Following signs of potential intervention by two European leaders, the European Court for Human Rights, and the United States in a growing debate over care for hospitalized Kremlin critic Aleksei Navalny, the Russian public hospital treating the opposition leader suddenly reversed course on August 21 and authorized his medical evacuation to Germany.
“We do not mind his transfer to another hospital, which his relatives will indicate to us,” Anatoly Kalinichenko, the deputy chief physician at Omsk Emergency Hospital No. 1, the Siberian facility treating the comatose Navalny, told reporters. The family, he added, will take responsibility for that decision.
A flight on a Bombardier Challenger 604 has been scheduled from Omsk airport for the morning of August 22, the state-run Radio Sputnik reported. The business jet’s destination was not named.
Navalny’s wife, Yulia Navalnaya, and associates suspect poisoning as the reason why the 44-year-old anti-corruption activist, arguably Russia’s most prominent opposition figure, became seriously ill and passed out on an August 20 flight from the Siberian city of Tomsk to Moscow. He has been in a coma in Omsk Emergency Hospital No. 1 since the morning of August 20, when his flight made an emergency landing in the city.
Navalnaya and his colleagues have insisted on the activist’s evacuation to a hospital outside of Russia, but a council of Omsk and Moscow physicians earlier on August 21 had rejected such a move as too risky.
The physicians’ surprise change of mind followed a few hours after the European Court for Human Rights, located in Strasbourg, France, stated that it would rule on a request for “an interim measure” that would “indicate to the Russian Government” that Navalny should be allowed medical evacuation to Germany.
It was the latest in a steady buildup of expressions of international concern over the Navalny case.
Earlier in the day, two of the European Union’s leaders, French President Emmanuel Macron and German Chancellor Angela Merkel, jointly called for an investigation into the reasons for Navalny’s unexpected illness and hospitalization.
The 44-year-old anti-corruption activist, after passing out on a flight to Moscow from the Siberian city of Tomsk.
"What is very, very important now is that it (the hospitalization) is urgently clarified: How did this situation come about? We will insist on that," Deutsche Welle reported Merkel as saying.
U.S. National Security Adviser Robert O’Brien had commented on August 20 to Fox News that allegations that Navalny was poisoned are “extraordinarily concerning and if the Russians were behind this ... it's something that we're going to factor into how we deal with the Russians going forward,” according to U.S. News and World Report.
U.S. President Donald Trump told reporters that the United States is “looking into” these reports.
The Kremlin, which backtracked on an earlier offer to facilitate a Navalny evacuation, did not immediately publicly respond to any of these statements.
Omsk doctors claim they have found no evidence of poison in Navalny’s body samples, but that has done nothing to stint the tide of negative publicity for the Kremlin over allegations that it played a role in poisoning the opposition politician.
For both international and independent Russian media, recollections of past international poisoning scandals in which the Kremlin was implicated or of other attacks, both fatal and non-fatal, against Russian President Vladimir Putin’s opponents run strong.
A demonstrator in the Russian city of Kazan on August 21, 2020 holds a sign that declares "My Russia is poisoned."
Fearing a cover-up, Yulia Navalnaya and the activist's colleagues were engaged throughout the day on August 21 in a public battle to prevent his remaining in Omsk Emergency Hospital No. 1.
After presidential spokesman Dmitry Peskov claimed he had not received an official request for assistance with an evacuation, Navalnaya wrote a letter to Russian President Vladimir Putin.
A plane with doctors from Germany, arranged by Berlin's Cinema for Peace Foundation, arrived in Omsk to take Navalny to Berlin’s Charite – Universitatsmedizin Berlin, a large university hospital that, in 2018, treated another hospitalized Russian government critic, publisher-activist Pyotr Verzilov, for what German doctors said likely was a case of poisoning.
Under Russian law, however, next-of-kin have no say in the treatment of an adult patient, commented Konstantin Lebedinsky, head of the department of anesthesiology and intensive care at North-Western State University in St. Petersburg. That decision falls to the patient or, if unconscious and ordinarily mentally competent, to a council of doctors.
A video of Yulia Navalnaya’s attempt to enter the Omsk hospital’s intensive care unit to speak with the German doctors who, according to chief physician Aleksandr Murakhovsky, had consulted with Russian physicians about leaving Navalny in the facility, illustrated family members' restricted rights.
Two uniformed police officers and two men in plainclothes, whom Navalnaya described as members of the special services, prevented her from proceeding along a hospital corridor.
Detailed medical reasons for the unexpected turnaround in the Russian physicians’ decision about an evacuation were not provided.
The Omsk hospital’s deputy chief physician, Anatoly Kalinichenko, stated only that a scan showed that Navalny’s brain is “in a stable condition” and that “there is no immediate threat to his life.”
Chief physician Aleksandr Murakhovsky earlier on August 21 had described Navalny’s condition as slightly improved since his hospital admission the previous morning, but emphasized that, since he had passed out on a flight, he could not safely be transported to another hospital by plane.
Poison had not been found in the activist’s body samples, he stated, but a “common industrial substance” used to produce plastic cups -- 2-ethylhexyl diphenyl phosphate – was identified on the surface of Navalny’s clothes and hands. "This is not a poison, not a poisonous industrial chemical,” he added.
The state-run news agency TASS cited Russian law enforcement agencies as denying a report by Navalny colleague and lawyer Ivan Zhdanov that a hazardous poisonous substance had been found in the activist’s body.
The S7 airline stated that Navalny had not eaten or drunk anything on board the Tomsk-Moscow flight, though a fellow passenger’s Instagram photo shows Navalny earlier drinking something out of a paper cup at the Tomsk airport’s Venskaya Kofeynya cafe.
Rather than poisoning, Murakhovsky identified a “sharp drop in blood sugar” from a “carbohydrate imbalance,” as among the five “working” explanations that the Omsk doctors’ council was considering for Navalny’s case.
He did not elaborate about other potential diagnoses. The Omsk hospital also has eliminated COVID-19, a stroke, or a heart attack as reasons for Navalny’s rapid decline.
The political activist began to feel poorly after his S7 flight took off from Tomsk en route to Moscow early on August 20.
Spokeswoman Kira Yarmysh, who was traveling with him, stated that Navalny was perspiring and asked her for a tissue. He requested her to keep talking to him “to concentrate on the sound of the voice,” she added.
Navalny then went to the plane’s restroom, where he passed out.
An Instagram video posted by a fellow passenger shows flight staff with apparent medical equipment going to the back of the plane. Sounds of a man loudly groaning can be heard in the background.
Perspiration and difficulty focusing – the two symptoms that spokeswoman Yarmysh indicated that Navalny had on the flight – often occur during hypoglycemia. Involuntary physical movements or vocalizations also can occur. If the low blood sugar is left unattended, the person may lose consciousness. A coma is possible and can lead to death.
Doctors reportedly found that Navalny had high blood sugar levels and acetones in his urine. By itself, the body responds to extreme hypoglycemia by releasing more glucagon to try and boost the blood sugar level and decreasing insulin production, according to the U.S. National Institutes of Health. Significantly high blood sugar levels (over 240 mg/dl) lead to acetones in urine.
Alternatively, ketoacidosis, extremely high blood sugar levels which the body is unable to correct by releasing insulin, also can lead to a loss of consciousness and a life-threatening coma.
However, as diabetics who have experienced either severe hypoglycemia or ketoacidosis can attest, medical personnel usually can diagnose these conditions promptly, as has not been the case for Omsk Emergency Hospital No. 1.
The hospital’s medical explanations carried little weight with Russian analysts interviewed by Current Time before the decision to authorize Navalny’s evacuation. Despite the lack of firm evidence, these analysts all agreed that poisoning had caused the activist’s coma, and that Russia’s security services played some role.
“In a country that is ruled manually with a rigid hierarchy, only they can be involved” in the case, asserted retired KGB officer Gennady Gudkov, now a politician and outspoken Putin critic.
The Omsk doctors have found themselves in an awkward – and potentially risky – situation, agreed Andrei Kolesnikov, head of the Russian domestic politics and political institutions program at the Carnegie Moscow Center.
Navalny’s presence “is terribly disadvantageous for them, and they feel very uncomfortable in such circumstances because they bear not so much a medical responsibility as a political responsibility,” Kolesnikov said. “It’s in their interest to save lives, but it is in their interest to keep the secret of what actually happened” to Navalny, he added.
Political columnist Fyodor Krasheninnikov, a friend of Navalny, termed the hospital’s handling of the case “a disgusting tragi-farce” intended to “play for time” until any poisons have exited Navalny’s body.
Whatever the explanation, chances for pinpointing within Russia what exactly happened to Navalny and why do not exist, concluded Kolesnikov.
“[A]s in the past, we’ll get lost in guessing,” he said. “The sole thing that we can hope for now is that Navalny will get well, regain consciousness, and will be healthy.”
Chief physician Aleksandr Murakhovsky earlier on August 21 had described Navalny’s condition as slightly improved since his hospital admission the previous morning, but emphasized that, since he had passed out on a flight, he could not safely be transported to another hospital by plane.
Leading Moscow doctors, he added, “are not worse than in a German hospital.”
Poison had not been found in the activist’s body samples, he stated, but a “common industrial substance” used to produce plastic cups -- 2-ethylhexyl diphenyl phosphate – was identified on the surface of Navalny’s clothes and hands. "This is not a poison, not a poisonous industrial chemical,” he added.
The state-run news agency TASS cited Russian law enforcement agencies as denying a report by Navalny colleague and lawyer Ivan Zhdanov that a dangerous poisonous substance had been found in the activist’s body.
The S7 airline stated that Navalny had not eaten or drunk anything on board the Tomsk-Moscow flight, though a fellow passenger’s Instagram photo shows Navalny earlier drinking something out of a paper cup at the Tomsk airport’s Venskaya Kofeynya cafe.
Rather than poisoning, however, Murakhovsky identified a “sharp drop in blood sugar” from a “carbohydrate imbalance,” as among the five “working” explanations that the Omsk doctors’ council was considering for Navalny’s case.
He did not elaborate about diagnoses other than hypoglycemia that were under consideration. On August 20, mainstream Russian media cited unnamed law enforcement sources as saying poisoning by a hallucinogenic drug was another possibility – a claim Navalny supporters rejected since, they said, he does not use narcotics.
The Omsk hospital also has eliminated COVID-19, a stroke, or a heart attack as reasons for Navalny’s rapid decline.
The political activist began to feel poorly after his S7 flight took off from Tomsk en route to Moscow early on August 20.
Spokeswoman Kira Yarmysh, who was traveling with him, stated that Navalny was perspiring and asked her for a tissue. He requested her to keep talking to him “to concentrate on the sound of the voice,” she added.
Navalny then went to the plane’s restroom, where he passed out.
An Instagram video posted by a fellow passenger shows flight staff with apparent medical equipment going to the back of the plane. Sounds of a man loudly groaning can be heard in the background.
Perspiration and difficulty focusing – the two symptoms that spokeswoman Yarmysh indicated that Navalny had on the flight – often occur during hypoglycemia. Involuntary physical movements or groaning also can occur. If the low blood sugar is left unattended, the person may lose consciousness. A coma is possible and can lead to death.