Handicap International's Work with Disabled People in the North Caucasus
By Catherine Naughton, Handicap International
Chechnya is a small territory of the Russian Federation situated in the Northern Caucasus, in the southern region of Russia, between the Black Sea and the Caspian Sea. This area is known to the world because, for the last nine years people everywhere have heard news reports from the region; people associate 'Chechnya' with war, with bombing, with kidnappings, human rights abuses, murder, landmines and most recently with terrorism.
The roots of the conflict are complex, but basically Chechnya having been part of the Soviet Union, declared its independence from Russia in 1991. Russia sent in troops in 1994 to assert Russian rule, a war went on between Chechen forces and Russian federal troops untill 1996, and ended in a peace agreement. In 1999, Russia again sent in troops and conducted heavy aerial bombardments, leaving the city of Grozny and all its structures destroyed.
As usual in such crises, the poor and the marginalized in Chechnya are the most vulnerable, and suffer the most. It is in this context that people live in Chechnya and International agencies attempt to ameliorate the situation. 'Handicap International' has been active now in the North Caucasus for two years.
Disability in Chechnya
As part of the Soviet Union, Chechnya had Soviet style health and social services. While people with disability were provided with small state pensions, most forms of 'support' were in themselves a form of marginalisation and exclusion. For example, Education and employment for people with disability was provided separately from 'normal' people, if at all. Children with disabilities largely grew up in state institutions- internats, with little prospect of employment, marriage, and life fulfilment. All of the common beliefs/ prejudices exist towards disability. There is now an additional stigma for disabled men in Chechnya: an injured/disabled man is considered to be a fighter, and an enemy of the state.
There are now 25,000 people registered as disabled in Chechnya. Through mine injuries alone this number increases each month: in the month of March, 50 mine injuries were reported in Grozny. Chechnya is a heavily mined zone, once Russian military authorities claimed to have placed 2,000,000 mines during the second conflict- and, to date, there is no humanitarian de-mining underway.
Handicap International in the North Caucasus
HI is an international non-profit, non-religious solidarity organisation, working in over 50 countries worldwide with people with disability in order to improve their lives. The approach of HI is called 'global', in the sense that all the issues that limit the potential and opportunities of people with disabilities are within the scope of the activities of the association. While HI's expertise was initially developed in the field of physical rehabilitation, HI now works in a broad spectrum of fields--dealing with all the things that matter to people-- education/training, employment/ income, health, and rehabilitation/ prosthetic services.
Intervention in Chechnya
HI initially intervened in Chechnya to provide emergency assistance to people injured in the conflict, distributing items to help people regain some independence, such as wheelchairs and crutches. During the time of doing this work, the plight of injured and disabled people, the state of the health services, and the absence of rehabilitation services, prompted HI to broaden the scope of activities, in order to provide ongoing direct support to people, and also to support the doctors and nurses who work directly with people. This support consists of donations of materials essential for emergency operations, and postoperative patient care, training for staff in rehabilitation, and assistance in repairing rehabilitation rooms.
Training
Continuing professional development of health staff is an integral part of the health system in Russia, but due to the conflict, this has been disrupted for some years. While HI wished to assist in the development of rehabilitation facilities, it was clear that training needed to go hand in hand with equipment distribution in order to ensure a good quality of care. The training also focuses very strongly on how health staff can help a person to regain their independence. The training for health and rehabilitation staff often takes place in the neighbouring republics of Ingushetia, or Kabardino Balkaria, as the security situation in Chechnya does not allow for such activities. Topics are chosen according to the training needs expressed by staff and represent the most common, and challenging conditions they are dealing with, like amputation and spinal cord injury. Key staff from busy hospital departments also have had the opportunity to undertake longer periods of study outside the region in order to consolidate and update their skills. In addition to this training which is focussed on physical aspects of functional rehabilitation, HI also carries out capacity building for local NGOs in disability issues, project development, and general training for the volunteers who help in the distributions done in Chechnya.
Networking and information sharing
It is clear that people only can receive effective rehabilitation, if all of the people delivering their care are able to communicate. This is something very difficult in the context of Chechnya. Most people do not have access to phones, and coordination meetings between doctors, prosthetists, nurses, NGO workers do not exist. For this reason at all trainings held, all the caregivers, from many different spheres are invited in order to share information, get to know and understand each others roles, and eventually, in this way to facilitate care of injured people. People themselves have difficulty located where services are. This applies to NGO workers, hospital staff, and most importantly people with injuries or disabilities. A directory of services for people with amputation in the North Caucasus was published by HI early this year, to enable people themselves to see what services are available, and how they can access them.
Disability issues
Throughout this work, the autonomy and the rights of people with disability remain a central principle. In order to prevent people who have been injured by violence in Chechnya remaining victims their whole lives, they not only need access to proper health care, and the opportunity for rehabilitation, but they also deserve to be accepted and welcomed in society. During all training seminars held by HI, people with disability are actively involved- trainers with disabilities from the Moscow based disability NGO Perspektiva not only provide excellent facilitation skills, but also through their professionalism and knowledge convey the message, that, given the opportunity, people with disability can participate and can lead as well as anyone else- and indeed better than anyone else when it comes to the subject of tackling marginalisation and exclusion.
Partnership
Partnership is a core value of HI. In Chechnya HI's partners are diverse - they include government ministries, local NGOs, international agencies, and the local disability association representing 15,000 people with disabilities, or their families in Chechnya. Our activities in the region are supported by the European Union through ECHO, and HI has also undertaken joint training projects and publication of materials with WHO.
This article is dedicated to all the people in this tragic situation, in hope that the journey towards a real and lasting peace will begin, and that people in Russia, and in Chechnya will no longer have to live their lives in fear and suffering.
For more information on humanitarian action in the north Caucasus, see www.ocha.ru
For more information on HI activities worldwide, see www.handicap-international.org
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