emphasized the need for patience and cultural sensitivity [1].
Additionally, the period saw the first attempts to train local Karakalpak medical
cadres. Although the majority of doctors were Russian or Tatar, short courses were
organized in Khiva and Turtkul to prepare feldshers and sanitary instructors from
indigenous communities. These efforts were modest in scale but represented an
important precedent for later decades, when medical education in Karakalpakstan would
expand considerably.
Logistical challenges remained persistent. The transportation of vaccines and
medical supplies from Tashkent or Samarkand required crossing hundreds of kilometers
over poor roads or river routes. In winter, ice on the Amu Darya often delayed deliveries.
Health authorities reported cases where quinine shipments spoiled due to prolonged
storage in unheated depots.
Despite such obstacles, the foundations of a public healthcare administration were
laid by 1924:
A centralized reporting system on epidemic conditions.
A rudimentary network of feldsher and maternity points.
The first vaccination and disinfection campaigns.
The beginnings of local cadre training.
The development of health propaganda targeted at reducing illiteracy and
superstition.
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These initial structures were still fragile, but they demonstrated a clear shift away
from sporadic medical assistance toward systematic public health policy. In subsequent
years, especially after the creation of the Karakalpak Autonomous Oblast within the
Kazakh ASSR, these efforts would intensify as part of the Soviet modernization drive
across Central Asia [2].
Another critical dimension in understanding the early Soviet healthcare system in
Karakalpakstan between 1917 and 1924 is the interplay between economic hardship,
demographic shifts, and the struggle to establish new public health practices among
traditionally semi-nomadic communities.
During this period, the region faced severe economic dislocation. The collapse of
the Khiva Khanate’s feudal administration and the impact of the Russian Civil War
created widespread poverty and food shortages. Many Karakalpak households relied on
fishing, limited agriculture along the Amu Darya, and animal husbandry, all of which
were disrupted by instability and requisitioning policies. Chronic malnutrition weakened
immunity and made the population more susceptible to epidemics.
The Soviet government, while committed in principle to modernizing healthcare,
struggled with limited fiscal resources. Health budgets in Khorezm were a fraction of
what was allocated to Turkestan’s more developed areas such as Tashkent and
Samarkand. Archival documents show that in 1922 the Khorezm People’s Soviet Republic
devoted less than 2% of its state budget to health services, with Karakalpak districts
receiving only a portion of that amount. Consequently, most feldsher-midwife stations
were poorly equipped, lacking even basic sterilization equipment or steady supplies of
vaccines [3].
An important feature of healthcare development in Karakalpakstan was the need
to adapt medical assistance to nomadic and semi-nomadic lifestyles. Unlike urban
centers, many Karakalpak communities moved seasonally between fishing grounds,
pasturelands, and irrigated fields. This mobility complicated efforts to establish
permanent clinics. To address this, health authorities experimented with mobile medical
brigades
–
teams of feldshers, sanitary instructors, and sometimes Red Cross volunteers
who traveled by boat or cart to remote encampments.
The authorities also experimented with integrating healthcare with broader
educational and economic reforms. For example, in 1923 several experimental “red auls”
were organized
–
semi-permanent villages where health instruction was combined with
efforts to introduce collective farming practices and literacy training. In such auls, health
educators were tasked not only with treating illnesses but also teaching basic sanitation
(boiling drinking water, isolating the sick, cleaning living spaces). While coverage was
modest, these experiments foreshadowed later Soviet attempts to combine medical
services with social engineering [4].
Another priority was maternal and child health. Infant mortality rates were
estimated (based on partial records) to exceed 250 deaths per 1,000 live births
–
among
the highest in the Soviet East. To combat this, Soviet administrators focused on:
Establishing “roditelskiye punkty” (birth points) staffed by midwives.
Providing basic childbirth kits (clean linens, disinfectants).
Training Karakalpak women as auxiliary midwives through short courses in Khiva.
Encouraging breastfeeding and discouraging harmful folk practices during
childbirth.
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The scarcity of qualified personnel remained a persistent problem. Even in 1924,
Karakalpak territories had no more than a handful of formally trained doctors. Most
medical care was provided by feldshers, many of whom had only partial education,
supplemented by short emergency courses in epidemic control.
Despite these challenges, by the end of 1924, observers noted clear progress [5]:
✓
Vaccination rates among settled communities increased.
✓
Infant care initiatives began to reduce neonatal mortality in some districts.
✓
Mobile brigades were better organized and supplied.
✓
The population’s familiarity with Soviet medical practices slowly grew.
This early foundation of modest but systematic health services laid the
groundwork for the more extensive Soviet healthcare campaigns of the late 1920s and
19
30s, when Karakalpakstan’s public health infrastructure would become more robust
and integrated into the broader Central Asian health system.
СО
N
С
LUSI
О
N
The years 1917
–
1924 marked a transitional phase in the history of healthcare in
Karakalpakstan. Under imperial rule, medical services were scarce and mostly
traditional. The revolution and civil war initially worsened conditions, but also paved the
way for a new model of Soviet public health. Despite severe difficulties, this period
witnessed the beginnings of systematic vaccination campaigns, the establishment of
feldsher stations, and the first steps toward creating an organized health system that
would expand in subsequent decades.
RЕFЕRЕNСЕS
1.
Акчурин, Н. И. Очерки истории здравоохранения Туркестана и Средней
Азии.
–
Ташкент: Медицина, 1967.
2.
Руденко, С. И. Каракалпаки.
–
Ленинград: Изд
-
во АН СССР, 1934.
3.
Фёдоров
-
Давыдов, А. А. Туркестан в годы гражданской войны.
–
Москва:
Наука, 1971.
4.
Khalfin, Н. А. Национально
-
государственное размежевание советского
Востока.
–
Москва: Наука, 1975.
5.
Central State Archive of the Republic of Uzbekistan, fond R-245 (Khorezm
People’s Soviet Republic health reports, 1920–
1924).
