Remote control project in Chechnya allows for health care in a highly insecure region

What is a remote-control project model?

A remote control project, is a project that functions without the presence of an expatriate team at the actual project site.

The Country Management Team (the head of mission, the medical coordinator and other management team members) usually have few, if any, possibilities of visiting the actual project site and are often based in a location quite far from the actual project.

This type of project model is implemented as a result of the security risks for international aid workers at the project site. The activities of the project are thus carried out exclusively by a team of local doctors, nurses, logisticians and administrators, who coordinate the on-the-ground operations.

Despite the end of the war for independence from Russia, the Republic of Chechnya and the health of the Chechen population continue to be affected by instability. Beneath the relatively calm surface, a different conflict continues to persist, with frequent reports of security incidents, vehicle explosions and shootings.

Violence has also spread to neighboring regions of Ingushetia, Dagestan, Kabardino-Balkaria and North Ossetia.

Due to the insecurity, Médecins Sans Frontières (MSF) has chosen to implement a "remote control" project in the Northern Caucasus. For the projects located in Chechnya, the work is supervised by the management team members who are located in the coordination office some 1,000 kilometers away in Moscow. The members of this team are occasionally able to make very quick and short visits to the region.

In a context where the health needs are so extensive, MSF has responded in Chechnya with broad medical programs, including primary care clinics, surgery, tuberculosis (TB) treatment and mental health support. In MSF supported clinics, Chechen doctors treat a population suffering from stress-related illnesses. MSF mobile clinics reach out to internally displaced person (IDPs) who returned to Chechnya but continue to live in temporary shelters.

With a special emphasis on mother-and-child care, MSF provides pediatric care and gynecology services, and supports existing mother-and-child facilities in Grozny and introduced a mental health component into its programs in 2002. MSF's presence in Grozny's Hospital ##9 supports the neurosurgery and trauma departments, where MSF doctors treat over 150 violence-related trauma cases a year, and an intensive care unit, as well as a reconstructive surgery project to treat long-standing war injuries.

TB treatment was one of the major unmet needs in Chechnya following the end of the war. Started in 2004, the MSF-supported TB treatment program recently expanded and now covers the population of the republic and ensures access to the TB patients in the remote mountainous regions in the south.

One by one, humanitarian organizations are closing down their emergency programs in Chechnya. However, the security situation in the region remains volatile and MSF assessments demonstrate a persistent need for health services for the population. as well a the precariousness of the situation.

"We can see that there is real progress in Chechnya, but also a potential that things might change for the worse at any moment," said Willem de Jonge, MSF Head of Mission responsible for Chechnya.