Violence and Injury Prevention Unit (PVI)
IMPLEMENTATION OF THE WHO PLAN OF ACTION ON A CONCERTED PUBLIC HEALTH RESPONSE TO ANTI-PERSONNEL MINES
SHORT UPDATE AND ACTIVITIES PLANNED FOR 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
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.
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.
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.
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
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.
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.
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.
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
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.
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.
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.
§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
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.
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:
Assessments carried out in Eritrea, Mozambique, Rwanda, South Africa, Uganda, Zimbabwe and Afghanistan.
Implementation in the first year in Iraq, Somalia and Vietnam