Summary action points based on findings

·         Follow-up services are required to address the needs identified by survivors surveyed in 2013 and 2014.

·         Prosthetics and economic opportunities in the mine-affected northern region need to be made sustainable.

·         Technical support is needed to advance the progress in incorporating victim assistance into the national disability and development sectors.

·         Extensive knowledge of small-scale affordable prosthetics services developed though Albania’s victim assistance program should be replicated throughout the country for the assistance of other amputees and survivors of explosive remnants of war (ERW) and weapons.

Victim assistance commitments

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

Casualties

Casualties Overview

In 2013, the Albanian Mine and Munitions Coordination Office (AMMCO) reported three casualties of AXO entered in the national database, including one injured boy.[1] AMMCO reported eight casualties of AXO for 2012 and six AXO casualties for 2011.[2] The last landmine casualties reported were in 2005. The national NGO ALB-AID recorded 10 accidents involving AXO or unexploded ordnance (UXO) through media monitoring in 2013; five people were killed, two of the casualties were children.[3]

A total of 982 mine/UXO and AXO/ERW casualties (146 killed; 836 injured) have been identified in Albania between 1997 and 2013. The Albanian Mine Action Executive (AMAE) casualty database for Kukës region contained information on 272 mine and ERW casualties (34 killed; 238 injured) for the period 1999–2005.

Cluster munitions casualties

There have been at least 55 cluster munition casualties in Albania. The Kukës database recorded 53 casualties from cluster munition remnants (nine killed; 44 injured).[4] Two additional casualties due to the use of cluster munitions were also identified.[5]

Victim Assistance

There are at least 836 mine/ERW (including AXO) survivors in Albania.

Victim Assistance since 1999[6]

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

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

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

In 2012, ALB-AID developed a project to build a sustainable survivors network and has worked on expanding opportunities to access physical rehabilitation services for survivors and amputees in other parts of the country. A study on the transition from mine action to national ownership noted that Albania’s victim assistance program had the capacity to expand its focus beyond the mine-affected northern regions, and more recently to the Gerdec explosion site, to assist survivors of explosive ordnance and other persons with disabilities throughout the country. ALB-AID worked with local associations in AXO-affected areas to make rehabilitation more accessible to amputees in the other regions.

Assessing victim assistance needs

In 2013, ALB-AID conducted an assessment of socioeconomic and health needs of marginalized UXO/ERW victims in six counties (Korça, Dibër, Durrës, Elbasan, Berat, and Gjirokaster) of Albania, with 296 respondents among the 354 survivors that were visited. The survey was carried out by ALB-AID within the framework of the Albanian Mine Action Programme (AMAP) with financial support from Austria. Implementation of the survey was conducted through four stages: 1. the preparatory phase including liaising with the Ministry of Social Welfare and Youth Department of Social Policies to ensure institutional support and design of the questionnaire—adapted to the Albanian context—in cooperation with AMMCO Victim Assistance Officer; 2. completion of the questionnaire through individual interviews; 3. Medical checks; and 4. Data processing and preparation of the survey report. The process was closely monitored by the AMMCO Victim Assistance officer. The survey also identified 189 people who are casualties of AXO previously not registered in the national database.[7]

From January to June 2014, ALB-AID implemented an assessment of social-economic and health needs of marginalized UXO/AXO victims in Lezha and Shkodra in counties. During the project, 168 mine/AXO victims were visited; of this total 126 survivors were interviewed (some did not wish to be interviewed) including 38 UXO/AXO survivors who were not previously registered in the national database.[8]

These projects resulted in detailed, consolidated socioeconomic data on survivors and their needs that was shared with Albanian line ministries and local municipal service providers for social support services. The project also raised awareness among local government institutions (social welfare departments) of their responsibilities to address the need for social and economic inclusion of UXO/AXO survivors.[9]

Victim assistance coordination[10]

AMMCO is responsible for coordination of victim assistance activities, resource mobilization, and liaising with the government. In 2013, AMMCO’s mandate continued to involve expanding Albania’s existing victim assistance program to include other AXO and UXO survivors and persons in need of assistance.[11]

The objectives of Albania’s National Victim Assistance Plan were aligned with the recommendations of the Cartagena Action Plan.[12] The national Mine Action Plan (2010) aimed to make victim assistance sustainable by building sufficient national capacity and by linking future progress with implementation of the National Strategy on People with Disabilities (NSPWD).[13] Albania signed the Convention on the Rights of Persons with Disabilities (CRPD) on 22 December 2009 and the Albanian Parliament adopted the CRPD on 15 November 2012, with ratification occurring 11 February 2013.

As at 1 July 2014, Albania had not submitted Article 7 transparency reporting for the Mine Ban Treaty or the Convention on Cluster munitions for calendar year 2013.

Survivors were represented in victim assistance planning and implementation of services including the AXO survivor survey through participation in ALB-AID.[14]

Service accessibility and effectiveness

Victim assistance activities[15]

Medical care and Rehabilitation

The National Trauma Center, located within the Military Hospital in Tirana, is responsible for treating people with injuries and trauma. Some physiotherapy is available in this center; however the service remained limited and was not specific to the rehabilitation needs of all patients. No psychological support is provided in this center and there are no doctors specializing in rehabilitation.[16]

In 2013, amputees from throughout the country, including mine/ERW survivors, continued to utilize the capacity of the Kukës Prosthetic Workshop. The Kukës Prosthetic Workshop, situated in the Kukës regional hospital and integrated into the hospital’s human resources funding, faced difficulties in securing enough raw materials and components to produce and repair prostheses.  Support from Austria through ITF Enhancing Human Security for the purchase of rehabilitation equipment resulted in the workshop receiving the supplies of materials in September 2013.[17] The Nursery Faculty of Tirana continued to implement a sustainable program of physiotherapy training in 2013.[18]

Overall, regional hospitals and other health centers did not provide physiotherapy services. As a result, not all those in need could readily access these services. Rehabilitation medicine remained at the beginning stage in Albania and was far from meeting the needs of survivors and other persons with disabilities. Some rehabilitation, mainly physiotherapy, was offered by small private clinics and professionals. More structured private services offered rehabilitation with other forms of therapy in addition to physiotherapy.[19]

Economic and social inclusion and psychological support

A law adopted in June 2012 requires assistant teachers in classes with children with disabilities. Previously, children with disabilities had not been integrated into the public education system.[20] The new law on pre-university education improved the opportunities for students with disabilities by ensuring that inclusive education will be made available while isolated special education will be gradually eliminated, that local authorities make schools accessible, and that educational institutions are obliged by law not to discriminate against students with disabilities (and such discrimination can include a lack of reasonable accommodation).[21]

ALB-AID initiated a survivor network advocacy and awareness-raising project with a small grant from the ICBL-CMC Survivor Network Project from August 2012 to July 2013.[22]

Generally, resource constraints and lack of infrastructure made it difficult for persons with disabilities to participate fully in many social activities. Governmental social services agencies were often unable to implement their programs due to lack of funding.[23]

A national strategy and action plan for the development of mental health services for 2013 to 2022 was adopted in February 2013. However, there was no progress towards the development of community-based mental health services in 2013.[24]

Laws and policies

Due to the differentiated status of certain disabled persons’ organizations and associations and the lack of official status for certain disabilities, there continued to be unequal access to rights among persons with disabilities.[25] Differences in legal status meant that most mine survivors with disabilities were not eligible for the state benefits available to some other groups of persons with disabilities.[26] For example, only those survivors who are registered as “labor invalids” due to an accident while at work may receive benefits, including free transportation, subsidies on utilities, and study scholarships for their children.[27]

This remained the main concern for survivors; if they were not working when they were injured, they are not recognized as persons with disabilities and therefore do not benefit from disability benefits. In early 2013, survivors publically declared their requests through the ALB-AID Survivors Network Project and sought the recognition of their rights in existing disability legislation and strategies.[28] However, differentiated status for certain groups of persons with disabilities remained in 2013. Delays in payment of the disability benefits were also reported.[29]

The European Commission (EC) reported that drafting new legislation and implementation of existing legislation should be priorities “with a clear focus on the rights of persons with disabilities.”[30] In 2013, employment offices and vocational training centers were trained in the law on promotion of employment, including the quota for persons with disabilities. The draft framework law on inclusion of and accessibility for persons with disabilities was not finalized.[31] Implementation and monitoring mechanisms needed to be in place to guarantee protection for socially vulnerable and/or persons with disabilities. The needs of persons with disabilities were not considered in program and budget plans of line ministries.[32]

Legislation prohibited discrimination against persons with disabilities in employment, education, access to healthcare, and the provision of other state services. However, service providers did sometimes discriminate against persons with disabilities. The law mandated that new public buildings be accessible to persons with disabilities, but this was not regularly enforced.Widespread poverty, unregulated working conditions, and poor medical care posed significant problems for many persons with disabilities.[33] Persons with disabilities continued to face difficulties in accessing education, employment, healthcare, social services, or decision-making.[34]

Albania ratified the CRPD on 11 February 2013.