Early every morning in the Cambodian village of Mongol Borei, doctors open the doors of a small field hospital and let in the latest casualties from the country’s civil war. Most of them are victims of land mines – civilians like Nean Pok, a 20-year-old farmer who had her foot blown off while gathering firewood near her home, or six-year-old Chok Chuon who lost her leg when she jumped on a mine while playing near a railway line. Yet those who reach hospital are the lucky ones; nearly as many again die in the fields from loss of blood or lack of transport to get medical help.
In remote areas across the world where civil wars have raged during the past decade, unexploded mines are a crippling scourge. People in Cambodia and Afghanistan are probably suffering most, but mines also injure large numbers of civilians each year in Mozambique, Burma, Somalia, Ethiopia, Angola, El Salvador and Nicaragua. Even in the Falklands, military units still search for small antipersonnel mines that were scattered from Argentine helicopters across pastures and peat bogs nine years ago.
This plague is partly due to advances in technology, which have made mines much easier to hide than to find. Modern mines are sometimes tiny, weighing only between 20 and 50 grams, and can be scattered in their thousands across forests and fields from rockets or aircraft. Made from nonmetal parts, they are almost impossible to detect. As new mines emerge from military laboratories, old but equally lethal models are unloaded onto the arms market or supplied direct to resistance groups such as the Mujaheddin in Afghanistan or Cambodia’s Khmer Rouge.
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Now two human rights organisations based in the US, Human Rights Watch and Physicians for Human Rights, are calling for an international ban on the use of land mines. They say that all attempts to make mines more humane or more discriminating weapons of war have failed. They argue that mines should be recognised as a violation of the international rules of war, as intentionally bombing civilian areas or torturing prisoners already are. An international ban would not eliminate land mines immediately, but it could stigmatise them and eventually make them as vilified as chemical weapons are now.
What makes mines so abhorrent is the indiscriminate destruction they cause. Unlike bullets or artillery shells, mines cannot be aimed. They lie dormant until peasants, their children or animals trigger their detonating mechanism. Land mines recognise no cease-fire, and long after the fighting has stopped, they can maim or kill the grandchildren of the soldiers who laid them.
In 1981, the UN adopted a protocol restricting the use of mines. It calls on military commanders to warn civilians of the presence of minefields, keep maps of where they place mines and remove the mines when they are no longer required. Small, scatterable mines are banned entirely unless they include a mechanism that renders them harmless after a specific period of time.
The protocol has had little effect, however: only 31 nations have signed and ratified it. Arms merchants in the US, Britain, Italy and Egypt (all countries which have signed the protocol, though they have not yet ratified it) continue to ship these weapons freely to armies and resistance groups around the world. The Soviet Union, which has both signed and ratified the protocol, used mines in Afghanistan in ways that clearly violated its provisions. According to Afghan refugees interviewed by the human rights organisation Asia Watch in 1990, Soviet troops left mines in abandoned houses, mosques, on roads and in grazing areas until they withdrew in 1989. ‘The ground will be fighting us for years after the Soviets have left,’ says an Afghan refugee in neighbouring Pakistan.
China, meanwhile, continues to supply most of the mines used to devastating effect by the Khmer Rouge in Cambodia. The Khmer Rouge, one of three guerrilla groups fighting against the Cambodian government, has used mines intentionally against the civilian population. It has mined rice paddies and country paths to halt agriculture, keeping the peasants from growing any food in an effort to force the government to the bargaining table.
Last April, one of us (Eric Stover) joined a delegation from Asia Watch and Physicians for Human Rights on a visit to Cambodia to investigate the use of mines there. No one interviewed during the trip, with the exception of Red Cross workers, had ever heard of the UN protocol on mines. The delegation found that none of the four warring fact-ions kept maps of minefields or routinely warned civilians of their location.
In the town of Battambang, at a noisy food stall in the old market, a group of soldiers scoffed at the idea of clearing the mines they had laid. ‘Who would be so crazy?’ said the oldest. ‘It would be more dangerous than fighting. And, anyway, who would pay us?’ One of his younger companions, a man in his mid-twenties, said: ‘When we fight, mines are good weapons. But they’re bad weapons for farmers and our families.’
In the past year, the danger of mines has become so great on railways in Cambodia that trains now push two wagons loaded with logs in front of the locomotive to detonate mines. Most passengers ride in carriages behind the locomotive. But for those who wish to risk their lives for a free ticket, there is always a seat on the front two wagons.
Cambodia’s civil conflict is the first war in history where mine-related casualties have surpassed injuries caused by all other weapons. Cambodia has the highest percentage of disabled inhabitants of any country in the world. Of the country’s 8.5 million inhabitants, over 30 000 are amputees, and a further 5000 or so amputees live in refugee camps along the Thai border. In 1990 alone, as many as 6000 Cambodians had a leg or foot amputated as a result of an injury caused by a mine. By comparison, in 1989 surgeons in the US, which has a population of 220 million, performed no more than 10 000 amputations on patients who had suffered traumatic injuries.
Cambodia’s medical system cannot cope with the carnage. In field hospitals across the country, victims of land mines lie on bamboo mats in overcrowded wards with soot-black walls, flies swarming about their bandaged stumps. Many suffer from chronic anaemia or malaria. There is no food, barring what relatives bring. In most state-run hospitals patients must pay for their medicines. ‘If you can’t pay, you die. It’s that simple,’ a foreign doctor said.
During morning rounds in the hospital in Mongol Borei, Chris Giannou, a Canadian surgeon with the International Committee of the Red Cross, stopped next to the bed of an elderly woman named Praing Choeun. Three days earlier, Choeun had stepped on a mine and spent 12 hours in an ox cart and on the floor of a truck before she made it to the hospital. This is typical: according to a study published in the US Journal of Cardiovascular Surgery in 1989, people injured by land mines who arrived at one hospital in Thailand spent an average of more than eight hours getting to the hospital.
Giannou carefully lifted back Choeun’s sarong and revealed a badly infected stump. ‘If that had been caused by shrapnel from an artillery shell, you would do a simple debridement, clean it up, no problem,’ he said. ‘But these mines drive dirt and bacteria as well as the shrapnel up into the tissue. So infection spreads fast.’ The shock wave from an exploding mine also destroys blood vessels well up the leg, says Giannou, so surgeons are forced to amputate much higher than the site of the actual wound.
Giannou’s work is further complicated by the use of plastic casings on mines, which become deadly shrapnel. Unlike metal, these dark, frog-green fragments are difficult to detect on X-rays when embedded in tissue or bone. They must be located by eye and extracted, but they are often overlooked. If the fragments are not removed, they can cause serious infections later, including osteomyelitis, an infection of the bone cortex and marrow.
Most amputees in Cambodia will leave hospital without artificial limbs and will return to their villages with little hope for the future. There are no rehabilitation centres in Cambodia, and in an agrarian society where muscle power means survival, amputees are often viewed by their families and communities as simply another mouth to feed, producing nothing. Because Buddhist culture in Cambodia sets much store on inner and outer ‘wholeness’, young boys who have lost a limb cannot become monks. As a result, many amputees become beggars or petty criminals.
American Friends Service Committee and Handicap International are currently the only sources of artificial limbs in Cambodia, and the number they turn out, 1300 a year, falls far short of the demand. Only one in eight amputees – most of whom are soldiers – receives an artificial limb. At the present rate it will take 25 years just to handle the existing waiting list of mine victims. Fortunately, however, help appears to be on the way. By the end of 1991, the International Committee of the Red Cross and the Cambodia Trust, an Oxford-based charitable organisation, plan to open orthopaedic workshops in Phnom Penh and Battambang. Meanwhile, new techniques for constructing more flexible and easily fitted artificial limbs are being developed in a number of countries around the world, including neighbouring Vietnam .
Of course, finding and clearing mines would be far better than the best prosthesis or system of medical care for victims. But it is a difficult and dangerous job because detection is precisely what mines are designed to avoid. Mines are the original ‘stealth’ weapons, says Tom Hafer of the US Defense Advanced Projects Research Agency. Hafer’s job is to find new technologies that can reveal where mines have been hidden. If he could discover a cheap and effective way to find mines, it would give US soldiers an advantage in battle. So DARPA is experimenting with any technology that may provide some hint of buried explosives, including radar, X-rays, chemical detectors, and infrared detectors .
Unfortunately, these new techniques are being designed primarily for the use of military forces, and this means they are unlikely to offer much for civilians trying to reclaim farms and forests in mine-infested areas like Cambodia. Military forces don’t need to find every mine; they simply want to be warned if there is a minefield ahead. ‘To find a field, only a few discoveries will do,’ says Hafer. Once soldiers have been warned of the danger, they call in ploughs, earth-moving equipment and explosives to clear a narrow path so they can march on. British forces use a fire hose filled with explosives, called a Giant Viper, that is laid across suspected minefields by a rocket. When the explosives are set off, they clear a path through the minefield. But these techniques, aimed only at clearing narrow paths through a minefield, fall far short of what is required to reclaim an area for civilian use.
In addition, the techniques that Hafer is developing would be most effective against large mines that can blow up vehicles carrying troops. None of the equipment can eradicate small mines that are buried or strewn about by the thousand in order to kill or maim individual soldiers, and that remain as a threat to civilians when the armies move on. ‘Anti-personnel mines are very difficult to deal with,’ says Hafer. ‘I’m not sure we have any practical solutions to that.’
There appears to be no reasonable hope that technological developments will end the devastation that mine warfare has wreaked on the populations of Cambodia and Afghanistan, or prevent similar horrors elsewhere. The only way forward may be to ban land mines.
Politically, this will not be easy; when the idea of banning land mines was proposed to one official of the US Congress, he asked, ‘On what planet?’ But such a step would not be unprecedented. There are certain actions that have been outlawed, even in war. Nations and their armies cannot, for example, intentionally bomb civilian areas, nor can they torture prisoners of war or make public spectacles of them. Land mines deserve similar treatment.
Eric Stover is a freelance writer specialising in medical and human rights issues. He is a consultant to Human Rights Watch and Physicians for Human Rights.
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1: STEP FORWARD THE COMPUTERISED ARTIFICIAL LEG
Like Cambodia, Vietnam is a country where the legacy of war has been a large number of civilian casualties caused by land mines. The Vietnamese are adopting a high-technology approach to producing artificial legs for these victims, with more than 100 amputees each month being fitted with prostheses designed and produced by computer. The new legs are lighter, stronger, more flexible and more comfortable than the rigid wooden limbs worn by other amputees in Vietnam and elsewhere. The system, called the ‘Seattle Shapemaker’ because it was pioneered at the Prosthetics Research Foundation in Seattle, Washington, even uses a lifelike foot that is springy, enabling amputees to run, jump or walk with no limp.
For war-torn countries suffering an epidemic of amputations, the speed with which the system produces new limbs may be even more important than their lifelike appearance. David Boone, a specialist in prosthetics with the foundation, says that a patient can walk out of its clinic in Hanoi within an hour equipped with a well-fitting plastic leg. Traditional techniques can take a week or longer, and the materials they use – untreated wood and leather – do not survive well in tropical climates or during work in rice paddies.
To start with, technicians make a plaster cast of the patient’s stump, over which the artificial limb must fit. The Seattle Shapemaker then traces the shape of the cast with a needle, taking measurements about every 6 millimetres. These measurements are automatically entered into the computer, which displays the shape graphically on its screen.
But the socket of the prosthesis should not match the outline of the stump exactly, because some parts of the stump can bear more weight than others. The Seattle Shapemaker’s computer program, using a technique pioneered by researchers at University College London, is able to make many of these alterations automatically. The computer shapes the socket so that the end of the amputated bone has more room, for instance, because the skin there cannot bear much weight. It makes the socket fit tighter over the patellar tendon just below the kneecap, because it can take lots of pressure and rubbing. But Boone doesn’t let the computer have the last word: ‘I typically spend 30 seconds or a minute making small changes to the computer’s design,’ he says. Boone’s alterations also help ‘teach’ the computer to make similar changes in the future.
The computer controls a lathe that cuts this shape into a block of soft material, usually a plaster made of cornflour or tapioca. This becomes the mould for the socket of the artificial limb.
The Seattle Shapemaker arrived in Hanoi in June 1990. Apart from occasional work by visiting technicians from the US, the equipment is operated entirely by local personnel. According to Boone, each artificial limb costs about $190, and the cost will drop as production rates increase.
The Prosthetics Research Foundation hopes to see the system introduced in Thailand, the Philippines, El Salvador and several countries in Eastern Europe. A similar system, developed at University College London, is being used in China.
Susan Walker of Handicap International says that the cost and complexity of computer-designed prostheses limit their use in poor countries. In Cambodia, for instance, HI can produce a below-knee prosthesis from local materials for $12, and an above-knee limb for $20. The 12 workshops that HI has opened in Cambodia cost less than $1000 each to set up. And, unlike the Seattle Shapemaker, the production of HI’s prosthetic devices requires no power. This is crucial in Cambodia, where both electricity and diesel fuel are in very short supply.
A low-technology alternative to traditional prosthesis designs is also being tried out in Nicaragua. There, doctors are using a prosthetic foot created from simple materials like wooden blocks and the rubber patches used in repairing car tyres. The design, adapted from one invented 11 years ago in Jaipur, India, needs none of the complex moving parts and expensive fittings required for more sophisticated artificial limbs. The ‘Jaipur foot’ is covered entirely in vulcanised rubber, and can be fabricated in large quantities for less than $30. It requires no imported materials other than sheets of raw aluminium, is impervious to mud and water, and lasts up to five years. Most traditional prostheses survive only two years of use.
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2: DETECTING THE HIDDEN MENACE OF MINES
Metal detectors are the traditional tools of mine detection, and they are still the only devices that American soldiers currently have at their disposal. Electromagnetic fields from these devices cause any electrical conductors nearby to produce a magnetic field in response. But modern mines are built with as little as one gram of metal, so this equipment is frequently useless. Even fuses do not require any metal or electronic parts. They can consist of mechanical devices which are made of plastic that snap inward under pressure, detonating the mine.
Specially trained dogs, usually Alsatians, are one of the best aids to finding mines. They sniff out the mine’s explosive, so they can find a plastic mine that a metal detector misses, and ignore metal objects (such as spent artillery shells) that the detector senses. The problem is that once the dogs are in the field, they can only work for a few hours each day and must have a quiet environment with no distractions.
Under the direction of Tom Hafer of the US Defense Advanced Projects Research Agency (DARPA), the Pentagon is experimenting with machines that imitate the nose of an Alsatian. These chemical ‘sniffers’ sample the air, looking for telltale vapours from explosive chemicals in buried mines. Hafer says that these devices may be fitted with a small drill to take samples of air from the soil, since there may be more vapours trapped there.
Other devices beam gamma rays and X-rays into the earth. The radiation excites atoms of nitrogen that are abundant in explosives, causing them to give off thermal neutrons or gamma rays of their own. A similar technology is now being tested at airports to detect terrorist bombs. But just as at airports, the biggest problem is false alarms, says Hafer. Copper or chlorine in the soil will react to radiation much as nitrogen does.
Radars that can see into the earth could be carried aboard aircraft, surveying the ground below for evidence of unusual buried objects. Depending on its wavelength, a radar beam can reflect off objects buried half a metre under the surface. To detect mines, radars would generally use frequencies between 500 megahertz and 2 gigahertz, says Hafer. Shorter wavelengths would not penetrate the earth very well, and longer wavelengths would not detect small enough objects. Many mines, especially antipersonnel mines, would escape detection, admits Hafer, and it would be difficult to distinguish between mines and other bits of buried metal. But identifying even a few mines could provide a useful warning for advancing troops, because it could signal the presence of a much larger minefield.
Nancy Del Grande at the Lawrence Livermore National Laboratory in California is trying out infrared sensors that measure slight differences in the heating and cooling of the ground’s surface during the day. These anomalies might be due to objects buried just below the surface, like mines. In one experiment, Del Grande’s equipment successfully pinpointed simulated mines buried beneath the surface of the desert. Vegetation, however, would frustrate this technique.
None of this equipment has yet made it into the military inventory, because many problems remain to be resolved. Many of the devices are very expensive, and all of them are unreliable. Rocks, vegetation, buried pieces of metal and wet soil can either mask the presence of mines or produce a rash of false alarms. To improve the accuracy of the detectors, DARPA is funding research on computer programs that may eventually do a better job of sorting out the ‘signature’ of a real mine from the natural background. Hafer hopes that more powerful computers will help solve this problem: ‘We are reluctant to discard an approach just because it requires a huge computer, because in 10 years that might not be a problem.’