Kosovo's Health System Dies And Civilians Are Casualties

By MIKE O'CONNOR
1330 words
3 November 1998
Copyright 1998 The New York Times Company. All Rights Reserved.

PRISTINA, Serbia, Nov. 2 -- The climate of fear in Kosovo during the Yugoslav Government's offensive against ethnic Albanian rebels has caused the rural health system to collapse, aid workers and the few remaining health workers say, and hundreds of civilians may have died as a result.

The workers also say that doctors who have been treating civilian victims of the war have been arrested, beaten and in at least two cases killed by the Government forces.

While aid workers contend that they see a pattern of attacks on doctors, it is unclear whether it is an intentional effort to destroy the health care system or the inevitable result of war.

Many doctors who previously served Kosovo's rural population have been afraid to give medical care to civilians in areas controlled by rebels, aid officials say. The few doctors who remained behind rebel lines are working without supplies and equipment, and in many cases their clinics have been destroyed.

Doctors say that even with a cease-fire that is allowing many civilians to return to their villages, fear among doctors and their patients is so high that people continue to die needlessly for lack of care.

Kosovo is a province of Serbia, which is the larger of the two republics that make up Yugoslavia. Ninety percent of the province's residents are ethnic Albanians.

The Government troops have destroyed many villages, including health clinics, and hundreds of civilians have died during the offensive. Many civilians in rebel-held areas are afraid to go to Government-controlled areas for needed care, international medical officials say.

Confronting a panorama of misery and illness, those officials say they do not have exact numbers of civilians who have died without treatment or of physicians who have been stopped from treating the ill. But they say that about 20 doctors have been arrested or have fled the country and that hundreds of civilians may have died because of the collapse of the rural health care system.

The officials, fearful that their efforts will be stopped by the Government, declined to give their names.

''This is a systematic policy on the part of the Government,'' said a senior official of an international health agency, who spoke on the condition of anonymity. ''It is intended to remove medical people and to destroy the rural health care as much as they can get away with. It's working fairly well.''

Yugoslav Goverment officials said that there was no policy of intimidating health care workers and that the doctors who had been arrested were guilty of supporting armed insurgents.

In the area of Kosovo around Orahovac, and in other areas, civilians are afraid that if they leave rural zones where the rebels dominate to seek health care in the regional hospital, they will be arrested.

For those people, medical care has virtually stopped, except for the simplest treatments or for care offered by the occasional visiting foreign doctors from aid agencies. Local doctors say many of their colleagues have fled or have been arrested, sometimes on charges of aiding the rebels. Those remaining work without adequate medication or even electricity.

On a rural road in that region on Sunday, a panic-stricken man, a father for 10 minutes, flagged down a passing car and said: ''My wife just had the baby, and then she lost consciousness. Get her to the hospital. No one from this area is safe taking her there.''

The nearest medical clinic was destroyed by Government forces. A district health center in Malisevo is empty of staff and medicine, its doors barricaded and possibly booby-trapped by the Serbian police like other places in this area.

The new father thought the presence of a journalist in the car would offer protection so that he could get his wife to the hospital.

They had returned only the day before from three months of living in the open in the forest while hiding from Government forces who had overrun and looted their village.

Shukrije Krasniqi, 19, was quivering as her husband, Qamil, and his relatives wrapped her in blankets against a freezing drizzle, and put her in the car. His mother, Hanife Krasniqi, considering the idea carefully, decided to go too. The husband, fearing arrest, stayed behind.

At the Government hospital in Orahovac, the staff said Mrs. Krasniqi had suffered kidney failure and was close to death. They criticized her mother-in-law for not having made sure that she received good prenatal care. The mother-in-law took it, stiff with anger. She forced a smile and apologized.

They transferred Mrs. Krasniqi from the car in which she had arrived to a filthy gurney with a torn, stained plastic cover and shoved it into an ambulance, banging her head against the spare tire.

After demanding money to pay for gasoline, they sent her to the hospital in Pristina, the provincial capital, two hours away. She remained in critical condition there late today. The baby girl survived.

After destroying many villages and displacing more than 250,000 people, the Government has withdrawn many of its forces from Kosovo under threats of NATO air strikes. But the fear remains. And as civilians who fled begin to come out of hiding and return to their villages, they and the doctors who cared for them report that many villagers died while on the run.

''We woke up to the sound of artillery shells coming in, and we just started to run,'' said a doctor in the village of Kisna Reka, describing the residents' earlier flight. ''There was no time to take medicine.'' He would only give his first name, Ismet, saying he feared arrest.

''In the mountains the old people and the babies were the weakest, and we could not help them all,'' he said. ''Unfortunately, some died.''

His clinic was destroyed. He has put together something makeshift and rather primitive. ''This is where I will stay for a long time,'' he said, ''because for me it is too dangerous to leave.'' Asked if he was perhaps being too cautious, he quickly named four doctors, personal friends, two of whom had been killed, he said, and two of whom had been arrested.

In central Kosovo two other doctors sat in their hideout on Sunday. Though they were well behind rebel lines, a 9-millimeter pistol was within quick reach on a window ledge.

''I haven't moved from this area for eight months,'' said Dr. Gani Halilaj. ''I know what will happen if they get me.'' The other physician, Dr. Fadil Beka, said: ''Whenever the police interrogate someone from around here they always ask where the doctors are. But I have a good conscience. I know that doctors are to help people, anyone who needs their help.''

Dr. Beka, a surgeon, estimated that he has done 300 operations in three months, somewhat less than half on wounded rebel fighters.

The two doctors said that they are the only physicians in an area with about 15,000 people and that lack of medical supplies along with unsanitary living conditions have killed many of their patients.

The clinic they put up to replace the one destroyed in the military offensive also houses 13 people.

''Three days ago I had a patient with tuberculosis,'' Dr. Halilaj said. ''Now, four others in his family have it too.''

Dr. Beka, speaking of the regional health center in the nearest town where the two doctors once worked, said; ''Before the offensive five other doctors used to come here, our colleagues from Glogovac. But it is too dangerous now and they won't take the risk.''

The United Nations refugee agency says nearly all of the estimated 50,000 refugees who had been living in the open have now gone home or have been taken in by others. The American State Department says some 10,000 still have no shelter.

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