Bulletin of the World Health Organization

Disabled often among the ‘poorest of poor’


In reality, for a person in a wheelchair even leaving the house often proves a daunting task, as most older buildings in Russian cities and towns either have no lift or their lifts are too narrow for a wheelchair.

In a recent case that ended in court, activists had to mount a full-scale legal battle to secure permission for a five-year-old girl with Down syndrome in a town near Moscow to be accepted into a nursery.

According to official figures, of some 650 000 disabled children in the Russian Federation only about 185 000 receive general or special education. Over 70% of disabled children in the country receive little or no formal education.

The situation is similar in most low and middle-income countries. To address the lack of services for the disabled, the United Nations has launched an offensive to galvanize governments and grass roots into action.

In 1993, the General Assembly adopted the UN Standard Rules on the Equalization of Opportunities for Persons with Disabilities. The rules, written from a human rights perspective, offer guidelines on how countries can create more equitable conditions for people with disabilities. Although not compulsory, they implied that states should take a strong moral and political commitment to take action.

“The rules have contributed enormously to the development of legislation and to the confirmation and strengthening of disabled people’s organizations (DPOs),” Dr Federico Montero, Disability and Rehabilitation Coordinator with WHO in Geneva, told the Bulletin. “These elements have also played a key role in promoting and improving participation and inclusion of persons with disabilities in many societal activities.”

Number one on the rules list is raising awareness. Last February the campaign received a surprise high-profile boost when the US Academy awarded its Oscar for the best foreign film to The Sea Inside, the story of a quadriplegic Spanish activist fighting for the right to die after 30 years of immobility.

The film’s success is certain to bring the disability issue to the forefront of public debate. That debate may in turn help the United Nations implement its second key strategy for promoting the rights of the disabled, community-based rehabilitation (CBR).

At the heart of CBR lies the notion that disabled people should achieve their rights within rather than outside their communities and societies.

Over the years CBR has evolved from a medical model to a more holistic one, putting a major emphasis on human rights and inclusion. Though much work still needs to be done to ensure CBR’s success, studies so far indicate that it has already had a positive impact on the lives of those involved.

CBR programmes have helped people with disabilities to become more visible and shown that they can contribute to family and community life. They have also had a positive impact on the self-reliance of many children and adults with disabilities, especially through training in daily living skills.

As one CBR programme participant in Africa said: “Previously, I felt very inferior but after I joined the CBR programme … I have been able to overcome that feeling … I can now assess myself with others and say that I can perform certain activities and tasks better than the able-bodied.”

Andrei Shukshin, Moscow

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