Prague, 23 April 1999 (RFE/RL) -- Health care workers attending to refugees in Macedonia and Albania have had a few surprises. Among them is the fact that even though the refugee camps are filthy and overcrowded, there has been no serious outbreak of disease.
Jan Theunissen, a medical doctor who coordinates the World Health Organization's humanitarian aid program for Kosovo refugees, says the most crippling diseases experienced so far have been respiratory infections caused by the dampness and cold. What's more, less than 60 refugees have died so far, all of natural causes. That's about the same number of deaths as in a normal population. Even so, Theunissen says the situation could change dramatically at any time.
He spoke with RFE/RL by telephone from Copenhagen.
"There have been no outbreaks of major disease. But I must say that this can change any day. Today, I'm telling you this. Tomorrow we could have a major outbreak of something."
One of the biggest concerns is a shortage of water and proper sanitation. Although the refugees have water to drink, there isn't enough for washing. Some haven't showered in more than a week. There aren't enough latrines either, and that means there is human waste lying out in the open. And although food is available, garbage collection has become a major concern. Stale food is thrown in heaps along with empty sardine tins and used disposable diapers that are now distributed by some aid agencies. The garbage is accumulating everywhere, even along the stairs to some mosques, which are normally swept clean every day.
With so much waste in such a small space, the area is an ideal breeding ground for dangerous communicable diseases such as cholera and typhoid fever. Theunissen says cold weather has helped reduce the danger. But once temperatures increase, many of the streams the camps get their water from will dry up. And the bacteria that cause disease will start to multiply, increasing the chances of an epidemic.
"Then you can expect all kinds of problems. Cholera could be the first, typhoid fever, salmonella infections, you would have diseases like scabies and lice. If you have lice then you have to be very afraid of body lice. Then you can have very dangerous diseases like trench disease which was a disease from the first world war and if that happens you can expect a lot of people to die."
Theunissen adds that many of the refugees, especially those who fled Kosovo at the beginning of the crisis, have stayed healthy because they were healthy when they arrived. But he says many of the more recent arrivals are already weak by the time they reach the camps, and that makes them more vulnerable to disease and increases the chances of an outbreak.
"Those people have been chased around for many days from one place to another and the campaign against the people has also intensified, crops have been burned and people simply have less to eat, so the health condition is simply much worse now than it was in the beginning of the refugee crisis."
To try to prevent epidemics, health workers plan to start a mass vaccination program this weekend against several potentially deadly diseases. They'll target children under 12 years old and give them vaccines for measles, polio, diphtheria and tetanus. Theunissen says health workers expect to give vaccines -- a shot which helps build up resistance to a disease -- to at least 180,000 children.
Another concern is the refugees' mental health. Aid workers say many of the refugees arrive in a state of mental shock. Without proper counseling for trauma, the shock could lead to other psychological problems such as depression, suicides or uncontrolled violence. Counselors are working in the camps to try to help refugees deal with their traumatic experiences. But according to Theunissen, they are still not able to provide nearly enough help.