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.  

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.  

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.

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.

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. 

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.

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.

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.

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.