War-related stress major health concern

SARAJEVO, Bosnia-Herzegovina - Two Bosnian soldiers were guarding an outpost on the outskirts of Sarajevo last year, when a grenade hit their trench. The blast blew one man to pieces; the other man was unharmed, physically.

When a relief patrol arrived days later, they discovered the living soldier talking and joking with the gathered parts of his dead comrade.

"We now have him under psychiatric care on our ward," said Dr. Ismed Ceric, general manager of the psychiatric clinic of Kosevo Hospital, the city's largest. "We are slowly explaining to him that his friend is, in fact, dead."

The tortured soldier is not alone. As many as 153,000 people in Sarajevo will need some kind of mental health treatment in coming years as a result of war-related mental disorders, according to Dr. Ceric. And that estimate does not include areas under the control of the Bosnian Serb militia.

"We believe that everyone in the city is or will suffer from some kind of stress-related mental illness due to this long war, and about 40 percent will need some kind of (psychiatric) medical attention," he said. "For almost four years, no one felt safe here. Bombing, sniping, the mental impact is still to be seen."

During the war, even the psychiatric ward was targeted by Bosnian Serb artillery. Dr. Ceric, sitting in an office marred by shrapnel, said the clinic was hit about 30 times. "It was very difficult to treat the patients," he said. "When they bombed my home I didn't get angry. But when I came to the clinic and saw the catastrophic events here, I became so angry I could kill someone."

Making educated guesses based on American clinical studies, Bosnian health officials estimate 60 percent of Sarajevo's 383,000 people will be able to cope with their depression or other mental problems caused by the war. The other 40 percent won't, and, of them, 10 percent to 20 percent will remain chronically mentally ill.

If the chronically mentally ill number is only 10 percent of the total population, that is 38,300 people needing long-term mental health treatment. Those numbers would swamp the city's mental health services. Some basic medical help is coming into the city from the World Health Organization and other relief agencies have promised aid. But treating the mentally ill falls to the local services. Currently the city has 16 psychiatrists, 10 psychologists and about 30 mental health social workers.

By comparison, less than 1 percent - approximately 62,000 - of the state of Ohio's 11 million residents have been declared severely mentally disabled. In Hamilton County, which has more than twice Sarajevo's population, there are only 4,953 people diagnosed as severely mentally disabled.

In 1994, a study by the Hamilton County Community Mental Health Board found that about 18 percent of the county's population have a diagnosable mental illness or mental disorder.

Ohio also has many more people than Bosnia to help with the treatment of mental illness. The state has more than 5,500 licensed psychologists and psychiatrists and thousands of others working in the mental health field.

In all walks of life, war stress is apparent, said Dr. Ceric. Elderly men can't sleep. Elderly women cry uncontrollably. Husbands become violent. Wives, burnt out after years of scrounging meals for their families, suffer mental exhaustion. Children, many kept in their homes for four years by fearful parents, are now terrified to have those parents leave their sight.

Dr. Ceric said the mental health department is trying to set up community treatment centers to hold group therapy sessions to reach as many people as possible. But the shortage of staff and funds makes the task seem impossible. "I don't know what is going to happen in the future." he said. "I don't see how we can handle this . . . I tell people look, we'll manage something, but in truth we don't have the tools in our hands."

Published Feb. 8, 1996