Legacy of the secret war: medical needs in the UXO-contaminated areas in Laos.

Laos is a small country about the size of Utah. A Lao physician jokingly told me with a sad smile that "Americans thought Laos was a part of Vietnam during the war." The war in Laos was, however, an intentional secret war. The number of bombs dropped during the Vietnam War was greater than the bombs dropped in Europe during World War II. This bombing, which left an enormous number ofUXOs (unexploded ordnances), has created a silent public health emergency in Laos today. In any war, including the Gulf War, as much as 20 percent of the munitions remain unexploded in the ground, endangering anyone engaged in daily activities in the rice fields or a school yard. Nearly one half of the victims ofUXO injuries in Laos are children younger than 15 years. In many postconflict countries agricultural production is estimated to increase 150 percent if there are no land mines, a type ofUXO. There is no doubt that the longterm impact caused by UXOs is serious physically, socially, and psychologically. According to the 1997 National UXO Survey by Handicap International, a French nongovernmental organization, the highest priority for UXO clearance is given to the districts along the Ho Chi Minh Trail in the southern province, and the second highest priority is given to the districts in Xieng Khouang province in the northwest. The prioritization of the Handicap International survey was based not only on the number of UXOs remaining but also on the proximity of UXOs to populated areas. I will describe the medical needs in Xieng Khouang and the districts around the Ho Chi Minh Trail, where I visited during 1997.