Fear is dominating people’s lives in the North Caucasus republic of Ingushetia. MSF (Doctors Without Borders) is one of the few aid organisations still working in the republic and witnessing the severe impact violence is having on the people.

“I have become very nervous, irritable recently,” 65-year-old Sultan tells his counsellor. “Every time I hear about a killing or a kidnapping I remember my own nightmare again. I was taken into the forest with no explanation; they put a bag over my head and led me somewhere striking my shoulder with a machine gun. Whenever I think about it I get a dull ache in my chest, my blood pressure rises and my fingers grow numb. I hope that you will help me.”

Every day the tiny Russian republic of Ingushetia is shaken by explosions, shootings and attacks. The republic has a similar sized population to Edinburgh but more than 200 people have been killed there this year. Neighbouring Chechnya suffered two horrific wars between 1994 and 2003, during which time more than 200,000 Chechen refugees fled to the safe haven of Ingushetia, where MSF provided assistance in the huge tented camps. But while Chechnya seems to be stabilising, Ingushetia is no longer the safe haven it was. Some of the insurgents who were fighting the Russian authorities in Chechnya have crossed to Ingushetia and the mountainous republic is becoming one of the most violent areas in the Russian Federation.

“When I arrived in early 2007, the last of the camps for displaced Chechens had been closed down and destroyed,” says MSF’s head of mission, Willem de Jonge, “We were running clinics and providing mental healthcare for the remaining Chechen refugees, who were living in crowded temporary housing such as converted poultry farms or abandoned cafés. We are still providing basically the same services, but the big difference is that now the local Ingush people need our assistance just as much as the refugees.”

Madina, one of MSF’s team of nine mental health counsellors, has seen the atmosphere in the republic change: “Here – and it was the same in Chechnya during the war – there are many people who go to sleep dressed. They don’t change into pyjamas because you never know what will happen to you at night. And how can you go out undressed? Our culture doesn’t permit that.”

“This is not open warfare,” says de Jonge. “There are not mass groups of people fleeing and no new refugee camps are springing up. But the violence has increased and civilians are caught in the middle of a cycle of attacks and counter-attacks between the insurgents and the federal authorities. When you go into some villages, people stay behind closed doors – they’re simply scared to go outside. Any young male is at risk of being taken by either side. “It’s frustrating to be powerless to change the situation, but I am proud of the work our mental health counsellors are doing. It’s common for major traumatic events to trigger the onset of psychological problems, and people here are living in very real fear, which tends to perpetuate their problems and prevent recovery. The best thing we can do for these people is offer them dedicated psychosocial counselling.”

MSF’s mental health teams are based in three district hospitals, which receive a regular stream of injured people. The Ministry of Health staff refer these patients and their relatives to MSF’s counsellors and local doctors acknowledge the positive impact of this cooperation; they see their patients get better both physically and mentally after these sessions. “Every day emergency hospitals in Ingushetia receive victims of armed violence,” says Lamara Umarova,supervisor of MSF’s northern Caucasus psychosocial programmes. “When people experience traumatic stress, it overturns their perception of the world. After counselling
sessions people are better aware of their condition, their problems.They understand how to cope with them, but it’s not easy to do that given the situation they live in.”

The situation of fear is expressed by one 10-year-old girl’s account to her counsellor: “I’m afraid to go out in the street, I’m afraid of the soldiers, of the military vehicles. My uncle was killed by the military recently, it was before my eyes. I miss him. He was very kind to me. When I’m on the way to school I just pray to God there are no military on my way.”

“Traditional coping mechanisms – family ties, friendship, religion – do not work well today,” says Mareta, MSF’s mental health programme manager. “We learn about violent incidents from the Internet or from the news, which is very unusual for this small republic. People don’t want to talk about it to their friends and neighbours.” It is not easy to relieve acute traumatic stress, but observing the principle of strict confidentiality, using different counselling techniques and simply displaying sincere human sympathy allows the counsellors to gradually gain their patients’ trust and help them.

“Today we see people come to our counsellors in search of confidential, neutral, unbiased assistance,” says Mareta. “In this difficult situation the most important thing for our patients is to speak out about their problems and to be heard. For example, there’s a pregnant woman who our counsellors have worked with for weeks. Her husband had been killed and she was grieving his death terribly. After a while they put her in a group composed of other women in the same situation and she understood that she was not alone. She began gradually to take care of others, and she even took another pregnant widow under her wing. Now she’s about to give birth – and she feels much more positive and strong. That is the valuable result of our work here.”

Solidarity

People in Ingushetia have told me several times how important it is for them to feel and see that an international organisation is there with them in this tiny forgotten republic. It gives them a sense that not everyone has abandoned them. For me this really emphasises the need to simply be present, to show solidarity with the people, on top of the actual help we are providing towards the improvement of their physical and mental states.”

26.01.2010

Source: Doctors Without Borders