Casualties

Casualties Overview

In 2013, the Monitor identified 220 casualties from mines/ERW including victim-activated IEDs in the Islamic Republic of Pakistan. Among 175 recorded civilian casualties, there were at least 45 children (23 boys and eight girls)[1] and 19 women. The vast majority of casualties were civilians, at 80%. Security forces represented 20% of the total, with 44 recorded casualties, including one military personnel killed and five injured when the landmine they were working to defuse exploded.[2] The 2013 figures were calculated from the database of Sustainable Peace and Development Organization (SPADO), which included at least 280 media reports of casualties of mines/ERW and IEDs in Pakistan for 2013; the difference in the total reported is due to the variation in media descriptions of the types of explosive devices used.

Khyber Pakhtunkhwa (KPK, formerly North-West Frontier Province), the Federally Administered Tribal Areas (FATA), and Balochistan continued to have the highest numbers of mine/ERW casualties in Pakistan; the combined annual totals for these areas accounted for more than 95% of all mine/ERW casualties in Pakistan in 2013.[3]

The 2013 casualty total represented a decrease from the 247 mine/ERW casualties recorded in 2012 and still a very significant drop in the total number of annual casualties from the 569 mine/ERW casualties identified in 2011. However, given the considerable variation in the availability of annual casualty data over time, it is not possible to be certain of the extent to which changes in recorded casualties are indicative of actual trends versus shifts in media coverage and use of terminology.[4]

The number of annual casualties caused by antivehicle mines reported in 2013 (119) remained stable compared to 2012 (100) but still represents a significant drop from 2011 (293). However, antivehicle mine incidents continued to cause a significant portion of recorded casualties (56%) in 2013. The number and ratio of antivehicle mine casualties in 2011 were the highest since Monitor reporting of the differentiation between mine types began in 2006 (249).

The proportion of total mine/ERW casualties reported to have been caused by victim-activated IEDs (35) continued to be more than three times lower than recorded in 2010, when victim-activated IEDs caused more than half of all casualties. Prior to 2010, the ratio had been increasing since at least 2007.[5] In 2013, more than 80% of casualties caused by victim-activated IEDs were children playing with devices that resembled toys.

Due to the lack of official data or a comprehensive data-collection mechanism, the total number of casualties in Pakistan is not known. In its transparency reporting for 2013, Pakistan reiterated, as it had in previous years, that there had been no ERW casualties.[6] However, between 1999 and 2013 the Monitor identified at least 3,817 (1,433 killed; 2,291 injured; 93 unknown) from landmines, victim-activated IEDs, and ERW.[7] It is likely that the total number of casualties is much higher. Pakistan reported 1,596 “IED attacks” in 2013, “including” antipersonnel mines and antivehicle mines; of these attacks, 70% were said to have caused casualties. Pakistan officially reported that “No Explosive Remnants of War (ERW) exist in Pakistan.”[8]

Victim Assistance

The Monitor has identified 2,293 mine/ERW survivors in Pakistan since 1999.

Victim assistance in 2013

Access to services remains a challenge for most people with disabilities, including mine/ERW survivors, particularly those from rural areas. In particular, in FATA, KPK, and Balochistan, access to services, particularly medical care, continued to be restricted due to violence, government restrictions on access, and by security concerns arising from continued attacks on humanitarian and health workers which limited the ability of aid organizations to provide assistance.[9] Due to government reservations, restrictions on its operations, and significant security concerns marked by the kidnapping and murder of a staff member, the ICRC decreased most of its activities significantly in May 2012.[10] In 2013, the organization looked to consolidate its physical rehabilitation project.[11] Towards the end of the year, discussions with the government were well underway to expand the scope of activities of the ICRC in Pakistan.[12]

Assessing victim assistance needs

National NGOs including SPADO collected information on casualties and survivors as part of their broader program activities. In 2012 and 2013, SPADO reported that a combination of decreased funding, the security situation, and restrictions on its activities in FATA and KPK reduced its information gathering activities to media monitoring for new mine/ERW casualties.[13]

Victim assistance coordination

Pakistan reported that the Military Operations Directorate of the Pakistan Army was the focal point for victim assistance, but also asserted that there were no casualties. It was not indicated if the Military Operations Directorate was responsible for both military and civilian survivors.[14] Pakistan has also reported that a “procedure/program” for victims of IEDs is in place through individual rehabilitation programs including emergency and ongoing medical care, physical rehabilitation at army medical units and hospitals, and economic reintegration through monetary compensation and employment. However, it was not reported if civilians could access these services.[15] In 2013, it was reported that opportunities to liaise with national authorities and other stakeholders on a data collection network and legal frameworks comprehensively addressing the issue of weapon contamination remained limited, given the prevailing political and security sensitivities.[16]

Several ministries were involved in disability issues, including the Ministry of Health and the Ministry of Social Welfare and Special Education.[17] Responsibility for inclusive education, social welfare, and the protection of the rights of persons with disabilities was passed to the provincial level after the dissolution of the Ministry of Social Welfare and Special Education in April 2011.[18] Pakistan has a National Policy for Persons with Disabilities (2002–2025).

Pakistan did not provide updates on victim assistance services (including rehabilitation programs) or on coordination in its most recent Convention on Conventional Weapons (CCW) Protocol V Article 10 report and CCW Amended Protocol II Article 13 report.[19]

Survivor participation and inclusion

No information was available about the inclusion of mine/ERW survivors in coordination, implementation, or monitoring of strategies that are relevant to them. However, the government planned to include persons with disabilities, along with national and international NGOs, in formulating an action plan for implementation of the Convention on the Rights of Persons with Disabilities (CRPD).[20]

Service accessibility and effectiveness

Victim assistance activities[21]

Emergency and continuing medical care

Local hospitals were inadequately equipped and staffed to respond to the needs of survivors, lacking specialized medical, surgical, and first aid facilities for affected areas.[22] People living in remote areas and those displaced or directly affected by conflict suffer from a critical lack of medical services.[23]

Despite existing needs, ICRC activities to improve the availability and quality of services throughout the casualty care chain in 2013 were heavily restricted. The ICRC field surgical hospital in Peshawar remained closed in 2013 and training courses on handling weapon wounds could not be conducted.[24] The Pakistan Red Crescent Society received material and financial support from the ICRC to strengthen its five basic health units and one mobile health unit, where treatment and care were provided to respond to the needs of the population in Balochistan, FATA and KPK.[25]

MSF noted that health services in Pakistan were often not affordable. In many regions, insecurity further restricted access to services. In KPK, near the Pakistan-Afghan border MSF teams also managed the emergency and surgical services of the Hangu Tehsil Headquarters hospital, run since 2012 by the Ministry of Health. Populations affected by conflict, including Afghan refugees, often sought medical assistance in the district hospital of Chaman, Balochistan province, also operated by MSF, which reported that 17% of patients treated in the emergency room in 2013 were victims of conflict.[26]

Physical rehabilitation including prosthetics

Access to rehabilitation services remains a challenge for most people with disabilities, particularly those in rural areas. Barriers to access services included transport, poverty, lack of awareness about services, cultural and physical barriers, illiteracy, and the security situation. In 2013, more mine/ERW survivors (724 of 2,578 beneficiaries in total) received prosthetics at ICRC-supported rehabilitation centers.[27] However, this remained a significant decrease in the number of mine/ERW survivors receiving services compared to recent years.[28]

The Christian Hospital Rehabilitation Centre in Quetta reopened under the management of the national disability and rehabilitation NGO CHAL Foundation after having closed shortly after the 2012 kidnapping and murder of an ICRC health delegate in the area.[29] The ICRC maintained its support for the Pakistan Institute of Prosthetic and Orthotic Sciences (PIPOS) and its seven satellite centers; for the CHAL Foundation and its four centers in the northwest and Balochistan; for the Paraplegic Centre Hayatabad (PCH) in Peshawar; as well as for the Muzaffarabad Physical Rehabilitation Centre which was handed over to the government of Azad Jammu and Kashmir as an autonomous center in November 2013. The ICRC also provided support on an ad hoc basis to the Akbar Kare Institute in Peshawar and to the Children’s Amputee Rehabilitation Program (C-ARP). House-bound patients in KPK benefited from care, home nursing kits, and house-modification services provided by the PCH. It was also reported that in 2013 patients treated at ICRC-supported centers had much shorter waits for prostheses and orthoses, thanks to improved production capacities. The centers increased production collectively by 123% compared to 2012, partly owing to ICRC-sponsored scholarships, sharing of staff experiences between the centers, and practical mentoring. Overall, in 2013 16,836 people benefited from physical rehabilitation services at ICRC-assisted centers, which represented an increase of 82% compared to 2012.[30]

Rehabilitation services for military survivors of mines/IEDs and ERW were available through army hospitals. Complicated cases were referred to the Armed Forces Institute of Rehabilitation Medicine.[31] The quality of prosthesis received was based on military rank rather than need.[32]

Social and economic inclusion

In 2013, the ICRC assisted in the establishment of sporting events, as well as of cricket and basketball teams, to promote inclusion of persons with physical disabilities receiving services within the network of assisted centers. The PCH also had a skills development program which included a mobile phone repair setup as well as sewing skills development where ICRC donated manual sewing machines to the trainees who displayed a capacity to earn an income from tailoring and sewing after discharge.[33]

Pakistan had previously reported that IED survivors were provided with monetary compensation, employment, and commercial or agricultural property. No figures were provided on the number of survivors who received assistance, or on how many were civilian or military.[34] In January 2014, the provincial government of Balochistan passed a new compensation law for civilian victims of terrorism and armed conflict which enables victims to get assistance within 15 days through a new “Civilian Victims Fund.” The new legislation also includes an appeals process and government-funded medical care while providing dependents of the victims with continued economic assistance including education. The new law explicitly prohibits discrimination of any type against victims.[35] As of May 2014, rules to guide implementation of the law still needed to be formulated.[36]

Few psychological support and economic inclusion programs were available in Pakistan.[37]

The government declared the federal capital and provincial capitals as “disabled-friendly cities.” It established 127 special education centers were established in main cities. Employment quotas for persons with disabilities lacked adequate enforcement. Most persons with disabilities were supported by their families. The law provides for equality of the rights of persons with disabilities, but this was not fully implemented in practice.[38]

Pakistan ratified the CRPD on 5 July 2011.