The Disabled Survivors of Disasters: A Proposed

Model for Capability Enhancement and

Empowerment for Risk Reduction

Dr. Subhasis Bhadra

Associate Professor and Head,
Department of Social Work,
Central University of Rajasthan, Bandarsindri,
NH-8, (Jaipur-Ajmer highway), Kishangarh
District:- Ajmer, Rajasthan, (India). PIN-305817

11th and 12th July 2019

Disability Inclusive Disaster Risk Management in India
Institute of Seismological Research, Gandhinagar, Gujarat
 Focus of this presentation:
• Medical and social model of practice
• Understanding Disability in context of Disaster
• National and International Guidelines on Disability in
Disaster:
• Findings and Supportive Review:
• Empowerment and Capability Enhancement Approach
• Model for Facilitating Holistic Rehabilitation
• Conclusion
Disability for social work Practice:
– The social model of disability: barriers in the society
that limits the opportunities for a person with disability
– Medical Model of disability: problem concentrated
with the person who needs multiple care

Carson Grant (2009), The Social Model of disability, Scottish Accessible

information forum
 The disasters in India and Disability is
invariably an issue of concern
Kashmir Earthquake Indian Ocean Tsunami (2004)
Gujarat Earthquake (2001)
(2005)

Mumbai Train
Gujarat Riots (2002) Uttarakhand (2013) Blast(2006)
- Human made or natural disasters: The response to be toiled
according the nature of the injuries, socio-political context.
- In natural disasters severe injuries were due to falling of heavy
objects, hit by bolder, floating objects and being trapped under
rubbles.
- In man-made disasters the injuries were largely burn injuries,
bullet injuries, blast injuries, and cut by sharp weapon
 Disability in Disaster:
• Disaster is “a severe disruption of
ecological and psychosocial which
greatly exceeds the coping capacity of
the affected community”- WHO, 1992
– Deaths, destruction, injuries are common
– Disaster disturb the equilibrium of the
society and long term recovery effort is
crucial
– Disabled are one of the marginalised sections
– Injury in disaster causing permanent
disability is the major challenge in
rehabilitation in-post disaster phase
 Disaster leading to disability:
• The nature of disaster has a close link with the severity of the
physical injuries and subsequent complexities in socio-
economic, political atmosphere for rehabilitation.
• The disability of an individual survivors cause stress for whole
family
• Multi-sectoral integrated support is needed, but in practice the
psychosocial problems less addressed.
• Practices for rehabilitation of survivors with permanent
disability, SCI , amputation focused more on care- (medical
model of disability) less on support – (social model disability)
• Social Model is an addition to Medical model
 Marginalisation due to injury/ disability:

• Disabled due to injuries (Specially,

Paraplegics, Amputees) are double victim of disasters.
• Physical limitations, inability to accept the disabled condition,
attached social stigma, lack of community acceptance cause
serious marginalisation.
• Programmatic reason of marginalisation of service : people living
near town was able to get support by professionals than disabled
living in distance villages.
 UN Convention (2007) and
disaster
• "State parties shall take, in accordance with their
obligations under international law, including
international humanitarian law and international
human rights necessary measures to ensure
protection and safety of persons with disabilities in
situations of risk, including situations of armed
conflict, humanitarian emergencies and the
occurrence of natural disasters". -Article 11, The
Convention of the Rights of Persons with Disabilities (United Nations,
2007),
 International Guidelines
• Ensure in every situation equal access to appropriate services and support.
• Inclusion of marginalised is a priority and it includes women, children,
older people and people living with HIV/AIDS and disabled.
• Sphere Project (2011): disability is one of the cross cutting issue that
should be considered in every sector (health, housing water sanitation, food
security etc.) of disaster response programme.
• IASC-MHPSS (Inter Agency Standing Committee , 2007): Protection and
special programme for care for person with disability, disaster induced
disability and injuries
 National Guidelines for working
with marginalised population
• PSS-MHS (2009): programme
to ensure integration and
normalization
• State Governments have to lay
emphasis on the restoration of
permanent livelihood------------
---people belonging to
marginalised and vulnerable
sections
• Change in the proportion of
opportunities for marginalised
groups.
 Important Acts
• (a) Right of the Persons with Disabilities Act 2016,
• (b) National Trust for the Welfare of the Persons with Autism,
Cerebral Palsy, Mental Retardation, and Multiple Disability Act,
1999,
• (c) Rehabilitation Council of Disability Act 1992.

• “The persons with disabilities shall have equal protection and

safety in situations of risk, armed conflict, humanitarian
emergencies and natural disasters” (Right of the Persons with Disabilities Act 2016)
• Guidelines by NDMA on disaster management have considered
the persons with disability/ differently abled as one of the
vulnerable sections of the society and there must be special
provisions for them during rescue, rehabilitation, in disaster
management and risk reduction programme.
 Findings and Supportive Review
• Persons with permanent have a very high probability of
developing mental health problems - depression ,anxiety and
post traumatic stress disorder.
• Mental health problems are not only the product of physical
disability and the change in the social and economic
atmosphere; rather widely connected with all the life changing
events following the disaster.
• Disaster imposes a lot of challenge to lead a normal life, the
people with severe injuries has no choice except being
dependent on others for each and every needs to live. „Golden
hour‟ is most crucial.
• Problem to get accustomed with the altered status, adapt a
negative coping, tend to show lack of satisfaction with the
service and support.
 Findings and Supportive Review
• Initial days continuous medical care needed. Post-operative
complications are common. home based care is most essential to
enhance the quality of life.
• Care-giver and family members experience a higher level of stress
and burden. Permanent disability of one leads to a multi-fold
burden to the family that correspond to the socio-economic
function and psychosocial wellbeing of the whole family
• Community based rehabilitation, home based care is most crucial
for the rehabilitation, but, in most the situation they significantly
suffers from lack of service provisions in the long-term
• Communities need to be disabled friendly for the successful
implementation of the rehabilitation planning and programming,
otherwise community tend to fail assume the long-term
responsibility to ensure inclusion.
 Findings and Supportive Review

• The persons with disabilities faced four times more serious

incidences of health challenges, and required 17.8% more
number of hospitalization. Further poverty and disability
operates in a cycle.
• Major impairments requiring health-related rehabilitation
include amputations, traumatic brain injuries, spinal cord
injuries (SCI), and long bone fractures.
• The persons with pre-existing disabilities are more likely to die
in a natural disaster.
• Lack of health-related rehabilitation in natural disaster relief
may result in additional burdening of the health system
capacity
 Empowerment and Capability Enhancement
Approach
• Multiple social construct- „equality in service‟ and „equality in
assess‟…„inclusion in programme‟ or „inclusive programme‟
in the rehabilitation planning.
• Disaster preparedness has a major impact on limiting the
nature of the injuries among the survivors
• Working for the survivors of disaster is essentially an
enabling, empowering process
• Empowerment is “the process of helping individuals, families,
groups, and communities to increase their personal,
interpersonal, socio-economic, and political strength and to
develop influence towards improving their circumstances.”
(Barker (2003)

• Proposed model contributes towards development of the

capabilities of the survivors with disability
 Model is based on ‘Capability
approach’ of Sen and Nussbaum:
• The „capability approach‟ measured the development of
the society is a function of the level of well-being or
standard of living of individuals within that society.
• Functioning may vary from the elementary, such as
being adequately nourished and being free from
avoidable disease, to complex activities or personal
states, such as taking part in the life of the community
and having self-respect.
• "Capability" refers to the feasible alternative
combinations of these functionings.
• The best possible combinations of the functioning help
to achieve the capability and enhance well-being.
Sen, A. K. (1999). Development As Freedom. Oxford: Oxford University
Press
• A return to full functioning requires the restoration of
interrelated capabilities (Nussbaum‟s model):
– Life. Being able to live……. not dying prematurely
– Bodily health: good health; being nourished ….. adequate
shelter
– Bodily integrity: freely move …. Secured from violence,
assault
– Senses, imagination, thought: freedom of expression
– Practical reason:…….. Planning of one‟s own life
– Play:…able to laugh, enjoy recreational activities
– Control over one's environment: (A) political participation;
(B) Material- hold property

Nussbaum, M. (2011). Creating Capabilities: The Human

Development Approach. Cambridge, MA: Harvard University Press
 Proposed four levels model:
• Level-A: Cross-sectional factors for disaster
interventions
• Level-B: Core mental health functions for the
psychosocial well-being of the survivors.
• Level-C: Inter-sector services for facilitating
wellbeing
• Level-D: Mainstreaming disability in disaster for
holistic rehabilitation:
• A-1: Multi-sectoral support need
comprehensive implementation.
Level-A: Cross-
– Agreement on Minimum agenda and sectional factors
maximalist goal
– Continuous assessment
Coordinated approach,
• A-2: Continuous service for HRP. assessment

Human Rights Perspective

– HR standards, avoid stigmatization,

Evaluate and monitor

A-1
marginalization, ensure dignity Survivors with
– Long-term, sustainable paradigm Disability, SCI

A-4
A-2
• A-3: Human Resource Development amputation and
their care-givers
– PWD as active productive member
– Capacity development for staff, volunteers
Human resource
• A-4: M&E for progress. A-3
– Research, Data keeping, management,
update
– Special focus pre-post disaster phases,
disabled, disaster induced disabled
• B-1:Community participation and Level-B: Core
empowerment, mobilization Mental Health
– Stake holders active engagement
– Self-help, strengthen local institutions Social
engagement
• B-2:Skill to strengthen self- B-1
confidence, and socio-economic up
development
– Skills to promote livelihood Skill Survivors with
Developm Disability, SCI Health
– Supporting working environment ent
amputation and
Services
their care-givers
• B-3:Appropriate, contextual info. B-2 B-4

– Sensitive, targeted, relevant

– Support positive coping, opinion Information
dissemination
• B-4:Enhance QOL and Standard B-3
– Physical, MH care
– Supportive aid, facilities at grass-roots
– Referral, follow-up
• C-1:Financial security & Level-C: Inter-
meaningful engagement.
– Individual/family focused sector services
– Considerable income generation
• C-2:Disabled friendly dwelling Livelihood Medical
Promotion assistance &
unit. supplies
C-1
– Structure and other facilities to C-4
support, livelihood, recreation
– Encourage close community Survivors with
ties. Disability, SCI
amputation and

• C-3:Security to remove barriers their care-givers

– Secured health care, job,

Income, service for dependent
Shelter & Social
Family members disabled friendly Security
• C-4:Regular stock and supplies housing C-3
C-2
– Medicine
– Maintenance of supporting aid
• D-1: DP in the cycle of disaster Level-D: Mainstreaming
– Inclusive DP, planning (4R) disability
Disaster
– Mitigation preparedness (D-1)
• D-2:Empowering, inclusive
– Equality in service, Access
– Legislative measures,
Accountability of authorities

Multi-disciplinary
approach (D-4)
Policy measures
Survivors with
Disability, SCI

(D-2)
amputation and
• D-3:Integrated effort. their care-givers

– Through 4R, disability

Focus, engagement, PWD, family
-Marge with other Prog (DMHP).
• D-4:Academic engagement
– Inter disciplinary approach
Integrated work
– Research for innovation (D-3)
– Strengthening
 Proposed model for
rehabilitation of the PWD:
 Conclusion:
• Rehabilitation for the person with Disability, SCI
and amputation is long drawn process
• Intensive investment in an integrated manner with
involvement of professionals from different
discipline.
• Mental health and psychosocial well-being is one
of the crucial integral parts in their rehabilitation.
• Family as a unit of care in community.
• Caregiver and the family members at par with the
persons with permanent disability, should be
considered in the community based rehabilitation.
 Thanks
bhadrasubhasis@gmail.com
Questions..????
 Contd…..
• Children & youths who were disabled due to amputation
became excluded in the schools, college, in social situation.
• In disaster where injuries, permanent disability was less in
number, people received very minimal support (like, corrective
surgery) as most of the agencies were interested to provided
support to mass.
 Common IASC-MHPSS Social
functions considerations

Core mental health and

psychosocial support activity Food
Coordination security
and
nutrition
Communit
y
Assessment, Health
monitoring Mobilizati
services
and evaluation on & Shelter
support and site
planning
Protection and
human rights
standards Dissemina
tion of
Education
informatio Water and
n sanitation
Human resources
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