SPLIT, CROATIA -- A major outbreak of typhoid has hit overcrowded refugee encampments in Bosnia, along with cases of other infectious diseases such as waterborne hepatitis A and dysentery, according to the World Health Organization and the United Nations refugee agency.
This week's surge in reported disease came as snow and sub-freezing temperatures arrived in Bosnia, bringing fresh misery to refugee families huddled in unheated and unsanitary encampments. Reports of scurvy in northern Bosnia led U.N. officials to revise already dire warnings about the health and food emergency.
"We're deeply concerned -- if anything we underestimated the trouble in Bosnia," said Donald Acheson, the World Health Organization's special representative.
Medical authorities in Bosnia and Croatia have diagnosed 25 cases of typhoid among the Bosnian refugees who fled the central Bosnian town of Jajce when it fell to Serb forces Oct. 30, according to Fabrizio Hochschild, representative of the U.N. refugee agency here.
Typhoid cases have been identified among refugees in the central Bosnian towns of Zenica, Travnik and Tomislavgrad.
"It certainly qualifies as a major outbreak," Acheson said. "Today we have put out a warning to all appropriate authorities that drinking water in all war-affected areas must be boiled or purified."
Typhoid is spread almost exclusively by water or food that has been contaminated with sewage. Because it has a two-week incubation period, the extent of the outbreak among the highly mobile refugee population is unknown, but it is probably larger than the number of cases reported so far.
"It would be surprising if there weren't cases we don't yet know about," Achesen said, "particularly in Serb-controlled Bosnia."
Croatian medical authorities are worried enough about the outbreak to have announced they will relax restrictive border regulations and accept any Bosnian refugee stricken with typhoid for treatment at Croatian medical facilities.
Cases of hepatitis A have been reported in the Bosnian city of Tuzla, the towns of Zavidovici and Bihac and in a particularly grim refugee shelter in an abandoned sports hall at Posusje, near the Bosnia-Croatia border.
Acheson declined to give a number of hepatitis cases because any number "would be an underestimation." Hepatitis A often is contracted through water or food that has been contaminated with human waste. Under usual circumstances, prevention is simple -- boiling of all drinking water, and cooking or peeling of all vegetables and fruits.
But boiled water and cooked food is an impossible luxury for many of Bosnia's 500,000 displaced people, about half of whom are crammed into unheated school buildings and abandoned military barracks while they wait for the war to end or for a third country to take them in. Many of those facilities have no indoor plumbing, let alone hot water.
Doctors and refugee leaders also report a steady increase in the cases of pneumonia and tuberculosis. The size of the refugee population increased 10 percent in the past month, according to the United Nations refugee agency. U.N. officials said surveys of refugees arriving in central Bosnia from northern Bosnian town of Tuzla, now nearly cut off by fighting, showed evidence of severe malnutrition, including scurvy.
Achesen said U.N. estimates of Bosnia's food needs in September assumed populations would have some access to local produce. In most places, however, the fighting and displacement have been too intense for any harvest, he added.
War and the weather also are slowing the delivery of desperately needed food and building supplies by Western nations. Bosnia's tortuous mountain roads are already obstructed by snow, ice and disabled trucks. The main roads between the coast and the interior are still under artillery and tank fire, despite the week-old cease-fire.
Continuing assaults by Serb forces on the besieged towns of Travnik, Maglaj and Olovo have raised fears of a new exodus of 100,000 more Muslims and Croats from central and northern Bosnia.
Those concerns increased with news of the fall to Serb forces late Sunday of a string of Muslim-Croat defensive positions outside Travnik. Bosnian government radio, quoting Bosnian army sources, said Serb forces were moving infantry and weapons in Bosnia and Serbia proper in preparation for heavy fighting. The report said Serb forces were using the truce negotiated by all sides in Bosnia's seven-month war to regroup and redeploy.
