1. www.surrey.ac.uk/politics/cii Missing and disappeared: the challenge of including injured survivors in casualty counts. Marie Breen-Smyth University of Surrey The study was commissioned by WAVE and funded by the OFMDFM via the Community Relations Council, but the views in this paper are those of the author alone.

2. www.surrey.ac.uk/politics/cii General problems of counting the casualties of armed conflict Specific difficulties with MIAs or ‘disappeared’ casualties Injury as another form of missing-ness and disappearance Summary of 2011-2012 study of seriously physically injured in Northern Ireland Key issues in addressing the needs of such casualties Key challenges in including injured people in casualty counts Implications for peace and reconciliation OUTLINE

3. www.surrey.ac.uk/politics/cii General problems of counting the casualties of armed conflict Capacity in war zones No standard methods What data to collect: name, age, gender, cause of death but what else? Issues about inclusivity Reliability and validity & verification issues

4. www.surrey.ac.uk/politics/cii Specific difficulties with MIAs or ‘disappeared’ casualties Definitional difficulties Lack of good comprehensive data from consistent reliable source Condition of casualties/ missing changes over time, aging and deteriorating health means needs tend to increase over time Focus on physical needs to exclusion of psychological needs Aging population lends urgency to need to make provision, some are dead already.

5. www.surrey.ac.uk/politics/cii CVSNI Summary of Previous Research Survey/ResearchYearFindingsSample Size Survey extrapolated to current population* Cost of the Troubles Study (COTTS) 2002 25.5% -severe or very severe experience 36% -severe or very severe impact 1,346 456,169 644,004 Who are the Victims: Cairns and Mallet (NISRA 2003) 200316% consider themselves direct victims 30% considered themselves indirect victims 1,000 286,224 536,670 The Legacy of the Troubles: Muldoon, O et al 200530% of the sample had direct experience of the troubles 3,000536,670 CVSNI Omnibus Survey (NISRA) 201030% of survey had been directly affected by the conflict 1,179536,670

6. www.surrey.ac.uk/politics/cii Injury as another form of missing-ness and disappearance Seriously injured and disabled often missing from casualty counts They quickly disappear (or never appear) in public accounts Counting only fatal casualties under-represents the damage caused by armed conflict Ignores ongoing costs (health, social, economic, psychological) absorbed (or ignored) by families, health care systems, social security etc Normalises armed conflict: injured ‘disappear’ in time.

7. www.surrey.ac.uk/politics/cii Multiple conflict related deaths Single conflict related death Multiple conflict related injuries Single conflict related injury Multiple accidental deaths Single accidental death/ everyday tragedy PREVALENCE HIERARCHIES OF ATTENTION CONFLICTCONFLICT PEACEPEACE

8. www.surrey.ac.uk/politics/cii Summary of study Difficulty in definition of cohort: Physical? Psychological? Recovered? Disabled? Focused on “life-threatening severe and/or disfiguring physical injury” All participants have physical injuries Psychological injury included alongside physical Study of the needs of ‘people severely injured or disfigured by the conflict in Northern Ireland and their carers’

9. www.surrey.ac.uk/politics/cii Summary (full report available at http://www.surrey.ac.uk/politics/cii/Projects/ ) http://www.surrey.ac.uk/politics/cii/Projects/ aimed to define injury audit total numbers of casualties, range of injuries examine their needs and available services

10. www.surrey.ac.uk/politics/cii Review of literature 50 in depth Interviews Survey of injured people –Self completion – simple, short format –Focus on measuring needs and priorities –Focussed on injured rather than carers –Embed PDS measure 60 minute film with Northern Visions

11. www.surrey.ac.uk/politics/cii Key findings

12. www.surrey.ac.uk/politics/cii Injured civilians versus injured security services personnel – security personnel better provided for than civilians, resistance to seeing this amongst former Variation of benefits advice standards – especially re: new DLA rules and cuts [Wave have good provision] Counselling & psychological services – trauma focussed help not widely available, waiting lists – not awareness / access among injured of PTSD and trauma counselling

13. www.surrey.ac.uk/politics/cii Justice: In rural areas and for some in Belfast have to deal with knowing about perpetrators in their community/locality – most don’t want ‘revenge’. For most, justice not a pressing concern – exceptions possibly victims of security forces / collusion Being badly advised about compensation – Bloomfield [derisory amounts] pre 2002 – post 2002 still there are problems, delays, perceived inequities etc Impact of injury on family and carer Current activities

14. www.surrey.ac.uk/politics/cii Inequities in compensation, disqualification from benefits, so all now benefit dependent Lack of (or reduced) occupational pension provision (except security forces) Service providers – new funding criteria – Inadequate or inappropriate psychiatric service for injured and survivors in NI. Voluntary/NGO provision versus NHS

15. www.surrey.ac.uk/politics/cii Key issues in addressing the needs of injured casualties

16. www.surrey.ac.uk/politics/cii Segregation of services sectarian security-civilian; DPOA, SEFF, Phoenix PRRT –v- the rest; Disability –v- victims Disability Action, Carers Assoc –v- victims & survivors groups SEFF FAIR etc CUNAMH RFJ etc WAVE etc

17. www.surrey.ac.uk/politics/cii Key challenges in including injured people in casualty counts Developing and agreeing operational definitions of ‘injury’ Basing these on humanitarian rather than political principles Designing and agreeing methodologies and protocols across contexts and agents Overcoming the short term sensational focus of reporting on armed conflict Designing methods that address the longitudinal nature of injury counts, by updates over time, addressing longevity –v- life expectancy Countering government objections based on financial reluctance to meet the costs of properly addressing injury

18. www.surrey.ac.uk/politics/cii Implications for peace and reconciliation Continuing segregation and division; No mechanism for putting the past behind Living next door to the perpetrator – especially rural visibility People trapped in fear and past trauma Disparities in provision for civilians and former security forces Left to individuals to cope: failure to establish any measures in peace process to address these issues Risks of revenge

19. www.surrey.ac.uk/politics/cii Implications for peace and reconciliation Some injured people are political agents, they and their carers and families continue to live and speak and act politically Post conflict reconciliation must be grounded in truth and focused on rights of victims and efforts to discover the circumstances of their death or injury. Attempts to reduce the incidence and impact of armed violence must make genuine efforts to monitor and understand ALL the human consequences, including injury.