Wheelchair accessibility of mosques in Riyadh

1 Introduction

Engagement in an occupation, from an occupational therapy perspective, is considered an ultimate goal for human beings and has great influence on health and wellbeing (the American Occupational Therapy Association, AOTA [1]. According to Occupational Therapy Practice Framework: Domain and Process, occupations offer a central meaning to individuals and groups [1]. Occupation may be defined as “activities of everyday life, named, organized and given value and meaning by individuals and a culture. Occupation is everything people do to occupy themselves, including looking after themselves, enjoying life and contributing to the social and economic fabric of their communities” [1]. Religious and spiritual activities are meaningful and purposeful to individuals and groups [1]. People tend to express their religious and spiritual needs according to their respective religions. Muslims, for example, have their own beliefs and rituals. Islam, one of the major religions in the world, has five pillars or essentials including Praying (Salat). Praying at least five times a day is mandated in Islam [2]. To be closer to Allah (God), according to Islam, prayers must take place in a mosque, especially at noon on Friday.

Having a disability may prevent a person from performing religious rituals (World Health Organization (WHO) [3]. Disability is defined by the International Classification of Functioning, Disability and Health (ICF) [3] as “an umbrella term for impairments, activity limitations and participation restrictions. It denotes the negative aspects of the interaction between individuals (with a health condition) and their contextual factors (environmental and personal factors)” [3]. The ICF can be used to evaluate the impact of impairment on the individual’s ability to participate in daily life activities and act in his/her environment. The ICF can also be used to evaluate the effectiveness of interventions directed toward minimizing the impact of disability and maximizing participation [4]. According to Bromley, Matthews and Thomas 2007 [5], impairment and disability can be viewed from two perspectives, the medical and the social models. The medical model views disability as existing in the person, while the social model implies disability is a problem of society not acting successfully in terms of environmental design and service provision to people with disabilities (PWD) [5]. The models are supported by the ICF [3].

From an occupational therapy perspective, for a disabled follower of Islam, accessibility to a mosque is essential. Welage and Liu 2011 [6] state that the term ‘accessibility’ refers to the “degree to which an environment can be approached, entered, operated in, or used safely and with dignity by PWD.” [6]. Environmental factors, according to the ICF, are external to persons and can affect their performance positively or negatively [3].

To enable integration into society, PWD must have full accessibility to public places [7]. From a global perspective, the WHO created guidelines, adopted by all countries, prohibiting discrimination against disabled persons [3]. According to Ellek 1991 [8] the United States of America (USA) promulgated the Disabilities Act (ADA), a comprehensive civil rights regulation that prohibits discrimination and guarantees PWD the same opportunities as everyone else [8]. The ADA emphasize that PWD should have access to employment opportunities, public transportation, public places (e.g. restaurants, schools, museums), telecommunication, to purchase goods and services, and to participate in state and local government programs and services [8].

In addition to the ADA, Kurniawan 2010 [2] states that Universal Design (UD) has been developed as a means of providing accessibility to all buildings for wheelchair and other disables users as well as nondisabled. Accessibility to public buildings is a widespread problem [9], as Evcil 2009 [10], reports that accessibility to public buildings in Istanbul is also problematic to wheelchair users [10]. Implementing UD principles in mosques will enable wheelchair users to perform prayers at the required times [2].

A study conducted by Meyers, Anderson, Miller, Shipp, and Hoenig 2002 [11] on adult wheelchair users in Boston and North Carolina reported that participants faced challenges in accessing religious buildings, homes of their friends and relatives, and work-places. Another study was conducted in three large shopping centers in New Mexico to assess the enforcement of the ADA accessibility guidelines for parking lots, entrances, ramps, elevators, telephones, rest rooms, and food courts. The study concluded that none of the malls were fully compliant in any areas of accessibility for wheelchair users [12]. Similar results were concluded in an earlier study that was conducted on 13 public buildings (private and governmental) for accessibility for wheelchair users [13]. Hamzat and Dada 2005 [14] conducted a study in Ibadan, Nigeria, assessing wheelchair accessibility in 38 public buildings including hospitals, schools, social and recreational centers, and government buildings. Results revealed a low level of wheelchair accessibility of the targeted public buildings [14]. Welage and Liu 2011 [6] reviewed 12 studies concerning wheelchair accessibility in public buildings. The study concluded that parking lots had the lowest compliance rate to accessibility while building entrances had the highest, and none of the studies reported 100% compliance to accessibility codes in spite of law enforcement [6].

The Kingdom of Saudi Arabia (KSA) is the second largest Arab country with a population of more than 28 million and almost all Saudi citizens are Muslims, Riyadh is the capital of KSA with a population of more than six million people [15]. There are limited studies about wheelchair users and mosque accessibility in Riyadh, which is important in the context of 3.73% of KSA population having functional disability [15]. Motor vehicle accidents, stroke, cerebral palsy, head and spinal cord injuries are the leading causes of disabilities in KSA [15]. According to the Ministry of Islamic Affairs (MOIA), Riyadh City has more than 17 thousand mosques [16].

KSA adopted the Persons with Disabilities Guidelines in 2000 [17], it included the Saudi Building Code detailed guideline, which was released by the Ministry of Municipal and Rural Affairs and approved by cities Municipalities. The Saudi Building Code included all accessibility laws, regulations, and guidelines for all types of disabilities including wheelchair users and it is consistent with the ADA and the UD. One of the chapters focused on wheelchair accessibility to mosques with technical details to all aspects of accessibility starting from the proper selection of the location of the mosques to be within easy reach of people using wheelchairs, parking lots, ramps, entrances and doors, bathrooms and ablution’s (Wadoo’) areas, and lighting and sound systems [17]. The main purpose of the law was to promote the inclusion of PWD in all aspects of their daily life including worshiping, education, and public services.

According to Al-Mansoor (2016), three essential elements are required in a mosque architecture: the prayer hall where the prayer takes place, the ablution (wudoo) area where Muslims must wash certain areas of their body in preparation for prayer, and the lavatories area. The three areas are separated from each other which add accessibility requirements especially for persons with physical disability. Al-Mansoor (2016) concluded that people with physical disabilities experience difficulties in accessing several areas of the mosque such as the entrance, ablution area, the lavatories, and the shoe racks [18]. The purpose of this study was to assess the accessibility of mosques in Riyadh from the perspective of wheelchair users and their caregivers.

2 Methods

3 Results

A total of 48 male wheelchair users participated in the study. The participants were recruited from 15 mosques that met the inclusion criteria. More than half of the participants (54%) were 21–35 years old and 18% were above 45 years old (Table 1). The majority (98%) were Saudi citizens. A small group (19%) was using the wheelchair temporarily (1 month to less than 3 months) with 81% were using the wheelchair permanently. The main reason for using the wheelchair was due to a spinal cord injury resulting from motor vehicle accidents, followed by a stroke. The majority (64%) go to the mosque 3–5 times per day (Table 1).

The responses to the 11 Likert statements indicated that mosques were mostly not accessible. Regarding the proximity of the mosque to their residence, 67% agreed or strongly agreed that they live close to the mosque (within 2 kilometers) and 59% agreed or strongly agreed that when inside the mosque they can maneuver the wheelchair easily. Parking lot accessibility was not appropriate for 42% of the participants with 21% being neutral. The majority (67%) of the participants disagreed and strongly disagreed that the bathrooms were accessible. Most of the participants disagreed and strongly disagreed that the ablutions area (69%) (Wadoo’) and the sinks (71%) were accessible. Those who disagreed and strongly disagreed that entrance and exits to mosque were accessible (42%) were more than those who agreed and strongly agreed (40%). In addition, 31% did not find the door handles and shoe racks (27%) accessible. The majority of the participants (84%) indicated that they needed someone to assist them in pushing their wheelchairs. Overall, 86% were dissatisfaction with mosques’ accessibility to wheelchair users (Table 2).

The majority of the 12 caregivers (67%) accompanied the wheelchair user 3-4 times a day to assist in propelling the wheelchair. When asked about their level of satisfaction about accessibility to mosques for wheelchair users, 84% reported dissatisfaction (Table 3).

The purpose of this study was to explore the accessibility of mosques in Riyadh from the perspective of wheelchair users and their caregivers. The researchers targeted the mosques that met the inclusion criteria. It was notable that the number of wheelchair users that used the mosques were low compared to the high population in the areas in Riyadh chosen for this study. Only few wheelchair users were witnessed in the mosques in spite of the efforts of the research assistants going to the mosques at different prayer times to identify possible participants. This observation gave an indication about the accessibility issues of the mosques for wheelchair users in spite of the significance of prayer in mosques by all Muslims [2, 18]. Therefore, poor access for PWD to mosques presented a physical barrier for the majority of wheelchair users to participate in an important occupation in their daily life which is to perform prayers in a mosque. This was the main reason for not reaching the aimed sample size.

None of the participants were female due to the fact that culturally the majority of females in KSA pray at home. The finding that the cause of disability of the participants was mainly motor vehicle accidents is supported in literature related to causes of disability in KSA [15].

Mosques are available in all areas in KSA, in each business, neighborhood, shopping centers and all public places. Living in close proximity to a mosque therefore was not an issue. In addition, mosques are spacious and can accommodate hundreds of people during prayer time, supporting the finding that wheelchair users did not find it difficult to maneuver the wheelchair while inside the prayer hall [2, 18].

The wheelchair users did face challenges in several aspects. Accessibility to the parking lots was not appropriate. Wheelchair users needed assistance from a caregiver to drive them to the front of the mosque, exit the car, being placed in a wheelchair and entering the mosque. After this process, the caregiver has to park the car in an overcrowded parking lot, not developed to accommodate wheelchair users. The findings were consistent with findings of other reviewed studies [6, 18].

Before any prayer, the Muslims must perform ablutions (Wadoo’). During the ablutions, the person praying must wash his hands, arms, mouth, nose, face, ears, head, and feet a number of times in an organized manner. Prayer according to Islam cannot be done without ablution. After completing the ablution process, Muslims cannot use the bathroom until they complete the designated prayer. If the bathroom is used prior to prayer, they have to repeat the ablution process again before the next prayer time. Each mosque must have enough bathrooms as well as areas that are designated for ablution and equipped with sinks, faucets, and any other supplies required. However, the results showed that bathrooms and ablution areas were not accessible for most wheelchair users, possibly the reason why wheelchair users refrain from going to mosques although it is mandatory in Islam. Ramps were not available in some mosques posing a challenge for wheel chair users while entering and leaving the mosque. Mosques with ramps were not well designed and did not follow the universal design of ramps. Similar results were found in other studies [2, 18].

Muslims are not supposed to enter the prayer area with their shoes on. They have to remove their shoes, place them on the shoe racks outside the prayer area and then retrieve the shoes again on their way out. Some participants indicated the accessibility of the shoe racks as a problem.

In general, the majority of wheelchair users were not satisfied with the mosques’ accessibility, expressing their dependence of an assistant to accompany them. Their dissatisfaction regarding the mosques’ accessibility was consistent with the caregivers’ responses. In spite of having building codes adopted by the KSA and specifically outline the technical aspect of Mosques design guidelines for wheelchair users, it was found that the codes were not enforced and not followed [17]. Accessibility issues to mosques’ parking lots, bathrooms, ablution areas, sinks, entrances and exits, door handles, and shoe racks created a serious participation restriction to wheelchair users.

The physical environment of the mosques in this case, according to the ICF, impacted wheelchair users a great deal and restricted their community participation. The lack of accessibility to public places including mosques/worshipping places, employment, education, and other public services play an important role in segregating PWD from the mainstream and preventing the society from benefiting from this important group of people. The ICF concepts provided a structural framework which supported this study. It was clear how the physical environment of the mosques restricted wheelchair users (people with activity limitations due to their impairment) from participating in a meaningful occupation, which is performing their daily prayers in a mosque. However, if proper accessibility guidelines for PWD were implemented, the situation may be different and could lead to more wheelchair users participating in prayers within the mosques.

5 Conclusion

Mosques targeted in this study were found not to be accessible for wheelchair users. The current situation mandates seclusion of wheelchair users to pray in their houses and prevents them from practicing an important part of their faith. Wheelchair users must be accompanied by someone to overcome the environmental barriers preventing them from practicing their independency which adds an additional burden on their families. Enforcing current legislation of KSA to guarantee accessibility of mosques will ensure the freedom of all to practice their faith, independently, in a meaningful and valued manner.

Conflict of interest

None to report.