Slaying the demons – war trauma in the Balkans

Stari Most (Old Bridge) in Mostar in Bosnia Herzogovina was destroyed during the war
Stari Most (Old0 Bridge) in Mostar in Bosnia Herzogovina was destroyed during the war (© Eric Beauchemin)

In 1991, old scars were ripped back open when fighting broke out again in the former Yugoslavia. Five years of ethnic cleansing, war rapes, concentration camps, a quarter of a million dead and 2.5 million refugees and displaced people have left even deeper wounds in the Balkan psyche. About 700.000 people in Bosnia and Croatia were severely traumatized by the war, according to a report by the European Community Humanitarian Office. Another 700.000 are in need of therapy. Some organizations put the figures even higher, and experts say many of the 1.8 million people who took refuge elsewhere in the former Yugoslavia and Europe are also in need of counseling. The experiences of many of the Balkans’ trauma victims cannot be forgotten. Even months or years later, some experiences remain all too vivid, all too gruesome, almost too painful to hear or recount.

Original broadcast: 1996

Transcript

Radio Netherlands, the Dutch International Service, presents “Slaying the Demons – war trauma in the Balkans”. The program is produced and presented by Eric Beauchemin.

Former Yugoslavia was created in 1918. You had almost every 10 or 20 years some sort of massive traumatization, some sort of massive imprisonment, some sort of war and massive loss of people and suffering. So families didn’t have time to go appropriate through the mourning process.

In 1991, old scars were ripped back open when fighting broke out again in the former Yugoslavia.5 years of ethnic cleansing, war rapes, concentration camps, a quarter of a million dead and 2.5 million refugees and displaced people have left even deeper wounds in the Balkan psyche. About 700.000 people in Bosnia and Croatia were severely traumatized by the war, according to a report by the European Community Humanitarian Office. Another 700.000 are in need of therapy. Some organizations put the figures even higher, and experts say many of the 1.8 million people who took refuge elsewhere in the former Yugoslavia and Europe are also in need of counseling. The experiences of many of the Balkans’ trauma victims cannot be forgotten. Even months or years later, some experiences remain all too vivid, all too gruesome, almost too painful to hear or recount.

They have ordered us to get in our night clothes out of the house, and we had to stand there waiting for them to say what they will do with us. He says there were six women between them, two families together. While they were standing there, they ordered his wife to enter inside the house to look for the gold and money. They have put a knife under his chin, on his throat, and they told women: “you had better find Deutsch marks and money and gold because if you do not bring absolutely everything you own, we are going to cut his head off.” He said while they were holding a knife under my throat, I imagined that women are inside searching for what they said: money and gold, while actually they have been raped most viciously over and over and over again – his wife and all the other women.

She was raped by three men behind the house. Then they said: “and now we are going to cut you open unless you give us absolutely every penny that you have in the house”. So they entered the bedroom, and she gave them absolutely every single penny that they had in the house because she was feeling that she’s buying not only her life but her husband who is outside with the knife under his throat. And then the fourth man came. Then he said…he raped her, the fourth man. And after that, he said “and now we are going to play doctor, and we are going to have an examination”.

Well, she’s describing what happened to her after that because he has asked her to open her legs, that he’s going to play a doctor and he put his hand inside her. She was screaming with pain and he told her, “now after that, you better lick every of my fingers off”. She says she was bleeding extremely heavily, and she was begging for mercy because she said: “I had operation two years ago and I can be your mother. And please stop it.” Another woman of her family had the skin on her throat slit because she didn’t do it as quickly as they wanted. Well, after that, the other man came and he said: “well, we had our fun with you Muslims, and I hope you will never, ever be able to bear little Muslims again”.

A few months after the multiple rape and expulsion, the couple – in their 60s – is still too terrified to give their names or even mention the name of their village. They are still only beginning to grasp the sudden and profound changes which exile have brought about. They still haven’t come to terms with what took place in their village that Friday afternoon. Like many of the survivors of the terror of the past four years, they look numb, gaze off in the distance and constantly relive the horror.

I suffer from severe insomnia. Many of the other refugees who share this room with me, both adults and children, also have sleeping problems. People toss and turn. They talk in their sleep. They sweat. We’re all very nervous.

This former Bosnian soldier in his early 40s is one of 40-thousand people –mostly Muslims – who were expelled from the UN safe zone of Srebrenica in July of last year. The Bosnian Serbs, who overran the enclave, promised them safe passage to the Bosnian Federation. Most ended up in the city of Tuzla. 6-thousand of them, according to the International Red Cross (up to 10,000 according to the survivors) never completed the journey. They were killed in the worst massacre in Europe since the Second World War.

I often can’t fall asleep when I go to bed. I see pictures again in my head, especially images of the fall of Srebrenica and our journey on foot to Tuzla. It feels like I’m looking through a camera lens. I see everything very clearly. It happens mostly at night but sometimes during the day too. When I’m alone and not talking to anyone, the images reappear. When it happens, I don’t only see the pictures. I can also clearly hear, for example, the sounds of a creek or of wood cracking. I can’t stand noise anymore. I get very angry and explode. I pick fights all the time and I know that I behave strangely. Things which never used to bother me now irritate me intensely. I feel tense all the time. My nerves are shot. I buy sleeping pills and tranquilizers for myself. I just don’t think counseling can help me. Besides, there aren’t any counselors at this refugee center. None of us sees any future for ourselves. We no longer see a reason to carry on the struggle for life. We had everything, and nowadays we have nothing. We’re just beggars.

Like hundreds of thousands of others, both this former Bosnian soldier as well as the elderly rape victim and her husband suffer from PTSD, Post Traumatic Stress Disorder. In Bosnian, it’s known as the “Vietnam Syndrome” because of the large number of American servicemen who were scarred by their experiences in southeast Asia. PTSD is a normal reaction to an extremely abnormal events. Vesna Puratic, the mental health coordinator for the Dutch branch of Médecins sans Frontières or Doctors without borders, in the Bosnian capital Sarajevo.

It’s usually with soldiers or refugees, people who were extremely exposed to severe traumatization. It’s mainly manifested with nightmares, very often sleeping disorders, fears, sometimes having no appetite at all, some physical reactions, very thin people, very pale people, sometimes emotionally empty people.

The emptiness stems from people’s utter helplessness in the face of life and death situations. They feel like they’ve lost all control over their lives. According to Dr. Milan Kosuta, a psychologist and psychotherapist who heads the mental health unit of the WHO, the World Health Organization in the Croatian capital, Zagreb, trauma victims isolate themselves in order to try to come to terms with their experiences.

Very often people instead of going ahead towards the future and being present in the here and now, very often they are going back to their traumatic events and they relate the whole future life with their traumatic event. And very often, this destructive behavior have symptoms such as alcohol abuse, drug abuse, family violence and so on and so on.

In Croatia, experts have already noticed an increase in suicide and murder rates, and they say growing numbers of people are drinking or taking drugs. In Bosnia, officials are reluctant to admit it, but Sarajevans say alcohol and drug abuse have become rampant there. Because of the brutality of the war and the huge numbers of people involved, psychiatrists soon realized that trauma would become a major problem in the region. The first psycho-social programs were set up when the fighting was still going on, but it was clear that there weren’t enough qualified local professionals to deal with the hundreds of thousands of trauma cases in the former Yugoslavia. The European Union estimated last year that less than one percent of the trauma victims in Bosnia and Croatia would be able to receive the treatment they need. Local and non-governmental organizations now have over 200 psycho-social programs in the Balkans. Some are tiny. Others are not only offering therapy, they’re also training nurses, social workers, teachers and others to work as counselors. Dr Guus van der Veer is a Dutch psychologist and psychotherapist who works at a mental health center for refugees in Amsterdam. He’s gone to Bosnia twice over the past year to give psycho-social training courses for the Dutch wing of MSF, Doctors without Borders. Even though every case is unique, says Dr. van der Veer, there are certain techniques to treat trauma.

Imagine a client that is suffering from panic attacks during the day and repeated nightmares when he tries to sleep. Now, different approaches are possible. For example, you could help the client to understand why his panic attacks are occurring. We call that psycho-education, explaining the background of symptoms in his individual case and take that as a point of departure for looking for different ways of coping with the symptom. And quite often it can result in control over the symptom. So, for example, if somebody gets a panic attack triggered by sounds of explosions or loud noises or whatever, well these happen all the time in a city. You can learn people how they can relax themselves when they feel a panic attack coming. When they know what’s going on, they are less surprised by a panic attack. That may also bring them some relief and result in a loss of anxiety, things like that.

MSF began by offering counseling to medical students because it’s likely that they will see the effects of trauma in their patients for many years to come. The Dutch-branch of MSF is now visiting secondary schools throughout Sarajevo to offer group therapy sessions to anyone who is interested. Every Wednesday, 17-year-old Sajina and her 10 classmates head off to a counseling center, right off Sarajevo’s noisy main thoroughfare. Two women supervise the 1.5 hour weekly session: a nurse and psychologist Nevrita Ovuka.

During our sessions, we discuss a number of themes like love, hate, the future, relationships, family, concentration, conflict resolution and so forth. We let the teenagers express their ideas and feelings, but we try to steer the conversation. They have to reach a point where they feel comfortable with themselves again. That’s what we are trying to teach them here.

My father is died. It’s very difficult for me. She lost her father and that trauma was the hardest for her in the war. And it’s nice that she had to say that to somebody, and these ladies are that persons. EB: How was your father killed? Grenade. EB: When? 1992. EB: But that happened four years ago. You haven’t spoken to anybody about that? No, I speak with people, but in a different way. That was not enough for her. EB: What’s the difference? She thinks there is a limit, a border between her and the others. But it was not happening here and she was not in the situation to talk to her mother about that problem. EB: Why not? It’s too painful for her mother. The counselors here told her that the best way is to talk to her mother about it, and she’s trying right now but it’s very hard. That conversations are very, very short. It’s difficult for her to talk to her mother about that. EB: But speaking here to these women, then it’s no problem? No, it’s not. It’s very nice to me. She feels different here. She feels so nice here. She thinks she can say everything that she feels here.

Mental health experts in Sarajevo say the strains that 17-year-old Sajina and her mother are experiencing are quite common nowadays. The war put enormous strains on families. Not only are parents and children are having trouble discussing the events of the four years, communication is also breaking down between parents and in Sarajevo, for instance, the divorce rate is soaring. According Dr. Nevrita Ovuka of the counseling center, many adults are simply unwilling to accept that they too may need some help.

Parents also really need counseling. Let me just tell you an anecdote. At one of the schools where we were counseling children and teenagers, we also invited the parents to come. They didn’t want to because they thought it was a waste of time. They’re afraid people will say they’re crazy. Counseling is a new concept for many parents, and that’s a problem.

Parents speak furtively of some of the odd precautions they took during the war: like the couple with two teenage daughters who decided at the beginning of the siege of Sarajevo never to go out. For more than 3 years, whenever they went outside, they always made sure at least 15 minutes separated them…just in case. The detail may seem insignificant, but it highlights how deeply the war and the siege affected people’s daily lives. Now that peace has returned, says Dutch MSF consultant Guus van der Veer, people just want to get on with their lives.

People in this country are less used to psychological forms of help than in other countries. So there is a need for help, but whether these people will be able to request assistance from psychologists is another matter. At the moment, I think that the counseling centers we have here in Sarajevo have quite a lot of work to do. But they seem to be coping with the demand for the moment. As soon as there is more attention in the media for the psychological consequences of war trauma, I mean the local media here, maybe the amount of referrals will grow. There may also be a bottleneck because not all physicians and also not all psychiatrists in this country know what counseling is.

In Tuzla, the charity Norwegian People’s Aid initially had similar difficulties in getting women to seek therapy. Dr. Larissa Kovakovic says a great deal of time and energy has gone into trying to eliminate the taboos surrounding psychology.

The most important thing is to stimulate women to ask for help. The longer they wait, the harder it is for us to help them. When we started this program two years ago, the only way for us to reach people was to go to refugee centers. But later on, especially when we started advertising, the number of people coming to ask for help increased.

To try to lower the barriers as much as possible, Norwegian People’s Aid also set up a 24-hour hotline. More and more of the outpatients at the Tuzla Women and Children’s Center actually first contacted the hotline. Even though the center was originally designed to provide psychological assistance to women who’d become refugees or displaced persons, it was soon decided to expand the center’s activities and include, for instance, basic literacy classes. The women – many of them from rural areas – can also take classes in English, German, hair dressing, tailoring and carpet weaving.

She made carpets before the war. EB: So why is she here at this particular course? Is it simply to earn some money? This organization is helping me to survive. I lost a lot of family members in the war, especially when Srebrenica fell. I think this is the only way for me, to be here, to work here and to forget what happened. That is my new life here. EB: Do you have any family members left? Your husband, your children? I lost my husband 10 years ago. My son was taken as a prisoner, and he spent a long time in a Serbian concentration camp. He was beaten. He was tortured, and he died. I lost some relatives of my extended family, and I’m alone. I have nobody, only adopted child, foster child. I’m more than satisfied with my job here because nobody in my family is employed. This work helps us to survive. This is my only resort I have in life. And I’m a woman who came from the village. I’m a peasant woman, and I simply didn’t get used to live in a town. I’m afraid of big buildings because I had always small house, and this house reminds me of the house I had. So working here is a relief for me.

This is our second room for female psychotherapy. We have a television and video recorder here for their relaxation time although it’s now empty room. We already had two groups here this morning and one is about to come at 1 o’clock when our driver will pick them up and bring them here for another treatment.

While the women attend therapy or follow courses, they can leave their children downstairs in the day care center. The literacy and handicraft courses are a key element of the Norwegian People’s Aid program, but they must go hand in hand, believes Dr. Larissa Kovakovic. Many of the women here, she says, are from Srebrenica and other areas where horrible crimes were committed during the war. As time goes on, Dr. Kovakovic and many other counselors are finding that the therapy sessions are becoming an even greater strain.

To be honest, I’m finding it more and more difficult to listen to the women’s stories day after day. The other members of our team feel very much the same. I mean, these women tell us about their children and babies who were slaughtered before their very eyes. Some of the women had their children taken away from them in Srebrenica. I’m shocked by much of what I hear. I find it painful to listen to these stories, and it gets harder as time goes on. We try to do things to support our counselors. We organize dinners, provide relaxation and try to organize courses abroad from time to time. We don’t have the resources, but we do what we can to help prevent burnout.

Peace returned to Bosnia over half a year ago, but the demand for psycho-social therapy is constantly growing. Already, counseling centers are having trouble providing treatment to everyone who requests it. And more and more people are likely to turn to therapy as they discover that they’re unable to cope with their traumas on their own. Mental health experts feel that it’s essential that everyone who was traumatized receive some sort of therapy. They point to research which shows that if trauma victims are not treated, they could pass on their symptoms to their children or even their grandchildren. Dr. Milan Kosuta of the World Health Organization has seen in his own practice how trauma is passed from one generation to the next.

I was asked to visit one family. And in this family, the son was very, very aggressive towards his mother. Later on, she told me that she had survived the holocaust. She was Jewish origin. And after several conversations, she and me realized that for years she gave him messages actually what she experienced during the Second World War as a victim. And she never had a chance to elaborate this, what happened to her. She developed a need to have aggressor in her life. And she simply sent the messages to the son, and he was brought up in terms to be aggressor.

The authorities and mental health experts are concerned that the tens of thousands of men on all sides who fought in the war will be particularly susceptible to passing on their traumas to the next generation. Many of the soldiers are now being demobilized and find themselves without a job, without many prospects and with all too many bad memories. Emir is one of them. He’s a physiotherapist by profession in his early 30s. He joined the Bosnian army when the war broke out but soon became disillusioned.

In the beginning, we had something. But after a few months, we don’t have anything: no arms, no food, no electricity, no water. It was horrible. I was wounded three times in the first war: ’92-’93, three times. I was wounded in the leg, head and breast, in the hand. EB: Were many of your friends killed? Yes, yes. After everything and after four years, I cannot see anybody. Everything was for nothing because everybody only lose. EB: What did you lose? I lose everything. I lose half of family. I lose my job, health. EB: Do you feel angry or bitter? No, no. What I feel? I feel depressive, also sometimes angry, also sad, also, I don’t know, only bad.

Emir and others who suffer from severe trauma will need more than a lot of time and intensive counseling to recover. They also need stability and peace.

I think that it is impossible to help if there is uncertainty. I think the people will encapsulate the traumas and traumatic events and the way how did they experience and the way how did they cope. I don’t see any hope if uncertainty will continue. The most terrible, the most horrible for this situation is uncertainty.

According to Dr. Kosuta of the WHO, one of the ways to remove some of the uncertainty is to make sure that those who committed serious human rights violations be tried by the International Tribunal on the former Yugoslavia in The Hague. It won’t heal the wounds of the 700.000 severely traumatized people in Bosnia nor the 700.000 others who also need therapy. But it will help slay some of the demons which are haunting them.

It is for sure impossible that all the criminals can be punished. We cannot expect this. But this is not so important for the society. What is important for the society is that on symbolic level that those who were responsible – and there are not so many people who were responsible for these crimes – that those people must be brought to the court. This can have enormous healing effect. Even this is not ideal. I don’t think that if you punish aggressor that you will recover. It is not, but without punishing the aggressor, it is almost impossible to recover.

“Slaying the Demons” was produced and presented by Eric Beauchemin. Technical production: Peter Bos. This has been a Radio Netherlands’ presentation.