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Inclusion in the time of pandemic

Tools and resources to support an inclusive preparation and response
to the COVID-19 emergency

MSF intervention in a nursing home in Marche region, Italy. April 2020. ©MSF/Vincenzo Livieri.

What can MSF do for an inclusive preparation to the COVID-19 response?

A message to our projects from the TIC Project on Inclusion of Persons with Disabilities in MSF 

An inclusive approach during the prevention and response to the COVID-19 pandemic intends to limit the risk of exclusion from awareness messages and access to healthcare for the groups that are often the most invisible, neglected or discriminated against.

Older people and persons with disabilities are among the most vulnerable and will be particularly affected by COVID-19. While the importance of a stronger patient-focus and community approach has been growing in the movement, some key actions can make a difference, namely:

- During sensitization and information campaigns, always think two ways of communication: audio and visual – sound and text.

- Particularly in the preparation phase, contact organizations representative of persons with disabilities to discuss how to best use them as communication channels towards their groups and how to best include the needs of persons with disabilities. This also naturally applies to other groups and minorities at risk of being forgotten in the prevention and in the response.

Without inclusion of persons with disabilities, there is no inclusion and no impartiality

Interview with Habiba Ali-Amin, MSF International Board member

In this interview, Habiba Ali-Amin discusses the situation of persons with disabilities in emergencies, the transformative potential of patient-centred approach in MSF and the global COVID-19 crisis as an opportunity to rethink vulnerability and fully embrace inclusion.

In the article “The Forgotten Crisis: People with Disabilities”, recently shared with the association, you have focused on persons with disabilities as a group that is both extremely vulnerable and often forgotten in humanitarian contexts. Having worked across displacement settings and conflict zones, including in Kenya, Somalia and South Sudan, how would you describe the situation of persons with disabilities in emergencies?


Persons with disabilities are often stigmatised throughout their lives and seen as taboos, outcasts, curses. They are marginalised and traumatised. They are abandoned. Conflicts, emergencies and outbreaks do not choose, but affect everyone. Because of marginalisation, people with disabilities are among  the hardest hit by any crisis. It is a community that is truly vulnerable, the people we forget. There are different kinds of disability. In settings where I have worked, people with visual impairments sometimes get the support they need, while people with intellectual disabilities often suffer the highest incidence  of violence. When it comes to sexual and gender-based violence, abandonment and rejection, they face so many risks. Everybody else is struggling, everybody else is stuck, but people with disabilities are  the most affected. Unfortunately, our modus operandi is one that still neglects these populations. We look at them, but we do not actually see them.  

What is the reason why we do not see persons with disabilities?

It is the question of the speed of our work and of the concept of assistance that we think we should deliver. But it also has to do with our attitudes and our mindset. We have unconscious biases that make it difficult to realise the presence of people with disabilities. This clearly affects our capacity to include them in our programmes. When constructing our facilities, we do not think of slopes, places where wheelchairs could pass, persons using crutches or the size of the door that patients will walk through. Our WASH teams do not consider latrines for people with physical impairments. We might hire a translator from the local language for a single international staff, but we cannot afford one who would speak sign language or use sign language for interpretation of health promotion messages. We have been discussing inclusion and diversity at the associative and the executive level, but we still forget that forest is made of individual trees, and we look at a forest as a forest – as a group, as a whole. I hope that as we approach 50 years  of MSF, we will understand what impartiality truly means and what inclusion truly means. Because there is no inclusion and no impartiality without inclusion of persons with disabilities.  

In what way has the COVID-19 pandemic exacerbated the challenges faced by persons with disabilities in contexts where MSF intervenes?  

This pandemic affects everyone. Persons with disabilities and the elderly are at higher risk, but everybody else is vulnerable too, as anyone can get infected. In many contexts, COVID-19 comes with a huge stigma. When it touches persons with disabilities, it is a stigma among people already stigmatised for life. Public health measures put in place in response to the pandemic are discriminatory. Videos of handwashing procedures only show people without physical disabilities, while some people cannot rub their hands together. Water and soap are unavailable in many contexts. Inclusive information sharing is a huge gap. Despite an information overload, nothing is adapted to the needs of persons with disabilities. It is also very difficult to find a face mask that is both transparent, to allow for lip reading, and breathable. Persons with disabilities often rely on others for support, so physical distancing has been very challenging, because everybody else rejects or neglects those who need additional assistance. Many people have lost their job or part of their income due to the lockdown. This reduced socio-economic status, together with increasing stigma and anxiety around COVID-19, further worsen the situation. Because persons with disabilities are marginalised and discriminated against, it is very challenging for them to access healthcare services. Many hospitals, including those supported by MSF, have been converted into COVID-19 facilities, and access to care has been reduced due to the risk of infection. This comes on top of all pre-existing barriers.

Outside of your role within MSF, you continue working at community level. What is the focus of this work in the time of COVID-19?

I am currently involved in several initiatives. One focuses on mental health among the most vulnerable populations, with and without disabilities. We do teleconsultations, provide counselling on loss and grief, and work with people with hearing impairments to offer them mental health awareness, self-help and tools to deal with anxiety. As COVID-19 causes something called “quarantine fatigue”, we advise  on how to go about it and how to identify needs. I am also involved in the community work in Somalia and among the refugees in Nairobi, most of whom are Somali. We use social media platforms to raise awareness of COVID-19, answer any questions and encourage people to make cloth masks and donate them to the most vulnerable in their communities. 

What can MSF do to ensure an inclusive response to this global emergency? How can we integrate inclusive solutions into our broader medical humanitarian action?

In MSF, we have immense experience in emergency response, but we still consider that disability is not our territory. Once we change this mindset and start seeing persons with disabilities as individuals with their specific needs, inclusion will become easy. One size does not fit all. This means that we need to analyse and compromise, and continuously adapt our emergency response. People with disabilities should be included in every phase.

We can include persons with disabilities in emergency guidelines and in rapid assessments. We can contact actors on the ground that have better access to people with disabilities. When constructing hospitals, one of the leading factors for the logistics teams should be access for people with disabilities. These are some of the things I would love to see happen. 

In finding and adapting inclusive solutions, we need to take advantage of the expertise of local staff and local organisations, for whom response to emergencies is daily bread. Some concepts of disability are context-specific. We should gather such information and localise. I also think that we should identify and contact organizations representative of people with disabilities. Today, if you were to ask a FieldCo or any other coordinator about which organizations work with people with disabilities, I am almost sure they would not know. Things could be different if inclusion was a topic of discussion during key trainings and gatherings, such as PPD, SANOU or the head of mission week. 

The COVID-19 pandemic is an unprecedented crisis, but also an opportunity to rethink our approach to vulnerability and inclusion. What change or process would you like to see it trigger within MSF?

We keep saying, “These are unprecedented times”. Extraordinary times call for extraordinary measures – including changing how we work. I am curious to see what MSF will be like post-COVID-19. Because one thing is certain: we cannot go back to our old ways.

If this pandemic offers an opportunity, it is because in this crisis everybody is feeling vulnerable. HIV is different, tuberculosis is different, malnutrition is different – but COVID-19 puts everybody in the same category. We complain about isolation, but this lockdown allows us to grasp the situation of persons with disabilities, who have been truly isolated all their lives. We also realise the mental health burden of isolation. For the first time, MSF has operations almost everywhere, including in Europe, which is not a norm for our interventions. The pandemic has challenged everybody, wherever we are. This is an opportunity to see that just as COVID-19 does not discriminate neither do other crises. In conflicts and disasters, persons with disabilities are always vulnerable and always affected.

What processes or approaches already present within MSF do you see as having particularly strong potential for becoming drivers of an inclusive change?

All five OCs are already pushing for a more patient-centred humanitarian action. I like to call this approach “person-centred”. It means that when looking at someone, we break all obstacles to see them, also beyond their physical aspect. Compassion should be our guiding force, and we should not forget that populations we work with are always composed of persons.

COVID-19 has changed the way we do assessments and explos. Numbers clearly show that persons with disabilities are not as few as we might think they are. MSF has worked for many years with topics such as HIV. Confronted with stigma and neglect surrounding HIV/AIDS, we have fought for the rights of the people. This kind of work is not new to us – we only have to change our mindset.

Our vocabulary is also evolving: we are talking more and more about communities, and not beneficiaries, which is very positive. I am an ambassador of community engagement, and I think it is high time we embrace it. We need to bring it further into our action, together with words like localised decision-making, cooperation, collaboration, partnership. Partnerships and collaborations are still relatively new for MSF – but maybe we could look at organisations of persons with disabilities as our partners on the ground.

What opportunities do such collaborations with disabled people’s organisations bring?

They allow for further engagement of persons with disabilities in the humanitarian response as active participants and resources in their communities. Persons with disabilities are able to contribute to the society in many ways. They are often creative and innovative, as they have to find solutions by themselves to different challenges they face. Technically qualified persons with disabilities are very competent and hardworking, because in many contexts they have to prove to others their ability and competence, against different biases that persist. Direct interactions with people with disabilities help tackle prejudices and instil a more inclusive mindset, making us more empathetic and more understanding of specific needs they might have.

What would be your message on inclusion for the MSF movement?

As we are going into our 50 years, we should go back to our principles, for instance the principle of impartiality, which should be of essence, as it is very much about how we treat patients and communities. Being impartial means that we only consider a person’s humanitarian needs. If your consultation room is not accessible enough, if the health care service provided is discriminating, or if you do not overcome your prejudices, there is no way you will be able to see this patient objectively and professionally. This applies to culture, religion, creed, political convictions – but also to disability. For a while now, we have opened the door for inclusion and diversity, but we must remember that inclusion that does not include persons with disabilities is not inclusion.

These are challenging times. In MSF projects and missions around the world, you are all working very hard to face this pandemic and save as many lives as possible amid all the other challenges in the field. For that, I thank each and every one of you. As we face COVID-19 and enter a post-COVID-19 reality, let us consider this as one of the many lessons learnt. Together we will all make it!  

Habiba Ali-Amin is a clinician and a mental health practitioner with a degree in Psychology from the University of Nairobi, Kenya. She first started working with refugees in Dadaab refugee camp, in Kenya, in 2006. Since joining MSF in 2006, Habiba has held a number of roles in that time, including Deputy Medical Coordinator, Field Coordinator, Emergency Field Coordinator and Medical Referent across displaced people and conflict settings, including in Somalia, South Sudan and Kenya. When not working with MSF she does psychotherapy among urban refugees and research on mental health among the Somali community. She was elected to the International Board in June 2019.

Organizations representative of persons with disabilities

A growing database of key organizations representative of persons with disabilities in countries
and regions where MSF intervenes. For an efficient collaboration in the field, and to enhance proximity to the communities we serve, we strongly encourage our projects and missions to map and contact local organizations.

COUNTRY/REGIONORGANISATIONWEBSITECONTACT PERSONEMAIL/PHONE
AfricaAFUB -  The African Union of the Blind


https://www.afub-uafa.org/Lucas Amoda,
Interim Executive Director

lucas@afub-uafa.org
gladys@afub-uafa.org
info@afub-uafa.org

AngolaANCAA - The Angolan National Association
of the Blind and Partially Sighted
-Venceslau Francisco Mujinga,
President

Salvador António,
General Secretary
ancaaangola1992@gmail.com

+ 244 924260935 ,
+ 244 923259553
+ 244 912757012 or 222775361

CambodiaABC - Association of the Blind in Cambodia

- Mr Boun Mao ,
Executive Director

boun.mao@online.com.kh

phykun1119@gmail.com
abc@online.com.kh

LaosLAB - Lao Association of the Blind


www.lablao.org/Kongkeo Tounalom, Presidentlabofbvi@gmail.com

+85 621414949

MozambiqueACAMO - The Mozambican Association
of the Blind and Partially Sighted

http://acamo.co.mzSérgio Miguel da Conceição,
President
 
Raul Sitoe ,
Secretary General

Felizardo Sabão,
Coordinator

Amelia Senguaio ,
Administrator
sergiomc73@gmail.com ,
+258 848260015

acamobeira@yahoo.com.br
+258 23313651

MozambiqueFAMOD - The Mozambican Forum
of Disabled People's Organisations
(an umbrella organisation)

https://www.facebook.com/FAMOD.MOZ/Cantol Ponja,
President 
cantol_alc@yahoo.com.br

famodmoz@gmail.com
+258 21419304

NepalEye Health Project Nepal

-Mr Hari Sharan Bista,
Project Manager
nabpnepal@gmail.com



NepalNepal Association of the Blind

www.nabnepal.orgMr Nar Bahadur Limbu ,
Director

central.nabpnepal@gmail.com



WorldWorld Blind Union - the internationally recognized organization representing the 253 million blind
and partially sighted persons in 190 member countries
www.worldblindunion.orgFor the list
of members,
click here

For detailed contact information,
consult the list of members



Showing entries (filtered from total entries)

Towards an inclusive response

Webinars

COVID-19 Disability Inclusion Webinar, organised
by the Programme for Evidence to Inform Disability Action (PENDA) 

PENDA is a consortium led by the International Centre for Evidence in Disability (ICED), based at London School of Hygiene and Tropical Medicine (LSHTM), funded by the Department for International Development (DFID), in partnership with CBM, ADD international, and Help Age International.

This comprehensive 45-minute webinar provides a valuable insight of actions that can be taken for inclusive response at the different stages of the COVID-19 pandemic, whether it comes to prevention, treatment, continuity of care, or the aftermath of the crisis. It also provides valuable information regarding WASH and health promotion in the times of COVID-19.

Further recommendations from organizations focused on inclusion of older persons and persons with disabilities

Mobirise

Disability Inclusive Community Action –COVID-19 Matrix, by CBM

A matrix for disability-inclusive response at the community level, with brief action points within five key areas: compassion, communication, networks, participation and access. 





An elderly woman affected by the North East Syria emergency, October 2019. Photo by Jake Simkin.

COVID-19: Guidance and advice for older people, by HelpAge International

"The document provides guidance and advice for older people about COVID-19. It gives some basic information on what COVID-19 is and how it is spread, followed by key advice on what older people can do to reduce
their risk of catching the virus, and what they should do if they need medical help or support". It is currently available in English, Spanish, Russian, Arabic and Bangla.

Monday 30 March 2020: MSF opens an accommodation structure with a capacity of 50 beds (which can be extended to 150 beds) for vulnerable people in Brussels. Photo by Pablo Garrigos.

Toward a Disability-Inclusive COVID-19 Response: 10 recommendations from the International Disability Alliance

In response to the COVID-19 pandemic that disproportionately affects persons with disabilities, the International Disability Alliance has compiled a list of barriers faced by persons with disabilities in this crisis, along with solutions and recommendations. 
The document is available in English, French, Spanish, Arabic, Portuguese, Korean and Chinese. 

A woman carries a bucket of water in the Malakal Protection of Civilian (PoC) site, in north-east South Sudan. Photo by Igor Barbero/MSF.

Putting equality, inclusion and rights at the centre
of a COVID-19 water, sanitation and hygiene response,
by WaterAid


The article highlights gender inequality and vulnerability of persons living with chronic health issues or with disabilities in WASH and emergency contexts. It discusses how our emergency response to the COVID-19 pandemic can mitigate new and existing vulnerabilities among people affected, and provides a simple list of dos and don’ts.









Briefing given by MSF Mobile Teams to the staff of the retirement home. Photo by Olivier Papegnies/MSF.

Including people with
disabilities in responses to
the COVID-19 pandemic.
Guidance for development partners, by Sightsavers International

"This document provides practical guidance for development partners to develop disability-inclusive responses to the COVID-19 pandemic during the emergency phase of the COVID-19 pandemic. In the immediate- and long-term response to the pandemic, it is vital that all development partners take steps to strengthen health systems that are disability-inclusive".

Topics discussed include: intersectionality; assessing gaps and needs; engaging people with disabilities and DPO's; accessible and inclusive communications; healthcare and essential services; livelihoods and social protection; education; independent living and housing; and evidence generation. 

An MSF health worker checks the medical condition of a patient admitted to the inpatient therapeutic feeding centre in Galkayo South hospital, Galmudug state, Somalia. Photo by MSF.

Guidance Brief: A disability inclusive COVID-19 response in Somalia, by Humanity & Inclusion



A rich yet concise document about inclusive preparation and response in Somalia that covers the following topics:
- Specific risks faced by persons with disabilities during the COVID-19 outbreak;
- Protection risks for specific groups during the COVID-19 outbreak; 
- Recommendations for inclusive planning and preparedness;
- Recommendations on an inclusive COVID-19 response;
- Selected global resources on COVID-19 and persons with disabilities;
- Contacts of organizations of persons with disabilities and disability specific organizations with interest in connecting for awareness raising.

MSF in the elderly care home (Residencia Nuestra Señora de las Mercedes) in El Royo, Soria province. Photo by Olmo Calvo/MSF.

Disability considerations during the COVID-19 outbreak, by WHO


A short document that explains why additional considerations are needed for people with disability during the COVID-19  outbreak and suggests appropriate actions and protective measures that can mitigate the impact of the pandemic on this group. Key messages may need to be adapted to the local context.



Emiliano, an MSF doctor, offers his support in a nursing home. For weeks, the staff of these facilities have been busy day and night to protect their guests from coronavirus. Italy, April 2020. ©MSF/Vincenzo Livieri.

Policy Brief: The Impact of COVID-19 on Older Persons,
by the UN

The document covers the following topics:
- The impact on health, rights  and long-term care services for older persons; 
- The effects of physical distancing and stigma;
- Integration of a focus on older persons in the socio-economic and humanitarian responses to COVID-19;
-  Harnessing knowledge and data,  sharing good practices, and expanding participation by older people. 
It analyses the key risks, gathers solutions and recommendations, and discusses the place and the role of older people in this global crisis.

Sources of ideas for inclusive information and sensitization campaigns

Examples that can inspire and help develop materials on COVID-19
adapted to the needs of persons with disabilities in your mission or project

Messsages on COVID-19 might not be available to people with sensory impairments. Lack of access to essential information on the disease and its prevention contributes to the spread of the virus and threatens mental health, deepening anxiety and isolation. Communications barriers can easily be reduced by using two ways of communication: visual and audio, text or image and sound, in all sensitization campaigns.

When it comes to inclusion of the deaf and hard of hearing, it is also possible to create short messages and videos in sign language to communicate more efficiently towards this group in our missions and projects. Such materials usually have to be developed in collaboration with local sign language interpreters or local organizations representative of persons with disabilities. Sign languages, which have evolved over years in the different deaf communities across the world in a similar way that natural languages have, vary widely between countries and ethnic groups. In some countries, more than one sign language is in use, and countries with the same spoken language may still have different sign languages. The number of sign languages worldwide probably exceeds 300. There have been attempts to develop a single sign language for broader international use, but with limited success. In the International Sign – the language of one of the videos we recommend below – meaning has to be continuously negotiated, as signers combine signs from their national sign languages with signs understandable for a larger audience.

Video in International Sign, produced by the Mill Neck Family of Organizations, based on the message sent out by UNICEF.  

A video in sign language that conveys key messages about the coronavirus and translates information about the measures introduced by the government. Filmed in Uganda by Light for the World.

A role-play video in sign language explaining facts and myths about the coronavirus. Produced in Uganda by Light for the World.

A video with sensitization messages presented by persons with disabilities in a local language, by the Nigerien Federation of Persons with Disabilities ( Fédération Nigérienne des Personnes Handicapées).

Testimonies

Stories of persons with disabilities and other vulnerable people
affected by the pandemic

MSF response to COVID-19 in Spain: elderly care home Residencia Nuestra Señora de las Mercedes in El Royo, Soria province. Photo by Olmo Calvo/MSF.

COVID-19: Older people's stories, by HelpAge International


HelpAge International is working with older people and network members around the world to respond to the threat of the COVID-19 pandemic. Find out about their experiences and their reactions to the spread of the virus.






Zahra, a 6-year-old refugee who suffers from autism and mental issues, in the Moria camp in Greece. Photo by Anna Pantelia/MSF.

COVID-19 blog series, by Social Development Direct (SDD)


Drawing on its expertise in gender, social inclusion and safeguarding, SDD has launched a COVID-19 blog series to help identify and respond to the needs of the most vulnerable individuals and nations as part of both the humanitarian response and long-term recovery planning. Blog posts highlight the impact of the pandemic on persons with disabilities, but also on other neglected groups, and bring a broader inclusion perspective to the discussion on the COVID-19 response. 

Nyumanzi settlement camp, Adjumani, Uganda. Photo by Isabel Corthier.

In Uganda, a deaf man loses his leg after being shot during curfew,
by IDA

The story is part of the Voices of People with Disabilities during COVID19 Outbreak series. It highlights the risks that people with disabilities may face due to communications barriers and lack of access to essential public information.






Recommended reads

Articles on various disability-related issues in the time of coronavirus

Key online repositories of resources on disability and COVID-19 

Mobirise

International Disability Alliance (IDA), COVID-19 and the disability movement


The webpage includes, among others, resources and tools for action, resources
by IDA members and partner organizations, and stories of persons with disabilities affected by the pandemic. 

Mobirise


International Disability and Development Consortium (IDDC), Repository of resources on disability inclusion and Covid-19

A regularly updated repository of resources focusing on COVID-19, disability, mental health, chronic health conditions and related topics.

Mobirise


Source, COVID-19 pandemic




A database of resources from experts around the world on COVID-19 and how it intersects with disability.


Mobirise

Gallaudet University, World Signed Languages Resources on COVID-19, Advocacy & Risk Reduction Information

An open-access database of sign language information resources, created to support deaf community advocacy efforts in emergency contexts. It contains public information produced by worldwide deaf community organizations, videos of deaf interpreters working in public information settings, and print or video news items about deaf advocacy and signed language access. The TIC project does not take responsibility for the content, which has to be assessed and adapted by the users. 

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