At least 3,385 survivors have been identified by the Monitor since 1999 in the Republic of the Union of Myanmar. However, this is believed to be only a small fraction of the actual figure, which was estimated by the NGO Mine Free Myanmar to exceed 40,000.[1]

Victim assistance since 2015

A Technical Group on Victim Assistance, a sub-working group of the national Mine Risk Education Working Group facilitated by Handicap International (HI), was established in September 2014. The Technical Group on Victim Assistance, was tasked to define the victim assistance component of the 2015–2016 Mine Risk Strategic National Plan. Since its establishment, it also monitors implementation of victim assistance and shares information on victim assistance issues. It also creates linkages between the Mine Risk Education Working Group and disability-rights actors.[2]

In 2015, there was a continued increase in rehabilitation and economic inclusion services available to survivors within Myanmar. However, it has been estimated that Myanmar requires approximately 300 prosthetic technicians to meet the needs of amputees, but has less than 30.[3]

In 2015, a representative of the Ministry of Social Welfare, Relief, and Resettlement reported that Myanmar was taking an integrated approach towards victim assistance, based on the Convention on the Rights of Persons with Disabilities (CRPD), in its national disability law and national social protection strategy.[4]

In early 2015, Danish Deming Group/Danish Refugee Council (DDG/DRC) conducted a “Landmine and Explosive Remnants of War Victims Survey” in Kachin and Kayah states that incorporated needs assessment and evaluation of opportunities for possible future activities. The DDG/DRC found through survey interviews with survivors and victim assistance organizations that the greatest needs included psychosocial support, livelihood assistance, and socio-economic reintegration. They also found that victim assistance needed to be integrated into the larger disability and rehabilitation sector, which also needed to be made sustainable.[5]

The first state-wide disability survey in Kayah state, conducted by World Education in 2015, determined that almost 9% of persons with physical disabilities had acquired impairments due to landmine injuries.[6] HI reported that mine/explosive remnants of war (ERW) survivors in Kawkareik district in Karen state “may account for one third of persons with physical disabilities; in some villages this percentage is as high as 75%.”[7]

In 2014, the Ministry of Health and Sports and the ICRC agreed to build two new physical rehabilitation centers in Kyaing Tong in Shan state, and Myitkyina in Kachin state.[8]

More actors were involved in delivering, planning, and organizing all aspects of victim assistance.

Assessing victim assistance needs

HI and the Myanmar Physically Handicapped Association (MPHA) Victim Assistance Center in the Kyaukkyi township of the Bago region surveyed mine survivors and other persons with disabilities. Survey results were to be used for interventions and evidence-based strategy. During needs assessments, referrals were made to appropriate and accessible services for mine survivors and other persons with disabilities. HI also developed directories of services in Mandalay, Ayeryawerdy, and East Bago (Kyaukkyi township).[9]

World Education worked to improve data collection and information sharing about persons with disabilities in Kayah state.[10]

In June 2017, a national consultation on disability statistics and Incheon Strategy indicators was organized by the Economic and Social Commission for Asia and the Pacific (ESCAP) in cooperation with the Ministry of Social Welfare, Relief and Resettlement. The consultation reviewed the national statistical system to assess progress, challenges, and gaps in disability policy and data collection.[11]

The MPHA reported that a significant number of military personnel, armed group members, and civilians had acquired impairments and lived with disability due to conflict. Of approximately 12,000 amputees in Myanmar, two-thirds were believed to be landmine survivors.[12]

Victim assistance coordination

The national Technical Group on Victim Assistance operates under the umbrella of the National Mine Risk Working Group (MRWG) and is chaired by the Ministry of Social Welfare, Relief and Resettlement. HI coordinated the national Technical Group on Victim Assistance, gathering national and international actors. The Technical Group on Victim Assistance continued to meet regularly in 2016.[13] Members of the group include international and national NGOs, the UN, the ICRC, and the Myanmar Red Cross Society (MRCS), as well as international cooperation agencies. In 2017, HI created a Disability Inclusion Unit (DIU) for awareness-raising and mainstreaming of disability issues.[14]

The Ministry of Health and Sports is responsible for the medical rehabilitation of persons with disabilities, and the Department of Social Welfare, within the Ministry of Social Welfare, Relief, and Resettlement is responsible for vocational training, education, and social protection strategies. During 2016, the government recognized the Myanmar Federation of Persons with Disabilities (MFPD; formerly called the Myanmar Council of Persons with Disabilities, MCPD) to serve as an umbrella group for disabled people’s organizations (DPOs). The National Committee on Disability, the ministerial committee mandated with promoting the rights of persons with disabilities, did not meet in 2016.[15]

The MCPD (later the MFPD) was formed in December 2014. A council member stated that the group would “work to adopt a law to protect disabled people and to implement the CRPD.”[16] World Learning provided technical support for local disability activists to organize the first Myanmar National Disability Conference, in order to elect representatives to a new 21-member MCPD. It continued to develop organizational and technical capacity in the MCPD with international disability law experts from the United States International Council on Disabilities and support from USAID.[17]

Myanmar has a National Strategy for the Development of Persons with Disabilities (2016–2025).[18]

A consultation Workshop on the National Strategic Disability Plan sponsored by the MCPD was held from 29 August to 2 September 2016. The Department of Social Welfare along with disability self-advocates participated in the development of implementation activities for 2017–2022 based on the objectives of the Myanmar National Strategy for Development of Persons with Disability (2016–2025), including a budget for the Myanmar fiscal year 2017–2018.[19]

Several institutions were involved in the coordination of physical rehabilitation; the Ministry of Health and Sports, the Ministry of Defense, and the MRCS played roles in the provision of mobility aids, especially prosthetics and orthotics.[20]

Although there is no direct representation of mine/ERW victims, survivors belong to broader DPOs that participate in various coordination roles.

Service accessibility and effectiveness

Victim assistance activities

Emergency and continuing medical care

Health in Myanmar has been affected by decades of ethnic conflict, centralized decision-making, and the exodus of qualified health professionals, including qualified physicians, nurses, and community health workers. The availability of medicines, medical equipment, and hospital/clinic beds are inadequate. Hospital facilities are dilapidated and require renovation. The reliability of electricity in health facilities is an ongoing challenge. Those people living in areas of armed conflict and other remote areas often cannot access to healthcare “within a few days’ walk.” Most health workers employed by ethnic and community-based health organizations attend initial training and periodic professional development seminars, with additional clinical supervision at the Mae Tao Clinic or other ethnic health clinics. Medics working in areas with landmines receive more intensive training in trauma management.[21]

In response to increased government security interventions against armed elements in Rakhine, the ICRC expanded its support for the healthcare response by reimbursing the health ministry for the cost of each transfer made by the outpatient referral service from northern Maungdaw to nearby hospitals.[22]

There were parallel health systems in Myanmar, particularly in conflict-affected areas: centralized state services and local ethnic and community-based health providers.[23]

Health Convergence Core Group (HCCG) worked to improve health systems. It is composed of four ethnic health organizations and four community-based health organizations: Burma Medical Association, Back Pack Health Worker Teams, Karen Department of Health and Welfare, Karenni Mobile Health Committee, Mae Tao Clinic, Mon National Health Committee, National Health and Education Committee, and the Shan Health Committee. In March 2016, HCCG held a seminar on Health Reform, Towards a Devolved Health System in Burma, to develop a set of health policy and health system recommendations for the new government of Myanmar and ethnic health organizations.[24] No further activities were reported in 2016–2017.

Physical rehabilitation, including prosthetics

As most rehabilitation centers are located in major cities and travel costs are high, persons with disabilities, especially those living in rural areas, often face tremendous difficulties in order to access services.[25]

In 2016, the ICRC continued to support the Hpa-an Orthopaedic Rehabilitation Centre (HORC), run jointly by the Myanmar Red Cross Society and the ICRC, and to support three centers managed by the Ministry of Health, located in Mandalay and Yenanthar, enabling people living in remote areas to have access to services. It also opened the Myitkyina Physical Rehabilitation Center in Kachin state. The ICRC covered transportation and treatment costs for the most vulnerable patients. In 2015, 39% (301 of 764) of prostheses delivered in ICRC-supported workshops were for mine/ERW survivors; this was a decrease in real and percentage terms from previous years (44%, or 351 of 802 in 2015; 49%, or 502 of 1,027 in 2014).[26]

The Myitkyina Physical Rehabilitation Center in Kachin state opened in October 2016, it was created through a partnership between the ICRC and the Ministry and Health and Sports. The 60-bed center was expected to serve up to 1,500 patients a year with prostheses, orthoses, and physiotherapy, once it reaches full operational capacity.[27] The Ministry of Health and Sports approved the construction of two new physical rehabilitation centers proposed by the ICRC, one for Myitkyina and another for Kyaing (Eastern Shan state) in 2016. The centers are needed to address the high demand for services in those conflict-affected regions.[28]

Exceed Worldwide opened a new prosthetic-orthotic center at the Mandalay Orthopaedic Specialist Hospital in January 2017. Jointly established by the Ministry of Health and Sports, with support from Japan, the center planned to offer prosthetic services to people in need in Mandalay and nearby regions and states.[29]

The MPHA produced prosthetics and assistive mobility devices at a small workshop in its office in Yangon. About a third of MPHA’s members are landmine survivors.[30]

HI provided victim assistance in Kayin state and East Bago, including rehabilitation, psychosocial, and livelihoods support. HI and the MPHA jointly created a Victim Assistance Disability Program in the Kyaukkyi township of Bago region. The program established a local Victim Assistance Center, supported by UNICEF, which provided the following activities:

• Information to mine survivors and other persons with disabilities on their rights as promoted by the CRPD and Myanmar’s law on the Rights of Persons with Disabilities;
• Organization of social gatherings to promote the social participation of survivors and other persons with disabilities;
• Created a service directory to assist in this;
• Provided home-based peer-to-peer psychosocial support through nine trained volunteers;
• Community-based repair of assistive devices, orthosis, and prosthesis through four ICRC-trained volunteers.[31]

World Education supported a prosthetics workshop providing mine/ERW survivors in Kayin state. In 2015–2016, it ran a Victim Assistance and Disability Program including, capacity-building for local organizations assisting persons with disabilities and landmine survivors, advocacy among service providers for increased inclusion, economic inclusion, access to medical and vocational support funds networking, and coordination with disability actors, including the Department of Social Welfare community-based organizations, DPOs, and other service providers.[32]

Peace Myanmar Aid Foundation/Humanitarian Mine Action Initiative Myanmar runs a mobile prosthetics workshop in eastern Bago region.[33]

A free rehabilitation camp, established in February 2017, provided prostheses for 400 amputees, the majority being landmine survivors. Rehabilitative and technical assistance for the camp was provided by Bhagwan Mahaveer Viklang Sahayata Samiti (BMVSS, also known as the Jaipur Foot Foundation) with the help of the U Nu Daw Mya Yi Foundation (UNDMYF). The project was supported with a grant from India.[34]

Psychosocial support

A psychosocial program combined with a community-based prosthetics service was launched by HI, MPHA, and the ICRC for survivors in 2015. This joint activity created the first Victim Assistance Center in Myanmar, in Kyaukkyi township, eastern Bago region.[35] As of September 2017, psychosocial support was limited to peer-to-peer counselling through 30 community volunteers—persons with disabilities linked to MPHA Victim Assistance Centers and trained by a psychologist.[36]

Economic and social inclusion

A lack of understanding about persons with disabilities as well as poor infrastructural accessibility make it difficult for persons with disabilities to attend school or find employment. World Education provided livelihood training and small business start-up kits to landmine survivors and other persons with disabilities in Kayin state.[37]

AAR Japan Vocational Training Center for Persons with Disabilities provides training in tailoring, hairstyling, and computers free-of-charge in Yangon. The center supports graduates to achieve economic independence, gain employment, open their own shops, or become teachers at the center.[38]

The Ministry of Education policy is reported to discriminate against persons with disabilities, on the basis that schools are allowed to refuse to accept an enrolment application for a child with a disability if they feel they cannot support them. The ministry is also reported to discriminate against persons with disabilities in employment advertisements for teaching positions by saying they need not apply. In response to criticism about the practice, a ministry representative was quoted as saying, “we need to appoint those with normal hands and feet to be teachers at basic schools.”[39]

Laws and policies

The National Assembly passed the Law on the Rights of Persons with Disabilities in June 2015. The process of drafting by-laws for the Law on the Rights of Persons with Disabilities also started in that month.[40] The laws prohibits discrimination against persons with physical, sensory, hearing, intellectual, and mental disabilities in employment, education, access to healthcare, the judicial system, or in the provision of other state services. It also directs the government to assure that persons with disabilities have easy access to public transportation. In 2016, the government was still in the process of drafting implementation guidelines for the disability law and did not effectively enforce these provisions.[41] In October 2015, the first meeting for the creation of by-laws took place, with the participation of the Myanmar Federation of Persons with Disabilities (MFPD), also known as the Myanmar Council of Persons with Disabilities (MCPD).[42] However, in September 2017 it was reported that implementing rules and regulations were yet to be released.[43]

Myanmar adopted and launched a National Social Protection Strategic Plan in December 2014 through the Ministry of Social Welfare, Relief, and Resettlement to provide an allowance to all persons certified with a disability.[44]

Military veterans with disabilities received benefits on a priority basis, usually a civil service job at equivalent pay. Official assistance to non-military persons with disabilities in principle included two-thirds of pay for up to one year for a temporary disability and a tax-free stipend for permanent disability; however, the government did not provide job protection for private sector workers that became disabled.[45] Veterans’ disability pension rates, although inadequate, were about three-times the level what they were before funding for social programs was increased in 2015. In addition to a K90,000 pension; veterans who lost limbs receive compensation of about K100,000 (US$80) per month, those who lost vision receive K12,000 per month.[46]

Injured ranking soldiers, particularly officers, are often employed in military service in administrative positions or other support roles, depending on their level of education and the severity of their disability. There are believed to be dozens of army-built community settlements where disabled veterans and their families receive free housing. However, ordinary soldiers lacked job opportunities and ways of finding extra income. The free housing was often located in remote areas where there were no jobs, and that lacked basic amenities such as running water and electricity. Many veterans’ children are migrant workers in Thailand and provide financial support for the families through remittances.[47]

Myanmar acceded to the CRPD on 7 December 2011. The convention entered into force for the country on 6 January 2012. The MPHA received a second year of funding to build the capacity of DPOs to monitor and report on CRPD implementation in Myanmar as well as to prepare an alternative (shadow) report for submitting to the CRPD committee.[48]

Victim assistance for Myanmar refugees in Thailand

Landmine survivors from Myanmar may cross the border to Thailand to receive medical care and rehabilitation at Mae Tao Clinic in Mae Sot, or through ICRC referrals to Thai hospitals in public district hospitals in the Thai-Myanmar border provinces and HI services in refugee camps.[49]

Assistance for refugees in Bangladesh

In response to the Rohingya crisis, as of October 2017, HI provides immediate rehabilitation or psychological assistance. In partnership with a local center for disabilities and development, HI operated a fully equipped mobile rehabilitation center to remote areas of Bangladesh for physical therapy and fitting measurements for prosthetics.[50]