Ingushetia, a small republic of the Russian Federation, in the North Caucasus, bordering Chechnya, once housed over 140,000 displaced Chechens who fled the war. Nowadays, there are an estimated 18,000 internally displaced persons (IDPs) in the republic, many of them living in precarious conditions. But the situation of the local population is not much better. With few natural resources and unemployment around 70 percent, the future here looks bleak. And over the last two years, the situation has deteriorated further – Ingushetia has become one of the most violent areas in the Russian Federation. "There are daily attacks on law-enforcers and officials," said Willem de Jonge, MSF Head of Mission. "The population itself has become the innocent victim. They are subjected to continuous violence through a cycle of attacks and counter-attacks." People tend to limit themselves to staying at home as much as possible. There is no war going on, but the population lacks security: literally every day the small republic is shaken by explosions, shootings and attacks. More than 170 people were killed in 2008 and 139 in the first half of 2009. The constant feeling of stress and anxiety draws many people into depression. "Every day, emergency hospitals in Ingushetia receive victims of armed violence," said Lamara Umarova, MSF Mental Health Officer. "It is beyond normal human life and people experience traumatic stress. It overturns their perception of the world. Our counselors work with the victims of violence and their relatives who are also suffering." MSF has been present in Ingushetia since 1999, when the second Chechen war started, supporting the displaced. Today MSF provides primary health care to IDPs and most vulnerable groups of local population. Psychosocial program has been an important element of MSF activities in the republic since 2003. This work continues today, but its scope and focus has expanded, since almost all the inhabitants of Ingushetia are suffering from the current violence. Mental health services are implemented by nine counselors in three districts of Ingushetia with a focus on acute trauma. The three main centers are working five days a week in the district hospitals of Nazran, Sunzha and Malgobek. Aiming to provide better access for people in need, the counselors see clients in six village polyclinics weekly. Over the past two years, MSF has experienced a sharp rise in numbers of mental health consultations in Ingushetia, the proportion of violence-related consultations growing to approximately 80 percent. The insecure situation in the republic has changed the atmosphere in the society. "Traditional coping mechanisms – family ties, friendship, religion - do not work well today," explained Mareta Gudiyeva, MSF Mental Health Program Manager. "Feelings of distrust and (a lack of) safety prevail among people. We learn about violent incidents from the internet or from the news, which is very unusual for this small republic. People don’t want to talk about it to their friends and neighbours. They have become almost accustomed to this violence." The clients’ stories mental health counselors tell are painful. A a woman, 24, who was going to work in a car with her husband and baby twins when a sudden explosion killed her husband instantly and injured her. Fortunately the babies were not injured. It is not easy to relieve acute traumatic stress, but observing the principle of strict confidentiality, using different counselling techniques and simply displaying sincere human sympathy allows our counselors to gradually gain their clients’ trust and render effective assistance to them. "Today we see people come to our counselors in search of confidential, neutral, unbiased assistance," Gudiyeva said. "In this difficult situation the most important thing for our clients is to speak out their problems and to be heard. They trust MSF and that is the valuable result of our work here."