Casualties and Victim Assistance

Summary findings

·         The quality of physical rehabilitation declined with the withdrawal of international support; the government lacked the capacity to procure adequate materials and equipment

·         Progress in implementing physical accessibility standards contributed to increased access to education for children with disabilities

·         Limited progress in the implementation of the national victim assistance plan was identified in 2012; the government developed a monitoring tool for the plan and aimed for a full evaluation in early 2014

Victim assistance commitments

The Republic of Uganda is responsible for a significant number of landmine survivors, cluster munition victims, and survivors of other explosive remnants of war (ERW) who are in need. Uganda has made commitments to provide victim assistance through the Mine Ban Treaty and as a signatory to the Cluster Munition Convention.

Casualties Overview

Details and trends

In 2012, the Uganda Mine Action Center (UMAC) reported four mine/ERW casualties in two incidents.[1] As has been the case since 2010, all casualties occurred in northern Uganda. Three of the casualties were children; two boys and a girl. The fourth casualty was a deminer.

This represented a significant decrease from the 15 casualties reported in 2011, though it was similar to the three casualties reported in 2010.[2] Following a peak of about 150 casualties per year during 1996–1997, the number of annual casualties has decreased significantly; since 2003, casualties have been 21 or fewer per year.[3] However, given the lack of a central data collection mechanism, it is likely that some casualties were not identified.[4]

The total number of casualties in Uganda is not known. At least 2,763 casualties (529 killed and 2,234 injured) had been identified by December 2012.[5] Of the people injured, 1,814 occurred in northern Uganda and the remaining 420 were in the west. All casualties in the west were recorded as injured; if any were killed, they were not recorded. This was due to the fact that data collection has been mainly carried out by local survivors’ organizations whose primary interest is identifying survivors. As such, it is certain that people have been killed by mines/ERW in western Uganda who have not been recorded.[6]

Cluster Munition Casualties

A 2006 survey of mine and unexploded ordnance (UXO) casualties in Gulu district determined that 3% of recorded casualties (1,387 at the time) were caused by cluster munition remnants. Five other suspected submunition casualties were reported in 2006.[7] As of the end of 2012, no additional casualties caused by cluster munition remnants had been identified since 2006.

Victim Assistance

There are at least 2,234 mine/ERW survivors in Uganda.[8]

Victim Assistance since 1999[9]

When monitoring of victim assistance began in 1999, most victim assistance services were provided by international organizations responding to the needs of thousands of internally displaced persons (IDPs) and refugees based in northern Uganda. Services were mainly limited to emergency medical care, trauma response, and physical rehabilitation services. Most services were free for mine/ERW survivors. However, long distances and a lack of affordable transportation prevented some 50% of survivors from accessing needed care in that year.

The formation of the Uganda Landmine Survivor Association (ULSA) in 2004 increased opportunities for peer support and survivor-led advocacy, though ULSA’s activities were limited due to its dependence on scarce external funding. However, by the end of 2011 ULSA had supported the development of dozens of local survivor associations in western and northern Uganda.

With the significant reduction in violence in northern Uganda in 2006 and progress towards peace in neighboring countries, several international organizations closed or reduced their programs in Uganda between 2008 and 2010, transferring the responsibility to provide victim assistance services to relevant government ministries. At the same time, mine survivors who were IDPs returned home to other parts of the country, increasing the need for updated surveys and victim assistance services in those areas.

Through the end of 2012, the impact of the departure of several international organizations from northern Uganda remained and there were gaps in physical rehabilitation, economic inclusion and psychological support as well as the means to access services. As a result, there were more survivors in need of services than there had been some 10 years before. Handicap International (HI) responded to the existing need by launching a new victim assistance program in western Uganda in 2010 that was designed to facilitate access to existing programs and services in the area of health, rehabilitation, psycho-social support, and livelihood. This program was implemented in cooperation with government ministries, non-governmental entities such as the ICRC, and associations of persons with disabilities and survivors, and facilitated access to micro-finance, apprenticeship and vocational training.

Throughout the period, victim assistance coordination was very limited. Uganda developed a national victim assistance plan in 2008 which was revised in 2010 and extended by two years to 2014. In 2011, the National Intersectoral Committee on Disability was formed and included a mandate to coordinate victim assistance.

Victim Assistance in 2012

In 2012, the withdrawal of international support for victim assistance in Uganda continued with the closing of ICRC’s program in support of physical rehabilitation and the closing of other international programs. This was only partially offset by increased support from national groups that attempted to fill gaps. Physical rehabilitation was most affected with marked decreases in availability and decline in quality of prosthetics; just a small percentage of all people with disabilities in need of assistive devices were receiving services. The Intersectoral Committee on Disability, convened by the Ministry of Gender, Labour and Social Development (MGLSD), absorbed and replaced the Forum on Victim Assistance as the coordinating mechanism responsible for victim assistance. Progress was seen in increasing the physical accessibility of public buildings around the country, but particularly in urban areas with the implementation of physical accessibility standards.

Assessing victim assistance needs

In 2012, no efforts by the government to assess the needs of mine/ERW victims were identified. During the year, the MGLSD, with the support from HI, developed a standard data collection tool on disability with specific sections asking for information on mine/ERW victims. The Ministry of Health (MoH)- Disability Desk, National Council for Disabilities (NCD), Uganda Bureau of Statistics (UBOS), National Union of Disabled Persons Uganda (NUDIPU), ULSA, and Community Based Rehabilitation Association (COMBRA) all contributed to the design of the disability data collection tool. This tool was intended to be used by all stakeholders in identification of persons with disabilities and assessment of their needs. One such use was to be the August 2014 census to determine the number of persons with disabilities in Uganda, including landmine survivors.[10] However, by May 2013, no system had been put in place to unify, manage, and update disability-related data or coordinate its use.[11] Uganda’s Comprehensive Plan on Mine Victim Assistance 2010–2014 sought to establish a database on disability by 2011.[12]

In 2009, Uganda collected baseline data to identify the needs of survivors and the gaps in services in four districts in northern Uganda.[13] Through the same survey, all disability-related services and providers in mine-affected districts were mapped.[14]

No progress was identified in 2012 to establish a national casualty surveillance system that had been under development since 2008.[15] In early 2012, staff members of the MoH and MGLSD were identified to receive training to lead the implementation of the surveillance system.[16] The surveillance system was intended to include data on mine survivors and other persons with disabilities.[17]

Various NGOs and service providers collected data on the needs of survivors and other persons with disabilities in the areas where they were working. In northern Uganda, HI, ULSA, and the Association of Volunteers in International Service (AVSI)—through the Gulu Regional Referral Hospital orthopedic workshop—assessed the needs of survivors.[18] ULSA carried out a needs assessment of survivors in five districts within northern Uganda.[19] In western Uganda, the Kasese Landmine Survivor Association (KALSA) and HI assessed the needs of survivors. Family members of survivors were included in the needs assessment.[20]

Victim assistance coordination[21]

In 2012, the Intersectoral Committee on Disability, convened by the MGLSD, absorbed and replaced the Forum on Victim Assistance as the coordinating mechanism responsible for victim assistance.[22] Participants in meetings of the committee shared information about their activities and this was said to result in better coordination of services.[23] Committee meetings were infrequent as compared with previous years when it was the Forum on Victim Assistance. This was due to a lack of funding and reduced support from international organizations that had been involved in victim assistance.[24]

In November, the Office of the Prime Minister hosted a national meeting of all mine action stakeholders, including government and NGO victim assistance stakeholders.[25] The MGLSD also participated in one of the National Community Based Rehabilitation Steering Committee’s quarterly coordination meetings.[26]

During 2012, MGLSD and other victim assistance operators worked toward the implementation of the Comprehensive Plan of Action on Victim Assistance 2010–2014, published in August 2010.[27] The victim assistance plan had been reviewed and aligned to relevant national policies such as the National Development Plan and the National Disability Policy, as well as to international mechanisms such as the Convention on the Rights of Persons with Disabilities (CRPD), the Cartagena Action Plan, and the Convention on Cluster Munitions.[28] However, ULSA identified little progress in the implementation of the victim assistance plan in 2012.[29]

In 2012, MGLSD coordinated the development of a monitoring tool for the Comprehensive Plan of Action on Victim Assistance 2010–2014. The tool was piloted in the districts of Lira, Apac, Oyam, Kitgum, Pader, and Agago, in northern Uganda.[30] A full evaluation of the victim assistance plan was scheduled for early 2014.[31]

Uganda provided updates on progress in and challenges to victim assistance at the Twelfth Meeting of States Parties to the Mine Ban Treaty in Geneva on 3 December 2012 and at the Mine Ban Treaty intersessional meetings in Geneva in May 2013.[32] Uganda did not report on victim assistance at meetings of the Convention on Cluster Munitions during the reporting period. Uganda did not submit a Mine Ban Treaty Article 7 report for 2012; its last Mine Ban Treaty Article 7 report (for 2011) did not provide information on victim assistance.[33]

Inclusion and participation in victim assistance

ULSA was included in coordination meetings of the Intersectoral Committee on Disability. Survivor leaders took part in piloting the monitoring tool for the victim assistance plan.[34] Survivors were involved in the development and pretesting of the disability data collection tool. Survivors participated in meetings of the National Steering Committee on Community Based Rehabilitation.[35]

Survivors and persons with disabilities were involved in the identification and assessment of survivor needs and supported them in accessing medical, rehabilitation, and economic inclusion services.[36] Survivors were involved in the design and implementation of ULSA’s economic inclusion project in northern Uganda.[37]

Service accessibility and effectiveness

Victim assistance activities[38]

Medical Care

Government efforts continued in 2012 to improve emergency medical response in the rural areas through the purchase of ambulances and other activities.[39] However, the cost of specialized treatment and medications still prevented many survivors from getting the ongoing healthcare they needed.[40]

Physical Rehabilitation

By the end of 2012, there was a decrease in the availability and a decline in the quality of physical rehabilitation services in the country as long-time support from international organizations, including the ICRC and Doctors with Africa CUAMM, ended. This followed the closure of several other international programs in recent years. AVSI, after temporarily suspending services at the Gulu Regional Orthopedic Workshop in 2011, reopened the center and handed over its management to the MoH in 2012.[41] The MoH also assumed responsibility from international organizations for supplying materials and components at several rehabilitation centers. However, government-purchased materials were of a lower quality, affecting the quality of prosthetic devices,[42] and the MoH indicated that it was “struggling to sustain services.”[43]

The closure of international programs also reduced access to rehabilitation centers as support was no longer available for transport and accommodation costs. Such costs were beyond what most survivors could afford.[44] According to the MoH, just a small percentage of all people with disabilities in need of assistive devices were receiving services in 2012 due to the low production rates of centers, the lack of information among people with disabilities about the services available and their location, and poverty among people with disabilities, which made it difficult for them to cover the cost of accessing the services.[45]

Partially offsetting reductions in the availability of physical rehabilitation, in 2012 the Lira Regional Referral Hospital established an orthopedic center that, for its first year of operation, provided free rehabilitation services to landmine survivors and other persons with disabilities in several districts in northern Uganda. However, a lack of knowledge about the center prevented the full use of the facility.[46] The Church of Latter Day Saints and the Watoto Church in Kampala began providing financial and material support for physical rehabilitation during the year.[47]

Psychological Support

No overall changes in the provision of psychological support were identified in 2012. HI trained self-help groups on peer-to-peer counseling in western Uganda and provided counseling sessions for all survivors and persons with disabilities who were surveyed.[48] ULSA provided peer support to survivors identified through surveys in northern Uganda and trained local groups in peer support.[49] Several local survivor groups continued to provide peer support in both western and northern Uganda.

Social and Economic Inclusion

Accessing micro-credit through mainstream financial institutions remained a major challenge for mine/ERW victims in 2012.[50] The Ugandan government, through the MGLSD, continued to provide grants and vocational training to persons with disabilities, including landmine survivors, in northern Uganda. Some 500 survivors, either directly or through survivor groups, received support between 2010 and 2012.[51] The MGLSD also launched a new program in 2012 to provide three-year pensions for persons with disabilities from chronically poor households. Survivors were also entitled to participate, however the ministry had no information about whether any survivors had benefited from the program.[52] ULSA and HI also provided livelihood support to survivors and other persons with disabilities in western and northern Uganda in 2012.[53] Following training by ULSA on Uganda’s obligations and commitments to survivors, a local survivor group in Pader district successfully lobbied for their inclusion in the district council to aid in the design and implementation of local development projects.[54]

Social inclusion activities for mine/ERW survivors, such as sports programs, remained extremely limited in Uganda in 2012. HI trained self-help groups on how to promote sports and leisure programs as a means to increase the inclusion of their members (both survivors and other persons with disabilities) in their communities.[55]

Overall, there was some increased awareness of available services for mine/ERW survivors within their communities due to the production of a service directory and training conducted on its usage by HI. HI’s outreach targeted service providers and local authorities, as well as survivors themselves.[56]

Gender-appropriate services were not available to all persons with disabilities in health centers. In addition, it was very difficult for children to access services as often as needed.[57] Both HI and ULSA provided age and gender-appropriate services.[58] A government-launched program on inclusive education and the national accessibility campaign increased access to schools for children with disabilities.[59]

Laws and policies

The law prohibited discrimination against persons with disabilities, but it was not enforced and discrimination was common.[60] The review of the Disability Act 2006 to ensure harmonization with the requirements of the CRPD, started in 2010, was ongoing through May 2013.[61] In November 2012, the State Minister for the Elderly and Disabled was reported as having indicated that some funds for the assistance mine/ERW victims had been misappropriated.[62]

As of February 2013, the Uganda Building Control Bill was pending before the Ugandan parliament that would make obligatory the accessibility standards that were launched in 2010. The bill would also enable accessibility audit teams, along with the Kampala Capital City Authority, to enforce the standards.[63]

Although implementation of the standards was not yet mandatory in 2012, some progress to implement them was evident by early 2013. ULSA found that most new structures in Kampala were being constructed to the accessibility standards and some adaptations were made to older buildings, such as ramps to enter hotels and schools.[64]

HI, who worked with service providers in Kasese district to improve physical accessibility, noted that actors had information on the accessibility standards to guide them in making required modifications. However, at the district level, most service providers did not have the resources to make their facilities accessible.[65]

Uganda ratified the CRPD on 25 September 2008.