Gun Violence, Disability and Recovery

1. Gun Violence, Disability and Recovery Cate Buchanan Surviving Gun Violence Project

2. Facts about the book • Foreword by José Ramos-Horta, Nobel Peace Prize Laureate (1996), President of Timor-Leste (2007–12) and a survivor of gun violence. • Stories and reflections from over 35 survivors of gun violence from all over the world. • Over 45 practitioners and professionals contributed thematic and country chapters and sections. • Over 65 peer reviewers from a variety of disciplines. • Funded by the Government of Norway.

3. Alex Galvez, Transitions Foundation Shot in 1992 at age 14, during a robbery in a shop where he was buying a drink. Left paraplegic, he dropped out of school and nearly died from infections. Spent 2 years in hospital, mostly in USA. In 1998 Alex was one of the founders of TF, an NGO dedicated to assisting people with disabilities through rehabilitation, training and employment.

4. What’s in the book? • Thematic chapters: Victims’ rights and international standards; Traumatic injuries; Rehabilitation/recovery; Social protection • Country studies: Guatemala, Somalia, South Africa, Canada, India • Shorter ‘Spotlights’: Colombian victims’ law; Gun violence and masculinity; Assistance to survivors in peace agreements; Massacre in Guyana; El Salvador’s gun tax and victims’ services; profiles of survivors; and other themes. • A pioneering annex identifying international standards relevant to survivors of gun violence

5. Misuse of guns and injury types No accurate data exist on those who survive gun violence – possibly 3-14 times the number of people who die. Global armed violence leads to the deaths of some 500,000 people a year Guns are used discriminately (e.g. kidnapping at gunpoint) and indiscriminately (e.g. someone shot in crossfire) Other weapons like mines and bombs are rarely used in crime, because of the risk to the holder of the weapon. Gunshot injuries are unpredictable compared to other weapons; consequences for emergency care & rehabilitation.

6. Disability 15% of the world’s population has some form of impairment. 80% of people living with disability live in low-income nations. People with impairments are particularly susceptible to co-morbidities due to unequal access to health care. A study in one of the world’s largest refugee camps found that gunshot injuries were the single major cause of physical impairment: 32% of all cases. In societies where women have low status, women and girls with impairments are especially marginalised.

7. Highlights from the book • Effective trauma care can reduce levels of impairment. • In low- and middle-income countries, 50-80% of deaths from traumatic injury occur before reaching hospital. • Rehabilitation: one of the weakest links in survivors’ recovery • In 62 countries no rehabilitation services are available. • In the US, spinal cord injury rehab has reduced in last decade. This means less time to train family members in caregiving, fewer resources for adapting houses, less psychosocial support. • Survivors lose their livelihoods; welfare/social protection is patchy. • Guatemala: only 20–30% of population has social security. • Canada: long-term care eg physiotherapy not covered by Medicare

8. Highlights from the book (2) • Involvement in gun violence is a way of asserting one’s manhood • Male survivors with disabilities may feel emasculated. • Martin, a survivor in South Africa, wants revenge on the man who shot him: “I’m not just going to shoot him when I pay revenge. I’m going to kill him.”A cultural norm legitimises the use of violence and aggression to restore “being a man.” • Gun violence: third leading cause of spinal cord injury in the USA. • Average health costs in 1st year of a traumatic spinal injury: $311,000–$953,000. Survivors often un-insured, unable to pay. • Once discharged, some young American gun violence survivors are placed in nursing homes with geriatric and mentally ill patients because of a lack of accessible housing.

9. ProtaisMbonimumpa, Burundi Protais on his tricycle at his vegetable and fruit shop in Bujumbura. 7 years ago he was shot and permanently injured by a thief in his home. Protais struggled to support his wife and six children. He already had this shop but couldn't go to rural areas to buy his goods. With a tricycle from Handicap International he is now mobile enough to purchase produce himself.

10. Gender • Not a token focus in the book, every element takes account of gendered impacts. • Caregiving for injured family members falls largely to women and girls, limiting their opportunities for work or school, and often causing their own health to deteriorate. • Gun violence results in more female-headed households, due to disproportionate number of men killed or impaired. • Males comprise > 90% of gun homicide victims. • Risk of dying by homicide for a man aged 15-29 in the Americas: nearly 28 times higher than worldwide average.

11. Church door sign in South Africa A sign asks visitors to the J.B. Webb Chapel Central Methodist Mission, Johannesburg, to leave their weapons outside.

12. Recommendations Trauma/Emergency Care: Audit trauma care systems, educate health professionals on violence/disability, train first responders. Rehabilitation and Psychosocial support: Rehabilitation immediately post-injury, better training for community workers Peer support initiatives: Sustainable funding, use survivors’ leadership, connect hospitals to post-discharge support projects Caregiving: Create a ‘carer’s pension’, research on the consequences for caregivers, particularly women and girls Social protection/assistance: Consider the full-cost of care, no-fault disability insurance, review eligibility criteria Conflict and post-war : Include trauma, disability and recovery in UN DDR Standards; focus on survivors in peace agreements

13. Recommendations (2) Development planning: Attention to disability and violence Survivor-responsive policing and justice: Rights protected by law, greater accountability, ‘joined up’ policies Perpetrators: Investing in this group for violence prevention, impacts on their families if they are injured Engage survivors in research, analysis & advocacy activities A Global Fund for all Survivors of Armed Violence by 2015 Strengthen normative frameworks and policies:Make linkages acrossinternational instruments and implement what we have. Survivor-sensitive gun laws: Portion of gun sales taxes and license fees dedicated to improving services for survivors.

14. Research gaps Caregiving – domestic labour of girls and women Impact of peer support Masculinity, disability and identity post-violence Rehabilitation and disconnection from gang life Quantitative studies – how many non-fatal gun injuries? Health and welfare needs, changes over time and costs Evaluation of good practice in rehabilitation, victims’ services and justice mechanisms Exploring the victim/perpetrator nexus

15. Buying the book The book will be available on the SGVP site as an ebook, in PDF form and as a print on demand ‘traditional’ book. 100% of proceeds from the sale of the book will go to the Transitions Foundation of Guatemala when you buy it from the SGVP website. Visit http://survivinggunviolence.org/book/ to order!

16. Surviving Gun Violence Project Email: info@survivinggunviolence.org Facebook: www.facebook.com/SGVProject Twitter: www.twitter.com/SGVProject Website: www.survivinggunviolence.org