As Chechen Conflict Ebbs, Critical Humanitarian Needs Still Remain

It has been nearly four years since the most intense fighting subsided between Russian government and rebel forces in the North Caucasus and republic of Chechnya. Tens of thousands of internally displaced persons (IDPs), who had fled to the neighboring republics of Ingushetia and Dagestan, have returned to Chechnya. At the same time, reconstruction has increased in the Chechen capital, Grozny, the scene of indiscriminate bombing less than a decade ago, and the republic's airport has been reopened. Yet the Caucasus region remains highly volatile.

Fighting outside Chechnya has increased and a large military presence still inhabits the region. Abductions, disappearances, assassinations, and bombings continue in Ingushetia, North Ossetia, and Dagestan.

Inside Chechnya, the security situation is still precarious for civilians. Dangers may range from being caught in the middle of sporadic gunfire to getting into a car accident involving heavy military vehicles, the latter recently having become a common cause of trauma. Basic health services, particularly in the areas of obstetrical and gynecological care, are woefully lacking and, when available, remain out of reach for many impoverished returnees. Through clinics in and around Grozny, MSF and local Chechen doctors see a population with high levels of chronic illness, including lung, kidney, and cardiovascular diseases.

Furthermore, the MSF teams also witness widespread needs for psychosocial care, caused by years of exposure to violence and displacement. An MSF survey of IDPs living in temporary accommodation centres in Ingushetia and Chechnya found that nearly all the people interviewed were suffering from anxiety, insomnia, or depression. Chechnya's wars also took their toll on the republic's tuberculosis (TB) control system. As a result, MSF supports TB hospitals serving a population of 400,000. And many survivors of the wars still need care for crippling injuries. MSF has tried to meet some of this need by operating a reconstructive surgery programme in Grozny hospital No. 9 since 2006.