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A farmer's son outside the village of Tartakupir in Karakalpakstan.

This year, Karakalpakstan suffered a severe drought, the worst in a century. Outside the village of Tartakupir, two children cross a dry irrigation canal. Normally the canal would be filled with water for the fields. People don't have money for food; they have no clean drinking water, and must drink from polluted drainage canals. Everywhere I went, I heard stories about people leaving Karakalpakstan because of the drought. One day at my guide's house in Nukus, a shy young man in his twenties appeared. He was staying for a few days. He told me that until this year, he drove a combine on a collective farm in northeast Karakalpakstan. The drought destroyed the farm's rice crop, so there was no work. He took his wife and two children to Kazakhstan, but it was too expensive there. So he returned, and had come to Nukus to look for a job there. I asked him what kind of job he wanted. He looks at me for a moment. It was a stupid question. "Anything," he said quietly.

TB specialist Berdibek Reimov works in the Muynak dispensary. Karakalpakstan is in the midst of a tuberculosis epidemic. Muynak has a particularly high rate. A Muynak native, Reimov, 57, remembers when the town was an island. "I am mad that the sea is gone," he says. "But you can't cry. It doesn't make any difference." I asked him about the town's future. "Without hope you can't live," he says. "So of course I have hope."