‘Why are you leaving?’

Lynne Mastnak, a child psychiatrist, records the daily round in Kosovo before and since the bombing

1 January, Pristina. The UNHCR security officer rang early this morning to say that the main road through the area of Likovc, in Drenica, was now clear. We have been wanting to set up an emergency clinic there for the last two months, but it has been off-limits to all humanitarian aid workers since an International Committee of the Red Cross vehicle hit a mine, killing one doctor and seriously injuring another. Drenica was the poorest part of Kosovo long before the current wave of violence, and the region that suffered most from the weapons searches and arrests inflicted by the Serb police force on the predominantly Albanian population over the previous decade. It was here that the KLA first emerged a year ago, and here that some of the fiercest assaults were carried out by the Yugoslav military during the offensive of 1998.

My translator and I left at once, driving though the acrid wall of smog that has enveloped Pristina for the last week, up small winding dirt roads into the Drenica hills, past the upturned, mangled wreck of the ICRC vehicle. Almost every house in this area is in ruins. The torched houses have a peculiar ugliness. Each window has its thickened eyebrow of soot, the roof is missing and the chimney-pots on brick columns stand free above the eaves. Sadako Ogata said a few weeks ago that a humanitarian disaster had been averted. People are no longer shockingly visible camped out on mountain-sides. Instead they are tidied away in plastic benders in their skeleton homes or crammed in with neighbours, drinking contaminated water and dependent on hand-outs. Booby-traps are a hazard. A woman found one under her bed, a dog set another off in an orchard.

What is left of Likovc sprawls over three hilltops, the destruction outlined against a backdrop of snowcapped Albanian Alps. Only 15 of the 170 houses remain undamaged. The white school building and the cultural centre are gutted; the small clinic is a pile of rubble; teenagers are selling cheap biscuits, chewing-gum and cigarettes on upturned milk crates; and Dr E, who came back three weeks ago, has turned a shop into a temporary clinic. He is overwhelmed, however. He thought it would be helpful if one of our teams set up in a village a few kilometres away, where the clinic is still standing. We found a displaced family living in two of the rooms, the others had been wrecked by police occupants. We said we would bring plastic and wood for the windows, a couple of stoves for warmth and start next week.

For the rural population access to health care is difficult. It is not simply that many clinics have been destroyed or their doctors have fled. Every time I go into the field there seem to be more police. They have adapted to the conditions imposed by the October agreement between Milosevic and Holbrooke and travel in white vehicles, remarkably similar to those used by aid workers, and have mobile checkpoints. I saw 11 jump out of a van in one village recently, only to move on before any international verifiers arrived. So people are too frightened to move. They know that with identity cards from this region they risk interrogation and beating. And if they do get to a hospital, how to pay? Free health care is only available to those who are employed and have health cards. The vast majority of Albanians lost their jobs in the wave of dismissals that followed the removal of the province’s autonomy in 1989. Of the few people who were employed before the conflict, most have lost their papers in flight.

12 January. Every time I go through the Baice checkpoint it seems a little more entrenched. Last October there was just a single young man in KLA uniform with a kalashnikov. Then it was four men in a car, then a small wooden booth. Now it is a small wooden booth, plus stone cairn and red bollards, but we are waved through without problems. The clinic is packed. My colleague Mark and a local Albanian doctor come twice a week and see around a hundred and forty patients a day. Mark wanted me to visit a small boy called Illir who had been in Belgrade for three months with a badly injured leg, and had only just discovered that his father was dead.

We went round to the house to find one of the two small rooms packed with people – some twenty members of the extended family – waiting for me. The easiest way to begin in these situations is to get the children to help me draw a family tree on a big piece of paper. It is a common enough psychiatric practice at home, but here it’s invaluable: the children are immediately engaged, everyone gets a chance to introduce themselves while I get an approximate sense of who belongs to who. Most significantly, it allows the family to name and identify the dead in a natural way, and say as much about what happened as they want to. Illir’s sister Laura explained that their father and two sisters, aged 8 and 13, were killed by shells as he tried to load the family onto a tractor. She herself was wounded and watched her little sister die on the way to the doctor. Illir was too badly injured to know what was happening. Now he is very angry. When I asked if he wanted to explain what happened to him, he started to cry and an uncle rushed across and begged him to stop. It would do no harm, I suggested, if he could cry for a bit. After a time he started to rage, not so much about his dead father but about how dangerous everything was now, how hundreds and thousands had been made homeless and how many had been killed. ‘And they will lay mines and they will shell us again and they will kill old ladies and children and they do not care, and who will look after us now? There is no one and we will never be safe.’ He went on in this vein, curled up hot and sweaty with my arms round him on one side and his uncle’s on the other, Bini translating in a low murmur as the others pressed up close, half of them crying as well.

14 January. Another NGO asked me to assess Faton, a 14-year-old. He and his father, 20-year-old brother and two uncles were taken by the police, stripped naked and badly beaten. Then, because his father pleaded for his life, Faton was allowed to escape. He wandered in the woods for two days until he found his way home. Meanwhile the police had rounded up his female relatives. ‘They put a gun in my mouth and said give us weapons,’ his mother told me. ‘I said: “I don’t have any so kill me if you want.” Then they told me to go and look for my husband, whom they had killed. We had heard the shots.’ What she found first were the piles of clothes, then the cut and beaten bodies – her eldest son’s eyes had been gouged out. When Faton came home he clung without speaking to his mother for two weeks. Now, some three months later, the family are still displaced and live in one room. Faton is frightened all the time, jumpy, and unable to sleep. His head is full of images of the police. I teach him muscular relaxation. At least it makes him and the family laugh. I also teach him ways to keep the thoughts at bay, promising to visit again and practise with him. It is one thing to treat children when the source of distress is irrational, or has to do with some event that is properly in the past; quite another when the object of fear remains visible from the bottom of the garden, fully armed with a machine-gun and knife.

Driving home, I saw some small boys playing ice hockey on a frozen stream, skating on foot-skis. But the landscape is mapped by the horrors of my patients’ stories: the iron-works that figure in 16-year-old Dardan’s nightmares because he saw five men thrown into the furnace when he was imprisoned there; the red brick farm where Arlinda’s invalid father was executed with all the men of his village; the small wooded valley where Simon’s mother, aunt, grandmother and three young cousins are buried, having been killed, along with 16 others.

18 January. It is three days since the massacre at Recak. International Medical Corps suggested I go out with them to do some kind of psycho-social assessment of the displaced families in the neighbouring villages. We set off in a convoy of four vehicles carrying food, blankets and plastic. The roads were narrow and twisting, with deep ruts in the frozen snow. We encountered small groups of people everywhere, some in outdoor clothes, some less adequately dressed, none with any idea of which way to go. We were not sure either, as by this point we could hear shelling, although where it was coming from was unclear. We told them which village we were headed for and suggested they come and pick up food and blankets there. Petrovac, three kilometres from Recak, was half-destroyed, and seemingly deserted, except for six women and girls weeping and completely bewildered in the middle of the street. Apparently there were more people sheltering in one of the houses and a woman in labour in another. The IMC field co-ordinator decided to split the convoy, leaving me to find the other villagers and the Médecins du Monde obstetric team to attend to the woman in labour, while he took two cars to assess the next village.

The women and children led me to a house where twenty or thirty women, children and babies and one very old man were sitting in a single room, terrified, listening to the sound of shelling, which was now quite close and frequent. ‘It’s been going on intermittently for three days,’ the owner of the house said. ‘Most people are in the mountains but these are too old or weak to travel, so I said they could come here, but we’ve had nothing to eat, and what everyone wants is to leave.’ A plump woman in a leather coat burst into tears: her cousin had been killed in Recak, please would I take her away?

I sat on the floor drinking the coffee that they had insisted on making me and wondering what I was going to do. If I emptied all the materials from the car, I could fit in three people. MDM would have the pregnant lady, but it seemed unlikely that the other two cars would drive back into a bombardment to collect us. I said, more reassuringly than I felt, that it would be better if we all stayed inside for the moment, and that I did have some food and blankets. A 14-year-old girl told me she had seen her uncle killed in front of her. I put an arm around her thin shoulders and she cried and cried. The owner was saying he had a more secure basement if necessary. Then I heard someone shouting in English from the yard and went out onto the balcony to see a bespectacled man wearing the OSCE badge of the Kosovo Verification Mission.

‘Are you the doctor? I’ve come to tell you to leave, as it’s getting very dangerous.’

‘That’s very kind of you, but there are 27 women and children here and I really don’t feel we can leave them behind. I can get three in my vehicle, what about you?’

The OSCE man considered this for a moment.

‘Probably five. I will call up another vehicle, see what I can do.’

We unloaded the aid we were carrying and waited while the local KLA men cheered us up by saying it would be good if we could go soon, as there were tanks heading our way. When two UNHCR cars and another OSCE car turned up, just like the cavalry, we found a place for everyone from the house. We drove the five kilometres to Stimje in convoy and arrived in a sunlit main street with no sign of destruction, people shopping, IMC waiting. The only evidence of war was the large number of journalists fastening onto our disembarking passengers like seagulls diving for food. The disjuncture was so great I wanted to shake my head clear, wondering if I had imagined the whole thing.

I do not know how to do any kind of psycho-social work in this context. If people are terrified the only thing to do is to try and make them safe, no amount of empathy or counselling can substitute for action to change the situation. One of the local doctors that I teach remarked the other day that it was all very well understanding how the individual responded to stress, but wasn’t the Albanian population suffering from communal stress, brought on by the last few years of living under some sort of apartheid, and did I honestly think there was a medical solution for that?

Recak has frightened everyone and even those who were hoping that better times might be coming are now sure they are not. Security is what people want. Most fit young men in most of the villages I visit serve in what they call ‘our army’, because they see no other way to make themselves safe. There are no neutral civilians in this war. Milosevic is right. If he wants to eliminate the KLA, he will have to uproot the civilian population: a project in which he has already had some success, and in which I and the international community assisted him today.

26 January. The other morning my driver said he did not care where he lived as long as it was safe and he could have a decent life, without it mattering whether he was Albanian or not. We had spent two hours with a family who had fled to the hills in May when their house was destroyed, come home in June and spent the summer rebuilding, only to see it all reduced to rubble in September – and this time one sister killed by shelling. The mother is seriously depressed and they all sit aimlessly on blanket-covered sofas in a cousin’s room wondering if I will do anything to ‘lift the grief.’ Their material circumstances are not so terrible – the room is dry and warm and clean – but the apathy, the feeling of hopelessness is unbearable. It is the endless repetition of these little scenes across the country that wears you down. There is a grandmother with a tiny room above her daughter-in-law’s stable. They all live in it now, because the main house has burned down; and while I might find an odd beauty in climbing ancient stairs past a byre with the soft sound of cows below, they are deeply ashamed. ‘We have not lived here for twenty years,’ they say. The grandmother lost most of her relatives in the Obrinj massacre and has stopped eating and ‘gone off her feet’. She has terrible arthritis and heart failure as well, but it is grief that is killing her. She lies curled up under a blanket with the few remains of everyone’s belongings piled around her.

Sometimes I feel I am drowning in a sea of grief. The days blur into each other and the stories lose their edges. It seems as if I have been driving for ever on snow-covered roads, over streams, past small stands of oak trees and into the shells of former villages, to be ushered through gates into a walled compound where the main house stands roofless and windowless and the family have moved into the outhouse. I take off my shoes and am led over plastic and paper to a carpeted room with blanket-covered sofas on four sides, smoke-blackened walls, a cast-iron stove, magazine pictures and photos tacked to the wall. I am served cheap soft drinks, coffee or glasses of tea, as families talk of what has happened and who was lost and what, if anything, remains.

There are a small number of patients who have serious psychiatric problems. Today I saw one woman with a severe agitated depression and another who was psychotic, but the vast majority are not psychiatrically unwell, they are simply overwhelmed by the magnitude of their loss. They want me to provide some symptomatic relief, but more importantly they see me as a witness, someone from outside who will listen to what has happened and, by listening, give it validity, even if I cannot offer real solutions.

10 February. ‘It’s not exactly Belfast yet,’ our Head of Office says, starting the weekly programme manager’s meeting. Albanians have been killed in ones and twos all over Kosovo in the last week, and while the Serbs allowed the KLA onto an aeroplane to go to Rambouillet, one Albanian mother and child, and an elderly grocer have paid the price in a bomb attack in the centre of Pristina. Aid vehicles are increasingly targeted, with slashed tyres, stones through windows. The incidence of tit-for-tat grenade attacks on Serb and Albanian bars is increasing and we are all now restricted to cafés and bars either below ground or one floor up. Car checks are mandatory. It feels as if peace is the other side of an electrified fence: you can see it from close up, but no one has worked out how to switch off the current or open the gate; meanwhile there are negotiations going on about how to reduce the voltage.

Yesterday Laura arranged half my dolls in a box and told me they were attending a peace conference. Illir wanted to know ‘which one is Slobodan, so I can kill him’. Laura told him Slobo was not there, and that he should not play war all the time, but Illir played war for the rest of the session. He piled up the remaining dolls, called them Serbs and then mowed them down with tanks, he dug trenches, became a KLA commander, ordered the bombing of Belgrade, and organised a funeral for dead KLA soldiers.

Not all my children play like this. Simon, who has lost many more of his family than Illir, is entirely apolitical and constructive. An intelligent, serious five-year-old, he loves the toy mobile phone for the different musical notes it makes, and has spent most of the last few sessions experimenting to see what degree of vertical tilt he can apply to the railway-track and still get the toy train to run. In conversation we edge towards what has happened to his family. I do not see my job as ‘making children talk’ so much as helping parents to listen and to answer any questions as straightforwardly as they can. In many of the families, there is a conspiracy of silence. The remaining parent lies to protect the child and the child keeps quiet to protect the parent, knowing that certain questions make mummy cry. In this way the fear and perplexity grow. In one family, the mother had told the children that Daddy was in Germany, while they were hearing in the village that he had been killed. Simon has started to talk about some of his experiences with his father, and to look at pictures of his mother.

23 February, Skopje. I came back from a week’s leave to find myself evacuated to Macedonia. We all sit glued to the TV, flicking from CNN to Euronews to the BBC. Will they sign, won’t they? I can’t believe the Albanians are about to turn down the best deal they are likely to get from the West. Rumours drift in from the border: it is closed (not true); the Yugoslav Army have mined the bridge on the main road to Pristina in preparation for a Nato invasion (true). There are hundreds of Albanians crossing the Macedonian border (also true); perhaps we will have to run our clinics here.

26 February, Pristina. So they didn’t sign, and we are back in Kosovo. There are now tanks, soldiers and police everywhere. I had to wait for 30 minutes yesterday morning while a Yugoslav army convoy left the base on the edge of town on its way to a ‘military training exercise’. In my area it is all very quiet I am beginning to understand why the KLA refused to sign. I went to give a load of baby-hygiene kits to Dr E and found him lounging on his examination couch dressed for the first time in army fatigues. ‘When I heard they wanted to disarm the KLA, I immediately put on my uniform.’ He thinks Nato is not serious. It made promises and threats all last year and never acted. The Yugoslav security forces are building up by the day, in massive breach of last October’s agreement. There is fighting in the north, still no response from Nato. So why would it be different in future? ‘We would sign and then be stuffed.’ But there does seem to be some genuine consultation going on, and the general opinion seems to be that they should sign.

10 March. This process of democratic consultation may cost the Albanians dear. The violence grows by the day. Thirty or forty Albanian shops were destroyed in a nearby town a few days ago. Every day of the week there are machine-gun attacks or grenades in bars somewhere in the province. On Serbian TV we are treated to Deputy Prime Minister Vojislav Seselj threatening the mass killing and expulsion of Albanians if Nato comes in. The Yugoslav Army have decided to secure the Macedonian border to prevent Nato getting through and to stop weapons smuggling. They say there are ‘no restrictions on civilians living in the area’, but this does not seem to have reassured anyone. About five thousand people have fled in the last few days. UNHCR say that between sixty and eighty thousand have been displaced since Christmas. There is continual shelling. Every child psychiatrist knows that to threaten and do nothing invites escalation, and that is exactly what is happening. It seems perfectly possible that large parts of Kosovo will have been destroyed before anyone gets to the next round of negotiations in Paris. Illir spent a lot of time playing with the toy mobile phone in his last session, calling up Mark or me to come and get him as he was in danger and needed help.

12 March. I went out with one of the mobile teams to a village in Klina to see psychiatric cases but none arrived so I played GP for the day, reviewing the usual mixture of babies’ coughs and colds and elderly ladies with high blood pressure and aches and pains, until the last patient came in: a very thin man with bulging eyes, sweaty skin and a look of extreme anxiety. This is the sort of diagnosis that medical students should be able to make across the room: thyrotoxicosis – too much thyroid hormone pumping round his body, making him, as he told me, agitated and restless, making his heart beat too fast and giving him bouts of chest pain. He knew what was wrong. Until a year ago he had regular treatment and check-ups in Pristina, but the war put a stop to that and for the last two weeks he has felt increasingly ill. We had run out of the drugs that might help him, and anyway he needed hospital admission.

The trouble is that none of the mobile teams carries men of his age – fighting age – as a matter of policy. The fact that he has always been a civilian and an invalid does not matter. A few days ago the IMC medical co-ordinator watched helplessly alongside monitors from the Kosovo Verification Mission, as a hundred men were separated out from a refugee group near the border and taken to a police station. The pressure on the mobile medical teams is growing by the day; Médecins sans Frontières, for example, has been accused of smuggling weapons and assisting terrorists – completely untrue. All our cars are regularly stopped and searched. Recently a colleague of mine had a female patient taken out of his patrol and interrogated for five hours before being released. A few days later, the police impounded his drug boxes for a customs check. On discovering that everything was in order they announced that customs never return confiscated goods.

So we drove into Klina and asked if the OSCE would escort us, as this was a medical emergency. We then drove out together to the man’s house. His family gathered around him as I explained that we would take him but that even the presence of the monitors could not provide an absolute guarantee. Nor could we guarantee his security once he was in hospital: people have been arrested there. The man stood in the garden in the spring sun, his feet half-pushed into old shoes, surrounded by his family, children and dogs, and agonised. He had been arrested and interrogated by the police the last time he went into Klina. I explained that his condition was very serious, possibly fatal, and unlikely to improve without treatment; that we would do all in our power to give him safe conduct, but that our powers were limited: it had to be his decision. He decided not to go, and his family seemed to agree. This is the war the world does not see on television, where a man would rather risk a heart attack than travel to get medical assistance.

15 March. Seven Albanians including a five-year-old were killed in bomb attacks in two marketplaces, as the Albanian delegation left for Paris. The Serbian news scarcely mentioned it. They led with the 1001 pigeons that have been sent from Belgrade as a message of peace. I have worked all day with the sound of distant thunder in my ears – the continuous shelling of villages south of Mitrovica. People listen, judge the distance, shrug and carry on, despite the absence of seed, of animals and of a roof. Actually a lot of roofs have been replaced, and holes in walls patched up, but few fields are ploughed. There is fresh grass appearing where there should be newly-turned earth, so this year again there will be little food.

I went to see Faton, who has moved back home with his family, but he is not improving. Whenever police cars go by on the main road (which they do very frequently) he becomes extremely distressed. When his family try to calm him he shouts: ‘You have not been in their hands as I have.’ My techniques help a bit but the images still fill his mind. He feels guilty at being alive when his father, uncles and brother are dead, and thinks often of killing himself. Luckily he has a sensible best friend/cousin who is with him all the time. I know I may be evacuated again in a few days and decide to start him on medication while there is still time to monitor it.

I got home to find the Albanians have signed the peace accord at Rambouillet, accepting disarmament, autonomy and no guarantee of independence. Baton Haxhiu, the editor of Koha Ditore, ate with us in the pizzeria. He was furious with Hasim Thaqi, one of the KLA negotiators, for holding out for so long, giving the Serbs the time for a massive military build-up. ‘People like that should not be politicians, if they cannot act responsibly.’ Milosevic, he pointed out, has now concentrated almost two-thirds of his military hardware in and around Kosovo. ‘If there are airstrikes here, the Albanian population will be attacked, but airstrikes elsewhere will not achieve anything.’ In fact, the Albanians are hostages whatever happens, to all-out war if the West does nothing, and terrible reprisals if they act. Ylber Hysa, a writer, rang me tonight and asked whether I can take his family with me if I am evacuated. Of course.

Illir is in hospital, it looks like he has osteomyelitis. When I tried to get to see him the Serbian guard at the door of the orthopaedic ward refused me entry. ‘Can I see the duty doctor?’

‘He’s out.’

‘And the sister in charge?’

‘She is not here.’

He was in his little booth, with his electric heater and newspaper. I was powerless.

18 March. The villages in eastern Drenica are under continual bombardment. Nine thousand have fled in the last three days. Driving up towards Likovc Bini and I notice new trenches and piles of stones by the road, presumably to be used as some form of barricade. I asked Simon how things had been in the last week.

‘Fine.’

‘Anything happened?’

‘War, and more war,’ he said in a weary way.

‘Are you frightened?’

‘No.’

In the last two sessions he has been putting various plastic animals and dolls on the railway line and taking pleasure in the train crashing into them.

‘Nato will come and kill all the Serbs.’

‘Do you want them killed?’

‘Yes, because they are killing us.’

Today he made a pile of all the small plastic objects saying: ‘Look, I’ve got ammunition – lots of ammunition.’

I told his father I was concerned about a renewed onslaught on the village. Would he let us take the children out to Pristina? But he didn’t want them to go at the moment. Knowing the children would find leaving him almost as terrifying as facing renewed shelling, I didn’t push it.

Illir’s family are glad he is in hospital as they feel increasingly unsafe, and Faton at least has had a few nights dreamless sleep. His cousin says he is less preoccupied, so I leave a month’s supply of drugs. I got back into town to find that the talks in Rambouillet had collapsed and that we could be evacuated at anytime. Illir is apparently being discharged, so I must get him home. I worry how his family will cope if they have to flee with a child on crutches.

19 March. I came in to find that the US Office for Disaster Assistance, who fund us, had asked us to cancel all field operations today, as they felt it was too dangerous. My dilemma over Illir was solved by Dr C, his consultant, deciding he is, after all, not well enough to be discharged. Dr C is one of Kosovo’s leading Albanian orthopaedic surgeons. Universally admired, he has kept his job in the hospital. We agreed that Illir was probably safer here than at home and Dr C promised to look after him. When I went up to visit Illir, I found my way blocked by a small phalanx of cleaners, who said I couldn’t walk on the wet floor. Had they not at the same moment allowed two Serbian doctors and a man in filthy trainers straight through, I might have believed them. As I tried to creep by in his wake, they screamed at me in Serbian that I was ‘uncultured’. So back to Dr C, who ushered me past the glaring but now silent cleaners to Illir’s room. He was lying on his bed, staring at a battered Serbian children’s book. He does not speak the language, but the ward had no Albanian books. He was angry and fed up at not going home, so Bini and I told him about yesterday’s visit and I started to tell him a story. Then my mobile phone went. It was our field officer, saying I would be evacuated in an hour and a half.

How to tell a sick and lonely ten-year-old in a hostile hospital ward that you are leaving immediately and do not know when you will come back, because there may be airstrikes? That you do not want to go at all, but have no choice because you are now a pawn in a larger game called ‘Evacuate Internationals to Show Milosevic We Are Serious’? And that you have absolutely no idea what is likely to happen, except that in the short term it is not going to get better? I hugged him, promised to return whenever I could and hid some money in his trouser pocket. It felt like abandonment to me, and I know that is what it felt like to him. Then I was running across the hospital grounds. Before long we were in a small convoy of national and international staff on the road to Skopje. At the border the Serbian customs officer was unusually friendly. ‘Why are you leaving?’ he asked Ylber’s wife, Elvira, smiling down at her baby, ‘Nothing is going to happen.’

6 April, Blace, Macedonia. Yesterday’s shift began in the medical tent at the Blace border crossing at 4 p.m. A squalid encampment of plastic shelters stretches across water meadows beside the railway line as far as the eye can see. The train continues to shuttle into no man’s land, dropping off yet more people. Our medical tent is full. The mattresses and blankets are damp and filthy. There has been no time to dry anything out, as stretcher-bearers keep running new cases in. A rest tent was put up three days ago, but it is already completely full of chronically sick or paralysed people who are not well enough to put on buses and not sick enough for the Macedonian Red Cross to transfer them to hospital. The Macedonian Red Cross seems reluctant to deal with anyone. A number of their doctors are present but their tent remains empty. I spent Friday trying to persuade them to transfer three emergencies: a pregnant woman who had been bleeding for three days; a man with all the symptoms of a perforated ulcer; and another with a suspected myocardial infarction. The only way to get a response was to secure the intercession of the Albanian Deputy Minister of Health, who fortunately stuck his head in our tent from time to time.

In the evening there was the usual procession of hyperventilators: young women, so distressed that their rapid breathing brought on a temporary paralysis in the hands. Just before I ended my shift at midnight I was asked to see a man who was trying to bite anyone who came near him. He was sitting tense and shoeless outside the tent. His wife, in tears, said he had never been like this before but had suddenly ‘gone crazy’. He was too angry and incoherent to interview, but Dr L and I managed to slip our arms through his and lead him into the tent. To my relief, he accepted the drugs I offered and promptly fell into a deep sleep on one of the wet mattresses. I don’t think it is the horror of being driven from their homes at gunpoint that pushes some people over the edge, but the humiliation first of suffering those experiences and then of finding themselves penned like animals in a field full of garbage and excrement, given occasional handouts of food, water, plastic and blankets, but deprived of any information, or any control over what happens to them.

It is impossible to stay focused on individuals. I wake up tired old ladies after two hours’ sleep to tell them their mattress is needed by someone sicker than themselves. I walk along the muddy track between the police line and crush barriers scanning faces for friends and trying not to hear the endless requests called out to me. ‘Where are we going? What is going to happen to us?’ ‘I am so sorry, I don’t know,’ I keep mumbling hopelessly.

My biting man was himself again today, but there was no knowing from such a short assessment whether this was the beginning of something serious. I have never practised in this way before. One brief contact and then I consign my patients to the void. I gave his wife some medicine to administer if he became disturbed again and told her to get medical help. She rummaged in her bag and insisted on giving me a blue silk scarf. After she had gone I leant against the Land Rover and wept.

7 April, Kukes, Albania. Yesterday afternoon we found Bini’s parents in the medical tent. They lived in an apartment block in the centre of Pristina. His mother told us the first night of bombing felt like liberation. Then the Serbs set up a sniper position in the flat above them and a tank appeared below the balcony. Tanks were also jammed in all the spaces under the apartment blocks. The words ‘Don’t Touch’ along with the 4 Cs symbol appeared in Cyrillic on her Serbian neighbour’s door and Bini’s father, who is close to Rugova, received a visit from three armed police who searched through all his books and papers and shouted abuse. The police returned the next day with machineguns and told them to take the train to Skopje immediately. They had a car so they drove and spent four nights queuing at the border. Nothing terrible happened to them but they saw others beaten and harassed for money, and watched as fresh graves were dug by the roadside. Serb civilians were asking 100 Deutschmarks for bread and 50 Deutschmarks for one minute on the phone. The nights were worse, with the police drunk and abusive. Eventually they decided to abandon the car and walk into the field. They chose the right moment: at 7 a.m. yesterday morning they saw the Serb police turn the remaining queue around at gunpoint and force it back towards Pristina. Today Serbian TV has announced a unilateral Easter ceasefire and says all refugees can come home. Bini’s father, normally a moderate man, wants the Nato bombing intensified.

Two more psychotic patients last night. One was a middle-aged university man, who suddenly turned on his Albanian neighbour as they were waiting in the field at Blace for the buses to show up, and tried to kill him with the open end of a tin can. He sat with us in the medical tent, words pouring out at a fantastic rate as he explained how his son had told him to cheer up, because the red buses were coming to take them all to Nato camps. When he saw that the buses were white he ‘knew’ that they had come to take them to their deaths. And when he saw a policeman’s head turned at a particular angle he ‘knew’ that his neighbour, whom he had never liked, was in a conspiracy to kill his only son, so he had to kill him first. He did not think he was ill, but was happy to take something to calm him down, as he had not slept for five nights.

As for the buses, they were arriving in unusually large numbers and people were being processed at speed. When I walked into the field at 11 p.m., it was a mass of sodden blankets, torn plastic and abandoned personal possessions: shoes, wet jumpers and coats, children’s toys, half-eaten food. The Macedonians, in remarkable synchronisation with the Serbs, had decided to clear their side of the border area. No one was told where they were going. UNHCR thought it might be Albania or Greece. This morning around thirty thousand people have ‘disappeared’.

8 May. A friend from Drenica turned up in the Bar American last night. He seems to be able to get in and out. He told me that almost all of the villages in which I worked have been destroyed, but that Simon and his family are alive in an area held by the KLA. No news of Illir and Laura, however, or of any of my other patients. The rest of his story is a catalogue of death and destruction. I cannot take in all the details, and I have no way of figuring out what is true, but what he says ties in well enough with the individual accounts I listen to every day. Yesterday a patient told me that their entire extended family, including 12 children, were gunned to death around them. And this morning we heard that Fehmi Agani, Rugova’s adviser, was pulled off a train to Macedonia and shot. But my friend thinks it would have been ‘ten times worse’ if Nato had not intervened. He wanted Nato to do something as quickly as possible about the 800,000 still trapped inside. Airdrops of food and arms and the deployment of ground troops were what he had in mind. As to the West’s continuing commitment to autonomy rather than independence: ‘The destruction of the Yugoslav killing machine will bring independence.’

My working life is acquiring some kind of stability. Six of us pay an exorbitant rent for a tiny apartment looking out on a tractor camp where families are sleeping 15 to a trailer. I have two clinics. One is in the dilapidated state-run polyclinic in the centre of town. We spent our first morning scrubbing the floor and buying chairs for patients to sit on. I saw an eight-year-old Kosovar girl who is clearly autistic. Her family told me she was the one person totally unaffected by the shelling of their village. But where to find the special education that she needs? The second clinic is in the field hospital of the United Arab Emirates Camp. Dr Sayeed, a Dublin-trained consultant physician, has given me a tent and allowed me to carpet it with mattresses and blankets so that it vaguely resembles a Kosovar sitting-room. The doctors here agree that grief, anger and disorganisation are normal responses to what has happened. They do not, thank goodness, label everyone as ‘traumatised’. So my time is taken up with the seriously unwell: those who were sick before, or who are now completely overwhelmed. And for the first time in my life I am working with a physician who lets me put psychiatric patients in a medical ward. They include a Bosnian woman who wandered across the border, dishevelled, disoriented and mumbling to herself about Zvornik (ethnically cleansed in 1992). She appears to have chronic schizophrenia. I am hoping she will respond a little to being clean and stable and on medication, and perhaps her husband and sons, who she says lived in Prizren, will turn up. Then there is a boy of 12 who opened his door eight weeks ago (before the air-strikes began) to find seven bodies outside, including his cousin’s. Like Faton, he is jumpy, unable to sleep and unable to keep the images at bay. And to his deep embarrassment he wets the bed every night. We have cured this simply by moving him from a tent containing 26 people and miles from the latrines to the children’s ward, where he feels safe to go to the toilet at night.

The stability is illusory, however. UNHCR and the Albanian Government keep telling us how insecure it is here because, along with the Apache helicopters, we are within range of Serbian artillery. So everyone should move south. Serbs are not the only threat. Refugees, aid workers and journalists have all been robbed at gunpoint. A couple of days ago some Kosovar refugees held up staff in a food tent with a hand grenade and a pistol. One man at the UAE camp was somehow arrested by KLA police posing as civilians, interrogated and beaten for two days for suspected collaboration with the Serbs, then released with an apology. The incomers (some seven thousand yesterday) for the most part move on within a few hours. But the effect of these exhortations to head south on those already settled is simply to increase the general feeling of unease, because so far no new sites have been established. The UAE administration went to see a site offered by the Albanian Government, only to find it was a marsh full of toxic waste with no access to clean water or electricity. The UAE also decided to register all those who would like to relocate when they do find a site for the camp. Three hundred out of eight thousand registered, which puts paid to the idea that people are staying because some camps provide ‘luxury conditions’. (Hard to see a 26-person tent with a rubble floor as luxurious.) Most people have clung to the ruins of their villages until driven out. They will stay here in the open air, risking Serb artillery fire if they have to, because moving on would mean they had given up on the possibility of going home. Staying put signifies their refusal to accept that Kosovo is lost.