Health Action

- in the North Caucasus

NEWSLETTER ON EMERGENCY PREPAREDNESS AND RE SPONSE, DECEMBER 2001

The latest on TB in Chechnya and Ingushetia Like many other health institutions in Chechnya, the republican tuberculosis (TB) service is ex- periencing serious hardships. Despite consider- able damage to TB facilities during the latest conflict, efforts are made to even partially meet the needs of the remaining population of the republic. According to information provided by Dr A. Makhmoudov, the chief TB physician of the re- public, during the UN mission to Grozny on 21 November 2001, the TB infrastructure is totally ruined. Out of 900 TB beds in former time only The republican TB dispensary in Grozny. 165 are available, in the Shali, Gudermes and Nadterechny districts. The situation is even worse with regard to medical staff. There remain only 19 TB doctors compared to 119 prior to conflict. Of them, only nine doctors have the proper qualifications and experience. Others are former GPs and have no appropriate training. X- ray and laboratory diagnostics is unreliable due to their scarcity and equipment. The republican TB dispensary in Grozny, where a concentration of population remains high, needs major reco n- struction as only three rooms can actually be used for outpatient consultation. No gas, elec- tricity or adequate heating are available. TB The TB infrastructure in Chechnya is completely drugs reportedly regularly sent by the Russain destroyed. Federation Ministry of Health are always in short population among whom 206 BK+ cases were supply. revealed. Nonetheless, even under these strained condi- Immunodiagnostics among children is poor, also tions the TB service continues to function. Al- due to the short supply of tuberculin. This was though no communication is available between only well organized in the Nadterechny district of districts in Chechnya, reports delivered by hand Chechnya, with 14 209 children diagnosed. by the republican TB dispensary collated the in- formation as follows: Bacillus of Calmette and Guerin (BCG) was given primarily to newborns; however, quite a sub- For the first nine months of the year 2001 42 stantial number of them remained non- 855 persons (an estimated 5% of the total immunised. population) were screened by fluorography (small format x-ray) for TB. 3 108 sputum For nine months of 2001, 704 cases of “active” smear analysis were also made during this pe- TB were registered in Chechnya, out of which riod and 324 BK positive cases were detected. 656 persons with pulmonary TB were newly de- The majority of patients (2 784) were from rural tected. 278 of them (42%) had advanced de-

1 structive stages of the disease. In Grozny, there a replenishment of reagents and other expend- were 105 newly detected TB cases with 82 per- ables. sons having experienced a decay of the lungs The TB service is presently staffed with 42 doc- (i.e. 78%). This might have contributed to the tors, although according to normative require- high mortality from tuberculosis, totalling in ab- ments there should be 68. solute figures 101 persons in Chechnya, seven of them in Grozny. TB raining courses In November WHO held in Nazran two training Ingushetia: Opening of the new department courses within the framework of the joint WHO/ in the Nazran TB hospital MoH I/MOH RF project on TB control and pre- On 14 December 2001, the inauguration of the vention in Ingushetia. The first course, attended TB control project took place in Nazran in co n- by 23 Ingush doctors on 12-16 November, was junction with the official opening of the addi- devoted to “Management of TB control pro- tional TB department (for 50 beds) set up by gramme at district level”. The participants were WHO/UNHCR in the TB hospital “Krepost”. presented with the WHO strategy of TB control Prior to that, the TB service in Ingushetia was presented by WHO and the Central TB Research represented by: Institute in Moscow (CTRI) faculties in five WHO training modules. · The Republican TB hospital (dispensary) in The second course, held on 19-23 November, “Krepost”, Nazran district, with 190 beds; covered the subject of “Laboratory diagnostics of · An out-patient clinic for 120 consultations TB”. The course was attended by 18 doctors and per day, the clinical bacteriological labora- laboratory assistants. Appraisals carried out at tory and an X-ray cabinet; the end of each course showed that the partici- · The Malgobecksky TB dispensary for 60 co n- pants gained deep practical knowledge of the sultations per day; material. Upon completion of the course they were subsequently awarded certificates. The · TheSunzhensky TB dispensary for 60 consul- other three training courses: “Case detection”, a tations per day. training course for nurses and feldshers and a The bacteriological laboratory of the republican training course for general practitioners, TB doc- TB dispensary is now well-equipped, thanks to tors and epidemiologists will take place in early humanitarian aid; however, it periodically needs 2002.

The health and nutritional status of young children and their mothers in Ingushetia · to carry out an analysis of the health and In July-August 2001, UNICEF, in collaboration nutritional status of the population; with the National Research Institute for Food and Nutrition in Rome, conducted a survey to · to compare nutrition and health indicators of investigate the health and nutritional status of resident and IDPs; children under five and their mothers in In- · to measure indicators of micronutrient defi- gushetia. Below, the survey results are sum- ciencies of public health relevance; marised. · to evaluate feeding patterns of infants and young children; and The general objective of the survey was to · to identify criteria for screening vulnerable evaluate the nutritional status of children under groups and vulnerable individuals. five and their mothers among residents and A two-stage cluster sampling procedure was ap- IDPs and to evaluate immunization coverage in plied to select a representative sample of children. The specific objectives were: households in two strata (residents and IDPs).

2 The survey was carried out on 1 417 households clusively breastfed. Exclusive breastfeeding and included 1 052 children under 5 (6-59 dropped to 6% at the age of six months. In months), 1 389 children under 2 (0-24 months) IDPs exclusive breastfeeding was more and 1 464 women of reproductive age (15-45 common (14% at four months of age and years). The survey involved the administration 9% at six months of age) than in residents of a questionnaire, the implementation of physi- (8% at four months of age and 5% at six cal measurements in children under five (weight months of age). The administration of other and height, or length) and their mothers liquids in addition to breast milk increased (weight, height) and biochemical assessment of up to the age of four months, when 50% of micronutrient status (serum haemoglobin in the resident children and 60% of the IDPs women and children, serum retinol in children). children were fed in this way. After the age The survey showed that: of four months, predominant breastfeeding dropped progressively in both strata reach- · low body mass index (BMI) (<18.5 kg/m2) ing the prevalence of 35% in residents and was observed only in about 2% of the moth- 47% in IDPs at the age of six months; ers, while more than one-third of the women aged 25 and above were overweight or · one-fifth of the children were using infant obese (42%). Higher degrees of obesity formula, usually as a substitute for breast were uncommon (12% with BMI 30.1-40 milk, with significant differences between kg/m2 and 0.5% with BMI>40 kg/m2); residents (30%) and IDPs (25%). Cow's milk was used as an alternative to breast milk for · anaemia was present in more than half the infants under six months in 32% of the mothers, with a higher prevalence in IDPs cases among residents and in 15% among (54%) than in residents (51%). Severe IDPs. Cow's milk became a major food item forms of anaemia were uncommon, with a after the age of six months; however, even higher prevalence in residents (1.4%) than in the second year of age, 20% of the chil- in IDPs (0.2%); dren were not consuming it. Fermented milk · low height-for-age was observed in 9% of was not used in the first six months of life the entire sample of children (6-59 months), and was therefore not used as a breast milk with a higher proportion in IDPs (14%) than substitute; in residents (8%); · the early introduction of liquids other than · the overall prevalence of low weight-for- breast milk was a very popular habit in In- height was 6%, and no difference was de- gushetia, both with residents and IDPs. Wa- tected between the two strata nor between ter was introduced as early as from the first gender; week of life and by the age of three months · anaemia was observed in 34% of the chil- almost all the children were given water. It dren (6-59 months) without differences be- is important to note that infants were often tween population strata. Severe cases were given black tea. Fruit juices were popular as detected in less than 1% of the population; well, and they were introduced at around 1-2 months of age, especially in resident · poor night vision in children was reported by children; 3% of the mothers, with a higher prevalence in residents (4%) than in IDPs (1%). How- · solid or semi-solid complementary foods ever, low values of serum retinol were very were given to the children since the second uncommon, with a prevalence lower than month of life. Biscuits and fruit were intro- 1% and without differences between popula- duced first. Vegetables were started earlier tion strata; in residents than in IDPs. Bread, pasta and rice were introduced in the second semester · the vast majority of children under 2 years of life. Protein rich foods were introduced of age were being breastfed, at least par- earlier in residents than in IDPs. Meat was tially (86%), with no significant differences consumed by 20% of resident children in the between residents and IDPs. Nine per cent first semester of life and introduced after the of the children under four months were ex- age of six months in IDPs. Fish was intro-

3 duced at five months in residents and in the breastfeeding, exclusive breastfeeding up to second semester in IDPs. Cheese consump- six months and continued breastfeeding af- tion was common in residents in the first ter six months. The early introduction of liq- semester of life, while IDPs reported co n- uids should be strongly discouraged; sumption only in older infants. Eggs were · complementary feeding guidelines should be the only protein rich food introduced before developed and promoted through the health the age of six months in both group; staff, particularly regarding the introduction · bread was the staple food in both residents of meat, dairy products, fruit and vegetables and IDPs even if the general diet was signifi- from about six months; cantly different in the two groups. IDPs had · dietary guidelines for adults should be pro- a carbohydrate rich diet with almost daily moted, aimed at the control of body weight consumption of bread and pasta. The co n- and the promotion of fruit and vegetable sumption of protein rich foods such as meat consumption; or milk was significantly greater in residents · the establishment of a nutritional surveil- than in IDPs. Pulses were more frequent in lance system by using local resources should IDPs. Vegetables and fruit were consumed be carried out. The data collected are to be more frequently in residents than in IDPs. used to develop adequate and effective nu- On the whole, the survey indicated solid pro- trition policies; gress towards the achievement of the year 2000 · public health measures should be taken to goals of the World Summit for Children as far as ensure maintenance and surveillance of the the prevalence of stunting and the immunisation immunisation programme; coverage are concerned. There is, however, a widespread although not severe micronutrient · as an intervention that is part of an overall problem, which can be dealt with by dietary integrated strategy for preventing and co n- modifications and improvements. trolling iron deficiency anaemia, the use of fortified foods (in particular, fortified wheat Outstanding objectives for the future in the co n- flour in the country where bread and pasta text of this survey may be outlined as follows: are staple foods) can be promoted. · breastfeeding promotion should be carried out in order to achieve timely initiation of

INGUSHETIA AND THE NEIGHBOURING REPUBLICS

Mental health did not participate in the mentioned WHO course The regular monthly meeting on psycho-social also recommended a set of specialized literature. coordination took place on 29 November at the Both chief doctors of the psychiatric hospitals WHO office in Nazran. Seventeen participants briefed the meeting on the current situation and from 12 different organizations working in me n- the number of patients they were treating. De- tal rehabilitation took part in the meeting. Spe- spite the fact that minor repairs were already cial guests were the chief doctors of the Che- made, the main parts of the hospitals are still chen psychiatric hospitals of Darbankhi and seriously damaged. WHO informed about the Samashki. WHO briefed about its activities dur- coordination efforts and the results of negotia- ing the last month and distributed specialized tions with UNHCR, ICRC and UNICEF to contrib- literature for upgrading the knowledge of psy- ute to the reconstruction, winterisation and im- chologists and counsellors working in psycho- provement of general hygiene in these two hos- social rehabilitation centres in Ingushetia and pitals. Chechnya, which was called for as fo llow-up of In December, WHO covered the travel expenses the latest WHO training course. The NGOs who for a psychiatrist from Chechnya for training at the Moscow Institute for Psychiatry and deliv-

4 ered soft toys and drawing material to the chil- develo pmental anomalies, infectious diseases dren psycho-social rehabilitation centre in Aki- (measles, viral hepatitus, rubella) and pre g- Yurt, Malgobek district, Ingushetia. nancy disorders. The high incidence of diseases CARE International, together with the trainees is due to the environmental factors to which the from ARD, conducted the fourth module of psy- Chechen population is exposed: overcrowding, chosocial rehabilitation for 38 teachers from inadequate quantities and qualities of water, Chechnya and Ingushetia from 30 November-2 poor sanitation, inadequate shelter and an n-i December. The other seminar for 32 teachers adequate food supply (UNICEF). from Chechnya and Ingushetia was conducted together with CARE and the local Institute of Health assistance Teachers’ Skill Improvement on 1-3 December. In November 2001, the International Committee The last module for the teachers organized by of the Red Cross distributed a shipment of medi- CARE together with CPCD trainees, is scheduled cal items designed for surgical and orthopaedical on 7-9December (UNICEF). wards to the Ingush Republican hospital in Naz- ran. A similar distribution was arranged in ten Medicine for health hospitals in Chechnya. In Nazran, on 26-30 November, IMC conducted a training course for medical personnel from MoH I and IMS staff. The main topic of the train- ing course was management of acute respiratory tract infections (ARTI). The course was attended by 53 health care professionals. MSF-Switzerland completed the distribution of hygienic kits to 4 000 IDPs living in collective centres in Khasavjurt (Dagestan).

EPI Rational drug use in primary health care was the Results on monitoring of distribution of vaccina- theme of two recent training courses in Nazran. tion cards provided by UNICEF to medical insti- Following an analytical investigation on the de- tutions of Ingushetia demonstrate that registra- termination of vital problems in the health status tion system is being gradually introduced. Cards of the IDP population, self-medication habits and are issued when mothers seek help at hospitals drug treatment, which helped identify the main or during the outreach vaccination. tasks for targeted education of health care workers and IDP patients, the special Project on Pharmaceuticals in NIS Health technologies, Water and sanitation Pharmaceuticals and Quality/WHO Regional Of- Training course on general hygiene in IDP camps fice for Europe in collaboration with EHA/NC On 3-4 December, a training course on general programme conducted two training courses on hygiene in IDP camps to reduce outbreaks of “Rational drug use in primary health care” for communicable diseases was conducted by WHO health care workers from Ingushetia and Chech- in Nazran for selected representatives of the IDP nya on 10–12 and 13–15 December 2001, in community from Ingushetia and Chechnya. The Nazran. course covered the following topics:

· protection and control of drinking wate r Health status quality;

The chief paediatrician of Ingushetia reports an · adequate sanitation; increase in child mortality. The reasons respon- · rodent control; sible for such increases are: war traumatism, respiratory track infections (RTI), malnutrition, · garbage removal;

5 · food safety and adequate nutrition. Russian Theatre in Vladikavkaz. Six more per- The participants were presented with the Hu- formances were developed by the Russian Thea- manitarian Charter and minimum standards in tre to provide psychosocial relief to the children. disaster response, and received advice and in- It is expected that the Theatre Company will formation on things they can change or monitor provide additional performances for children themselves to minimize the risk of infectious during the holiday season. diseases outbreaks in a crowded environment. 15 mine victims receive new prostheses each The participants recommended the continuation month through the Vladikavkaz Prosthetic Cen- of such courses with the involvement of a wider tre. The psychosocial counsellor working at the audience in order to more actively raise public centre continues to provide relief to the children awareness on hygienic issues. and helps them to cope with their disability. The Vladikavkaz Rehabilitation Centre provides physical therapy to mine victims on a weekly Mine awareness basis. VoM transports approximately ten mine UNICEF developed and implemented, together victims per week from the IDP camps ni In- with the NGO community and ICRC, a survey to gushetia to the Rehabilitation Centre. gauge the scope and depth of mine awareness knowledge and information among IDPs residing As a part of the Vocational Training programme, in tent camps, spontaneous settlements and four-hour classes in English and computers are with host families in Ingushetia. The survey was given to the IDP children on a daily basis (UNI- a follow-up of previous efforts undertaken by the CEF). Voice of the Mountains (VoM) in June 2000 and DDG/DCA mine awareness (MA) instructors co n- UNHCR in March 2001. Over 800 men, women tinued performing MA sessions for IDPs living and children were interviewed by the UNI- with host families in Ingushetia in November. CEF/NGO survey team during 5-14 November. The instructors worked in the Malgobekskiy dis- Among other questions, the respondents were trict and covered 532 persons within two weeks. asked whether they knew people injured by 21 053 IDPs from Chechnya, living with host mines and bombs and whether they had been families, received MA information. fitted by prostheses as well as questions on who On 16 November, DDG/DCA MA instructors com- provided them with mine awareness information menced MA sessions for IDPs: first-formers and over the past year and when, and whether they newcomers attending public schools in In- had passed on this information to others in their gushetia. The team worked in schools in the family and community. The survey also included Malgobekskiy district. They gave MA information questions on knowledge about mines and unex- to 1 069 children two weeks. ploded ordinance (UNICEF). One MA instructor worked at DDG/DCA informa- On 12-14 November, WHO held a tra ining tion centres and gave MA information to 236 course on “manufacturing techniques in different IDPs who have recently moved to Ingushetia types of prosthesis” at the WHO/UNICEF sup- from Chechnya. ported prosthetic workshop in Vladikavkaz, The total number of people who received MA North Ossetia, for 14 participants. Prosthetic information from DDG/DCA instructors in No- technicians and doctors from pros- vember is 1 837 (DRC/ASF). thetic/orthopaedic workshops and centres in Piatigorsk, Stavropol, Nalchik and Vladikavkaz attended the course. World AIDS Day WHO is financing the purchasing, assembling On 1 December the Ministry of Health of North and adjustment of 36 prosthesis for amputees Ossetia and Swiss Disaster Relief, the imple- from Chechnya. menting partner of UNHCR, helped organize Approximately 400 IDP children living in the pri- "World AIDS Day" in Vladikavkaz. vate sector in Ingushetia were taken by Save Approximately 400 school children and teachers the Generation to see the newly developed from the schools of North Ossetia were invited to drama on mine awareness, performed by the

6 Appeal for the North Caucasus in Moscow on 27 November 2001. The launch of the appeal was part of a global launch by the UN Secretary- General in New York calling on the international community to provide contributions to sustain the lives of 33 million people affected by eight- een crises in countries around the world (OCHA). From 27-29 November, in Nazran, the Norwe- gian Refugee Council (NRC) in collaboration with the Caucasian Refugee Council (CRC), Mercy Corps, the Office for the Coordination of Hu- manitarian Affairs (OCHA), and the UN High Commissioner for Refugees (UNHCR) conducted a Sphere Project workshop on disaster response. The workshop was oriented for UN and NGO Swiss Disaster Relief held a republic-wide contest for staff managing the emergency and disaster re- school children to draw a picture on the topic ”Dan- sponse programme. The participants obtained a gers of AIDS”, with prizes going to the best. working knowledge of the Sphere Project and attend. Swiss Disaster Relief held a republic- explored the practical application in their pro- wide contest for school children to draw a pic- gramme of the minimum standards in core areas ture on the topic ”Dangers of AIDS”. The win- of humanitarian assistance such as water supply ners of the contest received a certificate and a and sanitation, nutrition, food aid, shelter and gift from Swiss Disaster Relief and their draw- site planning, and health services (OCHA). ings were used for preparation of an anti-AIDS poster. The meeting was addressed by the De p- Upcoming events uty Minister of Health of North Ossetia. The On 18-21 December 2001, in Moscow, WHO in WHO representative at the meeting briefed the collaboration with the All-Russian Centre for Dis- audience on the global activities devoted to the aster Medicine Zaschita is organizing a workshop World AIDS Day, on the news in AIDS drug re- for national focal points in the Ministry of Health search and on what world leaders and organiza- of NIS countries on disaster management and tions could do in order to achieve a significant eme rgency preparedness and response in the price reduction of anti-AIDS drugs to make them affordable, also to the non-wealthy patients. health sector. North-Ossetian children showed a specially pre- WHO will hold a one-week training course on pared cultural programme against AIDS. psychological therapy methods for children and adult invalids for 25 participants (medical staff and psychologists) from Ingushetia and Chech- News in brief nya on 28 Jan-2 Feb 2002, in Nazran. The United Nations in the Russian Federation presented its 2002 Consolidated Inter-Agency

CHECHNYA

Mental health “Bella” and “Satsita” (partially) and is targeted In November 2001, DRC/ASF continued imple- at IDPs from 6 to 25 yeas of age. mentation of the psychosocial rehabilitation pro- The components of the programme include: gramme in Ingushetia. The programme is car- · Training: The first training programme on ried out in the following IDP camps: “Alina”, practical psychology and psychotherapy of traumatic stress was held in December

7 2000. Twenty-one participants with a mostly hospital, which it plans to rehabilitate in the teaching or medical background were near future. trained. Seven trainees were later employed as field staff; EPI · Therapy groups: A course on group psycho- UNICEF delivered 200 000 vaccination cards to therapy comprises 14 daily sessions for up Chechnya to cover the entire population of chil- to 16 children in each group. Differentiated dren in the republic. The cards were handed pre-group and post-group assessments of over to the chief epidemiologist of the Chechen the psychological state are conducted with Republic who, together with the staff of the Re- each beneficiary. Every participant has at publican Cold Centre, will be involved in the dis- least one counselling session with the psy- tribution process (UNICEF). chologist, whom based on the assessment results, takes a decision on the relevance of Despite the UNICEF efforts in timely and prompt further individual counselling. The group ac- provision of TB syringes and the availability of tivities started on 1 April 2001. The number other materials, paediatricians in Chechnya of groups is 33 (as of 26 November); the faced difficulties in conducting revaccination in number of beneficiaries over the period was the republic due to a lack of tuberculin for Mantu 641; testing. As reported by the chief sanitary doctor, the absence of some vaccines not included into · Individual therapy (Total number of clients – the Russian vaccination calendar causes death 208); and accidents among children (UNICEF). · Open groups and speciale;

· On 16 November 2001, a training pro- Water & Sanitation gramme on tolerance and conflict prevention for 75 adolescents (aged 13 to 25) was UNICEF continues through the Polish Humanita r- launched. The objective of the programme is ian Organization (PHO) to distribute clean pota- to prepare a team of young trainers desig n- ble water to the population of Grozny in health ing and conducting training programmes on centres, schools and other general distribution the same topics for children and teenagers points. Water produced in four purification units in the project area and other regio ns. is being trucked to 85 water bladders for further distribution. To ensure appropriate household · Rehabilitation programme for the DRC field water storage, UNICEF has delivered to PHO a staff. second load of nine thousand 10L jerrycans for subsequent distribution in Grozny. Health assistance UNHCR has provided PHO with water trucks and In November 2001, medical distributions of the water bladders. ICRC has supplemented the International Committee of the Red Cross cov- programme by providing pumps, storage tank- ered surgical and orthopaedic wards of ten hos- ers, and hoses. pitals in Chechnya (in Grozny, Argun, Gudermes, In November, UNICEF and PHO signed an Shali, Kurchaloy, Urus-Martan, Achkhoy-Martan agreement which stipulates the setting up of a and Khassavyurt). garbage and sewage collection system for UNICEF delivered, through MSF-F, the women- Grozny, targeting health centres, and focusing and-children-health related drugs to maternity on the special treatment of medical wastes. hospitals in Shatoy, Chiry-Yurt, Starie Atagi, UNICEF continued to make inputs in reducing Sernovodsk and Grozny. public health hazard by the distribution of hy- After completion of the rehabilitation and provi- giene and disinfectant materials to NGOs and sion of equipment to the maternity and infec- governmental partners both in Ingushetia and tious departments of Hospital no. 2 in Guder- Chechnya. Three metric tonnes of chloramine mes, MSF-Switzerland has now completed an were promptly delivered on request of the Che- assessment of the surgical department of this chen Sanitary Epidemiological Service (SES) due

8 to a reported increase in the incidence of hepati- sary teaching materials for their future work tis (UNICEF). (DRC/ASF). To sustain its mine action campaign, UNICEF Mine a wareness provided its partner, the Chechen NGO Minga, with 50 walking sticks, 50 wooden crutches and Chechen Teachers Course: 30 teachers from the 100 Canadian crutches. UNHCR provided 16 sets Groznenskiy district of Chechnya attended a of bed linens, mattresses and blankets for Minga DG/DCA teachers course during the month. The and Let’s Save the Generation received 30 sets teachers obtained all knowledge necessary for of bed linens, blankets and mattresses for distri- performing mine awareness activities at their bution to mine victims from extremely vulner- schools. In addition, they received all the neces- able families in Chechnya (UNICEF).

HEALTH AGENCIES IN ACTION

MSF-France activities in the North Caucasus Background nities in Sleptsovskaya and Nazran with antibio t- ics and other necessary me dical items. At the MSF-F started its activities in the Northern Cau- casus in 1992 (when the conflict in the Prig- same time MSF F started winterisation of ten orodny district of North Ossetia erupted) with spontaneous settlements in Ingushetia and the the provision of assistance to IDPs from North distribution of blankets, bed sheets and mat- Ossetia in Ingushetia. When hostilities started in tresses for some groups of IDPs in Ingushetia Chechnya in 1994, MSF-F offered humanitarian and in Chechnya. assistance to Chechnya by supporting a number In January 2001, when an MSF-H colleague was of medical facilities, particularly in the Shatoy kidnapped in Chechnya, MSF-F suspended all region. However, after the kidnapping of a vol- programmes in Chechnya and Ingushetia. unteer in Ingushetia in July 1997, MSF-F In March 2001, activities were resumed in In- stopped its activities in the North Caucasus. gushetia. From March to June, MSF-F ran a At the beginning of the second conflict in Chech- medical and logistics project. The logistics co m- nya, in October 1999, MSF-F assisted Chechen ponent comprised the construction of 14 rooms refugees in Pankijski valley in Georgia with me n- for the most needy IDPs in the spontaneous set- tal health support to children. Together with tlement in Plievo. In May, an assessment was ICRC, a referral mechanism was devised to en- made in the 20 in most need of humanitarian sure better access for IDP patients to a local assistance spontaneous settlements in In- public health structure. In June 2001, a similar gushetia and a new logistics project was elabo- mechanism was launched in Nazran, Ingushetia . rated. In August 2000, after an assessment of several In July 2001 activities were extended in both medical structures in Chechnya MSF-F renewed fields, medical and logistic, and activities in its programme there. Within the framework of Chechnya were resumed. this programme, drug donations were provided to the Central Maternity of Grozny, hospitals in Current activities Shatoy and Sernovodsk, medical dispensaries in Sharoy and Itum Kale and the two medical posts INGUSHETIA in IDP camps in Se rnovodsk. Medical Programme: In November 2000, MSF-F opened two antenatal At present, MSF-F is running three antenatal and gynaecological clinics: in Logowaz, a spon- and gynaecological clinics: mobile clinic for 350 taneous settlement in Na zran, and in the IDP consulta tions per month in the Nazran district camp Bart, in Karabulak. It also supplied mate r- (Logowaz, Surhahee, Ali Yurt and Plievo), a

9 medical post for 450 consultations/month in the The Sanitation component of the programme IDP camp Bart, and another clinic for 450 co n- provides for the construction of additional show- sultations/month in MRO, a spontaneous settle- ers and latrines, improvement of waste water ment in Sleptsovksaya. Each clinic is staffed by disposal and increasing the capacity of the water a gynaecologist-obstetrician and a nurse. Pa- distribution system in the spontaneous settle- tients are provided with an examination, consul- ments where MSF F carries out construction and tations/advice and treatment recomme ndations repair works. and are given contraceptives upon request. Pa- The distribution component of the programme tients in need of psychological support are iden- provided for the distribution of hygienic and con- tified and re ferred to the MSF-F psychologist. tainer (bucket, basin, jerrycan) kits for 16 000 Once a week, a medical team visits maternities IDPs in summer and bedding kits for 5 000 IDPs in Nazran and Sleptsovksaya to follow up its pa- in winter this year. tients. Obstetric departments of Nazran and

Sleptsovskaya maternitities are supplied with drugs, dressings and other medical material on a CHECHNYA weekly basis. Medical Programme: An MSF-F psychologist provides psycho-social At present MSF-F provides monthly support to rehabilitation to pregnant IDP women and the following medical structures: Grozny Central women in the maternities. The main objective is Mate rnity, Shiri Yurt hospital, Shatoy hospital, to prevent puerperal psychosis and disturbances Sernovosk hospital, Sharoy and Itum Kale dis- in mother and child relationships and to provide pensaries and Sernovosk Medical Point. Once in psycho-social support to women living in pre- two months, assistance is provided to the Stary carious conditions. In future, MSF-F plans to Atagi Maternity and the burn unit of Hospital open (in MRO) a paediatric clinic for children N°4 in Grozny. MSF-F provides drugs, materials, under five. dressing items, medical equipment, hygienic The logistics programme: items, bedding, stationery and containers. Dona- tions are made in accordance with assessed This programme consists of three components: monthly consumption, volume of medical activi- sanitation, rehabilitation and the distribution of ties in the respective medical structure and the non-food items helping people to survive in rate of attendance. strained conditions of spontaneous settlements. The logistics programme: Rehabilitation: Rehabilitation: MSF-F is currently conducting the To help IDPs from Chechnya to survive yet an- full rehabilitation of a medical dispensary near other winter in Ingushetia, MSF-F built 72 Shatoy and repairing the roof and heating sys- rooms (one room/family) in Nazran and in Plievo tem in the Shiri Yurt hospital. In addition, it pro- this summer for the most vulnerable IDPs (wid- vides assistance to IDP camps in Sernovodsk ows with children, big families, families with in- (4 000 people in total) through insect disinfect- valids, IDPs living in unacceptable conditions ing, distribution of hyg ienic and bedding kits, and IDPs having no place of residence in camps improving general sanitation and building new or the private sector). The programme also in- toilettes. cludes various repair works in IDP spontaneous settlements and connection to gas pipes for set- (The above information was kindly provided by tlements without central heating. Until the end Marie-M. Leplomb, Medical coordinator, MSF of January 2002, works will be conducted in five France). spontaneous settlements.

10 MSF-France training for gynaecologists/obstetricians from Ingushetia and Chechnya In November, MSF-F organized a training semi- management of post-partum haemorrhage, nar in Moscow for gynaecologists/obstetricians which is a quite frequent problem both in Chech- from Chechnya and Ingushetia. It was attended nya and in Ingushetia. Other topics were: by ten participants: from Nazran (2), Caesarean section management, premature de- Sleptsovskaya (1), Sernovosk (1), Central livery, infection during pregnancy, anaemia in Grozny (1) and Stari Atagy (1) maternities and pregnancy, sexually transmitted infections, ma- four gynaecologists form the MSF-F team. jor gynaecological diseases management. In ad- The seminar was conducted by a gynaecol- dition, another purpose of the seminar was to ogy/obste trics consultant from France, with spe- give the participants the opportunity to ex- change their views and share professional ex- cific experience in the humanitarian field. perience. Training covered a wide range of subjects re- lated to an obstetricians’ daily work. The main The importance of the course was highly appre- interest of the participating doctors was the ciated by the participants; however, it was management of high blood pressure in pre g- pointed out that a longer and more substantial nancy, pre-eclampsia and eclampsia treatment. scientific training would also be worth conduct- Much attention was also given to prevention and ing.

WHO INFORMATION SERVICES

The WHO information service assists agencies New: UNICEF: The Health and Nutritional Status working in the health sector in the North Cauca- of Children Under Five and their Mothers in the sus. This service includes an electronic library in Republic of Ingushetia , September 2001 which most manuals are available in English and Please contact WHO for a complete list of re- Russian. Furthermore, hard copies of the English sources, to co ntribute or to receive a document: version of the Emergency Health Library Kit are ([email protected]). available for copying at the WHO office in Mos- cow (see contact information below).

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

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