All the above people have been
injured by a landmine.
Many victims are alone in isolated locations when they are injured.
They may have been collecting wood or thatch or herding animals. They
can lie for hours waiting for help, with shattered bones and severe
bleeding. First the rescuers must negotiate the minefield before they
give any support to a victim. Once basic first aid has been applied
evacuation may then involve a bumpy ride through mountains or jungle
that may take days. ICRC statistics claim that only 25% of mine victims
arrive at hospital within 6 hours of being injured with 15% having to
travel for more than 3 days before they reach a hospital.
A mine victim, besides suffering a physical injury, may also develop posttraumatic stress disorder (PTSD). There are three main symptom clusters in PTSD; (a) Intrusions, such as flashbacks or nightmares, where the traumatic event is re-experienced. (b) Avoidance, when the person tries to reduce exposure to people or things that might bring on their intrusive symptoms. (c) Hyperarousal, meaning physiologic signs of increased arousal, such as hyper vigilance or increased startle response. The onset of PTSD follows the trauma with a latency period which may range from a few weeks to months (but rarely exceeds 6 months). If treated a victim could recover in the majority of cases. In a small proportion of patients the condition may show a chronic course over many years and a transition to an enduring personality change.
CHARACTERISTICS OF HIGH RISK PERSONS
According to the ICRC, those at highest risk of mine injury are the rural
poor. Villagers foraging for firewood and food, herding cattle, or tilling
their fields are particularly at risk. Similarly, when refugees and internally
displaced persons return home they are at a greater risk because they
are now less familiar with their former home environment which is now
changed. In the case of some countries, young men and women are returning
who were actually born in refugee camps and have never seen their parents'
The ratio of death to injury is considerably greater in children, perhaps because their vital organs are closer to the blast and comparatively less protected, and their bodies are less able to withstand blood loss. Those at highest risk of the indirect health consequences of landmines (i.e., waterborne diseases, malnutrition, childhood infections, etc) are again mostly the disadvantaged poor, especially children.
NATURE OF MINE INJURIES
There are three main patterns of injury seen in those landmine victims who survive for long enough to reach hospital. Some mines, by design, kill the person who triggers them; this is the case for the bounding mines which will explode at waist height. Therefore, the proportion of wounded who die or who suffer amputation depends on the type of mine.
BASIC INJURY TYPES
1. The first injury type relates to stepping on a buried anti-personnel mine; that usually results in a traumatic amputation of the foot or leg with severe injury of the other leg, genitalia and arms. This first pattern tends to be the most severe.
2. The second pattern is seen when the victim triggers a fragmentation mine. Their bodies are peppered by hot razor sharp metal fragments. If he or she is not killed immediately they suffer from horrific wounds which can affect any part or all of the body.
3. The third relates to accidental detonation whilst handling
a mine; it is seen among mine-clearers, those planting mines or curious
children who pick up or play with mines. This pattern inevitably involves
severe wounds of the hands and face.
The type of lifestyle an amputee will lead will depend on the severity of their injury. If they have only lost one leg below the knee (BK) then, with the proper prosthetic leg, they will be able to return and carry out most of the same psychical activities as they could do before the accident. This will include walking; running; climbing; planting rice; playing sport, etc. After they have practised their walking and manage to do so without a limp there may be little outward signs of the amputation.
If they lose a leg above the knee (AK) or are a double amputee, then they can expect to be reliant on crutches or a wheelchair for the rest of their lives. This will be very hard, especially in countries like Cambodia, Angola and Mozambique where there are not many pathed roads or paths.
The rescue and first aid procedure involves getting the wounded person out of the minefield and stopping the bleeding. Most bleeding can be stopped by a firm dressing or 'compress'. However, a traumatic amputation may require some sort of tourniquet which must be applied as close as possible to the wound. Many limbs are lost or have to be amputated higher than otherwise necessary because tourniquets are applied too high on a limb and left on for too long.
Anti-personnel landmine injuries account for a disproportionate number of amputations amongst war wounded. Around 82.5% of all amputations performed in ICRC hospitals are for victims of landmines. The average hospital stay for patients with bullet wounds is 18.1 days, but for a landmine injury patient it is 32.3 days. Whereas a bullet wound patient requires on average 1.9 operations and 0.5 units of blood, landmine patients will require 4 operations and 3.2 units of blood.
The surgery of mine-injured patients can be a challenge to even the most experienced surgeon. Wounds caused by landmines are not seen in civilian practice and they do not correspond to any of the modern surgical specialities. They require skilled surgery, large amounts of blood for transfusion, antibiotics, other drugs and prolonged hospitalisation. All dead and contaminated tissue must be taken off, as well as any foreign fragments (such as dirt, plastic casing, bone, etc.) leaving the wound for four or five days before it is closed. A surgical amputation either of an entire limb that is beyond repair or at a point above a traumatic amputation needs to be carried out.
A NEW LIMB
After four or five weeks, when the surgical treatment has been completed,
all the wounds are healed and the swelling of the stump has settled, the
patient is ready to be fitted with an artificial limb (a prosthesis).
The fitting of an artificial limb, which will be with them for life, is
an essential part of the rehabilitation of a mine-injured amputee. In
biological terms, it replaces that part of the organism responsible for
locomotion and fulfils the same function as the lost part. It negates
the need for crutches and thus frees the amputee's hands for the tasks
of everyday living and helps in regaining some of their dignity lost.
For a young active person an artificial limb may need to be replaced every two years. Thus during one amputee's lifetime they may cost the community thousands of dollars. Of course a poor farmer, soldier or villager could not afford these costs, where a weekly wage may be as low of $10 US per week and must depend on international organisations to pay for and supply the materials and expertise.
The focus of rehabilitation has always been on the physical aspects of
disability, which does go some way to supporting amputees psychologically.
However, the need to furnish additional psychological assistance and help
with finding a place in society is too difficult and has largely been
neglected. Little is known about what happens to mine amputees after a
fitting and then later in their lives. In some countries, amputees form
gangs and turn on the society that has rejected them; in others, there
is an unofficial family-or clan-based form of support that the handicapped
people have to organise themselves.
Goliath: Landmines, the Invisible Goliath, Paul Hubbard & Joseph Wehland July, 1997, http://library.thinkquest.org/11051/history.htm
Coupland, Robin M., Assistance for Victims of Anti-persoinnel Mines: Needs, Constraints and Strategy. ICRC Geneva, August 1997.