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MSF: Neglected Chechnya

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  • Bella Shidiskas
    Source: Médecins Sans Frontières Date: 1 Aug 2000 Neglected Chechnya MSF first started working in the North Caucasus in the early 1990s and reinforced its
    Message 1 of 1 , Aug 1, 2000
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      Source: Médecins Sans Frontières Date: 1 Aug 2000

      Neglected Chechnya

      MSF first started working in the North Caucasus in
      the early 1990s and reinforced its presence during the first Chechen
      war (1994-1996). However MSF teams withdrew at the end of December
      1997 following several kidnappings of aid workers.

      For an extended period both during and after the
      recent conflict, MSF had no aid programme in Chechnya itself and it
      was impossible for teams to enter the republic as the border was

      Over 250,000 Chechens were displaced in the recent
      conflict and forced to resettle in Ingushetia, Dagestan and
      Georgia. The bulk of the displaced, nearly 200,000, went to
      Ingushetia. MSF was able to start some relief work there by November

      Although MSF aid projects were able to start in
      the areas with displaced populations access to Chechnya was hampered
      by both a refusal to gain access from authorities and an uncertainty
      due to the hostile climate for humanitarian workers in the city.

      In February, 2000, MSF was able to reenter
      Chenchnya itself and has begun distributing medicines and medical
      equipment throughout many of the city's health centres and hospitals.

      In this collection of details from the MSF
      operations in the North Caucasus, reports of MSF programmes in the
      field, as well as a personal account from the MSF head of mission,
      explain the problems faced by both MSF and the people living there.

      MSF activity in North Caucasus September 1999 -
      July 2000


      MSF's first response to the crisis, in September
      1999, was to provide emergency assistance for the inhabitants of
      Chechnya fleeing the war and entering Georgia from the Zinvali border
      crossing point. These refugees then settled in the Pankissi Valley
      where MSF continued to work until December, 1999. MSF volunteers
      carried out a vaccination campaign against polio and measles, referred
      serious cases to the Tbilissi Hospital, supplied medicines to health
      posts and assisted persons suffering from psychological trauma.


      The bulk of the inhabitants who fled from Chechnya
      - more than 200,000 - poured into the neighboring Russian republic of
      Ingushetia. In November 1999, MSF started distributing relief items
      (such as blankets and hygiene kits) to this population. Hygiene kits
      continue to be donated in Northwestern Ingushetia.

      Teams started supplying local hospitals and
      clinics in Ingushetia with medicines and medical equipment in December
      1999. This support is on-going and aims to assist the Ingush health
      system cope with the tremendous extra burden imposed by the influx of
      internally displaced persons (IDPs).

      In January 2000, Chechen professionals recruited
      by MSF participated in an intensive, ten-day basic training course in
      Moscow. Since then, workshops for the national staff have been held on
      a regular basis, both in Moscow and in Nazran. They cover specialized
      topics such as WHO and MSF medical standards, security issues,
      logistics and management.

      In the district of Malgobeck, located in
      Northwestern Ingushetia, two mobile clinic teams have been conducting
      more than 120 consultations a day for the past few months. These
      mobile teams, each composed of a doctor, a gynecologist, and a nurse,
      travel to the 11 villages of the district and cover a target
      population of 30,000 IDPs. Besides treating skin diseases, respiratory
      infections, diarrhea and STDs, they provide invaluable psycho-social
      support to a traumatized population. In addition, since last May, a
      gynecologist and a social nurse in an itinerant bus have been offering
      consultations to women, who represent a majority of the IPDs.

      The results of surveys recently carried out by the
      teams will shed more light on the basic needs of the IDPs in
      Ingushetia. What seems clear for now is that most of them will have to
      stay in the republic through the winter. MSF plans to pursue its
      current medical and relief activities, and to respond to water,
      sanitation and basic shelter needs as they arise.


      In the Russian republic of Dagestan, MSF has
      recently begun distributing basic medical kits to health posts,
      clinics and hospitals in three districts. These medical structures
      were directly damaged, or secondarily affected, by the fighting
      between Chechens and the Russian army between August and October,
      1999. Assessments in other areas of the republic are being conducted
      to determine the needs of the internally displaced, who were either
      uprooted from their homes within Dagestan during the first phase of
      the conflict, or later came from neighboring Chechnya.


      In February 2000, MSF began distributing medicines
      and medical equipment throughout Chechnya. In spite of the ravages of
      two wars and years with no salaries and inputs, many hospitals and
      clinics in the republic have managed to continue functioning. MSF is
      working to help restart the health system, providing the doctors with
      the tools and supplies they need to work. Teams are also collecting
      data on war-trauma injuries.

      In addition MSF is carrying out light repairs in
      destroyed and damaged clinics and hospitals in order to spur the
      re-opening of these health structures.

      The organization hopes to gain further access to
      the vulnerable populations in Chechnya and to increase its activities
      in the war-torn republic.

      The continuing cost of war

      In spite of the insecurity and the risks, Chechnya
      is one of the places where MSF should be present. Hopefully, we can
      learn from the dedication of the hospital staff here and their ability
      to continue working in the most difficult of situations.

      By Kenny Gluck

      The world is full of hidden disasters which fail
      to catch our attention and, as a result, suffer from neglect. More
      rare are the modern tragedies that unfold in the full public eye but
      suffer from neglect none the less. Chechnya has been one of them.

      The bombing and destruction of Grozny - once a
      city of 400,000 people - and of villages throughout Chechnya were a
      nightly feature of television news throughout the past winter and
      spring. Despite the media attention, the population of Chechnya
      endured the war and its ravaging consequences with little or no
      assistance from the outside world.

      International relief groups, including Médecins
      Sans Frontières (MSF), were painfully slow in responding to the
      plight of the population in Chechnya. The intensity of the fighting
      and the history of attacks on aid workers kept us from reacting with
      the efficiency we have managed in crises elsewhere in the world, while
      other agencies were hindered by the role of Russia in the United

      The Continuing Cost of War

      Although the large-scale and indiscriminate
      bombing in Chechnya, which drove over 250,000 people from their homes,
      has ended, the war is still wreaking havoc on the lives of the
      republic's inhabitants. Hundreds of thousands of them stayed here
      throughout the war - unable to leave or unwilling to abandon their
      homes. Many thousands of displaced persons have started to return to
      Chechnya hoping to rebuild their lives. The huge numbers of mines and
      unexploded ordinance which dot the Chechen landscape are continuing to
      kill and main the population.

      Every day new casualties - from landmines, from
      artillery - are being brought into Chechnya's hospitals and
      clinics. In May there were over 161 new war-related injuries in the
      capital of Grozny. 150 of these cases were serious enough to require
      hospitalization, and half of those hospitalized were women or children
      under the age of 15. But these numbers only reflect the wounded
      admitted into four of Grozny's ten hospitals. The total is, without
      question, far higher.

      In June the victims of mines and shelling
      continued to pour into Chechnya's hospitals and clinics. Most of the
      victims are people trying to get by in spite of Chechnya's failed
      economy. Ilias, a 16 year-old boy from a village outside of Grozny, is
      a typical case. He and his relatives had woken up at dawn to cut hay
      for their livestock. They were unable to plant crops this year because
      of the war. With no jobs available in Chechnya, cows are one of the
      few sources of food for many villagers.

      Tragically the truck which Ilias and seven of his
      relatives were riding in struck an anti-tank mine left over from the
      fighting. Five of his relatives were killed. Ilias is now a patient in
      Grozny's hospital No. 9, most of which was destroyed by the Russian
      bombing of the city. He lies covered in bloodied sheets, in the only
      section of the hospital that survived the war. Both of his legs and
      his hips are shattered by the explosion. The doctors who operate on
      him worry they will not be able to find the medicines necessary for
      his legs to heal.

      A Health System Which Refused to Die

      The enormous needs inside Chechnya and in
      neighboring Ingushetia were met, first and foremost, by the good will
      and deeds of neighbors, friends and especially by a Chechen health
      system which refused to die.

      When I first came down to Ingushetia to open the
      mission for MSF, I looked up old friends who could help us understand
      the new situation and open an office. I found Bisultan Borziev,
      himself a refugee from Grozny from the previous war. He was housing 25
      refugees from Chechnya. Bisultan is now the Program Manager for MSF
      in Ingushetia.

      The doctors and nurses here have struggled
      throughout the war to keep their hospitals and clinics open. Movsar
      Idalov and Roman Edalov, two surgeons now with MSF, used to work in
      different hospitals in Grozny. After Russian bombing in late 1999
      destroyed their workplaces, they fled back to their native village
      with what equipment they could recover from the ruins and set up an
      operating theater in a basement there. For almost three months they
      labored underground providing emergency services for their fellow
      villagers as well as hundreds of refugees fleeing from Grozny and the
      Argun gorge. It was only when the front lines came to their village
      that they gave up their makeshift hospital and escaped to Ingushetia,
      joining a convoy of cars. An attack on the convoy killed two of their
      companions and wounded five others.

      Dr. Anderbek Bakayev was more fortunate. His
      village was largely spared. As the head surgeon of the Stary Atagi
      Hospital, he treated hundreds of wounded and performed life-saving
      surgeries during the intense bombardments in late 1999 and early
      2000. Stary Atagi is one of the many hospitals which has continued,
      against all odds, to serve the population in central Chechnya.

      Hospitals without Drugs

      The wounded are still coming to the Stary Atagi
      hospital, which was partly destroyed during the last war in 1995. The
      conditions have not improved greatly since the more recent fighting
      ended in the area. Although Stary Atagi has been under Russian control
      since February, it is still without sufficient medicines and
      equipment. It has received no support whatsoever from the Russian

      The lack of drugs in Stary Atagi is a situation
      repeated in hospitals and clinics throughout Chechnya. Most patients
      have to depend on the few medicines available on the market, or on
      what humanitarian organizations like MSF have been able to

      The doctors, who have already gone through two
      wars, do not understand why so many resources are available for the
      war while so few for the hospitals. In May, some of the medical staff
      in Chechnya received one or two months' salary. For many it was the
      first, long-awaited payment they had seen in five years - but it came
      to only US $25. In some hospitals, even this pittance has not yet

      The enormous burden these hospitals and clinics
      have suffered during the war is only aggravated by the lack of support
      that continues to plague them. In those areas under Russian control,
      it is essential the government assume its responsibility for providing
      health care to the citizens and for supporting the beleaguered health

      An Effort to Respond

      MSF has been trying to find ways of supporting the
      clinics and hospitals that have managed to keep functioning. Since
      February, the organization has been providing medicines and medical
      equipment to health structures throughout Chechnya. Unable to import
      because of Russian customs restrictions, MSF logisticians Natasha
      Khodakevich and Yelena Nevskaya have become experts in the complicated
      task of procuring medicines in Russia.

      Every month, MSF has been able to supply basis
      drugs for 120,000 people in Chechnya and Ingushetia. Where clinics
      were destroyed in the bombing, MSF teams also carry out light repairs
      - giving each clinic at least several furnished and enclosed rooms
      where patients can be examined.

      Supplying the hospitals and clinics in Chechnya
      requires the MSF staff to negotiate their way through the dozens of
      Russian military checkpoints that dot the roads in the war-torn
      republic. There are 19 Russian military checkpoints between the Stary
      Atagi hospital and the MSF office in Ingushetia. The needed supplies
      make it through to the hospital only thanks to the charm, bravado and
      persistence of the staff here. Far too often however, the checkpoints
      close and aid is unable to pass.

      For the wounded, the checkpoints can be a deadly
      obstacle. On a recent visit to the Stary Atagi hospital, MSF staff
      member Satsita Eskieva spoke with Imran, a 24 year old father of two
      from the village of Gikalo, just south of Grozny.

      Early last month, Imran went to cut hay in the
      fields outside the village. He stepped on a mine at about 7 o'clock in
      the evening. His left leg was completely shattered. His right leg was
      shot through with shrapnel. For over two hours he dragged himself
      through the fields, losing blood, towards his house. It was after 9
      o'clock when he crawled to the edge of the village. His fellow
      villagers immediately tried to take him to the near-by hospital in
      Stary Atagi - but they were not allowed to the pass the Russian
      military checkpoint which lies between Gikalo and the hospital. Even
      when the village leader contacted the soldiers at the checkpoint and
      explained the situation, they refused to let Imran be taken to the
      hospital. The soldiers answered that they would open fire on any
      movement on the road near the checkpoint. All night Imran waited with
      no medical attention, slowly losing blood with nothing to ease the
      pain. When he made it to the hospital in the morning, the doctors
      could do nothing except amputate his leg.

      A Needed Presence

      All of the MSF national staff are themselves
      refugees. Some, like Bisultan, lost their homes in the first war and
      moved to neighboring Ingushetia. Others, like Satsita, saw their
      neighborhoods reduced to rubble and ashes in the bombing of Grozny in
      1999 and 2000. Still others, like Roman and Movsar, rebuilt their
      homes in the months of hope that followed the end of the war in 1996,
      only to see them destroyed again in the current fighting.

      The medical personnel in Chechnya's hospitals and
      the MSF national staff watched with desperation as humanitarian
      agencies fled the region in 1996 and 1997 in the face of violent
      attacks on aid workers. They waited in frustration for months in the
      current war for aid to finally arrive. A doctor in the Stary Atagi
      hospital was extremely thankful when the first MSF team visited the
      hospital. His gratitude, he said, was more for the fact that we had
      come than for the boxes of medicines. For years people in Chechnya
      have felt rejected by the world - left to suffer in isolation.

      "The fact that you have come back reminds us that
      we are part of the same world," he said. "That is more important for
      us than anything else that you could bring."

      In spite of the insecurity and the risks, Chechnya
      is one of the places where MSF should be present. Hopefully, we can
      learn from the dedication of the hospital staff here and their ability
      to continue working in the most difficult of situations.

      Kenny Gluck is the Head of Mission for Médecins
      Sans Frontières in the North Caucasus.

      Reproduction or redistribution of the above text,
      in whole, part or in any form, requires the prior written consent of
      the original source.

      Related Documents: Latest Emergency Updates:
      Russian Fed. - Chechnya Latest By Country: Russian Federation Other
      documents by: Médecins Sans Frontières

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