2001 SCG: Economic Sanctions, Health, and Welfare in the Federal Republic of Yugoslavia 1990-2000
Author: Garfield, R.
From 1991 to 2001, the Federal Republic of Yugoslavia (FRY) was subject to a wide range of economic and diplomatic sanctions. It was widely assumed that the sanctions severely and negatively affected the living conditions of the population, and the social infrastructure of the country. In truth, however, it was never clear how, to what extent, or in what ways such effects occurred. As a consequence, much debate took place on the issue without the benefit of quantified or reliable information on the sanctions' impact. For this reason, UN humanitarian agencies working in Belgrade launched an inter-agency assessment study, co-funded by UNICEF and OCHA, to evaluate the impact of sanctions on the humanitarian situation in FRY.
Purpose / Objective
This study is primarily a tool for vulnerability assessment and programming in FRY. It should also contribute to a wider understanding of the complexity of the analysis of the sanctions' impacts. The results of this study should help orient international efforts to ensure that assistance is appropriate and effective. The study also has important implications for the ways that multilateral sanctions can be instituted in the future to reduce humanitarian damage. In view of great increase in donor interests towards FRY since the democratic change occurred in October 2000, this study will be useful in pointing toward priority areas for not only humanitarian but also transitional assistance.
This study uses an approach proposed in 1998 based on indicators in five major areas: public health; economics; demographics, indicators of population living standards and movement (including refugees and internally-displaced people); governance and civil society; and indicators of coverage and dependence on humanitarian activities. As this study began nine years after sanctions were initiated, it was possible to collect baseline indicators only retrospectively. A wealth of data was available for baseline and ongoing monitoring. Five main criteria were used to specify indicators: data availability, replicability, relevance to vulnerability, effects of sanctions, and quantifiability.
The following sources were utilised:
- Semi-structured interviews during August, October, and November 2000 with people in UN agencies in FRY, local and international NGOs, governmental employees responsible for humanitarian programs before and after the October elections, and university and think-tank researchers
- Focus groups were held with high school students and psychologists in Valjevo, FRY in August, with public health workers of Belgrade in October, and with academics in Belgrade in November
- Statistical annuals of the governments of FRY and Serbia, and unpublished data from government sources for the most recent years
- Data from representative household surveys carried out by the World Food Programme, World Health Organisation, and UNICEF mobile teams during 1996, 1999, and 2000
- Reports from interdisciplinary field research teams who visited areas believed to have the most vulnerable groups and institutions since the 1999 NATO bombing campaign
- A wide variety of reports from Yugoslav researchers and UN organisations
- A two-day consultative seminar in November, bringing together program participants and officials in eight priority topical areas
There was a wealth of information to draw upon. Close to 100 relevant, original documents were utilised and more than 40 meetings with about 70 people were held. Nonetheless, many types of information on subtle indicators of psychological and social status were available only as individual impressions or hearsay.
Key Findings and Conclusions
The humanitarian impact of sanctions--
Economists estimate that the impact of sanctions on the FRY economy was less severe than were the secession of 4 of the 6 republics of the former Yugoslavia, central government mismanagement, and the destruction inflicted by NATO bombings in 1999. Loopholes and inadequate enforcement of sanctions also mitigated their impact. They were, nonetheless, severe enough to retard economic recovery.
In principle, humanitarian goods were exempt from the sanctions imposed on the FRY. In practice, such goods were limited in many ways. Financial sanctions interrupted or froze outside sources of support, including remittances from family members abroad, pension payments, and funds for private voluntary agencies. Even international humanitarian organisations were affected. In 2000, for example, the ICRC and ECHO arranged to fund the local purchase of 4,000 tons of wheat for the WFP in Belgrade. Funds and approval went from Brussels via Geneva to a bank in Germany, where they were frozen. After a month's delay, the funds were re-routed via a bank in another country and only reached Belgrade because that bank failed to institute sanction controls.
Restricted cultural and social contacts led to intellectual and scientific isolation. Professionals were barred from international travel, denied scientific information, cut off from international research funding, shunned by professional organisations and excluded from the international mail system. Many of the people most capable of responding to the country's humanitarian needs were thus limited and discouraged from acting. The effects of this isolation may take more time to correct than the economic blows of the 1990s.
Faced with sanctions and other economic threats, people adapted. The gradual rise in importance of the private sector in all areas, including education and health, weakened the social fabric, encouraged disrespect for social norms, and created inefficiencies and imbalances in the economy. Until the 1990s, the state provided cradle-to-grave social benefits, including a well-developed health care system with few user fees. By the end of the 1990s, most medicines and medical procedures were purchased privately, leaving some IDPs, refugees and other vulnerable groups at a distinct disadvantage. Survival depended increasingly on political or family connections, charitable help from humanitarian organisations or black-marketeering. Drug use, domestic violence, and the proportion of young people reporting psychological or emotional trauma rose.
The impact of external sanctions was magnified by the Milosevic government, which imposed its own internal measures to limit access and increase profits for government-related importers. Thus, while essential drugs including insulin and basic antibiotics were in short supply, a smuggler's market meant that certain expensive non-essential and 'luxury' products were widely available. The government's internal controls on access to, and the price of goods - including humanitarian goods - were perhaps as important as the international limits imposed by sanctions. These restrictions allowed access to basic entitlements and opportunities to be abused, thus worsening economic and social discrimination. Rather than responding to the needs of vulnerable groups, sanctions thus contributed to vulnerability among women, those living on pensions, those not well connected politically, and those earning only salaries in the formal sector of the economy.
The bureaucracy of sanctions--
The UN sanctions committee authorised the delivery of humanitarian goods, providing a mechanism by which medicines and related products could be imported. The procedure for requesting an exemption was complex, confusing and time-consuming. The committee was quickly overwhelmed with the volume of requests, and lacked the expertise to assess them. Even requests from the ICRC and the WHO sometimes failed to elicit timely responses. Up to half of the funds available for medical imports could not be used because of the lack of timely approvals from the sanctions committee.
WFP and UNICEF carried out important humanitarian assessments and provided services to needy groups. Other groups with predominant mandates in cultural or economic development were far more limited. UNDP had only an observer mission in Serbia until 2000, and UNESCO and the World Bank never fielded missions. WHO could only field a humanitarian assistance mission as its constitution does not permit full technical offices in countries that are not currently members of the UN. This prevented assistance for health systems reform that might have improved the appropriateness or efficiency of health programs.
These problems paled in comparison to the unanticipated impact of the lifting of UN sanctions in 1996. It was widely assumed that this would mark a return to "business as usual." Instead, the result was often no business at all. Firms had withdrawn their representatives from the FRY during sanctions and sold goods under the authority and legal protection of the UN. The sanctions committee used FRY funds frozen in international accounts to pay for many medical imports. Without these guarantees and supervision by the sanctions committee, firms in the FRY ran up bad debts and lost the confidence of sellers. With a smaller and unstable market after sanctions, continued instability in relations with the FRY, and on-again, off-again sanctions among the states in the region, many firms believed it economically or politically too risky to sell their goods there. Ironically, the end of UN sanctions resulted in decreased access to imported medicines. There is insufficient awareness of the continuing consequences of sanctions, and of the need for the continued facilitation of trade to protect supplies of humanitarian goods.
Intellectual and cultural isolation--
While not part of the stated intentions of sanctions in FRY, cultural and intellectual isolation of the country was one of its major impacts. Sanctioning bodies, however, should make clear that such isolation is not among their goals and work to facilitate mechanisms, including mail and Internet communications, and sales of humanitarian goods, which are permitted under the sanction rules.
The status of UN humanitarian organisations working in countries that are not currently members in good standing of the UN general assembly should be reviewed. The current arrangement of 'observer' missions, which do not officially permit the sharing of scientific information or the provision of technical assistance with potential humanitarian benefit, should be revised. It may require the creation of a new kind of observer mission status that does not contribute to the intellectual and cultural isolation of the target country.
Improving the administration of humanitarian protections--
Sanctions committees in the past have been set up to judge what goods should be allowed into a sanctioned country. The UNSC could instead play a proactive role by setting up parallel mechanisms to assure a "humanitarian corridor" to assist in the acquisition of approved goods, including intellectual goods. Such a group should also be proactive to assure that permitted goods can indeed be acquired, and take action to prevent the discouragement of such sales during and after the period of sanctions. It can facilitate monitoring of humanitarian conditions and help identify and respond to the needs of vulnerable groups. These recommendations are consistent with the recommendations of the informal Working Group of the SC to increase secretariat capacity to monitor and implement humanitarian protections under sanctions.
Monitoring humanitarian impact--
Monitoring of the humanitarian impact of sanctions should begin as soon as sanctions are contemplated, and continue throughout and following the period of sanctions. It is sobering that even well-trained professionals working with good data systems in the FRY believed that the major impacts of sanctions were a rise in infant mortality and an increase in malnutrition among young children. Not only were these popular views untrue; infant mortality declined faster in the FRY than in any other country in the region! At the same time, a rise in mortality among older adults and a growing epidemic of cardiovascular illnesses went largely unnoticed. The greatest problems of food availability did not occur among young children, but among pensioners in cities, hospital patients, and some refugees and IDPs. Impartial monitoring by international authorities throughout the period of sanctions can help reduce such misinformation, draw attention to real problems, help identify vulnerable groups, and facilitate a more effective response to problems among those in greatest need, both during sanctions and after they end. Such monitoring should be informed by the experiences of other countries to focus on those humanitarian indicators that may change in a short period of time, at a country's level of social and economic development. This will more often include process indicators of access to expected goods and services than disaster-related outcomes of child malnutrition and mortality.
As the FRY case shows, monitoring should not only be focussed on humanitarian conditions, but on the effectiveness of sanctions exemptions as well. National level monitoring should be supplemented, whenever possible, with support and encouragement of local level assessments. The latter can strengthen the ability of local communities to raise funds, set priorities, identify those groups and individuals at greatest need, and engage in local capacity building to speed recovery. Assessments should be multi-sectoral and be carried out periodically to identify trends in the population rather than just one-time snapshots of the situation.
Some may wish to re-establish the system of comprehensive state medical and social services that existed prior to the 1990s. Such a backward-looking approach is a poor basis for planning today. Priorities in the social sector should instead be the training and retraining of health and education staff to catch up to standards of practice in 2000. In the health sector, for example, this would include a shift in attention from curative to preventive and promotive actions health and social welfare practices.
What can be done now in FRY to assist the humanitarian situation:
- Improve water quality and availability
- Promote breast feeding
- Public health interventions
- Import and other controls on drug supplies
- Information management
- Prioritizing programs
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