International Activity Report 2004
North Caucasus

International staff: 14
National Staff: 246

Helping a displaced, desperate population

The past year has proved particularly difficult for MSF in the North Caucasus. There has been a further deterioration in security in the Chechen and Ingush republics, with violence increasingly spilling over into Ingushetia from Chechnya. At the same time, authorities have conducted a systematic closure of the internally displaced persons camps in Ingushetia in which MSF has been working. The closures have forced thousands of people to return to Chechnya or find private assistance in Ingushetia.

The closing of camps – the last of which occurred in June 2004 – was the result of a so-called "twenty point plan" published by the Russian authorities in March 2002, which scheduled the closures as part of a "normalization" process in Chechnya. This plan has proceeded despite the fact that, during the past year, political uncertainty and violence have, if anything, increased in Chechnya, and despite calls by MSF and other NGOs to give displaced people a real choice between staying and going. While there is little evidence that physical force was used to persuade the displaced people to return home, a campaign of psychological coercion that featured threats and the cutting off of gas and electricity, as well as promises of compensation that have subsequently gone unfulfilled, resulted in many people returning. The same process of squeezing people out was then applied to those living in more dispersed and informal settlements.

Those who returned to Chechnya were placed in what are called Temporary Accommodation Centers. MSF at first hesitated to provide assistance in these new settlements because it did not want to appear to condone the process of "normalization" or run the risk of accelerating the camp closures in Ingushetia. However, as the numbers swelled and the conditions became abysmal, MSF was left with no choice but to provide aid to alleviate the suffering caused by atrocious overcrowding and extremely poor sanitation. MSF now also offers primary health care and counseling services in the settlements.

MSF has continued to run mobile clinics, improve hygiene standards, augment maternity facilities, increase pediatric care, and provide medical supplies and drugs for the displaced people remaining in Ingushetia. In the first four months of 2004, the MSF team working in three maternal and child health care clinics had conducted more than 7,400 medical consultations among a population of whom 95 percent are displaced people and 5 percent are local residents.

The organization also continues the difficult work of supplying hospitals and clinics in Chechnya itself and has started a tuberculosis (TB) treatment project there. In addition to providing medical treatment to those with TB, MSF makes available psychosocial counselors for TB patients, trauma victims and medical personnel caught up in the bloody crises that make up daily life in Chechnya. Since the start of 2004, MSF has conducted more than 10,000 medical consultations in Chechnya including 225 surgical interventions and 960 newborn deliveries.

One small success, though not a lasting one, was that the 140 housing units that MSF had built in Ingushetia for displaced people who wished to stay were finally approved by the Russian authorities. In early 2003, these houses had stood empty while the authorities argued about their legality and at one stage ordered their destruction. However, in February 2004, displaced people received permission to move into them. As this report goes to press, however, the authorities have once again decided to question the houses' legality and have reversed the decision to let displaced people live in them. In the meantime, MSF has constructed more than 150 new housing units and rehabilitated many more.

The continuing danger in Chechnya and the failure of the "normalization" project were exemplified by the assassination of A. Kadyrov, the Kremlin-backed president of Chechnya, and its aftermath. His death in a bombing in May 2004 was followed by a surge in violence, culminating in an attack by armed groups on the headquarters of the Ingush Interior Ministry, which left more than 90 people dead. MSF provided surgical help and emergency medical kits to nearby health facilities in response to both incidents.

The increase in violence, the level of threat to civilians and aid workers and bureaucratic hurdles have further diminished the space in which independent humanitarian organizations can operate. Because of security concerns, the activities of all of MSF's projects in the region have been carried out mostly by national staff members and managed by international volunteers who are obligated to communicate with the aid team from outside of the area. MSF's core values of providing independent witnessing and solidarity and of working in close proximity with those most in need have become increasingly strained in this region.

MSF has worked in North Caucasus since 1999.