DEMAND FOR THE ESTABLISHMENT OF THE STATE OF HUMANITARIAN EMERGENCY IN BOSNIA AND HERZEGOVINA WITH THE AIM OF SAVING HEALTH AND LIVES OF THOUSANDS OF REFUGEES AND MIGRANTS (Short draft)

DEMAND FOR THE ESTABLISHMENT OF THE STATE OF HUMANITARIAN EMERGENCY

IN BOSNIA AND HERZEGOVINA WITH THE AIM OF SAVING HEALTH AND

LIVES OF THOUSANDS OF REFUGEES AND MIGRANTS (Short draft)

Dimitar Anakiev, MD

spec. Global Health

Ongoing humanitarian crisis in Bosnia and Herzegovina has reached a dramatic phase: the winter. It is the last moment to prevent harder consequences by establishing the state of humanitarian crisis. The government of BiH is not capable of solving the refugee & migrant crisis which takes place in its territory. On the other side humanitarian organization IOM, UNHCR, UNICEF etc. which spent most of the money allocated to solve the crisis, haven't done what was necessary. We face misleading reporting about the situation.

1.BOSNIA AND HERZEGOVINA: West Balkans' state Bosnia and Herzegovina (3.5 mil. population) belongs to the category of so called post-traumatic societies. Very often it is referred to as “failed-state”. Its political system does not function properly, official unemployment rate is at 35.33 percent, corruption index 38. Health care system in the country is still in development after wars in the 90'. Conflict of 1991-1995 in the region produced more than 74.000 uprooted civilians (refugees and IDPs). Because of the above mentioned Bosnia and Herzegovina itself is the subject of humanitarian, economical and political help with the High Representative from EU. In the new refugee and migrant crisis (Balkan Route No. 2) it appears that Bosnian government together with humanitarian organizations which are operating in its territory (IOM, UNHCR, UNICEF...) is not able to face a global flux of refugees and migrants on a regular basis: a dangerous humanitarian crisis has been created in BiH in the past year, which has not yet been officially disclosed even though civil society is constantly warning. Less than 10% of the total number of incoming refugees and migrants are properly treated. Reports given by humanitarian actors very often have no informative value or are misleading.

2. REFUGEES AND MIGRANTS IN B&H (POPULATION): The authorities in Bosnia and Herzegovina (BiH) detected the arrival of 21,201 refugees and migrants to the country between 1^st of January 2018 and 31^st of October 2018. This increase follows a large increase in September, after a relatively stable four-month period between April and August in which an average of 2,329 arrivals were detected each month, with a low of 2,293 and a high of 2,489. It is estimated that between 4,500 and 6,000 refugees and migrants remain in BiH in need of humanitarian assistance at various locations, in particular in Una-Sana Canton (USC).

3. ACCOMODATION/SHELTER: “Establishing sufficient, winterized, safe, and protection

-sensitive accommodation has been and continues to be a key challenge and focus of the response.” (UNCHR). The UNCHR statement from the same report continues: “ While occupancy rates fluctuate on a daily basis, as of 31^st of October 2,064 spaces were available across six locations in BiH, not including safe accommodation and hostels made available to a limited number of particularly vulnerable cases.” To this data it has to be added that only 450 spaces of mentioned 2,064 have regular public health control, like the one in Hadžići (Public health control is not carried out in neighboring AC Trnovo, for example). That means that 3/4 of mentioned 2064 spaces are not suitable for accommodation. Therefore the assertion that almost 1/3 of the refugees and migrants are adequately accommodated is misleading. Over the year, the BiH authorities and humanitarian actors have provided accommodation for less than 10% of the refugee and migrant population. Even more confusing is that the UNHCR report does not mention hundreds and hundreds of men, women and children who are facing winter conditions, sleeping in wetlands, on a bare ground, covered only with polyvinyl. In Bosnia -10 degree Celsius is a normal winter temperature. Let's recall: in the humanitarian cluster the task of the UNHCR is precisely to build a shelter. More than 90% refugees and migrants are facing Bosnian winter without a proper shelter, a huge number of them have no shelter at all.

4. HEALTHCARE: One of the most dramatic sectors of humanitarian refugee crisis in BiH. Reports written by humanitarian actors are incompetent and misleading. Following their reports one can learn that refugees and migrants are incorporated into primary health care of BIH. The phrase “primary health care” is repeated nearly as many time as phrases like “basic standard” or “kitchen”.

But it must be clearly and loudly stated that refugees and migrants in BiH do not have access to the primary health care. Even more, from June 2018 they have been denied access to the health care system of BiH and pushed into uncertain embrace of humanitarian medicine (the MSF, which took part in separating refugees and migrants from the local healthcare system, was waiting for work permission for more than 10 months). The UNCHR report on healthcare from October 2018 contains exactly 1071 words but among them not even one basic parameter of healthcare can be found: no mortality, no morbidity, neither any other parameter. Total number of medical check-ups (3580) in the entire Bosnia and Hercegovina, that is mentioned in the report, is unrealistic for such a big population with special needs. One small health center alone, like Velika Kladuša, during the period when refugees and migrants were part of BiH health care (until June 2018) had about 1000 check ups per month serving 6 time smaller number of refugees! This indicates, what we all know, that health care of migrants and refugees actually does not exist, especially not primary health care and public health control. As a consequence, we can see volunteer medical staff helping migrants in the middle of the street, in the fields or in the inns. The situation is dramatic. The UNHCR health care report does not mention any epidemic among many we had witnessed. Further more, the UNHCR report does not mention to what extent have he instructions of Institute for Public Health BiH issued in May 2018 been applied until today? How many doctors have been mobilized in and in how many medical teams? How many unemployed and young doctors are among them? How many specialists? We do not know anything about it because not a single step has been is made. Ten days ago we noticed a young refugee in Bihać with a big open wound on his femur after the curettage of phlegmon in a local hospital. He was putting bandages on it in the middle of the street. In Velika Kladuša a team of volunteers cares for about 30 refugees and migrants on a daily basis and offer medical care on the streets. At the very moment they report about flu epidemic among migrants from wild camp Trnovi. What is the medical situation in wild camp Ključ? We do not know. But somehow professional humanitarian actors still fail to recognize the situation.

CONCLUSION: Thousands of refugees and migrants without shelter and health care are facing the Bosnian winter. It is the very last moment to activate humanitarian emergency cluster by establishing the state of humanitarian crisis in Bosnia and Herzegovina.