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Yugoslavia: Report Denounces UNMIK For 'Degrading' Conditions At Mental Health Facilities

By Ulpiana Lama

Mental Disability Rights International, a Washington-based advocacy group, says that patients at UN-administered mental-health facilities in Kosovo live in inhumane and degrading conditions and have been physically and sexually abused. UN authorities acknowledge serious problems exist at the facilities but say efforts are under way to try to rectify the problems, which are made worse by a lack of funds.

Prague, 16 August 2002 (RFE/RL) -- A two-year investigation by Mental Disability Rights International (MDRI) found what it calls serious human rights abuses against people with mental disabilities at facilities in Kosovo administered by the United Nations.

MDRI -- a nongovernmental advocacy organization based in Washington, D.C. -- conducted seven fact-finding missions to Kosovo between September 2000 and July 2002. Officials examined the level of health care at inpatient and community facilities in Kosovo, including two social-care facilities; two psychiatric wards at general hospitals; the psychiatric ward of the Lipljan jail; two group homes for children with disabilities; a special school for children with disabilities; and two recently established community mental-health centers.

The MDRI report focuses particularly on three institutions in the Kosovar capital, Pristina: Shtime, a 285-bed facility for individuals with mental disabilities; the Elderly Home, a 165-bed facility housing people of all ages, including teenagers; and Pristina University Hospital's psychiatric ward, a 75-bed short-term facility.

The MDRI report is titled "Not on the Agenda: Human Rights of People With Mental Disabilities in Kosovo." It says UN operations in Kosovo "have fallen far short" of international standards. It says patients have been consigned unnecessarily to lifetime institutionalization and that the UN has tolerated conditions of confinement that are "abusive and inhumane."

In an interview with RFE/RL, Dr. Eric Rosenthal, founder and executive director of MDRI, said conditions inside these institutions are appalling.

"We have two major types of objections. We have, after two years of investigation, discovered some very serious abuses within psychiatric facilities in the Shtime social institution, at the Pristina University General Hospital psychiatric ward, and in the Elderly Home. We received a number of reports of physical and sexual abuse. At Shtime, we also found inhuman and degrading conditions of living for the entire population of the institution -- inappropriate psychiatric care, degrading conditions. It is smelly. It is filthy. It is unhygienic."

Rosenthal says MDRI sent a letter in June 2001 to Hans Haekkerup, who was at the time the chief administrator for the UN Mission in Kosovo (UNMIK), informing him of the group's preliminary findings.

"We brought this to the attention of UNMIK one year ago. We wrote a very strongly worded letter in June to Hans Haekkerup, and the response was primarily denial. They said that not one case of rape had been reported to the director of Shtime, when we knew very well that Norwegian Red Cross staff members at Shtime had observed cases of rape and had reported them."

RFE/RL spoke with a former employee at Shtime, who wished to remain anonymous. He says the living standards within the center, especially after the war, were "absolutely unacceptable." In addition, he says, "the wages of the local staff are miserable and the work is extremely hard."

A spokeswoman for UNMIK, Susan Manuel, says the UN does not challenge the main findings of MDRI's investigation.

"I'm not disputing the report. We acknowledge that there are serious problems here. The situation particularly in the mental institution in Shtime has been bad for a long time. But the situation in mental health is not that simple. First of all, the report talks about the incidents of people in the Shtime institution, and we are on a program of trying to sensitize the staff there and trying to set up a structure by which the staff can report abuses freely. We are in the process of drafting a new law. And also the law would require that all those people in Shtime now, that their cases, would be reviewed and evaluated and they would either be sent to another institution or released."

Manuel notes the MDRI report doesn't take into account recent improvements, such as the construction of three community health centers and special apartments for persons with minor mental disabilities.

Manuel also emphasizes that the three institutions that are the focus of the MDRI report are no longer directly managed by UNMIK.

Following last November's general elections in Kosovo, UNMIK transferred limited, partial powers to the new government in Kosovo. From the beginning of this year, Shtime and the Elderly Home have been under the supervision of the Kosovo Ministry of Labor and Social Welfare, while the psychiatric ward at Pristina hospital is run by the Ministry of Health.

Dutch psychologist Hilbert Belksma, who has worked for UNMIK since last September, is in charge of Shtime. After nearly a year on the job, Belksma says he is pleased to report some major progress at the facility.

"We have moved most of the children out of the major institution to a house next to the institution, and to a house in a Serbian enclave called Gracanica."

The children were moved as part of a program established by UNICEF and operated by Doctors of the World.

The director of the psychiatric ward at Pristina Hospital, Dr. Afrim Blyta, complains about the lack of proper medicine and equipment.

"You cannot manage the work in a clinic if you are constantly exposed to the incredible lack of cures, which are indispensable for such an institution. We urgently need medicines that control the behavior of patients. Frequently, we have failed because of the absences of remedies to keep under control and calm down our many patients with psychotic troubles. They become too aggressive. They attack the personnel, and in some cases they have seriously injured our staff members."

UNMIK says the abuses and harsh conditions at these facilities are the result not of improper management, but the lack of funds. Manuel says, "The problem is money, and it is very difficult now to get the money for mental health in Kosovo or to get money for anything in Kosovo. The donors simply are not interested in funding improvements to the mental health system in Kosovo."

For MDRI's Rosenthal, this is no excuse. "Number one, protection against physical and sexual abuses does not cost a lot of money, and there is no excuse for this kind of abuse. They're spending money to rebuild the toilet. Why not spend money to put up a locked door that can prevent men from going into the women's ward at night? In May of last year, a social worker from the Norwegian Red Cross said that men come onto the women's ward and have their way with them at night. We asked them at that time, 'Why don't you put up a good, strong locked door?' And they said, 'We don't have money.' That's ridiculous."

Rosenthal says reforms must focus on the building of new community-based homes and services, not on rebuilding inadequate facilities.

Belksma agrees in principle with the need for community-based houses, but says money should be spent now so that the current residents of Shtime are humanely accommodated until such time that community houses are opened.

"Before we establish these houses in the community, we need to house 230 residents in Shtime. I cannot put them on the street. Nobody is interested in them. They cannot go to the families. We have a large population of Serbian residents -- 115 of the 230 residents of Shtime are from Serbia. We are talking with the Serbian government in Belgrade to bring these people back to their own families or to a house or an institution in Serbia. It is very difficult to bring back people to Serbia because the institutions in Serbia are overcrowded. They have the same financial problems we have here in Kosovo, and family members are simply not interested in their family [members] living in Shtime anymore. Lots of residents in Shtime have been there since the 1990s, [some] even longer. So their families are dead or simply not interested."

The MDRI report has been endorsed by the Red Cross and Human Rights Watch and was funded by the Open Society Institute. It says the UN Mission in Kosovo deserves credit for responding quickly to an immediate crisis following the war in Kosovo at a time when hundreds of people in psychiatric facilities faced life-threatening conditions. But it says that while UNMIK organized an effective response to the medical emergency, "it did not create a framework to protect the human rights of people detained in institutions."

It charges that UNMIK "has failed to abide by its obligations under international conventions or by the UN General Assembly standards to which it holds other nations."

It recommends that UNMIK should commit itself to raising the funds necessary to protect the rights of people with mental disabilities. UNMIK, it says, must take immediate action to create a system of accountability to ensure the protection of people with mental disabilities from violence and sexual abuse.

A 2 million-euro package promised by the Dutch government could provide some of the funds needed to begin making improvements in the lives of the mentally ill in Kosovo.

(The full MDRI report is available on the Internet at