Abkhazia: Closure Cuts Off Health Care

Those dependent on services financed by the Georgian government struggle to access care.
By Tamuna Shonia

Residents of Abkhazia reliant on medical treatment in Georgian-controlled territory have been hit hard by the closure of the Enguri bridge, which divides the de-facto republic from Georgia.

The bridge was closed by the Abkhazia authorities on February 27 due to concerns over coronavirus and has since only re-opened for two days, between June 22-24, to allow citizens to return home.

This has severely restricted the movement of people who are dependent on healthcare programmes financed by the Georgian government, particularly those needing long-term treatment such as dialysis or cancer therapy,

Abkhazia broke away from Georgia after declaring independence in the early 1990s and became embroiled in a year-long conflict. Since then, Russia continues to be the only major country in the world to recognize its independence, with most of the world supporting Georgia’s claim to sovereignty.

Some 700 patients - both ethnic Georgians and Abkhazians living on either side of the conflict line - currently receive long-term treatment at the methadone replacement therapy programme in Zugdidi, running since 2009.

Nata Abuladze, a doctor at the programme, explained that the bridge closure had created problems for at least 44 beneficiaries who lived in Abkhazia and came to the centre three times a week.

"During the pandemic, we had to adjust our work schedule and practice,” she said. “Usually, when our beneficiaries are able to travel from Abkhazia freely, they receive one dose in our centre and the rest of the medication – a five-day dose - they take home with them.

“When the bridge was closed however, these patients were left without medication, which is life-threatening for them because they cannot substitute it with anything except street drugs, which contains a great risk of transmitting various diseases.”

Abuladze stressed that, with no similar programme in Abkhazia, the patients’ only option was to come to Georgian-controlled territory to receive treatment.

"For those who could not come, we sent drugs via courier, who had a notarised power of attorney and who carried medication to the bridge where he handed it over to a person waiting on the other side of the Abkhazian checkpoint. For those addicted to drugs, this programme is a salvation,” she said.

One 39-year old patient at the centre, who asked to remain anonymous, explained that the bridge’s closure had been a serious problem for him.

As he was not considered to be a patient with a serious medical condition, he was not allowed to cross for several days. When he did finally make it over the bridge, he was not allowed to return and so had been forced to stay with relatives in Zugdidi for the last two months.

“For me this programme is a way out of the pit, I don't have to hang around the streets and look for drugs anymore,” he said, adding, “I have a lot of friends who live there [Abkhazia] and are unable to come here. They’ve become thin like sticks because they didn’t take medication.

“In Abkhazia, street drugs are very difficult to find and are very expensive these days,” he continued. “During the pandemic, the prices went up in a month, since the beginning of March, one shot is about 800 Georgian lari which is about 20,000 Russian rubles (260 dollars). If you ask why it’s so expensive, the answer is ‘you Abkhazians have nowhere to go and you will pay even more.’”

Before joining the Zugdidi programme, he received treatment at the methadone centre in Tbilisi by run by Pati Gabunia, a doctor who he said had tried hard to open similar treatment facilities in Abkhazia but was never able to do so because of opposition by the local authorities.

It was Gabunia who advised him to seek treatment in Zugdidi instead of travelling all the way to Tbilisi.

“If it was not for Doctor Pati, I wouldn't be alive today, and there are many others like me, the man said.

Since 2009, the Georgian government has also funded a kidney dialysis programme treating 108 patients at the Zugdidi Referral Hospital.

Hospital director Sulkhan Orzhomia said that they had 20 patients from Abkhazia on the programme, all requiring dialysis three times a week. These patients were forced to stay in Zugdidi after the closure in order to receive treatment.

A Gali resident, who asked to remain anonymous, described how his cousin had been unable to access emergency treatment after he had a heart attack.

“We called the ambulance which transported him to the Gali hospital, where after realizing that they couldn’t help him, doctors said he needed to be taken to the Sukhumi hospital,” the man said.

“He passed away there roughly three hours after he arrived, with doctors saying he died because of a heart attack. I’m confident that had the border been opened, in Zugdidi or Kutaisi, the doctors would have been able to save him. In Sukhumi, they can’t even perform the simplest procedure such as putting in a stent, which is likely what my cousin needed.”

Eka Shonia, an oncologist at the Samegrelo-Upper Svaneti Oncological Centre, explained that the closing of the Enguri checkpoint had affected many of her patients’ care.

“In the months leading up to the closure of the border, we had 20 patients who had been receiving treatment at our centre,” the doctor said. “As a result of the closure of the bridge, they were unable to cross during this period of time and we have received information that unfortunately, some of them have passed away.

“The treatment process for cancer must remain consistent, with regular checkups and updating of the treatment strategy. When this doesn’t happen, the patient’s condition grows significantly worse and in some cases, they may die as a result,” Shonia concluded.

Madonna Korkelia, a 57-year-old Gali resident, explained that the closure had been very stressful.

"We are waiting every day for the opening of the bridge, but now they tell us that it will not be opened until July 15,” she continued. “They are going to open the border with Russia on the Psou River first and only after that the bridge on the Enguri.”

Korkelia explained that a large part of the issue was that Abkhazia is economically unable to sustain itself, which is reflected in the healthcare system.

“Similar to previous years, the Russian Federation had to transfer 64 million dollars to the Abkhazian budget this year,” she continued. “They thought that this amount would solve many problems. Russia is the donor to Abkhazia, 65-70 per cent of the budget is the funds transferred from Russia. They have been waiting for this money for six months, but now Abkhazians realize that they are doomed.”