Former Soviet republics languish in shadow of plague: As health care in the region collapses, old diseases resurface, writes Andrew Higgins in Moscow

CHOLERA, diphtheria, malarial mosquitoes and even 'black death' have resurfaced in the former Soviet Union as a rudimentary health-care system crumbles and doctors confront diseases previously thought to have been eradicated or confined to the poorest regions of the Third World.

Health organisations have been warning since last year that Russia and newly independent states, particularly those in Central Asia, risked public health catastrophe because of declining stocks of drugs, plummeting rates of vaccination and widespread civil strife. Early this summer, after a tour of hospitals and clinics, a noted cancer specialist and prominent authority on health care, Dr Nikolai Trapeznikov, declared: 'There are almost no healthy people in Russia.'

Such alarm has acquired new urgency following the reappearance of several potentially fatal illnesses. On Saturday, Thomson Holidays suspended 'city-break' holidays to Moscow and St Petersburg because of reports that diphtheria was reaching epidemic proportions. Russian television, appealing to viewers to inoculate themselves and their children, on Saturday reported more than 4,000 cases of diphtheria this year, including 900 in Moscow. Six people are said to have died in the past week from the disease, which attacks the throat and can be spread by kissing or shared utensils. The illness was declared eradicated in the Soviet Union in the 1960s. The new strains are more virulent and difficult to treat.

Another threat is cholera; a homeless man was diagnosed with the disease in Moscow. The situation is far more serious in Georgia, Tajikistan and other anarchic parts of the former Soviet Union, where the collapse of civil order has left piles of rubbish on the streets, cut off supplies of clean water and played havoc with health services. A report by Care International estimated that in Tajikistan whooping cough increased by 2,000 per cent last year, measles by 190 per cent and diphtheria by 320 per cent.

According to Radio Russia, malarial mosquitoes are breeding in more than 10,000 reservoirs and ponds near Moscow. In some cases the end of Soviet-era censorship may make problems seem new when in fact they existed for years but were hidden. A steep decline in health, though, is certain. In Russia, the death rate going up and the birth rate is going down. Last year, for the first time since the Second World War, deaths in Russia exceeded births, shrinking the population by around 220,000.

Russia has the best hospitals in the former Soviet Union but even here 42 per cent are without hot running water. The population is cursed by ill health. Men are particularly sickly: 61 per cent smoke and alcoholism is endemic. Their life-expectancy is around 63 years, nearly 10 years fewer than for Russian women and eight years fewer than in the West.

Kazakhstan provides the most harrowing vision of potential demographic disaster. At least two people there are said to have contracted bubonic plague - the 'black death' that ravaged medieval Europe and parts of Asia. Two months ago, the three-year-old daughter of a Kazakh shepherd was reported to have died from the plague. Some doctors, though, are sceptical about the reports.