First Middle East Conference on Landmine Injury and Rehabilitation: "Surviving the scourge of landmines"

Every day the doctors and nurses of the International Committee of the Red Cross look into the frightened eyes of men, women and children whose limbs have been shattered by anti-personnel mines, sickened by the knowledge that they must perform yet one more amputation. Our physiotherapists look into the eyes of those who feel they have lost their dignity because they can no longer provide for their families. Far too often, our delegates see fertile farmland lie fallow while communities go hungry. They, like so many other humanitarian workers, have seen enough of the pain and anguish these weapons inflict. It was their reaction to this seemingly interminable suffering that prompted the ICRC to work for a total ban on anti-personnel landmines. 

The case against these weapons is well known. Armed, laid and abandoned, anti-personnel mines wreak havoc in post-conflict societies. Unless removed or detonated, they kill and maim months or even years after the fighting has supposedly come to an end. Mines cannot distinguish between a soldier and a civilian, and it is all too often the civilian that is the unfortunate victim. The presence of mines can render large portions of national territory unusable and impede reconstruction of the country. Contaminated farmland and roads mean that communities can no longer feed themselves and hinder aid agencies in their efforts to supply sorely needed humanitarian assistance. 

Yet the impact of these weapons on individuals is what makes the greatest impression on our minds. As you have heard, it is the mine victims and their families who know first-hand the personal anguish and misery caused by these weapons. Only mine survivors can tell you about the true exte nt of the pain and shock immediately following the explosion and the difficulty of reaching a medical facility quickly. Only they can tell you what it feels like to undergo the multiple operations and extensive rehabilitative treatment required to regain a measure of mobility and dignity. Only they can tell you of the psychological distress caused by their inability to find work, the fact that they are often shunned by their families and communities, and the struggle to maintain an adequate standard of living. In many contexts the hurdles they face are immense. While some survivors overcome their injuries and lead active lives, many require long-term aid and assistance.

It was these realities that led the ICRC to launch a public appeal in 1994 calling for a total ban on anti-personnel mines. Working closely with an extraordinary coalition of non-governmental organizations, international agencies, governments and private individuals, it had but one goal in mind - to put an end to the carnage. This unprecedented mobilization helped to bring about an international treaty banning the use, production, stockpiling and transfer of anti-personnel mines. When the treaty was signed in Ottawa, Canada, in December 1997, it marked the first time in history that a weapon in widespread use had been outlawed. This success clearly shows that in the face of cruelty and barbarity humanity is neither powerless to act nor incapable of achieving results.

Yet, sadly, the tragedy continues. In the time it takes me to give this address, one more person will become a landmine victim. Somewhere in the world, maybe here in this region, a man, woman or child will step on a buried mine or disturb a tripwire and, as we have seen all too often, his or her life will be changed forever. 

It is estimated that every month 2,000 men, women and children are killed or injured by landmines. As systematic data collection in mined areas is often difficult, this number may be lower than the real figure. Statistics gathered by the ICRC show that in 1997 seven hospitals in Afghanistan alone admitted over 1,900 mine-injured patients. Can it be that the number of cases treated in these few hospitals represents nearly 10% of the estimated total? Since it is well known that many victims die before reaching medical treatment and that Afghanistan is just one of many mine-affected countries, the true figure is likely to be much higher.

The Middle East region has not been spared the agony caused by these weapons. Several countries are reported to have serious problems with mines, many of them left behind after the Second World War. Subsequent conflicts have dramatically increased the scale of the problem, and while two thirds of the countries of the world have now signed the Ottawa treaty only two – Qatar and Yemen – are in the Middle East region. Nonetheless, it must be recognized that there is now a clear trend towards abandoning the use of these weapons. The fact that 127 States have signed the Ottawa treaty and that, after only seven months, 23 have deposited their instruments of ratification show indisputably that it is no longer a question of " if " a ban will come into effect, but " when " . An international norm against the use of these weapons is maturing quickly and there can be little doubt that in time their use will become stigmatized just like the use of exploding and dum-dum bullets and chemical and biological weapons.

It is clear that if the purposes and objectives of the global movement to rid the world of anti-personnel mines are to be achieved, much remains to be done. States which have neither signed nor ratified the treaty must be encouraged to do so. Some States will require assistance in meeting their treaty obligations. Yet this should not deter them. Under the treaty, a State Party is entitled to seek cooperation and assistance for mine clearance, the destruction of stockpiles an d the care and rehabilitation of victims. Those States Parties in a position to do so have a responsibility to provide such assistance. Nonetheless, mines continue to threaten communities, prevent the return of displaced persons, and hinder reconstruction and economic development. In many mine-affected countries rehabilitation services are lacking. All States clearly share the humanitarian objectives of the Ottawa treaty. To make them a reality, continued attention and greater resources must be brought to bear on the landmine problem. The lives, welfare and future of many innocent people depend upon it.

As part of its mandate to care for and protect the victims of war, the ICRC has played a central role in treating and rehabilitating mine victims and teaching communities about the dangers of mines. As you will hear throughout this conference, mine wounds are horrific. While similar wounds can occasionally be caused by other weapons, the anti-personnel blast mine is unique in that it is actually designed to cause such appalling injuries 100 percent of the time. Mine wounds require skilled surgery, large amounts of blood for transfusion and prolonged hospitalization. Few doctors in civilian practice have experience in dealing with such injuries.

The ICRC has placed great emphasis on developing surgical techniques in an effort to improve the quality of care afforded to mine victims. We continue to inform and train surgeons from all over the world in the application of these techniques, and to produce videos and brochures on the proper surgical management of war wounds.

In terms of rehabilitation, the ICRC is currently running 22 physical rehabilitation programmes in 11 countries. Between 1979 and 1997 our workshops manufactured nearly 120,000 artificial limbs, many of which went to mine survivors. In 1997 alone we produced 11,300 prostheses and of these 7,200 went to mine survivors. These programmes are tailored to each coun try's social and economic needs and are designed to be taken over in the long run by a local organization or governmental body. To eliminate the need to import expensive ready-made prosthetic components from abroad, the ICRC has introduced new materials and developed special moulds to facilitate low-cost production at the local level. 

Yet rehabilitation must go further than the provision of artificial limbs. Job training, gainful employment and counselling are essential features of the solution to the problem. The ICRC has learned that mine amputees can be valuable workers, particularly in limb-fitting centres. Employing them to help fellow survivors not only benefits the workers themselves but also has a positive impact on patients who are trying to come to terms with the accident which has befallen them. In our Kabul workshop, 60% of the employees are war-wounded, many of them mine survivors.

As it is likely to be many years before some communities can hope to live free from the threat of mines, teaching people how to avoid injury is another important activity. The ICRC is currently running mine-awareness programmes in Azerbaijan, Bosnia-Herzegovina and Croatia, and need assessments are being conducted in Georgia, Sudan and Uganda.

Over the last year and a half much attention has been focused on bringing a treaty prohibiting anti-personnel landmines to fruition and developing new technologies to remove mines that are already in the ground. Throughout this process it was the voices of the victims and survivors that rang out the loudest. It was their plight and their contributions that led most of the world to reject anti-personnel mines as weapons of war. Let us not forget their efforts and the fact that many of them have needs which must be met. Assistance to victims and prevention of mine accidents remain major challenges for the international community. States in the Middle East must do their part by re-examinin g the utility of the anti-personnel mine. The ICRC believes that in doing so they will, as so many other States have already done, reject it as a barbaric device and sign, ratify and implement the Ottawa treaty. Only once that has been accomplished will we be able to say that the end of the landmine crisis is in view.

In closing, I would like to say that the ICRC hopes the future does not present similar challenges to those posed by the landmine crisis. With new weapons on the horizon whose full impact is unknown, concerns about indiscriminate effects and unnecessary suffering remain real. Existing law requires States to review all new weapons in the light of the criteria laid down by international humanitarian law. Such an examination will go far in ensuring that a problem of this magnitude will never happen again.

Réf. EXSO 98.07.11-ENG