This in-depth feature is an extended version of an article published on Asian Correspondent.

More than four decades after the last bomb fell from the skies above the remote and landlocked Southeast Asian nation of Laos, its countryside remains littered with deadly remnants from a conflict which long-ago faded into distant memory for many in the West. For the people of Laos however, the harmful impacts of the Vietnam War continue to reverberate deep into the 21^st Century.

A covert nine-year US bombing campaign resulted in more than two million tonnes of ordnance being dumped on Laos between 1964 and 1973. This campaign was dubbed the ‘Secret War’, as the raids were conducted without the authorization of Congress and without the knowledge of the American public. During the onslaught around 30,000 people were killed or maimed, and an additional 20,000 casualties have been incurred since the campaign ended, as civilians have inadvertently come into contact with unexploded ordnance (UXO) left behind.

In recent years there has been a marked reduction in annual deaths and injuries – from more than 300 in 2008 to less than 50 last year – following an intensification of nationwide clearance efforts. However, this success in reducing the direct physical impacts of UXO must not blur the wider humanitarian legacy of the US bombing campaign in Laos: less than 2% of the total contaminated land area has been cleared, in a country which remains amongst the poorest in the region. In short, UXO serves as a major and debilitating impediment to Laos’ development.

Around 80 million cluster bomblets remain hidden in forests, submerged along river banks and buried in fertile soil. This extensive level of contamination renders large swathes of agricultural land unusable, denting crop production and worsening food insecurity. The presence of UXO also hampers construction: vast areas of land need to be painstakingly cleared before building work can begin, making infrastructure projects more dangerous, costly and time-consuming. The long-term injuries suffered by victims have also created a nationwide disability crisis, placing a huge burden on the country’s overstretched healthcare system and depriving many families of income.

These effects combine to harm social and economic development at both the local and national level, leaving many Laotians unable to escape a life of isolation, poverty and hardship.

Before assessing the impacts of UXO on development in more detail, it is essential to first trace the history of the UXO problem in Laos: from the Vietnam War and subsequent bombing campaign to the more recent clearance efforts of the last two decades.

The US bombing of Laos has long been overshadowed by the wider narrative of the Vietnam War, which began in 1955 and ended when Saigon fell twenty years later. The conflict was often viewed through the lens of the wider struggle between the two global superpowers of the Cold War era, when the US sought to contain the spread of communism through halting the ‘domino effect’ in Southeast Asia. In this context in the early 1960s, large numbers of US troops became engaged in an increasingly bloody and intractable ground war against the communist North Vietnamese.

By 1963, the war had spilled across Vietnam’s long and snaking western border. North Vietnamese troops began smuggling arms and equipment to south Vietnam along the Ho Chi Minh Trail; an overland supply route carved through the dense forests of neighbouring south-eastern Laos and eastern Cambodia. At the same time, Pathet Lao communist fighters were increasingly engaging in battles with the US-backed Royal Lao Army in northern Laos, further raising US concerns over the ‘domino effect’ in the region.

In December 1964, the US responded to these developments by launching what became the most extensive bombing campaign in history, aimed at disrupting activity along the Ho Chi Minh Trail. Congress had not been consulted and for several years the US government denied the existence of the campaign, referring only to ‘reconnaissance flights’ over Laos. Over the next nine years Laos became the most heavily bombed country, per capita, in the world. In total, US aircraft flew more than 580,000 sorties and dropped more than two million tonnes of ordnance.

Cluster bombs – each containing up to 700 smaller bomblets which are released mid-air and dispersed over a wide area – were the most frequently-used weapon. Around 260 million bomblets in total were dropped during the campaign. Of these, around 80 million failed to detonate and now make up the bulk of UXO remnants littering the countryside. The scale of contamination is in fact so severe that UXO are present in 14 of Laos’ 17 provinces.

The true extent of the campaign only became public knowledge after a series of US Senate hearings in 1971, which first exposed the ‘Secret War’ in Laos. Over the decades, further details have emerged as state department documents have been declassified and US military strike records have been released. Despite an initial public outrage the suffering inflicted on Laos remained in the headlines for only a relatively short period of time. Four-and-a-half decades on, the affair has drifted from public consciousness and has been largely forgotten.

The impacts on the civilian population have been overwhelming. More than 50,000 people have been killed or maimed since the bombing started in 1964, with 20,000 falling victim since the campaign ended in 1973. Children are disproportionately affected as they often mistake spherical cluster bomb casings for toys, accounting for 40% of UXO casualties.

Most accidents are caused by direct impact. This can occur when agricultural workers dig the soil, when villagers attempt to move or defuse bombs themselves, and when children mistakenly play with cluster bomblets. The burgeoning scrap metal trade in Laos has also exacerbated the problem, leading many impoverished residents to take huge risks for a quick financial return.

In the past twenty years UXO clearance efforts have gathered pace after several decades of inaction. In 1996 the Lao National Unexploded Ordnance Programme (UXO-Lao) was established. UXO-Lao works with NGOs and international partners to co-ordinate nationwide clearance efforts on the ground. This was followed ten years later by the establishment of a National Regulatory Authority (NRA) to oversee the management of the UXO sector. International NGOs such as Mines Advisory Group, Handicap International and Legacies of War have played a vital role in raising awareness and undertaking complex removal work.

The direct humanitarian impacts of UXO in Laos are slowly receding. In the past two decades, more than 1.4 million UXO items have been destroyed and more than 3 million people living in the most heavily-contaminated areas have attended risk education classes. UXO-Lao says that since 2010, UXO clearance has made possible the construction of 478 new schools, 78 water systems and 75 new roads. In addition, the rate of death and injury from UXO has been reduced by 86% since 2008, with the government now aiming to limit casualties to less than 40 per year.

These figures are encouraging, yet still more needs to be done to tackle the huge scale of the problem: it is worth remembering that less than 2% of contaminated land has been cleared. Taking time to consider this reality – that 98% of contaminated land remains littered with UXO – allows for further reflection on the potentially hidden, longer-term and more indirect implications of the US bombing campaign. In this sense, it must be asked: to what extent has UXO impacted Laos’ development?

Despite achieving annual GDP growth of above 8% in the last few years, Laos remains one of the poorest countries in Southeast Asia. In the latest version of the UN Human Development Index, Laos is ranked 138^th out of 188 countries, with only Myanmar (145) and Cambodia (143) faring worse in the region. Whilst there are numerous factors determining a country’s level of development, it can be argued that in the case of Laos, UXO contamination plays a unique role in stunting progress.

The correlation between UXO and underdevelopment is most visible through the prism of poverty. According to the World Bank, 41.7% of people in Laos earn less than $3.10 per day, whilst 16.7% of the population earn less than $1.90 per day. This represents a higher proportion of people living below the poverty line compared to other Southeast Asian states. In addition to a high poverty rate at the national level, a growing divide is emerging between urban and rural areas. The UNDP reported that the poverty rate was three times higher for the 63% of Laos’ population whom reside in the countryside, where the UXO threat is greatest. In fact, the correlation between poverty and UXO contamination is stark, with 42 of the 46 poorest districts being in areas with widespread UXO presence. This trend is especially pronounced in remote mountainous areas where it is more difficult to conduct clearance operations, and along the border with Vietnam where bombing was heaviest.

The correlation between UXO contamination and poverty is clear, yet explaining exactly why the presence of UXO exacerbates poverty and worsens development outcomes is a more complex undertaking. In this sense, UXO contamination has negative implications in three broad areas which are vitally important to Laos’ development: agriculture, infrastructure and healthcare.

Firstly, UXO hampers agricultural production and worsens food insecurity. Even before the bombing campaign, Laos already found itself disadvantaged due to its rugged mountainous geography. Agricultural land accounts for only 10% of total land area, according to the Asian Development Bank (ADB). This is amongst the lowest in the region, and far less than neighbours Thailand (43%), Vietnam (36%) and Cambodia (33%). The presence of UXO across half of Laos’ arable land compounds these existing geographical disadvantages, meaning that only a small proportion of fertile land is able to be farmed. UXO has hit food production hard, leaving the country incapable of providing adequately for its burgeoning population, which now stands at 6.9 million.

As a result, rates of malnourishment are amongst the highest in the region. A 2016 study found that 18.5% of the population were undernourished, compared to 14% in Myanmar and Cambodia, and 11% in Vietnam. Laos was also found to have the highest rate in the region of stunting in children under five years of age, which stands at a staggering 43.8%. As the population continues to grow, food insecurity is likely to worsen. This is already pushing villagers to take great risks in attempting to conduct UXO clearance themselves and farm land which may be contaminated.

Whilst it is true that geographical constraints have historically restricted agricultural development in Laos, it is equally undeniable that the widespread presence of UXO – rendering hundreds of square kilometres of farmland unusable – is a decisive factor in explaining the difficulties endured by Laotian farmers and the poor performance of the country’s agricultural economy.

Secondly, UXO acts as an impediment to the provision of critical infrastructure. Laos’ geographical features – notably its mountainous terrain, dense jungles and lack of coastline – unfortunately serve as natural barriers to construction and free-flowing trade, yet the presence of UXO again compounds these problems. As a landlocked nation, Laos depends on overland transportation to move goods around the country, yet UXO contamination makes the construction of transport routes more dangerous and time-consuming than almost anywhere else on the planet. Land must be extensively surveyed and painstakingly cleared before construction work can begin, lessening the incentive for foreign investment in infrastructure projects.

As a result of UXO, Laos is desperately lacking in adequate road and rail links, leaving vast areas of the country isolated and disconnected from the main urban centres of Vientiane and Luang Prabang. This makes it difficult for goods to be transported to and from the countryside, leaving many rural areas to sink deeper into poverty whilst the cities prosper.

Large construction projects also face considerable delays and extra costs as a result of UXO contamination. For example, construction of the 1,075-megawatt, 350-metre tall Nam Theun II Dam, completed in 2010, was only able to get underway after three years of prior UXO removal work costing almost $17 million. The Dam project provides just one example of the many instances where additional costs have been incurred to build on UXO-contaminated land.

Thirdly, UXO has placed a huge burden on the healthcare system in Laos. There are more than 12,000 survivors of UXO accidents across the country, most of whom have some degree of disability and will require support for the rest of their lives. The most common injuries sustained are the loss of a limb, blindness, hearing loss and shrapnel wounds. It is estimated that 40% of survivors require limb amputation, leading Laos to have one of the highest rates of disability globally. In the heavily-contaminated Xieng Khouang province alone, there are more than five-thousand disabled residents. The high amputation rate results from the majority of incidents occurring in remote, inaccessible areas, meaning that professional medical attention is often several hours away.

The strain placed on Laos’ fragile healthcare system is overbearing. Many facilities are ill-equipped to deal with the severity of injuries in the immediate aftermath of an accident; for example, blood transfusions are often not possible in rural clinics, meaning that blood loss, rather than the injury itself, is a leading cause of death amongst UXO victims. In the longer-term, survivors require years of physical rehabilitation, psychological counselling, and custom-made devices to replace missing limbs.

Survivors face difficulty in resuming their normal lives, and households are plunged into poverty as families become unable to rely on the productivity of the main breadwinner. Relatives are forced to give up work to help care for injured family members, whilst children often stop attending school and instead seek employment to replace lost income.

The poverty-inducing effects of blast injuries and the additional burden placed on health services exacerbates the negative impacts of UXO on development. A high rate of disability means a depleted workforce, whilst families are weighed down under the burden of care, leaving tens-of-thousands of Laotians unable to contribute towards economic growth.

In recent years the UXO problem has been addressed with greater urgency, alongside a growing recognition that UXO poses a threat to development. In September 2016, Laos’ Prime Minister Thongloun Sisoulith and then-UN Secretary General Ban Ki Moon inaugurated a new sustainable development goal for Laos, entitled Lives Safe from UXO: Remove the UXO Obstacle to National Development. This initiative – known as SDG18 – aims to further reduce casualties, address the needs of victims and clear the highest-risk areas by 2030.

Last year the government also announced plans to carry-out a nationwide UXO survey, aiming to produce a reliable estimate of contamination across the country by 2021. This will enable the most heavily-contaminated areas to be prioritized and facilitate closer co-ordination between UXO-Lao, international NGOs and private sector firms.

The most significant boost to clearance efforts however came last September, when then-US president Barack Obama announced a $90million funding package to be spread over the next three years, dwarfing previous US commitments. In a speech in Vientiane – during his historic first visit to Laos by a sitting US leader – President Obama acknowledged the harm inflicted by the bombing campaign, stating: ‘‘I believe the United States has a moral obligation to help Laos heal.’’

The successful visit followed a period of sustained engagement with Laos as part of the previous administration’s ‘pivot’ towards Asia, in which the US sought closer alliances with ASEAN member states as a counter to China’s growing influence in the region. However, Donald Trump does not appear to view Southeast Asia as such a high priority, prompting concerns over future UXO funding and raising questions over whether the US commitment to ‘‘help Laos heal’’ will be a long-term one.

Over the last two decades, steady progress has been made in tackling the UXO threat in Laos. The US has finally recognized the harmful legacy of the covert bombing campaign it conducted during the Vietnam War, which was overwhelmingly disproportionate in terms of its devastating long-term impact on civilians. In the last few years, greater engagement and funding has enabled clearance operations to move forward at a faster pace. In humanitarian terms, the recent intensification of clearance work has brought dramatic improvements: casualty numbers have reduced to an all-time low, and the majority of the rural population are now aware of the dangers posed by UXO.

Yet there remains an awfully long way to go. Four decades on from the US’ ‘Secret War’, its humanitarian legacy may be fading; but its developmental legacy persists. Despite recent economic growth, Laos still lags behind its neighbours and remains amongst the poorest nations in Southeast Asia. Given the painfully slow and careful nature of the work required to clear even the smallest area of land, UXO contamination will continue to pose a severe impediment to Laos’ development for decades to come. The widespread presence of UXO compounds the natural constraints imposed by Laos’ mountainous geography, denying it the opportunity to lift itself out of poverty and join Southeast Asia’s growing band of middle-income countries.

The ongoing experience of Laos serves as a painful reminder of the potential for conflicts to kill, maim and hold back development long after they have been consigned to the history books. Given the fact that only 2% of contaminated land has been made safe since clearance activities began more than 20 years ago, further international engagement and funding reassurances will be needed if there is to be a sustained, long-term effort to tackle the crippling legacy of UXO in Laos.