Syrian Refugees with Disabilities and the Scramble to Accommodate Them

BY KYLEE TSURU

Frederik Buyckx / Handicap International

Malak, just 6-years-old, is now an amputee. She lost her left leg in an air strike that burned her sister and blinded her brother.

Shua’a, 9, lost her left foot in a bombing raid that killed her 12-year-old sibling.

Abdel, a teenager, has muscular dystrophy.

Ahmad, 8-years-old, was born with spina bifida.

Upon entering Jordan, these children lived in either Zaatari or Azraq, Jordan’s two largest refugee camps, and are among thousands of refugees with disabilities in the country just south of their native Syria. At least 30 percent of Syrian refugees in Lebanon and Jordan have a specific need (defined as living with impairment, injury or chronic disease), according to a report by Handicap International and HelpAge International.

The report states that one in five refugees is affected by physical, sensory or intellectual impairment, one in seven is affected by chronic disease and one in 20 suffers from injury, with nearly 80 percent of these injuries resulting directly from the conflict. In three out of four cases, these injuries will lead to a permanent disability because of their severity and the lack of medical treatment.

“When people are on the move, or really fleeing, they enter a new environment that is busy and different. It is especially hard for that individual and family to cope if a disability is involved,” said Mica Bevington of Handicap International, an organization that provides aid to people with disabilities and other vulnerable populations living in conflict and disaster zones.

Zaatari, Jordan’s fourth largest “city,” is a five-hour drive through the Jordanian desert from Rukban, a main entry point into Jordan from Syria. By air, Zaatari looks like rows of small, white Monopoly houses. Upon closer inspection, the shelters are trailers marked by blue letters—UNHCR. The acronym tags the occupants inside the trailers as displaced people registered with the UN refugee agency living in Jordan’s oldest camp for Syrian refugees.

Since the Jordanian government created the camp five years ago, over 450,000 Syrian refugees have passed through Zaatari, giving it the title of largest refugee camp in the world at that point. As of May 1, 79,822 refugees were registered as living in the camp. Most of the population comes from southern Syria, 80 percent call the city of Deraa home, and arrived in the tent city between 2012 and 2014. Though the reason for the creation of the city is far from typical, the camp runs like a metropolis, complete with schools, mosques, hospitals, shops and a central market dubbed the “Champs-Elysees.”

Occupants attempt to make the camp a home, finding jobs and creating communities laid out in a graph paper grid of dirt-hued, wind-whipped white trailers. But often overlooked and unseen are the most vulnerable of an already susceptible population— refugees with disabilities. The World Health Organization estimates that 15 percent of the world’s population has a disability, with several million now living as displaced people.

“It is extremely hard to find accessible facilities and services for persons with disabilities in this kind of setting,” said Elisa Fourt, Handicap International’s regional communication advisor on the Syrian and Iraqi crisis. “In the frame of an emergency response, accessibility is generally not the first thing humanitarian actors think about. They think about setting up tents, latrines, etcetera. But they do not always wonder if and how a person in a wheelchair or with crutches could ever access it.”

Fourt, 27, lives in Amman, the capital of Jordan and works in that country and Lebanon with refugees and internally displaced people who have disabilities. She says accessibility is the biggest challenge for a disabled refugee in a camp.

“It is an issue that we face in all emergency situations, because usually when you have a large influx of people, obviously, you have to move really fast and set up camps and services,” she said. “You think of a group as a whole, not of those with disabilities. It is a constant challenge.”

In 2014, another camp opened in Jordan to accommodate the steady influx of Syrians fleeing civil war and terrorism in their country. Azraq is approximately a two-hour drive from Zaatari and home to over 35,000 Syrians, though over 50,000 have been registered there by the UN High Commissioner for Refugees since it opened. Azraq is three times the size of Zaatari—nearly six miles of white trailers and dirt streets make up the encampment – and its population varies greatly from the country’s first refugee camp. People who took fled later to Jordan come from further regions of Syria. Over 25 percent of the population is from Aleppo, and over 10 percent are from Homs. Half of Azraq’s population arrived at the camp last year, meaning they lived through five years of war in Syria before entering Jordan.

“We generally face more situations of psychological trauma and encounter more recent war injuries,” Fourt said of disabilities seen in Azraq. War injuries, like loss of limbs, hearing and sight impairment, and varying degrees of paralysis, not to mention psychological trauma, plague the Syrian refugees with disabilities who live in Zaatari and Azraq. Other disabilities – chronic illness such as diabetes or HIV and developmental disabilities like cerebral palsy or spina bifida—are also considerably more difficult to treat and manage in a humanitarian crisis.

The United Nations Convention on the Rights of Persons with Disabilities specifically calls attention to disabled people affected by humanitarian emergencies and requests more “inclusive and responsive humanitarian interventions.” Without organizations dedicated to bringing aid to refugees with disabilities, specialized health and rehabilitation services lack altogether. According to a report released on April 30 by UNHCR on registered Syrians in Jordan, 7.3 percent of the population were children at risk, 6.9 percent have a serious medical condition, 2.9 percent are women at risk and 2.9 percent have a disability. The aid organization and other humanitarian aid organizations have different criteria for who qualifies as a refugee with a disability. Amputees will be registered as having a disability, but an individual with cerebral palsy or spina bifida may not qualify.

Emma Pearce, the senior program office for disabilities at Women’s Refugee Commission, says it is important to identify and address vulnerabilities disabled refugees face, particularly in the early stages of the crises. “They need food, they need shelter, they need health care, these are basic needs that need to be addressed when they have just been displaced.”

In Jordan, the most commonly identified impairments were physical or sensory. With Azraq’s vast size, refugees with disabilities are forced to cover large distances to benefit from a specific service. According to Fourt, UNHCR tries to place refugees with disabilities in caravans closer to handicap accessible latrines, but even then, it is not guaranteed.

“Other than that, they receive exactly the same humanitarian aid as anyone else,” Fourt said. “They are treated exactly the same.”

Something as basic as registering as a refugee, getting meal vouchers or accessing water is difficult. But for the four percent of refugees in Jordan with intellectual impairments, the new environment proves to be especially challenging.

“If a child used to go to physical or occupational therapy sessions before the conflict twice a week, then the conflict started and the hospital closed or was destroyed, they could not benefit from that care,” Fourt said. “Most of the time they can’t walk, so the family carried them all the way to Jordan. When they arrive here if they haven’t been provided with right rehabilitation care for years, it is like starting from scratch. We have met a lot of individuals who were able to walk and can’t anymore because they weren’t benefitting from care for two, three, four years. For people in the camps especially, the setting is not adapted whatsoever for someone with a disability.”

With assistance from the European Civil Protection and Humanitarian Aid Operations and Handicap International, Ahmad, who was born with spina bifida, attended weekly physiotherapy sessions in his family’s temporary home in Azraq camp. Abdel, who has muscular dystrophy, attended physiotherapy sessions before the war began, but when the conflict broke out, the family had to discontinue therapy. At Azraq, he received physiotherapy. The aid organizations also provided a wheelchair for the young boys, making it easier for them to get to the camp school, which was located far from where the family originally established a home.

Handicap International fits children who lost limbs due to the conflict, like Malak and Shua’a, with prostheses.

“A disability increases one’s vulnerability,” Fourt said. “Refugees with disabilities are generally considered as highly vulnerable people and in theory, they are more likely to benefit from the humanitarian assistance than refugees who do not suffer from a disability. But in practice, it is not always the case.”

Handicap International and other humanitarian aid organizations dedicated to providing aid for refugees with disabilities aim to provide services needed that are lacking in the Syrian crisis. They assist refugees with registration and advertise their services throughout the camps and other areas with large populations of refugees. In Jordan, 80 percent of refugees live in urban settings. Nearly 28 percent of Syrian refugees who fled to Jordan live in Amman, primarily for financial and employment opportunity.

Whether a refugee with a disability lives in a city or camp, Handicap International provides mobility aids, such as wheelchairs, walkers or crutches. They fit refugees with amputated limbs with prosthetics, and provide regular physical and occupational therapy. If the refugee can’t make it to the station, aid workers work on the individual in their home.

According to Pearce, focusing on resilience is just as important as assisting with vulnerabilities.

“You want to push people up to being more resilient,” Pearce said. This should be an objective we put in place when we are working with persons with disabilities,” What we want to do is start thinking ‘how do we support persons with disabilities to develop skills, to develop assets?’ That is what will shift them along that spectrum from vulnerability to being resilient, to being safer, to being protected and to having their rights respected in the community.”

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