Health Action

− in the North Caucasus

NEWSLETTER ON EMERGENCY PREPAREDNESS AND RESPONSE JANUARY-MARCH 2006

Epizootic of Avian Flu in the Southern Federal okrug of the Russian Federation

Nine subjects of the Southern Federal okrug of production; control over borders; sanitation- the Russian Federation have been hit by epizo- quarantine checks; control over water supply otic of Avian Flu, caused by A (H5N1) virus, in and food markets; securing an appropriate February-March 2006. According to the data of stock of drugs and medical consumables; alloca- the Federal Surveillance Service of Consumer's tion of additional hospital beds; organization of Rights and Human Well-Being (www.gsen.ru), practical training/field exercises among state 30 districts, 7 cities, 78 residential areas and six health facilities, and awareness activities. bird farms have been affected in Stavropol Krai, Dagestan Republic, Krasnodarsky krai, Republic All over this period WHO has been closely moni- of Kalmykia, Republic of Adygea, Kabardino- toring the Avian Flu situation, providing constant Balkaria, Chechen Republic, North Ossetia and updates on recent developments and activities, Astrakhan oblast. By the end of March, the epi- undertaken by the authorities. WHO examined zootic and preventive measures (culling) has the national response plan to Avian Flu and es- killed over 1,3 million birds. tablished contacts with relevant and responsible state authorities, including the Ministries of In order to minimize and eliminate the conse- Health and Agriculture, the Federal Surveillance quences of the Avian Flu epizootic, and following Agency, Emercom in the Republics of Chechnya, the recommendations, issued by the Federal Ingushetia, North Ossetia and Kabardino- Surveillance Service of Consumer's Rights and Balkaria, as well as held negotiations with the Human Well-Being, the Ministries of Health of chief specialists on infections, epidemiology and respective republics, in cooperation with territo- surveillance of the Southern Federal okrug about rial agencies of surveillance control (SES) and WHO potential assistance in strengthening epi- other responsible actors, have introduced and demiological service in the North Caucasus implemented on their territories a detailed action through the use of national experts, planning of plan, including, inter alia, creation of a special training courses, implementation of public Emergency Commission comprised of relevant awareness campaigns and distribution of infor- state structures in each republic; organisation of mation materials. mobile disinfecting teams; registration, monitor- ing and surveillance of all poultry and cattle; On March 20-24 WHO funded participation of vaccine procurement and poultry vaccination; four experts from Chechnya, Ingushetia, North coordination with the veterinary service to iden- Ossetia and Kabardino-Balkaria in the All- tify risk groups of people in contact with con- Russian certified training course on epidemiol- firmed Avian Flue; provision of additional per- ogy, organised by the Federal Institute of Epi- sonnel to make door-to-door inquiries (especially demiology in Moscow, as part of its prepared- in the areas of suspected Avian Flue cases); ness plan on Avian Flu and strengthening na- control over health status of workers in poultry tional surveillance capacity.

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Children hit by unknown disease in Schelkovskoy district of Chechnya

At the end of 2005, 89 cases of an unknown dis- Stavropol clinics and sanatoriums and rehabili- ease with symptoms of asphyxia, fainting fits tation centre in Argun, a large number of chil- and hysteria were registered in Schelkovskoy dren was still reported to continue experiencing district of Chechnya. The disease hit mainly chil- serious health problems, linked mainly to con- dren and teenagers, coming from Staro- vulsions, aggression and hallucinations. Children gladovskaya, Shelkozavodskaya and Shelk- do not attend schools. Chechen officials are ovskaya settlements. Chief psychiatrists from deeply concerned over the children’ health the Serbsky state research centre of social and status and call for their thorough medical ex- forensic psychiatry in Moscow diagnosed it as a amination and subsequent follow up and psycho- conversion-spasmodic syndrome spread by social rehabilitation. means of psychological contagion. According to In April, WHO will undertake a special monitor- the specialists of the centre, hysteria-caused ing mission to Schelkovskoy district of Chechnya spasms and hysteric reactions are the most an- in order to receive first-hand information. WHO cient mechanism of reaction to stress. The gov- will visit the central district hospital in Shelk- ernment of the Chechen republic has allocated 5 ovskoi, district hospital in Chervlennoe and FAPs million roubles from its reserve fund for medical in Staroshedrinskaya and Kobi, as well as pay treatment of affected children. However, three visits to the families of affected children. months later, after treatment, received in

INGUSHETIA AND CHECHNYA

Demography WHO continues delivering (with WFP support) food commodities to the Republican TB hospital in Nazran, Ingushetia. In January - March, As of 31 March 2006, a total of 25,080 internally around 330 TB patients (with over 40 children) displaced persons (IDPs) from Chechnya (5,710 received some 8600 kg of flour, over 900 kg of families) were registered for assistance in In- oil, 120 kg of sugar and 30 kg of salt every gushetia in the database of UNHCR's implement- month. ing partner, the Danish Refugee Council (DRC). Of this total, 9,051 persons (2,001 families) were in temporary settlements, and 16,029 per- Epidemiology and immunization sons (3,709 families) in private accommodation.

Despite high standards and timely vaccination of TB children against poliomyelitis in the Russian Federation, re-vaccinating of children at the age On 24 March, the Republican conference com- of twelve and twenty-four months falls short of memorating 2006 World TB Day took place in the required norm in a number of regions, in- Nazran, Ingushetia. 150 representatives from cluding Chechnya. With this in view and in ac- the government bodies, health professionals, cordance with the special resolution, signed by educational institutions, clergy, NGO and UN the Chief Sanitary Doctor of the Russian Federa- community attended the event, coupled with the tion, Chechnya will conduct an additional vacci- children’ drawing contest and performance and nation campaign in spring 2006. The campaign distribution of awareness booklets. will involve no less than 95% of children under five years old and will be held on 24-29 April and

22-27 May. Control over implementation of the additional vaccination campaign is entrusted to

2 the heads of regional health service bodies and ground waters. Many of the functioning refiner- head sanitary doctors of the respective territo- ies do not comply with the state required tech- ries. nological process of oil processing. A large num- Within its EPI programme, aiming at increasing ber of existing boreholes are not properly the coverage and quality of the immunization sealed, with oil spreading around them and pol- services for children in Chechnya and In- luting hundreds of hectares of land. Only 30- gushetia, UNICEF has recently procured: 35% of water springs are fit for purification, with over 150 000 disposable syringes for distribution practically all surface water sources dangerously to paediatric and mother and child health facili- polluted, either by human or industrial waste. ties, medical equipment (electronic scales and In a number of industrial enterprises in Grozny auxanometers) for 43 primary health care facili- radioactive material is stored right on their terri- ties in Chechnya and 20 in Ingushetia, tori es, with local authorities lacking resources for IT equipment (computers and printers) to the its removal and transportation to a specialised epidemiological departments of the local Minis- facility. Consequently, poor health of population, tries of Health, as well as to the vaccination cen- and particularly, the growing need for oncologi- tres in five districts in Ingushetia and 16 rural cal services in the republic, can be attributed to districts (plus Grozny city) in Chechnya. the poor environmental situation and pollution, as well as to stressful leaving conditions. As

reported by the MoH of Chechnya, the number Within the framework of the same project, and of oncological patients in the republic is increas- in cooperation with the MoH of Ingushetia, ing – while there were 1,614 oncological patients UNICEF conducted a one-day conference for registered in the republic in 2004, in 2005 this paediatricians and epidemiologists to discuss figure grew up 2,437. More children and younger future immunization strategies and other rele- people are diagnosed with cancer annually. vant issues, as well as the poor environmental Many of the registered oncology forms have not situation, pollution and stressful living condi- been recorded before. A considerable proportion tions. Some 19 participants, including two spe- (up to 50 %) of detected patients have grave cialists from the Statistical Department of the oncological conditions The highest oncology Chechen Ministry of Health, the ICRC and vari- rates (lung and skin cancer) are in the areas of ous NGO representatives attended the confer- traditional oil refinery industry (Kurchaloi, Shali, ence. Grozny, Grozny-Selsky) and military activities (Achkhoi-Martan, Shali and Vedeno). Reproduc- Health situation tive system organs cancer is more common in Gudermes, Shali, Achkhoi-Martan, Urus-Martan and Grozny. The most common registered can- According to the numerous reports, received cer forms include gastrointestinal, lung, skin, from the responsible authorities in Chechnya, mammal, and uterus cervix. Blood oncology is the environmental situation in the republic re- increasing, particularly, in Grozny, Grozny- mains alarming. The republican environmental Selsky, Urus-Martan and Achkhoi-Martan dis- control service does not function. The depart- tricts. ment of natural resources, located in Gudermes, At the same time, the oncological service of the does not perform the required duties. There is republic experiences grave problems. There is no control over industrial production and mining. only one oncological dispensary and ten beds The overwhelming majority of activities involving available in city hospital N1 in Grozny. Staffing is environmental pollution is performed without the limited to eight qualified doctors, other health necessary licenses, ecology passports, or per- workers not having required training and back- mission documents. Despite regular checks for ground. Lab and diagnostic capacities merely compliance with environmental standards, no function. Strong shortage of drugs is a constant actions against violation or preventive measures problem. Haematological services can be ob- to ensure compliance with environmental stan- tained only at Hospital no. 10 in Grozny, which, dards are taken. The main concern refers to having the necessary equipment for plas- mini-refineries, polluting the surface and under-

3 mapheresis, experiences persistent lack of IRC continues distributing multivitamins and drugs and medical consumables. Most patients dental hygiene education pamphlets to school- undergo chemotherapy at home, for lack of aged children in Ingushetia and in Grozny. The space or conditions for in-patient services. organization has also assisted in delivery of sani- No systematic detection and/or prophylactic ac- tary napkins donated by UNHCR to two local tivities take place in the republic. Only minimal hospitals in Ingushetia and distributed 10 First oncology treatment can be received. Conse- Aid Kits in IRC-run schools and the IRC-run quently, the bulk of patients is referred for out- Sport Centre in Ingushetia. of-town treatment. Handicap International carried out a training The situation with communicable diseases in course on polio (17-19 January) for 20 staff of Chechnya is reported as critical with limited lab its 14 assisted health rehabilitation facilities in and treatment possibilities. In 2005, increased Argun, Chechnya and a training course on stroke morbidity was registered in 32 out of total listed (16-18 March) for its 20 staff in Kislovodsk. 38 communicable diseases (e.g. scarlet fever rates have been 23 times higher than in 2004). In January-March IMC continued CPR/first aid Among the leading infections are flue, respira- training sessions for its personnel, residents of tory diseases and intestinal infections. 77% of local communities of IMC MMU operations and all registered intestinal infections are diagnosed state health workers. as of “unknown etiologic nature”.

Health assistance HIV/AIDS

ICRC Plan of Action for 2006 envisages contin- Ingushetian AIDS centre reports a total of 492 ued assistance to the vulnerable population in HIV cases in 2005, including 48 new ones. In the North Caucasus. Reinforcing health services Chechnya there are 560 HIV cases reported for in one of the priorities, with the ICRC assisting in 2005, 108 of them newly registered. 2006 up to 13 hospitals in Chechnya, one in

Dagestan and one in Ingushetia, as well as the WHO has sponsored participation of two doc- Grozny central blood bank. The ICRC will also tors-laboratory technicians from the Republican support the repair of public infrastructure such Aids Centre in Grozny in the training course on as the water supply and sewerage systems in “Introduction to improved quality in laboratory Chechnya, Ingushetia and Dagestan and con- diagnosis and treatment of HIV/AIDS in Saratov, tinue mine risk education through building safe organized by the NGO American International play areas for children in Chechnya. The ICRC Health Alliance (6-10 February), delivered two also plans to help in restoration of a children's sets of HIV laboratory equipment to Gudermes department of the tuberculosis health centre in central district hospital and central district hospi- Nalchik, and an asylum for disabled children in tal in Naur (Chechnya), and 8.000 HIV aware- Prokhladny, Kabardino-Balkaria. ness booklets to the Republican AIDS centre in In line with this, in addition to the regular sup- Grozny (February), as well as held a one-day ply of medicines and laboratory consumables to training course on HIV/AIDS transmission and the hospitals in Chechnya, Ingushetia and prevention for UN and NGO staff in Nazran (31 Dagestan and provision of several hospitals in March). Chechnya with Insulin and medical donations to the Republican Blood Bank in Grozny, in Febru- ary, ICRC has rendered ad hoc assistance to Caritas Internationalis provided some 51 test Vladikavkaz Emergency Aid hospital. systems to the Chechen AIDS centre and is ex- pecting to send another 48 in the near future.

4 Mother and child health 1-3 March: a training course on infections (in- cluding Prevention of Mother-to-child transmis-

sion of HIV) in modern obstetric and gynaeco- Two maternity hospitals were opened in Chech- logical care, for 21 Chechen health workers in nya - Maternity hospital no 2 in Gronzy and a Nazran; maternity hospital in Kurchaloi district. 9-15 March: a training course on IMCI for 10

pre-selected IMCI facilitators from North Os- Within the framework of programs on “Making setia-Alania; Pregnancy Safer " (MPS), “Promotion of Effective 13-17 March: two series of training courses on Perinatal Care” (PEPC) and “Integrated Man- HIV PMTCT for altogether 40 Chechen and In- agement of Childhood Illnesses" (IMCI), funded gush state health workers, including paediatri- by the Swiss Agency for Development and Coop- cians, neonatologists and gynaecologists. eration (SDC), WHO has organised in January- March the following events: 30 January – 3 February: a practical course on WHO facilitators assisted ACF in holding a train- "Newborn Care and Breastfeeding” in Vladi- ing course on breastfeeding in Nazran (6-8 Feb- kavkaz, North Ossetia. 20 Obstetricians, neona- ruary) for 20 specialists, including 11 state tologists, paediatricians and children nurses par- health workers from Shatoi/Sharoi /Itum-Kale ticipated; districts, 8 ACF staff and 2 people from Chechen NGO “Sintem”. 26 February - 7 March: a training course for 40 state health workers (obstetricians and gynae- cologists) on Essential Obstetric Care and Family UNICEF Mother Empowerment Project (MEP), Planning in North Ossetia; aimed at raising mothers’ awareness on various topics related to breastfeeding, immunization and early recognition of common childhood ill-

nesses plans to target some 10,000 resident and IDP pregnant women, mothers and other pri- mary child care providers living in Chechnya and Ingushetia, in 2006. In Ingushetia, the project

is carried out by the Republican Centre for Dis-

ease Prevention, in Chechnya - by the Republi- can Children’s Policlinic in Grozny. UNICEF also continues to distribute its brochures on breast- feeding to pregnant women and mothers at-

tending the sessions.

Participants of the training on essential obstetric care in Vladikavkaz IRC continues to work in Chechnya towards im- proving the health outcomes of war-affected mothers and children in Grozny by providing pregnant women with psychosocial counselling,

health education and safe motherhood kits.

Mental health

On 27 March, UNICEF opened a Family Centre ‘BINONTÆ’ (‘family’) in Beslan. The centre is opened in partnership with the Ministry of Edu-

Practical classes were arranged at the Republi- cation of North Ossetia and aims to facilitate can clinical hospital strengthening the families’ capacity to ensure a protective environment for the psychologically

5 affected children, as well as to reduce the effects among different target groups and took an ac- of long-term psychological trauma originating tive part in the development and distribution of from the crisis in Beslan. This project is based 4,000 questionnaires in all districts of Chechnya. on the results of the ‘Stress and Family’ situation assessment conducted by UNICEF in February UNICEF has conducted, through the Israel through ‘Harmony’, the Russian Institute of Psy- Trauma Coalition (ITC)/Herzog Hospital, the chotherapy and Counselling (St. Petersburg). second ‘Trauma Counselling’ training out of the five planned for 21 specialists from Chechnya. UNICEF continues the implementation of the Peculiarities of post-trauma stress disorder, ‘Thank You All Who Helped Beslan’ project, in acute stress reactions, grief processing in chil- the framework of its emotional rehabilitation dren and parents, self-regulation and cognitive programme, carried out through the Centre of intervention techniques were among the topics Ecological Education ‘Obninsk’. In addition to included in the agenda of the training. preparing some 120 hand-made ‘Thank You’ postcards and sending them to different people UNICEF has also carried out, in partnership and organizations that provided support in the with ‘Harmony’, the Institute of Psychotherapy aftermath of the Beslan tragedy, the participants and Counselling from St. Petersburg, the second of the project have collected and prepared mate- training of trainers for 23 school-based psy- rials for a mobile exhibition of the children’s art chologists from Chechnya. works and a ‘Thank You All Who Helped Beslan’ book, which will be presented during the com- memoration of the second anniversary of the IRC continued working with children in closed school n. 1 events. In February, some 200 chil- and open psychosocial groups in Ingushetia and dren from Beslan took part in the work of the Chechnya. Over 100 children per month were UNICEF-supported centre. Activities included art covered in each group in every republic. Psycho- interventions, game and theatre techniques, social counsellors were also working with 5-6 painting and modelling nature scenes. Two year old children in five schools in Grozny. Provi- groups of children, parents and teachers took sion of individual counselling to children, parents part in winter and spring camps with similar and teachers in Ingushetia and in Grozny also programmes. continued, as well as holding parents’ meetings with children’s psychosocial health as a topic. 1160 copies of the monthly psychosocial news- UNICEF, in partnership with the Russian chari- letter “SINTEM” were distributed in Ingushetia. table foundation ‘NAN’, launched stage 2 of its In addition to that, IRC arranged for 19 children ‘Psychosocial Baseline Study in Chechnya’, so as from Chechnya and Ingushetia to go to a one- to further deepen the analysis of the data on week retreat addressing psychosocial issues psychological state of Chechen children and the through games and other relevant activities and availability and quality of the available govern- facilitated training on the “psychology of educa- mental and non-governmental psychosocial pro- tion” for 15 psychosocial counsellors. grammes, collected during the first stage (com- pleted in November 2005). The activities planned under stage 2 will enable UNICEF to Other news thoroughly analyze the children’s environment, not only within their family, but also at school Two issues of the “Bulletin for health care man- and at the community-level, so as to identify agers in Russia”, were published by WHO ways to strengthen it and make it more protec- Zdravinform health data base project and WHO tive. NAN also organized and facilitated three Documentation centre in Moscow in January- seminars for a group of psychologists, involved February 2006, the first one had Blood safety as in the UNICEF-supported training process for the topic, the second – alcohol-related health- specialists in Chechnya. The psychologists were care problems. The bulletin can be obtained at provided with skills in conducting interviews http://zdravinform.ru

6 List of abbreviations: Health Action in the North Caucasus is a news- letter on the Disaster Preparedness and Response ACF: Action Contre la Faime programme (DPR) of the World Health Organiza- CPR: Cardio-pulmonary resuscitation tion Regional Office for Europe. The information is DRC: Danish Refugee Council compiled by the WHO Humanitarian Assistance EPI: Expanded Programme on Immunization Programme in the North Caucasus, the Russian FAP: Feldsher/obstetric post Federation. GP: General practitioner HI: Handicap International All rights are reserved by the organization. The ICRC: International Committee of the Red Cross document may, however, be freely reviewed ab- IDPs: Internally displaced persons stracted, reproduced or translated in part or whole, IMC: International Medical Corps but not for sale or for use in conjunction with com- IMSMA: International Management System for mercial purposes. This newsletter is not an official Mine Action necessary represent the stated policy of WHO. IR: Islamic Relief Correspondence should be addressed to: IRC: International Rescue Committee Russia Office of the WHO Special Representative LSG: Lets Save the Generation of the Director General in the Russian Federation MDM: Médecins du Monde WHO publication. The views expressed in it do not MMU: mobile medical units 28, Ostozhenka, MoH I: Ministry of Health of the Republic of In- 119034 Moscow gushetia The Russian Federation MoH RF: Ministry of Health of the Russian Fed- Attn: Irina Tarakanova [[email protected]] eration Tel.: (+7) 095 787 21 52/12 MoH Ch: Ministry of Health of Chechnya Fax: (+7) 095 787 21 19 MRE: Mine Risk Edication Editors: Mr Bengt Stalhandske MSF−B: Médecins sans Frontières-Belgium [[email protected]], Irina Tarakanova MSF−F: Médecins sans Frontières-France [[email protected]] MSF−H: Médecins sans Frontières-Holland PHO: Polish Humanitarian Organization For more information about WHO Disaster Prepar- PTSD: Post-traumatic stress disorder edness and Response programmes, please con- OCHA: United Nations Office for the Coordination tact: of Humanitarian Affairs Dr Gerald Rockenschaub [[email protected]] SARC: Saudi Red Crescent Society SES: Sanitary Epidemiological Surveillance The "Health Action in the North Caucasus" news- STI: Sexually Transmitted Infections letter of the Disaster Preparedness and Response TAC: Temporary accommodation centre programme (DPR) can be found at UNICEF: United Nations Children's Fund UXO: Unexploded ordnance http://www.who.int/hac/crises/rus/sitreps/en/in VOM: Voice of the Mountains dex.html WHO: World Health Organization

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