Identifier
Created
Classification
Origin
07PRISTINA331
2007-04-26 15:41:00
UNCLASSIFIED//FOR OFFICIAL USE ONLY
Embassy Pristina
Cable title:  

KOSOVO: NEW APPROACH NEEDED TO HELP

Tags:  EAID PGOV PREF SENV YI KCRS UNMIK 
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RUEHLN RUEHLZ RUEHPOD RUEHROV RUEHSR RUEHVK RUEHYG
DE RUEHPS #0331/01 1161541
ZNR UUUUU ZZH
O 261541Z APR 07
FM USOFFICE PRISTINA
TO RUEHC/SECSTATE WASHDC IMMEDIATE 7299
INFO RUEHPH/CDC ATLANTA GA IMMEDIATE
RUEHZL/EUROPEAN POLITICAL COLLECTIVE
RUCNDT/USMISSION USUN NEW YORK 1131
RHMFISS/CDR USEUCOM VAIHINGEN GE
RUFOADA/JAC MOLESWORTH RAF MOLESWORTH UK
RHFMIUU/AFSOUTH NAPLES IT
RHMFISS/CDR TF FALCON
RHEFDIA/DIA WASHDC
RUEKJCS/SECDEF WASHINGTON DC
RUEPGEA/CDR650THMIGP SHAPE BE
RHEHNSC/NSC WASHDC
RUEAWJA/DEPT OF JUSTICE WASHDC
RUFOANA/USNIC PRISTINA SR
UNCLAS SECTION 01 OF 04 PRISTINA 000331 

SIPDIS

SENSITIVE
SIPDIS

DEPT FOR DRL, INL, AND EUR/SCE, NSC FOR BRAUN, USUN FOR
DREW SCHUFLETOWSKI, USOSCE FOR STEVE STEGER

E.O. 12958: N/A
TAGS: EAID PGOV PREF SENV YI KCRS UNMIK
SUBJECT: KOSOVO: NEW APPROACH NEEDED TO HELP
LEAD-CONTAMINATED ROMA

REF: A. A. 05 PRISTINA 001138


B. B. 06 PRISTINA 000049

C. C. 06 PRISTINA 000109

D. D. 06 PRISTINA 000256

E. E. 06 PRISTINA 000339

UNCLAS SECTION 01 OF 04 PRISTINA 000331

SIPDIS

SENSITIVE
SIPDIS

DEPT FOR DRL, INL, AND EUR/SCE, NSC FOR BRAUN, USUN FOR
DREW SCHUFLETOWSKI, USOSCE FOR STEVE STEGER

E.O. 12958: N/A
TAGS: EAID PGOV PREF SENV YI KCRS UNMIK
SUBJECT: KOSOVO: NEW APPROACH NEEDED TO HELP
LEAD-CONTAMINATED ROMA

REF: A. A. 05 PRISTINA 001138


B. B. 06 PRISTINA 000049

C. C. 06 PRISTINA 000109

D. D. 06 PRISTINA 000256

E. E. 06 PRISTINA 000339


1. (SBU) SUMMARY: A year after the opening of Osterode camp,
a USG-funded medical treatment facility for lead-poisoned
Roma in northern Mitrovica, 134 Roma ) including 69 children
) still live in the highly contaminated Cesmin Lug camp for
internally displaced persons (IDPs). Thirty-one children
living at Osterode have been treated for lead poisoning.
Indications are that blood lead levels (BLL) in both treated
and untreated Roma living in Osterode have decreased due to
conditions in the camp which reduce exposure to lead.
However, USOP has not received a report or any systematically
organized data from the World Health Organization (WHO) on
the outcome of their lead therapy program in Osterode. We
are also concerned about how our assistance was spent. For
example, services intended for Osterode residents only, as an
incentive for Roma to move there from Cesmin Lug, were made
available to inhabitants of Cesmin Lug. We support continued
USG funding of this vital public health issue, but we will
also need to use our participation to improve the overall
approach to this difficult issue. The UN will need to close
Cesmin Lug; develop a strategic plan for the sustainable
return of the Roma IDPs at both camps and reduce unsafe lead
smelting practices; revise the treatment protocol based on
Centers for Disease Control (CDC) recommendations; increase
oversight to ensure that measures essential to Roma safety
are implemented; and ensure the broad sharing of information.
Absent these changes, it will be difficult to bring about
either sustained reduction in BLLs or a durable solution to
healthier living conditions for Roma. We have sought advice
from the CDC on refining the WHO approach and would welcome
their further engagement. Any future funding from the USG

should be leveraged to secure the needed restructuring of
international efforts to support this vulnerable community.
END SUMMARY.

CONTAMINATED CAMPS HURT ROMA HEALTH


2. (SBU) WHO discovered in 2004 that large numbers of Roma
children in lead-contaminated IDP camps in northern Mitrovica
had BLLs over 6.5 times higher than what WHO considers
acceptable. There were reports of several child deaths
attributed to the poisoning. Much has improved since that
time, but daunting challenges remain, and many factors
contribute to the continuing plight of the Roma. These
include a lack of a long-term strategic plan for the
sustainable return of Roma in the northern Mitrovica camps;
lack of clarity in the roles and responsibilities of the
international agencies involved; lack of trust and
cooperation between stakeholders; difficulty obtaining
necessary blood samples; political issues with Serbia's
Ministry of Health; lack of income generation activities for
Roma, apart from camp services and hazardous battery
reprocessing; and the slow pace of reconstruction at the
southern Mitrovica Roma mahala (neighborhood).

CESMIN LUG NEEDS TO CLOSE


3. (SBU) The most significant threat to these Roma IDPs,
however, is that the heavily contaminated Cesmin Lug camp
remains open and occupied. In early 2006, there was a plan
to close all three lead-contaminated Roma camps, including
Cesmin Lug. Recognizing that UNMIK bore responsibility for
moving Roma from the poisoned camps, we suggested that
USG-funded treatment should not begin while Roma remained at
those camps, as post-treatment patients have an increased
vulnerability to lead contamination (ref C). Unfortunately,
there was insufficient political will to close Cesmin Lug.
(NOTE: Osterode was a Yugoslav military base before its
occupation by French KFOR and subsequent transformation into
an IDP camp. Some Kosovo Serbs claim a derivative property

PRISTINA 00000331 002 OF 004


right to it and are loathe to see more Roma move in. END
NOTE.) Today, UNICEF, OSCE, UNHCR, WHO and the UNMIK staff
dealing with the Roma all agree that closing Cesmin Lug is
the primary health priority for the Roma. Lead-safe Osterode
has space for the 134 Cesmin Lug residents.

NEXT STEPS TO IMPROVE ROMA HEALTH


4. (SBU) Following the closure of Cesmin Lug, several other
actions would significantly improve the Roma health situation
in the short term. First, Osterode camp, opened about a year
ago, needs funding at a level that allows hygiene measures to
resume and camp security to continue. Osterode was foreseen
as safer than Cesmin Lug partly because, while Cesmin Lug
children play in contaminated soil, Osterode is paved and can
be washed down. Unfortunately, due in part to conflict with
northern Mitrovica municipal authorities and the water
company, water supply in Osterode has been highly unreliable
and expensive. According to camp management, the camp has
not been washed down since October 2006 because of high water
costs. Lack of water also contributes to contamination,
since Roma parents who smelt batteries off-site cannot wash
themselves or their clothing before returning to their
children. Temporary water shut-offs have delayed the
delivery of lead treatment at the in-camp health clinic.
Osterode,s security guards prevent Roma residents from
smelting batteries on the premises. Water and security are
critical to maintaining lower levels of lead contamination in
Osterode.

MEDICAL OUTREACH


5. (SBU) Second, Roma must be encouraged to cooperate with
the lead abatement treatment. According to UNICEF, the
record-high Roma BLLs have attracted numerous
"needle-wielding" doctors over the years, fostering Roma
skepticism towards medical professionals. According to WHO,
this has resulted in some Roma parents refusing to allow
doctors to take blood samples from their children. Recent
samples are necessary before treatment can begin, as lead
levels change within two months of re-exposure. Thus a
continuing education component, so Roma will understand the
danger of lead poisoning and battery processing, and the
value of treatment, is important to encourage Roma to be open
to the testing.

LEAD CHELATION THERAPY


6. (SBU) Third, the treatment strategy must be revised. We
are dissatisfied with the extent of lead chelation therapy
thus far. Of the 260 children living in lead-contaminated
camps this time last year, only 31 have received the full
course of treatment. At minimum, a dozen children at
Osterode still have BLLs above 45 micrograms/deciliter (NOTE:
CDC and WHO consider 10 and above as an indication that a
health intervention is needed. END NOTE.) Sixty-nine
children live at Cesmin Lug and likely have extremely high
levels. We have yet to receive WHO documentation of the
initial and current BLL of even the 31 treated children, nor
BLLs of all the children tested, despite our continued
requests for data. Furthermore, as an adjunct to CDC lead
treatment guidelines, a substantial portion of USG funding
was spent on a food basket program for all IDP families in
both Cesmin Lug and Osterode. WHO felt this was an essential
component of the medical treatment to maintain the
nutritional status of this population, which is constantly
exposed to lead and other heavy metals. Had this camp-wide
feeding program not been implemented, we would likely still
have funds to continue targeted treatment for those suffering
from lead poisoning. Finally, the political affiliations of
local medical personnel in northern Mitrovica may not be
compatible with the professional discharge of their duty to
provide medical care. Pressure from Kosovo Serb hardliners
is reportedly to blame for the clinic being over-staffed on
paper while the Roma remain untreated and underserved in

PRISTINA 00000331 003 OF 004


practice.

A NEW PARTNERSHIP


7. (SBU) We would like CDC to assist us by refining the
treatment strategy according to their well-tested protocols.
An updated approach would include strategies to reduce risk
of Roma lead exposure, clarification of the treatment
protocol and the role of nutritional supplements therein, and
a recommendation for an untainted, on-site implementation
mechanism. For example, a short-term international medical
lead expert or an international medical NGO could implement
the therapy under close supervision of CDC. Perhaps through
CDC some coordination with WHO could be possible. We believe
that the next phase of lead chelation therapy should be
conducted by someone who is on-site and reporting progress
regularly to USOP.


8. (SBU) In the longer term, Roma should be encouraged to
stop smelting batteries. According to UNICEF and WHO,
selling lead smelted out of dead batteries (to parties
allegedly using it to make new batteries) is the major
income-generation activity for the Roma but is also a major
health risk. A safer approach would be to confine battery
recycling to a battery recycling facility. Furthermore, it
would be counterproductive if this battery smelting practice
is instituted along the river in the newly-built mahala.
Finally, the dead batteries may be brought into Kosovo
illegally; stepped-up customs awareness and enforcement could
help. If Roma continue to smelt batteries, they should at
least have access to a reliable water supply to wash after
smelting and before feeding and playing with their children.

RETURNS TO MAHALA AND ELSEWHERE


9. (SBU) Finally, a long-term strategic plan for eventual
Roma return must be developed. According to Norwegian Church
Aid, UNMIK,s implementing partner managing Osterode, and
UNMIK, of the 129 households in Cesmin Lug and Osterode, 83
are from the southern Mitrovica mahala, which Albanians
burned to the ground in 1999. The first phase of mahala
reconstruction was completed in March and 102 families have
returned there from Osterode, Montenegro, and Serbia ) a
major accomplishment. Phase two, which would ideally allow
the remaining displaced mahala residents to return, has not
yet been funded. In addition, 46 of the families in the
camps are not from the mahala; they are from elsewhere in
Kosovo -- Mitrovica (14),Tuneli Pare and Vushtri (nine
households each),Stari Trg (six),Pristina (five),and
Istok, Peja, and Prizren (one each). (NOTE: In anticipation
of an eventual transfer of authority from UNMIK to the new
Mitrovica municipalities with a joint oversight board
envisioned in the Ahtisaari proposal, and the ensuing
political shake-up, UNHCR may be in a better position than
the Kosovo government to take responsibility for Roma IDPs
from UNMIK. Although UNHCR has overseen the successful
dismantling of the Plementina Roma IDP camp in Kosovo, it is
not yet stepping forward to take on the similar challenge in
northern Mitrovica. END NOTE.)


10. (SBU) COMMENT: We have come a long way from last year )
only 69 Roma children live and play in a severely
lead-contaminated environment, down from 260. Still, much
more needs to be done to bring about a durable solution. Our
first step will be engaging with UNMIK to close Cesmin Lug
and to implement the points described above. We hope we can
engage CDC in this important public health issue to get their
professional perspective and refine the approach by the WHO.
The Swedes and the Norwegians have been generous in their
support of the Roma, particularly in the reconstruction of
the mahala. Our preference will be to continue to focus our
own resources in the health sector, while working within the
donor comunity and with the host government to address the
broader challenges. We are reluctant to commit additional
funds absent the kind of structural improvements needed to

PRISTINA 00000331 004 OF 004


give these broad programs a credible chance of success. We
will work with CDC, PRM and others to ensure that our money
is spent judiciously and can be used to leverage a broader
and more effective international effort. END COMMENT.
KAIDANOW