|UNICEF tent camp children receive psychosocial help after the Cast Lead operation in Gaza 2009. Photo by John Tordai, UNRWA archive.|
Disability and Rehabilitation in Palestine
By Dr. Waddah Malhis
People with disabilities in Palestine make up 4 to 6 percent of the population. More than 35 percent of the people with disabilities are physically disabled due to the Intifada, traffic and work accidents, malnutrition, traumas, and home births. Violence and unrest associated with the occupation have produced a generation of physically and psychologically traumatised children and youth. In addition, the tradition of marriage between close relatives has resulted in many children being born with disabilities.
The West Bank/Gaza Strip features a very young population age structure; 46 percent of the population is 14 years of age or younger. In the Gaza Strip the proportion of the total population aged 14 and under rises to 50 percent.
In Palestine, kindergarten facilities cover only an estimated 20 to 30 percent of children between the ages of three and five, and half of the facilities act only as caretakers rather than venues that meet development needs. Studies suggest that many mothers lack adequate knowledge of how to meet the development needs of their young children.
West Bank and Gaza Strip children have a shortage of safe play areas. As a result most children are forced to play in the streets and risk being injured through various forms of accidents.
Palestine has one of the most progressive jurisdictions regarding the rights of persons with disabilities in the society. The law on disabilities was approved in 1999 but there are a lot of obstacles that face the enforcement of the Palestinian disability law. In the Palestinian community we still have problems facing the habilitation and rehabilitation services. Families are unable to cover the costs of daily needs: medical materials, tests, treatments, and technical aids. There are access problems and high transportation costs. There is also a shortage in home/community adaptations.
On the part of professionals there is inadequate attention to early detection policies and a shortage in organised intermediate-level referral services. In addition, there is a lack of adequate skills to deal with severe and multiple disabilities and inadequate qualification of educational staff working with the disabled in mainstream educational settings. There are psychosocial issues such as social stigma and discrimination against women and girls with disabilities.
In the Palestinian territories we began to think about planning for rehabilitation programmes during and after the Intifada when several leading non-governmental organisations and grassroots committees formed special rehabilitation programmes, both institutionalised and community-based to meet the needs of disabled persons.
We adopted the strategy of community-based rehabilitation programmes, which are based on some principles that aim to build potential community through providing comprehensive and efficient services in order to strengthen the abilities of disabled persons.
From the point of view of rehabilitation services, the strategy aims to provide suitable services for all disabled persons at three levels: The community level; the regional level; and the national level.
This strategy assumes that about 60 to 70 percent of disabled persons could be served at the community level (CBR programmes), 20 to 30 percent could be served at the regional level (intermediate level services), and about 10 to 20 percent need more specialised services (national centres).
The total Palestinian population throughout the world is 7.5 million. The total West Bank and Gaza Strip population is estimated at 2.8 million; 1.8 million live in the West Bank (including the Arabs of East Jerusalem). The West Bank and Gaza Strip are marked by a high degree of urbanization. Four-fifths of persons in the Gaza Strip live in urban areas whereas two-thirds of the population in the West Bank live in urban areas.
There are only four national centres in the field of physical disability that serve the Palestinian population in Palestine: The Jerusalem Princess Basma Centre for Disabled Children, which serves the disabled children from the central and northern parts of the West Bank; Abu Raya Rehabilitation Center, which serves the adults from the central and northern parts of the West Bank and children with spina bifida; the Bethlehem Arab Society, which serves the disabled population of the southern parts of the West Bank; Al-Wafa Rehabilitation Center in Gaza, which serves the disabled population of the Gaza Strip.
The Jerusalem Princess Basma Centre for Disabled Children is the principal provider of prosthetic and orthotic devices for the Palestinian population. The role of the Centre as one of the national centres in Palestine is to diagnose, investigate, and formulate comprehensive habilitation and rehabilitation programmes for children with special needs up to age 15, as well as to give support and advice to their families. In addition, the Centre organises vocational training opportunities for the disabled adults of East Jerusalem.
An annual total of 200 to 220 children from the West Bank are referred to the Centre and stay as in-patients, whereas a total of 60 to 80 children from the Jerusalem area are referred for day care services.
A total of 22 young adults with special needs, males and females who are 18 or older, participate as trainees at the vocational training sheltered workshop. The aim of this programme is to enable them to be active members of their communities. Every child spends a period of two weeks to two months at the in-patient department. The presence of the mother or family member is mandatory.
The Centre aims to be a model for mainstream education within an inclusive setting at its secondary level school.
A total of 677 students from East Jerusalem between the ages of 3 and 17 are receiving regular pre-school and mainstream education within an inclusive setting. Seventy-four are hearing impaired, thirty-three are physically impaired, and six are visually impaired. This coincides with our vision of total integration of all children with special needs within their own communities.
The Centre is involved in research studies in the fields of disability and rehabilitation. The Centre was involved in a Middle East regional research study that aimed to improve the functional motor abilities of Palestinian children with cerebral palsy. The Centre will also house a research programme, to be named for the late Dr. Amin Majaj, in commemoration of his renowned research programme.
The Centre is an active member in the East Jerusalem Hospital Forum, which was created to provide networking and coordination of efforts among the hospitals. The network brought together the six health organisations in Jerusalem: Makassed, Augusta Victoria, St. Joseph, St. John, Red Crescent Society, and the Princess Basma Centre.
The creation of this network was a response on the part of these organisations to changing political realities that threatened their survival, their ability to facilitate complementary and joint planning, and their ability to promote collective excellence amongst members. It is a sign of hope that provides the motivation to work together towards a better future for our health care sector.
Dr. Waddah Malhis is the medical director of the Jerusalem Princess Basma Centre for Disabled Children.