The Syrian Refugee Crisis: Shining a light on the response to impairment, disease, and disability

By Ollie King

As of 2014, Syrians constitute the worlds largest refugee population. To most, this comes as no surprise. The media is packed with stories of huge migrations of people fleeing war-torn Syria in search of refuge, a journey beset with danger for even the most able-bodied men, women, and children. Those so often ignored or ill-considered in these circumstances are those who are not able-bodied - refugees suffering injury, impairment, and disability.

The recognition of persons with disabilities is a fairly recent addition to the United Nations (UN) treaty body system. The introduction of the Convention on the Rights of Persons with Disabilities (CRPD) in 2006 is the manifestation of this recognition; a unified document of special clauses and elaborations on previously established rights that serves to shine a light on the needs of people disabled by a society that is unable to cater to their needs. The CRPD is intended to mark the end of a long history of invisibility for disabled people in the eyes of nation-states and the wider international community. However, in the context of human displacement, the promise of recognition and special attention is severely lacking. Article 11 of the CRPD is explicit in committing States Parties to the protection and safety of persons with disabilities in humanitarian emergencies. So where is the international community failing in its mandate to protect refugees with disabilities? What can be done to improve the recognition and response to disabled refugees fleeing conflict?

 Picture sourced from http://www.aljazeera.com/indepth/inpictures/2015/09/window-desperate-journey-150917085100247.html

A rare example of a comprehensive study carried out in this area comes from HelpAge International and Handicap International. Published in 2014, the collaborative study collected data from Syrian refugees in Jordan and Lebanon, seeking to establish their number and their specific needs. Alarmingly, it found that 22% of refugees are affected by an impairment, with 6% affected by an impairment deemed severe (to illustrate how significant this is, the World Report on Disability estimates that 15.3% of the entire world’s population suffers from an impairment). Furthermore, elderly people are disproportionately represented - 70% have at least one impairment, and are twice as likely to suffer intellectual impairments when compared to children.

Levels of conflict-related injuries are notably high in the case of the Syrian conflict - one in 30 refugees that fled to Lebanon, and one in 15 refugees in Jordan were injured as a direct result of the fighting. Working-age men are particularly exposed to the risk of injury; aside from their role in combat, the responsibility for fetching food, water and other provisions often falls to them. Some young men even travel back to Syria to check on their property, contributing further to a life already fraught with danger for Syrian males in particular. Without effective rehabilitation, injury-related health conditions are likely to deteriorate into permanent disability.

Picture sourced from www.http://edition.cnn.com/2012/12/13/opinion/syria-unreported-refugees/

Looking to issues of psychological well-being, half of the refugees affected by impairments, injuries and non-communicable diseases reported at least one sign of recurring psychological distress. These signs include changes in behaviour, emotional state, cognition, and relationships. Once again, the elderly were disproportionately affected, with over 65% reporting one or more of the aforementioned signs.

Crucially, the study found significant difficulties in ‘activities of daily living’ (ADL). ADL is a term used by healthcare professionals to refer to basic self-care activities such as bathing, feeding and dressing oneself. In the general refugee population worldwide, 6% reported difficulties in ADL. Within the Syrian refugee populations in Lebanon and Jordan, 45% of refugees with an impairment, injury or chronic disease had difficulties in ADL; this figure rose to 60% for elderly refugees. This is a staggering increase with severe ramifications. Those struggling with ADL are far less likely to access family and community support strategies, and static and mobile outreach programmes.

As demonstrated, the danger and suffering that disabled people face during humanitarian emergencies is significantly enhanced. The inability of response programmes to tackle the needs of disabled refugees effectively comes down to the lack of a clear picture. Whilst the study conducted by HelpAge International and Handicap International is a step in the right direction, we still lack an understanding of the level and nature of help required within the majority of refugee populations around the world. For this reason governments, national institutions, and NGOs remain profoundly limited in their responses. Injuries become permanent disabilities when they are not treated and rehabilitated, chronic diseases go unchecked and untreated without simple diagnoses and medication, and psychological distress is allowed to fester and endure to become yet another plight for those already impaired.

Picture sourced from http://www.mirror.co.uk/news/world-news/syrian-refugee-carries-disabled-brother-6380968

For those nations receiving refugees, it is essential that they work with dedicated NGOs and healthcare organisations to share information and research for adequate response programmes. Data collection should be inclusive and participatory, allowing all groups an opportunity to engage in focus group discussions so that they can have some input into programme design. Sphere standards must be applied to the collection of data, which should be disaggregated by age and gender (The Sphere Project, launched in 1997, was developed to set minimum standards in the core areas of humanitarian assistance). In addition, data must be further disaggregated by impairment, injury, and chronic disease. Using questions established by the Washington Group, measurements of disability must be incorporated into every statistical survey that concerns refugees. With the collection of refugee statistics remaining constant, the information produced can be compared between different contexts. The accurate collection of data will ultimately contribute to the design and delivery of specific response programmes that are the result of a rigorous analysis of the problems at hand.

Historically, the recognition of the specific needs of people with disabilities has been severely lacking. Left in the dark, they have been overlooked in the formation of policy and the consideration for accessibility in societies worldwide. Today, the CRPD has led the way in providing visibility to people with disabilities. However, consideration for those suffering with a disability within refugee populations is far from adequate. The first step in providing services for this diverse group of suffering people is recognising their size and the diversity of their needs. While HelpAge International and Handicap International have set an important example, we are far from reaching the necessary depth of understanding. Only a deep understanding will allow for a response that is so desperately needed by the most vulnerable of an already vulnerable refugee population.