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Karadžić was voted President of Republika Srpska, the Bosnian Serb administration, in Pale on about after the breakup of the Socialist Federal Republic of Yugoslavia.

In 1983, Karadžić started working at a hospital in the Belgrade suburb of Voždovac.

After the Bosnian parliament voted on sovereignty on 15 October 1991, a separate Serb Assembly was founded on 24 October 1991 in Banja Luka, to exclusively represent the Serbs in Bosnia and Herzegovina.

The following month, Bosnian Serbs held a referendum which resulted in an overwhelming vote in favour of staying in a federal state with Serbia and Montenegro, as part of Yugoslavia.

The party aimed at unifying the Republic's Bosnian Serb community and joining Croatian Serbs in leading them in remaining as part of Yugoslavia in the event of secession by those two republics from the federation.

Throughout September 1991, the SDS began to establish various "Serb Autonomous Regions" throughout Bosnia-Herzegovina.