Chechnya Stricken by TB

An epidemic of tuberculosis is raging through Chechnya, virtually unnoticed by the outside world.

According to Khisamidin Isayev, a leading specialist with the republic’s health ministry, one person a day is dying from the disease.

Russia as a whole has a high incidence of TB by world standards, with an average of 86 sufferers per 100,000 of population. But in Chechnya, the health ministry estimates, the rate is truly catastrophic, with three per cent of the population sick affected.

The World Health Organisation is aware of the problem: its specialists monitored the disease in the republic in 2001-2 and allocated three million US dollars to a programme aimed at fighting TB. However, because of security concerns, the scheme is operational only in Ingushetia, the neighbouring republic to Chechnya.

A TB clinic has opened at the Nazran hospital in Ingushetia – which also has a serious TB problem – while there is so far no equivalent large medical centre in Chechnya.

The rudimentary health system in Chechnya has all but collapsed. The two largest hospitals in Grozny are both in ruins and another in the northern Shelkovskoye region is barely functioning. Formerly, the republic had the facilities for treating 1,200 TB patients at a time. Now it has the capacity to deal with just 150.

Zarema Khaidarkhanova, who heads the TB department at the hospital in Gudermes, said that they were tending to 46 patients, while many others had to be treated at home.

“We cannot give the outpatients medicine, there is only enough for those who in the hospital,” Khaidarkhanova told IWPR. “They have to buy their own. And it’s not only the patient who needs the medicine, but the people looking after him or her, so they don’t get infected. Most families don’t have the money for that. That means that one person gets sick, it poses a threat to the whole family.”

A lethal combination of factors is helping spread the disease. One is Chechen customs. Tuberculosis was widespread in Chechnya even in Soviet times. The men used to travel to distant regions of Russia to find work and laboured there in unsanitary conditions. Women and children working on tobacco plantations in Chechnya also got ill.

Nowadays the risk comes more from Chechens’ habit of going to visit a sick friend or relation.

The Umkhayev family in the village of Mesker-Yurt consists of a mother and seven children, all of whom now have TB. Only the eldest daughter, who recently got married, is having treatment. The others do not even know where to go to be treated. And it now transpires that many of their visitors have contracted the disease as well.

War, homelessness and flight are also taking their toll and the continuing brutal tactics of the Russian military in Chechnya directly contribute to the spread of the disease. In August 2000 the father of the Umkhayev family was led away by soldiers and his corpse was found in a pit near the village not long afterwards. The loss of a male breadwinner means his family cannot afford to get proper treatment.

In March 2000, a man who calls himself just Yury K was taken from his home and brought to one of Grozny’s police stations because he had no identity documents. He told the policemen that he was ill with TB but no one listened. He was put in a cell with a group of men who were weakened by beatings, torture and hunger. Because of Yury K, they then succumbed to tuberculosis too.

“Tuberculosis is a social disease,” explained Ruslan Abdullayev, who runs the TB clinic at Gudermes hospital. “The state is responsible for spreading it and it’s the state’s fault that people live in such awful conditions. That’s why TB has flourished like this in Chechnya. The state has to change this situation.”

Ruslan was speaking to IWPR in a crowded office in the hospital. A few meters away another doctor was examining a patient. The doctors have to make do with three small rooms and none of the special equipment they need.

The Gudermes doctors used to have a good building but it was taken away from them by the OMON, or special police force, from the city of Kaliningrad. The same is true of two other health centres, the Shatoi hospital, which now houses a military headquarters and the Grozny railway hospital, also taken over by the military.

For the past three years, efforts have been made to turn a former kindergarten in Zavodskoi region of Grozny into a new TB clinic. But work is going slowly because there is no money to finish the job.

Lack of funds has also hit the availability of mobile X-ray machines. Only two remain of the 40 Chechnya had before the war and even they don’t work because of a shortage of film or petrol.

Recently, supplies of the vaccine tuberculine arrived in the republic after many delays. But they are enough for only 80,000 children, which will leave many more unprotected. And to be fully effective, every child needs to be vaccinated three times.

Russia’s health ministry has drawn up a programme to combat the spread of TB in Chechnya and pledged more than five million dollars for it. But Isayev says there is no guarantee they will be given the money.

And while the waiting goes on, every day the number of casualties of this war, fought without bombs or mines, is growing.

Natalya Estemirova works for the human rights organization Memorial in Chechnya.