Years After the War, Veterans Relive Nightmares

By Nidzara Ahmetasevic and Merima Husejnovic in Sarajevo, Goran Jungvirth in Zagreb and Zelimir Bojovic in Belgrade.

Ivan J, aged 52, and Milan, aged 54, may well have fought each other in 1991. What they have in common is their past life in the same country and the war that brought them to the front lines.

Today, Ivan from Croatia and Milan from Serbia have other things in common: nightmares and a syndrome known a post-traumatic stress disorder, PTSD.

“The worst thing is dreaming about my friends being shattered to pieces,” Ivan explains. “At one stage everything was fine. The weather was sunny and we were playing card games… but a moment later there was shooting and explosions… and then we were carrying their shattered bodies wrapped in canvas.”

Milan’s traumas started shortly after he returned from the battlefields in Vukovar, eastern Croatia.

“On going back to my village, I realized that everything had changed and I was no longer the same person,” he says. “I see images of battlefields. I dream of running away, falling down and shooting. People are running and screaming. I hear grenades and bullets. Then I wake up and can hardly breathe.

“I dream of a friend being hit by a bullet from the back,” he adds. “As the bullet leaves his body through his stomach, it pulls out his internal organs. I am paralyzed by fear and just look at him. Being aware that he is going to die soon, he hardly manages to whisper: ‘Take care of my kids.’”

Experts believe many former soldiers in the 1990s suffer from PTSD, though the exact number is hard to estimate. Some assessments indicate that more than 30 per cent of war veterans in Serbia, more than 15 per cent of those in Croatia and up to 40 percent in Bosnia suffer from this syndrome. The high number in Bosnia reflects the fact that the war was most brutal and lasted longest there.

Sufferers say they do not get the care they require in any of the three countries. They say poor living conditions, a grim economic situation and frequent reminders of the past war make their conditions worse. The high number of suicides committed by former soldiers in those three countries highlights the serious nature of the problem.

Traumas that return each night:

Samir, 40, became a soldier in his early twenties. After his friend was killed, he lost faith “in everything”, he says. Today, lighting one cigarette after another, Samir suffers from insomnia, and when he does fall asleep, he sees images of the battlefield as it looked 17 years ago.

“When I go to sleep… it all comes back and I blame myself,” he said. “I sleep only a little and wake up tired because I have nightmares. Sometimes I do not remember them, which they say that’s a good thing. But, when I wake in the morning I know I had bad dreams.”

Repeat experience of war traumas is common among those suffering from PTSD, says Dr Alma Dzubur Kulenovic, a psychiatrist at the Stress-related Disorders Section at the University Clinical Centre in Sarajevo.

“They have nightmares, or traumatic dreams that are quite different from common dreams as the images are clear and perceptible; my patients call them movies,” she explains.

“Traumatic events reoccur. They feel as if they are present. They wake up and for a moment, don’t know where they are. They are looking for a gun, or hitting someone lying next to them, thinking that they are fighting for their lives.”

According to Zeljko Spiric, Chief of the First Section with the Psychiatric Clinics of the Military Medical Academy in Belgrade, about every fifth veteran in Bosnia has suffered from PTSD at one point or another. And more than a half of all veterans suffer from at least one psychiatric disorder, the most frequent ones being depression (22 per cent) and alcohol abuse (20 per cent).

Dr Spiric adds that many veterans get divorced and some become violent towards family members.
Milan Latinovic, assistant minister of Health and Social Protection in the Republika Srpska, says the situation is similar in the Bosnian Serb entity. There, the number of people suffering from mental problems and diseases is increasing.

“Certain consequences, such as suicide or work disability, are frequent in the case of these patients, which means that this disease and disorder are having a significant influence on the economic and social life in many communities,” Latinovic says.

Radomir Drobac, chief of the psychiatric section at Bjelovar County Hospital, in Croatia, has worked with war veterans for several years. He notes how people who experienced horrific events can “relive their traumas in short memories or nightmares”, adding that this represents one of the most common symptoms of PTSD.

“Further on, an emotional lethargy and isolation from other people can also develop, as well as a loss of joy, and avoidance of activities that remind the person of the trauma,” he adds. “They even often have suicidal ideas as well.”

An illness that is hard to prove:

In all three countries, former soldiers complain about the treatment they receive. Problems exist with the procedure proving that they suffer from PTSD, as well as the level of disability they are accorded on the basis of PTSD. The financial support they are entitled to is determined by the level of their disability.

The procedure to prove the existence of PTSD is complicated and often arduous. According to the Law on the Rights of War Veterans and their Family Members of the Federation of Bosnia and Herzegovina, “the circumstances under which the injury occurred (….) and manifested itself prior to December 23, 1997” are taken into consideration when determining the disability level.

Dr Dzubur-Kulenovic claims that PTSD can manifest itself at any time after the traumatic experience, adding that this can happen immediately after the event or up to 30 years later.

“Treatment is of the utmost importance. By treating individuals, we hope to cure society as a whole,” he adds.

Dr Dzubur-Kulenovic believes it is very important for PTSD sufferers to find employment, adding that the society should help demobilized soldiers through compensation.

“It is difficult to treat a man who loves his child when he does not have money to buy food for his child,” he says. “This man remembers his good life and then the four years he spent in trenches.”

Due to many cases of abuse and the large number of wounded and mentally sick veterans, the system by which disability levels are determined in Croatia is rigorous.

“During the process, which lasts for about three years, the veteran appears before the Disability Level Commission six times,” Dr Drobac of Bjelovar says.

Some sufferers, often former soldiers, have formed associations to make their lives easier and improve their rights. Zivot (“Life”), in Sarajevo, is one. Kerim Toholj, the association president, says that he is not satisfied with the way the authorities treat former war veterans suffering from PTSD.

“People used to have jobs and everything else and now they have nothing,” he says. “They sit in corners, watching people who did not take part in the war who have jobs and drive expensive cars… They become frustrated,” Toholj adds.

Toholj says the establishment of the Federation Association of War Veterans, who were medically treated for PTSD, linking all the various cantonal associations, was “the only way” for them to start fulfilling their rights.

He also says that whether or not they fought one another in the 1990s all the PTSD sufferers’ associations in the country should now unite.

“The war is over. We have the same problems now,” Toholj says. “People should understand that we should fight together to get something in our life.”

Routes to recovery:

However, Dr Dzubur Kulenovic says help is already available and easily accessible to patients in all three countries.

“All they have to do is ask. However, people often find it easier to see their doctor if their arms or feet ache than if they have some mental problems, including PTSD,” he admits.

Immediately after his return from battle Milan tried to find help by approaching doctors. However, no doctors then recognized PTSD symptoms.

It was only after 2000 and his visit to the Military Medical Academy, VMA, where he spoke to psychiatrist Zeljko Spiric, that he managed to improve his mental health a bit. As of 2005 he has received regular therapy at the VMA and is feeling much better now.

“The help I am getting now is good for the time being, but there are times when the symptoms worsen,” Milan says, adding that it is hard for people with PTSD to live in small towns, as people do not understand the disorder.

”Some people think I am not normal, which I find hard to cope with,” he adds.

Samir is in the same position. After five years of treatment, he still has to keep this information from other people, as he “cannot talk about this to them”.

Nevertheless, his therapy has helped him to curb feelings of rage, which occur from time to time, as well as his urge to enter into physical conflicts with other people. “Thanks to the therapy I manage to find the strength to tell myself not to do something; I can control myself,” Samir says.

Samir has been under therapy since 2004, when he was diagnosed with chronic PTSD with permanent changes of personality and severe depression. He told Justice Report that having PTSD had affected his family life.

“This is the worst thing, that I would yell at my child,” he says. “There were situations when I was not able to control myself. I even tried to physically get even with my wife. I know other people have had similar experiences, because we talk about that.”

Members of the Zivot Association who have often experienced similar problems, also try to overcome them through occupational therapy, such as making vases using recycled glass.

“There was one man who attempted to commit suicide twice but who has found peace here,” Toholj said.

“He thought he had become a burden to everybody but then he came here and started working with us. All these people are looking for some kind of relief and occupational therapy is the best therapy for them.

“We should not let these people be alone and relive those tragic events,” Toholj says.

Nidzara Ahmetasevic and Merima Husejnovic are BIRN – Justice Report journalists in Sarajevo. Goran Jungvirth is regular correspondent from Zagreb. Zelimir Bojovic is Belgrade correspondent for Radio Free Europe and BIRN.