CRIME AND PUNISHMENT

 Photo: Dirk Planert


How can it be that it is a crime to help people?

We connect feet, we clean wounds, clarify about basic hygiene, prescribe paracetamol to fever patients, and much more - just for the reason because no one else does. Neither the red cross in Bosnia, neither the local hospital, nor any international aid organisations.

What are we supposed to do?

Should we just turn around and let these people screw up and melt? That is literally what happens in vucjak if we do not intervene. And now we're not allowed to intervene anymore. We were kicked out of camp and even had to pay a fine for doing the work that we do the work, Bosnia, Bosnia and the European Union. We have even done this job voluntarily and voluntarily.

Are you kidding us?

In a camp like vucjak, even a small cut wound is a serious injury. It is not helped people when a few times a week the doctors and sisters show up and treat only the emergencies. Because a small cut wound develops, under the crappy conditions in vucjak, within days, in an icy wound, which takes a whole limb. And something like this must be prevented by daily, Multi-hour medical care. In fact, these people are simply helped when you clean the wound and change the bandage or even protect the wound with a bandage.
Yesterday I was at camp and I had to say to the people repeatedly: No, I must not treat you. No, I'm not looking at your wounds. No, I can't help you. No, I was banned. It was the most difficult thing I've had to do in a long time. How can i deny these people basic help, if I can actually help them, should, will and even have to? In Germany you can be charged with failed assistance!
It's puking! We're puking. Bosnia is puking me. The EU is puking on me. This is a daily violation of the convention on human rights, for which the EU has even received a peace prize. A convention on human rights, which has also signed Bosnia. Every person has a right to medical care!

Refugees too!

Johanna Thomé, team vucjak

The comment:  The situation shows very well and very openly the character of European Union. Defending rights of refugees & migrants and avoid at the same time direct political action against the EU politics at this address is not possible. It is not possible to avoid giving precise and right political names for the political actors and their servants. It is not possible of defending human rights in abstract way addressing mist and fog instead of real reasons for the humanitarian crisis we face in B&H and around the globe. I must say I am very much ashamed of my colleagues, medical doctors and medical associations, medical chambers etc. (profession and organization with enormous power and influence) for being silent, for being conformists, for pretending that massive human rights violation related to medical care of refugees and migrants is something happening apart from political system they belong acting as ostriches, acting as the violation of human rights related to health care is not part of their regular duties, duties of medical doctors. Reduction of medical profession to being apparatchik is very much shameful for this profession. Very similar can be said for all medical humanitarian organizations... At the same time I want to congratulate common people educated (or not) in hurry to act as paramedics & medics & ... for the purpose of assistance of people in need as volunteers in the field along with some rare professionals enough courageous to voluntarily do their professions against the will of politics with clear advocacy of human rights. Along with shameful politics of EU we face huge erosion of medical profession in context of massive violation of human rights. We are back in 19th century. Welcome to the hell!

Dimitar Anakiev, MD (DfA)

MEASURES TO FIGHT EPIDEMIC OF SCABIES IN CAMP VUČJAK, BIH

MEASURES TO FIGHT EPIDEMIC OF SCABIES IN CAMP VUČJAK, BIH


Dimitar Anakiev, MD
Global Health spec.


According to the last report (yesterday) of our chief medic in camp Vučjak by Bihać, BiH the morbidity from scabies among refugees and migrants is 2-3 times higher than expected in such conditions (10-15% should be the expected percent, instead we have 30%). Scabies is most often spread during a relatively long period of direct skin contact with an infected person (at least 10 minutes) which may occur during sex or living together but spread of infection may also occur during brief contact or by contaminated objects. It typically only occurs in those with a poor immune system (refugees and migrants are typical case). Areas with a lack of access to water also have higher rates of disease but 2-3 times higher rate shows that medical care does not exist at all. That is not acceptable for many reasons. Also, "symptomatic therapy" does not exist. Bad conditions are often taken as an excuse but the measures to fight scabies in such conditions are relatively simple if medical workers in the field are willing to firmly and systematically organize themselves in the very direction of healing so massive infection of people from scabies.

Let us see what is needed:

Causal therapy:

1. BENZYL-BENZOATE (BENZIL BENZOAT in Bosnian). Very effectively heal scabies if used properly and together with measures of hygiene. Proper use means: apply benzyl-benzoate over whole body during three days without taking shower ("luckily" there is no shower in the camp Vučjak). After three days of many times applied benzyl-benzoate in the way that whole body was covered it can be washed out.

Hygiene measures:

2. Usually bedding and clothing used in the last three days should be washed in hot water and dried in a hot dryer. As the mite does not live for more than three days away from human skin, more washing is not needed.  For the case you cannot wash clothes and bedding (your case!) take clothes and bedding into plastic bag (as such for taking trash) hermetically close the bag (tie it) for 3-7 days. Each beg with bedding and clothes taken needs to have name of the patient it belongs.

Organization:

3. Exchange of bedding and clothing is needed. So you need to have warehouse well supplied all the time. You need coordination and collaboration with different organization.

4. You also need budgeting buying benzyl-benzoate approximately 50 EUR for each 10 patients. In Bosnia is benzyl-benzoate much cheaper (2-3 times) than in Western Europe but anyway one dose-container (for 3 days) cost nearly 5 EUR (9,4 KM - see the picture bellow). So to stop epidemic you need approximately 1.500 EUR for 300 patients (30% of 1000 people). So you need to organize campaign for donation.

5. Medics and paramedics must follow patient to their beds and take bedding and clothes and also watch the situation and check nearest neighbours on scabies.

LET US ORGANIZE AND GO TO ACTION STOPPING THE SCABIES EPIDEMIC IN VUČJAK!

OLOMOUC SUMMER SCHOOL IN REFUGEES LAW AND RIGHTS

SHORT DRAFT OF NEEDS ASSESSMENT FOR REFUGEE EMERGENCIES (NARA) IN REFUGEE CAMP VUCJAK, BIH

Photo: Dirk Planert



SHORT DRAFT OF NEEDS ASSESSMENT FOR REFUGEE EMERGENCIES (NARA) IN REFUGEE CAMP VUCJAK, BIH

Erazem Rajnar, chief medic

Vucjak, BIH, 13/8/2019

0. General atmosphere:

The local population is welcoming to the migrants and willing to provide help, but due to their own economic and social standing their patience is nearing its border, which manifest in more and more anti migrant postings on social media and threats to some volunteers. The local health system is severely underfunded and underequipped to handle their own patients, with the migrant situation putting additional stress on the system, adding to the discontent of the local medical workers and the locals with the migrants..

1. Humanitarian context:

The refugees in the Bihac area of Canton Una-Sana, federation of B&H, are divided between three camps, Bira, Boric and Vucjak. The situation is critical everywhere, with the conditions in camp Vucjak being the worst.

2. Shelter

The camp itself opened on June 12th ,on the old landfill near the village of Vucjak, about 10km out from the center of Bihac. Since then, the camp has grown and is currently housing between 600 and 1200 refugees, depending on the flow of migration and police raids. The average number of people in the camp is around 800 at any given time. The camp spans on 0.1 km², far to small for the number of people being held there. The tents built by the local red cross are mostly 10 person cotton tents with polyester floor, but there are not nearly enough and most refugees sleep outside or in the big tents meant for food distribution. While the floor is currently dry, any rain turns the camp into a mud field, with the previous purpose (landfill/dumpyard) of the land still showing and toxins in the ground still active. There are no permanent objects with the exception of one ruin of a house which is at the center of the social life in the camp. While day and night temperature difference in the tents is high, it is not critical yet, however, with the coming of the autumn and winter, the shelters provided will offer little to no protection from the elements. Vector control does not exist. (Lyme boreliosis is endemic to the area). The local red cross is replacing small tents with big tenets and has stockpiled 10 heating cannons for the tents, but they are not in use yet.

3. Water, sanitation and hygiene (WASH)

There is no electricity or running water. While 4 German red cross sanitation containers are installed there, the quantity and quality do not meet Sphere standards for humanitarian situations. The water is brought to the camps 3 times a day with a small truck cistern and frequently runs out. While the quality of water is not in question where the cistern is filled, the quality of water in the camp is questionable due to old/inappropriate water containers being used.

For the current number (around 800) refugees, there should be 40 toilets provided, however, only 8 are there, filling just 20% of the standard. None of the toilets have adequate lighting or are within 50 meters of the living quarters, failing the other major requirements and only providing safety, but not privacy. This is one of the reasons why the refugees choose to do their business in the surrounding Forrest, the other being horrendous sanitary conditions at the provided facilities.

The number of showers is 20, 10 of those outside and 10 in the sanitation containers, however the ones inside are mostly not functional and therefore not usable. Most refugees choose to shower outside or directly from the tap.

4. Health care

Healthcare is provided only by volunteers with various medical experience, so the quality of care varies. Since there is no electricity diagnostic equipement is limited, and most work is done with improvised means. All medical supplies are paid for from private donations collected by Dirk Planert and there is no local medical support. Red cross provides no medical help at all, other than allowing the volunteers to work undisturbed. They do, however, distribute 2 meals every day for the majority of the camp. The clinic is also not housed in a permanent structure, but in a tent, meaning all medical supplies have to be removed from the camp when the clinic closes as the people use it to sleep in it at night. There is no running water and washing hands is impossible for the medical workers. Instead, wet wipes and hand disinfection are used. The local emergency room declines to send ambulances to the camp so all emergencies have to be driven with volunteers private vehicles, but the medical capabilities of the clinic are at least equal or greater to those of the emergency room, so very few migrants are driven there, except for getting a referral to hospital. Daily, around 12-15% of the camp seeks medical attention, along with red cross and police personnel occasionally. Due to the work load and operational pace, medical records are hard to maintain/manage, and only the most severe examples are logged, however this is done in improvised manner potentially incompliant with patient privacy and informational security needed for such an evidence. The private nature of funding enables the health workers to provide care above the local standard, but very few have the knowledge, as most volunteers are either students, ambulance workers or nurses, making the operation heavily dependent on the individuals, rather than establishing a system anyone can take over/work in.

Mortality:

Information is currently not available

Morbidity:

Around 30% of the population has scabies, which are, in these hygienic conditions only able to be treated symptomatically. Infections of abdomen and genitals appear in around 1% of the population and infections of respiratory tract appear in around 20% of the population. There are a few diabetics (type 1 and 2), and around 30 people are have various cardiac illnesses. The mental health of the population is problematic, but most problems can be solved with therapeutic talk and very few need medicine. Mechanical injuries of the musculoskeletal system appear in around 23% of the population, but very few of them are serious or a result of police violence. Most prevalent are soft tissue infections from wounds acquired with walking or from local flora and fauna, which appear in around 60% of the population, and small allergic reactions to local flora which appear in around 30% of the population.

5. Conclusion

While the situation in the camp is manageable right now, with the summer ending and rain season starting, we can expect a lot more illness and infections, as well as cold injuries if the camp will remain open throughout the winter. While the official standing is that the camp will be closed, no one is doing anything concrete, so the local red cross is preparing to dig in for the winter. Medical supplies and donations to keep the clinic running are urgently needed, as preparations for winter need to be made. A permanent structure for the clinic is also needed, as well as raised beds and blankets for the refugees.

Bosnian Refugees' Situation

HUMANITARIAN MEDICAL TRIANGLE

Environment Comparison Slovenia/B&H (Refugees)

Matthew 25: 42-45

Good reading for the Christian leaders of EU, including Slovenian, Hungarian and Croatian but also for Valentin Inzko.

DONATION OF 200 EUROs NEEDED FOR KITCHEN IN KLADUŠA

DONATION OF 200 EUROs NEEDED FOR KITCHEN IN KLADUŠA

(I just received this message from Asim Latan Latić and his kitchen team - they feed the refugees for years):
*
"Excuse me for taking your precious time, doctor. We have meat and vegetables for one (1) month but no one gives us money to pay the rent and refugees come every day so if you can in any way, through your friend, to collect 200 euros to pay the rent, thank you and greetings from the team."

DOCTOR FOR ASYLEES MEDICAL (DfA) TEAM SLOVENIA/BOSNIA

Meet part of the medical staff of Doctors for Asylees who care for the health of migrants in Slovenia and Bosnia

HZS VK (Humanitarna zdravstvena stanica Velika Kladuša)

Vodja HZS VK: Adis Imamović

POLITIČKA NEUTRALNOST HUMANITARNIH RADNIKA / POLITICAL NEUTRALITY OF HUMANITARIAN WORKERS

Humanitarni radnici, ne bi smeli da koriste nesreću drugih za političku reklamu. Nicanje anarhističkih zastava i simbola "anti-fa" kod bosanskih humanitaraca je zato vrlo upitno. Optuživanje napaćenog bosanskog naroda za fašizam još upitnije…Kako se uz sve ovo uklapa rad na tuđem jeziku, isto je upitno.

Humanitarian workers should not use the misfortune of refugees for political advertising. The waving of anarchist flags and symbols of "anti-fa" among Bosnian humanitarians is therefore very questionable. The accusation of the war-weary Bosnian people for fascism is even more questionable ... How does all this work for these working in foreign language, the same is questionable.

U vezi lažne politizacije humanitarne situacije u BiH: Umesto da se oštrica kritike uperi ka vladi i takozvanoj "međunarodnoj zajednici" - koji su odgovorni za stanje - sa ciljem da se begunci i migranti integrišu u zdravstveni sistem BiH - našta po zakonu imaju pravo - posledično zahtevajući da EU komisija novac ulaže u zdravstveni sistem BiH (umesto u IOM) mi imamo situaciju da pojedinci optužuju vlastiti narod za fašizam, što je potpuno suludo, Isticanje nekih političkih zastava i simbola ima cilj da pokaže kako se oni politički bore, što je laž, jer reć je o konformizmu najgore vrste.

P.S. Novac uložen u IOM ide u privatne (tajkunske) džepove a novac uložen u zdravstveni sistem BiH ide za dobrobit naroda. To jasno pokazuje za šta se treba boriti.

Regarding the False Politicization of the Humanitarian Situation in BiH: Instead of sharpening the criticism towards the government and the so-called "international community" - who are responsible for the state - with the goal of integrating migrants into the health system of BiH - demanding that the EU commission invests money in the BiH health system (rather than IOM) we have a situation where individuals are accusing their own people of fascism, which is completely absurd. The highlight of some political flags and symbols has the purpose of showing how they are politically struggling, which is a lie because it is about conformism of the worst kind.
P.S. The money invested in IOM goes into private (tycoons') pockets and the money invested in the health system of BiH goes to the benefit of the people. This clearly shows what to fight for.

REPORT ON HEALTH CARE OF MIGRANTS AND REFUGEES IN BOSNIA

(summarizing one year of experience in B&H)

Curriculum for the lecture in Maribor on 18th of June, International Conference/ Pushing forward

Dimitar Anakiev, dr. med

Doctors for Asylees (Dfa), Slovenia

General statements:

-Health care of migrants and refugees in BiH borders on genocide

-Migrants and refugees in BiH, concerning the respect of human rights, have a worse status than war prisoners

Short description of five pillars:

1-The Health Care Law of FB&H which explicitly legit¹ health care for refugees and migrants was suspended. We do not know who suspended it and when. But we have seen that until June 2018 the refugees and migrants were not any more integrated into the local healthcare system. They were simply pushed back from the healthcare of FB&H. So the first pushback was not at Croatian borders but in healthcare. The pusback from healthcare is even more dangerous because soon it became standard, legit of racism in practice. At this point we are back in practice of „two medicines“ known from the history of colonialism („Corps de santé des colonies“ & „Assistance médicale indigene“). The paravane for the puscback of refugees and migrants from healthcare in FB&H was the MSF. They staged in the field without work permission 5 months (From June to October). Probably we have here a case of complicity between humanitarian organization and politics but maybe they were just missused by the politics².

2- As a consequence the Primary Health Care was and is suspended too (The case of Pakistanny minor who died from bacterial pneumonia on 13^rd of December 2018 in camp BIRA, Bihać, after waiting more than two weeks to get help with high fever and coughing)... No reporting about epidemics no special treatment for people with disabilities, no special treatment of vulnerable people, no special treatment of drug users, no approach toward chronically ill patients etc. etc.

3-A public health program Medical Treatment of Migrants (all measures plus checking and reporting forms) issued by Institute of Public Health FBiH in May 2018 was and is suspended too (never came into action).

4- Emergency Medical Service (EMS) does not work for migrants and refuges. (The case of Abdulhamid, old 34, from Algeria, who died 3^rd of February from bleeding after waiting in very hard condition for medical help nearly two hours in front of MIRAL camp, Kladuša – the EMS never came )

5-Humanitarian Medical Help is not suspended, it is offered but in a form that violate basic laws of humanitarian medicine. That means it is subordinated to the politics which produces crisis. It is not only difficult to reach, too often absent, of low efficiency using paracetamol in neraly any occasion as an universal medicine for all illnesses but it fails in the very mission of humanitarian medicine: to support patients and advocates their human rights. Humanitarian medicine is on the stage in B&H but it seems without a mandate to really fulfill its mission.

Conclusion: Lavish political forces is present in health care of migrants and refugees in BiH. This policy (Recently I read an adequate name: necro-politics³ ) makes health care ineffective bringing massive violation of human rights and consequently producing humanitarian crisis.

That is why we think that state of emergency in humanitarian crisis needs to be declared ASAP starting from an international coalition of NGOs (including local NGOs).

Notes:

¹Diagnosis of Health Policy in B&H: http://zdravniki4azilante.blogspot.com/2018/08/diagnosis-of-health-policy-toward.html

²MSF in Bosnia: How to keep good name without a good work: http://zdravniki4azilante.blogspot.com/2018/12/msf-in-bosnia-how-to-keep-good-name.html

³Artan Sadiku, Using Borders Against the Life („Granicama protiv života“:https://kosovotwopointzero.com/sr/granicama-protiv-zivota/?fbclid=IwAR0mHZO_RpPkoYIEeqxQWpMxs9nUumbkeRs7mSlHU1gYkIRXVTHAqLtvrBE)

STATE OF EMERGENCY (Joint declaration)

JOINT DECLARATION ESTABLISHING THE STATE OF EMERGENCY IN HUMANITARIAN CRISIS IN BOSNIA AND HERZEGOVINA WITH THE AIM TO SAVE HEALTH AND LIVES OF THOUSANDS OF REFUGEES

“A humanitarian emergency is an event or series of events that represents a critical threat to the health, safety, security or wellbeing of a community or other large group of people, usually over a wide area” (Humanitarian coalition, 2013).

We, medical and non-governmental organisations, declare officially from today the state of emergency in humanitarian crisis in Bosnia and Herzegovina with the aim to immediately save health and lives of thousands of refugees currently surviving in the country.

On-going humanitarian crisis in Bosnia and Herzegovina caome to its new dramatic phase: the winter. We consider that it is now the last moment to prevent harder consequences for human lives by declaring from today the state of emergency in humanitarian crisis.

We thus appeal the government of Bosnia and Hercegovina, the European Union and United Nations (UN) to join our movement, to declare the state of emergency in humanitarian crisis in Bosnia and Herzegovina and to use all human and material resources necessary to immediately save human lives.

Our declaration is based on the following main facts:

• Number of refugees in Bosnia and Hercegovina is constantly growing. The national authorities in Bosnia and Herzegovina detected the arrival of 21,201 refugees and migrants to the country between 1 January 2018 and 31 October 2018 (source: Inter-agency Refugee/Migrant Situation Report October 2018). This increase follows a large increase from September 2018- after a relatively stable four-month period between April and August 2018 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 - at least- between 4,500 and 6,000 refugees and migrants remain in the country in need of humanitarian assistance at various locations, in particular in Una-Sana Canton (USC).

• Only 1/3 of refugees got proper accommodation/shelter. UN agencies state the following in Inter-agency Refugee/Migrant Situation Report October 2018: “While occupancy rates fluctuate on a daily basis, as of 31 October 2,064 spaces were available across six locations in Bosnia and Hercegovina, not including safe accommodation and hostels made available to a limited number of particularly vulnerable cases”. It can also be noticed that among the 2,064 spaces mentioned, 450 spaces have regular public health control. In other words, it means that almost only 30% of the refugees get proper accommodation. Lastly, report does not mention hundreds and hundreds of men, women and children who get into winter, sleeping in wetlands, in a bare ground, covered only with polyvinyl. In Bosnia and Herzegovina, -10° Celsius is a normal winter temperature and majority of refugees in the country get in Bosnian without proper shelter or no shelter at all.

• Healthcare is one of the most dramatic sectors of humanitarian refugee crisis in Bosnia and Herzegovina (along with shelter). Despite what is prescribed by the law and what is mentioned in different official reports (“refugees are incorporated into primary healthcare”), primary health care is still not allowed to refugees in Bosnia and Herzegovina. UN agencies’ report on healthcare from October 2018 (source: Inter-agency Refugee/Migrant Situation Report October 2018) contains exactly 1071 words but among them no one basic parameter of healthcare (no mortality, no morbidity and not any other medical parameter such as any epidemic). The noticed total number of medical check-ups mentioned in report (3580) for whole Bosnia and Herzegovina is unrealistic for such big population with special needs. Health care of refugees actually nearly does not exist, especially not primary health care and public health control. That is why we can see volunteer medical staff helping refugees in the middle of street, in fields or in inns. This situation is dramatic and represent an absolute emergency.

• West Balkans' state Bosnia and Herzegovina (3,5 million population) belongs to category of so called “post-traumatic societies”. Unemployment rate is 35.33% (source: Tradings Economics), corruption index 38 (source: Transparency International). Health care system in the country is still in development after war in the 1990’s. Conflict 1991-1995 in the region produced more than 74.000 uprooted civilians (refugees and IDPs) (source: UNHCR). That is why Bosnia and Herzegovina is itself the subject of humanitarian, economic and political help from the United Nations/European Union for twenty years. By consequence, despite the presence of different UN agencies and humanitarian organisations in the country, Bosnia and Herzegovina is a too fragile state to absorb and adequately face properly refugees’ flux of the new “Balkan route” which started in January 2018. Less than 10% of total number incoming refugees and migrants are properly treated. Reports given by UN agencies/national authorities very often underestimate the needs/figures. A dangerous humanitarian crisis appeared in Bosnia and Herzegovina for the last months, as civil society is constantly warning. Today, it reached a peak and a dangerous point of potential non-return if nothing is implemented and state of humanitarian crisis not officially declared.

Hundreds of refugees are currently without shelter and health care and are getting into the Bosnian winter. It is now the very last moment to activate humanitarian crisis cluster by establishing the state of emergency in humanitarian crisis in Bosnia and Herzegovina. (Written in November 2018)

Kladuša Mobile Clinic June 7th 2019

Ambulanta prve medicinske pomoći za migrante u Kladuši trenutno ne radi iz bezbednostnih razloga.zbog masovnih tuča. Želimo da se situacija čim pre normalizira jer mnogima je pomoć neophodna. Naš medik Piksi koji striktno poštuje ograničenja, juče je rešavao komplikovane rane kao što je ova na slici. Bolest ne zna za pauze pa tako i medicina.