International Activity Report 2003
North Caucasus

International staff: 18 National staff: 255

The past year has been particularly difficult for MSF in the North Caucasus. Faced with the kidnapping of staff member Arjan Erkel in August 2002, obstruction by the authorities and an increase in security threats and the danger of violence, the organization has been extremely challenged to provide effective independent humanitarian aid in the region. The vast reduction in the capacity to carry out humanitarian work in the North Caucasus has not been echoed by a reduction in needs, which remain pressing. The pressures on humanitarian action, after all, only matter because the need for assistance continues to be acute.

Refugees pushed back into war zone

"We dread for our lives if we have to return to Grozny, particularly for the lives of our sons." –  mothers in Znamenskoye camp speaking to MSF staff before the camp was closed in June 2002

June 2002 saw the publication of a "Twenty Point" plan by the Russian authorities to repatriate nearly 120,000 internally displaced persons (IDPs) from Ingushetia to Chechnya by 1 October 2002. While the plan was never completely ful. lled, it signaled the start of a concerted campaign of harassment and coercion that resulted in the closure of several tent camps and the dispersal of tens of thousands of IDPs to the war zone of Chechnya.

MSF immediately protested the plan, claiming that the current climate of extreme violence in Chechnya was the principal reason why the civilian population fled, as well as why they refused to return to Chechnya. It was also stressed that any repatriation should be voluntary. It was clear that conditions for a secure and voluntary return did not exist in Chechnya. Coinciding with the "Twenty Point" plan was a marked change in the attitude of the authorities toward NGOs working with the displaced. Increased tax and safety inspections, as well as endless administrative red tape, contributed to an atmosphere of noncooperation. One example: in late June, the Ingush Minister of Health rescinded a Memorandum of Understanding with MSF for the opening of a tuberculosis hospital in Ingushetia. The authorities made it clear that this was linked to the "Twenty Point" plan: since the IDPs would be returning to Chechnya, there would be nobody left to treat. Within two weeks, the first camp was closed. The camp in Znamenskoye, in Chechnya but right on the border with Ingushetia, had tents torn down and latrines shut in the weeks preceding its closure. Gas, water and electricity were cut off. The 2,200 displaced people who had been living there were dispersed around Chechnya or consigned to overcrowded temporary accommodation centers in Grozny.

Early warning system set up

In July 2002, MSF was able to set up a network of community health workers in Ingushetia to improve proximity to the IDPs and knowledge of the field situation. These health workers were also to play an important role as an early warning system, allowing MSF to react in case of an emergency, particularly one that touched the most vulnerable groups. The health workers were made aware of IDP rights as well as MSF's awareness-raising role. They were asked to pass on information about any incidents that put pressure on the IDPs to return to Chechnya.

Even as the first incidents began to be reported, the dangers of returning to Chechnya became increasingly apparent. "My two sons went to visit their father in Samashki, in Chechnya and were detained by the military," says a displaced woman living in a camp in Aki Yurt, Ingushetia. "After a few days, soldiers threw away the dead body of one of my sons. The second survived but was very cruelly beaten. His face was covered with black bruises and his legs and body covered with knife cuts." There were many accounts like this.

Operations suspended in Chechnya

The security situation began to seriously deteriorate after the closure of the camp in Znamenskoye. Mine incidents, security warnings and, most of all, kidnap threats involving aid workers became the norm. On July 23, Nina Davydovich of the Russian NGO Druzhba ("Friendship") was kidnapped in Chechnya (she was released in January 2003). MSF suspended operations there following the abduction but decided to continue to provide direct life-saving assistance in emergency situations. This included supply of medicines and medical material to Chechen surgical facilities and continued work by MSF's Chechen doctors in cases of emergency.

Arjan Erkel kidnapped

On August 12, Arjan Erkel, Head of Mission for MSF in Dagestan, was kidnapped by gunmen in the city of Makhachkala. In Dagestan, prior to the kidnapping, MSF had been providing essential drugs to ten hospitals in the region as well as running a program of psychosocial assistance in the city of Khazaviurt on the Chechen border. MSF immediately extended the suspension of activities (in place in Ingushetia since Davydovich's kidnapping) to the whole of the Northern Caucasus in response to the abduction but resumed operations in Ingushetia a month later for the sake of the thousands of civilians in the republic in dire need of assistance. (In September 2002, MSF was also deeply saddened by the untimely death of Rori Duncan, one of its project coordinators for the North Caucasus.) MSF began to work tirelessly to secure Erkel's freedom, repeatedly calling on the Russian authorities to press their investigation into the kidnapping. In the ensuing months, MSF also sought to apply public pressure for his release, through press releases, events marking the captivity, and a worldwide petition that has since received over 380,000 signatures.

When Arjan Erkel remained missing after one year, MSF issued a damning report of the Russian authorities' investigation into the kidnapping. In the report, MSF severely criticized the investigation of the case and expressed doubts for the . rst time about the determination of the Russian authorities to find a resolution.

Moscow theater crisis – MSF plays a silent role

Autumn saw the beginning of a new phase in the tactics of Chechen separatists in their struggle for independence. A theater full of people was taken over by a group of suicide bombers demanding that Russia withdraw from Chechnya or else they would blow up the theater. Both the separatists and the authorities requested that MSF come to the scene. MSF immediately sent doctors to the theater but they were not asked to intervene during the crisis or during the immediate aftermath of a gas attack by the Russian Special Forces which eventually claimed the lives of nearly 120 people.

MSF quickly turned its attention to the hospitals, which were completely inadequately prepared for the in. ux of patients overcome by the gas. "There were people dying and dead at the reception area of the hospital," recounted one MSF doctor who visited Hospital 13, where most of the theater-goers were transferred. "They were just dumped there. I saw doctors getting sick and almost passing out as they gave mouth-to-mouth resuscitation to patients." Over the next three days and nights, MSF secretly delivered medicines, equipment and food to Hospital 13 and the central medical distribution center.

Deportation

Meanwhile, the situation of the Chechens in Ingushetia continued to deteriorate. The tent camp in the district of Aki Yurt, which accommodated 1,500 displaced people, was closed on December 2, 2002. In the run-up to the closure, MSF told the IDPs that it would pay for accommodation in the private sector for those who chose to stay in Ingushetia. Nineteen families took up the offer in what was to become known as the "Cash for Shelter" program. Some people were shipped by the Ingush authorities back to Chechnya, transported on trucks and buses and unceremoniously left to shift for themselves. Although the government had promised to set up temporary accommodation in Grozny, it was not enough for all who needed it and it was not yet finished. People who had fled the republic in terror now returned in terror and without assistance, finding shelter in cowsheds, kindergartens and abandoned factories.

Suicide bombers strike at heart of Grozny

MSF has maintained the capacity to respond to emergencies in Chechnya through local staff members. One example of a typical emergency intervention: on December 27, 2002, the main administration building in Grozny was blown apart by a truck driven by suicide bombers. Within an hour MSF contributed two dressing kits as well as bandages to the trauma and neurosurgery departments of Grozny's Hospital 9. The following months were to be increasingly characterized by similar emergency interventions as suicide bombers attacked government structures in Znamenskoye, Gudermes and Grozny. In Znamenskoye, MSF delivered infusion kits and dressing kits; additional supplies were sent from Nazran to the Mozdok military hospital in Northern Ossetia, where many of the victims of the Znamenskoye bombing were transferred. The Mozdok hospital was itself destroyed by suicide bombers in August 2003.

MSF alternative shelter declared illegal

"If the camps are closed, I will dig a pit in the ground and sit in it together with my children" – displaced person living in Ingushetia

In order to provide IDPs with a real choice between staying in Ingushetia and returning to Chechnya, at the end of November MSF began building alternative shelters with the agreement of the Ingush authorities. As the first 180 out of a proposed 1,200 rooms in structures resembling barracks were completed in January, the project was declared illegal due to new construction legislation. Soon after, in an effort to evaluate the needs and collect testimony, MSF began a survey to identify the most vulnerable families in the tent camps. Over 3,000 families were interviewed, 98% of whom said they did not want to return to Chechnya. Ninety-three percent of those who did not want to return gave the reason as fear for their family's safety.

Two months after the shelters were declared illegal, MSF received a letter from the Ingush procurator ordering their demolition. At the time of going to press, another camp, Bella, was subject to the same pressures as Aki Yurt and Znamenskoye, thus forcing the remaining 1,500 people there to return to Chechnya or else find refuge in other camps. Over a 12-month period, throughout Ingushetia, approximately 40,000 refugees had been pushed back into Chechnya, and the rooms which MSF had built were still standing – but empty.

Tuberculosis treatment in Chechnya – a small success story

In March 2003, a mini-project was started by donating tuberculosis medicines to three facilities in Chechnya; follow-up monitoring revealed that only one patient defaulted out of the 94 participating. The remainder successfully finished their treatment in June.

Every day

Every day is an emergency in Chechnya, and for Chechens who have . ed to Ingushetia and Dagestan. The ongoing con. ict in Chechnya, the deterioration in security, the continued obstruction by the authorities and, most of all, the abduction of Arjan Erkel have placed restrictions on MSF's activities throughout the region. Nevertheless, during this difficult year, MSF continued to provide support to medical facilities in the region overwhelmed by the increase in violence and weakened by under-funding. As of August 2003, MSF was still doing extensive work in the region, though most places were too insecure to send international staff. Often through local staff, MSF was still distributing medicines and material to scores of health facilities and rehabilitating health facilities in Chechnya; still focusing on the humanitarian issue of shelter for displaced Chechens in neighboring republics weighed down by an ever-increasing pressure to return; still running prenatal and gynecological, pediatric, and general clinics in Ingushetia; still reacting to emergencies stemming from the ongoing con. ict inside Chechnya itself. And MSF was still working to secure the release of Arjan Erkel, missing for more than a year.