Submission to the Office of the United Nations High Commissioner for Human Rights on Article 11 of the CRPD

Human Rights Watch welcomes the opportunity to provide input to the Office of the United Nations High Commissioner for Human Rights (OHCHR) for its study on the rights of persons with disabilities in situations of risk and humanitarian emergencies. Human Rights Watch believes that further examination of Article 11 of the Convention on the Rights of Persons with Disabilities (“the Convention”) is important for ensuring the protection of the rights of all persons with disabilities.[1]

This submission is based on Human Rights Watch’s research on the Central African Republic,[2] Syria,[3] Yemen,[4] as well as on our ongoing monitoring of the rights of persons with disabilities in situations of risk and humanitarian emergencies in Nepal and Iraq. The document addresses a number of the questions posed in the OHCHR call for submissions;[5] however, rather than answering each question comprehensively, we instead underscore several concerns and observations that figure prominently in our research. We focus on three issues in particular:

1. The compounded challenges and unique needs of persons with disabilities in situations of risk and humanitarian emergencies;
2. Challenges persons with disabilities face in accessing medical services and basic necessities in situations of risk and humanitarian emergencies;
3. Discrimination that persons with disabilities face in responses to situations of risk and humanitarian emergencies.

Throughout, we stress the inherent interdependence between Article 11 on situations of risk and humanitarian emergencies and other provisions of the CRPD, asserting the need for a holistic interpretation of the Convention.

Compounded challenges and unique needs

While humanitarian crises and situations of risk create challenges for all individuals affected, these challenges are especially felt by persons with disabilities, whose vulnerability is increased for a number of reasons. Challenges created by war, natural disasters, and other situations of risk are compounded for persons with disabilities by physical, communication, and other barriers.[6]

For example, in Yemen, where an estimated three million people with disabilities live, limited fuel, lack of electricity and rubble-covered streets limit the ability of people with disabilities—particularly those in wheelchairs—to move freely around their communities, flee for safety, or access basic services.[7] In many instances, this has meant that persons with disabilities become virtually imprisoned in their homes.[8]

In such situations of risk, families of people with disabilities are faced with a difficult, often split-second choice: either flee and save themselves, or risk being killed to save a relative with a disability. As a result, people with disabilities are at risk of being left behind.[9]

In Iraq, for instance, Human Rights Watch documented cases of children with disabilities being left behind by family members forced to flee.[10]

In the Central African Republic, Human Rights Watch found that in the wake of attacks on communities by armed groups starting in 2013, at least 96 people with disabilities were abandoned or were unable to escape and that 11 were killed in Bangui, Boyali, Yaloké, and Bossemptélé. Given the lack of data collection and monitoring, this figure is likely a fraction of the total.

Some people with disabilities in Central African Republic spent days or weeks, and in a few cases up to a month, in deserted neighborhoods or villages with little food or water. People with physical or sensory disabilities interviewed by Human Rights Watch told us that they were often unable to negotiate the unfamiliar and uneven terrain without assistance.[11] A key challenge in escaping was the absence of assistive devices such as wheelchairs, tricycles, or crutches, which were lost in the chaos, left behind, or looted. Furthermore, many people with physical or sensory disabilities found the prospect of the journey too daunting and so decided to stay behind. Others chose to stay in their homes believing that, because of their disability, attackers would spare their lives. But in some cases, people with disabilities who were unable to flee, were killed by the attackers. 

The risks to persons with disabilities in emergency situations are increased further by barriers to receiving information or being made aware of the danger they face. For instance, since the attacks in Central African Republic occurred without warning, many people who were deaf or had psychosocial or intellectual disabilities simply did not hear, know about, or understand what was happening. The situation of people with psychosocial or intellectual disabilities has been particularly ignored, since even domestic disability rights organizations focus almost exclusively on people with physical disabilities.[12]

Finally, financial barriers pose particular challenges for inclusion of persons with disabilities in humanitarian response. For example, with limited aid available, aid agencies in Central African Republic were often unable to address the specific needs of people with disabilities. Of the eight UN and nongovernmental aid agencies Human Rights Watch interviewed, none were systematically collecting data on people with disabilities, and their needs were not fully included in the agencies’ programming.  Of the data that is collected on people with disabilities, it often fails to specify crucial factors such as age and gender, which limits the efficacy of the programs being implemented.

Access to education, and medical and humanitarian services in emergencies

An example of the effect of leaving persons with disabilities out of responses to humanitarian crises is the lack of access for children with disabilities to education. Globally, it is estimated that over 28.5 million primary-school-age children are out of school in conflict-affected countries.[13] Given the absence of reliable data in humanitarian crises, it is difficult to ascertain exactly how many children with disabilities remain out of school in these contexts. In the Central African Republic, Human Rights Watch found that children with disabilities often did not have access to education services provided through the internationally-led humanitarian response. For example, in one temporary school set up in M’Poko IDP camp, Human Rights Watch found that out of nearly 3,800 children enrolled, only 14 had mild physical or sensory disabilities. The director of the school told Human Rights Watch that the school was unable to accommodate children with sensory, psychosocial, or intellectual disabilities because teachers are not appropriately trained. Even children with physical disabilities are often unable to attend school due to lack of adequate seating and accommodations or because of parental concerns that they will be left behind in the case of an attack.

During and in the aftermath of crises, persons with disabilities face significant barriers to accessing medical services and basic necessities. Sometimes this is because of challenges in physically reaching the resources, the destruction of hospitals and other infrastructure on which persons with disabilities rely, shortages of vital supplies because of limited humanitarian access or demand for them to treat people injured in the conflict, or the closing down of key services for persons with disabilities.

Human Rights Watch documented instances of these barriers in Syria, Yemen, and Central Africa Republic. In December 2012, many psychiatric hospitals in Aleppo, Syria, were bombarded causing staff to flee and leaving patients to fend for themselves, making them easy targets for snipers. The few psychiatric facilities that remained open, such as Dar al-Ajaza, faced chronic shortages of food, water, and medicine.[14] Already sparse services for people with are also at risk of being destroyed in conflict settings. For example, the only school for specialized children with disabilities in Gaza was destroyed during the 2014 conflict in Gaza.

The destruction of important infrastructure for persons with disabilities has also been documented in Yemen: with dozens of hospitals damaged, closed, or unable to receive supplies since the Saudi-led coalition began its aerial bombing campaign on March 26, 2015. People with disabilities were not able to access much-needed health care and medicines. More than 300 organizations that provided specialized services for people with disabilities had to close, many with their facilities in shambles. In many hospitals across Yemen that remained functioning, people with pre-existing disabilities were reportedly being denied access to medicines they require because of the urgent need to treat people injured in the conflict.[15] Further, schools and hostels for children with disabilities, including a school and girls’ hostel run by al-Aman Association for the Care and Rehabilitation of the Blind, were among buildings destroyed in coalition airstrikes on April 20.[16] Conflict can also cause disabilities, further compounding the need for disability focused humanitarian responses. The Israeli attacks on Gaza in 2014 injured 3,436 children, as a result 10 percent of those injured now have a permanent disability.[17]

Human Rights Watch research in the Central African Republic highlights how many of these challenges persist once persons with disabilities find their way to sites for internally displaced people, including difficulties accessing sanitation, food, and medical assistance.[18] People with disabilities interviewed by Human Rights Watch in IDP camps said that they were unable to make their way to food distribution sites as the locations were not accessible, or that by the time they made their way to the site with assistance, the distribution was already over. Further, accessing basic necessities such as latrines was difficult as some were not fully accessible and often people with physical disabilities had to crawl on the ground to enter, exposing them to potential health risks, such as life-threatening infections, respiratory problems related to inhaling excessive amounts of dust, or being burned on open fires. Persons with disabilities also faced increased barriers to accessing basic medical care even when it is provided in the camp if, for instance, there were no sign language interpreters for people with hearing disabilities. The dire living conditions and lack of access to medical care at the Bossemptélé Catholic mission, where Human Rights Watch conducted interviews, led to 53 people, as of April 2015, among the displaced community in the camp, including children and adults with disabilities, dying from malnutrition, respiratory illnesses, and other diseases. Additionally, access for persons with psychosocial or intellectual disabilities was even further restricted: in the areas that Human Rights Watch conducted research, there were no community-based mental health services available and only one hospital in Bangui provided a few psychiatric medications.[19]

This issue goes well beyond the Central African Republic. Around 7.6 million persons with disabilities live in situations of forced displacement around the world, according to the Women’s Refugee Commission (WRC), of whom women and girls with disabilities are particularly susceptible to gender-based violence and exploitation as community and government protection mechanisms deteriorate.[20] The WRC report continues: “Despite this, persons with disabilities are often excluded from programs and services designed to prevent and respond to GBV in humanitarian settings.”[21] Further, the WRC found in Lebanon that while most Syrian refugees with disabilities were able to access UNHCR registration, because of limited financial resources most were generally unable to access long-term rehabilitation services.[22] In this context, the WRC also found that many NGO workers and protection staff viewed persons with disabilities though the medical model, “failing to recognize social factors that may increase their vulnerability to protection concerns, and require a more comprehensive case management approach.”[23]

Discrimination

The gravity of the crisis in the Central African Republic, coupled with the alarming number of humanitarian emergencies globally, has resulted in an overwhelming burden on aid agencies. Although the United Nations had categorized the situation in the Central African Republic as one of the gravest by its standards, the country had not received adequate humanitarian funding, to the detriment of persons with disabilities. With limited available resources, aid agencies were often unable to address the specific challenges faced by people with disabilities. Of the eight UN and nongovernmental aid agencies Human Rights Watch interviewed, none were systematically collecting data on people with disabilities, and their needs were not fully included in the agencies’ programming. [24] One senior UN official familiar with the emergency response in the CAR told Human Rights Watch: “We don’t pay enough attention to the issue of disability. We should be doing more. There is no place for discrimination in humanitarian action.”[25]  

International donors and humanitarian organizations are uniquely placed to facilitate and implement a disability-inclusive humanitarian response. As such, international donors and humanitarian organizations should ensure that their own assistance strategies and policies hold up to the principles of non-discrimination, inclusion and equality articulated in the Convention on the Rights of Persons with Disabilities and other treaties. In that regard, donors should ensure that new money they provide for infrastructure requires such infrastructure to be accessible for people with disabilities and that other barriers to the participation of persons with disabilities in their communities are also avoided. Indeed, it is also essential for donors to ensure that humanitarian efforts they invest in are disability-inclusive.

Recommendations

To comply with Article 11 of the Convention on the Rights of Persons with Disabilities, Human Rights Watch recommends that governments, donors and humanitarian agencies:

• Ensure persons with disabilities, including those with newly acquired disabilities due to the crises, are explicitly identified as a high-risk population with specific needs when responding to humanitarian crises and situations of risk
• Include persons with disabilities, with specific representation for women with disabilities, in the planning and decision-making processes regarding responses to humanitarian crises and situations of risk; appoint persons with disabilities to camp management committees to ensure that their concerns are represented; if local organizations exist for persons with disabilities, consult them on how to include persons with disabilities in any humanitarian and aid programs; reach out to and support local organizations of persons with disabilities
• Ensure that information related to and during situations of risk and responses to them are accessible for individuals with a range of disabilities, including in sign language and easy-to-read formats
• When evacuations are undertaken, facilitate accessible evacuation for persons with disabilities
• Ensure access to basic services for persons with disabilities, including equal access to food and non-food distributions; provide adequate medical care, including mental health care, counseling and psychosocial support; help children with disabilities access education, including by training teachers and making classrooms fully accessible
• Call on aid organizations to work with local authorities once persons with disabilities, including those with newly acquired disabilities due to the crises, are resettled in their neighborhoods so that families have access to services such as medical care and schools
• Maintain disaggregated data (especially by disability, gender, and age) throughout humanitarian emergencies
• Include women and girls with disabilities in gender-based violence prevention programs in humanitarian settings, and hold accountable humanitarian organizations for considering the needs of girls and women with disabilities in gender-based violence programs
• Integrate disability into the training for humanitarian workers, emphasizing the social model of disability, the unique needs of persons with disabilities, and the importance of longer-term planning, holistic rehabilitation, and community inclusion and including how to identify and address discrimination, direct and indirect, against persons with disabilities
• Develop an action plan to include and support persons with disabilities in peacekeeping activities, with a special focus on how civilian protection and humanitarian support programs can incorporate their needs
• Ensure that newly-built infrastructure, including child-friendly spaces, are accessible to adults and children with disabilities
• Ensure that new funding for infrastructure requires such infrastructure (1) to be accessible for persons with disabilities and (2) to not create additional barriers to the participation of persons with disabilities in their communities.
• Assess all new funding to ensure it is not used to support, rebuild or reinstate systems or practices that violate the rights of persons with disabilities.

We hope the Office will find the comments in this submission useful and would welcome any opportunity to discuss them further with you. Thank you for your attention to our concerns.