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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.