This report summarizes the findings and recommendations of an 11-member, multi-disciplinary expert Psychosocial Needs Assessment Delegation to Kosovo organized by the International Rescue Committee. Integrating diverse outlooks that represent the best thinking in the field, the delegation visited Kosovo from September 8 to 13, 1999. The objectives were to assess the nature and quality of psychosocial and mental health services, define priority needs and identify service gaps, and make recommendations on the key issues.
Applying a broad conceptual framework that recognizes the interdependence of psychological and social factors on psychosocial well-being, the delegation's inquiry and analysis focused on the spectrum of prevention and assistance needs and services at four levels: society at large, local communities, families, and individuals.
New problems and new service configurations are emerging almost daily. Moreover, despite tragic losses, insecurity, massive dislocation, and extensive suffering and brutality -- all of which have led to disruption at all four levels of the framework=BE there is also evidence of resilience, with many returning Kosovars restoring their lives, villages, and towns.
Among the groups at highest risk are women who were raped or otherwise brutalized; people in underserved rural areas; the elderly and widows; people who witnessed mass murders and other atrocities; and minority groups such as Serbs and Roma. A significant number of adolescents have lost developmental opportunities at a critical time in their lives. There was evidence of some members of this group turning to substance abuse and violence. Rampant insecurity and anxiety about insufficient shelter for the upcoming winter are virtually universal.
The delegation identified issues in six areas requiring immediate attention:
- approaches to psychosocial assistance;
- coordination and standards;
- education, training, and capacity building;
- planning and evaluating interventions,
- and sustainability.
The contributions of the U.S. State Department Bureau of Population, Refugees, and Migration to psychosocial assistance in Kosovo are well recognized. These contributions have promoted psychosocial concerns across the board and established for the U.S. government a leadership position. To consolidate this position and improve the scope and quality of psychosocial assistance, the delegation recommends a number of additional initiatives that the U.S. government can undertake. In summary, these include:
Approaches to Psychosocial Assistance
Establish a task force, including experts
from Eastern Europe to continue the assessment begun by this delegation
and help further define priorities, guide program approaches and map and
assess the efficacy of psychosocial services.
Promote and support programs that emphasize
dialogue among ethnic groups and tolerance building as a first step towards
Coordination and Standards
Create culturally relevant standards for psychosocial assistance programs and develop new models of coordination for their implementation.
Education, Training and Capacity Building
Encourage and fund partnerships between universities and professionals in the region in the fields of psychiatry, psychology, social work, nursing, and teaching.
Planning and Evaluating Program
Establish sound criteria for funding
psychosocial assistance and mandate monitoring and evaluation of programs.
Provide long-term resources to local institutions including training, technical assistance, and small grant support to Kosovar NGOs.
These actions are critical in meeting the psychosocial needs of Kosovo citizens and in coordinating an appropriate international response to the crisis. The lessons of Kosovo could easily be applied to other situations of war, forced migration and mass violence.
KOSOVO PSYCHOSOCIAL NEEDS ASSESSMENT
Neil Boothby, Ph.D., Director, Children in Crisis, Save the Children USA
Frederick Burkle, M.D., MPH, Director, Center of Excellence in Disaster Management and Humanitarian Assistance, CDC Honolulu; Executive Director, Health Unit, IRC
Mary Diaz, MA, Executive Director, Women's Commission for Refugee Women and Children
Matthew J. Friedman, M.D., Ph.D., Executive Director, National Center for Post-Traumatic Stress Disorder (PTSD)
Anica Mikus Kos, M.D., Head, WHO Collaborating Center for Child Mental Health, Ljubljana; Head, Center for Psychosocial Help to Refugees
Barbara Lopes Cardozo, M.D., MPH, International Emergency and Refugee Health Branch, CDC
Maryanne Loughry, MA, Pedro Arrupe Tutor, Refugee Studies Programme (RSP), University of Oxford
Salih Rasavac, BA, Program Manager, Corridor Psychological Therapy Program, Sarajevo
Marie de la Soudiere, MSW, Director, Children Affected by Armed Conflict Technical Unit, IRC
Captain John J. Tuskan, Jr., RN, MSN, Senior Public Health Advisor, Refugee Mental Health Program, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Department of Health and Human Services
Michael G. Wessells, Ph.D., Professor of Psychology, Randolph Macon College; Consultant, Christian Children's Fund