Disability during armed conflict and emergency situations

What is disability?

The UN estimates that there are 500 million persons with disabilities in the world today. This number is increasing every year due to factors such as war and destruction, unhealthy living conditions, or the absence of knowledge about disability, its causes, prevention and treatment.

The Right to Rehabilitation Persons with disabilities have the right to rehabilitation (a process aimed at enabling persons with disabilities to reach and maintain their optimal physical, sensory, intellectual, psychiatric, social functional levels, providing them with the tools to achieve higher levels of independence) Rehabilitation is a right for every individual with disability regardless of the type and degree of their disability and Governments, organizations and communities are required to ensure the provision of appropriate rehabilitation services to persons with disabilities.

The most important costs of war are human costs whether deaths, injuries, disabilities or displacement. Armed conflict  and war impacts on health in a variety of ways, ranging from direct injuries, permanent disabilities and deaths to indirect effects such as population displacement, decline in social services and disruption of medical and public health programs .

In conflict, the nature and severity of impairments and disabilities associated with the injury differ greatly from peacetime counterparts. Several factors may contribute to prognosis and outcome. Evacuation time,  access to timely and adequate medical resources, and strategies adopted to treat a potentially large number of severely wounded cases in an often short period of time affect the medical management of the  injured.

Many people get impairments as a direct result of conflict or disaster situations, or arising from the inadequate healthcare and resources in the post-conflict or post disaster milieu.

The isolation and exclusion resulting from these impairments lead to more people becoming disabled.  “Disabled people are often made invisible by society, and invisibility can be lethal in situations of armed conflict or natural calamity.  Past experiences of disaster management shows that persons with disabilities are the most affected group and emergency responses are inadequate to reach out to disabled people.  In the aftermath of a conflict or disaster, disabled people may find their situation exacerbated by the loss of family members or carers, moving to inaccessible housing, loss of mobility and other aids, and lack of accessible information, food, water, sanitation and other infrastructure.  Persons with disabilities especially women, are particularly vulnerable to violence, exploitation and sexual abuse.

Prevalence of depression among populations that have experience armed conflict is 60-70% as opposed to 10-20% in non-conflict countries.  People who have suffered physical disabilities due to war require rehabilitation services at all levels.  The occurrence of a wide variety of psychological symptoms and syndromes in the populations in conflict situations is widely documented by available research. However, research also provides evidence about the resilience of more than half of the population in the face of the worst trauma in war situations. There is no doubt that the populations in war and conflict situations should receive mental health care as part of the total relief, rehabilitation and reconstruction processes.

The impact of armed conflict on the persons with disabilities in Syria

The unjustified blockade and the present conflict in Syria have had a devastating impact in particular on persons with disabilities and their related services. Emergency services in Syria are limited now and for the most part inaccessible which have resulted and will continue to result in serious threats to persons with disabilities.

Many of those who were injured during the military operations sustained permanent disabilities owing to the severity of their injuries and/or the lack of adequate and timely medical attention and rehabilitation.  Syrian hospitals reportedly had to discharge patients too early so as to handle incoming emergencies.  Many injuries cases resulted in amputations or disfigurement. The moral impact of conflict situation on persons with disabilities due to mental disorders, such as post-traumatic stress disorder is increasing in Syria.   There is a need to consider how traumatic combat situations can impact a person moral health later on in life. Suffering “moral injuries” can cause feelings of betrayal, shame, and grief.

Persons with disabilities and their families will have paid a much higher price during this conflict, as they have found it harder to safely evacuate into shelters, and to access emergency food and relief programmes, in addition to the disruption in their usual rehabilitation services.

In addition, programmes for persons with disabilities had to be closed down during the uprising and rehabilitation services stopped (for instance, organizations providing assistance were unable to access stocks of wheelchairs and other aids). Many social, educational, medical and psychological programmes have not yet fully resumed.

We have interviewed several persons of the seriously injured, who described their daily lives as a constant ordeal. People, who were paralyzed, for example, need colostomy bags, physiotherapy to avoid bedsores, special anti-bedsore mattresses, wheelchairs, pain relief medication, and anti-coagulants. Some of them had to rely on charitable donations to pay the cost of hospitals. In addition, many of the injured cannot return to their previous jobs, or have lost work and study opportunities. The loss of income affects both the victims and their families.