Cancer, desperation, and a hospice that never opens: Why Uzbekistan’s terminally ill patients face a painful end

There are over 133,000 cancer patients in Uzbekistan, with more than 4,000 of them battling the final stage of the disease. In modern healthcare systems, individuals suffering from terminal illnesses spend their final days in specialized medical facilities. However, in Uzbekistan, the reality is quite different — both the unbearable pain and emotional burden are experienced not only by the patients but also by their families. This is because, apart from Samarkand and Khorezm, there are no hospices in the country. A recent case that went viral on social media — where an elderly homeless cancer patient was abandoned in an apartment building entrance — has prompted a closer look at the situation.

On March 7, a video surfaced showing a terminal cancer patient being turned away by hospitals for four consecutive hours. In the footage, emergency medical personnel could be heard stating that the woman was in stage 4, that she was inevitably going to die, and that no further assistance would be provided to her.

Prompted by this heartbreaking case, Kun.uz organized a discussion on the state of oncology in Uzbekistan, the challenges faced by patients, and the reasons behind the delay in opening hospices.

The discussion featured Aziz Hamroqulov, Head of a Department at the Ministry of Health; Ilhom Aslanov, the Ministry’s Chief Specialist for Emergency Medical Services; as well as oncologists Shermukhammad Umirov, Yahyo Ziyayev, and Rustam Norboyev.

Do you think the actions of the medical personnel in this situation justified?

Aziz Hamroqulov: As soon as this video surfaced on social media, the Ministry of Health formed a task force to investigate the incident. An internal inquiry was conducted to assess the situation. As for the patient, she is currently receiving treatment at the Tashkent City Oncology Hospital.

I am not entirely aware of what transpired with the doctor in question. When a person is under extreme stress or frustration, they may not always be able to control their words or actions. For this reason, I cannot definitively say whether their behavior was right or wrong. I also do not know what kind of challenges that doctor was facing at the time. From what I understand, the patient was not simply abandoned on the street—she had already received medical assistance. Following that, she was admitted to the Tashkent City branch of the Republican Oncology Center, where she is currently undergoing treatment. Therefore, I cannot label the doctor as guilty or innocent because medical services were indeed provided.

Ilhom Aslanov: If we base our assessment on the part of the incident that was shared on social media, then yes, the actions of the emergency medical staff were inappropriate. This is primarily an issue of ethics and professionalism. In medicine, there are strict ethical guidelines that govern the conduct of healthcare workers, particularly regarding their interactions with patients, patients’ relatives, and fellow medical professionals.

It’s not just about whether what was said was right or wrong—the issue is that such words should not have been spoken at all. The doctor, unaware that their conversation was being recorded and would be made public, was likely trying to explain the situation to other staff members. This was confirmed through our investigation.

Regardless of the circumstances, the doctor should not have allowed emotions to dictate their response. We know that emergency medical teams respond to 20-30 calls a day, and the emotional toll of each case can accumulate. We conduct extensive training on how to manage such stress, ensuring that no negative energy from one case affects the next.

In reality, on that day, the emergency medical team attended to the patient four separate times and took her to multiple medical facilities. However, both the emergency team and the hospitals assessed that the patient did not require immediate emergency intervention. There are two types of medical treatment: emergency and planned care. The role of emergency medical services is to address life-threatening conditions and, when necessary, transport patients to specialized facilities for further care.

As a specialist, I can say that while the doctor’s actions were not technically incorrect, their choice of words and the emotional response were highly inappropriate. Decisions regarding patient admissions are beyond the jurisdiction of emergency medical teams—there are specific ministry regulations governing this. Emergency services do not have the authority to admit patients to oncology hospitals, as these facilities provide planned, rather than emergency, care. In Tashkent, we only have emergency departments that admit patients based on the nature and location of their medical condition. In this case, the designated hospital was the First Tashkent City Clinical Hospital, where the patient was transported. The subsequent handling of the situation should be reviewed by the relevant authorities.

Shermukhammad Umirov: We watched the video multiple times. While there were some breaches of medical ethics by both the emergency medical staff and neighborhood police officers, there is also a misunderstanding here. The video is short—it does not provide any information on where the patient was picked up from or where she was taken. There was also a dispute between the emergency doctor and the neighborhood officer over whose responsibility it was to transport the patient.

In my view, the emergency medical team should have transported the patient to the designated hospital for urgent care. The larger issue here is that oncology patients often face difficulties getting admitted. Many hospitals hesitate to accept terminal cancer patients and may instead provide them with painkillers before sending them home.

If a second emergency team arrived, they may not have known the patient’s original location. In such cases, medical personnel should confirm the patient’s address by speaking with local authorities. Every neighborhood has responsible officials who can verify where a person lives.

A more coordinated approach involving local neighborhood committees and medical staff would have prevented this issue from escalating on social media. If they had worked together, the patient could have been transported home with the necessary support.

Yahyo Ziyayev: Our colleague did not violate medical ethics in this case. The statement about the patient being in the final stage of cancer was not made directly to the patient but rather in an external conversation. The doctor was clearly overwhelmed with emotion, which is understandable given the circumstances.

The patient was repeatedly taken to different medical institutions, and the emergency medical service had responded to her case seven times before. However, since there was no immediate emergency—no severe bleeding, fractures, or life-threatening injuries—she was not prioritized for emergency admission. If we were to hospitalize every terminally ill patient in emergency care units, we would risk overcrowding and denying space to patients in urgent, life-threatening situations.

From a medical standpoint, emergency care facilities are designed to handle immediate crises. Oncology treatment falls under planned medical care. For instance, if a cancer patient experiences acute bleeding, they would need emergency surgery, which requires specialized teams. This level of care cannot be provided by an oncology center outside regular hours—it must be handled by dedicated emergency services.

Ultimately, the broader issue remains: the lack of hospices in Uzbekistan means that terminally ill patients and their families are left without adequate support. Until this gap is addressed, similar cases will continue to arise, placing undue strain on both patients and the healthcare system.

Rustam Norboyev: In this situation, [all parties involved] are victims. The patient is clearly suffering, and so is the doctor. After responding to 30 calls, the 31st one can lead to frustration. I know for a fact, and my colleagues confirm, that at least 10 of these calls are due to a fever of 37.5°C, which is not justified. Another issue is that the doctor doesn’t know where to take the patient. We are now coming to a consensus: the absence of hospices. Patients like these should be sent to hospices.

It was correctly pointed out that when a patient is admitted to an ordinary hospital, they take up a bed, and more importantly, they do not receive the appropriate and necessary care. Regular doctors differ from hospice doctors in their approach, behavior, and treatment methods. Such patients should either be treated at home or, if that is not possible, in a hospice. Unfortunately, the main issue is that the hospice has not yet been completed. If it had been built, we wouldn’t have needed this discussion, and the current situation wouldn’t exist. Ambulance staff would simply transport the patient to a hospice, solving the issue entirely.

Watch the full interview on YouTube.