Hektoen International

A Journal of Medical Humanities

Uzbekistan: The miracle between the two rivers

The student of ancient history, of the old Persian Empire and of the exploits of Alexander the Great, will recognize the two rivers bounding modern Uzbekistan as the Oxus, now Amu Darya, and the Jaxartes, now the Syr Darya. He will have read about the ancient Silk Road, the old countries of Sogdiana and Khwarazm, and the great physicians and philosophers Ibn Sina (Avicenna) and al-Biruni who worked there.

More recently, however, he would have learned that Uzbekistan is an increasingly modern country, the landlocked home of more than 38 million people, mostly Uzbeks but also Tajiks, Kazakhs, Russians, Tatars, and Koreans whom Joseph Stalin relocated there. Uzbek, part of the Turkic family, is the national language, officially written in the Latin script, but Russian is still widely used in business and for communication between ethnic groups. Tajik is commonly spoken in historic cities such as Samarkand and Bukhara. Tashkent, the capital, rebuilt after a devastating earthquake, is modern and has splendid wide avenues, an impressive metro, and well-stocked traditional markets. Other Uzbek cities have also undergone extensive modernization.

Like other Central Asian states, Uzbekistan was conquered by Imperial Russia in the nineteenth century and after World War I was incorporated into the Soviet Union. This brought about mass literacy, industrial development, public health institutions, new opportunities for women, and a more modern infrastructure, but also political repression, religious restrictions, forced collectivization, and an economic system dominated by cotton production. Cotton became so central to Soviet planning that enormous quantities of water were diverted from the rivers to irrigate the fields. This brought about the catastrophic shrinking of the Aral Sea, once one of the world’s largest inland bodies of water. Former fishing towns became deserts; wind carried salt and chemical residues from the exposed seabed across western Uzbekistan. This remains one of the century’s most serious environmental disasters.

Uzbekistan became independent in 1991 as the Soviet Union collapsed. Islam Karimov, formerly the head of the Uzbek Communist Party, became the country’s first president and remained in power until his death in 2016. At first, his government maintained extensive state control with restrictions on political opposition, censorship, and with a heavily regulated economy. Shavkat Mirziyoyev’s accession to the presidency in 2016 marked the beginning of a new phase of economic and administrative reforms. The government has allowed more space for public discussion, relaxed currency controls, and reduced visa requirements for visitors. It sought foreign investment and promoted private enterprise, tourism, industrial modernization, and international trade.

This transformation has already altered the country’s appearance and produced visible results. Expanding cities have new apartment buildings, business centers, roads, and parks, and have become major international tourist destinations. Manufacturing, construction, services, mining, textiles, food production, and information technology have grown alongside the traditional agricultural economy. Uzbekistan remains rich in natural resources, including gold, copper, uranium, and natural gas, which supply much-needed export revenue. Cotton is still significant, but the country is moving toward greater diversification, producing fruits, vegetables, wheat, silk, and other higher-value products.

Rural Uzbekistan consists largely of desert and dry steppe. The vast Kyzylkum or “Red Sand Desert” covers much of the country, but fertile valleys and irrigated oases support most of its population. The Fergana Valley in the east is especially productive and densely settled. Uzbekistan possesses substantial reserves of gold, copper, uranium, and natural gas, but manufacturing, construction, services, horticulture, and tourism are becoming increasingly important. The government has sought to modernize agriculture, improve transportation, attract investment, and expand regional trade. It faces serious difficulties because Uzbekistan’s climate is dry and its water supplies are limited.

Culturally, modern Uzbekistan combines tradition with rapid change. Historic cities such as Samarkand, Bukhara, and Khiva contain magnificent examples of Islamic architecture and were important centers along the ancient Silk Road. Modern Uzbekistan seeks to preserve these treasures while promoting cultural exchange and tourism. Education and technology have now become key priorities, universities are expanding their programs, and schools, businesses, and government services are adopting digital technologies. Foreign institutions have established branches in Uzbekistan, and instruction in English and digital technologies has expanded. The country is constitutionally secular, but Islam is the dominant religion. Since independence, religious practice and education have revived considerably: mosques have reopened, and pilgrimages have become more common. Society remains generally moderate, and religious observance exists alongside customs inherited from the Soviet period and the older Central Asian traditions. Social life is changing. Young Uzbeks use global social media, study foreign languages, follow international fashion, and increasingly question customary expectations about careers, marriage, and women’s roles.

Uzbekistan inherited a centralized Soviet-style public health system that still needs modernization. Urban residents generally have better access to specialists and advanced treatment than those in remote districts. Key concerns include maternal and child health, noncommunicable diseases, air pollution, and unequal access to care. Government investment and international partnerships are strengthening hospitals and primary care, but staff shortages and regional disparities persist. Modern Uzbekistan is therefore a country of striking juxtapositions, where high-speed trains pass near ancient caravan routes, smartphones coexist with customs centuries old, and restored Islamic monuments stand beside Soviet apartment blocks and ambitious new business districts. The state celebrates Timur and the Silk Road while pursuing industrial development, international finance, and digital technology. There is greater openness, sustained economic growth, and a new sense of possibility. Thus Uzbekistan today lives simultaneously in several historical worlds. Its ancient cities recall Silk Road merchants; its mosques preserve the achievements of Islamic society; its modern cities represent developments of the twenty-first century.


GEORGE DUNEA, MD, Editor-in-Chief

Summer 2026

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