The Disability Monitor Initiative- Middle East Journal

issue 1 February 2009

Inside you will find:

Editorial: Social Protection for Social Inclusion: So Much Remains to be Done. Alexandre Cote, Governance and Social Inclusion Advisor . SI.EM.PRE

Social Protection: a Favour or a Right? Marie-Noëlle AbiYaghi, Regional Research Officer, Handicap Interna- tional, Middle East.

Social Protection and Disability in Brief. Dorothea Rischewski - Planning Officer, Social Protection Section / Stephanie Köstermenke - Intern, Social Protection Section / Rapha- ela Nix - Intern, Social Protection Section / Sanna Stockstrom - Planning Officer, Social Protection Section

SOCIAL PROTECTION Social Protection and Persons with Disabilities in the Laws: Recognized Rights and Unframed Provisions. Muhannad Alazzeh, Regional Advocacy Coordinator. Handicap AND PERSONS WITH International, Middle East.

Ensuring Access to Social Services: a Condition to Mitigate A DISABILITY IN THE Risk of Poverty among Persons with Disabilities. Darryl Barrett, Disability Services Coordinator, Handicap Interna- tional, Middle East.

MIDDLE EAST: Gate Keeping: Urgent Need for Reform to Ensure Fair and Effective Access to Social Protection Entitlements. ISSUES, CHALLENGES Alexandre Cote, Governance and Social Inclusion Advisor . SI.EM.PRE Initiative for Proper Gate-Keeping: the Rights and Access Programme. Lebanon. AND DEBATES Ms. Hyam Fakhoury, responsible for the Research and Development Unit/Rights and Access, Ministry of Social Affairs, Lebanon

Can Cash Transfers Reduce Inequality for Persons with Disabilities? Afrah Al Ahmadi, Senior Human Development Specialist, World Bank, Yemen Country Office

Cash Transfers and Persons with Disabilities: the case of Yemen. Adib Nehmeh, PA for Poverty Reduction Policies UNDP, SURF-AS

Health Insurance for Persons with Disabilities: Real Practices or Pure Wishes? Views from public official, Jordan, and Civil Society, Palestine. Rima Canawati, Bethlehem Arab Society and Dr Munther Ammari,, Ministry of Health, Jordan.

Exemptions for Persons with Disabilities: a Vaccine Against Exclusion? The Debate… Nasser Jaber, President of the Bethlehem Sport Club of Disabled, Palesyine and Amer Makarem President of theYouth Association of the Blind, Lebanon.

Useful Links and Bibliography.

What’s Next? Disability Monitor Initiative-Middle East, (DMI-ME) Monitoring Legislative Change, Social Innovation and Public Policies

Location local actors including Disabled Peoples Lebanon, Egypt, Palestine, Jordan, Syria, Organizations (DPOs), service providers Iraq, Yemen and local authorities. The methodology behind the DMI-ME is to gather information Launched by CBM and Handicap on a local level through field work within international, together with, Bethlehem Handicap International (HI), CBM or Arab Society for Rehabilitation, Arab partner projects in order to have first hand Organization of Disabled People, Lebanese information. It includes consulting with Physical Handicapped Union and Al Hussein people with disabilities, their representative Society for Habilitation/ Rehabilitation of the organisations, service providers, as well as Physically Challenged Advance and Atfaluna local and national authorities. , The Disability Monitor Initiative (DMI) for Middle East is an advocacy initiative that Monitoring legislations gathers and disseminates information on The DMI-ME will monitor the evolution relevant disability topics underpinning the of legislation of all Arab countries with move towards full participation and equal regards to the compliance or not with the opportunities of people with disabilities. The United Nations Convention on the Rights of DMI-ME is primarily based on field research Persons with Disabilities (UNCRPD). consulting with people with disabilities, service providers, members of civil society, Monitoring Public Policies government officials and local authorities. Often the missing links between socially The objectives of the DMI-ME are to build innovative practices and upgraded up knowledge on the situation of people with legislation is the development of sound disabilities, examine best practices in terms public policies. In the Middle East, a key of social innovation happening on the grass- focus of the DMI-ME will be the monitoring roots level as well as to inform about policy of development and enforcement of public reforms on the national and international policies and allocation of public resources. levels. The aim is that the DMI-ME will serve Attention will be paid to budgeting issues, as a tool for reporting on critical issues decentralization, and institutional capacities affecting people with disabilities in an effort to enforce legislation. The DMI-ME will to support the empowerment of relevant also pay a special attention to policies of stakeholders with information. multilateral and bilateral agencies as they can strongly influence local stakeholders Monitoring social innovation: both from civil society and public sector. One of the key features of the DMI-ME is whilst disseminating information, it A combined perspective monitors social innovation carried out by In this way the DMI-ME has a unique

Disability Monitor Initiative-Middle East Disability Monitor Initiative-Middle East 11 NovemberFebruary 2009 2008 Issue. Issue. November 2008 Issue. 2 perspective on disability issues; it looks at national development frameworks, in both the macro level policies in place while collaboration with policy-makers and civil monitoring how these policies translate society groups. into practice and how these practices impact the lives of people with disabilities. The Making It Work initiative is based The DMI-ME should contribute actively to around four clear objectives: making available knowledge that will help stakeholders in the implementation of the 1. To develop the capacity of UNCRPD. The objective of the DMI-ME stakeholders (at local, national and is to be an advocacy tool to monitor and regional levels) to collect information on facilitate the sharing of knowledge on the key disability issues and practices that ways that local organisations, authorities uphold the principles of the UNCRPD. and international agencies develop and support reforms that promote and 2. To develop the capacity of enable the full participation of people with stakeholders to use this information disabilities. to produce thematic reports and working papers with clear policy The Disability Monitor Initiative- recommendations. Middle East and the Making It Work project 3. To develop the capacity of The ratification of the UNCRPD sets a stakeholders to monitor the major challenge: how to bridge the huge implementation of the report gap that exists between the standards recommendations and any subsequent set by this international convention and changes in policy. the actual standards of existing services, systems and policies, particularly in low 4. To facilitate the international exchange or middle income countries. The central of these reports through an interactive aim for Making it Work is to reduce this website. gap through processes of information dissemination and exchange, and in Making It Work builds upon lessons doing so, to promote a model for inclusive learned through the Disability Monitor development. The purpose of this initiative Initiatives in both South East Europe is to develop a monitoring tool that will (www.disabilitymonitor-see.org) and the support the collection and exchange Middle East and also the work of Source of information about inclusive disability (www.asksource.info) in managing an policies and practices. The goal is to international information exchange system. promote a bottom-up approach to inclusive development, where actors and agencies The guidelines for the development of such working at the field level (particularly initiatives will be elaborated based on the in countries where there are limited South East Europe and the Middle East resources) have the opportunity to influence Disability Monitor Initiatives.

Disability Monitor Initiative-Middle East February 2009 Issue. 2 Index

Editorial: Social Protection for Social Inclusion: So Much Remains to be Done. 1 Alexandre Cote, Governance and Social Inclusion Advisor . SI.EM.PRE

Social Protection: a Favour or a Right? Marie-Noëlle AbiYaghi, Regional Research Officer, Handicap International, Middle East. 6

Social Protection and Disability in Brief. Dorothea Rischewski - Planning Officer, Social Protection Section / Stephanie Köstermenke - Intern, Social Protection Section / Raphaela Nix - Intern, Social Protection Section / Sanna 10 Stockstrom - Planning Officer, Social Protection Section

Social Protection and Persons with Disabilities in the Laws: Recognized Rights and Unframed Provisions. 13 Muhannad Alazzeh, Regional Advocacy Coordinator. Handicap International, Middle East.

Ensuring Access to Social Services: a Condition to Mitigate Risk of Poverty among Persons with Disabilities. 15 Darryl Barrett, Disability Services Coordinator, Handicap International, Middle East.

Gate Keeping: Urgent Need for Reform to Ensure Fair and Effective Access to Social Protection Entitlements. 18 Alexandre Cote, Governance and Social Inclusion Advisor . SI.EM.PRE Members of the DMI-ME Steering Committee: Al Hussein Initiative for Proper Gate-Keeping: the Rights and Access Society for Habilitation/ Programme. Lebanon. 20 Rehabilitation of the Ms. Hyam Fakhoury, responsible for the Research and Development Unit/Rights and Access, Ministry of Social Affairs, Lebanon Physically Challenged, the Bethlehem Arab Society for Rehabilitation and Can Cash Transfers Reduce Inequality for Persons with the Lebanese Physical Disabilities? Handicapped Union Afrah Al Ahmadi, Senior Human Development Specialist, World Bank, Yemen Country Office 23 Cash Transfers and Persons with Disabilities: the case of Yemen. Adib Nehmeh, PA for Poverty Reduction Policies UNDP, SURF-AS Members of the DMI-ME Advisory Committee: Health Insurance for Persons with Disabilities: Real Practices or ADVANCE, Arab Pure Wishes? Views from public official, Jordan, and Civil Society, Organization of Disabled Palestine. 27 Rima Canawati, Bethlehem Arab Society and Dr Munther Ammari,, Ministry of Health, People and Atfaluna. Jordan.

The Opinions expressed by the DMI Journal Exemptions for Persons with Disabilities: a Vaccine Against and publications do not Exclusion? The Debate… Nasser Jaber, President of the Bethlehem Sport Club of Disabled, Palesyine and Amer 30 necessarily reflect the Makarem President of theYouth Association of the Blind, Lebanon. opinions of the Advisory Committee members. What’s Next? 34 The Advisory Committee is not responsible for any Selected Publications 38 information published Events 40

Disability Monitor Initiative-Middle East 3 February 2009 Issue. Editorial: Social Protection for Social Inclusion: so Much Remains to be Done.

Alexandre Cote, Governance and Social Inclusion mechanisms for persons with disabilities. Advisor . SI.EM.PRE In the past, social protection in the Middle East and North African Region or Amir is an eight-year-old boy who is not MENA has been focusing on extensive expected to attend classes in a university public employment, subsidies for main nor get married. He has cerebral palsy. consumption items like food and energy, His mother cannot seek employment as and free basic heath care and education. all her time is spent taking care of and These mechanisms are designed for the supporting Amir and due to the lack of majority of the population and have failed (government) assistance and services, to take into consideration specific needs she incurs huge expenses for special and rights of persons with disabilities. health care, rehabilitation, education and With the successive economic crises, and technical aid; expenditures that his parents conflict in some areas, and consequences do not have to pay out for their two other of economic liberalization, these social children. Payments made for Amir’s protection mechanisms have been healthcare are the funds they will never be shrinking and targeted programs and able to save for Amir’s higher education or measures have taken their place, most marriage, potentially spoiling economic and of the time failing to properly address the education opportunities for his two other needs of persons with disabilities, revealing siblings. What is worse is that Amir has de facto that the rights of nearly 10 much more to risk living in poverty when percent of the population are neglected. he reaches adulthood compared to other children, as he will be up against obstacles It is worth highlighting that most of the primarily due to the lack of safety nets and past and current policies in the region support mechanisms for persons with a are guided by a medical and charitable disability like him. approach to disability, which focus on few benefits, free health care (bribe Amir could be Lebanese, Jordanian or excluded), tax exemptions (if you are Egyptian as most of the countries in unable to give, at least don’t take), mere the region have poor social protection support for technical aids and quota for

Disability Monitor Initiative-Middle East February 2009 Issue. 4 public employment. These measures comprehensive social protection systems have provided temporary relief to the and optimally utilize resources available to burden of persons with disabilities but support the daily struggle of persons with certainly did not contribute to reinforce their disabilities to become part of society. opportunities for education, employment and participation on an equal basis with This 1st issue of the Disability Monitor others in society. Journal has gathered views of policy- makers, service providers, and Good initiatives by NGOs, mostly organizations of persons with disabilities supported by foreign funds and local in an attempt to set a framework for private donations or public programs further debate and discussion among such as the Lebanon “right and access” stakeholders. We therefore propose a or the Yemeni disability fund, show that combination of theoretical and practice- innovative mechanisms can be developed. based articles about social protection But as disability remains at the margin issues including gate keeping and social of the policy makers’ agenda due to the services, and practical focus on three lack of sound understanding of disability crucial issues which are constantly under issues, so far, no country has succeeded in debate health insurance, cash transfer and scaling up and sustaining good initiatives exemption. and developing national social protection schemes that combine effective safety Because the Middle East is full of nets and supportive measures to prevent interesting initiatives, because the task is persons with disabilities and their families huge and complex, and because available to remain in or fall into poverty and ensure resources are scarce, understanding their full participation. together and learning from each other is now a duty if we really intend to uphold and With the United Nations Convention on promote more inclusive societies. Rights of Persons with Disabilities, States have the duty to ensure that children and adults with disabilities both enjoy their rights to live in the community, access education, health care, employment and enjoy equal opportunities as others. Middle Eastern societies, like most in the world, remain discriminatory and non-inclusive to persons with disabilities; they desperately need to develop supportive and

Disability Monitor Initiative-Middle East 5 February 2009 Issue. Social Protection: A Favour or a Right? General Issues and Trends.

Marie-Noëlle AbiYaghi, Regional Research Officer, other alternatives such as “social policy”, Handicap International, Middle East. “social security”, “social insurance”, or “safety nets”. In this paper, we refer to The approach to social protection has social protection as all public and significantly evolved over the two last private initiatives that provide income decades encompassing a wide range of or consumption transfers to the poor, issues and generating strong debates among protect the vulnerable against livelihood practitioners, policy makers and academics. risks, and enhance the social status Is social protection to be understood as a set and rights of the marginalized with of coping mechanisms, whether implemented the overall objective of reducing the as earned rights or State granted entitlements economic and social vulnerability of the or as a set of policies ensuring protection poor and other marginalized groups.2 of all and inclusion of vulnerable groups? In a context of economic and political crises, However, it must be noted that there are Middle East societies face a great dilemma many different interpretations of what whether extended social protection should be exactly constitutes social protection. At the seen as a right or a favour? risk of oversimplifying these differences, one can identify two (2) different visions of The national and international commitments social protection: to global poverty reduction reflected in the - A limited vision that considers social Millennium Development Goals, and more protection as a means of providing short- specifically the commitment to halve, between term assistance to help individuals and 1990 and 2015, the proportion of people households cope with shocks while they whose incomes are less than 1USD a day, seek new economic opportunities that will have underscored the extent and persistence immediately allow them to improve their of poverty in developing countries. There is situation; an emerging consensus among multilateral institutions on the need for developing - A broader foresight that looks at social countries to strengthen and develop social protection as having both short-term protection policies and programmes as an and long-term functions in poverty urgent response to poverty and vulnerability reduction: helping people to conserve and 1. This consensus has centered on accumulate assets and transform their “social protection” as a framework that socio-economic relationships so they are covers a wider range of programmes, not constrained from seizing opportunities stakeholders, and instruments relative to through clientelism.

Disability Monitor Initiative-Middle East February 2009 Issue. 6 In cases where people, due to their age Defining social protection in the Middle East or disability, are dependent on others, this While scientific literature mainly adopts a broader vision envisages long-term forms of perspective focusing on institutions (their social assistance such as grants and non- functions, modes of financing, rules on contributory pensions. The narrow vision sees expenses, relationships among themselves a clear distinction between social protection and other groups or agencies, rules and and livelihood promotion, while the broad administrative organizations), organizing vision sees them as being closely related. systems in ideal types, namely: the professionally-based (Bismarckian) and Social security is a funded system, which the citizenship-based (Beveridgian) form of ensures that beneficiaries or their families social protection with two (2) major trends: are compensated for risks that leave a residual or minimalist welfare state or a them unable to work, and thus unable to more generous and encompassing one. generate income. As far as institutional social security Social protection has been traditionally coverage goes in the Middle East region, associated with a range of public policies it does not seem like the region is unique that “rich” industrialized countries put in or different from other regions in the world. place in order to protect individuals from However, wide differences from country to poverty and deprivation. Such programmes country is apparent: from Tunisia that has are typically comprised of labour standards, engaged in the extension of a compulsory employment protection, other schemes contributive employment-related social linked to life-cycle contingencies (i.e., security (i.e., mainly pensions and health maternity, family allowances, old age insurance) to include most categories of pensions), compensations for work-related the working population to Yemen, where emergencies (i.e., unemployment, work only a very small percentage of the working injuries). In the 90s, the social protection population, mainly public servants, are concept experienced a transformation covered for pensions. Countries such as within the context of economic crises and the Gulf monarchies, where statutory social structural adjustments; it has come to define security is provided to all citizens, but where an agenda for social policy in developing foreigners who represent a majority of the countries. In this context, social protection population in some countries, are excluded becomes broader than social security, social while other nations like Egypt have a assistance or safety nets3 . significant percentage of workers covered, but

1 See IADB, 2000, Social Protection for Equity and Growth, Washington DC: Inter-American Development Bank. Asian Development Bank 2001, Social Protection Strategy, Manila: Asian Development Bank. ILO, 2001, Social Security. A New Consensus, Geneva: International Labour Office. World Bank, 2001, Social Protection Sector Strategy: from Safety Net to Springboard, Sector Strategy Paper, Washington DC: The World Bank. See the Definition of the United Nations: United Nations, 2000, Enhancing social protection and reducing vulnerability in a globalizing world, Report of the Secretary General to the Thirty-ninth Session E/CN.52/2001/, Washington DC: United Nations Economic and Social Council.

Disability Monitor Initiative-Middle East 7 February 2009 Issue. where actual coverage is losing value, and Universalisation and extension of social finally Palestine and Iraq, where occupation security: a global necessity and war generate different forms of insecurity that go far beyond that related to labour… Only a very small proportion of the world’s population, especially of developing In studying developing countries4 countries, benefits from any institutionalised , it eventually becomes obvious that social protection, and the majority has had “theoretical’ categories encounter several to rely exclusively on community and family limitations, mainly as a result of the solidarity as well as on other forms of ad presence of dual protection systems: hoc assistance and charity. formal and informal ones. In this context, the institutional perspective faces the Only one person in five of the world problem brought about by the existence of population has adequate social security the latter, informal institutions- that provide protection, while less than half has any some degree of protection to a majority of kind of social protection at all. the population and cannot be reduced to a category of sheer « care ». Several orientations have been drawn to extend social protection mechanisms to Thus one major challenge is to define cover vulnerable people. These debates the object « social protection regimes » about social security are linked to the separately from institutional approaches shifting ideological ground on the respective that we believe are inappropriate in contexts roles and responsibilities of individuals, where the social role of the State is weak, family and community, market and State. deficient or incomplete; where protected The erosion of the nation-state and new employment concerns only a minority of considerations about citizenship, are partly workers; where social rights have no or little linked to the migration of people across meaning for most; and where most people borders, fleeing or seeking opportunities to tend to resort to other forms of protection. survive economically. These perspectives It is therefore necessary to also look into reflect different visions of who is supposed protection services provided by the family to share the responsibility for an improved and the community in order to understand social protection: The State, the employers the kind of resources that may be mobilized and/or powerful groups within a society or to satisfy social needs. the Individual?

3 On the one hand, the World Bank moves beyond the traditional perspective of social protection and defines a “social risk management” framework, adding macroeconomic stability and financial market development to typical social protection programmes. The ILO, on the other hand, looks at social protection as based on basic rights, describing it as “entitlement to benefits that society provides for individuals and households - through public and collective measures- to protect them against low or declining living standards arising out of a number of basic risks and needs”. See: World Bank, 2001, Social Protection Sector Strategy: from Safety Net to Springboard, Sector Strategy Paper, Washington DC: The World Bank. Van GINNEKEN Wouter, 2000, The extension of social protection: ILO›s aim for the years to come›, in A. Norton (ed.) Social Protection: New Directions of Donor Agencies, London: Department for International Development, pp. 33- 48

Disability Monitor Initiative-Middle East February 2009 Issue. 8 Is Social Protection a Right? Towards the labour force, particularly in situations a strengthening of social rights and where economic productive investments security in the region are lagging, kept in the hands of powerful individuals and families, and not carried out The general situation of rights in the Arab with the welfare of the larger population in States is quite problematic; economic, mind. The particular place of many Arab social, human, civic and political rights countries in the globalized economy and 5 remain restricted in most countries . their general conditions of insecurity has However, it can be noted that, even though lead to their marginalization and that of large national trajectories are diverse (colonial parts of their active population. influence, resources, etc.), social rights are more often a favour granted by the ruler This situation makes it necessary to than a social and political conquest attained emphasise social protection, and more through social movements and that they are specifically on its “procedural arm”, - with often granted on a discriminatory basis (i.e., social security as a right, since the concept based on nationality, labour status, gender, of social protection tends to become a etc.). Furthermore, security is also an issue common political word which renders the in the Arab states. Social security is one situation more precarious for the most among the many dimensions of security that vulnerable groups or categories. are not granted on a regular basis to citizens, residents and workers. To a large extent, This situation makes it necessary to the security of a person or family depends emphasise social protection, and more on his economic assets social standing and specifically on its “procedural arm”, - political capital. Many Arab States have with social security as a right, since the actually engaged in extending social security concept of social protection tends to coverage to unprotected workers, but political become a common political word which will and/or economic resources often lack renders the situation more precarious significant reforms. The market alone cannot for the most vulnerable groups or integrate the most vulnerable groups of categories.

4 We borrow here elements from two papers : Destremau Blandine and Lautier Bruno: “Social protection and social rights regimes in developing countries: towards the construction of a typology”, presented at the (RC19), International Sociological Association: “Social Policy in a Globalizing World : Developing a North-South Dialogue”, University of Florence, Italy, Political and Social Science Department, September 6 -8, 2007 Destremau Blandine with Marie-Noëlle AbiYaghi: “The social protection challenge: How can informal workers enjoy social rights in Arab countries?” written for the ILO/CAWTAR project “Gender and Rights in the Informal Economies of Arab States”, 2007.

5 On the debate on security vs. liberty it would be interesting here to see LOCKE John, ed.1988, Two Treatises of Government, Cambridge Texts in the History Political Thoughts. LOCKE John, ed 1990, A Letter Concerning Toleration, Prometheus Books. And: HOBBES Thomas, ed. 1996, Leviathan or the Matter, Form, and Power of a Commonwealth, Ecclesiastical and Civil, Oxford University Press.

Disability Monitor Initiative-Middle East 9 February 2009 Issue. Social Protection and Disability in Brief

Dorothea Rischewski - Planning Officer, Social are traditionally those poor households Protection Section / Stephanie Köstermenke - Intern, that for various reasons beyond their Social Protection Section / Raphaela Nix - Intern, control cannot sufficiently satisfy all family Social Protection Section / Sanna Stockstrom - members’ basic needs, and who often Planning Officer, Social Protection Section cannot afford quality health care and education. These families are also the first In this article, social protection is presented as ones to be affected by external – climatic, poverty reduction tool especially for persons political or economic – crises. In low- with disabilities often presented as one of the income countries, families’ having a family most vulnerable groups. GTZ briefly reviews member with a disability often belong to the a range of public policy initiatives and tools to poorest socioeconomic stratum. Amartya achieve an integrated social protection system Sen provided the theoretical foundations for for persons with disabilities. understanding that households including a person with a disability are particularly Poverty, social protection and disability destitute as they need more financial means are closely linked to fulfil their needs than persons without Enhancing social security by building, disabilities6 . Evidence also shows that improving and extending systems of social households with a disabled household head protection in developing countries is an are poorer than the average7 and that important contribution to poverty reduction. persons with disabilities themselves have To be socially protected means, for example, less employment opportunities compared having access to health financing schemes to persons without disabilities8 . Likewise, such as a national or a community based children with disabilities are enrolled in health insurance, to social assistance school less frequently9 and their attendance measures such as cash transfers or in kind rates are lower10 . Lesser schooling and contributions, as well as being eligible to employment opportunities can have a mid and micro finance offers. long-term impact on a households’ capacity to Beneficiaries of social protection measures build up assets and human capital.

6 SEN, Amartya, 1999, Development as freedom. Oxford, Oxford University Press. 7 HOOGEVEEN Johannes G, 2005, “Measuring welfare for small but vulnerable groups: poverty an Disability in Uganda”. Journal of Economies 14: 603 - 631. 8 RISCHEWSKI, Dorothea, H. Kuper, O. Atijosan, V. Simms, M. Jofret-Bonet, A. Foster, C. Lavy (2008): “Poverty and musculoskeletal impairment in Rwanda”. Transactions of the Royal Society for Tropical Medicine and Hygiene 102, 608- 617. 9 FILMER, L and L. PRINTCHETT (1999). The effect of household wealth on educational attainment around the world: demographic and health survey evidence. Washington, World Bank. 10 RISCHEWSKI, op cit.

Disability Monitor Initiative-Middle East February 2009 Issue. 10 Persons with disabilities and social beneficiaries. Recommendations for protection – existing evidence inclusion are to treat disabled people exactly like non-disabled people in terms Facilitating poor families with a person of benefit design, but to exempt them with disability access to social protection from the conditions associated with CCT schemes can assist in addressing programs - as disabled persons have immediate needs as well as in building higher opportunity costs in complying with up human capital for mid- and long-term them than non-disabled people, and as the poverty reduction. The little evidence existing infrastructure often does not allow existing so far on the inclusion of persons compliance with the conditions for persons with disabilities into social protection with disabilities. Therefore CCT programs programs is guided by the twin-track should additionally be coupled with policies approach, which implies the analysis of to make service delivery more inclusive12 . social protection measures regarding their Marriott and Gooding take a look both at inclusiveness, and exploring ways for target target group specific and at mainstream group specific programs. programs of social assistance and their capacity to actually reach persons with Opportunities for including a disability disabilities. Recommendations include component in social protection programs strong legal foundations for social should be taken in order to better meet the assistance to persons with disabilities needs of persons with disabilities in general as to make sure disabled people have a programs. For the mainstreaming of this right to social protection and can claim target group into social protection programs their entitlements; the involvement of Sophie Mitra also suggests focusing on persons with disabilities in the design, removing physical and communication- implementation and evaluation of social related barriers as well as social barriers protection mechanisms; as well as which might prevent the target group from embedding measures of social assistance accessing benefits11 . into more comprehensive programs13 .

Daniel Mont examines the way German Technical Cooperation and conditional cash transfer (CCT) programs inclusive social protection reach persons with disabilities when the conditions are the same for all Guided by the United Nations

11 MITRA, Sophie (2005). Disability and social safety nets in developing countries, Social Protection Discussion Paper No. 0509. Washington, World Bank. 12 MONT, Daniel (2006). Disability in conditional cash transfer programs - drawing on experience in LAC. Third international Conference on Conditional Cash Transfers June 26 – 30, Istanbul. 13 MARRIOTT, Anna and Kate GOODING (2007). Social assistance and disability in developing countries. Haywards Heath, Sightsavers International. 14 United Nations (2006). Convention on the rights of persons with disabilities. New York, United Nations.

Disability Monitor Initiative-Middle East 11 February 2009 Issue. Convention on the Rights of Persons 2. persons with disabilities might 14 with Disabilities , the German Technical require higher financial means than the Cooperation Agency (GTZ) actively general poor to satisfy their needs, considers persons with disabilities in its development programs. The principles 3. programs should be designed, for inclusive development are laid implemented and monitored in a down in the policy paper “Disability and participatory manner to ensure that 15 Development” , combining the human specific needs of persons with disabilities rights based with the twin track approach. are being addressed, Evaluation of current social protection schemes designed by GTZ and their 4. pilot studies can help create best partners regarding their inclusiveness practice examples regarding either demonstrate that an accurate poverty target group specific programs as well as assessment facilitates the participation mainstreaming inclusive social protection of persons with disabilities: the selected programs. beneficiary households in a CT program in Zambia, where the poorest 10% of the population were identified through a community based poverty assessment, included a high proportion of households with a person with disability (Ministry of community development and social services and GTZ, 2007)16 . At GTZ, new social protection schemes are designed with attention to the following considerations:

1. persons with disabilities are disproportionally represented among the poor and therefore in particular need of social protection measures,

15 Deutsche Gesellschaft für technische Zusammenarbeit (2006). Disability and development - a contribution to promoting the interests of persons with disabilities in German Development Cooperation. Eschborn, GTZ. 16 Ministry of community development and social services and GTZ (2007). Evaluation report, Kalomo social cash transfer scheme. Lusaka, GTZ.

Disability Monitor Initiative-Middle East February 2009 Issue. 12 Social protection and persons with disabilities in the laws: Recognized rights and unframed provisions.

Muhannad Alazzeh, Regional Advocacy Coordinator. 3. Some of the Arab countries adopt the Handicap International, Middle East. disability card as gate keeping to access to the disability services. The pure medical The Arabic legal culture does not recognize identification of the disabilities in addition to the social services or the social protection the procedures of diagnosing and identifying as integral concept could be formulated on some types of disabilities, have definitely shared bases and under same category. narrowed the scope of the implementation of the related laws, this leads to serious Analyzing the social protection approach exclusion of large number of PwDs from components and trying to conduct a quick the provided services, particularly who analogy on the Arab disability laws, will lead have specific types of disabilities such as to the following facts: the psychosocial and the non-apparrant 1. The medical approach as a main criterion disabilities which are not recognized in the to define the disability and the welfare present Arab disability laws. approach as a general legal-frame of the 4. Most of the national laws are keen to provisions in the Arab disability laws, have mention that the provided services by negatively effected the legal provisions the State are free-of-charge, Specific set forth in the national laws particularly indications in this regard could be noticed those related to the services’ provisions. on the vocational and physical rehabilitation Legally, the services are being presented services, this is in harmony with the needs as fragmented activities of which the State and the medical based approaches which is encouraged to carry out, not as rights manipulate the disability legal texts, plans or generate obvious obligations and entail clear programs. With regard to the other services, responsibilities of which shall be fulfilled by (education, assistive devices , health etc), the State within a specified period of time. they are being provided by small fees or free of charge in some cases according to the 2. The cash transfer as one of the social monthly income or based on a study case of protection aspects in the disability field is not the beneficiary. it’s worth mentioning that the recognized in the legal frame of the disability disability services provided by the private in the most of the Arab disability laws, unless sector are chargeable and expensive, we consider the provisions on the financial having said that, there are some exceptions assistance for specific types of disability in make the services in the private sector very exclusive cases one of the forms of available by modest fees or free of charge if cash transfer. Such texts could be noticed in the service provider intends to benefit from most of the Arab disability laws particularly the tax-exemption which is granted in many for persons with intellectual disability.

Disability Monitor Initiative-Middle East 13 February 2009 Issue. disability laws as an award for the private decisions, this makes these exemptions sector to encourage the service providers to without legal immunity and it is easy to amend, make their services available. delete or change the related provisions by a decree or decision by the successors. The 5. The assistive devices and the technical detailed conditions and bases of benefiting support are frequently stated in the national from the exemptions are usually enacted by laws as main tools to achieve the physical executive regulations adopted by the related and the information accessibility Based on ministries (I.E ministry of social affairs and the welfare and the needs approach. The ministry of finance), these regulations are legal provisions which organize the benefit of rarely comprehensive and mostly exclude these devices are considered the main form some types of disabilities or at least stipulate of the charity characteristic which prevails restrictions of which creat a discriminatory in the Arab disability laws, This “justifies” scheme. This attitude is in accordance with the the ambiguity and the broadness of these needs , medical and the charity approach that provisions. these exemptions are based on. 6. Different types of financial exemptions such as taxs-exemptions and exemptions The exemptions should be taken as a from the fees of some services are stated temporary compensation for lack of accessibility in the Arab laws on different levels but on and reasonable accommodation . the same bases, the welfare and the charity The compensatory principle shall form the approach, The latter makes the provided exemptions-provisions-base if a well-paved exemptions a type of the alms without direction is projected to accomplish the equal clear legal-reference, moreover, some opportunities and to ensure secure and important exemptions for instance, have transparent system to access and benefit from been decided upon ministerial decrees/ the exemptions as a type of the social services.

Country The Main Law Law #39/ 1975 on the rehabilitation of disabled persons and related amendments Law #12/ 1996 Egypt on the rights of the child, and the Amending Law #126/ 2008, in addition to extensive regulations and ministerial decrees. Law #31 /2007 on the rights of disabled persons and the national strategy on the affairs of the Jordan disabled persons 2007. Lebanon Law #220/ 2000 on the rights of disabled persons

Palestine Law #4/ 1999 Law #61 /1999 on the welfare and rehabilitation of disabled persons, Law #2/ 2002 on the fund Yemen for the welfare and rehabilitation of disabled persons, Law #10/ 1997 on the social fund for development and Law #31/ 1996 on social care. Brief overview of Middle East Countries and Disability Laws

To see the full table on Legal entitlements please refer to the DMI website.www.disabilitymonitor-me.org

Disability Monitor Initiative-Middle East February 2009 Issue. 14 Ensuring access to Social Services: a condition to mitigate risk of poverty among persons with disabilities.

Darryl Barrett, Disability Services Coordinator, people have disabilities19 . For poverty Handicap International, Middle East. reduction, sustained economic growth and social development to be possible, Too often the social protection understanding the participation of people with disabilities is restricted to in cash or in-kind assistance in society needs to be guaranteed20 . It is and omits the fact that such measures estimated that only 2 percent of persons compensate the lack of opportunities such with disabilities in developing countries measures might not support actively persons have access to basic services, including with disabilities to reach their full potential. rehabilitation; the need for improvement in Though challenging for technical and this area is evident 21. Ensuring the access resources related issues, ensuring access to to basic or social services by governments social services appears to be a key condition in both developed and developing nations for inclusion of people with disabilities. is now seen as a major factor in the ability of the public sector to address issues of Disability is often viewed as being health, education, inclusion and overall both a cause and a consequence of quality of living for its citizens, especially poverty17. However, in accordance marginalized groups like those living with with the international consensus on the disabilities. Millennium Development Goals, and eradicating poverty, this goal is unlikely While there remains no consensus on the to be achieved unless the rights and definition of “social services”, the concept needs of persons with disabilities are can be generally approached from two (2) considered18 . It has been estimated that perspectives. Firstly, social services can up to 20 percent of the world›s poorest be viewed as those services that affect

17 BERRY Chris, FORDER A, SULTAN , S, MORENO-TORRES, M, 2004, Approaches to Improving the Delivery of Social Services in Difficult Environments, PRDE Working Paper 3, UK Department for International Development. 18 Ibid. 19 ELWAN Ann, 1999, Poverty and Disability A Survey of the Literature, Social Protection Unit Human Development Network, World Bank. 20 Stakes National Research and Development Centre for Welfare and Health http://info.stakes.fi/ ssd/EN/disabilityandpoverty/facts/index.htm as at 27 September 2008. 21 DESPOUY Leandro, 1993, Human Rights and Disabled Persons (Study Series 6), Centre for Human Rights Geneva and United Nations, New York. http://www.addc.org.au/webdocs/Disability%20&%20Poverty/Fact%20Sheets/INCLUSION%20INT_FACT%20SHEET_Fact%20Sheet%20on%20 Poverty%20and%20Disability.pdf

Disability Monitor Initiative-Middle East 15 February 2009 Issue. an individual on a very personal level such important for the Middle East, as the World as the provision of housing, personal care Bank has indicated that regardless of the assistance, social support and protection22 improved living standards in the region in . In addition to the personal aspect related to the past 30 years, the gap between the rich social services, a broader view can likewise and the poor, urban and rural are steadily be adopted. Social services can go further increasing26. Following the high revenues than providing personal benefits, in that the received by oil-rich Arab countries in the availability of services such as education, 1970s and subsequent economic inflow health care and employment, social services effects in non-oil rich Arab countries, bring about social cohesion and set basic governments were in a position to consider living standards with improvements on the investing in much needed social activities. equalization of opportunities23 . Social In the 1980s, governments in the region services therefore can be viewed as those were openly spending money on social covering a diverse range of services that services, including health care and education. work to reduce poverty, discrimination and However, in the following decade, spending social exclusion by enabling vulnerable and and budgets were re-evaluated when the marginalized groups (such as persons with real cost of these previously considered “free disabilities) to have equal opportunities services” were calculated27 . Governments within the community24. While providing the started looking more closely at containing services needed by marginalized or vulnerable the costs of social services and the issue of groups in society, social services provide an “access” to these social services became an equally important preventive function as the important aspect, particularly for marginalized provision of social services can avert groups groups such as persons with disabilities28 . from potentially falling into poverty or becoming increasingly marginalized due to economic or Ensuring that people have access social factors that may aggravate their inability to services, especially in difficult or to compete for health care, education and challenging environments is continually other basic services25 . being recognized as vital for the abovementioned personal and social This preventive aspect is particularly reasons related to a basic standard

22 CHIRIACESCU D, Ensuring Access of People with Disabilities to Social Services: The Need for Regulatory Mechanisms in South East Europe, May 2006, Handicap International. 23 Ibid. 24 ZAFIRIS Tzanatos, 2000, Social Protection in the Middle East and North Africa: A Review, Paper presented at the Mediterranean Development Forum, Cairo, World Bank, p3. 25 Ibid p.11. 26 Ibid p.14. 27 BALE Malcolm D., Reaching the Rural Poor in a Globalizing World, Paper from Expert Group Meeting on Globalization and Poverty Reduction: Can the Rural Poor Benefit from Globablisation? United Nations, 89- November 2001, New York. 28 Ibid.

Disability Monitor Initiative-Middle East February 2009 Issue. 16 of living, social inclusion and the the importance of contemplating on equalization of opportunities, in reference effective social service provision is that to various international agreements regional governments in the Middle East and understanding on the manner and now have a reference they can use and method of improving the situation for are working with international actors to poor and marginalized groups. Access ensure that service provision remains a to services is a crucial component in the priority and access to services for persons global aspirations reflected in the Millennium with disabilities and other marginalized Development Goals and as targets for groups is highlighted. For example, in donors when working with governments Yemen, the World Bank is working with the and non-governmental organizations29 . government to ensure that the Social Fund For example, the European Disability Action for Development improves access to basic Plan (2006- 2007) established priorities for services for marginalized Yemini citizens, the promotion of access to services relating and provides a transparent model for social to social inclusion and social protection30. service provision in the country33 . Similarly, the European Association of Service Providers for People with Disabilities With governments in the Middle East (EASPD) has also recommended for its receiving the UNCRPD positively, reflected 2008- 2009 action plan that access for all to in the signatories and ratifications of services is vital in their overall strategy31. the governments of the region, there is momentum and spirit in addressing some of The United Nations Convention on the many challenges faced by persons living the Rights of Persons with Disabilities with disabilities. From issues of legislation (UNCRPD) also underscores the on disability and proactive social policy to importance of ensuring access to services access to education services and assistance for persons with disabilities in various with employment opportunities, regional articles and as a cross-cutting issue (i.e., governments can be viewed as not only Articles 2, 19, 24, 25, 26, 27 and 28 to having the duty but could also be considered name a few)32 . as having the desire to positively affect change, with respect to ensuring access to The positive impact of international services for persons with disabilities in the instruments and policy papers reflecting Middle East.

29 Disability High Level Group, Disability High Level Group Position Paper, European Platform for Rehabilitation Meeting 1112- October 2007. 30 Ibid. 31 European Association for Service Providers for Persons with Disabilities, EASPD input on the bi-annual action plan on disability (20082009-) at http:// www.easpd.eu/LinkClick.aspx?fileticket=354358 61636149646B6F513D&tabid=3531&stats=false as at 28 October 2008. 32 United Nations Convention on the Rights of Persons with Disabilities 33 BALE Malcolm D., op cit.

Disability Monitor Initiative-Middle East 17 February 2009 Issue. Gate Keeping: Urgent Need For Reform to Ensure Fair And Effective Access To Social Protection Entitlements.

Alexandre Cote, Governance and Social Inclusion - Aggregating individuals needs to Advisor . SI.EM.PRE obtain an overview of situation and needs of persons with disabilities allowing Gate keeping is a mechanism allowing public policy formulation in terms of type and authorities to assess needs of persons with effectiveness of support needed, diversity of disabilities and decide who can be granted services to be created and their geographic entitlements and support granted by laws. distribution, staff training… If well designed and implemented, those - Allowing the most effective allocation of mechanisms contribute to an effective support resources available to people with disabilities, a good monitoring of the situation of people with disabilities In Middle East: A restrictive gate keeping and an optimal allocation of resources. reflecting restrictive policies Unfortunately in most of Middle Eastern countries, due to restrictive legislations and In Middle East those mechanisms policies, gate keeping can turn to be a tool are very limited and often reduced to that misleads the analysis of the situation of medical check and certificates, carried people with disabilities and doesn’t allow an out without a very clear frame (use of equitable distribution of public support. international classification such as WHO International Classification of Functioning), Being the system of decision making that administratively processed in different guides effective and efficient targeting institutions which decide whether persons of services and support for people with with disabilities applying, are entitled or not disabilities and other vulnerable groups, to certain support described in the laws. As Gate keeping is one of the fundamental much as the needs assessment is limited aspect of public policies aiming at supporting the diversity of entitlements granted is also children and adult with disabilities. The gate very limited, for two reasons: keeping mechanism operates at macro - As the laws, for most of them, are (local, national) and micro (individual) level. based on medical approach to disability, Ideally, it has three main functions: they do not focused on support to inclusion of person with disabilities and - At the individual level, ensuring that therefore offer a very little scope of person with disabilities benefit from a support (exemptions, technical aids, and comprehensive needs assessment and health insurance or pension benefit) are granted and oriented towards the most effective support they can get. - As the public sector do not provide

Disability Monitor Initiative-Middle East February 2009 Issue. 18 much services supporting people with could be effective gate keeping, and disabilities (non inclusive school and the Yemen disability fund which extend few support or specialised services) and possibilities of access to services for didn’t develop regulatory mechanism people with disabilities. allowing strong partnership with NGOs doing so, it cannot grant access to a Gatekeeping at macro level: assessing needed diversity of services. needs or creating invisible one?

The lack of information of persons with Assessing individual needs and having disabilities and their families, especially the opportunity to collect and organise

Sch.1: Gate keeping mechanism

among poor one, about their entitlements, data, gate keeping mechanisms should is also a strong limitation that prevents allow steering the balanced distribution them to benefit of the limited support they of social services at the territorial level, could get and therefore generate even in accordance with the real needs of the more inequality. users. Therefore, it should also allow concerned public authorities to target Interesting initiatives are taking place and allocate their resources for the best in Lebanon with the rights and access outcome on life of people with disabilities in program which is an example of what an accountable manner.

Disability Monitor Initiative-Middle East 19 February 2009 Issue. Unfortunately the limitation of the system - Persons who don’t know about their itself creates a strong bias. Because very entitlements, the system, and what it can few data exist about situation of people with brings them never make the step to get disabilities, gate keeping structure becomes assessed and register often the only trusted source of information, even if they reflect of very partial part of Worth to be mentioned that some ministries in the real situation of people with disabilities. charge of gatekeeping, aware of their strong Indeed, many people with disabilities budget limitation don’t seek to extend coverage remain invisible to the “system”: of their system as they know they might grant access to inexistent support due to lack of - Persons who are not entitled by laws to get resources and therefore would have to manage support as every gatekeeping mechanisms even more users frustration. This approach reflect strictly laws and their definition of undermines strongly the data collection and disabilities: for instance in some countries macro needs’ assessments that are essential only mobility disability is considered, to bring challenges of persons with disabilities therefore persons with sensory or intellectual where it should be: higher in the agenda of impairment don’t “exist” for the system. policy makers.

Initiative for Proper Gate-Keeping: The Rights and Access Programme. LEBANON.

Ms. Hyam Fakhoury, responsible for the Research rights for persons with disabilities and the and Development Unit / Rights and Access, National Committee for the Disabled (NCD) Ministry of Social Affairs, Lebanon was constituted by Law No. 243 / 1993.

The Right and Access programme is a good The NCD is the ultimate reference to all example of a gate-keeping mechanism that issues related to persons with disabilities facilitates access of persons with disabilities in Lebanon. Its mission is to define policies to the full enjoyment of their rights by in favor of persons with disabilities and optimizing use of available resources and to follow-up the execution conducted by public-civil sector collaboration. the Ministry of Social Affairs (MOSA) in coordination with all concerned public and 1- How did you initiate the Rights and private institutions. Access programme in Lebanon? The Rights and Access Programme (R&A) Following the recommendations of a national was born from the 1st National Committee in seminar on disability regrouping more than 1994. It was born from the necessity of the 150 NGOs, experts, and representatives of National Committee to execute its mission concerned private and public institutions, Law and its goals that were defined as follows: No. 243 / 1993 was issued; stipulating general - Ensuring all the rights of persons with

Disability Monitor Initiative-Middle East February 2009 Issue. 20 disabilities in Lebanon, - Accessible centers: there are currently - Facilitating access to these rights and all six (6) centers in Lebanon (Beirut, the accompanying privileges, and Baalbek, Hadath Taanayel, Tripoli, and Sarafand) and we are in the process of - Transforming relationships between the opening another one in Halba- Akkar. private and public sectors from a one based on “affiliations” (to a community, a party, etc.) These administrative centers are to one based on “rights” and “rights” alone. run permanently by trained staff and physicians; they are authorized to receive 2- Who are the main actors? the persons with disabilities and their The National Committee for the Disabled which families, create and update personal files, launched the program is one of the main actors issue the Individual Card and deliver all for R&A. It is a semi-public organization that other “visas” needed to obtain the rights comprised of eighteen (18) representatives from and services provided by the government each of the following: the Government (from as per Law No. 220 / 2000 (e.g., technical MOSA), NGOs recognized as service providers services, special care, exemption from for the disabled, disabled peoples’ organizations specific taxes, etc.). (DPOs) as well as disabled individuals. Each type of impairment (motor, mental, hearing and - The adoption of the WHO 1983 visual) is entitled to four (4) representatives classification of impairments as a reference each; twelve (12) members are elected by their bases and two (2) experts are nominated by the - The individual disability card: More than Minister. The President of the Committee is the 68,000 of these cards have been issued. Minister of Social Affairs, the Vice-President, The aim is to facilitate the evaluation of the its General Director and two (2) other members qualitative and quantitative needs of the are the Head of the Disabled Service, and the disabled in Lebanon and to secure access Director of Social Services. R&A is integrated to their rights. This card allows its holder to into the Ministry of Social Affairs. benefit from all the rights and advantages as defined by laws of and decrees in the country. As stipulated in the Law No. 220 / 2000 that replaced Law 243 / 93, MOSA is the National - The production of norms, standards Executive Body tasked to address all issues and procedures related to specialized, on disability. Its objectives is are 1) to ensure institutional or proximity services. the transition of persons with disabilities from - The elaboration of necessary the state of marginalization they are currently legislations and regulations. experiencing to total integration, and 2) to transform the relation of disability from mere - Covering technical aids and specialized “charity work” to professional work based on services, aimed to coordinate with all rights and duties. public coverage institutions in Lebanon

3- What are the main components of the - A developed automated, decentralized programme? administrative system to manage, monitor

Disability Monitor Initiative-Middle East 21 February 2009 Issue. and upgrade or improve the program. and bring with them some basic official - Awareness and information on rights of documentation: an identification card, two persons with disabilities. (2) photos, a family civil registry record, a social security card and complete medical 4- How does the programme complement file, if available; an audiogram is mandatory the existing social security scheme? for those with hearing impairments. The accredited specialized physician examines The Rights and Access programme the person and fills an application form while guarantees an administrative infrastructure the center’s staff completes and processes that allows targeting the needs of the the application. The individual disability card persons with disabilities more directly and is provided on the spot if the person has a facilitates access to the required services “classified” impairment; this is free-of-charge. provided by public and private institutions. All other “visas” or certificates for other In this regard, the Rights and Access public services for persons with disabilities programme is a pilot project, as its purpose is follow a similar procedure, requiring to harmonize existing schemes: social security, pertinent documents relevant to the service. civil servants, and other schemes, focusing Procedures are printed and available in all on an accessible, transparent adequate and centers and in MOSA. Appointments can be dynamic procedure, optimizing both service given to shorten any waiting time in the center provision and management of public funds. and to ensure the presence of the specialized medical doctor. Home visits can be conducted 5- What are the benefits for the persons when the disability is too severe. with a disability enrolled in this programme? 7- What are the key limitations of the system? There are no direct financial benefits for Although there are administrative constraints persons with disabilities who register at the that hinder the development of the program, MOSA and/or R&A. The Rights and Access the main limitation of the system is that programme distributes the Individual Disability its funding comes from the budget of the Card according to pre-set classifications of Ministry of Social Affairs and it is public impairment, morbidities, causes and their knowledge that the agency generally suffer identified needs and rights; consequently, it from a lack of funds. And since 1998, when also supplies “visas” for other organizations, the Programme was launched and the MOSA government services and exemptions. financially covered the proximity services delivered by accredited institutions to persons 6- What are the procedures of with disabilities, such as wheel chairs, assessment and granting entitlements? incontinence aids and bed sore prevention The person with disability should first go to aids, the lack of or decreasing budget reflects a reception R&A of their choice, usually the an important threat to the system, especially one nearest their place of work or home as far as its expansion is concerned.

Disability Monitor Initiative-Middle East February 2009 Issue. 22 Can Cash Transfers Reduce Inequality for Persons with Disabilities?

specifically for the most vulnerable groups. Adib Nehmeh, PA for Poverty Reduction Policies This obligation requires no contributions UNDP, SURF-AS from the concerned parties and individuals as it relies heavily on State budget or grants. Cash transfers can be defined as the In contrast, the second trend compels provision of assistance in the form of cash beneficiaries of any given social protection to the poor or those who face a probable system to finance the rights and services they risk, in the absence of the transfer, of falling are enjoying34 . Generally, the more the social into poverty. Transfers targeted at persons protection system includes wider segments with disabilities recognize that they are of society, the more it favors the first trend, facing much more barriers than others to wherein service is provided by the State, earn a living and that some persons with especially if the State adopts a human rights- severe impairments might have difficulties based approach and if the service in question even if given the opportunity to participate is one of the (morally, politically, and legally) in livelihood programs or if education and binding “basic” human right (as indicated and employment policies are more inclusive. protected in various human rights covenants, Disability targeted transfers thus, intend national legislations and Constitutions). The to provide basic income security to this philosophy, and subsequent practice, a vulnerable groups. Nevertheless, some State implements has an impact on persons observers argue that transfer programs with disabilities and has implications on targeted at persons with disabilities seem the adopted definition of disability and the to follow a charity view of disability rather perspectives used to deal with persons with than a development and rights perspective disabilities. In this light, the United Nations to empower and involve persons with Convention on the Rights of Persons with disabilities. Adib Nehme gives us a closer Disabilities (UNCRPD) is supposed to look on the issue and its challenges. constitute the adopted approach.

Background Disability defined

The social protection systems present According to the UNCRPD, disability does significant differences, where two (2) not result from a person’s impairment important theoretical trends prevail; the first or deficiency, but from the interaction of trend holds the State (or society) responsible persons with disabilities with attitudinal and for ensuring basic services and rights for all, environmental barriers that impede their

34 This may either be in the form of a general contribution to a certain fund, such as contributions to the social security fund or any of its related clauses or coverage (i.e., end of service indemnities, maternity, sickness etc.) or in the payment of duties and fees to be settled as soon as the specific service is availed, whether as a nominal fee or full or partial payment for the service.

Disability Monitor Initiative-Middle East 23 February 2009 Issue. full and effective participation in society on contributions to financing the process, will in an equal basis with others. In other words, turn, create a less-enabling environment. disability is defined as a relation between a person with specific characteristics As explained earlier there are different and an environment that might not be systems of contributions; public contributions complementary, supportive to or helpful on the one hand and private contributions in dealing with these characteristics; on the other. Hence, we must point out that and since disability is based on interaction, there is no ready-to-use formula but an it does not occur without the presence optimal balance among the merits of different of both parties constituting the relation. approaches must be attained, based on Consequently, the responsibility of the the level of participation of citizens in the society and the environment are deemed decision-making process and adherence to structural and essential factors in terms of the human rights-based approach. creating a disability. It implies securing the Cash Transfers rights for a person negatively affected by the environment, causing him/her to be disabled; Assistance and transfers are tools of the this also means that the government and social protection system and safety nets; the private sector shall assume a higher there are basic differences between two (2) level of responsibility in eliminating main kinds of assistance: in-kind assistance factors causing disabilities from the in all its forms or “traditional assistance” and environment. However, this should not conditional and unconditional cash transfers. translate into more obligations (i.e., higher contributions) for persons with disabilities to Cash transfers vis-à-vis in-kind assistance finance and/or make the necessary changes When we speak of the transfers system, we in the surrounding environment. do not refer to the non-organized material On the contrary, statistics and studies support that takes place within families undertaken in most countries illustrate that the or any group bound by kinship, but to a number of persons with disabilities is higher in more structured system of providing cash the poor and low-income groups than among assistance that may be conditional or other groups. As a result, governments unconditional, to specific groups of persons and community-based groups, in which the based on a pre-set eligibility criteria. Cash private sector effectively participates, tend to transfers are based on the assumption adopt the approach which underscores the that the recipients are in a better position importance of public or direct contributions to determine their priorities in expending through charges and fees in exchange for the the money or assistance provided; while use of and access to services; this will have the provision of in-kind assistance (e.g., a more negative impact on a person with a food, clothing, appliances, books, etc.) disability. Even if persons with a disability assumes that the provider is in the best are exempted from fulfilling some obligations, position to ascertain what is best for the the approach, which puts emphasis on beneficiary and accordingly chooses the

Disability Monitor Initiative-Middle East February 2009 Issue. 24 form or kind the assistance will take. best form of assistance (i.e., cash or in-kind, depending on the context). This is why we Cash transfers: what NOT to do cannot be adamant in saying that the cash The feasibility of conditional cash transfers transfer system is the best form of assistance is still being debated on and has not yet for persons with disabilities, without taking reached a consensus. At best, these have into consideration existing social policies or achieved mixed results35 , while programs social protection systems, especially those with one or more of the characteristics below encompassing persons with a disability. In are expected to receive severe criticisms: fact, only after these have been taken into consideration can cash transfers actually • Conditional and in-kind assistance mean make sense. that the provider has decided the priorities, expressed as a specific requirement or Is it convenient, especially for persons restriction; with a disability relative to other citizens?

• The system adopted for choosing While we cannot completely answer in the beneficiaries may not be accurate or affirmative, in-kind assistance to persons objective; with a disability are usually devices that compensate for the impairment of certain • Ensuring that beneficiaries abide by the physical functions, such as prosthesis, conditions requires complicated monitoring artificial limbs, wheelchairs, Braille equipment and follow-up systems; and and hearing aids, etc.. It may also be in the • No set timeframe as to when the program form of drugs or equipment for health care implemented is expected to finish. purposes (e.g., water mattresses, diapers, Experience has shown that this system tends etc.); in the case of persons with a disability, to become a form of continuous support, provision of in-kind assistance takes top- whereas provision of the assistance should most priority, whether it is supplied directly or end on the basis that the beneficiary has through cash transfers specifically intended become self-sufficient, presumably due to his/ for the purchase of these and other similar her being a recipient of the assistance. equipment or devices.

Cash transfers, person with a disability Caveats on Conditional Cash Transfers and other vulnerable groups Are conditional cash transfers the best However cash (or other in-kind) transfers form of assistance? can target persons with a disability as Cash transfer systems is a safety net well as other fellow citizens as long as the component and consequently, a social poverty indicator is present. With persons protection element. An integrated social with a disability, it is often the case that their protection system should be first established, capacities and environmental conditions are and within it, a method of establishing the not properly identified and consequently are

35 The most successful cases can be found in Latin American countries such as Brazil, Mexico, and Chile.

Disability Monitor Initiative-Middle East 25 February 2009 Issue. not covered by the framework of conditions in-kind assistance systems and institutions generally stipulated in the conditional transfer for persons with disabilities and will fully system. A good example of this is the engage in guaranteeing the requirements of condition of sending the child to school to the care or service provided to them. While avail of the assistance when there is a lack in other countries with fewer resources, such of well-equipped schools to accommodate initiatives will depend on the space given in children with disabilities. In this situation, the public arena by the State to the social it is difficult to imagine that the cash society and private sector. Moreover, one and in-kind transfer systems address should take into consideration the impact of and encompass the needs of persons International Organizations like the World with disabilities. Thus, it is imperative Bank (WB) - that can be considered as the that a system appropriate to the needs of initiator and promoter of such systems in the person with a disability is created, at least countries where it operates. temporarily, or sections are reserved for them in a public system. However it is Generally speaking, we can say that important to emphasize that the main issue governments and some development actors is the elaboration of social policies and the in the Arab region are resisting the switch public system to ensure social protection, from the current systems to cash transfer specifically for persons with disabilities. systems for various reasons some more compelling than others. Role of the State In this regard, would be important to note that The role of the State in such systems varies Arab countries are highly bureaucratic, with from one country to the other. In some Arab the public sector suffering from large gaps countries, especially the oil-producing ones, in technology, human and organizational the State plays a major role in the disability capacities, and high rates of corruption and sector, specifically in providing the financial nepotism. This is compounded further by the resources while in some cases, three (3) presence of multiple social groups, unevenly factors favour this trend: distributed among regions, religions, rites and tribes of one country. Primarily due to 1. Dominance of the State in the social and the factors cited above, the adoption of a economic sectors; computerized technical cash transfer system 2. Religious, moral, and ideological is more difficult, often resulting in high levels backgrounds influence and to a certain extent, of errors and loss, aggravated by a less- perpetuate patron-client relations between the effective monitoring capacity. Thus, it would State and less-favoured groups (in this case, appear to the citizens and some social persons with disabilities); and categories and groups that the authorities are allocating funds for their supporters and 3. Availability of financial resources mostly or people of their region or kin rather than derived from oil revenues. assigning the funds on objective criteria In this case, the State will create cash and based system.

Disability Monitor Initiative-Middle East February 2009 Issue. 26 Cash Transfers and Persons with Disabilities in practice: The Case of Yemen

focusing on community-driven development Afrah Al Ahmadi, Senior Human Development Specialist / World Bank, Yemen Country Office and provision of basic services. It has established a special program for disability, wherein it supports access to rehabilitation Social assistance programs, such as cash and social services, capacity building for transfers, and social funds, have been used disabled peoples’ organisations (DPOs) and to help reduce poverty and mitigate income non-governmental organisations (NGOs) shocks for excluded and marginalized working on disability issues and provide groups. However, social assistance disability policy support. While DF is a programs have not been designed within disability-specific mechanism, the SFD and the context of an integrated social protection SWF target a wide range of Yemeni poor, strategy, which renders their efficiency quite including the poor persons with a disability. problematic. Afrah Al Ahmadi discusses the specific case of Yemen. The DF provides financial assistance to persons with disabilities for health care, Background education and assistive devices; this In the mid-90s, the Government of Yemen assistance is also extended to NGOs and (GOY) initiated a Social Safety Net DPOs as fund support for activities targeted Program (SSN) to mitigate adverse impacts at persons with disabilities. The SWF, on of the economic reform program on the the other hand, is the national cash transfer poor. The number of sub-programs under program with persons with a disability as the SSN grew over time and includes: (i) part of its eligible beneficiaries. A discussion Social Welfare Fund (SWF); (ii) Social Fund on targeted cash transfers to persons with for Development (SDF); (iii) Public Works a disability in Yemen would include both the Program; (iv) the Disability Fund (DF); (v) Disability and Social Welfare Funds; while the Productive Families Program; and (vi) the SWF provides direct cash transfers, the DF Agricultural and Fish Production Promotion makes available in-kind transfers to persons Fund. The overall objective of these funds with disabilities. is to provide protection and services to the poor. Three (3) of these funds have direct The Disability Fund was established in targeting for persons with disabilities: DF, 2002 with the objective of providing stable SFD, and SWF. and fixed financial resources to support different projects to rehabilitate persons SFD has a wide range of programs with disabilities; these projects were

Disability Monitor Initiative-Middle East 27 February 2009 Issue. expected to directly benefit the disabled. of YR2,000 per family. In response to the food crises, the Government has doubled The Fund is also expected to coordinate the amount of cash transfer. within the social protection network to ensure that various needs of the disabled are met. SWF makes available two (2) types of Hence, the Fund channels financial resources assistance: permanent social assistance to persons with disabilities by: (i) financing and temporary relief. The groups targeted projects and activities implemented by DPOs for the former include orphans, widows and NGOs directly benefiting persons with and divorced women, single women and disabilities (e.g., vocational training, physical the permanently disabled, if they are not rehabilitation and special education); and receiving income from other sources, such (ii) purchasing direct services for persons as pensions or the Martyr’s Fund. Groups with disabilities (e.g., assistive devices, targeted for temporary relief consist of the health care and educational assistance). temporarily disabled, and families with a The Fund operates through branches at missing or imprisoned household head, the Governorates level and the manner of unemployed convicts who have spent at its operation is mainly reactive, whereby least three (3) months in prison. In principle, persons with disabilities have to access the the beneficiary has to be without income Fund and submit an application to avail of the or lacking or without the potential to earn assistance. income.

This approach limits the access of persons At the end of 2006, nearly three-fourths of with disabilities to the assistance, especially the one (1) million targeted beneficiaries those in the rural areas (Yemen is over 70 were in the “permanent” category absorbing percent rural). about 80 percent of the budget. The dominance of “permanent” category The Social Welfare Fund36 was beneficiaries creates a risk of non- established in 1996 with the singular graduation from the program. objective of providing cash grants to vulnerable groups that are identified to be The distribution of SWF benefits follows a using a categorical approach (e.g., orphans, three-staged targeting approach: in the first women without support, completely and/ stage, the number of “cases” is distributed or partially disabled persons and poor, among governorates based on food-poverty needy persons). Until recently, the amount estimates of 1998 - 99; the next stage of of assistance was YR 1,000 monthly at targeting is based on estimates of district the minimum, with an additional YR 200 level food-poverty estimates and the last for each family member and a maximum stage, within a district, applicants are

36 This section quotes from the report ”An Integrated Approach to Social Sectors Towards a Social Protection Strategy – Phase 1”, World Bank, 2008.

Disability Monitor Initiative-Middle East February 2009 Issue. 28 evaluated according to fifteen (15) criteria reform program, the SWF is considering to determine their degree of deprivation. introducing Conditional Cash Transfers On a scale of zero (0) to 26, those that (CCT) to protect the long-term human score over 21 are automatically selected, capital of the poor by linking cash transfers while those that score below twelve (12) with education and health programs. are automatically disqualified; local elected Furthermore, by its mandate, the DF could councils decide on the cases that fall in- play a more important role in reducing between. inequity in favor of persons with disabilities, by supporting the rehabilitation and The SWF is currently reforming its targeting development of persons with disabilities. mechanism. The new targeting approach Attaining equity requires a supportive policy will depend on the 2005 household budget framework and proactive programs for the survey and used the proxy means-testing in empowerment of persons with disabilities. defining the poor; the new approach would The SFD is supporting the development also involve the community in the process. of a National Strategy for Disability that is It is expected that the new approach will expected to provide the policy framework minimize the leakage of SWF assistance to and help bring the different programs the non-poor. targeting persons with disabilities together and work in a coordinated manner. Can these funds transfer be useful to persons with disabilities? The SWF is The DF support to individual persons with a cash assistance mechanism aimed to disabilities through assistive devices and help the poor cope with extreme poverty. physical rehabilitation is a very important The principle behind the assistance would contribution that when it is linked with be coupled with other social protection other initiatives supportive of longer- programs (i.e., skills training, employment term development like skills training and and education) to help beneficiaries move inclusive education, it can better prepare out of poverty and to mitigate the risks of the person with disability to be integrated falling into poverty. The transfer amounts in mainstream society. to only 10 percent of the consumption expenditure of the poor so while SWF cash A key challenge for most of the existing transfers helps; it does not replace other programs, particularly the DF is the sources. capacity to reach out to persons with disabilities in the rural areas. Many Currently, the cash transfer is not initiatives exist in Yemen but many are conditional, meaning, the family or biased for the urban areas and lack the individual have complete freedom on capacity and resources to reach those in how to spend it. As part of its ongoing the rural areas.

Disability Monitor Initiative-Middle East 29 February 2009 Issue. Health Insurance for Persons withDisabilities: Real Practices or Pure Wishes? Views from public official and civil societies

While the right to health care services is stipulated in national laws, access to these services is often hindered by several obstacles generated by macro and micro political problematiques. Rima Canawati draws the situation for persons with disabilities in Palestine.

Palestine: Rima Canawati. Before obtaining the health insurance, persons Head of Special Education & Community Programs with disabilities should first be referred to a Psychosocial Intervention Program Coordinator district level medical committee to determine Low Vision Program Manager the percentage their disabilities, since only Bethlehem Arab Society those with a disability percentage of 60 percent or more can be entitled to health insurance 1- What is stipulated by law concerning under the current regulations; although the access to health services in Palestine? Is Palestinian Law No. 499/ on the rights of this being implemented? persons with disabilities asserts that all persons with disabilities are entitled to health services The Palestinian Law on the rights of persons covered by the government health insurance with disabilities No. 499/ stipulates, «to free-of-charge regardless of the disability guarantee health services that are included in percentage. the government health insurance free of charge both to the individual with the disability and to 2- Can you explain how the health care his/her family.» system works in Palestine?

Unfortunately, the law is not implemented. The health service providers in Palestine However, an agreement was reached between are the Palestinian Ministry of Health, non- the General Union of Disabled Palestinians government organizations, the private sector (GUDP) and the Palestinian Ministry of and the UNRWA. NGOs are still the main Social Affairs during the second Intifada that service providers in the rehabilitation sector, allows persons with disabilities to avail of providing national, intermediate and grassroots- government health insurance and enable them level rehabilitation services as well as assistive to receive health care services for 60 New devices. Health services are restricted to health Israeli Shekels (NIS = $17) to be paid once. centers, general hospitals and private clinics Two years ago, this fee was canceled and in addition to rehabilitation centers while many persons with disabilities became entitled to free specialized health services are still lacking, government health insurance. Nevertheless, particularly in the public sector. Majority of children and adults with disabilities are patients seek these specialized services at the entitled to health insurance for themselves NGO and private sectors if available; otherwise, and not their families, unless the head of the they seek those services abroad being self- household himself/herself has a disability. referred or, when entitled to public health

Disability Monitor Initiative-Middle East February 2009 Issue. 30 insurance, referred by the Palestinian Ministry and general public hospitals in cities whenever of Health which covers around 70 to 90 percent needed; patients without disabilities have to of the cost of treatment incurred depending pay fees for public health insurance (around on the period during which the person has 960 NIS = $270 per year). been insured (i.e., 70 percent for those newly- insured, 80 percent for those insured for the It is important to note that the health system past three (3) months and 90 percent for those in Palestine has been overburdened due to insured for at least one (1) year. increased emergency demands, a result of the rising number of conflict-related injuries, Nevertheless, treatment expenses for civil the tight siege imposed on Palestinian servants, public workers and persons with territories and the continuous decline of the disabilities are 95 percent covered, while those Palestinian economy. The country is currently for the staff of the Ministry of Health and those experiencing severe constraints: an apparent injured in the Intifada are fully-covered. The lack of specialists and qualified medical and referral decision has to be done by the National paramedical human resources, a considerable Referral Committee situated in Ramallah, shortage of medical supplies and technical which might take a long time before a decision resources that has adverse effects on the is acted on unless the patient has personal quality of the health services rendered. contacts with top government officials. 4- Do all persons with disabilities have Those who have these personal relations can equal access to health care services? even get referrals from NGOs, the private sectors or abroad, even if the same services Not all persons with disabilities have equal are made available by the public sector. access to health care services in Palestine; Restrictions on constant movement, especially particularly those who come from poor families with the construction of the separation wall and live in remote rural areas a significant that has divided the Palestinian territories into number of them face problems accessing the isolated cantons, has led to the establishment needed specialized health services unavailable of specialized health services at the district in the public sector because the referral level by NGOs and actors in the private sector system is quite bureaucratic, centralized and to meet the emerging needs of the Palestinian ineffective. population. 5- Are there any other conditionalities to Nevertheless, patients with public health access health services? (i.e., be employed, insurance still need to avail of the health etc.)? services they are entitled to, from public In general, there are no conditionalities for hospitals in other districts, rather than being health insurance, as long as they pay the referred to NGOs despite difficulties in access required fees that majority of the population and expenses encountered. Patients entitled cannot afford due to the sluggish economy and to public health insurance may avail the health stifled by continued Israeli restrictions on trade services at primary health clinics in rural areas

Disability Monitor Initiative-Middle East 31 February 2009 Issue. and movement. Everyone is entitled to public conditions that make it very difficult to break the health insurance; public workers are usually vicious cycle of disability and poverty. At any insured by the Palestinian Authority but the rate, there is no official disability and poverty Palestinian health system remains inefficient. related statistics available in Palestine.

As for persons with disabilities, they can access 8- How many persons with disabilities do public health services made available when their not have adequate health insurance in disability percentage exceeds 60 percent, as Palestine? per the Jordanian Law of 1951. This does not correspond to the Palestinian Law on the rights There are no official statistics but in principle, of persons with disabilities No. 499/ that has not all persons with disabilities are entitled to public yet been implemented due to severe financial health insurance in Palestine. However, even constraints on the part of the Palestinian persons with disabilities who do use their health Authority. The disability percentage is decided insurance do not receive adequate, quality by a designated Medical Committee at the health services since the health system and district level appointed by the Ministry of Health. infrastructure in Palestine has been damaged under deteriorating conditions; moreover, public 6- Are there any fees for health services? health services often lack human and technical resources and even medical supplies. Health insurance fees of the government amount 9- What are the consequences of the lack to 960 NIS, equivalent to $270 per family per of healthcare coverage for persons with year. However, the person, whether with or disabilities in Palestine? without disability, should also cover five (5) to thirty (30) percent of his/her treatment expenses The lack of health care coverage for persons when referred to the NGOs the private sector or with disabilities in Palestine has negative abroad, depending on the period during which implications for early detection, identification he/she has been insured, as explained earlier. and proper diagnosis of disabilities and Public workers are automatically covered by the implementation of early intervention. Moreover, Palestinian Authority. it causes further complications in the person›s health condition as well as an increase 7- How many persons with disabilities are disability and mortality rates among persons living below the poverty line in Palestine? with disabilities. According to World Bank reports, more than 66 percent of the Palestinian population lives JORDAN: Dr Munther Ammari, below the poverty line. Almost all persons with Chief of Early Detection and Diagnosis of Disabilities disabilities in the country also subsist below in the Mother and Child Health Directorate, Ministry of the poverty line and they are among the most Health, Jordan disadvantaged persons in the world, often over- The Law on the Rights of persons with represented among the poorest of the poor. disabilities (No.31 for the year 2007) The situation is more complicated for persons with disabilities in Palestine due to prevailing stipulates in Article 4 that the Ministry of Health

Disability Monitor Initiative-Middle East February 2009 Issue. 32 shall provide citizens with disabilities with related to issues concerning them. services and rights in the following fields: It is important to note that the law is generally implemented, but some particular points are - Preventive programs and health education only partially implemented such as the neonatal including necessary surveys for early screening for PKU, hearing loss and congenital detection of disabilities hypothyroidism; the Ministry of Health seriously - Diagnosis, scientific classification and looks into applying the above screenings in issuing medical reports for persons with national and worldwide programmes. disabilities Now let us examine more carefully the health - Medical, physiological rehabilitation and care system in Jordan: therapeutic services at different levels and making them easily accessible on the one hand we have, the Ministry of Health (MOH), which includes the Jordan - Primary health care for women with Medical Council, the Higher Health Council and disabilities during pregnancy, delivery and MOH hospitals; post-natal periods on the other hand, MOH health centers are - Free medical insurance comprised of the Royal Medical Services, medical services of governmental universities, In addition to that the abovementioned private hospitals, the United Nations relief and services, according to this law, the Higher works agency (UNRWA) and primary health Council for the Affairs of Persons with care services. The latter encompasses pre- and Disabilities was established to give the issue of post-natal care, family planning and child care. disability its due importance within the policies There are 414 maternal and childhood centers in Jordan, putting it on the top of the list of (MCH centers) covering all the regions of Jordan national priorities. It also aims to improve that provide its services free-of-charge. We have the quality of life of persons with disabilities to mention that all children from birth until six (6) and empower them to live a decent and years of age have free medical insurance. productive life within their respective families. Another goal of the Council is to curb and All persons with disabilities have equal reduce the rates of occurrence of disabilities access to health care services in Jordan in the Kingdom; it also focuses on improving but the rehabilitation services, such as the quality of the services made available to physiotherapy, occupational therapy, speech persons with disabilities, taking the gender therapy and training, are not available in rural differences into consideration and preventing and remote areas. discrimination against them to realize equity in opportunities and enhance self-reliance. There are no conditionalities for entitlements Finally, it seeks to broaden the participation of and there are no fees for health care as all disabled persons and integrate them in society, disabled persons are entitled to free medical in view of their right to participate in decisions coverage.

Disability Monitor Initiative-Middle East 33 February 2009 Issue. There are no statistics on disabled persons It is recognized that early detection will lead to early intervention of rehabilitation yielding below the poverty line because the numbers the best results; in the case of the lack of the are unstable. health care, the relatives are asked to reach Sometimes however, some medications or the services from the nearest available center. rehabilitations aids may not be available so they Jordan is a small country so the consequences have to bring their own or seek help for adequate for people in remote areas are less as they can health services from the national welfare fund, likewise reach the nearest service within an the «Royal Diwan» or from the Higher Council for hour or so. the Affairs of Persons with Disabilities. Exemptions for Persons with Disabilities: A Vaccine against Exclusion? The Debate…

The exemptions issue is quite a controversial one: on the one hand, exemptions are seen as a good means to compensate for the extra costs generated by a disability; and on the other hand, some activists in the disability movement see that the exemptions are based on a charity and medical perspective. Two activists, coming from different contexts (Palestine and Lebanon) shed the light on these different perspectives on this issue’s “debate’’.

Palestine: Nasser Jaber a pilot initiative in the event of effective President of the Bethlehem Sport Club of Disabled implementation. Article 6 of the aforementioned law states that all persons with disabilities are exempted from tariffs, customs duties and taxes 1-Can you please narrate to us your imposed on medical and educational materials actions and advocacy efforts to provide and equipment, as well as on assistive devices exemptions for persons with disabilities? and personal transportation used by persons Since the early 90s, persons with disabilities with disabilities. There are also exempted started taking the lead in setting up and institutions and schools that ensure the managing their own institutions and clubs, transportation of persons with disabilities. influencing decision-makers to grant them 2- Are there residency and occupancy their full rights so that they would live in dignity requirements? and independence. Their demands were met in 1999 when local community institutions As far as I know, there are no residency and adhered to the Persons with Disabilities’ claim occupancy requirements. But the intended movement. The 1999 Law No. 4 on the rights beneficiary must hold a resident status in of persons with disabilities is considered Palestinian territories.

Disability Monitor Initiative-Middle East February 2009 Issue. 34 3-What are the disability requirements 5-What kind of exemptions are generally (eligibility criteria)? implemented for persons with disabilities?

The eligibility criteria are set as follows: Persons with disabilities are exempted from paying tariffs, customs duties and taxes. - The concerned person must have a disability, as wells as an impairment rate 6-And in Palestine, are people with defined by the Palestinian Minister of disabilities entitled to exemptions? If yes, Health. By virtue of the law, this Ministry is what kind of exemptions? the body entrusted with such tasks Yes, as mentioned earlier, persons with - Permanent impairment rate must be 80 disabilities in Palestine are entitled to percent and above exemptions in accordance with the law, more specifically in accordance with Article 6 of - The concerned person must be Palestinian the aforementioned law; these exemptions citizens encompass tariffs, customs duties and taxes. However, no consensus has been reached by 7-What additional disability-related costs are the official parties requested to set an exemption you facing (personal impairment and lack rate equal to that of impairment instead of of support services generating even more depriving a considerable portion of people from expenses)? accessing the service. This issue has not yet been settled and the State is asked to set an Unfortunately, our society totally refuses to exemption rate equivalent to that of impairment. recognize the capacities of persons with Thanks to this step, a considerable number of disabilities. I do believe that we are facing a people are expected to benefit from this service. crisis of confidence caused by insufficient social awareness campaigns. It is worth mentioning 4- What are the income requirements? How that this on-going confidence crisis begins in the do you define income? Does the existence early stages of education and becomes a huge of an income disqualify the person with barrier that separate persons with disabilities disability from an exemption? from other segments of society. One should Generally, exemptions are not connected to also bear in mind that persons with disabilities income but are, in some cases, related to vehicles have had their share, in one way or another, (personal means of transportation). If the applicant in building this barrier; these factors along with or person requesting is jobless and classified as those that have increased the burden of disability a social case, in other words, if the concerned and its complexities. In this case, persons with person is poor and cannot afford to buy a car, disabilities have a hard time looking for a job, exemptions are brought into attention due to the regardless of their academic and vocational danger that Persons with Disabilities might be achievement levels. The situation is further exploited by opportunists who would avail of the aggravated by the failure of the State to make privilege as not everyone is entitled to it, thus available the needed services and subsidies. costing the State a considerable amount of money. Given all these factors, tutors of children with

Disability Monitor Initiative-Middle East 35 February 2009 Issue. disabilities were unfortunately obliged to abandon believe that the standard rule should not be their students, which sometimes expose them to the exemption; the standard rule and principle exploitation, abuse and persecution. is that persons with disabilities have the same duties and obligations as their co-citizens. 8-In your opinion, do exemptions for persons Legislative bodies should examine what the with disabilities contribute to the alleviation extra costs are for a person with disability and of their exclusion? Why and how? decide on corresponding exemptions.

Provided exemptions that hopefully will A lot of disabled peoples organizations (DPOs) be increased and developed to a greater and activists in the disability movement did not extent, help in dealing with some issues and understand our position concerning this matter; contribute, though to a lesser extent, to the unfortunately, there is always the temptation for alleviation of the financial burden when buying some DPOs to request that most of the services assistive devices for persons with disabilities; and goods to be completely free-of-charge. devices typically include wheelchairs, printings equipment, specific computers for persons 2- What are the general requirements to with visual impairment and other mechanisms. qualify for exemption? These are provided in such a manner that persons with disabilities achieve a smooth and To be eligible for the exemption, an applicant easier integration into society. must have a documented physical or mental impairment and hold a disability card provided Persons with disabilities can also buy their by the Lebanese Ministry of Social Affairs37 . own transport vehicles exempted from tariffs, customs duties and taxes. When such measures However, I maintain that the only requirement are implemented, the cost of a given vehicle is and condition should be the extra cost that a more than halved and consequently, they will person with a disability has to pay because be more independent and will be able to move of his/her disability, independent from his/her around easily. All these factors will contribute to will. One should not be eligible for disability widen the horizon of persons with disabilities in exemptions if they cannot engage in gainful terms of education and job opportunities. work due to a physical or mental disability; in this case, they would consequently fall under another Lebanon: Amer Makarem. vulnerable category, that of the unemployed. President, Youth Association of the Blind, Lebanon The most important requirement/criteria should 1- Could you please narrate to u your actions be based on the fundamental rights of citizens concerning the exemptions for persons with and human beings. disabilities? 3- What are the income requirements and When the Law 220 / 2000 was being expanded, what is considered income, and does the some activists in Lebanon were demanding to existence of an income disqualify the have the exemptions mentioned. I personally persons with a disability for an exemption?

37 http://www.socialaffairs.gov.lb/ShowPage.asp?spID=1201020

Disability Monitor Initiative-Middle East February 2009 Issue. 36 Income, generally referring to salary and wages, disability (personal impairment and lack social security payments, interests38, should of support services generating even more not be a condition for exemptions especially expenses) are you facing? if we consider that exemptions are for the provision of basic fundamental needs and I am visually-impaired, therefore, I cannot goods and not for subsidiary and luxury goods. use the public transportation, which is not 39 For instance, some persons may be tempted accessible in Lebanon, or avail of the service ; to buy luxury cars; exemptions to make the car I am obliged to take a taxi, which costs me three accessible in this case, will be disapproved. (3) times more than the “service” and up to ten Exemptions should target basic services such (10) times more than the public transportation. as access to education, health and leisure. Access to education and culture is also problematic as Braille books are expensive. 4- What kind of exemptions is generally implemented for persons with a disability? 6- In your opinion, do exemptions for persons And in Lebanon, are persons with disabilities with disabilities contribute to the alleviation entitled to exemptions? What kind of of their exclusion? Why and how? exemptions? Well, if marginalization comes from the The most common exemptions are: impossibility or difficulty to access fundamental and basic services such as health, education, - Free public transportation social life, leisure, transportation, etc., then - Customs exemptions exemptions can be a tool to alleviate exclusion - Accessibility/special devices for persons with disabilities. - Cultural activities/museums 7- Anything you would like to add? Persons with disabilities are entitled to a few exemptions in Lebanon such as municipality I think it is important to highlight one point: who fees and taxes, registration taxes and pays for the exemptions and the extra costs of customs for cars; however, these are not all disability? NGOs and civil society organizations implemented. have to contribute but this is mainly the responsibility of the State. The State is responsible 5- What additional costs related to your for providing public services for its citizens.

38 Income includes: - disability payments, - all Social Security payments, - salary and wages (including bonuses), - interest (including non-taxable interest on state and local bonds), - total dividends, - net earnings from farming, rentals, business or profession (including amounts claimed as depreciation for income tax purposes), - income from estates or trusts, - gains from sales and exchanges, - the total amount received from governmental or private retirement or pension plans, - annuity payments (excluding amounts representing a return of capital), - alimony, - unemployment insurance payments, - workers’ compensation, etc. 39 Cheap collective cab.

Disability Monitor Initiative-Middle East 37 February 2009 Issue. What’s Next?: These interviews highlight various concerns stakeholders are able to diagnose the and several challenges not only with respect weaknesses and to identify the problems. The to the CRPD ratification, implementation or next step then should be the capacity building monitoring,but also in the sought occurrence of of the rest of the stakeholders to enhance the radical change in the disability movement the decision making process and direct it to milieu which turns it as a whole to the rights mainstream disability inclusively. The current based approach. In the same time, these positive trends of the decision makers in the interviews provide common intentions, strong Arab world (which deduced from the number of motivations and joint positions towards promoting the signatures and ratifications, additionally the the human rights culture and disability movement. progressive national initiatives in some countries), the winds of change which started to blow already must be invested by the local, national, regional through the region with the kick-start of the CRPD and the international bodies to create good in 2003, thrusts ahead this trend. practices aimed at enhancing the human rights of It is clear now that the rights-oriented PwDs and the bases of the services provision. Selected Publications:

Social Protection: The MENA region entered the 1980s with historically high growth rates averaging about seven percent BEATTIE Roger, 2000: “Social Protection for all: But per annum which was also among the highest in how?” in: International Labour Review, vol. 139, n° comparison to other developing regions (especially 2, pp. 129 - 148. due to oil revenues). Poverty was the lowest in DESTREMAU Blandine and LAUTIER Bruno, the region compared to other regions. But there 2007, “Social protection and social rights regimes in was a reversal of fortune in the 1990s and many developing countries: towards the construction of a countries have since experienced negative growth typology”, paper presented at the RC19 conference rates. The risk of falling oil prices was not hedged. “Social Policy in a Globalizing World: Developing a Households in MENA countries now receive less North-South Dialogue”, Florence, September 2007, income from selling the labor of their members unpublished. than they did a decade ago; they have more debt to repay than their ancestors and will pass even ESPING-ANDERSEN G., 2002, “The Sustainability greater liabilities to their offspring; the young of Welfare States: Reshaping Social Protection”, in B. face higher unemployment rates; the old remain Harris-White (ed.) Globalization and Insecurity. Political, largely unprotected from their inability to work; Economic and Physical Challenges, London: Palgrave, and all have less water available for consumption pp. 218 -232. and irrigation. In a word, they are more vulnerable. Reducing vulnerability is not synonymous to TZANATOS Zafiris, “Social Protection in the Middle poverty reduction and goes beyond policies that East and North Africa: A review”, In Employment endeavor to bring the poor to an acceptable level Creation and Social Protection in the Middle of minimum consumption. It is broader in that it East and North Africa, HANDOUSSA Heba and includes the reduction of the risk for the non-poor TZANATOS Zafiris, World Bank of falling below the poverty line and the creation of

Disability Monitor Initiative-Middle East February 2009 Issue. 38 opportunities that would lead to the improvement of the only factor behind a financial crisis; the problem living conditions of the poor and the non-poor. At is the generosity of the current schemes. Moreover, first, the reduction in risk should be sought in the badly designed benefit formulas and eligibility role of the macroeconomy and the functioning of conditions introduce unnecessary economic the labor market to create wealth and employment. distortions and make the systems vulnerable to However, even the most enabling environment adverse distributional transfers. The book does would never eliminate risks, and social protection not present a general model that could solve the programs can play a useful role in catering for the problems of all pension systems in MENA countries. needs of those who do not fully share the benefits of Instead the authors focus on outlining a framework growth or job creation. for guiding discussions on pension reform and making objective policy choices. This assessment HILAL Jamil, 1998, « The Limits of Informal Social will be useful for policy makers and government Support Systems in the West Bank and Gaza Strip officials involved in pension reform in the Middle », Economic Development and Poverty Reduction, East and North Africa region. Mediterranean Development Forum, September 36- 1998, Morocco. STANDING Guy, 2002, Beyond the New Paternalism: Basic Security as Equality, Verso, JÜTTING Johannes, 2000, « Social Security Systems London. in low-income countries: concepts, constraints and the need for cooperation », ISSR, vol. 53, 42000/, pp. 361-. The century of labouring man has come to an end, and yet governments continue to link social LAUTIER Bruno, 2006: “Towards Universal Social entitlements to the performance of labour. This Security and Protection of the “most vulnerable”, in book argues that the era of market regulation has Social Protection and inclusion. Experiences and ended in an era of fiscal regulation: new social policy issues, ILO – STEP, Strategies and Tools and economic insecurities have spread around against social Exclusion and Poverty Programme, the world, boosted by globalization and flexible Social Security Department. labour markets, and compounded by privatization and increased selectivity of social policy. This ROBALINO David A. 2005, Pensions in the Middle global insecurity has spawned growing and vastly East and North Africa Time for change, The World underestimated inequalities. Bank. Washington D.C., http://siteresources. To overcome these seemingly endemic insecurities worldbank.org/INTMENAMENA/Resources/1_ and inequalities, Guy Standing argues for a MENAMENA_Pension_Reform_Complete.pdf complex egalitarianism, in which basic income security is recognised as a right for all. Work This is the first comprehensive assessment of (including voluntary, community and care work), pension systems in the Middle East and North and not labour, must be the basis of a ‘good Africa. While other regions - Central Asia, Eastern society,’ and policies must be judged by their Europe, and Latin America, in particular - have capacity to promote occupational security. been actively introducing reforms to their pension systems, Middle East and North African countries SUPIOT Alain (ed.), 2006: Protection sociale et have lagged behind. This is explained, in part, by travail décent. Nouvelles perspectives pour les the common belief that, because demographics normes internationals du travail, Travaux conduits remain favorable - the countries are young and the à l’initiative du BIT, Semaine Sociale de Lamy, labor force is expanding rapidly - financial problems Supplément n° 1272, 4 septembre. are far in the future; as a result, pension reform does not have to be a priority in the broader policy VAN GINNEKEN Wouter, 2007, “Social Security agenda. However, the authors show that aging is not and the global socio-economic floor: towards a

Disability Monitor Initiative-Middle East 39 February 2009 Issue. human rights-based approach”, paper presented at This paper deals with how social safety nets may the RC19 conference “Social Policy in a Globalizing reach the poor with disabilities in developing World: Developing a North-South Dialogue”, countries. It presents a framework for analyzing Florence, September 2007, unpublished. the inclusion of disability in social safety nets. The paper first reviews evidence on the relation between Cash Transfers: disability and poverty, and discusses the roles that MONT Daniel, 2006, “Disability in conditional cash safety nets may play with regard to disability. Safety transfer programs - drawing on experience in LAC”, nets can reach persons with disabilities through Third international Conference on Conditional Cash inclusive mainstream programs as well as disability Transfers June 26 – 30, Istanbul. targeted programs. The advantages and challenges of disability targeting are then discussed. The STANDING Guy, 2007, How Cash Transfers Boost paper proceeds to analyze different ways that can Work and Economic Security, UNDESA Working be used to include disability considerations in the Paper #58, October. implementation of mainstream safety nets through the reduction of physical, communication and social There has long been a minority view that providing barriers surrounding such programs and through people with cash is an effective way of combating the careful design and evaluation of safety nets. The poverty and economic insecurity while promoting use of disability targeting versus or in combination livelihoods and work. The mainstream view has with disability mainstreaming is then discussed. nevertheless been that giving people money, without conditions or obligations, promotes idleness and dependency, while being unnecessarily costly. This Events: paper reviews recent evidence on various types A conference about the rights of persons with of schemes implemented in developing countries, disabilities and the media was held in Egypt in including several pilot cash transfer schemes, July 2008. It targeted the media staff: (Radio and assessing them by reference to principles of social TV directors, TV hosts, media producers and justice. It concludes that experience with cash writers, journalists, and actors). It was organized transfers is strengthening the case for a universal in cooperation between the National Council of basic income. Childhood and Motherhood in Egypt and the Special Rapporteur’s office under the patronage Social Protection and Disability: of the first lady of Egypt. It included presentations about the drama and disability and presentations GTZ, Deutsche Gesellschaft für technische on the international documents in addition to the Zusammenarbeit, 2006, Disability and development national aspect of the disability. - a contribution to promoting the interests of persons with disabilities in German Development Cooperation, Eschborn, GTZ. The campaign on the War and Disability was launched in Lebanon in July 2008 it included video MARRIOTT Anna and GOODING Kate, 2007, spots present the consequences of the war and its ˝Social assistance and disability in developing impact on the disability. The participants were from countries», Hayward’s Heath, Sight savers the national, regional and international disability International. alliances. It included as well presentations on the global survey and some related reports. MITRA Sophie, 2005, “Disability and social safety nets in developing countries”, Social Protection Discussion Paper No. 0509. Washington, World Bank.

Disability Monitor Initiative-Middle East February 2009 Issue. 40 Contributors: Disability Monitor Initiative South East Europe http://www.disabilitymonitor-see.org/index.htm Editorial: Alexandre Cote GTZ http://www.gtz.de/en/ Coordination, Research and Interviews: International cooperation enterprise for sustainable Marie-Noëlle AbiYaghi development with worldwide operations. Translation: World Bank Nicole el Azzi http://web.worldbank.org/wbsite/external/topics/extsocia Proofreading: lprotection/0,,contentmdk:20263372~menupk:282656~p Maria Tanya Gaurano agepk:148956~pipk:216618~thesitepk:282637,00.html Accessibility: International Labour Organisation Christiane Noe http://www.ilo.org/public/english/protection/ Social Security Department; Global Social Graphic Design: Trust Issa Istanbouli http://www.ilo.org/public/english/protection/secsoc/are as/policy/gst.htm Social Security Statistics Disclaimer http://www.ilo.org/public/english/protection/secsoc/are We welcome this opportunity to promote our activities and as/stat/sso.htm publications. Please note that the material contained on this Strategies and Tools against Exclusion and publication and on our Website is for information only. We try to poverty (STEP) keep the information up to date, but we cannot guarantee its http://www.ilo.org/public/english/protection/secsoc/are accuracy at all times. as/step.htm The responsibility for opinions expressed in signed articles, SANABEL Regional Microcredit Network. studies and other contributions rests solely with their authors, http://www.sanabelnetwork.org/news/ and publication does not constitute an endorsement by the Disability Monitor Initiative-Middle East of the opinions expressed Social Fund for Development YEMEN in them. http://www.sfd-yemen.org/ Neither Handicap International, CBM nor any other agency or Social Fund for Development Egypt entities thereof, assumes any legal liability or responsibility for the accuracy, completeness, nor usefulness of any information, http://www.sfdegypt.org/ product or process disclosed in these examples. United Nations Enable, Rights and Dignity of The views and opinions of the originators expressed therein do Persons with Disability not necessarily state or reflect those of the Handicap http://www.un.org/disabilities/index.asp International, CBM or any agency or entities thereof.

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