>Date: Mon, 10 Jan 2000 10:02:23 +0100
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>To: andolina at burlo.trieste.it
>From: Paola Lucchesi <paola.lucchesi at mail.inet.it>
>The Institute for War & Peace Reporting (IWPR) is a London-based independent
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>Copyright (C) 1999 The Institute for War & Peace Reporting <www.iwpr.net.
>Serbia's health-care system is on the brink of collapse, and with medicine
>short, the country's infrastructure damaged by the war, and an influx of
>refugees from Kosovo, infectious disease is rising.
>By Milenko Vasovic in Belgrade
>In Smederevo, a town on the Danube 40 kilometres downstream from Belgrade,
>the infectious diseases ward at the Saint Luke health clinic has issued
>warnings of a jaundice epidemic (hepatitis A). Over 50 cases were registered
>during November and December. Another 100 cases have been recorded since
>January 1. This is comparison to an average of 80 cases annually, according
>to Dr Jasna Avramovic.
>The Serbian Institute for Medical Protection of the Ministry of Public
>Health registered 1,767 confirmed cases between January and October 1999.
>This figure represents a 2.5 fold increase for the same period in 1998. The
>largest increase was recorded in Vojvodina and southern Serbia.
>Poor hygiene, contaminated water and cramped living conditions provide ideal
>breeding conditions for jaundice. Contaminated water supplies are thought to
>be behind the increase in cases in Vojvodina, a relatively rich region in
>The standard of living in southern Serbia is, however low. Large numbers of
>Serbs refugees from Kosovo are living in cramped, collective accommodation
>in the region. In Lebane, a town in the south and one of the poorest in
>Serbia, 55 people were infected with hepatitis A by the end of November
>according to reports in the pro-government daily newspaper Politika. Health
>authorities had declared an epidemic in the town on August 30.
>The Yugoslav United Left (JUL) holds power in Lebane and rather than
>focusing attention on combating the spread of disease, local officials are
>wasting time and money currying favour with the regime of Serbian President
>Slobodan Milosevic in Belgrade. Meantime, the average income in Lebane is
>204 dinars (10 German marks), enough to buy 10 cheap bars of soap.
>Since 1994, tuberculosis (TB) has also been on the increase in Serbia. Lack
>of money forced the closure of TB clinics and the compulsory screening
>programme in the years before 1994. But it was believed the disease had been
>eradicated in Serbia. However 450 new cases have been recorded in Belgrade
>alone in the past year.
>Dr Miodrag Djordjevic, a Belgrade epidemiologist said, anticipates a rise in
>the number of those infected over the next year due to the war in Kosovo,
>the subsequent NATO air bombardment and the influx of Serb refugees from
>According to official data, 389,122 people in the Federal Republic of
>Yugoslavia (FRY) contracted infectious diseases in 1998. Dr Svetislav
>Ristic, head of epidemiology at the Federal Institute for Medical
>Protection, blames the current economic crisis for a large number of these
>cases. Medicines are cheap in FRY. Prices set by the state in April 1996
>still apply, despite the fact that the exchange rate has collapsed against
>the DM from 3.3 dinars to 20 dinars now.
>Because of these low prices much of Serbia's medicines end up, by legal and
>illegal means, in the pharmacies of Republika Srpska (RS) and Macedonia. The
>heard medicine Dilcoran costs 6 dinars in FRY but six times as much in RS.
>Hence pharmacists from RS travel to Yugoslavia and buy up whatever stock
>they can find.
>Likewise various Serbian firms sell pharmaceuticals abroad, having obtained
>export licences in questionable ways. The Belgrade daily Blic published a
>report alleging that a Syrian man travelling on an Iraqi passport 'legally'
>exports pharmaceuticals from Serbia. Again Serbian medicines are openly sold
>in pharmacies in Kosovo for hard currency. Given that the Belgrade regime
>refuses to co-operate in any way with the administration in Kosovo, the
>implication must be that these drugs arrive in the province illegally.
>A lack of money to buy raw materials has hindered the manufacture of
>pharmaceuticals in Yugoslavia. The Belgrade government compounded these
>difficulties when it confiscated the country's largest pharmaceuticals
>company, ICN, from its owner Milan Panic, a strong opponent of Milosevic.
>Faced with a bill amounting to $180 million for medicines that it could not
>pay, the government launched a take-over of the factory, on the grounds that
>Panic had failed to fulfil his obligations as owner. The end result  is that
>many drugs manufactured by ICN are no longer produced in Serbia. Furthermore
>ICN used to donate large quantities of medicines to the most needy in
>Serbian society, such as pensioners.
>Humanitarian aid shipments of medicine and equipment to Serbia are
>insufficient to meet the needs of a badly organised health-care system
>struggling to cope with increased demand stemming from the influx of
>There are plentiful quantities of one kind of medicine - the sedative
>Bensedin. It is the best-selling medicine in Serbia. Each month an estimated
>50,000 packages of Bensedin are sold in Belgrade alone.
>"A quarter of the population of Serbia currently live with serious mental
>problems," a recent conference of Serbian psychologists concluded.
>Psychologist Dr Jovan Maric, a frequent commentator on mental health issues,
>said "Depression is the dominant state of mind in this country". Hence the
>high demand for tranquillisers.
>The ruling coalition party JUL controls the senior positions in the Serbian
>health service. Leposava Milicevic holds the office of health minister;
>Milovan Bojic, a deputy prime minister is also director of Dedinje clinic;
>Jovan Hadzi Djokic is director of the Serbian Central Clinic; Tomislav
>Jankovic is director of the Serbian health-care fund. In addition the
>majority of hospital directors are also members of JUL or Milosevic's
>Socialist Party of Serbia (SPS). Many doctors complain that these hospital
>directors ride rough shod over medical ethics and are complicit in
>maintaining poor working conditions.
>"The situation in the Serbian health-care is tragic. We are ill as a nation
>and we have nothing to treat ourselves with. We have professionals, but our
>hospitals are in a miserable condition," Dr Milena Jaukovic told IWPR. "The
>equipment is outdated and there are no medicines. Even if there were to be a
>political change, we would need humanitarian aid for a long time."
>Milenko Vasovic is a regular contributor to IWPR.