Although precise numbers on new landmine victims are elusive, it can be said with certainty that landmines are continuing to inflict casualties in nearly every region of the world. In 2002 and early 2003 reports of landmine casualties came from 61 countries in Africa, Asia, Europe, Latin America, the Middle East and North Africa.

A wide range of challenges in providing adequate support to landmine victims have been identified by twenty affected States and by international agencies involved in providing assistance. The most frequently cited are:

• the lack of accurate data on the numbers of victims and where they are located;
• the fact that large numbers of victims live in rural areas where access to health facilities is limited or nonexistent;
• the lack of adequate transportation facilities;
• the inability of assistance agencies to reach victims due to insecurity caused by ongoing armed conflicts or tensions.

Each State bears primary responsibility for the well being of its citizens. It follows that each mine-affected State Party is ultimately responsible for caring for mine victims within its territory. However, the Ottawa Convention recognises the challenges faced by mine-affected States Parties, most of which are countries where health facilities are inadequate or have been disrupted by war. The Convention requires all States Parties that have the means to do so to provide assistance for the care, rehabilitation, and socio-economic reintegration of mine victims. Such assistance can be provided directly to the concerned State or indirectly through the United Nations, non-governmental organisations, or the International Movement of the Red Cross and Red Crescent.

The requirement that mine victims be provided with assistance is one of the unique features of the Ottawa Convention that distinguishes it from traditional international humanitarian law and arms control treaties.

• Emergency and pre-hospital care (evacuation, first aid, and transport to hospital).

• Hospital assistance (surgery and medical care).Proper surgical intervention improves prospects for rehabilitation. Yet relatively few surgeons are familiar with the amputation techniques appropriate for mine injuries.

• Physical rehabilitation (physiotherapy and fitting with orthopaedic appliances such as prostheses, orthoses, crutches, and wheelchairs). Orthopaedic appliances help those who remain disabled to recover their mobility. Mine survivors require physical rehabilitation for the remainder of their lives. A child that steps on an anti-personnel mine today will need 25 prostheses in his or her lifetime.

• Socio-economic reintegration (vocational training and creation of employment opportunities). The psychological trauma and loss of self-esteem of mine survivors can be eased through family support, community acceptance, and employment, which restores a person’s feeling of productivity and dignity. Mine survivors themselves consistently say that their top priority is to become productive community members and contribute to supporting their families.

It is the plight of landmine victims that gave rise to the Convention, and it was first and foremost to them that political leaders promised a better future when they signed the treaty in Ottawa in December 1997. But since then, it has become clear that this promise has been difficult to implement. Although there are many ongoing programmes to assist mine victims and other disabled, these are clearly insufficient to meet the needs of victims worldwide. Progress in this field since the adoption of the Ottawa Convention is not easy to measure.

The ICRC has noted that some additional resources have been made available for victim assistance and that some new programmes have been launched since the adoption of the Ottawa Convention in 1997. For its part, the ICRC started or resumed assistance to an additional 17 physical rehabilitation projects in 2003 alone, with a total number of 68 projects in 25 countries. However, some existing programmes in affected areas have been closed down or have had their capacity significantly reduced due to a lack of political support, bureaucratic obstacles or inadequate resources - or a combination of all three.

Although economic reintegration is a key priority for most mine survivors there are generally too few opportunities for them to receive vocational training or to gain employment. Both affected States and those able to provide support need to significantly increase the attention they give to fulfilling their commitments to assisting victims. Without discriminating against victims of other injuries or persons with other forms of disabilities, a certain priority needs to be accorded to health systems in mine affected areas that experience increased resource demands due to the specific needs of landmine victims and survivors.

The ICRC has urged greater participation of health and social service professionals, both from affected States and from relevant ministries in donor States, in the work of the Convention and at its implementation meetings. States Parties could also promote implementation of victim assistance commitments by bringing together health and social service professionals on a regional or national basis so that discussions occur at the closest possible level to where the needs exist. At the Nairobi Summit on a Mine-Free World, States will have to face the unique challenges of delivering on the Ottawa Convention’s promises to mine victims and of significantly increasing their ability to make, and record, progress in the coming years.