Question & problem
More than 10% of the world’s 35 million displaced people are people with disabilities. People with disabilities and their families are at significant risk of discrimination, stigma, violence, and marginalisation, and get little access to adequate services in humanitarian camps. Disabled people are frequently sidelined during health sector planning in humanitarian camps, and healthcare access is a particular challenge. The COVID-19 pandemic, and measures necessary for its containment, pose a particular threat and challenge in humanitarian settings. Containment measures such as mass ‘stay-at-home' orders, social distancing, self-isolation and quarantine are often unsuitable for, or difficult to implement in, camp settings. People in humanitarian camps, then, need special consideration within the COVID-19 response. However, among people in humanitarian camps, people with disabilities are particularly vulnerable to being left behind or overlooked in COVID-19 planning and programming. Their double vulnerability as refugees and disabled people warrants special consideration.
Recommendations
Key recommendation
Action
Much evidence documents the challenges which people with disabilities commonly face in humanitarian camps when trying to access healthcare. This literature, and the solutions it proposes, should be used to inform COVID-19 response delivery. For instance, messaging around COVID-19 prevention measures and healthcare guidelines for prevention must be accessible, inclusive and non-discriminatory.
Key recommendation
Action
People with disabilities may experience complex healthcare needs and so require ongoing access to basic and specialised healthcare services if their health is not to deteriorate during the pandemic response. Routine healthcare delivery needs to be adequately resourced despite the resource requirements of the pandemic response. Continuity of mental healthcare services is particularly important given the associations between the pandemic and increased stress.
Key recommendation
Action
WASH stations need to be close enough to where people live so as not to place women and children at risk of violence when implementing hygiene measures required to prevent infection. Efforts must be made to ensure continuity in sexual and reproductive health services for women with disabilities and early identification and intervention for children with disabilities to ensure that existing vulnerabilities are not compounded by disruptions in vital services. Further, as intimate partner violence rates may spike during lockdown, continuity of routine services for women (such as antenatal care) must be ensured to allow for ongoing IPV screening.
Key recommendation
Action
Key COVID-19 prevention interventions must be disability inclusive, and people with disabilities and their carers need to be supported to implement disease control measures such as social distancing and hygiene. It is possible that special measures such as priority testing for people with disabilities and their caregivers, ensuring temporary health facilities are accessible, and prioritising PPE for people with disabilities and their caregivers may be necessary and of benefit in humanitarian camps.
Key recommendation
Action
Although the evidence remains uncertain, it is possible that approaches such as targeted shielding, which aim to protect those most vulnerable from infection by helping them to live in dignity, safely and separately from the general population for an extended period of time, rather than implementing blanket measures on entire camps, may be to the benefit of at-risk populations.
Challenges
Challenge #1: Even when there is not a pandemic, people with disabilities face barriers to accessing appropriate healthcare in humanitarian camps.
- People with disabilities are among the most hidden, neglected and socially excluded of all displaced people and the specific needs of people with disabilities in these settings are overlooked in camps due to the emergency nature of the refugee process and prioritization of food, shelter and clothing.
- Treatable medical conditions frequently develop into major disabilities due to lack of proper medical attention.
- Disabled people are frequently sidelined during health sector planning in camps and encounter significant barriers to accessing basic health services, with specialized health and rehabilitation services being almost entirely absent.
Challenge #2: Due to lack of access to basic and specialised services, as well as high rates of comorbidities, people with disabilities are more vulnerable to infection – and serious illness – in camps during the pandemic.
- During a pandemic response, the diversion of resources, disruptions to medical supply chains, health-facility closures and shortages of healthcare workers can overwhelm health systems, particularly in humanitarian camps.
- People with disabilities who may rely on these services more heavily than others due to elevated rates of comorbidities among this population, will experience disruptions more adversely than people without disabilities.
- These comorbidities, if untreated, compound the susceptibility of people with disabilities to contracting, and becoming seriously ill from, COVID-19.
Challenge #3: Women and children with disabilities are vulnerable to gender-based violence and abuse in humanitarian camps, and some of the measures to contain COVID-19 may exacerbate these risks.
- Women and children with disabilities are at risk of gender-based violence and abuse in humanitarian settings, including camps, and may be excluded from supports and services if they do experience victimization.
- Gender-based violence around latrines is an important deterrent to women’s accessing latrine-adjacent handwashing stations, and WASH is a vital COVID-19 intervention, meaning that women with disabilities are either at risk of gender-based violence, or infection, depending on whether they attempt to utilise handwashing stations or not.
- However, the most common form of GBV in humanitarian settings is intimate partner violence (IPV), and violence in the home in the context of lockdown restrictions is a key issue.
Challenge #4: Recommendations for the pandemic response in humanitarian camps may be unsuitable for people with disabilities.
- Mainstream recommendations and interventions to prevent the spread of COVID-19 in camps may be hard to implement for people with disabilities. For instance, guidance documents note that hand hygiene is “a readily implemented behaviour” and that WASH is “an avenue of agency for protecting one’s own health, consistent with the rights to dignity and to fully participate in decisions related to assistance in humanitarian crises”.
- Yet, WASH behaviours can be difficult to do for many people with disabilities without adequate assistance and support.
Challenge #5: A whole-camp response to COVID-19 in humanitarian camps may exacerbate health inequalities, including among people with disabilities.
- Generic distancing measures and other COVID-19 interventions – when blanketly applied to everyone in a given camp – may exacerbate existing inequalities in healthcare access as the needs of people with disabilities – or difficulties they may experiencing in adhering to these – are overlooked.
Finding the answers
Given the recency of the pandemic at the time of writing, literature concerning the COVID-19 response for people with disabilities in humanitarian camps is lacking. As such, this evidence brief is based on a synthesis of evidence from two areas of literature: 7 articles concerning healthcare for people with disabilities in camps, and 6 papers concerning COVID-19 in these same settings. It presents the recommendations which are possible when the considerations noted in both bodies of literature are brought together.
Recommendations & actions
Key recommendation
Action
Much evidence documents the challenges which people with disabilities commonly face in humanitarian camps when trying to access healthcare. This literature, and the solutions it proposes, should be used to inform COVID-19 response delivery. For instance, messaging around COVID-19 prevention measures and healthcare guidelines for prevention must be accessible, inclusive and non-discriminatory.
Key recommendation
Action
People with disabilities may experience complex healthcare needs and so require ongoing access to basic and specialised healthcare services if their health is not to deteriorate during the pandemic response. Routine healthcare delivery needs to be adequately resourced despite the resource requirements of the pandemic response. Continuity of mental healthcare services is particularly important given the associations between the pandemic and increased stress.
Key recommendation
Action
WASH stations need to be close enough to where people live so as not to place women and children at risk of violence when implementing hygiene measures required to prevent infection. Efforts must be made to ensure continuity in sexual and reproductive health services for women with disabilities and early identification and intervention for children with disabilities to ensure that existing vulnerabilities are not compounded by disruptions in vital services. Further, as intimate partner violence rates may spike during lockdown, continuity of routine services for women (such as antenatal care) must be ensured to allow for ongoing IPV screening.
Key recommendation
Action
Key COVID-19 prevention interventions must be disability inclusive, and people with disabilities and their carers need to be supported to implement disease control measures such as social distancing and hygiene. It is possible that special measures such as priority testing for people with disabilities and their caregivers, ensuring temporary health facilities are accessible, and prioritising PPE for people with disabilities and their caregivers may be necessary and of benefit in humanitarian camps.
Key recommendation
Action
Although the evidence remains uncertain, it is possible that approaches such as targeted shielding, which aim to protect those most vulnerable from infection by helping them to live in dignity, safely and separately from the general population for an extended period of time, rather than implementing blanket measures on entire camps, may be to the benefit of at-risk populations.
Policy priorities
Health sector planning in humanitarian camps, and in respect to the COVID-19 response needs to involve people with disabilities, their caregivers, and disabled people’s organizations. The exclusion of these experts with lived experience from planning means that they will likely be excluded from services not designed with them in mind. Opportunities for involvement in camp management and decision-making processes more generally, needs to be enshrined for people with disabilities.
Conclusion
People with disabilities in humanitarian settings face vulnerabilities associated with both their exposure to a crisis, and their disability status. As such, considerations relevant to programming for people with disabilities in camps, as well as pandemic responses for people in humanitarian settings, need to be brought in conversation with one another. Doing so can inform actions to protect the health of people with disabilities in camps during the COVID-19 pandemic, and ensure that the pandemic and its response to do not widen existing health disparities.
Gaps & research needs
In humanitarian camps generally, there is a dire lack of data to inform planning and programming. The inadequate or unreliable data from these settings, especially concerning the position of people with disabilities, inevitably leads to lack of sufficient or appropriate services for disabled persons. Better routine public health monitoring, with a focus on people with disabilities, is imperative to inform an inclusive, effective COVID-19 response in camps.
Acknowledgements
Publication details: © Disability Evidence Portal and London School of Hygiene & Tropical Medicine, August 2020.
Suggested citation: Xanthe Hunt. How can the health of people with disabilities in humanitarian camps be supported during the COVID-19 pandemic? Disability Inclusive Development Observatory, 2020.
Disclaimer: The views expressed in this publication are those of the author/s and should not be attributed to the Disability Evidence Portal and/or its funders”.