The declaration of independence by the Republic of Croatia the following year foretold the conflict in Bosnia. Bosnia was caught between Croatia and the remnants of the Yugoslav Federation, dominated by the Serbian Republic. After four years of war, the Dayton Accords procured a cessation of hostilities but effectively partitioned Bosnia and Herzegovina into three ethnic segments. Efforts by the international community to foster cooperation between ethnic factions have been largely unsuccessful. As a result, the reconstruction of the Bosnian infrastructure has been hampered and the rehabilitation of damaged health facilities delayed.
Most medications are unavailable for the general population.
Primary care physicians, including emergency physicians, are in short supply and do not have access to essential equipment and supplies. In 1991, before the outbreak of hostilities, there were 33 certified emergency specialists in Bosnia. An oral examination is taken at the end of the training period. A private car or ambulance must transfer patients requiring hospitalization. Patients presenting to the hospital are first seen in a receiving room or, more frequently, are sent directly to a specialty department.