Other resources developed in the project include:
Approximately 15 per cent of any community may be persons with disabilities. 1 There may be even higher rates of disability in communities affected by crisis or conflict, 2 as people acquire new impairments from injuries and/or have reduced access to health care. In Lebanon, it is estimated that 900,000 persons are living with disabilities. 3 Persons with disabilities are one of the most vulnerable and socially excluded groups in any crisis-affected community. They may be in hidden in homes, overlooked during needs assessments and not consulted in the design of programs. 4 While gender-based violence (GBV) affects women, girls, men and boys, the vast majority of survivors globally are women and girls. 5 Persons with disabilities have difficulty accessing GBV programs, due to a variety of societal, environmental and communication barriers, increasing their risk of violence, abuse and exploitation. 6
The Lebanon Crisis Response Plan (LCRP) 2017 – 2020 recognizes that children with disabilities are at a higher risk of violence, abuse and exploitation, both inside the home and in the wider community, with women and girls with disabilities being among the most vulnerable to GBV. Both the LCRP and the Ministry of Social Affairs National Plan to Safeguard Children and Women in Lebanon 2014 – 2015 highlight commitments to strengthening national protection, child protection (CP) and GBV systems ensuring that women, girls and boys at risk and survivors of violence, exploitation and abuse have access to improved and equitable prevention and response services. 7 8
Despite these increased risks, women, children and youth with disabilities report a lack of information and awareness on GBV-related activities and how to access case management services, due to both physical and attitudinal barriers to accessing such services. 10
6The definition of disability continues to evolve over time. It is important to remember that persons with disabilities are not a homogenous group; they have different capacities and needs and contribute in different ways to their communities. 11
7The national Lebanese Law 220/2000 defines a person with a disability as “a person whose capacity to perform one or more vital functions, independently secure his personal existential needs, participate in social activities on an equal basis with others, and live a personal life that is normal by existing social standards, is reduced or non-existent because of partial or complete, permanent or temporary, bodily, sensory or intellectual functional loss or incapacity, that is the outcome of a congenital or acquired illness or from a pathological condition that has been prolonged beyond normal medical expectations.” 12
Article 1 of the UN Convention on the Rights of Persons with Disabilities (CRPD) states:
“Persons with disabilities include those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others.” 13
An impairment is a problem in the body's structure or function. 14 Impairments may be physical, intellectual, psychosocial and sensory.
Previous needs assessments in Lebanon have highlighted that family members, communities and service providers often view persons with disabilities through medical or charitable models, failing to recognize social factors, such as age and gender, that may increase their vulnerability to gender-based violence, requiring inclusion in prevention and empowerment efforts, and / or referral to case management agencies for appropriate follow-up. 16
The move towards a rights-based approach for working with persons with disabilities has gained significant international momentum over the past decade with adoption of the United Nations Convention of the Rights of Persons with Disabilities (CRPD). Persons with disabilities have a right to protection in situations of risk or in humanitarian crisis and should be able to both access services and participate in GBV programs and activities on an equal basis with others. 17 Persons with disabilities have a long history of discrimination and disempowerment by family members, caregivers, partners, and even service providers. GBV actors can play a central role in supporting women, children and youth with disabilities to make their own decisions and addressing the barriers they experience in their relationships, households and communities. GBV actors must use a rights-based approach when working with persons with disabilities, ensuring women, children and youth, with or without disabilities, have the same access to their programs, services and support.
9All interventions aimed at preventing and responding to GBV are guided by the principles of safety, confidentiality, respect, and non-discrimination – also known as the survivor-centered approach. These principles help to promote the survivor's recovery, strengthening their ability to identify and express their needs and wishes, and reinforcing their capacity to make decisions about possible interventions. 21 Case Workers must ensure these guiding principles are implemented when working with survivors with disabilities.
Some persons with disabilities may require assistance to communicate effectively with case workers. The decision about who to involve and when should be made in partnership with the survivor and include an analysis of risks to the survivor's safety if they choose to involve another person. Case workers should be aware that caregivers of persons with disabilities may also be perpetrators of violence. Case workers should discuss with the survivor their relationships with family members and both primary and secondary caregivers – this will help to identify appropriate risk mitigation strategies 13 where a caregiver is a perpetrator, as well as protective relationships that may support the survivor's recovery.
Any support persons engaged in the case management process, family members, caregivers and/or sign language interpreters, should be briefed on the principles of confidentiality. The case worker should also provide appropriate caregivers and family members with information about how to be supportive of the 14 healing process (e.g., by maintaining confidentiality; by not judging or blaming the survivor; and by not pushing them to take a particular action or service). Participatory activities may also be useful to assist persons with intellectual disabilities to better understand the principles of confidentiality; decide who they may and may not want to share information with; and to explore different strategies or ways to respond to questions from others.
Describing confidentiality to persons with intellectual disabilities
The guiding principle of non-discrimination means that case workers provide the same quality and range of service options to every survivor. It is important to present all available options to survivors with disabilities, even if it is not yet clear are how they will participate in these activities. Present all the options in a way that the survivor will understand. Be prepared to try several different ways of communicating these options (e.g., if there is an English class in your women's center, support the survivor to visit the class to show them what it involves). Give the survivor time to think about these 15 options and to ask questions. If the survivor expresses interest in a particular service or activity, then discuss together the potential barriers and strategies to address these.
“Informed consent” is when permission is granted with full knowledge of the possible consequences, risks, and benefits, and choice is free and voluntary. The CRPD highlights that adults with disabilities have the same rights as everyone else to make their own decisions, and that where appropriate measures must be taken to support them to make their own decisions. 24 An adult cannot lose their legal capacity to make their own decisions because they have a disability. 25
The informed consent process has three key components:
A Note About Children with Disabilities: In accordance with the Inter-Agency Standard Operating Procedures (SOPs) for SGBV Prevention and Response in Lebanon, children with disabilities above 15 years of age are able to participate in the informed consent process as individuals. However, their parent or a trusted adult should be included with the child's permission, unless they are involved in the abuse. Children under 15 years of age can participate in an informed assent process, but require the permission of a non-perpetrating parent or caregiver as well. 27 For additional information, please see the Standard Operating Procedures for the Protection of Juveniles in Lebanon (and the annexed guidance on working with children with disabilities).
When involving others in the informed consent and decision-making process, remember:
It is paramount that case workers always focus on the survivor.The survivor is the individual seeking services and all actions should be guided by their will and preferences. The interests of family members and caregivers may or may not be linked to the will and preferences of the survivor. For example, caregivers may want to pursue justice options. If the survivor does not understand the legal processes involved, then it is unlikely to promote healing and recovery, and may even expose them to further emotional harm, as they will have to recount their experiences to others. If the referral is not in the interest of the survivor, the case worker should not proceed, even if requested by caregivers. It is essential that the case worker explain to caregivers the importance of respecting the survivor's wishes, and any possible harm that could be caused to the survivor by certain actions. Exploring the reasons why caregivers think certain actions are in the best interest of the survivor can help to come to decisions that respect the needs and interests of the individual, and identify support that caregivers may require for themselves. 32
It is also important to maintain confidentialitywhen working with survivors with disabilities. If the survivor discloses information that they do not wish to be shared with their caregiver, the case worker 20 must respect and maintain the survivor's confidentiality and not share information with the caregiver. When sharing information, always think about why the caregiver needs that information and only share what is necessary to facilitate support for the survivor. For example, you may do a joint session with a survivor and their caregiver to review a case action plan, because it requires the caregiver or family member's action. In that case, they only need to know what is relevant for facilitating that part of the survivor's care. 33
6.3 Identifying and responding to caregiver needs 35
Caregivers are also exposed to the threat and reality of GBV, and case workers have to pay attention to their safety concerns and their opportunities to have more control over their lives. Caregivers are most often women and adolescent girls, meaning they already experience disadvantage within the household and community, and are likely over-burdened with domestic responsibilities, including the care of children and the elderly, and household chores. Caregiving can be a very isolating experience, and more so for women who are already less likely to have access to opportunities outside the home. This is also 21 an opportunity to talk about female caregivers’ own exposure to and risk of violence, including violence from the people they care for or domestic violence, and work with them to plan for safety and access to services.
As emphasized in other sections of this guidance, case workers should follow all standard operating procedures for case management when working with survivors with disabilities, including when identifying safety concerns and developing safety plans. Survivors with disabilities may have specific 25 safety concerns to take into consideration when developing safety plans with them. Safety plans for survivors with disabilities must be highly individualized and should take into account the following:
In most cases, persons with disabilities can communicate directly with staff with no adaptions, or relatively small adaptions. In other cases, it may be more difficult to determine the best way to communicate with the individual, and additional steps may be required. It is important when working with persons with disabilities that you take time to watch and listen. Each time you meet the person you will learn something new about them and understand better how they communicate and what they mean. 41
Below are some tips for frontline workers on ways to adapt verbal and non-verbal communication when interacting with persons with disabilities. 42
Different language is used in different contexts to describe disability and to refer to persons with disabilities. Some words and terms may carry negative, disrespectful or discriminatory connotations and should be avoided in our communications. The Convention on the Rights of Persons with Disabilitiesis translated into many languages, including Arabic, and can be a useful guide to correct interpretation of different disability terms. 43
29The table below also has some suggestions on tips for ensuring respectful language:
AVOID…. | CONSIDER USING….. |
30 | |
Referring to other people as “normal” or “healthy” | Try using “persons without disabilities” |
In cases that involve persons with complex disabilities, it may be necessary for supervisors to provide ad hoc support to the case workers during the initial phases of the case management process – in addition to regular weekly supervision meetings. During both individual and peer supervision sessions, supervisors should provide ongoing opportunities for staff to reflect on their personal values, beliefs and behaviors and how these impact on their work with survivors with disabilities. Ensure standard group supervision sizes – no more than 6-7 case workers per group – so that there is ample time for peer 32 exchanges and learning. Encouraging case presentations relating to survivors with disabilities in peer supervision will provide opportunity for case workers to share ideas and strategies with each other.
Below are sample guiding questions that could be used in supervision with case workers:
1 World Health Organization & World Bank (2011) World Report on Disability. http://www.who.int/disabilities/world_report/2011/en/
2 Handicap International & HelpAge International (2014) Hidden Victims of the Syrian Crisis: Disabled, Injured and Older Refugees. http://d3n8a8pro7vhmx.cloudfront.net/handicapinternational/pages/454/attachments/original/1397045203/Hidden_Victims_of_the_Syrian_Crisis—disabled__injured_and_older_refugees.pdf?1397045203
3 This estimate is determined using a global estimate that 15% of any population will be persons with disabilities (WHO & World Bank, 2011), and that the population of Lebanon is approximately 6 million people (World Bank, 2016, https://data.worldbank.org/indicator/SP.POP.TOTL?locations=LB).
4 Women's Refugee Commission (2014) Disability inclusion: Translating policy into practice in humanitarian action. http://wrc.ms/disability-inclusion-translating-policy-into-practice
5 International Rescue Committee (2014) GBV emergency response and preparedness: Participant handbook, page 7. http://gbvresponders.org/wp-content/uploads/2014/04/GBV-ERP-Participant-Handbook-REVISED.pdf
6 Women's Refugee Commission & International Rescue Committee (2015) “I see that it is possible”: Building capacity for disability inclusion in gender-based violence programming in humanitarian settings. http://wrc.ms/i-see-that-it-is-possible
7 Government of Lebanon & the United Nations (2017) Lebanon Crisis Response Plan 2017-2020. http://www.3rpsyriacrisis.org/wp-content/uploads/2017/01/Lebanon-Crisis-Response-Plan-2017-2020.pdf
8 Building Resilience and Development Programme: The MoSA National Plan to Safeguard Children and Women in Lebanon 2014-2015.
9 Women's Refugee Commission & UNICEF (2017) Disability Inclusion in Child Protection and Gender-Based Violence Programs. Training Needs Assessment Report: Gender-Based Violence (GBV) Programs, November 2017.
10 Women's Refugee Commission & UNICEF (2017) Disability Inclusion in Child Protection and Gender-Based Violence Programs. Training Needs Assessment Report: Gender-Based Violence (GBV) Programs, November 2017.
11 UNHCR. (2011). Working with persons with disabilities in forced displacement. http://www.unhcr.org/publications/manuals/4ec3c81c9/working-persons-disabilities-forced-displacement.html
12 UNESCO (2013) Social Inclusion of Young Persons with Disabilities (PWD) in Lebanon. http://www.unesco.org/new/fileadmin/MULTIMEDIA/FIELD/Beirut/images/SHS/Social_Inclusion_Young_Persons_with_Disabilities_Lebanon.pdf
13 The United Nations (2006) Convention on the Rights of Persons with Disabilities. https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html
14 World Health Organization (n.d.) Health Topic: Disabilities. http://www.who.int/topics/disabilities/en/
15 Interagency Gender-Based Violence Case Management Guidelines: Providing Care and Case Management Services to Gender-Based Violence Survivors in Humanitarian Settings. (2017) https://reliefweb.int/sites/reliefweb.int/files/resources/interagency-gbv-case-management-guidelines_final_2017_low-res.pdf
16 Women's Refugee Commission (2013). Disability Inclusion in the Syrian Refugee Response in Lebanon. http://wrc.ms/disability-inclusion-syrian-refugees
17 The United Nations (2006) Convention on the Rights of Persons with Disabilities. https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html
18 World Health Organization & World Bank (2011) World Report on Disability. http://www.who.int/disabilities/world_report/2011/en/
19 The United Nations (2006) Convention on the Rights of Persons with Disabilities. https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html
20 World Health Organization & World Bank (2011) World Report on Disability. http://www.who.int/disabilities/world_report/2011/en/
22 Interagency Gender-Based Violence Case Management Guidelines: Providing Care and Case Management Services to Gender-Based Violence Survivors in Humanitarian Settings. (2017) https://reliefweb.int/sites/reliefweb.int/files/resources/interagency-gbv-case-management-guidelines_final_2017_low-res.pdf
23 Interagency Gender-Based Violence Case Management Guidelines: Providing Care and Case Management Services to Gender-Based Violence Survivors in Humanitarian Settings. (2017) https://reliefweb.int/sites/reliefweb.int/files/resources/interagency-gbv-case-management-guidelines_final_2017_low-res.pdf
24 The United Nations (2006) Convention on the Rights of Persons with Disabilities. https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html
25 The United Nations (2014) Convention on the Rights of Persons with Disabilities General Comment 1. Article 12: Equal recognition before the law. https://documents-dds-ny.un.org/doc/UNDOC/GEN/G14/031/20/PDF/G1403120.pdf?OpenElement
26 Adapted from: Consent and people with intellectual disabilities: The basics. http://www.intellectualdisability.info/how-to../consent-and-people-with-intellectual-disabilities-the-basics
27 Inter-Agency Standard Operating Procedures (SOPs) for SGBV Prevention and Response in Lebanon (2014).
28 Adapted from: Consent and people with intellectual disabilities: The basics. http://www.intellectualdisability.info/how-to-guides/articles/consent-and-people-with-intellectual-disabilities-the-basics. WRC & IRC (2015) Tool 9: Guidance for GBV Service Providers: Informed Consent Process with Adult Survivors with Disabilities. https://www.womensrefugeecommission.org/component/zdocs/document/download/1161
29 Women's Refugee Commission & International Rescue Committee (2015) Building Capacity for Disability Inclusion in GBV Programming in Humanitarian Settings: A Toolkit for GBV Practitioners. http://wrc.ms/iseethatitispossible-gbv-toolkit
30 Consent and people with intellectual disabilities: The basics. http://www.intellectualdisability.info/how-to../consent-and-people-with-intellectual-disabilities-the-basics
31 The United Nations (2006) Convention on the Rights of Persons with Disabilities. https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html
32 Women's Refugee Commission & International Rescue Committee (2015) Building Capacity for Disability Inclusion in GBV Programming in Humanitarian Settings: A Toolkit for GBV Practitioners http://wrc.ms/iseethatitispossible-gbv-toolkit
33 Interagency Gender-Based Violence Case Management Guidelines: Providing Care and Case Management Services to Gender-Based Violence Survivors in Humanitarian Settings. (2017) https://reliefweb.int/sites/reliefweb.int/files/resources/interagency-gbv-case-management-guidelines_final_2017_low-res.pdf
34 Women's Refugee Commission & International Rescue Committee (2015) Building Capacity for Disability Inclusion in GBV Programming in Humanitarian Settings: A Toolkit for GBV Practitioners http://wrc.ms/iseethatitispossible-gbv-toolkit
35 Women's Refugee Commission & International Rescue Committee (2015) Building Capacity for Disability Inclusion in GBV Programming in Humanitarian Settings: A Toolkit for GBV Practitioners http://wrc.ms/iseethatitispossible-gbv-toolkit
36 Women's Refugee Commission & International Rescue Committee (2015) “I see that it is possible”: Building capacity for disability inclusion in gender-based violence programming in humanitarian settings. http://wrc.ms/i-see-that-it-is-possible
37 Wisconsin Coalition Against Domestic Violence (n.d.) Power and Control Wheel: Persons with Disabilities and their Caregivers. http://www.springtideresources.org/sites/all/files/People_with_Disabilties_and_Caregivers_Wheel.pdf
38 Women's Refugee Commission & International Rescue Committee (2015) “I see that it is possible”: Building capacity for disability inclusion in gender-based violence programming in humanitarian settings. http://wrc.ms/i-see-that-it-is-possible
39 Women's Refugee Commission & International Rescue Committee (2015) Building Capacity for Disability Inclusion in GBV Programming in Humanitarian Settings: A Toolkit for GBV Practitioners http://wrc.ms/iseethatitispossible-gbv-toolkit
40 Interagency Gender-Based Violence Case Management Guidelines: Providing Care and Case Management Services to Gender-Based Violence Survivors in Humanitarian Settings. (2017) https://reliefweb.int/sites/reliefweb.int/files/resources/interagency-gbv-case-management-guidelines_final_2017_low-res.pdf
41 Women's Refugee Commission & International Rescue Committee (2015) Building Capacity for Disability Inclusion in GBV Programming in Humanitarian Settings: A Toolkit for GBV Practitioners. http://wrc.ms/iseethatitispossible-gbv-toolkit