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Implementation of the United Nations standard rules on the equalization of opportunities for persons with disabilities: report on an intercountry meeting Cairo, Egypt, 2-4 May 2006

December 30, 2006 who_document

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WHO-EM/MNH/177/E WHO-EM/MNH/177/E

Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities Report on an intercountry meeting Cairo, Egypt, 2–4 May 2006

WHO-EM/MNH/177/E

Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities Report on an intercountry meeting Cairo, Egypt, 2–4 May 2006

Cover photo: A Pharaonic stela more than 3000 years old shows a man with disability participating in social rituals. This image, thought to portray disability following poliomyelitis, is one of the earliest known depictions of the social participation of a person with disability.

© World Health Organization 2006 All rights reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of speciﬁc companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. Publications of the World Health Organization can be obtained from Distribution and Sales, World Health Organization, Regional Ofﬁce for the Eastern Mediterranean, PO Box 7608, Nasr City, Cairo 11371, Egypt (tel: +202 670 2535, fax: +202 670 2492; email: DSA@emro.who.int). Requests for permission to reproduce WHO EMRO publications, in part or in whole, or to translate them – whether for sale or for noncommercial distribution – should be addressed to the Regional Adviser, Health and Biomedical Information, at the above address (fax: +202 276 5400; email HBI@emro.who.int).

Design by Ahmed Salah Mostafa Printed by Document WHO-EM/MNH/177/E/01.07/300

Contents Executive Summary................................................................................................................ 4 1. Background......................................................................................................................... 7 2. Introduction....................................................................................................................... 12 3. Overview of disability in the Eastern Mediterranean Region........................................... 16 4. Review of rules..................................................................................................................21 4.1 Rule 2: Medical care..........................................................................................21 4.2 Rule 3: Rehabilitation........................................................................................23 4.3 Rule 4: Support services.................................................................................... 26 4.4 Rule 19: Personnel training............................................................................... 29 5. Country reports................................................................................................................. 34 6. Recommendations............................................................................................................ 47 Annexes 1. Agenda......................................................................................................................... 49 2. Programme................................................................................................................... 50 3. List of participants....................................................................................................... 52

Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

Executive Summary In 1993, the United Nations General Assembly adopted The Standard Rules on the Equalization of Opportunities for Persons with Disabilities (UNSR), as guidelines to governments on how persons with disabilities can practice their rights as equal citizens. The Rules state in part: “The principle of equal rights implies that the needs of each and every individual are of equal importance, that those needs must be made the basis for the planning of societies, and that all resources must be employed in such a way as to ensure that every individual has equal opportunity for participation”1 . The World Health Organization’s Regional Ofﬁce for the Eastern Mediterranean organized an intercountry meeting in Cairo from 2 to 4 May 2006 on the implementation of the Rules related to health care. This was done in collaboration with WHO headquarters and Associazione Italiana Amici di Raoul Follereau. The objectives of the meeting were as follows: • Discuss the current situation of application of Rules 2 (medical care), 3 (rehabilitation), 4 (support services), and 19 (personnel training) in countries of the WHO Eastern Mediterranean Region; Identify major constraints to the implementation of the UNSR; Recommend national and regional strategies for overcoming the constraints, and for strengthening the application of these four rules; and Encourage regional networking and sharing country experiences towards stronger application of the UNSR.

• • •

The full text of the UNSR is available in English and Arabic at http://www.un.org/esa/socdev/enable/dissre00. htm 1

The meeting included country presentations, group discussions and plenary sessions on the four UNSR related to health. The meeting agenda, programme and list of participants are included as Annexes 1, 2 and 3, respectively. Country reports on the status of implementation of the Rules are attached as Annex 4. Recommendations

1. 2.

4. 5.

6. 7. 8. 9. 10.

11.

Ensure that all persons with different disabilities are given due attention, especially women. There should be no discrimination against persons with disabilities as compared to other members of society, and among themselves. Set up national and regional rehabilitation councils/authorities to coordinate different rehabilitation activities. These authorities also have a role in designing relevant training curricula for different personnel dealing with persons with disabilities, and in developing national policies. Promote low cost, locally made assistive devices that should be provided free of charge. This can be done through establishing local manufacturing units, and starting national funds to provide persons with disabilities with their requirements of assistive devices. Establish health management information systems concerning disabilities. Follow a systematic approach in training personnel. This includes mainstreaming rehabilitation studies in teaching and tertiary care institutions. Universities are also to be encouraged to start courses on disability and rehabilitation. Persons with disabilities should be involved in the different stages of training (planning, implementation and monitoring). A standardized training curriculum for all countries and all categories of health workers should be provided. Integrate rehabilitation services in primary health care systems. This should be accompanied by establishing appropriate referral systems with services in the secondary and tertiary levels. Adopt community-based rehabilitation strategy in national policies. Have plans of action to implement the UN Standard Rules. Nongovernmental organizations and disabled person organizations must be involved in applying this plan. Share information, resources and best practices. Set up regional and national rehabilitation councils/authorities to coordinate different rehabilitation activities. These authorities also have a role in designing relevant training curricula for different personnel dealing with persons with disabilities, and in developing national policies. Establish health management information systems concerning disabilities. 5

Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

12.

13. 14.

Share information, resources and best practices. Resource materials should be exchanged among countries, preferably in local languages. This could be done through an organization which can organize training, video conferences and exchange of experience. Establish a standardized training curriculum for all countries and all categories of health workers. Support and strengthen the community-based rehabilitation philosophy on the regional level. A partnership between WHO and regional bodies-such as the League of Arab Nations and ESCAP and nongovernmental organizations and disabled persons’ organizations should be developed in different areas related to disability. WHO should include persons with disabilities as experts in all ﬁelds, and encourage similar expert meetings to come up with recommendations for concrete strategies.

Background

1.1 Overview of the health-related United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

In 1993, the United Nations General Assembly adopted the Standard Rules on the Equalization of Opportunities for Persons with Disabilities (UNSR), as guidelines to governments on how persons with disabilities can practice their rights as equal citizens. These rules are regarded as international customary rules under international law, and imply a strong moral and political commitment on behalf of Member States to take action for the equalization of opportunities for persons with disabilities. The Rules offer persons with disabilities and their organizations an instrument for policymaking and action. They also offer a framework for international collaboration in the ﬁeld of disability. The purpose of the UNSR is to ensure that all persons with disabilities exercise the same rights and obligations as non-disabled citizens through the removal of various disabling barriers and maximizing full opportunities for participation. Persons with disabilities and their organizations should play an active role as partners in this process. The Rules state in part: “the principle of equal rights implies that the needs of each and every individual are of equal importance, that those needs must be made the basis for the planning of societies, and that all resources must be employed in such a way as to ensure that every individual has equal opportunity for participation”2. According to the UNSR, “equalization of opportunities” means the process through which the various systems of society and the environment, such as services, activities, information and documentation, are made available to all, particularly to persons with disabilities. The 22 rules of the UNSR consist of four chapters—preconditions for equal participation, target areas for equal participation, implementation measures, and the monitoring mechanism—and cover all aspects of the social and economic lives of persons with disabilities. The document can be ordered free of charge from: Disabled Persons Unit, Department for Policy Coordination and Sustainable Development, United Nations, Room DC2-1302, New York, NY 10017, USA, Fax: +1 212 9633062. It can also be found on: http://www.un.org/esa/socdev/enable/dissre00.htm 2

7 Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

The World Health Organization (WHO) particularly supports the monitoring and implementation of the following health-related Rules, and promotes their use for the development of national policies3. Rule 2: Medical care States should ensure the provision of effective medical care to persons with disabilities. In order to ensure that persons with disabilities have access to medical care, WHO: • • • • Develops normative tools including guidelines and a global plan of action to strengthen medical care and rehabilitation services; Advocates for the implementation of the UNSR; Supports countries to integrate medical care services into primary health care; Promotes strategies to ensure that persons with disabilities are knowledgeable about their own condition, and that their rights and dignity are supported and protected by professionals.

Rule 3: Rehabilitation States should ensure the provision of rehabilitation services to persons with disabilities in order for them to reach and sustain their optimum level of independence and functioning. In its efforts to ensure that persons with disabilities have access to rehabilitation services, WHO: • • Supports countries to integrate rehabilitation services into primary health care; Facilitates the strengthening of specialized rehabilitation centres, linking the services they offer to community-based rehabilitation.

WHO gives particular emphasis on community-based rehabilitation, and supports Member States in the following areas: 3

More measures towards the implementation of these four Rules are included in the WHO Action Plan (2006–

2011).

• • • • • •

Preparing guidelines for community-based rehabilitation; Initiating and/or strengthening community-based rehabilitation programmes; Improving country-level data and information on disability and communitybased rehabilitation; Documenting evidence-based best practices in community-based rehabilitation; Conducting regional and country workshops to promote community-based rehabilitation and relevant guidelines; Organizing regional and international training programmes on community-based rehabilitation.

Rule 4: Support services States should ensure the development and supply of support services, including assistive devices and technologies, to assist persons with disabilities to increase their level of independence in their daily living and to exercise their rights. WHO assists in ensuring that persons with disabilities have access to support services through: • • • • Providing assistance for the development of programmes and national policies on assistive devices and technologies; Creating a database on the availability of appropriate assistive devices and technologies in low and middle-income countries; Promoting relevant research; Organizing country and regional workshops.

Rule 19: Personnel training States are responsible for ensuring the adequate training of personnel, at all levels, involved in the planning and provision of programmes and services concerning persons with disabilities. WHO currently regards capacity-building in the area of disability and rehabilitation as one of its priorities, and plans are taking place to: • • Advocate for the implementation of the UNSR, in particular Rule 19; Develop a package of training materials for health professionals involved in disability and rehabilitation; 9 Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

•

Contribute to preparation of a disability and rehabilitation curriculum for schools of public health, medical schools and other health-related institutions, initially beginning with ﬁnalization of a chapter on disability and rehabilitation in WHO’s TEACH-VIP curriculum for injury prevention and control; Promote the inclusion of disability issues in the curricula of technical and professional schools so that their graduates are able to inﬂuence decisions about and facilitate access to services for persons with disabilities.

1.2 Results of a global survey on implementation of the UNSR

In 1999, WHO collected information on the status of implementation of the UNSR by means of a questionnaire sent to all Member States, and to around 600 nongovernmental organizations working in the ﬁeld of disability. This questionnaire, developed at the request of the UN Special Rapporteur on Disability, was designed for the purpose of monitoring the implementation of the UNSR. The objective of the survey was to identify government policies in the areas of the four health-related Rules, and to identify strategies adopted and problems encountered during implementation. Out of 191 countries contacted, 104 responded. Among countries of the Region, responses were received from Bahrain, Cyprus, Djibouti, Jordan, Kuwait, Lebanon, Morocco, Oman, Saudi Arabia, Syrian Arab Republic and United Arab Emirates, and 10 local nongovernmental organizations. Based on this information, it appears that there is a tendency for the medical care system not to provide this service to certain disability groups in countries like Djibouti, Lebanon and Morocco. In Jordan and the Syrian Arab Republic, all groups of persons with disabilities are reported to be included within the medical care system. Programmes range from prevention and early detection and diagnosis to treatment of impairments, referrals and counselling for parents. In Yemen, where the medical care system is weak and inaccessible for large numbers of people living in rural communities, persons with disabilities have little access to medical care. The degree of participation of disability groups in the planning and evaluation of medical care services ranges from “never” as in Djibouti, “sometimes” (Jordan, Morocco and Syrian Arab Republic), to “often” (Lebanon). Social services in countries of the Region do not reach large numbers of the population who have disabilities. In countries like Morocco and the Syrian Arab Republic, less than 20% of the population is covered by social insurance schemes

that protect against disability. WHO estimates that only 1% to 2% of persons with disabilities in the majority world have access to rehabilitation services. These services are either non existent or located only in the country capitals. According to the World Bank note on disability issues in the Middle East and North Africa (June 2005): Physical rehabilitation services by government-sponsored programmes vary signiﬁcantly among countries in the region. Djibouti, Egypt, Morocco and Syrian Arab Republic reach out to less than 5% of the disabled population, while Jordan, Bahrain and Lebanon cover somewhere between 6% and 20% of their respective population with disabilities. The Islamic Republic of Iran has been reported to cover from 41% to 60% of the population with disabilities. In Djibouti rehabilitation services are provided essentially for persons with mobility impairments, while in most other countries services include persons with hearing, visual, intellectual impairments, those with learning difﬁculties, chronic diseases and mental illness. In Yemen, government-sponsored rehabilitation programmes cover mobility and visual impairments. Local nongovernmental organizations have established rehabilitation programmes for children with hearing and intellectual impairments. However, almost all government and nongovernmental organization rehabilitation services in Yemen are urban-based and do not reach out to persons with disabilities in rural areas.

In addition to government-sponsored programmes, eight nongovernmental organizations working in the area of disability in countries of the Region answered the 1999 WHO questionnaire. The survey indicated that rehabilitation services are provided through community-based rehabilitation programmes, in which persons with disabilities, their families and organizations participate. Nongovernmental organizations also partially ﬁnance assistive devices and equipment. In most countries, the bulk of rehabilitation services are provided by such organizations, but the number of disabilities covered is limited, with very few available services for mental health and learning disabilities. Nongovernmental organizations vary substantially in the quality of their services, with many using old rehabilitation techniques with little exposure to new science, tools and practices. They tend not to evaluate their programmes nor do they deal with mild and moderate degrees of disabilities, which are either not diagnosed or misdiagnosed.

11 Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

The Eastern Mediterranean Region has a large number of public and private universities. However, very few can produce the type of specialties and/or competencies which would enable the mainstreaming of disability issues. Most university programmes suffer from a lack of international knowledge in the area of disabilities. This is reﬂected by the lack of accreditation programmes, continuing education opportunities, and research related to disability. Current education and training programmes for professionals in the various ﬁelds of disability are inadequate. They usually do not have the full range of knowledge at their disposal to be effective, lack a multidisciplinary approach, and in many cases are not accredited or licensed.

Introduction

In May 2001, WHO organized an international consultation in Oslo, Norway, in collaboration with disabled people’s organizations and organizations of health professionals on the theme of “Rethinking Care – from the Perspective of Disabled Persons”. In the same period, in consultation with the United Nations Special Rapporteur on Disability, WHO carried out a survey in 68 countries in all world regions about the implementation of the UNSR, speciﬁcally with regard to the four rules related to health care (i.e. Rules 2, 3, 4 and 19). As a result of this survey, it was recommended to strengthen the implementation of UNSR at country level. In response, WHO proposed the organization of a series of intercountry meetings, involving representatives from ministries of health and social welfare and national disabled people’s organizations, with the aim of promoting the implementation of the UNSR. The ﬁrst intercountry meeting on the implementation of the UNSR was organized in the WHO South-East Asia Region in 2003. The second meeting was organized in the African Region in 2004. The third meeting was held in the Region of the Americas in 2005. The present meeting, the fourth intercountry meeting on implementation of the UNSR, took place in Cairo, Egypt, on 2–4 May 2006. The objectives of the meeting were to: • Discuss the current situation of application of Rules 2 (medical care), 3 (rehabilitation), 4 (support services), and 19 (personnel training) in countries of the WHO Eastern Mediterranean Region; Identify major constraints to the implementation of the UNSR; Recommend national and regional strategies for overcoming the constraints, and for strengthening the application of these four rules; and

• •

•

Encourage regional networking and share country experiences towards stronger application of the UNSR.

The meeting was attended by Her Royal Highness Sheikha Hessa bint Khalifa bin Ahmed Al-Thani, United Nations Special Rapporteur on Disability, and representatives of eight countries of the Eastern Mediterranean Region: Egypt, Islamic Republic of Iran, Iraq, Jordan, Lebanon, Palestine, Pakistan and Sudan. A team from Qatar accompanying H.R.H Sheikha Hessa also participated and contributed to the meeting. There were representatives from governmental organizations (Ministries of Health and Social Affairs), as well as civil society (disabled people’s organizations and nongovernmental organizations). Dr Hussein A. Gezairy, WHO Regional Director for the Eastern Mediterranean Region formally inaugurated the meeting. In his address, Dr Gezairy pointed out that more than 40 million people with disabilities lived in countries of the Eastern Mediterranean Region. He highlighted the role of natural and man-made disasters in increasing the incidence of disability in the Region. People with disabilities in the Region had been included in different social areas for many years; however, the Region still suffered from barriers to access.

13 Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

Dr Gezairy then presented the most signiﬁcant international actions in the transition of disability services from a “charity” to a “rights-based” approach. A major milestone to this effect was the adoption of the UNSR by the UN General Assembly in 1993. WHO’s contribution to the implementation of the UNSR was its launch of a global survey to monitor four Rules pertaining to health. This was conducted by the UN Special Rapporteur on Disability in 1999. He shared some of the survey results, which suggested that the Rules needed more strengthening. Another main landmark for WHO was the development of the International Classiﬁcation of Functioning, Disability and Health, ofﬁcially endorsed in 2001. This was followed by a resolution (WHA58/23) during the Fifty-eighth World Health Assembly in which the Assembly urged Member States to strengthen implementation of the UNSR, support community-based rehabilitation, and include a disability component in national health policies and programmes. The resolution also requested WHO to support Member States in these efforts. Recognizing the many challenges facing persons with disabilities, Dr Gezairy emphasized their right to enjoy all aspects of life equally with non-disabled citizens. The only way to implement the UNSR was to involve persons with disabilities and their organizations, which was an area that still needed work. He advocated more development of community-based initiatives, and utilizing the Regional Ofﬁce’s considerable experience in this area in order to change public attitudes regarding the provision of high quality life for persons with disabilities. In her opening address, H.R.H Sheikha Hessa noted that the UNSR represent a set of moral obligations that apply to Member States, local governments, the public and private sectors, service providers, families, and any social structure or individual dealing with persons with disabilities. The UNSR serve as policy guidelines, tools for policy making, proposals for concrete action, and a base for technical, economic and international cooperation. They identify barriers to the inclusion and participation of persons with disabilities, and help governments to remove them. The overarching principle governing the UNSR and which gives them moral and political authority is the concept of equalization of opportunities. She then moved on to the area of health, emphasizing that it is a human rights issue that needs to be accessed by all, particularly infants and children with disabilities. Among many factors denying the right of persons with disabilities to health, Sheikha Hessa drew attention

to the inaccessibility of the physical environment, lack of relevant information and of health awareness. The rights-based approach to disability was a principle which the UN Special Rapporteur used to discuss the subject areas of the meeting, namely access of persons with disabilities to medical care, rehabilitation, support services, and trained personnel. She emphasized that persons with disabilities should be provided the same level of health-related services within the same system as non-disabled members of society. Sheikha Hessa ended her speech by encouraging the participants to come up with strong ideas towards the implementation of the UNSR. Dr Federico Montero, WHO headquarters, addressed the opening session and reiterated the commitment of WHO to implementing the four Rules related to health care. The importance of these four rules stemmed from the fact that they were prerequisites for the equal participation of persons with disabilities. He drew attention to some of the most important events related to disability in the past 30 years, and commented that there were still many activities to be done in relation to disability. He considered disability as part of human diversity, and that the foundation of a digniﬁed life was the right to health, which involved much more than medicine. Dr Montero discussed the availability, acceptability, accessibility, affordability and quality of medical and rehabilitation services. He stressed the need to strengthen rehabilitation services, which were currently the weakest component of primary health care. This was important given that rehabilitation was a powerful tool for empowering persons with disabilities and their families. In his opening presentation, Dr M.T. Yasamy, Regional Adviser for Mental Health and Substance Abuse, gave a historical perspective on the social integration of persons with disabilities in the Eastern Mediterranean Region, and the mixed attitudes towards them. He then presented data on the current situation of disability in the Region, the results of the 1999 survey on the implementation of the UNSR, and strategic directions for the future. Dr Nawaf Kabbara (Lebanon), Dr Ibrahim El Nekheikli (Egypt) and Ms Maryam Nikpoor (Islamic Republic of Iran) served as Chairpersons on a rotating basis. Dr

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Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

Syed Fazle Hadi (Pakistan), Dr Salem Al Majali (Jordan), Mr Muhamed Atif Sheikh (Pakistan) and Ms Hana Quaymary (Palestine) shared the duties of Rapporteur. The meeting included country presentations, group discussions and plenary sessions on the four UNSR related to health. The meeting agenda, programme and list of participants are included as Annexes 1, 2 and 3, respectively.

Overview of disability in the Eastern Mediterranean Region

As with most regions of the world, reliable statistics on the numbers of people with disabilities is lacking in countries of the Eastern Mediterranean Region. Although some countries in the Region have included disability questions in surveys, differing deﬁnitions, methodological approaches and variations in human and ﬁnancial resources have rendered comparisons among countries a difﬁcult task. WHO estimates that about 10% of the world’s population, or about 600 million people worldwide, are affected by one form of disability or another. Applying this proportion to the population of countries of the Region, and taking into account previous estimation by the World Bank regarding high and low estimation, would result in an average of about 40 million persons with disabilities. Based on country-level data available through UNSO, Metts (2004) estimated a low and high estimate of persons with disabilities for individual countries. Table 1 presents the results for a number of countries, most of which are in the Eastern Mediterranean Region. The range of prevalence estimates is between 1% and 10% of the population for countries like Djibouti and Yemen, and between 3.5% and 10% for other countries of the Region. For the group of countries in the table, which comprises a total of 250 million people, the range of persons with disabilities is estimated between about 10 and 27 million people. Ofﬁcial statistics tend to provide an incomplete picture of disability incidence since in many countries the data available come from unreliable sources or are constrained by heterogeneous deﬁnitions of disability. As well, governments and nongovernmental organizations do not apply the same deﬁnitions and standards. These differences among countries result in incomplete and inconsistent data, and illustrate the need for the establishment of common criteria for the deﬁnition and measurement of disability prevalence.

Table 1. Estimated population with disabilities in selected countries, 2002 Country Algeria Djibouti Egypt Islamic Republic of Iran Iraq Jordan Lebanon Morocco Syrian Arab Republic Tunisia West Bank and Gaza Yemen Total Source: Metts (2004) Low estimate 1 158 100 7 000 2 608 500 2 519 700 725 200 196 100 133 200 1 113 700 510 600 358 900 125 800 193 000 9 649 800 High estimate 3 098 700 69 300 6 979 500 6 741 900 1 940 400 524 700 356 400 2 979 900 1 366 200 960 300 336 600 1 910 700 27 264 600

Physical and cultural barriers discriminate against persons with disabilities. The social stigma associated with disability makes it common for families to “hide” family members with disabilities and restrict their access to education, rehabilitation services, and job opportunities. Among persons with disabilities who face lesser degrees of social stigma, a major barrier for their integration in society comes from discrimination in the form of impediments to infrastructure, accessibility to education, health services and work. Poverty, health, and disability are inextricably linked and form a cycle of events where poverty and disability reinforce each other. Poverty is not only a lack of income. It is also a lack of access to health and education services, work opportunities, and social activities. Poverty can be experienced either at a state level or an individual level. The causes for poverty at state level vary among failed wars, export constraints, corruption, and insufﬁcient national income to support basic services etc. Most countries have been affected by conﬂicts with neighbouring countries or other political events, leading to constrained development to meet the basic needs of the people. Poverty at an individual level, which can derive from poverty at state level, can result in poor nutrition, poor hygiene, bad sanitation, and reduced access to basic health care. Despite economic and developmental improvements in countries, there are signiﬁcant groups and numbers of poor people who have little opportunity to improve 17 Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

their circumstances. This is due to the economic and developmental status of their country, or their circumstances in their host country as is the case of Palestinian refugees. Children with disabilities are more likely to be neglected, malnourished, poor or die young. While all children with disabilities face challenges to their rights and are more vulnerable to violence, abuse and exploitation, girls with disabilities are generally more vulnerable than boys with disabilities. Additionally, girls in institutions and in areas of conﬂict are more at risk of violence and sexual abuse. Within some communities in the Eastern Mediterranean Region, boys are sometimes more valued than girls, which can result in the delay or the omission of effective rehabilitative interventions for girls with disabilities. Studies from the Region have shown that in some communities the number of males with disabilities is greater than the number of females with disabilities. Such data raise questions around the apparent phenomenon of missing females with disabilities. Is it that females with disabilities are more disadvantaged, with a higher social cost and with a higher rate of illness and subsequently premature death relative to males with disabilities? Alternatively, perhaps under-reporting occurs where families ‘forget’ about the presence of their female members with disabilities, or are hesitant to declare them because of the stigma involved. Both examples point to a female disadvantage and therefore raise the issue of the relationship between disability and gender. Anecdotal evidence seems to point out that women with disabilities have less access to education, rehabilitation services and employment opportunities than men with disabilities4. Across the Region, many mothers report that they have difﬁculties in establishing whether their children have impairments. These difﬁculties are rooted in professional and social attitudes and a lack of capacity of appropriately trained staff. The main factors contributing to this situation include: • Medical staff are reluctant to advise parents that a child has some degree of impairment, and parents are left to discover this by themselves. This action delays the parents’ acceptance of the situation, which is vital for the family to effectively support the child for the future. Medical staff promote the belief that impairments are curable, and therefore encourage the families to proceed with lengthy costly treatments that in the end are shown ineffective. This is due to the fact that early detection of disabilities is not included in most curricula of health professionals.

•

Abu-Habib L. Gender and disability: women’s experiences in the Middle East. Oxfam, 1997.

•

Parents do not want to believe that their children have some kind of impairment and do not seek appropriate advice as early as possible. Many children with disabilities are viewed as a burden and believed to bring shame on the family. Consequently severely disabled children are hidden away, deprived of nutrition, comfort and all levels of social interaction. Fathers and other extended family members do not value children with disabilities as much as non-disabled children, and do not always give the necessary support to the mothers to gain a diagnosis and appropriate rehabilitation support.

Communicable diseases, high rates of consanguinity, weak prenatal and child health services, trafﬁc accidents and political violence, are important determinants contributing to current levels of disability in the Eastern Mediterranean Region. Countries like the Islamic Republic of Iran, Iraq and Yemen have malnutrition rates for children under ﬁve years of age that are higher than the average for lower middleincome countries5. Not all the population in the Region has access to improved water sources. For example in Yemen, 31% of the population drinks water from unsafe sources. Infant mortality in countries of the Region is more than one third higher than the average for lower middle income countries. HIV/AIDS is of increasing concern. In 2002, there were 83 000 new cases of infection in countries (Jenkins and Robalino, 2003). Despite the current low levels of HIV/AIDS prevalence as compared to other regions of the world, it is expected that exponential growth in infections will materialize in the future. Death rates from road crashes in 2002, which can be used as a proxy for injuries from road accidents, are high. The mortality rate per 100 000 population caused by road trafﬁc injury in countries of the Region is among the highest in the world, about 26.4, compared to 19 for the world as a whole (WHO, 2003). About 130 000 people died in road accidents in the Middle East and North Africa in 2002. There are no estimates available on the impact of road accidents on disability but the World Report on Road Trafﬁc Injury Prevention (WHO 2004), states that worldwide, the number of people killed in road trafﬁc crashes each year is estimated at almost 1.2 million, while the number injured could be as high as 50 million. Military and civil conﬂict is another source of disability in the Region. Ongoing examples include the conﬂicts in Afghanistan, Iraq and Palestine. Data from the West Bank and Gaza show that the ongoing conﬂict has had a sharp negative impact on employment and income among Palestinian families, and malnutrition rates among 5

Osman G. Asia Paciﬁc journal of clinical nutrition. 2003, 12 (3): 337–43.

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Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

young children are on the rise. Because of such conﬂicts, the provision of basic health, education and water services has become erratic. In the recent past, the Iran-Iraq war had a high impact in terms of disabled combatants. In addition to the most visible aspects of physical injury, there is also the mental and psychological impact from exposure to traumatic events. There is evidence of increased domestic violence in the West Bank and Gaza during the intifada, and there is anecdotal evidence of long-term adverse effects on school performance of children exposed to traumatic events. A recent study in Lebanon, conducted in association with Harvard University and WHO headquarters, showed that 17% of the population was suffering from a certain form of mental distress (Karem and Al, 2006. Lancet). The study highlights the relationship between disorders and prior exposure to conﬂict events, even if this exposure has taken place years before. It showed that 2% of the population were diagnosed with or found to have post-traumatic stress disorder (PTSD), and only 1 in 4 people with PTSD (i.e. 0.5% of the population) had a form of PTSD that was sufﬁciently disabling to be categorized as a severe mental disorder. It is difﬁcult to assess the extent of post-traumatic stress disorder in Iraq. During the past few years, the Eastern Mediterranean Region has witnessed a number of important initiatives, raising the issue of mainstreaming disability. During the 56th session of the UN General Assembly (2001), it was proposed to establish a Special Committee that would be responsible for studying the question of a new international convention on promoting and protecting the rights of persons with disabilities. In August 2002, the Ad Hoc Comittee on the International Convention was designated to consider proposals related to a comprehensive and integral international convention to promote and protect the rights and dignity of persons with disabilities. As a result, the International Conference on the Rights of Persons with Disabilities was held in October 2002, and paved the way for the Arab Decade of Disabled Persons, 2004–2013. The ten main points identiﬁed for the Decade are: education; health; legislation; rehabilitation and employment; the disabled woman; the disabled child; accessibility and transport; globalization, poverty and disability; information and awareness; and recreation and sports. In May 2003, the Economic and Social Commission for Western Asia (ESCWA) organized and led the Arab Regional Conference on Norms and Standards Related to Development and the Rights of Persons with Disabilities. In June 2003, Sheikha Hessa

bint Khalifa bin Ahmed Al-Thani of Qatar, was appointed as the Special Rapporteur on Disability for the Commission for Social Development for the period 2003–2005, to take a leading role in protecting the rights and dignity of persons with disabilities. Her mandate was later extended until December 2008. In addition, and within a theme that has evolved over the past years, ESCWA is ensuring that its cities are more humane by being made accessible and user-friendly by all. A number of countries of the Region have issued disability-related legislation, reﬂecting varying approaches to mainstreaming disability. Some current legislation is “rights-based” (broad), and includes disability as a small component. The components are usually delegated to an executive authority that is neither qualiﬁed nor has budgetary means to achieve the goals set forth. Enforcement mechanisms and resources for disability services are limited.

Review of rules

4.1 Rule 2: Medical care

The group discussions were preceded by a presentation in which Dr Sunil Deepak, WHO Consultant, WHO/HQ, highlighted some of the major issues linked to medical care services for persons with disabilities. These include different approaches 21 Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

to service delivery, difﬁcult access to medical care, lack of multidisciplinary teams, difﬁculties in early detection, the focus on curative aspects, and the plight of persons with severe disabilities. Following the presentation, the participants were divided into three groups which raised the following issues. There are several factors that prevent persons with disabilities from beneﬁting from good quality, affordable, acceptable and accessible medical services. These include inadequate ﬁnancial resources, limitations of existing health facilities and infrastructures (including physical inaccessibility), lack of legislation, low level of awareness among decision-makers, shortage of information, negative attitudes towards persons with disabilities, high cost of medical services, and discrimination. Access to medical services is particularly at a disadvantage at the community level, which lacks trained doctors and health professionals, and for young children with impairments. Possible ideas to improve access of persons with disabilities to medical services include drafting laws and enforcing those that exist, implementing screenings, audiometric and visual tests for newborns, raising community awareness and advocacy about disability, improving the capacities of nongovernmental organizations to provide services in areas that lack them, forming a national rehabilitation authority or monitoring body, providing information about available services, equipping hospitals with facilities for early detection and intervention, increasing accessibility of medical services, training medical and paramedical staff, strengthening the referral system, and expanding the medical insurance coverage to all persons with disabilities. With regard to reasons behind the inadequacy of some components of the medical care system, the participants highlighted the lack of long term strategies for health care, deﬁcient coordination among different medical facilities, and unavailability of statistics on disability. Suggested solutions to improve these components included the establishment of multisectoral consultative committees. The participants acknowledged the importance of implicating disabled people’s organizations in planning and evaluating medical care services, and remarked that this is not widely practised in the Eastern Mediterranean Region. This results from the limited number of disabled people’s organizations, their underestimation by society, lack of awareness (among persons with disabilities and decision-makers), and the fact that social integration has not been encouraged for people with disabilities and their organizations. Increased participation of disabled people’s organizations in the area of medical services can be encouraged by enhancing the education of persons with

disabilities, supporting the establishment of such organizations and building their capacities, in addition to having legislation to support the socioeconomic mainstreaming of persons with disabilities. The participants discussed the reasons why medical care services may not carry out early detection of disabilities. These included lack of resources, awareness and adequate training of health workers. This can be overcome by screening for the causative factors of disability, improving the general health system, and providing health education. The costs of medical care are often too high for persons with disabilities and their families. This can be overcome by the involvement of the private sector (to cover insurance costs in partnership with governments), provision of information about available insurance schemes, promotion of local production of assistive devices and aids, and increasing the number of trained personnel. It was acknowledged that medical care services are lacking in rural areas and disadvantaged urban neighbourhoods. This results from the fact that specialists are not willing to provide services to these areas. This can be overcome by the promotion of community based rehabilitation services, establishing basic rehabilitation units at the grassroots level, and involving focal persons such as lady health workers. Prevention of disabilities can be encouraged through public awareness, establishing rehabilitation centres and screening for some diseases such as thyroid disorders and phenylketonuria. 4.2 Rule 3: Rehabilitation

The session started with a presentation by Dr Deepak on rehabilitation services, and the gaps which the WHO survey revealed in terms of the application of Rule 3. In many cases, rehabilitation is given low priority in terms of ﬁnancial allocations, and sometimes the private sector plays a major role in providing rehabilitation services in areas where they are not provided by the government. Other problems facing rehabilitation services are that they are not multisectoral, are far from each other and are not accessible. As well, many resources are spent on surveys, leaving little resources to implement what is needed. For this reason, surveys should be conducted when there is a will and resources to do something concrete. He gave an overview of the different approaches to rehabilitation such as the institutional, outreach, and community based 23 Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

rehabilitation, and concluded his presentation with the role of persons with disabilities in rehabilitation activities. Following the presentation, the participants were divided into three groups to discuss Rule 3. The group work raised the following issues. Persons with disabilities, their families and organizations must be involved in all stages of rehabilitation services: planning, implementation and evaluation. They should also be included as rehabilitation experts and consulted as to their needs and what can improve their quality of lives. National rehabilitation strategies should be developed, including different rehabilitation approaches such as community-based rehabilitation, outreach and independent living. There should also be formal national councils/authorities to coordinate rehabilitation services. Such councils should not be managed by any ministries. Rehabilitation services are not enough in some countries due to lack of resources, and difﬁcult terrain. A cost effective way of dealing with these problems is to have focal persons in each area/district/county to identify persons with disabilities and refer them to appropriate services in other regions. A prerequisite for this is developing strong referral systems Another reason why rehabilitation services are not currently effective is that rehabilitation personnel have limited knowledge about speciﬁc impairments. There is particular shortage in speech and occupational therapists and vocational trainers. This requires training the rehabilitation team working with persons with disabilities and their families. In this regard, regional and international cooperation is encouraged. Tools to diagnose and assess the type and extent of disabilities should also be developed, and guidelines for dealing with each disability and injury should be formulated. If rehabilitation services exist, they are usually not comprehensive, which requires the promotion of integrative rehabilitation systems initiated from the grassroots level. It is important to promote the community-based rehabilitation strategy at community level, due to its potential in overcoming current deﬁciencies in the provision of rehabilitation services. The success of such programmes will be ensured with the active involvement of persons with disabilities. Community-based rehabilitation programmes must be multisectoral and deal holistically with persons with disabilities.

The extent of available rehabilitation services should be determined through needs assessments, listings of existing services, and starting data banks at central, district and local levels. The resulting information should be disseminated through the internet and mass media. Particular focus should be given to provide such information to the community level. Rehabilitation departments at district hospitals should be expanded to provide a minimum level of rehabilitation services, and funds should be allocated by the State to provide free rehabilitation services. In addition to the role of the State, nongovernmental organizations should also be involved at the grass roots level for the provision of rehabilitation services. Through its ofﬁces, WHO should bring to the attention of policy and decision makers issues such as resources, awareness and advocacy and other problems facing different countries in providing appropriate rehabilitation services. Discussion

Dr Montero stressed the importance of including a rehabilitation component in dealing with acute illnesses such as spinal cord injuries and strokes. Acute health care should be given more attention since it now comes at the end of the continuum of rehabilitation services. There is a need for a high level governmental body to support and coordinate activities in rehabilitation and make sure that professionals and the disability movement are working in harmony. This is particularly needed in the cases of countries which have resources and little coordination. Persons with disabilities must be implicated in this committee. With regard to the type of rehabilitation services, Dr Montero said that there is a need for both community-based rehabilitation as well as institutions. This does not mean having expensive equipment, because rehabilitation can be performed with very simple equipment. What is needed is to change attitudes in institutions (through training personnel), so that rehabilitation professionals work more in partnership with persons with disabilities and their families. This will largely improve the effects of rehabilitation.

25 Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

Dr Yasamy highlighted the importance of involving local communities in providing at least minimum rehabilitation services, particularly in disadvantaged areas (e.g. urban slums, rural areas and conﬂict situations). With regard to referral systems, Dr Montero stressed that the development of rehabilitation services should be promoted on the community, district, and national levels. It is particularly important to ensure that a rehabilitation component is introduced within existing services. There was a lot of debate and discussion about community-based rehabilitation. According to Dr Kabbara’s experience, some community-based rehabilitation projects were not very successful, and were more like outreach programmes. He advocated a paradigm shift into the independent living approach, where persons with disabilities are in charge of their life and living as autonomous as possible. Persons with disabilities proved to be successful in implementing such programmes, because of their will to change, which professionals often lack. The idea that community-based rehabilitation is a strategy/philosophy not a programme was stressed, and the link between it and class/wealth was raised. It was concluded that independent living can be an underlying goal in all rehabilitation programmes, and there should not be a division between it, community-based rehabilitation and outreach projects. Governments should be forced to provide adequate rehabilitation services and put disability high on their agendas. The UNSR is a tool that can be used to raise awareness to promote development of rehabilitation and medical services, and ensure that persons with disabilities have access to them. Care must be taken to have a coordinated, comprehensive and multisectoral approach that will ensure the sustainability of rehabilitation services. Integrated programmes are preferred to vertical ones because they are more cost-effective. There is a need for national disability plans due to the current lack in strategic planning with regard to rehabilitation. 4.3 Rule 4: Support services

After a presentation by Dr Deepak, the participants were divided into three groups who raised the following issues.

• •

•

• •

Existing facilities for the provision of assistive devices should be mapped and disseminated through disability resource centres. Local manufacturing of simple assistive devices at reduced costs (e.g. Jaipur Foot) should be encouraged through incentives such as tax exemption and interest-free loans to local organizations6. Public and private partnership should also be developed. Persons with disabilities and their families must be involved in different stages of providing an assistive device, and their feedback regarding the quality and effectiveness of the device must be taken into account. Prescription of assistive devices should be given by licensed authorized organizations. Technicians should be trained on the provision of assistive devices through master and degree programmes. Distribution of free assistive devices should be given to those in need through mechanisms such as Bait-ul-Mal, zakat, social security, medical insurance, assistive devices fund, and governmental funds for needy persons. Rental services should also be available. All imported assistive devices, their spare parts and raw materials should be tax exempted. Patients with life-long needs like spinal cord injuries must be provided with ripple mattresses, wheel chairs, toilet chairs, and transfer boards, etc.

The Jaipur Foot is an improved version of the conventional Solid Ankle Cushion Heel (SACH) foot. It is a soft multi axial foot. Its greatest advantage over the SACH foot is that it allows all natural movement of the foot, including dorisﬂexion movement and looks like a natural foot. 6

27 Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

•

• •

Research and development regarding assistive devices should be conducted in collaboration with international disability nongovernmental organizations and technical institutes. Persons with disabilities and their families should be trained for the use and maintenance of assistive devices. The unavailability of personal assistance can be solved through communitybased rehabilitation services which involve the stakeholders, and the allocation of government funds.

Recommendations to improve support services included: issuing a disability card by national health organizations, fair allocation of national budgets to all types of disabilities, involving persons with disabilities in the decision making and planning of all strategies concerning them, encouraging volunteerism, improving accessibility and having government subsidies for the production of assistive devices. Discussion

A question was raised about the use of zakat money with persons with disabilities and whether it can be considered as charity. The answer was that zakat is not a charity, but rather a form of taxation for Muslims. It is the right of needy Muslims to receive it, whether they are disabled or non disabled. Therefore, there is no stigma attached to it, and its use to cover different requirements and needs of persons with disabilities. It is essential to assure that governments provide assistive devices as part of public services in addition to their efforts in providing medical care and strengthening rehabilitation. This results from the fact that assistive devices are a prerequisite to any efforts towards equalization of opportunities. Governments should also reduce working hours of care-givers so that they are able to care for persons with disabilities. Consulting persons with disabilities and their families in providing support services must be a reality, because professionals are often not in touch with actual needs. One example from Palestine is that hospital patients tell doctors that they do not need prosthesis and orthosis. What they need is re-adaptation of their house. All types of disabilities must be treated equally, and there should be no discrimination among different groups of persons with disabilities. Some countries have few disabled people’s organizations. It therefore becomes very important to empower and facilitate groups of persons with disabilities to form disabled people’s

organizations and build their capacities to develop income generation activities in addition to lobby for their rights. It was mentioned that funds for personal assistance were managed better through disabled people’s organizations than the governments. Dr Yasamy emphasized the need to focus on personal assistance, particularly that many countries do not have home care systems even in the private sector. After an injury, there is no house care after the patient is released from hospital. One possibility is to have mobile health support units that are discounted or free and provided by professionals, laboratory technicians, who visit homes. This is much less costly that the cost of not giving support, and policy makers should be convinced of adopting this policy. Volunteers should also be encouraged to participate in such home care, especially that the culture of volunteerism is prevalent in countries of the Region. Dr Montero drew attention to the fact that personal assistance is not conﬁned to home settings. It can be needed in educational settings, e.g. hearing students helping deaf students in schools and universities. All health services should be accessible. Ministries of health should have a mandate that private clinics are accessible. 4.4 Rule 19: Personnel training

After an introduction from Dr Deepak, the participants were divided into three groups according to type of organization they belonged to (Ministry of Health, Ministry of Social Affairs and disabled people’s organizations and nongovernmental organizations). The following issues arose during the group work. • • • • • • Policy-makers consider training as waste of time and money, so they allocate a small amount of the budget for it. Personnel are paid low salaries and are provided no incentives by the government, which leads to their demotivation. Training professionals is very costly, and there is a shortage of training institutes. Lack of expertise in the ﬁeld of rehabilitation for the provision of training. Lack of training materials/curricula, and if available, there are not always culturally and linguistically appropriate. Persons with disabilities are usually not involved in the development of curricula and training modules. 29 Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

•

Women with disabilities have no access to training, particularly about activities of daily living. Suggested solutions related to training personnel were:

• • • • • • • • • • •

•

Sensitization, orientation and training of regular schoolteachers to be able to include children with disabilities in their classrooms Increasing staff incentives and salaries. Adopting a systematic approach in training Adapting available training curricula culturally and linguistically. Mainstreaming disability issues in general curricula. Establishing more training institutes for speech and occupational therapy. Establishing a training strategy at all levels. Different professionals (e.g. doctors, nurses, etc.) should be trained on detecting and screening disabilities. Setting up training standards by the international disability community that are accepted by the State. Updating training regularly. Directing training through different professional associations as a pre-requisite for receiving a training license. Establishing a training network between countries (e.g. an integrated multidisciplinary course on disability, where different subjects and disciplines are delivered to medical personnel. Governments should take their roles in training in coordination with universities, nongovernmental organizations, persons with disabilities.

With regard to the types of training required, the participants mentioned degree courses, capacity-building (increasing capabilities to face new challenges, and advocacy and awareness for communities and care givers. Concerning trainees, the participants mentioned that they can be rehabilitation professionals such as doctors, occupational, speech and physiotherapists, etc., other professionals such as engineers and teachers, managers and staff of nongovernmental organizations, persons with disabilities leading disabled people’s organizations, personal attendants of persons with severe disabilities, as well as rehabilitation and non rehabilitation professionals. With regard to trainers, the participants stressed that trainers must be certiﬁed. Trainers could be persons with disabilities and their families, qualiﬁed organizations having expertise such as nongovernmental organizations, universities, disabled people’s organizations and qualiﬁed personnel. Discussion

During the discussion, it was noted that even non-qualiﬁed people (e.g. mothers of children with disabilities) could and should be involved in training. To illustrate this point, an example was mentioned from Pakistan, where there was an acute shortage after the earthquake. In the absence of medical professionals, rehabilitation workers were given basic training in order to ﬁll the existing gap. They proved to be successful, 31 Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

and after a few months, they worked under the supervision of professionals. Other participants felt that non-qualiﬁed people (e.g. mothers) should take part in shaping training, and in providing role models. However, unless they are trained and qualiﬁed, they should have no training responsibilities so as not to provide wrong information. Dr Montero raised the issue of criteria for deﬁning who is qualiﬁed or not. He commended the idea of networking among countries because some countries have developed courses and training materials, which can be modiﬁed according to each place’s special circumstances. He gave an example of the training provided by the University of Alexandria. A need for accreditation bodies and authorities that monitor everything related to training was mentioned. Both the UN Special Rapporteur and Dr Montero emphasized the need towards family empowerment and involving persons with disabilities in all stages of the rehabilitation process. It was mentioned that there are strong barriers by professionals to recognize this, because of their training which makes them rather inﬂexible. Dr Yasamy mentioned that involvement of families in rehabilitation should be given careful attention. This results from the fact that sometimes professionals may depend too much on families, leading about 80% of caretakers to develop severe depression. He suggested providing families with support and assistance, particularly within projects which depend on families. Dr Montero drew attention to the fact that information about sexual and reproductive health is more difﬁcult to give to children and adolescents with disability, and many professionals do not want to take responsibility for it. Dr Hussein Abouzaid talked about the need for having maximum actions at the primary health care level and not in specialized centres. With regard to the UNSR, the UN Special Rapporteur mentioned that the four rules discussed in the meeting are vital to give opportunities to persons with disabilities to achieve full participation, and that they should be complemented by other rules. She emphasized that UNSR should be used together with other instruments such as national plans. This results from the fact that the UNSR are not legally binding and on their own, they cannot achieve far-reaching results. This is unlike the UN Convention, which is going to be legally binding. Therefore, governments, disabled people’s organizations, civil society, and UN agencies should work together to achieve best results of the UNSR.

The UN Special Rapporteur noted that while some countries are familiar with and implement the UNSR, others do not know about them. She mentioned successful examples from Latin America, where good work is being done with limited resources. In some countries, there is strong collaboration among different organizations in applying the UNSR. The UN Special Rapporteur presented some of the activities she is organizing to activate the application of the Rules, such as meetings for Arab women with disabilities. A main obstacle facing her is funding, because few countries participate ﬁnancially in such activities. Dr Montero noted the existence of other UN Special Rapporteurs and the importance of collaborating with them. With regard to funding, he stressed the need for someone to give full attention to the funding issue in the Eastern Mediterranean Region. Dr Alaa Sebeh suggested that an e-mail group be established to share documents, experiences and good practices.

33 Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

Country reports on the status of implementation of the UNSR

5.1 Egypt

Ms Nani Saleh, chairperson of a disabled people’s organization for parents of children with intellectual impairments, presented a report on the situation of disability in Egypt. She pointed to the increasing shift to a rights-based approach in dealing with disability, and cited some statistics about the prevalence of disability and available services. She indicated that the employment quota for persons with disabilities is largely not applied. With regard to Rule 2 (medical care), medical care services are available in Egypt and are provided by governmental and nongovernmental bodies. However, they cover only a small percentage of actual needs. With regard to Rule 3 (rehabilitation): • Rehabilitation services are available in Egypt and are provided by governmental and non governmental bodies. However, they cover only a small percentage of actual needs. There have been governmental efforts supported by the First Lady to upgrade institutions for children with intellectual impairments. With regard to Rule 19 (personnel training): • • Teachers in some institutions for children with intellectual impairments were trained as part of a project to upgrade public special education institutions. One disabled people’s organization (Right to Live) established a centre to train professionals.

•

Successes in the implementation of the UNSR include collaboration between various ministries and nongovernmental organizations, and raising awareness about disability issues.

Major constraints to implementation of the UNSR

• • • •

Available services do not cover needs, particularly in rural areas and urban areas outside big cities. High level of poverty among persons with disabilities. Inaccessibility of public services. Funding problems facing nongovernmental organizations and disabled people’s organizations.

5.2 Islamic Republic of Iran

Mr Mohammad Mahmuzadeh, Deputy for Rehabilitation of the Isfahan Welfare Organization, presented his country’s report. He described the prevalence and incidence of disability. He also explained the status of the different rules related to health care. The Islamic Republic of Iran follows a systematic and successful system for training its rehabilitation professionals. There is a University of Social Welfare and Rehabilitation Science, which offers academic courses in different rehabilitation specialties as well as practical experience. About half the graduates (the most successful) join the staff of the State Welfare Organization. During their work at the Welfare organization, staff are periodically assessed. If they successfully pass the assessments, they are promoted and the State funds their graduate studies. If they fail these assessments, they are demoted and not given the opportunity to pursue further studies. With regard to Rule 2 (medical care), medical services are provided nation-wide by the Welfare Organization, which is a department of the Ministry of Health and Medical Education. With regard to Rule 3 (rehabilitation): • • The Welfare Organization provides medical rehabilitation services in centres for physiotherapy, occupational therapy, eudiometry, speech therapy, etc. There are social rehabilitation services available to persons with visual and intellectual impairments and the elderly (e.g. educational courses, training programmes, caring centres, sanitariums). There are more than 100 vocational rehabilitation centres available to persons with intellectual impairments. 35 Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

•

Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

•

There is a national community-based rehabilitation programme (currently covering 30 provinces). The programme is under the aegis of the Welfare Organization and runs within the primary health care referral framework.

With regard to Rule 4 (support services), the Welfare Organization has centres for orthopaedics, and distributes yearly a considerable number of free hearing aids, wheel chairs, different walking sticks, Braille typewriters, cassette recorders and other support services. With regard to Rule 19 (personnel training), different professionals such as physicians, primary health care managers and therapists were trained on communitybased rehabilitation. Successes in the implementation of the UNSR include collaboration between various ministries and organizations, and the presence of a disability law. A major constraint to the implementation of the UNSR is insufﬁcient work opportunities for persons with intellectual impairment who receive vocational rehabilitation. 5.3 Iraq

Dr Sabah al-Rubayi, Director General of Specialized Services and Medical Operations Department in the Ministry of Health, discussed the main issues related to disability in Iraq. He emphasized the link between disability and mortality, which results from the deﬁciency in trained personnel and medical facilities. Although there is a lack of reliable statistics, there are indicators towards an increase in the prevalence of disability due to the violent conditions in which Iraqis have been living for decades. He then presented the different services available to persons with disabilities in Iraq. With regard to Rule 2 (medical care), there are three hospitals for spinal cord injuries and one for the disabled. With regard to Rule 3 (rehabilitation): • • There is a hospital for medical rehabilitation. There are 12 rehabilitation centres providing different therapeutic and rehabilitation services.

•

The Ministry of Labour and Social Affairs operates special institutions for persons with physical, hearing, visual and intellectual impairments. It also provides vocational training. With regard to Rule 4 (support services):

• •

There are 12 prosthesis and orthosis factories, which can produce up to 5000 limbs annually. Medical supplies and aids are available.

With regard to Rule 19 (personnel training), there are qualiﬁed staff, including rehabilitation physicians, physiotherapists, prosthetis/orthotists, occupational therapists, specialists in the rehabilitation of persons with visual impairments, social workers, and speech therapists. A major success in the implementation of the UNSR was the preparation of a draft national strategy for persons with physical disabilities. Major constraints to the implementation of the UNSR

• • • • • • • •

Shortage in qualiﬁed personnel. The unstable context, which increases the risk of having disabilities and decreases the government capacity to properly deal with disabilities. Poverty and lack of social services. Shortage in the production of artiﬁcial limbs (20 000 required annually, and maximum 5000 are produced). Lack of coordination between relevant bodies. Lack of national policy on disabilities. Many nongovernmental organizations lack resources and capacity. Administrative changes, e.g. in abolishing the Inter-ministerial Commission on Disabilities, and transferring the facilities it operated to the Ministry of Health.

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Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

5.4 Jordan Dr Salem Al Majali, Consultant of Physical Medicine and Rehabilitation at the Ministry of Health, presented the current situation of disability in Jordan. He indicated the challenges in estimating prevalence and in providing enough services for the growing population with disabilities. With regard to Rule 2 (medical care): • • • • • • • There are programmes for prevention, early detection and diagnosis, and treatment of impairments. There is referral to different services. There is regular medical treatment provided for persons with disabilities. Detection methods are available in mother and child health care units. Medical care is provided free of charge by government ministries. Primary health care services cover villages and urban areas. Availability of medial and paramedical personnel at the local, district, provincial and national levels. With regard to Rule 3 (rehabilitation): • • • • • • Implementation of community-based rehabilitation and institutional rehabilitation programmes at district, provincial and national levels. There are programmes for rehabilitation techniques and for counselling parents. Rehabilitation services cover between 6%–20% of persons with different types of disabilities. Rehabilitation services are provided by the government, private and voluntary sectors. There is a national institute for community-based rehabilitation. Rehabilitation services include vocational rehabilitation, and residential care. With regard to Rule 4 (support services): • Assistive devices and equipment are partially ﬁnanced by the government, social insurance schemes, nongovernmental organizations and by persons with disabilities themselves. The government provides different types of assistive devices and equipment.

•

• • •

Provision of assistive devices includes their production, distribution, maintenance and information about availability. Support for families with children with disabilities is partially ﬁnanced by the government and nongovernmental organizations. Availability of sign language interpretation services. With regard to Rule 19 (personnel training):

• • •

Training is a high priority in Jordan. Some agencies are training their personnel. Disability issues are included in the training curriculum of different professional groups.

Successes in the implementation of the UNSR

• • • • • •

Collaboration in the area of community-based rehabilitation between local and international nongovernmental organizations and governmental bodies. Some services are available to children with disabilities as part of the public system. Medical care providers are often family members and sometimes professionals paid by the State or by nongovernmental organizations. Medical care is provided free of charge by government ministries. Villages and urban areas are covered by primary health care and communitybased rehabilitation. Disabled people’s organizations participate in different stages and aspects of rehabilitation and support service provision.

Major constraints to the implementation of the UNSR

• • • • • •

Rapid growth in population with disabilities. High cost of providing rehabilitation services. Rehabilitation services usually do not involve persons with disabilities and their communities. Only working adults and between 21%–40% of the population are covered by social insurance schemes. Absence of a national rehabilitation programme. Some groups do not receive rehabilitation services.

39 Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

• • • •

Personal assistance is not provided. Persons with disabilities are not involved in staff training programmes. Rural and remote areas are at a disadvantage with regard to disability services. Community-based rehabilitation and outreach programmes do not cover need.

5.5 Palestine

Ms Hana Quaymary, Director General of People with Special Needs, highlighted the efforts of the Ministry of Social Affairs in the West Bank. She discussed disability prevalence, available rehabilitation services, the challenges facing the implementation of the UNSR, and the need for better outcomes. In order to better implement the UNSR, Ms Quaymary suggested a systematic approach in training, implementing the disability law, having an accurate disability database, having a holistic approach towards rehabilitation, and promoting partnership between the government and civil society. In order to graduate from Palestinian universities, students must complete 300 hours of volunteer work. This was suggested as a mechanism in order to provide assistance to persons with disabilities. Dr Khamis Elessi, Head of the Medical Rehabilitation Team at Al-Wafa Hospital, gave an overview of the hospital services as well as the most common impairments in Gaza. With regard to Rule 2 (medical care): • • • Ministry of Health provides diagnosis and medical care. There is medical insure for all persons with disabilities provided by the Ministry of Social Affairs. The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) provides medical care services. With regard to Rule 3 (rehabilitation): • • • • • There are rehabilitation services by the Ministry of Health. There is a referral system from the Ministry of Health to local nongovernmental organizations. There are vocational rehabilitation centres. 174 nongovernmental organizations are working in the ﬁeld of rehabilitation. There are specialized rehabilitation services.

• • •

There are community-based rehabilitation and outreach programmes (some run by nongovernmental organizations and some by UNRWA). The Ministry of Social Affairs covers rehabilitation fees in nongovernmental organizations. UNRWA covers rehabilitation fees for refugees in nongovernmental organizations. With regard to Rule 4 (support services):

• •

The Ministry of Social Affairs covers fees of assistive devices and equipment. UNRWA provides assistive devices and equipment.

An important success in the implementation of the UNSR is that programmes applying the community-based rehabilitation strategy are successful. Major constraints to the implementation of the UNSR

• • • • • • • •

Increase in the number of persons with disabilities. Challenges and delays facing the implementation of the 1999 disability law. Lack of financial resources. Absence of a national policy for rehabilitation. Deﬁciency in trained professionals. Shortage in training programmes related to rehabilitation. Lack of coordination between relevant stakeholders. Absence of programmes working on empowerment of persons with disabilities and enabling their social integration.

5.6 Pakistan

Dr Syed Fazle Hadi, Executive Director of the Pakistan Institute of Medical Sciences at the Ministry of Health, presented the main activities of the Pakistan Institute, particularly with regard to the 2005 earthquake. He gave a background on the situation of disability, including the health system, main rehabilitation services, and disability legislation. The average stay in a veterans’ hospital for persons with paraplegia was 13 years, and some patients stayed for 29 years. The system, which gave the patients many beneﬁts, made them develop a dependence on it. A change in hospital management took place, with a view towards allowing patients to live independently. The patients were given vocational training and provided with knitting and sewing machines. They 41 Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

were then sent home with all the assistive devices they required (e.g. orthopaedic beds), and a monthly stipend for personal assistance. Initially, the patients resisted this change. However, when they experienced living independently in their communities, they became satisﬁed. In the second presentation from Pakistan, Dr Maryam Mallick described WHO emergency efforts in response to the earthquake disaster. In the aftermath of the earthquake in Pakistan, wheelchairs were distributed to the affected areas. When WHO staff returned later, they found that the wheelchairs were sold and replaced by donkeys because they were more appropriate for use in the rugged mountainous terrain of the region. Similarly, urine bags were not used by persons with disabilities who thought that they would return the urine back to the body. They were replaced by Pepsi bottles. These two examples draw attention to how important it is for professionals to consult and to believe in the need to learn from persons with disabilities with regard to support services. The ﬁrst example highlights the importance of learning from persons with disabilities, while the second shows the need of persons with disabilities to be well informed and educated by professionals. With regard to Rule 2 (medical care), the Directorate of Special Education provides medical and paramedical support to persons with disabilities. With regard to Rule 3 (rehabilitation): • • • • There is a National Council for the Rehabilitation of Disabled Persons. The Directorate of Special Education provides vocational training. There are ﬁve national training centres for persons with disabilities. The National Trust for the Disabled establishes model institutions for the rehabilitation of persons with disabilities. It also prescribes and undertakes specialized programmes of training and instructions for persons with disabilities. The National Institution for the Handicapped provides diagnostic, therapeutic and rehabilitative services. There is free medical cover for persons with disabilities. There are ﬁve rehabilitation centres. The community-based rehabilitation strategy is adopted.

• • • •

With regard to Rule 4 (support services), the Directorate of Special Education provides specialized aids and equipment. There are also artiﬁcial limb centres.

With regard to Rule 19 (personnel training): • • The Directorate of Special Education trains special educators. The National Institute of Special Education develops specialized training courses for teachers of governmental and nongovernmental institutions as well as special courses for parents and community leaders.

5.7 Sudan

The Sudan report presented a real picture of the successes and challenges facing the application of the UNSR. The involvement of persons with disabilities in rehabilitation, and the availability of assistive devices in some areas were the main successes. Challenges included the lack of implementation mechanisms and of trained personnel, and the discontinuation of the family-based rehabilitation programme. With regard to Rule 2 (medical care): • • Persons with disabilities are provided with the same level of medical care within the same system as non-disabled members of society. Persons with disabilities are provided within the health system with regular treatment and medicines which they may need to preserve and improve their level of functioning. With regard to Rule 3 (rehabilitation): • • • The government and nongovernmental organizations provide rehabilitation services. Persons with disabilities in six states out of 25 have access to rehabilitation services. Persons with disability participate in the design and organization of rehabilitation services through their organizations, and are involved in rehabilitation services as trained teachers, instructors and counsellors. With regard to Rule 4 (support services): • The Ministry of Social Welfare supports development, production, and distribution of assistive devices and disseminates knowledge about them, with the support of zakat chamber and nongovernmental organizations. 43 Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

• •

Sign language courses are provided. Available technology and local materials are used to produce simple inexpensive assistive devices (artiﬁcial limbs centres), with the involvement of persons with disabilities. Assistive devices are ﬁnancially accessible to all persons with disabilities in six states. Special requirements of girls and boys are considered concerning the design, durability and age-appropriateness of assistive devices and equipment. With regard to Rule 19 (personnel training):

•

• • •

• •

Not all medical and paramedical personnel are trained and equipped to give medical care to persons with disabilities. There is still no mechanism to achieve this. There is a strong need to train medical care providers to not give inappropriate advice to parents, thus restricting options for their children. Most authorities providing services in the disability ﬁeld give adequate training to their personnel. The principle of full participation and equality are reﬂected in the training of professionals in the disability ﬁeld, as well as in the provision of information on disability in general training programmes. There is a need to develop standardized training programmes in consultation with disabled people’s organizations7. Persons with disabilities are involved in the current training programmes as teachers, instructors or advisors.

Successes in the implementation of the UNSR

• • •

A disability act was approved and endorsed in 2005. There is a national policy and strategy for disability. Persons with disabilities are organized in different unions (for the deaf, blind, physically handicapped).

Major constraints to the implementation of the UNSR

• •

Weak political commitment towards disability problems The social welfare rehabilitation council for persons with disabilities is ineffective due to lack of budget, ofﬁces, and trained personnel.

• • • • • • •

• • • • • • • •

Lack of coordination between relevant governmental bodies. Lack of trained personnel in the ﬁeld of the disability (ofﬁcial and community levels). Lack of equipment and supplies. Lack of rehabilitation programmes for persons with severe disabilities. Lack of personal assistance programmes in all states. Lack of early detection and intervention units. There are no implementation mechanisms for persons with disabilities to receive medical care within the health insurance system (according to the Disability Act). There are no multidisciplinary teams of professionals specialized in early detection and assessment. There is no national rehabilitation programme (family-based rehabilitation programme was stopped). Persons with severe disabilities have no access to rehabilitation services, due to the lack of trained personnel and other needs. Most rehabilitation services are available to persons living in six states out of 25. There are no personal assistance programmes, and there is strong need to design and develop such programmes. Local community workers are not trained in early detection of impairment. There are no mechanisms for the government to implement its responsibilities in ensuring adequate services for persons with disabilities. There are no training programmes targeting community workers, and there is strong need to design and develop such programmes.

5.8 Discussion The Eastern Mediterranean Region lacks reliable data about disability. Factors that affect the quality, reliability and completeness of disability data are: how statistics are generated; who generates them; when they are generated; and what deﬁnitions are used to generate them. Although standardized deﬁnitions such as the International Classiﬁcation of Functioning, Disability and Health exist, the spectrum and deﬁnitions of disability are still being decided upon by Member States during the drafting of the UN Disability Convention. Dr Montero mentioned WHO’s efforts to ensure that the upcoming World Report on Disability and Rehabilitation can support Member States to produce more robust and evidence-based data. The process of writing the report aims to provide a framework to help Member States collect data in a uniform manner. 45 Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

He further stressed the importance of paying attention on what can be done to improve and strengthen the services needed by persons with disabilities, even in the absence of accurate data on disability. Dr Kabbara commented that there is no clear direction towards the social and rights-based approach in countries of the Region, and that the medical approach is still much more prevalent. He emphasized the idea that both approaches are linked, and that the more we move towards the social approach, the less medical cost. The role of persons with disabilities and their organizations was not very apparent in the country presentations, especially with regard to their partnership with other stakeholders. It is therefore important to be critical of ourselves and look at the gaps in order to be able to improve the situation of persons with disabilities. H.R.H. Sheikha Hessa mentioned that her ofﬁce has ﬁnished gathering data from the latest global survey on the implementation of the UNSR and that the data are now being analysed. The initial analysis suggests that there is an overlap between different national bodies providing services for persons with disabilities, and that there is lack of awareness among the different sectors/stakeholders. The link between disability and mortality was established, particularly in the case of areas of conﬂict and natural disasters. This is due to the deﬁciency in specialized medical personnel and facilities.

6. Recommendations National level

Ensure that all persons with disabilities are given due attention, especially women. There should be no discrimination against persons with disabilities as compared with other members of society, and among themselves. Set up national and regional rehabilitation councils/authorities to coordinate different rehabilitation activities. These authorities also have a role in designing relevant training curricula for different personnel dealing with persons with disabilities, and in developing national policies. Promote low-cost, locally made assistive devices that should be provided free of charge. This can be done through establishing local manufacturing units, and establishing national funds to provide persons with disabilities with the assistive devices required. Establish health management information systems concerning disabilities. Follow a systematic approach in training personnel. This includes mainstreaming rehabilitation studies in teaching and tertiary care institutions. Universities should also be encouraged to start courses on disability and rehabilitation. Persons with disabilities should be involved in the different stages of training (planning, implementation and monitoring). A standardized training curriculum should be provided for all countries and all categories of health workers. Integrate rehabilitation services in primary health care systems. This should be accompanied by establishing appropriate referral systems with services in the secondary and tertiary levels. Integrate the community-based rehabilitation strategy in national policies. Develop plans of action to implement the UN Standard Rules. Nongovernmental organizations and disabled person organizations must be involved in applying these plans. Share information, resources and best practices. 47

4. 5.

7. 8.

Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

Regional level

10.

Set up regional and national rehabilitation councils/authorities to coordinate different rehabilitation activities. These authorities also have a role in designing relevant training curricula for different personnel dealing with persons with disabilities, and in developing national policies. Establish health management information systems concerning disabilities. Share information, resources and best practices. Resource materials should be exchanged among countries, preferably in local languages. This could be done through an organization which can organize training, video conferences and exchange of experience. Establish a standardized training curriculum for all countries and all categories of health workers. Support and strengthen the community-based rehabilitation philosophy at the regional level. A partnership between WHO and regional bodies-such as the League of Arab Nations and ESCAP and nongovernmental organizations and disabled persons’ organizations should be developed in different areas related to disability. WHO should include persons with disabilities as experts in all ﬁelds, and encourage similar expert meetings to come up with recommendations for concrete strategies.

11. 12.

13. 14.

Annex 1 Agenda

1. 2. 3. 4. 5. 6. 7. 8. 9.

Opening of the meeting UN Standard Rules on the Equalization of Opportunities for Persons with Disabilities Introductory presentations Country presentations Theme 1: Medical care services for persons with disabilities: an introductory presentation to explain the theme, followed by discussions in 3 groups and plenary discussion. Theme 2: Rehabilitation services: an introductory presentation to explain the theme, followed by discussions in 3 groups and plenary discussion. Theme 3: Support services – an introductory presentation to explain the theme, followed by discussion in 3 groups and plenary discussion. Theme 4: Training of personnel: an introductory presentation followed by discussions in 3 groups and plenary discussion. Closing session: Final discussions, recommendations and closure of the intercountry meeting.

49 Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

Annex 2 Programme

Tuesday, 2 May 2006

8:00–8:30 8:30–9:00 9:00–9:30 9:30–10:00 10:00–11:00

Registration Opening of the meeting – Dr Hussein A. Gezairy, Regional Director, WHO/EMRO UN Standard Rules on the Equalization of Opportunities for Persons with disabilities – Her Royal Highness Sheikha Hessa, UN Special Rapporteur on Disability Disability and Health – Dr F. Montero, Coordinator, WHO/HQ Persons with disabilities in EMR – Dr M.Taghi Yasamy RA/ MNH,EMRO WHO/DAR survey on application of UN Standard Rules and its implications / Dr Sunil Deepak, WHO/DAR consultant

11:00–11:20

11:20–14:00 Country presentations (1) 14:00–15:30 Country presentations (2) 15:30–16:45 Theme 1: Medical care services for persons with disabilities: an introductory presentation to explain the theme, followed by discussions in 3 groups 16:45–17:30 Plenary discussion Wednesday, 3 May 2006

9:00–10:30 Theme 2: Rehabilitation services: an introductory presentation to 10:30–11:00 explain the theme, followed by discussions in 3 groups

11:00–14:00 Plenary discussion on rehabilitation services 14:00–15:30 Theme 3: Support Services: an introductory presentation to explain 15:30–15:45 the theme, followed by discussion in 3 groups 15:45–17:00 Plenary discussion on support services Thursday, 4 May 2006

9:30–10:30 Theme 4: Training of personnel: an introductory presentation followed by discussions in 3 groups 11:00–11:45 Plenary discussion on training of personnel 11:45–13:00 Closing session: Final discussions, recommendations and closure of the intercountry meeting

51 Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

Annex 3 List of participants Egypt

Dr Sayeda Abu Alsood Deputy of the General Department for Social Rehabilitation Ministry of Social Welfare Cairo Dr Ibrahim Soliman Mohamed Soliman El-Nekhely Director General of Children with Special Needs Directorate Ministry of Health and Population Cairo Email: dr_elnekhely@yahoo.com Mrs Naeema Ismail Saleh Chairman, The Right to Live Association for Intellectually Disabled Cairo Email: ayha34@yahoo.com

Islamic Republic of Iran

Dr Mohsen Shati Executive Administrator of Community Based Rehabilitation Ministry of Health and Medical Education Teheran Email: mohsen_shati@yahoo.com Mrs Maryam Nikpoor Teheran Email: zottrehnik485@yahoo.com Mr Mahmoud Mohammadzadeh Deputy for Rehabilitation of Isfahan Welfare Organization The State Welfare Organization Teheran Email: mah_mohmmadzade@yahoo.com

Iraq

Dr Sabah Qadori Director General, Specialized Services and Medical Operations Department Ministry of Health Baghdad Email: sabahrubayi@yahoo.com Dr Abdul Razzak Meki Abdul Razzak Coordinator National Assembly for United Organization Civilian Society Baghdad Email: dr_abdulrazakalkayse@yahoo.com Dr Arkan A. M. Saeed Al-Zahawi Representative of the Iraqi Labour and Social Affairs Baghdad Email: drankanzahawi@yahoo.com

Jordan

Dr Salem Nimer Al Majali Consultant of Physical Medicine and Rehabilitation Al Bashir Hospital Ministry of Health Amman Email: dr_salem55@yahoo.com Dr Sylvia Salem Director Ministry of Social Development Amman Email: meschool@go.com.jo Ms Hanan Shahada Director Ministry of Social Development Amman Email: meschool@go.com.jo 53 Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

Lebanon

Dr Nawaf Kabbara President, National Association for the Rights of Disabled People Beirut Email: nawafk@cyberia.net.1b

Palestine

Dr Khamis A. Elessi Head of Medical Rehabilitation Team Al-Wafa Medical Rehabilitation Hospital Gaza Email: Khamis_essi@yahoo.com Mrs Hana Quimary Director General of People with Special Needs Ministry of Social Affairs West Bank Email: hqamary@yahoo.com Mr Ayman Al Halaby Rehabilitation Directorate International Cooperation Department Ministry of Health Gaza

Pakistan

Dr Syed Fazle Hadi Executive Director, Pakistan Institute of Medical Sciences (PIMS)/ Chairman, Rehabilitation Committee Federal Ministry of Health Islamabad Email: syedfhadi@yahoo.com Mr Muhammad Atif Sheikh President, Special Talent Exchange Programme (STEP) Islamabad Email: atif963@hotmail.com

Sudan

Dr Rida Ali Saeed Ofﬁcer of Disability Unit Ministry of Social Welfare Khartoum Email: mohdeltom@yahoo.com Dr Mohamed Tom El Zain Director of Noncommunicable Disease Directorate Federal Ministry of Health Khartoum Email: mohdeltom@yahoo.com

United Nations Special Rapporteur on Disability

Her Royal Highness Sheikha Hessa bint Khalifa bin Ahmed Al-Thani Doha Email: info@srdisability.org Mr Mamoun Alkhoub Doha Email: mamoun@srdisability.org Mrs Wadha Al-Rumaihi Doha Mrs Haya Al-Ganim Doha

55 Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

Implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities

Observers

Ms Jahda Abou Khalil General Director of the Arab Organization of Disabled People Beirut Mr Mohamed Salah Ahmed Head, You Are Not Alone Cairo Ms Dalia Behairy Focal Point, You Are Not Alone Cairo WHO Secretariat

Dr Hussein A. Gezairy, Regional Director, WHO/EMRO Dr Mohamed Abdi Jama, Deputy Regional Director, WHO/EMRO Dr Houssain Abouzaid, Acting Director, Health Protection and Promotion, WHO/ EMRO Dr M. Taghi Yasamy Regional Adviser, Mental Health and Substance Abuse, WHO/ EMRO Dr Federico Montero Coordinator, Disability and Rehabilitation Team, WHO/HQ Dr Sunil Deepak, WHO Consultant, WHO/HQ Dr Jaffar Hussain, Regional Adviser, Healthy Lifestyles Promotion, WHO/EMRO Dr Mohamed A. Assai, Regional Adviser, Community Based Initiatives, WHO/ EMRO Dr Maryam Mallick, Technical Ofﬁcer, WHO Pakistan Dr Alaa Sebeh, Temporary Adviser, WHO/EMRO Ms Gehan Sherkawi, Temporary Adviser, WHO/EMRO Dr Gihan El-Nahas, Medical Ofﬁcer, WHO/EMRO Mrs Marianne Orfali, Senior Administrative Programme Clerk, WHO/EMRO Mrs Hoda Shenouda, Secretary, WHO/EMRO

Основные сведения

Организация Всемирная организация здравоохранения (ВОЗ / WHO)

Тип документа Meeting reports

Дата December 30, 2006

Источник who_document