- Name/s of institution(s) and any collaborating partner(s)
-Ministry of Agriculture and Environmental Protection
-Institute of Public Health of Serbia
-University of Novi Sad
- Country/Countries of focus (if global, please specify)
Republic of Serbia
- Relevant impact/s of climate change on health (see topics 1-3 above)
-Increased mortality during the summer heat wave (mostly cardiovascular and malignant neoplasms mortality)
-Increase of incidence of vector-borne diseases (malaria, dengue, West Nile virus, etc.), as well as the spread of waterborne diseases
- Description of the activity, including
- Research, analyses, tools, methods or approaches (that have been used or developed), etc.
-Monitoring results and research by Institute of Public health of Serbia
-Expert judgement based on the EU monitoring results and research
- Key results (including both quantitative and qualitative evidence)
During last decade Serbia faces with damage to human health related to observed climate change in both direct and indirect ways. During the summer heat wave on July 2007 increased mortality was recorded in Belgrade. It was found that as mean daily temperature increases over 90th, 95th and 99th percentiles, average number of deaths increases for 15.3%, 22.4% and 32.0% (Stojanovic et al., 2014). There were a total of 167 excess deaths between 16 and 24 July, 2007. People aged 75 years and older accounted for 151 (90%) of all excess deaths and increase of mortality among elderly was 76% in comparison to the baseline mortality. Cardiovascular and malignant neoplasms mortality accounted for the highest absolute numbers of excess deaths, 77 and 49, respectively, but the biggest relative increase in mortality was from diabetes mellitus (286%), chronic kidney disease (200%), respiratory system diseases (73%), and nervous system diseases (67%). Excess female mortality was over two times higher than excess male mortality (54%:23%) (Bogdanovic et al, 2013).
During floods that hit Serbia in May 2014, as a direct impact 51 casualties was recorded related to the floods and landslides, of which 23 drowned. An indirect threat of flooding was potential occurrence of contamination of surface water, groundwater and surrounding soils with hazardous materials and sewage. Heavy metals were released from mine workings to the Korenita stream in Loznica Municipality when a dam broke. Also, spring supply for Mali Zvornik Municipality was affected by heavy metals due to the groundwater level raising into old mine workings, and had to be taken out of service. Another indirect impact of this flood episode on health sector was that 15 municipalities reported that some of its health facilities had been damaged and several of them were temporally closed.
On the other hand, indirectly, climate change brings new challenges in controlling of infectious diseases. Climate change will definitely lead to a change of distribution and increase of incidence of vector-borne diseases (malaria, dengue, West Nile virus, etc.), as well as the spread of waterborne diseases, such as cholera and diarrhea. In 2012 Institute of Public Health of Serbia established a seasonal permanent monitoring of West Nile virus for human population. During summer season of 2012, total number of registered (probable and confirmed) cases was 71, including nine deaths that may be linked to West Nile virus. In 2013, 302 cases of West Nile virus infection were recorded by the end of October, as well as 35 mortality cases, which are approximately four times higher than for 2012. This large increase suggests that West Nile virus may represent a growing threat to human health in Serbia in the future. Beside West Nile fever, Lyme disease as well as malaria occurrence is increasing (Figure 1). In 2012, these two vector-borne diseases, closely related to climate conditions experienced mild decline, while the increasing trend six years before is obvious. For the first time in past several years, in 2012, was reported inflammation of the brain caused by a virus transmitted by ticks (four cases).
According to the relevant legislation, West Nile fever is not subject to mandatory reporting. However, taking into account the epidemiological situation of the disease in countries environment, the presence of house mosquito, Culexpipiens, which is the main vector of the disease in Serbia, the presence of reservoirs of infection (different types of birds) and the corresponding climatic conditions in summer, Institute of Public Health of Serbia (IPHS) in May 2012, forwarded to the municipal institutes methodological guidelines for establishing control over the West Nile fever.
Institute of Public Health of Serbia together with Republic Hydrometeorological Service of Serbia (RHMSS) introduced an early warning system in situations when extreme climate conditions threaten the health of the population. From the 1st May to the 30th of September, RHMSS will issue an alert to the possible occurrence of periods with extreme temperatures published on its website, but they will also forward the alert to the IPHS web site ( in order to take preventive measures to minimize the risk to the public health.
Moreover, analysis show following impacts of climate change on human health (modified -Maibach et al., 2011 and Kovats and Kristie, 2006):
Weather events / Health effects / Populations most affectedHeat Waves / -Premature death
-Heat-related illnesses such as heat stroke, heat exhaustion, and kidney stones
-Heat stress
-Excess deaths / Elderly, children, diabetes, poor, urban residents, people with respiratory diseases, those active outdoors (workers, athletes, etc.).
Poor air quality / -Increased asthma occurrence
-Increased chronic obstructive pulmonary disease (COPD) and other respiratory diseases / Children, those active outdoors (workers, athletes, etc.), elderly, people with respiratory diseases, poor.
Extreme rainfall and floods / 2Injuries
3Death from drowning
4Increased water-borne diseases from pathogens and water contamination from sewage overflows
5Increased food-borne disease / Residents in flood prone areas, elderly, children, poor, residents in the areas under the risk of water torrents
Wildfires /
- Death from burns and smoke inhalation
- Injuries
- Eye and respiratory illness due to fire-related air pollution
Droughts / -Disruptions in food supply
-Changing patterns of crops, pests, and weed species
-Water shortages
-Malnutrition
-Food- and water-borne disease
-Emergence of new vector-borne and zoonotic disease / Poor, elderly, children
Increased average temperature / -Increased food-borne disease, such as Salmonella poisoning
-Increased vector-borne disease such as West Nile virus, encephalitis, Lyme disease, etc.
-Increased strain on regional drinking water supplies
-Increased vulnerability to wildfires and associated air pollution / Children
Those active outdoors (workers, athletes, etc.)
Increased temperature and rising CO2 levels / -Increased allergies caused by pollen
-Increased number of cases of rashes and allergic reactions from plants such as weeds / People with respiratory disease, people with acute allergies, children, those active outdoors (workers, athletes, etc.)
- Include outputs of the activity (e.g. papers, publications, policies, etc.)
-Publications, National communication, workshops for stakeholders
- Potential challenges met when undertaking the activity, and how those have been overcome
-Law level of understanding of importance of the issues
-Insufficient reediness for inclusion of the findings into policies and actions in the sector
- Planned next steps (as appropriate)
Despite the reported progress in the area of monitoring of vector borne disease and development of early warning system on heath waves, important improvements are still needed. Therefore, deeper and more detailed analysis of impacts of observed and projected climate conditions and establishment of data basis, potentially in cooperation with World Health Organization are needed and planned.
- Good practices and lessons learned (as appropriate)
-Improvement of cooperation among stakeholders (more efficient involvement of Ministry of Health)is required
-Establishment of unique data base available to public is among the highest priority
-Raising awareness activities on continuous basis are required
- Relevant hyperlinks, including to information sources
- Contact details for further information
Danijela Bozanic, UNFCCC NFP
- Relevant pictures/graphics
Figure 1: Number of Lyme disease (left) and of Malaria tropica (right) cases in Serbia in the period 2006-2012 (source: Institute of Public Health of Serbia)