Volume 1 No. 2 Volume

ISRAELI-PALESTINIAN PUBLIC HEALTH MAGAZINE FEBRUARY-MARCH 2005

Palestinian Perspective Community-Based Rehabilitation and Human Rights Israeli Perspective Shaping Vision into Policy for People with Disabilities Special Interview Dr. Benedetto Saraceno, Director of Mental Health and Substance Abuse, WHO

A New Look at Disabilities Advisory Board Members: Dr. Sameer Abdalla Mission Statement Director, Palestinian Economic Research Institute (MAS), Ramallah bridges, the Israeli-Palestinian with health care. Developed with Dr. Mousa Thabet Abdulaziz School of Public Health, Public Health Magazine, is a unique health care professionals, decision Al-Quds University, Jerusalem Prof. Joseph Abramson publication conceived of, written, makers and academics in mind, the Emeritus Professor of Social Medicine, edited, produced and managed joint- magazine covers public health top- Hebrew University, Jerusalem Dr. Ahmad Abu Tawahena ly by Palestinian and Israeli academ- ics relevant to both populations and Clinical Psychologist,Clinical Supervisor, Gaza ics and health professionals under seeks to analyze the impact of the Dr. Rafik Al Husseini Deputy Director General, Director of the sponsorship of the World Health conflict on the health and well-being Operation, Welfare Association, Jerusalem Organization (WHO). The maga- of both societies. In both structure Prof. Alean Al-Krenawi, PhD Chairman, Spitzer Department of Social Work, zine embodies the WHO paradigm and content bridges is a coopera- Ben-Gurion University, Beer Sheva Dr. Dan Bar On of “Health as a Bridge for Peace”: tive endeavor seeking to build rela- Chair, Department of Behavioral Science, the integration of peace-building tionships, links and common under- Ben Gurion University, Beer Sheva Prof. Zvi Bentwitch concerns, strategies and practices standing. Chairman of Board, Physicians for Human Rights Dr. David Chinitz Senior Lecturer, Health Policy and Table of Contents Management, School of Public Health, Hebrew University - Hadassah, Jerusalem Editorial 3 Prof. Orly Elpeleg by Hani Abdeen Head of Metabolic Disease Unit, Shaare-Zedek Medical Center, Jerusalem A Community-Based Approach 4 Dr. Eyad El Sarraj to Rehabilitation in Palestine and Chairman, Gaza Community Mental Health Programme its Implications for Social Life, Ms. Tamar Gozansky Human Rights and Democracy Former Member of Knesset Israel, by Arne H. Eide, Ghada Harami Lecturer in Ben Gurion University, Beer Sheva and Cindy Greer Prof. Miriam Hirschfeld Michlelet Emek Izrael Shaping Vision into Policy and 8 Dr. May Kaileh its Implementation – People with Family Health Officer, UNRWA, West Bank Dr. Joseph Katan Disabilities in Israel Bob Shapell School of Social Work, by Dina Feldman Tel Aviv University, Tel Aviv Dr. Omayah Khammash From Palestine to New York – 13 Director of MARAM Project, West Bank A Learning Journey Dr. Sharif Munzer by Suha Tazami President's Advisor for Health Affairs, Former Deputy Minister of Health, PNA, West Bank An Interview with Dr. Benedetto 14 Prof. Avinoam Reches Saraceno, Director of Mental Chairman, Ethics Committee, Health and Substance Abuse, WHO Israel Medical Association Dr. Varsein Shaheen by Oriella Ben-Zvi Director of Research and Planning, Protecting Health Following 16 Welfare Association, Jerusalem the Asian Tsunami Dr. Nihayah Tilbani Head Business Department, WHO Health Action in Crisis Department Faculty of Economics and Administrative Report January 6, 2005 Science, Al-Azhar University, Gaza Dr. Theodore Tulchinsky Cover Photo: UNDP/PAPP, George Azar How to…Making Gynecological 18 Associate Professor, Braun School of Public Services Accessible to Women Health, Hebrew University - Hadassah, with Disabilities: Creation of Jerusalem a Model Clinic Prof. Sam Tyano Prof. of General Psychiatry and Child and by Hila Ben Shushan Adolescent Psychiatry, Tel Aviv University, News Items 24 Tel Aviv World Health Day 2005 27 Editorial Board: by Shiri Ourian Dr. Ambrogio Manenti Head of Office, WHO West Bank and Gaza A Day in the Life – A Family’s 28 Prof. Hani Abdeen The Editorial Board invites submissions Tragedy and Rehabilitation Dean, Al-Quds Medical School, of letters, comments or articles on public by Daniel Ben Simon Al-Quds University, Jerusalem Dr. Fathi Abumoghli health to bridges at: A Day in the Life – National Health Officer, [email protected] Arqam’s Lost Dreams 30 WHO West Bank and Gaza Ms. Randi Garber by Abdel-Basit Khalaf JDC-Middle East Program, Jerusalem Disability and Rehabilitation – 32 The ICF-WHO photos are awarded photographs Dr. Itzhak Levav WHO’s View Consultant to WHO, Jerusalem from the photo contest "Images of Health and Disability 2002 and 2003". The contest has been Readers’ Forum 34 Production team: organized in order to promote the understanding and use of the International Classification of by Sarah Capelovitch Ben Or Consulting / Functioning, Disability and Health (ICF). Goldfinger Communications Letters to the Editor 35 Abir Barakat This publication contains the views of independent authors and does not necessarily represent the opinion of the Editorial Board or Freelance Communication Consultant the Advisory Board individually or collectively on any matter. The named authors alone are responsible for the views expressed in Maria Restrepo WHO West Bank and Gaza this publication. The designations employed and presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of Hagit Maimon Graphic Designer its authorities, or concerning the delimination of its frontiers or boundaries. The World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its issue. 2 bridges February-March 2005 priority to pay attention to advoca- cy and lobbying local and national government authorities to pass laws and policies that will facilitate and improve access to opportunities and A New Look at resources for people with disabili- ties in Israeli society. In the “How to –” section, the author has high- lighted ways to improve accessibil- DisabilitiesDisabilities ity to a gynecological clinic beyond changes in physical infrastructure. by Hani Abdeen A new feature in this issue is the “Readers’ Forum” section where members of the community pose he story of Abdullah ibn There are two different schools of controversial public health topics Maktum in the Qu’ran thought that underpin the disabil- or new ideas for discussion. In this (Surat Abasa) is an ity perspective, namely, the medi- edition, the Invitation to a Forum early illustration of the cal model and the social model. on Developmental Disabilities arti- way people with disa- The medical model perceives disa- cle by Capelovitch begins a dialogue Tbilities are related to by our socie- bility to be an individualized prob- about current theories and practices ties. Abdullah ibn Maktoum, a per- lem with undue power given to for developmental disability disor- son with a visual disability, is first able-bodied professionals to make ders. Capelovitch raises many ques- ignored by the Prophet Muhammad, decisions on behalf of people with tions that still need clarification and then becomes his advisor and disabilities. This model imposes a through the exchange of viewpoints eventually is delegated to a position presupposition of inferiority, both and experiences. The section aims of responsibility in the city of Medi- physical and intellectual, upon to generate an interesting discus- na in the Prophet’s absence. people with disabilities. The social sion in upcoming issues. Unfortunately, throughout his- model, in contrast, is the antith- Médecin du Monde (MDM) tory few people with disabilities esis to the medical model. The addresses health issues generat- have been able to overcome soci- focus is placed upon the communi- ed by the separation wall such as etal barriers both physical and atti- ty and society rather than the indi- the difficulties patients and medi- tudinal and reach ibn Maktum's vidual. It maintains that disability cal staff face in accessing clinical prominence. Yet the issue of dis- has less to do with the body or facilities. It highlights the negative abilities has generated sufficient mental functions, and is more so impact the separation barrier has worldwide interest at the social, the consequence of social barriers. on people’s lives and the Palestin- legal and governmental levels only Furthermore, under the social mod- ian health care system. in the past two decades specifically el, disability is seen as a human No doubt, the calamity that has dating back to 1981 when the Unit- rights issue, which requires the befallen South-East Asian countries ed Nations declared that year, the participation of people with disa- as a consequence of the tsunami dis- International Year of Disabled Per- bilities to achieve common mutual aster is heartbreaking and calls for sons, and in 1982, when the Gener- goals. the support of all regions to show al Assembly adopted the World Pro- The article in this issue by Harami support and rally around the people gram of Action concerning Disabled et al, addresses the way the needs of affected. In the news section, WHO Persons. Palestinian people with disabilities has delineated the way needs can be Our understanding of the issue of are met through community based assessed and how healthcare facili- disability is being reshaped. This rehabilitation (CBR) programs and ties on the local and global levels has been achieved by empowering how Palestinian society is becoming can mobilize and render assistance people with disabilities, including more receptive to including the disa- to those unfortunate communities children, to change their perspec- bled through change of attitudes and affected by this horrific natural dis- tive, so that they perceive them- community advocacy. Policy makers aster. selves and each other as powerful and legislators are also important in Through cooperation and build- people with the legitimate right to bringing about desirable change in ing bridges of solidarity and under- determine how they live their lives the disability movement. The arti- standing do we achieve our lofty and determine the priorities for the cle by Feldman depicts the field of goals in public health. We should provision of disability services, giv- policy and legislation as key factors be motivated by a Ugandan saying, en the scarcity of human and finan- affecting inclusion of people with “It is the teeth that are together that cial resources. disabilities. It has become a key can bite the meat.”

February-March 2005 bridges 3 A Community-Based Approach to Rehabilitation in Palestine and its Implications for Social Life, Human Rights and Democracy by Arne H. Eide, Ghada Harami, Cindy Greer photo: UNFPA/Steve Sabella uring its 20-30 year his- families. (3,4) On the other hand, ment of the CBR program was recent- tory, community-based there is an abundance of literature ly carried out1 (2), comprising multi- rehabilitation (CBR) from all over the world describing ple methods and data collection: has evolved into a com- the situation for people with disabili- 1. Baseline Follow Up – A baseline munity development ties as suppressed and disadvantaged follow up study was conducted. Dstrategy for rehabilitation, equaliza- in all respects, and characterized by It comprised of a sample of 1075 tion of opportunities and the social poverty (5) as well as exclusion from or 5.5% of 19840 registered peo- integration of people with disabili- social participation. (6) Internation- ple with disabilities. Community ties. (1) Further development of CBR ally, these issues have been given Rehabilitation Workers (CRWs) has included human rights, democ- considerable attention, as manifest- completed questionnaires about racy and a gender perspective with- ed in the United Nations’ Standard the impact of the CBR Program for in the scope of its programs. In this Rules (1994) and the World Program each of the people they serve. article, data from a previous impact of Action (1993). To the extent that 2. Record Audit – Structured inter- assessment (2) is applied to analyze CBR is a viable strategy for includ- views with CRWs about 57 indi- the role of CBR in creating opportuni- ing and involving disabled individu- viduals were sampled across ties for social participation for a seg- als into social, economic and politi- regions and according to specif- ment of the population that previous- cal life, it is argued that this strategy ic criteria to ensure a broad rep- ly lacked such opportunities. This is is a means of strengthening the very resentation (gender, age, type of discussed in relation to human rights foundation of democracy and human disability, level of impact). and democracy within the context rights in a society. 3. Semi-structured Interviews and of the severe and violent conflict Focus Groups - Nineteen semi- between Israel and Palestine. CBR in Palestine structured interviews (individu- While there are many examples CBR in Palestine dates back to 1989 als and groups) and two focus of evaluations of CBR around the and is coordinated by the Central group discussions were carried world, there are few examples in the National Committee for Rehabilita- out in two regions. Interviewees literature of attempts at measuring tion (CNCR). The main implement- included service providers, indi- its impact on the social integration of individuals with disabilities and their “…social integration of the most vulnerable into society has tangible effects on the quality of השיקום המבוסס בקהילה (CBR) ”.social relations in general מיושם בכל רחבי העולם, כולל פלשתין, כאסטרטגיה היוצרת הזדמנויות לשילוב ing partners are 23 non-governmen- viduals with disabilities and other החברתי של אנשים עם מוגבלויות בקהילה. tal organizations grouped into five household members (most often הסקירה שלהלן לגבי השפעת ה-CBR על regional committees (Nablus, Jen- the mother), representatives from השילוב החברתי בפלשתין, מדגימה כיצד -in, Southern Region, Central Region different disability groups, a med פועל ה-CBR מעבר לאסטרטגיות אחרות and Gaza) that coordinate the work. ical relief committee, and a local של שיקום, ומתפרש גם לתחומי קידום ערכי .The Norwegian Association of the committee דמוקרטיה וזכויות האדם. תכנית ה-CBR Disabled (NAD) and the Diakonia מעניקה למשפחות ולקהילות מקומיות Regional Office have been the main Results תקווה לעתיד טוב יותר, וגם ערכים ויכולת שיהיו בעלי חשיבות רבה בשביל פלשתין supporters of the CBR program since The baseline study revealed that בשנים הבאות. its inception. At the heart of CBR, is a community integration was described -multi-level and multifaceted strategy as the main input for 92% of the indi ﻟﻘﺪ ﻃﺒﻘﺖ ﻋﻤﻠﻴﺔ إﻋﺎدة اﻟﺘﺄﻫﻴﻞ اﻟﻤﺮﺗﻜﺰة -that comprises a variety of activities viduals in the sample. This compris ﻋﻠﻰ اﻟﻤﺠﺘﻤﻊ ﻓﻲ ﻣﺨﺘﻠﻒ أﻧﺤﺎء اﻟﻌﺎﻟﻢ ﺑﻤﺎ initiated nationally, regionally and at es a number of activities which aim ﻓﻴﻬﺎ ﻓﻠﺴﻄﻴﻦ ﻛﺎﺳﺘﺮاﺗﻴﺠﻴﺔ ﺗﻬﺪف إﻟﻰ ﺧﻠﻖ the local community level. The pre- to improve the social integration of ﻓﺮص ﻟﻠﺘﻜﺎﻣﻞ اﻻﺟﺘﻤﺎﻋﻲ ﺑﻴﻦ اﻷﺷﺨﺎص ذوي /dominant conceptualization of CBR the person with disabilities and his اﻻﺣﺘﻴﺎﺟﺎت اﻟﺨﺎﺻﺔ وﻋﺎﺋﻼﺗﻬﻢ ﻣﻊ اﻟﻤﺠﺘﻤﻊ. -from the 1990s primarily represent- her household into the local commu وﻳﻮﺿﺢ اﻟﺘﻘﻴﻴﻢ اﻟﺘﺎﻟﻲ أﺛﺮ ﻋﻤﻠﻴﺔ إﻋﺎدة ed by the World Health Organization nity. In many instances this implies اﻟﺘﺄﻫﻴﻞ اﻟﻤﺮﺗﻜﺰة ﻋﻠﻰ اﻟﻤﺠﺘﻤﻊ ﻓﻲ ﻋﻤﻠﻴﺔ WHO), has influenced the practical changing the situation from relative) اﻟﺘﻜﺎﻣﻞ اﻻﺟﺘﻤﺎﻋﻲ ﻓﻲ ﻓﻠﺴﻄﻴﻦ، وﻳﺒﻴﻦ -implementation of the program. (7, isolation to active social participa اﻟﺘﻘﻴﻴﻢ ﻛﻴﻒ أن ﻋﻤﻠﻴﺔ إﻋﺎدة اﻟﺘﺄﻫﻴﻞ ﻗﺪ -Following a gradual expansion, tion equal to that of other house (8 ﺗﺠﺎوزت اﺳﺘﺮاﺗﻴﺠﻴﺎت إﻋﺎدة اﻟﺘﺄﻫﻴﻞ ﻟﺘﺸﻤﻞ the program today covers approxi- holds and individuals. Of the total ﺗﻌﺰﻳﺰ اﻟﺪﻳﻤﻘﺮاﻃﻴﺔ وﺣﻘﻮق اﻹﻧﺴﺎن. -mately 50% of the population in the number of individuals in the sam ﻻ ﺗﻬﺪف ﻋﻤﻠﻴﺔ إﻋﺎدة اﻟﺘﺄﻫﻴﻞ إﻟﻰ ﺗﺰوﻳﺪ اﻟﻌﺎﺋﻼت واﻟﻤﺠﺘﻤﻊ اﻟﻤﺤﻠﻲ ﺑﺎﻷﻣﻞ West Bank and 75% in Gaza. ple, 531 of the 1,075 total individuals وﺑﻤﺴﺘﻘﺒﻞ أﻓﻀﻞ ﻓﺤﺴﺐ، ﺑﻞ ﺗﺰودﻫﻢ showed changes in their situation ﺑﺎﻟﻤﻌﺮﻓﺔ واﻟﻘﻴﻢ واﻟﻘﺪرة أﻳﻀﺎ، واﻟﺘﻲ ﺳﺘﻜﻮن -Impact Assessment of CBR from isolation towards social partici ذات أﻫﻤﻴﺔ ﺑﺎﻟﻐﺔ ﻟﻠﻔﻠﺴﻄﻴﻨﻴﻴﻦ ﺧﻼل A comprehensive impact assess- pation. This suggests that there is a اﻟﺴﻨﻮات اﻟﻘﺎدﻣﺔ.

February-March 2005 bridges 5 photo: UNFPA/Steve Sabella

“Many mothers shared the isolation of the family member with a disability. This could be due to the stigma attached to having a child with a disability or due to the extra burden involved.”

potential for increased or improved as well as their human and demo- ence relieves pressure on the family, social integration and participation cratic rights. Much of the CRWs’ especially the mothers. The CRWs for approximately half of the regis- efforts are at the community level frequently can then include moth- tered people with disabilities in the including, but not limited to, visit- ers and family members in a process area currently covered by CBR. ing and talking to families in a cer- that often leads to increased aware- In the baseline follow up study, tain neighbourhood with a particular ness about the potential and rights the CRWs were asked to describe problem, conducting public meet- of people with disabilities. The next their main input in each of the sam- ings to increase awareness in a local step is encouraging their active pled individuals. These 18 input community, as well as meeting with involvement in the local community items were coded yes (1) or no community leaders like teachers and and in many cases activities aimed (0). A model comprising this input headmasters to promote inclusive at bringing about changes in policy index and a number of variables that education. The CRWs’ long term and practice to the benefit of people could be expected to explain varia- contact with the disabled individu- with disabilities. tion in community integration (age, als and their families often instils Through focus group discussions, duration of CBR contact, region, pre- a sense of security in families that it became evident that the CBR pro- vious treatment, number of disabili- may feel threatened due to cultural gram had contributed to promoting ties) revealed that CBR input contrib- beliefs surrounding disability issues, awareness, positive attitudes and uted uniquely (2 = 41.44, p < .01). stigma, and general ignorance. acceptance of people with disabili- The record audit confirmed the Interviews with the disabled indi- ties in the local communities. These level of impact on social integra- vidual and their families (most often discussions provided further support tion indicated in the baseline study. the mother) confirmed that the work that the program, by advocating for Progress in social integration was of CRWs often had a direct impact equal rights and opportunities, pro- measured in 31 of 52 individuals of on their social situation, especial- moting involvement of people with which more than half had improved ly for the mothers. Many mothers disabilities and their families in the substantially. Interviews with the shared the isolation of the family local communities, and enabling CRWs confirmed the importance of member with a disability. This could people with disabilities to obtain the process of establishing trust and be due to the stigma attached to hav- their rights to education and par- acceptance, changing negative atti- ing a child with a disability or due ticipation, had played a significant tudes towards people with disabili- to the extra burden involved. The role in democratization and human ties, and focusing on their potential individual’s increasing independ- rights.

6 bridges February-March 2005 CBR – Promoting CBR Program seeks to invest these special competence that contributes Democratic Values important values in the communi- and adds quality to society when giv- The impact assessment of CBR in ty by promoting equality, tolerance, en the right opportunities. Palestine has clearly demonstrated democratic processes, and respect The impact assessment has shown that the efforts by the CRWs and their for human rights. It is argued that how working with CBR promotes supervisors have a direct impact on social integration of the most vulner- important values in the communi- the level of social integration and par- able into society has tangible effects ty that are essential in strengthen- ticipation of individuals with disabili- on the quality of social relations in ing the base for a future, democratic ties and their households within their general. Inclusion of this group and state. The CBR Program in Palestine local communities. The CBR Program consideration of their interests foster makes its contribution in this regard. in Palestine is based on a broad defi- a sense of responsibility and maturity Through the CBR program, many nition of disability and rehabilitation in attitudes and in decision making individuals, families and local com- which includes the socio-political are- processes that also include social dis- munities are equipped not only with na. Recognizing that the foundation tribution aspects. The social inclusion hope for a better future but also with of a state is based not only on struc- of people with disabilities and their knowledge, values and ability that tures, but on people, values and prac- families also implies that their poten- will be of great importance for Pales- tices, it has been a deliberate strategy tial as members of society may be ful- tine in years to come. of the CBR Program to combine “tra- ly utilized not only for their own ben- ditional” rehabilitation with a proc- efit but also for benefit of the local Arne H. Eide, Professor, Research Director ess pursuing human rights and dem- communities. People with disabilities of SINTEF Health Research, Oslo, Norway. ocratic ideas and practices. Thus, the have a unique experience and thus a [email protected] Ghada Harami, Palestinian, Director of Rehabilitation Program, Diakonia and NAD Status of Disability Distribution of type of disability among Middle East Office, Jerusalem. in Palestine people with disabilities in Palestine, 1997 [email protected] Rehabilitation and disability-related Type of Disability Percentage Cindy Greer, Development Advisor, services and programs in Palestine Movement 29.7 date back to the 1940s. They have International Department, Norwegian primarily been carried out by local and Vision 19.6 Association of Disabled (NAD), Oslo, international NGOs. Until the 1970s, Other 16.6 Norway. [email protected] disability programs were limited mostly Psychological 14.1 to blindness and deafness. In the 1980s Speech 10.7 Footnotes and during the Intifada, many NGOs Hearing 9.3 1. The full report of the CBR impact assessment started special programs for disabilities is available from any of the authors of this Total 100.0* article. and community-based rehabilitation 2. Editorial note: Given that the worldwide (CBR). When the Palestinian National *Data from the Palestinian Central Bureau of Statistics accepted estimate of people with disabilities (PCBS), 1997 Authority (PNA) took full responsibility in the population is 10%, it is likely that this for the health sector, rehabilitation and figure is an underestimate of the true number of • Physical Disabilities The main causes of people with disabilities in Palestine. disabilities were given special support, physical disabilities are cerebral palsy (24%) References especially in terms of institutional capacity and poliomyelitis (21%) 1. Community Based Rehabilitation for and with building and staff development. • Hearing Disabilities The main causes of People with Disabilities. Joint Position Paper. The data show that approximately 46,063 International Labour Organisation (ILO), United hearing disabilities are otitis media and fever Nations Educational, Scientific and Cultural (1) people with disabilities live in Palestine, due to meningitis. Organisation (UNESCO) and World Health constituting 1.8% of the total population2. • Psychological Disabilities The main Organization (WHO), 1994. In the West Bank, the governorates psychological disorders in Palestine are stress 2. Eide A H. Impact Assessment of the reporting the highest rate of disabilities are Community Based Rehabilitation Programme in related disorders (28.7%), post traumatic Palestine. SINTEF Report no. STF78 A014512. Qalqiliya and Tulkarm at 2.3%, followed stress disorders (19.5%), depression (17.5%), Oslo, SINTEF Unimed; 2001. by Tubas at 2.1%. Jerusalem, Ramallah, Al- anxiety (13.2%), co-morbid psychiatric 3. Mitchell R. Community-based rehabilitation: Bireh, Jericho and Al Khalil have the same disorders (15.7%) and somato-form disorders the generalised model. Disability and rate at 1.7% of the total population. In the Rehabilitation, 1999; 21:522-528. (5.3%). 4. Thomas M. Editor’s comment. Asian Pacific Gaza Strip, the highest rate of disabilities • Speech Disabilities The percentage of Disability Rehabilitation Journal, 2002;13:1. was reported in the Gaza governorate at people with speech disabilities in Palestine is 5. Beresford P. Poverty and disabled people: 1.7% followed by North Gaza at 1.6%. about 10.7% of total disabilities. challenging dominant debates and policies. Since the beginning of the current conflict Disability & Society 1996; 11(4):553-567. 6. Lister R. The Exclusive Society: Citizenship in September 2000, 52,927 Palestinians References 1. Palestinian Ministry of Health, Annual Report, 2003 and the Poor. London, Child Poverty Action have been injured. The Palestinian 2. Qotta, S.An. Epidemiological study on the prevalence Group, 1990. Ministry of Health (MOH) estimates of stress related psychiatric disorder among Palestinians 7. Helander E, Mendis P, Nelson G, Goerdt that 10% of the injured people will in Gaza Strip. Report of study results, Gaza community A. Training in the community for people with mental health program, 1998. disabilities. Geneva, World Health Organisation, have at least one permanent disability, 3. Abo-Jeab, S. Situation analysis of physically disabled 1989. people in Gaza strip. Report of the study results, 2000. which means that an additional 5,000 4. Palestinian National Authority. Ministry of Health. 8. Helander E, Mendis P, Nelson G, Goerdt Palestinians should be added to the National strategic health plan, 1999. A. Training in the community for people with number of people with disabilities. 5. Salem, M. A documentation of the experience of self- disabilities. 2nd Edition. Geneva, World Health organization among physically disabled Palestinian, 1992. Organisation, 1999. Gender Distribution 6. Palestinian Central Bureau of Statistics. Population Bibliography The prevalence of disability among men housing and establishment census, 1997. 1. United Nations. The Standard Rules on the 7. David P. Willis, Disability Policy, 1989. Equalisation of Opportunities for Persons with and boys is higher than in women and 8. National Rehabilitation Society, annual report, 2000. girls. Palestinian males are at higher risk for 9. Atfalna Deaf Society. Report about deaf situation in Disabilities. New York, United Nations, 1994. Gaza, 2000. 2. United Nations. World Program of Action injury due to higher rates of male youth 10. Al Nour. Blind Disability Center, report of blind in Concerning Disabled Persons. New York, United participation in the Palestinian Intifada. Gaza, 2000. Nations, 1993.

February-March 2005 bridges 7 Shaping Vision into Policy and its Implementation - People with Disabilities in Israel by Dina Feldman

:(ccording to the global- fested in the following services (1 המאמר עוסק בתיאור מצבם של אנשים עם מוגבלות בישראל והרוח החדשה שנוצרה ly accepted estimate, School System: לקראת ובעקבות חקיקתו של חוק השוויון ,people with disabilities • special education, small classes לאנשים עם מוגבלות, התשנ"ח - 1998. חוק make up more than 10 extra teaching hours, adaptation זה מקדם את מסורת הטיפול והשיקום של -percent of the popula- of suitable teaching methods, tech אנשים עם מוגבלות בישראל אל השלב Ation. To date, the data which exists nologies and materials, provision הבא של השתלבות מלאה בחברה על בסיס ,identifies the number of people with of supplemental paramedical care של זכויות אדם, אזרחות מלאה ותורמת, disabilities living in Israel as approx- assurance of safe transport, day שותפות ומעורבות בתהליכי קבלת החלטות .imately 13 percent of the popula- care centers, and more וניהול חיים עצמאיים בקהילה. העבודה מתארת את המציאות הנוכחית, את tion*. Approximately one third of people האתגרים וכן את הפעולות הנעשות לשם with disabilities are in special educa- ������������������������������������������������� יישום עקרונות חוק השוויון הלכה למעשה. ������������������������������������������������������ tion and two thirds are included in �� the mainstream education system. �� ��� �� New legislation is being implement- ﺗﺼﻒ اﻟﻤﻘﺎﻟﺔ وﺿﻊ اﻷﺷﺨﺎص ذوي ��� ed which emphasizes the impor- ��� اﻻﺣﺘﻴﺎﺟﺎت اﻟﺨﺎﺻﺔ ﻓﻲ إﺳﺮاﺋﻴﻞ، واﻟﺴﻴﺎﺳﺔ .tance of inclusion اﻟﺠﺪﻳﺪة اﻟﺘﻲ ﺗﻢ ﺗﻄﻮﻳﺮﻫﺎ واﻟﺘﻲ ﺗﺘﻌﻠﻖ ﺑﻘﺎﻧﻮن :Medical System اﻟﺤﻘﻮق اﻟﻤﺘﺴﺎوﻳﺔ ﻟﺬوي اﻻﺣﺘﻴﺎﺟﺎت اﻟﺨﺎﺻﺔ -eligibility for medical and paramed • اﻟﺬي ﺳﻦ ﻋﺎم ١٩٩٨. وﻗﺪ ﺳﺎﻫﻢ ﻫﺬا اﻟﻘﺎﻧﻮن ������ �������� ���������� ������ ������ ������ ical services, public, mental health ����������� ����� ������� ������� ﻓﻲ ﺗﻄﻮﻳﺮ اﻟﺜﻘﺎﻓﺔ اﻹﺳﺮاﺋﻴﻠﻴﺔ اﻟﻌﻼﺟﻴﺔ، وإﻋﺎدة ,and psychosocial rehabilitation ���������� ﺗﺄﻫﻴﻞ ذوي اﻻﺣﺘﻴﺎﺟﺎت اﻟﺨﺎﺻﺔ، وﻧﻘﻠﻬﻤﺎ -Source: Myers-JDC Brookdale assistant technology and equip إﻟﻰ ﻣﺮﺣﻠﺔ ﺟﺪﻳﺪة ﻓﻲ ﻋﻤﻠﻴﺔ ﺗﻜﺎﻣﻞ ﺗﺎﻣﺔ ﻣﻊ .Traditional Policy ment اﻟﻤﺠﺘﻤﻊ؛ اﻧﻄﻼﻗﺎ ﻣﻦ ﻣﺒﺪأ ﺣﻘﻮق اﻹﻧﺴﺎن، :and Services Transportation ﻣﻮاﻃﻨﺔ ﻛﺎﻣﻠﺔ وﻓﺎﻋﻠﺔ، واﻟﻤﺸﺎرﻛﺔ ﻓﻲ ﻋﻤﻠﻴﺔ -Since the establishment of the State • eligibility for vehicles and expens اﺗﺨﺎذ اﻟﻘﺮارات واﻟﺤﺼﻮل ﻋﻠﻰ اﺳﺘﻘﻼﻟﻴﺔ ﻓﻲ -of Israel, its policy towards people es for their upkeep as well as dis اﻟﻤﺠﺘﻤﻊ. -with disabilities has been character- counts or exemptions from pub ﻛﻤﺎ ﺗﻌﻜﺲ اﻟﻤﻘﺎﻟﺔ اﻟﺤﻘﻴﻘﺔ ﻋﻠﻰ أرض اﻟﻮاﻗﻊ، واﻟﺘﺤﺪﻳﺎت اﻟﺘﻲ ﺗﻔﺮﺿﻬﺎ، وﺗﻀﻊ ized by assurance of their social secu- lic-transportation fares, allocation ﻣﺒﺎدئ ﻗﺎﻧﻮن اﻟﻤﺴﺎواة ﻓﻲ اﻟﺤﻘﻮق ﻗﻴﺪ -rity and delivery of personal, medi- of reserved seats in public-trans اﻟﻤﻤﺎرﺳﺔ. cal, and rehabilitative assistance. portation vehicles, special parking These policies were aimed to permits and accessibility in public ensure all persons with disabilities transportation. with basic living conditions and to Housing: enable them to acquire, or reacquire, • eligibility for accessible public skills that assist them to function in housing. all aspects of life. The policy mani- Social Security and Rehabilitation:

8 bridges February-March 2005 photo: DZICEK/ICF- WHO

• eligibility for disability benefits, per- outlook aspiring to remedy the indi- incapability of the people with dis- sonal assistance, vocational training vidual’s disabilities and offer total abilities, and instead put the respon- and placement, as well as sheltered protection out of grace and com- sibility for this state of affairs on the housing and leisure activities. passion to a more complementary physical, technological and psycho- outlook, which views all of society social inaccessibility of society. The Current Status as responsible for integrating peo- new law challenged Israeli society The broad array of services ple with disabilities into its ranks. to view persons with disabilities as described above was intended to The alternative outlook is based on endowed with both the capability shape a social situation in which human rights, equal opportunity and and the right to dignified life, liber- people with disabilities could inte- accessibility, so that the individu- ty and honest labor, based on inde- grate fully into society. But reality al with disabilities might feel and pendence and human rights rather proved that despite these measures, become an integral part of this soci- than favors, compassion and char- the degree of such integration was ety, regardless of the type or severity ity. (4) This amounted to a declara- much less than had been expected. of his disability. tion of the need for investment of A different strategy was needed to be public resources in decreasing stig- employed in order to create the suita- The New Approach ma, assuring accessibility of the liv- ble infrastructure for the full integra- The Equal Rights Law for Persons ing environment and encouragement tion of people with disabilities into with Disabilities (1998) rejected the of employment in the open market, society and the labor market. (2, 3) widespread claim that the inability at the expense of long-term shel- It was determined that the desired to fully integrate into Israeli soci- tered facilities as implemented, for reform required a transition from an ety stems from the weakness or the example, by the United States federal

February-March 2005 bridges 9 "The Equal Rights Law for Persons with Disabilities (1998) rejected the widespread claim that the inability to fully integrate into Israeli society stems from the weakness or the incapability of the people with disabilities. Instead it put the responsibility for this state of affairs on the physical, technological and psychosocial inaccessibility of society.”

administration. (5) abilities and their family members, as properly provide for their special This breakthrough in the legal to demand that they be provided needs in a manner enabling them to situation was scored by the ruling basic conditions for a dignified life, spend their lives in maximum inde- handed down in 1996 by the High with an emphasis on social securi- pendence, privacy and dignity, while Court of Justice in the suit brought ty and mobility. Beyond the mate- making the most of their capabili- by Shahar Botzer against the munic- rial achievements, these strikes ties”. ipality of Maccabim-Re’ut, which enhanced awareness that people The new Law considers affirmative concerned the inaccessibility of dual- with disabilities must be part of the action a legitimate means for pro- purpose structures (for schools and society and participate in any forum moting equal rights principles. This shelters) in a new town. In this rul- discussing their affairs, as declared mechanism, which is cited in the pre- ing, Supreme Court Judge Barak, by the universal slogan “nothing amble to the law, refers to all fields of addressed, for the first time, the about us without us”. life1, but of the full draft of the Law, realities of life for persons with dis- only four sections have so far been abilities as a human rights issue and The Equal Rights Law enacted2. These sections deal with ruled that there must be a shift from The new Law views persons with the principles of equality, the conti- benevolence toward people with dis- disabilities, of any kind and severity, nuity of employment, accessibility of abilities in isolation to an approach as citizens equal to any others, who public transportation and the estab- which integrates them into society are entitled to fulfill all their rights lishment of the Equal Rights’ Com- and assures them of equal opportu- and to receive services provided to missioner’s Office and its Advisory nities based on human rights. all citizens. Committee. The range of this mecha- Gaining momentum, social organi- Furthermore, the Equal Rights Law nism’s applicability is currently limit- zations led by people with disabili- set a goal for Israel to “protect the ed, and is relevant mainly to the field ties led two long strikes held oppo- dignity and liberty of persons with of employment in the open market. It site the Ministry of Finance in 1999 disabilities and anchor their right should be noted that in many foreign and 2002, with the participation to equal and active participation in countries, affirmative action also of hundreds of persons with dis- society in all fields of life, as well applies to higher education.

10 bridges February-March 2005 Employment Status of while relying on as clear and applica- logical gates for people with all kinds People with General ble definition as possible. of disabilities to society by enabling Disabilities (6) According to the definition of the them to enter and move freely in Unemployed: Equal Rights Law, a person with dis- buildings and in open spaces and to • 85% of recipients of general disability abilities is “a person with a physi- get accommodating services free of benefits from the NII are not working. cal, mental, or intellectual (including social stigma and barriers. • Among recipients, only 19% report that they would like to work. cognitive) impairment, whether per- The third section of the Equal • 34% report that they are unable to manent or temporary, which substan- Rights Law states that persons with work due to the state of their health. tively limits the person’s function- all types of disabilities shall be enti- • 2% do not wish to work at all. ing in one or more central areas of tled to accessible and suitable pub- • 30% are people over 55 years old who life.” A special, quantitative formula lic-transportation services at a rea- do not believe that they can find their has been developed by professionals sonable frequency, including access place in the workforce because of their and civil societies to define severity, to stations and ports where public- age. based on evidence, existent tools and transport services operate. In this Employed: • Among those who are working, only structures for assessment. section, public-transportation servic- 15% have any form of employment: The generic approach toward per- es include urban bus lines, trains, air - 9% are working in the free market sons with disabilities requires enlarg- transport and ships intended for the (usually part-time) ing the investment to change the general public. - 6% are engaged in protected attitudes of employers and employ- General accessibility is the next employment provided by the Ministry ees about the capability and moti- section of legislation which is close of Welfare and Health which are often vation of people with disabilities to to pass in the coming months. It is segregated from the population. work and improve dramatically the intended to enhance the reasonable vocational, technical and academic accessibility of governmental, public, Employment training. However, this task poses municipal and private sites which Employment is a central area of additional, challenges both for the serve the public in all areas of life human life that ensures dignified universities and school system, par- (Proposed Law #2951, 2000). livelihood. In order to enable persons ticularly the special-education sys- with disabilities to become inclusive tem, and for the vocational rehabili- Establishment of the Equal in the working world, proper physi- tation system, which at present are Rights Commission and its cal, sensory, mental and psychoso- not designed enough to prepare a res- Advisory Committee cial accommodations and affirmative ervoir of employees with disabilities In the summer of 2000, the Equal action must be assured, and indeed for the open, modern market. (3) Rights Commission for Persons with these matters occupy a central part Disabilities was established in the of the Equal Rights Law. Accessibility Ministry of Justice, signifying addi- The Equal Rights Law refers explic- Accessibility is the main mecha- tional steps in a process towards itly to accommodations and to affirm- nism of implementing equality. It is social reform. The Equal Rights Com- ative action and states that “actions what opens the material and psycho- mission is responsible for the promo- by the employer, according to this section, may be carried out as a plan An Institutional b) The requirement stated in paragraph a) including provisions for preferential Example shall apply to all procedures of training, employment, or promotion, of per- On November 30, 2003, the cabinet hiring and promotion of workers in the sons with disabilities who are quali- adopted Resolution #1073, which pertains Civil Service. fied for the role or the position, and to the promotion of the human rights of The Civil Service Commissioner is required, whose qualifications are similar to persons with disabilities. Section 3 of this in consultation with the Commissioner those of other candidates for the role resolution refers to affirmative action for for Equality of Persons with Disabilities persons with severe disabilities in hiring and with the Minister of Welfare, to or position.” That is, in order to enjoy and promotion by the Civil Service, as promulgate instructions in all that affirmative action, candidates with follows: concerns the application of paragraphs disabilities must first be qualified for a) In accordance with the provisions of a) and b) above, including the setting of the post. This does not mean lower- section 15 a (b) (3) of the Appointments tests to determine severe disability and ing requirements or bending criteria, Law, [it is resolved] to require every methods of diagnosing such disability, but rather activation of a system of ministry and budgetary unit to grant all according to the recommendations of adjustments to permit a candidate to priority in hiring and promotion of the inter-ministerial team (Civil Service- manifest the capabilities relevant for employees to candidates with severe Ministry of Justice-Ministry of Industry disabilities, provided that these and Trade) which will be joined by a carrying out the job. In the matter of candidates are qualified for the positions representative of the Minister of Welfare, affirmative action, a consensus has in question and that their qualifications for the application of the requirement been forged that the focus must be are similar to those of other candidates of proper advocacy for persons with on persons with severe disabilities, for said positions. disabilities in the Civil Service.

February-March 2005 bridges 11 tion and the implementation of the case. Fifteen of the 25 members of people with disabilities and the gen- Equal Rights Law’s basic principles, the Advisory Committee are persons eral public, so that the stigma can be the prevention of discrimination with disabilities, including the chair- alleviated and society will become against persons with disabilities, man and deputy chairman. They fully accessible in every respect. the removal of obstacles they face, include persons with disabilities on Progress in the enactment of the Law the formulation of a comprehensive behalf of the representative organiza- for Equal Rights of Persons with Dis- social policy for the encouragement tions of persons with disabilities and abilities, the framing of the United of the integration and full participa- represent people with physical, sen- Nations Convention, the enlistment tion of persons with disabilities in sory, mental, intellectual, and cogni- of activists and practitioners and the society and more. The office now tive disabilities as well as representa- increase in budgetary allocations in includes the Commissioner, a legal tives of the public and families. this area, are greatly bolstering hopes counseling unit, a unit for the pro- The members of the Advisory that in the foreseeable future, Israeli motion of accessibility, an Internet Committee represent the perspec- society will enable more and more people with disabilities to become an integral and contributing part of society.

Dina Feldman is the Commissioner for Equal Rights of Persons with Disabilities in the Ministry of Justice. She is a clinical and medical psychologist with a PhD in social work.

Footnotes: 1. At this stage, only the initial parts of the law have been passed and the bill now being deliberated in the Knesset includes additional parts. 2. The remaining sections deal with accessibility, housing in the community and personal assistance, culture, leisure and sports, education and schooling, the judiciary system, special needs and information (Equality Law proposal, 2000.) References: “The alternative outlook is based on human 1. D. Feldman and D. Arians: People with Disabilities in Israel, 2004 - Part 2 (Hebrew.) rights, equal opportunity and accessibility, so Jerusalem: Ministry of Justice, 2004. 2.“Rights of People with Disabilities,” in Report of the Public Committee on Comprehensive that the individual with disabilities might feel Legislation, headed by Dr. Israel Katz (Hebrew.) Jerusalem, 1997. and become an integral part of this society.” 3.“Integration of People With Disabilities in Society and Work,”\in State Comptroller’s information center (www.mugbal- tive of people with disabilities and Annual Report #52, for 2001 and Accounts of Fiscal Year 2000 (Hebrew.) Jerusalem: State uyot.justice.gov.il), a unit for public participate in official international Comptroller’s Office, 2002. 4. D. Feldman and Sh. Yahalom: “Corrective applications, public relations and a activities like the formulation of the Discrimination for People with Disabilities training unit. A senior division for convention for protection and pro- in Israel,” in I.. Ma’or (ed.), Corrective Discrimination and Advocacy Assurance in inclusion into society is now in the motion of the rights of persons with Israel (Hebrew.) Tel Aviv University: Ramot Publishing House, 2004, pp. 399-426. process of being staffed. disabilities currently underway in 5. Kregel, J., and Dean, D.H. (2002). Sheltered the United Nations. (7) vs. supported employment: A direct comparison of long-term earning outcomes for individuals Advisory Committee with cognitive disabilities. In Kregel J., and The Law for Equal Rights of Per- Summary Dean, D.H., Wehman, P. (Eds), Achievements and challenges in employment services for sons with Disabilities mandated the After many years of broad invest- people with disabilities: A longitudinal impact of workplace supports. creation of an Advisory Committee ment in the medical system, social 6. N. Strossberg, G. Bar, B. Morgenstein and to the Commission, with the purpose security and rehabilitation, Israel is D. Na’on: Recipients of General Disability Allowance and Recipients of Workplace of advising the office on matters con- moving forward to promote the full Disability Allowance – Needs and Answers. Study Report (Hebrew.) Jerusalem: JDC-Israel cerning its missions, the promotion inclusion of people with disabilities Brookdale Institute and National Insurance of the law’s principles, equality and within the society on the basis of Institute, 2004. 7. U.N. (2004). Draft comprehensive and integral prevention of discrimination, and the human rights and full eligibility to international convention on protection and encouragement of active integration contribute and express their talents promotion of the rights and dignity of persons with disabilities. Final text complied as adopted in society by persons with disabili- in practice. This new approach is (CRP.4, plus CRP.4/Add.1, Add. 4 and Add. 5) *Electronic Resources: ties. Most of the committee’s mem- only in its initial stages and requires Myers – JDC – Brookdale Institute Website bers are required to be persons with a change in attitudes and priorities http://brookdale-en.pionet.com/default.asp National Insurance Institute of Israel Website disabilities, and that is indeed the among policy makers, professionals, www.btl.gov.il/English/eng_index.asp

12 bridges February-March 2005 photo:

From Palestine UNDP/ Steve Sabella to New York A Learning Journey Suha talks about what she learned from her medical training in New York both in and out of the classroom by Suha Tazami

verwhelming. That is assumed I am an Israeli when I said ”Coming out of the how I would describe I was from Jerusalem. When I cor- conflict, the last thing my first day at the New rected him, I saw the disappointment York-Presbyterian Hos- in his eyes. He didn’t like it when I I wanted was for a pital. The massive size talked to others about Palestine and member from the ‘other Oof the place and the very large and our living conditions and one time side’ to be there.” busy staff presented a whole new we had an argument about it. How- system to adapt to. I just hoped it ever, we saw patients together and on staff was always busy, but organized wouldn’t take a long time. After all, I a professional level we were civil. and there was always something to had worked really hard over the past Although there wasn’t much time do. People spent their time efficiently nine months to make my personal to socialize, I met some other Ameri- and were aware of their responsibili- project happen. can Jews at the hospital who were ties. I believe that this is the basis for When I finally arrived in New York very friendly and interested to hear a successful institution. City, I felt ready for my six week elec- about the current situation at home, I envied the students for having tive medical training in rheumatolo- my life and my school. Many were such a well organized annual sched- gy and pediatric neurology at one of eager to understand and help. ule, which they knew well in advance the largest health institutions in the What struck me most was the igno- and could therefore make their plans United States. rance I had to face about the situa- accordingly. For us, we can barely It was a very big transition for me tion in our part of the world. I don’t make plans for the next day as we after six years at Al-Quds Universi- blame people for it, but it disappoint- live in the land of the unexpected! ty Medical School, the only medical ed me, especially those who don’t Our future is always threatened by school in Palestine. The question that know about the Palestinian story. our present situation. Yet we perse- kept running through my mind was One day in the clinic, I introduced vere, we survive, and come to life – will I survive here? But my fears myself to one of the attendees as a again. didn’t get me down. On the contrary, Palestinian from Jerusalem. On the whole, my experience in they motivated me to get the best I “So are you done serving in the New York gave me the opportunity can from such an opportunity. army?” she asked. to explore another healthcare sys- To my surprise, there was a Jewish Puzzled, I tried to clarify, “Which tem. I was empowered to adhere to Israeli medical student who was also army do you mean?” my humanistic values and my devo- studying with me on the same team. “The Israeli army,” she replied. tion to become a good physician so I That was quite a coincidence. Com- I never expected to be asked this can serve my community which is in ing out of the conflict, the last thing question and I ended up explaining great need. I wanted was for a member from the to her about my status in Israel. In addition, it gave me the opportu- “other side” to be there. Besides these types of emotional nity to represent the only Palestinian Initially, I didn’t have a problem upsets that I went through, the expe- medical school to people on another with it. I didn’t even give it much rience was interesting and enlighten- continent and show that we exist. thought. But unfortunately, the Israe- ing. I was impressed with the organi- li student had a problem with me. I zational structure of the American Suha Tazami is a senior medical student at sensed it from the first moment we medical system, something which our the Al-Quds University School of Medicine were introduced, especially when he institutions unfortunately lack. The in Palestine.

February-March 2005 bridges 13 photo: Trieste dei Manicomi , Trieste 1975

Mental Health Is a Public Health

PriorityAn Interview with Dr. Benedetto Saraceno, Director of the Mental Health and Substance Abuse Department, WHO by Oriella Ben-Zvi

rom your perspective, ness from a perspective of “adjust- schizophrenia; and one million peo- what are the main chal- ed life years” rather than simply by ple commit suicide every year. That lenges in the area of mortality outcome, mental illness means every second, a life is taken. mental health today? Is becomes much more relevant than This clearly demands that mental mental illness, as a dis- before. illness be given significant priority Fability, an increasing priority in The suffering surrounding men- on the public health agenda espe- public health? tal illness by the individual and by cially when the burden of disease is Mental health is an increasing the family is enormous. Depression, measured by human suffering and priority in public health for several alcohol abuse and suicide are diseas- the near total loss of productivity of reasons. The way in which mental es that disable people for years and patients and caregivers. health is perceived has changed. The years. People may not know that Health care systems plays a sig- World Health Organization and the there are 450 million people suffer- nificant role. They give low financial World Bank measure public health ing from mental or neurological ill- attention to disabilities. Ministries priorities by “adjusted life years” ness around the world; 150 million of Health usually spend less than which combines mortality and mor- from depression; 76 million from 2% of the health budget on disabili- bidity. When examining mental ill- alcohol disorders; 25 million from ties. This directly increases the gap

14 bridges February-March 2005 between treated and untreated peo- fer from this disease, but because In the specific context of the Israe- ple with disabilities. Moreover, many this problem has other health and li-Palestinian conflict, how do you health professionals don’t have the social consequences – domestic vio- see the role of WHO in assisting the skills and resources needed to treat lence, traffic collisions and violence Palestinian population and support- people with disabilities who often against children which pose an ing their mental health system? receive un-therapeutic treatment in immense negative impact on com- The WHO has been assisting the large institutions which are isolated munities. Palestinian health authorities to and not up to medical standards. The fourth important priority is strengthen and improve their mental What are the priority areas in assisting countries to improve the health systems for quite some time. the coming years in terms of men- organization of their mental health They’ve assisted in conceiving a stra- tal health? services. We still see very traditional tegic action plan for the West Bank Human rights, I believe, is a main models; hospital based models are and Gaza to shift from a hospital concern. This is a prism through the norm and the rule. We need to based model to more community ori- which mental health must be viewed. decentralize to reach out to commu- ented care with a capacity for real out- Electro-shock treatment still exists nities and decrease the hegemony of reach and mental health teams that without consent and often without large institutions. We need to ampli- are integrated at the primary care lev- anesthesia. People with mental ill- fy the voice of mentally ill patients so el. This requires an immense shift in ness are locked up within institu- they are not simply objects of inter- mentality on the part of psychiatrists tions for long periods of time. Mental vention. This requires a remodeling and social workers who must learn illness also exposes a family to stig- of the relationship between provider to see themselves more as communi- ma, physical restraint and violence. and patient. In fact, a peaceful revo- ty leaders than as providers working These are perhaps the most evident lution is needed where mental health from large hospitals. This requires issues related to human rights and becomes the business of every one modernization of thinking around mental health. But there are other and not just a few psychiatrists. mental health; it requires training issues including the quality of serv- Conflicts pose health threats of and the development of models of ices which are simply not acceptable different sorts. What are the main care around community centers. This challenges in supporting local sys- may meet resistance in the most tra- photo: tems to protect the mental health ditional components of the medical of the population? sector, but we need to push them to ICF-WHO This is a hard question. In a con- be leaders of innovation. flict situation – as opposed to a What are your thoughts on health natural disaster which has a peak as a bridge for peace? and then is over – populations are Tolerance, respect, compassion, exposed to chronic trauma. In a con- not discriminating based on the color flict, children and vulnerable popu- of a person’s skin, religion or ethnic lations are exposed to daily threats background, these are all characteris- to their lives resulting in long-term tic of quality health care. Health care trauma. Learning to cope with every- is based on a philosophy of human day insecurity is a huge challenge. rights, solidarity, and compassion. This can’t be reduced to individual These characteristics make health intervention. This is about looking and medicine a privileged and unique in most countries – even in devel- at a community and how they can sector to build bridges for peace. oped ones. I think it is important to protect and defend themselves from note that human rights violations mental illness. There is great risk of Dr. Saraceno's career is marked are not only specific to poor coun- transforming a collective experience by extensive clinical work, research and tries but rich ones, too. to an individual problem; one needs the publication of over 100 scientificarticles. A second priority area is suicide. a public health approach rather than He has also co-authored and edited a The numbers are alarming. There an individual, clinical approach. number of books. He was a lecturer at are countries where this is particu- What is needed is a strong edu- Harvard University, Invited Professor of larly evident. The countries with the cation system which is able to pro- Psychiatry at the University of Geneva and highest suicide rates are all post- vide an environment that, in spite of senior scientist and adviser in a dozen Soviet countries. They need urgent the conflict, gives a solid framework international research projects. For ten years intervention. This is also true for Chi- for children and adolescents. Strong he served as Head of the Laboratory of na where significantly more women family support to cope with day to Epidemiology and Social Psychiatry and as than men commit suicide. day suffering is also crucial. And you Director of the WHO Collaborating Centre Alcohol abuse is another area not need a strong health system that can for Research in Mental Health at the only because 90 million people suf- respond to citizens’ needs. "Mario Negri" Institute in Milan.

February-March 2005 bridges 15 Protecting Health Following the Asian Tsunami WHO Health Action in Crisis Department Report January 6, 2005

he earthquakes and tsu- the needs of all affected people are nium Development Goals (MDGs). namis that struck twelve a critical sign that recovery is under- Supported by strong institutions, countries on December way. civil society and NGOs, they have 26, 2004, from South- Health indicators provide highly been active in coordinating health East Asia to the Horn sensitive measures of the effective- activity since the first hours of relief. Tof Africa, caused one of the worst ness of the response and rehabilita- It is right that they will take the lead natural disasters in modern history tion. If the recovery of local health in relief and rehabilitation. and directly caused over 150,0001 services is delayed or ineffective, deaths, leaving at least half a million infectious diseases such as cholera, Health Action in Crisis people injured and five million peo- diarrhea, hepatitis and pneumonia During the period immediately fol- ple homeless or without adequate can add to the heavy toll of the dis- lowing the tsunami, local and nation- access to safe drinking water, food aster. The risks are especially severe al health services took the lead in or health services. for the very young and the elderly. responding to people’s distress. They Displacement and overcrowded con- were supported by an extraordinary A Focus on Life ditions may also lead to an increased mobilization of neighborhoods, civil The response to any disaster has risk of measles, influenza, meningi- society groups and nongovernmen- one primary focus – enabling those tis, respiratory infections and tuber- tal organizations from the affected who are affected to live, to sustain culosis. Pre-existing chronic diseas- communities. These same groups their lives and to enrich their liveli- es and events such as childbirth can are taking the lead in repairing dam- hoods. become life-threatening if left unat- aged water, sanitation and health The health sector is called upon as tended. Vector-transmitted diseas- systems. They are the heroes of the an integral part of the initial response es such as malaria and dengue are hour and they will be the drivers of because: likely to pose significant threats for rehabilitation. • Much suffering and death can be weeks and months following such a The most pressing needs are safe averted if health issues are addressed disaster, particularly if environmen- food and drinking water, sanitation in the earliest stages of the response. tal needs are not addressed. and hygiene, shelter for those who • Health indicators including infor- Local and national systems are displaced, protection from vec- mation about disease incidence serve showed remarkable coping capaci- tors of disease and basic essentials as a barometer of the response. They ties, ensuring rescue, assessments like soap and the means to cook. are an early and sensitive measure of and vital relief in the first week. Wherever possible, WHO has sought the effectiveness of the humanitarian Before this catastrophe, health sys- to guide this assistance, whether action. tems in the affected countries had from governments, private actors, • Functioning, dependable, accessi- many strengths and contributed to NGOs or UN partners. ble health services that respond to achievements towards the Millen- WHO has concentrated on five key

16 bridges February-March 2005 areas of assistance: be ensured so that all in need can the WHO response in the rehabilita- • Surveillance of disease: Teams access the services they require. tion phase will focus on the follow- of experts have been deployed in Many of these items are obtained ing areas: countries through the WHO Global locally, though external donations • Planning of health systems and serv- Outbreak Alert and Response Net- which are carefully matched to local ices: Based on assessments of health work (GOARN), producing daily need can make a vital difference. needs and capacity of the health care epidemiological updates to ensure WHO has focused on enabling the infrastructure, WHO will assist gov- that national authorities are able to in-country health groups to procure ernment plans for rehabilitation of provide early warning of potential these items on their own. health services. In many areas, health health threats as they emerge, verify • Coordination of international care workers have died or have been them and trigger a prompt and cor- health response: The coordination displaced and human resources rect response. effort must enable an effective health needs will also need to be urgently • Access to essential health care: sector response, appropriate use of addressed. WHO provides technical Assessment and response to need is volunteer health workers and the support to ministries of health so that accomplished by 1 – collating infor- fullest possible involvement of local interested donors and financial insti- mation from reviews of damage to communities including women’s tutions execute plans that reflect the health service infrastructure; 2 – iden- organizations. WHO helps coordi- long-term needs of all in line with tifying the health needs of affected nate, manage assistance and secure national goals and MDGs. populations; 3 – analyzing the results the best possible outcomes through • Policy guidance: WHO’s exten- together with health ministries as donor briefings and technical sup- sive health expertise, made available quickly as possible and; 4 – distribut- port including common Logistical under the guidance of its member states, within UN and other inter- national coordination, is used by affected communities to guide the overall international health assist- ance. All international agencies are applying the lessons of earlier crises as they support recovery. One criti- cal requirement is that rehabilitation incorporates building local capac- ity to assess risks, prepare for and respond to any future catastrophes. This includes initiatives to reduce dis- aster damage in critical health facili- ties. Such matters were addressed at the UN World Conference on Disas- ter Reduction in Kobe, Japan, held at the end of January 2005. WHO Archive Conclusion

photo: The tsunami crisis is a devastating tragedy. It is a major set back to the ing the information to all who seek to Supply Systems used by NGOs and social, economic and health devel- save lives and support recovery. the UN system. opment gains of recent years with- • Essential public health: WHO pro- in the region. WHO is focused both vides technical guidance to nation- Health Action in on the health needs of the survivors al authorities, NGOs and all other Rehabilitation and the reconstruction and rehabili- humanitarian actors, about health The continued good health of pop- tation of health systems. Both must policy including the disposal of dead ulations is key to the social and eco- be addressed together with a long- bodies, responses to disease out- nomic fabric of communities. There- term strategy to reduce the vulner- breaks, maintaining water quality, fore, successful action to preserve ability to future disasters. It is imper- dealing with excreta, sewage and health is a critical starting point ative that international support is chemical threats, managing chronic to sustainable development. We adequate, effective and sustained. diseases, vaccination programs and must never forget that poor people, It must be country-led, country-cen- maintaining mental health. together with persons suffering from tered and country-coordinated. • Strengthening supply systems: The disabilities and chronic disabilities, supply of medicines, equipment, remain vulnerable even as longer Footnotes 1. Estimates have escalated since the date of the transport and other vital assets must term efforts are started. Therefore, summit where this brief was first presented.

February-March 2005 bridges 17 How to... Making Gynecological Services Accessible to Women with Disabilities: Creation of a Model Clinic by Hila Ben Shushan

he specific needs of A Model Accessible clinic requires more than just physi- women with disabili- Gynecological Clinic cal renovations. It requires increasing ties that arise from the The Forum of Women with Dis- awareness among both consumers combination of their sex abilities for Women with Disabili- and service providers to the special and disability have long ties is engaged in a project which needs of women with different types Tbeen neglected by both disability aims to tackle the inadequate pro- of disabilities and the development of and women’s organizations in Israel, vision of appropriate health serv- appropriate and dignified responses as well as the government and oth- ices for women with disabilities in to meet these needs. The following er public bodies. Women with dis- Israel. The project defines accessibil- are important steps in the process: abilities face multiple challenges in ity as a situation that enables peo- 1. Engage key players to guide the accessing basic rights such as health ple with disabilities to be independ- process including women with dis- care, employment and even parent- ent and to have equal and dignified abilities, health professionals, health hood. In many cases, the special access to services enjoyed by the service organizations, disabled rights needs of women with disabilities mainstream population. According activists, and donor organizations. are misunderstood or overlooked to this definition, even one step at 2. Choose the clinic that serves a even by well-intentioned policy- a clinic entrance, for example, rep- large number of women with disa- makers and service providers, caus- resents a significant impediment to bilities and in which there is interest ing unnecessary hardships. Health women who use wheelchairs. The of the service providers and staff in professionals and policy-makers are model clinic addresses all types of the process. often unaware of the special needs disabilities to ensure that it is acces- 3. Assess the accessibility needs and and the complexity of treatment of sible to women with physical, sen- determine appropriate responses. women with disabilities, resulting sory, developmental, and emotional 4. Develop a training program for in the provision of inadequate serv- disabilities. clinic staff (medical, administrative ices. The development of an accessible and ancillary).

18 bridges February-March 2005 How to Develop an • Waiting spaces and examination ing table outlines ideas for meeting Accessible Clinic rooms must be spacious. these needs: Ensuring that a clinic is accessible • Elevators should be installed if Impairment Accessibility Intervention Physical • A hydraulic gynecologic to women with disabilities necessi- there is more than one floor. Impairment table that can be tates dealing with three elements: • Parking must be built with a ramp lowered so the women can transfer herself and • The medical staff's profession- that enables a person with a wheel- not have to be lifted on al knowledge and attitude towards chair to reach the pavement. to the table. patients. Developmental • Staff should use simple Disabilities language and make sure • The accessibility of the building Non-Medical Equipment they are understood. where the clinic is located Small and relatively inexpensive • Use concrete aids, such as pictures or dolls, to • The provision of appropriate equip- design elements will ensure a wel- facilitate explanations. ment, medical and non-medical coming environment and dignified • Staff should take measures to decrease visit for all women with disabilities. fears and anxieties. Staff Training • a low reception desk Emotional • Allow more time for Disabilities the examination. The service provider’s attitude • alternative communication sys- • Understand how towards the patient is the most tem for women with sensory impair- psychiatric medications affect women’s health. important factor in making health ment Visual • Use verbal explanations services accessible. The goal of an • clear signs for women with senso- Impairment and instructions. Hearing • Use written effective training program is to pro- ry impairment Impairment explanations and vide the clinic staff (medical, admin- • a low water fountain instructions. • Adopt alternative istrative and ancillary) with tools • a low public phone communication systems to enable them to relate and pro- such as digital signs in waiting rooms with vide appropriate services to women Medical Equipment numbers showing whose across the range of disabilities. Spe- The following items contribute to turn it is. cific areas to be covered are: accessible and dignified service pro- Engaging in a participatory process How to... rather than just renovating a facility has the added value of: Making Gynecological Services Accessible to Women • raising awareness of women with disabilities' right to health services • opening channels of communi- with Disabilities: Creation of a Model Clinic cation and developing cooperative by Hila Ben Shushan relationships with those responsible for providing these services • medical information about the vision: • development of a training program treatment of women with disabilities • height-adjustable gynecological that can be replicated in medical • technical advice on how to make examination chairs and health science schools to ensure treatment accessible • a sliding board to enable transfer future generations of service pro- • sensitization to needs of women from a wheelchair to an examination viders is sensitized to the needs of with disabilities chair women with disabilities. • a hydraulic lift for moving immo- Ensuring that women with disabil- An Accessible Building bile patient from a wheelchair to an ities have the basic right of access to The adaptations required to create examination chair health care is a worthy goal for health an environment accessible to women • an ultrasound machine with an care systems around the world. with mobility impairment are more extended arm and option to enlarge expensive and invasive than those picture on screen (for women with a Hila Ben Shushan is the coordinator of required for other types of disabili- visual impairment). the Forum of Women with Disabilities ties. Therefore it is important to con- • an external fetal monitor for Women with Disabilities in Israel, a sider a priori the physical aspects of • a sterilization machine, special partnership of Bizchut and Joint Israel- the building where the clinic will be speculum and other equipment as Disability and Rehabilitation Unit. housed. Following are recommended necessary

criteria for physical accessibility: The information in this article is based on a • Doors and corridors should be Different Disabilities, project in progress undertaken by the Forum of Women with Disabilities for Women with wide enough to enable maneuvering Different Needs Disabilities (a partnership of Bizchut, the of a wheelchair. For a clinic to be fully accessible it Israel Human Rights Center for People with Disabilities and the Joint Israel-Disability and • At least one toilet should be acces- must take into account the specific Rehabilitation Unit) with the support of the Pfizer pharmaceutical company. The model sible to people with mobility impair- accessibility needs for women with clinic will open in April/May 2005. ment different disabilities. The follow- Bizchut website: www.bizchut.org.il

February-March 2005 bridges 19 How to... Making Gynecological Services Accessible to Women with Disabilities: Creation of a Model Clinic

:photo • מתקן הרמה הידראולי להעברת חולה עם מו– גבלות בניידות מכסא גלגלים לכסא-בדיקה UKHANOW/ICF-WHO • מכשיר אולטרא-סאונד עם זרוע מוארכת ואופציה להגדיל את התמונה על הצג (בשביל נשים מוגבלות-חושים) • מוניטור עוברי חיצוני • מכשיר חיטוי, ספקולום מיוחד, וציוד נוסף לפי הצורך צרכים שונים למוגבלויות שונות כדי שהמרפאה תהיה נגישה לגמרי, עליה להתחשב בצרכי הנגישות הייחודיים של נשים עם מוגבלויות שונות. הטבלה שלהלן מתווה רעיונות למענה על הצרכים הללו: הליקוי ההתערבות להבטחת נגישות ליקוי פיזי שולחן גינקולוגי הידראולי שניתן להנמיכו כדי שהאישה תוכל לעבור אליו בעצמה ולא יהיה צורך להרים אותה אליו. ליקויי • על הסגל להשתמש בשפה פשוטה התפתחות ולהבטיח כי המטופלות מבינות. • יש להשתמש בעזרים מוחשיים, כגון תמונות או בובות, כדי להקל על מתן הסברים. • על הסגל לנקוט באמצעים כדי להפחית פחדים וחרדות. מוגבלויות • יש להקצות זמן רב יותר לכל בדיקה נפשיות • יש להבין את השפעתן של תרופות פסיכיאטריות על בריאות האישה. ליקוי ראיה יש להשתמש בהסברים והנחיות מילוליים. ליקוי שמיעה • יש להשתמש בהסברים והנחיות בכתב. • יש לאמץ מערכות-תקשורת חלופיות כגון שלטים דיגיטליים בחדרי ההמתנה, המראים את מספרה של הבאה בתור. הכניסה לתהליך של השתתפות בצרכי המ– טופלות, ולא רק שיפוץ המתקן, יש לה ערך מוסף מכמה היבטים: • הגברת המודעות לזכותן של נשים עם מוגב– לויות לקבלת שירותי בריאות • פתיחת ערוצי תקשורת ופיתוח יחסי שי– תוף-פעולה עם האחראים להגשת השירותים האלה • פיתוח תכנית הכשרה שניתן לחקותה בבתי הספר לרפואה ולמדעי הבריאות, כדי להבטיח שהדורות הבאים של מגישי השירות יהיו רגי– שים לצרכיהן של נשים עם מוגבלויות הבטחת זכות-היסוד של נשים עם מוגבלויות • איזורי ההמתנה וחדרי הבדיקה צריכים להיות • מערכת תקשורת חלופית לנשים לקויות- לטיפול רפואי היא מטרה ראויה למערכות הב– מרווחים. שמיעה ריאות בעולם כולו. • יש להתקין מעליות אם תהיה במרפאה יותר • שילוט ברור לנשים לקויות שמיעה מקומה אחת. • מתקן שתייה נמוך הילה בן-שושן היא רכזת פורום נשים עם מוגבלויות • יש לבנות משטח חניה עם שיפוע שיאפשר • טלפון ציבורי נמוך למען נשים עם מוגבלויות בישראל, שבו שותפים הגעה אל המדרכה בכסא גלגלים. ארגון "בזכות" והיחידה לנכויות ולשיקום של ג'וינט ציוד רפואי ישראל. ציוד שאינו רפואי כדי להבטיח נגישות מירבית, הכרחי להצטייד מרכיבי עיצוב קטנים וזולים-יחסית יוכלו בפריטים האלה: המידע הכלול במאמר זה מבוסס על פרויקט המתבצע מטעם פורום הנשים עם מוגבלויות בישראל (שותפות של להבטיח סביבה נעימה וביקור מכובד לכל אשה • כסאות-בדיקה גינקולוגיים מתכווננים בגובה ארגון "בזכות," המרכז הישראלי לזכויות אדם של אנשים עם מוגבלות. • לוח-החלקה שיאפשר מעבר מכסא גלגלים עם מוגבלויות, והיחידה לנכויות ולשיקום של ג'וינט ישראל) בתמיכתה של חברת התרופות פייזר. המרפאה לדוגמה • דלפק-קבלה נמוך לכסא-בדיקה תיפתח באפריל-מאי 2005.

20 bridges February-March 2005 How to... Making Gynecological Services Accessible to Women with Disabilities: Creation of a Model Clinic כיצד להבטיח שירותים גינקולוגיים לנשים עם מוגבלויות? מאת הילה בן-שושן

שים עם מוגבלויות ניצבות בפני את– המטופלות, הן בקרב מגישי השירות, לצרכים הכשרת הסגל גרים מרובים בדרכן למימוש זכויות המיוחדים של נשים עם סוגים שונים של מו– יחסם של מגישי השירות כלפי המטופלות יסוד כגון טיפול רפואי, תעסוקה, גבלויות, ופיתוח מענה הולם ומכובד לצרכים הוא המרכיב החשוב ביותר בהנגשת שירותי ואפילו הורות. ארגונים למען אנשים האלה. להלן כמה מן השלבים החשובים בתהליך הבריאות. מטרתה של תכנית הכשרה יעילה היא עם מוגבלויות וארגוני הנשים בישר– הזה: לתת לסגל המרפאה (הצוות הרפואי, המינהלי אל, וכן נהממשלה וגופים ציבוריים אחרים, לא 1. לערב דמויות-מפתח בהנחיית התהליך, ובהם וצוות העזר) את הכלים שיאפשרו להם להתיי– השכילו לטפל בסוגיה זו. במקרים רבים, נתק– נשים עם מוגבלויות, בעלי מקצועות רפואיים, חס לנשים עם כל מגוון המוגבלויות ולהגיש להן לים הצרכים הייחודיים של נשים עם מוגבלויות ארגונים המגישים שירותי בריאות, פעילים את השירות ההולם. תחומים ספציפיים שייכל– בחוסר הבנה או בהתעלמות. לעתים קרובות, למען זכויות אנשים עם מוגבלויות, וארגונים לו בתכנית הם: בעלי המקצועות הרפואיים וקובעי המדיניות התורמים תמיכה כספית. • מידע רפואי על הטיפול בנשים עם מוגבלויות אינם מודעים כלל לצרכים הייחודיים של נשים 2. לבחור את המרפאה כך שתשרת מספר גדול • ייעוץ טכני על דרכי הנגשת השירות עם מוגבלויות ולמורכבות הטיפול בהן, והתוצ– של נשים עם מוגבלויות, נוסף על האינטרס של • הגברת הרגישות לצרכיהן של נשים עם מו– אה היא הגשת שירותים בלתי מספקים. מגישי השירות והסגל. גבלויות מרפאה גינקולוגית נגישה לדוגמה המרפאה לדוגמה מבטיחה נגישות בכל התחומים, פורום הנשים עם מוגבלויות מפעיל פרויקט כדי שתהיה נגישה לנשים עם מוגבלויות פיזיות, חושיות, שמטרתו לתקן את השירותים הרפואיים הב– התפתחותיות ורגשיות לתי מספקים המוצעים לנשים עם מוגבלויות בישראל. הפרויקט מגדיר את הנגישות כמצב 3. לאמוד את הצרכים להבטחת הנגישות ולק– התאמת מבנה נגיש המאפשר לאנשים עם מוגבלויות לחיות חיים בוע את המענה ההולם עליהם. ההתאמות הדרושות כדי ליצור סביבה נגישה עצמאיים ולקבל גישה שווה ומכובדת לשירו– 4. לפתח תכנית הכשרה לסגל המרפאה (הצוות לנשים המוגבלות בניידות הן יקרות ומורכבות תים שמהם נהנית האוכלוסיה הכללית. על-פי הרפואי והמינהלי וצוות העזר). יותר מאלו הדרושות לשם מענה על הצרכים הגדרה זו, למשל, אפילו מדרגה אחת בכניסה הנובעים ממוגבלויות אחרות. לכן חשוב לשקול למרפאה יש בה מכשול משמעותי לנשים המ– כיצד לפתח מרפאה נגישה מלכתחילה את ההיבטים הפיזיים של המבנה שתמשות בכסא גלגלים. המרפאה לדוגמה מב– הבטחת נגישותה של המרפאה לנשים עם שבו תשוכן המרפאה. להלן אמות-מידה המו– טיחה נגישות בכל התחומים, כדי שתהיה נגישה מוגבלויות מצריכה טיפול בשלושה מישורים: מלצות לנגישות פיזית: לנשים עם מוגבלויות פיזיות, נפשיות, התפת– • הידע המקצועי של הסגל הרפואי והיחס שלו • הפתחים והפרוזדורים צריכים להיות רחבים חותיות ורגשיות. כלפי המטופלות. די הצורך לתמרון בכסא גלגלים פיתוחה של מרפאה נגישה מחייב לא רק שי– • נגישות המבנה שבו ממוקמת המרפאה. • לפחות חדר שירותים אחד צריך להיות נגיש פוץ מבני. הוא מחייב מודעות מוגברת הן בקרב • אספקת הציוד ההולם, הרפואי והאחר. למוגבלי-תנועה.

February-March 2005 bridges 21 How to... Making Gynecological Services Accessible to Women with Disabilities: Creation of a Model Clinic

ﻟﻺﺷﺮاف ﻋﻠﻰ ﻫﺬﻩ اﻟﻌﻤﻠﻴﺔ ﻛﺎﻟﻨﺴﺎء ذوات وﻓﻴﻤﺎ ﻳﻠﻲ ﺑﻌﺾ اﻟﻤﻌﺎﻳﻴﺮ اﻟﺘﻲ ﻳﻮﺻﻰ ﺑﻬﺎ وﻳﺒﻴﻦ اﻟﺠﺪول اﻟﺘﺎﻟﻲ ﺑﻌﺾ اﻷﻓﻜﺎر ﻟﺘﻠﺒﻴﺔ اﻹﻋﺎﻗﺎت، اﻟﻌﺎﻣﻠﺒﻦ ﻓﻲ ﻣﺠﺎل اﻟﺮﻋﺎﻳﺔ اﻟﺼﺤﻴﺔ، ﻓﻴﻤﺎ ﻳﺘﻌﻠﻖ ﺑﺘﻴﺴﻴﺮ اﻟﻮﺻﻮل إﻟﻰ اﻟﺒﻨﺎﻳﺔ: ﻫﺬﻩ اﻻﺣﺘﻴﺎﺟﺎت: وﻣﻨﻈﻤﺎت اﻟﺮﻋﺎﻳﺔ اﻟﺼﺤﻴﺔ، وﻧﺸﻄﺎء ﻓﻲ اﻟﺪﻓﺎع • اﻳﺠﺐ اﻷﺧﺬ ﺑﻌﻴﻦ اﻻﻋﺘﺒﺎر أن ﺗﻜﻮن اﻷﺑﻮاب ﻋﻦ ﺣﻘﻮق اﻟﻤﻌﻮﻗﻴﻦ واﻟﻤﺆﺳﺴﺎت اﻟﻤﻤﻮﻟﺔ. واﻟﻤﻤﺮات واﺳﻌﺔ ﺗﺴﻤﺢ ﺑﺪوران اﻟﻜﺮﺳﻲ اﻹﻋﺎﻗﺔ اﻟﺘﺪﺧﻞ ﻓﻲ ﺗﻴﺴﻴﺮ اﻟﻮﺻﻮل ٢. ﻗﻢ ﺑﺎﺧﺘﻴﺎر اﻟﻌﻴﺎدة اﻟﺘﻲ ﻣﻦ ﺷﺄﻧﻬﺎ أن اﻟﻤﺘﺤﺮك. إﻋﺎﻗﺎت ﻃﺎوﻟﺔ ﻫﻴﺪروﻟﻴﻜﻴﺔ ﻟﻠﻔﺤﺺ ﺗﻘﺪم اﻟﺨﺪﻣﺔ ﻷﻛﺒﺮ ﻋﺪد ﻣﻦ اﻟﻨﺴﺎء ﻣﻦ ذوات • اﻳﺠﺐ ﺗﺨﺼﻴﺺ ﺣﻤﺎم واﺣﺪ ﻋﻠﻰ اﻷﻗﻞ ﺟﺴﺪﻳﺔ اﻟﻨﺴﺎﺋﻲ ﻳﻤﻜﻦ ﺧﻔﻀﻬﺎ ﻟﺘﺴﺘﻄﻴﻊ اﻹﻋﺎﻗﺎت وﺗﺨﺪم ﻣﺼﺎﻟﺢ ﻣﻘﺪﻣﻲ اﻟﺨﺪﻣﺔ ﻟﺬوات اﻻﻋﺎﻗﺔ اﻟﺤﺮﻛﻴﺔ. اﻟﻤﺮأة ﻧﻘﻞ ﻧﻔﺴﻬﺎ دون اﻟﺤﺎﺟﺔ إﻟﻰ وﻃﺎﻗﻢ اﻟﻌﻤﻞ. • اﻏﺮف اﻻﻧﺘﻈﺎر واﻟﻔﺤﺺ ﻳﺠﺐ أن ﺗﻜﻮن أن ﺗﺮﻓﻊ ﻋﻠﻰ اﻟﻄﺎوﻟﺔ. ٣. ﻗﻢ ﺑﺘﻘﻴﻴﻢ ﻣﺪى ﺳﻬﻮﻟﺔ اﻟﻮﺻﻮل إﻟﻰ اﻟﻌﻴﺎدة، ﻓﺴﻴﺤﺔ. إﻋﺎﻗﺎت • اﻋﻠﻰ ﻃﺎﻗﻢ اﻟﻌﻤﻞ أن ﻳﺴﺘﺨﺪم وﻗﻢ ﺑﺎﺗﺨﺎذ اﻻﺟﺮآت اﻟﻤﻨﺎﺳﺒﺔ. • اﻳﺠﺐ ﺗﻮﻓﺮ اﻟﻤﺼﺎﻋﺪ إن ﻛﺎﻧﺖ اﻟﺒﻨﺎﻳﺔ ﻣﻜﻮﻧﺔ ﺗﻄﻮرﻳﺔ ﻟﻐﺔ ﺑﺴﻴﻄﺔ وأن ﻳﺘﺄﻛﺪ ﻣﻦ أﻧﻪ ﻗﺪ ﺗﻢ ﻓﻬﻤﻪ. • ااﺳﺘﺨﺪم وﺳﺎﺋﻞ إﻳﻀﺎح ﻣﻠﻤﻮﺳﺔ ﻋﻠﻰ اﻟﻌﻴﺎدة اﻟﻨﻤﻮذﺟﻴﺔ أن ﺗﻮﻓﺮ ﻛﺎﻓﺔ اﻟﻤﺴﺘﻠﺰﻣﺎت اﻟﺘﻲ ﻣﻦ ﺷﺄﻧﻬﺎ ﻣﺜﻞ اﻟﺼﻮر أو اﻟﺪﻣﻰ ﻟﺘﺴﻬﻴﻞ اﻟﺸﺮح. أن ﺗﺴﻬﻞ وﺻﻮل اﻟﻨﺴﺎء ذوات اﻻﻋﺎﻗﺎت؛ ﺳﻮاء أﻛﺎﻧﺖ ﺟﺴﺪﻳﺔ، أم • اﻋﻠﻰ ﻃﺎﻗﻢ اﻟﻌﻤﻞ أن ﻳﺘﺨﺬ اﻹﺟﺮاءات اﻟﻤﻨﺎﺳﺒﺔ ﻟﺘﺨﻔﻴﻒ ﺣﺴﻴﺔ، أم ﺗﻄﻮرﻳﺔ أم إﻧﻔﻌﺎﻟﻴﺔ اﻟﺨﻮف واﻟﺘﻮﺗﺮ. إﻋﺎﻗﺎت • ااﻣﻨﺢ وﻗﺘﺎ إﺿﺎﻓﻴﺎ ﻟﻠﻔﺤﺺ. ٤. ﻗﻢ ﺑﺘﻄﻮﻳﺮ ﺑﺮﻧﺎﻣﺞ ﺗﺪرﻳﺒﻲ ﻟﻄﺎﻗﻢ اﻟﻌﻤﻞ ﻣﻦ أﻛﺜﺮ ﻣﻦ ﻃﺎﺑﻖ واﺣﺪ. • • إﻧﻔﻌﺎﻟﻴﺔ ااﻓﻬﻢ ﻛﻴﻒ ﻳﺆﺛﺮ دواء اﻟﻌﻼج (اﻟﻨﻮاﺣﻲ اﻟﻄﺒﻴﺔ واﻹدارﻳﺔ). اﻳﺠﺐ ﺗﻮﻓﺮ ﺳﻄﺢ ﻣﺎﺋﻞ ﻓﻲ ﻣﻮﻗﻒ اﻟﺴﻴﺎرات اﻟﻨﻔﺴﻲ ﻋﻠﻰ ﺻﺤﺔ اﻟﻤﺮأة. ﻳﻤﻜﻦ اﻟﺸﺨﺺ اﻟﺬي ﻳﻌﺎﻧﻲ ﻣﻦ ﺻﻌﻮﺑﺔ ﻓﻲ إﻋﺎﻗﺎت • ااﺳﺘﺨﺪم اﻟﻠﻔﻆ ﻹﻋﻄﺎء ﻛﻴﻔﻴﺔ ﺗﻄﻮﻳﺮ ﻋﻴﺎدة ﻣﻴﺴﺮة اﻟﻮﺻﻮل اﻟﺤﺮﻛﺔ ﻣﻦ اﻟﻮﺻﻮل إﻟﻰ اﻟﺮﺻﻴﻒ. ﺑﺼﺮﻳﺔ ﻟﻀﻤﺎن أن ﺗﻜﻮن اﻟﻌﻴﺎدة ﻣﻴﺴﺮة اﻟﻮﺻﻮل اﻟﺘﻌﻠﻴﻤﺎت وﻟﻠﺸﺮح. ﻟﻠﻨﺴﺎء ذوات اﻹﻋﺎﻗﺎت ﻫﻨﺎك ﺛﻼﺛﺔ ﻋﻨﺎﺻﺮ اﻟﺘﺠﻬﻴﺰات ﻏﻴﺮ اﻟﻄﺒﻴﺔ: إﻋﺎﻗﺎت • ااﺳﺘﺨﺪم اﻟﻜﺘﺎﺑﺔ ﻛﺄداة ﻟﻠﺸﺮح ﺳﻤﻌﻴﺔ وإﻋﻄﺎء اﻟﺘﻌﻠﻴﻤﺎت. ﻳﺠﺐ ﺗﻮﻓﺮﻫﺎ: ﻣﻦ ﺷﺄن ﺑﻌﺾ ﻋﻨﺎﺻﺮ اﻟﺘﺼﻤﻴﻢ ﻗﻠﻴﻠﺔ • • ااﺳﺘﺨﺪم وﺳﺎﺋﻞ اﺗﺼﺎل ﺑﺪﻳﻠﺔ اﻟﻤﻌﺮﻓﺔ اﻟﻤﻬﻨﻴﺔ وﺗﻮﺟﻬﺎت ﻃﺎﻗﻢ اﻟﻌﻤﻞ ﻧﺤﻮ اﻟﺘﻜﻠﻔﺔ ﻧﺴﺒﻴﺎ أن ﺗﻮﻓﺮ ﺟﻮا ﻣﺮﻳﺤﺎ ﻟﻠﻨﺴﺎء ذوات ﻛﺎﻷرﻗﺎم ﻟﺘﺤﺪﻳﺪ اﻟﺪور ﻓﻲ ﻏﺮﻓﺔ اﻟﻤﺮﺿﻰ. اﻻﻋﺎﻗﺎت: اﻻﻧﺘﻈﺎر. • اﺳﻬﻮﻟﺔ اﻟﻮﺻﻮل إﻟﻰ اﻟﺒﻨﺎﻳﺔ اﻟﺘﻲ ﺗﺤﻮي • اأن ﻳﻜﻮن ﻣﻜﺘﺐ اﻻﺳﺘﻘﺒﺎل ﻣﻨﺨﻔﻀﺎ. اﻟﻌﻴﺎدة. • اﻧﻈﺎم اﺗﺼﺎل ﺑﺪﻳﻞ ﻟﻠﻨﺴﺎء ذوات اﻻﻋﺎﻗﺎت اﻟﺪﺧﻮل ﻓﻲ ﻋﻤﻠﻴﺔ ﺗﺸﺎرﻛﻴﺔ أﻛﺜﺮ ﻣﻦ ﻣﺠﺮد • اﺗﻮﻓﺮ اﻟﻤﻌﺪات اﻟﻤﻼﺋﻤﺔ؛ ﺳﻮاء أﻛﺎﻧﺖ ﻃﺒﻴﺔ اﻟﺤﺴﻴﺔ. إﻋﺎدة ﺗﺮﻣﻴﻢ ﻟﻠﻤﺮﻓﻖ ﻟﻪ ﻓﻮاﺋﺪ إﺿﺎﻓﻴﺔ: أم ﻏﻴﺮ ﻃﺒﻴﺔ. • اإﺷﺎرات واﺿﺤﺔ ﻟﻠﻨﺴﺎء ذوات اﻻﻋﺎﻗﺎت • ازﻳﺎدة اﻟﻮﻋﻲ ﺣﻮل ﺣﻘﻮق اﻟﻨﺴﺎء ذوات اﻟﺤﺴﻴﺔ. اﻹﻋﺎﻗﺎت ﺣﻮل اﻟﺨﺪﻣﺎت اﻟﻄﺒﻴﺔ. ﺗﺪرﻳﺐ ﻃﺎﻗﻢ اﻟﻌﻤﻞ • اﺣﻨﻔﻴﺔ اﻟﻤﺎء ﻏﻴﺮ ﻣﺮﺗﻔﻌﺔ. • اﺧﻠﻖ ﻗﻨﻮات ﻣﻦ اﻻﺗﺼﺎل وﺗﻄﻮﻳﺮ ﻋﻼﻗﺎت ﺗﻌﺘﺒﺮ ﺗﻮﺟﻬﺎتﻣﻘﺪﻣﻲ اﻟﺨﺪﻣﺔ ﻧﺤﻮ اﻟﻤﺮﺿﻰ • اﺗﻠﻔﻮن ﻋﻤﻮﻣﻲ ﻏﻴﺮ ﻣﺮﺗﻔﻊ. ﺗﻌﺎوﻧﻴﺔ ﻣﻊ ﻣﻘﺪﻣﻲ ﺗﻠﻚ اﻟﺨﺪﻣﺔ. ﻣﻦ أﻫﻢ اﻟﻌﻮاﻣﻞ اﻟﺘﻲ ﻣﻦ ﺷﺄﻧﻬﺎ أن ﺗﻴﺴﺮ وﺻﻮل • اﺗﻄﻮﻳﺮ ﺑﺮﻧﺎﻣﺞ ﺗﺪرﻳﺒﻲ ﻳﻤﻜﻦ أن ﻳﻄﺒﻖ ﻓﻲ اﻟﺨﺪﻣﺎت اﻟﻄﺒﻴﺔ. وﻳﻜﻤﻦ اﻟﻬﺪف وراء ﺑﺮﻧﺎﻣﺞ اﻟﺘﺠﻬﻴﺰات اﻟﻄﺒﻴﺔ: ﻛﻠﻴﺎت اﻟﻄﺐ وﺟﺎﻣﻌﺎت اﻟﻌﻠﻮم اﻟﻄﺒﻴﺔ ﻟﻀﻤﺎن ﺗﺪرﻳﺒﻲ ﻓﻌﺎل إﻟﻰ ﺗﺰوﻳﺪ ﻃﺎﻗﻢ اﻟﻌﻴﺎدة (ﺳﻮاء ﻟﻀﻤﺎن ﺳﻬﻮﻟﺔ اﻟﺤﺮﻛﺔ ﻳﺠﺐ ﺗﻮﻓﻴﺮ اﻷدوات إﺣﺴﺎس اﻟﺠﻴﻞ اﻟﻘﺎدم ﻣﻦ ﻣﻘﺪﻣﻲ اﻟﺨﺪﻣﺔ اﻟﻄﺒﻲ أو اﻹداري أو اﻟﻤﺴﺎﻋﺪ) ﺑﺎﻷدوات اﻟﺘﻲ اﻟﺘﺎﻟﻴﺔ: ﻟﺤﺎﺟﺔ اﻟﻨﺴﺎء ذوات اﻻﻋﺎﻗﺎت. ﺗﻤﻜﻨﻬﻢﻣﻦ ﺗﻮﺟﻴﻪوﺗﻘﺪﻳﻢاﻟﺨﺪﻣﺎت اﻟﻤﻨﺎﺳﺒﺔ • اﻛﺮاﺳﻲ ﺧﺎص ﺑﻔﺤﺺ اﻷﻣﺮاض اﻟﻨﺴﺎﺋﻴﺔ إن ﺿﻤﺎن ﺣﻖ اﻟﻨﺴﺎء ذوات اﻻﻋﺎﻗﺎت ﻓﻲ إﻟﻰ اﻟﻨﺴﺎء ﻣﻦ ذوات ﻣﺨﺘﻠﻒ اﻹﻋﺎﻗﺎت. ﻳﻤﻜﻦ ﺗﻌﺪﻳﻞ ارﺗﻔﺎﻋﻬﺎ. اﻟﻮﺻﻮل إﻟﻰ اﻟﺮﻋﺎﻳﺔ اﻟﻄﺒﻴﺔ ﻫﻮ اﻟﻬﺪف اﻟﺤﻘﻴﻘﻲ واﻟﻘﻀﺎﻳﺎ اﻟﻤﺤﺪدة اﻟﺘﻲ ﻳﺠﺐ ﺗﻐﻄﻴﺘﻬﺎ ﻓﻲ • اﺗﻮﻓﻴﺮ ﻟﻮح ﻣﻨﺰﻟﻖ ﻳﺴﺎﻋﺪ اﻟﻨﻘﻞ ﻣﻦ اﻟﻜﺮﺳﻲ ﻟﻨﻈﺎم اﻟﺮﻋﺎﻳﺔ اﻟﻄﺒﻴﺔ ﻓﻲ ﻣﺨﺘﻠﻒ أﻧﺤﺎء اﻟﻌﺎﻟﻢ. ﻫﺬا اﻟﺒﺮﻧﺎﻣﺞ ﺗﺸﻤﻞ: اﻟﻤﺘﺤﺮك إﻟﻰ ﻛﺮﺳﻲ اﻟﻔﺤﺺ. • اﻣﻌﻠﻮﻣﺎت ﻃﺒﻴﺔ ﺣﻮل ﻋﻼج اﻟﻨﺴﺎء ذوات • اﻣﺼﻌﺪ ﻫﻴﺪروﻟﻴﻜﻲ ﻟﻨﻘﻞ اﻟﻤﺮﻳﺾ اﻟﺬي ﻫﻴﻼ ﺑﻦ ﺷﻮﺷﺎن ﻫﻲ ﻣﻨﺴﻘﺔ ﻣﻨﺘﺪى اﻟﻨﺴﺎء اﻻﻋﺎﻗﺎت. ﻻ ﻳﺴﺘﻄﻴﻊ اﻟﺤﺮﻛﺔ ﻣﻦ اﻟﻜﺮﺳﻲ اﻟﻤﺘﺤﺮك إﻟﻰ ذوات اﻻﻋﺎﻗﺎت ﻓﻲ إﺳﺮاﺋﻴﻞ وﻫﻮ ﻣﺸﺮوع • اﻧﺼﺎﺋﺢ ﺗﻘﻨﻴﺔ ﺣﻮل ﺗﺴﻬﻴﻞ اﻟﻮﺻﻮل إﻟﻰ ﻛﺮﺳﻲ اﻟﻔﺤﺺ. ﺷﺮاﻛﺔ ﺑﻴﻦ ”ﺑﺰﺧﻮت“ ووﺣﺪة إﻋﺎدة اﻟﺘﺄﻫﻴﻞ اﻟﻌﻼج. • اﺟﻬﺎز ﻓﺤﺺ اﻷﺷﻌﺔ ﻓﻮق اﻟﺼﻮﺗﻴﺔ ﻣﻊ ذراع ﻓﻲ اﻟﻠﺠﻨﺔ اﻟﻴﻬﻮدﻳﺔ اﻷﻣﺮﻳﻜﻴﺔ اﻟﻤﻮﺣﺪة • ااﻟﺸﻌﻮر واﻹﺣﺴﺎس ﺑﺤﺎﺟﺎت اﻟﻨﺴﺎء ذوات ﻳﻤﻜﻦ ﻣﺪﻩ ﻣﻊ ﺧﻴﺎر ﺗﻜﺒﻴﺮ اﻟﺼﻮرة ﻋﻠﻰ ﻟﻠﺪﻋﻢ- إﺳﺮاﺋﻴﻞ. اﻻﻋﺎﻗﺎت. اﻟﺸﺎﺷﺔ (ﻟﻠﻨﺴﺎء ذوات اﻻﻋﺎﻗﺎت اﻟﺒﺼﺮﻳﺔ) اﻟﻤﻌﻠﻮﻣﺎت ﻓﻲ ﻫﺬا اﻟﻤﻘﺎل ﻣﺮﺗﻜﺰة ﻋﻠﻰ ﻣﺸﺮوع ﻣﻨﺘﺪى • اﺟﻬﺎز ﻋﺮض ﺧﺎرﺟﻲ ﻟﻠﺠﻨﻴﻦ. اﻟﻨﺴﺎء ذوات اﻻﻋﺎﻗﺎت اﻟﺬي ﻣﺎ زال ﻗﻴﺪ اﻟﺘﻨﻔﻴﺬ وﻫﻮ ﺑﻨﺎﻳﺔ ﻣﻴﺴﺮة اﻟﻮﺻﻮل • اﺟﻬﺎز ﺗﻌﻘﻴﻢ، ﺟﻬﺎز ﻓﺤﺺ اﻟﻤﻬﺒﻞ وﻣﻌﺪات (ﻣﺸﺮوع ﺷﺮاﻛﺔ ﺑﻴﻦ ”ﺑﺰﺧﻮت“، ﻣﺮﻛﺰ ﻟﺤﻘﻮق اﻹﻧﺴﺎن ﻟﻸﺷﺨﺎص ذوات اﻻﻋﺎﻗﺎت ووﺣﺪة إﻋﺎدة اﻟﺘﺄﻫﻴﻞ وذوات إﺟﺮاء اﻟﺘﻌﺪﻳﻼت ﻋﻠﻰ اﻟﺒﻨﺎﻳﺔ ﻟﺨﻠﻖ ﺑﻴﺌﺔ أﺧﺮى ﺣﺴﺐ اﻟﺤﺎﺟﺔ. اﻻﻋﺎﻗﺎت ﻓﻲ اﻟﻠﺠﻨﺔ اﻷﻣﺮﻳﻜﻴﺔ اﻟﻴﻬﻮدﻳﺔ اﻟﻤﻮﺣﺪة ﻣﻼﺋﻤﺔ ﻣﻦﺷﺄﻧﻬﺎ أن ﺗﻴﺴﺮوﺻﻮل اﻟﻨﺴﺎء اﻟﻠﻮاﺗﻲ ﻟﻠﺪﻋﻢ) ﺑﺪﻋﻢ ﻣﻦ ﺷﺮﻛﺔ ﺑﻔﺰر ﻟﻸدوﻳﺔ. ﻳﻌﻤﻞ اﻟﻤﻨﺘﺪى ﺑﻌﺎﻧﻴﻦ ﻣﻦ ﺻﻌﻮﺑﺔ ﻓﻲ اﻟﺤﺮﻛﺔ أﻛﺜﺮ ﻛﻠﻔﺔ وأﻛﺜﺮ إﻋﺎﻗﺎت ﻣﺨﺘﻠﻔﺔ، اﺣﺘﻴﺎﺟﺎت ﻣﺨﺘﻠﻔﺔ ﻛﺸﺒﻜﺔ دﻋﻢ وﻛﻤﺮﻛﺰ ﺑﺤﺚ وﻣﺠﻤﻮﻋﺔ ﻣﻨﺎﺻﺮة وﺣﺸﺪ اﻟﺘﺄﻳﻴﺪ ﻟﺘﻘﻮم اﻟﺴﻠﻄﺎت ﺑﺴﺪ ﺣﺎﺟﺎت اﻟﻨﺴﺎء ذوات ازدﺣﺎﻣﺎ ﻣﻦ ﺗﻠﻚ اﻟﻤﺨﺼﺼﺔ ﻟﺬوات اﻻﻋﺎﻗﺎت ﻟﻜﻲ ﺗﻜﻮن اﻟﻌﻴﺎدة ﻣﻴﺴﺮة اﻟﻮﺻﻮل ﺑﺼﻮرة اﻹﻋﺎﻗﺎت اﻟﻤﺨﺘﻠﻔﺔ. ﺳﻴﺘﻢ ﻓﺘﺢ اﻟﻌﻴﺎدة اﻟﻨﻤﻮذﺟﻴﺔ اﻷﺧﺮى. ﻟﺬا ﻣﻦ اﻟﻀﺮوري اﻷﺧﺬ ﺑﻌﻴﻦ اﻻﻋﺘﺒﺎر ﻛﺎﻣﻠﺔ ﻳﺠﺐ اﻷﺧﺬ ﺑﻌﻴﻦ اﻻﻋﺘﺒﺎر اﻟﺤﺎﺟﺎت ﻓﻲ ﻧﻴﺴﺎن ٢٠٠٥. اﻟﻌﻨﻮان اﻻﻟﻜﺘﺮوﻧﻲ ”ﺑﺰﺧﻮت“ ﻣﺴﺒﻘﺎ اﻟﺒﻨﺎﻳﺔ اﻟﺘﻲ ﺳﺘﺤﻮي اﻟﻌﻴﺎدة. اﻟﺨﺎﺻﺔ ﻟﻠﻨﺴﺎء ذوات اﻹﻋﺎﻗﺎت اﻟﻤﺨﺘﻠﻔﺔ. www.bizchut.org.il/eng/upload/.more/women.html 22 bridges February-March 2005 How to... Making Gynecological Services Accessible to Women with Disabilities: Creation of a Model Clinic UNFPA/Steve Sabella UNFPA/Steve photo:

ﻛﻴﻔﻴﺔ ﺗﻴﺴﻴﺮ وﺻﻮل اﻟﺨﺪﻣﺎت اﻟﻄﺒﻴﺔ

ﻫﻴﻼ ﺑﻦ ﺷﻮﺷﺎن اﻟﻨﺴﺎﺋﻴﺔ ﻟﻠﻨﺴﺎء ذوات اﻻﻋﺎﻗﺎت

ﻻﻋﺎﻗﺎت ﺑﺎﻟﻨﺴﺎء ذوات اﻻﻋﺎﻗﺎت، واﻟﻨﺎﺟﻤﺔ اﻟﻨﺴﺎء ذوات اﻻﻋﺎﻗﺎت؛ اﻷﻣﺮ اﻟﺬي ﻳﺆدي إﻟﻰ ﻋﻠﻰ ﻣﺪﺧﻞ اﻟﻌﻴﺎدة اﻟﻄﺒﻴﺔ ﻋﻠﻰ ﺳﺒﻴﻞ اﻟﻤﺜﺎل ﻋﻦﻛﻮﻧﻬﻦﻧﺴﺎءﻣﻦﻧﺎﺣﻴﺔ،وﻟﻬﻦاﺣﺘﻴﺎﺟﺎت ﺗﻘﺪﻳﻢ ﺧﺪﻣﺎت ﻏﻴﺮ ﻣﻼﺋﻤﺔ. ﺗﻤﺜﻞ ﻋﺎﺋﻘﺎ ﻟﻠﻨﺴﺎء اﻟﻠﻮاﺗﻲ ﻳﺴﺘﺨﺪﻣﻦ اﻟﻜﺮﺳﻲ ﺧﺎﺻﺔ ﺗﻢ ﺗﺠﺎﻫﻠﻬﺎ ﻣﻦ ﻗﺒﻞ اﻟﻤﻨﻈﻤﺎت اﻟﺘﻲ اﻟﻤﺘﺤﺮك. ﻓﺎﻟﻌﻴﺎدة اﻟﻨﻤﻮذﺟﻴﺔ ﺗﺄﺧﺬ ﺑﻌﻴﻦ ﺗﻌﻨﻰ ﺑﺎﻟﻨﺴﺎء ذوات اﻻﻋﺎﻗﺎت ﻓﻲ إﺳﺮاﺋﻴﻞ، ﻧﻤﻮذج ﻟﻤﺎ ﻳﺠﺐ أن ﺗﻜﻮن ﻋﻠﻴﻪ اﻟﻌﻴﺎدات اﻻﻋﺘﺒﺎر ﻛﺎﻓﺔ ﺟﻮاﻧﺐ ﺗﻴﺴﻴﺮ اﻟﺤﺮﻛﺔ؛ ﻟﻀﻤﺎن اﺑﻤﺎ ﻓﻴﻬﺎ اﻟﺤﻜﻮﻣﺔ واﻟﻤﺆﺳﺴﺎت اﻟﻌﺎﻣﺔ، ﻣﻦ اﻟﻄﺒﻴﺔ اﻟﻨﺴﺎﺋﻴﺔ ﻟﺘﻴﺴﻴﺮ وﺻﻮل اﻟﻨﺴﺎء وﺻﻮل اﻟﻨﺴﺎء ذوات اﻹﻋﺎﻗﺎت اﻟﺠﺴﺪﻳﺔ ﻧﺎﺣﻴﺔ أﺧﺮى. ذوات اﻻﻋﺎﻗﺎت واﻟﺤﺴﻴﺔ واﻟﺘﻄﻮرﻳﺔ واﻹﻧﻔﻌﺎﻟﻴﺔ. ﺗﻌﺎﻧﻲ اﻟﻨﺴﺎء ذوات اﻻﻋﺎﻗﺎت ﻣﻦ ﺗﺤﺪﻳﺎت ﻳﻌﻜﻒ ﻣﻨﺘﺪى اﻟﻨﺴﺎء ذوات اﻻﻋﺎﻗﺎت إن ﺗﻄﻮﻳﺮ اﻟﻌﻴﺎدة اﻟﺘﻲ ﻳﺴﻬﻞ اﻟﻮﺻﻮل إﻟﻴﻬﺎ ﻣﺘﻌﺪدة، ﺧﺼﻮﺻﺎ ﻓﻲ اﻟﺤﺼﻮل ﻋﻠﻰ ﺣﻘﻮﻗﻬﻦ ﻋﻠﻰ ﺗﻨﻔﻴﺬ ﻣﺸﺮوع ﻳﻬﺪف إﻟﻰ اﻟﻮﻗﻮف ﻋﻠﻰ ﻳﺘﻄﻠﺐ أﻛﺜﺮ ﻣﻦ ﻣﺠﺮد إﻋﺎدة ﺗﺮﻣﻴﻢ ﻟﻠﺒﻨﺎء، ﻣﻦ ﻧﺎﺣﻴﺔ اﻟﺤﺼﻮل ﻋﻠﻰ اﻟﺮﻋﺎﻳﺔ اﻟﻄﺒﻴﺔ، اﻟﺨﺪﻣﺎت ﻏﻴﺮ اﻟﻤﻨﺎﺳﺒﺔ ﻓﻲ اﻟﻤﺠﺎل اﻟﻄﺒﻲ ﻟﻴﺸﻤﻞ زﻳﺎدة اﻟﻮﻋﻲ ﺑﻴﻦ اﻟﻤﺮﺿﻰ وﻣﻘﺪﻣﻲ واﻟﺘﻮﻇﻴﻒ، وﺣﺘﻰ ﺗﻜﻮﻳﻦ أﺳﺮة. وﻓﻲ ﻛﺜﻴﺮ ﻣﻦ اﻟﻤﻘﺪﻣﺔ ﻟﻠﻨﺴﺎء ذوات اﻻﻋﺎﻗﺎت ﻓﻲ إﺳﺮاﺋﻴﻞ. اﻟﺨﺪﻣﺎت ﺣﻮل اﻟﺤﺎﺟﺎت اﻟﺨﺎﺻﺔ ﻟﻠﻨﺴﺎء اﻟﺤﺎﻻت ﻧﺠﺪ أﻧﻪ ﻳﺴﺎء ﻓﻬﻢ اﺣﺘﻴﺎﺟﺎﺗﻬﻦ، أو وﻳﻌﺮف اﻟﻤﺸﺮوع ﺗﻴﺴﻴﺮ اﻟﻮﺻﻮل، ﻛﺤﺎﻟﺔ ذوات اﻹﻋﺎﻗﺎت ﻓﻲ اﻟﻤﺠﺎﻻت اﻟﻤﺨﺘﻠﻔﺔ، ﺗﺘﻢ اﻟﻤﺒﺎﻟﻐﺔ ﻓﻲ ﻫﺬﻩ اﻟﻨﻈﺮة، وإن ﻛﺎﻧﺖ ﺑﺤﺴﻦ ﺗﻤﻜﻦ ذوات اﻻﻋﺎﻗﺎت ﻣﻦ اﻟﺤﺼﻮل ﻋﻠﻰ واﻟﻌﻤﻞ ﻋﻠﻰ ﺗﻄﻮﻳﺮ ردود ﻣﻨﺎﺳﺒﺔ وﻣﺸﺮﻓﺔ ﻧﻴﺔ ﻣﻦ ﻗﺒﻞ ﺻﻨﺎع اﻟﻘﺮار وﻣﻘﺪﻣﻲ اﻟﺨﺪﻣﺎت. اﻻﺳﺘﻘﻼﻟﻴﺔ، واﻟﺘﻤﺘﻊ ﺑﺤﻘﻮق ﻣﺴﺎوﻳﺔ وﻣﺸﺮﻓﺔ ﻟﺘﻠﺒﻴﺔ ﻫﺬﻩ اﻻﺣﺘﻴﺎﺟﺎت. وﺑﺎﻟﺘﺎﻟﻲ ﺧﻠﻖ ﺻﻌﻮﺑﺎت ﻻ ﺣﺎﺟﺔ ﻟﻬﺎ. ﻓﻲ اﻟﻮﺻﻮل إﻟﻰ اﻟﺨﺪﻣﺎت اﻟﺘﻲ ﻳﺘﻤﺘﻊ ﺑﻬﺎ وﻓﻴﻤﺎ ﻳﻠﻲ ﺑﻌﺾ اﻟﺨﻄﻮات اﻟﻬﺎﻣﺔ ﻓﻲ ﻫﺬا وﻏﺎﻟﺒﺎ ﻻ ﻳﺪرك اﻟﻌﺎﻣﻠﻮن ﻓﻲ ﻣﺠﺎل اﻟﺮﻋﺎﻳﺔ ﻋﻤﻮم اﻟﻨﺎس. اﻟﻤﻀﻤﺎر: اﻟﺼﺤﻴﺔ وﺻﻨﺎع اﻟﻘﺮار ﻣﺪى ﺗﻌﻘﻴﺪ ﻋﻼج وﺑﻨﺎء ﻋﻠﻰ ﻫﺬا اﻟﺘﻌﺮﻳﻒ ﻓﺈن درﺟﺔ واﺣﺪة ١. ﺣﺎول أن ﺗﺸﺮك أﺷﺨﺎﺻﺎ رﺋﻴﺴﻴﻴﻦ February-March 2005 bridges 23 happening in health The Separation Barrier to Health Care by Medecins du human rights. Monde-France MDM has been present in the Pal- Médecins du monde (MDM – estinian territories since 1995. It op- France), has teamed up with Physi- erates in Gaza, Nablus and some cians for Human Rights (PHR) and villages affected by the Wall. May, the Palestinian Red Crescent Society 2004, marked the beginning of the (PRCS) in a joint art campaign ap- “Wall Response Program”. The pro- pearing both in the Israeli and Pal- gram’s activities include providing estinian press in an effort to address technical and financial support for health issues generated by the sepa- a total of 11 clinics run by Health ration barrier. Work Committees (HWC) in the MDM, PHR and PRCS share a North Jordan Valley and south of common position on the separation Bethlehem as well as establishing barrier (also referred to as the Wall). an ambulance station with PRCS in The Wall appears as the final and the East Jerusalem town of Aizaria. most visible part of a network of From the beginning, MDM decid- barriers, both physical and adminis- ed to take action against the Wall’s trative, which restricts Palestinians’ negative health impact by voicing David Tartakover right to life and freedom of move- the patients’ and medical staff’s dai- ment in the Palestinian territories. paign will be exhibited in six major ly difficulties in accessing medical Since it does not follow the Green European cities including Paris and facilities due to the Wall. To date, Line and encroaches into the West London later this year. over 80 testimonies have been gath- Bank, the tracing of the Wall is both MDM-France is an international ered in the field. These testimonies disproportionate, in its health im- solidarity association. It depends combined with medical data analy- pact, and illegal. It violates both In- on the volunteer commitment of sis have been compiled in an MDM ternational Human Rights Law and its members, who are medical pro- report entitled “The Wall – The Ul- International Humanitarian Law. fessionals, in order to address the timate Barrier”. The testimonies pre- In order to address the public at health needs of the most vulnera- sented in this report and MDM’s large, MDM will reach out to people ble populations both in France and medical expertise in the field illus- through inserts in the press illustrat- in 52 countries around the world. trate the deterioration of the Pales- ing the work of Israeli and Palestin- Based on 25 years of medical expe- tinian health care system due to the ian artists. These inserts will be en- rience, it bears witness to the ob- ongoing construction of the Wall. riched with medical messages about stacles in accessing medical care For more information: the impact of the Wall. The art cam- and denounces the violations of www.healthandwall.org Palestinian Public Perceptions Highlights of the forthcoming Pal- • 40% receive health coverage from tions involved in assistance to Pal- estinian Public Perceptions – Report the Government, 17% from UNRWA estinians. 8 show: and 26% cover their own medical The full report is presented by the • 44% of Palestinians say that em- expenses. Graduate Institute of Development ployment is the most important need This survey is one of several which Studies (Geneva University) in col- followed by food with 31% of the analyze the living conditions of Pal- laboration with several Palestinian population. estinians over the last four years. institutions, the Swiss Agency for De- • 45% say the most needed commu- The surveys rely on polls that meas- velopment and Cooperation as well nity facility is water. ure Palestinian’s perceptions about as several UN agencies. The reports • 51% of Palestinians chose a spe- living conditions, their evolution, are issued twice a year. Reports 1- cific health facility because it is cov- assistance received and its impact, 7 are available at www.dartmonitor. ered by health insurance and 16% as well as many other relevant top- org and Report 8 will be available because it’s the cheapest. ics for individuals and organiza- shortly.

24 bridges February-March 2005 Disabled and Beautiful by Gilli Buium People with disabilities don’t have it easy. In addition to coping with their disability, they also have to face a society which is unaccepting. They confront physical barriers like inac- cessible infrastructure as well as so- cial barriers such as lack of accept- ance as equal members of society. This reality motivated a group of young, disabled people, known as Benadam (human-being in Hebrew) to take action. The group was estab- lished last year by three disabled peo- ple in their 20’s who want to revo- lutionize the way society perceives disabled people. Their main strategy is to put on provocative events with which disabled people aren’t usually associated. Their most recent event was a trendy fashion show featuring disabled people as the models. The slogan for the fashion show was “I am disabled and sexy”. "I feel as beautiful and attractive as any other person," said Ido Gruen- gard, one of the organizers of the project and an architecture student at Tel-Aviv University. "Our mission is to show that we are regular people, just like anybody else," he added. So- ciety, according to Gruengard, looks

at disabled people as passive and in- received wide coverage in the media, competent. The fashion show allowed fulfilling the organizers’ main goal – them to prove otherwise. They pre- to make everyone see them as equal, sented young, people with disabilities instead of simply disabled. who are active and enjoying a fulfill- Next on Benadam’s to-do list is ing personal and professional life. to open up a coffee shop where the They came on stage proudly wear- waiters are disabled. The underlying ing designer clothes made especially idea is to have people who are not for the occasion by the most popu- disabled served by disabled people lar Israeli fashion designers. The – a rare reversal of roles and a crea- show packed the Dome nightclub in tive approach to challenging the way Tel Aviv which volunteered its loca- disabled people are perceived. tion and the evening was a huge suc- For more information: cess. In addition, the fashion show www.benadam.co.il

February-March 2005 bridges 25 happening in health

Patient’s Friends Society Sunrise Group – Breaking

the Silence Sabella UNFPA/Steve

by Carol El Jabari photo: The Sunrise breast cancer support group was established in 2000 under the auspices of Patient’s Friends Soci- ety-Jerusalem as the first such initia- tive in the Occupied Palestinian Ter- ritories. The women aim to ‘break the silence’ surrounding cancer diag- nosis and increase awareness about prevention, early detection and treat- Project Cope: ment. They are also committed to im- proving patient- professional commu- Coping with Breast nications to facilitate better treatment for those diagnosed with cancer. Cancer Among At present, over 50 patients and survivors from Jerusalem and the West Bank are registered with the Palestinian and group which seeks to address the psycho-social aspects of living with Israeli Women cancer. Several women have been trained as Reach to Recovery volun- by Yael Rockoff and social workers. teers visiting patients in their homes Thirty five Israeli and Palestinian The event was sponsored by Project and in hospital. In addition, they professionals participated in a round- COPE, a cooperative project initiat- also volunteer to take calls on the table discussion about breast recon- ed in 2000 for health professionals helpline from men and women all struction after breast cancer surgery and women living with breast can- over the country. This service is ad- at the YMCA, Jerusalem, this past cer in a joint effort to fight breast vertised in the local press and on lo- January. The event was part of a fo- cancer, create networks among pro- cal radio and television. The helpline rum which aims to provide an are- fessionals and women with cancer, phone number is 02-6277990. na for networking and professional as well as expand and develop serv- Many members of the group par- growth for Palestinian and Israeli ices to address unmet needs. The ticipate in empowerment activities health professionals. COPE partners are Patient’s Friends which include conferences, seminars, At the meeting, reconstruction Society—Jerusalem (PFS), the Israel language courses (to learn Hebrew in techniques were presented by Dr. Cancer Association (ICA), JDC-Mid- order to better understand the physi- Aziz Shoufani, a plastic surgeon and dle East Program (AJJDC, JDC-Isra- cians and nurses who treat them in the Medical Director of St. Joseph’s el, Myers JDC-Brookdale Institute) Israeli hospitals) and monthly meet- Hospital in East Jerusalem, and Dr. and Augusta Victoria Hospital, East ings with Israeli survivors to learn, Dean Ad El, Director of the Plastic Jerusalem. share and network. In June two mem- Surgery Burns Unit at Rabin Medi- In his concluding remarks at the bers and the group coordinator plan cal Center in Petah Tikva. Dr. Ila- roundtable discussion, Dr. Omar Ab- to attend the International Reach to na Kadmon, the Breast Care Nurse dul Shafi, general surgeon and mem- Recovery conference in Athens. This at Hadassah Hospital, Ein Karem, ber of Patient’s Friends Society’s will be an excellent opportunity to spoke about reasons women choose board of trustees, commented that meet women from all over the world to reconstruct or not, the timing of cooperative projects such as COPE, living with breast cancer- to discuss the surgery and other psychosocial play an important role in promoting how they deal with it, be exposed to factors. Three breast cancer sur- coexistence and improving under- new scientific and psycho-social mat- vivors, one Israeli and two Pales- standing. ters and have a chance to have fun. tinians, spoke about their person- To learn more about Project COPE For more information about the al experiences with reconstruction. contact Yael Rockoff, JDC COPE Co- Patient’s Friends Society: Participants included oncologists, ordinator, at 972-2-6557272, or by e- www.pfsjer.org surgeons, nurses, general physicians mail at [email protected]

26 bridges February-March 2005 World2005 Health Day Make every mother and child count

by Shiri Ourian The WHO invites all stakehold- the real wealth of societies. ers to make a personal commitment 3. Millions of lives could be saved Make every mother and child to organizing events around World using knowledge we have today. count. This is the slogan for World Health Day. “This is an opportuni- The challenge is to transform this Health Day 2005 which will be held ty to raise awareness regarding the knowledge into action. on April 7. According to the WHO, health threats to mothers and chil- 4. In order to make a difference, we this reflects the reality that the health dren that are often overlooked. Ap- must all join forces and act. To- of women and children is not a top propriate advocacy on this issue gether we can do it. Each one of priority for many governments and could make a significant difference,” us has a role to play. the international community. reports Dr. Ambrogio Manenti, Head Each year more than half a mil- of Office, WHO West Bank and Gaza. To support your events, the WHO lion women die from pregnancy-re- The World health report, devoted to has developed a variety of resources lated causes and 10.6 million chil- maternal and child health, will be including: dren die, 40% of them in the first launched on World Health Day. • design and promotional materials month of life. Almost all of these In order to make a coherent, glo- (logos, toolkit, posters, etc.) deaths are in developing coun- bal impact, events can be oriented • resource documents about mater- tries and many could be prevented around the following messages: nal and child health with well-known interventions, if 1. Too many mothers and children • World Health Day 2005 website only these interventions were more are suffering and dying each year. which includes a place to register widely available. 2. Healthy mothers and children are your event

All of these sources are available online at www.who.int/world-health-day/2005/en/

February-March 2005 bridges 27 A Day in the Life A Family’s Tragedy and Rehabilitation by Daniel Ben Simon

t was after midnight and Eli- yahu Shrabkovsky, a veteran journalist at the EFE Spanish news agency, was finishing his 24 hour shift. Another day Iof this bloody Intifada had come to a close. Just before Eliyahu went to bed, he heard on the radio that there had been a suicide attack at Mike’s Place, a famous restaurant on the Tel-Aviv seashore. Another suicide bomber blew himself up causing chaos and panic. “There were many casualties,” the news reporter announced. Eliyahu jumped from his bed and returned to his desk. Without hesi- tation, he started to write the story. Over time he had grown accustomed to writing a wide range of stories – most of them tragedies, very few happy stories. Tonight, once again, he was writing about a tragedy. For a few moments his mind drifted to the victims – the dead, the nearly dead, the seriously injured, the slightly injured and the shock victims. He thought of those who witnessed the horror and the unfortunate who had to collect the body parts. At times he felt submerged in hor- rible thoughts. How long will this bloody conflict last? Has God cursed the Holy Land? Will I live to see the day when Israelis and Palestinians live happily as good neighbors? More than once, despair filled his heart. But that evening he was too up the phone. unable to speak. busy writing the story. There wasn’t “Don’t worry, everything is ok,” “Not too bad,” replied Sarit, Ari- enough time to dwell on existential the voice on the other end half cried, el’s girlfriend. thoughts. half whispered. Marta felt dizzy. For a few moments The telephone rang. In the other “Ariel is just injured.” she sat idle in her room. She didn’t room, Marta, Eliyahu’s wife, picked “How bad?” asked Marta, almost know how to tell her husband that

28 bridges February-March 2005 A Day in the Life A Family’s Tragedy and Rehabilitation by Daniel Ben Simon

their son, Ariel, was among those like newcomers in their own coun- ist. He attended many peace demon- who had been injured at that ill-fat- try. Nearly all of their friends speak strations and rallies for co-existence. ed restaurant. Eliyahu knew that his Spanish. Like most of them, they are In his eyes, there was nothing uglier son was a regular guitarist at “Mike’s not at ease with Hebrew and would than war, nothing more inhumane Place”, but he was working on his rather read and write in their native than bloodshed. story and Ariel didn’t come to his language. “For God’s sake,” he said, sitting mind. He always wrote about the The drive to Tel-Aviv seemed inter- in his living room on a rainy and others. Even in his nightmares, he minable and excruciating. When they windy evening in Jerusalem, “What never imagined that one day, his son arrived at Tel-Hashomer Hospital, on earth drives a young man to kill would be one of them. they were met by a group of doctors. himself and take so many with him? “I was writing the story of the sui- “They told us that Ariel was seri- This is madness. Ariel is a musician cide attack,” recalled Eliyahu, “The ously injured,” recalls Eliyahu, “that and his mission in life is to make reports were saying 30 victims, may- our child suffered from burn injuries people happy. Why would anyone be 40. Then my wife came close and that he will need a long recov- want to kill him? What has he done to me and looked at me. I couldn’t ery.” wrong?” understand why she was staring at As they spoke to the doctors, Eli- After his son recovered, his heart me.” yahu and Marta saw nurses push- went out to the thousands of Pales- tinians who had been injured dur- “The patient was covered with bandages from ing the Intifada. How many of them head to toe. Only his eyes were uncovered. They received the treatment that his son received? looked at him. It was Ariel.” “The Israeli doctors saved his life thanks to their devotion, tireless “Ariel is among the injured,” Mar- ing a bed down the corridor. The efforts and love for Ariel,” he said. ta told her husband. patient was covered with bandages “How many injured Palestinians are “How bad?” he asked, his voice from head to toe. Only his eyes were as lucky as Ariel? I’m afraid that trembling. uncovered. They looked at him. It none. I’m afraid that their hospitals “Not too bad,” she replied. was Ariel. They could hardly control are ill-equipped and many die as a Eliyahu and Marta hardly found their emotions. Their 23 year-old son result of a lack of medication, treat- the time to grasp the tragic news. was alive but he looked so helpless. ment, and highly-trained doctors.” They drove to the hospital in Tel- It took six weeks of painful and This experience has not shattered Aviv. Though they had toughened daily treatment before Ariel fully Eliyahu and Marta’s dream of peace. since they immigrated to Israel in regained his consciousness. During On the contrary, it has bolstered their 1969, nothing prepared them for this that period, Marta stayed at his bed- quest for a better life for Israelis and painful experience. Two years after side. Eliyahu returned to his work Palestinians. the Six Day War, the young couple in Jerusalem after a few days at the “We always hated war,” said Eliya- left their native and beloved Argenti- hospital. hu. “Now we hate it even more.” na, to start a new life in Israel. They “I needed a mental break,” he said. Marta nodded, smiling. chose to settle in Jerusalem and nev- “Seeing Ariel lying in bed uncon- er thought about moving to another scious for so long was unbearable Daniel Ben Simon writes for the Israeli city, more peaceful or less danger- for me. So I went back to work just newspaper “Haaretz”. ous. to get busy and to forget a little bit.” Ben Simon’s writings focus mainly on More than 30 years later, they hard- His son’s injury provoked trou- issues relating to Israeli society. ly considered themselves entirely bling thoughts. He always considered In 2004, he received the Sokolov Prize for Israeli. At times they still feel and act himself a pacifist and a peace activ- journalism.

February-March 2005 bridges 29 A Day in the Life Arqam’s Lost Dreams by Abdel-Basit Khalaf

30 bridges February-March 2005 of his cells and spinal cord. His spi- nal cord was seriously damaged and A Day in the Life only about 15% of it is still function- ing. “I was gradually informed by my physicians that the two bullets affected my spinal cord as well as Arqam’s Lost Dreams my nerves. I was also informed that I would not able to walk or use my by Abdel-Basit Khalaf arms,” Arqam added. Now Arqam spends his day either lying in his bed or sitting in his wheelchair which is a great source t the age of 23, many intense pressure in my ears and then of discomfort. “I try to forget my young men have start- I felt like I was flying in the sky,” pain but I can’t succeed. My night ed their university edu- Arqam recalls with pain on his face. is very long, full of nightmares,” cation with a career in This feeling was only the begin- Arqam said. mind and many are ning of Arqam’s agony which has Arqam decided to hold on to the Aalready looking for a partner, per- lasted four years and has become water pipe equipment he had once haps even starting a family and car- increasingly worse. used in the hopes that he will use rying out other dreams of young The Family Takes on the Disability them again one day. At the same adulthood. Arqam was taken to Sheikh Zayed time, he encourages his brother to This is not the case for Arqam Hospital in Ramallah where he was follow his career track. Sometimes Abu Al-Hyjaa’. Arqam was born in in as state of coma for two weeks. he asks his brothers to show him the the Jenin refugee camp and thus, Once conscious, he moved from one tools so he can remember. from birth, his dreams were limited. hospital to another and from one He was forced to drop out of school rehabilitation center to the next. He The Sorrow Persists before completing high school and spent an entire year away from home Arqam’s mother’s eyes seem to be began learning how to install water and ended up with a special bed constantly full of sorrow. Her silence pipes to earn some money and help and a wheelchair in his room. His indicates the family’s shock and con- his family financially. brothers Alaa’ and Noor as well as tinuous suffering. The family cannot Life has not smiled upon Arqam. his parents learned about names of afford to send Arqam to Germany for He and his family will never forget drugs and medical equipment such treatment and sometimes, because the night of January 6, 2002. On that as Lizoral, Linotral, Contlix, suppos- of their poor financial situation, they night, on his way home on the Haifa itories, urine packs, medical pipes, are not able to secure medicine for road, Arqam stopped to help a young and sterilizers. “My son suffers from Arqam. Despite his disability, Israe- man who was bleeding on the road- a continuous urinary tract infec- li soldiers forced him and his family side. Outside of his car, Arqam was tion. He needs to have his blood and outside of their home on two sepa- shot twice in the neck by an Israe- urine tested all the time in addition rate occasions into very cold weather li soldier. Arqam now lives life with to physical therapy,” says Arqam’s so that the house could be searched 90% disability, paraplegia and lost father covering his face. He adds, “I empty of people. dreams. burst into tears every time I remem- Arqam’s dreams have changed. He ber the situation of Arqam.” no longer thinks of finding a partner Arqam’s Cage “My brother needs to have his or building his own home as he did Arqam’s room shows reminders of urine pumped out six times a day. before. His dreams are now about this tragedy – a wheelchair, a special- He also needs to have physical thera- getting through each day. ly designed bed and a cupboard full py, in addition to changing his sleep- He concluded by saying, “I hate to of drugs and medical instruments. In ing position all the time,” says his listen to the news which talks about another corner of the room there are brother, Alaa’, who was forced to killing, bloodshed and people with two birds in a cage. Arqam refers to leave school to help his brother. disabilities like me.” them and says “I am in a cage, too.” “When I was shot, I felt as if life Facing the Tragedy Abdel-Basit Khalaf is a writer and had forsaken me. I recited the open- The young boy who once special- journalist specializing in women’s ing chapter of the Qur’an twice. My ized in water pipes and installation and children’s development as well as head was spinning quickly. I felt is now an expert on the functioning environmental issues.

February-March 2005 bridges 31 CASTILLO/ICF-WHO photo:

bout 600 million peo- ple in the world expe- Disability and rience disabilities of various types. Eighty percent of the world’s Rehabilitation Adisabled people live in low-income countries; the majority of them are poor and do not have access to basic services including rehabilita- WHO’s View tion facilities. Their primary struggle is to survive and meet basic needs such as food and shelter, particular- Disabilities continue to be an ly in case of severe or multiple dis- increasing problem especially in low- abilities. The global disabled population is income countries. The availability increasing. Population growth, med- and quality of rehabilitation for the ical advances that preserve and pro- long life, war injuries, landmines, disabled has a major social, political, HIV and AIDS, malnutrition, chronic conditions, substance abuse, acci- and economic impact on society dents and environmental damage, all contribute to this increase.

32 bridges February-March 2005 Social and Economic Factors dren are born or acquire a disability positive attitudes towards disability, Social issues are an intrinsic part of of which no more than 10% receive through a commitment to working disability issues – human rights, eco- appropriate rehabilitation. In low- in close alliance with persons with nomic conditions, particularly pover- income countries, children’s disabili- disabilities and their families, while ty and societal conditions including beliefs, attitudes and practices result “The estimated number of people who require in social and environmental barriers for disabled people. rehabilitation services at any point in time is The estimated number of people 1.5% of the global population, i.e. about 90 who require rehabilitation services at any point in time is 1.5% of the glo- million people.” bal population, i.e. about 90 million people. The number of disabled peo- ple continues to be estimated at 7% to 10% of the population, although individual countries have given numbers that vary from approxi- mately 4% to 20%. These estimates reflect many persons whose needs for rehabilitation services, and for equal rights and full participation, have not been met.

Community Participation Community Based Rehabilitation (CBR) is a strategy to promote the sense of “community ownership” and the full participation of disabled people in all its activities. The major objective of CBR is to enable per-

sons with disabilities to maximize CALASANS/ICF-WHO their physical and mental abilities, to access regular services and oppor- photo: tunities and to achieve full social integration within their communities ties are usually identified when they promoting the concept of independ- and societies. CBR may also serve are 3 to 4 years old. As a consequence, ent living and full participation in as a stimulus for community leaders rehabilitation starts too late, losing the community. and social groups to come together. the opportunity to provide an early Such a forum enables a variety of intervention during a period when Collaboration concerns to be addressed, in addi- rehabilitation has a larger impact. Intersectoral collaboration among tion to the needs identified by disa- health, education, social and labor bled people themselves. Shift in Professional sectors is needed in order to ensure Attitudes that persons with disabilities receive Women and Children Education of professionals in the all available services to assist them with Disabilities health and social services has tra- in achieving equal opportunities. Because women are most often the ditionally focused on the “medical” The involvement of persons with primary caregivers, particular atten- aspect of disability whereby the indi- disabilities is an essential feature of tion is to be given to the role that vidual was seen as dependent rath- all programs. People with disabili- they play in their homes and com- er than a person with a potential for ties and the organizations represent- munities. Furthermore, it will be independent living. This “profession- ing their interests play an active role important to consider the needs of al” approach to disability, which is in promoting equal opportunity. As girls and women with disabilities, discipline and disease oriented, fre- such they have a major economic, who confront a double disadvantage quently reinforced the concept that social and political impact on socie- caused by gender discrimination and the individual was a “patient” or a ty and on the restructuring of health limited opportunities for people with “social case” rather than a “person”. and social programs. disabilities. Rehabilitation professionals have a For more information: According to UNICEF, 10% of chil- major role to play in enhancing more www.who.int/ncd/disability/

February-March 2005 bridges 33 Readers’Readers’ ForumForum Invitation to a Forum on Developmental Disabilities by Sarah Capelovitch

he publication of bridg- don, UK) began to question the effi- when motor behavior is most var- es prompted me to reach cacy of inhibiting pathological pat- iable, and try to plan intervention out to Israeli and Pales- terns of movement and facilitating then. tinian colleagues work- “righting and equilibrium reactions” 6. Therapists must keep “hands on” ing with children with as a means to improve function. at a minimum and encourage the Tspecial needs and their families. Par- Today the Bobaths’ thoughts and use of adaptive equipment. amedical professionals and others clinical applications are evolving. 7. Do not work for normalization are invited to exchange ideas, pose The Bobath-NDT concept is incor- of movement patterns; work for questions and send suggestions or porating evidence-based research increasing activity and level of thoughts on how to meet the chal- participation. lenges presented by children with 8. Invite parents to be equal and

special needs. photo: active partners in the intervention I will start the dialogue with some team.

thoughts on current developments in UNFPA/Steve Sabella There is a great deal more to be movement science theory and how it said on this subject. Many questions is reshaping traditional interventions can and should be raised as to how strategies. the movement sciences have impact- Three of the most currently influ- ed our clinical work. How does it ential sources reshaping clinicians' impact on delivery of Community- thinking are: Based Rehabilitation (CBR)? Does 1. The World Health Organization in movement science and adapting it affect approaches or relationships (WHO) ICIDH-2: International intervention strategies accordingly. within families of children with spe- Classification of Impairments, Current theories about motor cial needs? Some of the theoretical Activities and Participation 1997, behavior suggest: and clinical suggestions are cultur- and its latest edition – Interna- 1. Treatment strategies should not be ally-influenced. I invite you to share tional Classification of Function- directed at the impairment level, your thoughts on this and ways we ing, Disability and Health1 as this does not seem to lead to can work together. 2. The Dynamic Systems Theory – functional gain. Bridges invites you to submit ideas a framework to explain develop- 2. Allow the child with cerebral pal- for joint Israeli-Palestinian projects, ment in general and motor behav- sy (CP) or other neurological con- activities and efforts to our Readers’ ior specifically2 ditions to find his or her best solu- Forum at [email protected] 3. The principles of Family-Centered tions to a motor challenge. Care3 3. Select goals that are related to Dr. Sarah Capelovitch is a pediatric The core principles of these three activity and participation with therapy consultant and Senior Tutor at sources have led clinicians to rethink peer groups, family and society, the European Bobath Tutors Association and modify intervention strate- rather than choosing goals at the (EBTA). [email protected] gies used with infants and children. level of the impairment (e.g. tone References: One of the intervention approach- reduction). 1. International Classification of Functioning, Disability and Health. Available at www3.who. es, or rather intervention concepts, 4. Motor behavior is influenced by int/icf.icftemplate.cfm 2. Thelen, E and Smith, L.B. (eds), undergoing changes is Bobath-Neu- the child’s personality and moti- 1994. Dynamic Systems Approach to the rodevelopmental Treatment (NDT), vation and by the conditions in Development of Cognition and Action (Cognitive Psychology). A Bradford Book, the widely used and taught by certified the environment. MIT Press, Cambridge, MA. instructors the world over. During 5. Therapists must be able to iden- 3. CanChild Centre for Childhood Disability and Research. Available at www.fhs.mcmaster. the 1980s, Dr. and Mrs. Bobath (Lon- tify transition periods in the child, ca/canchild/

34 bridges February-March 2005 LettersLetters toto thethe EditorEditor

Best wishes for bridges eralize data that refers to populations a polio epidemic in one of those dis- Dear Dr Manenti, with very specific characteristics that tricts. This outbreak included 15 cases I was delighted to find out about cannot represent the whole popula- among young adults and 1 death; one and read the launch issue of ‘Bridg- tion. Also the sources of informa- case of polio in the West Bank pre- es’ - a courageous. well-designed and tion should be valid, reliable and not ceded the outbreak in young adults very readable initiative. Please accept biased. in the adjacent area of Hadera, Isra- my best wishes for the success of the • Health professionals from both com- el. (2) This experience showed that project. It is heartening to see that munities should feel the importance both OPV and IPV alone have impor- all of the members of the Advisory of the magazine and see it as a tool tant shortcomings and that IPV-only Board are either Israelis or Palestini- with direct impact on their proffe- populations were susceptible to and ans. I was particularly glad to see the sion and their patients. When choos- could transmit imported wild poliovi- two articles about ambulance driv- ing the articles, the gap between the rus. (2) ers, the interview with Richard Hor- Palestinian and Israeli health care sys- The Ministries of Health of the Pal- ton and the article by David Nabarro, tems should be considered. estinian Authority and of Israel have and the short piece about Physicians Finally, I wish the magazine all the continued to use the combined OPV/ for Human Rights - Israel. success. IPV program since 1988, and has With reiterated best wishes. Yousef Muhaisen, Jerusalem been adopted by some other states Sir Iain Chalmers in the Middle East. Despite periodic Editor, James Lind Library reports of wild poliovirus in the sur- Oxford, UK Why change a successful veillance of sewage in Gaza, no clini- vaccination policy? cal cases have been discovered in the The subject of polio immuniza- area since 1988. Help to Sustain tion policy is under review in many The Israeli Ministry of Health is the Initiative countries as progress is being made currently debating polio immuniza- Dear editor toward global eradication. It is use- tion policy and may consider adop- Congratulations for this initiative. It ful to recall the Israeli and Palestin- tion of an IPV only policy. Such a is a good start for real and construc- ian joint, pioneering work in polio change is, in my view, unjustified. tive dialogue and exchange of experi- control using a system of combined The combined OPV/IPV strategy has ence and ideas for the benefit of the live oral polio (Sabin) vaccine (OPV) protected the area despite the risk of health sector in the Palestinian and with inactivated injected Salk vaccine importation of wild virus as well as Israeli communities. The sponsorship (IPV). This combined program led to from vaccine associated cases. Israe- of the WHO will strengthen “Bridges” the successful eradication of poliomy- li-Palestinian cooperation in this field and give it more credibility. elitis in Gaza, the West Bank in the has been a great success and should However, I think it is more difficult early 1980s, and later in Israel after be extended to other fields of public to advocate this magazine in the Pal- 1988. health cooperation. estinian community than the Israeli The “Gaza System” was original- Ted Tulchinsky, MD MPH, community, due to the general prob- ly adopted to quell large epidemics Jerusalem lems and obstacles the Palestinian of clinical poliomyelitis cases occur- References society faces as well as health sector ring in Gaza and to a lesser extent in 1. Tulchinsky TH, Abed A, Shaheen S, Toubassi specific problems such as lack of free the West Bank, during the 1970s and N, Sever Y, Schoenbaum M, Handscher R. A ten year experience in control of poliomyelitis access to health services for patients especially in the years 1976 and 1977, through a combination of live and killed vaccines in two developing areas. American and health professional. despite widespread and intensive use Journal of Public Health, 1989;79:1648-55. I’d like to suggest the following of OPV. In fact, cases included chil- 2. Slater PE, Orenstein WA, Morag A, Avni A, Handsher R, Green MS, Costin C, Yarrow points to guarantee the sustainability dren who had received up to 4 doses A, Rishpon S, Havkin O, et al. Poliomyelitis of this initiative: of OPV. outbreak in Israel in 1988: a report with two commentaries. Lancet. 1990;335:1192-8. • “Bridges” should touch on the cur- The combined OPV/IPV program rent obstacles related to the conflict showed dramatic results almost Forthcoming issues on the health stiuation in the oPt. It immediately in eliminating poliomy- will feature: could be used as a platform to raise elitis in Gaza and subsequently in the awarness in both societies for this West Bank. Israel used OPV-only in • Nutrition issue. most of the country except for two • Women's Health • The articles should be up to date, districts which used IPV-only from • Mental Health with recent data and should not gen- 1980-1988. In 1988, Israel suffered • Health Promotion

February-March 2005 bridges 35 WHO Office for West Bank and Gaza Old Nablus Road, Sheikh Jarrah, P.O. Box 54812, Jerusalem Tel: +972-2-5400595, Fax: +972-2-5810193 © World Health Organization, 2004 To contribute please send articles to [email protected]