May 7, 1999

BY ELLEN MERCER

The population of Albania is usually 2.5 million, but this figure has increased by more than 350,000 in the past few months due to the influx of refugees from Kosovo. Last year, psychiatrists in Albania studied the prevalence of PTSD in the 800 Kosovar refugees who had been removed from Yugoslavia last October. They had not yet analyzed the results of this study when hundreds of thousands more spilled over the borders into this tiny country. Albania has 90 psychiatrists, including trainees.

Like Americans, Albanians often hear the latest news about Kosovar refugees from CNN. As masses of refugees have tried desperately to reach safety, news of atrocities inflicted by the Serbs have emerged: Women have been forced to "assist" in the execution of their husbands, most men over 17 years of age have been "lost," one woman who was forced to leave her house and wasn't allowed to take her baby heard her baby's screams as the house burned.

International refugee and relief organizations are working hard to help the refugees with such basic needs as food, shelter, and medical care; organized mental health care is still pending. Anastas Suli, M.D., chair of psychiatric services at the University Hospital of Tirana, indicates that the main problem is the lack of an organized system for debriefing the refugees and providing appropriate treatment for their conditions.

All refugees are suffering from acute stress disorder with such symptoms as anxiety, depression, irritability, and shock. It is only a matter of time until many of them develop posttraumatic stress disorder. In the meantime, it is imperative that these individuals tell their stories. The Albanian psychiatrists are attempting to train social workers and nurses to debrief the refugees-there is a great need for individuals to do such debriefing on the "front lines," according to Dr. Suli. They need help from individuals and institutions with experience in dealing with such massive trauma.

Currently 15 Kosovars are in the country's four psychiatric hospitals, but there are many more who need to be there. More than 65 percent of the refugees are living in the homes of Albanians, but it is only a matter of time until the citizens of this extremely poor country will run out of resources for themselves as well as their guests. The remaining 35 percent reside in tents erected by international relief organizations.

Dr. Suli has presented a project proposal to UNICEF consisting of three areas: (1) to train people on the front lines to debrief the refugees; (2) to train psychiatrists, other physicians, social workers, and nurses in contact with refugees suffering from acute stress disorder; and (3) to produce leaflets and broadcasts to explain what is a normal reaction to this very abnormal situation and to encourage people to try and relax and express their feelings.

"It is ironic that Albania has not solved its own problems, and now we are faced with this terrible tragedy," said Dr. Suli. "I could never have imagined that such brutality and cruelty could exist."

American psychiatrists and others can help through donations to the International Red Cross, the World Health Organization, or UNICEF, to name a few. Also, Albanians have tremendous respect for Americans, according to Dr. Suli, and would welcome psychiatrists and mental health professionals to come to help them organize a system of care. The psychiatrists there need support as well as they hear the refugees recount their terrible tales.

Dr. Suli can be contacted at the University Hospital by fax at 011-355-42-64703 or e-mail at anastasi@icc.eu.org; or through me at (202)-682-6286; e-mail: emercer@psych.org.