Ratko Mladić, the Serb warlord who terrorised Bosnia in the 1990s, was on Wednesday forcibly removed from court after a shouting outburst delayed the reading of the verdict in his trial for the last genocide committed in Europe.

The long-anticipated verdict was previously delayed for half an hour after Mladic asked the judge if he could take a short bathroom break.

The delay was extended as rumours began to circulate that the former Bosnian Serb commander, who had appeared healthy when sitting in court, had suddenly been taken ill.

As he entered the ICTY courtroom, Mladic had infuriated relatives of the victims as gave a broad smile and gave a thumbs up to the cameras.

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Mladić, who was commander of the Bosnian Serb army during the 1992-95 Bosnian conflict and for several years was one of the world’s most wanted fugitives, is now 74 and in poor health. His lawyers have argued he is not well enough to hear his verdict and sentence in person, but it is not clear whether they will seek a last-minute postponement. A judge has already rejected a defence effort earlier this month to have the judgment put off.

The trial in The Hague, which took 530 days spread over more than four years, is arguably the most significant war crimes case in Europe since the Nuremberg tribunal, in part because of the scale of the atrocities involved. The International Criminal Tribunal for the former Yugoslavia (ICTY) heard from 591 witnesses and examined nearly 10,000 exhibits concerning 106 separate crimes.

Legal scholars say Mladić is almost certain to be found guilty of genocide for the massacre at Srebrenica in July 1995, where more than 7,000 Muslim men and boys were killed, most by summary execution. The Bosnian Serb political leader, Radovan Karadžić, was convicted of genocide last year for his role in the Srebrenica killings. Mladić was shown on video giving orders to his troops as the army-age men and teenage boys were separated from their families, shortly before the executions began.

“He is definitely the personification of evil for many, many survivors and victims and that’s why this trial is so important – because it gives a certain sense of justice to people who have been have waiting for this moment for many years,” Serge Brammertz, the ICTY chief prosecutor, told the Guardian, on the eve of the verdict.

Brammertz oversaw the successful hunt for Mladić during the general’s last years in hiding and then his marathon prosecution.

He said: “The Mladić case has definitely been one of the most important cases at this tribunal. He was been on the run for many years, and I remember when I started in 2008, everyone was quite pessimistic about the chances of getting Mladić ever arrested.”

Facebook Twitter Pinterest A Bosnian woman offers prayers at the Potocari memorial near Srebrenica. Photograph: Dimitar Dilkoff/AFP/Getty Images

The Bosnian Serb military leader was first indicted in 1995 but the Nato allies who sent peacekeepers to Bosnia after the war initially had little interest in arresting him, fearing it could only be achieved with a major battle and significant bloodshed.

After UK, US, French and German special forces stepped up their efforts to hunt war criminals in 1997, Mladić went into hiding, eventually withdrawing to Serbia, where he was sheltered by the army.

Brammertz said it was European solidarity in demanding Serbia hand over war crimes suspects on the ICTY list before Belgrade could even begin talking about financial aid and eventual EU membership, that eventually led to his arrest. He was found by Serbian police, living in squalor in May 2011, in a cousin’s village home near the border with Romania.

The Mladić trial is the last major case to be heard by the tribunal, an ad hoc experiment in justice established by the UN security council, that is now winding down.

In Bosnia, the verdict will be closely watched to see if Mladić is found guilty of genocide on another count, concerning mass killings elsewhere in Bosnia outside Srebrenica, particularly in Prijedor, where Bosnian Serb forces ran horrific prison camps and murdered thousands of Muslims and Croats.

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Karadžić was found guilty of crimes against humanity for mass murder in locations apart from Srebrenica, but not for genocide, which caused outrage among Bosniaks (Bosnian Muslims) who have been seeking acknowledgment from the tribunal that genocide was committed across the country.

There was also fury that Karadžić was sentenced to 40 years rather than life imprisonment. Any sentence less than life for Mladić is likely to trigger protests from survivors and victims’ families.

In Serbia and the Serb-run half of Bosnia, the ICTY trials have done little to change the minds among nationalists, who still see Mladić as a war hero and increasingly deny Serb responsibility for the mass murders of the Bosnian war.