Bosnian doctors fax for food

BMJ 1995; 310 doi: (Published 01 April 1995) Cite this as: BMJ 1995;310:821

An urgent appeal for help for doctors in Bosnia was made last week at a joint meeting in London of the World Health Organisation and the European Forum of National Medical Associations. In a faxed message saying that its representatives could not attend because Sarajevo airport had closed, the Bosnian Medical Association said, “We acknowledge that it's impossible for our fellow national medical associations to pay our salaries, but we appeal to the forum for food aid for doctors working in Bosnia.”

The impassioned appeal was a stark reminder to the meeting that the problems facing doctors in central and eastern Europe are of a different order to those in the west. “Eight countries are at war in Europe,” said Dr Jo Asvall, WHO regional director for Europe, “and in former Yugoslavia alone there are four million refugees. Inequity in health has been widening steadily in the past few years. For example, the average life span in Russia is now only 59 years.”

Political and economic unrest is challenging health care reforms in central and eastern Europe, and the low status and morale of doctors in some countries do not encourage them to take part in improving their health services. “Our association is now four years old, and, although we are making progress, doctors here are very disenchanted with medicine. They get little support from the public or the government, and with the same salary as factory cleaners it is unsurprising some leave,” said Dr Albert Andrev, president of the Russian Medical Association.

“Our problem,” said Dr Rytis Virbalis of the Lithuanian Medical Association, “is that we have a government that does not even recognise health care as a priority. For us it is very important to have a consensus statement that underlines the key role that medical associations have in changing health care systems and shaping future policy. Politicians take more notice of our views if we have a pan-European mandate to do this.” (See also p 876.)

“In Romania the government has been very selective in the topics on which it has sought our advice,” said Dr Radu Dop, vice president of the Romanian Medical Association. “We are now very worried about a new threat to our professional independence. In three weeks' time a bill is going to be passed in parliament to promote a new national medical association to work with it more closely. All doctors are going to be forced to join it—otherwise, their right to practise will be withdrawn.”

Despite behind the scenes discussions on how best to respond to the Bosnian plea, the three day meeting closed without the WHO or national medical associations agreeing on any practical response. But the meeting did issue a supportive statement. Dr Otmar Kloiber, of the German Bundesarztekammer (the German medical association) said, “It's a pity we did no more. If I was a doctor in Bosnia I'm not sure how much comfort I would derive from good words.”—TESSA RICHARDS, BMJ

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