LETTER TO GERMAN ANTI-FASCISTS

Dear comrades,

From June 2018 medical health care of refugees and migrants in Bosnia and Herzegovina became exclusive field of political struggle. More than 10.000 people that are stuck in B&H are deprived by authoritarian politics for the right of primary health care. They live in miserable condition far under the the level of hygiene minimum, two third have all kind of skin infection, more than 15% have scabies, one third are wounded mostly being beaten by Croatian police and all other illness are presented including often stomach troubles and diarrhea. On 10th August one third of refugees and migrants in wild camp Trnovi in Velika Kladuša had diarrhea, more than two third was not able to eat lunch and dinner. Now cold days are coming with possibilities of epidemic respiratory infections.

For all that reasons a group of activists-volunteers-medical workers from June 2018 try to organize alternative medical health care in Bosnian Frontier even we face police pressure and obstacles. Until now we did it using own sources but these are limited. We need your solidarity help. What are our needs in organizing alternative healthcare for migrants and refugees in Bosnian Frontier? Before all that is vehicle for transportation and clinic. We would like to borrow one second hand Renault Traffic or similar vehicle if possible. Second, we need monetary support for regular buying drugs. Drugs in Bosnia are relatively cheap. Benzil-benzoat we use for scabies about 20-30 a week cost about 5 EUR one bottle. It is half price than in Slovenia but it is 100-150 EUR each week only one medicine. That is why each single donated euro is precious for us. Thank you for your support.

Dimitar Anakiev, MD

Medical Coordinator volonteer

S.O.S. Bosnian Frontier

GREETINGS FROM BIHAĆ

Photos by Fabienne Dimmer

About 1.500 refugees and migrants in never finished building of Student Home and park Borići just by the Student Home. In private houses more 1.500 refugees and migrants. Containers by building offers 15 toilets and 10 showers plus two tapes in backyard. No medical services. That is the situation.

ORGANIZING MEDICAL CARE TO REFUGEES AND MIGRANTS OUTSIDE THE SYSTEM – An experience from the Balkans' Route No.2

 ORGANIZING MEDICAL CARE TO REFUGEES AND MIGRANTS OUTSIDE THE SYSTEM – An experience from the Balkans's Route No.2

Dimitar Anakiev, MD
spec.Global Health

First of all why organizing medical care outside the system? And second, what does it really mean? Few days ago a group of volunteers in Velika Kladuša were discussing impossible situation that government of B&H as well as EU government(s) do not allow helping refugees and migrants that stuck in Bosnian Frontier. At the moment they are about 4000 of them just at the Frontier (3000 in Bihać and 1000 in Kladuša) while in all B&H estimated number goes over 10.000. Everyday new 400-500 refugees and migrants cross Serbian/Bosnian border while about 50 of them try each day to continue their way to EU crossing Croatian border with very small chances to avoid being pushed back, beaten and humiliated by Croatian police defending the Fortress of Europe. All volunteers discussing the situation agreed that the similar political will can be recognized in decision of not receiving boats and ships with refugees rescued from the open sea into the European ports and in prohibiting health care to refugees and migrants stuck in Bosnia and Herzegovina. Prohibited are both regular health care of the system and humanitarian health care (MSF is in place many months but without permission to work; it is playing taxi service to local doctors occasionally delivering health care to refugees and migrants beyond the legal procedure...In Bihać, we have heard, doctors from the Health Center do not want to work with MSF because of low payment. More than one month MSF do not buy drugs in local pharmacy and their container in the refugee camp Borići is closed with the inscription „We are not here for the moment“...) Here we have the answer to the first question: organizing health care outside the system is the last line of defense of human lives and also human dignity and rights. That simply.
Not much more complex is to describe what does it mean and why it happens. We face two main problems at this point:

1. Confrontation with the (political misuse of) police
2. Problem of constitution and self-organization of medical unit

In the regular meeting between Kladuša's  police chief with the camp Trnovi's coordinator that took part on 8th of August 2018, the police chief expressed his opinion that „doctor-volunteer in camp is illegal“. Even if we forget human rights this statement is actually illegal because Federation B&H Health Care Act orders „No one is allowed to endanger human life“ and „in an emergency situation each person is obliged to deliver first aid to wounded or ill people in accordance with own knowledge and abilities as well as helping them of reaching the nearest healthcare institution ( Article No.3). At this point no one physician will have doubts in legality of voluntary delivering medical care in accordance with the situation and abilities. The pressure is more on the side of camp coordinator who must bear the tension of possible confrontation with the politically influenced police he/she usually must collaborate with. This pressure tends to affect the organization because doctor alone, doctor who is not supported by medical unit, cannot really use her/his knowledge in the best possible way. The „spontaneous“ solution: „Do not worry doctor, we will help you as much as we can, just go to the camp and heal people“ has significant limits.
The most basic medical unit has two members and car. Two members of the medical team are doctor and nurse. Also possible combination is doctor and medic/paramedic or doctor and community health worker (CHW) but in that case the CHW must be trained for work in the situation. Medical team without doctor would have very limited goals because only doctor has special authorization and he/she can take full responsibility over the health situation including documenting and advocacy of the patients...At this point it is necessary to stress that medical work is autonomous by its nature, it cannot be subordinated to other sectors but independent and self-regulated in all important questions.
The most simple car needed is minivan or van – second hand or borrowed - a little bit more ambitious is motorhome. Medical team will build the storage for drugs and establish network of collaborators regarding LAB, ECG, RTG and other diagnostic or therapeutic procedures to the level they need according to the situation. In Slovenia in 2016-2017 we formed a network of volunteers, sponsors and donors among private sector medical actors. This network supported our medical work with refugees and migrants coming from the Balkan's Route No.1 much better than public system controlled by restrictive policy. It is usually needed to get connected also with the institution of healthcare in the community because medicine is not an isolated activity. Even in condition of negative political atmosphere and legal restrictions there are always medical workers, particularly among doctors, but also among nurses, with independent, professional/human and responsible posture able to listen and understand colleagues working with people in hard conditions.
If medical team voluntarily help the refugees and migrants than the cost of medical care is reduced to formula: cost of drugs & equipment plus overheads. That seems to be bearable of self organization.
Reason of organizing medical care outside the system lies in confrontation with official politics towards refugees and migrants and political motivation in general. It goes beyond humanitarian work which is usually limited to the neutral position for the reasons of being somehow incorporated into the system. But what if political system establishes inhumane principles? That is our situation and this situation is totally political, that is why it requires politically motivated medical crew being conscious about political situation and political mistreatment of their patients. Because only politically motivated doctors and nurses can take risk of confrontation with political system and of working outside the system. Being neutral in such political situation means to collaborate with the system which openly and massively endangers human lives.
If police in Kladuša continues to treat voluntary medical work in camp Trnovi as illegal then probably they consider refugees and migrants as prisoners of war. In such case principles of Geneva Conventions must be activated to support doctors and nurses in medical treatment of war prisoners.

DIAGNOSIS OF HEALTH POLICY TOWARD REFUGEES AND MIGRANTS IN BOSNIA AND HERZEGOVINA

HEALTHCARE LAW OF FB&H REGARDING REFUGEES AND MIGRANTS ILLEGALLY SUSPENDED BY THE EU - MASSIVE VIOLATION OF HUMAN RIGHTS IN B&H

A short draft of Diagnosis of Health Policy Towards Refugees in Bosnia and Herzegovina, August 2018

Dimitar Anakiev, MD

spec. Global Health

Refugees and migrants reached Federation of Bosnia and Herzegovina in the beginning of 2018. From January to June 2018 they solved all their health problems using the healthcare system of FB&H. As reported on 4^th June by the Head of Health Center Velika Kladuša, Dr. Senad Okanović, they have average visit of 30 migrants per day – that is less than 10% of visit prevalence regarding total number of refugees and migrants in Velika Kladuša (1). Dr. Okanović also said that they very successfully solved all clinical cases and also epidemiological-hygiene control but they have financing problems because they received only support from local actors. Not a single cent from 1,5 million euros donated by the EU to the government of B&H in June 2018 went to support legal institutions of healthcare in FB&H. Healthcare Law of Federation Bosnia and Herzegovina strictly understand and respect health as a human right, including primary health care: articles 3, 12, 26 and 27 legitimated healthcare rights very specifically for foreigners, refugees and migrants(2) what is totally opposite to the EU legislature.

Even more, article 76. of Asylum Act of Bosnia and Herzegovina grants right to primary health care to all asylum seekers.

Refugees and migrants, now temporary settled in wild camps in Bosnian Frontier, including families with small children, were brutally deprived for asylum right in the EU. They were pushed back, shot, kidnapped, beaten, sexually humiliated and looted by the EU officials in their attempt to ask for asylum in the EU (3). The result is stuck of more then 10.000 people in B&H among them about 4.000 in Bosnia Frontier (Una-Sana Canton)(5)

Even Bosnian & Herzegovina government officially never declared a state of emergency the official Healthcare Law in Federation of B&H was put out of power for the refugees and migrants. What way this group of people were deprived for the legal rights we do not know but obviously this way was not legal, not public and not democratic. Three months (June-August) all actors: state officials and Doctors without Borders (MSF) are acting illegally in attempt to exclude refugees from legal rights to healthcare legitimated by the FB&H legislation. Especially the role of MSF is obscure. They appear visible in the streets of Bosnian Frontier in June 2018 as a symbol of “emergency” and deprivation of refugees and migrants for the legal rights. It seems they took part in the political show of the European Union... MSF officially has not permission to work in B&H but they act as a kind of taxi service to local doctors occasionally delivering health care to refugees and migrants beyond the legal procedure. In that way MSF is used for public shield in the process of depriving refugees & migrants for healthcare rights.

When in July 2018 I arrived for the first time at Temporary Refugee Camp “Trnovi” in Velika Kladuša the situation was catastrophic: prevalence of visiting doctor was 25% with alarming morbidity: 66% refugees had all kind of skin infection, wounded about 30%, scabies 15%, a lot of stomachache and diarrhea, (some of them more then 10 times by night), pharyngitis and flu along with headaches, anxiety, sleeplessness and psychological problems. As described in my short draft of NARA document (6) especially hygienic-epidemiological situation was alarming. Contrary to the report of dr. Okanović, just one month ago, refugees and migrants taken out of the official legislation into the hands of MSF & EU show picture of heavy and massive violation of human rights regarding the healthcare.

MSF mobile unit -without official permission to work – to whom is joined local doctor, visits refugee & migrants camp Trnovi three times a week for three hours (main camp with about 350 people is visited two times and once a week they visit dislocated group). So the main part of the camp has availability of doctor six hours a week. MSF vehicle is parked not in the camp but at the parking lot on the other side of the river Kladušnica. That means doctor cannot see the situation in the camp, perhaps they (MSF & doctor) are not interested in it. Not to mention distance between doctor and patient so important in humanitarian context and also standardized by professional standards for medical work in humanitarian context. In one word: refugees and migrants in FB&H are not only illegally deprived for healthcare they also receive substandard humanitarian medical help. They are beaten, humiliated and left alone - just in public, thanks to presence of MSF, it appears they have “regular” (humanitarian) medical care. To this picture let me add that state officials does not allow medical preventive departments to visit refugee and migrant camps. That is why, if you visit for example web-site of Institute for Public Health FB&H, you will not find the information about hygienic-epidemiological situation in camp Trnovi. It is not registered that on 10^th August one third of refugees and migrants had diarrhea and two-third was not able to eat lunch and dinner. There are numerous information that local health centers stopped delivering medical care to refugees and migrants, only life threatening conditions is considered for treatment. That is EU standard for refugees and migrants.

To complete the picture of massive violation of human rights regarding medical care of refugees and migrants in FB&H it is interesting to note local police judge that volunteer medical help in camp Trnovi is “illegal”...(!)

In the end of the day, as we know from praxis, the question of deprivation of human right is never isolated on deprived people but it affects people of the area in general. Because there are not two medicines: one for them and one for us. The Medicine is only one as history of colonialism gave lesson to humanity long time ago.

NOTES:

(1)https://www.radiovkladusa.ba/dr-senad-okanovic-direktor-zu-dom-zdravlja-velika-kladusa-situacija-po-pitanju-zdravstvenog-aspekt-u-velikoj-kladusi-u-kontekstu-migrantske-krize-zabrinjavajuca-ali-ne-i-alarmantna/

(2)Službene novine Federacije BiH, broj 46/10 iz 2010.

(3)Numerous reports, from Slovenian Delo Daily News from 11^th July, Amnesty International Slovenia, RTV SLO MMP, to many locals portals and media in different countries

(5)http://balkans.aljazeera.net/vijesti/postaje-li-krajina-antemurale-migrantis

(6)http://zdravniki4azilante.blogspot.com/2018/08/short-draft-of-needs-assesstment-for.html

SHORT DRAFT OF NEEDS ASSESSTMENT FOR REFUGEE EMERGENCIES (NARA) IN REFUGEE CAMP “TRNOVI”, VELIKA KLADUŠA, BOSNIAN FRONTIER

SHORT DRAFT OF NEEDS ASSESSTMENT FOR REFUGEE EMERGENCIES (NARA)

IN REFUGEE CAMP “TRNOVI”, VELIKA KLADUŠA, BOSNIAN FRONTIER

Dimitar Anakiev, dr.med, spec.GlobalHealth

Velika Kladuša, BIH, 29.07.2018

0.Newspaper titles from Unsko Krainske novine KRAJINA, issue 27.07. 2018:

-Local government wants to help Federal government in solving migrant crisis (page 3)

-New refuge center to be created in Bosanski Petrovac? (page 3)

-Interview with migrant from Pakistan (page 4)

-Report from Hotel Sadra (Cazin) about vulnerable families (page 8)

-Protest against unresolving migrants situation in Sarajevo (page 9)

-Muslim religious leader Kavezović visited migrants in Velika Kladuša, reportage (page 10)

-Mobile children care for migrants in Bihać (page 16)

1.Humanitarian Context:

According to one of camp coordinators the number of refugees in Bosnian Frontier (Bosanska krajina, area of municipality Bihać, Cazin and Kladuša, part od Canton Una-Sana, Federation B&H) is about 1000. On the other side, media reports mention 3000-5000 migrants in Bosnia and Herzegovina. The most critical situation is in refugee camp „Trnovi“, Velika Kladuša, with about 350 refugees, mostly male settled in improvised tents in the marshes by Kladušnica river. Families from Velika Kladuša and Bihać are settled in Hotel Sedra, Cazin (approximately 100 people).

2.Shelter

Refugees reached Velika Kladuša in March 2018. In the beginning they were settled in public parks. On May 17 they were moved by the decision of mayor of Velika Kladuša to the marshes by Kladušnica river. At the moment the ground is dry but any rain change it and all tents are full of water. The camp site is about 8 hectares, what is too small for the number of refugees. There is no solid facilites, only tents improvised by the plastic & nylon. Day and night temperature differences in the tents are high, vector control does not exist (Bosnia is an endemic area for Lyme borreliosis).

3.Water, sanitation and hygiene (WASH)

The municipality extended electrics and drinking water line to the camp site. Also five (5) chemical toilets are installed. Nothing of those reaches Sphere standards for humanitarian situation:

--According to the number of refugees (350) settled in Velika Kladuša already 5 months the minimum number of toilets that is required is seventeen (17). That means 11,76% only of reaching standards but it is even worse because the type of toilets are not adequate (small tank, needs for frequent emptying that does not function at all)

--The number of showers are only two (2), required minimum standard is twenty five (25) for 350 people in humanitarian context, that is only 8% of needed according to Sphere standards. The situation makes people nervous and causes fighting among them.

--There are thee (3) tapes in the camp (adequate number!) but it is used for all: personal hygiene, drinking water, „shower“, laundry washing (no laundry facilities in camp) so it is always crowded.

4.Health Care

Health care is based in patrol system of MSF mobile medical unit plus local EMS units and Bihać hospital secondary. Actually primary health care does not exist including public health control.

Prevalence of visiting doctor is very high: 25% (Comparison: in Ljubljana asylum facilities it is 6-8%, in Zagreb 7%, in refugee camp Domiz (Iraq) with 40.000 refugees it is only 0.5%). The main figures:

--Mortality: available official figuers show 12 people drowned dead in river Kupa/Kolpa (nearby Croatian-Slovenian border), one (1) death from knife stabbing in camp-fight, one (1) deatah from illness (pneumonia & encephalitis)

--Morbidity: 66% all kinds of skin infection, 30% injuries (result of both: Croatian police violence after attempts of illegal crossing border and internal camp fights and violence), 15% scabies also some number of stomach problem, diarrhea, tonsillo-pharyngitis, and flu. Also, some number of refugees complain to headache, sleeplessness and psychological problems.

5.Conclusion:

Inadequate site, very low hygiene level and violence makes health hazard situation extremely high, especially during the summer. High percent of prevalence of visiting doctor shows that health situation is already bad. According to health hazard risks and available health figures refugee camp Trnovi needs permanent 5 days stationary primary health care with 6-8 hours health control and help (doctor plus nurse) / correction of WASH situation immediately.

REFUGEE CAMP "TRNOVI", VELIKA KLADUŠA, B&H, IS A PICTURE OF EUROPEAN RACISM