Persons with disabilities in conflict-affected countries

Sub-Saharan Africa

Claude TardifHead of Physical Rehabilitation ProgrammeInternational Committee of the Red Cross

Geneva, Switzerlandctardif@icrc.org

World Bank WorkshopConflict-Affected Countries in Sub-Saharan Africa:

Disability issues and StrategiesWashington, December 4th 2008

Content

Definitions Situation in conflict-affected countries Situation of persons with disabilities Strategies and responses ICRC physical rehabilitation activities Resources

Some definitions

Disability Disability is an evolving concept and results from

the interaction between persons with impairments and attitudinal and environmental barriers that hinders their full and effective participation in society on an equal basis than others

Impairments An impairment is damage to an individual's

physical, mental, intellectual or sensory condition

Some definitions

Persons with disabilities

Those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis than others

Situation in conflict-affected countries

Social support system disrupted Displacement of population Disruptions to schooling Traditional community coping mechanisms may

broken down

Economic situation deteriorate At country and population level

Situation in conflict-affected countries

Health care system disrupted

Depriving the population of essential preventive or curative care

The general health status of the population decrease

Increase number of injuries and trauma Lack of personnel, infrastructure and funds

Situation of persons with disabilities

WHO estimates that there are more than 600 million persons with disabilities( between 7 and 10 per cent of the world's population)

80 per cent live of developing countries Persons with disabilities are highly over-

represented among the poor About 82% of them live below poverty line Poverty is a cause and a consequence of

disability

Situation of persons with disabilities

Persons with disabilities are not a homogeneous group: they have different types of impairments with

various degrees of severity; have diverse combinations of education and skills and have different degrees of support from their family and community

They are marginalized by laws, customs, attitudes, in addition to having a difficult environment

Ensuring the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity is a challenge, even in the resource-rich environment of developed-countries.

The constraints inherent to war-torn countries, where the ICRC usually operates, make this task particularly difficult.

ICR

C P

hysi

cal R

ehab

ilit

atio

n P

rogr

amm

e The challenges

Strategies and Responses

Inclusion Rather than organizing “special” or segregated

activities for people with disabilities, inclusive policies promote the inclusion and equal participation of people with disabilities in all mainstream activities. Promoting inclusion involves the removal of all physical, institutional, social, attitudinal and environmental barriers that prevent the full and equal inclusion of people with disabilities in the activities enjoyed by others members of the society

Strategies and Responses

Balancing social action with interventions at the individual level

Inclusive education Inclusive education promotes the inclusion of all

children in schools and learning environments, regardless of their particular needs or vulnerabilities.

Positive employment policies: encouraging the employment of persons with disabilities

Strategies and Responses

Universal design This means that all infrastructure and facilities should be

designed to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design

Reasonable accommodation This means making any necessary and appropriate

modifications and adjustments to the physical environment and infrastructure to ensure that persons with disabilities can live independently and participate fully in all aspects of life

Access to rehabilitation Rehabilitation is the process of

removing, or reducing as far as possible, the factors that limit the activity and participation of a person with disability, so that he/she can attain and maintain the highest possible level of independence and quality of life: physically, mentally, socially and vocationally.

Strategies and Responses

Strategies and Responses

Access to rehabilitation

The ultimate goal of rehabilitation is to provide the individual with the best possible opportunity for full and effective participation and inclusion in society, with possibilities to study, work, access services, etc. that are equal to those of other citizens.

Strategies and Responses

Access to rehabilitation To achieve full inclusion, many different interventions may

be needed, which, depending on the individual’s type of disability, may include one or several of the following: medical care, physiotherapy, occupational therapy,

supply of assistive devices (such as hearing and vision aids, prostheses, orthoses, wheelchairs and walking aids), speech therapy, psychosocial services/counseling, social support, education (inclusive and special), vocational training, job placement, support for economic self-reliance and the eradication of physical, social and financial barriers

The ICRC and the disability issue

While the ICRC recognizes that all areas of rehabilitation are important and while providing assistance in different areas, its main contribution is the assistance provided to physical rehabilitation

As part of its mandate, the ICRC provides physical rehabilitation assistance through its operational programme the "Physical Rehabilitation Programmes (PRP)" and through the "ICRC Special Fund for the Disabled (SFD)"

Mandate

ICRC Physical Rehabilitation Programme (PRP) ICRC is an impartial, neutral and independent

organization whose exclusively humanitarian mission is to protect the lives and dignity of victims of war and internal violence and to provide them with assistance.

ICRC Special Fund for the Disabled (SFD) To ensure the continuation of work started under

ICRC operational programmes for people affected by conflict, and to support physical rehabilitation centres in low incomes countries.

ICRC PRP ICRC SFD

Pre crisis

Acute crisis

Chronic crisis

Post crisis

Development

Distribution of responsibilities PRP - SFD

The PRP and the SFD provide similar support, and it is primarily the political context and the needs that decide which channel the ICRC uses in a given situation.

What is physical rehabilitation?

Physical rehabilitation is an important part of the integrated rehabilitation process, enabling person with physical impairment to gain mobility which is a main condition

for the person to participate in social life, work and education

What is physical rehabilitation?

Physical rehabilitation includes the provision of assistive devices such as prostheses, orthoses, walking aids and wheelchairs along with appropriate therapy allowing an optimal use of the deviceTh

e IC

RC

an

d t

he

dis

abil

ity

issu

eP

hys

ical

Reh

abil

itat

ion

Objectives of the ICRC physical rehabilitation assistance

The main aims of ICRC support for physical rehabilitation activities are to increase accessibility to services, improve the quality of these services and ensure their long-term functioning

Accessibility to services

ICRC PRP and SFD physical rehabilitation projects: ensure that all types of services are available ensure that all persons who need services know about the

services and have equal access to centres, without discrimination

ensure that systems of transportation and accommodation are available

ensure that provided services are affordable, without compromising on quality

ensure link with other rehabilitation service providers

Quality of services

ICRC PRP and SFD physical rehabilitation projects: Ensure that trained professionals in the field of P&O and

physiotherapy are available Ensure that physiotherapy services are an integrated part of

the P&O provision Ensure that all patients receiving services have access to

repairs and maintenance Ensure that the technology used is appropriate for the

context

Long-term functioning of services

ICRC PRP and SFD physical rehabilitation projects: Services are imbedded into a national health/social care

system Services are financially, technically and managerially

sustainableSustainability is the ability of programmes to continue over time to

meet the demands of users, providing appropriate technology, of acceptable quality, at affordable cost, in an accessible manner, enabling PWD to assert their rights, while contributing to the strength of the local health system, with minimal external input

Thank you!IC

RC

Phy

sica

l Reh

abil

itat

ion

Pro

gram

me

Resources

Women's Commission for refugee women & children (www.womenscommission.org) Disabilities among refugees and conflict-affected

populations

Survivor Corps (www.survivorcorps.org) Supporting and Implementing P&O Services in Low-Income

Settings

Handicap International (www.handicap-international.org) Good practices for the economic inclusion of persons with

disabilities in developing countries

Resources

WHO (www.who.int) Guidelines on the provision of manual

wheelchairs in less resources settings Guidelines for training personnel in developing

countries for prosthetics and orthotics services

International Committee of the Red Cross (www.icrc.org)