How can we ensure the safety and wellbeing of children with disabilities during humanitarian crises?

Equity Depth Local Relevance Feasibility
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Question & problem

The United Nations estimates that nearly 79 million people around the world have been displaced from their homes as a result of humanitarian crises since 2018 (e.g., disaster, war, political unrest). Approximately 40% of those displaced are children. Among this group, children with disabilities are especially susceptible to the increased risk of violence, neglect, and long-term psychosocial distress during humanitarian crises. Unreliable and limited scoping, research, inadequate priority-setting and varying definitions of disability for this vulnerable group make it challenging to ascertain the exact proportion of children with disabilities among the world’s refugee population. Methods to ensure the safety and wellbeing of children with disabilities during humanitarian crises is paramount to enhancing post-crisis recovery, development and capacity-building for future resilience. Growing evidence highlights that investing in inclusive child protection mechanisms, educational and disaster risk reduction programmes is key to improving health and social outcomes for children with disabilities during humanitarian crises.

Quote

For children with disabilities, an opportunity for their inclusion in DRR initiatives would enhance their participation and their capacity to face and contribute during a disaster.
Ronoh & Marlowe, 2015

Recommendations

Recommendation #1: Improve data collection & registration for children with disabilities in humanitarian settings

Key recommendation

Recommendation #1: Ensure that data regarding children with disabilities and their diverse needs is collected and reported when conducting scoping activities in humanitarian crises

Action

Use participatory action methods to map the distinct needs and priorities of children with disabilities in humanitarian settings and use the evidence to design more disability-inclusive programmes. Capturing context-specific vulnerabilities related to type of disability, age, sex, risks and their respective capacities is key to understanding and supporting researchers, educators, community members and policy-makers to develop targeted strategies for inclusion, participation and effective responses for the group.

Recommendation #2: Incorporate an inclusive & multi-faceted MHPSS approach to support a continuum of wellbeing

Key recommendation

Recommendation #2: Incorporate an inclusive, preventive and promotive MHPSS approach for better supporting a continuum of wellbeing and mental health adjustment for children with disabilities during crises

Action

Psychological First Aid is a supportive and non-intrusive intervention that prioritises practical assistance, linking people with community networks and identifying and referring those who need more specialised services for strengthening mental health outcomes. School-based programmes can also benefit children in improving functional and mental health outcomes through CBT components, psychoeducation and skill training to develop resiliency. Building the capacity of teachers in communicating with and addressing their needs is imperative to successful school-based mental health approaches. However, it is essential that any mental health and psychosocial support services for children with disabilities should be adapted and designed for inclusion and accessibility. Preventative components to programming are key to identifying and reinforcing individual and community strengths that protect children against distress due to further exposure to adversity.

Recommendation #3: Actively encourage the contribution of children with disabilities towards disability-inclusive disaster risk reduction & child protection mechanisms

Key recommendation

Recommendation #3: Promote the active involvement of children with disabilities in disability-inclusive child protection and risk reduction planning

Action

Children with disabilities should be actively invited to participate in opportunities for consultation and participation in coordination groups and committees for designing inclusive humanitarian responses. Activities for input include identifying reliable communication and alert methods for signalling potential harm, mapping evacuation routes and how to use safety equipment

Recommendation #4: Improve coordination and planning to improve access to basic needs & safety

Key recommendation

Recommendation #4: Coordinate across state and non-state humanitarian actors to improve this group’s access to basic needs and safety

Action

Advocate across multiple humanitarian actors to ensure that recreational, healthcare, child protection spaces, educational initiatives, WASH facilities and shelters are safe, accessible and sustainable to children with disabilities with diverse needs and staffed with individuals who are trained to better communicate with and respond to their needs. Conducting sensitization drives also aids in reducing stigmatising attitudes and disability-targeted elements of abuse in communities, schools and other sectors. Encourage community strengthening through vigilance and policing practices to identify cases of violence and make pathways for victim support and mental health services easier to access.

Recommendation #5: Strengthen education in emergency settings for children with disabilities to better cope and respond to crises

Key recommendation

Recommendation #5: Strengthen education in emergency settings for children with disabilities to better cope and respond to crises

Action

Ensuring that schools are located in safe areas, are structurally sound, utilise flexible building designs and accessible routes to school to accommodate children with disabilities in the event of a disaster. Invest in the capacity building of teachers on inclusive educational techniques, enhanced communications methods for children with sensory and intellectual disabilities, mapping risks in school-settings and conducting risk-reduction activities like hazard minimization and disaster simulation to encourage children with disabilities in developing local solutions and identifying support systems in the event of future crises.

Challenges

Challenge #1: Children with disabilities are particularly susceptible to the harmful impacts of displacement, disaster and conflict

  • In addition to the existing challenges of ensuring safety for children during disaster or conflict, children with intellectual and/or physical disabilities are more vulnerable to harm as they may not be able to respond to immediate safety concerns prevalent in humanitarian settings. Additionally, being devoid of their own community protection structures, the additional dependency on others in unsafe environments can increase their likelihood of experiencing abuse and exploitation.
  • In response to preventing and addressing violence against child refugees, child protection mechanisms, laws, policies and services have been adopted by many humanitarian aid agencies and host countries. However, many of these have not been designed with disability-inclusion in mind, e.g. ensuring physical access for those with mobility barriers, or visual impairments as well as minimising social and institutional access due to stigma around disability.

Challenge #2: Despite the increased vulnerability of children with disabilities in humanitarian settings, their experiences and needs are often neglected in respective disaster risk reduction planning and strategy

  • Limited evidence and research conducted in this area highlights how input from children with disabilities (in comparison with adult caregivers and children without disabilities) was historically considered to be of lower quality, lacking validity and offering little in terms of contribution towards effective disaster risk reduction and child protection. This undermines their valuable input towards effective child protection and disaster risk reduction planning and contributes to their vulnerability.
  • The exclusion of children with disabilities from contributing towards the development of inclusive disaster risk reduction initiatives and protection mechanisms is partly due to the lack of reliable and consistent use of terminology around disability and reflects the general neglect of data collection on disability within literature. Even the term “children with disabilities” is poorly articulated and arbitrary and this lack of clarity on the use of the term contributes to their continued exclusion and engagement in child protection and disaster risk reduction activities and planning.
  • Children with disabilities are also largely ignored in mapping and situational analyses undertaken in humanitarian settings. This introduces blind spots in adequate needs assessment for this group, silences their advocacy, limits their involvement in stages of programme decision-making and disempowers them from contributing towards more disability-inclusive policy and practice.

Challenge #3: Limited research and evidence available on effective interventions to improve the mental health and wellbeing of children with physical, developmental and psychosocial disabilities during war and conflict

  • It is estimated that as many as 50% of child refugees suffer from traumatic stress symptoms and require interventional support to manage their distress. While there are now many promising approaches to reduce trauma symptoms and psychosocial distress in refugee children, little is known about key drivers or strategies to promote resilience and coping skills in children with developmental and physical disabilities.
  • The lack of awareness and recognition of this group’s diverse experiences can result in their needs failing to be adequately met, which compounds their disproportionately negative experience of conflict.

Challenge #4: Unstable and inequitable access to protective systems

  • For those who manage to escape a conflict or disaster zone to an area of refuge, access to healthcare, education, recreational activities, social empowerment initiatives and child friendly spaces may still be limited.
  • Numerous international guidelines promote the development of inclusive, safe schooling systems as essential to creating a protective environment for children’s post-conflict recovery and development. However, disaster and crises fracture stable educational systems and those in host countries struggle with over-crowding, language barriers and limited resources to keep up with the growing demand for schooling. Children with disabilities face additional barriers when accessing education in humanitarian settings and are less likely than others to attend and benefit from the protective benefits of school.

Finding the answers

This evidence brief was developed through a review of reviews, peer-reviewed literature and normative guidelines examining systematic, narrative, and other types of review evidence on the topic of safety, protection, risk-reduction and wellbeing for children with disabilities. All recommendations are based on reviews of literature from low- and middle-income countries, as well as some findings from high-income countries where the recommendations made were transferable to low-resource settings. This evidence note is based on the findings of 5 reviews, 4 peer-reviewed papers and a policy brief from UNHCR, all of which covered literature from HIC to LMIC settings.

Recommendations & actions

Recommendation #1: Improve data collection & registration for children with disabilities in humanitarian settings

Key recommendation

Recommendation #1: Ensure that data regarding children with disabilities and their diverse needs is collected and reported when conducting scoping activities in humanitarian crises

Action

Use participatory action methods to map the distinct needs and priorities of children with disabilities in humanitarian settings and use the evidence to design more disability-inclusive programmes. Capturing context-specific vulnerabilities related to type of disability, age, sex, risks and their respective capacities is key to understanding and supporting researchers, educators, community members and policy-makers to develop targeted strategies for inclusion, participation and effective responses for the group.

Recommendation #2: Incorporate an inclusive & multi-faceted MHPSS approach to support a continuum of wellbeing

Key recommendation

Recommendation #2: Incorporate an inclusive, preventive and promotive MHPSS approach for better supporting a continuum of wellbeing and mental health adjustment for children with disabilities during crises

Action

Psychological First Aid is a supportive and non-intrusive intervention that prioritises practical assistance, linking people with community networks and identifying and referring those who need more specialised services for strengthening mental health outcomes. School-based programmes can also benefit children in improving functional and mental health outcomes through CBT components, psychoeducation and skill training to develop resiliency. Building the capacity of teachers in communicating with and addressing their needs is imperative to successful school-based mental health approaches. However, it is essential that any mental health and psychosocial support services for children with disabilities should be adapted and designed for inclusion and accessibility. Preventative components to programming are key to identifying and reinforcing individual and community strengths that protect children against distress due to further exposure to adversity.

Recommendation #3: Actively encourage the contribution of children with disabilities towards disability-inclusive disaster risk reduction & child protection mechanisms

Key recommendation

Recommendation #3: Promote the active involvement of children with disabilities in disability-inclusive child protection and risk reduction planning

Action

Children with disabilities should be actively invited to participate in opportunities for consultation and participation in coordination groups and committees for designing inclusive humanitarian responses. Activities for input include identifying reliable communication and alert methods for signalling potential harm, mapping evacuation routes and how to use safety equipment

Recommendation #4: Improve coordination and planning to improve access to basic needs & safety

Key recommendation

Recommendation #4: Coordinate across state and non-state humanitarian actors to improve this group’s access to basic needs and safety

Action

Advocate across multiple humanitarian actors to ensure that recreational, healthcare, child protection spaces, educational initiatives, WASH facilities and shelters are safe, accessible and sustainable to children with disabilities with diverse needs and staffed with individuals who are trained to better communicate with and respond to their needs. Conducting sensitization drives also aids in reducing stigmatising attitudes and disability-targeted elements of abuse in communities, schools and other sectors. Encourage community strengthening through vigilance and policing practices to identify cases of violence and make pathways for victim support and mental health services easier to access.

Recommendation #5: Strengthen education in emergency settings for children with disabilities to better cope and respond to crises

Key recommendation

Recommendation #5: Strengthen education in emergency settings for children with disabilities to better cope and respond to crises

Action

Ensuring that schools are located in safe areas, are structurally sound, utilise flexible building designs and accessible routes to school to accommodate children with disabilities in the event of a disaster. Invest in the capacity building of teachers on inclusive educational techniques, enhanced communications methods for children with sensory and intellectual disabilities, mapping risks in school-settings and conducting risk-reduction activities like hazard minimization and disaster simulation to encourage children with disabilities in developing local solutions and identifying support systems in the event of future crises.

Policy priorities

One of the numerous challenges faced by children with disabilities in humanitarian settings is the continuity of care. Disability-specific healthcare, educational and recreational approaches are rarely available over the long term as they are run by NGOs restricted by short funding cycles. Countries experiencing disasters or protracted crises, and host countries where refugees are seeking residence need to be held accountable for ensuring sustainable, equitable and non-discriminatory access to services for this vulnerable group. National ministries and departments responsible for social welfare, protection, education and health should be encouraged to shift away from charity models and develop policies and tangible actions to integrate and mainstream disability into state-run humanitarian response and incorporate the group’s safety and wellbeing into their Standard Operating Procedures (SOPs) and Strategic National Plans.  

Conclusion

This brief reviewed evidence-based recommendations on how to ensure the safety and wellbeing of children with disabilities in humanitarian settings. The right to safety for all is enshrined in Article 11 of the CRPD, yet this population has been consistently neglected in the global literature around children affected by disaster and crises, and as such the recommendations made are limited to specific humanitarian settings (e.g., natural disasters, war and conflict) and towards children with physical and mobility challenges. There is a need to further explore their diverse needs and experiences by recognising them as independent actors who can meaningfully participate in and contribute to the development of services and policies targeted towards them. Despite schooling being regarded as essential to building children’s resilience in crisis contexts, their protective effects are not well translated towards this group due to the additional barriers they face when participating in education in emergencies. Humanitarian agencies and national ministries should take notice of this gap and invest in more equitable educational institutions and recreational approaches that can in turn build on the capacities of children with disabilities to counteract the negative effects of displacement, advocate for their rights, protect themselves from violence, improve their physical and psychosocial coping skills to better cope with future adversity and support them in contributing to their communities.

Gaps & research needs

There is still a huge gap in understanding the complex range of diverse challenges that are experienced by children with disabilities during humanitarian crises. Only by directly engaging with this group can researchers identify valuable lessons, realities, barriers and opportunities for their meaning involvement and contribution towards designing more effective pathways for their safety and wellbeing in crises settings

Acknowledgements

Peer Review: This brief was reviewed by Sarah Polack, Associate Professor at the International Centre for Evidence in Disability in LSHTM.

Publication details: © Disability Evidence Portal and London School of Hygiene & Tropical Medicine, September 2020.

Suggested citation: Onaiza Qureshi. Evidence Brief: How do we ensure the safety and wellbeing of children with disabilities during humanitarian crises? Disability Evidence Portal, 2020.

Disclaimer: The views expressed in this publication are those of the author and should not be attributed to the Disability Evidence Portal and/or its funders.