100 000 ethnic Armenians have been displaced after a military offensive by Azerbaijan. Sharmila Devi reports.

Aid agencies say that Armenia will face tremendous challenges in expanding health and other services for the more than 100 000 ethnic Armenians who fled a lightning offensive launched by Azerbaijan on Sept 19, and which recaptured the Nagorno-Karabakh enclave.

The refugees had previously suffered more than 9 months of blockade by Azerbaijan after it closed off the main road to Armenia from the enclave, called Artsakh by ethnic Armenians, few of whom appeared to be left there. Aid agencies are now rushing to help Armenian authorities, who vowed to look after the refugees.

Many of the refugees without relatives in Armenia were provided with temporary accommodation in hotels, hostels, and social centres. The Armenian Government also committed to giving each refugee a one-off cash payment of US$250 for emergency supplies such as blankets and medication, and subsequent payments of $140 per month for 6 months for rent and utilities.

“It's a difficult and unpredictable situation after the displacement and attack on Nagorno-Karabakh”, Iren Sargsyan, Senior Humanitarian Education Adviser for Save the Children, who is Armenian, told The Lancet. “I’m resilient and have worked in many emergencies but it's really difficult when you’ve relocated back and live here. The Armenian government and society are welcoming and supporting people as much as they can but they will need help in the long-term especially for housing and employment”, she said.

Urgent needs among the new arrivals, besides shelter, include treatment for chronic diseases such as hypertension, diabetes, heart disease, and cancer. WHO said it was providing urgent medical support including medicines for non-communicable diseases to cover 3 months of treatment for up to 50 000 people. It also dispatched burn kits after the explosion of a fuel depot on Sept 25 on the route taken by the refugees to Armenia that killed at least 170 people and injured 200 more. WHO said it would also support the Armenian Government to integrate more than 300 doctors and 1200 nurses who had fled the Karabakh region as of Sept 30 into the Armenian health system.

“At the first major town the refugees are fleeing to [Goris], I saw an immense outpouring of solidarity from the local Armenian community and volunteers, who are doing all they can to provide food, water and shelter”, Robb Butler, Special Envoy for WHO's Regional Director, said in a statement on Oct 1. “But you see the despair on many of the faces of the displaced. They have left everything behind, their homes, their belongings, the graves of their loved ones.”

Among the refugees were an estimated 2070 pregnant women and almost 700 were expected to give birth over the next 3 months, said the UN Population Fund, the UN's sexual and reproductive health agency. 66% of refugees said they had not had enough food in the last 3 months during the blockade of Nagorno–Karabakh, whereas 45% said they had reduced either the number of meals or portion size, Ketevan Khashidze, Chief Executive Officer of Care Caucasus, part of Care International, told The Lancet.

“The influx of people was very sudden and at the start, there was only sporadic distribution of winter clothes and mattresses”, she said. “Given the overwhelming crisis, the government is now managing but support will be needed for the long-term, including for host families. We know from our experience in Georgia and elsewhere in the region that these crises have a very long-term effect.”

Armenia had registered almost 86 000 of the refugees as of Oct 3. It was not known exactly how many ethnic Armenians had remained in Nagorno–Karabakh, which had been de facto separate since it fought a war to secede from Azerbaijan in the early 1990s. Azerbaijan retook much of the area in 2020. The International Committee of the Red Cross said the Karabakh town of Khankendi, known as Stepanakert among Armenians, was close to empty and that its priority was to find those “extremely vulnerable cases, elderly, mentally disabled people, the people left without anybody”, said Marco Succi, Head of Rapid Deployment of the International Committee of the Red Cross, in a statement. “The medical personnel have left. The water board authorities left. The director of the morgue…the stakeholders we were working with before, have also left. This scene is quite surreal”, he said.

Russia had peacekeepers in the region, but it refused to intervene when Azerbaijan launched its offensive in Nagorno–Karabakh. On Oct 3, the Armenian Parliament voted to join the International Criminal Court, which has issued an arrest warrant against Russian President Vladimir Putin. Western countries have pledged to support Armenia.