Needs and Capacity Assessment of Mine/ERW Victims Inhambane and Sofala provinces, Mozambique

1. Rede para Assistência às Vítimas de Minas Needs and Capacity Assessment of Mine/ERW VictimsInhambane and Sofala provinces, Mozambique December 6th 2013

2. Overview of presentation Quick background on HI Movie on the reality faced by survivors in Mozambique Understanding the challenges faced Historical background to this assessment Methods and findings of the assessment Future steps to improve Mozambique’s capacity to respond to the needs of victims

3. A long history with people with disabilities French doctors in 1982 in Thai Cambodian refugee camps Three decades of comprehensive support to people with disabilities Co-funder of the International Campaign to Ban Landmines in 1992 – Nobel Peace Price 1997

5. What is victim assistance? It is a process that involves a rights-based, holistic & integrated approach Understanding the challenges faced Medical care Physical rehab Psycho- social support Socio – economic inclusion Laws and policies provide overall protection of rights Laws and policies Social/economic inclusion Physical rehab Medicalcare Psychological support Understanding the challenges faced

6. Understanding the challenges faced • Survivor needs and capacities assessments • Mapping of services

7. Historical background to this assessment • Hans Risser, UNDP Chief Technical Advisor on Mine Action in Mozambique

9. Mozambique context • Mozambique ratified • 1998: Mine Ban Treaty (MBT) • 2010: Convention on the Rights of People with disabilities (CRPD) • 2011: Convention On Cluster Munitions (CCM) • The National Demining Institute (IND) is responsible for collecting data on mine victims, but not all cases are reported • The Landmine Monitor has reported at least 2.447 casualties until 2012. Government estimates that there are more than 10,000 casualties. • For 6.8% of all persons with a disability in Mozambique, the impairment was caused by mines/ERW (SINTEF study 2009) • Mozambique ranks amongst the 10 lowest countries on the HDI

10. Objectives of the Needs Assessment • Mobilize stakeholders on issues affecting victims and other persons with disabilities • Collection of data on the challenges faced by victims (as per CAP action 23 & 25) in order for the government of Mozambique to develop a National Action plan that responds to the needs of victims • Dissemination of needs and capacities of mine victims shared with national authorities and partners to build a response at the level of policy, plans and services

11. Area of implementation • Inhambane and Sofala are among the most heavily mine/ERW-affected provinces of Mozambique • HI is already working with local authorities (mine clearance) • Operational motives (accessibility)

12. Key Steps in Conducting the Assessment

13. Partners/authorisations • Partners: IND and Ministry of Women and Social Action • Approval of the assessment protocol by the Bioethics Committee of the Ministry of Health • Presentation of the protocol to the National Council on Disability (CNAD), as well as to authorities in the provinces of Inhambane and Sofala: - Permanent Secretaries - Provincial Direction of Health - Provincial Direction of Woman and Social Action - Administrative offices prior to the study

14. Collection of Quantitative Data Sample size: statistically representative number determined based on total number of known casualties reported in Monitor: 2.444 up until early 2012): 292 survivors were needed to obtain a representative national sample Study group • 301 survivors were surveyed (average of 25 per districts) Control group • 291 members of the community of the same age and sex who live in the immediate surroundings of survivors were also surveyed

15. Collection of Qualitative Data Focus groups • 11 focus groups comprised of survivors and families of people injured or killed by mines/ERW (one per district) In-depth interviews • 60 in-depth interviews were conducted with community leaders, representatives of Disabled People Organizations, NGOs and service providers (hospitals, schools, social services)

16. Survivors’ Profile By sex and age • 20,6% women and 79,4% men • Youngest survivor was 19 at time of interview • 86,4% were older than 40 • 80,1 % of survivors had their accident during the war • 35,3% of which were a soldier • Circumstance of the accident

17. Findings on Survivors: Type of impairment and use of assistive devices Type of impairment • 61% sustained a leg amputation • 11.5% sustained an arm amputation • 6,4% was blinded in one eye • 4,4% lost one or more fingers Use of assistive devices • 53,9% uses assistive devices (prostheses, crutches or canes) • 55,8% of the devices are not appropriate (hurtful, poor quality, damaged) • 65,7% face physical barriers to access to public services

18. Findings on Survivors: Socio economic profile Socio-economic profile 21.3% live below the poverty line (<$ 1.25 / day) 37% earn less than the minimum wage (<2850 mts - $95/month) 46,8% are living in extreme poverty 33% never attended school 74,1% work of which 69% in the field 90.7% express the accident decresaed their ability to work

19. Findings on Survivors: Access to services and community participation Access to Services • 91.6% had access to basic health care services – BUT TODAY • 83.4% are currently in need of such services • 45.8% had access to more complex health services – BUT TODAY • 39.2% currently more complex health services • Only 13,5% as a permanent of INAS • Only 16.2% received assistance: -8.4% assistive devices - 7.8% funding

20. Findings on Survivors:Community Participation • 30.1% has already served as a community leader • 24.7% is a member of a Disabled People Organization .

21. Relative vulnerability:Differences with the control group • 53.2% of survivors have the same family situation and ability to send children to school, access to basic health care as the rest of the community. HOWEVER: 46.8% are relatively more vulnerable • Survivors have a more precarious housing situation: house without windows (65.4%); dirt floor (71.8%), poor sanitary facilities (73.8%), no access to safe drinking water (48,7%) • Survivors produce only 75% of what their neighbours are producing • Significantly more survivors receive a pension – which is a sign of the fact they live in extreme poverty • Survivors are still showing signs of post traumatic stress disorder

22. Relative vulnerability between Civilian and Soldiers amongst the Survivors • There are no socio-economic differences between "civilian" and "soldier” survivors: no differences in the level of education, access to basic services, health and participation in the community

23. Service providers’ view on disability and related services • Majority of service providers are knowledgeable about disability rights and need for better inclusion of PWD Challenges identified: • Poor quality of rehabilitation centres including lack equipment, including P&O • Lack of human and financial resources of service providers • Lack of specific strategies to ensure access of PWD to services • No database to monitor and evaluate impact of policies and programmes on survivors and other PWD

24. Specific Needs of Survivors • Free access to prosthetic & orthotic services, including assistive devices – in order to increase productivity in the field • Access to psychosocial support to process trauma • Free access to health services, including medication to alleviate pain • Implement specific training programs (agriculture techniques, small business, etc.) to improve professional skills and livelihoods

25. Needs shared by others • Access to safe water, electricity, housing • Improve the access to Health • Improve the access to Education and Vocational training • Information about existing services available in local language Livelihoods programs • Access to Social Protection programs

26. Recommendations to address specific needs of survivors • Equip and improve Rehabilitation Service Centers, including P & O to provide suitable assistive devices • Identify subgroups of most vulnerable survivors and prioritize the poorest. i.e. living below the poverty line/degree of disability • Promote and ensure access survivors to livelihood projects / development funds to improve their socio-economic situation. • Develop and implement Social Support Strategies to increase survivors access to basic social protection. • Optimize the presence in the districts of the ofINAS workers • Develop and implement peer-to-peer support programme. • Strengthen the capacity of DPOs to promote good practices and monitoring of national Action Plans for PWD and Survivors

27. Key messages • Conducting a survivor needs assessment is the only way to understand 1) the specific needs of survivors and 2) those that are shared with others – important advocacy tool!! • To use findings to mobilize actors to undertake

28. The National Council on Disability in Mozambique • Presentation by Mrs. Francisca Sales, Deputy Minister on Social Action, MMAS

29. Next steps on VictimAssistance in Mozambique • Support the inter-ministerial and multi-stakeholder coordination body on disability (CNAD) to develop a National Plan of Action that is responsive to the needs of victims • Decide on the format for the plan includes efforts: - In response to the specific needs of victims - To make the mainstream system more inclusive • Ensure that the plan is aligned with the PNAD II in order to facilitate a coordinated national response • Secure and allocate sufficient resources to operationalize the plan

30. Thank you and time for questions