SURVIVING GUN VIOLENCESOCIAL DIMENSIONS OF HEALTH INSTITUTEWEBINAR, 15 MARCH 2012 Cate Buchanan Surviving Gun Violence Project
AIMS OF THE SEMINAR Highlightsome of the knowledge gaps and potential areas for human rights and health practitioners and researchers to address Provide some information on the Surviving Gun Violence Project
WEAPONS AVAILABILITY& PRODUCTION 875 million small arms and light weapons Civilians hold nearly 75% (650 million) Armed groups hold about 1% 1249 companies in 90 countries make guns Legal trade: worth about US $7 billion Illegal & grey market: about 15% of all trade Grey market (covert arms transfers by govt- sponsored entities): larger than illegal trade At least 1 million firearms are stolen each year, the majority from private homes
FATALITY BURDEN An estimated 525,000 people die from armed violence annually (guns, mines, bombs etc). Inthe age group 15-44 years old, violence accounts for 14% of all male deaths; and 7% of all female deaths. Most of these deaths occur in countries not at war, but affected by violent crime, weak policing and dysfunctional justice systems.
INDIRECT IMPACTS OF GUN VIOLENCE Increased incidence and lethality of crime Displacement (refugees, IDPs) Collapse or erosion of social services Decline in formal +informal economic activity Distortion of investment, savings and revenue collection Erosion of social capital Distortion of access and use of public space, services, roads, transport
AND THOSE WHO SURVIVE? No accurate figures exist on those who survive gun violence – possibly 3-14 times the number of people who die. Violence (including homicide and suicide) and other injuries account for 9% of global mortality. Violence is a leading cause of disability.A study in one of the world‟s largest refugee camps found that gunshot injuries were the single major cause of physical impairment: 32% of all cases.
DISABILITY 15%of the world‟s population has some form of impairment. 80% of people with disabilities live in low- income nations. People with impairments are particularly susceptible to co-morbidities due to unequal access to health care. In societies where women have low status, women and girls with impairments are especially marginalised.
A WORD ON TERMINOLOGY The term “survivors of gun violence” or “survivors” is used to describe people who have been physically injured, intimidated, or brutalised through gun violence. Differentiate people who die (victims) from those who live through such violence (survivors), for the purpose of research or policy making
TERMINOLOGYThe term “victim”: used in the UN Declaration of Basic Principles of Justice for Victims of Crime and Abuse of Power (1985) used in weapons control processes like the Anti-Personnel Mine-Ban Convention (1996) and Convention on Cluster Munitions (2008) has been interpreted to include directly affected individuals, their families and communities.
MISUSE OF GUNS AND INJURY TYPES Guns are used discriminately (e.g. kidnapping at gunpoint) and indiscriminately (e.g. someone shot in crossfire) Other weapons like mines and bombs are rarely used to perpetrate crime, because of the risk posed to the holder of the weapon. Guns pose a serious security threat even when not fired, and are often used to threaten and intimidate. Gunshot injuries are unpredictable and diverse, with varying consequences for trauma and rehabilitation services.
SOME THEMATIC ISSUES Trauma care and access Rehabilitation Gender Mental health Victims and perpetrators Inequality and development Inclusive and ethical research and participation
TRAUMA CARE AND ACCESS Effective trauma care can reduce levels of impairment. In low- and middle-income countries, 50-80% of deaths from traumatic injury occur before reaching hospital. Access is mediated by income, transport, location etc.
REHABILITATION Rehabilitation services in developing nations are believed to reach only 1-3% of people in need (PAHO, 1994 – we need more recent research!) In the US, spinal cord injury rehabilitation has reduced in the last decade. This means less time to train family members in caregiving, fewer resources for adapting built environments (e.g. widening doors for wheelchair access in homes), and less psychosocial support.
GENDERMales comprise: 90% + of gun homicide victims 88% of gun suicide victims 80% of the 400 children killed and 3000 injured in accidental shootings each year in the US Therisk of dying by homicide for a man aged 15-29 in the Americas region is nearly 28 times higher than the average worldwide.
GENDER The presence of a gun in a household where there is partner/family violence multiplies the chance of a woman dying. Caregiving for injured family members falls largely to women and girls, limiting their opportunities to work or go to school, and often causing their own health to deteriorate. Gun violence results in more female-headed households, due to the disproportionate number of men being killed or impaired.
MENTAL HEALTH Gun violence is associated with psychological problems including flashbacks, anxiety, fear, low self- esteem, depression, alienation, self-destructive behaviour and suicide. Mental health services are typically under- resourced and overloaded. Mental health can be further affected through unintended re-victimisation from media images and coverage of gun violence, seeing armed men in security posts, etc.
VICTIMS AND PERPETRATORS In war zones or communities blighted by gang violence, survivors of gun violence may also be perpetrators. Distinction of “innocent” victims vs “guilty” perpetrators can have an effect on public sympathy and resources. Young men who are involved in or proximate to violent activity may be seen as „deserving‟ their injuries. Victims of gun violence are at increased risk of committing violence against others.
INEQUALITY AND DEVELOPMENT Growing focus on armed violence and development, e.g. Geneva Declaration on Armed Violence & Development (2006), Oslo Commitments on Armed Violence (2010) – ongoing gap is impact of injury and disability on livelihoods. In a survey of spinal patients at a rehabilitation clinic in El Salvador, the leading concern was how to make a living, not necessarily their long-term health. Livelihood stress affects education: children and young people drop out or engage in risky behaviour (e.g. drug couriering, sex work) to contribute to household income.
ETHICAL AND INCLUSIVE PARTICIPATION “Nothing about us, without us” Need to include survivors in research, advocacy, policymaking on armed violence, small arms control, development and security This would be a way to implement Article 4.3 (amongst others) of the 2006 Convention on the Rights of Persons with Disabilities, which calls for the active consultation and involvement of people with disabilities in processes of relevance to them.
SURVIVING GUN VIOLENCE PROJECT Supported by Government of Norway since mid-2011 Developing a website with an e-library of resources for researchers and policymakers Producing a multi-contributor policy-focussed report for late 2012 Networking amongst diverse communities to stimulate interest and engagement
FURTHER READING World Health Organisation and World Bank, World report on disability (Geneva: WHO, 2011). T. Kroll, “Rehabilitative needs of individuals with spinal cord injury resulting from gun violence: The perspective of nursing and rehabilitation professionals,” Applied Nursing Research, 21 (2008). C. Buchanan, “The health and human rights of survivors of gun violence: Charting a research and policy agenda, Health and Human Rights, Dec (2011). Geneva Declaration Secretariat, Global burden of armed violence: Lethal encounters (Geneva, 2011). World Health Organisation, World report on violence and health (Geneva: WHO, 2002). www.iansa.org www.smallarmssurvey.org
FURTHER READING Small Arms Survey annual yearbooks since 2001 Centre for Humanitarian Dialogue, Trauma as a consequence -- and cause -- of gun violence, Background paper No. 1 commissioned from Vivo International (Geneva: Centre for Humanitarian Dialogue, 2006). Centre for Humanitarian Dialogue, Surviving gun violence in El Salvador: A tax on firearms for health Background paper No. 3, (Geneva: Centre for Humanitarian Dialogue, 2007). C. Mock, “Trauma mortality patterns in three nations at different economic levels: implications for global trauma system development,” Journal of Trauma, 44 (1998).