Hektoen International

A Journal of Medical Humanities

Along the Silk Road in Central Asia

Kazakh yurts at night in the Kyzylkum Desert, Uzbekistan. Photo by Carsten Siegel, April 7, 2023, on Wikimedia. CC BY-SA 4.0.

The historical Silk Road was a vast network of land and sea routes that connected China with the West for over 2,000 years, facilitating the exchange of silk, spices, gold, and also ideas until the fall of the Byzantine Empire. Its origins have been attributed to the Han Dynasty, and Samarkand and Bukhara have long been important cities situated along its passage through Central Asia.

In the sixth century BCE, much of Central Asia was conquered by Cyrus, the founder of a powerful Persian Achaemenid empire. In 334 BCE, Alexander the Great defeated the Persians at the Battle of the Granicus, then followed through with his famous victories at Issus (333 BCE) and Gaugamela (331 BCE).

After the death of Alexander, the eastern part of his empire became the Seleucid State. Around 245 BCE, the Parthians separated themselves from the Seleucids and became a powerful independent empire. It stretched from Asia Minor to India and is remembered in history for its never-ending conflict with the Romans. The Parthians were followed by the extensive Kushan Empire, which also included parts of present-day Afghanistan and northern India.

In the fourth century BCE, the nomadic Hephthalites conquered the Kushan Empire and established a vast dominion that extended from the Caspian to the Aral Sea. After 565 CE, various alliances of Turkish and Altai tribes destroyed the Hephthalite empire and established a powerful Turkic Khanate that stretched from China to the Volga and included Central Asia in part.

In the seventh century, the Arabs conquered most of the area of the Silk Road, including Samarkand and Bukhara. The entire area came under the control of the Baghdad caliphs, first of the Umayyads and later of the Abbasids. The latter saw the flowering of the Arab civilization in central Asia under the famous caliph Abdul al Rashid. This period is remembered in the Thousand and One Nights and in the works of Avicenna,1 al-Baruni,2 and Rhazi.3

The Baghdad caliphs appointed governors in their conquered regions, but in time lost control over them. The Tahirids of Khorasan ruled independently from 821–873, then came the Saffarids of Sistan in the south (861–1003), and the Samanids of Bukhara (819–999). They were followed by the Daylamites or Bowawids (934–1062), the Seljuk Turks (1037–1194), and the Khwarezmian Shahs. Between 1215 and 1221, Genghis Khan conquered and destroyed all the cities of that area. He left his vast empire to his sons, Jochi, Ugedei, and Chagatai.

In 1363, Amir Timur seized Samarkand, which became the capital of a vast empire. He made Samarkand a beautiful city with masterpieces of architecture, palaces, mosques, and mausoleums, which still amaze with their beauty and size. He subdued a huge area from the Black Sea to the Ganges, but his empire split after his death in 1405, and his successors fought one another. In 1500–1501, an Uzbek chieftain, Muhammad Shaybani Khan, conquered Samarkand and the other main cities in the area, founding a Shaybanid dynasty and empire.

The subsequent history of Central Asia is complex. The area is inhabited by three main groups of people, each with different origins, languages, and cultures. The Uzbeks and Kyrgyz are Turkic, but the Tajiks are Persian-speaking Iranians. In the two hundred years after the conquest of Shaybani Khan, the composing parts of his empire seceded and underwent various rearrangements, leading eventually to the emergence of the three separate states of Bukhara, Kokand, and Khiva. In the 1860s, following an armed invasion of Russian troops, the Kokand Khanate was abolished, and in 1867, a Turkestan Governor-Generalship was established.

The Bukhara emirate and the Khiva khanate were soon also incorporated into the Russian empire. Power was concentrated in the hands of a governor-general, who carried out all the military and civil administration. The Russians focused on the agricultural sector of the economy, especially on cotton growth for the needs of industry. They diverted rivers, constructed oil mills, started mining operations, and built the Trans-Caspian railway to connect Central Asia with the European part of Russia. Their rule was ill accepted by the local populations, so that during World War One and its aftermath (1917 to 1921), much of the area became a struggle between guerrillas and troops of the Red Army. It ended with the victory of what became the Soviet Union.

In subsequent years, measures were directed to eradicate illiteracy and construct schools, but at the same time, much of the traditional lifestyle and culture was destroyed. In the 1930s, active industrialization took place, large factories were constructed, new cities were built, and old cities were reconstructed. During that period, the area suffered from Stalin’s political repressions: among the victims were leading politicians and cultural figures.

During World War II, most of the male population of the republics of the Soviet Union was taken to fight at the front, and the most important enterprises and people were evacuated to the republics of Central Asia. During this period, Tashkent became an evacuation center that gave shelter to refugees from the whole Soviet Union and was called the City of Bread and the City of Friendship of Nations. After the War, administrative arrangements were made within the Soviet Union that lasted until its dissolution in 1991, when Uzbekistan, Kyrgyzstan, and Tajikistan became independent states.

Uzbekistan became a country of 36 million and is known for its mosques, mausoleums, and other sites linked to the Silk Road, where Samarkand, a major city on the route, contains stunning landmarks of Islamic architecture, and Tashkent is its capital, with a population of more than three million people. Tajikistan, situated more to the southwest, has a smaller population of around 10.5 million, and after the dissolution of the Soviet Union has experienced three changes in government and a civil war. The Kirgiz tribes had remained under the Golden Horde and were overrun successively in the seventeenth century by the Kalmyks, in the mid-eighteenth century by the Manchus, and in the early nineteenth century by the Uzbeks. The Kyrgyz lands became a Soviet Socialist Republic (1936) which in 1991 declared its independence. Since then, the sovereign state of Kyrgyzstan has undergone three revolutions. It suffers from problems with low water levels as well as a rising nationalist backlash against Chinese influence.

Politically, the dominant trend has been the strengthening of executive power, often legitimized through referendums and managed elections rather than democratic liberalization. Yet governments are moving away from the Soviet model of centralized care toward Western-style management and financing. Attempts have been made to increase efficiency and achieve better tracking of health data, as well as making the countries more smoke-free through stricter bans and high taxation on tobacco. Doctors from Russia teach and support primary caring and perform advanced surgery, while China has offered its own approach to medical modernization, medical tourism, and cultural exchange. While the political trajectory trends toward authoritarianism, the healthcare sector offers a glimpse of genuine modernization, albeit one heavily reliant on the competing interests of foreign powers.

Further reading

  1. Rafeeq S. Avicenna: Prince of Physicians. Hektoen International Winter 2015. https://hekint.org/2017/01/28/avicenna-the-prince-of-physicians/
  2. Bakir AA and Dunea G. Al-Biruni. Hektoen International Spring 2023. https://hekint.org/2023/06/08/ai-biruni-973-1048/
  3. Sam R. Muhammad ibn Zakariya al-Razi. Hektoen International Summer 2012. https://hekint.org/2017/01/28/muhammad-ibn-zakariya-al-razi/

GEORGE DUNEA, MD, Editor-in-Chief

Fall 2025

|

|