Health in the North Caucasus

Newsletter on humanitarian health assistance, December 2000

More on Hepatitis A in the North Caucasus

(based on the WHO epidemiological experts’ field mission reports)

mains unknown as the war environment Following information received from differ- pre vents its identification. ent sources about the outbreak of hepatitis

A in and , WHO or- ganized an expert mission to review the No fatalities have been reported. The epidemiological situation. An inte rnational Sleptsovskaya district, along the Chechen epidemiologist accompanied by a Russian border, was the most affected. However, it public health expert visited Ingushetia should be added that the highest morbidity from 8 to 12 November. They visited three rates among the local population were reg- refugee camps, regional and republican istered in the Malgobeksky district. At the hospitals as well as specially established same time, numerous cases of the disease wards for the management of new cases of were also registered in Chechnya, Urus hepatitis A. Martan be ing the most affected district.

Hepatitis A is a recurrent problem in the Management North Caucasus as well as in some other In both Chechnya and Ingushetia, health parts of the former . The North and sanitation services h ave had a difficult Caucasus region is classified as a region of intermediate prevalence. This endemicity time coping with the situation. explains the periodic outbreaks: when hyg i- However, in Ingushetia the Republican SES provides anti-epidemic measures to curb enic conditions deteriorate, infection b e- the outbreak, including: comes apparent in older children and young adults. Internally displaced person (IDP) camps are a perfect setting for hepatitis A · tracing the path of contamin ation; transmission. It is the opposite of high · control of water quality, available data indicates that groundwater is potable at prevalence regions where young children the tap level, but secondary infestation usually contract the disease and de velop is very possible; immunity fo r life. · improvement of hygiene conditions, The first cases were reported in the middle e.g., supply of disinfectants, soap, up- grading of latrines and garbage pits; of August 2000 in the IDP camp Sputnik in · disinfecting of water camp tanks, indi- Ingushetia. The outbreak increased by mid - vidual buckets, etc.; disinfecting of September with a peak reached in mid- October, with 30-35 cases/week registered premises where patients were located; by the Sanitary Epidemiological Surveil- · isolation of patients for 15 days in spe- cial settings, i.e. installed tents to host lance Service (SES). Most cases are usually hepatitis A patients unable to be housed reported in the autumn, though by the end in the rayon infection hospital; of November the situation became rela- tively stable with the total number of cases · monitoring of contacts; and at 358, compared with 1,044 in 1994, the · an information campaign. year with the highest prevalence for the WHO has been proactive in initiating and entire decade. IDPs made up at least 60% supporting this exercise. of the pa tients, among whom two-thirds were children. All of the hepatitis A cases are only clinically diagnosed as viral labora- Full implementation of this programme faces constraints such as scarcity of equip- tory tests are for all intensive purposes un- ment and reagents, problems with the available. The exact source of infection re-

1 management of IDPs, unsatisfactory camp environment, etc.

In the management of hepatitis A cases, only symptomatic treatment was reco m- mended. Mass vaccination is not cost- effective in most situations. Patients follow a standard treatment that includes a special diet, vitamins and liver extracts, glucose and "corticoids for se vere cases".

In Chechnya, control measures and moni- Hepatitis A: Sunzhensky district. Infectious dis- toring are severely hampered due to the ease department at one of the hospitals. conflict. The WHO mission could not inve s- November 2000 tigate the situ ation in Chechnya because of security restrictions preventing UN staff from entering the republic.

INGUSHETIA, NORTH OSSETIA AND DAGESTAN

Demography According to DRC data from 27 November Tuberculosis : In early November, MoH/I 2000, the total number of Chechnyan IDPs held an extraordinary meeting on TB in In- in Ingushetia was 155,332. At the same gushetia, at which the necessity to under- time, according to official figures of the In- take urgent measures to pre vent a further gush Territorial Representative Office of the increase in morbidity and mortality from TB RF Ministry for Federal Affairs, Migration and to curb the spread of the disease and Nationality Issues (the former Migra- among the IDP and local population was tion Service of Ingushetia), the number of stressed. One of the urgent steps proposed Chechen IDPs in Ingush etia now exceeds was the isolation of TB patients, especially 175,200 (DRC). patients with active forms living in IDP set- tlements. It was planned to set up “isola- tion wards” in the tents and to employ per- Health Situation sonnel for conducting fluorographic exami- Hepatitis : In November, the Centre of Sani- nations, sputum collection and general tary Epidemiological Surveillance of In- treatment on the spot. The MoH strategy gushetia (SES-I) registered 103 cases of envisages that all IDPs over the age of viral hepatitis (of them 80 children) among seven be X-rayed on small format films the IDP population. (This is, however, not in accordance with WHO policy, which does not promote TB Morbidity: By 28 November, statistics on screening by means of small format X-rays infectious diseases collected by SES-I (fluorography)). Special tents have been showed that the highest morbidity in the set up for the isolation of 68 TB patients in IDP population was due to acute respiratory the newly esta blished camp Alina. infections (ARI), pediculosis, scabies, influ- enza and acute intestinal infections. Since October 1999, screening initiated by MoH/I has resulted in the X-raying of Data provided in November by Islamic R e- 28,632 IDPs (MoH/I). lief (IR) shows that the highest morbidity among the IDP population is due to acute According to data received from SES-I, on respiratory infections, diseases of the ali- 28 November 2000, the number of regis- mentary system and cardiovascular dis- tered TB cases in the IDP population was eases. Recent information gathered from 594 (with 317 hospitalised). And according IDP camps reveals an increasing number of to data provided by the republican TB dis- burns among IDPs due to gas stoves in pensary, out of 11,241 IDP children exa m- tents, which have no protection bars.

2 ined, 1,000 were infected with TB. 146 IDP In Chechnya , Little Star operates in the fol- children currently live in a TB risk area. lowing villages/towns:

In November, personnel from the field TB · Grozny (19 counse llors/psychologists) hospital of the All-Russian Centre for Disa s- · Valerik ter Medicine, Zaschita, toured IDP camps in · Urus-Martan order to evacuate TB patients to the hosp i- · Alpatovo tal. However, the majority of IDPs com- · Chechen Aul pletely re jected hospitalization as they did · Goiti. not want to leave their families or were try- ing to escape. CPCD has its own tents in camps (and rooms in Chechnya) where children take Reproductive health : Since October 1999 part in simulation games and art and drama the number of new-borns among the IDP therapy activities. Games and play therapy popula tion was 3,583, of whom 64 were form the basis for the work with children. stillborn and 32 died shortly after birth The CPCD counsellors have a range of fu r- (MoH/I). ther skills, including psycho drama, music therapy, neuro -linguistic programming, in- Vaccination: Since October 1999, MoH/I dividual counselling and relaxation exe r- has immunized 32,887 IDP children cises to comple ment the programme. The (MoH/I). children are also offered individual consu l- tations. Groups of children are selected a c- AIDS: According to the head doctor of In- cording to age and degree of trauma, in gushetia, "AIDS was unknown in the coun- consultation with parents and teachers. try until 18 months ago". At present, 56 Whenever possible, CPCD also run joint cases of HIV/AIDS have been re gistered in sessions for the children and their parents. the country. However, official data still re- ports 36 cases, six of them nationals. From February until September 2000, as part of the psychological rehabilitation pro- Drug supplies: MoH/I claims that thanks to gramme, CPCD sent groups of IDP children the efforts of various international organi- to spend 21 days (one group every month) za tions and NGOs, there is now a consider- with counsellors in a sanatorium in Nalchik able stock of essential drugs in Ingushetia. or Pre -Elbrus, Kabardino-Balkaria. During The most needed drugs now remain those this 8 -month period, 700 children were sent necessary for the treatment of specific dis- to Kabardino-Balkaria. eases, i.e. diseases of the nervous system, cardiac diseases, etc. The Agency for Rehabilitation and Devel- opment (ARD) continuously provides psy- cho-social su pport to children (ages 6-12), Mental Health teenagers (ages 13-18) and women in the CPCD is one of a few organizations provid- tent camp Sputnik. ing psycho-social rehabilitation for IDP chil- dren and students in Ingushetia and Chechnya. Health Services Disease Surveillance: Findings of the WHO As part of CPCD’s Little Star programme, mission to Ingushetia in November show 53 psychologists and counsellors work in that the system of disease reporting still the following refugee camps and spontane- utilised in both Chechnya and Ingushetia is ous settlements in Ingushetia: obsolete. Most of the medical staff inter- viewed during the mission were not aware · Severny and Sleptsovskaya (2 loca- of the existing Order of the Ministry of tions) Health of the Republic of Ingushetia (no. 98 · MRO, Sleptsovskaya of 29 May 2000) on the use of the new re- · Omega school, Sleptsovskaya porting form. Objectives must be redefined · Yandare and logistics updated in accordance with · Bart, Karabulak (3 locations) WHO guidelines. · Tupik-1, Karabulak · Tupik-2, Karabulak. TB: The republican TB dispensary has 130 beds. In the Malgobeck and Sleptsovskaya

3 TB dispensaries as well as in the feldsher hospitals in Ingushetia, were delivered and obstetric post in Dalakovo, TB patients are distributed to the Republican Hospi- provided only with out-patient treatment tal and the and Malgobeck district (report from the Stavropol anti-plaque in- hospitals. stitute). A WHO expert is currently in the North Dental services: According to BIF, the de- Caucasus collecting and analys ing available mand for dental services in Naran and data on the nutritional status of the war- Sleptsovskaya is high. Patients have to wait affected population. She will also carry out two to three weeks for treatment. a food box adaptation exercise in Ingushetia, prepare a training workshop on nutrition for health workers and NGOs in Health Assistance the North Caucasus, and identify imme diate In order to provide better hygienic condi- priorities for WHO action. tions for IDPs living in camps in Ingushetia, WHO has purchased the needed materials In early November, the hospital of the All- for the installation of 300 washbasins, d o- Russian Centre for Disaster Medicine, nated by Emercom, in three IDP camps: Zaschita, returned to Ingushetia and Sputnik, Bart and the newly esta blished opened at the TB dispensary in Nazran in camp Alina. order to speed up the diagnosis and re ferral of IDP patients su ffering from TB to other cities of the Russian Federation for treat- ment. By the end of November, the number of beds in the hospital was increased from 50 to 100. By 6 D ecember, 90 TB patients were undergoing stationary treatment. The hospital receives many patients from Grozny and Gudermes, sent there from health facilities in Chechnya. A mobile team regularly toured around the Prombaza, Bart and the railway Tupik, MTF, IDP camps where it conducted health education and took sputum smears from suspected TB IDPs.

Swiss Disaster Relief Swiss Disaster Relief will soon deliver lo- cally purchased medical equipment for the neuro -surgical department of the Republi- can Clinical Hospital (North Ossetia), the Republican AIDS Centre and a number of hospitals in Ingushetia.

WHO collaborating partner "Zaschita" unloads Islamic Relief medications donated by WHO for hospitals in Islamic Relief finished the construction and Ingusehtia and North Ossetia installation of equipment at the policlinic in the Sputnik IDP camp. The policlinic will The second part of pharmaceuticals and provide 24-hour medical assistance. The medical expendables (USD 80,000) pur- construction of another IR supported poli- chased by WHO was delivered by its col- clinic was also recently completed at the laborating centre, Zaschita, to Mozdok and newly established camp Alina. Both policlin- Nazran and was distributed to the Mozdok ics will provide primary health care and Central Republican Hospital (North Os- medication and will be staffed by two doc- setia), the republican clinical hospital in tors and two nurses. A night-shift doctor for Nazran, the Nazran and Karabulak city hos- emergencies will also be provided. pitals, and the Malgobeck and Sunzha cen- tral district hospitals (Ingushetia). ICRC and RRC In November, three oxygen concentrators Since the begin ning of the year, ICRC has purchased by WHO, for three of the main been providing assistance to all five hosp i-

4 tals in Ingushetia, enabling them to treat tionary clinic in Aki-Yurt, Malgobeck district, 1,620 surgical cases. It is closely monitor- with the aim of providing basic curative ing the situation in the hospitals and deliv- services to the IDP population. ers medical assistance whenever needed. Future plans include the creation of medical ICRC also supports two mobile medical points with four teams of medical special- teams and one stationary medical post set ists in IDP camps in Ingushetia and the up by the Russian Red Cross (RRC), in o r- training of medical personnel working in der to provide IDPs with basic health care. IDP camps.

The RRC visiting nurses programme pro- ARD vides basic care, including medical, to bed- The Agency for Rehabilitation and Devel- ridden elders (about 200 beneficiaries). opment (ARD) mobile medical team, co n- sisting of a physician, a paediatrician and a The RRC runs two mobile medical units in nurse, works in 16 spontaneous IDP set- Dagestan, which have provided medical tlements in Karabulak, Troitskaya and services to IDPs since December 1999. Sleptsovskaya. It provides medical assis- About 10,000 patients, including more than tance (treatment and consultations) and 3,400 children, have already benefited from free medication to IDPs, arranging trans- this assistance. Since January 2000, ICRC portation in emergency cases, and conducts has also provided local medical fa cilities immunizations. The mobile team serves with needed materials, allowing them to three locations daily. treat 505 surgical cases. ARD also employs a gynaecologist and a The local RRC branch also runs a home vis- hospital counsellor. The gynaecologist iting nurse programme for approximately works both at the Sputnik camp and as a 440 beneficiaries, mainly bedridden elderly. member of the mobile team. She examines pregnant women and provides home ser- In North Ossetia, ICRC has been providing vices and free medication to pregnant medical material to the Mozdok regional women and gynaecological patients. The epidemio logical centre on a monthly basis. hospital counsellor provides general medi- cal consultations and psycho-social support In the south of RRC, supported by to wounded people, provides them with free ICRC and the International Federation, pro- medication and organises transportation to vides IDPs from Chechnya with psycho- pro sthetic workshops. social counselling and legal advice. People in Need Foundation Benevolence International Foundation People in Need Foundation (PINF) continues Benevolence International Foundation (BIF) to operate a mobile clinic, providing pri- continuously provides surgical and curative mary health care to the IDP population in dental se rvices to the IDP population in nine spontaneous settlements in In- Nazran and Sleptsovskaya, where four doc- gushetia, focusing on clinical care, health tors work two shifts. 10-12 patients receive prevention practices, distribution of medi- treatment daily. BIF has recently distrib- cines and evacuation assistance, in serious uted 2,000 mother and child kits (consist- cases, to other parts of Russia. ing of first aid kits and clothes for new- borns) to newborn children discharged from In mid-February, MSF-France plans to start the three maternities in Ingushetia. In No- medical programmes targeted at pregnant vember, BIF conducted a series of pract i- women as well as other gynaecological pro- cal/consultative courses for local medical grammes in the cities Nazran and Karabou- personnel, facilitated by four physicians lak. MSF-France will soon receive a ship- from the US. ment of scales and hemoglobinometres for this purpose. BIF has purchased medicine and medical equipment (USD 50,000) to be distributed to clinics in refugee camps and to be used WHO-supported medical consultation by BIF doctors for the treatment of IDP p a- centre in Nazran tients. It has also recently put into opera- In view of the increasing number of IDPs tion a mobile clinic (for IDP camps in the with diseases a nd conditions requiring sp e- Karabulak and Nazran districts) and a sta- cialized care, which cannot always be pro-

5 vided in medical facilities in Ingushetia, WHO and UNHCR set up a pilot project to BIF has installed five shower complexes facilitate health care assistance to the most with 45 showers (10 in a tent camp in Aki- deprived IDPs. In mid -November a medical Yurt; 10 in a MRO camp, Sleptsovskaya consultation centre started working on the sta tion; 10 in the UN barracks, Surkhakhi premises of the UNHCR-supported counse l- village; 5 in MTF, Altiyevo village; and 10 in ling centre “VESTA”, in Nazran. IDPs are Kamaz Centre). All of these showers have accepted there by a medical doctor experi- been winterised. enced in the area of internal disease control and familiar with the local health services. BIF is currently installing the sixth shower She focuses her work on reviewing medical complex for five more showers. documentation and records (if available) of IDP patients who claim that existing ser- Fourteen shower installations, with 131 vices in RI cannot provide adequate care. cabins, insulated by the ICRC for the winter She also verifies the appropriateness of the period, are functioning in different camps reasons for the denial of medical care, pre- for IDPs in Ingushetia. pares a database to contribute to the a s- sessment of the health situation among IDPs, advises on further case ma nagement Landmine Awareness and referral to be agreed on with the a p- Landmine awareness is one of the six pro- propriate (MoH/RI) authorities. Finally, she grammes run by CPCD in Ingushetia and collects from MoH copies of the respective Chechnya. Through the Little Star pro- referral documentation to co mpare with the gramme, CPCD has access to many chil- database to further monitor the outcome of dren, and has, therefore, begun mines the activities. Eighty-seven IDPs have al- awareness work with the children who ready made use of the consultation centre. come to CPCD sessions. The staff hold gatherings and discussions with children, and distribute posters and leaflets in In- Water And Sanitation gushetia and Chechnya at all of the loca- UNHCR, through the Water State Commit- tions where the Little Star programme tee (Vodocanal), is implementing a project works. In many places where there is a on laying 40 kilometres of pipeline in the concentration of refugees, posters are dis- Malgobekski district. The new pipelines will played and leaflets distributed. significantly improve the ability of the sys- tem to transfer water to the population Today, CPCD is carrying out the follo wing (VESTA/UNHCR). mines awareness activities:

UNHCR/IRC are carrying out a wa- · Discussions, seminars, role plays; ter/sanitation project, including the installa- · Distribution of visual aids and leaflets; tion of 55 water bladders throughout In- · Data acquisition on mined areas and gushetia (VESTA/UNHCR). victims; · Development of contacts with institu- UNHCR/IRC water trucks provide, on a daily tions and organisations running mines basis, access to water for IDPs at 76 loca- programmes; tions, including spontaneous settlements, · Assisting children who need prostheses; host accommodations, the Zvozdny tent and camp in Karabulak, Rassvet in Sleptsovsk · Psychological assistance. and the Aki-Yurt tent camp (VESTA/UNHCR). CPCD conducts this work in schools in Chechnya, with teachers, children and their BIF has installed 50 toilets in IDP camps parents, and in IDP settlements in In- and some other locations in Ingushetia: 48 gushetia. toilets were installed in the camps, includ- ing 14 in Aki-Yurt; 12 in Surkhakhi; 8 in The aim of the ICRC mine awareness pro- Slepsovskaya; 7 in "Sputnik"; 7 in "Se v- gramme in Ingushetia is to inform IDPs of erny"; and 4 in the MTF camp of Altiyevo. the dangers the landmines and unexploded Two toilets were installed in the medical ordnance represent and to teach them stations of the humanitarian organizations some basic rules of behaviour in order to MDM and ARD in the Sputnik camp. limit the risk of accidents when they return

6 home. The ICRC mine awareness team has terial (posters and leaflets) for the pro- started printing the necessary teaching ma- gramme.

CHECHNYA

Demography Cyclical hepatitis peaks occur every three DRC/ASF continue to update information on years. These diseases are directly co n- the population of Chechnya through its 11 nected with the quality of the water. registration points. As of 27 November, the total number of people registered by Diabetes incidence has increased sevenfold, DRC/ASF in Chechnya is 762,602. threefold for hyper-thyroid and tenfold for cancer (lungs, skin and breast). A consider- According to the Ingush Territorial Repre- able rise in allergic and skin disease inci- sentative Office of the RF Ministry for Fed- dence has also been registered, up to 80% eral Affairs, Migration and Nationality Is- of patients with myoca rdial infarction die at sues (the former Migration Service of In- the pre-admission stage (MoH/Ch). Accord- gushetia), since the beginning of the mili- ing to the Deputy Head Sanitary Doctor of tary conflict in Chechnya in 1999, a total of the Chechen Republic cases of scabies and 302,390 IDPs from Chechnya fled to In- pediculosis have increased fivefold. gushetia. 68,792 of them went to other parts of Russia, and 91,181 returned to Tuberculosis : According to MoH/Ch, the Chechnya (DRC). prevalence of tuberculosis is 280 cases per 100,000 population.

Ecological Situation Reproductive health: Up to 90% of pre g- According to the MoH/Ch 6,000 metric tons nant women are admitted to maternity of crude oil are burnt daily in Chechnya. houses with genital or extragenital patholo- Makeshift mini-refineries discharge oil gies (MoH/Ch). waste directly into the ground, contaminat- ing water sources. Health Services According to MoH/Ch, all 13 health facili- Health Situation ties, except for those of Vedeno and Sha- Mortality: As reported by Medecins sans toy, operate at their maximum capacity, Frontieres-Holland (MSF-H) hostility related also performing surgery (10 district hospi- injuries are the main cause of death in tals, Hospitals no. 3 and no. 9 in Grozny, most of the hospitals in Chechnya. During Argun Hospital and Maternity House no. 1 the previous two months, there were over in Grozny) (MoH/Ch). 200 new wounded persons reported in 12 of the over 30 functioning medical facilities. MSF-H reports that all hospitals in Chech- Almost half of those hospitalised were nya suffered massive destruction during the women, children or elderly (OCHA). fighting. Ten hospitals and 11 dispensaries were completely destroyed and hospitals Morbidity: According to the head epidemi- now lack the resources to take care of pa- ologist of the Chechen Republic, during the tients. month of November, 1200 cases of infec- tious diseases (of them 400 children) and Bacteriological laboratories were recently 1742 cases of diseases of the alimentary opened at the ninth Municipal Hospital of tract (of them 682 children) were regis- Grozny and the SES. How ever, both need tered. During the last 10 months, 235 cases assistance in the form of technical equip- of hepatitis A (of them 182 children) were ment, culture mediums etc. registered in Grozny and 688 cases (of them 513 children) were registered in Chechnya. According to his estimations, Human Resources Chechnya is presently going through a peak The health sector has serious problems in of cyclical and seasonal hepatitis morbidity. the trainin g and the post-graduate educa- tion of health workers MoH/Ch.

7 Health Assistance mining pits of the city. 30-35% of the water ICRC supports three mobile medical teams is lost along the way. and one stationary medical post run by the local Red Cross. The mobile units provide One of the main problems in Grozny is the the population with basic medical help. absence of electricity, which is why the pumping station of Vodokanal is out of op- In November the ICRC assisted 16 hospitals eration. Out of 2,023 kilometers of water in Chechnya. The main effort was directed pipelines, 700 kilometers were already re- at improving the general conditions there paired by Vodokanal technicians. However, by distributing plastic sheeting and blan- further construction is no longer possible kets. Hospital no. 9 received, for example, due to the lack of necessary technical 20 stoves. Medical mate rial and medicines equipment, vehicles, construct ion materials for 220 surgical cases were provided. and financial re sources. For a long time, the workers have not received their salaries nor ICRC also supports the visiting nurses pro- any food assistance. It is impossible to in- gramme of the Chechen branch of the Rus- crease the output of water without resolv- sian Red Cross. 720 bedridden elderly are ing these issues (Municipal Water Systems assisted on a regular basis by 57 nurses. of Grozny Vodokanal). MSF-H provide regular medical and reha bilitation support to 24 health facilities According to the deputy head sanitary doc- in the Groznensky, Shalinsky, Shatoisky, tor of the Chechen Republic, the quality of Urus-Martan, and Vedensky districts of water, supplied through the central pipeline Chechnya (OCHA). system, is deteriorating. Fifty-four per cent (54%) of the water does not pass bacterio- PHO has recently installed a diesel electric- logical tests. ity generator for the SES (Sanitary and Epidemio logical Suveillance Service) lab. By the end of November IC RC completed the construction of two water tanks (75 m3 each) in the vicinity of pumping station no. Water And Sanitation 1 in Grozny. This will significantly improve At present, the main source of water for the access to clean drinking water for the popu- city is Chernorechensky vodozabor, from lation remaining in the city. which water is supplied to the centre of Grozny through centralized water supply Polish Humanitarian Organization has in- systems. Water supplied through this pipe- stalled a water filter at the Vodokanal water line system is not suitable for drinking: station and runs four water carriers, most pipelines are badly damaged and are supplying purified water to 40 distribution contaminated with oil from the many oil points around the city.

HEALTH AGENCIES IN ACTION

war. After the start of the second conflict, Islamic Relief: Summary of Ac- IR pulled out of Chechnya and initiated o p- erations in Ingushetia and Kabardino- tivities Balkaria. IR’s NC headquarters are in Nal- By Azamat Koumykov, IR, Manager chik (Kabardino-Balkarian Republic). The regional representative is Mohammad Alla. of Ingushetia Food assistance: IR provides emergency food assistance to Chechen IDP residents of the "Sputnik" and "Severny" (now "Alina") camps, approximately 14,000 people, and Islamic Relief (IR) has been working in the to the IDP residents of the seven villages of North Caucasus (NC) since 1997. It started the Nazran region: Yandare, Ghazi-yurt, its relief activities (focusing on healthcare, Ali-yurt, Sourkhakhi, Ekazhevo, Dolakovo income generation and education) in the and Kantyshevo (approximately, 16,000 Chechen Republic after the end of the first

8 people). IR distributes food boxes in Sput- nik and Severny. Each food box is intended to support a family of four and contains flour, sugar, vegetable oil, buckwheat, macaroni, tea, rice, condensed milk, can- dles and match boxes. In the villages of the Nazran region, IR distributes WFP food commodities (IR is WFP's implementing partner). Moreover, IR supports 200 fami- lies of Ingush IDPs from the Prigorodny re- gion of Northern Osetia through the distri- bution of its fo od commodities.

Water and sanitation: IR is responsible for supplying water to the Severny and Sputnik camps. Each of its two water carriers makes three trips to the camps daily. Du r- ing the winter IR installed 30 metal 30-ton water reservoirs in the camps and distrib- uted 8,000 plastic co ntainers to the IDPs. In Sputnik, Se verny and the villages of the Nazran region IR distributes sanitation par- cels on a monthly basis. Each parcel is in- tended for a family of four and contains 15 pieces of toilet soap, 10 pieces of washing soap, washing detergents and hygiene nap- kins for women.

Healthcare: IR runs seven mobile clinics that operate in Sputnik, Severny and spon- taneous settlements of IDPs in the Nazran re gion. Each clinic is staffed by a medical doctor, a nurse and a driver. Recently, IR built two health centres in Sputnik and Alina. The health centres will provide more so phisticated medical care than the mobile clinics.

Shelter: IR is finishing the construction of a new IDP camp for 3,000 residents in the village of Yandare of the Nazran region. The settlement will be created in place of the Income generation: IR is carrying out sev- old "sovkhoz" colle ctive farm and will be eral income generation programmes tar- provided with central heating, gas and wa- geted at Ingush IDPs from the Prigorodny ter systems. region of North Osetia, such as donating cattle to IDP families.

IR activities in the Chechen Republic Emergency assistance . Since 1 September, IR has dispatched three humanitarian convoys of food commodities to Grozny. The distribution was carried out in cooperation with the Administration of the Chechen Republic. In early December 2000, the IR regional representative had a meeting with Akhmad Kadyrov (head of the Chechen Administration) and it was agreed

9 that IR will initiate full-scale relief activities in the republic in the near future.

IR activities in the Kabardino-Balkarian Republic Education: IR runs a big computer centre in Nalchik, providing courses in personal co m- puting and the Internet.

Healthcare: IR provides permanent assis- tance to the hospitals of Nalchik. The latest donations of IR to the municipal and repub- lican hospitals were two dialysis machines, IR provides food assistance to kindergartens, o r- TV sets for the p atients, two mobile clinics phanages and other social institutions. and medical supplies.

SEMINARS & WORKSHOPS

Expanded Programme on Immuni- · to give the definition and explain the zation purpose of disease surveillance in eme r- In Ingushetia, on 9-11 November, the gencies; Sanitary Epidemiological Surveillance Se r- · to explain the difference and advan- vice/MoH/RF in collaboration with MoH/I tages of emergency surveillance meth- and with support of UNICEF and WHO con- ods versus routine practice; ducted a seminar on the Expanded Pro- · to brief on key and supplementary func- gramme on Immunization (EPI). Training tions of surveillance; sessions were attended by 61 medical and · to establish priorities; epidemiological staff from Chechnya, In- · to explain why standard case definition gushetia and North Ossetia. One day was should be used; and used by WHO experts to review the issues · to evaluate the emergency surveillance of a disease surveillance and early response form recommended by WHO. system and to present control measures for Assessment of the WHO recommended hepatitis A in conjunction with the current emergency surveillance reporting form was outbre ak of the disease. of special importance in view of its contin- ued use in Ingushetia and Chechnya. Par-

ticipants agreed that the form was simple Seminar on Communicable Disease and practical, allowing for the better moni- Emergency Surveillance toring of morbidity in relation to controlling On 11 November 2000, in Ingushetia, two measures. WHO experts ran a one-day seminar on communicable disease surveillance in Participants expressed a strong wish to o b- emergency situations. At the seminar, a t- tain more information on the existing public tended by 55 Chechen medica l profession- health surveillance systems and their possi- als (epidemiologists and paediatricians), ble adaptation to the current and antici- internationally recommended approaches pated situation in Chechnya. With this in for communicable disease surveillance in view, WHO is considering holding more emergency situations were presented. The training courses on emergency surveillance outbreak of hepatitis A in Ingushetia was and use of the WHO recommended ap- used as one case example. proaches for public health staff (epidemi- ologists) in the North Caucasus and on The objectives of the seminar were as fo l- standard case definitions for local health lows: care professionals. · to provide an overview of surveillance methods;

10 Taking into account the high levels of ARI, · The national regulation on pharmaceuti- diarrhoeal diseases, malnutrition and other cals (import-substitution programme, conditions in children, it might be worth drugs dona tions regulation, etc.); new combining courses on standard case defin i- legal provisions regulating drug pro- tion and Integrated Management of Child- curement, certification, licensing and hood Illness (IMCI). drug manufacturing.

Workshop participants were provided with Problems and Issues of Rational Drug an outline of the presented information and Use in the Russian Federation supporting documentation. A representative of MoH/RF, who attended a part of the On 14-15 November, WHO held a workshop meeting, expanded on current country pol- entitled “Problems and Issues of Rational icy in pharmaceuticals and distributed the Drug Use in the Russian Federation” in guidelines: “On the importation and expor- Moscow for representatives of NGOs and tation of medical goods received as hu- international agencies involved in health manitarian assistance (MoH, Ru ssia. care provision and drug supply support in 14/05/98). There were many questions the North Caucasus. The workshop was or- about drug donations, particularly questions ganized within a programme framework of on donated drug registration procedures, humanitarian assistance in health to the rules for import and export of donated North Caucasus by the WHO Special Project medical products, and recommendations on on Pharmaceuticals in the NIS. Supported the choice of drug manufacturers in Russia by ECHO, it was a component of WHO e f- and abroad. A format for claiming donated forts to promo te rational drugs use concept. drugs was also discussed, among other is- sues. The overall objective of the workshop was to facilitate the work of organizations do- The participants appreciated the importance nating pharmaceuticals to the North Cauca- of rational drug use and therapy regimens sus. The specific objective of the workshop and called of the holding of short-term was to inform representatives of interna- seminars, organised by WHO, for the medi- tional non-governmental organizations cal staff working in the North Caucasus (NGOs) involved in health care and the (with the participation of NGOs). It was also supply of pharmaceuticals of the general decided that WHO guidelines addressing parameters of the pharmaceutical system in rational drug use problems would be a use- the Russian Federation, prescription pra c- ful educational tool. tices and the potential of more efficient drug use, particularly in the war-stricken It was agreed that an inventory of activities republics of the North Caucasus. In addi- carried out by various NGOs and by inter- tion, the most frequently used drugs pro- national agencies in the North Caucasus is duced locally were described and compared needed in order to improve the efficiency of to western analogues. humanitarian aid.

The following issues were on the agenda of the workshop: Mine awareness On 20-27 November, UNICEF and UNHCR · A brief description of the Russian p har- conducted a mine awareness seminar for maceutical market in 1999-2000; 40 teachers and psychologists from Chech- · The Russian pharmaceutical traditions nya (including 15 participants from Kur- and the most frequently used drugs, chaloy and 13 participants from Grozny and with an interna tional comparison; monitors from the NGOs Voice of the Moun- · A federal list of essential drugs and na- tains and Vesta). tional guidelines for the treatment of prevailing diseases; drug lists fo r free of In Moscow, on 4-8 December, UNFPA and charge distribution; regional lists of e s- WHO held a 5-day seminar at the Russian sential drugs; Centre for obstetrics, gynaecology and · The availability of medical information perinatology on ultrasound diagnostics for (clinical recommendations, guidelines obstetrician-gynaecologists. It was a t- and RuNet); promulgation and informa- tended by, among others, health profe s- tion; and sionals from Chechnya and Ingushetia.

11 obs tetrics, gynaecology and perinatology) a On 14 December, in Nazran, WHO held a roundtable to summarise the results of a series coordination meeting on nutrition for local of training workshops on antenatal care, and international NGOs. A WHO expert on obstetric care and family planning/STI nutrition briefed on recent findings with re- prevention held by UNFPA and WHO in gard to the nutritional status of the IDP population and the food box adaptation e x- October this year for obstetrician- ercise carried out during the mission. gynaecologists and midwives from Chechnya and Ingushetia. The participants also worked In Moscow, on 21 December, UNFPA and out recommendations for a future round of WHO held, (at the Russian Centre for training seminars. NEWS IN BRIEF

NEWS IN BRIEF

WHO top official visits Russia

On 31 October to 4 November the Director Launch of the 2001 UN Consolidated Inter- General of the World Health Organization, Dr. Gro Harlem Brundtland, paid an official agency Appeal for the North Caucasus visit to Moscow at the invitation of the Rus- As part of a global effort launched by the sian Government. During her meetings with UN Secretary-General in New York on 28 high level p olitical and professional leaders, November, the UN in Moscow presented on the country’s health emergency issues, in- 29 November, its 2001 Consolidated Inter- clu ding TB, HIV/AIDS, smoking and alcohol, agency Appeal for the North Caucasus were discussed. She also focused on the (Russian Federation) seeking USD necessity of pursuing reforms within the 44,870,925 for humanitarian assistance health system to make it more effective on be half of those affected by the events in and more accessible for the poor in Rus- Chechnya. Various UN agencies, including sian. the Food and Agriculture Organization (FAO), the UN Development Programme (UNDP), the UN Population Fund (UNFPA), the UN High Commissioner for Refugees (UNHCR), the UN Children’s Educational Fund (UNICEF), the World Food Programme (WFP), and the World Health Organization (WHO) plan to work in the following se c- tors: protection, food, agriculture, shelter and non-food items, health, water and sani- tation, education, mine action, economic recovery and infrastru cture.

Meeting with participants of the TB workshop at the WHO office in Moscow

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Holiday gifts for children WHO has been distributing 1000 cosy s oft teddy bears to children in war-affected ar- eas of the North Caucasus, Russian Federa- tion. Sick children in hospitals, settlements of displaced population from Chechnya, and handicapped children in orphanages are the first to receive the holiday gifts. This humanitarian action is a part of the WHO mental health rehabilitation programme in the North Caucasus. It has been supported by ECHO and the governments of the USA and the Netherlands. It is being imple- mented with the help of a number of volun- teer organizations in Russia and Denmark.

WHO INFORMATION SERVICES

WHO has established a small information service to assist agencies working in the health sector in the North Caucasus. This service includes an electronic library in which most manuals are available in English Please contact us for a complete list or to and in Ru ssian. Furthermore, hard copies of contribute: ([email protected]). the English version of the Emergency Health Library Kit are available for copying at WHO-Moscow. This list below is only the If you do not have e-mail, please bring a most recent documents. diskette to the library to obtain copies.

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UNFPA: Report on a four-week training course entitled: “Professional approach to the promotion of the reproductive health of population in the North Caucasus”. Piati- gorsk. 2-27 October, 2000 (Available in Russian);

WHO: Problems and Issues of Rational Drug List of abbreviations: Use in the Russian Federation. Seminar re- port. November 2000; ARD: Agency for Rehabilitation and Development ASF: Danish Peoples Aid CPCD: Centre for Peacemaking and Community Development WHO: Communicable disease surveillance DCA: Dan Church Aid of the Chechen displaced population in the DDG: Danish De -mining Group DRC: Danish Refugee Council Republic of Ingushetia. Travel report. No- EMERCOM: RF Ministry of Emergencies vember 2000; ICRC: International Committee of the Red Cross IMC: International Medical Corps MDM: Medecins du Monde WHO: Assessment of the epidemiological MoH/I: Ministry of Health of Ingushetia MoH/RF: Ministry of Health of the Russian Federation situation in Ingushetia following a reported MoH/Ch: Ministry of Health of Chechnya outbreak of hepatitis A. November 2000 MSF-B: Medecins sans Frontieres-Belgium MSF-F: Medecins sans Frontieres-France MSF-H: Medecins sans Frontieres-Holland OCHA: Office for the Coordination of Humanitarian Affairs PINF: People in Need Foundation PHO: Polish Humanitarian Organization RRC: Russian Red Cross UNFPA: United Nations Population Fund UNICEF: United Nations Children's Fund UNHCR: UN High Commissioner for Refugees WFP: World Food Programme WHO: World Health Organization "Zaschita": All-Russian Centre for Disaster Medicine "Zaschita"

This newsletter is not an official WHO publica- tion. The information is compiled by the WHO Unit for Emergency Health Coordination for the North Caucasus, and is intended for public in- formation. For comments, please contact: [email protected] or Irina Tarakanova, Tel.: 787 21 12. Contact address of WHO in Moscow: 28, Ostozhenka str., Tel.: 787 21 52/12.

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