The Reintegration of Landmine Survivors in Mine-affected Northeast Albania
by Melanie Reimer [ Consultant ]
The Albanian Mine Action Executive is the mine-action coordination center in Albania responsible for coordinating and monitoring all mine-action activities in the country. AMAE and the government of Albania has established a concrete victim-assistance strategy and plan outlining targets and goals to be achieved by the year 2009. Albania is one of the few States Parties that is included in the United Nations-led completion initiative and aims to achieve its Article 5 obligation of the Ottawa Convention1 by 2010.
Typical house in a mine-affected region in Albania.
All photos courtesy of the author
During the Kosovo conflict of 1999, landmines and unexploded ordnance were emplaced and cast along the 120-kilometer (75-mile) Kosovo/Albania border and up to 20km (12 miles) inside of the northeast Albania region of Kukes, affecting a total area of 15,250,000 square meters (3768 acres). As a result, approximately 25,500 inhabitants have been unable to access their land, and records show that 238 civilians have been injured and 34 have died. In an area where inhabitants are dependent on subsistence farming for survival, landmines have greatly affected the residents’ ability to provide for their families; the mine-affected region is the poorest in the country with a 30-percent unemployment rate.2 There are 39 directly mine-affected villages, all of which have experienced severe difficulties as a result of the mine threat including loss of livestock from mine accidents, restricted freedom of movement and poor access to medical and educational facilities.
The national mine-action structures for coordinating and managing mine action were established in 1999 with the Albanian Mine Action Committee as the inter-ministerial, policy-making body and the Albanian Mine Action Executive as the coordinating and monitoring mine-action center. AMAE has coordinated the collection of incident and accident reports from 1999, which were inserted into the Information Management System for Mine Action in order to help with mapping and planning mine-action activities (initially including clearance and mine-risk education, and later to involve planning and coordinating for victim assistance).
Victim-assistance initiatives commenced in 2001 with mine amputees being sent to Slovenia for physical rehabilitation and prostheses because of the comparatively poor quality of medical treatment available in Albania. This low level of medical treatment is partially a result of Albania’s imposed isolation under 47 years of Communist rule, which ended in 1992. However, it is also a result of the lack of funding and expertise available to invest in the provision of quality treatment—technology, education and services.
In 2003, a project involving animal husbandry commenced to help mine survivors establish simple home-based livelihoods. It was not until 2003, that a well-coordinated and comprehensive victim-assistance strategy was developed and adopted with the goal of building a sustainable victim-assistance capacity by 2009. This strategy aims for all mine survivors to be physically, socially and economically rehabilitated into their communities. The VA strategy is based on a priority needs assessment undertaken by the United Nations Development Programme, AMAE and a local nongovernmental organization, Victims of Mines and Weapons Association. Mine survivors, their family members, local authorities and medical institutions involved in the survivors’ care were included and interviewed during the assessment in order to identify the priority needs mine survivors face and develop a concrete plan to address them.
Strengthening Medical Care
Medical assistance in northeast Albania was identified as being limited compared with the rest of the region because the mine-affected part of the country is geographically remote; it has poor roads, is surrounded by high mountains and is enshrouded by snow for five months of the year. The Kukes region is comprised of three districts: Kukes, Has and Tropoja. Each district has a primary city with a main hospital. The hospitals in Kukes and Tropoja have surgical capabilities and have thus been the focus of support of the program in improving the quality of medical assistance provided. For difficult cases requiring intensive surgery and care, patients are transported by helicopter to Tirana as arranged with the district hospital and the Ministry of Health authorities in Tirana. Through AMAE coordination and funding provided from multiple sources, new surgical equipment ultrasounds, patient monitors and medical supplies were procured and provided to both the Kukes and Tropoja hospitals. Additionally, trainings in how to use this new equipment were provided as a part of the handover procedure.
The VA program not only focused on improving the quality of health care available at the hospital level, but also identified improving health-care services at the village level as extremely important. As all 30 mine-affected villages along the Kosovo/Albania border employ village nurses, who could be immediately available to provide emergency first-aid to those injured by landmines, a community-based rehabilitation network was established to improve service delivery. Nurses were identified and trained in emergency first aid and ongoing medical support; supplies, including stretchers, microsurgery kits, blood-pressure cuffs and electric sterilizers, were provided to the nurses. With nurses residing in landmine survivors’ villages, relationships between nurses and survivors strengthened, resulting in greatly improved mine survivors’ access, and medical and social service quality.
Sight impairment is a problem that many landmine survivors have, and this problem usually does not receive sufficient attention in the arena of victim assistance. Twenty-six of the landmine/UXO survivors in Albania were identified as sight impaired, the majority of whom were children at the time of their accidents. The treatment received in the hospital following their injury involved basic surface removal of the shrapnel from their eyes. Funds were raised in Albania at Adopt-a-Minefield’s charity event, the Night of a Thousand Dinners, and screening and treatment was provided to 12 of the 26 sight-impaired survivors, who were still able to be treated effectively, at a private clinic in Tirana. To date, the Albanian mine-action program, with support from the United States Embassy, has held four successful Night of a Thousand Dinners to raise awareness about the landmine problem in Albania and to raise money to support landmine survivors.
Facilitating Return to Work
The needs assessment found that physiotherapy exists in Albania but is not well known or standardized in terms of training. There are two individuals trained in physical rehabilitation to varying degrees in the Kukes region, one based at Kukes Regional Hospital and the other at the hospital in Tropoja. There is one prosthetic/orthotic health center, the National Prosthetic/Orthotic Centre; it is staffed by six technicians, one orthopedic physician and three shoemakers. The technicians learned their trade while on the job and did not receive any official or standardized training. As approximately 100 of the landmine survivors are amputees, adequate capacity for the provision of physical rehabilitation and prostheses is important.
Bardhyl Nurishi is a 46-year-old man who lost both of his legs to landmines in 2001 while grazing his animals in the meadows of northeast Albania near his house. Nurishi is from a poor remote village in the mountains of Kukes where he lives with his wife and their four children.
Nurishi’s life improved significantly when he received his first prostheses in 2004 at the Institute of Rehabilitation in Slovenia and became mobile once again. In 2006, Nurishi was selected to participate in the vocational training project funded by the European Commission through UNDP and the Victims of Mines and Weapons Association. He was trained in repairing small electronic equipment and devices, a dream he had for some time. Since completing the training in 2007, Nurishi has opened a thriving business in his commune. He is enthusiastic about his work and proud that he can feed his children again. Nurishi plans to relocate with his family to the coastal city of Durres in the near future and, once there, open a larger business in electronic repair.
The VA program has an ongoing physical medicine and rehabilitation project using Handicap International expertise and the U.S. Department of State funding to strengthen this capacity. A new prosthetic center has been set up at Kukes Regional Hospital with two new technicians being trained. In total, six technicians working in Albania are being trained to International Society for Prosthetics and Orthotics Category 2 standards, and a newly standardized physiotherapy program at the University of Tirana commenced in 2006. A rehabilitation center has been established in Kukes Hospital with funding provided by the government of France and the European Commission through UNDP and the United States Department of State through the International Trust Fund for Demining and Mine Victims Assistance and Handicap International. It was equipped with materials including assistive devices, a parallel bar for walking, a treadmill, and a home fitness center. In addition to the local capacity being built, 130 amputees (including repeat cases) have been sent to Slovenia for physical rehabilitation and prostheses with support from the U.S. Department of State through the International Trust Fund For Demining and Mine Victims Assistance3 since 2001.
There are no trained counselors or social workers in the hospitals or the mine-affected villages of Albania, and few exist in Albania at large. This has been identified as a problem as mine/UXO survivors are at risk to acute post-traumatic stress disorder, anxiety or depression following their accidents and would benefit from psychosocial support. Victims of Mines and Weapons, a local NGO, provides psychosocial support and organizes social events for mine survivors throughout the year, including summer camps for children of mine survivors and social outings for mine survivors themselves. Additionally, VMA employs a mine survivor who is a member of Raising the Voices,4 and provides guidance and support to landmine survivors in the hospital and back at home in their villages.
The needs assessment conducted in 2003 recognized that mine survivors face great difficulties in returning to work or school following their accidents. The majority of mine victims were male breadwinners at the time of their accident. These difficulties in returning to work are a result of their injuries, the high unemployment rate in the region, and the engrained belief (perhaps a result of communism) that the government should provide for them. The VA program, recognizing the significant role work plays in providing self-identity and self-worth, has advocated for vocational trainings and socioeconomic reintegration projects to support mine survivors and their families. To date, 67 mine survivors and their families have been assisted in establishing home-based livelihoods in animal husbandry, and 30 mine survivors received vocational and business training in starting businesses. These projects have been extremely successful and it is planned for another 20 survivors to be supported in animal husbandry and another 45 to receive vocational training by mid-2009.
The majority of child mine survivors stopped attending their schools following their accidents, as commuting and studying was difficult. Ten children have been supported in returning to their studies with transportation and private tutors to catch up with their peers; they are now succeeding in their studies.
In January 2005, the Albanian government approved its first National Strategy on People with Disabilities. This strategy aims to improve the living conditions of persons with disabilities (including mine/UXO survivors) in the fields of education, employment, support services and free access through asserting the fundamental rights of persons with disabilities. The Albanian government is also following closely the developments regarding the Convention on the Protection and Promotion of the Rights and Dignity of Persons with Disabilities,5 and the Ministry of Foreign Affairs has publicly expressed Albania's commitment to become a signatory member of this convention.
Looking to the Future
Albania has been listed as one of 25 States Parties to the Ottawa Convention with the highest number of mine casualties that is committed to taking responsibility for the care and well-being of their mine and UXO survivors. The multi-faceted victim-assistance strategy established in 2003 and revised in 2005, aims to improve standards for mine victims in Albania by the end of 2009 in the areas of short- and long-term medical care, physical rehabilitation and provision of prostheses, psychological and social support, educational and socioeconomic reintegration, legislation and public awareness, and advocacy for mine survivors and other people with disabilities. A national victim-assistance workshop, held in spring 2007 with all major national and international actors, and including landmine survivors themselves, reviewed the current situation, the progress made, and reaffirmed the actions remaining to be taken. Albania is well on its way to achieving its goals in the area of victim assistance by the end of 2009.
Melanie Reimer has been working as a UNDP consultant in victim assistance with the Albanian Mine Action Executive since 2003. She first became involved with mine action in 2002 while working with the Jaffna District Mine Action Centre in Sri Lanka coordinating and monitoring victim assistance. She is currently working on her Master of Science degree in occupational therapy at Queens University in Kingston, Ontario.
- Convention on the Prohibition of the Use, Stockpiling, Production and Transfer of Anti-personnel Mines and on Their Destruction, Oslo, Norway. 18 September 1997. The document was opened for signature in Ottawa, Canada, 3 December 1997, commonly known as the Ottawa Convention. http://www.icbl.org/treaty/text/english#5. Accessed 12 September 2008.
- Kukes Regional Development Strategy (2005). United Nations and the Government of Albania. http://www.undp.org.al/index.php?page=detail&id=67
- International Trust Fund for Demining and Mine Victims Assistance. http://www.itf-fund.si/. Accessed 1 October 2008.
- Raising the Voices, a collaboration between Landmine Survivors Network and the International Campaign to Ban Landmines, is a human rights and leadership training program that empowers survivors to build the skills, knowledge, and capacities to become advocates for themselves and others.
- Convention on the Rights of Persons with Disabilities, adopted by the U.N. General Assembly on 13 December 2006 and opened for signature on 30 March 2007, entering into force with the 20th ratification on 3 May 2008. http://www.un.org/disabilities/convention/conventionfull.shtml. Accessed 2 October 2008.
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