Injury & rehabilitation  

Little information is available on the numbers and circumstances — physical, mental, economic or social — of people who survive gun violence. Data suggest that:

  • In the United States, it has been estimated that for every firearm death, three people with non-fatal gun injuries report to hospital; many more do not go to emergency rooms, increasing the estimate to as many as six non-fatal injuries per fatality.[1]
  • Gun violence is the third-leading cause of spinal cord injury in the Unite States.[2]
  • The long-term survival rate for people with traumatic injuries has increased over the past three decades.[3]

In most contexts, in addition to physical injuries, trauma and mental health problems resulting from gun violence can be severe.[4] These include flashbacks (reliving or remembering the event), involuntary memories, nightmares, dissociative states, or physiological and emotional arousal or withdrawal.[5] Psychological trauma is not limited to the individual survivor but can also affect witnesses, police/emergency workers, caregivers, family and friends, who are referred to as secondary survivors.

Rehabilitation seeks to prevent permanent disability in people with impairments. In addition to medical care, it can involve caregiving arrangements, assistive devices, environmental adaptations and psychosocial support. For example, rehabilitation processes can support families with training in caregiving skills and adjustments to the physical environment such as home and workplace adaptations (e.g. widening doors for wheelchair access). However access to rehabilitation services is uneven:

  • A 2005 global survey revealed that fewer than half of countries had rehabilitation policies and programmes, and only 50% had legislation in the area.[6]
  • In 1994, the Pan American Health Organization estimated that rehabilitation services in developing nations reached only 1-3% of people in need.[7]
  • Only 5-15% of people experiencing disability can access assistive devices in the developing world.[8]
  • In the US, spinal cord injury rehabilitation services have contracted in the last decade, leaving less time to train family members, fewer resources for adapting built environments, and less psychosocial support.[9]
  • Mental health services in most countries are under-resourced and under-publicised; in low-income and violence-affected settings the service gaps are particularly severe.[10]
Access to rehabilitation services is uneven

Rehabilitation seeks to prevent permanent disabilities in people with impairments. The focus is placed on self-management, through caregiving arrangements, assistive devices, environmental adaptations and psychosocial support. For example, rehabilitation processes can support families with training in caregiving skills and adjustments to the physical environment such as home and workplace adaptations (e.g. widening doors for wheelchair access). However access to rehabilitation services is uneven:

  • In 1994, the Pan American Health Organization estimated that rehabilitation services in developing nations reached only 1-3% of people in need.[6]
  • Only 5-15% of people experiencing disability can access assistive devices in the developing world.[7]
  • In the US, spinal cord injury rehabilitation services have contracted in the last decade, leaving less time to train family members, fewer resources for adapting built environments, and less psychosocial support.[8]
  • Mental health services in most countries are under-resourced and under-publicised; in low-income and violence-affected settings the service gaps are particularly severe.[9]

Resources and References

Transitions Foundation

Disabling Bullet Project

Leonard Cheshire Disability and Inclusive Development Centre

Rehabilitation International

Vivo International

World Health Organisation, Disabilities and rehabilitation webpage

Atlas Alliance, Norway

 

More resources: Click here for a document with more website suggestions, articles and reports

 

[1] J. Bonderman, OVC Bulletin, Working with Victims of Gun Violence, United States Department of Justice, Office of Justice Programs (Washington DC: Office for Victims of Crime, 2001).

[2] 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), pp. 45-49.

[3] D. J. Strauss, M. J. DeVivo, D. R. Paculdo and R. M. Shavelle, “Trends in life expectancy after spinal cord injury,” Archives of Physical Medicine and Rehabilitation 87 (2006), pp.1079-85.

[4] See, for example, E. H. Carrillo et al, “Spinal cord injuries in adolescents after gunshot wounds: an increasing phenomenon in urban North America,” Injury 29/7 (1998), pp. 503-507; Y.S. Oeun and R. F. Catalla, I live in fear: consequences of small arms and light weapons on women and children in Cambodia, Working Group for Weapons Reduction (Phnom Penh: WGWR, 2001).

[5] Centre for Humanitarian Dialogue, Trauma as a consequence — and cause — of gun violence, Background paper No. 1 commissioned from Vivo International (Geneva: HD Centre, 2006), p.2.

[6] World Health Organization and World Bank, World Report on Disability (Geneva: WHO, 2011).

[7] R. L. Leavitt (Ed), Cross-cultural rehabilitation: An international Perspective (London: WB Saunders, 1999), p. 99.

[8] World Health Organization, Community Based Rehabilitation: CBR Guidelines (Geneva: WHO, 2010).

[9] T. Kroll, (2008), pp. 45-49.

[10] Lancet Global Mental Health Group, “Scale up services for mental disorders: a call for action,” The Lancet 370/9594 (2007), pp. 1241-1252.

 

Image: Dr. Dario Kuron Lado, Head Surgeon at Juba Teaching Hospital, South Sudan. (Kate Holt 2006)