By Vesna Peric Zimonjic
BELGRADE, Feb 10 1996 (IPS)

Wars, economic crisis and international sanctions have decimated Serbia’s once-extensive state health care services. Now the wry advice given in Belgrade is: ‘Get sick only if you have to’.

The crisis is the cumulative effect of wars fought across the former Yugoslav Federation, and particularly the international sanctions applied in May 1992 on Serbia and Montenegro – still federated under the name Yugoslavia – for Belgrade’s part in fomenting the conflict in Bosnia-Hercegovina.

People are eating less well, reducing their ability to resist illness. And the worsening tension of daily life has boosted diseases influenced by “psychological factors” — high blood pressure and angina pectoris. These are among the leading causes of death in Serbia.

Prior to the war, state-funded systems provided almost free health care for all. Officially the sanctions exclude humanitarian supplies. But what does come through the monitors is both slow and insufficient. All imports of drugs, equipment and equipment parts are filtered by a U.N. sanctions committee.

Serbia’s well established domestic pharmaceutical industry has almost collapsed through lack of imported raw materials and spare parts. Their assets abroad were frozen until sanctions were relaxed in November as Belgrade cooperated with a U.S. brokered peace process.

The 1992-94 Statistical Yearbook, produced by the Belgrade- based Institute for the Improvement of Public Health estimates that the mortality rate rose by 28 percent over the three year period among Serbian civilians alone. It carefully separates war-related deaths or deaths among the 600,000 refugees who fled the wars in Croatia and Bosnia-Hercegovina.

There were massive increases in deaths from chronic diseases normally treatable with drugs. Deaths among heart disease and blood pressure cases increased by 429 percent, by 174 percent among brain haemorrhage cases, and by 156 percent among diabetics.

Infant mortality rates rose from 16 per thousand live births in 1990-91 to 23 per thousand by 1994, when the national birth rate fell by 12,000. In 1992 the first case of death from tuberculosis was recorded in more than 50 years.

“Mathematically speaking, people are taking in at least a third calories less in their daily meals for years,” says the yearbook. “Instead of 3,160 in 1991, it was about 2,000 calories per day in years that followed.”

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By Vesna Peric Zimonjic
BELGRADE, Feb 8 1996 (IPS)

Wars, economic crisis and international sanctions have decimated Serbia’s once-extensive state health care services. Now the wry advice given in Belgrade is: ‘Get sick only if you have to’.

The crisis is the cumulative effect of wars fought across the former Yugoslav Federation, and particularly the international sanctions applied in May 1992 on Serbia and Montenegro – still federated under the name Yugoslavia – for Belgrade’s part in fomenting the conflict in Bosnia-Hercegovina.

People are eating less well, reducing their ability to resist illness. And the worsening tension of daily life has boosted diseases influenced by “psychological factors” — high blood pressure and angina pectoris. These are among the leading causes of death in Serbia.

Prior to the war, state-funded systems provided almost free health care for all. Officially the sanctions exclude humanitarian supplies. But what does come through the monitors is both slow and insufficient. All imports of drugs, equipment and equipment parts are filtered by a U.N. sanctions committee.

Serbia’s well established domestic pharmaceutical industry has almost collapsed through lack of imported raw materials and spare parts. Their assets abroad were frozen until sanctions were relaxed in November as Belgrade cooperated with a U.S. brokered peace process.

The 1992-94 Statistical Yearbook, produced by the Belgrade- based Institute for the Improvement of Public Health estimates that the mortality rate rose by 28 percent over the three year period among Serbian civilians alone. It carefully separates war-related deaths or deaths among the 600,000 refugees who fled the wars in Croatia and Bosnia-Hercegovina.

There were massive increases in deaths from chronic diseases normally treatable with drugs. Deaths among heart disease and blood pressure cases increased by 429 percent, by 174 percent among brain haemorrage cases, and by 156 percent among diabetics.

Infant mortality rates rose from 16 per thousand live births in 1990-91 to 23 per thousand by 1994, when the national birth rate fell by 12,000. In 1992 the first case of death from tuberculosis was recorded in more than 50 years.

“Mathematically speaking, people are taking in at least a third calories less in their daily meals for years,” says the yearbook. “Instead of 3,160 in 1991, it was about 2,000 calories per day in years that followed.”

Since 1992, Serbia has periodically faced shortages of basic foodstuffs like flour, sugar, cooking oil, milk or meat. The public transportation system was a daily horror for commuters in Belgrade – a city of two million – due to gasoline shortages. As oil and gas imports were forbidden by the sanctions, central heating was almost non-existent for three long, cold winters.

The shortage of medical equipment that has resulted from the spares problem has severely affected preventative medical programmes, notably scanning for cancers.

Leading Belgrade doctors point out that the rise in the cancer occurrence since 1992 has met their worst expectations and came to the rate of eight percent annually. Belgrade Oncology Institute statistics show that in the years 1992, 1993 and 1994, about 30,000 new cancer patients were registered annually.

Due to the almost neglected work in the field of prevention and problems with obtaining the spare parts for the equipment, only 13 percent of cancers were diagnosed at the early stage. In 1991, more than 35 percent of diagnoses was established at the early stages of cancer.

“It was even worse than war”, says Dr Nikola Mitrovic, head of the Oncology Institute. “Since 1992, about 3,000 to 3,500 people died in Belgrade annually due to cancer, which was not the case ever before.”

“There are 145,000 cancer patients in Serbia now, and a good number of them was registered in the period 1992-1995,” he explains. About 20.000 people in Serbia died of cancer every year since 1992. A decade earlier, the number did not reach 10,000.

Almost all of them agree that the mental health of the nation is also in danger, due to the prolonged effects of poverty, war in neighbourhood and instability of situation in Serbia. the feeling of “no life purpose, no prospective” is cited by their patients as the most common cause of depression.

“Almost everybody that comes to see me is at least depressed for the start” says Dr Jovan Maric, one of the most prominent Belgrade psychiatrists and university professors.

“The crisis has lasted too long, people have endured too long in everyday poverty and uncertainty. impoverished and pushed to the brink of despair, people became deprived from the elementary feeling of dignity of their existence,” he explains.

Thousands of people have lost their jobs in Serbia due to the sanctions and the statistics of Belgrade sociology faculty say that the middle class has almost disappeared since 1991.

“The ordinary people were living in movie that looked like nightmare. They lost their jobs, the war nearby was going on endlessly, the social values were falling apart, the criminality rate at home was rising, the hyperinflation (313 million percent in 1993) ruined their lives” independent belgrade weekly NIN says.

“Even the everyday routine became situation causing stress – shopping for food, using public transportation system, living in cold apartments in winter and listening to the daily news” it adds.

It will take years to rebuild Serbia’s economic base and with economic reforms expected to accompany the reconstruction, the days of a strong pharmaceuticals industry feeding a well funded state health service may be gone for ever.

“The effects of bad health care will be felt for decades to come,” concluded a recent study by the medical faculty of Belgrade University, “and the population will continue to suffer from deteriorated general health, especially children and older people.”

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