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Ifrc - chernobyl humanitarian assistance and rehabilitation programme charp in belarus ukraine and russia (appeal 01.60/2001)CHERNOBYL: HUMANITARIAN ASSISTANCE
AND REHABILITATION PROGRAMME (CHARP)
IN BELARUS, UKRAINE AND RUSSIA
Click on programme title or figures to go to the text or budget
As a result of the explosion of the fourth unit of the Chernobyl nuclear plant on 26 April, 1986 tens of thousands
of square kilometres of land remain severely contaminated in Ukraine, Belarus and the Russian Federation. A
population of over 4 million people are still living in these areas. Launched in 1990, the Federation’s longterm Red
Cross Chernobyl Humanitarian Assistance and Rehabilitation Programme (CHARP) addresses basic health needs
of those living in the most contaminated areas. The programme first concentrated on screening food supplies and
the surrounding environment through radiometric testing. From 1992 onwards, six mobile diagnostic laboratories
(MDLs), based in six highly affected regions, screened background radiation and provided medical examinations
to adults and children in remote areas. Basic health information on measures to mitigate the impact of radioactive
contamination on general health was also distributed to the population.
In 1996, the CHARP programme was modified and adapted to meet new needs. Since the radiation situation hadstabilised, the dosimetrical part was significantly reduced and the number of people targeted for medical screeningwas increased from 60,000 to 90,000 per annum, with a special focus on children and people who were children atthe moment of the accident – the most vulnerable in terms of thyroid gland cancer. In June 1997, six new MDLs,redesigned to facilitate the increase in examinations, replaced the old ones. Three new MDLs now operate inBelarus, two in Ukraine and one in the Russian Federation. This resulted in a significant reduction of the costs ofthe programme. Local management was successfully introduced and calls for increased ONS support were made.
A further element of the revised CHARP was the introduction of a psychosocial support (PSS) programme. Thisbegan as a pilot project in 1997 in Belarus, where Red Cross workers and volunteers were trained in PSS helping techniques. In November 1998, the project was initiated in Ukraine, and then in Bryansk Oblast, in the RussianFederation, in November 1999. CHARP also included the supply of multivitamins, milk powder and medication (including ‘Levothyroxine’, usedfor the treatment of people whose thyroid has been removed). Training is provided to the MDL staff on the mostup to date techniques used by CHARP. During 1999, CHARP maintained the emphasis on increasing the number of medical checkups, with a focus onthyroid gland examinations, and further improving and expanding psychosocial assistance to the population. Asignificant part of CHARP’s budget continues to be devoted to the provision of multivitamins for children living incontaminated areas and levothyroxine medicaments for people with thyroid gland pathologies. However, theprogramme is facing a severe shortage of funds, and new initiatives have been put on hold and existing activitiesare under consideration to secure the required support. In addition, ECHO’s decision to stop its funding addsfurther pressure on the programme.
Programme Assistance Strategy
Fourteen years after the Chernobyl disaster, the situation in the three affected countries – Belarus, Russia and
Ukraine – remains worrying. Concerns about cancer attributable to the accident are still high. Important questions
remain open with regard to the effects of radiation on human health. The psychosocial impact of the accident on
the population is obvious and has been underlined at numerous international Chernobyl conferences. It is therefore
considered essential to continue to provide comprehensive humanitarian assistance to the people affected by the
disaster, and this calls for the concerted efforts of all concerned. Throughout its history, CHARP has accumulated
a wealth of lessons and developed new skills in the communities. This represents a unique asset in case of further
or similar disasters.
CHARP, a well organised and coordinated Federation Disaster Response programme, provides the population withvital medical and psychological assistance. It is especially important for people living in remote and radiationpolluted areas with less and less access to health care facilities. For many of them, the check by the MDLs is theonly regular opportunity to identify potential lifethreatening diseases. In Ukraine and Bryansk Region (Russia) theRed Cross MDLs are the only mobile laboratories operating in rural areas. In all regions, the work of the MDLs iscoordinated with the health authorities. Data collected confirms the high incidence of thyroid gland pathologiesand cancer, especially in children and persons who were young at the time of the disaster.
Experts from research and scientific centres in Belarus, Ukraine and Russia, as well as scientists from othercountries, expect these illnesses to continue until the years 20052010. These bleak prospects, together with adeterioration in living conditions and a drastic reduction in health and social welfare services throughout theformer Soviet Union, point to a clear and compelling need for the Programme to continue. Since services of such alevel and quality cannot be provided in the near future by the Governments of the three countries, it is critical tocontinue to provide CHARP services to the afflicted population. The ongoing economic crisis has delayed effortsfrom ONS and local governments to increase their participation in the selfsustainability potential of theprogramme.
1. Health and Care
Background and progress to date
During the ten years the Chernobyl Assistance and Rehabilitation Programme (CHARP) has been implemented,
significant practical expertise was collected on the health consequences of the Chernobyl nuclear accident. This
resulted in high-quality and cost-effective services (medical screening) being provided to the most vulnerable
among the four million people residing under unfavourable conditions in the contaminated areas.
The general strategy of the CHARP is based on distribution of assistance by six mobile diagnostic laboratories(MDLs) through the network of the three operating National Societies of Belarus, Ukraine and Russia. Theprogramme is run in co-operation with corresponding Ministries (Health and Emergency) in each country toco-ordinate the activities of mobile diagnostic laboratories in the affected regions. In addition, CHARP continuesto provide psycho-social support, distribution of multivitamins to children and some medicines to victims of theChernobyl disaster.
The Chernobyl accident had a negative impact on health, evidenced by still increasing numbers of thyroid glandcancer cases induced by radiation and other pathologies. For instance, during the first half of 2000, the Red CrossMDLs examined about 45,000 people and detected 45 cancer cases (41 cases in adults and 4 cases in children),which were confirmed at regional medical institutions as a result of additional examinations. It makes an incidenceof 100 cases per 100,000 people which is more than 16 times higher than in countries not affected by theChernobyl disaster. For example according to the World Health Organization (WHO), in Europe the highestincidence rate was in Finland (5.8 cases), Norway (5.1 and 1.6 cases), Italy (4.8 and 1.8 cases) and Switzerland(4.3 and 2.6 cases).
From 1990 to the present, CHARP provided humanitarian assistance to about 2,500,000 beneficiaries. Through it,240 tons of milk powder and 114 million multivitamins were distributed to children living in the contaminatedareas. More than 15,000 patients with thyroid gland pathologies were provided with medication (levothyroxine).
People who underwent an operation for thyroid cancer need to take this hormone for the rest of their lives.
The mobile diagnostic laboratories, providing medical screening since 1994, screened more than 400,000 peopleaffected by the Chernobyl disaster. Of that figure, some 169,000 were diagnosed with various kinds of pathologiesand referred to medical institutions for further examination or treatment. Since 1994, the MDL specialists detected 302 cases of thyroid gland cancer (242 cases in adults and 60 cases inchildren). These patients were referred to specialised medical institutions where they received appropriatetreatment, which is available now in all three countries. Almost all cases referred were able to recover except fortwo children who died because the cancer was detected too late and metastasis was too advanced.
Nearly 250 Red Cross workers and volunteers were trained to provide psychological support for about 15,000people. Also, some 8,000 persons are educated annually on subjects related to the consequences of the Chernobyldisaster.
The CHARP was established in consultation with different agencies (such as WHO, UNICEF, US Agency forInternational Development, and Japan’s Sasakawa Foundation) as well as with related medical institutions such asradiology centres, dispensaries, clinics and many local and foreign leading specialists and experts. Contacts withother agencies still working in the region are maintained.
At present among the primary donors of the CHARP include the Japanese and British Red Cross Societies. Thelong lasting response needed to deal with the consequences of the disaster make it difficult for traditionalemergency funding to continue for years. Alternative funds/partners are necessary.
Goal The primary goal of CHARP is provision of health screening and psychological support to the victims of the
Chernobyl nuclear disaster residing under unfavourable conditions in the rural areas.
Objectives and Activities planned
Objective 1 to continue annual screening for up to 15,000 persons by each mobile team (90,000 in total
annually), focusing on high risk groups such as children and young people who were children at the moment of the
accident (aged between 0-18).
To achieve this objective, the Red Cross Sosieties of Belarus, Ukraine and Russia together with the InternationalFederation’s delegation in Minsk will ensure efficient management of the activities of the MDLs to reach thetargeted number of check-ups per year. The Red Cross teams, following the concept of the programme, providescreenings in the most remote areas where state medical care services are limited due to the difficult economicconditions in the three countries. In total, 90,000 people will be screened and provided with accurate andimmediate information on the state of their health and, if necessary, be referred for further examination and/ortreatment to the necessary medical institution. The quality of screening (early detection of pathologies) will be improved through: training of mobile teams’ staffand use of up-to-date screening equipment; introduction of the latest achievements in screening technologies to thefield; regular supplying of reagents for MDLs; proper use and safety of the equipment and maintenance ofvehicles; further improving feedback between MDLs and medical institutions to where patients are referred by RedCross doctors.
Objective 2 to develop rehabilitation and psychological support activities in order to strengthen stability and
resources of the affected population to cope. Activities to achieve this objective will include: responding to the
psychological needs among the most vulnerable groups of the affected population; organizing social activities in
the affected areas through creation of self-help groups in the communities by RC workers and volunteers; training
of affected communities on stress management; improvement of services quality through education and training of
the mobile teams’ staff, RC trainers and volunteers; publishing and distribution of brochures, leaflets, and other
information materials to help inform the affected communities on effective coping mechanisms.
Objective 3 to supply multivitamins to children and needed medicines to thyroid cancer patients. To achieve this
objective the Minsk delegation will arrange procurement and supply of vitamins (containing C, D, B-group with
iron, folic acid, stable iodine) to be distributed to 40,000 children in the region between January and June 2001 (a
period of high vitamin deficiency). Also, L-thyroxine will be distributed through the local medical network and
Red Cross-covered regional communities to people suffering from thyroid cancer and other pathologies.
It is expected that 90,000 affected people will be provided medical services annually. These services include:
examinations by highly qualified professionals; ultrasound screening of the thyroid gland and abdominal cavity;
examinations by endocrinologists; blood and urine analysis. Modern diagnostics technologies will be introduced
into the field which will allow for more precise diagnosis. The incidence of radiation-induced disease will be
monitored and followed-up on. The ability to cope with a crisis situation and stress management will be developed
in the affected population. Annually, some 25,000 people will receive psycho-social assistance at Red Cross
centres, including those living in the remote, contaminated areas. Health promotion and disease prevention will be
achieved. Distribution of vitamins to children will lower incidence of diseases involving the immune mechanisms
and generally improve their health state. Distribution of L-thyroxine to thyroid cancer and other patients will help
them maintain hormonal balance and save their lives.
Health of at risk populations in contaminated areas of Belarus, Russia and Ukraine monitored and improved.
Thyroid cancer patients supported with follow-up treatment. Children’s health and immune systems bolstered.
Trained Red Cross volunteers and staff also improving psych- social well-being and health awareness of
Monitoring and Evaluation arrangements
The programme is supervised and co-ordinated by the International Chernobyl Co-ordination Committee (ICCC)
composed of the presidents of the three operating Red Cross National Societies (Belarus, Ukraine, Russia) and the
head of the Federation’s delegation in Minsk. Three CHARP counterparts from the National Societies and threelocal managers of the Federation’s delegation form a working group, chaired by the head of delegation, whichprovides evaluation of the programme’s implementation. The ICCC and the working group meetings take place atleast twice a year. At the regional level, management is undertaken by the chairpersons of regional Red Cross committees where theMDLs are based, in conjunction with local authorities and programme partners. The overall daily management ofthe whole programme is carried out by three local managers at the delegation in Minsk. An evaluation of CHARP will be carried out in March-April 2001 by external and local experts to determine itsfuture. Assessment of the psycho-social component of the CHARP will be carried out by experts from theReference Centre for Psychological Support in Copenhagen.
The programme encompasses long-term activities and, as such, requires sustained funding.
Difficulties/obstacles in importing vitamins from abroad due to specific local customs and governmental procedures can be avoided with local purchase.
The psycho-social service is a comparatively new field of operation for the local Red Cross networks, so they require technical support from sister National Societies. DELEGATION: CHERNOBYL (CHARP)
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Table 7.6h Persistency of Discharge Regimen by Follow-up Period, 2006 to 2010 Recipients with Pancreas After Kidney (PAK) Transplants Year of Transplant Discharge Regimen (w/ or w/o Steroid Use) CyA+Aza At Discharge (N) At Discharge (%) 6 Months PostTx (%) 1 Year PostTx (%) 2 Years PostTx (%) 3 Years PostTx (%) CyA+MMF At Discharge (N) At Discharge (%) 6 Mon