Sarajevo, March 14, 2007




Lack of access to medical care - and inexplicable charges - make it hard for Bosniaks to return to homes in Serb entity.

Bosniak returnees are complaining of routine mistreatment in hospitals and health centres in Republika Srpska, RS.

They say doctors frequently refuse to treat Bosniak patients, or slap charges on them for treatments that are supposed to come free of charge under their insurance policies.

Many former exiles returning to pre-war homes in the RS, who have been unable to access health care, have been forced to re-register in the Muslim-Croat Federation in order to get health care there.

In Srebrenica, in eastern Bosnia, for example, 30 per cent of the Bosniak returnees have registered as residents of the Federation.

Legal and medical experts say setting up a federal health ministry may be the only way to resolve the problem.

Mirhunisa Zukic, chairwoman of the exiled and displaced persons association, also says the 1995 Dayton peace accords needs to be redefined to ensure refugees are both able to return to pre-war homes and live a normal life, once they are there.

Under annex VII of article II in the Dayton accords, the parties are obliged to create favourable political, economic and social conditions in their respective territories for refugees and displaced persons. They are also obliged to reintegrate returnees and protect them from discrimination.

In theory, this provision has been respected. The UN refugee agency, the UNHCR, claims 1.025 million of the 2.2 million refugees registered when the Dayton accords were signed have returned to pre-war homes.

But the real story is different from the rosy picture painted by the UNHCR figures. Problems linked to access to health care, among other matters, have compelled many of the million or so returnees to sell their homes and go back to the Federation.

A field analysis conducted by the Bosnia and Herzegovina association of refugees and displaced persons concluded that only one-third of returnees had retained their property over the long term. The rest had given up and gone.

The health care muddle reflects the broader constitutional crisis in the republic. The ten cantons of the Federation, the RS and the District of Brcko, which functions as a separate unit, all have their own health ministries. None operates on a nationwide, federal, level.

The negative effect of this cumbersome division of responsibility is reflected in the fact that a worryingly high percentage of the total population, about 40 per cent, have no health care insurance at all.

Even those with the right insurance are far from well covered when it comes to treatment. “Those who are insured often have to travel hundreds of kilometres to get treatment in hospitals covered by their insurance,” said Arif Smajkic, an advisor to the ministry of civil affairs. The formation of a federal health ministry would resolve many of these problems, he added.

The authorities tried to resolve the headaches over health care six years ago with the signing of an agreement. This bound the two entities to cooperate on hospital care and in theory enables all patients to receive treatment anywhere in the country. But it is a dead letter.

Sabra Mujic of Srebrenica is one of many Bosniak returnees who was charged a fee for treatment in the RS, which she ought to have received for free.

Mujic, who needs frequent treatment for kidney problems, was made to pay 62 convertible Bosnian marks (about 30 euro) for recent medical help in her hometown of Srebrenica.

Now she has changed her address in order to get access to health care in the capital, and so has registered as a resident of Sarajevo once again.

“The [healthcare] document is ineffective,” said Mirhunisa Zukic. “The situation out there is really bad.”

Other Bosniak returnees to the RS depend on the services of volunteer medics from the Federation.

On February 17, we found the waiting room in Srebrenica’s health centre full of returnees making use of the opportunity to be treated by doctors from the Tuzla-based NGO Woman’s Power.

The organisation has been sending doctors to Srebrenica twice a month for the past five years.

One of them, Branka Antic Stauber, said patients either did not trust Serbian doctors from Srebrenica or had been unable to exercise their right to free health care in the town.

It’s not only returnees who often find it difficult to exercise their health care rights in the RS. Long-term Bosniak residents also find themselves on the receiving end of inexplicable medical fees.

Fata Salkic of Srebrenica was made to pay 52 convertible marks for a blood and urine test even though she had valid health care identification. She never found out why she had to pay for the treatment. Since then, she has relied on free check-ups by the volunteers from Tuzla.

Halid Mesanovic, from the village of Urisici, about an hour’s drive from Srebrenica, also said he received poor treatment in Srebrenica health centre on grounds of his nationality.

When Mesanovic was bitten by a snake six months ago, a doctor at the Srebrenica health centre told him he needed to go to Zvornik for anti-snake-bite serum, even though the law obliges every hospital in Bosnia and Herzegovina to keep supplies of serum for such emergencies.

The centre’s director, Petar Loncarevic, has since admitted this was an incorrect procedure and said the doctor who instructed the snakebite victim to go to Zvornik had been transferred.

Loncarevic stressed that all his staff had recently been instructed by the RS authorities in Banja Luka to provide correct medical services for returning exiles.

But Suljo Cakanovic, also a doctor in the Srebrenica hospital, said the situation facing Bosniak patients in the RS was generally unsatisfactory.

He claimed a pregnant Bosnian Muslim returnee had been charged 50 convertible marks for the delivery of her child in Zvornik although she had full medical insurance.

Cakanovic said the imposition of fees for what are supposed to be free treatments was a major disincentive to Bosniaks wanting to return home to the RS.

“It’s tantamount to the ethnic cleansing of returning exiles,” he said. “If this trend continues, there will be no Bosnian Muslims left in the RS.”

Branka Antic Stauber, of Woman’s Power, said a state health insurance fund would make it much easier to tackle this and other problems.

So do many others. Legal experts from the Sarajevo-based association Your Assistance, meanwhile, urge returnees to contact them when they experience problems in exercising their rights.

Omer Ibrahimovic, a constitutional expert, said Bosnia and Herzegovina could not function as a state unless all political parties, institutions and public enterprises fully respected the Dayton annexes, which specify that human rights and freedoms are guaranteed to all citizens, regardless of their sex, ethnicity, religion or beliefs.

Damir Arnaut, a constitutional advisor to Haris Silajdzic, a member of the Bosnian presidency who is known for his opposition to the entity-based framework, said the medical issue highlighted the lack of mechanisms to enforce the Dayton provisions defining basic human rights and freedoms.

“Human rights in Bosnia and Herzegovina cannot be implemented in the country unless it functions as single state,” said Arnaut.

By Saida Mustajbegovic in Sarajevo (Balkan Insight, 14 Mar 07)


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