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Economic Sanctions, Health, and Welfare in the Federal Republic of Yugoslavia, 1990 -2000

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Foreword
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 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. The study was led by Richard Garfield RN DrPH, Clinical Professor from Columbia University in New York and Visiting Professor at London School of Hygiene and Tropical Medicine in London. Dr. Garfield is a specialist in assessing humanitarian conditions among civilians with extensive experience in sanctions-related assessments in other countries through the 1990s.

This study is primarily a tool for vulnerability assessment and programming in FRY. It should also contribute to wider understanding of the complexity of the analysis of sanctions impacts. Although all sanctions against FRY were lifted by early 2001, the humanitarian impact of sanctions will most likely continue for some time to come. 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.

As an inter-agency endeavor the study greatly benefited from the information and expertise shared by our colleagues from the UN in FRY, as well as experts from the FRY and Serbian Government, our NGO partners and numerous local experts. I would like to express my appreciation and gratitude for their cooperation.

Steven Allen
UN Humanitarian Coordinator/Resident Coordinator a.i.

1. Summary

The republics of the Federal Republic of Yugoslavia (FRY)experienced many social and economic threats during the 1990s. Among these were economic sanctions imposed by the United States (US), the European Union (EU)and the United Nations (UN). This report documents changes in living conditions in the FRY through the 1990s and identifies the extent to which economic sanctions contributed to worsened health and well-being. Though the threats were many, humanitarian damage attributable to sanctions was limited. We examine the resources, resilience, and adaptations that prevented worse humanitarian damage from occurring. Suggestions are made to assist the FRY to recover following sanctions and recommendations to improve humanitarian protections during future economic sanctions. This report presents the views of the author and not necessarily those of collaborating individuals or organisations.

In 2001 the FRY consisted of Republic of Serbia and Republic of Montenegro. Within Republic of Serbia, besides Central Serbia, there are two autonomous provinces, Vojvodina and Kosovo &Metohija. The only unambiguous and uncontested administration of the FRY is the Republic of Serbia territories of Central Serbia and autonomous province of Vojvodina. During the 1990s Slovenia, Croatia, Bosnia and Herzegovina and Macedonia became independent of the former Yugoslavia.

The last sanctions against the FRY were lifted in January 2001. The measures - ranging from a visa ban to trade and arms embargoes - were established first to discourage warfare, then to bring compliance with the Dayton Peace Accords of 1995, and finally to oppose the actions of the Milosevic government in Kosovo. But they also hindered economic recovery, encouraged a burgeoning grey economy and black market and restricted access to essential humanitarian goods. Estimated GDP declined from $3,420 per capita in 1989 to $1,390 in 1993. Between 1993 and 1999, more than half the people were impoverished, unemployed, refugeed or displaced. In all, humanitarian assistance to Serbia in 1990s probably totalled between US $5bn and $10bn. In per-capita terms, this level of assistance was perhaps unmatched in any other recent crisis.

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. The cost of fuel increased three-fold, crippling the energy sector and leading to frequent power cuts and fuel shortages, leaving many homes without heat. The regime politicised energy supplies by making less coal and oil available to communities that voted against the Milosevic government in 1996. In turn, the European Union supplied 34 opposition communities in its 'energy for democracy 'programme. Though amounting only to small energy stocks, the confusion of political and humanitarian criteria in this programme made a considerable contribution to obscuring the human rights-related objectives of sanctions.

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 then 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.

After sanctions

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 uring 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.

Lessons for the future

While not part of the stated intentions of sanctions, cultural and intellectual isolation was one of its major impacts. Confusion about sanctions rules and the potential for discrimination against people in a sanctioned country are great. Sanctioning bodies should make clear that such isolation is not among their goals and work to facilitate communications, including mail and Internet, if they are permitted under sanction rules.

Sanctions committees of the UN and other international organisations have a particularly important role to play. Sanctions committees have established to judge which goods should be allowed into a sanctioned country. They could instead be given a more activist charge, to assure a 'humanitarian corridor '- assisting the country to acquire approved goods. A sanction committee should also help ensure that permitted goods can be purchased, and should encourage such sales during and after the sanctions period. These committees could also monitor humanitarian conditions, and identify and facilitate response to the needs of vulnerable groups.

The status of UN humanitarian organisations working in countries that are not currently UN members should be reviewed. The current arrangement of 'observer 'missions, which are limited in providing scientific information and technical assistance with potential humanitarian benefit, should be revised. It may require the creation of new norms for observer missions to avoid contributing to intellectual and cultural isolation.

Monitoring the humanitarian impact of sanctions should begin as soon as they are under consideration, and should continue throughout the period of sanctions. It is sobering that in Serbia well-trained professionals, using good data systems, believed that the major impact of sanctions was a rise in infant mortality. Not only was this not true, but infant mortality declined more in the FRY than in any other country in the region in the 1990s. At the same time, a rise in mortality rates among adults went unnoticed. Impartial monitoring by international authorities throughout the period of sanctions can draw attention to substantive problems, help identify vulnerable groups and facilitate a more effective response to the difficulties of those in greatest need, both during sanctions and during a transition period after they end.

The FRY case shows that monitoring should not only focus on humanitarian conditions, but also on the effectiveness of sanctions exemptions. Monitoring needs to be country-specific. The high level of obesity in Serbia, for example, renders traditional crisis measures of malnutrition insensitive to changes in living conditions. National-level monitoring should, wherever possible, be supplemented by local-level assessments. Monitoring should include not only outcome measures related to mortality, but also process indicators related to mental health, social cohesion, and identity. Such monitoring could increase the capacity of local communities to raise funds, set priorities, identify groups and individuals at greatest need and engage in local capacity-building to speed recovery. Rather than just one-time snapshots of the situation, assessments should be carried out periodically and multi-sectorally.

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