PHYSICAL REHABILITATION PROGRAMME ANNUAL REPORT 2014 International Committee of the Red Cross 19, avenue de la Paix 1202 Geneva, Switzerland T +41 22 734 6001 F +41 22 733 2057 Email: [email protected] www.icrc.org © ICRC, August 2015 CONTENTS
CONTENTS...... 3
FOREWORD...... 4
1 – INTRODUCTION...... 6 APPROACH...... 7 DEVELOPING NATIONAL CAPACITY...... 8 BEYOND PHYSICAL REHABILITATION...... 8 POLYPROPYLENE TECHNOLOGY...... 9 SPECIALIST SUPPORT...... 9
2 – OVERVIEW OF ACTIVITIES IN 2014...... 10 IMPROVING ACCESS TO SERVICES...... 10 IMPROVING THE QUALITY OF THE SERVICES PROVIDED...... 14 PROMOTING THE LONG-TERM AVAILABILITY OF SERVICES...... 17 BEYOND PHYSICAL REHABILITATION ...... 18 COOPERATION WITH OTHER BODIES...... 20
4 – PROJECT ACTIVITIES...... 24
4.1 – AFRICA...... 25
4.2 – ASIA...... 46
4.3 – THE AMERICAS...... 68
4.4 – NEAR AND MIDDLE EAST...... 78
ANNEX 1 – ICRC PUBLICATIONS...... 88 PHYSICAL REHABILITATION ...... 88
3 FOREWORD
The International Committee of the Red Cross (ICRC) the organization has worked to remove barriers hinder- is an impartial, neutral and independent organization ing access to appropriate physical rehabilitation services. whose exclusively humanitarian mission is to protect the ICRC physical rehabilitation projects are planned and lives and dignity of victims of war and other violence and implemented in such a way as to strengthen the physi- to provide them with assistance. Established in 1863, the cal rehabilitation services available in the country ICRC is at the origin of the International Red Cross and concerned, the primary aims being to improve access Red Crescent Movement. It strives through its delega- to services for people with disabilities, to upgrade the tions and missions around the world to fulfil its mandate quality of those services and to ensure their long-term to protect and assist the millions of people affected by availability. Enabling a person with physical disabilities armed conflict and other violence. to gain or regain mobility is an important step toward inclusion. However, the ICRC acknowledges that physi- The UN Convention on the Rights of Persons with cal rehabilitation alone is often not enough to ensure full Disabilities, which seeks to promote, protect and ensure participation. It thus strives to provide more comprehen- full and equal enjoyment of all human rights and funda- sive assistance for disabled people by addressing their mental freedoms, requires States Parties to take effective rehabilitative needs and by helping them to reintegrate measures to ensure that people with disabilities have access socially and economically. to rehabilitation services (Article 26) and to mobility devices (Article 20). Ensuring access to physical reha- Over time, the ICRC has acquired a leadership position in bilitation, which involves providing physiotherapy and physical rehabilitation, mainly because of the scope of its mobility devices (prostheses, orthoses, walking aids and activities, the development of its in-house technology, its wheelchairs), is the core objective of the ICRC’s Physical acknowledged expertise and its long-term commitment Rehabilitation Programme (PRP). The term “rehabilita- to assisted projects. In most countries where the ICRC has tion” refers to a process aimed at removing – or reducing provided physical rehabilitation support, such services as far as possible – restrictions on the activities of people were previously either minimal or non-existent. In most with disabilities and at enabling them to become more cases, ICRC support has served as a basis for establish- independent and enjoy the highest possible quality of life ing a national rehabilitation service that cares for those in physical, psychological, social and professional terms. in need. Between 1979 and 2014 the ICRC’s Physical Different measures, such as medical care, therapy, psycho- Rehabilitation Programme provided support for more logical support and vocational training, may be needed. than 190 projects (centres) in 50 countries and one ter- Physical rehabilitation is an important part of the rehabili- ritory. Large numbers of individuals have benefited from tation process. It is not an objective in itself but an essential physical rehabilitation services, which have included the part of fully integrating people with disabilities in society. provision of 437,910 prostheses, 595,897 orthoses, 47,638 Restoring mobility, which is the backbone of ICRC physi- wheelchairs, 455,876 pairs of crutches, physiotherapy and cal rehabilitation projects, is the first step towards enjoying follow-up (repair and maintenance of devices) with the such basic rights as access to food, shelter and education, assistance of the ICRC. finding a job and earning an income and generally having the same opportunities as other members of society. In 2014 the Physical Rehabilitation Programme provided assistance in 113 projects in 28 countries and one territory; Since 1979 the ICRC’s physical rehabilitation activities more than 318,000 people (an increase of 13% on the 2013 have diversified and expanded throughout the world as figure) benefited from various services at ICRC-assisted
4 PHYSICAL REHABILITATION PROGRAMME Foreword
centres. The services included the provision of 20,101 low-income countries that are not covered by the Physical prostheses, 74,102 orthoses, 4,495 wheelchairs and 19,118 Rehabilitation Programme, with priority being given to pairs of crutches as well as appropriate physiotherapy projects formerly implemented by the ICRC. In 2014 the treatment for 153,461 people. Children represented 28% SFD provided assistance in 45 projects in 20 countries. and women 20% of the beneficiaries. The services provided by SFD-supported centres included the production of 5,109 prostheses and 17,759 orthoses In addition to its operational Physical Rehabilitation and the distribution of 274 wheelchairs and 2,187 pairs Programme, the ICRC provides support for physical of crutches. Of the total number of prostheses supplied, rehabilitation through its Special Fund for the Disabled 1,679 (33%) were for mine survivors. (SFD). Created by the ICRC in 1983, the SFD provides support similar to that provided through the Physical This report describes the worldwide activities of the Rehabilitation Programme. It is primarily the politi- ICRC’s Physical Rehabilitation Programme in 2014. cal context and the specific needs that decide which Information on the activities of the Special Fund for the channel the ICRC uses in a given situation. The SFD’s Disabled may be obtained from its 2014 Annual Report mission is to provide support for physical rehabilitation in (www.icrc.org/fund-disabled). T. Leblanc/ICRC T.
5 1 – INTRODUCTION
The UN Convention on the Rights of Persons with on the type of disability, various measures may be needed Disabilities (UNCRPD) seeks to protect, promote and to achieve this end. They range from medical care and ensure full and equal enjoyment of all human rights and physical rehabilitation to social support, vocational train- fundamental freedoms. It requires States Parties to take ing and other help in attaining economic self-reliance. effective measures to ensure that people with disabilities Physical rehabilitation is an integral part of the process have access to mobility devices (Article 20) and reha- required to ensure the full participation and inclusion in bilitation services (Article 26) and enjoy full inclusion society of people with disabilities. It includes providing and participation in the community (Articles 19 and 26). people with physical disabilities with mobility devices, such as prostheses, orthoses, walking aids and wheel- People with disabilities generally have poorer health, lower chairs, as well as with therapy that will enable them to levels of educational attainment and fewer economic make the fullest use of those devices. Physical rehabilita- opportunities than other members of society. As a result, tion must also include services for maintaining, adjusting, many of them are forced into poverty and excluded from repairing and renewing the devices as needed. day-to-day activities. Health-care services, education, employment, transportation, information and technology Access to physical rehabilitation is important from both are today still inaccessible to large numbers of people with human rights and human development perspectives. disabilities. The 2011 World Report on Disability, pub- Personal mobility and the availability of assistive devices lished by the World Health Organization and the World is a precondition for equal participation in and being a Bank, gives a list of barriers faced by people with disabili- productive member of society. The use of assistive devices ties wishing to access appropriate physical rehabilitation is a means of gaining mobility, opportunities for education services. These include the absence of a national plan and work, and improved health and quality of life. These or strategy, non-existent or inadequate services (where outcomes are important indicators of human development. services exist, they are often located in major cities only), Assistive devices may also prevent falls, injuries and other the lack of trained professionals, and insufficient finances impairments. Consequently, investment in the provision of to cover the cost of services, including transport to places assistive devices can reduce health-care costs and economic providing them. Conflicts and other situations of violence vulnerability and increase productivity and quality of life. exacerbate the constraints faced by people with disabilities in relation to meeting their basic and specific needs. Some Although the ICRC had undertaken some physical reha- have difficulty fleeing to safety, while those who are able to bilitation activities before 1979, the establishment of the do so struggle with the change in terrain, lose their mobil- Physical Rehabilitation Unit that year marked the begin- ity aids/equipment in the process and/or cannot access ning of a serious commitment in this field. Two operational rehabilitative care. Detainees with disabilities also have to projects were implemented in 1979 under the newly estab- contend with several challenges while they are in held in lished Physical Rehabilitation Programme (PRP). Since temporary or permanent places of detention. 1979 the ICRC’s worldwide physical rehabilitation activi- ties have diversified and expanded. It has now acquired a Rehabilitation is a process that aims to remove restrictions leadership position in this context, partly because of its on the activities of people with disabilities, or to reduce development of the polypropylene technology now also those restrictions as much as possible, and to enable them used by several other organizations as part of standard to become more independent, participate fully in society practice in the production of prostheses and orthoses and enjoy the highest possible quality of life. Depending in many low-income countries. Between 1979 and 2014
6 PHYSICAL REHABILITATION PROGRAMME 1 – Introduction
SERVICES PROVIDED 1979 - 2014 The ICRC endeavours to respond to physical rehabilita- 595,897 tion needs at the individual, structural and societal levels, notably by helping to improve the accessibility, quality 437,910 436,758 and sustainability of services along the rehabilitation chain (emergency and continuing medical care; physi- cal rehabilitation and psychological support). It directly assists people injured during armed conflicts and other situations of violence as well as other people with physical disabilities, with a view to reducing, as much as possible, the impact of their injuries and/or disabilities on the qual- 47,638 ity of their lives.
Prostheses Orthoses Wheelchairs Crutches (pairs) In the conflict-racked countries where the ICRC carries out its mandate, it is not only people directly affected by the conflict (those injured by landmines, bombs and the ICRC’s Physical Rehabilitation Programme provided other ordnance) who need physical rehabilitation but also support for more than 190 projects in 50 countries and people indirectly affected – people who become physi- one territory. Over half the centres were newly built, fre- cally disabled because the breakdown of normal health quently with substantial ICRC co-funding of construction services prevents them from receiving proper care and/or and equipment. The programme’s operational activities vaccinations. The projects assisted by the ICRC provide have expanded from two centres in two countries in 1979 services for all those in need. to a total of 113 assisted projects in 28 countries and one territory in 2014. A direct result of this steady growth in The ICRC’s PRP projects are designed to strengthen the the number of assisted centres is the rise in the number overall physical rehabilitation services in a given coun- of people receiving services. People with disabilities who try. They are planned, implemented and monitored in a have received services continue to benefit from the infra- manner that takes account of the life-long needs of people structure and expertise developed by the ICRC, not only with disabilities. People who have been provided with a during the period of assistance but afterwards, too. Thus, first device have the right to expect services whenever the true number of beneficiaries is higher than indicated repairs/new devices are needed. To optimize impact, by the statistics, which do not include those treated after various modes of action are implemented in combination: the ICRC’s withdrawal from assisted centres. persuasion, support, substitution and mobilization. The mode of action and the level and type of assistance used to respond to the needs of people with disabilities depend APPROACH on the urgency and magnitude of the needs, the possibil- ity of working with a local partner and the ICRC’s overall In its work to enable people with physical disabilities analysis of the situation. to gain or regain mobility, the ICRC acknowledges that physical rehabilitation alone is often not enough to ensure ICRC projects are implemented with the following aims: their full participation in society. As a pendant to the provision of a wide range of services providing direct ``Improving accessibility: The ICRC takes all possible assistance for people with disabilities, the ICRC therefore measures to ensure that everyone in need of physical also seeks to strengthen national capacities as a means of rehabilitation services has access to them on an equal- overcoming the different barriers to accessing services opportunity basis, regardless of social, religious, ethnic faced by people with disabilities. This is done by: or other considerations. Special attention is given to vulnerable groups, such as women and children. ``working closely with local partners; ``Improving quality: The ICRC promotes the ``supporting national authorities in the management, application of internally developed guidelines based development, implementation and monitoring on international norms. The organization also of national physical rehabilitation services; promotes a multidisciplinary patient-management ``supporting service providers to ensure that they approach that includes physiotherapy and ensures that have the means to provide services; the ICRC technology used to produce appliances and ``increasing and strengthening human resources aids for people with disabilities remains appropriate for physical rehabilitation; and up to date. ``strengthening national and regional professional ``Ensuring sustainability: The ICRC works with and associations; helps to strengthen the capacity of local partners from ``providing direct support for potential service the outset. In addition, whenever necessary, the ICRC users to ensure that they have access to services by ensures project continuity through its Special Fund for subsidizing the cost of travel to the services, the cost the Disabled (SFD). This long-term approach not only of accommodation and food while receiving services takes account of the ICRC’s residual responsibility, and the cost of services provided at centres; and but also reduces the risk of any loss of investment in ``working closely with people with disabilities human resources, capital and materials. organizations.
7 PHYSICAL REHABILITATION PROGRAMME ANNUAL REPORT 2014
``Promoting full inclusion and participation: The disabilities and personnel, this represents a significant ICRC facilitates the social and economic reintegration loss in terms of investment of human capital and materi- of people with disabilities through various assistance als. As noted above, people with disabilities need access and advocacy activities implemented directly or with to functioning rehabilitation services for the rest of their partners. It also lobbies with the national authorities for lives. In order to improve the chances of services continu- the implementation of related treaties or legislation. ing to function, the ICRC pursues a long-term approach when setting up and managing its projects. While assis- In order to achieve these aims, the ICRC pursues a tance is given in order to increase access to and improve twin-track approach: assistance is given to both the the quality of the services, the ICRC is always attentive to national system and to users of its services. Assistance fostering its partners’ managerial and technical capacity to the national system aims to ensure that the system from the outset. It does this by training and mentoring, by has the means to provide services. It includes support at improving facilities and by promoting an effective physi- centre level to ensure that centres have the capacity to cal rehabilitation policy within the government. provide and manage services. This support may include constructing/renovating facilities, donating machines, Besides developing the capacities of the service provid- tools, other equipment, raw materials and components, ers, the ICRC also works closely with national authorities developing local human resources and supporting the responsible for the physical rehabilitation sector in their development of a national strategy for physical rehabilita- roles of overseeing, managing and regulating the sector. tion. Assistance is also provided for the pertinent national Since 1979 the ICRC has developed several tools (stock authorities to manage and supervise activities related to management, patient management, treatment protocols, physical rehabilitation. Assistance for users is intended to etc.) to support managers of assisted centres. These ensure that they have access to the services. That includes management tools have also been distributed to other covering travel, accommodation and food expenses, the organizations working in the same area. cost of treatment at the centres and, when needed, the cost of implementing specific activities to overcome inequality Since the quality and the long-term availability of services among vulnerable groups in accessing services. depend largely on a ready supply of trained profession- als, the training component of ICRC-assisted projects has gained in importance over the years. The presence of DEVELOPING NATIONAL CAPACITY trained professionals also increases the chances of rehabil- itation facilities continuing to function in the long term. In The Physical Rehabilitation Programme strives to develop 2003 an in-house training package for orthotic/prosthetic national capacities so as to enable the national sector to over- technicians (Certificate of Professional Competency – come the different barriers faced by people with disabilities CPC) was developed by the ICRC and recognized by and to meet their basic physical rehabilitation needs, and to the International Society for Prosthetics and Orthotics do this in the most prompt, humane and professional way (ISPO). Since 1979 the ICRC has run formal prosthetic possible. For that reason, the ICRC supports local partners and orthotic (P&O) programmes leading to a diploma (governments, NGOs, etc.) in providing these services. The in more than 12 countries, as well as formal training in level of support varies from one country to another but the physiotherapy in one country. It has also provided schol- aim is always to develop national capacity, technical and arships enabling a number of candidates to be trained in managerial. However, in certain circumstances the ICRC P&O or physiotherapy at recognized schools. Over the may take over the role of the authorities entirely in this years, support from the ICRC through scholarships or field. Ninety per cent of the ICRC’s projects have been, and formal training programmes has led to nearly 595 people continue to be, managed in close cooperation with local becoming P&O professionals and to more than 200 partners, primarily government authorities. Few centres becoming physiotherapy professionals. Besides working have been or are run by the ICRC alone, but there are two toward increasing the number of professionals, the ICRC situations in which this may happen: when there is no suit- provides support to either establish national P&O schools able partner at the outset and when a centre is established or to strengthen existing P&O and PT schools. to treat people from a neighbouring country. In 2014, apart from one centre in Iraq (Erbil) and all eight projects in Afghanistan, assisted centres were either government-run BEYOND PHYSICAL REHABILITATION or managed by NGOs, National Red Cross/Red Crescent Societies or private entrepreneurs. The aim of ICRC projects is to help to fully integrate and ensure the participation of people with disabilities The ICRC’s withdrawal from functioning rehabilitation in society, both during and after the period of assistance. projects has been successful in a number of instances; on Although its focus is on physical rehabilitation itself, the some occasions, however, the result after a year or so has ICRC’s Physical Rehabilitation Programme recognizes the been an empty centre without materials, trained person- need to go beyond physical rehabilitation to ensure that nel or service users. In countries with limited financial people with physical disabilities have access to other ser- resources, the needs of people with disabilities, including vices that give them equal opportunities, allow them to rehabilitation, are seldom given priority. The result is enjoy human rights and enable them to live in dignity. a poorly funded and poorly supported sector, includ- Several initiatives have been launched as part of the ICRC’s ing centres. Besides the impact on people with physical physical rehabilitation projects to promote inclusion and
8 PHYSICAL REHABILITATION PROGRAMME 1 – Introduction
participation, sometimes with or in support of organiza- of prostheses and orthoses; the technology has also been tions specializing in this field. For example, people with adopted by a significant number of organizations involved physical disabilities are directed to microeconomic assis- in physical rehabilitation. tance programmes run by the ICRC or local organizations or enabled to access education and vocational training and To highlight the ICRC’s role in developing and promot- to participate in sporting events. In addition, the ICRC pro- ing better technology, such as that using polypropylene, vides support for awareness campaigns and advocacy and a brochure on the subject was published in 2007. It con- seeks to deepen the national authorities’ commitment to tains information about the suitability of this technology assisting people with disabilities, notably in relation to the for developing countries and the advantages to be gained UN Convention on the Rights of Persons with Disabilities. from its use.
POLYPROPYLENE TECHNOLOGY SPECIALIST SUPPORT
The ICRC initially used raw materials and machinery Apart from developing technologies and training pro- imported from established Western suppliers to produce fessionals, the ICRC uses its specialists to promote prosthetic and orthotic components. However, it soon high-quality services. Its pool of experts, drawn from started developing a new technology using polypropylene more than 25 countries, is by far the largest among the as the basic material, thus bringing down the cost of reha- international organizations working in the same area. bilitation services. Recognition for the vital role played by Over time, the average number of expatriates per project the ICRC in making rehabilitative devices more widely has dropped from seven (in 1979) to approximately 0.8 available – by introducing low-cost, high-quality technol- in 2013, mainly because of the ICRC’s greater experience ogy – came in 2004 in the form of the Brian Blatchford and the growing number of locally trained professionals Prize awarded by ISPO. It is now standard practice to use working at assisted centres. the technology developed by the ICRC in the production L. Merlo/ICRC
9 2 – OVERVIEW OF ACTIVITIES IN 2014
In 2014 the ICRC continued its efforts to remove the ``signed a tripartite agreement with CHAL Foundation barriers faced by people with disabilities in accessing and Indus Hospital to set up two new rehabilitation appropriate physical rehabilitation services, to enhance centres in Karachi and Muzaffargarh (Pakistan). the quality of those services and to promote their long- term availability. In Africa, the ICRC provided support for 35 projects in 11 countries. In south-western Algeria, the ICRC con- The information contained in this section provides a tinued to provide support for the activities of the Centre summary of activities carried out by the ICRC in 2014. Martyr Chereïf, managed by the Polisario Front’s Public More detailed information is provided in Chapter 4 of this Health Authority. The centre was originally located in report, “Project activities.” Noukhaila but had been moved to Rabouni, within the hospital compound, from where it continued to provide physical rehabilitation for the Sahrawi population living IMPROVING ACCESS TO SERVICES in refugee camps. In Burundi, the ICRC continued to work in conjunction with the Saint Kizito Institute in Throughout the year, the ICRC continued to improve Bujumbura, which is managed by the Archdiocese of access to services by applying its twin-track approach, Bujumbura, the aim being to provide physical reha- that is, by providing assistance for both the national bilitation services for people from the centre’s catchment system and users of its services. Assistance for the areas – Bubanza, Bujumbura Mairie, Bujumbura Rural, national system aims to ensure that the system has the Cibitoke and Muramvya Provinces. In Chad, the ICRC means to provide services, while the goal of providing continued supporting the two main centres providing assistance for users is to overcome barriers faced by them physical rehabilitation services in the country, the Maison when seeking to access services. Notre Dame de la Paix in Moundou (southern Chad) and the Centre d’Appareillage et de Rééducation de Kabalaye (CARK) in N’Djamena (central Chad), both managed Support for service provision and users of services by local NGOs. The ICRC also continued supporting a referral system for people with disabilities from eastern In 2014 the Physical Rehabilitation Programme assisted and northern Chad and financed their transportation 113 projects in 28 countries and one territory. Apart to N’Djamena; it also covered accommodation costs for from the two local component factories in Cambodia people without family support in N’Djamena while they and Afghanistan, the local unit manufacturing crutches received treatment. The ICRC signed an agreement with in Iraq and the P&O Institute in Iraq, all assisted projects the Minister of Public Health to support the process of were rehabilitation centres. In 2014, in addition to the drafting the national plan, in which the ICRC agreed to projects supported at the end of 2013, the ICRC: cover the cost of recruiting an international expert for that purpose. In the Democratic Republic of the Congo, ``signed a new collaboration agreement with the Centre the ICRC continued to cooperate with Shirika La Umoja de Rééducation pour Handicapés Physiques (CRHP) in Goma and Heri Kwetu in Bukavu. In Kinshasa, ICRC in the Democratic Republic of the Congo; signed an agreement with a new partner, the Centre ``started to work with two new centres located in de Rééducation pour Handicapés Physiques (CRHP). Bangalore and Vellore (India); Direct support was provided to improve infrastructure, and equipment and tools were donated. A workshop run
10 PHYSICAL REHABILITATION PROGRAMME 2 – Overview of activities in 2014
by disabled former soldiers was given ICRC support to department at Niamey National Hospital (HNN). In 2014, enable it to provide crutches in Kinshasa. after the refurbishment of the physical rehabilitation department at HNN and the establisment of a vast net- In Ethiopia, the ICRC continued providing support for work linking the disabled associations in the country, the seven physical rehabilitation centres in Arba Minch, project entered a new phase. Most of the ICRC’s activi- Assela, Bahir Dar, Dessie, Dire Dawa, Mekele and ties in 2014 focused on improving services for the large Menegesha. Support was also given to establish three number of people seeking them at HNN (an increase of new physical rehabilitation centres in the remote western 27% compared to 2013), building up the service provision border regions of the country – in Assosa, Gambella and and logistical capacities of the department and managing Nekemte. The rehabilitation centre in Nekemte already the services. provides regular services for people with disabilities living in the western parts of Oromia Region, while Assosa In South Sudan, the conflict that started in December and Gambela are still struggling to obtain the required 2013 and the ensuing insecurity in Juba led to the project human resources and government operational budgets. being put on hold. National staff employed at the assisted In conjunction with the Ministry of Labour and Social centres returned to work in January but were not confi- Affairs (MoLSA), the Ministry of Health, the Ministry dent that security was sufficient to permit the facilities to of Education and the Medical Faculty of Addis Ababa reopen. Following a request from the President’s office to University, the ICRC also conducts training courses in provide crutches for the wounded at three hospitals, the prosthetics and orthotics at the National Rehabilitation centre in Juba slowly resumed operations in order to meet Centre at the Black Lion Hospital. In Guinea-Bissau, the the need. In April 2014 the project was again fully opera- ICRC continued supporting the Ministry of Public Health tional and people with physical disabilities steadily began in the management of the Centro de Reabilitação Motora to return to the centre despite the extremely high trans- (CRM), which opened in 2011 with the financial support port costs, the insecurity, the poor road infrastructure and of the ICRC and which serves as the national referral the devaluation of the South Sudanese pound. In Sudan, centre. Since its reopening, the CRM has increased its the Humanitarian Aid Commission, the government activities in terms of the number of service users and body in charge of relations with humanitarian organi- services/programmes provided and it is well on the way zations, asked the ICRC to suspend its activities, citing to regaining some of its former good reputation. The technical issues. In September the ICRC received a letter number of people with physical disabilities receiving from the Sudanese authorities informing it that the sus- services at the CRM increased by 31% compared to 2013. pension has been lifted and after nine months of absence, the ICRC therefore relaunched its activities. During the In Libya, ICRC operations were challenged by the increas- suspension of ICRC activities, the National Authority for ingly insecure working environment and renewed armed Prosthetics and Orthotics (NAPO) continued to provide fighting, compounded by the existence of a general politi- physical rehabilitation services at reduced capacity until cal and security vacuum. In June the head of the ICRC its operations came to a standstill in late May. The NAPO sub-delegation in Misrata was killed by unidentified was able to resume its services in October after the ICRC armed men in Sirte. This led to a temporary reduction of had provided new supplies of raw materials. ICRC international staff and in July, following the severe inter-militia clashes in Tripoli and the destruction of the In Asia, the ICRC provided support for 45 projects in 11 airport, the decision was taken to temporarily relocate the countries. The ICRC’s physical rehabilitation project in remaining international staff to Tunis, from where they Afghanistan combines physical rehabilitation with activi- have been operating since then. Despite these setbacks, ties aimed at social inclusion and participation of people the ICRC continued to operate in Libya through its 140 with disabilities in society. It works in coordination with national staff and its four offices in Benghazi, Misrata, the Afghan authorities but is entirely and directly man- Sabha and Tripoli. Nonetheless, the events forced the aged by the ICRC. In 2014 it continued to manage and ICRC to completely review, if not reset, its operational finance seven physical rehabilitation centres and the priorities and objectives in Libya for the rest of 2014 as Kabul Component Factory, to conduct formal P&O train- well as to change its operating model in the country. The ing and to contribute to the social inclusion of people with physical rehabilitation department at the University of disabilities through education, vocational training, micro- Misrata was about to be inaugurated when the serious finance and employment and to promote and implement security incident took place in Sirte on 4 June. sports activities. In Bangladesh, the ICRC continued to support the activities of the Centre for the Rehabilitation In Mali, the ICRC continued for the second year to work of the Paralysed (CRP) in Savar and Chittagong. The closely with the Père Bernard Verspieren physical reha- structure of the CRP incorporates the Bangladesh Health bilitation centre (CPBV), which had been established by Professions Institute (BHPI), the CRP’s academic institu- the PROPHET association. While not providing direct tion, which is recognized by the State Medical Faculty support, the ICRC reimbursed the cost of physical reha- (SMF). The BHPI offers diploma and Bachelor’s and bilitation services for people with physical disabilities Master’s degree programmes in, for example, physiother- who were victims of the conflict in the north of the coun- apy, occupational therapy and rehabilitation. Since 2014 try. The ICRC Special Fund for the Disabled provided it has also been running a prosthetic and orthotic (P&O) technical support until the end of 2014. In Niger, the diploma programme with the first 10 students enrolled ICRC continued to support the physical rehabilitation under scholarships provided by the ICRC.
11 PHYSICAL REHABILITATION PROGRAMME ANNUAL REPORT 2014
In Cambodia, the ICRC continued its cooperation In Pakistan, the ICRC continued its support for 15 pro- with the Ministry of Social Affairs, Veterans and Youth jects. These projects included five managed by CHAL Rehabilitation (MoSVY) in support of the Battambang Foundation and located in Bagh, Balakot, Bisham, Quetta Regional Physical Rehabilitation Centre, the Kompong and Swabi and six managed by the PIPOS Rehabilitation Speu Regional Physical Rehabilitation Centre and the Services Project (PRSP) and located in Bannu, Buner, Di Phnom Penh Orthopaedic Component Factory. The Khar, Dir, Peshawar and Saidu. In addition, the ICRC Phnom Penh Orthopaedic Component Factory contin- continued its support for the Muzaffarabad Physical ued to provide components for all physical rehabilitation Rehabilitation Centre (MPRC) and the Hayatabad centres in Cambodia, thus ensuring proper care for all Paraplegic Centre in Peshawar. The ICRC also continued those receiving services at centres throughout the coun- to support the Akbar Kare Institute – the only comprehen- try. In China, the ICRC continued to provide support sive cerebral palsy centre in Pakistan – and the Pakistan for the Yunnan branch of the Red Cross Society of China Institute of Prosthetic and Orthotic Sciences. The ICRC, in running its Orthopaedic Rehabilitation Centre in CHAL Foundation and Indus Hospital entered into an Kunming and its repair workshop in Malipo. The objec- agreement regarding cooperation and collaboration in tives of ICRC assistance are to develop the capacity of the the area of physical rehabilitation for people with dis- Kunming and Malipo centres, which are managed by the abilities. The tripartite agreement includes setting up two Yunnan Red Cross branch, to ensure that the most des- new rehabilitation centres in Karachi and Muzaffargarh titute people with disabilities have access to appropriate (both centres are expected to start providing services services. In the Democratic People’s Republic of Korea, in early 2015). In the Philippines, the ICRC continued the ICRC continued to assist the Ministry of the People’s to cooperate with the Davao Jubilee Foundation by Armed Forces by providing financial and technical sup- providing support for its physical rehabilitation centre. port for the Rakrang Physical Rehabilitation Centre. The Besides physical rehabilitation activities, the centre offers ICRC continued to donate essential materials and compo- medical consultations, psychological counselling and nents to ensure the provision of services. community-based rehabilitation services. In conjunction with national and international partners, the Foundation In India, the ICRC continued to provide support for also facilitates the social and economic inclusion of four centres, three of which were in the state of Jammu people with disabilities by sponsoring scholarships for and Kashmir: the Artificial Limb Centre at the Bone and children and by integrating economically vulnerable Joint Hospital in Srinagar, the Artificial Limb Centre at adults into the workplace. the Government Medical College in Jammu and the P&O department of the Voluntary Medicare Society (VMS) in In Sri Lanka, the ICRC continued supporting the Jaffna Srinagar. The fourth centre, the Physical Rehabilitation Jaipur Centre for Disability Rehabilitation (JJCDR) until Reference Centre in Raipur, is in the state of Chhattisgarh. end of June. As planned, the JJCDR eased out of ICRC In addition, the ICRC started to provide support for two technical and financial support by mid-year, receiving additional centres, the Christian Medical College (CMC) a last shipment of ICRC-donated materials and compo- in Vellore and Mobility India (MI) in Bangalore. nents to cover its production needs up to the end of 2015. The JJCDR has been able to cope with the gradual reduc- In Myanmar, the ICRC continued to support the Hpa-an tion of support without adverse consequences for the Orthopaedic Rehabilitation Centre (HORC), which is provision of services. run jointly by the Myanmar Red Cross Society and the ICRC, as well as the Yenanthar Leprosy Hospital In the Americas, the ICRC provided support for 15 pro- and Mandalay General Hospital, both managed by the jects in four countries. In Colombia, the ICRC continued Ministry of Health. However, the ICRC terminated its working closely with the Ministry of Health and Social support for Mandalay General Hospital at the end of Protection (MSPS) in setting out standards and guide- 2014. The ICRC also continued to support the prosthetic lines for regulating the physical rehabilitation sector. foot and crutches manufacturing unit at the National In addition, the ICRC continued to work with the two Rehabilitation Hospital, which is managed by the Ministry existing training institutions for P&O professionals, the of Health and located in Yangon. Following the Ministry Servicio Nacional de Aprendizaje (SENA) in Bogotá of Health’s acceptance of the ICRC’s proposal to establish and the Instituto de Técnicas Integradas Multiples de two physical rehabilitation centres (PRCs) in Myitkyina Occidente (TIMDO) in Cali. In terms of service provi- (Kachin State) and in Kyaing Tong (Eastern Shan State) sion, the ICRC’s principal partners were still the Hospital in order to respond to the high demand from services Universitario del Valle and Ortopédica Americana in users in those conflict-affected regions, the Ministry gave Cali. Because of the recurrent lack of involvement from its approval for the Myitkyina PRC to be constructed in the provincial authority, the ICRC decided to suspend 2015 and for the Kyaing Tong PRC to be constructed in its collaboration with the Centro Cardio-neuromuscular 2016. The Ministry of Health and the ICRC signed the in Cucuta in September 2014. The ICRC also provided project agreements for the two PRCs on 26 November material support for the Centro Integral de Rehabilitación 2014. In Nepal, the ICRC continued supporting the P&O de Colombia (CIREC) in Bogotá and the Fundación REI department at Green Pastures Hospital in Pokhara and para la Rehabilitación Integral in Cartagena. the Yerahity Rehabilitation Centre in Kathmandu, which is managed by the Nepalese army and provides services The ICRC’s projects in Mexico, Honduras and Guatemala for military personnel and civilians. were part of a regional effort by the organization to ensure
12 PHYSICAL REHABILITATION PROGRAMME 2 – Overview of activities in 2014
access to suitable rehabilitation services for migrants. security situation had an impact on the implementation Many of these migrants suffer serious injuries while trav- of activities. Nevertheless, the number of individuals elling north in dangerous conditions, with little chance receiving services at ICRC-assisted centres doubled in of gaining access to physical rehabilitation. The strategy comparison to 2013. Discussions with the authorities con- and approach employed in Guatemala complement those tinued – on opening a new centre in Sa’ada to ensure used in El Salvador, Honduras, Mexico and Nicaragua. In access to services for people with disabilities from Sa’ada all those countries, after identifying migrants in need of governorate and its surroundings. physical rehabilitation services, the ICRC refers them to one of the assisted centres, where it then covers the cost of treatment, transport and accommodation. Before they Services provided are returned to their countries of origin, migrants fitted with devices in, say, Mexico, are informed of how they In 2014 more than 318,000 people with physical dis- may continue to receive services through the network of abilities benefited from various services at ICRC-assisted ICRC-partnered centres in the various countries. In addi- centres. The services included the provision of 20,145 tion to ensuring that migrants have access to services, prostheses, 74,104 orthoses, 4,495 wheelchairs and 19,118 the project in Guatemala provided similar support for pairs of crutches, as well as physiotherapy for nearly mine survivors. In Guatemala, the ICRC continued to 154,000 people. In addition, to the services mentioned work with the Centro de Atención a Discapacitados del above, several people attended the centres for follow-up Ejército de Guatemala (CADEG), the Hospital Infantil de and maintenance and repair of their devices. Thirteen Infectología y Rehabilitación (HIIR) and a private service per cent more people received services at ICRC-assisted provider, Clínica Ortopédica y Rehabilitación CLOR S.A. centres in 2014 than in the previous year. Children repre- In Mexico, the ICRC continued to work with the Orthimex sented 28% and women 20% of the beneficiaries. Prosthetics and Orthotics Centre in Tapachula (Chiapas state) and with the National Rehabilitation Institute in Mexico City. In Honduras, the ICRC continued to work Ensuring equal access to services with the TELETON integral physical rehabilitation centre in San Pedro Sula and the Vida Nueva physical rehabilita- The ICRC takes all possible measures to ensure that tion centre in Choluteca to ensure that returned migrants everyone in need of physical rehabilitation has equal had access to adequate physical rehabilitation services. access to it, regardless of social, religious, ethnic or other considerations. Throughout the year, specific activities In the Near and Middle East, the ICRC supported 18 were implemented in projects to overcome inequality in projects in two countries and one territory. In Gaza, the accessing services for specific groups such as women, ICRC, with the support of the Norwegian Red Cross, children and minority groups. This included supporting continued to provide assistance for the Artificial Limb outreach and mobile clinic visits for those living in remote and Polio Centre in Gaza City, which is managed by the areas (Cambodia, Guinea-Bissau, Mali, Myanmar, Nepal, Municipality of Gaza, the aim being to ensure access to the Philippines and Sudan), supporting the opening of appropriate physical rehabilitation services in the Gaza small repair workshops and/or referral sites (China, South Strip. In addition, in March the ICRC completed its pro- Sudan and Sudan), supporting the implementation and ject on post-surgical physiotherapy for inpatients, which functioning of separate clinical areas for women when was developed to reduce the risk to these service users needed, providing scholarships to increase the number of of becoming physically disabled during hospitalization. women professionals (Yemen), and so on. The project was implemented from 2008 to 2013 in six Ministry of Health hospitals. In Iraq, the ICRC continued to support 13 facilities around the country, 10 of them Services for mine/ERW survivors managed by the Ministry of Health: four in Baghdad (Al-Wasity Hospital, the Sadr Al Qanat P&O Centre, the In 2014 the ICRC provided assistance for 12 of the 28 States Baghdad Centre and the Al-Salam Crutch Production party to the Anti-Personnel Mine Ban Convention that Unit) and one each in Basra, Falluja, Hilla, Najaf, Nasiriya had acknowledged their responsibility for landmine survi- and Tikrit. One was managed by the Ministry of Higher vors: Afghanistan, Burundi, Cambodia, Chad, Colombia, Education (the P&O institute) and one by the Ministry the Democratic Republic of the Congo, Ethiopia, Guinea- of Defence (Baghdad). In addition, the ICRC continued Bissau, Iraq, South Sudan, Sudan and Yemen. In all those to manage the Erbil Physical Rehabilitation Centre. The countries, survivors’ access to services was facilitated by ICRC was not the only organization supporting the the ICRC. This was also the case for survivors from the physical rehabilitation sector in Iraq but was by far the Sahrawi population living in refugee camps in south- main organization providing support to strengthen the western Algeria and for survivors in China, Guatemala, country’s physical rehabilitation sector. In Iraq, 16 Syrian India, Myanmar, Nepal, Niger, Pakistan and Sri Lanka. refugees were given access to physical rehabilitation at the Erbil centre; in Lebanon, 33 Syrian refugees had access In 2014 the ICRC-assisted network of centres provided to physical rehabilitation services, for which the ICRC 6,543 prostheses and 279 orthoses specifically for mine provided financial support. In Yemen, the ICRC contin- survivors (of the total number of prostheses and orthoses ued assisting four physical rehabilitation centres in Aden, provided, 20,145 and 74,104 respectively); it also ensured Mukalla, Sana’a and Taiz. As in the past, the prevailing access to physiotherapy treatment for 11,563 survivors (of
13 PHYSICAL REHABILITATION PROGRAMME ANNUAL REPORT 2014
SERVICES PROVIDED IN 2014 ``Supporting the development and/or implementation 74,104 of all services (P&O, physiotherapy, wheelchairs, walking aids) at assisted centres; 20,145 19,119 ``Supporting the professional development of existing professionals by developing and conducting short courses and by making available ICRC specialists to support the activities of the assisted centres; ``Supporting the development of treatment protocols and guidelines; ``Providing scholarships for formal training in P&O 4,495 and physiotherapy and/or conducting formal training.
Prostheses Orthoses Wheelchairs Crutches (pairs) Supporting the professional development of existing professionals
In the course of the year, several approaches were used a total of 153,478 people receiving physiotherapy treat- to enhance the quality of the services provided at the ment). In addition, many survivors were provided with assisted centres. While ICRC specialists continued to wheelchairs and walking aids. Children accounted for provide on-the-job training and mentoring in all projects, 3% and women for 8% of the total number of survivors efforts were maintained to increase and update the skills who received prostheses and orthoses. In Afghanistan, and knowledge of people who were already working. The Cambodia, Chad, Colombia, the Democratic Republic of following are some examples: the Congo, Ethiopia, Iraq, Myanmar, South Sudan, Sudan and Yemen, the ICRC continued to be the main interna- ``In South Sudan, a module on physical rehabilitation tional organization providing physical rehabilitation and for beneficiaries in need of devices or mobility aid assisting in its provision. was organized for physiotherapy students at St Mary’s University; ``In India, the ICRC sponsored the attendance of Improving access to appropriate clubfoot services one staff member from a national training institute, SVNIRTAR in Orissa, at the global educators’ meeting In 2014 the ICRC continued its efforts to enhance club- in Kobe, Japan. It also sponsored the participation foot services as part of its assisted physical rehabilitation of three staff members from assisted centres in projects. Activities were therefore reinforced in countries training on foot orthoses, the attendance of seven staff where the ICRC had already conducted clubfoot projects members at the conference organized by the Orthotics (Afghanistan, Cambodia, Ethiopia, Nepal and Pakistan). & Prosthetics Association of India (OPAI), and the Contacts were maintained with the Global Clubfoot attendance of three staff members from the assisted Initiative, an international consortium whose aim is to centre to attend the South Asian Association for mitigate the consequences of clubfoot throughout the Regional Cooperation (SAARC) conference on Best world; the ICRC is a member of the board of trustees. Practice in Rehabilitation Therapy in Mobility, which Guidelines have been produced internally to standardize was held in Bangalore. the ICRC’s approach for children affected by clubfoot; the ``In Myanmar, the ICRC sponsored the attendance of Ponseti method has been recognized as the best approach two candidates at a two-week Ischial Containment to implement in ICRC-assisted projects. Socket (ISC) seminar in Tanzania. ``In Myanmar, the ICRC funded the third amputation surgery seminar for 27 junior surgeons working IMPROVING THE QUALITY at remote stations in the south-eastern part of the OF THE SERVICES PROVIDED country. The focus was on the most appropriate surgical techniques to ensure optimal use of the A number of factors helped to improve services: enhanc- prosthetic device. ing local technical and clinical capacity and the skills ``In Pakistan, several short courses were conducted contributed by expatriate specialists, improving the on various aspects related to P&O, physiotherapy ICRC-developed polypropylene technology, develop- and wheelchair services. The ICRC supported ing treatment guidelines, promoting a multidisciplinary three wheelchair training sessions attended by 26 patient-management approach and emphasizing the qual- participants. In addition, P&O students from PIPOS ity rather than the quantity of the services provided. The were supervised during their internship. ICRC’s approach to improving the quality of appropriate ``In Afghanistan, physiotherapy students were physical rehabilitation services encompasses numerous supervised during their internship at the ICRC’s activities; the key activities are listed below and three of centre in Kabul. them are then discussed in greater detail. ``In Colombia, the ICRC organized six short-term training courses for P&O professionals, which were attended by 25 people from various service providers. It also conducted two seminars on physiotherapy
14 PHYSICAL REHABILITATION PROGRAMME 2 – Overview of activities in 2014
for lower-limb amputees, which were attended Conducting formal training in P&O by 22 people from Colombia and six other Latin American countries. In addition, 20 P&O students In 2014 the ICRC also continued to conduct formal P&O from the SENA were given an introductory course training in Afghanistan and in Ethiopia. In Afghanistan, in physiotherapy by the ICRC. The team from the the second course for P&O technicians (ADPO 2), con- Physical Rehabilitation Programme participated ducted in partnership with the Ministry of Public Health, in three war surgery seminars, with a view to entered its second year and was attended by 18 students improving the quality of amputations and promoting (six of whom were women). The students were from interdisciplinary rehabilitation services. ICRC-managed centres (12) and from centres managed ``In Mexico, Honduras and Guatemala, the ICRC by the Swedish Committee for Afghanistan (4) or the sponsored the attendance of two ortho-prosthetists Ministry of Public Health (2). They came from various from each country at a two week training course parts of the country, including Faizabad, Ghazni, Herat, conducted by Don Bosco University (El Salvador) in Jalalabad, Kabul, Khost, Laghman, Lashkar Gah, Mazar- the prosthetic production of prostheses for amputees e-Sharif and Takhar. with hip disarticulation. ``In Gaza, the ICRC sponsored the attendance of three In Ethiopia, the ICRC continued, in conjunction with P&O technicians at a training course in orthotics Ministry of Labour and Social Affairs, the Ministry of jointly organized by TATCOT and the ICRC Special Health, the Ministry of Education and the Medical Faculty Fund for the Disabled in Tanzania. In conjunction of Addis Ababa University, to conduct a three-year course with the ICRC’s mental health and psychological in P&O. Of the 23 people attending prosthetics and support (MHPSS) team, sessions were conducted orthotics training conducted by the ICRC, 15 successfully for ALPC staff in general as well as specifically passed Level 3 (i.e. benchworker level) and are now con- for technical staff to help improve the quality of tinuing their training to reach Level 4 (i.e. clinical level). rehabilitation for service users who had experienced Seven of them graduated from Level 5 (i.e. advanced traumatic situations during the recent conflict. training for upper limb orthotics/prosthetics and spinal ``In Iraq, the ICRC organized seven training modules orthotics) and are now practising their newly acquired covering different aspects of physical rehabilitation at skills at their rehabilitation centres. the ICRC-managed centre in Erbil; they were attended by 54 professionals from the various centres assisted by the ICRC. Support for the development of new national training ``In Yemen, a Training for Trainers course (ToT) on programmes in P&O dynamic alignment and gait training for lower limb prosthetic users was conducted at the High Institute In Bangladesh, the ICRC continued to provide support of Health Sciences (HIHS) for 10 participants from the for the Bangladesh Health Professions Institute (BHPI) to institutes for physiotherapy assistants in Aden and Sana’a. establish a P&O training programme (ISPO Cat. II level). The training started in 2014 and 10 students enrolled (all In addition to fostering the development of appropriate of them sponsored by the ICRC). physical rehabilitation services at assisted centres, the ICRC maintained and supported several national profes- In Ethiopia, work on establishing a permanent train- sional associations as a means of enhancing recognition ing structure for prosthetic/orthotic technicians based for the profession and its status. This included the follow- on the training courses currently run by the ICRC has ing activities: been under way for some time. In 2014, discussions with Addis Ababa University made significant progress ``For physiotherapy, the ICRC maintained and towards establishing a Bachelor’s degree in prosthetics supported professional organizations in Afghanistan, and orthotics as the last step in ensuring the sustainability Cambodia, Chad, Colombia, the Democratic Republic of such training in Ethiopia. of the Congo, Ethiopia, Gaza, Niger, Sudan and Yemen and worked closely with several physiotherapy In Yemen, the ICRC signed an agreement with the High training institutions (Afghanistan, Colombia, Institute of Health Science in Sana’a to open a P&O Ethiopia, Iraq, South Sudan and Sudan). department and launch a P&O training programme to ``For P&O, the ICRC maintained and supported several curb the shortage of trained personnel in the country. national professional associations in work to enhance Renovation of the P&O department was begun and com- the profession (Afghanistan, Bangladesh, Cambodia, pleted in 2014. Chad, Colombia, the Democratic Republic of the Congo, Ethiopia, India, Pakistan and Niger). It also In Iraq, support for the development of the physiotherapy worked closely with and provided support for several curriculum at Hawler Medical University (Iraqi Kurdistan P&O training institutions (Bangladesh, Cambodia, Region) was initiated with support from Slippery Rock Colombia, Iraq and Pakistan). University (USA).
15 PHYSICAL REHABILITATION PROGRAMME ANNUAL REPORT 2014
Project No. of School Years Qualification Support to strengthen existing national training students programmes in P&O and PT Iraq 3 NCPO1 2010-2015 Master’s degree 1 TATCOT2 2011-2014 ISPO Cat. II In Iraq, the ICRC supported the efforts of the P&O and South 1 TATCOT 2011-2015 ISPO Cat. I physiotherapy departments at the Baghdad Institute of Sudan 1 TATCOT 2012-2016 ISPO Cat. I Medical Technology to strengthen the quality of training. 1 TATCOT 2012-2015 ISPO Cat. II Support was also provided for Al-Nahrain University to Nepal 1 CSPO3 2011-2014 ISPO Cat. II establish a P&O training programme at the university. In Philippines 1 CSPO 2011-2014 ISPO Cat. II Guinea- order to contribute to the development of these various 2 ENAM4 2011-2014 ISPO Cat. II training programmes, the ICRC sponsored candidates Bissau for training at the National Centre for Prosthetics and 6 Mobility India 2012-2015 ISPO Cat. II Yemen 6 Mobility India 2014-2017 ISPO Cat. II Orthotics at Strathclyde University in Glasgow. 3 Mobility India 2013-2016 ISPO Cat. II 3 PIPOS 2011-2015 ISPO Cat. II In Colombia, the ICRC continued to work with the two 4 NCPO 2012-2015 Master’s degree Pakistan existing training institutions for P&O professionals: at the 2 TATCOT 2011-2014 ISPO Cat. I SENA in Bogotá and at the Instituto TIMDO in Cali. The 4 CSPO 2011-2014 ISPO Cat. II ICRC works with universities which have a PT curricu- 2 CSPO 2014-2017 ISPO Cat. II lum and promote the inclusion of the “management of 1 CSPO 2013-2016 ISPO Cat. II Myanmar Rehabilitation Therapy amputees” in their curriculum. At the end of 2014, eight 1 Mobility India 2014-2015 universities had included this subject in their curriculum. Assistant 1 SSPO5 2013-2015 ISPO Cat. I 3 ENAM 2011-2014 ISPO Cat. II In Ethiopia, the ICRC began to work closely with the Chad 1 ENAM 2012-2015 ISPO Cat. II Physiotherapy School of the University of Gondar to 1 ESK6 Benin 2013-2016 BSc in Physiotherapy support clinical placements at supported centres for Cambodia 1 CSPO 2013-2016 ISPO Cat. II fourth-year students as part of their prosthetic, orthotic Niger 1 ENAM 2012-2015 ISPO Cat. II and mobility aids course. 1 TATCOT 2012-2015 ISPO Cat. I 2 Mobility India 2012-2014 ISPO Cat. II (single discipline) Bangladesh 1 Mobility India 2013-2017 BSc in P&O Providing scholarships for formal training 1 Mobility India 2014-2017 ISPO Cat.II in P&O and physiotherapy 10 BHPI7 2014-2017 Diploma 1 ESK Benin 2012-2015 BSc in Physiotherapy Burundi 1 ESK Benin 2013-2016 BSc in Physiotherapy While ICRC expatriates (ortho-prosthetists and physi- 2 TATCOT 2013-2016 ISPO Cat. II otherapists) continued to provide on-the-job training DPR Korea 2 CSPO 2013-2015 ISPO Cat. II and mentoring in all projects, efforts were maintained to 1 UDB8 2013-2016 ISPO Cat. I Colombia increase the number of qualified local professionals by 1 TIMDO9 2012-2014 National diploma in P&O providing and sponsoring training in prosthetics, orthot- 1 Mobility India 2012-2016 BSc in P&O Sudan ics and physiotherapy and by conducting short-term 1 Mobility India 2012-2015 ISPO Cat. II courses to update and refresh the skills and knowledge of Afghanistan 26 Razi Institute 2013-2015 BSc Physiotherapy those already working in those fields. In 2014, 109 people Central African 4 ENAM 2014-2017 ISPO Cat. II completed, continued or began P&O or physiotherapy Republic courses subsidized by the ICRC. Democratic Republic of 2 ENAM 2014-2017 ISPO Cat. II the Congo
1National Centre for Prosthetics and Orthotics (Strathclyde University, Glasgow). 2 Tanzania Training Centre for Orthopaedic Technologists. 3 Cambodia School of Prosthetics and Orthotics. 4 Ecole Nationale des Auxiliaires Médicaux. 5 Sirindhorn School of Prosthetics and Orthotics. 6 Ecole Superieure de Kinésithérapie. 7 Bangladesh Health Professions Institute. 8 School of Prosthetics and Orthotics, Don Bosco University. 9 Instituto de Tecnicas Integradas Multiples del Occidente.
16 PHYSICAL REHABILITATION PROGRAMME 2 – Overview of activities in 2014
Access to appropriate P&O technology physical rehabilitation services. Work also continued with the Ministry of Public Health and other Throughout the year, the ICRC continued to support stakeholders, which included the Association des orthopaedic component factories in Afghanistan and Professionnels de l’Orthopédie et de la Rééducation Cambodia. In Afghanistan, the factory supplied 14 cen- du Tchad (APORT), to draft a national plan to address tres with its products, free of charge. Seven of these physical rehabilitation needs in Chad. An agreement centres are managed by the ICRC; international NGOs was signed between the Ministry of Public Health manage the others. In Cambodia, the factory managed and the ICRC to support the process of drafting the by the Ministry of Social Affairs, Veterans and Youth national plan; in the agreement the ICRC agreed to Rehabilitation continued to provide components for all cover the cost of recruiting an international expert for physical rehabilitation centres in Cambodia (11), thus that purpose. ensuring proper care for all who receive services at centres ``In the Democratic Republic of the Congo, ICRC throughout the country. led and hosted three sessions of the Committee on Physical Rehabilitation and attended monthly sessions In addition, the quality of the prosthetic/orthotic compo- of the sub-cluster on disability. The ICRC organized a nents produced by CR Equipements SA, which makes use workshop on the national situation regarding physical of ICRC-developed technology, was monitored through- rehabilitation and provided support for national out the year via systematic feedback from field projects. professional P&O and PT associations to enhance Research continued, with a view to upgrading and further their structures and to organize national events. developing the entire range of products. In close coopera- ``In South Sudan, the ICRC continued to work closely tion with CR Equipements, the ICRC also continued work with the Ministry of Gender, Child and Social Welfare to develop a new prosthetic foot, a new prosthetic knee (MoGCSW) to strengthen the latter’s capacity to and a new prosthetic hand. implement, coordinate and lead-manage physical rehabilitation activities. The ICRC started to discuss an increase in support for centre management and to PROMOTING THE LONG-TERM AVAILABILITY establish a national board in charge of supervising the OF SERVICES quality and quantity of physical rehabilitation services. ``In Afghanistan, the ICRC maintained close working The ICRC endeavoured throughout the year to ensure relations and coordination activities with the relevant long-term services, not only by providing support for authorities and participated in the drafting of training but also by implementing projects in close coop- guidelines, in particular for the treatment of spinal eration with local partners, by continuing to develop cord injured service users (SCI) and participated management tools, by supporting the work of bodies in the Disability Stakeholder Commission Group, a coordinating local rehabilitation and by promoting the working group set up at the Ministry of Labour, Social development of national policies for the provision of Affairs & Martyrs and Disabled (MoLSAMD) to physical rehabilitation services. promote social reintegration. ``In Pakistan, to further enhance the long-term functioning of PR services in Pakistan, a concept to Local partners establish a supply chain covering a wider range of raw materials and components was developed with To help services to continue functioning after it has with- the support of the ICRC. The ICRC is also providing drawn, the ICRC has adopted a long-term approach to support to enable a member of the management staff implementing and managing its rehabilitation projects. at CHAL Foundation to attend a two-year training Implementing projects with local partners is the cor- programme in project management. nerstone of this strategy. Of the 99 projects assisted by ``In Iraq, the ICRC worked closely with government the ICRC in 2014, 55 had been undertaken in conjunc- ministries involved in rehabilitation, actively tion with governments (ministries of health or of social participated in meetings of the Higher Committee affairs), 42 with local NGOs, three with private entities for Physical Rehabilitation, organized a national and three with National Societies. Ten other projects were workshop on physical rehabilitation in Erbil and implemented directly by the ICRC. continuously assessed supported centres. ``In Yemen, 42 participants took part in a national The ICRC conducted several activities to ensure the long- coordination seminar organized by the ICRC. Participants term sustainability of services, for example: were from the four assisted PRCs, Directorates of the Ministry of Public Health and Population (MoPHP) and ``In Ethiopia and Sudan, two teams (one from each other stakeholders. A sub-committee with representation country) completed the Senior Leadership Training from the centres was constituted to follow up the Programme, which was managed by Management recommendations of the seminar. Science for Health, conducted by Yale University, facilitated by managers from the ICRC’s Physical Supporting management at centres Rehabilitation Programme and sponsored by USAID. ``In Chad, the ICRC continued to encourage the The ICRC also helped management staff at assisted centres Ministry of Public Health to increase its investment in to improve their management skills and their knowledge
17 PHYSICAL REHABILITATION PROGRAMME ANNUAL REPORT 2014
of physical rehabilitation. In most of its assisted projects, Amputees Rehabilitation Programme (C-ARP) such as it introduced an ISPO cost-calculation system, which socio-psychological development sessions to help provide enabled managers to draw up budgets for their centres. In psychological needs for 15 children. Sports equipment addition, managers were given close support to develop was distributed to 20 children to enable them to par- and implement standard working procedures (human ticipate in healthy activities at school and in their home resources management, stock management, service user environment. In Cambodia, to ensure access to eco- management, etc.). nomic reintegration programmes, social workers from the MoSVY employed at assisted centres facilitated the enrol- Throughout the year, ICRC specialists helped managers ment of 58 people with disabilities in socio-economic of assisted centres to improve management of stock and programmes. In Colombia, at the end of the year the orders, administration of the annual budget and fund ICRC initiated a social and reintegration project under allocation, organization of machinery and equipment the management of the Economic Security Department maintenance, service user management (by means of for those receiving physical rehabilitation services with a database) and wheelchair services. In Cambodia, the the assistance of the ICRC. In Honduras, 20 returned ICRC continued to provide financial support, enabling migrants received training and funds for microeconomic one centre manager to enrol in a three-year management initiatives that would ease their reintegration in their training course. communities. The funds provided by the ICRC enabled the returned migrants to create small income-generation Over the year, the deployment of the ICRC-developed projects (barber shop, selling shoes, etc.). computerized user management system (Patient Management System – PMS) was extended. The PMS was In the Philippines, with ICRC support, the Davao Jubilee developed by the ICRC as a tool to manage user records Foundation celebrated the importance of technology and services at physical rehabilitation centres. It is now in in empowering the lives of people with disabilities in use in 16 countries (61 centres). Mindanao and called for efforts to ensure that modern technology is accessible to people with disabilities. Several advocacy campaigns on empowering people with disabil- BEYOND PHYSICAL REHABILITATION ity groups from various areas in Mindanao were launched through different activities. For instance, the Davao In the course of the year, the ICRC supported several Jubilee Foundation, in cooperation with the Surallah activities that went beyond physical rehabilitation services local government (South Cotabato) conducted a two-day and set out to promote the inclusion and participation resource mobilization training workshop for people with in their societies of people with disabilities. In 2014 the disabilities leaders; it was attended by 18 people with dis- ICRC maintained and, in some cases, provided sup- abilities. This workshop specifically stressed the fact that port for people with disabilities organizations in most through adaptive and assistive technology, people with countries where it was providing assistance. Support in disabilities can make the most of their potential in their celebrating the International Day of People with Disability communities; resource mobilization activities such as was provided in most countries. In addition, socio- the development of small group websites showcasing the economic reintegration and sports activities continued to products of their livelihood projects play a key role. receive support from the ICRC, as shown in the following examples. In Ethiopia, there was a strong focus on the International Day of People with Disability on 3 December 2014, with the ICRC supporting a number of different programmes Socio-economic reintegration in connection with that event. In the Oromia region, sup- port was provided for the Oromia Agency of Labour and The ICRC’s physical rehabilitation project in Afghanistan Social Affairs for an awareness-raising activity in Bishoftu combines physical rehabilitation with activities aimed at highlighting issues relevant to people with disabilities. social inclusion and participation of people with disabili- The centre in Nekemte ran a programme in the town with ties in society. In 2014 over 3,000 people with disabilities ICRC support, introducing its activities and services for were offered social inclusion opportunities such as educa- people with disabilities. In partnership with the Ethiopian tion (around 1,400), vocational training (250), microcredit Basketball Federation (EBF), the ICRC held an exhibition (540), employment (54) and sport (400). Special home of different sports for people with disabilities at the EBF teaching was provided for 230 children with severe physi- headquarters. cal disabilities who were unable to attend schools, while transport was provided for those with problems in reach- In Iraq, the ICRC-run Erbil physical rehabilitation centre ing school or university. Home adaptations were made had four employees with disabilities and the ICRC con- and accessible toilets and baths built to improve home tinued to stress the importance of employing people with mobility of people with spinal cord injuries. disabilities at partner institutions. Moreover, the ICRC’s economic security activities provided economic support In Pakistan, besides some activities organized in con- for socio-economic reintegration for 50 households in junction with partners for the International Day of which there was a family member with a disability. People with Disability, the ICRC continued to sup- port social integration activities run by the Children
18 PHYSICAL REHABILITATION PROGRAMME 2 – Overview of activities in 2014
In Yemen, isolation and stigmatization are challenges match between Bangladesh and Nepal was organized experienced by people with disabilities that will require by the CRP with ICRC support. both political and social willpower if they are to be over- ``In Cambodia, with the financial support of the come. The ICRC continued to network with local NGOs ICRC and the International Olympic Committee, and others, with a view to increasing the inclusion of the Cambodian National Volleyball League for people with disabilities in their communities. In 2014 the Disabled (CNVLD) expanded the women’s ICRC-managed microeconomic initiatives provided loans wheelchair basketball programme in Battambang and for 86 people with disabilities to start businesses. The in Kampong Speu. All athletes now undergo regular International Day of People with Disability (3 December) weekend training under the supervision of CNVLD and the Arabic Day of Persons with Disabilities (13 staff/coaches and they all also took part in two 10-day December) were celebrated in different cities in Yemen basketball training sessions conducted by an ICRC- in 2014. The ICRC distributed 1,500 T-shirts bearing a sponsored international trainer. special message about equality and donated 16 wheel- ``In India, the ICRC worked in partnership with the chairs to the General Union for Sports for the Disabled. newly established Wheelchair Basketball Federation, A marathon was organized for eight women and eight Choice International (UK) and other organizations. In men as part of the Arabic Day of Persons with Disabilities this framework, a country-wide wheelchair basketball celebrations in Sana’a. event was organized in six Indian cities, including the first national wheelchair basketball tournament in Chennai. Overall, 177 people with disabilities Promoting access to sport for people with disabilities participated in the training sessions; they came from Amar Jyoti (18), Bangalore (38), Chennai (140), the Access to sport increases self-confidence and self-esteem. CMC in Vellore(12), the Indian Spinal Injuries Centre In 2014 the ICRC supported several activities for people (ISIC) in New Delhi (44), Kochi (43) and the PRC in with disabilities, as shown in the following examples. Pune (22). Two round-table discussions on developing disability sports and social inclusion also took place in ``In Afghanistan, the ICRC continued to promote New Delhi and Chennai. sports activities such as football, volleyball, ``In Ethiopia, 24 basketball wheelchairs were donated badminton and wheelchair basketball. The latter to the Ethiopian Basketball Federation (EBF) as an currently has over 300 players, with six men’s and additional step to support wheelchair basketball three women’s teams at six different locations. in Ethiopia and, by doing so, to increase social National tournaments were organized for male and participation/inclusion opportunities for people with female players, with the aim of raising awareness of disabilities. This donation was channelled to four disability and of supporting the Afghan Paralympic Regional Basketball Federations (in Addis Ababa, Dire Committee. Men’s and women’s national teams were Dawa, Southern Nation and Oromia), and will be selected. The men’s team took part in international followed in 2015 by support for training and capacity competitions in Europe. The Wheelchair Basketball building for coaches, referees and players. In 2014 Federation of Afghanistan (WBFA) is in the process of the EBF officially ratified wheelchair basketball in its obtaining recognition by the International Wheelchair constitution and is now the “owner” of the sport in Basketball Federation (IWBF). Ethiopia. With support from the ICRC, this will have ``In Bangladesh, the very first Bangladesh national a significant impact on the sustainability of the sport seminar and training workshop on physically disabled in that country. The inclusion of wheelchair basketball cricket was held in cooperation with the Bangladesh (a “para” sport) within the EBF, an able-bodied sports Cricket Board (BCB); it was supported by the England organization, is the first in Ethiopia and is important and Wales Cricket Board (ECB) and the British in facilitating social change with regard to people with High Commission (BHC) in Dhaka. More than 100 disabilities. participants, officials, coaches, health-care staff and ``In Gaza, a wheelchair basketball tournament physically disabled cricketers received disability to promote social inclusion through sports was awareness information and hands-on practical organized by the ICRC in cooperation with the training. The CRP physically disabled cricket and Paralympic Committee and the Wheelchair Basketball wheelchair basketball teams received ICRC support Federation of Gaza. The tournament consisted of to hold intensive training camps to improve their 4 teams of 20 players each, making a total of 80 overall performance. Organized by the CRP in participants. The event was widely appreciated by the Savar with ICRC support, the 13th conference of the ICRC’s main contacts and the local media. Asian Spinal Cord Network (ASCoN) and associated physically disabled sports events were attended by over 300 national and international participants. The ICRC sponsored athletes with physical disabilities from Bangladesh, India and Nepal to enable them to compete in wheelchair basketball, table tennis and powerlifting activities. On the International Day of People with Disability, a friendly wheelchair basketball
19 PHYSICAL REHABILITATION PROGRAMME ANNUAL REPORT 2014
COOPERATION WITH OTHER BODIES increasing access to appropriate treatment and methods of prevention in low and middle-income countries. The In order to set technology standards, draw up guidelines for GCI’s vision is that the enormous burden of disability training professionals and further develop the field of phys- caused by untreated (or wrongly treated) clubfoot could ical rehabilitation, the ICRC continued interacting with be lifted if more and more people gained the skills to rec- various bodies involved in physical rehabilitation and dis- ognize and treat clubfoot effectively, primarily using the ability issues: the International Society for Prosthetics and Ponseti method. The ICRC is actively participating in the Orthotics, the World Confederation for Physical Therapy, work of the GCI through field projects and as a member the World Health Organization and the International of the board of trustees. Society of Physical and Rehabilitation Medicine.
Academic institutions in developed and developing International Society for Prosthetics and Orthotics (ISPO) countries
The Physical Rehabilitation Programme maintained close In 2014 the ICRC continued to interact with various contact with ISPO throughout the year. This included training institutions to improve the polypropylene tech- participation in the open board meetings, educational nology that it had developed and to provide support for committee meetings, inspections and evaluations of the professional development of people working in the schools and several other activities conducted by ISPO. field of physical rehabilitation. The institutions and sup- port activities included:
World Confederation for Physical Therapy (WCPT) ``the Tanzanian Training Centre for Orthopaedic Technologists: serving as a member of the Advisory The Physical Rehabilitation Programme maintained close Board; contact with the WCPT throughout the year and par- ``the Pakistan Institute of Prosthetic and Orthotic ticipated in different working groups and/or network Sciences: providing support for its P&O training discussions such as the WCPT Network for Physical programmes; Therapist Educators. ``Teesside University (UK): providing support for developing quality standards for physiotherapy; ``research activities at the International Centre for International Society of Wheelchair Professionals (ISWP) Evidence in Disability of the London School of Hygiene & Tropical Medicine. The ICRC is a member of the Advisory Board.
National and international forums on victim assistance World Health Organization (WHO) Throughout the year, the Physical Rehabilitation The Physical Rehabilitation Programme (PRP) main- Programme participated in forums on victim assistance tained close contact with WHO throughout the year. The held under the different weapons treaties such as the Anti- PRP is a member of the Guidelines on Health-Related Personnel Mine Ban Convention, the Cluster Munitions Rehabilitation Development Group and supports the Convention and the Convention on Conventional GATE Initiative. Weapons. In 2014 the Physical Rehabilitation Programme participated in the work prescribed under those conven- tions, which included attending meetings of the Standing International non-governmental organizations Committee on Victim Assistance and Socio-Economic Reintegration as well as the Meeting of the States party to Besides the regular and ongoing contacts at field the Anti-Personnel Mine Ban Convention. level between the ICRC and other organizations, the Physical Rehabilitation Programme held regular meet- ings at headquarters and in the field with organizations African Federation of Orthopaedic Technicians (FATO) such as Handicap International, EXCEED, Johanniter- Unfall-Hilfe, the Christoffel-Blindenmission (CBM) and The ICRC’s Physical Rehabilitation Programme (PRP) and Motivation UK in order to share information and to the ICRC Special Fund for the Disabled signed an agree- coordinate activities. ment with the FATO, under which both organizations would work to improve and promote access to appropriate rehabilitation services in Africa. Under this agreement, Global Clubfoot Initiative (GCI) the PRP actively supported various activities organized by the FATO and actively supported the work of several The Global Clubfoot Initiative was launched by a group FATO committees such as the Scientific Committee, the of international non-governmental organizations to sup- Education Committee and the Advisory Board. port the development of clubfoot projects, with the aim of
20 PHYSICAL REHABILITATION PROGRAMME 2 – Overview of activities in 2014
Organisation Africaine pour le Développement des Centres pour Personnes Handicapées (OADCPH)
The OADCPH was created to promote access to physical rehabilitation services in Africa through several activities, including the implementation of a central purchasing outlet based in Lomé (Togo). As the ICRC considers this an excellent way of facilitating access to materials and components for assisted projects, several activities were implemented in 2014 in support of the initiative. J. Björgvinsson/ICRC J.
21 3 – PHYSICAL REHABILITATION PROGRAMME AROUND THE WORLD
ICRC headquarters
ICRC-assisted prosthetic/orthotic centres
22 AFRICA 11 countries 35 projects ASIA 11 countries 45 projects THE AMERICAS 4 countries 15 projects 4 countries and 18 projects NEAR AND MIDDLE EAST 1 territory
30 countries and TOTAL 113 projects 3 – PHYSICAL REHABILITATION 1 territory PROGRAMME AROUND THE WORLD
ICRC headquarters
ICRC-assisted prosthetic/orthotic centres
23 4 – PROJECT ACTIVITIES
24 4.1 – AFRICA
25 B. Heger/ICRC B. ICRC PHYSICAL REHABILITATION PROGRAMME ANNUAL REPORT 2014
ICRC SUPPORT IN AFRICA AT A GLANCE In 2014 the ICRC provided support for 36 projects in 11 countries: Algeria (1), Burundi (1), Chad (2), the Democratic Republic of the Congo (5), Ethiopia (10), Guinea-Bissau (1), Libya (1), Mali (1), Niger (1), South Sudan (3) and Sudan (10). `` In Guinea-Bissau, the number of people with physical disabilities receiving services at the CRM increased by 31% compared to 2013. `` In Niger, the number of people with physical disabilities receiving services at the CRM increased by 27% compared to 2013. Services provided Service users attending the centres 22,915 New service users fitted with prostheses 1,783 New service users fitted with orthoses 1,706 Prostheses supplied 3,923 Orthoses supplied 4,774 Wheelchairs supplied 752 Walking aids supplied (pairs) 5,209 Service users receiving appropriate physiotherapy services 11,899 Children represented 33% and women 19% of those benefiting from services. In Mali, 52 people with physical disabilities had access to physical rehabilitation services owing to financial support from the ICRC. In the Democratic Republic of the Congo, the ICRC developed accessibility to psychosocial support for beneficiaries in its Kivu-based projects. Developing national capacities Sixteen candidates were sponsored for formal training in P&O and three candidates for formal training in physiotherapy. In Ethiopia, of the 23 people attending prosthetics and orthotics training conducted by the ICRC, 15 successfully passed Level 3 (i.e. benchworker level) and are now continuing their training to reach Level 4 (i.e. clinical level). Seven of them graduated from Level 5 (i.e. advanced training for upper limb orthotics/prosthetics and spinal orthotics) and are now practising their newly acquired skills at their rehabilitation centres. Promoting the long-term functioning of services In Ethiopia and Sudan, two teams (one from each country) completed the Senior Leadership Training Programme conducted by Yale University. This training programme was managed by Management Science for Health, facilitated by managers from the ICRC’s Physical Rehabilitation Programme and sponsored by USAID. In Chad, the ICRC continued to work with the Ministry of Public Health and other stakeholders, including the Association des Professionnels de l’Orthopédie et de la Rééducation du Tchad (APORT), to draft a national plan to address physical rehabilitation needs in Chad. In the Democratic Republic of the Congo, the ICRC organized a workshop on the national situation of physical rehabilitation and supported national professional P&O and PT associations (ATOC and UKC) to develop their structure and organize national events. Promoting inclusion and participation In most countries where the ICRC provided assistance, support was given to either government bodies and/or people with disabilities organizations to organize activities to mark the International Day of People with Disability. In the Democratic Republic of the Congo, the ICRC built a basketball ground in Bukavu and furnished teams in three provinces with sports wheelchairs. In addition, the ICRC converted a hotel in Goma to make it accessible for wheelchair users. In Ethiopia, the ICRC donated basketball wheelchairs to the Ethiopian Basketball Federation (EBF) as an additional step to support wheelchair basketball in Ethiopia and, by doing so, to increase social participation/inclusion opportunities for people with disabilities. In Guinea-Bissau, the ICRC supported the Federaçoa de Desportos para Deficientes da Guinée-Bissau in the organization of a wheelchair basketball tournament to mark the International Day of People with Disability.
ALGERIA LYBIA
MALI NIGER CHAD SUDAN GUINEA- BISSAU ETHIOPIA SOUTH SUDAN
DEMOCRATIC REPUBLIC OF THE CONGO BURUNDI
26
ICRC/ PRP_14 PHYSICAL REHABILITATION PROGRAMME 4.1 – africa
ALGERIA SAHRAWI REFUGEES LIVING IN SOUTH-WESTERN ALGERIA
National partner PORTUGAL SPAIN TUNIS Public Health Authority of the Polisario Front Location of project ALGIERS Rabouni MOROCCO TUNISIA Services in 2014 Service users attending the centre 436 New service users fitted with prostheses 8 LIBYA New service users fitted with orthoses 18 WESTERN Rabouni SAHARA Prostheses 22 LIBYA Orthoses 40 Wheelchairs 2 MAURITANIA MALI Crutches (pairs) 14 NIGER Service users receiving physiotherapy 424 ICRC/ PRP_14 Beginning of assistance: 2007 MALI NIGER
In 2014 the ICRC continued to provide support for the than those provided by NGOs during their sporadic mis- activities of the Centre Martyr Chereïf, managed by the sions. Transport and financial resources remains major Polisario Front’s Public Health Authority. The centre was obstacles to accessing rehabilitation services. Within the originally located in Noukhaila but had been moved to camps, which are spread over a fairly large area of desert, Rabouni, within the hospital compound. It offers physi- there is little public transport and, especially for indi- cal rehabilitation for the Sahrawi population living in viduals who have mobility impairments, it is difficult to refugee camps. There are five camps – four of them access the local facilities. within a radius of 35 km from Rabouni (Auserd, Bujdoor, El Ayun and Smara); the fifth, Dakhla, is situated 150 km In 2014 several activities were implemented by the ICRC from Rabouni. The Ministry of Public Health (MoPH) is to increase access to services. They included donating the main body responsible for disability issues and physi- materials and components to enable the centre to pro- cal rehabilitation services. vide services, establishing a referral network with the hospitals and conducting outreach visits in the differ- It remains unclear how many people were living in the ent camps. The objectives of this outreach programme camps (estimates range from 45,000 to 165,000) and how were the same as in the past, i.e. to identify potential many people with disabilities were in need of access to beneficiaries, to provide follow-up for those who had physical rehabilitation services. As of August 2014 the already received services, to perform basic repairs and to Saharawi Association of Landmine Victims (ASAVIM) disseminate information on the services provided by the had collected detailed information on 1,006 victims centre. Two outreach visits were conducted in two camps of mines, cluster munitions and other ERW who were in 2014. In 2014 a total of 436 people with physical dis- living in and around the Rabouni refugee camps on the abilities received various services at the ICRC-assisted Algerian border with Western Sahara. The Polisario centre (this number does not include people receiving authorities reported a total of 1,413 people killed and services during outreach visits). Services included the injured by mines/ERW in April 2014. Action on Armed provision of 22 prostheses (73% for mine survivors), 40 Violence (AOAV) carried out a survey in 2012 and orthoses (15% for mine survivors), 2 wheelchairs and 14 located 300 amputees who had been landmine victims. pairs of crutches as well as physiotherapy for 424 people There are 700 people with disabilities registered on the (34% for mine survivors). Children represented 29% and ICRC’s database of beneficiaries. With regard to weapon women 19% of the beneficiaries. Throughout the year, contamination, in 2005 the Polisario Front, through the the ICRC ortho-prosthetist and physiotherapist provided Geneva Call Deed of Commitment, pledged to unilater- mentoring and on-the-job training. ally ban the stockpiling of anti-personnel mines and to cooperate in mine action. To mark the International Day of People with Disability in 2014, a two-day ceremony was organized by the The physical rehabilitation sector is the responsibility of MoSA, with support from the ICRC and other organiza- the MoPH and the Ministry of Social Affairs (MoSA). tions. The event took place at El Ayun camp. On the first The MoPH has a physiotherapy department at the day, the various organizations and associations active in “national” hospital in Rabouni and basic services at each the camps, including the MoSA, gave presentations; the of the wilaya hospitals covering the Auserd, Bujdoor, El second day was given over to festivities and dancing and Ayun and Smara camps. Through its network, the MoSA singing competitions; most people with disabilities in the is responsible for registering people with disabilities in camps participated. the camps and for providing supplementary assistance for children with cerebral palsy. Before ICRC assistance was provided, obtaining access to physical rehabilitation was virtually impossible as no services were available other
27 PHYSICAL REHABILITATION PROGRAMME ANNUAL REPORT 2014
In 2015 the ICRC intends to: ``enhance quality by continuing to provide ICRC ortho-prosthetists and physiotherapists, by providing ``support the Centre Martyr Chereïf by donating on-the-job training for technicians and physiotherapy materials and components and by broadening the assistants working at the centre and by cooperating types of service provided (i.e. wheelchair services, with international NGOs and associations that could clubfoot services, etc.); sponsor the visit of international experts; ``continue to support outreach visits to the camps to ``promote the long-term functioning of services by identify those in needs, to perform basic repairs and continuing to support the MoPH and MoSA in to train/educate families with children affected by managing physical rehabilitation services and facilitating cerebral palsy; the social integration of people with disabilities.
28 PHYSICAL REHABILITATION PROGRAMME 4.1 – africa
BURUNDI
National partner RWANDA Institut Saint Kizito Location of project Bujumbura Services in 2014 Service users attending the centre 2,808 BUJUMBURA New service users fitted with prostheses 7 New service users fitted with orthoses 221 DEMOCRATIC REPUBLIC OF THE CONGO Prostheses 12 Orthoses 452 UNITED REPUBLIC OF TANZANIA Wheelchairs 0 Crutches (pairs) 92 Service users receiving physiotherapy 988 ICRC/ PRP_14 Beginning of assistance: 2010
In 2014 the ICRC continued to work closely with the for most of those in need. The main causes remained the Saint Kizito Institute in Bujumbura, which is managed same: lack of facilities and professionals and the cost of by the Archdiocese of Bujumbura, the aim being to pro- treatment (users have to pay for the services). Burundi is vide physical rehabilitation services for people from the one of the 30 States party to the Anti-Personnel Mine Ban centre’s catchment areas – Bubanza, Bujumbura Mairie, Convention that have acknowledged their responsibility Bujumbura Rural, Cibitoke and Muramvya Provinces – for landmine survivors. As in 2010, the estimated number four of which were the areas in Burundi most severely of survivors was approximately 5,000. In 2014 the head contaminated by weapons. of Victim Assistance in the General Directorate for Civil Protection participated in a joint ICRC/African Union Burundi signed the UN Convention on the Rights of workshop on victim assistance in Addis Ababa. Persons with Disabilities (and its Optional Protocol) on 27 April 2007 and ratified it in March 2014. There are In order to increase the accessibility of services, the ICRC no current national statistics on the prevalence and inci- continued to cover the cost of treatment for 26 poor people dence of disabilities and handicap in Burundi. A General with physical disabilities. In all, 2,808 people with physical Census of Population and Housing in 2008 revealed the disabilities benefited from the various services provided by prevalence of a major handicap in Burundi of 4.5%, with the ICRC-assisted centre. Services included the provision provincial variations ranging from 3% to 7.1%, increasing of 12 prostheses, 452 orthoses and 46 pairs of crutches as sharply with age. well as physiotherapy for 988 people. Children represented 85.5% and women 7% of the 2,808 beneficiaries. The physical rehabilitation sector of Burundi was the responsibility of the Ministry of National Solidarity, The quality of the services provided was enhanced by Human Rights and Gender (MNSHRG), which was also technical and clinical mentoring by an ICRC ortho- responsible for numerous vulnerable groups (refugees, prosthetist and an ICRC physiotherapist. ICRC specialists women/children, indigent citizens, etc.). In 2014 the provided on-the-job training and mentoring for the entire MNSHRG covered the costs of physical rehabilitation ser- staff of the assisted centre. The clinical personnel con- vices for indigent people with impaired mobility through tinued improving the quality of physical rehabilitation the Solidarity Fund. For the Saint Kizito Institute, that services and a multidisciplinary approach was routinely represented only about 5% of its total income from treat- applied when prescribing mobility aids and/or physical ment. Following implementation of the Strategic Plan for therapy. The ICRC continued to provide two scholarships the Development of Medical Rehabilitation 2011-2015, to enable two candidates to attend formal physiotherapy the Ministry of Public Health (MoPH) now also deals training (three years) at the Faculty of Health Science in with rehabilitation. The MoPH continued to cover the Benin; it also continued to provide scholarships to enable cost of physical rehabilitation for children under five years two candidates to receive formal training in P&O (three of age; for the Saint Kizito Institute that represented only years) at TATCOT in Tanzania. about 30% of the total income from treatment. To promote the long-term functioning of services, the The network of providers of physical rehabilitation ser- ICRC continued to support the directorate of the Saint vices in the country includes two government-run centres, Kizito Institute in managing the centre and in its efforts three centres managed by religious communities (such as to mobilize the relevant authorities. Throughout the year, the Saint Kizito Institute) and one private establishment the ICRC continued helping the directorate to reorganize in the capital. All centres providing services for people the services, to implement new treatment protocols and to with disabilities are members of the Réseau des Centres develop an organization chart. Following the revised cal- pour Personnes Handicapées du Burundi (RCPHB). culation of the cost of producing assistive devices in 2012, Access to suitable rehabilitation services remains difficult the Saint Kizito physical rehabilitation centre continued
29 PHYSICAL REHABILITATION PROGRAMME ANNUAL REPORT 2014
to systematically apply the prices set. Service users are ``enhance the quality of services through support now asked to pay the full or a partial amount, depend- and mentoring by an ortho-prosthetist and a ing on their social condition. In 2014 the Saint Kizito physiotherapist, both from the ICRC, and by Institute continued to assume full financial responsibility providing scholarships for four candidates to attend for covering all running costs associated with its physical formal training courses in P&O and in physiotherapy; rehabilitation services and covered all costs related to the ``promote the long-term functioning of services by purchase of components and materials. In addition, the continuing to support the Institute in its efforts to ICRC actively participated in several national workshops further improve its management and by supporting addressing national coordination and the development of the directorate of the Institute in its work to obtain the national plan of action. the support of the relevant authorities and to mobilize potential donors in order to increase the financial contributions; In 2015 the ICRC intends to: ``promote the inclusion in society of the Institute’s students by developing the concept of inclusive ``improve access to services by continuing to support education through sport and games with the Institute’s the activities of the Saint Kizito Institute and by covering pedagogical team. the cost of treatment for 50 poor people with disabilities;
30 PHYSICAL REHABILITATION PROGRAMME 4.1 – africa
CHAD
EGYPT National partners LYBIA Secours Catholique et de Développement (N’Djamena) Maison Notre Dame de la Paix (Moundou) Location of projects NIGER Moundou, N’Djamena Services in 2014 Service users attending the centres 5,932
SUDAN New service users fitted with prostheses 234 N'DJAMENA New service users fitted with orthoses 182 NIGERIA Prostheses 390 Orthoses 630 Moundou Wheelchairs 42 CENTRAL CAMEROON AFRICAN SOUTH SUDAN Crutches (pairs) 466 REPUBLIC ICRC/ PRP_14 Service users receiving physiotherapy 4,150 Beginning of assistance: 1981
The ICRC continued supporting the two centres provid- Access to physical rehabilitation remained difficult for ing physical rehabilitation services in the country, the most of those in need. The main causes remained the Centre d’Appareillage et de Rééducation de Kabalaye same: lack of financial support from the social system to (CARK) in N’Djamena (central Chad) and the Maison cover the cost of treatment (people with disabilities there- Notre Dame de la Paix in Moundou (southern Chad), fore being obliged to pay for the services), lack of facilities both managed by local NGOs. The ICRC also continued and professionals, and the cost of transport (when avail- supporting a referral system for people with disabilities able). While the exact number of people with disabilities from eastern and northern Chad and financed their in need of physical rehabilitation services is unknown, it is transportation to N’Djamena. In addition, it covered the obvious that the two functioning centres do not have the cost of accommodation for those without family support capacity, in terms of infrastructure and human resources, in N’Djamena while they received treatment. to meet the needs.
The Ministry of Social Affairs, National Solidarity and In the course of the year, several activities were imple- Women was responsible for protecting the rights of people mented by the ICRC to improve accessibility to services. with disabilities, while the Ministry of Public Health was Assisted centres were supplied with raw materials and responsible for physical rehabilitation. However, there components to ensure that they could provide services. was no direct involvement by the government in physical The cost of services for 157 people at the CARK was rehabilitation and those seeking services had to pay for covered. Through the referral systems implemented in them. Rehabilitation services were available in only six of eastern and northern Chad, 36 people with disabilities the country’s twenty-three regions. The sector included from those regions received treatment at the CARK, with the two centres assisted by the ICRC, which were the only ICRC support. In those regions, the ICRC conducted a centres providing full physical rehabilitation services, campaign to disseminate information about the possibil- and eight centres providing only physiotherapy services. ity of accessing services with the support of the ICRC. The Centre National d’Appareillage et de Rééducation In total, over 5,932 people with physical disabilities ben- (CNAR), managed by the Ministry of Health, opened in efited from various services at ICRC-assisted centres in November 2014 but is not operational, despite an appro- 2014. Services included the provision of 390 prostheses priate budget and newly recruited administrative staff (39% for mine survivors), 630 orthoses (1% for mine and physiotherapy assistants. survivors), 42 wheelchairs and 466 pairs of crutches as well as physiotherapy for 4,150 people (4% for mine sur- Chad signed the UN Convention on the Rights of Persons vivors). Children represented 41% and women 19% of with Disabilities (UNCRPD) in September 2012, but the 5’932 beneficiaries. the application decree for the domestic law protecting the rights of people with disabilities, adopted in 2007, The quality of the services provided by the two centres was has remained inoperative, pending the President’s signa- enhanced by technical and clinical mentoring by ICRC ture to render it law. Chad is among the 30 States party specialists (a physiotherapist and an ortho-prosthetist). to the Anti-Personnel Mine Ban Convention that have ICRC specialists also provided on-the-job training and acknowledged their responsibility for landmine survivors. mentoring for the entire staff of both centres. The ICRC Landmines and explosive remnants of war continue to also continued sponsoring four people to enable them to be a threat for many rural communities, particularly in attend P&O training at the Ecole Nationale des Auxiliaires the north and, to a lesser extent, in the east. With ICRC Médicaux (ENAM) in Lomé (Togo) and one physiothera- financial support, a Foreign Affairs Ministry staff member pist at the ESK (Ecole Supérieure de Kinésithérapie) in participated in a workshop on victim assistance, jointly Cotonou (Benin). Three of them completed their training organized in Ethiopia by the African Union and the ICRC. in 2014 and commenced work at the centres.
31 PHYSICAL REHABILITATION PROGRAMME ANNUAL REPORT 2014
To ensure the long-term sustainability of services, In 2015 the ICRC intends to: the ICRC continued supporting both centres in their efforts to locate additional sources of income and in ``continue to support the Ministry of Public Health their determination to improve their management. To in the development and implementation of the Plan promote and increase access to services, the ICRC gave National de Réadaptation Fonctionnelle au Tchad; both directors support to submit project proposals to ``continue to pursue advocacy efforts to address authorities and international NGOs. With the ICRC’s rehabilitation needs in Chad with the authorities, help, the CARK acquired financial support from the particularly the Ministry of Public Health and the European Union in August 2013 for a three-year project, Ministry of Social Affairs; “Agir en faveur de la personne handicapée.” In parallel ``work closely with the Ministry of Health and with to such support, the ICRC continued to encourage the Handicap International to open the Centre National Ministry of Public Health to increase its investment in d’Appareillage et de Rééducation (CNAR); physical rehabilitation services. Work also continued ``facilitate access to services by continuing to support with the Ministry of Public Health and other stakehold- both the CARK in N’Djamena and the Maison Notre ers, including the Association des Professionnels de Dame de la Paix in Moundou, by operating a referral l’Orthopédie et de la Rééducation du Tchad (APORT), system for people with disabilities from eastern and to draft a national plan to address physical rehabilita- northern Chad, by covering their transportation costs tion needs in Chad. An agreement was signed between and by covering the cost of treatment for some of the the Minister of Public Health and the ICRC to support most vulnerable beneficiaries at the CARK; the process of drafting the national plan, in which the ``enhance the quality of services by continuing to ICRC agreed to cover the cost of recruiting an interna- sponsor candidates for formal training in P&O at tional expert for that purpose. Throughout the year, the ENAM and physiotherapy at ESK, and by promoting ICRC maintained close contact with – and in some cases a multidisciplinary approach; provided support for – several government institutions, ``promote the long-term functioning of services by including the National Mine Action Centre, APORT, the supporting assisted centres in their efforts to secure National Network of Rehabilitation Actors, and several additional sources of income, by continuing to help organizations for people with disabilities in their activi- to make their managerial staff self-sufficient and ties to support the sector. by maintaining close contact with and support for national institutions, organizations working on behalf In 2014 the ICRC provided financial support for the of people with disabilities and Handicap International; Association d’Entraide aux Handicapés Physiques du ``support social inclusion by working closely with the Tchad (AEHPT) in the organization of the International National Paralympics Committee (CNPT) and AEHPT Day of People with Disability. on the construction of a wheelchair basketball court.
32 PHYSICAL REHABILITATION PROGRAMME 4.1 – africa
DRC DEMOCRATIC REPUBLIC OF THE CONGO
CENTRAL AFRICAN SOUTH SUDAN National partners REPUBLIC Ministry of Health, Ministry of Higher Education and Scientific Research, Ministry of Defence, CAMEROON local NGOs
UGANDA Location of projects CONGO Goma GABON Bukavu, Goma, Kinshasa (3) RWANDA Services in 2014 KINSHASA Bukavu BURUNDI Service users receiving services with direct support from the ICRC 915 UNITED REPUBLIC New service users fitted with prostheses 160 OF TANZANIA New service users fitted with orthoses 62 Prostheses 320 Orthoses 87 Wheelchairs 49 ANGOLA ZAMBIA Crutches (pairs) 331 ICRC/ PRP_14 Service users receiving physiotherapy 370 Beginning of assistance: 1998
In 2014 the ICRC continued to cooperate with Shirika rehabilitation sector and services are provided through La Umoja in Goma and Heri Kwetu in Bukavu. In a network of centres managed by the government (in Kinshasa, the ICRC signed an agreement with a new Kinshasa), religious organizations or local NGOs. The partner, the Centre de Rééducation pour Handicapés DRC is among the 30 States party to the Anti-Personnel Physiques (CRHP). Direct support was provided to Mine Ban Convention that have acknowledged their improve infrastructure, and equipment and tools were responsibility for landmine survivors. The ICRC main- donated. The ICRC also covered transportation and tained close contact with the Congolese Mine Action treatment costs for people directly affected by the con- Centre and the United Nations Mine Action Service flict and other people with physical disabilities, as well throughout the year and participated actively in quar- as expenses for food and accommodation. After having terly coordination meetings on victim assistance. identified and assessed beneficiaries, the ICRC referred them to centres that had signed cooperation agree- The total number of people with disabilities in need of ments. A workshop run by disabled former soldiers was physical rehabilitation services remains unknown and supported by the ICRC to enable it to provide crutches access to services is difficult. People with disabilities face in Kinshasa. numerous barriers such as poverty, insecurity and poor and dangerous traffic conditions. Service users have to Although the UN Convention on the Rights of Persons deal with the lack or low capacities of service provid- with Disabilities (UNCRPD) was signed in July 2013, the ers and high prices. There is no financial participation DRC is not yet on the official list of the countries having by the State. Throughout the year, the ICRC worked ratified it. Apparently, the required documents have not on enhancing access to services by rehabilitating and yet all been sent to New York. The country is still work- developing partner centres’ facilities and by providing ing on specific legislation for people with disabilities materials and components for assisted and non-assisted but the 2016 polls are focusing government members’ centres to ensure continuity and quality of services. For attention on remaining in power. Furthermore, the beneficiaries, the ICRC covered the cost of transport document submitted to the Assembly was not the and accommodation for most of the civilians whom it one approved by the Ministry of Social Affairs and referred to the centres and strengthened its referral net- drafted together with the sub-cluster on disability. work, working closely with several international NGOs. Although officially in charge of physical rehabilitation, The cost of treatment was subsidized for 915 people the Ministry of Health (MoH) does not manage any with physical disabilities, both civilians and weapon- centres and its involvement in rehabilitation remains bearers, who needed physical rehabilitation services (an modest, consisting mainly of paying bonuses to staff increase of 5% since 2013 and 21% since 2012). Among from recognized and registered centres. The MoH is other services, the ICRC, which works with only three also organizing training courses on clubfoot for physi- centres, achieved a record of 320 prostheses (6% for otherapists through the National Community-Based mine survivors) and 87 orthoses produced. 331 pairs of Rehabilitation Programme (PNRBC), its coordinating crutches and 49 wheelchairs (including 28 sports wheel- body for physical rehabilitation and the PRP’s main chairs) were also provided; 370 of the beneficiaries had interlocutor. The Ministry of Social Affairs, National access to suitable physiotherapy services. Children rep- Solidarity and Humanitarian Action was closed down resented 9% of the beneficiaries, women 25% and mine during the last change of government, and social affairs victims less than 1%. now depend on one of the Vice Prime Ministers. In the area of rehabilitation and disabilities, the national sub- The quality of devices is improving in the Kivu centres cluster on disability, which is subject to supervision by since three ortho-prosthetists (two in Bukavu and one the WHO health cluster, is the most active body. Human in Goma) completed their studies, which were spon- resources are still poor in quantity and quality in the sored by CBM, and returned to their workshops in
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September with a diploma. The ICRC began support- In 2015, the ICRC intends to: ing Heri Kwetu in Bukavu in December by covering the cost of one additional P&O salary for 12 months. ``facilitate access to services by continuing direct The ICRC ortho-prosthetists and physiotherapists support for people with physical disabilities (covering have been closely supervising the quality of services the cost of treatment and transport), by continuing in the partner centres, providing on-the-job men- to cooperate with two service providers in North and toring and support. ICRC sponsorship enabled two South Kivu and one in Kinshasa, by strengthening candidates from Kinshasa and Goma to start a three- cooperation with local and international NGOs, year training course on prosthetics and orthotics at with the Congolese Mine Action Centre and the the National School of Medical Auxiliaries (ENAM) in Service d’Éducation Civique et d’Actions Sociales of Lomé, Togo. The ICRC also sponsored attendance at an the Ministry of Defence to identify people in need ISPO congress in South Africa for the president of the of services, by donating materials and equipment well-developing Congolese P&O association (ATOC). A to rehabilitation centres (ICRC-assisted centres and new physiotherapy room is currently being built on the others) as needed and by implementing a specific partner’s premises in Goma. referral programme for people from the Kivus and possibly from other provinces as well; To ensure the long-term functioning of services and ``improve the quality of rehabilitation services at good coordination with the authorities, the ICRC main- assisted centres through the presence of a ortho- tained regular contact with the PNRBC. In Kinshasa, the prosthetist and a physiotherapist (both from the ICRC led and housed three sessions of the Committee on ICRC), by improving the infrastructure of the assisted Physical Rehabilitation and attended monthly sessions centres, by conducting training courses at the assisted of the sub-cluster on disability. The ICRC organized centres, by sponsoring refresher courses for staff a workshop on the national situation of physical reha- and by sponsoring more personnel to attend formal bilitation and supported national professional P&O P&O training at the École Nationale des Auxiliaires and PT associations (ATOC and UKC) to develop their Médicaux (ENAM) in Lomé (Togo); structure and organize national events. The ICRC’s ``promote the development of the rehabilitation has provided assistance for UKC in its application for sector in the DRC by implementing the ICRC-MSH membership of the World Confederation for Physical Senior Leadership Programme and the Essential Therapy (WCPT). Management Package, by participating in local fora, by maintaining close contact with the pertinent In 2014 the ICRC developed accessibility to psychoso- ministries and stakeholders involved in physical cial support for beneficiaries in its Kivu-based projects, rehabilitation and by sponsoring participation of key sought to raise awareness of disability by advocating stakeholders in important international gatherings; and providing financial assistance for local NGOs to ``continue to support and promote the social inclusion organize inclusive cultural and sport events on various of people with disabilities by making psychosocial international days. The ICRC mentored the National support available to the beneficiaries in the Kivus, Congolese Paralympic Committee in the creation of by providing support for people with disabilities a provincial league in South Kivu, built a basketball organizations to run inclusive advocacy events, by ground in Bukavu and furnished teams in three prov- providing developmental support for the National inces with sports wheelchairs. For the civil society, Paralympic Committee and support to run sports ICRC transformed a hotel in Goma to make it accessible activities, by supporting access to education or home for wheelchair users and improved accessibility of its tuition for children with disabilities (school fees, own premises. accessibility for physically impaired people).
34 PHYSICAL REHABILITATION PROGRAMME 4.1 – africa
ETHIOPIA
ERITREA National partners SUDAN YEMEN Ministry of Labour and Social Affairs (federal level) , Bureaux of Labour and Social Affairs Mekele (regional level), Tigrean Disabled Veterans Association, Cheshire Services Ethiopia Bahir Dar
TI Location of projects OU Dessie IB DJ Arba Minch, Assela, Assosa, Bahir Dar, Dessie, Dire Dawa, Gambella, Mekele, Menagesha, Nekemte Assosa Services in 2014 ADDIS ABABA Dire Dawa Nekemte Service users attending the centres 6,082 Gambella New service users fitted with prostheses 751 Asela New service users fitted with orthoses 706 SOUTH Prostheses 1,977 SUDAN Arba Minch Orthoses 2,203 Wheelchairs 431 SOMALIA KENYA UGANDA Crutches (pairs) 2,505 ICRC/ PRP_14 Service users receiving physiotherapy 3,252 Beginning of assistance: 1979
The ICRC continued providing support for seven physi- Social Affairs within the policy framework established cal rehabilitation centres in Arba Minch, Assela, Bahir by the MoLSA. Dar, Dessie, Dire Dawa, Mekele and Menegesha. Support was also given to establish three new physical rehabilita- The availability of physical rehabilitation services is still tion centres in the remote western border regions of the limited and concentrated in urban areas. Awareness of country – in Assosa, Gambella and Nekemte. The reha- such services is low and formal or informal referral sys- bilitation centre in Nekemte is already providing regular tems have not yet been implemented or strengthened. services for people with disabilities living in the western Access to rehabilitation services is hindered by the lack parts of Oromia Region, while Assosa and Gambela are of services and by the absence of information about those still struggling to obtain the required human resources services that are available. In addition, most people with and government operational budgets. The ICRC-assisted disabilities may not be able to cover the transport, food physical rehabilitation centres are managed by regional and accommodation costs associated with travelling to governments through their Bureau of Labour and Social the nearest rehabilitation centre. To help overcome these Affairs or by local NGOs such as the Tigray Disabled barriers and to improve access to services, the ICRC Veterans Association in Mekele or Cheshire Services continued to cover the costs of transport, food and Ethiopia in Dire Dawa and Menagesha. In conjunction accommodation for people with disabilities receiving with the Ministry of Labour and Social Affairs (MoLSA), physical rehabilitation services; it also continue to donate the Ministry of Health, the Ministry of Education and the imported materials and equipment needed by assisted the Medical Faculty of Addis Ababa University, the rehabilitation centres. As a result, more than 6,000 people ICRC also conducts training courses in prosthetics and with physical disabilities had access to free rehabilitation orthotics at the National Rehabilitation Centre at the services. For approximately half of them, namely those Black Lion Hospital. who were more economically vulnerable, registration fees and the costs of transport and food were covered. Services The number of people with disabilities in Ethiopia included the provision of 1,977 prostheses (18% for mine remains uncertain; estimates vary from 0.8 million, survivors), 2,203 orthoses, 431 wheelchairs and 2,505 according to a census conducted in 2007, to nearly 15 pairs of crutches as well as physiotherapy services for million, the figure reported by the 2011 World Report on 3,252 people (5% for mine survivors). Children accounted Disability. Most people with disabilities live in rural areas for 21% and women for 20% of the beneficiaries. where basic services are limited and often inaccessible, and most of them lack opportunities to earn a living. In The quality of the rehabilitation services provided at response, the government of Ethiopia has adopted and ICRC-assisted centres was enhanced through close profes- implemented a number of laws, policies and standards: sional coaching and mentoring by ICRC specialists. First, it included a disability clause in the constitution, rati- the service provision and its impact on the beneficiaries fied the UN Convention on the Rights of Persons with were closely monitored through systematic assessments Disabilities (UNCRPD) in 2010, developed a physical performed on sample selections of beneficiaries. Apart rehabilitation strategy, adopted laws on accessibility from looking into technical and clinical issues that needed and, more recently, approved a national plan of action to be addressed in order to improve quality, these assess- for people with disabilities. The MoLSA is the main ments also looked into the beneficiaries’ perception of government body responsible for the socio-economic accessibility, quality and the socio-economic impact of rehabilitation of people with disabilities. Activities to the rehabilitation services received. It is worth mention- address disability issues are coordinated at the fed- ing the significant socio-economic impact as 54% of the eral level by the MoLSA’s Social Welfare Development people with disabilities assessed stated that they had not Promotion Directorate. At the regional level, disability- been able to perform any activity before being given related issues are handled by the Bureau of Labour and access to rehabilitation services, while 61% of them stated
35 PHYSICAL REHABILITATION PROGRAMME ANNUAL REPORT 2014
that they were now working to earn their own living wheelchair basketball (a “para” sport) within the EBF, or contributing/providing to the household income. an able-bodied sporting organization, is the first in Second, the physiotherapy support was aimed at better Ethiopia and is important in facilitating social change framing the numerous thematic issues in the multidis- with regard to people with disabilities. ciplinary team approach at assisted centres. A prosthetic gait analysis training course was completed by 15 physi- There was a strong focus on the International Day of otherapists from the 10 supported PRCs and other PRCs People with Disability on 3 December 2014, with the ICRC working in prosthetic services in Ethiopia. The physi- supporting a number of different programmes linked to otherapy and multidisciplinary staff were given ongoing the celebrations. In the Oromia region, support was pro- clinical support, including a focus on referral to existing vided to the Oromia Agency of Labour and Social Affairs social inclusion services. Close cooperation was initi- for an awareness-raising activity in Bishoftu highlighting ated with the Physiotherapy School at the University of issues relevant to people with disabilities. The centre in Gondar to support clinical placements at supported cen- Nekemte ran a programme in the town with ICRC sup- tres for fourth-year students on the prosthetic, orthotic port, introducing its activities and services for people with and mobility aids course. Lastly, of the 23 people attend- disabilities. In partnership with the Ethiopian Basketball ing prosthetics and orthotics training conducted by the Federation, the ICRC held an exhibition of different sports ICRC, 15 successfully passed Level 3 (i.e. benchworker for people with disabilities at the EBF headquarters. level) and are now continuing their training to reach Level 4 (i.e. clinical level). Seven of them graduated from Level 5 (i.e. advanced training for upper limb orthotics/ In 2015 the ICRC intends to: prosthetics and spinal orthotics) and are now putting their newly acquired skills into practice at their rehabili- ``continue supporting accessibility to rehabilitation tation centres. services by (1) providing assisted rehabilitation centres with imported materials and equipment; and (2) by For a number of years now, the ICRC’s Physical implementing a service user support system policy Rehabilitation Programme has been supporting the – covering travel, food and accommodation costs – MoLSA and other government stakeholders in develop- specifically targeting the more economically vulnerable ing and implementing strategies for addressing disability people with disabilities living in rural areas; issues in Ethiopia. This includes, or has included, (1) ``continue to improve the quality of services (1) financial and technical support for developing a national through close technical coaching and mentoring by physical rehabilitation strategy (published by the MoLSA ICRC ortho-prosthetists and physiotherapists; (2) in June 2011) and its implementation plan, which was by implementing or strengthening multidisciplinary completed in 2013 and is still currently being evaluated approaches and improved service user management by the MoLSA and other stakeholders; (2) participation procedures; (3) by improving physiotherapy services in various steering groups, such as the MoLSA/ICRC through on-the-job training and centralized support Technical Commission and the wheelchair stakeholder for University of Gondar students; (4) by supporting group. The priority areas tackled during 2014 included the professional integration of newly graduated P&O establishing a permanent training structure for pros- personnel; (5) by ensuring systematic beneficiary thetic/orthotic technicians based on the training courses feedback and technical assessments; (5) through currently run by the ICRC. Significant progress was training and updated guidelines for the provision made in the discussions with Addis Ababa University of wheelchairs to ensure the implementation of regarding the establishment of a Bachelor’s degree in international standards in line with WHO guidelines; prosthetics and orthotics as a last step in ensuring the (6) by continuing to train P&O staff in accordance sustainability of such training in Ethiopia. Another with recognized international standards; priority area was the establishment of a national supply ``continue supporting the long-term sustainability chain for importing and distributing materials and of the rehabilitation services by assisting the relevant equipment for physical rehabilitation. authorities and other stakeholders in defining and implementing the necessary managerial, financial During 2014, 24 basketball wheelchairs were donated to and technical policies and strategies. Special the Ethiopian Basketball Federation (EBF) as an addi- attention will be given to (1) implementing an tional step to support wheelchair basketball in Ethiopia autonomous supply chain for rehabilitation services; and, by doing so, to increase social participation/inclu- (2) supporting an exhaustive calculation of the sion opportunities for people with disabilities. This cost of providing rehabilitation services; and (3) donation was channelled to four Regional Basketball supporting the development of a BSc degree in P&O Federations (Addis Ababa, Dire Dawa, Oromia and at Addis Ababa University; Southern Nation), and will be followed in 2015 by sup- ``continue to facilitate social inclusion/participation of port for training and capacity building for coaches, people with disabilities by working with the Ethiopian referees and players. In 2014 the EBF officially ratified Basketball Federation to consolidate the provision wheelchair basketball in its constitution and is now of wheelchair basketball at a regional level through the “owner” of the sport in Ethiopia. This will have a material and technical support. significant impact on the sustainability of the sport in Ethiopia with support from the ICRC. The inclusion of
36 PHYSICAL REHABILITATION PROGRAMME 4.1 – africa
GUINEA-BISSAU
National partner MAURITANIA Ministry of Public Health DAKAR SENEGAL Location of project Bissau MALI Services in 2014 GAMBIA Service users attending the centre 1,595 New service users fitted with prostheses 46 BISSAU New service users fitted with orthoses 41 Prostheses 54
GUINEA Orthoses 53 Wheelchairs 66 Crutches (pairs) 61
SIERRA LEONE Service users receiving physiotherapy 1,423 ICRC/ PRP_14 Beginning of assistance: 2010
In 2014 the ICRC continued supporting the Ministry of being consolidated; four out of seven regions have been Public Health (MoPH) in the management of the Centro covered to date. Networking with regional partners is in de Reabilitação Motora (CRM), which opened in 2011 process. The implementation of a wheelchair project in with the financial support of the ICRC and serves as the conjunction with the German Embassy has resulted in the national referral centre. Since its reopening, the CRM has provision of appropriate wheelchair services for 30 people increased its activities in terms of the number of service living in the regions. In all, 1,595 people with disabilities users and services/programmes provided and it is well on benefited from services provided by the ICRC-assisted the way to regaining some of its former good reputation. centre (including 137 people assessed during outreach The number of people with physical disabilities receiving activities). The services included the provision of 46 services at the CRM increased by 31% compared to 2013. prostheses (18% for mine victims), 53 orthoses, 66 wheel- chairs and 61 pairs of crutches as well as physiotherapy The country has no specific disability legislation. The treatment for 1,423 people (1.4% for mine victims). MoPH is responsible for the management of the CRM, the Women represented 25.5% and children 19.2% of the only rehabilitation facility in the country. The Ministry of beneficiaries. Defence and the Ministry of Social Affairs are responsible for subsidizing the cost of services for war veterans and In-house training and supervision/support by an ICRC disabled civilians respectively. In 2014 Guinea-Bissau ortho-prosthetist and an ICRC physiotherapist continued ratified the UN Convention on the Rights of Persons with in 2014. The technical skills of CRM staff have improved Disabilities (UNCRPD). The key actor in achieving this and progress has been made in the development/imple- was the Guinea-Bissau Federation of the Disabled, the mentation of treatment protocols. The multidisciplinary umbrella organization for 13 national associations. The team approach and cooperation with external partners Federation organized the first national conference on has been strengthened. The set-up of treatment facilities the rights of people with disability on 1 and 2 December and the workshop has been optimized. Although there 2014. According to a census conducted in 2009, there is room for improvement, the centre’s P&O services are are around 5,200 people with musculoskeletal disabili- developing positively, in terms of both technical skills and ties in the country; a sizeable percentage of them would organization and staff commitment. For further capacity be eligible for some kind of rehabilitation services. The building, the ICRC continued sponsoring P&O students real number of physically disabled is probably higher. from Guinea-Bissau. Since September 2014, three P&O Diagnostic facilities and hospital/medical services are graduates from ENAM in Togo have started working poor or non-existent and payment for treatment poses a at the CRM. One more student is expected to finish his major problem. Networking/referral between the existing studies in mid-2015. To secure a stable supply of water at facilities is inadequate. the CRM, a solar pump has been installed with financial assistance from the ICRC. Access to physical rehabilitation services remains diffi- cult, mainly owing to the lack of rehabilitation facilities/ To promote the long-term functioning of services, the professionals and of financial resources to cover the cost ICRC continued to work closely with the MoPH to of services. In 2014 the ICRC conducted several activities strengthen its capacity to implement, coordinate and to improve accessibility, including by donating materi- lead-manage physical rehabilitation activities, as well als and components (for both P&O and physiotherapy), as with the centre directorate. In addition, the ICRC by reimbursing the cost of treatment and transport for maintained close working relations with the Ministry of service users attending the CRM and by supporting the Defence (Secretariat for War Veterans) and the Ministry centre’s outreach activities. The outreach activities, which of Social Affairs. began in 2013, have raised awareness and facilitated access for regional service users. The programme is currently
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On 3 December, the International Day of People with ``enhance the quality of services by providing ongoing Disability, the ICRC supported the Federaçoa de Desportos in-house training/support by ICRC specialists, by para Deficientes da Guinée-Bissau in the organization of offering short training courses for professional staff, a wheelchair basketball tournament for men and women. by implementing programmes for children with The ICRC supported the poster campaign as well as the clubfoot, by extending/optimizing other physiotherapy printing of T-shirt and banners. The ICRC also funded services and by continuing sponsorship for one P&O the logistics involved in organizing the event. student at ENAM in Lomé; ``promote the long-term functioning of services by assisting the CRM directorate/MINSA to develop its capacity to In 2015, the ICRC intends to: manage physical rehabilitation services, by negotiating reimbursement of the cost of services with the Ministry ``further improve access to services by reimbursing the cost of Defence and the Ministry of Social Affairs and by of services (transport) for those in need and by supporting expanding network activities with alternative partners the extension of the outreach programmes and other to secure future funding for the CRM. information activities in close cooperation with the associations working on behalf of people with disabilities;
38 PHYSICAL REHABILITATION PROGRAMME 4.1 – africa
LIBYA
National partners University of Misrata TRIPOLI Location of projects TUNISIA Misrata Misrata Services in 2014 - No statistics available Service users attending the centre New service users fitted with prostheses ALGERIA EGYPT New service users fitted with orthoses Prostheses Orthoses Beginning of assistance: 2011 NIGER
CHAD SUDAN
ICRC/ PRP_14 CHAD
Throughout 2014, ICRC operations in Libya were build local capacities and provide good quality physical challenged by the increasingly insecure working envi- rehabilitation services for disabled civilians could not ronment and renewed armed fighting, compounded by start in 2014. They were put on hold because it proved the existence of a general political and security vacuum. impossible to ensure the permanent presence of mobile In June the head of the ICRC sub-delegation in Misrata ICRC staff in Libya. With ICRC-provided materials, all was killed by unidentified armed men in Sirte. This led the equipment installed and qualified staff hired by the to a temporary reduction of ICRC international staff University of Misrata, the Misrata physical rehabilita- and in July, following the severe inter-militia clashes tion department was about to be inaugurated when the in Tripoli and the destruction of the airport, the deci- serious security incident took place in Sirte on 4 June. sion was taken to temporarily relocate the remaining Following the incident, it became clear that it would international staff to Tunis, from where they have been not be possible to base the ICRC expatriate technician operating since then. Despite these setbacks, the ICRC needed for the training in Misrata and the project there- continued to operate in Libya through its 140 national fore had to be suspended. staff and its four offices in Benghazi, Misrata, Sabha and Tripoli. The ICRC’s existing set-up and stocks have allowed it to be the first and the main international In 2015, the ICRC intends to: organization to respond to the emerging humanitar- ian needs. Nonetheless, the events forced the ICRC to ``continue liaising with the University of Misrata to completely review, if not reset, its operational priorities find ways to support its efforts to open a physical and objectives in Libya for the rest of 2014 as well as to rehabilitation department. change its operating model in the country.
Two long-term training programmes leading to a BSc in P&O that had been planned by the ICRC together with the Universities of Tripoli and Misrata in order to
39 PHYSICAL REHABILITATION PROGRAMME ANNUAL REPORT 2014
MALI WESTERN SAHARA National partner Centre Père Bernard Verspieren (CPBV) ALGERIA Location of project Bamako Services in 2014 MAURITANIA Service users attending the centre 52 New service users fitted with prostheses 32 New service users fitted with orthoses 20 Prostheses 44 NIGER BAMAKO Orthoses 2 BURKINA FASO Crutches (pairs) 1 Service users receiving physiotherapy 17 GUINEA BENIN TOGO Beginning of assistance: 2013 CÔTE D'IVOIRE GHANA NIGERIA ICRC/ PRP_14
In 2014 the ICRC continued for the second year to work In 2014 the ICRC reimbursed the cost of services for 52 closely with the Père Bernard Verspieren physical rehabil- people with physical disabilities from the conflict area itation centre (CPBV), which was run by the PROPHET in the north of the country. The ICRC also provided association. While not providing direct support, the ICRC financial support so that two visits (one in Gao and one reimbursed the cost of physical rehabilitation services for in Timbuktu) of the CPBV’s mobile clinic could be organ- people with physical disabilities who were victims of the ized, which gave 35 people with physical disabilities access conflict in the north of the country. The ICRC Special to services. These services included the provision of 44 Fund for the Disabled provided technical support until prostheses, 2 orthoses, and 1 pair of crutches. In addition, the end of 2014. 17 people had access to appropriate physiotherapy treat- ment at the CPBV in Bamako. Mali is a vast, landlocked country. It is the second largest country in West Africa and the fifth poorest country in the world. Over 90% of Malians live on less than USD 2 In 2015 the ICRC intends to: a day. Mali ratified the UN Convention on the Rights of Persons with Disabilities in 2008. Disability issues are the ``improve access to services by starting to provide responsibility of the Ministère de la Solidarité, de l’Action support for the CNAOM in Bamako and its regional Humanitaire et de la Reconstruction du Nord (MSAHRN). centres, by donating material and components for Technical services such as the provision of prostheses and the CPBV centre, by raising awareness of the services orthoses were the responsibility of MSAHRN, while physi- available at ICRC-assisted centres, by supporting otherapy services were dealt with by the Ministère de la information campaigns (radio broadcasts and leaflets) Santé et de l’Hygiene Publique. The total number of people and by cooperating closely with the associations with disabilities is not known but was estimated at over working for the well-being of people with disabilities; one million. People with physical disabilities face several ``improve the quality of services by providing support barriers in accessing services, including, for example, the and mentoring by ICRC specialists (ortho-prosthetist cost of services, the cost of transport to access the centres and physiotherapist), by improving the working and the lack of functioning centres. environment at the CNAOM, and by identifying CNAOM personnel who could benefit from P&O The physical rehabilitation sector included government- training at ENAM in Lomé (Togo); managed centres and NGO-managed centres, such as ``promote long-term functioning of services by the Centre Père Bernard Verspieren. The government- providing support for the Ministère de la Solidarité, managed centres included the national centre located in de l’Action Humanitaire et de la Reconstruction du Bamako; the Centre National d’Appareillage Orthopédique Nord and the Ministère de la Santé et de l’Hygiene du Mali (CNAOM), and regional centres located in Gao, Publique to develop their capacity to manage physical Kayes, Mopti, Ségou, Sikasso and Timbuktu. Many of rehabilitation services and by maintaining close these centres are equipped but not functional owing to contact with national professional associations and the lack of materials and components, qualified human people with disabilities associations. resources and financial resources.
40 PHYSICAL REHABILITATION PROGRAMME 4.1 – africa
NIGER
National partner LIBYA Niamey National Hospital (HNN) ALGERIA Location of project Niamey Services in 2014
MALI Service users attending the centre 475 New service users fitted with prostheses 149 New service users fitted with orthoses 223 NIAMEY CHAD Prostheses 108 Orthoses 163 BURKINA FASO Crutches (pairs) 88
NIGERIA Wheelchairs 3 BENIN GHANA Service users receiving physiotherapy 154 TOGO CAMEROON ICRC/ PRP_14 Beginning of assistance: 2012
In 2014 the ICRC continued to support the physical reha- orthoses, 3 wheelchairs and 88 pairs of crutches as well as bilitation department at Niamey National Hospital (HNN). physiotherapy for 154 people (21% for mine survivors). In 2014, following the refurbishment of the physical reha- bilitation department of HNN and the establishment of the To improve the quality of services, ICRC specialists vast network of disabled associations in the country, the continued their support and mentoring. The ICRC also project entered a new phase. Most of the ICRC’s activities in continued to sponsor, for a third year, one person to 2014 focused on improving services for the large number of attend formal training in P&O at the Ecole Nationale des people seeking them at HNN (an increase of 27% compared Auxiliaires Médicaux (ENAM) in Lomé (Togo). to 2013), building up the service provision and logistical capacities of the department and managing the services. To promote long-term functioning, the ICRC worked closely with the hospital’s directorate to strengthen the lat- In Niger, disability issues are the responsibility of the ter’s capacity to implement, coordinate and lead-manage Ministry of Population, Gender and Child Protection; physical rehabilitation activities and with the centre manager the Ministry of Health deals with physical rehabilitation to strengthen supervision and administrative capacities. services. Niger ratified the UN Convention on the Rights of Persons with Disabilities and its Optional Protocol in In 2014 the ICRC supported the Fédération Nigérienne 2008. It ratified the Anti-Personnel Mine Ban Convention de Sports Paralympiques and celebrated the International in 1999. There are no reliable data on the incidence of Day of People with Disability event with several types of disability in Niger; the exact number of people seeking games such as a powerlifting, table tennis and wheelchair access to physical rehabilitation services is unknown. The basketball for people with disabilities. Ministry of Health has a five-year national health develop- ment plan (Plan du Développement Sanitaire 2011-2015) but it makes no reference to physical rehabilitation. The In 2015 the ICRC intends to: physical rehabilitation sector had three service providers, but HNN’s physical rehabilitation department was the only ``improve access to services by continuing to support one that had a significant impact. Access to physical reha- HNN’s efforts to provide appropriate physical bilitation services remained difficult for several reasons: rehabilitation services, by raising awareness of the lack of service providers and qualified P&O profes- the services available at ICRC-assisted centres, by sionals (only five professionals for the whole country), the covering the cost of services and transport for those lack of financial resources to cover the costs of services and in need, by supporting information campaigns (radio the lack of transportation for potential beneficiaries. broadcasts and leaflets) and by cooperating closely with the associations working for the well-being of In 2014 the ICRC implemented several activities aimed at people with disabilities; increasing accessibility: improving the existing facilities ``enhance the quality of services by providing support at HNN and subsidizing the cost of treatment, transport and mentoring through ortho-prosthetists (from the and accommodation for those arriving from the north- ICRC) and work towards identifying HNN personnel ern region. The ICRC also provided financial support who could benefit from P&O training at ENAM; to enable HNN to purchase materials and components ``promote the long-term functioning of services by from the Organisation Africaine pour le Développement continuing to provide support for the Ministry of des Centres pour Personnes Handicapées (OADCPH). In Health to develop its capacity to manage physical all, 475 people with physical disabilities benefited from rehabilitation services and for the directorate of various services at the ICRC-assisted centre (an increase the hospital, and by maintaining close contact with of 27% compared to 2013). The services included the national professional associations and people with provision of 108 prostheses (30% for mine survivors), 163 disabilities associations.
41 PHYSICAL REHABILITATION PROGRAMME ANNUAL REPORT 2014
REPUBLIC OF SOUTH SUDAN
National partners Ministry of Gender, Child and Social Welfare (MoGCSW) SUDAN Ministry of Social Development (MoSD) Location of projects Juba, Rumbek, Wau Wau Services in 2014 ETHIOPIA CENTRAL Rumbek Service users attending the centres 1,937 AFRICAN REPUBLIC Juba New service users fitted with prostheses 140 New service users fitted with orthoses 60 Prostheses 324
DEMOCRATIC Orthoses 118 REPUBLIC OF KENYA THE CONGO Wheelchairs 159 UGANDA Crutches (pairs) 1,517 ICRC/ PRP_14 Service users receiving physiotherapy 556 Beginning of assistance: 2006
The project was put on hold as a result of the conflict that victim assistance (National Mine Action Strategic Plan started in December 2013, the ensuing insecurity in Juba 2012-2016). The ICRC supported the MoGCSW in its and the resultant need to reduce the number of expatriate efforts to develop a national disability policy and par- staff on site. National staff employed at the assisted centres ticipated in meetings of the Victim Assistance/Disability returned to work in January but were not confident that Working Group. The mandate of the South Sudan War security was sufficient to permit the facilities to reopen. Disabled, Widows and Orphans Commission, created Following a request from the President’s office to provide in November 2006, is to formulate and promote policies crutches for the wounded at three hospitals, the centre in and legislation for the protection, care and welfare of Juba slowly resumed operations in order to meet the need. people with war-related disabilities, war widows and war In April 2014 the project was again fully operational and orphans and to advise the Government of South Sudan people with disabilities steadily began to return to the on the most effective procedures for implementing such centre despite the extremely high transport costs, the inse- policies and programmes. curity, the poor road infrastructure and the devaluation of the South Sudanese pound. Since the start of the conflict The ICRC conducted several activities aimed at improv- in December 2013, the Nuer ethnic group has had great ing accessibility, i.e. helping with the cost of transport difficult in accessing physical rehabilitation services. and accommodation for those attending both sup- ported centres, developing a referral system, conducting Despite the many constraints experienced in 2014, the some outreach visits, supporting information cam- ICRC continued supporting the Ministry of Gender, paigns (radio broadcasts and information leaflets) and Child and Social Welfare (MoGCSW) in the man- donating materials and components to ensure that the agement and operation of the only two operational PRRC and the RRC had the means to provide services. physical rehabilitation centres in South Sudan, the Almost 2,000 people with physical disabilities benefited Physical Rehabilitation Reference Centre (PRRC) in from various services at ICRC-assisted centres; children Juba, which served as the referral centre for the whole represented 6% (1% in 2013) and women 23% of them. of South Sudan, and the Rumbek Rehabilitation Centre The services included the provision of 324 prostheses (RRC) in Lake State. In addition, the ICRC upgraded the (8% for mine survivors), 118 orthoses, 159 wheelchairs ICRC Physical Rehabilitation Referral Unit in Wau to a and more than 1,500 pairs of crutches as well as physi- centre providing a wider range of services. otherapy services for 556 people.
The Landmine and Cluster Munition Monitor’s Country To improve quality, ICRC specialists (ortho-prosthe- Profile on South Sudan, which was last updated on tists and physiotherapists) continued their support and 30 November 2014, reported that the number of anti- mentoring activities. The ICRC continued to provide personnel mine victims increased from 21 in 2012 to 46 scholarships for three candidates to attend formal train- in 2013 (18 were killed). At the end of 2013, 3,456 mine/ ing in P&O at TATCOT and at Tumaini University ERW survivors were identified. In 2011 the MoGCSW (both in Tanzania). In addition, the ICRC organized a estimated that there were 50,000 direct or indirect mine/ module on physical rehabilitation for beneficiaries in ERW victims. Despite the size and scope of the need, the need of devices or mobility aid for physiotherapy stu- South Sudan Landmine Victims Association reported a dents at St Mary’s University. All those activities were decline in the availability of services. South Sudan has undertaken in order to build local capacity to provide not yet joined the UN Convention on Conventional high-quality services, which is essential to ensure long- Weapons or the UN Convention on the Rights of People term functioning. with Disabilities. It has acceded to the Anti-Personnel Mine Ban Convention. With support from the National To promote the long-term functioning of services, the Mine Action Authority, the MoGCSW coordinates ICRC continued to work closely with the MoGCSW
42 PHYSICAL REHABILITATION PROGRAMME 4.1 – africa
to strengthen its capacity to implement, coordinate ``enhance the quality of services by continuing to and lead-manage physical rehabilitation activities. The provide mentoring and support by ICRC specialists ICRC started to discuss increased support for the centre (ortho-prosthetists and physiotherapists) for the management and to establish a national board in charge personnel at the assisted centres, by continuing of supervising the quality and quantity of physical reha- to sponsor candidates for formal training in bilitation services. P&O in Tanzania, by continuing to provide PT training at St Mary’s University and by promoting a The ICRC was the only partner assisting the MoGCSW multidisciplinary approach; with the celebrations for the International Day of People ``promote the long-term functioning of services by with Disability, which took place on the premises of the strengthening the MoGCSW in the management of PRC in Juba. physical rehabilitation activities and by lobbying for the establishment of a national board; ``increase the social inclusion of people with disabilities In 2015 the ICRC intends to: by supporting sports activities, sponsor beneficiaries for a vocational training and outsource the kitchen ``facilitate access to services by continuing to support and cleaning of the Rumbek centre to a people with the government physical rehabilitation centres in disabilities organization. Juba and Rumbek, continue to operate the unit in Wau and establish similar units at the PRCs inMaiwut and Malakal, continue to donate materials and components, and to cover the cost of transport, accommodation and food for people with physical disabilities attending the centres;
43 PHYSICAL REHABILITATION PROGRAMME ANNUAL REPORT 2014
SUDAN
EGYPT LIBYA SAUDI National partners ARABIA Dongola National Authority for Prosthetics and Orthotics, Ministry of Welfare and Social Security, Cheshire Home for Disabled Children CHAD Location of projects KHARTOUM Kassala Al Fashir, Damazin, Dongola, Gedaref, Kadugli, Kassala, Khartoum (2), Nyala ERITREA El Fasher Services in 2014 Nyala Gedaref Kadugli Service users attending the centres 2,683 Ed Damazin New service users fitted with prostheses 288 New service users fitted with orthoses 193 CENTRAL Prostheses 672 AFRICAN ETHIOPIA REPUBLIC SOUTH SUDAN Orthoses 1,026 Crutches (pairs) 179 DEMOCRATIC REPUBLIC OF Service users receiving physiotherapy 565 THE CONGO UGANDA KENYA SOMALIA ICRC/ PRP_14 Beginning of assistance: 1985
In February the Humanitarian Aid Commission, the gov- disabilities in Sudan, of whom approximately 450,000 are ernment body in charge of relations with humanitarian in need of physical rehabilitation services and assistive organizations, asked the ICRC to suspend its activities, devices such as prostheses and orthoses. Sudan is among citing technical issues. In September the ICRC received the 30 States party to the Anti-Personnel Mine Ban a letter from the Sudanese authorities informing it that Convention that have acknowledged their responsibility the suspension had been lifted and after nine months for landmine survivors. of absence, the ICRC therefore relaunched its activities. During the suspension of ICRC activities, the National The National Authority for Prosthetics and Orthotics Authority for Prosthetics and Orthotics (NAPO) con- (NAPO) was established in 1975 to provide prosthetic tinued to provide physical rehabilitation services at and orthotic services. In 2013 the NAPO became an reduced capacity until its operations came to a standstill authority in Sudan by Presidential Decree; its recogni- in late May. The NAPO was able to resume its services in tion by the Government of Sudan allows for greater October after the ICRC had provided new supplies of raw financial and managerial autonomy. A Board of Directors materials. The ICRC was unable to monitor the services was established, of which the ICRC continued to be a provided by the NAPO for most of the year. member in an advisory capacity. The NAPO supports the State physical rehabilitation centres by providing In 2014 the ICRC maintained its partnership with professional clinical staff from the NAPO pool of human the Federal Ministry of Welfare and Social Security resources and materials and components donated by the (MoWSS) and the National Authority for Prosthetics and ICRC. The NAPO is the advisory body and reference Orthotics (NAPO) in order to support and strengthen point for all matters related to physical rehabilitation physical rehabilitation services in Sudan. The ICRC pro- for the Government of Sudan; it is also a member of the vided materials and technical expertise for the NAPO’s National Council for Persons with Disabilities. national referral centre in Khartoum and its regional physical rehabilitation centres in Damazin, Dongola, People with physical disabilities still faced several bar- Gedaref, Kadugli, Kassala and Nyala. The mobile work- riers in accessing services, including long distances to shop, also supported by the ICRC, conducted only two reach centres, the lack of a transportation system and field visits. Support for the Cheshire Home for Disabled money to cover the cost of transport, and security- Children in Khartoum (KCH) continued, as did the sup- linked constraints. As a result of the suspension of ICRC port for the Al Fashir repair workshop managed by the Al activities, access to services for people with physical Fashir Disabled Society. disabilities was reduced. Despite the ICRC’s suspension of activities, 2,683 people with physical disabilities had The MoWSS continued to be the main body responsi- access to services at the different assisted centres follow- ble for disabilities issues in in Sudan. The Government ing the donation of materials and components by the of Sudan ratified the UN Convention on the Rights of ICRC. Services provided included the provision of 672 Persons with Disabilities (UNCRPD) in 2009. Following prostheses (0.7% for mine survivors), 1,026 orthoses and ratification of the UNCRPD, the MoWSS established the 179 pairs of crutches as well as appropriate physiotherapy National Council for Persons with Disabilities (NCPD), services for 565 people. Children represented 31% and which is responsible for developing disability policy, women 21% of the beneficiaries. advocacy and raising awareness about the rights of people with disabilities in different federal ministries In 2014 the technical and clinical support provided by and among the general public. A national census car- ICRC specialists (ortho-prosthetists and physiothera- ried out in 2008 put the population at approximately 32 pists) was limited. However, the ICRC continued to million. There are an estimated 1.3 million people with sponsor candidates to enable them to attend formal
44 PHYSICAL REHABILITATION PROGRAMME 4.1 – africa
training in P&O at Mobility India (one to continue his repair workshop and by assessing the possibilities studies for a BSc and the other for diploma-level studies). of supporting the establishment of the new regional centre in El Obeid; To promote the long-term functioning of physical ``improve the quality of services by supporting the rehabilitation centres in Sudan, the NAPO focused its NAPO and the regional centres’ clinical services, attention on establishing a School of Prosthetics and by conducting training sessions for benchworkers Orthotics in Khartoum. An agreement was signed by the from the NAPO and the State PRCs, by providing NAPO with El Nileen University to establish a permanent monitoring and on-the-job training and by continuing P&O training programme in Sudan. Six officials from to sponsor candidates to attend formal training in the NAPO and other Sudanese government institutions P&O in India; completed the Senior Leadership Training Programme, ``promote the long-term functioning of clinical services which was conducted by Yale University and managed by by strengthening support for NAPO management, Management Science for Health, facilitated by the ICRC by working with the MoWSS to develop career paths and sponsored by USAID. for P&O professionals, by developing management training activities to develop the capacity of managers at the NAPO and State PRCs and by supporting the In 2015 the ICRC intends to: efforts of the NAPO and El Nileen University to establish a permanent P&O school in Sudan; ``increase access to services by supporting the ``promote inclusion and participation of people with NAPO and the regional centres by donating raw physical disabilities by undertaking an assessment materials, by covering the costs of food, transport of inclusion activities in Sudan to identify potential and accommodation for people receiving services areas where meaningful support can be given, by at the Nyala centre, by continuing to support the developing links with the National Council for activities of the mobile workshop, by continuing to Persons with Disabilities, the Union of Physically support the Cheshire Home for Disabled Children Disabled and other organizations working in the field in Khartoum, by continuing to support the Al Fashir of physical disability.
45 4.2 – ASIA
46 W. Yanhui/ICRC Yanhui/ICRC Wang W. PHYSICAL REHABILITATION PROGRAMME 4.2 – ASIA
ICRC SUPPORT IN ASIA AT A GLANCE In 2013 the ICRC supported 45 projects in 11 Asian countries: Afghanistan (8), Bangladesh (2), Cambodia (3), China (2), the Democratic People’s Republic of Korea (1), India (6), Myanmar (4), Nepal (2), Pakistan (15), the Philippines (1) and Sri Lanka (1). `` In India, the ICRC started to work closely with two new centres located in Bangalore and Vellore. `` In Pakistan, the ICRC signed a tripartite agreement with CHAL Foundation and Indus Hospital to set up two new rehabilitation centres in Karachi and Muzaffargarh. `` In Sri Lanka, ICRC halted its support for the Jaffna Jaipur Centre for Disability Rehabilitation in June. Services provided Service users attending the centres 174,012 New service users fitted with prostheses 4,441 New service users fitted with orthoses 13,081 Prostheses supplied 11,129 Orthoses supplied 26,834 Wheelchairs supplied 2,710 Walking aids supplied (pairs) 11,934 Children represented 28% and women 18% of the beneficiaries. In Afghanistan, over 3,000 people with disabilities were aided by the various activities in the social inclusion programme. In Afghanistan, the ICRC-managed component factory continued to provide components for seven non-ICRC centres free of charge. In Cambodia, the ICRC-supported component factory in Phnom Penh continued producing components for all the centres, ensuring proper care throughout the country. Developing local capacities Thirty-seven candidates were sponsored for P&O courses and one candidate was sponsored for a physiotherapy course. In Afghanistan, the ICRC sponsored 26 physiotherapy assistants to continue their studies leading to a BSc in Physiotherapy. Eighteen people (including six women) entered the second year of the P&O training course conducted by the ICRC in Afghanistan. In Bangladesh, the ICRC continued to support the P&O Training Programme of the Bangladesh Health Professions Institute and provided scholarships for 10 candidates to start the training. Promoting the long-term functioning of services In Afghanistan, the ICRC maintained close working relations and coordination activities with the relevant authorities and participated in the making of guidelines. It also attended the Disability Stakeholder Commission Group of the MOLSAMD, a working group set up to promote social reintegration. In India, the ICRC continued to promote the long-term functioning of services by strengthening the capacity of its various partners. It also established close links with organizations such as Cure India, Jiv Daya Foundation, Motivation India and the Indian chapter of ISPO to ensure the smooth functioning of various physical rehabilitation organizations and activities. In Cambodia, besides promoting access to the centres and improving the quality of the services provided at the centres, the ICRC continued implementing its strategy for strengthening the capacity of the MoSVY at central and provincial levels to manage all activities at the centres and at the component factory. Promoting inclusion and participation In Afghanistan, over 3,000 people with disabilities were offered social inclusion opportunities such as education (around 1,400), vocational training (250), microcredit (540), employment (54) and sport (400). Special home teaching was provided for 230 children with severe physical disabilities who were unable to attend schools, while transport was provided for those with problems in reaching school or university. In Cambodia, to ensure access to economic reintegration programmes, social workers from the MoSVY employed at assisted centres facilitated the enrolment of 58 people with disabilities in socio-economic programmes. In Pakistan, the ICRC supported the social integration activities of the Children Amputees Rehabilitation Programme (C-ARP), such as socio- psychological development sessions to help provide psychological needs for 15 children. Sports equipment was distributed to 20 children to enable them to participate in healthy activities at school and in their home environment. In most countries the ICRC supported the events organized during the International Day of People with Disability. In Afghanistan, Bangladesh, Cambodia and India, the ICRC continued to support sports activities for people with disabilities.
DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA CHINA AFGHANISTAN
PAKISTAN NEPAL
INDIA MYANMAR BENGLADESH
CAMBODIA PHILIPPINES
SRI LANKA
ICRC/ PRP_14 47 PHYSICAL REHABILITATION PROGRAMME ANNUAL REPORT 2014
AFGHANISTAN
TURKMENISTAN UZBEKISTAN TAJIKISTAN National partner Faizabad None Location of projects Mazar-i- Faizabad, Gulbahar, Herat, Jalalabad, Kabul (2), Lashkar Gah, Mazar-e-Sharif Gulbahar Jalalabad Sharif Services in 2014 Service users attending the centres 104,584 Herat KABUL New service users fitted with prostheses 1,106 New service users fitted with orthoses 5,564 Prostheses supplied 4,148 Lashkar Gah Orthoses supplied 13,177 Wheelchairs manufactured and supplied 1,246
ISLAMIC PAKISTAN Crutches (pairs) manufactured and supplied 7,135 REPUBLIC OF IRAN Service users receiving physiotherapy 69,769 ICRC / PRP_14 Beginning of assistance: 1987
The ICRC’s physical rehabilitation project in Afghanistan MOLSAMD has a deputy minister who is supposed to combines physical rehabilitation with activities aimed at be the focal point for any disability issue and who is in social inclusion and participation of people with disabilities the process of drafting a new national policy for people in society. It works in coordination with the Afghan authori- with disability. The ministry is faced with a huge task and ties but it is entirely and directly managed by the ICRC. In is criticized for making slow progress and for its charity 2014 it continued to carry out the following activities: approach. The MoE is implementing a policy of inclusive ``Managing and financing seven physical rehabilitation education which, although it is undoubtedly good in centres which provide appropriate physical theory, is encountering obstacles in practice. The Mine rehabilitation services throughout the country; Action Coordination Centre of Afghanistan (MACCA) is ``Managing and financing the Kabul Component supposed to be responsible for coordination in the area of Factory, which produces components needed disability. Afghanistan is one of the 30 States party to the for the provision of prostheses and orthoses and Anti-Personnel Mine Ban Convention that have acknowl- manufactures walking aids and wheelchairs; edged their responsibility for landmine survivors. The ``Providing material, components and technical number of national and international organizations work- assistance for seven non-ICRC rehabilitation centres; ing in the field of disability has decreased due to financial ``Conducting formal training in P&O; cooperating with constraints and security issues. There are few that are able physiotherapy schools; training physiotherapists; to work effectively in the countryside; most of them are ``Managing a special programme for spinal cord operating in the main towns. injuries (home care programme); ``Contributing to the social inclusion of people with The number of people with disabilities in Afghanistan disabilities through education, vocational training, is uncertain, as is its population, which is estimated to microfinance and employment and by promoting and be between 29 and 31 million. According to the authori- implementing sports activities. ties, people with disabilities account for 2-3% of the total population, meaning that they number between 600,000 The Afghan constitution recognizes the rights of people and 900,000. Roughly 450,000 to 650,000 of these people with disabilities and has a domestic disability law protect- need access to physical rehabilitation services. The cur- ing those rights and ensuring access to health, education, rent annual production of mobility devices in the country employment and social inclusion. Its implementation is indicates that demand has outstripped the capacities encountering obstacles. Afghanistan has ratified several of the existing centres. In 2014 physical rehabilitation international conventions, such as the UN Convention on services were available through a network of 17 centres, the Rights of Persons with Disabilities (UNCRPD) and seven of which managed by the ICRC, the others by the Anti-Personnel Mine Ban Convention. As disability non-governmental organizations, apart from two that are is a cross-sectoral issue, all government ministries are managed by the MoPH (in Kabul and Khost, with neg- expected to deal with matters related to it. Three of them ligible impact on needs and questionable performance). are particularly involved: the Ministry of Public Health As these centres are concentrated in only some of 34 (MoPH), the Ministry of Social Affairs & Martyrs and provinces, people with disabilities are forced to travel long Disabled (MOLSAMD), and the Ministry of Education distances to access services. There are numerous obstacles (MoE). The MoPH has a dedicated unit for disability to rehabilitation (and to health services in general): igno- issues, the Disability Rehabilitation Department (DRD), rance; the lack of compassion, dedication, accountability which has the task of developing guidelines for the and professionalism among medical personnel; a shortage implementation of services, quality assurance monitor- of physiotherapists and orthopaedic technicians; preju- ing standards and reporting tools. The DRD is struggling dices against disability; poverty; distances and transport to find an effective role and is often in conflict with difficulties; violence; and ethnic and political divisions. the organizations working in the field of disability. The The ICRC has been contributing to the removal of such
48 PHYSICAL REHABILITATION PROGRAMME 4.2 – ASIA
obstacles through dissemination and training activities, Convinced that physical rehabilitation is just one step by working closely with health facilities, by establishing a towards inclusion and participation of people with dis- referral system and by making its centres examples of bar- abilities in society, the PRP in Afghanistan has been rier-free facilities. Much work remains to be done. Despite promoting social inclusion since 1997. In 2014 over 3,000 plans and promises, disability unfortunately remains a people with disabilities were offered social inclusion secondary priority. opportunities such as education (about 1,400), vocational training (250), microcredit (540), employment (54) and In all, 104,584 people with physical disabilities benefited sport (400). Special home teaching was provided for from various services at the ICRC-managed centres (an 230 children with severe physical disabilities who were increase of 10% compared to 2013). The services included unable to attend schools, while transport was provided the provision of 4,149 prostheses (58% for mine survi- for those with problems in reaching school or university. vors), 13,177 orthoses, 1,246 wheelchairs and 7,135 pairs Home adaptations were carried out and accessible toi- of crutches as well as physiotherapy for 69,769 people lets and baths built to improve home mobility of people (10% for mine survivors). Children represented 33% with spinal cord injuries. The ICRC continued to pro- and women 16% of the beneficiaries. Among the newly mote sport activities, football, volleyball, badminton and registered service users, they were 2,528 children suffer- wheelchair basketball. The latter currently has over 300 ing from cerebral palsy and 723 with clubfoot. Under the players, with six men’s and three women’s teams in six ICRC’s home care programme for people with spinal cord different locations. National tournaments were organ- injuries, 1,572 people were aided during 6,946 home visits. ized for male and female players, with the aim of raising awareness of disability and of supporting the Afghan Throughout the year, several activities were implemented Paralympic Committee. Men’s and women’s national with a view to continuing to improve service quality. The teams were selected. The men’s team participated in ICRC continued to develop the professional skills of local international competitions in Europe. The Wheelchair P&O technicians and physiotherapists working at ICRC Basketball Federation of Afghanistan (WBFA) is in the centres and at non-ICRC facilities. The second course for process of obtaining recognition by the International P&O technicians (ADPO 2), conducted in partnership Wheelchair Basketball Federation (IWBF). with the MoPH, entered its second year and was attended by 18 students (six of whom were women). It leads to an internationally recognized diploma (ISPO Cat. II). The In 2015 the ICRC intends to: work began on preparing 11 students (2 women) for an blended learning BSc-level training for P&O profession- ``facilitate access to services by continuing support for als (joint collaboration between the ICRC, Human Study the seven centres, by conducting outreach visits, by and Mahidol University in Thailand). Refresher courses continuing its home care programme and the special were attended by all the physiotherapists and 30 trainees programme for children with cerebral palsy and for attended the second year of the Physiotherapy School. those with clubfoot, by maintaining a good working The treatment protocols for the most common patholo- relationship with health-care facilities and other gies seen in the centres were reviewed and updated. organizations, by supporting the development of referral networks (especially in areas where no service Because of the difficulties presently faced by Afghanistan is available) and by continuing to donate components and the large number of people with disabilities in the to non-ICRC centres and giving them training and country, it is unrealistic to expect the government to be technical support; able to provide the services needed. The ICRC is aware ``enhance the quality of services by continuing to train that it will be many years before the authorities are able P&O personnel and physiotherapists with the support to take over and ensure the long-term functioning of of expatriate specialists, improve the quality of the services. Nevertheless, the process started several years components and wheelchairs produced at the Kabul ago to ensure that a progressive handover can take place factory, and monitor and supervise physiotherapy at some point in the future has continued, with the services and the production of mobility devices; aim of empowering the Afghan employees. Additional ``promote long-term services by developing local management responsibilities were transferred to them, capacities, by participating in forums on disability and courses and training were provided. The ICRC issues and by supporting government action maintained close working relations and coordination to promote physical rehabilitation and social activities with the relevant authorities and participated reintegration; in the drafting of guidelines, in particular those relat- ``continue the social inclusion programme and the ing to the treatment of service users with spinal cord promotion of participation in sport among people injuries (SCI). It also attended the Disability Stakeholder with disabilities as a mean of rehabilitation and Commission Group of the MOLSAMD, a working group recreation, support the Afghan Paralympic Committee set up to promote social reintegration. The ICRC also and build a basketball court in Gulbahar (originally continued to cooperate with most organizations work- scheduled for 2014 but postponed). ing in the field of disability as well as with the Afghan Association of Physiotherapists and the Afghan National Society for Orthotics and Prosthetics.
49 PHYSICAL REHABILITATION PROGRAMME ANNUAL REPORT 2014
BANGLADESH CHINA CHINA National partner
BHUTAN NEPAL Centre for the Rehabilitation of the Paralysed (CRP) Location of projects Savar, Chittagong INDIA Services in 2014
INDIA Service users attending the centres 818 DHAKA New service users fitted with prostheses 184 New service users fitted with orthoses 634 Savar Chittagong Prostheses 199 Orthoses 1,160
MYANMAR Beginning of assistance at the CRP: 2003
ICRC/ PRP_ 13
In 2014 the ICRC continued to support the activities of working with and on behalf of people with disabilities. the Centre for the Rehabilitation of the Paralysed (CRP) In 2013 the Disabled People’s Rights and Protection Act in Savar and Chittagong. The CRP was established in entered into force. This legal framework focuses on basic 1979 with the purpose of assisting people with spinal rights and non-discrimination, and is more in line with cord injuries. Today, the centre caters for a far broader the UNCRPD than the Disability Welfare Act of 2001. group of people with disabilities, who are given access to There are no exact figures for the number of people with health, rehabilitation, education, employment, the phys- disabilities in the country. The Bangladesh Population ical environment and information. Besides the centres in and Housing Census 2011 works with a figure of 1.4%, Savar and Chittagong, the CRP has eight other centres which is highly disputed by stakeholders within the field located in Barisal, Ganakbari, Gobindapur, Manikganj, of disability. A more realistic figure is the 9% estimate Mirpur, Moulvibazar, Nawabganj and Rajshahi, where a used by the UN Economic and Social Commission for variety of services are provided. Of the 10 centres man- Asia and the Pacific (2012). Physical rehabilitation in aged by the CRP, only those in Savar and Chittagong Bangladesh was largely provided by NGOs and private are providing P&O services. The structure of the CRP stakeholders. incorporates the Bangladesh Health Professions Institute (BHPI), the CRP’s academic institution, which is rec- Access to rehabilitation services remained difficult for ognized by the State Medical Faculty (SMF). The BHPI most of those in need because of the barriers, such as offers diploma and Bachelor’s and Master’s degree pro- the high cost of transport, treatment and accommoda- grammes in, for example, physiotherapy, occupational tion, the lack of service providers and qualified staff, therapy and rehabilitation. Since 2014 it has also been lack of awareness about the existence of rehabilitation running a prosthetic and orthotic (P&O) diploma pro- services, and frequent strikes (hartals) in 2014 (albeit gramme, with the first 10 students enrolled under far fewer than in 2013). The ICRC conducted several scholarships provided by the ICRC. activities aimed at improving accessibility, i.e. assisting with the cost of transport, food and accommodation Bangladesh’s disability legislation is enshrined in the for poor service users attending the CRP in Savar and constitution (1972), which pledges to protect the rights Chittagong, and donating raw material, machinery, tools and dignity of all citizens of Bangladesh equally and and components to ensure that all assisted centres had without any bias or discrimination whatsoever. In 2001 the means to provide services. In addition, the ICRC the Parliament of Bangladesh enacted the Disability and the Bangladesh Red Crescent Society (BDRCS) Welfare Act (DWA) 2001 (also known as Bangladesh introduced a referral mechanism. Since the start of the Protibondhi Kollyan Ain (BPKA)), which gave constitu- activity in October 2014, volunteers from the Chittagong tional recognition to the rights of people with disabilities Division of the BDRCS registered over 60 people with for the first time in the history of country. Bangladesh physical disabilities and referred them to the CRP in ratified the UN Convention on the Rights of Persons Chittagong. In all, 818 people with physical disabilities with Disabilities (UNCRPD) in 2007, and the Optional benefited from various services at the ICRC-assisted Protocol in 2008. The Ministry of Social Welfare has centres (an increase of 30% compared to 2013). The ser- official responsibility for disability, with a Department vices included the provision of 199 prostheses and 1,160 of Social Services being responsible for preparing plans orthoses. Children accounted for 74% and women for and policies in the disability field through a National 4% of the beneficiaries. Coordination Committee on Disability. The committee works with the Centre for Disability in Development and The quality of services at ICRC-assisted centres was the National Forum of Organizations Working with the enhanced by continued mentoring and in-service train- Disabled, which is an umbrella organization of some 150 ing by the ICRC specialist. The ICRC provided five people people with disabilities organizations and NGOs/INGOs with scholarships in 2014: two completed successfully
50 PHYSICAL REHABILITATION PROGRAMME 4.2 – ASIA
single-discipline training in P&O at Mobility India (MI) In 2015 the ICRC intends to: in Bangalore (India), one began a three-year diploma level at MI, one continued to attend a BSc-level training ``increase access for beneficiaries to the CRP in Savar course at MI and one continued to attend a BSc-level and Chittagong by continuing supporting and training course at TATCOT (Tanzania). In order to further expanding the BDRCS referral mechanism, address the P&O human resources needs in Bangladesh, by donating raw materials and components, and the Bangladesh Health Professional Institute (BHPI), by subsidizing the cost of transport, food and which is the CRP’s academic institution, in cooperation accommodation for poor people with physical with the ICRC established a P&O Cat. II diploma course disabilities in need of P&O services; which obtained approval by the State Medical Faculty. ``enhance the quality of provided services by continuing The first 10 students were enrolled under ICRC pro- mentoring and in-service training by ICRC specialists, vided scholarships. by further restructuring the P&O department at the CRP in Savar, by reorganizing user flows, by Throughout the year, the ICRC supported several activi- improving the working conditions at the CRP in ties promoting inclusion and participation of people Chittagong, and by continuing to provide scholarships with disabilities. These included several sports events to enable candidates to attend P&O training courses; for people with physical disabilities that were either ``promote long-term functioning by implementing sponsored and/or organized by ICRC; the very first management protocols together with a stock Bangladesh national seminar and training workshop on management system and a service users management physically disabled cricket was held in cooperation with system, and by continuing to support the BHPI’s P&O the Bangladesh Cricket Board (BCB). It was supported diploma programme / training school; by the England and Wales Cricket Board (ECB) and the ``promote participation and inclusion by expanding British High Commission (BHC) in Dhaka. More than cooperation with the Bangladesh Cricket Board 100 participants, officials, coaches, health-care staff and (BCB) and the Ministry of Youth and Sports (MoYS) physically disabled cricketers received disability aware- for the planned physically disabled cricket activities, ness information and hands-on practical training. The by organizing a four-nation International Physically CRP physical disabled cricket and wheelchair basketball Disabled Cricket Tournament with participating teams received ICRC support to hold intensive training teams from Afghanistan, Bangladesh, India and camps to improve their overall performance. Organized Pakistan, and by supporting the CRP with sport by the CRP in Savar with ICRC support, the 13th con- activities, such as a wheelchair basketball competition ference of the Asian Spinal Cord Network (ASCoN) on the International Day of People with Disability. and associated physically disabled sports events were attended by over 300 national and international par- ticipants. The ICRC sponsored athletes with physical disabilities from Bangladesh, India and Nepal to enable them to compete in wheelchair basketball, table tennis and powerlifting activities. On the International Day of People with Disability, a friendly wheelchair basketball match between Bangladesh and Nepal was organized by the CRP with ICRC support.
51 PHYSICAL REHABILITATION PROGRAMME ANNUAL REPORT 2014
CAMBODIA
National partner Ministry of Social Affairs, Veterans and Youth Rehabilitation THAILAND LAO PEOPLE'S Location of projects DEMOCRATIC REPUBLIC Battambang, Kompong Speu, Phnom Penh BANGKOK Services in 2014 Battambang Service users attending the centres 10,183 PHNOM New service users fitted with prostheses 234 PENH New service users fitted with orthoses 333 Kompong Prostheses 1,647 Speu Orthoses 1,174 Wheelchairs 497 VIET NAM Crutches (pairs) 679 Service users receiving physiotherapy 2,993 ICRC/ PRP_14 Beginning of assistance: 1991
In 2014 the ICRC continued its cooperation with the MoSVY. At the beginning of 2013, a new institution, the Ministry of Social Affairs, Veterans and Youth the Persons with Disabilities Foundation (PWDF), has Rehabilitation (MoSVY) in support of the Battambang been created under the MoSVY. Its mandate is to provide Regional Physical Rehabilitation Centre, the Kompong rehabilitation services for people with disabilities, manage Speu Regional Physical Rehabilitation Centre and the the rehabilitation funds for implementing various projects Phnom Penh Orthopaedic Component Factory. Since such as support for education and vocational training, 2004 the ICRC has progressively reduced its role in manage job placement services and prepare policies for managing the assisted projects and focused on strength- assisting and supporting people with disabilities. ening the MoSVY’s capacity (at national and centre level), gradually transferring all responsibilities to it. ICRC staff Cambodia is among the 30 States party to the Anti- continued to act as advisers for MoSVY personnel in Personnel Mine Ban Convention that have acknowledged managing service provision at centre level and the physi- their responsibility for landmine survivors. Landmines cal rehabilitation sector at the national level. In all, 10,183 and explosive remnants of war (ERW), including clus- people benefited from various services provided at ICRC- ter munitions, continue to pose a threat in many rural assisted centres. communities despite mine/ERW clearance and long- standing mine-risk education activities. From January to Cambodia has signed a considerable number of agree- December 2014, 154 mine/ERW casualties were provi- ments and international programmes concerning people sionally recorded by the Cambodian Mine/ERW Victim with disabilities, such as the UN Convention on the Information System. This figure represents an increase of Rights of Persons with Disabilities, signed in 2007, and 39% compared to 2013. As in previous years, most of the the World Programme of Action concerning Disabled accidents occurred in the five northern and western prov- Persons (1982). It also supports the Biwako Millennium inces, Banteay Meanchey, Battambang, Oddar Meanchey, Framework for Action Towards an Inclusive, Barrier-Free Pailin and Pursat. Five of these provinces were covered by and Rights-Based Society for Persons with Disabilities the Battambang Regional Physical Rehabilitation Centre. in Asia and the Pacific 2003-2012. At the end of 2012, Cambodia ratified the UN Convention on the Rights of In 2014, to enhance the accessibility of services, the ICRC Persons with Disabilities. continued to provide direct support for beneficiaries (covering, together with the MoSVY, the cost of trans- The MoSVY has primary responsibility for providing port and of accommodation at the centres), maintained rehabilitation services and training in vocational skills for its support for the centres’ outreach programmes and people with disabilities. There were 11 physical rehabilita- provided support for the development of a comprehen- tion centres spread throughout the country, two of which sive network of potential partners within the centres’ are supported by the ICRC (Battambang and Kompong catchment areas. In all, 10,183 people benefited from Speu). Apart from the 11 centres, the physical reha- various services provided at ICRC-assisted centres. The bilitation sector consists of the Phnom Penh Orthopaedic services included the provision of 1,647 prostheses (81% Component Factory (supported by the ICRC), the for mine survivors), 1,174 orthoses, 497 wheelchairs and Cambodian School for Prosthetics and Orthotics, the 679 pairs of crutches as well as physiotherapy for 2,993 Technical School for Medical Care, which provides train- people (57% for mine survivors). Children represented ing for physiotherapists, and two professional associations, 10% and women 15% of the beneficiaries. In addition, the the Cambodian Association of Prosthetists and Orthotists Phnom Penh Orthopaedic Component Factory contin- and the Cambodian Physiotherapy Association. The ued to provide components for all physical rehabilitation Disability Action Council, a semi-autonomous body centres in Cambodia, thus ensuring proper care for all attached to the MoSVY, was also part of the sector; it people receiving services at centres throughout the coun- provided technical, coordinating and advisory services for try. Both ICRC-assisted centres continued their outreach
52 PHYSICAL REHABILITATION PROGRAMME 4.2 – ASIA
programmes: 8,261 people were assessed and 6,058 P&O In 2015 the ICRC intends to: devices and 518 wheelchairs repaired during the visits. ``facilitate access to services by maintaining its support To improve the quality of services, the ICRC continued for the Battambang and Kompong Speu centres and for developing the skills of local personnel. In addition to the Phnom Penh Component Factory, by supporting ongoing mentoring for all personnel, the ICRC con- the centres’ outreach programmes, by providing direct tinued to provide a scholarship for one candidate to support for service users, and by strengthening the attend formal P&O training (ISPO Cat. II level) at the referral networks in the areas covered; Cambodian School of Prosthetics and Orthotics (CSPO). ``continue to enhance the quality of services through continued assistance by ICRC specialists, through Besides promoting access to the centres and improving active support for further developing the national the quality of the services provided at the centres, the capacity to deliver services and gain technical and ICRC continued implementing its strategy for strengthen- clinical autonomy, and by providing a scholarship for ing the capacity of the MoSVY at central and provincial one candidate to attend formal P&O training; levels to manage all activities at the centres and at the ``promote the long-term functioning of services component factory. Throughout the year, the ICRC sup- through active participation in the work of the PWDF, ported MoSVY efforts to strengthen management of the by continuing to develop the capacity of MoSVY sector. In 2014, with the financial and technical support personnel (central and centre levels) to manage of the ICRC, the MoSVY continued to monitor the imple- physical rehabilitation activities, and by developing mentation of a stock management system at all centres the institutional capacity of the MoSVY to take on and tried to implement a common centre management greater responsibilities; tool, the Patient Management System. Both systems were ``promote sports and social inclusion activities such as developed by the ICRC. In addition, the ICRC contin- MEI, and try to foster participation in international ued to promote the long-term functioning of services by competitions. actively participating in the work of various committees addressing disability issues, by providing some financial support for the Cambodian ortho-prosthetists and pro- fessional physiotherapists associations, and by providing a scholarship for one deputy manager, enabling him to study for a Bachelor’s degree in business.
To ensure access to economic reintegration programmes, social workers from the MoSVY employed at assisted centres facilitated the enrolment of 58 people with dis- abilities in socio-economic programmes. With the financial support of the ICRC and the International Olympic Committee, the Cambodian National Volleyball League for the Disabled (CNVLD) expanded the women’s wheelchair basketball programme in Battambang and in Kampong Speu. All athletes undergo regular weekend training under the supervision of CNVLD staff/coaches, and all of them also took part in two 10-day basketball training sessions conducted by an ICRC-sponsored inter- national trainer.
53 PHYSICAL REHABILITATION PROGRAMME ANNUAL REPORT 2014
CHINA
National partner RUSSIAN FEDERATION Red Cross Society of China, Yunnan branch Location of projects
KAZAKHSTAN Kunming, Malipo MONGOLIA BEIJING Services in 2014 KYRGYZSTAN DEMOCRATIC PEOPLE'S Service users attending the centres 378 REPUBLIC OF KOREA New service users fitted with orthoses 1 REPUBLIC OF BHUTAN KOREA Prostheses 214 NEPAL Kunming Orthoses 1 BANGLADESH INDIA MYANMAR Service users receiving physiotherapy 209 LAO PEOPLE'S Beginning of assistance: 2003 THAILAND DEMOCRATIC REPUBLIC CAMBODIA PHILIPPINES VIET NAM BRUNEI DARUSSALAM SRI LANKA MALAYSIA ICRC/ PRP_14 SINGAPORE BRUNEI DARUSSALAM
In 2014 the ICRC continued to provide support for the China has not yet acceded to the Anti-Personnel Mine Yunnan branch of the Red Cross Society of China in run- Ban Convention but has endorsed the “ultimate goal of ning its Orthopaedic Rehabilitation Centre in Kunming a total ban.” Since 2004 the Yunnan branch of the Red and its repair workshop in Malipo. The objectives of ICRC Cross Society of China has registered 365 landmine sur- assistance are to develop the capacity of the Kunming vivors and fitted them with devices at its Orthopaedic and Malipo centres, which are managed by the Yunnan Rehabilitation Centre in Kunming. The majority of branch, to ensure that the most destitute among people these survivors were injured in the southern section with disabilities have access to appropriate services. of Wenshan prefecture (Malipo and Maguan counties bordering on Viet Nam). In 2014 the Yunnan branch The Ministry of Civil Affairs, the China Disabled Persons’ supplied 17 prostheses for victims of mines and unex- Federation and the Ministry of Health are mandated to ploded ordnance. address issues associated with disability. In the province of Yunnan, their resources – in terms of the money, Throughout the year, the ICRC continued supporting the knowledge, human resources and infrastructure required Yunnan Orthopaedic Rehabilitation Centre and its repair to cover the needs of disabled people – appear to be lim- workshop, thus allowing services to be brought closer to ited. To improve conditions for people with disabilities, beneficiaries living far from Kunming. In all, 378 people the government has set specific targets for the coming with physical disabilities benefited from various services years, notably in the areas of rehabilitation, educa- at the ICRC-assisted centres. The services included the tion, employment, protection of rights, and sports and provision of 214 prostheses (8% for mine survivors) and leisure activities. The State Council published the first 1 orthosis as well as physiotherapy for 209 people (7% for draft of the Regulation governing the Construction of a mine survivors). Children accounted for 4% and women No-obstacle Environment to promote social participation for 21% of the beneficiaries. for people with disabilities and to make daily life easier for them as well as for the elderly. The China Disabled Persons’ Federation decided to pursue the government’s In 2015 the ICRC intends to: objectives mainly through community-based rehabilita- tion activities. The second National Sampling Survey ``continue supporting the Yunnan Orthopaedic on Disabilities conducted in 2006 estimates that there Rehabilitation Centre and its repair workshop by are 83 million people (6.34% of the total population) in donating materials and orthopaedic components China who are living with some form of disability. More necessary to ensure service provision, the aim being to than 75% of them live in rural areas, where they are the ensure access to services for 500 people with physical most vulnerable groups, with limited access to health disabilities, and by developing partnerships with services, education, job opportunities and social activi- various actors; ties. People with disabilities encounter difficulties every ``enhance the quality of services provided through day in a society whose economy is undergoing a massive regular support and mentoring for local personnel market-oriented transition. The China Disabled Persons’ (technical, clinical and managerial staff) through Federation estimates that nearly 10 million of them are regular visits by an ICRC specialist. living in poverty.
54 PHYSICAL REHABILITATION PROGRAMME 4.2 – ASIA
DPRK DEMOCRATIC PEOPLE’S REPUBLIC OF KOREA
National partners Red Cross Society of the Democratic People’s Republic of Korea, Ministry of People’s Armed
CHINA Forces Location of projects Pyongyang Services in 2014 BEIJING Service users attending the centres 491 PYONGYANG New service users fitted with prostheses 268 New service users fitted with orthoses 10 Prostheses 474 REPUBLIC OF KOREA Orthoses 18 Wheelchairs 22 Crutches (pairs) 240
ICRC/ PRP_14 Service users receiving physiotherapy 439 Beginning of assistance: 2002
In 2014 the ICRC continued to assist the Ministry of the physiotherapy assistants and other personnel at the People’s Armed Forces by providing financial and techni- centre. The ICRC continued sponsoring two people to cal support for the Rakrang Physical Rehabilitation Centre. attend formal P&O training at the Cambodian School of Prosthetics and Orthotics. In 2014 the ICRC continued The Democratic People’s Republic of Korea has ratified to provide managerial support for the centre’s man- the United Nations Convention on the Rights of Persons ager and to promote clinical, technical and managerial with Disabilities and there is a domestic law on the standards. Protection of Persons with Disabilities. Several national institutions are involved in physical rehabilitation. The On the International Day of People with Disability (3 Ministry of Public Health has overall responsibility for December), Rakrang PRC and the ICRC held a half-day the sector and is managing the Hamhung Orthopaedic sports event for all service users and staff at the centre. Factory. The Military Medical Bureau of the Korean The ICRC introduced various sports activities specially People’s Armed Forces (KPAF) ensures access to ser- designed for people with various types of amputations vices for military personnel (and their families) and as an example of encouragement for service users to manages the Rakrang centre. The Korean Federation for actively participate in their community and, as their the Protection of the Disabled (KFPD) was created in skills and confidence increase, to take part in national 1998 within the Ministry of Public Health. The KFPD and international sports competitions. has an advisory role in establishing State policies on such matters as advocacy, awareness and the prevention of disability. The KFPD also manages physical reha- In 2015 the ICRC intends to: bilitation centres in various regions of the country and is involved in establishing regulations for special education ``enhance access to physical rehabilitation by donating and vocational training. materials and components needed to ensure the provision of services; To improve the accessibility of services, the ICRC con- ``enhance the quality of services by providing regular tinued to donate essential materials and components support and mentoring for centre personnel (technical, to the Rakrang centre. In all, 491 people with physical clinical and managerial), by organizing refresher/ disabilities benefited from various services at the ICRC- upgrading courses in these areas, which will be assisted centre. The services included the provision of conducted by an ICRC ortho-prosthetist and an ICRC 474 prostheses (1% for mine survivors), 18 orthoses, 22 physiotherapist, and by continuing to provide scholarships wheelchairs and 240 pairs of crutches as well as physi- for the two candidates to attend formal P&O training at otherapy for 439 people. Children represented 3% and the Cambodian School of Prosthetics and Orthotics; women 11% of the beneficiaries. ``strengthen understanding of physical rehabilitation among personnel at the Red Cross Society of the To improve the quality of services, an ortho-prosthetist Democratic People’s Republic of Korea, and provide and a physiotherapist, both from the ICRC, contin- financial and technical support for management of the ued to conduct several courses for P&O technicians, Rakrang centre.
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INDIA CHINA Srinagar National partners CHINA Indian Red Cross Society, Voluntary Medicare Society, Ministry of Health of Jammu and Jammu Kashmir, Ministry of Social Welfare Chhattisgarh, Christian Medical College Vellore, Mobility PAKISTAN BHUTAN India Bangalore, Ministry of Social Justice and Empowerment NEPAL Dimapur Location of projects NEW DELHI BANGLADESH Bangalore, Jammu, Raipur, Srinagar (2) and Vellore Raipur Services in 2014 MYANMAR Service users attending the centres 31,256 New service users fitted with prostheses 396 New service users fitted with orthoses 1,971 Prostheses 650 Vellore Orthoses 3,592 Bangalore Wheelchairs 304 SRI LANKA ICRC/ PRP_14 Crutches (pairs) 1,655 Service users receiving physiotherapy 5,786 Beginning of assistance: 2004
In 2014 the ICRC continued to provide support for four Centres and given approval for 247 District Disability centres, three of which were in the state of Jammu and Rehabilitation Centres throughout the country, which Kashmir: the Artificial Limb Centre at the Bone and deal with the full range of disabilities. Joint Hospital in Srinagar, the Artificial Limb Centre at the Government Medical College in Jammu and the For a number of reasons access to rehabilitation nev- P&O department of the Voluntary Medicare Society ertheless remained difficult for the poorest people. For (VMS) in Srinagar. The fourth centre, the Physical example, some facilities were not fully operational owing Rehabilitation Reference Centre in Raipur, is in the state to insufficient funds for equipment, materials and pro- of Chhattisgarh. In addition, the ICRC started to pro- fessional staff. Access to rehabilitation was made more vide support for two additional centres, the Christian difficult by the lack of facilities, particularly in rural Medical College (CMC) in Vellore and Mobility India areas, the lack of awareness of existing services, inad- (MI) in Bangalore. equate legislation, and the absence of schemes to cover costs during treatment (accommodation, food, etc.). The Ministry of Social Justice and Empowerment (MSJE) coordinated the Indian physical rehabilitation Throughout the year, the ICRC implemented several sector. The Ministry’s Division of Empowerment of activities to increase accessibility to services. These Persons with Disabilities (DEPD) facilitated the empow- activities included donating materials and components, erment of people with disabilities, regulated physical covering the cost of transportation and accommoda- rehabilitation services and various disability funds, and tion for service users at assisted centres, and supporting implemented India’s legal framework related to physical campaigns to disseminate information about the activi- disability (Persons with Disabilities Act). ties of the assisted centres. In 2014, 31,256 people with disabilities benefited from various services at Along with the MSJE, other ministries such as the ICRC-assisted centres. The services included the provi- Ministries of Women and Child Development, Health sion of 650 prostheses (4% for mine survivors), 3,592 and Family Welfare, Human Resource Development orthoses, 304 wheelchairs and 1655 pairs of crutches and Labour and Employment are engaged in various as well as appropriate physiotherapy for 5,786 people. activities related to early identification, intervention, Children accounted for 10% and women for 35% of the education, preventative medical intervention and social beneficiaries. inclusion. India ratified the UN Convention on the Rights of Persons with Disabilities in 2007, but not the Quality was ensured by continued on-the-job training Optional Protocol. The Empowerment of Persons with and mentoring by the ICRC team of ortho-prosthetists Disability Division finalized the Rights of Persons with and physiotherapists. The ICRC sponsored the par- Disabilities Bill in 2014 after extensive consultation ticipation of one staff member from a national training with relevant stakeholders. The Bill is in keeping with institute, SVNIRTAR in Orissa, to attend the global the provisions of UNCRPD. It will replace the exist- educators meeting in Kobe, Japan. It also sponsored ing Persons with Disabilities Act (1995) and has since three members of staff from assisted centres to attend been approved by the Cabinet for submission to the training on foot orthoses, seven staff members to attend Parliament. The Government of India has established a conference organized by the Orthotics & Prosthetics seven national institutions to deal with disability issues. Association of India (OPAI), and three staff members These institutions are engaged in human resource devel- from the assisted-centre to attend the South Asian opment, providing rehabilitation services for people Association for Regional Cooperation (SAARC) con- with disabilities, research and development. The central ference on Best Practice in Rehabilitation Therapy at government had also set up eight Composite Regional Mobility India, Bangalore.
56 PHYSICAL REHABILITATION PROGRAMME 4.2 – ASIA
The ICRC continued to promote the long-term function- In 2015 the ICRC intends to: ing of services by strengthening the capacity of its various partners. It also established close links with organizations ``improve accessibility of services by continuing to such as Cure India, the Jiv Daya Foundation, Motivation support the various assisted-centres by donating India and the Indian chapter of ISPO to ensure the materials and components, by supporting referral smooth functioning of various physical rehabilitation networks in the various states, and by continuing to organizational structures and activities. subsidize the cost of transport, accommodation and food for service users at the centres; In order to promote the inclusion of people with ``Improve the quality of services by strengthening disabilities through sports, the ICRC worked in partner- the skills and knowledge of national rehabilitation ship with the newly established Wheelchair Basketball professionals (P&O and PT) through mentoring and Federation and Choice International UK as well as with support by ICRC specialists, by sponsoring candidates other organizations. In this framework, a country-wide for attend formal training and/or seminars in P&O, wheelchair basketball event was organized in six Indian physiotherapy and wheelchair services, by enhancing cities, including the first national wheelchairs basketball treatment protocols, the multidisciplinary team tournament in Chennai. Overall, 177 people with dis- approach and technical guidelines, and by developing abilities from Amar Jyoti (18), Bangalore (38), Chennai the capacity of faculty members in the P&O national (140), the CMC in Vellore(12), the Indian Spinal Injuries institutions; Centre (ISIC) in New Delhi (44), Kochi (43 and the PRC ``promote the long term-functioning of services by in Pune (22) took part in the training sessions. Two strengthening the skills of assisted-centre managers round-table discussions on developing disability sports and by continuing to support organizations for people and social inclusion also took place in New Delhi and with disabilities; Chennai. In 2014 the ICRC sponsored the celebration ``promote the inclusion and participation in society of the International Day of People with Disability in of people with disabilities by promoting education, Jammu and Kashmir. livelihood, employment and sports.
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MYANMAR
CHINA National partners NEPAL BHUTAN CHINA Myanmar Red Cross Society, Ministry of Health INDIA Location of projects BANGLADESH Yenanthar Hpa-an, Mandalay, Yangon, Yenanthar Services in 2014 Mandalay VIET NAM LAO PEOPLE'S Service users attending the centres 3,251 DEMOCRATIC REPUBLIC New service users fitted with prostheses 291 New service users fitted with orthoses 12 Hpa-an Prostheses 1,027 YANGON THAILAND Orthoses 23
CAMBODIA Crutches (pairs) 945 Wheelchairs 25 VIET NAM Service users receiving physiotherapy 689 ICRC/ PRP_14 Beginning of assistance: 1986
In 2014 the ICRC continued to support the Hpa-an sections of society: 85% of all people with disabilities in Orthopaedic Rehabilitation Centre (HORC), which is Myanmar did not have a job and their academic achieve- run jointly by the Myanmar Red Cross Society (MRCS) ments were considerably below the national average, with and the ICRC, as well as the Yenanthar Leprosy Hospital only 10% attending high school. People with disabilities and Mandalay General Hospital, both managed by the in Myanmar suffer from a traditional belief (also found Ministry of Health. However, the ICRC terminated its in other countries in the region) that their condition support for Mandalay General Hospital at the end of is somehow a “moral punishment,” either because the 2014. The ICRC also continued to support the prosthetic person has bad karma from a previous existence or as a foot and crutches manufacturing unit at the National religious or spiritually based punishment for some wrong- Rehabilitation Hospital, which is managed by the Ministry doing in their current life. People with disabilities in of Health and located in Yangon. Following the Ministry Myanmar, especially those living in rural areas, often have of Health’s acceptance of the ICRC’s proposal to establish to overcome tremendous difficulties to access services as two physical rehabilitation centres (PRCs) in Myitkyina most of the centres are located in major cities and travel (Kachin State) and in Kyaing Tong (Eastern Shan State) in costs are high. order to respond to the high demand from services users in those conflict-affected regions, the Ministry gave its Several government ministries, including the Ministry approval for the Myitkyina PRC to be constructed in 2015 of Health (MoH) and Ministry of Defence (MoD), and for the Kyaing Tong PRC to be constructed in 2016. were involved in the provision of physical rehabilita- The Ministry of Health and the ICRC signed the project tion services. In addition, services were also available agreements for the two PRCs on 26 November 2014. through centres managed by the Myanmar Red Cross Society (MRCS) and/or by national organizations. The Myanmar ratified the UN Convention on the Rights of Department of Social Welfare at the Ministry of Social Persons with Disabilities in 2011. The Department of Welfare, Relief and Resettlement remained responsible Social Welfare at the Ministry for Social Welfare, Relief for community-based rehabilitation and for providing and Resettlement is the government coordinating body social welfare services through preventive, protective and for disability issues. Various legal provisions for people rehabilitative measures. with disabilities exist in current Myanmar legislation. The disability law that was initially drafted in 2011 was Throughout the year, the ICRC implemented several still being studied by the Parliament in 2014. In June activities to improve accessibility to services. These activi- 2014 the first Myanmar National Disability Conference ties included supporting the MRCS’s Outreach Prosthetic took place with the participation of over 500 people. The Programme (OPP) for areas covered by the Hpa-an conference objectives were (1) to discuss the main barri- Orthopaedic Rehabilitation Centre (HORC) as well as ers that people with disabilities experience and to issue for Upper and Central Myanmar, covered by Yenanthar a statement that highlights the rights of people with dis- Leprosy Hospital. In addition, the ICRC supported the abilities to enjoy full access and inclusion in society; (2) to launch by the HORC in July 2014 of the Mobile Repair advocate for the adoption of the National Draft Disability Workshop, which has successfully complemented the Law; and (3) to establish the Myanmar Council of Persons OPP activities. with Disabilities. The 2010 Myanmar National Disability Survey, endorsed by the Ministry of Social Welfare, Relief The importance of these programmes cannot be empha- and Resettlement, indicated that 1,276,000 people in sized enough: they enable people living in remote areas to Myanmar (2.32% of the population) have some form of access the closest service providers. In 2014, 250 people disability – 11.22% of all households are affected. The benefited from the services provided through the HORC survey gave further proof of the fact that people with dis- outreach programme, while 144 people were referred from abilities are disproportionately represented in the poorest the northern state to the Yenanthar Leprosy Hospital. The
58 PHYSICAL REHABILITATION PROGRAMME 4.2 – ASIA
HORC Mobile Repair Workshop, which started operat- In 2015 the ICRC intends to: ing in July 2014, has provided services for 1,046 people. Through a children’s summer programme launched at ``facilitate access to services by continuing to support the HORC in 2009 that earmarked the summer school the activities of the assisted centres, by strengthening holiday season (April-May) to prioritize admission for the referral programme and mobile repair workshop, children, 54 children benefited from services in 2014. A by covering the cost of transport and accommodation similar programme at Yenanthar Leprosy Hospital also for those attending the centres, by informing the fitted 14 children during the summer season in 2014. In public about services available and by starting the all, 3,251 people benefited from various services at the construction of the Myitkina Physical Rehabilitation ICRC-assisted centres. The services included the provi- Centre (Kachin State); sion of 1.207 prostheses (49% for mine survivors), 23 ``enhance the quality of services by providing ongoing orthoses (4% for mine survivors), 25 wheelchairs and 945 support through ICRC specialists, by providing pairs of crutches as well as appropriate physiotherapy for scholarships and continuing training for P&O 689 people (62% for mine survivors). . Children repre- specialists as well as for physiotherapists, surgeons and sented 4% and women 9% of the beneficiaries. administrative personal and by offering organizational support; The quality of services was enhanced through several ``promote the long-term functioning of services activities in 2014. In addition to regular in-house and by strengthening its partners’ capacities and by on-the-job training, the ICRC sponsored four candidates supporting the implementation of a national to attend P&O training, three of them at the CSPO in coordination body; Phnom Penh, (Cambodia) and one who attended a two- ``promote the inclusion of people with disabilities in year ISPO Cat. I upgrading course at the Siridorn School society through sports activities programmes. of Prosthetics and Orthotics in Bangkok (Thailand). In addition, the ICRC sponsored one candidate for a12-month certificate course in physical rehabilitation therapy at Mobility India. The ICRC also sponsored two candidates to enable them to attend a two-week ischial containment socket (ISC) seminar in Tanzania. The ICRC also funded the third amputation surgery seminar for 27 junior surgeons working at remote stations in south- eastern Myanmar. The training made it possible to focus on the most appropriate surgical techniques to ensure optimal use of the prosthetic device.
Apart from promoting access to the centres and improv- ing the quality of the services provided there, the ICRC continued supporting the directorate of the Hpa-an centre and the directorates of the MoH-managed centres.
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NEPAL
National partners International Nepal Fellowship Nepalese Army
CHINA Location of projects Kathmandu, Pokhara Services in 2014 Service users attending the centres 2,023 New service users fitted with prostheses 102 Pokhara New service users fitted with orthoses 101 KATHMANDU Prostheses 151 Orthoses 169 Crutches (pairs) 159 INDIA Wheelchairs 189 ICRC/ PRP_14 Service users receiving physiotherapy 666 Beginning of assistance: 2004
The ICRC continued supporting the provision of physi- most people with disabilities cannot afford to travel to cal rehabilitation services at Green Pastures Hospital a physical rehabilitation centre. In addition, complex in Pokhara and at the Yerahity Rehabilitation Centre administrative procedures prevent many people with dis- (YRC) in Kathmandu. Since 2009 the YRC has been the abilities from registering for and obtaining government sole government-run facility in Nepal providing physical support. rehabilitation services for military personnel and civilians. To enhance access to rehabilitation services, the ICRC Nepal ratified the UN Convention on the Rights of and the Nepal Red Cross Society worked together to Persons with Disabilities and its Optional Protocols at the disseminate essential information to people with physi- end of 2009. Several government ministries are involved cal disabilities through a network of local organizations, in disability, the main ones being the Ministry of Women, authorities and service providers. The ICRC provided Children and Social Welfare (MoWCSW), the Ministry financial support for Green Pastures Hospital and of Health and Population and the Ministry of Peace and Partnership for New Life to enable them to organize a Reconstruction (MoPR). The MoWCSW is responsi- users’ follow-up camp in Butwal. In 2014, 2,023 people ble for implementing programmes related to disability, with physical disabilities benefited from various services including the registration of people with disabilities. The at ICRC- assisted centres (an increase of 47% compared MoPR works as a government conduit, financing mine to 2013). These services included the provision of 151 action and assisting conflict-related victims. However, its prostheses (7% for mine survivors), 169 orthoses, 189 ability to fulfil this role has been constrained by a lack of wheelchairs and 159 pairs of crutches as well as physio- capacity. The Nepal National Federation of the Disabled therapy for 666 people (2% for mine survivors). Children is an umbrella organization that represents organiza- represented 8% and women 31% of the beneficiaries. tions working for people with disabilities throughout the country. It has been leading the disability movement in Support and mentoring were provided regularly for per- Nepal since 1993, drawing the attention of public officials sonnel at the two ICRC-supported centres. The aim was and civil society to the rights and dignity of people with to enhance the quality of service provision. The ICRC disabilities by emphasizing social inclusion, mainstream- also continued to develop its partners’ technical capac- ing and equality of opportunity. ity by sponsoring training at the Cambodian School of Prosthetics and Orthotics (CSPO) in Phnom Penh. Two There are no accurate data on the prevalence of disability P&O technicians who completed their training course in Nepal and the available statistics do not reflect the in September 2013 are currently working at the YRC range of disabilities. Physical disability is still considered and one P&O technician from Green Pastures Hospital by many Nepalese to be a punishment for sins committed graduated in 2014. in a previous life. Children with disabilities particularly suffer the consequences of this belief. Most people with disabilities are also excluded from primary-level educa- tion and health care, mainly because of the high cost of treatment.
Access to physical rehabilitation services remains a challenge for the rural population. Potential beneficiar- ies living in mountainous areas hesitate to travel long distances because of limited (unreliable) public trans- port and the expense involved. The ICRC covers these expenses for some people with physical disabilities but
60 PHYSICAL REHABILITATION PROGRAMME 4.2 – ASIA
In 2015 the ICRC intends to:
``enhance access to services at Green Pastures Hospital and the YRC by continuing to provide support for planning and implementing an outreach programme with the aim of reaching people living in remote areas and by donating raw materials and components to Yerahity Rebilitation Centre; ``enhance the quality of services provided at ICRC- supported centres through technical and managerial support; ``promote the long-term functioning of services by providing managerial support for the YRC, and strengthen synergies between ICRC-supported centres, government actors and coordination bodies working in the physical rehabilitation sector.
61 PHYSICAL REHABILITATION PROGRAMME ANNUAL REPORT 2014
PAKISTAN
UZBEKISTAN National partners TAJIKISTAN CHINA TURKMENISTAN Saidu Bisham Ministry of Health, Muzaffarabad Physical Rehabilitation Centre, CHAL Foundation, Pakistan Muzaffarabad Institute of Prosthetic and Orthotic Sciences (PIPOS), PIPOS Rehabilitation Services Project, Dir Khar Hayatabad Paraplegic Centre, Abkar Kare Institute (AKI) Peshawar ISLAMABAD Location of projects AFGHANISTAN Bannu Bagh Bagh, Balakot/Bisham, Bannu, Batagram, Buner, Dir, Khar, Muzaffarabad, Quetta, Peshawar Swabi (3), Saidu, Swabi, Buner Battagram Services in 2014 Quetta Service users attending the centres 19,845 ISLAMIC New services fitted with prostheses 1,736 REPUBLIC OF IRAN INDIA New service users fitted with orthoses 4,405 Prostheses 2,355 Orthoses 7,403
ICRC/ PRP_14 Wheelchairs 353 Crutches (pairs) 1,054 Service users receiving physiotherapy 6,811 Beginning of assistance: 1985
In 2014 the ICRC continued its support for 15 projects people with physical disabilities benefited from various in Pakistan. These projects included five managed by services at the ICRC-assisted centres (an increase of 18% CHAL Foundation located in Bagh, Balakot, Bisham, compared to 2013). The services included the provision Quetta and Swabi and six managed by the PIPOS of 2,355 prostheses (22% for mine survivors), 7,403 Rehabilitation Services Project (PRSP) and located orthoses (2% for mine/ERW survivors), 353 wheelchairs in Bannu, Buner, Di Khar, Dir, Peshawar and Saidu. and 1,054 pairs of crutches as well as physiotherapy for In addition, the ICRC continued its support for the 3,525 people (15% for mine survivors). Children rep- Muzaffarabad Physical Rehabilitation Centre (MPRC) resented 46% and women 10% of the beneficiaries. In and the Hayatabad Paraplegic Centre in Peshawar. 2014, the PCH, with financial support from the ICRC, The ICRC also continued to support the Akbar Kare completed 24 home modifications and 294 home visits Institute – the only comprehensive cerebral palsy centre to follow up beneficiaries within their communities. The in Pakistan – and the Pakistan Institute of Prosthetic MPRC, CHAL and the PRSP continued their clubfoot and Orthotic Sciences. The ICRC, CHAL Foundation programmes, through which 890 children were treated and Indus Hospital entered into an agreement regarding using the Ponseti method. Over the year, wheelchair cooperation and collaboration in the area of physical services were enhanced through close cooperation with rehabilitation for people with disabilities. The tripartite Motivation UK. The ICRC supported training for the agreement includes setting up two new rehabilitation centres’ personnel and supervised the provision of centres in Karachi and Muzaffargarh (both centres are wheelchair services at the assisted centres. expected to start providing services in early 2015). Besides mentoring and support by ICRC specialists, Several government ministries, including the Ministry several activities were undertaken to enhance service of Health and the Ministry of Social Welfare, were quality. Several short courses were conducted on various involved in disability issues. In 2012 Pakistan adopted its aspects relating to P&O, physiotherapy and wheelchair National Policy for Persons with Disabilities “to provide services. The ICRC supported three wheelchair train- by 2025 an environment that would allow full realization ing sessions, which were attended by 26 participants, of the potential of persons with disabilities through their and continued sponsoring candidates to attend formal inclusive main-streaming and providing them full sup- P&O training at different institutions (two at the CSPO port of the government, private sector and civil society.” in Cambodia, four at Strathclyde University in Scotland Many people with physical disabilities faced barriers in and three at PIPOS in Pakistan). accessing physical rehabilitation services, including the lack of financial means to travel to service providers and Throughout the year, the ICRC provided support for to cover the cost of services, ongoing disturbances, etc. authorities and partners to manage services, develop There is also an increased prevalence of poliomyelitis and implement the national strategy/plan and to develop cases as a result of active militant operations against vac- and implement national standards, working proce- cination workers and programmes. dures and coordination mechanisms. In particular, the ICRC continued to support the Pakistani branch of In 2014 the ICRC strove to enhance access to the centres the International Society for Prosthetics and Orthotics that it assisted by covering the cost of transport, food (ISPO). Emphasis was also placed on capacity build- and accommodation and the cost of services for people ing and support for PIPOS – the only internationally with physical disabilities attending the ICRC-assisted recognized P&O training facility in Pakistan. To further centres, and by donating equipment and necessary mate- enhance the long-term functioning of physical reha- rials/components to all assisted centres. In all, 19,845 bilitation services in Pakistan, a concept to establish a
62 PHYSICAL REHABILITATION PROGRAMME 4.2 – ASIA
supply-chain offering a wider range of raw materials ``enhance quality by continuing to provide support and components was developed with the support of from ICRC ortho-prosthetists and physiotherapists, by the ICRC. The ICRC is also supporting one of CHAL accepting students from PIPOS for clinical placements Foundation’s management staff to attend a two-year at assisted centres, by continuing to sponsor P&O training programme in project management. trainees at PIPOS and other schools, by conducting short-term training courses, by supporting PIPOS Besides some activities organized in conjunction with to strengthen its educational programme and by partners for the celebration of the International Day conducting several refresher courses for those of People with Disability, in 2014 the ICRC contin- working in the home follow-up programme at the ued supported social integration activities conducted Hayatabad Paraplegic Centre; by the Children Amputees Rehabilitation Programme ``promote the long-term functioning of services and a (C-ARP), such as: socio-psychological development sense of involvement through close contact with the sessions to help provide psychological needs for 15 chil- Ministry of Health in Pakistan-administrated Kashmir dren. Sports equipment was distributed to 20 children to with a view to ensuring the smooth running of the enable them to participate in healthy activities at school Muzaffarabad Physical Rehabilitation Centre, by and in their home environment. providing support for directors/managers of assisted centres in developing their managerial skills, by assisting in the further development of ISPO Pakistan In 2015 the ICRC intends to: and by supporting the implementation of the supply chain within the country; ``facilitate access to services by continuing to support ``promote inclusion and participation in society the activities of CHAL Foundation and the PRSP for people with disabilities by supporting sports network of centres, the activities of the Muzaffarabad activities, by continuing to work closely with the Physical Rehabilitation Centre, the Paraplegic Centre Children Amputees Rehabilitation Programme and Hayatabad, the Akbar Kare Institute and the activities by assessing the possibility of providing support for of the Indus Hospital in Karachi and Muzaffargarh microeconomic activities and/or skills development by covering the cost of services, transport and programmes with appropriate implementing partners. accommodation for those attending the assisted centres and by continuing to provide support for outreach activities implemented by assisted centres;
63 PHYSICAL REHABILITATION PROGRAMME ANNUAL REPORT 2014
PHILIPPINES
National partner Davao Jubilee Foundation Location of project MANILA Davao Services in 2014 Service users attending the centres 534 New service users fitted with prostheses 58 New service users fitted with orthoses 13 Prostheses 91 Orthoses 22 Davao Wheelchairs 62 Crutches (pairs) 53 Service users receiving physiotherapy services 368 MALAYSIA ICRC/ PRP_14 Beginning of assistance: 2000
In 2014 the ICRC continued to cooperate with the Davao basis. There are not many institutions providing physi- Jubilee Foundation by providing support for its physical cal rehabilitation services in the country and very few rehabilitation centre, the Davao Jubilee Rehabilitation trained P&O professionals. As a result, people with dis- Centre. The Foundation assures access to its services abilities usually have to rely on the support of a limited for everyone who needs them, irrespective of his or number of charitable organizations. her financial means or affiliation to opposition groups. Besides physical rehabilitation activities, the centre For many years the Davao Jubilee Foundation has offers medical consultations, psychological counselling been the only professional, non-profit service provider and community-based rehabilitation services. In con- of physical rehabilitation services on the island of junction with national and international partners, the Mindanao. In the Philippines, the most commonly used Foundation also facilitates the socio-economic inclusion form of land transport is the bus as it is relatively cheap of people with disabilities by sponsoring scholarships for (1 Philippine peso per kilometre). However, the average children and integrating economically vulnerable adults return fare to the Davao Jubilee Centre is 500 pesos. This into the workplace. As in the past, in 2014 the ICRC is prohibitively expensive as one-third of the popula- strove to meet – more comprehensively – the needs of tion lives on less than 90 pesos a day. To improve access conflict-affected victims. The ICRC enhanced access to services, the Davao Jubilee Rehabilitation Centre to physical rehabilitation services for conflict-related established a referral and follow-up system for amputees victims by providing financial support. It completely registered with the local authorities in two provinces. subsidized service costs, including expenses for trans- In early 2014 the ICRC proposed that our partner port and accommodation, for 99 victims of the conflict increased its catchment areas so as to reach beneficiar- (as opposed to 63 in 2013). ies in conflict areas. In May 2014, with the support of MNLF, the Davao Jubilee Foundation conducted its first Created in 2008, the National Council on Disability medical mission in Sultan Kudarat. Affairs (NCDA) is the national government agency mandated to formulate policies and to coordinate the In 2014, 534 people with physical disabilities benefited activities of all agencies, both public and private, relat- from various physical rehabilitation services at the ing to disability issues and concerns. The NCDA is also ICRC-assisted centre (an increase of 30% compared to mandated to monitor the implementation of various 2013). The number of people receiving services at the laws to ensure that the civil rights of people with dis- centre has increased significantly since the beginning of abilities are protected. It is also required to strengthen ICRC assistance (from 45 in 2008 to 534 in 2014). The the database on disability for policy formulation and services included the provision of 91 prostheses (2% programme development, conduct policy reviews and for mine survivors), 22 orthoses, 62 wheelchairs and 53 engage different interested parties in dialogue. The gov- pairs of crutches as well as physiotherapy for 368 people ernment recognizes that the provision of assistive devices (1% for mine survivors). Children represented 40% and and equipment is an important measure in ensuring that women 16% of the beneficiaries. people with disabilities have the same opportunities as everyone else, in the workplace and elsewhere. The In 2014 the ICRC continued to enhance the quality Department of Social Welfare and Development, the of services provided at the Davao Jubilee Foundation. Department of National Defence, the NCDA and local Clinical and technical support and mentoring were government units have funds to subsidize, to a limited provided by an ICRC ortho-prosthetist. During the extent, the provision of assistive devices and rehabilita- year, the candidate sponsored by the ICRC for three tive care for those who cannot afford them. However, years to attend P&O training at the Cambodian School because of the shortage of funds, only a few people are of Prosthetics and Orthotics in Phnom Penh graduated assisted every year, usually on a first-come-first-served and started to work at the centre.
64 PHYSICAL REHABILITATION PROGRAMME 4.2 – ASIA
Throughout the year, the ICRC continued to support the In 2015 the ICRC intends to: directorate of the Davao Jubilee Foundation in its efforts to strengthen the capacity of the centre. ``enhance access to services for victims of the internal conflict by continuing to subsidize the cost of services “Sustainable Development: The Promise of Technology” (first fittings, replacements, repairs, etc.) and by was the theme of the International Day of People with covering the cost of transport, accommodation and Disability in 2014. With ICRC support, the Davao Jubilee food for 100 beneficiaries, by setting up a crutch Foundation celebrated the importance of technology manufacture unit, by supporting the establishment of in empowering the lives of people with disabilities in a wheelchair service provision, by providing financial Mindanao and called for efforts to ensure that they have support for the Davao Jubilee Foundation to construct access to modern technology. Several advocacy cam- a new dormitory for service users including one paigns on empowering people with disability groups from kitchen, one dining room and a training centre and various areas in Mindanao were launched through differ- by continuing to support the development of new ent activities. For instance, the Davao Jubilee Foundation, services; in cooperation with the local government of Surallah, in ``enhance the quality of service provision through the province of South Cotabato, conducted a two-day technical and managerial support from an ICRC resource mobilization training workshop for people with prosthetist-orthotist; disabilities leaders; it was attended by 18 people with dis- ``continue promoting the long-term functioning of abilities. The workshop specifically stressed the fact that services by developing tools to ensure the technical, through adaptive and assistive technology, people with managerial and financial independence of the centre. disabilities can make the most of their potential in their communities; resource mobilization activities such as the development of small group websites showcasing the products of their livelihood projects play a key role.
65 PHYSICAL REHABILITATION PROGRAMME ANNUAL REPORT 2014
SRI LANKA
Jaffna National partners INDIA Jaffna Jaipur Centre for Disability Rehabilitation Location of projects Jaffna Services in 2014 (January to June) Service users attending the centres 649 New service users fitted with prostheses 29 New service users fitted with orthoses 37 COLOMBO Prostheses 173 Orthoses 95 Wheelchairs 12 Tangalle Crutches (pairs) 16 Service users receiving physiotherapy 360 ICRC/ PRP_14 Beginning of assistance: 2007 (Jaffna), 2011 (Tangalle)
Between January and June 2014 the ICRC contin- ued supporting the Jaffna Jaipur Centre for Disability Rehabilitation (JJCDR), which offered a broad range of services, including the provision of prosthetics, orthotics, various mobility aids (wheelchairs, tricycles, crutches, etc.), physiotherapy, microcredit and financial support for disabled students. It was the only centre providing physi- cal rehabilitation on the Jaffna peninsula. As planned, the JJCDR eased out of ICRC technical and financial support by mid-year, receiving a last shipment of ICRC-donated materials and components to cover its production needs up to the end of 2015. The JJCDR has been able to cope with the gradual reduction of support without adverse consequences for the provision of services.
With the support of the ICRC, 649 people with physi- cal disabilities benefited from various services provided by the JJCDR. Services included the provision of 173 prostheses (40% for mine survivors), 95 orthoses, 12 wheelchairs and 16 pairs of crutches as well as physi- otherapy for 360 people. Children represented 7% and women 29% of the beneficiaries.
66 PHYSICAL REHABILITATION PROGRAMME 4.2 – ASIA
67 O. Matthys/ICRC O. 4.3 – THE AMERICAS
68 O. Moeckli/ICRC O. PHYSICAL REHABILITATION PROGRAMME 4.3 – THE AMERICAS
ICRC SUPPORT IN THE AMERICAS AT A GLANCE In 2014 the ICRC supported 15 projects in 4 countries: Colombia (8), Guatemala (3), Honduras (2) and Mexico (2). `` ICRC projects in Guatemala, Honduras and Mexico were part of a regional effort by the ICRC to ensure access to suitable physical rehabilitation services for migrants. The strategy and approach employed in these countries complement those implemented in El Salvador and Nicaragua through the ICRC Special Fund for the Disabled. Services provided Service users attending the centres 20,512 New service users fitted with prostheses 571 New service users fitted with orthoses 3,395 Prostheses supplied 987 Orthoses supplied 4,358 Wheelchairs supplied 299 Walking aids supplied (pairs) 88 Service users receiving appropriate physiotherapy services 11,794 Children represented 12% and women 29% of the beneficiaries. In addition to ensuring access to physical rehabilitation services for migrants in Mexico and returned migrants in Guatemala and in Honduras, the ICRC covered the cost of treatment for 23 Salvadorians at the centre assisted (Don Bosco University) by the ICRC Special Fund for the Disabled. Developing local capacities In Colombia, the ICRC organized six short-term training courses for P&O professionals, conducted two seminars on physiotherapy for lower-limb amputees, and provided an introductory course in physiotherapy. In Guatemala, Honduras and Mexico, the ICRC sponsored attendance by several candidates at a two-week training course, conducted by Don Bosco University (El Salvador), on the production of prostheses for amputees with hip disarticulation and attendance by several candidates at a two-week seminar (in Cartagena, Colombia) on the management of lower limb amputees for physiotherapists. Promoting the long-term functioning of services In Colombia, several activities were implemented at national and centre levels. At the national level, they included mobilization and cooperation with other interested parties, support for the Ministry of Health and Social Protection in regulating the provision of physical rehabilitation services, and support for national training institutions that conducted training in P&O or physiotherapy. Promoting inclusion and participation In Colombia, at the end of the year the ICRC initiated a social reintegration project under the management of the Economic Security Department for people receiving physical rehabilitation services with the assistance of the ICRC. In Honduras, 20 returned migrants received training and funds for microeconomic initiatives that would ease their reintegration in their communities. The funds provided by the ICRC enabled the returned migrants to create small income-generation projects (barber shop, selling shoes, etc.).
MEXICO
GUATEMALA HONDURAS
COLOMBIA
69
ICRC/ PRP_14 PHYSICAL REHABILITATION PROGRAMME ANNUAL REPORT 2014
COLOMBIA
National partners Carthagena Ministry of Health and Social Protection, Local non-governmental organizations (Centro Integral de Rehabilitación de Colombia -CIREC in Bogotá, Fundación REI in Cartagena, Instituto
PANAMA VENEZUELA TIMDO in Cali), Private provider (Ortopédica Americana in Cali), Government institutions Cúcuta (Centro de Rehabilitación Cardioneuromuscular in Cúcuta, Hospital Universitario del Valle in Cali, Servicio Nacional de Aprendizaje (SENA) in Bogotá) BOGOTÁ Location of projects Bogotá (3), Cali (3), Cartagena (1), Cúcuta (1) Cali Services in 2014 Service users attending the centres 12,062 New service users fitted with prostheses 446 ECUADOR BRAZIL New service users fitted with orthoses 2,645 PERU Prostheses 748
ICRC/ PRP_14 Orthoses 3,330 Wheelchairs 285 Crutches 43 Service users receiving physiotherapy 8,101 Beginning of assistance: 2006
In Colombia, the ICRC resumed its physical reha- managed by the Ministry of Health and Social Protection bilitation support in 2006 under the umbrella of the (MSPH) and consists of (1) the National Council on comprehensive mine action programme implemented Disabilities and (2) departmental and municipal dis- in conjunction with the Norwegian Red Cross Society abilities committees. Their activities consist mainly of (integrated partnership). In order to strengthen the disseminating information about disability issues, train- national rehabilitation sector, the ICRC concentrated ing government staff and implementing the Registro on cooperating with public institutions at national level. para la Localización y Caracterización de Personas However, owing to the limited availability of public ser- con Discapacidad (RLCPD). In parallel, the MSPS had vices, the ICRC decided to work with a wide range of set up a national database called SISPRO which com- service providers, including private centres, public hos- piled information on the population of people with pitals and local non-governmental foundations, as well disabilities. Colombia is among the 30 States party to as training institutions (public and private facilities). the Anti-Personnel Mine Ban Convention that have Each working relationship was established and managed acknowledged their responsibility for landmine survi- in an individual manner, depending on the capacity vors. Colombia is endowed with a powerful legal arsenal of the institutions and their possibilities to address the to assist and integrate people with disabilities and there needs of victims of the armed conflict. were notable advances over the years but many of the policies are not fully put into practice owing to the lack In 2014 the ICRC continued working closely with the of resources. Health and physical rehabilitation services Ministry of Health and Social Protection (MSPS) in today remain inaccessible for the poorest people living drafting standards and guidelines for regulating the in areas affected by the armed conflict. physical rehabilitation sector. In addition, the ICRC continued to work with the two existing training insti- The Ministry of Health and Social Protection (MSPS) tutions for P&O professionals, the Servicio Nacional was responsible for the physical rehabilitation sector. de Aprendizaje (SENA) in Bogotá and the Instituto de While not directly involved in service provision (which Técnicas Integradas Multiples del Occidente (TIMDO) comes mainly from private providers and local non- in Cali. In terms of service provision, the ICRC’s prin- governmental organizations), its main responsibility was cipal partners were still the Hospital Universitario del to regulate the sector. In that regard, the MSPS devel- Valle and Ortopédica Américana in Cali. Because of oped (with the support of the ICRC) and published, in the recurrent lack of involvement from the provincial 2010, Resolution 1319 on good manufacturing practice authority, the ICRC decided to suspend its support for developing and adapting made-to-measure medical for the Centro Cardio-neuromuscular in Cúcuta in prosthetic and orthotic devices, with the aim of regulat- September 2014. The ICRC also provided material ing the sector. In 2013 the MSPS decided to update the support for the Centro Integral de Rehabilitación de document and in 2014, the ICRC participated in final- Colombia (CIREC) in Bogotá and the Fundación REI izing the first revision of Resolution 1319. The revised para la Rehabilitación Integral in Cartagena. resolution (scheduled for 2015) should facilitate the implementation of the national standards of good prac- Colombia ratified the UN Convention on the Rights tices in the country. of Persons with Disabilities in 2011. In 2007, the Colombian government established the Sistema Nacional Through donations of materials as well as technical and de Discapacidad. This entity, which is still active today, is managerial assistance and on-the-job mentoring, the
70 PHYSICAL REHABILITATION PROGRAMME 4.3 – THE AMERICAS
ICRC contributed during the year to improving access ICRC initiated a social reintegration project under the to physical rehabilitation for 12,062 people with physi- management of the Economic Security Department for cal disabilities, who received various services from the those receiving physical rehabilitation services with the network of assisted centres. The services included the assistance of the ICRC. provision of 748 prostheses (8% for victims of explosive devices), 3,330 orthoses (0.2% for victims of explosive devices), 285 wheelchairs and 43 pairs of crutches as In 2015 the ICRC intends to: well as appropriate physiotherapy for 8,101 people. The ICRC made a special effort to reach people with ``continue working with the Norwegian Red Cross physical disabilities in remote rural zones. Through this Society on a comprehensive mine action project activity, 338 people received assistance, including the involving (in addition to rehabilitation) data- provision of a comprehensive interdisciplinary service gathering, support for the social and economic in Cúcuta and in Cali (138 people) and the provision reintegration of survivors, mine risk reduction and of transport, food and accommodation enabling 251 public education; people to access the services. ``continue supporting accessibility to rehabilitation services by developing new working relations with The quality of services continued to be enhanced service providers in Bucaramanga, Medellin and through various activities supported by the ICRC. The Pasto, by continuing the donation of materials and ICRC organized six short-term training courses for P&O components when needed, and by providing direct professionals; they were attended by 25 people from support for people with physical disabilities living in various services providers. It also conducted two semi- remote rural areas; nars on physiotherapy for lower-limb amputees, which ``continue enhancing the quality of services by were attended by 22 people from Colombia and six other providing ongoing support by ICRC specialists, Latin American countries. In addition, 20 P&O students by conducting short courses, by promoting a from the SENA were given an introductory course in multidisciplinary approach and by assisting training physiotherapy by the ICRC. The team from the Physical institutions (SENA, TIMDO, etc.); Rehabilitation Programme participated in three war ``implement specific activities promoting access to surgery seminars, with a view to improving the quality appropriate wheelchairs services, by encouraging of amputations and promoting interdisciplinary reha- the availability of local products, by disseminating bilitation services. information about good practice and by mobilizing for the inclusion of wheelchairs in the Plan obligatorio The ICRC continued working closely with national de Salud; institutions and with the management of the assisted ``promote the long-term functioning of services centres to promote the long-term functioning of services. through continuous support for the Ministry of Throughout the year, several activities were implemented Health and Social Protection in developing standards, at national and centre levels. At the national level, they policies and guidelines; included mobilization and cooperation with other inter- ``promote inclusion and participation by providing ested parties, support for the Ministry of Health and assistance for the beneficiaries of physical Social Protection in regulating the provision of physical rehabilitation services, as needed; rehabilitation services, and support for national training ``initiate activities in Bogotá for detainees with institutions that conducted training in P&O or physi- disabilities together with the ICRC’s Protection otherapy. The ICRC works with universities which have Department. a PT curriculum and promote the inclusion of the “management of amputees” in their curriculum. At the end of 2014 eight universities had included this subject in their curriculum.
In Colombia, there were many initiatives to promote the inclusion and participation of people with disabili- ties but most were located in major urban centers. The most frequently cited local organizations working in this field were Fundir, Arcangeles, Corona Foundation and CIREC. In recent years one of the most important initiatives was the Pacto de Programa Productividad which brings together several organizations to pro- vide support for people with disabilities seeking to obtain professional training and employment. In 2014 the Colombian Red Cross employed one person with reduced mobility to work on the implementation of the disability inclusion resolution adopted at the 2013 Council of Delegates of the International Red Cross and Red Crescent Movement. At the end of the year the
71 PHYSICAL REHABILITATION PROGRAMME ANNUAL REPORT 2014
GUATEMALA
National partners UNITED STATES OF AMERICA Centro de Atención a Discapacitados del Ejército de Guatemala (CADEG) Hospital Infantil de Infectologia y Rehabilitación (HIIF), Clínica Ortopédica y Rehabilitación (CLOR S.A.) Location of projects Guatemala City MEXICO CITY Services provided by cooperating partners in 2014 Tapachula Service users receiving services at cooperating centres 7,285 San Pedro Sula Prostheses 90 Orthoses 680 GUATEMALA CITY Choluteca Walking aids 1 Beginning of assistance: 2009
ICRC/ PRP_14
ICRC projects in Mexico, Honduras and Guatemala health rehabilitation, promoting joint actions to restore were part of a regional effort by the organization to disabled people’s quality of life, to develop their normal ensure access to suitable rehabilitation services for activities and to participate actively in society. migrants. Many of these migrants suffer serious injury while travelling north in dangerous conditions, with The physical rehabilitation sector included several service little chance of gaining access to physical rehabilita- providers managed by the government, by a foundation, tion. In El Salvador, Honduras, Guatemala, Mexico and by the Ministry of Defence (including the CADEG) and Nicaragua, after identifying migrants in need of physi- private providers (including CLOR). However, only a cal rehabilitation services, the ICRC refers them to one few of these service providers provide P&O services and of the assisted centres, where it then covers the cost of most of them are located in Guatemala City. Because treatment, transport and accommodation. Before they the vast majority of P&O service providers are located are returned to their countries of origin, migrants fitted in the capital, people with physical disabilities in need with devices in, say, Mexico, are informed of how they of P&O services have to travel long distances and often may continue to receive services through the network of incur high transportation costs (outside and within the centres partnering with the ICRC in the various coun- capital) in reaching the services. tries. In addition, the project in Guatemala provided support to ensure that migrants, mine survivors and Through donations from the ICRC, all those centres children had access to services. were equipped, when needed, with specific tools to ensure that migrants, mine survivors and children had In Guatemala, the ICRC continued to work with the access to appropriate physical rehabilitation. In all, 7,285 Centro de Atención a Discapacitados del Ejército people with physical disabilities benefited from services de Guatemala (CADEG), the Hospital Infantil de of the ICRC-assisted centres. The services included the Infectologia y Rehabilitación (HIIR) and a private service provision of 90 prostheses (32% for mine victims), 680 provider, Clínica Ortopédica y Rehabilitación CLOR S.A. orthoses, and 1 pair of crutches. Women represented In Guatemala, the ICRC’s support for improving access 0.6% and children 6% of the beneficiaries. Of the total to services for all people with physical disabilities focused number of prostheses and orthoses provided by the on three specific groups, victims of former conflict, chil- assisted centres, 53 prostheses and 654 orthoses were dren and returned migrants with physical disabilities. provided for the groups specifically targeted by the ICRC: victims of former conflict, children and returned Guatemala ratified the UN Convention on the Rights migrants with physical disabilities. of Persons with Disabilities in 2009. The protection of the rights of people with disabilities is inscribed To improve the quality of P&O services, the ICRC in Guatemala’s constitution and in specific laws. The invited two ortho-prosthetists from the assisted-centres National Council for the Assistance of Persons with to attend a two-week training course conducted by Disabilities (Consejo Nacional para la Atención a las Don Bosco University (El Salvador) on the production Personas con Discapacidad, CONADI) is the national of prostheses for amputees with hip disarticulation. agency responsible for promoting disability policy. The Multidisciplinary team work has been implemented at Law on Care for Persons with Disabilities requires the CLOR S.A. and in order to strengthen the quality of Ministry of Health (MoH) and the Guatemalan Social physiotherapy services, the ICRC sponsored the physi- Security Institute (IGSS) to provide comprehensive otherapist from CLOR to attend a two-week seminar (in rehabilitation services for people with disabilities. In Cartagena, Colombia) on the management of lower limb fact, the MoH has two specific hospitals for physi- amputees for physiotherapists. cal rehabilitation, one for adults and one for children (the HIIR). The MoH is also in charge of the issue of
72 PHYSICAL REHABILITATION PROGRAMME 4.3 – THE AMERICAS
In 2015 the ICRC intends to:
``continue supporting accessibility to rehabilitation services by continuing to work closely with the CADEG, the HIIR and CLOR, by donating materials and components, by covering the cost of treatment for its target groups and by covering completely and/or partially the cost of transportation and accommodation; ``continue to improve the quality of services by providing continuous support and mentoring through its specialists, by promoting multidisciplinary team work and by strengthening the skills and knowledge of physiotherapists; ``continue supporting the long-term sustainability of the rehabilitation services by supporting the management at the assisted centres through the introduction and implementation of ICRC management tools.
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HONDURAS
National partners UNITED STATES OF AMERICA TELETON in San Pedro Sula, Vida Nueva in Choluteca Location of projects San Pedro Sula and Choluteca Services provided by cooperating partners in 2014 MEXICO CITY Service users receiving services 1,106 Tapachula at cooperating centres San Pedro Sula Prostheses 129 Orthoses 348 GUATEMALA CITY Choluteca Wheelchairs 13 Walking aids 41 Beginning of assistance: 2013
ICRC/ PRP_14
ICRC projects in Mexico, Honduras and Guatemala were to the implementation of a policy to meet the needs of part of a regional effort by the organization to ensure people with physical disabilities. This document calls access to suitable rehabilitation services for migrants. for substantial contribution by the civilian and private Many of these migrants suffer serious injury while trav- sector (churches, NGOs, foundations, private service elling north in dangerous conditions, with little chance providers, etc.). Private initiatives, such as the TELETON of gaining access to physical rehabilitation. In Honduras, organization and a few smaller NGOs/foundations are, Guatemala, México, El Salvador and Nicaragua, after in fact, providing services. Although there were reha- identifying migrants in need of physical rehabilitation bilitation centres in most part of the country, only few services, the ICRC refers them to one of the assisted of them were providing P&O services. They were only centres, where it then covers the cost of treatment, trans- three centres with qualified ISPO trained technicians in port and accommodation. Before they are returned to the country, e.g. Hospital San Felipe in Tegucigalpa and their countries of origin, migrants fitted with devices in, the two ICRC assisted-centres, TELETON in San Pedro say, Mexico, are informed of how they may continue to Sula and Vida Nueva in Choluteca. It is therefore diffi- receive services through the network of centres partner- cult for people with disabilities who need P&O services ing with the ICRC in the various countries. to access services as the centres are located only in the major cities, often requiring people to travel long dis- In Honduras, the ICRC continued to work with the tances to reach them. TELETON integral physical rehabilitation centre in San Pedro Sula and the Vida Nueva physical rehabilitation In all, 1,106 people with physical disabilities benefited centre in Choluteca to ensure that returned migrants from services of the ICRC-assisted centres. The services had access to adequate physical rehabilitation services. included the provision of 129 prostheses, 348 orthoses, While its area of focus was ensuring that migrants with 13 wheelchairs and 1 pair of crutches as well as appropri- physical disabilities had access to services, all those ate physiotherapy for 3,614 people. Women represented attending the two assisted centres benefited from the 15% and children 40% of the beneficiaries. Of the support given by the ICRC. total number of people with physical disabilities who accessed services at the ICRC-assisted centres, 132 were Honduras ratified the UN Convention on the Rights of returned migrants with physical disabilities (124 men Persons with Disabilities in 2008. The process of updat- and 8 women) who had access to services with financial ing public policy in the development of the law for people support from the ICRC. The services included the provi- with disabilities (Article 60) began in February 2012 sion of 56 prostheses, 5 orthoses, 4 wheelchairs and 13 with the creation of a technical committee. Through the crutches as well as physiotherapy and medical treatment. Directorate-General for Development for People with Disabilities (DIGEDEPDI), the Secretary of Interior and To improve the quality of P&O services, the ICRC Population became the leadership of a committee with invited two ortho-prosthetists from the assisted cen- the participation of people with disabilities, parents and tres to attend a two-week training course conducted by professionals from different civil society organizations Don Bosco University (El Salvador) on the production and government institutions. According to the National of prostheses for amputees with hip disarticulation. Statistics Institute, 14% of the population of Honduras Multidisciplinary team work improved with the intro- has a disability (impairment, mental problems, blind- duction of physiotherapy services at the Vida Nueva ness, etc.). Of those 14%, 95% were without employment centre and in order to further strengthen physiotherapy and 80% lived below poverty line. services, the ICRC sponsored the physiotherapist work- ing at the centre to attend a two-week seminar (in Together with organizations in the civil sector, the MoH Cartagena, Colombia) on the management of lower limb and DIGEDEPDI have prepared a document leading amputees for a physiotherapists.
74 PHYSICAL REHABILITATION PROGRAMME 4.3 – THE AMERICAS
Twenty returned migrants received training and funds for microeconomic initiatives that would ease their reintegration in their communities. The funds provided by the ICRC enabled the returned migrants to set up small income-generation projects (barber shop, selling shoes, etc.).
In 2015 the ICRC intends to:
``continue supporting accessibility to rehabilitation services by continuing to work closely with TELETON and Vida Nueva, by donating materials and components, by covering the cost of treatment for its target groups and by covering part or all the cost of transportation and accommodation; ``continue to improve the quality of services by providing continuous support and mentoring through its specialists, by promoting multidisciplinary team work and by strengthening the skills and knowledge of physiotherapists; ``continue supporting the long-term sustainability of the rehabilitation services by supporting the management of the assisted centres through the introduction and implementation of ICRC management tools.
75 PHYSICAL REHABILITATION PROGRAMME ANNUAL REPORT 2014
MEXICO
National partners UNITED STATES OF AMERICA Orthimex in Tapachula, National Rehabilitation Institute in Mexico City Location of projects Tapachula and Mexico City Services provided by cooperating partners in 2014 (for migrants only) MEXICO CITY Service users receiving services 36 Tapachula at cooperating centres San Pedro Sula Prostheses 12 Wheelchairs 1 GUATEMALA CITY Choluteca Walking aids (pairs) 3 Beginning of assistance: 2009
ICRC/ PRP_14
ICRC projects in Mexico, Honduras and Guatemala while the provision of P&O services in the public sector were part of a regional effort by the organization to is limited to some DIF and IMSS centres, mainly in ensure access to suitable rehabilitation services for Mexico City. As for the others, in the 31 states of Mexico migrants. Many of these migrants suffer serious injury services are mainly subcontracted to the private sector. while travelling north in dangerous conditions, with little chance of gaining access to physical rehabilitation. In 2014, 36 migrants with physical disabilities benefited The strategy and approach employed in Mexico com- from various services at the assisted centres with the plement those implemented in Honduras, Guatemala, financial support of the ICRC. These services included El Salvador and Nicaragua. In all these countries, after the provision of 12 prostheses, 1 wheelchair and 3 pairs identifying migrants in need of physical rehabilitation of crutches. Women represented 6% and children 6% of services, the ICRC refers them to one of the assisted cen- the beneficiaries. In addition, to ensure access to physi- tres, where it then covers the cost of treatment, transport cal rehabilitation services, the ICRC covered the cost of and accommodation. treatment for 23 returned migrants with physical dis- abilities in El Salvador (directly covered by the regional In Mexico, the ICRC continued to work with the delegation in Mexico). Orthimex Prosthetics and Orthotics Centre in Tapachula (Chiapas state) and with the National Rehabilitation Multidisciplinary team work has improved with the cre- Institute in Mexico City to ensure access to adequate ation of a provisional working relationship between the physical rehabilitation for migrants injured when falling private Orthimex centre (does not employ any physio- off trains on the way to the United States. therapists) and the DIF centre in Tapachula. To improve the quality of P&O services, the ICRC invited one Mexico ratified the UN Convention on the Rights ortho-prosthetist from Orthimex to attend a two-week of Persons with Disabilities in 2007. The Mexican training course conducted by Don Bosco University (El government designated the National Human Rights Salvador) on the production of prostheses for amputees Commission and the 32 public human rights agencies in with hip disarticulation and the ICRC sponsored can- each state and the Federal District as the bodies respon- didates from the DIF to attend a two-week seminar (in sible for overseeing implementation of that Convention. Cartagena, Colombia) on the management of lower limb Recent disability-related data were available from the amputees for physiotherapists. 13th National Census of Population and Housing, which was conducted in 2010. Disability assessment followed the recommendations of the Washington Group on Disability Statistics and identified 5,739,270 (5.1%) people with disabilities, 51.1% of whom were women. Policies and legislation endorse the rights of people with disabilities.
The public and private network of rehabilitation cen- tres covered a large part of the country, even if they are still far from covering all needs. Physical rehabili- tation services provided by public institutions such as the National System for the Integral Development of the Family (DIF), the Mexican Social Security Institute (IMSS) and the National Rehabilitation Institute (INR) focus on physical, occupational and/or speech therapy,
76 PHYSICAL REHABILITATION PROGRAMME 4.3 – THE AMERICAS
In 2015 the ICRC intends to:
``continue supporting accessibility to rehabilitation services by continuing to work closely with Orthimex and the National Rehabilitation Institute, by donating materials and components, by covering the cost of treatment for its target groups and by covering part or all the cost of transportation and accommodation; ``continue to improve the quality of services by providing continuous support and mentoring through its specialists, by promoting multidisciplinary team work and by strengthening the skills and knowledge of physiotherapists; ``continue supporting the long-term sustainability of the rehabilitation services by supporting the management at the assisted centres through the introduction and implementation of ICRC management tools.
77 4.4 – NEAR AND MIDDLE EAST
78 G. Leite Piccolo/ICRC G. Leite PHYSICAL REHABILITATION PROGRAMME 4.4 – NEAR AND MIDDLE EAST
ICRC SUPPORT IN THE NEAR AND MIDDLE EAST AT A GLANCE The ICRC supported 19 projects in 4 countries and 1 territory: Gaza (1), Iraq (13), Lebanon, Syria (1) and Yemen (4). `` In Syria, the ICRC started to provide physical rehabilitation assistance in mid-2014. `` In Lebanon, the ICRC started to provide physical rehabilitation assistance in October. Services provided Service users attending the centres 100,924 New service users fitted with prostheses 1,438 New service users fitted with orthoses 18,705 Prostheses supplied 4,106 Orthoses supplied 38,138 Wheelchairs supplied 734 Walking aids supplied (pairs) 1,889 Service users receiving appropriate physiotherapy services 45,057 Children represented 40% and women 21% of the beneficiaries. ICRC-managed microeconomic initiatives enabled 50 households with a person with disabilities to set up an income-generating scheme in Iraq, while 86 people with disabilities received loans to start businesses in Yemen. In Iraq, 318 Syrian refugees were given access to physical rehabilitation at the Erbil centre; in Lebanon, 51 Syrian refugees had access to physical rehabilitation services with the financial support of the ICRC. Developing local capacities A total of 18 candidates, seven of whom were women from Yemen, were sponsored to attend P&O courses at various training institutions, with the aim of increasing access to services for women when these candidates returned. In Yemen, the ICRC signed an agreement with the High Institute of Health Sciences (HIHS) to establish a P&O training programme. Promoting the long-term functioning of services In Gaza, the ICRC provided managerial support for the board of directors of the assisted centre. In Iraq, the ICRC participated actively in meetings of the Higher Committee for Physical Rehabilitation; conducted, in close cooperation with the Ministry of Health (MoH), an assessment of all assisted centres; and organized, in close cooperation with the MoH and the MoH of the Iraqi Kurdistan Region, a two-day national workshop. Several issues were discussed at the national workshop, including the link between national policies and strategies and physical rehabilitation. In Yemen, the ICRC continued working closely with national institutions and with the management of the assisted centres to promote the long-term functioning of services. Promoting inclusion and participation In Gaza, a wheelchair basketball tournament to promote social inclusion through sports was organized by the ICRC in cooperation with the Paralympic Committee and the Wheelchair Federation of Gaza. In Iraq, the ICRC, in conjunction with the Iraqi National Paralympic Committee, hosted sports events on the International Day of People with Disability. In Yemen, the ICRC continued to network with local NGOs and others, with a view to increasing the inclusion of people with disabilities in their communities.
SYRIAN ARAB REPUBLIC LEBANON GAZA STRIP IRAQ
GAZA STRIP
YEMEN
ICRC/ PRP_14 79 PHYSICAL REHABILITATION PROGRAMME ANNUAL REPORT 2014
GAZA
National partners Artificial Limb and Polio Centre Gaza Ministry of Health Location of project TEL AVIV Gaza Strip Services in 2014 Service users attending the centres 2587 New service users fitted with prostheses 75 Gaza New service users fitted with orthoses 287 Prostheses provided 182
JORDAN Orthoses 337 Wheelchairs 21 ISRAEL Crutches (pairs) 158 EGYPT Service users receiving physiotherapy 781 ICRC/ PRP_14 Beginning of assistance: 2007
In 2014 the ICRC, in partnership with the Norwegian for nearly two months, 2,587 people with disabilities Red Cross, continued to provide material and tech- (approximately 3% more than in 2013) received various nical assistance for the Artificial Limb and Polio services at the ALPC. The services included the provision Centre (ALPC) in Gaza City, which is managed by the of 182 prostheses, 337 orthoses, 21 wheelchairs and 158 Municipality of Gaza, the aim being to ensure access pairs of crutches as well as appropriate physiotherapy for to appropriate physical rehabilitation services in the 781 people. Children represented 40% and women 10% Gaza Strip. In addition, the ICRC team were effective of the beneficiaries. During the last armed conflict in during the recent armed conflict, reactively respond- July 2014, all referral hospitals in the Gaza Strip suffered ing to immediate rehabilitation needs at major referral from a severe shortage of devices. As a result, assistive hospitals in the Gaza Strip. The hospital projects once and mobility devices were donated to six major refer- supported by the ICRC were revisited to assess the ral hospitals; materials for two burns units in the Gaza physiotherapy response during the conflict. Assistive Strip were also provided. In total, 287 wheelchairs, 2,320 and mobility devices were donated and they were highly crutches (elbow and axillary), 555 walking frames and 30 appreciated by the hospital. A review on post-surgical air mattresses were donated. inpatient physiotherapy services in 2014 was conducted, highlighting the effective role of physiotherapists during ICRC specialists (ortho-prosthetists and physiothera- an emergency. pists) continued to provide on-the-job training and mentoring for ALPC P&O technicians, benchworkers The Ministry of Health (MoH) continues to be respon- and physiotherapists. Closer multidisciplinary coop- sible for the rehabilitation sector in the Gaza Strip and eration between P&O technicians, physiotherapists and a large number of local and international non-govern- orthopaedic surgeons was established but is still a “work mental organizations continue to work in the field of in progress,” with efforts ongoing to ensure good qual- physical rehabilitation. The International Coordination ity services. Particular emphasis was placed on clinical Department (ICD) coordinates the rehabilitation-related reasoning, fitting and training, and efficient use of avail- activities of the MoH and of international organizations able resources. Three P&O technicians were sponsored in the Gaza Strip. After the 2012 survey, there have been to attend an orthotic training co-organized by TATCOT no specific disability prevalence studies. However, after and the ICRC Special Fund for the Disabled in Tanzania; the recent armed conflict in 2014, preliminary findings additionally, the clinical coordinator of the ALPC visited from the MoH indicate that approximately 1,134 injured Battambang Physical Rehabilitation Centre (PRC) in individuals (833 individuals aged 18 years and over, and Cambodia to learn about PRC centre management and 301 individuals under 18 years) are expected to have to proficiency in service provision. In conjunction with deal with permanent disabilities. the ICRC Mental Health and Psychological Support (MHPSS) team, sessions were conducted for ALPC staff The ICRC conducted several activities to improve acces- in general and specifically for technical staff to help sibility, including the donation of prosthetic and orthotic improve the quality of rehabilitation interventions pro- materials and components needed to produce mobility vided for service users who had experienced traumatic devices and the provision of financial support for 38 situations during the recent conflict. people with disabilities to cover the cost of transport. The ALPC, in cooperation with the ICRC, conducted 6 The ICRC continued to provide managerial support dissemination sessions for 89 participants from the MoH for the ALPC directorate; the Fundraising Strategy and from national and international organizations work- for the ALPC was completed and recommendations ing in the rehabilitation sector in order to help strengthen such as job descriptions, an organizational chart and referral mechanisms and disseminate information about cost calculations were drafted and later finalized. The ALPC services . In 2014, despite the closure of the ALPC ICRC continues to promote the use of polypropylene
80 PHYSICAL REHABILITATION PROGRAMME 4.4 – NEAR AND MIDDLE EAST
technology to help provide alternative cost-effective ``enhance the quality of services through continuous options. The ALPC now has contracts for its 33 staff mentoring by ICRC specialists, by providing scholarship members, although the matter of permanent contracts to enable several candidates to attend formal P&O for the technical (P&O and PT) and support staff (12 training , by continuing the training provided by ICRC in total) continues to require attention. The accredita- MHPSS sessions for ALPC staff and by conducting a tion process has resulted in recognition of the ISPO service user feedback survey on satisfaction with and the Cat. II qualifications for all five technicians by the MoH meaningful impact of ALPC services; authorities in the Gaza Strip. ``promote the long-term functioning of services by obtaining accreditation from the Palestinian A wheelchair basketball tournament to promote social authorities on the West Bank for P&O professionals, inclusion through sports was organized by the ICRC in by implementing cost calculations and treatment cooperation with the Paralympic Committee and the guidelines, by continuing to develop network links Wheelchair Federation of Gaza. The tournament con- with national and international organizations with sisted of 4 teams of 20 participants from each team, total a view to securing sustained donor support for of 80 participants. The event was widely appreciated by administrative and salary costs; our main contacts and local media. ``promote the inclusion and participation of people with disabilities by conducting a two-week wheelchair basketball camp to help the Paralympic Committee In 2015 the ICRC intends to: establish a classification system and help build the technical capacity of coaches and players, and by ``improve access to physical rehabilitation services promoting the International Day of People with by continuing to support the ALPC by providing Disability among national and international players. materials, components and assistive devices, by partly covering transport costs for service users who lack financial resources, by continuing to support the ALPC in its efforts to disseminate information about its activities, by establishing an active wheelchair assembly unit at the ALPC and by further diversifying orthotic services at the ALPC;
81 PHYSICAL REHABILITATION PROGRAMME ANNUAL REPORT 2014
IRAQ
National partners TURKEY ISLAMIC REPUBLIC OF IRAN Ministry of Health, Ministry of Higher Education, Ministry of Defence; Ministry of Health, Arbil Ministry of Higher Education of the Kurdistan Regional Government Location of projects SYRIAN ARAB REPUBLIC Tikrit BAGHDAD Baghdad (5), Basrah, Erbil, Falluja, Hilla, Najaf, Nassirya, Tikrit Services in 2014 New service users attending the centres 33,155 Fallujah New service users fitted with prostheses 849 Al-Hilla New service users fitted with orthoses 9,741 Najaf Prostheses 3,098 Nassirya Basra Orthoses 16,962 Wheelchairs 365 SAUDI ARABIA KUWAIT Crutches (pairs) 790 ICRC/ PRP_14 Service users receiving physiotherapy 7,627 Beginning of assistance: 1993
In 2014 the ICRC continued to support 13 facilities functioning; eight were government-managed facilities around the country, 10 of them managed by the Ministry and one was managed by the ICRC. of Health (MoH): four in Baghdad (Al-Wasity Hospital, the Sadr Al Qanat P&O Centre, the Baghdad Centre In Iraq, the provision of health and rehabilitation services and the Al-Salam Crutch Production Unit) and one has been negatively affected by the decades of con- each in Basra, Falluja, Hilla, Najaf, Nasiriya and Tikrit. flict, violence and international sanctions, with severe One was managed by the Ministry of Higher Education consequences for more than 3.5 million Iraqis with disa- (the P&O institute) and one by the Ministry of Defence bilities. Rehabilitation services are free of charge and the (Baghdad). The ICRC continued to manage the Erbil MoH provides free accommodation in general hospitals; Physical Rehabilitation Centre. The ICRC remains the however, the services are often based in centralized areas main organization supporting the physical rehabilitation and with limited accessibility. Because of the shortage sector in Iraq. of qualified human resources, some of the physical rehabilitation centres have waiting lists and there are Iraq became a State Party to the Mine Ban Treaty in very few female ortho-prosthetists with the exception of 2008 and acceded to the UN Convention on the Rights Baghdad, which among other things, had limited access of Persons with Disabilities (UNCRPD) in 2013. Under for women to some facilities. Article 32 of the Constitution of Iraq, people with dis- abilities are entitled to protection and rehabilitation. Throughout the year, the ICRC implemented several The entitlement to basic health care and rehabilitative activities to increase accessibility to services; including services from the MoH as well as cash transfer benefits donating raw materials and components to all assisted and specified services from the Ministry of Labor and centres, supporting the most vulnerable with transport Social Affairs (MoLSA) are protected under laws passed costs and providing dormitory facilities in Erbil PRC. In in 2013 on the Care of Persons with Disabilities and 2014 a total of 33,155 people with disabilities received Special Needs and the Social Protection Law of February services within the network of ICRC assisted- centres. 2014. In the Iraqi Kurdistan Region, a law providing The services included the provision 3,098 prostheses stipends for people with disabilities and special needs (28% for mine survivors), 16,962 orthoses (0.1% for mine was passed in 2011, and in 2012 a law mandated a 3% survivors), 365 wheelchairs and 790 pairs of crutches as quota for employment in the public sector. The physical well as physiotherapy for 7,627 people (10% for mine rehabilitation sector was mainly the responsibility of the survivors). Children represented 35% and women 13% MoH, although the Ministry of Environment also had of the beneficiaries. As the security situation deteriorated a victim-assistance component through its Directorate in June, there was a high influx of internally displaced of Mine Action, in line with its formal responsibility people, in particular in the Iraqi Kurdistan Region, for all matters relating to ERW. The Higher Committee adding to the increase in demand for physical rehabilita- for Physical Rehabilitation and Prosthetics & Orthotics tion services caused by the arrival of Syrian refugees. To (HCPRPO), a MoH body, dealt with all issues related meet this demand, the ICRC established assessment visits to the provision of mobility aids nationwide, except for in four refugee camps within the region, ensuring access areas under the jurisdiction of the Kurdistan Regional to services for 318 Syrian refugees. Government (KRG). With the exception of the coun- try’s Kurdish region, physical rehabilitation services Apart from ongoing mentoring and support by ICRC were provided through a network of centres run by the specialists, 7 out of 11 planned national training mod- MoH (14), the Ministry of Defence (1), the Ministry of ules intended to enhance the quality of services were Higher Education (MoHE) (1), the Iraqi Red Crescent conducted (four were cancelled because of the secu- Society in Mosul (1) and private service providers. In the rity situation) at the ICRC-managed centre in Erbil; Iraqi Kurdistan Region, nine rehabilitation centres were 54 people took part. With ICRC support, Iraq’s only
82 PHYSICAL REHABILITATION PROGRAMME 4.4 – NEAR AND MIDDLE EAST
prosthetic/orthotic school continued to work towards ``enhance quality by monitoring physical rehabilitation meeting internationally recognized standards and the activities at assisted centres through ICRC specialists development of the physiotherapy curriculum at Hawler in conjunction with the HCPRPO, by organizing 10 Medical University (Iraqi Kurdistan Region) was ini- national training modules, by continuing to provide tiated with the support of Slippery Rock University. scholarships for those enrolled in postgraduate During the year, 27 physiotherapy students completed education, by upgrading the practical skills of the internships at the PRC in Erbil. present P&O and physiotherapy teachers, and by working with the HCPRPO to implement quality To promote the long-term functioning of services, control tools and treatment protocols; the ICRC worked closely with government ministries ``promote the long-term functioning of services by involved in rehabilitation, actively participated in meet- assisting and strengthening the HCPRPO at the ings of the HCPRPO, organized a national workshop MoH of Iraq and at the MoH in the Iraqi Kurdistan on physical rehabilitation in Erbil, and continuously Region as well as at the Higher Committee for assessed supported centres with the MoH. The ICRC Physiotherapy in order to develop a comprehensive continued to sponsor three P&O students pursuing post- national rehabilitation strategy, by strengthening the graduate studies at Strathclyde University in Scotland close working relations with Directorates of Health with the aim of strengthening the capacity of the P&O so as to increase the focus on physical rehabilitation, Institute in Baghdad. by systematically mapping rehabilitation services, by assisting the MoHE of Iraq and MoHE in the To promote the social inclusion of people with dis- Iraqi Kurdistan Region to upgrade training and abilities, the ICRC, in conjunction with the Iraqi education in prosthetics and orthotics as well as in National Paralympic Committee, hosted sports events physiotherapy so that they are more in line with on the International Day of People with Disability. The international standards, and by continuing to support ICRC-run Erbil physical rehabilitation centre had four Erbil Governorate in the planning of a new physical employees with disabilities and the ICRC continued to rehabilitation centre in Erbil; place emphasis on the importance of employing people ``encourage the social inclusion of people with with disabilities among partner institutions. Moreover, disabilities by working with disabled people’s 50 households with a family member with a disability organizations to promote implementation of the received economic support for socio-economic reinte- UNCRPD, by making it easier for people with gration through the ICRC’s economic security activities. disabilities to take part in sports events by donating wheelchairs to the Iraqi National Paralympic Committee and marking the International Day for In 2015 the ICRC intends to: People with Disability, by creating awareness about physical infrastructure at health facilities, and by ``facilitate access to services by donating raw materials, enhancing the employability of people with disabilities components, tools and physiotherapy equipment, at the supported physical rehabilitation centres. by continuing to support the cost of transport for destitute beneficiaries living in remote areas of the Iraqi Kurdistan Region, by improving dissemination to local entities and authorities of information on services available for people with disabilities, by further developing an integrated approach with the Economic Security and Protection departments, including the socio-economic reintegration of people with disabilities, and by continuing to support Syrian refugees and internally displaced people with disabilities by providing assistive devices, including wheelchairs;
83 PHYSICAL REHABILITATION PROGRAMME ANNUAL REPORT 2014
LEBANON
National partners Not yet identified Location of projects
Services in 2014 BEIRUT Service users receiving services with the support of the ICRC 51 SYRIAN ARAB REPUBLIC New service users fitted with prostheses New service users fitted with orthoses Prostheses Orthoses Wheelchairs GOLAN ISREAL Crutches Service users receiving physiotherapy ICRC/ PRP_14 JORDAN Beginning of assistance: October 2014
In 2014, with the influx of Syrian refugees, the ICRC the Ministry allocates only USD 16,000 per annum to decided to conduct a physical rehabilitation needs each private and accredited prosthetic/orthotic clinic. assessment mission. The ICRC then decided to start With this sum, an average of 10 people per clinic can be being active in physical rehabilitation in Lebanon and fitted with complex braces or artificial limbs. in October, the ICRC Physical Rehabilitation Project Manager started his mission. Between October and December 2014, the PRP manager invested time and In 2015 the ICRC intends to: effort to understand and integrate into the Lebanese physical rehabilitation sector. Out the 23 P&O service ``continue assessing the situation for Syrian refuges providers in the country, 6 have been visited and their in need of physical rehabilitation services and services were assessed as good. One in Tripoli and one in when needed, provide financial assistance to access the Bekaa Valley became the referral points for PRP ben- appropriate physical rehabilitation services; eficiaries in need of mobility devices. Discussions about ``maintain close contact with the Lebanese authorities possible collaboration with P&O and PT syndicates and and with professional associations to further enhance their needs were started. At the end of 2014, the ICRC working relations; provided financial assistance for 51 people in need of ``support the opening, in conjunction with the Iranian physical rehabilitation services. Red Crescent Society, of a physical rehabilitation department at Nabatiyeh Hospital. Lebanon signed the UN Convention on the Rights of Persons with Disabilities in 2007, but has not yet ratified the Optional Protocols. The National Council on Disability (NCOD) is the key mechanism for pol- icy-making with regard to people with disabilities in Lebanon. Its mission, which is defined in Law 220/2000, is mainly to prepare the general policy on disability or to adopt norms and standards for public institutions. From 1994 until now, the National Council made a number of achievements. It played a key role in preparing and lob- bying for the passing of Law 220/2000 and the adoption of the disability card programme, including the classi- fication of different forms of disability. The Ministry of Public Health, while responsible for regulating the sector, is not directly involved in physical rehabilitation service provision but reimburses the cost of assistive devices for economically vulnerable service users. Services are provided through a network of private providers across the country. The Ministry of Public Health and the Lebanese Syndicate of Prosthetists/Orthotists agreed on a national price list for P&O devices. Currently, the Ministry of Public Health lacks funds and has reduced its aid. Previously, people needing assistive appliances could have them replaced after two years. Today, those devices are replaced only after four years. Additionally,
84 PHYSICAL REHABILITATION PROGRAMME 4.4 – NEAR AND MIDDLE EAST
SYRIA
National partners
TURKEY Syrian Red Crescent Society Location of projects
Services in 2014: No statistics available Service users receiving services with the support of the ICRC New service users fitted with prostheses
LEBANON New service users fitted with orthoses IRAQ Prostheses Orthoses DAMASCUS Wheelchairs
JORDAN Crutches SAUDI ARABIA Service users receiving physiotherapy ICRC/ PRP_14 Beginning of assistance: 2014
In 2014 the ICRC decided to start physical rehabilitation In 2015 the ICRC intends to: assistance following a needs assessment mission con- ducted in 2013. Although the original plan was to have ``improve access to services by continuing to support ICRC specialists in Syria at the beginning of the 2014, the physical rehabilitation services provided by their arrival was postponed until mid-2014 for several the SRCS, by opening a centre in Aleppo and by reasons. From mid-2014 until the end of year, ICRC spe- continuing to assess possibilities to decentralize the cialists laid the foundations for a project that will ensure provision of services in other regions; access to appropriate physical rehabilitation services in ``improve the quality of the services by providing two cities, Damascus and Aleppo. support and mentoring by ICRC specialists and by supporting the establishment of a physiotherapy The conflict and the economic sanctions imposed by department at the SRCS-managed centre in other countries seriously affected the possibilities for Damascus. people with physical disabilities to access physical rehabil- itation services. While the needs are increasing, existing rehabilitation centres have been destroyed, have closed down, are not accessible, and/or lack staff, funding and/or material. Among other services, the Syrian Red Crescent Society (SRCS) was managing a temporary centre in Damascus as security issues rendered their main centre inaccessible. The ICRC donated materials and compo- nents to the SRCS, enabling it to provide services. In addition, the ICRC established contact with the Ibn Nafis hospital, where the Ministry of Health is managing a physical rehabilitation centre.
85 PHYSICAL REHABILITATION PROGRAMME ANNUAL REPORT 2014
YEMEN
National partners Ministry of Public Health and Population, Ministry of Social Affairs and Labour, Rehabilitation SAUDI ARABIA Fund, Care for Handicapped Persons Location of projects OMAN Aden, Mukalla, Sana’a, Taiz Services in 2014 SANA'A Service users attending the centres 65,131 New service users fitted with prostheses 514 Taiz New service users fitted with orthoses 8,677 Mukalla Prostheses 826 ERITREA Aden Orthoses 20,839 DJIBOUTI Wheelchairs 348 Crutches (pairs) 941 SOMALIA ICRC/ PRP_14 Service users receiving physiotherapy 33,236 Beginning of assistance: 2002
As in the past, the prevailing security situation Insecurity remains a major stumbling block for many had an impact on the implementation of activities. people with disabilities in accessing physical rehabilita- Nevertheless, the ICRC’s support for the physical reha- tion services. The services are centralized in major cities bilitation sector in Yemen continued to increase from and there are no outreach programmes. According to one centre in 2002 to four centres in 2014. In 2014 the the National Disability Strategy document, health ser- ICRC continued assisting four physical rehabilitation vices are widely inaccessible by the rural population, centres in Aden, Mukalla, Sana’a and Taiz, all man- which constitutes 75% of total population in Yemen. aged by the Ministry of Public Health and Population The shortage of female professionals, especially for (MoPHP) and the only functioning centres in the coun- P&O services, remains a hindrance for access to PRCs try. Discussions with the authorities – about opening services by women. To improve accessibility for women, a new centre in Sa’ada to ensure access to services for the ICRC sponsored two additional women to attend people with disabilities from Sa’ada governorate and formal P&O training, thus taking the total of Yemen its surroundings – were successful and at the end of women on ICRC scholarship at Mobility India to seven. the year, an agreement was signed between the ICRC The ICRC also promoted general service accessibility by and the local Directorate of Health (and endorsed by supporting the MoPHP to construct a physical rehabili- MoPHP) to construct a fifth centre in Sa’ada, which tation centre in Sa’ada. should start operating in early 2015. In addition to the material and technical assistance, gait training area at In 2014 the ICRC promoted accessibility to services by the PRC in Taiz was renovated. donating raw materials and components to all assisted centres. In all, 65,131 people benefited from various Yemen ratified the UN Convention of the Rights of services at ICRC-assisted centres. The services included the Persons with Disabilities in 2009 and it is one of the provision of 826 prostheses (7% for mine survi- the 30 States party to the Anti-Personnel Mine Ban vors), 20,839 orthoses, 348 wheelchairs and 941 pairs Convention that have acknowledged their responsibil- of crutches as well as physiotherapy for 33,236 people. ity for landmine survivors. The MoPHP continued Children represented 42% and women 26% of the ben- to be in charge of the physical rehabilitation sector, eficiaries. The total number of women receiving services which consisted of four physical rehabilitation centres showed a small increase compared to 2013 (+ 2%); how- (all assisted by the ICRC), four training institutions ever, it is expected that this figure will increase with the for physiotherapy and three funds created to alleviate return of women students from Mobility India. the living conditions of people with disabilities. The Ministry of Social Affairs and Labour (MoSAL) was The quality of the services provided at the assisted cen- responsible for welfare and for coordinating the provi- tres was maintained through continued support from sion of services for people with disabilities. In February ICRC ortho-prosthetists and physiotherapists, who pro- 2014 the MoSAL published the National Disability vided on-the-job mentoring, short training courses and Strategy and its Plan of Action for the period from monitoring. In 2014 the ICRC provided scholarships 2014 to 2018. The National Disability Strategy outlines for six more candidates to study P&O at Mobility India; the vision, objectives and principles of a “rights- this is in addition to the nine Yemeni students already based” approach to disability for Yemen. The National enrolled there. Of these 15 students, 7 are women; they Disability Strategy also proposes a time frame within were given scholarships in the hope that when they which the Strategy will be implemented, including return, access to services for women will increase. A the establishment of the Care and Rehabilitation training course for trainers (ToT) on dynamic alignment Fund for Handicapped Persons (CRFHP), which will and gait training for lower limb prosthetic users was con- assume responsibility for overseeing the implementa- ducted at the High Institute of Health Sciences (HIHS) tion, monitoring and evaluation. for 10 participants from the Aden and Sana’a institutes
86 PHYSICAL REHABILITATION PROGRAMME 4.4 – NEAR AND MIDDLE EAST
of physiotherapy assistants. In addition, the ICRC signed ``promote the long-term functioning of services by an agreement with the HIHS in Sana’a to open a P&O continuing to provide support for the MoPHP and department and launch P&O training programme to for centre directorates, by providing training and curb the shortage of trained personnel in the country. technical support for the implementation of the Renovation of the P&O department was started and ICRC-developed centre management tools (Patient completed in 2014. A booklet on hygiene and stump and Management System and Stock Management), by prosthesis care was produced and distributed to the four continuing to facilitate national coordination meetings main PRCs so as to educate beneficiaries. for all assisted centres, the MoPHP and stakeholders, by lobbying for and supporting the implementation The ICRC continued working closely with national insti- of the National Disability Strategy and plan of tutions and with the management of the assisted centres action endorsed by the MoSAL and by selecting, in to promote the long-term functioning of services. In conjunction with the HIHS, four candidates to attend 2014, 42 participants took part in a national coordina- formal higher training in P&O as prospective teachers tion seminar organized by the ICRC. Participants came for the P&O department at the HIHS; from the four assisted PRCs, MoPHP Directorates and ``promote the inclusion and participation of people other stakeholders and a sub-committee with represen- with disabilities by continuing to ensure access to tation from the centres was constituted to follow up the MEI, by supporting sport tournaments and the recommendations of the seminar. Despite budgetary celebration of the International/Arabic Day of Persons constraints, the MoPHP realizes and appreciates the with Disabilities in December 2015. importance of having qualified personnel in their insti- tutions and therefore sponsored two physiotherapists to study for an MSc degree in Turkey.
Isolation and stigmatization are challenges experienced by people with disabilities that will require both politi- cal and social willpower if they are to be overcome. The ICRC continued to network with local NGOs and others, with a view to increasing the inclusion of people with dis- abilities in their communities. In 2014 ICRC-managed microeconomic initiatives provided loans for 86 people with disabilities to start businesses. The International Day of People with Disability (3 December) and the Arabic Day of Persons with Disabilities (13 December) were celebrated in different cities in Yemen in 2014. The ICRC distributed 1,500 T-shirts bearing a special message about equality and donated 16 wheelchairs to the General Union for Sports for Disabled. A marathon was organized for eight women and eight men as part of the Arabic Day of Persons with Disabilities celebrations in Sana’a.
In 2015 the ICRC intends to:
``facilitate access to services by continuing to donate polypropylene-related raw materials and components to the Aden, Mukalla, Sana’a and Taiz centres and by providing financial assistance for the construction of a new centre in Sa’ada. In preparation for the Sa’ada PRC, the ICRC will sponsor six people from Sa’ada to study physiotherapy at the High Institute of Health Sciences. The ICRC will lobby with the MoPHP to plan for the staffing and budget of the Sa’ada PRC; ``enhance the quality of services by continuing to sponsor candidates (15) at Mobility India and provide (6) additional P&O scholarships for two women from each centre (Mukalla, Sana’a and Sa’ada, evaluate the training course for trainers (ToT) on gait training conducted in 2014 for the HIHS and the Amine Nasher Institute in Aden, organize a Ponsetti workshop for staff at ICRC-supported PRCs involved in clubfoot management, and to inaugurate the P&O Department at the HIHS;
87 ANNEX 1 – ICRC PUBLICATIONS
The following documents are available through the ICRC website and, in most cases, can be downloaded directly from there. PHYSICAL REHABILITATION
Towards Social Inclusion – Physical Rehabilitation Programme
This brochure promotes the ICRC’s physical rehabilitation work, describing the benefits of these services for people with disabilities – from recovering their mobility to being integrated back into society. It also explains what the ICRC does to ensure that people have access to physical rehabilitation and describes some of the situations in which it provides those services.
P&O Manufacturing Guidelines
Manufacturing guidelines for trans-tibial, trans-femoral, partial-foot, trans-humeral and trans-radial prostheses and ankle-foot, knee-ankle and patellar-tendon-bearing orthoses and for using the alignment jig in the manu- facture of lower-limb prostheses were published in 2007 and widely distributed among all ICRC-assisted projects and NGOs and among stakeholders involved in provid- ing P&O services in developing countries. Each manual contained material that should be of help in transferring skills in projects.
88 PHYSICAL REHABILITATION PROGRAMME Annex 1 – ICRC Publications
Polypropylene Technology
To mark the ICRC’s role in developing and promoting appropriate technology, such as the polypropylene tech- nology, a brochure on the subject was published in 2007. It provides the necessary information about the advan- tages and appropriateness of using this technology for producing prosthetic and orthotic devices in developing countries.
Physiotherapy
The “Physiotherapy” leaflet is a concise introduction to the work of the ICRC’s physiotherapists. It explains the role that these professionals play in physical rehabilitation and hospital projects as well as the ICRC’s approach in this field
Exercises for Lower-Limb Amputees
This booklet/CD-ROM provides examples of basic post-prosthetic exercises for use by physiotherapists, physiotherapy assistants, ortho-prosthetists and others involved in gait training for lower-limb amputees. The aim of these exercises is to help amputees to regain their self-confidence and to walk as well as possible.
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MISSION The International Committee of the Red Cross (ICRC) is an impartial, neutral and independent organization whose exclusively humanitarian mission is to protect the lives and dignity of victims of armed conflict and other situations of violence and to provide them with assistance. The ICRC also endeavours to prevent suffering by promoting and strengthening humanitarian law and universal humanitarian principles. Established in 1863, the ICRC is at the origin of the Geneva Conventions and the International Red Cross and Red Crescent Movement. It directs and coordinates the international activities conducted by the Movement in armed conflicts and other situations of violence. 4250/002 08.2015