Volume 3 Issue 2 - January 15, 2005
Post-tsunami rehabilitation through the lens of disability
Early on the morning of December 26, 2004, as the world was preparing for the New Year, a deadly wave, described as the “worst human tragedy in decades”, shattered thousands of lives -- killing over 1,58,000 people, leaving many more injured, displaced and family-less. Anjali Sen Gupta wonders if aid is actually reaching disabled survivors of the tsunami.
In this moment of extreme misery and grief, our heart goes out everybody who is suffering, in particular to disabled people who have fallen victim to this tragedy, to people with disability who have survived this catastrophe and to those who may have been rendered physically/mentally disabled by this tragedy.
Many people around the world have rallied with support and help. For example, the United Nations (UN) has secured $717 million in record time for tsunami victims in Asia -- the first time the world body has collected so much money in such a short space of time after a disaster. Relief and rehabilitation work is on in full swing in the affected areas.
However, in any crisis, disabled people are likely to feel the negative impact of the crisis more keenly than other citizens. Their ability to cope and survive may be completely dependent on others, and the capacity of any family to support its disabled members is keenly tested in a crisis. Anecdotal evidence from acute emergencies suggests that disabled people suffer particularly high rates of mortality and morbidity. In addition to those who were disabled before the onset of the crisis, many more become disabled as a result of a range of factors. Such factors may include:
- Poor medical care.
- Interruption of preventive healthcare programmes.
- People with impaired mobility who are able to flee may be subsequently become more dependent because wheelchairs and other aids were left behind.
- Disabled people tend to be invisible to emergency registration systems. They are frequently left unregistered, which means that they fail to receive their basic entitlements to food, water and clothing and their specific needs are not met either.
- Frequently, the breakdown of support structures within a disaster affected population endangers the position of disabled people. They may lose their ability to function independently and within their dignity.
It cannot, and should not, be assumed that general distributions to the affected population will automatically reach the disabled members of that population, or that disabled people in a refugee camp will automatically have equitable access to whatever water is available. There are many reasons why disabled people are excluded, and unless agencies working among the affected people take specific actions, things will not change. Common reasons why disabled people fail to receive their entitlements include:
- They are hidden by their families.
- They may not know there is a distribution because they cannot attend community meetings, cannot hear radio announcements, or no provision has been made to inform them in any alternative way about their entitlements and available services.
- Problems of access may be aggravated by poor terrain or lack of mobility aids, or (for people with impaired sight) assistance with orientation.
- Emotional distress and or mental illness, often caused by the trauma of the crisis, is another reason why people are prevented from gaining access to relief distribution for themselves and their families.
- Disabled people and their families may not consider themselves to be capable of participating in micro-enterprises programmes.
Disability and the post-crisis reconstruction phase
Major reconstruction often follows emergency relief work, but planners often miss the opportunities to avoid recreating the inequitable status quo by adapting the design of the built environment to meet the needs of disabled people. For example, if schools are not rebuilt in a way that allows disabled children (both those who were previously disabled and the newly disabled) to attend school, this sends a damaging message to the disabled child and places limitations on his or her entire life. The long-term costs are high, since a disabled child who is prevented from going to school is far les likely to find employment and contribute directly to the national or local economy and will thus require lifetime assistance from the state or his or her family.
Disability too needs to be addressed
Most of the following guidelines are based on a code of minimum standards set forth in the Sphere Project: Humanitarian charter and minimum standards in disaster-response. In a remarkable international initiative aimed at improving the effectiveness and accountability of disaster response, this Charter sets out what people affected by disasters have a right to expect from humanitarian assistance. It points out that disability is an important cross-cutting issue which needs to be addressed by all those involved. It is based on the principles and provisions of international humanitarian, human rights and refugee law. Many UN technical staff participated in the development of this handbook. The UN Inter-Agency Standing Committee has endorsed the handbook and called upon all its members to use it.
The Charter includes key indicators and guidance notes in five core sectors - water supply and sanitation, nutrition, food aid, shelter and site planning, and health services. In each of the areas indicators relate to the needs of at-risk and vulnerable groups, including disabled people.
Human-rights framework: Emergency responses must be set firmly within a human-rights framework, demonstrating a commitment to ensuring equitable and inclusive service delivery.
The needs of disabled persons are the same as anyone else: Many of the items that disabled people need in emergencies are no different from other peoples needs, but it is important to bear in mind that they might need some specific utilities. For example: it can be harder for people with physical impairments to keep warm, due to lack of movement and poor circulation, so they may have increased need for warm clothing, blankets, firewood. Enabling aids (hearing-aids and batteries; crutches etc.) should be provided.
Prioritisation of disability issues is also a responsibility of donors: Donors could require a disability analysis, as many now incorporate a gender perspective, as a condition for contracts. There is a particularly strong case for this to happen in the reconstruction phase after an emergency, since there is an opportunity for equal access facilities to be integrated from the very beginning, for example in the reconstruction of public buildings.
Representation: T he participation of disaster-affected people in decision-making throughout the project cycle (assessment, design, implementation, monitoring and evaluation) helps to ensure that programmes are inclusive, equitable and effective. Special effort should be made to ensure the participation of a balanced representation of people within the assistance programme, including disabled people.
Communication and transparency: The sharing of information and knowledge among all those involved is fundamental to achieving a better understanding of the problem and to providing coordinated assistance. The results of assessments should be actively communicated to all concerned organisations and individuals. Mechanisms should be established to allow people to comment on the programme, for example, by means of public meetings or via community-based organisations. For individuals who are homebound or disabled, specific outreach programmes may be required.
Train volunteers and agencies ahead of time: It is commonplace in post-disaster situation for many services to be dispensed by volunteers. It is therefore important, where feasible, to train volunteers ahead of time in the basics of dealing with their fellow residents with disabilities.
Agencies and associations across India are busy working among the people, disabled and non-disabled alike, and providing relief and rehabilitation. Rajul Padmanabhan of Vidya Sagar says, “There is a lot of mental trauma among the survivors of the tsunami. Group counselling sessions are being held in some places.” Vidya Sagar is, and indeed many other organisations are, coordinating with other agencies to expand the network of relief. For instance, the Tsunami-Relief, Rehabilitation Coordination (TRRC), Tamil Nadu and Pondicherrry, has released a report titled ‘Post Disaster Rapid Situation/Impact Assessment Report', which has been designed and carried out in cooperation with non-governmental organisations, students and movements. The post-disaster situation of four tsunami-affected zones reveals that the number of persons severely injured or disabled is 751 (Chennai), 1,291 (Cuddalore), 3,713 (Nagapattinam), and 3,643 (Kanyakumari), respectively. The report also gives data for four districts in Chennai zone, as well as information on many other heads – such as number of people in trauma, physical damages, financial loss, disaster profiles, etc. (For details, contact email@example.com)
Others have pledged to help the survivors of the disaster by providing assistive devices like crutches, wheelchairs, collars, spinal corsets, etc.
NCPEDP, in association with DPI-India, has set up a Core Group of National Disability Network (NDN) partners who will study the impact of the tsunami vis-à-vis persons with disability in the affected areas. The members of the Core Group are:
- Javed Abidi, Convenor
- Rajul Padmanabhan, Vidya Sagar, Tamil Nadu
- Rama Chari, Senior Programme Officer, NCPEDP
- Dr Meenu Bhambhani, DPI-India, West
- J.K. Mukherjee, Sahara, Andaman and Nicobar Islands (He can be contacted on his cellphone, on 0-9434261027)
- Dr R. Narayanan, Pondicherry Physically Handicapped Welfare Association, Pondicherry (He can be contacted on his phone, on +0413 2237283)
- Kanika Sinha, Coordinator, NDN
Chari and Padmanabhan are are going on a two-day trip to the Andamans, on January 19 and 20, to assess the situation on the ground.
The fact that the needs of persons with disabilities need to be given priority in all relief, rehabilitation and reconstruction work will be highlighted by the NCPEDP at the highest levels. For instance, it plans to raise the issue with the Indian Prime Minister. Another issue of concern is that all long-term planning must also include disaster management strategies that help deal with such catastrophes.
Many disabled people have been, and still are, structurally excluded from relief programmes. Although the effect of the emergency is felt even stronger by disabled people and their relatives, the exclusion of persons with disabilities in emergency situations is even stronger than in ‘normal' situations. Their basic needs are simply not adequately met and their human rights are at best ignored, at worst abused. The exclusion or omission of disabled people has a negative impact on the quality and effectiveness of programmes.
Disabled people are among the poorest of the poor, the most disempowered, and the most in need, they are present in every community in the world, as well as in all populations targeted by relief and development interventions. Aid workers may not see them or know about them, but they will be there and they are likely to be among the most vulnerable or marginalised people within the target beneficiary population.
It follows that many agencies may be currently failing to fulfil their mandates. It is still not uncommon for relief and development agencies and donor institutions to be blind to disability or to ignore its impact when analysing a given situation and the needs of those who are most affected by an emergency. However, by including disability as a factor in assessments and using a variety of approaches to ensure that all people can obtain the relief to which they are entitled, it is possible to ensure that disabled people are included. This will lead to fuller, more effective compliance with the mandates and the humanitarian obligations of every relief and development agency.
A national cross-disability advocacy organisation, National Centre for Promotion of Employment for Disabled People, has set up a Tsunami Relief Fund to help disabled survivors of the tragedy. (Read the appeal for details of how you can help.)
(Written with inputs from: Barbara Oosters' (CBM, EU Liaison Officer) paper ‘Looking with a disability lens at the disaster caused by the tsunami in South-East Asia'; and Tsunami-Relief, Rehabilitation Coordination (TRRC), Tamil Nadu and Pondicherrry. )
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