Each month, about one million people cross through checkpoints like Stanytsia Luhanska in east Ukraine. More than half are older people traveling into areas under Ukrainian control to collect social benefit payments. Between January and early April, according to the Organization for Security and Co-operation in Europe (OSCE), at least 19 people died while crossing these checkpoints, mostly older people with heart-related complications. Ukrainian officials have voiced deep suspicion and even hostility toward this population, suggesting they are “anti-Ukrainian.” The government also forces them to register as internally displaced persons and to provide addresses in government-controlled areas – a legal fiction which often involves paying monthly fees to landlords there – and to make the difficult journey through Ukrainian crossing points at least once every 60 days. If they fail to register or cross, the authorities automatically stop paying their pension. Spend an hour in Stanytsia Luhanska and it becomes clear just how arduous these requirements are for older people. Dozens pass by in wheelchairs, while others can walk only with crutches, walkers, or canes. Some people pay up to 200 hryvnia (about US$7.60) to be ferried one half of the journey in hand-pushed carts – no small price for someone on a pension of 2000 hryvnia (US$76).

Posted: January 1, 1970, 12:00 am

More than 13,500 asylum seekers remain trapped on the Greek islands in deplorable conditions as winter begins on December 21, 2017. Greece, with support from its European Union partners, should urgently transfer thousands of asylum seekers to the Greek mainland and provide them with adequate accommodation and access to fair and efficient asylum procedures.

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

Shantha Rau Barriga is the founding director of the disability rights division at Human Rights Watch. She leads research and advocacy on human rights abuses against people 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. Shantha also serves as co-chair of the Leadership Management Team at Human Rights Watch, and is head of the Brussels office.

Shantha is a founding member of the International Network of Women with Disabilities, member of the Amnesty International Advisory Group on Disability Rights, expert advisor to the Catalyst for Inclusive Education Initiative and a senior advisor to United for Global Mental Health. She also served on the UNICEF Advisory Board for the 2013 State of the World’s Children report.

Before joining Human Rights Watch, Shantha participated in the UN negotiations toward the Convention on the Rights of Persons with Disabilities, working as part of a global coalition to advocate for strong protections on non-discrimination, accessibility, education, legal capacity, independent living and international monitoring. She also previously worked with UNICEF Tanzania, carrying out an assessment on children with disabilities in refugee camps in Kibondo.

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. Shantha is married and has two sons.

Posted: January 1, 1970, 12:00 am

Sixteen beds fill a room with barred windows in a closed institution for children with disabilities.

© 2018 Human Rights Watch

Media in Kazakhstan have reported that 4 children living in a state residential institution for children with disabilities have died, while a further 16 were hospitalized with measles and intestinal infections.

The institution, located in Ayagoz, a town in eastern Kazakhstan, has been under quarantine since early April due to the Covid-19 pandemic. Medical professionals, including the region’s head pediatrician, have not attributed the children’s deaths or illnesses to Covid-19. But the tragic deaths and numerous hospitalizations serve as an urgent reminder that children in residential institutions are at particular risk from infectious diseases.

The risk of Covid-19 exposure is higher among populations that live in close proximity to each other, where the virus can spread rapidly. In addition, the virus disproportionately affects people with underlying conditions, which may be the case for some children with disabilities. More than 100 residents live in the children’s institution where the 4 children died.

While authorities have taken the important steps of opening an investigation on criminal charges of medical negligence in this case and initiating comprehensive inspections of these types of children’s residential institutions across Kazakhstan, these deaths and hospitalizations should also spur the authorities to do more. They should take urgent measures to move as many children with disabilities as possible out of state residential institutions and into family-based care.

The virus poses a specific threat to the hundreds of children with disabilities currently living in institutions in Kazakhstan, but it’s not the only one. Human Rights Watch has found that the children are also at risk of physical violence, forced sedation, isolation, and and neglect. Some children told us that staff beat them, forcibly administered sedatives to punish or control them, and forced them to take care of younger children.

Regardless of this pandemic, home remains the best place for children with disabilities. The Kazakh government should urgently look to reallocate resources from institutions to families or other family settings in the community, so they have the necessary support to care for their children.

Until the children can safely be moved out, authorities should increase infection control measures inside institutions, ensure all people within them can practice social distancing, and provide adequate access to health care for residents and staff.

In doing so, they may help prevent the kind of tragedy that unfolded in eastern Kazakhstan.

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

You are told not to leave your home. No one can visit. Food supplies may be limited. You are waiting for authorities to tell you when you can enjoy your freedom again. 

Long before the COVID-19 pandemic, this was the daily reality for many people with disabilities living in institutions and mental hospitals across the world. Many of us now are getting a glimpse of what it can be like to live under such restrictions. 

With countries just now beginning to ease lockdowns put in place to stop the spread of the coronavirus, we can now better empathize with what it’s like to be cooped up in one place and what that can do to our mental and physical health. Our lockdown is temporary, but imagine what it must be like if this were the norm: living in isolation, deprived of friends and freedom, not just for weeks, but for years, and in many cases until you die. 

People with real or perceived psychosocial disabilities live in inhumane conditions, isolated from society in prayer camps, where they often are shackled for days or even years. © 2017 Shantha Rau Barriga/Human Rights Watch

In recent weeks, I’ve been thinking a lot about people I’ve met when I visited closed facilities over the years. The young boy with Down Syndrome and a broad smile, who was abandoned as a baby at an overcrowded institution warehousing more than 1,000 men, women and children with disabilities in New Delhi, India. Or the young man trapped in a psychiatric hospital in Croatia for years because his family wouldn’t take him home. Or the woman with a mental health condition whose ankle was chained to a cement floor at a spiritual “healing” center in Ghana. 

It has taken a global pandemic to give the public something that years of advocacy never could: an urgent and unflinching sense of what living in isolation and, for some, under harsh restrictions is really like. 

Even for those in privately-run facilities, no amount of expensive care and well-meaning therapies can make up for the loneliness that comes from living in a locked facility. The social isolation that people suffer can fuel anxiety, depression, poor sleep and a decline in immunity. 

It’s not only inside institutions where people with disabilities are locked up. Take the parents I met in Nepal who felt they had no choice but to lock up their 12-year-old son, who has a developmental disability and was shunned from school, so that they could work in the fields. He was allowed to leave his room just once a day to get some fresh air. My colleagues and I have met scores of people with mental health conditions who have been confined in back rooms, basements or even goat sheds completely alone, in many cases held down by chains. One woman in Indonesia was locked in a shed for more than 15 years.  

We should use this new awareness to fundamentally rethink why it’s acceptable that people with disabilities, including people with mental health conditions, are forced to live this way.

A resident lays on the floor in the women’s ward of Thane Mental Hospital, a 1,857-bed facility in the suburbs of Mumbai.

© 2013 Shantha Rau Barriga/Human Rights Watch
One key reason for the status quo — in addition to stigma and discrimination — is that we just haven’t built up the services needed to support people with a disability to live independently. The services that do exist are mostly centered in residential institutions and hospitals. We need to seize this opportunity to shift from institutionalization to robust support networks at the community level. Many groups, including organizations run by people with disabilities, have been pushing for community-based services such as peer support programs, emergency advice helplines for people going through a mental health crisis, and online psychosocial support. Let’s listen to them. This is where governments need to invest. 

This means that governments must deliver more than just medical or psychological help. For most of us living through this lockdown, life quickly became more stressful as we struggled to do basic things such as buying food, paying bills, getting medication or keeping a job. For people with certain disabilities, getting daily practical support is essential. Innovative programs, such as one in Brussels, are doing just this and could be a model for other countries on how to empower and support people with mental health conditions without resorting to force or institutionalization. 

Transforming mental health care and institutions is no easy task, especially with the world’s resources fully stretched in response to the COVID-19 crisis. But this pandemic is not just a health emergency; it's also an opportunity to develop a system of support services that work better for people with disabilities and respect their rights. Now that we’ve caught a glimpse of what it’s like to be locked up, we surely can’t let people with disabilities continue to live in a permanent state of lockdown.

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

School-age children in Lebanon.

Top photos, bottom left photo: © 2017 Amanda Bailly for Human Rights Watch. Bottom center and right photos: © 2017 Sam Koplewicz for Human Rights Watch

(Beirut) – Lebanon’s Covid-19 response has overlooked people with disabilities, who have not been provided with accessible information about the virus or consulted in preparing the government’s emergency response plans, Human Rights Watch said today.

People with disabilities are facing barriers in getting health care. Children with disabilities cannot access remote education on an equal basis with others, and families of children with disabilities do not have the support and services they need to help them cope with the crisis.

“The Lebanese government’s Covid-19 response has completely ignored the rights and needs of people with disabilities, who were marginalized long before the virus hit,” said Aya Majzoub, Lebanon researcher at Human Rights Watch. “This exclusion is robbing people with disabilities of potentially life-saving information and services that they need to weather this crisis.”

Human Rights Watch interviewed six disability rights activists and six parents of children with disabilities, all of whom said that the government’s Covid-19 response overlooked the specific needs of people with disabilities.

The government should ensure that health care is accessible to all, without discrimination. But it has not made arrangements for people with disabilities – who may frequently need health care – amid the lockdown and stay-at-home orders, despite requests by activists, the activists and parents said.

Sylvana Lakkis, president of the Lebanese Physical Handicapped Union, said that her organization has been receiving a large volume of calls from people with disabilities asking for help in getting necessary medication. She said that some who need respirators for underlying health conditions said they have become more difficult to find amid the restrictions.

Accessible information on the pandemic is essential for people to make life-saving decisions about how to protect themselves and to get necessities and services during quarantine and self-isolation. But the government’s television and social media information campaigns may not be accessible and none target people with disabilities, said Dr. Moussa Charafeddine, president of the Friends of the Disabled Association in Lebanon.

Private initiatives and international organizations like UNICEF have produced some material about Covid-19 that is accessible for people with disabilities, but many people with disabilities are still not getting life-saving information, said Fadia Farah from the Lebanese Association for Self-Advocacy (LASA) and Lakkis, of the Lebanese Physical Handicapped Union.

The government’s communication strategies should include qualified sign language interpretation for televised announcements, websites that are accessible to people with various disabilities, and telephone-based services that have text capabilities for people who are deaf or hard of hearing, Human Rights Watch said. Communications should use plain language to maximize understanding.

The government should urgently consult with disability-rights experts to identify potentially life-threatening gaps in its Covid-19 response, Human Rights Watch said. Officials had contacted just one of the six groups Human Rights Watch spoke to, the Learning Center for the Deaf, to draft a guide for municipalities on people with disabilities in the pandemic. But Human Rights Watch was unable to determine whether the guide was finalized or published.

Children with disabilities have also been disadvantaged by school and institution closures since February 29 that have mandated online or remote learning without accommodating the needs of children with disabilities. Most children with disabilities in Lebanon are denied enrollment in schools, and for the few who can enroll, schools lack reasonable accommodations to help them learn. Some schools have set up distance learning, but this teaching method is often not accessible or cannot accommodate the needs of children with disabilities.

Video

Video: Schools Discriminate Against Children with Disabilities in Lebanon

Lebanon’s public education system discriminates against children with disabilities. Children with disabilities are often denied admission to schools because of their disability. And for those who manage to enroll, most schools do not take reasonable steps to provide them with a quality education.

Amer Makarem, from the Youth Association of the Blind, said that online classes and lessons are generally not accessible for students with visual disabilities. Some teachers are sending lessons on WhatsApp, sometimes as image files that are not accessible, he said. Nadine Ismail, from the Learning Center for the Deaf, said that remote learning is especially difficult for deaf children, who need large screens to focus and programs that allow a teacher to use sign language and show documents simultaneously.

Parents of children with developmental disabilities said that the private schools at which their children were enrolled were merely sending videos to watch at home and were not conducting one-on-one educational or therapy sessions that the children had in school. All the parents interviewed said that they had nowhere to turn for educational support.

Even before the pandemic, the government’s only option for the majority of children with disabilities was to enroll in one of about 100 specialized institutions funded by the Social Affairs Ministry. The ministry owes these institutions substantial payments, interfering with their ability to provide quality education, and the lack of government monitoring raises serious concerns about their ability, in some cases, to fulfill the children’s right to education.

Nonetheless, for many families the specialized institutions are the sole providers of learning and other services, including food and health care. Their closure has deprived children with disabilities and their families of these resources and services.

Disability rights advocates that operate some of these institutions said that the government had ordered them to close with no guidance on continuing their educational programming remotely. Dr. Weam Abou Hamdan, general director of the National Rehabilitation and Development Center, and Dr. Mousa Charafeddine, president of the Friends of the Disabled Association in Lebanon, which offers learning and rehabilitation services to children with intellectual disabilities, said that their institutions started distance learning programs on their own initiative.

Under both Lebanese and international law, all children should have access to a quality education without discrimination. The government should recognize the disproportionate impact school closures have on children with disabilities and engage in continuous social and policy discussion with educators and organizations of people with disabilities to assess needs and agree on education measures for students with various types of disabilities.

As the schools might be transitioning back to onsite learning starting June 1, the government should make equity a top priority, and include tools and guidance for schools to support students with disabilities and to provide remedial teaching. The government should also measure possible increases in drop-out rates of children with disabilities and work with advocacy organizations to ensure children return.

“The Lebanese government should urgently take into account the needs of people with disabilities,” Majzoub said. “This includes making sure they have access to information, health care, and the resources children with disabilities need to continue their education, while taking meaningful steps to make schools more inclusive.”

Posted: January 1, 1970, 12:00 am

6 April 2020, Mexico, Tijuana: Several people wearing face masks who claim to have experienced Covid-19 symptoms are waiting to be tested outside an emergency room. 

© 2020 Omar Mart'nez/picture-alliance/dpa/AP Images
“What would happen to me? What happens if they don’t understand what I say?” These are the kinds of wrenching questions going through the mind of José Miguel, a 33-year-old man with multiple disabilities in Mexico, when thinking about the medical care he might receive if he contracted Covid-19. José Miguel's sister, Isabel, a colleague of mine, recently tweeted about José Miguel's heart wrenching request that his family not take him to the hospital for critical medical care if he contracts Covid-19. He is used to having a family member or personal assistant who knows him well with him to help communicate his needs and wishes, something he would not be allowed to have if admitted to an intensive care unit for Covid-19 treatment.

In Mexico, as in some other countries, when people become infected with Covid-19 and become very sick, they are often admitted to intensive care units to get life-saving care, including oxygen or, in very serious cases, mechanical ventilators to facilitate breathing. When this happens, patients are immediately isolated and separated from family members, who would be put at risk of contracting Covid-19, or spreading it further in the hospital if they themselves are infected.

While these strict measures have a clear health purpose, they also risk negatively impacting people with certain types of disabilities, including people with autism, intellectual disabilities, or dementia who may have difficulty understanding why they are suddenly isolated and alone, and risk not being understood or misunderstood by medical staff in the absence of someone experienced in communicating with them.

Without the guaranteed personal support they need to cope and communicate, people with disabilities like José Miguel may choose not to go to hospitals, even if they contract Covid-19. This puts them at serious risk of health complications and even death.

Many public and private hospitals have staff dedicated to supporting patients, including those with disabilities, with essential tasks like eating, bathing, and other necessities. But for some people, this type of support isn’t enough to receive the quality of care to which they are entitled. People with certain disabilities may require the assistance of someone who knows them well, who can help with communication and who can explain the situation and how long it is expected to last, repeatedly if needed, and provide emotional support. These supporters can be vital to ensure medical decisions are made with informed consent.

As part of their Covid-19 response, health authorities in Mexico should take the need for this kind of assistance into account, particularly when people with certain disabilities enter intensive care units, as they would normally do before the health emergency started. Indeed, on April 29 the Ministry of Health published a “Guide for Health Protection for People with Disabilities in the context of Covid-19”, which specifically addresses the need for reasonable accommodation in these cases. To ensure its implementation, the guide should be widely publicized with proactive outreach to healthcare staff.

Under international human rights law, states have an obligation to provide reasonable support, also known as reasonable accommodation, to ensure people with disabilities can enjoy their rights, including the right to the highest attainable standard of health, on an equal basis with others.  

When a patient with a disability asks directly, or through their representative, to have a support person present when being admitted to an intensive care unit, the hospital should assess the request on a case-by-case basis. To determine whether accommodation is reasonable, staff should determine whether it will impose an excessive burden on staff, given the specific context, such as the size of the hospital, number of staff available, or other factors. If a decision is made to allow a support person to accompany the patient, hospitals should ensure she is equipped with the same protective gear and has access to the same hygiene measures used by other staff who enter that patient’s room.

If Mexican health authorities ensure these policies are put in place, people like José Miguel and his family will not be forced to make the impossible choice between forgoing life-saving care or risking a hospital stay without the support necessary to cope with the difficult situation and have the best chance of recovery.

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

The dormitory in the men’s forensic ward of the Accra Psychiatric Hospital in Ghana. The dormitory has since been refurbished. 

© 2019 Shantha Rau Barriga/Human Rights Watch

(Brussels) – Ghana’s Accra Psychiatric Hospital has confirmed that a patient has tested positive for Covid-19, causing concern about protection for other patients and staff, Human Rights Watch said today. The infected woman was admitted to the acute care ward of the government-run hospital on April 20, 2020 and developed symptoms within days. She was tested for Covid-19 and transferred to an isolation unit on April 23, and her test was confirmed positive on April 27.

To prevent further infections, the government should immediately ensure that all psychiatric hospitals in the country test staff and patients, release as many patients as possible to avoid overcrowding, and ensure that staff and patients have adequate personal protective equipment.

“Despite the best efforts of hospital staff, many patients, staff, and their families are now at risk because they had contact with a patient who has contracted Covid-19,” said Shantha Rau Barriga, disability rights director at Human Rights Watch. “Closed settings like psychiatric hospitals act as incubators for the virus. Wherever possible, people with mental health conditions should be allowed to leave if they choose.”

After the woman’s positive Covid-19 diagnosis, the hospital attempted to transfer her to the Covid-19 treatment center, but the municipal authorities, who have to approve any such transfer, refused. Dr. Akwasi Osei, head of the Ghana Mental Health Authority, said they refused because she was a mental health patient.

“This is obvious discrimination,” he told Human Rights Watch. “If this person didn’t have a mental health condition, she would have been allowed to go to the treatment center. They are just afraid. But people with psychosocial disabilities should have the same access to Covid-19 treatment as anyone else.”

The hospital has approximately 370 in-house patients, 11 of whom are in the women’s acute ward and 80 of whom have been admitted to the hospital through Ghana’s court system. It is testing 87 staff and patients who came into contact with the woman. Staff have also been required to self-isolate until their test results are cleared. In the meantime, the hospital needs to find staff from other wards, who did not have possible contact with the patient, to take additional shifts, Dr. Osei said.

In March, the hospital issued protocols for managing Covid-19, detailing preventive measures and screening practices for staff. The protocols require healthcare providers to “maintain one meter distance at all times from service users.” But the protocols are geared almost entirely to the staff, and do not inform residents how to protect themselves.

Since 2011, Human Rights Watch has been documenting the situation in the mental health system in Ghana. Conditions in psychiatric hospitals have improved steadily, with patients being released to reduce overcrowding. Earlier in 2020, Accra Psychiatric Hospital renovated the men’s forensic ward, which previously had filthy toilets and holes in the roof of the dormitory-style rooms. However, people with psychosocial disabilities, such as bipolar condition or schizophrenia, continue to be subjected to involuntary admission and treatment, with little possibility of challenging their confinement.

As of April 28, the Ghana Health Service reported 1,671 cases of Covid-19 – 1,433 from Greater Accra Region alone – and 16 deaths. The country’s two largest cities, Accra and Kumasi, were under partial lockdown between March 30 and April 20. In his April 19 national address, President Nana Akufo-Addo noted that Ghana ranks first in Africa in the number of Covid-19 tests administered per million people and that the government has scaled up the domestic production and distribution of personal protective equipment to healthcare facilities. The president listed these as among the reasons for lifting the partial lockdown.

But a week later, authorities reported the highest single-day increase in confirmed Covid-19 cases. On April 28, the Ghana Medical Association expressed concern about insufficient distribution of personal protective equipment to healthcare workers, after 13 doctors tested positive for Covid-19.

To address the pandemic, the government should ensure that hospitals are fully equipped with personal protective equipment and regularly test staff and patients. Mental hospitals should avoid new admissions as much as possible to reduce and prevent overcrowding. Municipal authorities should also confirm that anyone with a mental health condition who tests positive for Covid-19 will be admitted to local treatment centers without delay or discrimination.

To minimize the number of daily outpatient visits during the pandemic, Accra Psychiatric Hospital has looked into phone consultations, having medications delivered to patients, and creating a home visit team. These initiatives should be carried out or scaled up, Human Rights Watch said.

Ghana and its international development partners, such as the United Kingdom Department for International Development (DFID), should also expand community-based services for people with psychosocial disabilities to reduce overcrowding in hospitals and avoid restricting people’s liberty. This is also an opportunity to further develop the QualityRights Initiative – a training program for mental health professionals supported by the World Health Organization that promotes attitudes and practices that respect the dignity and rights of people with psychosocial and intellectual disabilities.

“This is a chance for Ghana to re-think a system that often restricts people’s freedom and choices and instead invest in services that let people with disabilities live independently,” Barriga said. “It’s also a moment for the government to ensure that people with disabilities are included in the Covid-19 response. People with mental health conditions deserve no less than others.”

Posted: January 1, 1970, 12:00 am

Rohingya refugees place empty jars in a line while waiting to collect water in Cox's Bazar, Bangladesh on April, 20, 2020. 

© 2020 Mohammad Hussain
(Bangkok) – The Bangladesh government’s new Covid-19 restrictions on access to aid put Rohingya refugees at greater risk, Human Rights Watch said today. The lockdown measures cut humanitarian workers in refugee camps by 80 percent and put the refugees at severe risk of food and water shortages and disease outbreak.

Bangladesh authorities should ensure that any pandemic containment measures do not hinder aid groups’ ability to provide food, water, and health care, or prevent them from protecting refugees most at risk, including women and girls facing violence and domestic abuse.

“Bangladesh authorities need to protect against the spread of Covid-19 in the Rohingya refugee camps, but every effort should be made to limit the harm from lockdown measures,” said Brad Adams, Asia director. “Any Covid-19-related restrictions shouldn’t significantly hinder aid groups’ ability to provide food, water, health care, and protection.”

On April 8, 2020, the Bangladesh refugee relief and repatriation commissioner issued a directive that restricts services and facilities in the Rohingya refugee camps to those termed “critical” and reduces access for humanitarian aid staff by 80 percent. While these measures were adopted to avoid an outbreak of Covid-19 in the camps, 14 aid workers interviewed by Human Rights Watch said that the drastic reduction in operations capacity has affected their ability to perform even those services deemed “critical.” Health workers said that these interruptions could impede a prompt medical response to the virus and have long-term health consequences.

Over 900,000 Rohingya refugees are living in refugee camps in southern Bangladesh after fleeing mass atrocities in neighboring Myanmar. The extremely cramped conditions make the camps vulnerable to rapid spread of the Covid-19 virus if an outbreak occurred there.

The government’s new directive protects “critical” services including health, nutrition, water, food, gas, hygiene, sanitation, waste treatment, identification of new arrivals, and “ensuring quarantine.” But aid workers said that the staff restrictions and an internet blackout are obstructing their efforts to provide even these core services and to effectively respond to the Covid-19 threat.

Staff reductions have also halted some vaccination programs such as the measles vaccine. The camps have previously had outbreaks of measles and other infectious diseases. A health care worker said:

Because of the restrictions and manpower shortage, the supply of the vaccination to the health posts or clinic has been interrupted. I cannot stress how important it is to maintain the vaccination coverage. Dealing with the Covid-19 outbreak should not mean we stop measures to prevent other diseases. Otherwise the refugee camps could be hit by a secondary outbreak like cholera or the measles.

Some camps are facing serious food and water shortages. Seventeen refugees from 4 settlements – camps 7, 9, 11, and 18 – told Human Rights Watch that food rations haven’t been replenished and are dwindling and that some areas have no drinking water. Aid workers said the restrictions have led to disruptions in water and sanitation, which the World Health Organization (WHO) has said are essential to protecting human health during the Covid-19 outbreak. One aid official reported receiving complaints about overflowing latrines in some areas because there are not enough staff members to address these issues.

Shortages of water and sanitation failures also increase the risk for older people and those with disabilities who cannot easily reach or wait in lines for functioning toilets and washing facilities. Without safe and private hygiene spaces, women and girls may be forced to choose between using the toilet and risking assault or harassment.

Violence against women and girls has been a widespread problem in the camps. However, the recent lockdown measures cease all protection activities including access to “child and woman-friendly spaces” and gender-based violence case management. Women’s rights activists said that since the lockdown began, they have had increasing domestic violence and sexual abuse reports. But because of restrictions on communications, aid workers are unable to remotely coordinate support and protection services. One protection team member said that without officers working in the camps, “now if a woman is raped, that news will not reach me and she will not get any support from us.”

The United Nations refugee agency, UNHCR, has urged governments to ensure that “critical services for survivors of gender-based violence are designated as essential and are accessible to those forcibly displaced.”

Some aid workers allowed to enter the camps have had to postpone critical services because they lack personal protective equipment to guard against Covid-19. The UN and donors should work with the Bangladesh government to ensure that all those performing critical services, including Rohingya volunteers, have sufficient equipment.

Aid workers also reported harassment at checkpoints entering the camps and stigma in Cox’s Bazar for working in the camps during the pandemic. “We have heard several cases from our staff of being intimidated by the police at the checkpoints,” an aid worker told HRW. “Some of our staffs have been evicted by their landlords for being health workers at the camps. This is a disaster because these are the only people who can save us from this outbreak.”

Restrictions on the internet and phone services have facilitated the spread of misinformation, deterring refugees from seeking urgent medical care. Refugees have expressed concern that they will be “taken away” if they report Covid-19 symptoms. One refugee said “There is a widespread rumor here that if anyone has any coronavirus symptoms, he or she is taken somewhere and killed.”

The humanitarian aid group Médecins Sans Frontières (MSF) reported that the number of patients coming to clinics has dropped significantly and they fear this could lead to a serious outbreak of other illnesses in the camps. “When people have symptoms, they are purposely not coming to the health facilities because they are afraid that they will be taken away,” one aid worker said. “We have seen a decline in respiratory infection patients coming into our clinic.”

Several refugees said that after local clinics turned them away for lack of capacity or referred them to MSF, security forces stopped them at checkpoints and prevented them from reaching MSF clinics on camp outskirts. Other refugees seeking medical care outside the camps said they were deterred by officers questioning them about their illnesses or hostility from local community members. People with HIV, for example, said they stopped taking their medication because traveling to obtain it required explaining their status. “There are not many health workers now available inside the camp, but I fear going outside to get my medicine because it feels like they [local residents] hate us and will beat us if they find us outside,” one refugee said. “The security checkpoints are another obstacle to cross.”

Women and girls in the camps already faced serious obstacles to safe reproductive health care, and Bangladesh authorities should heed calls from aid groups and activists to safeguard access in the Covid-19 response.

Any measures taken to restrict movement for public health or national emergency reasons must be lawful, necessary, and proportionate, as well as nondiscriminatory. Bangladesh authorities should use best practice guidance on scaling up Covid-19 readiness in crowded camps.

“Bangladesh is in a race against time to contain the spread of Covid-19 in the Rohingya refugee camps, but the government’s new restrictions could make things worse,” Adams said. “Instead of shutting down the internet and severely curtailing basic services, the government should work with humanitarian groups to ensure aid and protection reaches those in need.”

Posted: January 1, 1970, 12:00 am

Summary

The schools do not want girls [with disabilities] to go to the classes. Usually they argue that they are not normal people so they cannot sit in the classrooms and learn like other students.

Disability rights activist, Kabul, April 2018

Some time ago, my friends and I decided to go to the market in our own wheelchairs and shop ourselves. But people called us “grasshoppers,” which is why we decided to stay at home.

S.A., Herat, April 2018

Afghanistan has one of the largest populations per capita of persons with disabilities in the world. At least one in five Afghan households includes an adult or child with a serious physical, sensory, intellectual, or psychosocial disability. More than 40 years of war have left more than one million Afghans with amputated limbs and other mobility, visual, or hearing disabilities. Many Afghans have psychosocial disabilities (mental health conditions) such as depression, anxiety, and post-traumatic stress, which are often a direct result of the protracted conflict. Other Afghans have pre-existing disabilities not directly related to the conflict, such as those caused by polio.

Violent changes of power, long periods of contested government, endemic poverty, and widespread lawlessness, insecurity, and hostilities have undermined even minimal efforts by successive governments to conceive, adopt, or enforce policies to address the needs of persons with disabilities, even as this population has continued to increase.

The massive internationally funded reconstruction effort that began in Afghanistan in 2002 offered a new opportunity to address this long-standing deficiency. The government has drafted important legislation and ratified core international human rights conventions, but its efforts to address even the most fundamental needs of this population for access to health care and education have fallen far short of promised goals. Donor funding has led to improvements in roads and other infrastructure, but reconstruction efforts have proceeded with little planning for the needs of persons with disabilities, especially as Afghanistan’s cities experienced rapid growth after 2002. Major urban areas have both public and private transportation in the form of bus systems, but these have no modified services or accessible vehicles for persons with disabilities. Most public buildings lack ramps, elevators, and wheelchair-accessible toilets.

One student who uses a wheelchair described the problem she faced trying to attend school: “Unfortunately, I cannot go to school by myself—I need someone to take me to school and pick me up. The school has no ramp, so it’s hard for me to get in and out of the classroom, and sometimes even that’s impossible.”

Video

Afghanistan: Women with Disabilities Face Systemic Abuse

Afghan women and girls with disabilities face high barriers, discrimination, and sexual harassment in accessing government assistance, health care, and schools.

Entrenched discrimination means that persons with disabilities face significant obstacles to education, employment, and health care, rights guaranteed under the Afghan constitution and international human rights law. For example, many persons with disabilities in Afghanistan have not acquired a national identity card (taskera), without which it is not possible to obtain many government services or to vote in local and national elections. The long distance to the district or provincial centers and lack of someone to help them are the most serious obstacles preventing them from getting a card.

Persons with disabilities are overrepresented among the several million Afghans who are internally displaced, and face greater difficulties gaining humanitarian assistance. Aside from a small stipend available to those who acquired a disability as a result of the war, there are no publicly funded social protection services for persons with disabilities in Afghanistan. Combat veterans receive the bulk of this assistance.

War and corresponding insecurity have greatly undermined efforts to deliver services, particularly outside urban areas. While a number of nongovernmental organizations (NGOs) have provided services to Afghans with disabilities, they have reached only a fraction of the population in need. Donor fatigue with funding social services in Afghanistan since 2002, as well as the withdrawal of most international forces in 2014, has led to reduced support for programs and services.

This report describes the everyday barriers that Afghan women and girls with disabilities face in one of the world’s poorest countries, in which decades of conflict have decimated government institutions and development efforts have failed to reach many communities most in need. As the fighting in Afghanistan has intensified since 2016, research in rural areas—where the vast majority of Afghans with disabilities live—has become particularly difficult. For this reason, our research is based on interviews with women and girls with disabilities living in the Afghan cities of Kabul, Herat, and Mazar-e Sharif, some of whom relocated to those cities because there was no support or services available for them in their home villages.

Obtaining access to health care, education, and employment, along with other basic rights, is particularly difficult for Afghan women and girls with disabilities, who face both gender discrimination and stigma and barriers associated with their disability. Indeed, Afghan women with disabilities face intersecting forms of discrimination in a society where gender bias and violence against women are endemic. Women with disabilities are generally seen as unfit for marriage. One woman who acquired a disability in an airstrike told Human Rights Watch that her fiancé’s parents no longer wanted her to marry their son because they felt she was incapable of carrying out necessary chores on the family farm.

Whether married or single, women with disabilities are often seen as a burden on their families and are at increased risk of violence both in and out of the home. Afghan women who already face significant obstacles in finding work outside the home find those difficulties are compounded if they have a disability. As our research shows, Afghan women with disabilities who have sought government assistance or employment are at increased risk of sexual harassment within government institutions.[1]

Girls with disabilities often lose out entirely on education. Many students, especially girls, face long journeys to their nearest government school, and girls with physical disabilities may not be able to make the daily journey without dedicated transportation, which is not available. Public schools are not equipped to accommodate the needs of students with disabilities to attend classes or participate in activities, and very few private schools include children with disabilities. Families who have children with disabilities incur additional costs for treatment if they seek medical care. Even minor costs can mean that treatment is out of reach for many.

In 2012, Afghanistan ratified the Convention on the Rights of Persons with Disabilities and its Optional Protocol. In 2013, the Afghan parliament approved legislation, the Law on Rights and Privileges of Persons with Disabilities, ensuring the rights of persons with disabilities to participate actively in all aspects of society. However, there are very few services to assist and support persons with disabilities in Afghanistan. The International Committee of the Red Cross (ICRC) and a number of NGOs provide some health and educational services, but the demand far outstrips available resources. Given Afghanistan’s many needs, assistance for persons with disabilities has not been a high priority for the government or donors.

On December 3, 2018, United Nations Security Council member countries shone a spotlight on the disproportionate impact of armed conflict on persons with disabilities, leading to the adoption of Security Council Resolution 2475 in June 2019. Persons with disabilities have been invisible on the peace and security agendas of many countries around the world, but are among the people most at risk during conflicts and humanitarian crises. As talks in Afghanistan proceed, it is essential that planned assistance and policies reach communities most affected by the war and make a priority the needs of persons with disabilities who have paid a high price for decades of conflict.

Key Recommendations to the Government of Afghanistan

  • Amend existing legislation and policies to ensure that all persons with disabilities, not only those with conflict-related disabilities, are entitled to services and financial assistance.
  • Support efforts to develop sustainable solutions to increase access to quality, inclusive education for children with disabilities, particularly girls, including by developing strategies to expand community-based education (CBE), incorporating CBE into the government’s education system, making specific arrangements for integrating girls with disabilities into CBE, and ensuring long-term funding for CBE.
  • Accelerate measures to ensure all public buildings are accessible by building ramps and making toilets and other facilities accessible, and require all businesses and educational institutions to provide these within a reasonable timeframe.
  • Implement a comprehensive review of health services for persons with disabilities to improve outreach and access, particularly in rural areas.
  • Increase public awareness on disability and mental health, including through de-stigmatizing campaigns that emphasize the dignity and equality rights of persons with disabilities, and on the availability of services.
  • Establish accessible and confidential complaint mechanisms to ensure that any alleged abusive or harassing behavior by government officials is properly investigated and appropriate remedies are provided in the event of a violation. Information about how to use these mechanisms should be distributed in accessible formats.

Methodology

This report is based primarily on research by Human Rights Watch researchers from April 2018 through January 2020 in Kabul, Mazar-e Sharif, and Herat, Afghanistan.

We conducted 23 interviews with women with disabilities and 3 interviews with family members of women and girls with disabilities. We also interviewed 14 healthcare and education professionals, including representatives from the United Nations and international and local nongovernmental organizations providing services to persons with disabilities in Afghanistan. Most interviews were conducted in person, but some interviews with officials were conducted by email.

As the fighting in Afghanistan has intensified in recent years, security outside major urban areas has deteriorated, making it very difficult to interview women in smaller towns or rural areas. The stigma associated with disabilities also deters many women with disabilities from speaking about their situation with people outside their immediate family.

All of the women interviewed were informed of the purpose of the interview and the ways in which the information would be used, and were assured anonymity. This report withholds identifying information for most interviewees to protect their privacy and security. The exceptions were for those women who are already known because of their position within the disability rights movement in Afghanistan. None of the interviewees received financial or other incentives for speaking with the researcher.

In April 2019, Human Rights Watch asked the Afghan government for details on its assistance policy; that information is included in this report. In June 2019 and again in February 2020, we provided government officials with a summary of our findings. At time of writing, we had received no response to these findings.

 

I. Background

Persons with Disabilities

Accurate statistics are often hard to find in Afghanistan, and there are no official up-to-date statistics on how many of Afghanistan’s 35 million people have disabilities. A 2005 government survey was the first effort to assess the needs of this population, but its outreach to rural and less secure areas of the country was limited.[2] It concluded that approximately one in five households (roughly 1.2 million people) included a family member with a “severe” disability, and nearly two in five (roughly 2.4 million people) had some disability.[3] Subsequent government surveys, including one in 2013 that was limited to six of Afghanistan’s 34 provinces and focused on physical disabilities, estimated that 2.4 percent of the population, or roughly 800,000 people, had a physical disability.[4] According to the Community Centre for the Disabled (CCD), nearly 70 percent of Afghans with disabilities live in rural areas.[5]

The most common causes of disability are conflict-related injuries, including from landmines and explosive remnants of war; trauma and psychological distress; and cerebral palsy and polio.[6] Visual disabilities are common; the World Health Organization estimates that 1.5 million Afghans have either a partial or total loss of vision, caused in 80 percent of cases by treatable conditions.[7] Poor access to basic health services, especially in rural Afghanistan, is a leading cause of preventable disabilities.

A donor-funded 2005 study was the first to focus on mental health. It found that 67 percent of Afghans reported experiencing impairment as a result of trauma or other psychosocial conditions related to the conflict, with the unemployed, older persons, and widowed women particularly affected.[8] The study also noted that women with disabilities, regardless of the cause, had a higher prevalence of other mental health conditions.[9]

A 2011 World Bank report estimated that half of the Afghan population age 15 years or older experienced depression, anxiety, or post-traumatic stress.[10] Other studies on mental health in Afghanistan have found that the combined factors of war, poverty, domestic violence, and social marginalization result in women being disproportionately affected by mental health problems and psychosocial disabilities.[11] A 2017 study noted that despite an official governmental policy of prioritizing health care for women with disabilities, those surveyed did not report any improvement, and in some areas described a decline in all available health care after 2005.[12]

Afghan Laws and Policies on Disability Rights

In October 2003, the Afghan transitional government drafted its first comprehensive policy on the rights of persons with disabilities, developed in coordination with relevant United Nations bodies. The policy incorporated language and recommendations from the Standard Rules on the Equalization of Opportunities for Persons with Disabilities and from the Biwako Millennium Framework for Action Towards an Inclusive, Barrier-Free and Rights-Based Society for Persons with Disabilities in Asia and the Pacific, as well as from discussions then underway on drafting the Convention on the Rights of Persons with Disabilities.[13] The policy established a number of priorities for the Afghan government, among them:

  • increasing public education and awareness about disability as a human rights and development issue and the need for disability sensitive terminology;
  • the development of a comprehensive national rehabilitation policy;
  • the development of a single education system to meet the needs of all learners within an inclusive environment and address the high illiteracy rate among persons with disabilities;
  • a comprehensive national employment strategy to address the employment needs of persons with disabilities;
  • creating barrier-free access in the urban environment; and
  • integrated data collection on statistics and research on disability in Afghanistan.[14]

More than 16 years later, progress on these objectives has been extremely limited.

The 2004 Constitution of Afghanistan promotes the integration of persons with disabilities into public and social life. Article 22 prohibits any form of discrimination between Afghan citizens. Article 53 provides for financial aid to persons with disabilities and guarantees their “active participation and reintegration into society.” Article 84 makes provision for two persons with disabilities to be appointed by the president as members of parliament.

Afghanistan ratified the Convention on the Rights of Persons with Disabilities and its Optional Protocol in September 2012. The Afghanistan Independent Human Rights Commission (AIHRC) is responsible for monitoring implementation of the treaty. Afghanistan has also made commitments as part of its obligations as a party to the Mine Ban Treaty and the Convention on Cluster Munitions to provide assistance to persons who acquire a disability as a result of a landmine or explosive remnant of war, specifically by expanding access to physical rehabilitation services; prioritizing physical accessibility, particularly for services and for government buildings; and providing psychosocial and psychological support.[15]

In 2013, the Afghan parliament passed the Law on Rights and Privileges of Persons with Disabilities, which prohibits discrimination against persons with disabilities and stipulates that the state is to promote the active participation of persons with disabilities in all aspects of society.[16] The law also states that 3 percent of jobs in government and the private sector are to be reserved for persons with disabilities—a provision that is seldom enforced.[17] NGOs working on disability rights have criticized the Law on Rights and Privileges of Persons with Disabilities for failing to provide assistance to people who have acquired disabilities outside of conflict.[18]

The law classifies three categories of persons with disabilities who are eligible to receive financial assistance: military officials, civil servants, and civilians who have acquired a disability as a result of a conflict-related incident. Those determined to have a “full permanent disability” or “partial permanent disability” are eligible for financial assistance.[19] People who have been born with or acquired a disability for reasons other than conflict-related are not eligible for any financial assistance from the government.

An official with the Office of the State Minister for Martyrs and Disabled provided the following chart detailing financial assistance:[20]

No.

Categories

“Degree of disability”

Payable amount

1

Military armed forces, police, and civil servants

“Full and permanent disability”

100 percent of the final wage

2

Civilian

“Full and permanent disability”

5,000 afghanis (US$64) per month

3

Military armed forces, police, and civil servants

“Partial permanent disability”

50 percent of the final wage

4

Civilian

“Partial permanent disability”

2,500 afghanis (US$32) per month

Afghanistan’s State Ministry for Martyrs and Disabled Affairs has overall responsibility for advancing the rights of persons with disabilities and is required to coordinate and consult with representative organizations of persons with disabilities and with the Disability Stakeholder Group (DSG), which includes the ministry and relevant NGOs, UN agencies, and civil society organizations.[21] However, NGOs working on disability rights have criticized the ministry for failing to adequately consult with organizations of persons with disabilities and their allies.[22]

Nongovernmental Assistance Programs for Persons with Disabilities

While there is no national nongovernmental organization representing persons with disabilities in Afghanistan, a number of Afghan NGOs offer programs to support persons with disabilities, ranging from rehabilitative services and vocational training to advocacy. Among these are the Accessibility Organization for Afghan Disabled, Afghan Landmine Survivors Organization, Development and Ability Organization, Afghanistan Association of the Blind, and Afghan National Association of the Deaf. The major international organizations providing support to Afghans with disabilities include the International Committee of the Red Cross, Afghan Red Crescent Society, Swedish Committee for Afghanistan, Humanity and Inclusion (operating as Handicap International in Afghanistan), and Serve Afghanistan.[23] The ICRC has provided rehabilitative services to adults and children with disabilities in Afghanistan since 1988.[24] The organization reported that in 2018, a record number of people—more than 12,000—sought assistance at its physical rehabilitation centers.[25]

A downturn in funding since 2013 has reduced the number and reach of programs and services available.[26] With most donor commitments up for review in 2020, the World Bank has warned that a substantial reduction in funding “would risk a reversal of the gains that have been achieved, driving increased hardship and poverty” throughout the country.[27] Afghans with disabilities would be among those hardest hit by such a reversal.

II. Barriers and Discrimination against Women and Girls with Disabilities

Barriers to Education

In January 2016, the United Nations Children’s Fund (UNICEF) estimated that 40 percent of all school-age children in Afghanistan did not attend school, and 66 percent of Afghan girls of lower secondary school age—12 to 15 years old—were out of school. For children with disabilities, the numbers are much higher, with an estimated 80 percent of girls with disabilities not enrolled in schools. This is despite children with disabilities having a right to access inclusive education and on an equal basis with others in their communities.[28] One government education official told Human Rights Watch that resistance from schools to accommodating children with disabilities and reluctance from families to send children with disabilities are major factors in children with disabilities not attending school.[29]

The Law on Rights and Privileges of Persons with Disabilities provides for the establishment of a comprehensive education system for persons with disabilities at the levels of basic education, higher education, and professional and technical training. It also compels the Ministry of Higher Education to develop rehabilitative education programs to provide persons with disabilities access to education. However, as of 2019, development of these programs remained in the planning stages.

Afghan government schools have failed to develop the institutional capacity to provide inclusive education or assist children with disabilities. Children with disabilities who attend regular schools generally receive no reasonable accommodations or specific assistance. Very few specialized schools for children with hearing or visual disabilities exist in urban areas, and they are of very limited scope. Major constraints include the long distance from children’s homes to schools and the absence of dedicated transportation and lack of assistants or other persons to accompany a child with limited mobility to school. Because there is no system to identify, assess, and meet the particular needs of children with disabilities, they are excluded from the education system.[30]

Some local NGOs work with school officials to allow girls with disabilities to attend school. An official with a humanitarian NGO stressed that for children with disabilities, the physical barriers are only part of the problem: children with certain physical disabilities “attending school cannot go to regular schools due to lack of ramps. In some cases, the school principals do not want to enroll them, because they need to be taken care of.”[31]

The head of a small organization working in Kabul with children with disabilities said she “personally talks with the school principals to accept and enroll these girls to the classes.”[32] A representative of another Kabul-based NGO working with women with physical disabilities noted that stigma is an additional problem for girls with disabilities, and their families do not allow them to go to school “because they are ashamed” of them.[33]

After Amina Azizi, who now works for the rights of women with disabilities in Afghanistan, lost her right leg in a rocket attack on her home in Kabul when she was a child, her parents kept her at home. When she finally convinced them to let her go to school, the teachers would not let her play with other children. She said that the view of disability in her community was that “death is better than being in this situation.”[34]

One student described the barriers for students with disabilities who do manage to get to school:

When I go to school, some of my classmates do not like me to be in the classroom. Especially when I get into the class with my wheelchair, sometimes the wheels touch their shoes or clothes and make them dirty, so they get angry.[35]

L.G., who had polio as a child, described her experience at school:

I couldn’t walk normally when I was in grade eight in school and I had severe headaches. I couldn’t sit normally on the chair—my waist started to ache, and I had to put my head on the desk to rest, but the teachers thought that I was lazy.[36]

A number of nongovernmental assistance programs provide educational services to children with disabilities, though they reach only a small percentage of those who need them. ICRC orthopedic centers in Herat and Kabul assist families with in-home tutoring for children with disabilities, and skills training for girls over 15 and women with disabilities. One woman described the tailoring course she had enrolled in run by the Herat ICRC center: “This training changed my life so much. From then on, I tailor at home, I sew clothes. I have customers and earn money.”[37]

D.A., 18, who became partially paralyzed after a car accident in 2005, said that her family moved to Kabul to obtain services that were not available where she lived in Ghazni. In Kabul, she was able to receive lessons through an ICRC program that sends teachers to the homes of children with disabilities.[38] She said:

I am alone.… I do not have class discussions, I do not have group work, and the whole education system is different for me … [but] the teachers treat me like a normal person.… I study and play basketball and get treatment.[39]

D.A. said that she hopes to study law at Kabul University, saying, “I would ask the government institutions and the Ministry of Labor, Martyrs and the Disabled to build ramps” at the university.[40]

Under the Convention on the Rights of Persons with Disabilities, the Afghan government is obligated to ensure that children with disabilities have access to an inclusive education system at all levels without discrimination, and that the whole school environment is designed to foster inclusion, not segregation. Inclusive education benefits all children. Children with disabilities should be guaranteed equality in the entire process of their education, including by having meaningful choices and opportunities to be accommodated in mainstream schools if they choose, and to receive quality education on an equal basis with, and alongside, children without disabilities. This entails an obligation to ensure that facilities, including toilets, are physically accessible to all students, and an obligation to ensure that the education schools offer is inclusive—that is, the teachers are trained in inclusive education methods and use accessible teaching materials, and the schools provide reasonable accommodations for children with disabilities.[41]

Barriers to Health Services and Other Government Assistance

I have no hope for the future, but if I get treatment, I would have hope.

–Rozina, who described getting a disabling leg injury in an airstrike, Jalalabad, December 2017

Although Afghanistan’s healthcare system improved after 2001, access to health care remains poor throughout much of the country, especially in rural areas. Corruption and insecurity have continued to limit the ability of the government to provide even basic health services.[42] Hospitals and clinics are not easily accessible outside of urban areas, and poor access to health services, especially in rural Afghanistan, is a leading cause of disabilities. For example, one of the main causes of partial or total loss of vision in Afghanistan are cataracts, a treatable condition.[43]

Among persons with disabilities, access to healthcare facilities and services may have actually worsened since 2005, according to a 2017 study.[44] One reason for this is that:

Disability and mental health were second-tier priorities until the BPHS [Basic Package of Health Services] review in 2004. Even after disability rehabilitation became a priority, the resources allocated to health services were insufficient to meet the additional needs.[45]

Physical rehabilitation is not available in all provinces, and because patients have to travel long distances to get services, many forego them altogether. Traveling to obtain services has been, for many families, complicated by poverty, poor quality roads, and danger along the way due to armed conflict. Moreover, government health services lack trained personnel and technical expertise to effectively deliver services to those with disabilities. A lack of female health service providers means that women and girls with disabilities have less access to services.[46]

The lack of female health workers and trained professionals has even further limited access to rehabilitative services for women with disabilities. Due to widespread gender segregation in Afghan society, women and girls, in addition to likely preferring to receive care from a female service provider, are likely to be barred by their families from accessing care from male professionals. Even in urban areas, women with disabilities often do not have access to adequate health care, opportunities for rehabilitation, or support and assistance. For women living in rural areas who have to travel great distances to reach a government or NGO clinic, the “absence of transportation, lack of paved roads, and distance to clinics constitute specific barriers to accessing health-care facilities.”[47] If a woman needs to travel to reach a clinic, she often needs a mahram (a male relative) to accompany her, which will increase the cost of treatment and make it more difficult for women to seek care.[48]

A young woman with a disability described her experience:

I have benefited from the Red Cross services in Herat, but the Red Cross is only limited to the cities and can’t provide any services to the remote areas. I know people who are in remote districts, but since they have no one [to bring them], they cannot come to the Red Cross and benefit from their services.[49]

M.A., 26, relocated with her family to Herat city from an outlying district when she was 7 after she became paralyzed in her legs because of cerebral palsy. In their home district, there were no services available for persons with disabilities. In Herat, she was able to obtain a wheelchair. She said:

If I return to my district and my wheelchair gets any damage, then there’s no one who can help me.… Sometimes I feel very sad … because I cannot get out of the house. In such times, I would love to get out, buy dresses for myself and attend wedding ceremonies. Girls of my age are going out, they go to places of recreation, but I am always at home. There is nothing fun for me. It has been two, three years that I’m having severe depression. I always cry.… There will be no one with me when I get older, and I really worry about this.[50]

Prenatal and maternal health care is particularly poor throughout rural Afghanistan. Maternal deaths remain among the highest in the world.[51] Poor prenatal health care is directly related to some childhood disabilities, including cerebral palsy, which is characterized by motor difficulties, often accompanied by visual, hearing, and learning disabilities.[52] Cerebral palsy is the most prevalent childhood disability in Afghanistan.[53]

Mental health services are especially lacking. People seeking government assistance for such services are referred to the Ministry of Public Health, but there are critical gaps in the availability and quality of psychosocial support and mental health services in Kabul and other cities, while in rural areas they are virtually nonexistent. Afghanistan lacks trained personnel in all areas of mental healthcare provision—psychiatrists, psychiatric nurses, psychologists, and social workers. The stigma associated socially with psychosocial disabilities (mental health conditions) is also a significant barrier for people seeking support.

Rozina’s case illustrates the barriers poor women with disabilities from remote areas face in accessing adequate disability support and mental health services. Rozina, a resident of Dehbala, Nangarhar province, was badly injured when her family’s car was hit by an apparent airstrike. Ten members of her family, including a 2-year-old child, were killed. Rozina’s injury to her leg left her with limited mobility; she also lost part of her vision in one eye. Although she received emergency treatment for her injuries at a local clinic, she received no follow-up treatment or care when her wounds became infected. She said, “I’m supposed to get married, but my future in-laws think I cannot now.”[54] In September 2018, local humanitarian workers convinced Rozina’s brother to take her to Kabul, where doctors were able to treat the infection and fit her leg with a metal rod, greatly increasing her mobility and reducing her pain. They were not able to treat her eye and told her she would need to get treatment in Pakistan, which the family could not afford.[55]

For those who have acquired a disability as a result of a conflict-related incident, the government’s system for determining eligibility for assistance and obtaining financial help has proven onerous. Many victims of insurgent attacks and their family members do not know what assistance is available to them or what steps they should follow to try to claim it.

Mariam, a 25-year-old woman with three children ages 1, 5, and 7, lost her husband, Mohammad Asif, in an insurgent bombing of the Jawadiya Mosque in Herat on August 1, 2017. She said she had no means of support and had been relying on help from other survivors and her husband’s relatives to feed her family.[56] Sima, who was a caretaker at the mosque and was injured in the attack, said she was treated at the hospital and went home, but continued to experience intense anxiety and could no longer work. She said she needed psychosocial support but had no idea where to get assistance.[57]

Barriers in Accessing Public Buildings and Transportation

Wedding halls, parks, shopping malls, universities—none of them have ramps so that I could go to those places with my wheelchair.… I hope one day ramps will be built in recreational places and shopping centers so I can go to those places, and I hope special places will be allocated … in the buses.

–B.A., Herat, April 2018

Persons with disabilities in Afghanistan face multiple barriers to accessing public buildings and transportation. All women face other cultural barriers in navigating public spaces in Afghanistan, but the difficulties are compounded if they have a disability.[58] Even for women in cities, the lack of accessible toilets, ramps, and elevators may prevent them from seeking support, or limit the times they attempt to access services.

According to the Ministry of Labor, Social Affairs, Martyrs and Disabled, the government has initiated plans for all municipalities to add ramps to public buildings and install elevators in new facilities. However, Kabul and other cities suffer from frequent power cuts, leaving elevators inoperable. Very few buildings are equipped with accessible toilets.[59] In its 2016 report, the AIHRC noted that 0.2 percent of persons with disabilities they interviewed had accessible toilets in their places of work, and 2.9 percent had access to ramps. The AIHRC has called on the government and other institutions to address these needs as priorities.[60]

W.S., 42, was wounded in a rocket attack in Kabul in 1999. She was pregnant at the time and lost the child. Her legs were badly injured, and since then she can walk only short distances with walking sticks. She said:

My home was at the Khairkhana hillside. The doctor advised me that I should live in a flat environment, that is why I moved here. When it’s raining and muddy, I can’t go out. In the winter and in the snow, the snow freezes the streets and I can’t walk.… I wanted to get a card from the Ministry of Martyrs and Disabled, but because it’s far away, I can’t go.[61]

A 26-year-old woman in Herat described the problems she faced:

It is better that I start with this example: the days that I go to the Red Cross Orthopedic Center for my leg massage, I don’t drink liquids such as water or tea because I know if I need to go to a toilet, first, there are no special toilets, and if there is any toilet, I can’t get to it without seeking help. So I must even control my need for a toilet, while it is a very basic need, while the normal people can go to a toilet any time they wish to.[62]

Another woman, who has received the small government disability stipend after being paralyzed in an explosion, said that even getting her assistance money was very difficult because reaching the bank or accessing public buildings was often impossible for her.[63]

F.S.’s family abandoned her in front of the ICRC Orthopedic Center in 2013 after they were deported from Iran. In addition to a physical disability, she has developmental and speech disabilities. She said: “I have no one in my life.… I so often wish to go out in the bazaar and shop for myself, but I can’t go out unattended.”[64]

A 2013 study on participation in Afghan elections found that 67 percent of persons with disabilities had not voted, either because they did not have registration cards, or because of the inaccessibility of polling stations, lack of accessible transportation facilities, and lack of assistance from polling station staff.[65]

Social Stigma and Discrimination

Afghan women and girls with disabilities face particular barriers to their rights, as gender discrimination and discrimination against persons with disabilities intersect. Too often, they describe social isolation, being humiliated in public or within their own families, being considered a source of shame for the family, and being denied access to public spaces and community or family social events. Afghan women with disabilities are often seen as unfit for marriage and a burden on their families. One young woman described the fears of many Afghan women with disabilities: “If you are a girl and a disabled person, even if you are married, you will always have the fear that you can get divorced from your husband at any moment as he may prefer another woman to you.”[66]

A representative of an NGO working with women with disabilities said: “Young girls with disabilities are ashamed of going out, and their families exacerbate this situation. For example, I know a family who doesn’t let their girl come out of the house, only because she has a disability.”[67]

At the age of 4, M.G. was badly injured in a traffic accident. A brain injury left her with cognitive disabilities, including the loss of speech, and she is partially paralyzed. A close relative described the difficulties the family faces when they try to bring Mina into public places:

When we take her somewhere with ourselves, she gets harassed by neighbors. For example, they say that M.G. is handicapped and should not even leave the house. They say, “Keep this crazy at home and you don’t have to bring it out.” The majority of the neighbors’ children harass and ridicule her. M.G. can’t go to school and study, and she won’t be able to in the future either.… She won’t be able to get married in the future, because no one will be willing to marry a mentally and physically handicapped person.[68]

D.S., 16, was born with congenital physical and intellectual disabilities. She is blind and requires assistance to do any activity. Her mother said that the women in the house take care of her:

In our family, her mother and sisters look after her and try to provide her with daily necessities by turn. But family men do not treat her well and do not want her to go out or be seen by anyone. Because she is a disabled girl and it is shameful to have a disabled person in the family in Afghanistan, especially if the disabled is a girl. Because of this, [D.S.] stays at home.[69]

Barriers to Employment

Women with disabilities face enormous obstacles in getting a job. According to the Community Centre for the Disabled, 90 percent of persons with disabilities are unemployed.[70] Under the Law on Rights and Privileges of Persons with Disabilities, 3 percent of jobs in government and the private sector are to be reserved for persons with disabilities.[71] However, the AIHRC found that the number of employees with disabilities working in government offices was less than 1 percent.[72]

Amina Azizi, the head of a small advocacy organization working on behalf of women with disabilities in Afghanistan, lost her right leg in a rocket attack on her home in Kabul when she was a child. When she first attempted to find a job, she said she was told, “‘Why are you seeking work, when those who are without disabilities are jobless?’” When she eventually found work as a radio presenter and advocate for persons with disabilities, she said the main focus of the programs “was to inform the public that persons with disabilities are active members of society and should be treated like everyone else. Disability is not weakness.”[73]

Parwana Sama Samadi, interviewed by the AIHRC, described a similar experience: “I tried my best to find an employment, but I received a negative and illogical response from any door I knocked. In spite of that, I did not lose my hope.”[74]

A government official responsible for social and support services acknowledged the problem:

Unfortunately, the percentage employing people with disabilities, especially women, is very low. Although men with disabilities face similar problems, in general it is much more difficult for women with disabilities, because in a male dominated society, employment of women is less common.… An extensive and appropriate awareness program about the qualifications of people with disabilities has not been conducted for the public institutions to assure them that disability is not incompetence and that disability does not impede their working potential.[75]

The ICRC and some NGOs working with persons with disabilities have a policy of hiring persons with disabilities in order to help overcome entrenched societal biases.[76]

Sexual Harassment of Women Seeking Assistance

When you get into the ministry, everyone looks at you as a sexual toy. They think that as you are not a healthy girl, you will never marry someone, and it makes it easier for them to have sex with you.

–M.I., Kabul, April 2018

Harassment of women is defined in Afghanistan’s Elimination of Violence against Women Law as “using words or committing acts by any means, which causes damage to the personality, body and psyche of a woman.” Anyone convicted of this offense can be sentenced from 3 to 12 months in prison. In cases in which the person who committed the harassment misused a position of authority, the sentence cannot be less than 6 months. The Anti-Harassment of Women and Children Law prohibits “hostile action or physical contact with women; publication of posters, pictures, audio and video clips that are against ethics; verbal or non-verbal abuse or illegitimate demands; intimidating or abusing a woman by threatening a demotion, transfer, termination, withholding of promotion, or withholding of a positive evaluation.”[77]

Sexual harassment is widespread in Afghanistan. A 2016 study found that 90 percent of the 346 women and girls interviewed said they had experienced sexual harassment in public places, 91 percent in educational environments, and 87 percent in workplaces. Afghanistan’s Elimination of Violence against Women Law and Anti-Harassment of Women and Children Law criminalize sexual harassment, including in the workplace.[78] The laws have had little effect, however, because there has been no political will to seriously investigate most reported cases of abuse.

According to NGOs advocating for the rights of women with disabilities in Afghanistan, sexual harassment against women with disabilities is a serious problem, particularly in government offices, including the Ministry of Labor, Social Affairs, Martyrs and Disabled.[79] In order to qualify for government assistance, a person who has acquired a disability must get a statement from the Ministry of Public Health to determine the percentage of their disability and the date it occurred, bring this to the Ministry of Labor, Social Affairs, Martyrs and Disabled, and then obtain a disability certificate. One NGO representative described the process:

For women, getting this certificate is a disaster. Those who have applied have been harassed by the ministry staff, but we cannot talk about this issue publicly as it will make us more vulnerable.[80]

A.G., a woman with a disability who had organized an advocacy group for other women with disabilities, said:

My own experience was this: I went to the ministry to see the minister and talk with him about my association.… When I went to his secretariat office and asked them to arrange a visit for me, the administrative staff who were working there asked me about the purpose of the meeting, and I told them that I want to talk about the challenges that small girls with disabilities face in going to schools.… I was sitting there for more than two hours and asking them every 30 minutes when the minister will be free.... The man looked at me and told me: “You are neither beautiful nor young. Even you have not applied a red lipstick! How come you are so confident to meet the minister?” I tore my proposal and my hope and threw them in the trash bin. My hands were shaking. I couldn’t believe a man could be as rude as he was.[81]

Another woman, M.R., described her experience:

I went [to the ministry] to get my disability certificate because the ministry pays up to 5,000 afghanis [US$64] per month based on the level of disability. I faced a very rude offer when I wanted to register myself at the ministry. The administrative employee who was working there told me that he will process my certificate if I sleep with him. He asked me to sleep with him for a night while standing in front of his colleagues, and they just started laughing at me, loud and louder.… One of them told me, “Then what do you want? You want to be registered and get paid by the government without paying our share? How do you want to get your disability card when you don’t want to sleep with us?” I started crying and left. Later, when I shared this story with other friends and women with disabilities, most of them had similar experiences. Even some of them told me that they will never visit the ministry because they will be harassed.[82]

P.F. described a similar experience:

I went to the ministry to get this certificate. They asked me whether I am married and when I said no, they told me that they can find me a husband. When I refused, the ministry employee told me that I can get this certificate only if I agree to be his girlfriend.[83]

In response to questions about sexual harassment, one official who met with Human Rights Watch said that he had not received any complaints about the sexual harassment of women with disabilities. A second official responded by email:

The MMD [Ministry of Martyrs and Disabled] has a reliable system, transparent functionality and believes that [the] system prevents … such issues. The MMD leadership is committed and has developed very reliable and applicable procedures for prevention of any kind of fraudulent actions such as bribes, sexual harassment, and any deeds which are against any applicable laws of the country.[84]

The stigma associated with reporting harassment of this kind—and the likely futility of doing so—means that few women, especially women with disabilities, report cases of abuse.

III. Recommendations

To the Government of Afghanistan

  • Implement a comprehensive review of legislation and policies to ensure they are in line with the provisions of the Convention on the Rights of Persons with Disabilities.
  • Amend existing legislation and policies to ensure that all persons with disabilities, not only those with conflict-related disabilities, are entitled to services and financial assistance.
  • Increase public awareness on disability and mental health, including through de-stigmatizing campaigns that emphasize the dignity and equality rights of persons with disabilities, and on the availability of services.
  • Support efforts to develop sustainable solutions to increase access to quality, inclusive education for children with disabilities, particularly girls, including by developing strategies to expand community-based education (CBE) programs which provide home-based teaching for children unable to attend government schools, incorporating CBE into the government’s education system, making specific arrangements for integrating girls with disabilities into CBE, and ensuring long-term funding for CBE.
  • Facilitate the equal access to education for children with different types of disabilities by training teachers and supporting efforts to make classrooms fully accessible.
  • Ensure that all persons with disabilities have the opportunity and accessible information to register as a person with a disability with relevant state agencies.
  • Establish accessible and confidential complaint mechanisms to ensure that any alleged abusive or harassing behavior by government officials is properly investigated and appropriate remedies are provided in the event of a violation. Information about how to use these mechanisms should be distributed in accessible formats. Those responsible for sexual harassment should be prosecuted under the applicable law.
  • Fund and accelerate measures to ensure all public buildings are accessible by building ramps and making toilets and other facilities accessible, and require all businesses and educational institutions to provide these within a reasonable timeframe.
  • Implement a comprehensive review of health services for persons with disabilities to improve outreach and access, particularly in rural areas.
  • Develop and publish uniform standards on accessibility in line with Universal Design Principles, and ensure that these standards address the needs of persons with different disabilities and other stakeholders. Coordinate and consult with persons with disabilities and disabled persons’ organizations on the standards and their distribution.

To Afghanistan’s International Partners, including the European Union and its Member States

  • Include human rights, including the rights of persons with disabilities, in all bilateral and multilateral discussions with Afghanistan.
  • Ensure that funding for civil society and economic and social development include benchmarks and reporting regarding progress in ensuring the rights of persons with disabilities.

Acknowledgments

This report was written by Patricia Gossman, associate Asia director at Human Rights Watch. It was researched by Fereshta Abbasi, a consultant with the Asia Division, and Patricia Gossman. It was edited by Kriti Sharma, senior disability rights researcher, and Brad Adams, Asia director. Heather Barr, acting women’s rights co-director, and Elin Martinez, senior children’s rights researcher, reviewed the report. James Ross, legal and policy director, and Joseph Saunders, deputy program director, provided legal and program review. The report was prepared for publication by Jose Martinez, administrative officer, and Fitzroy Hepkins, senior administrative manager.

We are deeply grateful to the women and activists who spoke with us about their experiences, and to the NGO representatives, health professionals, and government officials who provided us with their insights.

 

 

[1] This accords with research in other countries. According to a study by the United Nations Population Fund, girls and young women with disabilities face up to 10 times more gender-based violence than those without disabilities, and those with intellectual disabilities are particularly vulnerable to sexual violence. United Nations Population Fund, “Five Things You Didn’t Know about Disability and Sexual Violence,” October 2018, https://www.unfpa.org/news/five-things-you-didnt-know-about-disability-a... (accessed January 24, 2020).

[2] In 2018, the Asia Foundation launched a new survey to identify the prevalence of disability in the Afghan population and assess progress on access to services. The findings were not available as of February 2020. Asia Foundation, “TAF-Survey/Disabilities-Data Collection-April-2018-009,” http://www.acbar.org/upload/1522565703125.pdf (accessed May 20, 2019). See also Jean-Francois Trani and Paul Bakshi, “Challenges for Assessing Disability Prevalence: The Case of Afghanistan,” Brown School Faculty Publications, paper 29 (2008), https://openscholarship.wustl.edu/cgi/viewcontent.cgi?article=1027&conte... (accessed May 1, 2019).

[3] Ibid.

[4] The survey’s findings illustrate the variations in data about people with disabilities in Afghanistan given different methodologies and definitions for disability: “The results revealed that the prevalence of disability ranges from 0.6 percent to 2.4 percent for the whole population (individuals over 4 years old) and from 11 percent to 33 percent for people aged 69 and older in Kabul and Ghor, respectively. The … National Disability Survey in Afghanistan (NDSA) … defines disability as a multidimensional concept. This approach encompasses limitations associated with physical, sensory, intellectual disability, mental illness and psychological distress. The main missing dimensions of disability in [the 2013 survey] data are mental illness and psychological distress, which likely explain the lower prevalence estimated by this study.” Central Statistics Office, “Socio-Demographic and Economic Survey Provinces of Kabul, Bamiyan, Daykundi, Ghor, Kapisa and Parwan People with Disabilities,” June 2017, https://afghanistan.unfpa.org/sites/default/files/pub-pdf/UNFPA%20SDES%2... (accessed May 15, 2019).

[5] The Community Centre for the Disabled (CCD) is one of the members of Afghanistan’s Advocacy Committee for the Rights of Persons with Disabilities, which includes local and international NGOs that implement programs for people with disabilities in Afghanistan.

[6] Afghanistan is one of three countries, along with Pakistan and Nigeria, where polio has not yet been eradicated. Poor access to prenatal care and other maternal health services represent a significant risk factor for cerebral palsy. See US Centers for Disease Control and Prevention, “Causes and Risk Factors of Cerebral Palsy,” https://www.cdc.gov/ncbddd/cp/causes.html (accessed January 24, 2020).

[7] World Health Organization, “Afghanistan: Eye Care,” http://www.emro.who.int/afg/programmes/eye-care.html (accessed May 12, 2019).

[8] Jean-Francois Trani and Parul Bakhshi, “Vulnerability and Mental Health in Afghanistan: Looking Beyond War Exposure,” Brown School Faculty Publications, paper 40 (2013), https://pdfs.semanticscholar.org/4e05/dfbe7fe9d414c80c397e39fa75eb22f8f8... (accessed May 2, 2019).

[9] Ibid.

[10] Ghulam Dastagir Sayed, “Mental Health in Afghanistan: Burden, Challenges and the Way Forward,” World Bank, August 2011, http://siteresources.worldbank.org/ HEALTHNUTRITIONANDPOPULATION/Resources/281627-1095698140167/MHinAfghanistan.pdf (accessed April 2, 2018).

[11] Kenneth E. Miller et al., “Daily Stressors, War Experiences, and Mental Health in Afghanistan,” Transcultural Psychiatry, vol. 45, no. 611 (2008), http://tps.sagepub.com/cgi/content/abstract/45/4/611 (accessed May 11, 2019).

[12] Jean-Francois Trani et al., “Assessment of Progress towards Universal Health Coverage for People with Disabilities in Afghanistan: A Multilevel Analysis of Repeated Cross-Sectional Surveys,” The Lancet, vol. 5, no. 8 (2017), https://www.thelancet.com/action/showPdf?pii=S2214-109X%2817%2930251-6 (accessed May 13, 2019).

[13] Afghanistan was a member of the Ad Hoc Committee on a Compressive and Integral International Convention on Protection and Promotion of the Rights and Dignity of Persons with Disabilities. United Nations, Department of Economic and Social Affairs, Division for Social Policy and Development, First Session of the Ad Hoc Committee, “Documents of the First Session: List of Participants,” https://www.un.org/esa/socdev/enable/rights/ahc1documents.htm (accessed October 13, 2019).

[14] Transitional Islamic State of Afghanistan, “Comprehensive National Disability Policy in Afghanistan,” https://www.who.int/disabilities/policies/documents/Afghanistan.pdf?ua=1 (accessed May 17, 2019).

[15] Landmine and Cluster Munition Monitor, “Afghanistan: Victim Assistance,” October 2017, http://the-monitor.org/en-gb/reports/2018/afghanistan/victim-assistance.... (accessed May 30, 2019).

[16] Law on Rights and Privileges of Persons with Disabilities, http://moj.gov.af/Content/files/The%20Law%20on%20Rights%20and%20Privileg... (accessed June 14, 2019).

[17] Claire Anderson, “Overcoming Stigma against Disabilities in Afghanistan,” Asia Foundation, November 2, 2016, https://asiafoundation.org/2016/11/02/overcoming-stigma-disabilities-afg... (accessed June 12, 2019).

[18] Human Rights Watch meeting with the Social Association of Afghan Women with Disabilities, Ministry of Women’s Affairs, Hadafmand Association, and Women with Disabilities Association, Kabul, April 17, 2018. See also Landmine and Cluster Munition Monitor, “Afghanistan: Victim Assistance,” http://the-monitor.org/en-gb/reports/2018/afghanistan/victim-assistance.....

[19] These are based on assessments by the Ministry of Public Health. Human Rights Watch was unable to obtain clarification on how the determinations were made.

[20] Human Rights Watch email communication with Zakirullah Zaki, communication and public outreach expert, Office of the State Minister for Martyrs and Disabled, April 11, 2019.

[21] United Nations Children’s Fund (UNICEF)-Afghanistan, “Special Information Request,” https://www.ohchr.org/Documents/Issues/Disability/DecisionMaking/UN/UNIC... (accessed June 12, 2019). On October 7, 2019, the Afghan government issued Presidential Decree 75 creating the State Ministry for Martyrs and Disabled Affairs. Prior to that, the Ministry of Labor, Social Affairs, Martyrs and Disabled had overall responsibility for these issues. Human Rights Watch email communication with Zakirullah Zaki, April 11, 2019. See also “Ministry’s History,” State Ministry for Martyrs and Disabled Affairs, https://mmd.gov.af/ministrys-history (accessed March 12, 2020).

[22] Human Rights Watch meeting with the Social Association of Afghan Women with Disabilities, Ministry of Women’s Affairs, Hadafmand Association, and Women with Disabilities Association, Kabul, April 17, 2018. See also Landmine and Cluster Munition Monitor, “Afghanistan: Victim Assistance,” http://the-monitor.org/en-gb/reports/2018/afghanistan/victim-assistance.....

[23] Swedish International Development Cooperation Agency, “Disability Rights in Afghanistan,” 2014, https://www.sida.se/globalassets/sida/eng/partners/human-rights-based-ap... (accessed January 24, 2020).

[24] Before 1988, the ICRC provided treatment to Afghans from facilities near refugee communities in Pakistan. International Committee of the Red Cross, “International Review of the Red Cross,” no. 225 (1981), https://www.loc.gov/rr/frd/Military_Law/pdf/RC_Nov-Dec-1981.pdf (accessed June 12, 2019), pp. 372-373.

[25] These are in in Kabul, Mazar-e Sharif, Herat, Jalalabad, Gulbarhar, Faizabad, and Lashkar Gah. The ICRC also provides vocational training, micro-loans to start small businesses, and sports programs like wheelchair basketball, futsal, and recreational activities. The ICRC also trains and employs people with disabilities in its physical rehabilitation centers; most of its 750 staff are former beneficiaries. International Committee of the Red Cross, “Afghanistan: Record Number O=of Disabled Afghans Seek Assistance in ICRC’s 30th Year,” January 23, 2019, https://www.icrc.org/en/document/afghanistan-record-number-disabled-afgh... (accessed May 14, 2019).

[26] Afghanistan is highly dependent on international assistance. According to the World Bank, as of 2018, international aid comprised 40 percent of Afghanistan’s GDP, and was essential to maintain basic state functions. Rachel Cooper, “Aid Dependency and Political Settlements in Afghanistan,” UK Department for International Development, September 14, 2018, https://assets.publishing.service.gov.uk/media/5d0ced7ae5274a065e721702/... (accessed January 24, 2020). Afghan NGOs have reported a decrease in funding for programs supporting people with disabilities since 2013, the year before the withdrawal of most international forces from Afghanistan. Landmine and Cluster Munition Monitor, “Afghanistan: Victim Assistance,” http://the-monitor.org/en-gb/reports/2018/afghanistan/victim-assistance..... Donor aid to Afghanistan rose steadily after 2002, peaking in 2011 and declining since then: Afghanistan received US$6.867 billion in 2011, compared to US$4.239 billion in 2015, according to a 2018 report by Oxfam and the Swedish Committee for Afghanistan. The report noted that “the challenge to obtain accurate data on how much development aid has been received from 2010-2106 points to a lack of transparency and coordination within the aid sector of Afghanistan where clear financial data is not readily available, and agreed upon.” The report also noted that aid disbursements have been far lower than the pledges. Oxfam and Swedish Committee for Afghanistan, “Aid Effectiveness in Afghanistan,” March 2018, https://swedishcommittee.org/sites/default/files/media/aid_effectiveness... (accessed January 24, 2020).

[27] Mujib Mashal, “Afghanistan Needs Billions in Aid Even After a Peace Deal, World Bank Says,” New York Times, December 5, 2019, https://www.nytimes.com/2019/12/05/world/asia/afghanistan-aid-world-bank... (accessed January 24, 2020).

[28] Community Centre for the Disabled, “Assessing Participation of Persons with Disabilities in Past Three Elections in Afghanistan,” 2013, https://eaccess.s3.amazonaws.com/media/attachments/resources_mainresourc... (accessed May 31, 2019), p. 11.

[29] Human Rights Watch interview with director general of general education, Ministry of Education, Kabul, May 8, 2016.

[30] Human Rights Watch, “I Won’t Be a Doctor, and One Day You’ll Be Sick”: Girls’ Access to Education in Afghanistan, October 2017, https://www.hrw.org/report/2017/10/17/i-wont-be-doctor-and-one-day-youll....

[31] Comment by an official with a humanitarian NGO at Human Rights Watch meeting with the Social Association of Afghan Women with Disabilities, Ministry of Women’s Affairs, Hadafmand Association, and Women with Disabilities Association, Kabul, April 17, 2018.

[32] Human Rights Watch interview with I.A., Kabul, April 24, 2018.

[33] Human Rights Watch meeting with the Social Association of Afghan Women with Disabilities, Ministry of Women’s Affairs, Hadafmand Association, and Women with Disabilities Association, Kabul, April 17, 2018.

[34] Patricia Chadwick, “Amina Azimi — Raising the Voices of the Disabled in Afghanistan,” Internews, May 25, 2016, https://medium.com/local-voices-global-change/amina-azimi-raising-the-vo... (accessed May 30, 2019).

[35] Human Rights Watch interview with S.A., Kabul, April 11, 2018.

[36] Human Rights Watch interview with L.G., Herat, April 9, 2018.

[37] Human Rights Watch interview with G.A., Herat, April 11, 2018.

[38] Human Rights Watch interview with D.A., Kabul, December 28, 2019. The ICRC manages these programs for a limited number of students in urban areas. Human Rights Watch interview with Dr. Shayan, ICRC regional office, Herat, April 12, 2018.

[39] Human Rights Watch interview with D.A., Kabul, December 28, 2019.

[40] Ibid.

[41] “Reasonable accommodation is a key component of the right to inclusive education. Accommodations may include hearing aids; braille textbooks, audio, video, and easy-to-read learning materials; instructions in sign language for children with hearing disabilities; structural modifications to schools, such as ramps for children in wheelchairs; and additional qualified staff to assist children with self-care, behavior, or other support needed in the classroom. The denial of reasonable accommodations constitutes discrimination.” Human Rights Watch, “Just Like Other Kids”: Lack of Access to Inclusive Quality Education for Children with Disabilities in Iran, October 2019, https://www.hrw.org/report/2019/10/02/just-other-kids/lack-access-inclus....

[42] In 2018, Afghanistan ranked 168 out of 189 on the United Nations Human Development Index, the same as Haiti. United Nations Development Programme, “Human Development Reports: 2018 Statistical Update,” http://hdr.undp.org/en/2018-update (accessed June 14, 2019).

[43] World Health Organization, “Afghanistan: Eye Care,” http://www.emro.who.int/afg/programmes/eye-care.html (accessed May 12, 2019).

[44] Jean-Francois Trani et al., “Assessment of Progress towards Universal Health Coverage for People with Disabilities in Afghanistan: A Multilevel Analysis of Repeated Cross-Sectional Surveys,” The Lancet, vol. 5, no. 8 (2017), https://www.thelancet.com/action/showPdf?pii=S2214-109X%2817%2930251-6 (accessed May 13, 2019).

[45] Ibid.

[46] Landmine and Cluster Munition Monitor, “Afghanistan: Victim Assistance,” October 2017, http://the-monitor.org/en-gb/reports/2018/afghanistan/victim-assistance.... (accessed May 30, 2019).

[47] Trani et al., “Assessment of Progress towards Universal Health Coverage for People with Disabilities in Afghanistan,” The Lancet.

[48] Human Rights Watch meeting with Hagar International, Kabul, April 26, 2018.

[49] Human Rights Watch interview with B.A., Herat, April 10, 2018.

[50] Human Rights Watch interview with M.A., Herat, April 11, 2018.

[51] World Health Organization, “Maternal Mortality,” https://www.who.int/news-room/fact-sheets/detail/maternal-mortality (accessed May 5, 2019).

[52] “Cerebral palsy is a motor disorder caused by brain damage resulting from prolonged or difficult labour, diabetes in the mother, a brain haemorrhage, or lack of oxygen during birth. Very little is known about its causes in Afghanistan.” International Committee of the Red Cross, “First Cerebral Palsy Centre for Afghan Children Opens in Kabul,” May 21, 2004, https://www.icrc.org/en/doc/resources/documents/news-release/2009-and-ea... (accessed May 5, 2019).

[53] Human Rights Watch interview with Alberto Cairo, ICRC Orthopedic Center, Kabul, December 9, 2017.

[54] Human Rights Watch interview with Rozina, Jalalabad, December 2, 2017. Human Rights Watch documented the case in “Afghanistan: Weak Investigations of Civilian Airstrike Deaths,” May 16, 2018, https://www.hrw.org/news/2018/05/16/afghanistan-weak-investigations-civi....

[55] Human Rights Watch text communication with humanitarian worker in Jalalabad, October 23, 2018.

[56] Human Rights Watch interview with Mariam, Herat, December 8, 2017.

[57] Human Rights Watch interview with Sima, Herat, December 8, 2017. Human Rights Watch documented the incident in “No Safe Place”: Insurgent Attacks on Civilians in Afghanistan, May 2018, https://www.hrw.org/sites/default/files/report_pdf/afghanistan0518_web_1....

[58] Within more conservative Afghan communities, women only appear in public if accompanied by a male chaperone. As a result, much of the public space is male-dominated, and harassment of women who venture into it is common. See Samuel Hall, The Challenge of Becoming Invisible: Understanding Women’s Security in Kabul, 2012, http://samuelhall.org/wp-content/uploads/2012/02/The-Challenge-of-Becomi... (accessed May 15, 2019), p. 11.

[59] Human Rights Watch interview with government official, Ministry of Labor, Social Affairs, Martyrs and Disabled, Kabul, July 14, 2018.

[60] Human Rights Watch interview with Latifa Sultani, women’s rights program, Afghanistan Independent Human Rights Commission, October 30, 2018. See also Afghanistan Independent Human Rights Commission, “Report on the Situation of the Rights of Persons with Disabilities in Afghanistan 1393,” June 2016, https://www.aihrc.org.af/media/files/report%20on%20the%20situation%20of%... (accessed May 10, 2019), p. 23.

[61] Human Rights Watch interview with W.S., Kabul, December 30, 2019.

[62] Human Rights Watch interview with B.A., Herat, April 10, 2018.

[63] Farid Tanha, “Afghanistan: Fighting for Disability Rights,” Institute for War and Peace Reporting, April 6, 2017, https://iwpr.net/global-voices/afghanistan-fighting-disability-rights (accessed June 4, 2019).

[64] Human Rights Watch interview with F.S., Kabul, February 28, 2018.

[65] Community Centre for the Disabled, “Assessing Participation of Persons with Disabilities in Past Three Elections in Afghanistan,” 2013, https://eaccess.s3.amazonaws.com/media/attachments/resources_mainresourc... (accessed May 31, 2019), p. 9.

[66] Human Rights Watch interview with B.A., Herat, April 10, 2018.

[67] Comment by an official with a humanitarian NGO at Human Rights Watch meeting with the Social Association of Afghan Women with Disabilities, Ministry of Women’s Affairs, Hadafmand Association, and Women with Disabilities Association, Kabul, April 17, 2018.

[68] Human Rights Watch interview with M.G.’s relative, Kabul, December 29, 2019.

[69] Human Rights Watch interview with D.S., Kabul, December 30, 2019.

[70] Community Centre for the Disabled, “Assessing Participation of Persons with Disabilities in Past Three Elections in Afghanistan,” 2013, p. 11, https://eaccess.s3.amazonaws.com/media/attachments/resources_mainresourc... (accessed May 31, 2019); see also Afghanistan Independent Human Rights Commission, “Report on the Situation of the Rights of Persons with Disabilities in Afghanistan 1393,” June 2016, https://www.aihrc.org.af/media/files/report%20on%20the%20situation%20of%..., p.16 (accessed May 10, 2019).

[71] Claire Anderson, “ Overcoming Stigma against Disabilities in Afghanistan,” Asia Foundation, November 2, 2016, https://asiafoundation.org/2016/11/02/overcoming-stigma-disabilities-afg... (accessed June 12, 2019).

[72] Afghanistan Independent Human Rights Commission, “Report on the Situation of the Rights of Persons with Disabilities in Afghanistan 1393,” June 2016, https://www.aihrc.org.af/media/files/report%20on%20the%20situation%20of%..., p.22 (accessed May 10, 2019).

[73] Patricia Chadwick, “Amina Azizi Raising the Voices of the Disabled in Afghanistan,” Internews, May 25, 2016, https://medium.com/local-voices-global-change/amina-azimi-raising-the-vo... (accessed May 30, 2019). In 2007, Azizi founded the Women with Disabilities Advocacy Committee. In 2011, she created Empowering Women with Disabilities (EWD), an organization that provided training to women and girls with disabilities. When Human Rights Watch interviewed Azizi in Kabul, the organization had closed for lack of funding. Human Rights Watch interview with Amina Azizi, April 15, 2019.

[74] Afghanistan Independent Human Rights Commission, “Report on the Situation of the Rights of Persons with Disabilities in Afghanistan 1393,” June 2016, https://www.aihrc.org.af/media/files/report%20on%20the%20situation%20of%..., p. 18 (accessed May 10, 2019).

[75] Human Rights Watch interview with Sayid Aalam Hashemi, director of the Regulation of Social and Supportive Services to the Martyred and their Heirs, Ministry of Labor, Social Affairs, Martyrs and Disabled, Kabul, July 14, 2018.

[76] Human Rights Watch interview with Alberto Cairo, ICRC Orthopedic Center, Kabul, December 9, 2017.

[77] Ehsan Qaane, “Harassment of Women in Afghanistan: A Hidden Phenomenon Addressed in Too Many Laws,” Afghanistan Analysts Network, April 2, 2017, https://www.afghanistan-analysts.org/harassment-of-women-in-afghanistan-... (accessed May 27, 2019).

[78] Patricia Gossman, “#MeToo in Afghanistan: Is Anyone Listening?” Human Right Watch, December 20, 2017, https://www.hrw.org/news/2017/12/20/metoo-afghanistan-anyone-listening.

[79] Human Rights Watch interview with M.M., Kabul, April 17, 2018.

[80] Human Rights Watch meeting with the Social Association of Afghan Women with Disabilities, Ministry of Women’s Affairs, Hadafmand Association, and Women with Disabilities Association, Kabul, April 17, 2018.

[81] Human Rights Watch interview with A.G., Kabul, April 24, 2018.

[82] Human Rights Watch interview with M.R., Kabul, April 18, 2018.

[83] Human Rights Watch interview with P.F., Kabul, April 17, 2018.

[84] Human Rights Watch email communication with Selanay Ahmadi, advisor to the Minister for Martyrs and Disabled, Office of the State Minister for Martyrs and Disabled, April 11, 2019.

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

Afghan women and girls with disabilities face high barriers, discrimination, and sexual harassment in accessing government assistance, health care, and schools.

The report, “Disability is Not Weakness,” details the everyday barriers that Afghan women and girls with disabilities face in one of the world’s poorest countries. Decades of conflict have decimated government institutions, and development efforts have failed to reach many communities most in need. The Afghan government should urgently reform policies and practices that prevent women and girls with disabilities from enjoying their basic rights to health, education, and work. Afghanistan’s donors should support and advocate for the rights of all Afghans with disabilities.

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

Afghanistan: Women with Disabilities Face Systemic Abuse

Afghan women and girls with disabilities face high barriers, discrimination, and sexual harassment in accessing government assistance, health care, and schools.

(New York) – Afghan women and girls with disabilities face high barriers, discrimination, and sexual harassment in accessing government assistance, health care, and schools, Human Rights Watch said today.

The 31-page report, “‘Disability Is Not Weakness’: Discrimination and Barriers Facing Women and Girls with Disabilities in Afghanistan,” details the everyday barriers that Afghan women and girls with disabilities face in one of the world’s poorest countries. Decades of conflict have decimated government institutions, and development efforts have failed to reach many communities most in need. The Afghan government should urgently reform policies and practices that prevent women and girls with disabilities from enjoying their basic rights to health, education, and work. Afghanistan’s donors should support and advocate for the rights of all Afghans with disabilities.

“All Afghans with disabilities face stigma and discrimination in getting government services, but women and girls are the ‘invisible’ victims of this abuse,” said Patricia Gossman, associate Asia director at Human Rights Watch and author of the report. “The Covid-19 crisis will make it even harder for women and girls with disabilities to get adequate health care.”

Afghanistan has one of the world’s largest populations per capita of people with disabilities. More than four decades of war have left millions of Afghans with amputated limbs, visual or hearing disabilities, and depression, anxiety, or post-traumatic stress. The under-resourced Afghan health services are failing to meet the needs of this population, and women and girls with disabilities are far less likely to obtain any assistance.

Human Rights Watch interviewed 26 women and girls with disabilities and their families in the cities of Kabul, Herat, and Mazar-e Sharif, and 14 health and education professionals in these cities.

The Covid-19 pandemic exacerbates the problems faced by many people with disabilities. For Afghan women with disabilities who live in rural areas far from medical clinics, the absence of transportation, lack of paved roads, and long distances to clinics can create insurmountable barriers to obtaining health care. The Afghan government should undertake a comprehensive review of health services for people with disabilities, particularly in rural areas, to improve outreach and access.

A young woman whose family moved to the city because of her disability said: “I know people who are in remote districts, but since they have no one [to bring them], they cannot benefit from [healthcare] services.”

Government officials have sexually harassed women with disabilities, including when they visit ministries to claim disability benefits. The stigma associated with reporting abuse of this kind means that few women, especially those with disabilities, report those responsible. A woman in Kabul said: “I went to the ministry to get this certificate [for assistance]. They asked me whether I am married and when I said no, they told me that they can find me a husband. When I refused, the ministry employee told me that I can get this certificate only if I agree to be his girlfriend.”

Entrenched discrimination means that people with disabilities face significant obstacles to education, employment, and health care, rights guaranteed under the Afghan constitution and international human rights law. For example, many people with disabilities in Afghanistan have not been able to acquire the national identity card (taskera) needed to obtain many government services.

An estimated 80 percent of girls with disabilities are not enrolled in school. Resistance from schools to accommodate children with disabilities, lack of dedicated transportation, and families’ reluctance to send children with disabilities to school are major factors preventing children with disabilities from attending school. The Afghan government should develop sustainable solutions to increase access to quality, inclusive education for children with disabilities, particularly girls.

Girls with disabilities are far more likely to be kept home from school because of compounded socio-economic barriers and violence. An official with a humanitarian group said that children with disabilities “cannot go to regular schools due to lack of ramps. In some cases, the school principals do not want to enroll them, because they need to be taken care of.”

Afghan women and girls with disabilities are frequently socially isolated, humiliated in public or within their own families, considered a source of shame for the family, or denied access to public spaces and community or family social events. “I’m supposed to get married, but my future in-laws think I cannot now,” said a woman injured during fighting in 2017. “I have no hope for the future, but if I get treatment, I would have hope.”

“In preparing for possible peace talks, Afghanistan’s leaders have generally ignored the large population of Afghans who have disabilities, many as a direct result of the conflict,” Gossman said. “The government needs to ensure that anyone with a disability gets the assistance they need, now and in the future.”

Posted: January 1, 1970, 12:00 am

The picture shows the emblem of the United States Department of Health and Human Services.

© Tim Brakemeier/picture-alliance/dpa/AP Images

As experts warn that the Covid-19 pandemic could overwhelm emergency rooms across the United States, some state policies on emergency care have come under scrutiny for potentially discriminating against people with disabilities. Disability rights groups have begun challenging some of them.

On March 24, the Alabama Disabilities Advocacy Program filed a complaint with the US Department of Health and Human Services’ (HHS) Office of Civil Rights challenging the Alabama Department of Public Health’s 2010 emergency operations plan. The plan states that “persons with severe mental retardation [and] advanced dementia” among others “may be poor candidates for ventilator support.” In response to the complaint, the public health department removed the plan online, clarified that its more recent February 2020 crisis standards of care plan does not include this language, and announced that it would not discriminate in the use of ventilators.

The HHS Civil Rights Office, which said that the complaint had been resolved, also issued a statement informing all states that under US law, “persons with disabilities should not be denied medical care on the basis of stereotypes, assessments of quality of life, or judgments about a person’s relative ‘worth’ based on the presence or absence of disabilities or age.”

International human rights and US federal law prohibit discrimination on the basis of disability. In the context of Covid-19, states should be adopting preventive measures to reduce the need for triage that will deny emergency medical care to some.

But if and when hospitals do face the need to triage access to ventilators and consider factors such as likelihood of survival, it is critically important that they avoid creating blanket categories of people who will be denied treatment.

People with disabilities have the same right to health, including life-saving treatment, as everyone else. All states should ensure their triage policies do not discriminate against them.

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

Due to overcrowding, prisoners in Australia often have to “double-up,” with two and sometimes three people confined in a cell originally built for one. Difficult conditions of confinement can be particularly problematic for people with disabilities.

© 2017 Daniel Soekov for Human Rights Watch

Locked in cramped cells with others, being an easy target for violence, and getting bullied for your food and medication – that’s daily life for a prisoner with a disability in Australia. And the Covid-19 pandemic is only making things worse.

For the 43,000 people in Australia’s overcrowded prisons, social distancing is impossible. And while many governments around the world are releasing some inmates, Australia has so far relied heavily on lockdowns and ending visitation rights, both of which can have devastating consequences for prisoners with disabilities, who make up more than 50 percent of the prison population.

Lockdowns put people with psychosocial or cognitive disabilities – already at risk of being manipulated or abused by others – at heightened risk of violence, especially since independent oversight of facilities is limited. When I met James, a prisoner with a cognitive disability, two years ago, he told me he feared nothing more than being in lockdown in his cell where he had been sexually assaulted. “It happened in my room,” James said. “He [the assailant] was my cellie. Afterwards, he told me to kill myself. So I cut myself.”

Prior to the Covid-19 crisis, staff shortages meant prisoners could already spend more than 20 hours a day locked in their tiny cells, which is severely damaging to mental health. Now, prisoners have even less out-of-cell time, and only essential staff are on duty. This lack of meaningful social contact – combined with anxiety caused by Covid-19, the stress of a prison environment, and severely limited mental health services – means rates of self-harm could skyrocket, particularly for prisoners with disabilities, as well as for Aboriginal and Torres Strait Islander prisoners for whom separation from family, kin, and community can cause extreme anxiety.

Despite calls from human rights and other organizations, Australia has done little to effectively tackle these issues. To address the threat posed by Covid-19, the authorities should urgently reduce overcrowding by releasing those on remand and prisoners held for lesser or nonviolent offenses, prisoners near the end of their terms, and those at higher health risk. State governments should not only rely on simple lockdowns but work to properly protect the physical and mental well-being of those who remain in custody, particularly those most at risk. If not, the coronavirus could prove catastrophic in more ways than one.

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

Public health experts say that the main way to protect yourself from COVID-19 is to socially distance yourself from others, isolate those who become ill and wash your hands frequently with soap and water. In camps for internally displaced people or refugees, where so many people seek shelter and protection in armed conflicts or humanitarian crises, this is nearly impossible. Few can afford soap, clean water is rare and social distancing unrealistic. Trust me, I know.

I also know first-hand that it’s even more difficult for people like me: people with disabilities.

In 2015, I arrived in a refugee camp on the island of Lesbos in Greece after fleeing the war in Syria. I couldn't get water to wash my hands; the tap was just too high for someone in a wheelchair. The toilets weren’t accessible either. Some days, I had to hold my bladder for hours to avoid having to use a toilet.

A year later, I met some Human Rights Watch researchers who were documenting the situation for refugees, asylum seekers, and migrants with disabilities in refugee camps in Greece. They told me about Ali, a 22-year-old asylum seeker from Afghanistan. For two months, the only place where he could take a bath was in the sea, simply because the few showers in the Moria refugee camp on Lesbos were not accessible to him or other wheelchair users like him. As these places have become even more overcrowded, with Moria currently holding more than 19,000 people in a place designed for fewer than 3,000, the situation has only grown worse.

In some humanitarian crises, such as in the Central African Republic and South Sudan, Human Rights Watch documented that, without ramps, bars or other supports, some people with physical disabilities have to crawl to enter toilets. Can you just imagine what that feels like? I can. And with COVID-19 spreading across borders without control, this is not only an affront to dignity, it also carries huge, potentially life-threatening, health risks.

Hygiene is one key element of maintaining good health, and so is good information. People with disabilities living in camps for refugees and displaced people need information in a way that works for them. I worry about how people who are blind or deaf can get information about how to protect themselves from COVID-19. Is the information about this global pandemic presented in a way that makes sense for someone with an intellectual disability? I hope so, but I’m afraid not.

Last week, the UN released a COVID-19 Global Humanitarian Response Plan, and promised to address the needs of people most at risk, including older people, people with disabilities or chronic illness, women and children.

This is a great commitment, but I hope this is more than just lofty words on paper. What I’ve seen firsthand is that with governments, donors, and aid agencies overwhelmed with many competing priorities during serial humanitarian crises, the needs and concerns of people with disabilities are often overlooked.

Any government or aid agency’s response to COVID-19 should be planned and carried out in close consultation with people with disabilities and older people. People with disabilities, like myself, know best what risks we face and what we need. And COVID-19 testing and treatment needs to be accessible to people with disabilities.

When installing handwashing stations and sanitation facilities in camps, governments and humanitarian organisations also should ensure they are accessible to everyone. Finally, information on protection from the virus and information on how to get testing and treatment needs to be accessible to people with different types of disabilities and older people.

Nearly one year ago, I briefed the UN Security Council on the situation of people with disabilities in Syria. All 15 members of the Council nodded in agreement when I said: “This should not be just another meeting where we make grand statements and then move on…you can and should do more to ensure that people with disabilities are included in all aspects of your work – we cannot wait any longer.”

Security Council members vowed to do their best to make sure that the needs of people with disabilities were part in the humanitarian response in Syria and beyond. Now that the world is trying to defeat COVID-19, here’s your chance to make good on that promise. Again, this is a matter of life and death.

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