“Our Work Isn’t Finished Yet”

A Cambodian mine-affected boy (R) stands next to hundreds of defused landmines and unexploded ordnance (UXO) placed in a room of a private museum in Siem Reap. Tang Chhin Sothy/AFP/Getty Images

Twenty years ago, the Norwegian Nobel Committee announced it would award the 1997 Nobel Peace Prize to the International Campaign to Ban Landmines and the campaign’s coordinator, Jody Williams, for their work in securing a landmark treaty to ban antipersonnel mines globally. Physicians for Human Rights (PHR), as a founding member of the Campaign, shared in the prize.

But the work to ban landmines began several years earlier with a joint investigative trip to Cambodia by PHR and Human Rights Watch. One the members of that team was orthopedic surgeon and epidemiologist James Cobey, MD, MPH, who co-authored the seminal report Land Mines in Cambodia: The Coward’s War. Among the findings: one in every 236 Cambodians at the time had been injured by a mine, the legacy of years of war. And that shocking statistic counted only those people who were taken to a hospital.

Dr. Cobey spoke to PHR about how he ended up on that first trip and the chain of events that led to the Mine Ban Treaty, which came into force faster than any arms control treaty in modern history.

How did you first get involved in the initial land mine investigation?

I was sitting in my office – it was March 1991 – seeing patients, and in walks Eric Stover [then a consultant for Human Rights Watch and later executive director of PHR]. He was working with a bunch of groups doing human rights work, and he says, “We’re going to Cambodia for a six week trip.” Eric told me they had been looking for someone with expertise in epidemiology, and before I could interrupt, he said he’d already asked my office to clear my schedule.

We took off a few days later. I was an epidemiologist and an orthopedic surgeon, but I learned a great deal about human rights. I knew the history of Cambodia pretty well, but I didn’t know much about landmines – and I learned a lot quickly. In addition to myself and Eric, we were joined on that first trip by Rae McGrath, an engineer in the U.S. Army. He knew about mines and had founded the Mines Advisory Group.

What were you looking to accomplish once you arrived in Cambodia?

I spoke enough French to get through customs, and when we arrived, Phnom Penh [Cambodia’s capital] was almost empty. There were few people downtown, and we ended up in a small hotel in the city center. It’s there that I came up with my first epidemiological questionnaire and a plan to get data about land mine injuries from other hospitals in the country. Eric, of course, wanted testimony, but I wanted the numbers.

We started going around to government hospitals, NGO hospitals, and ICRC hospitals to gather data. We went through surgical log books. I talked to nurses and looked through about two years of data to see just how many injuries had been caused by mines. We then estimated the total number of hospitals in the country, the overall population, and we came out with an estimate that one in every 236 people in Cambodia had stepped on a landmine and wound up in a hospital.

How did those findings lead to the International Campaign to Ban Landmines?

In 1992, the International Campaign to Ban Landmines began taking shape [read a timeline of the campaign]. The founding members included the Vietnam Veterans of America Foundation, Handicap International, Human Rights Watch, the Mines Advisory Group, Medico International, and of course PHR. Jody Williams came on board to run the whole project. So I went around lecturing medical groups trying to galvanize other health professionals. PHR got the American Medical Association and dozens of other medical and health associations other groups on board to say that landmines were a danger to public health everywhere and to support the call for a ban.

In 1995, Belgium became the first country to outright ban anti-personnel mines, and then, in October 1996, the Canadians said they would try and pull a treaty together in Ottawa. The treaty took shape and was signed just a week before the Nobel ceremony in December 1997.

What kind of injuries do landmines inflict?

Often a landmine destroys one of your legs. If it’s a fragment mine, you hit a tripwire and have additional injuries to the chest or eyes. Sometimes the foot itself becomes a weapon. I’ve had to extract toe bones from people’s eyes – the foot basically became shrapnel. People can also be injured by mines from picking them up. Children do this because kids will pick up anything that looks different. They might throw around a butterfly mine like a toy. In Bangladesh I found people who’d lost both hands from picking up mines, others who’d lost an eye or had traumatic injuries to the face and neck. And, of course, there are the social effects as well. People without a leg are often socially looked down upon, excluded, or can’t get jobs.

Twenty years later, do you see all these efforts as a success? What’s left to do?

Looking back, there are a lot less mines being manufactured. A lot fewer people are dying from mines. We saved many lives because the number of landmine injuries dropped dramatically in the 1990s. But then, after the United States invaded Afghanistan and then Iraq, the issue of IEDs [improvised explosive devices] came up. So now we’re back with people knowing how to make these things at home and back to some of the injuries we saw before the treaty.

And, of course, there are still countries that have not signed the treaty [including three of the five permanent members of the United Nations Security Council: China, Russia, and the United States.]. When I was at a meeting in Tbilisi, Georgia, we sat there with generals from other countries around the region. They said: “The United States has the best military in the world, and if the United States won’t sign the treaty, we won’t either.” So the United States not getting on board is still an excuse for other countries not to sign. Our efforts have certainly saved lives, but our work isn’t finished yet.

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