Yemen: Disability Profile

Disability profile in Yemen

There is no accurate information or studies on the situation of disabled people in Yemen, just piecemeal and uncoordinated studies. In recent years, the government has given attention to data management on disability for program planning and policy making. A number of national surveys as a result have included some questions on disability. The accuracy of the results have remained limited however due to using narrow definitions of disability as well as other technical and logistical problems related to collecting specialist information on disability.

For example the population, housing and establishments census of 1994 had showed a proportion of disability at 0.54% with no difference between rural and urban areas (CSO, 1994). This is far from accurate and included only the severe cases of disability. The National Poverty Survey (1999) showed a 17-18% of stunting among children less than 5 years of age with the majority of cases due to malnutrition (CSO, 1999). The Household Budget Survey planned for 2005 makes reference to disabled people but definition is rather limited and leaves those with learning disability, psychological/psychiatric, and multiple disabilities excluded (CSO, 2004). The issue of definition remains the key factor responsible for variations in the results of surveys and studies.

Impairments and disabilities in Yemen are due to road accidents, hereditary issues, accidents from construction work and firearms, poor medical infrastructure and medical mistakes, iodine and vitamin A deficiency, poor maternal health related to malnutrition, and other environmental factors including epidemics, natural disasters, pollution, and inaccessible environments. Further, maternal health is notably affected by Qat ¹ consumption. According to The World Bank (1999), Qat severely reduces the appetite for women and leaves pregnant mothers without food for considerable times, causing nutritional problems for mother and child. There is a lack of awareness raising strategies on the prevention of disability in Yemen. This leads to new cases of preventable impairments on a daily basis ².

In Yemen as in other developing societies, poverty and disability are closely linked in a vicious circle (DAA/UNESCO, 1995; DFID, 2000; Stienstra, et al 2002). Poverty among disabled people surveyed for the Social Welfare Fund in 2002 reached 23% (SWF, 2002; MLSA, 2003). Breaking the yoke of poverty will help overcome problems related to disability. However, improving the economic conditions of the poor is not the only solution to deal with the issue of poverty and disability. There are other social, political and cultural measures that need to be put in place while dealing with poverty and disability (Turmusani, 2003). To achieve equality and social justice as promoted in Millennium Development Goal in Arab countries - MDG (MDG, 2003), the system of class has to be dismantled so that minority groups such as 'Akhdam' and disabled people become integrated into the mainstream. Until these social and cultural disabling barriers (represented by class, gender or disabilities) are removed, little social justice can be achieved in Yemen. Therefore development initiatives should focus on strategies to change social habits and behavior.

The Social Safety Nets created to alleviate poverty at the rate of 27% (National Poverty Survey, 1999) in Yemen has the potential to serve disabled people. Currently there are three specialist safety nets serving disabled people including the Social Welfare Fund (SWF) (providing financial assistance to the needy including disabled people); the Social Fund for Development (SFD) (a capacity building organisation); and the Fund for the Welfare of Disabled (Disability Fund - DF) which provides funding for various disability rehabilitation projects. Other existing safety nets have also the potential to serve disabled people and this includes t he Public Works Programme (create employment and income opportunities for low skill workers); the National Poverty Alleviation and Employment Generation Programme; the National Programme for Productive Families and the Small Scale Credit Units. Apart from the Fund for the Welfare of Disabled, all safety nets suffer from their budgetary limitations, including their dependency upon conditional foreign funding.

In conclusion, it is clear that markets alone can't deliver growth as argued earlier and this is more evident in the case of poverty and disability more than any other field. Both disability and poverty are cross-cutting issues. They should be tackled in a coordinated manner using a package of social, cultural and political measures together with economic reforms. All stakeholders should be involved in the process including disabled people and their organizations.

Issues and challenges

Rehabilitation policies in Yemen are spread over a number of legal documents issued by the Ministry of Legal and Parliamentary Affairs (MLPA). The Law for the Welfare of Disabled - Law Number 2 for the year 2002 remains the principal document. Other Laws referring to disabled people include: Child Law - Number 45/2002 (Articles 1115 - 123), Law for Social Welfare - Law Number 3/1996 including the establishment of The Welfare Fund, and Law Number 2/2002 for the establishment of the Fund for the Welfare and Rehabilitation of Disabled People. A major criticism of these laws is their limiting medical definitions, the absence of a coordination mechanism set up for the implementation of these laws, and priority treatment given to war disabled persons.

Despite all these laws, the rights of disabled people including disabled Yemeni to access services and provisions remain restricted by many institutional disabling barriers including the built environment in line with the social model of disability (Oliver and Barnes, 1998). Accessibility issues in fact are prerequisites to education, employment and participation in community life (UN, 1993, Rapley, 2003). Accessibility does not only include modification to buildings, but also necessary is changes in attitudes, an accessible legal system and accessible information and communication strategy that reaches all disabled people.

Strategies for the prevention of disability in Yemen remained largely limited to vaccinations. Little attention is given to reducing malnutrition among mothers and children, the reduction of Iodine and vitamin A deficiency, or road accidents, fire arms, constructions, medical mistakes, and diseases. The overwhelming majority of people acquiring impairments remain without services. The lack of an effective early intervention system means that impairments often develop into permanent disabilities, especially in rural areas where there is nearly total absence of disability support services including health education and necessary rehabilitation. Above all, an awareness strategy for changing attitudes towards the needs and abilities of disabled people is missing.

While Yemen is not a war zone country, land mines are still causing a number of impairments, especially among the rural population. According to the Yemeni Land Mine Action Centre, there have been 103 new injuries during the last 3 months throughout the country (YMAC, 2003). Existing orthopedic workshops are only located in big cities and this leaves the majority population out of rehabilitation services. People who receive artificial limbs have difficulty maintaining such devices due to distance in reaching the nearest workshop. Existing workshops produce mainly lower and upper limbs. Wheelchair production is limited and there is no agency producing wheelchairs for children or for sports. Moreover, splints, crutches or special seats for CP children are all missing. Overall, the physical rehabilitation provision in Yemen including physiotherapy services is generally weak and needs serious attention.

It is notable that education for disabled people in Yemen is generally segregated in institutions some of which are residential with long waiting lists. This is despite the policy for 'Education for All' adopted recently by Ministry of Education (ME, 2002). Overall, there are far more disabled students who can't access education ³ including higher education. Specialized preschool services for children with all kind of disabilities hardly exist apart from some individual urban based examples. For a rural society like Yemen with three quarters of its population living in scattered villages, Coleridge (2004) recommend the utilization of Community Based Rehabilitation (CBR) to serving disabled people not only in education but in other areas of community development.

While sign language is notably developed in Yemen with a dictionary already in place, speech therapy is missing whether for deaf people, people who have had accidents, strokes or for CP and other disabled people. Similarly, psychiatric facilities are absent apart from a handful of centers characterized by poor services. Services for elderly population are totally absent despite the notable increase in life expectancy in Yemen from 46 years in 1990 to 60 years in 2001 (UN, 2001).

Education and training are keys to assisting disabled Yemeni to become economically independent and active members in society. However, support services for young disabled people including vocational training and community apprenticeship is very limited. When they exist they concentrate on traditional handcrafts - sewing and knitting for girls and loom knitting for deaf and physically disabled boys. According to disability Law No 2/2002, five percent of the total workforce should be reserved for people with disabilities. In reality however, few employers comply with this quota system. The Social Fund for Development however - which has a special project for disabled people - has managed to employ a number of disabled women and men in its regional network, some of whom serve as disability officers themselves (SFD, 2002). This model of trusting in the ability of disabled people to lead their own development deserves study and support.

The capacity of Disabled People's Organizations to lead disability movement in Yemen is a major concern considering the potential role DPO's can play in empowering disabled constituents. There is a national union of disabled people (MLSA, 2001) already existing, but with no regional network or budget for operation. The capacity of the union to represent the interests of and to advocate the rights of disabled people is not always clear.

Government strategy

The Government of Yemen has shown high political commitment towards disability issues, but their strategy relied heavily on legislation or special safety nets funds as seen earlier. The Ministry of Social Affairs and Labor has taken the lead responsibility of serving disabled people in Yemen including issuing legislation - MSAL has a unit for CBR. Two other ministries provide services for disabled people including: the Ministry of Public Health and Planning (MoPHP) through its vaccination program, orthopedic support and physiotherapy services (MPH, 2000); and the Ministry of Education (ME) through its policy on 'Education for All' (ME, 2002).

Given the limited capacity of government structure to deal with disability issues, the Government in recent years has assigned much responsibility regarding the practical needs of disabled people to special safety net funds. These funds were created to reduce the yoke of poverty in the country and they include SFD, the Social Welfare Fund and Disability Fund as mentioned earlier. Moreover, the government has also delegated some responsibility for serving disabled people to the civil society.

This collaborative approach to development adopted by the Government goes in line with the participatory approach used in this study ⁴ on disability and poverty in Yemen, fully supported by both the Government and the World Bank. The World Bank has long recognized the importance of democratic process for sustainable economic development in Yemen. There has been much investment made in supporting the development of civil society and grass root action guided by the international framework of Human Rights (The World Bank, 2003).

Conclusion and recommendations

The overwhelming majority of disabled Yemeni, especially women ⁵, remain without services, particularly in rural areas. Government support is very limited, and recently established DPO's are too weak to bridge this gap of services as these DPOs themselves require capacity building. Disabled people especially in the regions had expectations of support by the disabled union but receive none. They also have expectations from the government, and lack faith in it at the same time. While there is political commitment at government level, lack of enforcement mechanisms have left laws ineffective. The International community provides some support to the disability sector but this could be enhanced much more considering the existing needs and the size of development cooperation in Yemen. The top priorities identified by disabled people were vocational training, employment, and financial welfare support.

Considering the poor infrastructure of the country and the very limited capacity at all levels, it is necessary to conduct further investigations into the capacity of disability sector in Yemen and the potential for the development of coordination mechanism for existing disability partners, both government and civil society including DPO's. A comprehensive strategy on disability would clarify the roles and responsibilities of each party which will greatly help meeting the needs of disabled Yemeni.

Issues to be considered in such a strategy may include awareness raising campaigns on disability prevention and early intervention; as well as positive disability terminology, human rights approach to disability; and inter-sectoral coordination are all important for the development of disability sector in Yemen. Equally important is the provision of rehabilitation services including vocational training, education, and employment and how these help in reduction of poverty and disability. There is a need to develop the capacity to manage data following a disability research approach.

The cross cutting nature of disability requires inter-agency coordinated effort for effective service delivery. For this reason there is clear justification for setting up of national coordination body with leading role given to disabled people organizations supported by MSAL who should oversee disability business in Yemen. The three fold government mandate of coordination, regulation and supervision of services including inter-ministerial coordination should be balanced, enhanced and strengthened at MSAL.

Disabled people organizations play a central role in their own empowerment process. Civil society including DPO's should be represented in all activities related to policy formation, program planning, implementation, and monitoring. In brief, it is important to mainstream disability into development national programs.

A strategy for poverty alleviation should take note of building human capacity to effectively use scarce resources in the community and not only building economic capacity. CBR approach to using local skills and resources is an important example - paper and simple orthopedic technology. Poverty reduction strategies should go hand in hand with friendly safety nets measures to include disabled clients in their target beneficiaries.

The high government political commitment towards disability has raised the profile of disabled people issues on public agenda. However, there is obvious need for a national strategy on disability with a mechanism for coordination ⁶ so that minority groups are reached.

Notes

1. This first stage research has been conducted under the World Bank Study on Poverty and Disability in Yemen during March and April 2004. The full Study will be completed in further date. Special thanks to Iqbal Quar - Team Leader of Yemeni Strategy for Children and Youth, The World bank, DC for her comments on an earlier draft of this paper.

Qat is considered as a stimulant substance that has dependency effect (MPD, MA, and FAO, 2002).

2. One family visited had 6 disabled boys and girls who have muscular wasting. Two more children are also diagnosed with the same disease but no symptoms manifest until now. The lack of services left this disabled family out of services including education, vocational training or job opportunities. The welfare fund has just recently decided to give 2000 YR / month (approx 10 - 11 US$) as financial support for this family.

3. The prevalent poverty in rural areas had led many parents to keep their children, especially girls at home to assist in family economy - farming, fetching water and woods, etc.

4. This first stage study gives a framework that will set the scene for a further in-depth investigation on disability and poverty in Yemen. In so doing, a brief situational analysis of disabled people in Yemen is being presented here based on discussion with stakeholders including disabled Yemenis. Disability partners in Yemen have identified a number of strategic issues that need to be looked at and addressed within Yemen strategy for children and youth.

Data for this study including demographic data have been gathered through a consultation process with disability stakeholders including those at the governorate level - this included all line ministries, INGO's, donors community, disability NGO's including disabled union, and disabled people and their families. A total of 50 organizations were visited and more than 150 people took part in 5 FGD including one large group discussion in Akhdam community. Both individual and focus group discussion were employed for data collection. Desk review has also been conducted and qualitative analysis has been used. Future study may focus on gathering primary and in-depth data from participants through both individual interviews as well as focus group discussions. Research team included researcher himself and two assistants from MSAL and SFD one of whom was a woman.

5. Until recently that there was special attention given to disabled women. Previously, disabled females were left behind and family given little priority for their education, training or rehabilitation. The Challenge Association for the Care of the Disabled is an advocacy initiative that support disabled women in Yemen. Based on a number of local surveys, the Women National Committee for the implementation of CEDAW reports 113,000 disabled people in Yemen, 36,852 of who are women. The illiteracy rate among disabled women is said to be at 95% and the number of disabled girls served in rehab centers is just over 1000 in 1999. Elderly females are particularly suffering more discrimination (WNC, 1999).

6. Based on consultations with various partners in Yemen including GoY and civil society it was obvious that the current Poverty Reduction Strategy Paper (PRSP, 2003) lacks the endorsement of many stakeholders who either don't know about it or are not convinced that they can play a role in it. This explains the very slow progress in the implementation of PRSP in Yemen. Since it came into force two years ago, there was hardly any effort at the national level to set up coordination mechanism to introduce it to stakeholders and to monitor its implementation.

Bibliography

Coleridge, P (2004) The Social Fund for Development: A Review of its Program in Disability. Internal Report, Jan-March 2004.

CSO (1994) Final Results of the Population, Housing and Establishments' Census. Central Statistical Organization (CSO) and Ministry of Planning and Development, Sana'a.

CSO (1999) Final Results of the Population, Housing and Establishment Census, General Report. Central Statistical Organization (CSO) and Ministry of Planning and Development, Sana'a.

CSO (1999) The National Poverty Survey. Central Statistical Organization (CSO) and Ministry of Planning and Development, Sana'a.

CSO (2004) Household Budget Survey 2005 - Final Questionnaire. Central Statistical Organization (CSO) and Ministry of Planning and Development, Sana'a.

DAA/UNISCO (1995) Overcoming Obstacles to the Integrating of Disabled People, Disability Awareness in Action (DAA), London.

DFID (2000) Disability, Poverty and Development. Department for International Development (DFID), London.

MDG (2003) The Millennium Development Goal in Arab Countries: Towards 2015 Achievements and Aspirations. UNDP, New York

ME (2002) Education for All Strategy, internal document. Ministry of Education, Sana'a.

MLPA (2002) Child Rights Law No 45 for 2002. Ministry of Legal and Parliamentary Affairs (MLPA), Sana'a.

MLPA (2003) Labor Law No 5 for 1995. Ministry of Legal and Parliamentary Affairs (MLPA), Sana'a.

MLPA (2003) Law for the Social Welfare Fund for 1996. Ministry of Legal and Parliamentary Affairs (MLPA), Sana'a.

MLPA (2002) Law for the Welfare and Rehabilitation of Disabled No 61 for 1999. Ministry of Legal and Parliamentary Affairs (MLPA), Sana'a.

MLPA (2003) Law of Social Welfare No 31 for 1996. Ministry of Legal and Parliamentary Affairs (MLPA), Sana'a.

MPD, MA, and FAO (2002) The National Conference on Qat: Towards the Formulation of a Comprehensive Qat Policy in the Republic of Yemen - Technical Field Study. Ministry of Planning and Development (MPD), Ministry of Agriculture (MA), and UN Food and Agriculture Organization (FAO), Sana'a.

MPH (2000) Health Sector Reform in the Republic of Yemen: Strategy for Reform. Ministry of Public Health and Planning (MPHP), Sana'a.

MSAL (2001) Charter for the National Union of Yemeni Disabled Organizations. Ministry of Social Affairs and Labour (MSAL), Sana'a.

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

PRSP (2003) The Republic of Yemen's Poverty Reduction Strategy Paper 2003 - 2005. Yemen News Agency Printing Press (Saba), Sana'a.

Rapley, C (2003) Reconsidering the disability Dimension in Development Cooperation Activities; building national capacities for full participation and equality. Regional Workshop towards a Comprehensive and Integral International Convention on Protection and Promotion of the Rights and Dignity of Persons with Disabilities. October 14-17, UNESCAP, Bangkok.

SFD (2002) The Annual Report of the Social Fund for Development (SFD). SFD, Sana'a.

Stienstra, D, Fricke, Y, and D'Aubin, A (2002) Baseline Assessment: Inclusion and Disability in World Bank Activities. Canadian Centre on Disability Studies.

SWF (2002) Social Welfare Funds' Poverty Survey 2002-2003. Social Welfare Fund (SWF), Sana'a.

Turmusani, M (2003) Disabled People and Economic Needs in the Developing World: political perspective from Jordan. Ashgate, Aldershot.

UN (2001) Yemen Common Country Assessment: United Nations in Yemen. UN, Sana'a.

WNC (1999) National Report on the Implementation Level of the Convention on Elimination of All Forms of Discrimination Against Women. Women National Committee (WNC), Sana'a.

World Bank (2003) Yemen National Strategy for Children and Youth. Issue Paper, The World Bank, DC.

 printer-friendly format