RPN 24 September 1997

8. Emergencies in the CEE/CIS: new challenges for UNICEF's child related programmes by Maarit Hirvonen


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.

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October 1997