Physicians for Human Rights (PHR) has released a 10-year study of the negative impact of the oppression of Kosovar Albanian physicians from 1989-1999 on the subsequent development through 2008 of the Kosovar health system.

 

The report, Perilous Medicine: The Legacy of Oppression and Conflict on Health in Kosovo, details the detention, torture, prosecution and killing of Kosovar Albanian physicians by Serbian forces during the 1998-99 war which took place during the decade-long exclusion of the majority of Kosovar Albanian physicians from the state health system. It describes the destructive legacy of these years on the subsequent reconstruction and current state of the Kosovo health system.

 

“This is among the most thoroughly documented studies of brutal political interference with the ethical practice of medicine,” said Leonard S. Rubenstein, JD, PHR President, and currently a Jennings Randolph Senior Fellow at the U.S. Institute of Peace. “Our research shows that in the period 1998 and early 1999, Serbian police and paramilitary forces targeted Kosovar Albanian physicians for allegedly providing care to members of the Kosovo Liberation Army. This persecution breached the requirements of human rights law and the Geneva Conventions by failing to respect physicians’ ethical obligation to provide medical care to patients, including wounded combatants, without regard to political affiliation.”

The study, available at http://physiciansforhumanrights.org/, revealed that Serb forces killed three physicians and “disappeared” another. At least two of the three individuals killed were targeted because they were doctors. Among the other findings:

• 14 physicians were charged with crimes and arbitrarily detained;
• 12 physicians were tortured while in custody; and
• 8 were prosecuted in court for the so-called “offense” of providing medical care to a “terrorist”.

The forms of torture included severe beatings, sometimes with rubber batons and guns, placement of plastic bags over the doctor’s head, and threats of death if the doctor did not confess. The physicians were subjected to cruel and inhuman conditions of confinement, including deprivation of adequate food, water, and sanitation.

Dr. Luan Jaha, one of the physicians who was arrested, detained and tortured and a co-author of the report, said, “The report is a milestone in the history of the Kosovo medical community, a means of revealing the truth. As a community we affirm the values of human rights and equal treatment for all.”

The study showed that the intimidation succeeded. Fifty-four doctors fled or went into hiding as a result of the assaults on their colleagues. In 35 additional cases, physicians feared providing ethically-appropriate care due to the risk of serious repercussions. And in ten such cases, physicians were physically threatened but not arrested.
The report found that the threat of arrest was constant. One doctor told PHR:

Every time we go into the field to see a patient, we run a big risk from the police, who classify you as a ‘terrorist’ if you work with ‘terrorists.’ We give help to everyone; we are humanitarians. We are legal -- we have books and records of treatment.

PHR also found that in the period 1998-early 1999, Kosovar Albanian patients were increasingly subjected to discrimination, exclusion from health facilities and physical abuse while in hospitals.

The report also reveals that, after NATO and Russian forces entered Kosovo as part of a peace agreement ending the war in 1999, groups of Kosovo Albanians violently attacked the Kosovo Serbian population, including Serb physicians. The report did not find that these individuals were targeted as physicians, but contributed to all of them either leaving Kosovo or practicing only in Serb enclaves.

In the aftermath of the war, the report found, UN officials responsible for administering Kosovo under the peace agreement initiated a planning process for a new health system in the devastated province.

Dr. Jennifer Leaning, a PHR board member and professor at the Harvard School of Public Health who interviewed hundreds of physicians and who traveled to Kosovo for the release of the report, stated:

The experience of war, persecution, brutality, and displacement left the Kosovar Albanian medical community traumatized but it was crucial to include these many well-trained and experienced physicians in the design of a health system that could be equitable and consistent with human rights principles.

Nevertheless, the report finds that the UN agencies and others who developed the new health system did not fully engage the voices and experiences of Kosovar doctors in the planning process. Moreover, planners introduced a new model of practice unfamiliar to patients and providers alike that was never adequately resourced. These failures caused many experienced providers to flee into private practice.

The report concludes that the failure to integrate these physicians into the planning for a new system, combined with capacity limitations, management deficiencies, lack of transparency and accountability and absence of a sound health financing system resulted in a fragmented and inequitable health system that persists in Kosovo today, in violation of the right to the highest attainable standard of health. Access to the most experienced providers, as well as medication, now often requires private payment that is beyond the means of the majority of the population, a large percentage of whom are unemployed.

The report’s recommendations call for:

• The Kosovar medical community to develop an independent voice and leadership for creation of professional standards, ethics, and human rights principles for medical education and practice.
• The Government of Kosovo to support and develop a fully integrated and ethical system of health care with equal access to all members of society.
• The Government of Serbia to end its interference with Kosovo’s efforts to integrate health services within its borders.
• The international community to provide critical resources to develop a health system in Kosovo that is consistent with human rights principles.


 

 

Physicians for Human Rights (PHR) mobilizes the health professions to advance the health and dignity of all people by protecting human rights. As a founding member of the International Campaign to Ban Landmines, PHR shared the 1997 Nobel Peace Prize. To download the report, visit http://physiciansforhumanrights.org