1. SURVIVING GUN VIOLENCE
SOCIAL DIMENSIONS OF HEALTH INSTITUTE
WEBINAR, 15 MARCH 2012
Cate Buchanan
Surviving Gun Violence Project

2. AIMS OF THE SEMINAR
 Highlightsome of the knowledge gaps and
potential areas for human rights and health
practitioners and researchers to address
 Provide
some information on the Surviving
Gun Violence Project

3. WEAPONS AVAILABILITY
& PRODUCTION
 875 million small arms and light weapons
 Civilians hold nearly 75% (650 million)
 Armed groups hold about 1%
 1249 companies in 90 countries make guns
 Legal trade: worth about US $7 billion
 Illegal & grey market: about 15% of all trade
 Grey market (covert arms transfers by govt-
sponsored entities): larger than illegal trade
 At least 1 million firearms are stolen each
year, the majority from private homes

4. FATALITY BURDEN
 An estimated 525,000 people die from armed
violence annually (guns, mines, bombs etc).
 Inthe age group 15-44 years old, violence
accounts for 14% of all male deaths; and 7% of
all female deaths.
 Most of these deaths occur in countries not at
war, but affected by violent crime, weak policing
and dysfunctional justice systems.

5. INDIRECT IMPACTS OF GUN VIOLENCE
 Increased incidence and lethality of crime
 Displacement (refugees, IDPs)
 Collapse or erosion of social services
 Decline in formal +informal economic activity
 Distortion of investment, savings and revenue
collection
 Erosion of social capital
 Distortion of access and use of public
space, services, roads, transport

6. AND THOSE WHO SURVIVE?
 No accurate figures exist on those who survive gun
violence – possibly 3-14 times the number of people
who die.
 Violence (including homicide and suicide) and other
injuries account for 9% of global mortality. Violence
is a leading cause of disability.
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.

7. DISABILITY
 15%of the world‟s population has some form of
impairment.
 80% of people with disabilities live in low-
income nations.
 People with impairments are particularly
susceptible to co-morbidities due to unequal
access to health care.
 In societies where women have low
status, women and girls with impairments are
especially marginalised.

8. A WORD ON TERMINOLOGY
 The term “survivors of gun violence” or
“survivors” is used to describe people who have
been physically injured, intimidated, or
brutalised through gun violence.
 Differentiate people who die (victims) from
those who live through such violence
(survivors), for the purpose of research or
policy making

9. TERMINOLOGY
The term “victim”:
 used in the UN Declaration of Basic Principles
of Justice for Victims of Crime and Abuse of
Power (1985)
 used in weapons control processes like the
Anti-Personnel Mine-Ban Convention (1996)
and Convention on Cluster Munitions (2008)
 has been interpreted to include directly affected
individuals, their families and communities.

10. MISUSE OF GUNS AND INJURY TYPES
 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 to perpetrate crime, because of the
risk posed to the holder of the weapon.
 Guns pose a serious security threat even when
not fired, and are often used to threaten and
intimidate.
 Gunshot injuries are unpredictable and
diverse, with varying consequences for trauma
and rehabilitation services.

11. SOME THEMATIC ISSUES
 Trauma care and access
 Rehabilitation
 Gender
 Mental health
 Victims and perpetrators
 Inequality and development
 Inclusive and ethical research and participation

12. TRAUMA CARE AND ACCESS
 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.
 Access is mediated by
income, transport, location etc.

13. REHABILITATION
 Rehabilitation services in developing nations
are believed to reach only 1-3% of people in
need (PAHO, 1994 – we need more recent
research!)
 In the US, spinal cord injury rehabilitation has
reduced in the last decade.
 This means less time to train family members in
caregiving, fewer resources for adapting built
environments (e.g. widening doors for
wheelchair access in homes), and less
psychosocial support.

14. GENDER
Males comprise:
 90% + of gun homicide victims
 88% of gun suicide victims
 80% of the 400 children killed and 3000 injured
in accidental shootings each year in the US
 Therisk of dying by homicide for a man aged
15-29 in the Americas region is nearly 28 times
higher than the average worldwide.

15. GENDER
 The presence of a gun in a household where
there is partner/family violence multiplies the
chance of a woman dying.
 Caregiving for injured family members falls
largely to women and girls, limiting their
opportunities to work or go to school, and often
causing their own health to deteriorate.
 Gun violence results in more female-headed
households, due to the disproportionate
number of men being killed or impaired.

16. MENTAL HEALTH
 Gun violence is associated with psychological
problems including
flashbacks, anxiety, fear, low self-
esteem, depression, alienation, self-destructive
behaviour and suicide.
 Mental health services are typically under-
resourced and overloaded.
 Mental health can be further affected through
unintended re-victimisation from media images
and coverage of gun violence, seeing armed
men in security posts, etc.

17. VICTIMS AND PERPETRATORS
 In war zones or communities blighted by gang
violence, survivors of gun violence may also be
perpetrators.
 Distinction of “innocent” victims vs “guilty”
perpetrators can have an effect on public
sympathy and resources. Young men who are
involved in or proximate to violent activity may
be seen as „deserving‟ their injuries.
 Victims of gun violence are at increased risk of
committing violence against others.

18. INEQUALITY AND DEVELOPMENT
 Growing focus on armed violence and
development, e.g. Geneva Declaration on Armed
Violence & Development (2006), Oslo
Commitments on Armed Violence (2010) – ongoing
gap is impact of injury and disability on livelihoods.
 In a survey of spinal patients at a rehabilitation
clinic in El Salvador, the leading concern was how
to make a living, not necessarily their long-term
health.
 Livelihood stress affects education: children and
young people drop out or engage in risky behaviour
(e.g. drug couriering, sex work) to contribute to
household income.

19. ETHICAL AND INCLUSIVE PARTICIPATION
“Nothing about us, without us”
 Need to include survivors in
research, advocacy, policymaking on armed
violence, small arms control, development and
security
 This would be a way to implement Article 4.3
(amongst others) of the 2006 Convention on
the Rights of Persons with Disabilities, which
calls for the active consultation and involvement
of people with disabilities in processes of
relevance to them.

20. SURVIVING GUN VIOLENCE PROJECT
 Supported by Government of Norway since
mid-2011
 Developing a website with an e-library of
resources for researchers and policymakers
 Producing a multi-contributor policy-focussed
report for late 2012
 Networking amongst diverse communities to
stimulate interest and engagement

21. FURTHER READING
 World Health Organisation and World Bank, World
report on disability (Geneva: WHO, 2011).
 T. Kroll, “Rehabilitative needs of individuals with spinal
cord injury resulting from gun violence: The perspective
of nursing and rehabilitation professionals,” Applied
Nursing Research, 21 (2008).
 C. Buchanan, “The health and human rights of survivors
of gun violence: Charting a research and policy
agenda, Health and Human Rights, Dec (2011).
 Geneva Declaration Secretariat, Global burden of armed
violence: Lethal encounters (Geneva, 2011).
 World Health Organisation, World report on violence and
health (Geneva: WHO, 2002).
 www.iansa.org
 www.smallarmssurvey.org

22. FURTHER READING
 Small Arms Survey annual yearbooks since 2001
 Centre for Humanitarian Dialogue, Trauma as a
consequence -- and cause -- of gun
violence, Background paper No. 1 commissioned from
Vivo International (Geneva: Centre for Humanitarian
Dialogue, 2006).
 Centre for Humanitarian Dialogue, Surviving gun
violence in El Salvador: A tax on firearms for health
Background paper No. 3, (Geneva: Centre for
Humanitarian Dialogue, 2007).
 C. Mock, “Trauma mortality patterns in three nations at
different economic levels: implications for global trauma
system development,” Journal of Trauma, 44 (1998).

23. CONTACT
 Cate Buchanan
cate@survivinggunviolence.org
 www.survivinggunviolence.org (under
construction)