Summary action points based on findings

• Develop, adopt, and implement a national disability plan that includes objectives that respond to the needs of survivors and recognizes its victim assistance obligations and commitments, together with a monitoring structure.
• Expand access to physical rehabilitation needs, particularly in provinces lacking services or where traveling to receive rehabilitation is difficult for survivors.
• Ensure that meaningful participation of survivors is increased at all levels.
• Prioritize physical accessibility, particularly for services and for government buildings.
• Provide psychosocial and psychological support, including peer support in particular to new survivors as well as those who have been traumatized and live in isolation.

Victim assistance commitments

The Islamic Republic of Afghanistan is responsible for significant numbers of landmine survivors, cluster munition victims, and survivors of other explosive remnants of war (ERW) who are in need. Afghanistan has made commitments to provide victim assistance through the Mine Ban Treaty and has victim assistance obligations under the Convention on Cluster Munitions.

Afghanistan ratified the Convention on the Rights of Persons with Disabilities (CRPD) on 18 September 2012.

Casualties

Casualties Overview

The Monitor identified 1,296 new casualties due to mines, victim-activated IEDs, and ERW in Afghanistan for 2014. The overall total included 470 civilian and 16 deminer casualties of mines/ERW recorded by the Mine Action Coordination Centre of Afghanistan (MACCA). Another 775 casualties from victim-activated IEDs recorded by UN Assistance Mission in Afghanistan (UNAMA) were included in the annual total.[1] Of the 1,242 civilian casualties reported for 2014, 664 were adults, including at least 57 women.

In 2014, children (561, including 80 girls) made up 45% of the total civilian casualties where the age group was known.[2] Similarly, in 2013 children (486, including 70 girls) made up almost half (47%) of the total civilian casualties where the age was known. This marked an increase from 2012 when children (432) accounted for a third (34%) of civilian casualties.

In 2014, there were 16 deminer casualties (two were killed and 14 injured), a significant decrease from 2013, when 22 deminer casualties (one killed and 21 injured) were reported. The total number of deminer casualties in 2014 was the same as in 2012, 16 (three killed and 13 injured).[3]

The 2014 casualty total of 1,296 represented an increase from 1,050 casualties in 2013,[4] and was closer to the 1,422 casualties[5] due to mines/ERW including victim-activated IEDs identified in Afghanistan for 2012.

In both 2014 and 2013, far fewer casualties among military and security forces were reported or identified than in previous years. This is unlikely to be representative of a trend, but rather due to changes in media reporting, other reporting sources, and the overall availability of data.

Data from Action on Armed Violence (AOAV), part of its global explosive weapon casualties monitoring project, included 33 casualties of victim-activated IEDs among Afghan security personnel (armed forces and police) and one International Security Assistance Force (ISAF) military casualty in 2014. These casualties were included in the Monitor casualty total for Afghanistan. The number of national security force casualties was relatively low in proportion to the 505 armed actor casualties (including non-state armed group (NSAG) actors) of all types of IEDs recorded by AOAV for 2014.[6]

In addition, Afghan security force sources reported on 16 NSAG members (suspected Taliban) killed while making or planting IEDs. As casualties of their own explosive devices—IEDs that may have been constructed to be detonated remotely on command—these were not included in the casualty total for Afghanistan for 2014.[7]

An increase in the number of civilian casualties of victim-activated IEDs (specifically pressure-plate IEDs, PP IEDs) was recorded in in Afghanistan in 2014. During the reporting period, MACCA took the step of integrating PP IED casualty data collection into its Information Management System for Mine Action (IMSMA), in order to respond to the needs of survivors and victims in accordance with the obligations of the Mine Ban Treaty.[8] MACCA reported serious concerns about the increased use of the “indiscriminate illegal” PP IEDs by anti-government elements in 2014. UNAMA recorded a 39% annual increase, with 775 civilian PP IED casualties (417 killed and 358 injured) in 2014. PP IEDs accounted for 26% of civilian casualties from all types of IEDs. MACCA and UNAMA established a close coordination mechanism for exchange and verification of data on casualties of mines, ERW, and PP IEDs in 2014.[9]

The total number of victim-activated IED casualties reported with disaggregated data for the years 2014, 2013 (557), and 2012 (913) was far higher than those identified in previous years.[10] Although the number of annual victim-activated IED casualties in 2013 was significantly less than in 2012, by mid-2014 UNAMA reported that the number of victim-activated IED casualties was again increasing.[11]

There was also an increase in the number of annual ERW casualties reported by MACCA, with 426 recorded for 2014, 6% higher compared to 399. Children were overwhelmingly the group most affected by ERW, with 352 child casualties (103 killed and 249 injured) making up 83% of the total of ERW casualties in 2014.

Both MACCA and UNAMA have expressed strong concerns about the sharp rise in civilian casualties from ERW associated with the closure of ISAF bases and high explosive firing ranges. Many of the ranges were not sufficiently cleared of ERW prior to closure.[12] MACCA identified 49 casualties that occurred on or near military bases and firing ranges in 2014 (52 in 2013 and 47 in 2012); the vast majority of these casualties were children: 78% in 2014 (73% in 2013 and 81% in 2012). Of all the casualties from ERW on firing ranges recorded from 2010 through 2013, almost all occurred during livelihood activities including: tending animals; household work; collecting food, water, or wood; hunting; recreation; and travelling. Only two were due to tampering.[13]

In advance of the NATO Summit in September 2014, members of the Agency Coordinating Body for Afghan Relief and Development (ACBAR) distributed an updated briefing paper on the impact of ERW left by international armed forces to key stakeholders in Afghanistan.[14]

Mines/ERW severely affected internally displaced persons (IDPs) in Afghanistan, however, in 2014, the number of casualties among IDPs dropped sharply, to 18.[15] In 2013, IDPs made up more than 20% of all civilian mine/ERW casualties recorded by MACCA.[16] There was an increasing trend in the number of IDP casualties during the period from 2010 to 2013 (97 in 2013, 94 in 2012, 45 in 2011, and 72 in 2010). There were estimated to be around 176,129 IDPs living near 434 known hazardous areas (in a radius of 5km²).[17]

MACCA data indicated that there had been 24,300 (4,802 people killed and 19,498 injured) between 1967 and 2014, not including victim-activated IED casualties.[18]

Cluster munition casualties

Since 1980, 752 casualties of cluster munition remnants were recorded. In addition, at least 26 casualties during cluster munitions strikes have been recorded.[19] One submunition casualty was recorded in 2014. Previously the last submunition casualties recorded by MACCA were in 2010.[20]

Victim Assistance

The total number of survivors in Afghanistan is unknown, but in 2006 the number was estimated to be 52,000–60,000.[21]

Victim assistance since 1999[22]

Access to victim assistance in Afghanistan was hampered by a severe lack of services, poor to non-existent infrastructure, ongoing conflict, and poverty. However, Afghanistan did make progress in victim assistance and disability issues, supported by significant international funds that were needed to improve services and conditions. A lack of coordination among donors funding services for persons with disabilities alongside other competing priorities for assistance was identified as a challenge. Over time, ministries demonstrated more national ownership of services for persons with disabilities, which were integrated into ministry policies and strategic planning with the assistance of MACCA technical advisors. National NGOs, disabled persons’ organizations (DPOs), and survivors’ organizations became increasingly active and participated regularly in disability coordination. Inclusive education increased since 2008.

Psychosocial support services increased from almost non-existent, as did peer-to-peer support, though they were still hardly available and remained insufficient to meet demand and needs. A community-based rehabilitation (CBR) network grew and became better coordinated.

Economic reintegration projects were limited and conducted mostly by NGOs under the coordination of relevant ministries—ministries paid some disability pensions to war victims and ran some vocational training.

Victim assistance under the Vientiane Action Plan 2011–2015

Movement restrictions (due to conflict, lack of accessible roads, and the cost of transport) were persistent obstacles to victim assistance in some parts of the country that continued through the period.

Despite improvements, geographic coverage of healthcare remained insufficient, particularly in terms of physical rehabilitation. Physical rehabilitation services were almost entirely operated by international NGOs and the ICRC under the coordination of the government.

Access to services and support for national and local DPOs and NGOs increased during the period 2010–2012. The ICRC increased its support to medical care and physical rehabilitation consistently throughout the period, while international NGOs continued to provide the remainder of physical rehabilitation services.

Funding challenges continued to impede progress. In 2013, there was an overall decline in the number of projects being implemented and some organizations were unable to fulfill their planned projects and overall mandates due to a decrease in international financial support. Although resources were greatly reduced, there were still some donors who sustained their support for persons with disabilities in ways that included survivors. MACCA and the UN Mine Action Service (UNMAS) increased financial support to victim assistance and disability-related projects by registering national and international NGOs, which could then receive specific project funding.

Victim assistance in 2014

Afghanistan reported that, while there was tangible progress on the ground, the scale of victim assistance services was inadequate compared to the need.[23] Funding decreased and many NGOs providing victim assistance and other services for persons with disabilities faced critical financial shortages. Due to the shortage of financial resources some provincial braches of NGOs ceased their victim assistance activities.[24]

Assessing victim assistance needs

No specific needs assessment surveys of survivors were conducted in 2014. The Ministry of Labor, Social Affairs, Martyrs and the Disabled (MoLSAMD) regularly registered persons with disabilities with war-related impairments and the dependents of persons killed (martyrs) in Kabul and in the provinces, in order to provide a monthly financial allowance. MoLSAMD also registered persons with disabilities not caused by conflict in Kabul.[25]

However, the social security registration system required a significant overhaul. An independent Vulnerability to Corruption Assessment (VCA) focusing on the challenges to obtaining legally guaranteed financial benefits faced by persons with conflict-related disabilities, including mine/ERW survivors, was published in 2015. It found serious problems with the system—including a “significant number of lengthy, convoluted, and at times seemingly arbitrary steps…nearly all of which constitute discretionary transactions conducive to bribery, influence, etc.”[26] The process was also found to place additional psychological and physical burdens on persons with disabilities “a group that many Afghans treat as outcasts, corruption contributes to their further marginalization from society.”[27]

MoLSAMD entered data on registered persons with disabilities and dependents of persons killed into an Excel spreadsheet software program, which effectively meant that it could be misused at any time. In 2015, the World Bank was implementing a project to establish a better electronic data system.[28]

In 2015, the office of the president of Afghanistan reported that a “lack of a standard mechanism for identifying the level of disability, and proper work system were described as the major problems at Ministry of Labor, Social Affairs and Disabled that has prevented the ministry to respond [sic] to the legitimate demands of the disabled and families.”[29] The independent VCA report recommended that new, detailed, and comprehensive criteria for determining eligibility for registration of persons with disabilities needed to be developed and made available publicly and to all applicants.[30]

MACCA supported the Ministry of Public Health (MoPH) in the development of disability and physical rehabilitation indicators for its Health Management Information System (HMIS). The HMIS directorate agreed to include these indicators in the revised HMIS, which was planned for 2015. The software for the National Disability Referral Guide was developed by MACCA in Access format, but not yet printed or publically available.[31]

A study by MoLSAMD and the Ministry of Education (MoE), carried out on eight components of victim assistance in Afghanistan, was used in 2014 to identify a list of projects to be prioritized by relevant ministries as well as economic reintegration and physical rehabilitation projects funded by MACCA in Kabul, Herat, Kandahar, and Kunar provinces.[32]

In 2014, Handicap International (HI) Community-Based Mine Risk Education (CBMRE) teams collected data on civilian mine/ERW casualties (specifically including mines, ERW, abandoned IEDs, and PP IEDs) from affected communities in 10 districts of Kandahar and Helmand provinces while conducting risk education sessions. Subsequently, verification data was submitted to the MACCA regional office in Kandahar. In May 2014, HI extended these activities to another four districts in the southern region.[33] Disaggregated data on mine/ERW casualties was collected and survivors and other persons with disabilities in need were referred to the HI Physical Rehabilitation Center (PRC) in Kandahar for assistance.[34] HI restarted its CBMRE in Kandahar and Helmand provinces in 2013 after a one-year pause due to lack of funding (April 2012 to March 2013).[35]

Most service providers collected information on the needs of survivors for use in their own programs. As in the following examples, recent assessments were carried out at local or regional levels, focusing on specific issues such as physical rehabilitation or accessibility.

• In 2014, the ICRC Physical Rehabilitation Program (PRP, known also as the Orthopaedic Program) conducted a vulnerability assessment of persons with disabilities, including mine/ERW survivors, through its social reintegration project. The homes of more than 3,000 persons were visited and their economic situations evaluated so that they could be provided with appropriate socioeconomic inclusion measures. A portion of beneficiaries were later re-assessed in order to evaluate the impact of the program on them. The results confirmed the high level of vulnerability of persons with disabilities.[36]

• During April 2015, HI, through its Victim Assistance (VA) project in Afghanistan, launched a baseline needs survey in three districts of Kandahar province,[37] identifying the health, social, and economic status of mine/ERW survivors and other persons with disabilities and their families (as immediate caregivers).[38]

• The NGO Afghan Amputee Bicyclists for Rehabilitation and Recreation (AABRAR) used a standard format for needs assessment of target beneficiaries. Short surveys were conducted to identify the needs of beneficiaries with disabilities for economic inclusion support in Kabul, Parwan, and Balkh province.[39]

The last comprehensive disability survey was in 2005.

Victim assistance coordination[40]

Coordination

MoLSAMD is the government focal point for victim assistance and regulating the legislation of disability issues overall.[41] Other national and international stakeholders support the government in developing or amending legislation. The MoPH and the MoE are involved in disability services and advocacy activities. The MoPH also coordinates training programs for physiotherapists and healthcare providers.[42] The work of these three key ministries is supported by MACCA technical advisors, who are funded by UNMAS.

In January 2014, MoLSAMD held its first-ever donors meeting, which was attended by more than 25 donors including representatives of embassies in Kabul. There were some assurances from donors to support the work of the ministry in the area of disability.[43] Previously, it was noted that greater donor coordination on disabilities issues would be particularly useful for Afghanistan.[44]

The MoPH is responsible for medical treatment and physical rehabilitation. Its plan of action consists of the Basic Package of Health Services (BPHS) and the Essential Package of Hospital Services (EPHS); physiotherapy services are included in both, while prosthetic services were only included in the EPHS. Although it is in the framework and action plans, physical rehabilitation, including delivery of services and funding, was not yet managed by the MoPH.[45] The MoPH Strategic Framework 2011–2015 counted improving disability services among its priorities, and the ministry’s focal point for disability, the Disability and Physical Rehabilitation Department (DRD), had an implementation strategy for the framework. MoLSAMD was responsible for the social inclusion of persons with disabilities through benefits and the pension system, while the MoE worked toward ensuring access to education. MACCA assists with overall coordination in the areas of disability and victim assistance.[46]

A specific coordination committee for victim assistance was established by MACCA in September 2013 with the aim of enhancing the coordination of victim assistance within MACCA, government line ministries (MoPH, MoLSAMD, and MoE), Mine Action Program of Afghanistan (MAPA) implementing partners, and other victim assistance stakeholders working in Afghanistan. The VA [Victim Assistance] Coordination Group held six bi-monthly meetings at MACCA, chaired by the victim assistance department, with the participation of all key monthly national and international victim assistance and disability organizations and representatives of the line ministries, including the MoPH, MoLSAMD, and the MoE.[47] The main goals on the agenda were to create and strengthen the coordination mechanism for disability stakeholders while highlighting the needs of, and support for, mine, cluster munition, and other ERW survivors within a broader disability context in order to reach most mine/ERW and war-impacted communities. The goals, which were aligned with relevant ministries’ priorities, also included mapping activities and avoiding duplication of resources. [48]

Several other coordination groups, including those noted above, regularly held meetings relevant to victim assistance and disability rights, both nationally (from Kabul) and at the regional level. MACCA and the participating ministries reported that these meetings resulted in improved coordination and cooperation between actors; strengthened support and cooperation between the responsible ministries and other stakeholders; and improved advocacy and awareness-raising. The various coordination group meetings included the following:

• DSCG, led by MoLSAMD and supported by MACCA technical advisors, held 13 meetings in 2014. Issues discussed included: the inclusive education policy, tax issues for DPOs and NGOs serving persons with disabilities, the establishment of national inclusive vocational training, and skill development guidelines and standards among many CRPD-related points.

• The Disability and Physical Rehabilitation Taskforce, coordinated by the MoPH, held ad hoc meetings in 2014. Activities focused on finalizing spinal cord injury management guidelines, enhancing professional training, strengthening coordination, fundraising for services, and long-term planning.

The Disability and Physical Rehabilitation Taskforce also launched a highly commended mapping report on the physical rehabilitation sector, which focused mainly on the accessibility of services to users and how service providers ensure accountability. The mapping report was officially endorsed by the Disability and Rehabilitation Department of Ministry of Public Health (MoPH-DRD) in June 2014, and subsequently launched in November.[49] During the November launching workshop of the Mapping Report on the Physical Rehabilitation Sector, MoPH-DRD officials declared their commitment to use the recommendations of the report for the future strategic planning of their department.[50]

• The Advocacy Committee for the Rights of Persons with Disabilities (ACPD), under the secretariat of the Afghanistan Independent Human Rights Commission (AIHRC) disability section, organized meetings on a quarterly basis and mostly focused on the advocacy issues of the rights of persons with disabilities. It also remained engaged throughout the year in other groups and meetings. Together with ACPD members, the MACCA/UNMAS Victim Assistance/Disability Advisor for MoLSAMD attended some 24 meetings, sessions, workshops, and advocacy and awareness events on various issues of the rights of persons with disabilities. The AIHRC also chaired ad hoc meetings of the ACPD to address the challenges faced by persons with disabilities and the low implementation of laws and policies, including international disability and victim assistance conventions as well awareness-raising and advocacy.

• The Afghan CBR Network conducted five workshops on five components of CBR with the financial support of the Community Center for Disabled People (CCD) for which World Health Organization (WHO) international CBR guidelines were translated into Pashtu and Dari languages, then printed and distributed by Afghan CBR Network members.

• The Inclusive Child Friendly Education-Coordination Working Group (ICFE-CWG), chaired by the MoE, held six meetings during 2014. More than 15 national and international organizations discussed activities, achievements, challenges, and the way ahead. The key outcome was development, translation, and printing of the first comprehensive policy on disability-inclusive education in Afghanistan.

• The Inter-ministerial Taskforce on Disability, chaired by the MoPH-DRD and hosted by MoLSAMD, was established for addressing specific objectives including the national disability policy development mechanism, the establishment of a national rehabilitation institute, holding a high-level CRPD workshop, establishing training curricula for social workers, and training of the psychosocial counselors. In 2014, follow-up on these issues was undertaken by both ministries. As a result, the national disability policy draft was widely circulated for consultation.

• MACCA established a “MAPA Gender Mainstreaming Strategy Focal Points” working group for implementation of its Gender Mainstreaming Strategy (including victim assistance). The focal points from implementing partners participated in several meetings led by MACCA through which the progress made by each organization was presented during the meetings. For example:[51]
  • Every partner organization developed an action plan for implementation of the MAPA Gender Mainstreaming Strategy;
  • Most implementing partners revised their job vacancy announcements in line with requirements of the gender strategy to facilitate opportunity for female applicants;
  • Some of the Implementing Partners reviewed/adapted their human resources policies, standard operating procedures, and codes of conduct in consideration of gender strategy and some organizations promised to do so according to their plans;
  • Most of the gender focus points conducted briefing sessions to their organization’s staff members, and others committed to do so according to their own action plans.

• National meetings of the UNCHR-led Afghanistan Protection Cluster (APC) in Kabul, (seven meetings were held in 2014) focused on lobbying activities on the protection of civilians and strengthening collaboration among protection actors. In APC meetings, HI endeavored to ensure greater inclusion of persons with disabilities and victim assistance approaches in other participants’ programs, protection strategies, and action plans and to ensure that the Office for the Coordination of Humanitarian Affairs (OCHA) Country Humanitarian Action Plan for 2015 would be inclusive of survivors and persons with disabilities.

While a lot of work remained to be done to integrate disability rights issues into the work of UN agencies, disability was on the agendas of some UN agencies in 2014, including the UNICEF and the World Food Program (WFP).[52]

As part of the process of handing over NGO-run physiotherapy clinics to district hospitals, in December 2014 the Swedish Committee for Afghanistan (SCA) and the MoPH jointly organized a national workshop on physical rehabilitation, in Kabul. Representatives from MoLSAMD and the ICRC, HI, AABRAR, DAO, CCD, and the Afghan Association for Physical Therapy (AAPT) also attended the workshop.The main objectives were to discuss the current status of the physical rehabilitation services, and handover of services to the frameworks of the governments Basic Package of Health Services (BPHS) and Essential Package of Health Services (EPHS). The MoPH committed to supporting the takeover of SCA district- and provincial-level physiotherapy clinics by BPHS and EPHS implementers. However, compared to NGO salaries, the low salary grades for physiotherapists, set by national salary standards, were recognized as a major obstacle in handover process.[53]

Policies and plans

In 2014, the process of developing the Afghanistan National Policy for Persons with Disabilities continued with the draft shared once again with government agencies and stakeholders for further feedback. The Afghanistan National Disability Action Plan (ANDAP) 2008–2011 was not revised; revision of the plan remained on hold since the ANDAP expired in 2011, pending the completion of the disability policy.[54] However, a number of other policies in Afghanistan refer to services for persons with disabilities, although do not necessarily mention victim assistance. These include the Health and Nutrition Strategy of the MoPH and the Inclusive Education Policy of the MoE.[55]

Afghanistan provided information on progress in and challenges to victim assistance at the Convention on Cluster Munitions intersessional meetings and Meeting of States Parties in 2014. Afghanistan was the co-coordinator for victim assistance for the Convention on Cluster Munitions in 2013–2014. Afghanistan presented victim assistance developments at the Mine Ban Treaty Third Review Conference in 2014.[56] Afghanistan made extensive use of all sections of its Convention on Cluster Munitions Article 7 report for 2014. Afghanistan also included detailed reporting on victim assistance activities in its Mine Ban Treaty Article 7 reporting for 2014.[57]

Survivor inclusion and participation

Mine/ERW survivors and their representative organizations were included in the planning and provision of victim assistance.[58] Persons with disabilities and their representative organizations were included in decision-making and participated in the various coordination bodies. However, it was sometimes reported that their views were not fully taken into account.[59] In 2014, the inclusion of persons with disabilities, survivors, and their representative organizations remained insufficient and was not yet effectively included as an essential component of activities.[60]

Parents of children with disabilities were involved in MoE inclusive education training in Kabul, which resulted in increased enrollment of children with disabilities into mainstream schools.[61] Many NGOs had a significant proportion of employees who were persons with disabilities. Mine/ERW survivors were included in the implementation of peer support, rehabilitation, and other services. Persons with disabilities employed by MACCA supported the activities of the key ministries and were included in NGO activities that MACCA supported.[62]

The ICRC Afghan Physical Rehabilitation Program was managed by persons with disabilities. The rehabilitation program maintained a policy of “positive discrimination,” employing and training only persons with disabilities. Service provision was entirely managed by survivors and persons with disabilities, including technical and administrative positions. The ICRC continuously consulted with and involved survivors in the decision-making process as survivors were fully integrated into its operations. The positive discrimination policy also aimed to demonstrate that persons with disabilities are an asset to society, not a burden.[63]

Service accessibility and effectiveness

Victim assistance activities[64]

Emergency and continuing medical care

Obtaining appropriate and timely medical treatment in conflict-affected areas remained difficult for much of the population. Attacks on medical personnel and facilities further impeded services.[65]

A lack of funding and attention to victim assistance issues combined with increasing levels of conflict in Afghanistan resulted in the need for an increase in medical care while there were fewer resources available. Medical care for persons with disabilities decreased in availability.[66] In rural areas, medical services were particularly reduced because of the lack of physical security.

ICRC-supported hospitals treated 1,827 weapon-wounded patients in 2014 (a similar number of beneficiaries compared to 2,023 in 2013); some 42% (861) were injured by mines/ERW (compared to 47%, 950 in 2014).[67] Some 1,560 weapon-wounded people reached the hospitals in southern Afghanistan in 2014 through an ICRC-funded transport system, which had a new referral procedure and improved monitoring (an increase from about 1,000 people in 2013).[68]

A report by Doctors Without Borders (Médecins Sans Frontières, MSF) in early 2014 found that the cost of healthcare was exacerbating the poverty of already very poor people in Afghanistan. Most of the population had access to basic public healthcare. However, the quality was reported to be extremely low, resulting in many patients having to resort to seeking higher cost private services, paid for “out-of pocket” with borrowed money. This, in turn, resulted in a cycle of debt.[69]

Physical rehabilitation including prosthetics

Physical rehabilitation was not available in all provinces.The number of the facilities providing prosthetic and orthopedic devices remained unchanged in 2014. Rehabilitation centers were concentrated in 12 of the 34 Afghan provinces and patients were often forced to travel long distances to access services. Physical rehabilitation services were available through a network of 17 centers, seven of which were managed by the ICRC; the others were managed by NGOs, with the exception of two that were managed by the MoPH. The MoPH-run rehabilitation centers in Kabul and Khost provinces were reported to have had made an insignificant impact on the needs of persons with disabilities and performance was questionable. The annual production of mobility devices in the country indicates that existing centers are insufficient to meet demand.[70] There was a significant shortage of rehabilitation services in many districts in Afghanistan, especially in rural areas and regions where insecurity and persisting violence is high.[71]

The obstacles to rehabilitation were reported to be numerous; the ICRC listed the following: “ignorance, lack of compassion, dedication, accountability and professionalism among medical personnel, prejudices against disability, poverty, distances and transport difficulties, violence, ethnicity and political divisions.”[72] Due to the challenges Afghanistan faces and the large number of persons with disabilities among the population, the ICRC reported that it would be unrealistic to consider the government capable of ensuring the needed services itself. Anticipating that it will take years before the national authorities have the capacity to fully manage the long-term functioning of services, the ICRC continued the process of providing training while transferring management responsibilities to Afghan employees for a progressive handover.[73]

In 2013, a mapping report on the physical rehabilitation sector, which was developed under the regional rehabilitation project (south Asia), was carried by HI with the involvement of all physical rehabilitation stakeholders of Afghanistan. The findings also demonstrated that there remained a shortfall in availability, geographical coverage, and quality of services.[74]

The geographic coverage of ICRC rehabilitation services remained the same in 2014, while the number of patients assisted through the program increased. Due to supervision and improved technology, the quality of some of the services improved. However, occasionally, during the time of high influx, quality did decline temporarily. The number of the new registered patients increased by 2.5% (from 8,902 in 2013 to 9,131 in 2014); the total number of persons with disabilities receiving services increased by more than 10% (94,868 in 2013 compared to 104,584 in 2014).[75] Delivery of prostheses in ICRC-supported centers totaled 4,149 (58% of which were for mine survivors), a slight decrease from 4,335 in 2013 (61% were for mine/ERW survivors) but still more than the 4,046 prostheses (62% were for mine survivors) delivered in 2012.[76]

Physiotherapists in Afghanistan are mostly employed by NGOs and international organizations, with only a few working in governmental hospitals and private clinics. The goal for long-term sustainability of rehabilitation is to gradually shift services into government institutions, as the medical sector is improved and is able to take over the provision of rehabilitation services.[77]

The SCA planned to hand over its physiotherapy clinics, currently operating within district hospital compounds, to begin operating under the Basic Package of Health Services (BPHS) by end of 2015. It worked to restructure its remaining ongoing physiotherapy activities towards community-based physiotherapy.[78]

The HI Physical Rehabilitation Center in Kandahar Province saw the needs for physical rehabilitation services continue to rise as the conflict intensified in 2014. The number of beneficiaries increased by 11% compared to 2013. HI found that 12% of the 6,668 beneficiaries at its Kandahar Province center were mine/ERW survivors in 2014. In Kabul and Parwan provinces, the number of beneficiaries in 2013 and 2014 was maintained even though in 2014 activities lasted only five months compared to nine months of implementation in 2013. Physiotherapy services in Herat Province were phased-out during 2014; the number of people who received services decreased from 2013 by 53% accordingly.[79] HI had to stop delivering physiotherapy services in health facilities below the district hospital level from November 2014, in part due to lack of funds, but also due to the MoPH policy requirement that physiotherapy services should be provided only as part of the BPHS through district hospitals and health clinics. However, due to a lack of professional physical rehabilitation staff, many of them do offer physiotherapy.[80]

HI continued to work with the two community-based organizations, Serving Emergency Rehabilitation and Vocational Enterprises (SERVE) and Women Affairs Council (WAC), to deliver community-based physical rehabilitation services in Kabul province.[81] During the last quarter of 2014, HI’s PRC in Kandahar province carried out an external evaluation focused on improving cost efficiency and sustainability for remodeling the center. As a result, among other changes, the repair of mobility aids was stopped from the beginning of 2015, as there existed cheap private repair workshops.[82]

Due to a lack of funding, services at the physical rehabilitation center in Kunar Province remained on hold in early 2015 and it was anticipated that it would be forced to close down entirely if donor funding was not secured.[83]

Social and economic inclusion and psychological support

In 2014, the ICRC offered more than 3,000 persons with disabilities social inclusion opportunities.[84] The ICRC also continued to promote a wide range of sports activities. In most ICRC rehabilitation centers, sport became a consolidated activity to effectively address physical rehabilitation and social reintegration. The ICRC made concerted efforts to increase the sports activities and to improve the perception of inclusive sport for persons with disabilities. Still, room for improvement was needed overall and there were very limited opportunities for sports for persons with disabilities throughout the country.[85] In Jalalabad sports activities stopped because no transportation and equipment were available due to a lack of funding.[86]

The ICRC provided micro-credits for persons with disabilities and their families to become more self-sufficient, provided vocational training, distributed stationery kits to students, and supported home tuition for children.[87] In 2014, HI expanded socioeconomic inclusion opportunities for mine/ERW survivors and other persons with disabilities in Kandahar and Helmand provinces, with project training and preparation throughout December.[88]

ALSO transferred education and training services from two of its regional mainstreaming centers to local existing institutions that could provide similar services. It continued to operate offices in both regions.[89]

A lack of psychosocial support, particularly peer support, has remained one of the largest gaps in the government-coordinated victim assistance and disability programs, although some national and international NGOs provided these services.[90] HI found that psychosocial support services were still almost non-existent.[91] The MoPH trained 200 psychological support counselors who began working in district hospitals. ALSO peer support activities and projects funded by MACCA/UNMAS operated in Kabul, Herat, Bamyan, and Balkh to provide support and counseling sessions, which were completed in early 2014.[92] Peer support was provided to 810 new landmine survivors and persons with disabilities living in isolated situations. Almost half (47%) were female. In Herat, ALSO provided training for income-generation for women with disabilities.[93]

Gender

Women were often marginalized and were not adequately targeted for the provision of services by international donor organizations.[94] The Mine Action Program of Afghanistan (MAPA) Gender Mainstreaming Strategy 2014–2016 stated, “Existing discrimination and bias sometimes mean that women can be hard to reach when implementing surveys and as a result, this means that their priorities–frequently the priorities of their children and of basic community survival–can be excluded. In areas such as victim assistance…gender determines the access to and impact of activities and services, where females often face more restrictions compared to males.”[95] Many NGOs, both national and international, provided assistance to women with disabilities in major provinces. However, women with disabilities in remote provinces and districts required more support.[96]

In 2014,MACCA shared the Gender Mainstreaming Strategy 2014–2016 with its implementing partners to ensure that the gender aspects of mine action, including victim assistance, were addressed.[97]

Laws and policies

There were no significant changes in legal frameworks relevant to victim assistance in 2014. The Law on the Rights and Benefits of Person with Disabilities and the Law on Rights and Benefits for Relatives of Martyrs and Disappeared Persons remained the key legislative provisions.[98]

The Law on the Rights and Benefits of Persons with Disabilities was amended[99] in March 2013. However, the law contained discriminatory provisions and was not in conformity with the principles of the CRPD. MoLSAMD accorded special treatment to families of those killed and injured in war, which was the only group to receive financial support for persons with disabilities.[100] It was also reported that greater benefits were paid to those members of the current and past Afghan armed forces who had become persons with disabilities.[101] NGOs reportedly did not discriminate between persons with disabilities based on the reason or type of their disability.[102]

Following amendments to the National Law on the Rights and Privileges Persons with Disabilities, welfare payments for people with disabilities caused by war were raised and ranged from AFS1,500 to AFS5,000 (approximately US$30 to $90) per month; the quota of governmental scholarships reserved for persons with disabilities was increased from 5% to 7%; the quota of housing set aside for persons with disabilities was also increased to 7%. Land was to be provided free of cost for persons with disabilities (rather than with a 50% discount as was provided previously) and housing with a 30% discount (instead of a 20% discount).[103] The Afghanistan Civil Aviation Authority developed a procedure for discounting about 20% off airfares of national airline companies for persons with disabilities in national and international flights.[104]

According to the law, persons with disabilities should comprise 3% of state employees. However, 94% of those places were not filled as the state employed only 637 of the 11,280 persons with disabilities required by the quota. The Independent Joint Anti-Corruption Monitoring and Evaluation Committee reported that many persons interviewed noted that numerous violations of the Law on the Rights and Privileges of Persons employment quota occurred due to bribery and nepotism that resulted in job opportunities being taken away from persons with disabilities.[105]

The constitution prohibits any kind of discrimination against citizens and requires the state to assist persons who have disabilities and to protect their rights, which include healthcare and financial protection. Overall, persons with disabilities faced challenges, such as limited access to educational opportunities, a lack of physical access to government buildings—including ministries, health clinics, and hospitals, a lack of economic opportunities, and social exclusion.[106]

There was reportedly almost no attention to the implementation of CRPD in Afghanistan and, overall, there was a decrease in consideration of the conventions’ requirements.[107] It was reported that although Afghanistan had joined the relevant treaties and conventions, the provisions were not implemented.[108]

National NGOs ALSO, CCD, and ROAWV collectively implemented the Disability Rights Watch Afghanistan (DRWA) project in all 34 provinces of the country. The project’s main objective is to prepare an initial parallel (shadow) civil society report on Afghanistan’s implementation of CRPD.[109]