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Persons with disabilities and climate change in Nepal: Humanitarian impacts and pathways for inclusive climate action

Jennifer M'Vouama, Humanity & Inclusion (HI)
Mosharraf Hossain, Team Leader, Global Inclusion Consulting Ltd
Sukharanjan Sutter, IRG Development Services Limited
Mahesh Ghimire, local consultant, Nepal
August 2023

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Climate change is affecting every region on Earth and already causing irreversible impacts. While it is a global phenomenon, its negative impacts are felt more intensely by poorer countries and poor communities heavily reliant on natural resources and lacking coping and adaptive capacities to deal with a changing climate. Within those poor communities and countries, persons with disabilities are often amongst the most marginalized people. They experience attitudinal, physical and communication barriers that undermine their access to services and opportunities supporting their well-being and resilience. For this reason, they tend to be disproportionately vulnerable to climate impacts, including more frequent and intense disasters, as those exacerbate pre-existing vulnerabilities. Yet, while it is acknowledged that climate change will exacerbate inequity should we fail to ensure inclusive and participatory decision-making processes in climate governance, disability inclusion in climate action largely remains marginally addressed. Persons with disabilities have been historically left out of climate responses at various levels, from local and national country plans to global negotiations occurring at the UN Conferences of the Parties1 (COP).


Nepal is experiencing an increasing number of climate-related disasters, with a global study ranking it as the fourth worst hit country in the world by weather-related loss events in 20172. Urban floods, landslides, extreme heat, storms, drought, and wildfires are very common climate disasters affecting communities across the country, especially rural populations and their natural resource-dependent livelihoods. Nepal’s vulnerability to climate change lies in its varied topography marked by steep terrain and remoteness, its diverse geo-climatic system and social vulnerability, exacerbated by challenges to deliver effective and comprehensive disaster risk reduction and management strategies. To address this serious threat to economic development and prosperity, Nepal has put in place a rich overarching climate change policy framework early on, encompassing dedicated policies and plans, as well as sectoral planning processes integrating climate resilience. Nepal has also established various leadership, coordination, and stakeholder engagement mechanisms to guide climate change policymaking, articulate implementation across the government’s three-tier federal structure, and ensure dialogue with key stakeholders including civil society actors.

Endorsed in 2011, Nepal’s Framework on Local Adaptation Plans for Action (LAPA) is a particularly praised initiative, promoting a bottom-up, inclusive, and flexible approach for integrating climate adaptation and resilience aspects into local planning. This pioneering, community driven process, places the adaptation needs and opportunities of most vulnerable and highly vulnerable groups at the heart of the approach. Gender considerations factoring intersecting factors of marginalization such as age and ethnicity have been given priority in these processes, to address women’s increasing economic insecurity and workload due to climate change. But inclusion of women with disabilities, or persons with disabilities in general in local adaptation planning has not been strongly evidenced to date.


According to Nepal Census 2022, 2.2% of the Nepali Population have some form of disability, mainly a physical disability. However, other sources estimate this figure to be much higher. Nepal ratified the United Nations Convention on the Rights of Persons with Disabilities (CRPD) in 2008 and passed the Disability Rights Act in 2017, establishing constitutional directives to support persons with disabilities and making it illegal to discriminate based on disability. Yet, perception of persons with disability in Nepal remains generally negative, due to persistent and deep-rooted Hindu religious beliefs associating disability with sinning in a previous life. Women and girls with disability face greater marginalization and discrimination and tend to be hidden away by families. Nepal’s caste system also plays a role in shaping the vulnerability of persons with disabilities. Thus, widespread stigma compounded by the intersectionality of certain factors, combined with structural inaccessibility, create significant barriers to have equal access to resources and participate in decision-making. This tends to translate into poor socio-economic status, poor health outcomes, and no or low education levels, especially among women and girls. Persons with disabilities in Nepal can register under social welfare to access several disability-targeted benefit packages, including a Disability Grant. However, the process tends to be paved with barriers, leading to high exclusion rates.
It is in this context that HI sought to better understand the unique challenges and opportunities for persons with disabilities in the face of climate change in Nepal. This report is intended to inform how persons with disabilities understand and perceive climate change, what is their experience of dealing with climate extremes, what is the impact on their health, livelihoods and support system, and their actual level of inclusion in climate adaptation planning. To capture those perspectives, HI surveyed 388 persons with disabilities across Nepal’s 7 provinces, consulted 20 key informants from the disability movement, government institutions, and the aid sector, and conducted 8 targeted focus group discussions to hear from women, youth, and persons representing diverse disability types. This report is a contribution to the growing evidence base documenting the disproportionate impacts of climate change on persons with disabilities and calling for disability-inclusive climate action at all levels of governance.

Humanitarian inclusion standards for older people and people with disabilities

ADCAP
TILL, Celia
et al
February 2018

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The Humanitarian inclusion standards for older people and people with disabilities provide guidance across all areas and at all stages of emergency response to ensure older people and people with disabilities are not left out.

The standards consist of nine key inclusion standards, including identification, safe and equitable access, knowledge and participation, and learning. Alongside these, there are seven sector-specific inclusion standards, which include protection, shelter, health, and water, sanitation and hygiene.

Each standard comes with key actions, guidance, tools and resources, and case studies illustrating how older people and people with disabilities have been included in humanitarian responses.

The sector-specific standards provide guidance in three key areas: data and information management, addressing barriers to inclusion, and participation of older people and people with disabilities.

By implementing the key action points provided, organisations will build up a greater evidence base, deliver more inclusive programmes, and be able to better demonstrate impact on the lives of those most at risk during humanitarian crises.

The standards can be used as guidance during programme development, implementation and monitoring, and as a resource for training and advocacy.

Landmine Monitor 2017

INTERNATIONAL CAMPAIGN TO BAN LANDMINES – CLUSTER MUNITION COALITION (ICBL-CMC)
December 2017

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Landmine Monitor 2017 provides a global overview of the landmine situation. Chapters on developments in specific countries and other areas are available in online Country Profiles on the website.

Landmine Monitor covers mine ban policy, use, production, trade, and stockpiling in every country in the world, and also includes information on contamination, clearance, casualties, victim assistance, and support for mine action. The report focuses on calendar year 2016, with information included up to November 2017 when possible.

The Victim Assistance section covers: assessing the needs; frameworks for assistance; enhancing plans and policies; inclusion and active participation of mine victims; availability of and accessibility to services (medical care, rehabilitation including prosthetics; socioeconomic inclusion; education, pyschosocial support); guaranteeing rights in an age- and gender-sensitive manner; communicating objectives and reporting improvements; legal frameworks and new laws.

Inclusive and integrated mother, newborn and child health programming: Beyond mortality

OLCHINI, Davide
November 2017

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This policy paper describes the operational terms of Handicap International’s mandate and values as applied to Mother, Neonatal and Child Health (MNCH). Presenting the approaches and references underpinning Handicap International’s actions, choices and commitments, its purpose is to ensure consistency across its practices while taking account of different contexts. Intended as a document to guide programme staff, the paper defines the topic, describes the target populations and sets out the methods of intervention (activities and expected results) and the indicators used to monitor and evaluate. It also aims to ensure that Handicap International programmes implement all projects in accordance with the presented methods of intervention

 

The SDGs focus on a broader scope of activities and are thus slowly but surely shifting from mortality to address in a more comprehensive manner the well-being and achievement of maximum potential for children and adolescents. With a robust component in sexual and reproductive health, this represents a significant frame of reference for Handicap International’s work in MNCH as it has paved the way for integrating MNCH-related impairments into existing health services. The framework of the SDGs provides a clear vision of the importance of multi-sectorial interventions, which encompass the limit of vertically-organised health systems centred on curative aspects, to offer a more integrated and preventive package of interventions that include chronic conditions, impairments and health for all. After many years of implementing MNCH projects, Handicap International is well-positioned and firmly established as a major player in this process.

Quality inclusive education for children with disabilities in Ethiopia

HANDICAP INTERNATIONAL ETHIOPIA
2017

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Achieving education for all in Ethiopia will remain a distant aspiration if most of the 5 million children with special educational needs in the country cannot go to school. Since 2014, Handicap International have been supporting 49 schools to become places where everyone has a role to play in making schools more inclusive.

Cluster Munition Monitor 2017

INTERNATIONAL CAMPAIGN TO BAN LANDMINES – CLUSTER MUNITION COALITION (ICBL-CMC)
August 2017

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Cluster Munition Monitor covers cluster munition ban policy, use, production, transfers, and stockpiling in every country in the world, and also contains information on cluster munition contamination and clearance activities, as well as casualties and victim assistance. Its principal frame of reference is the Convention on Cluster Munitions, although other relevant international law is reviewed, including the Convention on the Rights of Persons with Disabilities. The report focuses on calendar year 2016, with information included into July 2017 where possible. Sections are: cluster munition ban policy; contamination and clearance; casualties; victim assistance; and status of the convention

 

Including children with disabilities in humanitarian action

UNICEF
July 2017

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"The purpose of Including Children with Disabilities in Humanitarian Action is to strengthen the inclusion of children and women with disabilities, and their families, in emergency preparedness, response and early recovery, and recovery and reconstruction. This series of booklets provides insight into the situation of children with disabilities in humanitarian contexts, highlights the ways in which they are excluded from humanitarian action, and offers practical actions and tips to better include children and adolescents with disabilities in all stages of humanitarian action. The booklets were created in response to UNICEF colleagues in the field expressing a need for a practical resource to guide their work. The information and recommendations are based on evidence and good practices gathered from literature and field staff experiences. The six booklets on how to include children and adolescents with disabilities in humanitarian programmes are as follows: 1) general guidance; 2) child protection; 3) education; 4) health and HIV/AIDS; 5) nutrition; 6) water, sanitation and hygiene (WASH)".

General guidance available July 2017. Others to follow.

In addition to the PDF versions in English, Arabic and French, the guidance is also available in a range of accessible formats, including EPUB, a Braille-ready file and accessible HTML formats. 

The guidance was developed in collaboration with Handicap International.

Factsheet. Maternal health and rehabilitation

HANDICAP INTERNATIONAL;
March 2017

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Maternal health concerns the health and wellbeing of mothers from before pregnancy (pre-conception), during pregnancy (ante-natal), during and after childbirth (peri- and post-natal). Common impairments and activity limitations from obstetric fistulae, pelvic floor dysfunction, maternal depression and musculoskeletal disorders are outlined and examples of rehabilitation strategies are given. A case study of fistula in Burundi is reported.

Child health and rehabilitation. Factsheet.

HANDICAP INTERNATIONAL
March 2017

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Child health encompasses physical, mental and social well-being of children under the age of five. The leading causes of under-five deaths are pre-term birth complications, pneumonia, birth asphyxia, diarrhoea and malaria. Malnutrition contributes to nearly half of all under-five deaths. All these conditions contribute hugely to child impairments too. Common impairments and activity limitations related to child health including birth defects, cerebral palsy, developmental delays, burns, falls and injuries and road traffic injuries are outlined and different examples of rehabilitation across the care cycle are given. A case study of cerebral palsy in Haiti is cited. 

Diabetes and rehabilitation. Factsheet.

HANDICAP INTERNATIONAL
March 2017

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Diabetes is the 9th most common cause of years lived with disability. Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. This causes an increased concentration of glucose in the blood (hyper glycaemia). There are three types - Type 1, Type 2 and gestational. Common impairments and activity limitations are reported including: neuropathy; peripheral vascular disease; retinopathy; kidney complications; stroke and depression. Different examples of rehabilitation in the care continuum are provided. A case study of diabetes in the Philippines is cited.

Cardiovascular diseases (CVD) and rehabilitation. Factsheet

HANDICAP INTERNATIONAL
March 2017

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Cardiovascular disease (CVD) refers to conditions that affect the heart and blood vessels. Most commonly this includes coronary heart disease (heart attacks), cerebrovascular disease (stroke) or raised blood pressure (hypertension). A stroke occurs when a blood clot (ischaemia) or a bleed (haemorrhage) disrupts the blood supply to part of the brain, starving that area of oxygen. Stroke is a leading cause of serious long-term disability. Common impairments and activity limitations from cardiovascular diseases are hemiplegia, word forming difficulties and slurring of speech, cognitive function, depression, sensory loss and shortness of breath. Different examples of rehabilitation in the care continuum are given. A case study of stroke in Nepal is provided. 

HIV & AIDS and rehabilitation. Factsheet.

HANDICAP INTERNATIONAL
March 2017

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The Human Immunodeficiency Virus (HIV) is a virus that makes the immune system collapse, making a person totally defenceless to infections. A person living with HIV may experience episodic and/or chronic impairments. These may result from illness and/or from treatment side effects, in particular: general fatigue and weight loss; neurological disorders; mental and cognitive disorders such as dementia; and joint and muscle problems. Different examples of rehabilitation across the care cycle are given. A case study in India is provided.
 

Road traffic injuries and rehabiliation. Factsheet.

HANDICAP INTERNATIONAL
March 2017

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The rate of road accidents is increasing globally and the resulting deaths, injuries, physical disabilities and psychological distress are creating a tremendous negative economic impact on victims, their families and society in general, especially in low and middle income countries. Common impairments and activity limitations from road traffic injuries are musculo-skeletal injuries, spinal cord injuries (SCI), traumatic brain injury and psychological distress and depression. Different examples of rehabilitation across the care cycle are provided. A case study of brain injury in Laos is provided. 

Inclusive disaster risk reduction

LAFRENIERE, Annie
WALBAUM, Veronique
2017

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This policy paper defines the themes of inclusive disaster risk reduction and explains how these activities fit into the HI mandate. It also identifies the target population and defines modalities of intervention–standard expected outcomes, standard activities–as well as monitoring and evaluation indicators.

Pilot testing of 3D printing technology for transtibial prosthesis in complex contexts (Togo, Madagascar and Syria)

CONICAVE, Jerome
TAN, Daniele
2017

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In January-October 2016, Handicap International carried out a pilot testing of 3D printing technology for transtibial prosthesis in Togo, Madagascar and Syria. The aim of the study was to explore and test how physical rehabilitation services can be more accessible to people living in complex contexts via innovative technologies (such as 3D printing, treatment processes that use Internet technology and tools) and decentralised services by bringing them closer to the patients. This scientific summary provides the context, the objectives, the methodology, the results of the study, and perspectives for the future.

A number of technical appendices are available

RS/05

Minimum technical standards and recommendations for rehabilitation

NORTON Ian
December 2016

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This document is the result of collaboration between a working group of rehabilitation experts convened by WHO and external consultations. It is thus based on collective experience in rehabilitation during responses to recent large-scale emergencies and also on published data. In time, the minimum standards for rehabilitation in emergencies will be part of a broader series of publications based on the Classification and minimum standards for foreign medical teams in sudden onset disaster.

 

The purpose of this document is to extend these standards for physical rehabilitation and provide guidance to emergency medical teams (EMTs, formerly known as “foreign medical teams”) on building or strengthening their capacity for and work in rehabilitation within defined coordination mechanisms.The standards and recommendations given in this document will ensure that EMTs, both national and international, will better prevent patient complications and ensuing impairment and ensure a continuum of care beyond their departure from the affected area. This document gives the minimum standards for EMTs in regard to the workforce, the field hospital environment, rehabilitation equipment and consumables and information management. Notably, the standards call for:

 

• at least one rehabilitation professional per 20 beds at the time of initial deployment, with further recruitment depending on case-load and local rehabilitation capacity;

• allocation of a purpose-specific rehabilitation space of at least 12 m2 for all type 3 EMTs; and

• deployment of EMTs with at least the essential rehabilitation equipment and consumables according to type.

 

EMTs are encouraged to exceed the minimum standards outlined in this document; supplementary recommendations are included. All teams on the Global Classification List of quality assured teams are required to use the minimum technical standards for rehabilitation, and demonstration of adherence to the standards will be necessary for verification. Support in achieving the minimum standards will be available through EMT mentoring, if necessary

Situation of wage employment of people with disabilities (Ten developing countries in focus)

HANDICAP INTERNATIONAL
December 2016

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One of the fundamental rights that is often denied to persons with disabilities is the right to employment. Based on 35 years of work with persons with disabilities in more than 60 developing countries, Handicap International has decided to study this issue of employment and disability. It challenges ten developing country teams to reach out to their local partners to capture the reality of employment today. This qualitative study gives very useful information about country teams’ vision of decent work for persons with disabilities in those environments where specialized resources are rare and inclusive policies remain in their infancy. Despite many obstacles, it identifies some positive promises and future tracks for better practices and efficient services. Many stakeholders, like local business and employment bureaus, are piloting innovative ways to get people to work, and to retain their skills as this positive dynamic evolves. Bringing these experiences to different audiences is the main goal of this document. Hopefully it will be the first piece of a more comprehensive data set and bank of best practices that reinforce access to decent jobs for people with disabilities wherever they happen to live in our global world.

As the movement for cash transfer programming advances, how can we ensure that people with disabilities are not left behind in cash transfer programming for emergencies?

REDUC, Marie
PLA CORDERO, Ricardo
et al
December 2016

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A short review of the literature was carried out which derived some specific recommendations with regards to the needs of people with disabilities in cash transfer programming in the braod categories of: appropriate beneficiary targeting and assessment; accessibility of training and sensitisation materials; physical and sensorial access to markets, vendors and distributions points (including ATM); access to activities in cash for work; accessibility of technology; access to lost goods and services

LANDMINE MONITOR report 2016

INTERNATIONAL CAMPAIGN TO BAN LANDMINES – CLUSTER MUNITION COALITION (ICBL-CMC)
November 2016

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Landmine Monitor 2016 provides a global overview of the landmine situation. Chapters on developments in specific countries and other areas are available in online Country Profiles at www.the-monitor.org/cp. Landmine Monitor covers mine ban policy, use, production, trade, and stockpiling, and also includes information on contamination, clearance, casualties, victim assistance, and support for mine action. The report focuses on calendar year 2015, with information included up to November 2016 when possible. 

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