“We used to distribute flyers with phone numbers so that patients could remember us. However, I noticed that they often left them behind, afraid of being seen with them. That’s when I came up with the idea of offering tea instead. We provide a small 100-gram package of tea, with information pasted on one side detailing who we are and how to contact us. I’ve never seen it left behind. Patients receive it as a gift,” explains Alu Gamakharia, the founder of the “Peaceful and Business Caucasus” association.
In occupied Tskhinvali, residents discover that they can receive free treatment in Georgia through word of mouth and flyers attached to tea packages. However, neither we nor they openly discuss what the Georgian side offers to residents of the occupied territory, fearing the reaction of the de facto government. Consequently, fewer and fewer people from Tskhinvali are seeking treatment in Georgia. In light of this situation, the question arises: Is the “Referral Service” State program fulfilling its mission?
Launched in 2010, the referral program entitles residents to free emergency and planned inpatient services in any medical institution in Georgia, up to a limit of 15 thousand. This covers cases such as trauma, burns, wounds, and bleeding, as well as conservative and surgical treatments, including operations for conditions like concussion, ulcers, or appendicitis.
Residents of occupied territories receive full financing in Georgia not only for operations but also for all necessary analyses and examinations, including high-tech and expensive tests.
“Human relations are crucial for changing existing perceptions. The portrayal of Georgians as enemies has been perpetuated, and programs like these play a role in dissolving these tensions. While there are numerous flaws, the overarching goal remains paramount,” emphasizes former public defender Ucha Nanuashvili.
Although the government acknowledges the purpose and mission of the program, they appear to lack comprehensive awareness of its shortcomings.
“The government of Georgia aims to extend the benefits of the progress achieved through ongoing reforms to the population of Abkhazia and the Tskhinvali region/South Ossetia,” as stated in the 2010 strategy, which has not been updated in 11 years.
The Office of the State Minister in Reconciliation views free healthcare as a successful avenue for reconciliation and civil equality. However, the reality does not reflect such optimism.
What do people from occupied Tskhinvali know about the “Referral Program”?
When residents of Tskhinvali relocate to Georgia, they often lack clear information about what services they are entitled to receive free of charge, what documents they need to provide, which clinics they should visit, and how to access them. Official structures fail to provide this information adequately, leading individuals to rely on personal contacts for guidance.
“There should be designated social workers to assist with these matters, as the current bureaucratic approach is not effective. Despite significant investment in these services, the desired outcomes have not been achieved. Improvements in communication are essential. Even if I were to come to Tbilisi now, I would struggle to find a good doctor, that is why these people need assistance. The connection with Tbilisi has weakened over time, and navigating the city has become challenging. People need support in knowing where to go in such a large city and which transportation to take,” shares Alu Gamakharia, who leads the organization financed by COBERM, through the UN and the EU.
According to her, people from occupied region emphasize the importance of creating a warm and friendly environment for patients: “We receive special training for this purpose. Our staff, trained to the level of social workers, are dedicated to comforting these individuals, embracing them, and ensuring they leave with a changed mindset and improved mood.”
Zurab Bendiashvili, the head of the “Coalition for the Rights of IDPs” organization, also plays a crucial role in assisting Ossetian patients who come to Georgia. He explains, “Sanakoev’s administration is not well-received in Tskhinvali, so they prefer to maintain distance. Anyone who arrives maintains a connection with me, for assisting and supporting them.”
According to representatives of various organizations, political initiatives are implemented with caution and minimal publicity. The State tries not to provoke Russian special services and the de facto authorities, thus refraining from openly disseminating information.
Tamaz Bestaev, the head of the so-called South Ossetia Administration’s Health and Social Care Service, confirmed that patients primarily rely on their personal contacts for information. In cases of confusion, they often reach out to him or Dimitri Sanakoev directly, as there is no dedicated hotline for inquiries.
Bestaev noted that Tskhinvali’s small size fosters a close-knit community where everyone is interconnected, either as a relative or friend, minimizing communication barriers. However, he recalled a specific instance involving a citizen of Ossetia who was unaware of the existence of the “Referral Program” and consequently returned to Tskhinvali with his son, who had been brought to Tbilisi for treatment, due to financial constraints.
“The mother brought her son with fever, and leishmaniasis was diagnosed at the Institute of Parasitology. They informed her that the child needed treatment and should be admitted. However, the clinic was unaware of the financing option for such cases, as they had not encountered such a patient before. Since the mother lacked funds, she sadly took her child and went to Vladikavkaz. Unfortunately, they couldn’t provide treatment there. Eventually, our disaster response team located them at Lars and brought them back here,” explains Tamaz Bestaev.
When asked whether similar misunderstandings could arise due to a lack of information, Bestaev agreed.
Former Public Defender and founder of the Democracy Research Institute, Ucha Nanuashvili, mentioned that he does not recall conducting an information campaign about free state healthcare. He stated, “Information was disseminated more on a personal level, among acquaintances and through word of mouth, which seemed to have a greater impact. If any initiatives were undertaken, they were often funded or supported by international organizations rather than the state budget.”
Why is the Number of Beneficiaries of the “Referral Program” Decreasing?
Since 2010, the program has financed 3 935 cases of residents from the Tskhinvali region, with approximately 11.9 million GEL allocated from the budget for their treatment. Interestingly, in recent years, there has been a noticeable decline in the number of people seeking treatment, particularly after 2016.
Citizens have the option to move between the occupied Tskhinvali region and Georgia with the assistance of the International Committee of the Red Cross (ICRC). The declining effectiveness of the “Referral Program” is also reflected in ICRC statistics. Since its inception in 2010, the ICRC has facilitated 1 677 medical evacuations. However, the number of evacuations has been decreasing since 2016.
We sought input from the administration of South Ossetia and organizations directly involved with residents of the occupied territory regarding the reasons for the decline in program usage.
Zurab Bendiashvili suggests that the decrease in program users may be linked to the cessation of financing for diagnostic services. Since 2017, patients from Tskhinvali are no longer eligible for free diagnosis during their initial visit to the doctor to determine the cause of their complaints. This aspect of their healthcare is now funded by COBERM.
“The expenditures were deemed inefficient. When we pressed for specific figures, they couldn’t provide them. Efficiency should be measured by how much money is spent, how much is saved, and what criteria are used for evaluation, but they couldn’t offer a concrete response. When these services were provided for free, individuals would come, use the services, perhaps make purchases in Lilo, and then depart. The primary goal of the ‘Referral Program,’ to encourage these individuals to visit more frequently, was relatively successful,” explains Zurab Bendiashvili.
Tamaz Bestaev described the process as chaotic and uncontrollable, resulting in a burden on the budget:
“Previously, a patient would arrive with concerns of headache, back pain and various other issues. They would receive inpatient care, and all expenses were covered. They would undergo examinations for free, then perhaps shop in Lilo Market before leaving. We do not have the luxury to sustain this. They presented us with a bill of 3 000 GEL. This was straining our budget. We are not the USA, what are we supposed to do?” shares Tamaz Bestaev, Head of the Health and Social Security Program of the South Ossetian Administration.
Various complicating factors coincided with the change in financing methods, including events such as the “Chorchana-Tsnelisi crisis,” the blockade of crossings, and a general tightening of policies by the de facto government, coupled with the strengthening of Russian propaganda efforts. These circumstances are officially acknowledged by the Government as reasons for the hindering the “Referral Program.”
Former Public Defender Ucha Nanuashvili points out pivotal moments during the blocking of crossings in 2017 and 2019, which hinders people from seeking treatment: “Citizens faced significant challenges in moving freely, with permissions often denied unless the patient’s condition was deemed extremely serious. While the situation has improved somewhat, this restriction persisted for an extended period.”
Alu Gamakharia, the founder of the association “Peaceful and Business Caucasus,” attributes the decrease in the number of people receiving treatment in Georgia to the stringent strategy of the de facto authorities in Tskhinvali aimed at separating the Ossetian community from the Georgian one. She notes that historically, Ossetians were closer to Georgians than to Abkhazians. “We need to raise this issue urgently in meetings in Ergneti and in Geneva. It is a humanitarian problem that individuals who are ill, even those with relatives on our side with whom they communicate by phone, are physically unable to come,” emphasizes Gamakharia.
The administration of South Ossetia acknowledges that the effectiveness of the “Referral Program” is hampered by Russian propaganda and the strict control exerted by the de facto government in the region. However, they express uncertainty about what measures the Georgian side could take to counteract these challenges. Tamaz Bestaev highlights that local television broadcasts misinformation about organ trafficking in Georgia, leading some of the population to believe it.
“Procedures have become more stringent, with offers being made for treatment in Vladikavkaz or Krasnodar instead. They exert considerable effort to prevent individuals from accessing treatment in Georgia, particularly if they have ties to the Government or their families. Russian propaganda has twisted people’s perceptions,” explains Bestaev. He further adds, “Without the referral program, it would be even more challenging to maintain communication with them.”
When asked whether the issue of the “Referral Program” could be discussed in Geneva or at Ergneti meetings to facilitate unrestricted access to its benefits for citizens, Bestaev responds pessimistically: “Even if it were discussed, it is unlikely to yield results. Our side is powerless as long as Russia’s influence and intentions remain unchanged.
