By Asiyat Vazayeva in Karabulak (CRS No.165, 06-Feb-03)
"Why have they driven us into a corner?!" shouts an inscription in large white chalk letters. Next to it is a drawing of a Chechen landscape.
The words and pictures, drawn on the canvas roof of a tent, are the first thing each new visitor sees as he enters the Centre for Medical and Psychological Help in the Soglasie (Accord) camp in Karabulak, Ingushetia.
The artist is a young Chechen refugee boy named Ayub, who lives in Karabulak. There are dozens of pictures around the canvas walls of the centre and in picture albums, but none is as striking as Ayub's cry of despair, which sums up the fears and miseries of a whole generation of Chechen children.
"The war has brought psychological suffering to everyone it has touched," said Khapta Akhmedova, a professional psychologist who works for the centre at Karabulak. "But the most dangerous changes are in children - which can lead to post-traumatic stress disorders and have a negative influence on the whole life of the child."
Officials estimate that there are currently 291,000 Chechen children and adolescents under 18 in Chechnya itself. In Ingushetia, the figure is estimated to be 40,000, most of them refugees.
All have experienced more than eight years of conflict and violence.
Only a few organisations try to tackle the enormous psychological problems this has caused. The French charity Médecins du Monde has been working in Chechnya since the first war began there in 1994 and has set up 53 Centres for Medical and Psychological Help throughout Chechnya and Ingushetia. However, there are only around 30 trained psychologists working in the republic.
The centres have identified children as a priority. And, as those who work there have discovered, each child has experienced the conflict differently.
"Even non-specialists have noticed the difference between children who left Chechnya at the beginning of the war and those who left at the height of the fighting," said Akhmedova the psychologist at Karabulak. "It was possible to protect the first group from severe traumatic situations. And they have kept up their capacity to play, communicate and do cognitive tasks."
As for the second group, who experienced war first-hand, they tend to be withdrawn, irritable, quick to take offence or aggressive, Akhmedova said. They find it harder to adapt to normal things in life.
Alisa D from the western Chechen village of Bamut, who now lives in the Sputnik camp in Ingushetia, was one of the second category. Other people noticed how in games she became extremely emotional and agitated, then got tired and suffered from headaches and slow reactions.
Once in a group therapy session, Alisa, playing the role of a doctor, attacked her "patient", a psychologist, and held a toy knife to her throat. On another occasion, she bit her elbow. No complaints or pleas could persuade her to stop.
By visiting Alisa's family, the psychologist was able to find out about the causes of the girl's trauma.
It turned out that at the beginning of the first war in Chechnya, Alisa's mother left for the nearby village of Alkhazurovo to visit her own mother. While they were away, the Russian air force began to bomb Bamut and heavy armour moved towards the village. The villagers had to spend the nights in their cellars before Alisa's father managed to get his children out through the woods.
As they escaped, Alisa saw dead and wounded and was constantly afraid for her missing mother. It took a month of ordeals before the family was reunited in Ingushetia.
After the first war ended in 1996, Bamut lay in ruins, following one of the most intense battles of that conflict, but Alisa's family went back home and managed to repair their house. However, fighting broke out again in 1999 and on September 27 that year Russian forces again bombed Bamut. One bomb struck the mosque and killed several men at midday prayer.
Alisa's family again left the village, this time fleeing for Ingushetia. The father could not endure camp life and has gone back to live with relatives in Chechnya, increasing the anxieties of his wife and family.
Alisa is at least now outside the war zone. But tens of thousands of children are still living in Chechnya with constant fears about their day-to-day safety.
Nowhere is completely safe. On December 31 last year, the human rights organisation Memorial reported that an explosive device had been found under the New Year's tree in the centre of Grozny. Two Russian soldiers were detained in the act of laying the device and taken for questioning to a nearby police station.
Kyuri Idrisov, a well known Chechen psychiatrist who works for the charity Médecins du Monde, made another important point, addressing a recent conference organised by the World Health Organisation in Moscow - post-traumatic stress amongst adults has to be tackled in parallel with that of children.
"The psychological state of a child, especially a young child, depends not so much on what happens around him or her, as on the reaction and state of his parents," Idrisov said. "If the grown-ups (the mother first of all) experience emotional stress, it is immediately transmitted to children, even if the family is in a safe environment."
Idrisov, led an in-depth study - financed by the WHO - of the psychological health of the population of Chechnya, which has experienced crisis almost continuously since 1991.
Over three months, the specialists talked to 1400 people of different ages and social backgrounds in four areas of Chechnya.
They concluded that 86 per cent of the Chechen population was suffering from physical or emotional "distress" - about thirty per cent more people living in the Chernobyl reactive zone. Thirty-one per cent of those studied showed symptoms of ill health recognizable as post-traumatic stress syndrome.
Idrisov says that the problem has reached crisis levels and needs urgent attention.
"There is a vital need to create a centre for psychological health in Chechnya," he said. "Its function should be not only medical and psychological rehabilitation but sanitary and educational work. We have to change the awful tradition of paying no attention to people's psychological health."
Ute Enderlein of the WHO agrees but added, "The problem is too universal. It has to be solved on a state level. And the work that humanitarian organisations are doing is localised and cannot affect the situation as a whole."
Asiyat Vazayeva is a freelance journalist based in Nazran, Ingushetia