Chapter 5

THE PEOPLE

The population increased by about 71 percent from 1950 to 1969 and in 1970 was increasing at a rate that would double the number of inhabitants in approximately twenty-six years. The median age, about nineteen years, was increasing slowly. The abundance of rural population and the increasing tempo of industrial development provided potential for rapid urban growth, but government controls and a scarcity of housing tended to restrict population movements.

Persons of Albanian ethnic origin constituted about 97 percent of the 2.1 million population in early 1970. Of ancient Illyrian descent, they have maintained their homogeneity despite many invasions and centuries of foreign occupation. The Communist regime, in its effort to develop social and cultural solidarity, attempted to reduce consciousness of the differences between the major subgroups, the Gegs in the north and the Tosks in the south. Some progress has been made, but a continuing struggle is being carried out against customs and beliefs that are considered remnants of the past and detract from the achievement of Communist objectives (see ch. 5, Social System).

The Albanian language is a derivative of the tongues that were spoken by the ancient Illyrians and Thracians. For many centuries its continuity was maintained by only verbal means. A standardized alphabet was not developed until the twentieth century. Since World War II considerable progress has been made in making the Tosk dialect the standard written language. In the late 1960s there were still some variations in spelling.

The pattern of settlement was predominantly one of widely dispersed villages; approximately two-thirds of the people lived in communities with less than 1,000 population. Only twelve cities had more than 10,000 population in 1969. The quadrangular area formed by the cities of Durres, Tirana, Elbasan, and Fier, all of which are linked by rail and roads, was experiencing the most rapid growth in the 1960s.

There was a very slight improvement in living standards from 1950 to 1970. Despite modest growth in the economy, the per capita gross national product (GNP) in 1967 was the lowest in Europe, an estimated United States equivalent of $320. The average citizen's welfare in the allocation of resources for food, consumers' goods, and housing was sacrificed to the development of industry and the program to achieve eventual self-sufficiency in agriculture. Reduction of disease and improved health were the most important gains countrywide. Also, by 1970 electricity had been extended to over two-thirds of all villages. Consistently high levels of population growth placed severe strains on available supplies of food, consumers' goods, housing, and services.

POPULATION

The total population in January 1970 was an increase of approximately 500,000 over the 1960 official census total of 1,626,315. The distribution by age groups in 1970 was: under fifteen years of age, 42 percent; fifteen to thirty-nine years, 37 percent; forty to sixty-four years, 16 percent; and sixty-five years and over, 5 percent. With almost 60 percent of its inhabitants under forty years of age and a median age of approximately nineteen years, the population was extremely youthful, and indications were that it would remain so into the 1970s. The proportion of persons in the dependent age groups, under fifteen and over sixty-four years, to the working age group, fifteen to sixty-four years, was 887 to 1,000.

The overall ratio of males to females, 106 to 100, was the highest among the Communist countries of East Europe. The preponderance of men was greatest at ages below forty; in the age group above sixty-four there were only 77 men to 100 women. The higher ratio of men for the total population was attributed in part to the high infant mortality rate among female infants, caused by neglect and the deference accorded to male progeny. Losses in World War II, an estimated 28,800 persons, or 2.48 percent of the population, had little influence on the ratio of males to females and the population structure.

In keeping with the traditional pattern of a highly dispersed population, the country remains predominantly rural. About two-thirds live in villages and in the countryside. Urban population increased from about one-fifth to one-third of the total during the 1950-70 period and would have increased to a greater extent had the government not taken measures, beginning in the mid-1960s, to build up agriculture and to restrict city growth. During the drive to reduce the number of people involved in administration and to increase production forces in the mid-1960s, thousands of persons living in the city, including some from the bureaucracy and the Party, were sent to the country.

Housing in the cities was greatly overcrowded, and the allocation of new dwellings built by state funds and controlled by the government provided further restrictions on city growth. Indications were that the expansion of industry would continue to require urban growth but that the rate of growth would be controlled. The largest cities and their populations in 1967 were: Tirana, 170,603; Durres, 80,066; Vlore, 57,745; Korce, 53,563; and Shkoder, 49,095.

The birth rate declined only slightly from 1950 to 1970 and in 1968 was 35.5 per 1,000 population (see table 3). Fertility continued at a high level, and there were no apparent influences that tended to reduce the prevailing rate of births. No information was published concerning the effects, if any, on the birth rate of women's employment outside the home, abortions, contraceptives, or other restraints on population growth.

The expansion of medical services and improvement in the standard of health during the 1950s and 1960s resulted in a marked decline in the mortality rate, from 14 per 1,000 in 1950 to 8 per 1,000 in 1968. The age structure of the population, with a preponderance in the lower age brackets, provided the potential for a continuing low mortality rate.

A concomitant of the reduced death rate was an increase in life expectancy. Data from domestic sources indicated that the average life expectancy at birth increased from 53.5 years in 1950 to 66.1 years in 1965.

Because of the highly restrictive policies of the Communist regime, migration into and out of the country had a negligible influence on the size and composition of the population. Internal migration was controlled by requiring approval for persons to move from one location to another. Specific data on the scale and character of population movements were not available.

The pattern of sustained high birth rates and declining death rates resulted in high rates of natural increase. Total population increased by 71 percent from 1950 to 1969, whereas the average increase for all other East European Communist countries, excluding the Soviet Union, was 18 percent. The growth rate for 1970 was estimated at 2.7 percent.

Government and Party leaders, voicing the need for greater numbers of people for the building of socialism, supported a continuing high level of population growth. They were undeterred, in the face of persistent shortages of food and the requirement for foreign assistance, in their encouragement of a sustained high birth rate and the payment of an allowance for each child.

_Table 3. Albanian Vital Statistics for Selected Years, 1950-68 (per thousand population)_

Year Birth Death Natural increase

1950 38.5 14.0 24.5 1960 43.3 10.4 32.9 1968 35.5 8.0 27.5

Source: Adapted from U.S. Department of Commerce, Office of Technical Services, Joint Publications Research Service (Washington), "Protection of Mother and Child Health, the High Expression of Socialist Humanism, Realized by the Party During the 25 Years of People's Power," by Vera Ngjela et al., in Shendetesia Popullore (People's Health), Tirana, 1969 (JPRS: 50,302, _Translations on Eastern Europe, Political Sociological, and Military Affairs_, Nos. 204, 1970).

ETHNIC GROUPS

Persons of non-Albanian ethnic origin--Greeks, Vlachs, Bulgars, Serbs, and Gypsies--constitute only about 3 percent of the population. Among the Albanians, the natural dividing line between the Gegs and the Tosks is the Shkumbin River, but there is some spillover on both sides. Numerically, the Gegs predominate, making up slightly over one-half of the Albanians within the country (see ch. 2, Historical Setting).

Despite successive foreign invasions and centuries of occupation, a distinctive ethnic identity was preserved. Mountains and the lack of communication routes provided isolation and opportunity to evade intruders. Nevertheless, the imprints of foreign influences were considerable. Additions and modifications to the language were made from the Latin, Greek, Slavic, and Turkish contacts. Lacking an organized religion as part of their Illyrian heritage, Albanians embraced the Muslim, Orthodox, and Roman Catholic faiths brought to them by their conquerors (see ch. 5, Social System).

Individual Albanians distinguished themselves in the service of the Roman and Turkish empires and were noted for their ability as soldiers. It was not until the nineteenth century when they began to seek autonomy that their history was recorded in writing. Kinship and tribal affiliations, a common spoken language, and folk customs served to provide continuity and common identity through the many centuries of relative obscurity.

There are marked differences in the physical appearance of the typical Geg and the typical Tosk, but until World War II the greatest contrast was in their social systems. The Geg and Tosk dialects differ, and there are also variations within subgroups. Some progress was made under the Zog regime in bringing the clans, whose authority prevailed particularly in the north, under government control and in eliminating blood feuds (see ch. 5, Social System).

After the Communists emerged victorious they imposed controls, the objective of which was to eliminate clan rule entirely; they waged a continuing struggle against customs and attitudes that, they believed, detracted from the growth of socialism. Blood feuds were brought to an end. Party and government leaders, in their effort to develop national social and cultural solidarity in a Communist society, publicly tended to ignore ethnic differences.

In practice, Enver Hoxha, the Party leader, who came from the south and received the bulk of his support during World War II from that area, frequently gave preference to persons and customs of Tosk origin. In the late 1960s Party and government leaders continued to devote considerable effort to the suppression of customs and rituals that, they declared, were vestiges of the patriarchal, bourgeois, and religious systems of the past. On one occasion in 1968 the Party announced that because of its influence 450 infant betrothals were annulled and 1,000 girls renounced ancient customs, including the taboo against females leaving their village (see ch. 5, Social System).

The Gegs, because of their greater isolation in the mountainous areas of the north, held on to their tribal organization and customs more tenaciously than the Tosks. As late as the 1920s approximately 20 percent of male deaths in some areas of northern Albania were attributed to blood feuds.

Under the unwritten tribal codes, which included the regulation of feuds, any blow, as well as many offenses committed against women, called for blood. Permitting a girl who had been betrothed in infancy to marry another, for example, could cause a blood feud. The _besa_ (pledge to keep one's word as a solemn obligation) was used under various conditions and included pledges to postpone quarrels. A person who killed a fellow tribesman was commonly punished by his neighbors, who customarily burned his house and destroyed his property. As fugitives from their own communities, such persons were given assistance wherever they applied.

A man who failed to carry out prescribed vengeance against a member of another tribe or that individual's relatives was subjected to intolerable ridicule. Insult was considered one of the highest forms of dishonor, and the upholding of one's honor was a first requirement for a Geg. On the other hand, if the individual carried out the required act of vengeance, he was in turn subject to extinction by the victim's relatives. Women were excluded from the feud and, when escorted by a male, he too was considered inviolable. In other respects, women's position in society generally was one of deprivation and subjugation (see ch. 5, Social System).

The isolation from influences beyond his community and the constant struggle with nature tended to make the Geg an ascetic. Traditionally, his closest bonds were those of kinship, as a member of a clan. Obstinate and proud, the Geg proved himself, under the leadership of his compatriots, a ruthless and cruel fighter. Visitors from outside the clan were generally suspect, but every traveler was by custom accorded hospitality.

Less isolated by rugged terrain and with greater, although limited, contact with foreign cultures, the Tosk generally was more outspoken and imaginative than the Geg. Contacts with invaders and foreign occupiers had influence and, before 1939, some Tosks had traveled to foreign countries to earn sufficient funds to buy land or to obtain an education. The clan or tribal system, which by the nineteenth century was far less deeply rooted and extensive in the south than in the north, began to disappear after independence was achieved in 1912.

Of the minority ethnic groups, persons of Greek descent are the most numerous. Estimates based on World War II and earlier data indicate that they compose approximately 2 percent of the population. They are most numerous in the southwestern coastal area of Dhermi and Himare and the region extending southward to the Greek border from Gjirokaster. They have adopted Albanian folkways and dress. Although their first language is Greek, they speak Albanian as well.

Persons of Vlach, Bulgar, Serb, and Gypsy origin make up about 1 percent of the population. The Vlachs in Albania have lost much of their homogeneity and adopted the ways of their Tosk neighbors. The typical Vlach is akin to the modern Romanian. Both are descendants of Romanized Dacians or Thracians of the pre-Christian era.

Under Communist rule the Vlachs, mostly herdsmen, have been incorporated into the collectivized economy. Previously, they grazed their flocks in the mountains in the summer and then returned to the valleys in the winter. They are most numerous in the Pindus Mountains and in the Fier, Korce, and Vlore areas. Persons of Bulgar origin live mostly in the border area near Lake Prespa; a few persons of Serb derivation live in the Shkoder area; and Gypsies are scattered in various places.

There are large numbers of persons of Albanian origin living outside the country. Estimates based on Yugoslav data indicated the total number in Yugoslavia in 1970 was approximately 1 million, of which about 70 percent were in Kosovo. Data is generally lacking on the exact number in other areas, and estimates vary widely. There may be as many as 250,000 in Italy and Sicily, 350,000 in Greece, and 80,000 in the United States. They are found also in Bulgaria, Egypt, Romania, and Turkey. The degree to which persons living outside the country have retained Albanian customs and language varies. Indications are that they have retained their clannishness to a considerable degree.

LANGUAGES

Albanian, of Indo-European origin, is the only surviving language of the early Thraco-Illyrian group and is spoken by all or nearly all inhabitants. Some of the minority ethnic groups also speak the tongue of the country from which their families originated.

Modern Albanian is derived from the ancient Illyrian and Thracian, but many outside influences are evident. Additions and modifications, beginning in the pre-Christian era, were made as a result of foreign contacts. Most important of these were the Latin and Italian influences during the centuries of Roman domination and trade with the Venetian merchants and, later, in the nineteenth and twentieth centuries. Contributions also were made by the Greeks, Turks, and Slavs. The first written documents in Albanian did not appear until the fifteenth century; therefore it is difficult to trace the development of the language during the earlier period.

The repressive policies of the Ottoman rulers over a period of 450 years, beginning in the fifteenth century, further retarded language development. Written Albanian was forbidden, and only the Turkish or Greek languages could be used in schools. Emigré Albanians, particularly those in Italy after 1848, helped keep the written language alive. Until the nineteenth century continuity of the language in Turkish-dominated areas was provided largely by verbal communication, including ballads and folk tales (see ch. 7, Communications and Cultural Development).

By the early twentieth century more than a dozen different alphabets had developed. Some were predominantly either Latin, Greek, or Turko-Arabic. Many were a mixture of several forms. It was not until 1908 that a standardized orthography was adopted. The Latin-based alphabet of thirty-six letters, approved at that time by a linguistic congress at Monastir, was made official by a government directive in 1924 and continued in use in 1970.

Letters are written as they are pronounced. There have been variations in the spelling of many words because of dialectical differences, and they still persist despite the government's efforts to develop a uniform language. A dictionary was published by the Institute of Sciences in Tirana in 1954, and it indicated that the spelling of some words varied. During the 1960s the Linguistics and History Institute, which was part of the State University of Tirana, carried on studies relating to language origins and morphology, but no lexicon was known to have appeared as of early 1970 to standardize spelling or supersede the 1954 dictionary.

The two principal Albanian dialects are Geg, spoken by about two-thirds of the people, including those in the Kosovo region of Yugoslavia, and Tosk, by the remaining third. There are subvarieties of both dialects. Despite the considerable variations that developed in the many isolated communities, Albanians are able to communicate easily with each other.

Efforts were made by the government during the 1920s and 1930s to establish the dialect of the Elbasan area, which was a mixture of Geg and Tosk, as the standard and official language; but the local dialects persisted, and writers and even officials continued to use the dialect of their association. After the Communists, most of whose leaders had come from southern Albania, acceded to power, the Tosk dialect became the official language of the country. In 1952 the Albanian Writers' Union, a Party-controlled organization, took action to make Tosk the only dialect to be used in publications.

SETTLEMENT PATTERNS

Some two-thirds of the people live in rural areas in a widely dispersed pattern of small villages. The urban population, according to 1969 data, lived in forty cities with 1,000 to 10,000 inhabitants and twelve cities with over 10,000 dwellers; of the latter group, six had 10,000 to 30,000 inhabitants; two had 30,000 to 50,000; three had 50,000 to 100,000; and one, Tirana, was approaching 200,000.

The heaviest concentrations of settlement in the late 1960s were in the districts of Tirana with a density of 528 persons per square mile, Durres with 469, Fier with 323, and Lushnje with 298. The area surrounding Korce and the area immediately around, and to the south of, Shkoder were among the most thickly settled even though the administrative districts of Korce and Shkoder were not heavily populated when considered in their entirety (see ch. 3, Physical Environment).

Several factors contributed to the pattern of settlement. Large expanses of mountains and generally rugged terrain made the building of land transportation routes difficult. Poor soil and lack of water during part of the year did not provide support to large concentrations of people. Mineral and other resources were generally not readily accessible or were difficult to exploit (see ch. 3, Physical Environment).

Coastal cities generally have a small hinterland, and their influence does not extend beyond their borders. The port of Durres, with road and rail links to Tirana, Elbasan, and Fier, is an exception. During the 1960s the area generally bounded by these cities experienced the greatest growth of industry and population of any region. Vlore, a port and naval center, increased almost fourfold between 1945 and 1967, but it lacks links with inland areas.

Tirana, the capital and largest city, increased from about 60,000 inhabitants in 1945 to 170,000 in 1967, largely because of the expansion of industry and a growing bureaucracy. It is located on the inner margin of the coastal plain and is surrounded by an area of the better soils of Albania. The streets in the central area of the city, where government buildings are clustered, are wide and attractive; many parts of the city are much like the rural villages. Tirana has become the most industrialized city and continues to be a collecting and distributing point for agricultural products of the area.

Centers for inland mountain valley or upland basin communities are Berat, Elbasan, and Korce. They, like most cities, have changed little in appearance and retain much of the flavor of nineteenth-century agricultural life.

The typical mountain village, of 70 to 100 homesteads, is located on an isolated slope among rocks and thin scrub-like vegetation. Only footpaths link it by land with the outside world. During the summer there is a drought period which requires that water use be limited to drinking. Houses are clustered in the south, whereas in the northern mountains they tend to be dispersed. Fields and pastures are located some distance from the village. Water must be carried from a common source, usually a spring. Mountain villages frequently are located at 1,300 to 1,600 feet above sea level. This is generally the line of contact between the underlying impervious serpentine rock and layer of limestone and the point where spring water comes to the surface.

At lower levels the villages are laid out around the collective or state farms or enterprises, many of which were previously estates or patriarchal settlements. Here the houses are more substantial, and the fields or other place of work are near the village. Water is carried from a common source. Open sewers run down the streets of some villages, but this condition is gradually changing. Electric power has been extended to about 70 percent of all villages, but other facilities and amenities, except medical services, have been little improved since the end of World War II.

LIVING CONDITIONS

The standard of living in 1970 was very low, and life was difficult for the masses despite very modest improvements in living conditions during the 1950s and 1960s. The standard of living was the lowest in Europe and was improving at a slow pace because priority was given to industry, to increasing the means of production, and to developing eventual self-sufficiency in food production, especially of cereal foods. The most widely felt improvements were in health services and in use of electricity, which resulted from expanding the electrical network to many villages.

Plans for the late 1960s and 1970 called for 23 to 25 percent of the state budget to be spent on social and cultural sectors. In 1967, when total planned budget spending was 3.6 billion leks (5 leks equal US$1--see Glossary), the sum for social and cultural sectors was 837 million leks, of which 189 million were for health, 167 million for social insurance, 143 million for assistance to mothers and children, and 338 million for education and culture.

The government maintained that it was improving living conditions by increasing food supplies and commodities and by construction of public facilities and structures. In February 1970 the chairman of the State Planning Commission reported that 1,200 dining rooms, 1,140 bakeries, 1,850 public baths and laundries, and 187 water mains had been built and that electricity had been supplied to 1,096 additional villages in 1968 and 1969, leaving only 663 without electricity. Although these additions added to the amenities of life, the rapid growth of population caused heavy strain on the very limited total resources available.

Medical authorities asserted that many diseases and afflictions that had taken heavy tolls of life and tended to debilitate large segments of the population before 1950 had been greatly reduced or eliminated. These successes were primarily attributable to large-scale inoculation programs, elimination or reduction in the number of disease-spreading pests, and expansion of health services. Malnutrition, unsatisfactory sanitary-hygienic conditions, and indifference to medical aid in some areas posed problems for further improvements.

The Communist regime, posing as the protector of the masses, credited itself with a revolutionary transformation in the health standards of the country. Data on health and disease from other than Albanian sources were not available. Statistics released by the Ministry of Health indicated substantial improvements during the 1960s. Responsibility for shortcomings and inadequacies relating to health care was attributed to backwardness on the part of the people or to the lack of resources. Failures on the part of the Party or government were not mentioned.

There were widespread epidemics of measles in 1948 and 1949 and 1954 and 1955, of Asiatic influenza in 1957, of typhoid in 1945 and 1950, and of poliomyelitis in 1953. Health officials stated that there were no epidemics during the 1960s.

Malaria was one of the most prevalent diseases before 1950. Health authorities, assisted by the Rockefeller Foundation beginning in the 1920s, made considerable progress in eliminating mosquitoes and reducing the incidence of malaria before World War II. The campaign was continued by the Italians during their occupation. The ravages of war greatly increased the spread of malaria from 1945 to 1947; according to Communist reports, 60 to 70 percent of the population were afflicted in those years, in comparison with 16.5 percent in 1938.

The United Nations Relief and Rehabilitation Administration provided food, medicine, and antimalarial assistance in 1945 and 1946, and the Communist regime followed up with a concerted effort against the disease, which reduced the percentage of persons afflicted to approximately 7 percent in the early 1950s. Health officials declared in 1970 that malaria had been eradicated by 1967, and no cases had been recorded after that date.

Health authorities reported that measles had been eliminated by 1970 through a program of mass vaccinations. The last major epidemic, that of 1954-55, afflicted almost 14 percent of the population. The incidence among children under three years of age was 60 percent, and 1,712 children under age fifteen died.

A broad program against tuberculosis was begun in the 1960s that included general prophylactic measures and vaccine injections. Health officials planned completion of vaccinations countrywide in 1970. It was estimated that almost 15 percent of the population had tuberculosis in the mid-1950s. Officials reported that the incidence of this disease had dropped to less than 0.2 percent in 1968.

The Health Ministry reported progress in combating many other diseases. Syphilis, once prevalent, was eliminated. A broad program of serologic examinations involving over 2.3 million persons between 1947 and 1968 was utilized to detect venereal disease and was instrumental in reducing the rate of syphilis infection from 3.14 percent in 1949 to 0.02 percent in 1968. Incidence rates per 1,000 population of other illnesses decreased from 1955 to 1968 as follows: abdominal typhoid, from 5.2 to 2.4; dysentery, from 87.7 to 14.5; diphtheria, from 2.3 to 0.5; poliomyelitis, from 0.4 to 0.1; brucellosis, from 2.4 to 0.8; and arthritis, from 2.2 to 0.8. Trachoma was eliminated, and no cases of rabies were reported in the 1967-69 period. Deaths per 100,000 population from contagious diseases, including influenza, decreased from 220 in 1950 to 43 in 1968. Data on the number of deaths from heart ailments, cancer, and other causes were not published.

Although progress was made in reducing mortality among children up to one year of age--from 121.2 per 1,000 live births in 1950 to 75.2 in 1968--the rate remained unusually high. Failure to obtain timely medical assistance was given as the primary cause of death by health authorities. Malnutrition, shortages of professional medical personnel, and insufficient health facilities were also contributing factors. The rate for cities in 1968 was 65.4 as compared with 78.0 in rural areas. Some areas in the mountains of the north ran as high as 136.9 during the 1963-67 period. About three-fourths of all infant deaths occurred during the first six months after birth. In 1960 only 34 percent of infant deaths were diagnosed; by 1967 the percentage had increased to 65. Medical aid by a physician or midwife was provided for about 99 percent of births in cities; in rural areas approximately 61 percent of births were with medical assistance.

There were indications that some segments of the population, those in remote and most poverty-stricken areas, were in poor health. A 1968-69 study of 1,580 children up to three years of age in thirteen northern localities, reported by the Ministry of Health, showed that 60 percent suffered from neuromuscular disorders in various degrees and that 47 percent suffered from rickets. The principal causes for these abnormalities, according to the official study, were malnutrition and unsatisfactory hygienic-sanitary conditions.

Health and medical organizations from national to local levels were under the Ministry of Health. In the 1960s the departments of the ministry were: epidemiology, pharmaceuticals, sanitary inspectorate, medical prophylactic institutions, personnel, administration, finance, and planning. Data for 1968 reported by the minister of health listed facilities countrywide as: 196 hospitals and other facilities with beds; 11,922 beds for medical use; 1,108 first aid stations and polyclinics; and 36 dispensaries and tuberculosis centers. The average annual increase in hospital beds from 1950 to 1968 was 323; in 1968 there was 1 bed for every 169 inhabitants.

The total number of persons employed in health and medicine increased from 9,881 in 1960 to 14,370 in 1967. The numbers of professional and semiskilled workers in 1969 were: physicians, 1,396; stomatologists (mouth specialists), 183; pharmacists, 262; medical aides, 725; dental assistants, 139; pharmacist assistants, 334; midwives, 1,091; nurses, 4,100; and laboratory technicians, 737. Dentists were not listed as a separate category. The average number of inhabitants per doctor in the districts was approximately 2,000; however, in two districts the average was over 3,000, and in one, less than 1,000. All medical personnel were in government employ, and no private medical practice existed.

The expansion of medical services after World War II was made possible to a large extent by accelerated training programs. A school for training medical assistants was begun in 1948 and, starting in the early 1950s, the Red Cross conducted courses for semiskilled medical workers. A medical college for training professional personnel was established in 1952; in 1957 it became the Faculty of Medicine of the State University of Tirana, and the first doctors were graduated that year. During the 1950s most physicians were trained in the Soviet Union. In the late 1960s the number of persons undergoing training as midwives was increased, and the goal was to have at least one midwife in every village by June 1971.

The use of mobile medical teams and equipment played a major role in expanding and improving medical care in rural areas. Laboratory, X-ray, and other services once available only in the largest cities were established in the district and sometimes at lower levels. The regime, in its effort to build up agriculture in the mid-1960s, set as an objective the improvement of living conditions in the countryside and the elimination of the differential between city and country. Medical assistance to rural areas continued to increase in the late 1960s, but in late 1969 the minister of health stated that the differences between the center and the districts and between the cities and the villages were very pronounced. He directed that action be taken to lessen the gap but added that differences would continue to exist.

Nutrition

Food supply--perennially a problem because of poor soil, primitive methods of cultivation, and lack of readily accessible resources--did not keep pace with population growth. For the late 1960s calorie intake per capita per day probably did not exceed 2,100 to 2,200, while the estimate for the mid-1950s was 2,200 to 2,300. The diet lacked protein and other protective elements. An estimated 80 percent or more of food intake was carbohydrates. Fruits and green vegetables were in short supply, and meats were a real scarcity. Little progress had been made in increasing livestock herds during the period of Communist rule, and credits to procure adequate supplies of protective foods from sources outside the country were not available (see ch. 8, Economic System).

The diet generally depicted scarcity and, in the mountain and rural areas, was simple and routine. Dishes, high in starch content, made from corn, wheat, rice, and potatoes were basic. Yogurt, cheese, and prepared dry beans were among the most commonly found other foods. Green vegetables and fruits appeared seasonally in limited quantities.

While some progress has been made in improving sources of drinking water, the vast majority of rural families, and some in the smaller cities, must rely on unprotected sources. Central sewage systems are found in only the largest cities.

Housing

Living quarters became increasingly overcrowded as population expanded at consistently high rates. Party First Secretary Enver Hoxha stated in December 1967 that the entire country, especially urban areas, was experiencing a housing crisis. Reports on housing construction indicated that the situation further deteriorated in the late 1960s because of the necessity to divert resources to even higher priorities, to the building of industry and procurement of food and clothing. War and natural catastrophes added to the burden. In World War II some 35,000 dwellings were destroyed. Earthquakes in November and December of 1967 demolished 3,500 homes. In April 1969, when 6,500 buildings were damaged or destroyed by earthquakes, additional thousands of homes had to be replaced or repaired.

Hoxha stated in late 1969 that 185,000 flats and houses had been built since World War II. The average annual rate of construction, as indicated by incomplete reports for the 1960s, was 6,000 private dwellings and 3,000 state-owned and cooperative apartment units. Total requirements were not stated, but with annual population growth at approximately 40,000 to 50,000 persons, and considering reports relating to crowded conditions, the critical condition was unresolved. Hoxha stated in late 1967 that the housing situation had reached the point where in some instances five persons were living in one room.

Most rural houses are of one or two rooms, with a hearth, and are of simple construction. They are small and sparsely furnished. Many are made of natural rock or stones. Urban houses and apartments are usually small and lack central heating. Kitchen and toilet facilities in apartments must be shared by three or four families.

Social Insurance

The social insurance program is administered by state organizations and covers medical care, compensation for incapacities, old-age pensions, family allowances, and rest and recreation. Social insurance was introduced in 1947. Several modifications were made later to the basic program. The law of 1953 provided a program closely resembling that of the Soviet Union, and for a number of years, following the Soviet example, trade unions administered a large number of social insurance activities. In 1965 the state assumed the administration of all phases except those for rest and recreation facilities.

The social insurance program, as provided for in the Council of Ministers decision of September 13, 1966, and effective January 1, 1967, included benefits for workers, employees, and others. Peasants in the collectives were not included in this law, but similar welfare benefits were provided from funds established by their organizations. The 1966 law continued the policy announced in 1964 that free medical care was provided to everyone. Drugs, such as penicillin and antibiotics, and vitamins prescribed during outpatient treatment had to be paid for by the user. Funds for social insurance payments came from the state budget. Contributions were paid by state institutions and enterprises that were in the role of employers.

Workers who became incapacitated and had over ten years of work credit received payments at the rate of 85 percent of the average wage for the last month worked; persons with less than ten years' service received 70 percent, except that temporary or seasonal workers were given less. When disability resulted directly from work, pay was given at the rate of 95 percent for most trades and 100 percent for persons working in mines. Compensation was less when incapacity resulted from an accident unrelated to work. Payments under these circumstances depended on age and years of work credit. Veterans who served in the Army of National Liberation before May 1944 and some of the Party elite were allowed an extra 10 percent when incapacitated (see ch. 2, Historical Setting).

Pregnant women were given eighty-four days' leave under normal circumstances and 95 percent of their monthly wage if they had worked over five years. They received 75 percent if they had worked less than five years. Workers could remain at home for limited periods to care for the sick and receive 60 percent of their pay. When children under seven years of age were ill, the worker was permitted up to ten days' leave during a three-month period. A subsidy, a one-time payment, of 280 leks was provided for each child. Upon the death of a family head or his spouse, 300 leks were provided for funeral expenses.

Old-age pensions were based on age and years of work. Payments were computed at the rate of 70 percent of the worker's average monthly wage. The minimum pension was 350 leks, and the maximum was 900 leks per month; two exceptions were veterans of the Army of National Liberation who served before May 1944 and Party leaders, who were awarded an additional 10 percent. Women who reared six or more children to the age of eight were permitted to retire at age 50 when they completed fifteen years of work, instead of the usual requirement of twenty years.

Wages and Prices

The limited data available indicated that in early 1966 factory and manual workers received 400 to 800 leks in wages per month. Skilled workers were paid 400 to 1,500 leks, and senior officials received up to 1,500 leks per month. After the reduction in the size of the bureaucracy was announced in late 1966, the maximum for officials was reduced to 1,200.

Prices in leks per pound for foodstuffs in 1966 were approximately as follows: bread, 1 to 2, depending on type; flour, 2 to 2.5; sugar, 4.5; beans, 3 to 4.5; beef, 6.5; and lamb, 8.5. Prices for other commodities, in leks, were as follows: a man's suit, 400 to 1,300; a pair of men's shoes, 120 to 200; radio, 500 to 2,400; and a bicycle, 800 to 1,300.

During the late 1960s the consumer continued to feel the squeeze of the drive for greater economic self-sufficiency and the priority given to the building of means of production. Despite announcements of greater benefits to the worker, the average citizen in early 1970 continued to pay approximately 90 percent of his income for food and shelter. Basic commodities and foodstuffs were in short supply, and waiting in line at distribution points was required to obtain the most commonly used items. Manufactured items were generally of poor quality. Automobiles were owned by the government only, and bicycles, a status symbol, were available to only a few.