The problem of landmine victim assistance
A current estimated 300,000 mine victims struggle to survive with minimal assistance from their communities,governments and the international community. A boy in Angola.
Credit: MAG/Sean Sutton
The world faces a tremendous challenge in how to assist the survivors of landmines whose lives and often the lives of their families have been shattered with one explosion. Each year there are between 15 and 20,000, most innocent civilians, either killed or wounded by landmines. Casualties have been reported in more than 60 countries across the globe.
The purpose of a landmine is to wound a person in a conflict situation rather than kill them so they become a burden to those who have to support them. In war this means a burden to an army or a militia, but in peace it means a burden on a family or a community, often for life.
"The difficulties start with receiving adequate emergency care, getting an ambulance to come and being able to receive a blood transfusion, medicine and doctors," said Sue Wixley Spokeswoman for the International Campaign to Ban Landmines (ICBL).
One of the main topics slated for the Nairobi Summit on a Mine Free World is victim assistance, something that critics of the mine treaty say is sorely lacking. Organisers say that this will be the first disarmament convention to look at the plight of the victim and his or her right for help, illustrating a new type of disarmament diplomacy.
"The issue of landmines is all about people, real people and about how we can work together to avoid future mine victims. What is remarkable is to see the changed level of behaviour worldwide as a result of the campaign and treaty, in relation to landmines the international behavioural norm has spread far beyond the 143 member states," said Ambassador Wolfgang Petritsch, chair of the Nairobi Summit.
"Even among non-signatories mines have become less acceptable and we see levels of use and production reducing dramatically worldwide. A real change in attitude has taken place - and this is remarkable. We are really on the way to altogether ban and eliminate one kind of vicious weapon from the earth," he said.
More than 300,000 people live with mine-related injuries, according to the 2003 Annual Report of Landmine Survivors Network, an organisation created for and by landmine survivors. For many of these victims, whether they live in Afghanistan, Angola or Mozambique proper assistance does not exist. The 30 countries in the world with the most severe landmine and or unexploded ordnance (UXO) problems are also among the poorest in the world.
Mine-affected countries suffering from conflict or going through post-conflict reconstruction face immense challenges in providing adequate assistance for their victims. With buildings looted or destroyed, no water, electricity and sewage systems, blocked supply lines and patient access, the difficulties can look insurmountable. Failing economies and weak governments are a weight on struggling healthcare systems. Security, too, is a major issue with aid workers in conflict areas sometimes targeted by violence.
"The needs for landmine victim assistance are immense. It is not at all sure whether we are going to succeed or not in our mission," Stan Brabant, head of the Mine Policy Unit, Handicap International Belgium told IRIN.
The Landmine Monitor Report 2003 identified over 11,700 new landmine victims in 2002. Of this number at least 2,649 were children, a staggering 23 percent. More than 85 percent were innocent civilians.
"It is important to remember, however, that the 11,700 figure represents the reported casualties and does not take into account the many casualties that are believed to go unreported, as innocent civilians are killed or injured in remote areas away from any form of assistance or means of communication," said the report.
Collecting accurate information on landmine/UXO victims can be difficult, especially in areas where conflict is taking place, remote areas or in countries where there are no means to monitor public health records. Organisations have to rely on government records, databases, hospital records, local media reports and more to identify new casualties, said the report. What needs to be done?
Some experts say a major safety element for people is awareness. Minefields will not disappear tomorrow and people are forced to live and work around them. If they know where the mines and UXOs are and the danger they pose, then communities can carry on with life but armed with information to help them.
"UNICEF's mandate is about mine education," said UNICEF Sudan Project Officer Una McCauley. "Mines are terrible things. If you know where they are and what they can do you can make a decision."
The lucky few will receive appropriate limb replacement; even fewer have any chance of rehabilitation assistance.
There are several different ways to spread the word about mines and UXO's. One is directly through villagers. Another effective option is to work with the agencies that work with mines. If these people know about the risks then they can provide information on the ground. Often people in mine areas are illiterate and have no access to radios. Aid workers tend to be the best vehicle to get the word out.
"We have been targeting the youth," said McCauley. "We have to give them accurate information so they have a sense of value about their lives. The youth take unnecessary risks and at least we can tell them the risks are there."
Youth skills are targeted at parents too so that families are educated about mines and UXO's. "We want to say: 'don't be terrified but know what's out there'," said McCauley.
The International Campaign to Ban Landmines (ICBL) has worked to strengthen the Ottawa Treaty by creating guidelines for victim assistance and has offered recommendations for emergency medical care, physical rehabilitation, prosthetics, and psychological and social support. It also has looked at employment and economic integration for mine victims.
The ICBL has also been pushing for further public awareness about mine victims and accessibility in public places for persons with disabilities. It says there are few funds or organizations willing to work on these areas.
Many countries lack the psychological support that is needed for victims. The process of reintegration and trying to become a part of their community can be overwhelming for a victim. Often they find they are being rejected and dismissed by the prejudices of non-disabled people.
"Women have reported that they are no longer able to marry because they are rejected from their community. Some even have to become beggars to survive. If they are lucky they can become part of income generating programmes," said the ICBL spokeswoman. Access to assistance
Mines cause the severest of injuries and it is important for a victim to receive immediate and appropriate attention. There are three patterns of mine injuries. If the mine is stepped on while buried, it can tear off the foot or the leg. A fragmentation mine that is detonated via a trip wire can cause multiple injuries on the body. Mines can also blow off fingers, hands or parts of the face when handled. Blindness and injuries to the chest or abdomen are also common.
Often, even if assistance is available to a victim, access can be extremely limited. According to the Landmine Survivors Network, fewer than 10 percent of all the landmine victims have access to proper medical care and rehabilitation facilities. On top of this, a majority of care centres are located in urban areas, while victims tend to be in rural regions where most of the mines are laid.
"In Angola, victims sometimes have to walk between 100 and 200 km in order to get access to the closest centre with basic heath care. Many of them do not make it, and are left to die on the road," Brabant told IRIN.
Experts say that one possible solution is to provide assistance on a provincial level, creating a balance between cities and more rural areas.
"The difficulties start with receiving adequate emergency care, getting an ambulance to come and being able to receive a blood transfusion, medicine and doctors," said the ICBL spokesperson. Afghanistan is one of those countries where victims have to be carried or spend hours of riding on a donkey to get to the health care facilities.
"After the operation (if one is performed), extensive ongoing rehabilitation is needed, they are in need of prosthetics, they have to pick up their pieces, and try to manage their life after the accident. Often they do not have the money for public transport to the clinics," she said.
Margaret Arach Orech knows all about the problems facing landmine victims. She was severely wounded in an ambush by the Lord's Resistance Army in Uganda in 1998 when the bus she was travelling hit a mine. She lost her right leg.
"My family gave me all the support after the accident. My friends took off. I was abandoned. Not all, but some in my village thought I have had bad luck and the accident was a punishment for something wrong that I did. Why me? To this day I have not yet seen some of my friends," she told IRIN.
Age is no barrier to the deadly harvest of landmines. In Cambodia two young boys fall victim but receive state of the art prosthetics from the ICRC.
"The types of victim assistance that is lacking the most is economic integration and socio-economic support, so that landmine survivors may regain their position in society socially and economically as a way of improving their lives," she said.
Orech points out that landmine victims are in great need of psychological support, and that it is just as important as physical rehabilitation but often not recognised.
Afghanistan has one of the world's highest number of landmine victims and the country has hardly reintegrated its hundreds of thousands of disabled war victims. More than a million people are living with disabilities in Afghanistan, and of that figure at least 250,000 people are victims of landmines and UXOs. This number is still rising, at least 40 people fall victim each month, as people return to their villages, some which were on frontlines. Several years ago that number was as high as 300 to 400 a month during wartime.
Landmine victims face a lifetime of difficulties. Even if they are lucky enough to have had surgery or prosthesis they then have to move back into a society that might not accept them. Often they have difficulty in finding work - the unemployment rate for survivors can be anywhere from 40 to 60 percent.
Again, effective and accurate data collection is necessary in order to efficiently utilise scant resources. Even if a country has facilities sometimes it is unclear whether victims have access to them or if they are sufficient for victims needs. Who has responsibility?
Currently 143 countries have acceded to the 1997 Ottawa Treaty and by doing so have sworn to never use, develop, produce, otherwise acquire, stockpile, retain or transfer anti-personnel mines.
Two deadlines are imposed on signatories, the first is to destroy their stockpiles four years after they acceded to the treaty and the second, to clear mines in their territory within 10 years after it was ratified. In addition, there are particular obligations that signatories are responsible for: mine risk education and for victims health, including rehabilitation and reintegration into their communities.
Because the number of landmine victims increases every day, and their needs are long lasting, there is no deadline for victim assistance. Signatories also undertake to prevent any activities that are in contravention of the treaty and to adopt implementation measures (such as national legislation) in order to ensure that the terms of the treaty are upheld in their territory. Significantly, states party to the treaty cannot allow non-signatories to keep landmine stocks on territory under their jurisdiction or control.
The Ottawa Treaty, which states that the signatory parties are to do their utmost to provide assistance for the care and rehabilitation, including the social and economic reintegration, of mine victims. However, advocates for landmine victims say since the treaty was signed, the signatory governments have dropped their responsibility concerning victims. They say landmine survivors are not a priority as compared to victims of HIV/AIDS and Malaria.
"Countries in Africa are beginning to take responsibility, but the needs of the victims are overwhelming and structures need to be developed. The treaty provides a mechanism for victim assistance, but it cannot respond to all needs," Brabant told IRIN.
In the absence of national governments providing assistance, the Anti-Personnel Mine Ban Convention states that assistance may also be provided through the United Nations system, international, regional or national organisations or through non-governmental organisations. Who helps the victims?
The United Nations Mine Action Service (UNMAS), established in 1997/8, is responsible for the coordination of all mine action service within the UN system. In addition to UNMAS, a number of UN agencies work assisting victims. Among them, the United Nations Children's Fund (UNICEF) focuses on the rehabilitation of survivors.
There are a variety of organisations that actively contribute to providing assistance for landmine victims.
Handicap International, specifically their French and Belgian divisions, have assisted landmine victims for 24 years, developing and advocating appropriate technology and a policy for public health covering a whole spectrum of disabilities.
For many victims the situation is as hopeless in 2004 as it was 10 years before. Mine victims need more help.
Credit: MAG/Sean Sutton
The International Committee of the Red Cross (ICRC) provides surgical and physical rehabilitation programmes for landmine victims. The ICRC supports hospitals that provide artificial limbs to survivors, first aid services and material, training and financial support to increase a victim's chances of surviving until arrival at a hospital.
The ICRC also provides mine action programmes. Between 1999 and 2003 artificial limbs were distributed to 48,000 hospitals supported by the ICRC. Through their Special Fund for the Disabled, centres were able to assist thousands more mine-injured people with prosthesis and more than 4,000 people could receive first-aid services in conflict zones.
The Landmine Survivors Network is an umbrella organization that collaborates with non-governmental organisations involving victim assistance. They work to improve the health of mine victims, increase their opportunities in life and strengthen their rights. Funds for assisting the victims
Funding for victims assistance comes from an array of donors. National governments, the European Union, the World Bank, various corporations and aid organisations all contribute. Funding either is paid through the UN system or through aid groups working directly with the victims.
"The funding has risen but it is still not enough and in many cases we are facing bureaucracy that disables the funding to be channelled to the target group 'the victims," said Brabant.
Often there is not enough funding to follow-through with a patient. Emergency funding runs out leaving the victim short-changed as needs still remain.
"Two years after my first prosthetic limb could no longer fit and I needed a replacement. I was unable to get this as the only functioning orthopaedic centre located in northern Uganda had run out of funding. I waited after it got funding to resume work," Margaret Arach Orech told IRIN.
To try to solve this problem the ICRC began the Special Fund for the Disabled in 1983. The fund is intended to carry on helping victims even after the organisation ends operations in mine-affected countries. In 2003, the Special Fund for the Disabled assisted 35 projects in 16 countries and delivered more than 6,500 prostheses to amputees.
Organisers of the Nairobi summit recognise that there has not been sufficient assistance directed to mine victims in recent years. Martin Barber, the senior director of UNMAS, admitted that there had been little focus on mine victims in the past but that this would change. He told IRIN, "There is going to be a big focus on mine victims at Nairobi. There's going to be a survivor's summit the morning of the 28th November where 50 to 60 landmine survivors will meet some key senior political officials from a dozen countries and have a dialogue."
Some critics are less forgiving of the treatment of mine victims. Rae McGrath, co-laureate of the 1997 Nobel Peace Prize claims, "The world has done nothing for mine victims. Go to any affected community and ask them how excited they are about what has happened since the 1997 treaty - they would look at you blankly."
Organisers and delegates alike are clearly expecting a lot from the Nairobi summit, where approximately 600 representatives will converge in Kenya at the end of November. How they address the issue of mine victims is high on the agenda and mine victim agencies around the world will be looking forward to concrete commitments for future support.