1. Persons with disabilities in conflict-affected countries Sub-Saharan Africa Claude Tardif Head of Physical Rehabilitation Programme International Committee of the Red Cross Geneva, Switzerland ctardif@icrc.org World Bank Workshop Conflict-Affected Countries in Sub-Saharan Africa: Disability issues and Strategies Washington, December 4th 2008

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

3. 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

4. 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

5. 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

6. 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

7. 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 disability

8. 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

9.  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. ICRC Physical Rehabilitation Programme The challenges

10. 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

11. Strategies and Responses  Balancing social action with interventions at the individual levellevel  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

12. 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

13.  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

14.  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.

15. 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

16. 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)"

17. 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.

18. 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.

20. 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

21. 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 device The ICRC and the disability issue Physical Rehabilitation

22. 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

23. 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

24. 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

25. 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 sustainable Sustainability 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

26. Thank you! ICRC Physical Rehabilitation Programme

27. Resources  Women's Commission for refugee women & children (www.womenscommission.org)www.womenscommission.org  Disabilities among refugees and conflict-affected populations  Survivor Corps (www.survivorcorps.org)www.survivorcorps.org  Supporting and Implementing P&O Services in Low-Income Settings  Handicap International (www.handicap- international.org)www.handicap- international.org  Good practices for the economic inclusion of persons with disabilities in developing countries

28. Resources  WHO (www.who.int)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)www.icrc.org