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Caring for Colombia's landmine survivors
World Report
Caring for Colombia’s landmine survivors Colombia has made a concerted effort to bring down its casualty rates from landmine explosions but gaps still exist in care and support for survivors. Anastasia Moloney reports.
www.thelancet.com Vol 373 June 13, 2009
“foot breakers”, which are the size of a tin of tuna and notoriously difficult for sniffer dogs to detect, are the guerrilla’s preferred weapon of choice, and have been increasingly used since the mid-1990s. For these rebel groups, landmines are a fairly easy and cheap way to dampen the morale of
“...Colombia...is home to the highest number of new landmine victims reported each year.” government troops, increase enemy casualties, and protect stakes in the drug trade by protecting fields of coca, the raw ingredient for cocaine. “Illegal armed groups use landmines as mechanisms for defence, to contain government military offensives, and to keep control of their coca fields and cocaine processing laboratories”, explained Andrés Dávila, director of Colombia’s Presidential Programme for Integrated Action Against Antipersonnel Mines (PAICMA). However, under-reporting of civilian casualties is a common problem because of ineffective mine incident databases and because some survivors fear being socially stigmatised. Landmine survivors are sometimes wrongly associated with participating in guerrilla activities and there is the assumption that landmine accidents are caused by those planting mines. Only recently have serious attempts been made to reduce the number of landmine victims in Colombia. The problem assumed a greater urgency, following the country’s ratification of the Ottawa treaty in 2001 (the international agreement to ban all mines) and a presidential decree that created the government anti-mine programme (PAICMA) 2 years ago. “The setting up of the presidential
programme signalled the recognition of the magnitude of Colombia’s landmine problem and raised its importance, while the ratification of the Ottawa treaty made the problem more visible, particularly among the military”, said Dávila. However, victim assistance in Colombia remains “inadequate” and progress is “slow”, according to a 2008 report published by the non-governmental organisation (NGO) Landmine Monitor. The report highlights that psychosocial assistance for 1 year after landmine incidents is “virtually nonexistent”, and although rehabilitation centres are usually of “good quality”, very few outreach services exist. The government recognises that substantial gaps exist in providing adequate support and medical care to landmine victims, particularly over the long term. The issue of victim assistance “is one of my big frustrations”, said Colombian vice-president, Francisco Santos, who has adopted a hands-on role in raising awareness and securing greater international and private sector funding for anti-landmine programmes. “We have designed perfect policies in terms of attention
The printed journal includes an image merely for illustration Reuters
Amid a decades-long armed conflict that pits government forces against guerrilla groups, Colombia is the only country in Latin America where landmines and improvised explosive devices (IEDs) continue to be planted regularly by the country’s two main rebel groups, the Revolutionary Armed Forces of Colombia and the smaller National Liberation Army. Although the number of people killed or injured by landmines and IEDs in Colombia has been declining, the country still has one of the highest landmine casualty rates in the world and is home to the highest number of new landmine victims reported each year. With over 7700 landmine survivors registered in Colombia since 2002, of which 35% are civilians, landmines on average claim three victims a day. And although new legislation aimed at strengthening landmine victim rights, education campaigns about mine risks, and demining operations have helped to reduce landmine casualty rates in Colombia, assistance to civilian survivors remains inadequate and patchy. In 2007, for the first time since 2002, the number of recorded landmine casualties in Colombia decreased. This trend has continued, with government figures showing a 44% reduction in recorded landmine victims in the first 3 months of this year, by comparison with the same period last year. This decline represents “a permanent change in the historic trend”, according to the Colombian Government. So far this year, over 220 landmine victims have been registered in the country. Members of the armed forces account for over half of all landmine casualties, while the bulk of civilian survivors are adult men living in rural areas. Costing just US$5 to make, homemade landmines, known locally as
A rehabilitation centre for soldiers injured by landmines in Medellin, Colombia
2013
Getty Images
World Report
A soldier dismantles a landmine in north Colombia’s San Francisco municipality
to victims but it often happens that people can’t access the resources that are there”, he said in April. Poor awareness among local health officials and survivors about their rights and benefits, and a lack of specialist training and expertise among medical staff to deal with landmine injuries, means survivors often do not receive the adequate care they are legally entitled to. In theory, emergency treatment and prosthetic limbs for landmine survivors are free in Colombia. But survivors must claim assistance within a year of a mine injury, and government funds rarely cover transport and lodging costs for survivors. Most landmine victims are among Colombia’s poorest citizens, often caught in the middle of the armed conflict. “Along with their poverty, vulnerability, and living in remote and poor areas of the country, victims sometimes don’t know about how to claim their rights because of fear and ignorance, in addition to being injured and sometimes displaced from their homes”, said Dávila. Bureaucratic bottlenecks in Colombia’s public health system is another major hurdle that landmine survivors face in accessing medical treatment. Health-care providers are often reluctant to treat mine victims because 2014
the government and or insurance companies are failing to reimburse hospitals quickly. “Some hospitals are refusing to treat landmine victims because insurance companies place obstacles in paying out claims”, said Dávila. Currently, the government is focusing on building up a detailed picture of the country’s 2900 civilian landmine survivors to improve medical care, while building closer links with NGOs working in Colombia, including UNICEF and Landmine Monitor. “We need to first sort out what type and amount of assistance each and every landmine victim has so far received in order to see exactly where the gaps and needs are. If I could have a complete medical history of every mine victim in the country, then we would be getting somewhere”, said Davila. He also plans to set up emergency response teams, who can provide treatment to mine victims in remote rural areas and “guide them through the paperwork”. The most tangible progress has been made in the demining of military bases and in the destruction of Colombia’s stockpile of mines as part of the country’s commitment to the Ottawa Treaty. The National Demining School, set up 3 years ago, includes a team of 240 deminers who carry out all demining operations in the country, and who are certified by the Organization of American States to ensure that mining clearance operations comply with international standards. So far, mines sown by the army in and around 22 of Colombia’s 34 army bases have been cleared. The government says it is confident it will reach its target of clearing all mine areas planted by the military by 2011. However, the demining of civilian areas in Colombia is still in its early stages and is hampered by a scarcity of trained deminers. It is not known how much of the country is contaminated with mines, and few maps of mineaffected areas exist. And while the armed conflict continues with some areas still not firmly under government
control, clearing the countryside of landmines remains a major challenge. “Although some mine clearance is underway in civilian areas, all suspected hazard areas have not been systematically surveyed and all known mined areas have not been publicly identified. This lack of information limits the ability of the Colombian government to set priorities and conduct operational planning”, states the 2008 Landmine Monitor report. Education campaigns are being seen as a key way to reduce landmine casualties in Colombia. Government and NGO-led workshops, school seminars, leaflets, and posters have helped raise awareness in at-risk communities about how to prevent landmine accidents and spot possible minefields. However, NGOs working in conflict zones have encountered resistance from rebel groups, who often view anti-landmine campaigners with suspicion. NGOs highlight that community workshops are still not reaching those most in need, especially remote rural communities and indigenous groups living in national parks. The level of awareness among the civilian population is “disappointing”, according to a field study done by the International Committee of the Red Cross in 2007. The study found that in three mine-littered provinces, only less than half of the interviewees could respond correctly when asked what mines were, and 45% did not know how to identify a mined area. While political will remains to tackle Colombia’s landmine problem and funding for anti-mine and demining programmes continues to flow from donor countries, there is a real chance that mine casualty rates in Colombia will continue to decline. But if mine victim assistance is to be improved, effective data collection and monitoring systems of landmine survivors need to be implemented, bottlenecks removed, and greater priority placed on training specialist medical staff.
Anastasia Moloney www.thelancet.com Vol 373 June 13, 2009
Caring for Colombia’s landmine survivors Colombia has made a concerted effort to bring down its casualty rates from landmine explosions but gaps still exist in care and support for survivors. Anastasia Moloney reports.
www.thelancet.com Vol 373 June 13, 2009
“foot breakers”, which are the size of a tin of tuna and notoriously difficult for sniffer dogs to detect, are the guerrilla’s preferred weapon of choice, and have been increasingly used since the mid-1990s. For these rebel groups, landmines are a fairly easy and cheap way to dampen the morale of
“...Colombia...is home to the highest number of new landmine victims reported each year.” government troops, increase enemy casualties, and protect stakes in the drug trade by protecting fields of coca, the raw ingredient for cocaine. “Illegal armed groups use landmines as mechanisms for defence, to contain government military offensives, and to keep control of their coca fields and cocaine processing laboratories”, explained Andrés Dávila, director of Colombia’s Presidential Programme for Integrated Action Against Antipersonnel Mines (PAICMA). However, under-reporting of civilian casualties is a common problem because of ineffective mine incident databases and because some survivors fear being socially stigmatised. Landmine survivors are sometimes wrongly associated with participating in guerrilla activities and there is the assumption that landmine accidents are caused by those planting mines. Only recently have serious attempts been made to reduce the number of landmine victims in Colombia. The problem assumed a greater urgency, following the country’s ratification of the Ottawa treaty in 2001 (the international agreement to ban all mines) and a presidential decree that created the government anti-mine programme (PAICMA) 2 years ago. “The setting up of the presidential
programme signalled the recognition of the magnitude of Colombia’s landmine problem and raised its importance, while the ratification of the Ottawa treaty made the problem more visible, particularly among the military”, said Dávila. However, victim assistance in Colombia remains “inadequate” and progress is “slow”, according to a 2008 report published by the non-governmental organisation (NGO) Landmine Monitor. The report highlights that psychosocial assistance for 1 year after landmine incidents is “virtually nonexistent”, and although rehabilitation centres are usually of “good quality”, very few outreach services exist. The government recognises that substantial gaps exist in providing adequate support and medical care to landmine victims, particularly over the long term. The issue of victim assistance “is one of my big frustrations”, said Colombian vice-president, Francisco Santos, who has adopted a hands-on role in raising awareness and securing greater international and private sector funding for anti-landmine programmes. “We have designed perfect policies in terms of attention
The printed journal includes an image merely for illustration Reuters
Amid a decades-long armed conflict that pits government forces against guerrilla groups, Colombia is the only country in Latin America where landmines and improvised explosive devices (IEDs) continue to be planted regularly by the country’s two main rebel groups, the Revolutionary Armed Forces of Colombia and the smaller National Liberation Army. Although the number of people killed or injured by landmines and IEDs in Colombia has been declining, the country still has one of the highest landmine casualty rates in the world and is home to the highest number of new landmine victims reported each year. With over 7700 landmine survivors registered in Colombia since 2002, of which 35% are civilians, landmines on average claim three victims a day. And although new legislation aimed at strengthening landmine victim rights, education campaigns about mine risks, and demining operations have helped to reduce landmine casualty rates in Colombia, assistance to civilian survivors remains inadequate and patchy. In 2007, for the first time since 2002, the number of recorded landmine casualties in Colombia decreased. This trend has continued, with government figures showing a 44% reduction in recorded landmine victims in the first 3 months of this year, by comparison with the same period last year. This decline represents “a permanent change in the historic trend”, according to the Colombian Government. So far this year, over 220 landmine victims have been registered in the country. Members of the armed forces account for over half of all landmine casualties, while the bulk of civilian survivors are adult men living in rural areas. Costing just US$5 to make, homemade landmines, known locally as
A rehabilitation centre for soldiers injured by landmines in Medellin, Colombia
2013
Getty Images
World Report
A soldier dismantles a landmine in north Colombia’s San Francisco municipality
to victims but it often happens that people can’t access the resources that are there”, he said in April. Poor awareness among local health officials and survivors about their rights and benefits, and a lack of specialist training and expertise among medical staff to deal with landmine injuries, means survivors often do not receive the adequate care they are legally entitled to. In theory, emergency treatment and prosthetic limbs for landmine survivors are free in Colombia. But survivors must claim assistance within a year of a mine injury, and government funds rarely cover transport and lodging costs for survivors. Most landmine victims are among Colombia’s poorest citizens, often caught in the middle of the armed conflict. “Along with their poverty, vulnerability, and living in remote and poor areas of the country, victims sometimes don’t know about how to claim their rights because of fear and ignorance, in addition to being injured and sometimes displaced from their homes”, said Dávila. Bureaucratic bottlenecks in Colombia’s public health system is another major hurdle that landmine survivors face in accessing medical treatment. Health-care providers are often reluctant to treat mine victims because 2014
the government and or insurance companies are failing to reimburse hospitals quickly. “Some hospitals are refusing to treat landmine victims because insurance companies place obstacles in paying out claims”, said Dávila. Currently, the government is focusing on building up a detailed picture of the country’s 2900 civilian landmine survivors to improve medical care, while building closer links with NGOs working in Colombia, including UNICEF and Landmine Monitor. “We need to first sort out what type and amount of assistance each and every landmine victim has so far received in order to see exactly where the gaps and needs are. If I could have a complete medical history of every mine victim in the country, then we would be getting somewhere”, said Davila. He also plans to set up emergency response teams, who can provide treatment to mine victims in remote rural areas and “guide them through the paperwork”. The most tangible progress has been made in the demining of military bases and in the destruction of Colombia’s stockpile of mines as part of the country’s commitment to the Ottawa Treaty. The National Demining School, set up 3 years ago, includes a team of 240 deminers who carry out all demining operations in the country, and who are certified by the Organization of American States to ensure that mining clearance operations comply with international standards. So far, mines sown by the army in and around 22 of Colombia’s 34 army bases have been cleared. The government says it is confident it will reach its target of clearing all mine areas planted by the military by 2011. However, the demining of civilian areas in Colombia is still in its early stages and is hampered by a scarcity of trained deminers. It is not known how much of the country is contaminated with mines, and few maps of mineaffected areas exist. And while the armed conflict continues with some areas still not firmly under government
control, clearing the countryside of landmines remains a major challenge. “Although some mine clearance is underway in civilian areas, all suspected hazard areas have not been systematically surveyed and all known mined areas have not been publicly identified. This lack of information limits the ability of the Colombian government to set priorities and conduct operational planning”, states the 2008 Landmine Monitor report. Education campaigns are being seen as a key way to reduce landmine casualties in Colombia. Government and NGO-led workshops, school seminars, leaflets, and posters have helped raise awareness in at-risk communities about how to prevent landmine accidents and spot possible minefields. However, NGOs working in conflict zones have encountered resistance from rebel groups, who often view anti-landmine campaigners with suspicion. NGOs highlight that community workshops are still not reaching those most in need, especially remote rural communities and indigenous groups living in national parks. The level of awareness among the civilian population is “disappointing”, according to a field study done by the International Committee of the Red Cross in 2007. The study found that in three mine-littered provinces, only less than half of the interviewees could respond correctly when asked what mines were, and 45% did not know how to identify a mined area. While political will remains to tackle Colombia’s landmine problem and funding for anti-mine and demining programmes continues to flow from donor countries, there is a real chance that mine casualty rates in Colombia will continue to decline. But if mine victim assistance is to be improved, effective data collection and monitoring systems of landmine survivors need to be implemented, bottlenecks removed, and greater priority placed on training specialist medical staff.
Anastasia Moloney www.thelancet.com Vol 373 June 13, 2009