- in the North Caucasus

NEWSLETTER ON EMERGENCY PREPAREDNESS AND RESPONSE JULY-AUGUST 2003

Mother and Child Health in the Within this framework WHO carried out in 2002 North Caucasus one orientation meeting and in 2003 one planning workshop, one IMCI training course at national level and several training courses for facilitators. Since the beginning of the emergency humani- tarian assistance in the North Caucasus mother The MPS component of MCH programme was and child health was a major component of the realized during the last twelve months through humanitarian response. Maternal and infant the organization of training courses on Neonatal mortality rates are three to four times higher in and Obstetrical Care and breastfeeding. the North Caucasus than average in the Russian All in all, WHO trained over 100 health care Federation. Together with WHO and UNICEF workers from and Ingushetia in MCH many NGOs and local health institutions are im- programmes. plementing Integrated Management of Childhood Illnesses (IMCI), Mother Empowerment (MEP) and Making Pregnancy Safer (MPS) pro- grammes.

IMCI is designed to strengthen and reinforce the capacity of local health structures to deal with the most common conditions causing mortality and morbidity in children less than five years of age. Major life-threatening diseases of childhood are acute respiratory infections (ARI), diarrhoea, measles and malnutrition. The following three components are addressed in the strategy: WHO trainees improving their clinical skills -case management through provision of locally Republican hospital, Nazran adapted guidelines, -introduction of IMCI into the national health policy, WHO agreed with the leading child health spe- cialist from the Ministry of Health of Chechnya -promotion of preventive measures and effective to introduce and implement the IMCI strategy in family and community practices. two pilot regions in Chechnya (Argun and The benefits of exclusive breastfeeding, com- Shali). The agreement envisages assessment of plete immunization and best practices for the child health in these regions, training of primary most common childhood diseases are addressed health care staff in IMCI, coordination and in the MEP at the community level. monitoring of the implementation. The WHO- The MPS initiative emphasises the importance of trained facilitators will conduct their first train- affordable improvements in the health and well- ing on IMCI for primary health care staff in being of pregnant women and their infants. these two pilot regions in mid-September.

1 INGUSHETIA AND CHECHNYA

Demography In August medical specialists from SES completed a WHO-sponsored PC training in Nazran. The acquired knowledge will help SES According to the latest DRC data (31 August) staff to improve disease surveillance and re- the number of IDPs registered in Ingushetia is porting. WHO previously donated computer about 80,000. Of these, about 12,000 IDPs are equipment to several SES in Chechnya and In- registered in five IDP tent camps, about 24,000 gushetia. – in temporary settlements, over 43,000 – in private accommodation. Epidemiology and Immunisation

TB The National Cold Centre in Grozny received 23,800 doses of measles and parotitis vaccines On 1-9 July an expert from the Central TB Re- in August. This allowed health care workers to search Institute (Moscow) conducted a regular resume vaccination activities in the republic. monitoring visit to the Republican TB Dispen- sary, city hospitals, district polyclinics, FAPs and IDP camps in Ingushetia to assess the perform- SES of Chechnya reported completion of the first ance of the TB service and general health care and second stages of the polio vaccination services in the republic. The expert also carried among children under 5 years old, conducted in out a training course for TB and general service June-July 2003. According to SES, Chechnya doctors from Chechnya (23 participants) on TB nearly 180.000 children were vaccinated in two detection and treatment and a refresher training months, representing a coverage rate of 97%. on the same subject for TB doctors from In- According to UNICEF, compliance with the Na- gushetia (18 participants). tional Immunization Calendar in the republic has mainly been pursued at the state health care Communicable disease facilities. surveillance Health Assistance

The measles epidemic situation, witnessed in Ingushetia in April-June has been stabilising In July-August MDM donated to the hospitals in over July-August. In August only 35 new cases Chechnya: have been reported by the Sanitary Epidemiol- 1) petrol generators for the operating ogical Service (SES) of Ingushetia, compared to rooms and intensive care units of eight 284 cases in June. MoH/Ingushetia, in coopera- hospitals in Chechnya (four hospitals in tion with WHO, UNICEF and other health part- Grozny and hospitals in Vedeno, Guder- ners took appropriate measures in response to mes, Shatoi and Znamenskoe); the April-June outbreak of the disease. Mobile 2) Artificial ventilators and anaesthetic ma- teams were sent to all major settlements in In- chines (one hospital in Grozny, hospitals gushetia to carry out measles, and also parotitis in Urus-Martan and Gudermes); and polio vaccinations. UNICEF supported the campaign by procuring disposable syringes for 3) Intravenous infusion equipment (two the vaccination centres in Ingushetia and hospitals in Grozny, hospitals in Urus- Chechnya and provided Vitamin A for 10,000 Martan, Gudermes, Kurchaloj, Argun and children, following the request of MoH/I. Nozhai-Yurt). MDM also set up in these hospitals medical li- braries and donated surgical books.

2 Mental health and psychosocial The MoH, Chechnya discussed with WHO as pos- rehabilitation sible solution the creation of psychotherapy de- partments in all functioning state policlinics. Children’ festival

The annual Children's Festival, organized and Therefore, polyclinics in Grozny may be selected supported by WHO, took place in Nazran, In- for participation in such a pilot project. Avail- gushetia on 24 July. Children from psychosocial ability and accessibility of such services in poly- rehabilitation centres, run by local and interna- clinics, bearing the main workload of patients tional NGOs as ARD, Care, CPCD, Druzhba, IRC and outpatient care services, will allow people and Save the Generation participated in the not willing to apply for assistance to a psycho- performance, staged at the central Palace of neurological dispensary to receive initial profes- Culture in Nazran. Young participants from the sional assistance in these polyclinics. six centres showed their talents and skills to the People applying for health assistance for a so- auditorium of some 250 Chechen and Ingush matic disease may suffer additionally from psy- children. chosomatic disorders, which then can be treated by the in house specialists. It is believed that such approach may become functional and effi- One of the main objectives of the festival was to cient in setting up a model of full and complex address children with important health issues. professional assistance where health and psy- Awareness messages on the necessity of keep- chosocial components will be integrated. ing up with basic elements of safe and essential hygiene habits were therefore incorporated in To support the MoH in Chechnya WHO will or- the three-hour festivity. ganize training courses on counselling tech- niques and improvement of diagnosis and treatment of early posttraumatic stress disorders for primary health care doctors from policlinics in Grozny.

HIV/AIDS

Within the framework of the WHO HIV pro- gramme sponsored by the Government of Nor- way, in July a training course addressed 43 doctors and nurses from antenatal departments Children performing at the Summer Festival 2003 of hospitals in Ingushetia and Chechnya. Two in Nazran experts from the Federal AIDS Centre in Moscow discussed prevention of mother-to-child trans- mission of HIV. Lectures were given on epide- Psychosocial rehabilitation in Chechnya miology, clinical management, diagnosis and prevention of HIV infection. Handouts on clinical The Ministry of Health of Chechnya expressed management and treatment of HIV infection during a recent meeting its special interest in were distributed to all participants. introducing improved psychotherapy services in the Republic, since currently adequate psycho- logical and psychiatric assistance does not exist. In August/ September the Head of the Anti-AIDS The MoH mentioned lack of professionals, lack of Centre in Nazran participated in a WHO- relevant trainings to upgrade skills and the geo- sponsored training on "Polymerase chain reac- graphical remoteness as some reasons for the tion (PCR) diagnostic of infectious diseases". The inadequate service. course was conducted at the Central Research Institute of Epidemiology of the MoH RF in Mos-

3 cow. The Ingush specialist was provided with individual support was provided to 63 benefici- theoretical and practical knowledge on the appli- aries. HI also continued to support Rehabilita- cation of polymerase chain reaction method, tion and Trauma departments of hospitals in very much needed for the work with the previ- Chechnya - equipment was donated to the Ar- ously donated laboratory equipment. Specifi- gun Hospital and rehabilitation centre, Republi- cally, the training addressed such issues as: can Veteran hospital and medical college in work with clinical materials, electrophoresis, and Grozny and to the NGO “Save the Generation”. the use of PCR diagnostic for HIV, hepatitis, tu- Besides that, in August HI conducted in Nalchik berculosis and Cytomegalovirus. (in collaboration with MDM) a training workshop “Psychological support of people with war injury Water and sanitation and disability”. Thirty participants, among them ARD psychologists, social service- and NGO- In mid August regular access to drinking water workers attended the workshop. Additionally in was established in the village of Voznesenskaya Chechnya, HI continued its distribution of post- in Chechnya. The project was implemented with ers, aiming to promote social inclusion of dis- financial and technical support of the ICRC in abled people. agreement with the local administration and the water board of the republic. 3,200 m of pipeline were extended from an existing water pipeline to ICRC distributed 122 pairs of crutches to benefi- satisfy the needs of about 8000 IDPs and local ciaries through its supported hospitals in July- residents, living in Voznesenskaya. The network August. runs through the main streets of the village, with 10 public fountains along the pipeline. The first meeting of the Mine Survivors Club, Also in August the water supplier Grozvodocanal organized by ICRC, was held in Gudermes on 29 received from ICRC a water crane. July. The meeting was attended by mine and UXO survivors, their relatives and representa- tives of the Chechen Association of Invalids, who UNICEF continuously contributes to the im- pointed out the major constraints faced by mine provement of personal and environmental hy- accident survivors: inability to get immediate giene practices in Chechnya, supporting state skilled medical assistance and lack of psycho- and NGO-run health facilities. In July-August logical rehabilitation and social care. hygienic, anti-parasite and disinfectant products have been distributed to medical institutions in Ingushetia and Chechnya, including the Grozny Disinfectant Station, Gudermes city hospital, Other News Nadterechny and Itum-Kale district hospitals,

SES of Nadterechny, Naursky and Shelkovsky On 4-7 July ICRC carried out in Nalchik a round districts, to Caritas-run kindergartens in Chech- table discussion. Ten Chechen representatives, nya and Ingushetia, to the Ministry of Emer- including the Minister of Health, his deputy and gency and to IDP tent camps and temporary representatives of medical institutions from Shali settlements in Ingushetia. Chloramide powder and Urus-Martan participated in the meeting to and soap were also distributed to IRC and ICRC, discuss primary health care policy in the Russian the Chechen Rehabilitation Centre in Argun and Federation and Chechnya. the Malgobek district hospital in Ingushetia.

On 17 July, WHO, in a joint mission with ECHO, Assistance to the disabled OCHA, UNICEF and UNSECOORD visited selected health facilities in Grozny. Among the locations Handicap International (HI) supports people with visited were the Republican paediatric clinical disabilities in Ingushetia and Chechnya through hospital; Republican orthopaedic centre; Inter- provision of wheelchairs, walking frames, national Humanitarian Initiative (IHI) office; crutches and hygienic kits. In July-August, this MDM health post; city hospital N4; paediatric

4 polyclinic N 4. (A detailed mission report from “Water and Sanitation in Emergencies”, the health facilities is available in the WHO field “Mental Health Services in Disaster/Manual for office in Nazran). Humanitarian worker”, “Mental Health Services in Disaster/Instructors WHO supported the newly established Health Guide”, Information Statistical Centre, Ingushetia with “Public Health and Chemical Incidents” and professional printer for production of health “Natural Disasters”. promotion material. A few more copies are available at the WHO of- fice, Moscow. WHO translated the following books into Russian and distributed them to all regional Ministries of Health and institutes dealing with emergencies:

List of abbreviations: Health Action in the North Caucasus is a news- APNC: Chechen Association of Psychiatrists and letter on the Disaster Preparedness and Response Narcologists programme (DPR) of the World Health Organiza- ARD: Agency for Rehabilitation and Development tion Regional Office for Europe. The information is ASF: Danish Peoples Aid compiled by the WHO Humanitarian Assistance CPCD: Center for Peacemaking and Community Programme in the North Caucasus, the Russian Development Federation. DCA: Dan Church Aid DDG: Danish De-mining Group All rights are reserved by the organization. The DRC: Danish Refugee Council document may, however, be freely reviewed ab- EMERCOM: the RF civil defence and disaster stracted, reproduced or translated in part or whole, ministry but not for sale or for use in conjunction with com- EPI: Expanded Programme on Immunization mercial purposes. This newsletter is not an official FAP: Feldsher/obstetric post WHO publication. The views expressed in it do not GP: General practitioner necessary represent the stated policy of WHO. HI: Hndicap International Correspondence should be addressed to: ICRC: International Committee of the Red Cross Office of the WHO Special Representative IFRC: International Federation of the Red Cross of the Director General in the Russian Federation IDPs: Internally displaced persons 28, Ostozhenka, IMC: International Medical Corps 119034 Moscow IMSMA: International Management System for The Russian Federation Mine Action Attn: Irina Tarakanova [[email protected]] IR: Islamic Relief Tel.: (+7) 095 787 21 52/12 IRC: International Rescue Committee Fax: (+7) 095 787 21 19 LSG: Let’s Save the Generation MDM: Médecins du Monde Editors: Dr Corinna Reinicke MoH I: Ministry of Health of Republic of Ingushetia [[email protected]], Irina Tarakanova MoH RF: Ministry of Health of the Russian Fed- [[email protected]] eration For more information about WHO Disaster Prepar- MoH Ch: Ministry of Health of Chechnya edness and Response programmes, please con- MSF-B: Médecins sans Frontières-Belgium tact: MSF-F: Médecins sans Frontières-France Dr Jan Theunissen [[email protected]] MSF-H: Médecins sans Frontières-Holland PHO: Polish Humanitarian Organization OCHA: United Nations Office for the Coordination The "Health Action in the North Caucasus" news- of Humanitarian Affairs letter of the Disaster Preparedness and Response RRC: Russian Red Cross programme (DPR) can be found at SARC: Saudi Red Crescent Society http://www.euro.who.int/emergencies. SES: Sanitary Epidemiological Surveillance SHA: Swiss Humanitarian Aid TAC: Temporary accommodation centre UNICEF: United Nations Children's Fund UNHCR: United Nations High Commissioner for Refugees UXO: Unexploded ordnance VOM: Voice of the Mountains WFP: World Food Programme WHO: World Health Organization Zaschita: All-Russian Centre for Disaster Medi- cine "Zaschita" 5 6 7