Introduction
Conflict and disaster often put people at greater risk of discrimination and/or victimization especially vulnerable groups such as elderly female children and those with existing disabilities or chronic health conditions. In some cases this can also include specific ethnic or religious backgrounds minorities who face disproportionate risk in times of disaster and conflict.[1] [2] While some of the causes of this vulnerability may be endogenous, it is generally due to environmental or societal factors that preceded the disaster and conflict. Medical and cosmetic professionals any factors that may make certain groups of people more vulnerable should be identified and addressed. It should be recognized that health priorities cannot be adequately assessed without considering the specific vulnerability of these groups to risk and conflict when acknowledge that these groups are not homogeneous and that the risks they face vary from individual to individual based on the interaction of both individual and environmental factors.[2] Rehabilitation professionals are likely to interact with these groups as part of their role. They’ve been done knowledge to understand the challenges faced by these groups and have an important role to play in protecting vulnerable populations. As such they should engage with all available humanitarian protection mechanisms to raise any concerns encountered.[3]
Children
As the frequency and severity of disasters increases worldwide, children are among those most at risk from the risk posed by a disaster. They represent a significant proportion of those coping with long-term catastrophic risks.[2] Children are a superior being a vulnerable group especially infants and young children who are partially or totally dependent on adults. Older children and adolescents are psychologically and physically fragile and may experience post-traumatic stress disorder or related symptoms. They get death injury disease and torture and often have to cope with disruption or a delay in their educational achievement after a disaster. Policies that protect children and young people including family and community policies are often impacted by disaster and conflict. Children may be separated from their families and this situation puts them at increased risk of injury and exploitation including human trafficking or recruitment by armed groups.[4]
As rehabilitation professionals, we need to recognize the physical and emotional vulnerabilities and consider the types of material social psychological and emotional support that infant children and adolescents may require compared to adults. Again after disaster and conflict situations in which children’s voices are often not heard[6] and as a result children’s rights and needs are often inadequately addressed. This has long-term negative consequences for them and their communities.[7] The consequences of disaster and conflict include decline children’s physical health and emotional and psychological well-being in both the short and long term. Table 1 shows the vulnerabilities faced by children and young people in the context of risk and conflict including affecting factors.
Table 1. Various vulnerabilities of Children in disasters and conflicts and factors affecting vulnerability[5]Physical vulnerabilityMental vulnerabilityEducational vulnerabilityVarious vulnerabilitiesChildren exposed to disastersDeathInjuriesDisease and illness Poor nutritionHeat stressPosttraumaticAbuseAnxietyDepressionEmotional problemsSexual problemsSomatic complaintsBehavioral problemsLack of school attendance Delayed academic achievementDelayed achievementFailure to complete educationFactors Vulnerable to Children in DisasterPoor neighborhoods in hazardous areasLiving/going to school in substandard housingLoss of a parentFamily separationChild characteristics (ethnicity age gender etc.)Size strength stage of developmentPoor nutritionParental distressInsecure housing/ unhygienic Accommodation.Life bullyingFamily separationDeath of a loved oneLoss of propertyDamage to home/schoolDirect exposure to disaster or media involvementChild characteristics (race age gender etc.)Poor performance pre-disasterParental distressLow social supportNew life stressorsPoor coping skills Inability to cope with new life stressors supportMovement damage to school buildingsLoss of displaced students and teachers Loss of vital recordsDelayed enrollmentMore school transitionsFamily instability Undesirable/unsupportive school environments Poor academic achievement before and disaster looms Loss of parent / guardianIncreased workload requirements
All countries except the United States have ratified the United Nations Convention on the Rights of the Child (UNCRC), which provides a comprehensive code of rights that provides the highest standards of protection and assistance for children. The UNCRC is a legally binding international agreement setting The civil, political, economic, social and cultural rights of every child, regardless of race, religion or ability, apply to all children within the jurisdiction of each state, whether they are nationals or not. Organizations engaged in humanitarian response should With child protection policies in place, it is critical that rehabilitation professionals become familiar with and follow these child protection guidelines.
Health care at risk – the responsibilities of health care workers working in armed conflict and other emergencies highlights the following questions that rehabilitation professionals can use to guide their thinking about how to support children and young people in the aftermath of disasters, and [8] Do children have unimpeded access to health care? If not, what is the reason? Pervasive insecurities? Economic or cultural constraints? Are children particularly vulnerable to, for example, abduction for trafficking in sexual violence or forced membership in armed forces or armed groups? Trying to get health care services? Do I know what I should do with an unaccompanied child, such as agreeing to treatment and discharge? [8]
Women
Gendered cultural and social norms provide significant sources of inequality and exclusion for women worldwide. They often manifest themselves through economic and political consequences including gender inequality in areas such as schools and universities an asset-based participation of the labor force enrollment coupled with lower social skills and lower autonomy and mobility. Given this pre-disaster and conflict status of women it is not surprising that women are generally more likely than men to be injured or killed during disasters and that violence against women and girls can escalate in emergencies. Women also face increased care tasks such as providing food and water and caring for the sick and injured after disasters and conflicts which further affects their participation.
The 1979 Convention on the Elimination of All Forms of Discrimination against Women and the 1999 Optional Protocol to the Convention on the Elimination of All Forms of Discrimination against Women protect women’s rights in times of disaster. Another minimum standard for Safety Gender is The Emergency Response Framework, developed by the International Committee of the Red Cross, provides rehabilitation workers with minimum standards for gender protection and inclusion limiting exposure to risks of violence and abuse and ensuring that emergency systems “do no wrong”. As recovery professionals we can advocate for the inclusion of women in disaster planning at all stages including recovery. It will contribute to resilience and women’s empowerment and reduce stereotypes and discrimination about women’s roles without harm and. conflicts but throughout their environment.
Healthcare at Risk – The Responsibilities of Healthcare Workers Working in Armed Conflict and Other Emergencies highlights the following questions that rehabilitation professionals can use to guide their thinking about how to support women and girls in the aftermath of disaster and conflict. [8] Is there unimpeded access to healthcare? If not, what is the reason? Pervasive insecurities? Economic or cultural constraints? Does local custom dictate that women should only be treated by female healthcare workers? Are women particularly vulnerable to harm such as trafficking or sexual violence When trying to get or benefit from health care? What can I do to curb practices like female genital mutilation and lessen their impact? What child care facilities are available to women seeking health care? Can I guide women in health education program planning that includes families? is female Who has to pay for their health care or that of a family member vulnerable to sexual exploitation? [8]
Older Persons
The success of industrialization and advances in modern medicine and technology have led to an increase in average life expectancy and a consequent increase in the proportion of the population over the age of 60. The United Nations defines an older person as anyone aged 60 and over. according to According to the World Health Organization (WHO), there were 600 million people over the age of 60 in 2000, and this number is expected to increase to 1.2 billion by 2025 and 2 billion by 2050, with those affected by humanitarian crises The number is increasing. [9] Pre-existing conditions and positions Compounded by the specific problems and risks posed by crises and emergencies themselves are the main challenges and protective factors affecting older persons in humanitarian crises. These can be found at the individual community and structure levels. Older people often compound other forms of Vulnerabilities or inequalities, such as gender, race, education level, income, health status, or access to justice accumulated over a lifetime. When older persons are unable to fully enjoy their rights during normal times, their vulnerability in emergencies may increase:[10]
Figure 1. Distribution of People Aged 60+
- Older people who had pre-existing conditions including emotional and communication difficulties have been shown to be more likely to be seriously injured or killed as a result of accidents and conflicts
- Older persons are neglected in both disaster risk reduction strategies and emergency response, and are not prioritized for medical and rehabilitation services
- Social isolation and reduced access to care support can lead to more difficult access to basic needs, including food, water, shelters and toilets, and can mean that older people face higher risks related to safety, protection and dignity, and are vulnerable to violence and exploitation. these factors can [11][12] It also contributes to worsening health conditions during disasters and conflicts.
- Older people may also face a variety of security issues resulting directly from the disaster and conflict with human rights violations committed by armed groups of states or other international or national actors or may result from crises a it has individual family or community results.
Table 2. Safety Issues Faced by Older People in Disasters and ConflictsAt the level of national armed forces and international actorsAt individual family and communitySafety and security:Physical risk or harm – reduced regenerative capacity and challenges a about transport puts older people greater risk of injury and makes them more vulnerable to the long-term effects of an injury.Violence:Acts or threats of physical sexual or psychological abuse. A cycle of dependency discrimination and isolation may place older people at risk for abuse within the family. Among local officials people can become victims of perceived vulnerability.Residential land and property rights:Interference or discrimination against construction land property and features with difficulties in proving ownership due to ownership lost documents and increased number of a eviction.Neglect and deprivation:May prevent older people from accessing needed goods and services. This may be unintentional or may result from intentional discrimination.Documents:Loss or destruction of personal documents (such as ID birth certificate or marriage certificate) . and difficult to replace.Isolation and dependence:The lack of support and social connections exacerbates the isolation of the elderly as much as increased support a required in day-to-day activities.Freedom of movement:Restrictions on rights of residence or business travel at any level the country as well as to leave that country and return at any time.Family structure and family divisions:Family structure for example households headed by older people households headed by women or widow and households with multiple dependent children pose specific safety risks for the elderly people and their families.The undesirable family separation that affects the elderly increases their social isolation and reduces the amount of support making it difficult for the elderly to access goods and services if they need.Humanitarian principle of impartiality:Humanitarian assistance and are not provided according to need and are not discriminatory.Failure to ensure access and availability of services to older persons is a gross violation of the fundamental principle of non-discrimination.
There is currently no United Nations Convention on the Rights of Older Persons or universally applicable standards that can be used as a reference for legislation to protect the rights of older persons. This has not changed despite frequent calls for greater action to promote full enjoyment Older persons often remain neglected within the current international legal framework because of all the human rights enjoyed by older persons. The 1991 United Nations Principles for Older Persons [13] provide an authoritative framework for the rights of older persons, including independent participation in care Self-actualization and dignity that can be applied in emergency and humanitarian settings. The Madrid Plan of Action on Aging[14] is a practical tool approved by the United Nations General Assembly in 2002 to assist governments in addressing issues related to population ageing, including social Protecting Health Nutrition Urbanization Infrastructure Housing and Caregiver Training This also includes humanitarian disasters as one of eight key action areas, focusing on equal opportunity and inclusion. [2]
Figure 1. Checklist for Older Persons Involvement in Disaster Management
The humanitarian needs and demands of older people should be included in all phases of emergencies and humanitarian response, including engaging with older people to ensure their participation in decision-making. This helps reduce their vulnerability to further harm Equitable use of early warning systems and evacuation mechanisms for community-based risk reduction activities. Rehabilitation professionals have a role to play in this and can support the process by assessing the protection issues facing older people, including in all countries decision-making and advocacy for older persons during disasters and conflicts. Figure 1 outlines the key elements of including older persons at each stage of the disaster management process.
Health care at Risk – The responsibilities of health care professionals working in armed conflict and other emergencies highlight the following questions that you can use to guide your thinking about helping older people with after disasters and conflicts.[8]Do the elderly have problems reaching health care? Are their homes locked in?Are there any issues with how wars or other emergencies have affected the health of the elderly?Can the elderly claim their pension in order to pay for their health to me?
Persons with a Disability
It is estimated that over one billion people in the world today have a disability which corresponds to about 15% of the world’s population or one in every seven people. Between 110 million (2.2%) and 190 million (3.8%) aged 15 years and over have severe disability in employment, respectively while some 93 million children or one in 20 under the age of 15 suffer from moderate or severe disabilities. Since the adoption of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), disability has been firmly established as a human rights and development issue. There is a growing body of evidence that people with disabilities experience worse socioeconomic outcomes and poverty than people without disabilities. Article 11 on “Disasters and Humanitarian Emergencies” specifically focuses on the responsibilities of states to take “all measures necessary to ensure the protection and safety of persons with disabilities in dangerous situations including situations involving armed humanitarian emergencies and natural disasters ”[15] while Article 32 embraces the necessity that international cooperation to address the limited capacity of some countries to respond to disaster situations and humanitarian crises highlighting that emergency and humanitarian activities should include people with disabilities among.
People with disabilities may be disproportionately affected by disasters and conflicts, with evidence that the mortality rate for people with disabilities (2.06%)[16] is double or even quadruple that of the general population (1.03%)[16] in disaster settings. [2][17] In emergency situations People with disabilities may also be more likely to be forgotten, lose basic assistive equipment such as eyeglasses, hearing and mobility aids and/or medications, or be prevented from benefiting from humanitarian services due to a range of environmental, physical and social barriers. [18][17] They may They also have less access to basic needs, including food, water, shelter, toilets and healthcare services, may also face higher risks related to safety, protection and dignity, and may be particularly vulnerable to violent exploitation and sexual abuse. [17] Traditional Care Institutions within the community are also disrupted, and the capacity of carers and care settings to provide and support people with disabilities is often reduced, further increasing the vulnerability and risk of people with disabilities. [8]
There is growing recognition that inclusion of disability is critical to effective humanitarian response and many policy tools and guidelines have been developed worldwide to support the inclusion of disability in humanitarian assistance including the Charter on Inclusion of Persons with Disabilities in Humanitarian Services (2016) Humanitarian Inclusion Standards for Older Persons and Persons with Disabilities (2018) and Interagency Standing Committee (IASC) Guidance on Persons a Including Disabled Persons (2019). Despite all of this the existing guidelines still remain a significant gap in engaging people with disabilities in humanitarian assistance in the field. Further measures should therefore be taken to promote enhanced humanitarian inclusion of disability including:[19]
- Recognizing people with disabilities not only as recipients of humanitarian assistance but also as key actors in the response.
- Capacity building of humanitarian actors on the ground to ensure they are not only equipped with the knowledge on the ‘what’ of disability inclusion, but also have the resources to address the ‘how’ to ensure inclusion in humanitarian responses.
- Systematically integrate disability inclusion into key global agendas and ensure that it is no longer a separate, independent workstream but is considered closely related to other marginalized issues such as gender equality, age-sensitive programming and mental health mainstreaming Health and psychosocial support. [19]
The following webinar recording, organized by ICVA PHAP and the Inter-Agency Standing Committee (IASC), presents guidelines on the inclusion of people with disabilities in humanitarian assistance and discusses how the guidelines can be implemented in practice.
The needs and requirements of people with disabilities focusing on different types of disabilities should be included in all types of emergency and humanitarian interventions. This includes contacting disability organizations where they are to ensure their participation people with decision-making disabilities. This helps reduce their vulnerability to new hazards by providing access to community-based risk reduction activities early warning systems and evacuation procedures. Cosmetic professionals can support this process by adding to it people with disabilities in all decision-making processes and by ensuring that the plan focuses not only on those injured in the disaster but also includes all persons with disabilities.
Healthcare at Risk – The Responsibilities of Healthcare Workers Working in Armed Conflict and Other Emergencies highlights the following questions that you can use to guide your thinking about how to support people with disabilities in the aftermath of disasters and conflicts. [8] Do people with disabilities have difficulty accessing health care or rehabilitation services? Are they confined to their own homes? What means of transportation do they have? Are persons with disabilities discriminated against in access to health services, education, etc.? Which institutions provide Disability services? Is there information on how the facilities on which persons with disabilities depend, including health care facilities, have been affected by the conflict? Is there a risk of persons with disabilities being exploited due to insecurity Resulting from armed conflict or other emergencies? Can people with disabilities pay for medical expenses? [8]
Resources
Children
- Child Friendly Spaces in Emergencies Save the Children
- Children’s Rights in Disaster Information Sheet International Disaster Law Project
- Protecting Children in Disasters A Guide for Parks and Recreation Professionals Save the Children
- Child protection in emergencies – A toolkit for practitioners in Pacific Island countries UNICEF
- Participation of children and youth in emergencies UNICEF
Women
- Handbook for the Protection of Women and Girls UNHCR
- Gender Handbook for Humanitarian Action Interagency Standing Committee
- Minimum Standards for Protection Gender and Emergency Inclusion ICRC
- Protection Gender and Inclusion in Emergency Instruments ICRC
- Gender and Disaster Bibliography & Reference Guide Po 1 2nd Edition
- Gender and Disaster Bibliography & Reference Guide Po 2 2nd Edition
- Gender and Disaster Network
Older Person
- Inclusion Standards for Older Persons & Persons with Disabilities Age & Disability Empowerment Planning
- Aging & Disability in Humanitarian Response Aging and Disability Working Group
- Providing Safety Kits for Older People in Emergency Situations supports Age International
Persons with a Disability
- Inclusion of Persons with Disabilities in Humanitarian Services Interagency Standing Committee
- Inclusion Standards for Older Persons & Persons with Disabilities Age & Disability Empowerment Planning
- Emergency Disability Reference Manual for Humanity and Inclusion
- Aging & Disability in Humanitarian Response Aging and Disability Working Group
- Guidelines on Disability and Emergency Management for Health World Health Organization
- High Risk and Persons with Disabilities European and Mediterranean High Risk Convention
- A Quick Guide Towards Disability Inclusive Humanitarian Action Dutch Alliance for Disability and Development
- Mainstreaming disability in humanitarian action in 2021 – Field research by the Bangladesh Institute for the Law of Peace and Armed Conflict in Cox’s Bazar
- Case Study Collection 2019 – Integrating People with Disabilities in Humanitarian Action CBM International Humanity & Inclusion and International Disability Alliance
References
- ↑ World Health Organization and UNICEF. Guidance Note on Disability and Emergency Risk Management for Health. World Health Organization, UNICEF, Geneva, Switzerland. 2013. Available at: http://www.who.int/hac/techguidance/preparedness/disability/en/ [Accessed 09 March 2022].
- ↑ Jump up to:2.0 2.1 2.2 2.3 2.4 World Confederation for Physical Therapy. WCPT Report: The Role of Physical Therapists in Disaster Management. London, UK: WCPT; 2016
- ↑ Skelton P, Foo W. Responding Internationally to Disasters: A Do’s and Don’ts Guide for Rehabilitation Professionals. London, United Kingdom: Handicap International. 2016.
- ↑ Lathia C, Skelton P, Clift Z. Early rehabilitation in conflicts and disasters, 2020.
- ↑ Jump up to:5.0 5.1 Peek L. Children and Disasters: Understanding Vulnerability, Developing Capacities, and Promoting Resilience – An Introduction. Children Youth and Environments. 2008 Jan 1;18(1):1-29.
- ↑ A. Jabry, After the Cameras Have Gone – Children in Disasters (2nd ed, 2005) Plan International.
- ↑ J. Todres, ‘Mainstreaming Children’s Rights in Post-Disaster Settings’ (2011) Emory International Law Review 25: 1233-1261.
- ↑ Jump up to:8.0 8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8 International Committee of the Red Cross. Health Care in Danger: The Responsibilities of Health-care Personnel Working in Armed Conflicts and Other Emergencies. International Committee of the Red Cross; 2012.
- ↑ Office for National Statistics. Interim Life Tables, 2008–2010. http://www.ons.gov.uk/ons/rel/lifetables/interim-life-tables/2008-2010/index.html?format=hi-vis (accessed 28 Jan 2012)
- ↑ UNECE. Policy Brief on Ageing – Older Persons in Emergency. No. 25 November 2020
- ↑ Zhang L, Li H, Carlton JR, Ursano R. The injury profile after the 2008 earthquakes in China. Injury[Internet]. 2009 Jan [cited 2014 Jul 22];40(1):84 – 6. Available from: www.ncbi.nlm.nih.gov/pubmed/19117564 [Accessed on 05 March 2022]
- ↑ Allaire A. Protection interventions for older people in emergencies. HelpAge International; 2013.
- ↑ United Nations General Assembly. 46/91 Implementation of the international plan of action on ageing and related activities. [Internet]. 1991. p. A/Res/46/91. Available from: www.un.org/documents/ga/res/46/a46r091.htm [Accessed on 05 March 2022]
- ↑ United Nations. Political Declaration and Madrid International Plan of Action on Ageing. 2002. Available from: www.un.org/en/events/pastevents/pdfs/Madrid_plan.pdf [Accessed on 03 March 2022]
- ↑ Jump up to:15.0 15.1 United Nations, Division for Social Policy and Development Disability. Convention on the rights of persons with disabilities and optional protocol. [last accessed 22.03. 2022].
- ↑ Jump up to:16.0 16.1 NHK Fukushi Network Shuzaihan. Higashi nihon daishinsai ni okeru shogaisha no shiboritsu [Death rate among persons with disabilities in the eastern Japan earthquake]. Normalization, November 2011:61–63 (in Japanese) (http://www8.cao.+go.jp/shougai/suishin/kaikaku/s_kaigi/k_37/pdf/ref4–1.pdf, accessed 1 February 2013).
- ↑ Jump up to:17.0 17.1 17.2 World Health Organization, UNICEF. Guidance Note on Disability and Emergency Risk Management for Health. World Health Organization, UNICEF, Geneva, Switzerland. 2013.
- ↑ Disability-tsunami emergency response summary for ACFID, January 2005. Deakin, Australian Council for International Development, 2005.
- ↑ Jump up to:19.0 19.1 Inter-Agency Standing Committee. Inclusion of Persons with Disabilities in Humanitarian Action. 2019 Available from: https://interagencystandingcommittee.org/iasc-task-team-inclusion-persons-disabilities-humanitarian-action/documents/iasc-guidelines [Accessed on 03 March 2022]
- ↑ PHAPassociation. An introduction to the new Physiopedia Plus. Available from: https://youtu.be/0bJgGcyJylo[last accessed 12/03/22]