Over the weekend, Islam Karimov, the president of Uzbekistan, was rushed to hospital after reportedly suffering a severe stroke. Immediately, questions about the power vacuum that could open upon his passing have been asked, and rightfully so. The consequences of his death could be grave, not only for his country, but also a region marked by poor governance, cronyism, crime, corruption and fragility.

Uzbekistan President Islam Karimov with Russian President Vladimir Putin in June (Photo: Getty)

The 78-year-old Karimov's hospitalisation has revived speculation about the inevitable power transition in Uzbekistan, a country Karimov has ruled with an iron fist since even before the collapse of the Soviet Union in 1991. He is the only leader an independent Uzbekistan has ever known.

But, like many autocratic leaders, Karimov has been hesitant to open the door to any obvious successor for fear his authority might be undermined, and his presidency ended at a time not of his choosing. It is a trap that, to a large extent, all Central Asian leaders have fallen into.

Of the five Central Asian republics - Uzbekistan, Turkmenistan, Tajikistan, Kyrgyzstan, and Kazakhstan - only two have seen leadership change since the end of the Cold War.

Turkmenistan’s sole transition, following the death of President Niyazov in 2007, was relatively smooth. Kyrgyzstan’s power transitions were more bloody, marked by protest and revolution. It's notable that in both countries leadership changes have seen the continuation of poor governance and political restrictions with no noticeable reforms or increases in living standards.

But in Kazakhstan, Tajikistan and Uzbekistan, the same ruling figures have held power for a generation.

Over a quarter of a century, power has been increasingly absorbed by the men who rule these former Soviet Republics. In Kazakhstan, the result has been at least somewhat constructive. President Nazarbayev has modernised the Kazakh economy and largely eradicated the abject poverty that defines the region, creating a Kazakhstan that, while politically constrained, grants a certain level of economic opportunity to its people.

The Tajik and Uzbek cases, in contrast, have been less positive. Both countries are mired in corruption, poverty and economic stagnation. Remarkably, Tajikistan receives up to 70% of its total national income from just two sources: remittances from Tajik workers in Russia, and the illicit opioid trade originating in Afghanistan. Uzbekistan, the most populous regional actor, similarly shares a poor economic outlook.

The potential passing of Karimov leads to many questions about the future of the country and the region. Central Asia is entering a fragile period in its post-Cold War history, with regional tensions rising, and international interests magnifying.

First, who will possibly take Karimov’s place? The new leader would be required to quickly diffuse the tensions likely to emerge from the diverse set of ethnic, religious and political groupings within the country. Many of these have never wielded political influence, and will naturally be seeking an opportunity to assert influence over the Uzbek regime.

Second, if a power vacuum does emerge, can transition possibly be peaceful? Previous power struggles in the region have been violent. In Tajikistan, Civil War raged from 1993-1997, resulting in up to 50,000 deaths and the implementation of an even more repressive regime.

Third, while Karimov has managed to assert secularism on the Uzbek population, the majority consider themselves Muslim. Their religion has been institutionally and legally stifled – as is the case across much of the region – further disenfranchising large sections of the population. The influence of fundamentalist non-state actors, such as ISIS, and al-Qaeda is, while not dominant, an observable problem in Uzbekistan and elsewhere in Central Asia. Whether or not these organisations can capitalise on the potential chaos of a leadership vacuum will determine their long-term influence in the region, and whether the West, Russia and China should be more concerned.

Finally, if Karimov does die or is rendered unable to lead, the reaction of all the major players in the region will be worth watching. The US, Russia and China each have a vested interest in Central Asia and at times these compete. Karimov successfully capitalised on the US regional presence during the Afghan War. So too has he developed strong relationships with the Russian and Chinese governments.

Other actors are also vying for an increased stake in the economic and political future of Central Asia. India, Turkey and Iran have all stepped up efforts to deepen regional ties and capitalise on the resource wealth of the region.

We don’t know much about how an Uzbekistan without Karimov would act and that uncertainty extends to the future of all the bilateral relationships forged in the last 25 years.

The date to watch is September 1, Uzbekistan’s independence day. A Karimov no-show at national celebrations would be unprecedented, and signal the severity of his ailing health.

While Uzbekistan receives few headlines, it is now entering its most tumultuous period in recent history. And the consequences will likely cross borders.