• MEDICAL GROUP DOCUMENTS SYSTEMATIC AND PERVASIVE ABUSES BY SERBS AGAINST ALBANIAN KOSOVAR HEALTH PROFESSIONALS AND ALBANIAN KOSOVAR PATIENTS

Contact: Jennifer Leaning, M.D. (781) 259-9108 / (617) 909-3559 Barbara Ayotte (617) 695-0041 ext 210 / (617) 549-0152

MEDICAL GROUP DOCUMENTS SYSTEMATIC AND PERVASIVE ABUSES BY SERBS AGAINST ALBANIAN KOSOVAR HEALTH PROFESSIONALS AND ALBANIAN KOSOVAR PATIENTS

The systematic Serbian oppression of Albanian Kosovar physicians in Kosovo has escalated drastically since the conflict began in February 1998, according to preliminary findings released today from a two-month study by Physicians for Human Rights (PHR). Abuses committed date primarily from late summer and fall of 1998 and extend into the period beyond the Holbrooke/Milosevic agreement on October 12, 1998.

The Boston-based group documents a pattern of Serbian intimidation of Albanian Kosovar doctors, jeopardizing the already fragile health care system in a time when Kosovars returning to their villages are in greatest medical need. The intimidation is marked by instances of murder, torture, detention, imprisonment, and forced disappearances of ethnic Albanian Kosovar physicians. The PHR study, which will be released in early 1999, also cites cases of Albanian Kosovar patients who have been abused by Serbian police and Serbian health professionals, including instances where patients have been beaten, chained to beds or radiators, and placed under constant armed police guard.

The health and human rights group, whose key recommendations were transmitted in a letter sent today to Yugoslav President Slobodan Milosevic, also cited interrogation and harassment of Albanian Kosovar physicians, including threats of death, by Serbian police. Medical facilities operated by ethnic Albanian Kosovar physicians have been searched, property confiscated, and many clinics and health centers in contested areas have been burned to the ground. Ambulance transport has also been interrupted.

"Attacks on health facilities, doctors, and their patients are war crimes," said Jennifer Leaning, M.D., a member of the PHR board of directors and one of the lead researchers in the study. "Albanian Kosovar physicians attempting to provide assistance to people living in areas of conflict or currently or previously controlled by the Kosovo Liberation Army (KLA) have been harassed and hunted in a campaign that disregards norms of medical neutrality that are protected under international human rights and humanitarian law," said Leaning. “The Serbian authorities have defied the principle that civilians and combatants alike are entitled to medical treatment in times of conflict. Instead, Serb police have branded medical practices as acts of “terrorism” and abused physicians and patients, calling them “terrorists”. Further, by attacking community leaders such as physicians and creating fear throughout the population, the Serbian authorities are conducting a campaign against ethnic Albanian civil society."

The Geneva Conventions, including both Protocols, specify an extensive array of protected acts, persons, and facilities in the delivery of health care to civilians and combatants, in a wide range of conflicts, including the one now being waged in Kosovo. Wounded persons not engaged in combat, including civilians, are entitled to medical care.

There has been a long history of discrimination against ethnic Albanian physicians in the Serb-run state health care system in Kosovo--mass firing from employment in 1990, elimination of training opportunities in state medical schools and hospitals, and requiring the use of the Serbian language rather than Albanian in all interactions with patients, including the writing of prescriptions and instructional materials. During the same time, ethnic Albanians have been impeded access to the state-financed health care system. The current oppression of ethnic Albanian Kosovar health professionals, however, has acquired an acutely violent character.

The PHR team, composed of three physicians, one lawyer, and two health researchers, conducted interviews with 105 individuals in Kosovo from October to December 1998, collecting data relating to 75 cases of alleged abuse of Albanian Kosovar health professionals and patients and 52 cases of physician flight from Serbian threats. The individuals interviewed included physicians, lawyers, representatives from major humanitarian organizations, and eyewitnesses to abuses against Albanian Kosovar physicians and patients. Many of those interviewed requested anonymity for fear of reprisal from the Serbian authorities.

The widespread abuses committed by Serbian authorities against Albanian Kosovar physicians and other health workers include:

Murder

The PHR team investigated the murder of one Albanian Kosovar physician who was tortured and killed because he was fulfilling his professional obligation to provide care to patients in need. Dr. Leci,a general practitioner in a private clinic in Gradice was hunted by Serbian police on September 24-25, 1998 and killed sometime between September 24-27. Confirmed reports state that his body,when found, revealed that his right hand had been cut off.

Another leading physician in the ethnic Albanian Kosovar community, not one known to have taken an active role in delivering medical care in KLA- contested areas, was killed on the evening of November 18, 1998 in suspicious circumstances. Dr. Zejnullahu, a physician in the town of Pec, was attacked by three masked men who spoke fluent Serbian, carried Kaleshnikovs, and fired several lethal shots at close range while Dr. Zejnullahu’s family was by his side.

Detention/Arrest for Delivering Medical Care

Albanian Kosovar physicians have been accused of crimes despite the lack of credible evidence of criminal acts. PHR has documented four cases of physicians held in detention and five cases of physicians brought to trial, with four of these resulting in convictions.PHR has also received unconfirmed reports of many physicians in custody, which it is currently investigating.

One physician told PHR he was arrested while trying to calm patients who had rushed into a clinic in advance of a Serbian attack on his village. Another was arrested while returning home after fleeing from a Serbian advance on his town, and a third was arrested while maintaining a home supply of medical drugs in a KLA-controlled area deprived of medical supplies.

In these cases, the physicians were alleged (whether formally charged or not) to have engaged in the practice of medicine on behalf of people labeled “terrorists” and thus have committed acts of terrorism themselves. The charges are brought under Articles 125 and 136 of the Criminal Code of the Federal Republic of Yugoslavia and, in the cases where PHR has confirmed that these charges have been applied, Serbs have extracted confessions from physicians and imposed inhumane prison conditions.

Torture/Physical Abuse

Albanian Kosovar health workers reported many instances of torture and/or physical abuse by Serbian authorities while in police custody. PHR has documented six cases of physical abuse and threat of abuse by Serbian police. Physicians reported that the abuse usually occurred within the first three days of detention, during which time the police are required to complete their investigation and present findings to an investigating judge.

In the cases PHR documented, four Albanian Kosovar physicians were beaten by hand or stick applied to torso or hands; one physician had a plastic bag wrapped around his head, resulting in near suffocation, and another was threatened with electric shock.

A physician who requested anonymity told PHR that the Serbian police:

“…beat me like an animal; they beat me with the gun butt, but they were kicking me, they beat me with their fists…in the police station. I had to sign everything they wanted to stop the torture.. I signed one paper I wasn’t allowed to read.”


Police attempting to extract a confession from another physician asked him several times a day if he had changed his mind about cooperating. He was summarily beaten when he declined to “confess”. Such confessions have been used as the sole evidentiary basis for subsequent cases.

Search of Medical Facilities/Seizure of Supplies/Destruction of Medical Facilities

PHR has received reports of many instances and documented eight cases where Serbian police invaded medical facilities and engaged in a range of behaviors in violation of international law: search of premises, seizure of medical supplies, destruction of facilities, and destruction of homes of physicians.

Forced Flight from Medical Practice

Over half of the 54 physicians interviewed by PHR had been forced to leave their practice entirely or had limited their involvement dramatically since the onset of the conflict in February 1998 out of fear of Serb harassment. Lists of physicians who have left their established place of practice are obtainable with difficulty, since those compiling the lists and those on the lists are in danger if their names or whereabouts come to the attention of the Serbian authorities.

Two lists that could be compared and validated by the PHR team indicated that 17 health care professionals (12 physicians, 2 anesthesiologists, 1 epidemiologist ,1 dentist and 1 nurse) from the area around Pec in northwest Kosovo had either fled the country or were in hiding. Thirty-five health professionals from the Decan area (26 health professionals and 9 dentists) had either fled or were in hiding. The category of "in hiding" includes those who left or were driven from their established practice and went deeper into KLA-controlled area to continue to provide medical care to civilians trapped in the conflict; those who left one town and went to live with their families elsewhere in Kosovo, while continuing to practice informally; and those who left their established sites and stopped practicing altogether.

PHR is particularly concerned about the fate of Dr.Hafir Salja, a physician at the Glogovac Medical Center. On April 10, 1998,Dr. Salja was reportedly arrested from a car he was riding in with two colleagues and taken to the Pristina Police Department. The two colleagues were released but Dr. Salja remains missing. Some reports indicate hs seen alive and had joined the KLA, others report that he is in custody at the Military Court in Nis. PHR has not been able to confirm either story.

Police Harassment

The 54 physicians interviewed cited frequent police harassment and abuse. Over 25% of them had been brought into police offices for "informative talks", a procedure where a person is held for an indefinite period of time and subjected to threatening questions relating to his political leanings or affiliations. Physicians traveling on the roads are vulnerable to such police action.

As a result, physicians who try to reach villages that have been cut off from medical support must travel circuitous back roads (increasingly at risk of landmine injuries) and at night to avoid the frequent police checkpoints along the tarmac roads. One physician reported to PHR that it is safer to be caught with a gun than with medical supplies.

PHR has received reports of four instances of police interference with ambulance transport, including one where the physician interviewed said that the Serbian policeman had held a gun to his head, only lowering it when a bus rounded the curve on the main road. Another ambulance, clearly marked with a Red Cross, was stopped in Rahovic by Serbian police so that Serb authorities could examine the bandage of the ethnic Albanian patient to verify she had an appendectomy as opposed to a war wound. The Serbian police beat the driver, technician and nurse and slapped the patient. They broke the windows of the ambulance.

Abuses against Hospitalized Albanian Kosovar Patients Include:

While not the principal focus of PHR’s study, PHR has received numerous reports and comments from many parts of Kosovo describing instances and a general pattern of abuse of dozens of ethnic Albanian patients in state-controlled, Serbian-run hospitals. Informants insisted upon total anonymity and further specification of hospitals or the sources of our information would jeopardize the safety of individuals still in Kosovo.

In three of the major state-run hospitals, informants provided PHR with examples of the nature of the dozens of abuses committed against ethnic Albanian Kosovar patients by Serbian police, including: interrogating seriously ill patients in the hospital, despite efforts by their Albanian Kosovar physicians to prevent this practice; chaining patients who are considered terrorists to their beds or radiators on a 24-hour basis with armed Serbian police guards in or just outside their rooms; and extinguishing their cigarettes on the backs of the hands of patients returning to the recovery room from the operating room, still coming out of anesthesia. In one instance a post-operative patient with an external fixation devise fixed to his femur was prematurely removed from the hospital by Serbian police, dragged into a police station and then imprisoned. In another case, Serbian police were reported to agitate their batons in the wounds of patients, risking infection and the delay of healing.

Informants also told PHR of cases where Serbian physicians and nurses slapped Albanian Kosovar patients because they were crying or had a wound perceived by the staff to be consistent with a combat injury.

Some ethnic Albanian families reported that they were prevented from delivering food and clean clothing to their ill relatives for up to 24 hours. Some patients’ families were extorted significant amounts of money by Serb police and Serb physicians in order to secure adequate food, medical care, and necessary pharmaceuticals.

In a number of instances, PHR received reports that Serbian police delayed taking injured men to the hospital in order to interrogate them or arrested injured men while they were in the hospital regardless of their medical condition and despite the protests of ethnic Albanian physicians on staff.

These abuses violate Yugoslavia’sobligations under the Convention Against Torture and the Geneva Conventions, both of which it has ratified. The Geneva Conventions stipulate that all persons in need of medical care in war, whether civilian or combatant, and regardless of the nature of war, are considered protected persons under the terms of Common Article 3 and Protocol II.

Abuses Against the Ethnic Albanian Kosovar Population:

The pattern of interference with medical care and punishment of those who try to deliver it sows widespread fear and anxiety in the Albanian Kosovar population. Their leaders are under attack and threat of death: as the niece of the physician killed in Pec cried out to us, “Are they trying to kill the best of us, one by one?"

The Albanian Kosovar physicians interviewed by PHR are afraid but, in general, still resolute. They feel a strong obligation to continue to serve their people and provide needed medical care, but they are forced to be inescapably aware of the personal danger and the danger to their families that their insistence on medical practice now entails. A few of the physicians interviewed by PHR showed signs of depression, even despair,and many are exhausted, on the verge of burn-out.


The Serbian authorities, by conducting an assault on a most visible group of community leaders and by blocking access to a service needed by all people, particularly a people at war, have deployed a strategy aimed at banishing the application of international law and obliterating a potent source of comfort and support for the population. Unless the international community takes action to halt this assault on health care and those who provide it, the Serbian authorities will continue to pursue a policy this decade has now made familiar: the imposition of great suffering on vast numbers of civilians in open violation of international law and norms.

Abuses Against Serbian Health Professionals and Patients

PHR has learned of one instance occurring on July 16-17, 1998 during the KLA offensive on Orahovic when KLA forces entered the hospital and held a group of nurses (including 2 Serbian nurses) and patients on the hospital premises in order, the KLA soldiers said, to ensure their protection from fighting outside. No one was harmed and the troops left after two days. During this instance, however, it was reported to PHR that one Serbian physician and one Serbian technician were taken by the KLA and have not been seen since. This report has not been confirmed but PHR plans to continue its investigation of this incident and to report on whatever further instances of abuses against Serbian medical staff it may find.

Recommendations:

In separate letters sent to FRY President Milosevic and President Clinton today, PHR urged the FRY Government and the United States and international community to take the following immediate measures:

To the Government of the Federal Republic of Yugoslavia:


1. President Milosevic must immediately release without condition those doctors and other health personnel who have been detained, including those convicted, who were exercising their professional responsibility to provide medical treatment to wounded or sick civilians or to combatants. Such activities are protected under international humanitarian law, and must be permitted in all circumstances in Kosovo.


2. The Serb authorities must immediately end their attacks and persecution on both medical personnel and their patients who come from areas formerly or currently under KLA control and permit health personnel to operate without interference.


3.The Serb authorities must immediately end their impediments to the transport of medical supplies and pharmaceuticals, stop all harassment at checkpoints, and permit free access to all parts of the country to Albanian Kosovar doctors and health personnel.


4. The Government of Serbia should provide extensive assistance to the local Albanian medical community for purposes of rebuilding and re- equipping the clinics and hospitals that its forces have destroyed in the course of the past year.

To the United States Government and Countries Engaged in Monitoring the Conflict in Kosovo

Neither the agreement brokered by Ambassador Richard Holbrooke nor the October 1998 Organization for Security and Cooperation in Europe (OSCE) Agreement to place a verification mission in Kosovo includes an explicit human rights mandate or makes specific demands on the FRY government with regard to ceasing human rights abuses. Therefore,PHR recommends that:


1. A human rights component must be incorporated into the Kosovo Diplomatic Mission (KVM) mandate and given high priority. A suitable number of personnel placed in the field should have adequate training in human rights principles and human rights monitoring.

2.The protection of members of the Albanian Kosovar medical community and their patients must be a top priority in all diplomatic dealings with Belgrade. The representatives of those governments involved in the KVM must exert themselves to the maximum possible extent to provide protection and assistance to Kosovo's beleaguered civilian population, including physicians and other health personnel in the performance of their duties.

3.The Kosovo Diplomatic Mission should make every effort to set up local offices throughout Kosovo, particularly in those areas that were once under KLA control or are under KLA control now. The diplomatic monitors should live in the communities and open readily accessible offices where they can receive witness testimonies of human rights abuses. Monitors should be guaranteed the right to travel to any site. They should report publicly on all incidents, including impediments placed on their access by the Serb authorities.

4.The international diplomatic community, including the KVM monitors, should monitor and denounce the persecution of independent Albanian Kosovar doctors and health professionals. They should attend trials of doctors and medical personnel, protest harassment, imprisonment, and other abuses, and accompany the independent doctors whenever possible when they deliver medical services, particularly to areas of former or present KLA control. International monitors should also be present at State- run hospitals and clinics to help deter abuse and discrimination against Albanian Kosovar patients.

5.Diplomatic monitors should be present at every place of detention or imprisonment to deter abuse and torture of detainees and to help assure the regular access of the International Committee of the Red Cross to those in detention.

6.The International Criminal Tribunal for the Former Yugoslavia (ICTY)should open criminal investigations into the destruction of health clinics and hospitals and the murder bySerb authorities of at least one and perhaps two Albanian Kosovar doctors as violations of international humanitarian law within the Tribunal's purview.

7.International humanitarian organizations should continue, to the maximum extent possible, to collaborate with local independent Albanian doctors in Kosovo, employ them to participate in mobile clinic visits to displaced communities, share with them supplies and pharmaceuticals, and cooperate with them to rebuild the network of independent health clinics that were destroyed by the Serb army and police.


To the International Medical Community

PHR urges the international medical communityto call for the protection of their colleagues in Kosovo and to demand that those providing medical care to those in need be allowed to do so.

A full report of PHR’s work in the region will be released in February 1999.

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Physicians for Human Rights (PHR) mobilizes the health professions and enlists support from the general public to protect and promote the human rights of all people. Since its founding in 1986, PHR has conducted dozens of investigations in countries throughout the world to document torture, political killings, prison conditions, and the health consequences of armed conflict. As a founding member of the International Campaign to Ban Landmines, PHR shared in the 1997 Nobel Peace Prize. PHR has worked in Bosnia since 1993. Its several projects in the region involve working with the relatives of the missing: the Antemortem Database Project, the Identification Project, the Forensic Monitoring Project, and the Forensic Needs Assessment Project. PHR has provided evidence of war crimes for both of the International Criminal Tribunals (former Yugoslavia and Rwanda). Charles Clements, MD, is President; Carola Eisenberg, MD, is Vice-President, Leonard Rubenstein, JD, is Executive Director, Susannah Sirkin is Deputy Director; Mary-Jo Adams is Director of Development; Barbara Ayotte is Director of Communications; Holly Burkhalter is Advocacy Director; Gina Cummings is Director of Campaigns; and Richard Sollom is Senior Program Associate.