Issue 5.2 | August 2001 | Information in this issue may be out of date.
The Necessity of Implementing a Public-Health Approach to Humanitarian Demining
by Daniel H. Wolf, President, and Steven Barmazel, Publications Director, Terra Segura International
Landmines are an epidemic, yet unlike other programs fighting epidemics, humanitarian demining does not conscientiously apply public-health techniques. National mine-clearing projects conform to inflexible military models that maximize central control while stifling local initiative. Intensive mine-at-a-time clearing efforts, though urgent in heavily trafficked areas, are applied across the board, dissipating demining resources. This makes reducing risks across large areas and populations impossible, resulting in continuing and unnecessary deaths from unaddressed mine fields.
Clearing every mine field is beyond the world’s demonstrated willingness to expend capital. Speeding reclamation and reducing casualties within existing resources requires more emphasis on overall risk reduction, more efficient methods and technologies and increased incentives for private action.
Public-health programs do this by balancing what is best for individuals with what is best for all. Expensive acute care, such as caring for the sick during cholera epidemics, is the smaller part of the solution; the larger part is generalized threat reduction (e.g., providing reliable, potable water systems). The goal is to achieve the highest society-wide health benefit for the available funds, which are always insufficient.
A public-health approach in demining would optimize efforts to greatly reduce risk in concentrated areas where civilian exposure is extreme and needs are urgent (e.g., clearing paths to wells and schools), and moderately reduce risk over very large areas (e.g., locating and marking mine fields without clearing them, conducting mine awareness education and establishing lasting community response teams).
The wider perspective of public-health programming stresses coordination and cooperation with other organizations to cut costs for activities such as victim rehabilitation, economic development and employment generation. Not only are overall risks and casualties reduced for given outlays, but communities and their economies also recover faster.
Humanitarian demining is more than reducing postwar injuries. It is also meant to build the conditions for a stable peace and a robust prosperity. Improving the whole public health is as important as eliminating individual threats.
Why Conventional Demining Is So Expensive
Manual demining is the gold standard for near-100 percent removal. However, the inherent risks eviscerate individual productivity. Checking for booby traps, clearing vegetation, probing carefully, digging up numerous suspicious objects and rotating crewmembers to deter stress and boredom requires multitudes of low-skilled detection personnel. With more than 3,000 personnel, for instance, the Cambodian Mine Action Center (CMAC) cleared only 10 sq km a year out of some 3,500 affected sq km. As a consequence, labor costs are astronomical.
Bureaucratic factors also increase costs. Centralization robs the tooth of clearing activities by concentrating excessive resources in the bureaucratic tail. Relying on peacekeeping forces and national armies for leadership, the organizational models for these projects, not surprisingly, are military. Though appropriate for combat, when applied to mine clearance, this model is inefficient, not economical, stifling to local initiative and adaptation, and slow to respond to new or newly-discovered beneficiary needs. Experimentation is directed from above, innovation must run a gauntlet of policies and doctrines, and local responses to local conditions must pass through levels of bureaucratic filters.
Furthermore, most projects suffer all the typical problems of systems with third-party funding. A handful of distant agencies disburse most demining money, so these donors (plus army headquarters when the deminers are active-duty soldiers) become the projects’ true clients; the people living in mine-infested areas are simply powerless beneficiaries. Priorities of donors and national officials often trump the needs of deminers and mined communities.
Accountability is the reason usually given for bureaucratic structures, but small spending for actual demining is the reality, irrespective of justification for high overhead. The Bosnia Mine Action Center, despite enormous spending since 1995, has not even finished its preliminary task of mapping all minefields, much less accomplished sizable clearance. Even minefields around Sarajevo remain unmarked, a fact that was tragically proven last year when two children were killed instantly and a third died slowly within earshot of her parents while Norwegian People’s Aid deminers tried frantically to rescue her. However, with more than 3,000 personnel, CMAC cleared only 10 sq km per year out of some 3,500 affected square kilometers.
When accountability is de-emphasized to allow greater efficiency, however, abuses occur. The United Nations for years praised CMAC as a model of effectiveness and "sustainability." Recent exposure of nepotism, inefficiency and misfeasance in CMAC (specifically, the clearing of land for the commercial use of former Khmer Rouge officers) led to funding cutoffs and contraction. Some who have worked with LAO-UXO in Laos allege that it would collapse without expatriate advisers. LAO-UXO may be more robust than that, but an exodus of expatriates would likely cause foreign donors to lose confidence, causing LAO-UXO to shut down from lack of funds.
A recent U.N. policy review, noting the prevalence of "poor management compounded by inappropriate and unsupportive U.N. administrative and budgetary mechanisms, lack of forward planning and disputed lines of authority," recommended that the United Nations "not be involved in the direct implementation of mine action activities."1
Even the most effecient programs are expensive. Total monthly expenses for the Afganistan Mine Action Program, for example, run $800 (U.S.) per deminer, only $150 (U.S.) of which is actual wages; the rest is equipment, transport, food accommodations, insurance, medical support, etc. Total costs for the program’s five expatriate supervisors reach $250,000 (U.S.) each.2 The unfortunate result of all these factors is that clearance costs more than most agricultural land is worth. This eliminates one of the most powerful incentives for investing in demining—the lure of positive returns on investments. Private landowners will not invest in land clearance unless they expect to make a profit in order to support their families. Likewise, a government ministry in a poor country will not invest in clearing large areas if it cannot expect positive net revenues, even considering the economic and social value of avoiding injuries and deaths. It must invest its limited funds in growth and development, not simply spend in ways that may produce net reductions in collective economic well being.
Improvements in Planning Demining
The picture is not entirely dismal. Coordination between military and civilian organizations has improved, and the United Nations has responded to critiques by beginning to focus on the coordination among, rather than the actual operations of, NGOs.
Additionally, in an attempt to match needs with available resources, demining planners now apply triage to lands (i.e., prioritize them according to risk and necessity and authorize "treatment" according to these priorities). Obviously, acute threats such as mined schoolyards and water sources are treated immediately even at great cost. Ideally, public infrastructure and transportation are cleared next, then private infrastructure and productive lands, and finally low-value lands such as pastures and wastelands.
The desired treatments for these various levels of need have evolved into three accepted risk-reduction "treatment levels." From the top, Level 3 is complete clearing (the most expensive), akin to acute care; Level 2 is demarcation of minefield perimeters (meant to put mined land in a safe holding pattern while making the unmined surrounding land available); and Level 1 is an aspirin-like treatment, generating general location data and impact information for planning purposes, accompanied by mine awareness training that is often ineffective.
Unfortunately, funds are too limited in many cases even to clear the most critical areas, much less mark mine fields to keep people safely out. Even when funds are available, the middle level of care is largely unattainable because Level 2 surveys apply the same labor-intensive techniques used for clearance itself, which is very expensive, especially in densely vegetated areas.
In order to make serious headway, overall performance must increase dramatically without expecting increased public funding. The challenge is enormous, and responsible agencies must go beyond easy fixes—they must make substantial changes in their organization and procedures and bring along donors and affected constituencies in both mined and donor countries.
Getting started requires three strategic responses:
The Utilitarian Approach to Reducing Societal Threat
Notwithstanding the humane concern underlying all public-health programs, economic rationality and practicality govern attacks on everything from typhus epidemics to airplane crashes because it is impossible to protect everyone completely in a world with finite resources.
To end a typhus epidemic, for example, officials divide funds and efforts among acute care, programs of prevention and behavioral change, and construction of sanitation infrastructure. Similarly, to reduce airplane accidents, officials simultaneously promote safety in design, manufacture and operation. Attempting to eradicate all flies that carry typhus at the expense of other variables would be an ineffective (and Sisyphean) strategy, as would spending all available funds to build a "perfect" airplane while leaving flight operations unregulated. In both cases, working to eliminate a single risk factor results in more deaths than a strategy of risk reduction that is optimized but incomplete.
Striving to achieve a perfect solution for a single aspect of public-health problems wastes resources. The fundamental premise is that the whole population is better off (i.e., stays healthier and lives longer) if all people are protected to some degree than if a few are protected completely. Instead of focusing resources on a small portion of the population, public-health workers apply a significant proportion of their resources in a relatively thin layer over large groups, perhaps even entire populations.
So it should be with demining. Every day, people and livestock stray into unmarked and unfenced mine fields, and every day, dozens of people succumb to the odds they face there. Reducing aggregate threat levels (i.e., reducing the odds of encountering a mine in all populated areas) would reduce death and injury more than the present practice of expending almost all resources on eliminating mines completely in only a few places. This method would also contribute more to economic development, political stability and tax generation.
Public-health programs and methodologies vary considerably by disease and social setting. Some methods are primarily epidemiological—identifying causes. Others are sociological; (e.g., working to change hygiene habits) or public-works-oriented (building sanitary water and sewage systems to interrupt disease cycles). All programs share two goals: 1. to implement the most effective strategic attack on the epidemic in order to stop it in its tracks and 2. turn it around and to maximize effectiveness per dollar invested.
Not coincidentally, the second goal flows from the first. Good public-health programs exploit the weaknesses of their disease adversaries and reinvent themselves as they confront new conditions. Using tools from the fields of epidemiology, economics, sociology and political science, among others, programs analyze not only the disease but also the social and technical advantages and impediments faced in the struggle against disease.
Public-health officials are not magicians but pragmatists. They attempt to maximize organizational effectiveness and optimize use of available resources in order to minimize aggregate death and injury. This requires constantly analyzing and tinkering with organizational functioning; developing, testing and refining improvements; integrating new technologies; and continually attending to stakeholders at all levels. Ignoring any single element threatens optimization efforts.
Immediate Practical Measures: Improving Performance Within Existing Constraints3
Years of deminer debates and complaints prompt the following suggestions:
Transition of Institutions: Relaxing Constraints and Enhancing Adaptive Response
In the longer term, to better enhance economic rationality, it is possible to vary organizational fundamentals such as:
Conclusion: The Larger Benefits of a Public-Health Approach
In mined countries, poverty is the rule, and devastation is both cause and effect. Most land has low economic value relative to land in rich countries, and expected revenues are small. This makes most demining economically irrational and therefore unsustainable. Mine clearance depends on philanthropy, a funding stream that is presently inadequate and possibly subject to erosion. Changing this picture will require careful but dramatic action.
Better humanitarian demining is justifiable on the basis of faster casualty reductions at lower cost. But the benefits go far beyond this. As demining costs fall and investments in land remediation increase, economic activity of all kinds will recover and expand. The result will be more prosperity and political stability, reduced reliance on economic assistance, fewer economic causes of conflict, and less need for foreign military interference and peacekeeping.
This article is based on a paper Mr. Wolf presented to the UXO/Countermine Forum, New Orleans, April 9––12, 2001.
1 Study Report B: The Development of Indigenous Mine Action Capacities, United Nations, Department of Humanitarian Affairs, Policy and Analysis Division, Lessons Learned Unit, Robert Eaton, Team Leader, New York, pp.3, 6.
2 Figures provided by Prof. James Trevelyan, Dept. of Mechanical and Materials Engineering, University of West Australia; quote taken from personal e-mail communication June 19, 2001. Professor Trevelyan notes that he will soon have newer cost figures, which he expects will show improvement.
3 This and the following section are adapted from Daniel H. Wolf, "Efficient mineclearing: mission impossible?" Defense Procurement Analysis, London, England, Spring 2001, pp.161––4.
4 Or see Daniel H. Wolf and Steven Barmazel, "The Use of Limited Detonation for Level 2 Surveys," paper presented to the UXO/Countermine Forum 2001, New Orleans, Louisiana, April 11, 2001.
5 See Daniel Wolf, "Militarism, Bureaucratism, and Centralism: Why Good Technology Alone Will Not Fix Humanitarian Demining," paper presented to the Mine Warfare Association’s Fourth Annual Conference on Technology and the Mines Problem, Naval Postgraduate School, Monterey, California, March 12–16, 2000.
Wolf and Steven Barmazel