The International Classification of Functioning, Disability and Health (ICF) defines disability as a complex phenomenon, reflecting the interaction between features of a person’s body and features of the society in which he or she lives (WHO, 2002). Using this ICF definition of disability, it is estimated that over a billion people worldwide have some form of disability (WHO & World Bank, 2011).
Several conventions and treaties have been put up mainly to improve the plight of refugees with disabilities such as; The Convention on the Rights of Persons with Disabilities (CRPD) and its optional Protocol that was adopted on 13th December 2006 at the United Nations headquarters in New York where in Article 18, it calls upon States Parities to recognize the rights of persons with disabilities to liberty of movement, to freedom to choose their residence and to a nationality, on an equal basis with others; and Article 11 explicitly addresses protection of persons with disabilities in situations of risk, including armed conflict, humanitarian emergencies and the occurrence of natural disasters.
The World Programme of Action (1982) also pinnacles the situation of displaced persons where it calls for the removal of social and physical barriers that confront persons with disabilities among refugee populations. The Standard Rules on the Equalization of Opportunities for Persons with Disabilities (1993) as well calls for the equalization of opportunities of refugees with disabilities to be integrated into general development programmes (Rule 21). Much as all these policies have been put up, a lot is still desired as far as improving the plight of women and children with disabilities is concerned.
As of 2011, the United Nations High Command for Refugees (UNHCR), defines a refugee as a person “who are outside their country of nationality or habitual residence and unable to return there owing to serious and indiscriminate threats to life, physical integrity or freedom resulting from generalized violence or events seriously disturbing public order”.
Specific data on refugees with disabilities is limited (Rohwerder, B., 2017), however what is known is, as of 2019, nearly 26 million refugees around the world have been forced to flee their homes and around half of these are children under the age of 18 with women and girls accounting for 50 per cent of the world’s refugees (UNHCR, 2019).
It is evident that in situations of wars and natural disasters where people are forced to flee their homes and countries for safety of their lives, disabilities in form of physical, intellectual, sensory, and mental impairments are bound to happen. In all these harsh conditions, UNHCR, (2011) notes that refugees with disabilities are more likely to be sidelined in every aspect of humanitarian assistance due to physical, environmental and societal barriers against accessing information, health and rehabilitation services and human rights protection. Therefore it is with this background that challenges faced by refugee women and children with disabilities who are most vulnerable be highlighted so that host governments and other humanitarian agencies address them so that the conditions of these individuals are improved.
Refugee status in Uganda
In a recent UNHCR Refugees and Asylum-Seekers report on Uganda dated 29 February 2020; Uganda tops the list in Africa in hosting refugees and stands fourth in the world, hosting a total of 1,411,098 of refugees and asylum seekers that are hosted across her 14 refugee settlements with Bidibidi in Yumbe District-West Nile being the largest hosting 232,109 refugees. In the same UNHCR report, most of refugees hosted in Uganda are from South Sudan at 873,741(61.9%) followed by DRC at 409,882 (29%) ( UNHCR, 2020).
General state of Disability issues in Uganda
Uganda has ratified the United Nations Convention on the Rights of Persons with Disabilities (CRPD). Besides this, Uganda has friendly laws and policies relating to disability rights such as; The National Council on Disability Act 2003 (with additional amendments in 2013); The 2006 Disability Act; The 2006 Equal Opportunities Commission Act; The 1997 Local Government Act and the 1996 Children’s Statute (with amendments in 2016). Also a number of policies and policy guidelines support interventions for persons with disabilities that include; The 2015 Orphans and Vulnerable Children Policy, the 2006 National Policy on Disability; The 2012 Disability Guidelines and the Alternative Care Framework. Albeit all these laws and policies in place, there is still long way to go as far as implementing these policies fully is concerned.
Recent findings from Uganda Functional Difficulties Survey (2017), indicate that 17 per cent of adults (aged 18 years and above), 7 per cent of children aged 5 to 17 years and 4 per cent of children aged 2 to 4 years had a disability. This survey highlighted different categories of disabilities such as visual disabilities, hearing disabilities, mobility and upper body functioning; mental disabilities and other conditions such as dwarfism and albinism. Of these categories, Psychosocial and /or intellectual difficulties under mental disabilities were most among adults and children followed by difficulty in walking/climbing under mobility disabilities (Uganda Bureau of Statistics, 2018).
In Uganda major causes of disabilities according to Uganda Functional Difficulties Survey (2017), among children aged 2 to 17 years, were congenital (i.e., from birth) or because of sickness such as malaria (10%) and measles (5%). The survey further reports that causes of disability among adults were congenital & home accident (each standing at 7%) followed by road traffic accidents and violence at 4% and 3% respectively. With no doubt the environment and setting in which refugees live in makes them get more prone to all these causes predominantly congenital, malaria and violence.
It should be noted that lack of adequate, reliable, relevant and recent information on the nature and prevalence of disability in Uganda and in particular among refugee populace remains a challenge.
Challenges faced by refugee women and children in Uganda’s refugee settlements
Refugees with disabilities are frequently faced with discrimination challenges from their peers and even their community at large. Considering the Uganda Functional Difficulties Survey (2017), that described discrimination as unfair treatment in various aspects of life, such as: relationships, religious, cultural and social day-to-day activities where for all forms of discrimination, more adults with disabilities experienced discrimination (41%) where as children aged 5 to 17 years with disabilities that experienced discrimination stood at 28%.
Women of reproductive ages and are with form of disability in most cases have been denied their sexual and reproductive health (SRH) rights, yet universal access to sexual and reproductive health is a fundamental human right and its goal number three on the Sustainable Development Goals where efforts to improve sexual and reproductive health worldwide have been laid out in relation to good health and wellbeing, and gender equality (Starrs AM et al., 2018).
Accessing reproductive health services such as family-planning, prenatal care, safe delivery, post-natal care, appropriate treatment of infertility; treatment of reproductive tract infections, sexually transmitted diseases, including HIV/AIDS; breast cancer and cancers of the reproductive system is a major challenge in refugee settlements especially by women who have any form of disability. This is because most of the health facilities that could provide such services are at a distance yet some of these women have mobility challenges. For example in Kyangwali refugee camp, accessing health facilities such as Maratatu, Rwenyawawa, Ngruwe, Kasonga and Mombasa is not easy for women because they are too distant like 10-18km away. For Kinryandongo Refugee settlement, the nearest Health centre III which is located in the refugee settlement is 20 Km away from the Kimogola village host community and yet the village is remote and poorly served with access roads. All these make the lives of those children and women with disabilities even more complicated.
Furthermore, Uganda Functional Difficulties Survey (2017) reports that women with disabilities often feel disrespected while accessing health facilities. The survey shows that 9% of persons with disabilities felt disrespected or humiliated by the treatment and behavior of staff at health facilities while 7% of females reported that they had been mistreated when seeking help for physical problems. This is problem of disrespect and humiliation can be worse in humanitarian settings due to limited health facilities and sometimes attitudes of healthy workers.
Women and girls with disabilities are frequently exposed to sexual and gender based violence, domestic abuse and physical assault. Most of those with intellectual and mental disabilities are regularly exploited and neglected from the community either by their own fellow refugees or host communities. Their life is further toughened by the fact that they may have difficulty in accessing support and services that could reduce their risk and vulnerability (Pearce, 2014). In a 2007 report by Rachael Reilly to assess the situation of those living with disabilities among displaced and conflict-affected populations, it was revealed that in the Dadaab refugee camp in Kenya, Somali children with disabilities were sometimes tied up and had stones thrown at them, or suffered verbal abuse from other people in the community. It was also revealed by Trani et al., (2011) that young girls with disabilities are especially vulnerable to violence and abuse on their journeys to school in conflict affected states. Anecdotal reports inform the same type of mistreatment and abuse in Uganda’s refugee camps especially those in Adjuman and Yumbe districts in West Nile.
In most African cultures, it is reported that mothers are often blamed for their children’s disabilities and may suffer physical or sexual abuse from their husbands and other family members. This has increased stigmatization among these mothers and for those elderly women with disabilities, it has been widely reported that they are abandoned by their family members making them exposed to numerous challenges of life as it may be hard for them to access basic health care.
In regards to education access, refugee children with disabilities attending schools are extremely low. In most of Uganda’s refugee settlements, enrollment by children with disabilities is low and at the same time dropout rates is high to those few who happen to enroll due to diverse challenges they face such as lack of appropriate teaching aids, flexible curricula and assistive learning devices. Also lack of special needs support staff and some schools being located far away from homes made it hard for those children with physical disabilities to reach. Even when they can reach those schools, buildings are physically inaccessible for those ones on wheel chairs due to poor structural designs that do not favor this category of people. Another issue that discourages most of these children with disabilities in refugee settlements to attend school was language barrier. For example in most refugee camps in West Nile such as Rhino camp and Bidibidi, teachers were teaching in English yet these children from South Sudan were initially taught in Arabic in their home country before flight. This greatly demotivated them from proceeding with school.
Safety challenges are seriously faced by refugee women and children with disabilities where most of them have ended up losing their lives or getting more severe injuries in case of danger. For example women and girls with disabilities reported finding it difficult to escape violence in conflict affected parts of northern Nigeria and were often abandoned (Jerry et al., 2015). This is eminent that the same happens in Uganda’s refugee settlements as well mainly because those with hearing and visual impairments may not see or hear what is going on and thereafter may find themselves in traps of the enemy due to the environment they live in.
Livelihood challenges such as lack of income generating opportunities due to the fact that these women with disabilities are often discriminated. For example Refugee women with disabilities living in urban contexts report that poverty and a lack of income-generating opportunities increase the likelihood that they may engage in sex work and/or exploitative relationships (Rosenberg, 2016). This has been hardened by the fact that they cannot favorably compete for humanitarian assistances given to them as they are outcompeted by their counterparts who have no disability challenges.
Policies that integrate both disability and gender should be translated to local community leaders so that they can understand them in order to easily defend and protect the rights of those with disabilities. This can be done through practical on ground trainings with all stake holders. With this being done, community leaders and stake holders’ negative attitude to people with disabilities can easily be overcome.
Identifying capabilities and skills possessed by women and girls with disabilities should be focused on and supported rather than focusing mostly on their weakness. In some refugee camps such as Bidibidi, fast cash based beneficiaries have been extended to refugees, but this has not been the case to those with disabilities. This therefore calls for equal consideration to even those that are vulnerable. When this is done, women refugees can be empowered and in the long run they can improve on their own individual conditions.
Reproductive health issues of women and adolescents with disabilities should take a Centre stage at all times by planners. Village health teams should be facilitated to reach out to different homes where these categories of people are so that issues relating to reproductive health are addressed such as family planning, antenatal and post natal attendance, all of which will reduce risks such as forced sex, violence, maternal mortality and morbidity among these refugees with disabilities.
Additionally regarding reproductive health rights, in almost all refugee settlements in Uganda, information gap about family planning and low male involvement in maternal health issues of their wives is reported. This can be even worse among those with disabilities. Therefore community leaders, health workers have a duty to ensure relevant information is disseminated to all in a comprehensible language so that access to these services is improved.
Teachers should be taught and trained with special needs education so that they learn how to handle learners with disabilities in these refugee settings. This can be done by government through ministry of Education and other humanitarian agencies. Brails for visually impaired learners can be provided; wheel chairs can also be extended to those learners with mobility challenges. Above all environmental settings of schools should be designed in the way that they favor learners with disabilities where walk ways, buildings that are easily accessed by these individuals are put up both at schools and health facilities in these refugee settings.
Counseling services should be enhanced especially to those refugees with disabilities that have faced gender based violence including sexual violence that is highly reported in these settings. Counseling brings about psychological healing and reduces mental disabilities.
Cultural beliefs and practices that have continued to block opportunities for refugee women with disabilities need to be discouraged. For example anecdotal findings in Nakivale refugee camp in western Uganda, revealed that existing family planning services are very low because the refugees believe that the more you produce more number of children, the more the chances of accessing food aid. Culturally it was also found out that most women have no power to determine the child control as men are not comfortable with stopping child production and they influence and control the decisions. All these beliefs and practices affect women with disabilities critically and should be discouraged at all times due to their imminent challenges.
It is evident that a lot of factors have contributed to the many troubles facing refugee women and children with disabilities in Uganda’s refugee settlements. Some of these factors include negative attitudes of family members, health practitioners and the community. It is also no doubt that gaps in policy implementation have remained where most of good policies have kept on paper and follow up to ensure that these policies are executed on ground is less.
The government of Uganda through the office of the prime minister and ministry of Gender and social development plus humanitarian organizations including local partners should prioritize issues facing refugee women and children with disabilities in order to improve on their plight in their communities.
This article is dedicated to all women and men all over the World who have advocated greatly the rights of individuals with disabilities, your efforts are greatly treasured.
Jerry, G., Pam, P., Nnanna, C., & Nagarajan, C. (2015). What violence means to us: women with disabilities speak. Nigeria Stability and Reconciliation programme & Inclusive Friends.
Pearce, E. (2014). Disability Inclusion: Translating Policy into Practice in Humanitarian Action. WRC.
Rohwerder, B. (2017). Women and girls with disabilities in conflict and crises. K4D Helpdesk Report. Brighton, UK: Institute of Development Studies.
Rosenberg, J.S. (2016). Mean Streets: Identifying and Responding to Urban Refugees’ Risks of Gender-Based Violence – Refugees with Disabilities. WRC.
Starrs AM, Ezeh AC, Barker G, Basu A, Bertrand JT, Blum R, et al. Accelerate progress-sexual and reproductive health and rights for all: report of the Guttmacher-Lancet Commission. Lancet. 2018; 391(10140):2642–92.
Uganda Bureau of Statistics (2018). Uganda Functional Difficulties Survey 2017. Kampala, Uganda.
United Nations High Commissioner for Refugees, UNHCR. Figures at a Glance-Statistical Yearbooks. 2015.
World Health Organization and World Bank, 2011, World report on disability, viewed 10 December 2020, from http://whqlibdoc.who.int/publications/2011/9789240685215.
World Health Organization, 2002, Towards a common language for functioning, disability and health: The international classification of functioning, disability and health, viewed 23 November 2020, from http://www.who.int/classifications/icf/ training/icfbeginnersguide.pdf
World Health Organization, United Nations Population Fund: Promoting sexual and reproductive health for persons with disabilities WHO/UNFPA guidance note. World Health Organization; UNFPA, Geneva, New York (2009).