Summary action points based on findings

• Provide follow-up to address the needs identified by survivors surveyed since 2013;
• Identify and evaluate the needs of persons with disabilities who live in remote rural areas, including survivors;
• Significantly improve the availability of rehabilitation services;
• Apply the knowledge developed though Albania’s victim assistance program to create small-scale affordable prosthetics and rehabilitation services throughout the country;
• Make sustainable the existing health and prosthetics services in the mine-affected northern region;
• Identify funding for economic inclusion opportunities.

Victim assistance commitments

The Republic of Albania is responsible for landmine survivors, cluster munition victims, and survivors of other explosive remnants of war (ERW). Albania has made commitments to provide victim assistance through the Mine Ban Treaty and Convention on Conventional Weapons Protocol V, and has victim assistance obligations under the Convention on Cluster Munitions.

Albania ratified the Convention on the Rights of Persons with Disabilities (CRPD) on 11 February 2013.

Cluster munitions casualties

There have been at least 55 cluster munition casualties in Albania. The Kukës database recorded 53 casualties from cluster munition remnants (nine killed; 44 injured).[1] Two additional casualties, due to the use of cluster munitions, were also identified.[2]

Victim Assistance

There are at least 841 mine/ERW survivors, including those injured by abandoned explosive ordinance (AXO), in Albania.

Victim assistance during the Cartagena Action Plan 2010–2014 and Vientiane Action Plan 2011–2015

Victim assistance activities were coordinated and monitored by AMMCO and carried out in cooperation with implementing partners including ALB-AID, the Ministry of Health, Ministry of Welfare and Youth, Kukës Regional Hospital, Directorates of Public Health, UNDP

Albania, International Trust Fund Enhancing Human Security (ITF), and the University Rehabilitation Institute Republic of Slovenia.

Immediately after Albania was declared mine-free in 2009, international funding for victim assistance was drastically reduced. Although much was said about linking mine action to development, no funding was made available for such activities.[3] Economic inclusion and psychological support remained the most serious needs of survivors. Overall, widespread poverty, unregulated working conditions, and poor medical care posed significant problems for many persons with disabilities.

A five-year project to build capacity in the rehabilitation sector through the training of physiotherapists and the establishment of a prosthetics workshop in the mine-affected area was successfully completed by 2012. Some delays in implementation were attributed to general difficulties experienced by the overall healthcare reform process in Albania. However, a teaching program for physiotherapy was successfully established and integrated into the state Nursing Faculty. ALB-AID (formerly VMA-Kukës, founded in November 2000) provided direct victim assistance, including economic inclusion.

Services provided by state institutions to persons with disabilities, including mine/ERW survivors, improved in the cities of Albania in 2010. Most survivors received some support from the Ministry of Social Welfare and Youth. However, despite improvements, available support was insufficient to meet the basic needs of survivors and all other disabled persons in Albania, particularly in the areas of employment and economic inclusion.[4]

In 2011, the main victim assistance provider in Albania, ALB-AID, continued to implement victim assistance programs at an extremely reduced level due to decreased funding, with just one economic inclusion project that continued into 2012. In other parts of Albania, except the Gerdec munitions storage explosion site, ALB-AID was not able to provide direct services to survivors due to the lack of funding.[5]

A study on the transition of internationally supported mine action to national ownership noted that Albania’s victim assistance program had the capacity to expand its focus beyond the mine-affected northern regions, and to the site of the Gerdec munitions storage explosion, to assist survivors of explosive ordnance and other persons with disabilities throughout the country.

The five-year collaborative project to support Albania in developing a national physical medicine and rehabilitation (PMR) system concluded in 2012. The Nursery Faculty of Tirana continued to implement a sustainable program of physiotherapy training into 2015.

However, rehabilitative medicine remained at the beginning stage in Albania and was far from meeting the needs of survivors and other persons with disabilities. Some rehabilitation, mainly physiotherapy, was offered by small private clinics and professionals. More structured private services offered rehabilitation with other forms of therapy in addition to physiotherapy.[6]

ALB-AID developed a project to build a sustainable survivors network in 2012, and simultaneously began planning to undertake needs assessment surveys in order to expand opportunities to access physical rehabilitation services for ERW survivors and amputees in other parts of the country. In 2013, ALB-AID, with help from the Albanian Mines and Munitions Coordination Office (AMMCO), began conducting assessments of socioeconomic and health needs of marginalized UXO/AXO victims within the framework of the Albanian Mine Action Programme (AMAP).[7]

These survey projects resulted in detailed, consolidated socioeconomic data on survivors and their needs that was shared with Albanian line ministries and local municipal service providers for social support services. The project also raised awareness among local government institutions (social welfare departments) of their responsibilities to address the need for social and economic inclusion of UXO/AXO survivors.

Assessing victim assistance needs

Data on all people injured by cluster munitions in Albania is disaggregated by age and gender.[8] In 2013–2016, a socioeconomic and medical needs assessment of marginalized explosive remnants of war victims in Albania was conducted by ALB-AID in three phases. In total, 979 people were visited and 726 survivors completed the survey. Of the survivors surveyed, 382 were identified from the AMMCO IMSMA data base and 344 survivors were never previously registered and newly contacted. During the first phase in 2013, the survey was conducted in Berat, Durrës, Elbasan, Gjirokastër Korçë, Peshkopi, and (with the support of Austrian Government). During the second phase in 2014, the survey was carried out in Shkoder and Lezhe, and during the third and final phase in 2015, the study was conducted in Tirana, Fier, Vlore, and Kukes. Both the last phases were conducted with the support of United States US) Department of State. The data was then processed and published. The aim of this survey was to promote the improvement of access of victims to medical and socioeconomic services provided by public and private, central and local operators, including different national and international institutions and associations.[9]

ALB-AID utilized capacity from both its survivor network and the personnel who had worked at the unplanned munitions explosion area of Gerdec to survey survivors, some of whom live in extremely remote areas.[10]

Victim assistance coordination[11]

AMMCO is responsible for the coordination of victim assistance activities, resource mobilization, and liaising with the government. AMMCO’s mandate continued to involve expanding Albania’s existing victim assistance program to include other UXO/AXO survivors and persons in need of assistance.[12]

The objectives of Albania’s National Victim Assistance Plan were aligned with the Mine Ban Treaty, Convention on Conventional Weapons (CCW), Convention on Cluster Munitions, and CRPD and designed to contribute to the enhancement of emergency and continuing medical care, physical rehabilitation, psychosocial support, socioeconomic inclusion, and data collection, as well as to the relevant laws and policies for all mine/ERW survivors throughout Albania.[13] The national Mine Action Plan (2010) aimed to make victim assistance sustainable by building sufficient national capacity and by linking future progress with implementation of the National Strategy on People with Disabilities (NSPWD).[14]

The National Disability Committee formed in 2015 was chaired by the minister of social welfare and included representation from seven disabled persons’ organizations (DPOs) and seven service providers.[15]

Detailed information on victim assistance was reported in Form H of Albania’s Convention on Cluster Munitions Article 7 report for 2015.[16] Albania provided reporting on victim assistance activities in Form J of its Mine Ban Treaty Article 7 report for 2015.[17] Demonstrating effective use of reporting mechanisms, the same victim assistance activities were also reported in its CCW Protocol V and Amended Protocol II reporting.[18] Albania provided a detailed update on victim assistance progress at the Convention on Cluster Munitions First Review Conference in Dubrovnik, in September 2015.[19]

Participation and inclusion

Survivors were represented in victim assistance planning and implementation of services, including the AXO survivor survey, through participation in ALB-AID.[20] A landmine survivor leader was also a representative of a unique political party that specifically represents persons with disabilities.

Service accessibility and effectiveness

Victim assistance activities[21]

Medical care and rehabilitation

In 2015, Albania reported that in most cases inclusive/comprehensive rehabilitation services are not operational, limited in number, and those that do exist are often inaccessible for the majority of persons with disabilities. Therefore, persons with disabilities “have to refer themselves to private services to meet their needs.”[22]

The National Trauma Center, located within the Military Hospital in Tirana, is responsible for treating people with injuries and trauma. Emergency training for doctors and nurses was provided by Turkey, with the aim of creating an improved and modern emergency response capacity. AMMCO communicated with the Ministry of Health during these developments.[23] Kukës Hospital was upgraded with CT  scan equipment in 2015 with support from Japan, and the cardiology unit was upgraded with support from Turkey. With a view to long-term sustainability, the Ministry of Health of Albania provided €45,000 for the production and repair of prostheses for mine/ERW survivors and other persons with disabilities.[24]

At the Kukës Regional Hospital Physiotherapy Unit and at the district hospital in Tropoja, training was provided by the government and NGOs. In 2015, the Prosthetic Workshop at the Kukës Regional Hospital was upgraded with new equipment and raw materialsThe Kukës prosthetics workshop produced 30 new prostheses and made 91 major repairs for survivors and other amputees in 2015, similar in number to 2014. The Nursing Faculty of Tirana continued to implement its program of physiotherapy training 20 students graduated in 2014, and 25 more were registered for 2014–2015.[25]

A physiotherapy education program based on European standards continued to be implemented by the Nursing Faculty of Tirana.[26]

Economic and social inclusion and psychological support

Generally, resource constraints and a lack of infrastructure made it difficult for persons with disabilities to participate fully in many social activities. Governmental social services agencies were often unable to implement their programs due to a lack of funding.[27] Albania identified a need for US$145,000 to implement vocational training and career development for survivors and their family members in the period 2016–2017.[28]

In 2015, the Albanian Disability Rights Foundation (ADRF) was assisting local governments with action plans for enhancing the employment of persons with disabilities on the basis of new national legislation. It also held capacity-building workshops on the issues, including one in Kukës.[29]

National laws and policies

Many persons with disabilities lived in isolation and suffered social exclusion, lacking services to enjoy the right to live independently and be included in the community. In 2014, a civil society submission to the Universal Period Review (UPR) highlighted issues that women with disabilities are among the most disadvantaged in Albania and subject to multiple forms of discrimination. In particular, women with disabilities in remote and rural areas, and older women with disabilities, were socially isolated and often faced violence and abuse within the family.[30] In 2016, the following recommendations regarding women with disabilities were made in relation to the implementation of the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW):[31]

• Conduct in-depth studies on the specific needs of women with disabilities in the field of health. Increase access to healthcare services for women with disabilities by assessing needs and abilities these women have to benefit from services.
• Include issues of women with disabilities in labor legislation and health workers’ protocols. Women with disabilities to be actively involved in developing and implementing programs, policies and protocols related to health and social issues.
• Create specific measures for identification, treatment, and protection for women with disabilities who are at risk of, or victims of, abuse.
• Establish a system of indicators based on gender and disability to monitor the implementation of disability and gender equality strategies. 

In July 2014, Albania adopted Framework Law No. 93/2014 “On the Inclusion of and Access for People with Disabilities.” The law promotes and protects the rights of persons with disabilities through the provision of assistance and support with a view to affording them full and effective participation in society on an equal basis with others. Non-discrimination and gender equality are two key principles of the law. The new law includes provisions for the establishment of a State Committee for Persons with Disabilities composed of representatives of different ministries and civil society organizations.[32] Some NGOs criticized the law because they asserted it would transfer some powers from civil society organizations to the government.[33] The government created the committee for persons with disabilities in February 2015. Albania has social services agencies to protect the rights of persons with disabilities, but the agencies often lacked funding to implement their programs. Resource constraints and lack of infrastructure made it difficult for persons with disabilities to participate fully in civic affairs.[34] Of the AXO/UXO survivors surveyed by ALB-AID, 37% (271) reported that they did not have access to daily social activities or rehabilitation and education services for persons with disabilities due to a lack of infrastructure for persons with disabilities.[35] 

Secondary legislation for the 2014 law on inclusion of persons with disabilities contained a sub-act of incentives for the employment of persons with disabilities, including six full salaries after which 50% of salary is provided through government support and coverage of employees’ social insurance. The package and other economic inclusion initiatives for persons with disabilities were supported by USAID.[36]

Albania submitted its initial CRPD Article 35 report, as approved by decree no. 460 in May 2015. The CRPD reporting notes that for many years the UNDP has provided support to the government of Albania for enhancing healthcare, rehabilitation, and social and economic reintegration of mine/ERW survivors in the northeastern region of the country, through the Mine Action Plan.[37]

Legislation prohibited discrimination against persons with disabilities in employment, education, access to healthcare, and the provision of other state services. However, service providers did sometimes discriminate against persons with disabilities. The law mandated that new public buildings be accessible to persons with disabilities, but this was not regularly enforced.Widespread poverty, unregulated working conditions, and poor medical care posed significant problems for many persons with disabilities.[38] Persons with disabilities continued to face difficulties in accessing education, employment, healthcare, social services, or decision-making.[39] The People’s Advocate (ombudsperson) identified problems faced by persons with disabilities in Albania, including that legal provisions for the employment of persons with disabilities were not applied and persons with disabilities living in remote rural areas sometimes did not benefit from social and healthcare services. Persons with disabilities lacked access to public urban transportation, public and private premises, and governmental structures at central and local level.[40]

Previous delays in disability and pension payments were addressed. Pension reforms occurred in July 2014. In 2015, disability payments were linked to the consumer price index.[41] Changes in legislation that altered the criteria for disability pensions affected some persons with disabilities adversely.

Survivors’ representatives reported that due to the amendments of July 2014, access to the disability pension was reduced for many mine/ERW survivors. This was a result of instructions on the implementation of the legislation, issued by the Ministry of Health and Ministry of Social Welfare and Youth, restricting the granting of pension to double amputees.[42]

Law No. 54/2012 amending the Law on Social Programmes for Housing Inhabitants in Urban Areas prioritizes the housing needs of women with disabilities, among other vulnerable groups of women.

ADRF and the Civil Rights Defenders organization published a monitoring report on the Law on Protection against Discrimination in the Field of Disability, and a survey report on Objectives in the Governmental Program and Plan for Disability, both in December 2014.