Four years after the BBC first highlighted the appalling plight of mentally handicapped people caught up in the middle of Albania's internal conflict, a return trip has revealed dramatically improved conditions for some.

But others remain in the "living hell" of psychiatric hospitals.

When correspondent Bill Hamilton visited the orphanage in the city of Berat in 1993 there seemed little hope for its young inmates.

Children deprived of care wandered naked and aimless around the ramshackle grounds, their bodies covered with flies. Withdrawn and depressed they appeared dead to the world, lost in the squalor of their surroundings.

The BBC's report inspired a strong international response from charities led by Britain's Children Aid Direct. And when Bill Hamilton returned to Berat recently he found the orphanage transformed almost beyond recognition.

Play, not squalor, is the new rule

Smiles had replaced the tearful expressions he had seen on the same youngsters' faces on his previous trip. Happy laughing children played in a building renovated and redecorated to meet their needs.

The new team of professional carers, who run the orphanage, are so intent on preserving this new atmosphere that they took up arms earlier this year to protect the recently-created physiotherapy room from looters.

The home's Director Edlira Kadiu told Bill Hamilton: "As a result of your film many European charities donated money to reconstruct this home. Now we won't let anyone even touch this place, let alone destroy it."

Bill Hamilton said the improvements at the home were a practical demonstration of how charity aimed directly at individuals' needs can produce healthy and encouraging results.

Overcrowding is so bad some patients chose bare metal rather than the ward beds

However, two hours' drive away he saw a vision of the nightmare future that may still await the children of Berat if the international community does not respond generously to Albania's latest pleas for aid.

At an adult psychiatric hospital he found conditions he described as an "affront to humanity" and which the overstretched staff called "hell on earth".

There were vulnerable and confused patients shivering in stark rooms with no heating and no glass in the window frames. Some inmates perched on bare metal bed frames in a pathetic attempt to escape the chronic overcrowding.

There was worse to come. When the BBC crew asked to see inside the isolation ward they found 25 cowering patients infected with Tuberculosis.

"Staff openly admitted to us that these patients are literally waiting to die," said Bill Hamilton. "Two have perished in the last few days. There's no heating here and the worst of the winter has yet to come.

"Help for the Albanian health service has been pledged by the World Bank. But so long is the country's list of medical needs that the survival of patients like these will depend on how quickly and generously the outside world responds."
 

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