Challenges and Opportunities in Mine Action Victim Assistance

Executive Summary

Landmines and explosive remnants of war continue to claim thousands of victims annually, creating lifelong challenges that extend far beyond initial trauma. In 2022 alone, 4,710 people were killed or injured by these weapons, with civilians accounting for 85% of casualties. Each survivor's journey reveals the complex, intergenerational impact of explosive ordnance contamination on communities and healthcare systems.

Mine Action's comprehensive response framework operates through five essential pillars: Clearance, Risk Education, Victim Assistance, Advocacy, and Stockpile Destruction.

Among these, Victim Assistance represents a unique challenge, requiring sustained, long-term commitment to support survivors throughout their lives. Current funding meets only a fraction of the need, with Victim Assistance receiving just 4% of total Mine Action funding in 2021, despite the extensive costs of prosthetics, rehabilitation, and ongoing care.

The landscape of Victim Assistance is evolving rapidly. Traditional challenges of accessibility, resource sustainability, and technical capacity are being met with innovative solutions. Mobile prosthetic units are bringing care directly to remote communities, while emerging technologies like 3D printing are reducing costs and improving service delivery. However, significant gaps remain, particularly in coordinating care across different regions and ensuring consistent long-term support for survivors.

This analysis examines both persistent challenges and promising opportunities in Mine Action Victim Assistance. By understanding the complex interplay between funding constraints, technological innovation, and service delivery models, we can work toward more effective and sustainable support systems for survivors. Our findings suggest that success requires not only increased resources but also fundamental shifts in how we approach program design, implementation, and coordination.

Key recommendations include:

·       Integrating Victim Assistance more closely with national healthcare systems

·       Adopting hybrid service delivery models combining fixed facilities with mobile units

·       Leveraging new technologies such as those incorporated in Mobile Amputee Support Units to improve both care quality and program efficiency

·       Developing innovative funding mechanisms to ensure sustainable long-term support

·       Strengthening data collection and coordination among stakeholders

By addressing these critical areas, the Mine Action community can better serve the needs of survivors while building more resilient and effective assistance programs for the future.

Introduction

When a landmine survivor in rural Cambodia received her first prosthetic limb in 1995, she faced a lifelong journey of rehabilitation, maintenance, and adaptation. Today, while the technology has advanced significantly, many survivors worldwide still struggle to access consistent, quality care. This reality underscores both the progress made and the considerable work that remains in Victim Assistance.

The story of Thaibah illustrates the importance of improving Victim Assistance and support for amputees in particular.

NGO Care International shared the story of Thaibah, a 16-year-old girl from Yemen, who in 2017 lost her leg after stepping on a landmine while tending to her family's goats. The explosion not only resulted in the loss of her leg but also inflicted severe injuries on her other leg, necessitating multiple surgeries. Her family, already facing financial hardships, sold their land and livestock to afford a prosthetic limb costing approximately $925. Unfortunately, the prosthesis was ill-fitting, causing infections and rendering it unusable.

The ongoing conflict in Yemen further complicated access to consistent medical care and rehabilitation services. Despite their efforts, Thaibah's family struggled to provide the necessary support for her recovery, leading to feelings of being a burden and diminishing hopes for her future.

Victim Assistance should encompass comprehensive support for survivors of landmine and ERW incidents, their families, and affected communities. This support includes emergency and ongoing medical care, physical rehabilitation, psychological support, socioeconomic reintegration, and advocacy for survivors' rights.

The Global Scale of Need

Current Impact

The scope of Mine Action Victim Assistance extends across multiple dimensions. According to the Landmine Monitor 2023, in 2022, at least 4,710 people were killed or injured by landmines and explosive remnants of war, with civilians accounting for 85% of these casualties, though this figure likely understates the true scale as many incidents in remote areas go unreported. The impact ripples through families and communities, affecting hundreds of thousands of people who depend on or care for survivors.

Victim Assistance programs need to operate globally. Where the national healthcare capacity has been overwhelmed, International Non-Governmental Organisations (INGOs) seek to establish Mine Action Victim Assistance programmes.

According to International Campaign to Ban Landmines (ICBL) and Landmine Monitor Reports these currently are in effect in Afghanistan, Cambodia, Angola, Colombia, Vietnam, Laos, Iraq, Syria, Ukraine, Sudan and South Sudan, Bosnia and Herzegovina, Mozambique, Somalia, Sri Lanka, Chad, Ethiopia, Yemen and Zimbabwe. These countries are not the only ordnance contaminated nations, but face some of the most extreme EO contamination and therefore VA needs, with each nation and region requiring context-specific solutions that account for local resources, culture, and infrastructure.

Aside from the scale of donor engagement in Victim Assistance, there are challenges. Donors prioritising VA are often not the same donors engaged in other pillars of Mine Action. This may lead to disjointed funding undermining coordination in MA programming, as conflicting donor requirements cause different MA effects to be carried out in geographically different areas.

To better improve programme, Mine Action specialists would need to diversify their responses, including VA as a component of a strategic holistic Mine Action response, and coordinating donor proposals to invite typically MA clearance donors to absorb VA funding into the MA response, or to link VA proposals to other donors with Clearance and EORE proposals for separate donors. The individual components of these strategic responses may appear less attractive prospects as their outputs would be compromised by planned cooperation with other MA responses, and donors would need to take into account the total effect achieved by more coordinated funding efforts.

Resource Requirements

The financial scale of Victim Assistance is substantial. Individual care packages vary significantly:

• Initial medical care and basic rehabilitation typically costs between $1,000 and $5,000 per survivor

• Comprehensive long-term support often exceeds $20,000 per person

• Prosthetic devices, ranging from $300 to $3,000, require replacement every few years

• Annual maintenance costs average $300 to $1,000

• Socioeconomic reintegration programs require $1,000 to $3,000 per beneficiary

When aggregated globally, these costs reach hundreds of millions of dollars annually. However, current funding meets only a fraction of the need, with the International Campaign to Ban Landmines reporting that in 2021, Victim Assistance received just 4% of total Mine Action funding.

Ongoing Challenges

Resource Sustainability

Unlike Mine Action land release operations with definable endpoints, Victim Assistance requires long-term, sustained support. A survivor injured at age 20 might need assistance for 50 years or more. Children require new prosthetics as they grow and this support is vital for them to be join in with their friends during their developmental years. This ongoing requirement creates particular funding challenges as donor interest often wanes over time, especially in protracted post-conflict situations.

Consider the case of a young survivor in Angola:

Sapalo, a 14-year-old boy from Luena, illustrates the struggles faced by landmine survivors in Angola. After losing both legs in an explosion, Sapalo's family, subsistence farmers with limited means, found it challenging to afford his medical care. The underfunded hospital required families to purchase even basic necessities like blood for transfusions. Without adequate support, Sapalo's prospects for obtaining prosthetic limbs and accessing education were bleak, highlighting the systemic issues in providing sustained assistance to survivors[1].While initial emergency care funding was readily available, securing consistent support for prosthetic replacements and rehabilitation has proved increasingly difficult over the years. This pattern repeats across many affected regions, where initial care is strong but long-term support falters.

Access and Infrastructure

Many mine/ERW incidents occur in remote areas with limited infrastructure, creating significant service delivery challenges. According to Action on Armed Violence, in Mozambique, many survivors live in regions where essential services are scarce. Traveling to provincial capitals for treatment can mean journeys of 200 to 400 kilometers, posing substantial obstacles to receiving timely and adequate care. Long journey sto acces care result in not only the physical demands of travel but also substantial costs and potential security risks. These barriers often result in delayed or foregone care, compromising recovery outcomes for individuals and preventing or delaying wider societal conflict recovery.

Technical Capacity

The specialized nature of mine/ERW injury treatment requires specific expertise often scarce in affected regions, with an already low capacity further degraded by the effects of armed conflict. Conflicts lead to resource depletion, increased workloads, and unsafe environments, prompting HCWs to flee. In Syria, 50% of health workers and 95% of physicians in Aleppo have left the country since 2011[2]. From emergency trauma care to prosthetic fitting and psychological support, the technical demands are high. Training and retaining qualified professionals presents an ongoing challenge, particularly in remote or conflict-affected areas.

Data and Coordination

Effective assistance requires accurate data about survivors, their needs, and available services. International Mine Action Standards provide an excellent framework for information management[3] for Clearance and EORE operations, However, privacy concerns, limited technology infrastructure, and poor coordination between service providers often result in fragmented, duplicated or incomplete information. This hampers planning and resource allocation while making it difficult to demonstrate program impact to donors.

Emerging Opportunities

Technological Innovation

Recent advances offer promising solutions to longstanding challenges:

• Remouldable sockets

• Circular economy concepts in prosthetic product design and the creation of a service model

• 3D printing may enable local production of custom prosthetics at reduced costs

• Telemedicine platforms connect remote survivors with specialists

• Smart prosthetics with embedded sensors provide data for proactive maintenance

• Digital health records improve continuity of care

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Mobile Service Delivery

The Mobile Amputee Support Units (MASU) model used by the Restoring Hope programme in Gaza is illustrative of how innovative approach can transform service delivery. These units currently operating in the Jordanian field hospital aim to bring specialized care directly to affected communities, dramatically reducing travel barriers while maintaining high-quality standards. The success of MASU in Gaza shows how mobility and technology can combine to overcome traditional access challenges.

Integration with National Systems

Growing recognition of the importance of integrating Victim Assistance into national health and disability services offers several advantages:

• Enhanced sustainability through existing systems

• More comprehensive care beyond mine/ERW-specific needs

• Improved resource leverage from national health programs

• Better coordination of services

Capacity Building Through Technology

Digital platforms create new opportunities for professional development and training. Virtual reality systems provide hands-on experience in prosthetic fitting, while online learning programs help maintain and upgrade healthcare workers' skills in remote areas. These tools can help build and maintain technical capacity more efficiently than traditional training methods.

The Path Forward

Innovative Funding Approaches

New funding mechanisms could help ensure more sustainable resource flows:

• Results-based financing tied to specific outcomes

• Social impact bonds engaging private sector investment

• Integration with broader development funding

• Community-based funding models

Enhanced Data Systems

Improved data collection and management systems could transform program effectiveness:

• Blockchain technology for secure, transparent record-keeping

• Standardized reporting mechanisms across providers

• Real-time monitoring and evaluation systems

• Improved coordination between stakeholders

Hybrid Service Models

Combining traditional facilities with mobile units and telemedicine creates more comprehensive coverage:

• Fixed centres for complex cases and specialized care

• Mobile units for routine maintenance and basic services

• Telemedicine for remote consultation and monitoring

• Community-based support networks

Community Engagement

Strengthening local involvement enhances program sustainability:

• Training community health workers

• Developing peer support networks

• Building local capacity for basic maintenance

• Engaging survivors in program design and implementation

Conclusion

The future of Mine Action Victim Assistance lies at the intersection of humanitarian commitment and technological innovation. While the challenges of providing comprehensive, lifelong care to survivors remain substantial, emerging solutions offer unprecedented opportunities to transform service delivery and improve outcomes. The integration of mobile units, telemedicine, remouldable prosthetic sockets demonstrates how innovation can extend the reach of limited resources.

However, technology alone cannot address the fundamental need for sustained funding and coordinated support. Success requires a multilayered approach: strengthening national healthcare systems, fostering local expertise, embracing technological advances, and developing sustainable funding mechanisms. Most critically, we must ensure that survivors' voices and experiences guide program development, recognizing that each individual's journey extends beyond physical rehabilitation to encompass psychological healing and social reintegration.

By combining proven methodologies with innovative approaches, while maintaining unwavering focus on survivors' needs, the Mine Action community can build more resilient and effective assistance programs. The path forward demands not only financial investment but also a renewed commitment to collaboration across sectors, borders, and disciplines. Through such coordinated effort, we can work toward a future where every survivor has access to the comprehensive, dignified care they need—not just for immediate recovery, but for lifelong wellbeing.