Mission completed by D. Serrano Fitamant
Psychology Consultant to UNFPA
***The views expressed in this document are those of the consultant, and do not
necessarily represent the views of UNFPA***
OBJECTIVES OF THE UNFPA MISSION:
During the past month (since mid April) rumors of massacres, torture, and especially
rape, have intensified with the flux of refugees coming across the border. A number of
heart wrenching interviews were recorded with Kosovar women by international journalists.
In front of cameras, the women described the threats of physical violence, barbarous acts,
the locking up of women and collective and repeated rapes. Personnel in international and
local Non Governmental Organizations (NGOs) confirmed the rumors and articles in
newspapers which refer to "extensive sexual violence". At the same time they
admit that they have not been able to meet any of these victims.
The first objective of the mission was to verify the information that had been
circulating regarding the existence of sexual violence. History has confirmed that in all
conflicts women (among others) are subjected to sexual violence. Nevertheless, the level
of its systematization, depends on the particular context.
Whatever type of rape, and however frequently it occurs, does not change the
seriousness of the act for each individual. Immediate and up-to-date knowledge of the
problem enables an appropriate response in terms of timing and quality of assistance, by
the official and humanitarian organizations involved.
It is important to define the type of violence that the female Kosovar population is
subjected to (i.e. isolated or collective acts, spontaneous acts or acts which occur while
they are imprisoned, etc.) in order to respond with the appropriate psychotherapy. It is
also essential to evaluate the extent of the systematization of rape in order to prepare
the necessary information and response structures, appropriate for both the medium and
long term. Therefore, it is crucial to interview the victims and the direct witnesses of
sexual violence which may have taken place in Kosovo in the last few weeks, and in
particular since the brutal expulsion of this population, outside of its own country.
According to these criteria, the capacity of the personnel of organizations already in
place, and the capacity of NGOs to deal with these types of victims are evaluated.
Finally, appropriate recommendations are made based on the situation in the field.
Constraints
The evaluation mission in Albania and Macedonia was planned for a period of 10 days. A
2-day extension was granted. The methodology was planned in Tirana and its vicinity as
well as in Kukes, Albania. Given the complexity of the situation in the field, the total
lack of existing information on the subject by the humanitarian personnel already in
place, and the difficult logistical conditions even in Tirana, it was impossible to extend
the mission into Macedonia within the given time period
In effect, it is quite difficult to reach the personnel of the international
humanitarian organizations and of the United Nations, because they are overworked and
constantly moving from one place to another.
The denial of cases of rape by certain international and national medical personnel has
made the work of reaching and dealing with the victims even slower and more delicate.
CARING FOR VICTIMS OF SEXUAL VIOLENCE
The influx of large numbers of refugees into Albania, together with the economic
poverty of the country, resulted in the arrival of about a hundred humanitarian
organizations specialized in food relief, health and medical aid.
Recently, testimony by victims of torture and barbarous acts, resulted in an evaluation
mission sent under the auspices of the Organization for Security and Cooperation in Europe
(OSCE), the United Nations High Commission for Human Rights, and a team from the
International Tribunal in The Hague. They were interested in violations in a general
manner but not specifically concerned with sexual violence. Each of the organizations has
its own personnel, its own objectives and different methods of investigation.
Numerous NGOs are planning psychosocial training. However, it seems that the concept of
psycho-trauma has been treated in a general manner without any differentiation being made
between different types of trauma. Without a doubt, this oversight can be explained by the
lack of reliable data currently available on the problem, and the fact that it seems that
there are no trainers specialized in sexual violence currently present in the field. To
the best of this consultant's knowledge, during the month of April, no organizations were
treating the specific psycho-traumatic problems of the Kosovar women from a psychological
perspective. For example, in Kukès, a city close to the border, some tents exclusively
house women, desperately waiting for the arrival of their daughters who were kidnaped
before being able to cross the border. Other women simply wander in a distraught state
around the camps.
Female Kosovar refugees in Albania are receiving medical treatment. However, the fact
that a woman may have been raped does not affect how she is treated in Tirana. Clearly,
the treatment of sexually related trauma victims calls for trained personnel and
specialized support.
Another factor affecting the situation is the individual psychological defense
mechanisms of the humanitarian personnel in dealing with rape. It is difficult to
conceptualize the manner in which different reactions are represented. Unconscious
behavior can affect, and may considerably distort, the willingness of humanitarian staff
to listen to the information that the refugee women would provide, if they sensed that the
humanitarian personnel was psychologically prepared to listen without making any
judgements.
In terms of the male Albanian personnel (although sometimes this occurs with female
personnel too), the majority categorically refuse to accept the possibility of the
occurrence of rape. For example, an Albanian doctor posted at the Tirana sports center
assured the consultant that he had never heard any talk about rape. At the same time his
nurse cried out "yes, yes, a lot a lot." The doctor then ordered the nurse (in
Albanian) to be quiet or else "he would end up having to go and get the victims"
for the consultant.
Nevertheless, the consultant did find volunteers and UN personnel in the maternity
hospitals and camps in Tirana that were sensitized to the problems of rape. Unfortunately,
the amount of work to be done, the number of refugees that need assistance, and the lack
of specifically trained personnel prevents many women from receiving support.
Based on interviews with various UN agencies and organizations there seems to be
considerable approval regarding UNFPA's initiative to organize a mission assessing sexual
violence in Kosovo.
The context of the interviews and some initial comments:
Victims and direct witnesses were interviewed in the camps and maternity hospitals in
Tirana and Kukès. As long as no Albanian personnel was present, all the women approached
by the consultant agreed to be interviewed. The women who were interviewed did so
according to their own volition and conditions (i.e. agreement of the woman or group of
women, absence of journalists and men). They were chosen spontaneously and were not
recommended or pre-selected by any humanitarian organizations. All the interviews were
conducted anonymously.
The consultant was assisted by a female Albanian interpreter who was sensitized and
briefed on methods for interviewing female victims of sexual violence. The information in
this report is exclusively based on the interviews with victims and direct witnesses. Any
data obtained through people who were in contact with the refugees is explicitly indicated
as such.
A SYNTHESIS OF THE EVIDENCE COLLECTED
Reports of sexual violence have been circulating for some months but attention of the
international community was focussed on achieving success in the Rambouillet negotiations.
In the past few weeks there has been a significant upsurge in the occurrence of these
acts. This increase seems to correspond to the first week after NATO's initial bombings.
New women arriving from Kosovo indicate that the violence is increasing. According to the
interviews, it seems that the phenomenon, and in particular the abduction of groups of
women, is more and more prevalent.
Families are generally turned out of their homes by armed men and sometimes even by
their Serbian neighbors. They often have only a few minutes to leave the premises and
sometimes their homes are burned.
Illegal Confinement
It is primarily the young women who are rounded up in villages and small cities. The
soldiers take groups of 5 to 30 women to unknown places in trucks or they are locked up in
houses where the soldiers live. Any resistance is met with threats of being burned alive.
Gjakova, Pec and Drenitza were often indicated as places where kidnaping and collective
rapes took place. The women were individually raped by many men, during a few hours but
sometimes even for days. Women who were released have lacerations on their chests,
evidence of beating on their arms and legs. Their backs also show signs of beatings and
they were covered in dirt. Agonizing screams could be heard for many hours. Kosovar men
who tried to interfere were killed on the spot. One woman was beaten to death in front of
the door of the house where her daughters were being tortured.
All of the victims interviewed by the consultant were raped or sexually violated in
Kosovo, and none of the women interviewed were locked up for more than three days. Some of
the kidnaped women who were taken to unknown places have not yet reappeared, according to
their families and neighbours.
One victim's husband said that he saw a building in Prizren where the first floor
contained weapons, the second floor was for the soldiers and the third floor contained
about 30 women. One of the women who was able to escape was shot down in the street.
In general, the rapists wear masks although this is not always the case. They separate
the women from the men. They form a circle around the naked women and force them to do
humanly degrading acts.
Other acts of torture
In Berlenitz, women told of soldiers separating the men from the others. Soldiers
wearing masks encircled the young boys and women. The young boys had their throats slit
one at a time, but only after their ears and sometimes theirs noses had been cut off. The
torturers sharpened their knives in front of the women and terrorized children. They then
cut open the stomachs of many pregnant women and skewered the fetus on their blades.
One of the witnesses was 32 years old. She was spared because her pregnancy was not yet
visible. She is currently in a clinic trying carry out her pregnancy in spite of severe
contractions that began during the scene of the torture.
In the same city a group of 30 young girls was forced to follow the soldiers into a
house while the mothers waited outside. For two hours the mothers listened to the screams
of the young victims who then came out one by one. Some were covered in blood, others were
crying and their heads were hanging low.
Husbands and older brothers were killed separately. Female soldiers burned their bodies
in a house. Speaking in Serbian, the soldiers made racist insults about their victims and
spoke with vengeance about the help being given to the refugees on the other side of the
border.
Analysis of sexual violence in conflict situations
Refugees were asked about the significance of the use of sexual violence in the current
conflict. Two interpretations stem from the responses.
The first interpretation is related to the idea of "plunder". At control
points the soldiers would demand money, then jewelry, then tell the women to undress in
order to verify that they were not hiding anything. When they had nothing left the
soldiers would take their "payment" by raping the most attractive women. Often
they were between the ages of 15 and 25. In general, 1 to 5 men committed the rapes and
the women were immediately released after the violation.
Related to this, on 28 March 1999, news on Yugoslav television showed the prisons being
opened up to recruit delinquents into the army in order to make up for the massive
desertion of Kosovar men. The interviewees thought that one of the reasons for spontaneous
and individual rapes stemmed from those men who had been recruited from the prisons (some
are marginalised drug addicts) and hastily incorporated into the army. However, the
victims often identified the groups of male torturers as obeying a single well-known
leader.
The second interpretation of the victims and the witnesses relates to rape as a
"concrete manifestation" of the profound hate which the Serbians feel toward the
Kosovars. They felt this to be true in the cases of the abduction of groups of women,
collective and repetitive rapes, sexual torture and imprisonment. Judging from the insults
and threats of the torturers, some victims were allowed to live so that they could tell
other people about the determination of Serbian power, and thus eliminate any desire on
the part of the refugees to return. Several weeks ago, men and women who were still alive
were systematically killed.
Rape is the primary act of taboo being used by the Serbians. It is an act of sacred
violation. By raping women - taking possession and totally exploiting the female body -
the Serbians are violating even those Kosovar men who are inaccessible and hidden in the
mountains. It appears as though ancestral and latent hate has been exacerbated to its
highest point and reigns among the soldiers who are armed in the service of three leaders
active in the region. The women who have been violated say they are forever
"dead" for having been subjected to absolute defilement.
There is no concrete evidence of the "systematization" of sexual violence.
However, the NATO bombings, have been taken in a sense by troops as a "psychological
license" for collective sexual violence. The daily evolution of the situation and the
weight of the evidence collected from interviews with the most recent refugees leaves room
for the most somber perspectives concerning the risks which the Kosovar women still in
Kosovo face. Even though it existed to some extent already, the politics of terror have
proliferated in the last month based on a deep-seated racism.
Albanian men, Kosovars and international personnel suggest that the Muslim tradition is
the primary reason that women are refusing to speak about their experiences. Nevertheless
we have seen that many women certainly wish to speak out as witnesses about the
atrocities, on the one hand, and about their personal experience, on the other.
Whatever the case, it is clear that the women need an appropriate context to speak out,
which up until now, has not been available. While it may seem anecdotal, the following
example should be noted: Last week an male humanitarian staff member of an international
organization, in a camp set up in a sports center in Tirana, used a loud speaker to invite
any women who were victims of violence to come up to him and obtain a questionnaire which
was to be filled out. Numerous questionnaires were handed out but only two were returned.
One woman who had been locked up and raped during three days commented on the announcement
and told the consultant: "How can you expect me walk up to that man just like that.
We have our pride. We are Kosovar. Speaking with you like this, the two of us, is not the
same, it is between us" (The interviews were all conducted anonymously and among
women).
For lack of other possibilities, namely, available humanitarian personnel who can
respond to such delicate matters, the Kosovar women ended up talking about their
experiences in front of flocking journalists. Even though the sensationalization of these,
so to speak, "fresh testimonies" is regrettable, there may have been one
advantage. It has allowed each Kosovar woman to realize that she is not alone in her
horrific physical and psychological suffering and that at least she can share some of her
burden with other women who can understand her.
RECOMMENDATIONS
1 Distributing this report
Many UN agencies, NGOs and embassies are interested in this UNFPA assessment report,
which confirms the real need for information on the subject. Given the presence of dozens
of NGOs already in the field, and the imminent arrival of numerous others there must be an
urgent and immediate sensitization and identification of the specificities of dealing with
cases of sexual violence. Even though this report can not be considered exhaustive, it is
the first step in a long process of trying to deal with and understand the problems of
this crisis. This report should be distributed as quickly as possible to all partners
concerned with this situation.
2 Circulating the information
It is important that official organizations, humanitarian personnel and UN agencies
involved in collecting the testimonies of the victims, share the general information they
obtain from the refugees. Even though everyone has their own agenda and different
objectives in terms of the refugees, the overall aim is to help the victims regain their
dignity as human beings, in spite of the violence to which they have been subjected. By
sharing certain types of information the psychological care teams will be able to locate
and deal with the violated women in a much easier fashion.
In many cases, the groups of women who have been attacked come from the same villages,
or were raped in similar time frames. They arrive at the border at approximately the same
time. Once they cross over, they separate and it becomes increasingly difficult to give
them the individualized support they need. It is necessary to identify the victims as
early as possible in order to help them as soon as they arrive and to continue the
treatment even when they are sent to different countries.
3 Collaborating/Coordination of Activities:
There are many NGOs currently in Albania. We have identified about 15 organizations
that are developing projects for the traumatized population. The projects are often
similar, in particular, concerning the training of local personnel in dealing with
psychosocial problems and psychological trauma. However, there are no long term strategies
being made (i.e. follow up of pregnant women who have been raped, the future of these
babies, reintegration of the victims into their families, mediatised messages on helping
the reintegration process for all of the population, etc.). In order to avoid the
duplication of projects and to enable the optimal and immediate distribution of tasks, it
is essential that the activities formulated to support victims of sexual violence are done
in a coordinated fashion.
There is a need to recruit someone who could support the coordination of the various
efforts in this area. This person should be a female psychologist, specialized in
post-trauma problems and in the psychotherapy of victims of sexual violence. In order to
provide appropriate care for these women the principal role of this coordinator should be
to:
- offer all the "psycho-socio-medical" NGOs training in post-trauma problems of
victims of sexual violence so that they can identify those women who have been victims of
sexual violence from among the others who have been traumatized
- develop a programme of Comprehensive Support for Victims of Sexual Violence which should
be integrated into other programmes of other UN agencies and NGO's.
This programme should take into account the short, medium and long term needs of women,
as well as the need to support to existing Albanian structures which could assist these
women refugees
- coordinate different projects developed within the context of the programme of
Comprehensive Support for Victims of Sexual Violence and monitor the work completed
- establish a technical supervision system for local and international personnel, meaning
psychological debriefing for individuals and groups, in order to avoid the deterioration
of the mental health of those who are in direct contact with the victims.
4. Programme of Comprehensive Support for Victims of Sexual Violence in the medium
and long term
No matter how qualified the psychologists, doctors and social workers in the field may
be, only some of the rape cases will be revealed, just as is the case in other armed
conflicts. We should also realize that most of the cases of rape will never be discussed
because of self-preservation and protection of the family (i.e. avoiding the risk of
divorce, revenge of a husband, the risk of exclusion from the community or family, the
shame placed on the family, etc.). Therefore, the objective is not to make a woman speak
about her experience at any cost.
Under appropriate conditions, and at the present time, it seems that the Kosovar women
are willing to talk about how they have been violated, to concerned people who have been
trained in psychological interviewing methods. However, just as in many other similar
situations, many of the cases of rape will only be revealed in several months, when the
women actually give birth.
Many Kosovar refugee families stated that it was impossible for them to keep a baby
that was the result of a rape even if the woman did not necessarily want to have an
abortion. In this way a violated woman would be able to reintegrate into her family
although the newborn baby would not be accepted.
We should then expect to encounter a large number of abandoned babies in the months to
come. The personnel working in the maternity hospitals in Tirana and in integrated
centers, as well as the medical personnel in the camps and various social support
structures, should be trained to recognize pregnant women who do not want to raise their
child. There are certain well-known psychological mechanisms apparent in trauma patients,
which can be used to identify violated women. A psychosocial support and follow up program
for the pregnant women and their families should be established in order to facilitate the
birth.
It is assumed that many women who have become pregnant as a result of sexual violence
will seek to terminate their pregnancy. Abortion is legal in Federal Republic of
Yugoslavia and in Albania, where it is legal up to 12 weeks, and up to 22 weeks in cases
of pregnancy as a result of rape. As per the Programme of Action of the International
Conference on Population and Development, any provision of abortion should be safe and
post abortion counseling should be offered promptly.
Emergency contraception, legal in FR Yugoslavia and in Albania, should be a part of any
medical response to women who have been victims of sexual violence, as an option for these
women. However, in this particular case, most women who were raped in Kosovo ended up
walking for days to reach the border, or to find a vehicle that would take them out of the
area. Therefore emergency contraception could not be administered, as it would have had no
effect. Nevertheless, emergency contraception should continue to be provided to victims of
sexual violence who have access to it within 72 hours, or for unprotected sexual relations
and/or sexual violence within the camps themselves.
According to the Amsterdam declaration of 21 June 1994, children who are born as a
result of a rape should not be marginalised. The programme of Comprehensive Support for
Victims of Sexual Violence should be integrated into all the other programs dealing with
refugees, so that the victims are not stigmatized. Programmes for dealing with these
children should complement others that already exist for unaccompanied children (i.e.
UNICEF programmes). Special attention should be given to these children in terms of legal
rights and protection (i.e. adoption laws, nationality, etc.).
There has been no constructive sensitization process aimed at the Kosovar population in
general, or for women in particular. Consideration must be given to the reintegration of
victims of sexual violence into the community, and to their physical and psychological
needs. A process of reducing feelings of guilt should be encouraged and supported among
the entire refugee population. Appropriate messages should be transmitted throughout the
camps (small working radios can be given to the refugees) and on Albanian television in
order to reach the numerous Kosovars that are being hosted by families in Albania.
Various training programs have already been initiated or are about to begin. The
Council of Europe has established a training program that deals with methodologies on
carrying out interviews. Local and international NGOs, humanitarian departments of
governments (British, French, etc.) and UN agencies are all considering psychosocial
training and in some case training for post-trauma stress disorder (UNICEF, WHO, Médecins
Sans Frontières Belgium, Medicos del mundo, Caritas, IFRC, Women center, etc.).
The UNHCR and UNICEF have already worked on sensitization pertaining to sexual violence
and UNFPA should collaborate closely with them.
Specific components on psycho-traumatic post rape problems should be included in
existing training programs for refugees. It is important that everyone is informed about
the act of rape and the self-defense mechanisms which victims develop. Personnel should be
able to identify sexually violated women based on a number of symptoms. The victims can
then be directed to specific NGOs that provide excellent and appropriate care.
Working in such crisis situations can be traumatic for humanitarian personnel.
Psychological support for this personnel is indispensable, not only for the well being of
the women who have been traumatized, but also for the mental stability of people working
in the field. Part of the coordinator's job description would be to utilize his/her
psychotherapeutic skills to ensure regular supervision of the teams working in the field
and to undertake psychological debriefing.
The extensive media coverage of rape committed in Kosovo, is not negative, in itself.
It has contributed to the mobilization of the international community, just as it did
under similar circumstances during the conflict in Bosnia. However, interviews where women
explain in front of the camera how they were raped as they tried to cross the border,
could provoke general panic among the refugee population.
One Kosovar woman stated: "Now when people speak about Kosovar women they will
only remember rape." Stigmatizing the victims in such a manner could result in
violence among families and inter-ethnic revenge.
In order to prevent the victims from totally withdrawing themselves in reaction to the
extensive media, a two-tier strategy should be developed. First, it is indispensable that
internationally recognized women with high political and media profiles speak out publicly
and ask the press to maintain respect for the victims. Second, providing specialized
support to the victims should help counter the perverse effects of media over-exposure.
Document compiled by Dr S D Stein