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Helping restore dignity among the war-wounded


The ICRC's physical rehabilitation programme observes its 25th anniversary in August 2004 and has, over its lifetime, helped hundreds of thousands of people regain their dignity and reintegrate into society. In addition, the ICRC's pioneering technology has been adopted by many other organizations.


Addis Ababa. Physical rehabilitation centre supported by the ICRC. Workshop for manufacturing prosthesis.©ICRC/ref. et-e-00066 

In the 1970s, the increasing use of anti-personnel landmines led to a growing number of amputations amongst the war wounded – a phenomenon first documented by the ICRC on the basis of its experiences in hospitals in Pakistan and Cambodia. 

The victims of antipersonnel mines and other unexploded ordnance have to live with the consequences long after the fighting has ended. Horrendous injuries leave combatants and non-combatants alike struggling to rebuild their lives and find a new role in society. In societies ridden by or recovering from conflicts their needs cannot always be a priority and, even when it is, the capacity to provide prostheses and orthoses for those in need does not always exist.

" Survival of the war wounded is always the top priority, " says Theo Verhoeff, head of the ICRC's Orthopaedic Unit, " but also important is restoring dignity and providing victims with the best chance of resuming an active part in society. "

This was the driving force behind the establishment of the organization's Physical Rehabilitation Programme in 1979.


 Humble beginnings  

It began with programmes in just two countries -- Angola and Ethiopia -- and mushroomed in proportion to the scale of the landmines problem to encompass 87 projects in 36 countries.

During 25 years, more than 300,000 people have been assisted with prostheses and/or orthoses and many more have benefited from physiotherapy. In addition, more than a quarter of a million pairs of crutches and 15,000 wheelchairs have been distributed to those in need.

The programme has gone through many changes in reaching its 25th anniversary. In the beginning, the ICRC used mainly expatriates to provide services but now local employees carry out the bulk of the work with expatriate coaching and the training of national prosthetists and orthotists is an integral part of the programme. 

Courses aim to comply with the recommendations set out by the International Society for Prosthetics and Orthotics (ISPO) and are carried out in close cooperation with the relevant national health ministry.


 Technological Innovation  

The programme has also seen advances in the materials used to produce prosthetic/orthotic appliances and components.

" At the start, we had to use expensive imported components and raw materials, " explains Theo Verhoeff, " The ICRC developed a low cost, good quality technology using polypropylene. This has many ad vantages. It is clean, easy to use, light-weight, low-cost and has a long-storage capacity. "

So successful is it, in fact, that the ICRC's technology has, over time, been taken up by other organizations active in this specialist area.

Indeed, at the 11th World Congress of the ISPO in Hong Kong at the beginning of August, the ICRC received the Brian Blatchford prize in recognition of its work. The prize is awarded every three years to individuals or organizations that have an outstanding record of innovative achievement in the field of prosthetics and/or orthotics.

 Long-term help  

Although awards are always welcome the focus remains on the victims.

" An amputee is disabled forever and requires access to functioning rehabilitation services for the rest of his/her life, " says Theo Verhoeff, " Assuring long-term quality services is a challenge. "

This was the motivation for the establishment of the ICRC's Special Fund for the Disabled in 1981, which became an independent foundation three years ago.

Its main functions are to ensure the continuing existence of centres from which the ICRC has withdrawn, to assist the establishment of centres in other developing countries and to provide help to improve access to the services for those in need. This can mean, for example, subsidising the cost of transport, lodging and food during the time required for physical rehabilitation, including the fitting of a prosthesis or orthosis.


 A lot left to do  

Although more than 140 states have now signed the Ottawa Convention that prohibits the use and stockpiling of landmines and commits them to clearing infested areas, much work still needs to be done to achieve the goal of a mine free world.

The scourge of these weapons and other unexploded ordnance that fail to distinguish between combatants and non-combatants, between man, woman or child will therefore require the services of the ICRC's physical rehabilitation programme for many years to come.

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