15. Kosovo Region

One of the most striking phenomena about the emergency operation in Kosovo has been the scale and speed of events that have occurred, in terms of refugees leaving Kosovo as well as returning. This has required a swift and flexible approach to planning and implementation of the humanitarian response, including the implementation of effective and appropriate nutrition interventions. The latest UNHCR estimates suggest that 810,000 refugees have returned to Kosovo from neighbouring countries and abroad since June 15^th. Thousands more continue to return each week (USAID - 15/09/99).

Kosovo

KFOR estimates that there are a total of 1,564,300 people now living in Kosovo. Of this total, 97,100 are ethnic Serbs, 1,294,200 are ethnic Albanians and the remainder are Croats, Roma and other minorities. The 97,000 ethnic Serbs represent only 51% of the 1998 estimate of ethnic Serbs living in Kosovo. In addition, the 73,000 other minorities are only 43% of the 1998 estimate for other minorities (USAID - 15/09/99).

A pattern of general unrest and systematic violence continues in Kosovo. The opposing parties vent their anger and hatred through reprisals, retribution killings and burning each other's property. These remain serious issues. The biggest other security difficulty faced by much of the population is the presence of mines, unexploded ammunition and booby traps in the areas most affected by the fighting (AAH - UK - 08/99).

Shelter and water

Shelter is currently one of the most crucial problems. UNHCR has estimated that 50,000 houses have been destroyed and a further 76,000 damaged in the last year. Approximately 300,000 people have lost their homes. Donors have already pledged enough materials to winterise the 76,000 damaged structures, but there are logistical problems in getting the materials into Kosovo. The cold weather is already affecting some Kosovars living in tents in the hills (USAID - 25/09/99).

Several major problems exist in supplying water to urban populations. The greatest problem is that the water boards are losing between 40-50% of the piped water to leaks in the system. The leaks continue to exist as there is no material to replace or patch up the pipes. In addition, the urban water board workers have not been paid for 3-6 months (USAID - 15/09/99).

Food and agricultural assistance

The general high level of preparedness of the international community resulted in the flow of food aid into the province being quick to start after the end of the conflict. In late June, a WFP/FAO EMOP was approved to provide emergency food assistance to some 2.5 million refugees, IDPs and war-affected persons in the Balkan region for a period of six months (July-December 1999). This includes the assistance required for approximately one million IDPs who remained within Kosovo throughout the conflict but, prior to the establishment of NATO peace-keeping forces, could not be accessed (FAO - 28/07/99).

Blanket food distribution by WFP and other donors was originally designed to reach 80% of the Kosovar population. Targeted food distributions began in mid-September. These will assist 900,000 beneficiaries (estimated 53% of the population) who were selected using criteria agreed by WFP, UNHCR and other organisations. The targeting takes into account both geographical and community-based systems. The introduction of targeted food aid will result in a general shift of focus to the west of the province where needs are greater (UNHCR - 27/09/99; WFP - 07/09/99, 24/09/99).

WFP sub-offices have reported that the implementation mechanisms of partner organisations are well established. Standardised reporting on a weekly basis has begun. Consultations are being held between WFP with technical assistance from UNHCR and implementing partners on the establishment of joint monitoring and impact assessments. A task group to monitor the selection criteria has been set up. This will aim to monitor the implementation of the criteria and will also focus on how the criteria are being monitored in practice, i.e.: how families are prioritised and how vulnerability is perceived by communities, and what arrangements or adaptations are made by local distribution partners in situations of food shortfalls (UNHCR - 27/09/99; WFP - 07/09/99).

A major challenge for the humanitarian operations in the winter months in Kosovo will be to reach the remote areas of the country, which become inaccessible due to weather conditions. WFP is currently identifying these areas in order to pre-position stocks with rations lasting at least 2-3 months. Other preparations include the distribution of firewood and the preparation of community shelters in urban areas with cooking facilities that allow individual families to cook for themselves (in preference to institutional food provision) (UNHCR - 15/09/99, 27/09/99; WFP - 07/09/99, 24/09/99).

Seeds, tools and machinery are being provided as agricultural assistance in Kosovo. There are concerns that insufficient seeds will be imported into Kosovo before the winter planting. As of mid-September only 18% of the total requirement had arrived. This could obviously affect the population's food security adversely (UNHCR -15/09/99).

Nutritional Survey in Kosovo

AAH-UK conducted a province-wide nutritional survey of children under five and their mothers in late July in order to assess any change in nutritional status since the last survey undertaken in Kosovo in December 1998, and in the camps in Macedonia and Albania in June 1999 (see Annex). The results of all four surveys can be seen below.

	Kosovo population December 1998 n=922		Albania Camps June 1999 n=906		Macedonia Camps June 1999 n=859		Kosovo population July 1999 n=922
	Acute	Severe	Acute	Severe	Acute	Severe	Acute	Severe
Wt-for-ht*	2.0	0.2	4.6	0.2	2.4	<0.1	3.1	1.0
Ht-for-age	9.4	2.1	14.6	3.0	10.4	2.6	10.7	3.0

* these figures include oedema

The problem of stunting (height-for-age) is a cause for concern. A prevalence of 10.7% corresponds to 24,565 children. An infant feeding and weaning survey performed alongside the most recent nutritional survey found that many of the common breast-feeding and weaning practices in the study sample were inappropriate, and did not follow internationally accepted recommendations. Cows' milk, tea and biscuits were introduced too early and formed too high a proportion of the diet. 35% of mothers stopped breast-feeding before six months, which was coupled with an increased uptake of infant formula. This was combined with a low intake of fruit, vegetables, meat, fish, and eggs. These practices have major implications for the growth of the child and also for iron deficiency anaemia and diarrhoea.

Amongst the mothers of children surveyed, 4.9% had a BMI<18.5kg/m² and thus were classified as malnourished (see table below). Using a MUAC criteria (MUAC<220 mm) a smaller proportion (3.9%) of mothers were diagnosed as malnourished. If these indicators were combined (those mother with BMI less that 18.5 kg/m² and MUAC < 220 mm) then 2.3% of mothers were classified as energy deficient and 4.7% as normal, but vulnerable. There was not a significant association between maternal and child nutritional status, which may be because the number of cases of malnutrition was small.

BMI<16	16<=BMI<17	17<=BMI<18.5	18.5<=BMI<25	25<=BMI<30	BMI>=30
0.0%	1.0%	3.9%	64.4%	21.6%	9.1%

The coverage of measles vaccination in Kosovo was very low (14%) when a vaccination card was required as proof of vaccination. When family history was taken into account the reported coverage increased to 71%, but this result should be interpreted cautiously as there was some confusion as to which vaccine the children had received.

Food security

This section is drawn from an AAH-UK study undertaken in July which investigated the possible impact of food insecurity on the nutritional status of the population and an FAO/WFP food assessment mission to Kosovo in late June The section includes a review of food security during the conflict as well as the more recent food security situation in Kosovo post-conflict.

Coping strategies during the conflict

Only two families of the 55 interviewed had not been displaced during the preceding months. A wide range of coping mechanisms enabled displaced people to survive (either in the mountains, or moving from village to village), without a significant impact on their nutritional status. For adults reducing the number of meals per day was common practice, although children were exempt. Families in tense areas pre-positioned food and cooking stoves or sag (special pans for baking bread) in hiding places in the mountains to be ready in case of evacuation. Where there was no time to pre-position, families escaped with food and sac, with men returning to the village after dark to take more supplies from their own homes or from the stocks of other empty houses - sometimes with a KLA escort. Assistance received prior to the mass exodus from AAH and other agencies was also important. Some villagers fled to the summer pastures on higher ground, where they survived on the milk from the cattle (AAH-UK - 08/99).

For those moving from village to village, they either depended on food stocks carried with them, or residents shared their resources. Special kitchens were sometimes made available for the displaced to cook collectively. Villagers developed systems of collecting excess harvest and distributing it to those less well off (AAH-UK -08/99).

In urban areas, state shops continued to trade but were mostly frequented by the Serbian population. Most markets were closed, although Prizren and Gjilan markets continued to trade. Meat was widely available and cheap (6 DM per kg) in Prizren because many of the animals that had been killed were sold. The most severe food shortages appeared to be suffered on the journey to escape Kosovo (AAH-UK - 08/99).

Post-conflict - Food Security in Kosovo

The food security situation for many is very poor and is expected to remain so for at least the next twelve months. In the worst affected areas the loss or destruction of food stocks is total, as they were either eaten by the displaced, resident, KLA or Serb forces - or were burned in houses or on bonfires (AAH-08/99). Massive disruption to agricultural activities has taken place in the province. Preliminary FAO and WFP analyses indicate that, in the worst affected areas, where food production was severely reduced, food aid will be required to cover the bulk of the food needs until at least spring 2000 (FAO - 28/07/99).

The area planted last autumn was sharply reduced due to insecurity and/or the basic lack of equipment and seeds. Compared to pre-war years, the reduction was between 40-60% although, in the worst affected zones the reduction was over 60% e.g., the Drenica triangle. Growing crops were damaged during the conflict from burning, bombing, grazing animals and lack of fertilisation and pest control. By harvest time (late June) many families were able to return to their farms, although the lack of serviceable machinery and the insecurity in many areas, due to mines and unexploded bombs, were expected to make harvesting extremely difficult this year (FAO - 28/07/99).

The spring crop of maize, vegetables, beans and potatoes has been sharply reduced because mass displacement coincided with the planting season. There has also been widespread loss of livestock. Before leaving their villages, farmers freed their animals to run loose and many were subsequently slaughtered by passing military and paramilitary forces. Tentative estimates put losses of larger ruminants at some 40%, and those for small livestock at over 50% (FAO - 28/07/99).

Trade in food items of commercial origin has resumed remarkably quickly in the few weeks since the end of the conflict, and prices are similar to those reported for 1997. The previously imposed ban on Albanian shopkeepers trading basic foodstuffs has now been lifted. However, more than 50% of shops in rural areas are still not trading, which is in part due to the greatly limited purchasing power among both the rural and urban populations. Only a fraction of the total needs can be met through purchases in the following year, especially as households have many essential non-food expenses (AAH-UK - 08/99).

The majority of households have suffered severe loss of livelihood as a result of loss of livestock; loss of work-horses for ploughing, reduced harvests, death of a wage earner in the family and loss of black market trade. This has had a significant impact on the diet as micro-nutrient and high quality animal protein intakes are seriously compromised, and will be even more so during the coming winter months (AAH-UK - 08/99). Humanitarian aid is the main source of food for the majority of households.

Albania

In early June, the Government of Albania estimated that 460,000 Kosovar Albanians had temporarily settled in Albania: 280,000 of these refugees were staying with host families, 83,000 were accommodated in tented camps, and 95,000 in collective centres throughout the country. There are currently 4,239 refugees in the country. The large majority of refugees returned spontaneously, while only a small minority relied on organised repatriation (UNHCR - 24/07/99, 15/09/99; USAID - 15/09/99).

It is anticipated that the residual caseload in Albania will be relatively small. The scale of food and nutrition interventions was reduced significantly during July and August. UNHCR now has exclusive responsibility for these refugees (WFP - 24/09/99).

Food Security in Albania

An FAO/WFP food supply assessment mission to Albania in June found that the impact of the Kosovo crisis on agricultural production, food prices, the local economy, and overall food security of the resident population appears to have been small. Indeed, there may have been a marginal, although very temporary, positive impact on some hosting families who have been able to benefit from emergency food parcels and additional income earned from renting to refugees. The mission concluded that the precarious food security, which is experienced by many Albanian households, is attributable mainly to the general economic and development difficulties that the country has experienced throughout the 1990s rather than the extraordinary circumstances created by the crisis (FAO/WFP - 07/07/99).

The potentially enormous burden of providing asylum to nearly half a million refugees was alleviated by the fast and adequate response of the international humanitarian community in supplying food and other types of emergency assistance. Had this effort not taken place, the crisis could have had "quite a severe impact" on the already poor Albanian population (FAO/WFP - 07/07/99).

Macedonia

Latest reports from UNHCR/Skoje indicate that there are currently some 5,125 refugees in camps and collective centres in Macedonia and 16,054 refugees with host families. (USAID - 15/09/99).

Food Security in Macedonia

An FAO/WFP food and crop supply assessment mission, which took place in mid-June, found that the impact of the refugee crisis on agricultural production, food prices, and the overall food security in Macedonia appears to have been small because of the quick response of the international humanitarian community in supplying food and other types of emergency assistance. The mission found no evidence of significant food shortage or malnutrition problems in the country (FAO/WFP - 07/07/99).

The crisis, however, undoubtedly aggravated the general economic instability already experienced by the country, and as a result there has been a significant increase in poverty levels. Affected households are finding it increasingly difficult to pay for everyday expenses, and changes in food habits were reported. The major factor causing this was the collapse of trade with Federal Republic of Yugoslavia (FRY), one of Macedonia's most important export markets and a vital source of raw materials. The loss of the fruit and vegetable market, and of lamb, in particular, is reflected in lower produce prices. Hence the financial situation of farmers has deteriorated. Non-agricultural households have also been affected due to the interruption in the supply of raw materials for the manufacturing industry, which has led to an increase in unemployment (FAO/WFP -07/07/99).

In May-June 1999, before the return of the refugees to Kosovo, AAH conducted a food security survey among host and non-host families in randomly selected villages in eight geographical areas in Macedonia (AAH -07/99). The study reported similar findings to that described above, in that the interruption of trade with FRY was the major indirect cost of the crisis to the Macedonian population. In addition, AAH assessed and compared the household income and expenditure of both host and non-host families. It was found that there was no difference in the income available for host and non-host household members (assuming that total household income is divided evenly between all members). The reasons given for this finding included: households originally chosen to be hosts had higher incomes; host-families were given money/food by the refugee families or aid agencies; and non-host families supported host families by giving them (directly, or indirectly through local NGOs) food and money. The AAH survey also found that income coming from relatives abroad was an essential coping strategy for 60% of the refugees and a large proportion of the host families.

Under a recently signed agreement, a consortium of donors will distribute a food basket to the current welfare recipients in Macedonia who are in the categories of "most vulnerable". This will include pensioners, partially employed and unemployed in selected hardest-hit towns. More than 60,000 families, all of whom already receive a cash benefit from the Government, will also receive a monthly ration (FAO/WFP - 07/07/99).

Serbia

The total number of non-Albanian (mostly Serb and Roma) displaced people from Kosovo in Serbia as of September 10^th was 220,000. The vulnerability of these IDPs has recently been highlighted when several hundred were removed from the schools which served as their temporary collective center, but then found the alternative municipal facilities lacking in basic maintenance (OCHA - 10/09/99).

A joint WFP/UNHCR assessment mission to Yugoslavia confirmed that food assistance is needed in Central Serbia. The most food-insecure are the newly arrived IDPs, and population groups with minimal income, little family support and no link to rural areas. In August, ICRC provided food aid to 140,000 IDPs from Kosovo. The number of beneficiaries is expected to increase given the recent identification of 317,000 "social cases" in Serbia. These include people in institutions, handicapped people without income or property and pensioners with low income. Most towns in Serbia continue to experience shortages of basic food items (meat, oil, sugar). Controlled prices for food were recently raised (OCHA - 10/09/99; WFP - 27/07/99, 07/09/99).

Overall, the nutritional situation of the IDPs and returnees in the worst-affected regions of Kosovo (Drenica) are at moderate risk (category IIb) due to the widespread loss of livelihood and their dependence on humanitarian assistance until they can re-establish themselves. The other returnees are probably not at heightened risk (category IIc). The IDPs in Serbia may be at moderate risk but no information on their nutritional status is currently available and hence they are classified as unknown (category III). The refugees remaining outside Kosovo are not at heightened risk (category IIc).

Recommendations and Priorities:

Macedonia:

· Re-establish markets for both agricultural and industrial products which have been disrupted over the past years.

· Support programmes which could lead to a regeneration of the food economy for both Kosovo and Macedonia e.g., purchase lamb from Macedonia for the Kosovars.

· Supply essential agricultural inputs for the autumn planting season, and for the maintenance and rebuilding of the agricultural machine pool.

· Supply materials for the rebuilding of residential structures and water systems.

· Continue to extend the active search for malnourished children through regular nutritional surveys and treat the cases of severe and moderate malnourished children.

· Begin routine vaccination activities in order to increase vaccination coverage.

· Educate health professionals and mothers about nutritional practices, focusing on weaning and breastfeeding.

· Initiate a mechanism of growth monitoring for nutritional surveillance of individual children.

· Monitor the targeting of the general ration.

· Monitor the food security situation, including a follow-up survey in 6 months time (January).

· Follow the movement of population to and from towns and villages and ensure that the basic needs of the vulnerable displaced are being met.

· Make efforts to supply before the winter enough food stocks for those villages which are isolated and inaccessible during this period.

· Continue to stress and support the need for a consolidated, collaborative and coordinated approach between all of those active in the humanitarian distribution field.

· Support the distribution of shelter kits to allow homes to be habitable before the winter.

· Supply food assistance to IDPs and population groups with minimum income in Central Serbia and Montenegro.