Epidemics Have Started

The World Health Organization (WHO) announced last week that - according to information from the field - there is danger of a typhus epidemic breaking out in northern Bosnia. The news was short; it mentioned the communities of Zenica, Travnik and Kakanj. Since May, this area has been exposed to brutal and wasteful war activities by all three warring sides. In the given Balkan conditions, that means a total break down of the system of social infrastructure - at a material level - and the destruction of society's tissues at a sociological level. Namely, the quantities of highly explosive ammunition and efforts made to waste both the envious man and his fat neighbor have destroyed the delicate balance of civilizational values. Complex systems such as electricity and communication networks and water supply got hit first; medical protection and efficient medical aid depend on an open communication system in order to provide free access to drugs, equipment and staff - especially in the case of an epidemic.

That's how a tragic paradox occurred: a modern civilized society - even in its modest form, like in northern Bosnia - is far more susceptible to catastrophes, such as epidemics, which as a rule can be expected to spread in war - than a primitive one. The coming Winter, according to estimates by CIA and the International Red Cross, could claim as many as 10,000 to 200,000 lives in Bosnia-Herzegovina (depending on how much help will be provided) solely as the result of epidemics and lack of protection from the cold, even if the war were to stop immediately.

The war in Bosnia already resembles scenes enunciated in The Revelation of Saint John the Divine: all four riders have ridden out - Death, War, Famine and Pestilence. Humanity can deal successfully with each one of them (except, of course, with death) - war is evaded by rationality, hunger by labor and disease by medical treatment; together they are invincible.

War, especially such a dirty and psycho pathological one, brings contagious diseases; furthermore, the outrageous disrespect for all rules of warfare, the lack of formal and informal conventions, honor, chivalry and elementary human morality exclude that minimum of possible help to the victims of the diseases. Even worse: it seems that throwing human and animal corpses into the enemy's wells is a traditional custom in these parts; since ethnic cleansing is the final goal, everything is allowed, including preventing humanitarian convoys from passing through; if you can't destroy the enemy by arms, use starvation and diseases. Recent incidents concerning the "spontaneous" erecting of barricades in order to stop the humanitarian convoys in Bosnia, the systematic cutting off water and electricity, and the medieval sieges of towns are all proof of the kind of methods being used. This is total war and everything is permitted. That is why claims that a "religious war" is being fought are shameful and hypocritical: neither Christianity nor Islam allow such things; furthermore, they list them among the deadly sins.

This is where typhus comes in. There are two kinds: typhus fever (Typhus exanthematicus) and abdominal typhus (Typhus abdominalis). According to what some doctors from Medecins sans frontieres told VREME, it seems that in northern Bosnia we are dealing with an epidemic of abdominal typhus in its initial phase. The epidemiology manuals describe it as an acute intestinal contagious infection with endemic focuses, which appears both sporadically and in the form of an epidemic. It is caused by Salmonella typhi, a highly resistant bacterium, which under favorable circumstances multiplies quickly, primarily in victuals. The ways of transmission are personal contact, water, food, flees and soil. Before the era of antibiotics, the carrier percentage was 3% to 5%, which is an important fact in the northern Bosnian case: namely, there are hardly any antibiotics available in those parts, and bearing in mind the situation in other regions of that unfortunate land, the disease threatens to spread. The abdominal typhus - if one must compare - is less serious than typhus fever. Under the normal circumstances, the prognosis is favorable. It lasts for about one month, with a constant high temperature (39-40 degrees Centigrade), heavy headaches, delirium and a general weakness. However, the possible complications are worrying, and range from perforations, internal bleeding, peritoneal symptoms, thrombophlebitis, pneumonia... Relapse is common. From the epidemiological point of view, the especially dangerous characteristics of abdominal typhus are a long incubation period (15 to 45 days) and latent virus carrying, which can go on for a long time, according to some sources even for a life time (the most acute cases). Prophylaxis, i.e. prevention, consists of a number of measures which are simple and efficient under normal circumstances: pure drinking water and food, correct disposal of waste materials (junk and feces), eradication of flees' nests (they are an important carrier of the disease), vaccination and a normal, civilized life. Very simple, but in northern Bosnia (and Bosnia in general) mainly impossible.

The doctors claim to be worried, since the lack of medical staff, drugs, disinfecting and disinsecting devices and normal living conditions will increase the death rate and help in spreading the disease.

According to our laws on the wiping out of contagious diseases, one can conclude that in the territory of the former Yugoslavia there is danger from some fifty diseases and parasites listed among those which require obligatory epidemiological treatment. Plague, cholera, typhus fever and smallpox also figure on the list. If things continue to develop this way, the abdominal typhus in Zenica, Travnik and Kakanj could just be the beginning. Typhus fever is considered endemic (potentially dangerous on a permanent basis) in Serbia, Kosovo and Bosnia, where it spread during the Second World War. We tend to forget that an epidemic of typhus fever in 1915 in Serbia claimed many lives: without antibiotics, the death rate was 40% (today, if antibiotics are used, it will be around 1%).

The total degradation of general hygiene, lack of medical protection and pharmaceutical supplies in the war-torn regions, especially in the besieged towns (population density is an important factor) dramatically increases the risk of epidemics. Not to mention bad nutrition and exposure to the cold. The doctors believe that it would be wise to make all three warring sides agree upon basic conditions for the wiping out of the disease and start cooperating in that respect, since microbes cannot tell the difference between Serbs, Croats and Muslims. It is to be believed that this advice will fall on deaf ears: had there been reason in the first place, there would not have been war.