"The outlook for Chechnya is grim", said MSF operational director Freek Landmeter, who has recently returned from a visit to the Caucasus. "The occasional shelling and mines still kill and wound hundreds of people each month. Very few in Chechnya have faith that the conflict will come to an end soon."

In Chechnya and the neighbouring Russian republic of Ingushetia, where many Chechens fled to, MSF is currently distributing essential medicines. The medicines go directly to various hospitals and clinics. In addition MSF has mobile clinics in Ingushetia and is providing additional support to one hospital in Ingushetia and two in Chechnya.

In Chechnya many hospitals and clinics only receive the drugs that MSF provides. In Ingushetia, hospitals receive some supplies from the Ministry of Health, but these are not enough for them to cope with the influx of internally displaced people (IDP).

"The Chechen staff we are working with are very motivated, but also critical towards their own system, which gives us a guarantee that the drugs end up in the right places," said Landmeter.

"For the near future, we are planning to rehabilitate parts of two hospitals and to re-establish good operating theatres and small in-patient departments in Grozny and Staryy Atagi. In many places, surgery and patient care still takes place in basements and private houses. The next step might be the introduction of a mental health programme."

In Ingushetia, Landmeter was very impressed with the official health system.

"Ingushetia houses approximately 120,000 IDP in camps, private houses and with host families," he said. "Existing health services are open to the refugees and the Ministry of Health has set up clinics in all camps. Although the clinics are underfunded and lack resources, they have provided far more services to the IDP population than NGOs ever could have. The situation of the displaced in Ingushetia is also unsure. Most of the IDPs refuse to return to Chechnya because of the lack of security there. Many IDPs fear that the Russian government will attempt to force them back against their will."