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The former Socialist Federal Republic of Yugoslavia comprised Bosnia-Herzegovina, Croatia, Macedonia, Montenegro, Serbia and Slovenia. Each nation, however, had diverse groups within its borders. Starting in 1991, Slovenia and Croatia declared independence for the federation followed by Bosnia-Herzegovina and Macedonia. Bosnian Muslims make up around 40% of the population of Bosnia-Herzegovina, with Serbians and ethnic Croatians the other major groups. Bosnian Muslims are recognised as having a distinct ethnic identity, separate from Serbians and Croatians in Bosnia-Herzegovina.
The civil war in Bosnia-Herzegovina that followed its break-away from the former Yugoslavian Republic involved atrocities including "ethnic cleansing" of Muslims in Bosnia by Serb military and police. This genocide was characterized by concentration camps, mass murders (especially of men), torture and a Serb policy of raping Muslim women. The vast majority of casualties (approximately 250,000 killed) were civilian. An outflow of refugees resulted in large numbers of Bosnians being displaced to other countries.
1089 Bosnian immigrants migrated to Ireland under special humanitarian provisions as programme refugees to escape the fighting in the civil war. Many of these will have experienced food shortages, forced repatriation, torture, rape or death of family members and may present with post traumatic stress disorder. Second-generation stress-related symptoms can also be prevalent. Evidence from England shows that Bosnian Muslims face added stress and delayed recovery due to the burden of displacement and adaptation difficulties when they settle abroad (Hunt: 2005). Evidence from Ireland shows high degrees of unemployment amongst Bosnians (40%) which acts as an added stress factor (O'Regan: 1998).
Islam is a major religion in Bosnia-Herzegovina but other important religions include Orthodox Christians and Roman Catholics. Bosnian Muslims will only eat Halal meat. Pork products and alcohol are forbidden. However, Bosnians are generally more relaxed in their religious practice than many other Muslims coming from outside Ireland. Men often drink alcohol and women usually wear western clothes and do not always cover their heads. At Ramadan, Bosnian Muslims are required to fast between sunrise and sunset for a period of 30 days.
The language of Serbo-Croatian was officially used in Bosnia-Herzegovina. Today a Bosnian language closely related to Serbo-Croatian is acknowledged. When translation is needed, it is important to discuss the ethnicity of the interpreter as well as the language desired by the client due to the uneasy political tensions.
In Bosnia-Herzegovina, particularly in rural areas, traditional life for Muslims involved arranged marriages, bride-price and strong demarcation of male and female roles. Women's role was restricted to the household. These practices are changing rapidly, with equal status between men and women becoming the norm, and women usually work outside the home. However, this process of change may cause intergenerational conflict and marital disharmony. Women are still responsible in the domestic sphere. Family honour is extremely important to Bosnians and authority still lies predominantly with the male head of the household. The extended family is important in Bosnia-Herzegovina and grandparents will often live with their children and take care of their grandchildren while the parents work. There is also a strong tradition of god-parenting amongst Muslim Bosnian families which gives additional social support to families.
Bosnians in Ireland usually live in nuclear family groups where possible. Some Bosnians in Ireland will be in a "mixed marriage" (ie Bosnian with Serb or Croat). Those with mixed marriages may find it difficult to join ethnically distinct Bosnian community groups due to ethnic and religious tensions. There is much potential for social isolation especially if they are not confident in English.
Traditionally healing with teas, herbs, grasses and ointments are commonly used in Bosnia-Herzegovina. For example, coughs may be relieved by the inhalation of the steam from chamomile tea with a linen cloth over the patient's head. Honey and pollen may be taken to ensure longevity. There is also a strong traditional use of thermal mineral springs.
Generally speaking, however, Bosnians follow the same medical understandings that pertain in Ireland.
Free medical services were made available in Bosnia-Herzegovina for children, students and the elderly. A health insurance system operated through employment schemes for all workers that gave provision for health care, medications, family planning, maternity allowances, and dental care. Although the health care service suffered during and after the war these are the models that Bosnians will be familiar with. Paying for private health care services in Ireland will therefore be unfamiliar but medical card services and accessibility to PRSI related services will be similar.
Bosnian patients are traditionally encouraged to communicate about physical suffering and relatives give moral and physical support. The health provider is expected to give high significance to discussions of symptoms and complaints. Some people may have chronic fear of serious disease. The client is likely to want detailed explanations of tests and procedures. Treatment is often not considered complete without medication.
While awareness of health issues is high this is often not implemented in life../style. Exercise is uncommon, people may be overweight and men commonly smoke.
Bosnian Muslims may be reluctant to seek dental care in Ireland because dental care in some regions of Bosnia may have been painful. They may require support for the first visit to overcome fear induced by past dental treatment.
There is a stigma associated with mental illness for Bosnian families. Where mental health illness is recognised there may be the view that medication is the only treatment and psychotherapy, group therapy or occupational therapy may be rejected. Despite the ban on alcohol, alcoholism is not unknown amongst Bosnians, usually directly related to PTSD and unemployment. In some cases violence towards wives and children is also evident.Infants may be given food supplements at three months of age, such as carrots or potatoes with milk. Toilet training may commence early at six months of age. Traditionally, children were not pampered for fear of producing "softies". Traditionally, sons are given preference over daughters.
Parents of a disabled child may feel shame and isolate themselves from the rest of the community, thus not taking advantage of social services available. Mothers may fear that the Irish system of Health Clinics will attempt to impose Irish practices on their child.
Children may have unexplained behavioral problems related to previous traumatic experiences in Bosnia such as a fear of stairs or bedwetting. Children may have to cope with severe emotional problems amongst older family members. Inside households, men may smoke heavily despite the presence of young children, and tend to be unaware of the dangers of passive smoking.
Many Muslim women prefer to see only female health care providers and would refuse gynecological examinations by males. This may also extend to male interpreters being present during consultations.
Women are used to a system where abortion is used more often than the Pill. In Ireland the condom is the most popular form of contraception. The Pill is unpopular due to its perceived side effects and a fear that it may cause cancer.
Many Bosnian women, particularly those from rural areas, did not go out to work previously but were occupied on farms, in family business or with their families. Women who join the workforce to help the family economy are often expected to fulfill all domestic duties.
This is a very good American site that describes traditional health seeking practices as well as giving useful facts (i.e. outlining prevalent diseases amongst the target community). It specifically looks at refugee populations and includes excellent links to other sections that give more detail on issues such as women and health, refugee experiences and health, infectious diseases etc. Recommended. ۞ ۞ ۞ ۞ ۞
This is an excellent Australian 2003 government sponsored site that gives a cultural profile in a very concise and approachable way. It gives practical advice on how to approach patients who have arrived as asylum seekers and refugees who may have suffered from torture or trauma. It also covers health seeking practices and traditional health beliefs. Recommended. ۞ ۞ ۞ ۞ ۞
This very readable Canadian site gives a short account of the county's geography, history, sports, arts, work, family and health. It is socially orientated rather than health focussed, as it is designed to initiate communication and integration between habitual Canadian residents and newly arrived immigrants. It will therefore not explain aspects of culture to a depth that some health care providers would need. However, it does offer avenues and ideas that could be used to open up a productive communication process between health care providers and clients that would lead to relevant information being exchanged. ۞ ۞ ۞
This reliable UNICEF site gives background information and health related statistics that could prove especially useful for health care providers who need to determine the health and social history of their clients. Some cultural information can also be deduced relatively easily from the statistical detail. There is an emphasis on children's and women's health due to UNICEF's focus on children. ۞ ۞
This site from the US Library of Congress presents an extensive volume on the country, but it is no longer up to date especially where statistical data is sought. However, it is easy to find sections on health and social topics which are very comprehensive. It gives the major diseases that affect the people and it outlines the classical medical services that are available. Although the volume is easy to navigate the writing is not very approachable. It is heavy on fact but gives no information on traditional medicine and cultural issues that could affect access to health. Use as a last resort and be aware that major changes will have taken place in the last decade. ۞
This BBC site will give you a brief overview of the current political situation in each country. This may help you to know what political situation your client may have left behind and what their relations are currently living with. It also gives a brief overview of statistics - population, religions, languages, life expectancy and exports. ۞
This site gives you basic facts and a map of each country. It gives basic demographic details that include religion, ethnicities, health risks, mortality rates etc. which may be useful, especially if comparative material is required. A short synopsis of the political situation in the country is included. ۞
O'Regan C (1998) Report of a Survey of the Vietnamese and Bosnian Refugee Communities in Ireland. Dublin: Refugee Agency;
ClannHousing Association (1999) From Bosnia to Ireland's Private Rented Sector: A Study of Bosnian Housing Need in Ireland. Dublin: Refugee Agency
Bosnian Community Development Project 01 6719202
SPIRASI does not necessarily agree with the facts and opinions presented in this guide or any linked websites.
This Cultural Profiles web-site was designed to be fully compliant with modern standards for web publication (as specified by the W3C). The pages will be accessible and readable on any display using any web browser, old or new.