15. Kosovo Crisis
The situation in the Balkans has changed significantly since the
last RNIS update (May 12th). Large numbers of people are returning to Kosovo
from the Former Yugoslav Republic of Macedonia, Albania and Montenegro since the
signing of a peace agreement on June 9th and the deployment of Nato troops
within Kosovo. The latest figures from UNHCR estimate that up to 606,000 people
had returned by July 6th. Note that this number changes constantly as more
refugees are leaving. UNHCR and other agencies had not established
organised-repatriations, up until very recently as security remains a concern
due to mines and booby-traps on roads and in dwellings. UNHCR-organised
repatriations are now underway (UNHCR - 28/06/99, 06/0799; WFP -18/06/99).
Situation within Albania and Macedonia
The camps in Albania and Macedonia are (reported to be)
emptying very quickly. Reports indicate that the more at-risk refugee caseloads,
for example female-headed households, the elderly or those with limited
financial resources, remain in the camps. Most camps in Kukes are now almost
empty and are used as transit centres for refugees coming from the rest of
Albania before going back to Kosovo. In Kukes WFP is providing a basic food
ration for refugees going back to Kosovo (UNHCR - 27/06/99).
In Macedonia, 3 out of an initial 7 camps have now closed (as of
4th July), and UNHCR estimate the remaining camp population to be 12,598 (as
compared with 110,000 refugees in camps in early June). At the height of the
crisis the total caseload was almost 270,000, which according to most recent
estimates has fallen to 26,972. Estimates of refugees in host families are
estimated at 14,374, although this figure is disputed by the Macedonian
UNHCR recommends that all returnees are provided with food aid
on arrival in Kosovo, and thus a repatriation ration is not provided. Reports
from NGOs indicate that refugees in camps are stockpiling food to take with
them. Refugees in host families usually collect their monthly ration before they
return (distribution in camps is on a daily basis and in host families on
The distribution of WFP food commodities continues to those
refugees remaining. These distributions are carried out by national and
international NGOs, some of whom have an independent food pipeline which
increases the complexities for effective food co-ordination. As a result rations
vary according to geographical location. A lack of food distribution reports and
adequate information about different food aid pipelines means that it is not
possible to know what is actually distributed
The rations scales that are available in Macedonia indicate that
some camps provide as little as 1700 or 1800 kcal, which in practice may be
further reduced (because of leakage or under-distribution). Many refugees were
unable to cook food and received bread, canned meat, milk, cheese and later
fruit and vegetables for a period of 3 months (UNHCR - 03/07/99). During April
WFP distributed some 1.5 million rations of bread, 290,500 'humanitarian daily
rations', 250,000 rations of biscuits and 130,000 rations of canned fish to
beneficiaries in Albania. In addition, some 32,600 weekly rations of basic
commodities were distributed (WFP -11/06/99,22/06/99).
As bread is the main staple food for the refugee and host family
population in the region, UNHCR and WFP have agreed to produce and distribute
bread instead of wheat flour to refugees in camps on a daily basis. WFP is
responsible for supplying the wheat flour and UNHCR is responsible for the cost
of production, transportation and distribution of the bread. WFP produced bread
through arrangements with some 71 bakeries in Albania by early June. This number
will probably decrease as the refugees leave the country. Some mobile bakeries
will soon be moved to Kosovo (WFP - 11/06/99; 22/06/99). Refugees in host
families are generally provided with a monthly ration of wheatflour (UNHCR -
Wasting does not appear to be an issue in this crisis. The
nutritional situation of the refugees remaining in the camps in Albania and
Macedonia is reported to be satisfactory and stable. A recent survey by
UNHCR/AAH/IMCH/UNICEF (see Annex), reported that the prevalence of wasting was
2.3%, which is virtually identical to the NCHS/CDC/WHO reference population. The
prevalence of stunting (height-for-age) was 10.4%. This prevalence was similar
to that reported in a province-wide survey of Kosovo undertaken in December 1998
indicating that the protein-energy status of the refugees in the camps has not
been negatively affected by the crisis.
The most worrying finding from the survey was that 23% of
children less than 4 months received neither breastmilk nor infant formula.
Anecdotal evidence indicates that cows milk is given to these children. This
practice is reinforced by distribution of UHT milk in the general ration and
through MCH without adequate warning of the dangers of providing this to
children less than six months.
All agencies managing camps have agreed to stop the unsupervised
distribution of infant formula. Remaining camp stocks will be collected by AAH
and stored by UNICEF. AAH is also preparing instructions in Albanian for the use
of infant formula and canned baby foods. There are still some agencies
distributing infant formula, and milk powder, to refugees in host families.
Virtually all households were found to receive food in the
general distribution. 56% of households bought food in the camps to complement
the general ration. In camps with unrestricted access, almost one third bought
food outside the camp. Also, whilst refugees were not permitted to cook in camps
at the time of the survey, over 40% of refugees had the ability to cook.
It is also worth noting that both in the camp and host family
refugee population, the proportion of elderly people is much lower than that
found in the AAH survey in December 1998. This indicates that elderly people
remained in Kosovo.
Less information is available on the nutritional situation of
the refugees who are housed with host families. In some cases they have been
hosted by these families for several months before the escalation of the crisis
in March. The resources of the host families in the affected areas are normally
only sufficient for their own needs and they are being stretched by the
additional burden of providing for the essential needs of the refugees in their
Rations for host families and related refugees
An agreement between WFP, UNHCR and the Albanian Red Cross has
resulted in the Red Cross being responsible for the provision of food parcels
for the majority of the refugees living with host families and for the host
families themselves for June and July (FAO - 29/04/99; WFP - 04/06/99). In
Macedonia, the Macedonian Red Cross distributes WFP food rations to refugees in
host families, and CRS (with OFDA funding) provides food rations for host
families. A number of NGOs provide complementary foods, such as milk, fruits and
vegetables, canned meat, baby-foods, pasta, beans etc.
Situation within Kosovo
Many agencies have now re-opened offices which had to be closed
when the war broke out in the urban centres of Kosovo, and also in Serbia.
Tensions in Kosovo remain high. Although NATO troops are attempting to protect
both ethnic Serbs and Albanians, some deaths, mainly Serb, have been reported.
Initial assessments in the rural areas of the province have reported that
extensive rebuilding will be required in many areas before commercial or
agricultural activities can resume as normal (UNHCR -28/06/99).
Anecdotal reports suggest that the some of the IDPs who remained
in Kosovo during the bombing, often hiding in woods around villages, may have
micronutrient deficiencies. Complementary feeding programmes are being
established to target children under five years old and breast-feeding mothers
(AAH - 21/06/99). No further information specifically on the nutritional status
of the IDPs who remained within Kosovo is currently available to the RNIS.
The most recent reports from within Kosovo indicate that there
are no diseases of public health importance with epidemic potential, or any
significant incidence of malnutrition. Access to most rural villages, however,
is still restricted and thus a complete and comprehensive assessment of the
situation has not been made yet (UNHCR-27/06/99).
The commercial food supply in Kosovo is nearly non-existent
therefore creating a huge demand for food assistance. Since June 13th WFP has
been organising daily convoys of food from Skopje to Kosovo. In some of the more
remote areas the organisation has had to use helicopters to drop the food as the
roads are unsafe (WFP - 25/06/99). Eight food distribution points are now
operational throughout Kosovo and other micro-distribution points are being
set-up (UNHCR - 27/06/99).
NGOs are distributing return packages, for example, CRS and
Doctors of the World (DOW), with OFDA funding, are planning to distribute 3 day
ready to eat food packages to internally displaced and returnees who are unable
to cook for themselves for the first few days. The European Community
Humanitarian Office (ECHO) is also funding the distribution of return-packages.
IDPs in Serbia and Montenegro
On June 23rd WFP started to distribute food aid to some 50,000
Kosovan Serb IDPs in central Serbia and some 10,000 in FYR Montenegro (WFP -
25/05/99). An estimated 72,000 ethnic Serbs have been displaced from Kosovo to
date (UNHCR - 06/07/99).
Overall, the international community has been
successful in preventing acute wasting, among the Kosovan refugees. The
situation of Kosovan refugees in the region is therefore category IIa - not
critical. The continued provision of humanitarian assistance to Kosovan
returnees inside Kosovo is expected to reduce their nutritional risk, however,
until the full situation within Kosovo is assessed, it is possible that pockets
of malnutrition, particularly micronutrient deficiencies associated with acute
food insecurity remain. Hence the situation within Kosovo remains category IIb -
moderate risk. Little information is available about the situation of the
Kosovan Serbs, and given their recent displacement they are considered to be
category IIb - moderate risk.
Recommendations and Priorities:
The international community has been successful in preventing
wasting and associated humanitarian crises. However, there has been much
criticism of the international community's handling of the Kosovo crisis. The
main criticism has centred around the issue of co-ordination of humanitarian
action, which is critical in order to plan a standardised response, which both
integrates the main players, and takes a multi-sectoral approach to reducing
risk and addressing humanitarian needs.
There are unprecedented number of agencies and institutions
involved in this humanitarian operation, including for example, UN agencies,
donor organisations, NATO and more than 350 non governmental organisations, all
of whom are involved in delivery of humanitarian assistance.
An enormous (and possibly disproportionate) amount of financial
and human resources have been spent on this situation. The distribution of these
resources, however, has been uncoordinated and uneven; recently the United
Nations Assistant High Commissioner for Refugees complained to donors that only
about one third of the $400 million for refugees had been donated, and that
UNHCR was operating on a 'hand-to-mouth' basis (BBC website, 1/7/99). Much of
the assistance has been channelled bilaterally through NGOs working in the
Balkans, for example, the food directed through CRS described above. This means
that a substantial part of the humanitarian assistance programme in Kosovo falls
outside UN co-ordination.
The effects of this lack of co-ordination have included:
· The distribution
of inappropriate and costly foodstuffs as food assistance to refugees. This
includes potentially lethal breastmilk substitutes and nutritionally inadequate
low protein biscuits;
· Controversial airdrops of food
into Kosovo, which have been criticised as unnecessary;
· A general dearth of
information on the health and nutritional problems of the affected population
and how they might best be dealt with, particularly those refugees hosted in
· Ad hoc as opposed to
co-ordinated approaches to the provision of food supplies that resulted in great
discrepancies in rations depending not on need but rather on location (WFP -
· A lack of transparency and
accountability due to unacceptably low reporting requirements for the millions
of dollars spent.
The immediate task before the international community now is to
focus on the current phase of humanitarian assistance and peacekeeping in Kosovo
in order that internationally agreed principles, guidelines, and standards are
adhered to by all parties - humanitarian, political, civilian and military.
Proper assessments by appropriate technical staff will ensure that subsequent
decision-making and response are based on sound analysis. The need for
co-ordinated strategies based on humanitarian principles, should not be obviated
by the wider political