Maintaining blood supply during war and siege conclusions from experience in Sarajevo, Bosnia-Herzegovina

During the war and siege of Sarajevo (1992-1995) two key principles guided the work of the Blood Transfusion Institute in ensuring sufficient quantities of safe blood: Firstly, blood must wait for patients, not patients for blood. And secondly, the staff of the Blood Transfusion Institute had to take the risk of being shot, not the blood donors. Our work mainly focussed on ensuring sufficient quantities of whole blood by mobilizing blood donors. As a result of our experience, we make recommendations for war/siege blood policy. After the war (1995), we developed three medium-term strategies to deal with the complex changing environment. The strategies focused on the continuation of blood donor motivation, the provision of safe blood components, and the management of blood services. A very important aspect is to have a decentralized system for blood supplies.