Africa's Missing Billions - Oxfam International

Direct costs, with a focus on medical expenditureDirect costs arise directly from violence and necessitate realpayments. Direct costs include the cost of maintaining security – suchas increased military expenditure and costs for policing and justice –as well as the cost of dealing with refugees and IDPs and theloss/depreciation in assets (both in terms of major infrastructure andalso household assets such as animals and farmland).Medical costs are one of the most obvious direct costs caused byarmed violence. It is important to note that often these costs are notactually met; one study in Ghana found that in rural regions only 51per cent of persons with gunshot injuries receive care at a hospital orclinic, 49 and elsewhere the chronic shortage of hospital facilities andthe limited access of poor people to these facilities results in woundsbecoming infected and in the death or disability of victims. 50Costs cannot be generalised and, obviously, are specific to differentsituations and injuries. Box 1 below gives one example. In Uganda,the direct costs of treating firearm injuries are around $0.5m per year,around 80 per cent of which is paid for by the government. The outof-pocketcosts average $58 per victim, more than several months’salary for most victims, a significant burden. 51 In Kenya, a spinalinjury caused by firearms costs around $23,815 per year; this includesthe cost of a wheelchair, treatment, food, drugs, etc. 52Gun violence especially impacts young men, who may have longproductive futures ahead of them. Men aged 15–29 account for half ofall non-conflict firearm homicide victims globally. Anecdotalevidence from Africa suggests that men are the major victims ofgunshot injuries. In four studies from Kenya, Nigeria, and Uganda,the male:female ratio for such injuries ranged from 6:1 to 12:1. 53 InSouth Africa, homicide primarily involving firearms was the leadingcause of death among men aged 15–21. 54It is worth noting that violence committed with firearms generateshigher costs than violence committed with other weapons, due to theserious nature of the injuries caused. For example, the averagegunshot injury in the USA costs 50 times more than the averagecut/stab wound. 5514Africa’s missing billions, IANSA, Oxfam, and Saferworld, October2007