The underreporting of landmine and explosive remnants of war injuries in Cambodia, the Lao People's Democratic Republic and Viet Nam.

Perspectives Injuries place an enormous burden on individuals, households, and communities and they exacerbate poverty. 1 A substantial but often under-recognized cause of injury in post-conflict environments is the presence of landmines and explosive remnants of war (ERW), such as abandoned ordnance or weapons and cluster munitions, bombs, mortars or other devices that failed to detonate on impact but remain volatile and can explode if touched or moved. This under-recognition, which is partly the result of underestimates, has global implications because it affects to what extent the resources assigned to injury prevention and the rehabilitation of injured people are prioritized. This paper provides detailed case studies of three countries that are heavily contaminated with landmines and ERWs and where mine action programmes – i.e. programmes for humanitarian , non-military purposes – have been in place for a long time: Cambodia, the Lao People's Democratic Republic (PDR) and Viet Nam. The purpose is to illustrate the degree to which injuries caused by landmines and ERW are un-derreported. The paper highlights how little has been published in the health literature on the subject of landmines and ERW and the failure to include available national data on the injuries caused by these devices in global burden of disease (GBD) estimates. The GBD is a measure that combines the contribution of both mortality and impaired functionality resulting from a range of diseases and injuries to provide a national ranking for comparing disease burdens across countries and, by implication, for assessing the relative importance of a given health problem at the national and global levels. Hence, underreporting is of global relevance. The underutilization of available national data on injury from landmines and ERW has probably affected the national burden of disease estimates for 2004 and 2008 and perhaps the regional and global estimates in the 2010 GBD study conducted by the World Health Organization (WHO). In this paper we examine the reasons for this underuti-lization of in-country data and provide recommendations of relevance to the global context. The paper proposes that the revisions to the tenth revision of the International Classification of Diseases (ICD-10) and to GBD figures, that are under way, provide opportunities to generate more accurate estimates and to better capture the current burden of injury from landmines and ERW. Studies conducted in 2004 and 2008 provided country-specific burden-of-disease profiles. The GBD estimates presented in this paper were derived from these profiles. In …