KOVIN, Yugoslavia -- Serbia's mentally ill -- some of its least responsible and most helpless citizens -- are paying a heavy price in the penalties against their country for its aggression in Bosnia.
Before the collapse of Yugoslavia, the mental hospital here was idyllic. It was set in a vast parkland. Therapy was far advanced.
But these days, Kovin doctors say they have been forced to return to the methods of the last century, with patients routinely being tied to their beds and locked in small rooms with bars on the windows to punish aggressive behavior.
"Accidents" are frequent: They include a man castrating himself with glass punched out of a window, another man gouging his own eye out, one woman strangling another after a quarrel and yet another committing suicide. Women are forced to shave their heads because of lice. There are many cases of tuberculosis. The townsfolk of Kovin are now afraid of the mental patients they used to welcome in their midst.
The reason for the dramatic change is the imposition of United Nations sanctions on Serbia 16 months ago for its role in the Bosnian war. Medicines used to calm and treat the patients are now unavailable. Although medicines are not subject to sanctions, the hospital cannot afford foreign medicines ,and the local drug industry is unable to import many raw materials. Food and basic necessities, including heating oil, are also in desperately short supply. Officials say patients have lost 20 to 60 pounds over the past year. They predict that as many as a quarter of the 1,000 inmates will die this winter.
The most distressing ward is where severely disturbed male patients are kept. Even on the approach to the battered building, the stench of waste is overpowering. "We no longer have disinfectant, and the men continually wet the beds," one of the nurses explained.
Inside, the men are kept locked behind bars.
"Cigarettes, cigarettes, give us cigarettes. We haven't had cigarettes or coffee for months," pleaded one inmate.
The locks on many of the windows had been broken off, sending a chill autumn wind whistling through the unheated wards. The mattresses on the rusty metal beds were just mangled pieces of foam with no covering.
In several wards, men were tied by both wrists to their beds because they had been aggressive. One young inmate, 22-year-old Dinko Nikolic, had been manacled because he attacked his mother when she came on a visit, pleading with her to take him home. Across the packed room -- filled with babble, and one man neighing like a horse -- another inmate was being tied down after attacking another patient.
The director of the hospital, Dr. Dusan Jagodic -- a soft-spoken man who clearly cared deeply about the plight of his patients -- painted a desperate picture of the state of the hospital. He said he used to receive an annual $500 per patient -- "a minimum, but it was enough." Now he gets the equivalent of $37. He said the poverty is so dire that there is no longer any detergent or hot water to wash laundry. The patients eat mostly beans and almost never get meat or fresh fruit and vegetables.
"We have almost no medicines -- not even to cover 10 per cent of our needs," he said. "Not even antibiotics and vitamins. Our patients are so disturbed and badly fed they are destroying our ** facilities, the furniture and their clothes. The people working here have reached the end of their physical and emotional resources. They are also poorly paid and have little motivation to work."
He spoke proudly of the past, when a broad program of occupational therapy meant patients spent much of their time painting, singing, knitting -- and even held exhibitions. Now, he said, all the staff could do was to "keep them alive, and soon we will not even be able to do that."
He said relatives frequently used to visit and bring parcels. But visitors are now rare since most Serbs are living on the verge of poverty themselves and cannot afford to buy extra food and provisions. Many also used to come from long distances but can no longer afford bus and rail tickets.
The plight of the Kovin mental hospital is shared by Serbia's five other mental hospitals, which care for 4,600 patients in total. But it also echoes the poverty into which the rest of Serbia has been plunged since the imposition of sanctions. Unemployment stands at more than 60 percent. Shop shelves are empty. Official estimates say Serbia has only a quarter of the heating oil it needs this winter. Prices are 500,000 times what they were last January.
Although the Kovin mental hospital and many other institutions are in desperate need of help, U.N. officials say privately that donors simply do not want to give any aid to the Serbs. "We meet a blank wall when we ask. Potential donors say, 'They started the war, they should suffer the consequences.' It's as simple as that," said one U.N. official.
She said that although the U.N. High Commissioner on Refugees has 10,000 metric tons of aid in storage in Serbia, donors say it must be used in Bosnia. "It is people in the mental institutions and other social cases that suffer the most," she said. "In many ways, they are worse off than refugees, who at least get a small amount of aid -- these people get nothing, and nobody wants to help them."
Staff members at the Kovin mental hospital said they could not comprehend why there was no interest in the patients they could see dying before their eyes. Like most Serbs, they believed that the sanctions have been unjustly imposed and blame the outside world.