From human-rights monitor to health-project coordinator
by Koenraad Van Brabant, HPN November 2012

Koenraad Van Brabant, outgoing HPN Coordinator, interviews Christina ter Braak, MSF-Holland, Uzbekistan

Koenraad Van Brabant Christina, how does a young woman from Holland end up working in Uzbekistan?

Christina ter Braak My first six-month stay in Uzbekistan was in 1996, teaching Dutch and English at Tashkent University. After my Bachelor’s degree, I did a Master’s in development studies. For my thesis – on unemployment in Uzbekistan – I spent another three months there doing research; every single person I spoke to had an opinion on the subject. Subsequently, I applied for a job in the Tashkent office of Human Rights Watch (HRW), and was invited for recruitment tests in New York. But the reply was slow in coming, and I returned to Uzbekistan to work for a Dutch tour company. Some time later, HRW offered me the job, and I worked with them for six months in 1999–2000.

KVB Working with HRW in the field meant you inquired into politically-sensitive matters. Did HRW give you any practical training?

CTB Not really; I had little idea of the structure of the organisation, and never saw anything like a handbook. I was the assistant to the director of the Tashkent office, who was very competent. Practical back-up would also be readily available from New York, but I had no pre-departure training as such.

KVB Was the government open to HRW’s presence?

CTB HRW was registered with the ministries of foreign affairs and justice. Every time HRW produced a report, a copy was given to government officials. Every year, we would also request a meeting with high-ranking officials. Of course, they read or reread our reports before each meeting. Highprofile cases related, for example, to the treatment of local human-rights activists in Uzbekistan would occasionally be discussed.

KVB How, in practical terms, did you go about monitoring the human-rights situation in Uzbekistan?

CTB I wondered about this at the outset, knowing that the government is fairly authoritarian and people are afraid to talk. But you would be surprised how many people came to the office. Families of people who had been arrested were referred to us by local human-rights activists. People also took note of us as we sat in on trials, and would ask who we were and what we were doing, and would contact us at a later date. Those who are harassed or arrested often tend to know each other. Family members of those arrested and local human-rights workers are important contacts, although you need to make a judgement about what you are being told. HRW’s reporting is as objective as possible. Sources are checked extremely thoroughly.

KVB Religious activism is one of the major threats as perceived by the government. What position would you take if you came across an Islamic activist whose human rights were being violated, but who was in fact striving to establish an Islamic state without much respect for human rights or democracy?

CTB Clearly, I cannot and do not talk here on behalf of HRW or MSF, only from my own perspective. But this is certainly an issue, especially since religious movements have been repressed. I would make a distinction between organisations, movements or parties that are prepared to use violence to achieve their goals, and those that aren’t. I would say that someone who expresses his opinion in a peaceful way, and does not forcibly try to make others accept that opinion, cannot be persecuted. I think that there are many people in Uzbekistan who are curious about what is in the Koran, and who want to be good Muslims. They want to know how to pray, how to dress properly, and you can’t refuse them that. Religious activists have that missionary zeal and they want to convert, but not all of them will put a gun to your head to achieve that goal.

KVB What was it like, as a Western woman from a liberal country, to meet devout Muslims, who have different views on the roles of men and women? Was it difficult for them to meet with you, or was it a normal type of interaction?

CTB It was in fact fairly normal. Don’t forget that under Soviet rule men and women interacted in a free and open way. Several people I met admitted to having become religious only in the last few years, but are certainly used to seeing all kinds of people and relationships. For me it is not difficult to communicate; I see through their rhetoric and try to talk in a way that they can understand, I try to indicate that I know a little about their culture and religion. But as soon as it is suggested that I could convert, I explain my background and worldview. In the end, it is a question of being respectful, but also making yourself respected.

KVB Uzbekistan is better off than Tajikistan, but social services have nonetheless declined. Does the government have active economic and social policies?

CBT The government is active in the area of economic policy, especially in trying to attract foreign investment to prestige products. But this generates few employment opportunities, and the population is growing fast. The legal framework is not very enabling for the creation of small private enterprises and regional trade. The financial system also inhibits economic development, and tax rates discourage entrepreneurs. Who you know is much more a guarantee of success than what you know. As far as social policy is concerned, the structures exist on paper. There is a pension system, support for young mothers and large families, and unemployment benefit, but a lot has only limited depth and substance. Take health reform, for example. There are big pilot projects; the World Bank is there, the European Commission’s Tacis technical-support programme is there, the Ministry of Health itself is putting money in, and it all looks very impressive – but so far ordinary people have seen few tangible results, and are losing their trust in a system which runs on (unofficial) paid medical care, and which lacks affordable medication.

KVB What made you move from HRW to MSFHolland?

CBT There were several reasons, but for me an important one was to get more organisational opportunities for my own professional development. MSF-Holland gave me a lot of background information, they gave me an extensive preparatory briefing, they had everything on paper, provided mission manuals, and I knew more what I was going to do when I left to take up my current post in the Ferghana Valley.

KVB Was it important to you, having worked with HRW, that MSF’s mandate also included a ‘witnessing’ role?

CBT Yes, it was good to see this recognised within MSF. The priorities are different, but the organisation recognises the importance of wider contextual knowledge.

KVB Why a project in the Ferghana Valley? I thought it was one of the richer parts of Uzbekistan.

CBT MSF-Holland already had a large project in western Uzbekistan, which was part of its wider Aral Sea Area Programme. But it was felt that health needs in the east could not be ignored. The general impression is that the Ferghana is agriculturally rich, but many people are subsistence farmers. Last year drought destroyed many crops, and the area is prone to landslides from the surrounding mountains. Because of the valley’s shape, there are areas where the groundwater is very high and all the irrigation water collects, bringing with it all the pesticides from the cotton fields, and nothing grows there. These problems, combined with collapsing social-welfare structures, made the population prone to basic but widespread health problems. MSF is trying to tackle these problems through its health-promotion activities. In all, Ferghana is not as rich a region as people tend to think.

KVB The Ferghana Valley cuts across Uzbekistan, Tajikistan and Kyrgyzstan. It is often said that, if there is a regional conflict in Central Asia, it will be around the Ferghana Valley. Is that correct?

CBT Of course, the borders between these countries have very weird shapes, and border issues are an important factor in political relations between them. There have been armed incursions, and the potential for conflict is there, but I would say primarily because of structural or internal conditions. There is a large population, not enough soil for everyone to grow food, and not enough work. The infrastructure is crumbling, and many non-native Uzbeks, who used to staff the service sectors, have left. I would point to natural disasters, disputes over natural resources and social tensions as major risks. Of course, economic and social deterioration constitutes a tinderbox that could be lit by an external fire. But for the time being the state exercises strong and widespread control. This keeps the situation calm, but in the long run stability has to come through social and economic development.

KVB Usually, NGO work takes place at the microlevel. How do you deal with the ‘macro-dimensions’ of the context you work in? Do you engage at national policy level?

CBT We are not trying to directly influence health reform policies at national level, but we do work closely with our national counterparts at local level, and hope to give them some tools that they can use in their future policy implementation. In the Ferghana Valley, we have an extensive programme of health education, which is playing a growing role in the health-reform process by shifting the emphasis from over-staffed curative services towards a more rational and widely-spread primary health care system.

KVB Even if public health contributes to a better cost–benefit ratio, at some point you still need to look at overall health economics and the overall financing of health care. Are other organisations working in this area?

CBT Yes, health reforms are supported by a loan from the World Bank for communications and equipment investment. Tacis is assisting in the restructuring of the Ministry of Health, and its local and regional branches, include computerising data reporting systems. USAID is supporting research on implementation and medical retraining in some pilot projects, one of which is in Ferghana, where the whole health structure is being redesigned, and where medical staff are being retrained as family or general practitioners. A modern health system should be up and running by 2005.

KVB What is the most stimulating aspect of working in Central Asia, and what is the most difficult?

CBT The most difficult thing is the bureaucracy and lack of initiative, even among highly-educated people; the most stimulating aspect of being here is that the people are often very warm and hospitable. Everything here has two layers, and it takes time to discover the one underneath. Government officials can be very friendly with you, although they have no intention of giving you what you need. On the other hand, people can offer you a table full of food, and what you don’t see is that they may have to eat dry bread for two weeks after that because they have given you more than they can spare. It takes time to find out what’s really happening, and it takes time to get anything done. But once you feel that you have reached that level of understanding and acceptance, you feel very comfortable and useful. 

For more on MSF’s work in Uzbekistan, see <>.