to Refugee Health
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.
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
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
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.
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)
- Cholera, poliomyelitis,
- HIV infection and
- Pneumonia and respiratory
- Cardiovascular diseases
- Low birth weight infants
and related problems
- Dental caries
- Drug and alcohol abuse
- Post traumatic stress
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.
OR Back to
Geissler, E. M. (1998).
Cultural Assessment. St. Louis, Mosby.
Doctors Without Borders
International Medical Corps
Bongers, Cory Laisure, Tracey Mackling (Baylor University School of Nursing)