The politics of terror

This article first appeared in The Lancet. Sir - Tom Parfitt's Medicine and health policy article (Apr 17, p 1291)1 on the sexual violence experienced by Chechen asylum seekers in the UK is of great interest. The fact that sexual abuses are occurring against men and women is crucial to an understanding of the realities of living in Chechnya at this time. The findings of the report reinforce the view of our organisation, and that of many others working in the north Caucasus, that an unacceptably high level of brutality and violence remains in Chechnya. Extreme violence, abductions, assassinations, torture and "cleansing" operations persist. These realities run contrary to the repeated mantra of "normalisation" put out by the Russian authorities, who are keen to uphold the illusion that the war is over. In response to the global war on terror, Russia has been able to position the Chechen conflict within the framework of the international fight against terrorism. The subsequent silence of the international community with respect to war crimes in Chechnya has shattered the hopes of many that the situation will improve. Chechnya is currently witnessing a health and humanitarian crisis. Years of war have left medical services in chaos. Unable to cope, they are propped up by donations from the international aid community so that local medical staff can continue to treat patients. Available drugs and services are insufficient to treat key causes of morbidity and mortality: cardiovascular disease, cancer, and tuberculosis. Many medical staff have fled the country. Those who remain are frustrated at the lack of equipment and poor access to new and improved protocols. Because of the repeated kidnapping of expatriate workers, Chechnya remains closed off to international scrutiny. Our colleague, Arjan Erkel, Médecins Sans Frontières' Head of Mission in Dagestan, was released by captors on April 11, 2004, after 20 months as a hostage. Arjan's long detention, and the abduction of more than 50 international humanitarian aid workers since 1995, has crippled the ability to provide aid to war affected civilians in this region. It is almost impossible to deal effectively with medical emergencies because the risks involved in moving around prevent medical staff and patients from reaching the hospitals. Health centres are too dangerous for the war wounded and are consequently avoided. Many staff express fear for their own personal safety because they work in hospitals where guns and violence are commonplace. Despite the violence and intimidation in their homeland, the forced return of thousands of Chechen refugees living in temporary camps and shelters in the neighbouring republic of Ingushetia continues. As part of the normalisation strategy, the authorities are attempting to close all tent camps by mid-2004. Such camps have provided refuge for more than 200,000 Chechens since the start of the second Chechen war in 1999. Measures include intimidation, deregistration of refugee status, and cutting off electricity and water supplies. Access to the camps for humanitarian aid workers has been severely restricted. Although many Chechens are living here in appalling and desolate conditions, most say they are too frightened to return to Chechnya. The basic right of Chechens to take refuge in Ingushetia must be respected by the authorities until the situation in Chechnya is safe. For those living in Chechnya, the international community must ensure that medical and humanitarian aid reaches them, and they must be reassured that they have not been forgotten. By Sally Hargreaves, *Andrew Cunningham Médecins Sans Frontières, 2/24 Kaloshin Street, Moscow 119002, Russia ( FOOTNOTE" 1 Parfitt T. Russian soldiers blamed for civilian rape in Chechnya.