Geopolitics, Paralysis and Health Policy: On the Implications of the Dayton Peace Accords for Bosnia & Herzegovina’s Transplantation System

ABSTRACT

More than 25 years after Dayton Peace Accords (DPA), the shadows of the Yugoslav and of the subsequent construction of independent states based on ethnic division still looms over Bosnia & Hercegovina (BiH), its population, and the everyday life of people. The construction of its two major political entities – the Federation of Bosnia & Hercegovina (FBiH) and the Republika Srpska (RS) – is reflected in the health care system where it unfolds highly detrimental effects. Here, we can witness the severe impact on BiH’s ability to establish an effective system for organ donation and transplantation. Based on a series of 26 interviews with patients, patients’ organisations, clinicians and politicians BiH and its neighbours, the article identifies obstacles in clinical practices, post-Dayton bureaucracy as well as mistrust and corruption as major themes articulated by our respondents, ultimately imprisoning them in a Post-Dayton paralysis. Desperation amid the deadlocked structural conditions and contemplating alternatives ways of getting access to transplantation seem logical outcomes of a system widely regarded as deficient. This exemplifies the prosaic legacies of wars and the fragile state of BiH’s politico-administrative system.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. The study was carried out within the framework of a Collaborative Research Centre focusing on Processes of Spatialisation under the Global Condition (SFB 1199, https://research.uni-leipzig.de/~sfb1199/). As of 2018, 133 interviews with professionals in the field of organ donation and transplantation from more than 30 European countries were conducted under the auspices of the project „Cross-border assemblages of medical practices“ (PI: J. Miggelbrink) as part of Collaborative Research Centre 1199 „Processes of spatialisation under the global condition (Funding: German Research Foundation / DFG).

2. The Brčko District shows a less polarised picture, with about 34,5% Bosnian Serbs, about 42,5 Bosniaks and a little more than 20,5% Bosnian Croats.

3. For a detailed account of the creation and subsequent affairs in the Brcko-district, see (Jeffrey 2006), Dahlman and Ó'Tuathail 2006.

4. This is seen to have been tackled in the Republika Srpska at least to some extent given its more centralised political system (International Crisis Group 2010, 13).

5. During our conversations, the precise name of the respective company was explicitly stated. Yet to prevent spreading potentially false allegations, we chose to omit the name, yet maintain our perspective of describing how clinicians and patients in BiH rationalise and explain the state of affairs in transplantation medicine in BiH.

Additional information

Funding

Funding for this study was provided by a grant from German Research Foundation (DFG) under the auspices of the Collaborative Research Centre 1199 ‘Processes of Spatialization under the Global Condition’ at the University of Leipzig, sub-project B05 ‘Cross-border assemblages of medical practices’ (2016-2019).