Russia: Progress in Russia offset by setbacks in the north Caucasus

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Chechnya, Ingushetia and Dagestan The kidnapping of an MSF volunteer in the Russian republic of Chechnya in January 2001 exemplified the difficulties of bringing humanitarian aid to an area where violence is a daily occurrence and independent humanitarian action is not respected. The volunteer was released unharmed after several weeks, but MSF work in Chechnya itself was suspended. Programs continue in Ingushetia and Dagestan, where hundreds of thousands of displaced people live in sometimes appalling conditions. MSF has also assisted Chechen refugees in Georgia (see page 63). While not reestablishing a permanent expatriate presence, MSF was nevertheless able to return to Chechnya itself in June 2001 to help rebuild the 45-bed maternity ward at the central hospital in Gudermes, Chechnya's second-largest city. Despite the illusion of normalization and statements about "reconstruction" put forward by Russian authorities, and the ongoing rhetoric that a political solution must be found for Chechnya, low-level war and a campaign of fear and terror continue. In November 2000, MSF gave its testimony at the Council of Europe and at the time issued a report called "The Politics of Terror." This report underscored the ongoing climate of fear in Chechnya and the consequences of the war on the lives of ordinary people (see the following pages for excerpts of the report). MSF work continues to address medical and structural needs stemming from the conflict and population flows. Regular donations of drugs and medical materials have been made to 25 health facilities in Chechnya; to 22 health facilities in Ingushetia, burdened by the influx of more than 140,000 displaced people; and to health posts and small hospitals in Dagestan, near the Chechen border. MSF doctors and nurses provide medical care to thousands of displaced people living in host families and collective centers in the Ingush district of Malgobeck, and in collective centers located in and near the Ingush capital, Nazran, and in the Dagestan city of Kazhaviurt. MSF has also distributed basic relief items to people in all these areas and carried out construction and repair work to improve the sanitary and living conditions of the displaced. MSF programs elsewhere in Russia The situation in other parts of Russia was more encouraging. By late 2000, the government had approved the concept of "harm reduction" for intravenous drugs users and the need for preventive health measures in the Russian prison system. "Harm reduction" programs promote safer behavior among intravenous drug users and have been an important part of MSF's HIV/AIDS prevention programs in Russia since 1996. Direct outreach in Moscow and the training of health workers from 60 other cities were key parts of this program. MSF also offered training on HIV/AIDS prevention strategies to inmates and prison staff in seven pilot penal institutions, and conducted the third nationwide mass media campaign to promote sexual health and condom use. Given the scope of the AIDS epidemic in Russia, MSF promoted the creation of a new NGO, AIDS Foundation East-West (AFEW), that would focus exclusively on this problem. Many of the AIDS programs run by MSF in Russia will be handed over to AFEW, while some projects will be handed over to other local counterparts. Duma recognizes the need to address homelessness Over four million homeless people throughout Russia are excluded from public services. After years of letters, meetings, and negotiations with health officials, government representatives, and parliamentarians, MSF was invited to speak at a deputy session of the Duma (parliament) in Moscow. The Duma finally voted to create municipal health and social centers for the homeless in Moscow. In the meantime, MSF continues to fill a gap by providing more than 500 medical and social consultations every week for Moscow's more than 100,000 homeless. Pilot program expands from prisons to civil society In Russian prisons, about one in every ten inmates is infected with TB. MSF's anti-TB pilot program within the prison system of Kemerovo, Siberia ensures that all active TB cases are quickly detected, isolated, and treated using the "DOTS" (Directly Observed Treatment Short Course) method. MSF has cured more than 4,000 patients since the program began in 1996. Plans to begin treating 150 prisoners with multi-drug resistant TB are under negotiation. At the same time, MSF is working toward expanding the DOTS program beyond Kemerovo's prison walls and into the civil sector. MSF also assisted residents of the Siberian town of Lensk during floods in late May 2001. International staff: 39 National staff: 274