At an artificial limbs centre in Kabul. Credit: Najibullah Musafer/Killid/IPS

By Carey L. Biron
WASHINGTON, Feb 3 2014 (IPS)

The U.S. government is being urged to conclude a review of national policy on landmines that has dragged on for more than four years, a lag that some say has indirectly led to the injury or death of more than 16,000 people.

Rights and advocacy groups are now mounting a new campaign to urge President Barack Obama to finish the review, hold true to pledges that have been lingering for years, and formally join an international treaty to ban antipersonnel mines. In a letter sent to the president on Friday and publicly circulated on Monday, critics of U.S. policy on the issue urged the administration to sign on to the 1997 Mine Ban Treaty and to move to begin to destroy the millions of landmines that remain in the country’s stockpiles.“It’s a real paradox. The United States has shown extremely good behaviour on this issue in recent years, yet it still reserves the right to use these weapons." -- Mica Bevington

“Your administration’s review is now into its fifth year, and it is hard to understand why the process should be delayed any further, particularly after the administration said more than one year ago that the review would conclude ‘soon’,” the letter, signed by 17 rights, watchdog and advocacy groups on behalf of several hundred civil society organisations, states.

“We have repeatedly urged the US to fulfill its long-held intention to join the Mine Ban Treaty. U.S. accession would help to convince the other countries not yet party to join, strengthening the norm against the weapon, thereby ensuring it is not used in the future and creates no additional humanitarian and socio-economic harm.”

Some 161 countries are currently party to the Mine Ban Treaty, which came into effect in 1999. Last year just a few countries are known to have used antipersonnel mines, including Syria and Myanmar, but nearly three dozen remain outside of the treaty, including China, Egypt, India, Iran, Israel, Pakistan, Russia, South Korea, Sri Lanka and others.

The United States, meanwhile, is the only member of NATO not to have signed onto the treaty, as well as the only country in the Western Hemisphere other than Cuba.

“We believe that U.S. involvement in this treaty would deter others,” Steve Goose, the executive director for Human Rights Watch (HRW)’s Arms Division and a lead signatory of the new letter to President Obama, told IPS.

“These countries wouldn’t come onboard the day after the U.S. signs, but they would be affected by the fact that the United States has aligned itself fully with this new international standard.”

4,000 per year

The treaty, also known as the Ottawa Convention, bans the use, sale or stockpiling of landmines, while also mandating that members destroy all mines within their territories. The treaty is widely seen as having been successful in significantly bringing down the number of landmine-caused injuries and deaths, from about 25,000 per year to current levels of around 4,000 per year.

Needless to say, that number is still very high. Advocacy groups suggest that millions of landmines remain in upwards of 60 countries, some left over from as long ago as World War II, highlighting the uniquely dangerous nature of these weapons.

Broad recognition of the unacceptably long-lasting nature of anti-personnel mines led then-president Bill Clinton to decide, in 1997, that the United States would join the Mine Ban Treaty in 2006. While his successor, George W. Bush, reversed this decision, stating that the United States would never join the treaty, many had expected President Barack Obama to change course yet again when he took office in 2009.

Instead, in December 2009 the president announced that his administration would undertake a policy review. And while that review seems to have gotten off to a strong start, with administration officials reportedly talking to a broad group of stakeholders in 2010, its finalisation has since been held up repeatedly.

It is unclear what has slowed down the U.S. policy review. Some have pointed to a 2009 Pentagon statement suggesting it wanted to maintain the option of using certain mines in Afghanistan, while others say concerns over the possibility of war on the Korean peninsula could play a part.

The U.S. State Department was unable to comment for this story, though an agency official in December noted that the review was “pressing forward to conclusion”. Yet HRW’s Goose says recent weeks have seen a new flurry of action.

“This review has limped on now for almost five years, though we’ve been hearing that an announcement could now happen in coming days or weeks,” he says.

“That’s why we feel now is the time to try to push them over the hump, get the right decision made and have it announced publicly. We’ve gotten mixed signals about what the review will contain, but we’re optimistic that we’ll have a positive outcome.”

U.S. paradox

Particularly confusing for advocates is that fact that the United States has largely conformed to the Mine Ban Treaty’s mandates for decades. Indeed, since the early 1990s it has been the world’s most generous anti-mine donor.

Further, the U.S. military has reportedly not used antipersonnel mines since the Gulf War, in 1991, and has not exported any of the weapons since 1992. The country even halted all landmine manufacturing in 1997.

Nonetheless, the U.S. military continues to stockpile as many as 10 million landmines. And these, of course, remain available for future use unless new policy specifically bars doing so – or unless the government moves to destroy these caches.

“It’s a real paradox. The United States has shown extremely good behaviour on this issue in recent years, yet it still reserves the right to use these weapons,” Mica Bevington, communications director for Handicap International U.S., a charity that won the 1997 Nobel Peace Prize for its anti-mine work, told IPS.

“We feel that now is the time for the U.S. to put the other foot down and join the treaty. Doing so might encourage other countries – such as China and Russia – to join the treaty, and it would also ensure that these millions of deadly weapons are destroyed once and for all.”

Handicap International, which runs the world’s largest anti-mine operation, currently has de-mining and rehabilitation operations in 37 countries. The group says that 70 percent of the victims of landmines or unexploded ordnance are civilians, with nearly a third being children.

“With these injuries comes a community-wide sense of fear, and they require long-term support rehabilitation and attention,” Bevington says. “We need to put politics aside and remember that the victims here are people.”

The media and public perception play a role in how different conditions are treated and how the disabled view themselves. Credit: Bigstock

By Samuel Oakford
UNITED NATIONS, Oct 2 2013 (IPS)

When U.N. Secretary-General Ban Ki-moon opened a recent high-level meeting on disability and development that promised a place for the issue in the post-2015 agenda, he cited three examples of incapacity.

All three were stories of children or adolescents, even though the World Health Organisation estimates nearly 200 million adults have a functional difficulty.When aid is “solutionist", it only looks for problems where data lies, like the drunk who searches for his keys under a streetlamp and not where he dropped them.

Ban’s comments illustrate what many see as a key difficulty in representing disability, both in language and in the democratic decision-making process.

Activists say the lack of attention at the international level is not simply an oversight but a product of a confused conception of disability and the unique experiences of different groups of disabled people.

The reality, they argue, is that certain classes of disabled people coincide more easily with the orientation of international guidelines for healthcare intervention and with public understanding of health.

A dominant assumption in interventions is that “we save people because when we save them they are going to have a full life and produce a lot, so society benefits,” said Bruce Jennings, director of bioethics at the Centre for Humans and Nature and a lecturer at Yale University.

Saving lives means a country will have a more reliable workforce, a guarantee of vital importance in places like Sub-Saharan Africa where populations have been ravaged by HIV/AIDS.

But a focus on mortality puts those with severe and cognitive disabilities in a precarious limbo.

“What is the rationale for spending a great deal of resources for supporting the quality of life of people with severe cognitive problems when the usual answer our society gives for spending resources in healthcare is future productivity?” Jennings told IPS.

In developing countries, where 80 percent of the world’s disabled live, social integration and sustained healthcare for them can be financially unpalatable to governments when set alongside well-subsidised international measures that focus on vaccines for polio or cutting edge treatments for AIDS.

Programmes that focus on pharmaceutical solutions are seen as easier to account for in cost-benefit terms.

But for the disabled, there is often no pill to end their distress or help overcome social barriers. For severe cases, years of rehabilitation and attention from public sector healthcare are required.

“It’s a difficult subject to bring up,” said Antony Duttine, rehabilitation advisor at Handicap International.

“It’s perceived as quite costly to provide care and support but equally it’s a moral and legal issue that you have to look into.”

Whose voice?

As is true for many activists, those with first-hand experience of disability are often the clearest voices for progress.

“We need to include people with disabilities not just as the beneficiaries but the participants,” said MP Reen Kachere, minister of disability and elderly affairs in Malawi.

Participation is especially important in developing countries, said Kachere, where international projects have to navigate the historical question of paternalism.

“The disability advocacy community has very much been oriented towards inclusiveness and participation of individuals with impairments in the decision-making processes,” Jennings said.

A common refrain among advocates is “nothing decided for us without us.”

But participation raises the question of representation, he said.

“I’m not sure someone who has experience living in a wheelchair is a good representative for someone with cognitive impairments,” noted Jennings.

Because of how varied conditions are, differences arise in how integrated the disabled feel in society.

“It is relatively easier for a person who is blind or a person with physical disability to access services, but there is much more stigma attached to cognitive disabilities,” said Gopal Mitra, a programme specialist for children with disabilities at UNICEF.

“Disability is not a homogeneous group,” he told IPS.

The media and public perception play a role in how different conditions are treated and how the disabled view themselves.

In the United States, victims who lost limbs when bombs went off at the Apr. 15 Boston marathon have received millions in crowd-sourced medical care. At the same time, more than 50,000 U.S. diabetes patients undergo lower extremity amputations each year. Worldwide, someone loses a leg to diabetes every 30 seconds. All of them will require lifetime care.

Images of children or victims of a tragedy are easier to digest for the public than those whose descent into incapacity is slow or genetic. Physical disabilities are easier to understand than mental ones, and as a result societies are more likely to allocate money to that which they can comprehend, said Jennings.

“There is an image of the disabled as being physically limited and cognitively sound,” he said. “By having the public have a person in a wheelchair be the paradigm of disability in their mind and thinking that we deal with disability if we have wide doors and lifts on public buses is an unfortunate mistake.”

Even as organisations catch up with contemporary theory on the fluidity of gender and sexual orientation or the vastness of the disability spectrum, their efforts can still be constrained.

The problem, as disability activists see it, comes in large part from the total lack of language concerning the disabled in U.N. Millennium Development Goals (MDGs). See Part One

The result can be a self-perpetuating cycle.

“Countries are not tracking and reporting progress on children and adults with disabilities as far as MDG achievements are concerned,” said Mitra. “Countries are not connecting data. Unless you have numbers, it is difficult to plan or allocate resources.

“However, the point is 15 percent of the world’s population is people with disability. If you don’t include this 15 percent no development goals can be achieved.”

At its worst, say critics, when international aid is “solutionist”, it only looks for problems where data lies, like the drunk who searches for his keys under a streetlamp and not where he dropped them. And disability is notoriously hard to define and track.

Though an understanding of the different forms of disability may allow society to better help, the ultimate solution may be the idea of a common shared experience.

“I think the rational is solidarity, empathy, dignity, mutuality, equality and respect,” says Jennings. “It’s very hard to put a metric on those.”

Excerpt:

Orlando Javier Salgado Rubi (front, left), Minister Advisor on Disability Affairs of Honduras, speaks about the "The post-2015 development agenda and inclusive development for persons with disabilities" on Sept. 23, 2013. Credit: UN Photo/Rick Bajornas

By Samuel Oakford
UNITED NATIONS, Oct 1 2013 (IPS)

Amidst the incomprehensible suffering that followed the 2010 earthquake in Haiti, international aid agencies rushed to provide services to the displaced and injured.

The lives of 4,000 severely wounded Haitians were saved by emergency amputations carried out by groups on the ground.“Money from international agencies focuses on diseases like malaria and HIV/AIDS and not disability.” -- Orlando Javier Salgado Rubi

Three years later, many of the NGOs have left, and the government of Haiti, still grappling with the disaster’s aftermath, will eventually have to be the primary care provider for tens of thousands of disabled survivors who will require a lifetime of medical services.

That handoff, even if coordinated with the best of intentions, is still fraught with the complexities of disability. If emergency life-saving care is a medically and morally indisputable need, the aftermath and care of the chronically disabled is anything but well-defined, particularly in the developing world, say experts.

“If someone has lost a leg in an earthquake, they need a replacement leg every few years for the rest of their life,” said Antony Duttine, a rehabilitation advisor at Handicap International.

“There’s a constant need for rehab or prosthetic services,” he told IPS.

But once a crisis or disaster falls out of the news cycle, capturing the focus of donors can be difficult, especially given disability’s wide spectrum, ranging from loss of limbs to severe cognitive impairment. See Part Two

The World Health Organisation estimates that even before the earthquake, Haiti was home to more than 800,000 people with disabilities. Their care can be overlooked when aid is earmarked for “crisis”.

Often the poorest and most marginalised in the world, the disabled are hurt more than anyone by policies that diminish or ignore the importance of basic, long-term care.

According to disability activists, the structure and language of international development goals can make the cards feel stacked against them.

International guidelines

In 2000, the then-189 member states of the U.N. agreed on a set of eight Millennium Development Goals (MDGs) that would guide international development through 2015. None of the eight included language regarding disability.

Shortly afterwards, groups wielding billions of dollars and mandates to save lives entered developing countries and infused their medical systems with never before seen levels of funding.

The assistance, however, went to very specific targets.

“Money from international agencies focuses on diseases like malaria and HIV/AIDS and not disability,” Orlando Javier Salgado Rubi, Honduran minister for disability affairs, told IPS.

With the cash came metrics and a pinhole focus on diseases that can be treated or prevented with the latest pharmaceuticals and vaccines. Unlike hard to ascertain measurements of broad quality of life improvements, the statistical successes of these targeted programmes are easily tracked.

The largest of the organisations involved in this push continues to be the Bill and Melinda Gates Foundation. As a result of their involvement in Africa, the pay for doctors working on HIV/AIDS grew significantly in many countries.

However, investigations have found this leads to a “brain drain” out of basic care and towards more high-profile diseases, severely undermining the viability of the existing healthcare system.

(The Bill and Melinda Gates Foundation did not respond to a request for comment.)

Basic and sustained care is of paramount importance to the disabled community. The availability of services, for instance, affects how a family is able to help their child, says Gopal Mitra, a programme specialist for children with disabilities at UNICEF.

“With lack of services, we see families hiding their disabled children because of stigma,” Mitra told IPS.

“But where there are rehabilitation services, families are much more positive and the solutions are more holistic, because at the end of the day the families want their child or adolescent family member to make the best in life,” said Mitra.

By any measure, MDG programmes have helped save lives, decrease malnutrition and put more children in schools. Yet as result of reductions in mortality, a greater number of children in the developing world are surviving illness, only to be left severely disabled.

“We are seeing more people with different kinds of impairments and disabilities,” said Duttine. “Children who might previously have died but now have survived can have brain damage and cerebral palsy or other birth impairments.”

Without parallel growth in long-term care, disabled survivors can be neglected, he says. This new responsibility can weigh on a national health system already depleted by the incentives offered by foundations.

International development guidelines are bereft of language on necessary follow-up, says Mitra.

“What about access to basic services for them? What about access to education, access to nutrition and healthcare. This is a problem.”

The attention span of the aid community is no greater than the metrics and guidelines that direct it, he says.

It was not until 2007 that the U.N. Convention on the Rights of Persons with Disability – with a few notable exceptions, including the United States – was signed and ratified.

On Sept. 23, the U.N. General Assembly was given over to a “High Level Meeting on Disability and Development.”

Thirteen years after the MDGs were first articulated, delegates promised that when the current set expires, the world’s largest minority would be included in post-2015 development goals with specific language.

“We believe that persons with disability should be held as beneficiaries in all development activities and as full participants in the development,” said Reen Kachere, Malawian minister of disability and elderly affairs.

Disability groups hailed the event. For representatives like Minister Rubi, who is blind, the convening was an important step and one he couldn’t have predicted until recently.

“When I lost my sight at 18, I never thought I would end up speaking on this issue at the U.N.,” Rubi told IPS.

Groups like Handicap International are cautiously optimistic. They know that altering the conversation on a rights issue is a painstakingly slow process.

The sluggishness is no more evident than at the United Nations itself, where in the 2013 MDG Report, among its 59 pages, disability is mentioned but once. And only two days after the high-level meeting, when the issue should have been fresh in the minds, the release of an outcome document on achieving MDGs remarkably made no mention of the issue.

In Part Two of this series, IPS looks at why disability may have been ignored in international guidelines.

Excerpt:

Disaster Risk Management Project (DRM). An elderly person with a disability goes down the stairs of the Cyclone shelter in Mohanagar, Sitakunda, Bangladesh. Credit: Brice Blondel/Handicap International

By Lucy Westcott
UNITED NATIONS, Aug 20 2013 (IPS)

Upon first glance, the emergency checklist distributed in Haiti after the 2010 earthquake looks like any other. Organised into key categories like water, sanitation and hygiene, and psychosocial support, the information is typical of the kind circulated for emergency response.

But after a closer read, with recommendations for latrines to be built with a 90cm diameter so a wheelchair can turn around, and 80-cm-wide doors for wheelchair or crutch-users to pass through comfortably, it is clear that the checklist, distributed by Handicap International, was intended for persons with disabilities living in the disaster-ravaged country.“When we don’t include people with disabilities, that’s when the most deaths and casualties happen.” -- Fred Doulton of UN Enable

Natural disasters are common in many developing countries across the globe, and organisations like Handicap International are helping communities plan better for their disabled populations. There are between 2.9 and 4.2 million persons with disabilities among the world’s 42 million forcibly displaced population, according to data from the United Nations Refugee Agency (UNHCR).

For many people living with disabilities in developing countries, social stigma and cultural barriers prevent community cohesion, which is essential for emergency planning and preparedness, Annie Lafrenière, social inclusion and technical adviser at Handicap International, told IPS.

“People won’t speak about social barriers… they’ll talk about ramps [instead],” Lafrenière said. “[People with disabilities] are not considered the same as everyone else.”

Developing countries are vulnerable and at a higher risk of disasters because they are less prepared and equipped to deal with them, and not necessarily because they are more exposed to hazards, Lafrenière says. Persons with disabilities are often invisible to relief activities and unable to reach food or water checkpoints due to destroyed roads or non-accessible transportation.

“Meeting basic needs… remains a priority and often a challenge for communities affected by disasters, whether they are persons with or without disabilities,” Lafrenière says. “What our experiences have shown us… is that the presence of disability amplifies the impact of the disaster on a person’s life… and reduce[s] the range of strategies to cope with them.”

Inclusive planning is one improvement that can be made by communities in developing countries, and one that Handicap International stresses. It’s vital that disabled people are part of planning meetings and committees, as they help to spread awareness while offering their expertise.

“When we don’t include people with disabilities, that’s when the most deaths and casualties happen,” Fred Doulton, social affairs officer at UN Enable, which focuses on the rights of disabled people and is part of the United Nations Economic and Social Council (ECOSOC), told IPS. “By asking [people with disabilities] directly about what they think, you get to the core issues.”

The United Nations Office for Disaster Risk Reduction (UNISDR) recently released a survey asking persons with disabilities around the world about their experience living with and preparing for disasters.

In the Indonesian province of East Nusa Tenggara (NTT province), Handicap International is working with schools and children with disabilities and their families to improve awareness and response to disasters. The region is prone to flooding, landslides and whirlwinds; in 2012 there were 258 whirlwinds, 28 times the number recorded in 2002, according to Indonesia’s National Disaster Mitigation Agency (BNPB).

“We are implementing activities within the community to increase resilience to natural disasters, but we are also implementing activities within schools to be sure that children with disabilities will be taken into consideration,” Catherine Gillet, programme director for Handicap International in Indonesia/Timor-Leste, told IPS from the ground.

The NTT province consists of rural communities living in hilly areas and on dry and rocky land. The terrain can be treacherous, with communities staying either in valleys near the rivers, where there is a high risk of floods during the rainy season, or on the slopes of hills near areas suitable for crop cultivation, but where landslides pose a huge risk.

The children, mainly in grades three to five, raise awareness among their peers about disaster risk and are involved in risk assessment and identification. Disabled and non-disabled schoolchildren also demonstrate good practices for evacuation in disasters and work together in mock drills.

“For children with disabilities [the main challenge] is the problem of access, the problem of moving around,” Mathieu Dewerse, regional operational coordinator for Handicap International in Indonesia/Timor-Leste, told IPS.

“This is compounded in the case of disasters. If we think about a landslide, the road may be cut, there could be rocks on the road. If this is a child that uses crutches, it’s very hard to move around,” Dewerse says.

During past disasters, children with mobility disabilities have been supported by tricycles or motorbikes, Dewerse says.

For children with sensory impairments in the region, access to information is one of the main concerns. Communities have set up flag systems to compensate for the sound of an evacuation signal, which can’t be heard by children with hearing impairments, and have recruited friends and family to make sure they get away safely.

“Take the example of a child who doesn’t see. It’s a very big problem, especially if they have to evacuate quickly,” Dewerse says.

The provision of more mobility devices adapted to the needs of children with disabilities is an important step in helping communities the next time there is a flood or landslide, Dewerse says.

In the neighbouring Philippines, Handicap International replaced the cumbersome wheelchair of Joshua Degas, a 10-year-old boy with cerebral palsy, after Tropical Storm Washi in 2011, with one his own size, improving his future mobility in the face of potential disasters.

(See Part One and Part Two)

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