An Albanian refugee from Kosovo is examined by a doctor who is also a refugee from Kosovo. (KRT)

By R. Jeffrey Smith
Washington Post Foreign Service
Tuesday, April 20, 1999; Page A1

TETOVE, Macedonia – Vesel Elezi lost his medical clinic and his patients when Yugoslav security troops roamed through the Kosovo city of Urosevac on April 4 and ordered residents to leave. He and his family sought refuge in Lamaj, the remote hillside village where he was born.

Masked troops found him there a week ago, as they went door to door to drive away any residents still in the green hills of south-central Kosovo, according to refugees who were there. A neighbor hiding 30 yards away said that when the troops confronted him, Elezi pleaded for his life, saying, "I'm a doctor. I'm a health worker." One of the soldiers replied, "You are exactly the person I am looking for," and Elezi was shot.

Under a provision of the 1949 Geneva Conventions governing the conduct of war, doctors and other health care professionals are supposed to be exempt from deliberate hindrance or attack. But in Kosovo, the situation is reversed: Refugees say that Yugoslav troops are deliberately targeting not only ethnic Albanian doctors but also their facilities, leaving virtually the entire remaining population without access to medical treatment.

The security forces apparently want to rid Kosovo of medical workers who might provide care to ethnic Albanian guerrilla fighters, according to humanitarian aid workers and refugees. The government also wants to make life in the province as difficult as possible to encourage ethnic Albanians to leave.

Details of what has happened recently to medical care facilities in Kosovo – or other institutions there – are difficult to verify, because no foreigners have been allowed free access there for weeks. But the accounts of refugees paint a uniformly grim picture of declining health among the estimated 1 million ethnic Albanians who remain in the province, 500,000 to 800,000 of whom have been driven from their homes.

Since NATO airstrikes began March 24, soldiers have attacked and destroyed more than 90 community-based health care clinics run by the Mother Teresa Society, according to officials of the organization who have fled here. Before the onset of ethnic violence in 1998, the clinics served about 2,000 patients a day.

On the day after the bombings started, the preeminent medical clinic in Kosovo, located in downtown Pristina, the provincial capital, was not only looted and bombed but booby-trapped, residents said. Most of the doctors have fled, and those who remain in the Serbian province are in hiding and isolated from patients who also fear leaving their homes.

"It is a catastrophe," said Isuf Dedushaj, president of the Kosovo Red Cross, an ethnic Albanian organization. With a serious food shortage and many people forced to live outside after being expelled from their homes, the lack of drugs or treatment means "there are big chances for epidemics to spread and Kosovo to be turned into a massive grave."

Virtually all of the ethnic Albanian patients at the public hospital in Pristina – including those with chronic diseases, and infectious ones such as tuberculosis – have been expelled in recent weeks by the Serbian hospital administrators and by government troops, according to several former patients who have fled to Macedonia. Last week, the influx of refugees included four dialysis patients in dire need of treatment.

At the same time, the refugees said, the Yugoslav military has moved artillery, radar, some tanks and other armored vehicles onto the hospital grounds. This would constitute a violation of the Geneva Conventions upholding the principle of medical neutrality, said Sheri Fink, a doctor who works for the Boston-based Physicians for Human Rights and has been interviewing refugees in Macedonia.

"We have found systematic abuses against ethnic Albanian doctors and patients in Kosovo," Fink said. She cited the case of a refugee who recently arrived at the Brazda camp near the Macedonian capital of Skopje "with a very serious gunshot wound in his extremities and gangrene of the feet . . . [who had] his toes amputated without anesthesia by a nonsurgeon."

Even before the Yugoslav government began an all-out war on March 20 against members of the separatist Kosovo Liberation Army, security forces had frequently harassed – and in several cases assassinated – ethnic Albanian health care workers on grounds that they must have been helping the rebels, said officials with the Mother Teresa Society and the Kosovo Red Cross.

Xhevat Gashi, a well-known doctor from Pec who played a leading role in Kosovo's ethnic Albanian medical association, was killed last fall, according to Dedushaj. Two Djakovica doctors and three from the surrounding region were subsequently slain. Since last summer, 10 workers from the Mother Teresa Society have been killed, six have been permanently disabled by gunshots and one is missing.

According to the society's chief administrator Marte Polokaj, its principal warehouse was burned down on March 25 and a secondary warehouse, where some medicines were stored, was looted before being trashed. "I don't know how people are surviving," she said.

Medical care in Kosovo has suffered since 1989 as a result of ethnic tensions, when Yugoslav President Slobodan Milosevic – then the president of Serbia – ordered thousands of ethnic Albanian professionals fired from their jobs and replaced by Serbs. The number of state-run medical institutions in Kosovo was cut by three-quarters, leaving most ethnic Albanians to rely on a rudimentary health care system staffed by physicians in private clinics that lacked access to good equipment or modern medical texts.

After the purge, rare diseases such as neonatal tetanus, abdominal typhus, polio and hepatitis began to crop up in Kosovo, and more than 170 epidemics occurred from 1990 to '98, said Dedushaj, who is an epidemiologist. During widespread fighting last year, 17 small hospitals and 28 outpatient clinics were destroyed. At public institutions, ethnic Albanians had to pay in cash for medications, while Serbian patients received theirs at state expense.

As tensions rose in early February, when NATO threatened airstrikes to compel peace negotiations in France, Serbian administrators in the Pristina hospital transferred 60 ethnic Albanians wounded by stray bullets or shrapnel into a ward of tuberculosis patients, placing them at grave risk, said Dedushaj and surgeon Blerim Feka.

Ethnic Albanian physicians in the surgical, ophthalmological and gynecological clinics were fired. Then, on the day after the NATO airstrikes began, the hospital's administrators removed 30 ethnic Albanian patients. Only those who could not walk were allowed to stay, and even this policy was altered a few days later so that several paralyzed patients had to leave. .

"It is a disaster," Feka said. "All the medical care [in Kosovo] is given by neighbors," who have no training. "I have seen 70 percent of my former colleagues," including doctors and professors of medicine at the ethnic Albanian University of Pristina, at Macedonian refugee camps. "The people who are based there do not have drugs" to treat such chronic ailments as diabetes, rheumatism and respiratory infections.

Suleman Aliu, the editor in chief of Bujku, an ethnic Albanian newspaper, said he saw the armored vehicles driven onto the hospital grounds when many patients were ousted. From his nearby apartment, he said, "I saw the police break down the doors of the faculty [building] and go out an hour later with boxes."

Dedushaj said he drove through the city a day after the first airstrikes and found the front wall of the large Rezonanca medical clinic blown away and its equipment – including two X-ray machines, an ultrasound and the sole CAT-scan machine in Kosovo – looted from the premises. By the next day, "there was no way to pass" because of the police presence on all main roads, he said.