Chechnya - Ingushetia: Testimonies and sanitary data

Contents
The refugee and displaced persons camps|
The camps in Chechnya
The camps in Ingushetia
Observations on Health
Difficulties of access to health care
Main diseases
Violations of international humanitarian law
Eyewitness accounts
Difficulties of access to the populations
The Grozny survivors
The protection of medical personnel
The protection of civilians
Summary executions and the filtration camp
Médecins du Monde’s position
Médecins du Monde in Chechnya

Refugee and Displaced Person Camps

Camps in Chechnya

Sernovodsk, Argun, and Gudermes

The responsibility of the devastated population falls under the authority of the Russian Ministry of Emergencies, whose mission is to ensure the moving of displaced persons and to bring assistance to the population in the camps.

Our practice of having these camps (buildings, tents, trains) in the towns of Argun, Gudermes, and Sernovodsk, allows us to point out the insufficient levels of material for alimentary aid (very irregular distribution of food), sanitation, and medical aid.

For fear of reprisals, a large part of the war-torn population prefers to avoid places controlled by the Russian authorities. The wounded and the sick do not have access to medical aid. Evaluated at 100,000, this displaced population has no access to Ingushetia, and lives in an extremely precarious state (40,000 in Grozny, 60,000 to 100,000 in camps or in various devastated towns).

Sernovodsk Camp

The camp at Sernovodsk, comprised of freight cars, is near the border between Ingushetia and Chechnya. On the morning of December 17, the Ingushetian authorities organized the departure of the first thirty-six cars of the camp at Severny (Ingushetia) towards Chechnya. The first cars, having left for Sernovodsk (in Chechnya), are parked along a small ruined train station, 2 km from the center of the village. Before the trip, only the occupants of the first seventeen cars were informed of the departure, and three days worth of food supplies was given to them. The nineteen following cars left without provisions, with only enough time to gather up the children. At the beginning of January, ten other cars were taken to Severny. Today, at Sernovodsk, 2400 people, 800 of whom are children, are living in 47 freight cars.

The hygienic conditions are minimal: there is neither laundry detergent nor bleach, only soap that came three months ago. The MTchS (Russian Ministry for Disasters and Emergencies) is studying the possibility of bringing soap. Water sources exist but the water is not potable and interruptions are frequent and can last two or three days. A water truck provides water to the cars (for three days) but very irregularly. This allows the heating of the cars and the preparation of tea. The head of each car is in charge of collecting coal, brought by the MTchS of Sleptsovsk. Nevertheless, not everyone profits equally from the arrivals: the strongest take their supply first. With ironic humor, one woman declares: "If we stay here, Sernovodsk will become a real desert. We’ve cut down almost all the trees." There is no shower, but a bath/shower tent is in the works. The women wash the clothes in a hot water spring.

The supplying of food is uncertain. Almost every ten days, the refugees receive: 200g of tinned meat, 30g of tea, 250g of sugar, 130g of pasta, 400g of buckwheat, 350g of cabbage, and 400g of bread. Only the children got two mandarin oranges and an apple for New Year’s.

Camps at Argun and Gudermes:

Argun is 10 km east of Grozny; Gudermes, 25km. In each of these towns are two camps, installed in two large apartment blocks. These were already occupied during the first war (1994-1996). These apartment blocks have been torn by shells: stairways full of holes, broken windows, demolished walls "without water (one water supply, in the middle of the square), without electricity or heating. These apartments are standing in spite of everything: all around, the brick houses have been completely destroyed. The families room in apartments, as far up as they can get. Children loiter in the stairways, made of debris and holes, on the steps that still exist" they wait. The roads, underneath the mud, destroyed by the bombings, are difficult to travel. There are 1500 displaced Chechens in the camps at Argun and 2000 at Gudermes. Many people come from all around for medical aid and food.

Médecins du Monde has, in these apartments, a consultation room, a storeroom, and a classroom. In the Chechen camps, the organization brings medical and psychological aid to the homeless. In each town are two occupational therapists and two nurses (around fifty consultations a day: the room is always busy). Médecins du Monde attempts to assure the psychological well-being of the children in therapy workshops. The objective is to create a space for games, and to work on the troubles and traumas by using different activities: role-playing games, drawing, model-building "it is astonishing to open a door of "the broken-down apartment" of Argun and find yourself in "class": colors, garlands, drawings"

Camps of Ingushetia

Sputnik, Karabulak, and Severny

There are three main refugee camps in Ingushetia: Sputnik (9000 people) and Severny (7000 people), near the Chechen border, at Sleptsovsk, and Karabulak (9000 people), 20km away, on the road to Nazran, the capital. Nearly 260,000 Chechens are now refugees in Ingushetia. 75% of them live with Ingushetian families who take in and lodge refugees or rent them houses.

25,000 of them benefit from free basic health care nearby. Médecins du Monde is present at three medical centers (one in each camp) and two tents dedicated to "mental health" programs: at Sputnik and Karabulak.

• The camp at Karabulak is made of tents and freight cars. Below an embankment, a road separates the camp of tents from a long train of freight cars. 9000 refugees are housed in these two areas. The population, however, is often much larger since refugees staying with local families or in nearby sheds also come to the camp. Far too many people live in the tents, where many single women must share living space with unknown men. In light of cultural traditions, this is a daily humiliation piled on suffering that is already much too heavy. Many families are thrust into misery. Children stay inside the tents, having no shoes or warm clothing.
• The camp at Severny is made up of a long train, 160 freight cars (2 km long) in an arc atop a hill. Below, on the other side of a muddy alley, the common area: potable water (brought by water trucks), showers, a school soup is distributed once a day. The position of the train, high up (at least a meter of ground), complicates the movement of 7000 refugees: a difficult and perilous descent, an ascent made easier by wooden stairways.
• Sputnik is an enormous camp of tents situated in open country at the foot of dry hills. These military tents are lined up along muddy alleyways. Twenty to fifty people are sheltered in each one. The families separate themselves to find space more easily. The refugees keep warm by virtue of a stove situated in the center of the tent. At the entrance to the camp, in a dilapidated building, are communal showers and a central kitchen. One meal is prepared daily. Within the camp, the only water source is near the latrines, which lack doors: they have been burned for warmth The last personal effects and jewelry have been sold. Many things are bought, such as wood for the stove.

Observations on Sanitation

DIFFICULTIES WITH ACCESS TO MEDICAL CARE

In Grozny:

Since November, the medical buildings in the capital have been demolished.

So have the buildings for assistance, cellars used as centers for surgery, and peripheral buildings. Since February 1, we have been denied access to the only surgical building that Médecins du Monde occupied, on the outskirts of Grozny at Stara-Sunja.

In Grozny and other nearby bombed towns, only the wounded who can be moved and transported individually can be accommodated by the surgical centers.

The seriously wounded have no choice but to die where they are. At the current estimate, less than 50% of the wounded have access to a hospital.

In Grozny, all accounts agree that in general it is impossible for people to leave their cellars in order to be treated.

In surrounding towns:

From the start of our evaluation of the eight buildings used by Médecins du Monde, we could see:

• the risk involved in accepting patients, the lack of an emergency unit, the possibility of moving only 50% of the wounded to the hospital in another town 30 to 50 km away;
• the lack of responsibility for medical supplies (IV’s, medications) and food for the families;
• the inability of the hospitals to accommodate the demands of the situation: many of the wounded and sick are afraid of identification and possible pursuit or detention.

Nevertheless, the medical personnel exhibit remarkable motivation and, despite not having been paid for two years, continue their work in the hospitals.

All of the people that Médecins du Monde teams examined who were wounded from the intensive bombing showed serious traumatic injuries, often needing amputations. The buildings being used generally have no more than a hundred beds, and these are rapidly filled. The medical personnel are insufficient, but they ensure at least a minimum of care using a minimum of material.

The worst of the wounded and those with neurological injuries die for lack of the possibility of evacuation to Ingushetia.

In four months, the hospital at Nazran received only 251 wounded.

The level of psychiatric assistance in Chechnya today is almost non-existent. Two psychiatric hospitals were operating in Chechnya until the bombings began. The hospital at Kakan Yurt was completely destroyed and the resident psychiatrist was killed in November. The hospital at Darbankhi was 80% demolished and of the 150 patients who lived there, no more than twenty survived in the awful conditions. Five people died of starvation in November.

In Ingushetia,

On top of the Ingushetian population of 350,000 inhabitants, benefiting from only a minimal health system, is added the population of 180,000 to 200,000 refugees, causing an overflow of the existing structures (five hospitals, a total of 1040 beds).

Access to these buildings for the refugees without financial means is hampered by payment for medicine, examinations, and sometimes doctors.

Thus, the only possible access to primary medical care is in the camps, which excludes the refugee populations in villages or in buildings, mosques, schools, etc…

In the Nazran maternity ward, 1200 new Chechens have been born since October, and more are born in tents and freight cars.

Main pathologies

State of physical health

The medial state of the population encountered in Ingushetia and Chechnya is alarming (statistics as of January 2000):

• more than half the population examined had respiratory diseases (pneumonia, bronchitis ORL): 58.6% of children, 54.7% of adults. Living in cold tents with close personal contact has led to a widespread cold and flu epidemic.
• 11.9% of children and 15.1% of adults are affected by intestinal disease (gastritis, diarrhea) due to poor food, malnutrition, and poor water quality.
• 35% of children suffer from malnutrition. All of the patients suffer from dehydration and weight loss from 5 to 10 kg.
• 4.6% of children and 8.4% of adults are affected by cardiac disease (arterial hypertension, heart sickness) due to humidity, cold, or aggravation of other medical conditions and poor medical care.

Overall, on the subject of the general health of the population:

• 30 to 40% have dermatosis and all are living in seriously unclean conditions, without the possibility of hygienic aid for months, with scabies, lice, eczema, and frostbite.
• 90% suffer from physical and psychological exhaustion.
• 70% are anemic.

The mediocre state of sanitation, the absence of vaccinations for children, and the overcrowding of facilities only aggravates the state of health of the population and heightens the risk of epidemic.

State of mental health

Psychological treatment is considered to be a task above and beyond the emergency mission, and assumes conditions of symbolic repair that may never be possible given the impunity of Russian aggression. All the same, the immediate response to the different manifestations of a traumatized life (psychosomatic problems, irritability, insomnia, serious depression, anxiety, impaired psychiatric symptoms) allows the partial healing of suffering and contributes to the prevention of PTSD (Post Traumatic Disorder).

Today, the entire population has fallen victim to psychological trauma and 25% of the people have serious psychological trauma. The winter climate conditions, the poor environment (poor living conditions), insufficient food and the uncertainty of the future are all aggravating factors. They translate to aggressiveness, instability, anguish, and insomnia for all the refugees.

The trauma is linked:

• to direct effects of an extremely violent war against the civilian population.
• to the living conditions of refugees and displaced persons outside combat zones.
• to the revisiting of recent psychological injuries, linked to the deadly war in 1994-96, especially for children.

The majority of refugees arrived in Ingushetia before October, having fled to avoid the combat and the violence against civilians. All experience a deep feeling of helplessness. Women who are on their own, of which there are many, are in a particularly fragile state, not without consequence for the children, especially the very young. On top of the heavy difficulties of everyday life are piled the absence of prospects for the future and a distinct fear of returning to Chechnya. This fear has risen with the return to Ingushetia of families who tried to re-enter the so-called "liberated" areas without success. For the survivors of the bombing of Grozny who have seen the wounded dying all around them, who have witnessed killings and massacres, who have been victims of violence and humiliation, the psychological trauma is deep and will probably lead to irreversible psychological consequences.

Violations of International Humanitarian Rights

The Geneva Convention, in Additional Protocol II, relative to non-international armed conflicts, presents two principles: "Every person who is wounded, sick, or a casualty, whether or not he/she took part in the conflict, will be respected and protected"; "Sanitation and religious personnel will be respected and protected" "Sanitation personnel will receive all available aid; no constraint will be placed on these personnel in an attempt to make them perform contrary to the ethics of their profession."

The testimony compiled in this statement reveals, with no possibility of ambiguity, the violation of these basic rights.

THE COLLECTION OF TESTIMONIES

For 20 years, Médecins du Monde’s job has been to heal the most vulnerable populations, but also, through its function as a witness, to denounce human rights violations and especially the hindering of access to medical care.

In the case of Chechnya, a person in charge of collecting eye-witness reports was sent in December to the Chechen refugees: his job was to retrace the journey of patients from the beginning of their malady to their arrival at a center run by Médecins du Monde. These journeys have stopped because of the war. This halt of medical availability is directly linked to disrespect for international law.

The collection of testimony requires a certain degree of delicacy: it involves spending a great deal of time listening to people before bringing them to tell their story. Many are scarred from stress, fatigue, and sickness. Two types of person were interviewed:

• the medical teams of Médecins du Monde attest to the consequences of the war and their patients’ lack of access to medical care;
• the patients themselves, sometimes during their medical exam, recount the events through which they have lived and their medical history from the beginning of their sickness. For the wounded: the circumstances of their injury, the conditions of access to aid, the story of their displacement, etc.

DIFFICULTIES OF ACCESS TO POPULATIONS

Médecins du Monde is the only humanitarian organization to intervene in Chechnya. This presence has held up due to the fact that Médecins du Monde, since 1995, has never left Chechnya and has run all its programs thanks to important local personnel. Outside Médecins du Monde is a humanitarian desert and we are saddened by it.

DIFFICULTIES WITH ACCESS TO AID

Since the fall of Grozny (January 31 - February 2), there have been an estimated 80,000 to 100,000 displaced persons within Chechnya. This population roams about, in distress, without medical or nutritional aid. In principle, they are under the protection and aid of the Russian Ministry of Disasters and Crises, which must transport them to the refugee camps from the ruined towns and periodically provide them with basic foodstuffs. This population is the poorest, often aged, and unable to leave for Ingushetia. This accounts for their precarious situation and the degraded psychological state of more than 25% of the people. The completely impoverished state of the medical dispensaries and hospitals leaves little opportunity for medical care.

Nazran, January 8, 2000. A member of Médecins du Monde tells us:

Yesterday, having celebrated Aïd, a mandatory (and welcome!) rest, we decided to go to Chechnya to Gudermes and Argun, to the refugee camps and the hospital. A "wild ride" which stopped at Pervomaskaia, in front of the bridge that crosses the river Sunja, at the entrance to Gudermes. Salman Radouev had just retaken the town two hours before. There were shell blasts and gunshots. Sometimes fate works in our favor. In fact, we had left two hours late on account of the arrival of a delivery of medicine originally scheduled for Monday.

Hospital at Sleptsovsk, January 13, 2000 in the trauma ward (40 beds, 51 patients of whom 46 are casualties of war). First room: three beds in the room, two women, bed-ridden with injuries. There are five women in all. Leana, five years old; her aunt speaks. The child watches us without opening her mouth: "We come from Grozny. We left November 27 for Martan Chu. We stayed there for one month, then went to Urus Martan. She was injured January 4. Her sister, her brother, her mother and her aunt died that night. Her father is in the Ukraine, divorced. We stayed in the cellar for three days because there were explosions all the time. Her head, her hips, and her leg were injured. She had the beginnings of gangrene but now it’s all right. We couldn’t get to the hospital right away but a doctor managed to get to us and give us some basic medical aide. On January 7 I brought her to the hospital at Urus Martan but it was difficult to treat her there. The conditions weren’t at all favorable. I brought her to Goikhi. Here I can buy medication: analgine, demodrol, pelomekol. I’ve already spent 1000 rubles. We have to stay here another month."

Madina, 22 years old; it is Madina’s mother and aunt who explain: "We are from Samatchki and have been here for three months, day and night. She has already had two operations on her right leg (she has pins in it now). We’re waiting for the third, scheduled for next week. Her right hip is also hurt. During the first war, her left hip was hurt, July 28, 1995. She was going out of the cellar around 9:00 in the morning to look for water and she was wounded. We couldn’t get her out until two days later because we had to wait for a passage. My house was destroyed, she’s all I have left now. We arrived by bus at Urus Martan passing the posts long after they were closed. Since she was injured they let us pass, after ten hours of waiting. At the post, in the line of refugees, there were many injured and someone opened fire on us. There were fifty-seven killed. We were five or seven meters from the shots. I don’t know how we’re still alive."

In the second room, Aslambek, 28 years old, arrived from Grozny two days ago. His right leg has gangrene. Except for his name, Aslambek can’t answer questions. He begins a sentence, tears well up. He stares at us. Moussaev, his neighbor: "I’m 41 years old. I’m waiting to be transferred to another hospital or else to go home. I was injured in the elbow on November 15 at Goiti, in a "liberated"area. I was a civil servant in the ministry of migration until 1997; I would like to work. They shot a missile that killed twenty people and injured at least a hundred. I received the first medical aid at Stari Atagui and then went through Tcheri Yurt, Chali, and arrived five days later at Sleptsovsk."

In the hallway, Saïd, 30 years old. His sheets are dirty and blood stained. In a corner, an old woman, his mother watches over him. His left thigh is injured. He shows us some x-rays. He tells us: "We’re from Grozny, from the textile neighborhood. I was injured January 7 by a missile explosion. My friend was killed right next to me. Two days later, I managed to get to the war hospital wearing a white flag. The next day, I arrived at Sleptsovsk. I haven’t had an operation yet because they don’t have the right equipment. I have to go to the trauma center at Kurgan. But we have no money. There might be a possibility at Nazran. I only know that I’ll lose my leg if I don’t get an operation."

Ousman, 25 years old, his mother calls to me while her son is carried to the entrance to smoke a cigarette. He was injured at Goiti on November 15 by missile shrapnel: "It took ten days to get here. His toes were rotting. We’ve been here for two months. My first son died in the first war. I only have him [Ousman] left. The doctors haven’t told me if an operation is necessary or not. They haven’t told me anything. I bought an ointment but I don’t know what he needs."

January 4, 2000 Sputnik camp (Ingushetia). The story of Valit, 12 years old, is told by his older brother.

"Around four in the morning on October 18, I woke up. A huge noise filled the house. A shell had just landed on us. My mother was crying. She tried to get my sister out from under the rubble. For I don’t know how long we tried to get them out, it seemed like hours. We reached the cellar. My mother improvised a bandage for Valit’s hand. The firing didn’t let up. We had to wait. We went out several times but we had to go back to the cellar because they were bombing all the time. By the time we got out it was daytime. Our neighbor brought my parents and Valit to the hospital at Urus Martan." At Urus Martan, Valit was anesthetized. The surgeons cut off his thumb. He says he didn’t feel sad but shouted for someone to help his sister. Then he was evacuated to the hospital at Sleptsovsk because the one at Urus Martan was bombed. Two weeks later, the wound opened, he lost blood and his thumb was infected. There were still two pieces of shrapnel. He had another operation without anesthetic. Until November 1 his family lived with people of Sleptsovsk, then arrived at Sputnik. "Now, Valit just goes to the dispensary for new bandages. But he’s changed. Before he lost his finger, he joked all the time. Everyone wanted to play with him. He was sort of the leader of the children of Guiki. Now, he doesn’t play with kids his own age and always looks for protection from older kids or adults. When he tells about what happened, he always says that if he hadn’t pushed my sister against the wall, the roof would have killed her. He’s very happy that he did that. In the tent, I often see him trying to do things. He wants to help my mother, but he can’t handle the teapot. We don’t know when he’ll be able to have plastic surgery. The surgeon said it needs to be done as soon as possible." Rosa, psychologist for the children from Médecins du Monde met him January 6, 1999. He was constantly smiling, a sort of grimace, but his eyes were sad, she recalls. He always has solitary games. He seems to act normally, sleeps well, has a good appetite. His parents think he’s fine. On the other hand, Rosa thinks he needs psychological support even though he can talk about the events with ease: Valit saw his grandfather die and his neighbors killed.

THE SURVIVORS OF GROZNY

After the different strategic phases: bombings, nearby clean-up and street fighting, securing of sectors, part of the surviving population can come out of the cellars. We met them around Grozny and in the Chechen camps (Sernovodsk: freight cars and an old agricultural/technical school, Gudermes and Argun). All of them recounted their dramatic escape: brutality, rape, summary executions of Chechen men. The streets littered with bodies. The psychological trauma is serious for 100%; skinniness for 80%, of whom 20% are excruciatingly thin; anemia 70%; gastrointestinal problems 40%; dermatosis 30%.

One of the last surgeons still present in Grozny told us of his flight from the town with the sick. Arrested with his medical team at Alkhan Kala on February 2 as they evacuated the last wounded from Grozny, he was released a week later at Gudermes. They were the only people working in the cellars of Grozny after the bombings and the destruction or closing of every hospital in the capital last October and November.

I haven’t always agreed with what was going on around me, but as a doctor I have never doubted my actions: staying to cure the sick, especially since most of them were civilians. Even while Russian soldiers were arriving at the hospital, I stayed up to make sure they were healed correctly like the others. Anyway, as a rule I sent our female doctors to take care of them first. Once they felt secure, the male team took over. My principle has always been that once a person passes through the door of maternity ward no. 2, they have no nationality or color.

I operated in Grozny until January 6. The night of January 1, while I was operating, the walls were shattered along with the roof, and I finished the operation in the open air. Nobody was hurt. It was a very large bomb that fell. The cellar was destroyed, so we had to clear it out. The neighbors helped us and three people were killed in the bombings. The next day, we withdrew to the center of town in a bunker. Anyway, on January 8 another big bomb finished the maternity ward off completely. We thought we were safe in the bunker, but one night the hospital was bombed. Fortunately there was nobody in the operating room.

The team was made up of twelve doctors: three surgeons, two trauma specialists, three anesthesiologists, and four general practitioners. We had three hospitals in Grozny: the cellar of maternity ward no. 2 where we operated on the injured, another place for the post-op and recovery, and a third at Staraia Sunja for those not as seriously sick. In four months we performed 6000 operations on 4000 wounded people.

As for the combatants, each group had its own surgeon. In each section, a doctor decided where to send the patient. At our three health centers there were two doctors so that a sick person could get the quickest possible access to the necessary treatment. Each group had its own method of transport and an evacuation never took more than two hours. The drivers knew the roads that were safe from snipers. None of these "taxis" was hit by gunfire. We took three or four hours of rest per day. Our number, important in the case of trauma specialists and surgeons, is what saved us. The people who arrived were mostly aged and Russians, wounded. I think a lot of people are still in the cellars, around 40,000. In fact, we operated mainly on civilians. Many of the patients from the hospital at Gudermes passed through our hospitals. We took care of their evacuation, but often the aged didn’t know where to go. As far as surgical equipment, I had taken care of my reserves in 1995. I applied to the Red Cross, Médecins du Monde and I got all the instruments for vascular surgery and all the material for sutures.

On January 30 we took our last injured because there was going to be a secure corridor on the 31. I left with eighteen doctors in the direction of Alkhan Kala. The wounded (to all appearances the commanders) were transported by another team (the combatants, I suppose), 105 people of whom 73 were injured. There was heavy fire and it was a major effort just to reach the Sunja river. We walked for 35 km but we couldn’t get to Alkhan Kala directly. As such, we stayed at Zavadskoï (a part of Grozny). It was impossible to pass the checkpoint. It was one in the morning. The "corridor" was actually mined, with only a narrow path, like a sidewalk, that was safe. We were only fifty meters from the river. There, I heard a soldier shout "Don’t pass or we’ll fire." So I gave the order to my team to retreat but I quickly realized that we couldn’t go backwards. If we took the un-mined corridor they fired, and the field all around was mined. In light of this, we continued a few meters forward and found ourselves in a ditch. We stayed there for about ten minutes without moving. Some combatants showed up and declared "We’re going to free up the passage." Five or six were killed: they stepped on mines. Only their clothing was left on the ground. There were gunshots everywhere. Despite all this, we went out. When we arrived at the river, a rocket exploded a few meters from me. When I regained consciousness, someone in the group was dragging me.

When we got to Alkhan Kala there were already a lot of wounded people. I had never before smelled the odor of blood so strong. All the emergency aid they had there, it still wasn’t enough. We stopped the hemorrhages and performed a few manipulations to save some lives. We worked for twelve hours in that place with window and doors wrecked. Rockets were falling. There were six more injured. I asked the representative of the population to do something, either finding medicine or transporting the injured. He left to go find some buses. He said he’d help us, and that way we’d be able to transport people to the hospital at Urus Martan. We believed him. So, we took the bus. Needless to say, I had doubts as to the honor of our enemies. We found ourselves in a completely different place with our patients. Everything that happened next, I can’t tell you. Afterwards, the FSB (ex-KGB) became interested in me around the third day. They wanted me to tell them that we helped the fighters. They even accused me of being one of them. By examining my fingers, they decided that I had been using a gun because the skin was harder, when it was actually from pulling the threads of the sutures!

PROTECTION OF MEDICAL PERSONNEL

Since the beginning of the war, the Chechen medical buildings have been methodically and systematically bombarded. Since the beginning of February, medical teams have been imprisoned. Around February 7, Russian soldiers have moved on the hospital at Alkhan Kala and taken away the medical team. Fifteen doctors and three nurses as well as their patients, all in all 114 people were taken to the filtration camp of the NGDU (Direction of oil extraction) at Tolstoï Yurt. Two days later the medical team was taken to another camp at Tchernokoz. A new director was named, but the medical team wasn’t replaced. We don’t have information on what became of the patients.

PROTECTION OF CIVILIANS

In one week, five towns were razed in the south and west of Grozny (Alkhan Yurt, Chami Yurt [Feb. 2], Katir Yurt [Feb. 3], Guekhi Chu [Feb. 4], Chalaji [Feb. 5]) with a high cost of human life. The hospital at Atchkoi Martan took in 73 seriously wounded civilians in four days, of whom ten were children with grave war injuries: head trauma, thoracic, abdominal, limbs in need of amputation. Ten wounded died because they couldn’t be evacuated to Ingushetia. The closing of the border is in effect and the hospital at Nazran has only received one patient in recovery since that closing. Unfortunately, we can’t count the number of seriously injured who have no choice but to die in their bombed towns because they can’t be transported.

Sernovodsk, freight car 18, February 8. An encounter with some escapees from Grozny, blind, aged, paralyzed, having arrived on February 2. Tamichka, 57 years old, almost blind: When we left the cellar, they began to search us. There was a young man with his mother. They made him strip down and searched him. My grandson, twenty years old, was also searched. Then they asked us to wait while they went to search for food and water. They promised to take us to a hospital. While we were living in the cellar, we went to look for water at a sulfurous spring near the old club. Then we boiled it. Otherwise the boeviki brought us water. Sometimes we bought it. We had some small food reserves. We weren’t suffering from hunger. The MTchS evacuated the weakest. But they lied to us when they promised that we’d be taken care of in a hospital. We left at 8:30 in the morning and got to Znamenskoe. In Grozny the smoke was oppressive; there were lots of strong odors. It was said that ammonia had exploded somewhere, some bombs. When the federal troops attack a house, they throw grenades into the yard. They always do that. We had written in big letters that blind people lived there. We had hung a white flag as well. I can’t sit up and I have to stay there, lying down. I have gall-bladder problems. I didn’t see very well before the war, but after five months spent in the cellar my vision has gotten much worse. The cellar was very damp and drafty. For my sickness I was supposed to drink mineral water but there wasn’t any. One time we went for twenty days without eating. My body is tired from lying down, but if I sit up I get dizzy. I can’t sleep. When the federal troops learned that the cellar was full of blind people, they didn’t touch us but I heard that they tortured the Russians and Chechens who were staying in their cellars. They accused them of being Wahabi.

Piatimat, 50 years old, her aunt: "As they fired on us the Russians stole everything they could, the carpet, the TV -The kontrakniki were the worst. The poor young soldiers have nothing to eat. It was us giving them something to stay alive on. They fight and sometimes are killed by the kontrakniki. Guikhi Chu isn’t a secure area yet. Once a day two or three bombs fall and the clean-up continues. It’s another way to continue the pillage. Bassaev never killed a single young soldier. He even clothed and fed them. It’s the kontrakniki that kill them. When I was in the cellar I thought we were going to die, but Allah saved us my only thought was that it would be necessary to save the children. The soldiers were posted sixty meters from our cellar. I was convinced that they were going to kill us. We tried to reassure each other. Before, we didn’t think it was such a risk since the forest was very close by and if they had scores to settle with the boeviki it would happen in the forest. But evidently they were concerned with civilians.

Interview at Nazran on February 3 with Tamara, 43 years old. In an individual house, thirty-three people (only one man) share two rooms of about twenty square meters. Two beds and a few blankets, a table, and a television. Half of the house is inhabitable because the construction isn’t finished. The owner asks 800 rubles a month. Tamara arrived on January 27 from Grozny: From November until January 13, I was living in a cellar without water or electricity in the Beriozka neighborhood in Grozny. There were ten of us. Until January 5, the boeviki (Chechen fighters) brought us things to eat. In the middle of a serious bombing by helicopters we had four wounded and four killed, old people and children. When I left the cellar on January 13, I saw a young girl who had been burned, her fingers cut off. It was impossible to cross the street because of the snipers firing. They threw grenades into the cellars. I saw corpses in the street with their heads severed. Now, the kontrakniki (Russian mercenaries) do it so people will think it’s the work of the boeviki. Several times my sister, Reissa, went to Nazran and back to bring us tea and a little food. During the first war, the soldiers weren’t so savage. They didn’t take women and they gave chocolate to children. Anyway, they aren’t soldiers when they’re so young and nice. It’s the kontrakniki who loot, steal, and rape. My teeth hurt, and I can’t sleep anymore. Do you know where I can get help for my teeth? I spit bile. On January 28, I left Grozny on foot. The house was completely destroyed. I didn’t know what to bring. The soldiers gave us five minutes to leave and showed us the route to take. The assured us it was secure. But there were people shooting at us and some people stepped on mines. I ran into some federal troops and I asked them to do something for the wounded, to take them to Vladikavkaz to be treated. To try and save my life, I told them that it was some boeviki who had fired at us. I continued on my trail on foot. I passed five posts: Tachkala, Kataima, Ivanovo, Electro Pribor, and novi ostonovka and Sobatchevka, then I got into a bus. I told the driver that I had been walking for three days and had no money. He let me on.

Tsotsin Yurt, February 5. Since November the hospital has been set up in an old school. It has no running water and the electricity is provided by a generator. Samir tells how, a few days ago, Russian soldiers arrested nine of the sick, all civilians and even one with tuberculosis. They returned twenty-four hours later, injured, beaten, covered in bruises.

Sernovodsk, agricultural school, February 7. Vladimir, 67 years old: "I live at 130 Lenin Street, in the Minutka neighborhood. On January 14, I was outside in front of my apartment building when a ground-launched missile landed. I lost consciousness and I have bruises from it. Some people brought me into their apartment. The strongest went down into the cellar; we stayed on the first floor. My wife took care of me. Me, I never sympathized with an armed man whether he was boeviki (Chechen fighter) or a Russian soldier. But we waited for the federal troops, not because we liked them, but because we thought it would all end at last. There were no hospitals nearby so I stayed where I was. January 25 was hell. It rained bombs, constant firing, all night long" even though there were no combatants. January 31 the federal troops arrived in our building, guns at the ready, and gave us fifteen seconds to get out. We had to lie in the snow and their commander declared: "I have orders to kill everyone who stays in Grozny. Why are you still here?" We replied that we had no money to leave. So he put men on one side and women on the other. He said he would let the women live. They shut us in a cold and somber room. They shot four men. When night fell, they put us in a BTR and took us to Michurina. There, in a deserted place, not far from the Grozinskaia Selskaia hospital, they abandoned us. We spent the night outside and a MTCHS (Russian Ministry of Crises) truck arrived on February 1. It was a truck in which you wouldn’t even transport cattle. They told us that they would bring us to Znamenskaia, but I didn’t want to leave. The commander replied that I could stay but he couldn’t guarantee my safety. As such, I stayed in the truck, and here I am.

Kurtchaloi hospital, February 14. Ousman, 33 years old.

I come from the village of Petropavlovskaia. On October 26, as I was leaving the house, a mortar fired from a tank landed three meters from me. I was deafened, and when I came to all I could see was my knees. I realized that I had no legs. The bombing came at 3:00 in the afternoon. There were fifteen people hurt all around me. I saw the shredded body of a man next to me. Two days earlier another mortar landed in the village and two people died in their yard. Before the mortars started falling in the village, the federal troops used to fire out in the fields, injuring people working there, but they didn’t fire on the village. That’s why we weren’t living in the cellars.

Some people from the village found me in the street and took me to the military hospital in maternity ward no. 2. I lost a lot of blood before arriving at Grozny. I spent two days in recovery. Because of the bombings I was brought here. For a month and a half I received free medical assistance, but for two months now I’ve had to buy everything, from bandages to medicine. They count every ruble.

One of my legs is healing badly. I need a wheelchair. A man from Batchi Irt offered one for 5000 rubles. I didn’t buy it because I need to pay for medicine first.

Last week the surgeons did a skin graft and it’s not working. They give me dimedrol to sleep but it’s not enough. Lately I’ve been taking relanium.

The pain wakes me up at night, although it’s not as bad now. Often I stay awake all night. What can you think about when you’re missing your legs?

I have no hope left and nobody on whom to rely. The doctors can’t do anything except give me bandages and put cream on the wounds. They have no prostheses.

A month ago, soldiers came to the hospital to check our papers. They were there with Russian doctors asking us questions. One of the federal troops pulled back the blanket over my legs and pointed his gun at me. Then they left, promising to send salaries to the local doctors.

SUMMARY EXECUTIONS AND FILTRATION CAMPS

In order to verify that each Chechen isn’t a terrorist, a number of round-ups have been performed. For example, in the village of Stari Atagui on January 28: sixty-eight young men were taken prisoner in the middle of the night and taken to the filtration camp near Naour. Since then, there has been no news of them. The same thing happens to columns of refugees from which men are picked out and brought to unknown destinations, near Katir Yurt. The same thing happens in other areas according to the same procedure (the filtration camp at Goriatchevodsk, near Tolstoi Yurt). Reliable information on the camp at Gariatchivodsk describes a state of humiliation, torture with degrading sexual connotations and inhuman conditions of imprisonment.

Sputnik, February 17, interview with escapees from Guekhi Chu. Ousman, 42 years old: "The 3000 men of Bassaev left the village on February 6. There were checkpoints everywhere. The Russians let them pass. Maybe the fighters sold them their passage towards the mountains, I don’t know. In any case, the federal troops began bombing on February 7 at 9:00, which lasted until February 10. At night they didn’t fire, but in the daytime it was a deluge of missiles fired from airplanes, from helicopters, cannons firing, tanks and snipers encircling the village" The entire southern part of the village was destroyed. People ran for their cellars or those of their neighbors. I saw eleven people killed by bullets, a dozen wounded, and sixteen men between 20 and 26 years old arrested on the pretext of verification of identity but also to see if they were combatants [an exam of the shoulders and fingers to see if they had been marked by a gun. But in the villages with agricultural work, all the men carry their burdens on their shoulders]. February 8 we tried to get out but it was impossible. We left at eleven and the clean-up began at two. We made a white flag. They made us go out hands on the back of the neck, one by one, separating the young from the old, men from women. In my neighbors’ they shot four men after looking at their shoulders and hands. They weren’t interested in their papers. Another of my neighbors, 70 years old, was killed by a sniper. They took everything of value from the houses: gold, rugs, TV’s.They were drunk. We left on February 11 from Guekhi Chu at eight in the morning and arrived at Sleptsovsk the next day. We passed through Chami Yurt but there the road was closed. So we changed our route to head towards Katir Yurt. There they were only letting women and children pass. We waited for two hours and they let us pass. At Guekhi Chu, they hadn’t set up a command post, only check posts all around the village. There was no market or humanitarian aid since all the roads were closed. For the time being most people were living on winter reserves.

Rouslan, 22 years old, out of the filtration camp at Chernokoz on February 5, 2000. This account was sent to the newspaper Le Monde which published it in the edition of Tuesday, February 15, 2000: Russian soldiers were hitting us in the spine with hammers. I had a bed with neither springs nor blankets. They took my leather jacket, my papers, my watch. In eight days I only ate three times. The food was a little plate of uncooked couscous with a little water. In the room (the holding area) there were little holes plugged with cotton. I wasn’t allowed to lie down.

During the night, it was impossible to sleep because of the cries you heard from other cells. For 48 hours, you don’t sleep and then they beat you so badly that you pass out. I was brought here on a stretcher. I lost eight kilos. I wasn’t allowed to use the toilet for 19 days.

While the doctor listened to his chest, I went to talk to his sister. A refugee from Gudermes, the mother decided to bring her two sons to the camp at Sputnik; she thought it was safer. Rouslan was arrested at the tenth border post at Snamenka. He had no passport, only a paper saying "permission to pass ninth form" stamped with the sign of a wolf, from the command post at Gudermes. At this post, the federal troops (Russians) detained a ten year old boy and a thirteen year old girl: "February 4 they beat me for the last time and made me a present". There were four who hit me with the butts of their guns. When they brought me to the inspector so I could sign papers admitting that I was a combatant or that I had aided them, they threatened me by showing me electric wires. Thank God I passed out and they brought me back to my cell. Some of my companions had their ears cut off, teeth sawed off, shredded lips, burst ear-drums. They hit us on the sole of the foot and often the guys passed out. I never saw the faces of the soldiers since they wore masks and it was forbidden to look them in the face.

One day I looked one of them right in the eyes and got punished badly for it. At night, dreaming, I saw my cell-mates as though they were in a photo. They asked me to send news of them to their families. Before leaving, they all gave me their address. Until last night I dreamed constantly. I wasn’t sleeping more than two hours a day. But yesterday, I saw doctor Kuri and he gave me a pill. Now I feel better. During those 21 days, I changed cells three times. There was a special cell where the federal troops made you grow your beard, to exchange you for one of their own. It depended on the cell, but there were from 30 to 40 in each one. The guards watched us 24 hours a day, changing every eight hours. They abused women as well. They beat a pregnant women and raped the young women. A 14 year old girl was put in a room with men and was raped for four days. After that, some commission came by the prison and they took her.

Amongst ourselves, we could talk in low voices, only in the cell. They sent in tear gas as well. Every evening the soldiers asked the "cell leader" how many there were, and when he told them they gassed him in the face. The 14 year old girl had come to visit her imprisoned mother. Otherwise, all visiting was strictly forbidden. But with this woman, the soldiers agreed, for a price: 5000 rubles for five minutes and she could see her two daughters. When the two young girls came in, they took the 14 year old in the hallway and put her in that room full of men. The mother was in prison because she had a photo of a man in her bag and they brought her to Chernokoz, here, to explain herself. The 10 year old boy and 13 year old girl were arrested in the camp on the pretext that they didn’t have the proper papers. Now, all men from 10 to 60 years of age must have a passport or a "spravka", proof of residence. When I got out of Chernokoz there were 310 people, but nine others were bailed out with me and sixteen had just arrived. Then they brought me to Znamenka, to the checkpoint where they took me. They took my fingerprints and my picture. The next day, February 5, they let me go.

When I asked his age, he seemed to relax and continued to tell his story without responding to the simple question: The soldiers took drugs and pills. At night, they play music, drink alcohol and begin to have fun, all night long. They take people from the cells and torture them. At dawn, there are only four or five cells that they haven’t gone into. There are around 25 cells. There’s also a refrigerator and a "closed" room. That’s the first place they put the new arrivals. It’s very cold; you can see your breath. I stayed there three days. By the first hour, they beat me. They beat you until they’re too tired to go on. When their arms get tired they use their feet. All day you have to keep your hands on your neck. They tell you how to act. You are never allowed to raise your head. They are always asking where the boeviki are. I told them that I’d only seen them on television. Then they make you sign papers saying you’re a combatant. At the time I was supposed to go back to the interrogation, my family arrived to buy my freedom. A train was supposed to leave for Mozdok on February 6 or 7. If my family hadn’t arrived, I’d be there as well. The third day of my detention, a young man admitted that he’d fought in the first war. He did it to save the others in his cell. They beat him for a long time. He was the first to be shot. The others who confessed simply disappeared. Nobody had ever heard a firing squad before. Afterwards, I saw his body lying in the yard. A corpse lying on the ground. The soldiers threw their cigarette butts on him. They put him outside because they thought that someone would ask for his return. And if someone wants him back, in their eyes that makes him a combatant. Compared to my cell-mates, I wasn’t so bad off. They had broken ribs, some had even forgotten their own name from blows to the feet. It gets so bad it goes to the head. Now, I have no papers, how can I get back into the hospital? In the refugee camps they give us proof that we live there but at the checkpoint they say those are no good. Now my passage to Chernokoz is written on my documentation. For 300 dollars, you can get a passport.

End of his examination: no internal bruises but his back is broken. Serious bruises all over his body, his abdomen, and his spinal column. Abdominal pains. No signs of sexual abuse. Serious head trauma. Rouslan was beaten for at least half an hour per day, mostly with a stick. The doctor told him to get a spinal x-ray. For this, he wrote a little note to the doctor at the central hospital in the hope that he’ll do his job for free.

Staraia Sunja, east of Grozny. A young man, 28 years old, in a room, lying on the ground, between life and death.

I arrived yesterday, from Khankala (housed with a local person) where I spent three nights. The federal troops cut a deal with the boeviki and traded me for a paratrooper captain. Two days later they learned he was dead. They found the body of the captain somewhere. They said that since they had nobody to trade for, they were going to kill me.

When a soldier was killed they really went to work on me. They put a pillow over my head and beat me.

At the beginning they gave me chicken broth, but then they stopped. I was hungry. Sometimes they gave me cigarettes.

They made me lie down with my hands and feet tied. They put out their cigarettes on my arms and poked me with sticks.

All my papers were in order and I was never a fighter. Before being injured, I lived in Staraia Sunja with my sister. Two weeks ago, while my sister was away looking for a car to bring me (from Khankala) to her house, someone denounced us and I was taken by the federal troops.

Every night the soldiers came into the room. While one asked questions the others beat me on the face and the body. I haven’t gotten any medication since I was operated on two months ago. It was in the military hospital in Grozny (maternity no. 2). After the operation, I had to go home because there wasn’t even room to take in the boeviki. They took me there and I spent a week in the cellar. A woman brought me medicine and once she gave me an IV. She took care of me and washed me. It was hard to find a car which is why I spent so much time in the cellar.

It was a division with many corps: omon’, Sobor (special unit for rapid intervention), volunteers, soldiers, with General Bulgakov in charge. I asked them to free my hands and Valera, one of the soldiers, untied me. When we left there the federal troops told me I had to go by headquarters to get my passport back. But I heard the officers talking amongst themselves. They wondered what they would do with me. They wanted to send me somewhere. Thanks to that soldier Valera, I’m not dead; he dropped me off in the street.

Sernovodsk, agricultural school, February 7. Zarema, 32 years old: "I lived in Minutka with my husband. In September 1999, when the war started, we decided to stay to protect our possessions and our apartment. We hoped that the fighting wouldn’t last long or that a corridor would be provided for civilians. We didn’t have the time to leave Grozny in December. So we stayed for three months in the cellar with other neighbors. January 27, 2000, my husband Ruslan and two other neighbors were taken from the cellar by Russian soldiers. They killed them next to the house."

According to Zarema, her passport and other documents were in order. Ruslan never participated in military action.: "he was killed without any trial, any reason" I begged the soldiers to let me bury my husband. I was on the ground, crying, kissing their hands and feet, but they refused. January 31, when she left Grozny with other inhabitants of the town, she asked the soldiers again to see her husband’s body, to say farewell, but in vain; "they took me from Grozny in a BTR and then in the MTHS cars to Sernovodsk." Zarema lives with psychological trauma with other symptoms aggressiveness, irritability, suicidal tendencies, trauma repetition syndrome, hearing problems, memory problems, nightmares.

Encounter with four other women. All are very dirty and can’t or don’t want to wash for fear of catching cold. They are Russian. One of them is Chechen (Chechen women only account for two of the twenty or so escapees brought by the MTCHS) and is angry when I ask her to tell me about the conditions of her arrival: "What do you want me to say? It’s not terrible enough here. There’s nothing to eat and no place or means for washing after living like dogs in the cellars for months." A babushka picks up from there, a story full of tears: 15 seconds! They gave us 15 seconds to get out of the cellar or they would throw a grenade in. I couldn’t take anything, not even a scarf. I arrived here in slippers. When we got out, they (federal troops) separated the Russians from the Chechens. They began to look at our passports and all of a sudden a soldier fired on an old Chechen even though his papers were in order. Then they took the men to a hall. They had them take a step forwards, another backwards, and another to the side; all the while they had fun by firing on them. There were Russians who had no passport but who survived. Why do they want to separate us when we eat from the same plate? They also shot an old man who was shouting and then told us that if we spoke they would burn our brains.

Karabulak, February 19. Assan, bus driver. "I come from Kulari but I’ve lived in the camp since the beginning of November. When there are men on the bus, you run into problems. To pass each checkpoint you have to pay at least 100 rubles. If you’re wearing gold, a ring, or even if there’s gold in your teeth they can decide to keep you and take them by hitting you in the mouth.

At Kulari there have never been boeviki. The village was bombed twice: November 26 or 28 I saw two men killed and four injured, and the second time a few days later: a woman killed and six injured. Their commander came to the village to apologize: "It was a mistake" he said.

The command post was set up at Alkhan Yurt and worked for Kulari and Ermolov as well.

I also saw missiles falling on Chami Yurt on February 4. Thirty-eight people were killed.

Now, on the road, they have reinforced the troops. The omon’ and the soldiers are there in greater numbers. They say the road will be closed soon. In the three villages there’s no hospital so if you are sick you have to go 30 km to Urus Martan and past five checkpoints.

On January 25 a helicopter fired on the bus and the two cars in front of me. They went up in flames. After two days of waiting, I brought the three burned people to Nazran. I brought one whose hand was injured from shrapnel to Kulari two weeks ago. Over there life goes on since people support each other but twelve houses are completely destroyed.

At Aldi (near Grozny) they shot 106 people. (A list of thirty-six dead is circulating around the camp.) The clean-up began on February 5. It wasn’t identity papers they were interested in, but money and gold. It’s the kontrakniki who loot and shoot civilians. They all wear bands around their heads with their faces exposed and they wear the black flag of pirates. They take sofas, rugs, gold, televisions, then burn the houses. People were shot in these streets: Natacha Mazaeva, Tsemlianskaia, Pereulok2, Vorojnejkaia. Officially Aldi has been a secure area since January 5, an area for refugees. There were two journalists who filmed everything. A Russian and a Kazakh, but they took their equipment and beat the Russian. Today the village is officially closed, but women manage to arrive on foot. The bodies in the mosque still haven’t been buried. They’ve been there for two weeks.

It’s mostly old people who stay in Aldi; there are around 200.

At Chernoreché there are around 100 bodies. The clean-up began January 5 there as well. It’s the same thing at Kataiama. The bodies are taken to Salionaiai banka to a mass grave. They arrested about a hundred people and sent them to Mozdok, Pravaberejnaia and Chernakozova, to filtration camps. Chernokoz is an old prison that can hold 2000 people.

Médecins du Monde’s Position

In the case of a non-international armed conflict, as is the case in Chechnya, grave violations of the Geneva Convention, notably Article 3 also part of the four Conventions of August 12, 1949, constitute war crimes, seen as crimes against humanity by their scale, recognized as any of the acts listed below, committed against persons not directly participating in hostilities:

• Suffering brought against the life and bodily well-being, especially murder in all its forms, mutilations, cruel treatment, and torture;
• Suffering brought against the dignity of human beings, especially inhuman and degrading treatment;
• Taking of hostages;
• Condemnations pronounced and executions carried out without prior judgment handed down from an official tribunal, coupled with legal guarantees generally recognized as indispensable.

Also considered to be grave violations:

• Deliberate attacks directed against the civilian population in general or against civilians who do not directly take part in hostilities;
• Deliberate attacks against buildings devoted to religion, teaching, art, science or charitable action, historic monuments, hospitals and places where the sick and wounded are gathered, on the condition that these buildings are not begin used for military ends;
• Pillage of a town or locality, even under assault;
• Declaration of no quarter.

The collection of accounts put together by Médecins du Monde, but also by other NGO’s (Human Rights Watch, FIDH, Memorial):

• reporting on grave violations of Human Rights and International Humanitarian Law,
• including reports on filtration camps and mass executions (massacre at Alkhan Yurt in December) and summary executions (Grozny right now),
• visual confirmation by our Chechen teams and expatriates of the destruction of public buildings (especially hospitals) and the destruction of towns and villages,
• the destruction in progress of Grozny,
• the accounts and reports on the state of pillage and violence in so-called secure areas under Russian control,
• current bombings on mountain villages that hurt mainly civilians (HRW Feb. 18),
• the Russian ultimatum, given December 5 to the population and defenders of Grozny that "on December 11, all persons remaining in the town will be considered as terrorists and will be destroyed by artillery and aerial bombing"
• permitting an indisputable label of "grave violations and war crimes"

Médecins du Monde asks of the Russian authorities:

• the immediate halt to violations of basic human rights,
• free access for humanitarian aid to the territory, including Grozny,
• the possibility of independent evaluations,
• a guarantee that humanitarian assistance personnel have secure conditions in which to work.

Médecins du Monde asks the international community and the French government to use every means at their disposal, political, economic, and legal, to guarantee the protection of civilian populations in the territories of Chechnya and Ingushetia.

Médecins du Monde in Chechnya

HISTORY

December 11, 1994: Russian troops enter Chechnya

1995: Médecins du Monde takes medical responsibility, in Chechnya and Ingushetia, of six Chechen refugee camps, bringing medicine, primary health care, and surgical programs.

1996: Médecins du Monde adds a "mental health" program to its medical program. The organization makes an effort to lighten the trauma of adults and children by the presence of psychologists, educators, and psychiatrists.

1997: Increase of hostage-taking in Chechnya where the practice has become standard since the war of 1994-1996.

February 1998: Departure, for reasons of security, of expatriates of Médecins du Monde. Missions already in place are maintained thanks to the local medical team with which Médecins du Monde worked since the beginning of its intervention in Chechnya.

October 1, 1999: Russian forces enter Chechnya. Médecins du Monde is the only NGO present in Chechnya, at Gudermes, Argun, and Grozny.

October 27, 1999: The organization’s teams are forced to evacuate Grozny due to intensified bombing of the town.

TODAY

Médecins du Monde carries out programs of primary health care and mental health in Chechnya and Ingushetia. The teams work in close collaboration. The doctors, pediatricians, and also teachers have been trained to detect problems in order to be able to respond to necessity and direct the worst cases to specialists, psychiatrists, and psychologists.

The latter work by forming therapy groups, individual sessions, prescriptions for symptoms, which allow the verbalization and defusing of various manifestations of psychological trauma.

• In Chechnya, the local team is made up of eleven Chechen volunteers who carry out programs of psychological support and provision of medicine in refugee camps: provision of medicine in the camp at Sernovodsk (Chechen/Ingushetian border) or in places of important consultation activity: flu epidemics, anemia, etc. Support at four refugee camps in Argun and Gudermes: provision of medicine and materials for therapy. In Chechnya, certain hospital sites are provided with medicine and surgical material: Gudermes, Kuchatoi, Tsotsin Yurt, Novi Atagui, Strai Atagui, Grozny, provision at the medical post at Staria Sunja until the embargo on the town at the beginning of February.
• In Ingushetia, 35 local volunteers intervene in the three refugee camps: Sputnik, Karabulak, and Severny which house 25,000 refugees in tents and freight cars. Médecins du Monde carries out programs of primary health care (three dispensaries for sixty daily medical exams) and mental health. At Sputnik, the “mental health” tent takes in over a hundred children a day: a space is made for them, detached from the surrounding desolation. Through recreational and collective activity the needs of the children can express themselves, with treatment being continued through individual sessions and support from mothers. At Karabulak, it is mostly adolescents who take part in collective activities.

Since October 1999, the Médecins du Monde team has performed 40,000 medical exams and 14,000 mental health exams in the three Ingushetian camps.

LOCAL CHECHEN PERSONNEL

Humanitarian action rests on a few basic principles, one of which is free access to victims and unimpeded evaluation of their needs. In war-torn Chechnya, this is difficult, sometimes impossible (risk of abduction, bombing). Without the presence of permanent expatriates, Médecins du Monde has relied, since 1998, on local personnel and has introduced "remote control": linked with the organization, since the beginning of its intervention in Chechnya (1995), the coordinator or the administrators, doctors, psychologists, logistic staff and nurses, all Chechen, share the values and practices of Médecins du Monde. Thanks to them Médecins du Monde is the only medical NGO currently present in Chechnya. All the same, expatriates go regularly to support their action with evaluation missions.