SDG 3: Good Health and Well-Being
3.1.1 – Number or proportion of health facilities damaged or destroyed by explosive weapons
There were no health facilities damaged or destroyed by the landmine explosion in Wacha Khwara.
There is no direct global study of landmine-specific attacks on health facilities, However, in Afghanistan, one of the most heavily mined countries in the world, landmines have rendered many public buildings inaccessible. In 2012, the government revealed that 8,300 public buildings, including health facilities, were unusable due to the presence of landmines, affecting 623,000 people.
More specifically anti-personnel mines were found within 200m of six different health facilities, limiting the access of 2,900 people.
3.1.2 – Number of health workers killed or injured by explosive weapons, disaggregated by gender
There were no health workers killed or injured by the landmine explosion in Wacha Khwara.
Health workers are frequently at risk in conflict zones. If the workers are being funded by foreign governments or NGOs this can fuel the idea that said workers are agents of a foreign interest, thereby exacerbating the danger and hostility they may face.
At the beginning of 2013, in Pakistan, there was a spate of attacks against polio vaccination workers. This was due to a rumour spread by Pakistani Taliban leaders that the vaccination drive was a cover for an American spying operation.(This rumour was made more believable by the scandal of the US government previously using a vaccination programme to identify Osama bin Laden). In January 2013, two polio vaccination workers were killed by a landmine in the remote tribal Kurram region. Officials said that healthcare workers Muzamel Hussain and Akbar Badshah had been administering the vaccine drops to children in the village of Malikhel and were on their motorcycle when a mine in the road exploded. It was unclear whether they were specifically targeted but it was the third attack against polio workers in Pakistan that week.
3.1.3 – Shortages in essential medical supplies
There were no reported shortages in medical supplies. Faiqa was transferred from a civilian to a military hospital to have her leg amputated. Whether this was due to a lack of supplies is unclear.
In mine-afflicted areas of Pakistan, there are no specialised medical facilities for landmine or explosive violence victims and local hospitals are not equipped to adequately deal with such injuries. According to the SPADO this is due to a lack of trained staff, medicines, equipment, ambulances which all stems from underfunding and non-existent infrastructure in these regions.
Often, landmine victims lose one or more limbs and also a great deal of blood which must be replaced immediately. However, the typical areas that landmine explosions occur, in rural conflict-zones, are also areas where blood-bank capacity is severely limited, both due to their remoteness from urban areas but also their proximity to conflict.
3.1.4 – Number or proportion of ambulances destroyed (locally)
There were no ambulances destroyed by the landmine explosion in Wacha Khwara.
Ambulances that operate in landmine contaminated areas are at risk. In September 2020, an ambulance in Mali, carrying six women, one of whom was pregnant, hit a landmine with all passengers being killed.
An eerily similar incident occurred in March 2021 when an ambulance carrying a pregnant woman and five passengers hit a landmine in Burkina Faso, near the border with Mali. All the passengers were killed.
Both incidents have been linked to heightened Islamist activity in the region.
3.2.1 – Number or proportion of health facilities with service disruptions
There were no reports of service disruptions attributed to the landmine explosion in Wacha Khwara.
Landmines make certain areas inaccessible. As such, community-based health teams can be prevented from carrying out their work. Conversely, according to UNMAS, landmine contamination has consistently prevented civilian access to hospitals in Iraq. This means infectious diseases are likely to spread more freely in areas that health workers and civilians cannot access each other.
3.2.2 – Health worker density and distribution per 10,000 population, compared with pre-conflict
There were no reports of impacts to health worker density attributed to the landmine explosion in Wacha Khwara.
Pakistan has one of the lowest densities of health workers in the world, with essential health professional (physicians, specialists, nurses, lady health visitors (LHVs) and midwives) density of 1.4 per 1,000 population, which is much below the World Health Organisation’s recommendation of 4.45. There is no available disaggregated data on how landmines impact health worker distribution. However it is worth further investigation whether a country with such a shortage would prioritise the deployment of health workers into hard to reach, heavily mined areas.
3.2.3 – Difference in proportion of births attended by skilled health personnel, compared with pre-conflict
There were no reports of impacts to births attended by skilled health personnel attributed to the landmine explosion in Wacha Khwara.
In Yemen, the nation with the sixth highest landmine casualty count, maternity care resources have been significantly impacted by the conflict. As reported by UNICEF, between 2015-18, only 3 in 10 births took place in health facilities. And even those who make it to hospitals will find them struggling with even basic resources. As of 2019, only 51% of health facilities were fully functional, and nearly all suffered severe shortages of medicines, equipment and staff. One in every 260 women died during childbirth, and one in every 37 children died in the first month of life. Yemen’s population has suffered from a range of explosive weapons, all of which will have contributed to this precarity in maternal care.
3.2.4 – Difference in proportion of the population with access to affordable medicines and vaccines, compared with pre-conflict
Since the launch of a compensation scheme for landmine victims in the north-west region, medicines and equipment have become more affordable for its recipients. Faiqa’s family was able to buy an air-conditioner to ensure her wound does not become infected in the warm summer months. However, others have reported that they have never received their compensation. Wazir Alam that despite showing their medical documents he has been refused what he is owed by the local government. “They send us away saying we didn’t lose our legs to landmine blasts, as if we’re making it up,” he told Dawn.
A study of the social cost of landmines in Afghanistan, Bosnia Cambodia and Mozambique found that the households with a landmine victim were 40% more likely to have difficulty in providing food for the family. This has the knock-on effect of those families struggling to afford the requisite medical expenses. Many landmine victims are forced into begging as a result.
On a national scale, resources that are diverted into assisting landmine victims are, according to the WHO, “not available for other public health measures such as vaccination, sanitation, safe water supply, nutrition and vector control.”
1 – Difference in maternal, neonatal and under-five mortality, compared with pre-attack
2 – Difference in mortality rate attributed to cardiovascular disease, cancer, diabetes or chronic respiratory disease, compared with pre-attack
3 – Difference in reported cases of and number of deaths from preventable diseases such as cholera, measles or polio or changes in the life expectancy of HIV-positive patients, compared with pre-attack
Despite her injuries, Faiqa is otherwise physically healthy. However, her amputation means she is perennially at risk from infection and blood clots. The development of a disease such as diabetes will further complicate this problem. For example, in the US, one-quarter of diabetics suffer from a wound problem in their life. There were no differences in mortality results based on this landmine detonation.
It is worth noting that the majority of the victims of landmines in this area are children.
Despite children bearing the brunt of landmine death and injury in the region, the general trend for the maternal mortality rate (MMR) is one of progress. Nationally, the MMR has dropped by a third between 2006/7 and 2019/20.
A 2020 study that quantified various maternal and child health indicators, found that the scores for antenatal care, facility delivery, skilled birth attendance and oral rehydration therapy were “significantly lower for severe conflict provinces when compared to minimal conflict provinces.” However, any data on this indicator disaggregated by weapon type is unavailable.
A SPADO research paper highlighted how female victims in Pakistan’s landmine-afflicted rural communities suffer the most severe implications from their injuries. “In these areas they contract marriages at a young age, and consider their marital status as one of the most important aspects of their lives. Married women and mothers who are responsible for taking care of their children, cooking, looking after the home and their husband become unable to perform such activities and men in many cases marry another woman. For single women who are disabled, it’s difficult to marry.”
A Brown university study in Colombia found a link between the prevalence of landmine explosions and impaired neonatal health. The study attributed the randomness of landmine attacks with the health impacts, suggesting that the terror felt by mothers in reaction caused issues such as low birthweight and preterm deliveries. It also noted that the more landmine attacks experienced, the lower the use of prenatal care services.
In relation to 3.3.2, preterm babies are susceptible to a range of complications including: chronic lung disease, developmental delays, learning disorders, cognitive deficits, behavioral problems and hyperactivity. So if incidence of landmine explosions does increase the rate of preterm babies, they will likely increase the rate of respiratory disease. Additionally, underweight babies, preterm or not, have a greater chance of developing Type 2 Diabetes.
Away from landmines specifically it is worth noting that a 2020 medical study, that looked at death rates in 193 countries over 27 years, found that conflict led to a significant rise in indirect deaths relating to HIV-AIDS, cardiovascular diseases, tropical diseases, enteric infections, respiratory infections and tuberculosis.
Another study, from 2016, found that rates of polio were higher in countries with political conflict and instability. “Wars and conflict have resulted in the reemergence of polio in countries that were polio-free for decades, and may contribute to the spread of the virus to neighbouring countries,” it concluded. However, the disaggregated analysis of a specific weapon type on these findings has yet to be produced.
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