In an unprecedented development, Uzbekistan’s government has officially announced that President Islam Karimov has fallen ill and will require treatment for an unspecified amount of time.

The unusually frank statement released on August 28 follows unconfirmed rumors that had been circulating overnight about Karimov possibly suffering of a stroke or a heart attack. Central Asia-focused news website ferghana.ru ran a report claiming Russian cardiologist Leo Bokeria had traveled to Uzbekistan to treat Karimov, only for the doctor to quickly quash that speculation.

The authorities’ hand was likely forced by preparations for independence day celebrations on September 1, which Karimov would have been duty-bound to attend. The president has at some major public events in recent years been given to performing energetic jigs in a transparent attempt to defy those predicting his imminent death.

No more information about the president’s state of health has been provided, but attention will now inevitably quickly turn to succession issues. Karimov has never indicated any clear figure he would like to have take his place, which opens up the prospect of a jostle for power among insiders.

Still, early betting is that Prime Minister Shavkat Mirziyayev could eventually claim the spot.

“Mirziyayev’s administrative heft is, among things, defined by his closeness to the presidential family and the support from the head of the National Security Agency, 72-year old Rustam Inoyatov,” Russia-based analyst and journalist Arkady Dubnov wrote on his Facebook account.

Indeed, this is the fundamental point. The succession conundrum has by some parameters long been settled since the National Security Agency, or SNB in its Russian initials, has arguably long been de facto running the country. 

Significantly for the diplomatic ramifications though, Mirziyayev is the candidate likely to be preferred by Russia. Karimov has firmly rebuffed overtures from Moscow to join regional groupings like the Eurasian Economic Union, preferring instead to steer a course of balanced relations with the West, China and other economic partners. It is thought, however, that Mirziyayev would be more warmly disposed to such cooperation with Russia.

Formally, should Karimov provide incapable of fulfilling his duties, power will be administer by the speaker of the Senate, Nigmatilla Yuldashev, a former minister of justice. Yuldashev would in all likeliness be quickly sidelined were Karimov’s incapacity to prove permanent.

Before anybody rushes to bury Karimov though, it should be remembered that rumors of his grave ill-health are nothing new. Only the confirmation from the government is.

In early 2015, ahead of the March presidential election, an opposition website given to disseminating often unfounded speculation reported, citing unknown supposed sources, that Karimov had fallen ill. That followed claims from the People’s Movement of Uzbekistan (PMU), a Norway-based opposition group headed by long-exiled leader Muhammad Solih, that Karimov had fallen into a coma in January that year.

Sure enough, the president had not appeared on television for a long period of time, but Karimov is not especially camera-friendly at the best of times.

Either way, it seems likely that nothing certain will be known until after the independence holiday, so the suspense could be agonizingly extended. 

This article has been updated to correct erroneously named speaker of Senate.