The MSF team was encouraged by a recent decree by the Ministry of Internal Affairs which ordered the police to allow the homeless to take refuge from the cold in Moscow train stations. The stations are open around the clock and permanently heated. They are crucial shelters for those who have no where else to go and do not have adequate protection from the cold. And, in a mid-afternoon visits to Kurksy station last week, sleeping bodies and groups of bedraggled, ill-dressed homeless people were very visible.
 

You wouldn't think it was necessarily news, given that very words 'Russian winter' conjure images of bitter cold, fur coats and lots of vodka. But the last weeks have seen a record-breaking cold snap hit Moscow, Russia's capital, with temperatures of minus 22 to 31 degrees centigrade - the lowest since 1978-1979 - for seven days. Normally temperatures would be around minus 10 to 15 at this time of year.

It was the kind of weather that caused nostril hairs to freeze, and numbed any skin exposed to the elements for more than a few minutes. Enforced power cuts were imposed by the city authorities to non-essential industries, trolley bus cables snapped, and snow-balling children were kept home from school.

But while most of city life continued much as normal, how did these conditions affect the most vulnerable, the homeless adults and children who are a sad presence on the capital's streets? MSF has run a project for street children and teenagers in Moscow since 2003, and has been monitoring their situation as well as providing essential care.

"We find that the street kids we work with are very resourceful, says Justine Simons, Project Co-ordinator. "When their usual sleeping area in a small hollow underneath a train platform gets too cold, they use the meagre money they have to find shelter inside - like one of our beneficiaries Sasha, who gives 75 roubles (2 euro) to the owner of a computer club to allow him to spend the whole night there."

Alexei, a 16 year old who lives on the streets, also described how he combats the cold: "During the day I hang out in the metro, there's a radiator near the wall. It is very hot, I even sweat. Then I go out to breathe and come back...the police...kick me out if I come too close to the metro ticket booth and try to beg for money."

Some of these survival schemes have dangerous consequences: one of the temporary hut-like dwellings that the kids built on wasteland near a station recently caught fire and burnt down. In another incident, an attempt to cook hot food in a dilapidated attic with pirated electric wires caused a dangerous short circuit.

MSF's outreach teams work year-round on the streets and in railway stations with Moscow's population of homeless kids, which MSF estimates to be between 250 and 500. The outreach model MSF uses has been developed from years of experience as a way of effectively gaining the trust of these vulnerable children, and is almost unique in Russia.

At this time of year most kids are to be found sheltering in one of the city's railway stations, and the team provide basic health care (the registration system in Russia means that non-Muscovite children are not eligible for free care in Moscow clinics, and around 80% of MSF's beneficiaries are originally from other regions); information, both oral and written, about how to notice the signs of exposure and protect oneself from the cold; and extra clothing if needed.

The street kids that MSF meet usually have hats and gloves (often provided by MSF), but their thin jackets and shoddy footwear do not give them much protection. The contrast between their inadequate clothing, and the padded jackets and mittens of the outreach workers and journalists who talk to them, is striking.

The outreach workers will also help a child find accommodation or free food and purchase railway tickets for those who want to go home. As a complement to its outreach work, MSF also runs a day centre, which has been open at the weekends during the severe frosts. Here kids can get hot showers, receive medical and psychological help and benefit from skills training.

The MSF team was encouraged by a recent decree by the Ministry of Internal Affairs which ordered the police to allow the homeless to take refuge from the cold in Moscow train stations (one of the final recommendations, in fact, of the adult homelessness program that MSF operated in Moscow for eleven years until 2003).

The stations are open around the clock and permanently heated. They are crucial shelters for those who have no where else to go and do not have adequate protection from the cold. And, in a mid-afternoon visits to Kurksy station last week, sleeping bodies and groups of bedraggled, ill-dressed homeless people were very visible.

Sadly, some homeless have told MSF that, while the police are letting them in to stations, they are often beating them cruelly, particularly at night. And the staff at the city-run medical and disinfection point for the homeless - based on a model pioneered by MSF during its program for adults - have treated cuts and bruises that patients allege were sustained in police beatings.

For the kids, the alternative to a night in a station or sheltering in a computer club, is a stay in one of Moscow's temporary orphanages, or Pryuts. Over 1,000 Pryut places (for Muscovites and non-Muscovites combined) exist in Moscow, which should be ample for the street kid population. But the kids do not view them as an attractive option. Partly this is because they are tainted by association with the city's coercive legal system - in sporadic operations to 'clean-up' the streets, the police often dump children they find in a Pryut against their will.

But it is also because the Pryut's offer a very 'institutional' model of care. Many have received substantial amounts of investment in recent years, but MSF's view is that this extra cash should be targeted at increasing the psychosocial support and rehabilitation available in the facilities. Most of the children MSF works with have been in and out of these institutions many times; when asked why they don't stay, they say that they resent the restrictions on their freedom, and also that Pryuts are, simply, boring.

The severe cold will also bring health problems in its wake. Fortunately, MSF has seen no alarming health consequences yet among kids (in contrast to adults - city authorities have reported more than 27 deaths since January 16). However, the project doctor, Ramil Goutov, notes that "the consequences for glue sniffers can be dangerous."

As one of MSF's beneficiaries said, "We were sniffing not to be frozen over. When you sniff you feel warmer. You are doped and you don't care about the cold."

It is likely that the team will start to see colds, flu and severe respiratory infections in the coming days, many will be hard for the kids to shake off until spring comes in April or May. So, while the cold will become a distant memory for most Muscovites and European observers, it will remain a harsh fact of life for the vulnerable children of the streets.

As Ceric, a long-time street dweller pragmatically observed, "If you are living on the street you have to put up with everything...you gotta get used to the cold and forget about it."