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Out on its own

By John Sparrow
The dramatic break-up of the Soviet Union has been followed by years of quieter but no less dramatic hardship and the enormous struggle associated with major change. What has this meant for Russia and for the Russian people and how has it affected the Red Cross and Red Crescent world?

It was the tourist season in St Petersburg, the time of the White Nights when daylight and sightseers alike lingered until midnight in the splendid boulevards of imperial Russia. The Winter Palace, its Hermitage museum, the Summer Gardens... the tourists were devouring them, oblivious to a contemporary drama around them.

Few spared a glance for the solitary figures of vagrants shuffling down the central thoroughfare of Nevsky Prospect, across Palace Square, or along the embankments of the Neva river that empties into the Gulf of Finland.

Not that Eugeny Ivanov cared. He was focused. Forty-five years old, homeless for the last year, Eugeny scoured the streets for empty bottles and waste paper. With thousands of others in this city of culture and refinement, he scavenges for survival. Beneath the imperial splendour of St Petersburg is a growing legion of homeless and socially troubled people, of lonely and infirm elderly, of destitute refugees, impoverished single mothers, alcoholics and abused children.

And St Petersburg is not exceptional in this regard. Political instability and economic chaos that followed the break-up of the Soviet Union have left many Russians in dire straits. More than six million are unemployed. The health-care system is in shambles. Galloping inflation has eroded salaries and pensions leaving increasing numbers unable to make ends meet. Crime has spiralled, overwhelming police who last year failed to investigate 35 per cent of violent crimes, among them 8,000 murders.

The litany does not end there. The few remaining social services are overloaded and withering under pressure from displaced people and refugees. The number of displaced is expected to rise by 620,000 this year to reach 1.7 million, partly a consequence of the conflict in the republic of Chechnya but also a reflection of the growing number of Russian nationals leaving former Soviet republics for the Russian Federation.





Red Cross crisis

There can be few – if any – National Societies that have faced a greater challenge than the Russian Red Cross as it grapples with the needs of its changing nation. When in 1992 the Soviet Union disintegrated, so did the then Alliance of Red Cross and Red Crescent Societies, leaving in its wake 15 distinct Red Cross and Red Crescent Societies in 15 Newly Independent States. Gone was the state structure with which the Red Cross had been so closely connected. Gone were a substantial part of the 137 million paying members; gone the institutionalised support and the contributions of industry.

Nadezhda Sorokina, chairwoman of the Red Cross in Nizhny Novgorod’s Leninsky district, has lived through these dramatic changes. From the 1950s she worked tirelessly for what she says was the biggest, strongest, most influential National Society the Red Cross Movement has seen – if unlike any Western one.

Sorokina remembers a time when everyone bought charitable Red Cross stamps; every factory in town had a Red Cross presence; and 70 or 80 per cent of workers felt obliged to be Red Cross members. To illustrate this, she pulls out records from a car parts plant. They show that the plant employed around 12,000 people of whom 78 per cent were paid-up Red Cross members and 1,250 were Red Cross blood donors. The plant had 40 Red Cross first-aid posts covered by 180 volunteers. Some 400 workers a year underwent first-aid and civil defence training. The Red Cross was as prominent a part of the plant as a trade union in western Europe. Plant managers would never refuse funding.

All that collapsed with perestroika. Suddenly there were no more generous plant managers. Plants were privatised and workers laid off. Red Cross stamps were cancelled. Memberships lapsed, volunteers faded. No one could afford to work for nothing. In some places the Red Cross faded away and, for all practical purposes, ceased to exist.

But the grass roots run deep across the vastness of Russia. There is un-common strength and resourcefulness there. It’s reflected in the words of Dr Oleg Sidorov, Chairman of the Russian Red Cross Central Committee in Moscow. “Do not ask me about what was, or what we have lost,” he says. “Ask me about what is, how we are responding, how we must respond in future, how we will do that.”

Support has come from both the Federation and the ICRC. Since 1991, a Federation delegation has been based in Moscow, and it has helped implement medical and social programmes. Concern for failing health care and widespread shortages of essential drugs and medical supplies was an early priority. The immediate aim of a
Sfr 72.6 million appeal in 1993 was to alleviate the medical needs of the most vulnerable. Specially designed medical kits benefited some 4.5 million Russians. In 1995, a Sfr 5.8 million relief operation targeted struggling hospitals in remote regions of the country.

The Federation has also been assisting the Russians in developing their National Society. Training for district committees in resource development and financial management – previously unnecessary skills here – has taken place around the country. With Canadian Red Cross know-how, a first-aid programme to prepare instructor-trainers for teaching community-based first aid is under way. So is an American Red Cross/Federation effort to strengthen the visiting nurses programme.

For its part, the ICRC has had a delegation in Moscow since 1992 and is present throughout the northern Caucasus, where in cooperation with the Red Cross and Red Crescent local committees, it is assisting the victims of the conflict in Chechnya and vulner-able groups in Ingushetia and North Ossetia. By advising and funding branches to meet essential community needs, however, it is helping strengthen the long-term position of the Red Cross in the region. It is also disseminating international humanitarian law and providing support for tracing activities throughout the country.
Regardless of the important and continuing need for outside assistance, at the end of the day, the challenge for the Russian Red Cross is to meet increasing needs with sharply reduced resources. Ultimately, this calls for important changes in structure, priorities, and approaches, all of which take time – another terribly scarce commodity in Russia today.


Visiting nurses

There is more than nursing to the visiting nurses programme. It is more than checking blood pressures or providing medicines; more than checking people over and providing injections. It is listening and caring. It’s companionship. For the lonely elderly of Russia, the visiting nurses are friends and confidantes.

When Olga Andreyeva visits the paralysed, speech-handicapped Vladimir Serov, 60, in St Petersburg daily, she breaks the isolation of his apartment confines. She is this war victim’s access to the outside world, the ear to his troubles, his opportunity for conversation.

When Natasha Labanova visits Alexander Sakulin, 87, in the town of Borksy near Nizhny Novgorod, this retired school director and philosopher who has suffered a stroke and has problems walking, tells her she’s the light of an old man’s life. Down from the wall comes his guitar so he can sing her a love song.

“Alexander Alexandrovich,” she scolds him, laughing. Tomorrow, he tells her, he’ll play the accordion – after she’s checked his blood pressure.

Smart thinking

“You name it and we have it,” Tatjana Linjova, head of the Red Cross in St Petersburg, says. “Of 5 million inhabitants, 25 per cent are pensioners and, of those, 120,000 need help. We have 100,000 homeless children, 50,000 needy refugees. Do you have a picture? There is more.”

Tatjana Linjova is concerned with resource development. She has her own term for it: smart thinking. “In a sense,” she says, “it has become easier for the Red Cross to work because in a free society you can take the initiative. The only thing is, collecting funds is more difficult than it would be in an affluent land. It is a time for smart thinkers.”

She is smart. Off Nevsky Prospect is a used clothing distribution point supported by the Swedish Red Cross and the Federation. Impoverished mothers come for children’s clothes; students and workers on minuscule salaries rummage for themselves. Once the clothes were free but many were ashamed to take a handout. So now they pay a nominal price, acquire a receipt for a Red Cross contribution, and the clothing distribution nets $1,500 a month that buys food for Red Cross canteens.

Across town in the Kalininsky district, colleague Larisa Fedorova is doing some smart thinking of her own. With a population of 503,000, Kalininsky has felt the demise of Russia’s redundant military industry. A big percentage of its industry was military and closures swelled the ranks of the jobless. Meanwhile the number of homeless has grown sevenfold over the past five years.

Hard times, alcoholism, property-related crime have all contributed. Property scams have become rampant throughout Russia, as privatisation of state-owned accommodation has placed houses and apartments in the hands of occupiers. Often the poor, the uneducated, the elderly or the alcoholic will be convinced to sell their homes for a song, or the promise of cash and an alternative dwelling. The new home turns out to be a hovel, and the cash buys little more than the vodka with which to drown their sorrows.

Chairwoman of the district Red Cross, Larisa Federova knows the misery too well. Her public canteen brings the troubled and homeless to her. Eugeny Ivanov is one of them. “I must have a hospice,” she says. “We feed people, listen to them and try to help but then they return to the streets.” She has presented a plan to the authorities. She wants them to provide a hostel in return for essential community service provided by the homeless. What concerns her most are the children. Of the 200 people she feeds a day, 40 on average are youngsters.

The homeless also need hospital care. Health insurance does not reach the unregistered. You have to live somewhere to obtain it. So, except in emergency cases, cash-strapped hospitals turn the homeless away knowing bills will never be paid. That’s not the case in Hospital No. 18 where Red Cross wards care for the needy and a steady supply of second-hand hospital equipment acquired free by Federova in the Netherlands secures the wards for Red Cross use.


Filling the cracks

Unavoidably, as with the homeless, there are other groups that are left outside the social welfare loop: refugees and the elderly, for example. There are also groups with special needs, like those affected by technological disasters, for whom health care requirements are too demanding for the fragile systems in place. With little resources of its own, but with great amounts of ingenuity and drive, the Russian Red Cross is trying to fill the gap; to catch those that regularly fall through the cracks of medical and social services.

Officially there are 5,150 refugees and displaced in St Petersburg, but the true figure, says the Red Cross, is
closer to 50,000. People like Khalil Chinarghul, 36, who lives with his wife Rakhila and five children in a rundown former student hostel in the Vyborgsky district of town. One miserable room with a shared kitchen costs him US$60 a month, half what he earns as an unlicensed market trader.

Khalil is an Afghan. After the fall of Afghanistan’s communist regime, he fled to Russia. They were among some 300 families to settle in St Petersburg, hoping to acquire refugee status and assimilate. The authorities thought otherwise and so far only a handful have been accepted. Most have short-term visas requiring constant extension.

Without status, they are essentially outside the system and beyond the protection of the law. Khalil’s story is typical and it isn’t just one of impoverishment. The Afghans complain of police harassment and of extortion and intimidation in the markets, the only place where most of them can earn something.

So they turn to the Red Cross. On a bank of the Neva, a patrician building houses its centre for refugees, the hub of its refugee programmes, and a meeting place. Here the Red Cross informally brings together the authorities and the refugees, providing a neutral ground for calm assessment of problems.

Tatjana Linjova wants the chief of police to come to the centre. “He is a very nice man,” she says. “It’s just that when he thinks of refugees he trembles. Usually his job is to arrest them and take them to prison. No one likes refugees. People say deport them. I say feed them first and take care of them. By the time we’ve done that people should realise they are human beings.”

Needy and home-bound elderly Russians first turned to the Red Cross for social and medical care back in the Tsarist era. Over the years needs have grown, a consequence of a turbulent century. Millions of people lost their lives during the internal repression of the 1930s, and more than 25 million died as Russia resisted Hitler. Today that tragedy is reflected in a huge population of lonely, ailing, elderly people without extended families to care for them. Add to this widows and widowers whose pensions have been eaten by inflation and there is a massive problem.

The authorities acknowledge the plight of pensioners but are often unsure what to do about it. With the health care system so desperately short of money, the elderly frequently fail to qualify for what assistance there is. A bed-bound diabetic with ulcerous legs needs daily cleaning and bandaging. But while he isn’t a candidate for a hospital bed reserved for acute illness, he’ll more than likely be deemed too sick for the lesser medical care of social services.

Responding to this burning need across Russia, the Red Cross Visiting Nurses Programme provides medical care and a social eye (see box p.4) in the home. Nurses see to a patient’s health, then to hygiene, shopping, even the collection of a pension if necessary. The success of the programme can be seen in state recognition. In social service terms, those in most need are left to the Red Cross nurses, and some local authorities even fund them. Sadly, funding falls short despite support from the Federation and many National Societies. Needs are simply enormous.

Finally, the Russian Red Cross is assisting the victims of Chernobyl, Chelyabinsk and Semipalatinsk. The nuclear disaster at Chernobyl is a sadly familiar one but those of Chelyabinsk in the southern Urals, where a secret nuclear weapons plant contaminated an area the size of Belgium, and of Semipalatinsk, a former Soviet nuclear testing site in what is now Kazakhstan, are less well known. In all cases, the consequences of nuclear contamination can be difficult to measure, but early detection and a well-informed public are essential. Ten years after Chernobyl, in the Federation-supported programme, mobile laboratories of the Russian Red Cross remain the front-line monitors on which remote populations rely.


Maria Klanova: Making it happen

Far from everything, in the Altai Mountains of south-western Siberia is a land of forests and lakes and white-water rivers immortalised by the great painter Grigory Ivanovich Gurkin. Birds of prey soar on the thermals, bears prowl the wooded mountainsides, snow-capped peaks rise to over 4,000 metres.

But the sense of peace and well-being the artist found early this century is tempered today by something else: grinding poverty. The Altai Republic, 93,000 square kilometres bordering Kazakhstan, China and Mongolia, reflects an appalling state of Siberian health and ever worsening social conditions. Two-thirds of the 200,000 people inhabiting the republic live in rural areas where life expectancy for a man is ten years younger than the average in the Russian Federation.

Maria Klanova, 45, the ethnic Altaian who nurtures the republic’s Red Cross, is sombre. One of the aboriginal race who make up 31 per cent of the population, she says, “Everything just keeps getting worse. It is so important for the Red Cross to be back in action.”

In 1991, the long-held aspirations of this beautiful extremity of Siberia led to the creation of a new republic within the Russian Federation. Somehow in the complexity of change and crisis, the Red Cross was lost. Now Klanova – a relative newcomer to the Movement – is slowly but surely bringing it back.

An information officer with the Ministry of Health, she was hesitant in 1994 when asked by former workers to resurrect their Red Cross. She wasn’t too sure what the Red Cross stood for. “By the time I was,” she says, “I realised how much we needed it.”

She had no phone, no car, no office or funding. She asked friends how to organise a general assembly. There she was elected chairwoman unopposed, along with a committee. “I figured out no one else wanted the job but I’m a stubborn sort of person. I thought: I’ll just make it happen.”

Today the diminutive Klanova has an office in the media building of the republic’s capital, Gorno-Altaisk, just down the corridor from the television station and the two most widely read newspapers. The chief reporter of the Altaidyn Cholmony (Altai Star), is Klanova’s unpaid publicist, and coverage of the Red Cross leaves nothing to be desired.

“It’s only one room,” says Klanova, “but it is a location where the committee can meet, and we can work efficiently. I have to pay rent and I am always in debt, but the Red Cross has an address and a telephone number.”

Her only funding is a hard-won state subsidy, and the economic profile of the Altai Republic holds little promise of donors. There is no industry; most people depend on agriculture and that is deep in the doldrums. In terms of income, the republic is 80th on the Russian Federation roster.

What it does have is unspoiled nature, and the natural resources for herbal products and alternative medicines. Working closely with the republic’s development office, Klanova has dreams of a green industry that could bring a generous percentage to the Red Cross.

For now, though, she must struggle on. She still has no means of transportation. Getting into the mountains depends on a lift but someone is always going somewhere and, on a bright summer day, half a day’s drive south-east of Gorno-Altaisk, she bumps towards the Altai heartland. It is clear from the look in her eyes that what she’s lacking in concrete terms – cars, contributions, for instance – she makes up for in courage, determination and personal commitment and, watching her work, one is forced to recognise that these are the things that matter most.

Chechen conflict

As if such needs were not daunting enough for Russia, there’s war as well. Ruslan Isayev was a teacher in a technical institute when the conflict in Chechnya started. He knew a lot about oil; nothing of humanitarian action. But as he sheltered in a basement during a Russian bombardment he met a doctor tending the wounded who asked for his help. Her name was Madina Elmurzaeva and she headed what was left of the Red Cross in Chechnya.

As fierce fighting engulfed the city, Isayev found himself searching the streets for the wounded, the frightened and the homeless whom the Red Cross was trying to help. A tall, thickset man with a greying beard, he wore a sheet with a Red Cross on it and earned himself the nickname “big target”.

Looking for the living, he more often found the dead. “The streets were littered with bodies,” he says. “Since no other organisation was moving around, it was up to us to bury them.” The operation cost Dr Elmurzaeva her life. She led a team combing the basements, assisting the sick and wounded, but the streets were short-staffed and when time allowed she lent a hand collecting bodies. A booby-trap mine blew her apart as she lifted a corpse that covered it. Four Red Cross volunteers died with her.

Isayev was persuaded to take over but has yet to come to terms with her death. “Thirty-seven years old. Three children,” he says. “The woman had such courage.”

Today many dead still await identification. Photos of decomposing faces, those they found and buried in common graves, or exhumed in the search for the missing, are kept by the local Red Cross. Stern-faced relatives call to search through them. It isn’t merely a question of knowing, or of reburying loved ones in a proper grave. Unless bodies can be found families cannot claim allowances.

While 700 faces remain anonymous, 1,400 names are unaccounted for. Those are the disappeared, males of fighting age, most of them alleged to have been captured. Assisted by the ICRC, and working closely with state authorities, the Chechen Red Cross has a tracing mission. “These men were breadwinners,” says Isayev, “but unless we can show what happened to them, their families will have no compensation.” The Red Cross is high profile in Chechnya. The ICRC is ensuring that. Its relief, water and medical programmes have spread throughout the republic. In Grozny alone the ICRC has provided up to 600,000 litres of water a day. Its public kitchens in Grozny and Gudermes feed close to 3,000 people a day. Ever since the outbreak of war the ICRC has sought to ensure an adequate supply of water to the population of Grozny. The scale of destruction has wrought massive disruptions to water systems and, where it can, including in some villages south of Grozny, the ICRC has repaired the infrastructure. When necessary, it has trucked in water and set up reservoirs.

As well as distributing medicines, it supports and rehabilitates clinics and hospitals. Hospital No. 4 in Grozny is one of them. Supported by the ICRC since it was looted and partially destroyed in 1995, its maternity department is Grozny’s busiest, serving over half the city and the surrounding villages. Without the ICRC, hospital personnel say, the department’s future would be in question.

Out of crisis, however, has come long-term thinking. Across the northern Caucasus the ICRC is funding and helping branches implement what it terms community-relevant activities. These fund visiting nurses, provide home meals and simple home maintenance to the housebound and needy and ensure that branches have stocks of relief goods, basic medicines and medical equipment to distribute as necessary.

“These are essential services,” Pieter de Rijke, ICRC cooperation delegate, says, “but they are also a way for the Red Cross to say to the community ‘this is what the Red Cross can do, so support it.’ It is a question of gaining new credibility and public acceptance.”



Part of the whole

Some five years after what is commonly referred to as the collapse of communism, where does Russia and the Russian Red Cross stand? In some ways, the prevailing feeling is that it stands alone. This is the case in as much as it is difficult to maintain high levels of outside assistance once a perceived crisis is over and the hard work of transition begins.

But it is also true in a deeper sense. The enormous needs and scarce resources often mean that people are left to fend for themselves. Raisa Puris, chairwoman and only member of the district Red Cross committee in Ust-Kan in the Altai Republic, at once exemplifies and explains the problem. “It is difficult to unite people into a movement,” she says, “when all they think about is finding food to eat.” Some places are worse than others, of course, and the Ust-Kan region is especially poor.

There are reasons to hope, though. Nizhny Novgorod has become a showcase for Russian economic reform, and its young governor Boris Nemtsov has conjured it into one of the more dynamic corners of the country. Unemployment is down to four per cent – half the Russian average – and there is significant evidence of new small businesses. Young people there are enthusiastic and full of energy.

In the Red Cross world, clearly a new pragmatism is surfacing in branches from the Gulf of Finland to the Sea of Japan. It would be misleading to suggest that in this enormous land some are not still reeling from change. But, no longer de facto departments of health administrations, many social welfare organisations are gaining the respect and support of the community, as well as that of domestic and foreign donors.

The way out of a centralised economy is necessarily long, however, and now that the process is well under way it is clear that Russia’s future is not about adopting someone else’s system and getting on with business as usual. Economists and the Red Cross and Red Crescent Movement alike will benefit from noting that it is about shaping new ideas to fit a unique and complex reality; about tailoring things to fit an immense, resourceful and amazing group of people; about investing in a process that will take a long time.

John Sparrow
John Sparrow is a freelance journalist based in Amsterdam. He is a frequent traveller to the Russian Federation


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