On January 10, MSF started a leafleting campaign on Moscow streets to raise awareness of the homeless people that other Moscovites pass every day. The leaflet includes the aaddresses of shelters, places for assistance as well as simple advice should a person ever come across a person who seems to be in danger. The advice starts with the simplest advice: Call an ambulance.
The homeless are called 'bomzhi' - a derogatory term which officially means 'without permanent residence' but has become associated in the public mind with alcoholism, vagrancy and criminality.
Winter officially begins in Russia on December 1 but, in reality, it started in October when the temperature dropped below zero and the first frozen corpses of homeless people began appearing on the streets of Moscow. Now with the temperature regularly down to minus 30 Celsius during the night, it is clear that this shall be another season where homeless people in Moscow are going to die in the streets - by the hundreds - from exposure.
Since the cold season began, 319 people have died (as of January 20) on Moscow streets. In October, 41 homeless people froze to death. In November, another 60 died. And winter temperatures had not even sunk to their lowest. Almost every winter for the past ten years, the temperature has been as low as minus 35 Celsius. The wind-chill can take it as low as minus 40.
The Russian winter is savage and anybody forced to live rough is endangered every hour of the day. Over the past four years, 1,667 people have died in the streets of Moscow from hypothermia. Last winter a total of 430 people, 90% of them homeless, died of the cold in the Moscow streets.
Often these deaths bring little more than indifference from the general public. Most passer-bys, or the police, will likely walk past the bodies without calling an ambulance.
The homeless are called 'bomzhi' - a derogatory term which officially means 'without permanent residence' but has become associated in the public mind with alcoholism, vagrancy and criminality.
"People usually see them in metro wagons and vestibules," said Dr. Alexei Nikoforov, medical co-ordinator of the MSF homeless project in Moscow. "They only see that they are stinky and dirty with scabies, dysentery, lice and tuberculosis."
MSF and the 'bomzhi'
At the MSF dispensary at 17 Krasnogvardeisky Bulvar there are several people packed together, waiting in the entrance. Some are only in rags, and some are dressed normally. Some have visible wounds, and some are coughing. Almost all of them have plastic bags with their belongings
Vladimir, one of the homeless of Moscow is being treated by MSF doctor Arkhan Nasibov. He is one of the homeless of Moscow being treated by MSF in the dispensary. He has big wounds on his legs.
"These wounds are from a group of youths attacking me without me provoking them," he said. "Afterwards they took the little money I had."
The last time he was injured it was the police hitting him to get him out of their district. Usually they hit people on the feet, which is the worst place and makes it difficult to move about. These wounds heal slowly. Vladimir is from the vicinity of Moscow but has no identity or registration documents.
"Somebody robbed me and took my documents," he said. "Without a passport and registration it is impossible to get housing and to get a job."
Although it is no longer illegal to be homeless, there are few services available to them. Russian authorities claim they are only 2.5% of the total population and are not a social problem that needs to be addressed. Today there are few provisions offered by the state for the homeless.
In fact, the authorities still perceive the homeless more or less as criminals. Often, they are not helped through the medical and social structures or are denied access by health personnel because they are seen as being carriers of infectious diseases. This erroneous perception stems from the skewed picture of the homeless presented regularly by the media. In truth, the homeless reflect a reality of the health situation in the general population where there are transmittable diseases like tuberculosis and respiratory infections.
There are also some specific health problems for the homeless, like trophic ulcers, infected wounds and burns because of their way of living - and many of the homeless drink excessively
The root causes of being homeless often comes from unfortunate circumstances, including family problems, unemployment or loss of residence connected to the job. In the early and mid 90's a lot of people were hit by housing fraud due to rapid privatisation, and they lost their housing.
A decade with the Moscow homeless
MSF started working in Moscow in 1992 - and started a programme with the homeless in May of that year. At that time unofficial estimates were that there were 30,000 homeless in Moscow. Offical stats have consistently under-estimated the figures and it is only now, ten years later, that the official figures have reached 30,000. But today the well-respected Social-Economic Studies Research Institution puts the figure at 100,000 - and four million homeless in total across the country.
This winter, seven hostels on the outskirts of the city were ordered to make 1,600 hostel places available to homeless people without documents during the winter season. When the hostels were checked by MSF last week, only 746 places had been made available. In addition, the city made no attempt to let the homeless know of the availability of hostel places.
Only 10% of the homeless in Moscow are Muscovites. The others have great difficulty gaining access to essential services as they have no Moscow registration. A recent initiative by the Moscow City government to address this issue proved to be wholly inadequate: An order was given to seven hostels on the outskirts of the city to make a total of 1,600 hostel places available to homeless people without documents during the winter season. When the hostels were checked by MSF last week, only 746 places had been made available. In addition, the city made no attempt to let the homeless know of the availability of hostel places.
Every year the situation remains grave and every year the numbers of people MSF has cared for at its medical point have increased.
"The homeless situation has entered a chronic state," said Alexei Nikoforov. "Last year 7,000 new faces came to the MSF dispensary in Moscow. Most of them come from the regions and the CIS (Commonwealth of Independent States) looking for a job. Due to the economic situation, there have been lay-offs in industry and the military."
Over ten years, MSF has provided a total of: 183,629 medical consultations; 55,360 social consultations; vaccinated 11,955 people; and the hospitalisation of 11,164 persons.
Conditions have improved slightly
"Now, at least, there is some recognition among politicians of the difficult situation facing the homeless in Moscow," said Alexei Nikiforov. "There are some shelters and a medical point is to be set up, although not for the homeless who come from outside Moscow. After extensive lobbying the Moscow parliament last year voted in favour of the MSF-model. Sooner or later the authorities will have to prevent homelessness, improve the homeless` living conditions and restore their dignity reintegrating them into society, the MSF doctor Alexei Nikiforov ends.
Prisoners
A group that is doubly stigmatised are the ex-prisoners, who account for 30% of the homeless. When imprisoned, the person loses both their home registration and passport. Often these essential identification papers are not returned, making it almost impossible to re-enter society.
Hope after all
Even though the situation is very bad there is hope for the homeless of Russia. In St. Petersburg MSF has been able to halt its projects because of successful lobbying alongside the local organisation Nochlezhka, to the city authorities. The authorities have acknowledged the homeless access to basic rights by giving registration to all as well as free access to health care. With Nochlezhka, MSF has been working on a federal law for the homeless, seeing bits and pieces coming into place.
A normal life
Unlike the widely accepted stereotypes of people choosing to live on the streets, the homeless have the same goals for their lives as the rest of Russians.
"Basically they all want a normal life," Alexei Nikiforow says. "That is why we have to continue to break down the stereotypic view of the homeless."