http://www.thelancet.com/journal/journal.isa

The Lancet
Volume 359, Number 9305     09 February 2002

BELGRADE Assistance for Serbs and Roma from Kosovo

On Feb 12 Slobodan Milosevic goes on trial at The Hague, on charges relating to the Kosovan, Bosnian, and Croatian wars. While these crimes have rightly attracted much international attention, other suffering has received less attention.
    In Kosovo, after the 1999 NATO action, many Serbs and Roma sought safety elsewhere in Serbia. Today they live in harsh conditions with little possibility of return. Their physical and mental health are one of many challenges for a weakened Serbian health and welfare system.
    During the 1990s Serbs in Kosovo had superior access to jobs, education, and housing, supported by ever-more violent oppression. When Kosovo came under UN administration in June, 1999, Serbs and Roma fled, fearing violence from Albanians. Those remaining in Kosovo today are largely trapped in "enclaves" guarded by troops of the Kosovo Force (KFOR, the NATO intervention force). Many have had their property destroyed or occupied, and have no work. Those who have left have little hope of a safe or dignified return.
    More than 187 000 people moved from Kosovo, becoming internally displaced people (IDPs) in another part of their home country, Serbia. Some 8% of Serbia's 10·6 million population are IDPs or refugees--the highest proportion of any European state. The Serbian economy and infrastructure has been crippled following the disastrous decade of Milosevic's authoritarian regime, economic sanctions, international debt, and damage from NATO bombing. Unemployment is 30% and the average monthly wage is less than US$75. With social security barely functioning, 13% are dependent on humanitarian assistance for survival.
    Last summer, the International Committee of the Red Cross (ICRC) noted that "there is a chronic shortage of essential drugs, more than 60% of the medical equipment is not working, while the remaining equipment is mostly obsolete. Basic services such as water and heating need to be repaired in many places."
    Roma were targeted in Kosovo because they were regarded as Belgrade allies: the ICRC estimate that 20 000 fled to Serbia. There they face widespread discrimination. A recent Oxfam survey of Roma in Serbia found 66% unemployed, 45% of children were malnourished, only 1·4% living beyond the age of 60, 90% unable to cover food costs, and 97% without money for health care. There are many unofficial complaints of discrimination in access to health care.
    Most IDPs from Kosovo live in private accommodation, usually struggling to finance the rent. 6·9% live in "collective centres". Official collective centres are usually disused and run-down hotels, resorts, and barracks. Unemployment is heightened by collective centres being out of town, and by the stigma of being from Kosovo. Scabies and lice infestations are the norm. A collective centres in Salaë is typical in squeezing six people into each room of about 16 m2. Not one person has work. Families receive the same basic food each day, and have not had meat or fruit for months.
    Unofficial collective centres are sites that IDPs have taken over themselves, such as workers' huts and prefabricated buildings. Hazards include faulty electricity supplies, inadequate sewage facilities, and the risk of being moved on from the site. One centre, Kluz barracks in Grocka, receives a delivery of water just once a week. Some Roma are in shanty towns, such as Mali Leskovac, a settlement of 146 dwellings on the outskirts of Belgrade. Homes are constructed from any available material, such as boarding, sheeting, and card. Water is carried from unreliable sources, and there is no sewage system. Some residents live by searching through garbage for food and recycleable items.
    A disproportionately high morbidity rate in collective centres was found by Swiss Disaster Relief. The main causes were cardiovascular disease, diabetes, asthma, and tuberculosis. The Institute of Public Health of Serbia found that 95% of IDPs sampled from collective centres, and 67% of IDPs in private accommodation, cannot cover basic health costs. UNHCR receives thousands of assistance requests for medication and basic surgical materials. The ICRC has been distributing essential drugs to 7000 IDPs a month.
    International humanitarian assistance is reducing as responsibility passes to the Serbian authorities. Short-term relief-based programmes are being replaced by long-term reconstruction and development projects. However, reforms can burden the most vulnerable, who are left without a safety net. The Serbian government is requesting assistance for the transition.
    IDPs must manage their harsh living conditions. It is understandable that the ICRC, among others, has found that "mental disorders are frequent and on the rise, especially in collective centres". A Serbian organisation, International Aid Network (IAN), found that 24% of IDPs have started taking tranquillisers since leaving Kosovo.
    One innovative project by IAN is a video link to Strpce (a Serbian community in southern Kosovo). IDPs can see and learn about their homes, and communicate directly with those who remained. Mental health workers assist the group in developing mutual support and in dealing with their distress, grief, frustration, and anger.
    Other voluntary organisations are also concentrating on community projects that emphasise sustainable mutual support, developing people's skills, and mixing with the local community. This avoids individuals being pathologised, and supports those who would not otherwise come forward. For example the Red Cross is developing income-generating projects for self-sustainability. One IDP in Varajevo commented on a community project, run by the Japanese agency JEN: "when I came here I had depression at having to leave everything behind, this weaving is what really helped. I've been doing it since I was a child. The hardest thing is being alone, and here you meet people, it's the only place we're together."
    The international community needs to support Serbia's general development, but also assistance to vulnerable groups, such as the Kosovo IDPs, remains vital. While the world's attention may turn to Milosevic's trial, the people he claimed as his own, displaced and destitute in their own country, are among the many paying the price for his ambitions.

Hannah Roberts

Mailsenden