Support for Refugees with Disabilities and Other Specific Health Care Needs

 

 

Kara Naseef
Third-year student at University of Michigan Law School.

Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

– Universal Declaration of Human Rights, Article 25

States Parties shall take, in accordance with their obligations under international law, including international humanitarian law and international human rights law, all necessary measures to ensure the protection and safety of persons with disabilities in situations of risk, including situations of armed conflict, humanitarian emergencies and the occurrence of natural disasters.

– UN Convention on the Rights of Persons with Disabilities, Article 11

 

Regardless of how individuals with disabilities or other special needs qualify for refugee status, many of those individuals do not receive the support they need to thrive. There is little dispute that individuals with disabilities or other specific medical needs can be considered “members of a particular social group” for the purposes of international refugee status.[1] But for many refugees, although a disability is not the basis of their refugee claim, they may have disabilities and other needs resulting from war or conflict that require extra attention and care.

There is a lack of formal procedures to identify individuals with disabilities and other specific health needs. Some individuals who become refugees are born with physical, sensory, or mental challenges; other refugees develop special care needs from living and aging in conflict zones. Trauma and injuries from violence and long journeys may begin as simple injuries but are often exacerbated by the journey and the lack of medical services. These individuals require accommodations beyond the typical assistance, such as continued access to particular medical services. They are uniquely affected by the disruption of their daily routines.

Disabilities are often overlooked when humanitarian organizations plan and implement projects.[2] Catalina Devandas Aguilar, the Special Rapporteur on the Rights of Persons with Disabilities noted that, “[m]any countries lack formal procedures to identify migrants and refugees with disabilities and, consequently, fail to provide them with protection and essential services, such as shelter and medical care that are accessible and responsive to their needs.” This problem was also recognized by Aleema Shivji, Executive Director of Humanity & Inclusion UK on World Refugee Day.  Larger international organizations and governments must partner with organizations such as Humanity and Inclusion and the Lebenshilfe to better support refugees with disabilities since international obligations already require them to provide additional accommodations to this population.[3]

Chapters 2 and 3 of the 1951 Refugee Convention enumerate the rights granted to recognized refugees. Many of those rights—public education, association, gainful employment, etc., cannot be realized if Member States do not provide accommodations for disabilities. Furthermore, Article 2 of the Convention of the Rights of Persons with Disabilities (CRPD) requires signatories to provide reasonable accommodations to ensure equal access to human rights and fundamental freedoms.[4] This RefNote surveys primary contexts in which refugees with disabilities find themselves—conflict zones, refugee camps, resettlement, seeking asylum—as well as challenges to accessing necessary accommodations in each of those contexts.

Fleeing Conflict

As of 2016, of the 66 million displaced persons worldwide, nearly 13 million had disabilities. The Syrian refugee crisis has been well-covered internationally, but aid efforts and the media tend to overlook disabled, injured, and older Syrian refugees. A study by HI found that “one in five refugees is affected by physical, sensory, or intellectual impairment; one in seven is affected by chronic disease; and one in twenty suffers from injury, with nearly eighty percent of these injuries resulting directly from the conflict.”[5] Those with these special needs face greater barriers to accessing employment, healthcare, food, shelter, and other necessities. Older refugees and those with special needs are also more likely to experience psychological distress from dislocation and separation from loved ones.

Humanity and Inclusion (HI), a UK organization, strives to provide the refuge and services that national and international governments fail to provide. To address the complex needs of older, injured, and disabled Syrian refugees, HI recommends building staff capacity to identify and serve these individuals in both planning and implementation of programs. The Women’s Refugee Commission recommended research and evidence-gathering to determine the most effective assistance for refugees with disabilities, as well as employing a “resilience approach” in humanitarian settings.

Refugees Living in Camps or Detention Centers

Refugee camps and detention facilities—temporary living arrangements challenging for even the most physically able refugees—create and exacerbate physical and mental challenges. For example, in Omugo, Uganda, where the South Sudanese people have found refuge, one young girl, paralyzed from a bout of polio, was unable to access the school in the camp until provided with a wheelchair. In another case, a man with an amputated leg left his prosthetic limb behind in his hurry to flee the violence in his home country.  In addition to physical disabilities, loneliness and isolation are common feelings shared by those living in camps, such as Omugo. If left unaddressed, they can lead to serious mental and physical health complications.

In January 2017, Human Rights Watch found that refugee camps in Greece failed to properly identify refugees with disabilities when they arrived at the camp.[6] In response to this finding and the recognition of the conditions in European Union (EU) refugee camps, the European Parliament called for increased EU funds targeting the needs of refugees with disabilities.

HI pays particular attention to people with disabilities and other vulnerable populations that may be overlooked due to their complex needs. HI is currently the only organization providing rehabilitation services in the Ugandan camp.

Manus Island and Nauru Detention Centers offshore of Australia have famously contributed to the traumatization of generations of refugees. One psychologist and traumatologist observed domestic violence, sexual abuse and child abuse, as well as self-harm and suicide. In 2016, the Papua New Guinean Supreme Court found the Manus Island Center to be “unconstitutional and illegal” and ordered it closed. The Court was motivated in part by the “inhumane” conditions in which children as young as seven were living. Just over a year later, however, the Australian High Court held that Australia was not limited by the domestic rulings of another domestic court and that Nauru could continue housing refugees.

Resettled Refugees

The UN High Commissioner for Refugees (UNHCR) Handbook and Guidelines includes that Member States must treat refugees in the same manner as nationals in social security, which includes legal provisions for sickness, disability, and old age. Refugees rely on international organizations for protection, food and shelter, and other assistance as they await relocation; this requires persistent self-advocacy. Refugees with disabilities must also advocate for additional services and accommodations before and after relocation; this feels embarrassing to many and can be difficult given language and resource barriers. Some of these individuals never received a formal diagnosis or other critical medical care.

Refugees with disabilities face higher physical, environmental, and societal barriers.  Follow this link to see a chart (Chart 6) detailing the main barriers that people with disabilities reported.

Within the United States, the suicide rate of resettled Bhutanese Refugees is nearly three times higher than the national average.[7] One study published in the National Library of Medicine found an association between suicidal ideation in this population and the inability to find work. These refugees struggle to access the education and employment that could impact their socioeconomic status in their new home.

The Lebenshilfe organization is a German group dedicated to serving refugees with disabilities and aiding their integration into the community. The Lebenshilfe organization focuses specifically on individuals with mental disabilities and the support they need to live as independently as possible.

Asylum Seekers

The United States began detaining asylum seekers and separating them from their families long before the most recent press coverageOne woman fled Brazil with her grandson hoping to find schools better equipped to educate him and accommodate his epilepsy and autism. After the principal of her grandson’s school in Brazil was fired as a result of her complaints, she could no longer live safely in her country. The United States rejected her asylum claim, finding that the policeman who targeted her was acting in his private capacity and not as a state agent. After the United States rejected this woman’s application for asylum, her grandson was sent to state-run facilities for “unaccompanied minors.” His mother has legal immigration status in the United States but cannot provide the constant care that diagnoses of epilepsy and autism require. Such a drastic change in daily life and routine can be devastating to a child with autism.

Unfortunately, the U.S. government will only provide services to unaccompanied minors until they turn twenty-one, at that point, they will have to be self-sufficient or seek alternative services. The Brazilian boy may access education and medical care until he turns twenty-one. The UNHCR Handbook and Guidelines specifies that the adjudicator must give weight to the personal circumstances of an individual, including age, health, and disability, when determining internal relocation options. These factors should be considered in each aspect of an applicant’s claim. The United States should reconsider the strict application of its age-based policy and enact legislative means to ensure protections for individuals like him.

In 2007, the U.S. Committee for Refugees and Immigrants published a guide for serving refugees with disabilities. The guide is meant to help service providers assist refugees with disabilities and other special needs. However, it is unclear to what extent service providers have successfully implemented the recommendations in this guide. While it is an important step for U.S.-based organizations to acknowledge the unique needs of young migrants, especially those with disabilities, it is not enough.

Conclusion

The international community has failed to uphold its obligations under the Refugee Convention, the Universal Declaration of Human Rights, and the CRPD.[8] It is notable, yet insufficient, for the international community to agree that disabilities can form the basis for a refugee claim.

The efforts of organizations including the Lebenshilfe organization, Humanity and Inclusion, and the U.S. Committee for Refugees and Immigrants should serve as a model to other organizations. Governments and large international organizations must expand partnerships with organizations serving refugees with disabilities and other specific health needs. These efforts must include data collection to determine the scope of this challenge and unmet needs. Staff who interact with migrants at various stages in their journey also need training on identification of disabilities and other special health challenges. Advocacy groups ought to find ways to hold government entities accountable to prioritize resources for this exceptionally vulnerable population.

 


[1] Hathaway & Foster, The Law of Refugee Status, 451 (2014); Mansha Mirza, Resettlement for Disabled Refugees, Forced Migration Review, July 2010, at 30, http://www.fmreview.org/disability-and-displacement/mansha-mirza.html.

[2] See Brent C. Elder, Stories from the Margins: Refugees with Disabilities Rebuilding Lives, 10 Societies Without Borders 1 (2015), https://scholarlycommons.law.case.edu/swb/vol10/iss1/2/.

[3] For a list of partner organizations see NGOs & UN Agencies Assisting Persons with Disabilities: A Non-Exhaustive List of Organizations Working with and for Persons with Disabilities World-Wide, UN High Commissioner for Refugees (Apr. 2008), http://www.refworld.org/cgi-bin/texis/vtx/rwmain?page=search&docid=48297a4e2&skip=0&query=disability.

[4] See Refugees with Disabilities: Are New Qualification Norms Required to Address Today’s Protection Needs?, European Database of Asylum Law (Jan. 17,  2017), http://www.asylumlawdatabase.eu/en/journal/refugees-disabilities-are-new-qualification-norms-required-address-today%E2%80%99s-protection-needs.

[5] Handicap International & Help Age International, Hidden Victims of the Syrian Crisis: Disabled, Injured and Older Refugees 4 (2014), http://d3n8a8pro7vhmx.cloudfront.net/handicapinternational/pages/454/attachments/original/1397045203/Hidden_Victims_of_the_Syrian_Crisis%E2%80%94disabled__injured_and_older_refugees.pdf?1397045203.

[6] See Thematic Focus: Migrants with Disabilities, European Union Agency For Fundamental Rights (2016), http://fra.europa.eu/en/theme/asylum-migration-borders/overviews/focus-disability.

[7] In the last 20 years, the United States has resettled approximately 85,000 Bhutanese Refugees.

[8] See Mary Crock et al., The Legal Protection of Refugees with Disabilities (Elgar Studies in Human Rights eds., 2017).

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