Yugoslavia: Follow-up to YUG30738.E of 25 February 1999 on the availability of treatment (drug therapy, psychotherapy, etc.) for people who have schizophrenia, and whether international sanctions have interfered with the ability of the authorities to provide treatment for them (January 1998 - February 1999)
| Publisher | Canada: Immigration and Refugee Board of Canada |
| Author | Research Directorate, Immigration and Refugee Board, Canada |
| Publication Date | 1 March 1999 |
| Citation / Document Symbol | YUG31469.E |
| Cite as | Canada: Immigration and Refugee Board of Canada, Yugoslavia: Follow-up to YUG30738.E of 25 February 1999 on the availability of treatment (drug therapy, psychotherapy, etc.) for people who have schizophrenia, and whether international sanctions have interfered with the ability of the authorities to provide treatment for them (January 1998 - February 1999), 1 March 1999, YUG31469.E, available at: https://www.refworld.org/docid/3ae6ac2c2b.html [accessed 21 May 2023] |
| Disclaimer | This is not a UNHCR publication. UNHCR is not responsible for, nor does it necessarily endorse, its content. Any views expressed are solely those of the author or publisher and do not necessarily reflect those of UNHCR, the United Nations or its Member States. |
A 4 March 1999 letter sent to the Research Directorate by the WHO (World Health Organization) Special Representative to the Federal Republic of Yugoslavia in Belgrade states:
With reference to your inquiry to WHO Office for Humanitarian Assistance in Belgrade of 26 January 1999, we have consulted the national manager for mental health and learnt the following:
Availability of treatment for schizophrenia:
Patients with schizophrenia are referred by the primary health care level (communal primary health care center) to the respective specialists of neuropsychiatry (either specialist service within the primary health care center or in the out-patient psychiatric consultation practice in the district hospital). This level determines the phase and severity of disease and decides whether there is a need for hospitalization (acute cases, serious exacerbation etc.).
In case that hospitalization is needed, the patient is referred to the psychiatric ward of the district hospital, or to a special mental health institution (Institutes at University clinics or special mental hospitals). After hospital treatment the patient returns to the communal psychiatric service (either in the primary health care center ("Dom zdravlja(Helath House" or Communal dispensaries for mental health). Both drugs and psychotherapy are included in the treatment, again depending on the phase of the case.
Price of treatment: Psychiatric care for schizophrenia is a mandatory form of health care (prescribed by the Law on Health Care(wording and reference to the law may be obtained). No exact price for treatment could be obtained as it varied depending on hospitalization, length of intensive treatment, etc.
Availability of drugs:
WHO and various humanitarian organizations have been receiving repeated appeals from major psychiatric hospitals for assistance in providing them with psychiatric drugs such as: melleril, haloperidol, lithium and long list of other drugs.
Drugs listed on the "reimbursable list of drugs" defined by the Health Insurance Fund can be purchased if prescribed by authorized physicians in state owned pharmacies. They are free of charge for defined categories (under the age of 18, above the age of 65, communicable disease, some categories of mental health, diabetes mellitus etc.), or with a co-payment of 8 dinars per prescription. Drugs which are not on the "reimbursable list" must be paid in their full price.
There are frequent shortages for drugs from the reimbursable list in state pharmacies (due to economic difficulties, or if they are not available through the local pharmaceutical industry). The state does not reimburse drugs purchased in private pharmacies (there are exemptions for some imported drugs, which are processed on a case-by-case basis).
Sanctions effect:
It is difficult to judge the exact effect of sanctions, however it is obvious that the whole health system is in a very difficult financial situation resulting form the grave economic situation during the sanctions period. Health institutions cannot fulfil their financial obligations towards drug wholesale companies and towards the pharmaceutical industry. Therefore drug supplies to health institutions are not regular. Availability of locally produced drugs varies(greatly, with major periodical shortages(due to the fact that the pharmaceutical industry cannot collect payments and thus cannot import the necessary raw materials and produce drugs.
Drugs which are not produced locally are imported in limited amounts by the state or through private companies. Drugs imported by private companies are available in private pharmacies only. This situation has been observed with regard to all fields of medicine, not only mental health.
I hope that this information which represents my personal viewpoint will be helpful to your service.
This Response was prepared after researching publicly accessible information currently available to the Research Directorate within time constraints. This Response is not, and does not purport to be, conclusive as to the merit of any particular claim to refugee status or asylum.
Reference
World Health Organization Regional Office for Europe, Area Office for Humanitarian Assistance, Belgrade. 4 March 1999. Correspondence with the WHO Special Representative to the Federal Republic of Yugoslavia.
