Vera Remškar sat at the conference table in the white room of the FTK office. She looked wistfully out of the fingerprint-smudged window.
“She drank Domestos bleach, a whole container of it,” Remškar said.
She took a moment to gather herself.
“They had to chop up her insides… she is covered in scars. She was a beautiful girl. Is a beautiful girl,” Remškar said, her eyes glassy.
The executive director of Fondacioni Together Kosova, was telling the story of a young girl who attempted suicide because of her depression. She had nobody to call or talk to before she decided to drink a bottle of bleach. No lifeline to hang on to.
“After the war in Kosovo, the suicide rate increased 400 percent,” Remškar said. “We wanted to know what increased this high rate of suicide. The war was not the cause of this rate of suicide, it was the events that happened afterwards.”
The aftereffects of the 1999 war are having tremendous consequences for the young people of Kosovo. Fifteen years after the conflict, the burdens of living in a post-war society are taking its toll on the younger generations of Kosovars.
Organizations such as Fondacioni Together Kosova are creating ways in which the young people of Kosovo can express their feelings, questions, and concerns. Nukjevet.net, (You’re not alone) a website launched by FTK, looks to build a culture of seeking help by allowing people to post their mental health questions online anonymously. Once the question is posted, a certified psychiatrist will respond within three to four days.
But even with advances in mental health care, young Kosovars are still faced with difficult issues and a society that is not traditionally open about dealing with these issues.
“The youth is 60 percent of the population. They don’t see future for themselves in Kosovo,” said Sami Rexhepi, a neuropsychiatric doctor at the community-based mental health clinic in Pristina.
According to the 2013 World Bank report, Kosovo has the youngest population in Europe, with more than 70 percent of its population under the age of 35.
An evidence review by the Child and Adolescent Mental Health Unit found that war traumas, economic poverty, political instability, and transitional democracy are large factors in the quality of life for Kosovars. The review found that in this context, the increasing number of suicides in post-war Kosovo is becoming a large concern for policy makers. Before the war, Kosovo had the lowest percentage of suicides in Europe.
The evidence review found that suicide rates increased significantly in post-war Kosovo. Half of the reported suicides were by people between age 15 and 34 years old.
“Kosovo is still very closed. It is developing… people are still in survival mode. Some people go into criminality. Some people give up, some commit suicide. The society is under a lot of pressure. Everyday pressure with added hardship. Unemployment. The inability to travel or leave Kosovo,” said Fried Didden, executive director at Kosova Health Foundation.
Many Kosovars feel like something is wrong with them because they are not accepted. They take it personally, Didden said.
This is a problem apart from the environment itself. The problem resides in socio-economic issues, he explained.
In 2014, the U.S. Central Intelligence Agency reported that Kosovo’s citizens are the poorest in Europe. They have an average annual per capita income of $7,400. Kosovo is also considered the country with the highest level of unemployment worldwide among people below the age of 25, with a 73 percent unemployment rate.
“Suicide traits, mainly among young people have been increasing…This is because PTSD, lack of job opportunities, high level of poverty, and low level of education,” said Skender Syla, head of the World Health Organization based in Prishtina. “The Kosovo society is transitioning right now.”
The events that occurred after the war influenced children and young adults, Remškar said. They had to move to the city, they lost whatever possessions they had.
“They feel as if nobody likes them, nobody wants them,” she added. “All of this affects their mental health directly.”
A portion of young Kosovars were displaced during the war and were raised in different countries. Now they are being sent back to Kosovo.
According to Didden, they don’t do well. At least 40 percent have developed mental issues.
“Imagine a child that lives in the EU for several years who does not learn the mother tongue of the home country. When the family is expelled, this has a much larger impact on the child than on the parents,” he said.
The burdens faced by the youth in Kosovo often lead to depression, or another form of mental illness. That can lead to a loss of hope and thoughts of suicide.
“If you break your hand, I will fix it, and in six months it will be healed. If you cut your arm, I will bandage it, and in five days, it will be healed. But with your spirit, you will be immobilized,” Rexhepi said.
The mental aftereffects of the war are not limited to young people.
“Consequences of PTSD are being faced now you can expect after 10 or 15 years,” Rexhepi said as he took a long draw from his withering cigarette. “I had a husband and wife. He asked how to empower his wife because she was raped during the war. She’s not guilty. It’s not her fault.”
Rexhepi released a smoky cough and then smashed the butt of his cigarette into an almost-full ashtray. He withdrew a nearly-empty cigarette pack and lit another.
“’I was not strong enough to protect her because she was my wife,’ was something this man said. There were two brothers who watched their wives get raped,” he added.
The war left lasting mental damage to people of all ages, he explained. The first-hand mental damage left on one generation will also have an effect on the next.
“The war leaves consequences, not only in this generation, but in the coming generations… There is a transmitting of trauma,” said Melita Kallaba, a psychiatrist at the Kosova Rehabilitation Centre for Torture Victims.
The issues with the system stem from the way mental health is diagnosed and treated. Right after the war, the international community swept in to treat war victims and other mental patients. But since then, the international support has faded and left the ill-equipped Kosovar government to care for all mental illness issues.
Sihana Bejtullahu, a project coordinator at Fondacioni Together Kosova, remembers when the internal community provided aid.
“I was 9 years old after the war. International NGOs came in. They asked, ‘Do you have nightmares, how do you remember the war?’ Then they pick up 2 or 3 people from class. Year by year, those NGOs stopped their programs. After the war, there were about 1000 schools in Kosovo and only 46 psychologists. A school can have around 2000 children… There was a help line. A professor from Jordan created a help line with a psychologist. It lasted 6 months and then they ran out of funds.”
According to Gani Halilaj, director of the Division of Mental Health, the total budget of the Ministry of Health for this year is 130 million. About 3 percent is directed to mental health. This is approximately 3.3 million.
The mental health network is divided in all of the regions of Kosovo.
Halilaj explained the steps of receiving mental health treatment: First, the client goes to the family doctor. The doctor diagnosis the patient’s mental health problems and directs him to a specialized doctor. That doctor works in the clinic of psychiatry and decides if the patient has to stay in an integrated house. If the patience meets the criteria, he is accepted into treatment by the health system. Halilaj did not specify what the “criteria” for acceptance was.
According to some experts, that “criteria” aren’t always fair for all patients.
“Kosovo presents challenges in regards to conflict of interests, corruption, lack of money and staff,” said Skyla.
In some cases, the doctors won’t treat mental health patients with the seriousness that is needed.
“If you are going through depression, they will call you crazy. It’s much easier to talk to a friend. We don’t have very strong institution that could help you… A lot of doctors that don’t take you seriously,” said Bejtullahu. “Private clinics, economic issues prevent this.”
According to Remškar, the clinics are not ready to handle the mental health issues posed by young Kosovars.
“Suicide rates are still high. They are increasing. If something happens to a young person, they will send them to a clinic for adults… they aren’t equipped to handle young people,” Vera said. “The problem in Kosovo is the lack of services in place. There is a huge need for psychological help… There is a stigma about mental health… It is a huge problem to seek health.”
Remškar worries that if the trend continues, suicide will become a behavioral pattern as it is in other countries.
She pushed back her chair and again gazed through the spotted window.
“It is the future of this country,” she said taking a deep breath and releasing a tired sigh. “Kosovo cannot afford to not deal with problems faced by young people when half the country is young… they should be the generation to move the country ahead.”
(Sarah McIlwain is a reporting intern at KosovaLive this summer in collaboration with Miami University in the United States)[wzslider autoplay=”true” info=”true”]
