MSF began working in Azerbaijan in 1991.

Statistics

• Population approx 7.7 million (July 1997)
• 83% of the population Azeri
• Other ethnic groups in Azerbaijan include Russians, Armenians and Daghestanis.
• Main religion - Muslim (87% of population)
• Main language spoken - Azeri (82% of population)
• Number of IDPs living in Azerbaijan - 845,000
• Less than 5% of IDPs have been able to return to their place of origin
• Unemployment estimated at 37%
• World Bank estimates over 60% of population live below the poverty line
• Infant mortality rate of 22.6 deaths per 1000 live births
• Maternal mortality rate of 44.6 per 1000 live births

Issues

Recently the Azeri Government passed a new law requiring people to pay for their medical care. While some people say that this is just legalising a process which has long taken place anyway (ie people used to have buy their health care unofficially), numbers of hospital admissions have drastically reduced. One MSF doctor who works in Sumgayt's Hospital Number One, said that since this new law came into effect, admissions have fallen by 50%.

There are on-going tensions and disagreements between Azerbaijan and Armenia over the territorial rights to Nagorno Kharabagh - an enclave of land currently controlled by Armenia but surrounded by Azeri land. Conflict started in 1988, cease-fire since 1994. There are still a large number of troops situated on both sides of any border territory, occasional border skirmishes, and no agreement between the two countries, despite attempts at mediation by the OSCE. A 1994 cease-fire is still in effect.

As a result of the Nagorno Kharabagh conflict, 845,000 IDPs live in Azerbaijan. Many of these people are Azeris who had a comfortable standard of living in Nagorno Kharabagh before the conflict, and now live under extremely difficult conditions - in railway carriages, refugee camps of mud and wooden huts, in what were once student dormitories - 5-7 people per room. In these dormitories there can be 140 on one floor with just one male and female toilet and one kitchen. As a result, the prevalence of disease in such places is higher than for the average population. These people live a life in limbo where they hope, but do not know when they will be able to return to Nagorno Kharabagh. Most have been living in Azerbaijan for about six years. There are reports of people who keep their bags packed for the day they can go home.

Many of these people are jobless - you see men gathered in big groups on the streets just passing time talking to each other. State allowances are inadequate and these IDPs have the lowest status of any group in the community.

There is no national drug policy. As a result, there is not much control of the supply of drugs and the quality. Border controls are inadequate so now many drugs of varying qualities are being brought into Azerbaijan and sold. Also, all kinds of medications can be purchased without prescription. This poses a problem for diseases such as TB where people could buy drugs and treat themselves, or be taking poor quality drugs, increasing the likelihood that they will develop multi-drug resistant (MDR) TB. MDR TB is extremely difficult and expensive to treat, and the cure rate is much lower than for drug-sensitive TB. 

A profile of Sumgayt

• 40 mins drive north-east of Baku on the coast
• population 350,000

History

In 1933 the Soviet Government decided to situate the infrustructure for Azerbaijan's oil industry in Sumgayt. Over the next 50 years, the population of Sumgayt grew from 6,000 to 350,000. In the 1950's, other industries started to develop in Sumgayt. From this time onwards, until the collapse of the Soviet Union, toxic chemicals including DDT and caustic soda, phosphate fertiliser and even chemical weapons were produced in Sumgayt.

According to the UNDP, at the height of production an estimated 70,000-120,000 tonnes of toxic waste was released into the atmosphere each year. Following the collapse of the Soviet Union, many of these factories lost their raw material supply, marketplace, and lacked the funds to modernise to bring their production up to Western standards to compete on the open market. As a result, the factories in Sumgayt today only run at 10% of their capacity.

Present

According to the CIA's World Factbook website, Sumgayt is "the most ecologically devastated area of the world" workers in Sumgayt suffer from cancers, heart and bone defects, deficiency in immune systems there is a high incidence of birth defects.

The MSF programme in Sumgayt

MSF targets medical assistance to over half a million vulnerable people in Sumgayt, including a large number of internally displaced people (IDPs) as a result of the war in Nagorno Kharabagh.

This work started in 1995 and includes four dispensaries providing free basic health care and referrals. About 2,800 patients visit the four dispensaries each month.

MSF also provides assistance to government health structures so that they can provide free and adequate health care for MSF referrals, and a few vulnerable patients already in the government structures whom MSF is asked to help. This assistance comes in the form of providing drugs, medical and non-medical supplies and logistical support. In addition, MSF has provided building rehabilitation and staff training.

Since 1996, MSF has been implementing a scabies epidemic control program in conjunction with the Ministry of Health in Sumgayt. This program provides assistance to the governmental skin/STD dispensary to ensure free scabies treatment for the whole population.

In the region, MSF is also involved in assistance to government structures for preventative health care, cold chain management and laboratory work. Health education is another important part of MSF's work, and the organisation started such activities in Sumgayt in 1996. This work has involved the dissemination of information on the prevention and treatment of common diseases to patients in the MSF dispensaries, during maternity consultations in the hospital and polyclinic, in the skin and STD dispensary and to the wider community in public meetings and schools. This public health education has included an awareness campaign for scabies for children within and outside Sumgayt.

The MSF programme in Imishli/Fazuli/Saatli MSF works in the south-west of the country in the regions of Imishli, Fazuli and Saatli. Its programs include:

• The provision of primary health care to vulnerable people
• Public health education
• Reproductive health training for gynaecologists and midwives
• STD prevention, diagnosis and treatment
• A malaria program
• Emergency medical preparation for disease outbreaks such as diphtheria and plague
• Health facility rehabilitation (including water supply) and vaccination management.

MSF is also about to begin an STD survey in Sumgayt, Imishli and Saatli in order to provide information to the Ministry of Health for developing national STD protocols.