Summary action points based on 2013 findings

·         Intensify efforts to improve access to rehabilitation services in remote and rural areas, including allocating resources and ensuring that transport is available.

·         Coordinate for the rapid implementation of recently adopted legislation as well as for existing policies and planning that could hasten developments in the availability and accessibility of services.

·         Integrate responsibility for the allocation of resources for services, referral, and outreach—including transport and accommodation—into government budgets.

·         Structure state support for peer-to-peer counseling and survivor-driven economic indicatives.

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

Casualties

Casualties Overview

Lao PDR reported 42 ERW and cluster munition casualties for 2013. The majority of casualties were children 27 (21 boys and six girls), among the 15 adult casualties there were 13 men and two women.[1]

The casualty total for 2013 represented a continuing reduction in annual mine/ERW casualties from 56 casualties for 2012, 99 casualties recorded for 2011 and 117 casualties for 2010.[2]

By the end of 2012, the National Regulatory Authority for the Unexploded Ordnance/Mine Action Sector in the Lao PDR (NRA) had identified at least 50,525 mine/ERW (including unexploded submunitions) casualties, including 29,506 people killed and 21,019 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.[3] The NRA reported 702 mine/unexploded ordinance (UXO) victims from 2008 to 2013, of which 41% were children.[4]

Cluster munition casualties

Unexploded submunitions were reported to have caused 7,591 casualties in the period 1964–2013.[5]

Victim Assistance

Lao PDR has estimated that there are some 15,000 mine/ERW survivors still living, including approximately 2,500 survivors of unexploded submunitions.[6]

Victim assistance since 1999[7]

The assistance provided to survivors in Lao PDR remained inadequate throughout the period.[8] 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. Emergency medical care throughout Lao PDR remained inadequate to meet survivors’ needs for most of the period. However, progress was made with the development of a system of village health volunteers, in addition to an Asian Development Bank project with the Ministry of Health that improved primary health care services in northern provinces by 2008. More recently, World Education and the Ministry of Health improved the availability of healthcare to survivors significantly.[9]

Physical rehabilitation services, run by the government in association with the Cooperative Orthotic and Prosthetic Enterprise (COPE), showed improvement. With a new outreach program introduced in 2010, they were better able to reach survivors in rural areas.

There was only limited psychosocial support for mine/ERW survivors; however, peer support increased marginally from 2010. 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.

Victim assistance in 2013

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.”[10] Survivors lacked access to quality medical care and professional health workers in physical therapy, occupational therapy, and psychological support. Training in emergency medical attention and first aid in 2013 improved the availability of local emergency care.

Assessing victim assistance needs

The NRA Survivor Tracking System, an ongoing system for collecting data on new casualties, was designed to provide an ongoing survey of the survivors’ needs. In 2013 more than 10,000 individual forms had been received by the NRA. Data are entered into the IMSMA database for analysis. The data was planned to be shared with stakeholders including civil society organizations, for use in the preparation of work plans and funding requests relevant to addressing the needs of survivors.[11]

Association for Aid and Relief Japan collected information on 29 ERW survivors.[12] World Education, the Quality of Life Association (QLA) in Xieng Khouang province, and the Department of Health interviewed 44 ERW survivors after their discharge from hospital in order to provide follow-up support.[13] Handicap International (HI) conducted participatory rural appraisals in 40 villages of rural districts of Savannaket province, which identified of 626 persons with disabilities, including 81 ERW survivors.[14]

Victim assistance coordination in 2013

Regular meetings of the TWGVA were held in 2013, participants included the NRA, other relevant government agencies, national and international NGOs, and survivors.[15] In March 2013, a new Victim Assistance Strategic Plan was completed. The strategic plan addresses seven pillars of victim assistance: data collection; medical care; physical rehabilitation; psychological support and social inclusion; economic rehabilitation and education; legislation and policy; and coordination.[16] The NRA Victim Assistance Strategy received final approval from the NRA Board in February 2014.[17]

Lao PDR reported that once the victim assistance strategy is adopted the focus of coordination efforts will shift to defining shared responsibilities with the disability sector, identifying gaps in resources, and developing a disability framework that is inclusive of cluster munition victims and other survivors of ERW.[18]  In this regard, 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.[19]

Victim assistance is one of the three main components of the NRA strategy entitled “Safe Path Forward II 2011–2020.”[20] 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.[21] The strategy and its victim assistance component were included in Lao PDR’s Millennium Development Goals Compact of 2010.[22] A key indicator for progress under these Millennium Development Goals includes “the number of survivors receiving proper assistance.”[23]

The Ministry of Labor and Social Welfare holds primary responsibility for the needs of, and related services to, persons with disabilities through the National Committee for Disabled People and Elderly (NCDE), previously the National Committee for Disabled People, NCDP. The title and responsibilities changed slightly in September 2013.[24]. . Due to the large number of mine/ERW survivors with disabilities in Lao PDR, the Ministry of Health also worked extensively on victim assistance and rehabilitation in coordination with international NGOs. The NRA acknowledged the need for a strong national disability framework that is inclusive of victim assistance.[25]

Lao PDR reported on victim assistance in 2013 in its Convention on Cluster Munitions Article 7 report, made statements on victim assistance at the Meeting of States Parties to the Convention on Cluster Munitions in Lusaka in September 2013 and also at the Parties Convention’s intersessional meetings in Geneva in April 2014 and the Meeting of States San Jose in September2014.[26]

Inclusion and participation in victim assistance

Survivors, persons with disabilities and their representative organizations participated in TWGVA meetings and in the implementation of services. Representatives of the Lao Disabled People Association, Lao Ban Advocates, Lao Disabled Women’s Development Center and Quality of life Association actively participated in consultative processes and special events including annual review meetings and ERW sector-wide working group meetings.[27]

Lao PDR has not included a survivor on its delegation at the Convention on Cluster Munitions Meetings of States Parties or intersessional meetings.

Service accessibility and effectiveness

Victim assistance activities[28]

Emergency and continuing medical care

There was a continuing lack of access to health services in services in Lao PDR. The health care system remained underdeveloped and under-funded; health workers had inadequate skill levels. This directly contributed to shortfalls in the quality of services across the health system.[29]

The availability of emergency care and continuing medical care increased in 2013. World Education and QLA supported survivors with direct funding of services for individual survivors by administering the United States (US) financed War Victims Medical Fund. World Education, Association for Aid and Relief Japan and Catholic Relief Services provided first aid training for healthcare workers and village health volunteers. In 2013, the NRA, Ministry of Health, international NGOs and organizations that have provided training for village health volunteers in the past, met and started discussions on developing the first National First Aid Curriculum.[30]

Physical rehabilitation including prosthetics

Rehabilitation services continued to be provided by COPE on a similar scale to the previous year, however there was a focus to local capacity building with slightly increased outreach services. Financial and technical support continued for the five government-managed rehabilitation centers in the country as did the “COPE Connect,” its outreach and community awareness raising project. COPE reported that prosthetic devices were distributed to 845 people. Out of this number, 233 patients were ERW accident survivors and of those, 10% were new patients.[31]

COPE covered all the necessary costs for those receiving treatment. However many survivors were not aware of, or unable to reach, the available services. COPE continued “COPE Connect,” its outreach and community awareness raising. In 2013, COPE Connect teams visited 22 districts in 5 provinces, all together visiting 71 districts of 11 provinces since the project started in 2009. It established networks with provincial health departments, district health offices, district hospitals, and village and community health workers, and trained local professionals in identification and referral. Clinical assessment teams also travelled to remote and rural areas and referred people with disabilities to appropriate services.[32]

Production decreased at the wheelchair and tricycle workshop at the government-managed Centre for Medical Rehabilitation in 2013 compared to 2012.[33]

Monitoring visits and assessments of the quality of services at three government-managed prosthetic and rehabilitation centers (Vientiane, Xieng Khuang, and Pakse) were conducted by the ICRC SFD in 2013 finding improved quality compared to previous years. ICRC SFD continued to support the development of local capacity within the national rehabilitation service through training programs. It also provided for the costs of prostheses fitting form destitute persons with disabilities, most from ERW contaminated areas and minority ethnic areas[34]

Economic and social inclusion and psychological support

Psychological support was generally not available to survivors. QLA provided peer support in conjunction with other project activities in Xieng Khouang province. Volunteers for the HI Ban Advocates Project also extended their provision of peer support for survivors.[35]

Laws and policies

The decree on the Rights of Persons with Disabilities, which had been prepared at the beginning of 2008, was submitted to the Ministry of Justice in July 2012 and passed to the Cabinet in November 2012, was finally approved and adopted on 18 April 2014. The Decree on 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.[36]

Regulations promulgated by the Ministry of Labor and Social Welfare and the Lao National Commission for Persons with Disabilities protect persons with disabilities against discrimination; however, the regulations lacked the force of law. The Ministry of Labor and Social Welfare established regulations regarding physical accessibility, and some ramps were built in Vientiane. Legislation adopted in 2009 requires that the construction of buildings, roads, and public places provide facilities for persons with disabilities. The law does not mandate accessibility to buildings built before its enactment. Some progress was made on physical accessibility; however, a lack of resources for infrastructure slowed the retrofitting of most buildings and limited government staffing prevented effective implementation.[37]

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