IMPLEMENTATION OF THE WHO PLAN OF ACTION ON A CONCERTED
PUBLIC HEALTH RESPONSE TO ANTI-PERSONNEL MINES
SHORT UPDATE AND ACTIVITIES PLANNED FOR 1999
February 1999
1. General considerations
In May 1998 the 51st World Health Assembly endorsed the WHO Plan
of Action on a Concerted Public Health Response to Anti-Personnel Mines,
developed by the Violence and Injury Prevention Unit. This plan has three main
components:
Surveillance and Information
Pre-Hospital and Hospital Care Management
Physical and Psychosocial Rehabilitation
2. Priority objective one of the Plan of Action: Surveillance and
Information
Objective:
To strengthen the surveillance capability of national health systems to
assess the severity of the problem through the collection of data on mortality,
morbidity and disability as well as the response capacity through the collection
of data on level of health care facilities, capacity, organization, equipment,
staff, etc.
Background:
Data on landmine-related injuries and disability are difficult to collect
because the regions most affected by landmines are generally among the poorest
and most inaccessible, and are sometimes still at war. Current statistics on
landmine-related injuries are often based on extrapolations from partial survey
information. Better understanding the magnitude of landmine-related injuries is
crucial for the development of appropriate interventions, impact evaluation, and
optimal use of resources.
Implemented activities:
28-30 September 1998:
In order to initiate a process of consultation/involvement of Ministries of
Health in countries, WHO convened the First Inter-Regional Workshop on a
Concerted Public Health Response to Anti-Personnel Mines, in Kampala, Uganda,
28-30 September 1998.
During country presentations, it clearly appeared that surveillance systems
documenting the number of landmine victims are lacking. Ministries of Health
asked WHO for technical assistance to develop such systems.
21-22 January 1999:
In order to respond to recommendations made in Kampala providing countries
with a data collection strategy and tools to better document the incidence of
fatal and non-fatal landmine-related injuries, WHO has convened a technical
meeting involving the representatives of the International Committee of the
Red Cross, the International Campaign to Ban Landmines (represented by
Physicians for Human Rights), the Injury Control Centre - Uganda and the London
School of Hygiene and Tropical Medicine.
Objectives of the meeting were:
To initiate a group of experts representing several institutions involved in
data collection on landmine-related injuries
To review existing tools and strategies for data collection
Based on the review carried out, to develop a data collection tool to
document the incidence of fatal and non-fatal landmine-related injuries.
To discuss a common and integrated strategy for data collection on the
incidence of landmine-related injuries.
Outcome:
Two instruments were agreed upon:
1. Minimal recommended data set for surveillance on landmine-related
injuries: a tool for surveillance that will allow data collection on the
number of victims and the following data elements: demographics, activity at
time of injury, place of occurrence (location and type of area), arrival
sequence, type of device, result of injury, clinical characteristics,
disposition and outcome.
2. Minimal recommended data set for surveys to capture information on
victims of fatal and non-fatal landmine-related injuries:A tool
similar to the one for surveillance was developed to be used to capture
information on existing fatalities.
Activities planned for 1999:
Pilot testing of the surveillance instruments:
Based on the needs of countries and the availability of staff, pilot testing
of both tools was tentatively planned to occur, in the first half of 1999.
Implementation of surveillance systems. Once data collection
instruments have been finalized, data collection systems will be implemented in
the 10 countries that participated in the Kampala meeting. All have expressed
interest in developing surveillance systems. This part of the project will
start in August 1999. Surveillance systems will be set up gradually during the
period between August and December.
Dissemination of the data: data that was collected will be
disseminated in order to be used by Governments, UN agencies and NGOs for
adequate planning of service response to mine victim assistance.
3. Priority objective two: Emergency and post-emergency care
management
Objective:
To cooperate with Ministries of Health of affected states and, jointly with
ICRC disseminate and/or develop standards for strengthening the capacity of
health care services in emergency and post-emergency care management, with due
attention to laboratory and blood bank services needs.
Background:
The most critical moments for a person who has sustained a mine injury are
the first hours immediately after the injury. A considerable percentage of mine
victims die before reaching the hospital or health centre. This is mainly due
to the fact that the access to a health centre in the surrounding area is
lacking. In several rural areas it can take more than six hours to reach a first
aid centre. Therefore the care of a mine victim must start at the site of the
injury. The first persons that will care for the victim are villagers and
community members. In some cases a Community Health Worker (CHW) with basic
health care training might be available. The community has the responsibility to
get access to the victim and assist him/her. This requires, inter alia,
the knowledge about how to enter the minefield. The time saved could make the
difference between life and death of a mine victim.
Implemented activities:
28-30 September 1998:
The First WHO Inter-Regional Workshop on a Concerted Public Health response
to Anti-Personnel Mines, held in Kampala, Uganda, in September 1998, emphasized
the need to conduct training on pre-hospital care in most of the participating
countries.
Activities planned for 1999:
The "First Tromso Workshop on Prehospital Management of Mine
Injuries",organized by the Trauma Care Foundation, Tromso
University and WHO will be held on the 15-20 March 1999.
Main objectives:
to bring together all the trainers from the different countries where the
pre-hospital care training programmes have been implemented for some years to
exchange experiences and discuss the immediate life saving procedures for mine
victims (A Village University @ training model);
to make recommendations for the further development and improvement of
local life-saving projects for mine victims
to develop pre-hospital training guidelines adapted to the different
country realities.
A three folded training course
Training of trainers (Sudan, June 1999)
training at district hospital level(date to be decided)
training of trainersand training of villagers (date to be
decided)
Participants shall include all the African countries that participated in the
Kampala workshop: Angola, Burundi, Djibouti, Eritrea, Ethiopia, Mozambique,
Rwanda, Somalia, Sudan and Uganda.
The same type of training will be carried out in other regions, once
completed in the African region.
Priority Objective three: Physical and Psychosocial Rehabilitation
Objective:
To develop national standards and comprehensive programmes for physical and
psychosocial rehabilitation of landmine victims within the frame of
community-based rehabilitation programmes in order to ensure complete
integration of persons with disabilities within the community. To assure the
provision of prosthetic and other assistive devices, including maintenance and
repair. To promote decentralization of rehabilitation services through primary
health care, supported by an appropriate referral system.
Background:
The main challenge of direct mine victim assistance is how to transform an
injured person in a minefield into a fully integrated and productive citizen of
his or her society. Several steps need to be undertaken in order that this
challenge is successfully met. These start with the evacuation and transport of
the wounded, first aid, adequate surgery, and safe blood for transfusion.
Whenever the victim is an amputee, he/she will require the fitting of a
prosthesis and psychological and social support. The successful accomplishment
of all these different tasks will depend upon a well functioning health and
social service system.
Implementation strategy:
In order to provide a concerted WHO response to Resolution WHA 51.8,
endorsing the plan of action, the Violence and Injury Prevention Team has joined
efforts with the Disability and Rehabilitation team and the Nations for Mental
Health team. The three teams will secure mutual programme delivery at country
level.
Implemented activities:
§28-30 September 1998:
The First WHO Inter-Regional Workshop on a Concerted Public Health response
to Anti-Personnel Mines, held in Kampala, Uganda, in September 1998, emphasized
the need to conduct integrated rehabilitation activities in most of the
participating countries.
Discussions have been held with the Italian NGO "Emergency" to develop
collaboration in the area of physical and psychosocial rehabilitation.
Activities planned for 1999:
A community based approach to rehabilitation of landmine victims
Aim:
To develop, within a Community Based Rehabilitation/Primary Health Care
framework, strategies for provision of rehabilitation services to landmine
victims, including the assessment of psychosocial needs of landmine victims.
Outcomes:
Increased awareness among governments and donors about the need for creating
a continuum in rehabilitation services, from the conflict period to the
long-term reconstruction;
Increased awareness about the need for decentralisation of rehabilitation
services and for increased community participation;
Support for coordinated and integrated responses by the international
community for rehabilitation intervention in conflict and post-conflict
situations.
Increased awareness on the psychosocial needs of a landmine victim in order
that he/she becomes a fully integrated member of the society.
Time frame and countries:
Three years
Assessments carried out in Eritrea, Mozambique, Rwanda, South Africa,
Uganda, Zimbabwe and Afghanistan.
Implementation in the first year in Iraq, Somalia and Vietnam
About Us
Our Research Products