Afghan Technical Consultants (ATC), established in 1989, is one of the largest Afghan humanitarian national mine clearance organization.[62] ATC implements mine clearance program in 29 provinces of Afghanistan. In 2003 it had an annual budget of US$6.5 million and received funds from UNMAS, Japan, EC, USAID, Germany, UK and UNA-USA. ATC activities include manual mine clearance, battle area clearance, mechanical mine clearance, explosive ordnance disposal and mine risk education. In 2003, ATC employed 1,610 personnel. ATC reports clearance in 2003 of a total of 4,238,302 square meters of mined areas and the destruction of 6,012 antipersonnel mines, 508 antivehicle mines and 379,702 UXO. ATC deminers have experienced the most mine accidents among the demining NGOs in Afghanistan. From 1989 until August 2004, 31 ATC deminers were killed and 284 injured in demining accidents.[63] In 2003, five ATC demining staff was injured. Agency for Rehabilitation & Energy Conservation in Afghanistan (AREA) is an Afghan NGO established in 1993. Since 1997 it has been conducting a Community Based Mine Clearance Program (CBMCP) in Nangahar province. The main objective of CBMCP is to empower the local population by providing them with the capacity to clear their land. AREA reports that for CBMCP in 2003 it received US$458,143. With 153 deminers, it cleared 458,504 square meters of grazing land, and destroyed 12 antipersonnel mines and 12,108 items of UXO.[64] One deminer was killed and another injured in a mine incident in 2003. Since its inception CBMCP teams cleared a total of 1,981,053 square meters of land and destroyed 198 antipersonnel mines. Danish Demining Group (DDG) is an international NGO that has been operational in Afghanistan since 1999.[65] Its aim is to act as a force multiplier to the existing programs. DDG works in close coordination with Monitoring, Evaluation and Training Agency (META). DDG deploys three demining teams of 30 persons engaged in manual and mechanical clearance, and 12 Quick Response teams for EOD tasks. DDG employed 207 people in 2003. DDG’s demining teams cleared 577,607 square meters of mined area and its Quick Response teams cleared more than 400,000 square meters of land in 2003. More than 20,000 mines and 170,000 items of UXO were destroyed. Funding of approximately $4.3 million for 2003 was provided by DANIDA, SIDA and the European Commission (through UNMAS). In 2003, six DDG deminers were injured in three mine incidents. Demining Agency for Afghanistan (DAFA) started its activities in 1990. Based in Kahandar, its manual and mechanical demining teams have been conducting clearance of battlefields and mined areas in the southern and western regions of Afghanistan, mainly in Kahandar, Helmand, Zabul, Urzgan and Nimroz provinces. DAFA says that in 2003 it received US$4.2 million from UNMAS/MACA. DAFA employed 831 people, including 662 field staff and cleared a total of 512,101 square meters of mined land and 8,613,943 square meters of battlefield area, destroying 354 antipersonnel mines, 59 antivehicle mines and 19,925 items of UXO. From 1990 to December 2003, DAFA destroyed 21,530 antipersonnel mines, 628 antivehicle mines and 31,5605 items of UXO.[66] In the same period, seven deminers were killed and 141 injured during mine clearance operations; one deminer was injured and two others were killed in 2003. The HALO Trust is a UK-based mine clearance agency working in the central and northern regions of Afghanistan since 1988.[67] The HALO Trust Afghanistan program is one of the oldest and largest programs with over 2,000 employees. HALO works in nine provinces, carrying out general and technical survey, manual and mechanical clearance, UXO disposal and mine awareness training. Following the demise of the Taliban, HALO has expanded by 60 percent, with teams concentrating on the abandoned Northern Alliance/Taliban front line in the Shomali Valley, the Andarab Valley and between Kunduz and Taloqan. HALO also provides clearance assets for road construction projects, including Kabul–Doshi-Pul-i-Khumri to Sherkhan Bandar, Puli-Khumri to Mazar, and Mazar to Aqina roads. . In 2003 HALO cleared 2,910,405 square meters of minefields and 43,419,144 square meters of battle area, and destroyed 5,825 antipersonnel landmines, 292 antivehicle mines and 27,983 UXO. HALO’s annual budget for mine action operations in Afghanistan is approximately US$10.5 million. It receives funds from the governments of the United States, Norway, United Kingdom, Netherlands, Ireland and Germany, and the European Commission, the Association to Aid Refugees (Japan), Roots of Peace and UNMAS. The Afghan government provides support through office space, storage facilities, and quality assurance monitoring. Mine Detection and Dog Center (MDC) began mine action activities in 1989 with 14 mine detecting dogs donated by Thailand.[68] MDC deploys 26 mine dog groups for mine clearance operations in all provinces, and 33 mine dog groups for minefield survey operations conducted in cooperation with MCPA and the Quality Management Inspection Teams (QMIT) of META. In 2003, MDC cleared a total of 14,244,697 square meters of mine and UXO contaminated land, including 1,834,026 square meters of agricultural land, 807,650 square meters of residential areas, 10,486,900 square meters for roads and 1,116,121 square meters of grazing land. During clearance operation, MDC destroyed 68 antipersonnel mines, 181 antivehicle mines, and 1,505 UXO. MDC employed 1,066 personnel, including 1,013 field staff, and received US$5,157,652 in 2003. Organization for Mine Clearance and Afghan Rehabilitation (OMAR) is an Afghan NGO engaged in manual and mechanical mine clearance, EOD/UXO clearance, emergency health services, rehabilitation and mine risk education.[69] It started mine clearance activities in 1992. OMAR reports that in 2003, with a budget of US$3.2 million and 750 personnel, it cleared 1,000,840 square meters of mined areas and 1,045,100 of former battlefield. It destroyed 922 antipersonnel mines and 5,552 UXO. OMAR received funds from UNOPS, Germany, NOVIB, Japan, Medico international, Japan International Volunteer Center and USAID. Since early 2002, Mines Advisory Group (MAG) has provided EOD training to two OMAR teams to assist them to deal with new types of UXO found following the coalition activity with funds from Austria and Norway.[70] In 2003-2004, MAG is providing an expatriate technical field manager to set up a quality management system for OMAR. MAG is also providing OMAR with specialist training in mechanical demining, using a Minecat 230 midi-flail which will be handed over to OMAR.[71] During 2003, demining operations three OMAR field staff were injured in landmine incidents. Since 1992, fifteen OMAR deminers have been killed and 51 injured in mine clearance activities. Mine Clearance Planning Agency is primary engaged in landmine surveys. It is implementing the Landmine Impact Survey with the Survey Action Center.[72] It also undertakes clearance operations as part of two-meter minefield boundary clearance and reduction of suspected mined areas. In 2003, it cleared 1,063,351 square meters of mined areas. From 1990 to 2003 MCPA reduced or cleared about 34.2 million square meters of mined land as part of its survey work, and destroyed 6,138 antipersonnel mines, 730 antivehicle mines and 13,975 UXO. Monitoring, Evaluation and Training Agency (META) was formed in early 1997 as an integral part of the Mine Action Program for Afghanistan.[73] META has been responsible for conducting mine action technical and management training courses, monitoring and evaluation of demining operations, investigations into mine-related accidents and trials of technical and reference materials. Since its inception, META has conducted 1,400 technical training courses for new and existing field personnel of MAPA, and, in partnership with Cranfield University (UK), has run 10 management courses for managers and supervisors. In 2003, META established 16 two-men Quality Management Inspection Teams, which have carried out 460 Quality Assurance and 100 Quality Control inspections. META has investigated 353 accidents, 25 missed mine incidents and 20 non-demining accidents that have occurred within the program since 1990. It employs 200 people and has an annual budget of about US$1 million with funds from UNMAS, UNOPS, UNICEF, US Department of State, Geneva International Center for Humanitarian Demining, the World Bank, USAID, and DANIDA. RONCO Consulting Corporation, a US commercial mine clearance contractor, continues to be engaged in mine action mainly for ISAF and military forces. Since 2002, it has been clearing Bagram Air Base. Mine Risk EducationOrganizations working in mine risk education (MRE) in Afghanistan have included the Afghan Red Crescent Society (ARCS), Afghan Technical Consultants (ATC), the Afghan Mine Awareness Agency (AMAA), the Agency for Rehabilitation and Energy Conservation in Afghanistan (AREA), the Ansar Relief Institute (ARI), the Association for Aid and Relief (AAR), the BBC Afghan Education Project (BBC-AEP), the Demining Agency for Afghanistan (DAFA), the HALO Trust, Handicap International (HI), INTERSOS, the Mine Clearance Planning Agency (MCPA), the Monitoring Evaluation and Training Agency (META), the Organization for Mine clearance and Afghan Rehabilitation (OMAR), Save the Children-USA (SC-US) and UNICEF. UNMACA and UNICEF, with Afghan Government focal points (notably the Ministry of Education), coordinate MRE agencies. The Afghan government reports that these 15 organizations have provided mine risk education to 10.6 million people since 1990.[74] In addition, many more people attended short MRE briefings in schools or when returning to Afghanistan from Pakistan or Iran.[75] Mine Risk Education has been a component of the Mine Action Program for Afghanistan (MAPA) since its inception in 1989. Initially the program targeted refugees living in camps on or near the Pakistan border, with activities designed to disseminate the mine awareness message to large numbers of people in a short time. The program moved into Afghanistan in response to the critical needs of the population.[76] MAPA reports that it began in 2003 to focus more on community-based activities, aimed at assessing risk behaviors and seeking ways to change them.[77] This approach is also aimed at integrating MRE into community structures such as local government agencies and education, health, and religious institutions. According to MAPA, fifteen agencies were engaged in MRE activities in 2003, and a total of 2,220,057 people were reported to have attended MRE sessions. In addition, MRE activities were conducted by primary school teachers throughout the country under the supervision of the Afghanistan Ministry of Education. Number of Civilians Attending MRE Sessions (1999-2003)[78]
According to information in past editions of the Landmine Monitor Report, more than 8.44 million civilians attended mine risk education sessions from 1999 to 2003: 979,640 in 1999; 1,076,553 in 2000; 729,318 in 2001; 3,436,410 in 2002; and, 2,220,057 in 2003. The Afghan Red Crescent Society worked with the financial and technical assistance of the International Committee of the Red Cross. Its mobile male and female teams held MRE sessions in 14 provinces of central, north and northeast regions.[79] ARCS collected data on accidents and oriented its MRE accordingly.[80] ARCS teams also received 140 clearance requests from mine-affected communities in 2003. Following agreements signed with agencies involved in clearance and marking, 65 percent of the requests received a response from mine clearance agencies, “a rate three times higher than the previous year” according to the ICRC.[81] One hundred percent of the clearance requests forwarded to DDG, 85 percent of the clearance requests forwarded to HALO Trust and 32 percent of the requests forwarded to the UN Area Mine Action Centers received a response.[82] In Takhar Province, the ICRC said, “Thanks to [an efficient integrated approach] and a well-coordinated mine awareness operation in the province, the number of casualties reported in the period under review indicates a satisfactory downward trend in the number of mine/ERW [explosive remnant of war] casualties, taking into consideration the expected mine/ERW incidents in a post-conflict situation in a highly mine/ERW contaminated location, which shows a high flow of returnees.”[83] The Agency for Rehabilitation and Energy Conservation in Afghanistan has been providing MRE in Herat, Badghis and Ghor provinces. In 2003, AREA provided MRE in the Herat region while its community-based mine clearance program was operating in the Nangarhar region.[84] The Ansar Relief Institute is an Iranian NGO. ARI was established in 1994 and works in collaboration with the UNHCR and the government of Iran to support the repatriation of Afghan refugees from Iran. ARI is based in Mashad, Iran and only operates on the border between Iran and Afghanistan where it has three field offices. ARI employed retired military experts to train its male and female trainers.[85] Handicap International has been conducting community-based mine risk education since 1996. The project operates in six south and western provinces: Ghazni, Zabul, Kandahar, Helmand, Farah and Herat. An external evaluation of the project took place in 2001.[86] In 2003, HI employed 104 people, including 72 field staff. Sixty-one percent of the people attending MRE sessions were briefed by volunteers. HI also provided MRE to Internally Displaced Persons (IDP) in Zare Dasht camp (Kandahar province), as well as to aid workers.[87] In support of ICBL/ACBL, HI field staff collected 187,178 thumbprints between 1999 and 2003.[88] The program collects information from villagers concerning mine victims, unexploded ordnance and previously unidentified minefields. Between 1999 and 2003, HI received 3,729 requests for clearance. As a result, HI deployed two EOD teams in April 2003 in Kandahar.[89] As of 31 December 2003, 57 reports had been responded to and 720 UXO had been destroyed. The two EOD teams moved to Herat in February 2004.[90] The Organization for Mine clearance and Afghan Rehabilitation started its MRE activities in 1990 in Afghan refugee camps of Pakistan. It moved to Afghanistan in 1991 and currently operates all over Afghanistan. OMAR employs about 100 MRE staff, including 20 females. In 1998, OMAR started training volunteers, but abandoned this approach in 2001. OMAR generally provides MRE through direct presentations.[91] OMAR’s MRE tools include leaflets, posters and signboards.[92] Save the Children-USA began its Landmine Education Project in Kabul in early 1996. It provides training and builds the capacities of agencies that have educational programs in child-focused MRE. SC-US also works closely with communities and trains volunteers, teachers and health workers. Operations are undertaken in hospitals, clinics, mosques and Kuchi nomads settlements.[93] An external evaluation of the project was conducted in 2000.[94] MRE has also been provided by clearance agencies in areas where they are working. MRE was conducted by volunteers from ATC demining teams, “in their free time, after finishing their demining work for the day.”[95] Survey teams of MCPA provided MRE to farmers, herders and villagers in mine-contaminated communities where they work.[96] HALO Trust worked with 4 MRE teams[97] and provided MRE in central and northern provinces; its highest numbers were reached at the UNHCR Refugee Center in Puli Khumri.[98] Association for Aid and Relief (AAR) Japan in cooperation with UNMACA and UNICEF developed materials for MRE operators. In 2003, AAR produced kits for community-based and school-based MRE.[99] BBC Afghan Education Project (BBC-AEP) has been broadcasting MRE messages since 1994, mainly as part of the “New Home, New Life” soap opera. Based on the radio soap opera it has also produced a Monthly Cartoon Journal, which includes mine risk education dialogues. The BBC (Persian and Pashto services) is one of the most popular radio programs in Afghanistan.[100] The impact of the program is monitored every two months, but not specifically for MRE.[101] An evaluation report released in July 2002 indicates that “MRE agencies are omitting to measure the impact of their work among their target groups in a systematic and regular manner. There is therefore little indication whether their projects are having the desired impact or not and no relevant information to inform adaptations or new project design. There is not even information to guide MAPA and the donors as to whether MRE is a project worthy of new or increased funding.” The evaluation calls on META to “develop expertise and capacity to conduct impact assessments,” but indicates that there “will still be a need for external evaluators for MRE in Afghanistan.”[102] As a result, META, with the assistance of INTERSOS and UNICEF, developed a system to enable KAP (knowledge, attitudes, practices) surveys to take place every four months.[103] In 2003, META reports that it carried out training courses for 348 trainees of MRE agencies, 129 teachers/trainees from the Ministry of Education, 57 expatriates and 90 staff from eight NGOs. META also conducted 60 external monitoring missions of MRE field operations.[104] Mine Action FundingAccording to UNMACA, financial contributions for the Mine Action Program for Afghanistan for 2003 totaled more than US$75.2 million. Of the total amount: 72 percent was allocated to mine action activities focused on responding to prioritized community needs; 22 percent supported mine and UXO clearance for major infrastructure projects, including road construction, power line repairs, and school and health clinic rehabilitation; and, nearly 6 percent was spent on Peace building funding for stockpile destruction and the Mine Action for Peace project, which is a reintegration project designed to train demobilized combatants in community-based demining, mine risk education, and permanent marking.[105] According to information collected by Landmine Monitor, from 1991 to 2003 approximately $341 million was invested in the humanitarian mine action program for Afghanistan. In June 2004, Afghanistan reported that the international community had provided more than $321 million over 14 years to conduct mine action activities in Afghanistan.[106] The 2003 strategic plan for mine action in Afghanistan indicates that $500 million is required to clear the remaining 800 million square meters of contaminated areas and 500 million square meters of battle area over a ten-year period.[107] The strategic plan is scheduled for reviewed in early 2005 utilizing the Landmine Impact Survey data to establish new priorities and revise the budget.[108] Mine Ban Treaty States Parties have emphasized the importance of finding ways for mine-affected states to contribute to mine action, given scarce domestic resources. The Afghan government’s non-financial support to mine action organizations is a good example. For instance, the government provides office space, storage facilities and quality assurance monitoring for HALO Trust. The details of donor funding for 2003 and for the years 1991 to 2003 are given in the following tables: Funding for Mine Action Program for Afghanistan (January-December 2003)[109]
Funding for the Mine Action Program in Afghanistan 1991-2003 (US$)[110]
Landmine CasualtiesIn 2003, UNMACA recorded 846 new casualties from landmines, UXO and cluster munitions, of which 184 people were killed and 662 injured; at least 80 were females.[111] In comparison, the ICRC recorded 847 mine/UXO casualties for the same period, including at least 384 children; 772 were civilians.[112] However, key actors in mine action estimate that there are currently about 100 mine/UXO casualties a month in Afghanistan. The collection of comprehensive landmine casualty data in Afghanistan remains problematic, due in part to communication constraints and the time needed to centralize all the information. The ICRC is the principal source of mine casualty data, providing the UN Mine Action Program with about 95 percent of its information on new casualties. Many mine casualties are still believed to die before reaching medical assistance, and are therefore not recorded in the statistics. The Landmine Impact Survey data on casualties from 2001-2003 shows that 654 (38 percent) of the 1,714 landmine casualties recorded died from their injuries.[113] Mine casualties continue in 2004. The ICRC recorded 423 new mine/UXO casualties to the end of June 2004, including 47 people killed and 376 injured. It is not possible at this time to determine the exact number of landmine casualties or mine survivors in Afghanistan. The number of estimated new mine casualties has declined over time. In 2000, it was estimated that casualties could be as high as 150 to 300 a month, a decrease from the 300-360 a month in 1997 and the estimate of 600 to 720 a month in 1993.[114] At the end of 1997 it was estimated that between 90,000 and 104,000 people had been killed or injured by landmines, based on an average rate of 14-16 casualties per day for the 18 years since major mine-laying started; about 30 percent of those casualties were killed.[115] However, in 1999, the Comprehensive Disabled Afghans’ Program (CDAP), estimated that as many as 800,000 people, or 4 percent of Afghanistan’s population, were disabled, including some 210,000 landmine-disabled.[116] The Ministry of Martyrs and Disabled has collected data on a total of 75,688 persons with disabilities, including 13,624 mine survivors (18 percent).[117] As stated previously, the ICRC is the main source of mine casualty data in Afghanistan. The ICRC began collecting casualty data in March 1998 from 36 ICRC-supported health facilities in Kabul and a few other major cities. In January 2002, the ICRC expanded the program initiating community-based data gathering in all mine-affected areas of Afghanistan, except the Kandahar region where Handicap International has been involved in community-based data collection since 1998. Mine casualty data collection is now provided by about 492 health facilities supported by several agencies and organizations, including the Ministry of Public Health (MoPH), Afghan Red Crescent Society, International Federation of Red Cross and Red Crescent Societies, ICRC Orthopedic Centers, Aide Medicale International, HealthNet, Ibn Sina, Mercy Committee International, Afghan Health and Development Services, Norwegian Afghanistan Committee, International Medical Corps, Coordination of Humanitarian Assistance, Norwegian Project Office, Danish Afghan Committee, International Rescue Committee, Médecins Sans Frontières, Médecins Du Monde France, International Assistance Mission, Swedish Committee for Afghanistan, and others.[118] As of June 2004, the ICRC database contained information on 8,212 mine/UXO casualties between 1998 and 2004: 423 in 2004; 847 in 2003; 1,460 in 2002; 1,622 in 2001; 1,442 in 2000; 1,403 in 1999; and 1,015 in 1998. The database also contains information on more than 1,928 casualties recorded between 1980 and 1997.[119] Data collection is an on-going process and statistics are continually updated as new casualties, and those from previous periods, are identified. Handicap International also collects casualty data through its Community-based Mine Risk Education program. In 2003, HI recorded 265 new mine/UXO casualties in the Kandahar region; an increase over the 174 casualties recorded in 2002.[120] An analysis of ICRC casualty data reveals that in 2003, activities at the time of the incident included tampering (21 percent), tending animals (12 percent), traveling by vehicle (12 percent), playing or recreation (ten percent), collecting wood, fuel or scrap metal (eight percent), farming (seven percent), traveling on foot (six percent), military activity (five percent), incidental passing (four percent), demining (two percent), other activities or unknown (13 percent). Since 1998, 44 percent of casualties occurred while people were engaged in their daily activities (tending animals, collecting wood or water, farming, fishing/hunting or traveling on foot); 12 percent occurred while playing or engaged in other recreational activities. In 2003, children under 18 years of age accounted for 384 new casualties (45 percent). Of the total 847 new casualties, 82 (ten percent) were female and 772 (91 percent) were civilians. Since 1998, children under 18 years of age accounted for 3,701 new casualties (45 percent). Of the total 8,212 casualties, 646 (eight percent) were female and 6,603 (80 percent) were civilians. In 2003, antipersonnel mines were responsible for 272 new casualties (32 percent), antivehicle mines 113 (13 percent), UXO 284 (34 percent), cluster munitions ten (one percent), fuzes 49 (six percent), booby-traps 22 (three percent), and the cause of 97 casualties (eleven percent) is specified as other or unknown. Since 1998, antipersonnel mines were responsible for 3,712 casualties (45 percent), antivehicle mines 440 (six percent), UXO 2,691 (33 percent), cluster munitions 269 (three percent), fuzes 253 (three percent), booby-traps 107 (one percent), and the cause of 740 casualties (nine percent) is other or unknown. In 2003, new mine/UXO casualties were reported in 32 of the 34 provinces in Afghanistan. The highest number of casualties was recorded in the provinces of Kabul (14 percent), Nangarhar (12 percent), Parwan (11 percent), Kandahar (9 percent), and Herat (7 percent). Only about four percent of casualties reported having received MRE before the incident occurred, and less than four percent were aware that they were in a contaminated area. Of those injured in 2003, at least 177 required an amputation and at least 44 suffered injuries to one or both eyes.[121] As of July 2004, the UNMACA database contained information on 13,874 mine/UXO casualties since 1988. The information provides an indication of the trends in reported mine casualties but does not provide a precise representation of the true number of casualties over time. Mine/UXO Casualties recorded by UNMACA – 1988 to 2004[122]
*Reported casualties to July 2004 In 2003, three mine clearance personnel were killed and another 17 injured during survey or clearance activities. Since the start of mine action in Afghanistan in 1989 through 2003, more than 658 mine clearance personnel have been killed or injured during survey or clearance activities. The majority of accidents occurred between 1989 and 1999 with 63 personnel killed and 509 injured. Among the demining agencies, Afghan Technical Consultants (ATC) has experienced the highest number of accidents with 300 casualties reported, followed by DAFA with 118 casualties, MCPA with 74 casualties and OMAR with 66 casualties.[123] In the first six months of 2004, another six deminers were killed or injured during clearance operations. Soldiers and peacekeepers continued to be killed or injured by landmines and UXO in 2003, during mine clearance operations, on patrol, or otherwise. In January, a US and a Polish soldier were injured in a mine accident, and two more US soldiers were injured in February and April.[124] In April, several Italian soldiers were injured when their vehicle hit a mine in Khost Province.[125] In May, one German peacekeeper was killed and another injured when their vehicle hit a mine.[126] In July, three Dutch ISAF peacekeepers were injured when their vehicle hit a landmine near Kabul.[12]7 In October, two Canadian peacekeepers were killed and three others were injured when their vehicle hit an antivehicle mine in Kabul.[128] In May, the first death in Afghanistan’s nascent national army occurred when an Afghan soldier fresh from training stepped on a landmine while on patrol.[129] There are also several other reports of Afghan soldiers fighting with coalition forces falling victim to landmines. In 2002, soldiers killed or injured in landmine incidents/accidents include one Australian soldier killed and another injured and one Canadian, two French, three New Zealand, four Polish, two Romanian, and one Turkish soldier injured. US military casualties include five soldiers killed and ten injured in landmine and UXO incidents. In March, three Danish and two German peacekeeping soldiers were killed and another eight injured while destroying missiles at a munitions dump in Kabul. In May, a Bosnian deminer lost a foot after stepping on an antipersonnel mine, and in August a Swiss deminer was injured in central Afghanistan. In December 2001, four US soldiers and one British soldier were injured in mine incidents.[130] US soldiers continue to be killed and injured in landmine incidents in 2004. In February, one soldier was killed and nine others injured when their vehicle hit an antivehicle mine in Ghazni province; and in a separate incident another soldier was injured after his vehicle hit a mine near Kunar.[131] In March, three soldiers were injured when their vehicle hit a mine near Ghazni; and in a separate incident, two soldiers were injured by a landmine at Bagram airfield.[132] In May, three soldiers were killed when their vehicle hit a mine in Kandahar.[133] In June, four US soldiers were killed when their vehicle hit a mine in Zabul province.[134] Survivor AssistanceDecades of conflict has severely impacted on healthcare in Afghanistan. The health infrastructure is damaged and poorly maintained, lacks trained staff, resources and supplies, and is unable to meet the basic health needs of the population.[135] According to the World Health Organization (WHO), 65 percent of Afghans do not have access to health facilities.[136] Consequently, it is believed that many mine casualties die before reaching a medical facility due to the lack of emergency medical care or an adequate evacuation/transport system to a suitably equipped health facility; estimates were as high as 50 percent of casualties in 1999.[137] In many mine-affected areas no regular ambulance service exists and the roads are in poor condition or non-existent; sometimes casualties are transported by donkey or pack mule.[138] The WHO stated that one of the priorities in Afghanistan should be establishing and strengthening emergency health services with the appropriate geographic coverage, and that “the international aid and donor community have immense responsibilities to ensure that the health needs of Afghans are being addressed, and met accordingly.”[139] In 2003, the Ministry of Public Health worked to develop administrative structures, and human and financial resources, to rebuild the health system; however, gaps still exist in the facilities needed to provide adequate surgical care for mine casualties.[140] In June 2003, the World Bank announced a US$59.6 million grant to improve access to healthcare in rural areas and to build the capacity of the Ministry of Public Health and of Afghan healthcare workers.[141] The rehabilitation and reintegration needs of mine survivors and other persons with disabilities are also not being met. For every one person with a disability that receives assistance through existing programs, 100 more reportedly do not receive assistance.[142] In 2002, only 60 out of 330 districts had rehabilitation or socio-economic reintegration facilities for the disabled and even in those districts the needs were only partially met.[143] The on-going Retrofit Landmine Impact Survey found that for 1,714 “recent” mine/UXO casualties (654 killed and 1,060 injured) identified in 1,927 impacted communities as of 27 September 2004 only 825 reported receiving some form of emergency medical care (48 percent). Of the 1,060 survivors, 725 received some form of emergency medical care (68 percent), 160 received rehabilitation (15 percent), only 27 reported receiving vocational training (less than three percent) since the incident, and the care received by 61 survivors is unknown (6 percent); 40 survivors received no care (4 percent). The percentage of survivors receiving emergency medical care in the districts surveyed to date rose from 57 percent in 2001 to 71 percent in 2003.[144] National and international NGOs and agencies continue to play an important role in the delivery of assistance to landmine survivors and other persons with disabilities in Afghanistan, in collaboration with the Ministry of Public Health and the Ministry of Martyrs and Disabled. In 2002, Afghanistan reported 17 national, nine regional, 34 provincial and 41 district hospitals, along with a network of 365 basic healthcare centers and 357 health posts. However, about 50 percent of available hospital beds are in the capital, Kabul, while 20 percent of districts reportedly have no healthcare facilities.[145] Emergency and continuing medical care is provided through the Afghan hospital network and international NGOs and agencies. Hospitals in the Afghan healthcare network assisting mine casualties/survivors include the Indira Ghandi Child Health Institute, the Paraplegic Hospital and the Armed Forces Academy of Medical Sciences. The Indira Ghandi Child Health Institute in Kabul, one of the main hospitals for the treatment of children under 15 years-of-age, is partially supported by the Indian Government. In 2003, eight mine survivors, seven boys and one girl, were treated in the orthopedic/surgery ward; in 2002, 23 mine survivors received treatment.[146] While the hospital has experienced doctors, it lacks resources, equipment and medical supplies. The hospital’s greatest need is reportedly food. Children admitted to the hospital often suffer from poor nutrition and are too weak to respond well to treatment.[147] The Paraplegic Hospital in Kabul city assisted 35 mine survivors in 2003; 14 were hospitalized for further for treatment. The Paraplegic Hospital also assesses the degree of disability of patients who are then referred to Ministry of Martyrs and Disabled for assistance and employment support; more than 3,500 people have been assessed.[148] The 600-bed Armed Forces Academy of Medical Sciences, the only public hospital for emergency trauma cases in Kabul, accepts all emergency cases including military personnel and civilians. On average, ten new mine casualties are admitted each month; three were admitted the day before Landmine Monitor visited the hospital. The hospital employs 300 doctors and 400 nurses but this number is reportedly insufficient to meet the needs of patients. The physical infrastructure of the hospital is run-down and in need of renovation. It lacks equipment and has only limited supplies to treat emergency cases.[149] Since 1999, the Italian NGO Emergency has operated a general hospital providing emergency surgery, internal medicine and pediatrics in Anabah-Panshir Valley, a surgical hospital in Kabul since April 2001, and 24 first aid/public health centers, providing emergency medical care, surgery, physical rehabilitation, psychological support, social reintegration programs and transportation to the hospitals. The 110-bed surgical hospital in Kabul provides the only intensive care unit for civilians in Afghanistan. The hospital is well-equipped and staffed by experienced doctors, nurses and physiotherapists; more than 90 percent of the staff are nationals.[150] In 2003, Emergency assisted 263,526 people, including 264 landmine and 132 UXO casualties, and provided 14 wheelchairs, 874 crutches, and six walking sticks. A new surgical center is under construction in Helmand region.[151] In 2002, Emergency assisted 3,246 surgical patients (396 mine casualties), and in 2001, only 1,348 surgical patients (120 mine casualties) after the conflict caused the suspension of activities in Kabul from 17 May to the beginning of November 2001. Emergency’s activities are funded through private donors, local public institutions, fundraising campaigns and Italian local authorities.[152] For the first time in 2003, the Slovenian International Trust Fund for Demining and Mine Victims Assistance (ITF) provided funding to Emergency in Afghanistan following a donation from Hungary.[153] Under a special arrangement, the International Security Assistance in Afghanistan hospital in Kabul accepts up to ten or twelve of the most seriously injured mine casualties a month. While the hospital is housed in military tents, facilities are of a very high standard and well-equipped to handle trauma cases.[154] The ICRC has supported hospitals, clinics and first aid posts in Afghanistan since 1987 providing medicines, medical and surgical supplies, training, and repair and renovation of facilities. Support is also provided to the ambulance services in Kabul. Since 1999, more than 25 hospitals and clinics, and sixteen first aid posts received regular support, including eleven hospitals in 2003. Since 2001, ICRC-supported hospitals surgically treated more than 2,000 mine/UXO casualties, including 411 in 2003, and 779 in 2002.[155] In addition, the ICRC has been providing surgical training in emergency techniques to Afghan surgeons for about ten years.[156] Since 1980, Médecins sans Frontières provided essential medical aid to hundreds of thousands of Afghans, including mine casualties. MSF’s program supported emergency interventions, surgical care, general healthcare, and safe blood transfusions in several hospitals and health clinics in 13 provinces throughout Afghanistan with a team of 80 expatriate staff and over 1,400 Afghan staff. However, MSF announced the closure of its programs in Afghanistan on 28 July 2004 because of security concerns after the killing of five of its international staff in June. MSF will hand over it programs to the Ministry of Public Health and other organizations.[157] The International Medical Corps (IMC) provides medical care and psychosocial support in 24 health clinics in the central region, three in the western region, and eight in the eastern region (plus three clinics supported by the WHO). In 2002, IMC assisted 379,039 people, including 145 landmine survivors.[158] The UNOPS/Comprehensive Disabled Afghans Program (CDAP) serves as the national coordinating body for rehabilitation services provided by NGOs, and has operated a community-based rehabilitation program for persons with disabilities in Afghanistan since 1991, in close cooperation with the Ministry of Martyrs and Disabled and other relevant ministries. CDAP’s main area of work includes orthopedic services, physiotherapy, employment support, home-based therapy, and special and primary education, in 46 districts of 14 provinces: Kabul, Badakhshan, Balkh, Farah, Ghazni, Herat, Jawzjzn, Kandahar, Kundoz, Logar, Nangarhar, Samangan, Takhar, and Wardak. In early 2003, CDAP expanded its program in four districts of northern Kabul province and is jointly implementing a vocational training and micro-credit program. CDAP’s vocational training program includes classes in 40 different skills and apprenticeships. The micro-credit program provides loans of up to a maximum of $300 which are repaid over a period of seven to eight years; more than 5,000 people have benefited. CDAP works with the Swedish Committee for Afghanistan, ICRC, Sandy Gall’s Afghanistan Appeal and Handicap International. The ICRC provides CDAP with orthopedic materials and HI cooperates in training and capacity building. In 2003, CDAP assisted 24,350 persons with disabilities, including 3,226 mine/UXO survivors. CDAP distributed 472 prostheses and fitted 397, and 52 wheelchairs and 592 crutches; 325 landmine survivors benefited. CDAP employs 445 technical and managerial staff. The annual budget is US$4.5 million and the main donors are UNDP, USAID, Japan, Germany, France and Sweden; previously funding also came from Canada, Denmark, Netherlands, Norway, and the United Kingdom.[159] Due to a budget shortfall in 2000, CDAP closed its community rehabilitation program in 18 districts.[160] Other measures undertaken by CDAP include development of a better coordination mechanism of services, development of a national strategy on disability, unification of prosthetic and orthotic technology, development of a national curriculum for physiotherapy, development of a national dictionary of about 2,000 songs for persons with impaired hearing and establishment of a Physiotherapy School in Kabul.[161] The ICRC is the principal service provider to mine survivors in Afghanistan and reports treating 65,000 patients (with all types of disabilities) since beginning its activities in 1987 at its orthopedic centers in Kabul, Mazar-i-Sharif (since 1991), Herat (since 1993), Jalalabad (since 1995), Gulbahar (since 1999) and Faizabad (since 2001). The centers fit upper and lower limb prostheses and orthoses, provide free medical care, physical rehabilitation, psychosocial support, vocational training, micro-credits for small business, and public awareness services related to government rules and programs. All services are free-of-charge. The ICRC’s orthopedic centers employ six expatriates and 450 Afghans, including 50 women; about 85 percent have a disability. The orthopedic centers produce prostheses, orthoses, crutches and wheelchairs while other orthopedic components are produced in the Kabul center. Components are provided free-of-charge to other CDAP-supported centers in Ghazni and Taloqan, the Guardians center in Kandahar, and the International Assistance Mission center in Maimana. In 2003, the ICRC assisted 25,000 people, including 6,000 mine survivors. Since 1999, the ICRC centers fitted 21,562 prostheses (15,960 for mine survivors), produced 33,531 orthoses, 36,538 pairs of crutches, and 3,997 wheelchairs, and provided 408,247 physical therapy treatments, including 3,887 prostheses (2,838 for mine survivors), 8,036 orthoses (31 for mine survivors), 4,837 pairs of crutches, 782 wheelchairs, and 105,881 physical therapy treatments in 2003. The ICRC also provides on-going training for orthopedic technicians and physiotherapists. In 2003, the ICRC, in cooperation with the Ministry of Public Health and NGOs, initiated a six-month training course in prosthetics and orthotics.[162] The ICRC’s Social Reintegration program assisted 1,701 people with a disability in 2003 with vocational training, special education, job placement, and micro-credits for small businesses.[163] Vocational training is available for 15-30 year-olds in around 20 different skills including training as prosthetic technicians to work in the orthopedic centers, tailoring, sewing, embroidery, bicycle repair, and floristry. Since the program started in 1997 to January 2004, 772 children were sent to public school; 636 people received vocational training; 842 gained employment through the job placement center; and 2,393 accessed micro-credits. Under the micro-credits program beneficiaries are offered a $350 interest-free-loan to start up their own business. The loan is repayable in 18 monthly installments.[164] Sandy Gall’s Afghanistan Appeal (SGAA) operates orthopedic and physiotherapy services, disability awareness and health education in Kabul and Jalalabad. The orthopedic workshops produce prostheses, prosthetic feet, orthoses, wheelchairs, crutches and other mobility aids. The orthopedic centers reportedly have long waiting lists for services. In 2003, SGAA assisted 5,333 people, including 473 landmine survivors. Services are free-of-charge for persons with disabilities. In August and September 2003, SGAA opened two new physiotherapy centers, one in Kunar province and the other in Laghman province. SGAA plans to expand its orthopedic program to Nuristan and Kunar provinces. In 2002, SGAA started a two-year physiotherapy course in Jalalabad. The first group of 19 students graduated in January 2004. In 2003, SGAA started a 6-month upgrade course for orthopedic technicians; the diplomas are recognized by the Ministry of Public Health. Four technicians also started an 18-month practical training program in orthopedic technology. Up to September 2003, SGAA’s major donors were the Diana, Princess of Wales Memorial Fund and the European Commission. Since then SGAA reports that it has not been able to secure other long-term donors and may have to reduce services in 2005.[165] Since 1998, the Kabul Orthopedic Center (KOC) in Kabul has provided physical rehabilitation and orthopedic devices for mine survivors and other persons with disabilities. In September 2002, Sandy Gall’s Afghanistan Appeal partially resumed its financial assistance to the KOC, having withdrawn it during the Taliban period. In 2003, the KOC operated as a joint project between the government, SGAA, and the NGO Ashram International. The KOC works closely with the government’s Academy of Medical Sciences and provides assistance free-of-charge. Between October 2002 and September 2003, the KOC assisted 2,298 physiotherapy patients and produced 1,165 orthopedic devices.[166] In calendar year 2002, the KOC assisted 5,320 people, produced 642 prostheses (510 for mine survivors), and distributed more than 3,000 assistive devices, including crutches, wheelchairs, and walking sticks.[167] Handicap International provides physical rehabilitation and prostheses through its orthopedic center in Kandahar and collects information on persons with disabilities in the Helmand, Zabul, Farah, Ghazni and Herat provinces through a network of community volunteers. Since June 2001, HI cooperates closely with the Afghan NGO Guardians in Kandahar. Guardians provide physiotherapy, prosthetics, and limited health services at its main rehabilitation center/orthopedic workshop in Kandahar and two health units in Quetta (Pakistan). HI is responsible for the production of orthoses, wheelchairs and walking aids, while Guardians produces and fits prostheses. In 2003, the Kandahar center assisted 2,060 people (72 landmine survivors), and produced 162 prostheses, and distributed 2,823 crutches, 171 wheelchairs and 679 other assistive devices.[168] In 2002, the center assisted 1,243 people (128 landmine survivors), and produced 1,164 prostheses and 349 orthoses, and distributed 2,518 walking aids and 84 wheelchairs.[169] HI commenced its program to support mine survivors and other persons with disabilities in Herat and the province of Badghis in January 2002. The program focuses on upgrading physiotherapy centers, through training, materials and technical support to physiotherapy services. HI is cooperating closely with CDAP and the Ministry of Martyrs and Disabled.[170] The International Assistance Mission (IAM) operates physiotherapy and ophthalmic rehabilitation and psychosocial support programs. IAM works with the cooperation of the Intermediate Medical Institute and the Ministry of Public Health. It operates the Noor Eye hospital in Kabul and eye clinics in Herat and Mazar-i-Sharif and provides financial and technical support to the Physiotherapy School of Kabul and the Blind School of Kabul.[171] The Technical Orthopedic Center (TOC), founded almost 30 years ago, resumed providing orthotic and prosthetic assistance in March 2003 after having been closed for five years. TOC is supported by the Ministry of Public Health and employs 55 personnel. In 2003, TOC assisted 640 people, including 450 landmine survivors; 28 percent of survivors were children and four percent were women.[172] Physiotherapy and Rehabilitation Support for Afghanistan (PARSA) provides physiotherapy services, through its two clinics in Kabul. PARSA also distributes wheelchairs, and walking aids, and refers amputees to the ICRC or Kabul Orthopedic Center. In 2003, the physiotherapy center assisted 3,156 people; in 2002, 3,600 assisted, including about 500 mine survivors.[173] Since August 2002, Association for Aid and Relief (AAR)/Japan provides physiotherapy services through its clinics in Kalafgan and Khawjaghar districts of Takhar province. In 2003, AAR assisted 3,072 people in the clinics, including some mine survivors. In addition to clinical services, AAR conducts outreach services on a regular basis in order to expand the service to remote areas; 792 people were assisted in this program. In 2002, AAR provided physiotherapy assistance for 327 people, including 22 landmine survivors, and distributed 37 prostheses.[174] In January 2002, an Indian orthopedic team arrived in Kabul with 1,000 prostheses for Afghan amputees, which were fitted free of charge. The Indian government funded the project, with the prostheses provided by the BMVSS charity from Jaipur.[175] In 2003, the NGO Help Handicapped International started a program in cooperation with the Ministry of Public Health to fit Jaipur Foot prostheses for Afghan amputee mine survivors in Kabul. The program consists of an annual 21-day camp to fit prostheses; 402 mine survivors were fitted in 2003. The next camp is planned for September/October 2004.[176] Afghan Amputee Bicyclists for Rehabilitation and Recreation (AABRAR) focuses on the physical rehabilitation and socio-economic integration of people with a disability through physiotherapy, recreational rehabilitation, vocational training, and psychosocial support at its centers in Jalalabad (since 1992) and Kabul (since 2002). In addition to providing physiotherapy services, health education, mine risk education, and literacy training to more than 3,000 people a year, AABRAR’S main activities include a bicycle training program for about 600 disabled men and boys each year to teach them how to ride and repair bicycles. Graduates receive a bicycle at the end of their training which can be used for transport or as a mobile shop. In Kabul in 2003, the Disabled Cycle Messenger Service started with 15 graduates from the bicycle training program and three support staff. All the messengers are amputees and are mostly landmine survivors. For disabled women and girls, AABRAR offers six-month vocational training programs for 80 to 100 people each year in carpet weaving, embroidery, ball making and tailoring. Graduates receive a sewing machine and raw materials at the end of the program as a means to generate income. AABRAR reports that 80 percent of graduates from the two programs gain employment or are earning an income. In Kabul, there is a three-year waiting list for training and in Jalalabad there is a two-year wait. In 2003, AABRAR assisted 4,466 people (about 80 percent are mine/UXO survivors), distributed 300 crutches and 600 bicycles, and employed 99 people, including 60 with a disability.[177] AABRAR also encourages social participation through sport and organizes events including an annual bicycle race on the International Day of Disabled Persons on 3 December. AABRAR supported the establishment of the Afghan Paralympic Foundation in February 2004. Two athletes from Afghanistan competed in the Paralympics in Athens in September. One, a cyclist with the disabled messenger service in Kabul, is a double below-knee amputee and mine survivor. The other is a 14-year-old girl who competed in the running, marking the first time that an Afghan woman with a disability has competed in the games.[178] Serving Emergency Relief and Vocational Enterprises/Enabling and Mobilizing Afghans with Disabilities (SERVE/EMAD) provides training in mobility/living skills, early intervention programs, school reintegration programs, psychological counseling, and vocational training for the sight and hearing impaired, and physically disabled in Kabul, Parwan, Kapisa, Laghman, Nangarhar and Konar provinces. SERVE/EMAD also provides mobile basic eye services and special education services to visually impaired children, along with preventive education to the rural population, and operates a school for the hearing impaired, and community-based rehabilitation. EMAD works with other relevant organizations including IAM and CDAP. In 2003, SERVE/EMAD assisted 1,350 people with a disability. In 2002, the program assisted 517 people; about 40 percent were mine/UXO survivors.[179] Support Service for Disabled (SSD) is providing literacy and vocational training, professional counseling, and producing artificial limbs in the provinces of Paktia, Paktika, Wardak, Baghlan, Ghazni, Balkh and Kabul. In 2003, SSD assisted 24 landmine survivors. SSD plans to extend its activities to all other provinces.[180] The US government’s Leahy War Victims Fund (LWVF) has pledged $2.8 million to CDAP for the period April 2003 to April 2006 to assist mine survivors and other war-injured.[181] In 2002, the LWVF provided $1 million to support the socio-economic reintegration of mine survivors and others persons with disabilities as well as funds for training Afghan orthopedic technicians.[182] Two mine survivors from Afghanistan took part in the Raising the Voices training in Geneva in May 2003. In January 2004, one of the participants established the Afghan Disabled Union to advocate on behalf of mine survivors and other persons with disabilities. The Union has 180 members. Future plans include a vocational training program; however, the organization lacks funding support to implement activities.[183] Based on discussions with service providers during a visit to Kabul from 21-31 March 2004, the Landmine Monitor Victim Assistance Research Coordinator concluded that some of the key challenges to providing adequate and appropriate assistance for mine survivors and other persons with disabilities in Afghanistan include: facilitating access to services for people living in remote areas; improving and upgrading facilities for healthcare and rehabilitation; capacity building of local healthcare workers; ensuring quality of services and sustainability in the relevant government ministries; creating more opportunities for vocational training and income generation; raising awareness on the rights and needs of persons with disabilities; and ensuring that sufficient funding is available to meet the needs. Disability Policy and PracticeThe Ministry of Martyrs and Disabled is the focal point for all issues relating to persons with disabilities, including mine survivor assistance. The MoMD has collected data on a total of 75,688 persons with disabilities, including 13,624 mine survivors (18 percent), from all provinces of Afghanistan to facilitate access to monthly pensions. However, the MoMD has not established a comprehensive database with detailed information on the individual needs of the people identified. The MoMD also organizes vocational training courses.[184] In 1999, legislation was approved stipulating that persons with disabilities would be granted free medical care, a monthly pension and employment opportunities commensurate with their abilities and degree of disability.[185] The social security benefit of 300 Afghanis a month (about US$6) for persons with disabilities is reportedly insufficient to maintain a basic standard of living; and the bureaucratic procedure of applying for the payment prevents many disabled people from receiving the benefit.[186] The Transitional Islamic Government of Afghanistan approved the establishment of the National Disability Commission (NDC) in 2002, with representatives from the Ministry of Martyrs and Disabled, the Ministry of Public Health, the Ministry of Justice, and the Ministry of Finance; however, the NDC must be approved by the Cabinet before it is officially recognized. The Commission was tasked with drafting a new comprehensive law on the rights of persons with disabilities in Afghanistan.[187] In October 2003, a collaborative initiative between government ministries, indigenous and international NGOs, UN agencies, and associations for the disabled created the “Comprehensive National Disability Policy.” The implementation of the policy is to be coordinated by the proposed National Disability Commission, and in close cooperation with the NGO sector.[188] Handicap International acts as an adviser to the relevant ministries to assist in the development of a long term strategy for assistance to persons with disabilities that includes adequate geographic coverage and representation of all stakeholders. A needs assessment of persons with disabilities is planned.[189] Under the new 2004 Afghanistan Constitution, the State will take “necessary measures for regulating medical services and financial support to...disabled or handicapped, and their active participation and re-integration into society in accordance with the law.” The Constitution also “guarantees the rights and privileges of pensioners and disabled and handicapped.....”[190] The government aims to mainstream disability through the integration of persons with disabilities into schools, vocational training, and employment, and to fight discrimination through media campaigns and national legislation.[191] [1] When the Taliban controlled nearly all of the country, Afghanistan’s seat at the United Nations was still occupied by the government of Burhanuddin Rabbani, known as the Islamic State of Afghanistan or Northern Alliance, which was ousted by the Taliban in September 1996. Both the Taliban and the ousted government made statements in support of the mine ban. For more details see Landmine Monitor Report 1999, pp. 433-434. |
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