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Asian Development Bank

Chapter 5.5 Inclusion

Disability

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The WHO estimates that 15% of the world’s population lives with some form of disability.+WHO, World Report on Disability (Geneva: World Health Organisation, 2011), http://www.who.int/disabilities/world_report/2011/report.pdf, p. 29. Disabled people are highly vulnerable to disasters, on account of social marginalisation as well as impairments. Although their vulnerability is acknowledged, disaster planning often overlooks their needs and capacities, and disaster managers have limited or no contact with disabled people’s groups or organisations working on their behalf. Disasters also cause injuries and, in some cases, long-term disabilities: in the 2010 Haiti earthquake, an estimated 2,000–4,000 people had limbs amputated due to their injuries.+M. Tataryn and K. Blanchet, Giving With One Hand … Evaluation of Post-Earthquake Physical Rehabilitation Response in Haiti, 2010 – A Systems Analysis (London: London School of Hygiene and Tropical Medicine, 2012), http://www.cbm.org/article/downloads/84419/Evaluation_of_Post-Earthquake_Physical_Rehabilitation_Response_in_Haiti__2010_-_a_systems_analysis.pdf, p. 7. Disasters worsen existing disabilities, as the health of those with impairments or chronic diseases may deteriorate when medication and medical support are disrupted.

5.5.1 Disability and vulnerability: a social perspective

Traditionally, disability has been viewed from a narrow medical or charity perspective. The medical approach defines disabled people by their individual impairments (which can be of many kinds, physical and mental, including impaired sight or hearing, lack of mobility and difficulty in understanding or communicating). The charity model assumes that they are to be pitied and helped. But disability should be seen in wider social terms: as the social consequence of having an impairment, or as the result of the interaction between a person’s impairment and external obstacles such as physical barriers and prevailing attitudes that prevent disabled people from participating in society.

Disability is linked to economic and social vulnerability and exclusion. Disabled people are more likely to be poor, without education, isolated and marginalised, misunderstood or avoided by neighbours, excluded from community structures and either dependent on others or assumed to be so. Some specialists in disability believe that, because disabled people lack status in their communities, little effort is made by those communities to save them from disasters: there is anecdotal evidence of them being abandoned in crises while others flee to safety.

People with disabilities are also frequently overlooked in disaster planning and marginalised in disaster practice. They are often invisible to outsiders, hidden within households by culture and stigma, fearful that identifying themselves as disabled will lead to prejudice or abuse, and missed out of census or other registration mechanisms. It is assumed that they need specialist support and so they are referred to other, usually medical, specialists, although their basic needs are the same as everyone else’s. Construction of accessible buildings and public facilities does not take place because it is thought to be too expensive.

5.5.2 Working with disabled people to reduce risk

A number of steps can be taken to support people with impairments. Many are simple and inexpensive. The first step is to identify who is disabled, the nature of their disability and how this will increase their risks to known hazards. In some countries and locations this is done through formal disability or special needs registers compiled by governments, health authorities, universities or NGOs. Pakistan’s Information Resource Centre on Disability, set up in 2009, collects data through a network of disabled people’s organisations, including such information as identity card numbers, basic facts about their disabilities and their locations. The database was used by responders to the 2010 floods.+‘Analysis: How To Make Disasters Less Deadly for the Disabled’, IRINNews, 16 September 2013, http://www.irinnews.org/report/98758/analysis-how-to-make-disasters-less-deadly-for-the-disabled. Such databases are not widespread, however, largely due to the difficulty and cost of collecting and updating data. On a smaller scale, VCAs (see Chapter 3) can perform this role, but conscious effort is needed here, since in practice VCAs often overlook disabled people (see Case Study 5.6: Overlooking disability in VCAs). Further steps can then be taken to raise awareness of the risks they face and how to deal with them, improve the security of homes and workplaces, assist them to move to safe places when severe hazards threaten, and attend to their specific needs during and after an emergency.

Disability specialists recommend a ‘functional’ approach to supporting disabled people’s disaster coping. This means thinking flexibly about addressing a broad set of function-based needs (e.g. communication, medical needs, maintaining functional independence, mobility) and reflecting the capabilities of the individual, irrespective of their specific diagnosis or status. Particular effort is needed to support people with mental health needs, as they tend to be even more excluded than people with physical impairments.

Case Study 5.6 Overlooking disability in VCAs

The aims of a VCA should be to identify vulnerable groups, the factors that make them vulnerable and how they are affected, assess their needs and capacities and ensure that projects, programmes and policies address these needs. In theory, therefore, VCA offers a good opportunity to incorporate disabled people’s needs and resources into DRR programming, and disabled people are sometimes mentioned explicitly as a category of vulnerable group in guidelines on how to carry out a VCA. However, a recent study of a number of assessments, carried out in a range of locations and at different scales by a variety of agencies, indicated that, in practice, disability was generally disregarded or received only a passing mention. Even in VCA manuals, disabled people’s capacities were overlooked, and they were not given opportunities to participate in community assessments. The study concluded that there was a need to change the core attitudes of disaster professionals towards disability, as well as those of communities.

J. Twigg, ‘Attitude Before Method: Disability in Vulnerability and Capacity Assessment’, Disasters, 38 (3), 2014.

Methods for communicating risk and early warnings should be appropriate to the nature of the disability. Examples include printed material in large type or braille for partially-sighted or blind people, sign language on television broadcasts for the deaf and face-to-face discussions with people with learning difficulties or other problems that may affect their understanding of messages. Field staff should be trained to communicate with disabled people effectively. Public shelters need to be organised with their needs in mind (see Box 5.4 Good practice in emergency shelter management).

Box 5.5 Good practice in emergency shelter management

The main elements of good disability practice in communal shelter management include:

  • ensuring equal access (this includes accessible parking, exterior routes, entrances, interior routes to the shelter area and toilets serving the shelter area);
  • shelter staff (professional and volunteer) are trained in meeting disabled people’s needs and plan for them in advance;
  • availability of food, including special diets;
  • provision of technical support (e.g. access to electricity for medical and mobility devices and refrigeration for medication);
  • use of appropriate methods of communication (visual, audio and interpreters);
  • appropriate and sufficient medical and volunteer assistance is available (including families, personal support networks, and where appropriate care animals);
  • promoting and sustaining disabled people’s independence and safety when sheltering;
  • involving people with disabilities in shelter planning;
  • monitoring and evaluating shelter activity and practice; and
  • assistance in returning home, or provision of/assistance in finding temporary accommodation for those unable to return to their homes immediately after an event.
J. Twigg et al., ‘Disability and Public Shelter in Emergencies’, Environmental Hazards, 10 (3–4), 2011.

Improvements to the physical environment give greater protection and make evacuation easier. Homes, offices, escape routes and emergency facilities should be designed (or redesigned) with disabled people’s needs in mind. This might include securing furniture and providing ramps, handrails, pathway marking systems, special signage and wider passageways and staircases. The concept of universal design is helpful here: this is an approach to the design of products and environments to make them as usable as possible by as many people as possible, regardless of age, ability or situation.

Disaster preparedness plans must recognise that people with disabilities often need more time to make necessary preparations for an emergency and to move to a place of safety. Staff training will be needed here, in communicating with disabled people, assisting them and using relevant equipment; staff also need to be aware of the diversity of impairments and needs, to make sure nobody is left out. Many disability and disaster organisations recommend the formation of personal support (also known as self-help or ‘buddy’) groups. These groups typically comprise three or more people known to the disabled person and trusted by them – family members, friends, neighbours or colleagues – who are aware of the person’s needs, work with them to make preparations for potential disasters (including emergency bags containing essential items such as medication and assistive devices), and support them during crises.

One key principle is that a person with disabilities should always be seen as the expert on their own disability. Another is that they are often able to help themselves, given the right resources and opportunity. Although some do indeed require considerable help, many disabled people have skills, experience and other capacities that can be utilised in a disaster. In some crises they may have a psychological advantage, making them less liable to injury or panic, because they have to deal with difficult physical and environmental limitations daily.

Agency staff and community volunteers ought to be trained to support the independence and dignity of people with disabilities or impairments. Modern approaches to disability and development place greater emphasis on participation. People with disabilities are increasingly demanding that they are not simply treated as problems to be solved by planners, but as part of society, entitled to equal opportunities and rights. Some disability activists believe disabled people should be more assertive and demand to be included in DRR planning. Plans involving disabled people and partnerships between DRR and disabled people’s organisations must be developed in advance of an emergency, but it seems that there is little contact between them in normal times. Disaster managers tend to discuss disability questions with other disaster managers; disabled people’s organisations tend to discuss disaster issues with other disability agencies.

Like other marginalised groups, disabled people should be involved in DRR planning, implementation and monitoring. Their participation in VCA is key to identifying vulnerabilities, needs and resources. It can also build their confidence, raise their profile within communities and help them to create or strengthen social contacts. However, careful consideration must be given to the most effective ways to engage them, as some standard participatory methods may be unsuitable (for example, transect walks for people with mobility difficulties). Community vulnerability mapping, on the other hand, does appear to be a valuable entry point for developing a collective understanding of whom a community considers to be disabled and why, as well as starting discussion about their situation. Specific questions about disability can also be included in interviews and surveys.

Case Study 5.7 Disabled people and disaster planning

In 2012–13 the Council of Persons with Disabilities Thailand was invited by the Thai military to take part in humanitarian assistance and disaster response training exercises in order to incorporate perspectives on inclusive disaster management.

In Quang Nam Province, central Vietnam, a joint project between the government and the NGO Malteser International engaged disabled people, their caregivers and their organisations in village-level early warning and evacuation planning. Disabled people were given training and support to take part in village disaster risk management committees, with the result that all 47 villages in the project produced disability-inclusive plans that included door-to-door warnings and priority evacuations.

C. Axelsson, Disability Inclusive Disaster Risk Management: Voices from the Field and Good Practices, Disability Inclusive DRR Network for Asia and Pacific/Christian Blind Mission, 2013, http://www.cbm.org/article/downloads/54741/Disability_Inclusive_Disaster_Risk_Management.pdf.