Prosthetic and Orthotic Services for Disabled Palestinian Refugees in Lebanon

Project to Improve the Quality of the Prosthetic and Orthotic Services for Disabled Palestinian Refugees in Lebanon. Start: July 2006. Duration: 2 years. Sponsor: DFID/ CSCF. Project Development: IAC

The 405,000 Palestinian refugees in Lebanon face specific problems. They do not have social and civil rights, and have very limited access to the government's public health or educational facilities and no access to public social services. The majority rely entirely on the United Nations Relief and Works Agency for Palestinian Refugees in the Near East (UNRWA), supported by local and international NGOs, to provide education, health, relief and social services. All 12 official refugee camps suffer from serious problems - living conditions are characterized by high population densities and inadequate basic infrastructure, with open sewers, limited supplies of clean water and unsatisfactory drainage systems which make flooding commonplace in the often harsh winters. In addition, the years of conflict and hostilities, and the feeling of an insecure future all affect the health of the refugees.

High rates of congenital abnormality, trauma, vascular disease, and the complications of diabetes mellitus, all increase the prevalence and incidence of disability requiring prosthetic (artificial limbs) and orthotic (foot, leg and spinal supports) services. However, our survey of these services in early 2005 (visit our archive section) revealed: poor coordination; little access to rehabilitative services or planned follow-up; no programme of in-service training or continuing professional development for orthopaedic technicians (who make and maintain the prostheses and orthoses); no central register of the disabled to facilitate follow-up; no user involvement in the delivery of care; no form of quality control; and consequently poor uptake of services, poor compliance and poor outcomes for the disabled.

Our place of work is within the 12 Palestinian refugee camps distributed throughout the country. The immediate beneficiaries are the estimated 600 disabled Palestinian refugees in Lebanon (300 amputees and 300 others with disabilities) currently requiring prosthetic and orthotic services, together with the 120 new beneficiaries arising each year. Many of these beneficiaries are adult males supporting families, so if their quality of life and productivity are improved their families (an estimated 3,000 people) will also benefit. In all families with a disabled member, others sacrifice earnings, education and even marriage in order to provide continued support. The improved skill base and coordination of technicians, surgeons and rehabilitative staff within the camps will benefit others with disabilities.

RI a wealth of world-wide experience in the health and landmine action (including the rehabilitation of those disabled by landmines), we have eleven, continuous years of experience working in Lebanon, in conjunction with the Lebanese Ministry of Public Health and local communities. In the past five years we have successfully delivered a series of water/sanitation and health infrastructure projects within Palestinian refugee camps, in conjunction with the United Nations Relief and Works Agency for Palestinian Refugees in the Near East (UNRWA) and local NGOs. We work with a wide network of service providers and humanitarian agencies to share good practice, foster cooperation and coordination, and advocate for the wider rights of Palestinian refugees.

Human Rights Implications for the Project
The Universal Declaration of Human Rights was adopted by the General Assembly of the UN in 1948. Of the 30 Articles the following are perhaps the most relevant to this project:

Article 19. Everyone has the right to freedom of opinion and expression; this right includes freedom to hold opinions without interference and to seek, receive and impart information and ideas through any media and regardless of frontiers. This Article is usually applied to freedoms of the press. However, it is also relevant to such freedoms that may be enjoyed by interest and service user groups in expressing opinions or lobbying authorities for the improvement in services.

Article 25. (1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control. This Article protects the human rights of all to equity of access to medical and social services.

Article 27. (1) Everyone has the right freely to participate in the cultural life of the community, to enjoy the arts and to share in scientific advancement and its benefits. Unfortunately, disabled Palestinian refugees have not enjoyed equitable access to the new prosthetic/ orthotic technology widely available elsewhere in the world.

The World Health Organisation (WHO) International Conference on Primary Health Care which met at Alma-Ata, USSR, 6-12 September 1978, also published a Declaration that clearly identified the rights of all people to have access to high quality primary health care and to be involved in the planning and delivery of their health care.

As the Palestinian refugees have no rights under Lebanese law, these international Declarations badly need to be applied to this vulnerable population. This project begins to address all of the above. An in-country network of agencies working with disabled Palestinians will be established, and links will be formed with the global projects supported by the ICRC Physical Rehabilitation Programme, and with the Palestine Platform (an international NGO network advocating for the rights of Palestinian refugees, of which we are a member). These links will provide avenues for the promotion of refugee access to health and social support services as a basic human right.