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Lost in transition

Wedged between Europe and Russia, Ukraine is wracked by crippling economic problems, widespread corruption, inter-communal tensions and the collapse of public services. Vulnerable groups, such as the elderly and ethnic Tatars, are struggling to get by in these uncertain times. The Ukrainian Red Cross, with support from the ICRC, is providing them with basic medical services.

Consultation time at the first-aid post in Sari Bash, Crimea.
©Thierry Gassmann / CICR

‘‘WE have no water and no heating, but at least we have peace and quiet,” explains Susana, a nursing assistant at the first-aid post of Sari Bash. It would be hard to find a more isolated spot than Sari Bash, a remote village on the Crimean steppes where water is delivered by tanker, in return for a fee. A town council composed of ethnic Tatar women runs the village. “Our men have gone to the towns to look for work, but most of them never come back because they have found other women.” In Sari Bash — a former collective farm of the Soviet era — the Tatars make up nearly 80 per cent of the population of some 200,000, for whom the future remains desperately bleak.

Of Turkish origin, descendants of the Mongols of the Golden Horde, the Tatars have had a turbulent history. Accused by Stalin of collaborating with the enemy during the Second World War, the Crimean Tatars were deported to Uzbekistan in May 1944. Many died during this forced exodus. Twelve years ago, around 250,000 Tatars returned to their ancestral lands in Crimea, although most of them were obliged to resettle in sparsely populated areas far from the richer southern end of the peninsula from where they originated.

Despite some recent material improvements, the Tatars live in harsh conditions. The population is declining in many of the resettled areas, prompting Mustapha, a doctor in Krylovka who returned from Uzbekistan in 1989, to say, “In 50 years, there will be no more Tatars!” Behind the joke lurks the fear of assimilation — mixed marriages between Tatars and Russians or Ukrainians are on the rise — by those who lived through the trauma of deportation.

A network of solidarity

Beginning at the end of the 1980s, when perestroïka was in full swing, the Tatars’ return to Crimea sparked fierce intercommunal tensions between them and the local Russian community. “The Tatars came back to Crimea at the worst possible moment, when Ukraine’s economy was crumbling,” says Paul- Henri Arni, ICRC regional delegate in Kiev. As more and more people became poverty-stricken following the collapse of the Soviet Union and the transition to a market-based economy, competition for the few public services still available, in particular health, became intense.

To help alleviate some of the hardship, in 1998 the Ukrainian Red Cross — in cooperation with the ICRC — set up first-aid posts in some 30 vulnerable villages in Crimea. Since then, these posts have served as the only health facilities accessible to isolated communities. The National Society and the ICRC supply medical equipment and basic medicines, enabling the first-aid posts to diagnose a whole range of health problems and, where necessary, to treat such conditions as high blood pressure and respiratory and cardiovascular disease.

This programme is also an antidote to the pervasive loneliness. After 70 years in exile in Uzbekistan, 84-year-old Medina lives by herself in Sari Bash and regularly receives home visits from a nurse working at the first-aid post. With the progressive erosion of the health and social protection once provided by the state, these consultations represent the only health care most of the beneficiaries receive. In 2004, 19,400 patients, including 2,060 children, were treated at these first-aid posts.

©Joe Lowry / International Federation

Beyond new borders

UKRAINE’S position on the edge of the enlarged European Union (EU) has thrown the spotlight on a raft of socio-economic challenges. Bordering three new EU member states, the country is both a source and transit point for migrants hoping for a better life. A combination of conservative “official” mindset, liberalized sexual behaviour and high use of injected drugs has led to a worrying explosion in new HIV/AIDS infections — one international aid agency says that AIDS is the biggest crisis affecting the country since the Second World War (when millions died). Tuberculosis is still a threat, as are the severe winters. Grinding poverty is endemic in villages and on the ragged edge of cities, whilst the very land is contaminated by the disaster that looms over the whole region: Chernobyl — still the focus of a long-term International Federation appeal.

Against this catalogue of misery, the Ukrainian Red Cross is quietly getting on with business, accepting that donor interest in wide-scale relief programmes has moved on, and transforming itself into a provider of services and knowledge for its branches. For the first time, the International Federation’s annual appeal for Ukraine includes a resource development project, designed to generate funds within the country, and through a revamped web site.

Home-visiting nurses will now be trained to give not just bed baths and medicaments, but also to dispense legal advice on social entitlements. And the National Society is celebrating a small but significant victory: its first successful application to the Global Fund for AIDS, TB and Malaria, whereby these nurses will give advice and support to homebound people living with AIDS.

Another ground-breaking programme will reach out to people affected by human trafficking: women escaping to work in the “hostess” industry in the West, and other undocumented workers. There are ambitious plans to give trafficked women vocational employment and a safe space to prepare for reintegration into their communities.

In schools across the country young Red Cross volunteers inform their peers about HIV and AIDS, speaking frankly about safe condom use and the dangers of injecting drugs. In the heavily industrialized town of Zaparozhe, Red Cross workers have teamed up with Project Hope and local taxi-drivers to provide safe, clean needles for at-risk drug users, foreshadowing expanded harm reduction activities.

Despite the change in focus, traditional needs continue. At one Red Cross branch we visited, 68-year-old widow Maria wept quietly, as her future was wrecked yet again. Social transition has been hard on Maria and countless others. Her son, who paid US$ 1,000 to be illegally transported to work in Portugal, recently died there of pneumonia, aged just 40. “The Red Cross has given me some support,” she whispers. “But I have a handicapped grand-daughter to support, and just 240 hrivna [less than US$ 50] coming in each month. I worry about the future. What can be done?”


A never-ending emergency

The Tatars are not the only ones suffering from the upheavals following the dissolution of the Soviet Union. “The crisis has been going on for a long time,” stresses Ivan I. Usichenko, president of the Ukrainian Red Cross. “In a few years, perhaps, our services will no longer be needed, but for the time being the [social and medical] emergency is here to stay.” Indeed, you don’t have to travel far in this country to get an idea of how widespread the suffering is — not only in Crimea — and what it means in humanitarian terms.

Throughout the country, living conditions have deteriorated and the labour market dwindled, as a result of the dismantling of the Soviet collective agricultural system. Many people have moved elsewhere looking for work in the capital, Kiev, or across the border in Poland. For others, primarily the elderly and pensioners, it is too late to start over. With the average pension around US$ 30 per month, they can barely afford to pay for food and basic necessities. Health care, once provided free-of-charge, is now too expensive and the elderly are left to suffer in isolation.

In Dmitrovka, in the Crimean region of Sovetskiy, the Friedrich Engels collective farm was closed down a year ago. For the 1,200 inhabitants, of whom a third are pensioners, the closure was both brutal and painful. As one elderly patient puts it: “I can’t find the words to describe the depth of my feelings about the changes that have taken place here.”

The Ukrainian Red Cross is well aware of this reality. In the last three years it has opened more than 500 health care and social centres. Red Cross volunteers, most of whom are highly motivated women, run the centres. They provide first aid and basic preventive and primary health care, distribute clothing and organize outings and concerts for the elderly. “I am happy to see what the Red Cross is doing for the elderly in the district, especially the good idea of offering a free sauna once a week,” comments Vladimir Abisov, mayor of Krasnoperekopsk. In fact, for the vulnerable people it assists, the Ukrainian Red Cross is like a warm and soothing sauna. Others compare it to an oasis in the desert. Sauna or oasis? Certainly, a bit of both.

Jean-François Berger
Jean-François Berger is ICRC editor of Red Cross, Red Crescent.

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