MISSING PIECES - Inter-Parliamentary Union

THEME 3
texts it will not be possible to achieve a comprehensive and integrated
victim-services policy, but the coordination of policy development between
the different sectors that interact with victims of violence is a reasonable
policy strategy for strengthening victim services. . . .It is equally important
to identify institutional policies guiding service provision to victims of
violence, for example in hospitals, specialised medical and forensic services,
police stations and counselling centres.” 39 Assistance to survivors of gun
violence raises the same challenge – identifying where support services
and assistance can be integrated into existing systems using approaches
that would develop, strengthen or re-orient services, rather than creating
vertical specialised services in resource-limited settings.
Studies in a number of low income countries note that low-cost sustainable
improvements can be made to health care through training of ‘first
responders’ and existing medical staff, as well as better organisation of
existing resources and equipment. 40 This is a critical policy response governments
can ensure exists or provide assistance for. The WHO notes that
“. . .50-80% of trauma deaths occur before arrival at hospital in both developed
and developing countries, rapid and effective trauma care can substantially
reduce death and disability following injury.” 41 One study confirmed
that improvements in the provision of pre-hospital trauma care are possible
by training those most likely to be at the site of an accident first. 42 As
one example, long distance truck drivers in Ghana—often first on the
scene of road-accidents—were trained in basic emergency trauma care to
bolster weak formal emergency medical services with positive results. The
same type of approach can be considered in many instances for trauma care
related to gun violence.
Much of what low income countries need to do to prevent deaths occurring
soon after injury is well within the reach of these economies—
they are simple and relatively inexpensive interventions which are
not being instituted yet. And most don’t require surgeons—but first
aiders, nurses, drivers . . .
—Dr. Olive Kobusingye, Ugandan trauma surgeon and prevention advocate 43
Another study of mine-affected areas in Kurdistan and Cambodia
also noted the value of investing in training, and providing or reorganising
supplies and equipment. In these settings where ambulances still remained
unavailable, death rates among injured people fell from 40 to 9 per cent
thanks to training of first responders, and advanced training in trauma
71