Casualties

Casualties Overview

The National Regulatory Authority for the unexploded ordnance (UXO)/Mine Action Sector in the Lao PDR (NRA) reported 99 landmine/explosive remnants of war (ERW) casualties for 2011. As in past years, the majority of casualties (56) were children: 51 boys and 5 girls. Civilian adult casualties included 30 men and 11 women. The 99 casualties recorded for 2011 represented a decrease from the 117 casualties for 2010.[1] However, data was not considered to be accurate; even after six years of work on the NRA casualty data collection system, there was little or no improvement in the quality of the data available.[2]

As of the end of 2011, the NRA had identified at least 50,469 mine/ERW (including unexploded submunitions) casualties, including 29,491 people killed and 20,978 injured since 1964. The majority of casualties recorded (30,128) occurred during the conflict years from 1964 to 1973. Most casualties were caused by landmines.[3] The first phase of a nationwide casualty survey recording retrospective data was completed in 2008. It identified 50,136 mine/ERW casualties which, not including unexploded submunitions, caused the most casualties, followed by landmines and then unexploded submunitions.[4]

Cluster munition casualties

Unexploded submunitions were reported to have caused 7,580 casualties in the period 1964–2011 (3,176 were killed; 4,371 injured; 33 outcome unknown).[5]

Victim Assistance

Lao PDR has estimated that there are some 12,500–15,000 mine/ERW survivors still alive, including approximately 2,500 survivors of unexploded submunitions.[6] 

Victim assistance since 1999[7]

The assistance provided to survivors in Lao PDR remained inadequate throughout the period.[8] Landmine/ERW survivors represent a significant proportion of people with disabilities in Lao PDR. Most survivors come from the poorer remote areas, belong to ethnic minorities, and are disproportionately disadvantaged by the existing limitations in the provision of services. In Lao PDR, financial constraints are the main barrier to accessing healthcare. Emergency medical care throughout Lao PDR remained inadequate to meet survivors’ needs for most of the period, although progress was made with the development of a system of village health volunteers, in addition to an Asian Development Bank project with the Ministry of Health that improved primary health care services in northern provinces by 2008. More recently, World Education and the Ministry of Health improved the availability of healthcare to survivors significantly.

Physical rehabilitation services, run by the government in association with the Cooperative Orthotic and Prosthetic Enterprise (COPE), showed improvement. With a new outreach program introduced in 2010, they were better able to reach survivors in rural areas. Retaining prosthetics staff remained a key challenge for the rehabilitation sector services because government salaries for health care workers were very low, but better paid opportunities were available in the private sector.

There was only limited psychosocial support for mine/ERW survivors, however, peer support increased. Social and economic reintegration programs for mine/ERW survivors, provided by NGOs, remained limited but had increased since 2009. Regulations protecting persons with disabilities from discrimination and requiring accessible buildings did not have the force of law.

Assessing victim assistance needs

In 2011, Lao PDR continued to lack sufficient information about survivors’ needs.[9] The second phase of the national victim survey, which started in June 2009, was intended to complete information on all survivors of incidents occurring since 2008, but the needs assessment component was not implemented.[10] One of the UNDP’s main objectives in 2011 was to support the NRA in their efforts to improve data on ERW casualties disaggregated by sex and age and to develop a system of registering survivors’ needs in the areas of medical care, physical rehabilitation, economic inclusion, and psychosocial support.[11] The Survivor Tracking System was intended to establish the survivors’ needs. By June 2012, training workshops for provincial and district focal points had been held in all of the 10 provinces planned for survey and 30% of the expected survey forms had been returned. Data and a summary report were planned to be distributed to all operators and stakeholders upon completion.[12]

The data collected on new casualties lacked detail on survivor’s injuries and needs; the data was not used by service providers to implement victim assistance activities.[13] The NRA shared data on survivors with members of the Technical Working Group on Victim Assistance (TWGVA) upon request. Data was mainly requested in order to develop work plans.[14]

Victim assistance coordination in 2011

The TWGVA held six regular meetings in 2011. TWGVA participants included the NRA, other relevant government agencies, national and international NGOs, and survivors. The meetings were mostly concerned with data collection.[15]

The Victim Assistance Strategic Plan, which had been under development by the NRA Victim Assistance Unit since 2008, was not used by the NRA or the TWGVA; a revised plan was being drafted in 2012.[16] The Victim Assistance Strategic Plan was to have been finalized after the completion of six position papers (on data collection, medical care, physical rehabilitation, psychosocial rehabilitation, economic rehabilitation, vocational training, and advocacy). In mid-2012 the position papers remained in draft form and had not been translated or reviewed by the NRA or the TWGVA. Some of the draft documents were reported to need updating.[17]

Victim assistance is one of the three main components of the NRA strategy entitled “Safe Path Forward II 2011-2020.”[18] The Safe Path Forward II was approved by the Office of Prime Minister in June 2012.[19] The strategy and its victim assistance component were included in Lao PDR’s Millennium Development Goals Compact of 2010.[20] A key indicator for progress under these Millennium Development Goals includes “the number of survivors receiving proper assistance.”[21]

National standards for victim assistance developed in 2007 remained in draft form pending the completion of the national victim assistance strategy.[22]

The Ministry of Health held primary responsibility for  services related to the needs of persons with disabilities more generally. Because of the large number of mine/ERW survivors with disabilities in Lao PDR, the ministry worked extensively on victim assistance and rehabilitation in coordination with international NGOs.[23] Reinforcement of linkages between victim assistance and the broader disability sector was still needed in 2011.[24]

Lao PDR reported on the international funding received by NGOs that provided victim assistance in 2011 in its Convention on Cluster Munitions Article 7 report, made statements on victim assistance at the Second Meeting of States Parties to the Convention on Cluster Munitions, in Beirut in October 2011, and also at the Convention’s intersessional meetings in April 2012.[25]

Inclusion and participation in victim assistance

Survivors, persons with disabilities and their representative organizations participated in TWGVA meetings. Survivors provided input into the development of the survivor tracking system questionnaires through the TWGVA.[26] Throughout 2011 and into 2012, increasingly more survivors participated in the delivery of services, particularly those supported by World Education, including economic inclusion, peer support, referral through provincial survivor committees and other sharing of information on available services. [27]

Lao PDR has not included a survivor on its delegation at the Convention on Cluster Munitions Meetings of States Parties or Intersessional Meetings.

Service accessibility and effectiveness

Victim assistance activities[28]

Overall, there was a continuing lack of access to health services in Lao PDR. The health care system was underdeveloped and under-funded, and health workers had inadequate skill levels. This directly contributed to shortfalls in the quality of services across the health system.[29] The NRA reported that, by the end of 2011, World Education had committed to providing assistance to all new survivors from the 17 provinces of Lao PDR, subject to availability of funds. World Education reimbursed hospitals for the cost of survivors’ treatment through the requests of the NRA.[30]

COPE increased the number of beneficiaries of prosthetic and orthotics services in 2011 and continued to provide the five government-managed rehabilitation centers in the country with both financial and technical support. A new training project was established in 2011 to further develop the range of orthotic devices produced by the centers in order to address a greater range of patient needs.[31]

In 2011, resources from donors, together with funds raised through the COPE Visitor Centre, enabled COPE to cover the cost of services, local transportation and food allowances during treatment for all those who attended the centers. However, the need for services was greater than the numbers of people attending the clinics since many survivors were not aware of, or unable to reach, the available services. COPE enlarged “Cope Connect,” its outreach and community awareness raising project, into Luang Namtha province in the north of Lao PDR in 2011.[32]

The ICRC Special Fund for the Disabled (SFD) conducted quality assessment of services at three government-managed prosthetic and rehabilitation centers in 2011 (Vientiane, Xieng Khuang, and Pakse), which resulted in an improvement in the quality of devices. In the first quarter of 2011, just one third of devices assessed at the Xieng Khuang center and some three quarters of devices assessed at the center in Vientiane met quality standards. Measures to correct this were taken and a second round of assessments in 2011 indicated a significant improvement, with between 90% and 100% of devices at the three centers fulfilling minimum quality standards.[33]

The AAR Japan closed down its office in Vientiane and transferred wheelchair production facilities and capacity, including all former AAR employees, to the government-operated Centre for Medical Rehabilitation wheelchair workshop.[34] The government sector took over management while all funding continued to be provided by Deseret International Charities as it had under AAR. The scale of production remained similar to the previous year.[35]

Psychological support was generally not available to survivors. However, World Education staff continued providing peer support in conjunction with other project activities.[36] Basic Needs also provided some limited psychological social support to survivors.[37]

World Education supported the establishment of a survivor-led NGO, the Quality of Life Association, in Xieng Khouang province, which was registered in September 2011 by local World Education staff. In addition to operating a visitors center selling handicrafts, the Quality of Life Association began to carry out assistance activities formerly undertaken by World Education in the province. By mid-2012 Quality of Life Association income-generation projects were still in the early stages of development.[38]

In late 2011, a forum was held by the LDPA in conjunction with HI to encourage businesses in Lao PDR to employ people with disability in the workplace. Starting in 2009, the LDPA, with HI support, ran a project linking people with disabilities with employers. As of 2012, the project had registered some 300 people with disabilities as jobseekers, of which about 10% had secured employment.[39]

In 2011, it was reported that there was an increase in the social inclusion of people with disabilities, including survivors, particularly those living in Vientiane and other cities.[40] In January 2012, the first ever national sporting event for people with disability, involving over 200 people, was organized in Luang Prabang province.[41]

As of April 2012, civil society was still an emerging concept in Lao PDR, where a decree for establishing not-for-profit associations was first enacted in 2009. The developing relationship between state and civil society was also a complicating factor in progress toward fulfilling the needs of persons with disabilities.[42] The LDPA, the national umbrella organization for disability groups that was established in 2001, was officially recognized as a civil society organization by the Ministry of Home Affairs in September 2011.[43] The Lao Association of the Blind, which was formed in September 2007, also finally received government approval to hold their inaugural general assembly in September 2011.[44]

A draft decree on the Rights of Persons with Disabilities, prepared at the beginning of 2008, was still pending government approval by mid-2012.[45] Regulations promulgated by the Ministry of Labor and Social Welfare and the Lao National Commission for Persons with Disabilities protect persons with disabilities against discrimination, however the regulations lacked the force of law. In 2011, the Ministry of Labor and Social Welfare established regulations regarding physical accessibility and some ramps were built in Vientiane. Legislation adopted in 2009 requires that the construction of buildings, roads, and public places provide facilities for persons with disabilities. The law does not mandate accessibility to buildings built before its enactment. There were no reports of discrimination in the workplace. [46]

Lao PDR ratified the Convention on the Rights of Persons with Disabilities on 25 September 2009.