Fokko de Vries, MDA Doctor's Diary from Macedonia

Fokko de Vries, MD, (38) left Amsterdam in early April to assist Doctors Without Borders in refugee camps in Macedonia. He has previously worked in Sarajevo, Rwanda, and Sri Lanka. Fokko kept a diary of his first week in the camps in Brazda and Ragusa.

Wednesday 7 April

We depart from Zestienhoven in a Russian freight plane chartered from a Romanian airline. We are a mixed company of doctors, nurses, logisticians, and press people. We try to conceal our fear of flying with jokes about draughty windows, rusted-up wings, and loose bolts. The cargo is made up of all sorts of aid supplies, presenting us with a view of several hundred latrine plates. They are for building squat toilets that consist of a piece of plastic with a hole and two footprints and make me think of the footprints of Gavrillo Princip, the assassin of the Hamburg crown prince Frans Ferdinand, in the pavement of Sarajevo. They were preserved at the exact spot where he fired the fatal shots that led to the First World War. They have since been removed, hacked out of the pavement since the last war in Bosnia, because Princip was a Serb.

The flight is breathtakingly beautiful, with a detour via Italy because the airspace is partially closed as a result of the tomahawk diplomacy being waged below. On our arrival at Skopje airport a uniformed individual gratuitously snarls at us that it's all Clinton's fault. In the corner of the airport a group of refugees are waiting for a flight to an unknown destination in a 'third country.' Turkey? Norway? There are rumors about Cuba - why not? There are even Bosnians who have landed in Bangladesh. Of their own free will, of course. After all, someone who has been driven out their home, separated from their family and utterly exhausted is perfectly able to make decisions. At least that's what the host countries would have us believe.

Thursday, 8 April

I visit the refugee camps Stankovic and Brazde, between Skopje and the Kosovo border. Brazde is a former airfield that still has a hangar and two old propeller planes. There is a large NATO presence in both camps. Soldiers are working day and night at setting up tents, distributing food and blankets, setting up water facilities, building latrines and carrying away refuse. Brazde accommodates some 20,000 people, a number that is constantly changing with the continued arrival of new refugees and the evacuation of the ad-hoc camp at Blace. The presence of so much armed green comes as a shock for the Doctors Without Borders veterans, something without precedent. A humanitarian mission is difficult to square with a military mission. The initial confusion gives way to a purposeful approach: the building up of a Doctors Without Borders' presence and the planning for a seamless handover with the military.

Around the Brazde camp stand armed Macedonian police and soldiers. There is no freedom of movement. This is against international law, which says that refugees are free to move around after being registered. But we now know that many international treaties - with a nod to Bismark - are not worth the paper they are written on.

Friday 9 April

I carry out a reconnaissance mission to check out the situation on the Yugoslav/Macedonian border. Driving through the part of Macedonia mainly populated by Albanians, we hear on the radio a version of the former Eagles hit: 'Welcome to hotel Macedonia'. Our driver, of mixed Albanian, Macedonian and Turkish descent - a typical specimen of Homo balkanus - shakes his head pityingly.

The Macedonian border is closed. On a pretext, I manage to cross the hundred-meter wide no-man's land. A stethoscope round the neck works wonders! Some 250 people have been camping in the strip since yesterday evening. The Serbian border police had (mis)informed them that they would be allowed into Macedonia if they left their cars behind. And would they be so kind as to hand over the car keys?

Much more serious is the report that some 300 hundred cars - number of people unknown, but including the people already in no man's land - were sent back to Yugoslavia in a joint action by the Serbian and Macedonian police. There are stories that they are to be used as a human shield. It can't be verified in the present circumstances, but nothing can be excluded either. A long queue of people are waiting at the closed Serbian border. A human chain of misery stretching out towards the border from every little village in Kosovo, facing an uncertain future. A chain of hundreds of thousands of innocent citizens.

Nobody dares to cross the mountains along this part of the Serbian border. The rumor of landmines alone is enough to stop people, whether true or not. A busload of people are carried off under police escort to the Neprostance refugee camp, which is run by German NATO troops.

Saturday, 10 April

This morning, visit the mobile hospital set up by the Israeli army in Brazde refugee camp. They have an operating theatre, laboratory, X-ray equipment and even a blood bank. The way they work and speak is extraordinarily professional. But there again, they already have more than 50 years of war experience. I then hold a clinic myself. Doctors Without Borders has set up a number of polyclinics, a dressing station, and a dispensary. All rather improvised at first. It's not exactly easy listening to heart and lung murmers through the noise of the generators powering the high-tech mortuary set up by the Norwegians.

Most of the medical problems are chronic conditions. People with high blood pressure, diabetes, epilepsy, and asthma who no longer have any medicine, as most of the refugees have nothing more than the clothes they stand up in. Other problems are typical camp complaints: diarrhea, colds, mange, and lice. Finally there are the mental problems. People present vague complaints, but as soon as they feel somewhat reassured we give them an opportunity to let it all out, to tell their stories.

There is a constant pattern in the stories, which are now generally familiar. Everybody speaks of masked paramilitaries, looting, threats, the midnight knock on the door, the bodies lying here and there. Some people recognized the voice of their neighbors behind the masks. The people are mostly still anesthetized, in the phase of denial and disbelief. In the coming weeks this will crystalize out into more specific psychiatric problems of unrestrained aggression, nightmares and depressions. A growing number of women are no longer able to breastfeed as a result of the tension.

My colleague, a pediatrician who has his tent close by, tells his personal story to the refugees. How he was driven out of Hungary by the Russians as a 12 year-old child. He tries to get across the message that it doesn't have to represent the end of your life, and that it means a lot for him personally to be able to help other people now.

A girl of 15 has a panic attack. I try to calm her, and we chat about the Spice Girls and Brad Pitt. But she's a Back Street Boys fan, which puts me in a different generation. We share our feelings of rage and powerlessness with the refugees. In the evening we chat with the other members of our team over a glass of the local ouzo. A clear sky above us, blossoming trees in front of us. In the distance is a white streak above and below the mountains. Snow is lying above, and the tents are standing below. It's cold in Brazde.

Sunday, 11 April

Today - Easter Sunday according to the orthodox calendar - the medical care in Brazde camp is formally handed over by NATO to the aid organizations. This is an historic event, something that has never happened before. British, German, Dutch, Italian and Norwegian soldiers stand in a semi-circle. A priest in army uniform holds a speech full of Bible quotes about good and evil. Many blink away a tear, and some psalms are sung. A Kosovar boy has pushed to the front. His shoes are three sizes too large. The serene silence is broken now and then by low-flying helicopters or a mobile phone with the tones of Big Ben. But the most startling is the British colonel who with an eye to the watching cameras finishes with 'See you all in Pristina!'

Hold a clinic for the rest of the day. We're having more and more trouble with journalists. I have mixed feelings about them. The American press in particular gives me the feeling of wanting to soften up public resistance to a possible ground war. A number of journalists in search of steamy stories ask specifically for women who have been raped. I break off a number of interviews because of attempts to make me come out with explicit political statements concerning NATO and Doctors Without Borders.

I continue my clinic. A following patient tells me that he was tortured by the Serbian police one and a half years ago. He was struck repeatedly on the neck until he lost control of the right side of his body. Then they let a teargas grenade explode in his hand and cut off the remains of his fingers with a pair of scissors. I can do no more than report the facts. He needs plastic surgery, but above all pyscho-social therapy. He is alone in the camp. There is no news of his family.

The whole conflict consists of numbers. So many refugees here, so many people killed there. But in the end it is a summation of individual suffering. Each person has their individual story. The story of expulsion, flight, waiting at the border, the conditions in the camp, the loss of all future perspective, but above all the uncertainty as to the fate of loved ones and the absolute certainty as to the fate of loved ones who have already been murdered.

I suggest to the boy that he should have psycho-social counseling and some psychiatric medication. He dismisses this, on the grounds that he is not worth it. An extremely low self-valuation is another expression of trauma. However he agrees to have his story written down by human rights experts, as in this way the guilty parties may perhaps one day - but probably never will - be brought to justice.

In addition to its medical mission, Doctors Without Borders also has a clear advocacy mission. We are also very well aware of our special responsibility in this respect. Apart from medical secrecy, it is unethical to get traumatized people to tell their story without after-care being organised. Doctors Without Borders will therefore survey the need for a psychological trauma treatment program, based on know-how previously acquired in Sarajevo. This is especially desirable for people being cared for by private individuals at home. It is also a preventative activity.

Monday 12 April

This morning, examine a patient who is eight months pregnant. I let her hear the baby's heart beating. She begins to cry. She has waited ten years for the pregnancy. And then this. What sort of life will her child have? In the afternoon it is the turn of the Italian medical troops, our neighbors in the camp, to leave. How different from the British ceremony. An officer blows up a plastic glove, draws a face on it, calls it Pinocchio and gives it to us as a mascot. Ciao bambini! We will miss them.

Afterwards I once more see the patient who has been tortured. He has become unreachable, with hallucinations about cetniks pursuing him in the camp. Alas, I have to give him an injection to calm him down, but he deserves better treatment. As I walk through the camp for a 'house call', I'm assailed from all sides with the question of whether I have a telephone. Just as in Africa you constantly hear 'mzungu, mzungu' (white person) all around you, and in Amsterdam 'hashish? hashish?', here you constantly hear 'telephone? telephone?'. Information from the home front is terribly important for the refugees. In this post-modern age there could well be place for a humanitarian organisation that distributes mobile telephones, for example TSF: 'Télécommunication Sans Frontières'.

The few times that we lend someone a mobile phone are particularly emotional. What conclusion should you draw if nobody answers at home? Or if the line is engaged? Sometimes a stranger picks up the phone. That evening there is an internal discussion at Doctors Without Borders about whether or not we should go into Kosovo. We share our concern about the situation there. The refugees that we are caring for now - however bad their situation may be - are at least safe for the time being. The majority of the Kosovars are still in Kosovo, for the moment at least. We can only guess at their fate. The discussion brings up all sorts of aspects that touch on individual consciences and fears. But the feeling of powerlessness predominates.

I drive back home with a Kosovar cardiologist who has started today with Doctors Without Borders. His name is Lullie, which sounds absurd to Dutch ears. He tells me that as a refugee he was taken in by total strangers, ethnic Albanians. I can't see Dutch people doing that. When I ask whether Macedonians have also taken in Kosovars he simply laughs. He then tells me about rumors that Yugoslavia wants to become a member of the Russian Federation.

Tuesday, 13 April

The taxi driver who takes me to the office holds a monologue in broken German, French and English - the lingua franca of all taxi drivers - about Greater Albania, Clinton, Lewinsky, and the usual. He has worked for three years in Iraq. Yugoslavia built the military airfields there. Which of course have now also been destroyed by American bombs. We drive past the wrecked station building where the clock on the front wall has remained stopped at the moment when the earthquake struck Skopje in 1963. I then leave for the Radusa refugee camp near the Yugoslav border. Or is it the Serbian border? Or soon just the Kosovar border? Time will tell.

The trip is breath-taking, through an empty, innocent landscape. There is a rusted railway line from the time when the iron mines were still being worked. Since then there has been an economic slump. Birds of prey circle above our heads. Suddenly we see the camp, a large number of tents set up without intervening spaces on the side of a mountain. Some 1,200 people are living on this patch of mud, far from the inhabited world. The camp is organised by the Macedonian government. It is guarded by police on all sides, and patients are not allowed to leave. We hold a clinic in a tent. There is a pregnant woman, a man with cancer, a boy with a bad knee who suffers from hemophilia, and a three month-old baby with a scrotal hernia. Patients who should be brought away from here. But in fact everyone should be gotten away from here. The living conditions are unacceptable.

I make a short visit to the health post for the local people. There are hardly any facilities. No telephone, no ambulance and hardly a laboratory. In the empty room that once housed the X-ray equipment hangs a portrait of Tito. Nothing now remains of his heritage: the workers' self-management, the movement of non-aligned countries and the socialist Federal Republic of Yugoslavia. Shortly afterwards a gleaming Mercedes drives up. The Bulgarian ambassador comes to visit and makes all sorts of promises for medical facilities. Even Taiwan has already promised 26 doctors for the village.

Afterwards I hold a clinic in Brazde. Some youths are burning a few pallets, somebody has a radio and there is dancing. For a few moments we're back in Kosovo. In the evening I write up this diary at the office. An icon hangs on the wall in front of me. To the right I look over the town of Skopje, rebuilt after the 1963 earthquake. On the left hangs a recent map of Europe. How will it look in ten years time?