Applying the Minority Perspective to Disability in Afghanistan

Ethnic background

Historically and until recently, many societies have been designed to meet the needs of the majority population. The needs of minority groups including those with disabilities as a result have been excluded or poorly addressed. This institutional exclusion is not only in terms of services, but can also be seen in policy and program planning. This is especially true for disabled people who belong to minority ethnic groups (Asch, 2001).

In Afghanistan, racial and ethnic difference is an issue which has contributed to the escalation of conflict in the country and widened the difference between various sections of society. There are at least 6 major ethnic groups in the country with a majority being Pushton. These groups have their own language, and culture. This makes differences obvious even under the same religion of Islam - there are variations of Islam such as Sunni and Shiite and recent years had seen conflict between them. This is particularly the case between the largely Pushton followers of Sunni Islam and the mainly Hazara Shiite. While the geographic variation between rural and urban living contribute to this difference, language and religion remain two determinants of group identity in Afghanistan.

Difference naturally, generates an opportunity for learning and for growth. In a democratic environment where the human rights of all people are respected, difference always is a healthy sign for potential development. For some individuals and groups however, difference may generate fear and fear may generate more difference unfortunately. Unless these differences are resolved in a healthy manner - through communication, they will escalate and cause rifts and gaps between groups such as in Afghanistan. Difference however, is not only confined to expressed values and beliefs but also manifest in the way people look, physical materialist appearance and physical status, and which group people belong to, etc. The core issue of difference is the exclusion of those perceived as different from the norm.

Disability and exclusion

The difference of disability is often perceived as a ground for exclusion from society especially the economy and this is also evident in Afghan society. Oliver and Barnes (1998) argue that much of the exclusion of disabled people has been supported by institutional practices. The fact that disability was considered a charity issue, few provisions were made for disabled people. Available provisions therefore did not give disabled people the rights to accessing education, employment etc, but instead was left to the good will of society to provide disability services voluntarily and not according to the law.

There are certain sectors which experience a higher level of exclusion among disabled people, intensifying or multiplying the level of exclusion based on ethnic minority origin. This is evident in Afghanistan and includes people with severe intellectual - mental and psychiatric - or multiple disabilities, elderly people, rural disabled, those displaced by violence, the war disabled and disabled refugees. Children with disabilities have traditionally been seen as less worthy of social investment - access to education for example - than other children. Women with disabilities often suffer double discrimination. Minority groups, including racial and ethnic minorities, are similarly disadvantaged.

The invisibility of disabled Afghans means exclusion from all spheres of socio economic and cultural life as well as exclusion from the democratic process in its various levels. A lack of participation in the political process can result in policy being formed without the active involvement of groups likely to be affected by its outcome. It can also lead to passivity and dependence which serve to perpetuate the invisibility of disabled people. Invisibility often means that the universal right of equal opportunity is simply not applied equally to disabled people, contrary to what is outlined as recommended by the UN Standard Rules and the current UN draft disability convention.

While disabled people have been largely excluded from the mainstream in Afghanistan, progress has been made in understanding disability issues and providing specialized services including CBR programs mainly for physically disabled people. Notably, there has been greater advocacy for disabled peoples' rights and gradual development of skilled professionals working in this sector. For example, the recently completed Comprehensive National Disability Policy has been developed in close collaboration with the disabled community.

There are three groups of disabled people in Afghanistan which experience higher levels of discrimination and exclusion than others: children with disabilities, disabled women, and elderly disabled people, to be further discussed below.

Children with Disabilities

There are no reliable national data available on the incidence of disability among children or among the population in general in Afghanistan. However, the U.S. Centre for Disease Control (CDC) and UNICEF conducted a disability survey in 2003 and they found that 1% of Afghan children are disabled (CDC/UNICEF, 2003). It is believed however that there are more children with disabilities than 1% in Afghanistan. Landmines alone have disabled thousands of children who often fetch water, collect wood, tend the flocks, or play in the fields unaware of the danger buried under their feet. The weak preventative health services have led to a high incidence of disabling conditions such as polio and tuberculosis. The high level of birth complications and under-nourishment amongst girls and women, and inadequate medical care, also gives rise to impairments such as cerebral palsy in newborns. According to WHO, the infant mortality rate is 165 per 1000 live births (WHO, 2002). Malnutrition, poverty, and road accidents contribute to a higher rate of disability among children.

Exclusion of disabled children from services is evident in Afghanistan regardless of their ethnic minority backgrounds. For example, The Civic Voluntary Group (GVC), an Italian NGO, conducted a study on disabled children in education in the city of Kabul in 2003 and found that only 1.11% of total students were with disabilities. In rural areas where ethnic groups are more evident due to the tribal nature of Afghan society, exclusion of disabled children is clear due to total absent of services in such places. Until recently, exclusion of girls from education was a common practice, but this is slowly changing. However, the lack of female professionals continues to exclude many girls from receiving services due to cultural restriction on female/male relations. This is especially true for rehabilitation and medical services where women's bodies may only rarely be examined or treated by male professionals. The International Convention on the Elimination of All Forms of Racial Discrimination recognizes that racial discrimination can itself cause disability. For example, racial groups may be restricted or denied access to services and this may escalate impairments into disability. Given the gravity of the situation of disadvantaged minority groups in Afghanistan such as Hazarah for example, there are a number of INGO's who focus their work on serving these groups.

Nowadays, there are little opportunities for children to play and practice normal childhood life activities. There is a rather dangerous phenomenon in Afghanistan concerning street children. In big cities, especially in the capital Kabul, there are hundreds of kids who took to the street as home and as a place for earning a living, mainly from begging - many of these children are disabled. The fact that war has left many children without fathers or without family altogether, meant that these children have to survive on the street especially in the absence of an effective education and welfare support system.

Moreover, the war has brought the risk of displacement of countless number of families and individuals. Many families of disabled children have moved to urban centers in search of security and job opportunities especially after the ban of poppy (illegal drugs) production in their rural areas or when losing the breadwinner. While, urban living helped many children get an education, it exposes them to other forms of city dangers such as road accidents and increased pollution, homelessness and gang habits, and street children life.

The majority of Afghan children lost members of their family in the war and all of them had been through the war and the resulting aftermath. It is believed that children have been traumatized by the war, especially if this involves the loss of family members. While this is the situation, there are still nearly no psychological and counseling services for these children at all. It is believed by both the international community and the government that the traditional family unit has mechanisms to cope with such mental health problems. However, this has not been properly debated, researched or documented.

Based on the above analysis, growing up as a disabled child in Afghanistan is a challenging process that is full of dangers and exploitations as cited above. Although Afghanistan has ratified the CRC, there are no special laws to promote and protect the rights of disabled children which are prescribed by Article 23 of the international Convention on the Rights of the Child (CRC) unfortunately.

Disabled women

Although the situation of women in Afghanistan is improving, there is still much to be done regarding women's rights and the status of women in society. The traditional gender role that confines women to the role of housewives and deprives them of education and employment is still common, especially in rural areas. The lack of sufficient female rehab workers has also affected the use of rehab services by girls and women as indicated earlier. Female early marriage, the lack of mother and child health care and the high fertility rate for women are all factors that work against the progress of women in Afghanistan.

When women are disabled they are more vulnerable to marginalisation and exclusion. Disabled women are often deprived of education altogether as well as other life opportunities including work, participation in political debate and denied the right to establish their own families. There is lack of awareness regarding women with disabilities and reproductive health needs - more often disabled women are regarded as sexless (Nagata, 2003).

To raise the profile of women in the country, the Transitional Government of Afghanistan has established a separate ministry for women issues. Despite this ministry, gender and women issues have not been mainstreamed into other government programs until now. Moreover, disability issues among women have not been taken into account in the programs of this ministry either. There is an obvious lack of a gender and disability strategy for this ministry as well as throughout the country.

As far as we can ascertain, there are no studies on the situation of disabled women in Afghanistan. The working group on disabled women which was set up for drafting recommendations for the national disability policy has debated the issues of disabled women in terms of needs and priorities. The needs of disabled women have been identified to include: education including higher education, health and medical care, participation in all spheres of life including public events with media coverage, involvement in policy making process and employment of disabled women in all key ministries. These were guided by the international framework of CEDAW, the Biwako Millennium Framework (BMF) and the new draft disability convention.

This working group comprised representatives of all stakeholders working with women including disabled women themselves. They recommended a number of strategies for meeting the above needs including mainstreaming disability and gender, setting up an office responsible for the employment and advocacy of disabled women's rights, setting up modern training programs as well as reviving old techniques of home based training, promoting accessibility standards including accessible housing system, policy monitoring should be carried out with participation of disabled women, and supporting disabled women against violence including psychological support and counseling services. The latter is interesting to note as both the government and the international community regularly question the value of psychological services. Yet, we find disabled women calling for psychological support among their priorities for independent living.

Elderly disabled people

There are indicators showing the aging population in Afghanistan and the urgency for special programs to cater for their needs. The fact that many men were killed in the war meant that widows were left to age and die naturally. Moreover, as the war ended, it is expected than the mortality rate for both women and men will rise above the low life expectancy of 45 years ( UNICEF, 2003 ). This means more people will live to old age and experience old age impairments such as hearing and vision problems as well as other mobility problems. Indeed, aging and disability will develop a closer association.

Traditionally, disability services reached primarily those disabled by war, usually young or adult males. Although, these war disabled persons have grown up now, until this moment, disability programs have not considered services for the elderly population apart from limited orthopedic services. This is especially true for older women who require interventions different from the population of younger women who need an emphasis on maternity care. Recently, however, disability programs have paid attention to children's issues as a priority in terms of education and physical rehabilitation. Overall, the elderly disabled population remains very under-researched and underserved, deserving the attention of planners, service providers and policy makers.

Cross cutting issues

Trauma and psychological support : The long years of war resulted in not only an increased death toll, but also bereaved, stressed, and traumatized society who requires much psychological support. The Taliban practices of punishments in public including amputation and stoning, has also been another source of trauma and distress, especially among children and women. Psychosomatic illness is quite common among women due to stress and depression. The social and economic capacity of many families has been significantly reduced due to the loss of breadwinners or other family members. State welfare support to families of martyrs and disabled people are nearly nonexistent. Many families are being left with war or landmine disabled members who need rehabilitation services including counseling. The mental health situation of women, children, and refugees, are particularly poor within this war-torn country. Although, there is a substantial proportion of drug users and dealers who also have mental health problems, there is hardly any service for this group either.

The low profile of mental health issues in Afghanistan is mainly due to negative public perception and stigma of those who are mentally ill. There is stigma towards mental illness, often perceived as being punishment of sin. Many families conceal the presence of mentally ill members to protect the family reputation and marriage prospects for other siblings. Mentally ill people are therefore often kept away from sight and remain an invisible group among the already excluded disabled population. They are as a result prevented from education, vocational training and other community services.

The national health plan adopted by the Ministry of Health had no specific reference to the problems of people with mental health impairments. The Interim Health Strategy 2002-2003 and the Basic Package for Health Services for Afghanistan, 2003 have both identified mental health issues as a challenge for post conflict development of health sector in the country. However, neither identified mental health issues as a priority and therefore, no plans for specific programs were proposed. It is therefore, perhaps no surprise to find a lack of mental health facilities and mental health professionals in the country.

Accessibility : An effective inclusion strategy for the largely excluded disabled people in Afghanistan requires comprehensive rehabilitation program including psychological support system. This will be possible only within a barrier-free environment that keeps universal design ideals in mind. It is not enough to make buildings accessible if there is no accessible transport system to get people to such places. Equally, it is important for disabled people to have accessible housing where they can live independently. Accessible environment can be useful not only to disabled people but to everybody including elderly population, pregnant women, children, and other groups.

Central to accessibility standards is an information and communication system that covers all types of disability, gender, geographic areas, and all age groups. This system may include training programs and provision of specialist devices when necessary.

Self help groups : Disabled people know best about their priorities and their organizations have a strategic advantage to advocate their rights and influence public decisions concerning their issues (Kasnitz, 2001). Currently there are a number of informal self-help groups of disabled people in Afghanistan including one group for disabled women - NADWA - National Association of Disabled Women in Afghanistan. These groups are independent from the government and have the potential to foster disability movement in the future. However, training, awareness raising, financial support, and collaboration with other stakeholders especially the government is all necessary for the development of this sector. DPI Asia and Pacific have conducted leadership training for these groups in Afghanistan last year and communication continues between DPI and some of these groups.

There is an obvious need for grass roots action to support the future disability movement in Afghanistan. The working group on self-help groups for planning the national disability policy has identified the needs of disabled people to include different self help groups according to types of disability, financial support for such groups, friendly and cooperative government relations, and supporting the development of self-help groups into recognized organizations including umbrella organizations.

Conclusion

The fact that disabled Afghans were a hidden group meant that society knew very little about their situation: their needs and aspiration, and more importantly about their abilities and their rights. It can be argued that empowering minority disabled groups therefore, necessitate not only giving power to disabled people over their lives, but also making knowledge about disability available to the public including policy makers and the disabled community themselves, hence making disability a visible issue. This will create opportunity for debate over disability issues and present a chance for change. The participation of disabled people and their organization in this debate is fundamental and goes in line with the Afghan Comprehensive National Disability Policy 2003 as well as in line with UN Standard Rules, BMF and the recently drafted disability convention.

Despite the fact that the recently endorsed National Constitution of Afghanistan made all citizens equal before the law in terms of their rights and responsibilities, disabled people continue to be deprived of services on many grounds and this is often justified by lack of resources. Until now national plans took little notice to integrate disability concerns into their respective programs. The Comprehensive National Disability Policy has emphasized the value of coordinated and collaborative effort between all stakeholders in dealing with disability issues including those pertaining to minority invisible groups.

References

Afghan Constitution (2003) Draft National Constitution of Afghanistan. http://www.constitution-afg.com/draft_const.htm

BMF (2003) Biwako Millennium Framework for Action Towards an Inclusive, Barrier Free and Rights Based Society for Persons with Disabilities in Asia and the Pacific (BMF). United Nations Economic and Social Council, Otsu City, Shiga, Japan.

CEDAW (1979) The Convention on the Elimination of all Forms of Discrimination against Women.

Civic Voluntary Group (2003) The Situation of Disabled Children in the Education System in Afghanistan: a study for the city of Kabul. Kabul: GVC.

CRC (1989) The United Nations Convention on the Right of the Child.

ICERD (1965) The International Convention on the Elimination of All Forms of Racial Discrimination.

Kasnitz, D. (2001), 'Life Event Histories and the US Independent Living Movement', in M. Priestley (ed.), Disability and Life Course: Global Perspectives, Cambridge University Press, Cambridge, pp. 67-78.

Ministry of Public Health (2003) Interim health strategy 2002-2003.

Ministry of Public Health (2003) A basic package of health services for Afghanistan.

MMD (2003) The Comprehensive National Disability Policy. URL: www.disabilityafghanistan.org

Nagata, K (2003) Gender and Disability in the Arab Region: the challenges in the New Millennium. Asia Pacific Disability Rehabilitation Journal, Vol 14, No 1, 2003.

Oliver, M. and Barnes, C. (1998), Disabled People and Social Policy: From Exclusion to Inclusion, Longman, London.

UNICEF (2003) The State of the Worlds Children.

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