Surveys to Achieve Quality of Life for Landmine Survivors

by Dr. Reykhan Muminova [ Tajikistan Mine Action Centre ]

Minefields along Tajikistan's borders with Afghanistan, Uzbekistan and Kyrgyzstan, as well as centrally concentrated civil-war minefields continue to kill and injure Tajik citizens. Through victim-assistance projects, the Tajikistan Mine Action Centre hopes that all landmine survivors can be physically rehabilitated and socially and economically reintegrated into their communities.

Tajikistan was identified at the First Review Conference of the Mine Ban Convention1 in Nairobi, Kenya, as one of 24 States Parties with a significant number of mine survivors and “with the greatest responsibility to act, but also the greatest needs and expectations for assistance” in providing adequate services for the care, rehabilitation and reintegration of survivors.2 The Tajikistan Mine Action Centre coordinates all mine-action activities within Tajikistan and has a victim-assistance cell, which started functioning in 2006. The VA cell is responsible for assisting the government in the creation of the national strategy to assist landmine survivors, coordinating meetings with all governmental and nongovernmental organizations involved in victim assistance in Tajikistan, updating the names of landmine and unexploded ordnance victims in the Tajikistan landmine database, working with the government and nongovernmental organizations, coordinating all VA works in the country and mobilizing donor support.

In July 2006, the Commission on the Implementation of International Humanitarian Law adopted Tajikistan’s Victim-Assistance Objectives and Plan of Action 2005–2009 and established an inter-ministerial coordination group that discusses VA challenges and tries to coordinate the work of all relevant government ministries, integrating their work into wider government programs.

The author’s research in to victims’ needs is underway inTavildara district.
All photos courtesy of the author

First survey. During the research phase of my thesis project at the National Research Institute for Rehabilitation of Persons with Disabilities (20042006), in the first survey, I found that landmine survivors rate poorly on any index indicating their quality of life (QoL). There is a high limitation on their physical activity due to amputation of one or more limbs and reduced emotional well-being due to depression, anxiety and physical maladies. Impaired social abilities lead to a reduced capacity to communicate as well as other emotional conditions. Projects for the improvement of QoL for persons with disabilities focus on integrated rehabilitation, using a holistic approach. The main goal is to achieve the best possible QoL by giving people good functional capacity, promoting their integration into society and encouraging independence, which will lead them to a productive and useful way of life.

Needs assessment. In mid-2006, TMAC developed a VA needs assessment questionnaire in the Tajik language in order to begin surveying landmine survivors. The needs assessment survey finally gained Canada’s support and was implemented in March of 2008. All existing data is being analyzed to set priorities for short- and long-term improvement of survivors’ QoL. A detailed report on the mine victims’ survey serves as a tool for making decisions about issues related to their rehabilitation. Based on the needs assessment conducted, the TMAC was able to develop a long-term VA strategy and draft and present project proposals to the donors. Landmine survivors identified the need to resume their roles as productive community members and contributors to their families’ well-being.

Obligations of any society to persons with disabilities include providing opportunities for a full life, such as the preservation of their family, participation in society, communication, spiritual development and access to all spheres of life (such as education, healthcare, social welfare, labor, culture, sport and leisure).

Professional Rehabilitation

TMAC has found that the two most important parts of disabled life are professional rehabilitation (being able to work) and career activity (getting a job). Obstacles to re-entry into the workforce facing landmine survivors in Tajikistan include inflation, unemployment and lack of nongovernmental enterprises to assist with rehabilitation and workforce reintegration in Tajikistan. All of the aforementioned factors forced survivors, even those with amputations of extremities, to go to Russia to take part in migrant-labor opportunities.

Rehabilitation is not simply prophylaxis, treatment and outplacement, but a completely new approach to the patient through repeated socialization and reestablishment of personal and social status for the survivor. A job is important as it gives financial support necessary for survival and simultaneously provides a person with a sense of independence. In addition, disabled persons benefit from social contacts and their roles as active members of their families or society. We revealed that VA projects impact not only the survivors, but also their families and all those with whom they interact.

Survivors enjoy art therapy at the summer camp; it helps them express their emotions while socializing with others who have met similar challenges.

Income-generating initiatives. One of Tajikistan’s first projects in the field of mine-victim assistance was the project “Income-generating Initiatives,” which started in 2005 within the framework of an agreement between the United Nations Development Programme, which funded the project, and the Red Crescent Society of Tajikistan, which implemented it through TMAC. This project was initiated to “facilitate access to income-generation opportunities” for 72 mine-affected families in six districts, including three districts in Sugd region and three in Rasht Valley. Each of the families was provided with two sheep or goats for breeding and food consumption.3 The main aim of this project was to reduce the vulnerability to poverty of selected mine survivors and their families. In addition, 21 families are currently involved in an RCST-sponsored beekeeping project in Darvoz district.

In the framework of the individual projects, and thanks to the generosity of people around the world, who donated through a benefit event sponsored by UNDP and TMAC in November 2006, 11 landmine survivors received assistance in 2007 through the VA program to start small-scale enterprises: Five survivors received sewing machines; two survivors each received a musical instrument so they could play at weddings and parties for a modest income; one survivor received beekeeping equipment; and three survivors received shoe-repair equipment. The TMAC decided to help these victims in this way because the survivors requested these items at the time of the needs-assessment survey.

Allowing mine/ERW survivors to adopt an income-generating activity enhances their self-esteem, positively affecting everyone around them. The extent and value of this effect was assessed by a professional psychologist. Results revealed that survivors suffered from various borderline psychiatric disorders. Since the assessment, project proposals on psycho-social support have been developed but have not yet been supported by donors.

Summer Rehabilitation Camp. Another victim-assistance project, Summer Rehabilitation Camp, is one of the important stages in assisting landmine survivors’ reintegration into society, helping them to cope with psychological problems and adjustment issues. The camp also assists them in regaining and maintaining a healthy and positive outlook on life. For the past three years, a total of 76 landmine survivors (every year about 25 survivors from different age groups) and children from mine victims’ families spend their rest and leisure time in two-week summer camps at the sanatoriums and rest houses situated in the beautiful Romit and Varzob Valley resort areas close to the capital, Dushanbe.

Summer camp 2007: It was both fun and useful to the survivors and their families.

TMAC’s summer camps create an impact on survivors’ general health by bringing together physiotherapy and massage in a bright, friendly, and warm atmosphere. The camp usually supports psychological rehabilitation through individual and group psychological discussions and seminars; art and creative work under the supervision of professional psychologists and artists; movies; and dance. TMAC also provides some cultural stimulation through excursions to the ancient fort at Hisor and to the capital city, Dushanbe. Meetings between the survivors and representatives of the Ministry of Labour and Social Protection of Population of the Republic of Tajikistan and survivors that cover pensions, education and other issues are also held during the summer camp. The survivors find these meetings helpful.

Summer camps enhance communication, promote social contact and increase self-esteem, all of which promote future, sustainable social functioning on the part of landmine survivors and an increase in their QoL. TMAC’s main partners are the Ministry of Labour and Social Protection of the Population of the Republic of Tajikistan, RCST and Harmony in the World, a local NGO.

Legislation Harmonization

As the result of the Harmonization of Tajik Legislation According to the Implementation of the International Humanitarian Law, and after comprehensive analysis of the existing legislation, experts revealed that the subject matter of existing Tajik legislation appropriately addressed concerns discussed at the Ottawa Convention and its first Review Conference in Nairobi. The project, however, underlined that the mechanisms for implementing laws do not work properly, and it recommended that TMAC develop a national program for improving the quality of life of persons with disabilities. This program would create a working group of interested parties and define the dates of project implementation and implementing partners.

The needs assessment survey revealed that one of the problems is the low level of survivors’ awareness of their rights. In this regard, the project devoted to the ratification of the U.N. Convention on the Rights of Persons with Disabilities,4 which was supported by the U.S. Embassy, is very relevant. The first roundtable was conducted in December 2007 and the results were reported via mass media.

During field meetings with survivors, a VA officer and his assistant have been helping survivors and explaining how to write letters to the Ministry of Labour and Social Protection of the Population about the possibility of future government assistance or changing the status of their disability groups to qualify for additional benefits. In addition, 14 survivors were recommended to establish their “group of disability” through the Medical Labour Expertise Committee.

During field visits and the needs-assessment survey, a team of experts discovered that more than 10 survivors were not aware of the possibility of obtaining prostheses. The team referred the survivors to representatives of local RCST branches and recommended them to receive prostheses at the National Ortho Center.

TMAC continually identifies survivors who need treatment and rehabilitation and refers them to the appropriate specialized healthcare services. To achieve comprehensive rehabilitation of landmine survivors, it is necessary to integrate governmental, social, medical-psychological, professional, pedagogical and legal activities of the survivors into society.

Cooperation. A good relationship was established between TMAC and the International Trust Fund for Demining and Mine Victims Assistance in Slovenia. In November 2007, the Institute for Rehabilitation, Republic of Slovenia conducted the first introductory trainings for three Tajik doctors with financial support from the ITF on the topic of comprehensive rehabilitation organization. As a result of TMAC’s correspondence and personal meetings with the ITF and professors of the Institute for Rehabilitation, Republic of Slovenia, the ITF agreed to continue conducting such trainings for Tajik rehabilitation doctors.

TMAC, in cooperation with the Ministry of Health and with support of ITF, conducted a six-day training on “Rehabilitation of the Patients with Trauma Amputation of the Limbs” in May 2008 in Dushanbe. Twenty doctors (surgeons, trauma specialists and physiotherapists) from the mine-affected districts as well as specialists from National Research Institute of Rehabilitation of Persons with Disabilities (Dushanbe) and National Ortho-Centre attended the training. The training course was conducted by a team of professors and lecturers from the Institute for Rehabilitation, Republic of Slovenia and consisted of theoretical and practical aspects. This is the first course of its type conducted in Tajikistan, and it was considered as an extremely

The lecturers introduced the participants to key areas of development and achievement in European rehabilitation medicine, modern technology in the area of rehabilitation and prosthesis, principals of physiotherapy and many other aspects related to complex rehabilitation and assistance to the people with amputated limbs.

Conclusion

Through official needs-assessment surveys and my thesis research in Tajikistan, we found that survivors of landmines in Tajikistan suffer a myriad of problems. Physical and psychosocial rehabilitation and providing income-generating opportunities for the survivors and their families was found to be essential to improving their quality of life. JMA icon

Biography

Reykhan Muminova is a psychiatrist; she graduated from the Tajik State Medical University in 1988. Muminova worked as a psychiatrist for the National Research Institute of Rehabilitation of Persons with Disabilities in Dushanbe, Tajikistan, where she started her research devoted to landmine survivors. She is an author of more than 20 scientific articles in different medical journals and research papers published in Tajikistan and abroad. She has worked for TMAC since May 2006 and made significant contributions to its surveys and VA activities.

Endnotes

  1. Convention on the Prohibition of the Use, Stockpiling, Production and Transfer of Anti-personnel Mines and on Their Destruction, Oslo, Norway. 18 September 1997. The document was opened for signature in Ottawa, Canada, 3 December 1997, commonly known as the Ottawa Convention. http://www.icbl.org/treaty/
    text/english
    . Accessed 22 May 2008.
  2. Ending the Suffering Caused by Anti-personnel Mines: Nairobi Action Plan 2005–2009. Geneva International Centre for Humanitarian Demining, 2004. http://www.gichd.ch/fileadmin/pdf/mbc/MSP/6MSP
    /Nairobi_Action_Plan.pdf
    . Accessed 23 January 2008.
  3. Landmine Victim Assistance in 2005: Overview of the Situation in 24 State Parties, 2nd ed. International Campaign to Ban Landmines, 2005. http://www.standingtallaustralia.org/pdfs/Landminevic2005.pdf. Accessed 16 May 2008.
  4. The Convention on the Rights of Persons with Disabilities can be found at http://www.un.org/disabilities
    /convention/conventionfull.shtml
    .  Accessed 12 June 2008.

Contact Information

Reykhan Muminova
Victim Assistance Officer
Tajikistan Mine Action Centre
15 M.Kurbonov Str.
Dushanbe / Tajikistan
Tel: +992 372 223 51 87
Fax: +992 372 221 66 87
Mob: +992 91 903 23 64
E-mail: muminova16(at)inbox.ru