War and mortality in Kosovo, 1998-99: an epidemiological testimony

Background The total number, rates, and causes of mortality in Kosovo durin g the last war remain unclear despite intense international attention. Unde rstanding mortality that results from modern warfare, in which 90% of casua lties are civilian, and identifying vulnerable civilian groups, are of crit ical public-health importance. Methods In September 1999 we conducted a two-stage cluster survey among the Kosovar Albanian population in Kosovo. We collected retrospective mortalit y data, including cause of death, for the period of the conflict. Findings The survey included 1197 households comprising 8605 people. From F ebruary, 1998, through June, 1999, 67 (64%) of 105 deaths in the sample pop ulation were attributed to war-related trauma, corresponding to 12 000 (95% CI 5500-18 300) deaths in the total population. The crude mortality rate i ncreased 2.3 times from the pre-conflict level to 0.72 per 1000 a month. Mo rtality rates peaked in April 1999 at 3.25 per 1000 a month, coinciding wit h an intensification of the Serbian campaign of "ethnic cleansing". Men of military age (15-49 years) and men 50 years and older had the highest age-s pecific mortality rates from war-related trauma. However, the latter group were more than three times as likely to die of war-related trauma than were men of military age (relative risk 3.2). Interpretation Raising awareness among the international humanitarian commu nity of the increased risk of mortality from war-related trauma among men o f 50 years and older in some settings is an urgent priority. Establishing e vacuation programmes to assist older people to find refuge may prevent loss of life. Such mortality data could be used as evidence that governments an d military groups have violated international standards of conduct during w arfare.