Kosovo: Psychological Wounds

More than three years after he was released from a Serbian prison, it is still difficult for Arsim Uka to turn on the light in his bedroom on awakening.

"When the light would go on at the prison, everybody had to wake up quickly and turn facing the wall with our hands behind and on our knees - those who were not quick enough were subjected to inhuman tortures and beatings," he recalled.

Uka's recollection and fear is just one of thousands of such memories that plague the survivors of the 1999 Kosovo conflict during which more than 10,000 people were killed and half a million uprooted before NATO military intervention expelled the Serbian forces.

Four years after the war, the corridors at the Neuro-Psychiatric Hospital in Pristina are full of people waiting to be treated for conditions caused by what doctors call post-traumatic stress disorder. In reality, little help is available for them: there are only about 30 psychiatrists and psychologists in the contested province and the government does not have any programmes to treat such trauma.

Despite the passage of time, the problem is growing, with one survey indicating that the number of reported cases more than doubled between 2001 and 2002.

Uka has travelled to the Kosovo Centre for the Rehabilitation of Victims of Tortures from Podujevo, 40 km north of Pristina. His missing teeth are a reminder of the tortures he suffered during his ten-month incarceration in Leskovac prison in Serbia, on charges of abducting an ethnic Serb.

He tells doctors he suffers from stomach pain and deep depression, which is accompanied by constant thirst and frequent nightmares.

He recalls in an interview how the prison guards had forced all the Albanian prisoners to get into cold water without removing their clothes and were then forced to walk around in the snow.

Barely suppressing tears, he also says he was sexually abused in prison. "I had the feeling that I was going crazy there - it still haunts me from time to time," he said.

The centre said in January that the number of patients treated for psychiatric disorders increased from 1,187 in 2001 to 2812 last year.

Dr Ferid Agani, a neuro-psychiatrist, said it is not surprising that more people are being diagnosed with the disorder, " Right after the end of the war, people had to think of their most immediate problems such as reuniting with their families, rebuilding their destroyed houses, facing the new post-war reality and things like that, but now that these issues might have been partially solved, people are starting to suffer more spiritual pain."

In September 1999, the US Centre for Disease Control, CDC, concluded from a survey of 1,358 people that 18.7 per cent of those questioned showed signs of the ailment. A year later, a similar study showed that 25 per cent were affected.

People most likely to suffer are children, raped women and those who have lost their loved ones in war or were held and tortured in Serbian prisons.

The CDC survey estimated that 67 per cent of Kosovo Albanians are suffering psychological disorders. Some have flashbacks, accompanied by deep emotions, fear, anxiety and uncontrolled reactions.

But Dr Agani said that most Kosovars try to contain this within the family and do not ask for help from doctors until symptoms become very serious. Which is why experts believe that the actual number of people suffering from severe depression is much higher than surveys indicate. Psychologists blame mental health problems for increasing rates of crime, suicide, family violence and divorce.

But the biggest problem is that Kosovo is not equipped with the necessary medical expertise and medical staff to treat patients with such emotional problems. There are only 26 neuro-psychiatrists, four clinical psychologists and one child psychiatrist in the whole of Kosovo. As a result, few patients get adequate treatment.

Dr Agani said the current social, political and economic difficulties in the province are also leading to increased cases of emotional distress.

According to the 2002 annual report of the ministry of labour and social affairs, 57.1 per cent of the able-bodied population is unemployed, half live below the poverty line and 12 per cent do not have even minimal living conditions.

Hannu Vuori, an official at the United Nations Mission in Kosovo responsible for health, acknowledged that the health ministry does not have any specific programme or funding for people suffering from post-traumatic stress disorder.

"Such projects have not been foreseen because mental health is considered a very complex speciality and we have not had any proposal from competent specialists in the field who would be able to implement such projects for people suffering from the trauma," Vuori said.

Alma Lama is an independent Kosovo journalist