War Crimes in the Balkans: Medicine Under Siege in the Former Yugoslavia 1991-1995 (review)

War Crimes in the Balkans: Medicine Under Siege in the Former Yugoslavia 1991–1995. A Report by Physicians for Human Rights (1996).

The images of forced displacement, mass killings, systematic rape, and wanton destruction of towns and villages have been a permanent fixture of any discussion about the war in the former Yugoslavia. At a time when many feel that what is left to be revealed is the extent of the already known horrors, Medicine Under Siege comes to alert us to yet another dimension of this war: namely, how access to medical care became an instrument of war.

This report, prepared by Physicians for Human Rights (PHR), is based on eight on-site investigations conducted by the group in the former Yugoslavia over a three year period beginning in October, 1992. In chilling detail, the report presents evidence of the following:

1. 1. Deliberate attacks on hospitals and clinics in numerous towns and villages, including Sarajevo, Mostar, Bihac, Gorazde, Vinkovici, and Slavanski Brad;

2. 2. Torture and summary executions of patients and medical staff. In the most notorious case, that of Vukorar Hospital, Serb military and paramilitary units removed over 200 patients and staff from the hospital wards and took them to Ovcara, never to be seen again. It is widely believed that they were summarily executed and buried in a mass grave on the outskirts of Ovcara; ¹

3. 3. The continuous obstruction of the delivery of essential food, medicine, and medical supplies which resulted in hundreds of casualties from starvation and untreated illnesses; and

4. 4. The targeting of ambulances and other medical vehicles which often led to the death of transferred patients and the accompanying medical staff.

What emerges is the picture of a conflict in which all known legal and customary restraints were simply set aside. In PHR’s own words, “the wounded became combatants to be killed and medical facilities became strategic military targets. . . . interference with medical care was not a collateral, unavoidable consequence of war, but instead was deliberate, consistent, and a part of the strategy that chose civilians as the primary target.” ²

While this report includes much valuable information, what stands out is the discussion on the principle of medical neutrality. Medical neutrality is a normative construct which is anchored on key provisions of international human rights law, international humanitarian law, and medical ethics; it seeks to provide guidelines for health professionals concerning their rights and responsibilities in both wartime and peacetime. The report’s classification of violations of medical neutrality constitutes an invaluable framework for any future investigations of similar violations. ³

The study concludes with a series of recommendations ranging from the need for arrest and prosecution of those responsible for war crimes and the need of the United Nations to amend the provisions of its peacekeeping mandates so as to safeguard medical neutrality. It also mentions the responsibility of the major powers to name the senior political and military leaders who have presided over atrocities in the former Yugoslavia. While all these ideas constitute perfectly legitimate proposals, some have already been grounded by the exigencies of the Dayton process. For example, there is no way that the US will ever provide to the War Crimes Tribunal intelligence reports directly linking senior Serb and Croat political and military leaders to the planning and/or commission of atrocities. These leaders’ support is considered critical to the success of the already problematic Dayton Peace Accord; hence, any “smoking gun” revelations will not be forthcoming. Given that already indicted individuals like Ratko Mladic can live in peace in the village of Han Pijesak (in the US sector), or like Radovan Karadzic, can publicly appear with impunity in Banja Luka (in the British sector), no major breakthrough can be expected on this front.

There are two minor corrections that I would like to mention. On page sixty-one, the report refers to Article 16 of the Fourth Geneva Convention; rather, it should refer to Article 16 of the 1977 Geneva Protocol I. Likewise, on page ninety-one, the reference should not be to Articles 54...