Shantha Rau Barriga is director of the disability rights division at Human Rights Watch. She leads research and advocacy on human rights abuses against persons with disabilities worldwide including: the shackling of people with psychosocial disabilities, denial of education for children with disabilities, violence against women and girls with disabilities, institutionalization of children and adults with disabilities, and the neglect of people with disabilities in humanitarian emergencies. She has worked on projects on Central African Republic, China, Croatia, Ghana, India, Indonesia, Morocco, Nepal, Peru, Russia, Serbia, Uganda, the United States, Yemen and Zambia.  

Shantha was a member of the UNICEF Advisory Board for the 2013 State of the World’s Children report and is a founding member of the International Network of Women with Disabilities. 

Before joining Human Rights Watch, Shantha participated in the UN negotiations toward the Convention on the Rights of Persons with Disabilities. Shantha received degrees from the Fletcher School of Law and Diplomacy at Tufts University and the University of Michigan, and was a Fulbright Scholar to Austria. She speaks German and Kannada.

Posted: January 1, 1970, 12:00 am

(Nairobi, June 21, 2017) –People with disabilities in the Central African Republic have faced violent attacks, forced displacement, and ongoing neglect in the humanitarian response, Human Rights Watch said today. A peace accord signed on June 19, 2017, offers a chance to help this abused and marginalized group.

People with disabilities face high risk from violent attacks and forced displacement and are being neglected by aid groups as conflict in the Central African Republic intensifies.

New Human Rights Watch research in the country shows that people with a range of disabilities are often unable to flee violence, are especially vulnerable to attack while trying to flee, and face unsafe and unhealthy conditions in displacement camps.

“The peace accord should bring a respite for civilians who have been brutalized in this conflict, especially people with disabilities who suffer violence and neglect,” said Lewis Mudge, Africa researcher at Human Rights Watch. “People with disabilities and other at-risk groups should get the protection and assistance they desperately need.”

In April 2017, Human Rights Watch interviewed more than 30 people with disabilities in Bambari and Kaga-Bandoro, two towns affected by a recent surge in violence. This research builds on an April 2015 report to reveal the ongoing abuse that people with disabilities face in the conflict.

To improve protection for people with disabilities, the United Nations peacekeeping mission, MINUSCA, and relevant United Nations bodies should monitor and report publicly about abuses against these people and dedicate resources to improving the limited humanitarian assistance that they receive, Human Rights Watch said. Governments should also urgently contribute to the UN’s humanitarian appeal for the Central African Republic.

In some cases, people with disabilities either could not or chose not to flee an attack. “Jacques” from the town of Wadja-Wadja said that fighters from a Seleka faction, the Union for Peace in the Central African Republic (l’Union pour la Paix en Centrafrique, UPC,) killed his friend “Spa,” a 40-year-old man with a physical disability, when they attacked the town of Yassine on March 20.

“Spa did not like his crutches because he felt they made him slow,” Jacques said. “When the attack started, he was not moving. I don’t know why. Maybe he thought he would not be killed because he had a disability. When I went back to Yassine I saw him dead. He had been shot in the chest. He was still in the same place I saw him when I fled.”

Human Rights Watch interviewed people with various physical disabilities who were threatened or shot at as they tried to flee fighting. One woman who cannot walk watched as her two children, 4 and 5, drowned while trying to cross a river alone.

The peace accord should bring a respite for civilians who have been brutalized in this conflict, especially people with disabilities who suffer violence and neglect. People with disabilities and other at-risk groups should get the protection and assistance they desperately need.

Lewis Mudge

Africa researcher

On June 19, the government and 13 of 14 armed groups active in the country signed a peace accord mediated by the Roman Catholic Community of Sant’Egidio. The accord commits the parties to end their hostilities and to recognize last year’s presidential election results.

The accord is a step toward ending the conflict that should also promote accountability for grave crimes that were committed. This includes criminal prosecutions under the jurisdiction of the Special Criminal Court, a hybrid domestic court with local and international staffing, and the International Criminal Court (ICC), Human Rights Watch said. The accord takes note of both courts and calls for the creation of a Truth, Justice and Reconciliation Commission.

More than 500,000 people are living in camps for internally displaced people, and about 400,000 are refugees in neighboring countries. There is no data on the numbers and needs of people with disabilities.

For people with disabilities, either from before the conflict or due to injuries sustained during attacks, conditions in the internal displacement camps are particularly harsh. Camp residents receive limited aid but people with disabilities, especially those without family members, struggle to get food due to the often chaotic and disorganized nature of food distributions.

“At food distributions people fight and I have to crawl on the ground to find a little,” said “Yvonne,” a 55-year-old woman with a physical disability who fled fighting in Bakala and lives in the PK8 camp outside of Bambari. “Sometimes I don’t even have two beans.”

Others said they cannot access showers and toilets because they lack ramps and are too small for a wheelchair. “François,” who fled Ndassima, described his struggles at the PK8 camp. “The access to the toilets is so difficult,” he said. “I have to walk with my hands and I don’t have gloves. I must wrap my hands in tissue if I can find it. Most of the time I can’t find it. Honestly it makes me pity myself.”

People with disabilities living in displacement camps in Kaga-Bandoro hold a meeting in April 2017. The group convenes each Sunday, and members say they receive very little assistance.

© 2017 Edouard Dropsy for Human Rights Watch

Access to the camps is part of the problem. UN agencies and other aid groups are sometimes unable to get supplies to camps due to danger on the roads. The lack of resources presents another problem. A UN humanitarian appeal has received only 28 percent of its US$399 million target from donor nations.

While the UN and aid organizations are managing a complex crisis with limited means, they could do more to identify and report on the challenges to assist people with disabilities, and devise programs to address their plight, Human Rights Watch said.

Absent UN monitoring and reporting, the full impact of the conflict on people with disabilities remains unclear. A 369-page Mapping Report issued by the UN in May documents war crimes by all parties to the conflict from 2003 to 2015, but does not cover how people with disabilities have been affected by the fighting. Reports from the secretary-general also have not mentioned the conflict’s impact on people with disabilities.

“People with disabilities are suffering disproportionately in the Central African Republic and then falling through the cracks,” Mudge said. “Governments and the UN should dedicate more funds and improve the protection of civilians, with special attention to those in urgent need.” 

“Jeanette,” a 27-year-old polio survivor, in the “MINUSCA” camp in Kaga-Bandoro. “I do not have a wheelchair and I have to use shoes on my hands to move around… It is very dirty and I’m filthy in other people feces if I try to use the toilet. I am scared it will make me sick,” she said.

© 2017 Edouard Dropsy for Human Rights Watch

Conflict in the Central African Republic

The Central African Republic has been in crisis since late 2012, when mostly Muslim Seleka rebels began a military campaign against the government of Francois Bozizé, seizing Bangui in March 2013. Their rule was marked by widespread human rights abuses, including the wide-scale killing of civilians. In mid-2013, the Christian and animist anti-balaka militia organized to fight the Seleka. Associating all Muslims with the Seleka, the anti-balaka carried out large-scale reprisal attacks against Muslim civilians in Bangui and western parts of the country.

In 2014, African Union and French forces pushed the Seleka out of Bangui and, by the end of the year, the Seleka had split into several factions, each controlling its own area. Since November 2016, the conflict has spread east as Seleka factions turned on each other. Conflict spread to the Ouaka province in December as some factions joined forces with anti-balaka groups in the area. In May, attacks by groups in Bangassou displaced thousands of people. Fighting between these groups remains a serious threat to civilians in the center of the country.

The government of President Faustin-Archange Touadéra struggles to maintain security and has little presence in areas outside the capital, Bangui, due to the activity of armed groups. The UN peacekeeping force in the country, the Multidimensional Integrated Stabilization Mission in the Central African Republic (MINUSCA), is the only force with the capacity to protect civilians. It has a mandate to use force, but has struggled at times to stop attacks or keep roads open. The force itself has increasingly come under attack, losing six peacekeepers in May.

“Francis,” a 16-year-old polio survivor, was forced to flee Bakala with his family when UPC (the Union for Peace in the Central African Republic) forces attacked in December 2016. “There was shooting everywhere,” he told Human Rights Watch. “My father just threw me into my wheelchair and he pushed me as fast as he could.”

© 2017 Edouard Dropsy for Human Rights Watch
The conflict has created a humanitarian crisis. More than 483,000 people have fled the country and over 503,000 are internally displaced. Over 2.2 million people require humanitarian assistance.

On June 19, the Community of Sant’Egidio in Rome mediated a peace accord between the government and all of the armed groups active in the country except 3R (“Return, Reclamation, Rehabilitation,”) which reportedly could not attend due to logistical reasons. The accord calls for an immediate ceasefire in return for political representation, as well as the creation of a Truth, Justice and Reconciliation Commission with a 12-month mandate. The creation of a truth commission does not preclude investigations and prosecutions for war crimes by all parties, including in domestic courts, the Special Criminal Court and the ICC, which has a mandate to investigate grave international crimes in the country.

People with Disabilities Victims of Attacks

Clashes Around Bria: November 2016 – January 2017

On November 21, clashes broke out between two Seleka factions, the Popular Front for the Renaissance of Central Africa (Front Populaire pour la Renaissance de la Centrafrique, FPRC) and the Union for Peace in the Central African Republic (l’Union pour la Paix en Centrafrique, UPC) in Bria, the capital of the Haute Kotto province, over control of roads leading to diamond mines around Kalaga, a town 45 kilometers from Bria. The fighting left at least 115 combatants and 14 civilians dead and 76 civilians wounded, and displaced up to 10,000 people.

“Laurence,” a 55-year-old polio survivor who cannot walk, said he fled Ndassima, a gold mining center in the Ouaka province between Bria and Bambari, in January due to fighting:

I can’t walk fast and when we heard the shooting I told my family we had to leave. My family had to walk slowly to make sure I could make it. As we fled, one of my sons was killed five kilometers outside of town. He was 13-years-old. He was trying to help me move faster and he was hit by a bullet. It then took us five days to walk to Bambari…We had no food that entire time.

“Arun,” a 43-year-old Peuhl man with an intellectual disability, said he fled Bria in November after the fighting began. He was traveling with a group of about six people when FPRC fighters attacked:

When we were attacked in the bush, I was very scared. I thought I was already dead and it was hard to think. One of the attackers tried to shoot me and I don’t know why I am alive. I thought I had been struck by a bullet. I just ran. I don’t know how many days it took me to get to Ippy. I just walked.

Arun estimated that, because he was confused and disorientated, it took him at least a week to walk in the savannah woodlands to Ippy where he eventually found other Peuhl.

Kaga-Bandoro: October 11, 2016

On October 12, FPRC fighters and fighters from another group, the Central African Patriotic Movement (Mouvement Patriotique pour la Centrafrique, MPC), killed at least 37 civilians and wounded 57. The fighters razed the l’Évêché camp for displaced people in Kaga-Bandoro, forcing thousands of people to flee. About 7,000 people displaced by fighting in the region had been living in the camp. The attack was in response to the killing of a Seleka fighter the previous night, but tensions in Kaga-Bandoro had been high since September 16, when Seleka fighters killed six civilians in Ndomete, a town 10 kilometers away. 

“Janet,” a resident of the Catholic Mission neighborhood, sought shelter at the home of a neighbor, Bakoudou Kankandi, who is deaf and does not speak. Seleka fighters soon broke down the door asking if there were men in the home, she said. Janet told them no but the fighters made everyone leave the house and go to the MINUSCA base. When they saw Kankandi, they got angry and shot him dead. “‘You said there were no men here – is this not a man?’ Janet recalled the Seleka fighters saying. “I said, ‘No, he is deaf and dumb, he does not understand.’ But they shot him anyway.”

At least three older people with disabilities were left behind at the displacement site and burned to death in the fire, survivors said.

A relative of Gilbert Bingimale, an older man with a physical disability, said that the family had to leave Bingimale in the hut so they could save the children. “It was burned down and when we came back later we found him still there,” the relative said. “He must have hidden thinking he would be safe. All his skin had burned off.”

A relative of Pauline Pharama, a 70-year-old blind woman, said he could not reach Pharama after the attack started. He said he returned the next morning and found her body charred and eaten by dogs.

Ouaka, Ouham and Nana-Grébizi Provinces: 2014 – 2015

On November 10, 2014, UPC fighters entered Bolo, a town in the Ouaka province, residents said. They immediately started shooting at people, causing villagers to flee. At least 11 people were killed, including at least two people with disabilities. A witness to the attack, “Léonard,” said:

Isaac Kimari was paralyzed and could not move. When the Seleka came they burned homes and Isaac was still inside his. Two of his family members, Henrietta Achie and Ange Lebaja, stayed and died in the house with him. We don’t know why they decided to stay.

Another man with a physical disability, Justin Jemafou, was also killed in the attack. “Justin could not move a side of his body,” Léonard said. “He was killed trying to crawl away.”

In November 2014, anti-balaka forces from Pende attacked Ngbima in the southern Ouaka Province. According to 10 residents, on November 25 they killed 28 civilians in Ngbima, including a 25-year-old woman with a physical disability named Yassimara. Her husband said:

Yassimara was born with a bad foot. She could walk on it, and she could only move with a cane and could only move slowly. We were at home when the attack started. It was early in the morning and we heard the shots. I saw people running out of their homes. I heard the anti-balaka shouting, “Take Ngbima! Attack!” I ran to the bush, but my wife stayed at the house. I did not have time to get her. I just hoped she would be okay. They burned the house with her in it, she never tried to run. After the attack we found some of her bones and buried them.

In the village of Bizomo in February 2015, on the road between Batangafo and Kaga-Bandoro, Peuhl fighters killed Paul Orogbia, a 70-year-old man who was blind. A relative of Orogbia said:

When the village was attacked, he [Orogbia] refused to move. He said, ‘Where do you want to take me? I don’t have any strength and I am blind.’ He said he preferred to stay and die. We returned to the village during the night and found his body – he had been shot. We buried him the same night.

Some people acquired disabilities from Seleka attacks. “Maurice,” a 35-year-old man from Bokandji, near Botto in Nana-Grébizi province, was captured by the Seleka in 2014. As the Seleka looted his home they asked him where he hid his money. He insisted that he had none:

One of the Seleka said, ‘Let’s cut his throat.’ But another said, ‘No, if we do that he won’t really feel death.’ They tied me up with my hands to my feet behind my back and threw me into a cooking fire. I tried to roll out but they pushed me back into the fire. My right side was on the fire and they stepped on me to push me into it. I lost consciousness. When I woke up I was at the hospital. The doctors wanted to amputate my right arm, but my mother refused. It is now useless.


Dangers of Displacement

In areas under attack, people are often forced to flee their homes to save their lives. They face dangers when displaced but people with disabilities, particularly physical disabilities, are at even higher risk.

“Jeanette,” a 27-year-old woman with a physical disability, had to flee her home in Ngoulekpa I, in the Nana-Grébizi province, in 2014 when the Seleka attacked. Her father was killed in the attack and her mother fled without her, leaving her alone with her two children. She said:

The Seleka started to burn the house so we had to flee. My kids [4 and 5 years old] were young and I was moving on my hands, so we were slow. Nobody could help us. We got to a stream and my children tried to cross it. But they could not swim and the water was too deep. I watched as they both drowned. I then had to crawl to Kaga-Bandoro.

Yassine: March 20, 2017

On March 21, fighters from the UPC attacked a group of several hundred displaced people in the largely undefended town of Yassine.

“Fidel,” a 55-year-old resident of neighboring Wadja Wadja, who has a physical disability, said he fled into the surrounding woods. “I was running with crutches and I’m lucky to be alive,” he said. “I was moving slowly with the crutches, but I managed to hide in the bushes. I tried to push myself back but I fell into a stream.”

“Blandine,” a 30-year-old woman with a physical disability caused by polio, said she pretended to be dead during the attack on Yassine because she could not run away. “Everyone ran and nobody would help me,” she said. “I just stayed on the ground and put my face in my hands. I heard screaming and shooting.” As UPC fighters looted Yassine, they found Blandine, stole her belongings, and told her to leave, she said. While leaving Yassine, she said she saw at least seven dead children, three dead women and four dead men. She crawled to Agoudou-Manga, seven kilometers away, and waited for three days before a truck came that could transport her to Bambari.

Bakala: December 11, 2016

On December 11, as fighting raged between the UPC and the FPRC, the UPC temporarily took control of Bakala, a town close to several gold mines in the Ouaka province. As the UPC attacked they quickly started to kill civilians, associating them with either FPRC sympathizers or anti-balaka.

“Monica,” a 30-year-old polio survivor who cannot walk, lost her husband and three children in the fighting:

During the attack, I went into the house to hide. My husband and I agreed beforehand that if there was an attack he would take the kids into the bush and hide. He told me to stay in the house and he left. The Peuhl [UPC] chased them into the bush and shot them all. After the attack, I wanted to look for my family so I crawled into the bush toward the river. I spent two days there until a neighbor came and told me my family was dead. He helped me get to Bambari. My children were 4, 3, and 2 years old.

“Francis,” a 16-year-old boy with a physical disability, fled Bakala with his family when the attack began. “There was shooting everywhere,” he said. “My father just threw me into my wheelchair and he pushed me as fast as he could.” Once out of town, Francis’ father pushed him 75 kilometers in his wheelchair, which Francis still has at the PK8 camp in Bambari, where he lives. “It took us three days,” he said. “When it was dangerous my father would hide me in the bush and move ahead alone to make sure it was safe. We had no food and no water during that entire time.”

Kaga-Bandoro: October 11, 2016

“Remy,” a 36-year-old man with a physical disability, said he has had trouble thinking clearly and expressing himself since he lost his arm in a grenade explosion in 2015. “I start to tremble when I am in the sun and I can’t walk [well],” he said. During the attack on the l’Évêché camp Remy was alone:

I don’t like to be in crowds, I preferred to stay in the hut alone. When I heard the attack, I was alone and I did not know where to go. I went outside. It was confusing. I could not move and I just stood there. I think I would have been killed had someone, I don’t know who, not grabbed me and made me run. He just told me to run or I would die.

“Clarise,” a 30-year-old mother of six who cannot walk, fled Ngououaka I for Kaga-Bandoro in 2014, a 15-kilometer journey that she said took one week and that she had to make alone, slowly crawling on her hands. She was also at the l’Évêché camp when it was attacked. She said:

When I saw they were burning huts I knew we had to run. I told my kids to leave me so they could move fast. I then followed by myself, moving with my hands. Bullets were going past me and I saw Seleka killing people. Then I was trapped by the smoke of the burning huts, but I just kept moving forward. It is by the grace of God that I managed to escape.

“André,” a 60-year-old polio survivor who cannot walk, said he fled the Kaga-Bandoro camp when he heard shots. “I knew I had to run as there was nobody to help me,” he said. “I had to flee on my hands, I saw dead people all around me. I was not helped by anyone and I was very scared. At any moment, the Seleka could have just shot me as well.”

“Michel,” a 35-year-old with a similar physical disability, had a similar experience and fled the Kaga-Bandoro camp using his hands. “I was abandoned by my family,” he said. “It was everyone for himself, so I had no choice but to move or die.”

Some people with disabilities had assistance when fleeing attacks. “James,” a 38-year-old man with a physical disability, said his brother carried him to safety when the l’Évêché camp was attacked. But he said that some people with intellectual disabilities apparently did not know they should flee. “Laurence,” a 29-year-old man with an intellectual disability, said he was abandoned when the camp was attacked. “When the huts were burning I stood there and watched them,” he said. “I did not like to see them burning, but I wanted to wait to see if our hut would burn.” His father ran back for him amid the fighting and took him to safety.


Fleeing Before the Fighting

Some people with disabilities said that, as the violence spread, they fled their homes preventively, before the fighting arrived.

“François,” a 45-year-old man with a physical disability from Ndassima, explained why he decided to leave for Bambari:

It was in 2015. The UPC were saying that useless people that could not work in the gold mine should leave. They told me, ‘If you stay here we will lock you in a house and burn you alive in it.’ I had no choice. I can’t run away, so I walked to Bambari. I used to sell things in Ndassima, I was not useless as they said. I would like to do business again, but I have nothing here. I do nothing during the day.

“Florence,” a 23-year-old woman with physical disabilities, said she fled Bakala in the days before the fighting when she heard rumors of an impending attack. She had to get to Bambari, 75 kilometers, using her hands as she did not have crutches. It took her several days.

“Salé,” a 42-year-old Peuhl man who was shot by anti-balaka fighters and severely injured his foot during an attack near Ngakobo in early 2015, said his health was deteriorating so he decided to go to Bambari. “First the anti-balaka targeted the Peuhl, but now the coalition [FPRC and anti-balaka] are targeting us,” he said. “I knew that if there was another attack I would not be able to run.”



Life in the Camps

More than 503,000 people are living in camps for internally displaced people in the center and eastern part of the country, most of them receiving assistance from the UN and other aid groups. In April, Human Rights Watch conducted research in five displacement camps in two of the larger towns in the east, Bambari and Kaga-Bandoro. All the camps were receiving limited humanitarian assistance, such as tents, food, and medicine. There, people with disabilities, many of whom had survived violent attacks, face daily hardships, in particular when it comes to sanitation and food.

Water and Sanitation

Access to water and sanitation services, such as latrines and showers, is a daily struggle for people with disabilities in the eastern camps. Without ramps, bars, and other support, some people with physical disabilities must crawl on the ground to enter these areas, exposing them to health risks.

“Emmanuel,” a 38-year-old man who was injured when he fell while fleeing a Seleka attack in 2015 and now cannot walk, described the obstacles to using the toilet at the Lazare camp in Kaga-Bandoro. “I have to sit on the ground where other people defecate,” he said. “I don’t have gloves so I just try to wash my hands afterward. I don’t feel like a human being.”

“Michel,” 35, who is in the “MINUSCA” camp in Kaga-Bandoro, said that after almost four years, he has given up on getting services at the camp. “I can only go to relieve myself in the bush; I must go on my hands,” he said. “But now the new camp has been here for so long and people are defecating in the bush on the perimeter of the camp, so I find myself crawling through other peoples’ feces.”

“Monica,” 30, described similar difficulties at the PK8 camp in Bambari. “I have to use the toilet in the bush because I don’t have anything to protect my hands in the camp toilets,” she said. “In the bush I sometimes crawl through other peoples’ feces. These conditions make me sick because it is so dirty.”

“Geraldine,” a 70-year-old blind woman living alone in the PK8 camp in Bambari, said she has almost burned herself by walking into open fires and often struggles to find a toilet. “I’m alone and it is difficult for me to find the toilets,” she said. “Sometimes I have people help me, but usually I just find my way into the bush on the outside of the camps.”

“Florence,” a 36-year-old woman with a physical disability living in the PK8 camp, said:

To wash myself I must wait until it is night and I do it by my hut because I can’t get to the shower. I deplore these conditions of life, but I have no power to change it so I have had to get used to it.

Access to Food

Food distribution can be sporadic at displacement camps in Bambari and Kaga-Bandoro and people with disabilities, especially those without families, often struggle to obtain supplies in the chaos during disorganized distributions.

“It is very difficult to get food when it is distributed,” said 40-year-old “Thierry,” a man with a mobility disability who lives at the “MINUSCA” camp in Kaga-Bandoro. “Everyone is mixed and people start to fight with each other after a few minutes, so we people with disabilities must watch from the sidelines and just try to get what is left over.”

UN Peacekeepers’ Mandate

In April 2015, when the UN Security Council renewed the peacekeepers’ mandate, it expressed for the first time “serious concern about the dire situation of persons with disabilities in the CAR including abandonment, violence and lack of access to basic services.” The mandate stressed the need for the humanitarian response to address “the particular needs of persons with disabilities.” The Security Council specifically mandated MINUSCA to monitor, investigate, and report on abuses against persons with disabilities. When the Security Council renewed the mandate one year later, in April 2016, the language on people with disabilities was dropped.

Despite abundant evidence that people with disabilities are particularly at risk of attacks and abuse in the Central African Republic, monitoring and reporting efforts still fail to include this vulnerable group. MINUSCA’s report on human rights in the country from June 1, 2015, to March 31, 2016, for example, does not include any information about abuses committed by armed groups or government forces on people with disabilities.

Likewise, while the independent expert on the human rights situation in the Central African Republic mentioned the situation for people with disabilities affected by the conflict in her July 2015 report, the next year’s report did not include the issue. The secretary-general’s annual reports to the Security Council on children and armed conflict have covered the Central African Republic since 2016, but not explicitly included information on children with disabilities.

The 369-page comprehensive UN Mapping Report documents serious violations of human rights and international humanitarian law in the country from 2003 to 2015. The report covers 620 crimes “of the most serious gravity” by various parties but does not identify the crimes of which people with disabilities were victims.

The next renewal of the peacekeeping mandate is to be in November.



To the government of the Central African Republic:

  • Identify, register and include in any data collection efforts information on people with disabilities and their needs;
  • With international partners, develop an action plan to include and support people with disabilities and their local representative organizations in the humanitarian response to the crisis, especially in the eastern part of the country; and
  • Ensure access to basic services for people with disabilities in internal displacement camps. Provide priority and/or separate access to food and sanitation services for displaced people with disabilities in the camps.

To the UN Mission in Central African Republic (MINUSCA):

  • Assist the government in data collection efforts on people with disabilities and their needs; and
  • Include people with disabilities in human rights reporting.

To UN Agencies and Aid Organizations:

  • Assist the government in data collection efforts on people with disabilities and their needs;
  • Ensure equal access to basic services for people with disabilities in internal displacement camps. Provide separate access to food and sanitation services for people with disabilities in the camps;
  • Ensure the participation of persons with disabilities in the design, implementation, and monitoring of programs, strategies, and action plans that eliminate barriers to inclusion; and
  • Ensure that facilities in displacement camps, including access to sanitation facilities, are accessible to people with disabilities.

To the UN Security Council:

  • Request periodic reports, including from the secretary-general, on the situation of people with disabilities. 

To Donors, including the European Union and its member states:

  • Ensure the inclusion of people with disabilities in humanitarian assistance by requiring that all aid is accessible; and
  • Request implementing partners to report on beneficiaries with disabilities.
Posted: January 1, 1970, 12:00 am

People with disabilities face high risk from violent attacks and forced displacement and are being neglected by aid groups as conflict in the Central African Republic intensifies. New Human Rights Watch research shows that people with a range of disabilities are often unable to flee violence, are especially vulnerable to attack while trying to flee, and face unsafe and unhealthy conditions in displacement camps.

Posted: January 1, 1970, 12:00 am

(Brussels, June 1, 2017) – People with disabilities and other at-risk groups go unidentified on the Greek islands as the European Union inappropriately presses Greek authorities and medical aid organizations to reduce the number of asylum seekers identified as “vulnerable,” Human Rights Watch said today. The EU, and the Greek government, now prefer to contain all asylum seekers on the Greek islands. Before the new policy, asylum seekers identified as “vulnerable” were allowed to be transferred to the mainland to have their cases handled there.

Nujeen Mustafa is a Syrian disability activist who is hoping to get more EU involvement so that aid reaches all refugees, including people with disabilities.

During a visit to Greece from May 16 to 20 2017, Human Rights Watch met with representatives from the UN Refugee Agency (UNHCR), the International Organization for Migration (IOM), the European Commission, the Greek Asylum Service (GAS), local and international aid and medical organizations, lawyers, volunteers, and asylum seekers. Many of those interviewed by Human Rights Watch described indirect political pressure, in the form of multiple communiqués, to reduce the number of “vulnerable” asylum seekers and other migrants trapped on Greek islands, including people with disabilities, victims of torture, and survivors of sexual and gender-based violence.

“The European Union has hit another low in its efforts to deter new refugees and minimize obligations to ones already within its borders,” said Emina Ćerimović, disability rights researcher at Human Rights Watch. “The EU should be promoting the protection of asylum seekers, including those among them who may be particularly at risk, not unjustly pressuring the Greek authorities and medical actors to overlook them.”

Naima, 70, an older woman with a disability from Aleppo, Syria, with her daughter Hasne, in front of the shower area in Cherso camp, Thessaloniki. The showers are not accessible for people who use a wheelchair. Photograph by Emina Cerimovic. © October 2016 Human Rights Watch

According to aid organizations interviewed by Human Rights Watch, and unofficial notes from the protection working group meeting organized on March 14, 2017, in Athens, obtained by Human Rights Watch, a representative of GAS claimed there are too many people being identified as “vulnerable” and that the practice of referring them to the mainland and excluding them from the accelerated admissibility procedures is not sustainable.


Under Greek law, people identified as “vulnerable,” require special protection, including access to services and exemption from the accelerated admissibility process under the EU-Turkey deal, which was intended to send most asylum seekers back to Turkey. They are entitled to be given priority in the regular Greek asylum system and, until recently, were transferred to the mainland, where they could have easier access to services.
An EU official in Athens told Human Rights Watch that up to half of all asylum seekers on the islands who received a first instance decision – meaning a decision at the first level of the asylum process they applied to – on their asylum claims since the EU-Turkey deal came into force on March 20, 2016, have been identified as “vulnerable.” He said that the number of asylum seekers identified as “vulnerable” is higher than it should be, but did not express an opinion as to what an “acceptable” number of vulnerable refugees would be or why.

The official said that, in his opinion, the situation results from an allegedly broad definition of “vulnerability” under Greek law, and he alleged some nongovernmental organizations doing the assessments deliberately used an overly broad interpretation. The official, however, could not provide examples of how “vulnerability” criteria had been applied in an overly broad manner, or identify refugees who were considered vulnerable and should not have been. He also had no data on how many refugees identified as “vulnerable” had disabilities.

The European Union has hit another low in its efforts to deter new refugees and minimize obligations to ones already within its borders. The EU should be promoting the protection of asylum seekers, including those among them who may be particularly at risk, not unjustly pressuring the Greek authorities and medical actors to overlook them.

Emina Ćerimović

Researcher, Disability Rights Division

According to a representative of an international aid organization, the European Commission sent a letter to the Greek Ministry of Migration saying there was a need to further restrict the vulnerability criteria. As a result, the Greek Ministry of Health has been asked to provide a more precise and narrow definition of “medical vulnerabilities,” according to the source. The EU official and a representative of GAS confirmed to Human Rights Watch that Greek authorities are developing new guidelines to define and apply the vulnerability criteria.

The March progress report on the implementation of the EU-Turkey Statement says that the Greek Reception and Identification Service, together with the European Asylum Support Office (EASO), “are working on defining some of the vulnerability categories and developing a Standard Medical Assessment Template for the processing of vulnerable persons.”

The EU official in Athens also told Human Rights Watch that, in his opinion, recognizing a high number of people as vulnerable and moving them from islands to the mainland could act as an incentive for other “vulnerable” people to make the crossings. “We do not want to end up in a situation where vulnerable people will risk their lives to come to Europe,” the official added. He concluded that people who are identified as “vulnerable” might be returned to Turkey in the future, “the fact that someone is vulnerable doesn’t mean that they cannot be returned to Turkey depending on their individual case.”  

Human Rights Watch found that the experience of medical nongovernmental organizations assisting asylum seekers on the front line differed from what the EU official described. Stathis Poularakis, advocacy officer with Doctors of the World (MDM), an international medical nongovernmental organization that provides initial medical assessment of asylum seekers and other migrants arriving on the Greek island of Lesbos, told Human Rights Watch: “We cannot close our eyes. Most of these people have experienced trauma and loss and are vulnerable.” He said that some people’s vulnerability, including victims of torture and sexual or gender-based violence, is not immediately apparent. This makes it difficult to assess it properly in challenging conditions like the ones that prevail in Greek hotspots, following the EU-Turkey deal.

In contrast to the EU official’s claim of too many asylum seekers being deemed “vulnerable,” a representative of Medecins Sans Frontieres (Doctors without Borders, MSF) told Human Rights Watch that, in fact, MSF is providing treatment on the Greek islands of Lesbos and Samos to a high number of people who have not been identified as “vulnerable” despite meeting the criteria, including victims of torture and people with disabilities that are not readily apparent. “The system overlooks these people, either because of lack of training or rushed procedures,” he said.

MSF also said that the procedures used by the Greek authorities have made it increasingly difficult to register vulnerable people. “People with disabilities and victims of torture and gender-based violence are at highest at risk of going unidentified due to the new pressure to reduce the numbers,” an MSF representative told Human Rights Watch.

As of May, a new procedure requires that a person’s vulnerability be assessed within two to three days of their arrival on the islands. But representatives of MDM, MSF, and two lawyers providing legal advice on Lesbos told Human Rights Watch that it is almost impossible in such a short period to identify victims of torture, survivors of gender-based violence, or people with disabilities such as mental health conditions or intellectual disabilities, if their vulnerability is not visible or otherwise readily apparent. “You can’t have a proper assessment in two or three days,” Poularakis from MDM said. An MSF representative explained, “Most people are traumatized upon arrival and are not provided with an opportunity to build the trust and reveal their stories in such a short time.”

Yasami and Ali Habibi from Afghanistan, their 6-year-old twins and 2-year-old son, and Ali's 14-year-old brother, have all lived in this tent at Eiliniko camp in Athens when Human Rights Watch visited them in October 2016. Their 6-year-old son has a learning disability and difficulties walking. Photograph by Emina Cerimovic. © 2016 Human Rights Watch

“The EU seems to consider asylum seekers as mere numbers, ignoring the harsh reality of their experience”, Ćerimović said. “It’s an inconvenient truth that many asylum seekers, in particular people with disabilities, are at risk when they arrive and the EU’s focus should be on protecting them, not rushing to return them to Turkey.”

Background and EU Obligations to Asylum Seekers with Disabilities

In January, Human Rights Watch published its findings that people with disabilities were not being properly identified in the refugee reception system in Greece and did not have equal access to humanitarian assistance. In a report published in March, Human Rights Watch found similar failure to identify other at-risk groups, such as victims of torture.

In a briefing at the European Parliament in March, Nujeen Mustafa, a young woman with a disability who fled the Syrian war, called on the EU Commissioner for Humanitarian Assistance to ensure that aid reaches all refugees, including people with disabilities: “All of us, and especially people with disabilities, deserve much better.”

The EU-Turkey deal would return most asylum seekers from the Greek islands to Turkey under the flawed assumption that Turkey is a safe country for asylum seekers. The deal has left 12,873 asylum seekers bottle-necked in deplorable and volatile conditions on Greek islands since it went into effect on March 20, 2016. Thousands of asylum seekers are enduring extremely harsh conditions in overcrowded facilities, while their protection claims are being processed.

In an Action Plan published in December 2016, the European Commission recommended tougher measures aimed at increasing the number of returns to Turkey, including ending exemptions for vulnerable groups and people eligible for family reunification from the requirement to remain on the islands and go through the fast-track admissibility process that could more likely result in a return to Turkey. The commission also recommended expanding detention on the islands and curbing appeal rights.

According to unofficial notes from the protection working group meeting on March 14, 2017, in Athens, obtained by Human Rights Watch, a representative of the Greek Asylum Service said that people with mental health conditions, including PTSD, and victims of torture would not be transferred to the mainland “since their condition is not life-threatening.”

Under Greek law, nine categories of people, including pregnant women, children, victims of torture, survivors of sexual or gender-based violence, and people with disabilities are considered “vulnerable” or at-risk. Under the law, they require special protection, including access to services and exemption from the accelerated admissibility process under the EU-Turkey deal, which was intended to send most asylum seekers back to Turkey. They are entitled to be given priority in the regular Greek asylum system and until recently, were transferred to the mainland, where they could have easier access to services. The Greek Reception and Identification Service, supported by medical nongovernmental organizations, is responsible for identifying and registering people in “vulnerable” groups upon their arrival.

According to MSF and two lawyers interviewed by Human Rights Watch, it has become increasingly difficult to re-assess and register people with mental health conditions or victims of torture and/or gender-based violence as “vulnerable.” “The Greek authorities are legally obliged to take into consideration and re-assess the vulnerability throughout the procedure, but we are witnessing that is not the case despite medical certificates that we provide asserting their medical condition,” a representative explained. Pressure to exclude people with disabilities from being categorized as “vulnerable” individuals goes against the EU’s commitments under the Convention on the Rights of People with Disabilities. It also undermines the principles of the Charter on Inclusion of Persons with Disabilities in Humanitarian Action, to eliminate discrimination against people with disabilities in aid programming and policy, and to ensure people with disabilities’ access to aid and needed services. The charter was adopted at the Humanitarian Summit in Istanbul on May 23, 2016.

In line with the commitments made under the charter, the EU should immediately cease any pressure to reduce the number of people identified as vulnerable, Human Rights Watch said. The EU should issue clear guidance to field staff for identifying and registering people at-risk, including people with disabilities that are not readily identifiable.

The Greek Reception and Identification Services and officials conducting asylum procedures should be trained to identify and respond appropriately to the needs of people with disabilities, victims of torture, survivors of sexual and gender-based violence, and other “vulnerabilities” and to ensure access to services throughout the process. People with disabilities and other at-risk groups should be included and consulted in these efforts.

Posted: January 1, 1970, 12:00 am

Nujeen Mustafa is a Syrian disability activist, who spent some time living in Greece as a refugee. Basic services, such as toilets or running water, were not available to her and the many other refugees in the camp, and are still not available to date. Nujeen is hoping to get more EU involvement so that aid reaches all refugees, including people with disabilities.

Posted: January 1, 1970, 12:00 am

(Nairobi) – People with disabilities and older people in South Sudan face greater risks of being caught in fighting and greater challenges in getting necessary humanitarian assistance, Human Rights Watch said today.

Nyayak Olo Bapit, a Shilluk woman from Malakal, pictured in Juba. She was forced to flee Malakal after a bullet struck her left thigh during fighting there in January 2014.     

© 2017 Joe Van Eeckhout for Human Rights Watch

One year after the adoption, at the Istanbul Humanitarian Forum, of the Charter on Inclusion of Persons with Disabilities in Humanitarian Action, the United Nations and aid organizations should do more to accommodate the specific needs of people with disabilities and older people as they respond to the wider crisis and famine in South Sudan.

“People with disabilities and older people are often left behind during attacks and find themselves at much greater risk of starvation or abuse,” said Shantha Rau Barriga, disability rights director at Human Rights Watch. “This problem is especially acute in South Sudan, where decades of civil war has increased the number of people with disabilities, and where armed forces on both sides target civilians with impunity.”

In February and March 2017, Human Rights Watch interviewed more than 45 people with disabilities and older people in displacement sites in Juba and Malakal, as well as in Panyijar county in the former Unity state, where the UN declared famine in two counties in February. Human Rights Watch also met with aid organizations and the South Sudan Human Rights Commission.

People with disabilities and older people in South Sudan face greater risks of being caught in fighting and greater challenges in getting necessary humanitarian assistance. 

The current conflict began in South Sudan on December 15, 2013, when forces loyal to President Salva Kiir – a Dinka – clashed in the capital, Juba, with those of his then-vice president, Riek Machar – a Nuer. People with disabilities and older people have been targeted and abused by the warring parties, often because of their inability to flee ahead of attacks.

Throughout the conflict, Human Rights Watch has documented numerous cases of people with disabilities and older people being shot, hacked to death, or burned alive in their houses by the belligerents.

An older woman, recently displaced with her family from Mayendit to Panyijar county in the former Unity state, said that no civilians were off-limits in the attacks on her village: “The first time the government soldiers and militias came to my village in 2015, the old men and women who could not run were killed,” she told Human Rights Watch. “There was Gatpan Mut, for example, who was a little old, and Gatkui Jich, who couldn’t move, and many, many more whose names I can’t remember.”

During attacks in 2016 on Protection of Civilians (PoC) sites for displaced people inside of UN bases in Malakal and Juba, people with disabilities and older people were also left behind and struggled to find spaces to hide from attackers.

During a brutal attack by government forces on the Malakal PoC site in February 2016, three members of the same family with disabilities burned to death.

“When the fighting broke out, we fled to the UN compound and we left my mother and brother-in-law behind because they couldn’t walk and we couldn’t carry them,” a 45-year-old Nuer woman said. “The son of my brother-in-law, who had a mental health condition, would not leave his father behind so they all burned together in the fire.”

People with disabilities and older people who managed to flee violence have often faced problems getting crucial humanitarian assistance that other people don’t – from using latrines to accessing food distributions. People with limited mobility may not be able to reach aid hubs far from their displacement camps and cannot always rely on family or friends to carry them there.

“My children are not on the island and sometimes there are people who abandon their older relatives because we cannot offer them anything in return,” said an 80-year-old father of three children with lower body paralysis and no mobility device. “Now that I have been registered for the food distributions, I don’t know how I can access it unless I have someone to carry it for me because I have to crawl everywhere I go.”

With many aid programs focused on the UN PoC sites where more than 200,000 people have taken shelter, millions of other vulnerable civilians are effectively cut off from similar levels of support.

Aid groups, struggling to meet the needs of about 1.9 million South Sudanese displaced internally across the country as a result of the conflict and hunger, also face serious problems with security and access. Government and opposition soldiers have looted aid supplies, attacked staff, and obstructed access. To fulfil their missions, aid organizations should do more to ensure that they are meeting the needs of people with disabilities and older people, Human Rights Watch said.

Aid workers and donors should ensure that people with disabilities have access to humanitarian services on an equal basis as those without disabilities and that discrimination does not arise as a result of failing to make adequate provision for the needs of people with disabilities in their programming and distribution of assistance. They should ensure the participation of people with disabilities and older people in the design of their programs and develop strategies and action plans that eliminate physical, communication and attitudinal barriers to inclusion.

Humanitarian aid workers in South Sudan already do a lot with very little, but the needs of people with disabilities and older people – too often overlooked – need to be better integrated in their planning.

“The struggle for survival by people with disabilities and older people in the South Sudan conflict underscores just how devastating the abuses against civilians have been,” Rau Barriga said. “Humanitarian groups need to provide those who have managed to flee with life-saving assistance.”

The South Sudan Conflict

The current South Sudan civil war began as a political conflict between President Salva Kiir and his then-Vice President Riek Machar in December 2013. The fighting between forces loyal to the two men started in Juba and quickly spread to major towns north, some of which have changed hands multiple times. A power sharing agreement, signed between the two parties in August 2015, failed to end the fighting, including clashes and attacks on civilians in Juba in July 2016, and the government’s abusive counter-insurgencies elsewhere.

Both sides have committed abuses that may qualify as war crimes and crimes against humanity, including looting, indiscriminate attacks on civilians and the destruction of civilian property, arbitrary arrests and detention, beatings and torture, enforced disappearances, rape and gang rape, extrajudicial executions, and killings.

The war and abuses have created a devastating humanitarian situation. South Sudan has produced more than 1.7 million refugees, and 1.9 million South Sudanese are internally displaced. Famine was declared on February 20 in Leer and Mayendit counties, in the former Unity state, with high levels of food insecurity in the rest of the country. One hundred thousand people are starving, and about a million South Sudanese face the risk of famine. Roughly half of the country’s population needs food assistance.

An estimated 250,000 people with disabilities live in displacement camps in South Sudan according to the World Health Organization and Light of the World, an aid group. With global estimates that 15 percent of the world’s population lives with disabilities, there may be more than 1.2 million people with disabilities in South Sudan.

Legacy of Conflict, Inadequate Care

The current civil war and South Sudan’s long history of conflict between the Sudanese army and the southern Sudan People’s Liberation Movement/Army (SPLM/A), have caused disabilities among large numbers of civilians, with maiming and amputations, damaged or destroyed sight and hearing, or other impairments. More than 70 percent of amputations performed by the International Committee of the Red Cross (ICRC) in South Sudan result from conflict-related wounds.

The conflicts have also traumatized thousands. While there are no statistics about the number of people with mental health conditions as a result of war, Amnesty International reported in 2016 that the Health Ministry’s director of mental health had recognized an increase in the number of cases of trauma since the new war began.

Before and after the country’s 2011 independence, South Sudanese authorities have had limited capacity to respond to the medical, educational and mobility needs of people with disabilities. “No one has ever consistently pressured the government to respond to their needs,” said the interim head of the South Sudanese Human Rights Commission. “Politicians with a military background are used to seeing war amputees and the general thinking is that this is normal.”

Many of the people with disabilities interviewed had never or rarely seen a doctor. Other than those with injuries, the overwhelming majority didn’t know what had caused their disability. Chronic underdevelopment and lack of medical services have contributed to the emergence of physical and sensory disabilities linked to preventable or untreated conditions, such as polio, tuberculosis, cataracts, or other tropical diseases.

Aside from limited psychosocial, or mental health, and psychiatric services provided largely by foreign organizations, South Sudan’s capacity to respond to the needs of people with mental health conditions are also extremely limited. In 2012, Human Rights Watch found that authorities frequently detained people with mental health conditions for prolonged periods of time, in violation of national legislation and international human rights law.

Attacks on People with Disabilities, Older People

Since the beginning of the war, Human Rights Watch researchers have documented cases of people with disabilities and older people killed by government or opposition forces as they struggled to flee attacks, or because they were left behind.

In late December 2015, for example, government forces killed at least two people with disabilities and an older woman in the villages of Khorkanda and Gomba, during a string of attacks on areas under rebel control south of Wau, in the former state of Western Bahr el-Ghazal.

“The soldiers came shooting in the village around midday,” a man from the Khorkanda village, south of Wau, told researchers in April 2016. “We tried to flee and left my grandmother behind. She was very, very old. We ran to save our lives and did not pay attention to her. When the situation calmed down in the evening, we returned to the village and saw that she had been beaten to death under a tree. Her head was crushed.”

An older man said he fled his home in Mayendit county after receiving information that older people had been burned in a neighboring village in 2015. “The government forces rounded up the older people in one house and they burned the hut, so I couldn’t wait for this to happen to me too and I left,” he said.

Many of those interviewed said that soldiers made no distinction between legitimate targets and civilians, including children, women, people with disabilities, and older people. Some felt conflict has shattered many of the traditional power dynamics and cultural norms that previously governed the attitude of combatants toward civilians in South Sudan.

“Before this war, your enemies would say: ‘Disabled people are created by God so we cannot kill them, and women and children cannot be reached by the war,’” a 60-year-old former government worker with a severe mobility disability told Human Rights Watch in Juba. “But now they want to kill all the Nuer.”

Fleeing Violence

For people with physical disabilities, fleeing attacks is often much more difficult.

For example, a 51-year-old Nuer mother of seven with a physical disability and no mobility device had to make her way to the United Nations Mission in the Republic of South Sudan (UNMISS) alone after the fighting began in Juba on December 15, 2013, when thousands of ethnic Nuer fled to the UNMISS base for safety. “Because my legs were paralyzed, all I could do was to crawl the whole way from home to UNMISS,” she said. “It took me five hours. Whenever I would see soldiers, I would try to hide myself the best I could.”

Many had to rely on relatives, when they could, to carry or guide them to escape attacks.

“When Nyal was attacked in May 2015, my daughter helped me get out of our house and we ran to the river,” a 70-year-old blind woman said. “It was so deep that if you knew how to swim, you could. Since I could not see her, I would follow her only by the sound of splashes in the water. It was very dangerous, but since the enemy was near, what could we do?”

Those who helped people with disabilities were also more vulnerable as they carried or guided their loved ones to safety.

A 49-year-old mother of nine with a physical disability said that she was in the town of Bentiu, in the former Unity state, when the conflict began in 2013:

I was not able to run so two people carried me into the bush with them. One of them was my cousin, Gawar Tap Liep. As we ran, soldiers shot at us. A bullet struck him as he was carrying me. We both fell down. The soldiers were coming after us so my husband and other men took him into the tall grass to hide him and we ran further. When we returned at night, Gawar was dead.

Another woman with a physical disability from Panyijar county said that her father was killed by government-allied militias during the 2015 offensive on Unity state as he carried her to safety away from Mayendit:

We were on our way to Bur when we met the government militiamen. They shot randomly at us and a bullet hit my father as he carried me. We both fell to the ground. When the attackers reached up to us, they took all of our things and beat my mother, who was pregnant at the time.

At times, the treacherous journeys to safety have themselves caused injuries or diseases leading to disabilities, as families often need to walk for days through the bushes or swamps, which can be dangerous because of wildlife and mosquito- or water-borne diseases.

An 8-year-old boy fell sick and developed a physical disability while fleeing his village through the swamps with his family following an attack. His mother said:

We stopped on an island on our way south. At night, he had a high fever and shivers. The next day, he could not move his legs. We had to carry him on our backs. When we arrived to Panyijar, the people at the primary health care unit told us that it was because of tuberculosis. They gave him tablets. We don’t know if he will be able to walk again.

“I cannot move the way my brothers and sisters do,” the boy said. “It’s bothering me. When I go to bed, I feel sad because I cannot play with them now.”

The experience of fleeing violence has also contributed to trauma for numerous civilians.

A father of three children in the Juba displaced people’s site said that one of his daughters became traumatized after seeing the dead bodies of her aunt and cousins in December 2013 as they fled to the UNMISS base in Juba:

Before the war, she was OK. But then, she started to insult everyone and run away from home for many days at a time. At the hospital, they didn’t know what she has but they gave her Phenorbitone (used to treat anxiety problems). Now, she can’t even go to school here in the PoC. Otherwise she gets into fights with other children or just runs away, and there is no fence around the school to keep her in there.

Left Behind

Many people with disabilities and older people interviewed said that relatives managed to take them to safety at the time of an attack. But not everyone was so lucky. Some told their relatives and neighbors to go ahead, fearing that the presence of the person with a disability would slow the others. Others were simply abandoned.

An aid worker who provided services to people with disabilities in the Malakal PoC site at the time of the February 2016 attack on the camp, said that at least five people her organization had been helping were killed during the attack. “One of them was a Darfuri,” she said. “He was paralyzed and his family left him behind as they fled into town with the Dinka. His shelter caught on fire and he burned alive.” 

Three days after the attack, when the situation became calm enough to re-enter the PoC site, aid workers found 12 Dinka civilians with disabilities or older people who had been left behind by their relatives when they fled back into Malakal town. No one had attacked them, but they had received no water or food during that period. They were later taken to Malakal town to join their families.

One of them was an older, blind Dinka woman with a physical disability. “All the Dinka fled to town during the attack but I was left behind,” she said. “I was not afraid because I am blind and you cannot fear what you don’t see! But I was very thirsty because there was no water during that period.”

Other people with disabilities who stayed behind said they only managed to survive because they hid from attackers in time. 

A 60-year-old man with a physical disability said he decided to stay behind when government soldiers attacked his village in Mayendit county on the very day that the famine was declared in the area:

We were still sleeping when we heard the gunshots. I took my cane and stood up to leave the house and run to a nearby riverbed. I hid there alone for a good 12 hours because I told the children to run ahead with their mother. I cannot move fast enough and did not want to slow them. From where I hid, I saw the soldiers loot the whole village and burn it to the ground.

In rarer occasions, soldiers or commanders protected people with disabilities and older people who had been left behind.

In late January 2017, soldiers spared the lives of a number of people with disabilities and older people who had been left behind when government forces captured Wau Shilluk, a settlement near Malakal that hosted about 20,000, mostly Shilluk, displaced people.

About 30 of them were taken to the Malakal site for displaced people by nongovernmental group workers a month later. Those interviewed shortly after their arrival said that government troops did not abuse them upon order from their commander, who also instructed his forces to bring them food and water daily for over a month.

An older woman with sensory and physical disabilities said that she had declined to run away when the soldiers arrived in Wau Shilluk:

I told my daughter to go and leave me here because I am blind and cannot walk. I was afraid of slowing down other people. If I die, it is no problem, I told my daughter. When the soldiers arrived, they found me in my hut and said ‘We are with the government, and if it is OK with you we will bring you to another home with other people like you,’ which they did. And then they brought us food and water every day until the aid workers brought me to the Malakal PoC.

Challenges Accessing Aid

Displaced people with disabilities and older people who have sought refuge in the remote bushes of Western Bahr el-Ghazal, Upper Nile, Jonglei, and the Equatorias or on islands in the Sudd, are more likely to encounter difficulties getting aid than those who found their way to the PoC sites inside UN bases.

A blind 70-year-old displaced man in the Sudd said that there are gaps in the aid coverage. “Life on the islands is hard,” he said. “Some organizations have registered older people, but I never got registered because they did not come to this particular island. There’s no health clinic either on the island. To get medical assistance, I must travel to another island or to the mainland.”

On dozens of other refuge islands scattered through the swamps, nestled in and around the areas where the famine has been declared, conditions can be extremely difficult for people with disabilities and older people without nearby relatives. An 80-year-old man with lower body paralysis on Mer island said that food was scarce. “Sometimes I eat, sometimes I don’t,” he said. “I can go on for five days without food. All I have is water. When I am thirsty, I have to crawl to the borehole. I push the water can in front of me, and then I need to ask a child to pump the well for me. It takes a very long time to get to the water.”

The situation is a little easier in the UN sites. Now hosting more than 210,000 civilians in and around six UN bases, the PoC sites allow for a more effective distribution of aid and better protection. However, even in these sites, people with disabilities and older people encounter challenges getting services.

Conditions differ depending on the service providers in each site. Water and sanitation facilities, for instance, are not equally accessible to people with disabilities and older people living in the camps. For the time being, only a few latrines in the Malakal PoC site have been adapted to the needs of people with physical disabilities, with more about to be built. In the Juba PoC sites, there are more accessible latrines but not in every quarter.

A 37-year-old man with a physical disability in Juba said that the accessible toilets are often too far away from the homes of people with disabilities. “The regular latrines are not OK for us because there are no seats or hand bars to help us defecate,” he said. “And the specialized latrines are not enough in the camp, so going from home to the latrine can take a very long time. All the zones of the camp should have their own latrine for people with disabilities.”

People with disabilities interviewed in the Juba and Malakal said that the few adapted latrines they had access to were frequently used by other people and children, who often urinated or defecated on the sides, making it difficult for those needing to crawl into the latrine.

The common showers are not easier to use either because the floor is too high in Juba or made of slippery tarpaulin in Malakal. A 30-year-old singer who moves around on a tricycle and lives in the Juba site, said that it was almost impossible for him to reach the showers:

The floor of the shower rooms is almost half a meter above the ground, so people like me find it very difficult to climb in there. I have to bring the water in a jerrycan and then lift it in there, and there I have to try and stand on my tricycle to get in. I often fall to the ground.

As a result of these difficulties, many people with disabilities interviewed said that they preferred to take their showers right outside of their homes at night.

In the camps, getting food can also be a challenge for people who struggle to stand in line during distributions or to carry their rations back home. They often must rely on relatives or neighbors. “After receiving my rations, I have to ask someone with a wheelbarrow to carry in exchange for some money or a cup of grain, because I can’t carry it myself,” a 42-year-old man with a physical disability said at the Juba PoC site.

Schools in the PoC sites are also not adapted for students with sensory or intellectual disabilities.

A 22-year-old man with a developmental disability and leg paralysis said he had numerous problems in his quest to get his primary school diploma in one of the Juba PoC sites:

I want to go to school and play football because in my heart I want to become a footballer so I can run and strengthen my legs. But when I go to school, the children are very aggressive toward me. When I move around, I fall sometimes and they laugh at me because my tongue is weak and I cannot speak well. If I report to the teachers, they don’t do anything and often they tell me to sit at the back of the class. So sometimes I decide not to go to school and my heart beats very fast because I feel sad.

People with disabilities and older people can also occasionally face stigma and abuse from family and the community. “We’ve encountered cases of relatives physically abusing people with disabilities, beating them or forcibly taking their food or other possessions from them,” an aid worker said. Such abuse raises protection concerns that are frequently difficult to address because of the abused person’s dependence on relatives or neighbors who may be the ones abusing them.

People with disabilities and older people living in the sites also need help to make a living. Given the insecurity that usually surrounds the camps, people with disabilities or older people are less likely than others to have the opportunity to cultivate, fetch wood, or trade outside of the sites. Such economic insecurity can lead to heightened depression and anxiety among vulnerable displaced people.

A single mother of five children whose leg was amputated after she was struck by a bullet during a government attack on the Bor camp in 2014, said that the poor living conditions in the camp greatly affect her morale:

Now, I am thinking too much. Not about my disability but about how I can support my children. It is too much and I sometimes think that it is better for me to die because no one is supporting us. The PoC is very hot, there is no water, no soap, the plastic sheet that make up the shelter are broken and I don’t know how I can support my children.

 “People with special needs are often invisible, and their needs are not brought up to the surface,” a representative from HelpAge said in Juba. “Rarely do health organizations treat non-communicable diseases, such as diabetes or high blood pressure for instance. Likewise, few are preoccupied with the malnutrition of older persons or people with disabilities; the focus is on children and pregnant mothers.” 

Posted: January 1, 1970, 12:00 am
Posted: January 1, 1970, 12:00 am

Human Rights Watch welcomes the opportunity to submit evidence to the Portfolio Committee on Basic Education for its meeting on inclusive education on May 30, 2017. Through this submission, Human Rights Watch would like to share relevant information on children with disabilities and inclusive education from South Africa’s reviews by United Nations inter-governmental and expert bodies in 2016 and 2017.

In August 2015, Human Rights Watch released our report “Complicit in Exclusion”: South Africa’s Failure to Guarantee Inclusive Education for Children with Disabilities,” documenting barriers to inclusive, quality education for children with disabilities in South Africa.[1] Dewa Mavhinga, Senior Africa Researcher, presented our findings and key recommendations to the Portfolio Committee in March 2016.[2]

We acknowledge progress made by the Department of Basic Education with regards to the progressive provision of resources for learners who are blind or have low vision. Furthermore, we note that the Screening, Identification, Assessment and Support (SIAS) policy is being progressively implemented with a view to full implementation by 2019. However, our findings indicate that insufficient resources and qualified personnel mean the policy is not being implemented consistently everywhere, particularly in rural areas and under-resourced townships.[3]

Human Rights Watch has found that many of the barriers identified in our 2015 report persist, including: very long referrals to special schools and lengthy waiting lists, school fees and additional school-related costs, and severe transportation issues. Hundreds of thousands of children with disabilities are excluded from education across the country. Instead, these children should enjoy equality throughout their education, including by having meaningful choices and opportunities to be accommodated in mainstream schools, and to receive quality education on an equal basis with, and alongside, children without disabilities.

The Department of Basic Education does not appear to have produced accurate data that reflects current numbers of children with disabilities who remain out of school, and continues to rely on estimates and outdated data. We have also found that the government continues to prioritize funding for special schools, to the detriment of inclusive education.[4]  

The International Covenant on Economic, Social and Cultural Rights (ICESCR) entered into force in South Africa on April 12, 2015.[5] Under article 14, states which have not yet achieved free, compulsory primary education undertake to work out and adopt a detailed plan of action for the implementation of free compulsory primary education within two years of ratifying the treaty.[6] The plan should also fix a date, within the span of a reasonable number of years, to achieve this treaty’s guarantee of compulsory education free of charge for all. To date, the South African government has yet to fulfil this obligation. As documented in our research, public schools are not automatically free of charge. Most children with disabilities are obliged to pay fees to attend special schools, in addition to other costs, such as uniforms, food, transport, and special assistants to help them in the classroom. Fees in special schools typically range from R350-R750 (US$32-$68) per term. In many cases, parents reported not having access to fee waivers. As a result, hundreds of thousands of children with disabilities in South Africa cannot afford to attend school. [7]

In September 2016, the United Nations Committee on the Rights of the Child reviewed South Africa’s compliance with the Convention on the Rights of the Child.[8] In its review, the Committee expressed its concern at the multiple layers of discrimination and exclusion faced by the majority of children with disabilities, as well as at “the lack of: accurate and comprehensive data on children with disabilities; a comprehensive law and policy to realize the rights of children with disabilities, with clear baselines, a clear time frame and measurable indicators for the implementation, and mechanisms for monitoring implementation; effective multisectoral coordination within the Government, in particular in rural areas, to provide integrated services to children with disabilities; and effective provision of reasonable accommodation, such as through the provision of assistive devices and of services in Braille and in sign languages.”[9]

In its concluding observations, the Committee raised several concerns, including the large number of children with disabilities out of school or in special schools or classes, the lack of legislation guaranteeing the right to inclusive basic education for all children with disabilities, the ineffective implementation of relevant policies due to acute shortages of qualified staff, and insufficient allocations of financial resources. The low quality of education and inadequate curriculum for children with disabilities was also raised, particularly in terms of preparing children for further education, employment, and an independent life. The Committee also highlighted concerns about the failure to provide free, compulsory primary education to children with disabilities, and about discrimination and violence by teachers and other students against children with disabilities.[10]

The Committee made the following recommendations to the South African government:

  1. “Review Education White Paper 6: Special Needs Education: Building an Inclusive Education and Training System, of 2001, with a view to further developing a legal and policy framework for inclusive education, and to prioritizing the expansion of full service schools and the inclusion of children with disabilities in mainstream classes of mainstream schools;
  2. Allocate sufficient technical, human and financial resources for inclusive education, including the funding necessary for guaranteeing the provision of reasonable accommodation;
  3. Ensure free, compulsory primary education to all children with disabilities, provide reasonable accommodation, including personal assistants, at mainstream schools, free of charge, and prioritize enrolment in a school near to where the child concerned lives in order to avoid costly transport and boarding arrangements;
  4. Develop curricula and learning and teaching materials that facilitate respect for and the dignity and inclusion of children with disabilities in order to raise the awareness of teachers and students so as to eliminate stigmatization of children with disabilities and prejudice against them; and
  5. Improve the quality, adequacy and adaptability of education provided to children with disabilities, in order to facilitate their fullest possible social integration and individual development.”[11]

In May 2017, South Africa’s human rights record was also reviewed by the United Nations Human Rights Council.[12] During the review, South Africa was asked about access to inclusive education for children with disabilities. The draft report of the Working Group, dated May 12, 2017, contains two recommendations from Australia and Israel to implement the right to inclusive education of children with disabilities.[13] The South African government has until the thirty-sixth session of the Human Rights Council in September 2017 to respond to the recommendations.


Human Rights Watch recommends that the Portfolio Committee on Basic Education should:

  • Urge the Department of Basic Education and the Department of Social Development to work together to publish accurate and transparent data on the number of children with disabilities who are out of school, those who are on waiting lists for special schools, and those who have dropped out.
  • Call on the government to comply with its fundamental obligations on the right to education, particularly its obligation to make primary education free and compulsory for all students, including developing a detailed plan of action for the progressive implementation of free compulsory primary education within a set numbers of years, in line with its obligations under the International Covenant on Economic, Social and Cultural Rights.
  • Urge the government to adopt strong Norms and Standards for funding of inclusive education to ensure public special schools are adequately funded, and they qualify as “no fee schools.” Prohibit all public ordinary schools from imposing financial conditions on children with disabilities that children without disabilities would not incur, such as transportation, which impose undue financial barriers on children who do not access neighborhood schools.
  • Urge the Department of Basic Education to adopt stronger legal protections for children with disabilities to complement the South African Schools Act. This includes a clear duty to provide reasonable accommodation in public ordinary schools, accompanied by specific provisions that prevent the rejection of learners with disabilities from schools in their neighborhood. This should apply at all school levels, in transportation and other essential services.
  • Encourage the Department of Basic Education to adopt clear mechanisms to ensure department officials remain in control of enrollment decisions, to challenge unnecessary referrals to special schools and monitor sudden drop outs of learners with disabilities.
  • Urge the Department of Basic Education to adopt a weighting system, the method used to calculate a maximum student-to-teacher ratio per classroom, weighted according to the type of disability—in ordinary and full-service schools to ensure teachers are able to dedicate sufficient attention to every learner requiring additional support to overcome learning barriers.
  • Request further information and evidence from the Department of Basic Education on how children with disabilities are supported to follow the curriculum taught in mainstream classrooms, as well as data on the numbers of children with disabilities following and being tested on the same curriculum taught in ordinary schools.
  • Implement the recommendations from the UN Committee on the Rights of the Child.
  • Encourage the Department of International Relations and Cooperation to accept all recommendations made, concerning education and inclusive education of children with disabilities, during the United Nation’s Universal Periodic Review.

[1] Human Rights Watch, “Complicit in Exclusion”: South Africa’s Failure to Guarantee Inclusive Education for Children with Disabilities, August 2016,

[2] Human Rights Watch Statement to Portfolio Committee on Basic Education, South Africa, Presentation delivered by Dewa Mavhinga, Senior Researcher, Africa Division, March 8, 2016,

[3] “South Africa: Little Progress for Youth With Disabilities, Government Should Keep Promise to Open School Doors,” Human Rights Watch news release, August 19, 2016,

[4] Ibid.

[5] International Covenant on Economic, Social and Cultural Rights (ICESCR), adopted December 16, 1966, G.A. Res. 2200A (XXI), 21 U.N. GAOR Supp. (No. 16) at 49, U.N. Doc. A/6316 (1966), 993 U.N.T.S. 3, entered into force in April 2015.

[6] ICESCR, art. 14.

[7] Ibid, Human Rights Watch, “Complicit in Exclusion.”

[8] Human Rights Watch submission to the Committee on the Rights of the Child regarding South Africa, February 1, 2016,; Elin Martínez, “South African Official Brushes Off Children with Disabilities, The Government Should Guarantee Their Equal Right to Education,” Human Rights Watch dispatch, September 21, 2016,

[9] UN Committee on the Rights of the Child, “Concluding observations on the second periodic report of

South Africa,” October 27, 2016, CRC/C/ZAF/CO/2, (accessed May 24, 2017), para. 43 (a) – (d).

[10]  Ibid, para. 45 (a) – ( f).

[11] Ibid, para. 46 (a) – (e).

[12] “Human Rights Watch Submission to the Universal Periodic Review of South Africa,” September 2016, For more information, please see “Universal Periodic Review – South Africa,”

[13] United Nations Human Rights Council, “Draft report of the Working Group on the Universal Periodic Review: South Africa,” A/HRC/WG.6/27/L.14, May 12, 2017, (accessed May 23, 2017), recommendations 6.187 andf 6.188.

Posted: January 1, 1970, 12:00 am

Protesters rally on Capitol Hill in Washington, D.C. during US House voting on the American Health Care Act, which would repeal major parts of the 2000 Affordable Care Act know as Obamacare, May 4, 2017.

© 2017 REUTERS/Yuri Gripas
(Washington) – The US Senate should categorically reject the healthcare bill passed by the US House of Representatives on May 4, 2017, Human Rights Watch said today. If enacted into law in anything like its current form, the House version of the bill would tear down the foundations of a more equitable, rights-respecting healthcare system that were only recently put into place.
Since the Affordable Care Act (ACA) was enacted in 2010, Human Rights Watch has interviewed hundreds of people across the country about how protections under the law have affected their lives. One man told Human Rights Watch that he was able to get treatment for an opioid addiction that was ruining his life. An older person with Parkinson’s disease was able to get care in a nursing home that his family was unable to provide. A woman with a disability was able to live in the community instead of an institutiton. And one woman said that Planned Parenthood, which would lose funding under the bill, had been critically important to her wellbeing because the staff treated her with respect, when other providers had not.
“The American Health Care Act is an assault on the right to health that would do the most harm to those who can least afford it,” said Megan McLemore, senior health researcher at Human Rights Watch, “The Senate can and should abandon this destructive path as it begins its own deliberations.”
The American Health Care Act would eliminate insurance coverage and reduce access to quality health care for millions of people, including those with low incomes, women, older adults, and people with disabilities and chronic conditions such as HIV.
The final bill passed by the House would eliminate mandated coverage for a range of essential health benefits, cut funding for Medicaid and transfer key decision-making authority for the program to the states, and significantly weaken protection for people with pre-existing conditions.
Medicaid reimbursement for Planned Parenthood Services would be prohibited. ACA subsidies based on income and geography would be replaced with tax credits based mainly on age. The ability of many people to buy insurance coverage in the private market would decrease sharply, as the average subsidy for buying insurance would drop an average of 60 percent by the year 2020. Companies would be allowed to charge older adults five times as much as younger adults for coverage, and employers over a certain size would no longer be mandated to provide insurance to their employees.
If anything like the House bill becomes law, make no mistake about it - lives will be lost.

Megan McLemore

Senior Health Researcher

The Congressional Budget Office, a nonpartisan federal agency that advises Congress on budgetary issues, estimates that the legislation would result in the loss of insurance coverage for an estimated 23 million people in the next decade. By 2026, an estimated 51 million people under 65 would be uninsured, compared to 28 million who would be uninsured under current law.
If the American Health Care Act is passed in the Senate and signed into law, it would have potentially devastating results for millions of Americans who could face the loss of health coverage under both private insurance and Medicaid. Human Rights Watch and its partners have spoken to dozens of people about how proposed changes under the House bill would affect them.
“Susan,” 33, who, like some others Human Rights Watch interviewed, preferred using a pseudonum to protect her privacy, has had a heart condition, atrial fibulation, since she was 19. For most of her life, she had no health insurance. She told Human Rights Watch that the plans she was offered cost half of her income as an employee of a small non-profit organization. Under the ACA, she has a plan that is affordable for herself and her husband. “It was very stressful when I did not have health insurance,” Susan said, “and I am very fearful of what is going to happen to me if Congress takes this away.”
International human rights law protects the right to health, which is also indispensable to the enjoyment of other rights. Under the Universal Declaration of Human Rights, everyone has the right to a standard of living adequate for their and their family’s health and well-being, including medical care, and the right to security in the case of sickness, disability, old age, or other circumstances beyond their control.
In February 2017, the United Nations special rapporteur on the right to health, Dainius Pirus, sent an urgent letter to the Trump administration expressing serious concern about the impact that efforts to repeal core elements of the ACA might have on the right to health of residents of the United States. He urged the US government to protect the right to health, particularly for those “of low or middle income, and in situations of poverty or social exclusion.”
“If anything like the House bill becomes law, make no mistake about it,” McLemore said, “Lives will be lost.”



One of the most important ways the ACA achieved success in insuring more people was by expanding Medicaid to cover people with incomes up to 137 percent of the federal poverty level, providing health coverage to an additional 14 million people in 31 states. The American Health Care Act  would cut Medicaid by US$880 billion over 10 years, replacing the federal program with block grants to states and, beginning in 2020, setting caps on the amount of federal funding that could be spent per person. Medicaid expansion would be frozen for states that have already pursued it and phased out entirely by 2020.

Many states that expanded Medicaid under the ACA saw dramatic improvements in healthcare coverage for their residents. In Louisiana, for example, more than 400,000 people have gained health insurance coverage since July 2016 – more than 60 percent of them women.

Human Rights Watch spoke to one such woman in Louisana, “Jacquelyn.” She has endometriosis, a condition in which tissue that normally grows in the uterus grows outside it, for which she had to undergo surgery at a time she did not have insurance coverage. She made monthly payments to the hospital, then was able to go on the TV program Wheel of Fortune. She used her winnings to pay off the US$25,000 in medical bills.

It was not until July 2016, when Louisiana Governor John Bel Edwards expanded Medicaid, that she was fully insured and able to afford the health care she needed. She went to Planned Parenthood, where she now works, to have an IUD inserted to stop the daily bleeding that comes with endometriosis. She is also able to go to the dermatologist for preventative care that could be potentially life-saving, since she has a history of melanoma, which can be deadly.

“I am terrified that Congress will take away Medicaid expansion because most people on Medicaid are like me, what I call the poor middle class,” Jacquelyn said. “We are people who have student debt and medical debt and who work 40-50 hours a week to keep our heads above water.”

Insurance Coverage

The American Health Care Act changes the subsidy structure for purchase of private insurance under the ACA. The ACA based tax credits and subsidy amounts on income, age, and the local cost of insurance, while under the American Health Care Act, such assistance would be based only on age. This approach would result in less assistance for low income people, while benefits would increase for people with higher incomes.

“Monica,” 46, and her husband own a small business in Kenner, Louisiana. Prior to the ACA, she could not get insurance – either it was denied because she had a pre-existing condition, or was so expensive that she could not afford it. “Before the ACA, the only plans offered to me were more than US$1,000 a month,” she said. Currently, with the help of subsidies and tax credits provided for plans in the insurance exchange, she pays about US$300 a month for a “good plan” that covers her, her husband, and her daughter. She is very anxious about what would happen if the cost of insurance goes out of reach again. “It would be just devastating to my family,” she said.

Mental Health Care and Drug Dependence Treatment

In the US, approximately one in five adults has a mental health condition. But only half of people with mental health conditions are receiving treatment, and they are less likely to be insured than other people. The ACA attempted to address the situation by including mental heatlh and substance use treatment as a mandated essential health benefit for both private and public insurers. Under the American Health Care Act, states could opt out of this mandate, with potentially severe consequences for millions of people seeking treatment for mental and behavioral health problems.

“Deborah,” 49, who lives in Arizona, told Human Rights Watch what it had meant to her family to be without mental health coverage in their insurance plan prior to the ACA. When Deborah’s oldest son, Andrew, began having problems with addiction, her family’s insurance didn’t cover mental health care. He entered a rehab program in 2013, but Deborah and her husband had to pay US$10,000 up front for 30 days. That money would have gone to their mortgage payments. They didn’t make a payment for a year, and had to sell their house on a short sale in lieu of foreclosure. “We lost our home for medical care to save my son’s life,” she said.

In 2014, the family bought coverage under the ACA, and Andrew went back into rehab for a US$1,000 co-pay. “$1,000 vs $10,000 – that’s a huge difference,” she said.

Andrew died from an overdose in 2016, and Deborah wishes they had better mental health care coverage before the ACA. It would have meant better treatment and counseling for Andrew, she thinks. “How do you tell your child you can’t take them for care because you can’t afford it?”

While President Donald Trump has vowed that his administration will end the opioid epidemic, the American Health Care Act has the potential to worsen it. Rural America – particularly areas of Ohio, Kentucky, New Hampshire, and West Virginia – is already “ground zero” for the nation’s opioid crisis, and the House bill threatens to undermine progress being made on this issue.

By eliminating the requirement under the ACA to cover mental health care, including drug treatment services, both with private insurance and with Medicaid, the American Health Care Act would cause many people struggling with opioid dependence to lose access to treatment. In the 31 states that have expanded Medicaid, 1.2 million people who previously had no insurance have received drug treatment services.

Among them is Freddy, a 27-year-old from Tucson. When he first needed treatment for his heroin use, Arizona had not expanded Medicaid, and he had no health insurance. His parents paid out of pocket for him to enter a residential treatment center and ended up losing their home as they could no longer make the mortgage payments. “My parents had to choose between their house, or saving my life,” he said. He is now in outpatient treatment that is covered by Medicaid. He works at an airplane refurbishing company in the area and is in the process of recording a rock/funk album with his brother. “For once in my life,” he says, “I am actually happy!”

Women’s Health and Planned Parenthood

Medicaid is fundamental for women’s health in the US – covering roughly half of all births and 75 percent of public financing for family planning services, among other key women’s health services. Nearly half of low-income women in the US rely on Medicaid for health insurance, as do roughly one in three Black women, one in four Latina women, and one in five Asian and Pacific Islander women of reproductive age.

The bill’s ban on Medicaid reimbursements for Planned Parenthood services would also have devastating consequences. For more than 40 years, federal law has prevented Planned Parenthood, or any service provider, from receiving federal funding for abortion services, but the American Health Care Act targets the organization because it provides abortion care for women with non-federal money.

Planned Parenthood provides a broad range of services to women and men in some of the country’s most marginalized communities, including safe, non-judgmental services for victims of sexual violence; screening for cancer, diabetes and high blood pressure; vaccines; and other preventive health care.

More than half of Planned Parenthood’s clinics are in rural or urban areas that are designated by the federal government as “medically underserved.” In more than 100 counties throughout the country, Planned Parenthood clinics are the only providers of family planning services. Women like Jacquelyn would not be able to seek services at their preferred provider if the Senate adopted apunitive provision to ban Medicaid reimbursements to Planned Parenthood.

Nicole, a 25-year-old woman in Colorado, told Human Rights Watch that she usually seeks care at Planned Parenthood because she considers it compassionate in a way that other service providers are not. She was sexually assaulted one night after the Planned Parenthood clinic near where she lived closed. She couldn’t afford treatment in a private clinic because the deductible on the health insurance she had at work was too high. So she went to a hospital emergency room instead.

“I went to the hospital and saw a doctor and they made me feel like a slut,” she said. “I didn’t even want to tell them what happened, they were so mean about me just asking for a test. I felt alone and it was really bad.” She has since moved to an area where she has access to a Planned Parenthood clinic.

Older People

Contrary to the perception that only Medicare takes care of older people, Medicaid provides integral support to this growing demographic as well. For many of the 1.2 million older Americans who rely on institutional long-term care, almost two-thirds of them women, the median cost of one year in a nursing facility – US$90,000 – would be prohibitive without Medicaid contributions. Because Medicaid covers costs for a nursing facility stay beyond 100 days and for many community-based services, and provides support for people to remain at home, Medicaid cuts would make critical long-term care more difficult to obtain.

“Ken,” a 68-year-old former employee of a trucking company who has Parkinson’s disease, is in a nursing facility in Illinois. He moved there, far from his family, because he required more support and health care than he could obtain at home with the progression of his illness. Medicaid is “very important because that’s where I get the money to stay here,” he said. “I’m in a wheelchair all the time …  nobody at home to take care of me. If I couldn’t stay here, I don’t know where I would be.” His access to essential health services and a safe living environment would be curtailed without access to Medicaid.

“Mark,” 65, lives in Hayward, California. Mark is diabetic, and in spring of this year, the toes on his right foot had to be amputated due to complications from a staph infection. With an income of US$1,499 a month in Social Security, he relies on Medicaid to pay for necessary institutional care and for the rehabilitation sessions that are teaching him “how to walk again and do things without the use of my right foot.” Mark said that Medicaid “was not important to me until I got sick. I think that’s the way it is with a lot of elders. They won’t know it is a problem until it’s too late.” Cuts to Medicaid would threaten the ability of people like Mark to live safely, with dignity, and as independently as possible.

People with Disabilities

For people with disabilities, who have a right to community-based care, the shrinkage of Medicaid could be devastating and force many into instutional settings. It would phase out federal matching funds that give states incentives to support home- and community-based services. Over the next decade, the American Health Care Act would cut 25 percent of Medicaid’s budget – shrinking a program that serves more than 10 million people with disabilities.

In its current form, Medicaid allows people with disabilities to receive at-home personal care services. Medicaid also allows them to have choices and control over their lives – deciding where, how, and with whom to live, and enabling them to carry out normal daily activities from getting up in the morning, bathing, preparing breakfast, and going to work or school.

For people like Alana Thierault, a 50-year-old woman from California with spinal muscular atrophy, loss of Medicaid coverage and funding support for her home-based assistance may result in the end of her ability to live independently. Her condition is a form of muscular dystrophy, a genetic neurological condition that causes muscles to become weak.

Medicaid covers the services of home care workers, who go to her house in the mornings and help her perform ordinary daily activities like bathing, getting dressed, and going to work. If she were to lose those services, she wouldn’t be able to lead an independent life and she would end up living in an institution.

Stacey Milbern, a 29-year-old woman with a disability living in Oakland, said that if Medicaid supports were cut, “I likely would be living in an acute care facility – it’s very much an institutional setting and not my own home.” Milbern is able to get 24-hour attendant and nursing services, including 40 hours a week of private duty nursing that takes care of the medical side of her disability. Other attendants help her get out of bed and drive her to work.

Jade Theriault, who also has spinal muscular atrophy, said that cutting Medicaid “would be like a slow stripping of my freedom.” She now lives in her own apartment and has a team of five or six assistants who each spend two-hour blocks throughout the day to help her with daily activities, including overnight care. She uses a respiratory equipment and her attendants also help to operate it. If Medicaid were cut she wouldn’t be able to pay for these services.

Pre-Existing Conditions

The American Health Care Act would eliminate much of the ACA’s protection for people with pre-existing conditions, creating instead “high risk pools” that experts say will not be adequately funded in this legislation. These provisions and cuts to Medicaid would harm millions of Americans with chronic illness. Sixty percent of people with HIV depend on Medicaid for their health care.

Before Louisiana expanded Medicaid, “Roberta,” a 47-year-old school bus driver, struggled with her HIV care. She had no health insurance and could not always afford her anti-retroviral medication. “Sometimes I had to buy my pills from people I knew who had extra, one pill at a time,” she said. Now with Medicaid coverage, she was able to get glasses, was diagnosed with a thyroid condition she didn’t know she had, and has not missed a dose of her HIV medication.

Posted: January 1, 1970, 12:00 am

People with disabilities and older people in South Sudan face greater risks of being caught in fighting and greater challenges in getting necessary humanitarian assistance. 

Those who have managed to flee violence often face problems in camps or settlements that other people don’t – from using latrines to getting access to food distributions. People with disabilities and older people, now displaced by conflict or hunger, said they had to rely on family or friends to carry them to safety and bring them supplies, or be left behind.

Posted: January 1, 1970, 12:00 am

Human Rights Watch welcomes the opportunity to submit evidence to the Global Education Monitoring (GEM) Report on migration and education. Human Rights Watch has conducted research on children’s rights, including the right to education of refugees, asylum seekers, internally displaced persons, and migrants, for over two decades.

 SEPTEMBER 2014. Syrian Kurdish refugees look out from the back of a truck as they enter Turkey from the town of Kobane 
(Ayn al-Arab), Syria, and surrounding villages. 

© 2014 Michael Christopher Brown/Magnum

This submission includes an overview of the international legal framework protecting the right to education, factors contributing to children’s involuntary migration, and systemic barriers affecting education in host countries, as well as our recommendations. Examples included in this submission are based on Human Rights Watch’s interviews with children who find themselves in various countries, including Greece, Jordan, Lebanon, Mexico, Nauru, Nigeria, Pakistan, Sweden, and Turkey.

Children are often forced to move either internally or across international borders because of armed conflict, natural hazards, persecution, and violence. Our research has found that denial of education, often in violent settings, and systemic barriers to education can lead children to leave their home country. Moving involuntarily to a new country can have a devastating impact on the right to education for refugee, asylum-seeking, and migrant children (hereinafter collectively described as “involuntary migrant” children as per GEM terminology), particularly when host governments fail to take adequate measures to guarantee these children a right to access education on an equal basis with citizens of the host country.

Once in a new community or country, involuntary migrant and displaced children do not automatically have access to education. The office of the United Nations High Commissioner for Refugees estimates that 50 percent of primary school-age refugee children and 75 percent of secondary school-age refugees are out of school. The refugee agency also estimates that girls and women make up 70 percent of the world’s internally displaced population and are most likely to be out of school.

In many cases, governments adhere to policies and regulations that directly or indirectly prevent involuntary migrant and displaced children from going to school. Problematic policies include those that mandate school fees only for non-nationals, or require refugees to obtain government-issued documentation or legal status but in effect prevent many from doing so, as well as those that bar non-nationals from working. The effect of these policies leaves many children unable to register in school and many impoverished refugees unable to work lawfully. In many cases documented by Human Rights Watch, children often turn to exploitative and harmful forms of child labor to support their families. Many girls are married off before they reach age 18 after facing barriers to go to school.

Other factors also undermine the right to education of millions of involuntary migrant and displaced children around the world. These include: the lack or limited availability of education services in official and unofficial refugee camps; the limited availability of free secondary education and vocational training in host countries; and the lack of inclusive education and accessible services for children with disabilities. Within schools, involuntary migrant children, who often must adjust to school in a different language, and confront stigma and discrimination, will also feel the impact of existing barriers and harmful practices in host schools, including: oversized classes; a lack of adequate classrooms and trained teachers; widespread corporal punishment; and bullying and harassment on the way to school and in the classroom.

Some countries automatically detain children for immigration purposes, denying them their right to education, as well as other fundamental rights. In Mexico, Thailand, and Indonesia, voluntary and involuntary migrant children, both accompanied and unaccompanied, are often arbitrarily detained in unhygienic detention facilities without access to any formal education and are generally not allowed to leave the facilities to attend school. Even for children who avoid detention, the threat of immigration detention or deportations may lead families to avoid registering their children in the official school system. 

The overall result of governments’ policies and practices, discrimination, and other systemic barriers is that millions of involuntary migrant children are being deprived of their right to education, which is essential for their future and for the development of their host countries and countries of origin. Removing obstacles to education is critical for children to recover from conflict, persecution, and other factors forcing their movement; and to realize their rights to and through education.

Legal framework

All children have the right to education, free from discrimination of any kind.[1] At the primary level, education should be compulsory and available free to all.[2] Secondary education and vocational training should be made generally available and accessible to every child.[3]

The UN Refugee Convention provides that governments hosting refugees must accord them the same treatment accorded to nationals with respect to primary education.[4] The Convention on the Rights of the Child requires that governments adopt appropriate efforts to cater to the special needs of asylum-seeking and refugee children.[5] The Convention on the Rights of Persons with Disabilities requires governments to ensure equal access to basic services such as education including in emergency situations, such as armed conflict, humanitarian emergencies, and the occurrence of natural disasters,[6] and failure to do so is a form of discrimination.[7] Refugee and asylum-seeking women and girls should be assured the right to education without discrimination.[8]

The Committee on Economic, Social and Cultural Rights has “confirm[ed] that the principle of non-discrimination extends to all persons of school age residing in the territory of a State party, including non-nationals, and irrespective of their legal status.”[9] The Committee on the Elimination of Racial Discrimination also recommends that states “[r]emove obstacles that prevent the enjoyment of economic, social and cultural rights by non-citizens, notably in the area of education” and “[e]nsure that public educational institutions are open to non-citizens and children of undocumented immigrants residing in the territory of a state party.”[10] According to the Committee of the Rights of the Child, separated and unaccompanied children should have access to education during all phases of the displacement,[11] including any time they spend in detention.[12]

Deprivation of the right to education or other economic, social, and cultural rights may also give rise to an asylum claim.  The United Nations High Commissioner for Refugees has noted that, “Children’s socio-economic needs are often more compelling than those of adults, particularly due to their dependency on adults and unique developmental needs. Deprivation of economic, social and cultural rights, thus, may be as relevant to the assessment of a child’s claim as that of civil and political rights.”[13]

Displaced children, as citizens of their countries, have a right to education and training in their new communities. The UN Guiding Principles on Internal Displacement recommend that “authorities concerned shall ensure that such persons, in particular displaced children, receive education which shall be free and compulsory at the primary level. Education should respect their cultural identity, language and religion.”[14] Moreover, special efforts should be made to ensure the full and equal participation of women and girls in educational programs.[15]

The Convention on the Protection of the Rights of All Migrant Workers and Members of their Families guarantees the basic right of access to education for children of migrant workers on an equal basis with nationals of the states concerned. Migrant workers should also have equal access to educational institutions and services, and vocational guidance and training.[16]

Widespread Violence and Conflict as Push Factors

Human Rights Watch interviews with asylum seekers and migrants in many contexts found that children are fleeing abuses, including recruitment as soldiers, child marriage, and attacks on schools or other effects of armed conflict.

Refugee and migrant children and parents from El Salvador, Guatemala, and Honduras who fled to Mexico told Human Rights Watch that children are at risk of recruitment and other abuses by gangs as they walked to and from school. “To get to school, we had to pass by the place where the gang members were,” said Carlos G., who left San Salvador in 2011, when he was 17.[17] As a result, some children stopped attending classes in order to avoid the gangs as they went to and from school, and some left their countries to live and pursue their education elsewhere. Many of the children Human Rights Watch interviewed in 2015 said that they were pressured to join gangs, often under threat of harm or death to themselves or to family members. Girls face particular risk of sexual violence and assault by gang members. Other children gave accounts of being held for ransom or targeted for extortion.[18]

In Greece, Afghan children interviewed by Human Rights Watch in 2015 had fled Iran, where they first sought asylum, because of police abuse and lack of access to education, and many had been barred from school or were unable to afford fees and had become trapped in exploitative labor situations.[19]

Attacks on schools or other conflict-related barriers to education also cause children and their families to flee. Tarek, a 16-year-old Afghan who fled the fighting in Helmand Province in 2014, and who was seeking asylum in Greece, told Human Rights Watch in 2015:

There are schools, but not so many students because people are afraid to send their children because of the Taliban. One school is only open one day a week. Children do not go. The Taliban doesn’t allow children to go to school. If families let children go, the Taliban will kill them because in the future they may work for foreigners.[20]

Attacks on students and teachers, fear of recruitment, and violence have caused some refugee families to flee again after they tried to go home.[21] In August 2016, Human Rights Watch spoke to Ruun, a 36-year-old Somali mother of nine children, after she had returned to Dadaab camp, Kenya. She said she returned because she was worried her 14-year-old son would be recruited as a fighter if she remained in Somalia, and she couldn’t afford to take her children to school. “I came back here to be safe and secure and for my children to go to school,” she said.[22]

Systemic Barriers: School Fees, Indirect Costs, and Enrollment Restrictions

In most host countries, primary education is tuition-free and compulsory, and secondary education is usually free and available.[23] However, school fees, other school-related costs, administrative barriers, and the lack of enforcement of compulsory education for non-nationals, prevent children from accessing education.

Human Rights Watch has documented barriers to education facing Syrian refugee children in Jordan, Lebanon, and Turkey.[24] An inability to pay for transportation and education materials often prevents Syrian refugee children from attending school. Syrian families’ poverty has also contributed to an increase in child marriage among Syrian girls, who then often drop out of school.[25]

In Lebanon, we found that irregularities in the implementation of policies prevented the enrollment of many Syrian children. In many cases, school directors continued to require Syrian families to provide proof of legal residency, UN registration papers, health documents, and local attestation of residency to enroll, in contravention of Lebanon’s enrollment policy.[26] Lebanese authorities has allowed Syrian children to enroll in public schools and waived school enrollment fees. They also announced plans to open up afternoon “second shift” classes in 330 public schools.[27]

In Jordan, school officials have required Syrian children to produce official Syrian school certificates, which many families left behind when they fled, in order to enroll in secondary school, or at the grade level of their age group in primary school.[28] Jordanian authorities have not permitted most Syrians who left the country’s refugee camps after July 2014 to register their non-camp residence with UNHCR, receive humanitarian support, or obtain government-issued identification cards.[29] These cards had been required to enroll in public school, but Jordan’s education minister instructed public schools to allow Syrian children to enroll in the 2016-2017 school year. Jordan also doubled the number of schools operating “double shifts” to create spaces for up to 50,000 more Syrian students, and established a “catch-up” program to reach another 25,000 children ages 8 to 12, who have been out of school for three or more years.[30] Despite these positive steps, Jordan did not meet its enrollment targets: the education ministry implemented an improved enrollment monitoring system, which found that previous estimates had overstated enrollment.[31]

Similarly, Turkey issued a temporary protection regulation in October 2014 that ensured Syrians could remain lawfully in Turkey without official residency permits. Under its temporary protection regime, it has allowed Syrian children to attend public schools free of charge and accredited independent schools that teach a modified Syrian curriculum in Arabic—called “temporary education centers.” In addition, the government has provided avenues for qualified Syrian teachers to be compensated for their work in those centers, developed programs to offer language assistance, teacher training, and better oversight to ensure that schools across the country comply with their directives.[32]

Despite measures to expand enrollment, all three host countries enforce tough labor and immigration restrictions. Economic hardship particularly affects Syrian refugee children’s access to education in the host countries. Families in which the parents cannot work or do not earn a living wage are more likely to depend on child labor to survive, which means children miss school to work, often in hazardous conditions. Children turning 15 in Lebanon face particular challenges in maintaining legal residency because many do not possess the required passport or individual identification card, and are therefore at heightened risk of arrest while travelling to school. Syrians in Jordan who are caught working without work permits, which very few have, have been liable to arrest and transfer to a refugee camp. Thus, a large percentage of Syrian families in host communities depend on their children to work, as children are seen as at less risk of arrest. The government has established and extended grace periods in 2016 during which authorities refrained from arresting Syrians in order to allow them to apply for work permits; nearly 40,000 have been issued. However, Syrian children are still dissuaded from pursuing an education, since schooling will not help them in the only available job market for low-paid, unskilled labor.[33]

In January 2016, Turkey published a regulation that will allow Syrians with temporary protection status to apply for work permits six months after they receive temporary protection status.[34] Enabling Syrians to support themselves should have significant benefits for refugee children’s access to education, since child labor is a major cause of drop-outs and non-enrollment. However, by the end of 2016, only 13,298 permits had been issued to Syrian refugees in Turkey, which hosts 2.8 million registered Syrian refugees.[35]

In Pakistan, limited access to education for refugee children is one factor causing Afghan refugees and asylum seekers in Pakistan to return to Afghanistan, according to research conducted by Human Rights Watch in October and November 2016. Many Afghan refugee and asylum seekers in Pakistan cited the closure of Afghan refugee schools and exclusion of Afghan refugee children from Pakistani government schools as one of the key reasons they felt compelled to leave Pakistan. About half of the Afghans interviewed by Human Rights Watch said that from May 2016, their children had been excluded from Pakistani state schools or the authorities had shut down Afghan refugee schools.[36] Upon return, many Afghan children face significant administrative barriers to accessing education. Schools often request identification and transfer documentation, and many school officials apply arbitrary ages of enrollment in primary school. These barriers can be particularly harmful for girls, as discriminatory gender roles may mean that girls are more likely to lack identification, and to seek to enroll late and thus be affected by age restrictions and restrictions when enrolling mid-year. When families face difficulty obtaining the documentation necessary for a child to register or transfer, they may be less likely to go to great efforts to secure these documents for girls.[37]

In Iran, Human Rights Watch also found that a sizeable portion of unregistered Afghans are deprived of education as a result of Iranian policies. Afghan refugees in Iran have to pay school fees and show residency documents to be admitted to school, even though Iranian nationals are not subjected to the same conditions.[38] In 2004, for example, the Iranian government promulgated regulations that introduced mandatory education fees for all Afghan children.[39] Authorities consider these fees nominal but some Afghans say they are onerous.[40] According to Office of the United Nations High Commissioner for Refugees, in 2012 tuition fees for primary, junior high, and high school were raised as a consequence of the removal of subsidies, affecting both Iranian nationals and refugees.[41] Afghans without legal status or valid refugee documents face many difficulties in obtaining education for their children, with many children going uneducated or attending underground schools as a result.[42] In 2015, Iran reportedly allowed all Afghan children, including undocumented ones, to register for schools after Supreme Leader Ali Khamenei issued a ruling reaffirming the need for universal education.[43] However, some reports indicate that only 10 percent of Afghan children who were left out of school were able to enroll in schools.[44]

Ahmad, a 16-year-old Afghan who was raised in Iran, said:

I went to school, but my parents had to pay for me and my brother and sister because we were not Iranian. Iranian children do not have to pay. Two or three times I did well enough in exams to qualify for a special education program, but could not go, because I was Afghan. Refugees are also not allowed to study in university in Iran, so I decided for my future to go somewhere else. I didn’t want to go back to Afghanistan. Every day we heard about suicide bombings and someone or some group of people losing their life, even in Kabul. Every day there is a bomb blast. If I went back there, I imagine a dark future. I just want to have a chance to continue my education, nothing more.[45]

In Sweden, more than 35,000 unaccompanied children applied for asylum in 2015. Unaccompanied children are not detained in Sweden and are entitled by law to equal access to education.[46] However, the arrival of tens of thousands of children in 2015 has put a strain on this system, which has affected their right to education. Human Rights Watch found that delays in appointing guardians impacted children’s access to education, information, and support. No national agency has the responsibility to track guardianship appointments, living arrangements, school enrollment, health screenings, or assessments by social workers.[47] Four children reported that they were prevented from enrolling in school because they did not have a guardian.[48] Local officials told Human Rights Watch that, as the rate of arrivals increased and the delay in appointment of guardians began to significantly affect enrollment, informal arrangements were made with local school authorities so that staff from group homes could enroll children.[49]

Lack of Quality and Inclusive Education

Human Rights Watch found that language barriers, a lack of educational materials, such as textbooks, and inattentive or inadequately trained teachers have caused Syrian refugee children to drop out of school in Jordan, Lebanon, and Turkey. Lack of access to private, clean sanitation facilities at schools has also affected girls’ ability to manage their hygiene during menstruation and affect school attendance.[50] 

Lebanon’s public school system struggled before the ongoing refugee crisis, when only 30 percent of Lebanese students attended public schools, which suffer high rates of grade repetition and dropouts.[51] This problem is exacerbated for Syrian children enrolled in newly opened second shift classes, which are run in the afternoon to accommodate additional students. Under the ministry’s operating procedures, second shift teachers are drawn from the first shift, and new teachers are only hired if there are an insufficient number of teachers or qualified staff available from the first shift.[52] This leaves many teachers tired and overworked, reducing the quality of both shifts. Underqualified teachers and double shifts also affected quality of education in Jordan.[53]

Human Rights Watch documented that children with disabilities in Jordan and Lebanon have been largely excluded from efforts to provide Syrian children access to education.  Lebanese public schools are not inclusive, and many children with disabilities in Lebanon are unable to access quality education, despite a law that guarantees access to education for children with disabilities.[54] Syrians are not eligible for government funding that allows Lebanese children with disabilities to access institutions. Human Rights Watch found that public schools were turning away Syrian children on the basis of their disabilities. In Lebanon, a dozen humanitarian and disabilities organizations told Human Rights Watch that little or nothing had been done to ensure that children with disabilities could enroll in schools. Where Syrian children with disabilities in Jordan and Lebanon were able to enroll in schools, schools did not adequately accommodate the needs of children with disabilities to ensure they receive quality education on an equal basis with other children. This meant some Syrian refugee children with disabilities remain at home.[55] 

In Jordan, Lebanon, and Turkey, Human Rights Watch found that widespread corporal punishment of children by teachers, school administrators, and bus drivers; violence, bullying, discrimination, and harassment on the way to school and in the classroom have caused Syrian refugee children to drop out of school in these three countries.[56] Girls are also particularly affected. Parents are more likely to keep older girls home due to safety concerns and fears of harassment.[57] Discrimination in school can also affect children’s ability to learn or motivation to attend. Halima, 30, who now lives in Beirut, told Human Rights Watch:

My kids hate school, they don’t want to go. The monitor stands on their feet and pulls their hair. There is no respect for the student or the parent. [Teachers] insult the kids in class, calling them cow or donkey. The way that Syrian children are treated differently makes them close their minds.[58]


In Nauru, where some 1,200 refugees and asylum seekers have been sent for “regional processing” by Australia, Human Rights Watch and Amnesty International found that, in part due to bullying and harassment, many asylum seeker and refugee children have stopped attending school.[59] Save the Children Australia estimates that 85 percent of refugee and asylum seeker children on Nauru are not enrolled in school.[60] A school in the regional processing center closed in mid-2015 and refugee and asylum-seeking children attend local schools.[61] Harassment and violence against refugee and asylum-seeking children in local schools appeared to be prevalent. Parents and children reported that they are regularly called names, shoved, hit, have things thrown at them, and subjected to other forms of bullying and sexualized forms of harassment while at school.[62] Children reported being ignored when they complain of bullying and harassment to their teachers. Similarly, a July 2016 evaluation by Save the Children Australia found that refugee and asylum-seeking children, particularly girls, were subjected to physical violence by Nauruan students.[63]

Limited Access to Education in Refugee and Displacement Camps

In 2016, Human Rights Watch documented the situation of unaccompanied asylum-seeking and migrant children in northern France, living in the so-called “Jungle” camp in Calais. The only form of education available in the camp was provided by nongovernmental organizations or volunteers in the camp. When the camp in Calais was closed by the French government in late October 2016, children were taken to temporary reception centers across France. Between December 5 and 16, Human Rights Watch interviewed 41 unaccompanied migrant children from Ethiopia, Eritrea, Sudan, Syria, and Afghanistan and staff in six reception centers. Human Rights Watch found that children had access to limited informal educational and recreational activities in the reception centers.[64]

Like with all children, displacement and migration causes great disruption for children and young people with disabilities including their ability to attend school and receive an education. Unfortunately, while many efforts to support displaced and migrant children include providing them with access to education, Human Rights Watch research suggests that humanitarian needs analysis are most often not inclusive and do not factor in the specific needs of children and young people with disabilities, thereby affecting humanitarian aid allocations for inclusive education programs in camp and non-camp settings, impacting on children’s right to inclusive education.[65] In 2015, Human Rights Watch found that very few children with disabilities were enrolled in schools in camps like the M’Poko camp for internally displaced persons (IDPs) in Bangui, Central African Republic.[66] Of the nearly 3,800 children enrolled at the school in M’Poko, only 14 had disabilities. While the school itself was wheelchair-accessible, the route to the school was not. Children with physical disabilities needed a family member to drop them to school and pick them up, and they needed an assistive device. Without an assistive device, such as a wheelchair, children with physical disabilities can find it hard to sit all day on the floor.[67] School staff told Human Rights Watch that some parents were hesitant to send children with physical disabilities to school as they fear that their children will not be able to flee in case of an attack. Children with sensory or intellectual disabilities are unable to attend because the school does not have teachers trained in inclusive methods. The school staff has not actively sought to enroll children with disabilities.[68] The M’Poko camp has since been closed but Human Rights Watch research has not found evidence of children with disabilities getting access to inclusive education in camps for internally displaced people in other parts of the country.

In Greece, Human Rights Watch research conducted in 2017 found that children with disabilities who are refugees, asylum seekers, and migrants are not properly identified and do not enjoy equal access to services, including access to education, in Greek reception centers. One of the people working in Souda camp in Chios, which held 1,150 people when Human Rights Watch visited, said that the lack of access to education affects the mental well-being of migrants and asylum seekers.[69]

Across northern Nigeria, where many have become displaced because of Boko Haram attacks on schools and other targets, Human Rights Watch found that many children have limited schooling in displacement camps or in private homes and communities where they are hosted by friends, families, and others. For about 10 percent of displaced children, who are living in camps, there is some access to primary and secondary education, though it is far from adequate. In such camps, schools consist of children grouped according to their age in large rooms or underneath trees for three to four hours of lessons per day, in most cases three times a week. School materials such as paper and pencils are provided in UNICEF-supplied bags, but there are no textbooks for the children, or other teaching aids for teachers.  The education programs in camps utilize public school teachers from the same areas as the children they teach.[70]

For parents, the poor quality of teaching at the camp learning spaces evokes nostalgia for what they left behind in their violence-ravished communities. A father of nine children said:

There is no school here. What we have is rubbish. The children go for some hours and come back. They are not learning anything. No books. Only writing paper. It is not worth keeping my children here [in Maiduguri]. When I have chance we will go back to our village.[71]

Denial of Education Through Immigration Detention

International standards provide that the detention of any asylum seeker, whether a child or an adult, should normally be avoided. In countries like Indonesia, Malaysia, Mexico, and Thailand, migrant children are detained in immigration centers, where they often have limited to no access to education.[72]

Human Rights Watch found that Thailand’s immigration laws permit the indefinite detention of all refugees, including Rohingya and members of other ethnic groups from Burma, ethnic Uighurs from China, Pakistanis, and Somalis. Migrant children are held in squalid cells without adequate food or opportunity to exercise or receive an education.[73] 

In 2015, Human Rights Watch research into the situation of refugee and migrant children from El Salvador, Guatemala, and Honduras in Mexico found that children in detention appeared to be deprived of their right to education. Human Rights Watch heard of no instance in which children had access to regular, appropriate grade-level education in immigration detention centers and National System for Integral Family Development (DIF) shelters, regardless of the length of time they are held. At most, children may take part in activities, run on an ad hoc basis, that have a limited educational component, such as craft sessions and religious discussions.[74]

In mid-2016, Human Rights Watch investigated the situation of unaccompanied asylum-seeking and migrant children in detention in Greece, where children are often detained in so-called protective custody. Human Rights Watch found that unaccompanied children were routinely and arbitrarily detained in small, overcrowded, and unhygienic cells for prolonged periods, with little access to basic care and services. Human Rights Watch found no evidence that the unaccompanied children had access to educational opportunities or recreational activities.[75] Some children only had access to educational activities in safe spaces set up by UNHCR and nongovernmental organizations in refugee camps, where on-site staff and volunteers provided support specifically to unaccompanied children.[76]


Governments should:

  • Ensure, under law and in policy and practice, every child’s right to free and compulsory primary education, and ensure secondary education and vocational training is made generally accessible and available to all.
  • Revoke any laws or policies that discriminate against children of foreign nationality and deny them the right to education.
  • Delink immigration-related requirements from enrollment criteria, including residence permits or school fees that are not regularly applicable to nationals of their countries, particularly where such requirements effectively serve to isolate or discriminate against refugee and asylum-seeking children.
  • Ensure that enrollment and education policies are properly implemented at all levels to ensure that all children can access quality education on an equal and inclusive basis, and monitor compliance at the local level.
  • Ensure non-nationals have access to quality language support programs in primary and secondary schools, and vocational centers.
  • Ensure the provision of education in crises and displacement, and adopt special measures to ensure children can continue to go to school in highly insecure areas, including by reducing the distance to school, offering distance learning programs, and setting up protective spaces for girls and teachers.
  • With humanitarian and development agencies:
    • Ensure that internally displaced, asylum-seeking and refugee children and youth are included in national education plans, and collect better data to monitor their situation.
    • Ensure children with disabilities are included in all education efforts. When implementing education programs in the context of migration, organizations and governments should ensure there is no inadvertent discrimination against children with disabilities. An inclusive education program should provide all students with an equitable and participatory learning experience and environment that best corresponds to their requirements and preferences, including accessible classrooms, education materials, and teachers trained to adapt to different learning abilities and styles.  
  • Curtail detention of children for immigration purposes. In the exceptional cases where children are detained they should receive services and care appropriate to their age, including access to compulsory education. Governments should provide access to educational activities designed to provide a measure of continuity and give children the opportunity to reenter the formal education system at a later date. For those children who are in detention settings for longer periods—including applicants for refugee recognition, who may spend months in detention—governments should ensure that they receive access to educational programs that cover at least the curriculum of compulsory education at the primary level, and preferably also at the secondary level.


Humanitarian and bilateral donors, and agencies providing international support should:

  • Provide resources and technical cooperation to assist in the continuity of education in planning for emergencies and early recovery.
  • Target support to governments struggling to meet the education needs of internally displaced and refugee children, particularly in remote areas. All programs should be inclusive of children with disabilities.

[1]  Convention on the Rights of the Child (CRC), arts. 2, 28. International Covenant on Economic, Social and Cultural Rights (ICESCR), arts. 2, 13; United Nations Educational, Scientific and Cultural Organization (UNESCO) Convention against Discrimination in Education (1960), arts. 1-4.

[2] CRC, art. 28(1)(a); ICESCR, art. 13(2)(a).

[3] CRC, art. 2, 28(1), (b), (d); ICESCR, art. 13(2)(b).

[4] Convention relating to the Status of Refugees, 189 U.N.T.S. 150, entered into force April 22, 1954, art. 22.

[5] CRC, art 22(1).

[6] Convention on the Rights of Persons with Disabilities (CRPD), adopted December 13, 2006, G.A. Res 61/106, U.N. Doc A/RES/61/106, entered into force May 3, 2008, art. 11.

[7] CRPD, arts. 3(b), 4.

[8] Committee on the Elimination of Discrimination against Women, General recommendation No. 32 on the gender-related dimensions of refugee status, asylum, nationality and statelessness of women, CEDAW/C/GC/32, 2014, (accessed May 9, 2017).

[9] Committee on Economic, Social and Cultural Rights, General Comment No. 13: The right to education (article 13) (1999), E/C.12/1999/10, (accessed May 17, 2017), para. 34.

[10] Committee on the Elimination of Racial Discrimination, General Recommendation No. 30: Discrimination against Non-Citizens,

, CERD/C/Misc.11/rev.3 (2004), paras. 29-30. The Committee on the Elimination of Racial Discrimination issues authoritative guidance on the binding content of the obligations set forth in the International Convention on the Elimination of All Forms of Racial Discrimination, adopted December 21, 1965, 660 U.N.T.S. 195 (entered into force January 4, 1969).

[11] “Every unaccompanied and separated child, irrespective of status, shall have full access to education in the country that they have entered in line with articles 28, 29(1)(c), 30 and 32 of the Convention and the general principles developed by the Committee.” Committee on the Rights of the Child, General Comment No. 6, “Treatment of unaccompanied and separated children

outside their country of origin,” CRC/GC/2005/6 (2005), 9accessed May 9, 2017), para. 41.

[12] See United Nations High Commissioner for Refugees (UNHCR) Detention Guidelines, para. 56 (“During detention, children have a right to education which should optimally take place outside the detention premises in order to facilitate the continuation of their education upon release.”); Committee on the Rights of the Child, General Comment No. 6, para. 63.

[13] UNHCR, Guidelines on Child Asylum Claims, para. 14. See also Committee on Economic, Social and Cultural Rights, General Comment No. 11: Plans of Action for Primary Education, UN Doc. E/1992/23 (May 10, 1999), (accessed May 17, 2017) para. 4 (“The lack of educational opportunities for children often reinforces their subjection to various other human rights violations.”).

[14] UN Economic and Social Council, UN Guiding Principles on Internal Displacement, 11 February 1998, E/Cn.4/1998/53/Add.2, (accessed May 23, 2016), principle 23 (1) and (2).

[15] Ibid., principle 23 (3).

[16] Convention on the protection of the Rights of All Migrant Workers and Members of their families, adopted December 18, 1990, G.A. Res 45/158, U.N. Doc A/RES/45/158, entered into force July 1, 2003, arts. 30, 43, and 45.

[17] Human Rights Watch interview with Carlos G., México, DF, April 30, 2015.

[18] Human Rights Watch, Closed Doors, Mexico’s Failure to Protect Central American Refugee and Migrant Children, March 2016,

[19] “EU: Abuses Against Children Fuel Migration,” Human Rights Watch news release, June 22, 2015,

[20] Ibid.

[21] Human Rights Watch, “Growing Up Without An Education” Barriers to Education for Syrian Refugee Children in Lebanon, July 2016,; They Set the Classrooms on Fire” Attacks on Education in Northeast Nigeria, April 2016, Studying Under Fire, Attacks on Schools, Military Use of Schools During the Armed Conflict in Eastern Ukraine, February 2016,

[22] “Kenya: Involuntary Refugee Returns to Somalia, Camp Closure Threat Triggers Thousands Returning to Danger,” Human Rights Watch news release, September 14, 2016, For context on attacks against education in Somalia, see Human Rights Watch, No Place for Children: Child Recruitment, Forced Marriage, and Attacks on Schools in Somalia, February 2012,

[23] Human Rights Watch, “When I Picture My Future, I See Nothing” Barriers to Education for Syrian Refugee Children in Turkey, November 2015,; Seeking Refuge, Unaccompanied Children in Sweden, June 2016,; “Growing Up Without An Education” Barriers to Education for Syrian Refugee Children in Lebanon, July 2016,; “We’re Afraid for Their Future” Barriers to Education for Syrian Refugee Children in Jordan, August 2016,; Pakistan Coercion, UN Complicity: The Mass Forced Return of Afghan Refugees, February 2017,

[24] Human Rights Watch, “Education for Syrian Refugee Children,” undated,

[25] Human Rights Watch, “When I Picture My Future, I See Nothing;” “Growing Up Without An Education;” “We Are Afraid For Our Future.”

[26] Human Rights Watch, “Growing Up Without An Education.”

[27] Human Rights Watch, “Education for Syrian Refugee Children: What Donors and Host Countries Should Do,” September 2016,; UNHCR, “Lebanon: Inter-Agency Update, August-September 2016,” October 19, 2016, (accessed May 11, 2017).

[28] Human Rights Watch, “We’re Afraid For Their Future.”

[29] In November 2015, Jordan relaxed requirements for Syrians in host communities to comply with requirements to verify their residences, and reduced costs for them to obtain required health tests.

[30] Human Rights Watch, “Education for Syrian Refugee Children: What Donors and Host Countries Should Do.”

[31] “Remove Barriers to Syrian Refugee Education,” Human Rights Watch press release, April 5, 2017,

[32] Human Rights Watch, “Education for Syrian Refugee Children: What Donors and Host Countries Should Do.”

[33] Human Rights Watch, “Growing Up Without An Education”; “We Are Afraid For Our Future.”

[34] “Karar Sayısı: 2016/8375,” (accessed January 27, 2016).

[35] “Turkey issues work permits to over 73,500 foreigners,” Andalou Agency, January 18, 2017,

[36] Human Rights Watch, Pakistan Coercion, UN Complicity.

[37] Based on Human Rights Watch’s research on barriers to girls’ education in Afghanistan, conducted in 2016.

[38] Human Rights Watch, Unwelcome Guests: Iran’s Violation of Afghan Refugee and Migrant Rights, November 2013,

[39] Afghanistan Research and Evaluation Unit, “Second-generation Afghans in Iran: Integration, Identity and Return,”April 2008, (accessed September 4, 2012).

[40] Frances Harrison, “Iran’s Afghan refugees feel pressure to leave,” BBC, November 1, 2004, (accessed December 9, 2015).

[41] UNHCR, “Update on the Solutions Strategy for Afghan Refugees,” September 2012, (accessed December 9, 2015).

[42] Human Rights Watch, Unwelcome Guests.

[43] Human Rights Watch, World Report 2016 (New York: Human Rights Watch, 2016), Iran,

[44] “Few Afghan Kids Enroll in Iran Schools,” Financial Tribunal, December 1, 2015, (accessed April 4, 2016).

[45] “EU: Abuses Against Children Fuel Migration,” Human Rights Watch news release, June 22, 2015,

[46] Swedish Education Act, 2010:800, sec. 8; Discrimination Act, 2008:567, sec 1.

[47] Human Rights Watch, Seeking Refuge, Unaccompanied Children in Sweden.

[48] Human Rights Watch interview with Isah G., Gothenburg, February 2, 2016.

[49] Human Rights Watch interviews with Kristin Lindberg, Nordmaling, HVB Operations, January 31, 2016, and Mats Omgren and Victoria Sundling, January 29, 2016.

[50] Human Rights Watch, When I Picture My Future, I See Nothing;” “Growing Up Without An Education;” “We Are Afraid For Our Future.”

[51] Ministry of Education and Higher Education, “Reaching all Children with Education in Lebanon,” June 2014, (accessed March 28, 2016), p. 7

[52] Ministry of Education and Higher Education, Decree no. 719/M/2015 Public Schools Afternoon Shift Schedule – Executive procedures for teaching non-Lebanese children 2015/2016, art. 9.

[53] Human Rights Watch, Growing Up Without An Education;” “We Are Afraid For Our Future.”

[54] Bassam Khawaja (Human Rights Watch), “War is No Excuse for Depriving Children with Disabilities of an Education”, May 16, 2016,

[55] Human Rights Watch, Growing Up Without An Education”; “We Are Afraid For Our Future;” Based on research to be published in an upcoming report.

[56] Human Rights Watch, “Education for Syrian Refugee Children,” undated,

[57] Human Rights Watch, “When I Picture My Future, I see Nothing;” “Growing Up Without An Education;” “We Are Afraid For Our Future.”

[58] Human Rights Watch interview with Halima, Beirut, November 25, 2015.

[59] Human Rights Watch and Amnesty International, “Australia: Appalling Abuse, Neglect of Refugees on Nauru,” August 2016,

[60] See Nicole Hasham, “‘You Are Terrorists, You Make Bombs’: Racist Taunts Help Keep Nauru Refugee Kids Out of School,” Sydney Morning Herald, July 29, 2016, (accessed November 2, 2016)

[61] Ben Doherty, “School in Nauru detention centre to be closed,” The Guardian, March 30, 2015, (accessed May 3, 2017).

[63] See Hasham, “‘You Are Terrorists, You Make Bombs.’”

[64] “France/UK: Lone Children From Calais Left in Limbo, Ensure Fair, Transparent Process for UK Entry,” Human Rights Watch news release, December 21, 2016,

[65] Human Rights Watch, The Education Deficit: Failures to Protect and Fulfill the Right to Education in Global Development Agendas, June 2016,

[66] “Central African Republic: People With Disabilities Left Behind, Aid Agencies Should Include Them in Planning; Meet Basic Needs,” Human Rights Watch news release, April 28, 2015,

[67] Human Rights Watch, “Leave No One Behind,” pp. 19-20.

[68] Ibid.

[69] Greece: Refugees with Disabilities Overlooked, Underserved, Identify People with Disabilities; Ensure Access to Services, Human Rights Watch news release, January 18, 2017,

[70] Human Rights Watch interview with National Emergency Management Agency staff [name withheld], Maiduguri, September 10, 2015.

[71] Human Rights Watch interview with a parent [name withheld], Maiduguri, Nigeria, September 10, 2015.

[72] See Alice Farmer (Human Rights Watch), “The Impact of Immigration Detention on Children,” Forced Migration Review, 2013,; Michael Garcia Bochenek, “Children Behind Bars, The Global Overuse of Detention of Children,” Human Rights Watch World Report (January 2017),

[73] Michael Garcia Bochenek, “Children Behind Bars, The Global Overuse of Detention of Children.”

[74] Human Rights Watch interview with DIF staff, Tapachula, Chiapas, October 23, 2015.

[75] Human Rights Watch, “Why Are You Keeping Me Here?” Unaccompanied Children Detained in Greece, September 2016,

[76] Human Rights Watch interview with Kaiman T., safe space for unaccompanied children, Diavata refugee camp, Thessaloniki, June 28, 2016.

Posted: January 1, 1970, 12:00 am

Drugged, naked, left covered in feces and locked in a seclusion room for more than five hours without food or water. Repeatedly falling and hurting yourself in a dark cell while your distress and cries for help are ignored.

Miriam Merten shown on CCTV footage from a government hospital in New South Wales, Australia, 2014.

© Supplied

Nobody should be treated this way. But this is how Miriam Merten spent her final hours in the mental health unit of a government hospital in New South Wales, Australia, in 2014. 

Disturbing CCTV footage released by her daughter last week shows the 46-year-old Merten fell over 20 times in her cell, but no nurse came to her aid. When the cell door is finally opened the next morning, a disheveled Merten, covered in blood and feces, staggers through the corridors naked. Minutes later, Merten collapses to the floor and dies the next day of brain injuries.

The abuse came to light during an inquest. Until recently, Merten’s daughter did not even know the real cause of her mother’s death and found out purely by chance from a journalist. This raises the question, how many other Miriam Mertens are suffering in silence?

While many Australians were shocked by the footage, the use of isolation rooms remains common in the mental health system of Australia and other countries.

Isolation cells are used in psychiatric hospitals and prisons where people with psychosocial disabilities, or mental health conditions, are so grossly overrepresented that these institutions act as de facto mental health facilities. Our research in prisons in Western Australia and Queensland found that people with psychosocial disabilities or at risk of self-harm were often locked up in specially designed isolation cells with little or no furniture, were forced to wear a tear-proof hospital gown, and were kept under surveillance with limited human contact and limited or no access to any leisure activities. They are kept in these cells anywhere from a few hours to weeks. While the intent may be to keep the person safe, isolation rooms often make a person’s mental state even worse. Instead of a last resort, isolation rooms were commonly used in at least half of the psychiatric hospitals and prisons visited by Human Rights Watch in Australia.

An independent review has been ordered into Merten’s death, which would look into all aspects of the state’s mental health system, including the use of seclusion rooms.

But that’s not enough. The Australian government should ensure independent and regular monitoring of mental health settings, including in prisons. It should order an independent and impartial investigation of restrictive practices used in the mental health system. Let’s hope Miriam Merten’s needless death can be the catalyst for needed change.

Author: Human Rights Watch
Posted: January 1, 1970, 12:00 am

More than 600,000 children with disabilities are out of school in South Africa. In a country that has claimed to have achieved universal basic education, children with disabilities experience systemic barriers and discrimination on a daily basis. These children are not guaranteed a quality education on an equal basis with children without disabilities.

Drawing of a female student holding a placard that says “I want to learn” found in Boitumelo Special School in Kimberley, South Africa.

© 2015 Boitumelo Special School

Unequal access is one of the most evident forms of discrimination. Children with disabilities continue to pay school fees and costs that children without disabilities do not pay, or are asked to pay for services so they can go to school. Many parents cannot afford to send children to school, so many stay at home. Others are turned down by schools that do not want to enroll children with disabilities.

Although the government has recently devoted more attention to inclusive education, it has a long way to go to implement its inclusive education policy. A strong, global reminder that South Africa must to do its utmost to ensure children with disabilities have a right to education would have ripple effects at home.

There’s an opportunity to do just that on May 10, when the United Nations Human Rights Council in Geneva reviews South Africa’s human rights record.

One of the most positive contributions UN member states could make for South Africa’s children would be to press the government on why children with disabilities have not been guaranteed free and compulsory education on an equal basis with children without disabilities. They could also ask the government for a specific timeline to adopt a national plan to make education free, in line with its international obligations, and also ask how it will enforce it so that all children can go to school on an equal basis.

Author: Human Rights Watch
Posted: January 1, 1970, 12:00 am

© 2017 Mitch Blunt for Human Rights Watch


(Washington, DC) – New evidence has emerged of dangerously subpar medical care in United States immigration detention at a time when the Trump administration is seeking to increase its use, Human Rights Watch and Community Initiatives for Visiting Immigrants in Confinement (CIVIC), a group seeking to end immigration detention, said in a report released today.

The 104-page report, “Systemic Indifference: Dangerous & Substandard Medical Care in Immigration Detention,” reveals systemic failures, such as unreasonable delays in care and unqualified medical staff, that are likely to expose a record number of people to dangerous conditions under President Donald Trump’s ramped-up deportation and detention plans.

“The data reveals that people in immigration detention died needlessly under the Obama administration, even with its attempts at reform,” said Grace Meng, senior US researcher at Human Rights Watch. “The Trump administration has already announced its intent to roll back key reforms while detaining even more immigrants, which would likely mean more people will die needless and preventable deaths.”

New evidence has emerged of dangerously subpar medical care in United States immigration detention at a time when the Trump administration is seeking to increase its use.

The report is based on independent medical experts’ analyses of records from US Immigration and Customs Enforcement’s own investigations into 18 deaths in detention from 2012 to 2015, and the medical records of 12 additional people from 10 privately and publicly operated facilities across the country. Human Rights Watch also interviewed more than 90 people who are or were detained, as well as family members, attorneys, immigration advocates, and correctional health experts.

The medical experts found numerous incidents of substandard and dangerous medical care, including failure to follow up on symptoms that required attention; medical personnel apparently practicing beyond the scope of their licenses and expertise; severely inadequate mental health care; the misuse of solitary confinement for people with mental health conditions; and sluggish emergency responses. The experts agreed that such subpar care contributed to seven of the 18 deaths.

Among them was Raul Ernesto Morales Ramos, who died of organ failure with signs of widespread cancer in 2015, after being detained at Adelanto Detention Center in California. The two experts who reviewed the records from his death investigation found that there had been symptoms of widespread cancer two years earlier, but that they essentially went unaddressed until a month before he died. Throughout this time, Morales-Ramos repeatedly begged for care.

Witness: A Needless Death in US Immigration Detention

Witness: A Needless Death in US Immigration Detention

When Tiombe Kimana Carlos committed suicide at 34, she had spent two-and-a-half years in immigration detention at York County Prison in Pennsylvania.

Tiombe Carlos, detained at York County Prison in Pennsylvania, died in 2013, in her second suicide attempt in the two-and-a-half years she was detained. Staff knew she had a mental health condition requiring substantial support, but failed to create a mental health treatment plan. One expert called the mental health care she received “woefully inadequate.”

ICE officials at Hudson County Correctional Facility in New Jersey told Human Rights Watch that registered nurses review requests for care and that everyone is seen within 24 hours. But the medical records of one man indicated that when he sought care for abdominal pain so strong that he wrote, “I cannot walk with the pain,” he was only seen a month later.

The experts emphasized that in several instances there was evidence of substandard medical practices that could put people throughout entire facilities at risk of serious harm, even if it did not necessarily contribute to the person’s death. In the case of one man who died in 2014, the ICE investigation found a licensed vocational nurse was attempting to record vital signs four weeks after the fact “from memory.”

“The sheer number and consistency of cases involving inadequate medical care point to a crisis that warrants immediate action,” said Christina Fialho, an attorney and the co-executive director of CIVIC. “The medical experts’ analyses confirm what we have been hearing from detained immigrants for years. It’s past time to put an end to the substandard medical practices that harm many people in immigration detention each year.”

Human Rights Watch and CIVIC concluded that the US government lacks effective means to monitor and correct these problems in facilities under its control. An audit of Eloy Detention Center in Arizona by ICE Enforcement and Removal Operations prior to a string of suicides stated there was appropriate policy and procedure for suicide intervention. However, successive death investigations conducted by the ICE Office of Detention Oversight after the suicides flagged the lack of a suicide prevention plan.

In addition, according to its annual report to Congress, the Department of Homeland Security’s Office of Civil Rights and Civil Liberties, an oversight body, sent ICE 49 recommendations to improve conditions at an unnamed facility in Arizona that is clearly Eloy. It took ICE two years to respond, and the civil rights office concluded that it had not responded appropriately to 30 of the recommendations. Dr. Marc Stern, a correctional health expert who reviewed all the documents in this report, concluded, “From the evidence that I saw in the cases that I reviewed, we have a system that is broken for detainee health care, and adding more detainees to that system can only make it worse.”

Other experts who reviewed records for Human Rights Watch are Dr. Allan Keller, an expert in access to health care for prisoners, and Dr. Palav Babaria, chief administrative officer of ambulatory services at Alameda Health System in Oakland, California.

True reform to protect the rights of the men, women, and children in immigration detention should include an overhaul of laws that often require detention for no good reason

Grace Meng

senior US researcher

The US currently detains about 40,000 people a day, or more than 400,000 per year, at an annual cost of US$2 billion. Many people in detention are blocked under US law from having a bond hearing to determine whether their detention is necessary. The Trump administration’s recent request for supplemental funding had included a request for $1.2 billion for increased detention capacity from the 34,000 beds to an unprecedented 45,700. It is likely some of the $1.5 billion for border security in the reported appropriation deal will be used for increased deportation and detention, and more funds are likely to be requested for the final fiscal year 2018 budget.

In California, which detains more immigrants than any state except Texas, a bill is pending that could improve conditions. Senate Bill 29, Dignity Not Detention, would require localities that hold immigrants in detention for the federal government to adhere to the 2011 Performance-Based National Detention Standards and make these standards enforceable by the California Attorney General’s Office and local district and city attorneys.

“The detention system was sprawling and bloated, with oversight mechanisms that had no teeth even before President Trump was elected,” Meng said. “True reform to protect the rights of the men, women, and children in immigration detention should include an overhaul of laws that often require detention for no good reason.”

Posted: January 1, 1970, 12:00 am