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LRA victim in Lira, Uganda, in 2003  
LRA victim in Lira, Uganda, in 2003

Mutilated LRA victims await more plastic surgery – or not

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In the seven and half years since the Ugandan government and the Lord’s Resistance Army signed the cessation of hostilities, people in northern Uganda have been living peacefully. But thousands of victims of the LRA conflict still grapple with its after-effects: mutilation being one of the most glaringly obvious.

Since her lips were chopped off, Sarah Clementina has had a constant headache and been unable to carry anything heavy on her head. She was mutilated 20 years ago when the Lord’s Resistance Army attacked her family homestead. She also lost several relatives in the incident. But the 65-year-old grandmother has not lost all hope that she’ll one day appear more normal.

“I have so far been operated on twice, but look at what my mouth looks like,” she says. “Every time people pass by me, especially children, they stop to stare and some of them make nasty comments about my mouth or call me names.”

In 2000, plastic surgeons at Lacor Hospital in Gulu did surgery to help repair her lips – or rather, what was left of them. But the prosthetic lips she received did not keep her teeth from being exposed.

Clementina says doctors have told her she will have to go through several more procedures to repair her lips to the extent that they can cover her teeth. Her last operation was about six years ago. Since then, several people from NGOs and others claiming to be medical professionals have visited her, saying to want to help, but nothing has happened.

Trust Fund for Victims

In 2005, under the Trust Fund for Victims (TFV), organizations like the Association of Volunteers in International Service (AVSI), together with various hospitals in northern Uganda, started offering plastic surgery to LRA victims whose noses and lips were mutilated.

But Clementina was not among its beneficiaries. She was ineligible, as her ordeal took place long before the establishment of the TFV, created by the same Rome Statute that begat the International Criminal Court in 2002. Her surgery in 2000 was made possible by the late Piero and Lucill Corti, Italian doctors who owned the hospital where she got treatment.

Yet the TFV was founded to help people like her – survivors of crimes against humanity, war crimes and genocide who can rebuild their lives through the financing of projects and activities that address their needs.

Charles Luom is one such beneficiary.

Lack of plastic surgeons

One day in 2005, when Luom was in the garden with his brothers, LRA rebels attacked. His two brothers managed to escape, but the rebels captured him and forced him to carry the foodstuff they had looted from his homestead. After three hours, they stopped, had the abductees rest and then forced them to cook for them.

It was at that point that, as Luom recalls: “They told me I was too old, and so they cut off my upper lip and left me for dead.”

In 2006, a year after his ordeal, Loam and his wife heard a call on the radio. AVSI was encouraging listeners to come to a missionary hospital in Gulu District for cost-free operations. Sure enough, Loam’s wife took him there and some foreign doctors performed plastic surgery.

But just several months later, the prosthetic lip he received fell off. He returned to the hospital, and the local doctors who had helped the foreign doctors during the procedure said they would be in touch. He never heard back from them.

Two years later, Luom decided to visit other hospitals in the region since the threads used to fix his lip were causing unbearable pain. But none of the hospitals had plastic surgeons.

"Trying to learn to live with it"

According to Joyce Laker, AVSI’s programme manager, AVSI no longer offers plastic surgery because it is so expensive. In the past, doctors had to be hired and flown into the country for every needed operation, because northern Uganda lacks specialist plastic surgeons and AVSI does not have its own personnel for this. In fact, by the time the AVSI project started working in northern Uganda, many of the LRA victims had already been successfully operated on by other NGOs.

From 2006 to 2012, Laker says AVSI provided plastic surgery to a total of 92 beneficiaries. Selected according to the TFV’s definition of who constitutes a victim, these beneficiaries comprised 87 people with post-burn contractures and five with facial mutilations.

“For plastic surgery, these are mutilated persons or those who got burnt between July 2002, when the Rome Statute entered effect, and 2006,” Laker says.

She explains that follow-up surgery depends on the outcome of a given procedure. For those with post-burn contractures, 90 percent of beneficiaries required no follow-up. For facial reconstruction involving the lips and the nose, one to three operations are usually needed and they can be done in subsequent years.

Meanwhile, AVSI continues to operate in the region and the TFV remains one of its main donors. The rehabilitation AVSI offers today includes identification and assessment of beneficiaries, psychological counselling, production and delivery of prosthetics and orthotics and follow-ups.

Many victims who would benefit from further plastic surgery have stopped pursuing follow-up, or just wait for calls for victims by private organizations, such as the Christian Watoto ministries.

“Since the doctors I consulted told me that there was nothing I could do,” says Luom, “I have given up on having my lip repaired. Now I’m trying to learn to live with it.”

Editor's note of 30 April 2014

This article was updated to correct the misstatement that the TFV stopped funding ASVI as well as to provide a more detailed description of the services ASVI continues to offer.