Rehabilitation session for two young patients (left, Yasser, 12 years old) at the Sana’a rehabilitation centre | ©ISNA agency / HI
Pauline Falipou, HI rehabilitation expert, discusses the injuries inflicted by mines and bombs in Yemen.
The teams work on numerous cases of amputations caused by bombs, landmines or explosive remnants, including remnants of cluster munitions which, like landmines, are actually prohibited weapons. Landmines in particular often lead to lower-limb amputations: when someone treads on a mine, they trigger an explosion which rips their leg off. This leaves no choice but to amputate the affected limb.
As for bomb victims, they often sustain complex injuries: open wounds, fractures, burns, loss of muscle mass, nervous system damage etc. These injuries can be very difficult to treat, and people are often left with life-long pain and sequela.
HI teams also manage lots of patients with gunshot wounds: in these cases the victims may lose muscle mass but do not usually require amputation. However, they do have a high risk of infection. Patients with gunshot wounds face a long care pathway. After undergoing surgery, the rehabilitation required to regain mobility can take months. This long period of convalescence is tantamount to a temporary disability.
A mine explosion and the resulting loss of a limb are traumatic experiences: waking up in hospital with a leg missing is a shock for the victims who are already traumatised by the explosion and are often too afraid to leave their homes. This is followed by a period of anxiety: how am I ever going to get back to normal daily life with a leg missing or without my arms? How can I get back to work and feed my family? Many patients are in a state of complete physical and mental exhaustion. They stop speaking and have lost all willpower. They need psychological support.
It is also vital that the patient has a certain level of motivation for their rehabilitation to be effective. If they are depressed and “give up”, they are not receptive to the care provided, they will not do the exercises which are demanding and sometimes painful. Finally, when they undergo orthopaedic fitting they need to be ready to accept the prosthesis, which is not very natural.
In the last four years we have provided care to 2,500 victims of all types of explosive weapons, including 300 mine victims. If we compare our work here with interventions in other war zones, the proportion of mine victims is very high.
Landmines are used in Yemen to stop the enemy from advancing. They are found on the west coast of the country, mainly to the north, with a significant concentration around the city of Hodeidah which has seen the worst of the fighting in recent months. The victims killed and maimed by landmines are almost exclusively civilians.
The west of the country, mainly to the south, is also where there is the most contamination of explosive remnants of war: these include bombs dropped in raids which do not explode on impact and thus contaminate the district or village where they land, becoming a permanent threat to the population and claiming further victims, usually civilians.
The hospitals we work in are totally overwhelmed. There are many zones where there are no health services whatsoever and the situation has deteriorated during the conflict. The country has numerous areas deprived of medical services and these areas have increased with the war because many health centres have been rendered inoperative by the fighting. People travel extremely long distances to access treatment. We are one of the few organisations providing post-operative rehabilitation services in Yemen.