• About CIVIC

    CIVIC is a Washington-based non-profit organization that believes the civilians injured and the families of those killed should be recognized and helped by the warring parties involved.

    On this blog, you will find stories from our travels around the world as we meet with civilians and military, aid organizations and government in our quest to get war victims the help they need.

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    Sarah, Executive Director

    Marla B, Managing Director

    Kristele, Field Director

    Liz, Chief Communications Officer

    Trevor, CIVIC's fellow based in Afghanistan

    Chris, CIVIC's fellow based in Pakistan

    Jon, CIVIC's US military consultant

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SRI LANKA: ‘We have 450 beds and now have 1,700 patients’

This article was originally printed here:  http://www.guardian.co.uk/world/2009/apr/25/sri-lanka-war

Paul McMaster works as a Médecins Sans Frontières surgeon in Vavuniya hospital. This is an excerpt from his diary:

Wednesday 4.45am Woke up and started operating. A 15-year-old boy with severe blast injuries to his abdomen. He was on his own and in shock. Surgery took about two and a half hours and he was reasonably stable. The last I heard, at least, he was stable. But our concern is what happens to him now. This is a hospital with 450 beds, three intensive care beds, and we now have 1,700 patients with up to 50 coming in a day. There are patients on the floor, in the corridors, even outside. This boy is going to be on the floor. Infection is the main worry. The wounded take days to get to us by bus and infection has often set in by the time they get here. Many of them are dying on the buses that bring them, and the bodies are taken off along with the living.

7.45am I did the rounds of the emergency department. We have cases of people with their feet blown off waiting 13 hours to go into theatre. Three-quarters of the patients we see have blast injuries.

10am We had some discussions on how to increase the flow. There are teams working around the clock. We have three surgeons: myself, a Sri Lankan surgeon and another MSF surgeon from Tampa Florida. We have put two operating tables in one theatre. Things are fairly tight and congested but we get by. There are an extremely hardworking team of Sri Lankan anaesthetists and the Sri Lankan nurses here have been working 20 hours a day.

1.45pm Went back to surgery. A head injury to a child – a boy about nine. It took about two and a half hours and went OK. The problem is the internal damage to the brain. Only the next few days will tell how bad that has been.

4pm Began work on a lower leg amputation. A man had stood on a landmine. He had been with his wife and his daughter. We will operate on the wife tonight. The child has already had some surgery to remove pieces from her arm. Technically, the surgery on the man went well, but the problem is the landmine blasted soil into his leg. There is always the fear that infection will set in.

6pm I did a series of small cases – gunshot wounds. Over the course of the day I operated on 16 patients, five of them amputations on children. These are deeply traumatised people. The children in the emergency wards see people brought in with major blast limb injuries and are just sitting silently, emotionless, in the middle of all this, so we try to treat them and move them quickly out to the surgery or the ward.

9pm Finish surgery for the day. Going to find something to eat and then get some sleep.

Friday 2.30pm I have been in the whole time and do not have the big picture, but in the last 24 hours we have seen, for the first time, fewer patients coming in. Only 44 severely wounded patients came in to the hospital yesterday, although more have come in this morning. It might be that some of the other casualties are going elsewhere, to other hospitals. We’ve sent a team on a exploratory mission to try and find out exactly what’s happening.

One of the patients I have seen is a little girl of about seven or eight who has a severe leg injury. Her elder sister is in the same bed with wounds on her arms and legs. A third sister has burns to her face. Their mother has been killed and their father is in intensive care. With the level of aftercare that we can provide at the moment he has a 50/50 chance of making it, at best.

We have done 71 major operations over the past 24 hours. A lot of the these operations have been catching up on the last few days. It has been bedlam in the hospital. But it hasn’t got worse in the last 24 hours. We are only seeing the acute casualties. There are many people who are ill, several of the injured people also have chickenpox. We are hearing reports that there have been outbreaks of chickenpox in the camps because peoples’ immune systems are so weak.

I hear that some extra nurses are being sent to the hospital. The Sri Lankan medical authorities have made a real effort to send extra staff to help out. There are simply too many people to treat them all. We are not able to save some people because we need to provide more aftercare. There are simply not enough nurses.

• Paul McMaster is a retired surgeon from Droitwich, now based in Amsterdam.

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AFGHANISTAN: Who compensates those the Taliban hurts? (continued from below)

The UN reported that 1160 civilians were killed by Taliban or insurgent activities in 2008, and these are likely only an estimate given that in many Taliban-dominated areas, civilians are afraid to report individual targeting, threats, or other losses. If so many are affected by insurgent parties, what can be done to compensate and help them?

The most obvious question, of course, is what about the insurgents themselves? Although there are certainly examples of non-state actors in other conflicts providing compensation or victim assistance after a conflict incident, we haven’t seen much evidence of this in Afghanistan. One official told us of a Taliban group in the south paying 300,000 afghanis (about $6000) to those killed in conflict, but we were not able to verify this hearsay through any other sources. From using civilians as human shields to aggressively targeting and harassing those who cooperate with the government or the international community, it seems that insurgent tactics in recent years have trended more toward intimidation and fear than “winning hearts and minds” by providing compensation to victims of conflict.

If not the insurgents themselves, then who else could take responsibility for this population? Some of the different international militaries’ compensation and condolence payments, and also the USAID Afghan Civilian Assistance Program, will help victims of suicide attacks on international military convoys. They also typically will help those who are targeted by the Taliban (for example, drivers, translators, others) because they were assisting international military forces. But none of these programs would have helped Mustapha’s pain and suffering.

The Afghan government seems to be the best candidate for this, not only as a warring party but as the warring party with some responsibility for the wellbeing of all its citizens who are caught in the conflict. In fact, the Afghan government has two programs – an executive fund by President Karzai and a ministerial fund called the Martyrs’ and Disabled Fund – that should technically cover victims of pro-government (international military and Afghan government forces) and insurgent forces alike. In practice though, President Karzai’s fund has been used almost exclusively to address harm caused where international forces are involved (The one notable exception has been when it was given following a suicide attack targeting a crowd watching a dog fight in Kandahar province). The Martyrs & Disabled Fund – which provides a type of monthly pension program to the beneficiaries of those killed or to those disabled in any conflict-related incident – also fails to cover this need because significant issues in corruption and implementation prevent it from having much practical impact (for more, see Chapter 5 of CIVIC’s Afghanistan report).

CIVIC has been proposing a common compensation mechanism for Afghanistan. This compensation mechanism could take a lot of different forms, and one possibility is an all-encompassing fund or mechanism that would cover victims of any warring party involved – whether international military, Afghan forces or insurgent groups. Short of that, significant changes in the existing Afghan programs might be a way to get compensation to many of the civilians who are taking the brunt of increased insurgent activity.

AFGHANISTAN: Who compensates those the Taliban hurts?

Posted by:  Erica G.

One of the most difficult challenges we faced this year in our Afghanistan work was how to get compensation to victims of Taliban or insurgent abuses. They are not only responsible for a greater proportion of civilian deaths (55% in 2009, according to the UN), but often because of insurgent tactics that have knowingly placed civilians at risk, including using them as human shields.

A UNAMA official based in a remote and heavily Taliban-controlled province called me a few days ago with a recent case he had been dealing with: insurgents had apprehended a man named Mustapha and whipped him with a cable in his genital region until all that was left was a bloody pulp. Although the circumstances of why he was targeted were not entirely clear, one factor influencing the severity of the punishment was that insurgents felt he was not entirely supporting their cause, raising issues of a war crime violation. The UNAMA official felt so stricken with the pain Mustapha was in (he could not even afford pain medication) that he gave him all the cash he had on hand. He called to ask me if there were not some government program or way to get compensation for this man?

In my next blog posting, I’ll discuss more broadly what help might be available for victims of insurgents…

GUEST BLOGGER: Congo, the worst place to be a civilian

Posted by:  Catherine Philp, Journalist

In Rwanda last week, organisers put on a ceremony to mark the 15th anniversary of the genocide that killed 800,000 people in just 100 days. But next door in eastern Congo, tens of thousands of civilians are still caught up in the ongoing conflict that has killed more than five times that number in the past ten years.

Eastern Congo is reckoned to be the world’s worst place to be a child. By extension, it must also be the worst place to be a civilian. The arrest of the infamous Tutsi warlord Laurent Nkunda and the agreement to end the sanctuary of his opponents, the Hutu genocidiares, have not ending the fighting.

After the end of a joint Congolese-Rwandan mission to drive them out, the Hutu rebels have hit back at civilians, massacring scores and driving 100,000 villagers to flee beyond the reach of the refugee agencies on whose support they rely.

It is a depressingly familiar scenario. But it has far less to do with the lingering ethnic tensions from the genocide as it does with simple greed for a share in Congo’s extraordinary natural resources.

The civilians massacred and driven from their homes are the innocent victims of battles for control of land thick with gold and diamonds, as well as coltan and cassiterite, the essential components of high tech goods like laptops and mobile phones.

Any idea where the little bits of metal in your mobile phone come from? Maybe you should. There’s a good chance they come from mines controlled by armed men who butcher civilians, force pre-teenage children into combat and submit women to sexual violence so brutal that this region boasts the only hospital in the world dedicated to repairing female fistulas.

Thomas Lubanga, a Congolese warlord, made history earlier this year when he became the first defendant before the permanent International Criminal Court in The Hague on charges of child recruitment. This is necessary justice. But he will not be the last while the illegal control of the mineral trade continues, making the massacre of civilians a profitable business.

The campaigning group Global Witness, who have charted the role of the mineral trade in the conflict, have written to mobile phone manufacturers to ask them to account for the origins of their materials. Now they’ve been joined by the Enough Project, who have called on global electronics companies to prove to customers they are not helping to fuel the war.

Foreign governments like the United States and Britain might also want to look again at the huge budgetary support they give Rwanda, whose meddling in Congo has costs thousands of civilian lives. Without foreign money, its military adventures there and support for Tutsi rebels would have never been possible. While remembering the 800,000 people it lost in the genocide fifteen years ago, Rwanda must spare a thought for the civilians still dying in a slower, deadlier holocaust still burning across the border in Congo.

AFGHANISTAN: A family’s story, but who will listen

Posted By:  Erica G.

WASHINGTON, DC – I received an email recently from a friend in Afghanistan who helps develop local girls’ schools. She got a call from the family of a community elder who had assisted her in establishing a school for 200 girls in Taliban-heavy Logar province. The family said a week before Special Forces had raided their home and detained several of the men from their family. A week later they were still holding the community elder and the family did not know what they could do. The only reason they had been given was suspected Taliban involvement. No specific allegations were made to rebut, and they had no idea where their relative was being held, and whether he would be released. They were terrified, worried, and outraged. Some of their property had also been taken and they had no way to get it back.

It’s impossible to tell from the details whether the detention was valid or not – given the community leader’s involvement with the international community in building girls schools (not exactly the hallmark of Taliban) it seems unlikely that he was affiliated with the Taliban. But given the lack of transparency y over these actions, it’s impossible for the family or any international partners working with them to find out who was involved, or why they were targeted, much less whether it was justified. The odds of them receiving any compensation or redress for their losses, much less an apology for what happened if they are deemed innocent, are even slimmer.

We at CIVIC have seen examples of international military forces being more responsive to civilian losses in recent months – statements by Secretary Gates saying that we have to get better on this, and several incidents in November, January, and February, where we saw immediate recognition of civilian loss and attempts to provide payment or support to affected communities afterwards. But when complaints like this one come in, it makes me question whether the changes have been made at a PR level, and not at the deep, institutional level that they need to happen on.  After all the progress we’ve made in getting recognition to this issue, I still have nowhere to tell this family to go, and little hope that anyone will listen if the family tries to raise the issue.