Health services in the Kosovo Liberation Army operative zone of Llapi (1998–1999)

Abstract

With the aim of assessing the organization, functioning, and challenges of the healthcare service in wartime conditions, this paper has comprehensively and systematically examined data collected from the medical and military documentation of the ZOLL during the war of the Kosovo Liberation Army (1998 - 1999). The results provide a clear overview of the challenges and achievements of this healthcare system in an extremely difficult context, highlighting its vital role in addressing emergency situations during the war. The organization of the healthcare system included: primary care through 21 military ambulances, of which 13 were mobile; secondary care through the Military Hospital located in four different locations; pharmaceutical services with 11 depots functionally distributed throughout the entire Zone; as well as logistical services providing intersectoral support. The results showed that the planning and management of the healthcare service were well structured and professional, with particular emphasis on the early preparation of infrastructure and human capacities. The Healthcare Service sector had been established and made operational in a timely manner by the military organizational structures of the ZOLL and had followed an effective coordination strategy with the commands and operational units of the ZOLL. One of the key elements of success was the establishment of an integrated communication system through coded radio links, telephone lines, couriers, and regular meetings, which enabled uninterrupted and synchronized functioning among the different structures of the military healthcare system. Cooperation between the ZOLL and other operational zones, as well as with the General Staff of the KLA, functioned directly through the exchange of human resources and the coordination of activities, thereby increasing the military capacity to address healthcare challenges across all combat zones. During the preparatory period, important preventive measures were undertaken, such as vaccinating soldiers, identifying blood groups, issuing health booklets, providing first aid training, and equipping individuals with medical supplies. The initial planning included the engagement of 320 healthcare professionals of various profiles, and during the period of combat, a utilization rate of 89.4% of this capacity was achieved. During military operations, in many cases the provision of first aid and the evacuation of the wounded from the front line were carried out by the soldiers themselves. However, in certain situations, doctors and technicians of the healthcare service intervened directly in the field, providing first aid and assisting in the evacuation of the wounded. A significant challenge was the massive displacement of the civilian population and the lack of functional civilian healthcare institutions, which forced the military healthcare sector to also cover the needs of civilians. As a result, the number of medical visits for patients from the civilian population was 43 times higher than that for soldiers, while 77.21% of surgical operations were performed on civilian patients. In this regard, the data processed from the treatment of the wounded at the Potok Military Hospital provide a clear picture of the clinical workload and the efficiency of surgical treatment under severe wartime conditions. Of the 430 wounded patients treated, 98.84% of surgical interventions were successful, while the surgical mortality rate was only 1.16%. More than 83% of the procedures were performed under local anesthesia. The average age of the patients was 30.9 years, with a predominance of the 20 - 39 age group. The extremities were the most frequently affected region by wounds (44.65%), while multiple and thoracic injuries were more common among soldiers. The average hospital stay was 14.13 days, with longer stays for cases involving multiple wounds. This organization of the medical service (the Sanitation Sector) reflects common practices in other armed conflict contexts, where responsibility for the healthcare of the civilian population usually lies with civilian health institutions. However, during the KLA war, due to the collapse of the civilian healthcare system, this responsibility was inevitably transferred to military structures. This shift significantly contributed to the deterioration of the overall health situation and increased the risk of the spread of infectious diseases, including serious hygienic and epidemiological problems. In addition, the logistics unit ensured continuous material and technical support for the Healthcare Sector by providing food, fuel, spare parts for medical equipment, vehicles, generators, and other auxiliary equipment. It was also responsible for the preparation and distribution of food for patients and staff, as well as for the maintenance of technical equipment. The healthcare service in the ZOLL was built on stable organizational and professional foundations, despite the numerous challenges imposed by the realities of war. This experience constitutes an important example of healthcare management under extreme conditions and represents a valuable legacy for the field of military medicine and public health in general. In this context, the organization of the healthcare service in the ZOLL represents a remarkable model of professional mobilization under extreme circumstances, providing a meaningful example for the development of resilient healthcare systems in emergency situations. The documented experience from this zone not only attests to the courage and dedication of healthcare professionals during wartime but also offers valuable historical insights for the planning of health emergencies and crisis management in the future.