Preventable blindness and antipersonnel landmines
The antipersonnel landmine (APL) has become a public health scourge. For many years this passive weapon has caused terrible tragedy on rural populations in some of the world’s poorest countries. Enormous and needless human devastation has been caused by millions of antipersonnel landmines which were deployed as weapons of intimidation and terror by competing armies.
Antipersonnel landmines are used by military forces to deny opposing armies, civilians and refugees, mobility and territory. Landmines are rarely removed by those who place them. Left in the soil for many years, they become war’s deadly, destructive legacy to millions of civilians on whose homelands armies have fought each other. The United Nations has described this pestilence of passive weapons as ‘… one of the most widespread, lethal and long-lasting forms of pollution’1 the world has ever known.
Antipersonnel landmines may be detonated by the slightest pressure, even the step of a small child, many years after they have been armed. More than 400 million antipersonnel landmines have been deployed since the beginning of World War II. There are at least 250,000 landmine-disabled people in the world, and that number is increasing.2
Currently there are approximately 100 million antipersonnel landmines scattered in more than 60 countries.3 Approximately 90% of landmine injuries are inflicted on civilians. The number of blast and fragmentation injuries to civilians is estimated at 26,000 every year, or one every 22 minutes.4 It is likely that there are substantially more antipersonnel landmine-human encounters, because deaths from antipersonnel landmine explosions in developing nations often are not reported.
Many victims are killed outright or die soon after of very severe blood loss from major arterial trauma. Antipersonnel landmine survivors sustain multiple injuries which include traumatic amputation of feet, lower legs, hands and arms; blast injuries to all extremities, trunk, head and neck; penetrating injuries from shrapnel, stones, and other debris to all body areas.3
Landmine injuries may be classified into three patterns:6
Pattern 1: blast injuries caused by stepping on a buried mine; usually results in loss of one leg and often injuries to other leg and genitalia.
Pattern 2: injuries caused by above ground mines detonated by a trip wire; fragmentation injuries to chest, trunk, extremities (hands, feet, limbs), and face, often resulting in death.
Pattern 3: injuries resulting from handling mines; frequent in children who believe they are toys; severe head, facial and eye injuries.
Although injuries from all three patterns can involve eyes, pattern 2 and 3 cause more serious ocular injuries than pattern 1. People who are near to an individual who has detonated an above ground mine (pattern 2) may also sustain facial and ocular injuries because those mines may hurl steel shrapnel with penetrating effect for up to 50 metres.
The devastating psycho-social impact and economic effects resulting from antipersonnel landmine-inflicted death and maiming in peacetime have received the attention of international human rights activists. Intraocular blinding injuries have been underestimated until only recently.
Trauma from all causes is a common cause of monocular blindness, but is also significant as a cause of bilateral blindness.7Bilateral blindness has been reported to be associated with severe antipersonnel landmine trauma.8 There is very little data which documents the extent of blindness from APLs. Recent epidemiologic studies suggest that monocular and bilateral blindness from APLs is high.
In March 1997, Jackson and Foster reported that trauma was responsible for 4% of bilateral blindness in adults in a consecutive hospital study in Northwest Cambodia.9Of the 17 bilaterally blind in that study, 14 (82%) were blind from antipersonnel landmine injuries.
In a rural randomised population-based survey of 3,500 individuals in Kandal Province of Central Cambodia in 1996, Alan Rutzen and co-workers found that the prevalence of monocular blindness was 1.0%. Antipersonnel landmines were responsible for one-half of these whose best visual acuity in one eye was less than 3/60 (or 0.5% of the population surveyed).10Nearly all of those who had been blinded in one or both eyes by antipersonnel landmines in the Rutzen survey had also sustained traumatic amputation of at least one limb.
How can blindness and other serious trauma from antipersonnel landmines be prevented?
In the short term, avoidance of areas known to be mined is an obvious strategy.
Public awareness campaigns to educate populations at high risk in Southeast Asia, the Middle East, Central America, and Southern Africa have begun. Children are especially vulnerable to APL injuries because several types of mines, distributed from aircraft, which arm themselves automatically upon reaching the ground, appear to be toys (the so-called ‘butterfly’ APLs). Graphic posters in local languages depicting the extreme danger of walking in mined areas are effective educational methods. Landmine survivors also speak about APLs to audiences at high risk.
What can be done in the long term to prevent blindness, loss of limbs, and death from these hideous weapons?
The removal of 100 million APLs now planted in the Earth’s soil is a massive task. Although one APL may cost as little as $1.00 to manufacture, the cost can be as great as $1,000 to remove that same mine. Most de-mining is done manually by people specifically trained in detecting mines with special probes. De-mining is time consuming. De-mining is also dangerous. The cost of locating and removing 100 million antipersonnel landmines is projected to be billions of dollars.
Even before all APLs are removed from our Earth, there must be a comprehensive ban on all antipersonnel landmines. This will ensure that new APLs will not be deployed while millions of others are being removed. Such a treaty will include the prohibition of manufacture, distribution, deployment, and use of all APLs. This convention must be honoured by all nations.
Only when the world is rid of antipersonnel landmines forever will this passive and cowardly weapon cease to be a major cause of traumatic blindness world-wide and the source of incalculable human suffering.
1 Assistance in Mine Clearance. Report of the UN Secretary General, Document A/49/367, September 6, 1994.
2 Roberts S, Williams J. After the Guns Fall Silent: The Enduring Legacy of Landmines. Vietnam Veterans of America Foundation, Washington, DC, 1995.
3 Landmines: A Deadly Legacy. The Arms Project. Human Rights Watch, New York, New York, 1993; 51.
4 Hidden Killers, The Global Landmines Crisis. United States Department of State Bureau of Political-Military Affairs, Washington, DC, December 1994; 1.
5 Landmines: Time for Action. International Humanitarian Law. International Committee of the Red Cross (ICRC), Geneva, Switzerland, 1995; 14-18.
6 Cobey JC. Medical complications of antipersonnel landmines. Bull Am Coll Surg 1996; 81: 10.
7 Schwab; L. Blindness from trauma in developing countries. Int Ophthalmol Clin 1990; 30; 28-29.
8 Coupland RM, Korver A: Injuries from antipersonnel mines: The experience of the International Committee of the Red Cross. BMJ 1991; 303: 1509-12.
9 Jackson H, Foster A. Causes of blindness in Northwest Cambodia. Ophthalmic Epidemiology 1997; 4: 27-32. 10 Rutzen A: Unpublished data, 1996. Used with permission.
Please contact me, if you are interested in working toward a world-wide comprehensive ban of antipersonnel landmines:
Larry Schwab MD, American Academy of Ophthalmology, 655 Beach Street, San Francisco, CA 94120, USA. Fax: +1 304 599 7346, E-Mail: SCHWABWV@EARTHLINK.NET
Mines awareness training
A number of organisations, including the UN, Norwegian People’s Aid and the Red Cross and Red Crescent Societies, provide mine-awareness training in affected countries. Please see list of addresses in Antipersonnel Mines: Some Facts.
Information has been supplied by the British Red Cross.