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In the almost two years since the pandemic began, Turkmenistan has not seen a single case of covid-19.
Or at least, that's what the authoritarian and secretive government of the Central Asian country claims.
Turkmenistan, a former Soviet republic that is home to nearly 6 million people, is one of at least five countries that have not reported any coronavirus cases, according to a review of data compiled by Johns Hopkins University and the World Health Organization ( WHO).
Three of them are isolated islands in the Pacific and the fourth is North Korea, a tightly controlled hermit state.
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Turkmenistan's repressive President Gurbanguly Berdymukhamedov, who has ruled since 2006, has dismissed the reports of COVID-19 in the country as "false" and told the United Nations in a speech Tuesday that the response to the pandemic should not be "politicized".
But independent organizations, journalists and activists outside of Turkmenistan say there is evidence the country is fighting a third wave that overwhelms hospitals and kills dozens of people, warning that the president is downplaying the threat of the deadly virus in a bid to sustain your public image.
Women wearing masks cross a street in Ashgabat, Turkmenistan, on July 15, 2020.
Ruslan Turkmen, an exile from Turkmenistan and editor of the Netherlands-based independent news organization Turkmen News, said that he has personally collected the names of more than 60 people who he claims have died of COVID-19 in the country, including teachers, artists, and doctors.
Turkmen said it has verified all deaths recorded in health records and X-rays, revealing severe lung damage and medical treatment compatible with coronavirus victims.
"Instead of accepting it and cooperating with the international community, Turkmenistan decided to stick its head in the sand," Turkmen said.
The Turkmen government did not respond to CNN's requests for comment.
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How it developed
As covid-19 spread across the world in early 2020, Turkmenistan insisted it had no cases, even as border countries reported the outbreaks skyrocketing.
Iran, with which Turkmenistan shares a long land border, has reported one of the largest covid-19 outbreaks in the world with nearly 5.5 million cases in total, according to the World Health Organization (WHO).
"Do you see what happens in other countries in the region and how different could Turkmenistan be?"
said Rachel Denber, deputy director for Europe and Central Asia at Human Rights Watch.
Zero reported cases
Turkmenistan has not reported any cases of Covid-19 since the pandemic began.
According to the websites of the British and Australian foreign ministries, all flights to Turkmenistan are currently suspended and only Turkmen citizens can enter the country.
Turkmen said his sources in Turkmenistan started contacting him about COVID-19 cases around May 2020, around the same time that the coronavirus was spreading around the world.
He said the first messages he received spoke of a "strange, flu-like lung disease" that was affecting many people.
"It was at least 40 degrees Celsius outside, not a typical flu season," he said.
"We are not out of the woods yet."
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In June 2020, the US embassy in the capital Ashgabat issued a health alert for "reports from local citizens with symptoms that COVID-19 underwent COVID-19 testing" and got quarantined for up to 14 days.
The Turkmenistan government immediately called the statement "fake news."
A WHO mission to Turkmenistan in July 2020 did not confirm any coronavirus infection within the country, but said it was concerned about "an increased number of cases of acute respiratory infection and pneumonia."
A WHO official said Turkmenistan should act "as if covid-19 is circulating."
By then, the situation was out of control, according to Turkmen.
The government advised citizens to take strange public health measures, such as eating a particular type of spicy soup.
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In January this year, Turkmenistan announced that it had approved Russia's Sputnik V coronavirus vaccine for use in the country.
Then, in June, the World Bank agreed to lend US $ 20 million to the Turkmen government, mainly for its health facilities and construction, as part of a program to "prevent, detect and respond to the threat posed by covid-19."
As recently as Tuesday, President Berdymukhamedov said that the global community's efforts to address the covid-19 pandemic were "insufficient", although he did not mention the situation within his own country.
"The pandemic has exposed serious systemic flaws in the international response to this challenge," he said.
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"Turkmenistan is burning"
Despite Berdymukhamedov's claims that his country is COVID-19 free, the reality inside Turkmenistan is very different, according to independent journalists and activists.
Diana Serebryannik, director of the European-based exile group Rights and Freedoms of Turkmenistan Citizens, said her organization had heard through contacts in the country that hospitals are currently struggling to deal with the influx of cases.
Serebryannik said that his organization's Turkmen doctors now living abroad were in contact with their former colleagues in the country, allowing them to learn about the real situation and give them advice.
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She said doctors inside Turkmenistan had told her that both oxygen and ventilators were hard to come by in the country, treatment was expensive, and deaths from the virus could be in the thousands.
"Turkmenistan is burning, it is burning with covid ... Sometimes they don't even accept patients to the hospital, they just send them home," he said.
According to Serebryannik, the official cause of death in these cases is not listed as covid-19 or even pneumonia;
Instead, the medical certificates record a separate condition, such as a heart attack, he said.
When health workers have tried to speak about the reality on the ground, they have been pressured to keep quiet, according to the nonprofit Human Rights Watch.
Within the country, freedom of the press and independent scrutiny are not allowed: Turkmenistan was ranked 178th out of 180 countries and territories in Reporters Without Borders' World Press Freedom Index 2021, just above North Korea and Eritrea.
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Turkmen citizens who peacefully criticize the government have faced severe punishments, according to Human Rights Watch, including reports of torture and disappearances.
Foreign residents have also been affected by the Turkmenistan government's denials of the coronavirus.
In July 2020, Turkish diplomat Kemal Uchkun was admitted to Ashgabat hospital with symptoms similar to COVID-19, but was denied permission to evacuate to his home country, according to Asian Affairs magazine.
According to the BBC, X-rays sent to Turkish hospitals by Uchkun's wife were confirmed to show evidence of covid-19.
Asian Affairs magazine said Uchkun died on July 7.
The official cause of death was heart failure.
More recently, Turkmen said it had confirmed the death of a 61-year-old Russian language and literature teacher who had been in the hospital since August, according to Turkmen News.
Undermining the rosy image
Multiple authoritarian governments around the world have announced their covid-19 outbreaks and received international assistance, including China, the first country affected.
So why is Turkmenistan so insistent that it hasn't seen a single case yet?
Both Turkmen and Serebryannik said it all depended on President Berdymukhamedov, who, as a dentist by profession and a former health minister, had placed great emphasis on effectively governing the welfare of his people, at least in principle.
Turkmenistan President Gurbanguly Berdymukhamedov remotely addresses the 76th session of the UN General Assembly in a pre-recorded message on September 21, 2021.
Serebryannik said Berdymukhamedov, 64, wanted to appear to be a savior of the country and an impressive world leader by keeping COVID-19 out.
"Turkmenistan is a country where everything in the garden looks pink ... you have these state-of-the-art marble (health facilities) equipped with German, French, Japanese equipment, whatever," said the Turkmen journalist.
Admitting the presence of a deadly virus would undermine the idealized image that the president has created and leave Berdymukhamedov open to criticism and, potentially, held to account.
"It would be someone's failure, someone would have to take responsibility for that and who has the last word for that? The president," Turkmen said.
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There has been no indication yet that Turkmenistan is preparing to reverse its position and admit that it has COVID-19 cases in the country, but Serebryannik said he believed the government would have to do so eventually.
She said there had simply been "too much death."
Denber of Human Rights Watch said that international organizations that interact with Turkmenistan, including the WHO, have a duty to be honest with the world about the situation within the country.
"At a certain point you have to say, at what cost are you protecting that presence (in the country)? Are the measures you are taking to protect your relationship ... are they undermining your primary mission?" He said.
Denber indicates that in a global pandemic, with many outbreaks linked across international borders, nations have an obligation to provide accurate evidence and correct public information.
"We are all interconnected," he said.
"When one of us fails, we all fail."
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