Alchin Samedov, a 17-year-old from Baku, was suffering from acute tuberculosis when he was taken in by the Moscow shelter for homeless children, but every city hospital still refused to admit him.


"He was looking for a place for two days -- a teenager, spitting blood, with his right lung virtually disintegrated," said Natalia Glaskova, in charge of the sanitary service at Moscow's only shelter for children, on Altufyevskoye Shosse. "Finally we called 03 [the medical emergency service] and they took him to a hospital for the homeless."


An epidemic of tuberculosis has been spreading in Moscow, with the number of mortalities doubling over the last four years. "Almost 750 people died of TB in 1994, which is five times more than the number of deaths from diphtheria," said Irina Lytkina of the city epidemiological service.


Recent data from the World Health Organization show that Russia, along with Croatia and Romania, leads Europe in tuberculosis mortalities.


Lytkina said there are currently 35 people infected with tuberculosis for every 100,000 Moscow residents. These figures do not take into account city detention centers or shelters for the homeless, where the situation is even worse.


According to research carried out earlier this year by the Moscow Institute of Tuberculosis, every second child in the Altufyevskoye Shosse shelter is infected with tuberculosis, and every fifth is in urgent need of hospitalization.


"There are currently only 40 hospital places for children with TB in Moscow," said Natalia Sidorova, head of the Interior Ministry sanitary division. "We have to let others go and they continue infecting people around them."


Sidorova said there is only one 110-bed tuberculosis hospital for all of Moscow's detention centers, and it already holds four times that number. She said half the infected stay in the prison cells with their fellow inmates without medical treatment. Sidorova added that the Interior Ministry medical centers do not have enough antibiotics to treat people with the disease.


Igor Nadezhdin of the Moscow Health Department said the situation is aggravated by a shortage of tuberculosis specialists. He said Moscow has only 70 percent of the total number of TB specialists it needs, but he declined to give exact numbers. Nadezhdin said more than 50 percent of all those infected with tuberculosis are unskilled workers, most of them homeless and alcoholics.


"These people can't pay for their own treatment," Nadezhdin said. "But even after a forced hospitalization, some of them run away because they don't want to stay there for six or nine months."


Lytkina said a part of the problem is the cancellation of obligatory TB vaccinations for adults. Now this is only required for state employees in police, medical and food facilities. "There are 165,000 registered alcoholics in Moscow," she said. "I don't believe any of them have had TB vaccinations."