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Epidemiological Study

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Small Arms El Salvador – PowerPoint PPT presentation

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Title: Epidemiological Study


1
Small Arms
El Salvador
2
(No Transcript)
3
El Salvador (The Saviour)
  • Central America
  • 6.9 Million People
  • Most densely Populated Nation
  • Most industrialized

4
History
  • Coffee Staple Export
  • Oligarchy of several hundred families
  • Revolt in 1932, Military Dictatorship implemented
  • In 60s, land reform was encouraged

5
Build of Civil conflict
  • Reform opposed by military elite
  • Opposition arose (politically and military)
  • Death squads introduced to quell insurrections
  • Demonstrators were fired upon

6
Guerrillas
  • Guerrillas gained more power in 70s
  • Government controlled elections were biased
  • United States, fearing Cuba 2, funded El
    Salvadoran Govt.
  • Cuba, Nicaragua and Soviet Union funded
    Guerrillas

7
Civil War
  • Archbishop Romero, rural priest, proponent of
    social change
  • Assassination, sparking civil war
  • Guerrillas united, FMLN (Farabundo Marti National
    Liberation Front)
  • FMLN vs. Govt. Vigilante Death Squads

8
Wars effects
  • Hundreds of thousands wounded (mentally and
    physically)
  • 70,000 killed
  • Economy crumbled

9
Peace Talks
  • 6 Jesuit priests, housekeeper and her daughter
    murdered- International Attn.
  • US Congress sent in Task Force
  • Found that Priests were murdered by Govt., some
    American Govt. members knew
  • UN brought in and sponsored Peace Accords, signed
    by both sides

10
Peace Accords and after
  • FMLN and Govt. to dissolve several units
  • The introduction of social reform
  • International Supervision

11
After the War
  • Bad News
  • Many El Salvadorans are still unemployed
  • High homicide rates
  • Only 2 percent control nations wealth
  • Good News
  • FMLN won majority seats in 2000
  • US involvement still apparent- built military base

12
President Elias Antonio Saca El Salvador
13
What Happened next?
  • United Nations Observer Mission in El Salvador
    (ONUSAL) successful in addressing
    politically-motivated human rights violations
    BUT
  • New threat post-war - VIOLENCE - fear and
    insecurity
  • 95 of violent acts documented committed by
    military, government security forces and death
    squads
  • Intimidation, death threats, executions and
    disappearances common tools used against
    opposition
  • Judicial system found to be incapable of fairly
    assessing and carrying out punishment
  • Long history of youth violence 80 government
    troops and 20 FMLN recruits under 18 years of
    age

14
What About Today?
  • Today, crime is the major concern of most
    Salvadorans.
  • Fighting between government forces and
    revolutionary FMLN left 75,000 dead, over a
    million displaced and, 7,000 "disappeared".
  • Most of the survivors continue to suffer the
    psychological effects.
  • The root causes and inequalities of the war still
    exist today

15
El Salvador's pain ? Murder Rate Highest in Latin
America
  • El Salvadors murder rate is 54 murders per
    100,000 (the highest in Latin America)
  • No other country has a rate higher than 40 per
    100,000
  • The World average for death by murder is 10 per
    100,000

16
El Salvador's Murder Rate 5.5 Times World
Average, but Falling
  • 2005 3,812 murders were committed or 10
    murders/day
  • Estimate for 2006 3,430 or 9.4 murders/day
  • Majority of the killings were of people between
    the ages of 15 and 49 (46 between 20 and 29
    years)

17
Guns as a Public Health Issue
  • 78.5 of murders carried out with firearms, 13.6
    with knives and 3.5 with blunt instruments.
  • An even greater number of people are injured
    (non-fatal) by firearms every hour
  • Handguns are relatively affordable

18
Why?
  • The causes are many but include
  • Gangs
  • Poverty
  • The proliferation of guns
  • An ineffective court system
  • Organized crime
  • Family violence

19
Elusive Solutions?
  • The only thing which is clear is that this tragic
    situation requires efforts at all levels of
    society from the government, to the churches, to
    the schools, to the media, to business and
    community leaders

20
Prevention Model Drawing upon the public
health field, violence prevention and
intervention strategies can be categorized into
three levels
21
Primary Prevention Creating Safe Environments
  • Looks are the root cause, conditions and
    environment ways to proactively eliminate the
    possibility of violence and injury
  • Aim to prevent violence before it occurs
  • Examples- youth engagement and activity programs
    and community help groups on conflict resolution

22
Secondary Prevention Reducing Risk
  • Address attitudes and behaviors, focusing on
    early identification and intervention to reverse
    or reduce the impacts of violence
  • Focus more on the immediate responses to violence
  • Examples- pre-hospital care, emergency services,
    education

23
Tertiary Prevention Managing the Crisis
Situations
  • Reactive efforts and intervention that correct or
    treat a problem
  • Focus on the long-term care in the wake of
    violence
  • Examples- rehabilitation, reintegration, and
    attempts to lesson trauma or reduce the long term
    disability associated with violence

24
Epidemiological Study
  • Wounds and Firearms
  • El Salvador
  • 2003-2004

25
PtH Student Driven Project
  • Maria Emperatriz Crespin Najera
  • Overall objective actively participate, public
    health perspective, construction of program to
    control small arms violence
  • One specific objective research on small arms
    injuries
  • Published in Conflict and Survival volume 21(3),
    2005 working with Salvadoran Physicians for
    Social Responsibility (MESARES) and Salvadoran
    Medical Students for Social Responsibility
    (E-MESARES) - affiliated with International
    Physicians for the Prevention of Nuclear War
    (IPPNW)

26
Gun Violence Statistics
  • El Salvador 150/100,000 70 of homicides
  • USA 10.6/100,000
  • Britain 0.3/100,000
  • Perspective US murder rate with handguns is 15x
    greater than in Canada Ref Arya, N, British
    Medical Journal, (Editorial), volume 324, 2002

27
Information from UN development program (2003)
  • Three important factors driving violence in
    culture 1) youth culture and gangs 2)
    availability of drugs and alcohol 3) lack of (or
    ineffective) social controls
  • 12 of GDP spent on violence issues including
    fall-out in health care spending

28
Study Components
  • Review of governmental statistics on homicide
    from WFA (wounds from firearms)
  • Retrospective study of WFA in children (33
    cases/year compared to 3 cases/year in Mexico
    20 permanently disabled)
  • Prospective study on 100 WFA hospital admissions
    (tertiary care hospital in San Salvador)

29
Method
  • Six researchers, random selection of participants
    gt13 years based on consent and availability of
    researchers (June 2003-May 2004)
  • Data collected via survey -socioeconomic
    status -age, sex -family status -event
    history -cost of healthcare

30
Data collected
  • 789 visits for WFA (623 admitted 133 deaths)
  • 92 male (60 lt25 years old)
  • 62 single, living in San Salvador
  • 50 stable backgrounds
  • Larger than average family size
  • 90 in families with minimal income (50 lt100
    US/month)

31
Data collected
  • 27 completed high school
  • gt50 involved in sports
  • 12 gang members
  • 50 knew offender
  • 86 attacked on the street
  • 25 hit with gt3 bullets
  • Common injury - limbs

32
Healthcare costs
  • 1500 patient bed days
  • 300,000 US
  • 1.8M/year (10 of hospital budget)
  • Estimated 34M US cost to economy

33
Victim Profile
  • Young man
  • Urban centre
  • Unemployed/underemployed
  • Contributing to support of large family
  • Some education
  • Drugs, alcohol and firearms part of daily life
    (increase in WFA on Saturday nights and holidays)

34
Recommendations
  • Control access to firearms - lobby for arms
    regulation met with President - Society
    without violence planning team
  • Increase public awareness and educational
    programs - radio, television, public events,
    conferences, journal articles, involve student
    medical community, presented research to WHO,
    local government Paniagua,I., Crespin, E.,
    Guardado, A., Mauricio, A., Medicine Conflict and
    Survival. Wounds caused by firearms in El
    Salvador, 2003-2004 Epidemiological Issues, vol
    21 (3), 2005.

35
National Commission for Gun Law Review
Image from iansa website www.iansa.org
(downloaded Feb 26, 2005)
36
Goods for Guns A Case Study
37
Who?
  • Local business leaders alarmed by impact of armed
    violence
  • In 1995, these business leaders form the
    Patriotic Movement Against Crime (Movimento
    Patriotico Contra la Delincuencia-MPCD).
  • In 1996, MPDC decides to conduct weapons
    collection program

38
Why?
  • Association of Distributors (consumer goods) of
    El Salvador (ADES) members delivery trucks were
    regularly assaulted by armed men
  • ADES worried about security of employees
  • ADES wanted to help address this growing violence
    in El Salvador

39
Goals
  • Stated Goals
  • Raise awareness and encourage citizens to help
    combat crime
  • Cut the flow of weapons into the black market
  • Publicize its goals of providing incentives for
    civilians to exchange firearms and explosives
  • Hidden Goals
  • Create a safer climate in which to maximize the
    private sector economy in El Salvador, or more
    specifically, San Salvador

40
How?
  • The MPCD garnered support from the PNC, MoD,
    Rotary Club, and Catholic Church. They also
    received funding from various foreign
    governments, including Canada, although most
    funding came from national private sector.
  • They designed the program around highly
    publicized collection weekends

41
How?
  • Local churches acted as collection sites, staffed
    by members of the PNC, MoD, and civil society.
  • Any citizen could anonymously exchange any weapon
    for vouchers for supermarkets, drug stores, or
    clothing stores

42
How?
  • Weapons were documented individually, with forms
    signed by the MPCD, PNC, MoD and the Rotary
    Club this paper trail ensured the programs
    transparency and legitimacy. Weapons were then
    destroyed by the MoD.

43
What types of Weapons were Exchanged?
  • Among the citizens exchanging weapons were.
  • A middle aged woman with a shoulder bag
    containing five rocket launchers
  • A young soccer player with 35 40 mm grenade
    launcher projectiles in his backpack
  • A peasant man who arrived with wife and children
    to exchange two .22 caliber rifles for medication
    for his infant daughter

44
Goods for Guns A Success Story?
  • The program had many positive outcomes
  • Removal of thousands of weapons and hundreds of
    thousands of rounds of ammunition from
    circulation
  • Fostered relationships between private sector,
    civil society, media, government, police, etc
  • Provided a model that could be further developed
    in other countries
  • Demonstrated the high potential for media to
    contribute to public good
  • Raised awareness and encouraged new programs

45
But also many Shortcomings
  • The program primarily focused on the impact of
    small arms on upper and middle class, and
    therefore neglected many rural areas
  • The program was not linked to policies designed
    to limit supply of new weapons (During the period
    of the program, almost 50 000 new firearms were
    legally imported into El Salvador. This caused
    many donor states to withdraw support.)
  • Program failed to examine many of the reasons
    behind the gun violence (i.e.. No attempt was
    made to interview citizens about their
    experiences, motives, etc)

46
Evaluation
  • Evaluation is difficult due to lack of reliable
    statistics on firearm related injury and
    death BUT
  • Over the 3 Year period 9,500 weapons were
    collected along with over 100,000 rounds of
    ammunition
  • represents thousands of injuries that did not
    occur ? OUTCOME healthcare funds available for
    other health services.

47
GROUP 6 Our thoughts on possible interventions
48
Sports and Education
  • From the research
  • educated population (80 literacy rate)
  • common interest in sports Bring interventions
    to
  • sports clubs strict rules for association re
    drug use, guns (team pledges)
  • early school programs aimed a peace initiatives

49
Gun Violence and Disability Wheels of Change
Image Downloaded from iansa website ww.iansa.org
Feb 26, 2005
50
Government involvement
  • Lobby for sponsorship for school and sport
    programs
  • Small business investment and loan programs
  • President former sportscaster (special
    Presidential program for athletics)

51
Community Leaders and International Support
  • Religious leaders
  • Sport Celebrities
  • Monetary support for programs from countries
    involved in export of arms to El Salvador
    helped create problem NOW help fix it!
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