Essential Guidance for Working with Persons with Disabilities in Displacement I. Overview Persons with disabilities (PwD) may have one or more of the following: - Long term physical, mental, intellectual or sensory impairments (see endnote 1.) - Injuries - Chronic illnesses These factors, combined with social, cultural, environmental, economic, and political barriers hinder full, equal, and effective participation in society for many PwD. During crises and displacement, this discrimination is often magnified. WHO estimates that a minimum of 10% of the world's population experiences disability. Although there are no global figures available, the number of PwD currently in displacement because of conflict or natural disaster may well range into the millions. Like all people, PwD have differing capacities and needs, and contribute in different ways to the communities in which they live. In displacement, they have the same basic needs as other refugees or internally displaced persons (IDPs). In addition, they may also experience difficulty in moving, hearing, seeing, communicating and/or learning, amplifying the often severe challenges posed by displacement. Disability may also give rise to heightened protection vulnerabilities such as exposure to violence, discrimination, and exclusion of humanitarian assistance, education, livelihoods and health care. These challenges require that all protection activities are inclusive of PwD. PwD may require specific support related to their disability. Such support may include the provision of assistive devices, mobility aids, care giving support, or adaptive modifications to the physical environment to enable them to receive assistance and participate fully in household and community activities. II. Participation is key to Protection While displacement poses new challenges for all affected individuals, PwD become especially vulnerable if they are invisible, if their protection needs are not addressed, and if they are unable to participate in activities which impact upon them. To ensure that PwD are not neglected during crises, staff need to be aware of their own preconceptions regarding disability, which might increase the (unintended) exclusion of PwD. These preconceptions may stem from a lack of knowledge about disability, lack of exposure to PwD, and social and cultural attitudes to disability. When integrating disability into humanitarian programming, do not assume that PwD are automatically included. The participation of PwD is key to identifying and
developing appropriate solutions to disability challenges raised during displacement. Consultation and participation of PwD throughout all phases of crises and protracted conflict needs to be actively encouraged. ACTION - Consult and involve PwD in decision making, programming and leadership' structures, giving them the means to voice their opinion and participate in design, assessment, monitoring, and evaluation activities. Achieving a high standard of protection is only possible with the full inclusion, involvement and participation of PwD. Humanitarian actors must make every effort to create and sustain an inclusive environment for PwD, their care givers, families and communities. III. Key Considerations a) Rights-Based and Inclusive Programming PwD, as all other displaced persons, need to have an equal opportunity to enjoy the full range of human rights and to be included in programming. International standards and national legal frameworks provide orientation on how to reduce a discriminative environment. ACTION - Ensure staff awareness of international and national standards for PwD. (See endnote 2.) PwD have the right to be included in all humanitarian programming. They need to be integrated into all assistance programs and all activities. ACTION - Adopt a twin-track approach to mainstreaming: 1. Avoid developing distinct programming only for PwD, which can serve to further marginalise them, by designing all responses in ways which are inclusive of and accessible to everyone; 2. Include specific elements in general programmes to target disability. PwD have an equal right and need to be placed on an equal footing so they are consulted and actively participate in all humanitarian activities, including: - Fulfilment of basic needs, including security, food, water, shelter and health - Distribution of food and non-food items - Mechanisms to prevent and respond to SGBV and other key protection concerns - Vocational (re)training, livelihoods and micro finance programs - Inclusive education: integrate children with disabilities into mainstream school programs and child friendly spaces (See endnote 3.) - Provision of Information - Provision of safe infrastructure, including shelter, schools, and WASH facilities Make additional efforts to connect specific service providers with PwD. Targeted support for PwD may include: - Medical care - treatment of injuries and chronic diseases, provision of medication
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Adaptive aids and assistive devices - replacement, repair, and maintenance Rehabilitation Care giving Psychosocial support Protection monitoring
A multi-sector approach is needed to address all the risks, issues, and needs that IDPs and refugees with disabilities may identify.
b) Identification Refugees and IDPs with disabilities are made invisible through a lack of explicit and appropriate inclusion during identification and registration. PwD, especially those in secondary and tertiary displacement and/or living in dispersed urban settings, might be isolated which makes it difficult to locate and include in programming. Disabled Persons' Organizations (DP0s) and other civil society organizations may have client or membership lists. Consult with these actors to identify PwD needing specific assistance. Action - Identify disabled IDPs and refugees by taking the following steps: 1. Screen areas with high concentrations of displaced persons a first entry point for PwD 2. Consult with civil society actors and relevant public bodies, NGOs, religious groups, community based organizations, and Disabled PErsons Organizations or other civic for information on and locations of PwD 3. Involve PwD in Participatory Assessments and other assessment modalities 4. Use Multi Functional Teams (i.e. multi disciplinary) to collect data on PwD 5. Share data on PwD with partner agencies for follow up, ensuring confidentiality as appropriate 6. Disaggregate all findings by age and sex to have a more specific picture.
c) Prevention and Response to Sexual and Gender Based Violence (SGBV) and other Forms of Exploitation and Abuse Women, children and older persons with disabilities, those who are housebound, and those 'hidden' due to cultural stigma may be especially vulnerable to sexual and other forms of exploitation and abuse. Unfortunately, PwD are often excluded from SGBV prevention and response programs. Their inclusion needs to be systematically addressed. SGBV also increases vulnerability to HIV/ AIDS. Often legal, HIV/ AIDS and reproductive health services are not accessible to PwD and/or do not take needs of PwD into account. ACTION - Work with all partners to identify (see endnote 4) and establish a system to monitor high risk PwD and include PWD in all aspects of SGBV prevention and response mechanisms.
d) Information Dissemination and Communication
Ensure that information is accessible to PwD. Use appropriate forms of communication, each with clear messaging. For example, simple language is necessary to communicate key messages to persons with intellectual disability, picture formats and visual demonstration may reach those with hearing problems most effectively, radio and spoken communication are useful when reaching persons with visual impairments, and signage must be erected in areas which are physically accessible to reach persons with mobility challenges. ACTION - Format key messages, particularly those specifically targeting PwD, in appropriate and multiple, formats. Given the additional protection risks that certain PwD may be subject to, it is important to effectively communicate relevant protection information to PwD on how to access: - Subsidised health care (including provision of adaptive aids/assistive devices) - Key documentation including birth registration for children with disabilities - Sexual and Gender based violence risks and support - Government social support services - Education and school information.
e) Referral Systems Develop effective referral systems in partnership with DP0s, NG0s, women's groups, older persons' associations, faith based organizations, community based organizations, and Government partners to ensure that the specific needs and rights of PwD are met. ACTION - Create an effective referral system by mapping and liaising with Disabled Persons Organizations and relevant local or other service providers to determine who can do what, where, when and how.
f) Distribution of Food and Non-Food Items Distribution mechanisms should be inclusive and accessible for all. Distributions can exclude PwD who may be challenged in carrying heavy food distributions, be unable to wait for extended periods of time to access distributions or who may be physically unable to reach the distribution points. Non food items (NFI) may not be useable by PwD due their size or shape or food may not meet specific nutritional needs or be difficult to chew/swallow. Additional NFIs may be necessary, such as extra blankets for those who are bed bound. ACTION - Make distributions accessible for all: 1. Involve PwD in program design and delivery so that distributions are accessible and appropriate 2. Consider separate queues, transport support, smaller parcels, and/or door to door distributions for PwD 3. Consult PwD when deciding what items should be included in distributions. g) Family Reunification
Many PwD will depend on care giver support. Care givers can include family members, host families, transitional support providers and institutions. Separation from a care giver can severely affect a PwD's physical and psychosocial well-being and independence and increase their vulnerability to abuse, discrimination, and neglect. ACTION — During crises and displacement, prioritise PwD in reunification efforts and include PwD caregivers in reunification activities. h) Shelter, Housing and Office Accessibility When constructing (or adapting) temporary or permanent housing, involve PwD in the design of required adaptations. Prevent injury and new disabilities by eliminating obstacles at water points, latrines, schools, medical facilities, workplaces, and service providers. Consult PwD to identify and assess main barriers. Provide lighting in public areas, install hand rails with stairs, and construct ramps on buildings to reduce mobility barriers and increase safety. All new construction should be based on universally accessible design. (See endnote 5.) ACTION — Ensure that infrastructure and accommodation is safe, accessible, and appropriate: 1. Involve PwD in design and delivery of infrastructure support, consult PwD on specific needs 2. Work with PwD and construction partners to ensure that both temporary and permanent housing is accessible 3. Work with sector partners to ensure accessibility. i) Transportation Provide or facilitate access to transportation to displaced PwD so they can access services, such as registration and documentation. Establish strict criteria for the payment of transport fees from the beginning, targeting only those who otherwise do not have access. When providing transport for IDPs and refugees, make sure it is suitable. Loading persons with visual or mobility challenges onto crowded trucks, for example, does not enable safe and dignified transportation. ACTION — When transporting or facilitating transport of a PwD, always: 1. Consult them on their transport needs 1. Ask them to guide you on the best way to move them. 2. Do not separate a PwD from assistive devicès, adaptive aids and/or medication IV. Key Resources - The Convention on the Rights of Persons with Disabilities (CRPD),
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available at http://www.un.org/disabilities/ Resource Kit for Field Workers, Women's Commission for Refugee Women and Children, available at http://womensrefugeecommission.org/programs/disabilities Disability Checklist for Emergency Response, Handicap International, available at http://oneresponse.info/Disasters/Haiti/disabilities/Pages/default.aspx Communicating Effectively with People who Have a Disability, North Dakota Center for Persons with Disabilities, available at http://www.labor.state.ny.us/workforcenypartners/forms/communication.pdf Heightened Risk Identification Tool (HRIT), available at http://www.unhcr.org/refworld/docid/4c46c6860.html INEE Pocket Guide to Inclusive Education, available at http://www.ineesite.org/index.php/post/member_inee_pocket_guide_to_supporti ng_learners_with_disabilities2/
Endnotes: 1. Convention on the Rights of Persons with Disabilities (CRPD), 2006. 2. CRPD and the national legal framework. 3. Basic training may assist teachers to work more positively with disabled children in the classroom. 4. This process can be assisted by using the Heightened Risk Identification Tool (HRIT). 5. http://en.wikipedia.org/wikilUniversaldesign