Ruth Barron is a psychiatrist at Harvard Medical School and a member of Physicians for Human Rights. She and a colleague traveled to Kosovo in November and again in March to investigate abuses of medical human rights and allegations that doctors and health care workers had been specifically targeted by the Serb military.
The night before they arrived in Pec on their first trip, a 48-year-old physician was shot in his home by three Serbian-speaking masked men armed with automatic weapons. They had grabbed his 15-year-old son as he was taking out the garbage. The men hauled the boy into the house and indicated that they wanted all the family members to line up. "The father, a powerful, big guy, grabbed his son, pushed these guys out, shut the door, only to have automatic weapon fire wound him mortally and wound his daughter as well," Barron says.
The father was hit in the femoral artery and bled to death after Serbian police refused to fly him by helicopter to Pristina for surgery. His wife had died of cancer the previous year, so his four children are now orphans.
Barron and her colleague, Jennifer Leaning, met with the children for about three hours, "trying to help them in their acute traumatic state." The two sons and two daughters were in stunned disbelief. It is one of numerous cases she and Leaning investigated under the aegis of Physicians for Human Rights, which released a report last week warning that steps must be taken to address the psychological trauma the Kosovo Albanians have endured.
Barron and Leaning, a board member of PHR, returned in March in response to numerous requests from Albanian physicians who wanted a better understanding of such areas as medical ethics, international humanitarian law, psychological trauma and forensics. Barron and Leaning put together a booklet and teaching seminar that they presented as a day-long course to 25 to 30 Albanian physicians in three cities: Pec, Pristina, and Prizren. In Pec, they saw the four children: "They looked like normal kids. Starkly different from how we'd seen them in November," Barron said.
Barron and Leaning returned to the region again in April, hoping to find in refugee camps in Albania and Macedonia the doctors they had trained. They wanted to know whether those doctors were alive and to get their testimony as potential evidence in war crimes. By then, the four children had fled to Montenegro, another trauma. Once they found out the doctors were back, they sought their help in getting to an aunt's house in Tirana, another dodgy but ultimately successful journey.
Barron tells another story, of a 15-year-old girl who was shot through the stomach in the back yard of her home in a contested area behind Kosovo Liberation Army lines. She could not get adequate medical attention. Finally, she was sent in a car with her mother and a driver to a Serb-run hospital in Pristina. "Her mother was extorted of hundreds and hundreds of German marks on a daily basis by guards in the hospital," Barron says. The mother, a peasant in a strange city, had to get 10 Albanian blood donors every day in order for the daughter to get blood. "The daughter was in there for weeks. This was clearly against international law," Barron says.
Rumors became rampant that the girl had been killed in the hospital. Barron and Leaning determined that she had received appropriate surgical care, but the delay in getting treatment probably caused her death from overwhelming infection. Later, when Barron met with the mother, she found her ridden with guilt that she had not done enough. Barron tried to help her reframe the tragedy so that it was not a picture of guilt but of "the fabulous job she did for her daughter.
"This is the kind of thing that people have been through," Barron says. "We're hearing now how returning people are finding such devastation after surviving this long, and going through so much terror and hardship."
The Vietnam War and what happened to many returning veterans gave us an understanding of post-traumatic stress disorder. Kosovo is not a place where mental health assistance is part of the medical tradition: There were seven psychologists in Kosovo, Barron says. Individual and group therapy are going to be important, but so is the attitude of international relief agencies and their ability to deliver humanitarian aid in a "psychologically sophisticated or astute way," Barron says. She underscores the importance of involving the Kosovo Albanians in all phases of reconstruction -- empowering them and not just doing everything for them. They need to stay "in touch with the parts of themselves that remain strong and capable," Barron says.
Barron, a consultant to the Red Cross on disasters, says it is also important to get help quickly. Recovery from trauma generally involves three phases, she says: establishment of safety, remembrance and mourning of losses and a return to everyday life. "People have to be kept from having individual guilt about what they did or didn't do when armed Serbs had them at gunpoint," she says.
Physicians for Human Rights and researchers from Columbia University's Mailman School of Public Health documented widespread human rights abuses against Kosovo Albanians, including assaults on patients in hospitals, destruction of medical facilities and the targeted abuse of Albanian doctors. They want violating medical neutrality, a war crime, included in the indictment of Serb leaders.
They also outlined a framework that pays special attention to the medical and mental health components of rebuilding Kosovo. The mental health challenge is especially daunting, especially where there is so little tradition of mental health care. This is an entire people who have been traumatized again and again and again. The psychic damage is beyond imagination, but in the end, that will be the most important to repair.