Seventeen people, including two children, died during this year’s cotton harvest in Uzbekistan, the bloodiest year to date, according to a shocking new report.

The two children, ages 3 and 5, died of smoke inhalation when a fire broke out in their home in Karakalpakstan, a remote area in the country’s northwest. Their mother was forced to leave them home alone when she was ordered to pick cotton, said Umida Niyazova, the Berlin-based director of the Uzbek-German Forum for Human Rights, which produced the report.

The woman, who is unemployed and on social assistance, “could not afford to buy herself out of cotton picking,” said Niyazova.

Every year, this Central Asian country — notorious for the autocratic rule of President Islam Karimov — forces hundreds of thousands of people to work in the cotton fields, activists say. Last year, 11 people died, including a 6-year-old boy who suffocated under heavy bales of cotton.

Uzbekistan is the only country with state-sponsored slave labour.

In previous years, schools and public offices closed for months as children and civil servants worked in the fields from September to November. This year, bowing to international pressure, fewer schoolchildren were forced to pick cotton. The burden instead fell on university students, public-sector employees and the owners of private businesses, say activists.

But the government is still forcing people to work in the fields, said Matt Fischer-Daly of Cotton Campaign, a coalition of labour and human rights activists and agencies, which endorsed the report. “Instead of changing the policies that lead to forced labour, they are replacing children with more adults,” he said.

“It is good to see fewer kids in the fields … (but) we hope that the government quickly learns that replacing kids will not end pressure.”

Although fewer children ended up in fields, they still had no access to education because their teachers were forced to pick cotton, Fischer-Daly said.

The report added that hospitals and clinics were woefully understaffed — and in some cases closed — for the duration of the harvest, as public-sector employees worked in the fields to fulfil their cotton quotas.

One medical clinic in the Khorezm region, in northwest of the country, was operated by one doctor and one nurse; the clinic is normally staffed by two doctors and 13 nurses.

In the same region, a grandfather reportedly couldn’t find a doctor at the district hospital to treat his grandson. Instead, there was a sign that read: “All at the cotton harvest.”

But it was the high number of deaths that bothered activists the most.

Monitors inside Uzbekistan said there were a number of crashes involving vehicles transporting workers to the fields. In one instance, a cargo truck transporting students crashed, injuring 29, some of them seriously.

The report also said that at least five people died from heart attacks or health complications while picking cotton, and three people committed suicide, including a farmer in the Khorezm region who was humiliated and threatened by local authorities for failing to meet his quota.