The signing of the Convention on the Prohibition of the Use, Stockpiling, Production and Transfer of Anti-Personnel Mines and on their Destruction in December 1997 catalysed the creation of a political momentum around the issue of landmines.
This created an opportunity to promote the public health approach to victim assistance, starting with assistance to mine victims. The small percentage of victims due to landmines however (0.3% of the disease burden), as compared with other causes of injury and trauma (such as violence and road traffic accidents) made it imperative to shift from a focus on mine victims to a more comprehensive victim assistance approach that does not discriminate between different sources of injury and trauma.
WHO, in conjunction with the ICRC, stimulated the endorsement of a concerted public health strategy regarding mine victim assistance within the international agenda. The Joint ICRC-WHO Strategy for the Prevention, Care and Rehabilitation of Victims of Landmines emphasised the need to carry out an integrated, non-discriminatory approach to victim assistance and provided the framework for policymaking and programming. The framework allows policymakers to design a comprehensive national plan of action that incorporates victims of all types of trauma, identifies priorities, and presents a holistic plan that emphasises existing strengths and overcomes gaps and duplications.
Victim assistance emphasises capacity-building for the implementation of sustainable support to victims. It promotes a new humanitarian vision that focuses on long-term action and effective, transparent partnership, based on the needs of victims, and the co-ordination of all relevant actors and programmes.
Locally appropriate victim assistance, through the promotion of violence prevention, psychosocial rehabilitation and social reintegration, represents a first step in the community healing process. A comprehensive understanding of the factors that lead to violence and the availability of resources victims can access to manage the health, social and environmental consequences provides an opportunity for social reintegration and elaboration of the trauma in a healthy manner. The community can thus prevent the resurgence of violent attitudes and behaviour, and start working towards a peace-building process.
Progress achieved in the field of victim assistance needs to be consolidated and expanded within a broader human security context. The promotion of human security offers a framework to plan and implement interventions for the improvement of community security, and to approach non-intentional injuries, suicide, violence and crime from a health promotion and prevention perspective. Such an approach recognises that many security issues share the same risk factors, such as drugs, alcohol abuse and small arms, and it is advantageous to consider such risks in a global manner to promote the efficacy and efficiency of interventions. Furthermore, a same organisation, such as a municipality, is concerned by an ensemble of security concerns. It thus becomes more efficient to approach such an institution with a comprehensive issue of security rather than with piecemeal concerns. A global vision of human security allows for a shared understanding between different disciplines and sectors, and contributes to the development of global initiatives that aim to not only reduce a distinct concern, but also aims to promote the deeper issue of population security.
WHO/PVI proposes to build a network of expertise at the national level, composed of community actors, NGOs, academicians from the university, and the government and thus facilitate the development of culturally appropriate, sustainable approaches to victim assistance within a human security framework. Local experience, supplemented by lessons learned from other humanitarian contexts, can contribute to the design of appropriate training initiatives for all sectors concerned.
The following provides an overview of the translation of victim assistance into country action:
From Ottawa to Maputo
The signing of the Convention on the Prohibition of the Use, Stockpiling, Production and Transfer of Anti-Personnel Mines and on their Destruction in December 1997 catalysed the creation of a political momentum around the issue of landmines. WHO, in conjunction with the ICRC, stimulated the endorsement of a concerted public health strategy regarding mine victim assistance within the international agenda:
The Treaty Signing Conference in Ottawa on December 1997 represented the first official WHO involvement in the landmine arena.
Immediate steps were taken following the Conference at the WHO political and technical levels. WHO developed, in consultation with the ICRC, a Plan of action on a concerted public health response to anti-personnel mines.
As a follow-up to these consultations, a WHO resolution (EB 101.R23) “Concerted public health action on anti-personnel mines” was approved by the Executive Board at its 101st session and later endorsed at the Fifty-first World Health Assembly (Resolution WHA 51.8) on May 1998.
WHO and the ICRC collaborated to outline key principles in mine victim assistance. The Joint ICRC-WHO Strategy for the Prevention, Care and Rehabilitation of Victims of Landmines emphasised the need to carry out an integrated, non-discriminatory approach to victim assistance and provided the framework for policymaking and programming.
Following discussions with the Swiss Representatives at a donor meeting on demining and victim assistance in Ottawa on March 1998, the Swiss government, based on the ICRC-WHO Strategy and with the technical assistance of the WHO, the ICRC and UNICEF, elaborated the Bern Manifesto, which emphasised equity in access to services, sustainability, and country ownership.
The WHO Interregional Workshop on Landmine Victim Assistance at Kampala strongly endorsed the principles included in the Bern Manifesto and in the ICRC-WHO Strategy. The workshop brought the Ottawa Process to affected states, to the people and to the health sector, as it provided the opportunity for representatives from the Ministries of Health and the WHO Country Offices of the States present to work together with members of ICRC; UNICEF, ICBL and Handicap International in the elaboration of a framework on mine victim assistance. The meeting paved the way for national health policy aiming at victim assistance through capacity-building and strengthening of the health sector.
In this way, the “bottom-up process” was initiated, giving voice to the countries and providing them with the means and tools to manage country needs and thus further ensure sustainability.
In view of the venue of the First Conference of State Parties to the Convention on the Prohibition of the Use, Stockpiling, Production and Transfer of Anti-Personnel Mines and on their Destruction, further steps were taken by WHO/HQ, jointly with the Swiss and the Mozambican governments, to translate into action the principles elaborated in Kampala. Following several meetings in Maputo with Ministries concerned as well as with representatives of donor countries and NGOs, they developed a Strategic Framework for Planning Integrated Mine Victim Assistance Programmes, and demonstrated its applicability through the elaboration of a national Mozambican plan of action on victim assistance.
The presentation of the Strategic Framework by Switzerland at the Conference, and the incorporation of the principle of integrated public health action into the Maputo Declaration constituted a key step in the progress towards its adoption at a national level and towards national ownership that would ensure long-term sustainability of action.
Intersessional Process: From Maputo To Geneva 2000
Five expert committees were established as part of the intersessional process from Maputo to the September 2000 Geneva Meeting of State Parties. The Standing Committee of Experts focusing on landmine victim assistance holds Switzerland and Mexico as chairs and Japan and Nicaragua as rapporteurs. The committee offers a potential mechanism to maintain transparency of donor contributions and international development projects.
The venue is used to monitor the implementation of the Convention at the country level and to allow government, multilateral and non-governmental actors to co-ordinate action for the promotion of national victim assistance programming and policymaking. The participants aim to establish a basis for the development of a portfolio of collaborative, sustainable country plans that could be presented at the Second Meeting of State Parties to the Convention.
A regional approach has been adopted, whereby one country represents each region: Nicaragua, Cambodia, Mozambique, and Bosnia-Herzegovina. Government representatives and non-governmental counterparts at the country level present the status of country plans and outlined the key areas requiring technical and financial assistance from donors and technical agencies.
Consolidation of achievements on victim assistance
Following the collaboration established with the African and American regions, and the first meeting of the Standing Committee of Experts, the WHO aims to present a portfolio of consolidated achievements based on the ICRC/WHO policy agenda to the Second Meeting of State Parties at Geneva in September 2000. The Second Meeting of State Parties represents a key arena to present coherent, comprehensive country victim assistance plans to donors. Countries have the opportunity to discuss their plans and co-ordinate, with the technical assistance of agencies such as WHO, a series of donor countries around their plan of action.
Towards this goal, a regional process has been initiated:
- African Region: Three countries as reference programmes: Burundi, Mozambique and Uganda. The Mozambican government has fully endorsed the plan already.
- Region of the Americas: Nicaragua and additional Central American countries are in the process of being selected.
- Asia and the Western Pacific Regions: Collaboration with WPRO/SEARO should commence. Vietnam, Laos, Cambodia, Thailand and Sri Lanka are the countries considered.
- Eastern European Region:Bosnia and Kosovo have been selected to receive intensified support for the elaboration of strategic plans
WHO Country-based Process
AFRO: The African Region
On the occasion of a Maputo follow-up PVI/AFRO meeting in Harare in May 1997, Dr. Samba, Regional Director for the WHO Regional Office for Africa, established a Regional Working Group to elaborate a concerted public health response to landmine victim assistance for the African region.This group worked closely with the WHO/PVI/HQ to identify 3 countries for intensified assistance according to the following criteria: magnitude of the problem, commitment at the highest government level, security, an ongoing program, and English, French or Portuguese speaking (in order to facilitate the expertise and documentation in the 3 languages of the Regional Office). The three countries (Mozambique, Uganda, Burundi) were selected from those participating in the Kampala Process, thus providing a continuum from the elaboration of principles regarding victim assistance to the planning and implementation of country-level action.
HQ/AFRO Country Planning Meeting: Harare, August 1999
Within the purview of translating established principles of mine victims assistance into action, a Technical PVI/AFRO Meeting was organised at Harare on August 16-18, 1999 to further the agenda within the African region. The meeting aimed to support an integrated public health approach to landmine victim assistance in Mozambique, Burundi and Uganda through the elaboration of country plans of action and the mobilisation of technical, financial and political resources.
It was decided to present a regional, country-based approach at the Standing Committee of Experts of the Ottawa Process, that would reflect country needs and allow donors to visualise opportunities to become involved in the victim assistance process. The desire was noted to replicate the Harare process in other regions and promote the presentation of plans for each region within the intersessional arena.
A tool was presented to promote country-level coherency in action and to allow countries to present a comprehensive plan to potential donors, particularly through the intersessional process.
AMRO/PAHO: The Region of the Americas
PAHO began to implement in January 1999 a tripartite agreement with the governments of Canada and Mexico to collaborate with the Central American countries to achieve an integral approach for the rehabilitation of landmine survivors.
A joint planning process was initiated between WHO headquarters and PAHO to launch co-ordinated victim assistance in the Central American region. The preliminary planning involved four countries: Nicaragua, El Salvador, Guatemala, and Honduras. A first formal planning meeting with Nicaragua will take place in March 2000 to develop a national plan of action. The victim assistance programming process in Central America will be accompanied by a WHO headquarters-PAHO consultation on public health and human security.
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 International Campaign to Ban Landmines, a coalition of non-governmental organizations involved in the monitoring process of the mine ban treaty.