December 1998 Bulletin

An orthopaedist's crusade

'I wanted to show the world that this was a medical epidemiological disease.'

40 nations have ratified a treaty to destroy land mines

By Sandra Lee Breisch

James C. Cobey, MD recalls walking through the edges of Cambodian landmine fields "in miserably hot weather" in 1991 to small surgical hospitals belonging to the government and The Red Cross.

His mission: to conduct the first epidemiological study on land mine victims from hospitals' operating logs.

James C. Cobey, MD, displays a type of land mine that continues to maim and kill innocent people.
"I collected reliable estimates on the number of amputees, information on underreporting of deaths and injuries, inadequacy of emergency transportation, medical care, rehabilitation or failings in mine awareness that have helped galvanize support for a ban and helped promote increases in humanitarian assistance," explains Dr. Cobey.

He found 1 out of every 235 people in Cambodia was missing a limb due to land mine injuries and one-half of all war wounds were from mines. "But I realized later, I missed a lot of people who never got to the hospital," he noted.

After this five-week expedition, undertaken with a writer and landmine expert, he wondered, "Can we develop a constituency in the world or raise the issue to the world of the size of the problem?"

To this end, they produced a collaborative report, Land Mines in Cambodia: The Coward's War, in September 1991 which was published by Asia Watch and the Physicians for Human Rights (PHR), a national organization of health care professionals, scientists and citizens who investigate and prevent violations of international human rights and humanitarian law. The report called for an international ban on the use, production, sale, transfer, export and stockpiling of antipersonnel land mines.

"I wanted to show the world that this was a medical epidemiological disease," Dr. Cobey stresses.

In 1992, PHR and other groups formed International Campaign to Ban Landmines (ICBL), a leading health and human rights group.

ICBL's 1997 Mine Ban Treaty, which 40 nations ratified, goes into effect March 1, 1999. It calls for the destruction of all caches of stockpiled mines within four years and of mines already in the ground within ten years. ICBL received the Nobel Peace Prize in 1997 for its fight against land mines.

Russia, China, Iraq, Libya and Pakistan and the U.S. did not sign the treaty. President Clinton said the U.S. would ban all antipersonnel land mines by 2003, except in Korea where use would continue until 2006 if by that date, the Pentagon had found an alternative weapon to land mines. The administration won't sign the treaty because it says there is a need to protect the Korean border, to slow down the North Koreans from invading the South Korea, explains Dr. Cobey.
Between private practice in Washington, D.C. and family life, Dr. Cobey is developing ICBL's land mine monitoring system for tracking and evaluating implementation of and compliance with the treaty. He also trains and consults surgeons and other medical staff including Orthopaedics Overseas volunteers on trauma and reconstructive surgery. "I've treated many land mine victims and there's no injury that I've ever seen in the U.S. that comes close to the trauma of land mine injury," he says.
Dr. Cobey is a founder of the Health Volunteers Overseas and serves on the boards of Orthopaedics Overseas, Refugees International, the National Chapter of the American Red Cross, and is on the Board of Governors for the American Fracture Association.

Dr. Cobey is also an associate professor of orthopaedic surgery at Georgetown University School of Medicine. He teaches Academy courses on orthopaedic training in developing countries and international humanitarian law at medical schools and disaster relief for the American Red Cross.

He says he "enjoys" being part of the ICBL's "pressure cooker" coalition and has been instrumental in gaining support from various medical organizations including the Academy and the American Medical Association.

"We also have to keep putting pressure on governments," stresses Dr. Cobey, who says mines are used in 70 countries. "We want to be sure land mines are going to be really removed from the soil and people get appropriate medical and prosthetic care."

But as Dr. Cobey puts it, "International treaties are only as good as the court of public opinion because it's the court that maintains international law of what we accept and don't accept. Only by civil society monitoring it, watching it, making sure we all abide by it, will it be enforced."

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