ࡱ> vxstuqqbjbjt+t+\AA]     """66668n\L6T > (f f f f f f SSSSSSS$UWnS"f f f f f S""f f f  "f "f S66""""f S * J""Sf ta66jhRMinority Elderly Care SUMMARY OF THE COUNTRY PROFILE: Croatia rpd Barth A General context of Ethnic Minority Elders in Croatia Croatia became one of most attractive Central-East European countries for immigration in the late Austro-Hungarian Monarchy (19th century) because of its richness in natural resources, developing industry and trade, on one hand, and the dynamic emergence of its civil society, on the other. According to 1910 census, Croatia was a truly mixed (multiethnic) society with the share of 41.8% Croats, 24.% Serbs, 13.6% Hungarians, 14% Germans and Austrians, 2% Czechs, 2% Slovaks, and 5% of other ethnic groups in the total population of some 4.5 million inhabitants (Erdlyi, 1918). After the First World War, the country became one of constituent parts of Royal Yugoslavia (1918-1941), along with Serbia and Slovenia in retaining much of its multiethnic makeup. After the Second World War, in 1945, Croatia became one of six republics of the Socialist Federative Republic of Yugoslavia all until it declared independence along with Slovenia (December 1990). As part of former Yugoslavia, Croatia has remained a free land for large-scale population movements in terms of both immigration and emigration. During the 1960s and 70s large masses of both Slavic and non-Slavic ethnic groups settled in Croatia, mostly young adults, as labour force immigrants (Albanians, Greeks Hungarians from Vojvodina etc.). As of today, these groups still shape the ethnic map of Croatia, of whom great proportions are elderly by now (aged 55 or more). In 1981, Croatia was home to as many as 4.6 million residents of whom only some 75.1 per cent considered themselves as Croats. The rest of the population declared themselves either as a member of a national group group, and there existed over sixteen such groups, or declared themselves Yugoslavs or stayed undeclared on the matter of national/ethnic affiliation in using the constitutional right to do so (Article no. 170 of the SFRY constitution from 1974). In 1981, far the largest national-ethnic-minority (?) group were the Serbs (345 thousand people), followed by Hungarians, Italians, Muslims and Slovenes as the next most sizeable historic (indigenous) minorities with over 20 thousand members each, according to 1981 census. However, to understand the political context of ethnic minority in present-day Croatia and other successor states of former Yugoslavia, one has to accept the rather peculiar historical fact that minorities had no legal status neither in royal- nor in socialist Yugoslavia. There were national groups with claimed equal status and rights, hence all called citizens of Yugoslavia. On the other hand, paradoxically, there was always the pressing national question (nacionalno pitanje) on the agenda of every-day politics, which meant nothing more but a coversheet for claimed rights of a mainstream group (majority) regarding self-determination and supremacy over all other national groups (eventually called minority) on a given territory, such as Serbs vs. Albanians in Kosovo (Korsika 1989). Consequently, none of the successor States of the former Yugoslavia provides a definition but a list of recognised national groups (now called national-ethnic minorities), which are more or less arbitrarily drawn, and almost always leave some groups outside the minority protection framework. For instance, the Croatian Constitution listed only seven minorities until 2000, and now lists sixteen of them. In Slovenia, only Italians, Hungarians and Roma are recognised as minorities, and Bosniaks not. The current FR Yugoslavia does not recognise Croats, Vlachs (Aromanians), Sandzak Muslims and Roma as minorities. And finally, none of the Constitutions of B&H entities, i.e. the Federation of B&H and Republika Srpska (RS) names any minority, even as recognised ones, but all them lumps together in an imaginary category of others. B Demographic Patterns Age structure Much alike many populations in Europe, the population of Croatia found itself in the process of rapid ageing in the second half of the last century. According to recent estimates (Lang 2001), the share of persons of age older then 65 years makes about 13.1% of the total population in present-day Croatia. This would suggest that the population of Croatia is younger with only some 3 years as compared with the average of EU-member and similar West European countries (15.6%, n=17 countries), and older by 3 full years then the average population of EU-candidate countries (10.4%, n=13 countries). In short, the population of Croatia gradually shall arrive to the cluster of oldest populations in Europe, preceded by Finland, Portugal and Switzerland (Canetti et al., 1997/ Dank 1998). The following table shows this trend of ageing of Croatias population since 1953 until the last available population census (in 1991). Table 1. Proportional age distribution of population in Croatia from 1953 to 1991 (%) Age cohort1953 census1961 census1971 census1981 census1991 censusTotMFTotMFTotMFTotMFTotMF0-1427.029.025.327.228.925.622.623.921.520.922.219.819.420.418.315-6466.065.066.865.364.965.667.267.666.865.967.965.967.569.566.765+ older7.06.07.97.56.28.810.28.511.712.29.914.313.110.116.0Total100100100100100100100100100100100100100100100Source: 1999 Statistical Yearbook. Central Bureau of Statistics. Zagreb, October 1999. Table 5-7. (p. 83). Ethnic Minority population in Croatia The last reliable statistics one might count with regarding the ethnic map of Croatia, is the 1991 census data show below (Table 2), where ethnic-national groups were obtained on the basis of citizens self-declaration (preferred affiliation), as the sole criteria. Table 2. National-ethnic makeup of Croatias population, according to 1991 census Ethnic-national groups (ranked by size)Number of personsShare in total populationCroats373635678,10%Serbs a58166312,16%Bosniaks (formally Muslims)b434690,91%Slovenes b223760,47%Hungarians a223550,47%Italians a213030,45%Czechs a130860,27%Albanians b120320,25%Montenegrins b97240,20%Roma a-b66950,14%Macedonians b62800,13%Slovaks b56060,12%Ruthenians a32530,07%Germans a26350,06%Ukrainians b24940,05%Rumanians b8100,02%Russians b7060,01%Poles b6790,01%Jews a6000,01%Bulgarians b4580,01%Turks b3200,01%Greeks b2810,01%Austrians a2140,00%Vlachs a220,00%25. Other ethnic-national groups a-b30120,06%Undefined groups26.Yugoslavs1060412,22%27. Undecided733761,53%28. Not ascertained (NA)629261,32%29. Regional affiliation (identity)454930,95%a) Historic indigenous ethnic-national groups since the 19th century or before. b) Non-historic ethnic-national groups mainly settlers to Croatia between the two World Wars. Source: Population census 1991 Sourcebook of national groups by residency in Croatia [Croatian]. Zagreb (1992), pp. 42-215. 3- Settlement patterns As far as urban/rural residency is concerned, the next table displays the split both for the total population and each national-ethnic group at the time of the last federal census (1991). Table 3. Share of distinct national/ethnic groups in Croatian population in 1991 (census) Groups UrbanRuralTotal(n)(%)(n)(%)(N)(%)Total population2 597 205 54,32 187 06045,74 784 265100.0Albanians9 45678,62 57621,412 032100.0Austrians16979,04521,0214100.0Bosnians (Muslims)34 68679,88 78320,243 469100.0Bulgarians41590,6439,4458100.0Croats2 006 76953,71 729 58746,33 736 356100.0Czechs4 65835,68 42864,413 086100.0Germans1 50957,31 11642,42 635100.0Greeks17562,310637,7281100.0Hungarians8 00535,814 35064,222 355100.0Italians12 88460,58 41939,521 303100.0Jews57996,5213,5600100.0Macedonians5 44686,783413,36 280100.0Montenegrins8 68089,31 04410,79 724100.0Poles48771,719228,3679100.0Romani3 36750,33 32849,76 695100.0Rumanians58772,522327,5810100.0Russians58683,012017,0706100.0Ruthenians1 56648,11 68751,93 253100.0Serbs281 57048,4300 09351,6581 663100.0Slovaks2 72548,62 88151,45 606100.0Slovenians16 90875,65 46824,422 376100.0Turks28288,13811,9320100.0Ukrainians1 41256,61 08243,42 494100.0Vlachs1254,5731,822100.0 Other national-ethnic groups1 98665,91 02634,13 012100.0 Undeclared (170)55 86276,117 51423,973 376100.0Yugoslavs80 61576,025 42624,0106 041100.0Local affiliation22 22748,923 26651,145 493100.0Not ascertained33 57953,429 34746,662 926100.0Source: Population census 1991 Sourcebook of national groups by residency in Croatia. [Croatian]. Central Bureau of Statistics, Zagreb (1992), pp. 42-215. During and after the war the settlement patters of most ethnic minorities had changed in a rather dramatic way. According to update UNHCR estimates (31 December 2001), still some 43 thousands are in need for durable international protection and assistance regarding re-settlement to their pre-war homes and property in current (independent) Croatia. As the Human Rights Watch stated in one of its recent country reports on Croatia, Incidents [connected with resettlement] fall into two categories depending on location. In Eastern Slavonia, most incidents are called soft evictions, where Croat returnee owners attempt to pressure the Serb displaced who are occupants of their property to leave (...). In the Krajina and the Banija-Kordun area, incidents are generally the result of friction between Serb returnee and the Bosnia Croat refugees resettled by the Croatian authorities in the region (many of whom are now naturalised Croatian citizens). Incidents during 1998 included the placing of mine booby-traps in and around reconstructed housing for Serb returnees, as well as periodic cases of arson and dynamiting of unoccupied Serb housing (Human Rights Watch, March 1999; p. 1). 4- Projections What we can only forecast with fair accuracy is , that in the next few decades Croatias population shall become gradually older as far as the proportion of the elderly people (65+) is concerned. The estimates and projections are displayed in the next table (Table 6). Table 4. Actual and predicted share of elderly aged 65+ years in the total population Year1991a)1995a)1999b)2010cC)2020c)2030c)Part A: Share of elderly in the total population Population size478611247760124553769434186841398273947188Male 65+199239213804229434246206264205283519Female 65+356801375353394870415401437000459722%Male 65+8,589,249,209,169,119,07%Female 65+14,7015,2415,2915,3415,3915,45% Total share 65+11,6012,3412,3612,3812,4112,43Sources: a) Tomek-Roksandi and Budak (1997); b)  HYPERLINK http://www.euphin.dk/hfa/Presult.asp http://www.euphin.dk/hfa/Presult.asp; c) own calculation. The projected figures would suggest that in 2030, approximately 1 person out of every ten citizens in Croatia will be at age 65 years or over, with unequal share between genders (more elderly women, than men). The next table shows the actually registered (de facto), and the statistically projected (hypothetical) size of national-ethnic groups in (or from) Croatia, based on 1881 and 1991 census data.. The projections refer, of course, to a virtual situation as if were... no war in Croatia in the last ten years, and as if... all ethnic minority groups would maintain the same or similar trends of own reproduction, as registered in the period between the two consecutive census years before the war. Table 5. Actual and hypothetical trends growth of Minority Ethnic Communities in Croatia Minority groups1981 census1991 censusChange 1981-1991 2000 expected2010 expected2020 expected2030 expectedSerbs531502581663+9,4%636558696634762379834329Bosniaks2374043469+83,1%79594145740266856488625Slovenians2513622376-11,0%19919177321578514052Hungarians2543922355-12,1%19645172631517013331Italians1166121303+82,7%3891871097129884237280Czechs1506113086-13,1%11370987985847458Albanians600612032+100,3%241044828896738193797Montenegrins98189724-1,0%9631953994479357Romani38586695+73,5%11618201623498860716Macedonians53626280+17,1%735586141008911817Slovaks65335606-14,2%4811412835423040Ruthenians33213253-2,0%3186312130572995Germans21752635+21,1%3192386746855676Ukrainians25152494-0,8%2473245324322412Rumanians609810+33,0%1077143319062535Russians758706-6,9%658612570531Poles758679-10,4%608545488437Jews316600+89,9%1139216341077798Bulgarians441458+3,9%476494513533Turks279326+16,8%381445520608Greeks100281+181,0%7902219623517520Austrians267214-19,9%17213711088Vlachs1622+37,5%30425779Other minorities15533012+93,9%5842113302197442618Total677224760079883546107793714001171957631% of the total population14,7%15,9%18,0%21,1%26,4%35,5%* Note: The statistical forecast for the years 2000-2030 is linear, and it was based on the estimates of natural growth rates in absolute size of minority groups in Croatia in the period between the last two censuses (1981-1991), thus before the war. The pattern of change in the ethnic makeup that came along in Croatia during the 1980s would suggest, that the fastest growing minorities were the Albanians, Greeks, Jews, Roma, Bosniaks and Italians which are, with the exception of Bosniaks, all are of non-Slavic language and cultural background. This fact would define them closely as culturally much distinct ethnic groups from the local mainstream Slavic society, whether Croats, Serbs, Slovenes or else. Another interesting fact is, that most of these minorities, except for Italians, are members of larger ethnic populations with fastest growth rates in Europe (see Dank 1998). Another cluster of minority groups in pre-war Croatia must have been comprised of descendants the old ethnic mix of the Austro-Hungarian population and its cultural heritage on these territories, mainly consisting of Austrians, Germans and Hungarians, all with decreasing trend of natural growth. As stressed above, these and other projections made for the next three decades are hypothetical figures (much alike a lottery forecast). Surely, they shall become utmost interesting and challenging, when checked for predictive validity against newly incoming demographic and historic evidence. C - Socio economic profile Employment and ethnicity Thanks to the tradition and social policy of the Austro-Hungarian Monarchy, Croatias labour market was always open to the flow of labour force of very different national-ethnic groups. Even during the political dictatorship of King Alexander (1928-1941), hundred of thousands members of different ethnic groups and nationalities from all over the country came for work in Croatia. During the best economic years of socialist Yugoslavia, that is, in 1960s and 70s, the multiethnic character of the labour force was even strengthened particularly with the influx of workers from poorer areas such as Kosovo and Bosnia (Meznaric, 1986). Many ethnic minority groups became specialists, if not monopolists, in different sectors of economic activity: Albanians in bakery, Bosniaks in construction, Bulgarians in gardening, Serbs in public administration & defence (including police and military), to name only a few remarkable examples. The discrimination has started parallel with Serbias aggression on Croatia, when great many Serbs lost their jobs. At the time being, the situation has changed to the opposite. Because of international human rights surveillance over Croatia, there is rather a positive discrimination of Serbs on the labour market. As of today, the economic activity of adult population in Croatia maps itself onto the following structure, according to 1998 survey (cf. Statistical Yearbook, 1999; p. 132). (1) Persons in paid employment sector of state ownership and sectors in transition (46%); (2) Persons in employment private sector (30%); (3) Self-employed persons without employees (13%); (4) Self-employed persons with employees (5%); (5) Unpaid family workers (6%). Estimates on the economic activity of Croatias adult population are presented below. Table 6. Indicators of economic activity of adult population Activity rates (%)MalesFemalesTotalAge groups199619971998a)199619971998a)199619971998a)15-2446.744.345.542.941.042.844.942.744.225-4991.089.488.379.578.177.985.383.083.050-6455.352.449.630.128.828.141.738.038.065+17.216.212.711.49.17.213.79.39.3Average (M)e64.962.760.648.647.646.356.252.852.9Employment/population ratio (%)15-2434.331.132.131.130.128.932.930.530.525-4986.982.980.772.671.269.978.276.975.150-6452.049.947.328.427.426.438.237.836.065+17.216.012.511.29.07.013.511.89.1Average (M)58.756.954.243.542.740.450.649.346.8Unemployment rates (%)15-2426.529.929.527.026.932.526.728.531.025-497.87.38.68.78.810.48.28.09.550-646.14.84.65.84.46.26.04.65.365+---------Average (M)b)------15.716.517.7a)2nd half-year estimates based on annual Labour Market Survey conducted by Central Bureau of Statistics of Republic of Croatia. b) Administrative sources Source: Statistical Yearbook of Republic of Croatia (1999). Tables 6-13 to 6-16; p. 128. It is evident that the economic activity of the adult population has taken a trend of negative growth since the war. In this respect, far the most affected segment of the population appears to be the elderly (65+), indeed, especially the elderly women Again, no official data are available on the economic activity rates among the Ethnic Minority Elderly in different sectors of employment. Based on recent surveys of the Hungarian minority (Barth, 2001) one may suspect, however, that the rural ethnic elderly in Eastern Croatia (Slavonija and Baranja), must be far in worst economic situation and many of them left alone by younger members of the family, who moved either to bigger cities or left abroad. Household structure In 1991, the modal-size family in the general population of Croatia was consisted of 4 members (share 23.5%), typically consisting of a father, mother and two children. The rate of single households was 17.8%. Families with 2 members ware represented with 22.5% in the population, and families with 5 members or over were relatively rare (5 member 9.2%, 6 members 4.4%, 7 or more members 2.4%). The presence of the single households and 2-member families was gradually increasing since 1948. Regarding the elderly, no census data exist to show as how many persons aged 65+ live alone, in couples, and how many of them Live in extended, e.g. 3-generation families. Some data are available only for the metropolitan (Zagreb) elderly, where, in 1994, 64.7% of the elderly lived in small, i.e. one or 2-member families, and 35.3% in large families consisting of 3 or more members (Despot-Lucanin, Lucanin and Havelka, 1997). Again, there is no evidence on this matter regarding the Ethnic Minority Elderly. The only data we have are drawn from surveys on the Hungarian minority. The majority of the Hungarian elderly, contrary to general belief, live in relatively large families consisted of 3 or more members (52.5%), and the rates of single household persons among them was relatively low in 1991 (14.2%). The number of such (single) persons households has increased during the war, primarily due to migration, but in 1996 it still did not exceed one fourth of all surveyed families (24.8%). The head of the Hungarian households is typically the oldest male, and he often remains in his role as long as he is able to manage. In the case of death, typically his wife takes over the family leadership. Grandparents typically stay active in the family, in taking responsibility for housekeeping and small children. Data from another survey would suggest that Bosniaks family patterns are similar to the Hungarian ones, except that they tend to be larger and even more extended (Barth, 2002). Housing The residential construction in Croatia presently approximates the following pattern (Table 7): Table 7. Residential construction in Croatia (1997 data) No. of dwellingsm21-room and efficiency apartments2- room3-room4-room5+ roomsTotal12,5161,030,8181,3893,5384,1212,4561,012Private ownership11,723982,6651,1703,1563,9882,412997Other types and unknown79348,1532193821334415Source: Statistical Yearbook of Croatia (1999) Except for territorial distribution by counties, no other statistics are available on residential construction in Croatia, letting aside breakdown of types of dwellings where elderly people lived before the war, and where they live now in- or from regions hit by the war. The only figure we may quote here is that one of the many casualties caused by the war was the destruction of some 180,000 dwelling units. As far as ethnic minorities and their war casualties are concerned, including housing, we have survey data only for some 300 Hungarian families (a representative sample for the whole country) of whom some 65% lived in Eastern Slavonia and Baranja, i.e., in a region most heavily hit by war. The table below summarises the quantitative estimates on war losses of this minority group (Table 8) Table 12. Some indicators of war casualties of minority Hungarian families in Croatia (representative sample size n=300) MeasuresSurvey estimates 1991Survey estimates 1996Change 1991-96 (in %)Own family house (estimated size in m2)154,5924,01-84,5Rented family house (estimated size in m2)1,354,80255,6Own apartment (estimated size in m2)4,964,39-11,5Rented apartment (estimated size in m2)2,566,44151,6Own shop (estimated size in m2)2,050,22-89,3Rented shop (estimated size in m2)1,170,15-87,2Cars/per family0,700,45-35,7Farming machines/per family2,250,23-89,8Bicycles-motorcycles/per family2,130,58-72,8TV-radio sets/per family2,491,43-42,6Telephone-fax/per family0,170,04-76,5Books/per family59,630,41-99,3Music records-tapes/per family52,7919,53-63,0House appliances/per family5,981,78-70,2Pieces of jewellery/per family6,403,00-53,1Art works/per family4,170,24-94,2Source: Barth (1998-2002). Unpublished survey database. The problem of some 43 thousand war refugees and displaced persons concerning return to their pre-war houses, as reported above, is mostly connected with housing, i.e. their houses either destroyed or occupied by families in similar status but of another ethnicity. To quote a single line from one of recent Helsinki Committees country reports for Croatia (as of 2001): According to official data, 15,000 elderly Croatian citizens of Serb ethnicity returned to the wider area of Knin to their devastated houses or were accommodated in their relatives houses (...). According to the Committee, the most current problem in this area was the numerous unresolved requests for the return of property to their rightful owners: only ten percent of property had been returned. The Knin housing commission stated that it had resolved almost 60 percent of the requests, but that figure referred only to cases where the owner had to pay the temporary user in order to move back into his6her house (Annual report 2001 of the Croatian Helsinki Committee, Croatia, p. 103) Health conditions To quote the summary findings of recent surveys, The majority of the elderly aged 65 and over are able to perform all their daily activities independently, and only one out of five elderly persons need help (...). Long-term geriatric patients most frequently require the help because their functional disability is mainly related to a disease of the old age and not to the ageing process itself. The studies carried out at the Gerontology Centre of the Zagreb Institute of Public Health (...) showed that more diagnoses were registered in geriatric patients of the middle and late old age (>75) then in the patients of early old age (...). The most common diseases and conditions in the elderly users of general/family medicine practice in Croatia were cardiovascular diseases, diseases of the musculosceletal system and connective tissue, endocrine, nutritional and metabolic diseases, diseases of the nervous system, and mental and behavioural disorders (Tomek-Roksandic and Budak, 1997; p. 183). Another survey would suggest that among the urban elderly, whose average age was in 1979 58 years (range 45-73, N=289), of those still living in 1994 (n=99), only some 22.2% considered themselves as healthy, and the remaining 77.8% felt chronically ill (Despot-Lucanin, Lucanin and Havelka, 1997). One could hardly find ethnicity-related statistics, if any, in the Croatian public health literature. There was one single study, however, run with the symbolic project title Save Lives, which made an account of personal interviews with 10,594 persons, most of them elderly, in 524 settlements in regions formerly occupied by Serbs during the war (called UNPAs). Of the respondents 70% were Serbs. 28% Croats, 1.1% Bosnian Muslims, and 1% of unknown (not coded?) nationality. The results uncovered a dramatic situation. More then 75% of the remaining (non-fled) population were civilians over the age of 60. They were scattered in 524 villages and hamlets, with only one inhabitant in 73 of them. One third had no income, and only about 17% were eligible for pension or welfare. Only one-fourth of interviewees had access to public transportation or supply of goods and food, and half had electricity in their homes. Two thirds considered themselves ill, and some 6% needed emergency assistance, including a change of living conditions. In conclusion, the authors point out the fact that this humanitarian aid operation revealed an undescribed phenomenon so far (...). The military operation, first of low-intensity and long-lasting, and then an abrupt defeat of one party caused a total social collapse. The exodus of the inhabitants left behind a selected population of the elderly and helpless. Deprived of their family support network and having to deal with the consequences of the military operations significantly worsened the problems of the elderly. (Lang et al., 1997; p. 365) D - Providers Health and Social Care providers Mainstream (Statutory) As compared to other European countries, in the field of health care Croatia compares relatively well in Europe, maintain public health experts (Lang, 2001). Specifically, the population ratio of hospital beds in Croatia is closer to the westerns European than the central and eastern European average (WHO, 1999). There were 7.4 hospital beds per 1000 population in 1990, which dropped to 5.9 in 1994. It rose slightly to 6.2 beds in 1996 and fell again in 1997 to 5.4 in 1977, partly due to health policy and partly a result of war. During the conflict 29 hospitals and 3 rehabilitation centres a total of over 3,000 beds were destroyed and a great deal of equipment was damaged. As in most European countries, health care facilities and services are organised and used at three levels. Primary health care is delivered through health centres, emergency care centres, home care centres (with visiting nurses), and pharmacies. At this level, the current policy is to have a public/private mix: county authorities own health centres, as public health institutions, and two types of private practices. Patients have a free choice of their primary level physicians. Secondary care facilities include hospitals, sanatoria and policlinics. Hospitals are divided into general hospitals and specialists hospitals. The former have facilities for obstetrics and gynaecology, internal medicine, surgery and inpatient paediatric care, whereas specialists hospitals are organised around specific diseases, chronic illness or population groups. Tertiary care is provided in university clinics, clinical hospitals and clinical hospital centres at which and around medical education, nursing education and research being conducted. As far as social care is concerned, many critics would maintain that, unlike the health care system, the system of social care in Croatia is not adequate at the present (see WHO, 1999). The main obstacles are the followings. First and perhaps most importantly, there is only limited provisions for the dependent elderly on low incomes, and for those in special needs such as the mentally ill or physically handicapped. As a result, people who need social care fill beds in long-term care hospitals. Second, there is gap in co-ordination of the health and social care. The care of people suffering from serious long-term illness, or severe disabilities, is covered by health insurance through contracts with inpatient facilities (e.g. geriatric hospital departments). Health care for persons in social care institutions is provided separately through contracts with health teams in these institutions or through contracts with local health centres. Third, the category of elderly recipients is mixed by all other categories of beneficiaries in an unreasonable way. And finally, we may add, ethnic-specific statistics were never if ever recorded in the whole network of social welfare institutions. Non-government (civil society) Sector What is true for most post-communist countries in Central-East Europe regarding their Non-governmental (NGO) Sectors, with the exception of Hungary, Poland and a few more, it is more-or-less true for Croatia and other successor states of former Yugoslavia as well (Les, 1994; Skenderovic-Cuk and Podunavac, 1999). This is far to say as if civil society or a voluntary sector, volunteerism or what else in all these countries were non-existent, which would be a ridiculous and historically completely misleading statement (see Dimitrijevic, 2000). It is only to stress that what is known and researched for the lest ten years or so in most Western countries, from USA to Japan, and called alternatively either as a non-profit or third sector of post-modern societies (see Kuti and Marshall, 1991), coded not only differently by Law (if coded at all), but it has different meaning for ordinary people living today in Albania, in Bulgaria in Croatia, Bosnia or else, i.e. in this part of the world, then it means for people living, for instance, in the US, UK Sweden or Switzerland (see Lester, 1993). If one clicks on the update Internet homepage for Croatia ( HYPERLINK http://www.hr http://www.hr) and manages to find the listing of nonprofit organisations (neprofitne organizacije) as registered by civil code in this country, she or he might be rather suppressed. Namely, out of 85 registered nonprofit organisations only two NGOs appear on the list with clear-cut goal-setting (mission) to protect the own members and communities with minority rights presently living in Croatia. These are the Ceska beseda Zagreb in rough translation Czech Speech (homepage  HYPERLINK http://beseda.zpm.fer.hr http://beseda.zpm.fer.hr), and the other is the homepage of Hungarian Association of Scientists and Artists from Croatia (address  HYPERLINK http://pubwww.srce.hr/hmtmt http://pubwww.srce.hr/hmtmt). This last mentioned NGO has found itself devoted to electronic information publishing (...), information services and remote collaboration holding, to name a few features. The NGO sector in Croatia surely has rather a long tradition (since the Renaissance era of independent Republic of Ragusa/Dubrovnik, at least), but a rather short written history. This is because both during the royal and socialist Yugoslavia voluntary (civil) initiatives were either co-opted by the political establishment (as associations) or went underground as political movements (e.g. the Yugoslav Communist Party during the royal Yugoslavia). During the war, some 350 international NGOs kept invading (parachuting) Croatia, many of which took action just because to prove own existence on the third-sector international labour market, what some would call humanitarian-aid-business (see Hanckock, 1989). Similar scenario went on with even more INGOs (international humanitarian organisations) parachuting to Bosnia-Herzegovina during the warfare, with rather disgraceful impact made on the whole voluntary sector of Bosnias historic society (Barth, 2002). In summary, one may only speculate and exercise guesswork about the size and the role of the NGO sector in Croatia regarding Minority Elderly Care (MEC). It is a research question as which are the NGOs helping the Ethnic Minority Elderly in Croatia with clear-cut goal setting and mission, which are (a) non-political, (b) non-professional, (c) non-profit oriented, and above all, (d) non-aligned to any religious institution. This question stays open for non-profit sector research both for Croatia and for other CEE countries, including Hungary as one the most widely quoted countries for its development of the non-profit sector since its transition (see Szelman and Harsnyi, 1999). Service typology The structure and pattern of development of the Croatian health care system since 1994 is documented below (Table 13), with a footnote on its maintenance and functioning during the years of an acute (high-intensive) warfare.. Table 13. Health institutions in Croatia Institutions19941995199619971998 Health centres116122121120120Pharmacies41588094106General hospitals and clinics3437373737Special hospitals3231323333Polyclinics1521366496Institutes of public health1315212121Other health institutions 1)1010101212Social care organisations918416690Medical centres50000Health units30000Total =SUM(ABOVE) 2272 =SUM(ABOVE) 2307 =SUM(ABOVE) 2374 =SUM(ABOVE) 2444 =SUM(ABOVE) 2513Source: Statistical Yearbook of Croatia (1999) The reform of the Croatian health care system began in 1990 following multiparty elections, while other reform proposals evolved out of the Croatian Health for All strategy prepared by the Ministry of Health (cf. WHO Regional Office for Europe, 1999). According to the 1993 Health Care Act (Official gazette, Nos. 75/93, 95/96 and 1/97), citizens are granted for universal coverage, universal accessibility, acceptability, affordability; continuity of care, free choice of physicians and health care team; and provision through a mixed (public and private) system. The legislation emphasised the importance of health promotion and disease prevention. Health care was to be developed through planned approach to health care delivery at three levels (primary, secondary and tertiary). The principle of subsidiary was invoked in terms that the state should not offer services better delivered at county level, and the county should not offer services better delivered at municipal level. Health care was regarded as primarily the responsibility of the government but citizens were also urged to look after own health, with the slogan The duty of all citizens is to take care of their health (Article 3 of the Health Care Act). Social care facilities assume the following structure and pattern of development since Croatia declared independence (Table 14) Table 14. Institutions for social care of adults and elderly persons TypeNumberNumber of users, 000No of users/ institutionUsers/1000 elderly9298929892989298Institutions for adult disabled persons15NA1,64NA109NA1,43NAInstitutions for adults and elderly persons627210,9113,441761879,5411,7Pensioners homes37476,298,371701785,487,3Centres for accommodating adults and elderly16102,491,851561852,171,6Social and health care institutions9152,163,212402141,882,8Source: Statistical Yearbook of Croatia (1999) There are no official data available whatsoever as to what extent and in what way any types of so-called alternative medical and/or social services function currently in Croatia. To our best knowledge, they surely exist and function especially for- and in communities of some Ethnic Minority Elderly (e.g., Albanians, Bosniak Muslims, Roma), from herbal medicine to folk-doctors (Vogel, 1986). However, this is part of the traditional health culture of the entire Balkans, thus one may not wonder about that it continues to exist and function even in the post-modern era as its reaches, among other CEE countries, Croatia as well (Barth, 1994). Service usage pattern There exist an enormous amount of research literature, of a rather high-level professional quality, on patterns of utilisation of health and social services in Croatia and other parts of former Yugoslavia, including one of famous WHO international comparative studies run in late 1960s and early 70s (Kohn and White, 1976). One of these studies has shown that the typical motivation for the utilisation of health care services at the level of primary/family care (including both over-use and under-use tendencies) was not that much the seriousness of illness, as many would expect, but the perceived quality of doctor-patient interpersonal relationship in the eyes of the patient (Bartth, 1972). The changing pattern of health services utilisation looks like this in Croatia, for the last few years (see Tables 15-16): Table 15. General practice services: visits-examinations, 000 (1994-1998) Type1994 1995 1996 1997 1998 Visits to medical doctor1494012078127821353815667Home visits of general practitioners305204219251284Visits to other health workers59665352540355455778Home visits by health professionals277117998871Total =SUM(ABOVE) 23482 =SUM(ABOVE) 19746 =SUM(ABOVE) 20499 =SUM(ABOVE) 21419 =SUM(ABOVE) 23798 Table 16. Hospitals and in-patient clinics (status 1998) TypesNo.Patients admittedHospital daysNumber of bedsBeds/ 100 elderly (<55)Total: Of these selected types786863858620852272872,38General hospitals23299035265383383050,72Teaching hospitals5151225154812848900,42Hospitals for rheumatic diseases & rehabilitation1045639105067940630,35Hospitals for mental diseases617812125227635220,30Teaching hospital centres299129104478831760,27Orthopaedic hospitals233891011924920,04Hospitals for chronic diseases650371424924110,04Clinic for infectious diseases191021025233260,02Hospitals for pulmonary TB132501094573000,03Clinic for pulmonary diseases179071057472280,02Clinic for oncology18218846082200,71Clinic for casualty surgery15080658021940,17General in-patient clinics95219476491660,01Health resort11750349021350,01Orthopaedic clinic14000414821260,01Hospitals for allergic respiratory disorders12343120700,01Speciality hospital for geriatrics1241537499680,01Clinic for diabetes, endocrinology1158512220410,00Special in-patient clinic11315083290,00Total of selected types =SUM(ABOVE) 152 =SUM(ABOVE) 1356542 =SUM(ABOVE) 17064332 =SUM(ABOVE) 54049 =SUM(ABOVE) 5,52Source: Statistical Yearbook of Croatia (1999). Of the two statistical tables more interesting is, of course, the first table showing, among others the changing trend of home visits in decrease since 1994, what many public health professionals would consider as the back-bone to the tradition of social medicine, as invited by Andrija Stampar, one of the founding fathers of the WHO (cf. Grmek, 1966). The drop of home visits by members of primary care teams since entering the era of fee-for-service based health and social care seems catastrophic, especially from the perspectives of social gerontology, letting aside the special needs of great many Ethnic Minority Elderly. As far as the elderly population is concerned, primary health care assumes to play the main role in their care. Research would suggest, that the number of geriatric patients referred from general practice to additional specialist examinations and hospital treatment decreases with age, regardless of the increased morbidity in that age group (Tomek-Roksandic, 1988). Recent research also suggests that the elderly tend to under-use hospital services, and in most cases they rather entrust their health care to primary physicians. According to general practitioners opinion, most of the urban elderly requiring social welfare home services need assistance only in performing difficult house chores, but their share does not exceed 16% (Budak and Tomek-Roksandic, 1994). Again, no ethnic-specific data exist of any kind regarding the utilisation rates of health services, letting aside their age-specific morbidity and mortality rates as one would expect to be provided by health sector administration on a day-to-day basis. Barriers to access services Since no research data exist of any kind on this matter, we may rely only on some qualitative data gathered so for this project, including those gathered by the means of critical incidents and focus groups techniques. According to these sources, one may assume that, on the average, Ethnic Minority Elderly in Croatia do not have special barriers to access services other then virtually all elderly face, and in many respect, they are in better position as compared with their contemporaries living in EU-members countries (e.g. elderly Bosniak Muslims in Switzerland). First, they speak the language of the mainstream society (Serbo-Croatian) or any variant of it. Hence language barriers might be present and serious in some cases, and for some rural ethnic elderly (e.g. for elderly Hungarians from remote Baranja villages or Italian elderly hospitalised in Pula), but no one may expect as being typical. Secondly, given the tradition and character of a multiethnic society in Croatia, vast many Ethnic Minority Elderly (according to self-declaration) were a priori born onto so-called mixed families regarding ethnicity, or currently live in such families, including ethnic mix of their children and/or grandchildren. Thirdly, in front of a rather lasting tradition of social medicine in this country, as a professional values system established since the early 1920s in the history of health and social services in Croatia, one should not expect that themainstream providers, being Croats or else, would make discrimination when meet with Ethnic Minority Elderly. This last statement may sound too optimistic, yet as a research hypothesis, it should be kept fully open to be proved or disproved along this (MEC) project. One of major barriers to access services in present-day Croatia for senior citizens, in general, seem is of economic nature (rather then social or political). This boils down, in effect, to the inability of great many elderly in need to pay for ever increasing number of for-fee basic health and social services (e.g., home visits by community nurses). Another barrier is of geo-demographic nature. Specifically, most of the Ethnic Minority Elderly live in rather remote rural areas, and many of them simply cannot pay (out of nothing, as they call own monthly income, if any) even the price of a bus-ticket to travel to the nearest local Medical Health Centre (Dom zdravlja). And finally, there is the problem of tens of thousands of elderly people in need for health and social care, many of whom are, in effect, stateless persons. This category consists of many de facto residents of the country (who live in this country for most of their lifetime), who have no legal citizenship neither in Croatia nor in any of other successor states of former Yugoslavia, because of still largely unsettled status of citizenship for ethnic persons other then Croats, born in regions of former Yugoslavia else then Croatia (e.g. Hungarians born in Vojvodina, as regarded part of Serbia). E- Legal context In 1992, the Constitutional Law on Human Rights and Freedoms, and the Rights of Ethnic and National Communities or Minorities in the Republic of Croatia was drawn, and lately amended on 11 May 2000. Its claims (Article 3) that The Republic of Croatia shall protect the equality of the members of the national minorities: Albanians, Austrians, Bosniaks, Bulgarians, Czechs, Hungarians, Germans, Italians, Macedonians, Montenegrins, Poles, Romanies [sic], Romanians, Russians, Ruthenians, Slovaks, Slovenians, Serbs, Turks, Ukrainians, Vlach, Jews and other ethnic and national communities or minorities and encourage their universal development. Furthermore, Article 18 2., this same Constitutional Law reads: Members of ethnic and national communities or minorities whose share in the population of the Republic of Croatia is below 8% shall be entitled to elect at lest five and maximum seven representatives to the House of Representatives of the Croatian National Parliament, under the Law on the Election of Representatives to the Croatian National Parliament. Two such national/ethnic minorities do have, in effect, own legal representatives in the Croatian National Parliament (Sabor), i.e. the Hungarians and the Italians, while the others have joint representatives (e.g. Czechs. Slovaks, Ruthreians). This much about the legal status of minorities in the present-day Croatia, as defined by the Law. F- Refugees and asylum seeks As noted earlier, during the warfare in former Yugoslavia, a large-scale population movement took place in Croatia (Hebrang, 1994) and iSG@ BEN@lK LMNYE@,II@C@fRAJU@LS@w I@ ON @OLAZE@ENCE@-  INGn neighbouring Bosnia-Herzegovina (Bagari, 2000). Since 1991, a total of 373,161 persons moved from Bosnia and Herzegovina to Croatia, according to the data of the Croatian Statistical Bureau obtained from the Croatian Office for Refugees and Displaced Persons. Another large-scale migration took place in 1995, when approximately 250,000 ethnic Serbs left the temporarily occupied territories by the Serbia military, paradoxically called, UN Protected Areas, or UNPAs, throughout Eastern Slavonia and the self-determined Srpska Krajina (Banija-Kordun region). Recent estimates would suggest that some 77,846 Serb war refugees returned to Croatia. In the same period of time (1991-1999) some 102,686 people left Croatia as emigrants, mainly to Western Europe and North America, according to official statistics (see Statistical Yearbook of Croatia, 1999). In short, Croatia continues to be at the stake of interface between large-scale migration and asylum seekers. In this respect, it seems less at less risk as compared with neighbouring Bosnia and Herzegovina (see UNHCR Report, January 2001), thanks to its more stabilised immigration policy and civil law, including its code on minority rights in accord with international (EU) standards. However, beyond the screen of good-looking multiparty system and its every-day political rhetoric, social rights of great many victims of recent war seem far to be met. To quote again a line from the Croatian Helsinki Committee Report (2001) In 2000, the majority of cases [the Committee] dealt with were related to social rights, particularly the right to employment, severance pay and pension, failure to register workers as well as harassment at work and prohibition on joining trade unions. The situation was aggravated by the great number of bankruptcies. The unemployment rate increased by the end of December to 22.4 percent (Croatian Helsinki Committee Report 2001, p. 105). Quality of life issues Croatia entered the 1990s full with inter-ethnic tensions and atrocities between two constituent peoples of royal Yugoslavia (Serbs and Croats), with poor economic standing, and with a largely dysfunctional, poorly organised and expensive health system, and even more poorly organised social care system. Codes for minority rights did not exist. After declaring independence (in December 1990), the people of Croatia run through a bloody war the following major casualties: over 400 destroyed or severally damaged Croatian Catholic churches, 210 destroyed or damaged libraries, more then 12,000 persons were killed, 35,000 wounded, 25% of Croatias economy destroyed, with the total account of some 25 billion $US of material damage, to list some of scores. Even after more then five years of settled peace (as far as military operations are concerned), large parts of the Croatian general population still did not and could not normalise own lives in terms of subjective wellbeing (life satisfaction). Many face the lasting psychosocial and mental health consequences of war traumas, including PTSD, especially among war veterans, widows, refugee children, and displaced persons (see Henigsberg et al., 2001). In clinical encounters one my find an increasing number of people, particularly elderly, who cope with an ever worsening situation of economic and social welfare. As far as the quality of life issues are concerned, no systematic research has been conducted thus far. One recently accomplished pilot study (Barth, December 2001), however, sheds some lights on four primary factors along which ordinary people probably evaluate their subjective well-being: (1) economic security, (2) health matters, (3) outlook to the future, (4) family support. One of the most interesting findings of this survey was that the groups of Hungarian minority elderly (65+) in most of standardised psychometric QLS-measures (Krizmanic and Kolesaric, 1992), on the average, did not score differently from younger age groups. ANOVA age-effects were found only on two factor scales, Health and Expectations from future, by the elderly (>65) were scoring significantly below the average of all younger age groups. G- Funding of services There are three main avenues for funding health care services in Croatia: insurance funds, the state budget and county revenues. Health insurance is compulsory, and it includes medical, psychosocial and social work care, if needed. Health insurance rates are negotiated annually between the Ministry of Health, the Ministry of Finance and the Croatian Health Insurance Institute. The Croatian Health Insurance Institute distributes resources according to the agreed contracts with health care providers such as hospitals. The Ministry of Health and the Ministry of Finance decide the states annual budgetary contribution towards health care, which is then ratified by the parliament (Sabor). State funds amount to 5% of total public sector health care expenditure and they are mainly tied to tertiary health care, public health activities and capital investment. The counties also contribute from their own revenue towards the capital costs of the facilities that they own. According recent estimates (Lang, 2001), health expenditures in Croatia run 8.1% of GDP, which matches the level of most EU-members and similar countries (n=17, 8.2%), and it is above the average of EU-candidate countries (n=13, 6.2%), as well above the global average of some 36 European countries taken into comparison (7.2% GDP). I- Conclusion There are three fundamental reasons that justify Croatia to be taken, as one of ten other countries, in this important Pan-European project on Minority Elderly Care. First, Croatia is one of most multiethnic societies on the ethnic map of Europe, with a rapidly growing number of Ethnic Minority Elderly in its general population (estimated share 25% in Croatias elderly population 65+), dispersed across some 25 different national-ethnic minority groups, according to self-declared affiliation in 1991 census. Secondly, Croatia and its people recently went through a bloody war (1991-1995), of which one of the most sizeable group of victims are the minority elderly, indeed, many of which count as abandoned population on the agenda of every-day governmental politics. The vast majority of them are consisted of Serb, Hungarian, Bosniak Muslim, Czech and other Minority Elderly left behind after the war on remote rural areas. Third, great many greying Ethnic Minority Elderly in Croatia are exposed to discrimination and harassment by members of other greying local residents of different ethnicity, who would call themselves, by now, majority on the given territory. Most of these Ethnic Minority Elderly are returnees to places of their pre-war homes and property, and many of them are in need for special and continuos care from the part of the international community. Croatia, as by now, has a fairly well developed health care system with long tradition and historic roots in social and community medicine, and quite a strong professional tradition in the field of geriatric medicine and social gerontology. However, Croatia still has a very misty, unclear and problematic system of social welfare, as far provisions for the elderly concerned, letting aside the special needs of the Ethnic Minority Elderly. One problem seems to be rooted in unequal geographic distribution of social services and their outdated infrastructure (e.g. isolated homes for elderly much almshouses). Another problem seems to be rooted in a rather chaotic state of art in the non-governmental (NGO) sector of the whole Croatian society, especially from the perspectives of Ethnic Minority Elderly. And finally, there seem to emerge radical changes in the whole value system of professional attitudes (in becoming more-and-more business-oriented), in offering health and/or social services that most elderly people simply cannot afford to pay, regardless whether Ethnic Minority or else. There is no doubt about, that the health and social care system in Croatia has undergone profound structural changes since the country declared independence. In principle, universal access has been maintained to health and social services, the funding system of services seems well established, to name a few achievement. However, the inequalities both within and among different groups of users of health and social services seem as growing, along with the growth of so-called social discrimination between and within different social groups, whether based on ethnicity, economic standing, education or else. At the time being, in the absence of any empirical evidence, we simply cannot tell as if the quality, effectiveness and efficacy of health and social services in Croatia, including professional resources, were specific or different in the treatment of Ethnic Minority Elderly, as compared to Majority Elderly at given geographic areas or micro-settings (e.g., Hungarians in Osijek vs. Hungarians in Pula). This is an open question yet to be answered by further research, such are the perspectives of this one. References Barth (1972). Demographic characteristics, attitudes, doctor-patient relationship and the use of health services. [Croatian]. Zagreb: Republicki zavod za zastitu zdravlja SR Hrvatske. (Unpublished study) Barth (1994). The nonprofit sector in Croatia: A historic overview. Zagreb (Unpublished manuscript). Barath, . (1992). Patterns of helping and social support in American self-help groups. Cross-cultural perspectives. Baltimore (MD): The John Hopkins University Institute of Policy Studies. (Unpublished study) Barth, . (2000). Social scientists on ethnic relations in Croatia after 1989: Content analysis of an annotated bibliography. Migracijske teme. 16(1-2): 167-92.  E@2 S @JZ/  IA,@2-)4 %AK N@Jsi+Bo~ievi, I., Oreakovi, S., Stevanovi, Rodin, U., Nolte, E., McKee, M. (2001). What is happening to the health of the Croatian population? Croat Med J. 42:601-5. Budak, A. and Tomek-Roksandi, S. (1994). Rationalisation of health care: home care, nuring and rehabilitation in primary health care. [Croatian] In: L. Perai and E. Matrljian (eds.): Dani primarne zdravstvene zaatite. Labin: Dom zdravlja, 1994. p. 35-41. Canetti P, Coulman C, Eves R, Howards (eds) (1997). The economist pocket Europe in figures. London: Profile Books Ltd. [Hungian translation by Dank (1998). Eurpa szmokban. Budapest: Szukits Knyvkiad.] Central Bureau of Statistics of Republic of Croatia (1992). Census 1991: Population of Croatia by national affiliation and settlements. [C JU@ LA@I@ M@O@ O@E @LL @dr  ED@ TA@  JU@ M@ O@NJE@roatian] Zagreb: Republi ki zavod za statistiku Despot Lu anin J., Lu anin D., Havelka M. (1997). Role of psychological factors in the ageing process: stress and self-perceived health as predictors of ageing. Croat Med J. 38 (3): 222-227. Dimitijevic F (ed) (2000). Managing multiethnic local communities in the countries of former Yugoslavia. Budapest: Local Government and Public Service Reform Initiative Open Society Erdlyi D. (1928). The situation of Hungary in the lights of international statistics. [HKE@o  R@ S @ S@ ING @!&q OLJANOVI@XC @MI@OTH@+ ED@fST@ ING@f2  PENKAungarian] In VerecktQl napjainkig  V. Budapest: Franklin Trsulat.. 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The third sector: studies. [Hungarian] Budapest: Nonprofit Kutatcsoport. Kohn R and White K. (eds.) (1976). Health care: An international study. London: Oxford University Press. Korsika B (1989). Serbia and Albanians: An overview of Serbia s politics towards Albanians between 1913 and 1945. Ljubljana: Narodna in univerzitetna knjiznica. Krizmani V and Kolesari V (1992). Handbook for the application of Quality of Life Scale. [Croatian] Zagreb-Jastrebarsko:  Naklada Slap . Lang S (2001). Croatian health in European transition. Croat Med J. 42(5): 95-96. Lang S (2001). Croatian health in European Transition. Croat Med J; 42(1): 95-96. Lang S, Javornik N, Bakali K., Swedlund S, Ghidi V, Lueti V, Branko C (1997). Save Lives Operation in liberated parts of Croatia in 1995: an emergency health action to assist abandoned elderly population. Croat Med J. 35 (2): 265-270. Lzr G., Lendvay j, rkny A and Szab I. (1996). Majority minority: Studies on the historical national awareness. [Hungarian] Budapest: Osiris Kiad. Les E (ed.) (1994). The voluntary sector in post-communist East Central Europe. Form small circles of freedom to civil society. Washington, D.C. CVICUS World Alliance for Citizen Participation. Meznaric S (1996). Bosniaks. [Serbian]. Beograd: Zavod za izdavacku delatnost Filip Visnjic. Salamon LM (1992). Americas nonpofit sector: a primer. Washington, D.C. The Foundation Center. Skenderovic-Cuk N and Podunavac M. (eds.) Civil society in the countries of transition: Comparatrive analysis and practice. Subotica: Agency of Local Democracy Open University. Statistical Yearbooks of Republic of Croatia (1994-1999). [Croatian-English] @ NKYL@WEMAN@ RZagreb: Republi ki zavod za statistiku Szman Zs and Harsnyi L (1999). Fishes and nets. [Hungarian] Budapest: Nonprofit Kutatcsport  MTA Szociolgiai Kutat Intzet. Tomek-Roksandi S and Budak A. (1997). Health status and use of health services by the elderly in Zagreb, Croatia. Croat Med. J. 38(3): 183-189. Tomek-Roksandi S and Cota-Bekavac M. (1990) Needs for health care.[Croatian] In: Z. Durakovi, B. et al. (eds.) Medicina starije dobi. Zagreb: Naprijed. p. 423-429. Tomek-Roksandi S. (1988). Analysis of the use of primary health services by elderly people in Zagreb and assumptions for their comprehensive care. [Croatian]. Zagreb: Zavod za zaatitu zdravlja grada Zagreba. Tomek-Roksandi S. (1995). Comparison of health status of elderly in nursing homes and in general population. [Croatian] In: Katoli ka udruga  Kap dobrote. Zbornik radova Stru nog skupa  Svekolika briga za stare i nemone osobe te odgoj za karitativni rad. Zagreb: Katoli ka udruga  Kap dobrote . p. 131-40. Vogel A. (1986). Folk-doctors. [Croatian] Zagreb: Mladinska knjiga. WHO (1999) Health Care Systems in Tranmsition: Croatia. Copenhagen: WHO Regional Office for Europe European Observatory on Health Cae Systems. WHO Regional Office for Europe (2000). Highlights on health in Croatia. ( HYPERLINK http://www.who.dk/dokument/e68394.pdf http://www.who.dk/dokument/e68394.pdf) Zimmerman W (1996). Origins of a catastrophe: Yugoslavia and its destroyers. New York: Random House. TIC@ %E@ }ubrini, D. (1995). Generalities and basic facts about Croatia.  HYPERLINK http://www.hr/darko/etf/gen.html http://www.hr/darko/etf/gen.html Pcs, 2002-06-03  Note: War time health services. One of the main goals of Serbia s aggression on Croatia at its peak (1991-1992), was to destroy (a) health institutions, especially community health centres and general hospitals in major cities, of vital importance to a given territory at the stake of military operations (e.g., Vukovar, Osijek, Pakrac, Karlovac, Zadar); (b) schools and all other educational institution, including the famous Inter-University Centre in Dubrovnik; and (3) sacral religious objects other then Serbian Orthodox ones, including local churches and cemeteries (cf. Croatian Medical Journal, War Supplement 2, 1992). The ware time health services in Croatia worked according to the following rule: The Ministry of Health created medical corps during the years of conflict (principally during 1991-1992) to care for persons injured during the war. During those years, 9,941 people were killed and 28,734 were wounded, many requiring amputation. Together with military volunteer groups, volunteer health professionals, including psychologists, formed war-sanitary groups. Hospitals located near the front line (e.g. in Vukovar) were designated military hospitals by the Ministry of Health. Their priority was to care for wounded combatants and civilians. Hospitals further from the battlefield (such as in Zagreb, Rijeka or Split) were admitted to long-term care and rehabilitation of war-wounded. Neither the Croatian military not the health care system of the country had no experience of running large-scale public health programmes, letting aside crisis headquarters in order to deal with both civilian and military casualties. Other health services, and many ad hoc organised NGOs (such as Dobrobit/ Welfare, in Zagreb for the care of refugees and displaced elderly) and other rather short-lived, parachuting international NGOs to Croatia (not to single out any of more then 300 acting in Croatia in the period of crisis, 1991-1992), attempted to take care of children victims of war, women, displaced persons, refugees, elderly, the mentally ill and disables expelled major regional from local hospitals under attack, refugees and other civilian population (cf. WHO - HCS Report for Croatia, 1999). 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