Nearly 15 years after the wars began between Chechen separatist and Russian troops, Chechnya and its capital Grozny have seen reconstruction efforts and economic recovery over the past several years that some there even praise as “the Chechen miracle”. Meanwhile, violent incidents in Chechnya have become dramatically more prevalent since the war over South Ossetia between Georgia and Russia last August. Violent deaths, compared with those last summer, have almost doubled in number since, from 84 to 152.(1)

Last April federal Russian military forces officially terminated what they termed a counter-terrorism operation and what human rights organisations considered “a regional system of torture, forced confessions, and fabricated trials”.(2) Documented by human rights organisations as well as the national and international press, Russian forces continue their practices of enforced disappearance, torture, and other ill-treatment of alleged terrorists, while Russian authorities have faced a wave of killings of their representatives by increasingly organised insurgents.(3) The European Court of Human Rights, as of October, 2009, has ruled in over 100 cases of Chechen citizens that the Russian Government failed to properly investigate and prosecute human rights abuses by its forces, or found Russia directly responsible for human rights violations ranging from inhuman treatment to secret detention and deaths. Thousands more cases are pending.

The ongoing human rights violations from both sides of the conflict have direct health implications for the majority of Chechens still suffering from physical and mental war sequelae. Since the wars officially ended almost 10 years ago, reports from non-governmental organisations and data from UN organisations have portrayed desperate living and public health conditions in the Northern Caucasus, even compared with other disadvantaged regions within the Russian Federation. The infant mortality rate in Chechnya is at least twice the Russian average of 13 per 1000 livebirths, mainly due to diarrhoea and respiratory infections, and although trends have been improving, many thousands of women and children lack basic social services.(4)

After the wars, Chechnya’s inefficient health system was left overburdened and its infrastructure literally bombed. 3 years ago, the Kremlin made reconstruction efforts in Chechnya a policy priority, and the pro-Moscow Chechen Government reportedly invested heavily into a programme (Sdorovye) for health facilities and the procurement of medical equipment. International organisations and the Chechen health ministry officially announced and launched a series of programmes for health and education.(4, 5)

The official portrayal of successful health-system reconstruction, whose standards still lack behind even Russian standards, particularly for subspecialty care, leaves out the many qualified health professionals who have left for Moscow or abroad in search of better work and life conditions. Patients requiring services beyond primary care need to rely on a quota system that provides a limited number of grants to refer cases for specialised treatment that cannot be provided in Chechnya.(6) International organisations offering assistance with human rights investigations(7) are confronted with the refusal of the federal government to cooperate,(8) and the few non-governmental organisations operative in postconflict Chechnya are hindered in their work by an excessive burden of administrative hurdles created by recently imposed legal requirements.(9)

Similarly, those health professionals who stay in Chechnya are reluctant to speak out for improved health-services delivery, fearing to be regarded “unpatriotic”, a label which can soon become dangerous in the context of counter-terrorist activities. In a societal climate that analysts call one of the most repressive in the world,(10) health-care delivery and programming that meets the needs of the ill and vulnerable (eg, targeting women and infants, tuberculosis patients, or the 30 000 internally displaced persons still in Chechnya) are clearly challenging.

When Natalya Estemirova from the local human rights organisation Memorial was abducted and killed in Chechnya in July, 2009,(7) after a series of abductions and murders of prominent and less high-profile human rights activists, Memorial suspended its work there. The absence of independent monitoring mechanisms to hold policy makers and law-enforcement services accountable, and the lack of international attention and response, could create a dangerous nurturing ground for extremism. Spreading violence could become a threat beyond the region—and from there endanger global security.

Violence has resurged in Chechnya,(1, 3) menacing the health and health systems of its war-burdened population. The legitimate goal of controlling armed violence and stabilising a disadvantaged region will have to respect human rights to reverse this trend and bring sustainable improvements in health for this postconflict society. There is no miracle in Chechnya, but a situation that calls for international pressure from academia, parliamentary, governmental, and non-governmental organisations, and journalists.

Karsten Lunze
Preventive Medicine, Boston University
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*The article “Health and Human Rights: No Miracle in Postconflict Chechnya” was published at The Lancet, Volume 374, Issue 9704, Pages 1809 – 1810, on 28 November 2009.

References of the author:

(1) Mendelson SE, Malarkey M, Moore L. Violence in the North Caucasus: summer 2009. http://csis.org/publication/violence-north-caucasus-4. (accessed Oct 13, 2009).
(2) Council of Europe. Legal remedies for human rights violations in the North Caucasus. http://www.reliefweb.int/rw/rwb.nsf/db900sid/MMAH-7DW46X?OpenDocument. (accessed Oct 13, 2009).
(3) Council of Europe. Committee on Legal Affairs and Human Rights, situation in the North Caucasus region: security and human rights. http://assembly.coe.int/CommitteeDocs/2009/ajdoc43_2009.pdf. (accessed Oct 13, 2009).
(4) UNICEF. Issue facing children in Russia. http://www.unicef.org/infobycountry/russia_background.html. (accessed Oct 13, 2009).
(5) WHO Regional Office for Europe. First Results of EU Recovery and Development Programme for Northern Caucasus discussed recently in Kislovodsk. http://www.euro.who.int/emergencies/fieldwork/20080109_4. (accessed Oct 13, 2009).
(6) WHO. Health action in the North Caucasus. http://www.who.int/hac/crises/rus/sitreps/Health%20Action%20Feb_Mar_2005%20%20.pdf. (accessed Oct 13, 2009).
(7) UN. UN experts offer help in investigating killings of rights defenders. UN Daily News. http://www.un.org/news/dh/pdf/english/2009/21072009.pdf. (accessed Oct 13, 2009).
(8) RIA News Agency. Russia rules out UN expert probe into Chechen activist’s murder. http://en.rian.ru/russia/20090722/155588682.html. (accessed Oct 13, 2009).
(9) Kamhi A. The Russian NGO Law: potential conflicts with international, national, and foreign legislation. Int J Not-for-Profit Law 2006; 9: 34-57. PubMed
(10) Freedom House. Worst of the worst: the world’s most repressive societies 2009. http://www.freedomhouse.org/uploads/WoW09/WOW%202009.pdf. (accessed Oct 13, 2009).

Source: WaYNaKH