− in the North Caucasus

Home , Grozny, Murat Zyazikov, Nazran, Sunzha, Sunzha (river), Vladikavkaz

- in the North Caucasus

NEWSLETTER ON EMERGENCY PREPAREDNESS AND RESPONSE JANUARY-FEBRUARY 2004

Laboratory assessment mission to Grozny

From 16 to 19 February a WHO laboratory specialist carried out an assessment of selected laboratory facilities in Chechnya and Ingushetia. In Grozny, laboratories of city hospitals N2, N3 and N4, as well as the Republican clinical hospital and the city polyclinic N3 were assessed and in Ingushetia, the Sunzha district hospital and the Republican central clinical hospital in Nazran. After the mission the WHO expert briefed inter- WHO expert assessing laboratory facilities in ested humanitarian organisations, including Grozny

ICRC, Hammer Forum, MDM, MSF-B, IMC, IR, The laboratory assistants generally perform few, MSF-F and IHI in Nazran. simple and inexpensive manual techniques as direct bacteriological examination of urine, direct The main findings are that the physical condi- examination of faeces for parasites and a few tion of the visited laboratory facilities in Grozny haematological tests (Haemoglobin, white blood is precarious; with no access to central water count, etc). The specificity and quality of the and sewage and irregular electricity supply and results are questionable since neither Standard most buildings in dire need of rehabilitation. The Operating Procedures were noted nor quality equipment is often outdated and in some in- control measurements were in place. stances unsafe for handling. Insufficient provi- Also the safety of the working environment of sion of consumables and glassware leads to use the laboratory staff is questionable. broken materials and sometimes long expired test kits and reagents. The overwhelming majority of laboratory assistants have not received training in the last dec- ade.

The assessment of the Grozny city policlinic N3 revealed even less equipment and supplies, than in the hospitals’ laboratories, though policlinics are the first line out-patient health care provider and need to be able to provide differential diagnosis to refer appropriately.

The situation in the clinical laboratories in the Sunzha district hospital and the Republican clinical hospital (Ingushetia) is notably better. Al- Repair works at the Republican clinical hospital in though most of the equipment remains out- Grozny dated, test kits are new and the amount of pos- sible laboratory tests is quite impressive.

1 2. Training, upgrading of skills on new equipment and frequent supervisory visits.

3. Standard operational procedure manuals should be made available from the reference laboratory to guarantee uniformity in testing protocols and methods.

4. Quality Control Measures and Quality Assess- ment Schemes have to be developed, imple- mented and maintained.

5. Equipment supplies, training of personnel, and the layout of laboratories should be coordi- nated by an experienced professional.

(The full report, including lists of recommended equipment/consumables/reagents is available from WHO offices in Moscow and Nazran). Physical condition of laboratory facilities in Chechnya is precarious, the equipment being unsafe and outdated

Standard Operating Procedures were not available either.

The WHO laboratory specialist made following recommendations:

1. Each clinical hospital laboratory should be equipped with basic equipment and reagents; linked with physical rehabilitation of the building, including regular provision of electricity ( gen- erator). The overwhelming majority of laboratory assistants need training

INGUSHETIA AND CHECHNYA

According to the chief doctor of the TB service opened TB dispensary in Grozny provides inpa- of Chechnya 5,766 active TB patients were reg- tient services to 60 patients but has a 200-bed istered in 2003 including 1,051 newly diagnosed capacity. The MoH of Chechnya has provided patients. One third of them are residents of sufficient stock of TB drugs and the main re- Grozny. quest for humanitarian assistance comes for Furthermore, 1,841 cluster locations with one laboratory and general physiotherapy equipment and more TB persons were reported. The newly as well as food items for patients.

2 From 10 to 12 February WHO held a training plies (mattresses, blankets, buckets, water course on TB reporting, registration and moni- tanks and basic drugs and medical materials) to toring for 12 specialists in Nazran. The deputy people suffered as a result of a landslide in the head doctor from the central TB dispensary of village of Zandak in Nozhai-Yurt district of Orel region facilitated the course; he had been Chechnya in late December 2003. The landslide previously trained within the framework of the inflicted damage on 50 houses, out of which 14 WHO TB control programme in Russia. were completely destroyed. In addition, a gas- pipe, a power line, and a road were damaged. The Chechen authorities evacuated 250 people and distributed food to the victims.

WHO donated medical consumables to the central district hospital in Sunzha district of In- gushetia and health literature, posters and booklets to the Republican infectious clinical hospital in Grozny.

ICRC supported training of four doctors from Grozny in the training courses in Moscow. Two specialists from hospital N9 were trained at Bur- denko Neurosurgery Institute on neurosurgery and resuscitation, two others (from policlinic N9 Primary health care and Republican blood transfusion centre were trained at the Russian Medical academy of Post- From 14 to 29 January the IMC educational graduate education and at the haematological teams addressed a training course to 83 partici- centre of the Russian Academy of Medical Sci- pants on skin infectious and parasitic diseases ence. The organization has as well funded the for the personnel of their 24 assisted district participation of the cardiologist from Urus- hospitals and FAPs in Ingushetia and Chechnya. Martan district hospital at the All-Russian Cardi- IMC also carried out between 6 to 27 January ology Congress in Moscow. seven training courses for 65 Chechen IDPs with non-medical background in seven settlements in ICRC delivered medical equipment, including Ingushetia. One training session lasted for three lung ventilation devices, surgical tables, sterili- days and included special presentation and sation drums, autoclaves, etc. to the maternity practical classes on first aid in cases of cardio- department of city hospital N1 in Argun. pulmonary insufficiency, trauma and haemor- rhage, burns, drowning and birth assistance. The new programme of the local NGO “Memo- rial” arranges referral of individuals in serious WHO published 1000 copies of the 2004 table condition for medical treatment to other regions calendar with health awareness messages of the Russian Federation, covering all expenses. “Health for Chechnya”. The calendar was distributed to health care facilities in Chechnya and Ingushetia and among humanitarian organisa- The NGO “Hammer Forum” finalized the physi- tions. cal rehabilitation of children polyclinics N1 and N4 in Grozny. The facilities also received electro- cardiographs. Health assistance

MSF (Medecines Sans Frontiers) – France and MSF – Holland provided emergency relief sup-

3 Rational use of medicines 3000 MEP booklets with practical advice were distributed. On 10-11 February the NGO “Hammer Forum” On 24 February WHO/UNICEF held a joint conducted a workshop with head doctors of as- conference on breastfeeding in Nazran. Sixty- sisted hospitals and polyclinics in Grozny to dis- four participants from Ingushetia and Chech- cuss the promotion and active implementation of nya, amongst whom chief specialists from the rational drug use at all levels of health care. Ministries of health, representatives from medical colleges and university, doctors from the primary health care level Epidemiology and Immunisation and heads of hospitals were briefed on WHO/UNICEF Mother and child health strat- The 2003 annual state report of the SES of In- egy and discussed the current situation in this gushetia enumerates respiratory infections, area in the two republics. The advantage of acute intestinal diseases, TB, measles and viral breastfeeding was accentuated along with tech- hepatitis as the five leading infectious diseases. nical aspects and problems of breastfeeding in different situations.

UNICEF launched the next round of procure- ment of cold-chain equipment to primary health care facilities in Chechnya. Eighty-two health care facilities will receive refrigerators, cold boxes and vaccine carriers.

Slogan of the WHO/UNICEF breastfeeding Chechen health authorities report the aver- Conference: “Healthy life start for every child” age vaccination coverage among children in Chechnya to be 96.2%. But they also report a decrease in coverage from previous years: for measles from 81.7% to 71.7%, for rubella from 20,000 copies of the WHO brochure “Infant 98.4% to 33.9% and for Hepatitis B from feeding in emergencies, a guide for mothers” 105.3% to 33.9%. were re-printed and distributed by UNICEF.

UNICEF’s health inspectors visited selected health facilities in Chechnya and Ingushetia to Mental health and psychosocial re- verify the accuracy of records on vaccines ad- habilitation ministration, the adequacy of storage tempera- tures and expiry dates of vaccines. The mission UNICEF/PINF conducted in Nalchik a special revealed that in the National Cold Centre in training for 11 psychologists from 10 schools in Grozny and in the polyclinics N1 and N3 all vac- Grozny, providing them with specific knowledge cines are kept in compliance with the required on counselling methods. standards.

With the assistance of CARE Canada, UNICEF Mother and child health continues provision of psychosocial assistance to mine/UXO-affected children through various Twenty training sessions on key issues, in- types of interventions, including group and fam- cluding immunisation and breastfeeding were ily therapy, individual counselling, etc. Assis- held by UNICEF/Hammer Forum for 800 tance is provided at the Psychological-Medical women in Bart, Satsita and Sputnik IDP camps Centre in Vladikavkaz, the library of the Blind within the framework of the Mother Society in Grozny, and, until recently, in the Empowerment Programme (MEP). Additionally, “Satsita” IDP camp. CARE reports notable re-

4 duction of the stress level and increased self- The UNICEF/PHO water distribution pro- esteem and self-reliance in the assisted children. gramme has been reinforced by an additional water truck, bringing their total amount to 15. Working on a three-route-per-day basis the Two therapists from Grozny Polyclinic N7 under- trucks fill 153 water bladders and 27 stationary went a one-month on-the-job training in psy- water containers in schools, hospitals, and in the chotherapy at the Moscow Research Institute of private sector in Grozny. On average, 422 cu- Psychiatry, sponsored and organized by WHO. bic metres of water are daily delivered to the beneficiaries from two water pump- HIV/AIDS ing/purification centres. The breakdown of programme beneficiaries is as follows: health sector According to the latest available information a – 8.2 %, educational sector – 5.8%, private total of 410 HIV- positive cases have been reg- sector – 85 %, other – 1 %. istered in Ingushetia since 1999, with increasing numbers of infected women and children. With UNICEF/PHO are continuing their garbage this in view the Government of Ingushetia disposal programme in schools, hospitals and approved the Republican HIV/AIDS prevention private sector in Grozny. Two trucks service program for 2004-2006. The main objective of 171 garbage containers of 0.72 cubic metres the program will be aimed at the timely detec- capacity in 52 locations around the city; one tion of HIV cases, their diagnosis and further sewage disposal truck is servicing selected edu- treatment. In particular, the programme will in- cational, medical and private sector locations clude setting up the first inpatient facility pro- on a regular basis. viding health services to HIV infected people and a number of public awareness HIV prevention campaigns. 240,000 bars of soap, over 20 tons of chlora- mine and 400 litres of medifox were distributed

Water and sanitation by UNICEF to altogether 175 health and educational facilities in Chechnya and in Ingushetia.

The 2003 annual report from the SES of In- gushetia shows that almost 10% of centralised Assistance to the disabled water supplying sources in Nazran does not meet the state quality requirements. According to the latest available data the number of mine/UXO-related incidents in Chechnya According to the recent SES Chechnya assess- stands currently at 3,139. 643 of these incidents ment 80% of 18 city TACs are in hygienically resulted in the lethal outcome. According to the unsatisfactory condition, lacking for example statistics of the “Voice of the Mountains”, the washing rooms, garbage collection and even UNICEF’ NGO implementing partner, in 2003 the garbage containers. yearly casualty rate has decreased, as compared to the previous two years.

UNICEF completed training courses on hygiene education and best practices for school teachers Assistance to mine and UXO survivors at the from Ingushetia and Chechnya. 335 teachers Prosthetic workshop in Vladikavkaz is being con- from 57 schools received relevant training. The tinued. The selected beneficiaries are trans- project was carried out in cooperation with the ported from Chechnya to Vladikavkaz where Ministry of Education of Chechnya, the Centre they undergo measuring and fitting procedures for disease prevention of Ingushetia and the Re- and then receive prosthetic devices. UNICEF publican sanitary and epidemiological surveil- randomly monitored some of the beneficiaries lance service (SES). who confirmed they were satisfied with their quality of care.

5 organizations active in the North Caucasus, The Republican Clinical Hospital of Chechnya authorities from Chechnya and Ingushetia ad- received from UNICEF equipment for inducto- dressed the issues of transferring the major part therapy, for physical rehabilitation of mine sur- of humanitarian organizations’ activity to vivors. Chechnya and streamlining this activity and provision of humanitarian assistance through estab- lishment of a single coordination body. Also on ICRC continues its assistance program to the the agenda were the issues of security and Republican Orthopaedic Centre in Grozny. In communication. February, two specialists of the centre at- In the follow up meeting with Mr Ilyasov on 24 tended on-the-job training at the Central February, the UN representatives discussed the prosthetic research institute in St. Petersburg. format of the newly established coordination council and the five complementing working Other News groups, corresponding to assistance sectors.

From 25-29 January, the UN Under-Secretary- General for Humanitarian Affairs and Emergency List of abbreviations: Relief Coordinator, Mr. Jan Egeland, conducted DRC: Danish Refugee Council an official visit to the Russian Federation. He had EPI: Expanded Programme on Immunization a number of high-level meetings in Moscow and FAP: Feldsher/obstetric post in the North Caucasus, among them with the GP: General practitioner HI: Handicap International Federal Minister for Chechnya, Mr Stanislav Ilya- ICRC: International Committee of the Red Cross sov, the President of the Chechen Republic Mr IDPs: Internally displaced persons Akhmat Kadyrov, the President of the Republic IMC: International Medical Corps IMSMA: International Management System for of Ingushetia Mr Murat Zyazikov, the Minister for Mine Action Civil Defence, Emergencies and Elimination of IR: Islamic Relief IRC: International Rescue Committee Consequences of Natural Disasters, Mr. Sergei MDM: Médecins du Monde Shoigu, the Minister for Foreign Affairs, Mr. Igor MoH I: Ministry of Health of the Republic of In- Ivanov et. al. A wide range of issues related to gushetia MoH RF: Ministry of Health of the Russian Fed- cooperation between the United Nations and the eration Russian Federation in the North Caucasus was MoH Ch: Ministry of Health of Chechnya discussed, including the feasibility of more active MSF-B: Médecins sans Frontières-Belgium MSF-F: Médecins sans Frontières-France participation of the Russian Federation in inter- MSF-H: Médecins sans Frontières-Holland national humanitarian operations. In the North PHO: Polish Humanitarian Organization Caucasus Mr. Egeland visited three sites in OCHA: United Nations Office for the Coordination Grozny (a temporary accommodation centre for of Humanitarian Affairs SARC: Saudi Red Crescent Society returnees, a childcare centre, providing psycho- SES: Sanitary Epidemiological Surveillance logical assistance to disabled children and mine TAC: Temporary accommodation centre UNICEF: United Nations Children's Fund victims, and a maternity hospital) and three IDP UXO: Unexploded ordnance camps in Ingushetia. VOM: Voice of the Mountains WHO: World Health Organization

On 9 February a joint meeting on humanitarian activity in the North Caucasus was held in the House of the Government of the Russian Fed- eration in Moscow. The meeting was chaired by Mr Ilyasov, the Minister of the Russian Federa- tion, the Chairman of the governmental commis- sion for social and economic reconstruction of the Chechen Republic. Representatives of federal executive authorities, international humanitarian

6 Health Action in the North Caucasus is a newsletter on the Disaster Preparedness and Response programme (DPR) of the World Health Organiza- tion Regional Office for Europe. The information is compiled by the WHO Humanitarian Assistance Programme in the North Caucasus, the Russian Federation. All rights are reserved by the organization. The document may, however, be freely reviewed ab- stracted, reproduced or translated in part or whole, but not for sale or for use in conjunction with com- mercial purposes. This newsletter is not an official WHO publication. The views expressed in it do not necessary represent the stated policy of WHO. Correspondence should be addressed to: Russia Office of the WHO Special Representative of the Director General in the Russian Federation 28, Ostozhenka, 119034 Moscow The Russian Federation Attn: Irina Tarakanova [[email protected]] Tel.: (+7) 095 787 21 52/12 Fax: (+7) 095 787 21 19 Editors: Dr Corinna Reinicke [[email protected]], Irina Tarakanova [[email protected]] For more information about WHO Disaster Prepar- edness and Response programmes, please con- tact: Dr Jan Theunissen [[email protected]]

The "Health Action in the North Caucasus" newsletter of the Disaster Preparedness and Response programme (DPR) can be found at http://www.euro.who.int/emergencies.