Organization of American States
Washington, 25 October 1999

Dr. David Meddings
Epidemiologist, ICRC

Thank you Mr. Chairman, Ambassadors, distinguished guests:

I am going to discuss some of the research material contained in a study which the ICRC was mandated to carry out during the 26th International Conference of the Red Cross and Red Crescent Movement.

The first results we' d like to share with you concern a questionnaire about the subject, which was administered to a number of ICRC delegates last year. The delegates were asked to respond to the questions making reference to the setting where they had most recently completed a mission. We have information from 41 such questionnaires, and while that might seem like a small number, there is a reason for that. We quite deliberately wanted to assess the perceptions and views of ICRC delegates having extensive first hand experience in situations of armed conflict. Delegates who were administered the questionnaire had an average of 12 years ICRC experience, making them a rather exceptional group of individuals. The countries upon which they reported were situated throughout Africa, Asia and Central Asia, the Middle East, Europe, and Latin America.

There were a number of areas of strong consensus we feel are important. Military weapons are by no means to be found only in military hands. Delegates reported that civilians and criminal groups held these weapons in a majority of the settings, and in over a third of settings children were reported to possess these weapons.

Delegates were asked to identify the weapon type they believed was the most frequent cause of civilian death or injury, and the degree of consensus was striking. Notwithstanding the fact that these views reflect a global perspective, and a wide variety of particular contexts, the assault rifle was identified by a vast majority of delegates as the primary cause of civilian death or injury.

ICRC's President Cornelio Sommaruga has referred to this issue as a massive challenge for the ICRC. The final result from our survey that I'd like to share with you illustrates one very practical aspect of that challenge. Well over half of the delegates reported that armed security threats disrupted ICRC activities at least once a month, and as you can see here a substantial number reported that this was a weekly occurrence. Our ability to have access to victims, something which is of central importance to the ICRC, is frequently hampered.

I'll now move on and talk about a second study that is also incorporated in the arms availability report. This study examined the rate of weapon injuries during and after a period of conflict. The study took place in a region that was initially under contest by a number of military factions, which I've tried to show schematically here. One faction eventually asserted control over the region, and subsequently went on to control most of the remainder of the country. After this military transition the zones of inter-factional combat moved to areas hundreds of kilometers away from the region. ICRC began providing surgical care to people injured by weapons in this region in 1983, and we continue to do so today. The objective of the study was quite simply to contrast the rate of weapon injury in this region during the time it was under conflict with the subsequent time period where it was not.

All of this translates into a single, straightforward graph, with what we hope is a straightforward and yet not so trivial message. Weapon injuries declined between the two time periods but the extent of the decline was not dramatic. On first glance that might seem quite banal. But if we consider this, what it suggests is that, in such a setting, different forces begin to influence weapon use, and if these forces subside, they do so independently of the conflict.

The final set of study results that I'll discuss concern what we will call non-combat weapons injury. What we mean by this is that the circumstances surrounding such weapon injuries have nothing to do with inter-factional combat-weapon injuries inflicted in situations such as interpersonal violence, banditry, domestic violence etc.

This will be the only clinical slide I'll show. My apologies if it's upsetting to some of you, but I would like to clarify what I mean by a non-combat injury. This is an 18 year old woman whose been shot in the head. She's never been in active combat, nor was she somehow caught in a crossfire between combating factions. At the time of her injury she was 8 months pregnant and sitting in her garden.

Her X-ray shows the bullet lodged behind her right eye, and clearly indicates that it entered travelling backwards. This bullet literally dropped out of the sky, and this woman's injury has nothing to do with active combat, and everything to do with her living in a society where people with assault rifles and abundant supplies of ammunition fire these weapons into the air. So it is injuries like these that I'll be referring to in the following slides as non-combat injuries.

The study was carried out in northwestern Cambodia in a hospital ICRC had supported since 1991, and which was the sole facility in the region providing surgical care to people injured by weapons. Over a one year period we gathered information on all people admitted with weapon injuries that essentially allowed us to answer two questions: Firstly, "who" was injured, and importantly here we explicitly established whether the victim belonged to a military faction or was a civilian. Secondly, "how" were they injured? Here we obtained a complete description of the circumstances of the injury that allowed us to classify weapon injuries into those that were combat-related and those that were non-combat injuries. Now the study began in 1994, five months after the departure of UNTAC, which stands for the United Nations Transitional Authority in Cambodia.

I apologize if this slide seems crowded, but it's important to place this study in historical context. This graph shows the number of people with weapon injuries admitted each month to our hospital in northwestern Cambodia. While we have data about this going back to 1991, it's not until our study begins in 1994 that we can discriminate between combat related and non-combat injuries. The period during which UNTAC was present is shown here. UNTAC had two mandates. The first was to disarm 70% of Cambodia's military factions, and the second was to provide free and fair elections. It abandoned the disarmament component of its mandate shortly after its inception. Now there were complex political considerations underlying that decision -- but our experience here suggests that this decision had some very direct implications for Cambodian society that may not have been fully appreciated at the time it was taken. Following UNTAC's departure, weapon injuries increased. In fact, these numbers are the seasonally adjusted incidence of weapon injury during our study period and the periods prior to and during UNTAC. They show that, despite a 1.5 billion-dollar expenditure, the rate of weapon injuries was higher after UNTAC than it had been before. I'd now like to shift to our study period and show you some of our results.

We admitted approximately 900 people with weapon injuries over the study. This graph shows whether these injuries were inflicted on military personnel or civilians, and whether they were combat-related or non-combat injuries. There are three things I'd like to point out. Firstly, only 40% of weapon injuries we observed involved military personnel who sustained their injuries in combat. Secondly, non-combat injuries account for 30% of all weapon injuries - this means almost one in 3 people we admitted had sustained weapon injuries for reasons that had nothing to do with interfactional fighting. Finally, non-combat injuries disproportionately affect the civilian population.

If we look more closely at non-combat injuries, and ask what are the weapon types involved, we see that the vast majority involves firearms, and, to a lesser extent, fragmenting munitions.

This final graph gives some detail about the circumstances of non-combat injuries with these two weapon types. Now first of all, these are all non-combat injuries, with those due to firearms on the left side of this graph and those due to fragmenting munitions on the right. I'd like to draw your attention first to the firearm injuries on the left hand half of the slide. I remind you that firearm injuries were the single largest category of non-combat injuries. Here we see that fully 70% of these were inflicted intentionally upon civilians. We feel that that is an important finding. It reveals a pattern of weapon use in a society that is very much consistent with the concerns raised by ourselves and others. Over here we see our data for fragmenting munitions injuries. Once again, civilians disproportionately affected and a substantial number due to accidents - quite literally curious children pulling pins from hand grenades.

Ladies and gentlemen, we have tried to assess our institution's experience with these issues in an objective and rigorous manner, and the three studies we have carried out have each provided mutually reinforcing conclusions. The ICRC encourages governments, regional organizations and non-governmental organizations involved in the development of arms transfer limitations to reflect on these findings, and recognize that international humanitarian law is often the body of law most relevant to the stated purpose for which military-style arms and ammunition are transferred. Criteria based on humanitarian law considerations should become an important component of any new limitations developed in the coming years.

Thank you.