Issue 5.2 | August 2001 | Information in this issue may be out of date.
Victim Assistance in Central America: IGOs, NGOs and Governments Team Up
by Suzanne L. Fiederlein, MAIC
As with other mine-affected regions, Central America must respond to the human consequence of landmines: the survivors. After years of dominance by clearance operations, victim assistance and economic reintegration are now beginning to receive heightened attention in the region. Both the OAS and PAHO (the Pan-American Health Organization) have launched victim assistance programs in Central America, teaming up with government ministries, and local and international NGOs to expand and improve services for survivors.
All of the Central American countries are grappling with the challenges of economic reintegration, while the capability to meet the needs for rehabilitation is being enhanced through training programs organized by the OAS, PAHO and UNICEF, and involving international NGOs such as:
Various international NGOs also assist with the direct provision of prostheses and orthotics, although most of the patient services are carried out by local NGOs and government agencies.
El Salvador, the first country in the region to be cleared of landmines, hosts some well-established rehabilitation and reintegration programs. The German organization, MEDICO International, along with Medical Aid for El Salvador, helped establish the Organization for the Promotion of Disabled Persons of El Salvador (PODES) in 1992. The VVAF stepped in to provide PODES with funding and technical assistance. PODES continues to operate the largest rehabilitation program in El Salvador with a current caseload of over 900 patients and a staff of 23 employed in its workshops and administrative offices (see VVAF website: http://www.vvaf.org/humanitarain/elsalvador.shtml).
PODES is one of several NGOs in El Salvador devoted to victim assistance. The World Rehabilitation Fund (WRF) in recent years teamed up with the US Agency for International Development (USAID) to provide technical assistance to seven different Salvadoran organizations involved in providing a range of rehabilitation and reintegration services. The project served to bolster the peace process and has benefited ex-Salvadoran military and ex-FMLN combatants as well as civilians (see WRF website: http://www.worldrehabfund.org/programs/latnamer.htm ).
Overall, in Guatemala as well as in Nicaragua, victim assistance programs have only recently begun to garner increased attention by governmental and OAS officials who have tended to focus on clearance operations. However, NGOs such as the Center for Attention to the Disabled of the Guatemalan Army (CADEG) and the Guatemalan Rehabilitation Association (AGREL) have provided a measure of assistance.
The International Committee for the Red Cross (ICRC), Handicap International (HI), World Rehabilitation Fund (WRF) and Mercy Ships all have played a role in providing prostheses for landmine survivors in Nicaragua. However, the principal provider of rehabilitation services in Nicaragua is the Ministry of Health. In addition to services available at two Managua hospitals, Aldo Chavarría and Lenin Fonseca, a semi-private rehabilitation center, CENAPRORTO (Centro Nacional de Producción de Ayudas Técnicas y Elementos Ortoprotesicos), provides a range of services to landmine survivors as well as others in need of rehabilitation.
OAS Victim Assistance
The OAS victim assistance program provides funds to cover the cost of transportation, lodging and services for individual victims at CENAPRORTO.1 The center provides prosthetic and orthotic services as well as physical rehabilitation therapy and psychological counseling. It is a residential facility where patients stay while receiving services.
Since 1996, the OAS has assisted over 320 landmine survivors through its program in Nicaragua, essentially every victim in need of assistance who has come to the attention of the OAS program staff in Nicaragua.2 This number includes those requiring care for eye and ear injuries as well as amputated limbs. In addition to the Nicaraguan caseload, the program also assists one Honduran survivor and two Costa Rican survivors. The OAS also plans to include victim assistance in its recently-established demining programs in Ecuador and Peru.
Ambassador Marlene Talbott, Senior Advisor to the OAS Mine Action Program, notes that the assistance program grew out of the confidence Nicaraguans developed in the OAS as it undertook its supervisory role for the demining program.3 People in the community brought the needs of survivors to the attention of the OAS staff, which prompted the OAS to formally launch its assistance program in 1997. Ambassador Talbott, an outspoken advocate for landmine victims for many years, explains that the main mission of the OAS "is to provide immediate assistance for victims. Unlike other organizations [that] are providing support for infrastructure or other help, we are working in the field directly with the people and believe that in Central America the problem is manageable."
Funding for the program initially came from the government of Sweden, and has been supplemented by funds from the Canadian Landmine Foundation and the Women of the Americas (an association of female ambassadors and wives of ambassadors to the OAS) through the Trust for the Americas, an OAS-affiliated foundation.4 The ICRC assists CENAPRORTO in obtaining materials for the construction of prostheses, although much of it is procured through sources in the US and Canada.5
Victim Assistance Seminar
In June 2001, the OAS helped organize a three-day seminar in Managua on victim assistance. The first two days were devoted to training seminars conducted by the Center for International Rehabilitation (CIR). The seminars included hands-on instruction as well as an orientation to a new CIR-developed Internet course. The third day was devoted to information sharing among personnel involved in providing assistance to landmine victims. The participant list illustrates the large and varied role that local NGOs play in providing victim assistance in the region. However, some Nicaraguan NGOs have criticized the National Demining Commission for not effectively including them in the planning process and for not adequately addressing the needs for mine awareness education and victim assistance programs.6
Another new initiative of the OAS in Nicaragua is to launch a pilot program in association with the National Demining Commission and the National Institute of Technology to foster economic reintegration for landmine survivors. The pilot program will provide job training, start-up capital and job placement assistance to some 40-50 landmine survivors.7 The program will focus on providing practical job training that fits the Nicaraguan economic context, with an emphasis on vocational skills.
Other Programs in Central America
Net Corps Americas
Although the OAS is emphasizing vocational training in its Nicaraguan program, information technology and the Internet are becoming increasingly prominent in the efforts to provide assistance to persons with disabilities in the Americas. The Trust for the Americas, through its Net Corps Americas (NCA) program, helps support several projects for people with disabilities in Central America.8 The projects all involve sending high-tech volunteers to work with disability organizations in El Salvador, Guatemala, Honduras, and Nicaragua. Training includes the use of assistive technology as well as computer skills that facilitate entry into the job market. The NCA also helped develop a Virtual Disabilities Resource Center (VDRC) that serves people with disabilities and their organizations by providing access to diverse Internet-based information sources.
In El Salvador, the NCA established a special national program in conjunction with the Ministry of Labor and with funding from the US Department of Labor, Bureau of International Affairs. The program works with organizations for people with disabilities and the private sector to provide training, advice and job placement assistance to help promote the integration of the disabled into the private workforce.
Another major international actor in the field of victim assistance as well as mine awareness education is UNICEF. Since 1992, UNICEF has been active in promoting mine awareness programs in Central America, beginning with El Salvador but expanding its efforts to encompass Nicaragua and Guatemala. In Guatemala, UNICEF teamed up with CIR/PALM and the Ministry of Public Health and Social Assistance in 1998 to launch a training program for medical personnel in the areas of prostheses and orthotics and to engage in some community-based rehabilitation programs.9
In 2001, UNICEF changed course somewhat by enlisting the participation of ASCATED (Asociación de Capacitación y Asistencia Técnica en Educación y Discapacidad), a Guatemalan NGO with many years of experience working with disabled people, in a project to assist child victims of landmines and UXO. The first step has been to identify the victims, according to Dr. Fidel Arévalo, who heads up the project.10 Dr. Arévalo’s team has developed a survey form and currently is gathering the survey data. They will use the survey results to plan the assistance program.
PAHO’s Role in Victim Assistance
In 1999, the Pan-American Health Organization (PAHO), a specialized agency of the OAS and the regional office of the World Health Organization (WHO), responded to overtures from the governments of Canada and Mexico to devise a program addressing the needs of landmine survivors in Central America. The Tripartite Initiative to Support Landmine Survivors in Central America has been designed to strengthen the capacity of the governments of El Salvador, Honduras and Nicaragua to provide services to landmine survivors. The OAS and PAHO carefully coordinate their victim assistance programs so that they complement one another in order to more effectively respond to the needs of survivors. The Tripartite Initiative administered by PAHO focuses on capacity building while the OAS provides direct services to landmine survivors. In 2000, the US Agency for International Development through the War Victims Fund (USAID/WVF) entered into a co-partnership with the Tripartite Initiative in support of particular components of the program.
The four general objectives of the Initiative are to:11
According to Maria Teresa Gago of PAHO, as the Initiative has unfolded since 1999, it now encompasses four main activities: strengthening of socio-economic reintegration programs; expansion of community-based rehabilitation strategies into the primary health care networks; extension and strengthening of prosthetic and orthotic services; and development of a health and disability information system.12
Overall, many specific, small-scale training programs have been supported by the Initiative, drawing in the participation of local and international NGOs, universities, and governmental agencies.13 Again, the emphasis of the Initiative is to enhance local capacities to extend services to people with disabilities. The Initiative is only two years underway and promises to make a substantial contribution to building the national capacity for these mine-affected countries to meet the needs of their landmine survivors.
Differing Views on Victim Assistance
The increased attention to rehabilitation training and to initiatives in support of people with disabilities regardless of the reason for the disability, as represented by the Net Corps Americas program, reflect efforts to implement the Inter-American Convention for the Elimination of All Forms of Discrimination against People with Disabilities adopted by the OAS General Assembly in 1999. They also reflect the divergence of views within the victim assistance community over the proper course of action to take in responding to the needs of landmine survivors.
One perspective, as represented by Ambassador Talbott of the OAS, is that landmine victims need to receive specific, timely assistance to ensure their rehabilitation and reintegration, particularly in light of Article 6 of the Ottawa Treaty. This perspective has guided the OAS victim assistance program which has resulted in concrete improvements in the lives of survivors in Nicaragua.
The second perspective advocates enhancement of the overall capacity of national health systems to respond more effectively to landmine victims as well as to other people with disabilities.
The latter response would seem to be ideal from a developmental perspective, but due to the scale of the health system needs in most mine-affected countries, such an approach often sacrifices timeliness to efforts for comprehensiveness. For landmine survivors who are aware of Article 6 and have been repeatedly "surveyed" about their injuries, the failure to receive adequate, prompt assistance can be frustrating and disheartening.
Ambassador Talbott and Pan-American Health Organization officials Daniel López-Acuña and Maria Teresa Gago all agree that the task is to make assistance to landmine victims a top priority and to have it serve as a catalyst to improve health services to all those in need in the Americas.14
1 Care Program for Victims of Mines and UXO, under the Assistance Program for Mine Action in the Americas (AICMA) of the OAS.
2 Interview with Carlos Orozco, OAS-PADCA National Coordinator, Managua, Nicaragua, 25 June 2001.
3 Interview with Ambassador Marlene Villela-Talbott, Senior Advisor, Mine Action Program of the OAS, at OAS offices in Washington, DC, 12 June 2001.
5 Interview with CENAPRORTO staff, Managua, 25 June 2001.
6 International Campaign to Ban Landmines, Landmine Monitor Report 2000: Toward a Mine-Free World (New York: Human Rights Watch, 2000), pp. 286-7.
7 Interview with Carlos Orozco, OAS-PADCA National Coordinator, Managua, Nicaragua, 25 June 2001.
8 See the Trust for the Americas website: http://www.trustfortheamericas.org/english/ict/disabilities/ for more information on its projects and its specific organizational partners.
9 E-mail communication with Ramiro Quezada, UNICEF-Guatemala, 15 May 2001.
10 E-mail communication with Fidel Arévalo, ASCATED, 14 April 2001; Also, Interview with Dr. Arévalo during the Mine Action Information Systems Interoperability Workshop, James Madison University, Harrisonburg, Virginia, 14-15 June 2001.
11 Quoted from: Canada-Mexico Regional Seminar on Antipersonnel Landmines: "Reaffirming Our Commitment", Mexico City, 11th to 12th January 1999, as reprinted in: Government of the United Mexican States, Government of Canada and the Pan-American Health Organization, Supporting Landmine Survivors in Central America: A Tripartite Initiative, (no date given).
12 Interview with Maria Teresa Gago, PAHO/WHO Tripartite Initiative, at PAHO Headquarters, Washington, DC, 12 June 2001.
13 See the Four Year Consolidated Plan for the Tripartite Initiative for a comprehensive list of the various programs receiving support. The Plan can be found in: Government of the United Mexican States, Government of Canada and the Pan-American Health Organization Supporting Landmine Survivors in Central America: A Tripartite Initiative, (no date given).
14 Interviews with Ambassador Marlene Villela-Talbott, Senior Advisor, Mine Action Program of the OAS at OAS offices in Washington, DC, 12 June 2001 and with Dr. Daniel López-Acuña, Director, Division of Health and Services Development, Pan-American Health Organization and Maria Teresa Gago, PAHO/WHO Tripartite Initiative, at PAHO headquarters in Washington, DC., 12 June 2001.