Over seven weeks since the beginning of the NATO offensive, the exodus of 750,000 refugees from Kosovo in April and May 1999 has met with a vast relief operation, involving humanitarian organisations, NATO forces and Governments in a joint effort of unprecedented complexity.

The vast majority of the refugees want to go home as soon as possible. Clearly they can only do so if some sort of a political or military solution is found to ensure that they can return voluntarily and in safety. Currently there are around 231,000 refugees in Macedonia, some 450,000 Albania (35,000 have crossed from Montenegro), 64,000 in Montenegro, 20,000 in Bosnia.

It is possible that at current rates of refugee crossings, within the next six weeks the number of refugees in Albania could increase to 1.000.000. Albania is a fragile country that has not recovered from the civil unrest of 97/98. It is often repeated that it is the poorest country in Europe but the consequences of this statement are never considered.

Although refugees are being moved onto third countries from Macedonia, the international community, NATO countries in particular, still expect Albania to cope with hundreds of thousands of refugees, whereas Europe refuses to take in any significant amount of refugees. With a Balkan winter beginning in September, weak infrastructure and no provisions for medium term assistance, this is putting an unrealistic burden on Albania and exposing the refugees to unacceptable risks.

Unsustainability of the refugee pile up in Albania

Refugee distribution and assistance

Since the beginning of this refugee crisis the distribution pattern of refugees has stayed remarkably stable in spite of the focus on camps.

• 50 to 60% are living with host families spread across the 12 prefectures of Albania.
• 30 to 40% are in hundreds of collective centres (warehouses, abandoned factories, schools, unfinished buildings), new centres are appearing daily as others reach saturation
• Almost 15% of the refugee population are to be found in tents, or 65.000 in total.

The camps are increasing in size but so is the overall refugee population. The foreign military support is focused on the camps and transporting refugees from Kukes.

There are approximately 93,000 refugees staying in Kukes (official figure of 16 May), many of the refugees are afraid to move South and want to wait in Kukes for other family members to arrive, also there are many refugees who have arrived by tractor and who do not want to leave their tractors behind.

Roads are terrible and there is limited transport capacity to 'bus' the refugees to the South and the accommodation capacity to host refugees in the South is largely saturated. To accommodate the refugees who will be evacuated south, it is necessary to do extensive rehabilitation of the collective centres as most collective centres are in bad shape.

Due to the dispersion of the refugees and the fact that support to families, camps and collective centres produce specific needs, the aid effort will have difficulty covering all the needs of the Kosovo refugees.

A good illustration of this, came when we conducted a rapid household survey in Kukes, an area which has received a vast amount of aid since the beginning of the crisis. The survey of wild camps or tractor camps and hosting families was conducted on the 29th of April, and showed that 20% of the households had not received any food since arriving, 73% had only received the food parcel once and only 52% had received soap. 24% of the households had received at least one blanket. Bread was the only food commodity received systematically by the families interviewed. At least 61% pay a monthly rent and the average rent paid is 250 Dm per month.

Winterisation

The current refugee camps are not sustainable after September. The tents in the camps in Kukes are not winter tents and could not shelter refugees from a Balkan winter. NATO is building refugee camps in the mountainous region of Korce for a total capacity of between 35.000 and 50.000. These camps cannot provide sustainable living conditions through the winter. The refugees will have to be relocated or the camps rebuilt well before September, the start of the cold weather.

Only the refugees in host families (half of the current caseload of refugees) could be safe from the winter, but their housing conditions should be surveyed. MSF has come across many refugees living in out-houses, unfinished structures that are on private land (so considered as living with host families), that would need repair or rehabilitation for the winter. More to the point, many of the refugees staying with families are using their savings to pay for their accommodation and many are running out of money and will also be needing accommodation and assistance.

Paradoxically as we enter the hot summer months, winterisation is of immediate concern. To make the existing camps places where people can survive the winter and to rehabilitate the collective centres, planning needs to be made now and work needs to start on a massive scale in early July at the latest.

Protection

Refugees are by definition a vulnerable population and need to be protected. In the case of Albania, protection takes on a new meaning. The refugees here are vulnerable to organised crime. During the civil unrest of '97 it is reported that up to a million Kalashnikovs were looted from ministry of defense arsenals. The refugees themselves put security as their top preoccupation.

For example at the Tobacco factory in Shkoder currently holding 4600 refugees, we had to choose whether we were to supply hot meals or external lighting first. The refugees chose lighting as it increased their sense of security at night (fear of kidnapping by criminal gangs for prostitution networks in Europe etc). MSF is setting-up an incident report system for all the sites in which we are working.

Health and water

The refugees have arrived to Albania in relative good health. MSF has not come across malnutrition. Mortalilty is not alarming (less than 0.5/10.000/day). Today the health situation can be considered under control, but we are expecting to see a decline in the coming months due to the cramped living conditions and poor hygiene.

Further the water and sanitation facilities are barely sufficient to cope with the Albanian population. The system cannot cope with the increase in population without major immediate investment. Albania experienced a cholera outbreak as recently as 1994. MSF is building emergency water-sanitation facilities for collective centres and has a cholera preparedness programme.

MSF is currently running relief programs in Albania, Macedonia and Montenegro. As a humanitarian organisation and to ensure that we remain independent from the parties in the conflict, MSF has taken the decision to not accept any funding from NATO member governments or from organisations they fund (UNHCR, ECHO etc). MSF is fundraising for private funds only in NATO countries.