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.


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.

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 Serbia.

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 Kosovo.

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 refugees.

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.

Macedonia, Serbia, Kosovo
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