Russia 1998

International staff: 17 National staff: 85 Figures for the homesless soar There continued to be a decline in the overall level of health care, including a steady rise in TB and STD/HIV/AIDS rates. The numbers of homeless already excluded from the minimal social welfare system continued to swell. MSF continues to work on behalf of marginalised and vulnerable groups in Moscow and St. Petersburg to improve the situation of the homeless and limit their exclusion from the health services. It is very easy to become homeless in Russia and although precise numbers are difficult to ascertain, there are estimated to be as many as 100,000 in Moscow and around 50,000 in St. Petersburg. MSF offers them free medical consultations, vaccinations and health education, ensures a referral system to hospitals for treatment, promotes hygiene and access to available services, and provides clothes when necessary. Free consultations with social workers aim to encourage their reintegration into society, give information about the different services available and guidance in approaching the authorities. MSF also organises general awareness campaigns focusing on the plight of the homeless. TB rates soar TB has reappeared to become a major scourge in Russia. The incidence rate varies from region to region, but Siberia appears most affected with a rate twice the national average. This is largely due to a prison population of over one million crammed into overcrowded and insalubrious prisons in which TB spreads rapidly (30% of TB patients in Siberia are ex-prisoners). MSF works in Mariinsk prison hospital in Central Siberia housing well over twice the number of patients it was intended for. Smear positive cases are specifically targeted as they are the most contagious. MSF instituted DOTS and trains prison medical staff in its correct use. A similar programme opened in Novokuzniets prison hospital in June 1998. An important element of this programme is raising public awareness about the prison TB epidemic and its consequences for the general population in order to encourage the authorities to take adequate measures to confront the problem. An HIV/AIDS programme in Moscow includes a mass media awareness campaign, prevention work among injecting drug users, and training and information for health professionals. MSF also advocates for reform on HIV/AIDS prevention and other policy issues. Chechnya An MSF team continued to assist refugees from Chechnya sheltering in neighbouring Ingushetia until an MSF expatriate volunteer was kidnapped in July 1997, when work was terminated here and in Chatoi hospital in Chechnya itself. He succeeded in escaping after 15 weeks, but the worsening security situation also brought to an end MSF's involvement in North Ossetia and Dagestan. MSF keeps a close eye on the situation and is ready to intervene again in case of need. This falls under the emergency preparedness plan for manmade and natural disasters, which is an important function of the Moscow office.