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      Survivors of the war in the Northern Kosovo: violence exposure, risk factors and public health effects of an ethnic conflict

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          Abstract

          Background

          The aim of this population-based study was to assess the long-lasting effects of ethnic conflict on health and well-being (with a focus on injury and persistent pain) at family and community level. We have also investigated possible risk factors for victimisation during the conflict and factors contributing to healing.

          Methods

          We conducted a district-level cross-sectional cluster survey of 1,115 households with a population of 6,845. Interviews were carried out in Mitrovicë district in Northern Kosovo from September to October 2008, using standardised questionnaire to collect lifetime violence exposure, lifestyle factors and health information on individual and household.

          Results

          Ethnic Albanians made up 95% of the sample population. Crude mortality and under-five mortality rate was not high in 2008. Over 90% of families had been exposed to at least two categories of violence and human rights violations, and 493 individuals from 341 families reported torture experiences. During the two weeks before the survey, 20% of individuals had suffered physical or mental pain. There were differences in pain complaints according to gender and age, and whether people had been injured within 12 months, had lifetime exposure to violence-related injury, or had been tortured. Patterns of social and political participation in a family could affect the proportion of family members complaining of pain. The proportion of family members with pain complaints was related to a decline in the household income (coef = 9.31, 95% CI = 6.16-12.46, P < 0.001) and the fact of borrowing money (coef = 6.11, 95% CI = 2.91-9.30, P < 0.001) because of an injured person in the household. Families that were affiliated with the Kosovo Liberation Army, or had participated in a protest before or during the war, were likely to be targeted by Serbian paramilitary and law enforcement agencies.

          Conclusions

          Mitrovicë district is currently characterised by a low level of violence, but the effects of ethnic conflict on health and well-being have not gone. The level of lifetime exposure to violence, the proportion of family members reporting pain and lifetime violence-related injury, and family's financial burden were found to be inter-correlated. The sample confined to one ethnic group in one district limits the generalizability of the findings.

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          Most cited references27

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          Mental health, social functioning, and attitudes of Kosovar Albanians following the war in Kosovo.

          The 1998-1999 war in Kosovo had a direct impact on large numbers of civilians. The mental health consequences of the conflict are not known. To establish the prevalence of psychiatric morbidity associated with the war in Kosovo, to assess social functioning, and to identify vulnerable populations among ethnic Albanians in Kosovo. Cross-sectional cluster sample survey conducted from August to October 1999 among 1358 Kosovar Albanians aged 15 years or older in 558 randomly selected households across Kosovo. Nonspecific psychiatric morbidity, posttraumatic stress disorder (PTSD) symptoms, and social functioning using the General Health Questionnaire 28 (GHQ-28), Harvard Trauma Questionnaire, and the Medical Outcomes Study Short-Form 20 (MOS-20), respectively; feelings of hatred and a desire for revenge among persons surveyed as addressed by additional questions. Of the respondents, 17.1% (95% confidence interval [CI], 13.2%-21.0%) reported symptoms that met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for PTSD; total mean score on the GHQ-28 was 11.1 (95% CI, 9.9-12.4). Respondents reported a high prevalence of traumatic events. There was a significant linear decrease in mental health status and social functioning with increasing amount of traumatic events (P
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            War and mortality in Kosovo, 1998-99: an epidemiological testimony.

            The total number, rates, and causes of mortality in Kosovo during the last war remain unclear despite intense international attention. Understanding mortality that results from modern warfare, in which 90% of casualties are civilian, and identifying vulnerable civilian groups, are of critical public-health importance. In September 1999 we conducted a two-stage cluster survey among the Kosovar Albanian population in Kosovo. We collected retrospective mortality data, including cause of death, for the period of the conflict. The survey included 1197 households comprising 8605 people. From February, 1998, through June, 1999, 67 (64%) of 105 deaths in the sample population were attributed to war-related trauma, corresponding to 12,000 (95% CI 5500-18,300) deaths in the total population. The crude mortality rate increased 2.3 times from the pre-conflict level to 0.72 per 1000 a month. Mortality rates peaked in April 1999 at 3.25 per 1000 a month, coinciding with an intensification of the Serbian campaign of "ethnic cleansing". Men of military age (15-49 years) and men 50 years and older had the highest age-specific mortality rates from war-related trauma. However, the latter group were more than three times as likely to die of war-related trauma than were men of military age (relative risk 3.2). Raising awareness among the international humanitarian community of the increased risk of mortality from war-related trauma among men of 50 years and older in some settings is an urgent priority. Establishing evacuation programmes to assist older people to find refuge may prevent loss of life. Such mortality data could be used as evidence that governments and military groups have violated international standards of conduct during warfare.
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              Political violence, ethnic conflict, and contemporary wars: broad implications for health and social well-being.

              Ethnic conflict, political violence and wars that presently shape many parts of world have deep-seated structural causes. In poor and highly indebted countries, economic and environmental decline, asset depletion, and erosion of the subsistence base lead to further impoverishment and food insecurity for vast sectors of the population. Growing ethnic and religious tensions over a shrinking resource base often escort the emergence of predatory practices, rivalry, political violence, and internal wars. The nature of armed conflict has changed substantially over time and most strategic analysts agree that in the second half of the 20th century, contemporary wars are less of a problem of relations between states than a problem within states. Despite the growing number of armed conflicts and wars throughout the world, not enough attention has been paid to the local patterns of distress being experienced and the long-term health impact and psychosocial consequences of the various forms of political violence against individuals, communities, or specific ethnic groups. The short or long-term impact assessment on civilian populations of poor countries affected by war have been scarce, and studies focussing on experiences of collective suffering and trauma-related disorders among survivors are beginning to emerge in the scientific literature. The medicalization of collective suffering and trauma reflects a poor understanding of the relationships among critically important social determinants and the range of possible health outcomes of political violence.
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                Author and article information

                Journal
                Confl Health
                Conflict and Health
                BioMed Central
                1752-1505
                2010
                28 May 2010
                : 4
                : 11
                Affiliations
                [1 ]Rehabilitation and Research Centre for Torture Victims (RCT), Copenhagen, Denmark
                [2 ]Kosova Rehabilitation Centre for Torture Victims (KRCT), Pristina, Kosovo
                [3 ]Department of Psychology, University of Pristina, Kosovo
                Article
                1752-1505-4-11
                10.1186/1752-1505-4-11
                2893511
                20509915
                e1f09420-9d5f-4c70-b32b-356d57ebeb2c
                Copyright ©2010 Wang et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 20 October 2009
                : 28 May 2010
                Categories
                Research

                Health & Social care
                Health & Social care

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