New report highlights critical lack of rehabilitation services in conflict zones

• Globally, one in three people are living with health conditions that might benefit from rehabilitation. The needs are increasing year on year due to an ageing population and the growing prevalence of chronic, non-communicable diseases, injuries and traumas.
• Rehabilitation has long been overlooked in countries’ health systems. Without appropriate treatment following an illness or injury, many people develop disabilities that could have been prevented with access to rehabilitation. 
• In particular, in conflict affected areas, rehabilitation needs are largely unmet: more than 50% of people who need rehabilitation services cannot access them and, in some countries, the access to assistive technology is as low as 3%.
• One year on from the World Health Assembly resolution calling on states to strengthen rehabilitation services, access is still severely limited, especially in low-income and conflict-affected countries.
• Humanity & Inclusion, a charity supporting disabled and vulnerable people worldwide, has released a new report highlighting the problem and calling on states to turn their commitments into action.

At the end of May 2023, Member States of the World Health Organisation adopted the first-ever resolution to strengthen rehabilitation in health systems. One year later, a new report by Humanity & Inclusion (HI) illustrates the urgent need to turn commitments into action so that people in conflict affected regions can access the rehabilitation care they desperately need. 

Access to rehabilitation services is a global problem 

Globally, one in three people are living with health conditions that might benefit from rehabilitation. This number has increased by 63% from 1990 to 2019 and will continue increasing in the years to come due to an ageing population and the growing prevalence of chronic, non-communicable diseases, injuries and traumas.

While rehabilitation and assistive technology needs are enormous, they remain largely unmet, especially in low- and middle-income countries, and conflict-affected areas. More than 50% of people who need rehabilitation services cannot access them and, in some countries, the access to assistive technology is as low as 3%.

Rehabilitation services are vital

Strengthening rehabilitation services is essential in all contexts, even more so in conflict-affected ones, with a view to responding to the rehabilitation needs of people with both pre-existing and newly-acquired disabilities, including victims of explosive weapons and ordnance. 

This is why the World Health Assembly resolution, “Strengthening rehabilitation in health systems”, adopted in May 2023, calls on Member States to ensure timely integration of rehabilitation into emergency preparedness and response, including in emergency medical teams.

Early rehabilitation care prevents or reduces complications, speeds up hospital discharge, promotes long-term recovery, and facilitates independent living. Rehabilitation and assistive technology have been proven to reduce health complications, and foster people’s autonomy, participation in society, and economic productivity.

Access to rehabilitation and assistive technology also increase the access to education, social engagement, and work activities. The return on investment is significant: for every dollar invested in assistive devices, there is a return of nine dollars.

Valentina Pomatto, Inclusive Development Advocacy Manager at HI, says:
“Rehabilitation has long been overlooked in countries’ health systems. After an illness or an accident, some people develop a disability that could have been prevented with the help of rehabilitation. 
“Others see their mobility deteriorate without the right orthotic or prosthetic devices and in the absence of physical therapy that could have had a positive impact on their social and professional inclusion. 
“We know that nothing can change unless there is political will, a strong commitment to make things happen. The resolution at the 2023 World Health Assembly fixes this commitment into words and holds those in charge of delivering on this commitment accountable. Now these words need to be turned into actions” 

Huge rehabilitation needs in conflict affected regions

We know that conflicts cause surges in injuries and critical illnesses, thus increasing rehabilitation needs. In particular, explosive ordnance and weapons of all types remain a significant threat and continue to cause indiscriminate harm not only during attacks but also for many years after their use.

In 2022, at least 4,710 casualties of mines and explosive remnants of war were recorded, of which 3,015 people were injured. Civilians made up 85% of all recorded casualties, and children accounted for at least half of them. 
The same year, explosive weapons use was responsible for 31,273 casualties, of whom 17,038 were injured with a potential need for long-term assistance. Some 66% of these casualties were civilians. This percentage rises to 90% when explosive weapons are used in populated areas. 

Civilians like Shaha, 9, who lives in the rural area of Rajam Hadid in Iraq. When she was three years old, she lost part of her family and was injured by an explosive weapon while fleeing her village.  Shaha had severe burns on her hand and shoulder, along with jaw and eye injuries caused by shrapnel. Shaha has already undergone five jaw and three eye surgeries. She now has prosthetic eye lenses and wears glasses. She had difficulty in moving her right hand, but thanks to physiotherapy she is now able to move her hand and fingers. As Shaha gets older, she will need additional physiotherapy sessions to maintain good mobility in her hand.

Limited access to rehabilitation in conflict affected areas

The availability, affordability, accessibility and quality of rehabilitation services and assistive technology are further jeopardised in conflict-affected areas. 

The key obstacles facing people who seek rehabilitation and assistive technology, during and after conflicts, include the increased vulnerability of already fragile health systems, significantly disrupted services (including power and water outages), damaged infrastructure, shortage of health and rehabilitation professionals and equipment, and widespread unsafety. At the individual level, other obstacles may include displacement, situations of exclusion and abuse (including those caused by separation from carers), loss of income, lack of accessible information on services available and distance from rehabilitation services. 

The report highlights the story of Gloria in Colombia and her son Sebastian, who has Down's syndrome and multiple health complications. They fled violence in their villag. In the city where they now live, Sebastian has received rehabilitation services, but he cannot get the physiotherapy sessions he needs because of long waiting lists.

More needs to be done to ensure no one is left behind 

The existing policy frameworks should guide consistent and robust efforts and define accountability. However, these commitments have yet to be fully translated into action. Too many people are bearing the physical, social, and mental consequences of conflicts; too many of them are struggling to access the services they need, including rehabilitation, achieve their potential, participate in society and live full lives.
 

Notes

Link to the report: https://www.humanity-inclusion.org.uk/sn_uploads/document/HI-Rehabilititation-Matters-ENG-2024-UK_6.pdf 

Spokespersons: Valentina Pomatto, Inclusive Development Advocacy Manager at global disability charity NGO Humanity & Inclusion

HD photos and case studies from the report available upon request
The report sheds light on the often-forgotten people who struggle to access the services and care they need and to exercise their rights. It presents data and facts as well as the stories of seven people with lived experiences of accessing rehabilitation and assistive technology in conflict-affected areas in Colombia, Iraq and Lao PDR. They are children, women and men, of different ages and with different profiles: victims of explosive weapons or ordnance, internally displaced persons, persons with disabilities and caregivers.