ASSISTANCE FOR LANDMINE SURVIVORS
Just as with the number of landmines in the world, the number of landmine survivors remains difficult to definitively answer. Even more daunting is trying to get a complete picture of landmine casualties. Victim profiles vary from country to country but what is consistent is that the vast majority of mine victims are civilians.
While mine victims are not a new phenomenon, what is new is the focus on landmine victims landmine survivors because of the dramatic growth in awareness of the problem generated by the global movement to ban antipersonnellandmines, remove the mines from the ground, and provide assistance to victims and victimized communities all over the world.
The ban movement is helping to generate a much broader understanding of the landmine problem and the problems of landmine survivors and mine-affected communities as a whole. The ban movement has also provided a framework for dealing with all aspects of the landmine crisis the Mine Ban Treaty. This first Landmine Monitor Report is helping to underscore the gaps in information about the mine-affected in the world.
The Mine Ban Treaty and Victim Assistance
The ICBL pressed hard to have language related to assistance to mine victims included in the Treaty. The Preamble recognizes the desire of states parties to do their utmost in providing assistance for the care and rehabilitation, including the social and economic reintegration of mine victims
Article 6 of the Treaty requires that each state party in a position to do so shall provide assistance for the care and rehabilitation, and social and economic reintegration, of mine victims and for mine awareness programs. Article 6 states the right of each party to seek and receive assistance to the extent possible for victims. This article implies a responsibility of the international community to support victim assistance programs in mine-affected countries with limited resources.
Data Collection Landmine Victims and the Numbers Issue
Concrete information on mine victims remains difficult to obtain. While the desire of the international community to more effectively address all the complex issues related to the landmine epidemic has resulted in increased efforts to systematically collect data on mine victims, information still is seriously lacking. At this point in time, the ICRC remains the single most complete source, having collected data since 1979 through 45 projects launched in 22 countries.32 Since 1979, the ICRC has manufactured over 120,000 prostheses for more than 80,000 amputees. In 1997, of the 11,300 prostheses made, 7,200 were for mine victims. Still, according to the ICRC:
There is a general lack of credible data on countries affected by mines. In places such as hospitals there may be a concentration of mine victims. However, data collected from hospitals concerns survivors of mine injuries; data concerning those killed and the impact on the victims family must be sought from elsewhere. Most accurate data has come either from the ICRC hospitals or specific study teams who have performed epidemiological surveys in affected countries .Such specific studies are not easily funded (they are not considered as aid) and gathering data may be a difficult and possibly dangerous task. Information may be intentionally withheld because of its political or military implications Accurate collection of data is the first step in addressing an epidemic. This epidemic is no different.33
The country reports in the Landmine Monitor have pulled together a range of information on mine victims and assistance programs. This first report indicates, for example, that the number of victims is dropping in a several high-risk countries. These include: Afghanistan, Bosnia, Cambodia, Croatia, Eritrea, Mozambique and Somaliland. Certainly this is encouraging information, but the reasons for the decreases need to be analyzed. The country reports offer some possible explanations, but research is not systematic, and the explanations are often speculative or non-existent. In some cases, such as Cambodia, the decrease might be attributable to the fact that the fighting has greatly diminished as much as to anything else. In other cases, it might be in part the impact of mine awareness programs; or how demining programs have been prioritized and carried out, e.g., focusing on demining sites for relocating refugees before their return diminishes casualties. A clear understanding of why the decreases have happened is important to program planning, in particular in order to apply lessons learned to other situations and diminish the number of mine incidents.
The insistence on clear data overall is not an esoteric exercise. It has practical implications. Statistics are important for the development of assistance programs and the specificity of information gathered has an impact on the types ofprograms considered. For example, if a significant proportion of the mine victims of a country are children, assistance programs should be different than if the number is relatively small. Better data leads to better use of scarce resources.
At the same time, there has been concern expressed that data collection -- in particular surveys of mine survivors --can do more harm than good if they proliferate and are not closely linked to action that is tangible to the survivor community.
Landmine Survivors: Needs and Assistance
The baseline data on mine casualties and survivors may be lacking, but the basic needs of mine victims everywhere are well known. These include:
emergency medical care
amputation surgery and post-op care
wheelchairs and crutches
assistance for non-amputee mine victims (blindness, deafness, other)
combating social stigma
returning victims to economic productivity
While the complexity of needs facing landmine survivors are known to many, the majority of resources provided for victim assistance go toward medical and physical rehabilitation. Far fewer resources support psychological rehabilitation and socio-economic reintegration despite the fact that without this support, landmine survivors too often lead isolated and unproductive lives. As one ICRC doctor reports, The focus of rehabilitation has continued to be on the physical aspects of disability. Physical rehabilitation goes some way to supporting young amputees psychologically. However, the need to furnish additional psychological assistance and help with finding a place in society has largely been neglected. Little data exists on what happens to mine amputees later in life. In some countries, amputees form gangs and turn on the society that has rejected them; in others, there is an unofficial family or clan-based form of support for handicapped people.34
Landmine Monitor country reports clearly indicate that the bulk of the limited resources allocated to mine victim assistance are for the immediate medical and prosthetic needs of the survivor; and of course, in many instances, in many devastated countries even these needs are not met. In Angola, for example, it is estimated that over 5,000 new prostheses are required every year just to cope with the existing amputees and this is more than twice the number currently being produced in the country. But in country after country, Landmine Monitor research shows a dismal outlook for landmine survivors:
Angola: [Amputees] future will consist of being cared for by their families
Somaliland: The majority of mine victims do not receive any post-operative assistance .in October 1998 in a single day, the Somaliland Red Crescent Society saw sixty amputees who needed help with obtaining mobility devices.
Sudan: Basic infrastructure and public services in southern Sudan are practically non-existent. Psychological and social support facilities for mine victims are inadequate if available at all ..
Colombia: Social and economic reintegration programs for landmine and war-disabled are virtually non-existent in Colombia.
Nicaragua: While there is some social security available, most victims receive support from their families.
Laos: There is no standard follow-up for amputees receiving prostheses from the six centers functioning in Laos.
Azerbaijan: Psycho-social or physical rehabilitation programs are almost nonexistent.
Croatia: There are no prosthesis workshops in Croatia Mine victims do not receive any special treatment compared to other disabled.
Trying to analyze the funds that are allocated for mine victim assistance programs is no easier than it is for mine action programs. Even when there are centralized efforts to gather data, as with the UN Mine Action Support Groups informal gathering of information on bilateral donor support for mine action projects, a definitive analysis of the data is not possible because there are no standardized criteria for reporting. The UNMASG fact sheet, one of the most comprehensive collections of information to date, offers data through November of 1998 but does not indicate time period covered, which may vary from country to country listed and which do not make clear the time periods covered by their donations.35 The same lack of consistency and transparency in reporting support for mine victims that plagues mine action support makes a clear picture almost impossible at this point. This is another area where the ongoing Monitor system will press for clarity.
But while the overall picture might be confusing, one aspect is very clear and that is that assistance to victims, as reported by the donors themselves, is significantly less than funding for mine clearance programs. The UNMASG fact sheet looks at bilateral support to 35 countries, from 16 donor countries and the European Union. Donors indicated whether money was, in broad brushstrokes, for mine clearance, training, mine awareness, or victim assistance. Of approximately $410 million in bilateral support, about $23.6 million went toward support of mine victims, in one form or another. This fact sheet is only one indicator, and clearly one full of gaps and confusions, but it does give a sense of proportions allocated to victim assistance and mine clearance by the major donor countries in the world on mine action.
Addressing Survivors Needs
Assistance to victims is generally part of a countrys overall health and social services systems, such as they are. In the countries most devastated by conflict, basic medical and social services, which are generally weak under the best of circumstances, are usually weakened even more or collapse completely. In such cases mine victims suffer as do all those seeking assistance. In some countries, the ICRC, NGOs, UN agencies and others have stepped in and become the only source of care for landmine survivors and other war victims. But the needs of landmine survivors are long-term. Countries should be supported in developing their own health and social services sector to be able to handle the problem for years to come just as with the mine clearance part of the equation.
Ideally, disability issues should be dealt with in the mandates of several ministrieseducation, labor and employment, social welfare, interior, financenot only the health sector. Such an integrated approach is necessary if the range of issues related to rehabilitation and reintegration of landmine survivors are to be addressed. In its support for such integrated care, the international community needs to find ways to ensure that people with disabilities have a voice in the decision-making processes that affect their lives and the lives of their families. Where international agencies have had to step in and offer services, they should work to make the programs local and autonomous, just as is the goal of humanitarian mine clearance agencies. The long and the short of it is the international community needs to do more and it needs to do it better.
Another aspect of this part of the problem is the definition of victim. Individuals physically injured by landmines must be a focus of assistance because they have suffered most violently and most directly. At the same time, it is recognized that a broader definition of victim is possible, and often desirable, and can include families of the physically injured and mine-affected communities as a whole. But using a broader definition for program planning should benefit families and communities without taking away from the complex needs of the survivors themselves. For example, a very broad-based community development program in a heavily mine-infested area should not be considered assistance to mine victims unless there are explicit provisions to address the disability-related issues in that community. Broad based community development programs have traditionally ignored the problems of persons withdisabilities (whether they be amputees or others)and such stigmatized and marginalized groups do not benefit unless they are explicitly built into the planning of the program.36
The new focus on the problem of landmines should be channeled toward victim assistance planning being integrated into national policies. Landmine survivors should not be segregated from other war victims or persons with disabilities. Support from the international community must focus on local capacity-building and medical-physical rehabilitation should be seen as a precursor -- and not the end point -- of complete rehabilitation and true socio-economic reintegration of survivors into the larger community. While there are no guarantees against stigmatization of landmine survivors and other people with disabilities, an indigenous, long-term integrated approach can begin to address the problem. Finally, the international community must consciously work to ensure that its own programs and support do not encourage or add to the stigmatization of landmine victims and their families.
If increasing aid has become a major challenge, a certain number of initiatives over the last two years have been taken to draw up recommendations and standards for action. Some examples include the Berne Manifesto, initiated by WHO, UNICEF, the ICRC and the Swiss government. The ICBLs Working Group on Victim Assistance, created in February 1998 and made up of nearly 25 NGOs, has also formulated Guidelines for Care and Rehabilitation of Survivors.
Accurate data gathering and tracking of corresponding assistance will not fill the gap between the needs of the victims around the world and the paucity of resources allocated to aid them. In April 1998, the Victim Assistance Working Group of the ICBL developed a matrix of costs associated with comprehensive rehabilitation of the individual landmine survivor. Members of the Working Group used their own field experience and survey results from WHO, UNICEF, the American Red Cross and others and generated a figure of $9,000 per survivor. The figure is derived from estimated costs of various types of assistance ranging from first aid, emergency medical care, and prosthetics and physical rehabilitation to psycho-social support and vocational training and employment referral support.
It is estimated that the number of landmine survivors in the world is 300,000; thus, the total figure for their comprehensive support would be approximately $3 billion. The ICBL has called upon the international community to provide these funds within a ten year period. The U.S. government has challenged the international community to raise one billion annually over the next decade to create a mine-free world. Certainly the survivors of this global crisis should be part of the challenge. A world free of mines, but not free of the suffering of their victims is hardly a goal to strive for.
32 ICRC website: www.icrc.org
33 Dr. Robin M. Coupland, Assistance for Victims of Anti-personnel Mines: Needs,Constraints, and Strategy, (Geneva: ICRC, August 1997), p. 5.
34 Ibid, p. 15.
35 Mine Action Bilateral Donor Support, 16 November 1998, provided by the government of Norway.
36 A parallel example: UNICEF funds programs which do not only target children, but they require clear baseline indicators, external evaluations, etc. that the programs do indeed benefit children.