When we talk about gun violence, the focus is usually on the fatalities. There can be so much to discuss after someone is shot dead.
But what about the wounded, who remain present in our lives and in our neighborhoods and require care long after the dead are taken off and buried? Governments, interest groups and activists around the world may be doing what they can to reduce the number of deaths from firearms. But for every person who is shot but not killed, the conversation is just beginning.
Ambulance crews and trauma centers must scramble to keep the victims alive while the justice system tries to track down their assailants and protect them from repeat attacks. Released from the hospital, perhaps after multiple surgeries, they proceed to rehabilitation centers, which must strive to get them back on their feet while social service programs look in on them and ensure they still have a place to live and food to eat. Every society has an obligation to organize these services, find financing for them and make sure they reach those in need.
“Survivors have needs that must be addressed. More than needs, they have rights: the right to the best attainable standards of health, the right to live independently, and the right to participate fully in all aspects of life,” said José Ramos-Horta, a Nobel Peace Prize winner and until recently a senior United Nations diplomat, as well as a survivor of gun violence.
Ramos-Horta’s directive draws us into “Gun Violence, Disability and Recovery,” a new book produced by the Surviving Gun Violence Project, which is partly a volume of horror stories from around the globe, partly a guide to various approaches to aiding gun violence survivors and partly a road map to better and more ambitious ways to address survivors’ needs.
“Gun violence takes the lives of hundreds of thousands of men, women and children every year. Many millions more survive with injuries, psychological trauma, and/or impairments. Yet when states debate the weapons trade — typically only focusing on the illicit aspect — little is said about the people whose lives are ended or forever altered by their misuse,” Cate Buchanan, the book’s editor and director of the project, wrote.
Firearms are omnipresent and their impact on our daily lives is huge, wherever we live. Reliable statistics are extremely difficult to pin down on such key matters as the number of weapons in civilian hands and the number of gun deaths and injuries around the globe. But experts agree that survivors greatly outnumber those killed by armed violence.
A crucial gender distinction exists among the survivors. Young men, for whatever reasons, are far more vulnerable to gun injury (and also death) than other population segments. But the damage to women and girls does not stem from gunshot wounds alone. They are the ones who most often end up responsible for the care and support required by their injured siblings, boyfriends, husbands and fathers. The physical and emotional strains limit their ability to grow up in a healthy environment, participate in the economy, pursue a happy life, follow their dreams.
The costs, of course, are weighty, both financially and emotionally. Surviving a gun injury can be extremely expensive, particularly if rehabilitation takes time. In Burundi, for example, nearly 75 percent of gun violence victims need to go into debt or to sell their belongings to cover the cost of their health care. Heavy burdens are also imposed on the victims’ families and friends.
Julia Farquharson, a Canadian, wrote movingly in the book of her discovery that she could listen in on the final moments of her son’s life after a shooting, via a voice-mail message he left on her cellphone. “Hearing that voicemail has been a source of continuing trauma for me,” she said.
His death left her numb and eventually too sick to walk or to work. Another of her children, also traumatized by the sibling’s death, descended into a life of crime and never climbed out of it. “My mind tells me I can work, but my body won’t allow me to,” Farquharson wrote. “I am reduced to a disability pension.” Yet she became productive, launching a group called U-MOVE, United Mothers Opposing Violence Everywhere, to push for programs to help those left behind.
In Guatemala, bus drivers are frequent targets of shootings; on average, a driver is killed every other day, according to the book. The dead drivers leave behind spouses and children who have lost their means of support. For a long time, the drivers’ families were left to their own devices. In 2009, the widows formed an association to force the government to provide aid for surviving family members. The Ministry of Social Welfare now pays families the equivalent of $39 a month for two years for each murdered driver’s child under 16. (Alas, if a driver survives an attack, he and his family get nothing.)
In Somalia, gun violence is so common that some local tribal elders have laid out guidelines for compensating victims and their survivors. For killing a man, the payment of 100 camels is suggested, and 50 camels if the victim is a woman. For injuries, 50 camels are enough to compensate for the loss of an eye and 10 for the loss of a thumb.
Clearly, gun violence imposes burdens on governments at all levels, ranging from the need to pursue programs to reduce firearm injuries and deaths to providing the needed medical care, rehabilitation and social services.
In El Salvador, where some 3,000 people died in 2010 from gun violence and thousands more were seriously wounded, the government has sought to at least partly recover the cost of the medical care by taxing guns and ammunition, alcoholic beverages and tobacco products. The rate of taxation ranges from 2 to 30 percent.
About a third of the money is channeled to the country’s Health Solidarity Fund. Set up in 2005, this agency employs more than 2,400 people and provides a variety of supplementary public health services. The tax on guns and bullets accounts for about 1 percent of the fund’s budget, and gunfire survivors can benefit from several of the programs, although none of them specifically targets their needs. A separate office in the Ministry of Justice helps funnel public services to crime victims and the family members they left behind.
The quality and availability of trauma care is particularly crucial to gunfire survival; sadly, gun violence has been the catalyst for improvement and innovation in some countries, the book noted. “In Mexico and Colombia the high numbers of people injured in the ‘war on drugs’ have led to quality improvement being prioritized in trauma, and the Trauma Society of South Africa provides a good example of inter-disciplinary emergency care.”
Another plus: efficient delivery of well-designed health care to the victims of gun violence can contribute to a country’s stability “by affirming the role of the state in the visible delivery of basic services, and by supporting society’s more vulnerable members,” the book explained.
On the flip side, any and all shortcomings in this specialized type of care have harsh and immediate consequences. “Delays in surgery for a patient with an abdominal gunshot wound can lead to infection or death. Failure to provide early external oxygenation to a patient who has been shot in the head can lead to brain damage,” the book said. “In the longer term, a lack of assistive devices such as wheelchairs or suitable beds and chairs, combined with poor access to rehabilitation, leads to pressure sores, systemic infection, and premature death.”
In low- to middle-income countries, there is a constant scramble for acute-care hospital beds. This shortage, the book said, is aggravated by a parallel lack of rehabilitation facilities: where are the patients in the acute care beds to go when they need physical, occupational or speech therapy and rehabilitation after injury to their brains, spinal cords and skeletal systems?
“Do you ever live a normal life again after this?” asked Neville Beling, a South African who was shot in a bar in May 1993 and spent two years recuperating in a local hospital but has clearly not yet recovered. “The list is long of the things I no longer do, or dream about. Simple things you probably take for granted: standing at the edge of the sea and feeling the water lap at your feet. Small things are more important than the big things.”
“Gun Violence, Disability and Recovery,” edited by Cate Buchanan, 9781493101795
[This review was updated on Sept. 10, 2014.]