Aiding the Innocent: Victim Assistance
in the Middle East
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| "Because
eastern Turkey is cut off from the rest of Turkey, if you were
an amputee, there was nothing you could do. This program
literally lets people walk free again. It is healing patients,
not just physically, but in so many other ways."—Dr.
David B. Young, Program Director, Physicians for Peace’s
Walking Free Program |
by Sarah B. Taylor, MAIC
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Locals train at the TCF "Village
University" in Iraqi Kurdistan. Often, animals such as pigs
are used to train locals in basic medical care and in treating
landmine injuries. c/o Trauma Care
Foundation |
Introduction
Hussein Khair Allah, a landmine
survivor, recently spoke of his experience: "I was returning from a
fishing trip on November 15, 1997, when I was injured by a landmine on
the bank of the river Jordan, severing my right foot up to the ankle. I
am a fisherman and the major source of my income was from fishing, which
I am no longer able to do because of my injury. I need to work again to
be able to support my wife and six children." Allah’s story
mirrors those of many other landmine victims throughout the Middle East.
However, Allah is lucky; he was able to survive the injuries that the
landmine caused. Numerous others do not; for example, the Landmine
Monitor reports that five to 10 people die each day from landmine
accidents in Afghanistan.
Medical services and support systems
are essential if people like Allah are to survive their initial injuries
and then continue to lead fulfilling lives; therefore, this victim
assistance must begin in emergency care and then continue through
physical, social and economic rehabilitation. This is not an easy task
to accomplish, considering that between March 1999 and March 2000
landmine accidents occurred in Algeria, Egypt, Iran, Iraq, Israel,
Jordan, Kuwait, Libya, Lebanon, Pakistan, Oman, Syria, Yemen, Golan
Heights, Northern Iraq, Palestine and Western Sahara. In fact, 405
victims were reported in the Bajaur area of Pakistan alone.
Today, numerous organizations, both
governmental and non-governmental, are working to help improve the
survival rate and quality of life of landmine victims. By giving
immediate emergency care, fitting prosthetics and rehabilitating victims
physically, socially and economically, these organizations work to not
only save the lives of landmine victims but also to help them to return
to their previous lives with as much ease as possible. It is difficult
to express all that they do with mere words. Every day they save the
lives of those who, without them, would die; they lessen the burdens of
the survivors by helping them to adjust to their injuries. The
importance of these organizations is immeasurable.
Emergency Medical
Care
Trauma Care Foundation
The Trauma Care Foundation (TCF) works
together with the Tromsoe Mine Victim Resource Center (TMC). Other
partners include the University Hospital of Tromsoe Department of
Anesthesiology, the Faculty of Medicine, Norway and The World Health
Organization, and its headquarters are located at the University
Hospital of Tromsoe in Tromsoe, Norway. The organization consists of
numerous European physicians who are trained in trauma care, and the
purpose is to work with others, teaching local people of mine stricken
countries in order to create effective methods of saving both the limbs
and the lives of victims. An important aspect of this program is its
philosophy; workers do not focus on adhering to Western standards of
medicine. TCF realizes that this if often unrealistic in the regions in
which it works; instead they strive to create "self-reliance"
in which natives are able to save lives and limbs with the knowledge and
resources that they do have readily available. While TCF works
throughout the world to train natives in emergency medicine, they have
an extensive program in Northern Iraq, and in 2000, they began a new
program in Western Iran.
In order to accomplish its goal of
creating self-reliance among the local people of Northern Iraq, TCF set
up a "Village University." The Village University both teaches
and trains locals to be health workers and in doing so creates a support
network in which those who are trained are also taught to train and
teach others. This training is done systematically in 400 hours.
Surveys in Iraq found that 40 to 60
percent of all landmine victim deaths occur before the victim arrives at
a hospital. The Village University is designed to prevent as many of
these deaths as possible. The "mine-medics" are taught
individually and in teams on mannequins; live models and animal models
(all International ethical standards are adhered to in the use of the
animal models and all animals are purchased within the region that they
are used) are used to train the students in all aspects of trauma care.
Members of TCF train local Kurds with hands-on methods in trauma care,
including CPR, Basic Life Support (BLS) and Advance Trauma Life Support
(ATLS). More specifically, Kurds are taught and trained in breathing
control, bleeding control, airway control, chest tube placement and
airway incubation. Importantly, TCF also trains them to be effective
leaders, as these mine-medics will go on to teach other villagers first
aid. In fact, throughout the numerous Village Universities that TCF has
developed, mine-medics have trained over 7,000 local villagers as
"first responders." First-responders are trained to open
airways, stop the bleeding of injuries (without using tourniquets) and
perform CPR. Thus, mine-medics and first-responders together build
what TCF refers to as "Chains of Survival." Because mine
victims begin to die immediately after the injury occurs, it is
essential that trained health-care workers be readily available.
By working together, mine-medics and
first-responders are able to provide adequate immediate health care at
the scene of the accident. In the end, TCF has created a population of
health care workers who trust each other because they were trained with
each other and, in the case of first-responders, by mine-medics
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'Training in Victim Assistance. c/o Trauma Care Foundation |
themselves. Thus, a cohesive unit is formed and numerous limbs and lives
are saved. Finally, a handbook entitled "Save Limbs Save Lives:
Life Support for Victims of Mines, Wars, and Accidents" was
recently written by three physicians at TCF (Hans Husum, Mads Gilbert
and Torben Wisborg), which presents the theories and practices of the
Village University and other general methods of saving the lives of
landmine victims.
Prosthetic Care for
Amputees
Physicians for Peace and Limbs for Life
Based in Norfolk, Virginia, Physicians for Peace (PFP),
is a non-governmental organization dedicated to providing medical
services and supplies, medicines and medical education to needy areas
throughout the world. Originally founded by plastic
surgeon Dr. Charles E. Horton, also of Norfolk, Virginia, PFP has
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This man was one of the first patients fitted at
the new amputee rehab center in Dicle University, Diyarbakir,
Turkey. c/o Physicians for Peace |
completed approximately 200 missions throughout the world. In May 2000,
Physicians for Peace was invited by the Turkish government to the eastern part of Turkey to evaluate the prosthetic and amputee needs in
area and to aid the earthquake victims in Izmir.
When PFP arrived in eastern Turkey in
2000, it found a great need for its services. Program Director, Dr.
David B. Young, an orthopedic surgeon from Virginia Beach, Virginia,
stated, "We saw 59 patients in one morning—all victims of
landmines…both children and adults. They did not have any prosthetics,
rehabilitation or training in Dicle, which has a population of over one
million or in eastern Turkey, which has a population between three to
five million. The need is great." With this in mind, PFP, along
with its partners, began its plans for the Walking Free Program. The
program is a comprehensive prosthetic center at Dicle University in
Diyarbikir, Turkey, in which volunteer physicians and prosthetists fit,
train and rehabilitate amputees with prosthetics, free of charge.
Dr. Young aims to take
the project a step further by establishing a self-sustained center. He
stated, "We wanted to create a sustainable program to fit
prosthetics and train amputees. Medical care will then be for them and
by them. Sixty percent of the people there are unemployed; the program
will be an A to Z in prosthetic care, consisting of prosthetic training,
follow-ups, rehabilitation, etc." To achieve these goals, PFP
helped Turkish citizens receive medical training in the United States
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PFP volunteer, Richard T.
Sieller, P.T., C.H.T., hand/physical therapist from Virginia
Beach, VA, visits a young victim. c/o
Physicians for Peace |
and is in the process of creating a network between physicians and
prosthetists in the United States with those in Turkey. Recently, Halit
Ozdogan of Turkey completed a three-month training program in the United
States, where he learned modern prosthetic techniques; he is now working
at the center at Dicle University. Dr. Young stated, "They [Turkish
citizens] were trained at Hanger-Newington, which is affiliated with
Yale University, outside Hartford, Connecticut. But we also want to help
them in their education system. That will then bring to Turkey more
specialized treatments. We are also developing telecommunication online
between them and Turkey. This will create in-country and international
education, and we are in the process of developing a CD-ROM. Thus,
communication will be on disc and direct." Officially opened on
June 28, 2001, PFP estimates that in the first year, the newly trained
prosthetists will be able to fit approximately 60 amputees and 75 per
year in future years. Again, the services will cost the amputees
nothing.
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Two young amputees receive
much-needed assistance from the new center. c/o Limbs for Life
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Aiding them in
the project is Limbs for Life (LFL). LFL, also a non-governmental
organization, aids amputees throughout the United States in both
acquiring and caring for prosthetics. Through its work, LFL has acquired
a bank of artificial limbs, mostly donated by major manufacturers. An
amputee himself, Craig Gavras founded LFL in 1995 in Oklahoma City, Oklahoma
after being injured in the line of duty as a police officer. The Turkish
government also contacted LFL, and thus PFP and LFL joined together to
provide assistance in prosthetics to numerous amputees, the majority of
which are landmine victims. In the United States, an above-the-knee
prosthetic device can cost as much as $30,000 (US). Only a small portion
of the rural Turkish population can afford these kinds of prices. Thus,
LFL donated countless prosthetics and prosthetics parts to the Walking
Free Program, making it possible for amputees to receive new limbs
without a cost. Executive Director Craig Gavras also spoke of the great
need in this area. He stated, "There was unbelievable need; the
poverty level is astronomical… We supply anything that has to do with
prosthetics, and we decided to fit as many patients as we could."
Other contributors to the project
include Smith and Nephew, Inc. Rehabilitation Division, Hanger
Prosthetic and Orthotic Corporation and the Ronald McDonald House
Charities.
Rehabilitation:
Physical, Social and Economic
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A 13 year old landmine victim.
c/o WRF
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World Rehabilitation Fund (WRF)
Founded in 1995 by Dr. Howard A. Rusk,
the WRF’s purpose is to provide physical, social and economic
rehabilitation to those with disabilities in countries that are
afflicted by war. One of the numerous countries that receives assistance
from WRF is Lebanon. WRF first arrived in Lebanon in 1986, and in the
past 15 years, numerous rehabilitation projects have been implemented
and more than 70 agencies have provided medical services to the victims
of war in Lebanon. WRF’s main partner has been USAID. WRF has focused
a great deal of its efforts on the problem of landmines, entitling its
efforts "The Landmine Project." WRF’s programs not only
rehabilitate victims, they also educate citizens and create awareness
about the dangers of landmines.
Perhaps the most unique facet of WRF’s
Landmine Project is its extended philosophy concerning the
rehabilitation of victims. It believes in completely rehabilitating all
of the landmine victims, aiding them with physical rehabilitation and
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Dr. Nadim Karam speaking to
the community. c/o WRF
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then proceeding to help them integrate socially and economically back
into their communities. Since its arrival in Lebanon, WRF has helped to
establish a physical rehabilitation center, which now serves the entire
district of Jizzine. By providing basic physical therapy and
rehabilitation equipment to the Jizzine Government Hospital, WRF created
a center for landmine victims in an area where there was previously no
assistance. In the past, victims had to travel all the way to Sidon or
Beirut for therapy. WRF also provided the Vision Association for
Development, Rehabilitation and Care (VADRC), which is an NGO based in
Rashaya that provides assistance in mending and enhancing its existing
equipment in its Prosthetics and Orthotics Workshop, the only of its
kind in this area of Lebanon.
While WRF is dedicated to aiding Lebanon’s landmine
victims in their initial physical rehabilitation, their most recent
focus has been on the continuing socio-economic rehabilitation that is
essential in helping the injured return to a normal lifestyle. In fact,
in 1999, WRF and the United Nations Development Program (UNDP) came
together to create programs throughout the world that are focused
specifically on the socio-economic rehabilitation of disabled peoples,
especially landmine victims. When WRF joined with UNDP, Lebanon became
one of the partnership’s main focuses, as the project with UNDP will
compliment the existing one with USAID. In order to get a better
understanding of the need for this type of assistance, WRF conducted an
assessment test; however, the years that WRF has spent in Lebanon have
greatly helped in assessing and dealing with the needs. The program’s
main goal is to create agendas that will both socially and economically
integrate landmine victims back into their communities, returning the
quality of their lives back to the state it was before they were
injured. One of the ways that WRF is attempting to achieve this goal is
through community-based rehabilitation in various parts of Lebanon. WRF
aims particularly at creating community-based income generating programs
in the District of Jizzine, where the number of landmines is so high
that they affect not only victims,
but also the community at large. Hoping to generate potential incomes in
the community, WRF plans on building an actual facility for
socio-economic rehabilitation. By creating employment for the victims of
landmines, WRF feels that they will be able to lead productive lives;
this not only assists in their economic rehabilitation, but also in
their social rehabilitation, as they again become an important part of
their communities.
Another important part of this program
is entitled the "Kiosks Project." The Kiosks Project, which is
in association with VADRC, has created three kiosks in areas that have
high numbers of landmines. Kiosks are small stands or businesses that sell
numerous low-cost items, such as coffee. They are operated by landmine
victims, in the hopes of expanding both the job opportunities and
incomes available to victims. Khaled Nimr runs a kiosk in West Bekaa,
Lebanon. After stepping on a landmine and having his right leg amputated
at age six, the 25-year-old survivor was scarred both physically and
emotionally. Until recently, he had little hope of ever leading a normal
life within his community; WRF’s program has helped to change this. He
now has both the income and self-esteem that come with having his job.
WRF has done a great deal to assist
landmine victims throughout the world and particularly in Lebanon. In
the future, WRF hopes to expand their efforts in this area, focusing not
only on continuing education and awareness but also on the
socio-economic rehabilitation of adolescents, particularly females.
The International Committee of the Red Cross
In 1979, the International Committee
of the Red Cross (ICRC) created a specific unit designed to aid victims
of war and landmines in physical rehabilitation. Described as "…an
impartial, neutral and independent organization whose exclusively
humanitarian mission is to protect the lives and dignity of victims of
war and internal violence and to provide them with assistance,"
ICRC has set up 56 rehabilitation programs in 25 countries since 1979.
The year 2000 brought a record number
of individuals needing ICRC’s assistance; during this year, it
provided 16,442 prostheses and 11,005 orthoses worldwide. In fact, in
Afghanistan, the number of needed orthoses was greater than the amount
of prostheses. ICRC also increased the projects receiving assistance by
20 percent, and consequently hired more staff members. While
concentrating on the present, ICRC also looks towards the future.
Between 2000 and 2005, it hopes to obtain three important goals: to
develop project guidelines for the treatment of amputees, to create a
standard for training and develop a teaching package for local
employees, and to better and standardize raw materials such as
prosthetic components. During 2000, ICRC spent a great deal of their
efforts in the Middle East, providing physical rehabilitation to
individuals in Afghanistan and Iraq.
• Afghanistan
ICRC actually began helping Afghanis
before its project began there in 1987. In 1981, it assisted disabled
Afghanis in nearby Pakistan. In a nation where the need for physical
rehabilitation is great, the medical resources are extremely inadequate;
however, since 1987, ICRC has had prosthetic/orthotic centers in Kabul,
Heart, Mazari-Sharif, Jalalabad and Gulbahar. Between 1987 and 1999,
ICRC provided numerous services to the disabled. In fact, patients
received 30,435 prostheses and 15,747 orthoses. ICRC also renovated and
installed new equipment in the program’s center, and continuing
training was provided for the staff. Social and economic rehabilitation
was also provided for the disabled through micro-credit programs and
training.
In 2000, ICRC continued its aid.
Patients received 4,600 prostheses and 6,360 orthoses, and physical
rehabilitation was provided to all patients. ICRC registered almost
2,000 new amputees, 75 percent of which were landmine victims. Male and
female patients were treated in separate centers, and ICRC attempted to
make their services more easily accessible by decentralizing their
locations and working together with the Afghan Red Crescent Society.
ICRC also addressed the social and economic needs of the patients by
helping them find employment, encouraging them to start small businesses
and aiding them in attending school. In order to better the program
itself, ICRC held two national workshops and in-house courses. The
workshops focused on physiotherapy and orthopedic technology, and the
courses centered on local training needs. Finally, ICRC also encouraged
local employees to become more involved by giving them more managerial
responsibility.
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Basra, Iraq, Orthopedic
Center, Manufacturing Department, c/o ICRC
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• Iraq
ICRC began its program in Iraq in 1993
after serious worldwide sanctions were imposed on the nation. A country
that was at one time wealthy, ICRC strives to keep Iraq’s
rehabilitation centers up to date. It has created six prosthetic/orthotic
centers, which are found in Baghdad (where there are two), Basra, Najef,
Mosul and Arbil, it also supports the Baghdad Prosthetic/Orthotic
School.
Between 1993 and 1999, ICRC provided
numerous services to the disabled. For instance, patients received
10,595 prostheses and 6,410 orthoses. Like in Afghanistan, ICRC
renovated and installed new equipment in the program’s center and
staff received additional training.
In 2000, ICRC achieved many of its
goals in Iraq. Physical rehabilitation was provided, along with 2,807
prostheses and 1,446 orthoses, 53 percent of which were landmine
victims. While importing goods into the country is often difficult, ICRC
managed to acquire, under the oil-for-food program, prosthetic/orthotic
components from Europe. ICRC also established and/or upgraded
physiotherapy facilities and gait-training areas throughout the country.
In addition, a physiotherapist visited all centers, and a physiotherapy
handbook was created. In order to better the program itself, ICRC held,
along with the Ministry of Higher Education, four national seminars
covering topics such as partial foot prostheses and physiotherapy for
lower-limb prostheses. ICRC also conducted a meeting for all of the
program’s centers’ directors in order to discuss quality control,
and the Under-Secretary of Health visited a center in Baghdad and set up
a Steering Group for Prosthetic/Orthotic Services. Finally, ICRC
encouraged local employees to become more involved; two local employees
took over two positions and two were sent abroad to attend a physical
rehabilitation conference.
Conclusion
At the 1998 First Middle East
Conference on Landmine Injury and Rehabilitation, Queen Noor addressed
the severe problem of landmines in Middle East. She stated, "The Middle
East is the landmine heartland of the world… [It] is littered with, by
estimates, more than half of the world’s deployed landmines." To endure such a devastating infestation of
landmines, victim assistance is absolutely necessary in the Middle East.
In order to truly aid the victims of landmines, medical services must
begin with emergency care and continue through rehabilitation; this is
the only way to help victims return to some sort of normalcy.
Much of this region is also plagued
with poverty, making it difficult to provide all of the necessary
medical care to victims. Thus, organizations such as TCF, PFP, LFL, WRF
and ICRC play a fundamental role in creating better conditions for all
victims; without their generosity, this terrible situation would be much
worse. Through these organizations and numerous others like them, many
landmine victims who previously might not have made it through their
initial injuries are now back in the workforce, leading normal lives.
Contact Information
Odd Edvardsen
Manager
Tromsoe Mine Victim Resource Center
P.O. Box 80
9038 Ritoe
Tromsoe, Norway
Tel: +47-77-62-62-27
Fax: +47-77-62-80-73
E-mail: tmc@rito.no
Mads Gilbert, MD, PhD
Senior Anesthesiologist
Trauma Care Foundation
University and Regional Hospital
N-9038
Tromsoe, Norway
Tel: +47-77-62-61-90
Fax: +47-77-62-61-92
E-mail: mads.giblet@rit0.no
Website: http://www.traumacare.no/
Brian Fair
Associate Director of Development/Public Relations
Physicians for Peace
229 West Bute Street, Suite 900
Norfolk, VA 23510
Tel: (757) 625-7579
Fax: (757) 625-7680
E-mail: bfair@physiciansforpeace.org
Website: http://www.physicians-for-peace.org
Craig Gavras
Founder
Limbs for Life
120 N. Robinson, Suite 1913
Oklahoma City, OK 73102
Tel: 1-888-235-5462
Fax: (405) 235-5472
E-mail: cgarvas@limbsforlife.org
Website: http://www.limbsforlife.org
Anthony Starros, M.E., P.E.
Senior Consultant
World Rehabilitation Fund
386 Park Avenue South
New York, NY 10016
Tel: (212) 725-7875
Fax: (212) 725-8402
Email: wrfnewyork@msn.com
Website: http://www.worldrehabfund.org
International Committee of the Red Cross
Public Information Center
19 avenue de la Paix
CH 1202 Geneva
Tel: ++41-(22)-733-20-75
Fax: ++41-(22)-734-60-01
E-mail: press@gra@icrc.org
Website: http://www.icrc.org
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