Nord-Ost: Russia’s Medical Failure in the 2002 Crisis

ABSTRACT

The 2002 hostage crisis at a Moscow theater transfixed the attention of the world. While the initial assault, led by Spetsnaz commandos, successfully secured the building, the Russian security force’s utter failure at coordinating with medical services led to the preventable deaths of over 100 hostages.

INTRODUCTION

On October 23, 2002, the musical production of Nord-Ost was performing at the Dubrovka Theatre,¹ some 5 km from the Kremlin, the very seat of Russia’s power. At the start of the second act, the theater was suddenly swarmed by armed assailants, 22 men and 19 women, led by a Chechen rebel commander named Movsar Barayev.¹ The attack was meticulously planned and executed—the Chechens had prepared for 2-3 months prior and brought with them 15 rifles, 114 grenades, 11 pistols, and even a homemade grenade launcher.² Within minutes, they had secured 979 hostages.³ As Russian authorities scrambled to respond, the Chechens converted the theater into a veritable fortress. Many donned suicide belts; explosives were affixed to the theater’s columns,¹ key entry points were covered by explosives and snipers, and the explosives were constantly moved whenever hostages were released or visitors came into the building.²

Over the next several days, Russian authorities surrounded the theater, and conditions soon began to deteriorate. Despite the releasing of some 200 hostages, supplies inside the Dubrovka quickly ran low. The orchestra pit was converted into a mass latrine, further contributing to the miserable conditions.¹ Although the Kremlin insisted that they would soon open official negotiations, President Vladimir Putin never intended to negotiate, at one point telling his cabinet that “I want to stress that Russia will not enter into any agreement with terrorists and will not yield to any blackmail.”¹

THE ASSAULT

Between 05:00 and 05:15 on 26 October,² Russian special forces teams began pumping a powerful anesthetic gas into the Dubrovka’s air-conditioning system. The gas was not instantaneous—one hostage was able to call a local radio station some 2 min before being overwhelmed by the fumes, and some of the hostage-takers were described as screaming “Gas! Gas! Turn on the air conditioning!” One British hostage remembered the hostage-takers pointing out the dense clouds of smoke as they slowly descended from the ceiling.⁴ By some accounts, a handful of the Chechens were able to don protective respirators, while others on the outskirts of the theater were not affected at all.²

Approximately 15 min later, three separate Spetsnaz teams stormed the theater,² systematically eliminating most of the hostage-takers, conscious or not.¹ By 07:20, the building was deemed secure.² In one regard, the authorities were incredibly lucky—the terrorists had a brief window before the gas took effect in which they could have detonated the explosives and killed hundreds. Their failure to do so has been attributed to surprise,¹ a collapse in their hierarchy due to Barayev’s death during the early stages of the assault² or a combination of other factors.

THE HOSTAGES

While the initial stages of the assault succeeded, the rescue effort almost immediately fell into disorganized chaos.¹ Unsure of their orders, Spetznaz commandos began to simply carry out unconscious hostages at approximately 06:20, laying them out on the sidewalk in front of the theater.⁵ Although War Veterans Hospital No. 1 stood just across the street,² there was no field hospital set up nearby, no triage teams had been readied, and there had been no organized preparation to distribute the hostages across the city’s healthcare network.⁵ This specific failure to coordinate combat and logistical forces can be seen as part of a wider culture of miscommunication and disorganization within Russian counterinsurgency forces during both the First and Second Chechen Wars.⁶

There was no evacuation available until 07:20, when the first bus full of drugged captives finally left the theater. The next two buses didn’t leave until 07:50, and hostages were still being retrieved from the theater by 11:00.⁵ Even then, there were no medical personnel on board the buses, and the city’s police failed to clear traffic for the victims. The distribution of victims was also lax; some hospitals were completely overwhelmed by the influx of causalities, while others saw little more than a handful.⁵

While military medics visited Moscow hospitals several hours before the raid and cryptically advised staff to increase their supplies of naloxone,⁷ the authorities refused to release any further information on the gas. Initial responders were not told what chemical had been used and were not given instructions on how to treat affected hostages.¹ In contrast, the Spetnaz commandos appear to have been well prepared—reports after the incident noted that the theater’s floors were littered with empty syringes, presumably used by special forces as an antidote against exposure to the gas.² This failure of communication between security forces and medical personnel directly lead to the deaths of at least 125 hostages in the raid.¹ Hundreds more suffered from permanent damage to their vision and hearing.⁵ For several days following the raid, authorities placed armed guards at hospitals, ordering that none of the former hostages be released.⁴ To this day, the true formula of the gas remains classified.⁵

It wasn’t until under 30 October, under mounting international pressure, that the Russian Health Minister declared that the gas used was a derivative of fentanyl, and thus did not violate the Chemical Weapons Convention.⁴ The aerosol was likely a mixture of carfentanil and remifentanil, incredibly potent fentanyl derivatives typically used to tranquilize large animals. The Russian military had expressed an interest in these compounds since the early 1990s,⁴ and should have taken the extremely lethal potential of these gases⁴ into account when planning the attack. General Vladimir Vasil’ev’s assertion after the raid that the hostages needed only “a little fresh air”⁵ rings hollow in this regard, particularly when the hostages, weakened by 3 days of imprisonment in miserable conditions, would have been even more susceptible to the gas.²

In contrast, the November 15, 2015 multisite terrorist attacks in Paris, involving four separate locations and hundreds of hostages, show the lifesaving potential when civilian emergency medical services are properly coordinated with military personnel. Despite significantly less warning time than in the case of Nord-Ost, French personnel enacted the White Plan, a 20-year contingency for mass casualty scenarios. While the scale was similar to that of Nord-Ost, with 129 dead and over 300 injured, effective evacuation, triage, and treatment allowed the French response to save hundreds of lives. Even during the pivotal moments of the night, when government forces launched an assault on hostage-takers in the Bataclan concert hall, medical personnel were in active and transparent communication with both the government and the public, minimizing panic while maximizing the number of lives saved.⁸ The exceptionally low hospital mortality rate can be directly attributed to the successful coordination between various emergency units that night.⁹

CONCLUSION

The Nord-Ost assault was hailed as a success by the Russian government.¹⁰ Reportedly, Russian forces were willing to accept a maximum loss of 150 hostages.² Against such a well-prepared and entrenched enemy, collateral damage is likely inevitable. However, the utter failure of the security forces to coordinate even rudimentary evacuation and treatment with medical services led to scores of deaths that might have been prevented with even the most basic preparation.¹

ACKNOWLEDGMENTS

The authors have no acknowledgements.

INDIVIDUAL AUTHOR CONTRIBUTION

CPT M.D.T. compiled the research and wrote the first draft of the original manuscript. COL J.S. reviewed the manuscript, providing editing and advice. All authors read and approved the final manuscript.

INSTITUTIONAL CLEARANCE

Not applicable.

CLINICAL TRIAL REGISTRATION

Not applicable.

INSTITUTIONAL REVIEW BOARD (HUMAN SUBJECTS)

Not applicable.

INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (IACUC)

Not applicable.

FUNDING

None declared.

CONFLICT OF INTEREST STATEMENT

None declared.

DATA AVAILABILITY

The data that support the findings of this study are available on request from the corresponding author. All data are freely available.

REFERENCES

Author notes