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VICTIMS OF MUNITIONS in Lezhe and Shkoder Counties

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VICTIMS OF MUNITIONS in Lezhe and Shkoder Counties
A general overview of the situation and needs assesment

The views and conclusions expressed in this survey do not present the opinion of the donor - State Department of United States of America.

This survey for Lezhe and Shkoder counties is a further step for the completion of the Study "Victims of Munitions in Albania" realized in 2013 for the counties of Berat, Durres, Korçe, Gjirokaster, Diber and Elbasan with the support of the Austrian Federal Ministry for European and International Affairs

This survey is prepared by ALB-AID within framework of the Albanian Mine Action Programme with the financial support of the State Department of USA, Office of Weapons Removal and Abatement through ITF-Enhancing Human Security Slovenia.

The survey is divided into five chapters as follows:
Chapter I describes the history of accidents with ammunitions including UXO, AXO and ERW and in Albania, and Albania's approach to mine victim assistance in relation to international conventions.
Chapter II describes the purpose, objectives, methodology used and the steps followed to conduct the survey.
Chapter III describes the results of interviews about accidents classified by years, devices that have caused the accident, the activity of the injured person at the time of the accident, damage caused (amputation, limb loss, fractures, burns, etc. ), medical aid, medical check-up results, detailed information on the family situation, living conditions, education and their socio- economic situation . It also describes the needs for different services for the survivors.
Chapter IV describes recommendations for different institutions and stakeholders in order to change the current situation of mine/UXO survivors.
Chapter V describes the situation and needs of UXO/AXO/ERW victims by each county.

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VICTIMS OF MUNITIONS in Lezhe and Shkoder Counties

  1. 1. Jonuz Kola - Gertjon Çobo V I C T I M S OF MUNITIONS I N LEZHE AND SHKODER General overview of the situation and needs assessment Kukës, June 2014
  2. 2. Perface Acknowledgements .............................................................................................................4 List of acronyms………………………………………………....……….………………...5 Executive summary ............................................................................................................6 CHAPTER I Background information. About the accidents from UXO, AXO, ERW and munition in Albania and Key Actors .................................................................7 CHAPTER II Goal, Objectives and Methodology of the Survey ............................................................12 CHAPTER III. Survey results.. ..................................................................................................................20 CHAPTER IV Recommendations .............................................................................................................31 ANNEXES Aneks 1. Map of UXO Hot Spot Areas in Albania…………………………………..…...34 Aneksi 2. Needs Assesment Form used during interviews .................................................35 Aneksi 4. Photos during the completion of the questionaire and medical checks from ALB-AID staff.............................................................................................................................40
  3. 3. Jonuz Kola VICTIMS OF MUNITIONS in Lezhe and Shkoder Counties A general overview of the situation and needs assesment The views and conclusions expressed in this survey do not present the opinion of the donor - State Department of United States of America. Kukes, July 2014 2
  4. 4. Survey designers: Jonuz Kola and Gertjon Çobo (PHD) Victims of Munitions in Albania A general overview of their situation and needs Victims of Munitions in Shkoder and Lezhe, A general overview of their situation and needs Survey designer: Jonuz Kola This survey for Lezhe and Shkoder counties is a further step for the completion of the Study "Victims of Munitions in Albania" realized in 2013 for the counties of Berat, Durres, Korçe, Gjirokaster, Diber and Elbasan with the support of the Austrian Federal Ministry for European and International Affairs Data processors: Maliq Imeraj and Riza Ademaj (ALB-AID). Interviewers: Izet Ademaj, Shkelqim Muça, Neritan Muja and Riza Ademaj (ALB-AID). Contributed for the identification of the victims of munitions and assisted ALB-AID staff during field for the completion of questionnaires: Valbona Tula Director RDSHS Shkoder, Ardiana Jaku director RDSHS Lezhe, Marta Fetaj local assistant RDPSS Lezhe, Nersada Mandia local assitant RDPSS Shkoder. 3 Literary editor: Nazif Dokle Cover page: Picture of Agnesa Dullaj,student Kukdes Copyright © 2014: ALB-AID, Kukës Tel: (00355-2) 2424 006 e-mail: albaid@alb- aid.org ; www.alb-aid.org This survey is prepared by ALB-AID within framework of the Albanian Mine Action Programme with the financial support of the State Department of USA, Office of Weapons Removal and Abatement through ITF-Enhancing Human Security Slovenia
  5. 5. ACKNOWLEDGEMENTS We would like to thank Arben Braha, Executive Director of AMMCO and Veri Dogjani, Victims Assistance specialist (AMMCO) who provided us with data and support for the successful implementation of the project. Without their support, advice, information and communication with relevant ministries, this survey would not have been so complete. Special thanks go to Mrs. Denada Seferi, Director of the Department of Social Policies in the Ministry of Social Welfare and Youth, as well as to the Valbona Tula, director of RDPSS Shkoder, Ardiana Jaku, director of RDPSS Lezhe for their close cooperation and institutional support for the completion of this survey. ALB - AID thanks, in particular, the Office of Weapons Removal and Abatement, US Department of States for the financial support provided, as well as ITF Slovenia (International Trust Fund - Enhancing Human Security) 4
  6. 6. List of acronyms ALB-AID -Albanian Association of Assistance for Integration and Democratic Development AMMCO - Albanian Mine and Munitions Coordination Office AMAE – Albanian Mine Action Executive UNDP- United Nations Development Fund VMA- Association of Victims of Mines and Weapons EU – European Union UXO - Unexploded Ordnance AXO -Abandoned Unexploded Ordnance ERW- Explosive Remnants of War GICHD-Geneva International Centre for Humanitarian Demining IMSMA-Information Management System for Mine Action ICRC-International Committee of the Red Cross MSWY- Ministry of Social Welfare and Youth ITF- International Trust Fund RDPSS –Regional Department of Public Social Service 5
  7. 7. EXECUTIVE SUMMARY After the fall of communism, especially after the collapse of pyramid schemes and military depots looting by the population (1997), accidents from ammunitions, UXO's, AXO's, and ERW were increased dramatically. According to the data maintained in IMSMA format by AMMCO, 710 victims were registered during the period 1997-2013 across the country, 122 of which died during the accident. Mine victims of the Kukes county (272), through international support, within 10-12 years, were integrated into the communities where they live, including provision of necessary health services (prostheses, physiotherapy sessions, socio-economic integration support), no concrete steps were taken for the victims of UXO's, AXO's ERW and ammunition in other parts of Albania, except their registration by AMMCO on voluntary basis. The signature of the Convention on Cluster Munitions and the Antipersonnel Mine Ban Treaty obliges the Albanian government, within the framework of Victims Assistance, to take concrete steps for re-integration of victims of landmines UXO's AXOs and ERW including their registration, improvement of access to health and socio- economic services, etc. However there is not any comprehensive assessment survey about the situation of AXO/UXO/ERW victims and their needs for medical services and support for their socio-economic integration. Therefore, they have hardly benefited any support from the public services provided by the government institutions. ALB-AID based on the experience gained in Kukes, with the funding of Austrian Government and the support of the Ministry of Social Welfare and Youth conducted this survey in Korça, Dibër, Durrës, Elbasan, Berat and Gjirokaster counties. This survey describes the current situation of the victims of ammunitions, UXOs, AXO's and ERW, and identifies their needs for medical services and socio-economic support for their re-integrated with dignity in their societies. The survey is based on the information gathered through field interviews with 296 victims, documents collected from the Regional Departments of Social Services of the respective counties, municipal social administrators, different publications, as well as detailed data provided by AMMCO. The survey is divided into five chapters as follows: Chapter I describes the history of accidents with ammunitions including UXO, AXO and ERW and in Albania, and Albania's approach to mine victim assistance in relation to international conventions. Chapter II describes the purpose, objectives, methodology used and the steps followed 6 to conduct the survey. Chapter III describes the results of interviews about accidents classified by years, devices that have caused the accident, the activity of the injured person at the time of the accident, damage caused (amputation, limb loss, fractures, burns, etc. ), medical aid, medical check-up results, detailed information on the family situation, living conditions, education and their socio- economic situation . It also describes the needs for different services for the survivors. Chapter IV describes recommendations for different institutions and stakeholders in order to change the current situation of mine/UXO survivors. Chapter V describes the situation and needs of UXO/AXO/ERW victims by each county. Note: Relatives of the dead victims have not been interviewed because of their legitimate pain for their lost people, whom we understand, and it is a cultural tradition not to disturb the families about their beloved.
  8. 8. CHAPTER I Background information About the accidents from UXO, AXO, ERW and ammunition in Albania and the Key Actors 1.1 Background of casualties from UXO, AXO, ERW and ammunition in Albania Military ammunitions accidents1 started to be identified and made public only after 90s. Before 90-ties, accidents from ammunitions were almost inexistent because of strict security measures applied during the communist system. Albania during the communist system had been turned into a giant warehouse of all kinds of weapons and ammunitions, which, as a result of the paranoia of "invasion" from foreign armies, were spread in every corner of the country. According to the Report of the Security Commission of the Albanian Parliament 2, " In late 90s, the Albanian Armed Forces possessed 294 thousand tons of conventional ammunitions, consisting of Russian origin (1945-1956) , Chinese (1961-1974), and Albanian made(1976 -1990) starting from 7.62 mm calibers up to 160 mm, aviation bombs, sea mines, rockets, anti-air missiles, anti-tank rockets, antipersonnel mines and anti tank mines. All these ammunitions were spread in 182 regions and stored in 955 warehouses (depots) allover the country." With the collapse of the communist system ammunitions presented problems of insecurity, storage and maintenance. A large part of them had become dangerous over the passing of years as a result of lack of maintenance. In addition, ammunition depots became subject to theft and vandalism as a result of the negligence and carelessness from the soldiers and army officers. This phenomenon became common in almost all military establishments. The collapse of pyramid companies in 1997 was accompanied by major social turmoil. The country was plunged into chaos, which quickly spread in every corner of Albania. During the anarchy that followed these riots, almost all depots of the Armed Forces from the north to the south were looted by the civilian population. According to “Ushtria” Newspaper3, organ of the Ministry of Defense of the Republic of Albania, over 600 thousand small arms and light weapons and over 1.5 billion of peaces of ammunitions such as hand grenades, shells, bullets, etc were stolen. The following tables give in detail the types and quantity of mines, ammunitions and weapons that fell into the hands of people, including women and children, across the country. Table4 of munitions looted during the riots of 1997 No. Description Quantity 1 Bullets 7.62 1,460,000,000 2 Anti aircraft munitions 24,000,000 3 Hand grenades 3,500,000 4 Mortar shells 84,000 5 Artillery shells 270,000 6 Explosives 3,600 7 Detonator fuse 24,000,000 8 Anti personnel mines 215,000 9 Anti tank mines 1,000,000 Total 1,513,072,600 1 Munitions range from simple munitions to anti -tank rockets, air missiles, anti personnel mines, anti- tanks,...etc. 2 Source: Report of the Security Commission published in “Korrieri” newspaper, dated 27 March 2008 3 “Ushtria (Army)” newspaper, dated 7 October 2005, organ of the Ministry of Defense of the Republic of Albania 4 Source: Survey “Towards a Safer Albania”, page 15 (taken by Ushtria newspaper, dated 7October 2005) 7
  9. 9. Table5 of small arms and light weapons looted during the riots of 1997 No. Description Quantity 1 Pistol 38,000 2 Automatic weapon 226,000 3 Rifle 351,000 4 Machine gun 25,000 5 Grenade launcher KT 2,450 6 Mortar 770 Total 643,220 During the period of anarchy, the majority of the military depots and barracks exploded scattering munitions and other explosive devices in a wide perimeter up to 10 kilometers in the surrounding areas, thus creating very dangerous “hot spots" for local people. After these events, the geography of accidents from ammunitions, UXO's, AXO's, ERW, mines and small arms extended all over the country. The biggest number of accidents was recorded near the concentrated warehouses which were abandoned after the collapse of the army. To be noted is that 23 people lost their lives in a single accident as a result of the blast in the warehouses of Selita, Komsi municipality of Burrel. During the anarchy of 1997, according to the Ministry of Health about 4,400 people with serious injuries and wounds caused by ammunitions and misuse of small arms were treated in Albanian hospitals, while over 3,000 others were reported to have been killed. Damages caused from the looting of small arms and ammunitions are calculated to be around 61 billion Albanian leke.6 Ammunitions, UXO's/AXO's and ERW continue to take people’s lives at present, although 16 years have passed by since 1997. According to Media monitoring conducted by ALB-AID during 2007-2013 around 171 mine/UXO/AXO incidents have been registered allover Albania. In 2014, 14 UXO incidents have been reported, where 5 persons have died at the moment of accident while the others have been seriously injured. 5 Source: Survey: Towards a Safer Albania, page 15 (taken by "Ushtria" newspaper, dated 7 October 2005) 6 Source: Survey: Towards a Safer Albania, page 15 8
  10. 10. 1.2. The Key actors 1. Albanian Mine and Munitions Coordination Office (AMMCO) During implementation of the Mine Action Programme in Albania, the Albanian government set up two special structures, the Albanian Mine Action Committee (AMAC) – an inter-ministerial body for the designation of policies and the Albanian Mine Action Executive (AMAE), responsible for the coordination and monitoring of mine action operations. During the implementation of the Mine Action Programme, AMAE gathered knowledge and necessary technical expertise to ensure safety and efficiency of mine action activities from the implementing partners, in compliance with international humanitarian standards. In 2010, with the completion of demining operations, AMAE at the request of the Albanian Government was involved in coordinating unexploded ordnance hotspot operations in all its components, and changed its name to "Albanian Mines and Munitions Coordination Office (AMMCO) " to better reflect its new role and mission. AMMCO is currently responsible for coordinating, monitoring unexploded ordnance hotspots clearance operations, education and awareness about their risk, and assistance to the victims of mines and ammunitions. The Assistance Program for mine and UXO (ammunitions) victims consists of various components such as: emergency and ongoing medical care; physical rehabilitation and provision of prostheses; psycho - social assistance; social and economic reintegration; collection and analysis of data, and advocacy for the rights of mine and munitions victims and other persons with disabilities. AMMCO, with the support of donors and in close cooperation with health authorities in Albania has played an important role to advance the progress of victims assistance projects in Albania. However, the existing capacities at central and local level, currently serve not only to mine and ammunitions victims, but also to other persons with disabilities. In this context, with the support of various donor countries such as Austria, Czech Republic, France, Slovenia, Sweden, United Kingdom (DfID), USA and other international organizations like the International Trust Fund (ITF), the European Commission, UNDP, UNMAS, UNICEF ICRC and Handicap International, during the 14 year period AMMCO has coordinated and monitored projects on the socio-economic reintegration and improvement of the capacities of physical and medical rehabilitation of mine victims in the northeast of the country. Currently, the activities will be focused mainly on areas around the hotspots and on those that have the largest number of UXO victims and survivors. 9
  11. 11. 2. ALB-AID Association, Role and Experience in Mine Victims Assistance ALB-AID known as Victims of Mines and Weapons,(VMA) was established in early 2000, shortly after the end of the Kosovo war, from the former Care staff, which started mine risk education in Kukes region after the end of the Kosovo conflict. ALB-AID started Mine Risk Education Activities in order to raise awareness of the population in 39 mine affected villages in the border with Kosovo about the danger of mines in northeastern Albania. During its daily MRE activities in the field, ALB-AID identified many mine victims and started to collect information and to identify their needs. Gradually ALB-AID was involved in victims’ assistance and played a crucial role for their re-integration 10 in Kukes County. After the war, residents along the border with Kosovo, during their everyday activities such as grazing, collecting firewood, digging the fields, etc. faced with the presence of mines placed by the Yugoslav army within the Albanian territory. Because of the lack of proper information about the mining of these areas and due to the lack of education for the risks posed by mines, the first mine victims began to be registered. Within 3-4 years 210 mine accidents were registered in 39 mine affected villages along the border with Kosovo. During the 10 year period from 1999- 2009 until the completion of demining, 272 victims were recorded, 34 of whom died during the accident with mines, 84 had amputation losing their body limbs, 27 suffered serious eyesight damage, while the rest had various injuries as burns, fractures, and serious psychological symptoms, etc. ALB - AID, besides MRE activities with the people of 39 villages contaminated by mines, after registering mine victims, designed and implemented concrete projects for their socio- economic integration, and supported them to get the required medical services, prosthetic devices, physiotherapy service and psychosocial support. An important component of the work of ALB-AID has also been the advocacy and lobbying at various local and national government institutions as well as various donors for a broader support for the victims assistance for their involvement in various programs, especially international support and assistance, due to the lack of experience. With strong international backing it the Ortho-prosthetic Workshop was established at the Civil Hospital of Kukes, where prostheses for the victims are produced, repaired and maintained. It is one of the best workshops in the country which produces prosthetic devices for a lot of amputees from different regions of Albania, including those from traffic accidents. ALB-AID during a 14 year work, with international support, especially with the support of the U.S. State Department through Victims Assistance component has implemented many projects for socio-economic reintegration of victims. It has provided logistical support to the survivors to get health services including prosthetic devices, maintenance, etc. Through these projects more than 100 families benefited cows through a revolving fund, 104 survivors and their children received vocational trainings. Over 27 children received specialized medical assistance to improve their vision and cure their eyes. Another 21 child victims received additional classes in core subjects such as math, physics, and English and are supported with teaching and educational materials for 8 years in succession. Over 60 % of mine survivors who have received professional training, have opened their own businesses or are employed in various occupations in the local market. There are also survivors who are continuing university studies. After the explosion of the improvised ammunitions dismantling factory in Gerdec, ALB– AID, at the request of AMAE collected information and completed registration of 176 victims of Gerdec explosion using IMSMA format. After the completion of the registration ALB-AID identified and implemented several projects mainly with traumatized children affected by the explosion to help them reintegrate into their societies providing them special
  12. 12. courses for English and computer. ALB-AID conducted Mine/UXO risk education as well with the children and population of Gerdec and the surrounding villages. ALB - AID is currently working on the establishment of the National Mine/UXO/AXO Survivors Network. It is part of the Global and Regional Initiative for Mine Victims Assistance. ALB - AID is a member of the International Network for the Prohibition of Anti-personnel Mines and the International Coalition against Cluster Munitions. ALB - AID is gradually adopting its services to persons with disabilities as well, especially those who are in need prosthesis. In this context ALB-AID has been very active to urge the Albanian government to sign and ratify the Convention on the Rights of Persons with Disabilities. During 14 years of its existence ALB-AID has created a highly qualified expertise in on Victims Assistance, which could be replicated successfully in other parts of Albania and could be used for the integration of the persons with disabilities. Given the experience gained in the northeast Albania and Gerdec and the need for planned and coordinated support with all national and international institutions to support the victims UXOs, AXOs, ERW and ammunitions throughout Albania, ALB-AID, with the support of the Austrian Government has conducted this comprehensive Survey in six counties of Albania including Gjirokaster, Diber, Elbasan, Durres, Korçe, and Berat. With the support of the Department of the States of USA ALB-AID is presenting the results of the study in the next two counties, Lezhe and Shoder, thus completing identification of the situation and needs of UXO survivors in 8 counties of Albania. Another 3 counties remain to be completed for the whole Albania. They are Tirana, Vloraand Fieri. 3. International Conventions on Mine and Munitions Victim Assistance and obligations of Albania. Albania is active and has participated in various international initiatives for Mine Victims Assistance. In September 1998 Albania signed the Treaty for the Prohibition of Anti - personnel mines. In December 2008 Albania signed the Convention of Cluster Munitions. Within the framework of these conventions Albania, besides obligations for demining, is also committed to work on Victims Assistance for the re-integration of survivors. Albania reports annually on the level of implementation of the Convention on Cluster Munitions and the Anti-personnel Mine Ban Treaty, including victim assistance component. Pursuant to the Cartagena (Colombia) and Vientiane (Laos) International Action Plan on Victims Assistance the Albanian government has drafted a national plan for mine and ammunitions victims assistance. One of the objectives of this plan is to register victims of ERW, UXO, AXO and ammunitions in the entire country and to scale down the experience gained in the north - east of Albania in other counties to support re-integration of victims as well as persons with disabilities. This survey for the registration of the victims of ammunitions and identification of their needs in six counties of the country is in compliance with the National Plan of Action for Victims Assistance. 11
  13. 13. CHAPTER II The Goal, Objectives and Methodology of the Survey 2.1. Situation of the victims of ammunitions in Albania After the Kosovo conflict of 1999, AMAE with the support of international expertise began collection of data on mine victims in the Kukes region. In the process of data collection and registration of mine victims International and local organizations such as Care International, the International Red Cross, and Victims of Mines and Weapon, (VMA now ALB-AID) were involved. Within a 3 year period all mine victims in 39 villages bordering with Kosovo were recorded. With the support of the Geneva International Centre for Humanitarian Demining, in 2002 AMAE set up the IMSMA system for storing detailed information about mine and UXO victims. In 2005 with the support of UNDP, AMAE began collecting data on UXO / ERW / AXO accidents in Albania using IMSMA format. Until now detailed information on 979 mines and munitions victims in Albania has been recorded in IMSMA, including detailed data about 272 mine victims in north-eastern Albania. AMMCO continues to collect detailed information about mine/UCO/AXO and ERW accidents from ALB - AID and Albanian Red Cross from 2003 to date. This information is reflected in IMSMA database established for this purpose. Below there is a map of accidents from mines, UXO's and ERW from 1997 until 2013. Tabel e aksidenteve sipas qarqeve / Table of accidents according to the counties 12 300 250 200 150 100 50 0 Kukes Tirane Shkoder Berat Elbasan Diber Vlore Gjirokaster Lezhe Durres Casualties Injured Dead Fier Korçe However, to date there is not any comprehensive survey about the victims of accidents caused by ammunitions which could assess the real size of the damages and impact that UXO/ERW/AXO accidents have had on victims, their families and communities as a whole. Hence, UXO/ERW/AXO victims have not received any adequate attention and support from the government and state institutions. Many of them are left out of the government social and economic support schemes. There is a category of victims that do not benefited pensions because they were not employed at the time of the accident, as required by current law of social benefits. Being excluded, they have not been subject of treatment and support from any local, national or international NGO. On the other side lack of identification and presentation of their problems has brought about exclusion from several governmental and non- governmental programs, and
  14. 14. consequently they are marginalization and discriminated, their basic rights violated constantly. The tragedy of the accidents has been experienced and coped by the victims themselves and their families, including socio - economic and medical costs. Media has been the only formal supporter of the victims, which has presented the news, but not the consequences and the costs of the society. 2.2. The Aim and the Objectives of the Survey The aim of this survey is to promote the improvement of access of UXO/ERW/AXO victims to medical and socio-economic services provided by public and private, central and local operators, including different national and international institutions and associations. Objectives: This survey has had two main objectives: 1) Registration of UXO/ERW/AXO victims in two counties of Albania, (Shkodër and Lezhë) and 2) Analysis of the current situation and identification of the needs of munitions victims for medical services and socio-economic support for their integration. 2.3. Model and methodology used 2.3.1. Assessment Model The following model was applied to collect relevant information from the victims of ammunitions: Type of information collected Specific issues for which the detailed information is collected 13 Information about the accident Circumstances under which the accident occurred How the accident occurred, where did it occur, the device that caused the accident; Medical information Ways of obtaining medical care If there were amputations, injuries, malfunction what type of medical assistance was provided; ability to work; disability group; needs for further medical services, etc. Information about the family of the survivor Marital status, other family members; marital status at the time of the accident; household incomes; residence/house size; people residing in the dwelling apartment; conditions of the houses, etc.. Information about education and professional skills Level of education of the injured person, needs to improve vocational training courses, etc. Social –economic Information Social-economic situation of victims and their families Sources of Incomes before the accident and after the accident , has the victim lost job after the accident, skills possessed, economic assistance and social support provided by different actors, vocational training courses, social cohesion, family assistance, community assistance, how they feel in the community, their own and their family economic needs, etc.
  15. 15. 14 2.3.2. Aspects of assessment Assessed aspects Aspects of change Specific issues addressed by the assessment Health impact Impact of the accident on the health of the survivor Medical situation of the survivor after the accident Health situation Injuries caused by the accident Has the accident had direct impact on health and medical conditions of the survivor? Social-economic impact -Social-economic conditions-to what extent has the accident affected the change in the life of the victim and his/her family? - What is the direct impact of the accident including (positive or negative) changes in his/her life style? Way of living before and after the accident Aspects of changes in the life of the victim as a result of the accident Economic situation Economic situation of the survivors Has the economic situation of the survivor deteriorated after the accident? Have the incomes decreased after the accident? To what extent is the level of poverty among survivors of ammunitions? Social situation To what extent has the accident affected the life of the survivor? Has the dynamics of the behavior changed? Is there a new behavior of the survivor in the family? Is there any change of behavior of survivor's family towards him/her? Assessment of the needs for medical services and socio-economic support Needs for medical service and socio- economic support Ways of improving the survivor's situation/ conditions Improvement of medical services Needs for constant medical services Needs for prosthetic devices and their maintenance Needs for physiotherapy service Socio- economic support Needs for psycho-social support Needs for psycho-social counseling Needs for recreational activities Needs for employment/self-employment support funds for income generation/ improvement of economic situation Needs for vocational professional trainings/ crediting, councellings Support for establishment of Social Enterprises- Social business companies for survivors and persons with disabilities Advocacy /lobbying Needs for inclusion in the social support schemes, improvement of the disability pension scheme to include mine/UXO/ munitions survivors as well
  16. 16. 2.3.3. Survey Methodology The object of this Survey are the persons injured from incidents with munitions, UXO's, AXO's and ERW in two counties of Albania. (Lezhe and Shkoder) The survey is based on research methodology of data collected through questionnaires completed with each victim, interviews, official statistics collected by the departments of social services of targeted counties, various publications, etc. In total 126 victims have been interviewed. People who died during the accidents, were not included in this survey, because their family members refused interviews arguing that they would not like to recall the casualty. Implementation of the survey was conducted through four stages as follows: I) Preparatory Phase II) Completion of the questionnaire through individual interviews; III) Medical checks; IV) Data processing and preparation of the survey The entire process has been closely monitored by the AMMCO officer- the Victim 15 Assistance officer. Phase I. Preparatory Phase After the selection of staff, contacts were established with key actors involved and interested in conducting the survey. Although ALB - AID staff had capacities to collect data and perform the survey, a short training was conducted with the survey team for the techniques and specifications of interviewing the victims. The same questionnaire for interviewing (attached) which was prepared during the former project in cooperation with AMMCO VA specialist. The questionnaire is based on a model used by ICRC and GICHD in other countries for similar Victims Assistance projects. It has only been adopted to the Albanian context and modified to fit to the Albanian reality. After refreshing the established cooperation with the Ministry of Social Welfare and Youth, a meeting with the Department of Social Policies was organized to ensure institutional support from the Ministry and subordinate regional Social Service Directorates. This is also to ensure close cooperation with all actors in order to make sure qualitative information for the study. Regional Directorates of Social Service of Lezhe and Shkoder were visited after the establishment of contacts with the Ministry of Social Welfare and Youth in order to present the project and to discuss the requirements of the survey. Relevant agreements were signed with the directorates of each county in order ensure institutional commitment for the successful completion of the questionnaire and collecting of information and data from each targeted municipalities. In cooperation with regional directors of social service, local assistants of each county were selected. They were chosen to serve as a liaison between the ALB-AID, Regional Social service departments and the municipal social administrators. After the selection, training with local assistants was conducted, the Plan of Visits in each district was developed and forms of collecting information were designed. The AMMCO list of victims of two targeted counties was made available to the local assistants and regional social service departments to be shared with the social administrators of the municipalities. Local Assistants and social administrators were then instructed how to identify the current residence of victims. Local assistants organized meetings with municipal social workers and shared with them the list of victims, made available by AMMCO. At the same time social administrators were instructed to identify new victims unregistered in the AMMCO lists (if any) and to collect
  17. 17. information on potential accidents that might have been left out these lists. Social administrators made identification of the victims of ammunitions in their municipalities specifying their location, address, etc. During the identification process the social administrators as expected, identified 38 unreported accidents, 23 in Shkoder and 15 in Lezhe, not reported before, thus unrecorded in the IMSMA database of AMMCO. Phase II. Completion of the questionnaires – Field interviews The second phase continued 3 months from February until April 2014. After the collection of the contacts and information as well as specification of addresses by social administrators of municipalities, in coordination with local assistants, the field staff completed questionnaires with every victim individually in every village. During their field visits the field officers of ALB-AID were accompanied by local assistants and the social administrators of the respective municipalities. During this period, 168 victims and their families were interviewed in 64 municipalities of 2 counties. From those visited 126 persons have been interviewed personally, 78 in Shkoder and 48 in Lezhe. Interviewed from the list provided by AMMCO 88 persons while Pyetësort e plotësuar sipas qarqeve Questionaires completed in each county the other 38 injured persons interviewed were not reported before. They were indentified from the social administrators of the municipalities and project staff during the collection of information in the field. According to AMMCO database there were 138 accidents with UXO/AXO. From this list provided by AMMCO 52 persons have not been interviewed as follows:  11 persons rejected to be interviewed;  11 have died during the years after the accident  7 persons refused to be interviewed  12 persons were in Emigration,  1 person changed address  10 persons were not found in the addresses provided to AMMCO. These persons do not exist neither in the registers of Civil Records of municipalities provided in the IMSMA format (AMMCO) 16 Lezhe, 48, 38% Shkoder, 78, 62%
  18. 18. Each victim was visited and interviewed individually in his/her home in order to collect necessary information from them. Interviews lasted 50 to 78 minutes. The respondents were as follows: 13 females (10%) and 113 males (90%) as in the chart 17 below: Gjina e të intevistuarve Gender of the persons interviewed Meshkuj/Male 90% Femra/Female 10% The IMSMA format was filled for the newly identified victims. The collected data will be provided to AMMCO to be updated in the National IMSMA database managed by AMMCO. Phase III. Medical Check After the completion of the interviewing, medical check was organized with victims which had serious health problems during May and June 2014. Medical checks were organized at the regional level and included visits from the ophthalmologist, orthopedist, prosthesis technician, physiotherapist and psychologist. 14 medical examinations were conducted in total. During these medical checks 32 victims were visited by the oculists, 50 victims were visited by the orthopedists and prosthesis technicians and 77 survivors were visited by the psychologist, 43 of which with had serious psychological problems. Phase IV. Data processing and preparation of the survey The detailed processing of the data collected and identification of the needs presented in this study is done for 126 UXO survivors that have been interviewed from ALB-AID. After the completion of medical check, the collected information from all sources, besides information gathered through questionnaires, was computerized and processed. A detailed database was prepared in access format. The data was analyzed and a detailed study is prepared for the medical services and social-economic support needed for their re-integration and elimination of their discrimination as compared to other groups of persons with disabilities. Relevant recommendations were also drafted for public institutions to support improvement of medical services and assistance for socio- economic integration of UXO survivors. The General Part of the Study is translated into English. The study is distributed to the RDPSS's of Shkoder and Lezhe counties. The survey is also shared with the Ministry of Social Welfare, Youth and the State Social Service The Survey will serve to encourage different actors for the inclusion of munitions victims in various government policies and programs for people with disabilities, and total rehabilitation of the munitions victims in compliance with national and International standards and Conventions for Victims Assistance for Mine and UXO victims including Convention for the tights of persons with disabilities. . The survey findings and recommendations for next steps to be taken will be shared with all interested parties and will be published in the official website of the ALB AID association.
  19. 19. Key findings  38 UXO accidents previously unreported have been identified and registered in 18 Lezhe and Shkoder:  11 persons have died at the moment of accident with UXOs, while 11 others have died in the coming years due to poor medical support (Their families have not been interviewed for ethical purposes and are not included in this survey study  The victims of munitions, UXOs, AXO's and ERW are spread mainly in the poorest and remotest areas of the targeted districts.  The victims of munitions, UXOs, AXO's and ERW belong mainly to the poorest marginalized groups and are made of all age groups.  18 persons have been injured with land mine (14 %), 107 (85%) have been injured with me municitions,UXO's and 1 with unidentified object.  Out 126 interviewed 13 have been females.  At the moment of accident 11 have been children aged 5-18 years old, 83 belonging to 19-55 years old and 32 over 56 years old.  Out of 126 victims interviewed, 1 does not have any education, 72 have primary education, 40 secondary education, 13 university degree.  55 victims were heads of the families before the accident; 36 affirm that this role has changed after the accident.  81 survivors have had amputations whereas others have suffered fractures, injuries, et  25 persons (20%) have acquired technical medical devices as follows: 18 persons are equipped with prosthesis, 1 crutches, 5 with spectacles ,1 eye prosthesis  55 persons have displayed different disorders in hearing and vision  12 persons have got medical treatment outside Albania  43 survivors have serious psychological problems and need intensive psychological sessions.  55 persons have displayed different disorders in hearing and vision  81 persons have the ability to work of which 41 have completely lost the ability to work after the accident, while 40 have lost their partial ability to work.  81 injured persons feel physical difficulties in obtaining basic public services (64 %  122 respondents did not have access to daily social activities, rehabilitation and education services for persons with disabilities due to lack of infrastructure for people with disabilities and are not included in re-creative activities  106 survivors live in inappropriate houses that need various repairs including ramps.  87 survivors were included in the Social Assistance program (69 %), whereas 39 were not included (21 %).  47 survivors receive disability pension, 10 persons receive retirement pension (before the accident only 3 persons received retirement pensions, none received disability pension.)  59 persons are engaged in farming and animal breeding compared to 83 persons before the accident.
  20. 20. 19 The major Needs  74 survivors are in need of permanent medical services. This includes equipment with prostheses, repair of prosthesis, physiotherapy sessions, regular eyes' check, etc.  2 persons need to be equipped with prostatic equipments, 2 with crutches , 51 with leg and hand prosthesis, 13 with eye prosthesis, 1 wheel chair and 5 need to be equipped with spectacles. They also need periodic medical checks, intensive physiotherapy sessions, social support and peer support  29 injured survivors need to have periodic checks from the oculist  43 survivors with serious psychological problems need psychological sessions  18 persons reported special needs from which 13 reading equipments (brail) for blind, 1 linguistic tool, 3 persons need special books (sound with brails) and the last one an equipment for hearing;  57 survivors wish to attend vocational courses, 8 survivors wish to attend high school (Secondary school) and 7 wish to attend university studies.  118 survivors are in need of further support, from which 69 to get employed, 57 to attend vocational courses, while 25 of them ask to be supported with micro - loans for family home based businesses.  31 survivors ask for support for the reimbursement of their medicines, 107 are in need of support for prosthesis such as trans tibial (below the knee) prosthesis), trans femoral (above the knee) prosthesis, trans radial (below the elbow) or trans humeral (above the elbow) prosthesis, etc.,  22 persons have asked for the re-imbursement of the studies for their children while another 3 re-imbursement of the rent of the apartments where they live because they can not afford it  20 persons ask to improve access to daily social centers while 16 request to be included in sports clubs and re-creative activities  31 survivors have asked for the re-imbursement of health expenditures  Almost all survivors need to participate in recreational activities and psychosocial support to overcome the trauma. They need to be included in peer support programs.
  21. 21. Aksidentet sipas viteve / Accidents in years 8 60 20 17 1957-1991 1992-1996 1997 1998 1999-2000 2001-2005 2006-2013 Mosha në momentin e aksidentit Age of the victims at the moment of accident 19-25 vjeç 15% 36-45 vjeç 9% 20 26-35 vjeç 17% 5-18 vjeç mbi /over 66 vjeç 9% 56-65 vjeç 9% 17% 46-55 vjeç 24% CHAPTER III Results of Questionnaires 3.1 Accidents with Mines, Ammunitions, UXOs, AXO's and ERW According to the information and data collected it results that 145 UXO victims have been reported in the two counties of Lezhe and Shkoder during the years 1997 - 2013. While from 1957 until 2013 there were injured from mines UXOs and munitions 168 in these two counties. If we refer to the accidents in years (table below) we see that the incidents from mines and UXOs have been sporadic during 1991-1996. The accidents of this period could be considered as sporadic as compared to the accidents reported after 1996. In 1997 incidents with mines and munitions raised to 60 cases, followed by 29 incidents in 1998. Then in the following years again there is a reduction of incidents, but compared to the years before 1997 the number still remains high. The trend of incidents is illustrated in the following table. 19 25 23 70 60 50 40 30 20 10 0 It is worth noting some interesting figures for the period before 1991. Thus, during 1957- 1991 only 19 incidents with munitions were reported. 3.2. Age of the injured persons If classified by age, we note that 9 % of the injured were children, 15% teenagers, whereas 67 % belong to the working age group. Only 9 % were over 66 years old.
  22. 22. 3.3. Device that caused the accident 86 persons, 68 % of respondents have been injured by munitions and hand grenades, 18 persons, 7 % (18) have been injured by mines, 21 persons, 17 % with detonators, while 1 person fails to identify the device that caused his injury (might have been detonator). This comes as a result of the trauma that the injured persons have suffered as well as their vague memory, since the incident occurred several years ago. The table below describes accidents classified according to the type of device. Aksidentet sipas llojit të mjetit shpërthyes Accidents according to the type of device Tjetër/ Other Mine/ Mine 3.4 Activity of the survivor at the moment of the accident Another interesting data is the activity of the injured at the time of the accident. From most respondents it turns out that 17 % of them were working at the time of the accident. This includes primarily persons who were working in the army or soldiers when small arms, light weapons and ammunition warehouses were looted or robbed in 1997. Children make 8,7 % ( 11 persons) who have been injured while playing with their friends or manipulating the devices found, thus causing the injury. Other categories, smaller in number, are categories of those injured while engaged in agricultural works, such as digging the land, grazing cattle or collecting scrap, etc. . This group also includes other people who might have been by chance in the place of the accident, walking, going to visit relatives or travelling to school. Thus, 43 persons are injured while playing, 14 while walking, 12 farming and 20 persons injured while grazing animals (16%), while the last one was injured while collecting scrap. 21 17% E panjohur/ Unknown 1% Granatë dore/ Hand Granade 40% Municion/ Munition 28% 7% Lloji i aktivtetit në momentin e aksidentit Type of activity at the moment of the acciden Duke mbledhur skrap/ Collecting scrap 1% Të tjera/ Other 11% Duke punuar arën/ mbledhur dru/ Diging land/collecting firewood 10% Duke kullotur bagëtinë/ Grazing animals 16% Duke shëtitur/ Walking around 11% Në punë/ On job 17% Duke lozur/ Playing 34%
  23. 23. 3.5. Injures caused by accidents Individuals who have been part of the field interview are also categorized according to damage caused by accident. Field interviews showed that damages of the injured are various where the most important ones include amputation (loss of limbs), wounds, loss of eyesight, burns, superficial wounds, hearing damage, psychological trauma, etc. According to this categorization two main groups are distinguished: a) the group of people who have undergone amputation and b) the group of persons with various wounds. According to interviewees, 81 persons have had amputation as a result of the incident. Amputation includes limb losses such as loss of leg, hand or fingers etc. The second group includes 45 injured persons that have had different injuries as fractures, burns, etc., which will be addressed below. The largest number of people who have had amputation belongs to those who have lost the right or left arm, or injuries below the elbow as well as above the elbow, 43 % in total. 14 persons belong to this group, while another 17 have lost either the left or the right leg. This group also includes 31 persons (33%) who, besides losing one limb, have lost other parts or damaged such as fingers or toes etc. While referring to the second group of injured persons, those who have had various injuries, the largest number belongs to those who had eye injuries 35 persons, followed by 17 who had fractures; 23 burnings, 15 fragmentary wounds, 18 with other wounds like damage of stomach, los of hearing, etc After the incident 55 persons have displayed disorders with vision, hearing and nervous system (mental health) . Lloji i dëmtimit Type of damage caused 3.6. Medical Support All interviewed persons confirmed to have received medical support at the nearest hospital after the indent. The victims in remote villages were immediately transported to hospitals in the respective cities as appropriate, in an ambulance or other private vehicles. Likewise, nearly all survivors were treated initially with First Aid and then all those who had an urgent need for intervention, have undergone further surgery. It is worth mentioning that when local hospitals did not have the capacity to treat the patients, they were transported to hospitals in the capital city for more specialized interventions. According to the interviewees, almost all of them, 124 injured persons have received First Aid, while 109 injured persons 22 Amputime/ Loss of limbs 55% Plagë të ndryshme/ Wounds 69%
  24. 24. have undergone surgery of the first or second level after receiving First Aid. Interventions have been different, as we shall see in the following chapter. In specific cases, it was necessary to do painful operations including hand or leg cut. below detailed table of the type of Medical support received. Lloji i ndihmës mjeksore / Type of Medical Intervention/support 140 120 100 80 60 40 20 Referring to the support with Medical Devices and equipment of the injured the situation is as follows: 25 persons have got such devices from which 18 have received prosthesis, Syze/Spectatcles 20% 1 wheel chair, 5 spectacles and 1 eye prosthesis. 12 of them have taken medical treatment outside Albania mainly equipment with prosthesis and eye treatment as follows: 4 in Italy, 3 in Russia, 1 in Greece, 1 in Turkey, 1 in Ireland and 2 in Germany. 23 0 Ndihmë e parë/First Aid Surgery (I-st Intervention) Surgery (II-cnd intervention) Continous medical treatment Physical Rehabillitation Llojet e paisjeve mjeksore e përfituar nga të dëmtuarit Type of Medical device received byy the injured Proteza/Prosthesis 72% Paterica/Cratches 4% Proteza syri/Eye prosthesis 4%
  25. 25. 3.7. Incidents with UXOs and disability of the injured Accidents with UXOs have caused the loss of ability to work for the most injured that have had an incident. 40 respondents have been categorized as temporarily disabled, while 41 of them as permanently disabled. So there are 81 injured persons who claim to have totally Tipi i pa-atesise/Type of disability lost the ability to work, while the rest, 45 persons state that they are re-integrated into the community and work like any other individual with effective operational capacity like any other individual. 3.8. Needs for further medical support and treatment Asked if they need further medical support, 36 persons have acknowledged that they need ongoing medical support while 55 have mentioned that they need Medical Devices. Their needs are as follows: 72 % of the injured, 74 of them are in need of medical devices from which 51 persons need to be equipped with prosthesis for legs or hands, 13 with eye prosthesis, 1 with wheel chair, 5 with spectacles and the last 2 with prostatic devices. The table below illustrates the needs for medical devices in percentages: 24 Pa-aftësia e përhershme /Permanent disability 51% Pa-aftësi të përkoshme /Temporary disability 49% Lloji i paisjeve mjeksore për të cilat kanë nevojë të dëmtuarit Types of Medical Devices needed Proteza/ Prosthesis 68% Syze/ Spectatcles 7% Paisje prostetike / Prostetic equipment. 3% Paterica/ Cratches 3% Karroca/ Wheel chair Proteza syri/ Eye Prosthesis 18% 1%
  26. 26. 3.9. Information on the family situation Out of 126 respondents, 79 injured persons declared that they were married and 47 were single at the moment of the incident. The respondents confirmed that they had 248 children approximately 3,2 children per family. Most of the respondents are 46-55 years old (24 %) followed by those aged 36-45 (21 %), whereas children make up 9 percent. Mosha në momentin e aksidentit Age of the victims at the moment of accident Kush varet nga i aksidentuari? Who depends from the injured person? 1% Tjetër/other (1) 25 19-25 vjeç 15% 36-45 vjeç 9% 26-35 vjeç 17% 5-18 vjeç 9% mbi /over 66 vjeç 56-65 vjeç 9% 17% 46-55 vjeç 24% At this stage it has already been identified whether the respondents have other family members injured. Interviews showed that only 20 of them had kin's involved in the incident, while 106 responded negatively. The family members involved in the accident and injure were cousins injured as well. While referring to the question if the casualty have had the role of a bread winner in the family, 55 answered that they have been heads of the families and have insured incomes for their families, while 71 did not have this position. Asked if their position has changed, 36 persons have answered that the position has changed because of the disability after the accident while 90 persons have answered "no". Some injured persons who were not family members, after the accident also took this position. Vëllai/motra brother/sister ( 2) 1% Prinderit/parents (8) 4% Askush/None (41), 21% Fëmijet/Children (71) 36% Bashkëshortja/ bashkëshorti Spouse(73), 37% The accident has caused catastrophic consequences for the families of the injured, because the whole family is dependent from the head of the family who is often the breadwinner. The respondents answered as followed to the question who is dependent from the injured:37 % declared that the husband is dependent from the incomes secured from, while 36%
  27. 27. declare that their children are dependent from them , while 21 % declare that none is dependent form them. Pas aksidentit kush i siguron të ardhurat për familjen? After the incident, is the role of bread-winner responsibility of other household member (who) Another important point is the earning of incomes for themselves and their families from the injured persons. As they are part of different levels of damage, the income generation for their families is very difficult. The results of the survey show that 75 injured persons (56%) earn incomes for their family on their own, followed by 39 injured persons (28%) whose parents ensure incomes for them, followed by 13 cases where the spouses ensure incomes for their families. Incomes generated from these persons themselves have a double meaning, where “income provision by the person himself/herself" besides commitment to a systematic work also means disability pension that these persons benefit, either including guardian or not. Cases referred to parents are mainly people injured at an early age and are unable to be engaged in a stable job. When referring to incomes secured from the wife, it is primarily identified with jobs in agriculture, sales assistant, etc., jobs which are generally done by women. 3.10. Living conditions The injured survivors mainly live in the countryside. Quite a few of them live in towns. Referring to their residence, 95 respondents live in private houses and 31 in apartment buildings. The average size of the residence is 74.4 m2, while the average number of persons living in a residence is 5. A positive fact for the persons interviewed is that the majority, 118 of them affirm that they have private ownership of their property, therefore they are owners of their houses. 6 persons only state that they live in rented houses, 8 reside with relatives and only one person declares that he lives in an occupied property. An interesting fact about the conditions of the residences is that 48 % of the respondents declare that their houses are old and need to be repaired. Repair according to the respondents usually involve toiletries, roof and plumbing or electric installations. In total 106 injured persons have asked for the repair of their houses, while 20 injured survivors stated that their homes do not need any repair at all. As for the drinking water, 93 persons answered that they have drinking water. From them 64 % declared that water comes on scheduled time ( it is not 24 hours), while 35 % have drinking water 24 hours without stop. They stated that they do not have problems with sewage. Nearly all the respondents affirm to possess electrical appliances and devices such as televisions, furniture, furnishings, refrigerators, etc. None of the injured possess a car or farm 26 Prindërit/parents 28% Tjetër/other 1% Vëllai/motra/ sister/brother 2% Bashkshorti/ja/ Spouse 9% Fëmijet/children 4% Unë vetë/myself 56%
  28. 28. machinery. The only important property considering the aforementioned fact about the life in rural areas is the possession of land. It is clear that for most of them the agricultural land and animal breeding are the main source of their daily incomes. Either alone or family engaged, they work in agriculture for their survival. Shortly after the land, the second most important property is the possession of a cow, fruit trees, etc. According to the data collected, 48% ( 59 persons) are directly involved in farming. They poses in total 255 acres. While 9 persons ensure their incomes through cultivation of fruit tree farms, while 34 through animal breeding of cows. 3.11. Education Education is one of the pillars that may have penalized the full integration victims of UXOs AXOs, ERW and ammunitions. From the data collected the results are as follows: from the data collected it results that the majority of victims, 57 % have primary or high education, whereas 40 persons or 30% have higher education. Only a small number, 7% have university education. The facts show that people who have higher education are also better Arsimimi/ Education Universitet/ University 7% Pa arsim without education 1% Shkolle 9 -vjeçar/ Primary education 57% Me shkollë të mesme / High School 31% integrated into society providing their family income themselves, are stabilized at a regular job and are protagonists in social life. Persons with primary education are forced to earn family income through a third party (spouse, children), not only as a result of non- physical ability, but also due to lack of a profession. While persons with secondary education are in the center and are driven by external factors to be part of contemporary challenges, but for them too, lack of professional skills does not allow their integration. Regarding improvement of their education, 45% or 57 injured persons responded that due to their relatively old age, they do not prefer to continue their studies, but to attend Çfarë do të donit të përmirësonit në edukimin tuaj? If support what would you select to improve your education? 27 Nuk prononcohen/Nothing 43% Të vazhdoj shkollën/ To attend school 6% Të vazhdoj universitetin/ To attend university 6% Të ndjek Kurse të formimit profesional / Vocational Courses 45% vocational professional courses instead. This also comes from high unemployment that characterizes this stratum, and from considering vocational training as the only hope for employment. This group considers education as a quick and safe way for their integration. Another 8 injured persons wish to resume school where they left, 7 of them wish to attend university, while 54 of them do not show any interest at all.
  29. 29. 3.12. Socio-economic situation Socio- economic situation in the field looks hopeless. Survival of injured persons is based mainly on farming and animal breeding. The accident has caused disability loss of the job for the injured, thus causing economic difficulties. According to the table below it results that while before the accident 46 % were involved in farming, after the accident the number of persons engaged in agriculture is reduced to 24 %. The majority of them have expressed that the accident has caused loss of the job arguing Burimi i të ardhurave para dhe pas aksidentit/ Source of incomes before and after the accident 60 50 40 30 20 10 I punësuar me kohë të plotë/Full time job Pune sezonale/Seasonal job Pension invaliditeti/Disability pension I punësuar me kohë të pjesshme/Part time job Asnjë burim/None a) disability to work in the same job b) discrimination; c) refusal of the employers and government institutions. So 58 persons declare that the incident ha been the main reason to loose the job. within this group 48 declare that they lost the job because of accident, while 4 because of discrimination of "being disabled" and lack of qualification. Before the accident 22 % declare that before the accident have been employed while after the accident only 10% continue to be employed. There is increase of injured who relay on disability pension. Before the accident benefited elderly pension, while after the accident 47 persons or 27 of the injured persons benefited disability pension, while number of injured persons who benefit elderly pension increases from 3 to 7. 21 % of persons interviewed declared that they could move freely The table below illustrates more clearly the source of incomes after the accidents. 28 0 Bujqësi/Agricultuture Mbarshtrim bagetish/Animal breeeding I vet-punësuar/Self-emplyed Pension normal/Regular Pension Emigracion/emigration Tjetër/other Para Aksidentit/ Before the Accident Pas Aksidentit/ After the Accident Burimi i të ardhurave para aksidentit/ Source of incomes before the accident Pension normal/ Regular Pension 2% Pune sezonale/ Seasonal job 2% Pension invaliditeti/ Disability pension 0% Asnjë burim/ None 7% Punësuar me kohë të plotë/ Full time job 15% Tjetër/other 16% Emigracion/ Emigration 2% I punësuar me kohë të pjesshme / Part time job 7% Bujqësi/ Agricultuture 29% Mbarshtrim bagetish/ Animal breeeding 16% I vet-punësuar/ Self-emplyed 4%
  30. 30. Another important data is the social support that the injured persons have received after the incident. Only 4 persons declare that have got social support; 116 persons declare that they do not have Daily Social Centers at their municipalities; 33 persons have said that although they have asked for support , the government institutions dealing with vulnerable groups have not provided any such.61 % declare that they have been treated with cash benefit (economic aid), while 21% with disability pension. Another important fact is related to the lack of proper policies for employment for this disaggregated group of the society. Support for employment from Government Labor Office has been provided only to 4 persons, while 29 have been encouraged to attend school after the accident, another 9 injured persons have been encouraged to attend special schools. The lack of support from the government institutions for such disaggregated category should be treated seriously. Support for this category should be part of government policies for such groups. They should be included in Vocational Training Courses and programs. As for the difficulties faced by these survivors in receiving services from public institutions, such as public schools, hospitals or institutions, 82 of the respondents claim not to feel any difficulty, 44 feel difficulties and express their opinions to improve these public services. With regards to the social aspect, most of them, about 95 % say that the key to their integration in the community has been their family. 121 of the respondents or 90% have declared that they feel integrated to their communities and families. Besides family, an important role has been played by the community, although the figures here are lower, because of discrimination. Thus 117 persons declared that they have received visits from their friends and relatives. Frequent visits from friends or relatives are part of their consideration and an important factor for their social inclusion. Asked about this point they say that they are able to participate in daily activities and their mobility, either with or without prosthesis, does not hinder them to have a daily walks in the city or to be engaged in an activity. The difference occurs in social life, where the parties are separated, 79 of them said they participate in social life and 47 expressed negatively. By social life is meant exercising sports, culture, politics, etc. Thus 30 of them are involved in sports, 45 are engaged in cultural activities, 10 are part of local government councils. 3.13. Needs for further social-economic support As described in the table below, 93 % of the persons interviewed, 118 persons out of 126 injured persons, answered that they need economic support as follows: 43 % to start activities which increase employment and generate incomes; 34% asked for support to attend professional courses, 25% small loans to establish home based businesses. A great number of injured persons answered that they seek support for the re-imbursement of medicaments, scholarships for their school children etc. Thus 31 persons seek re-imbursement of expenditures for medicaments which cost around 60$ per month, 55 Për çfarë mbështetje ekonomike keni nevojë? What type of support do you need most 29 Mikro-kredi për të ngritur biznes familjar/ Micro-crediting for small business 17% Mbështetje për të ndjekur Kurse të formimit profesional / Support for Vocational Courses 34% Mbështetje për punësim/aktivitete që gjenerojnë të ardhura/ Income generation activities 49%
  31. 31. have asked for support to get new prosthesis, 22 persons seek support for the education of their children, 20 asked to be supported to have access to daily social- rehabilitation centers and education institutions for PWD, 18 injured persons ask for support to involve their children in different sports and cultural clubs, while the last 3 requested support to pay rent for the apartments where they live. 4. Special Needs of injured persons 18 persons have special needs as follows: 13 of the injured need reading tools for blinds, 1 person is in need of linguistic devices, 3 others are in need of brail books and the last one other hearing tools 5. Permission to use information and data gathered from injured persons. 81 persons have not given permission to share the information and data with government Institutions , while 2 persons did not like to share information with NGOs. While 29 persons agreee to share the information with government institutions and non governnet institutions but without personal data. Only 16 persons agreed to to share the information with personal data with government institutions and different non governnet institutions. 30
  32. 32. CHAPTER IV RECOMMENDATIONS 31 4.1 Key recommendations ‐ Looking at the data collected from this project it is clearly expressed that the needs for medical services including ortho-prostheses, physiotherapy, ophthalmology and trauma will be necessary for a long time for the injured survivors. ‐ The medical services that they receive at present are incomplete and have a high cost compared to their economic situation. These people are not able to afford expenses for the prosthetic device, treatment or occasional medical screenings and checks because most of them live on a pension or social welfare (cash benefit). ‐ Regional hospitals are not able to provide specialized services for the equipment of victims with prostheses, not even for their maintenance. So they are forced to turn to Tirana hospitals or private hospitals. This is impossible for most of the victims because the costs are unaffordable and they live in very remote areas. ‐ Regional hospitals are unable to equip amputees with prostheses and to maintain them. Under such circumstances it is necessary to mobilize different organizations, donors and government institutions enable support for the equipment of survivors with prostheses, as well as eye and vision services. ‐ The National Trauma Center is not functional and does not meet the needs for this category; it should re- dimension its function, because under such conditions it cannot serve to the amputees with professionalism to equip them with proper prostheses. ‐ The regional hospitals lack prosthesis Workshops or Units except Kukes County, which was set up with the support of the U.S. State Department. Looking at the territorial extent and number of high accidents from road traffic as well, it is urgent to establish Ortho-prosthesis Workshops in each Regional Hospital, which could not only produce prosthesis for the amputees but also for the maintenance of prosthesis. ‐ Ministries of the line such as the Ministry of Health, Ministry of Social Welfare and Youth should set standards for all amputated persons to be equipped with prostheses. ‐ Within the framework of amending the law on disability, the victims of mine, UXOs, AXO's and ERW should be included in the Law on social Services ‐ Most of the injured persons lack social cohesion, their mobility is very limited, and they are visited only by their relatives. Public institutions and NGOs through various recreational activities can create a more social cohesion for this marginalized group.
  33. 33. ‐ Most of the victims of munitions do not have professional skills, so they have a lot of difficulties in finding a job to ensure incomes for their families. Their professional training through vocational training courses is necessary to enhance their individual skills, to be competitive and participate in the local labor market. Only in this way they can be integrated and become independent from other family members. ‐ Almost none of the governmental institutions apply the current law for the employment of persons with disabilities. Both public and private institutions should pay more attention to the employment of these persons and be imposed to apply the law in force which applies fines or alternative payments. ‐ A considerable part of them can be reintegrated and assisted through projects that promote income generation and self-employment. These kinds of projects have been very successful in Kukes for the reintegration of mine victims. Among the favorites can be considered projects that can encourage handcraft work, strengthening of household economies, cultivation and processing of agricultural products, etc. ‐ All state institutional buildings lack ramps at the their entrances or can not be accessed because they are in upper floors, thus limiting the delivery of services to persons with disabilities, including mine and ammunitions victims. Institutions providing public services should immediately begin adaptation of their premises to become accessible for people with disabilities. ‐ In the country there are differences between mine victims and labor invalids, which contribute to the disparity between persons of this group. All disabled people should have unified treatment with no differences between them. ‐ In addition, there should be no discrimination between victims of mines and ammunitions and disabled workers; victims who were employed at the time of the accident receive pensions, while the injured people who were not employed are not treated with pensions, thus creating a difference in treatment. 32
  34. 34. Annexes Annex 1. Map of UXO Hot Spot Areas in Albania/ Harta e Hot Spoteve - Zona të rrezikshme - ish Magazinat dhe Depot e municioneve të Ushtrisë Shqiptare. Annex 2. Needs Assesment Form ued during interviews. Annex 3. Photos during the completion of the questionaire and medical 33 checks.
  35. 35. Aneks 1 Map of UXO Hot Spot Areas in Albania Harta e Hot Spoteve - Zona të rrezikshme -ish Magazinat dhe Depot e municioneve të Ushtrisë Shqiptare 34
  36. 36. Annex 2. NEEDS ASSESSMENT FORM ======================================================= 35 IMSMA use only MSMA Report ID: Date of report _____/_____/_______ (Date/month/year) Needs Assessment ID: ======================================================= Date of Interview _____/_____/______ (Date/month/year) I. INFORMATION ON THE ACCIDENT 1. Date and place of accident. Date of accident Place of accident Date Month Year Where Village/city Municipality District County 2. Activity at the time of accident ________________________________________ working, playing Walking, grazing animals, collecting scrap going to school tilling the land other________________________________ Comments_____________________________________________________________________ ______________________________________________________________________________ 3. Type of device that caused the accident Mine Munition Hand Grenade I do not know________________________________ Other (Specify)____________________________________________________________________ II.MEDICAL INFORMATION 1. Casualty has amputation Yes No If amputation yes, specify Left arm above - elbow Right arm above - elbow Left arm below - elbow Right arm below - elbow Left hand - fingers Right hand fingers Left leg above - knee Right leg above - knee Left leg below – knee Right leg below - knee Left foot - toe Right foot - toe 2.Injuries Avulsion (localization) cerebral trauma Eye injuries ( right left) Fractures Fragment injuries Paralysis - paresis Spinal cord trauma Burn Other_______________________ 3. Other injuries/comments________________________________________________ 4. Dysfunctions Eyesight Basic - motional apparatus Urology system Hearing Cardiovascular system Genital system Nervous system Digestive tract Other Respiratory system Endocrine system 5. Type of assistance received First aid Primary surgery Follow-up surgery Continuing Medical care Physical rehabilitation Psychosocial support Other 6. Has the victim become disable after the accident (lost the ability to work)? Yes ; No 7. If yes, Disability is: Permanent Temporary 8. Disability group; I - fully disabled and need constant care II - partial disabled and need limited care III - less disabled and need no care IV – less disabled and need no care Group was not provided other 9. Do you need further medical support? Yes No 10. If yes, What type____________________________________________________________
  37. 37. 36 11. Have you received technical medical devices? 12. If Yes ,Technical medical devices received Prosthetic Orthoses Wheelchair Aero phonic techniques Crutches Eye prostheses Other 13. If you received medical support/service outside Albania, please specify What country _____________________What exactly ___________________________________ 14. Do you still need medical equipment? Yes No 15. If yes, What type Prothetic device Oththosisi wheel chair; Prosthesis, Crutches eye prosthesis Aero-phonic devices glasses other Comments_____________________________________________________________________ ================================================================================== III. HOUSEHOLD INFORMATION 1.Marital status Single Married Divorced Widow (er) 2. Do you have children? Yes No, if yes how may __________________ 3. Age of children Age 0-5 Age 6-12 Age 13-15 Age 16-17 Age 18 and over 4. Do you have other household members that are casualties of mine /CM/ ERW/AXO? Yes No 5. If yes who? _ Children brother sister Other___________________________ 6. Number of individual household members dependent on casualty? Age 0-15 Age 16-18 Over 18 7. Does the casualty have the role of bread-winner in the family? Yes Shared Partial No 8. Have you been the main person to get the family incomes? 9. Has the role changed after the incident? Yes No 10. Who are you dependent from to make your living? None children spouse parents sibling’s grandmother/father other 10. After the incident is the role of bread-w inner responsibility of other household member (who) Myself. Other If not myself who owns the family incomes? Spouse Parents children Grandparents Siblings other Comments______________________________________________________________________ 12. Size of the living space? (m2) 13. Number of people living in same living space with the casualty? (Persons) 14. Type of residence? Private house Apartment Other 15. If you live in an apartment, in what floor? I-st Floor, II cnd Floor, III-rd Floor, IV-th floor,V-th floor. 16. Type of ownership of habitat? Owned Rented living with relatives Occupied 17. Condition of the apartment/house Old; New, repaired 18. Do you have drinking water at home? Yes No; If yes, per hour all the time, 19. Where are the toilets? Inside the house outside the house, 20. Does your house have a sewages system? Yes No; 21. Is your hose in need of repairs/reconstruction? Yes No; 22. If Yes, what type of repairs? Toilet roof, Other___________ Comments of the person who conducts the interview (mandatory)_______________________________________ ____________________________________________________________________________________________
  38. 38. 23. Household possessions (1 Yes, 2 No) which of the following devices do you have? Description Yes No Description Yes No Description Yes No Description Yes No Wood stove Heater Computer Car / Truck stove with Electricity Conditioner Internet Tractor Stove with gas TV set Land Line Vehicle Washing machine Video / DVD Cellular Agricultural What do you like to improve in your education? 37 machinery Fridge Digital receiver Bicycle Kitchen Shower Sewing Machine Solar Panel Furniture 24 Do you have other property? Arable Land Fruit trees Horse Livestock Sheep, cows, goat, pigs, other________ ==================================================================================== IV. INFORMATION FOR PROFESSIONAL SKILLS AND EDUCATION 1. Education level casualty has (select highest)? Request for education upgrade? No education Primary school Secondary school High school Technical school attend school College Attend University' University - institute Attend professional course Post - graduate ==================================================================================== V. SOCIAL-ECONOMIC INFORMATION 1. Source of income before incident? 2. Source of income (after the accident)? Agriculture Agriculture Animal husbandry Animal husbandry Family from abroad Family from abroad Self-employed Self-employed Employed part time Employed part time Employed full time Employed full time Seasonal job Seasonal job Pension Pension No income No income 3. Has the incident caused casualty loss of job? Yes No 4. If Yes how? Disability to do the same work; Discrimination Refusal from the employer, Lack of qualification Comments ________________________________________________________________ 4. Skills possessed by survivors Farming Accounting Language Beauty salon Construction Poultry keeping Radio technique Welder Vegetable growing Knitting - Sewing Bee keeping Bakery Computer Car repair Stock rising Carpentry Shoemaking Welder Other 5. The preferred field of the activity _________________________________________________________, Comments _____________________________________________________ 6. Has casualty received economic support? Yes No If yes in what year _______ 7. Do you receive now economic report? Yes No 8. If yes, what kind of support? Vocational trainings Business training Educational support Income generation grants Job placement Loans - micro-credit other 9. From who have you received economic support? State authorities’ Humanitarian organization other Comments__________________________________________________________________ 10. Are you involved in the program of social Assistance? Yes No
  39. 39. 38 11. If yes, describe what program? Disabled pension Economic Aid Pension as Single mothers Elderly pension Orphans (survivor pension) less than 18 years old Special pension Scholarship Other ______________ 12. Has the casualty been offered the vocational training form the labor Office? Yes No Describe ____________________________________________________ 13. Has the casualty been encouraged to complete the education? Yes No; Describe/Comment__________________________________________ 14. Does the local educational service meet the particular needs of the casualty? Yes No; Describe/Comment__________________________________________ 15. Have you attended special classes? Yes No; Have you attended additional courses Yes No 16. Have you used Special equipment/devices at school? Yes No 17. Do you feel difficulties in receiving services from government institutions, schools and hospitals? Yes No; Comments_______________________________________ 18. Is/Has the casualty receiving the peer support services? Yes How ___________________________________________________ No Why ___________________________________________________________ 19. Is the casualty receiving social work support service? Yes No If Yeas what? Daily service recreative activity, other______________ If yes from whom? Daily center of the municipality; NPOs other_________ If Not why? Lack of daily center; lack of such social services Comments__________________________________________________________________ 20. Has the family placed efforts to reintegrate the casualty into community? Yes No Comment_________________________________________________________________ 21. Has the community placed efforts to reintegrate the casualty into community? Yes No; Comment________________________________________ 22. Do you feel integrated in the society? Yes No Your comment____________________________________________________________ 23. Does the survivor have opportunity to participate in the day-to-day activities? Yes No Partially Mobility Yes No Accessibility Yes No Participate in social life (sport, cultural, political) Yes No 24. Mobility: Can the survivor move freely yes No Partially 25. Do you participate in social life? Yes No If yes, where? Sports, culture, politics, elected other___________ 21. Has survivor the casualty access to the special needs? Braille Sign language media Somniferous books Other____________ If other, describe ______________________________________ 27. Do you need further economic support? Yes No 28. In order to be re-integrated in the normal life, (for you and your family) besides financial support, what type of support do you need? Support for: employment Professional training centers; Micro-crediting to establish small business 29. Support for re-imbursement of health Mbeshtetje në para/rimbursim të shpenzimëve shendëtsore (ilaçe Yes, No; Approximate Monthy value of in lekë___________________________
  40. 40. 30. Support for prosthesis Yes, No 31. Support for re-imbursement/ scholarship for children to attend education/school Yes, No Approximately Monthly value lekë__________________________ 32. Access and inclusion in the daily social services, rehabilitation centers, education centers etc for PWD Village/city Municipality district Address 39 Yes, No 33. Increased inclusion of children in clubs, sports activities, and extracurricular activities? Yes, No 34. Support for the re-imbursement of the rent of the house Yes, No; other___________________________________________________ 35. Comments __________________________________________________________________ 31. Do you have anything else to add? ___________________________________________ ____________________________________________________________________________ ================================================================================== Interviewed person gives permission the information to be; Shared with authorities; Shared with organizations; No No Yes with personal data yes with personal data Yes without personal data yes without personal data ===========================================================-======================= Personal data about the person interviewed Date of birth ID Number/Passport Name Surname Date Month Year Birth place Village/city Municipality district county Country CURRENT RESIDENCE Signed by interviewed person Yes No Date; _______/ _____ / _________ (Date/month/year) SIGNATURE of the interviewer Photo
  41. 41. Annex 3. Foto nga plotësimimi pyetësorit dhe vizitat mjeksore Photos during the completion of the questionaire and medical checks 40
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