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Attacks on Croatia's hospitals
1018
Attacks
on
Croatia’s hospitals
SiR,—The Yugoslavian Federal Army and Serbian terrorists have
deliberately destroyed the cathedrals (Osijek), libraries (Vinkovci), and hospitals of Croatia. Hospitals in the cities of Osijek, Vukovar, Vinkovci, Pakrac, Zadar, Gospic, and Petrinja, as well as large medical centres in Vrlika and Hrvatska Kostajnica have been destroyed or seriously damaged. These hospitals serve large areas of Croatia-for example, almost a million people depend on Osijek Hospital for specialist services. The hospital in Pakrac was razed to the ground and patients (including those wounded and 270 psychiatric patients) spent 6 days in the cellar without water or electricity. The hospital in Zadar was destroyed by long-range heavy artillery and patients were trapped in the cellar without water and electricity for several days, because the Federal Army and Serbian extremists prevented evacuation of this heavily bombed city. In nearby Zemunik the hospital was captured, together with a doctor. The north Croatian city of Osijek (150 000 inhabitants) has a fully staffed 500-bed civilian general hospital plus a small medical school (a branch of the Zagreb University School of Medicine) with about 350 students. In September attacks on Osijek filled the hospital with wounded civilians and soldiers (from both sides); by Sept 27,1991, over 1300 wounded had been admitted to the hospital (including 15 Federal Army soldiers). Close to the hospital stands the Milan Stanivukovic army barracks. On Sept 17, in revenge for defeats by the Croatian police and national guard or for some other reason, the Federal Army attacked the hospital without warning. As firemen tried to extinguish fires caused by multibarrel rocket launchers they were killed by Army snipers in neighbouring buildings. Heavy artillery fire destroyed the departments of surgery and gynaecology and many other departments were severely damaged. Windows are smashed and water and electricity supplies interrupted; the rest of the hospital is at the end of its resources. Many of the medical staff, patients, and visitors have been victims-a nurse was killed and two female doctors were seriously injured, for example. 1000 people DEAD ON.
(patients, nurses, and doctors) had to take refuge in the hospital’s dark and humid basement. Newborn babies were often in the same room as psychiatric patients tied to their beds. The Army did not respond to appeals. This was not the first time that the hospital has been attacked. The hospital has often come under machine gun fire and the entrance has been destroyed by tank fire. The hospital is properly marked with many red crosses and is known to anybody who has ever visited Osijek. A full account of the attacks on Osijek Hospital will appear elsewhere.1 In Gospic, the capital of Lika province in central Croatia, severe fighting has made contact with the outside world almost impossible. However, we have learned that the regional general hospital there has also been heavily damaged by intentional direct heavy artillery fire from the neighbouring Federal Army garrison. That hospital too is a large building properly marked with red crosses. Just before the attack Army officers evacuated their families and those of local terrorists to the barracks. Experience from other towns and from villages in Banija, Lika, and Dalmatia tells us that this is a sign that total destruction is being planned. We fear that Gospic will be the fourth town levelled to the ground in this dirty war against Croatia, sharing the fate of Vukovar, Osijek, and Vinkovci. Are the ancient cities of Dalmatia (Sibenik, Zadar, and Split) next? The 600-yearold cathedral in Sibenik has already been intentionally damaged by a tank grenade. It seems that Yugoslav Federal Army and their allies start with the destruction of historical monuments, proceed with the civilian residential areas, and end their destructive mission with the
hospitals. Casualties of the fighting are recorded by the Medical Headquarters of Croatia. The accompanying figure shows numbers rising sharply in the 3 months leading up to Thursday, Oct 10,1991.1. Medical School, University of Zagreb,
IVICA KOSTOVIĆ MATKO MARUŠIĆ,
Salata 3, 41000 Zagreb, Croatia, Yugoslavia
for the staff and students, University of Zagreb Medical School
1. Glavirla K, Tucak A, Janoši K, Pajtler M, Lacković Z. Deliberate military destruction of the general hospital in the city of Osijeh. Croatian Med J (m press).
Albania,
a
plundered country
SIR,-In your issue of July 6 a Round the World report by Dr Offerhaus painted a very gloomy picture of medical services in Albania. This has been reinforced by the vivid television reports by Bill Hamilton of the BBC. I was in Tirana, the capital, in late September and can report that the situation has worsened. Stocks of very basic medicines (digoxin, propranolol, prednisolone, metoclopramide, insulin) and equipment (needles, syringes, skin antiseptics, surgical gloves) are now almost non-existent. With no foreign exchange Albania is totally dependent on foreign aid, which does not seem to be coordinated. There are sufficient doctors, dentists, and nurses in Albania but they lack the materials with which to practise their skills. They crave contact with other European doctors. I was the first UK doctor many had met. Chronic lung diseases are very common but because of the almost total collapse of the country’s infrastructure, nothing is being done in health education (eg, to reduce smoking) and factories are outdated so that pollution is severe. Hepatitis A and B, gastroenteritis, and tuberculosis are widespread. Antibiotic resistance is common. Up to 50% of strains of Salmonella typhi are resistant to chloramphenicol; 40% of strains of Pseudomonas aeruginosa (a seemingly common hospital pathogen) are resistant to gentamicin and carbenicillin; whilst most strains of Staphylococcus aureus produce penicillinase, penicillinase-resistant andstaphylococcal agents are scarce, and methicillin-resistant Staph has started to appear. Microbiology laboratory back-up, which would permit full patient investigation and antibiotic policy, are totally inadequate. Reagents and media are scarce. Without information on the prevalence of antibiotic resistance and in the absence of effective hospital infection-control programmes it will be impossible to implement an antibiotic policy. Whilst efforts such as Feed the Children are to be congratulated, it is only by a sustained effort through the health ministries of aureus
’".’y
4 SEEP
Croatian casualties (cumulative) up to Oct 10,1991.
The lack of impact of the various peace treaties is illustrated by the fact that four such agreements were reached during the 3 months of steep increase in casualties-namely, those of Brioni (July), Belgrade Sept 2, Igalo Sept 17, and The Hague Oct 10. There was a ceasefire treaty on Sept 26.
Attacks
on
Croatia’s hospitals
SiR,—The Yugoslavian Federal Army and Serbian terrorists have
deliberately destroyed the cathedrals (Osijek), libraries (Vinkovci), and hospitals of Croatia. Hospitals in the cities of Osijek, Vukovar, Vinkovci, Pakrac, Zadar, Gospic, and Petrinja, as well as large medical centres in Vrlika and Hrvatska Kostajnica have been destroyed or seriously damaged. These hospitals serve large areas of Croatia-for example, almost a million people depend on Osijek Hospital for specialist services. The hospital in Pakrac was razed to the ground and patients (including those wounded and 270 psychiatric patients) spent 6 days in the cellar without water or electricity. The hospital in Zadar was destroyed by long-range heavy artillery and patients were trapped in the cellar without water and electricity for several days, because the Federal Army and Serbian extremists prevented evacuation of this heavily bombed city. In nearby Zemunik the hospital was captured, together with a doctor. The north Croatian city of Osijek (150 000 inhabitants) has a fully staffed 500-bed civilian general hospital plus a small medical school (a branch of the Zagreb University School of Medicine) with about 350 students. In September attacks on Osijek filled the hospital with wounded civilians and soldiers (from both sides); by Sept 27,1991, over 1300 wounded had been admitted to the hospital (including 15 Federal Army soldiers). Close to the hospital stands the Milan Stanivukovic army barracks. On Sept 17, in revenge for defeats by the Croatian police and national guard or for some other reason, the Federal Army attacked the hospital without warning. As firemen tried to extinguish fires caused by multibarrel rocket launchers they were killed by Army snipers in neighbouring buildings. Heavy artillery fire destroyed the departments of surgery and gynaecology and many other departments were severely damaged. Windows are smashed and water and electricity supplies interrupted; the rest of the hospital is at the end of its resources. Many of the medical staff, patients, and visitors have been victims-a nurse was killed and two female doctors were seriously injured, for example. 1000 people DEAD ON.
(patients, nurses, and doctors) had to take refuge in the hospital’s dark and humid basement. Newborn babies were often in the same room as psychiatric patients tied to their beds. The Army did not respond to appeals. This was not the first time that the hospital has been attacked. The hospital has often come under machine gun fire and the entrance has been destroyed by tank fire. The hospital is properly marked with many red crosses and is known to anybody who has ever visited Osijek. A full account of the attacks on Osijek Hospital will appear elsewhere.1 In Gospic, the capital of Lika province in central Croatia, severe fighting has made contact with the outside world almost impossible. However, we have learned that the regional general hospital there has also been heavily damaged by intentional direct heavy artillery fire from the neighbouring Federal Army garrison. That hospital too is a large building properly marked with red crosses. Just before the attack Army officers evacuated their families and those of local terrorists to the barracks. Experience from other towns and from villages in Banija, Lika, and Dalmatia tells us that this is a sign that total destruction is being planned. We fear that Gospic will be the fourth town levelled to the ground in this dirty war against Croatia, sharing the fate of Vukovar, Osijek, and Vinkovci. Are the ancient cities of Dalmatia (Sibenik, Zadar, and Split) next? The 600-yearold cathedral in Sibenik has already been intentionally damaged by a tank grenade. It seems that Yugoslav Federal Army and their allies start with the destruction of historical monuments, proceed with the civilian residential areas, and end their destructive mission with the
hospitals. Casualties of the fighting are recorded by the Medical Headquarters of Croatia. The accompanying figure shows numbers rising sharply in the 3 months leading up to Thursday, Oct 10,1991.1. Medical School, University of Zagreb,
IVICA KOSTOVIĆ MATKO MARUŠIĆ,
Salata 3, 41000 Zagreb, Croatia, Yugoslavia
for the staff and students, University of Zagreb Medical School
1. Glavirla K, Tucak A, Janoši K, Pajtler M, Lacković Z. Deliberate military destruction of the general hospital in the city of Osijeh. Croatian Med J (m press).
Albania,
a
plundered country
SIR,-In your issue of July 6 a Round the World report by Dr Offerhaus painted a very gloomy picture of medical services in Albania. This has been reinforced by the vivid television reports by Bill Hamilton of the BBC. I was in Tirana, the capital, in late September and can report that the situation has worsened. Stocks of very basic medicines (digoxin, propranolol, prednisolone, metoclopramide, insulin) and equipment (needles, syringes, skin antiseptics, surgical gloves) are now almost non-existent. With no foreign exchange Albania is totally dependent on foreign aid, which does not seem to be coordinated. There are sufficient doctors, dentists, and nurses in Albania but they lack the materials with which to practise their skills. They crave contact with other European doctors. I was the first UK doctor many had met. Chronic lung diseases are very common but because of the almost total collapse of the country’s infrastructure, nothing is being done in health education (eg, to reduce smoking) and factories are outdated so that pollution is severe. Hepatitis A and B, gastroenteritis, and tuberculosis are widespread. Antibiotic resistance is common. Up to 50% of strains of Salmonella typhi are resistant to chloramphenicol; 40% of strains of Pseudomonas aeruginosa (a seemingly common hospital pathogen) are resistant to gentamicin and carbenicillin; whilst most strains of Staphylococcus aureus produce penicillinase, penicillinase-resistant andstaphylococcal agents are scarce, and methicillin-resistant Staph has started to appear. Microbiology laboratory back-up, which would permit full patient investigation and antibiotic policy, are totally inadequate. Reagents and media are scarce. Without information on the prevalence of antibiotic resistance and in the absence of effective hospital infection-control programmes it will be impossible to implement an antibiotic policy. Whilst efforts such as Feed the Children are to be congratulated, it is only by a sustained effort through the health ministries of aureus
’".’y
4 SEEP
Croatian casualties (cumulative) up to Oct 10,1991.
The lack of impact of the various peace treaties is illustrated by the fact that four such agreements were reached during the 3 months of steep increase in casualties-namely, those of Brioni (July), Belgrade Sept 2, Igalo Sept 17, and The Hague Oct 10. There was a ceasefire treaty on Sept 26.