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.

La pregunta y el problema

Los síntomas de una salud mental insuficiente son comunes durante un brote generalizado de una enfermedad infecciosa. En epidemias recientes como la crisis el Ébola y del SARS-CoV-1 se han reportado altos casos de depresión, ansiedad y de trastorno de estrés post-traumático (TEPT). Los síntomas elevados de una mala salud mental no están limitados a pacientes, sino que también son vistos en trabajadores de la salud, familiares y en la población en general. Los primeros indicios de evidencia provenientes de la pandemia del Covid-19 demuestran altos índices de una salud mental insuficiente y por lo tanto, la necesidad de proveer un servicio de salud mental. Este Informe de Evidencia resume la evidencia sobre apoyo a la salud mental durante la Covid-19 y otras pandemias recientes, informando sobre las normas y prácticas durante esta crisis.

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.

La pregunta y el problema

Las personas con discapacidades pueden tener más probabilidades de adquirir COVID-19 y, si se infectan, pueden tener más probabilidades de experimentar síntomas graves o morir. Aparte de las consecuencias de la pandemia relacionadas con la morbilidad y la mortalidad, las personas con discapacidad suelen depender de cuidadores para que les ayuden en tareas cotidianas, por lo que medidas de distanciamiento social pueden resultar imposibles. Además, los servicios e instalaciones de agua potable, saneamiento e higiene (WASH, por sus siglas en inglés) pueden ser inaccesibles para las personas con discapacidades y, en muchos entornos, los esfuerzos para brindar servicios socialmente distanciados han dado como resultado el despliegue de enfoques de atención médica digital o remota que a veces no son accesibles o inclusivos. Una de las intervenciones clave en respuesta a la pandemia del COVID-19 ha sido la atención internacional y la mejora de la financiación, la programación y los mensajes de los medios en apoyo de WASH. Las personas con discapacidades, que corren mayor riesgo de sufrir las consecuencias negativas del COVID-19, necesitan en su mayoría acceso a tales intervenciones. Sin embargo, el acceso a WASH se considera uno de los mayores desafíos de la vida diaria para muchas personas con discapacidad.

Health system strengthening refers to initiatives that improve one or more functions of health systems, leading to better health. There is a large body of evidence on what works to strengthen health systems in low- and middle-income countries (LMICs), much of which is aligned to the World Health Organization (WHO) health system building blocks (service delivery; health workforce; information; medical products, vaccines and technologies; financing; and leadership/governance). Despite the fact that some people with disabilities have additional health needs, and many face additional barriers to accessing healthcare, inclusion of people with disabilities is largely missing from this evidence base.⁵ Separately, a smaller evidence base exists on increasing the effectiveness of specific health-related services targeting people with disabilities, such as health-related Community Based Rehabilitation (CBR), rehabilitation services more broadly, and mental health services. This second evidence base is less closely aligned to the building blocks. Reviewing these outputs in parallel goes some way towards identifying effective strategies for strengthening health systems for disability inclusive development.