Title: UXO, NRH and the PBP: Crafting Meaningful Development Partnerships in Solomon Islands
In late June President Biden announced the establishment of the Partners of the Blue Pacific (PBP). PBP, made up of Australia, Japan, New Zealand, the United Kingdom, and the United States promises to build on the founding members’ longstanding commitment to the Pacific region. But what PBP will actually do is unclear as its mission is vague. In reality PBPs likely intent is to displace China from the region. Its announcement has been met with some skepticism. Some see it as an exclusive like-minded club that is co-opting the Pacific Island Forum’s Blue Pacific. If PBPs true intent is to deliver impactful development partnerships to the Pacific Region as a way to counter China’s presence it should start in Solomon Islands where the people have been asking for the removal of unexploded ordinances (UXO) that maim and kill and where the vulnerable outdated main hospital has limited resources to care for the critically injured.
Thousands of UXO litter the Pacific Islands where WWII battles took place. Solomon Islands is no exception having seen some of the fiercest engagements from 1942-45. 80 years on UXO and munitions are still being found. During Deputy Secretary Sherman’s recent visit to Solomon Islands for the 80th-anniversary commemoration of the Guadalcanal landings, 13 live bombs were discovered at Choiseul’s airstrip located adjacent to a primary school.
It is not known how many UXOs exist throughout the Solomon Islands archipelago. Abandoned US and Japanese military war surplus are found on land, in overgrown jungles and in the waters surrounding the islands. To date, there is no comprehensive registry or database that marks their location and support for their removal has been piecemeal by organizations like US funded Golden West Humanitarian Foundation, Australia’s Operation Render Safe, the Norwegian People’s Aid, and Safeground’s UXO detection and mapping program.
The majority of UXOs are found by accident. Honiara, Solomon Islands capital, is a densely populated urban area where a great deal of development is taking place. In a city built on WWII battle sites, it is not uncommon to unearth UXOs while excavating a building site. The discovery of buried UXO during a construction project shuts down the site until the Solomon Islands Explosive Ordnance Disposal (EOD) team assesses and then removes them. In some cases, these ordinances detonate suddenly before and even after they are identified maiming and killing people nearby. The presence of UXOs in urban Honiara poses an ongoing threat to the health of its people while impeding socioeconomic development.
In the outer, more rural islands explosives found in UXO, such as TNT and Hexanitrodiphenylamine (HND) are harvested by local fishermen for use in blast or dynamite fishing. Fishing yields are increased by setting off underwater explosions that stun and kill large numbers of reef fish. These practices reduce fish stocks, destroy fragile coral reefs, decrease marine ecosystem diversity and injure local fishermen. Despite blast fishing being illegal in Solomon Islands it continues to be a part of subsistence fishing practices.
As WWII UXOs degrade, they become unstable resulting in unpredictable risk to the population. The exact number of deaths and injuries in the country due to UXO is unknown. The Royal Solomon Island Police Force estimates an average of 15 Solomon Islanders are killed each year by UXO. The surgeons at the National Reference Hospital (NRH) in Honiara treat on average 10 patients per year who suffer blast injuries to arms, legs, torsos and heads. In reality, the actual number of deaths and injuries due to UXOs is likely much higher due to underreporting.
The presence of UXO in Solomon Islands will continue to pose a health threat to its people until they are cleared. Until then the country’s health system needs the capability to treat severely injured individuals in addition to the communicable and noncommunicable diseases endemic to the country. The National Referral Hospital provides care to over 100,000 people annually who are referred in from the outer islands as well as from the local communities on Guadalcanal. Over the past decade, Solomon Islands growing population has put pressure on the hospital’s capacity to provide care resulting in crowded wards, under-resourcing of supplies and manpower resulting in limitations to care. With no intensive care unit at NRH UXO blast victims and other people with critical illnesses die preventable deaths. The hospital’s campus suffers from deterioration and its location adjacent to Iron Bottom Sound and the Matanikau river rendered it highly vulnerable to hydrological natural disasters. In 2014 Cyclone Ida dumped 3 meters of rainfall on Honiara in 2 days. The resulting flood was extensive and deadly damaging some hospital wards and necessitating the evacuation of patients. In an assessment I conducted while working with the WHO in Honiara 75% of the health infrastructure was found to be vulnerable to future extreme weather events. NRH was deemed the most vulnerable.
NRH must be updated and relocated to higher ground where it can continue to provide specialty care during natural disasters. A working group within the Ministry of Health and Medical Services, along with international consultants, has identified a location for a new national referral hospital. They have outlined a phased development plan and estimated the cost per building phase. It is a shovel-ready plan that needs funding.
If the intent of President Biden’s PBP is to “deliver effective and efficient results” to the Pacific Region it should start with the Solomon Islands. By acknowledging and addressing the people’s concerns about their endemic UXO problem and the lack of a safe main hospital facility PBP can define its role in the region. PBP needs to commit to a long-term, coordinated UXO removal program that goes beyond the previous short-term approaches while assisting in bolstering the health system. UXOs in Solomon Islands are US and Japanese war debris and therefore it is their responsibility to definitively clean up this 80-year-old environmental mess. By committing to a long-term WWII UXO clearance program paired with addressing safety concerns at the National Referral Hospital PBP can translate its high-sounding rhetoric of “partnership and cooperation” into a meaningful start to regional action.
Eileen Natuzzi, MD, MPH is a retired trauma and acute care surgeon working on health capacity building in the Solomon Islands. Her mother’s brother was lost at sea when his ship the USS Quincy CA39 was sunk during the battle of Savo Island. As a way to recognize US and Solomon Island WWII sacrifices, she has worked on the health impacts of extreme weather events in the Solomon Islands as well as in establishing training partnerships with the doctors and nurses at the National Referral Hospital. Dr. Natuzzi has traveled to the Solomon Islands regularly for 18 years.