Action points based on findings

• Intensify efforts to improve access to rehabilitation services from remote and rural areas, including allocating resources to bring beneficiaries for rehabilitation and ensuring that transport is available.
• Hold regular disability sector coordination meetings and link victim assistance coordination with the development of disability strategies.
• Improve state support for psychological and social assistance, including peer-to-peer counseling and survivor-driven economic activities.
• Coordinate the rapid implementation of recently adopted legislation as well as existing policies and planning that could hasten developments in the availability and accessibility of services.

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 Convention on Conventional Weapons Protocol V and has victim assistance obligations under the Convention on Cluster Munitions.

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

Casualties

Casualties Overview

The National Regulatory Authority for Unexploded Ordnance/Mine Action Sector in Lao PDR (NRA) reported 42 casualties from unexploded submunitions and ERW for 2015. The majority of the casualties were male (39). Of the total, 19 were children, including one girl, and 23 were adults, including two women.[1] The casualty total for 2015 represented a slight decrease from 45 casualties in 2014, and was equal to that of 2013,[2] continuing a trend of reduction in annual mine/ERW casualties—from 56 casualties for 2012, 99 casualties recorded for 2011, and 117 casualties for 2010.[3]

By the end of 2015, the NRA had reported at least 50,612 mine/ERW (including unexploded submunitions) casualties, including 29,530 people killed and 21,082 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.[4] Lao PDR reported 702 mine/unexploded ordinance (UXO) victims from 2008 to 2013, of which 41% were children.[5]

Cluster munition casualties

Unexploded submunitions were reported to have caused 7,628 casualties in the period 1964–2014.[6]

Victim Assistance

In 2012, Lao PDR estimated that there were some 15,000 mine/ERW survivors still living, including approximately 2,500 survivors of unexploded submunitions.[7]

Victim assistance under the Vientiane Action Plan 2011–2015

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. In 2011, it was reported that there was a continuing lack of access to health services in Lao PDR. The healthcare system remained 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.[8]

Due to the large number of mine/ERW survivors with disabilities in Lao PDR, the Ministry of Health worked extensively on victim assistance and rehabilitation in coordination with international NGOs.[9] Association for Aid and Relief Japan (AAR) and the Ministry of Health significantly improved the availability of healthcare to survivors in Xiang Khouang province from 2010 through June 2014.

Physical rehabilitation services, run by the government in association with the Cooperative Orthotic and Prosthetic Enterprise (COPE), showed improvement. COPE covered the majority of the necessary costs for those receiving treatment. With an outreach program introduced in 2009, COPE was better able to reach survivors in rural areas. COPE continued “COPE Connect,” its outreach and community awareness-raising initiative. However, many survivors were unable to reach the available services.[10]

There was limited psychosocial support for mine/ERW survivors. However, peer support improved from 2010 in some districts. From 2013, psychological support increased significantly in Xieng Khouang province with the work of World Education. 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 were extremely slow to be adopted.

World Education, AAR, and Catholic Relief Services (CRS) provided first aid training for healthcare workers and village health volunteers. In 2013, the NRA, Ministry of Health, international NGOs, and organizations that provided training for village health volunteers in the past, met and started discussions on developing the first National First Aid Curriculum.[11]

In 2014,Lao PDR reported that it still has “a long way to go to provide support to survivors and their families. Beyond meeting their immediate emergency medical needs, very few survivors receive adequate physical, psychological, or economic support.”[12] During the year the quality of physical rehabilitation improved, according to people who used the services. Psychological support increased in the most ERW-affected areas. 

Victim assistance in 2015

Lao PDR stated that there were limited resources available and that few donors made victim assistance a priority.[13] The budget allocated to victim assistance is very limited, and as a result Lao PDR cannot pursue its strategic plan for the Dubrovnik Action Plan period through 2020.[14] Lao PDR also noted that it “has a long way to go to fully achieve the victim assistance goals within the broader disability and development frameworks.”[15] No change was reported by Lao PDR in its efforts to raise awareness of the rights of cluster munition victims and persons with other disabilities since 2010.[16]

Assessing victim assistance needs

The NRA Survivor Tracking System, a system for collecting data on new casualties, was designed to provide an ongoing survey of all survivors’ needs. The survey continued to be conducted in 10 provinces; some 8,918 survivor profiles had been recorded. The data is shared with stakeholders, including civil society organizations, for use in the preparation of workplans and funding requests relevant to addressing the needs of survivors.[17] In addition to the 10 provinces covered by the survivor tracking system, there are known to be mine/ERW survivors in the capital Vientiane. However, most of these are believed to be former military personnel who, as veterans with disabilities, are entitled to special social protection measures and are likely already covered by those systems.[18] 

World Education maintained its own detailed beneficiary database and information storage system. Its Victim Assistance Support Team (VAST) staff, including a data specialist, also had training on the Information System for Mine Action (IMSMA) used by the NRA and were able to make the data compatible.[19]

Handicap International (HI) and national disabled persons’ organizations (DPOs) supported the adoption of the Washington Group Questions relating to disability in the 2015 national census.[20] Lao PDR included basic questions relating to persons with disabilities in its national census in early 2015, but limited training of the census personnel created some confusion among respondents and preliminary results of the census did not mention data on disability.

An Australian-funded project to identify barriers and facilitators to social and economic participation and development for persons with disabilities in Lao PDR together with Lao organizations (government, DPOs, and international and national NGOs) was undertaken by Curtin University in order to improve their information about people living with disability, and develop disability-inclusive development policies and programs. Australia also supported a four-week program for Lao government representatives from the ministries of labor and social welfare, health, and education and sports, along with delegates from DPOs, service providers, and advocacy agencies.[21]

Victim assistance coordination

The NRA shared victim assistance information with stakeholders, attended meetings of actors in the disability sector and made presentations to regional meetings, and represented the Lao PDR government on victim assistance issues while working with NGOs to build capacity for stronger leadership in both victim assistance and disability issues. Victim assistance remained a minor component of the work of the ministries responsible for disability issues and it was, therefore, challenging to get victim assistance into the ministries’ agendas and strategies.[22]

Plans to hold regular disability sector coordination meetings and link victim assistance coordination with the development of disability strategies were yet to be realized, hampering rapid implementation of recently adopted legislation. A new strategic plan for the UXO Sector, developed in 2015, saw a need to improve the coordination of victim assistance between sector stakeholders and relevant ministries, and to better integrate assistance into broader disability sector programs and workplans.[23]

A victim assistance strategic plan was adopted in February 2014, with approval from the NRA Board,[24] after having being completed in March 2013.[25] The strategic plan addresses seven sections of victim assistance implementation: data collection; medical care; physical rehabilitation; psychological support and social inclusion; economic rehabilitation and education; legislation and policy; and coordination.[26]

The victim assistance strategy authorizes the NRA to support the National Committee for Disabled and Elderly People (NCDE) to:

• develop a sector-wide strategy for persons with disabilities, including ERW survivors;
• cooperate with the Ministry of Labor and Social Welfare to ensure adequate vocational and other training is provided; and
• cooperate with the Ministry of Health to ensure that the physical and psychological needs of cluster munition victims and other survivors are more adequately met.[27] 

As a coordination measure, service providers enter into memoranda of understanding (MoUs) with the relevant state ministries responsible for the sector in which the NGOs will operate. World Education has MoUs with the Ministry of Health and the Ministry of Education; COPE with the Ministry of Health; and HI with the Ministry Labor and Social Welfare.[28]

The Ministry of Labor and Social Welfare holds primary responsibility for the needs of, and related services to, persons with disabilities through the NCDE (previously the National Committee for Disabled People, NCDP. The title and responsibilities changed in September 2013).[29] The disability sector required far greater coordination and international backing. There were no official disability coordination meetings for all stakeholders.[30]

Frequent changes of designated disability focal points within ministries hindered the effective coordination of disability across government departments; there were no guidelines for government departments that ensure the participation of persons with disabilities in policy-making processes.[31]

In early 2015, World Education held multi-stakeholder consultations in the process of implementing its multi-year USAID-funded Training, Economic Empowerment, Assistive Technology, and Medical and Physical Rehabilitation (TEAM) project.[32]

Victim assistance is one of the three main components of the NRA strategy, entitled “Safe Path Forward II 2011–2020.”[33] 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.[34]

The strategy and its victim assistance component were included in Lao PDR’s Millennium Development Goals Compact of 2010.[35] A key indicator for progress under these Millennium Development Goals includes “the number of survivors receiving proper assistance.”[36]

In 2015, Lao PDR reported on victim assistance in its Convention on Cluster Munitions Article 7 report, and made statements on victim assistance at the Convention on Cluster Munitions First Review Conference in 2015 and the Sixth Meeting of States Parties in 2016.[37]

Inclusion and participation in victim assistance

In 2015, survivors, persons with disabilities, and their representative organizations participated in TWGVA meetings and in the implementation of services. Representatives of the LDPA, LDWDC, and QLA–Xieng Khouang province, actively participated in consultative processes and special events, including annual review meetings and ERW sector-wide working group meetings.[38]

HI’s Lao Ban Advocates project ended in March 2015. A final project workshop was held in February of that year.[39]

Lao PDR has never included a survivor on its delegation for the Convention on Cluster Munitions Meetings of States Parties or intersessional meetings.

Service accessibility and effectiveness

Victim assistance activities

Emergency and continuing medical care

Village health volunteers (6,000) provided basic healthcare and first responder emergency assistance in rural areas across Laos. World Education Laos worked with the Ministry of Health and various international NGOs, and village health volunteers to create a comprehensive First Aid curriculum for village health volunteers in 2016.[40] The approved curriculum was being used for training in Xieng Khouang, Houaphan, and Sekong provinces.[41]

Physical rehabilitation, including prosthetics

The Ministry of Health provides prosthetic and orthotic services in Lao PDR under the Centre for Medical Rehabilitation and associated physical rehabilitation centers, and in cooperation with COPE.

There are five rehabilitation centers, each in urban provincial centers. Clients are reimbursed for travel costs and a small living allowance during their stay for rehabilitation.[42]

The results of an independent client service satisfaction survey of COPE beneficiaries in 2015 found clients were satisfied overall with the service and assistive device they had received. Respondents to the evaluation in 2015 reported even higher levels of satisfaction than in 2014.[43]

A study carried out at the Vientiane, Savannakhet, and Xieng Khouang centers showed that while respondents reported being “quite satisfied” with the prosthetic devices received some 17.3% of participants reported that their device was in need of repair, and only 66.5% of devices used were said to be in good condition; 12.8% said they were not currently using their device, and some had not used their device at all. Among lower limb prosthetic users surveyed, 61.5% (88) were mine/ERW survivors. Respondents were happy overall about the technical skills of staff. Most respondents rated being treated with respect and dignity over technical capacity. The ability to travel to avail of services was affected by poor access to appropriate and affordable transport and the demands of agricultural work as well as the rainy season.[44]

The Faculty of Medical Technology in Laos conducted a four-week medical rehabilitation training program in August 2016, supported by the World Education Laos TEAM project. The four-week training focused on rehabilitation medicine for 10 medical doctors from central and provincial hospitals in order to create a broader physical rehabilitation medicine network.[45]

The ICRC began to support three physical rehabilitation centers in the Lao PDR. In the Lao PDR, some 270 persons with disabilities (including 201 mine/ERW survivors: 184 men, 15 women, and two girls) received rehabilitation, including prostheses, at the three rehabilitation centers that began to receive ICRC support in 2015.[46] HI also worked on improving the functional rehabilitation sector in Laos by implementing clear policies, developing a more effective training program, and establishing a management system in order to better meet the needs of persons with disabilities.[47]

Economic and social inclusion and psychological support

Disability-specific vocational training available to persons with disabilities was limited. The qualifications provided by these services were generally not accredited or officially recognized equally by other government vocational training programs.[48] In 2015, World Education and QLA provided vocational training and economic support specifically for survivors. Survivors also received education scholarships through World Education.[49] HI initiated a project to support persons with disabilities, including survivors and their family members, with income-generating and livelihood activities.[50]

Into 2015, the ICRC provided livelihoods support for UXO victims survivors and their families in southern Laos, through income-generating activities initiated in 2014.[51] Following an assessment of their impact, ICRC livelihood projects in southern Lao PDR were phased out; resources were reallocated to support physical rehabilitation services.[52]

Psychological support was generally not available in Lao PDR. There were only one or two psychiatrists in the country. Where mental health services did exist in the capital they were medical-based. Community-based services were not widely considered as a possible form of assistance. Disability organizations lacked knowledge on mental health issues and DPOs did not have the expertise to provide mental health services. World Education’s integrated victim assistance project, carried out by its Victim Assistance Support Team (VAST), mapped services and provided individual support to survivors to address psychologic and other needs, including referrals to services. To address depression, recognized among some survivor beneficiaries, World Education held a peer support meeting.[53]

The TEAM project partnered with AAR Japan to promote wheelchair basketball in particular in Vientiane during a project that lasted from May 2015 through May 2016. LDPA and AAR organized wheelchair basketball events and training as a social inclusion measure.[54]

The Ministry of Education and Sports and Ministry of Labor and Social Welfare joint strategy for implementing a National Vocational Qualification Framework for the period 2013 to 2018 specifically  provides easier access to vocational training for persons with disabilities, other marginalized groups and individuals living in rural communities.[55]

The ICRC, together with local authorities and the Lao Red Cross, upgraded water systems in areas contaminated with mines/ERW; this helped to ensure that communities had safe access to water for their daily needs.[56]

Laws and policies

The Decree on the Rights of Persons with Disabilities was finally approved and adopted on 18 April 2014. It had been prepared at the beginning of 2008, submitted to the Ministry of Justice in July 2012, and passed to the Cabinet in November 2012. The Decree on the Rights of Persons with Disabilities (Decree No. 137) was adopted alongside the Decree on the Organization of Operation of National Committee for Disabled People and the Elderly (Decree No. 232) of Lao PDR, thereby establishing a mechanism for coordination of implementation with the new NCDE.[57]

In 2014 and into 2015, HI supported efforts to establish strategic planning for implementation of the Decree on the Rights of Persons with Disabilities at national and local levels. It also carried out workshops for awareness-raising and the development of local action plans.[58]

The Ministry of Labor and Social Welfare established regulations regarding physical accessibility, and some ramps were built in Vientiane. Legislation adopted in 2009[59] requires that the construction of buildings, roads, and public places provide facilities for persons with disabilities. There is a list of access requirements that must be complied with in all public facilities. Yet construction companies were not always aware of these regulations and there was no enforcement mechanism to ensure compliance. Most public buildings were not modified or adapted, which limited persons with disabilities’ access to public services and employment. Public transport infrastructure was mostly not accessible.[60]

Social protection programs support war veterans with disabilities unable to work, however there were no social protection programs to support other persons with disabilities in similar situations. DPOs recommended that social protection programs should be extended to include all persons with disabilities.[61]