Meeting of NGOs on victim assistance: Keynote speech
Meeting of NGOs on victim assistance, 8-9 March 1997, Tokyo, Japan. Keynote speech by Urs Boegli, Head of the Communication Department, International Committee of the Red Cross.
Ladies and gentlemen,
In the time it takes for me to deliver this address someone somewhere in the world will step on an anti-personnel landmine. This person will probably be a civilian living in a rural community, possibly a young child not even born when the mine was laid. Just one more faceless statistic to add to the list of hundreds of thousands of men, women and children across dozens of countries world-wide, all victims of the epidemic of mine injuries.
As with all public health emergencies, the solution to the epidemic demands both curative and preventive action. Thus, in order to tackle the root of the problem--the very existence of anti-personnel mines as a legitimate weapon of war--the International Committee of the Red Cross is calling for their total prohibition and elimination. Nothing less than a total prohibition will be sufficient to stem the tidal wave of lost and broken lives and limbs, impoverished and malnourished communities, empty fields and villages--all consequences of anti-personnel landmines.
Mine clearance is also an essential preventive activity: slow, dangerous and expensive it may be, but the ICRC firmly believes that much more can be done to clear the scourge of mines from afflicted societies and communities in Africa, the Americas, Europe, as well as here in Asia. Where comprehensive mine clearance cannot yet be undertaken, community-based mine awareness programmes can help to equip i ndividuals and communities with the information and skills they need to minimize the risk of injury due to mines.
Yet, fields must still be cultivated, water drawn and firewood collected even if that sometimes means entering a mined area. Thus, for the foreseeable future, the global number of mine injured and mine amputees will continue to increase. The ICRC database of mine incidents has registered more than 9,000 victims since January 1995 in more than 40 countries. It is impossible to know what proportion of all victims are registered; they are certain to be only a small minority. And so few, far too few of these individuals receive the treatment and the care that they deserve. The message of the ICRC to the international community is therefore loud and clear-- please don't forget the victims.
Survivors of mine incidents typically suffer from three patterns of injury. Those who step on blast landmines usually lose a foot or a leg and suffer severe injuries to the other leg, genitalia and arms. Survivors of explosions of fragmentation mines, on the other hand, receive wounds similar to those from any other fragmentation device; such wounds can affect any part of the body. The third pattern of injury occurs where mines are accidentally detonated, for instance, by deminers or by children mistaking mines for toys. This pattern inevitably involves severe wounds to the hands and face.
Once a person has been injured by a mine the first priority is to get him or her safely out of the minefield and to stop the bleeding. This'first aid'can usually be achieved by the application of a firm dressing but a traumatic amputation may require some sort of tourniquet which must be applied as low as possible and released at regular intervals. Many limbs are lost or have to be amputated higher than otherwise necessary bec ause tourniquets are applied too high on a limb and left on for more than six hours.
Of course, the earlier a mine casualty reaches a competent medical facility the better. Early administration of antibiotics can help to prevent the onset of serious infection such as gangrene. It is generally believed that six hours is the time beyond which a contaminated wound becomes infected and thus life-threatening. In addition to antibiotics, measures must be taken to prevent tetanus.
The effects of anti-personnel mines on the human body are a relatively new subject in medical literature. Until recently, mine injuries were considered to be the same as any other caused by conventional weapons. However, mines inflict a much more severe injury by design: their intention is, almost invariably, to mutilate and sometimes also to kill. And not only do landmines inflict horrific direct injuries, they also drive dirt, clothing, metal and plastic fragments into the tissue and bone, often resulting in severe secondary infections.
Indeed, such is the appalling nature of landmine injuries, among the worst that ICRC surgeons have ever seen, that it was ICRC medical staff who prompted the organization to adopt its unprecedented stance against anti-personnel mines. Determined to put an end to the carnage, in November 1995 the ICRC launched a major international advocacy campaign with the unequivocal message: " Landmines must be stopped " . The campaign, which is run in co-operation with more than 45 National Red Cross and Red Crescent Societies, seeks to mobilize public opinion and foster political will through the press, television and radio not only to achieve an international prohibition of the use, stockpiling, transfer and use of all anti-personnel mines, but also to stigmatize their use in the public conscience. Hundreds of millions of peo ple around the world have already been reached by this message.
Here in Japan, the Japanese Red Cross has played a major part in sensitizing the Japanese public to the horrific consequences of landmines. In 1996, the Japanese Red Cross organized a highly successful symposium of mines with the Japanese Broadcasting Corporation and the ICRC greatly welcomes the continuing expansion of its national advocacy and fund-raising efforts on behalf of those affected by mines.
Indeed, a central component of the mines campaign is the need to strengthen the assistance provided to mine victims. Over the past ten years the ICRC has treated more than 140,000 war casualties, of whom about 30,000 were mine victims. As much as 85 per cent of all amputations performed in ICRC hospitals are as a result of mine incidents.
The surgical management of mine-injured patients can be a challenge to even the most competent surgeon. Wounds such as these are not seen in civilian practice and they do not correspond to any of the modern surgical specialities. The ICRC has produced video and teaching material about the specific surgical treatment of mine victims. Much of this has been adopted as standard teaching material for many of the world's military medical corps. In addition, a surgical seminar is held every year in Geneva for interested surgeons from national Red Cross and Red Crescent societies and the ICRC has organized training seminars in many countries, including Bosnia Herzegovina, Cambodia, Iraq, Myanmar, Pakistan and Peru.
After the surgical treatment and when all the wounds are healed and the swelling of the amputation stump has settled, a mine victim is ready to be fitted with an artificial limb. This normally occurs four to five weeks after completion of the surgical treatment. The fitting of an artificial limb is an essential part of t he rehabilitation of a mine-injured amputee. In addition to ensuring mobility it also constitutes the first step in regaining some of the dignity lost thereby facilitating the psychological recovery of the mine victim.
The ICRC follows a policy of " appropriate technology " in its limb-fitting centres. In many countries affected by mines, advanced modern technology may not be practicable or affordable. ICRC workshops now make artificial limbs out of polypropylene, a thermoformable plastic that is recyclable, easy to repair or replace, and cheap. In Colombia, for example, the introduction of polypropylene technology reduced the cost of a below-knee prosthesis from US$473 to US$212. Since 1979, the 45 ICRC rehabilitation projects in 22 countries have manufactured more than 100,000 artificial limbs for 70,000 amputees, as well as 140,000 pairs of crutches and 7,000 wheelchairs.
The ICRC puts great emphasis on the training of local technicians in the use of this technology; many mine amputees find employment in its limb-fitting centres. This ensures that the limb-fitting programme can continue once the ICRC withdraws. In recent years, partner organizations have been found to take over its programmes, the majority of them with some continued support from the ICRC. Most commonly, this is a governmental body in the country concerned, but some have been handed over to competent private foundations or to National Red Cross or Red Crescent Societies.
Those who survive mine injuries need a lifetime of rehabilitative care. But far too many mine injured fail to receive even the immediate physical assistance that they require. Poverty is often an issue in mine-affected countries. Although all assistance rendered by the ICRC is free of charge, in other cases mine victims may have to rely on aid agencies or forgo treatment completely.
Apart from the costs involved in treating mine victims, there are a number of other constraints that prevent mine victims from receiving adequate treatment. Access to the injured remains an important obstacle to their receiving assistance. Mine injuries remain a large-scale, scattered and largely unattended problem. Accurate collection of data is therefore the first step in addressing the mines epidemic. Improving the availability and flow of reliable data is crucial to helping not only to meet the needs of the survivors of mine injuries but also to prioritize mine clearance and community mine awareness activities.
In seeking to develop an effective strategy to meet the needs of a maximum number of mine injured and mine amputees it is abundantly clear that the process of making decisions about assistance requires an accurate and objective assessment of the needs, available resources, and likely constraints. Priorities must be established. Victims of anti-personnel mines are one category of the wounded; the wounded are one category of all people needing assistance. In addition to its expertise in providing medical assistance to mine victims it is in this decision-making process that the ICRC has perhaps the greatest experience to offer. There is no easy formula: a balance has always to be struck between the needs, the resources available to meet these needs and the constraints on meeting them.
The ICRC has gained considerable experience and expertise in treating and rehabilitating individuals injured by mines. This has been achieved by applying to each situation the means required to meet the needs while taking into full account the constraints specific to that situation. The donor community must focus as much on these constraints as on the technicalities of the assistance itself. These constraints must be circumvented in the short term but fully addressed in the long term.
Onl y a small proportion of the immediate needs are met by the ICRC and other agencies because:
- there is an obvious lack of funds for the projects already underway.,
- the specific constraints, imposed in any given country affected by the mine problem, may be insurmountable;
- a comprehensive and co-ordinated approach to the problem of victim assistance with a long term view is lacking.
There are three reasonable and immediate goals for improved assistance for mine victims: first, that all mine victims should have access to adequate surgical care and rehabilitation; second, that the psychological and social needs of those injured and disabled by mines should be effectively addressed; and third, that the impact on the social and economic development of affected countries of the presence of mines should be measured.
However, it is not enough to strive to meet these assistance goals alone if we wish to bring more and higher quality assistance to mine victims in the long term. Any concrete action in mine-affected countries must integrate assistance and prevention. We are sure that the key to improving mine assistance is the structured flow and analysis of information about the entire mine problem in any given situation. In each country or region affected by mines there should therefore be a system of information exchange between governments/local authorities, the ICRC and the National Red Cross and Red Crescent Societies, the United Nations and the network of non-governmental organizations. The information gathered would pertain to every aspect of assistance and prevention.
No single agency or organization can respond to the needs of the hundreds of thousands of mine amputees world-wide. But with better information, increased co-operation, great er resources and the necessary political will, stepping on a landmine should no longer mean that many mine victims have little left to live for. The ICRC will continue to work to increase the quality of and access to assistance for all those wounded by these abhorrent weapons. But if we are serious about ending the humanitarian crisis and horrible suffering anti-personnel landmines are causing they must be totally banned and eradicated forever from the surface of this planet.
Ref. LG 1997-031-ENG