Lest we forget

Amra Sarac shakes her head sadly and whispers: “You shouldn’t see
these.” Sitting in her office in Sarajevo’s Kosevo Hospital, the
largest in Bosnia, she opens a small box and produces two dozen
“family snaps” of babies that young raped Muslim women gave birth
to during the war. Sarac says she is now “mother” to all these
children and to their own mothers.

Sarac, chief of social services in Sarajevo’s main clinical centre,
is head of a team of eight social workers who deal with traumatised
victims of Bosnia’s war in the Sarajevo district. She also worked
in this capacity during the war with just one other colleague.
Helped by the World Health Organisation, she co-founded a healing
centre, called Sun, in Sarajevo for rape victims. However, it
stayed open for only three and a half years. It closed last year
and is now a narcotics centre. The next generation of children are
traumatised, many having lost parents and family members or are
unable to find work before succumbing to crime and drugs.

The wall above Sarac is lined with many of her international
diplomas and a picture of her shaking hands with Hillary Clinton
when she visited Sarajevo just after the the warring parties signed
the Dayton Peace Agreement in 1995 – which set up a central
government and two sub-state “entities”, the Muslim-Croat
Federation and the Serb Republic.

There is a widely held belief in Sarajevo that the West has
forgotten Bosnia, and that Afghanistan and Iraq are taking priority
– although the EU is still investing heavily.

But Bosnia still has massive problems. The WHO estimates there are
more than one million people with war-related traumas in the
Muslim-Croat Federation alone, in addition to a further 750,000 in
the Serb Republic.

Dr Ismet Ceric, professor of psychiatry at Kosevo Hospital
says:”M’decins sans FrontiŠres came here to help but I said
‘we have some effective programmes already and you should go to the
Serbs’ side’. But they are in denial and say they have no problems.
They are now suffering worse than us.”

Ceric says post-traumatic stress is now becoming a greater threat,
owing to unemployment and lowered expectations. It has also caused
paranoia and suspicion which have surfaced in alcoholism, drug
abuse, crime, prostitution, violence, suicide and murder.

To counter this, the Muslim-Croat Federation has reorganised its
mental health system so patients are treated in the community as
opposed to the pre-war system where they were treated in the four
main hospitals. In 1996 the World Bank gave the federation DM30m in
credit to help this process, and DM7m was immediately spent opening
38 local mental health centres, each treating patients from a
community of 25,000-50,000 people.

Each centre has 10 psychiatric beds for acute cases in the general
hospital psychiatry ward and a team comprising a psychiatrist,
psychologist, social worker, four psychiatric nurses and an
occupational therapist. Two more centres are also being built to
meet demand. Two years ago the Serbs finally accepted the same
model of health centres and have now opened six in the Serb
Republic which are co-operating with the Muslim-Croat Federation.

But Ceric’s prognosis is bleak. In the Muslim-Croat Federation
there are more than 300,000 deeply traumatised people, of whom
80,000 are also disabled, with a similar number in the Serb
Republic. And the economy does not help; in Bosnia unemployment is
40 per cent while salaries have fallen by a third since 1991.

Ceric says depression leads to many suicides through , and children
suffer from parental abuse. “I have a fear that stress will be
transmitted through the generations. Kids have no holidays, money
or communication with their parents, and before the war the
communist state controlled everything. Now individuals have to look
after themselves, and they can’t. Many kids resort to crime.”

However, there are glimmers of hope. In October Ceric is helping to
organise an international conference in Sarajevo, including the
Serb Republic and other former Yugoslav republics on health in
post-conflict and transition countries. There are also several
educational projects under way, including a three-year pilot
project dealing with primary mental health care in the Travnik
district run in co-operation with the US’s Harvard Trauma Centre.

The University of Sarajevo, with a Swedish university, has 30
Bosnian students completing a course in child and adolescent
psychiatry. And 30 psychiatrists, psychologists and social workers
have just completed a course in community psychiatry at the
University of Sarajevo with students spending one semester abroad
working in the UK, Italy and Slovenia.

But it is a long road, and Bosnia needs the help of the West more
now than ever to heal its wounds.