V. A Decade of Failure to Assist the Mitrovica Roma

Forced Displacement from Mitrovica

Prior to 1999 the "Roma Mahalla"[44] in Mitrovica, located on the south bank of the Ibar River, hosted the largest Roma community in the former Yugoslavia.[45] Over 8,000 people lived in the neighborhood.[46] According to a leading representative of displaced Roma from Mitrovica, the main source of income for most residents was daily private labor.[47] While the Roma community living there was considered to be poor, there were quite well-to-do families living in the Mahalla, residing in large family houses.[48]

The Roma community in Mitrovica already found itself in a difficult situation prior to the 1999 conflict. In the north of Kosovo, RAE were largely Serbian (and Romani) speakers, with limited knowledge of the Albanian language. Due to the linguistic affinity with the Serbs, as well as the fact that some Roma held official positions in ethnic-Serbian-dominated structures (including the police), they became resented by some members of the Albanian community.[49] As one of the Mahalla returnees stated to Human Rights Watch, "Roma have always been between Serbs and Albanians, and kicked from all sides. While we tried to stay neutral, we were always accused of choosing one side over another."[50]

In the 1999 conflict ethnic Albanians suffered mass expulsion and killings at the hands of Serbian forces. In the conflict's wake there was a wave of violence against minorities perpetrated by Albanians. This violence targeted RAE as well as Serbs, due in part to the perception of RAE as "Serbian collaborators."[51] Fearing repression, many RAE left Kosovo from 1999 onwards, becoming internally displaced persons in Serbia (which currently hosts over 22,000 Kosovo RAE, amounting to over 10 percent of all IDPs there) and Montenegro (currently over 4,400 Kosovo RAE, now formally refugees), or refugees in Macedonia (currently over 1,700 Kosovo RAE), and Bosnia (currently over 160 Kosovo RAE).[52] There are no reliable estimates of the number of Kosovo RAE who have sought refuge outside the region.

The destruction of the Roma Mahalla by Kosovo Albanians in June 1999 was one of the darkest chapters of the post-war violence against Roma. Fearing aggression from Kosovo Albanians, Roma had left the Mahalla and crossed to north Mitrovica. Their houses were looted and burned down by Kosovo Albanians. KFOR did not intervene to protect the property of the displaced, and the violence left over 750 houses destroyed and the entire Roma Mahalla population displaced.[53]

Initially, around half of the Mahalla's 8,000 inhabitants fled to the northern (Serbian-majority) areas in Kosovo where they occupied some public buildings (mainly the Zvecan primary school), and the rest moved across the then-administrative border into Serbia proper, planning to further relocate to various countries in Western Europe.[54] Some displaced Roma from Mitrovica subsequently also left northern Kosovo for Serbia, neighboring countries, and Western Europe. Reliable statistics for these onward movements are not available. However, the current total number of Roma living in the Mitrovica region hovers around 1,500.[55]

To accommodate displaced residents of the Mahalla who remained in northern Kosovo, UNHCR created the two camps at Cesmin Lug and Zitkovac in the vicinity of the Trepca mine complex. When the two camps were full, other displaced persons from the Mahalla spontaneously occupied former Yugoslav army barracks at Kablare (adjacent to Cesmin Lug) and Leposavic (45 kilometers northwest of Mitrovica), creating two more camps.[56] The majority of displaced Roma in Cesmin Lug, Zitkovac, and Kablare were housed in makeshift tents, huts, and metal containers.

The approximately 200 displaced persons who initially occupied the Zvecan primary school relocated to Zitkovac and Cesmin Lug in October 1999.[57] At the Leposavic barracks there were initially around 500 Roma IDPs. The numbers initially at the Kablare camps are not available as, according to UNHCR, "The Kablare barracks were never recognized by UNMIK formally as a temporary collective accommodation."[58] Over time, the camps received additional arrivals of persons hoping to receive international assistance and be included in the future rehousing plans.[59]

History of Efforts to Find Durable Solutions for Camp Residents

The camps were planned by UNHCR as a temporary solution. UNHCR tried to explore possibilities to find better accommodation for the IDPs-according to UNHCR these attempts failed because of unwillingness on the part of both Serbian and Albanian communities to identify any alternative location. "In 1999, we had to respond to an emergency and found the camps as a temporary facility," said Francesco Ardisson, senior protection officer at UNHCR Kosovo, "Unfortunately, we have been unable to find an alternative site because neither the Albanians nor the Serbs want them."[60]

The camps were managed by UNHCR until October 1, 2001.[61] During this period UNHCR was directly responsible for the camps, providing residents with food and hygiene aid, as well as coordinating periodic delivery of other aid such as clothes, and "assisting IDPs as per its mandate (protection and assistance) in Kosovo."[62]

UNMIK took over the task of camps management from UNHCR in October 2001, and was in charge of the camps until May 2008. During this period UNMIK was in charge of "administration of the camps, provision of technical and practical assistance to the residents, facilitating voluntary returns of the camp residents willing to return."[63] According to an UNMIK official, "One of the objectives of UNMIK has from the very beginning been to facilitate return of these camp residents to their homes in Kosovo."[64] Despite this, no returns (including individual ones) took place until June 2007.

The first scrutiny of the lead contamination problem was conducted by an American Roma rights activist, Paul Polansky, on his individual initiative, beginning in 1999.[65]  From 2004 on, Roma and other human rights organizations began issuing alarming statements about terrible health and living conditions in the camps. These prompted the World Health Organization to conduct an assessment in Cesmin Lug and Zitkovac in the summer of 2004. The assessment led to a WHO report in September 2004 alerting UNMIK to the adverse effects of lead contamination on Roma IDP health, and stressing the need to close the camps.[66]

It was only then that UNMIK actively started to seek to relocate the Mitrovica Roma as a group.[67] The first inter-agency coordination efforts took place in April 2005, when the key international actors (including UNMIK, UNHCR, WHO, UNICEF, and OSCE) formed the Mitrovica Action Team (MAT), to articulate and coordinate a sustainable solution for the residents of the camps.[68] The consensus that emerged among the stakeholders toward the end of 2005 was that return to the Roma Mahalla should be encouraged and supported as the most sustainable solution, while a new camp at Osterode (buildings and barracks abandoned by KFOR in late 2005) was deemed to be the best temporary solution available.[69] KFOR handed over the Osterode camp to UNMIK on December 10, 2005.

The NGO Norwegian Church Aid assumed responsibility for day-to-day management of the camps in December 2005.[70]Other agencies, such as UNHCR, WHO, and KFOR, continued to provide technical and practical assistance to the camps.[71]

From March to April 2006 the inhabitants of the Zitkovac and Kablare camps voluntarily moved to the Osterode camp (after the Kablare camp burned down in March 2006[72]), on the promise of better living conditions, food aid, and medical treatment.[73] These two camps were subsequently closed and demolished.[74]

UNMIK insists that the Osterode camp represented an improvement on the other camps close to Trepca. According to an UNMIK spokesperson,

To ensure that the new (Osterode) site would be a safer and healthier environment, UNMIK engaged a team of environmental engineers from the US Army who did a thorough testing of the soil, the water, and the buildings in Camp Osterode and presented their recommendations; there were no obvious signs of environmental contamination. After the remediation, WHO again tested the camp and has concluded that the camp is far safer from a lead stand point than the current camps. On 16 February 2006, Dr Marc Danzon, the Regional Director for Europe of the World Health Organization, accompanied by his senior advisers, joined the Principal Deputy SRSG, Larry Rossin, in calling on the Roma to vacate their current camps and to "immediately relocate to the safer environment of Camp Osterode as an emergency health requirement."[75]

According to Dorit Nitzan, head of the WHO country office for Serbia, WHO regarded Osterode as "lead-safer" than the other camps because of concrete surfacing in external areas of the camp, which reduces exposure to contaminated soil found in the other camps; the absence of the lead paint found on some doors in other camps; and the presence of running water inside the housing, which facilitates more regular washing.[76]

In parallel with the closure of Zitkovac and Kablare, the reconstruction of two apartment buildings (comprising 48 flats) and 54 individual houses took place on the site of the previously destroyed Roma Mahalla in south Mitrovica. In the early summer of 2007, around 90 families (450 people) from Zitkovac, Kablare, the other camps as well as other locations outside Kosovo moved back to the Roma Mahalla, making it the largest Roma return site since 1999. Many of those who returned did not remain (see Chapter VI, "Current Conditions in the Camps and the Rebuilt Mahalla").[77]

Only a fraction of the Cesmin Lug camp residents decided to move to Osterode, located only around 150 meters from their location, not believing that this temporary shift to such a close location would be advantageous from the medical point of view or otherwise.[78]

In January and October 2008 UNMIK provided two separate sets of replies to the UN Committee on Economic, Social and Cultural Rights, in which it responded to a number of questions about the situation in the camps and steps taken to address the problems. It quoted the assessment of its implementing partner Norwegian Church Aid that the residents of Cesmin Lug "continue to reside [there] by their choice," attributing the unwillingness to move to the alternative site of Osterode to "1) Lack of faith that safe, permanent housing will result from their humanitarian relocation, and that Cesmin Lug residents will not simply be relocated, yet again, from one 'temporary situation to another; 2) The perceived higher standard of living and social cohesion within Cesmin Lug camp when compared to conditions in Osterode; 3) The perception that Osterode camp, although intended to provide safe medical relocation and treatment for Roma IDPs exposed to unsafe levels of lead exposure, is, in itself, just as contaminated as Cesmin Lug."[79]Controversially, UNMIK described the illegal smelting of car batteries allegedly carried out by the camps' residents as the key cause of lead contamination (see below).[80]

The Kosovo Ministry of Communities and Returns took over responsibility for the camps from UNMIK in May 2008.[81] According to the information received by Human Rights Watch from an international official in Kosovo familiar with the situation, the handover of the management to the Ministry of Communities and Returns "was discussed in January 2008 with the Ministry, who agreed to finance the management of the camps Osterode and Cesmin Lug. The Ministry was assisted with the signing of MoU (Memorandum of Understanding) with NCA [Norwegian Church Aid], and the relevant information was handed over to the Ministry by NCA."[82] During his meeting with Human Rights Watch, Deputy Minister Ismet Hashani reiterated his ministry's commitment to finding durable solutions for residents in the camps.[83] But the minister failed to provide any details as to how the ministry was going to meet this commitment or a timeframe in which it planned to do so. Norwegian Church Aid ceased its camp management activities in December 2008, and in January 2009 a local NGO called the Kosovo Agency for Advocacy and Development (KAAD) took over camp management, with funding from the Ministry of Communities and Returns.[84]

On March 9, 2009, Human Rights Watch received an email from the leader of the Roma camps, Skender Gusani, in which he communicated the distress of camp residents over the lack of information about the future plans for Cesmin Lug and Osterode camps, both in terms of long-term housing and treatment for lead contamination. He stated that camp residents were concerned with the takeover of the camps' management by KAAD as another sign of the "international community" pulling out of the situation.[85] The common view conveyed by all of the Roma interlocutors interviewed by Human Rights Watch in November-December 2008 is that they have lost trust in the solutions proposed by the "international community" and that they are tired of empty promises and temporary solutions that become permanent. The current level of distrust makes it that much harder to negotiate an immediate evacuation of the camps because residents are afraid they would be removed to even worse conditions.[86]

On April 1, 2009, the Kosovo Ombudsperson published an open letter to the Kosovo Prime Minister Hashim Thaci, in which he described the results of his ex officio investigation into the situation in the camps, and called for the immediate and sustainable relocation of the camps' population, "in consultation with the community leaders, in a location where their safety and dignity are guaranteed."[87] The Ombudsperson also recommended "the immediate intervention of the (Kosovo) Ministry of Health, in cooperation with the (Kosovo) Ministry of Communities and Return in order to improve the health conditions of the Roma population still living in the camps and/or is still affected by the lead contamination."[88]

According to the information received by Human Rights Watch from the Ombudsperson, as of April 27, 2009, the government had yet to respond to the recommendation or reply to his letter.[89]

The European Commission referred to the problem in its most recent progress report on Kosovo, in November 2008.[90] Moreover, in a January 2009 reply to the European Parliament's written question about the status of current efforts to close the camps, it stated, "The Commission and the Kosovo Government are presently preparing the EU 2009 assistance package under the Instrument of the Pre-Accession [sic] to offer sustainable solutions to re-locate and treat appropriately some of the families living in the ... camps. Addressing this critical issue requires full commitment from all stakeholders, including the Roma community, as well as careful preparation and coordination between local and international partners involved."[91] The European Parliament, in a February 2009 resolution on Kosovo and the role of the EU, again recognized the seriousness of the situation in the camps, expressing "grave concern at the acute ill-health of Roma families in the Osterode and Cesmin Lug refugee camps," and urged the European Commission "to continue to work to secure the relocation, as a matter of urgency, of the families concerned."[92]

The current status of efforts to close the camps is discussed in Chapter VI.

Roma activists' efforts to compel a solution

Alerted by Paul Polansky's work, the international NGO the European Roma Rights Center (ERRC) conducted a series of trips to Kosovo in 2005, interviewing Roma leaders and raising the profile of this issue.[93] In September 2005 ERRC filed a criminal complaint on behalf of a camp resident with the Public Prosecutor in Pristina, alleging a violation of article 291 of the Kosovo Provisional Criminal Code, which states that whoever causes danger to human life or property by means of exposure to toxic and other harmful substances would be punished by imprisonment from three months to three years.[94] The complaint called for "an investigation to be conducted on those persons vested with effective exercise of power, who were responsible for the placement of Roma in the toxic land and aware of risks involved and consequences to health."[95] According to the person on whose behalf the complaint was filed, the activist Argentina Gidzic, no action was ever taken in response to her complaint.[96]

The organization Romano Them (now called Chachipe) and Roma organizations in Kosovo including the Roma and Ashkali Documentation Center and the Roma and Travelers Forum have also sought to focus attention on the issue.[97]

In August 2005, the Council of Europe Coordinator for Roma and Travelers activities conducted a field mission to Mitrovica to assess what measures were needed to avoid further lead poisoning. The mission report recommended immediate evacuation of the Roma community from the contaminated area.[98]

In February 2006 the ERRC filed an application with the European Court of Human Rights alleging human rights violations ranging from violation of the rights to life, health, and adequate housing, to cruel and unusual treatment and the lack of legal remedy. The complaint was rejected by the Court for lack of jurisdiction the same month.[99]

In July 2008 Diane Post, a Roma rights activist granted power of attorney by Mitrovica Roma families (and who had previously helped the ERRC to file the European Court complaint), helped an international law firm to file a complaint on behalf of the Roma families with the Human Rights Advisory Panel (HRAP).[100] Specific claims included: violation of the right to life; inhuman and degrading treatment; lack of recourse to an independent and impartial tribunal; interference with private and family life; violation of the right to a home; denial of access to data; and violation of the right to an effective remedy. The claim was deemed admissible on June 5, 2009, in relation to allegations of  violations of the right to life, the prohibition of inhuman and degrading treatment, respect for private and family life, the right to a fair hearing, the right to an effective remedy, the right to adequate housing, health and standard of living, the prohibition against discrimination in general, the prohibition of discrimination against women, and the rights of children. [101] The determination of the merits remains pending at this writing.

History of Efforts to Provide Medical Treatment for Lead Poisoning

Absence of a comprehensive strategy for treatment and decontamination

The November 2000 public health report commissioned by UNMIK (see Chapter IV) noted risk factors based on RAE ethnicity and proximity to Trepca. It recommended extended population testing for lead, and treatment (especially for high-risk groups such as children and pregnant women).[102] According to UNMIK, the report, "as part of a LONG TERM strategy, called for subjecting the entire Mitrovica population to epidemiological studies over several years, creating specialized medical teams, education and training of Serbian and Albanian local doctors, education campaigns, treatment provided outside of the contaminated area, periodic environmental sampling, extensive technical support for local health facilities, relocating the Roma camp to a lower risk area and continuous education on how to reduce lead exposure."[103]

When Paul Hunt, the then-UN rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, called on UNMIK in October 2005 to provide further information on its action to address the health problems in the camps,[104] UNMIK's prompt response referred to "ongoing measures to address the health issues, coordinated by the Ministry of Health through the Health Task Force, including medical teams that are working full time in the camps to provide regular and consistent health care." It also claimed that "consensus has been reached between health professionals on how to treat children and the public health situation had improved after repairs and renovation of the water and sewage infrastructure."[105]

In reality, since the publication of the 2000 report commissioned by UNMIK little progress has been made by international agencies or Kosovo institutions to develop a comprehensive strategy to deal with heavy metal contamination in the Mitrovica region as a whole.[106] Because of the large number of actors and the lack of coordination, the approach has always been scattered. In the words of a doctor previously involved in the camps, "all these efforts at best amounted to scratching the surface."[107]

UNMIK's 2008 statement attributing the high level of contamination principally to illegal smelting of batteries (see above) has been a source of ongoing controversy.[108] Roma leaders and camp residents told Human Rights Watch that smelting was discontinued in 2006 and Roma leaders said they are monitoring the community in order to make sure everybody adheres to the prohibition.[109] Nevertheless, according to an expert from the US Centers of Disease Control and Prevention, who visited the camps in February 2009, some evidence of individual smelting activities were found:

I saw evidence of a fire with the characteristics of an informal smelter including burn marks, metal debris and broken cement blocks which are often used to support a cauldron to melt metal. This site was on a cement pad next to the clinic facility (ambulanta). The solution to this is not to castigate the Roma for doing this work but rather to develop a way for them to do it safely.[110]

Chachipe, a Roma rights organization, argues that UNMIK's emphasis on the smelting by some Roma constitutes "blaming the victim" and serves as a smokescreen for the failure by UNMIK to tackle the real contamination sources, namely the piles of contaminated soil just behind the Osterode and Cesmin Lug camps.[111]

Testing and chelation therapy

During the period 2004-06, under the auspices of WHO at least three rounds of testing of blood samples from children, usually around 50 children each time. The capillary blood tests were analyzed by the Institute of Public Health attached to the hospital in north Mitrovica.[112]

After two rounds of blood tests in 2004 and 2005 (the results of which are not publicly available), the first administration of oral chelation therapy took place in August 2006 and the second later that year, on the initiative of WHO and the US Centers for Disease Control and Prevention, and provided through the Institute of Public Health.[113] Overall, around 40 children received oral chelation therapy.[114] Children from Osterode were chosen for treatment, rather than those from Cesmin Lug, because Osterode was considered a less contaminated environment, with fewer side effects for the children.[115] A third round of blood tests under WHO's auspices took place in 2006.

A weekly consignment of food rich in vitamins and calcium was delivered in the Osterode, Cesmin Lug, and Leposavic camps by Norwegian Church Aid beginning in 2005.[116] Other risk-reducing measures taken were daily washing of the concrete surfaces in Osterode camp, a practice that continues.[117]

Bloods tests, chelation therapy, and nutritional intervention all ceased in 2007, however. In a reply to the UN Committee on Economic, Social and Cultural Rights to questions about the steps taken to address the problems in the camps, UNMIK stated that medical treatment, including chelation therapy and nutritional supplements were "carried out for those IDPs relocated to Osterode Camp" but that "these medical components were discontinued in 2007 as determined by WHO to no longer be of necessity."[118] According to the information received by Human Rights Watch from UNMIK, the chelation therapy administered in 2007 "led to [a] dramatic decrease in blood-lead level to the extent that in June 2007, the US Center for Disease Control advised that the food supplement packages were no longer needed."[119] According to correspondence received by Human Rights Watch from a CDC representative involved in the Kosovo projects, "This was done with the understanding (...) that the relocation to Mahalla was in near future. The real tragedy is that relocation was not completed."[120] 

Since the decision by UNMIK to discontinue the "medical components" of the strategy dealing with the camps in 2007, there has been no systematic assessment of the health situation in the camps. But because of the small numbers of individuals reached and the inconsistent and time-limited provision of chelation therapy, it can be assumed that little impact has been achieved to mitigate the ongoing crisis of lead poisoning in the region.

Two years on, and with the camps still in existence, WHO once again assesses the lead contamination as critical:  On January 31, 2009, following a WHO delegation visit to Kosovo to assess the current situation in the camps, WHO issued a press release calling on the international and Kosovo institutions to increase efforts to reduce toxicity and to take action on relocating the camp populations. According to the press release,

Lead poisoning in this area poses a severe risk to the population of Mitrovice/a. WHO appeals for better coordination and communication between the health institutions and is ready to provide technical assistance.... WHO asks for those who are still living in temporary camps to be relocated to a lead-safe environment as soon as possible, and particularly for Cesmin Lug Camp to be closed as a matter of urgency, in order to avoid another wave of newcomers. The area near the tailing dams should be declared a hazardous place for humans.[121]

Community-led efforts

During our visit to Kosovo in November-December 2008, Human Rights Watch heard contradictory information regarding perceptions of the past efforts to test the population for lead and administer chelation therapy based on the test results. Some Roma leaders complained to Human Rights Watch that the results of lead testing were not transparently communicated and explained to the camp residents.[122] Skender Gusani, the leader of all the Roma camps, criticized the way in which assistance and treatment had been administered as haphazard. While admitting that "some attempts have been made by various NGOs and international organizations" to educate the Roma about the dangers of lead and about the kinds of treatment available, Gusani pointed out that "a few times constantly changing groups of children have their blood tested for lead and then are given some kind of pills. Everything was done in a way which is very far from professionalism and transparency."[123] This allegation is rejected by both WHO and Norwegian Church Aid representatives, who were in charge of (respectively) assisting the local structures in treatment delivery and managing the camps at that time.[124]

Nevertheless, due to the alleged lack of transparency of the results of the testing, camp residents became increasingly wary of the internationally coordinated efforts to test blood and treat contamination, although not with testing and treatment per se. After UNMIK discontinued testing and treatment, camp leaders turned to the Serbian state-run Mitrovica Institute for Public Health in late 2007 to run further blood tests. The institute carried out blood testing in April 2008 on children selected in all three camps in the north (Cesmin Lug, Osterode, and Leposavic), as well as the Roma Mahalla. These were not the same children tested previously.

The results of the April 2008 tests demonstrated unacceptably high lead levels in the children tested. Out of the 53 children tested, 21 had lead levels qualifying these children for immediate medical intervention (over 65 mcg/dl, which is the highest level the equipment can record).[125] The testing does not provide a breakdown by camp. No further chelation therapy has been administered.

Although the monitoring equipment was unable to record the precise lead level of these 21 individuals, WHO nonetheless conducted a  statistical assessment of the mean blood levels, finding an overall decrease, with the most significant drop-unsurprisingly-among individuals who had moved to the Mahalla.[126]

Treatment Compromised without Relocation

The November 2000 public health report commissioned by UNMIK pointed to the lack of effectiveness of treatment without relocation, stating that "treating people does not have a promising outlook if there is no possibility to keep them away from polluted area after that."[127] The report concluded that a comprehensive strategy was needed to address the issue, and that it should be "designed and implemented only on a basis of broad international cooperation." But it also noted that the "costs of such an enterprise will exceed financial capacity of UNMIK."[128]

According to Dorit Nitzan, who has been involved with the Roma camps since 2004,

The right approach to lead poisoning is to first remove the source or the people from the source of exposure. For this, WHO has constantly asked to relocate the population from the source of exposure. Treating them while in a lead contaminated area is not recommended practically. We were promised by UNMIK that the move to Osterode is for a short period, until the Mahalla is [re]built. However, the IDPs are still there. We call to concentrate efforts to move the IDPs from the lead contaminated areas, NOW."[129]

Ironically, UNMIK's explanation of the reason for the abandonment of medical treatment as not "medically relevant" from 2007 onwards (based on WHO's recommendation), combined with the argument that Osterode was "lead-safer," informed the policy approach of not treating the relocation from that area as an emergency.[130]