The Disabled

REFUGEES AT RISK

When dealing with the disabled, capitalize on their strengths... Do not focus or dwell too much on weaknesses.

The disabled in any society are at a disadvantage. In a refugee situation where even the able-bodied are in a struggle for survival, the disabled have less chance than the rest, and it is not uncommon to see the disabled abandoned by those who had previously cared for them. Thus, in a refugee emergency, it is important that special attention be given to this group and priority given to all cases in which the disability represents a serious obstacle to leading a normal life and achieving self-sufficiency.

Some of the major disabilities are due to:

· malnutrition
· vitamin deficiencies
· polio
· cerebral palsy
· leprosy
· epilepsy
· bums
· injuries due to accidents
· injuries related to armed conflict
· torture
· other severe trauma
· mental retardation and mental illness
· severe ear and eye infections.

Prevention: Preventive measures may have a greater overall impact on disabilities and handicaps than rehabilitation training. Preventive action begins with the earliest assistance and remains a continuing concern. While community services staff would not be responsible for their implementation, they can play an important role in encouraging refugee participation in carrying out measures which can prevent the incidence or worsening of impairments.

For example:

· adequate nutrition
· ready access to clean water
· adequate shelter
· adequate sanitation
· access to medical treatment
· adequate clothing and necessary
· control of pests that spread disease material items
· mother and child clinics
· exclusive breastfeeding for about 4-6 months and continued breastfeeding for up to 2 years or beyond
· vaccinations for measles, poliomyelitis
· safe working conditions and other diseases, as appropriate
· fire prevention and fire fighting measures
· elevated fire placed to prevent bums to children
· public health education children
· preventive mental health measures
· living arrangements that provide adequate physical security

Identification and Assessment: Before action can be taken for treatment and rehabilitation, disabled refugees must be identified and their needs assessed. When workers are in place before refugees arrive, a good way to identify disabled refugees is to screen all new arrivals, for those who need immediate assistance and those who should be followed up later. A combination of house-to-house visits and information from refugee leaders can be used to identify disabled individuals once refugees are settled. In both cases trained refugee community workers can play a major role.

Some disabled refugees will have impairments that are likely to become worse if proper medical care is not provided. Once handicapped and disabled refugees have been identified, it is strongly advised that they be medically screened as soon as possible. (See UNHCR Disabled/Medically-at-Risk form, annex no. 5).

Remember, "Our greatest need is to be needed." The disabled are also a part of the community. Their strengths can be an asset if used skillfully and sensitively. Look beyond the broken body to the mind and soul, the remaining skills that lie dormant and need to be tapped.

Disabled and handicapped refugees sometimes require immediate help to meet the requirements of daily living. If the refugee is having difficulties in carrying out the following activities then an immediate response will be necessary:

· obtaining food, water, fuel
· preparing food
· eating food
· washing himself/herself
· dressing
· washing clothes
· cleaning his/her house
· preventing injuries to parts of his/her body that have no feeling
· moving around inside his/her house and immediate living area
· moving around outside his/her living area
· going to the toilet or latrine
· working
· going to school
· understanding what is said to him/her
· expressing thoughts, needs and feelings
· taking part in family activities
· taking part in community activities
· (See assessment form for a person who is disabled or chronically ill, annex no. 6).

Treatment: Local resources for treatment and rehabilitation should be used as far as possible. At times it may be necessary to help to develop these services for the local residents as well as for the refugees. These may include production of prosthetic aids which are simple, inexpensive, durable, easy to maintain and repair, yet able to help the disabled person to overcome his difficulties in carrying out daily activities.

All existing services (i.e. basic health units, clinics, hospitals, dispensaries, etc.) should be used to support community-based treatment and rehabilitation services for disabled refugees.

An effective referral network involving governmental agencies, NGOs, religious leaders, traditional healers and community outreach workers should be worked out to avoid duplication of programmes and ensure that services are available to all.

Refugees suffering from disabilities requiring surgical intervention(s) and/or specialised rehabilitation not available in the country of asylum but necessary to restore or prevent further loss of functions, and thereby gain partial or total independence should be given priority for assistance. A limited number of disabled refugees with extraordinary medical problems may therefore receive treatment through international medical referrals, normally within the region where they have asylum.

Rehabilitation: Rehabilitation is not the automatic result of medical treatment or physical therapy. It also means achieving the level of physical, mental and social functioning of which a disabled person is potentially capable. This can range from completely normal functioning for some, to doing such basic tasks as feeding and dressing for others. The goal of rehabilitation work is to restore the disabled to the community in an effort at re-integrating them into the mainstream of the community's activities. It is better therefore for the disabled to participate in the same social services and other programmes as me rest of the refugee community, rather than in separate programmes.

Disabled refugees can contribute to their communities when given the chance. Rehabilitation includes removing barriers to their full participation. Ensure equal access to:

· housing
· transportation
· social and health services
· education
· work opportunities
· cultural activities
· recreational activities
· social interaction
· information of concern to refugees.

Families play a major role in helping (or preventing) disabled refugees to achieve social integration. Programmes should therefore be designed to keep the disabled in the family rehabilitation and receive the necessary support Families must be encouraged to take part in and training to fulfill this responsibility.

Examples of the ways in which Community Services can aid Disabled Refugees

General social welfare services

· Identify disabled refugees.
· Assist them to meet any immediate needs.
· Link them with medical treatment, physical rehabilitation or other needed services.

Education and training

· Help individuals achieve their intellectual potential.
· Teach skills to achieve self-support.
· Promote social integration for children through participation in school.
· Give priority to the disabled when selecting students, as they may have more difficulty than others in achieving self-support.

Individual case guidance

· Help disabled refugees see their own potential and use available resources.

· Help them resolve personal and family problems that can impede integration or self-support.

· Guide them toward employment or other means of self-support.

Self-help projects

· Enable disabled refugees to produce items to use or sell.
· Help participants to develop a sense of their own capacity for self-support.
· Reduce feelings of dependence and helplessness.
· Increase feelings of self-worth.

Community activities

· Help disabled refugees to take part in cultural, religious and recreational activities.

Incidence of Disability in Refugee Populations

The incidence of disability in refugee populations tends to be lower than that in the country of origin, because the disabled are often left behind, die during the exodus or during the emergency phase.

Rate of Survival

Few disabled survive the rigors of the flight into exile. For the survivors who find asylum, immediate action needs to be taken to prevent a fatal deterioration of their condition.

Check List

Are there any medical and rehabilitation facilities? If so, do refugees have access to them? If not, what is the alternative solution?

Have you identified the number of disabled persons and the type of disabilities?

Among those refugees with disabilities identified, how many would require special services?

Are these disabilities caused by circumstances leading to refugee situations?

What do nationals with disabilities do for treatment and rehabilitation?

What measures have been introduced to prevent disabilities: immunization, supplementary feeding, distribution of vitamin A, mine-clearing exercise?

Notes: