Northwestern Public Health Review

By Juan Meza

Here, I present multiple facets of this conflict: the plight of those displaced and injured by landmines, and the negative impact landmines have on Colombian public health; the inefficiencies of the current aid measures; the tangible efforts of Colombian NGOs; and the potential for a positive impact on the health of the displaced with North/South partnerships, one example being the Feinberg School of Medicine’s prosthetics researchers.

The history of a true civil war

There is an ongoing civil war in Colombia. While “[i]t makes no difference how long the conflict lasts, or how much slaughter takes place, [1]” some authors have a threshold as reference. “Civil war occurs when an identifiable rebel organization challenges the government militarily and the resulting violence results in more than 1,000 combat-related deaths, with at least 5 percent on each side [2].” Between July 2002 and June 2006, 8,810 persons were killed in combat in Colombia and 11,292 civilians were killed outside combat, for a total of 20,102 deaths arising from the conflict [3]. During that same period, 6,912 people were arbitrary captive and other 4,650 persons were kidnapped, for a total of 11,562 people deprived from freedom [4]. In 2010 alone, 1,597 civilians were murdered outside combat for socio-political reasons [5]. In total, between 1981 and 2012, 23,161 people were summarily executed, another 11,751 were killed in massacres, with further 25,007 people forcibly disappeared and over 5,700,000 displaced survivors [6].

How did the current conflict begin? During the fifties, in the context of the cold war, proxy wars, and brutal dictatorships all over Latin America, insurgent groups emerged with the ideal of changing the status quo [7]. Ejercito de Liberación Nacional (ELN) and Fuerzas Armadas Revolucionarias (FARC) are only two examples of various leftist groups formed in Colombia, but after more than 60 years, only those two continue operating in the rural areas. However, what started as a noble ideal to overcome corrupt governors and achieve land redistribution is now a group of rebels in charge of watching the drug production and terrorizing the people. The situation worsened in the eighties, as private landlords hired mercenaries from overseas to train their private security personnel [8]. These mercenaries became paramilitary armies with the most barbarous strategies to terrorize anyone connected to the political left, including non-armed leftwing leaders and their families. They acted with the support of the state [9]. While some of them demobilized, former combatants created death squads that continue operating in the drug production [10].

It is not a war of ideals anymore. The Colombian insurgent groups finance their operations with illegal activities, including production and protection of coca, opium and marihuana crops. In the context of the Colombian armed conflict, guerrilla groups, paramilitary groups, and even some demobilized former rebels have all engaged in drug production. Drugs are one of the main economic sources of Colombian insurgent groups including guerrillas, FARC and ELN [11], as well as former paramilitary groups under different names, such as Rastrojos, Urabeños, Aguilas Negras and Gastrillos Rojos. [12] As coca is one of their main economic sources [13], Colombian insurgent groups protect coca crops with landmines [14]. They manufacture and place landmines in strategic places, to protect locations where they have their weapons, medicines and illicit crops [15].

The public health impact of civil war

According to the United Nations Mines Action Service, Colombia has the second highest number of victims from landmines in the world, after Afghanistan [16]. Between 1990 and 2014, 10,628 people were victims of landmines [17]. “In over 60 mine-affected states and areas, the legacy of the past, as well as ongoing internal conflicts, still result in thousands of casualties each year, especially in the more seriously affected States such as Afghanistan, Pakistan, Colombia and Myanmar” [18]. Villagers, the people most seriously impacted by these minefields, are fleeing from their hometowns to the main cities looking for security in exchange for poverty. As expressed by Human Rights Watch, “many of the survivors… described how their injuries [from mine explosions] had compounded other problems that [they] or their families were already suffering due to abuses such as displacement, forced taking of land, or the killing of family members” [19]. Between 1981 and June 2012, over 5.7 million villagers were displaced from their lands [20]. This happened in 87% of Colombian towns [21]. They have resorted to marginal neighborhoods with problems of overcrowding, inadequate sewage systems, and poor health [22].

The new state of living for these people and families is indisputable: every displaced person is poor. Every household surveyed by the International Organization for Migration is below the poverty line, and 50% face indigent conditions [23]. Seventy-seven percent of displaced children that are now in Bogota do not have access to education. Twenty-three percent of displaced families reported that their children had dropped out of school [24]. Of the total infant mortality in the displaced population, 57% of cases could have been prevented, and access to vaccination for displaced children is 20% lower than the national rate [25]. Only 53% of the displaced population had access to medical services, even though 80% of them required such services [26].

The Colombian government has failed to provide adequate physical and mental health services to the victims of landmines. Even though Colombia is a party to both the Ban Mine Treaty and the Convention on the Rights of Persons with Disabilities, relief for victims of landmines is still far from becoming a reality. Law 1448 was issued in 2011 to grant economic assistance for the victims of the conflict. However, these ideas have fallen short in implementation, partially due to the short deadlines for the victims to apply for assistance. Other impediments include victims’ unawareness about their rights, the lack of resources and personnel at local hospitals, and the fact that displaced victims of war understandably focus their attention on survival rather than filling complex proceedings [27].

Image by Faith Simunyu.

A personal account: The kid unable to walk now plans to fly

José was just 12 when he lost his legs after stepping on a rock that concealed a landmine in a rural area in east Colombia: Tame, Arauca. It was on August 7, 2010, about 4:00 pm when his dreams to one day become a professional soccer player went away as he saw and realized what had just happened. He was walking back home from the plaza, where he had delivered the cassava harvested by his mother:

“I was walking normally and I stood up [on] a stone that began swinging, and when I was going to jump, to keep from falling, the mine exploded because it was there. I was thrown about 20 meters away and a post hit me when I was falling down… I fell into the same hole [left by the blast] and as soon as I looked it was when I realized that I no longer had a leg and the other was hung a single tendon. At the time I did not feel any pain” [28].

He was with another person, who went for help. A villager driving an old truck with poorly functioning breaks took them to the nearest first aid center. José had to wait until 9:00 pm for a helicopter to take him to a hospital in Cúcuta, the capital city of Santander. This strong kid had waited all this time before he fell unconscious during the flight to Cúcuta.

José had that same feeling when you wake up the next day after losing someone or something very important in your life. The night before, you just fall asleep devastated by the magnitude of the events. And the next day, just after you wake up, it is a matter of glorious seconds during which you do not remember what happened, until your memory strikes you down with reality. In José’s case, he had lost something and someone really important in his life: he had lost all at once both his legs and a part of himself—he had lost that soccer player he longed to be one day, his superego.

One month passed before his surgery was approved. At that time, the people in the hospital made the decision to amputate the remaining parts of his legs.

“I called the doctor and told him I was not going to let them perform the surgery over me because I wanted a knee surgery for the prosthesis to fit me better. It was a problem to make them understand not to take from me both legs, because the mine had only taken part of both feet, not all of them. The surgery [taking my legs above the knee] was performed [anyway] and ended at about 11:00 pm” [29].

Now a 16-year-old, José blames himself for stepping on that rock. He blames himself for jumping around as a kid, for exercising his right to be happy in a country where even happiness is limited by the war. “I think I would entitle my life… I would say: ‘My Failures’” [30]. One day he will know it was the government’s fault. He will know of the government’s motives not to release the shocking figures of victims of landmines presumably for the sake of preserving tourism. He will come to know of the government’s negligence to alert civilians where this war is taking place, and its fault in providing timely and proper access to health services that could have saved one of his legs. He will understand that it was not his fault whatsoever. However, in the meantime he has already started dreaming of better plans for himself:

 “Now I want to study aviation and enroll in an [aviation] course. Once I have access to a runway, I will practice. [When I did it once] they told me I am good, that it went well” [31].

José will need an advanced prosthesis to allow him to pilot a commercial flight from Chicago to Moscow, where he would stay a couple of days before flying other passengers to Johannesburg on his way back to Bogota. That is the story of the kid who wants to fly because he can no longer walk—how can we help José realize his dream [32]?

Current efforts to combat landmines

Campaña Colombiana Contra Minas [33] (CCCM) is an organization assisting victims of landmines in Colombia, pursuant to the principles of the 1997 Convention on the Prohibition of the Use, Stockpiling, Production and Transfer of Anti-personnel Mines and on Their Destruction (Mine Ban Treaty). CCCM supports victims of landmines, unexploded ordnances, and improvised explosive devices. It also monitors Colombia’s compliance with its obligations as a State Party to Mine Ban Treaty. “Mine victims’ in Colombia are often individuals in extremely vulnerable situations. Given this context, the work that the CCCM does is on various fronts [34].”  They want to create awareness for the victims of landmines, advocating for them on a national and international level. Additionally, a primary objective of CCCM is to empower landmine victims “so that they themselves demand that the State complies with its obligations to them” [35].

Since 2008, CCCM has worked closely with Mercy Corps [36] in order to define the strategic lines where CCCM should prioritize its work. Their three primary strategic lines focus on public policy, landmine survivor rehabilitation, and socio-economic reintegration of survivors.

In line with these objectives, they have launched a program to train 25 physicians on the production of prosthesis and orthotics. These 25 experts are now located in states where landmine presence is the highest: Caquetá, Nariño, Cauca, Meta and Huila. Despite the presence of these experts a lack of resources persists, and access to prosthesis and orthotics continues to be the greatest challenge for the victims of the Colombian conflict [37].

How U.S. Physicians and U.S. Medical Schools can help

A stronger and more pragmatic connection between the research on prosthetics and orthotics conducted in the Global North and the victims’ demand in the Global South is essential. The Millennium Development Goals (MDGs) were launched in 2000 in order for the global community to combat together, as global partners, extreme poverty, pandemic disease, environmental harm, war and civil conflict among other goals [38]. The Global Partnership, proposed as the Eighth MDG, has also been translated into North-to-South collaboration on research and implementation of solutions on disability [39].

However, one of the biggest challenges to overcome is the disparity between North and South on the allocation of research resources for disability. “The power in global research (including agendas and resources) is usually located in the North; and in disability research this power is largely held by non-disabled researchers and agencies” [40]. Sue Stubbs [41], the co-founder of the International Disability and Development Consortium, proposes a solution where experts from the Global North train the disability community in the Global South:

   “The [South African Federation of Disabled Research Program] provides a practical example of how local disabled people can be empowered to conduct research. Training in generic research (…) included 20 young disabled people where two people (a male and a female) were drawn from each member country. Already, these trained researchers are engaging in some conventional disability research currently going on the region. As part of unpacking the Millennium Development Goals, already four trainees from the team of 20 are part of the research groups that won tenders to carry out research projects for [South African Federation of Disabled]” [42].

Among other institutions in the Global North, the Northwestern University Prosthetics-Orthotics Center is conducting important research [43] that could be brought to Colombia in order to help the victims of landmines and, especially, the children that have lost their limbs. Some of this research focuses on the Junior Shape & Roll Prosthetic Foot, a prosthetic designed specifically for a child’s gait. Others have started research aimed towards bringing this prosthetic to low-income countries.

While the Global North is conducting important research for disabled people, landmine victims in Colombia have not received any benefits from these developments yet. Creating a partnership with Colombian landmine victims and their local physicians and activists would bring the benefit of these technologies to the people who need it the most. A North-to-South partnership between medical schools in the U.S. and Colombian victims of landmines would meet all the purposes of the global partnerships envisioned as the Eight MDG. As a matter of fact, such partnership would combat the extreme poverty of the Colombian victims of landmines, their poor health condition, and lack of medical assistance. By supporting the victims of war, such a partnership would additionally combat the environmental harm caused by the landmines’ pervasive presence in rural Colombia as well as the Colombian civil conflict that has sadly devastated my country, brothers, and sisters.

If you want to help José or CCCM please contact the author at jpcalderon@nlaw.northwestern.edu or the CCCM’s Director, Alvaro Jímenez Millán, at alvaro@colombiasinminas.org

i “Juliet Sorensen is a Clinical Associate Professor of Law with the law school’s Center for International Human Rights, where her teaching and research interests include international criminal law, corruption, and health and human rights. Professor Sorensen is a founder of the Northwestern Access to Health Project, an interdisciplinary partnership that analyzes access to health in resource limited settings. Professor Sorensen received the Excellence in Teaching Award from the Master’s in Public Health Program in 2014. In 2010, Professor Sorensen was appointed to the American Bar Association’s Global Anti-Corruption Task Force.  Professor Sorensen serves on the screening committee that assists Senator Durbin in selecting federal district court judges for the Northern District of Illinois.

“From 2003-2010, Professor Sorensen was an Assistant U.S. Attorney in the U.S. Attorney’s Office in Chicago, focusing on fraud and public corruption. Prior to her work at the U.S. Attorney’s Office, she worked as a litigation associate and a federal judicial clerk in Boston. She was also a maternal and child health volunteer with the U.S. Peace Corps in Morocco from 1995 to 1997. She received her B.A. in politics from Princeton University and her J.D. from Columbia University School of Law. She is a member of the New York and Massachusetts Bars and the Federal Bar Association, and is admitted to practice in the Northern District of Illinois, the District of Massachusetts, and the United States Court of Appeals for the Second Circuit. Professor Sorensen was a term member of the Council on Foreign Relations (2000-2005), and was a Chicago Council on Global Affairs “Emerging Leader” (2008-2010).  She has taught trial advocacy on behalf of the Department of Justice to prosecutors in South America and West Africa.”

http://www.law.northwestern.edu/faculty/profiles/JulietSorensen/ (Last visited: Aug. 20, 2014).

References

1. International Committee of the Red Cross, Commentary to the Geneva Conventions of 1949.
2. Paul Collier et al, Breaking the Conflict Trap: Civil War and Development Policy, World Bank, p. 11. For this paper’s purposes, internal conflict and civil war are deemed to be synonyms.
3. Comisión Colombiana de Juristas, Colombia 2002-2006: Situación de derechos humanos y derecho humanitario (2007). http://www.coljuristas.org/documentos/libros_e_informes/colombia_2002-2006.html (Last visited: Mar. 3, 2014).
4. Id.
5. Comisión Colombiana de Juristas, Colombia: sigue esperando la hora de los derechos humanos: Informe sobre la situación de derechos humanos y derecho humanitario: 2010-2012, (2012).   http://www.coljuristas.org/documentos/libros_e_informes/colombia_2010-2012.pdf (Last visited: Mar. 3, 2014).
6. Centro Nacional de Memoria Histórica and Departamento para la Prosperidad Social, ¡Basta Ya! Colombia: Memorias de Guerra y Dignidad (2013), at 33, 34, 36, 48. http://www.centrodememoriahistorica.gov.co/descargas/informes2013/bastaYa/basta-ya-memorias-guerra-dignidad-12-sept.pdf (Last visited: July 2, 2014).
7. Rafael Pardo, La Historia de las Guerras (2008) Ediciones B. Colombia at 504.
8. U.N. Special Rapporteur on Summary or Arbitrary Executions, Report on the visit to Colombia, U.N. Doc. E/CN.4/1990/22/Add.1 (Jan. 24, 1990). See also, Case of the Rochela Massacre v. Colombia, Judgment on the Reparations of May 11, 2007 Inter-Am. Ct. H.R.
9. Case of the Rochela Massacre v. Colombia, Judgment on the Reparations of May 11, 2007 Inter-Am. Ct. H.R.
10. Republic of Colombia, Politica Nacional Contra Las Drogas.
11. Organization of American States, The Drug Problem in the Americas (2013) at 30 and 79, http://www.oas.org/documents/eng/press/Introduction_and_Analytical_Report.pdf (last visited June 27, 2014).
12. Santiago González-Plazas, La erradicación manual de cultivos ilícitos en la sierra de La Macarena: un ejercicio sobre la futilidad de las políticas in Borradores de Investigación Informe de Seguimiento (2007), http://repository.urosario.edu.co/bitstream/handle/10336/3851/Fasc%C3%ADculo3.pdf?sequence=1&isAllowed=y (last visited: July 2, 2014) at 13. See also Fracisco Thoumi et al, El narcotráfico en las relaciones fronterizas de Colombia, Universidad del Rosario (2006), http://repository.urosario.edu.co/bitstream/handle/10336/1161/Anexo%202.pdf?sequence=3 (last visited: July 2, 2014) at 11.
13. Organization of American States, supra note 11 at 30 and 79. Santiago González-Plazas, supra note 12 at 13. Fracisco Thoumi et al, supra note 12 at 11.
14. El Tiempo, Bandas criminales siembran minas en varias zonas del país, (May 27, 2013) http://www.eltiempo.com/archivo/documento/CMS-12825863 (last visited: June 27, 2014). Human Rights Watch, Maiming the People (2006), http://www.hrw.org/reports/2007/07/24/maiming-people-0 (last visited: July 1, 2014) at 15 and 16 (fn 35).
15. Human Rights Watch, Maiming the People: Guerrilla Use of Antipersonnel Landmines and other Indiscriminate Weapons in Colombia (2007) at 16 (fn 35).  http://www.hrw.org/reports/2007/07/24/maiming-people-0 (Last visited: Mar. 2, 2014) (“The military describes having found landmines in the roots of coca plants, apparently designed to deter manual eradication of the crops.”).
16. UNMAS, About UNMAS in Colombia. http://www.mineaction.org/programmes/colombia (Last visited: Mar. 2, 2014).
17. Programa Presidencial para la Acción Integral contra Minas Antipersonal, Situación nacional por minas antipersonal y municiones sin explotar, http://www.accioncontraminas.gov.co/Situacion/Documents/Reporte_Situaci%C3%B3n_Nacional_V%C3%ADctimas_a_ENE_2014.pdf (last visited: July 6, 2014). See also, El Colombiano, Récord vergonzoso: Colombia superó 10 mil víctimas de minas. http://www.elcolombiano.com/BancoConocimiento/R/record_vergonzoso_colombia_supero_10_mil_victimas_de_minas/record_vergonzoso_colombia_supero_10_mil_victimas_de_minas.asp (Last visited: Mar. 2, 2014).
18. International Committee of the Red Cross, Anti-personnel mines. http://www.icrc.org/eng/war-and-law/weapons/anti-personnel-landmines/overview-anti-personnel-landmines.htm (Last visited: Mar. 2, 2014).
19. Human Rights Watch, supra note 15 at 11.
20. Centro Nacional de Memoria Histórica, supra note 6.
21. Comisión Colombiana de Juristas, Colombia 2002-2006: Situación de derechos humanos y derecho humanitario, (2007) at 15.  http://www.coljuristas.org/documentos/libros_e_informes/colombia_2002-2006.pdf (Last visited: Aug. 20, 2014).
22. Ana María Ibáñez et al, “Acceso a Tierras y Desplazamiento Forzado en Colombia,” Colombia, CEDE, Universidad de los Andes, 2004 at 20. http://economia.uniandes.edu.co/publicaciones/d2004-23.pdf (Last visited: Aug. 20, 2014).
23. Id. at 25-27.
24. Id. at 18.
25. Id.
26. Id. at 19.
27. nterview with Luz Estela Navas from Campaña Colombiana Contra Minas (CCCM.)
28. CCCM, Interview with José.  This is an unofficial translation by the author.
29. Id.
30. Id.
31. Id.
32. If you want to help José please contact the author at jpcalderon@nlaw.northwestern.edu or the CCCM’s Director, Alvaro Jímenez Millán, at alvaro@colombiasinminas.org
33. http://www.colombiasinminas.org/
34. Campaña Colombiana Contra Minas, A description of the work done by the Colombian Campaign to ban landmines.
35. Id
36. http://www.mercycorps.org/
37. If you want to help CCCM please contact the author at jpcalderon@nlaw.northwestern.edu or the CCCM’s Director, Alvaro Jímenez Millán, at alvaro@colombiasinminas.org
38. UNDP, Millennium Development Goals. http://www.undp.org/content/undp/en/home/mdgoverview/mdg_goals/mdg8/ (Last visited: Mar. 2, 2014).
39. Sue Stubbs, Building communities of trust in disability research, in: Disability and Social Theory: New Developments and Directions (2012) Palgrave Macmillan at 261.
40.  Id. quouting Bradley, 2007.
41. “Sue Stubbs is the Director, co-Founder and Advisor of EENET (Enabling Education Network) and also works as a freelance consultant in disability and inclusive development.
42. “Sue helped co found IDDC and coordinated IDDC until it opened its office in Brussels, Belgium. Other work by Sue includes disability advisor at Save the Children (1991-2000), consultant on Disability at the World Health Organisation (2004-2009), Manager at Intimate India, and Director of the Singing Heart.” http://www.iddcconsortium.net/who-we-are/members/individual-members/sue-stubbs (Last visited: Aug. 20, 2014).
43. Id. at 261. Internal citation omitted.
44. Northwestern University Prosthetics-Orthotics Center. http://www.nupoc.northwestern.edu/research/projects/index.html (Last visited: Mar. 2, 2014).

About the Author

Juan Meza

Juan Meza is a Colombian attorney focusing on international legal issues and human rights. He has counseled Campaña Colombiana Contra Minas and is currently clerking at the Extraordinary Chambers in the Courts of Cambodia – United Nationals Assistance to the Khmer Rouge Trials. Before that, he was the Len Rubinowitz fellow at EarthRights International. He previously worked as an associate attorney of different Colombian law firms, where his practice included domestic and transnational litigation, as well as probono work. He obtained an IHR LL.M. (Honors) at Northwestern University School of Law, as a member of the Access to Health Project in Mali and a clinical student at the Center for International Human Rights.