Persons With Communication Disabilities in Natural Disasters,War,and/or Conflict

Persons With Communication Disability in Natural Disasters and War and/or Civil Conflict

A natural disaster is a major adverse event resulting from natural processes of the earth, including floods, volcanic eruptions, earthquakes, hurricanes, tsunamis, monsoons, avalanches, blizzards, cyclones, heat waves, tornados, wild fires, mudslides, and epidemics. Disasters can happen anywhere in the world. The World Health Organization (WHO) estimates that between 2008 and 2012, there were 143.9 million persons around the world displaced by natural disasters. In 2012 alone, 52 natural disasters killed 9,656 people and affected 138.9 million people worldwide. Natural disasters since 2013 included typhoons and earthquakes in the Philippines; hurricanes in Mexico; and mudslides, hurricanes, and tornados in the United States (Huber, 2013).

War and other conflicts have also occurred around the world. Recent conflicts have included the Gulf War; genocide in Rwanda; and civil strife in the former Yugoslavia, Afghanistan, Colombia, Bhutan, the Congo Republic, Sudan, the former Soviet Union, Liberia, Sierra Leone, Somalia, Burundi, Angola, Syria, and many other countries around the world, resulting in millions of persons being killed and/or displaced. The United Nations High Commissioner for Refugees (UNHCR; 2007) considers displaced people to include refugees and internally displaced persons (IDPs). Refugees are defined as “people who are outside their countries because of a well-founded fear of persecution based on their race, religion, nationality, political opinion, or membership in a particular social group” (UNHCR, 2007). In 2012, there were an estimated 28.8 million people displaced by war and conflict including 12 million refugees living in resettlement camps in countries other than their own. The UNHCR, UN Refugee Agency (2013) provided assistance to approximately 15.5 million IDPs in 26 countries in 2013. The conflicts in Syria and the Democratic Republic of Congo (DRC) were responsible for nearly half of the new displacements, with 2.4 million and one million displacements, respectively (Internal Displacement Monitoring Centre, 2013). It is estimated that since the conflict in Syria began in 2012, more than 100,000 Syrians have fled their country at a rate of 5,000 per day (Internal Displacement Monitoring Centre, 2013). The UNHCR reported that there are nearly 2.5 million Syrians registered as refugees living in Lebanon, Turkey, Jordan, Iraq, and Egypt.

Displacements due to natural disasters and conflicts affect different populations in different ways. In both cases, persons with disabilities are disproportionately affected. In conflict and war, some of the disabilities may have resulted from serving as soldiers, guerrillas, or other combatants or from suffering physical and psychological trauma, including amputations and injuries from gunshot and/or land mines. Others may have mental trauma from witnessing family members and friends being tortured, maimed, killed, or raped.

Individuals with disabilities are disproportionately affected in natural disasters due to inaccessible evacuation route and difficulty in understanding impending danger or limited ability to communicate their needs or to respond to those calling for rescue. They are more likely to be left behind or abandoned during both disasters and conflicts.

According to the WHO and the UNHCR, the needs of persons with disabilities affected by disasters, conflict, and war should be addressed. Often the most immediate attention is given to those with visible impairments such as amputations and motor difficulty. The needs of persons with less visible impairments such as communication impairments, hearing loss, and cognitive impairments must also be addressed, particularly the needs of young children with language and cognitive disabilities.

When disaster and conflicts strike a community or region, there is an impact on children. Access to education in resettlement and refugee camps is uneven across regions and settings of displacement, particularly for girls and children of secondary school age. The infrastructure for providing an education for children is disrupted. School buildings and supplies may have been damaged or are unavailable. Appropriately trained teachers may not be available in relocation sites. The needs of children with disabilities are of greater concern. Although many relocation camps attempt to provide an education for the children, most do not attend to the special services and provisions necessary for children with disabilities, especially in those regions of the world where few children with disability received an education pre-conflict or pre-disaster.

War, Conflict, and Disability

Historically, the perception of the needs of persons with disability has been influenced by the cultural perception of disability (Munyi, 2012). However, the United Nations Convention on the Rights of Persons With Disabilities (CRPD; 2006) has had an influence on the perception of the rights of persons with disabilities worldwide. It calls for guidance in meeting the needs of persons with disabilities in risk management in disasters as well as war and conflict. Global and regional estimates of the injury-specific causes of disability are lacking due to differences in identification of persons with disabilities and differences in the perception of what constitutes a disability in a society. A significant proportion of disabilities around the world are caused by injuries from traffic crashes, falls, burns, and acts of violence such as child abuse, youth violence, and intimate partner violence. However, estimates from some countries suggest that up to one quarter of disabilities may result from injuries and violence related to war and armed conflict. In as much as wars and armed conflicts lead to disability, persons with disabilities are more likely to become victims of violence due to their disability. Children and women with disabilities are often more vulnerable to injury in times of armed conflict. According to WHO, for every child who is killed as a result of armed violence, 100 children are left with permanent, lifelong disabilities, including physical and/or cognitive limitations related to neurotrauma, paralysis from spinal cord trauma, partial or complete amputation of limbs, physical limb deformation resulting in mobility impairments, psychological trauma, and sensory disability such as blindness and deafness (UNHCR, 2007).

Persons with disabilities may have had a pre-existing disability prior to the conflict or they may have a disability related to the conflict. Persons with disabilities have been targeted in conflict or suffered disproportionate consequences in conflict, political unrest, or war, such as the German holocaust of World War II, the bombings of Hiroshima and Nagasaki in 1945, the Rwandan genocide of 1994, and the more recent conflicts in Somalia-Sudan (2006), and the ongoing Syrian civil war. For example, the German government instituted the Law for the Prevention of Progeny With Hereditary Diseases (Reichsdruckerei, 1935), which called for the sterilization of all persons who suffered from diseases considered hereditary, including mental illness, learning disabilities, physical deformity, epilepsy, blindness, deafness, and severe alcoholism. Conservative estimates suggest that at least 5,000 physically and mentally disabled children were murdered through starvation or lethal overdose of medication (U.S. Holocaust Memorial Museum, 2014).

Persons with disabilities were also disproportionately impacted by the bombing of Nagasaki and Hiroshima in Japan at the end of World War II. In addition to the long-term effects of exposure to and permanent health issues from radiation that occurred immediately after the bombing, 90% of health care workers were killed or disabled, leaving few persons to attend to the needs of people with disabilities. Emergency hospitals and health clinics were destroyed, and many of the workers needed to restore the health facilities were killed or injured. This left people with pre-existing disabilities and others with resulting disabilities with few to care for their needs (Atomic Bomb Museum, 2014; Ishikawa, Swain, & Committee for the Compilation of Materials on Damage Caused by the Atomic Bombs, 1981).

In the 1994 genocide in Rwanda, more than one million persons were killed. The attackers used machetes, leaving many people with amputated limbs, disabling scars, and widespread trauma. Many persons with disabilities were unable to understand the impending danger, to flee or seek safety from the approaching warriors. There was a large-scale massacre of deaf people and killing of nearly all patients with mental disabilities who were in the psychiatric hospital (Mutabazi, 1998). The number of persons with disabilities in Rwanda prior to the genocide was unknown because of lack of systematic identification of persons with a disability and cultural mores that meant concealing these people. As many as 300,000 people in post-genocide Rwanda have disabilities as a result of the genocide (Frederick Amateur Repeater Group, 2011). As was the case in Nagasaki and Hiroshima, many children were newly orphaned and many medical personnel and health care workers were killed during the genocide, with a resultant lack of needed services for survivors with disabilities (Blaser, 2002).

It has been estimated that more than 100,000 persons have been killed in the ongoing Syrian conflict and more than 300,000 civilians have been wounded resulting in permanent or long-term disability. Many civilians in a conflict are left with amputations, disfigurement, brain injury, spinal injury, and vision or hearing impairments, as well as mental health issues such as post-traumatic stress disorder (PTSD). War-related injuries causing permanent disabilities in children have included spinal cord and brain trauma; bone deformities in the legs and arms; and loss of hearing, sight, and mental capacities. In addition, because a lack of access to medical or health care often occurs during conflicts, an increase in the incidence of diseases such as tuberculosis, meningitis, poliomyelitis, and other diseases is possible (Weiss, 2013).

Persons with disabilities have special needs in conflict and disasters both during evacuation or flight and in resettlement or refugee camps. When families have to escape from dangerous situations, people with physical, mental, or sensory impairments may be unable to flee. Persons with vision or motor impairments are more likely to be left behind or abandoned during evacuation in disasters and conflicts because the actual evacuation or flight can be dangerous or difficult. Children with disabilities are particularly affected as they may be separated from their families or newly orphaned.

Once in refugee or relocation sites, persons with disability may have additional difficulties. Disruption to physical, social, economic, and environmental networks and support systems affect persons with disabilities much more than the general population. They may be separated from their family or support system (Karanja, 2009). Their special needs may not be recognized. The resettlement facilities may be inaccessible. The lack of privacy and accessible latrines and bathing areas increase the difficulties for persons with disabilities. There is also a potential for discrimination on the basis of disability when resources are scarce. Humanitarian workers may be unaware of the special concerns of persons with disabilities and may not able to communicate in the language of the refugee.

There is a general lack of specific data on the number of refugees and displaced persons with special needs. When data are collected, specific disabilities are usually not categorized. It is therefore difficult to understand fully or plan for the particular needs of persons according to their individual disabilities. Some persons with disabilities are turned away from shelters and refugees camps due to a perception that they need “complex medical” services (WHO, 2011). According to UNHCR (2014), although some refugees require physical therapy, physical aids, or prosthetic devices, special needs of the vast majority can be met with fairly minimal, economic interventions such as walking canes, knee braces, or therapeutic walking shoes. Other needed services include rehabilitation care and counseling, general public awareness campaigns, and promotion activities for mainstreaming disability issues into all sectors in the camps.

Natural Disasters and Persons With Disability

Natural disasters have an inordinate impact on persons with disabilities. For example, almost immediately after Hurricane Katrina devastated the U.S. Gulf Coast, the National Council on Disability (NCD; 2006) estimated that there were roughly 155,000 people with disabilities over the age of 5 living in the cities hardest hit by the hurricane. Their needs for the basics of food and water were compounded by chronic health conditions and functional impairments, including visual, hearing, and motor impairments. Individuals with hearing impairments were unable to receive messages and announcements about evacuation via television, teletypewriter (TTY), or over loud speakers. Persons with motor impairments were unable to seek higher ground or to climb to rooftops, or in many cases to access the rescue boats or other modes of transportation for evacuation. The American Association of Retired Persons (AARP; 2006) estimated that 73% of Hurricane Katrina-related deaths were among persons age 60 and above, although they comprised only 15% of the population.

When Hurricane Irene hit the east coast of the United States in 2011, only 26% of the shelters were accessible to persons with disabilities. The nearly 900,000 persons with disabilities in New York City were unable to obtain needed assistance during the storm. When Hurricane Sandy hit the same area in 2012, at least 22 of the 43 confirmed deaths were people 65 or older. Of particular difficulty were people with disabilities in high-rise buildings who could not evacuate or get needed supplies because of lost power for elevators. However, because attention to the needs of persons with disabilities is required by the Americans with Disabilities Act, special efforts were made by the Federal Emergency Management Agency to provide assistance for people with deafness, hearing problems, and blindness in the days following Hurricane Sandy (Ross, 2013).

When disasters strike, access to medical and rehabilitative care is often limited. For example, when the magnitude 7.0 earthquake hit Haiti in 2010, more than 100,000 people were killed and an additional 194,000 to 250,000, or 2% of the population, incurred amputations, spinal cord and brain injuries, complex multiple fractures, and other trauma requiring massive rehabilitation efforts. However, even before the earthquake struck, Haiti had few rehabilitation professionals and little capacity to provide assistive technologies, including prostheses and wheelchairs (Iezzoni & Ronan, 2010).

Communication and information are fundamental to coping with disasters; however, information and communication needs are often considered a low priority. When the magnitude 9.0 earthquake and tsunami struck Japan in 2011, 20,000 lives and 500,000 homes were lost. In spite of being considered among the most prepared for a disaster following the bombings in Nagasaki and Hiroshima at the end of World War II, the public address announcements were not given using Japanese sign language. Power outages made it difficult for persons to receive captioned electronic messages. It is estimated that 56% of the victims who lost their lives in the tsunami were above 65 years old, more than double the average of persons in the general population. The fatality rate for people with disabilities who were registered with the government was 2.06%, whereas that for the general population was 1.03% (WHO, 2014).

There have been few comprehensive studies of the impact of disaster preparedness for persons with disabilities. Gerber, Norwood, and Zakour (2010) surveyed 1,162 persons with disabilities and their household members. These persons had varying disabling conditions, including medical (n = 425), mobility (n = 334), hearing (n = 168), mental health (n = 137), cognitive (n = 127), visual (n = 127), and other impairments (n = 134). Of the respondents, 42% reported a disability themselves; 16% were members of a household that included a person with a disability; 42% were elderly who did not identify as having a disability; 58% were living in a community where a recent disaster had occurred, and 42% lived in an area where a major disaster had not recently occurred. Of the 1,162 respondents, 670 (57.7%) indicated that there had been a disaster that had caused an evacuation in their area in the recent past, and 463 respondents (39.8%) reported that they had themselves been evacuated. The key findings indicated differences in preparedness dependent on the type of disability. Persons with cognitive disabilities had more household preparedness than other groups. Seventy percent of persons with cognitive disabilities had knowledge of a specific evacuation destination; 80% had a plan for what to take with them; 90% had a plan to stockpile medications; and 49% had knowledge of the location of a public shelter.

People with hearing impairments had fewer steps in place for household preparedness for a disaster than other disability groups. Forty-eight percent had knowledge of a specific evacuation destination; 55% had a plan for what to take with them; 70% had a plan to stockpile medications; 29% had knowledge of the location of a public shelter; and 29% had steps in place for household preparedness.

Respondents with disabilities in a household reported a more difficult evacuation than their family members without disabilities. Approximately 59.5% of those with no disabilities in the household reported their evacuation experience went smoothly, compared with only 32.6% of respondents with disabilities in the household. A majority of respondents (63.6%) had relied on television for disaster information; 12.6% relied on information shared by family, friends, and/or neighbors. Persons with hearing (31.1%) and mental health (21.9%) disabilities used family, friends, and/or neighbors for their evacuation information. They used news organizations at a lower rate (33.5% and 38.0%, respectively) than did all other disability groups.

The UN Global Survey on Disaster Preparedness (United Nations Office for Disaster Risk Reduction, 2013) was completed by persons with disabilities in 126 countries. The top five hazards or disaster risks faced by survey respondents were floods (54%), extreme weather (40%), tornados (39%), drought (37%), and earthquakes (27%). A high percentage of survey respondents reported a degree of difficulty hearing (39%) or seeing (54%), walking or climbing steps (68%), and communicating (45%). Of the 5,450 respondents, 71% reported no personal preparedness plan for disasters and only 31% reported that they always have someone to help them evacuate. Thirteen percent never had anyone to help them. Only 20% of respondents said they could evacuate immediately without difficulty, 6% said they would not be able to evacuate at all, and the remainder said they would be able to evacuate with a degree of difficulty.

A key finding of both reports is that it is necessary to provide assistance for the needs of persons with disabilities. Disaster preparation should specifically address this issue for individuals who have hearing, cognitive, mental health, or communication impairments, so that they will be prepared when the situation arises.

War, Conflicts, and Children With Disability

War, conflicts, and disasters have a significant impact not only on children in general but also on children with disabilities. At least half of the estimated 57.4 million people displaced by war around the world are children, with as many as half of the children affected being separated from their families or newly orphaned. More than 100,000 children were separated from their families during the genocide in Rwanda in 1994 (Machel, 1996). Without the support of their family members, children are less able to obtain necessary services and adjust to the changes in their lives. For example, prior to the civil conflict in Syria, most children went to school in a country that highly valued education. Since the conflict began in 2012, nearly half of the 2.8 million school-age children displaced in Syria cannot get an education because of the devastation and violence in that country. Many Syrian refugees have relocated to Lebanon. Those who are able to attend school in refugee camps in Lebanon face additional problems. The Syrian school system is entirely run in Arabic, whereas Lebanese schools teach math and sciences in either English or French, which few Syrian refugees understand (IRIN Humanitarian News and Analysis, 2012). As a result, many Syrian children are placed in lower grades than the ones they were placed in while enrolled in the Syrian school system. In addition, the curriculum taught in Lebanon is considered to be more difficult and advanced compared with the curriculum in Syria, making it even harder for the refugee children.

UNHCR (2011) reported that access to education for refugees is limited and uneven across regions. Many of the classes that are provided are of very low quality, with as many as 70 pupils to one teacher. The teachers may have had limited or no formal training. Among Eritrean refugees in Ethiopia, less than 6% of refugee children had reached a benchmark reading level of fourth grade (Bensalah, Sinclair, Nacer, Commisso, & Bokhari, 2001).

Many refugee or displaced children have disabilities either as a condition prior to the conflict or disaster or as a result of the situation. Land mines continue to be a cause of death and disability in Europe and parts of Africa, especially among children who may not have been able to read warning signs or may not have understood the dangers. For example, Khaled (2012) reported that in Bosnia from 1996 to 2014, 20% of the 1,715 people killed by land mines were below 18 years of age. Between 2008 and 2011 in Somalia, 93 children were killed by land mines. According to the National Council for Combating Landmines (NCCL; 2014), land mines in the Sudan left more than 560 people dead and more than a 1,000 disabled in 2013. Typical landmine injuries in children include loss of limbs, injuries to the genital area, loss of sight and hearing, as well as psychological shock and emotional distress. According to the 1996 United Nations Study of the Impact of Armed Conflict on Children (Machel, 1996), armed conflicts in the previous decade caused more than a million deaths of children in poor countries.

Various factors contribute to the physical, psychological, and educational vulnerability of children with disabilities in disaster, including higher poverty rates, elevated risk exposure, and greater vulnerability to traumatic loss or separation from caregivers (Peek & Stough, 2010). The WHO (2011) estimates that there are more than 600 million persons with disabilities worldwide—between 10% and 15% of the world’s population—80% of whom live in developing countries. It also estimates that between 3.5 and 5 million of the world’s 35 million displaced persons live with disabilities (WHO, 2014), one third of them being children. While it is estimated that 100,000 persons have died as a result of the conflict in Syria, nearly 300,000 have been injured, resulting in amputations, brain and spinal injuries, vision and hearing impairments, and mental health issues that include PTSD (Weiss, 2013). This would suggest that there are thousands of Syrian children with disabilities living in refugee camps or are otherwise displaced.

The International Rescue Committee (IRC) conducted an assessment of disabilities among residents of the Kakuma refugee camp in the Northern Turkana District of Kenya in 2009. As many as 6.8% of the refugees had a recognized disability; of these, 51% were physically disabled, 26% were visually impaired, 16% had hearing impairments, and 10% had learning and cognitive deficits. In addition, a total of 125 persons had developmental disabilities (Karanja, 2009).

The UNHCR prepared a needs assessment of Syrian refugees with disabilities in the refugee camps in Central and West Bekaa, Lebanon. As shown in Table 1, of the 41 Syrian refugees with disabilities living in Bekaa, most were children with motor and/or sensory impairments and speech and cognitive impairments (UNHCR, 2014).

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Table 1.

Types of Disabilities Among Syrian Refugees in Bekaa Lebanon (UNHCR, 2012).

Disability type	n
Cerebral palsy	12
Spinal bifida	1
Erb’s palsy	1
Down syndrome	3
Hearing impairment	9
Vision impairment/blind	6
Speech impairment	6
Cognitive impairment	4
Congenital or accident	4

Source. Data from UNHCR (2014).

Note. UNHCR = United Nations High Commissioner for Refugees.

Displaced persons of all abilities encounter severe challenges; however, these difficulties are amplified for persons with disabilities (WHO, 2014). Whether the disability was a pre-existing condition or the result of the conflict or the disaster, traditional ways to address the problems often break down during displacement. Persons with motor or vision impairments may be unable to flee from the impending danger or to seek refuge; they may experience difficulty using escape routes or moving about in refugee camps when terrain has been altered due to the disaster or conflict. Persons with hearing impairment may be unable to access information about impending dangers, hear verbal messages or warnings, or hear rescuers. People with head trauma or a cognitive language impairment may have a limited ability to understand or cope with the situation and the need to seek assistance. For every person killed in a natural disaster, two to three are left with PTSD or a physical injury that could cause a lifelong disability (Care2, 2013).

Meeting the Needs of Displaced Persons With Disability

The UNHCR (2014) recognized that the specific needs of persons with disabilities are often overlooked, especially in the early phases of humanitarian emergencies. They recognize that women, children, and older persons with disabilities are particularly vulnerable to discrimination, exploitation, and sexual- and gender-based violence and that they may be excluded from supports/services. It also recognizes that children with disabilities are at a greater risk of abuse, neglect, abandonment, exploitation, health concerns, exposure to the risk of longer term psychosocial disturbances, family separation, and denial of the right to education. To address these needs, the UNHCR developed an education strategy for 2012–2016 that aims to develop skills and knowledge to enable refugees with disabilities to live healthy and productive lives. The first goal of this strategy is to improve education access and learning achievement among refugee children, focusing on the learning environment, teaching quality, and early childhood development and accelerated learning programs. The second goal is to increase access to post-primary education and training and to develop leadership skills and capacity to contribute positively to their communities, whether in a new community or in post-conflict reconstruction. The third goal is to expand tertiary education opportunities for refugees, both through scholarships to colleges in host countries and through distance learning.

The WHO 2014 humanitarian health action alert on disability and emergency risk management for health provided guidance for prevention, preparedness response, recovery, and reconstruction for workers at local, national, and international levels. The guidance identified the health-related actions that are required to ensure that appropriate supports are available for persons with disabilities in emergency situations. The report indicated that in spite of humanitarian efforts to provide care for displaced persons in emergency shelters and refugee camps, protection measures designed for the majority very rarely meet the specific needs of persons with disabilities. As a result, many displaced persons with disabilities are effectively deprived of the humanitarian aid and services they need.

Conclusion

In all wars and disasters, it is persons with disabilities that are first to die; persons with disabilities that are the first to get disease and infection; and it is persons with disabilities who are the last to get resources and medicines when they are handed out. They are treated as the bottom of the pile. (WCRWC, 2008)

Displaced persons of all abilities encounter severe challenges; however, these difficulties are amplified for persons with disabilities. Despite humanitarian efforts to provide care for displaced persons in refugee camps, assistance and protection measures designed for the majority very rarely meet the specific needs of those with disabilities. Due to a lack of identification and referral procedures, poorly adapted services, and poor access, hundreds of thousands of people with disabilities are effectively deprived of the humanitarian aid and services they need. Persons with disabilities are disproportionately affected by natural disasters, war, and conflicts. The key areas to be addressed in disaster preparedness and in resettlement and restructuring for persons with disabilities in conflict or disaster include communication, evacuation, identification, psychosocial support, health care, and education.