from southern Osh, because of water shortages.366 They had been using water from irrigation trenches and other open sources.367 Local water specialists say that irrigation water is unsafe for drinking because of groundwater pollution from industrial and municipal wastes; the absence of sewage systems; and the proximity of animal-breeding.368 Multi-lateral agreements between the four Central Asian States in 1992 and 2008, and a string of bilateral agreements, have tried to regulate water usage in the region369 with mixed success. UNDP estimates that 700 cubic meters of water is now available per person across Central Asia and 5,000 cubic meters is needed.370 In a context of general water shortage, stateless persons are in a weak position to press their right to it. Household demand is highest in Uzbekistan’s Ferghana Valley, the populous strip where Kyrgyzstan, Tajikistan, and Kazakhstan converge. It is also where many stateless persons in these States crossed their border. According to members of the Central Asian Alliance for Water,371 formed after a session of the UN World Water Forum, 60% of the Ferghana population has no access to clean drinking water. A UN inter-agency survey in 2006372 found that in Kazakhstan, 93.7 percent of the population uses an improved source of drinking water – 98.1 percent in urban areas and 87.7 percent in rural areas. The situation in South Kazakhstan, where many stateless persons live, was said to be below average – at 85.7% – with 6.8% of the population using water from surface sources. Sewerage provision was also less developed. There is a strong link between the ready availability of clean water, basic levels of sanitation, and hygiene in food preparation and storage. 5.3 Healthcare People documented as stateless, who are permanently resident on State territory, have the right to use the national health service on the same basis as citizens, according to the legislation of Tajikistan, Kyrgyzstan and Kazakhstan. Those registered as ‘temporarily resident’ can use it according to a procedure set down by the Ministry of Health in each State.373 Throughout the region, the national welfare sector has shrunk since Soviet times and increasingly been replaced by commercial medical care. Access to private medicine depends on variable fees. There is no information to suggest these are higher for stateless persons. In Turkmenistan, foreign nationals are entitled to use “the network of health institutions and medical services” according to legally established procedure374 and the same provision applies to persons legally recognised as stateless. In Turkmenistan no health provision is made for stateless persons 366 UN Office for the Coordination of Humanitarian Affairs, Running Dry: the Humanitarian Impact of the Global Water Crisis, October2006, available at http://www.irinnews.org/IndepthMain.aspx?reportid=62312&indepthid=13. 367 This carries the risk of water-borne disease, like typhoid and diarrhoea. 368 Central Asian Water Alliance, ELA partner Central Asian Alliance for Water successfully presents its 2009 ELA project to Regional Government, 3 March 2009, available at www.wecf.eu/english/articles/2009/03/bishkek-caaw.php. 369 In 1992, an Inter-State Commission for Water Coordination was set up by Kazakhstan, Kyrgyzstan, Tajikistan and Uzbekistan with World Bank help, to “manage and protect” its use, cited by Darya Pushkina in Cooperation or Conflict: Water in Central Asia. In October 2008, a CIS Summit in Bishkek agreed on cooperation in supporting hydro-energy; water accumulation; and fuel supply. There have also been bi-lateral agreements, including ten between Kyrgyzstan and Uzbekistan in 2004 on sharing gas and water, cited in the 2008 Central Asia Regional Risk Assessment by UNDP. 370 UN Development Programme, Poverty Reduction in Europe and the CIS: Water Governance, available at http://europeandcis.undp.org/poverty/show/AFC9C290-F203-1EE9-B2066514D56EDAD4#. 371 The Osh-based NGOs, Mehr-Shavat and Alay-Ata-Just. 372 UNICEF, Multiple Indicator Cluster Survey on Kazakhstan, submitted to USAID by UNICEF, Astana, May 2006, with support of UNFPA and ILO, available at http://pdf.usaid.gov/pdf_docs/PDACH102.pdf. 373 Article 9, 1997 Law No 500 ‘On the Legal Status of Foreigners’ in Tajikistan, as amended in 2009; Article 7, 1995 Law No 2337 ‘On the Legal Status of Foreigners’ in Kazakhstan; Article 9, 1993 Law No 1296-XII ‘On the Legal Status of Foreigners’ in Kyrgyzstan. 374 Article 9, 1993 Law ‘On the Legal Status of Foreigners’ in Turkmenistan, as amended in 2011. ~ 57 ~