Bosnia's Traumatised Citizens

Since his wife was murdered, his teenage daughter raped and his house burned down in front of him nine years ago, one of Dr Ismet Ceric's patients has not slept for a single minute.

"My patient is quite simply afraid to fall sleep, afraid of waking up and afraid of what he might see in his dreams. He is a medical phenomenon - he never sleeps, yet his body functions normally," said Dr Ceric, one of Bosnia's leading psychologists.

The patient is a classic example of Post Traumatic Stress Disorder Syndrome, PTSD, according to Dr Ceric. PTSD is caused by extreme traumatic experiences and expressed in a variety of physical or mental symptoms. First identified and recognised after the Vietnam war, for many years it was known as "Vietnam syndrome".

"I took heroin for the first time after I saw my father die in a massacre," said one young PTSD sufferer. "I'm still haunted by the image. I was 19 at the time."

Dr Lilijana Oruc, a doctor at Sarajevo's central clinic and member of a team working alongside experts from Harvard University to study post-traumatic stress in Bosnia, says that drug abuse, alcoholism and violence within families are all consequences of the syndrome.

"Six years after the war, post-traumatic stress syndrome has taken on a new dimension. Depression has become a significant component of the trauma, so people often contact us with depression and other forms of anxiety. In many cases trauma is expressed in organic and somatic disorders such as hypertension and diabetes," she said.

Doctors in Bosnia-Hercegovina see cases of severe trauma every day; some even think trauma suffered during the war is responsible for the increased mortality rate in the country. The most serious cases occur among people who witnessed massacres or bombardments, were prisoners of war, subjected to sniper fire, lived in basement shelters or saw terrible suffering inflicted on others.

However, with no serious research on the problem, there is no reliable data on the number of those affected, although the most pessimistic estimate is that 60 per cent of the population suffer with some form of PTSD.

Doctors believe that in some cases whole towns and regions are infected with the disorder. Gornji Vakuf and Mostar are two such examples; both towns were divided along ethnic lines during and after the war. "As for the people of Srebrenica, it's hard to know what to say about them. Many of the survivors who come to see us are emotionally dead," said Dr Oruc.

Although there is no comprehensive research on PTSD in Bosnia, experts from Harvard have conducted studies into the trauma suffered by refugees. "We have learned that people who experience mass violence or torture are unable to recover good mental health, irrespective of the passage of time," said head of the team Dr Richard Mollica.

The Harvard research began in 1996 and was conducted among Bosnian refugees in camps in Croatia. Data collected this year showed little change from that collected five years ago, with a quarter of refugees found to suffer from a nervous disorder. Moreover, the symptoms displayed by refugees were far more severe than those arising from ordinary depression.

"Our research has demonstrated that these people are in need of urgent treatment," said Dr Molllica. Unfortunately, there are almost no specialised clinics for PTSD in Bosnia-Herzegovina or the remaining refugee camps. The Sarajevo central clinic has recently opened a surgery for PTSD, but with only a small number of places it can treat only the most serious cases.

"It is important that humanitarian organisations coming to the region recognise this problem. Attempts to rebuild the country and the economy will not amount to much while large chunks of population are dogged with serious psychological disorders," said Dr Mollica.

Even the television or newspapers can be sources of stress. "Scenes of the recent events in the United States and Afghanistan could provoke a reaction in someone who has already experienced extreme trauma," said Dr Oruc.

In the immediate post-war phase, most requests for help came from soldiers. Today it is women and children who most often display PTSD symptoms. Women raped during the war - estimates to number 40,000 - are another high-risk group.

A study presented to the Sarajevo clinical centre described the cases of 18 raped women who were under psychiatric treatment. Eleven were pregnant, seven had been raped repeatedly. All suffered from PSTD, with ten showing signs of depression. Four had attempted suicide.

"We live in a world where hundreds of thousands of people have been subjected to violence," said Dr Mollica. "I only hope that our research will encourage governments and development agencies to look much harder at the social and economic disruption caused by the suffering of refugees and those who have experienced or witnessed terrible violence."

Sanela Hajdarhodzic is a freelance journalist based in Sarajevo.