Antipersonnel landmines: facts, fictions, and prioritiesBMJ 1997; 315 doi: http://dx.doi.org/10.1136/bmj.315.7120.1453 (Published 29 November 1997) Cite this as: BMJ 1997;315:1453
- Chris Giannou, medical coordinator of ICRC campaign to ban antipersonnel minesa
- a Division of Health Operations, International Committee of the Red Cross, CH 1202 Geneva, Switzerland
Over 100 million mines are buried in over 70 countries. Most victims are civilians. A lack of money prevents us adequately dealing with the problems created by antipersonnel mines. These are all fictions. What then are the facts?
Firstly, no one knows how many anti-tank or antipersonnel landmines there are in the old and current battlefields of the world, together with unexploded cluster bombs and other ordnance—all a danger to non-combatants. Yet the absolute number of mines is of little consequence. Whether a square kilometre of rural Angola contains 10 mines, 10 000, or 10 000 000 is not important: it is one square kilometre of farmland that cannot be used to grow crops to feed families. That is what is important.
Secondly, during most contemporary conflicts most victims of antipersonnel mines are military; some casualties, to varying degrees in different countries, are civilians. After a conflict is over, however, most if not all mine victims are civilians and those engaged in clearing mines.
Thirdly, it is not simply a lack of money that prevents us dealing with the problems caused by mines. To begin with we do not know the full extent of the problem to solve in any given country. These problems are so wide ranging, they need an equally wide ranging approach.
A pandemic of landmine injuries
Antipersonnel mines have disabled individuals, handicapped families, and mutilated entire societies. Their effects are widespread and continue long after a conflict has ended. The mining of agricultural land results in a severe loss of income for farmers; many families go into debt to pay for medical care for a wounded relative; malnutrition increases1; people are forced from their homes because families cannot eke out an existence2; there is an increase in casualties among returning refugees2; repatriation of displaced persons or refugees may be delayed or totally compromised; and if roads are affected rural immunisation campaigns by mobile teams, the provision of emergency relief supplies, and the resumption of normal commercial activity are blocked.
These socioeconomic repercussions can destabilise the fragile economies of postwar societies and thus exacerbate political tensions after a civil conflict. Scarce funds must be used for mine clearance, mine awareness, and tertiary curative medicine. The treatment of amputees from antipersonnel blast mines makes greater demands on hospital resources, blood supplies, and long term rehabilitation (including the fitting of artificial limbs, vocational training, and social reintegration) than does that of other war wounded, including those injured by fragmentation mines.3 These funds are then not available for infrastructure reconstruction, economic rehabilitation, or preventive primary health care.
There is a pandemic of landmine injuries, and like all epidemics, in their causes and consequences, the landmine pandemic is a social, economic, health, and political event which particularly targets the innocent, the weakest, and the least prepared. The response must therefore also have social, economic, health, and political aspects and it must include preventive, curative, and rehabilitative measures.4 The political response was negotiated in Oslo in September, and a new international humanitarian treaty will be open for signature in Ottawa in December. This is the beginning of prevention: a conscious decision on the part of states no longer to use antipersonnel mines, and a commitment to clear those sown in the fields.
Landmines not only injure individuals; by rendering agricultural land unusable and roads unpassable they also damage the fragile economies of nations trying to recover after conflicts
The problem is therefore not simply one of treating and rehabilitating people injured by landmines
For each area affected, the priorities—mine clearance, education, health services, repairing economic infrastructure—need to be identified and action targeted
The International Committee of the Red Cross has devised a mines information system to enable the many agencies involved to assess the priorities and coordinate their efforts
And yet we do not even know exactly how many casualties there are. One of the first victims of war is the health system. Destruction, disorganisation, dislocation of services; dispersal of health professionals; poverty; and, therefore, non-payment of salaries—all conspire to render a health system incapable of facing the demands of care for any wounded or sick. Access to the wounded, proper first aid, evacuation, transportation of patients, and the existence of functioning hospital infrastructure with qualified staff can be compromised, or simply non-existent. Statistics, in such a situation, do not exist.
A mines information system for collecting data
Using statistics gathered from hospitals and limb fitting workshops in several countries, internal reports, and extrapolating from published epidemiological reports,5 6 7 the International Committee of the Red Cross has arrived at an estimate of 24 000 people killed and wounded per year on average world wide. We believe that this is a conservative figure. We do not know the total number of casualties.
Data in general are lacking and, without statistics and facts, priorities cannot be established, policy articulated, and programmes planned. This is the first major obstacle to dealing with the problems that mines pose. To respond to this dearth of data, the International Committee of the Red Cross has proposed an organisational tool for promoting synergy among the various actors concerned and who are the sources of different types of information: political, military, and administrative authorities; non-governmental organisations; United Nations agencies; the International Committee of the Red Cross and national Red Cross and Red Crescent societies.
This tool is a mines information system.8 This should be used as part of a cooperative effort to standardise and systematise the collection of relevant data, then centralise and analyse them. Priorities could then be determined and programmes planned in any country, one province and one district at a time. For it is at each of these levels—village, district, province, and nation—that priorities must be decided and programmes planned and implemented.
What constitute the relevant data to collect? What determines the severity of the mine problem in a village (see box)? How to choose then among vying needs: mine clearance; mine awareness programmes to warn of the danger of mines for populations at high risk; health care of the wounded? Sufficient funding for a particular country may even be present, but without priorities it cannot be efficiently invested.
Factors that need to be determined in a given area
Mortality and morbidity
Capacity of the health system to deal with the needs
Civilian mined areas: residential, agricultural, industrial
Percentage of civilian population affected socioeconomically
Public or community programmes disrupted because of mines
Population density compared to density of mines laid
Transportation infrastructure affected
Indigenous mine clearing capacity
Method of laying mines
It is the human consequences that one must look at—the socioeconomic and humanitarian repercussions—to determine a coherent strategy for assessing the priorities. The International Committee of the Red Cross has defined a tentative list of factors which help to determine the gravity of the mine problem in a given region (see box).
Clearly a continuing conflict, with new mines being laid, poses security problems of an entirely different character from a postwar scenario. This difference must be addressed by any aid programme. The existence of widespread banditry, especially among newly demobilised combatants, creates special restraints. Were mines placed by a classical, well trained army or by irregular forces? Are minefields marked and fenced off? Do maps exist? Were mines delivered by air or by artillery, or were they hand placed?9 What types of mines were used: plastic or with a minimal metal content? These are some of the factors that determine the difficulty of mine clearance.
Determining how most efficiently to use national and foreign funding and setting proper operational priorities according to humanitarian criteria depend on the systematic collection of standardised data and a coherent analysis. As part of a coordinated approach, a mines information system, using the above factors to determine the gravity of mine infestation of an area is essential if all the agencies involved are to prevent more victims falling to mines and better helping those who do.