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SPECIAL PROGRAM Mind Is Another Battlefield in Kosovo News reports and images of fleeing Kosovar Albanians, graphic though they may have been, could not capture the full extent of psychological devastation suffered by the refugees, according to Supriya Madhavan, a physician who worked in a refugee camp in Macedonia. Depression, chronic headaches, insomnia, psychosomatic illnesses such as heart and back pains, and gastrointestinal problems far outnumbered the physical wounds, most of which were remarkably minor-dehydration, frostbite, fatigue, and stress fractures from walking. "I can't emphasize enough the mental health issues every step of the way as these people crossed the border. Mental health was the number one issue," said Madhavan, who is with the international emergency relief organization Doctors of the World. She described her experiences at a talk sponsored by Harvard Medical School Amnesty International on June 1. Among the greatest sources of psychological distress was the breakup of families. "Not one family was left intact when people fled Kosovo," she said. Though the end of the war has reunited many family members, many others were killed—sometimes right in front of their loved ones. Huge numbers of Albanians—children included—witnessed the horrors of seeing neighbors massacred. The trauma is not likely to disappear as the refugees return home. Kosovar Albanians will have to cope with both the loss of life and a new way of life as they adjust to their greatly changed country. "The next major project we're going to embark upon is mental health," said Madhavan. It will be a challenge, given the relative lack of research on the psychological effects of human-made disasters. A book appearing this month, Humanitarian Crises (Harvard University Press), describes how the psychological sequelae of humanitarian crises, in the wake of wars in Bosnia and Rwanda, are becoming so common that they are giving rise to a new field of medicine, "disaster mental health." One point made in the book, edited by Jennifer Leaning, assistant professor of medicine at Harvard Pilgrim Health Care, and colleagues, is that the immediate social environment may be an extremely important factor in determining how an individual is affected by a humanitarian disaster. In fact, Madhavan believes that just as the family was the source of psychological stress in war-torn Kosovo, it will be the key to healing. —Misia Landau
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