Landmines and disability: a challenge faced together

Landmines are among the most dangerous weapons in armed conflict – easy and cheap to plant, but extremely difficult and costly to remove. If not cleared, mines and explosive remnants of war (ERWs) continue to kill or mutilate long after the conflict has ended. They can last for decades, maiming and killing and disrupting the social and economic life of affected communities.

Although there are fewer mines in Uganda than in other mine-affected countries, such as Afghanistan, Angola, Mozambique and Iraq, they still pose a difficult problem. There is little or no information on the location or suspected location of mines, because this ordnance has been used on an ad hoc basis; what information is available has been obtained after civilian involvement in a mine/ERW accident, or from data collected by hospitals.

AVSI, mines and disability: survey findings

After a review of hospital records from Northern Uganda between July 1998 and February 2006, the Italian NGO AVSI and the Gulu Regional Orthopaedic Workshop identified mines and ERWs as one of the major causes of injury and disability in Acholi, accounting for nearly 20% of all injuries (over 2,500 individuals identified) over a six-year period. In the same period, 46% of amputations due to war-related injury were caused by mines and ERWs. Of the more than 1,000 amputees identified in the survey, more than 40% were due to war-related trauma.

AVSI conducted a second survey between October 2005 and February 2006, this time in collaboration with the Gulu District Population Office and Gulu District Rehabilitation Office. The survey, funded by ECHO, covered all 53 IDP camps in Gulu District. As such, it provides the first comprehensive picture of the impact of landmines and ERWs on the population of Acholi.

In carrying out the survey, AVSI employed trained IDPs, including landmine survivors themselves, to search out people affected by landmines within their own communities. Five teams of 20 interviewers carried out the research, based on a modified IMSMA (Information Management System for Mine Action) landmine victim questionnaire. Out of a total population of 468,407, the survey found 1,387 accidents due to landmines/ERWs between 1986 and 2006. Of these, 535 were fatal, and 852 led to injuries. These figures are far higher than previous estimates, which put the number of people affected at around 500.

One important finding is that, out of the 535 incidents leading to death, 61% occurred immediately on site, with bleeding as one of the main causes of death; most of the rest of the fatalities occurred either en route or at a health facility. The majority of the victims (38%) activated the device by stepping on it; 14% were either standing nearby or passing by the spot where the accident occurred. Injuries or deaths while farming accounted for 10%. Of the 1,387 incidents, 459 occurred along village footpaths, and 24% along roads or larger routes. A fifth of incidents took place around fields, 11% around homes and 9% around water points. The majority of the devices involved – 61% – were anti-personnel mines. ERWs accounted for 17% of incidents, and anti-tank mines 11%.

The survey also identified the different types of injuries suffered. Amputations (traumatic or surgical) of lower limbs were most common, accounting for 57% of casualties; 33% suffered injury to their upper limbs or other body parts, and 7% sustained minor injuries to the whole body. A total of 2.7% of the casualties lost their eyesight, and 0.3% lost their hearing.

The findings of the survey indicate that mines and ERWs are planted or left in places mostly frequented by civilians. The poor are predominantly affected, since they commonly travel on foot and need to continue farming despite the risks associated with moving around in insecure and war-affected areas.

Recommendations

The Ugandan government has pledged to respond to the problem of mines and ERWs. Uganda is a party to the Ottawa Convention, which bans the production, stockpiling, transfer and use of antipersonnel mines. The treaty also requires the implementation of a Mine Action Programme, comprising humanitarian de-mining, stockpile destruction, victim assistance, mine risk education and advocacy. Uganda destroyed its stockpile of antipersonnel mines in July 2003, along with 6,383 anti-tank mines.

One of the main recommendations coming out of the survey, concerning humanitarian de-mining and stockpile destruction, is that funding for these activities must be significantly increased. The Ugandan army removed a large number of mines and ERWs between 2003 and 2005, but progress had been inadequate, despite provisions within the National Policy on IDPs stating that the army and police must ensure that areas of return are cleared of mines and unexploded ordnance.

The survey also highlights a need to scale up and consolidate or improve the capacity of health services to treat and rehabilitate mine and ERW victims, together with the development of a community-based approach to victim assistance (of which the National Policy makes no mention). Over the last three years, much emphasis has been placed on Community Based Rehabilitation Workers (CBRWs). CBRWs are trained to work within the community and in IDP camps, providing basic medical services and where necessary referring patients to specialised health facilities. Another important role of the CBRWs is to identify possible social reintegration activities which respond to survivors’ assistance needs. CBRWs are active and effective, especially in rural areas.

The problem of mines/ERWs could be at least partially alleviated by increasing the level of awareness and knowledge within communities, and the survey emphasises the importance of involving landmine survivors in mine risk education. AVSI has implemented education activities since 2001, training and sensitising 76,000 people in Gulu, Kitgum, Pader and Lira districts. The agency has used a variety of methods to get its messages across, including drama, training, radio programmes, posters and booklets. Finally, survivors of landmine accidents need support to improve their standards of living through economic empowerment and social reintegration programmes. In Gulu District, this has been actively taken up by the Gulu Land Mine Survivors Group which, with support from AVSI, has built a workshop for the production of pottery and clay products.

Final considerations

The findings from the AVSI survey show that mine-related injuries in Northern Uganda are more widespread than previously thought, and that there is still a lot to do in this area. A sustainable community-based approach to mine risk education and victim assistance is imperative, with the direct involvement of district administrators, NGOs, hospitals, schools and community leaders. This is why AVSI has developed a holistic approach which seeks to work with communities to address their needs. Meeting the challenge of landmines will take the concerted efforts of the government, organisations like AVSI and communities themselves.

Davide Naggi (davidenaggi@hotmail.com) worked for AVSI in Uganda for five years. Valentina Frigerio is AVSI’s Communications Officer. Previously, she worked with the agency in Kitgum, Northern Uganda, as a Project Officer. Her email address is: valentina.frigerio@avsi.org.