hi rapport 2008 uk

8/6/2019 HI Rapport 2008 UK

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08 A N N U A L R E P O R T

B E L G I A N S E C T I O N


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Forewordpage 01

Approach by themespage 04

page 11Programmes overview

page 28Financial report

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Responsible editor: Jan BrigouHandicap InternationalRue de Spa, 67 - 1000 BrusselsBelgium

Tel.: 0032 (0)2 280 16 01Fax: 0032 (0)2 230 60 30E-mail: [email protected]

www.handicap-international.beAccount number: 000-0000077-77

Editors: Catherine Billiau, Aurore Van VoorenLay-out/Design: Chiquinquir GarcaPrinting: NevellandTranslation: ISO TranslationFront page image : L. AERTS

Free publication.Contact Handicap International for extra copies.Een Nederlandstalige versie is op verzoek beschikbaar.Une version franaise est galement disponible.

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| 01

I went to the park with my wife andtwo children to celebrate the fifthbirthday of my young son, Ahmad,says Raed Mokaled of Lebanon. Whenhe finished his birthday cake Ahmadwent off to play. Suddenly, we heardan explosion. I ran over and found mylittle boy covered in wounds. He wasbleeding badly. We got him tohospital, but after a four-hour strugglehe died. My other son, Adam, saidthat he had seen Ahmad pick up somekind of brightly coloured bottle, whichhad exploded immediately. As itturned out it was a cluster bomb! Ihope by telling my story to asmany people as I can to find a wayof banning cluster munitions aroundthe world. It is the responsibility of

the politicians to protect the rights of all children.

I met Raed during his visit to Brussels in2008. He is one of the Ban Advocates- a group set up on Handicap Interna-tionals initiative consisting of survivorsof cluster munitions explosions. Itsmembers travel the world, givingwitness accounts and convincing nationsto sign the Oslo Convention, that bansstorage, production and shipment of cluster munitions and advocates helpfor the victims. Handicap Internationalhas worked long and hard to see thisconvention come into force. On 3December 2008 almost a hundredcountries signed the convention.Handicap International had alwaysinsisted that the convention includereliable guarantees to help victims. Thefact that it now does is to my mind, an

achievement of the highest order. Hatsoff to the superb research and lobbying

work of the Policy Influencing unit atHandicap International Belgium! Thanksto this team and its efforts Belgiumbecame the first country to introducea ban on cluster munitions, and thisultimately led to an internationalconvention banning these weapons of death and destruction. The BanAdvocates left their mark on the overallprocess and created a lasting impressionamong the government representatives.All of a sudden, they put a face on thevictims, a face that leaves no oneunmoved. I too was deeply touched bythe witness accounts of people likeRaed. It is amazing how they haveturned this drama, which has soaffected their lives, into somethingpositive. One can have nothing but the

greatest of respect for them. Their determination has touched me deeply.

01Forewordof the General Director

HANDICAP INTERNATIONAL | ANNUAL REPORT 2008


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How does the future look? This is aquestion many of us have askedourselves. For the time being theworldwide economic situation is difficultto predict. Recession has hit extremelyhard in many developing countries.Now, on top of the enormous price risesof recent years, people are beginning tolose their jobs. In many of the countriesin which we operate, the situation islooking dire for the local populations.The most vulnerable people, includingthose with disabilities, may well bethe first to slip through the net. This is

why it is important that we now doeverything in our power to assist thesepeople. They can continue to rely on us,despite the pressure that we, as anorganisation, are experiencing as aresult of the recession. In the mean-time, we will need to fight our waythrough this crisis, but I am optimisticthat we will persevere, provided weapply the right measures at the righttime. Now, more than ever, we can makea huge difference in the lives of thedisadvantaged. Together, we will continueto devote ourselves to this cause.

Now, more than ever,we can makea huge differencein the livesof the disadvantaged.Together,we will continueto devote ourselvesto this cause.

Marc JoolenGeneral Director,Handicap International Belgium.

Over the years and due to our experience, the organisation has becomeexpert in the prevention, earlydetection and treatment of disabilities.Our experience in the treatment of children with disabilities has taught usthat, had we been able to take actionsooner, a great many complicationscould have been prevented. Rehabi-litation would also be much easier if disabilities were detected sooner. In2006, in Vietnam our organisation setup the first project devoted to thistheme, entitled Welcome to Life.Again in Vietnam, in 2008, wedeveloped the Congenital Differencesproject, which is designed to prevent,trace and treat congenital malfor-mations. Additional initiatives haverecently seen the light in Cambodiaand Congo. In some areas HandicapInternational plays a pioneering role.For example, the organisation hasdeveloped a unique training programme.Thanks to these courses, health workers

in the Cambodian countryside can learnto recognise the most common formsof disability and refer patients for further treatment. As always, we optedfor a cross-disciplinarian approach, whichrelies on training, awareness raisingand involving the local community andauthorities. This is an essential conditionfor ensuring the success of our projectsand providing sustainable solutions.Whilst on the right track in mother andchilds healthcare, we have no intentionof stopping and in the future we planto set up further new projects.

| 03HANDICAP INTERNATIONAL | ANNUAL REPORT 2008

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Themes

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When I saw a baby with clubfoot for the very first time during my work as a midwife, I knew what to dothanks to the training organised by Handicap International. I referred the mother to the rehabilitationcentre, located 85 km from Dai Lanh, when her baby was two days old. Two months later one can hardly tell that her son was born with clubfoot, and the physiotherapist expects the boy to walk normally by the age of two, says midwife Cuc, based in the rural Dai Lanh commune in Vietnam.

Disability prevention andMillennium Development Goals

The health and survival of mothers and children, especiallychildren under the age of 5, remain issues of critical importancein the 21st century. According to the latest figures available, over 530 000 women continue to die annually due to complicationsresulting from pregnancy or childbirth. 99% of these deaths

occur in the developing world, with women in sub-Saharan Africaand South Asia disproportionately at risk. Unacceptable levels of children, particularly under the age of 5, are also dying at the rateof 10 million a year 4 million of them within their first month of life. Yet a large number of these deaths could be prevented by usinginterventions that have proven effective, such as safe prenatal andchildbirth practices, proper detection and treatment of illnesses,and adequate nutrition. Most maternal deaths are avoidable aswell, primarily through access to skilled health personnel prior toand during childbirth, and to quality care when complications ariseduring labour.

Millennium Development Goalsand maternal & child healthThe Millennium Development Goals (MDGs) reflect the high levelof attention devoted to these priority areas. Two of these eight goalsrelate directly to maternal and child health: goal 4 aims to reduce theunder-five childhood mortality rate by two-thirds, and goal 5 intendsto reduce the maternal mortality ratio by three-quarters.

The MDGs have unquestionably been valuable in terms of focusinginterest and resources on these key areas. However, most healthand development actors are devoting themselves almost exclusively to reducing mortality in the developing world and thus largely neglecting the reduction and prevention of impairment and disability. Yet for every mother or child who dies, many more suffer from long-term or permanent disabilities explains MoniqueFerguson, Community Health Advisor for Handicap International.She adds: Following some reports, for every woman who dies inlabour, an estimated 30 others are injured or disabled. We alsoknow that we will find increased rates of childhood disability inareas where there is high mortality among children under the ageof 5. An estimated 7-19% of children are disabled in any givenpopulation, amounting to approximately 200 million disabledchildren worldwide. Finally, these disabled children and women areseldom able to receive adequate care and assistance: globally, only2% of disabled people have access to appropriate rehabilitationand other basic services.

Recognizing the importance in addressing these issues, our organisation is reinforcing its comprehensive approach to disabilitywith Maternal and Child Health (MCH) projects in Southeast Asia andcentral Africa. But with few other international actors intervening

directly in this arena, and fewer still with the level of expertiseHandicap International has developed over the years, theassociation is positioning itself as a pioneer in this domain.

Handicap Internationals current focus is on the antenatal, perinatal,and postnatal stages of pregnancy and child development, whichare when most impairments and disabling conditions are caused.These projects reflect the fact that many disabilities only becomeevident when the child starts attending school resulting in manychildren suffering needlessly from disabilities that could have beentreated or minimized much earlier in life.

Axes of interventionOur MCH projects follow several strategic axes of intervention. First,they seek to build and strengthen the capacity of the healthsystem, to prevent, detect, and treat disability. We accomplish thisprimarily by training health personnel and equipping healthfacilities, and by ensuring continuous care: from detection, toinitial treatment, to referral for longer-term specialized serviceswhen needed. Secondly, we work with community and healthworkers on the ground to raise awareness among familiesregarding the risk factors, causes, and signs of disability, educatingthem about preventive measures they can take and therapeuticoptions available in their communities.

Finally, we work with government representatives, in particular withministry of health officials, to increase their commitment inaddressing disability issues. We do this through research thathighlights the extent to which the population is affected, sustainedadvocacy efforts, and by proposing models on how governments canintegrate this priority into their national health plans.

A certain number of actions that address maternal and child mortalitycan be adapted or expanded so they include a focus on disability.Many of the causes that lie at the heart of high death rates(amongst others malnutrition, low levels of access and use of qualityhealth services) are responsible for high rates of disability as well.So Handicap Internationals support for improved antenatal careresults not only in reduced mortality rates, but in reduced childhooddisability rates.


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Technical notes :

Our MCH projects include primary and secondaryprevention interventions. Primary prevention refers toactions that reduce or prevent the causes of disability they address the conditions before they become disabling.An example is a woman taking folic acid prior to gettingpregnant in order to prevent foetal neural tube defects.Secondary prevention refers to actions that address thedisabling condition immediately, once it becomes apparent.An example is the surgery done to correct cleft palate ina newborn.

Major categories of childhood disability:cognitive/intellectual (learning disabilities)visual and hearing impairmentmotor (cerebral palsy)epilepsy/seizurespeech/languagebehavioural/developmental and others (autism).

Major causes of disability:genetic conditions (Down syndrome, etc.)problems during pregnancy (a woman who drinks alcoholduring pregnancy or gets an infection such as rubellamay result in a baby being born with an intellectualdisability)problems at birth (not getting enough oxygen during labour can lead to intellectual disability)health problems like meningitis, measles, or extrememalnutritionexposure to environmental pollutants like lead or mercury

Working at community levelHandicap International is also breaking new ground. For instance,there is no internationally validated tool for screening developmentaland congenital disabilities among children under the age of two.Our project teams identify these deficiencies and address them.Our pilot MCH project in Kinshasa developped a new bornimpairment screening tool for nurse-midwives. We are designing acomplete training programme to enable health staff in villages todetect the main forms of childhood disability in rural Cambodiaand refer them to other centres. Our success in this field rests notonly on targeted interventions such as these, but on the adoptionof a multi-disciplinary approach focused on education andawareness-raising, heightened involvement of the communitieswith whom we work, and a long-term commitment by governmentsand civil society partners in developing necessary skills andresources.

Our maternal and child health projects form an essential part of Handicap Internationals all-inclusive approach to disability. Theseprojects, for instance, are frequently associated with Community-Based Rehabilitation (CBR) projects in the same geographic zones.These CBR projects pick up where the maternal and child healthprojects leave off, by focusing on the integration of disabledchildren and adults within their communities, promoting their fullparticipation in society, and enabling the development of asupportive environment for disabled individuals and their families.

Worldwide, there is an increasing understanding that reachingthe MDGs will require tackling disability on all fronts fromimpairment prevention when possible to rehabilitation and finallyto the inclusion of disabled individuals as active, full-fledgedmembers of society.


Some institutions estimatethat 20 million women a year

suffer from a disabling conditionfollowing pregnancy or birth.

Information sources:

UNFPAWorld Health Organisation2008 Repport on Millenium Development GoalsUNICEF

Congenital/prenatal factors 15-20 %Transmittable diseases 20 %Non-transmittable somatic or mental conditions 40 %Trauma/injury 15 %


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Cluster bombsfinally prohibited!

On 3 and 4 December 2008, 94 states signed the Convention on Cluster Munitions.This treaty prohibits the use, stockpiling, manufacture and transfer of cluster munitions and includes groundbreaking provisions to assist victims. HandicapInternational actively participated in drafting this treaty and for several yearscampaigned to prohibit these weapons together with partners from the Cluster Munition Coalition, a network that includes about 300 NGOs. In the last two years,the process has accelerated. Stan Brabant, Head of the Policy Unit at HandicapInternational, talks about the background of the treaty.


Years of lobbying have resulted in a historical treaty signed in Oslo

What triggered this project? Stan Brabant : When Belgium became thefirst country to ban cluster munitions inFebruary 2006, after a year of very intensiveadvocacy efforts, many disarmament actorsturned to us. Suddenly, people realizedthat banning cluster munitions had becomepossible. We received enthusiastic reactions

from NGOs all over the world, and fromsome governments as well. We began tohope. We had already acquired substantialadvocacy experience with the landminecampaign, which resulted in the OttawaTreaty. Since then, government represen-tatives had realized that we were serious.In summer 2006, the war in Lebanon alsodrew attention to the problem of cluster munitions. Diplomatic pressure intensifiedbut traditional diplomacy failed to addresscluster munitions. Norway, a country witha long tradition in peace diplomacy, seizedthe opportunity and launched what was tobecome the Oslo process. In February 2007,46 states met for the first time and at theend of 2008 cluster munitions were bannedforever.

How did you convince government represen-tatives to sign the treaty? SB : First of all, we published two reportsthat drew attention to the human impact of cluster munitions, not exclusively based onfigures, but also showing the dramaticsituations caused by the use of theseweapons. Then we set up a group of victimsof cluster munitions, the Ban Advocatesthat gradually took on a major role in theprocess. Thanks to the interventions of thisgroup, government representatives were

directly confronted with the sufferingcaused by these weapons and we canthank the Ban Advocates for severalsignatures at the bottom of the treaty, bystates that were initially reluctant to do so.This is notably the case with Afghanistan

who decided - after a conversation on theeve of the signature conference with Soraj

Ghulam Habib, one of the Ban Advocates -to sign the treaty. Our strength comes fromworking with these people within anetwork. Compared to other diplomaticprocesses, everything went very quickly

Has the treaty been signed by a sufficient number of countries to have a real influence? SB : To create a new standard, we had togenerate a critical mass supporting thetreaty. With 98 signatures to date we cansay that this figure was reached. In thefuture, if a country that has not signed theConvention on Cluster Munitions uses this

weapon, it will be criticized all over theworld. In a few years, we have managed tomake the use of cluster munitionsunacceptable. The treaty will come intoeffect once it has been ratified by 30 states.The most important thing is to stop the

use of this weapon, to destroy stocks and- this is crucial - to ensure that victimsreceive the assistance to which they areentitled.

Speaking of that, does the treaty provide guarantees for victims? SB : We did indeed advocate for solidguarantees for victims. And we see asignificant success in the fact that theseguarantees were integrated. The concept of

a victim is defined broadly: it also includesthe families and communities that areaffected. The Oslo Treaty obliges signatorystates to provide medical aid, physicalrehabilitation, socio-economic and psycho-logical support for victims of cluster munitions, and to collect data on thesevictims. The text of the treaty also includes

a detailed list of very concrete measuresthat states are required to take whenproviding support to victims.

What challenges are still to come? SB : We still need to convince certain statesto adhere to the treaty. We also need toascertain that the treaty does not remainwishful thinking. Victims must benefit fromreal support; the guarantees contained inthe treaty must be put into practice. Thedaily life of cluster munition survivors andtheir families is what really counts.Consequently, we will monitor the evolution

of the situation in all countries, we willcollect information on government action(or inaction) and, obviously, we willcontinue to put pressure on governments.

What do you think was the greatest moment in this process? SB : The signature ceremony in Oslo. Theatmosphere was fantastic. At the end of theceremony, the entire Ban Advocates teamcame up on stage. One of them, BehiruMesele from Ethiopia, took the floor tothank everyone who had been involved inthe process. After his speech, the entireaudience stood up in thundering applause.I had never seen that at an internationalconference. It was unbelievable.


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Landmarks in the Oslo process

20052 February:All sections of HandicapInternational agreed to call for a ban on cluster munitions.

9 March:

Handicap International invitedthe Belgian Senate to worktoward a ban on cluster munitions.

7 April:Handicap International,Human Rights Watch,Netwerk Vlaanderen and theNorwegian Petroleum Fundorganized a joint pressconference in Brussels on thetheme: Cluster bombs: worsethan antipersonnel mines

14 April:A Belgian Senator tableda bill to ban fragmentationbombs.

28 June:The Senate Defense andForeign Affairs Committeeorganized a debate on thebill. Handicap Internationalwas invited to present itspoint of view. The bill wasamended to ban cluster munitions. On 7 July, the

Senate Plenary Meetingunanimously adopted theamended bill, which was thentransmitted to the House of Representatives.

200619 January:The European Parliamentlaunched an appeal for theeradication of cluster munitions.

16 February:Despite strong oppositionfrom the weapons industryand some internationalpressure, the Belgian FederalParliament adopted a lawbanning cluster munitions.A second law detailed the

definition of the weapon.2 November:Handicap Internationallaunched Fatal Footprint,the first global report onthe human impact of cluster munitions.

17 November:Following the failure of discussions on cluster munitions in the context of the Convention onConventional Weapons,Norway launched an alternativeprocess as Canada had donefor antipersonnel mines.

200722-23 February:Norway organized aninternational conference oncluster munitions. In the OsloDeclaration, 46 states agreed

to sign a treaty before theend of 2008, banning cluster munitions and providing aframework for the assistanceto affected communities.

23-25 May:67 states took part in theLima Conference (Peru) oncluster munitions. Among theparticipants, 27 countrieswere participating in the Osloprocess for the first time. Thetreaty began to take shape.

5-7 December:138 states took part in theVienna conference (Austria)on cluster munitions.

200818-22 February:A new draft text of the treatywas discussed at theWellington Conference (NewZealand). After a week of tension between supportersof a complete ban andsupporters of exceptions,participating states acceptedto negotiate and agreed onthe rules of thesenegotiations.

March and April:During the various regionalconferences in Africa, SouthEast Asia and Latin America,the positions of governmentsgradually came together onthe draft text of the treaty.

19-30 May:After two weeks of negotiations, 107 statesparticipating in the DublinConference adopted the textof the Convention on Cluster Munitions.

27 November :Opening of the open-air Fatal Footprint exhibition inBrussels. Photographs takenby Belgian photographersshowed the suffering of survivors of antipersonnelmines, cluster munitions andother unexploded ordnance.In 2009, this exhibition willalso travel to other Belgianand foreign towns.

3-4 December:At the Signing Conferencein Oslo, 94 states signed theConvention on Cluster Munitions.

List of countries that signedthe Convention on ClusterMunitions in December 2008:

Afghanistan, Albania,Angola, Australia, Austria,Belgium, Benin, Bolivia,Bosnia-Herzegovina,Botswana, Bulgaria,Burkina Faso, Burundi,Canada, Cap Verde, CentralAfrican Republic, Chad,Chile, Colombia, Comoros,Congo (Republic of), CookIslands, Costa Rica, Croatia,Czech Republic, Denmark,Ecuador, Fiji Islands,France, Gambia, Germany,Ghana, Guatemala,Guinea, Guinea-Bissau,Holy See, Honduras,

Hungary, Iceland, Indonesia,Ireland, Italy, Ivory Coast, Japan, Kenya,Laos (People's Republic of),Lebanon, Lesotho,Liberia, Liechtenstein,Lithuania, Luxembourg,FRY Macedonia,Madagascar, Malawi,Mali, Malta, Mexico,Moldavia, Monaco,Montenegro, Mozambique,Namibia, Nauru, Netherlands,New Zealand, Nicaragua,

Niger, Norway, Palau,Panama, Paraguay,Peru, Philippines, Portugal,Rwanda, Saint-Marin,Salvador, Samoa,Sao Tome and Principe,Senegal, Sierra Leone,Slovenia, Somalia, SouthAfrica, Spain, Sweden,Switzerland, Tanzania,Togo, Uganda, UnitedKingdom, Uruguay andZambia.


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In a few words, Eyal has just summarized the philosophy thatinspired Handicap International to re-invest in emergencysituations: not forsaking those who need it. For HandicapInternational, one essential action is to provide aid for children,women and men who are hit harder still in a crisis.

The organisation is returning to a field of action in which it hadalready been engaged in the past. After all, Handicap Internationalhas its roots in the camps where Cambodians fleeing the RedKhmer regime took refuge in Thailand. Subsequently, HandicapInternational intervened in many crisis situations, particularly inthe Tanzanian camps of refugees from Burundi in 1995, and inAlbania in 1999. In 1996, its action in favour of refugees broughtit the Nansen award from the United Nations High Commission for Refugees.

Responding to the needs of disabled people in crisis situations ispart of our mandate, which clearly indicates an obligation to assistpeople with disabilities in humanitarian crises triggered by armedconflicts or natural disasters.

We know that people with disabilities are particularly vulnerable,and their needs are often poorly perceived by humanitarianplayers intervening in emergency situations. For example, in thecamps around Goma we often saw that people with disabilities werenot correctly registered. Are they on their own, or accompanied,what disability do they suffer from? All this information makes iteasier in very practical situations to take their needs into account;how do wheelchair bound people get to the toilet or go to the

food distribution counter when paths are in poor condition or non-existent. But the problem goes further than simple accessibility:Handicap International endeavours to improve the awareness of humanitarian players in charge of organizing life in camps to actin favour of people with disabilities who are living there as well.


Similarly, in the post-emergency phase after a natural disaster,reconstruction must be planned following the supply of initial aid.From our standpoint, this includes building more accessiblehousing and an environment enabling people with disabilities toreturn to active life.

2007 marked the beginning of a new approach in emergencysituations, and 2008 was an opportunity to materialize it in manycontexts. Thus, we have developed our projects in North Kivu, aregion that has been ravaged by internal conflicts for years, withtwo projects in particular, one for respiratory physiotherapy andthe other for physiotherapy in hospitals. We also intervened inChina after the earthquake that struck Sichuan, to prevent andlimit the appearance of disabilities due to the earthquake.

So Handicap International has made a clear choice to launchemergency projects in a field that the organisation knows well,physiotherapy. This choice means that we can act quickly, withlittle equipment, ensure a cost-effective on victims of crisissituations. These projects can at times be transformed intodevelopment projects, like in China. Beneficiaries of a project thatbegan in a crisis situation may need medium or long-termtreatment. In that case, we leave the field of emergency aid tomove into that of long-term projects helping develop the capacityof our partners to provide care for people with disabilities.

Handicap International provides real added value. All in all, thereare few humanitarian players with experience in caring for peoplewith disabilities or who have sufficient expertise in treating certain

types of injuries. This observation was particularly poignant in our intervention in Sichuan. From the very outset, hospitals werecalling for specialists in the field of spinal injuries, amputations andconcussions the kind of injuries that our teams are used totreating in centres for para- and tetraplegics in Vietnam for example.

Handicap International andemergency situations:

new impetus

We have a commitment, a humanitarian mandate, and we do not take sides. I t doesnt matter who is in power. We are here to help those who need it most, and that is what wewill continue to do. Handicap International will not forsake the population. These werethe words of Eyal Reinich, coordinator of Handicap Internationals mission in Gomaduring the clashes in North Kivu in late October 2008.

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Victims of broken bones need physical therapists but the principleof physiotherapy which has techniques that are indispensableto prevent permanent disabilities is relatively unknown and littleused in China. The respiratory therapy administered to childrensuffering from malnutrition in Goma has proven its effectiveness.These children are very weak and their organisms offer littleresistance to respiratory diseases. Often, they are not able toevacuate the secretions that fill their lungs. Respiratoryphysiotherapy helps them recover faster. Many also show signs of

delayed motor development that the physical therapists try toimprove by means of simple exercises.

Handicap International does not necessarily intervene alone. Thiswas the case in China, but we often work with other organisations.In Rutshuru, in North Kivu, we are working in a hospital backed byDoctors without Borders that asked us to set up a hospitalphysiotherapy project. In Myanmar, the project was led jointly withHandicap International France. The French section took charge of rehabilitation treatment and psychological support for disabledpeople, while the Belgian section took charge of income-generatingprojects (for example, helping people with disabilities meet their families' needs by keeping a shop, raising pigs...) and actionsrelated to accessibility (putting in a ramp to reach the animal pens,or to gain access to the village). Material emergency aid suppliedto Cuba after hurricanes Ike and Gustav was coordinated by a fewhumanitarian players present in Cuba.

Sometimes we also need to intervene in a slightly different field of action, due to the lack of humanitarian staff. This was the case inCuba where we supplied goods for basic necessities (mattresses,blankets, etc.) and material to reconstruct schools. Few organisationsare working in the country and first and foremost, the beneficiariesof our development projects needed to recover decent livingconditions after the enormous damage done by the two hurricanesin 2008.

According to Irne Manterola head of Handicap International inCuba visited a town that had been struck by hurricane Gustav,she declared: The only thing the population wants is to find acceptable housing and recover basic living conditions () they havenothing left! In villages that had 24 or 25 houses, only one or twoare still standing the shops have been destroyed, the fieldsdevastated, the electricity poles swept away .

Our objective in 2008 has been to respond to emergency situationswhere we feel we have real expertise to contribute to the victimswelfare. These actions continue in 2009. Although we dont knowexactly where we will intervene tomorrow that is the rule for emergency action we are certain that we will continue to beactive in this kind of context, both to prevent and care for disabilities, and above all to see that people with disabilities areno longer rejected in emergency situations. We were at their sidein 2008, and we will be there in the years to come.


Our objective in 2008 has beento respond to emergency situations

where we feel we have real expertiseto contribute to the victims welfare.These actions continue in 2009.


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Programmes

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IN FIGURESInternational staff: 6National staff: 61Budget: 1.551.693

Principal donors:Belgian Directorate General for Cooperation and Development (DGCD),Canadian Auto Workers Union (CAW-Canada), Canadian Inter DevelopmentAgency (CIDA), Dutch Ministry of Foreign Affairs, Embassy of Francein Angola, Embassy of Japan in Angola,European Commission (EuropeAid),Ministry of Foreign Affairs of Ireland(Irish Aid).

Handicap International has been working in Angola since1995. This country has been deeply scarred by more thanthirty years war of and by the impact of landmines.Handicap International has developed various types of projects there. The physical rehabilitation centres were

taken over by the National Rehabilitation Programme in2005, but Handicap International continues its actionsparticularly with projects for education on the risks of mines, social-economic integration, promotion of therights of people with disabilities and community-basedrehabilitation (CBR).

Africa


Luanda

HuamboHUAMBO

HUILA

NAMIBE

BENGUELABenguela

Lubango

Bibala

1Angola

In 2008, teams for the CBR project whichcovers the provinces of Benguela, Huila,Namibe and Huambo have provided moralsupport and advice to people with disabilitiesand their families. In addition, the projectalso referred many of them to existingmedical or physical rehabilitation services,directly helping them obtain wheelchairs,crutches, medicines, to benefit from surgicaloperations, or aid their return to active life(vocational training or professional inte-gration) and gain access to school.

In the same year, the project Support toAssociations was in a start-up phase inseveral municipal districts in Benguela,Huambo and Lubango Provinces. Thisproject aims to strengthen organisations of people with disabilities in claiming their rights.

With the social-economic and socialintegration project, Handicap Internationalhas reinforced and supported teams of twopartner associations in Huambo Province.At the same time, the organisation beganto sensitise public administrations, micro-

credit agencies and private companies;these steps culminated in the signature of partnership contracts to promote employmentof people with disabilities. In 2009, HandicapInternational will continue to support thedevelopment of professional projects andtrain partner associations in the promotionof the right of employment for people withdisabilities.

But 2008, was also the end of the mine riskeducation project (MRE). For financial andstrategic reasons, Handicap Internationalhas decided to close its activities in thisfield by the end of the year.

In 2009, the organisation will focus on howto increase its impact on people benefitingfrom its projects, while limiting geographicdispersion. Handicap International will alsofocus on defending and promoting therights of people with disabilities, on theone hand in the implementation of concreteprojects and, on the other, in a more globalway, by reinforcing the associations of disabled persons in their capacity to claimtheir rights.


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Ivory CoastHandicap International launched its first project in the Ivory Coast in1996. At the time, the organisation supported physical rehabilitationcentres and trained national staff. Such training did not exist in theIvory Coast, a country that was in dire need of specialised physio-therapists and technical experts to make prostheses and orthoses.Handicap International has always been careful to conduct its actions incollaboration with local partners who would be capable of taking over the projects in the long run and could supply the necessary services for people with disabilities following the departure of our organisation.


IN FIGURESInternational staff: 3National staff: 23Budget: 453.078

Principal donors:Ministry of Foreign Affairs of Belgium(emergency aid).

Abidjan

BouakMan

Danan 03

Despite several evacuations over the yearsof the expatriate teams following thepolitical instability of the country, HandicapInternational was able to pursue its efforts

thanks to its partners. However, these yearsof armed conflict greatly weakened thegeneral health of the population andcontributed to the deterioration of medicalinfrastructures. Thus, Handicap Internationalput in place several hospital physiotherapyprojects: first in Bouak, then in Man andDanan. Indeed, physiotherapy is anefficient means to prevent and reduce thedisabling after-effects for hospitalisedpatients. Some cases treated (after-effectsof meningitis, cerebral malaria, HIV-AIDS)by the three teams of physiotherapistsdemonstrate the extent to which theindirect effects of the internal conflicts stillaffect the population, particularly due to adecrease in the number of children

vaccinated and problems in the implemen-tation of primary prevention programmes(malaria, HIV-AIDS).

The other patients treated, suffering frombedsores, after-effects of burns, amputations,respiratory problems or muscular weak-nesses demonstrate that physiotherapy isan integral part of the global care of patientsand contributes to an improved and morecost-effective quality of hospital care,particularly with shorter hospital staysand a quicker functional recuperation of thepatient.

In 2008, after Abidjan's physical rehabilitationcentre Vivre Debout was officially handedover to the local partner at the beginning of the year, the hospital physiotherapy projectsof Bouak, Man and Danan reached their conclusion.

The process of handing over the activitiesin the hospitals of Bouak, Man andDanan ended in late February 2009, whenHandicap International withdrew from theIvory Coast, leaving the management to thepartner hospitals.


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In Kinshasa, the CBR project took a newdirection in 2008. The objective of thisproject, which will run through 2008-2010,is to strengthen capitalization to reinforcethe training of the players involved in theCommunity Rehabilitation Committees, incharge of CBR activities and their empowerment. Still in Kinshasa, theorganisation continued its project of inclusive education, and launched a newmaternal and child health project mid 2008.Handicap International wants to reinforcethe staff competencies in several healthand motherhood centres in the area of prevention of disability at birth.

In 2008, Handicap International led aproject supporting six rehabilitation centreslocated in the regions of South Kivu, NorthKivu and Maniema in eastern DRC inpartnership with the ACHAC (Associationdes Centres de Handicaps dAfriqueCentrale). These six centres, working in acontext of war and isolation, neededequipment and consumables to respond tothe demands and needs of people withdisabilities.

In Kisangani, the teams working on theproject of reducing the risks linked tomines and unexploded ordnances (UXO)broadened their field of action beyond theborders of the province. One last - albeitvery important - part of this project wasconducted in North Kivu and somedistricts of the Eastern Province. Handicap

Handicap International has worked in theCongo since 1995. Up until now, the organisa-tion has developed activities in Kinshasa andKisangani. In Kinshasa, Handicap Internatio-nals action is structured around prevention,insertion, and rehabilitation. In Kisangani andthe neighbouring provinces, our objective isto reduce the risks linked to unexplodedordnances. In parallel to the long-termdevelopment projects, Handicap Internationalparticipates in emergency humanitarian aidthat is brought to the populations of theeastern part of the country, who areparticularly affected by the conflicts that haveshaken the region.


IN FIGURESInternational staff: 11National staff: 120Budget: 3.078.615 (Emergency projects included)

Principal donors:Belgian Directorate General for Cooperation

and Development (DGCD), Dutch Ministryof Foreign Affairs, European Commission(EuropeAid), Embassy of France in D.R. Congo,Ministry of Foreign Affairs of Belgium (ConflictPrevention), Survey Action Center (SAC),United Nations Development Program (UNDP).

Kinshasa

Kisangani

GomaNORTH-KIVU

EASTERNPROVINCE

RWANDA

BURUNDI

04

International conducted surveys on socialand economic impact together with localorganisations. These surveys allowed for the drawing of precise table on problemswith mines and UXO and allowed for there-appropriation of lands that were sus-pected to be contaminated.

In 2009, Handicap International will pursue

its work in the area of CBR in Kinshasabut will focus even more on reinforcingpartnerships with the civilian society anddefending the respect of people withdisabilities. Regarding the mother and childhealth services projects, it will besomewhat adapted to more adjusted tothe health context of the capital. Anexploratory mission will also take place inthe province of Central Congo, in both ruraland urban areas, in view of launching aproject in 2010-2011. In Kisangani, HandicapInternational will continue its ongoingactivities focusing on our efforts to reinforcethe local capabilities in view of a transfer of the project to the Congolese organisationsin 2011.

DemocraticRepublicof the Congo


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Since 1997, Handicap International has intervened in Colombia,first by supporting a Colombian organisation specialised in the

rehabilitation of persons with disabilities in Cartagena, then bydeveloping partnerships and activities with different kinds of institutions in various parts of the country. In 2008, from our Medellin and Cartagena offices, we intervened in five areas:Antioquia, Bolvar, Sucre, Santander and North Santander.

Latin America


Colombia

IN FIGURESInternational staff: 2National staff: 28Budget: 787.411

Principal donors:Canadian International DevelopmentAgency (CIDA), Directorate General for Cooperation and Development (DGCD),European Commission (EuropeAid),Ministry of Foreign Affairs of Belgium(Conflict Prevention and EmergencyAid), Swiss Agency for Developmentand Cooperation (SDC).

Medelln

Bucaramenga

Cartagena

Sincelejo

Ccuta

5

The work of Handicap International is

based around three main axes: to facilitatethe access of persons with disabilities tobasic services and ensure that their rightsare being respected; to support theprocesses of assistance to civilian casualtiesof the armed conflict and specificallyvictims of landmines and to promote theparticipation of persons with disabilities inthe social and economic life of societythrough the reinforcement of associationsof persons with disabilities.

There are in fact two parts to the projectAssistance for the victims of landmine

accidents. One branch is institutionalreinforcement, aimed at improving thetreatment of the victims of landmineaccidents by building the capacities of theauthorities and local institutions which arethemselves often ill-informed about therange of possible aids for victims. Thesecond aspect seeks to improve the livingconditions of the civilian victims of mineaccidents.

With its Community-based rehabilitation (CBR)project, Handicap International strengthensthe capacity of local communities toaddress disability. Local CBR committeesidentify the needs, conduct an analysis andconsider the context and family situation

before implementing an action strategy in

collaboration with the disabled individualand his other relatives. The project for improving the living conditions of personswith disabilities was launched in its currentform in 2008. Upon completion in 2010,2,700 persons will have benefited from it.

One of the new projects also launched in2008 was dedicated to the support for associations. Ten associations for personswith disabilities will benefit from supportto reinforce their structure and modes of operation so that they may claim their rights within the framework of the United

Nations Convention on the Rights of Personswith Disabilities.

In March 2009, Handicap International is setto extend its activities to five new areas of the country. The organisation will alsoconduct a survey on the situation andneeds in the field of education on the risksof mines, and examine the feasibility andnecessity of developing a project in thisarea. One of the key events for 2009 willbe the second follow-up conference on theOttawa Treaty (Mine Ban Treaty). Thisconference will be held from 30 November to 4 December in Cartagena, the centre of Handicap Internationals activities inColombia.


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Handicap International first intervened in Cuba in 1998 by contributing aidfor the production of prostheses. Since 2001, the organisation has gearedits actions to community-based rehabilitation (CBR) programmes, to whichthe field of inclusive education has been added, to promote integration of the most vulnerable people in Cuban society. In 2008, the mission openeda new CBR project in Holgun, as well as a project to support and reinforcethree associations representing people with disabilities in Cuba. The year was also marked by two particularly violent hurricanes striking the islandjust one week apart, leaving a fair proportion of the population inprecarious living conditions in the hardest hit areas.

Cuba


06IN FIGURESInternational staff: 2National staff: 3, financed by our partners to support Handicap International,plus the project teams, in all 87 people(financed by our local partners).Budget: 591.826 (Emergency projects included)

Principal donors:Belgian Directorate General for Cooperation and Development (DGCD),Flemish Ministry of Education (Belgium),Luxembourg Ministry of Foreign Affairs.

Havana

PINAR DEL RIO

GRANMA

HOLGUIN

The community-based rehabilitation project(CBR) continued in Granma Province (Westof the country) and in the eastern provinceof Pinar del Rio, reaching people withdisabilities living in rural zones far fromurban centres. These projects offer bothphysical rehabilitation care and psychologicaland social support. In 2008, the communityrehabilitation project was extended tothe Holguin region, neighboring GranmaProvince, with an approach geared more toaccess in the broad sense of the word(physical access to infrastructures, access toinformation and communication techniques,etc) for all kinds of disabilities. HandicapInternational also continued the project of furthering inclusion in the school system inCuba.

Another new project was set up early 2008to reinforce associations representingpeople with disabilities, particularly intheir management capacities. An importantpart of the project targets improving accessof people with disabilities to variousvocational training courses. This means thatHandicap International has worked onvocational training with members of threeassociations for the disabled active in Cuba,and, more generally, the organisation hasequipped adult vocational training centres tomake them more accessible to people withdisabilities and worked on diversification of training courses offered in vocational andspecial education schools. Handicap Inter-national will also be supporting these threeassociations so they can organise awarenesscampaigns in favour of inclusion.

The objective of Handicap International inCuba in 2009 continues to be to act as a

catalyst for various initiatives that focus onbuilding a more inclusive society by rein-forcing existing expertise and the socialstructure. With this is mind the organisationwill consolidate existing projects first andforemost, to capitalise on the lessons learnedfrom the experience acquired, while focusingon certain approaches, such as accessibilityfor all people with disabilities.

One of our objectives for the future is also towork more in the field of rehabilitation of people with a mental impairment and toimprove the quality of the services offeredto them.


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Phnom Penh

Battambang

Takeo

Siem Reap

Banteay MeancheyPreah Vihear

The approach developed by Handicap International in Cambodiahas evolved considerably, leading us into a more participatoryapproach based on the respect and promotion of rights. Peoplewith disabilities and their associations are more than ever equalpartners, working with us on programmes from their conceptionto their final evaluation.

Asia


Cambodia7

IN FIGURESInternational staff: 9National staff: 139Budget: 1.506.380

Principal donors:Australian Agency for InternationalDevelopment, Cambodian Ministryof Social Affairs, Directorate Generalfor Cooperation and Development(DGCD), European Commission(EuropAid), Global Road SafetyPartnership, Handicap InternationalLuxembourg, Japan InternationalCooperation Agency, LuxembourgMinistry of Foreign Affairs, Ministryof Foreign Affairs of Belgium(Conflict Prevention), Ministryof Foreign Affairs of Finland,Nippon Foundation, UNICEF.

Handicap International has continued itsroad safety programme. In 2008, focus wasdirected to the issue of wearing a helmet,which therefore increased from 27% in June2008 to 52% in December. This year theorganisation also prepared the resumptionof the RTAVIS project (data collectionconcerning road accidents) by the national

associations. Finally, we supported theMinistry of Health in the establishment of aglobal service for the study of accidents, nolonger limited only to road accidents.

In the area of the prevention of mine andunexploded ordnance accidents, HandicapInternational has progressed in preventionactivity by informing the public about theprohibition against the sale of suchdevices. The transfer of information has alsoimproved in order to speed up deminingoperations. These new projects have alreadydelivered their first results: a reduction of 45% in the number of accidents in the areaconcerned, far greater than in the rest of the country.

Handicap International continues to beactive in the physical readaptation centresof Siem Reap and Takeo. Linked to thesecentres, the Happy Child project in 2008allowed us to offer training in the earlydetection of disability in very young children,both by the personnel in treatment centresand by traditional midwives, and to improve

the quality and efficacy of the treatment inthe centres.

The Rights and Inclusion programmestarted in 2008. This approach aims toreinforce the Cambodian Disabled PeoplesOrgani-sation (CDPO). At the village level,Handicap International has supported thecreation of local disabled peoplesassociations. This part of the programmecurrently operates in 24 villages. Finally, theSport for all programme has just beenrevised. Twelve sports clubs have beencreated in primary schools, integrating able-bodied and disabled children, aiming toalter the attitude of the children and thecommunity towards disability.

In 2009, the transfer of competences willbe the key word in the orientation of our future rehabilitation activities. Indeed, theprocess of handing over the physicalreadapation centres has already beenlaunched by the concerned NGOs and theMinistry of Social Affairs, Veterans andYouth. Also, by the end of 2009, the CMVISprogramme for the collection of informationabout mine accidents should be entirelytaken over by the Cambodian Red Cross.The programme for the prevention of minerisks will be extended to five provinces.


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IN FIGURESInternational staff: 5National staff: 43Budget: 1.367.412 (Emergency projects included)

Principal donors:Belgian Directorate General for Cooperationand Development (DGCD), CanadianEmbassy in China, European Commission(EuropeAid), Grivat Foundation,Hirzel Foundation, Luxembourg Ministryof Foreign Affairs, State Departmentfor International Development of UnitedKingdom (DFID).

In 2008, projects for the early detection,prevention and intervention of disabilitiesin young children were launched inSichuan, in the Yuexi County and in Tibet,in the prefecture of Lhassa. One of the mainlines of this project is the training of healthcare professionals to the causes of disabilities during pregnancy and at birth,to prevent and identify disabilities ininfants and young children and ensurebetter care if necessary. Awarenesscampaigns aimed at the population alsotook place.

Handicap International pursued its rehabilita-tion projects in Tibet, as well as community-based rehabilitation projects in Sichuan,Guangxi and Tibet through the developmentof two new lines, in the area of educationand social insertion.

Throughout the year, the organisationpursued its actions supporting associationsof disabled people, amongst which itspartnership with the Tibetan association of deaf people and associations in Beijing andNanning (Guangxi).

Late 2008, the training project for health-care staff in orphanages came to an end. Inthe long term, this project should benefitsome 570,000 orphans and 200,000 health-care staff in orphanages.

2009 will see the launch of a community-based rehabilitation project in Sichuan inthe area struck by the earthquake. This willmark the passage to the next stage of anemergency project. This new project for helping the victims of the seism shouldspread over two years.

At the same time, Handicap Internationalwill work on a capitalisation document inthe area of community-based rehabilitation.This work will also lead to the organisationof an international seminar on community-based rehabilitation hosted in Beijing inSeptember.

ChinaDespite a growth rate of 9% in 2008, there are still many inequalities inChina, and people with disabilities are the first victims. Indeed, peoplewith disabilities hardly benefit from the countrys growth. The action thatHandicap International has conducted since 1997 to improve the care of

these people is thus still justified. Since that date, Handicap Internationalhas developed projects in the area of prevention, rehabilitation andinsertion, also conducting advocacy actions these past few years in anaim of raising the awareness of the population to the issues people withdisabilities are facing. We concentrated our interventions to areas in theSichuan province and in the autonomous regions of Guangxi and Tibet.2008 was marked by the earthquake that ravaged Sichuan. HandicapInternational was amongst the first to intervene.

Beijing

ChamdoLhassa

Nanning

ShigatseSICHUAN

TIBET

GUANGXI

08


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INDIA

Mal

Maldives The first Handicap International projects in the Maldives began after thetsunami of 26 December 2004. Since that time, the organisation hasprovided technical support to the Red Cross to improve access tobuildings and services for people with disabilities. It also supports thepublic authorities develop a national strategy in favour of people withdisabilities. Handicap International has thus facilitated the process of the integration into national law of the United Nations Convention onthe Rights of Persons with Disabilities. A community-based rehabilitationproject has been set up as well.


IN FIGURESInternational staff: 4National staff: 3

Budget: 303.188

Support to Tsunami projects imple-mented by Handicap InternationalFrance in Sri Lanka and Indonesia:592.609

Principal donors:Consortium 1212.

09

For 2008, one of the main objectives was toconceive and carry out a national survey onthe situation of people with disabilities toget a census of this population and itsneeds. In collaboration with governmentauthorities and community actors HandicapInternational has developed a functionallimitations screening process that enablesthe assessment of school-age children andadults, and is followed by referral toappropriate services.

On Thinadhoo and Hithadhoo Islands,Handicap International has already done thesurvey. People with disabilities have beenidentified and their situations have beenrecorded. Subsequently, they are put incontact with social workers.

During 2008, Handicap International alsosupported the creation of organisations of people with disabilities. The organisationfor the deaf and hard of hearing MaldivesDeaf Association (MDA) has been officiallyregistered, along with the association of parents of children with disabilities, TheAssociation for Disability and Development.These associations are now active in aseries of projects and awareness-raising.Thanks to the project implemented byHandicap International in cooperation withthe MDA and the Ministry of Education, fiveteachers have received training in signlanguage. Today, these individuals areleading training courses for teachers inspecial education. The Maldives signlanguage dictionary is now complete andwill be distributed to each school and tothe families whose members include a leastone deaf person.

At the end of 2009, the Handicap Interna-tional projects in Maldives will be finalized

and the organisation will withdraw fromthe country. In this last year, we areemphasizing research, advocacy andgovernment capacity building.


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Democratic Peoples Republic of KoreaAt the end of the Korean War in 1953, the Korean peninsula was divided into two parts: the DemocraticPeoples Republic of Korea (DPRK or North Korea) and the Republic of Korea (ROK or South Korea). NorthKorea has more than 23 million inhabitants. Handicap International has carried out interventions in NorthKorea since 1999 at the request of the Korean Federation for the Protection of the Disabled (KFPD). Theobjective was and still remains to provide the federation with technical support, to strengthen it and toenable the improvement of support offered to people with a disability. In 2005, the North Korean governmentannounced the end of humanitarian aid in the country and demanded the departure of non-governmentalorganisations. The former programmes were resumed within a support structure divided into seven units.European experts implement the projects. Since then, Handicap Internationals projects have continued aspart of unit seven which focuses on healthcare.

In 2008, we continued our support for orthopaedic services. A sanatorium for elderly and disabled people has alsobenefited from redevelopment work, technicalsupport and the distribution of walking aids.

Four years ago, a unique special educationproject was started at the school for thedeaf and hard of hearing in Wonsan.Handicap International also provides supportfor the special schools in Hamhung, andthere are now plans to merge the twoestablishments to increase capacities andto improve the services provided by these

schools.All of the projects in the DPR of Korea arecarried out in close partnership with theKFPD. The strengthening of the Federation


Pyong Yang

Hamhung

Weonsan

IN FIGURESInternational staff: 3National staff: 7 providedby our Korean partners .Budget: 791.784

Principal donors:Agency of the Federal Republic of Germany in Pyongyang, BelgianDirectorate General for Cooperationand Development (DGCD), EuropeanCommission (ECHO, EuropeAid),Swedish International DevelopmentCooperation Agency (SIDA).

10for the Protection of the Disabled aims toenable it to effectively carry out advocacyinitiatives concerning the application of rights people with disabilities. Trainingsessions, seminars and material to raiseawareness have been developed for thispurpose.

In addition to pursuing the initiativesundertaken in 2008, in 2009 we willcontinue to provide support for the KFPDwith the prospect of carrying out a nationalsurvey on disability and the structures for the disabled, the setting-up of a funding

system to allow potential donors to providethe federation with direct support. We willalso provide the KFPD with supportconcerning the process of revising the lawon the protection of disabled people.


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For the past ten years, the country has expe-rienced significant changes: population increase

but also a greater gap between the rich and thepoor, expansion of the road network andinfrastructures linking Laos to its neighbours. In1996, the organisation was selected by Laotianauthorities to conduct a national survey on theimpact of unexploded ordnances (UXO). After this, Handicap International focused its activitieson bomb clearance and the awareness of therisks of mines before extending its actions toroad safety and the insertion of people withdisabilities within the community.

Lao PeoplesDemocratic Republic


11IN FIGURESInternational staff: 6National staff: 88Budget: 849.290

Principal donors:Australian Agency for InternationalDevelopment (Ausaid), BelgianDirectorate General for Cooperationand Development (DGCD), EuropeanCommission (EuropAid), Georg KrausFoundation, United Nations ChildrensFund (UNICEF), United States Agencyfor International Development(USAID).

Vientiane

Savannakhet

Also in 2008, Handicap International supportsthe Lao Disabled People Association (LDPA)to promote the economic rights of peoplewith disabilities. Handicap Internationalconducted a survey and an analysis togather the information on the employmentsector in Vientiane, the capital city, and toexplore the employment opportunities for people with a disability.

The great majority of our projects areimplemented in Savannakhet Province. In2008, Handicap International conducted afirst task to evaluate the way in which thedifferent projects could be brought nearer together in an aim of working in closecollaboration. For example, community-basedrehabilitation and mother and child healthprojects will work in the same districts, inan integrated manner. Handicap Internationalwill launch more concretely the project for the employment of people with disabilitiesand will work following an approach basedon the rights of people with a disability.

Also in 2009, the organisation will work toreinforce the capacities of the governmentand local partners. Handicap Internationalwill encourage its partners so that, in thelong term, these partners will be capable of taking over these projects when HandicapInternational will leave.

In 2008, in addition to the activities in thearea of road accident prevention and the

reduction of the threat of unexplodedordnance (demining, accident prevention),a number of projects were undertaken or developed further. This was the case withthe community-based rehabilitation project(CBR), implemented first in 2006 in theprovince of Savannakhet. 2008 marks a newapproach with planned visits in thevillages. These meetings gather the inhabi-tants of several villages to offer themhealthcare advice, consultations with amedical team doctors and nurses andorthopaedic technicians and physiothe-rapists. People immediately benefit from

the necessary care. If a direct interventionis not possible, measurements are takendown for fitting patients with a prosthesisand are then sent on to a specializeddepartment in Savannakhet.

In late 2008, Handicap Internationallaunched a maternal and child healthproject. The organisation also developed anawareness programme aimed at parentsand healthcare professionals to raise their understanding of the specific needs of children with disabilities. A network of volunteer health workers active in thevillages was trained to offer direct supportat home.


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At the end of 2007, Handicap Internationalset up in Hanoi to develop a project similar to that of the Bach Mai Hospital in Ho ChiMinh City. In 2008, 58 patients wereregistered. They suffer from spinal injuries(para and tetraplegia) as a result of trafficaccidents, accidents at work or falls. From2010 to 2012, Handicap International willsupport the Vietnamese authorities indecentralizing the centre, by opening upsatellite centres in six of the poorest

provinces in northern Vietnam.Handicap International has continued in2008 to develop its maternal and infanthealth projects. Early 2008, a new projectbegan in Hue. It targets developing a modelfor prevention, early intervention andmonitoring of children suffering from acongenital disability. The organisation alsocontinued its project Welcome to Life,which aims at preventing deaths anddisabilities before and during birth. Thisproject was developed in Khanh HoaProvince. Handicap International supports

two hospitals, one in Hue and the other inKhanh Hoa, to enable them to provide better treatment of hydro-cephalus, offering trainingand equipment.

Finally, in 2008, the organisation hascontinued its road safety actions. HandicapInternational launched a road safety projectin a rural environment in 2008 in Dong NaiProvince where the number of accidents isgrowing dramatically. Providing equipment,donating ambulances, creating 25 basichealthcare stations and training volunteersin a partnership with the local Red Cross,awareness work and education of younger children to road safety these are alsoimportant aspects of this programme.

The projects carried out in 2008 willcontinue in 2009. The Welcome to lifeproject will be moving into the centralizationphase with a view to reaching an ever-growing number of beneficiaries. Two studies

will also be done in 2009 to set up newprojects. One will deal with social-economicintegration of people with disabilities, andthe other with people with disabilities inethnic minorities.

VietnamVietnam is a country enjoying strong growth. A positive evolution, but it iscrucial to ensure that people with disabilities are not marginalised or excluded from this overall improvement of the situation. Since 2001,Handicap International has been involved in Vietnam in the implementation

of projects for prevention of disabilities and rehabilitation of people withdisabilities due to war, accidents, and congenital or incapacitating diseases.Each project is implemented with a view to turning it over to local authoritiesso that the actions can continue in the long term and benefit as manypeople as possible.


Ho Chi Minh

Hano

Hu

Nha Trang

12 IN FIGURESInternational staff: 4National staff: 20Budget: 923.323 Principal donors:ANOVA, Association of the French inVietnam, BBGV, Belgian DirectorateGeneral for Cooperation andDevelopment (DGCD), Belgian

National Lottery, Children for a better World foundation,European Commission (EuropeAid),Luxembourg Ministry of ForeignAffairs, Province of Limburg(Belgium).


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Handicap International started its activities in Iraqi Kurdistan in 1991,with the creation of a Physical Rehabilitation Centre (PRC) in the town of Suleymaniyah. Seven years later, a second centre opened in Halabja,where more than 5,000 Kurds died and 12,000 were wounded in 1998,following attacks by Saddam Hussein's troops. Today, the victims of thistragedy are still treated at the Halabja centre. In 2001 and 2002, twosatellite units were opened in the border cities of Penjwin and Kalar. Athird unit in Raniya opened its doors in 2005: all these cities are inseverely mined areas. The centres and satellite units are situated in thegovernorate of Suleymaniyah, Northwest Iraq.

Middle East


Iraqi Kurdistan

13IN FIGURESStaff employed by KORD: 61Budget: 151.047

Principal donors:Cordaid, Dutch Ministry of Foreign Affairs, LuxembourgMinistry of Foreign Affairs.

Suleymaniah

In 2005, after more than 12 years in theregion, Handicap International decided tosupport the creation of a local NGO thatwould take over its activities. This efforthas continued over the past few yearsthrough the remote support of KORD, thenewly-formed national NGO. This remotesupport continued in 2008 through a newpartnership agreement covering the period2008-2011 and grew further thanks to thecollaboration of Handicap InternationalLuxembourg. The key elements of our partnership are assistance with financialmanagement and participation in thedevelopment and the implementation of their strategic plan.

On behalf of KORD, Handicap Internationalhas thus obtained financing, thanks to theDutch cooperation, for the period covering2008-2011 and new financing thanks to theLuxembourg cooperation (via HandicapInternational Luxembourg). Furthermore,short-term missions were carried out to

help KORD staff better prepare andimplement their awareness and lobbyingactivities with the Iraqi government.

In 2008, KORDs main activities remain thesupply of lower limb prostheses and lower and upper limb orthoses. KORD has alsocontinued to develop its revenue-generating activities to help the victims of antipersonnel mines care for their families,as well as activities to raise awareness of disability. Finally, the Iraqi organisationprepared the ground for lobbying activitywith the Iraqi government. This activity willmainly focus on the training and networkingof organisations that are composed of people with disabilities.

Obviously, in view of the chronic instabilityof Iraq since 2003, choosing a self-runninglocal organisation with a quasi-nationalinfluence proved to be a wining option.Indeed, it would have been very difficult,even dangerous, to maintain teams made

up of expatriate staff. Furthermore, HandicapInternational has always felt that it isessential to prioritise its activities on thedevelopment of a local structure to avoidan over-dependency in international aid,while lending greater legitimacy to a projectentirely run by Iraqi civil society.


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Projects incrisis situations


Budget: 103.079 Principal donors: Chaine du Bonheur, City of Paris,Handicap International Germany, Reuters Foundation AIDfund,Sanofi Aventis, Brussels-Capital Region.

On 12 May 2008, one of the most violent earthquakes in recenthistory struck the Chinese province of Sichuan. More than 80,000people were killed, 370,000 injured and 5 million lost theirhomes. Among the injured, an estimated 50,000 suffer fromdisabilities, of which 20,000 will be disabled for life.

The day following the earthquake, Handicap Internationals teamswere already on the spot to back up the two main hospitals inChengdu, the capital of Sichuan, providing rehabilitation services,

training hospital personnel in active methods for rehabilitation andproviding basic equipment. Six months after the earthquake, mostof the injured who received basic care in referral hospitals in theprovince have returned to their villages or their towns, or havegone back to temporary camps. These camps will house the victimsfor 2 to 3 years while the villages and towns which were destroyedare being reconstructed.

In 2009, this project will move into a post-crisis phase. HandicapInternational has assessed the situation in the hardest hit regionsand has identified a crying need for training in physicalrehabilitation techniques for the personnel in smaller hospitals,plus the need to set up monitoring services for home patients.Handicap International will be working in Mianzhu County (500,000inhabitants), located about 80 km north of Chengdu in one of thehardest hit zones with more than 50,000 seriously injured.

ChinaSichuan earthquake

Budget: 119.583 Principal donors: City of Paris, Ministry of Foreign Affairsof Belgium (Emergency Aid).

In September 2008, two hurricanes swept over Cuba with windsof more than 300 km/h. Material damage was enormous, and theeconomy, based to a large extent on tobacco production, nickelmining and tourism, was hard hit. The three provinces whereHandicap International is working were struck by both hurricanes,Gustav and Ike. The Handicap International projects for peoplewith disabilities had to be put on hold for emergency actions.

In a first phase, Handicap International provided a response todirect material needs after an assessment mission. Further to thisassessment, Handicap International ordered necessities likemattresses, sheets, blankets and towels, all articles that were nolonger available for purchase nor produced in Cuba since thestorms.

In Cuba, Handicap International leads community-based rehabi-litation and inclusive education projects in close collaboration withlocal partners, who distributed 3000 mattresses, sheets andblankets. The distributions continued early 2009 with roof-repair material (corrugated iron and fixing equipment) to 250 families inPinar, and 750 families in Banes, Holguin. In the four schools wherewe conduct inclusive education projects, we assumed the cost of repairing doors and windows.

CubaTwo hurricanes ravagethe Cuban coast


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Budget: 329.717 Principal donors: Luxembourg Ministry of Foreign Affairs,Ministry of Foreign Affairs of Belgium (Emergency Aid).

The eastern region in the Democratic Republic of the Congo hasbeen unsettled for many years by a latent conflict. The localpopulation is the first victim of this crisis. Currently, estimatescount roughly one million displaced persons.

In 2008, Handicap International worked at various levels to limitthe emergence or the consequences of disabilities, first in a hos-pital physiotherapy project for patients hospitalised in Virunga Hos-pital in Goma, then, with respiratory physiotherapy projects for malnourished children in a nutritional centre (CNT) and in campsfor displaced persons, complemented by physiotherapy for thosesuffering from motor impairments.

Handicap International also identifies children from 0 to 10 years

old with disabilities living in camps to ensure that they get all theaid they need. This includes referral to other structures for treatment. In this action the organisation back its partners workingin the camps, agents and community networks that are in a better position to identify children with disabilities and to send themto Handicap International for the necessary aid. Finally, theorganisation has opened a hospital physiotherapy project inRutshuru, in a hospital managed by MSF (Doctors without Borders)France.

In 2009, the organisation will also focus on taking into accountthe special needs of persons with disabilities and will work in thisfield with agencies organising life in the camps. We will also lookinto the possibility of developing actions geared to the health of mothers and infants in camps of displaced persons, as childbirthconditions have been identified as a major cause of disability.

Democratic Republic of CongoHumanitarian crisis in Kivu

Budget: 47.017 Principal donors: Ministry of Foreign Affairs of Belgium

(Emergency Aid).

Hurricane Nargis struck Myanmar on 2 May 2008, devastating alarge part of the Irrawaddy Delta. In June, Handicap Internationalgot authorisation to do a needs assessment mission. The projectdeveloped subsequent to this assessment anticipated mal-nutrition problems predicted by most of the players working inMyanmar, and planned for respiratory physiotherapy along thesame model as the project set up in Goma.

In September, when the project was about to be implemented,Handicap International realised that it had to be re-orientated sincethe anticipated famine fortunately did not take place. The Belgianand French sections decided to collaborate on a new projectconducted in a partnership with the PMI association. The Belgiansection of Handicap International gave physiotherapy trainingcourses to the PMI physical therapists, and the French section tookcharge of the physiotherapy and psycho-social support. HandicapInternational Belgium also helped transform the living area of peo-ple with disabilities to improve the accessibility of houses andpaths, for example. We also supported income-generating activitiesfor people with disabilities and their families.

Myanmar Help for the victims of Nargis



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2006 and 2007 closed with a major deficit, but encouragingelements in 2007 showed that the financial recovery of HandicapInternational was on the right track. This recovery was confirmedin 2008 with a deficit of 172,654 after allocation of provisions,charged to the organisation's own resources.

Financial results for 2008 show a clear improvement over previous years,resulting from the stabilization of costs at headquarters despite three wageindexations and an increase in operating costs due to the rise in the cost of energy (gas, electricity, ). Again on the subject of cost control, an effective jobwas done to control certain financial risks for which provisions were allocatedin 2007. Some of these provisions were taken back, which has had a positiveeffect on the results for 2008.

Among the positive points for the past year, we should also note animprovement in the results expected for private fundraising. On the one hand,this is due to a reduction in the cost of producing mailings and on the other hand, from income coming in from other sections of Handicap International.These occasional external incomes compensate a drop in funds collected bymeans of direct mailing. This drop has been particularly significant since the

financial crisis broke out in September 2008.The total budget of the organisation consists of 31.6 % of own resources and of 68.4% from funds supplied by institutional donors in the broad sense of theword (international bodies, ministries, foundations ...). Our institutional funds arerising and support the bigger 2008 budget, related to the expansion of programmes in keeping with the organisation's operational strategy:consolidation of programmes around certain development themes (rehabilitation,inclusive education, social and professional integration, road safety, maternaland child health, ... ) and an increase in emergency response programmes.

Nevertheless, we were forced to allocate new provisions to certain risks in 2008.One of the essential characteristics of the financial structure of the Belgiansection of Handicap International is that it is closely related to institutional

funding. However this requires complying with very strict rules for eligibility of expenditures, conclusion of contracts and other criteria for the validity of invoices. In recent years, controls have been reinforced, in the sense of verystrict compliance with administrative rules that not always take into accountthe constraints of the contexts in which we work. Consequently, we must foreseethe possibility of adjustments and continuously improve our tools andmonitoring procedures so that they remain as close as possible to this evolution.This improvement is now moving forward, but it means that we must chargecosts to 2008 for risks that have potential consequences for the future.

In this difficult context, Handicap International must recover its financial balance,budgetted for 2009, and that should continue in subsequent years. We will bepay particular attention to risks related to the world economic crisis affecting our private donors and also potentially influencing the budgets of institutionaldonors.

Programme realisation 76 %Communication andFundraising 12 %Operating costs 8 %

Lobbying and Education 4 %

Self-funding 31 %Belgian cooperation 26 %European Union 17 %National cooperation 13 %EU (outside Belgium)

Private financing 5 %(fondations, companies...)

National cooperationoutside EU 5 %United Nations 3 %

Financial report2008


Expenditures

Income


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Expenditures (in ) 2007 2008

Programme realisation 12 850 901,98 13 845 036,39Programme implementation 11 234 300,41 12 226 580,47 Exploratory missions 2 491,89 0,00Equipment and investments 1 115 315,57 1 171 858,13Transportation, communication and operating costs 1 673 513,35 1 922 678,08Materials and consumables 423 393,52 528 457,82Transport 47 041,87 97 218,59Local and expatriate staff 5 297 717,23 5 972 385,37Training, prevention and local education 987 558,04 888 663,68Support to partners, individuals 830 484,18 864 637,67Programme monitoring and evaluation 205 559,59 155 346,44Support actions Handicap International France (tsunami) 597 609,17 592 609,00Other programme costs 53 616,00 32 725,69Technical support 1 616 601,57 1 618 455,92Programme management 852 654,54 743 005,79Specialised services 763 947,03 875 450,13

Lobbying and Education 564 017,30 757 634,22

Fundraising 2 155 866,81 2 157 063,04Appeal and management of donations and sponsorship 1 848 266,00 1 811 103,86Communication & events 307 600,81 345 959,18

General services 528 395,69 678 202,12Exceptional charges 141 132,13 517 050,42Financial charges 294 245,90 336 923,68

Total expenditures 16 534 559,81 18 291 909,89

Income (in ) 2007 2008

Public financing 10 098 098,02 11 510 039,76International organisations 2 805 406,46 3 571 009,30European Union 1 843 025,90 3 078 759,23United Nations 962 380,56 492 250,07National organisations 7 292 691,56 7 939 030,46DGCD (Action Plan) 3 915 837,75 3 657 736,31Belgian Cooperation and others 991 000,71 1 072 756,65Within the European Union 2 093 586,17 2 297 006,95Outside of the European Union 292 266,93 911 530,55

Private Financing 965 858,51 1 010 394,06

Self-funding 4 609 424,34 4 913 748,08Fundraising 3 225 026,11 3 670 282,84Legacies and inheritances 416 376,26 232 880,7Sales and service provisions 72 645,46 25 265,17Sponsoring 31 983,00 14 800Others (Consortium) 863 393,51 970 519,37

Other operating income 145 916,50 169 967,43Subsidies 37 247,30 38 868,21Costs billable to third parties 28 797,39 16 914,77Other income 79 871,81 114 184,45

Financial resources 261 034,96 273 559,68Financial income 105 271,64 80 592,82Effect of exchange rate changes 155 763,32 192 966,86

Exceptional resources 80 829,25 241 546,14Total receipts 16 161 161,58 18 119 255,15

RESULT -373 397,85 -172 654,74


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Financial transparency We are particularly careful to ensure good management of thefunds made available to us. All the accounts of the association aresubject to external audits carried out by an auditor appointed bythe General Meeting, the Bureau Bossaert, Moreau, Saman sprl,corporate auditors. In addition, expenditures for our projects areregularly verified in specific audits ordered by our institutionaldonors. The accounts were approved by the General Meeting of

July 8, 2009. These various controls, reinforced by an internal auditand strict procedures, guarantee the optimal management of theresources put at our disposal.

Your right to informationHandicap International is an active member of the Association pour une Ethique dans la Rcolte de Fonds (AERF) (Ethical Fund

Collecting Association) and subscribes to the AERF code of goodconduct which includes the right to information. Donors, friendsand staff members are automatically kept informed of the use of funds. This is the purpose of the annual report. In addition, youcan always ask us for additional information:

an overview of the analytical operating accounts for costs, comments on what the organisation means by the use of cost

centres, particularly for collecting funds, the auditors report, the wage spread (ratio of the lowest to the highest gross wages), depreciation table.

These documents are available following a simple phone call to02/280.16.01 or on request by post or by e-mail. They can also beconsulted at the head office of Handicap International, rue de Spa67, 1000 Brussels.

www.vef-aerf.be

Community-basedrehabilitation 25 %Demining 21 %Rehabilitation centres 17 %Support to associations 8 %Emergency 7 %Tsunami projects 7 %Road safety 6 %Maternal and child health 5 %Inclusive education 3 %Socio-economic integration 1 %

Implementation of programmes

Africa : 43 %

Latin America : 10 %

Middle East : 1 %

Asia : 40 %

| 30

Tsunamiprojects :

6 %

Expenditures by theme


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Financial resultsas on 31st december 2008

Assets (in ) 2007 2008

Intangible assets 29 975,13 9 414,36Tangible assets 263 940,91 243 962,75Buildings and fitting 239 566,24 213 028,66Furniture and equipment 24 374,67 30 934,09 Other financial assets 60 593,24 67 526,12Total fixed assets 354 509,28 320 903,23

Reditors 2 762 040,30 2 551 446,10Operational active debts 482 886,41 34 466,18Transitional accounts 13 357,01 0,00Donors 2 215 824,00 2 381 964,67 Other active debts 49 972,88 135 015,25Stocks 7 631,33 6 607,92Prepayments and accrued income 384 450,57 467 658,38

Cash at bank and in hand 5 877 648,87 3 606 583,54Shares 513 944,19 114 686,60Cash at bank 5 053 963,09 3 103 708,81Cash in hand 298 771,87 377 370,03Internal transfers 10 969,72 10 818,10Total current assets 9 031 771,07 6 632 295,94

TOTAL ASSETS 9 386 280,35 6 953 199,17

Liabilities (in ) 2007 2008

Capital and reserves 2 579 372,96 2 205 975,11Result for the financial year -373 397,85 -172 654,74Total capital and reserves 2 205 975,11 2 033 320,37

Provisions for charges 10 000,00 0,00Provisions for liabilities 235 666,02 238 772,00Provisions for argument 24 701,90 11 500,00Total provisions 270 367,92 250 272,00

Long term debts 0,00 0,00Short term debts 4 558 547,15 3 394 426,17Donors 2 278 963,49 2 168 131,84

Fiscal and social debts 296 883,38 184 140,91Suppliers and other accounts 1 982 700,28 1 042 153,42Prepayments and accrued income 2 351 390,17 1 275 180,63Total debts 6 909 937,32 4 669 606,80

TOTAL LIABILITIES 9 386 280,35 6 953 199,17



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Donors

INTERNATIONAL PUBLIC DONORS

European CommissionEuropeAid Co-operation Officeto the European CommissionHumanitarian Aid Departmentof the European Commission (ECHO)

United NationsUnited Nations Childrens Fund (UNICEF)United Nations Development Program(UNDP)United Nations Office for the Coordinationof Humanitarian Affairs (UNOCHA)

NATIONAL PUBLIC DONORS

Belgian Directorate Generalfor Cooperation and Development (DGCD)

Ministry of Foreign Affairs of BelgiumC

hi rapport 2008 uk

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