A vital link
can be few National Societies that have faced a greater challenge
than the Russian Red Cross as it grapples with the needs of
its changing nation.
Bela, a 9-year-old refugee, sits by boxes
of humanitarian aid from the Red Cross at a refugee
camp in Karabulak, Ingushetia.
©Reuters / Alexander Demianchuk,
RUSSIA is the world’s largest country, covering 11
time zones and home to over 145 million people and 200 ethnic
groups. Over a decade on since the collapse of the Soviet
Union, Russia is on a brisk path of economic reform.
At the same time, over half of Russia’s decreasing
population are living on less than US$ 4 a day(1).
Russia is home to one of the highest incidence rates of tuberculosis
(TB) worldwide, and the highest recorded rate of multi-drug
resistance TB(2). HIV/AIDS is fast reaching
epidemic proportions, fuelled by an increasing population
of injecting drug users and deep-rooted stigma of and discrimination
against people living with HIV/AIDS. Russia’s socio-economic
problems are compounded by regular natural disasters (floods,
typhoons, earthquakes etc.) as well as man-made crises (conflict,
to the multitude of social and health problems is not easy,
especially when one is also trying to ensure one’s own
survival, but such is the challenge faced by the Russian Red
Cross today. The National Society has come a long way since
the collapse of the former Soviet Union in 1992. Over a decade
later, it is one of the most important civil society institutions
in the country, addressing some of the region’s most
urgent humanitarian problems. It has managed to successfully
raise funds and other resources locally and abroad for a variety
of programmes from primary health care for the elderly in
Moscow to harm reduction programmes for drug users in Irkutsk,
These days the Russian Red Cross is concentrating the majority
of its efforts and resources on health and social welfare
concerns, in particular the care of victims of TB and support
to undocumented migrants and displaced people. And new needs
are emerging. The National Society is increasingly among the
first to respond to such devastating tragedies as the hostage
crisis in Beslan.
(1) UNDP Human Development Report
(2) WHO Anti-TB drug resistance in the world: third global
disease new problem
At Seredka detention centre in Pskov region in northern Russia,
Igor (not his real name), a prisoner, awaits release. Igor
is looking forward to going home to the sister he left behind
seven years ago. But there’s a catch to what should
be a happy reunion. While inside, he was diagnosed with TB,
and when he’s released he’ll bring it back into
the community. That’s why the local Red Cross psychologist
has been to see him, to give advice and encouragement on how
to continue the treatment he has been receiving in prison,
treatment that will protect his family from this potentially
For Russia, TB is a problem comparable to a national disaster
with the incidence reaching 83.2 per 100,000 people in 2003
— one of the highest rates of TB worldwide. Inside Russia’s
prisons, infection rates are 40 times higher than the overall
rate. Every year 30,000 people die prematurely from TB among
a population which has fallen by 4.8 million in the past ten
Complementing the state health programmes, the Russian Red
Cross, with support from the International Federation, is
providing treatment to those suffering from TB. It concentrates
on treatment compliance among patients in prisons and at home.
To achieve maximum results it provides incentives, such as
social support, and legal and psychological counselling to
motivate people to finish their treatment. Information, education
and equipment for TB dispensaries and training on psychological
issues are part of the programme.
“What makes this Red Cross programme unique is the
human aspect,” says Zlatko Kovac, International Federation
TB programme coordinator in Russia. “People with TB,
often socially deprived and stigmatized by society, lack respect
and security. Red Cross nurses carry medicines, information
and comfort into their lives,” he says.
Kovac is referring to the visiting nurses programme, the
most mobile and multifunctional Red Cross service in health
and home care. The nurses are a bridge between the patients
and their families at home and the doctors in the hospitals
and polyclinics. Between 1999 and 2003, visiting nurses helped
72,000 people with health or social support, including 17,000
patients who were under their direct control for non-interrupted
Through implementation of the programme, the Russian Red
Cross is again working together with state medical services
in a joining of forces that has brought about success in reducing
infection rates and increasing community resilience.
An employee of an AIDS centre hands out
free condoms to young peole in central St. Perersburg.
©Reuters / Alexander Demianchuk,
Public health in Russia
RUSSIA faces a triple challenge in health. First, there is
a large health gap between Russia and its Western European
neighbours. The gap is due mostly to non-communicable diseases,
accidents, and injuries among adults, and to new diseases,
the most prominent of which is HIV/AIDS. Adult mortality rates
illustrate the problem. For example, if the current death
rates remained constant, then about 43 per cent of Russian
males who are aged 15 today would be dead before the age 60.
In Poland, the equivalent rate is 23 per cent. There are also
important variations among social, economic, and geographic
subgroups within Russia, in terms of financing, access to
services, and health outcomes.
Second, like many other countries, Russia is struggling to
meet with finite resources the growing demand for health services,
yet it makes inefficient use of those limited resources both
in terms of allocation and technical efficiency. The health
financing system in Russia is currently very fragmented and
much more decentralized than in most middle- or high-income
countries. Most public sector funds, over 85 per cent, are
raised and allocated at the regional level through general
revenues and a payroll tax. In effect, it is a collection
of multiple systems. There are multiple streams of funding,
each for different purposes, and sometimes for different sets
of providers. Finally, Russia has a more fundamental challenge
than disease control and the rationalization of health services.
This is the difficulty of reforming a strong tradition that
is grounded in the Soviet-era health system.
What and how to improve the system
The World Bank recommends that the following developments
be made to upgrade the quality of health care in Russia. First,
improving the aggregate health status of the population. To
achieve this goal, it is important to pay attention to prevention
at the levels of the household, outpatient services, and inpatient
Second, there is a major need to restructure the health services
delivery, in line with the needs of the population, with an
emphasis on a shift from inpatient to outpatient care. At
the same time, inequities in access to services and poor quality
of care need to be addressed. Weak governance and management
could be addressed through needsbased funding of services,
performance-based contracting of services, and improved systems
of licensing of health staff, external assessment via accreditation
of providers, health technology assessment, and operational
research. The use of clinical practice guidelines, improved
quality of equipment in line with needs, and performance monitoring,
would be useful for improving the quality of care.
Third, there should be an updating of the quality and quantity
of skills among medical professionals, as well as adjusting
training to develop those skills. Lastly, the World Bank has
identified a number of key changes to be considered in the
area of health finance.
World Bank activities
Over the past three years, the World Bank has had a growing
involvement in Russia. There is an array of non-lending activities
underway. For example, an economic impacts model was developed
looking at the impact of HIV on GDP growth over the next two
decades. The results showed that the cumulative number of
HIV-infected individuals by 2010 might rise to at least 2.3
million, which could lead to a decline in GDP of 10.5 per
cent by 2020.
The World Bank is running two projects in the country with
a third in development. The first is a tuberculosis and AIDS
control project, which aims to improve surveillance, monitoring,
strengthen case detection and improve case management. The
HIV/AIDS control component will support public information
campaigns, strengthen surveillance and monitoring, improve
laboratory service to ensure that the use of antiretroviral
drugs can be properly monitored and enhance blood safety.
The second is a health reform implementation project to pilot
a new model of health care delivery for the Russian Federation.
On the non-lending side, the Bank will need to work closely
with partners to improve access to affordable antiretrovirals.
There are several areas where a future collaboration between
the World Bank and the International Federation is possible,
in particular in the area of the care of the disabiled in
Russia. The World Bank is also very interested in the risk
mapping exercise that the International Federation is currently
undertaking for natural and man-made disasters.
Text written by the World Bank office
Russian prisoners suffering from tuberculosis
take their medicine at a prison camp outside the Siberian
city of Kemerovo.
©Reuters / Andrei Rudakov, Courtesy www.alertnet.org
While TB might be the biggest public health concern today,
these are early days for the HIV/AIDS epidemic in Russia.
Lars O. Kallings, special envoy of the United Nations secretary-general
on HIV/AIDS in Eastern Europe explains why it should be at
the top of Russia’s public health agenda now. “Let
me make clear why I think HIV/AIDS must be in the forefront
of concerns of the Russian Federation: because the epidemic
is spreading rapidly, because it threatens young people especially,
and because there still is an opportunity to curb the epidemic
before it does massive damage to the Russian Federation’s
HIV/AIDS first appeared in the country among needle-sharing
drug users. Although it is not known how far it has spread,
through sex, to the population at large, statistics indicate
that the epidemic is headed in a worrisome direction. Some
85 per cent of those living with HIV in the Russian Federation,
according to UNAIDS, are under the age of thirty – two
thirds are under twenty-five, and twenty per cent of the total
are still teenagers. A World Bank study predicts that by 2020
up to 10 per cent of an already decreasing population could
have the virus.
Economic development would be reversed as well. Projections
from the World Bank and the Russian Federation AIDS Center
show gross domestic product 4 per cent lower as a result of
AIDS by 2010 and 10.5 per cent lower by 2020, unless there
are more effective preventive measures taken.
Each day Russian Red Cross staff and volunteers are confronted
with the spreading epidemic in their work in prisons, as well
as with migrants and other vulnerable groups. Until now, a
conservative attitude within the National Society has prevented
it from facing this new crisis. Regional branches, as a result,
have taken the lead with some starting harm reduction programmes
and peer education initiatives. But plans are being made to
expand existing programmes and initiate new one.
The ICRC in the Russian Federation
THE ICRC has been working in the Russian Federation since
1992. From its regional delegation in Moscow, the ICRC carries
out a range of programmes aimed at the integration of international
humanitarian law (IHL) treaties in national legislation as
well as teaching and promotion amongst the armed and security
forces, universities, secondary schools and civil society.
In northern Caucasus, the ICRC runs a major humanitarian
operation comprising both protection and assistance programmes
as well as the promotion of IHL. Although this operation remains
hampered by the volatile security environment, the ICRC assists
the most vulnerable people by delivering material aid to the
resident population in Chechnya and to internally displaced
people in Ingushetia and Dagestan.
The ICRC also supports the repair of public infrastructure
such as the water supply and sewerage systems in Chechnya,
Ingushetia and Dagestan. As far as medical assistance is concerned,
the ICRC assists 12 hospitals in the region, as well as the
Grozny central blood bank, clinical laboratories and the Grozny
limb-fitting and rehabilitation workshop.
The ICRC strives to visit people detained in connection with
armed confrontations in Chechnya. It also implements mine
risk education programmes in order to help the civilian population
in general, and children in particular, to avoid the dangers
of mines and unexploded ordnance in Chechnya and Dagestan.
Despair and an inability to respond to social challenges:
these are the issues that the Russian Red Cross programme
for migrants deals with on a daily basis.
“Since 1997, the Russian Red Cross has accumulated
significant experience in this field” remarks Alla Yastrebova,
adviser to the Russian Red Cross President. “Our network
of consultation and counselling centres, summer camps for
children and work at railway stations supports migrants and
helps to promote tolerance, an acute issue in Russian society,”
Russian Red Cross has been running a programme for over 5
years in the Orenburg region, which borders Kazakhstan. This
region is one of the largest in the Russian Federation, an
important trade centre standing at the crossroads between
Europe and Asia. Here, roads from the Central Asian republics,
Siberia and the Russian Far East meet those from Moscow and
Sixteen passenger trains carry 110,000 passengers through
the city every day. Some 86 per cent of all migrants coming
here from the former Soviet states are from Central Asian.
Some 300,000 people — a population of a medium-sized
city — have settled in Orenburg region since the programme
began, giving it the third highest number of migrants after
Ingushetia and Ossetia, which neighbour Chechnya. During the
past three years about 23,000 people in Orenburg have received
free legal consultations and socio-psychological support from
the Red Cross.
Population movement exists in any state. There are many reasons
why people migrate, especially in a state with the kind of
dislocated infrastructure Russia has had since the collapse
of the Soviet Union.
The unfavourable economic climate, social conditions and
internal conflicts push not individuals, but whole families
into moving on against their will.
How can they prove individual persecution, a requirement
for getting legal status? Red Cross lawyers help them to formulate
the reasons correctly. Unlike state bodies, the Red Cross
makes no distinction between refugees, forced migrants or
unregistered involuntary migrants.
“Obtaining Russian citizenship is the most difficult
problem,” says Vladimir Kessler, Red Cross reception
centre lawyer in Orenburg. “Then come accommodation
About 3,000 forced migrants are on the waiting lists for
housing in Orenburg region alone. “We help people get
used to their new environment and together we write applications
to relevant bodies. Instead of fighting with the state machine
in vain we advise them how to deal with it in a correct legal
way and thus avoid stress and frustration,” Vladimir
“Sometimes our colleagues in neighbouring states help
to retrieve their documents,” he added.
In the world of migrants, full of misfortunes, the Red Cross
with its free and independent consultations and counselling
represents an island of conscience and goodwill.
According to Alexey Spitsin, head of the Federal Migration
Service in Orenburg, there is a big discrepancy between the
number of migrants registered (84,000) and the actual number
living in the region (300,000).
“I must admit,” he confesses, “that as
a state we are not able to solve all their existing problems,”
In April 2003, the Russian authorities said there were 472,300
forced migrants and refugees registered in the Russian Federation.
Around 43 per cent of them came from Kazakhstan, 13 per cent
from Uzbekistan and 10 per cent from Tajikistan. About 17
per cent were forced migrants within Russia.
The Russian Red Cross is determined to continue its help
to people on the move and will seek further funding for the
programme both within Russia and from external donors.
This year, the programme in the northern Caucasus is funded
by the ICRC, while the programmes in Kemerovo, Nizhni Novgorod,
Orenburg and Smolensk regions and at West-Siberian railways
are supported through the International Federation, primarily
by the Red Cross Societies of Sweden and Denmark.
ADDITIONAL support to the Russian Red Cross activities is
provided through programmes managed and financed through the
Russian delegation of the International Federation secretariat.
• provision of medical equipment and humanitarian supplies
in times of disasters
• food distribution during extreme weather conditions
and in isolated territories;
• financial support to migrants centres, offering legal
counselling, social support and
• summer camps for children;
• psychological support following major accidents or
• training for headquarters and district committees
in resource development and
• technical and financial support for the HIV/AIDS peer
• technical and financial support for TB programmes;
• support for small local development projects.
There is no doubt about the Movement’s solidarity and
support for the Russian Red Cross. Ten National Societies
are running joint programmes with it, from HIV/AIDS harm reduction
initiatives to food distribution for victims of cold waves.
But, while outside support is still vital, the National Society,
after a decade of transition, has emerged stronger, respected
and much needed for the decades to come.
As Tatyana Nikolaenko, the president of the Russian Red Cross,
sums up: “The Russian Red Cross has always been there
— in times of national emergencies, whether natural,
man-made, health or social disaster. And we plan on remaining
a national resource in times of need.”
Margarita Plotnikova is International Federation information
officer in Russia.