Health Action

- in the North Caucasus

NEWSLETTER ON EMERGENCY PREPAREDNESS AND RE SPONSE, FEB/MARCH 2002

Psychiatric care in the Chechen Republic Overview for the year 2001

Medical personnel Recent years have seen a decline in the level Since the early 1990s a mass outflow of medical of psychiatric care in Chechnya: professionals started from Chechnya. Twenty- · The doctors:positions ratio has declined two psychiatrists left, leaving in Grozny in 1996, by two thirds; for example, only four doctors with sufficient · Low case detection rate, in particular qualifications (29 are required by the standard among children and adolescents (records staff table). based mostly on visits); The exodus of psychiatrists occurred from rural · Inadequate condition of psychiatric facili- areas as well. Qualified psychiatrists are cur- ties and equipment supply; rently available only at the central district hospi- · Insufficient supply of psychoactive medi- tals of Naursky, Shalinsky, Kurchaloevsky and cations; Nadteretchny districts and in Grozny. In other districts, psychiatric care is provided on a part- · Low efficiency of bed utilization. time basis by neurologists and in Shatoisky and Schelkovsky districts by nurses. Mental health facilities In 2001, there were 0.2 psychiatrists per 10 000 The mental health services in Chechnya are pro- population in Chechnya (versus 1.5 of the na- vided by the republican psycho-neurological dis- tional average in 2000). pensary, two psychiatric hospitals: the republi- It should be noted that most doctors providing can psychiatric hospital in Darbankhi (180 beds: psychiatric care have not taken relevant profes- 60 beds operational as of 1 January 2002) and sional or refresher courses for the last five to six the psychiatric hospital in Samashki (50 beds years. operational since mid-2001) and psychiatrists Facilities and equipment working at the central district hospitals. The psychiatric facilities and available equipment By 1991, there were 1 060 psychiatric beds in are very insufficient or inadequate. Chechnya, including 110 at the republican dis- After the 1994-96 combat actions, the republi- pensary, 50 at the day-care department, 330 at can dispensary in Grozny has been located in a Darbankhi hospital, 200 at Goryacheistochnen- semi-ruined building which was almost co m- sky hospital and 220 at Samashki hospital. Since pletely destroyed in the 1999 military campaign. 1991, the psychiatric bed capacity has been re- Due to the lack of a building fo r the republican ducing annually and by 1999 it was 260 beds as dispensary, Grozny does not currently have an a result of the so-called health sector restructur- inpatient department, even for emergency care. ing in Chechnya (180 beds in Da rbankhi hospital No appropriate building has been found to date, and 80 in Samashki hospital). The reform did with the republican dispensary being temporarily not foresee any in-patient facilities for children accommodated at Polyclinic no. 7. who were to be sent for psychiatric care out of the republic. The Darbankhi and Samashki hospitals are housed in old buildings without essential utilities

1 and medical equipment. The medical furniture Performance of psychiatric hospitals has been discarded without replenishment for In 2001, the psychiatric hospitals of Chechnya several years. The Samashki hospital has not reported 878 admissions, including 795 by Dar- had a water supply for some years and relies on bankhi hospital and 83 by Samashki hospital, delive ries from rural areas and tank storage. versus 556 and 75 in 2000, respectively. The Outpatient psychiatric services bed occupancy rate was 59.6% and 32.6%, ac- cordingly. The incidence of mental disorder (primary cases) in Chechnya has increased over the last two Both hospitals are not adequately supplied with years: from 280 in 2000 to 1 190 in 2001, or medications (neuroleptics), let alone their vari- 0.3 to 1.3:10 000. This is due to more primary ety. However, this situation has improved tangi- visits by patients who apply to be co nsidered as bly with the recent months’ supplies by the Min- disable (with the corresponding benefits). istry of Health of the Russian Federation and humanitarian organizations. The lack of required Despite the high shortage of professionals, the neuroleptics and their assortment denies quality outpatient care effort averages 3 667 visits per treatment and entails short remissions and the doctor a year, or 67.9% (the standard is 5 400 high disability rate. Patients, staying at hospi- visits). tals, for the most part are administered mainte- Estimated prevalence of psychiatric diseases in nance treatment, resulting in frequent exacerba- 2001 for Chechnya was 1.3:10 000. tion.

Psycho-social rehabilitation in emergencies – a universal need By Zoya Khimchyan, researcher of the Institute of Psychology of the Academy of Sciences of the Russian Federation The long-lasting political and economic crisis in Chechnya and the many years of incessant hostilities resulted in a generation of “camp children”. Children, who are deprived of childhood, illiterate and some of them with an alarming de- velopmental lag and behavioural, affective and personality disorders. This problem was reco g- nised in a number of urgent needs of inte rnally WHO regularly arranges training workshops to im- displaced persons (IDPs), and presently in In- prove psychological rehabilitation work. gushetia there is a growing number of international governmental organizations and NGOs can not always be integrated successfully into involved in the psychosocial rehabilitation of af- the professional knowledge and skills. fected children from Chechnya. In the context of the current political and eco- Given the conditions, this work demands from nomic instability in Chechnya, professionals in the care -givers varied professional knowledge this field will remain increasingly in demand for and skills. Even the workers with psychological a long time. Therefore, WHO regularly arranges education need retraining for clinical psychology, training workshops to ensure sustainability and counselling and psycho-therapy, to say nothing better coherence of psychological rehabilitation about the volunteers working as non- work in the community. professional counsellors. The latter do gain size- I joined this process when I was invited to con- able practical experience; however, it is neither duct two WHO training workshops: the first on reviewed, nor arranged in order, and therefore psycho-diagnostics and therapy of post- traumatic stress disorders in general and the

2 second on more specific issue of psychosocial tres shape their new outlook and sense of their rehabilitation of disabled children. life in the protracted crisis, as well as acquire a The approximately 50 participants varied greatly new locally relevant speciality, i.e. the counsel- in the level of their qualifications and experience lor. in psycho-social rehabilitation. Educators, psy- The training and interactive exercises revealed chologists, physicians and students of psychol- the general professional and personal difficulties ogy schools were engaged in counselling chil- common for all of the participants: the partici- dren and their parents in the IDP camps and pants were rallied by, for example, their com- settlements via the work of centres for social mon woe (death of their kin, loss of home), and psychological rehabilitation and the preve n- bombings, unclear future. Few of them managed tion of mental disorders. to overcome their own traumas, which some- During the workshops the participants learnt times affects their work. about modern scientific perceptions of the na- The following recommendations were developed: ture of psychological trauma and its implications Ÿ professional upgrading should be continued for the psyche, methods of psycho-diagnostics both academically and practically, because and post-traumatic stress disorder therapy, and the participants need to increase and sys- particularly about the peculiarities of social and tematize their professional knowledge in psychological rehabilitation of disabled children. clinical psychology and counselling; Emphasis was placed on the specifics of the Ÿ a permanent supervision arrangement is work being carried out by counsellors and social required for professional upgrading and workers in the IDP camps. evaluation of the experience gained by rele- The educators themselves, while sustaining the vant practitioners to discuss specific clinical camp life hardships and burdened by their own cases and draft recommendations on social psycho-traumas, managed to counsel those who and psychological rehabilitation; needed it. Although aware of the shortage of Ÿ ongoing work is appropria te with rehabilita- relevant experience and knowledge, these work- tion professionals for prevention of the ers try to compensate for it by their high co m- “emotional burn-out” syndrome and psycho- mitment and infallible effort while running the emotional stress removal, because they suf- risk of professional burn -out (wishful thinking, fer a secondary trauma resulting from their secondary traumas at work, frustration for lack occupation and a chronic stress caused by of qualifications etc.). This problem was dis- their residence in the refugee camps; cussed during the workshops and appropriate preventive and health promotion methods were Ÿ a collection of relevant practical guidelines taught. on various aspects of social and psychological rehabilitation and booklets adjusted for The workshop participants have extensive ex- individual work in the refugee camps should perience of work in IDP camps, including the be prepared, and a sort of paediatric eme r- awareness of local ethnic and cultural particu- gency counsellor library created. lars. This activity helps many rehabilitation ce n-

Psycho-social support in emergencies On 6 February 2002, the International Organiza- health of the population. The forum gathered tion for Migration (IOM), in cooperation with the specialists in migration from state bodies, repre- Moscow Migration Research Programme co n- sentatives of independent Russian research ce n- ducted in Moscow the roundtable ”Migration and tres, national NGOs working with migrants, health in Russia: correlation, consequences and some donor organizations, international organi- control". The roundtable aimed to conduct a zations, other officials dealing with health care public discussion on the priority issues related to services and the mass media. The two main top- massive migration processes in the Russian Fe d- ics addressed were the impact on health of mi- eration, including the impact of migration on the

3 grants themselves and on the health of the re- ing psychological and psychiatric assistance to ceiving community. affected people in complex emergencies, as part The objectives of the roundtable were set as of services for migrants and IDPs. The meeting, follows: to identify the principal problems, needs which gathered representatives of public health and requirements of migrants, especially in the administration, the scientific community and field of infectious diseases and their spread; to practical institutions, considered the issues of: attract public attention and to establish inter- Ÿ organization of unique psychological and ministerial, national/international NGO coopera- psychiatric assistance to affected population; tion in order to better address the problem. Ÿ positioning of psychiatry in emergencies in The participants were very interested in the is- the overall system of psychiatric aid; sue of psychological rehabilitation, presented at Ÿ human resource development for the specific this meeting by the WHO North Caucasus pro- purpose of medico -psychological rehabilita- gramme, All-Russian Centre for Disaster Medi- tion in emergencies. cine “Zaschita” and the Russian Red Cross. In- A draft of the order of the Ministry of Health formation, inter alia, was released that a round- (MoH) addressing the aforementioned elements table discussion on the matter was planned by of the problem was debated and presented to the RF Ministry of Health. It took place on 12-13 the respective department of MoH RF. March 2002, with the stated purpose of improv-

Social and psychological rehabilitation centre for children and youth “Serlo” by Zeinap Batukaeva, Director of the Serlo Centre

10-years-old Seda wrote when requested to d escribe her life: “Only war was in my life…”

The Serlo Centre, a non-governmental organiza- issue of the psychological and social rehabilitation (NGO), was established in December 1995 tion of children and adolescents. Nor do they during the first round of hostilities in Chechnya take the necessary steps to help those who by a group of psychologists, health and educa- would like to do some good in this sense. tion workers. It has worked for over four years The first person to offer support to Serlo was Mr without any external financial support. Chris Hunter, from the Centre for Peacemaking At that time, orphans in groups of two to five and Community Development (CPCD). We were begging all over Grozny. Why they decided worked during March to May 2000 in Gvardey- to walk the streets and beg until sunset when skoye, Nadteretchny district, and, simultane- some Khamzat or Nurdin would let them into a ously, conducted the monitoring and began basement for a night confounded us. None of working in the Yuzhny IDP camp in Znamenen- them knew anything about their parents; they skoye (same district). In the beginning, our were just gone. I made a suggestion, asking if team of five psychologists-counsellors and five they would like to go with me to an orphanage. assistants had many technical obstacles, i.e. They could take a bath there, put on clean lack of premises. Two months later, a half of a clothes and eat. And then we would search to- 40-bed tent was allocated to us. Thus, the Serlo gether for their parents. They joined me and Centre has been operational in the Yuzhny camp later we were received by Native Home of since March 2000, with CPCD support in March Khadizhat. The children, however, fled three to May and OSCE since July. days later for “a free life”. Currently, we enjoy five well-equipped and spa- Neither the district administration nor the so- cious tents allocated by UNHCR, assisted by called social service of the republic reflect on the OSCE. Starting April 2001, we also began to

4 hanced by a competent response to social and psychological pro blems. We also are alarmed by the 16-18 and 21-year- old age groups. Last summer, we received a delegation of international and Russian experts at the Yuzhny IDP camp. They have yet to follow up their visit with the needed supplies. Educa- tion and vocational skill training are of great importance for these age groups, in particular a command of computers and languages, including

Chechen. Game therapy is an important activity at the Serlo We at the centre admire these brave children. centre. They inspire and support us by what they say

and do and we hope to be able to continue help- work in the Severny camp. In other words, we ing them. have been active in the Yuzhny camp for almost *** two years and in Se verny for about a year. Prior to the Serlo emergence in the Nadterechny dis- Structurally, the activities of the centre are: trict, no rehabilitation service was provided by I. Diagnostics: first 10 days of a three-month anybody. At present, our centre is unique here. cycle Our children, 6-7 years old, were born amid the 1. Visiting individual tents. Interviews with first round of hostilities in Chechnya. Currently, parents. Collecting data on children; they live in camps. In the summer of 2001, 2. Interviewing children; some IDPs were unable to bear camp life any 3. Forming the training groups according to longer and returned to Grozny, wherever they age: 6-7, 8-10, 10-12, 12-14 and 14-18. could find a shelter: a basement or a semi- ruined building where water was difficult to ob- II. 3 months of psycho-social rehabilitation tain, with electricity and gas supply shutdowns. Ø Morning: Exercises in the core groups However, they ultimately had to return to the camp in a dreadful fear of the horre ndous Structure of the training session: “clean-ups”. Recurrent post-traumatic stress 1. Activating game; disorder was diagnosed in virtually all of our pa- 2. Core exercises in five tents: tients. It was even harder to deal with them Ÿ music and video therapy; compared with the period preceding their flight to Grozny. Their children’s psyche had not re- Ÿ art therapy; covered and sustained a re-stress. Ÿ game therapy; We have five 6-16-year-old age groups in each Ÿ sport therapy; camp, 20 children each, totalling 200 children. It Ÿ individual interviews with children; is, unfortunately, insufficient to provide psychological counselling alone to children aged 6 to 3. Reflection/feedback; 16. Their parents also need counselling. Al- 4. Final result (daily report by counsellor). though frustrated, we did conduct interviews, try Ø Afternoon: Leisure (free attendance of the out va rious relaxation exercises and the like. centre): However, it is the third winter of outright idle- III. The last 10 days of the month: re- ness in the camp. We appealed to the OSCE, UNICEF and others for help. They can establish a diagnostics project while we will fill it with labour, at least Includes data processing: compiling group lists one bakery, or a women’s tailor workshop, or and determining the level of trauma, disability some repair team for men etc. The effect and etc. Children with severe trauma remain in the benefit for the people and society would be en- group for further rehabilitation while healthy children are discharged.

INGUSHETIA, CHECHNYA AND THE NEIGHBOURING

Demography Implementation of the trilateral programme of The estimated number of IDPs living in In- TB prevention and control gushetia was 140 683 persons as of 28 February The results of treatment of the first cohort of 2002 (DRC/ASF). patients started within the framework of the tri- According to the latest DRC/ASF survey data, as lateral WHO/MoH RF/MoH I programme on TB of 28 February 2002, the population of Chech- prevention and control in Ingushetia in Dece m- nya was 784 780 persons, with as many as ber 2001 were assessed in March 2002. The to- 137 566 internal IDPs. tal number of patients treated was 178, of them 97 were undergoing in-patient treatment and 81 patients were treated in outpatient facilities. TB prevention and control Twenty-eight originally (BK+) patients were suc- Training courses cessfully converted to (BK-) and were released Within the framework of the trilateral for further supportive therapy. (W HO/MoH RF/MoH I) programme of TB preve n- According to the TB project protocol to facilitate tion and control in Ingushetia, WHO held the TB surveillance and case management, WHO has following training courses on the organization of provided the republican TB control network in TB control for 111 participants, in Nazran, in Ingushetia with 3 (4x4) Lada cars. March: 11–13 March: “Epidemiology of TB and its co n- World TB day trol” for epidemiologists, TB specialists and medical professionals of general health service from Ingushetia; 14–16 March: “Principles of diagnosis and treatment of tuberculosis” for NGO personnel from Ingushetia and Chechnya; 18–19 March: “Case management” for TB specialists, medical professionals of general health service and primary health care network.

”To fight poverty and to com bat TB.” 24 March World TB day.

On 22 March World TB day was marked in In- gushetia by organizing a one-day technical conference in the republican hospital in Nazran. The conference was attended by representatives from the MoH I, the republican TB service, the humanitarian community and other organizations. Participants received information about UNHCR-donated prefabricated modules, set up by the current TB situation in Ingushetia, activities WHO in the Republican TB Dispensary within the framework of the trilateral programme of TB prevention of the TB service, and the results of the on- and control. going trilateral WHO/MoH RF/MoH I programme on TB prevention and control in Ingushetia. The

6 those who had no opportunity to attend WHO training workshops), working with the psycho- social rehabilitation of children and adults in In- gushetia in order to help them gain access to modern psycho-therapy methods. Regular mental health coordination meetings The regular monthly mental health coordination meeting were held by WHO on 21 February and 28 March, in Nazran. If you hide the disease, think of your next The first meeting addressed the following issues: of kin. 1. assistance to the Samashki psychiatric hos- conference was followed by a performance given pital in Chechnya: by children, undergoing TB treatment at the Re- Ÿ in response to a WHO request, the World publican TB Dispensary and a drawing contest, Food Programme (WFP) agreed to include the topic of which was fighting TB. the Samashki psychiatric hospital as a bene- ficiary of the WFP institutional feeding pro- Mental health gramme; WHO -sponsored training courses on psychosocial Ÿ the chief doctor of the hospital confirmed therapy the receipt of humanitarian aid from UNHCR On 4-8 February, in Nazran, WHO held a one- and ICRC, facilitated by WHO, but indicated week training course on psycho-social therapy that many more items were still needed; for handicapped children and adults. It was at- Ÿ MSF-H agreed to also provide some needed tended by 33 participants (psychologists and items to support the hospital (later in Febru- counsellors) from all NGOs working in rehabilita- ary MSF-H donated to the Samashki hospital tion centres for children in IDP camps in In- a washing machine, bed linen and hygienic gushetia and Chechnya. Medical doctors and items). psychologists from the Vladikavkaz children’s 2. News from the Children’s rehabilitation ce n- rehabilitation centre and the prosthetic work- tre “Malkh” (permanently supported by shop in Vladikavkaz also took part in the course. WHO): The course was the second in a series of three The head of the Malkh centre presented and dis- (the first course was conducted on 3-5 Nove m- ber 2001) and was facilitated by two psycholo- tributed the first issue of the newly edited news- gists from the Institute of Psychology of the paper Malkh. The first issue introduced readers to the centre’s activities and aims, described its Academy of Sciences of the Russian Federation. problems and needs. The newspaper showed The last course in this series was held in Nazran examples of children’s correspondence with their on 4-8 March. It was devoted to community- mates in other countries, as well as the difficult based psychological rehabilitation with special day-to-day living in Chechnya, and co ntained attention on stress-release and was again de- pieces of poetry etc. The newspaper will be a signed for psychologists and counsellors working monthly publication. One thousand copies of this with IDPs in Ingushetia and the population in issue were printed. Chechnya. It was facilitated by Ms R. Jarman, an ARD consultant from the UK, and was attended 3. PINF update by 25 people. PINF reported on an assessment of MoH and Exchange of training videos NGO psycho-social activities conducted in Chechnya and updated on its continuing activi- In addition to training activities, WHO is also ties in providing psycho-social assistance in Mal- rotating 15 psychological teaching videos, rec- gobeck, Nazran and Sunzha districts of In- ommended by the Institute of Psychology of the gushetia, where it works in some 20 schools Academy of Sciences of the Russian Federation with over 1700 students. between the organizations (especially among

7 At the second meeting WHO reported on its Grozny district and the Naurski, Shalinski, Urus- planned future activities in psychosocial rehabili- Martanovski, Achkhoi-Martanovski and Sunzhen- tation: ski districts. In Ingushetia the training is being Ÿ the carrying out of a specialized stress-relief held for medical personnel from state medical training for medical doctors/nurses from facilities and NGOs providing assistance to the NGOs working with IDPs in Chechnya; and a IDPs from Chechnya. one-month training for four psychiatrists In June CARE intends to start implementing the from Chechen psychiatric hospitals in the psycho-social community based programme in Moscow Research Institute of Psychiatry; four IDP settlements in Ingushetia and Chech- Ÿ the organization of two IDP children’s festi- nya. vals in Ingushetia and Chechnya in cooperation with UNICEF; Epidemiological surveillance Ÿ the continued purchase of psycho-social lit- Bacteriological media, ordered by WHO to erature, therapeutic material and the ex- strengthen the capacity of the Sanitary Epidemi- change of videocassettes among NGOs; ological Surveillance Service (SES) of Ingushetia Ÿ the support and partial co-sponsoring of the for early response and management of potential participation of a delegation of Chechen psy- outbreaks of infectious diseases arrived in Naz- chiatrists/psychologists at the “Second In- ran and were delivered to the Republican Sane- ternational Congress on Psychosocial Reha- pid for further distribution to its regional bilitation with and within the community”, in branches. Barcelona, Spain, on 26-30 May 2002. In addition, based on a request of the chief Ÿ sponsoring the two Chechen rehabilitation medical office of the Ingushetian Sa nepid and in centres (Serlo) in Znamenskoe. view of poor hygienic conditions and the vector The WHO sponsored rehabilitation centre spread for such infections as tularemia and "Malkh" published the second edition of its plague endemic in the region, WHO is to proceed newspaper. Interested NGOs working in the field with the purchase of relevant chemical agents to of mental health were invited to contribute in- ensure rodent control. formation on their activities to the paper in order In early March UNICEF has handed over 5 t of to make their rehabilitation centres known to chlorine powder to EMERCOM of Ingushetia for people, searching for help. disinfecting purposes.

The next mental health coordination meeting In February/March, the Ingushetian Sanepid re- will be held in Nazran on 25 April 2002. ported a certain seasonal increase of a number of cases of pediculosis. A slight increase in the

4. Care International update number of cases of acute respiratory diseases and influenza were also observed during the CARE is continuing its psycho-social training same period (see graphs below). programme for educational and health professionals working with war-affected children and their families. Up to the end of December 2001, 2000 1800 Pediculosis Month total 269 teachers and 83 health care workers from 1600 1400 98 schools and 27 medical institutions were Pediculosis Patients 1200 adults trained, directly serving over 8 000 children in 1000 Pediculosis Patients < 14 800 the formal and non-formal education systems in years 600 both Chechnya and Ingushetia. In February 400 Pediculosis Patients < 1 year 2002, CARE started three seminars for medical 200 0 professionals and three seminars for educational Nov Nov May July Sept professionals. The seminars will take place from March March Jan 2001 Jan 2002 February to May and will consist of four succes- sive modules. In Chechnya it is planned to invite medical personnel from the city of Grozny,

8 Pediculosis 1200 Month Patients 1000 800 ARI Month total Total adults <14 years <1year ARI Patients adults 600 ARI Patients < 14 years Jan 2001 1405 246 1159 0 400 ARI Patients < 1 year 200 Feb 101 11 90 0 0 March 703 353 350 0 Nov May July Sept Nov March March Jan 2001 Jan 2002 April 1155 353 802 0

May 1882 804 1078 0 EPI

June 1889 250 1639 0 In view of the serious concern expressed by various medical NGOs working in Ingushetia July 1538 387 1151 0 over a possible outbreak of measles in the re- Aug 969 393 737 0 public UNICEF, MSF-France, Hammer Forum Sept 1008 165 682 0 e.V., International Medical Corps (IMC) and WHO discussed in February the necessity to Oct 333 59 274 0 conduct a measles vaccination campaign for Nov 531 98 433 0 children under five in Ingushetia (local and IDP). Dec 423 31 392 0 Upon thorough consideration of the existing measles morbidity data and bearing in mind that Jan 2002 200 27 173 0 measles is not endemic in the region, it was de- Feb 126 10 116 0 cided not to pursue a vaccination campaign. March 493 102 391 0 However, it was agreed that the present MoH I Expanded Programme on Immunization (EPI) should be reinforced. In particular, Acute respiratory infections (ARI) Ÿ UNICEF committed to have enough stock of Month Patients vaccines and to ensure rapid mobilization of Total adults < 14 years <1 year necessary resources in case of an epidemic;

Jan 2001 11 2 9 0 Ÿ WHO will provide technical assistance and training of medical staff; Feb 0 0 0 0 Ÿ NGOs will support (upon request) MoH with March 286 119 167 0 human resources and will assist in arranging April 472 114 358 1 the immunization of incompletely vaccinated May 788 348 440 0 children (including non-registered IDP children). June 228 56 172 0 MOH I made it clear that there are no obstacles July 888 503 385 0 for NGOs to carry out injections in their local Aug 47 21 35 0 polyclinics. Is also suggested that NGOs start Sept 136 37 90 2 practicing the standard approach of daytime inpatient care at their field polyclinics if facilities Oct 59 23 36 0 provide for such treatment. Nov 125 44 78 0

Dec 102 35 61 6 STI/HIV/AIDS prevention Jan 2002 32 8 24 0 Within the framework of its STI/HIV/AIDS pre- Feb 20 8 12 0 vention project for the year 2002, WHO com- March 973 872 101 0 piled information on registered cases of HIV in Ingushetia. The data provided by the chief of the preventive department of the republican “Anti- AIDS” centre showed that in 2001 the number of

9 HIV cases tripled among the IDP population and It was agreed by the Grozny and Vladikavkaz quadrupled in the local Ingush population, as workshops that the first group of 10 Chechen compared to 1999. 95% of registered cases are amputees will be sent to the Vladikavkaz work- males. 94.4% of all cases are related to intrave- shop in March. It is envisaged to extend this nous drug use. 5% are assumed to be sexually programme in future and to treat monthly 10 transmitted. The percentage of transplacental amputees, until the allocated funds run out and infection is less than 1%. the Grozny workshop is able to serve the ampu- WHO arranged for the distribution of educational tees by itself. materials and posters on HIV/AIDS prevention Ÿ WHO agreed with the Vladikavkaz prosthetic to the Anti-AIDS Centre, NGOs and MoH I, and workshop to further extend its programme is now elaborating an HIV/AIDS aware- of prosthetic assistance to Chechen adult ness/prevention campaign with MoH I, aiming to amputees and to organize and realize pros- reach not only people with risky behaviour, but thetic assistance for about 40 adult war vic- the young generation at large, considering that tims. Twenty-five prostheses have already over 85% of registered HIV cases in Ingushetia been purchased by the Vladikavkaz work- are people in their reproductive age. shop. In early April it is planned to arrange fitting for the first group of ten Chechen amputees. ICRC Ÿ The joint WHO/UNICEF programme on serv- The ICRC economic security review, conducted ing children mine victims with prosthesis has by the ICRC in January-February 2002 showed been finalized. Sixty Chechen children re- that whilst all IDPs receive food assistance, the ceived prosthesis within the framework of basic food ration (provided by WFP through its this programme. implementing partners DRC, IR and SARC) alone does not provide the necessary nutritional re- Ÿ UNICEF, in partnership with Voice of the quirements per person per day. The compleme n- Mountains, continues to provide mine risk tary food ration (provided by ICRC, IR, SARC education presentations to schoolchildren in and the Migration Service) assists in providing Ingushetia and Chechnya through conduct- these nutritional requirements. ing lessons on the topic, and sponsoring mine risk education theatre performances to

the IDP children. Over the reported period Mine action programme UNICEF also provided crutches and walking The fourth Interagency coordination meeting on sticks to mine victims at the Vladikavkaz prosthetic/orthopaedic and psychological assis- prosthetic workshop, as well as continued to tance to war-wounded persons from Chechnya, maintain the IMSMA (International Manage- organized by WHO took place on 20 Fe bruary, ment System for Mine Action) database. 2002 in Vladikavkaz. The meeting was attended Ÿ ICRC announced that the prosthetic centre by representatives from the Ministry of Labour in Grozny will be re-opened in mid-July. and Social Development of North Ossetia, the Meanwhile, the training of three selected directors of the Vladikavkaz and Grozny pros- prosthetic technicians continues in Sochi in thetic/orthopaedic workshops, representatives of manufacturing and fitting prosthesis, to UNHCR, UNICEF, WHO and Handicap Interna- make them available as soon as the centre tional. starts receiving the patients. The participants reached a principal agreement Ÿ In February, ICRC interviewed 417 people that resources from the amount of about RR 1 (305 children, 90 parents and 22 teachers) million earmarked by the federal Ministry of La- in the IDP camps Alina, Bella, MTF-1 and bour and Social Development for prosthetic as- Bart with the aim to monitor the impact of sistance to the war-wounded from Chechnya its “Child-to-Child” programme on children. could be tapped for covering the cost of prosthe- On the basis of the results of this monitoring ses manufacturing in the Vladikavkaz workshop. ICRC will plan its further work with children living in IDP camps in Ingushetia, accommo-

10 dated in various sanatoria of the North Cau- Ÿ Voice of the Mountains is registering future casus and the south of Russia and also living candidates for the vocational training to be in Chechnya. started for mine/UXO victims in Chechnya at Ÿ ICRC held a seminar in Nalchik in February, the beginning of June. where 12 teachers fro m Chechnya were Ÿ Based on the results of a needs assessment briefed on basic rules of behaviour on the that had revealed a low level of mine aware- basis of the game sheet “Find the Safest ness on the territory of Dagestan, the ICRC Way”. initiated a mine awareness programme in Ÿ In collaboration with the NGO “Save the January 2002 in the Botlikh and Novolak re- Generation”, UNICEF set up two new tents in gions of the republic. Within the framework the IDP camp Bella to be utilized by mine of the programme, presentations are co n- victims on their way to the Vladikavkaz ducted that aim at raising the level of knowl- prosthetic workshop. edge about danger of mines and UXOs. By the end of February 83 presentations had Ÿ The UNICEF partnership with the local NGO been given to about 2 000 children, accord- Vesta for vocational training of mine victims ing to the latest available ICRC update. in Ingushetia will be e xtended until June.

HEALTH AGENCIES IN ACTION

IHI activities in Ingushetia The International Humani- provided to IDPs over 18 years of age. It is tarian Initiative Foundation worth mentioning that the services provided by (IHI) was established in the foundation often include psycho-social coun- 1998, in Poland, for the pro- selling by an IDP support centre, which consid- vision of aid to people in ers the visitors’ problems comprehensively, emergencies, patients, or- including health. The work with this community phans, the disabled and disaster victims. IHI group has demonstrated the need for a salvation employees have been stationed in the North centre, which would respond to any situation Caucasus since February 2000 and are carrying arising among the IDPs and requiring exte rnal out humanitarian activities in Chechnya and In- intervention. It is planed to establish such a ce n- gushetia in conjunction with other NGOs. IHI tre based on the existing Individual Aid Pro- maintains direct coordination with the Ingush gramme. Regional Humanitarian Initiative. The IHI Foundation is preparing to implement a Currently, IHI is implementing the Individual TB control programme in Chechnya. IHI plans to Child Emergency Aid Programme, supported by open a children’s TB hospital at the facilities of the Swiss Government Agency, in Ingushetia the Zvezdotchka (a star) Centre in Grozny. At and Chechnya. The majority of such eme rgency present, the city authorities are restoring the aid cases require health ca re and transportation centre. Medical equipment and supplies from to various cities of Russia for urgent inpatient France and Poland have been already delivered medical services. To date, IHI has sent over 20 and will be used for this purpose, i.e. the daily children with severe diseases to various clinics, operation of the hospital. saving both the children’s health and sometimes their lives. In certain acute cases, help is also

Recent update of activities of some humanitarian organizations in Chechnya On 1 March ICRC mobile teams started opera t- The Polish Humanitarian Organisation (PHO), the ing in the Shali and Argun districts in Chechnya. main UNICEF partner in the water and sanitation sector, continues its programme of purification

11 and distribution of potable water in Grozny, with monitoring the efficiency and quality of water a daily output of 500 m3, which covers the daily distribution in the city and defining the needs of needs of approximately 25 000 people. The wa- the inhabitants. The survey showed that despite ter is delivered by 12 tanker-trucks to 148 bla d- a sufficient water supply (on the average benefi- ders in 142 locations. By mid-March, ciaries collect up to 20 litres at a time) people PHO/UNICEF finished the construction of 22 la- still try to store water to last for a few days, de- trines in 13 hospitals and outpatient clinics in pleting water bladders at distribution points. Po- Grozny. Clean-up activities are conducted in and table water is still being used for household and around city hospitals. Collection of sewage and sanitary purposes, as beneficiaries have no other garbage has been effectively functioning since 1 sources of free water. The survey helped PHO March. identify locations for the additional future insta l- In March PHO continued distribution of jerrycans lation of water bladders, in view of the increasing and water-storage tankers to schools and hospi- population density and the growing water de- tals. PHO also put up around 120 biohazard co n- mand in the co ming hot season. According to tainers (8-10 litres) for the collection of dispos- PHO, a public relations campaign involving local able needles. media could help promote the importance of safe transport, storage and appropriate usage of po- The PHO survey, conducted in 72 locations (with table water. 789 people interviewed) in Grozny, was aimed at

Coordination the WHO coordination meetings. It was Ÿ At coordination meetings held in March both noted that the problem of hospitalisation in Moscow and Nazran, in addition to infor- does exist throughout the republic. Many of mation exchange on routine work and the hospitals are in bad condition and in emerging issues, discussion was still ongoing need of reconstruction. There is not enough to reach an agreement on minimum data set capacity for daytime care to serve both the for a reporting system, as a monitoring tool, local population and IDPs. The Deputy Minis- convenient for the majority of health part- ter recommended, in cases when a patient ners in the field. needs hospitalisation, he/she should be sent to the local polyclinic, which in its turn would Ÿ Several NGOs reported regular and repeat- refer him/her for further hospitalisation. She ing problems with the hospitalisation of IDPs also added that in many cases patients ar- in central hospitals. In many cases, patients riving from Chechnya for medical treatment forwarded to the hospitals or taken by an and requiring referral to other regions do not ambulance are declined services. The same have all the proper documentation. Nor do happens while requesting laboratory services they have, in many cases, the results of the for testing and analyses. This was confirmed needed tests and analyses. by the Deputy Minister of MoH I at one of

NEWS IN BRIEF

Three donor missions visited Chechnya and In- · At the same time the ECHO desk officer gushetia in February: for the Russian Federation also visited · On 5-8 February a delegation of repre- the region. sentatives from the embassies of the The programme of missions included meetings United States, Sweden and SIDA; with representatives of local authorities in · On 19-22 February a delegation of re p- Chechnya and Ingushetia, UN agencies and resentatives from the embassies of De n- NGOs as well as visits to IDP camps, spontane- ous settlements, host families and a UN sup- mark, Finland and Japan.

12 ported TB hospital. Donor representatives noted The taskforce meeting on the rehabilitation of that even though living conditions for IDPs re- the health sector in Chechnya was organized by main difficult, the effective mi plementation of MoH RF in mid-March to identify areas of mutual humanitarian assistance has made them toler- interest to make assistance better addressed to able. those who were most in need.

List of abbreviations: Health Action in the North Caucasus is a APNC: Chechen Association of Psychiatrists and newsletter of the Emergency Preparedness and Narcologists Response programme (EHA) at the World Health ARD: Agency for Rehabilitation and Development Organization Regional Office for Europe. The ASF: Danish Peoples Aid information is compiled by the WHO Humanitarian CPCD: Centre for Peacemaking and Community Assistance Programme in the North Caucasus, the Development Russian Federation. DCA: Dan Church Aid All rights are reserved by the organization. The DDG: Danish De-mining Group document may, however, be freely reviewed DRC: Danish Refugee Council abstracted, reproduced or translated in part or ICRC: International Committee of the Red Cross whole, but not for sale or for use in conjunction IDPs: Internally displaced persons with commercial purposes. This newsletter is not IMC: International Medical Corps an official WHO publication. The views expressed IR: Islamic Relief in it do not necessary represent stated policy of IRC: International Rescue Committee WHO. MoH I: Ministry of Health of Ingushetia MoH RF: Ministry of Health of the Russian Correspondence should be addressed to: Federation Russia Office of the WHO Special Representative MoH Ch: Ministry of Health of Chechnya of the Director General in the Rusian Federation 28, Ostozhenka, MSF-B: Medecins sans Frontieres -Belgium 119034 Moscow MSF-F: Medecins sans Frontieres -France The Rusian Federation MSF-H: Medecins sans Frontieres -Holland Attn: Irina Tarakanova [[email protected]] PHO: Polish Humanitarian Organization Tel.: (+7) 095 787 21 52/12 OCHA: Office for the Coordination of Fax: (+7) 095 787 21 19 Humanitarian Affairs RRC: Russian Red Cross Editors : Jeffrey V. Lazarus [[email protected]], Dr Mark SARC: Saudi Red Crescent Society Tsechkovski [[email protected]] and Irina SES: Sanitary Epidemiological Service Tarakanova [[email protected]] UNICEF: United Nations Children's Fund For more information about WHO emergency UNHCR: United Nations High Commissioner for preparedness and response programmes, please Refugees contact: WFP: World Food Programme WHO: World Health Organization Dr. Jan Theunissen [[email protected]] Zaschita: All-Russian Centre for Disaster Dr. Edouard Kossenko [[email protected]] Medicine "Zaschita" The newsletters of the Emergency Preparedness and Response programme (EHA) can be found at http://www.euro.who.int/emergencies (then click on “emergency preparedness and response programme”. · Health Action in Albania · Health Action in the Federal Republic of Yugoslavavia · Health Action in Kosovo · Health Action in the former Yugoslav Republic of Macedonia · Health Action in the North Caucasus · Health Action in Tajikistan