REFUGEE HEALTH

April 1999
		How are 700,000 refugees being cared for in the region surrounding Kosovo? What sort of medical attention do they need? Are they getting it? What kind of people are sent over to help the refugees?

What do aid organizations need? The IMC and Kosovo. What diseases are prevalent? How is the children's health? Can items be sent to help refugees? Can a retired doctor or nurse to help?     Strikes in Yugoslavia Coverage April 19, 1999: There are 600,000 refugees in the surrounding areas. April 13, 1999: Serbian refugees living in the US reflect on the plight of ethnic Albanian.. April 5, 1999: The worsening refugee crisis. March 31, 1999: Kosovo refugees flood into Albania. Complete NewsHour coverage of Health     International Medical Corps United Nations Commissioner for Refugees USAID's Kosovo Crisis Page U.S. Committee for Refugees Kosovo Human Rights Watch International Crisis Group Doctors without Borders Operation Kosovo	Giving money to aid organizations is one of the few ways many people outside of Europe feel they can help ease the pain of the conflict in Yugoslavia. But there are many who have chosen to volunteer for programs helping the more than half a million refugees in areas surrounding Kosovo. The need for attention is vast a varied with many of the elderly and children suffering in makeshift camps. With whole communities forced to leave, hundreds of thousands of people are now in areas built for a fraction of that. With no infrastructure to support the population, water, food, shelter and medical supplies are in demand. What are aids workers doing to help refugees? What kind of people are sent over to help the refugees? What sort of medical attention do the refugees need, and are they getting it? How much money has been donated to the organizations? Nancy Aussie, president of the International Medical Corps, answers your questions. The IMC has been operating in Macedonia and Albania since they were evacuated from Kosovo in March, along with other aid organizations. Questions asked in this forum: What do aid organizations need? The IMC and Kosovo. What diseases are prevalent? How is the children's health? Can items be sent to help refugees? Can a retired doctor or nurse to help?
	Paul Taube of Dallas, TX asks: What are the short and long-term resource needs of aid agencies handling the refugee crisis? Nancy Aussie of the International Medical Corps responds: Cash donations -- and in the long term, more cash donations. Cash support gives relief agencies the flexibility they need to respond to the changing needs of the refugees. IMC will still be providing health services and assisting people to rebuild their lives through our training of health professionals long after the cameras and the world's attention has moved on. These efforts will require long term financial support. Return to top. Charles Dark of Cincinnati, OH asks: When and why did the IMC become involved in Kosovo? How do you choose where to become involved? Nancy Aussie of the International Medical Corps responds: When: IMC has been providing vital lifesaving medical assistance to tens of thousands of vulnerable people caught up in the web of violence in the Balkans since the war began in Bosnia in the early 90s. When the violence widened last year to consume the province of Kosovo, IMC expanded its program of emergency care from Bosnia to Kosovo to help the hundreds of thousands of Kosovar civilians who were put at risk. Concurrently, IMC established emergency health programs in Albania in the middle of last year to provide for Kosovar refugees arriving in the early months of the crisis. IMC also set up an operations base in Macedonia to lay the groundwork for the massive flow of refugees that has occurred in recent weeks. IMC deployed its Kosovo-based health teams to Macedonia just hours before NATO began its air-strikes. Why: IMC believes that access to health care is a fundamental human right. Civil conflict, violence, and unimaginable suffering is often inflicted on civilian populations who don't have access to medical services. With IMC's considerable experience delivering health care to vulnerable populations in the midst of civil conflict, access to health care was a right which IMC could ensure. It is fundamental to the IMC mission and something that IMC does successfully the world over, from Angola, and Bosnia, to Rwanda, Somalia, Burundi, South Sudan, and Zaire. How we choose: A fundamental part of the IMC mission is to provide emergency health care to innocent civilians in underserved areas throughout the world. Thousands of Kosovars -- men, women, and children -- were being brutalized in the face of humanity through ethnic cleansing. We had the expertise, and, through the generosity of our donors, the resources with which to spring to their aid. Return to top. Brock Swain of Greenwood, DE asks: What are the types of disease that are prevalent in this area of the world and are they starting to show up among the refugee's? Nancy Aussie of the International Medical Corps responds: People who have arrived in the camps over the past few days are in worse condition that previous arrivals: distress, lesions in the feet due to walking, chronic diseases that have not received treatment for days: the most common non-communicable diseases are diabetes, asthma, hypertension and skin complaints (scabies), and they account for approximately 60% of refugee outpatient consultations. Frequent outbreaks of diarrhoeal diseases, including cholera, have occurred in the past in Albania and the surrounding areas. In actual fact, it is probably because of the cool weather that there have been no cholera outbreaks to date even though the camps are increasingly overcrowded (10 sq. meters or less per person compared to the 30 sq. meter UNHCR recommendation). The main communicable diseases reported in the camps are watery diarrhea and upper respiratory tract infections. (You may be familiar with something characterized by the press as the "Kukes Cough", which is currently widespread among children due to the persistent damp weather.) Return to top. Linda Blain of Pelham, NY asks: How is child health being maintained? Are they children immunized? Is there clean water? Nancy Aussie of the International Medical Corps responds: In Albania, IMC has an epidemiologist on its team who is coordinating maternal and child health with UNICEF and the Albanian Ministry of Health. Currently, IMC has set up 5 MCH clinics. There has been a great shortage of water as these people have made their way across country to reach security in Albania and Macedonia. It is for this reason that so many are dehydrated and that the incidence of scabies is so high. As I have already mentioned , there is a high rate of ARI --- "the Kukes cough" amongst children due to the persistent damp weather. IMC's experience in Kosovo since last year was that immunization coverage rates among Kosovar women and children in Serbia were low due to the difficulty they had accessing health services. For this reason, IMC, in conjunction with UNICEF, has begun emergency immunization campaigns in the camps of both Macedonia and Albania. With technical assistance from the CDC and WHO, IMC is also providing the MOHs in both Albania and Macedonia with logistical support to launch campaigns throughout their countries targeting women of reproductive age and children under 15 years - this is based on IMC's considerable experience of organizing national campaigns in Bosnia during and after the war there. A serious concern is the mental health of these children who have witnessed such terrible violence and who in many cases have been turned out of their houses with no notice and forced to endure robbery, humiliation, and violence as they have passed through checkpoints, and railroad stations --- IMC has been setting up groups in the camps in Macedonia to encourage play in an attempt to ameliorate the mental suffering: ball games, skipping rope, drawing and painting pictures etc. IMC's experience in Bosnia during the war was that "facilitating play" was the first step towards easing the incomprehensible trauma which children in these situations suffer - it is the first step to helping them recover from their ordeal. Return to top. S.B. Bloomquist of Littleton, CO asks: Our church is collecting toothbrushes, toothpaste, soap, etc. Will this kind of aid truly get there? Also, concerning the mental health of the children, will stuffed animals, decks of cards and small games or balls help? Will they get there? Nancy Aussie of the International Medical Corps responds: Our church is collecting toothbrushes, toothpaste, soap, etc. Will this kind of aid truly get there? Also, concerning the mental health of the children, will stuffed animals, decks of cards and small games or balls help? Will they get there? Yes, they'll get there -- eventually. Air transport is very limited -- there is only one runway at Tirana airport -- and the ports are congested with a lot of government paperwork to get things through customs. Frankly, your group's assistance would be much more effective in cash. Besides easing the congestion, it would mean that fewer vital resources would go to paying for transport. It would also encourage the local economies and give the aid groups on the ground the flexibility they need to respond to the priorities on the ground as they arise - and the children are number 1. Cards, balls, games, cuddly toys: they are all available locally but cash is needed to buy them -- we need to be considerate of the host communities in the region. Albania is the poorest country in Europe and the refugees it has taken in over the past few weeks exceed 10% of its own population. We need to pay special attention to local economies in these circumstances. Return to top. Adam Schneider of Fairfax, VA asks: What can a retired doctor or nurse to help? Nancy Aussie of the International Medical Corps responds: IMC is faced with a two-fold concern: the provision of health care to the refugees and also the support to the health systems in the host countries to ensure they do not become overburdened and collapse. For this reason, IMC has volunteer health practitioners working in both the camps (in mobile clinics) and also in MOH facilities alongside local counterpart physicians and nurses. Retired doctors and nurses make ideal volunteers -- they no longer have to worry about loans for their studies or their practices and they have the wisdom to share that comes with years of experience. IMC counts a large number of retired practitioners among its cadre of volunteers working all over the world to provide health care through training. Return to top.