Mine Victims Needs Assessment and Assistance Coordination

by Aziz Aliyev and Rauf Mamedov [Azerbaijan National Agency for Mine Action] and Umud Mirzoyev and Siyab Mamedov [International Eurasia Press Fund]

A UNICEF feasibility study conducted in early 2001 showed that medical and surgical facilities in Azerbaijan are adequate to meet the immediate needs of mine survivors. In general, physical-rehabilitation facilities are also considered suitable; however, the lack of psychosocial support to assist mine survivors with a disability is of particular concern. The study concluded that an integrated and comprehensive assistance program could not be established for the mine victims of Azerbaijan until a needs assessment was completed. In response, Azerbaijan planned and conducted a national survey to assess mine victims' needs, including prosthetic, social and economic needs, as a first step to developing national mine-victim-assistance priorities and programs. The results of the assessment are discussed in this article.

In January 2001, UNICEF Mine Action Coordinator Tehnaz Dastoor conducted a national mine-action feasibility study in Azerbaijan, which highlighted the need for comprehensive mine victim assistance. Since then, the Azerbaijan National Agency for Mine Action has been developing mine-victim assistance and implementing MVA-related activities. ANAMA's strategy involves combining the efforts of national and international organizations in assisting disabled people, as well as in developing and implementing a long-term MVA strategy for Azerbaijan. The Countrywide Mine/UXO Victim Needs Assessment Survey project was developed in 2003 and implemented in 2004 to collect the data necessary to address MVA needs in Azerbaijan.

The MVA Assessment Survey's objectives included establishing an extensive database, developing a well-articulated strategy and creating an effective network of relevant stakeholders in MVA. This survey was an integral part of the overall project entitled "Support to Azerbaijan Mine Action Programme,"1 which was funded by the European Commission. An MVA working group was established to complete the project planning, development and fundraising phases. The working group consists of representatives of relevant ministries, governmental agencies, and national and international nongovernmental organizations.

The working group thoroughly discussed project-related issues and predefined partner organizations for the implementation phase. These discussions also encouraged ANAMA to conduct a pilot survey in the Fizuli district. The results became part of the data of MVA Assessment Survey. The working group will continue coordinating future activities based on the needs-assessment survey results.

The International Eurasia Press Fund was chosen to administer and lead the survey as this nongovernmental organization had experience gained from conducting two previous surveys in Azerbaijan. Representatives of three other NGOs actively taking part in the MVA working group—Dirchelish, Shefali Eller and Babadagh—were also involved in this survey.

The Ministries of Defense and Domestic Affairs supplemented preliminary information on mine/unexploded ordnance casualties in addition to data from ANAMA's Information Management System for Mine Action database. The local branches and local authorities of the Republic Military Commissariat also provided information on mine/UXO survivors. The Ministry of Health and the Ministry of Labor and Social Protection of Population actively facilitated arrangements related to the survey.

Image 1
During the needs assessment interview. Photo courtesy of IEPF/ANAMA

IMSMA and an MVA Assessment Add-on

Data on almost 2,300 survivors was extracted from about 70 different source lists. The most comprehensive list was from the ANAMA IMSMA database, although much of this information was already outdated. Unfortunately, media announcements failed to attract participants who could offer additional information about mine/UXO victims.

In addition to information gathered to complete the standard IMSMA form, which is mainly focused on details of each incident and emergency medical care provided, an MVA Assessment Survey questionnaire gathered comprehensive information on the needs of survivors for medical and psychosocial care, physical and vocational rehabilitation, economic assistance and advocacy, as well as for education, training and sports.

Consequently, the incident details and needs of 1,883 mine survivors were entered into both the standard IMSMA incident casualty report and another relational Microsoft® Access database for the additional comprehensive questionnaire data. This new database consisted of seven tables for medical care, physical rehabilitation, social adaptation, economic assistance, professional rehabilitation, education and sport needs, and additional information, which mainly reflects economic status of the survivor. The data was prepared as tables and charts, which were analyzed and commented on. This Access add-on database is related to the various tables in the IMSMA database and further relations can be added if necessary.

Technical assistance was provided for the MVA Assessment Survey to develop the special Access add-on to IMSMA, ensure accurate data entry, check quality, and extensively review and analyze the data. Together with the information already stored by IMSMA about devices, general survey victim data and impact data from the Landmine Impact Survey, this add-on included multiple references of the newly gathered victim data and identified needs. A special Geographic Information System function was introduced to allow the team to present all the data according to geospatial distribution as well.

Figure 1
Some screen shots of the MVA needs-assessment-survey database, in the form of an add-on to IMSMA. Click image to view full version. Graphic courtesy of ANAMA

Capacity Developed

As a result of the project being implemented, 15 people were trained in survey procedures and interviewing techniques; 10 of them gained wide experience in the practical application of this knowledge. Seven people learned the data-entry process, having been introduced to it through IMSMA and Microsoft Access. Shamil Yagizarov, ANAMA Mine Information System Supervisor, developed various themes with IMSMA's Geographic Information System function to represent the spatial data. Extensive expertise was attained in multi-criterion data analyses as well by finding patterns, correlations and conclusions from the responses to the different survey questions. Some results of the Countrywide Mine/UXO Victim Needs Assessment Survey are presented below.

MVA Assessment Survey Results

Medical care. Surgical intervention needs were mentioned in 1,597 cases. Fragment extraction accounted for the greatest number of these interventions (544 cases). Some expressed a need for additional surgery, including 21 operations on residual limbs. Eighteen people emphasized their need for plastic surgery.

Medical treatment or consultation with specialists was also a predominant need. The need for a neuropathologist was mentioned by 1,552 people. A visit to a traumatologist was requested by 850 people.

While 802 people required the services of a general surgeon, just over one-seventh of this number—127 persons—actually needed surgical operations due to recent mine/UXO trauma. The rest were suffering from age-specific problems years after the incident as a result of growing older, such as body growth or shrinkage.

Many interviewees (1,607) answered the question of general health problems, allowing the researchers to record and elaborate on their needs in medical care accordingly. For example, 27 cases had been treated surgically and revealed that they needed the same surgical intervention repeatedly; 632 persons expressed their needs for other specialists. It became clear there is a need for nephrologists (kidney), ophthalmic (eye) surgeons and especially otologists (ear).

Physical rehabilitation needs: limbs. Total prosthetic needs were as follows:

Needs for prosthetic and assistive devices are outlined in Table 1.

Protheses Orthopedic Operations Orthopedic Products
Below knee 160 Replacement 213 Armchairs 69
Above knee 58 Repeat 198 Wheelchairs 129
Foot 14 Fitting 212 Crutches 355
Below elbow 18 Repair 49 Walking sticks 446
Above elbow 8
Hand 28

Table 1: Prosthetic and assistive devices needed.

Social adaptation. Forty-one people reported a loss of hearing, 10 of whom reported problems for both left and right sides. But only 23 of the 41 expressed their need for hearing-aid equipment, training in sign language and lip reading or additional technical means of communication. At the same time, there were many people with other losses and injuries also in need of adaptation due to hearing enervation from mine/UXO trauma.

The same situation occurred with eyesight adaptation; 132 people reported eyesight problems resulting from mine-related accidents. Of these, 111 people reported loss of eyesight. Forty-nine mine/UXO survivors totally lost vision in one eye and 20 lost all vision. Social adaptation for this category of disabled people requires specific training and equipment.

The social adaptation section of the questionnaire opened new prospects for related activities. Namely, 708 survivors indicated an interest in providing mine-risk education, 693 would have liked to participate in victim support groups, 625 offered to provide peer-support and 780 expressed a need to belong to an association for the disabled. These results reflect a great desire for such an association to help with social adaptation issues, and they should be kept in mind while developing mine-victim-related projects.

Economic assistance. This section of the questionnaire consisted of two distinct parts that could be named "support" and "assistance." The support area identified daily needs for help. The assistance area asked the question: "What would be of help for you to economically reintegrate into society?"

Answers also were twofold. A great majority (1,528) of the 1,819 who answered this section needed money for medical treatment. Many people (941) expressed a similar need for medications. Cars and housing were desired forms of assistance for 916 and 1,081 persons, respectively.

Help with starting a business was noted by 1,428 people who dreamed of running their own businesses and would have appreciated startup loans to make that possible. Raising livestock, plant husbandry2 and establishing small enterprises to meet local needs were the main types of businesses discussed. Land and raw materials, facilities and equipment, startup capital and specific training would be a great help for this category of mine/UXO survivors.

Professional rehabilitation needs. The survey section about professional rehabilitation needs contained more questions than any other single section in the questionnaire; 1,862 people answered questions in this section. Of these, 1,324 gave information about their previous professions: 343 persons had a profession that required a higher education; 442 persons had been manual laborers. Of the 1,862 surveyed, only 82 people who had jobs before the incident said they had jobs at the time of the survey.

There were 445 respondents who were currently employed at the time of the survey. The most common professions were drivers (29 respondents), farmers (26), policemen (24) and teachers (20). The rest of the 1,862 respondents were registered as disabled or on pension.

As the interviewees were mainly inhabitants of rural areas, livestock-raising and plant husbandry were the prominent professions respondents indicated they would like to do in the future if possible—839 and 570 persons respectively. In industrial professions, a preference of future employment was given to a driving profession (533 persons).

Image 2
Dilara Aliyeva, 62, was one of the mine victims interviewed during the survey. She stepped on a mine while grazing animals in a minefield laid by military actors and considered to be cleared. Photo courtesy of IEPF/ANAMA

Education and sports. In total, 1,787 people answered the education questions. Of the 739 respondents who wanted to take courses, the majority were interested in computer courses (433). Another 199 were eager to learn foreign languages and 107 considered accounting a good subject to study for a future. Finally, 208 persons expressed a desire to continue their education in universities.

Of those who answered the sport questions (1,837), table games were the most preferred (987) if proper rehabilitative care was received. Shooting a gun for sport and exercising at the gym were attractive respectively for 297 and 275 persons. Finally, there were some who, with the proper rehabilitative care, would have liked to participate in the Paralympic Games.

Degree of disability. The survey found that of the 1,753 respondents who answered the question, a total of 250 people had officially recognized first-degree disabilities; 973 people were classified as second-degree and 127 people had third-degree disabilities.3 There were also 403 people uncertain of their classification status: 257 people either had not received official recognition of a disability or had not yet been classified; 146 needed to change their classified disability degree4 to a higher one—90 from second to first, 53 from third to second and three whose degree change was still undetermined.

A total of 1,257 persons answered the question about pension receipt.5 Of them, 231 were first-degree, 882 were second-degree and 110 were third-degree disabilities. Another 34 people were receiving a pension but were not classified with a disability degree.

Unemployment. Of the 1,883 people interviewed who answered this question, 1,397 of them had no job. The greatest unemployment found among interviewees is shown below.

In analyzing the unemployed mine/UXO survivors, the researchers found 206 were of the first degree, 780 of the second degree and 99 of the third degree of disability; 312 people with no job had no disability degree.

Monthly Personal Income

According to the Azerbaijan Free Trade Unions Confederation,6 per-month earning and minimum cost-of-living estimates by experts at the time of the survey were as shown in Table 2.

Average salary $100
Minimum consumer basket per person7 $75
Minimum expenditure per working person8 $85

Table 2: Average salary and minimum cost of living per-month estimates in U.S. dollars.

A total of 1,264 people answered the question on their personal income. Income varied from US$5.40 to $250 per month, and 90 percent of interviewees earned a much lower-than-average salary. Eighty-five people had an income in the range noted and only 48 people had a higher monthly income. A total of 98 people had an income less than the minimum salary mandated by law ($20 per month at the time of the survey).

Monthly family income. In 1,605 cases of the 1,883 surveyed, the respondents provided answers on the question of family income. It appeared that 147 families had an income less than the minimum salary mandated by law. Monthly family income exceeded $200 in only six cases, an amount at the higher end of income distribution.

In many cases the disability pension of the mine victim was a big portion of a family income. Since the unemployment rate was very high, the other sources of income were the pensions of other family members and, in some cases, additional allowances provided for children, internally displaced person status, or other reasons.

The highest incidence of families with an income not exceeding 300,000 Azerbaijani manats per month (at the time of the survey US$60) were found in the districts of Terter (168 of the 184 that answered), Goranboy (76 of 85), Agstafa (55 of 67), Gazakh (48 of 78) and Tovuz (49 of 67) and in Baku (230 of 365) and Ganja cities (43 of 50).

Distribution by age. Of a total 1,883 interviewees, 1,775 people had information on the incident date and the distribution by age was considered to be applicable only for them. Several years had passed since many of the respondents' mine incidents. As they aged, they experienced health problems related to the incident as well as additional complications due to other illnesses and the economic difficulties of life as IDPs. In addition, their situations became much harder due to the onset of other diseases.

Civilian mine victims. Of 1,883 mine victims, 1,510 persons were members of the military or were civilians working with the army or militia at the time of their incident.

The most prominent activities for the other 373 civilian casualties at the moment of incident were tending to animals and plants—85 and 73 people, respectively. Forty-three people were doing household chores and 32 people were playing or engaging in recreational activities when the incident occurred. Only three people stated that they were tampering with devices. Eighteen people were collecting firewood or water, 13 were traveling and two people were hunting. Ninety people did not reveal the circumstances in which they were injured by mines or UXO. Six people were policemen on law enforcement duty and one was involved in humanitarian mine clearance. Seven people did not classify their activity at the moment of incident.

Most of the losses and injuries of civilians arose due to negligence and carelessness. Civilians involved in non-military activities accounted for 103 of 143 cases with loss of an arm or hand, eyesight or hearing and 43 of the 192 cases of lower limb amputations. In some cases, civilians were tampering with explosive devices and in other cases they were crossing into restricted areas. It can be concluded that in a number of cases civilian casualties resulted from treating explosive ordnances carelessly.

Recommendations

The main recommendations derived from the survey are as follows:

Biographies

HeadshotAziz Aliyev graduated in 1973 from the Azerbaijan State University and worked as a theoretical physicist in the Institute of Physics (Baku) until 1994. He has led the Information Department of ANAMA since May 2000 and is involved with the Mine Risk Education Cell and Mine Victim Assistance function. The Department maintains IMSMA and GIS with the data from six years of operations and various surveys.

HeadshotRauf Mamedov is a general practitioner and a graduate of Azerbaijan State Medical University in 1988. He worked in diagnostics as a cardiologist. From 1996 to 2000 he was involved in activities with Relief International in Azerbaijan as a Mobile Health Unit physician. He has worked for ANAMA since July 2001 and made significant contributions to the survey procedures described in this article.

HeadshotUmud Mirzoyev graduated in 1987 from M. Gorki Institute of Literature in Moscow. From 1988 to 1993 he led the department of the Literature and Art newspaper in Baku. He is one of the founders and Chairman of the International Eurasia Press Fund based in Azerbaijan. He has coordinated mine-related projects implemented by this NGO since 2000.

HeadshotSiyab Mamedov graduated from Baku State University. From 1973 to 1992 he worked as a journalist in the Imishli district and from 1992 to 1993 he worked for the local administration. From 1995 to 2000 he ran the Information Centre at the State News Agency. He has worked in the IEPF since 2000 and supervised field activities during various survey projects.

Endnotes

  1. The MVA Needs Assessment Survey was created with the specific objectives of establishing an extensive database, a well-articulated strategy and an effective network with relevant stakeholders on MVA. This sub-task was an integral part of a larger overall project titled Support to Azerbaijan Mine Action Programme that was funded by the European Commission through the United Nations Development Programme from June to October 2004.
  2. This survey defines husbandry as working on growing crops, vegetables fruits, etc.
  3. People with first-degree disabilities are completely disabled and incapable of working. They require constant assistance. People with second-degree disabilities are disabled but do not require constant attention. People with third-degree disabilities are partially disabled and cannot complete usual work. For more information see "Old Age, Disability, and Survivors" Social Security Programs throughout the World, Asia and the Pacific, 2004: Azerbaijan. http://www.ssa.gov/policy/docs/progdesc/ssptw/2004-2005/asia/azerbaijan.html. Accessed November 13, 2006.
  4. The disability degree is given for a period of time and subject to review by special medical-social expert commissions to ensure the classification is still correct.
  5. According to this survey, the monthly average of personal income including pensions from the state received for persons with a disability degree were US $50 for first-degree, $37 for second-degree, $28 for third-degree and only $8 for those not having an officially recognized disability. The respective figures for total average monthly family income were $62, $50, $43 and $24.
  6. The information gathered from the Azerbaijan Free Trade Unions Confederation was through an informal phone interview for purposes of the MVA Survey. The Azerbaijan Free Trade Unions Confederation is the national free trade union center for Azerbaijan with 1.3 million members.
  7. A consumer basket refers to a sample of goods and services used to track the prices of basic commodities and as a base for the Consumer Price Index. The minimum consumer basket is the minimum commodities and services needed to survive and is used to determine the minimum cost of living.
  8. A minimum expenditure shows how much each working person actually needs to spend at a minimum to survive. Compared to the minimum consumer basket, minimum expenditure per working person is higher because additional real-life expenses are calculated in, such as daily transportation expenses.

Contact Information

Aziz M. Aliyev
Information Manager
ANAMA
65 Fizuli St, 5th floor, AZ-1014
Baku / Azerbaijan
Tel: +99 412 497 38 51
Fax: +99 412 497 44 27
E-mail: aaliyev@anama.baku.az
Web site: http://www.anama.baku.az

Rauf Mamedov
MVA Project Coordinator
ANAMA
E-mail: rauf@anama.baku.az

Umud Mirzoyev
Chairman
International Eurasia Press Fund
1a, Mehdi Huseyn St., AZ-1006
Baku / Azerbaijan
Tel: +99 412 439 76 97
Fax: +99 412 439 49 15
E-mail: eurasiapress@azeurotel.com

Siyab Mamedov
MRE Specialist
International Eurasia Press Fund
E-mail: iepf_Siyab@yahoo.com