Introduction
The CEE (Central and Eastern European) and CIS (Commonwealth of
Independent States) countries with complex emergencies were an unfamiliar
field for UNICEF when called to assist their vulnerable child populations
in the early 1990s, first in the Balkans and then in the Southern Caucasus
and Tajikistan. Further emergency assistance was provided in 1995 to
internally displaced people (IDPs) in the neighbouring republic of
Chechnya in the Russian Federation.
The complexity of the emergencies, the nature of the assistance needs
and the potential for future crisis and population displacement in the
region have forced a re-evaluation of assistance and contingency planning.
Moving on from the early ad hoc, supply-heavy operations, current
programmes reflect a more developmental approach: low-cost, empowering,
preventive and focusing on capacity building and community level
activities.
Complex emergencies: current and potential
Following the collapse of the Soviet Union, many of the newly
independent countries were sucked into a power vacuum with an explosion of
old clan and ethnic rivalries. In several cases, local and regional
violence degenerated into wider warfare, causing great suffering with
deaths, mental and physical traumas and disabilities, breakdown of
communities, massive population displacements and the collapse of
traditional and moral values.
Despite the Dayton Accord, the problems in the former Yugoslavia(1), especially Bosnia and Herzegovina, are far from solved; and Kosovo in the Federal Republic of Yugoslavia (FRY), Eastern Slavonia in Croatia and Tajikistan are all still potential crisis areas. The latest example of the complexity of emergencies in the region is Albania where the state has failed to protect its ethnically homogenous population and to create opportunities for growth and progress, leaving the country in a state of near anarchy. In the Southern Caucasus, the cease-fire between Armenia and Azerbaijan has lasted since 1994 but the original problems of Nagorno-Karabakh remain unsolved in spite of the efforts of the Organisation for Security and Cooperation in Europe to bring concerned parties around the negotiating table. The fighting in South Ossetia, Georgia, has stopped but the area remains isolated and in dire need of assistance to facilitate the
return and integration of the displaced and refugee populations.
Hundreds of thousands of IDPs in Azerbaijan and Georgia are still
lingering in IDP centres or camps with little hope of an immediate return.
War in Chechnya is over but its legacy is a devastated country with a
deeply traumatised population still partly displaced outside its borders.
In Central Asia, all other ex-Soviet countries except Tajikistan have
been able to overcome the problems of power vacuum without larger internal
clashes. Tajikistan is unfortunate enough to be viewed by the Russian
Federation as a last frontier against Islam, and its southern border is
fortified against invasion from Afghanistan. The manipulation by external
powers of the internal power struggles in Tajikistan has resulted in a
divided country. The peace accord signed between the Tajik President and
the United Opposition in June 1997 creates a power-sharing arrangement,
though severe threats to peace still exist. The prevailing insecurity and
fragmentation of Tajikistan hamper assistance efforts and have forced
agencies to develop new strategies in order to address at least the most
urgent needs of the people. Lastly, China's border with Kazakstan,
Kyrgyzstan and Tajikistan could be a future area of instability if Beijing
increases pressure to avoid losing control of its northern regions.
Health issues and approaches
Within the region there is a large cadre of highly educated
professionals, among both the local population and the IDP and refugee
population. Their skills, however, have remained substantially
under-utilised due to the deteriorating infrastructure, failure or lack of
equipment, scarcity of medical supplies and meagre salaries. Medical
emergency assistance to the local and displaced populations has faced
particular problems because of outdated protocols of drug management and
of immunisation schedules, heavy bureaucracy relating to rules and
regulations for importing medical supplies and a primarily
curative-oriented health care system. Lack of iodine is a widespread
problem, prevalent specifically among the displaced population from
Chechnya. Different epidemiological emergencies (diphtheria, malaria,
polio, tuberculosis, typhoid) are the inevitable result of a degenerating
infrastructure, deepening poverty, population movements and crowded,
unsanitary living conditions.
The nature of the problems identified in the health sector forced UNICEF
and other medical assistance organisations to take a more developmental
approach from the outset. This was necessary a) to avoid the abuse and
misuse of limited resources, b) to achieve more in cost-benefit terms and
c) to introduce unfamiliar methods and approaches in order to bring the
ex-Soviet health systems closer to global mainstream medical practice.
The lack of resources means that low-cost approaches need to be
developed to address the emerging epidemiological problems, more along the
lines of UNICEF's preventive community/family based programmes in Africa.
The former Soviet safety net, which guaranteed at least some basic care at
an affordable cost for the most vulnerable, has in some places vanished
overnight. In the light of this, UNICEF is advising governments to provide
certain services free for young children and to provide special
arrangements to cover the health needs of destitute IDP women and
children.
The immensity of the needs has led UNICEF to concentrate on the most
urgent interventions and to collaborate with partners in the UN community
and outside. The use of internal or regional medical expertise combined
with updating the skills of UNICEF's local medical officers has proved
effective in facilitating the exchange of ideas and the introduction of
new notions between colleagues with a similar background of Soviet-era
medical training. The problem of obsolete practices can be solved partly
through the provision of refresher courses for medical staff. In order not
to create parallel systems, the needs of refugee and displaced populations
have been addressed through the enforcement of local structures and, where
possible, IDPs with appropriate skills have been mobilised to assist their
own displaced communities.
Community-based water and sanitation
The legacy of the old system weighs heavily on water supply facilities
in the region. Centralised structures with kilometres of pipes, often
uncovered, reaching from major city centres to the smallest of villages
have proved to be unsustainable. The infrastructure is collapsing due to
lack of maintenance and there are no resources for central purification.
The typhoid epidemic in early 1997, for example, in Dushanbe, the capital
of Tajikistan, was caused mainly by unsafe, untreated water supplies. Lack
of appropriate water and sanitation structures are especially problematic
in institutions such as schools, health clinics and IDP centres. The
decentralisation of the water supply system is the only longer term
solution to these problems, with the development at community level - such
as in Armenia and Tajikistan - of low-cost, locally produced and easily
maintainable water pumps, filters and sanitation installations.
Double challenge in education: quality and quantity
Education in the region has suffered enormously from lack of resources.
The literacy rate - formerly almost 100 per cent - is falling rapidly as
the educational system has less and less to offer and as children are
needed elsewhere to support their family. The IDP child population from
Chechnya offered a particular challenge, lagging behind even the most
recent Soviet standards due to local resistance to anything Soviet;
teaching methods were completely outdated and textbooks dated back some 20
years.
In a combined transitional and complex emergency context, the education
sector's needs are even higher than in 'normal' emergencies, yet attract
little interest from donors. Funds are needed to supply paper as well as
to upgrade dilapidated printing facilities; furthermore, the development
of textbooks consistent with the changed environment and social issues is
time-consuming and needs basic funding. Due to the lack of funding, only
minor 'gap-filling' assistance has been possible: provision of basic
school supplies, some production of new materials and a degree of
upgrading of teachers' skills through the introduction of interactive
methods and new subjects such as life skills and peace education both in
local schools and in IDP centres and camps.
'Education for peace and conflict resolution' is part of UNICEF's
emergency-related basic educational programmes in countries such as
Georgia, Tajikistan and the former Yugoslavia. In the absence of any
longer term strategies for this type of programme, the initiatives have
been very country specific and often isolated. They have the potential,
however, to encourage tolerance and the diffusion of violence in society,
and need to be more widely researched, developed and integrated as part of
the surrounding cultural environment.
Trauma relief programmes: new territory
UNICEF has been addressing the various war trauma related problems among
local and displaced child and women populations in the countries of the
former Yugoslavia, especially in Bosnia and Herzegovina, since 1992. If
these problems are not tackled, children will grow into adulthood with
unresolved psychological problems and will be unable to achieve their full
potential. Programmes also need to target women, the basic care-givers, to
help them regain their emotional balance and in turn be better able to
help their children.
In 1995, UNICEF introduced trauma relief activities to IDP communities
in the surrounding republics of Chechnya, in Dagestan and, in a more
limited scale, in Ingushetia. The programme was enthusiastically received
by health professionals, local authorities and the IDP communities
themselves after observing concrete positive behavioural changes among IDP
children who received initial attention through individual therapy
sessions. These trauma relief and treatment activities involved:
a) trauma relief sessions with severely traumatised IDP women and children
b) training and capacity building among local and IDP personnel to enable them to take charge
of individual or group sessions
c) research and subsequent incorporation of the knowledge of local cultural characteristics and
coping mechanisms into the treatment methodologies
This assistance was linked to empowering women's groups in the IDP
centres (with designated tasks such as labour division, arrangement of
temporary schooling and identification of most needy members of the
community) in the hope that this would provide them with valuable skills
to use in strengthening their own communities once back in Chechnya.
In Georgia and Azerbaijan, UNICEF has funded some innovative approaches
to improve the psychosocial wellbeing and cognitive development of young
and adolescent IDP children. In Georgia, IDP children selected by their
communities in the capital of Tbilisi participate in Sunday schools where
they learn to express themselves through drawing, music and theatre, and
where they are taught history and literature. There are plans to extend
this activity to other cities in Georgia with significant IDP populations.
In Azerbaijan, UNICEF is assisting multi-purpose centres for pre-school
children in IDP camps and in some communities in the 'newly liberated
areas' where IDPs have moved in the hope of finally being able to return
to their homes in Nagorno-Karabakh. The programme aims to include some
7,000 pre-school children by late 1997. In addition, young IDP women have
received basic training in early childhood development and psychosocial
treatment skills and are now used as monitors and teachers in the centres.
Experience gained through these activities may help encourage a wider
introduction of early childhood development awareness, plus peace and
conflict education, into Azeri society.
Institutionalised children: the need for special protection measures
The examples of Romania and Bulgaria have shown the appalling situation
of children - orphans and mentally and physically handicapped children -
in institutions. This particular child population is extremely vulnerable
and dependent on a state structure unable and/or unwilling to maintain a
rapidly deteriorating infrastructure, to contribute to staff salaries or
to guarantee basic health, nutritional and educational services.
Statistics suggest that this group is growing, due to population
displacement and increasing poverty which leads some families to hand over
their children to institutions.
The problem is enormous and cannot be addressed by any one agency alone.
In Georgia, various agencies are working together to assist some of the
most needy institutions. Instead of ad hoc measures, however, a
comprehensive policy for assisting this vulnerable child population needs
to be developed. This would include the identification of: criteria for
selection of facilities to be assisted, priority activities and
programmes, and viable partners in the UN and NGO community. In emergency
situations, UNICEF needs to pay special attention to the institutionalised
child population and to take additional measures to guarantee their
protection. This also includes the children in often over-crowded IDP
centres who are growing up without any experience of normal family or
community life. In addition to their material needs, these children need
programmes to address their psychosocial needs, having often suffered
traumatic experiences with memories of violent incidents linked to their
forced departure.
Contingency planning
As part of early warning and preparedness activities, contingency plans
are being developed for a number of potential emergencies where massive
population movements may be expected. A recent application of contingency
planning in the CEE/CIS region has been the Kosovo contingency plan
involving the offices of the FRY, Albania and the Republic of Macedonia;
in view of possible region-wide population displacement, this plan aims to
reinforce the social capacity of communities receiving most of the fleeing
population. These plans, however, need to be continuously adjusted to keep
pace with the changing socio-political environment.
Maarit Hirvonen is Programme Officer, UNICEF Emergency Programmes, Geneva.
1. The former Yugoslavia refers to all previous republics which were
part of Yugoslavia before partition: Bosnia and Herzegovina, Croatia, the
Federal Republic of Yugoslavia, the Former Yugoslav Republic of Macedonia,
and Slovenia.
October 1997