Summary action points based on 2012 findings

·         More support is needed to advance the Republic of Albania’s progress in incorporating victim assistance into the disability and development sectors.

·         Extensive knowledge on small-scale affordable prosthetics services developed though Albania’s victim assistance program should be used to assist other amputees and survivors of weapons in the country.

Victim assistance commitments

Albania is responsible for landmine survivors, cluster munition victims, and survivors of other explosive remnants of war (ERW). Albania has made commitments to provide victim assistance through the Mine Ban Treaty and Convention on Conventional Weapons Protocol V, and has victim assistance obligations under the Convention on Cluster Munitions.

Casualties

Casualties Overview

In 2012, the Albanian Mine and Munitions Coordination Office (AMMCO) reported eight casualties of AXO; five boys and one girl were injured, the other two casualties were adult men. AMMCO reported six AXO casualties for 2011.

A total of 980 (141 killed; 839 injured) mine/unexploded ordnance (UXO) and AXO/ERW casualties have been identified in Albania between 1997 and 2012. The Albanian Mine Action Executive (AMAE) casualty database for Kukës region[1] contained information on 272 (34 killed; 238 injured) mine and ERW casualties for the period 1999–2005.

Cluster munitions casualties

There have been at least 55 cluster munitions casualties in Albania. The Kukës database recorded 53 casualties from cluster munition remnants (nine killed; 44 injured).[2] Two additional casualties due to the use of cluster munitions were also identified.[3]

Victim Assistance

Albania is responsible for landmine survivors, cluster munition victims and other survivors of explosive remnants of war. Albania has made commitments to provide victim assistance through the Mine Ban Treaty and the Convention on Conventional Weapons and has victim assistance obligations under the Cluster Munitions Convention.

There are at least 839 mine/ERW (including AXO) survivors in Albania.

Victim Assistance since 1999[4]

Since 1999, Albania has made significant progress in developing all components of victim assistance in the northeast with the introduction of an initial victim assistance plan in 2003. Extensive data collection, used for program design and information sharing, contributed to the success of the regional victim assistance program in 2005–2009. Needs-based and comprehensive community-based programming, as well as linkages to broader development strategies, were applied to develop an exemplary victim assistance program. However, after the country was declared mine-free in 2009, resources for victim assistance in Albania declined and were insufficient to meet the needs of survivors.

Since 1999, progress in victim assistance was most prominent in the areas of medical care, employment and economic support in the northeast. A prosthetic and rehabilitation center was built in the mine-affected region. Conditions at the National Orthotic-Prosthetic Center in Tirana, once the only such facility in Albania, had been deteriorating since 2005, and in 2010 the center lost ICRC support. A five-year project to build capacity in the rehabilitation sector through training of physiotherapists and the establishment of a prosthetics workshop in the mine-affected area was successfully completed by 2012. Some delays in implementation were attributed to general difficulties experienced by the overall healthcare reform process in Albania. However, a teaching program for physiotherapy was successfully established and integrated into the state Nursing Faculty. The national NGO, ALB-AID (formerly VMA-Kukës, founded in November 2000) provided direct victim assistance, including economic inclusion.

Economic inclusion and psychological support remained the most serious needs of survivors. Overall, widespread poverty, unregulated working conditions, and poor medical care posed significant problems for many persons with disabilities.

Victim assistance in 2012

In 2012, the main victim assistance provider in Albania, ALB-AID, continued to implement victim assistance programs. However, due to decreased funding ALB-AID had just one economic inclusion project, which was not enough to address the significant employment needs among survivors. ALB-AID also has a project to build a sustainable survivors network and has worked on expanding opportunities to access physical rehabilitation services for survivors and amputees in other parts of the country. A study on the transition from mine action to national ownership noted that Albania’s victim assistance program had the capacity to expand its focus beyond the mine-affected northern regions, and more recently to the Gerdece explosion site, to assist survivors of explosive ordnance and other persons with disabilities throughout the country. ALB-AID worked with local associations in AXO-affected areas to make rehabilitation more accessible to amputees in the other regions.

Assessing victim assistance needs

ALB-AID maintained data on all its survivor members and continued its media monitoring of explosives and small arms incidents in 2012.[5] The Albanian Red Cross Society continued collecting data on AXO casualties in 12 AXO-affected prefectures of Albania for use by AMMCO. Data is disaggregated by age and gender, recorded in the Information Management System for Mine Action (IMSMA) database and regularly shared with the national statistical office. In 2012, AMMCO staff liaised with other key actors to lay the groundwork for a survey to identify the medical and socio-economic needs of explosive ordnance survivors in Albania, based on its AXO casualty data.[6]

Key victim assistance actors sought the most appropriate approach to sharing AXO “hotspot” casualty data with details of survivors between ALB-AID and AMMCO and relevant ministries, not only the statistical office, as well as other disability actors including the Labor Invalids Association. However, a protocol for sharing data was yet to be established.[7]

Victim assistance coordination[8]

AMMCO was responsible for coordination of victim assistance activities, resource mobilization and liaising with the government. In 2012, AMMCO’s mandate involved expanding Albania’s existing victim assistance program to include other AXO and UXO survivors.[9]

The objectives of Albania’s National Victim Assistance Plan were aligned with the recommendations of the Cartagena Action Plan.[10] The national Mine Action Plan (2010) aimed to make victim assistance sustainable by building sufficient national capacity and by linking future progress with implementation of the National Strategy on People with Disabilities (NSPWD).[11] In 2012, implementation of the NSPWD continued to be inadequate.[12]

Survivors were represented at all levels of planning and implementation of victim assistance through the participation of ALB-AID.[13]

Service accessibility and effectiveness

Victim assistance activities[14]

Medical care and Rehabilitation

The National Trauma Center, located within the Military Hospital in Tirana, is responsible for treating people with injuries and trauma. Some physiotherapy is available in this center; however the service remained limited and was not specific to the rehabilitation needs of all patients.[15] In 2012, AMMCO continued to negotiate with health care authorities to strengthen trauma services at the hospital.[16]

No psychological support is provided in this center and there are no rehabilitation physiatrists.

In 2012, amputees from throughout the country, including mine/ERW survivors, continued to utilize the capacity of the Kukës Prosthetic Workshop. However, in 2012 the Kukës Prosthetic Workshop, situated in the Kukës regional hospital and integrated into the hospital’s human resources funding, was facing difficulties in securing enough raw materials and components to produce and repair prostheses. The workshop also required an additional technician.[17] AMMCO was investigating how the model of the Kukës Prosthetic Workshop could be replicated in other regions of Albania.[18]

The National Prosthetic and Orthotic Center in Tirana was reportedly “badly managed, and not accessible to persons with disabilities.”[19]

The five–year collaborative project to support Albania in developing a national physical medicine and rehabilitation (PMR) system concluded in 2012. The Nursery Faculty of Tirana continued to implement a sustainable program of physiotherapy training in 2012.[20] In March 2012, the Albanian Association of Physiotherapists was established. The Association held the first National Congress of Physiotherapy in December.[21]

In 2012, the Ministry of Health in cooperation with AMMCO and the University Rehabilitation Institute, Slovenia held a training workshop on providing rehabilitation and assistive devices to people following amputation. Participants included surgeons, orthopedists, nurses, physiotherapists, and prosthetic/orthotic technicians from several hospital departments in Albania as well as from ALB-AID.[22]

Overall, regional hospitals and other health centers did not provide physiotherapy services. As a result, not all those in need can readily access it. Rehabilitation medicine remained at the beginning stage in Albania and was far from meeting the needs of survivors and other persons with disabilities. Some rehabilitation, mainly physiotherapy, was offered by small private clinics and professionals. More structured private services offered rehabilitation with other forms of therapy than just physiotherapy. The Lady of the Good Counsel Catholic University Hospital provided pool therapy with modern equipment. However, the cost of private rehabilitation was prohibitive to most people in Albania.[23]

Economic and social inclusion and psychological support

In 2012, ALB-AID continued to diversify its funding and began a new computer and literacy training program for mine/ERW survivors, persons with disabilities, and their family members, supported by the Vodafone Albania Foundation.[24] No progress was made regarding employment of persons with disabilities more generally in 2012. The Law on Employment Promotion was not adequately implemented and the employment quota stipulated by the law was not penalized according to the law. [25]

A law adopted in June 2012 requires assistant teachers in classes with children with disabilities. Previously, children with disabilities had not been integrated into the public education system.[26] The new law on pre-university education improved the opportunities for students with disabilities by ensuring that inclusive education will be made available while isolated special education will be gradually eliminated; local authorities make schools accessible; educational institutions are obliged by law not to discriminate against students with disabilities and such discrimination can include a lack of reasonable accommodation.[27]

ALB-AID continued to lack financial resources to implement psychosocial support activities in Kukës during 2012. However, during the year ALB-AID initiated a survivor network advocacy and awareness-raising project with a small grant from the ICBL-CMC Survivor Network Project supported by the Norwegian Ministry of Foreign Affairs.[28]

The Nursery Faculty of the University of Tirana ran a course in psychological assistance through a logotherapy program.[29] A capacity to provide psychological support and education assistance specifically relevant to survivors was developed by AMMCO and ALB-AID during a multiyear project for survivors of the Gerdec ammunition storage site explosion. In 2012 after completion of the project, trained psychologists were prepared to continue the work to assist other mine/ERW and AXO survivors throughout Albania. A need for psychosocial support existed in many hotspot areas where trauma continued to affect victims and members of the community, as well as in other areas affected by armed violence. However, in 2012 the national victim assistance program lacked the resources to extend or expand the project.[30]

Generally, resource constraints and lack of infrastructure make it difficult for persons with disabilities to participate fully in many social activities. Governmental social services agencies were often unable to implement their programs due to lack of funding.[31]

Laws and policies

The European Commission (EC) reported limited progress in the implementation of policies for persons with disabilities in 2012. Amendments made to the Law on Social Assistance and Services in 2012 resulted in persons with disabilities being excluded from receiving economic aid and disability allowances at the same time. An interministerial working group drafted and held consultations on a framework law on the rights of persons with disabilities. Due to the differentiated status of certain disabled persons’ organizations and associations and the lack of official status for certain disabilities, there continued to be unequal access to rights.[32] This remained the main concern for survivors; if they were not working when they were injured, they are not recognized as persons with disabilities and therefore do not benefit from disability benefits. In early 2013, survivors, through the ALB-AID survivors Network Project, publically declared their requests and sought the recognition of their needs in existing disability legislation and strategies.[33]

Differences in legal status meant that most mine survivors with disabilities were not eligible for the state benefits available to some other groups of persons with disabilities.[34] For example, only those survivors who are registered as ‘labor invalids’ due to an accident while at work may receive benefits, including free transportation, subsidies on utilities, and study scholarships for their children.[35] There were delays and disruptions to disability and pension payments in 2012. Electricity bills and telephone bills, which were reimbursed for a few groups of persons with disabilities, were suddenly interrupted for six months due to the economic situation. Subsequently, the law was amended to considerably reduce the amount of this reimbursement. The new reimbursement benefits started again at the end of 2012, though at a considerably lower rate.[36]

Legislation prohibited discrimination against persons with disabilities in employment, education, access to healthcare, and the provision of other state services. However, service providers did sometimes discriminate against persons with disabilities. The law mandated that new public buildings be accessible to persons with disabilities, but this was not regularly enforced. [37]

Albania ratified the Convention on the Rights of Persons with Disabilities (CRDP) on 11 February 2013. Albania signed the CRDP on 22 December 2009 and the Albanian Parliament passed national ratification of the CRPD on 15 November 2012.[38] Throughout 2012, UNDP, ADRF and ALB-AID had been advocating for the Albanian parliament to ratify the CRDP.[39] AMMCO also worked closely with the wider disability sector in Albania on the ratification of the CRPD.[40]