Casualties Overview

For 2011, the Monitor identified at least 812 casualties due to mines, victim-activated improvised explosive devices (IEDs), and explosive remnants of war (ERW) in Afghanistan. Mines of all types, including victim-activated IEDs, caused the most casualties (436). The vast majority of casualties in 2011, 716 or some 88% of the total, were civilian. Children (373) made up at least 52% of the civilian casualties where the age was known.[1] At least 49 civilian casualties were girls and 51 were women. There were 71 military casualties, including two women.[2] Clearance accidents caused 25 casualties among deminers.

Media monitoring identified 331 casualties of victim-activated IED/undefined mine types  in 2011,[3] a slight decrease from the 383 casualties recorded in 2010, which had marked a rise of more than 30% from 2009. In 2011, the UN Assistance Mission in Afghanistan (UNAMA) was quoted as saying that “two-thirds of all IEDs used in Afghanistan, and the vast majority that kill civilians, are designed to be triggered by a weight of between 10-100 kilograms,”[4] which places them clearly within the definition of anti-personnel mines.[5]

This total of 812 casualties identified in 2011 was a significant decrease from the 1,211 (33%) mine/ERW casualties the Monitor identified for 2010 but similar to the 859 casualties recorded for 2009.[6] The Mine Action Coordination Center of Afghanistan (MACCA) recorded 433 mine/ERW casualties for 2011; this was some 34% less than the 661 casualties that MACCA recorded for 2010.[7]

The ICRC recorded beneficiaries who were injured by mines/ERW. However, this information was not collected by the casualty data collection system and these appeared to be unique casualties which had not been included Monitor totals.[8] Based on field knowledge during the year, Handicap International (HI) regarded that it was more difficult to access casualty data and so the number of casualties in 2011 had likely not declined as compared with 2010 despite available casualty figures.[9]

Cluster munition casualties

Some 745 casualties of cluster munition remnants were recorded between 1980 and the end of 2011. In addition, at least 26 casualties during cluster munitions strikes have been recorded.[10]

MACCA reported that between 1979 and 2011 there have been a total of 21,100 mine/ERW casualties recorded (17,097 people injured, 4,003 killed).[11]

Victim Assistance

The total number of survivors in Afghanistan is unknown but, in 2006, was estimated to be 52,000–60,000.[12]

Victim assistance since 1999[13]

Access to victim assistance in Afghanistan was hampered by a severe lack of services, poor to non-existent infrastructure, ongoing conflict, and poverty. However, Afghanistan did make progress in victim assistance and disability issues, supported by significant international funds that were needed to improve services and conditions. A lack of coordination among donors funding services for persons with disabilities alongside other competing priorities for assistance was identified as a challenge. Ministries demonstrated more national ownership of services for persons with disabilities, which were integrated into ministry policies and strategic planning with the assistance of MACCA. National NGOs, disabled person’s organizations (DPOs), and survivors’ organization became increasingly active and participated regularly in disability coordination.

Movement restrictions (due to conflict, lack of roads, and the cost of transport) were persistent obstacles to victim assistance in some parts of the country that continued through 2011. Geographic coverage of healthcare expanded. Physical rehabilitation coverage remained insufficient despite improvements. Physical rehabilitation services were almost entirely operated by international NGOs and the ICRC under the coordination of the government. Psychosocial support services increased from almost non-existent, as did peer-to-peer support, though they were still insufficient to meet demand. A community-based rehabilitation (CBR) network grew and became better coordinated. Economic reintegration projects were limited and conducted mostly by NGOs, under the coordination of relevant ministries, while ministries paid some disability pensions and ran some vocational training. Inclusive education has increased since 2008. Disability legislation was adopted, but parts of the legislation were discriminatory against persons with disabilities.

Assessing victim assistance needs

No new survey or needs assessment was conducted for mine/ERW survivors in 2011. Existing data was used to support the delivery of services to survivors. MACCA supported the key government ministries to produce quarterly and annual reports from service providers and government implementing partners. In 2011, the Ministry of Public Health (MoPH) developed both a standard for the reporting of physical rehabilitation data and a format for the collection of that data; these were also used by organizations working for person with disabilities or implementing healthcare. Data was used by MACCA and the ministries for planning, strategies, policy development and reporting.[14] In May 2012, Afghanistan reported that it was “working on tools to help us track and report on disability services more effectively.”[15]

The Ministry of Labor, Social Affairs, Martyrs and the Disabled (MoLSAMD) started a pilot survey project of persons with disabilities in three provinces (Nangarhar, Logar and Bamyan provinces). The registration of people with war-related disabilities at MoLSAMD, including survivors, was ongoing; data was used to refer people to a disability commission where they would be assigned a category for determining their disability pension or compensation payment.[16]

Several service providers collected information for their own programs. The Afghanistan Red Crescent Society (ARCS) in southern Afghanistan and the provincial and regional hospitals also submitted data to the Area Mine Action Centers (AMAC).[17] Community Based Mine Risk Education teams from HI collected data on mine/ERW casualties in Helmand and Kandahar province, which was shared with the regional AMAC and the MACCA.[18] In order to inform its work plan, Clear Path International (CPI) collected program-specific data records concerning survivors, other persons with disabilities, and the general community in the regions where its partners implemented programs; this data was collected to assess changes in knowledge, attitude, and behavior; in the quality of life; and in daily living activities.[19]

ICRC centers continued to register and assess all survivors assisted; information was used to make appropriate referrals to rehabilitation, economic and social inclusion activities.[20]

Victim assistance coordination[21]

The MoLSAMD is the focal point for victim assistance issues. The MoPH and the Ministry of Education (MoE) are involved in disability services and advocacy activities. MoPH coordinates CBR and provides physical rehabilitation and psychosocial support services. The MoPH also coordinates training programs for physiotherapists and healthcare providers.[22] The work of these three key ministries is supported by advisers funded through the MACCA. The ministries’ advisors have the main roles of promoting the role of victim assistance and disability internally in each sector. However, their positions did not allow them to authorize or implement activities, and there remained a large need to strengthen the implementation and decision-making aspects of ministerial coordination.[23]

Disability Stakeholder Coordination Group (DSCG) meetings, lead by the MoLSAMD, were held regularly in 2011. Meetings were used to coordinate activities, share relevant information and ideas, and advocate for adequate legislation for persons with disabilities at national and regional levels. MACCA supported the organization of the DSCG meetings with technical assistance; the UN Voluntary Trust Fund for Mine Action (UN VTF) sponsored the meetings. Monthly meetings were held in Kabul. DSCG regional meetings were also held in Herat, Faryab, Mazar-i-Sharif and Jalalabad and Bamyan; in most regions, these were held on a quarterly basis. In 2011, the Afghanistan National Disability Action Plan 2008-2011 (ANDAP) remained the key strategic planning document in the field of disability and victim assistance. At the national level, disability stakeholders worked to coordinate services according to the plan, despite resource challenges.[24] However, ANDAP was not universally used at the regional level.[25]

In December 2012, Afghanistan reported that the government was in the process of revising the ANDAP. An ANDAP progress report showed that out just under half of all 158 action points where achieved by the stakeholders. [26]

The Inter-ministerial Task Force on Disability was established to improve coordination between the different ministries. The MoPH’s Disability and Rehabilitation Department chaired the Disability Task Force and meetings were hosted by MoLSAMD. Two meetings of the Inter-ministerial Task Force were held in 2011 to work on specific issues including CBR development, raising awareness of disability issues, advocating for the inclusion of people with disabilities and mainstreaming disability issues into broader ministry programs.[27]

The MoPH’s Disability and Rehabilitation Department coordinated the CBR network and was responsible for reporting on rehabilitation services.[28] In early 2012, the MoPH approved a Disability and Physical Rehabilitation Strategy to prioritize disability and rehabilitation programs and social inclusion of persons with disability.[29] ICRC and the Swedish Committee for the Disabled provided quarterly reporting to the MoPH for coordination purposes.[30] HI also provided regular reporting to the MoPH and had memoranda of understanding with the MoPH in each region in which it operated health and rehabilitation services.[31]

There was no specific coordination of victim assistance. Several groups, including those noted above, regularly held meetings relevant to victim assistance in Kabul and at the regional level:[32]

·         DSCG

·         MACCA coordination

·         The Advocacy Committee for the Rights of Persons with Disabilities

·         Disability taskforce

·         UN health and education clusters[33]

·         CBR network

·         The Afghan National Society for Orthotics and Prosthetics

 Many of the service providers attending the DSCG meetings were also involved in the other related coordination activities listed above. [34]

Recognizing the importance of maintaining good relationships at the community level in addressing disability issues in Afghanistan, HI and CPI with its partner organizations worked with community councils and community leaders to raise awareness about disability and rights of persons with disabilities.[35]

MACCA bolstered coordination for the victim assistance-related activities of the key ministries, MoLSAMD, MoPH and MoE, through financial and technical support. More specifically, MACCA support included representatives placed in the three key ministries. It also provided accreditation for victim assistance operators. CPI, the Development and Ability Organization (DAO), and the Afghan Disabled Vulnerable Society (ADVS) became accredited organizations in 2011. Through MACCA, the UN VTF provided financial support to approved victim assistance projects proposed by accredited organizations.[36] In early 2011, the MACCA and UNMAS began a sub-project to increase support to the government through the Afghanistan Disability Support Program (ADSP). However, continued financial support for ADSP was not secured and in 2012 ADSP activities were reintegrated into MACCA’s program responsibilities.[37]

The MoLSAMD had a five-year National Action Plan approved in March 2012 which directs ministries to provide vocational training, establish empowerment centers, distribute food, build accessible ramps in some government offices, conduct public awareness programs about the disabled, and to take other steps to assist Afghans with disabilities.[38]

Overall, many organizations noted that international funding to victim assistance and the disability sector decreased and was insufficient to meet their needs in 2011. There was a need for improved donor coordination to ensure that disability issues were not lost amongst competing priorities and changes in the geopolitical focus of donors. A potential for attracting the sub-group of disability donors which meet to support the National Priority Program, including MoLSAMD activities, was identified in 2012.[39] It was also noted that MoLSAMD had not been able to attract funding for disability services probably because it lacked a national strategy.[40]

Afghanistan provided information on progress in and challenges to victim assistance at the Mine Ban Treaty Eleventh Meeting of States Parties in November–December 2011 and also at the meeting of the Standing Committee on Victim Assistance and Socio-Economic Reintegration in May 2012. Afghanistan included detailed reporting on victim assistance activities in its Mine Ban Treaty Article 7 Report and its initial Convention on Cluster Munitions Article 7 report.[41]

Survivor inclusion and participation

Afghanistan reported on the inclusion of mine/ERW survivors and their representative organizations in the planning and provision of victim assistance in 2011.[42] Persons with disabilities were included in the DSCG meetings; DPOs, including mine/ERW survivors’ groups, led or participated in representative umbrella bodies that negotiated with the government. Persons with disabilities and survivors’ organizations were consulted on the strategic plans of ministries and were part of their ongoing development processes. The MoLSAMD advisor remained an active member of many disability stakeholders’ coordination groups and this gave survivor’s organizations and persons with disabilities access to government decision-makers.[43] However, survivors were not always seen to be closely consulted in decision making.[44]

Mine/ERW survivors were included in the implementation of peer support, rehabilitation, and other services. Persons with disabilities employed by MACCA supported the activities of the key ministries and were included in NGO activities that MACCA supported. Persons with disabilities, including MACCA staff, participated in international meetings and had input to the preparation of government statements and reports.[45]

The ICRC Orthopedic Program maintained a policy of “positive discrimination”, employing and training only people with disabilities; all service provision was entirely managed by survivors. The ICRC Orthopedic Program continuously consulted with and involved the survivors in the decision-making process as survivors were fully integrated into its operations.[46] Of HI Afghanistan’s 200 national staff members, 15% were persons with disabilities.[47] Among CPI’s 38 direct employees, more than one third (37%) were persons with disabilities.[48] Afghan Landmine Survivor Organization (ALSO), Accessibility Organization for Afghan Disabled (AOAD) and many other NGOs had a significant proportion of employees who were persons with disabilities.[49]

Service accessibility and effectiveness

Victim assistance activities[50]

Ongoing conflict slowed down the delivery of services by disability stakeholders and remained a significant challenge to victim assistance. Security limitations made it difficult to reach some mine/ERW survivors to provide health services, rehabilitation, and social assistance. Female personnel, in particular, were prevented from working in remote and unsecured areas; this resulted in the availability of disability services being inadequate and unequal, especially for women and girls.[51]

Patients in certain areas of Afghanistan, mainly in the south, were prevented by conflict, landmines or IEDs from reaching medical facilities.[52] No ICRC service provision was completely stopped, but occasionally the providing of services was reduced due to the poor security in some areas. The deteriorated security situation forced the ICRC Home Care Program and the Social Program to categorize some areas as off-limits.[53] The Swedish Committee for Afghanistan (SCA-RAD) reported that the implementation of disability services in their areas of operation was not significantly affected by conflict or the security situation.[54]

In some case, survivors with limited economic resources may not have been able to reach health facilities or gain benefits from available services, though many did. The MoPH lacked transportation facilities for poor people with disabilities and there was no outreach program to provide home-based health services.[55] The ICRC transported patients living in remote areas to its rehabilitation centers.[56]

No significant difference in the quantity of prostheses production was reported for 2011. However, the long-term availability of services increased in August 2010 when a new ICRC-run orthopedic center opened and began prosthetic production in Lashkar Gah, in the Helmand province which is highly affected by conflict. The center is the first rehabilitation facility in the province and is designed to manufacture some 50 prosthetic devices per month. All employees were persons with disabilities. Those in need of specialized treatment were referred to the HI center in Kandahar or ICRC in Kabul.[57]

Physical rehabilitation centers continued to be run by the same organizations, primarily ICRC and SCA, and others including the Kabul Orthopedic Organization (KOO), Empor Organization (EO), DAO and the MoPH-run Khost Orthopedic workshop which opened in 2011. The needs for physical rehabilitation were significant in other provinces where the NGOs do not operate and rehabilitation services are not available.[58] The newly-opened Khost Orthopedic Workshop and its physiotherapy department faced problems of procurement and human resources.[59] The ICRC center was still in the process of being established in early 2012.[60]

Inclusive education training by the MoE for teachers, as well as for children with disabilities and their parents, increased in 2011. Accessibility of education for children with disabilities improved. Monitoring visits to provinces showed increased enrollment of children with disabilities into general mainstream schools; awareness of disability issues among staff improved in the areas where inclusive education trainings were conducted. However, in 2011 national organizations providing education to persons with disabilities were affected by a shortage of funding and reduced their activities slightly.[61] ALSO and AOAD both expanded computer training, including for girls, in 2011.[62]

A lack of psychosocial support, particularly peer support, remained one of the largest gaps in the government-coordinated victim assistance and disability programs, though some national and international NGOs provided these services.[63] A severe lack of peer support services for mine/ERW survivors was reported due to discontinued international funding in 2012.[64] No measures were taken to provide additional services to address the lack of psychosocial support, including peer support, in 2011. The second Inter-country Psychosocial Rehabilitation Conference between Afghanistan and Tajikistan was organized and held in Tajikistan.[65]

Several organizations, including ICRC and NGOs, provided educational and vocational training as well as other social- and economic-inclusion opportunities. Although the ICRC’s services remained stable, many NGOs activities in the area were reduced due to the decrease in international funding. A great need for economic-inclusion services remained.[66] Ongoing peer support to enhance economic inclusion activities was found to be successful, improving the successful sustainability of small business projects.[67]

As part of a new program in 2011, the ICRC Orthopedic Program imported sports wheelchairs to be used in sports programs by persons with disabilities; these sports included volleyball, soccer, and basketball. The activities were held in Mazar-i-Sharif and Herat with both male and female teams.[68]

Physical accessibility remained a significant challenge because persons with disabilities in Afghanistan lacked access to many existing services. In Kabul, for example, some 95% of public buildings were not accessible for persons with disabilities, including mine/ERW survivors.[69] The buildings of the department of MoLSAMD that provides services to persons with disabilities were not physically accessible to persons with disabilities; many parts were unreachable for wheelchair users.[70]

To address accessibility challenges in the long term, CPI created and registered the Physical Accessibility Projects Consortium for Afghanistan, partnering with the Afghan Amputee Bicyclists for Rehabilitation and Recreation (AABRAR), ALSO, and AOAD in 2011.[71]

CPI coordinated and planned its own program activities together with its partner organizations. CPI devised objectives that matched those of the ANDAP and included geographic priorities presented by relevant ministries and the MACCA. The resulting work plan addressed the victim assistance needs as set out in the ANDAP, and in addition focused on creating physical accessibility in schools, health care facilities, mosques, and key government buildings in consultation with local community members (a total of 350 buildings in 2011). CPI combined specific site-adapted physical accessibility projects with awareness-raising on disability issues in the community. CPI’s extensive network of project partners included: AABRAR, the Afghan Disabled Vulnerable Society (ADVS), AOAD, ALSO, the Afghan Volunteer Doctor Association (AVDA), DAO, EO, the Engineering and Medical Department for Afghan Development (EMDAD), ROAWV, the Sustainable Alternative Economic Development for Afghans (SAEDA), and the Welfare Organization for Afghan People (WOAP).

The National Law for the Rights and Privileges of Persons with Disabilities was authorized in August 2010. In order to implement the law, MoLSAMD trained regional directorates in Kabul on its contents.[72] However, the National Disabilities Law contained discriminatory provisions and was not in conformity with the principles of the Convention on the Rights of Persons with Disabilities (CRPD).[73] In December 2011, a fifth national disability workshop was held in Kabul to review the disabilities laws. Participants, including government representatives, DPO representatives, and the Advocacy Committee on the Rights of Persons with Disabilities, all attended and contributed to recommendations for amending of the law.[74] By December 2012 the Law was under review in order to “bring it into conformity with the CRPD.”[75]

The constitution prohibits any kind of discrimination against citizens and requires the state to assist persons who have disabilities and to protect their rights, which include healthcare and financial protection. The constitution also requires the state to adopt measures to reintegrate and to ensure the active participation in society of persons with disabilities.[76]

Differences in treatment in Afghanistan were often not based solely on need but were influenced by the economic and social situation of survivors, as well as their gender and the cause of their disability. Women and elderly persons with disabilities received fewer services for these reasons, with no perceivable change during 2011.[77] MACCA did not note discrimination within ministry work or policies.[78] The MoPH maintained an inclusive policy and strategy enabling all Afghans to have access to any available services in the health facilities; it reported that there was no discrimination in the health services with regard to age, sex or disability.[79]

Ensuring the wellbeing and rights of people with disabilities, including survivors, in emergency situations became an issue due to factors such as the terrain and climate conditions and extensive flooding in 2012.[80]

Afghanistan ratified the CRPD on 18 September 2012.