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Background

The dissolution of the Soviet Union led to the creation or re-creation of a number of eastern European or Balkan states, including Bosnia, Croatia, and Macedonia. Borders and populations changed, in some cases leading to or renewing conflict among ethnic and religious groups. Conflict was most pronounced between Serbia (the former Yugoslavia) and Bosnia (formerly part of Yugoslavia). The roots of the conflict lie in the past history of the areas (e.g., forced assimilation and different allegiances in World War II), in religious differences (Christian and Muslim), and in nationalism. The Bosnian population has traditionally been more mixed than other Balkan countries (40% Serb, 38% Muslim, and 22% Croatian), with the capital, Sarajevo, seeming at one time to be a model of religious and ethnic tolerance. Most Serbs are Greek Orthodox, most Croats are Catholic, and most Bosnians are Muslim; with Bosnians tending to be more diverse with respect to religion than Serbs or Croats.

Conflict began in 1991 and in 1992, Bosnia (the Federation of Bosnia-Herzegovinia) declared independence from Yugoslavia. The conflict included "ethnic cleansing" of Muslims in Bosnia by Serb military and police. This genocide was characterized by concentration camps, mass murders (especially of men), and a Serb policy of raping Muslim women. The vast majority of casualties (approximately 250,000 killed) were civilian. An outflow of refugees resulted with approximately 800,000 Bosnians displaced to other countries and more than 200,000 coming to the United States.

The language of Bosnia is Serbo-Croatian (Bosnians now refer to their language as Bosnian), and many people also speak German, English, or another second language. In most respects, Serbo-Croatian is similar enough to English that Bosnians are able to learn English without exceptional difficulty. A relatively high level of education (at least eighth grade) helps in learning English. Some have difficulty with question formation and recognition of gender-specific names (many Bosnian women have a name ending in "ica" or "a").

Religion

Virtually all Bosnian refugees are Muslim. Islamic influences on health care beliefs and practices are discussed in the section on Religions. As discussed in that section, there are many factors that influence the extent to which a religion impacts health-related behavior. In the case of Bosnian refugees, generally a cosmopolitan group, Islam may have less of an impact on health beliefs and practices than among others from rural middle-eastern backgrounds. Bosnian women, for example, tend to be less intent on maintaining extreme modesty and are more willing to report gynecological problems than women from some other groups. At most, women will wear a scarf over their head and conservative dress. A Church World Service report noted that many Bosnians have a relationship with Islam similar to the relationship many Americans have with Christianity: "something restricted to the Sabbath and major religious holidays."

Family Structure

Although there are extended families living together in rural Bosnia, most Bosnian refugees live in nuclear family groups. Many families have a history of both wife and husband employed outside the home. Men usually have greater authority than women. Although polygamy is sanctioned in the Qurían ("marry of the women, who seem good to you, two or three or four . . . " Women: 4), it is only rarely practiced in Bosnia.

One of the more touching scenarios during the Bosnian war was a couple in love, with one person being Muslim and the other Christian. We see such couples among Bosnian refugees, and though they do not seem to romanticize the situation, still, they stand as testimony to the power of love.

Health care Beliefs and Practices

In Bosnia and Herzogovina, "the expected number of years to be lived in what might be termed the equivalent of "full health'" is 63.4 years for men and 66.4 years for women. Bosnia is thus 56th among 181 nations ranked by the World Health Organization (WHO) (WHO, 2000). Among all Americans, this "disability adjusted life expectancy" or DALE is 67.5 years for men and 72.6 years for women.

Except that the health care system in Bosnia is socialized, basic health care is similar in many respects to that in the United States. There is a greater emphasis on primary care and some sophisticated tests and procedures are generally unavailable. However, except for conflict and war-related shortages, primary care, at least, is similar. Nearly all Bosnians are familiar with western conceptions of hypertension, coronary disease, diabetes, treatment of infections, and so on. Some arrive in the U.S., with histories of treatment for thyroid deficiency, cancer surgery, and other sophisticated procedures.

Our research and experience have uncovered no specific health risks other than those related to war experiences, i.e., risk for post-traumatic stress disorder (PTSD), combat stress disorder (CSR), depression, and other sequelae of psychological trauma ñ including, despite Islamic prohibitions against alcohol, alcoholism. Reactions to war-trauma are discussed in detail in the section on Mental Health. Readers are strongly encouraged to refer to that section, as many Bosnians of all ages have lived through genocidal experiences and thus will have a very high risk for delayed reactions. Readers should also note that these experiences are essentially the same as holocaust experiences, hence reactions may continue through at least a second generation.

Like other refugees, Bosnian refugees tend have a poorer "global health" status than other people in the host country. Poor global health is characterized by poor appetite, decreased memory, little leisure time; and decreased or poor energy, patience, sleep, mood, and health.

Health Risks in Refugees from Eastern Europe or Russia (see Infectious Diseases page)

  • Nutritional deficit
  • Hepatitis B
  • Tuberculosis
  • PTSD (Bosnia)

Recommended Laboratory and Other Tests for Refugees from Eastern Europe or Russia

  • Hepatitis B surface antigen
  • PPD

Nutritional assessment, hemoglobin or hematocrit, and (for Bosnians) stool for ova and parasites should be considered. 

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References

Geissler, E. M. (1998). Cultural assessment. St. Louis: Mosby.

Goldstein, R. D., Wampler, N. S., & Wise, P. H. (1997). War experiences and distress symptoms of Bosnian children. Pediatrics, 100(5), 873-878.

Maners, L. (1993). The Bosnians. New York: Church World Sevice.

Sundquist, J., Behmen-Vincevic, A., & Johansson, S. E. (1998). Poor quality of life and health in young to middle aged Bosnian female war refugees: A population-based study. Public Health, 112(1), 21-26.

World Health Organization (2000). Healthy life expectancy rankings. Accessed on the World Wide Web on October 14, 2000 at http://www-nt.who.int/whosis/statistics/dale/dale.cfm?path=statistics,dale&language=english

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Links to Bosnian Sites and Other Resources

http://www.geocities.com/CapitolHill/Lobby/4634/ a home page that gives some background on Bosnia

http://www.public.usit.net/michaela/index.html International Bosnian Student Homepage ñ includes links

gopher://gopher.igc.apc.org/11/peace/yugo/crimes Comprehensive gopher site (focus on genocide) in Bosnian and English

http://www.students.haverford.edu/vfilipov/home2.html The Community of Bosnia Foundation ñ an extensive and recommended site. See their list of "Recommended Books on Bosnia" below.

http://www.phrusa.org/about/index.html Physicians for Human rights site. Focuses on genocide and related.

http://www-cgsc.army.mil/chap/courses/w-rel/bosnia.htm Some in-depth information on religion in Bosnia.

http://www.its.caltech.edu/~bosnia/ More on war crimes and related.

Recommended Books on Bosnia

From the Community of Bosnia Foundation (address above)

With No Peace to Keep: United Nations Peacekeeping and the War in the Former Yugoslavia (London: Grainpress, 1995). ISBN: 0952711400. Grainpress Ltd.
Four Panton Street, London SW1Y 4DL, United Kingdom
Tel: +44 (0) 171 - 930 5363, Fax: +44 (0) 171 - 839 1228, email: icu@gn-apcorg

Andras Riedlmayer, Killing Memory: Bosnia's Cultural Heritage and Its Destruction (Haverford, Pa: Community of Bosnia Foundation, 1994). Videocassette, 48 minutes. (Community of Bosnia Foundation, Haverford College, Haverford, PA 19041-1392. Price, $52.50, includes postage and handling). e-mail: msells@haverford.edu. Phone orders: 610-896-1027.

Kemal Kurspahic, As Long as Sarajevo Exists (Stony Creek, Ct.: Pamphleer's Press, 1997). ISBN: 0614957575 or 0963058770, $25.00, cloth.

Michael Sells, The Bridge Betrayed: Religion and Genocide in Bosnia (Berkeley: University of California Press, 1996). Cloth: ISBN 0520206908; $19.95. Orders: (609) 883-1759. Fax Orders: 1-800-99-1958

Ed Vulliamy, Seasons in Hell (New York: St. Martin's Press, 1994). Cloth, ISBN 0312113781, $22.95.

Roy Gutman, Witness to Genocide (New York: Macmillan, 1993). Cloth, ISBN 0025467506, $25.00; Paper, ISBN 0020329954, $12.00.

Norman Cigar, Genocide in Bosnia: The Policy of Ethnic Cleansing.247pp. College Station, TX: Texas A and M University Press. $29.95. ISBN 0 89096 638 9

Rabia Ali and Lawrence Lifschultz, Why Bosnia: Writings on the Bosnian War (Stony Creek, Ct.: Pamphleteer's Press, 1994). Paper, ISBN 0963058797, $19.95; Cloth, ISBN 0963058789, $35.00

Mark Almond, Europe's Backyard War (London: Mandarin, 1994), ISBN: 0749316594. London: Heinemann, 1994. ISBN: 0434000035 : 0434001058 (pbk)

Laura Silber, Yugoslavia: Death of a Nation (New York: Penguin, 1995 and 1996). Yugoslavia death of a nation Discovery Channel, 1995, Audiovisual, 5 pts. in 3 videocassettes (250 min.) : sd., col. ; 1/2 in. Originally produced for television broadcast.

Peter Maass, Love Thy Neighbor (New York: Knopf, 1996). Cloth, ISBN 0679444335; $25.00. Paper, Random House, 0679763899, $13.00.

Tom Cushman and Stjepan Mestrovic, This Time We Knew (New York University Press, 1996). Price, Paper: $18.95, ISBN: 0814715354; Cloth: $40.00, 0814715346

G. Scott Davis, Religion and Justice in the War over Bosnia (New York: Routledge, 1996). Cloth, ISBN, 0415915198, $55.00; Paper, ISBN 0415915201, $17.95 Retail Price.

David Rohde, Endgame: The Betrayal and Fall of Srebrenica, Europe's Worst Massacre since World War II (New York: Farrar, Straus and Giroux, 1997). Order information: 212-741-6900. Fax: 212-741-6973.