Dr. Munzer Alkhalil
Research Associate, R4HSSS
Steering Committee Member, Syria Public Health Network
The emerging health system in northwest Syria faces several challenges which affect vulnerable people, including one group in particular that is often overlooked, the people with disability. This includes “those who have long-term physical, mental, intellectual or sensory impairments that, in interaction with various attitudinal and environmental barriers, may hinder their full and effective participation in society on an equal basis with others”. According to the UN, almost 28% of Syrians have disabilities, almost double the global average, highlighting the impact of war and trauma on disability.
The lack of accessibility for this population is a significant issue. In addition to the negative association between conflict incidents and access to routine health services for all people in northwest Syria, many healthcare facilities and clinics in the area are not equipped to meet the needs of the people with disability, and healthcare providers lack awareness and understanding of the needs of individuals with disabilities. Moreover, transportation to these facilities can be difficult or impossible for those with mobility issues. This means that many persons with disabilities cannot access the medical care they need, which can lead to further deterioration of their health and well-being.
A painful example is the government health institutions’ buildings, including local health ministries and directorates, which should be an example for others; unfortunately, even their buildings are not accessible for the people with disability. Last month I had a conversation with a healthcare provider with disability. She told me that although she is proud to belong to Idlib Health Directorate (IHD) and likes to discuss some points about people with disability, she avoids visiting the institution; “It is embarrassing to ask people to carry me up the stairs”. Even when she visited the IHD two years ago to get a “license to practice the profession” with her father, she waited outside on the street, and her father did the process for her.
Also, the lack of equipment to facilitate the movement of the people with disability made them an easy target for warplanes in many cases. In a report published by Human Rights Watch in 2022, this quote is given; “Many times, I refused to leave the house to try to escape; it was just too difficult for me to run with crutches. It would take several people to help me get into the car, which would make them an easy target for an airstrike. I wanted to avoid exposing other people to that risk — Thara J., who lost a leg in an airstrike in 2015 when she was 13”. In addition to the ongoing suffering caused by the war, a devastating earthquake hit Syria and Turkey on February 6th, 2023, resulting in over 4,500 fatalities and leaving almost 11,000 families without shelter in northwest Syria. The earthquake has also had a particularly severe impact on persons with disabilities, many of whom have limited mobility and have experienced compounded suffering as a result.
Another issue is the lack of rehabilitation services for those who have been injured. The ongoing conflict in the region has led to a large number of individuals with physical injuries, such as amputations or spinal cord injuries. However, very few rehabilitation centres or programs are available to help these individuals regain mobility and independence. This can leave them feeling isolated and dependent on others for assistance with daily tasks.
The mental health needs of the people with disability are also often neglected. Many persons with disabilities have experienced trauma or are dealing with ongoing stress and anxiety due to the conflict. However, with only one psychiatrist in Idlib governorate, which has more than 3 million people, 65% of whom are displaced, we can imagine the availability of mental health services. Unfortunately, limited mental health resources are available to help the people with disability cope with their problems.
Finally, there is a lack of policies and programs that specifically address the needs and concerns of persons with disabilities. This includes a lack of opportunities for employment and economic independence. Many persons with disabilities find it challenging to find and maintain employment due to discrimination and a lack of workplace accessibility. This can leave them financially dependent on others and unable to support themselves and their families. For example, before the conflict, there was a recommendation by the Ministry of Health to implement a quota that 4% of their institutions’ employees were to be people with disability. Unfortunately, after 2011 there are no clear policies in the emerging health governance institutes regarding this recommendation.
The lack of equipment and suitable infrastructure might sometimes be justified due to the circumstances of the war; many health facilities buildings are intended for other purposes, where cemeteries, caves, and basements of houses were used to provide medical services to avoid risks related to the bombing of medical facilities. Moreover, emerging governmental institutions in northwest Syria still need more experience in dealing with all health system issues because they have evolved with minimal resources, complex security conditions, and were neglected by the international community. As a result, they are presently struggling to survive.
However, after more than a decade of conflict and the construction of many new medical facilities in somehow safe areas near the Syrian-Turkish borders, and with the cumulative experience in the emerging governmental institutions and the vast number of people with disability in this region, it is no longer acceptable to ignore the needs of this group.
The importance of addressing these issues and supporting the people with disability in northwest Syria cannot be overstated. As the health systems and new health infrastructure are being built in the region, it is crucial to consider the needs of this group and ensure that they are included and not left behind. Paying attention to this group is essential, as they are often marginalized, and their unique needs are unmet. It is also imperative to include them in the decision-making process and involve them in designing and implementing new policies and programs that affect them. By doing so, we can ensure that the people with disability in northwest Syria is not forgotten and can access the care and support they need to live healthy and fulfilling lives.