Mental health services in Kosovo

By Dr Helen Bolderson & Karen Simpson

Foreword by Malcolm Smart, (then Director of the Medical

Foundation )

Five years ago Serbian special police and paramilitaries, assisted by the Yugoslav Army, launched a brutal campaign of repression and "ethnic cleansing" against the predominantly ethnic Albanian population of Kosovo, killing many civilians and torturing, beating and raping others. As the repression intensified, NATO forces intervened, launching aerial bombing raids against the perpetrator forces. These too resulted in civilian deaths and were accompanied by an accelerating exodus of refugees fleeing from the conflict and repression in Kosovo.

Five years on, Kosovo is peaceful once more and that peace is underpinned by the deployment of an international military force, KFOR, and civilian administration, UNMIK (United Nations Interim Administration Mission in Kosovo). Some of those who fled abroad as refugees have since returned, but many others have not; their homes were destroyed, their possessions looted and they see no future for themselves in Kosovo. Some, indeed, fear to return because they remain haunted by memories of what occurred before they were driven to flee abroad - memories of parents, children or other loved ones being butchered before their eyes, of being brutalised and beaten by men who showed no mercy, of being raped or sexually tortured in other ways so humiliating and degrading that they scarcely dare confide that it occurred. Such are the ordeals that were experienced and indeed, still are being relived by some of those who subsequently became clients of the Medical Foundation and who now, five years on, are threatened with being forcibly returned to Kosovo by the United Kingdom (UK) Government.

As an organisation dedicated to working with survivors of torture and organised violence, the Medical Foundation for the Care of Victims of Torture in most concerned to ensure that such survivors are not returned to situations where they face the risk of further torture or violence or where their suffering is likely to be prolonged. For this reason, the Medical Foundation decided in 2003 to undertake research in Kosovo to establish the extent to which there now exist facilities and services to which survivors of torture and organised violence can turn for the psychological, therapeutic and other treatment that they may need. We decided to focus especially on local mental health services, noting that an important Mental Health Strategic Plan had been drawn up in 2000 by a multi-disciplinary task force of national and international experts, and because the availability of such services and their capacity were seen to be an extremely important indicator for the needs of torture survivors.

This report represents the fruit of that research, which was undertaken as an empirical study. Essentially, it shows that remarkable efforts are being made by a small number of health professionals to address the psychological and physical consequences of the 1999 war and the repression that preceded it, and the widespread trauma it caused across the Kosovan population, among ethnic Serbs as well as the majority ethnic Albanians. It also shows that despite the dedication of those providing mental health services, these services are far from adequate at the present time even to address the needs of the population already present in Kosovo. Indeed, there seems little prospect that these services will be able to cope even with present levels of demand within Kosovo without a substantial injection of international financial and other assistance. There is little prospect, therefore, that these services would be able to meet the needs of Kosovan survivors of torture and organised violence who are currently in the UK or other countries and who would require ongoing treatment should they be forcibly returned in the foreseeable future.

Life in Kosovo remains difficult for its inhabitants despite the progress that has been made since the end of the war. Poverty, inflation, lack of employment opportunities, and other economic and social problems continue to hamper development. Kosovo today is still a deeply divided society where there is a widespread sense of disillusion and where many among the population are still effectively traumatised by the recent conflict. It is all the more encouraging and impressive, therefore, that a small group of mental health and medical professionals is among those struggling locally to meet this challenge, and it is to them as well as to those Medical Foundation clients who are survivors of torture or organised violence in Kosovo that we dedicate this report.

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