Social Science & Medicine 56 (2003) 551–567 Impacts of an environmental disaster on psychosocial health and well-being in Karakalpakstan Eric J. Crighton a, * ,1 , Susan J. Elliott b , Joost van der Meer c,2 , Ian Small d , Ross Upshur a a Sunnybrook and Women’s College Health Sciences Centre, Department of Family and Community Medicine, Primary Care Research Unit, Room E-354, Toronto, Ont., Canada M4N 3M5 b McMaster Institute of Environment and Health, McMaster University, 1280 Main St. West., Hamilton, Ont., Canada L8S 4L7 c Ukraine Programme, M! edecins Sans Fronti " eres, 28a Esplanadna St., 3rd floor, Kiev, Ukraine 01023 d M! edecins Sans Fronti " eres, Aral Sea Area Programme, Konstitutsiya str., House 4, P.O. Box 333, 700 000 Tashkent, Uzbekistan Abstract The people of Karakalpakstan, along with those of the entire Aral Sea region, are facing a multitude of health problems corresponding to the drying of the Aral Sea and accompanying ecological consequences. In case studies of otherenvironmentaldisasters,researchhasshownthatenvironmentalexposuresmayimpactnotonlythephysiological but also the psychosocial health of individuals. This research aims to determine the contribution of the environmental disastertothepsychosocialhealthofpeoplelivinginKarakalpakstan,asemi-autonomousRepublicinUzbekistan.An interview survey was carried out by M! edecins Sans Fronti " eres, with the assistance of the McMaster Institute of Environment and Health, local Universities and local health care workers, on a random sample of 1118 individuals aged 18 years and older in three communities in Karakalpakstan in May/June 1999. The communities were chosen according to distance from the former seashore, urban/rural characteristics and ethnic composition. The survey includedquestionsaboutperceivedgeneralhealth,theGeneralHealthQuestionnaire,thesomaticsymptomchecklistof theSymptomCheckList-90,questionsaboutperceptionsoftheenvironmentaldisaster,socialsupportaswellassocio- demographic and socio-economic characteristics. Findings show that 41% of all respondents reported environmental concern while 48% reported levels of somatic symptoms (SCL-90) associated with emotional distress, above the normalized cut-point. Significant differences in levels of emotional distress were reported between men and women as well as between ethnic groups. Environmental problems are commonly perceived to be the cause of somatic symptoms and are significantly related to self-rated health status. r 2002 Elsevier Science Ltd. All rights reserved. Keywords: Psychosocial impacts; Aral Sea; Karakalpakstan; Uzbekistan Introduction The people of Karakalpakstan, a semi-autonomous republic in Uzbekistan, along with those of the entire Aral Sea area (Fig.1), are facing a multitude of environmental problems stemming from what is today recognized as ‘‘one of the worst ecological disasters the world has seen’’ (Saiko, 1994, p. 12). The disappearance *Corresponding author. Tel.: +1-416-480-6100 ext. 7131; fax: +1-416-480-4536. E-mail addresses: eric.crighton@swchsc.on.ca (E.J. Crighton), elliotts@mcmaster.ca (S.J. Elliott), cm@msf.kiev.ua (J.v.d. Meer), ibprivate@yahoo.com (I. Small), rupshur@idirect.com (R. Upshur). 1 Atthetimeofsurvey:McMasterInstituteofEnvironmentandHealth,McMasterUniversity1280MainSt.West.Hamilton,Ont., Canada L8S 4L7. 2 At the time of survey: M! edecins Sans Fronti " eres, Aral Sea Area Programme, Konstitutsiya str., House 4, P.O. Box 333, 700 000 Tashkent, Uzebekistan URL: http://www.msf.org/aralsea. 0277-9536/03/$-see front matter r 2002 Elsevier Science Ltd. All rights reserved. PII:S0277-9536(02)00054-0