Widespread pollution, ecological damage, nuclear testing, and poverty are wreaking havoc on the health of Xinjiang Uyghurs, some of the poorest citizens of China. Cities cloaked in dust 200 days of the year, factories belching pollutants unchecked into the atmosphere, filthy water, and a birth control policy that forces women to abort every unplanned pregnancy, are some of the factors that are making this province one of the unhealthiest in the country.

Urumchi, the capital, is China’s self-confessed most heavily polluted city, scoring 500 on the latest Air Pollution Index, way ahead of Xining, next on the list at 320. Dust storms from Xinjiang hit Beijing at least five times a year and tree-planting efforts are under way to stem erosion, but an underground coal mine that has been burning out of control for 25 years in Urumqi continues to belch fumes into the atmosphere while alternative forms of energy remain a distant dream. Winter air is thick with coal smog, and the nearby mountains can never be seen during the coldest months. Although vehemently denied by the Chinese government, underground nuclear tests in the Taklamakan Desert's Lop Nor site caused radioactive pollution to the land and also to the atmosphere which still registers today.

Uyghur doctors in the capital feel hopeless about the state of their people’s health. The clinics are full of people with respiratory diseases and cancers which can be directly attributable to the ecology. A massive increase in population, not only in the capital but in all other major cities as a result of Jiang Zemins "Go West" policy, means an increased burden on scarce resources. The capital is mushrooming out of control. With 500 Han Chinese arriving every week, factories are springing up all over the region, pouring pollutants into the air and water, and the strain on the land to produce more food, with added pesticides and fertilisers is immense. Chinese women who are only allowed one child, and Uyghurs who under normal circumstances would have six or seven are only allowed two or three, have on average ten abortions during their lives and this is taking a serious toll on their health.

"With all these people come health problems that our region is not equipped to cater for. The only decent hospitals we have are in the capital and even they are under-equipped and our doctors are ill-trained," said a young doctor. He said there was a divide between health care available to Uyghurs and Han Chinese. "Many of our people outside the capital don’t speak Chinese and most would prefer to go to a Uyghur doctor. Uyghur hospitals are in bad condition and our people cannot afford proper treatment," he said. "The Han tend to be wealthier and can usually afford the best treatment."

A law requiring all medical students to be fluent in Chinese before they can start their studies means many Uyghur medical-hopefuls have no chance of fulfilling their ambition. Hence the number of qualified doctors returning to their regions is small in comparison with the numbers of Han. They have better qualifications and lucrative contacts on qualifying and land the best jobs in the wealthiest areas, while the remoter reaches of Xinjiang by default have to make do with the poorest qualified Uyghur personnel in the sparsest of hospitals.

A young doctor remembers feeling like a second-class student in a class full of Han Chinese and almost having to sacrifice her own culture during her period of study. "I persuaded my parents to let me share a room with three Chinese girls so that I could practice. My parents were unhappy and insisted I ate separately and did not compromise my beliefs," she said. "I had to pretend I was an atheist like them, which was terrible for me, and always felt on the outside because I couldn’t eat with them. I almost became Chinese. Look at me!" She said pointing to her short hair, and her tight jeans. "I even think in Chinese now, and all because I wanted to become a doctor." Her intention is to return to her city eventually , but her father had to pay a bribe of a year’s salary so that she could get experience in the capital before returning.

With the lack of medical services, Folk practices are the norm, and bazar stalls are full of sacks of dried snakes, dried hedgehogs, lizards and every form of bark and plant imaginable. The self-appointed quacks throw concoctions together for a few cents, leaving the sick to fend for themselves back in their villages if the potion doesn’t work.

Unregistered medical clinics set up as cheap alternatives to the government service in small cities and villages where people are at the mercy of untrained or semi-skilled practitioners. But locals often have no choice but to use these facilities, as they can’t afford to pay for the state-provided ones.

The unregistered clinics often fail to meet even the lowest standards. In one of them, discarded drips and vials of drugs lay scattered on the stairwells, rubbish from home-cooked meals were mounted in corners. A single cold water washbasin served as an all-purpose repository for toilet refuse, blood, floor-cleaning and sterilizing equipment, and water from an unsealed leak squirted at rectangles over a floor covered in swirls of sodden sand from the streets. But its services were in great demand and every room was full of clinic patients attached to drips. A young Uyghur doctor ran up and down stairs all day attending to them. "We are in a crisis in Xinjiang," he said. He had to terminate his studies early, but felt he knew enough to run a small clinic. "Most of these people have infections from operations in the state hospital, or have kidney, throat and heart problems from the ecology. Some have cancer but they will die whoever treats them." Polio is a large problem in Xinjiang. "We often have polio here," said an Uyghur nurse. The birth control policy means that care is not available for children beyond the maximum three allowed. Lack of medical infrastructure in the villages also means there is little chance of every child being systematically immunized for anything.

The Chinese government admits that rural health care is abysmal. Reforms are about to be set in motion at the end of the year, according to Wang Longde, vice minister of health, admitting in the China Daily newspaper that village medical services were lagging behind the cities where 80% of health care is concentrated. Preferential policies are about to be launched to encourage medical workers to go to rural areas, but Uyghur doctors question government commitment to really change things for their people and remain cynical. "Han doctors will never go to rural areas to help the Uyghurs," said the young lady doctor.

By Ruth Ingram