Daily Archives: August 21, 2008

08MOSCOW2503, PRIVATE HEALTHCARE IN RUSSIA STILL IN ITS INFANCY

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Reference ID Created Released Classification Origin
08MOSCOW2503 2008-08-21 13:21 2011-08-30 01:44 UNCLASSIFIED//FOR OFFICIAL USE ONLY Embassy Moscow

VZCZCXRO5743
PP RUEHAST RUEHHM RUEHLN RUEHMA RUEHPB RUEHPOD RUEHTM
DE RUEHMO #2503 2341321
ZNR UUUUU ZZH
P 211321Z AUG 08
FM AMEMBASSY MOSCOW
TO RUEHC/SECSTATE WASHDC PRIORITY 9621
INFO RUEHYG/AMCONSUL YEKATERINBURG 3282
RUEHVK/AMCONSUL VLADIVOSTOK 2920
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEHPH/CDC ATLANTA GA

UNCLAS MOSCOW 002503 
 
SENSITIVE 
SIPDIS 
 
DEPARTMENT FOR OES/IHA 
USAID FOR GH, E&E 
HHS FOR OGHA 
 
E.O. 12958: N/A 
TAGS: TBIO SOCI SCUL RS
SUBJECT: PRIVATE HEALTHCARE IN RUSSIA STILL IN ITS INFANCY 
 
SENSITIVE BUT UNCLASSIFIED, NOT FOR INTERNET DISTRIBUTION 
 
1. (SBU) Summary: Fears of the demise of Russia's system of 
state-sponsored health care are premature.  The country has an 
enormous potential market for private health care, but the sector is 
still growing.  Private care is primarily available in outpatient 
fields such as cardiology, dentistry and orthodontics, urology, 
obstetrics/gynecology, plastic surgery, and drug dependency 
treatment for those few who can afford its higher costs.  Quality 
varies widely by the type of care and from one facility to another. 
The legal framework necessary to support a broad network of private 
medical institutions with a system of private, or even government, 
insurance is still lacking.  End Summary. 
 
2. (U) In recent years, Russian media has criticized the state of 
Russia's health care system.  Although the constitution provides for 
free health care at state expense, patients commonly pay for many 
supplies, even in state hospitals, including needles, bandages, and 
medicines.  The rise of an alternative system of private health 
services has aroused fears in some corners that these enterprises 
may someday replace state-sponsored health care entirely.  President 
Medvedev, speaking to World War II veterans on August 18, attempted 
to dispel that thinking: "Fears that medicine will be handed over to 
business are groundless.  That will not happen.  If private 
businesses want to invest in health care, they can set up their own 
private clinics.  But the state system of medical support will 
continue to exist has it has existed." 
 
3. (SBU) Several highly regarded private health clinics operate, but 
mostly in large cities such as Moscow and St. Petersburg.  The best 
known in Moscow are the European and American Health Centers, as 
well as the Center for Endoscopic Surgery and Kidney Stone 
Treatment, one of the oldest specialty private clinics, which opened 
in the early 1990s.  Many Russian patients consider the quality of 
care to be higher in private facilities.  However, a number of 
doctors told us that although facilities and equipment are often 
better at private health care centers, inpatient care is equal to or 
better in state centers.  Public institutions performing 
cardiosurgery and cancer treatment were singled out as superior to 
private counterparts.  Doctors consider Russia's inadequate medical 
education system to be a common barrier for all healthcare 
providers, public and private. 
 
4. (SBU) Russian health professionals see a variety of impediments 
to the development of widespread private health care.  According to 
one contact, the main obstacle is a lack of government regulation. 
Legislation has compelled the state healthcare oversight agency 
Roszdravnadzor to delegate its regulatory role in quality control to 
regional authorities over recent years, and regulatory resources are 
not yet sufficient in the regions to ensure adequate enforcement. 
Another contact from the Society for Evidence-Based Medicine more 
optimistically noted that if the constitution were implemented 
properly, private health care would develop over time as both 
government and private clinics attain equal access to insurance 
funds.  With a lack of legal enforcement, however, such development 
appears to be unlikely in the near future.  Another contact 
suggested that high property values in the big cities will 
eventually compel the government to sell off most of its state 
clinics to insurance companies to make way for private centers. 
 
5. (SBU) Comment:  Our limited survey of health practitioners and 
NGOs in Moscow suggests that private health care is available for 
those few who can afford it.  However, quality of care varies widely 
by specialty.  For the broader population, a system of private 
health care facilities with an integrated and functioning insurance 
network is a long way off.  Though some speculate that the 
government will be tempted to sell off state clinics in large cities 
to insurance companies as real estate prices soar, it is not clear 
if the legal framework for this exists. 
 
BEYRLE

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08MOSCOW2502, RUSSIA CONCERNED POST-MUSHARRAF INSTABILITY HARMS

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Reference ID Created Released Classification Origin
08MOSCOW2502 2008-08-21 13:15 2011-08-30 01:44 CONFIDENTIAL Embassy Moscow

VZCZCXYZ0002
PP RUEHWEB

DE RUEHMO #2502 2341315
ZNY CCCCC ZZH
P 211315Z AUG 08
FM AMEMBASSY MOSCOW
TO RUEHC/SECSTATE WASHDC PRIORITY 9620
INFO RUEHXD/MOSCOW POLITICAL COLLECTIVE
RUEHIL/AMEMBASSY ISLAMABAD 2523
RUEHBUL/AMEMBASSY KABUL 0556
RUEHNE/AMEMBASSY NEW DELHI 1182

C O N F I D E N T I A L MOSCOW 002502 
 
SIPDIS 
 
E.O. 12958: DECL: 08/21/2018 
TAGS: PGOV PREL PTER AF IN PK RS
SUBJECT: RUSSIA CONCERNED POST-MUSHARRAF INSTABILITY HARMS 
PAKISTAN'S ANTI-EXTREMIST EFFORTS 
 
Classified By: Political M/C Alice G. Wells for reasons 1.4 (b/d). 
 
1. (C) MFA Senior Counselor for Pakistan Aleksey Yudintsev 
told us on August 21 that Russia was concerned that 
Musharraf's resignation as President of Pakistan would 
contribute to the country's existing political instability 
and draw attention from Pakistan's efforts to fight its 
extremist insurgency.  The GOR thought that PM Gilani's 
government, which had already demonstrated indecisiveness in 
dealing with extremists, would allow the counter-insurgency 
to stall as the nation's political parties jockeyed to have 
their candidate replace Musharraf.  Yudintsev thought it 
likely that the already unstable political coalition behind 
Gilani would soon collapse, as the only thing holding them 
together was opposition to Musharraf. 
 
2. (C) Yudintsev said that while the GOR had long backed 
Musharraf as the individual most capable of maintaining 
stability in Pakistan and tackling the extremist threat, the 
President's near total loss of political support made his 
position untenable and required his resignation.  Yudintsev 
assumed that Musharraf and Army Chief Kayani consulted with 
Pakistan's closest partners, the U.S., Great Britain and 
China, on this issue.  Russia, however, does not have this 
type of relationship with Pakistan and remained silent. 
 
3. (C) Yudintsev explained that Russia had gained confidence 
in the Pakistani military's ability to control the nation's 
nuclear arsenal, and that the GOR's primary concern was that 
Pakistan end extremist control of the country's tribal 
regions.  Their use as a training ground for a variety of 
terrorist groups threatened not only Pakistan's stability, 
but, more importantly from Russia's perspective, Afghanistan 
and Central Asia.  Yudintsev said that the GOR also feared 
that individuals trained in Pakistani terrorist camps would 
bring their fight to Russia's Muslim regions. 
 
4. (C) Yudintsev expressed concern that with Musharraf gone, 
and a looming power struggle between Pakistan's political 
parties, the country was without clear leadership on regional 
and security issues.  Fortunately, Army Chief Kayani, who had 
proven himself a capable leader determined to keep the armed 
forces out of domestic politics, could step in as he did on 
his recent visit to Kabul to consult with Afghan and ISAF 
forces.  Yudintsev said the MFA was surprised Kayani went to 
Afghanistan after Karzai said bilateral ties would be 
downgraded after the recent bombing of the Indian Embassy in 
Kabul was linked to Pakistani intelligence.  The MFA assumed 
that the U.S. played a role in getting Kayani to Kabul. 
 
5. (C) Yudintsev explained that the GOR believed that 
Pakistan's Inter Services Intelligence (ISI) maintained 
contacts with militant groups in Pakistan, Afghanistan, and 
Indian-controlled Kashmir, although it remained unclear 
whether these were official contacts.  Yudintsev doubted that 
the top levels of the ISI or military would countenance such 
ties, considering that many of these officers were appointed 
by Musharraf and Kayani.  It was possible, however, that 
lower ranking officials, or even retired officers, maintained 
these contacts and were responsible for the suspected 
connection between the ISI and the Indian Embassy bombing. 
BEYRLE

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08MOSCOW2497, TFGG01: Russian media focuses on American hostility toward

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Reference ID Created Released Classification Origin
08MOSCOW2497 2008-08-21 11:40 2011-08-30 01:44 UNCLASSIFIED//FOR OFFICIAL USE ONLY Embassy Moscow

VZCZCXRO5628
OO RUEHAG RUEHAST RUEHDA RUEHDF RUEHFL RUEHIK RUEHKW RUEHLA RUEHLN
RUEHLZ RUEHPOD RUEHROV RUEHSR RUEHVK RUEHYG
DE RUEHMO #2497 2341140
ZNR UUUUU ZZH
O 211140Z AUG 08
FM AMEMBASSY MOSCOW
TO RUEHC/SECSTATE WASHDC IMMEDIATE 9614
INFO RUEHSI/AMEMBASSY TBILISI PRIORITY 3886
RUEHZL/EUROPEAN POLITICAL COLLECTIVE PRIORITY
RUEHXD/MOSCOW POLITICAL COLLECTIVE PRIORITY

UNCLAS MOSCOW 002497 
 
SENSITIVE 
SIPDIS 
 
E.O. 12958: N/A 
TAGS: PBTS PINR PINS PNAT PREL GG RS
SUBJECT: TFGG01: Russian media focuses on American hostility toward 
Moscow, a divided Europe, and Western media bias 
 
REF: A)MOSCOW 2343 B)MOSCOW 2366 C)MOSCOW 2383 D)MOSCOW 2407 
 
1.  (SBU) Summary: In the week since the signing of the six-point 
agreement, the Russian media concentrated largely on the conflict's 
aftermath, U.S. antagonism towards Russia, the division in Europe 
over how to deal with Moscow, and continued Western media bias. 
Outrageous characterizations of Saakashvili and Georgian "crimes" in 
the media dramatically decreased but not without a few potshots and 
unflattering pictures.  While it remains the number one news topic, 
overall coverage of the conflict has given way to other themes, 
including the Olympics and the economy.  End Summary. 
 
Media Anti-Americanism in media growing 
--------------------------------------- 
 
2.  (SBU) Since the end of active hostilities last week, Russian 
media shifted its focus away from slandering Georgia to blackening 
U.S. policies and actions in the Caucasus.  Television news and 
print media castigated the U.S.  Komsomolskaya Pravda, a popular 
tabloid, carried a photo of the Secretary with her head superimposed 
on the body of Conan the Barbarian and a caption urging her to "cool 
down."  Anti-American television commentator Mikhail Leontyev 
continued the highly emotional attacks, comparing the Secretary to a 
mental patient. 
 
3.  (SBU) Statements from Russian officials echoed the anti-American 
theme.  Russian UN diplomat Vitaly Churkin blamed the U.S. for 
preventing a UN resolution aimed at helping to settle the conflict. 
Russian Ambassador to NATO Dmitriy Rogozin said he would be 
"disgusted" to work with those who sided with the "aggressor", a 
clear jab at Washington.  Pro-Kremlin newspaper Izvestiya accused 
the U.S. of trying to scare Russia by threatening sanctions and 
diplomatic isolation. 
 
Europe divided? 
--------------- 
 
4.  (SBU) While Washington was painted as the aggressor in Russian 
media, Europe was portrayed as divided over whether to go along with 
the U.S. or keep an open line with Moscow.  Russian media played 
upon this image in its coverage of the NATO ministerial.  Izvestiya 
quoted UK Foreign Minister David Miliband as deviating from the U.S. 
line, commenting that "such a position in London... leaves Rice in 
the pleasant company of the Poles and the Balts."  Channel One, a 
state-owned broadcaster, said that despite Washington's intention to 
isolate Russia, "the doors of the NATO-Russia council aren't shut." 
 
Western media bias 
------------------ 
 
5.  (SBU) Since the beginning of the conflict, Russian media and 
officials accused Western news agencies of anti-Moscow bias (see 
reftels.)  These charges were parroted last week and have surfaced 
again this week.  The state-owned Russian TV station Vesti-24 
announced that Russia's mission to NATO has launched an Internet 
site designed to "break the information blockade of Russia regarding 
the events in South Ossetia."  Channel One ran a piece on a 
pro-Russian rally at NATO headquarters.  A Russian MP at the rally 
said "Western media will not show this [the rally] because they have 
an entirely different goal.  They work in this situation not as a 
media, but mostly as propagandists."  On the website Gazeta.ru, a 
commentator said coverage on BBC, CNN, and SkyNews was rife with 
"deliberate subjectivity." 
 
6.  (SBU) Comment: As foreseen in reftels, the Russian media put the 
South Ossetian conflict in the context of a wider conflict between 
the U.S. and Russia.  Continued complaints of Western bias from 
Russian language news outlets seem aimed to fuel domestic suspicion 
of reporting not coming from Kremlin controlled/influenced media. 
End comment.

Wikileaks

08MOSCOW2496, TFGG01: MIXED SIGNALS ON RUSSIAN TROOP WITHDRAWAL

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Reference ID Created Released Classification Origin
08MOSCOW2496 2008-08-21 11:32 2011-08-30 01:44 CONFIDENTIAL Embassy Moscow

VZCZCXRO5616
OO RUEHFL RUEHKW RUEHLA RUEHROV RUEHSR
DE RUEHMO #2496/01 2341132
ZNY CCCCC ZZH
O 211132Z AUG 08
FM AMEMBASSY MOSCOW
TO RUEHC/SECSTATE WASHDC IMMEDIATE 9612
INFO RUCNCIS/CIS COLLECTIVE IMMEDIATE
RUEHZL/EUROPEAN POLITICAL COLLECTIVE IMMEDIATE
RUEHXD/MOSCOW POLITICAL COLLECTIVE IMMEDIATE

C O N F I D E N T I A L SECTION 01 OF 02 MOSCOW 002496 
 
SIPDIS 
 
E.O. 12958: DECL: 08/21/2019 
TAGS: PREL PGOV RS GG
SUBJECT: TFGG01: MIXED SIGNALS ON RUSSIAN TROOP WITHDRAWAL 
 
Classified By: PolCouns Alice Wells: Reasons 1.4 (b, d). 
 
1.  (C) Summary. Russia continues to send mixed signals on 
when Russian troops will withdraw from Georgia, as well as 
the size of the peacekeeping force it expects to leave behind 
in South Ossetia and in the security zone located in Georgia 
proper.  Despite Medvedev's promises to withdraw Russian 
troops starting August 18, later revised to a withdrawal by 
August 22, the removal of troops has only just begun, raising 
some questions regarding Medvedev's standing within 
harder-line GOR circles.  While Medvedev first called for a 
stronger role for the OSCE mission in South Ossetia, Russia 
is now only willing to allow OSCE monitors into a buffer zone 
in Georgia, abutting South Ossetia, and only in order to 
monitor Georgian activity.  Russia has ruled out EU monitors 
in South Ossetia, purportedly due to objections of local 
authorities.  End Summary. 
 
Did Russian Troops Begin Withdrawal? 
------------------------------------ 
 
2.  (U) Statements made by the Russian leadership have sent 
confusing signals on the pace and scope of the Russian 
withdrawal under the 6-Point Plan.  President Medvedev had 
originally announced in an August 17 phone conversation with 
French President Sarkozy that Russia would begin on August 18 
the pullout of its troops, which had been sent to reinforce 
the Russian peacekeepers, to the security area agreed upon by 
the Joint Control Commission (JCC) in 1999.  Without 
explicitly linking the two issues, during that call Medvedev 
also called upon the Georgian side to return its military 
units to their home bases. 
 
3.  (U) On August 18, an MFA statement confirmed that August 
18 was the date for the beginning of the troop withdrawal, 
but specified that "the speed of our steps will depend on how 
conscientiously Tbilisi will fulfill that which is demanded 
of it." 
 
4.  (U) In his August 18 press conference, General Anatoliy 
Nogovitsyn, Deputy Chief of General Staff, clarified that 
President Medvedev in his August 17 phone call with Medvedev 
had only spoken of a "pullback" of forces, as opposed to a 
pullout.  Troops would not be "withdrawn" from the area, he 
stated.  Nogovitsyn also confirmed that Russian armed forces 
would erect a permanent base on South Ossetian soil, if South 
Ossetian authorities were to make such a request.  He noted 
that this would be a political, not military, decision. 
 
5.  (U) On August 19, Medvedev, in a second telephone call 
with Sarkozy, asserted Russia was withdrawing its troops from 
Georgia, and that by August 22 some of the peacekeepers would 
be pulled into the provisional security zone as delineated by 
the 1999 JCC decision.  Medvedev noted that by August 22, 
checkpoints and accommodation facilities would be ready for 
the peacekeepers.  The troops sent to support the 
peacekeepers would relocate to South Ossetia or Russia, 
Medvedev told Sarkozy, with the Kremlin statement not 
specifying the size of the contingent it intended to leave 
inside South Ossetia. 
 
6.  (U) In an August 19 press conference, Nogovitsyn said 
Russia "continued" to pull out its forces from Georgian 
territory, but accused Georgia of not withdrawing its forces 
from the conflict zone.  Up to this point, there was no 
outside confirmation that a withdrawal was actually happening. 
 
7.  (U) Nogovitsyn in his August 20 press conference 
elaborated that two lines of Russian military posts for 272 
peacekeepers would be erected in a "security zone."  Eight 
posts would be at the edge of this "buffer zone" in Georgia, 
10 along the administrative border of South Ossetia.  The 
security zone would follow the administrative border between 
South Ossetia and Georgia proper, abutting South Ossetia from 
the Georgian side.  Nogovitsyn claimed Russian forces had not 
violated any agreements, and that the "buffer zone" was part 
of the Russian side's area of responsibility.  He clarified 
that Gori was not part of the buffer zone.  An unnamed MOD 
source noted that the total number of troops remaining in 
Georgia, including South Ossetia, would therefore exceed the 
original number of peacekeepers (given in the press as 588 at 
the time of the outbreak of the conflict) by "several times," 
and include tanks and artillery. 
 
8.  (U) Russian infantry commander Colonel Konashenkov 
announced August 20 that the first troops would begin 
withdrawing from Gori.  His only explanation for the delay 
was that it always takes longer to withdraw troops than to 
insert them into an area.  An unnamed lieutenant colonel 
attached to the 58th Army told Reuters that day that troops 
had begun to withdraw from Gori in the direction of 
 
MOSCOW 00002496  002 OF 002 
 
 
Vladikavkaz via Tskhinvali, including six APCs, three T-90 
tanks, and a self-propelled missile launcher. 
 
9.  (U) On August 21, Interfax announced that a convoy of

more than 40 Russian military vehicles had passed through 
Tskhinvali en route for the Russian republic of North 
Ossetia.  The MOD said the units belonged to the 58th Army. 
 
Russia develops it position on OSCE monitors 
-------------------------------------------- 
 
10.  (U) On August 16, President Medvedev in a phone call 
with Finnish President Halonen advocated a stronger role for 
the OSCE mission in South Ossetia and "stressed the readiness 
of the Russian side for close interaction" with the mission. 
 
11.  (U) On August 18, the MFA in its statement repeated 
Russia's support for an increase in OSCE monitors, but called 
for that contingent to monitor Georgian "provocative actions." 
 
12.  (U) The MFA published a statement on August 19 referring 
to the OSCE decision to increase the number of OSCE monitors 
to 100, saying that 20 would begin their work "in the nearest 
future, in regions of Georgia adjacent to South Ossetia." 
Their task would be to monitor the "Georgian authorities' 
fulfillment of all their obligations," including the return 
of Georgian troops to their bases. 
 
13.  (U) On August 20, the Russian OSCE PermRep Voronkov told 
Russian newspaper Rossiskaya Gazeta that Russia was ready to 
approve monitors in the security zone, carefully delimiting 
the zone as territory that abuts South Ossetia from the 
Georgian side.  The modality of this force's deployment would 
have to be worked out carefully, he noted.  Voronkov 
speculated that the OSCE contingent could comprise 10-20 
persons.  He warned that absent a careful mandate, more 
monitors could only complicate the effort.  He asserted that 
only OSCE monitors could operate in the security zone, noting 
that Russia was a member of the OSCE, but not of other 
organizations intent on sending monitors, such as the EU. 
Voronkov said that according to international law, EU 
observers could only enter South Ossetia with consent from 
local authorities.  This consent would not be forthcoming, as 
South Ossetian officials had several times declared that they 
"didn't want to see any other observers except for Russian 
peacekeepers." 
 
Comment 
------- 
 
14.  (C) Russia is intent on undertaking this withdrawal on 
its own terms and it's similarly hard-line approach on the 
dispatch and mandate of the OSCE MMO's reflects its strategy 
of remaining the "guarantor" of South Ossetia and Abkhazia. 
Some questions have been raised by the seemingly tardy 
implementations of Medvedev's injunction for an August 22 
withdrawal, which -- if ignored or easily superceded -- would 
reinforce a "weak" President to a strong "silovik" circle 
around Putin.  Putin has been silent on the withdrawal.  End 
Comment. 
BEYRLE

Wikileaks