IV. Background

Kosovo's Romani Communities

In Kosovo the Romani communities are generally characterized as Roma, Ashkali, and Egyptians (RAE).[3] Although identities are fluid among ethnic Roma in Kosovo, those describing themselves as Roma are mainly Serbian- and Romani-language speakers, and tend to live in the Serb-majority areas (north of the Ibar River as well as the Serbian enclaves). Those describing themselves as Ashkali and Egyptians are Albanian-language speakers, who live mainly, but not only, in ethnic Albanian majority areas.

The first documented Roma arrivals to the Balkans were in the sixteenth century during the Ottoman period.[4] The majority of Kosovo Roma were traditionally Muslim; smaller numbers were Eastern Orthodox and Catholic.[5]

Separate Ashkali and Egyptian identities emerged during the period of the Socialist Federal Republic of Yugoslavia (1946-92). Some scholars have attributed this to the government's openness to the expression of new forms of Romani identity and the assimilation of certain Romani communities into Kosovo Albanian society, which led them to "rediscover" their ancient origins.[6]

The political instability in Yugoslavia that followed the death of Tito in 1980 affected Kosovo, with increasing tension between Serbs and ethnic Albanians, and discrimination against ethnic Albanians after Slobodan Milosevic came to power. Roma felt "stuck in the middle."[7] During the 1990s the division of Kosovo Roma into the Serbian-speaking Roma and the Albanian-speaking Ashkali and Egyptians solidified.[8]

The armed confrontation of the Kosovo Liberation Army (KLA) with Yugoslav government forces and Serbian paramilitary units, the subsequent NATO bombing, and the wave of retaliatory ethnic violence by Albanians at the start of international rule in Kosovo in 1999 resulted in RAE both fleeing and being forcibly expelled from Kosovo on a massive scale.[9] It is estimated that around 40,000 RAE remain in Kosovo today, as opposed to the estimated 200,000 before the war.[10]

The term RAE has been used by UNMIK since 2000 and is widely used among international agencies in Kosovo. The term remains controversial among some representatives of the Roma community, who see it as a factor contributing to the divisions within what they contend should be a cohesive and single community.[11]

The majority of the members of the Romani communities interviewed by Human Rights Watch for this report identify themselves as Roma. This report uses the term Roma to refer to that population, except where the person interviewed identified him or herself as Ashkali, in which case that self-identification is noted (none of those we interviewed for this report described or identified themselves as Egyptian).

Lead Contamination Symptoms, Effects, Testing, and Treatment

Lead is a poisonous metal that poses serious health and environmental hazards. Excessive lead levels in the human body can cause damage to the nervous and reproductive systems and kidney failure. Very high lead levels lead to coma and death.[12]

Symptoms of lead poisoning vary depending on the age of the individual and the extent of exposure.

Generally, people exposed to lead at a low level do not display symptoms of poisoning. The severity of symptoms increases with prolonged exposure. Symptoms can range from neurological and physical problems such as anxiety, insomnia, anemia, memory loss, sudden behavioral changes, concentration difficulties, headaches, abdominal pains, fatigue, depression, hearing impediments, muscle spasms, disorientation, convulsions, high blood pressure, and sore or bleeding gums.[13] The adverse health effects of lead poisoning can be irreversible.[14] Lead contamination can also exacerbate preexisting medical conditions such as kidney failure[15] and hypertension (increasing the risk for heart diseases and cerebrovascular diseases).[16]

Lead poisoning is particularly harmful to children, as they absorb lead more easily than adults. In children, exposure to lead can easily damage internal organs (especially the brain and kidneys) and the nervous system, stunt growth, damage hearing and speech, and cause behavioral problems.[17] A significant and irreversible effect of prolonged exposure to lead is the impairment of intellectual development (indicated by decreased IQ scores).

Among pregnant women, lead exposure can result in stillbirth, miscarriage, and can negatively affect brain development of a fetus, leading to disabilities and mental retardation.[18]

People can be exposed to lead through inhalation, ingestion, and skin contact. Other significant sources of contamination are motor vehicle exhaust of leaded gasoline, industrial sources such as smelters and lead manufacturing/recycling industries, lead water pipes, and leaded paints.[19] Poor and disadvantaged populations are more vulnerable to lead poisoning because poor diet increases the amount of ingested lead the body absorbs.[20]

There are a few different ways of testing for lead presence in humans. Tests on blood drawn from a vein are considered to be the most accurate.[21] Tests on capillary blood are deemed less reliable because they carry a greater risk of contamination (and thus should be confirmed through puncture of a vein). Another method of testing lead levels in human bodies is through taking hair samples.[22]

The most common treatment for lead poisoning is chelation therapy, which uses chelating agents (substances whose molecules can bond to lead and other metal ions, thereby neutralizing them), most commonly CaEDTA (ethylenediaminetetraacetic acid), a synthetic amino acid, to bind lead and reduce the circulation of lead in the blood. It can be administered through intravenous injection or orally (in a form of dimercaptosuccinic acid).[23]

Chelation treatment is generally prescribed in cases of severe lead poisoning with lead levels greater than 45 micrograms of lead per deciliter of blood (mcg/dL). For children with blood lead levels less than 45 mcg/dL, chelation therapy appears not to be beneficial.[24]Several studies have suggested d-penicillamine as both safe and effective in the treatment for low-level lead poisoning.[25] Clinical trials to assess the safety and efficacy of d-penicillamine are ongoing.[26]

Oral chelation therapy has numerous proven side effects, including headaches, skin irritation, nausea or stomach upset, extreme fatigue, fever, cramps, and pain in the joints.[27]Among the most serious possible side effects are kidney damage, bone marrow depression, shock, low blood pressure (hypotension), convulsions, disturbance of regular heart rhythm, allergic heart reaction, and respiratory arrest.[28] The drugs used in chelation therapy also eliminate other (useful) heavy metals from the body, such as iron, zinc, and cooper. A vitamin-, iron- and calcium-rich diet is typically proved to replenish essential minerals and to reduce the absorption of lead  into the blood.[29]

According to the US Centers for Disease Control and Prevention, lead detoxification strategies should be coupled with comprehensive environmental impact assessments and monitoring, to identify contamination sources, in order to devise strategies to minimize their impact.[30] Without eliminating lead exposure, chelation may not be fully effective[31] and chelating agents may facilitate absorption of lead from the gastrointestinal tract. The effect of treatment will further be attenuated by the resumption or continuation of lead ingestion.[32]

History of lead contamination in the Mitrovica region

Mitrovica, a municipality located in the north of Kosovo, has been for years known for its environmental pollution caused by the mining industry. The Trepca mine complex, established in 1926, focused on the extraction of lead, zinc, and cadmium, and to a lesser extent gold and silver.[33]

Academic studies during the 1980s and 1990s showed a high concentration of lead in the water, soil, and air in Mitrovica, and discussed the damaging impact on health of the region's inhabitants.[34] Despite these findings, the mine stayed operational until the Kosovo war closed it in 1999, and a year after the conflict, in June 2000, the local management of the mine complex unilaterally decided to reopen the facility. Around the same time, KFOR started receiving information about blood tests showing high levels of lead contamination among international troops stationed in Mitrovica. Based on that information, UNMIK decided to close the Trepca facility in August 2000, and to analyze the situation with the assistance of external consultants, KFOR, and local health workers.[35]

UNMIK commissioned two of its civil affairs officials to carry out a public health analysis of lead pollution in the region. Using past documentation, analysis of dust, soil, and vegetation samples collected in various locations in Mitrovica in August 2000, and consultation with international public health experts, their report, published in November 2000, showed that the level of lead contamination exceeded the norm by up to 176 times in the vegetation samples, by 122 times in the soil, and showed high concentrations of lead in dust (up to 4630 mg/kg). The report also analyzed blood tests on various populations in the area. Particularly high lead levels were observed among the Roma IDP camp residents, with the report pointing out that the contamination levels were "higher for Roma than non-Roma persons."[36] Other risk factors identified by the report were previous employment at Trepca and geographic proximity to it, with areas in the vicinity of the mines described as high-risk.

Despite the environmental risks posed by the Trepca mine, it continues to be seen by some as a potential source of prosperity for Kosovo. UNDP is currently said to be looking at the "sustainable reactivation" of the Trepca mine complex to help revitalize the region's economy.[37] On February 20, 2009, International Civilian Representative Pieter Feith emphasized the future role of Trepca as a unifying factor, connecting "the mines in the north and [population] centers in the south."[38]

Applicable Law in Kosovo

Both the UN and Kosovo authorities are obliged under international law to protect and assist minorities and displaced populations in Kosovo. UN Security Council resolution 1244 authorized the establishment of UNMIK mandated with broad executive and legislative powers to run civil administration functions, build democratic institutions and the rule of law, maintain security, and protect human rights.[39]

On December 12, 1999, UNMIK regulation 1999/24 "On the law applicable in Kosovo" entered into force, ruling the three main sources of law to be the regulations promulgated by the special representative of the UN secretary-general (SRSG), subsidiary instruments, and the law in force in Kosovo on March 22, 1989.[40] Article 1.3 of this regulation stipulates that the following international human rights standards shall be observed by both international and local authorities in Kosovo: the Universal Declaration of Human Rights; the European Convention on Human Rights (ECHR) with Protocols; the International Covenant on Civil and Political Rights (ICCPR) with Protocols; the International Covenant on Economic, Social and Cultural Rights (ICESCR); the Convention on the Elimination of all Forms of Racial Discrimination; the Convention on the Elimination of All Forms of Discrimination against Women; the Convention against Torture and Other Cruel, Inhumane or Degrading Treatment or Punishment; and the Convention on the Rights of the Child. 

To date, regulation 1999/24 has not been amended or repealed. Kosovo's 2008 declaration of independence was followed by the adoption of the Constitution of Kosovo, which entered into force on June 15, 2008.[41] Article 22 ("Direct Applicability of International Agreements and Instruments") preserves all of the international instruments mentioned above, with the notable exception of the ICESCR, while adding the Council of Europe Framework Convention for the Protection of National Minorities.

The provisional institutions of self-government (PISG) in Kosovo undertook to comply with the obligations under the ECHR and its five protocols through the 2001 Kosovo constitutional framework, which is compatible with UN Security Council resolution 1244. The government of Kosovo reiterated its commitment to do so in the 2008 constitution.

Neither UNMIK nor the government of Kosovo are states parties to these treaties. Kosovo is not formally recognized as a country in the Council of Europe, and as such it cannot ratify the ECHR.[42] Nonetheless, UNMIK and the government of Kosovo have agreed to respect these treaties as if they were parties to them, and it is appropriate to assess their compliance with them on that basis. It is also important to note that the UN human rights bodies (including the Human Rights Committee and the Committee on Economic, Social and Cultural Rights) have reviewed the acts of UNMIK as if it were a state party. For example, the Human Rights Committee has stated, in 2006, "It follows that UNMIK, as well as PISG, or any future administration in Kosovo, are bound to respect and to ensure to all individuals within the territory of Kosovo and subject to their jurisdiction the rights recognized in the Covenant."[43]

Map of the Mitrovica Region

© 2009 Human Rights Watch

Map of Mitrovica City

© 2009 Human Rights Watch