Southeast Asia’s landmine survivors cannot wait for perfect politics

Editorial Team SDG16
2 minutes ago
8 min read

In Southeast Asia, the landmine crisis is often described as a legacy problem. That is only half true. In countries such as Cambodia, Laos and Vietnam, many of the explosives still injuring civilians today were laid or dropped decades ago. In Myanmar, by contrast, the crisis is not only a legacy of conflict but also a current one, worsening with recent fighting. For survivors who lose limbs, the difference is academic: what matters is whether a prosthesis, rehabilitation and long-term support are available when they need them.

That is why the work of prosthetics and rehabilitation organisations across the region deserves far more public recognition than it usually gets. These groups do something governments and donors too often measure poorly: they turn survival into mobility, and mobility into dignity. They also keep national systems functioning in places where state capacity is uneven, budgets are tight, and contamination stretches across generations.

The scale of the wider problem remains stark. Landmine Monitor 2025 recorded at least 6,279 mine/ERW casualties globally in 2024, the highest annual total since 2020, with civilians making up 90% of known-status casualties. Myanmar alone recorded 2,029 casualties in 2024, the highest in the world for a second consecutive year and roughly double its 2023 total. The same report also notes declining international mine-action funding in 2024.

The organisations doing the unglamorous, essential work

In Laos, COPE (the Cooperative Orthotic and Prosthetic Enterprise) is one of the most recognisable names in survivor support. COPE says it works with the Centre for Medical Rehabilitation to ensure affordable, locally managed rehabilitation services. Its own history reflects the region’s reality: it was formed with Lao government and NGO partners amid growing casualties from unexploded ordnance linked to the 1964–1973 bombing campaign. COPE reports that in 1996 existing services delivered 138 mobility devices, and that since 2009 around 1,000 devices a year have been produced.

COPE’s model matters because it goes beyond fitting a limb. It supports referrals, mobile clinics, materials and training, and works as a bridge between donors and the Lao government. That integrated approach is exactly what mine survivors need: prosthetics are not a one-time intervention, but part of a chain that includes transport, repairs, physiotherapy, follow-up and social inclusion.

In Cambodia, Exceed Worldwide has built a long-term prosthetics-and-orthotics footprint rather than a short project cycle. Exceed says its Cambodia work began in 1989 and now includes training prosthetists, orthotists and technicians at a specialist school, plus free rehabilitation services at three clinics for those most in need. It also describes close collaboration with Cambodian public institutions, including what is now the Department of Prosthetics and Orthotics within the National Institute of Social Affairs.

This is a crucial point for policymakers: the best humanitarian organisations in this field do not merely “deliver aid.” They train national professionals, standardise care and strengthen institutions so services survive after donors move on. Exceed’s emphasis on accredited training and government-linked education in Cambodia is a textbook example of that logic.

In Myanmar, where conflict has sharply intensified contamination and casualties, the International Committee of the Red Cross (ICRC) remains one of the most important rehabilitation actors. The ICRC says it has supported physical rehabilitation services in Myanmar since 1986, and that as of 2025 it supports three Ministry of Health-run physical rehabilitation centres plus one Myanmar Red Cross Society orthopaedic rehabilitation centre. The ICRC also reports growing demand since 2021 and substantial 2024 outputs, including prostheses, orthoses, walking aids and physiotherapy sessions, as well as training for local staff.

That support is not abstract. According to the ICRC’s Myanmar rehabilitation factsheet, 4,880 persons with disabilities accessed care in 2024 through its supported programme, with 1,309 prostheses and 875 orthoses delivered, alongside 22,275 physiotherapy sessions. In a country where conflict, displacement and access constraints make continuity of care difficult, maintaining this kind of service pipeline is itself a major operational achievement.

In Vietnam, Vietnam Assistance for the Handicapped (VNAH) describes a long record of rehabilitation and assistive-device support delivered with government partners. VNAH says it has worked since 1990 and has delivered more than 128,000 artificial limbs, orthotic devices and wheelchairs, many for war and landmine victims, while also supporting policy reform and disability inclusion.

Vietnam’s case is especially instructive because the problem is not only clinical, but geographic and administrative. The contamination burden is vast, and long-term survivor care depends on provincial systems, local rehabilitation centres and sustained financing. Organisations like VNAH, alongside provincial mine-action structures and international operators, help keep that ecosystem connected.

Why these countries are still so contaminated

The reasons differ by country, and that distinction matters.

In Laos, the contamination crisis is driven above all by unexploded ordnance, especially cluster munition remnants (“bombies”), from extensive U.S. aerial attacks during 1964–1973. Landmine Monitor’s Southeast Asia factsheet describes Laos as the world’s most heavily contaminated country by unexploded cluster munition remnants.

In Vietnam, the Monitor attributes massive ERW contamination largely to extensive U.S. bombing in the 1960s–1970s, especially in central provinces near the former DMZ. It adds that antipersonnel mine contamination is linked primarily to past border conflicts with China and Cambodia, and that ports and river deltas were also mined during the war period.

In Cambodia, contamination stems from armed conflict spanning the 1960s through the 1990s, including heavy mine contamination in the northwest near the Thai border and cluster munition remnants in northeastern provinces linked to U.S. bombing during the Vietnam War.

In Myanmar, the pattern is different and more alarming in the present tense. Landmine Monitor’s regional factsheet describes heavy contamination from decades of internal conflict between the Myanmar armed forces and non-state armed groups, and reports increased mine use since the February 2021 military coup by multiple actors, including newly formed anti-coup groups.

How many people are affected

There is no single metric that captures “affected” populations, because some figures count casualties, others survivors, and others people living in contaminated areas. But available casualty data still gives a sense of the human burden.

· Cambodia: Landmine Monitor’s Southeast Asia factsheet lists 65,005 all-time mine/ERW casualties recorded from 1979–2023. Cambodia’s 2025 Article 7 report says CMAA provisionally recorded 49 mine/ERW casualties in 2024, including 8 amputations.

· Laos: The same Monitor factsheet lists 50,998 all-time casualties (1964–2023). A 2024 Lao government statement reported 47 victims in 2023, and 43 victims in the first six months of 2024, with children making up the majority in that period.

· Myanmar: The Monitor factsheet lists 7,177 all-time casualties recorded by the Monitor from 2000–2023, but the crisis has escalated sharply: Landmine Monitor 2025 records 2,029 casualties in 2024 alone.

· Vietnam: The Monitor factsheet lists 105,092 all-time casualties recorded from 1975–2020, while also noting that recent annual national casualty reporting is incomplete (for example, 2023 “not reported”).

These numbers likely understate total harm, especially in remote areas where incident reporting and access to services remain difficult. Lao officials themselves have publicly noted logistical and communication barriers in rural victim support.

What governments are doing now, and where support is coming from

There is no fair reading of the issue that ignores the role of current governments. National authorities are not absent; in fact, in several countries they are central to coordination, standard-setting and service delivery. The problem is that the scale of need still outpaces capacity.

In Cambodia, the government, through CMAA and related agencies, reports a broad victim-assistance framework that includes data systems (CMVIS), revised victim-assistance standards in 2024, a National Disability Strategy Plan 2024–2028, and physical rehabilitation services through PRCs. Cambodia’s Article 7 report says 26,988 persons with disabilities, including 8,860 mine/ERW survivors, received services from rehabilitation centres in 2024, and that 3,828 prosthetics were produced. The report also describes technical coordination structures involving multiple ministries and rehabilitation centres.

In Laos, the government’s National Regulatory Authority (NRA) continues to frame UXO/mine action through the national strategy and SDG 18 (“Lives Safe from UXO”). In a 2024 victim-assistance statement, Lao officials said they were mobilising funds for a UXO Victim Assistance Fund policy implemented with World Education and U.S. financial support through 2028, while also citing a Republic of Korea-supported project in two northern provinces that includes vocational training, assistive devices and rehabilitation equipment. At the same time, the government explicitly acknowledged that victim-assistance services remain significantly underfunded.

In Vietnam, mine-action governance is often most visible at the provincial level, especially in heavily affected areas such as Quang Tri. QTMAC reported in late 2024 that it coordinated with operators and authorities on risk education, victim assistance and field operations, and publicly thanked the U.S. government for funding to strengthen capacity and support mine-action activities in the province. QTMAC reporting also shows regular engagement with VNMAC and international operators, a sign that Vietnam’s response is increasingly system-based rather than project-by-project.

In Myanmar, the picture is more constrained and more fragile. The ICRC reports that the rehabilitation centres it supports are run by the Ministry of Health and the Myanmar Red Cross Society, which indicates some continuing institutional channels for care. But the broader context is an expanding conflict in which new mine use has spread contamination and casualties, making prevention and access vastly harder than in peacetime legacy settings.

So how long will a real solution take?

If “solution” means zero risk everywhere, the honest answer is: in some places, probably not within a generation. If it means reducing casualties sharply, ensuring rapid treatment, and guaranteeing prosthetics and rehabilitation for survivors, then progress is possible much sooner, but only with sustained financing and political continuity.

A reasonable estimate, based on the current scale of contamination and the uneven pace of clearance and reporting, is this:

· Cambodia could continue making major reductions this decade, but full resolution of all mine/ERW risk will likely stretch into the 2030s and beyond, especially where contamination is mixed and funding fluctuates. Cambodia itself has required repeated extensions to clearance timelines.

· Laos and Vietnam are likely facing a multi-decade challenge, especially for UXO/ERW contamination over very large areas. The objective in practice may be long-term risk reduction and targeted clearance rather than total removal in the near term.

· Myanmar is the hardest to estimate. Without a major reduction in conflict and new mine use, any timeline is speculative. In effect, clearance cannot “catch up” if contamination is still being added.

What tools are needed to actually eradicate the problem

The conversation often defaults to metal detectors and deminers. Those are essential, but they are only part of the answer.

A credible strategy needs at least six things: sustained multi-year funding, national data systems and survey capacity, trained local deminers and prosthetics professionals, stronger trauma referral and rehabilitation chains, community risk education (especially for children), and survivor-centred social and economic inclusion so an amputation does not become lifelong exclusion. The organisations mentioned above are already building many of these pieces, often quietly, and often with too little money.

Technology can help, better mapping, digital case management, and modern prosthetics manufacturing and repair workflows, but it cannot substitute for institutions. The real bottleneck in much of Southeast Asia is not a lack of know-how. It is the stop-start nature of political attention and donor support.

If there is one policy lesson from Cambodia, Laos, Vietnam and Myanmar, it is this: mine survivors do not need a cycle of sympathy. They need a system. And the organisations providing prosthetics, rehabilitation and follow-up care are not peripheral to that system, they are the proof that it can work.

For more information about organisations working on the ground, readers can consult the official websites listed below.