Saved from death only to go mad

The sun was shining, the birds were tweeting and a 63-year-old woman was doing her washing. "Everything is fine. We have no complaints. We have everything,'' she said. ``I'm happy." And almost certainly mad.

Behind her loomed the gutted hulk of the building where she used to live at 12 Motherland Street. The roof had collapsed. So too each of its three floors. All that remained were the bullet-scarred bricks of the outside walls.

In the distance boomed Russian artillery. The echo, counterpointed by the sinister, soft whoosh of Grad rockets miles away, ricocheted through the crumbling concrete and brick cavities of the nightmare that is now Grozny.

A flight of narrow steps strewn with debris led down to the dark cellar where the woman and nine elderly companions have lived for the past three months. Her eyes glazed and lips fixed in a terrible grin, she gave her name. "Just call me Rima the Blessed Virgin. That is my name. We are blessed. We are all so happy." She returned to the frantic scrubbing of threadbare clothes.

Such behaviour could be viewed as the triumph of the human spirit over the satanic havoc wrought on this city since President Boris Yeltsin sent the army into Chechnya on 11 December to restore "constitutional law and order".

According to doctors, though, such dogged contentment is rather a symptom of a medical disorder as shocking and dangerous as the cholera, diphtheria, typhoid and other more easily diagnosed ailments that may soon assume epidemic proportions.

In bombed-out streets, in damp, candle-lit cellars, in homes with gaping holes in the walls abound the signs of what medical jargon calls post- traumatic stress.

"I've seen it before but never in such quantities," said Michael Schubert, a German doctor struggling to set up a clinic in Grozny for the London- based Medical Emergency Relief International, or Merlin. "People do normal things that are not normal. They read months-old newspapers in the windows of wrecked apartments; they wander about aimlessly. People try to do things they have always done. They clean the street when there is no point. They say they are going shopping when there are no shops."

At times, the Russian authorities seem to suffer from the same malady. It was announced with much fanfare last week that the local television station had resumed broadcasting - an odd priority when the city is still without electricity, running water or gas, and many of the 100,000 people left out of a population of 400,000 live underground even though the shooting has mostly stopped. Salambek Khadzhiev, a former chemical engineer put in charge of a puppet Government of National Revival, says he worries about children surrounded by and inured to gunfire.

The mental scars of Grozny's post-war trauma may linger even longer than the rubble - and will store up trouble for the future. "First people have to understand what is going on," said Dr Schubert. "And that is very difficult." To try and help, Mdecins sans Frontires, the French relief agency, wants to bring in psychiatrists.

More pressing, though, are other concerns. Cholera is endemic to the region. Neighbouring Dagestan was hit by a lethal epidemic of the illness last year. There has even been talk, albeit exaggerated, about the risk of bubonic plague spreading through Grozny, a city dotted with the shallow graves of war dead and collapsed buildings entombing the remains of uncounted corpses.

Chechnya's health system, like nearly everything else, has been destroyed. On Pervomaiskaya Street, the grounds of what used to be the Republic Clinical Hospital are piled with shell casings and green wooden ammunition boxes. Snaking through the churned earth is the rusting track of a tank. A dead cat, its matted fur crawling with insects, lies on the smashed pavement outside a crumpled, pastel yellow building. This used to be the emergency room.

"We destroyed this not because it was a hospital but because [President Dzhokhar] Dudayev turned it into a military objective," said Mikhail Dronin, a colonel in Russia's occupying army. Of 13 hospitals in Grozny before the war, only three are functioning with the help of emergency generators and Western help. "When we say functioning," said Dr Schubert, "we mean that most of the buildings were destroyed but some are still standing." At the No 4 Hospital, a capacity of 510 beds has shrunk to 75.

With Grozny now under their thumb, the Russian forces no longer try to block relief supplies. Russian charity quickly dissolves, though, when it comes to rebel-held areas.

After Rwanda, Somalia, Yugoslavia and a string of other humanitarian disasters, the West, too, seems hit by a bout of post-traumatic stress. "Maybe it is that casualties were just not high enough,'' Dr Schubert said. ``After Rwanda you need at least 3 or 4 million to die before anyone pays much attention."