International staff: 37
National staff: 250
Over the last year, MSF has focused on responding to the outbreak of war between Russian forces and rebels in the Russian republic of Chechnya (see box). MSF decried the Russian government's indiscriminate bombing of Chechen civilians during the conflict and the lack of international response to the crisis. MSF's work elsewhere in the Russian Federation continues to target three key problems: the spread of HIV/AIDS, the medical and social exclusion of a rapidly growing homeless population, and the tuberculosis (TB) epidemic in Siberian prisons.
Attacking HIV/AIDS on many fronts
Russia now ranks among those countries with the fastest increase of HIV infection, the 50,000 registered cases indicating (according to WHO estimates) up to 500,000 infections in total. HIV/AIDS programs, based in Moscow, are run in collaboration with Russian health authorities and national NGOs. Begun in 1996, they are designed to be models for preventive health programs nationwide.
MSF activities include mass-media campaigns to raise awareness of the disease, the dissemination of HIV/AIDS information (through research, counseling, training, seminars, an information hotline and a library) and a "harm reduction" inititative targeted at the country's growing ranks of intravenous drug users, who make up 80 % of those registered with HIV. As part of this initiative, all 35 current needle exchange projects in Russia receive technical assistance and training from MSF.
To address HIV in the Russian penitentiary system, MSF began a three-year pilot program in July 1999. In collaboration with the Russian Ministry of Justice, preventive health measures are being implemented in six prisons throughout the country. MSF trains medical staff, inmates and prison guards in HIV prevention and distributes condoms and bleach to prisoners.
Russia's four million homeless
When MSF began working with Moscow's homeless in 1992, the official number for this marginalized population was 30,000. Today there are 100,000 homeless people in the capital, and four million throughout the country. MSF hopes to offer a model for socio-medical assistance that can be handed over to the Russian government and reproduced on a larger scale. This was done successfully with a similar MSF program in
St. Petersburg, which was handed over to the government in 1999.
MSF carries out more than 500 medical and social consultations per week, which include basic medical care, vaccinations and referrals to city hospitals. Teams lobby the Russian authorities and also help the homeless wanting to reintegrate into society to solve legal problems, replace official documents, seek jobs and find places where food and clothes are donated. Educating the general public about homelessness (through documentaries, posters, and mass-media campaigns) is also an important part of the work.
Siberian prisons carry a sentence of ill health
Penal detention in Russia often carries with it an extra-judicial sentence of ill health. Malnutrition and massive overcrowding have made Russia's prisons a breeding ground for TB. MSF uses the DOTS (Directly Observed Treatment Short Course) method to treat all prisoners in the Kemerovo region who have active (contagious) TB. MSF treats patients, trains staff on the implementation of DOTS and supplies laboratory equipment, materials and quality drugs to detect and treat TB. The program now covers the entire prison system in Kemerovo, including the pre-trial detention centers (SIZOs), where work began in February 2000.
MSF also addresses the problem of resistance to TB drugs (including multi-drug resistance, or MDR TB) by conducting research and ensuring the early detection and isolation of MDR TB patients. More broadly, MSF is setting up a system to supply MDR TB projects worldwide with quality drugs, after having negotiated significant reductions in drug prices.
Although the TB cure rate has risen and now hovers around 70%, further progress has been slowed by several factors, including the large number of MDR TB patients and high turnover rates in the prisons. And, not least, there has been no improvement in the underlying living conditions of most prisoners.