Kosovo, Europe’s youngest country, has the world’s fifth largest reserves of lignite, the cheapest and poorest quality coal and also considered to be the dirtiest fossil fuel. But has this been an asset or a curse for Kosovo? In thermal power plants Kosovo A and Kosovo B, salaries are generous but workers often fall ill and even die of respiratory diseases. However, in a country that has no established list of occupational diseases, little is being done to prevent this tragedy.

Out of a hot sunny day at the end of August 2018, Ismail Musliu enters the darkness of the 'boiler'. This is what the new building of the Kosovo B power plant, where coal is fired, is called. And this is his workplace. Kosovo B provides heating for the capital city of Pristina, which is around ten kilometres away. It is half past one in the afternoon and he is taking a final tour of the boiler for the day. He needs to check once again that everything is alright. He passes by the coal mills and cauldrons in which the temperature reaches 500 degrees Celsius. Here and there sparks fly and thunder rumbles. The elevator takes him 61 metres high where he becomes wrapped in heat as the air temperature rises to 40 degrees. Dust sticks to his washed-out cotton T-shirt bearing the logo of the company that employs him: KEK, shorthand for the Kosovo Energy Company. Dust and tiny black particles of coal enter his eyes, nose and mouth.

Ismail does not wear long sleeves, a mask, glasses or ear guards. He descends the metal grate stairs on foot. He does not hold onto the rail because, as he is not wearing gloves, it would make his palms completely black. On each level he peeks into the tubes, monitors whether there is any leakage, looks closely at the valves, checks whether something needs to be fixed. Indeed, it does: everything should be renovated because the machinery has been in use as long as Ismail has been working for KEK – 35 years. Ismail is an engineering technician born in 1954. He is now less than a year away from retiring from KEK, the biggest stateowned company in Kosovo. KEK consists of a surface coal mine and thermal power plants, Kosovo A and Kosovo B, which produce 98% of Kosovo’s energy. They use lignite, the poorest quality coal and therefore the cheapest. Kosovo is not only the youngest country in Europe but, with only 1.8 million inhabitants, also one of the smallest. Nevertheless, the country holds fifth place in the world’s lignite reserves, with 14 billion tonnes of ari i zi – black gold, as they call it.

"Is this a curse or a blessing for Kosovo?" Ismail wonders. For himself, when he looks back on his working life he feels content because it was spent in a company with handsome salaries and because he reached retirement in good health. In the third poorest European country, where the unemployment rate is 26.5% and life expectancy for men is 69 years, this is no small success.

At 3 p.m. the workers of KEK are picked up by buses that take them home. Ismail steps on board in a clean blue shirt and grey pants. There is no air conditioning in the bus so the driver keeps the doors open for the workers to cool down. Above the door a sign reads: "O Allah, please save me and all the workers entering the bus, riding it and leaving it". The transport used to be company-owned, as were the food and health services, but these have all now been privatised, and are consequently more expensive and poorer quality. The buses are old, the food is getting worse and medical expenses depend on insurance companies.

The bus drives around the outskirts of Pristina. The road is lined by cornfields, unfinished family homes, car showrooms, gas stations and scattered litter. After a halfhour ride, Ismail gets off the bus and walks home to his house on the hill. The interior of the house, built in 1997, is painted a calming white. It is situated as far away from the power plant and its polluting fumes as possible. He and his family used to live closer but there the dust was everywhere. They could not hang their clothes out to dry outside. In wintertime the snow was muddy. In the morning they would wipe down their furniture but by night time a dark layer would have settled over it once again. Since they could not fight the dust they had to escape it. Ismail has four grownup children and he would not like any of them to work for KEK. "I had no other choice, but this is a difficult and dangerous job," he says. When he showers at home, dark water drips off of him. When he blows his nose, a black trace is left on his handkerchief. His spit is black. Particles several micrometres in diameter can easily enter the lower respiratory tract and settle on the walls of the bronchi. The smallest ones break through into the lungs. These cannot be taken out.

Kosovo A: the worst single point source of pollution in Europe

Four out of the five Musliu brothers have worked in KEK at some point. Of these, only three are left as one brother developed cancer and passed away four years ago at the age of 62. His house is behind Ismail’s. In 2003 this brother was seriously injured at work. Having to climb quite high to tend to something around a pipe, he was hit by a rotating wire cable and fell on his head. He had to undergo two brain surgeries. KEK refused to pay damages or medical expenses so he sued the company and won 9,000 euros. He was on sick leave for months but was paid his salary for just one month. At the time, Ismail helped his brother and his family out financially, also helping to pay for his chemotherapy when he fell ill. Ismail is convinced that his brother’s illness was brought about by his work. Many of his colleagues died of cancer several years before their retirement, and many die after they retire. Workers in power plants or in the mine have no reduced years of employment and retire only when they turn 65, the same age as those working in offices. Men have the same retirement age as women.

The Kosovo A power plant has been declared by the World Bank to be the worst single point source of pollution in Europe. It was opened in 1962 and according to the government’s energy plan was supposed to be closed in 2017 and replaced by the privately owned New Kosovo power plant, which is financially supported by the World Bank. Plans to shut down Kosovo A and open the New Kosovo plant have been postponed to 2025 but construction work has not even begun yet, and it does not seem that anyone apart from the government or the KEK management believe this deadline to be realistic.

In its 2016 report, the European not-forprofit organisation the Health and Environment Alliance (HEAL) states that coal power plants emit thousands of tonnes of air-polluting particles which cost between 144 and 352 million euros in medical expenses. The worst effect on health is caused by high concentrations of the suspended particle PM2.5. Kosovo A and B emit the highest amounts of PM2.5 particles in Europe, with emissions as much as four times higher than those of most coal power plants in the Balkans. It has also been estimated that air pollution annually causes 852 premature deaths, 318 new cases of chronic bronchitis, 605 hospitalisations and 11,900 emergency medical examinations. It is not known how many KEK workers have fallen ill over the decades since no statistics have been kept.

Workers without medical insurance

This is what life is like in Kosovo. Until 2013 workers had no medical insurance nor were they paid compensation for work-related injuries. If they got ill they would not receive paid sick leave and they would have to cover their own medical expenses. "You get cancer and the union brings you five kilos of sugar, a kilo of coffee and that’s all. You turn into a welfare case," recounts Rafet Osmani, the president of the new trade union in KEK. Even if deaths occurred due to accidents at work, the company would not pay anything. As a kind of compensation it was customary to employ a member of the family of the deceased. Today, if a worker dies at work, the family receives 25,000 euros. In case of an accident at work, 70% of the salary is paid during the 190 days of sick leave. If someone falls ill, only 21 days of their sick leave is paid for, although there is a chance of receiving 40% of their salary for a longer period of time if it is covered by their health insurance. In Kosovo, no list of occupational diseases exists, so it is impossible to establish whether an illness was caused by exposure at the workplace. Every death is considered to be a death by natural causes and not occupation-related.

However, there is no place for doubt when it comes to KEK; too many of their workers die of respiratory tract illnesses. Lung cancer. Throat cancer. Oesophageal cancer. "About 70% of workers live to reach their retirement. The rest die before they turn 65. And most of them live just another year in retirement," says Osmani.

Along with health hazards – exposure to gases, dust, machinery vibrations and noise – the main problem at KEK is the small size of the workforce. "The age of our workers and of the machinery, that’s our problem," says Osmani. The union estimates that in total there are 4,225 workers employed but that every year 150 to 300 workers retire. The average age of a KEK worker is 57. The union believes there to be a deficit of as many as 1,000 workers. "However, the government won’t allow for new employment although KEK is the most profitable company in the country," says Osmani, who is also a workplace inspector in KEK. "Many in the management of KEK either have their own private companies or have connections with owners of private companies. Instead of employing new workers, KEK outsources jobs to these private companies. Due to the shortage of workers in KEK, the existing ones are expected to cover several positions at once. This hinders the implementation of safety measures at work since not all of them have received adequate training for various positions."

A drastic decrease in work-related injuries

Our conversation is taking place in the building of the Institute for Occupational Medicine, the construction of which was funded by KEK and which used to belong to the company. This is where workers would come for their regular medical check-ups until the institute was privatised, at which point a fee started to be charged. With its hallways emptied of patients, doctors and nurses are idling their time away in front of the entrance, waiting for their shift to end. "We used to have fifty patients a day, coming in for their general medical examinations. They were not allowed to return to work without written verification that they had had their check-up," says Rexhep Kaquri, MD, Director of the Institute.

"We also used to make suggestions about whether someone should change their position at work due to health concerns or when someone needed to pay special attention to a particular issue. We even had 24- hour duty. Should something happen to any of the workers we could intervene immediately. Now there is next to no one here because we are no longer a part of KEK, although we are the only occupational medicine specialists available. Our night shifts have been cancelled for the past two years because KEK stopped paying us. Almost three months ago our contract to do regular medical examinations expired and it still hasn’t been renewed. Not with us or with anyone else, although it is prescribed by law that workers undergo these examinations."

Still, the situation has improved a little. "In 2004, 380 work-related injuries were recorded in KEK," says Bekim Sadiku, an expert from the Office for Work Safety, Fire Prevention and Health Protection in KEK. "In 2007 there were 386, and in 2011 only 19. Finally, in 2017 just 7 injuries occurred. From 1999 until 2007 there were 43 work-related injuries with fatal outcomes. Nowadays, deaths hardly ever occur. The number of work-related injuries decreased because we started a more intense implementation of occupational safety and health training, which in 2011 became obligatory. Also, the supply of protective clothing has improved and internal controls of occupational health and safety tightened." However, when it comes to falling ill, says Sadiku, there are no risk estimations for particular positions, and no one is responsible for doing this.

"Were Kosovo a member of the European Union we would have to close down both power plants. Limitations on dust emissions according to EU standards are 50 mg and here they sometimes reach as high as 200 mg. In fact they used to reach 2000 mg," says Sadiku. Dust emissions have decreased at power plant Kosovo A due to filters installed on the chimneys in 2013. Furthermore, coal dust now gets transported by the hydro system, while before it was transported in open carriages which is why it got dispersed into the air.

A change of environment

Particles of coal dust inhaled in childhood can provoke later illnesses in adulthood. Fatmir and Fitim Mexhuani have been surrounded by dust their whole life, although both of them tried to escape it. They grew up in the house overlooking Kosovo A. The old power plant was their first neighbour. Fatim says he was ashamed of visiting Pristina as a child. The soles of his shoes were always black and in the capital they called him "dusty boy". Fatmir and Fitim are relatives, sons of two out of five brothers who were all employed in KEK. Four of them died in their fifties, their fathers among them. One died of gas poisoning and the others of cancer. "Our family covered their medical expenses," say the brothers. Around fifty members of their extended family lived in this area. Today there is no one left; everyone went away due to pollution and dust, they say. We came across them when, after their workday in KEK, they came to visit the rundown, abandoned house with its garden of apple trees. Fitim, 45, was the last one to move away, a year and a half ago. Fatmir, 57, has lived in Pristina for a long time. We ask what it is like for them to work in KEK. A long silence ensues, punctuated only by the sound of the cocks crowing outside. Slowly they shrug their shoulders in response. Are they worried about their health? "Yes, of course. We worry about our fathers’ fate befalling us," both of them reply without hesitation. "KEK pays zero attention to our health," adds Fitim. He doesn’t seem particularly angry about it though; it’s as if both of them have surrendered to their destiny. They already left their homes to move away. They cannot leave their jobs as well.

Just a short walk away from the house, Esat Selimi, 48, is working in a very different environment. He is surrounded by greenery: pine trees, a trimmed meadow, the chirping of birds. His workplace is the only part of this environment that looks like real nature. He is employed in the cultivation of the land surrounding KEK. The World Bank helped to get this new department established. "It gets no better than this in KEK," says Esat. His face looks more pink and healthy than that of the other workers we talked to. When he used to work in the mine he would need weeks just to clean his nose of dust. Ten years ago, when the new department was being set up, he applied for transfer straight away. It cost him 200 euros a month due to a smaller salary but he didn’t care. He knew that good health is worth much more. He grew up and still lives in Krushevac, a village in the vicinity of the power plant. For decades, the ash from KEK was dumped near his house, leading to the creation of Kodra e Hirit (translated as 'ash hill'), as the locals have dubbed it, where there used to be plains. Ash would fly around and further pollute the already polluted environment. Today, however, Kodra e Hirit has finally been restored and turned into a green area. This is what Esat is working on.

A day earlier, in the KEK head office in Pristina, the company’s acting manager Njazi Thaqi had replied to our question about the increasing number of workers suffering from cancer by saying that cancer is common everywhere in Kosovo and that he does not attribute it to KEK but to the bombing of the country during the war. Many people in Kosovo believe cancerous illnesses to be in good part a consequence of NATO’s air force bombing in 1999 when depleted uranium was used. We ask Esat about his feelings on this matter. He gets upset right away. "That is not true. I know that there is cancer everywhere, but there is more of it here," he says. "Last year two of my colleagues died of cancer in their fifties. My father is dying of throat cancer. He also firmly believes that it was brought about by KEK, because he lives nearby and because he worked in KEK for 40 years and there was no history of cancer in the family. My paternal uncle died of cancer, and he also worked in KEK. In my village there are only around twenty inhabited houses, yet around fifty people have cancer. Many of them work in KEK, especially the older generations, but others live nearby which boils down to the same thing. Only when I go somewhere far away can I smell the clean air. How then can all of it be from the war?"

His brother, Sherif Selimi, 41, who has also spent all his life in Krushevac, would like to find work in KEK. He expected to get employment there when his father, a worker at the company, got cancer. This used to be common practice, but it is no longer the case. Meanwhile, his wife Valbona, 40, has breast and skin cancer. Their son was diagnosed with bronchitis at the age of two. They are both convinced that it is all due to pollution: "the air we breathe, the land that gives us food, and the water we drink are all polluted." Sherif shows us footage of Kosovo A on his phone. Despite the installation of filters, the smoke exiting the chimney is dark. "On weekends they turn the filters off to cut down expenses. You see how black this smoke is? That is why. And there is more dust and the smell worsens as well. It’s a disaster! A disaster!" KEK management say filters are turned on continually and that it is not as easy to turn them off without entirely shutting down production but Sherif is not so easily persuaded. It would take his family less than two hours to pack up and leave this place where they were born if they had somewhere else to go. But there is no such place. For Sherif, there is only one conclusion: "since we cannot move away, employment in KEK is the best option we have. It is killing us, but we depend on it."•

Special report - Work-related cancer: emerging from obscurity Journaliste freelance

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Black gold in Kosovo decides on its workers’ life and death