Helping Azerbaijan: What Can Be Done?

Azerbaijan is one of the most unfree countries in the world, with human rights activists, critics of the government, journalists, bloggers, and members of opposition parties facing persecution and violence. The country has also been plagued by conflict, with the 6-week-long war in and around Nagorno-Karabakh in 2020 resulting in severe consequences for the region's inhabitants. As a result of the Azerbaijani military offensive and the illegal blockade of the Lachin Corridor, thousands of vulnerable refugees have fled to Armenia and require humanitarian aid. Here are some ways in which aid organisations and governments are helping Azerbaijan and its refugees, as well as some suggestions for how individuals can contribute.

Provide humanitarian aid to refugees and vulnerable people in need of shelter, food, and healthcare

Azerbaijan has a large number of internally displaced people and refugees, with approximately 700,000 Azerbaijanis displaced due to the Nagorno-Karabakh conflict. This conflict, along with the humanitarian crisis in the early 1990s when the Soviet Union collapsed, caused a loss of 16% of the country's territory and forced 600,000 people to flee their homes. As a result, Azerbaijan now has one of the highest numbers of internally displaced persons (IDPs) per capita in the world, with IDPs present in all 76 administrative districts.

The issue of food insecurity is prominent in Azerbaijan, with rising food prices threatening the community's food security. The basic food prices of items such as bread, eggs, and meat have increased considerably, while the farm gate price of farmers' products has decreased. This disproportionately affects poor and smallholder families in rural regions, where agriculture is the only source of income.

In addition to food insecurity, access to adequate shelter and healthcare is also a concern for refugees and vulnerable populations in Azerbaijan. While the government has made efforts to resettle IDPs, providing houses and abolishing tent camps, there are still instances of IDPs living in conditions without access to drinking water, gas, or sanitation. Furthermore, the healthcare system in Azerbaijan faces challenges due to inefficient and underfunded public healthcare. Although healthcare is offered free of charge for residents, the system suffers from a lack of medical staff and specialised scientific-research institutions.

To address these issues and provide humanitarian aid to refugees and vulnerable people in Azerbaijan, the following actions can be taken:

• Distribute food packages or provide financial assistance to vulnerable families struggling with food insecurity. This can include staple foods such as potatoes, flour, bread, and meat, as well as nutritional supplements to ensure adequate nutrition.
• Improve access to affordable, nutritious food by addressing the issue of rising food prices. This can be achieved through economic policies, price controls, or the implementation of social safety net programs.
• Provide temporary housing solutions or financial support for those in need of shelter, especially those living in conditions without basic amenities. This can include the construction of new settlements or the rehabilitation of existing structures to ensure access to drinking water, sanitation facilities, and safe housing.
• Expand and strengthen the healthcare system by increasing investment in public healthcare infrastructure, equipment, and medical staff training. This includes improving access to healthcare services in rural areas, where resources may be limited.
• Collaborate with international organisations, such as Médecins Sans Frontières (MSF), to provide emergency relief, food distributions, and medical care to those in need. MSF has previously provided mental health support, emergency relief, and treated people with tuberculosis in Azerbaijan.

Support human rights activists and civil society by advocating for freedom of expression and improved civil rights

Azerbaijan has been criticised for its human rights record by several independent bodies, including Human Rights Watch, which has accused the country of harassing and imprisoning political activists and human rights defenders. The country has also been criticised for its treatment of journalists, with Reporters Without Borders ranking Azerbaijan 167th out of 180 countries on the Press Freedom Index. Amnesty International has also urged an end to the "violent persecution of opposition activists".

To support human rights activists and civil society in Azerbaijan, you can advocate for the following:

• Freedom of expression: Azerbaijan has been criticised for its restrictions on freedom of expression, including heavy restrictions on free expression, the press, and the internet. You can advocate for the protection and promotion of freedom of expression in Azerbaijan, including the right to seek, receive, and impart information and ideas without fear of retaliation. This includes calling for an end to the harassment, intimidation, and imprisonment of journalists and activists who speak out against the government.
• Improved civil rights: Azerbaijan has been accused of violating human rights standards established in international law, including the right to liberty and security. You can advocate for the protection and promotion of civil rights in Azerbaijan, such as the right to freedom of assembly and expression of political beliefs. This includes calling for an end to the arbitrary arrests, indefinite detentions, and forced disappearances of government critics.
• Freedom of religion: Azerbaijan has been criticised for substantially curtailing freedom of religion. The government, which follows a strictly secular and anti-religious ideology, represses all religions and forbids political speech by religious institutions. You can advocate for the protection and promotion of religious freedom in Azerbaijan, including the right to practise one's religion without interference or discrimination from the state.
• Labour rights: Azerbaijan has been criticised for its repression of labour rights activists and constraints on labour rights. You can advocate for the protection and promotion of labour rights in Azerbaijan, including the right to form labour unions and strike. This includes calling for an end to the repression of labour rights activists and the dominance of state-owned enterprises in major industries.
• Minority rights: Azerbaijan has been criticised for discrimination against minority groups, such as the Lezgin and Talysh people. You can advocate for the protection and promotion of minority rights in Azerbaijan, including the right to equality and non-discrimination. This includes calling for an end to hate speech against Armenians and the discrimination and repression faced by other minority groups.

Provide medical and humanitarian aid to victims of conflict, including psychological support

Azerbaijan has been the site of much conflict, with the 6-week-long war in 2020 in and around Nagorno-Karabakh resulting in a mass exodus of people from the region. Médecins Sans Frontières (MSF) has been working in Azerbaijan since 1989 and provides medical humanitarian assistance to victims of conflict.

In 2023, MSF continued to provide mental health care to people in the disputed territory of Nagorno-Karabakh, as well as those fleeing to Armenia. They also provided emergency relief, food distributions, and medical care to those affected by the conflict. MSF has been offering essential items, including walking sticks and wheelchairs, to displaced families in 48 locations in the Kotayk and Ararat regions.

The European Union (EU) has also provided humanitarian aid to the region, allocating €38.4 million in humanitarian aid since the outbreak of the war in 2020. The EU's humanitarian relief operations have included early recovery aid, humanitarian demining in populated areas, and mine risk education. The funding has also been used to provide access to basic needs, healthcare, shelter, food, and protection.

The International Committee of the Red Cross (ICRC) has been active in Azerbaijan since 1992 and provides humanitarian protection and assistance to those in need. The ICRC implements various projects to increase mine risk awareness, provide first aid and psychological support to victims, and help authorities clarify the fate of missing people. They also work to alleviate the hardships faced by the conflict-affected population, in coordination with the Azerbaijan Red Crescent Society and the International Federation of Red Cross and Red Crescent Societies.

France has also mobilized additional assistance, providing €7 million in financial assistance for NGOs, UN agencies, and the Armenian Red Cross Society to cover social welfare, medical, and financial expenses. This is in addition to the €5.5 million that France had already allocated since the beginning of 2023, bringing the total support provided to refugees and displaced persons in Armenia and Nagorno-Karabakh to €12.5 million.

Assist with the rehabilitation of public health structures and basic healthcare services

Azerbaijan's healthcare system is provided by both public and private institutions and is regulated by the Ministry of Healthcare. The country has experienced several periods of healthcare reform, with the current system still bearing the influence of the Soviet Semashko model.

In the early 2000s, Médecins Sans Frontières (MSF) provided free basic healthcare in clinics just outside Sumgayit, on the Caspian Sea coast. However, MSF's regional health programmes were later handed over to other organisations.

Since Azerbaijan gained independence in 1991, the healthcare system has faced economic difficulties, causing a decline in the quality and access to medical services. In recent years, the World Bank has supported improvements to the healthcare system, with new medical establishments, upgraded equipment, and staff training.

Despite these improvements, Azerbaijan's public healthcare system remains inefficient and underfunded. To address this, the Azerbaijani government implemented mandatory health insurance in 2021, which covers primary, inpatient, emergency, and specialized outpatient care, as well as laboratory services, physiotherapy, and invasive radiology. This shift in focus towards insurance has resulted in less government investment in modernizing and subsidizing equipment for public hospitals.

To assist with the rehabilitation of public health structures and basic healthcare services in Azerbaijan, here are some suggested actions:

• Advocate for increased government investment in public healthcare infrastructure, including the construction and upgrade of medical facilities, especially in rural and underserved areas.
• Support the development and implementation of efficient management systems for public healthcare institutions to improve their overall effectiveness and accessibility.
• Encourage collaboration between international organizations and local healthcare providers to enhance the quality of basic healthcare services and address any gaps in service provision.
• Promote the establishment of more state-funded medical service centres, ensuring that basic healthcare services are accessible and affordable for all residents.
• Facilitate knowledge-sharing and training initiatives to upgrade the skills of healthcare professionals, with a focus on personnel working in public healthcare institutions.
• Assist in the creation and expansion of state pharmacies, especially in rural and remote areas, to improve the availability and accessibility of medications and medical supplies.
• Support the development and implementation of digital solutions to enhance the accessibility and efficiency of healthcare services, particularly in areas outside of Baku.

Support LGBTQI+ populations facing healthcare disparities and limited access to care

Azerbaijan has been ranked as the worst state in Europe for LGBTQIA+ rights protection, with LGBTQIA+ individuals facing high rates of violence, harassment, and discrimination, and bullying. Same-sex marriage is not recognised in Azerbaijan, and LGBTQIA+ individuals are not protected by anti-discrimination laws. They also face healthcare disparities and limited access to care. Here are some ways to help support LGBTQI+ populations in Azerbaijan facing these issues:

Raise Awareness and Advocate for LGBTQI+ Rights: Spread accurate information about LGBTQI+ rights and issues in Azerbaijan, both within the country and internationally. Support and amplify the voices of local LGBTQI+ activists, organisations, and media platforms, such as the online magazine *Minority Magazine*. Join or contribute to existing LGBTQI+ organisations in Azerbaijan, such as AZAD LGBT, Gender and Development, and Nafas LGBTI Azerbaijan Alliance. These organisations work to raise awareness, provide education, and advocate for legal and social changes to protect LGBTQI+ rights.

Provide Direct Services and Support: Offer direct services and support to meet the healthcare needs of LGBTQI+ individuals in Azerbaijan. This can include providing mental health services, testing and treatment for diseases such as hepatitis C, and ensuring access to essential items like walking sticks and wheelchairs. International organisations, such as Médecins Sans Frontières (MSF), have previously provided such support in Azerbaijan. Additionally, establish or support local initiatives that specifically address the healthcare needs of LGBTQI+ individuals, ensuring their inclusion and access to care.

Address Discrimination and Violence: Work towards eliminating discrimination and violence against LGBTQI+ individuals in Azerbaijan. Advocate for the inclusion of sexual orientation and gender identity in anti-discrimination laws and the enforcement of these laws. Support initiatives that provide legal assistance and protection to LGBTQI+ individuals facing discrimination or violence, such as the European Court of Human Rights cases against Azerbaijan for LGBTQI+ arrest and torture. Address family-based violence and bullying in schools by providing resources and training to help families and educators understand and support LGBTQI+ youth.

Improve Media Representation: LGBTQI+ individuals in Azerbaijan face negative representation in the media, which contributes to discrimination and hate crimes. Support and promote positive and accurate representation of LGBTQI+ individuals in the media and challenge discriminatory language and portrayals. Encourage media platforms to provide a safe space for LGBTQI+ voices and stories, helping to normalise and increase understanding of LGBTQI+ issues.

Push for Legal Recognition: Advocate for legal recognition of LGBTQI+ rights in Azerbaijan, including same-sex marriage, adoption, and the right to serve openly in the military. Push for the repeal of any remaining laws that criminalise or discriminate against LGBTQI+ individuals, such as the requirement for transgender people to undergo surgery to change their legal gender. International pressure and support have played a role in previous legal changes in Azerbaijan, such as the repeal of the anti-sodomy law in 2000.

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