Summary action points based on findings

• Intensify efforts to improve access to rehabilitation services from remote and rural areas, including allocating resources to bring beneficiaries for rehabilitation and ensuring that transport is available.
• Hold regular disability sector coordination meetings and link victim assistance coordination with the development of disability strategies.
• Improve state support for psychological and social assistance including peer-to-peer counseling and survivor-driven economic indicatives.
• Coordinate for the rapid implementation of recently adopted legislation as well as for existing policies and planning that could hasten developments in the availability and accessibility of services.

Victim assistance commitments

Lao People’s Democratic Republic (PDR) is responsible for significant numbers of cluster munition victims and survivors of other explosive remnants of war (ERW), as well as landmine survivors, who are in need. Lao PDR has made commitments to provide victim assistance through the Convention on Conventional Weapons Protocol V and has victim assistance obligations under the Convention on Cluster Munitions.

Lao PDR ratified the Convention on the Rights of Persons with Disabilities (CRPD) on 25 September 2009.

Casualties

Casualties Overview

The National Regulatory Authority for Unexploded Ordnance/Mine Action Sector in the Lao PDR (NRA) reported 45 casualties from ERW for 2014. The majority of casualties were children (28; 21 boys and seven girls), and among the 17 adult casualties there were 12 men and five women.[1]

The casualty total for 2014 represented a slight increase from 42 casualties in 2013,[2] although a trend in the continuing reduction in annual mine/ERW casualties remained—from 56 casualties for 2012, 99 casualties recorded for 2011, and 117 casualties for 2010.[3]

By the end of 2014, the NRA had reported at least 50,570 mine/ERW (including unexploded submunitions) casualties, including 29,522 people killed and 21,048 injured since 1964. The first phase of a nationwide casualty survey recording retrospective data was completed in 2008. It identified 50,136 mine/ERW casualties; of these, ERW caused the most casualties, followed by landmines, and then unexploded submunitions.[4] Lao PDR reported 702 mine/unexploded ordinance (UXO) victims from 2008 to 2013, of which 41% were children.[5]

Cluster munition casualties

Unexploded submunitions were reported to have caused 7,628 casualties in the period 1964–2014.[6]

Victim Assistance

In 2012, Lao PDR has estimated that there were some 15,000 mine/ERW survivors still living, including approximately 2,500 survivors of unexploded submunitions.[7]

Victim assistance since 1999[8]

The assistance provided to survivors in Lao PDR remained inadequate throughout the period.[9] Mine/ERW survivors represent a significant proportion of persons with disabilities in Lao PDR. Most survivors come from the poorer remote areas, belong to ethnic minorities, and are disproportionately disadvantaged by the existing limitations in the provision of services. In Lao PDR, financial constraints are the main barrier to accessing healthcare.

Emergency medical care throughout Lao PDR remained inadequate to meet survivors’ needs for most of the period. However, progress was made with the development of a system of village health volunteers, in addition to a project involving the Asian Development Bank and the Ministry of Health that improved primary healthcare services in northern provinces by 2008.[10]

Victim assistance under the Vientiane Action Plan 2011–2015

In 2011, it was reported that there was a continuing lack of access to health services in Lao PDR. The healthcare system remained underdeveloped and under-funded; health workers had inadequate skill levels. This directly contributed to shortfalls in the quality of services across the health system.[11]

Due to the large number of mine/ERW survivors with disabilities in Lao PDR, the Ministry of Health worked extensively on victim assistance and rehabilitation in coordination with international NGOs.[12] Association for Aid and Relief Japan (AAR) and the Ministry of Health improved the availability of healthcare to survivors significantly in Xiang Khouang province from 2010 through June 2014.

Physical rehabilitation services, run by the government in association with the Cooperative Orthotic and Prosthetic Enterprise (COPE), showed improvement. COPE covered the majority of the necessary costs for those receiving treatment. With an outreach program introduced in 2009, COPE was better able to reach survivors in rural areas. COPE continued “COPE Connect,” its outreach and community awareness-raising initiative. However many survivors were unable to reach the available services.[13]

There was limited psychosocial support for mine/ERW survivors. However, peer support increased from 2010 in some districts. From 2013 psychological support increased significantly in Xieng Khouang province with the work of World Education. Social and economic reintegration programs for mine/ERW survivors, provided by NGOs, remained limited but had increased since 2009. Regulations protecting persons with disabilities from discrimination and requiring accessible buildings either did not have the force of law or were extremely slow to be adopted.

World Education, AAR, and Catholic Relief Services (CRS) provided first aid training for healthcare workers and village health volunteers. In 2013, the NRA, Ministry of Health, international NGOs, and organizations that have provided training for village health volunteers in the past, met and started discussions on developing the first National First Aid Curriculum.[14]

In 2014,Lao PDR reported that it still has “a long way to go to provide support to survivors and their families. Beyond meeting their immediate emergency medical needs, very few survivors receive adequate physical, psychological, or economic support.”[15] During the year the quality of physical rehabilitation improved, according to people who used the services. Psychological support increased in the most ERW-affected areas.

Assessing victim assistance needs

The NRA Survivor Tracking System, a system for collecting data on new casualties, was designed to provide an ongoing survey of all survivors’ needs. The survey continued to be conducted in 10 provinces. By the end of 2014, all individual tracking forms had been received and the data was entered into the NRA database. The data is intended to be shared with stakeholders, including civil society organizations, for use in the preparation of work plans and funding requests relevant to addressing the needs of survivors.[16] In addition to the 10 provinces covered by the survivor tracking system, there are known to be mine/ERW survivors in the capital Vientiane. However, most of these are believed to be former military personnel who, as veterans with disabilities, are entitled to special social protection measures and are likely already covered by those systems.[17]

World Education maintained its own detailed beneficiary database and information storage system. Its Victim Assistance Support Team (VAST) staff, including a data specialist, also had training on the Information System for Mine Action (IMSMA) used by the NRA and were able to make the data compatible.[18]

Handicap International (HI) and national disabled persons’ organizations (DPOs) supported the adoption of the so-called Washington Group questions relating to disability in the 2015 national census.[19] The census was conducted in March 2015.

In the period 2008–2010, the NRA, working closely with the Ministry of Labor and Social Affairs, held workshops in 17 provinces to build a national focal point reporting network. In 2013, changes in administrative coordination placed these positions under the responsibility of the prime minister’s office, creating a need to train new staff. However, those people trained by 2010 still maintained contact with the NRA victim assistance section and provided information to the unit for victim assistance throughout 2014.[20]

Victim assistance coordination in 2014

Two meetings of the TWGVA were held in 2014; participants included the NRA, other relevant government agencies, national and international NGOs, and survivors.[21] The NRA shared victim assistance information with stakeholders, attended meetings of actors in the disability sector and made presentations to regional meetings, and represented the Lao PDR government on victim assistance issues while working with NGOs to build capacity for stronger leadership in both victim assistance and disability issues. Victim assistance remained a minor component of the work of the ministries responsible for disability issues and it was, therefore, challenging to get victim assistance into the ministries’ agendas and strategies.[22]

A new Victim Assistance Strategic Plan was adopted in February 2014 with approval from the NRA Board,[23] after being completed in March 2013.[24] The strategic plan addresses seven sections of victim assistance implementation: data collection; medical care; physical rehabilitation; psychological support and social inclusion; economic rehabilitation and education; legislation and policy; and coordination.[25]

The Victim Assistance Strategy authorizes the NRA to support the National Committee for Disabled and Elderly People (NCDE) to:

• develop a sector-wide strategy for persons with disabilities, including ERW survivors;
• cooperate with the Ministry of Labor and Social Welfare to ensure adequate vocational and other training is provided; and
• cooperate with the Ministry of Health to ensure that the physical and psychological needs of cluster munition victims and other survivors are more adequately met.[26]

As a coordination measure, service providers enter into memoranda of understanding (MoUs) with the relevant state ministries responsible for the sector in which the NGOs will operate. World Education has MoUs with the Ministry of Health and the Ministry of Education; COPE with the Ministry of Health; and HI with the Ministry Labor and Social Welfare.[27]

The Ministry of Labor and Social Welfare holds primary responsibility for the needs of, and related services to, persons with disabilities through the NCDE previously the National Committee for Disabled People, NCDP. (The title and responsibilities changed in September 2013).[28] The disability sector required far greater coordination and international backing. There were no official disability coordination meetings for all stakeholders or UN focal personnel appointed for the support of addressing disability issues.[29]

In April and May 2014, eight DPOs met to discuss the situation of persons with disabilities in Lao PDR and drafted a report to submit for the Universal Periodic Review (UPR). The report noted many issues relating to coordination, including the following: frequent changes of designated disability focal points within ministries due to staff turnover hindered the effective coordination of disability rights measures across government departments; there were no guidelines for government departments that ensure participation of persons with disabilities in policy processes; a lack of resources for DPOs and high competition between DPOs seeking funding impeded their ability to represent their members at policy level with the government; sustainable core funding to DPOs was identified as a priority for improved coordination.[30]

In November 2014, HI with the Lao Disabled People’s Association (LDPA) and NCDE organized a three-day strategic planning workshop, including participation of national and regional actors, to support initial brainstorming for the development of a national disability strategy and action plan to guide the implementation of the Disability Decree adopted earlier in that year. The final day of the workshop was dedicated to developing national strategy and action plan drafting.[31]

In early 2015, World Education held multi-stakeholder consultations in the process of implementing its multi-year USAID-funded Training, Economic Empowerment, Assistive Technology, and Medical and Physical Rehabilitation (TEAM) project. Overall, TEAM is designed to enable persons with disabilities, especially women and girls, to attain and maintain maximum independence and to fully participate in all aspects of life on an equal basis with others. The TEAM project is designed to develop the very limited medical and rehabilitative services available to persons with disabilities and improve their access to employment opportunities. In the first round of grants through the TEAM program, seven partner organizations were receiving sub-grants as support to implement projects to full the programs measurable objectives: CRS, HI, AAR, LDPA, Association for Autism (AFA), Lao Disabled Women’s Development Centre (LDWDC), and the Quality of Life Association (QLA)–Xieng Khouang province.[32]

Each ministry in Lao PDR also develops five-year plans that contributes to a national development plan. The ministries of Health and Labor and Social Welfare can build disability-specific objectives into these plans.[33]

Victim assistance is one of the three main components of the NRA strategy entitled “Safe Path Forward II 2011–2020.”[34] Two of the six strategic objectives relate to victim assistance, including: reduce the number of UXO casualties from 300 to less than 75 per year; and ensure that the medical and rehabilitation needs of all UXO survivors are met in line with treaty obligations. The latter was assigned a series of actions that began to be implemented in 2012, including setting up and maintaining a Lao Victim Information System (LVIS), strengthening physical rehabilitation services, providing emergency medical response at the village level, and developing an effective rural transfer/ambulance system to medical facilities.[35] The strategy and its victim assistance component were included in Lao PDR’s Millennium Development Goals Compact of 2010.[36] A key indicator for progress under these Millennium Development Goals includes “the number of survivors receiving proper assistance.”[37]

In 2014, Lao PDR reported on victim assistance in its Convention on Cluster Munitions Article 7 report, and made statements on victim assistance at the Meeting of States Parties to the Convention on Cluster Munitions in San Jose in September.[38]

Inclusion and participation in victim assistance

In 2014, survivors, persons with disabilities, and their representative organizations participated in TWGVA meetings and in the implementation of services. Representatives of the LDPA, Lao Ban Advocates, LDWDC, and QLA–Xieng Khouang province, actively participated in consultative processes and special events, including annual review meetings and ERW sector-wide working group meetings.[39]

HI’s Lao Ban Advocates project ended in March 2015. A final project workshop was held in February.[40]

Lao PDR has never included a survivor on its delegation for the Convention on Cluster Munitions Meetings of States Parties or intersessional meetings.

Service accessibility and effectiveness

Victim assistance activities[41]

Emergency and continuing medical care

The availability of emergency care and continuing medical care increased in 2014, with 42 survivors newly assisted by, World Education financed via the United States (US) War Victims Medical Fund, compared to 28 in 2013.

World Education provided medical support for survivors directly in seven provinces, but was available to provide assistance to all new survivors across all provinces of Lao PDR, when requests are made by the NRA. The program reimbursed hospitals for the cost of survivors’ treatment.[42] The War Victims Medical Fund provided initial medical assistance to patients and continuing medical care funding in 2014.[43]

Physical rehabilitation including prosthetics

In 2014, the Centre for Medical Rehabilitation and associated physical rehabilitation centers, with financial and technical support from COPE, provided over 1,000 services (560 for men, 209 for women, 172 for boys, and 127 for girls), with mine/ERW survivors making up 20% of the total. There were 522 prosthesis delivered to beneficiaries that year.[44]

Since the COPE Connect outreach program started in 2009, teams assessed over 3,000 people. Overall, a quarter of assessed patients accessed COPE-supported services. A similar number received referrals to other services. Female patients made up 40% of the total accessing services through the program. The percentage of female beneficiaries increased significantly in 2013 and 2014 compared to previous years.[45] COPE established networks with provincial health departments, district health offices, district hospitals, and village and community health workers, and trained local professionals in identification and referral. Clinical assessment teams also travelled to remote and rural areas and referred persons with disabilities to appropriate services.[46]

In 2014, COPE Connect spent additional time on follow-up interviews with patients who had already received assessments and referrals. This was done to better understand the paths and obstacles to access. The assessment was carried out to ensure both the quality and suitability of services. The interviewees were not recorded as outreach beneficiaries and, as a result, in 2014, the number of people recorded as accessing services through outreach was lower than previous years.[47]

The results of an independent client service satisfaction survey of COPE beneficiaries in 2015 found clients were satisfied overall with the service and assistive device they had received. Respondents to the evaluation in 2015 reported even higher levels of satisfaction than in 2014. The survey found that most assistive devices provided were being used and were in good condition. The most common reasons for not being highly satisfied were similar in both years and included length of time waiting, repairs, and expectations for follow-up. As such, concerns may be due to unrealistic expectations. Recommendations included integrated client counseling to improve understanding of services and devices available. This survey process was also important because reports of good services by past beneficiaries in their communities would lead to further use of referrals systems by survivors and other persons with disabilities.[48]

Economic and social inclusion and psychological support

Disability-specific vocational training available to persons with disabilities was limited. The qualifications provided by these services were generally not accredited or officially recognized equally by other government vocational training programs.[49] In 2014, World Education provided livelihoods training specifically for survivors. AAR also increased its support for livelihoods activities for persons with disabilities.[50] The ICRC provided livelihoods support for UXO victims survivors and their families in southern Laos, through income-generating activities.[51]

HI initiated a project to support persons with disabilities, including survivors and their family members, with income-generating and livelihood activities.[52]

Psychological support was generally not available in Lao PDR. There were only one or two psychiatrists in the country. Where mental health services did exist in the capital they were medical-based. Community-based services were not widely considered as a possible form of assistance. Disability organizations lacked knowledge on mental health issues and DPOs did not have the expertise to provide mental health services. World Education’s integrated victim assistance project, carried out by its Victim Assistance Support Team (VAST), mapped services and provided individual support to survivors to address psychologic and other needs, including referrals to services. To address depression, recognized among some survivor beneficiaries, World Education held a peer support meeting.[53]

QLA, with ongoing support from World Education, provided peer support in conjunction with other project activities, including livelihoods projects in Xieng Khouang province.[54] The NGO Basic Needs provided some psychological support services and built the capacity of the mental health system.[55]

LDPA and AAR organized wheelchair basketball events and training as a social inclusion measure. There was also a women’s team, however, getting women to join was noted as a challenge to be addressed.[56]

Laws and policies

The Decree on the Rights of Persons with Disabilities was finally approved and adopted on 18 April 2014. It had been prepared at the beginning of 2008, submitted to the Ministry of Justice in July 2012, and passed to the Cabinet in November 2012. The Decree on the Rights of Persons with Disabilities (Decree No. 137) was adopted alongside the Decree on the Organization of Operation of National Committee for Disabled People and the Elderly (Decree No. 232) of Lao PDR, thereby establishing a mechanism for coordination of implementation with the new NCDE.[57]

In 2014 and into 2015, HI supported efforts to establish strategic planning for implementation of the Decree on the Rights of Persons with Disabilities at national and local levels. It also carried out workshops for awareness-raising and the development of local action plans.[58]

The Ministry of Labor and Social Welfare established regulations regarding physical accessibility, and some ramps were built in Vientiane. Legislation adopted in 2009[59] requires that the construction of buildings, roads, and public places provide facilities for persons with disabilities. The law does not mandate accessibility to buildings built before its enactment.[60] It does, however, provide a list of access requirements that must be complied with in all public facilities. Yet construction companies were not always aware of these regulations and there was no enforcement mechanism to ensure compliance. Most public buildings were not modified or adapted, which limited persons with disabilities’ access to public services and employment. Public transport infrastructure was mostly not accessible.[61]

Social protection programs support war veterans with disabilities unable to work, however there were no social protection programs to support other persons with disabilities in similar situations. DPOs recommended that social protection programs should be extended to include all persons with disabilities.[62]