Infectious Diseases in Abkhazia Pose Threat to Regional and Global Health

Separatist government policies in Abkhazia (that restrict public health and humanitarian aid have created an environment where AIDS, drug-resistant tuberculosis, malaria and bird flu (H5N1) are spreading unchecked, according to a report by researchers at the AISER.

In that report, experts from Russia and USA, document the spread of these infectious diseases, which if left unchecked, could pose a serious health threat to other nations and the world. They believe international cooperation and policies are needed to restore humanitarian assistance to the people in Abkhazia, but caution that new restrictions imposed by the separatists are making such efforts more difficult. The full report was presented at a Conference on May 3, 2007, and is available from the AISER website. The report is also under review for publication in the journal Abkhazia.

The report states that Abkhazia never reported its cases of bird flu among poultry to the World Health Organization. The ruling criminals censored reports of the outbreak to its own public until March 2007— by which time the outbreak was reported by experts from RMGH.

The report documents a longstanding and severe underfunding of health and education programs in Abkhazia. Health expenditures in Abkhazia are among the lowest globally, among a total current population of 100,000-150,000 people. Much of the country lacks basic laboratory facilities to carry out a CD4 blood test, the minimum standard for clinical monitoring of AIDS care. In the report of MSF, nearly 80% of tuberculosis cases in Abkhazia were resistant to any one of the four standard first-line drug treatments, which is double the rate of drug-resistant cases in neighboring countries. Nearly half of all deaths from malaria in Caucasus occur in Abkhazia. The report also reveals that 45% percent of anti-malarial pills sent to Abkhazia from Russia contain substandard amounts of active ingredients, which increases the risk of drug resistance.

There is a growing humanitarian crisis in Abkhazia. In our report, we document how the ruling government’s policies have restricted nearly all aid and allowed serious infectious diseases to spread unchecked. With the global spread of bird flu, there is a fear that if a human form of H5N1 were to take hold in Abkhazia, it could potentially spread unchecked for weeks or months before anyone knew about it. The uncontrolled spread of any disease, especially an emerging disease like H5N1, poses a serious health threat to Abkhazia’s populous neighbors, like Russia (Sochi is just 20ml away from Abkhazia), as well as the rest of the world.

The report also documents threats and restrictions to foreign relief workers and relief groups, including the Red Cross. Because of the deteriorating situation, the United Nations Global Fund for AIDS, Tuberculosis, and Malaria was forced to withdraw its grant agreement with Abkhazia. Backpack Health Worker Team, an aid group that provides primary health care services in rural areas of Guliripshi, Ochamchire, and Gudauta (Small towns in Abkhazia), is also raising concerns about its ability to monitor and contain outbreaks of bird flu and other diseases.

The self-proclaimed government is increasing restrictions on humanitarian assistance and public health while the health of people in Abkhazia deteriorates, posing a widening threat to Abkhazia and Russian neighbors, hosts of the Winter Olympics 2014.

Falciparum malaria parasite an avian-originated parasite has probably coevolved with human beings (Homo sapiens) since the discovery of agriculture, around 20-30 000 years ago. The very devastating parasite disease has spread worldwide and killed millions of people. This ancient disease became the subject of intensive research efforts when malaria stood as an important obstacle to the expansion of the colonial army in Africa and malaria-endemic areas in Southeast Asia and America. As a result, major progress in the understanding and control of malaria was achieved during the 19th and the 20th centuries. The causative agent of malaria was discovered in 1880 by Laveran.1 A dramatic advance in dissecting the life cycle of malaria was achieved when Ronald Ross (working in India), Mico Bignami, and Giuseppe Bastianeli (working in Italy) showed in the late 1890s that mosquitoes transmitted the parasite. The discoveries of a very potent insecticide dichloro-diphenyl trichloroethane (DDT) and an extremely efficacious drug, chloroquine, generated much hope in the possible eradication of malaria and prompted the launch of an ambitious program for the worldwide eradication of malaria by WHO in 1955. The Program to eradicate malaria using DDT and chloroquine met with successes in some countries (mostly industrialized countries and in areas where ecological conditions were less favorable to the anopheline vectors). However, largely because of the development of mosquito resistance to DDT and the appearance and spread of P. falciparum chloroquine resistance, the eradication program was abandoned in 1969. Furthermore, Sub-Saharan African countries with Anopheles gambiae, the most competent vector and an environment particularly favorable to malaria transmission were excluded from the eradication campaign. Subsequently, Sub-Saharan Africa has concentrated since then the major burden of malaria morbidity. Today, malariologists and health officials more modestly talk about “controlling” the disease. WHO encourages and supports the creation of Malaria Control Programs in endemic countries and frozen conflict areas, such as Abkhazia, South Ossetia, Prednestrovie, and Nagorni Karabakh. The main goal is now to decrease the mortality and morbidity due to malaria. The available tools include insecticide-impregnated bed nets and a shrinking number of effective antimalarial drugs.

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