By Boris Kagarlitsky
MOSCOW — "After the parade of sovereignties, the parade of infections will begin!" This sombre prediction by Mikhail Narkevich, a leading Russian specialist in the field of sanitary inspection, was made in 1991. His prediction has now been borne out. Cholera is raging in Russia.
In the autonomous republic of Daghestan alone, more than 1700 people have been diagnosed with the disease or identified as carriers during an epidemic that began in June. So far, 18 people have died. Cases of cholera have also been recorded in other areas of the north Caucasus, as well as in Barnaul and Omsk in Siberia, in Vladimir in north-central European Russia, and even in Moscow. Beyond the borders of Russia, cholera has struck in Azerbaijan and Georgia.
The cholera bacterium has been discovered in the river Don near Voronezh in central Russia, and in lakes near Vyborg, north of St Petersburg. In these regions, there are no immediate grounds for alarm; the summer has ended, and the bacterium poses a danger only when water temperatures are relatively high. Moreover, control over the quality of drinking water in the country's northern regions is still relatively good.
But it is a different matter in the north Caucasus, which even in better times lagged behind other regions of Russia.
An acute intestinal infection which can kill within hours unless treated, cholera is usually thought of as a Third World ailment. It is a disease of countries where the social infrastructure is primitive or has fallen into decay — where drinking water is pumped from irrigation canals, and where decrepit sewers leak into water supply pipes. In the more backward areas of southern Russia, both situations are common.
The last serious outbreak of cholera in the USSR occurred in 1970 in Odessa and Rostov. At that time the situation was quickly brought under control. But in the past few years the danger of cholera breaking out, and the difficulties of containing an epidemic, have both mounted as spending on water supply and sewerage systems has dwindled.
The people most at risk from cholera have always been those on the bottom of the social pyramid. As the newspaper Izvestia noted recently, "Poor nutrition and stresses lower people's immunity, increasing their chances both of falling sick and of becoming seriously ill. It scarcely needs to be said how high these chances are among refugees and their families ..."
Fragmented response
The reasons the health services failed this time to put a quick stop to the epidemic go well beyond the problems with water supply and sewerage. Funds have been insufficient, coordination between regions has been lacking, and there is not enough official support. The unified Soviet health service, once the country's pride, no longer exists. There are not even normal exchanges of information. Every region tries to solve problems independently.
Organising quarantine in most of the areas of Daghestan affected by the epidemic has proven difficult or impossible, since for many weeks the republic's leadership resisted the process. The administrations in nearby Krasnodar, Astrakhan and Saratov demanded that immediate measures be taken. But the authorities in Daghestan described quarantine restrictions as "a violation of human rights", and stressed the financial harm which the republic could suffer as a result of such measures.
The local leadership has done its utmost to avoid even mentioning the word "epidemic". The Russian Ministry of Health at one point adopted a special resolution "On Urgent Measures to Combat Cholera", but the newspapers quoted experts who stated gloomily that this was "already useless". Journalists joked that since the cholera bacteria could not read, they would never get to find out about the resolution's "urgent measures".
The authorities in Daghestan only got around to setting up a crisis committee 55 days after the first case of the disease was recorded. Army doctors who came to wage war on the epidemic complained that medicines were being shamelessly plundered. Even chlorine, essential for purifying water, was being stolen. The medics told journalists that in settlements they had visited, people had never seen clean water in their lives.
Armed conflict
In some ways, the situation is most dangerous in "independent" Chechnya, where the local authorities refuse even to admit Russian medical personnel. Moscow has been receiving information about the development of the epidemic in the republic via the Foreign Ministry. An armed conflict is continuing in Chechnya, and numerous armed groups are trying to place a blockade on the capital, Grozny.
Health officials in Daghestan have concluded that the current outbreak probably began when returning Muslim pilgrims brought the bacterium with them from Asia — something that has happened repeatedly over the centuries. The risk of infection in Saudi Arabia itself is not especially great, but there has always been a high risk of becoming infected en route.
Pilgrims from the former Soviet republics used to travel to Mecca by air. A doctor was attached to each group, and when people returned they were checked. This practice has now ceased. Pilgrims make their way to Mecca however they can, preferring cheaper modes of transport such as buses or trains, and even hitch-hiking.
The state-dominated news media have assured the population that by October, as cooler weather sets in, the epidemic in the north Caucasus will stop of its own accord. This is a safe enough prediction, since the cholera bacterium cannot survive Russian winters. But unless the underlying situation changes by spring, cholera will be back.
Meanwhile, cholera is not the only disease ravaging the country. In the past three years the incidence of diphtheria in Russia has risen by 20 times, with more than 15,000 cases recorded in 1993. This summer 65 people, mostly children, were stricken with dysentery in Kursk province, south of Moscow. Other infectious diseases making a comeback include typhoid fever and anthrax.