Russian Federation

Eleven years after the start of the first Chechen conflict and despite official rhetoric claiming the situation has ‘normalised’, the majority of Chechens still struggle through lives burdened by fear, uncertainty and poverty. Thousands of Chechen refugees have been forced by Russian and Ingush authorities to repatriate from neighbouring Ingushetia. Their homes destroyed and lacking basic needs such as clean water and healthcare, many Chechens face grim conditions in overcrowded, temporary accommodation centers (TACs). Access to the republic remains a pressing problem.

In Grozny, the republic’s capital, a mobile team provides primary healthcare to six TACs, and general, gynaecological and paediatric consultations in four polyclinics. These clinics see a total of 5,600 patients per month.

MSF continues to distribute medicine and medical material to Grozny Maternity, which is the central maternity and referral hospital for all of Chechnya. In 2005, MSF provided drugs in support of 125,740 medical consultations in health structures in Shatoi, Sharoi and Itum Kale. In the rural region around Grozny — Grozny Selsky — MSF primary care mobile teams offer healthcare in 10 different village settlements. A primary healthcare clinic was also opened in May 2006 in Shelkovksy district in the northeast, offering gynaecological, paediatric and general services.

High rates of psychological distress

Mental health problems are widespread among the long-suffering population and mental health services are a large component of MSF’s programs. A survey conducted by MSF in September 2005 in six Grozny TACs showed that 77 per cent of respondents were suffering from discernible symptoms of psychological distress. Fifteen MSF counsellors work closely with the mobile medical teams, and also offer 24-hour services for patients and staff in the republic’s main trauma hospital — No. 9.

Expanding treatment for tuberculosis

MSF’s tuberculosis (TB) program expanded in 2005 to include a 4th dispensary, Karagalinkskaya. By June 2006 it had enrolled over 750 patients from a catchment area of 300,000 — indicating that rates of TB are very high. The program supports the existing TB dispensary system with drugs and necessary equipment, and also provides specialist lab services. The directly observed treatment system (DOTS) has been adapted to the conflict setting and MSF provides food to boost the nutritional status of patients. MSF health educators hold individual sessions, group work and public information campaigns on TB.

To improve the living conditions of the displaced, MSF organised distributions of non-food items such as mattresses, blankets, stoves and building material. In 2006, MSF is constructing sanitary facilities (water tanks, showers, latrines) for around 200 families in some of the most precarious settlements of the Chechen capital.

MSF is also expanding and developing its surgical programs in Grozny, providing training support and equipment to the neurosurgery and trauma wards of Hospital No. 9. A plastic and reconstructive surgery program for patients suffering disabilities from violence or accident related trauma, including gunshot wounds, mine injuries and burns began in July 2006.

Providing ongoing care in Ingushetia

In neighbouring Ingushetia, which saw an increase in violent incidents in 2005, MSF continues to provide mobile general, maternal and paediatric clinics in Nazran, Sunzha and Malgobek districts. A medical clinic also opened in July 2005 in the Angusht IDP settlement. The clinics conduct about 2700 consultations per month. Winterisation works were carried out in several of the spontaneous settlements, which still house about 9,000 Chechens.

Mental health services are a critical component of the program, with a team of counsellors working in 25-30 spontaneous settlements. In close collaboration with a network of local volunteers, they identify people who could benefit from individual therapy and organise group sessions and community activities.

MSF worked in the North Caucasus from 1993 to 1997 and resumed activity in the region in 1999.

Taking healthcare to the streets of Moscow

“We were sniffing not to be frozen over. When you sniff you feel warmer. You are doped and you don't care about the cold.”

The homeless youth that MSF works with in Moscow generally live in and around trains, subway stations or markets, developing compromising survival strategies to cope with the hostile environment on the street. Some kids beg or work with street vendors, most are exploited and controlled by criminal groups, and others become involved in prostitution. In winter, living conditions make them prey to flu and pneumonia. Sniffing glue, drinking or injecting drugs are ways to cope with hunger, weather and loneliness.

Healthy growth is often interrupted through lack of adequate diet. Sexually transmitted infections, dermatological and gastric problems, as well as the high risk of HIV/AIDS and other infections are but a few of the many health challenges faced by this vulnerable population. MSF provides primary care and first aid, referring patients on to secondary care for more complex issues.

Over the past ten years, official bodies responsible for the care of minors have attempted to respond to the multifaceted needs of homeless and neglected children, but teenagers living on Moscow's streets are invariably excluded from society. Their access to a full range of health services is fraught with obstacles.

The official system of police — hospital-priut (temporary orphanage) is more focused on coercion than rehabilitation, and does not facilitate access to appropriate healthcare, or include street work. At the core of MSF's approach is outreach: every day and night, several teams of MSF medical and psychosocial staff walk the streets and visit the areas where street youth gather, treating kids on the spot if possible, and advising and accompanying kids to get more specialised services for treatment. MSF also runs a day center where kids can participate in a range of therapeutic and educational activities and also shower, wash their clothes and take meals. The MSF multidisciplinary team supports each individual to make a sustained decision to leave the street, encouraging youths to come to terms with the difficulties of their past and take control of their future decisions.

The MSF street children and teenagers project focused much effort in 2005/2006 on developing networks with local organizations, establishing a partnership with a drug and alcohol rehabilitation clinic called NAN. In June 2006 a photo exhibition documenting the lives of the street kids, taken by the kids themselves, was also mounted in Moscow.

MSF believes there are, on any given day, 250 to 500 children living on the streets of Russia's capital. MSF works with an average of 80 kids each month, mostly boys of 15-16 years old.

MSF has worked in the Russian Federation since 1988.

Eleven years after the start of the first Chechen conflict and despite official rhetoric claiming the situation has ‘normalised’, the majority of Chechens still struggle through lives burdened by fear, uncertainty and poverty. Thousands of Chechen refugees have been forced by Russian and Ingush authorities to repatriate from neighbouring Ingushetia. Their homes destroyed and lacking basic needs such as clean water and healthcare, many Chechens face grim conditions in overcrowded, temporary accommodation centers (TACs). Access to the republic remains a pressing problem.

In Grozny, the republic’s capital, a mobile team provides primary healthcare to six TACs, and general, gynaecological and paediatric consultations in four polyclinics. These clinics see a total of 5,600 patients per month.

MSF continues to distribute medicine and medical material to Grozny Maternity, which is the central maternity and referral hospital for all of Chechnya. In 2005, MSF provided drugs in support of 125,740 medical consultations in health structures in Shatoi, Sharoi and Itum Kale. In the rural region around Grozny — Grozny Selsky — MSF primary care mobile teams offer healthcare in 10 different village settlements. A primary healthcare clinic was also opened in May 2006 in Shelkovksy district in the northeast, offering gynaecological, paediatric and general services.

High rates of psychological distress

Mental health problems are widespread among the long-suffering population and mental health services are a large component of MSF’s programs. A survey conducted by MSF in September 2005 in six Grozny TACs showed that 77 per cent of respondents were suffering from discernible symptoms of psychological distress. Fifteen MSF counsellors work closely with the mobile medical teams, and also offer 24-hour services for patients and staff in the republic’s main trauma hospital — No. 9.

Expanding treatment for tuberculosis

MSF’s tuberculosis (TB) program expanded in 2005 to include a 4th dispensary, Karagalinkskaya. By June 2006 it had enrolled over 750 patients from a catchment area of 300,000 — indicating that rates of TB are very high. The program supports the existing TB dispensary system with drugs and necessary equipment, and also provides specialist lab services. The directly observed treatment system (DOTS) has been adapted to the conflict setting and MSF provides food to boost the nutritional status of patients. MSF health educators hold individual sessions, group work and public information campaigns on TB.

To improve the living conditions of the displaced, MSF organised distributions of non-food items such as mattresses, blankets, stoves and building material. In 2006, MSF is constructing sanitary facilities (water tanks, showers, latrines) for around 200 families in some of the most precarious settlements of the Chechen capital.

MSF is also expanding and developing its surgical programs in Grozny, providing training support and equipment to the neurosurgery and trauma wards of Hospital No. 9. A plastic and reconstructive surgery program for patients suffering disabilities from violence or accident related trauma, including gunshot wounds, mine injuries and burns began in July 2006.

Providing ongoing care in Ingushetia

In neighbouring Ingushetia, which saw an increase in violent incidents in 2005, MSF continues to provide mobile general, maternal and paediatric clinics in Nazran, Sunzha and Malgobek districts. A medical clinic also opened in July 2005 in the Angusht IDP settlement. The clinics conduct about 2700 consultations per month. Winterisation works were carried out in several of the spontaneous settlements, which still house about 9,000 Chechens.

Mental health services are a critical component of the program, with a team of counsellors working in 25-30 spontaneous settlements. In close collaboration with a network of local volunteers, they identify people who could benefit from individual therapy and organise group sessions and community activities.

MSF worked in the North Caucasus from 1993 to 1997 and resumed activity in the region in 1999.

Taking healthcare to the streets of Moscow

“We were sniffing not to be frozen over. When you sniff you feel warmer. You are doped and you don't care about the cold.”

The homeless youth that MSF works with in Moscow generally live in and around trains, subway stations or markets, developing compromising survival strategies to cope with the hostile environment on the street. Some kids beg or work with street vendors, most are exploited and controlled by criminal groups, and others become involved in prostitution. In winter, living conditions make them prey to flu and pneumonia. Sniffing glue, drinking or injecting drugs are ways to cope with hunger, weather and loneliness.

Healthy growth is often interrupted through lack of adequate diet. Sexually transmitted infections, dermatological and gastric problems, as well as the high risk of HIV/AIDS and other infections are but a few of the many health challenges faced by this vulnerable population. MSF provides primary care and first aid, referring patients on to secondary care for more complex issues.

Over the past ten years, official bodies responsible for the care of minors have attempted to respond to the multifaceted needs of homeless and neglected children, but teenagers living on Moscow's streets are invariably excluded from society. Their access to a full range of health services is fraught with obstacles.

The official system of police — hospital-priut (temporary orphanage) is more focused on coercion than rehabilitation, and does not facilitate access to appropriate healthcare, or include street work. At the core of MSF's approach is outreach: every day and night, several teams of MSF medical and psychosocial staff walk the streets and visit the areas where street youth gather, treating kids on the spot if possible, and advising and accompanying kids to get more specialised services for treatment. MSF also runs a day center where kids can participate in a range of therapeutic and educational activities and also shower, wash their clothes and take meals. The MSF multidisciplinary team supports each individual to make a sustained decision to leave the street, encouraging youths to come to terms with the difficulties of their past and take control of their future decisions.

The MSF street children and teenagers project focused much effort in 2005/2006 on developing networks with local organizations, establishing a partnership with a drug and alcohol rehabilitation clinic called NAN. In June 2006 a photo exhibition documenting the lives of the street kids, taken by the kids themselves, was also mounted in Moscow.

MSF believes there are, on any given day, 250 to 500 children living on the streets of Russia's capital. MSF works with an average of 80 kids each month, mostly boys of 15-16 years old.

MSF has worked in the Russian Federation since 1988.

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