Summary action points based on 2012 findings

·         A mechanism for needs assessment of new survivors should to be integrated into the otherwise improved data collection on past casualties.

·         Intensive effort is required to improve access to services in remote and rural areas.

·         Resources need to be allocated for retrofitting of most buildings to make them physically accessible for persons with disabilities.

·         Legislation, policies and planning that could hasten developments in the availability and accessibility of services must be passed and implemented. In 2012 these remained stalled after several years at the approval phase.

Victim assistance commitments

Lao People’s Democratic Republic (PDR) is responsible for significant numbers of cluster munition victims and survivors of other explosive remnants of war (ERW), as well as landmine survivors, who are in need. Lao PDR has made commitments to provide victim assistance through the Convention on Conventional Weapons Protocol V and has victim assistance obligations under the Convention on Cluster Munitions.

Casualties

Casualties Overview

The National Regulatory Authority for the Unexploded Ordnance/Mine Action Sector in the Lao PDR (NRA) reported 56 mine/ERW casualties for 2012. The majority of casualties (35) were adult: 12 females and 23 males. Child casualties included four girls and 17 boys. The 56 casualties recorded for 2012 continued the decrease from 99 casualties recorded for 2011 and 117 casualties for 2010.[1] As a product of establishing an active network of district and provincial focal points across the country to report and investigate each mine/ERW incident through a detailed survey process, the NRA-reported casualty data for 2012 had a high degree of accuracy, detail and was close to, if not entirely, complete.[2]

By the end of 2012, the NRA had identified at least 50,525 mine/ERW (including unexploded submunitions) casualties, including 29,506 people killed and 21,019 injured since 1964. The first phase of a nationwide casualty survey recording retrospective data was completed in 2008. It identified 50,136 mine/ERW casualties; of these, ERW caused the most casualties, followed by landmines and then unexploded submunitions. [3]  The NRA reported 702 mine/unexploded ordinance (UXO) victims from 2008 to 2013, of which 41% were children.[4]

Cluster munition casualties

Unexploded submunitions were reported to have caused 7,586 casualties in the period 1964–2012 (3,180 were killed; 4,373 injured; 33 outcome unknown).[5]

Victim Assistance

Lao PDR has estimated that there are some 15,000 mine/ERW survivors still living, 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] Mine/ERW survivors represent a significant proportion of persons 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. However, 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.[9]

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.

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 either did not have the force of law or remained in draft form for years without being implemented.

In 2013, it was reported that many survivors injured as long as 20 years ago or more still had not received any assistance.[10]

Assessing victim assistance needs

In 2012, Lao PDR continued to lack sufficient information about survivors’ needs.[11] 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.[12]

The NRA Survivor Tracking System, an ongoing system for collecting data on new casualties, was designed to provide an ongoing survey of 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. Data was expected to be collected on more than 15,000 survivors and entered into the NRA database.[13] Approximately 80% of expected survey forms had been collected by March 2013 and were pending input into the database in July. Once collection, input and analysis were completed, the NRA planned to distribute data and a summary to all operators, ministries, local and international NGOs, and donor countries.[14]

However, despite the tracking system, data collected on new casualties in 2012 lacked detail on survivors’ injuries and needs. The NRA shared data on survivors with civil society organizations that are members of the Technical Working Group on Victim Assistance (TWGVA) and upon request. Data was primarily requested in order to develop work plans and was provided to a range of international and national civil society organizations.[15]

Victim assistance coordination in 2012

In a slight reduction in contact from its meeting once every two months in previous years, the TWGVA met quarterly in 2012. TWGVA participants included the NRA, other relevant government agencies, national and international NGOs, and survivors—including World Education staff and those survivors volunteering for the Handicap International (HI) Lao’s Ban Advocates project. The meetings focused on data collection, the establishment of the Survivor Tracking System, coordination, and updates from operators and relevant government sectors.[16]

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 and was discarded. A revised plan was drafted in 2012.[17] In March 2013, the new Victim Assistance Strategic Plan was completed, translated, and submitted to the NRA Board for approval. The strategic plan addresses seven pillars of victim assistance: data collection; medical care; physical rehabilitation; psychological support and social inclusion; economic rehabilitation and education; legislation and policy; and coordination.[18] Lao PDR reported in April 2013 that the final draft of the victim assistance strategy was expected to be adopted and implementation was expected to begin ‘in the next few months.’[19]

Six position papers on the victim assistance pillars were in development since 2009. By mid-2013 the papers were not being used by the NRA and were not presented to its board for approval. Only the strategic plan was under review.

Victim assistance is one of the three main components of the NRA strategy entitled “Safe Path Forward II 2011–2020.”[20] The Safe Path Forward II was approved by the Office of the Prime Minister in June 2012.[21] Two of the six strategic objectives relate to victim assistance, including: reduce the number of UXO casualties from 300 to less than 75 per year; and ensure that the medical and rehabilitation needs of all UXO survivors are met in line with treaty obligations. The latter was assigned a series of actions that began to be implemented in 2012, including setting up and maintaining a Lao Victim Information System (LVIS), strengthening physical rehabilitation services, providing emergency medical response at the village level, and developing an effective rural transfer/ambulance system to medical facilities.[22] The strategy and its victim assistance component were included in Lao PDR’s Millennium Development Goals Compact of 2010.[23] A key indicator for progress under these Millennium Development Goals includes “the number of survivors receiving proper assistance.”[24] However further investment of resources from the government and development partners is required to achieve these targets.[25]

National standards for victim assistance developed in 2007 remained in draft form pending the completion of the national victim assistance strategy.[26]

The Ministry of Labor and Social Welfare holds primary responsibility for the needs of, and related services to, persons with disabilities through the National Committee for Disabled People (NCDP). They held monthly disability coordination meetings in 2012 to address coordination and linkages between service providers and line ministries. Due to the large number of mine/ERW survivors with disabilities in Lao PDR, the Ministry of Health also worked extensively on victim assistance and rehabilitation in coordination with international NGOs. The NRA acknowledged the need for a strong national disability framework that is inclusive of victim assistance and, in 2012, the NRA Victim Assistance Unit worked to build linkages between victim assistance and the broader disability sector through increased cooperation with the NCDP. The NRA included support of the NCDP into the new draft Victim Assistance Strategic Plan.[27]

Lao PDR reported on the international funding received by NGOs that provided victim assistance in 2012 in its Convention on Cluster Munitions Article 7 report, made statements on victim assistance at the Third Meeting of States Parties to the Convention on Cluster Munitions in Oslo in September 2012 and also at the Convention’s intersessional meetings in April 2013.[28]

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.[29] Throughout 2012 and into 2013, increasingly more survivors participated in the delivery of services, particularly those supported by the Quality of Life Association (QLA), including economic inclusion, peer support, referral through provincial survivor committees, and other sharing of information on available services.[30] The Lao Disabled People’s Association (LDPA) is represented on the NCDP and actively participated in national planning and policy development with regards to people with disabilities.[31]

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[32]

Emergency and continuing medical care

The Lao PDR health sector suffers from endemic problems of low state spending and lack of competent staff. Basic healthcare has remained inaccessible to a large proportion of the rural population.[33]

There was a continuing lack of access to health services in services in Lao PDR. The health care system remained underdeveloped and under-funded; health workers had inadequate skill levels. This directly contributed to shortfalls in the quality of services across the health system.[34]

World Education worked directly in seven provinces but was available to provide assistance to all new survivors across all provinces of Lao PDR and they reimbursed hospitals for the cost of survivors’ treatment through the requests of the NRA.[35] Coordination of services for new survivors was increased at the provincial and community level with the strengthening of the network of focal points in the community supported by the NRA.[36]

The quality of emergency care and continuing medical care increased as World Education made services more accessible to survivors through training and other capacity building as well as through direct funding of services for individual survivors by administering the United States (US) financed War Victims Medical Fund (WVMF). In July–August 2012, World Education did an internal evaluation which found that the quality of care had improved and that the level of training had increased.[37]

Physical rehabilitationincluding prosthetics

In 2012, rehabilitation services continued to be provided by COPE on a similar scale to the previous year. Financial and technical support continued for the five government-managed rehabilitation centers in the country.[38]

COPE covered all the necessary costs for those receiving treatment. However, many survivors were not aware of, or unable to reach, the available services. COPE continued “COPE Connect,” its outreach and community awareness raising project, in eight provinces in 2012; it trained local health professionals in identification and referral. Clinical assessment teams also travelled to remote and rural areas and referred people with disabilities to appropriate services.[39]

Assessments of the quality of services at three government-managed prosthetic and rehabilitation centers (Vientiane, Xieng Khuang, and Pakse) were conducted by the ICRC SFD in 2012. Findings at the three centers showed that between 63% and 85% of the services assessed met acceptable quality standards. Improvements to quality were reported to be underway; however, progress remained tenuous. ICRC SFD continued to support the development of local capacity within the national rehabilitation service through training programs in 2012.[40]

Production increased at the wheelchair workshop of the government-managed Centre for Medical Rehabilitation in 2012 compared to the previous year.[41]

Economic and social inclusion and psychological support

Psychological support was generally not available to survivors. However, World Education staff provided peer support in conjunction with other project activities. QLA continued to build capacity and, by early 2013, was managing its own internal operations and provided peer-to-peer psychological support and socioeconomic services for survivors in Xieng Khouang and Sekong Provinces.[42] Volunteers for the HI Ban Advocates Project also extended their provision of peer support for survivors.[43] Basic Needs provided some limited psychological social support to survivors.[44]

A project linking people with disabilities with employers was continued, run by the LDPA, with HI support. In 2012, job placement services to Savanakhet Province were expanded.[45] The Vocational School for the Disabled, Sikeud, also provided vocational training to survivors in 2012.[46]

In 2012, it was reported that there was a continued increase in the social inclusion of persons with disabilities including survivors, particularly those living in Vientiane and other cities.[47] In January 2012, the first national sporting event for persons with disabilities, involving over 200 people, was organized in Luang Prabang province.[48]

A new project was launched in 2012 to reduce the environmental and infrastructural accessibility barriers for people with physical disabilities in Lao PDR. The project, by the Association for Aid and Relief (AAR) Japan in conjunction with LDPA, includes the development of the Multifunctional Centre to promote best practice in the construction of physical accessibility and a barrier-free living environment with sample ramps, bathrooms, and sliding doors on display.[49] The Multifunctional Centre was opened in November 2012.[50] Training of LDPA and NRA staff on rights advocacy and peer to peer support for cluster munition survivors was held by the HI Lao Ban Advocates Project in February of 2013. The project also raised awareness of survivors’ rights and needs throughout 2012.[51]

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; however, advancements were made in 2012.[52]

Laws and policies

A draft decree on the Rights of Persons with Disabilities, prepared at the beginning of 2008, was submitted to the Ministry of Justice in July 2012 and was passed to the Cabinet in November 2012. However, the draft was returned to the Ministry of Labor with 12 points of recommendations for revision. By March 2013, it was still pending government approval.[53]

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. Some progress was made on physical accessibility; however, a lack of resources for infrastructure slowed the retrofitting of most buildings and limited government staffing prevented effective implementation.[54]

Lao PDR ratified the Convention on the Rights of Persons with Disabilities (CRPD) on 25 September 2009. As of July 2013, Lao PDR had yet to complete its initial report to the CRPD, which was due in October 2011.