Russian Federation/North Caucasus: Aiding civilians bearing the brunt of low-level conflict

"Recently, it is the absolute sense of despair and hopelessness which is proving hardest to treat."
- MSF nurse from Chechnya who is herself displaced and now working with MSF in Ingushetia

Despite the region's insidious, ongoing conflict, MSF has been organizing ways to meet a small part of the population's needs in this changing environment. Teams continue to address some of the medical needs of the region's people, and in 2004, international staff were again able to visit Grozny, Chechnya's capital - where they had the vital opportunity to observe and discuss the MSF programs that have been managed for some time by national staff.

The last of the tented camps that since 1999 had provided refuge to Chechens who had fled to the Ingush republic was closed in June 2004. Faced with the prospect of homelessness, the majority of the internally displaced people (IDPs) chose reluctantly to return to Chechnya, leaving about 32,000 of the displaced people in Ingushetia.

They live mostly in derelict buildings roughly equipped for human habitation. Their living conditions vary from difficult to unbearable, in overcrowded, dank, dilapidated buildings that enable diseases such as tuberculosis (TB) and pneumonia to flourish.

MSF continues to support these IDPs by providing drugs and equipment to local health structures, and by providing shelter, logistical support and psychosocial counseling. In Malgobeck, MSF uses mobile clinics to help some of the area's 5,000 displaced people. The team provides approximately 200 medical consultations, 250 gynecological consultations and more than 130 pediatric examinations each month.

MSF staff works in the Ingushetian town of Sleptsovskaya and the city of Nazran, providing maternal and pediatric care, giving about 700 gynecological/obstetric clinic consultations and 750 pediatric consultations per month. In July 2005, MSF stopped similar work in the town of Karabulak.

Despite official claims that the situation in Chechnya has "normalized", so-called sweep operations to round up suspected rebels, landmine accidents, disappearances and violent trauma are common. Among the Chechens who have returned, many remain internally displaced, because their homes have been destroyed or their towns remain insecure.

An August 2004 MSF survey conducted among displaced people in Chechnya showed that 92.2 percent had been displaced for at least five years. The most destitute are housed in temporary accommodation centers (TACs) run by local authorities.

There are 32 TACS across the republic, the majority in or near Grozny. The TAC population (which local authorities estimate at about 37,500) lives under grim, unhealthy conditions. MSF has provided a range of services to TAC dwellers through mobile clinics that care for some 1,000 patients each month.

The clinics focus on mental health services, in response to evidence that many among the population suffer under severe strain and that much of their psychological illness is directly related to the pervasive climate of violence and fear.

MSF also continues to provide the central maternity facility in Grozny with drugs and medical materials and runs pediatric and gynecological/obstetric services in two of the city's polyclinics (for a combined 1,900 consultations per month). In July 2005, MSF started to support two more polyclinics, providing general consultations, pediatric and maternal care.

Treating TB patients and survivors of Beslan

MSF continues to respond to one of the most significant health crises in the North Caucasus: TB. Many of the republic's TB hospitals and sanatoriums are in poor condition after 10 years of war and neglect.

MSF focuses its work on three TB hospitals in the towns of Nadterechnye, Gudermes and Shali. It recently completed the rehabilitation of the hospital in Shali in January 2005, and has treated a total of 249 patients since June 2004. MSF has established a directly observed treatment system to help discharged patients adhere to their treatment.

In the republic of North Ossetia, the tragic death of more than 300 children and members of their families during a siege on a school in the city of Beslan, in September 2004, shook the region. MSF provided emergency medical kits to help treat some of the injured.


Helping Moscow's street children

In 2003, MSF opened a program that catered to the health and psychosocial needs of more than 15,000 homeless children and adolescents living on Moscow's streets. Like many capital cities, Moscow is a magnet for runaways, orphans and neglected children, many of whom have physical or mental health problems. Many of the youths with whom MSF works have acknowledged using injectable drugs.

Glue inhalation is very common and is often combined with tobacco and alcohol use. Unhealthy living conditions, including cramped quarters, early unprotected sexual activity and needle-sharing have enhanced the emergence of TB, sexually transmitted infections and HIV/AIDS among this group.

MSF's mobile outreach team composed of doctors, psychologists, social workers and teachers work daily with the most vulnerable street children who gather in the vicinity of railway stations, public squares and markets. The outreach team gives medical, psychological and social support to more than 650 children and adolescents each year and tries to create awareness of alternatives to living on the street.

In March 2005, MSF opened a day center as a complement to its outreach activities. The center sees as many as 20 children each day, providing them with a temporary refuge from the harsh realities of the street. More importantly, it offers various types of training and therapy, such as job-searching skills, health education and resilience-oriented therapy. Basic medical care is also provided, as are laundry and bathing facilities.

The street children project builds on MSF's 11 years of experience with the adult homeless population in Moscow, but is adapted to the hardships specific to the young. Among them are coercive national policies that empower police to arrest young street children and force them to enter hospitals and public shelters. Those who are not from Moscow can also be faced with removal to their place of origin.

MSF has worked in the Russian Federation since 1988 and in the North Caucasus since 1999.