What’s the difference between a landmine "victim" and a "survivor"?
Landmine victims are individuals or groups of people who have been killed or "have suffered physical, emotional and psychological injury, economic loss or substantial impairment of their fundamental rights through acts or omissions related to mine utilization."2 This is a broad definition meant to encompass families and communities affected by landmines. A survivor is a person who has non-fatal injuries caused by a landmine.
| The International Campaign to Ban Landmines identified 11,700 new reported landmine casualties in 2002.3 There are more than 300,000 landmine survivors worldwide, and to rehabilitate these survivors could cost more than $3 billion (US) over the next 10 years.4 |
What is meant by survivor assistance?
Survivor assistance is not restricted to providing medical treatment for initial traumatic injuries or the provision of prostheses. Survivor assistance also includes ongoing physical therapy and mental and emotional rehabilitation of survivors and their families. This can include rehabilitative care, psychological and social counseling, vocational training, broader public advocacy for disability rights, and judicial reform aimed at removing barriers that persons with disabilities face while reintegrating into society.
What is involved in prosthetic rehabilitation?
Artificial limbs at a prosthesis clinic.
For someone who has lost a limb, the amputation is a chronic problem; an amputee will spend the rest of his or her life missing a limb. Quality of life and social acceptance may depend upon having indefinite access to prosthetic care. For amputees to function effectively with prostheses throughout their lifetimes, they need permanent access not just to devices, but also to services. Regardless of how well-made it is, a prosthesis will need ongoing repairs and adjustments. At some point, the device will wear out and need to be replaced. Additionally, the wearer’s body will change over time, as will his vocational and recreational needs. For manual laborers or those who live in harsh environments, repairs and replacement will be more frequent.
I’m healed…now what?
Amputees practice using their new prostheses at a rehabilitation center in Mozambique.
When areas contaminated with landmines and unexploded bombs have been cleared or cordoned off; when the maimed survivors of an explosion are healed; when the provision of necessary prostheses, medical rehabilitation and psychological adjustment is completed—what then is the newly disabled person to do? What has become of his or her educational and vocational opportunities? Is there employment to aspire or return to? Will he or she be able to support him/herself and/or his/her family? Will he or she be able to fully participate in the social, political and economic life of his or her community and country? Will he or she be economically self-sufficient? These are all questions addressed by experts in the field of survivor assistance.
What kind of special economic hardships face landmine survivors?
A bilateral amputee using a wheelchair faces stiff challenges: how to get a job if he/she lacks transportation to get to the job site; how to educate the employer about his/her capabilities even as he/she works from a wheelchair; how to work within national labor laws that may limit options for the disabled. All these issues need to be addressed in a comprehensive, coordinated continuum of programs, policy reform and serious attitude adjustment.
| In Vietnam, over 75 percent of children with disabilities, many of them landmine survivors, receive no education whatsoever, a major factor contributing to the 90 percent plus unemployment rate of people with disabilities in Vietnam. |
What is the ultimate goal of landmine survivor assistance?
A comprehensive landmine survivor assistance program aims to provide individual economic self-sufficiency for the disabled survivor and any dependants for whom he/she may be responsible. In order to create meaningful programs that will contribute to the achievement of this goal, there have to be comprehensive assessments of the individual with the disability, the local situation in which he/she lives, and the national cultural, political and economic situation. People with disabilities should be evaluated in terms of their age, disability, educational background, vocational skills, work experience, and personal desires and goals. These individual profiles need to then be integrated into the reality of the locality’s educational system, employment support system, vocational training opportunities, area employer needs, employment opportunities, transportation infrastructure and economy. In completing these assessments, the service provider (non-governmental or local agency) must respond to the individual desire of people with disabilities, seeking their input and honoring their personal aspirations.
What can organizations do to help landmine survivors?
A health worker helps a small child who lost both legs in a landmine explosion learn to walk with two prostheses and arm crutches at an orthopedic workshop run by the International Committee of the Red Cross in the war-devastated city of Kabul.
Service providers have many options. Some concentrate on children and youth as they work with local authorities or the national government to ensure that mainstream educational opportunities for people with disabilities are accessible, relevant and available. Other areas where service providers may want to develop programs include vocational rehabilitation and training, development of self-employment programs and micro-loan funds to support them, and development of relationships with local employers and employment services to increase job opportunities. Another successful model for employment of people with disabilities that may warrant consideration is business enterprises for people with disabilities.
What factors contribute most to the success of survivor assistance programs?
The most successful programs have:
- Integrated rehabilitation into existing social systems.
- Employed staff with recognized credentials.
- Been responsive to patient suggestions and recommendations about how to improve service.
- Exploited public-private sector partnerships.
Recent experiences with humanitarian activities also suggest that advocacy, legislation and policy reform, which includes the participation of, and focus on, people with disabilities, is as essential for their social and economic reintegration as a prosthesis. Traditional beliefs and attitudes can be the greatest obstacle to the social and economic well-being of people with disabilities. Programs that have not addressed the issues of the culture, morals and belief systems of inhabitants can demonstrate little if any real success.
| Appropriate Technologies |
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| The development of appropriate technologies in developing countries is an essential requirement of any successful, sustainable orthopedic service delivery system. Appropriate technologies can be natural or synthetic. They can be imported or produced locally. However, they must be accessible, affordable, durable, easily repairable and functional. An ill-fitting or poorly aligned prosthetic limb can result not only in limited use but also in physical harm to the patient. The measure of success in prosthetics is not how many prostheses are provided, but how many are actually used on a regular basis. |
Endnotes
Survivor Assistance:
2 Definition used by the ICBL. (Return)
3 Landmine Monitor: Toward a Mine-Free World 2001; International Campaign to Ban Landmines, p. 37 (Return)
4 Landmine Monitor: Toward a Mine-Free World: "Executive Summary" 1999, International Campaign to Ban Landmines, 1997, p.22 (Return)
Next Chapter, Mine Risk Education