Albanians drawing water from a spigot on a state farm in central Albania
Courtesy Charles Sudetic

Breadline in Elbasan
Courtesy Fred Conrad

Medical Care and Nutrition

The government credited itself with a revolutionary transformation of Albanian health standards. According to official statistics, the incidence of malaria and other debilitating diseases that affected large segments of the population before 1950 had been greatly reduced or eliminated, and average life expectancy had increased about twenty years by 1988 (see Population, this chapter). These successes were attributable primarily to large-scale inoculation programs, the extermination or reduction in number of disease-spreading pests, and a general expansion of health services. In 1987 Albania had about one physician or dentist per 577 inhabitants (compared to one per 8,154 inhabitants in 1950), and one hospital bed per 168 inhabitants (compared to one per 229 inhabitants in 1950). All medical services were free. However, further improvements in health care were obstructed by malnutrition, unsanitary conditions, and a rapidly deteriorating economy.

Although considerably decreased, the infant mortality rate-- fifty deaths per 1,000 live births, according to data published by the United States government--was still much higher than that of other Balkan states in 1991. Many of these deaths were caused by low birth weight. Because of food shortages and inadequate prenatal care, the proportion of premature births increased from 7 to 11 percent between 1987 and early 1992. Hospitals lacked essential medicines and equipment the University of Tiranë Hospital, considered the best in the country, had only one incubator.

The United Nations Children's Fund (UNICEF) reported that 57 out of every 1,000 Albanian mothers died during pregnancy or childbirth--roughly ten times the average rate in Western Europe. Contraceptives could not be obtained. Abortions, which were legalized in the summer of 1991, were performed with poorly sterilized instruments, as were Caesarean sections. Patients at Tiranë's maternity clinic sometimes had to share beds or bring their own food.

The food supply--a perennial problem because of poor soil, occasional drought, primitive methods of cultivation, and a lack of readily accessible resources--did not keep pace with population growth under communist rule. The typical diet lacked protein and other vital elements. Families, regardless of size, received meager rations of meat, usually three to four kilograms per month. Eggs, cheese, sugar, and coffee also were rationed. Nonrationed goods, such as milk, green vegetables, and fruit, were often difficult to come by, and émigrés reported having to stand in line many hours to purchase them. Farmers relied on small private plots of land to supplement the35f heir provisions.

The economic disintegration of the late 1980s and early 1990s, hastened by a severe drought in the summer of 1990, a general strike the following year, and widespread food riots, compelled the country to become totally dependent on foreign food aid. Jolted by a flood of Albanian refugees, Italy delivered 83,000 tons of food to its eastern neighbor between September 1991 and January 1992. Additional emergency aid was received from Germany, Switzerland, the United States, and other countries, as well as from international relief agencies.

Data as of April 1992