Georgia’s Health Diplomacy

In a nondescript three-storey building in an industrial suburb of Kutaisi in western Georgia, a modest hotel provides free accommodation for residents of Abkhazia seeking medical treatment.

The facility is the brainchild of Alu Gamakharia, an internally displaced person (IDP) from Sokhumi, the de-facto capital of Georgia’s breakaway region of Abkhazia. In 2009 he founded the Peace and Business Caucasus Association to help people from the region receive medical care in Tbilisi-controlled territory.

The five rooms are dedicated solely to accommodating residents of Abkhazia and are almost always full, with volunteers helping guests connect with doctors and fill out forms in Georgian.

Gamakharia’s project is part of a UN-funded programme and is steadily growing. When it started in 2010 it had 150 Abkhaz beneficiaries a year; by 2021, this number had grown to 850.

Gamakharia himself left Sokhumi in 1993, during the war. By the time the armed conflict ended in September 1993, nearly 250,000 people, mostly Georgians, had fled the Black Sea region. He did not want his ties with Abkhazia to be severed, and soon established trade relations with entrepreneurs from the de facto republic.

"I am very grateful to these people, Georgian doctors, and my hosts."

"We met Abkhazians who came here and offered them a trade tour to Lilo market in Tbilisi, Batumi, etc. Then we noticed that these people wanted to go to the doctor. So the idea arose to offer medical assistance as well," Gamakharia told IWPR.

The venture is supported by a Georgian government programme launched 2010 that offers free medical services to the population of Abkhazia and that of Georgia’s other separatist region, South Ossetia. This in turn is funded by the Confidence Building Early Response Mechanism (COBERM), an apolitical scheme supported by the EU and implemented by the UN development programme.

To date, 37.2 million GEL (11.9 million US dollars) has been spent on the Medical Services Programme, with some 15,000 cases dealt with by 2021.

Supporters argue that it is a powerful means of rebuilding trust between Georgians and Abkhazians.

"The golden rule of conflict resolution is the existence and activation of socio-economic ties between opposing parties,” said Ivane Abramashvili, executive director of the Caucasian House think tank. “The referral programme is a good example of this, and there should be other such social programmes too.”

Lena (not her real name) is 61 years old and receiving cancer treatment.

"This is my third time in Kutaisi, and I am very grateful to these people, Georgian doctors, and my hosts. They were saviours,” she said. “I could either have gone to Russia or I could have come here. My son sent me here, and he did not make a mistake.”

Samira, 26, has a two-week-old child undergoing treatment in a Kutaisi clinic.

"I decided to leave for Georgia because I heard from others that Georgian doctors treat patients humanely,” she said. “I could not get it in Russia. Now I have left my child in the clinic so that I am not afraid that something will happen.”

However, the project has been stymied by a lack of support from the de facto administrations in Abkhazia and South Ossetia.

In January 2022, foreign minister of the de-facto Abkhazian government Inal Ardzinba banned COBERM’s activities, although it was not clear how this might affect the medical programme.

In recent years, fewer people from South Ossetia have accessed the programme than from Abkhazia, although initially both sectors accessed the services almost equally. There are only 53,000 people in South Ossetia as compared to 245,000 in Abkhazia.

Tamaz Bestaev, the head of health and social security in the South Ossetian administration, said that the decrease was because the territory’s de-facto government was preventing people from travelling to Georgian-controlled territory.

"The Ossetian population in Tskhinvali is not aggressive towards Georgians,” Bestaev said. “There are very few families that do not have an ethnic Georgian relative. The Russians know this and try to limit these relations in every possible way. People are not allowed to go for planned treatment; only patients with urgent and severe cases come to Tbilisi when they cannot be helped there, and there is not enough time.”

Since the South Ossetian authorities closed the Akhalgori checkpoint in 2019, people from the breakaway region must travel a long way to get to Tbilisi. They first go north, to the Russian city of Vladikavkaz, then enter Georgia from the Lars checkpoint. Due to the pandemic, this procedure has become even more complicated. Bestaev said that an official letter from the clinic was needed to verify that the person really needed investigation and treatment before Russian guards would allow the patient to cross the de facto border.

"People in Tskhinvali [the de-facto South Ossetian capital] are worried about this, but the fear of the local government is huge there, so they get used to the fact that they will not be able to come for planned treatment," Bestaev explained.

There has also been criticism that Tbilisi has not done enough to fund or promote the project.

Until 2016, Abkhazia and South Ossetia residents could access diagnostic services even for non-severe or life-threatening illnesses. Since then, however, the government has no longer funded preventative studies and diagnostics and people seeking medical support from the regions need a doctor certifying that the service is necessary.

Zurab Bendianishvili, the head of the Coalition for Refugee Rights NGO, said that this had been a mistake.

"The government said that it was an unnecessary, inefficient expenditure and the state cannot afford it, but how much money is currently spent from the budget? We asked the ministry to calculate the cost of preventive examinations in this programme; we have not seen such statistics so far," he said.

Bendianishvili, who has been working with IDPs from South Ossetia and the population of Tskhinvali for decades, said that travelling to Tbilisi for diagnostic services had allowed them to establish other connections.

"Trust has been restored between people.”

"Free preventative examinations were attractive for everyone, they came to the clinic, went to the Lilo market to trade, and it was good for the relationship,” he said. “If we want these people to come here, have social and economic relations with Georgians, then this part of the preventive medical services should have been maintained.”

Giorgi Jugheli, a doctor who hosts Abkhaz and Ossetian patients together with Gamakharia, was also dissatisfied with the activity of the Georgian government. Jugheli offers a rehabilitation course which is not funded by a referral programme.

"If restoring trust and relations is a priority of our state and society, why doesn’t the government show more diligence? If it does not have enough money to fund the programme, why not try to involve a private business in this initiative?” Jugheli said.

Some argue that Tbilisi also needed to promote the initiative. Gamakharia said that information about the referral programme spread only by word-of-mouth in Abkhazia.

“There is no other information campaign on this topic; the Georgian government is not active in this regard,” he said.

Conflict specialist Ivane Abramashvili said that while the government needed to take a cautious approach in such a sensitive situation, it could do more.

 "Now the problem is that this issue is not a priority within the government, Abramashvili continued. “I am sure that some members of the government do not even know about the referral programme and its benefits.”

However, Bestaev argued that the programme was well known, and that extreme tact was needed to continue to supply its benefits.

"We try not to aggravate the situation with excessive public relations. We are not about public relations, we care for people. If our silence brings good to these people, we will not speak out at all," he said, adding that the aim was to build connections with the local communities.

"We already knew that we could not return the occupied territory with lancets and ethanol. Other than that, this programme has achieved its goal. Trust has been restored between people.”