Sustaining, protecting and promoting public health in Bosnia and Herzegovina

Four years of war in Bosnia and Herzegovina have severely damaged the health care system and destroyed basic infrastructures. Yet in spite of these conditions and the reappearance of several "dormant" diseases, no major fatal disease outbreaks have occurred. Morbidity and mortality due to infectious diseases have remained surprisingly low. This article explores some of the reasons why this potentially enormous public health disaster was avoided. Public health interventions can generally be considered the outcome of two components: knowledge and action. War situations inhibit thorough or ideal data collection and therefore the balance between knowledge and action must be tipped towards the latter. In Bosnia and Herzegovina, the WHO/national health monitoring system maintained a sufficient level of surveillance so as to provide early detection of significant threats to health. As the lead health agency in the conflict, WHO applied several health monitoring strategies. Major fatal epidemics were avoided because health workers have become increasingly scientific in predicting epidemics in war situations and formulating the steps necessary to limit them. Some of the preventive interventions applied in Bosnia and Herzegovina to reduce the impact of infectious diseases are discussed.