VZCZCXRO8260
OO RUEHAG RUEHAST RUEHDA RUEHDBU RUEHDF RUEHFL RUEHIK RUEHKW RUEHLA
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 
 
¶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