In Serbia, the emergency medical services (EMS) system operates in a dangerous legal vacuum—not a result of administrative oversight, but of deliberate institutional inaction. For over five years, the Serbian government has failed to enact critical regulations that would ensure timely and equitable access to emergency care, leaving citizens vulnerable to preventable tragedies. On April 19, 2020, my wife Merita collapsed at home in Belgrade, soaked in cold sweat, barely able to speak. I called the EMS, my voice trembling as I described her history of pulmonary embolism. No ambulance came. I was told to call the local health center—during a police curfew that trapped us at home. The health center refused to send help, saying it wasn’t their responsibility, and advised me to call again with specific phrases like “she’s choking, chest pain” to force a response. In a desperate second call, I exaggerated her symptoms to secure help. Over 40 minutes later, the ambulance arrived—too late. Merita died in Belgrade’s Urgent Center. Our son, Đole, then five years old, watched the ambulance leave from a window. I wrote to officials, demanding answers. No one replied. That silence birthed the “Right to Life – Meri” movement, a vow to spare others our pain.
Merita’s story is not unique. On December 29, 2024, the parents of nine-year-old N. U. called the EMS in a panic as their daughter struggled with critical symptoms, including severe breathing difficulties. Instead of dispatching a team, the EMS operator insulted the family, telling them to “take a taxi” to the hospital. With no other options, the parents rushed N. U. to care themselves, but the delay cost her life. These are just two examples among dozens of testimonies collected by our movement—heart-wrenching stories of families left to fend for themselves when they needed help most. Behind each case lies a systemic failure rooted in Serbia’s refusal to regulate its EMS, a failure that has turned the right to life into a privilege for the few.
A System That Doesn’t Exist
In 2019, Serbia’s parliament passed a law requiring the Ministry of Health to establish clear rules for the organization and operation of EMS within 18 months—a provision known as Article 83, Paragraph 4 of the Health Care Act. This law was meant to ensure that every call for help receives a timely and standardized response, regardless of where a person lives or their financial status. Five years later, the Ministry has failed to enact these regulations, leaving the EMS in a legal void. In 2021, the Ministry acknowledged this gap in an official response (No. 500-01-113/2021-16), admitting the need for rules to govern EMS operations. Yet no concrete measures have followed. Over the past five years, at least four working groups were formed to draft these regulations—some never held a single meeting, while others dismissed proposals from advocates like us.
The consequences are devastating. In Serbia’s four largest cities, EMS responds to only 19.1% of 886,025 annual calls, leaving over 700,000 pleas for help unanswered. By contrast, Montenegro, a smaller nation with fewer resources, achieves a 77% response rate. Meanwhile, 39% of Serbia’s territory—mostly rural areas—has no EMS coverage at all, effectively excluding entire communities from life-saving care. This isn’t just a failure of logistics; it’s a betrayal of the public’s trust in a system meant to protect them.
Emergency Care as a Privilege
Without standardized protocols to guide how calls are prioritized, decisions about dispatching EMS teams are left to the subjective judgment of the healthcare worker answering the phone. A study conducted by our movement revealed stark inconsistencies: the same symptoms—chest pain, difficulty breathing—were deemed non-urgent in one case but a top priority in another. This lack of uniformity creates a lottery of life and death, where the outcome depends not on medical need, but on the arbitrary assessment of a dispatcher. For rural citizens, the elderly, or those without access to private healthcare, this inconsistency often means no help at all—a form of systemic discrimination that violates the basic principle of equal access to care.
Healthcare Resources in the Service of Profit
While citizens are left waiting, EMS institutes like the one in Belgrade generate millions in profit from commercial activities. Documents obtained by our movement show that Belgrade’s EMS earns over 20 million dinars annually (approximately $190,000) by providing services at events like concerts, sports tournaments, and trade fairs. In one instance, EMS teams meant for emergency calls were assigned to a Final Four basketball tournament for 11 days before and after the three-day event, leaving the public system understaffed. These teams, funded by taxpayer money through Serbia’s public health insurance system, are diverted to profit-driven activities while calls to the 194 emergency line go unanswered.
Double Standards: Private Clinics vs. Citizens
The disparities deepen when it comes to private healthcare. Contracts with private clinics guarantee that an EMS team will respond to every call, no questions asked, regardless of medical urgency. Yet ordinary citizens calling 194 are routinely denied help, often told their symptoms don’t warrant an emergency response. This creates a two-tier system where access to life-saving care depends on financial status rather than medical need. Even more troubling, EMS teams are often kept on standby for hours, waiting for potential calls from private clinics. During this time, they are unavailable to the public, increasing wait times and endangering lives. For those who can’t afford private care, the system offers little more than a roll of the dice—a gamble that too often ends in tragedy.
Systemic Impunity of Health Inspections
This crisis is compounded by a culture of impunity. Serbia’s health inspection, tasked with holding EMS institutes accountable, has failed to act. Under Serbian law (Article 258 of the Health Insurance Act), the inspection is required to file misdemeanor charges against healthcare institutions that fail to provide emergency care. Yet, in response to a freedom of information request, the inspection revealed a shocking truth: from 2020 to 2024, not a single charge was filed against the Belgrade Institute for Emergency Medicine, despite documented cases of death due to non-response. Instead, the inspection relies on internal reviews or external opinions, which lack the legal weight to enforce accountability.
The Ombudsman, Serbia’s independent body meant to protect citizens’ rights, has also failed to act. In one case, our movement filed a complaint (Ref. No. 10025) highlighting systemic failures in EMS response. The Ombudsman dismissed it without investigation, effectively shielding authorities from scrutiny. Meanwhile, the Republic Health Insurance Fund (RFZO), the only body legally authorized to retroactively assess whether an EMS intervention was justified, is sidelined. Dispatchers make snap decisions about urgency based on call recordings, bypassing the RFZO’s mandated role and rendering its oversight meaningless. This systemic refusal to enforce accountability ensures that no one is held responsible for the lives lost.
Call Recordings: Evidence the System Ignores
When a call to 194 goes unanswered, the only record of that plea for help is the audio recording of the conversation. These recordings are critical—they’re used by authorities to assess whether an EMS response was justified, often determining whether a dispatcher or institute faces scrutiny. Yet the Ministry of Health claims these recordings are not official medical documentation, meaning families have no legal right to access them. This is a grave injustice. If a recording is used to absolve the system of responsibility, it must also be available to families as a tool for seeking justice.
Under Serbian law, the RFZO is supposed to evaluate the urgency of a call after an intervention occurs, ensuring fairness and accountability. But in practice, dispatchers make unilateral decisions based on the call, decisions that lack legal weight to justify non-responses. By denying families access to these recordings, the system protects itself while leaving citizens without recourse—a clear violation of their right to a fair process and effective remedy, as guaranteed by international human rights standards.
Violation of Article 2 of the European Convention on Human Rights
The European Convention on Human Rights (ECHR) obliges states not only to refrain from taking life but to actively protect it. Article 2 of the ECHR, which guarantees the right to life, requires governments to establish an effective EMS system with timely responses, transparency, and accountability mechanisms. Article 13 ensures the right to an effective remedy when those protections fail. Serbia’s government is failing on both counts. The European Court of Human Rights has repeatedly ruled that states must take positive steps to safeguard lives, including regulating emergency services. When a state ignores warnings, fails to regulate EMS, and refuses to sanction institutions that deny care, it breaches its obligations under international law.
In Serbia, the absence of regulations—despite a clear legal mandate in 2019—creates a deadly gap. The Ministry of Health’s inaction has left the EMS without standards, oversight, or consequences for failure. This isn’t a technical oversight; it’s a systemic violation that has led to countless preventable deaths, each one a breach of the state’s duty to protect its citizens. Serbia’s failure to act not only undermines its own laws but also its aspirations to join the European Union, which demands adherence to human rights standards as a condition of membership.
Solutions Exist, Political Will Does Not
Other countries in the region prove that a functional EMS system is possible. Montenegro has established dispatch centers that record calls and achieve a 77% response rate, ensuring most citizens receive timely care. Croatia uses triage algorithms to standardize responses, minimizing subjectivity. Bosnia and Herzegovina has implemented transparent oversight mechanisms to hold EMS providers accountable. These examples show that the tools to save lives are within reach—but Serbia’s leaders lack the political will to act. The legal vacuum is not a technical error; it’s a choice, one that prioritizes profit and power over people.
Global Implications: A Warning to All Nations
Serbia’s crisis is a stark reminder of what happens when healthcare systems are left unregulated. The right to life, enshrined in international law, becomes a hollow promise when governments fail to enforce it. This isn’t just a Serbian problem—it’s a warning to any nation that allows legal gaps to erode public services. In an era of global health challenges, from pandemics to aging populations, ensuring equitable access to emergency care is more critical than ever. Serbia’s failure to act should prompt other countries to examine their own systems, lest they repeat the same mistakes. For Serbia, the path to EU membership hinges on proving its commitment to human rights—a commitment that, so far, remains unfulfilled.
The Right to Life Is Not a Luxury
Systemic failures are not abstract—they are measured in lost lives. Of 886,025 calls in Serbia’s four largest cities, over 700,000 went unanswered. Behind each number is someone’s mother, father, child, or neighbor who never received the help they needed. Merita, my wife, was one of them. Nine-year-old N. U. was another. And there are dozens more—families who have shared their stories with our movement, each one a testament to the human cost of neglect. These are not isolated incidents; they are the inevitable result of a system designed to fail the most vulnerable.
A state cannot remain a silent bystander while its citizens fight for their lives. Serbia must enact the long-overdue regulations, accredit EMS institutes, establish clear triage protocols, and punish those who fail to respond. These are the first steps, but they are not enough. The right to life must be protected by laws, not left to the whims of dispatchers, internal reviews, or the interests of those who see healthcare as a profit opportunity. Because if the system fails to protect the most vulnerable, it is no longer a system—it is organized neglect. And when a state does not protect the right to life, it becomes complicit in its loss.
A Call for Testimony and Justice
This is not just a matter of law, but of conscience. The time for silence is over. If you or someone close to you has experienced the tragic consequences of an EMS failure—whether a non-response, a delayed arrival, or a refusal to help—your story is not alone. We invite you to contact the “Right to Life – Meri” Movement so your experience can be documented and contribute to the fight for systemic change.
Your voice can become part of the evidence of systemic failures. Your testimony can help ensure no other family endures the same silence, the same emptiness, the same injustice Merita’s family and N. U.’s family have faced. Because the right to life does not end with an unanswered call—it begins with the responsibility of all of us.
Because the right to life does not end with an unanswered call—it begins with the responsibility of all of us.
