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Newsletter on humanitarian health assistance, December 2000

More on Hepatitis A in the North Caucasus

(based on the WHO epidemiological experts’ field mission reports)

Hepatitis A is a recurrent problem in the North Caucasus as well as in some other parts of the former Soviet Union. The North Caucasus region is classified as a region of intermediate prevalence. This endemicity explains the periodic outbreaks: when hyg i-enic conditions deteriorate, infection b e-comes apparent in older children and young adults. Internally displaced person (IDP) camps are a perfect setting for hepatitis A transmission. It is the opposite of high prevalence regions where young children usually contract the disease and develop immunity fo r life. The first cases were reported in the middle of August 2000 in the IDP camp Sputnik in Ingushetia. The outbreak increased by mid -September with a peak reached in mid-October, with 30-35 cases/week registered by the Sanitary Epidemiological Surveil-lance Service (SES). Most cases are usually reported in the autumn, though by the end of November the situation became rela-tively stable with the total number of cases at 358, compared with 1,044 in 1994, the year with the highest prevalence for the entire decade. IDPs made up at least 60% of the patients, among whom two-thirds were children. All of the hepatitis A cases are only clinically diagnosed as viral labora-tory tests are for all intensive purposes un-available. The exact source of infection re-

mains unknown as the war environment prevents its identification. No fatalities have been reported. The Sleptsovskaya district, along the Chechen border, was the most affected. However, it should be added that the highest morbidity rates among the local population were reg-istered in the Malgobeksky district. At the same time, numerous cases of the disease were also registered in Chechnya, Urus Martan be ing the most affected district. Management

In both Chechnya and Ingushetia, health and sanitation services h ave had a difficult time coping with the situation. However, in Ingushetia the Republican SES provides anti-epidemic measures to curb the outbreak, including: • tracing the path of contamin ation; • control of water quality, available data

indicates that groundwater is potable at the tap level, but secondary infestation is very possible;

• improvement of hygiene conditions, e.g., supply of disinfectants, soap, up-grading of latrines and garbage pits;

• disinfecting of water camp tanks, indi-vidual buckets, etc.; disinfecting of premises where patients were located;

• isolation of patients for 15 days in spe-cial settings, i.e. installed tents to host hepatitis A patients unable to be housed in the rayon infection hospital;

• monitoring of contacts; and • an information campaign. WHO has been proactive in initiating and supporting this exercise.

Full implementation of this programme faces constraints such as scarcity of equip-ment and reagents, problems with the

Health in the North Caucasus

Following information received from differ-ent sources about the outbreak of hepatitis A in Ingushetia and Chechnya, WHO or-ganized an expert mission to review the epidemiological situation. An inte rnational epidemiologist accompanied by a Russian public health expert visited Ingushetia from 8 to 12 November. They visited three refugee camps, regional and republican hospitals as well as specially established wards for the management of new cases of hepatitis A.

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management of IDPs, unsatisfactory camp environment, etc. In the management of hepatitis A cases, only symptomatic treatment was reco m-mended. Mass vaccination is not cost-effective in most situations. Patients follow a standard treatment that includes a special diet, vitamins and liver extracts, glucose and "corticoids for severe cases". In Chechnya, control measures and moni-toring are severely hampered due to the conflict. The WHO mission could not inve s-tigate the situ ation in Chechnya because of security restrictions preventing UN staff from entering the republic.

Hepatitis A: Sunzhensky district. Infectious dis-ease department at one of the hospitals.

November 2000

Demography According to DRC data from 27 November 2000, the total number of Chechnyan IDPs in Ingushetia was 155,332. At the same time, according to official figures of the In-gush Territorial Representative Office of the RF Ministry for Federal Affairs, Migration and Nationality Issues (the former Migra-tion Service of Ingushetia), the number of Chechen IDPs in Ingush etia now exceeds 175,200 (DRC). Health Situation Hepatitis : In November, the Centre of Sani-tary Epidemiological Surveillance of In-gushetia (SES-I) registered 103 cases of viral hepatitis (of them 80 children) among the IDP population. Morbidity: By 28 November, statistics on infectious diseases collected by SES-I showed that the highest morbidity in the IDP population was due to acute respiratory infections (ARI), pediculosis, scabies, influ-enza and acute intestinal infections. Data provided in November by Islamic Re-lief (IR) shows that the highest morbidity among the IDP population is due to acute respiratory infections, diseases of the ali-mentary system and cardiovascular dis-eases. Recent information gathered from IDP camps reveals an increasing number of burns among IDPs due to gas stoves in tents, which have no protection bars.

Tuberculosis : In early November, MoH/I held an extraordinary meeting on TB in In-gushetia, at which the necessity to under-take urgent measures to prevent a further increase in morbidity and mortality from TB and to curb the spread of the disease among the IDP and local population was stressed. One of the urgent steps proposed was the isolation of TB patients, especially patients with active forms living in IDP set-tlements. It was planned to set up “isola-tion wards” in the tents and to employ per-sonnel for conducting fluorographic exami-nations, sputum collection and general treatment on the spot. The MoH strategy envisages that all IDPs over the age of seven be X-rayed on small format films (This is, however, not in accordance with WHO policy, which does not promote TB screening by means of small format X-rays (fluorography)). Special tents have been set up for the isolation of 68 TB patients in the newly esta blished camp Alina. Since October 1999, screening initiated by MoH/I has resulted in the X-raying of 28,632 IDPs (MoH/I). According to data received from SES-I, on 28 November 2000, the number of regis-tered TB cases in the IDP population was 594 (with 317 hospitalised). And according to data provided by the republican TB dis-pensary, out of 11,241 IDP children exa m-

INGUSHETIA, NORTH OSSETIA AND DAGESTAN

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ined, 1,000 were infected with TB. 146 IDP children currently live in a TB risk area. In November, personnel from the field TB hospital of the All-Russian Centre for Disas-ter Medicine, Zaschita, toured IDP camps in order to evacuate TB patients to the hosp i-tal. However, the majority of IDPs com-pletely re jected hospitalization as they did not want to leave their families or were try-ing to escape. Reproductive health : Since October 1999 the number of new-borns among the IDP population was 3,583, of whom 64 were stillborn and 32 died shortly after birth (MoH/I). Vaccination: Since October 1999, MoH/I has immunized 32,887 IDP children (MoH/I). AIDS: According to the head doctor of In-gushetia, "AIDS was unknown in the coun-try until 18 months ago". At present, 56 cases of HIV/AIDS have been re gistered in the country. However, official data still re-ports 36 cases, six of them nationals. Drug supplies: MoH/I claims that thanks to the efforts of various international organi-zations and NGOs, there is now a consider-able stock of essential drugs in Ingushetia. The most needed drugs now remain those necessary for the treatment of specific dis-eases, i.e. diseases of the nervous system, cardiac diseases, etc. Mental Health CPCD is one of a few organizations provid-ing psycho-social rehabilitation for IDP chil-dren and students in Ingushetia and Chechnya. As part of CPCD’s Little Star programme, 53 psychologists and counsellors work in the following refugee camps and spontane-ous settlements in Ingushetia: • Severny and Sleptsovskaya (2 loca-

tions) • MRO, Sleptsovskaya • Omega school, Sleptsovskaya • Yandare • Bart, Karabulak (3 locations) • Tupik-1, Karabulak • Tupik-2, Karabulak.

In Chechnya , Little Star operates in the fol-lowing villages/towns: • Grozny (19 counse llors/psychologists) • Valerik • Urus-Martan • Alpatovo • Chechen Aul • Goiti. CPCD has its own tents in camps (and rooms in Chechnya) where children take part in simulation games and art and drama therapy activities. Games and play therapy form the basis for the work with children. The CPCD counsellors have a range of fu r-ther skills, including psychodrama, music therapy, neuro -linguistic programming, in-dividual counselling and relaxation exe r-cises to complement the programme. The children are also offered individual consu l-tations. Groups of children are selected a c-cording to age and degree of trauma, in consultation with parents and teachers. Whenever possible, CPCD also run joint sessions for the children and their parents. From February until September 2000, as part of the psychological rehabilitation pro-gramme, CPCD sent groups of IDP children to spend 21 days (one group every month) with counsellors in a sanatorium in Nalchik or Pre -Elbrus, Kabardino-Balkaria. During this 8 -month period, 700 children were sent to Kabardino-Balkaria. The Agency for Rehabilitation and Devel-opment (ARD) continuously provides psy-cho-social support to children (ages 6-12), teenagers (ages 13-18) and women in the tent camp Sputnik. Health Services Disease Surveillance: Findings of the WHO mission to Ingushetia in November show that the system of disease reporting still utilised in both Chechnya and Ingushetia is obsolete. Most of the medical staff inter-viewed during the mission were not aware of the existing Order of the Ministry of Health of the Republic of Ingushetia (no. 98 of 29 May 2000) on the use of the new re-porting form. Objectives must be redefined and logistics updated in accordance with WHO guidelines. TB: The republican TB dispensary has 130 beds. In the Malgobeck and Sleptsovskaya

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TB dispensaries as well as in the feldsher obstetric post in Dalakovo, TB patients are provided only with out-patient treatment (report from the Stavropol anti-plaque in-stitute). Dental services: According to BIF, the de-mand for dental services in Naran and Sleptsovskaya is high. Patients have to wait two to three weeks for treatment. Health Assistance In order to provide better hygienic condi-tions for IDPs living in camps in Ingushetia, WHO has purchased the needed materials for the installation of 300 washbasins, d o-nated by Emercom, in three IDP camps: Sputnik, Bart and the newly esta blished camp Alina.

WHO collaborating partner "Zaschita" unloads medications donated by WHO for hospitals in

Ingusehtia and North Ossetia The second part of pharmaceuticals and medical expendables (USD 80,000) pur-chased by WHO was delivered by its col-laborating centre, Zaschita, to Mozdok and Nazran and was distributed to the Mozdok Central Republican Hospital (North Os-setia), the republican clinical hospital in Nazran, the Nazran and Karabulak city hos-pitals, and the Malgobeck and Sunzha cen-tral district hospitals (Ingushetia). In November, three oxygen concentrators purchased by WHO, for three of the main

hospitals in Ingushetia, were delivered and distributed to the Nazran Republican Hospi-tal and the Sunzha and Malgobeck district hospitals. A WHO expert is currently in the North Caucasus collecting and analys ing available data on the nutritional status of the war-affected population. She will also carry out a food box adaptation exercise in Ingushetia, prepare a training workshop on nutrition for health workers and NGOs in the North Caucasus, and identify imme diate priorities for WHO action. In early November, the hospital of the All-Russian Centre for Disaster Medicine, Zaschita, returned to Ingushetia and opened at the TB dispensary in Nazran in order to speed up the diagnosis and re ferral of IDP patients su ffering from TB to other cities of the Russian Federation for treat-ment. By the end of November, the number of beds in the hospital was increased from 50 to 100. By 6 D ecember, 90 TB patients were undergoing stationary treatment. The hospital receives many patients from Grozny and Gudermes, sent there from health facilities in Chechnya. A mobile team regularly toured around the Prombaza, Bart and the railway Tupik, MTF, IDP camps where it conducted health education and took sputum smears from suspected TB IDPs. Swiss Disaster Relief Swiss Disaster Relief will soon deliver lo-cally purchased medical equipment for the neuro -surgical department of the Republi-can Clinical Hospital (North Ossetia), the Republican AIDS Centre and a number of hospitals in Ingushetia. Islamic Relief Islamic Relief finished the construction and installation of equipment at the policlinic in the Sputnik IDP camp. The policlinic will provide 24-hour medical assistance. The construction of another IR supported poli-clinic was also recently completed at the newly established camp Alina. Both policlin-ics will provide primary health care and medication and will be staffed by two doc-tors and two nurses. A night-shift doctor for emergencies will also be provided. ICRC and RRC Since the begin ning of the year, ICRC has been providing assistance to all five hosp i-

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tals in Ingushetia, enabling them to treat 1,620 surgical cases. It is closely monitor-ing the situation in the hospitals and deliv-ers medical assistance whenever needed. ICRC also supports two mobile medical teams and one stationary medical post set up by the Russian Red Cross (RRC), in o r-der to provide IDPs with basic health care. The RRC visiting nurses programme pro-vides basic care, including medical, to bed-ridden elders (about 200 beneficiaries). The RRC runs two mobile medical units in Dagestan, which have provided medical services to IDPs since December 1999. About 10,000 patients, including more than 3,400 children, have already benefited from this assistance. Since January 2000, ICRC has also provided local medical facilities with needed materials, allowing them to treat 505 surgical cases. The local RRC branch also runs a home vis-iting nurse programme for approximately 440 beneficiaries, mainly bedridden elderly. In North Ossetia, ICRC has been providing medical material to the Mozdok regional epidemio logical centre on a monthly basis. In the south of Russia RRC, supported by ICRC and the International Federation, pro-vides IDPs from Chechnya with psycho-social counselling and legal advice. Benevolence International Foundation Benevolence International Foundation (BIF) continuously provides surgical and curative dental se rvices to the IDP population in Nazran and Sleptsovskaya, where four doc-tors work two shifts. 10−12 patients receive treatment daily. BIF has recently distrib-uted 2,000 mother and child kits (consist-ing of first aid kits and clothes for new -borns) to newborn children discharged from the three maternities in Ingushetia. In No-vember, BIF conducted a series of pract i-cal/consultative courses for local medical personnel, facilitated by four physicians from the US. BIF has purchased medicine and medical equipment (USD 50,000) to be distributed to clinics in refugee camps and to be used by BIF doctors for the treatment of IDP pa-tients. It has also recently put into opera-tion a mobile clinic (for IDP camps in the Karabulak and Nazran districts) and a sta-

tionary clinic in Aki-Yurt, Malgobeck district, with the aim of providing basic curative services to the IDP population. Future plans include the creation of medical points with four teams of medical special-ists in IDP camps in Ingushetia and the training of medical personnel working in IDP camps. ARD The Agency for Rehabilitation and Devel-opment (ARD) mobile medical team, con-sisting of a physician, a paediatrician and a nurse, works in 16 spontaneous IDP set-tlements in Karabulak, Troitskaya and Sleptsovskaya. It provides medical assis-tance (treatment and consultations) and free medication to IDPs, arranging trans-portation in emergency cases, and conducts immunizations. The mobile team serves three locations daily. ARD also employs a gynaecologist and a hospital counsellor. The gynaecologist works both at the Sputnik camp and as a member of the mobile team. She examines pregnant women and provides home ser-vices and free medication to pregnant women and gynaecological patients. The hospital counsellor provides general medi-cal consultations and psycho-social support to wounded people, provides them with free medication and organises transportation to pro sthetic workshops. People in Need Foundation People in Need Foundation (PINF) continues to operate a mobile clinic, providing pri-mary health care to the IDP population in nine spontaneous settlements in In-gushetia, focusing on clinical care, health prevention practices, distribution of medi-cines and evacuation assistance, in serious cases, to other parts of Russia. In mid-February, MSF-France plans to start medical programmes targeted at pregnant women as well as other gynaecological pro-grammes in the cities Nazran and Karabou-lak. MSF-France will soon receive a ship-ment of scales and hemoglobinometres for this purpose. WHO-supported medical consultation centre in Nazran In view of the increasing number of IDPs with diseases a nd conditions requiring sp e-cialized care, which cannot always be pro-

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vided in medical facilities in Ingushetia, WHO and UNHCR set up a pilot project to facilitate health care assistance to the most deprived IDPs. In mid -November a medical consultation centre started working on the premises of the UNHCR-supported counse l-ling centre “VESTA”, in Nazran. IDPs are accepted there by a medical doctor experi-enced in the area of internal disease control and familiar with the local health services. She focuses her work on reviewing medical documentation and records (if available) of IDP patients who claim that existing ser-vices in RI cannot provide adequate care. She also verifies the appropriateness of the reasons for the denial of medical care, pre-pares a database to contribute to the a s-sessment of the health situation among IDPs, advises on further case ma nagement and referral to be agreed on with the a p-propriate (MoH/RI) authorities. Finally, she collects from MoH copies of the respective referral documentation to compare with the database to further monitor the outcome of the activities. Eighty-seven IDPs have al-ready made use of the consultation centre. Water And Sanitation UNHCR, through the Water State Commit-tee (Vodocanal), is implementing a project on laying 40 kilometres of pipeline in the Malgobekski district. The new pipelines will significantly improve the ability of the sys-tem to transfer water to the population (VESTA/UNHCR). UNHCR/IRC are carrying out a wa-ter/sanitation project, including the installa-tion of 55 water bladders throughout In-gushetia (VESTA/UNHCR). UNHCR/IRC water trucks provide, on a daily basis, access to water for IDPs at 76 loca-tions, including spontaneous settlements, host accommodations, the Zvozdny tent camp in Karabulak, Rassvet in Sleptsovsk and the Aki-Yurt tent camp (VESTA/UNHCR). BIF has installed 50 toilets in IDP camps and some other locations in Ingushetia: 48 toilets were installed in the camps, includ-ing 14 in Aki-Yurt; 12 in Surkhakhi; 8 in Slepsovskaya; 7 in "Sputnik"; 7 in "Sev-erny"; and 4 in the MTF camp of Altiyevo. Two toilets were installed in the medical stations of the humanitarian organizations MDM and ARD in the Sputnik camp.

BIF has installed five shower complexes with 45 showers (10 in a tent camp in Aki-Yurt; 10 in a MRO camp, Sleptsovskaya station; 10 in the UN barracks, Surkhakhi village; 5 in MTF, Altiyevo village; and 10 in Kamaz Centre). All of these showers have been winterised. BIF is currently installing the sixth shower complex for five more showers. Fourteen shower installations, with 131 cabins, insulated by the ICRC for the winter period, are functioning in different camps for IDPs in Ingushetia. Landmine Awareness Landmine awareness is one of the six pro-grammes run by CPCD in Ingushetia and Chechnya. Through the Little Star pro-gramme, CPCD has access to many chil-dren, and has, therefore, begun mines awareness work with the children who come to CPCD sessions. The staff hold gatherings and discussions with children, and distribute posters and leaflets in In-gushetia and Chechnya at all of the loca-tions where the Little Star programme works. In many places where there is a concentration of refugees, posters are dis-played and leaflets distributed. Today, CPCD is carrying out the follo wing mines awareness activities: • Discussions, seminars, role plays; • Distribution of visual aids and leaflets; • Data acquisition on mined areas and

victims; • Development of contacts with institu-

tions and organisations running mines programmes;

• Assisting children who need prostheses; and

• Psychological assistance. CPCD conducts this work in schools in Chechnya, with teachers, children and their parents, and in IDP settlements in In-gushetia. The aim of the ICRC mine awareness pro-gramme in Ingushetia is to inform IDPs of the dangers the landmines and unexploded ordnance represent and to teach them some basic rules of behaviour in order to limit the risk of accidents when they return

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home. The ICRC mine awareness team has started printing the necessary teaching ma-

terial (posters and leaflets) for the pro-gramme.

Demography DRC/ASF continue to update information on the population of Chechnya through its 11 registration points. As of 27 November, the total number of people registered by DRC/ASF in Chechnya is 762,602. According to the Ingush Territorial Repre-sentative Office of the RF Ministry for Fed-eral Affairs, Migration and Nationality Is-sues (the former Migration Service of In-gushetia), since the beginning of the mili-tary conflict in Chechnya in 1999, a total of 302,390 IDPs from Chechnya fled to In-gushetia. 68,792 of them went to other parts of Russia, and 91,181 returned to Chechnya (DRC). Ecological Situation According to the MoH/Ch 6,000 metric tons of crude oil are burnt daily in Chechnya. Makeshift mini-refineries discharge oil waste directly into the ground, contaminat-ing water sources. Health Situation Mortality: As reported by Medecins sans Frontieres−Holland (MSF−H) hostility related injuries are the main cause of death in most of the hospitals in Chechnya. During the previous two months, there were over 200 new wounded persons reported in 12 of the over 30 functioning medical facilities. Almost half of those hospitalised were women, children or elderly (OCHA). Morbidity: According to the head epidemi-ologist of the Chechen Republic, during the month of November, 1200 cases of infec-tious diseases (of them 400 children) and 1742 cases of diseases of the alimentary tract (of them 682 children) were regis-tered. During the last 10 months, 235 cases of hepatitis A (of them 182 children) were registered in Grozny and 688 cases (of them 513 children) were registered in Chechnya. According to his estimations, Chechnya is presently going through a peak of cyclical and seasonal hepatitis morbidity.

Cyclical hepatitis peaks occur every three years. These diseases are directly co n-nected with the quality of the water. Diabetes incidence has increased sevenfold, threefold for hyper-thyroid and tenfold for cancer (lungs, skin and breast). A consider-able rise in allergic and skin disease inci-dence has also been registered, up to 80% of patients with myoca rdial infarction die at the pre-admission stage (MoH/Ch). Accord-ing to the Deputy Head Sanitary Doctor of the Chechen Republic cases of scabies and pediculosis have increased fivefold. Tuberculosis : According to MoH/Ch, the prevalence of tuberculosis is 280 cases per 100,000 population. Reproductive health: Up to 90% of pre g-nant women are admitted to maternity houses with genital or extragenital patholo-gies (MoH/Ch). Health Services According to MoH/Ch, all 13 health facili-ties, except for those of Vedeno and Sha-toy, operate at their maximum capacity, also performing surgery (10 district hospi-tals, Hospitals no. 3 and no. 9 in Grozny, Argun Hospital and Maternity House no. 1 in Grozny) (MoH/Ch). MSF-H reports that all hospitals in Chech-nya suffered massive destruction during the fighting. Ten hospitals and 11 dispensaries were completely destroyed and hospitals now lack the resources to take care of pa-tients. Bacteriological laboratories were recently opened at the ninth Municipal Hospital of Grozny and the SES. However, both need assistance in the form of technical equip-ment, culture mediums etc. Human Resources The health sector has serious problems in the trainin g and the post-graduate educa-tion of health workers MoH/Ch.

CHECHNYA

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Health Assistance ICRC supports three mobile medical teams and one stationary medical post run by the local Red Cross. The mobile units provide the population with basic medical help. In November the ICRC assisted 16 hospitals in Chechnya. The main effort was directed at improving the general conditions there by distributing plastic sheeting and blan-kets. Hospital no. 9 received, for example, 20 stoves. Medical material and medicines for 220 surgical cases were provided. ICRC also supports the visiting nurses pro-gramme of the Chechen branch of the Rus-sian Red Cross. 720 bedridden elderly are assisted on a regular basis by 57 nurses. MSF−H provide regular medical and rehabilitation support to 24 health facilities in the Groznensky, Shalinsky, Shatoisky, Urus-Martan, and Vedensky districts of Chechnya (OCHA). PHO has recently installed a diesel electric-ity generator for the SES (Sanitary and Epidemio logical Suveillance Service) lab. Water And Sanitation At present, the main source of water for the city is Chernorechensky vodozabor, from which water is supplied to the centre of Grozny through centralized water supply systems. Water supplied through this pipe-line system is not suitable for drinking: most pipelines are badly damaged and are contaminated with oil from the many oil

mining pits of the city. 30-35% of the water is lost along the way. One of the main problems in Grozny is the absence of electricity, which is why the pumping station of Vodokanal is out of op-eration. Out of 2,023 kilometers of water pipelines, 700 kilometers were already re-paired by Vodokanal technicians. However, further construction is no longer possible due to the lack of necessary technical equipment, vehicles, construct ion materials and financial resources. For a long time, the workers have not received their salaries nor any food assistance. It is impossible to in-crease the output of water without resolv-ing these issues (Municipal Water Systems of Grozny Vodokanal). According to the deputy head sanitary doc-tor of the Chechen Republic, the quality of water, supplied through the central pipeline system, is deteriorating. Fifty-four per cent (54%) of the water does not pass bacterio-logical tests. By the end of November IC RC completed the construction of two water tanks (75 m3 each) in the vicinity of pumping station no. 1 in Grozny. This will significantly improve access to clean drinking water for the popu-lation remaining in the city. Polish Humanitarian Organization has in-stalled a water filter at the Vodokanal water station and runs four water carriers, supplying purified water to 40 distribution points around the city.

Islamic Relief: Summary of Ac-tivities

By Azamat Koumykov, IR, Manager

Islamic Relief (IR) has been working in the North Caucasus (NC) since 1997. It started its relief activities (focusing on healthcare, income generation and education) in the Chechen Republic after the end of the first

war. After the start of the second conflict, IR pulled out of Chechnya and initiated o p-erations in Ingushetia and Kabardino-Balkaria. IR’s NC headquarters are in Nal-chik (Kabardino-Balkarian Republic). The regional representative is Mohammad Alla. of Ingushetia

Food assistance: IR provides emergency food assistance to Chechen IDP residents of the "Sputnik" and "Severny" (now "Alina") camps, approximately 14,000 people, and to the IDP residents of the seven villages of the Nazran region: Yandare, Ghazi-yurt, Ali-yurt, Sourkhakhi, Ekazhevo, Dolakovo and Kantyshevo (approximately, 16,000

HEALTH AGENCIES IN ACTION

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people). IR distributes food boxes in Sput-nik and Severny. Each food box is intended to support a family of four and contains flour, sugar, vegetable oil, buckwheat, macaroni, tea, rice, condensed milk, can-dles and match boxes. In the villages of the Nazran region, IR distributes WFP food commodities (IR is WFP's implementing partner). Moreover, IR supports 200 fami-lies of Ingush IDPs from the Prigorodny re-gion of Northern Osetia through the distri-bution of its fo od commodities. Water and sanitation: IR is responsible for supplying water to the Severny and Sputnik camps. Each of its two water carriers makes three trips to the camps daily. Du r-ing the winter IR installed 30 metal 30-ton water reservoirs in the camps and distrib-uted 8,000 plastic co ntainers to the IDPs. In Sputnik, Severny and the villages of the Nazran region IR distributes sanitation par-cels on a monthly basis. Each parcel is in-tended for a family of four and contains 15 pieces of toilet soap, 10 pieces of washing soap, washing detergents and hygiene nap-kins for women. Healthcare: IR runs seven mobile clinics that operate in Sputnik, Severny and spon-taneous settlements of IDPs in the Nazran region. Each clinic is staffed by a medical doctor, a nurse and a driver. Recently, IR built two health centres in Sputnik and Alina. The health centres will provide more sophisticated medical care than the mobile clinics. Shelter: IR is finishing the construction of a new IDP camp for 3,000 residents in the village of Yandare of the Nazran region. The settlement will be created in place of the old "sovkhoz" colle ctive farm and will be provided with central heating, gas and wa-ter systems.

Income generation: IR is carrying out sev-eral income generation programmes tar-geted at Ingush IDPs from the Prigorodny region of North Osetia, such as donating cattle to IDP families. IR activities in the Chechen Republic Emergency assistance . Since 1 September, IR has dispatched three humanitarian convoys of food commodities to Grozny. The distribution was carried out in cooperation with the Administration of the Chechen Republic. In early December 2000, the IR regional representative had a meeting with Akhmad Kadyrov (head of the Chechen Administration) and it was agreed

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that IR will initiate full-scale relief activities in the republic in the near future. IR activities in the Kabardino-Balkarian Republic Education: IR runs a big computer centre in Nalchik, providing courses in personal co m-puting and the Internet. Healthcare: IR provides permanent assis-tance to the hospitals of Nalchik. The latest donations of IR to the municipal and repub-lican hospitals were two dialysis machines, TV sets for the p atients, two mobile clinics and medical supplies.

IR provides food assistance to kindergartens, o r-phanages and other social institutions.

Expanded Programme on Immuni-zation In Ingushetia, on 9−11 November, the Sanitary Epidemiological Surveillance Se r-vice/MoH/RF in collaboration with MoH/I and with support of UNICEF and WHO con-ducted a seminar on the Expanded Pro-gramme on Immunization (EPI). Training sessions were attended by 61 medical and ep idemiological staff from Chechnya, In-gushetia and North Ossetia. One day was used by WHO experts to review the issues of a disease surveillance and early response system and to present control measures for hepatitis A in conjunction with the current outbre ak of the disease.

Seminar on Communicable Disease Emergency Surveillance On 11 November 2000, in Ingushetia, two WHO experts ran a one-day seminar on communicable disease surveillance in emergency situations. At the seminar, a t-tended by 55 Chechen medica l profession-als (epidemiologists and paediatricians), internationally recommended approaches for communicable disease surveillance in emergency situations were presented. The outbreak of hepatitis A in Ingushetia was used as one case example. The objectives of the seminar were as fo l-lows: • to provide an overview of surveillance

methods;

• to give the definition and explain the purpose of disease surveillance in eme r-gencies;

• to explain the difference and advan-tages of emergency surveillance meth-ods versus routine practice;

• to brief on key and supplementary func-tions of surveillance;

• to establish priorities; • to explain why standard case definition

should be used; and • to evaluate the emergency surveillance

form recommended by WHO. Assessment of the WHO recommended emergency surveillance reporting form was of special importance in view of its contin-ued use in Ingushetia and Chechnya. Par-ticipants agreed that the form was simple and practical, allowing for the better moni-toring of morbidity in relation to controlling measures. Participants expressed a strong wish to o b-tain more information on the existing public health surveillance systems and their possi-ble adaptation to the current and antici-pated situation in Chechnya. With this in view, WHO is considering holding more training courses on emergency surveillance and use of the WHO recommended ap-proaches for public health staff (epidemi-ologists) in the North Caucasus and on standard case definitions for local health care professionals.

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Taking into account the high levels of ARI, diarrhoeal diseases, malnutrition and other conditions in children, it might be worth combining courses on standard case defin i-tion and Integrated Management of Child-hood Illness (IMCI).

Problems and Issues of Rational Drug Use in the Russian Federation

On 14-15 November, WHO held a workshop entitled “Problems and Issues of Rational Drug Use in the Russian Federation” in Moscow for representatives of NGOs and international agencies involved in health care provision and drug supply support in the North Caucasus. The workshop was or-ganized within a programme framework of humanitarian assistance in health to the North Caucasus by the WHO Special Project on Pharmaceuticals in the NIS. Supported by ECHO, it was a component of WHO e f-forts to promo te rational drugs use concept. The overall objective of the workshop was to facilitate the work of organizations do-nating pharmaceuticals to the North Cauca-sus. The specific objective of the workshop was to inform representatives of interna-tional non-governmental organizations (NGOs) involved in health care and the supply of pharmaceuticals of the general parameters of the pharmaceutical system in the Russian Federation, prescription pra c-tices and the potential of more efficient drug use, particularly in the war-stricken republics of the North Caucasus. In addi-tion, the most frequently used drugs pro-duced locally were described and compared to western analogues. The following issues were on the agenda of the workshop: • A brief description of the Russian p har-

maceutical market in 1999-2000; • The Russian pharmaceutical traditions

and the most frequently used drugs, with an international comparison;

• A federal list of essential drugs and na-tional guidelines for the treatment of prevailing diseases; drug lists fo r free of charge distribution; regional lists of e s-sential drugs;

• The availability of medical information (clinical recommendations, guidelines and RuNet); promulgation and informa-tion; and

• The national regulation on pharmaceuti-cals (import-substitution programme, drugs donations regulation, etc.); new legal provisions regulating drug pro-curement, certification, licensing and drug manufacturing.

Workshop participants were provided with an outline of the presented information and supporting documentation. A representative of MoH/RF, who attended a part of the meeting, expanded on current country pol-icy in pharmaceuticals and distributed the guidelines: “On the importation and expor-tation of medical goods received as hu-manitarian assistance (MoH, Ru ssia. 14/05/98). There were many questions about drug donations, particularly questions on donated drug registration procedures, rules for import and export of donated medical products, and recommendations on the choice of drug manufacturers in Russia and abroad. A format for claiming donated drugs was also discussed, among other is-sues. The participants appreciated the importance of rational drug use and therapy regimens and called of the holding of short-term seminars, organised by WHO, for the medi-cal staff working in the North Caucasus (with the participation of NGOs). It was also decided that WHO guidelines addressing rational drug use problems would be a use-ful educational tool. It was agreed that an inventory of activities carried out by various NGOs and by inter-national agencies in the North Caucasus is needed in order to improve the efficiency of humanitarian aid. Mine awareness On 20-27 November, UNICEF and UNHCR conducted a mine awareness seminar for 40 teachers and psychologists from Chech-nya (including 15 participants from Kur-chaloy and 13 participants from Grozny and monitors from the NGOs Voice of the Moun-tains and Vesta). In Moscow, on 4-8 December, UNFPA and WHO held a 5-day seminar at the Russian Centre for obstetrics, gynaecology and perinatology on ultrasound diagnostics for obstetrician-gynaecologists. It was a t-tended by, among others, health profe s-sionals from Chechnya and Ingushetia.

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On 14 December, in Nazran, WHO held a coordination meeting on nutrition for local and international NGOs. A WHO expert on nutrition briefed on recent findings with re-gard to the nutr itional status of the IDP population and the food box adaptation e x-ercise carried out during the mission. In Moscow, on 21 December, UNFPA and WHO held, (at the Russian Centre for

obstetrics, gynaecology and perinatology) a roundtable to summarise the results of a series of training workshops on antenatal care, obstetric care and family planning/STI prevention held by UNFPA and WHO in October this year for obstetrician-gynaecologists and midwives from Chechnya and Ingushetia. The participants also worked out recommendations for a future round of training seminars.

NEWS IN BRIEF

WHO top official visits Russia

On 31 October to 4 November the Director General of the World Health Organization, Dr. Gro Harlem Brundtland, paid an official visit to Moscow at the invitation of the Rus-sian Government. During her meetings with high level p olitical and professional leaders, the country’s health emergency issues, in-cluding TB, HIV/AIDS, smoking and alcohol, were discussed. She also focused on the necessity of pursuing reforms within the health system to make it more effective and more accessible for the poor in Rus-sian.

Meeting with participants of the TB workshop at the WHO office in Moscow

Launch of the 2001 UN Consolidated Inter-agency Appeal for the North Caucasus

As part of a global effort launched by the UN Secretary-General in New York on 28 November, the UN in Moscow presented on 29 November, its 2001 Consolidated Inter-agency Appeal for the North Caucasus (Russian Federation) seeking USD 44,870,925 for humanitarian assistance on behalf of those affected by the events in Chechnya. Various UN agencies, including the Food and Agriculture Organization (FAO), the UN Development Programme (UNDP), the UN Population Fund (UNFPA), the UN High Commissioner for Refugees (UNHCR), the UN Children’s Educational Fund (UNICEF), the World Food Programme (WFP), and the World Health Organization (WHO) plan to work in the following se c-tors: protection, food, agriculture, shelter and non-food items, health, water and sani-tation, education, mine action, economic recovery and infrastru cture.

NEWS IN BRIEF

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Holiday gifts for children WHO has been distributing 1000 cosy s oft teddy bears to children in war-affected ar-eas of the North Caucasus, Russian Federa-tion. Sick children in hospitals, settlements of displaced population from Chechnya, and handicapped children in orphanages are the first to receive the holiday gifts. This humanitarian action is a part of the WHO mental health rehabilitation programme in the North Caucasus. It has been supported by ECHO and the governments of the USA and the Netherlands. It is being imple-mented with the help of a number of volun-teer organizations in Russia and Denmark.

WHO has established a small information service to assist agencies working in the health sector in the North Caucasus. This service includes an electronic library in which most manuals are available in English and in Ru ssian. Furthermore, hard copies of the English version of the Emergency Health Library Kit are available for copying at WHO−Moscow. This list below is only the most recent documents.

P lease contact us for a complete list or to contribute: (par@who.org.ru).

If you do not have e-mail, please bring a diskette to the library to obtain copies.

WHO INFORMATION SERVICES

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UNFPA: Report on a four-week training course entitled: “Professional approach to the promotion of the reproductive health of population in the North Caucasus”. Piati-gorsk. 2-27 October, 2000 (Available in Russian);

WHO: Problems and Issues of Rational Drug Use in the Russian Federation. Seminar re-port. November 2000;

WHO: Communicable disease surveillance of the Chechen displaced population in the Republic of Ingushetia. Travel report. No-vember 2000;

WHO: Assessment of the epidemiological situation in Ingushetia following a reported outbreak of hepatitis A. November 2000

This newsletter is not an official WHO publica-tion. The information is compiled by the WHO Unit for Emergency Health Coordination for the North Caucasus, and is intended for public in-formation. For comments, please contact: par@who.org.ru or Irina Tarakanova, Tel.: 787 21 12. Contact address of WHO in Moscow: 28, Ostozhenka str., Tel.: 787 21 52/12.

List of abbreviations: ARD: Agency for Rehabilitation and Development ASF: Danish Peoples Aid CPCD: Centre for Peacemaking and Community Development DCA: Dan Church Aid DDG: Danish De-mining Group DRC: Danish Refugee Council EMERCOM: RF Ministry of Emergencies ICRC: International Committee of the Red Cross IMC: International Medical Corps MDM: Medecins du Monde MoH/I: Ministry of Health of Ingushetia MoH/RF: Ministry of Health of the Russian Federation MoH/Ch: Ministry of Health of Chechnya MSF-B: Medecins sans Frontieres-Belgium MSF-F: Medecins sans Frontieres-France MSF-H: Medecins sans Frontieres-Holland OCHA: Office for the Coordination of Humanitarian Affairs PINF: People in Need Foundation PHO: Polish Humanitarian Organization RRC: Russian Red Cross UNFPA: United Nations Population Fund UNICEF: United Nations Children's Fund UNHCR: UN High Commissioner for Refugees WFP: World Food Programme WHO: World Health Organization "Zaschita": All-Russian Centre for Disaster Medicine "Zaschita"

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