Landmines and explosive remnants of war: a health threat not to be ignored.

Editorials 160 Landmines and explosive remnants of war (ERW) continue to kill, injure and destroy lives and livelihoods. They cause an estimated 11 to 12 casualties daily and are not confined to a single part of the world. The six countries with the highest landmine and ERW casualties in 2011 – Afghanistan, Cambodia, Colombia, Myanmar, Pakistan and South Sudan – belonged to different regions. 1 Twenty years after the establishment of the International Campaign to Ban Landmines and 15 years after the monumental Mine Ban Treaty, the world has yet to overcome this scourge, which harms far more innocent civilians than military personnel. 1 In a paper in this issue of the Bulletin , Durham et al. note that in Global Burden of Disease (GBD) studies, the true number of landmine and ERW casualties has historically been under-reported. 2 Their paper was written before the release in December 2012 of the GBD 2010 report, which fails to specifically discuss accidents caused by landmines and ERW and categorizes them under " collective violence ". 3 In line with the Landmine Monitor's reporting on landmine and ERW casualties, the disability-adjusted life years (DALYs) attributable to collective violence have declined. 4 However, the problem of landmines and ERW persists and it would be a grave misjudgement to consider it solved. The health community has a major role to play in matters pertaining to landmines and ERW. The most apparent is ensuring an adequate health-care response, both immediate (e.g. acute trauma care and surgery) and long-term (e.g. rehabilitation), to the physical and psychological trauma of people injured by landmines and ERW casualties. Most of these people live in poverty, which tends to get worse after the accident. Furthermore, health services equipped to treat people with landmines and ERW injuries are often found in urban areas only, yet most accidents occur in rural and remote areas. Those who survive but with permanent disabilities, often face social and environmental barriers that can preclude their full and equal participation within their communities. With many health campaigns and calls to action to promote child health and survival, it is worth noting a substantial proportion of civilian landmine and ERW accidents occur in children – 42% on average, according to the Landmine monitor 2012. 1 Landmine and ERW contamination can also undermine the health of a population indirectly by destroying food security as well as access to safe water …