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Hidden Killers 1998: The Global Landmine Crisis Chapter V: Civilian Victims: Prevention and Response

"Near the start of this century, just 10 percent of wartime casualties were civilians. But as this century wanes, 90 percent of the casualties in contemporary conflicts are civilians."
                                     --Madeleine K. Albright, May 21, 1998

Notwithstanding current efforts by the world community to address the landmine problem, it is estimated that about 26,000 people a year are killed or injured by landmines. Civilians continue to bear the brunt of injuries and trauma caused by APL, and thus must be a focus of general international concern. The most critical need is to ensure that civilian populations are afforded every possible means to be made aware of the location, dangers, and proper precautions to take with respect to landmines and UXO in the ground. Second, every possible effort must be made to provide the survivors access to appropriate treatment and follow-up care to allow them to reintegrate into their societies. This chapter outlines the critical issues facing donors, governments and local communities as they address the needs of "at risk" civilian populations. It discusses prevention through mine awareness efforts, survivor assistance, reintegration of survivors into their communities and into society as a whole, and sustaining the infrastructure necessary to aid the survivors.

Mine Awareness

Mine awareness training, along with first aid training, can prevent or reduce the rate of deaths and injuries from landmines. The people most endangered by landmines are those who are not aware of their existence or the danger they present; those who are well aware of the danger, but do not know the appropriate response to the presence of a mine; and those who know the danger, but believe that they are obliged, based on necessity, to take risks. Some have argued that the quality of mine awareness training must be improved and be more robust. One authority has claimed that "the only measurements of programme success/failure have been the numbers of people reached by various programmes. These numbers tell very little about the effectiveness of the message." (footnote 1) The critique is based on his opinion that mine awareness training and materials, in some instances, have never been pre-tested; were not aimed at the visual and verbal literacy of the audience; were not age- and development-dependent; and were often ad hoc. Moreover, monitoring and follow-up were not considered as options. The construct of mine awareness training is changing, and, hopefully, the programs will shift from an emphasis on emergency response to an emphasis on early crisis intervention that engenders safe behavior at the village level. Mine awareness education should always accompany mine surveys and mine demarcation, mine clearance, and victim rehabilitation; these programs must, of necessity, be intertwined.

Survivor Assistance

Mine amputees in the poorest countries often leave the hospital without prostheses and return to their villages with little hope for the future. In some communities, the amputee returns as a burden on the family and on society, an outcast, and, depending on the tradition or culture, is marginalized with a lifelong stigma.

Numbers

Few countries have reliable data on the number of their disabled, not to mention landmine victims, which hampers the ability to properly plan resources. Data that assist planners in pinpointing specific areas of mine infestation are also often lacking, as well as data that link levels of affected populations with available services and resources. Data that are available typically reveal that male victims outnumber female victims by a significant margin. However, this difference may be simply a problem with reporting. It is often difficult for women to leave home and child care responsibilities to travel to a prosthetic center for the many weeks necessary for fitting and therapy. There may also be cultural inhibitions constraining such travel, as well as cultural biases that affect reporting.

Data and Their Risks

While there are many existing data systems that are attempting to capture the specific problems and critical issues associated with landmine survivors, there remains an urgent need to simplify and aggregate these systems and to ensure the consistency and usefulness of these efforts.

Overcoming Obstacles for the Productive Reintegration of Landmine Survivors into Social and Economic Mainstream

Landmine survivors face a wide array of challenges as they try to reclaim their lives. These include:

• Injuries and infections requiring first aid, surgery, and medical services.
• Disabilities requiring orthopedic services and facilities (prosthetics, orthotics, physical rehabilitation, etc.).
• Acute and lingering psychological and emotional problems requiring counseling.
• Basic human rights requiring special protection, national disability laws and policies, etc.
• Child amputees facing problems different from those of adults. During their years of rapid growth, children need more prosthetics, more adjustments to their prosthetics, and more therapy than adults; and children have special social and psychological needs that require tailored assistance. Moreover, the collapse of public health systems has allowed polio to spread unchecked, leaving another legacy of children who need orthotic devices and therapy.

Sustainability

As the number of mine victims increases every day, the services and institutional networks that provide for mine victims will have to be sustained for many years into the future. Creating and strengthening these systems also provide capabilities for coping with the needs of people disabled from deformities, traffic accidents, and other non-war-related causes(needs that would otherwise be neglected.

Developing countries trying to cope with these legacies typically have severely limited finances, no institutions capable of developing effective programs, and few technically and professionally trained personnel able to manufacture prostheses and orthoses or implement the programs needed to reach war victims. In some of these countries, transportation systems that were not well developed prior to the conflict were heavily damaged during the conflict. Services, therefore, must be decentralized and outreach programs offered to help the disabled obtain access to these programs.

Organizations that implement and support these services typically take some time to develop. They include central and local governments, NGOs, and advocacy organizations. NGOs tend to play a critical role, either because the local health authorities allocate more money to contagious and other disease programs or because the ministries lack technical capabilities in prosthetics. If the array of prosthetic service organizations is unevenly developed or unevenly effective, more advanced components may operate well below capacity, hindered by the relative ineffectiveness of related services.

There is a fundamental distinction between providing emergency or immediate response and long-term, sustained support systems. The distinction is reflected in the configuration of the international response system and the roles played by different assistance agencies. The ICRC is the principal international organization geared to rapid entry, even while conflict is still underway. The ICRC has been a technological leader. It introduced a polypropylene-based prosthesis that is gradually becoming a standard for use in mine-affected countries. The ICRC normally exits a country within two to four years after the end of hostilities, when the general emergency phase of the peace process is concluded, leaving behind at least a central working facility for production of prosthesis components and sufficient trained staff to keep the facility in operation.

Given the need to rapidly develop a capability to serve many more amputees than can be reached by an ICRC facility alone, there has usually been an international NGO response as well. The NGO facilities focus more and more on outreach, fitting, therapy, and other related services, relying on a central production workshop (established in most cases by the ICRC) for the standard prosthesis components.

The need for a larger world response is undeniable. It is commonly accepted that there are at least 300,000 mine-survivor amputees in developing countries and that an additional 2,000 of these victims are dying every month from complications caused by their original landmine injuries. Making some reasonable assumptions about the distribution between children and adults, these countries would need to produce and fit about 150,000 prosthetic limbs annually to meet the replacement needs of those already fitted and initial limbs for new victims. The actual need for future years is substantially higher, as a significant portion of that 300,000 has received no prostheses or has been fitted with unsatisfactory makeshift devices. Today, the total fitting capacity in these countries is roughly 35,000 limbs per year, less than one-quarter of the annual requirement, even without accounting for victims still waiting to be fitted with an initial (or adequate) prosthesis. The world has a long way to go before the primary objective of restoring and sustaining the mobility of mine victims will be met.

Footnotes

1. Stuart Maseln, "A Report for the United Nations Study on the Impact of Armed Conflict on Children," http://www.un.org/depts/landmine/newsletter/1_2/maslen.htm, February 27, 1998.

[End of Document]

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