Removing Barriers: The Path towards Inclusive Access - Disability Assessment among Syrian Refugees in Jordan and Lebanon (Jordan Report July 2018)

EXECUTIVE SUMMARY

Objectives

Concerning the lack of disability data in the Syria crisis context, Humanity & Inclusion (HI) and iMMAP conducted the study aimed at the following:

1.Provide statistically reliable prevalence of disability as well as disability disaggregated data indicators on access to services.

2.Increase understanding of the situation of Syrian refugees with disabilities and their households, compared to their peers without disabilities, in relation to the access to services including education, and key barriers experienced in accessing these services.

3.Recommend inclusive actions to be prioritized by humanitarian actors.

Methods

The study conducted a literature review, quantitative data collection as well as qualitative data collection.

Quantitative data was collected from 6,381 persons of randomly sampled 1,159 households in Azraq and Zaatari camps and Irbid between October 2017 and January 2018. In the light of the UN Convention on the Rights of Persons with Disabilities (UNCRPD), the study defined disability as interactions between personal and environmental factors. Disability was measured the level of difficulties a person faces when performing basic activities (referred as “domains”) regardless of impairments, using the modified Washington Group’s Extended Set (WG-ES) (more precisely, Short Set Enhanced plus fatigue) and Child Functioning Module (CFM).

Twenty-five Key Informant Interviews (KIIs) and 3 Focus Group Discussions (FGDs) were also conducted between November 2017 and January 2018 to elicit deeper insights on the educational situation of children with and without disabilities.

Findings

Prevalence of Disability

• 22.9% of surveyed Syrian refugees aged 2 years and above had disabilities (1,374 persons out of 6,003 persons): 13.8% in Azraq camp, 23.5% in Irbid and 30.5% in Zaatari camp. Understanding disability as the level of difficulties a person is facing when performing basic activities that could put him/her at risk of not participating in society, the prevalence of disability found by the study was markedly higher than the existing disability statistics at around 2-3% to less than 10%, many of which used questions focusing on a person’s medical conditions or impairments.

• The study further found that 62% of sampled households included at least one member with disabilities. This finding requires humanitarian actors to examine the impact of disability on households and consider the needs to promote appropriate parenting skills and support programs for families.

Causes of Disability

• 29.9% of persons with disabilities reported illness or disease as the primary cause of functional difficulties.

• Among persons who reported illness/disease, injury and malnutrition as causes of their disabilities, 24.7% considered the causes were related to the Syrian conflict. Among them, walking was the most common activity with which they faced difficulties, followed by anxiety, depression, fatigue and seeing.

• More females (34.6%) than males (24.7%) had disabilities related to illness or disease. Injuries, on the other hand, led to more males having a disability (14.7%) than females (7.1%). This suggests males’ higher exposure to risks of injuries in conflicts.

Disability Domains

• The most frequently experienced functional difficulties by adults aged 18 years and above were walking (14.4%), anxiety (11.4%) and fatigue (10.9%). Children aged 5-17 years faced difficulties related to anxiety (9.7%) and depression (5.9%), while children aged 2-4 years experienced difficulties related to communication (2.8%) and controlling behaviors (1.5%).

• The fact that anxiety and depression are the most common domains for persons aged 5 years and above may be surprising because often, disability data collection is associated with physical, hearing, seeing and intellectual impairments and rarely with mental health and psychosocial issues (anxiety and depression) or fatigue. A range of stress experienced by Syrian refugees, if not addressed timely and appropriately, could develop to critical conditions, and then to disability. It is particularly worrying that, among children aged 5-17, 9.7% exhibit daily anxiety and 5.9% show depression or sadness on a daily basis.
This data suggests the strong need for humanitarian actors to focus on Mental Health and Psychosocial Support (MHPSS), with careful attention to the young generation.

• Zaatari: Mental health issues were particularly prevalent in Zaatari camp. 19.9% of children aged 5-17 in Zaatari experience anxiety daily, higher than corresponding rates in Irbid (7.6%) and Azraq (2.3%).
Among adults aged 18+, anxiety was the leading domain affecting 15.0% of its populations in Zaatari, while the most cited difficulty was walking in Azraq and Irbid. This may be related to the nature of Zaatari camp, being established 7 years ago while Azraq is newer, opened in 2014. The relationship between the number of years refugees live in a camp setting and its impact on people’s mental well-being needs to be investigated.

Children’s Disability by Household

Income Level

• Poorer households are more likely to have children with disabilities (2-17) than households within higher income brackets. Around 80% of children with disabilities in at least one domain reside within households with a monthly income of 199 JOD or less.
This suggests a strong relationship between poverty and disability.

Assistive Devices

• Persons with disabilities continue experiencing functional difficulties despite assistive devices. 22.6% of those who use glasses, 19.0% of those who use hearing aids and 71.0% of those who use mobility aids still experience significant difficulties seeing, hearing and walking. The issues could be related to inappropriate fitting of assistive devices at the beginning and lack of longer term support in terms of regular maintenance and repair. Often, projects were only able to distribute the initial device, and not able to cover costs related to repair or maintenance when the devices were damaged or outgrown afterwards.

• By location, percentage of persons aged 18+ who have difficulties walking even with mobility aids is particularly high in Zaatari (80.4%) compared to 74.5% in Irbid and 67.5% in Azraq. There is a need to assess the physical accessibility in Zaatari as well as the capacity of established networks of service providers to deliver proper fitting and maintenance