International Medical Corps has partnered with The Association for Aid and Relief (AAR) Japan to build the capacity of Japanese community organizations to offer greater protection to people with disabilities in the aftermath of a disaster. In the March 2011 earthquake and tsunami, the mortality rate of people with disabilities was more than double than that for the average population. While AAR responded quickly and effectively, in the aftermath of the earthquake, it became clear that there was a critical gap in addressing the needs of people with disabilities (PWDs). As a result, International Medical Corps and AAR Japan are working to build the capacity of local communities and agencies to improve preparations for rescue, relief and recovery efforts that better reflect the needs of the entire population, with a special focus on PWDs.
Some of the factors that led to the disproportionate casualties experienced by the elderly and disabled were: physical inaccessibility of the temporary shelters (e.g. not accessible by wheelchair, difficult to access bathrooms, etc.); difficulty of PWDs in communicating needs; existing social attitudes toward the disabled; lack of access to critical information; and a lack of necessary medication/medical equipment at the shelters.
To ensure these groups do not suffer the same difficulty in a future disaster, International Medical Corps and AAR believe that it is important to establish emergency response standards that are applicable to all people, including the elderly and PWDs. Our agencies agreed that as a first step, persons with disabilities must be actively engaged in the earliest planning stages in non-disaster times. Their unique perspective and experience, based on International Medical Corps’ global approach to disaster risk reduction and emergency preparedness, is essential to the reducing PWD vulnerabilities and building capacity toward becoming self-reliant their stated need to be both respected and supported.
As part of our initiative, International Medical Corps and AAR Japan are partnering with Iwaki Jiritsu Seikatsu Center (IJSC), a local non-profit organization supporting PWDs in Iwaki City, Fukushima Prefecture, to pilot two inclusive emergency shelter exercises to a wide variety of local community members. There are two important goals for this activity. The first is to help develop assertive behavior among PWDs in Iwaki City so that they can articulate their needs and take ownership in the management of emergency shelters. The other goal is to raise awareness in the local community about the varied needs of persons with disabilities and the roles and responsibilities they can take on in times of disaster.
The model for the emergency exercise was developed and base-lined by observing another non-profit organization that does similar work in Koshigaya City, Saitama Prefecture. A local non-profit organization supporting PWDs had hosted an annual two-day emergency shelter event, beginning in 2011, that emphasized the active participation of traditionally vulnerable populations including persons with disabilities, children, women, and the elderly. According to Hide Higami, who is the Head of Koshigaya Sleep-Over Emergency Shelter Event Committee and also a person with disabilities, the purpose of this event is to have people experience what it is like to be in an emergency shelter on “Day One” of a big disaster.
On August 17–18, 2013, International Medical Corps Country Representative Yumi Terahata, AAR Japan Fukushima Program Coordinator Atsushi Naoe, and Iwaki Seikatsu Jiritsu Center staff member Yoshi Komatsu participated in Koshigaya’s third annual event. It was an incredibly educational experience for all three partner organizations, providing a number of ideas to incorporate into our own initiative. International Medical Corps and AAR will leverage this new relationship with the event committee members who facilitated this experience to utilize their advice and expertise, while also exploring ways to collaborate across prefectures in the future.
The first of International Medical Corps supported emergency shelter exercises in Iwaki City will take place later in 2013. The simulation, based on International Medical Corps’ emergency simulation exercises across the globe, will include an impromptu run-through (i.e., with no preparation and minimal information passed on to the participants regarding the nature of the exercise) which will allow all participants to experience what it would be like to suddenly be thrust into an emergency shelter without any personal provisions. A public school gymnasium will serve as the site of the drill, and International Medical Corps and AAR will invite a wide range of participants including persons with disabilities, women with small children, and the elderly to make this exercise as realistic and inclusive as possible.
The location of this exercise has been chosen because it is not up to universal design standards, like many emergency shelters in Japan (e.g., without ramps for wheelchair accessibility, etc.). Persons with disabilities will be paired with other members of the local community and will work together to note the various issues and obstacles around making a shelter accessible to persons with different needs. Building on the lessons learned during the first drill, participants will work together to improve the shelter plan. We plan on practicing the improved plan in the first quarter of 2014.
Blandine Butundi, 18 years old and expecting, was suffering from a life-threatening pregnancy complication.
“My first three months of pregnancy were the heaviest weight I carried since I was born …. the midwife of our Mundindi Health Clinic advised me to consult a doctor in Walikale [the regional capital]. I felt very heavy, yet I was only three months along.
One day I felt dizzy and collapsed at the house door. I was rushed to Walikale General Hospital on a motorbike, not knowing which world I was in. My heart was beating so fast and I felt very thirsty. I was sweating heavily. In the consultation room the midwife just said: ‘You are a lucky lady, you met the specialist in women’s care.’ It was Dr. Kennedy [head of obstetric surgery].
I was given an injection, and the only thing I remembered was the doctor telling me: ‘Something is wrong Blandine, we have to remove whatever is inside your stomach before serious damages occur.’ The rest of the story I was told by my mother.”
Blandine had suffered a miscarriage, and she needed surgery or would face infection and possible death. Thanks to the intervention of Dr. Kennedy Musavuli, she will soon be able to return home in good health. Dr. Kennedy, who received training in emergency obstetrical care and fistula care from International Medical Corps, was able to diagnose the miscarriage and conduct the necessary surgical procedure that saved Blandine’s life.
“The training we received with the support of International Medical Corps shaped our knowledge and experience much more,” said Dr. Kennedy. “Personally, I am so thankful to International Medical Corps for health support in many ways.”
Blandine is also thankful for the support of the skilled surgeons, and expects to return home from the hospital in the upcoming days.
“I have nothing to give to this doctor,” she notes. ”He is such a blessing to the Walikale people, a person who does things with his heart. If he was not there… I was already dead, my mother said. Now I am feeling like a normal person and I hope soon I will get back to my house.”
As part of its safe motherhood initiative, International Medical Corps trained surgical staff from the general hospitals at Walikale and Chambucha,located in Eastern Democratic Republic of Congo, in emergency obstetric surgery to address health issues such as Blandine’s.
In Blandine’s home territory of Walikale, International Medical Corps also recently organized trainings for frontline healthcare workers, such as the midwife in Mundindi who referred Blandine to a doctor, to recognize danger signs during pregnancy, ultimately benefiting over 33,000 women in the area.
International Medical Corps in Libya:
Following the outbreak of conflict in February 2011, International Medical Corps immediately deployed teams in Libya to provide emergency medical services, train local health workers and deliver vital medicines and supplies.
International Medical Corps remained in Libya as the conflict ended, shifting initiatives from emergency services to longer-term projects aimed at supporting efforts to eliminate major gaps in health care and restore the necessary infrastructure. To do this, International Medical Corps is working with the Libyan health sector to address the primary health, mental health and rehabilitation needs of a country emerging from war.
In addition to the physical wounds of war, many Libyans are also facing long-term psychological distress related to the conflict in a region plagued by a cultural stigma towards mental health needs. To address this stigma and the lack of access to mental health services, International Medical Corps is training local health workers throughout Libya in Psychological First Aid. Mental health services have also been integrated into all of International Medical Corps’ programs delivering primary health care.
Attitudes Towards People with Mental Illness:
In Libya, as in much of the Middle East, disabled people are often marginalized and discriminated against. Within existing rehabilitative care services, there is a lack of psychosocial support and psychological counseling services. The majority of the rehabilitation centers in Libya lack social workers and psychologists trained specifically in methods to provide psychosocial support and psychological counseling to persons with disabilities and their families. There continue to be major challenges, but International Medical Corps is working with local partners to advocate rights for the disabled, including the right to education, the right to employment, and the right to take part in everyday activities. Our work aims to increase the quality of life for people living with disabilities in Libya.
In Misurata, International Medical Corps has been working to reduce the stigma associated with disability in conjunction with physical rehabilitation services and psychosocial support. Since our initiative at the Al Tadamoon Centre, the psychosocial department dealing with psychological affairs has been revitalized and is now active. The program has formed a self-help support group for women, provided literacy classes for women with disabilities, and has created a photographic exhibition where women, working together, were empowered through learning camera skills and taking photos to illustrate their theme “dreams and challenges”. The exhibition allowed them to show and explore their daily experiences, hopes and dreams. They also developed their own newsletter and have led training sessions for staff members about disability issues. Mr. Meshbah Mansoor, a father of three participants in the program said:
“There wasn’t much for my daughters to do. They were just staying at home, bored and with little meaning in life. I am grateful for this project and impressed by the way my daughters have been treated by the staff in the project. They have a feeling of being community members deserving respect and opportunities like everyone else now.”
International Medical Corps’ work in Libya continues in conjunction with both the Government of Libya, and Disabled Peoples Organization to change attitudes towards people with disabilities. Prior to International Medical Corps' involvement in the rehabilitation centers in Misrata, initial assessments showed a lack of psychosocial activities, documentation systems, an internal and external referral network, and staff knowledge of disability issues.
However, a recent re-assessment has shown improvements in these areas, especially for group activities, referral networks, and change in staff knowledge and attitudes towards persons with disabilities; much of this shift is a direct result of trainings and on-the-job activity mentoring by International Medical Corps.
International Medical Corps continues to work with those affected by both physical and mental disabilities, many as a result of the war, by providing a holistic approach to rehabilitating vulnerable people and raising awareness of the disabled population in Libya.