Category Archives: DRR
I arrived in Nepal on May 12th, some hours after the massive aftershock that caused more casualties and a number of additional damages to properties and infrastructure.
I could see in the faces of people how their lives were shaken again, and how they didn’t see where and how to ensure the safety of themselves and their families. My first night in Kathmandu was broken by a number of aftershocks that woke me up and made me run outside in search of safety.
Though earthquakes are not new to me, every time it makes me realise how frightening they are, bringing a feeling of helplessness.
Three weeks later, life has become quasi-normal in Kathmandu, with its traffic jams, crowds in the street, shops and restaurants all open. If you don’t travel to affected areas you won’t see that two major earthquakes hit the city only few weeks back. Though people are still talking a lot about them and every day small aftershocks remind all of us that it has happened.
Working with partners – ensuring inclusion
It’s been three weeks of working with partners to provide support to the most affected people, to raise awareness about persons with disabilities and older people and to make sure that all of them are included and have equal access to relief, despite the challenges posed by isolated and remote villages and the upcoming rainy season.
Our partners are doing a great job to save lives and contribute to the effort made to assist people in need through trauma care and rehabilitation, organising medical outreach camps, providing psychosocial support – trying to help people to regain independence and normality in their lives. However, we still hear stories from persons with disabilities and older people not being able to access distribution points and being left behind – unintentionally – by relief stakeholders. It is a hard job to reach out to the most at-risk, as often they are not informed, cannot reach the front of the queue and their voices are not heard.
What would you do?
What would you do to find food if you are an 80 year-old man living more than a three-hour walk far from the main road and next city? You will walk downhill, hoping to access a relief package, and then find out that you have to carry a 30 kg bag back uphill …and that you can’t do it. You will seek support, but all other people are also too busy trying to survive to help you.
What would you do if you are a blind person trying to find out where distributions are happening and how to access them, only to discover that you have to compete to be front of the queue as there are not enough supplies for all? Obviously you’ll be at a disadvantage, and most likely you’ll lose out.
What would you do if you are a deaf person, having been transferred by helicopter to Kathmandu for trauma care and have no clue of what is happening to you as no one can communicate with you?
These are only few stories, but many more like this are reported every day…
It is great that donors and organisations are moving towards inclusive policies and frameworks, but exclusion happens on the field. What would you do if you were that relief worker and have limited aid to distribute? Field workers must be supported to turn inclusive policies into inclusive humanitarian action.
Advocating for inclusion
CBM works with our partner the National Federation of Disabled in Nepal (NFDN), supporting them to identify persons with disability and older people and assess their needs to then mobilise humanitarian stakeholders to respond to them. It is very encouraging as many of these organisations are willing to make the extra effort, but lack knowledge or information to ensure inclusion.
Bhojraj Ghimire, CIL Kathmandu (checked shirt) takes part in the workshop on disability inclusion organised by CBM and the International Federation of Red Cross and Red Crescent Societies (IFRC) in Kathmandu
Early last week I gave a two-hour orientation on disability inclusion to Red Cross staff, and the head of the delegation said:
“The Red Cross movement was created to help the most difficult to reach and the ones who couldn’t care for themselves, and yet in our response we reach only the easy one. We need to make the extra effort to access all those who are living in remote areas, who are facing barriers to access relief and whose rights we should protect.”
Well, this kind of statement and willingness to walk the extra miles is very encouraging as it will support the relief worker to pay attention and develop the mechanisms to help the older man to carry home his 30 Kg of goods, the blind person to find the distribution point and be in front of the queue or the deaf person to access a sign language interpreter to understand what is happening to him and get news from his family.
I will travel back to Europe soon but I’m confident that our partners will continue to raise their voices and to make them heard by all. Change is coming!
As we watch the events unfold in Nepal since April 25, we are reminded of the extra challenges that people with disabilities experience during disasters. Those with physical disabilities may struggle to flee to safety or travel long distances for essentials like food and water. The methods used to communicate an approaching disaster may not consider the needs of people who live with blindness, deafness or learning disabilities. Temporary shelter facilities, as well as other relief and longer-term recovery services, may not be accessible. And suddenly there is an influx of people experiencing new disabilities within the population; physical trauma caused by an earthquake, for example, may lead to the amputation of limbs or spinal cord injuries.
At the same time, people with disabilities show incredible amounts of resilience in emergencies. There are countless stories of people with disabilities helping their own community members. I think back to working in Haiti with CBM after the 2010 earthquake. Key members of our community rehabilitation team had disabilities themselves, yet refused to let disability equal inability. They worked hard within our teams to ensure that the needs of their whole society were being met.
This week, in the UK, we celebrate Mental Health Awareness Week- a perfect time to talk about the importance of mental health in disasters. People with psychosocial disabilities (those living with disabilities caused by mental illness) are often left behind during a disaster. In the Philippines after Typhoon Haiyan, we heard stories of people living with mental illness who had been chained in their homes and were unable to flee to safety when the typhoon was approaching. In addition, access to mental health care – and psychotropic medicines in low and middle income countries is an ongoing issue. During a disaster, the ability to access care and medication often shifts from challenging to virtually impossible.
The World Health Organization (WHO) estimates that after an emergency, the number of people experiencing mental disorders can as much as double within the population. At the same time, normal signs of distress within a population increase greatly. This information highlights something very important. First, there is a great need to continue to care for people with psychosocial disabilities after a disaster. In fact, the need has now doubled. But secondly, suddenly there is a large amount of psychosocial stress being experienced within the general population. This stress is a normal reaction to loss and to exposure to distressing events. Many will recover from these experiences, however a number of those who need psychosocial support can benefit from simple, cost-effective approaches such as Psychological First Aid.
CBM recognizes the importance of mental health and psychosocial support during emergencies. We also place a high value on the knowledge and understanding that our local partners have during emergencies within their countries. This is why CBM works hand in hand with our partners during and after emergencies.
In Sierra Leone, for example, our Enabling Access to Mental Health programme had already established an active mental health advocacy group, the Mental Health Coalition – Sierra Leone. The Coalition had become a focal point for mental health system development, in collaboration with the Government of Sierra Leone. When the Ebola outbreak started in West Africa, the Coalition was in the perfect position to support the coordination of mental health and psychosocial actors in Sierra Leone. They were able to advocate for better psychosocial support for health care workers. They also pushed to have mental health professionals (trained under the Enabling Access to Mental Health Programme) placed strategically throughout the country to offer support for those experiencing signs of distress and ongoing care for people with psychosocial disabilities. The Coalition supported the adaptation of training and activities to the local context, and advised on the development of strategies, policies and basic packages. Because we had a trusted partner already engaged on the ground, CBM was able to mobilize financial support so that they could continue their impressive work.
Now, looking to Nepal, CBM is currently implementing response work, again with strong partners, to offer mental health and psychosocial support. Already, CBM is a partner with a national level mental health group- KOSHISH. Our emergency response unit based in Kathmandu has been liaising with them since the earthquake struck, as part of our overall response, and we are now at the stage of providing them with support to be able to meet immediate psychosocial needs of people affected by the earthquake, and to improve access to basic relief aid as well as to specialise services for persons with psychosocial disabilities. In addition, we will draw on the knowledge and experience of our partners doing Community Based Rehabilitation work throughout Nepal. They are in the perfect position to provide their communities with psychosocial support, and we are already working to ensure that relevant staff members are also trained in Psychological First Aid.
People with Epilepsy often face similar stigma and discrimination in their communities as those with psychosocial disabilities. For this reason, we encourage our partners to also include people with Epilepsy into our mental health and psychosocial support programmes.
Addressing mental health and psychosocial needs is essential for complete and effective disaster response. I hope that by highlighting the work of CBM in emergencies, the experience, rights and needs of people with psychosocial disabilities, are clear. But more importantly, I hope to have shown a way to approach these challenges – not only will this strategy improve the situation for many individuals affected by the current emergency, but will build their resilience for the future, and therefore that of their families, communities and society as a whole.
CBM is working to bring urgent relief to people with disabilities in Nepal after the earthquake on 25th April, and provide vitally needed healthcare for both physical and mental health needs.
It has now over a year since the Ebola outbreak started in Guinea. CBM supported partners in Guinea and Sierra Leone – 2 of the 3 most affected countries – were forced to scale down their routine activities like community eye care, cataract operations, and community mental health care. The loss of local staff either from Ebola or due to difficulties in travel, and the reduction in clients coming for services has led to a risk of insolvency of institutions, among other negative effects. By extension, tens of thousands of people who depended on them for health, and other social services are no longer getting the services they require resulting in greater disability and deeper poverty.
CBM is working with a grass-roots organisation in Sierra Leone to reduce the vulnerability of people with disabilities and their families to Ebola through awareness raising strategies.
Dr Julian Eaton, Psychiatrist and CBM Mental Health Advisor for West Africa, tells us more about the mental health programme and its role in responding to psychosocial needs of the population in Sierra Leone.
Our activities in Sierra Leone since the Ebola outbreak started
When the Ebola crisis began in March 2014, our programmes in Sierra Leone were affected. Due to the rapid spread of this disease, there were significant travel bans imposed, bans on public gatherings, closure of schools, reduction in the use of hospitals by people etc. Routine cataracts and surgeries came to a standstill and routine programmes started collapsing.
We needed to continue supporting our existing partners as there was no income flowing in due to lack of day-to-day expenses of operations and surgeries etc. Business services started collapsing due to the lack of finances and there was a massive gap between what was existing and what was needed by the people.
CBM’s first response to the outbreak was to redirect our efforts as much as we could, within the framework of our programme, to support the mental health and psychosocial response to the outbreak.
CBM projects in Sierra Leone
The ‘Enabling Access to Mental Health’ Programme (EAMH) supported by CBM has been active for the past four years in Sierra Leone. Addressing the consequences of mental health is an important part of standard Ebola response. Today, this programme focuses more on the specific mental needs of people affected by this disease. It provides mental health facilities to families of Ebola victims, children who are now orphans, health workers who are under a huge amount of stress and survivors who are marginalised by their families and communities.
The programme has dedicated three blocks to:
- Block 1, Capacity Building: support the 21 mental health nurses trained by the EAMH programme in the districts, so they can provide services for those who are suffering the consequences of the outbreak. Other efforts, like the provision of trainers and specialists to prepare teams of other organisations (such as child protection) are also being made.
- Block 2, Advocacy: The EAMH has also established the Mental Health Coalition that brings together stakeholders to advocate for the inclusion of mental health in the government’s agenda. The Mental Health Coalition has been engaging from the beginning of the outbreak with the response pillars of both, the Ministry of Health and the Ministry of Social Welfare, to ensure that the mental health component of the outbreak is not neglected and that local actors are taken into consideration. The Coalition, being one of the main actors in this area, works in close collaboration with WHO, UNICEF, and the other NGOs.
- Block 3, Awareness: Radio programmes and support to the other blocks are being provided, to raise awareness about the psychosocial consequences of the outbreak, and to fight stigma and discrimination.
To address the massive increase in needs CBM has also added more resources to scale up support for psychosocial disability. We have collaborated closely with the WHO to write a standard manual for psychosocial first aid (both in English and in French). This manual is currently being used by national governments, WHO and other international and local NGOs in Sierra Leone, Nigeria, Mali, Guinea, Togo and Liberia.
In Sierra Leone the Mental Health programme has been the strongest programme supporting services outside psychiatric hospitals. It has deployed nurses who are the main referral for people doing counselling.
Building Resilience for persons with disabilities during the Ebola Crisis
Another project has begun to ensure the resilience of people with disabilities to the outbreak. CBM has liaised with our local partners in Sierra Leone to adapt all official messages from the WHO, UNICEF and the government, to ensure they are accessible for people with disabilities.
We are adopting a participatory approach in this project – our partners are conducting training sessions for Organisations for Persons with Disabilities (DPOs), who in turn train communities in the villages. We have involved key organisations in this project – specialist schools for hearing impairment, amputee groups etc. so that people with disabilities can have a say in how they want messages to be transmitted to them. Right now our collaborating local partner organisations are identifying other DPOs and organising workshops.
Disaster Risk Reduction and preparedness in Nigeria and Togo
We are strengthening capacities of Mental Health workers to provide mental health support in crisis situations. All these projects are strongly focused in working through our local partners, capacitating them, working in collaboration and therefore, assuring sustainability and continuation after the Ebola crisis period.
Beyond the realm of mental health, CBM is supporting existing partners involved in eye health in Sierra Leone, to sustain their programmes and to reduce the vulnerability of their target group to Ebola. The partners have had to scale down their eye health activities in their catchment areas thereby depriving communities of much needed eye health service. A person who is blind is doubly vulnerable compared to able-bodied members of society due to the fact that they require support in their daily living as a result of an inaccessible environment. A key strategy Ebola health workers are promoting is the “don’t touch rule” to reduce the spread of infection. Such a rule, to a person who is blind completely immobilises them and elevates their risk of infection to Ebola.
In this context, CBM eye health partners aim to: increase the knowledge of their staff and traditional leaders regarding Ebola to enable them to effectively sensitize communities in the catchment area; and to work with DPOs to reach out to persons with disabilities especially persons who are blind.
The current Ebola epidemic has overloaded and stressed health infrastructure in the affected countries; the number of health care workers – already insufficient before the outbreak – has gone down even further as many health workers became infected and lost the fight. Social stigma towards survivors of Ebola and their families has increased thus worsening distress and isolation. Family and social ties have been severed; cultural practices have been over-turned; and livelihoods have been severely strained.
In future, the affected countries, and the international community will have to engage at a much wider scale to re-establish the socio-cultural, economic, and political systems, which Ebola has severely shaken. This will be a critical and indispensable step if the affected countries are to overcome future public health challenges like the current one.
In the coming months, CBM will participate, with other development agencies and the governments of the three affected countries, in a major conference looking at lessons learnt in mental health and psychosocial support from the outbreak, and how we can work together to rebuild mental health services.
A research report from the International Centre on Evidence in Disability (ICED) formed the basis of a discussion today with the UN Committee of Experts on the Convention on the Rights of Persons with Disabilities.
It was a pleasure for me to facilitate a dialogue between the Committee and Dr Hannah Kuper, co-director of the ICED at the London School of Hygiene and Tropical Medicine on their recent research report ’The costs of exclusion and the gains of inclusion of persons with disabilities‘.
The first part of the research provides the evidence of the link between poverty and disability, described by Dr Kuper as ‘strong as the evidence between lung cancer and smoking’.
The second part of the research looks at three sectors, namely; health, education and employment, providing evidence from low and middle income countries on the costs of exclusion and the gains of inclusion of persons with disabilities…
Did you know that In Bangladesh, reductions in wage earnings attributed to lower levels of education among people with disabilities and their child caregivers were estimated to cost the economy US$54 million per year?
Or that the inclusion of people with sensory or physical impairments in schools in Nepal was estimated to generate wage returns of 20%?
Read more of this wonderful research, and disseminate it to the people who listen to economic arguments, but always ask for the evidence!
On Sunday 21 September, more than 300,000 marchers flooded the streets of New York City making it the largest climate change march in history and putting this important issue on the top of the global agenda. In addition, in conjunction to the opening of the 69th UN General Assembly, Secretary-General Ban Ki-moon hosted the UN Climate Summit on Tuesday, 23 September. It was lovely timing since it was also the Fall Equinox (Spring Equinox for my friends in the Southern Hemisphere – !Hola Uruguay!)
Due to this high-level event, climate change has been a pervasive topic at the UN and in NYC and this theme will continue to be important as the post-2015 development agenda progresses. One example is that the newly appointed President of General Assembly, Sam Kutesa, will hold a High-level Event on Combating Climate Change in June 2015.
With this increased emphasis on climate change and related disaster risk reduction (DRR) – in the post-2015 process, it is crucial that persons with disabilities are included in these conversations, debates and initiatives. Why is this important?
It is important because weather-related disasters are increasing in number and severity and the number of people affected by them has risen. Disasters and their aftermath have a huge impact on persons with disabilities who are among the most vulnerable in an emergency, sustaining disproportionately higher rates of morbidity and mortality, and at the same time being among those least able to access emergency support. For example, research indicates that the mortality rate among persons with disabilities was twice that of the rest of the population during the 2011 Japan earthquake and tsunami (UN, 2013). Moreover, for every person that dies during a disaster, it is estimated that three people sustain an injury, many causing long-term disabilities, such as the case in Haiti after the 2010 earthquake in which approximately 200,000 people are expected to live with long-term disabilities as a result of injuries (UN Enable, 2013).
Persons with disabilities are often forgotten, and most likely to be abandoned during disasters (DiDRRN, 2013)as well as more likely to be invisible and overlooked in emergency relief operations (Choy, 2009). When the emergency hits they may have difficulty reaching safe areas, become separated from family and friends which is a key to survival and coping, have trouble accessing vital emergency information, or lose assistive devices such as wheelchairs, crutches, prostheses, white canes or hearing aids. In addition, moving and transferring persons with disabilities requires handling techniques to avoid injury or further injury. Yet, the first-ever UN global survey of persons living with disabilities and how they cope with disasters indicates that the percentage of those with disabilities who could evacuate with no difficulty almost doubles if they were given sufficient time. This underlines the importance of early warning systems and ensuring that warnings reach all members of the community regardless of any mobility or communication barriers (UNISDR, 2013).
For the few who are evacuated, shelters are not accessible and consequently survivors with disabilities are also excluded from the emergency responses: including food, basic needs and health support. In addition, in the aftermath of a disaster, the damage to infrastructure caused by extreme weather events can reduce or completely remove access and safe mobility. Inclusive practice in all relief operations is needed to ensure that response and service delivery is not fragmented but mindful of all sources of vulnerability (Kett & Scherrer, 2009).
- Strong advocacy by and with persons with disabilities is needed to ensure disability inclusion is a key criterion in all emergency relief operations
- The evidence base concerning the vulnerability of persons with disabilities in weather-related emergencies, and key factors, which create resilience, need to be greatly strengthened, with key messages disseminated.
- Evaluations of both emergency and development programmes, in areas affected by a changing climate, need to clearly include disability in their terms of reference.
- Early warning systems need to ensure that warnings reach all members of the community, including persons with disabilities regardless of mobility or communication barriers.
- In the reconstruction phase following severe weather and other emergencies, it is essential that universal accessibility standards are applied in all public buildings and spaces, water and sanitation points and for the homes where people with mobility disabilities live.
Choy, R. (2009). Disasters are always inclusive: Vulnerability in humanitarian crises, Development Bulletin, Special Issue No. 73, April 2009, Development Studies Network, ANU, Canberra.
DiDRRN. (2013) Inclusion of Persons with Disabilities in Simulation Exercise. From: www. didrrn.net/home/
Kett, M and Scherrer, V. (2009). The Impact of Climate Change on People with Disabilities. Report of e-discussion hosted by The Global Partnership for Disability & Development (GPDD) and The World Bank (Human Development Network – Social Protection/Disability & Development Team).
UN. (2013). Panel Discussion on Disaster resilience and disability: ensuring equality and inclusion. United Nations Headquarters on October 10, 2013.
UN Enable. (2013). Disability, natural disasters and emergency situations: A need to include persons with disabilities. From: www.un.org/disabilities/default.asp?id=1546
UNISDR. (2013, October 10). UN Global Survey Explains Why So Many People Living with Disabilities Die in Disasters. [Press release 2013/29].