Summary action points

·         Develop, adopt, and implement a national disability plan, with a monitoring structure included.

·         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.

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.

Casualties

Casualties Overview

The Monitor identified 1,048 casualties due to mines, victim-activated IEDs, and ERW in Afghanistan for 2013. The total included 483 civilian and deminer casualties of mines/ERW recorded by MACCA and 557 casualties of victim-activated IEDs recorded by UN Assistance Mission in Afghanistan (UNAMA), as well as eight foreign military casualties reported in the media.[1] The 2013 casualty total represented a decrease from the 1,422 casualties[2] due to mines, victim-activated IEDs, and ERW identified in Afghanistan for 2012.

The vast majority (99%) of recorded casualties in 2013 were civilians. Far fewer military casualties were identified in 2013 than in previous years, though that may not be entirely representative of a trend due to changing availability of data.[3]

Children (486) made up 47% of the total civilian casualties where the age was known, including 70 girls. In 2012, children (432) accounted for 34% of civilian casualties. Another 547 civilian casualties in 2013 were adults, including at least 64 women.[4]

In 2013, there were 21 demining accidents resulting in 22 deminer casualties; one deminer was killed, 14 were severely injured, and seven deminers had minor injuries. This was an increase in comparison to 2012, when Afghanistan had 16 casualties (three killed, five severely injured, and eight with minor injuries) from 19 demining accidents. In 2013, the Mine Action Program of Afghanistan (MAPA) made efforts to reduce the number of accidents by raising the issue with key actors and implementers to address the root causes of accidents. Approximately 70% of demining accidents occurred in first six months of the year and around 40% of all accidents occurred in the first quarter of 2013.[5]

Of the casualty total for 2013, 465 mine and ERW casualties were reported by MACCA (133 people were killed and 332 were injured); 364 (78%) of these casualties were children. Of the 2013 MACCA total recorded casualties, 397 (85%) were due to ERW and the remaining 66 (14%) were due to mines.[6] Another two casualties (1%) were the result of abandoned improvised explosive devices. The MACCA total of 465 casualties was an increase of 26% (97) compared to 2012 when there were 363 casualties (91 killed; 272 injured), including 267 children.[7]

UNAMA noted that the increase in civilian casualties from ERW in 2013 corresponded to increased ground engagements between parties to the conflict. A possible second cause was the expedited pace of closure of International Security Assistance Force (ISAF) bases and high explosive firing ranges, as many of the ranges were not sufficiently cleared of ERW prior to closure.[8] In 2013, both the MACCA and UNAMA expressed strong concerns about a sharp rise in civilian casualties from ERW.[9] MACCA recorded 34 casualties that occurred on firing ranges in 2013 and 23 in 2012; the vast majority of these casualties were children: 91% in 2013 and 78% (18) in 2012. Of the 64 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.[10]

For 2013 and 2012, the total number of victim-activated IED casualties reported with disaggregated data was far higher than those identified in previous years.  Of the 557 reported civilian victim-activated IED casualties reported by UNAMA in 2013, 245 people were killed and 312 injured. This was a significant decrease from the 913 civilian victim-activated IED casualties (393 killed and 520 injured) reported by UNAMA for 2012.[11] However, by mid-2014 UNAMA reported that the number of victim activated IED casualties was again increasing.[12]

ERW, landmines, and abandoned IEDs severely affected internally displaced persons (IDPs) in Afghanistan. In 2013, IDPs (97) made up more than 20% of all civilian mine/ERW casualties recorded by MACCA.[13] There were an increasing number of IDP casualties during the period from 2010 to 2013 (97 in 2013, 94 in 2012, 45 in 2011, and 72 in 2010). This increase in casualties among this extremely vulnerable population likely resulted from an escalation of the conflict and ground operations between both national and international military forces and armed opposition groups as well as IDPs moving to live near hazard areas without knowledge of the risks or other choices of relocation. In early 2014, there were estimated to be around 176,129 IDPs still living near 434 known hazardous areas (in a radius of 5km²).[14]

MACCA data indicated that, between 1979 and 2013, there had been 22,546 mine/ERW casualties (people 4,389 killed and 18,157 injured), not including victim-activated IED casualties.[15]

Cluster munition casualties

Since 1980, 745 casualties of cluster munition remnants were recorded. In addition, at least 26 casualties during cluster munitions strikes have been recorded.[16] No cluster munition casualties have been recorded by MACCA since 2010.[17]

Victim Assistance

The total number of survivors in Afghanistan is unknown, but in 2006 the number was estimated to be 52,000–60,000.[18]

Victim assistance since 1999[19]

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’ organization became increasingly active and participated regularly in disability coordination.

Movement restrictions (due to conflict, lack of roads, and the cost of transport) were persistent obstacles to victim assistance in some parts of the country that continued through 2013.

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. 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, while ministries paid some disability pensions to war victims and ran some vocational training. Inclusive education has increased since 2008.

Victim assistance in 2013

In 2013, no new centers were established, and no existing centers were closed. However, all organizations had a difficult time in funding their projects and activities.[20] This resulted in 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.[21]

Many donors reduced their funding due to political reasons, the changing security situation or other factors. Although resources were greatly reduced, there were still some donors who sustained their support for persons with disabilities in ways that included survivors.[22] In addition, there was a fear of funding shortages due to the reduced involvement of the international community in the country connected to the withdrawal of the international military forces by the end of 2014.[23]

In 2013, the MACCA and the UN Mine Action Service (UNMAS)—increased financial support to victim assistance and disability-related projects to six national and international NGOs working in eight provinces.[24] With the funding, these NGOs implemented projects in the areas of physical rehabilitation, physical accessibility, mainstreaming centers, peer support, vocational training, inclusive education, awareness, advocacy, and capacity-building for persons with disabilities, their families, community, and related government staff.[25]

Afghanistan announced that in March 2013 some articles of the Law on the Rights and Benefits of Persons with Disabilities were amended to be “more in line with CRPD [Convention on the Rights of Persons with Disabilities] principles”. Changes that were made to the law included additions which did not benefit all persons with disabilities equally, such as increased financial support for persons with war related disabilities.[26]

Assessing victim assistance needs

In 2013, a list of disability and physical rehabilitation indicators was developed. It was undergoing the approval process by the Health and Management Information System (HMIS) department of the Ministry of Public Health as of September 2014.[27]

Child Protection units of the Ministry of Education (MoE) collected data from the field throughout the country which is reported to MACCA by the MoE Safety and Security Department.[28] Also, Afghanistan reported that, with the support of MACCA, a National Disability Referral Guide (NDRG) including software was developed to collect data from national and international disability stakeholders and develop a national referral system for service delivery.[29]

After a one year pause due to lack of funding (April 2012 to March 2013), Handicap International (HI) restarted its Community Based Mine Risk Education (CBMRE) project with teams in eight districts in Kandahar and Helmand provinces. This project identified people with disabilities, including mine/ERW survivors, and provided referrals to physical rehabilitation services (see Physical rehabilitation section below).[30]

Most service providers collected information on the needs of survivors for use in their own programs. All recent assessments were carried out at local or regional levels focusing on specific issues such as physical rehabilitation or accessibility. The last comprehensive disability survey was in 2005.[31]

Victim assistance coordination[32]

MoLSAMD is the focal point for victim assistance and broader disability issues. The MoPH and the MoE are involved in disability services and advocacy activities. The MoPH also coordinates training programs for physiotherapists and healthcare providers.[33] The work of these three key ministries is supported by MACCA technical advisors, who are funded by UNMAS.

The meetings are not very regular and the only real activity in 2013 was publishing the CBR guidelines with the support of MACCA and other partners. Also, the network remains very weak.[34]

In 2013, MACCA’s senior technical coordinator at the MoPH, along with its victim assistance senior technical advisors to MoLSAMD and the MoE, carried out a study of eight victim assistance components in Afghanistan.[35] The outcome was an improved understanding of the scope of problems and challenges with corresponding recommendations. A detailed list of projects to be prioritized for seeking funding was developed based on the study.[36]

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 were not yet managed by the MoPH.[37] 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.[38]

In September 2013, a specific coordination committee for victim assistance was established by MACCA. This victim assistance coordination mechanism aims to enhance the coordination of victim assistance within MACCA, government line ministries (MoPH, MoLSAMD, and MoE), MAPA implementing partners, and other victim assistance stakeholders working in Afghanistan. The VA [Victim Assistance] Coordination Group aims to hold bi-monthly meetings to review implementation of victim assistance and disability activities and to ensure that they are implemented in accordance with the Afghanistan Mine Action Standards for victim assistance and priorities identified by the relevant government ministries. Four VA Coordination Group Meetings were held between September 2013 and May 2014. Through the VA Coordination Group meeting, MACCA and UNMAS also presented the requirements for receiving donor project funding and its balance scorecard monitoring tool designed to systematically measure all mine action activities, as well as its implementing partner selection process.[39]

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. Most victim assistance service providers and actors reported having attended most meetings.[40] The various coordination group meetings included the following:

·         DSCG meetings, led by MoLSAMD and supported by MACCA technical advisors, were held monthly in 2013, and additional meetings were held to address specific disability issues;

·         The Inter-ministerial Taskforce on Disability, chaired by the MoPH-DRD and hosted by MoLSAMD, met twice; meetings addressed coordination among different ministries on the implementation of disability legislation;

·         The Disability and Physical Rehabilitation Taskforce, coordinated by the MoPH, organized four meetings in 2013; the task force finalized the technical and non-technical standards for physiotherapy and orthopedic technologies, organized working group meetings to complete guidelines for health and rehabilitation services for persons with paraplegia, and finalized the EPHS guideline including its translation into local languages;

·         The Inclusive Child Friendly Education-Coordination Working Group (ICFE-CWG), chaired by the MoE, met monthly in 2013 to discuss issues relevant to children with disabilities, particularly inclusive education. An inclusive education policy was drafted, translated into national languages, and shared with MoE for review and approval by its scientific and academic council;[41]

·         The Advocacy Committee for the Rights of Persons with Disabilities (ACPD) under the secretariat of the Afghanistan Independent Human Rights Commission (AIHRC) met on an as-needed basis to promote implementation of the CRPD.

In 2013, the process of developing a draft of the Afghanistan National Policy for Persons with Disabilities continued with a third draft completed by early 2014; this was to be shared once again with government agencies and stakeholders for further feedback. The Afghanistan National Disability Action Plan (ANDAP) 2008–2011 had not been revised; revision of the plan was pending the completion of the disability policy.[42] Guidelines for the constitution of National Disability Rights Commission were also developed. However, these were not yet put into practice by October 2014.[43] The commission would monitor and ensure the protection and promotion of the rights of persons with disabilities while also having the responsibility to monitor the progress of implementation of victim assistance obligations and commitments.[44]

It was reported that, although there was a lot of discussion taking place in the relevant ministries, the impact on the needs of persons with disabilities, including survivors, was limited and few practical effective results were seen.[45]

Afghanistan provided information on progress in and challenges to victim assistance at the Convention on Cluster Munitions intersessional meeting 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 also presented victim assistance developments at the Mine Ban Treaty Thirteenth Meeting of States Parties in 2013 and Third Review Conference in 2014.[46] Afghanistan made extensive use of all sections of its Convention on Cluster Munitions Article 7 report for 2013, using form H to present victim assistance achievements, the overall state of assistance, ministry contacts, and the budget required to further implementation assistance. Afghanistan also included detailed reporting on victim assistance activities in its Mine Ban Treaty Article 7 reporting for 2013.[47]

Survivor inclusion and participation

Mine/ERW survivors and their representative organizations were included in the planning and provision of victim assistance. Persons with disabilities and their representative organizations were included in decision-making and participated in the various coordination bodies. However, it was sometimes reported their views were not fully taken into account.[48]

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.[49] 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.[50]

The ICRC Afghan Physical Rehabilitation Project was managed by persons with disabilities. Through 2013, the rehabilitation project maintained a policy of “positive discrimination,” employing and training only people 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 the survivors in the decision-making process as survivors were fully integrated into its operations. The positive discrimination policy also aimed to demonstrate that people with disabilities are an asset to society, not a burden.[51]

In 2013, HI closely worked with local Shura structures to involve persons with disabilities in community decision making process. Ten persons with disabilities were included as Shura members in Herat province.[52]

Service accessibility and effectiveness

Victim assistance activities[53]

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.[54]

ICRC-supported hospitals treated 2,023 weapon-wounded patients in 2013; some 47% (950) were injured by mines or ERW.[55] About half of the all weapon-wounded patients (over 1,000) in 2013 reached the hospitals in southern Afghanistan through an ICRC-funded transport system, which had a new referral procedure and improved monitoring.[56]

A report by Médecins Sans Frontières (MSF) in February 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 resorting to seeking higher cost private services paid for “out-of pocket” with borrowed money. This in turn resulted in a cycle of debt.[57]

Physical rehabilitation including prosthetics

Physical rehabilitation was not available in all provinces. Rehabilitation centers are concentrated in 12 of the 34 Afghan provinces and patients often are forced to travel long distances to access services. The annual production of mobility devices in the country indicates that the existing centers are insufficient to meet demand. In 2013, physical rehabilitation services were available through a network of 17 centers, seven of which are managed by the ICRC; the others were managed by NGOs, with the exception of two that were managed by the MoPH (in Kabul and Khost, “with negligible impact on the needs”).[58] 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.”[59]

The Essential Package of Hospital Services (EPHS) was reviewed in 2013 and disability and physical rehabilitation were included in the revised EPHS, which was intended to make the rehabilitation services more sustainable. Through the new EPHS, disability and physical rehabilitation are better recognized by the health services providers and personnel.[60]

The ICRC reported that the number of new patients registered for rehabilitation increased by 12% from 7,929 in 2012 to 8,902 in 2013, while the total number of people assisted increased by 18%.[61] Delivery of prostheses in ICRC-supported centers also rose by 7% (to 4,335) in 2013 (61% for mine/ERW survivors).[62] Among the total number of newly registered amputees (1,203) at the ICRC-managed centers, approximately 45% (540) were mine/ERW survivors. However, in Helmand province, the most conflict-affected province in the country, the percentage of survivors was almost 70%.[63] Overall, the geographic coverage was unchanged and the quality of the services remained good. Following intensive training of physiotherapists and orthopedic technicians in Lashkar Gah, Helmand province, the assistance available was extended to persons with impairments and needs who had previously been referred to other centers.[64] Construction of a new rehabilitation center in Faizabad was suspended owing to technical problems.[65]

Geographical coverage improved in Kabul and Parwan provinces as a result of HI providing community-based rehabilitation services through local partners Serving Emergence Relief and Vocation Enterprise (SERVE) and Women Affairs’ Counsel (WAC) in March 2013. In 2013, HI also introduced new rehabilitation services in those provinces in the southern region of Afghanistan, including production of upper limb prosthesis and the construction and development of an advanced gait-training area for patients. Coverage was maintained in Herat and Kandahar province; the number of beneficiaries at HI’s Kandahar physical rehabilitation center increased by some 12% in 2013.[66]

In 2013, HI VA Teams in Kandahar and Helmand provinces identified and referred 354 persons with disabilities, including survivors, to HI’s Physical Rehabilitation Centre in Kandahar and to the ICRC Orthopedic Workshop in Lashkar Gah based on their location and needs. Out of those people with referrals, only about 60% managed to get rehabilitation services while for various reasons, including an inability to pay for transport or the high level of insecurity, the remaining 140 persons with disabilities referred could not access the rehabilitation centers.[67]

Social and economic inclusion and psychological support

In most ICRC rehabilitation centers, sport became a consolidated activity to effectively address physical rehabilitation and social reintegration. Throughout 2013, the ICRC continued to support the development of wheelchair basketball in Afghanistan. Teams existed in Kabul (men and women), Mazar (men and women), Herat, Jalalabad, Kandahar, and Maimana, with approximately 210 players nationally. In 2013, two national tournaments were organized (one for men and one for women) and the Afghan Paralympic Committee selected a national team to apply to attend official international competitions.[68]

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.[69]

A lack of psychosocial support, particularly peer support, has remained one of the largest gaps in the government-coordinated victim assistance and disability programs, though some national and international NGOs provided these services.[70] HI found that psychosocial support services were still almost non-existent.[71] The MoPH trained 200 psychological support counselors who began working in district hospitals. ALSO peer support activities and projects funded by MACCA/UNMAS in 2013 operated in Kabul, Herat, Bamyan, and Balkh to provide support and counseling sessions.[72] Survivor networks and disability NGOs including AABRAR, ALSO, Accessibility Organization for Afghan Disabled (AOAD), CCD, DAO, HI, and SCA, as well as the national skill development programs of MoLSAMD conducted a range of economic inclusion activities including vocational training and skill development.[73]

The MoE inclusive education project, technically and financially supported by UNMAS/MACCA, trained more than 2,500 school teachers in six provinces[74] and provided sign language and braille script teacher training in Kabul.[75]

Accessibility

Physical barriers remained one of the main obstacles to persons with disabilities and survivors accessing and receiving services. The majority of buildings remained inaccessible to persons with disabilities, thereby excluding many from benefitting from education and healthcare.[76]

Disability NGOs continued working on physical accessibility in public facilities, particularly MACCA/UNMAS-funded physical accessibility projects in Kabul, Herat, Helmand, and Kandahar provinces implemented by AOAD to make public buildings and services accessible according to priorities set by the MoLSAMD.[77] AABRAR constructed ramps (accessibility ways) in 17 provinces.[78] ALSO completed the second phase of a physical accessibility project at the Blue Mosque in Balkh Province. However, an ALSO project to make 40 health clinics in Bamyan province accessible, supported by CPI, was suspended due to funding shortages.[79] DAO also worked with partners, building ramps in mosques and schools in Kabul.[80]

Persons with disability interviewed by HI highlighted that accessibility codes were not respected in construction of commercial markets, which impeded their ability to establish their own small businesses in recognized market areas.[81]

Gender

In 2013, women and children were marginalized and were not adequately targeted for the provision of services by the international donor organizations.[82]

HI’s March 2013 needs assessment in Kandahar found that women with disabilities were more marginalized than men with similar impairments.[83] It was found that women with disabilities “lacked awareness about their rights, abilities and opportunities.” Most depended upon family members to sustain their livelihoods.[84] HI also conducted a household disability survey in two districts of Herat province that revealed that almost a quarter of households were headed by a female and that over half of all heads of households were illiterate. As head of household, the rate of unemployment was far higher among women (65%) than male heads of households (22%).[85]

In 2013, the ICRC supported professional skills training of local prosthetic and orthotic technicians and physiotherapists in partnership with the MoPH; a third of the students (6 of 18) were women. More than half of ICRC students (14 of 26) supported for diploma study in physiotherapy were women.[86]

There were also reported to be more organizations implementing age- and gender-sensitive economic inclusion projects in 2013. ALSO provided training in tailoring as home-based work, which enabled women with disabilities to improve their income, in part because they were often prevented from working outside the home or due to physical, attitudinal, and cultural barriers.[87]

Laws and policies

The rights of persons with disabilities were promoted during 2013; however, there still remained much to be done in this regard.[88] The Law on the Rights and Benefits of Persons with Disabilities was amended[89] and published in Official Gazette Number 1099 on 18 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.[90] Other provisions were applicable to all persons with disabilities regardless of the cause of their disabilities.[91]

When the National Disability Law on the Rights and Privileges of Disabled was amended, 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%. The 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).[92]

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.[93] Despite intense lobbying efforts, the ACPD and DSCG did not succeed in pushing the government to develop implementation plans for the CRPD and the Convention on Cluster Munitions. Action plans have not been developed and are delayed compared to what is recommended in the timeframes of those conventions’ instruments.[94] Several disability awareness- and CRPD-training sessions for health staff were held in 2013, including monitoring visits of health facilities, through which the level of awareness and understanding of disability rights increased.[95]

Afghanistan ratified the CRPD on 18 September 2012.