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Kosovo Refugees


Kosovo was an autonomous federal unit of Yugoslavia until 1989. In 1989, the Serbian government stripped away the basic rights of the Albanians (hereafter Kosovars) and suspended the Kosovo parliament. Initially, the Kosovars responded with peaceful and passive resistance. In 1992, the Kosovars continued to hold elections, chose their leaders, and utilize the Albanian language, education, and health-care. Later a guerrilla movement called the Kosovo Liberation Army (KLA) was formed after peaceful attempts were ineffective. In 1998, the Serbian (former Yugoslavian) government began a campaign of violence ("ethnic cleansing") against civilians, including women and children, causing over a quarter of a million Kosovars to flee the country.

Kosovo covers a total of 10,887 square kilometers with a population 2 million. Ninety percent of the population is ethnic Albanian. The country is about the size of Kentucky. Kosovo is bordered in the north by Serbia, the east by Bulgaria, the southeast by Macedonia, the west by Albania, and the northwest by Montenegro.

History of Immigration

Serbs have lived in Kosovo since the 6th century. Kosovo holds many Serbian cultural monuments and is considered by Serbs to be a national treasury and the center of Serbian statehood. Kosovo was the least developed region of the Serbian areas until the Second World War. Over the past several decades, Albanians from Yugoslavia, Greece, and Macedonia have migrated into Kosovo.

In 1998, Serbian aggression or ethnic cleansing against the Kosovar Albanians caused hundreds of thousands of people to leave their homes. It is estimated that approximately three-quarters of a million Kosovo refugees fled to Macedonia, Albania, Montenegro, Bosnia, and other countries abroad. After several months of being bombed, the Serbian government accepted a resolution to the Kosovo crisis and by June 20, Serb forces had left Kosovo. Over 715,000 refugees returned to Kosovo from neighboring countries and 30,000 from abroad.

Culture/Social Structure

Extended family is very important to Kosovars. They do not have nursing homes and tend to take care of their own. If the family can not take care of the elderly or children, neighbors help. Women are considered by men as equals and often function as decision makers. Teuta, a former ruler of Kosovo, was not only Roman Catholic, but also a woman. Many of the people live in villages among the mountains. Each village has a unique style and color concerning dress. The men of the villages wear beige hats. These hats are tradition for Albanians and this distinguishes them from other ethnic groups. Many urban Kosovars are educated at the University of Pristina located in the capital of Kosovo.


The Albanian language is one of the original nine Indo-European languages and is not derived from any other language. About 90% of the inhabitants of the Adriatic Coast, primarily in Kosovo and Macedonia speak Albanian. The official Albanian language, adopted in 1909 was written in a standard Roman orthography and based on the Gheg dialect. Since 1974, citizens of Kosovo and Macedonia speak varieties of eastern Gheg.


There is a mixture of religions in Kosovo, especially Islam, Orthodox, and Roman Catholicism. Roman Catholicism was the first religion of Kosovo, but many Kosovar refugees are Sunni Muslims. There is not a strong conservative or radical Muslim movement in Kosovo as there is in the Middle East. Please see the Refugee Health site section on religions for a discussion of Islam and Orthodox Christianity.

Health Care Practices/Beliefs

Male circumcision is strongly encouraged, but not forced. It is believed to be only a procedure for cleanliness. Female genital cutting or "circumcision" is not a practice and is condemned on an Islamic basis.

The younger generation participates in the use of narcotics at an alarmingly increasing rate. The use of alcohol and smoking are endemic and are increasing among the people as a whole.

Immunizations are considered very important. The medical profession goes into the villages and cities to provide immunizations.

Midwifes are often used in the villages for labor and delivery. Midwifes are often elderly women who have had babies and posses some of the knowledge needed in helping with labor and delivery. A few are medically trained. Hospitals are used by most urban women, but many of the resources taken for granted in Western countries are not widely available.

Birth control is hard to obtain and not highly utilized. The younger generations use it more often, but the older generation population desires to have more children to help with the land and the elderly. Many women use the saying "my son for me, my son for land."

As life expectancy has increased among Kosovars, chronic illness has increased as well. Hypertension and other cardiac-related illnesses take on increased importance inside Kosovo as well as among refugees. Kosovar refugees have not presented at countries of second asylum with any significant pattern of health problems.

Healthcare Concerns

The refugees of Kosovo are returning to their homes where over 50% are destroyed, and few, if any, health-care facilities are operable. Many organizations such as, International Medical Corps, Doctors Without Borders, and others (see links in Refugee Health site) are making special efforts to provide basic needs (food rations, blankets, clothes, soap, and mattresses) to people returning and living in remote areas.

On the average, Albanian women give birth to 2.7 children and fewer than 10% use contraceptives. The number of abortions is high and many women lose their life following complications. Maternal mortality in Kosovo, is the highest throughout Europe and infant mortality is increasing.

Due to the summer and winter weather extremes, lack of water, and overcrowding, epidemics are another major concern. Cholera, poliomyelitis, and meningitis are a problem in refugee facilities in and near Kosovo. Lack of housing secondary to ethnic cleansing and bombing also increases the risk of communicable disease.

Health Risks (Also see Infectious Diseases site for updates and details on diseases)

  • Malnutrition
  • Cholera, poliomyelitis, meningitis
  • HIV infection and STDs
  • Pneumonia and respiratory illness
  • Hypertension
  • Diabetes
  • Cardiovascular diseases
  • Low birth weight infants and related problems
  • Dental caries
  • Tuberculosis
  • Immunizations
  • Measles
  • Drug and alcohol abuse
  • Post traumatic stress disorder, depression

Mental Health

Refugees from Kosovo are vulnerable to mental health problems. Many will suffer from post traumatic stress disorder (PTSD) and depression as the most common psychiatric diagnosis. Other diagnosis may include somataform pain syndrome, dissociative disorders, and recurrent panic attacks. Women and girls who were raped often have a difficult time dealing with the long-term effects of the trauma. Pregnancy and STD testing may be needed with new refugees and should be done with sensitivity.

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Resource Materials and References

Geissler, E. M. (1998). Cultural Assessment. St. Louis, Mosby. Doctors Without Borders International Medical Corps United Nations

Authors: Kathryn Bongers, Cory Laisure, Tracey Mackling (Baylor University School of Nursing)