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Disability and povertyA global challenge$

Arne H. Eide and Benedicte Ingstad

Print publication date: 2011

Print ISBN-13: 9781847428851

Published to Policy Press Scholarship Online: March 2012

DOI: 10.1332/policypress/9781847428851.001.0001

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“My story started from food shortage and hunger”: living with landmines in Cambodia

“My story started from food shortage and hunger”: living with landmines in Cambodia

Chapter:
(p.189) Ten “My story started from food shortage and hunger”: living with landmines in Cambodia
Source:
Disability and poverty
Author(s):

Merete Taksdal

Publisher:
Policy Press
DOI:10.1332/policypress/9781847428851.003.0011

Abstract and Keywords

Cambodia is one of the countries in the world most contaminated with landmines and explosive remnants of war. The majority of people living with landmines there are poor subsistence farmers. One of them is Sok, a farmer who lost his leg in an explosion while clearing farmland in the forest. This chapter tells his story, along with those of other survivors, in order to illustrate life inside the minefields. In a country without a social safety-net, the vicious cycle between poverty and disability becomes visible through the high number of people with disabilities seen in the poor villages. After losing a leg and going into debt to pay for medical treatment, the disabled survivor or the family members will have to enter the mined area again and again, as they depend on farming, collecting wood, or using other natural resources to sustain their family.

Keywords:   Cambodia, landmines, minefields, social safety-net, farming, poverty, Sok

Cambodia is one of the countries in the world most contaminated with landmines and explosive remnants of war. The mines are not deployed in what we would traditionally call ‘minefields’, visualised by barbed wire and warning signs. Nearly 90% of victims in 2006 reported that there were no mine signs in the vicinity of the accident (CMVIS, 2007). In addition to the extensive placement of mines by all armies, the US dropped nearly three million tons of general-purpose bombs and cluster bomblets1 on Cambodia during the Vietnam War (Owen and Kiernan, 2006). During the Khmer Rouge period, mines were used along the Thai border to seal off agricultural cooperatives. Mines were never systematically cleared, overgrown with vegetation and immersed in water, but no less lethal (Davies and Dunlop, 1994). During the Vietnamese occupation, and later in the internal conflict, new mines have been placed as late as the end of the 1990s.

The majority of people living with landmines in Cambodia are poor subsistence farmers. One of them is Sok,2 a farmer who lost his leg in an explosion while clearing farmland in the forest. In this chapter, his story will be used extensively along with other survivors' stories in order to illustrate life inside the minefields. Although the rural population is aware of the danger of mines, they have to face the threat in order to avoid starvation. In a country without a social safety-net, the vicious cycle between poverty and disability becomes visible through the high number of people with disabilities seen in the poor villages. After losing a leg and going into debt to pay for medical treatment, the disabled survivor or the family members will have to enter the mined area again and again, as they depend on farming, collecting wood or using other natural resources to sustain the family.

Sok's story

“The accident happened three years ago, I was out in the jungle on my plot of land clearing the bush. I was not working for anyone else, I was trying to expand the farmland.” Sok lives with his mother and young son in a thatched-roof bamboo hut in a remote village in Samlot district in northwestern Cambodia. He is a strong man in his mid-thirties, used to hard labour as the breadwinner in the family. Initially he seems a bit shy during the interview, performed by fieldworkers from (p.190) Trauma Care Foundation (TCF-C), a Cambodian non-governmental organisation (NGO) engaged in improving survival of trauma victims in landmine-infested areas. Sok is in distress because his wife recently left him and he has more difficulty talking about the disruption in the family than the dramatic accident when he lost his leg. “I had been there many times before and I was not thinking of any danger. I was just thinking of the good and fertile land we would be able to cultivate if we got rid of the trees and the bushes. Of course we know that this used to be in the fighting area, but I had farmed the land for some time without any incident and thought it might be free from explosives by now.” He is indicating the size of the tree trunks with arm gestures while talking. He was chopping down the trees while his mother was clearing the shrubs and bushes.

After felling two trees, he stepped backwards and triggered an explosion: “When it suddenly exploded, I looked at my leg and told my mother that my leg was cut off. I was still standing up as usual and I looked at my missing foot, and then I searched around the ground and I moved slowly and sat down in the pit of the explosion. I was afraid there were still more dangerous mines than I managed to discover, but my mother took the chance to reach me and sat close. She cleaned the dirt from the wound. She tore her scarf into pieces, and applied a tight bandage on my leg. The other leg was also bleeding, just from cuts and wounds, and my foot was still intact. A few minutes later a man shouted to me. He came because he heard the explosion from a distance. I asked him for help and he came to carry me home. My leg was cut off!” The helper proved to be one of the neighbours and Sok instructed him where to walk to help him safely. The neighbour carried him on his back, as Sok explains that his body had gone numb and he was unable to stand up. “I was even unaware that my legs existed and I had to use my hands to lift my body and climb up on his back.”

The accident had happened less than a kilometre from his house and he was taken across the river on an inflated inner tube tyre and then carried home. The village medic was notified and he was transported by motorbike to the local health centre and later transferred by vehicle to the surgical hospital in the provincial capital. Sok had to have his left leg amputated. Many amputees describe immediate thoughts of suicide in what they see as a hopeless situation, but Sok denies having any thoughts like that. “When I was injured I felt sorry for my kid and wife. I was thinking about who would take care of my family. My wife had just delivered our baby and now I was amputated. I did not want to die or kill myself. I was willing to move on and earn money to feed my son so he would not suffer from starvation. I told my wife not to cry, and that I would find a job.” Sok stayed alone in the hospital for three weeks. Then he asked to be discharged and went home, worried about the well-being of his family. A relative had visited him at the hospital and encouraged him by saying that he could not be blamed for what had happened and that he did not deserve it. In accordance with Buddhist belief and local tradition, there is a tendency to see things that happen in life as a cause and effect of actions in earlier incarnations. Sok thinks about this sometimes and assumes that he may have committed sins in a previous life.

(p.191) His wounds were not healed when he left the hospital and it would be months before he could be fitted with a prosthesis at the ICRC13 workshop in the provincial capital. But he had to find a solution to plant the seeds. Three days after coming home, he started making his own artificial leg from local wood. He saw no future in lying idle at home in pain. He used light wood from the forest, cut it to the appropriate length and carved out the inside in order to reduce the weight. He filled in the hollow area at the top with cloth to soften the pressure against his newly operated stump, and fixed it with a rubber strap. He used wood with a piece from a rubber tyre at the end as a foot. After seven days of wearing it, moving around and working, the pain disappeared. He even managed to cross the river although with more difficulty than before, as he could not feel the slippery stones at the bottom of the river. Another problem was that he could not farm while using crutches – things took longer time and he was not as strong as before. “I am the person to earn the money for the family and I have to farm even if it is painful,” he said. When asked if it was difficult to make the artificial limb, he said: “People here have always created what they need by themselves. So we just do it!”

Sok showed great determination and will to find solutions. But the family was struggling very hard and was periodically living with the risk of starvation. Sok's lack of mobility means that he is unable to take additional jobs as a daily worker or to collect wood or use other resources in nature as he could before. He is also spending money on healthcare services, travelling to fit his prosthesis, buying painkillers and paying others to do tasks he could manage himself before. In addition, the family still lives in danger of the landmines in the same forest area. He is worried about the safety of his son and he continues farming the land where he lost his leg. A new worry is that he is unsure about his formal rights to the land which he put his life in danger to clear. There are rumours among the villagers that the authorities now classify the area as an environmentally protected area and that his traditional right of using land that he has cleared himself may be challenged. When his wife abandoned him, his elderly mother had to take responsibility for more of the daily household chores. Sok finds himself under a lot of strain, despite his hard work and efforts to manage.

Sok is one of many landmine victims in Cambodia who takes the continual risk of being exposed to landmines because of poverty and who is becoming even poorer because of his disability. As most landmine victims, he lives as a poor man in a poor neighbourhood with the least access to services in the society. He is too poor to hire others to do the dangerous tasks and he is too poor to avoid using the dangerous land himself.

(p.192) Mine Ban Convention

In September 2007, state parties to the Mine Ban Convention, along with humanitarian agencies, marked the 10-year anniversary of the key negotiations in Oslo, Norway. The treaty, signed by 122 nations in Ottawa in December 1997, was a result of intense lobbying from individuals and humanitarian agencies, and also resulted in the Nobel Peace Prize being awarded to the International Campaign to Ban Landmines (ICBL). Unlike other weapons, landmines continue maiming and killing long after the conflict has ended. The signatories to the Convention are committed to ban production, transfer, storage and use of landmines, as well as clearing mines from the ground, destroying stockpiles and assisting the survivors of landmine accidents, all within well-defined time lines. However, because of the vast number of landmines already placed, people in many countries around the world still face the problems related to living in a mined environment. Antitank mines and other explosive remnants of war are not banned and may have exactly the same effect on civilians as anti-personnel landmines. Even if the ban potentially saves people from being injured in the future, huge numbers of disabled people live in misery through injuries already inflicted.

The health of the whole family is at risk when a member becomes a burden in poverty-stricken households in marginalised societies. ICBL (2004) defines a victim of landmines as: ‘Those who either individually or collectively have suffered physical or psychological injury, economic loss or substantial impairment of their fundamental rights through acts or omissions related to mine utilisation’. All community members could, by this definition, be seen as victims of landmines when they limit their possibility of using resources in the forest, farming land in safety, contributing to poverty and psychological stress. However, disabled survivors in the same communities suffer an even larger burden of hardship than the general population with limbs and functions intact. For villagers living in the minefields, the legal definition of anti-personnel landmines in a convention is irrelevant. In this chapter, the word ‘mine’ is used when describing all explosive war remnants that have the same effects as devices formally defined as mines.

The Kingdom of Cambodia signed the Mine Ban Treaty on 3 December 1997, and the treaty entered into force on 1 January 2000. Although real progress has been made in the areas of mine clearance, stockpile destruction, research and data management, further improvements and reforms are needed if Cambodia is to meet its objectives and the goals of the Mine Ban Treaty. Victim assistance in particular calls for more support in all stages of their needs, from the emergency situation, their hospital stay through to rehabilitation to a functional life in their families (ICBL, 2006). Nearly all mine casualties now occur along the K5 mine belt and in the border provinces of Battambang and Banteay Meanchey, reflecting the demand for land. Almost all landmine victims have received mine risk education prior to their accidents. The boards from NGOs along the roads and in clinics warn villagers against chopping fire wood, harvesting bamboo, hunting game or ploughing their fields. Although the villagers are aware of the dangers, they have (p.193) no choice if they want to survive. “I can sit at home and starve to death, or I can plough my fields in danger,” a farmer said, requesting ‘real help’ from NGOs and the authorities. “If I had land without mines, of course I would not plough these fields. Everybody here has to take risks to survive.”

“People with power and guns can do as they like”

Ownership of land is a complicated issue in Cambodia and the cause of many local disputes. Historically, farmers living from slash-and-burn cultivation in the jungle obtained an informal user's right to the land they cleared and did not need any written contract as proof. During the French colonial period, the French implemented a Land Act, and by 1930 most of the rice growing fields were registered as private property, but all free areas and unoccupied land were still available for customary rights (Ramamurthy et al, 2001). During the Khmer Rouge rule, all private property was abolished and all land belonged to ‘Angkar’ (the community). The population was forcibly moved from the cities to become rural farmers. After the fall of the Khmer Rouge regime in 1979, displaced and starving people returned to their previous homes. The new government established collective property rights for land and housing. In 1989, the government established a free market economy, including the re-introduction of private property rights. Land was redistributed to rural households in established communities in an egalitarian manner. Those who continued living in border camps until 1989 and after, however, did not necessarily get land from this distribution, and agricultural landlessness was estimated at around 5% (Williams, 1999). Ownership prior to 1979 was invalidated. Land markets have evolved and much land has changed hands more than once in the last decade. Land trade was formally permitted in the early 1990s (Sophal and Acharya, 2002). Distribution of land ownership is highly unequal. Landless households have fewer assets and earn lower incomes compared to landholders, and the near landless are only marginally better off than the landless. Around 80% of the population lives in rural areas where there are few alternative income sources, and owning land is an important prerequisite for a life without degrading poverty. Demographic forces are influencing the balance between supply and demand for land. Rapid population growth since the end of 1979 has created a large demand for food. There are many people in the young age group and the plots the parents divide between their children are too small for a sufficient livelihood for each of the new families.

The commercial value of good agricultural land is increasing. Land that has been cleared by a professional landmine clearance agency has, in fact, had substantial investment, sponsored by the international humanitarian community. The intention behind humanitarian demining is to save lives and reduce disability, as well as improve livelihoods in poor countries. But in Cambodia, the poor subsistence farmers who already cleared the land ‘informally’ leg by leg and family member by family member, may be ‘pushed off’ their land by economic or other pressures. I witnessed this process when seeing a district under clearance (p.194) by international deminers in 2000, a village settlement area of bamboo huts along the road which housed around a hundred families. When passing the place three years later, the whole cleared area was occupied by a privately-owned chilli plantation and the previous inhabitants dispersed. People said that some of them were in the city looking for jobs and others had moved deeper into the forest in order to clear new land. That means breaking land in old minefields. This places the family at risk again of death and disability, as a result of poverty and lack of other options for a decent livelihood.

Irrespective of the presence of mines, poor farmers are at risk of ‘distress sales’ of land usually related to inability to pay back loans. The most important single cause of losing the land is debt caused by illness and payment for medical treatment (Williams, 1999). Money lenders demand extortionate interest rates from people without collateral and in the situation of acute needs of cash, the family with a mother in obstructed labour or a son bleeding from the loss of a leg, does not have negotiating power. Losing land is a first step in a downward economic spiral, as most people are fully aware at the time of the sale. Before selling their land they have usually tried all other options, from selling other assets (if any), sending family members as migratory workers to the city or Thailand, taking children out of school or mobilising financial resources through their extended family network. It is not difficult to force someone off their land if you belong to what the rural Khmers call ‘the power people’. “The people with money and guns can do what they like,” an old villager said.

So what some reports call ‘the process of land concentration’ is accelerating in Cambodia under the unregulated market economy from the 1990s. In reality, this means that some people become increasingly poorer while at the same time the economic indicators reflecting the progress of the economy in the country are improving (Weggel, 2007). The figures of economic performance are probably influenced favourably by chilli export sales, while landless families disappear without a trace, not only from their small houses and plots, but also in the gross national product (GNP). Landlessness increases by 2% per year (Sophal and Acharya, 2002, p 2) and despite favourable economic indicators, Cambodia continues to be among the world's least developed countries (Weggel, 2007). ‘Cambodia remains a minefield full of social constraints. One in three Cambodians still lives on less than 2,000 Riel ($0.50) per day’ (Weggel, 2007, p 145).

The deforestation of Cambodia has occurred rapidly. Between 1985 and 2002 the loss of forest was estimated at almost two million hectares. The pressure from environmentalists is strong when it comes to the need to preserve the natural habitat for wildlife and plant species, as well as for climatic concerns and flood protection. However, rural farmers have experienced that land that is placed ‘under protection’, which in turn causes them to lose their plots, still continues to be exploited but under the operation of bigger companies, or even logging or mining companies with concessions from the authorities. So Sok's worry about losing the user's right of the land he cleared is quite real, but whether it protects the forests for future generations in Cambodia remains to be seen. It is (p.195) well documented that ‘considerable areas of common property resources, such as forests, rivers, lakes and agricultural land (not redistributed in 1989) have become privately controlled. For example, millions of hectares of forests have been granted as concession forests to private companies and many large plantations have been developed’ (Ramamurthy et al, 2001, p 37).

“The only safe thing to do is to sit and die”

Sann, a mine victim from Pailin, has survived two different landmine accidents. He is a double amputee and previously supported his family by combining farming sesame seeds and running a small business. He had to leave his village because of a land dispute; he was not able to defend himself as a disabled person and he feared for his life. He is currently living what he calls a “miserable life” with the risk of starvation every month, together with some of his wife's relatives, in “the jungle”. The land he has access to in the new area has some bunkers on it, indicating that it was a previous front line and subsequently probably infested with explosive war remnants. His reluctance to enter that area is understandable, having suffered two life-threatening incidents before. But if his alternative is to sit at home and starve to death, facing the risk of the minefield may be less after all.

Many of the mine victims were injured when working as daily workers on other people's land. Ploughing a mine-suspected rice field in the wet and soft soil is very risky compared to just walking across the field in the dry season. If you can pay someone else to do it, you reduce your own risk. There are always destitute people, landless or migratory workers in need of a day's wage. In the district hospitals in northwestern Cambodia many of the injured mine victims come from other provinces. Sann is aware that his children will have a poor future if they stay where they are at the moment and he is hoping that they can move to some distant relatives in a city or at least in a more structured place than this “new” commune. The children have irregular attendance at the school and barely learn to read. According to Sann's wife, the teacher only shows up a day a week or so, and the rest of the time the children are dismissed. They do not have books or trained teachers. There is no clinic. The nearest clinic is almost always closed as the underpaid staff usually go home before lunch to treat patients at their private homes or dispensaries. The cost of hiring a motor taxi to get there is too much for them to pay anyway. Other public services in this area hardly exist. The village is inaccessible by road through the rainy season and for a double amputee a prosthesis can easily get stuck in the mud, so Sann is housebound for weeks at a time.

The health condition in the village is poor even within a Cambodian context, with high rates of malnutrition, dengue fever and malaria, and water-borne diseases. Many babies die as newborns because the mothers deliver at home and the mothers also risk dying. Cambodia has high maternal mortality compared to other countries in the region. An elder woman in Sann's village assists at deliveries on request, but she is not formally trained and is unable to make a difference (p.196)

“My story started from food shortage and hunger”: living with landmines in Cambodia

Access in the rainy season

when the mother is bleeding or the delivery is obstructed. When the midwife cannot come to the house due to landmines, floods or lack of communication, the same problems restrict the mother from reaching the clinic.

The social indicators in Cambodia are substantially worse than in its neighbouring countries. Around 20% of children do not attend primary school. Only one girl for every three boys attends secondary school. One baby out of 10 dies before reaching the age of one. Only around 30–35% of births are attended by skilled health personnel. There is a high prevalence of HIV/AIDS and only one third of the population in the countryside has access to clean water (Weggel, 2007). In the cities the situation is better; the national statistics do not reflect the unjust distribution of resources inside the country.

Poverty is a significant cause of disability, as pointed out in the examples of landmine accidents caused by lack of alternatives to making a livelihood. In addition, lack of access to basic healthcare means that simple infections, illnesses and injuries often result in permanent disability because they go untreated or are even mistreated. Poor nutrition is another cause of disability. By the age of two, half of all Cambodian children are stunted and malnourishment is a major cause of developmental delay and long-term intellectual disability. Iron and iodine deficiency can reduce intelligence and Vitamin A deficiency is the leading cause of childhood blindness. The United Nations (UN) concludes that ‘Cambodia's tragic and recent history of war has left it with the highest proportion of disabled people in the world’ (UN ESCAP, 2002, p 15). The benefits of national economic (p.197) growth have not had a major impact on reducing poverty, and rural communities have in particular been neglected. The situation for the poorest of the poor shows a downward spiral over the last 10 years: ‘the share of real per capita household consumption for the poorest 20 percent fell from 8.5 percent to 7 percent of total per capita consumption’ (WFP, 2007, p 16). The fact that inequality has been expanding rapidly while a significant proportion of the population experience absolute deprivation makes it unlikely for Cambodia to reach the targets of the Millennium Development Goals (MDGs).

Thavy

Thavy, a soft-spoken, 16-year-old female, was waiting for us at the health centre in Samlot. She had been notified by the local medic that we wanted to talk to her. “We” were a delegation of two foreigners with a translator and a fieldworker from TCF-C. However, we wanted to see her in her home environment and following a discussion she agreed to come with us in our car. We drove through the forest on a dusty path as far as it was driveable. From the car we walked through fumes of smoke and charred tree roots protruding from the burnt soil where the settlers had cleared land for slash-and-burn agriculture. The area had been in the war zone and had never had any professional mine clearance. It was a chilling feeling as we walked uneasily through the area, taking guidance and keeping our feet strictly on the path the villagers were using every day. The last three days they said that they had heard explosions from mines spontaneously detonating because of the fires in the grass. Luckily no one had been injured. The interview took place in the shade below the house, built in traditional style on stilts. Together with Thavy, the other seven people in the household were present: her parents, two sisters, a brother-in-law and two infants. The family had planted rice, beans, peas and pineapples on the new farmland surrounding the house. Her father limped to the scene, a result of a stroke that had weakened his left side and, as Thavy said, had affected his brain. He sat quietly, listening, but not adding to the conversation. The family moved into the forest and started clearing the plot in 2000 and the father had cleared most of the forest with his one normal functioning hand. Lately, his son-in-law had assisted him. They had also removed numerous “objects” from the ground with the utmost care. These were presumably different explosive remnants from the war.

Thavy was injured at 9am in the morning when walking on the road in the heavy rain. She was about a kilometre from home on her way to buy medicine from a local vendor and there were no adults around. She was not worried about mines because “everybody” was using the road regularly. There was heavy lightning and thunder and she didn't understand what had happened in the unexpected explosion. She was confused and didn't realise why she had fallen. When she understood that her leg was gone she tried calling for her sister. But nobody heard her cries. Around half an hour later, a man passed by, saw her and carried her on his back towards the health centre. He stopped at his house on (p.198) the way as she was in shock from the loss of blood. She had tried (unsuccessfully) to stop the bleeding with her own scarf. It was raining heavily and she felt very cold. She also described her emotional state as “in panic”. She was unconscious on arrival at the health centre where the medic bandaged her leg, wrapped her in a blanket and gave her intravenous fluids. She was transferred to the surgical hospital in the provincial capital escorted by three relatives, her mother, sister and brother-in-law, and stayed more than one month in the hospital. She was fitted with a prosthesis six months later but it was too loose on the stump and needed adjustment as she grew. She got another one fitted a year later, still in use at the time of our visit, although by now it was too tight and had caused blisters on her skin in the heat. The prosthesis was a bit shorter than her remaining leg so she walked with a limp. But she had no chance of doing anything about it until her school holidays. Then she might be able to go to town again, depending also on her parents' finances at the time.

Thavy explains that she feels frustrated and angry when walking with the prosthesis and that she cannot do the same as she could before. She cannot carry water. Activities are more complicated and painful now. But she is able to use a bicycle and can cycle to school. She knows another girl who is disabled from a mine accident who is also an amputee. They used to meet on the way to school. They talk about ordinary, daily things like other young people, but sometimes they talk about living without a leg. They feel worthless and ashamed about how different they are from other girls. Thavy used to play with the other girls before but when they play they run, and now she can't. So she tends to withdraw socially from interaction with others. It is no problem at school but others call her names and tease her because of her “unnatural” leg. This makes her shy. She is in grade 6 at school. She dreams of continuing until grade 12 but does not know if that is possible. She will most likely have to start earning her own money. As a disabled female she believes she will have to manage on her own and is unlikely to get married. She is interested in being trained as a tailor or in setting up a bride grooming beauty saloon, but will need assistance from an aid agency to be able to do that. There is no governmental support. Everybody has to manage their own lives and her family is very poor. She hopes that she will be able to earn a living as a tailor, even though she and her family live in the forest, quite far from the market.

Every time she walks in the area where her family lives she is afraid. She is worried that this might happen again and that she could risk losing her other leg. She is also worried about her sister's children or her father when he is clearing the land. She seems a bit surprised about our questions as everybody knows and it is obvious that “living in a mined area means living with fear”. But they have no other place to live and as a daughter of the household she is fully dependent on the decision of her parents.

The Cambodian social system is generally hierarchical. The main determinants for placement within the society are age and sex. Culturally and socially defined gender roles traditionally place men higher than women in the hierarchy. This (p.199) could also be explained as part of Buddhism where being reborn as a male is believed to be better. But symbolic markers also include a range of other factors such as wealth, reputation of the family, political position, individual character and employment. The traditional division of work in a farming family may be changed as a result of disability and impairment and many families show much flexibility when solving daily problems. But some spouses leave when their partner becomes “powerless”. It is hard to determine how pervasive beliefs related to destiny and ill deeds are and to what extent disruption of a traditional family is caused by the fact that it just becomes too much to bear. Many victims describe feeling guilty about the accident and that they worry about other people's perceptions of them. Informants in an interview study (Taksdal, 2002) seemed convinced that exposure to risks and protection from harm were linked to a person's inherent qualities. While some people seemed to see themselves as “resistant” to the impact of mines, others were more prone to accidents. It was also possible to improve resistance by “magic”, such as protective tattoos against bullets and mines. The explanation of “karma” as a predestined quality that can hardly be influenced by current actions, is described by words such as “luck”, “unluck”, “faith” or “destiny”. Clearly, some did not see it as arbitrary who was injured. If many people chop wood in the same place, why did the mine explode on one of them in particular? The victim may suspect that they have done something wrong in a previous life to deserve this ill faith of living as a disabled person suffering chronic pain. This perception may account for some of the problems disabled people have in getting back to a life with dignity and also when they complain about discrimination and social exclusion. They, as well as their social environment, may conclude that they have ‘bad karma’.

The head of the pagoda in one of the villages explained his understanding of the Buddhist interpretation:

‘The Buddhist faith mentions some explanations for the disability. First it may be karma. If in a previous life you have acted badly, you may suffer in this life. If you have previously acted well, you will receive good. You can be born into this life as a healthy person and become well educated because of the good you did before. This is Buddhist understanding. If you are bad and know you have behaved badly you can do something good. But you cannot mix good and bad. If you mix, you will receive both good and bad in the next life. If your bad actions are serious, you get the bad first. Those who share the conviction that you face bad results sooner if you have performed particularly bad actions in a previous incarnation, will feel that an injured child has worse karma than an adult victim.’

Some of the victims try their best to improve their chances in the next life. Doing ‘good’ is related to helping other people in need or supporting foundations in Buddhist wisdom: helping to build a temple, giving food to the monks on a daily (p.200) basis and giving clothes for the monks during religious festivals can improve your merits. There is a widespread use of offerings to small Buddhist shrines that most people have in their house or garden. Incense, fresh flowers and fruit are placed there to soften the spirits for a positive outcome of daily activities or for special events like weddings, travel or transactions. In a belief system with an holistic perspective of forces influencing each other, it may be unjustified to draw too rigid conclusions of one aspect. Even if the Buddhist faith explains things as the result of previous lives, the person who is suffering in this life has to struggle. Individuals with special needs place a burden on their family, a burden some families would not be able to absorb, irrespective of beliefs. Most families do their utmost to take care of the needs among the family members, as the family constitutes the first line of care. With the high proportion of disabled people in Cambodia where so many people know someone disabled or have a disabled relative or neighbour, this is probably altering the understanding of previous beliefs. A key factor seems to be to what extent the victim manages to re-establish a normal life as well as his/her ability to not lose contact with their family and social network. In daily activities, people make choices according to practical possibilities and limitations caused by poverty, rather than from faith.

Self-help groups

TCF-C, with the slogan ‘Save lives, save limbs’, is assisting trauma victims in reaching the clinics alive. Through networks of first aid-trained lay villagers and medics at health centres, TCF-C has built a ‘chain of survival’ from the minefields to the surgical hospitals in the city. However, the medics, although pleased with reducing the pre-hospital deaths, reported that the disabled survivors suffered from chronic pain and depression, and lived ‘hopeless’ lives in their villages after discharge from the hospital. Could something be done to help them, besides distributing analgesics? A study was conducted in cooperation with Tromsø Mine Victim Resource Centre (TMC),4 and concluded that the only correlation to the severity of chronic pain in the survivors was poverty (Husum et al, 2002). The hypothesis that poverty itself acts as chronic trauma was the rationale to initiate the self-help programme aimed at improving the economic situation and subsequently to act as a ‘painkiller’ for the victims.

Sok from Sam Lot was selected to become a member of a self-help group which included five members, all male subsistence farmers, who had all lost (at least) a leg. Sok tells how he joined the group: “One day soon after returning from the hospital, my uncle went to collect bandages and medicine for me. The medic remembered that I was newly injured and told my uncle that a poor, disabled man like me could be offered the chance to join the cow bank project. My name was registered by the medic from the time when he helped me and I was very happy to be informed that I would receive a cow. I really did not want anything else, just the cow!” Some of the others in the group wanted a loan, but for Sok the cow was very welcome. There was plenty of grass around the house and his wife or (p.201) his mother looked after the cow when he was at the farm. The first calf was born the first year and another one the next. Sok had become emotionally attached to the cow and had difficulty in deciding whether to keep the cow or the two calves, which was what he ended up doing. (The returned cows were then given to new members.) When Sok decided to keep the calves, he said he was sorry to give the cow away. “I love the cow and feel that it belongs to me and I hope that the other family will take care of it. It brought a lot of luck for me and I feel sorry to separate the calves from the mother.” Unlike a pig, which partly feeds on the same food as people, the cow eats grass, leaves and banana stalks. The main benefit of a cow is its reproduction. A cow can be used as a guarantee for a loan and can be sold very easily. When a cow produces a calf every year or two calves in three years, this helps pay for the building of a house, paying for education or social ceremonies, the bride price for arranging a wedding or covering the costs of medical treatment. A cow is valuable property in the household, Sok says, adding that many people have asked him why he got the cow when there are so many poor people in the area. His understanding is that TCF-C only helps the poor disabled, as they are not able to conduct business in the same way as those with their bodies intact.

The members of the group try to have regular meetings. They have a group leader and usually the medic also participates. Sok explains: “We meet with each other to discuss our problems and how to look after the cow or the business. We also have fun and laugh together, and try to meet once a month. But all of us cannot meet all the time, because we are busy with our lives and work hard with the farming. During the busy months we go to the farm early in the morning and return late in the evening and there is no free time to go out just to meet.” In his group they also tried to start a savings system, so that the group itself creates a buffer for unexpected expenses. But only two members of the group have had any surplus to save, so it has been put on hold. Sok sees the benefit of helping each other financially to avoid the money lenders and their high interest rates. He even thinks about other poor people in the village. When they are in trouble, they may borrow money from the group at a lower interest rate than the money lenders. In that way, the group member may get a slight return of their saved money, a tempting idea in a country where there is no real access to a bank account for the poor.

Although he has friendly relations with the other members, he has not shared the problems related to his divorce. He feels it would be a loss of face and the others couldn't help anyway. He understands that his wife had to take on many extra tasks because of his diminished strength and that he was moody and frustrated. “I get angry quicker than before because there is nothing I can do. I get angry quicker because of the difficulty in being an amputee and because I have to ask people to do things I used to do myself. When I asked my wife and she refused I was very angry, and I was more tired than before I was amputated. I was working harder with fewer results and I felt pity for my wife who had to do so much. Before I used to carry the water if there was no rain and I had to fill the water (p.202) jar at the house. Before, I could go to the river 20 times to refill the jar but when my stump aches and I lose my balance, fall down and come home with a broken container and no water. My wife said that she wanted to help when I was very tired, but I felt useless.”

In some of the self-help groups, the meetings seem to create friendships among the members. They share experiences on being disabled in a country with many prejudices against people “who are not whole” and practical tips on how to avoid problems or treat muscle spasms and blisters on their stumps. They talk about signs to look for in the health of the cow, how to contact the veterinary service and arrangements for breeding. They discuss aspects of improving the business for those who have loans and occasionally the medic and TCF-C field workers attend the meetings as a follow-up. Thavy, as a young woman, is a member of a group with adult males only and they live so dispersed that it takes a day to arrange a meeting. They use the health centre as the meeting place. One of the members of her group said that “We have to work all the time. We are clearing, ploughing, tilling, all the time doing something. We have no time just to meet.” A girl like Thavy has no influence over savings in the group, as long as it is her parents who control the family's income. Thus the medic is an important contact person for the group members. He comes to see them at their homes individually and Thavy describes the medic now as a friend of the family. The ability of the group to function depends on the geographical distance between the members, the age and gender and their ‘free’ time.

The head of the group in which Sok is a member has taken an active role. He is a father of four, grows rice, cashews and fruit and used to fish and catch snails and frogs in the rainy season. He is concerned about the emotional state of the returning amputees, remembering his own despair when he lay bleeding in his garden and felt that he would be better off dead than as a burden on his family. He says that people fall sick from “thinking too much” when they are inactive. Then they feel every ache and pain, worry and become depressed. “When I am busy I do not even think about being an amputee. With the prosthesis I can use my hands and I can do everything like before, but with some more difficulty.” He has started visiting the new mine victims when they come back, whether they are members of the group or not. He tells them, “I was like you.” He supports their emotions, their spirit and the feelings they have and encourages them to accept what has happened. He knows it is difficult because he has been through it himself, but he stresses the importance of having a focus. “What is gone is already gone, think about the things you can do!” He also shows them his own mobility with the prosthesis. Sok feels that the group leader has been a strong supporter in his own healing process.

Through TCF-C new victims have access to locally produced walking aids to help them get up and start moving. While waiting for a fitted prosthesis from the rehabilitation workshops in the city, which can take up to six months, there is plenty of time for pain and depression to grow and for debt to accumulate. “In Battambang city you see amputees as drunkards and beggars, but here in the forest (p.203) we take care of each other,” Sok says. There is no difference in value between ordinary and disabled people, he adds, and he does not believe that mine victims deserve what happened as a punishment. “We did not lay the mines and we are hard working, but life is very strenuous. There should be a system to help the needy. Those with full limbs can easily move as they like but in the rainy season we cannot move with wheelchairs or crutches and our artificial limbs get stuck in the mud. We cannot go to the market to sell our products and we are stuck.” The notion of the limitations it brings to be living in a mined environment can be summed up as “living in a prison without walls”.5

In Cambodia there is no social safety-net granting a pension or compensation to the civilian disabled, a system some interest groups are lobbying for. After the demobilisation of soldiers in 1998, veterans, according to certain conditions, got a monthly pension based on their military background, or because of disability. One of the group members is an ex-soldier with both legs amputated above his knees from two different accidents. He is entitled to a pension of nearly US$30 per month. This pension had to be collected personally at an office in the city, which made it a two-day journey every month. In connection with an incident concerning illness, he had to mobilise cash rapidly and the lender demanded double the amount back. The lender has taken over the right to his future pension until the end of 2009 (nearly three years). Now he is trying to feed his family through a soup kitchen at the roadside, financed by the micro-credit scheme of loans from the TCF-C. Many of the members focus on the value of getting interest-free loans with a reasonable pay-back time, as it gives them a fair chance. “The interest-free loan is a real help” and “this is helping and not just business”, are some of the statements from the members. Whatever income-generating activity they start with the loan – tailoring, battery charging, a local cinema or motorbike repair – the income is unpredictable and seasonal. Tying up the return payment in fixed monthly rates may be too inflexible. Typically the households are in deficit before the harvest and some people even talk about “the hungry season”. The effect of the loans on the family economy in a three-year perspective shows positive results, and preliminary results of ongoing research6 indicate that the pain problem is reduced. As long as the family has a standard of living on the same level as others in the community, the disabled family is seen as the same as any other family. The stigma of disability seems to be attached to being a burden on others. But if you behave like the social norm dictates, self-reliant, polite and friendly, the disabled person in the village is invited to social ceremonies and lives an ordinary family life as before.

Conclusions

“My story started from food shortage and hunger,” said Soda, a self-help group member from Baval. Now he is feeding his family through repairing engines and bicycles from a repair stall at the roadside. His son is an apprentice in his business, a business based on a vocational training course when he was newly amputated (p.204) and a workshop equipped through a micro-credit loan. He had no chance of farming for a living because of a permanent joint injury in his remaining leg. His loan is now paid back and although he is bothered with muscle stiffness and occasional cramping in the amputation stump, he sleeps well at night. He does not worry about his livelihood: “I earn a surplus these days,” he says.“My kids go to school and my wife wants to start a small shop in the village.” The road and a stretch of land on each side towards the clinic have been cleared professionally. He is hopeful that his children and grandchildren will manage well. “Maybe in the future children will not even know what landmines are,” he wonders. Soda doesn't say much spontaneously, neither does he say much about his life when asked. Often he responds that he doesn't remember or doesn't know. Like most Khmers he prefers to leave what has happened behind, tries to forget the bad things and looks ahead, not to re-experience trauma! He has lived through too much, as anyone with a minimal knowledge of Cambodian recent history can imagine: external and internal war, heavy bombardment, running through a burning jungle, losing all property, being displaced and at the mercy of others, living in a suppressive political environment and barely surviving from day to day; starting a family and almost losing everything because of a landmine; and an explosion shattering his body when he was giving the draft animals he borrowed to pull the cart a cooling bath in a pond when collecting bamboo in the forest. “You cannot understand the lives of the poor disabled in Cambodia,” he says. “It is a miserable life.”

Narratives in this chapter, stories from landmine victims in rural Cambodia, have illustrated aspects of the vicious cycle of poverty and disability. Because of a lack of a decent livelihood, people living in the minefields have to expose themselves to continued risk of traumatic accidents. In addition they have less access to healthcare and rehabilitation services, making the outcome of accidents worse. Living in poor areas with lack of proper education and alternative livelihoods, the possibility for the next generation to create a better future is limited. The children in poor households with a disabled breadwinner are at risk from dropping out of school and having to work at a young age. The vicious cycle is not limited to the individual person but continues to include the whole family and into the next generation.

References

Bibliography references:

CMVIS (Cambodian Mine Victim Information Centre) (2007) Monthly report, August 2007. Phnom Penh: CMVIS.

Davies, P. and Dunlop, N. (1994) War of the mines, Cambodia, landmines and the impoverishment of a nation, London: Pluto Press.

Husum, H., Resell, K., Vorren, G., Heng, Y.V., Murad, M., Gilbert, M. and Wisborg, T. (2002) ‘Chronic pain in land mine accident survivors in Cambodia and Kurdistan’, Social Science and Medicine, vol 55, pp 1813–16.

ICBL (International Campaign to Ban Landmines) (2004) ‘Assisting the Victims’, First Review Conference of the Landmine Convention, Conference paper.

ICBL (2006) Landmine monitor report 2006 – Toward a mine-free world, New York: Human Rights Watch.

Owen, T. and Kiernan, B. (2006) ‘Bombs over Cambodia’, The Walrus, October.

Ramamurthy, B., Boreak, S., Ronnaas, P. and Hach, S. (2001) Cambodia 1999–2000: Land, labour and rural livelihood in focus, Working Paper 21, Phnom Penh: Cambodia Development Resource Institute.

Sophal, C. and Acharya, S. (2002) Facing the challenge of rural livelihoods: A perspective from nine villages in Cambodia, Working Paper 25. Phnom Penh: Cambodia Development and Resource Institute, December.

Taksdal, M. (2002) ‘In a prison without walls. Living with landmines in Cambodia. Direct and indirect implications for public health’, Master's of Public Health thesis, Nordic School of Public Health, Gothenburg.

UN ESCAP (United Nations Economic and Social Commission for Asia and the Pacific) (2002) Pathfinders: Towards full participation and equality of persons with disabilities in the ESCAP region, Bangkok: UNESCAP.

Weggel, O. (2007) ‘Cambodia in 2006. Self-promotion and self-deception’, Asian Survey, vol XLVII, no 1, January/February.

WFP (World Food Programme) (2007) Integrated food security and humanitarian phase classification (IPC), Pilot in Cambodia, Final report, April. Cambodia, Phnom Penh: WPF (www.ipcinfo.org/attachments/Fullreport_IPC_Cambodia_WFP_may2007.pdf)

Williams, S. (1999) Review of secondary sources relating to land tenure and access, Phnom Penh: Cambodia Land Project, Oxfam GB. (p.206)

Notes:

(1) ‘Bomblet’ or ‘bombie’ is the term for small bombs inside the ‘mother bomb’ in cluster munitions or cluster bombs.

(2) The names used in this chapter have been changed, as well as some of the details in their stories and location. The people mentioned are members of self-help groups supported by Trauma Care Foundation (TCF-C) in Cambodia

(3) International Committee of the Red Cross. They operate an orthopaedic centre in Battambang city.

(p.205) (4) TMC is an action research centre aiming at improving local communities' resistance to the impact of war and suppression. It develops teaching material in advanced first aid, and trains local instructors in the countries where they carry out their projects. See www.traumacare.no

(5) This was a quote from one informant in an interview study conducted in Battambang province in 2000, resulting in a Master's thesis with the same title (Taksdal, 2002).

(6) Qualitative interviews with members who finished the intervention before 31 December 2006.