VZCZCXRO5882
PP RUEHDBU
DE RUEHDBU #0665/01 1491300
ZNR UUUUU ZZH
P 291300Z MAY 09
FM AMEMBASSY DUSHANBE
TO RUEHC/SECSTATE WASHDC PRIORITY 0380
RUEHDBU/AMEMBASSY DUSHANBE 0802

UNCLAS SECTION 01 OF 04 DUSHANBE 000665 
 
SIPDIS 
 
DEPT FOR SCA/CEN, PRM/ECA 
 
E.O. 12958: N/A 
TAGS: PREF EAID TI
SUBJECT: FY2009 TAFT FUND FOR REFUGEES PROPOSAL 
 
REF: STATE 14280 
 
1.Summary: Per reftel, post would like to submit a proposal for 
this year's Julia Taft Fund for Refugees that will benefit 
Afghan refugees in the Vakhdat district outside of Dushanbe 
where many Afghan refugees in Tajikistan have been forced to 
settle.   Post proposes supporting purchase of several pieces of 
key medical equipment for the central hospital in this district 
and using hospital facilities for basic healthcare training 
sessions that will bring together NGO experts, hospital 
specialists, and the local Tajik and refugee population on 
healthy lifestyle practices and prevention of HIV/AIDS, STDs and 
drug addiction. End summary. 
 
 
 
Refugee Population in Tajikistan 
 
¶2. The refugee population in Tajikistan is mainly Afghan - 
almost 99% of ethnic Tajik background - and resides mainly in 
the capital and surrounding regions and in the northern city of 
Khujand in Sughd province.   The refugee population includes 
about 600 fairly integrated long staying refugees who arrived in 
the early 1990s after the fall of the Najibullah regime. While 
the number of these earlier Afghan refugees in Tajikistan 
reduced dramatically since 2001 due to voluntary repatriation 
and resettlement programs, recent developments in Afghanistan 
have spurred an increase in new arrivals.  As of April 2009, 
Tajik government statistics indicated 2276 officially recognized 
refugees and 466 asylum seekers in Tajikistan.  According to 
UNHCR there was an 80% increase in arrivals from Afghanistan in 
2008 versus 2007.  Given the current situation in Afghanistan 
and the lack of options to go to other bordering countries, it 
is expected this increase in arrivals from Afghanistan will 
continue through 2009 and could result in some 4000 refugees in 
Tajikistan by year end. 
 
 
 
¶3. UNHCR notes the protection environment in the country is 
being affected by the increase of new arrivals.  The growing 
need is placing a strain on the current care and maintenance 
program, as the amount provided as cash assistance to vulnerable 
families has almost tripled.  The current difficult economic 
situation in Tajikistan and the poverty level of the local 
population often leads to a negative attitude towards Afghan 
refugees. 
 
 
 
The Vakhdat 'Region of Republican Subordination' 
 
 
 
¶4. The proposed project is intended to benefit the Afghan 
refugee population and local residents living in the Vakhdat 
district, a semi-rural community about 25 kilometers east of 
Dushanbe.  In 2000, the Tajik government prohibited refugees 
from living in 'urban' areas although fact that most of them 
already had settled in the largest cities of Dushanbe and 
Khujand.  The UN views this action as in possible violation of 
the Convention Relating to Status of Refugees.   When the number 
of Afghan refugees began to increase again in 2007-8, the 
government started enforcing the earlier decrees through a door 
to door campaign carried out by local militia, forcing those 
with refugee status to move from the cities to outlying areas. 
Outside of Dushanbe, refugees resettled in three major 
communities, Rudaki, Gissar and Vakhdat.  Vakhdat is the largest 
community of Afghan refugees in Tajikistan - where roughly 1000 
refugees are living among a local population of about 275,000. 
Unlike some of the pre-2000 arrivals from Afghanistan, most of 
the refugees in Vakhdat are relatively poor.   The members of 
this refugee community often depend on the head of household 
working a 'trading' business in the local markets, tend to have 
large extended families, and have found resettlement to a rural 
area often lacking in basic services difficult. 
 
 
 
The Healthcare Challenge 
 
 
 
¶5. In general , according to UNHCR, many refugees in Tajikistan 
are in poor health and some have serious disabilities or chronic 
diseases which require ongoing medical treatment.  Under UNHCR 
auspices, refugees and asylum seekers are provided free medical 
care in Dushanbe and Khujand.  For residents of Vakhdat, 
however, given the limited funds refugees have, the transport 
costs to and from Dushanbe may be prohibitively expensive, 
especially for ongoing treatments.  Refugees in Vakhdat have 
access to the local hospital and clinics for health care, but, 
up to now, have had to pay for locally received medicine and 
 
DUSHANBE 00000665  002 OF 004 
 
 
services, often including 'unofficial' fees.  In some cases, 
they are charged the higher rates for foreigners. Negotiations 
are underway between the Tajikistan Ministry of Health and the 
NGO 'Refugee Children, Vulnerable Citizens' (RCVC) that partners 
with UNHCR.  The agreement would require the regional hospital 
in Vakhdat - the intended recipient of equipment from this grant 
- to ensure free basic medical services for refugees.  Per the 
agreement, UNHCR and the hospital would split the cost of 
pharmaceuticals, surgery or hospitalization.  Assistance to this 
hospital would strengthen its ability to fulfill this agreement. 
 
 
 
Needs of the Central Vakhdat Hospital 
 
 
 
¶6. The Central Vakhdat Hospital and its affiliate 'policlinic' 
is the largest healthcare facility in the district with over 
13,000 patients, including many refugees, hospitalized there 
during 2008.  The hospital's  Chief Physician, Dr. Mirzotillo 
Umirzokov recently  participated in a USAID-funded short term 
exchange program on hospital management in the U.S. Among the 
challenges the hospital faces, the doctors cite difficulties in 
treating gastrointestinal illnesses and childhood diseases.  One 
deficiency in the hospital's ability to treat such conditions is 
outdated or non-working medical equipment.  In severe GI 
illnesses, an endoscopy is often needed, but since fasting is 
necessary beforehand and the patient may be weak, the travel to 
Dushanbe where there is modern equipment can be risky.  The 
hospital has one outdated gastroscope that was 'being repaired' 
when ConOff visited. Sick children often need a respirator or 
extra oxygen.  The hospital's respirators for children are from 
the 1980s and do not function to full capacity.  The hospital 
has one oxygen supplying device donated by UNICEF, but can serve 
only one patient at a time.   All of these pieces of medical 
equipment can be life-saving. Unlike in other refugee 
communities in Tajikistan, Vakhdat's population has not been 
educated on awareness and prevention of STDs or HIV/AIDS. 
 
 
 
Project Rationale 
 
 
 
¶7. Post proposes a project that will 1) increase the capacity of 
the main local hospital in Vakhdat handling local refugee 
medical needs 2) ensure that free of charge medical services for 
refugees and 3) use the increased collaboration of the hospital 
with the refugee community to provide a basic health education 
seminars.  Any assistance to this hospital would benefit the 
overall population of Vakhdat in addition to refugee groups. 
This is in line with encouraging integration of refugees into 
the local population and greater acceptance of refugees among 
the general population. 
 
 
 
Implementing Partner:  NGO Fidokor 
 
 
 
¶8. Post selected the NGO Fidokor to implement this project. 
Founded in 1996 with an overall mission of developing civil 
society in Tajikistan, Fidokor has carried out regional and 
local projects - many targeted to assisting vulnerable 
populations.   For ten years Fidokor was an implementing partner 
with UNHCR.   Two major programs have focused on HIV prevention 
and integration of Afghan refugees in Tajikistan.  Fidokor 
representatives are tapped into the leadership of the Afghan 
refugee community in Vakhdat and have access to regional 
institutions there as well as trainers and experts in public 
health issues.  Fidokor has been involved in Post-supported 
refugee projects in the past and is known to Post through work 
with USAID and other USG grant projects. 
 
 
 
Proposed Project:  Enhancement of Healthcare for Refugee and 
Local Population of Vakhdat 
 
 
 
¶9. Through the Taft Fund, Post would like to provide the Central 
Vakhdat Hospital the following three key pieces of needed 
medical equipment: 
 
Respirator (for children up to age 14) - $5,000 
 
Gastroscope   - $11,000 
 
 
DUSHANBE 00000665  003 OF 004 
 
 
Oxygen Supplying Device  - $500 
 
Estimated prices were obtained through initial research with 
medical suppliers in Dushanbe, but time for thorough 
price/quality comparison is built into project.  Project 
organizers have been assured that the hospital already has the 
technical expertise and capacity to immediately utilize this 
equipment. 
 
 
 
¶10. Project details and timeline follow (timetable is flexible 
depending on project approval): 
 
June - July, 2009 
 
Fidokor Project Director in collaboration with hospital managers 
will lead comparative analysis of medical equipment suppliers, 
determine best option for price/quality/local delivery of 
gastroscope, respirator and oxygen supplying device. 
 
July 2009 
 
Purchase and delivery of equipment to Vakhdat Central Hospital. 
 
July 2009 
 
Translation of existing Fidokor educational/prevention pamphlets 
on HIV/AIDS and STDs into Farsi (materials used in trainings in 
other parts of Tajikistan already exist in Russian and Tajik) 
 
August 2009 
 
Inaugural event at Vakhdat Central Hospital:  Fidokor will 
gather Afghan refugee group leaders and Vakhdat local community 
(jamiyat) leaders for a presentation at the hospital regarding 
new medical equipment/services.  Educational pamphlets on 
HIV/AIDS and STD prevention will be made available and upcoming 
health seminars will be announced. 
 
August -September 2009 
 
Preparation and conducting of three one day seminars by experts 
hired by Fidokor on awareness and prevention of HIV/AIDs, STDs, 
drug addiction and other aspects of maintaining a healthy 
lifestyle.  Each seminar will have a specific target audience - 
three separate seminars for men, women and youth - an approach 
that has worked well in the past on these topics.  The Vakhdat 
Central Hospital again will provide a space for these seminars 
which will include participation of some physicians from the 
hospital for consultations during the seminars. 
 
October 2009 
 
Final report due to donor. 
 
Note:  throughout the course of the project , project leaders 
will monitor the provision of free medical services to refugee 
per agreement with UNHCR. 
 
 
 
¶11. Detailed Budget 
 
Respirator        $5,000 
 
Gastroscope    $11,000 
 
Oxygen device            $500 
 
Seminar costs 
 
Supplies for participants                     $240 (20 
participants x $4 x 3) 
 
Supplies for trainers                            $150 ($50 x 3) 
 
Training module development                        $150 (COST 
SHARE BY FIDOKOR) 
 
Lunch/coffee for participants             $330 ($5 x 22 
participants x 3) 
 
Trainer honoraria                                 $150 ($25 x 2 
trainers x 3) 
 
24% salary tax                                     $37.50 
 
Publishing 
 
Development of health pamphlet                    $400 ($200 x 2 
COST SHARE BY FIDOKOR) 
 
DUSHANBE 00000665  004 OF 004 
 
 
 
Translation of pamphlet (Farsi)                       $100 ($50 
x 2) 
 
Duplication                                         $800 ($2 x 
400) 
 
25% salary tax                                     $25 
 
Other Expenses 
 
Salary of Project Director                   $600 ($140 x 4 
months) 
 
Salary of Project Accountant              $400 ($100 x 4) 
 
Organizational development               $380 
 
25% salary tax                                     $250 
 
Totals:             $19,962 (proposed for Taft Fund)       $550 
(cost share by Fidokor) 
 
 
 
Expected project results 
 
 
 
12.Through provision of medical equipment to the key hospital in 
the Vakhdat District, this project is intended to address an 
immediate gap in healthcare services that will impact the large 
refugee population living in this area.  At least 60 local 
refugees and local Vakhdat residents will receive targeted 
training on healthy lifestyle practices and specifically on 
HIV/AIDS, STDs and drug prevention awareness through training 
modules that have proven successful in other parts of 
Tajikistan.  Educational pamphlets will be distributed more 
broadly to the population visiting the hospital and policlinic. 
We anticipate that the project will enhance the hospital's 
ability to provide free health services to the refugee 
population and at the same encourage greater interaction between 
the refugee and local population jointly attending the health 
seminars.  If this project receives funding, we hope it will 
open the door for different forms of ongoing collaboration with 
the hospital in this area where larger number of refugee 
settlers may be expected and healthcare needs will also 
increase. 
 
 
 
¶13. Post consulted the Excluded Parties List System and the 
Department of Treasury Office of Foreign Assets Control before 
selecting Fidokor as our implementing partner on this project. 
Post certifies that it has the authority and capacity  to award 
a grant to the intended recipient agency prior to September 30, 
¶2009.  Post will forward to PRM via e-mail a signed code of 
conduct from the intended grantee, Fidokor. Embassy Dushanbe's 
point of contact for this project is Consular Officer Elisabeth 
Wilson (WilsonE@state.gov).  Post is ready to provide further 
information as might be needed to assist PRM in considering this 
project for support by the Julia Taft Refugee Fund. 
QUAST