Bioethics in the Former Yugoslavia: The War tragedy and Recent Trends in Croatia

- Nenad Hlaca, Ph.D.
Law School University of Rijeka
Hahlic 6, HR -51000 Rijeka, Croatia

Eubios Journal of Asian and International Bioethics 8 (1998), 111-113.

In some scientific circles bioethical dilemmas in the former Yugoslavia were imported with the new medical technology in the last decades. At the same time the socialist regime had a strong impact in which collective rights were more important and in which there was no place for liberalism and individualism in the protection of human rights. An historically important step in the development of the bioethical approach was the first Course "Human Rights and Medicine" organized at Inter University Centre for Postgraduate Studies in Dubrovnik in 1984. In the last thirteen years, even during the war, the Courses in Dubrovnik dealt with human rights issues in medicine and health care. In the multidisciplinary approach participants from Croatia and abroad discussed the ethical dilemmas and protection of human rights. The Hastings Center from New York organized in Dubrovnik the first East-West Bioethics Conference in 1989. Tragic events in the former state during the war focused the interests of the participants on the problems of the war victims, displaced persons and refugees as well on the ethical and legal aspects of the family dysfunction's on the 1994 Course. This year, the course was oriented to the new European reality: on the Convention on Human Rights and Biomedicine.

As a tragic war experience the problem of forced pregnancies will be stressed as a serious violation of the right to reproductive choice. Forced pregnancy through rape during the armed conflicts is treated as a war crime (UN doc.E/CN.4/1994/5). In the war in the former Yugoslavia rape is expressly considered as a break of international humanitarian law and as a crime against humanity in certain circumstances. In the same time during the war there were investigated serious examples of male sexual abuse. The problem of abortions of sexually abused Bosnian citizens refugees in Croatia was treated according to Croatian law. But the problem was that raped woman reached Croatia usually to late for the medically acceptable abortion.

The Inter University Center for Postgraduate Studies in Dubrovnik was an important bridge for the scientists from the dark side of the iron curtain where they established the first contacts with western colleagues.

The first Croatian legal document was carved on a stone slab in the year 1100 in old Croatian language and in glagolic script on the island Krk. That was a deed of gift proving that the Benedictines on this side of Adriatic used glagolic script and wrote in old Croatian language. From this part of my homeland there is also Vinodol Code from 1288. The Vinodol Code is a historical source of freedom of the districts in the north Adriatic. By means of these documents we try to explain a deeper meaning of Croatian history and express the hope for our future. Cornerstones of Croatian history were extremely important in the period of disintegration of the former state: the first free democratic multi-party elections took place in Croatia in 1990. Political pluralism, democratic liberties and market economy were introduced. Croatia tried to solve the problems with the former federal parts reasonably and peacefully. The Croatian Parliament legislated the text of the new Constitution in 1990. On the referendum held in 1991. 94% of the population voted for a sovereign and independent Croatia. But tragic war has been going on in the Republic of Croatia imposed by Republic of Serbia and federal army. Federal army with terrorist groups attacks Croatia with all its military potentials. To protect themselves Croatian people were forced to fight a defensive war against the powerful invader. Thousands of people leave their homes and become displaced people. In the same time there was few hundred thousands of refugees from Bosnia and Herzegovina in Croatia.

Croatia is a small country on a cross-road from North and East Europe to the Mediterranean and those leading from West and Central Europe to the East. It is strategic position for attacks and defense, but also the avenue of traffic, travel and trade. The population of Croatia shows the tendencies of birth-rate decrease to the limits of stagnation which leads to the majority of elder age population. The trend is very similar to those in the countries and nations on the economically higher developed level. The negative impact of political transformations is a large number of emigrants, especially the capable and young educated people and that negative process is still in progress. In the same time Croatia is finally an equal member of the international community which received recognition of its independence and has accepted all the obligations for responsible behavior in the international legal system. A synthesis of tradition and progress can be achieved by establishing a democratic state with limited and strictly controlled power, guaranties of human rights of all citizens, rule of law, freedom and equality. A modern market-oriented economy requires equality and free competition of all forms of ownership, based on private ownership controlled by a legal system in the best interests of all. Croatia as a welfare state will direct its attention on a long-term scale to modern social programs guaranteeing minimum social security to all its citizens and health for all through universal medical care.

Principles are clear But realty, especially during the war was tragic: soldier's who fought in the war, the displaced, invalids, orphans must be taken care for reintegration in the society, their homes rebuilt, production facilities restored... The bioethical situation during the war could be expressed in a literary sense by the Latin proverb: Inter arma silent musae or inter arma silent leges. The fact is that newly created Latin proverb is: inter arma silent bioethics. The war is the end of the love of life as Darryl Macer described bioethics.

According to large number of documents, individual statements given by witnesses and eye-witnesses who survived there was reported that 1000 Croatian civilians were massacred or brutally killed by the Serbian irregular paramilitary in the temporarily occupied Croatian territories. The Croatian Red Cross reports that total number of missing persons in Croatia was 13.788. By 3 December 1992 the total of 5.621 ex-detainees released from Serbian camps and prisons were registered by the Department of Information and Research of the Ministry of Health. From the total of all medically researched cases about 90% of all detainees were victims of torture (Government of the Republic of Croatia, Zagreb, 15 January 1993, Comprehensive Program for Protection and Help to Victims of Torture).

During the war in 1993. we were faced with problems related to the most violent tortures including sexual maltreatment of women during the war in Bosnia and Herzegovina. According to the official data 90% of all detainees from camps for non-Serbians were victims of torture.

The issue of forced pregnancy through rape as a tactic of war fare and as a war crime has been addressed extensively in the context of the recent war in former Yugoslavia. Rape was expressly considered a breach of international humanitarian law and a crime against humanity. The team of experts created to investigate that problem in former Yugoslavia was able to identify 119 pregnancies resulting from rape during 1992, although a strong argument was made that the number of rapes resulting in pregnancy was considerably higher due to under reporting (UN doc. E/CN.4/1993/50). A large majority of these pregnancies ended in abortion. According to the report one ethnic Croat woman who was detained in a Serb-controlled camp reported that while raping her, the men shouted "you will have a Serbian child". She was then told her that, if she were pregnant, she would be forced to stay until six months of pregnancy. The only intention which can be clearly deduced from this is that the aggressors sought to prevent her from obtaining an abortion. Some women were periodically examined by gynecologists with the result that if found to be pregnant, they were set apart and given special privileges until their seventh month when it was too late to obtain an abortion and only then to be released. (UN Security Council Final Report of the Commission of Experts Established Pursuant to Security Council Resolution 780(1992), UN doc.S/1994/674, Annex 241, No.65). In certain cases followed up by the team of investigating experts the infants were rejected by the women following their birth. The International Criminal Tribunal for the Former Yugoslavia was established to prosecute systematic sexual assault as a crime against humanity. A number of NGOs and individuals are urging forced pregnancies achieved as a result of such rapes to be prosecuted as a war crime.

It was a tragic fact that sexually abused women from Bosnia and Herzegovina usually reached Croatia as refugees too late when abortion as a solution for the problem was no longer medically acceptable. Adoptions will be an important legal instrument for the protecting the best interests of the children born form the part of the raped mothers. But in the legal realty Bosnian refugees were citizens of an internationally recognized state and it was not possible apply the Croatian Marriage and Family Relations Act from 1989.

In the same time the Medical center for Human Rights in Zagreb collected the data on about 20 cases of sexual abuses of man during the war activities in Croatia and Bosnia and Herzegovina. Here is testimony (Prij-408): "A man born on 1945, Muslim, lived in Kozarac, municipality of Prijedor, captured as civilian by Chetniks and taken to Omarska camps where he was beaten and maltreated One of the most disgusting crimes happened on June 16, 1992 when Jasmin Hrnic, Emir Karabasic, Hasan Kilic and E.J. had to cut off one another's genitals. All of them, except J.E. died due to the consequences. E.J. had to eat genitals. There were more such cases...." (Medical Center for Human Rights, Sexual Abusing of Men, Report, Complete documentation, data on witnesses and statements are field at the Medical Center for Human Rights in Zagreb, Croatia).

It is incredible that such enormous brutality can be committed in the end of this century and it is strange that bioethics should treat at the same time the problem of cloning and brutal abuse of basic human rights and dignity. In the war Croatia was not alone. Volunteers and NGOs from all over the world started with a support projects. At Inter University Center for postgraduate study in June 1994 was held the Course "Human Rights and Medicine". During the Course there were covered topics like: International Public Law and Protection of Human Rights in Medicine; Violations of Human Rights During the War in Croatia; Organizational Model and Functions of the Croatian Red Cross; UNHCR Activities During the War in Croatia and Bosnia and Herzegovina; Children's Medical Project - International Rescue Committee; Rape as a war Crime and Rehabilitation for Victims. In the same time during the Course we were in the field visit to displaced persons and demolished villages near Dubrovnik. Rijeka established the sister-city relationships with Kawasaki in 1977 mostly on cultural and scout contacts. In 1993 during the war in Croatia we received important material donation from our sister city for the emergent needs in medical aid and food. Children from Rijeka also participated in the educational and multicultural aid project Mail Art dedicated to psychological support for the earthquake victims in Kobe. In these days in Rijeka a delegation from the sister-city of Kawasaki will sign the new protocol for cooperation in the next ten years.

The former Yugoslav Constitution from 1974. divided legislative competencies between the units on the more confederate than federal level: units were independent in the legislative activities. From that period there is still in force for example the Act on Health Measures in implementation of the Right to Freely Decide Childbirth from 1978. The legal system of the Republic of Croatia is now in transition. The former "Communist" law is criticized as a liberal approach. Reactions in the mass media indicate that there is strong revival of the influence of the Roman Catholic Church.

The principle of health care reform now in Croatia as a sovereign state is a flexible step by step process based on realism with necessary changes. The health care reform is oriented towards more efficient resource management and privatization. The Medical Chamber has received extensive competencies in the Croatian health care system in the fields of medical ethics, sanctions and protection of patients rights. In Croatian medical practice there are introduced in the form of autonomous norms bioethical commissions as decision making bodies for the specific medical treatments: bone marrow transplantation, for example. On the University level an ethics committee was established in the Medical School of the University of Zagreb.

The situation in Croatia dealing with the bioethics is the vacuum in public policy. In some way bioethics is introduced in the policy making structures through independent academic experts in the law commissions. But discussions in the media about the draft of the new abortion code are a clear example how there is an urgent need of bioethical research as a method of transforming medical and biological chaos into order of moral principles. It seems that process toward moral transition will be very long and stressful.

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