Uzbekistan's only leader in intensive care

The man who has ruled Uzbekistan since the fall of the Soviet Union has suffered a stroke and is in intensive care, his daughter said on Monday, raising questions about stability and succession in one of the most autocratic and closed countries in the world.

Islam Karimov, 78, a former Communist Party leader and four-term president of the Central Asian country, had a cerebral hemorrhage on Saturday and is "receiving treatment in an intensive care unit," his daughter Lola Karimova-Tillyaeva wrote in her verified accounts on Instagram and Facebook.

Karimov, who yields unrivaled power in the country of 31 million, has not publicly named a successor.

"His condition is considered stable," Karimova-Tillyaeva wrote. "At the moment, it is too early to make any predictions about his future health."

The remarks were the first details to emerge about the nature of Karimov's illness from the country's ruling circles. A day earlier, the Cabinet of Ministers published a cryptic statement saying that Karimov had been hospitalized and "would require a certain amount of time for medical assessment and treatment."

"I think that the government only published that when it realized that Islam Karimov was very, very sick," said Daniil Kislov, the editor-in-chief of Fergana.ru, a news site that broke the story earlier that day.

In 27 years in power, Karimov has built a totalitarian state best known in the West for its brutality and isolation, for the torture of political prisoners and a yearly cotton harvest produced by forced labor. Steve Swerdlow, a researcher at Human Rights Watch, said that the country is holding thousands of political prisoners, far more than other former Soviet regimes, and that it is "known for political and religious repression that is unrivaled in the region."

Karimov cast his rule as a bulwark against the spread of Islamic extremism in the region and used an attempt on his life in 1999 by the militant Islamic Movement of Uzbekistan to justify mass arrests of Muslims in the country. He also found a role as an ally to the United States in the war on terror, allowing U.S. troops to use the country's Karshi-Khanabad Air Base as a staging point during the invasion of Afghanistan and until 2005.

The methods used in Uzbekistan's internal crackdown on political and religious enemies were brutal. In one case in 2002, Uzbek authorities were accused of boiling several prisoners, alleged Islamists, while still alive. In 2005, Karimov is believed to have ordered troops to fire on protesters in the eastern city of Andijan, killing hundreds in a massacre that furthered the country's isolation. Uzbekistan soon evicted the United States from the air base due to criticism from Washington.

"That moment defined the way that he has ruled," Swerdlow said of Andijan. "It's a classic authoritarian complex of insecurity and overwhelming strength."

Karimov, who was named the Communist Party boss of Uzbekistan in 1989, is the oldest of Central Asia's leaders, a cadre of former Soviet functionaries who will cede power in a series of important political transitions in the coming years.

For many years, a possible successor to Karimov's rule was considered to be his older daughter, Gulnara. But after she was named in international corruption probes and gained a wide following on social networks, she disappeared from public view and was reported to be under house arrest in 2014.

Karimov has a close circle of political allies, Kislov said. The most likely successor, he said, is Prime Minister Shavkat Mirziyoyev.

Mirziyoyev is thought to be friendly toward Russia, particularly because of family ties to Russian-Uzbek oligarch Alisher Usmanov. But there is little indication of how Uzbekistan's domestic or international policy might change under a new leader.

"Only one man has ever run Uzbekistan's politics, and that is Islam Karimov," Kislov said. "How another man would act when an authoritarian leader dies or is incapacitated ... we simply don't know."