Global Disability Summit: Key Takeaways On Disability-Inclusion In Protracted Conflict
Around 15 per cent of the world’s population lives with some form of disability. However, in conflict-ridden countries, this figure is said to be much higher. In Syria 3.7 million people, that is 27 per cent of the total population, aged 12+ has a disability.
The provision of complex care, namely the provision of reconstructive surgery, which is disability-reducing or disability-reversing in conflict settings is against a backdrop of damaged infrastructure, destroyed healthcare facilities and lack of the availability of sewage and water treatment system that ensure complex surgery can be done safely.
The Swisscross Side Event, Complex Care & Disability-Inclusive Humanitarian Action in War and Conflict at the Global Disability Summit 2022 is a discussion to understand how the circumstances of war and conflict can be a double burden to persons with disabilities, perpetuating inaccessibility and inequality in medical care, while also facing discrimination, stigma and economic hardships.
At this year’s Global Disability Summit, the world’s largest discussion on disability inclusion, Swisscross looked to highlight the often neglected and fiercely vulnerable communities of persons with disabilities in conflict settings.
The panel was moderated by Kimberly Gire, the Founder of Global Women Leaders Strategic Philanthropy and Co-chair of the Centre for Disaster Protection.
She was joined by Olivia Wells, the Director of Programs & Partnerships at Nadia’s Initiative, dedicated to rebuilding communities in crisis and advocating globally for survivors of sexual and gender-based violence. Professor Dr Ghassan Abu-Sittah, a multi-award-winning Plastic and Reconstructive Surgeon, who is a founding director of the Conflict Medicine Program at the American University of Beirut. And Dr Ian Furst, Oral and Maxillofacial Surgeon and CEO of Swisscross Foundation.
The following are key takeaways from the session.
1. The Ecology of War
The best framework to use to understand conflict, especially protracted and intense conflict, is to look at it in terms of an ecology of war. Conflict destroys, dismantles and damages living environments, healthcare systems and infrastructure, which in turn creates dangerous circumstances that cause physical injury.
Dr Ghassan Abu-Sittah explains that the ecology of war “creates a toxic environment as a result of environmental damage which increases the risks to human health and increases the risk of poisoning and congenital abnormalities. [it] destroys societies in terms of laws societies create to protect people with disabilities and [which] ensure their inclusion, but it also dismantles societies that provide informal care-settings for people with disabilities and disrupts the economy which means those with disabilities become more economically vulnerable.”
The importance of using the framework of ecology is to “escape from the concept that somehow war is a temporal event. It is not. It impacts people’s lives in a “permanent way.”
Persons with disabilities living in conflict settings face increased risk of injury, death, sexual violence, and lack of access to health services and complex care. The inaccessibility to humanitarian assistance including food, shelter, and medical care can have devastating impacts on the health and wellbeing of persons with disabilities.
2. Reinvestment in Health Systems
Reinvesting in health systems in conflict settings must be a priority for governments, funders, and humanitarian actors, especially as “the consequences for what can be alleviated in terms of disability is multiple-fold in conflict settings because of the vulnerability of people with disabilities in these areas.”
Most of the patients and communities Swisscross Foundation and panellists spoke about are from vulnerable populations, including the vast majority refugees or internally displaced.
“They live in camps and really this just amplifies the challenges that most people with disabilities face - low income, limited resources, lack of accommodations plus the times that they’re able to travel are restricted when they’re [living] in camps which adds another layer of problems to logistics. When you have someone with disabilities who needs complex care, they may have many, many appointments and needs and their movements are restricted,” explained Dr Ian Furst.
The panellists reiterated the fact that conflict is “dynamic” and in this environment for every one person wounded, there is another who has a congenital disability, that can often be reversed or at least improved and there is another person who has an injury acquired by the circumstances of war. This includes people who have suffered burns while living in camps. Dr Ian Furst explained that 30 to 40 per cent of their total patient volume in Erbil. Iraq are people who have burns acquired in a camp, leaving men, women, and children with acquired disabilities.
The case for reinvestment in health systems in conflict settings is not just about the medical and psychosocial help it provides very vulnerable communities, but how it has considerable economic consequences for those injured and with disabilities.
Dr Ghassan said: “We need to understand the economic consequences of a potentially reversible or a potentially reducible disability. A child with disability is cared for by up to 5 to 6 members of their family, because they’re unable to take care of themselves physically and economically. Therefore, an intervention that reduces that disability will not only set that child free but will set members of that family free. An early intervention for the child means they can become economically independent.”
Health systems reinvestment also means rebuilding a “new generation of reconstructive surgeons, health professionals and physiotherapists” in countries like Iraq, Syria, Libya, Yemen, and Palestine after the “migration of health workers [and] the loss of decades of skills in these countries.”
3. Context-Specific Care
In addressing disabilities in conflict settings, rather than the systemic level approach which we often see, healthcare needs to focus on the “pathology rather than the population.” Dr Ian Furst explained that focusing on a particular disability such as an amputated limb or severe burns allows to better build a system around this. “Creating solutions based on a pathology that are context specific. Ones that are designed to operate in fragmented healthcare systems that we have, rather than the ideal healthcare systems we’d like. Make these small resilient systems that treat a specific pathology that are designed to scale.”
Olivia Wells impressed on the importance of being “led by people from within the communities you are serving, who are the best to understand and deliver programs which benefit the community at grassroot levels.”
She explained: “The programs we develop are in tandem with the people that we are serving. One thing we are doing is to make sure all our programs are disability inclusive. What we have noticed from this community and especially women and women with disabilities is that they are often not included in the programming, which is designed to benefit them…it needs to be holistic, and survivor centred.”
All panellists were agreed that people they are serving in conflict settings do not need “parachute missions.” Instead, there is a need for long-term partnerships with local communities, which are not only led by local communities and organisations but are based and designed on context-specific solutions.
Olivia Wells concluded: “Bringing expats in has to be in tandem with local capacity building settings, while listening to local people and people directly affected by disabilities and then it becomes a shared learning experience.”
You can watch the session in full here.
