Home / Healthcare & Medicine / Global Health and Disability / Case study: rehabilitation in humanitarian settings
Case study: rehabilitation in humanitarian settings
Introduces people with disabilities' rehabilitation needs in context of humanitarian settings
SARAH POLACK: People with disabilities can be particularly vulnerable during and after humanitarian crises. They are all too often neglected in the planning, design, and delivery of humanitarian aid, and can face a range of additional challenges. During, for example, conflicts or natural disaster, they may find it harder to leave due to inaccessible evacuation routes or loss or damage to assistive devices. Difficulties accessing information about an emergency has also been documented, particularly for people with cognitive or sensory impairments. Following displacement, or when relief arrives, they may find it harder to access the services and protection they need, due to a range of barriers. Imagine a woman with severe mobility difficulties living in a refugee camp.
Inaccessible roads and buildings, long queues, negative attitudes among staff, may all make it very hard for her to access health services and also food programmes. Further, the food provided may not be appropriate for some people with disabilities who have particular nutrition requirements, such as children with cerebral palsy, leading to greater risk of malnutrition. People with disabilities may also require additional specific services, such as mental health services and rehabilitation services, for example, assistive devices, which are often sorely lacking, further limiting their participation. And at the same time, emergencies themselves can also lead to or exacerbate disability. We will now provide a few case study examples about disability in humanitarian settings.
SLIDE: REHABILITATION IN HUMANITARIAN SETTINGS
PHILLIP SHEPPARD: Rehabilitation is really about improving quality of life, and this applies across all humanitarian settings. So from sudden onset disasters, such as earthquakes or tsunamis or more naturally caused disasters, to instances of conflict or displacement. And over the last short amount of history, we’ve seen an increase in the number of disasters in the world. So, for instance, between 2000 and 2009, there’s been three times more disasters than between 1980 and 1989. Along with this, we’ve also seen a shift from high mortality to increased morbidity, meaning that there are now more people surviving disasters than in the past, which is obviously really good.
But along with that, there’s also been an increase in people that are surviving with some form of disability, and often lifelong disability. I was in Nepal during the earthquakes of 2015, and immediately after the earthquake people were rushing their family members and friends to the hospital. And they were doing this by any means possible. So in some instances, people were putting their family member in a basket and carrying them on their back. I even saw someone who made a makeshift stretcher out of bamboo and a sheet, and they would throw their friend on the sheet and carry them to the hospital. And this obviously opens up people to secondary injuries, say for spinal cord injuries or complex fractures.
And rehabilitation really has an important role in that aspect of it to first train military and first responders in how to perform safe transfers, but also to work hands on with individuals to make sure that we’re avoiding secondary injury. Then I moved on to supporting in emergency rooms, and what was happening there is that doctors and nurses and medical professionals were really doing what they do best, and they were saving lives. But there is really a backlog on the system, and there were thousands and thousands of people going to the emergency rooms.
So what rehabilitation workers can do is help, first triage patients so that we can divert them to either have surgery or receive lifesaving treatment, or we can triage them towards the wards. And when they are in the wards, we know that getting people moving early improves their function later, but it also allows people to go home sooner. And this is obviously good for the individual because they get to go back to their families and communities and interact with their societies, but it’s also beneficial for the health care system as a whole.
And when they do return to their communities, rehabilitation is essential to make sure that people are able to participate fully with society, and they’re able to go back and fit their family roles that they had before and also that they’re able to work and obtain either financial support through employment or go back to farming and support their families and communities in that way. Now, I’ve been working also, recently, on a project at the London School of Hygiene and Tropical Medicine, looking at the experiences of people with disabilities in conflicts and in instances of displacement. And rehabilitation is crucial, again, for all parts of the humanitarian crises.
So what we found is, when I was working in Ukraine, in the conflict along the east, was that people with disabilities were often unable to flee the areas prior to the fighting or when the conflict started. And they often ended up staying there very long periods of time after the conflict and leaving much after the fighting started, if they ever did. So again rehabilitation can really help improve function so that people are able to flee earlier and provide them a safe location to go to. Then, the second part of the project was working in refugee camps in Tanzania along the border of Burundi.
When we were speaking with people who were living in the camps themselves, we found that people with disabilities were often more susceptible to security issues and food insecurity and water insecurity. So, especially for people who had visual impairments or hearing impairments, there were often cases where people would, say steal the mattress that they were provided, or the food that they received during the food distribution and much more for people with disabilities than people without. And along with that, similar to what we were seeing in conflict areas, is that the structure of the service delivery, or the aid delivery itself, often didn’t take into account the specific requirements of people with disabilities.
So again, people were unable to send someone in their place to receive food distribution, the food distribution often ended up being in areas that were quite far from where the individual was living, and also, the health care facilities were often quite far. This is obviously difficult for routine services that people would need or health care, but even more difficult for people who require emergency medical services. Rehabilitation is really important for all of the disasters I was talking about, from sudden onset disasters, such as earthquakes or tsunamis, to instances of conflict or displacement.
SLIDE: MENTAL HEALTH IN HUMANITARIAN SETTINGS
JULIAN EATON: It’s clear to anyone who’s worked in humanitarian emergency settings that alongside the physical problems that people can have after an emergency, and the disruption in the social environment, and access to resources like food or shelter, is the distress that you can have, emotionally, following a traumatic experience. Now, the great majority of people in these settings will have an emotional response that is an appropriate one to a distressing thing happening to them. There’s only a relatively small proportion of people who will go on to have mental health problems that are more severe that they can’t cope with themselves.
And this is really an important lesson that’s been learned in the last 10 or 15 years that we shouldn’t really be focusing mainly on medical or even psychological interventions for people with these severe reactions. But we need to recognise, actually, that by supporting communities to look after the majority of people who have a level of distress, we can help the great majority of people in a non-medicalised and appropriate way. So that really is where the term mental health and psychosocial support comes from. There is a need to look at these two tracks.
On the one hand, looking first after the basic needs, and then after basic emotional support for the majority of the population, while at the same time, making sure that we can identify and support people who have more severe needs, like post-traumatic stress disorder, for example, and depression and anxiety. There’s also another group of people who need to be remembered. Those are people who have ongoing, pre-existing mental health problems. For example, it’s very important to go to a mental hospital and make sure that the people there are not neglected because staff have left the hospital, including in the worst cases, for example, if people are locked and unable to leave those secure environments.
The Ebola crisis in West Africa was a time when there was a lot of social disruption and a huge amount of distress associated with, not only people who were personally affected and infected by the condition, but also by the families around the community that was very disrupted by the experience. One of the lessons that was learned very quickly was that people’s emotional distress was one of the biggest problems that they talked about, and yet found it very difficult to get support. In the event, we were able to work extensively with lots of local populations, particularly with interventions for really addressing the basic emotional needs of people.
The best known of these is probably psychological first aid, which is really about helping people who are front line workers to be able to give good emotional support to people around them. It’s worth recognising that the people who are actually providing support themselves had emotional needs. It can be very distressing, for example, being involved with burying bodies, particularly in the environment where you had to be dressed in that way, and there was always a significant risk of being infected yourself. It is therefore necessary to make sure that mental health services were also able to respond to the needs of those people, as well as to the needs of people in the general population who were distressed.
There are good guidelines available for how to look after the mental health and psychological needs of populations. Most appropriately and well known is the Interagency Standing Committee reference group on Mental Health and Psychosocial Support guidelines. They have recently been reviewed to make sure that they’re disability inclusive. One of the important lessons learned in mental health over the last 10 or 15 years, after having worked in many emergencies in mental health, is that often, actually, they provide an opportunity to build services that are stronger after the emergency than they were before. It’s often a time when mental health needs are raised in profile. People recognise how important they are.
And actually, during a period of relatively good funding, there’s opportunities to set up good services, and quite often it’s possible to continue those services afterwards. That’s a process that’s been termed “building back better” and actually demonstrates that emergencies can actually prove to be an opportunity to build things and communities that are better than that were there before.
SLIDE: WHAT CAN BE DONE TO IMPROVE THE MEANINGFUL INCLUSION OF PEOPLE WITH DISABILITIES IN HUMANITARIAN CRISIS?
SARAH POLACK: So what can be done to improve the meaningful inclusion of people with disabilities and humanitarian crisis? Encouragingly, a recent coalition of organisations have developed the charter on inclusion of people with disabilities and humanitarian action. This includes key principles to make humanitarian work more inclusive of people with disabilities, and these need to be put into action. People with disabilities should not be seen as victims. They should be meaningfully included in all aspects of planning, preparing, and delivery of humanitarian response, drawing from their skills and experiences to ensure that response is inclusive and takes into account the diversity of needs.
A twin track approach is important, ensuring the efforts are inclusive of all people with disabilities, for example, accessible infrastructure, non-discrimination, inclusive education, as well as addressing the particular needs of people with disabilities, for example, the provision of assistive devices or sign language interpreters. And finally, there’s an urgent need to collect disability data in order to highlight the situation and to develop and inform the development of a more inclusive response.
In this Step, Dr. Sarah Pollack (LSHTM) introduces disability in humanitarian settings. She is then followed by Phillip Sheppard (LSHTM) who presents about rehabilitation in humanitarian settings, and Dr. Julian Eaton (LSHTM and CBM) who presents about mental health in humanitarian settings. Dr. Pollack then concludes by highlighting next steps for disability inclusion in humanitarian settings.
Disability inclusion in humanitarian settings is an important topic and this is the first time we are discussing it in our course. Our three presenters provide very insightful information about this topic, and therefore the video is longer than other videos in our course.
In this video, Dr. Pollack first presents an overview of disability in humanitarian settings highlighting that people with disabilities can be particularly vulnerable during and after humanitarian crises with examples.
Phillip Sheppard then follows discussing rehabilitation in humanitarian settings and provides examples form his work in Nepal, Ukraine and Tanzania.
Dr. Eaton then discusses mental health in humanitarian settings and provides an example from the Ebola crisis in Sierra Leone.
The video concludes by highlighting next steps for disability inclusion in humanitarian settings.
What are your experiences with people with disabilities in humanitarian settings? Share your experiences below.
Reach your personal and professional goals
Unlock access to hundreds of expert online courses and degrees from top universities and educators to gain accredited qualifications and professional CV-building certificates.
Join over 18 million learners to launch, switch or build upon your career, all at your own pace, across a wide range of topic areas.
