physical rehabilitation programme - icrc.org · first step towards enjoying such basic rights as...

PHYSICAL REHABILITATION PROGRAMMEANNUAL REPORT 2008

Cover photo: Alberto Buzzola/Rhythms Monthly

333

FOREWORD . . . . . . . . . . . . . . . . . . . . . . . . . 4

1 – INTRODUCTION . . . . . . . . . . . . . . . . . . . . 5

2 – OVERVIEW OF ACTIVITIES IN 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Improving the accessibility of services . . . 8Improving the quality of services . . . . . . 10Promoting the long-termfunctioning of services. . . . . . . . . . . . . . . . 12Cooperation with other bodies . . . . . . . . 13

3 – AROUND THE WORLD:PHYSICAL REHABILITATION PROGRAMME . . . . . . . . . . . . . . . . . . . . . . 14

4 – PROJECT ACTIVITIES . . . . . . . . . . . . . . 16

4.1 Africa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174.2 Asia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 304.3 Europe and the Americas . . . . . . . . . . . . . 474.4 Middle East and North Africa . . . . . . . . . 56

ANNEX – ICRC PUBLICATIONS . . . . . . . . . . . . . . . 65

CONTENTS

The International Committee of the Red Cross (ICRC)is an impartial, neutral and independent organizationwhose exclusively humanitarian mission is to protect thelives and dignity of victims of war and internal violenceand to provide those victims with assistance. Establishedin 1863, the ICRC is at the origin of the InternationalRed Cross and Red Crescent Movement. It works to fulfil its mandate to protect and assist the millions ofpeople affected by armed conflict and other situations ofviolence through its 80 delegations and missions aroundthe world.

Although the ICRC had undertaken some physical reha-bilitation activities before 1979, the establishment thatyear of the Physical Rehabilitation Programme (PRP)marked the beginning of a major commitment in thisfield. Since 1979, the PRP’s activities have diversified andexpanded throughout the world, from two projects in two countries in 1979 to a total of 85 projects in 25 countries and one territory in 2008. This develop-ment results from the recognition that humanitarianassistance in the form of physical rehabilitation requiresmore than an emergency response, since those in needof physical rehabilitation services will need such servicesfor the rest of their lives. Over time, the ICRC has developed a leadership role in physical rehabilitation,mainly because of the scope of its activities worldwide,the development of its in-house technology, its acknowl-edged expertise, and its long-term commitment toassisted projects. In most countries where the ICRChas provided physical rehabilitation support, such serv-ices were previously either minimal or non-existent. Inmost cases, the support provided by the ICRC has servedas a basis for the establishment of a national rehabilita-tion service dispensing care to those in need.

The term “rehabilitation” refers to a process whose aimis to remove – or to reduce as much as possible – restric-tions on the activities of physically disabled persons, and

to enable them to become more independent and enjoythe highest possible quality of life in physical, psycho-logical, social and professional terms. Different measures, such as medical care, therapy, psychologicalsupport, or vocational training, may be needed toachieve this end. Physical rehabilitation, which involvesproviding assistive devices (prostheses, orthoses, walk-ing aids and wheelchairs) and appropriate physiotherapy,is an important part of the rehabilitation process. It isnot an objective in itself, but an essential part of all themeasures needed to ensure the full integration of dis-abled persons in society. Restoration of mobility is thefirst step towards enjoying such basic rights as access tofood, shelter and education, getting a job and earning anincome, and, more generally, having the same opportu-nities as other members of society.

In addition, to its operational programme, the PhysicalRehabilitation Programme, the ICRC is also providingassistance in the field of physical rehabilitation throughits Special Fund for the Disabled. Created in 1983, theICRC Special Fund for the Disabled (SFD) providessimilar support as the PRP. It is primarily the politicalcontext and the need that determine which channel theICRC uses in a given situation. The mission of the SFDis to support physical rehabilitation services in low-income countries, with priority given to former projectsof the ICRC.

This report describes the worldwide activities of theICRC Physical Rehabilitation Programme in 2008.

Information on the activities of the ICRC Special Fundfor the Disabled may be obtained from the Fund’sAnnual Report for 2008 (www.icrc.org/fund-disabled).

4

FOREWORD

55

1 – INTRODUCTION

Rehabilitation is a process whose aim is to remove – orto reduce as much as possible – restrictions on the activ-ities of persons with disabilities, and to enable them tobecome more independent and enjoy the highest possi-ble quality of life. Restoration of mobility is the first steptowards enjoying such basic rights as access to food,shelter and education, getting a job and earning anincome, and, more generally, having the same opportu-nities as other members of society. Depending on thetype of disability, various measures, such as medicalcare, physical rehabilitation, vocational training, socialsupport, or help in achieving economic self-reliance,may be needed to achieve this end. Physical rehabilita-tion is an integral part of the process needed to ensurethe full participation and inclusion in society of personswith disabilities. It includes providing assistive devices,such as prostheses, orthoses, walking aids and wheel-chairs, together with the therapy that will enable dis-abled persons to make the fullest use of those devices.Physical rehabilitation must also include activitiesaimed at maintaining, adjusting, repairing and renewingthe devices as needed.

The main objectives of a national physical rehabilitationprogramme are to ensure that the services provided areaccessible, that they meet existing needs and are of goodquality, and that they continue to function in the longterm. ICRC physical rehabilitation assistance is designedto strengthen the overall physical rehabilitation servicesof a given country. It aims to improve the accessibility ofservices and their quality, and to develop national capac-ities to ensure their long-term viability.

History

Although the ICRC had undertaken some physical reha-bilitation activities before 1979, the establishment of thePhysical Rehabilitation Programme that year marked

the beginning of a serious commitment in this field.In 1979, two operational projects were implementedunder the newly established Physical RehabilitationProgramme.

Since 1979, the ICRC’s physical rehabilitation activitieshave diversified and expanded throughout the world.Between 1979 and 2008, the ICRC Physical RehabilitationProgramme provided support for 121 projects (centres)in 39 countries. Over half the centres were constructedduring this period, frequently with substantial ICRC co-funding for construction and equipment costs. Theprogramme’s operational activities expanded from twocentres in two countries in 1979 to a total of 85 assistedprojects in 25 countries and one territory in 2008. Adirect result of this steady increase in the number ofassisted centres is the increase in the number of benefici-aries receiving services. Since 1979, large numbers ofindividuals have benefited from physical rehabilitationservices, including the provision of prostheses, orthoses,wheelchairs and walking aids, physiotherapy, and follow-up (repair and maintenance of devices) with the assis-tance of the ICRC. The infrastructure and expertisedeveloped with the help of the ICRC has benefited

SERVICES PROVIDED 1979 - 2008

Prostheses Orthoses Wheelchairs Crutches (pairs)

314,457

251,905

28,471

355,064

66

PHYSICAL REHABILITATION PROGRAMME INTRODUCTION

patients not only during the period of assistance, but alsoafterwards. The number of beneficiaries is thus greaterthan indicated by the statistics, which do not includepatients treated after the ICRC’s withdrawal from assistedcentres.

The approach

In the conflict-affected countries where the ICRC under-takes its mandated activities, it is not only people directlyaffected by the conflict who need physical rehabilitationservices (those injured by landmines, bombs and otherordnance), but also those indirectly affected – people whobecome physically disabled because the breakdown ofnormal health services prevents them from receivingproper care and/or vaccinations. The projects assisted bythe ICRC offer services without discrimination to allthose in need.

The activities included in the ICRC’s physical rehabilita-tion projects are planned and conducted with the primary aims of improving the accessibility of services forthe physically disabled, upgrading the quality of thoseservices, and ensuring their long-term viability.

Improving accessibility: The ICRC takes all possiblemeasures to ensure that everyone in need of physicalrehabilitation services has access to them on an equal-opportunity basis, regardless of social,religious, ethnic or other considerations. Specialattention is given to vulnerable groups, such aswomen and children.Improving quality: The ICRC promotes the application of internally developed guidelines basedon international norms. The Organization also promotes a multidisciplinary patient-managementapproach that includes physiotherapy, and ensuresthat the ICRC technology used to produce appliancesand aids for the disabled remains appropriate andup-to-date.Ensuring sustainability: The ICRC works with andstrengthens the capacity of a local partner from thestart. In addition, whenever necessary, the ICRCensures project continuity through the Special Fundfor the Disabled. This long-term approach does not only take into account the ICRC’s residual responsibility, it also reduces the risk of any loss ofinvestment in human resources, capital and materials.

In order to promote these aims, the ICRC provides:

Financial/material assistance, including renovationof facilities; donation of machines, tools, equipment,raw materials and components; reimbursement ofbeneficiaries for travel, accommodation and foodexpenses; reimbursement of rehabilitation centres for services

Technical assistance, including low-cost, high-qualitytechnology; service protocols; specialists (ortho-prosthetists, physiotherapists, etc.) offering service and management supportEducational assistance, including direct training ofnational staff members, and sponsorships enablingthem to enhance their technical and administrativeskills at recognized regional training centres

ICRC projects aim to allow the physically disabled toparticipate fully in society, both during and after theperiod of assistance. Although its focus is physical reha-bilitation, the ICRC Physical Rehabilitation Programmerecognizes the need to develop projects in cooperationwith others so as to ensure that beneficiaries have accessto other services in the rehabilitation chain. In all proj-ects, referral networks are established with local andinternational organizations directly involved in otherparts of the rehabilitation chain. In addition, where theICRC is carrying out other activities, such as hospitalsupport and economic-security projects, efforts are coor-dinated to ensure that beneficiaries of physical rehabili-tation projects have access to proper medical care and tosocio-economic projects implemented by the ICRC.

Developing national capacity

ICRC projects are designed and implemented tostrengthen the overall physical rehabilitation services ina given country. For that reason, the ICRC will supportnational partners (governments, non-governmentalorganizations – NGOs, etc.) in providing physical reha-bilitation services. The level of support provided variesfrom country to country, but the aim is always to developnational capacity. In certain circumstances, however, theICRC may take the place of the authorities entirely.Ninety percent of the ICRC’s projects have been, andcontinue to be, managed in close cooperation withnational partners, primarily government authorities.Few centres have been, or continue to be, run by theICRC alone. There are two situations in which the latteroption may be adopted: when there is no suitable partnerat the outset, and when a centre is set up to treat patientsfrom a neighbouring country. In 2008, apart from onecentre in Pakistan (Muzaffarabad), one centre in Iraq(Erbil), and all seven projects in Afghanistan, assistedcentres were either government-run or managed by NGOs.

Sometimes the ICRC’s withdrawal from functioningrehabilitation projects is successful; but other times, thelong-term result is an empty centre without materials,trained personnel or patients. In countries with limitedfinancial resources, the needs of the disabled, includingthe need for physical rehabilitation, are seldom givenpriority. The result is poorly funded and poorly sup-ported centres. Besides the direct impact this has onpatients and personnel, it represents a significant loss interms of investment of human capital and materials. Ashas already been noted, a person with a disability needs

6

77

PHYSICAL REHABILITATION PROGRAMME ANNUAL REPORT 2008

access to functioning rehabilitation services for the restof his or her life. In order to improve the sustainabilityof these services, the ICRC has adopted a long-termapproach in implementing and managing its physicalrehabilitation projects. While the top priorities areincreasing the accessibility of services and maintaininghigh quality, the ICRC is always aware of the need toincrease its partners’ capacity for managing servicesfrom the outset. It does this by providing training andmentoring, strengthening infrastructure, and promot-ing the development and implementation of a nationalphysical rehabilitation policy within the relevant government structure(s).

Since 1979, the ICRC has developed several managementtools (stock management, patient management, treatmentprotocols, etc.) to support managers of assisted centres.These management tools have also been distributed toother organizations working in the same area.

As the quality of services depends largely on the avail-ability of trained professionals, the training componentof ICRC-assisted projects has gained in importance overthe years. The presence of trained professionals increasesthe chances that rehabilitation facilities will continue tofunction over the long term. In 2003, the ICRC devel-oped an in-house training package for orthotic/prosthetic technicians (Certificate of ProfessionalCompetency – CPC), which was recognized by theInternational Society for Prosthetics and Orthotics(ISPO). Since 1979, the ICRC has run formal prostheticand orthotic (P&O) training programmes leading to adiploma in more than 10 countries, and formal trainingin physiotherapy in one country. It has also providedscholarships enabling a number of candidates to betrained at recognized schools in formal prosthetics andorthotics or physiotherapy.

Even when the ICRC has completely withdrawn from acountry, the organization’s Special Fund for theDisabled can provide follow-up. This long-term com-mitment to patients and facilities, unique among aidorganizations, is much appreciated by the ICRC’s part-ners at both the level of the centres and at governmentlevel. It is one of the ICRC’s major strengths.

Services for mine/ERW(explosive remnants of war) survivors

The ICRC has provided support for 16 of the 26 StatesParties to the Ottawa Convention that have acknowl-edged their responsibility for landmine survivors(Afghanistan, Albania, Angola, Cambodia, Chad,Colombia, Democratic Republic of the Congo, Eritrea,Ethiopia, Iraq, Mozambique, Nicaragua, Sudan,Tajikistan, Uganda and Yemen), and continues to do sofor 13 of them (Afghanistan, Angola, Cambodia, Chad,Colombia, Democratic Republic of the Congo, Eritrea,Ethiopia, Iraq, Sudan, Tajikistan, Uganda and Yemen).Since 1997, the ICRC-assisted network of centres has

provided mine survivors with 110,725 prostheses and2,816 orthoses, together with appropriate physical ther-apy. In addition, many survivors received wheelchairsand walking aids.

Polypropylene technology

The ICRC initially used raw materials and machineryimported from established Western suppliers to produceprosthetic and orthotic components. However, theorganization soon started developing a new technologyusing polypropylene as the basic material, thus reducingthe cost of rehabilitation services. Recognition of theICRC’s vital role in making rehabilitative appliancesmore widely available, by introducing low-cost, high-quality technology, came in 2004 when the ISPO awardedthe Brian Blatchford Prize to the ICRC. The technologydeveloped by the ICRC is now standard practice for theproduction of prostheses and orthoses and is used by asignificant number of organizations involved in physicalrehabilitation.

To mark the ICRC’s role in developing and promotingappropriate technology, such as the polypropylene tech-nology, a brochure on the subject was published in 2007.It provides the necessary information about the advan-tages and appropriateness of using this technology forproducing prosthetic and orthotic devices in developingcountries.

Support by specialists

Besides developing appropriate technology and trainingprofessionals, the ICRC promotes providing qualityservices by deploying its specialists. With a large interna-tional pool of experts, the ICRC employs by far thelargest number of specialists among the internationalorganizations working in the same field. Over time, theaverage number of expatriates per project has decreasedfrom 7 in 1979 to 0.6 in 2008, mainly because of theincreased experience both of the ICRC and of the grow-ing number of national trained professionals working inassisted centres.

The ICRC continued its efforts to improve the accessi-bility of services, enhance the quality of those servicesand promote their long-term viability.

IMPROVING THE ACCESSIBILITY OF SERVICES

For the ICRC, improving accessibility to services implies:

That the services exist, and that potential serviceusers know they exist and how to access them That users have equal access to services, without anytype of discrimination, and that the services providedare affordable, without compromising on qualityThat the services are physically accessible to users,that they are provided as close as possible to whereusers live, and that users have access to other serviceswithin the rehabilitation chain

To this end, equipment material and components aredonated, direct support is provided to service users, cov-ering the cost of transport, accommodation and food,information about supporting centre activities is dis-seminated, and the ICRC supports the development of referral networks within the catchments areas ofthe centres.

Projects worldwide

In 2008, the ICRC Physical Rehabilitation Programmeassisted 85 projects in 25 countries and one territory,Apart from the two national orthopaedic componentfactories (in Cambodia and Afghanistan) and thenational unit manufacturing crutches (in Iraq), all otherprojects were physical rehabilitation centres. The ICRCalso began providing assistance in Uganda (one project)and resumed its support to three satellite centres man-aged by the Sudan National Authority for Prosthetics

and Orthotics (NAPO). At the beginning of the year, theICRC ended its support in Syria (one project), in Haiti(one project), in Azerbaijan (three projects), and for twoprojects in Ethiopia (Harar and Addis Ababa). In June2008, it ended its support for three projects in Angola.

In Africa, the ICRC provided support for 26 projects inseven countries: Angola (3 projects), Chad (2),Democratic Republic of the Congo (5), Eritrea (3),Ethiopia (6), Sudan (6), and Uganda (1). After nearly 30 years of support, the ICRC halted its assistance inAngola at the end of June, believing that Angola has allthe necessary means to provide effective physical reha-bilitation services. In Chad, the ICRC continued to support the activities of the two centres within thecountry, located in Moundou and in N’Djamena. In theDemocratic Republic of the Congo, the ICRC continuedto cover the treatment costs of those directly affected bythe conflict in five centres in the country. In Eritrea, theproject did not proceed as planned during 2008 sincethe Memorandum of Understanding was only signed inlate October; however some activities were implementedduring the year.

The ICRC provided support to six centres in Ethiopia,but discontinued its collaboration with the Harar centreand with the Prosthetics and Orthotics Centre in AddisAbaba. Nevertheless, these two centres continued toprovide services in 2008 with the material given by theICRC in 2007. In Sudan, while continuing to supportcentres in Khartoum, Nyala and Juba, the ICRC resumedits support to three satellite centres managed by theNational Authority for Prosthetics and Orthotics(NAPO) in Kassala, Damazin and in Kadugli with the aimof improving accessibility to services. In October 2008,the ICRC resumed its assistance to Uganda in the field of physical rehabilitation, focusing on the west (Fort Portal).

8

2 – OVERVIEW OF ACTIVITIES IN 2008

9


In Asia, the ICRC provided support for 31 projects in 10 countries: Afghanistan (7 projects), Cambodia (3),China (3), Democratic People’s Republic of Korea (2),India (2), Myanmar (7), Nepal (1), Pakistan (4),Sri Lanka (1), and Philippines (1). In addition, the ICRCcovered the cost of treatment for 398 persons inBangladesh who received 477 orthoses and 122 prosthe-ses. These services were provided by centres receivingassistance from the ICRC Special Fund for the Disabled.

While physical rehabilitation services were availablethrough a network of 14 centres in Afghanistan, onlyone was managed by the Afghan authorities; all the otherswere run by international organizations. In addition. In2008, the ICRC continued to manage six physical reha-bilitation centres throughout the country and oneorthopaedic component factory in Kabul, which alsoproduces wheelchairs. In Cambodia, the ICRC contin-ued to support two centres (Battambang and KompongSpeu) and the Phnom Penh Component Factory, theonly facilities directly managed by the authorities. InChina, the ICRC concluded its first phase of assistance,and the Yunnan branch of the Red Cross Society ofChina is now fully responsible for managing physicalrehabilitation activities with the assistance of the ICRC.In the Democratic People’s Republic of Korea, the ICRCcontinued to provide assistance to the Ministry of PublicHealth for the development of physical rehabilitationservices at its centre in Songrim, and to the MilitaryMedical Bureau of the People’s Armed Forces for thedevelopment of services at its centre in Rakrang.

In India, the ICRC backed the efforts of the Indian RedCross Society to improve accessibility of services inJammu and Kashmir by providing support for the P&Odepartments at the Jammu Governmental MedicalCollege and the Bone and Joint Hospital in Srinagar. InMyanmar, government restrictions imposed on theICRC continued to prevent the organization from ful-filling its mandate in accordance with its standard work-ing procedures. Since mid-2007, the ICRC has beendirectly supporting only the Hpa-an OrthopaedicRehabilitation Centre, run jointly by the Myanmar RedCross Society and the ICRC. However, formally ICRC-assisted centres managed either by the Ministry ofHealth (3) or the Ministry of Defence (3) were givenenough material to ensure that all the centres wouldcontinue to provide services in 2008. In Nepal, the ICRCcontinued to collaborate with the Green PastureHospital in Pokhara and agreed to provide assistance,starting in 2009, to the newly constructed first govern-ment-run rehabilitation centre, the Aerahiti NationalRehabilitation Centre.

The ICRC maintained its support for Pakistan’s Instituteof Prosthetic and Orthotic Sciences in Peshawar, for theQuetta Christian Hospital Rehabilitation Centre, andfor the Muzaffarabad Physical Rehabilitation Centre,

managed by the ICRC. In addition, the ICRC began col-laborating with the Hayatabad Paraplegic Centre(Peshawar) within the framework of the Home CareProject. In the Philippines, the ICRC referred beneficiariesand covered the cost of their treatment at the DavaoJubilee Centre. In Sri Lanka, the ICRC maintained itssupport to the activities of the Jaffna Jaipur Centre forDisability Rehabilitation, the only physical rehabilita-tion service provider in Jaffna peninsula.

In Europe and the Americas, the ICRC provided supportfor 10 projects in five countries: Azerbaijan (1),Colombia (5), Georgia (2), Russian Federation (1), andTajikistan (1). While direct assistance to Azerbaijanended in 2007, the ICRC has maintained close contactwith the management team of the facilities and hassigned a contract of services with the Baku centre asservice provider for the benefit of nine Chechenrefugees. In Colombia, the ICRC continued to providedirect assistance to five existing rehabilitation facilitiesin Bogotá, Cúcuta, Cartagena, Cali and Medellín withmanagement support, training, material and equip-ment. The ICRC’s physical rehabilitation project inGeorgia consisted of three components: support for theGeorgian Foundation for Prosthetic and OrthopaedicRehabilitation in Tbilisi, support for the Gagra centre in Abkhazia, and a referral service for patients fromSouth Ossetia.

From the beginning of its work in the RussianFederation, the ICRC focused on developing the coun-try’s capacity to provide appropriate physical rehabilita-tion services. Since that objective has been achieved, theICRC’s support to the Grozny Prosthetics and OrthoticsCentre ended in November. In Tajikistan, the ICRC con-tinued to support the Ministry of Labour and SocialProtection activities in the field of physical rehabilita-tion. In 2009, the ICRC will end its assistance inTajikistan, but the ICRC Special Fund for the Disabledwill provide limited support to facilitate the handover tothe Ministry.

In the Middle East and North Africa, the ICRC providedsupport for 18 projects in three countries and one territory: Algeria (2 projects), Iraq (12), Gaza (1), andYemen (3). In Algeria, ICRC assistance involved ensur-ing access to services for destitute Algerians by support-ing the activities of the Ben Aknoun Hospital P&Odepartment and for Saharawi refugees living in south-west Algeria. In the Gaza Strip, the ICRC supported theonly functioning centre there, the Artificial Limb andPolio Centre located in Gaza City. The ICRC providedsupport to 12 facilities in Iraq, while in Yemen, the ICRCcontinued to support the National Artificial Limbs andPhysiotherapy Centre in Sana’a, the Al-Mukalla Centrein Mukalla, and the Aden Physical RehabilitationCentre.

Providing services

In 2008, more than 167,000 people benefited from vari-ous services at ICRC-assisted centres. These servicesincluded the production of 20,817 prostheses and 39,667 orthoses, and the provision of 2,503 wheelchairsand 17,544 pairs of crutches. No statistics were compiledon the number of persons who were given physiotherapy,but such treatment was available for most of them, andmost received the treatment. The number of servicesprovided in ICRC-assisted centres in 2008 was on aver-age 6% greater than provided during the previous year.Children and women represented 27% and 17%, respec-tively, of all those benefiting from services.

Services for mine/ERW survivors

The ICRC provided support to 13 of the 26 StatesParties to the Ottawa Convention that have acknowl-edged their responsibility for landmine survivors(Afghanistan, Angola, Cambodia, Chad, Colombia,Democratic Republic of the Congo, Eritrea, Ethiopia,Iraq, Sudan, Tajikistan, Uganda and Yemen). In all thesecountries, survivors had access to services with the aid ofthe ICRC, as did survivors from Azerbaijan, China, theDemocratic People’s Republic of Korea, Georgia, India,Myanmar, Nepal, Pakistan, the Russian Federation, andSri Lanka.

The ICRC-assisted network of centres provided 8,326 prostheses (out of a total of 20,817) for mine sur-vivors and 562 orthoses (out of a total of 39,667), alongwith the appropriate physical therapy. In addition, manysurvivors received wheelchairs and walking aids.Children and women accounted for 5% and 8%, respec-tively, of the total number of survivors who had access toprostheses and orthoses. In Afghanistan, Cambodia,Chad, Colombia, Ethiopia, Iraq, Myanmar and Sudan,the ICRC continued to be the main international organization providing, and helping to provide, physicalrehabilitation services.

Promoting access to other servicesin the rehabilitation chain

Two ICRC physical rehabilitation projects (inAfghanistan and Colombia) had built-in socio-economic components. The project in Afghanistancombined physical rehabilitation services with activi-ties aimed at the social reintegration of the disabled.In 2008, more than 2,300 persons benefited from these activities, which included job placement, specialeducation, vocational training, and micro-creditschemes. Since 1993, the project has pursued a policy of“positive discrimination” in that all the centres trainedand employed only people with disabilities. Nearly all 500 employees of the project, male and female,are disabled former patients. In Colombia, the ICRCcontinued to refer mine survivors to a vocational train-ing centre.

Beneficiaries receiving services in assisted-centres inthe Democratic Republic of the Congo, Pakistan, theRussian Federation and Iraq also had access to assis-tance through the ICRC Micro-Economic Initiatives(MEI) programmes. In Cambodia, the ICRC main-tained close contact with the Cambodian Red CrossMEI programmes, and in all other projects, referralnetworks were established with local and internationalorganizations directly involved in other parts of therehabilitation chain.

IMPROVING THE QUALITY OF SERVICES

Services were improved through training of nationalprofessionals and expatriate specialists, support providedby expatriate specialists, improvements in ICRC-developed polypropylene technology, the drafting andimplementation of treatment guidelines, promoting amultidisciplinary patient-management approach, andemphasizing quality rather than quantity of servicesprovided.

Improvements in ICRC-developedpolypropylene technology

The ICRC has continuously monitored feedback fromthe field about the quality of prosthetic/orthotic compo-nents produced by CR Equipements SA, but efforts toimprove the full range of products continue. New prod-ucts have been developed and produced, including aluminium-free ankle joints, a low-cost alternative toankle-flex joints, a wider range of feet for manufacturinglong-stump trans-tibial prostheses, and a new design fororthotic offset knee joints.

The ICRC, in cooperation with the NorwegianUniversity of Science and Technology, initiated the project on life-cycle analysis of polypropylene technology.The analyses of field questionnaires and the University’sfirst visit to Cambodia revealed the need to raise

10

PHYSICAL REHABILITATION PROGRAMME OVERVIEW OF ACTIVITIES IN 2008

SERVICES PROVIDED IN 2008

Prostheses Orthoses Wheelchairs Crutches (pairs)

20,817

39,667

2,503

17,544

11


awareness about disposal issues in most supported cen-tres and to establish clear guidance, which will be devel-oped in the coming years.

Cooperation with the Bloorview Research Institute ofToronto, Canada, and the University of Melbourne isaimed at launching special research on improving CRknee-joint functionality for extension and swing-phasecontrol.

Enhancing national capacity to provide service

While ICRC expatriate specialists (ortho-prosthetistsand physiotherapists) continued to offer on-the-jobtraining and mentoring in all projects, efforts continuedto increase the number of qualified national professionalsby providing and sponsoring formal training in pros-thetics, orthotics and physiotherapy, and to update theskills and knowledge of those already working.

Improving physiotherapy services

Throughout the year, physiotherapy services withinassisted-centres were enhanced through several activi-ties. Nine persons completed or continued formal train-ing in physiotherapy subsidized by the ICRC. Amongthe candidates from Cambodia who were enrolled in thetraining provided by the Singapore General HospitalPost-graduate Allied Health Institute, two went toSingapore for a six-month clinical placement.

Project No. of School Year Diplomastudents

Sudan 2 Kigali Health Institute 2007 - 2010 BSc. Physiotherapy

Cambodia 2 Singapore General Advance certificate in

Hospital (clinical physiotherapy

placement in Singapore) 2008

5 Singapore General PT Upgrade Training

Hospital

(course in Cambodia) 2008

In addition, the ICRC supported the development ofphysiotherapy professionals by:

supporting a two-year training programme for physiotherapists in Afghanistan;implementing continuous training for physiotherapists in Algeria, the Democratic People’sRepublic of Korea, Ethiopia, Sudan, India and Pakistan;conducting refresher courses for physiotherapists inEritrea, Georgia, the Russian Federation, and Iraq;providing support to the Eritrea Ministry of Healthfor the development and implementation of a diploma-level national training course for physiotherapists.

Provision of appropriate physiotherapy services werealso supported by:

financing the construction of a new physiotherapydepartment at the Centre d’Appareillage etRééducation Kabalaye in N’Djamena (constructionshould be completed in 2009);donating physiotherapy equipment to four facilitiesin Colombia (Cali, Medellín, Cartagena, and Cúcuta);ensuring access to appropriate post-surgical rehabilitation at the Al Shifa Hospital in Gaza (donation of equipment, on-the-job training andmentoring by an ICRC physiotherapist);developing and publishing a booklet entitled“Exercises for Lower-limb Amputees”, that includes acomputer-animation video on gait training inEnglish, French and Spanish.

Improving P&O services

Throughout the year, P&O services within assisted cen-tres were enhanced through several activities. Fifty-eightpersons completed, continued or began formal P&Otraining subsidized by the ICRC. The ICRC also contin-ued its formal training in Sudan and Afghanistan andconducted several technical seminars within the frame-work of assisted projects in the fields of prosthetics andorthotics.

In Afghanistan, the ICRC started a three-year formalP&O training course for 16 students, including sevenwomen. The training follows the ICRC-developed pro-gramme. The Certificate of Professional Competencygiven at the successful conclusion of the training should entitle graduates to be recognized as ISPO Cat.II-levelprofessionals.

Project No. of School Year Diplomastudents

Iraq 3 CSPO 2007 - 2010 ISPO Cat. II

4 CSPO 2008 - 2011 ISPO Cat. II

Sudan 1 TATCOT 2007 - 2010 ISPO Cat. II4 TATCOT 2006 - 2009 ISPO Cat. II5 TATCOT 2008 - 2009 Single-discipline

diploma (Cat. II level)5 TATCOT 2007 - 2008 Single-discipline

diploma (Cat. II level)

Nepal 1 CSPO 2008 - 2011 ISPO Cat. II

Philippines 1 CSPO 2007 - 2010 ISPO Cat. II

DPRK 5 CSPO 2005 - 2008 ISPO Cat. II5 CSPO 2007 - 2010 ISPO Cat. II

Colombia 2 University of 2007 - 2010 ISPO Cat. II through Don Bosco distance learning

Colombia 6 University of 2008 - 2011 ISPO Cat. IIDon Bosco

India 1 Mobility India 2007 - 2008 Lower-limb prostheticsdiploma

1 Mobility India 2008 - 2009 Lower-limb prostheticsdiploma

Yemen 3 Mobility India 2008 - 2011 P&O diploma4 Mobility India 2006 - 2009 P&O diploma

Russian 4 St Petersburg 2005 - 2008 P&O diplomaFederation Social College

Pakistan 4 PIPOS 2007 - 2010 ISPO Cat. II

In Sudan, the ICRC, in collaboration with the NationalAuthority for Prosthetics and Orthotics, the El GeraifCollege, and the Ministry of Higher Education, started asecond intake into the Sudanese Diploma for Prostheticsand Orthotics training course for 15 students, six ofwhom are women.

The ICRC also supported the development of P&O professionals by:

conducting refresher courses in P&O in Colombia,the Russian Federation, Iraq, and Tajikistan;sponsoring eight technicians at refresher coursesoffered by the ICRC Special Fund for the Disabledregional training unit in Addis Ababa, Ethiopia.

Improving wheelchair services

Although wheelchairs are made available in most assistedprojects, providing them has always raised some con-cern. Affordable and individualized wheelchairs arescarce in many of the countries where the ICRC under-takes its activities. Even when wheelchairs are available,they are often not readily adaptable to the needs ofusers. Those who provide the services are not alwayscompetent to assess the needs of patients and to set outappropriate programmes for their treatment, whichincludes selecting the proper wheelchair and modifyingit to the user’s needs.

Throughout the year, the ICRC supported appropriatewheelchair services by:

conducting wheelchair service training for P&O technologists and physiotherapists from Afghanistan,Cambodia, Angola, Iraq, Pakistan and in theDemocratic People’s Republic of Korea;updating the wheelchair-production unit in Kabul;providing technical support to implement a one-month training course in wheelchair productionin Eritrea, in collaboration with the NorwegianAssociation for Disabled and the Association for thePhysically Disabled of Kenya.

Training of expatriate specialists

ICRC expatriate specialists do not directly providepatient services in most of the projects; rather, theyadvise national personnel on technical and clinical matters. Since it is important to maintain and developthe specialists’ skills and knowledge so that they cancontinue this work, they were offered several trainingprogrammes in 2008.

Three training seminars on Ischial Containment Socketfor Trans-femoral Prosthesis were held in cooperationwith the Dortmund “BundesfachSchule” for OrthopaedicTechnique, with the Vietnamese Training Centre forOrthopaedic Technologists in Hanoi (2 seminars), and

with the Tanzanian Training Centre for OrthopaedistTechnologists in Moshi (1 seminar).

In January 2008, the first course on POP immobiliza-tions and limb tractions was held in Addis Ababa for sixexpatriates.

To improve wheelchair services, the ICRC askedMotivation UK to design a training programme to equipICRC expatriate ortho-prosthetists and physiotherapistswith the skills and knowledge necessary for dealing withpeople requiring wheelchair services and for trainingnational personnel in providing such services. The lasttwo sessions of the “Wheelchair and Postural SupportTraining” course were held in India in January and June 2008. Between 2007 and 2008, 80 ICRC specialistswere trained.

PROMOTING THE LONG-TERMFUNCTIONING OF SERVICES

The ICRC worked to ensure the long-term functioningof services not only by supporting training activities, butalso by implementing projects in close cooperation withnational partners, developing management tools, pro-viding support for the work of existing national physicalrehabilitation coordinating bodies, and promoting thedevelopment of national policies for the provision ofphysical rehabilitation services.

National partners

To help ensure that services will continue after it with-draws, the ICRC has adopted a long-term approach toimplementing and managing its physical rehabilitationprojects, and working with national partners is the cor-nerstone of this strategy. In 2008, of the 85 projectsassisted by the ICRC, 53 were undertaken in collabora-tion with government authorities (ministries of healthor social affairs), 15 with local NGOs, two with privateproviders, and six with national societies. Nine otherprojects were implemented directly by the ICRC.

Throughout the year, the ICRC worked to ensure thelong-term functioning of services by:

providing support for the work of several nationalcoordinating bodies (in Afghanistan, Angola,Cambodia, Colombia, Iraq, Pakistan, and Sudan) inthe area of physical rehabilitation;promoting the establishment of a coordinating bodyin Colombia;supporting the development of national physicalrehabilitation policies in Ethiopia;maintaining efforts to enlist the support of otherinternational and non-governmental organizations incountries where the ICRC is supporting physicalrehabilitation services;

12

PHYSICAL REHABILITATION PROGRAMME OVERVIEW OF ACTIVITIES IN 2008

13


maintaining contact with the National Community-Based Rehabilitation Programme in the DemocraticRepublic of the Congo;supporting the Uganda Ministry of Health in itsefforts to develop a standard list of P&O materialsintended for the central store;maintaining regular contact with the Ministry ofHealth in Pakistan-administered Kashmir to developa strategy to hand over the Muzaffarabad PhysicalRehabilitation Centre, managed by the ICRC, to theauthorities;supporting the Ministry of Social Protection inColombia in developing and drafting a resolutionregarding standards for P&O services and in establishing a training programme for P&O personnel.

Supporting the centres’ management

The ICRC also helped management staff in assisted centres to improve their management skills and increasetheir knowledge of physical rehabilitation. In most of itsassisted projects, the ICRC introduced an ISPO cost-calculation system that enabled managers to draw upbudgets for their centres.

In Angola, during the first six months of the year, ICRCspecialists helped the management directorates of theassisted centres to improve their management of stockand orders, administration of annual budgets and fundallocations, maintenance of machinery and equipment,patient management, through a computerized database(Patient Management System), and implementation ofwheelchair services. In Cambodia, the ICRC providedfinancial support that enabled the managers of theKompong Speu and Battambang centres to enrol in athree-year management-training course.

COOPERATION WITH OTHER BODIES

The ICRC continued to interact with various bodiesinvolved in physical rehabilitation and in disabilityissues, including the ISPO, the World Confederation ofPhysical Therapists, CPT and the World HealthOrganization as follows:

International Society for Prosthetics and Orthotics

participation in ISPO board meetings, educationalcommittee and the ad hoc committee for non-industrial countries

International non-governmental organizations

regular meetings with organizations such asHandicap International, Cambodia Trust, ChristoffelBlinden Mission, and Motivation UK to share information and coordinate activities

Academic institutions in developed and developingcountries

Norwegian University of Science and Technology to launch a life-cycle analysis on its polypropylenetechnology

National and international mine-action groups

participation in meetings of the Standing Committeeon Victim Assistance and Socio-economicReintegration under the Ottawa Convention (inter-sessional meeting and the 9th States PartiesMeeting)

ICRC headquarters

ICRC-supported prosthetic/orthotic centres

PHYSICAL REHABILITATION PROGRAMME3 – AROUND THE WORLD:

1514


1514

AFRICA

ASIA AND THE PACIFIC

EUROPE AND THE AMERICAS

MIDDLE EAST AND NORTH AFRICA

TOTAL IN THE WORLD

7 Countries: 26 projects



3 Countries andone territory: 18 projects

25 Countries andone territory: 85 projects

4 – PROJECT ACTIVITIES

16

4.1 – AFRICA

17 © C

ICR

PHYSICAL REHABILITATION PROGRAMME AFRICA

18

ICRC SUPPORT IN AFRICA AT A GLANCEIn 2008, the ICRC provided support for 26 projects in seven countries:Angola (3 projects), Chad (2), Democratic Republic of the Congo (5), Eritrea (3), Ethiopia (6), Sudan (6), and Uganda (1).Services providedPatients attending the centres 18,902New patients fitted with prostheses 2,096New patients fitted with orthoses 3,118Prostheses delivered 4,465Orthoses delivered 4,806Wheelchairs distributed 804Walking aids distributed (pairs) 6,984Children and women represented 22% and 23%, respectively, of all those benefiting from services.Developing national capacities15 candidates sponsored to attend formal training in P&O 2 candidates sponsored to attend formal training in physiotherapyICRC conducted formal P&O training in SudanPromoting long-term functioning of servicesProvided support for the work of national coordinating bodies in Angola and Sudan in the area of physical rehabilitationContinued to support the development of national physical rehabilitation policies in EthiopiaContinued to maintain contact with the National Community-Based Rehabilitation Programme in the Democratic Republic of the CongoSupported the Uganda Ministry of Health in its efforts to develop a standard list of P&O materials intended for the central store

19

After close to 30 years of support, the ICRC halted itsassistance in Angola at the end of June, believing thatAngola has all the necessary means to provide effectivephysical rehabilitation services. Provision of physicalrehabilitation services fell under the Ministry of Health’sProgramme for the Rehabilitation of Persons withPhysical and Sensorial Disabilities. Until June 2008, theICRC provided support to the Centro Ortopédico NevesBenhinda in Luanda, the Centro Ortopédico Kuito/Biéin Kuito, and the Centro de Medecina de ReabilitaçãoFísica Dr António Agostinho Neto in Huambo. BetweenJanuary and June, more than 3,000 people benefitedfrom various services at ICRC-assisted centres. Theseservices included production of 420 prostheses (72% ofthem for mine survivors) and 80 orthoses (1% of themfor mine survivors), and provision of 21 wheelchairsand 710 pairs of crutches. Children and women repre-sented 13% and 23%, respectively, of the 3,048 personsbenefiting from services.

In Chad, access to physical rehabilitation servicesremained limited to the only two centres in the country:the Maison Notre Dame de la Paix in Moundou and theCentre d’Appareillage et de Rééducation de Kabalaye inN’Djamena, both managed by local NGOs. Throughoutthe year, the ICRC continued to support the activities ofthese two centres, which benefited more than 3,300 peoplein 2008. These services included production of325 prostheses (62% of them for mine survivors) and473 orthoses (4% of them for mine survivors), and pro-vision of 42 wheelchairs and 591 pairs of crutches.Children and women represented 41% and 17%, respec-tively, of the 3,315 persons benefiting from services.

In the Democratic Republic of the Congo, the Ministryof Health, though responsible for physical rehabilita-tion, did not manage any centres. Centres were managedby religious organizations, local NGOs, or by privatecompanies. As in previous years, the ICRC did not pro-vide direct support to centres, but covered the treatmentcosts of those directly affected by the conflict in centreswith which the organization had cooperation agree-ments, notably the Centre de Rééducation pourHandicapé Physique and the Centre OrthopédiqueKalembe Lembe in Kinshasa, the Hôpital St-JeanBaptiste Kansele in Mbiji Mayi, the Centre Shirika LaUmoja in Goma, and the Centre pour Handicapés HeriKwetu in Bukavu. In 2008, the ICRC covered the treat-ment costs of 674 patients who received 589 prostheses(16% of them for mine survivors), 129 orthoses (9% ofthem for mine survivors), 279 pairs of crutches and 15 wheelchairs. Children and women represented 11%and 15%, respectively, of all those benefiting from services.

In Eritrea, physical rehabilitation activities were man-aged by the Department of Social Affairs, which is underthe Ministry of Labour and Human Welfare. TheDepartment of Social Affairs was also responsible forother services to persons with disabilities, such as socialreintegration and vocational training. The Departmentof Social Affairs has two divisions that are directly linkedwith physical rehabilitation: the Division of Orthopaedics

is responsible for providing physical rehabilitation serv-ices and the Division of Rehabilitation is responsible forother rehabilitation interventions, such as Community-Based Rehabilitation and socio-economic reintegration.The national network of centres includes the main centre in Asmara (Adi Guadad), and two smaller centreslocated in Keren and Assab. Both the Keren and Assabcentres are satellites of Adi Guadad, meaning that theyare under direct supervision of the Asmara centre direc-tor. Since 2007, the ICRC has been collaborating withthe Ministry of Labour and Human Welfare, with theaim of strengthening the provision of appropriate phys-ical rehabilitation services within the country, and withthe Ministry of Health, in strengthening physiotherapyservices in the country.

In Ethiopia, the responsibility for ensuring that physicalrehabilitation services would be available to disabledpersons rested with the Ministry of Labour and SocialAffairs. However, the regional Bureaus of Labour andSocial Affairs were in charge of providing services ineach region. Services were provided through a networkof centres managed either by the regional Bureau ofLabour and Social Affairs or by local NGOs. In 2008, theICRC continued its support for six physical rehabilita-tion centres in Dessie, Mekele, Arba Minch, Asela, BahirDar, and Menegesha. More than 8,600 people benefitedfrom various services at ICRC-assisted centres that year.These services included production of 1,959 prostheses(27% of them for mine survivors) and 2,874 orthoses(2% of them for mine survivors), and provision of697 wheelchairs and 2,593 pairs of crutches. Childrenand women represented 18% and 24%, respectively, ofthe 8,681 persons benefiting from services.

In Sudan, the responsibility for providing physical reha-bilitation services in the northern regions of the countryrested with the National Authority for Prosthetics andOrthotics (NAPO), a State body affiliated with theMinistry of Social Welfare and Social Development.The NAPO managed the national referral centre inKhartoum and satellite centres in Dongola, Kassala,Kadugli, Nyala and Damazin. The Ministry of Gender,Social Welfare and Religious Affairs was in charge ofthe rehabilitation of physically disabled people in south-ern Sudan, while the Central Equatorial State (CES) was in charge of the Juba Rehabilitation Centre. In 2008,the ICRC continued to provide support to theKhartoum national referral centre, and to the Nyala,Kadugli, Kassala and Damazin centres, all managed bythe NAPO. It also continued to provide support to the Ministry of Gender, Social Welfare and ReligiousAffairs to ensure that services were provided in southernSudan. More than 3,158 people benefited from variousservices at ICRC-assisted centres in 2008. These services included production of 1,172 prostheses (15% of them for mine survivors) and 1,227 orthoses(9% of them for mine survivors), and provision of27 wheelchairs and 2,811 pairs of crutches. Children and women represented 24%, each, of the 3,158 personsbenefiting from services.


In Uganda, physical rehabilitation was under theresponsibility of the Ministry of Health and serviceswere available through a network of 14 centres. Ugandahas one training institution (Orthopaedic TechnologyTraining School) based in Mulago Hospital complex butit is not recognized by the ISPO. In October 2008, theICRC resumed its assistance in the field of physical reha-bilitation, focusing on the west (Fort Portal) and the east(Mbale), and on developing, together with the Ministry

of Health, a central store in Kampala, operated througheither the National Medical Store (NMS) or the JointMedical Store (JMS). In November and December 2008,26 people benefited from various services at ICRC-assisted centres. These services included production of23 orthoses, and provision of two wheelchairs and one pair of crutches. Children and women represented65% and 23%, respectively, of the 26 persons benefitingfrom services.


20© C

ICR

21


In Angola, the provision of physicalrehabilitation services fell under theMinistry of Health’s Programme forthe Rehabilitation of Persons withPhysical and Sensorial Disabilities.There was a significant number ofphysically disabled persons in thecountry, and access to services waslimited for most of them. Limitedtransportation and financial resourceshindered access to services for thoseliving in rural areas. Physical rehabil-itation services were providedthrough a network of 11 centres.

After nearly 30 years of support, theICRC halted its assistance in Angola,believing that the country has all thenecessary means to provide effectivephysical rehabilitation services.

Up to June 2008, the ICRC providedsupport to the Centro OrtopédicoNeves Benhinda in Luanda, theCentro Ortopédico Kuito/Bié inKuito, and the Centro de Medecinade Reabilitação Física Dr AntónioAgostinho Neto in Huambo. Overthe years, ICRC assistance included:

construction of CentroOrtopédico Kuito/Bié in Kuito,and the Centro de Medecina deReabilitação Física Dr AntónioAgostinho Neto in Huamborenovation of the CentroOrtopédico Neves Benhinda in Luanda

donation of equipment, materialsand components, allowing theproduction of 33,041 prostheses(41% of them for mine survivors)and 962 orthoses (7% of them formine survivors) and provision of985 wheelchairs and 20,406 pairsof crutchesinstitutional support through participation in national fora suchas the National Commission onDemining and HumanitarianAssistance, and the NationalCoordination Committee ofOrthopaedic Programmesprovision of direct assistance tobeneficiaries through covering thecost of transport to attend centresfor servicesdevelopment of national capacitiesfor providing appropriate physicalrehabilitation services

Between January and June, the ICRCcontinued to donate materials andcomponents to the three centres andcovered the cost of transport formost beneficiaries. In addition,materials and components weregiven to ensure that the centres couldfunction for a minimum of one yearafter the ICRC withdrew. During thatperiod, more than 3,000 people benefited from various services atICRC-assisted centres. These servicesincluded production of 420 prosthe-ses (72% of them for mine survivors)and 80 orthoses (1% of them formine survivors), and provision of21 wheelchairs and 710 pairs ofcrutches. Children and women rep-resented 13% and 23%, respectively,of the 3,048 persons benefiting fromservices.

During the first six months of theyear, ICRC specialists provided sup-port to the management directoratesof the assisted centres to improvemanagement of stock and orders,administration of annual budget andfund allocation, maintenance ofmachineries and equipment, patientmanagement through a computer-ized database (Patient ManagementSystem), and implementation ofwheelchair services.

ANGOLANational partnerMinistry of HealthLocation of projectsLuanda, Huambo and KuitoPatient services in 2008 January - JunePatients attending the centres 3,048New patients fitted with prostheses 112New patients fitted with orthoses 58Prostheses 420Orthoses 80Wheelchairs 21Crutches (pairs) 710Beginning of assistance: 1979

22


In Chad, access to physical rehabilita-tion services remained limited to theonly two centres in the country: theMaison Notre Dame de la Paix(MNDP) in Moundou and theCentre d’Appareillage et deRééducation de Kabalaye (CARK) inN’Djamena, both managed by localNGOs. Chad was one of the 24 StatesParties to the Mine Ban Treaty thatwere identified at the first ReviewConference (Nairobi, 2004) as havingsignificant numbers of mine sur-vivors. Mines and ERW continued topose a threat to people, particularly inthe northern and eastern regions ofthe country. The exact number of dis-abled persons is yet to be ascertained.

The ICRC ensured access to servicesby undertaking a number of differentactivities implemented at the CARKin N’Djamena and at the MNDP inMoundou. Throughout the year,assisted centres were provided withraw materials and components, andthe ICRC financed the constructionof a new physiotherapy departmentat the CARK (construction should becompleted in 2009). In addition, theICRC established a referral system fordisabled persons from eastern Chadand financed their transportation toN’Djamena and accommodationthere while undergoing treatment.About 16 persons from these regionshad access to physical rehabilitationservices in 2008. As service users haveto pay for services, the ICRC alsofinanced the treatment of 187 benefi-ciaries at the CARK. In total, morethan 3,300 people benefited from var-ious services at ICRC-assisted centres

in 2008. These services included production of 325 prostheses (62%of them for mine survivors) and 473 orthoses (4% of them for minesurvivors), and provision of42 wheelchairs and 591 pairs ofcrutches. Children and women repre-sented 41% and 17%, respectively, ofthe 3,315 persons benefiting fromservices.

The quality of the services providedby both centres was enhanced by thetechnical and clinical mentoringgiven by an ortho-prosthetist and aphysiotherapist from the ICRC. Inaddition, the ICRC provided financialsupport for four staff members fromthe centres to attend P&O refreshercourses given by the regional trainingunit of the ICRC Special Fund for theDisabled in Addis Ababa, Ethiopia.

To enhance the long-term function-ing of services, the ICRC continuedto support both centres in theirefforts to find additional sources of income and improve their management.

In 2009, the ICRC intends to:

enhance the quality of services byproviding continued support froman expatriate ortho-prosthetistand a physiotherapist and bysponsoring personnel from assisted centres to attend refreshercourses given by the regionaltraining unit of the ICRC SpecialFund for the Disabled in Addis Ababafacilitate access to services by continuing to support both theCARK in N’Djamena and theMNDP in Moundou, by operatinga referral system for disabled persons from eastern and northern Chad and covering the costs of transportation andaccommodation for them, and by covering the cost of treatmentfor some beneficiaries receiving services at the CARKpromote the long-term functioningof services by supporting assistedcentres in their efforts to findadditional sources of income, andby continuing to help their managerial staff to become self-sufficient

CHADNational partnersSecours Catholique et de Développement (N’Djamena), Maison Notre Dame de la Paix (Moundou)Location of projectsN’Djamena and MoundouPatient services in 2008Patients attending the centres 3,315New patients fitted with prostheses 159New patients fitted with orthoses 305Prostheses 325Orthoses 473Wheelchairs 42Crutches (pairs) 591Beginning of assistance: 1981

The Ministry of Health, thoughresponsible for physical rehabilita-tion, did not manage any centres.Centres were managed by religiousorganizations, local NGOs, or by pri-vate companies. The NationalCommunity-Based RehabilitationProgramme was the Ministry ofHealth’s coordinating body in thearea of physical rehabilitation. As inprevious years, the ICRC did not pro-vide direct support to centres in thecountry, but it covered the treatmentcosts of those directly affected by theconflict. After identifying and assess-ing patients, the ICRC referred themto centres with which it had coopera-tion agreements: the Centre deRééducation pour HandicapéPhysique and the Centre Ortho-pédique Kalembe Lembe in Kinshasa,the Hôpital St-Jean Baptiste Kanselein Mbuji Mayi, the Centre Shirika LaUmoja in Goma, and the Centre pourHandicapés Heri Kwetu in Bukavu.

The ICRC donated imported compo-nents and raw materials and compo-nents while the centres procuredlocally available materials. Theamounts reimbursed by the ICRCincluded the costs of manufacturingthe devices, of providing physio-therapy and of walking aids.Indirectly, this scheme promoted thelong-term functioning of the centresby generating income that allowedthem to cover their operating costsand to provide services for othergroups. Throughout 2008, the ICRCworked with several local organiza-tions to reach those in need and todisseminate information.

In 2008, the ICRC covered the treat-ment costs of 674 patients whoreceived 589 prostheses (16% of themfor mine survivors), 129 orthoses(9% of them for mine survivors),279 pairs of crutches and 15 wheel-chairs. Children and women repre-sented 11% and 15%, respectively, ofall those benefiting from services.

The quality of the services providedby the centres was enhanced by thesupport provided by ICRC ortho-prosthetists and physiotherapists(expatriate and national). The ICRCsponsored training for four techni-cians in refresher courses at theregional training unit of the ICRCSpecial Fund for the Disabled inAddis Ababa. In addition, the ICRCconducted a refresher course onalignment of lower-limb prostheses.

To ensure the long-term functioningof services, the ICRC continued tomaintain regular contact with the National Community-BasedRehabilitation Programme and toprovide ongoing support to the man-agement of the assisted centres.


facilitate access to services by continuing to give patients directsupport (reimbursement of thecost of treatment), strengtheningcooperation with local NGOs andassociations, the UN Mine ActionCentre and the Direction desOeuvres Sociales Militaires of theMinistry of Defence, with the aimof identifying those in need ofservices, and by donating equipment to centres as neededenhance the quality of services by continuing to provide supportin the form of an expatriate ortho-prosthetist, by sponsoringtraining for staff in refreshercourses at regional training unitsof the Special Fund for theDisabled in Addis Ababa, and byorganizing refresher courses in thefield of physical rehabilitationpromote the long-term functioningof services by participating innational fora and sponsoring candidates to attend the congressof the African Federation ofOrthopaedic Technologists(FATO)

23

DRC DEMOCRATIC REPUBLIC OF THE CONGO

National partnersRed Cross Society of the Democratic Republic of the Congo, Ministry of Health, local NGOsLocation of projectsKinshasa (2), Mbiji Mayi, Goma and BukavuPatient services in 2008Patients receiving services with direct support from the ICRC 674New patients fitted with prostheses 155New patients fitted with orthoses 38Prostheses 589Orthoses 129Wheelchairs 15Crutches (pairs) 279Beginning of assistance: 1998


24

Physical rehabilitation activities inEritrea were managed by theDepartment of Social Affairs, whichis under the Ministry of Labour andHuman Welfare. The Department ofSocial Affairs was also responsible forother services to persons with dis-abilities, such as social reintegrationand vocational training. TheDepartment of Social Affairs has twodivisions that are directly linked withphysical rehabilitation: the Divisionof Orthopaedics which is responsiblefor providing physical rehabilitationservices, and the Division ofRehabilitation, which is responsiblefor other rehabilitation interven-tions, such as Community-BasedRehabilitation and socio-economicreintegration. The national networkof centres includes the main centre inAsmara (Adi Guadad), and twosmaller centres located in Keren andAssab. Both Keren and Assab centresare satellites of Adi Guadad, meaningthat they are under direct supervi-sion of the director of the Asmaracentre. In addition, there is also asmall P&O workshop at the DendenCamp in Asmara. This workshopproduces lower-limb orthoses anddistributes walking aids and wheel-chairs for those living in the campand those living close to the camp.Since 2007, the ICRC has been col-laborating with the Ministry ofLabour and Human Welfare with theaim of strengthening the provision ofappropriate physical rehabilitationservices, including physiotherapy.Eritrea acceded to the Mine BanTreaty on 27 August 2001, becominga State Party on 1 February 2002.

In 2007, the Eritrean DeminingAuthority identified at least 70 newmine/ERW casualties, including 17 people killed and 53 injured; nostatistics were available for 2008.

The project did not proceed asplanned during 2008, since the project proposal and Memorandumof Understanding were signed in lateOctober. However, throughout theyear the ICRC:

conducted four refresher coursesfor 42 physiotherapists provided support to the Ministryof Health for developing andimplementing a national,diploma-level training course forphysiotherapistsprovided technical support toimplement a one-month trainingcourse in wheelchair production,in collaboration with theNorwegian Association forDisabled and Association for thePhysically Disabled of Kenya provided ongoing support to Adi Guadad activities by ICRC ortho-prosthetists and physiotherapists


support both the Ministry ofLabour and Human Welfare and the Ministry of Health instrengthening their respectiveactivitiesenhance the quality of services byproviding expatriate specialists (an ortho-prosthetist and a physiotherapist), implementingrefresher courses in physiotherapyand a six-month refresher coursein Lower-Limb Orthotics,supporting the Ministry of Healthin implementing formal physiotherapy training, andexploring the feasibility ofproviding formal training in prosthetics, orthotics and physiotherapy


ERITREANational partnersMinistry of Labour and Human Welfare, Ministry of HealthLocation of projectsAdi Guadad, Keren and AssabPatient services in 2008 No statistics availablePatients attending the centres New patients fitted with prosthesesNew patients fitted with orthosesProsthesesOrthosesWheelchairsCrutches (pairs)Beginning of assistance: 2007

25


In Ethiopia, the responsibility forensuring that physical rehabilitationservices would be available to dis-abled persons rested with theMinistry of Labour and Social Affairs(MoLSA). However, the regionalBureaus of Labour and Social Affairs(BoLSA) were in charge of providingservices in each region, usuallythrough a network of centres man-aged either by the regional BoLSA orby local NGOs. Access to physicalrehabilitation services remained dif-ficult, not only because of the limitednumber of centres but also becausemost disabled persons could notafford either or both the cost of trans-portation and of accommodation

during treatment. During a work-shop organized in 2008, the MoLSAproposed creating a DisabilityCouncil with the aim of bringing allrelevant ministries (Health, Educationand MoLSA) together to implementthe new UN Convention andDevelopment Social Welfare Policy.This Disability Council shall beestablished under the office ofthe Prime Minister. The FederalDemocratic Republic of Ethiopiasigned the Mine Ban Treaty on 3 December 1997 and ratified it on17 December 2004, becoming a StateParty on 1 June 2005. In 2007,Landmine Monitor identified at least84 new civilian mine/ERW casualties

in Ethiopia, and at least 62 casualtiesbetween January and July 2008. In2008, the ICRC continued its supportto six physical rehabilitation centresin Dessie, Mekele, Arba Minch, Asela,Bahir Dar, and Menegesha. WhileICRC support to the Prosthetic andOrthotic Centre (POC) in AddisAbaba and to the Harar PhysicalRehabilitation Centre ended in 2007,these two centres continued to pro-vide services with material and com-ponents given by the ICRC in 2007.

Throughout the year, the ICRCdonated materials and componentsto centres and provided direct supportto disabled persons by reimbursing

ETHIOPIANational partnersMinistry of Labour and Social Affairs, Tigrean Disabled Veterans Association, Arba MinchRehabilitation Centre, Cheshire Services Ethiopia, Prosthetic and Orthotic CentreLocation of projectsMekele, Dessie, Arba Minch, Asela, Menagesha and Bahir DarPatient services in 2008Patients attending the centres 8,681New patients fitted with prostheses 1,166New patients fitted with orthoses 2,106Prostheses 1,959Orthoses 2,874Wheelchairs 697Crutches (pairs) 2,593Beginning of assistance: 1979

© C

ICR/

DI S

ILVE

STRO

,Jea

n-Pa

tric

k

the centres for patients’ registrationfees (3,126 persons), transportationcosts (3,376 persons) and expensesfor food (3,404 persons). In 2008,more than 8,600 people benefitedfrom various services at ICRC-assisted centres. This number islower than in 2007 due to the termi-nation of support to the POC andHarar. However, the six assisted cen-tres increased services provision bynearly 26%. These services includedproduction of 1,959 prostheses(27% of them for mine survivors)and 2,874 orthoses (2% of them formine survivors), and provision of 697wheelchairs and 2,593 pairs ofcrutches. Children and women rep-resented 18% and 24%, respectively,of the 8,681 persons benefiting fromservices.

The quality of services provided atICRC-assisted centres was enhancedby the continued mentoring ofICRC ortho-prosthetists and phys-iotherapists. In addition, the ICRCconducted a two-week refreshercourse on gait training, manage-ment of amputees and poliomyelitisfor physiotherapists and physio-therapy assistants working in theassisted centres.

The ICRC provided support to centres and authorities, at bothregional and national levels, to promote the long-term functioningof services. Expatriates providedongoing support to the managerialstaff at the centres. Throughout theyear, the ICRC provided support tothe MoLSA in developing a nationalstrategy to provide physical rehabil-itation services. The first draft willbe discussed with major stakeholdersduring 2009. Once finalised, it willbe submitted to the Council ofMinisters for approval. At the regionallevel, the ICRC maintained regularcontacts with the Bureaus of Labourand Social Affairs and developed afive-year plan of action with each ofthem with the aim of increasingtheir involvement in each centre.


enhance the quality of services by providing expatriate ortho-prosthetists and physiotherapists,promoting multidisciplinarypatient-management, and conducting short training coursesin wheelchair management andin upper limb prostheses for personnel working in assisted centres facilitate access to services byreimbursing the costs oftransportation, food and registration fees directly topatients, donating the necessaryraw materials and components,and initiating support to theCheshire Home Ethiopia DireDawa Centrepromote the long-term functioning of services by maintaining support to the centres’ managerial staff,conducting training in severalaspects of managing the centres,supporting the implementationof the five-year action plan witheach Bureau of Labour and SocialAffairs, and assisting the MoLSAin developing and implementinga national strategy to providephysical rehabilitation services

26


27


SUDAN

The responsibility for providingphysical rehabilitation services in thenorthern regions of the country restedwith the National Authority forProsthetics and Orthotics (NAPO), aState body affiliated with theMinistry of Social Welfare and SocialDevelopment. The NAPO managedthe national referral centre inKhartoum and satellite centres inDongola, Kassala, Kadugli, Nyala andDamazin. The NAPO signed agree-ments with the relevant ministries ofthe states in which the centres arelocated to establish a framework forsharing responsibilities and carryingout activities. In addition, the NAPObegan establishing committees ineach state to coordinate work toimprove the situation of personswith disabilities. Such committeeswere created in Kadugli and Damazine.The Ministry of Gender, Social Welfareand Religious Affairs was in charge ofproviding rehabilitation services forphysically disabled people in southernSudan, while the Central EquatorialState was in charge of the JubaRehabilitation Centre. The SouthernSudan War Disabled, Widows andOrphans Commission, created inNovember 2006, formulates and promotes policies and legislation toprotect and care for persons withwar-related disabilities, war widowsand war orphans, and advises theGovernment of South Sudan on themost effective ways to implementsuch policies and programmes.

The Republic of the Sudan signed theMine Ban Treaty on 4 December 1997and ratified it on 13 October 2003,becoming a State Party on 1 April 2004.

Victim Assistance coordination groupswere well established in Sudan andthe ICRC maintained close contactwith them. The group in Khartoumis chaired by the National MineAction Centre while in the south, thegroup in Juba is chaired by theMinistry of Gender, Social Welfareand Religious Affairs.

In 2008, the ICRC provided supportto the Khartoum national referralcentre and the Nyala, Kadugli,Kassala and Damazin centres, allmanaged by the NAPO. It also sup-ported the Ministry of Gender, SocialWelfare and Religious Affairs toensure services were provided insouthern Sudan.

Throughout the year, the ICRCimplemented several activities toimprove accessibility to services.These included: resuming support tothree NAPO satellite centres (Kadugli,Kassala and Damazin), renovatingand extending Kadugli and Nyalacentres, providing the necessary rawmaterials and components to theJuba centre (the NAPO provided thematerial and components for the otherassisted centres), and covering the costsof transportation and accommodationfor persons receiving treatment at theJuba and Nyala centres. In addition,construction of the new referral centrein Juba, for southern Sudan, was com-pleted in December. In 2008, more than3,158 people benefited from variousservices at ICRC-assisted centres.These services included production of1,172 prostheses (15% of them formine survivors) and 1,227 orthoses(9% of them for mine survivors), and

provision of 27 wheelchairs and2,811 pairs of crutches. Children andwomen represented 24% each, of the3,158 persons benefiting from services.

With the aim of improving the qualityof services, the ICRC provided ongo-ing support and mentoring by ICRCortho-prosthetists and physiothera-pists. In January 2008, the ICRCstarted a second intake into theSudanese Diploma for Prostheticsand Orthotics training course for 15 students, six of them women, incollaboration with the NAPO, the ElGeraif College and the Ministry ofHigher Education. To improve thetraining facilities, the ICRC financedan extension of the premises.

The ICRC also provided scholarshipsfor 17 persons to begin, continue orcomplete formal P&O training atTATCOT (15 candidates) or formalphysiotherapy training at the KigaliHealth Institute (2 candidates). Allthese activities were undertaken todevelop national capacity for provid-ing high-quality services and areessential for ensuring the long-termfunctioning of services.

National partnersNational Authority for Prosthetics and Orthotics, Ministry of Gender, Social Welfare andReligious Affairs of the Government of South SudanLocation of projectsKhartoum, Nyala, Kadugli, Kassala, Damazin and JubaPatient services in 2008Patients attending the centres 3,158New patients fitted with prostheses 504New patients fitted with orthoses 590Prostheses 1,172Orthoses 1,227Wheelchairs 27Crutches (pairs) 2,811Beginning of assistance: 1985


facilitate access to services by providing support to the NAPOand its Nyala, Kadugli, Kassalaand Damazin satellite centres,maintaining support to the newlyconstructed referral centre inJuba, and covering the costs oftransportation, accommodationand food for some patients

enhance the quality of services byconducting the SudaneseDiploma for Prosthetics andOrthotics training, providingscholarships to candidates toattend formal training in P&Oand in physiotherapy, and providing ongoing supportthrough ICRC ortho-prosthetistsand physiotherapists

promote the long-term functioning of services by maintaining support to theNAPO to manage physical rehabilitation activities, and byassisting the Ministry of Gender,Social Welfare and ReligiousAffairs in the physical rehabilitation activities undertaken in southern Sudan

2828


© C

ICR/

GASS

MAN

N,Th

ierr

y


29

UGANDA

In Uganda, the Ministry of Healthwas responsible for physical rehabili-tation and services were availablethrough a network of 14 centres.Uganda has one training institution,the Orthopaedic Technology TrainingSchool, based in Mulago Hospitalcomplex, (which is not recognized bythe ISPO. Given the difficulty inobtaining reliable statistics on per-sons with disabilities, the UnitedNations Development Programmeworked with the Prime Minister’soffice, the Ministry of Health and theMinistry of Gender and SocialDevelopment to set up a database tocapture such information. TheRepublic of Uganda signed the MineBan Treaty on 3 December 1997 andratified it on 25 February 1999, becom-ing a State Party on 1 August 1999.National implementation legislationhas been under development for sixyears, but as of June 2008 had stillnot been enacted. The cumulativenumber of mine casualties in Ugandais not known. The government hasbeen reporting 900 survivors innorthern Uganda and 200 in westernUganda since 2005.

Between 1998 and 2002, the ICRCprovided physical rehabilitationassistance for three centres in Uganda(Fort Portal, Gulu, and Mbarara).Mbarara ceased functioning in 2006,when the centre ran out of materialand components donated by theICRC in 2002. The two other centrescontinue to function. Following anassessment conducted in early 2008,the ICRC resumed support for phys-ical rehabilitation. Begun in October,ICRC assistance focused on the west

(Fort Portal) and the east (Mbale)and on developing, with the Ministryof Health, a central store in Kampala,operated through either the NationalMedical Store or the Joint MedicalStore.

Assistance to Fort Portal began in lateOctober and focused on improvingthe centre’s structure and organiza-tion. Improvements were made tothe stores, stock management, dor-mitory, and machinery. In Novemberand December 2008, 26 people bene-fited from various services at theICRC-assisted centre. These servicesincluded production of 23 orthoses,and provision of two wheelchairsand one pair of crutches. Childrenand women represented 65% and23%, respectively, of the 26 personsbenefiting from services.

In October, a meeting was held inKampala with the Ministry of Healthand various representatives of cen-tres around the country to develop a standard list of P&O materialsintended for the central store. The listwas agreed and presented to theMinistry of Health.


improve accessibility to services bysupporting the activities of theFort Portal centre, initiating support to the Mbale centre,and covering the cost of transportand accommodation for a specificgroup of beneficiariesenhance the quality of services byproviding ongoing support andmentoring through ICRC specialists (ortho-prosthetists andphysiotherapists) and by sponsoringtwo P&O technicians to attendrefresher courses at the ICRCSpecial Fund for the DisabledRegional Training Unit in Addis Ababapromote the long-term functioningof services by supporting theMinistry of Health in creating a central store

National partnerMinistry of HealthLocation of projectsFort PortalPatient services in 2008 (statistics November and December)Patients attending the centres 26New patients fitted with orthoses 21Orthoses 23Wheelchairs 2Crutches (pairs) 1Beginning of assistance: 2007

30

4.2 – ASIA

© C

ICR/

SAUN

DERS

ON,

Davi

d

3131


ICRC SUPPORT IN ASIA AT A GLANCEIn 2008, the ICRC provided support for 31 projects in ten countries:Afghanistan (7 projects), Cambodia (3), China (3), Democratic People's Republic of Korea (2), India (2), Myanmar (7), Nepal (1), Pakistan (4),Sri Lanka (1), and Philippines (1).In addition, while not directly supporting a centre in Bangladesh, the ICRC covered the cost of treatment for 398 persons there who received 477 orthoses and 122 prostheses in 2008. These services were provided by ICRC Special Fund for the Disabled-assisted centres: BRAC Limb and Brace Centre in Dhaka (96 persons), BRAC Orthotics & Physiotherapy Centre in Mymensigh (80 persons) and the Centre for the Rehabilitationof the Paralyzed in Dhaka (222 persons).Services providedPatients attending the centres 92,028New patients fitted with prostheses 3,895New patients fitted with orthoses 6,198Prostheses delivered 10,128Orthoses delivered 13,994Wheelchairs distributed 1,589Walking aids distributed (pairs) 8,640Children and women represented 20% and 15%, respectively, of all those benefiting from services.In Afghanistan, more than 2,300 disabled persons received aid through the various activities of the social inclusion programme (job placement,special education, vocational training, micro-credit, etc.).Developing national capacities17 candidates sponsored to attend formal training in P&O 7 candidates sponsored to attend formal training in physiotherapyICRC conducted formal P&O training in AfghanistanPromoting long-term functioning of servicesProvided support for the work of several national coordinating bodies in Afghanistan, Cambodia, and Pakistan in the area of physical rehabilitation Maintained regular contact with the Ministry of Health in Pakistan-administered Kashmir to develop a strategy to hand over the MPRC (managed by the ICRC) to the authoritiesContinued to strengthen the capacity of the authorities in Cambodia to manage and run all activities at the centres and at the component factory

In Afghanistan, three ministries were directly involvedin the disability sector: the Ministry of Public Health,the Ministry of Social Affairs and Martyrs and Disabled,and the Ministry of Education. In each, a disability com-mission was operative as the referral point for any questions concerning the physical rehabilitation, socialreintegration and education of persons with disabilities.While physical rehabilitation services were availablethrough a network of 14 centres, only one was managedby the Afghan authorities; all the others were run byinternational organizations. In 2008, the ICRC contin-ued to manage six physical rehabilitation centresthroughout the country and one orthopaedic compo-nent factory in Kabul, which also produces wheelchairs.Close to 67,000 people benefited from various servicesat ICRC-managed centres. These services included theprovision of 3,967 prostheses (66% of them for minesurvivors) and 9,910 orthoses (0.6% of them for minesurvivors), and of 818 wheelchairs and 4,581 pairs ofcrutches. In addition, the majority of those who weregiven assistive devices also received appropriate physio-therapy. Children and women represented 25% and15%, respectively, of all those benefiting from services.

In Cambodia, although several government ministrieshad a role in disability issues, the Ministry of SocialAffairs, Veterans and Youth Rehabilitation was entrustedwith responsibility for providing physical rehabilitationand training in vocational skills to disabled persons.Physical rehabilitation services were provided through11 Physical Rehabilitation Centres covering 24 provinces.Among these, only two are directly managed by theMinistry: Battambang and Kompong Speu, which are

supported by the ICRC. With ICRC support, theMinistry also manages the Phnom Penh ComponentFactory, the sole producer of orthopaedic componentsand walking aids. The Factory supplies those devices,free of charge, to all 11 centres in the country and to theCambodian School of Prosthetics & Orthotics (CSPO).ICRC-assisted centres produced 1,675 prostheses (86%of them for mine survivors) and 1,394 orthoses (2.5% ofthem for mine survivors). Children and women repre-sented 8% and 13%, respectively, of the 10,201 personsbenefiting from services. At the same time, orthopaedicComponent Factory in Phnom Penh continued todonate components to all centres in the country.

The ICRC concluded the first phase of its assistance inChina. During the last five years, the ICRC helped to setup the Orthopaedic Rehabilitation Centre, in Kunming,and two repair workshops, in Malipo and Kaiyuan, allmanaged by the China Red Cross Society, YunnanBranch. The Yunnan branch of the Red Cross Society ofChina is now fully responsible for managing physicalrehabilitation activities. However, the ICRC continuedto monitor and support the services through missionsand donations of required components, walking aidsand wheelchairs. In 2008, the Yunnan centre produced176 prostheses, and 285 former beneficiaries had theirprostheses repaired. Children and women represented0.3% and 17%, respectively, of the 503 persons who hadaccess to services. In addition, roughly 15% of all thepatients belonged to minority groups.

In the Democratic People’s republic of Korea, theKorean Federation for the Protection of the Disabled,

32

PHYSICAL REHABILITATION PROGRAMME ASIA

© C

ICR/

PAGE

TTI,

Fran

co

33


the Ministry of Public Health (MoPH) and the MilitaryMedical Bureau of the Ministry of People’s ArmedForces provided physical rehabilitation services. Theywere in charge of the centres in Hamhung, Songrim andRakrang, respectively. In addition, the MoPH is runningthree repair workshops in Pyongyang, Chong Jin (NorthHamgyong province) and Sunchon (North Pyongyangprovince), where mainly leather prostheses, manufac-tured at the Hamhung Factory, are repaired or main-tained. In 2008, the ICRC provided assistance to theMoPH to develop physical rehabilitation services at itscentre in Songrim, and to the Military Medical Bureauof the People’s Armed Forces to develop services at itscentre in Rakrang. Some 1,508 persons benefited fromvarious services provided at ICRC-assisted centres.These services included the provision of 1,204 prostheses(0.17% of them for mine survivors) and 13 orthoses,49 wheelchairs and 1,859 pairs of crutches. In addition,most of those who received devices were also given theappropriate physiotherapy treatment. Children andwomen represented 1% and 12%, respectively, of allthose benefiting from services.

In India, the ICRC continued to back the efforts of theIndian Red Cross Society to improve accessibility ofservices in Jammu and Kashmir by providing supportfor the P&O departments at the Jammu GovernmentalMedical College and the Bone and Joint Hospital inSrinagar. With support from the ICRC, the assisted centre produced 76 prostheses (17% of them for minesurvivors) and 95 orthoses (17% of them for mine survivors) and distributed 20 pairs of crutches and 19 wheelchairs. Children and women represented 11%and 21%, respectively, of the 540 persons benefitingfrom services.

In Myanmar, government restrictions imposed on theICRC prevented the organization from discharging itsmandate in accordance with its standard working proce-dures, which are internationally recognized and whichthe Myanmar authorities had accepted in previous years.Since mid-2007, the ICRC has directly supported onlythe Hpa-an Orthopaedic Rehabilitation Centre(HORC), run jointly by the Myanmar Red Cross Societyand the ICRC. However, centres managed either by theMinistry of Health (3) or the Ministry of Defence (3),that were formerly assisted by the ICRC, were givenenough materials to ensure that the centres would continue to provide services. A total of 5,419 peoplebenefited from various services at the HORC (1,194)and within the MoH and MoD centres (4,225). Theseservices included production of 1,867 prostheses and1,204 orthoses, and provision of 26 wheelchairs and1,155 pairs of crutches. Children and women represented4% and 9%, respectively, of all those benefiting fromservices.

In Nepal, the first government-run rehabilitation centre,Aerahiti National Rehabilitation Centre, opened inKathmandu under the management of the Army. Thecentre started providing services in June (only for

persons with spinal-cord injury). Under a cooperationagreement with the government, the ICRC will provideassistance to establish a prosthetics and orthoticsdepartment within the rehabilitation centre. With ICRCfinancial support (reimbursement for treatment), theP&O department of the Green Pasture Hospital providedservices for more than 1,098 people and produced 97 prostheses and 174 orthoses in 2008. Children andwomen represented 14% and 27%, respectively, of the1,098 persons benefiting from services.

In Pakistan, the ICRC maintained its support to thePakistan Institute of Prosthetic and Orthotic Sciences inPeshawar, the Quetta Christian Hospital RehabilitationCentre, and the Muzaffarabad Physical RehabilitationCentre, which is managed by the ICRC. In addition, theICRC began collaborating with the HayatabadParaplegic Centre (Peshawar) within the framework ofthe Home Care Project. In 2008, more than 5,200 peoplebenefited from various services at ICRC-assisted centres.These services included production of 758 prostheses(39% of them for mine survivors) and 1,078 orthoses(8% of them for mine survivors), and provision of118 wheelchairs and 309 pairs of crutches. Children andwomen represented 19% and 14%, respectively, of the5,277 persons benefiting from services.

In the Philippines, physical rehabilitation services weremainly provided by national NGOs. In Mindanao, fiveof them were registered by the NCDA, including theDavao Jubilee Centre, managed by the Davao JubileeFoundation, to which the ICRC refers beneficiaries. In2008, the Davao Jubilee Centre provided services to 45 persons with the support of the ICRC, including theprovision of 43 prostheses and 34 pairs of crutches. TheICRC met the patients’ expenses for transportation,lodging, food, and for their treatment. Women repre-sented 16%, of all those benefiting from services. Whilea regular follow-up of those who received services in thepast was planned, in collaboration with the PhilippinesRed Cross Society, this activity was postponed becauseof the hostilities.

In Sri Lanka, the ICRC maintained its support to theactivities of the Jaffna Jaipur Centre for DisabilityRehabilitation, the only physical rehabilitation serviceprovider in Jaffna penisnsula. As a result of the politicalsituation, disabled persons in the Jaffna district of SriLanka faced many obstacles in getting the physical reha-bilitation that they needed. More than 842 persons benefited from various services provided with the assis-tance of the ICRC. These services included the provisionof 265 prostheses (55% of them for mine survivors) and126 orthoses (1.6% of them for mine survivors),67 wheelchairs and 35 pairs of crutches. Children andwomen represented 4% and 25%, respectively, of the842 persons benefiting from services.

34


Since disability is a cross-cuttingissue, touching several aspects of life,three ministries were activelyinvolved: the Ministry of PublicHealth, the Ministry of Social Affairsand Martyrs and Disabled, and theMinistry of Education. In each, a dis-ability commission operated as thereferral point for any questions con-cerning physical rehabilitation, socialreintegration and education ofpersons with disabilities. TheMinistry of Public Health has includedphysical rehabilitation in the BasicPackage of Health Services and theEssential Package of HospitalServices. While physical rehabilita-tion services were available through anetwork of 14 centres, only one wasmanaged by the Afghan authorities;all the others were run by interna-tional organizations. Afghanistanwas the only country in which theICRC had completely assumed thetask of ensuring access to rehabilita-tion services. Nevertheless, coopera-tion continued between the ICRCand the Ministry of Public Health,the Ministries of Social Affairs andMartyrs and Disabled and ofEducation, hospitals, health facilities,branches of the Afghan Red CrescentSociety, local associations of the dis-abled, and NGOs.

In 2008, the ICRC managed six phys-ical rehabilitation centres through-out the country and one orthopaediccomponent factory in Kabul, whichalso produces wheelchairs. In addi-tion, the ICRC started a formal P&Otraining programme, continued tomanage a special programme for

those with spinal-cord injuries(Home Care Programme), and sup-ported the social inclusion of personswith disabilities.

Access to rehabilitation services, andhealth services in general, was madedifficult by a number of obstacles:lack of awareness, ignorance, absenceof professionalism among medicalpersonnel, prejudiced views on phys-ical disability, poverty, distanceswithin the country and difficulties intransportation, violence, ethnic andpolitical divisions. While ICRC assis-tance aims to remove some of theseobstacles, much work needs to bedone to enhance accessibility to serv-ices and to allow persons with dis-abilities to play an active role withintheir communities. Throughout theyear, information was disseminatedthrough field trips, participation inconferences and round tables on dis-ability, cooperation and referral withthe Afghan Red Crescent and otherorganizations, close relations withhospitals and health facilities, andtraining for students of the MedicalFaculty and other paramedical schools.Close to 67,000 people benefited fromvarious services at ICRC-managedcentres. These services included the provision of 3,967 prostheses(66% of them for mine survivors)and 9,910 orthoses (0.6% of them formine survivors), 818 wheelchairs and4,581 pairs of crutches. Most of thosewho were given assistive devices alsoreceived appropriate physiotherapy.Children and women represented25% and 15%, respectively, of allthose benefiting from services.

The ICRC-managed component fac-tory provided, free of charge, compo-nents to four non-ICRC centres.Under the ICRC’s Home CareProgramme for paraplegics withspinal-cord injuries, 1,098 personsreceived assistance during 6,983 homevisits. The ICRC also ran a specialphysiotherapy programme for chil-dren with cerebral palsy (1,276 newregistrations in 2008).

The ICRC’s physical rehabilitationproject in Afghanistan combined theprovision of physical rehabilitationservices with activities aimed at inte-grating disabled persons into society.More than 2,300 disabled personsreceived aid through job placement,special education, vocational train-ing, and micro-credit schemes.

The ICRC maintained its support forthe professional development ofnational P&O technicians and physiotherapists working in ICRC-managed centres. Besides the ongo-ing mentoring and other forms ofsupport provided by ICRC ortho-prosthetists and physiotherapists, theICRC, in cooperation with theMinistry of Public Health, started athree-year training course in pros-thetics and orthotics. Sixteentrainees, 7 of whom are women, areenrolled and the training takes placein the ICRC dedicated facility in theKabul Ortho Centre.

AFGHANISTANNational partnerNoneLocation of projectsKabul (2), Mazar-i-Sharif, Herat, Jalalabad, Gulbahar and FaizabadPatient services in 2008Patients attending the centres 66,595New patients fitted with prostheses 888New patients fitted with orthoses 4,069Prostheses 3,967Orthoses 9,910Wheelchairs 818Crutches (pairs) 4,581Beginning of assistance: 1987

35


To ensure the long-term functioningof services, the ICRC maintainedclose contact with relevant authori-ties. While the complete handover ofthe project is not yet possible, theICRC continued to develop thecapacities of Afghan employees withthe aim of transferring all manage-ment responsibilities to them.


enhance the quality of services byconducting the formal three-yeartraining course in prosthetics and orthotics, improving the components and wheelchairs produced at the Kabul factory,maintaining its support for thetraining of physiotherapists, andproviding ongoing support fromICRC expatriate ortho-prosthetistsand physiotherapistsfacilitate access to services by supporting the six centres andtheir activities, conducting outreach visits, maintaining goodworking relationships with health care facilities and otherorganizations, supporting thedevelopment of referral networks(especially in areas where no service is available), and continuingto donate components to non-ICRC centrespromote the social reintegration ofdisabled persons by continuing itssocial inclusion programmepromote long-term functioning ofservices by developing nationalcapacities

© C

ICR

36


CAMBODIA

In Cambodia, although several government ministries had a role indisability issues, the Ministry ofSocial Affairs, Veterans and YouthRehabilitation was given the respon-sibility of providing physical rehabil-itation and training in vocationalskills to disabled persons. Physicalrehabilitation services were providedthrough 11 Physical RehabilitationCentres (PRCs) covering 24 provincesin Cambodia. Among these centres,only two are directly managed by theMinistry: Battambang and KompongSpeu, which are supported by theICRC. The Ministry is also manag-ing, with ICRC support, the PhnomPenh Component Factory, the soleproducer of orthopaedic compo-nents and walking aids, which theFactory supplies free of charge to all11 centres and to the CambodianSchool of Prosthetics & Orthotics(CSPO). In June 2008, a Memorandumof Understanding was signed betweenthe Ministry and all organizationssupporting the sector stating that theMinistry would manage all the PRCsby the end of 2011. The ICRC willcontinue to build the Ministry’scapacity to manage the Centres atboth the local and national levels.

Accurate statistics on the number ofpersons with disabilities inCambodia are not available. Themost accurate data, found in the2004 Cambodian Socio-EconomicSurvey, reports a disability rate of4%; mobility-related disabilitiesaccount for the second largest share(24%). Landmines and ERW continueto threaten many rural communities.

Long-standing mine-clearance andmine-risk education activities havehelped to reduce the number of newcasualties. In 2008, 266 casualtieswere reported by the CambodianMine/UXO Victim InformationSystem, which represents a decreaseof 24% over 2007 figures. Most casu-alties occurred in provinces coveredby the two regional physical rehabili-tation centres supported by the ICRC.

To ensure full participation of andequal opportunities for disabled peoplein social activities, the Ministry, incollaboration with various govern-ment and non-government organiza-tions such as the Disability ActionCouncil and the Cambodian DisabledPersons Organization, drafted legisla-tion on the Right of People withDisabilities, which is still pendingadoption.

The two ICRC-assisted centres inBattambang and Kompong Speuremain the most important providersof physical rehabilitation services.According to national statistics, theyprovided about 55% of all services in2007. To enhance access to services,the ICRC and the Ministry provideddirect support to patients, reimburs-ing transportation and accommoda-tion costs. The ICRC also maintainedits support for the centres’ outreachprogrammes, and supported thedevelopment of a comprehensivenetwork of potential partners withinthe centres’ catchment areas. Throughthe centres’ outreach programmes,8,892 patients were examined,3,537 devices were repaired and

281 wheelchairs and 1,310 pairs ofcrutches were distributed. ICRC-assisted centres produced 1,675 pros-theses (86% of them for mine sur-vivors) and 1,394 orthoses (2.5% ofthem for mine survivors). Childrenand women represented 8% and 13%,respectively, of the 10,201 personsbenefiting from services. In addition,the orthopaedic Component Factoryin Phnom Penh provided compo-nents for all the centres, thus ensur-ing proper care for about 15,000 per-sons annually.

To improve the quality of the servicesprovided, the ICRC developed thecapacity of national personnel toprovide services. Besides providingongoing mentoring for all personnel,ICRC ortho-prosthetists and physio-therapists conducted a third, two-week training course on wheelchairsand postural seating for all P&Otechnicians and physiotherapistsworking at assisted centres. In addi-tion, the ICRC sponsored trainingfor physiotherapists in a programmeto upgrade skills, which was conductedin Cambodia in cooperation with the Singapore General HospitalPostgraduate Allied Health Institute.During the year, seven physiothera-pists were enrolled in the training,two of whom attended a six-monthclinical placement in Singapore.

Beside promoting access to the cen-tres and improving the quality of theservices, the ICRC continued to buildthe capacity of the Ministry to man-age all activities at the centres and atthe Component Factory.

National partnerMinistry of Social Affairs, Veterans and Youth RehabilitationLocation of projectsPhnom Penh, Battambang and Kompong SpeuPatient services in 2008Patients attending the centres 10,201New patients fitted with prostheses 348New patients fitted with orthoses 425Prostheses 1,675Orthoses 1,394Wheelchairs 491Crutches (pairs) 1,442Beginning of assistance: 1991

37


In 2008, the ICRC participated inthe work of several committees thataddress disability issues. Expatriatestaff mentored directors and headsof departments in all centres, andthe ICRC provided scholarships forthe managers of two centres,enabling them to study for a bache-lor’s degree in business manage-ment.


enhance the quality of servicesthrough continued assistancefrom ICRC ortho-prosthetistsand a physiotherapist, by sponsoring two candidates toattend formal training in P&O(ISPO Cat. I), and by helping todevelop the national capacity todeliver services

facilitate access to services bymaintaining its support for theBattambang and Kompong Speucentres and the Phnom PenhComponent Factory, supportingthe centres’ outreach programmes,providing direct support forpatients, and helping to developreferral networks in the areascovered, including with theCambodian Red Cross Micro-Economic Initiative programme

promote the long-term functioning of services by participating in the PhysicalRehabilitation Committee,developing the Ministry’s capacities to manage physicalrehabilitation activities, and urging the Ministry to increaseits financial contribution forphysical rehabilitation services

© C

ICR


38

While many physical rehabilitationservice providers exist in China, thetwo main providers are the Ministryof Civil Affairs and the ChineseDisabled Persons’ Federation. Since2004, the Yunnan branch of the RedCross Society of China (YRC) hasbeen managing a physical rehabilita-tion centre in Yunnan, which provides free services to destituteamputees. The YRC also managedtwo repair workshops located inMalipo and Kaiyuan. Following theearthquake in Sichuan, the HongKong Red Cross asked the YRC topurchase needed equipment, set up aphysical rehabilitation facility andstart fitting amputees. The centreopened in September and some 30 to40 individuals received prostheses.The YRC sent four teams of oneorthopaedic technologist and onephysiotherapy assistant each to assistthe Hong Kong Red Cross for a five-month period.

The first phase of the ICRC’s assis-tance ended in 2008. During the pastfive years, the ICRC helped establishthe Orthopaedic RehabilitationCentre in Kunming and two repairworkshops in Malipo and Kaiyuan.The ICRC also sponsored a formaltraining course in prosthetics andorthotics for four candidates, whileICRC specialists provided intensivein-house training for technicians,workshop assistants and physiother-apy assistants. The ICRC also donatedall necessary production material,machines, equipment and varioustools. The YRC now manages allphysical rehabilitation activities. The

ICRC will continue to monitor andsupport the services by donatingrequired components, walking aidsand wheelchairs, and conductingfield missions

To enhance access to services, theYRC supported two repair work-shops to accommodate beneficiarieswho live far away from the Kunmingcentre. The YRC also conducted four outreach visits in which close to140 amputees were assessed and 37 prostheses were repaired on thespot; 60 beneficiaries received anappointment to have their prosthesesreplaced at the Kunming centre.During these visits, 13 new amputeeswere identified and had their first fit-ting. In 2008, the Yunnan centre pro-duced 176 prostheses and 285 formerbeneficiaries had their prosthesesrepaired. Children and women repre-sented 0.3% and 17%, respectively, ofthe 503 persons who had access toservices. In addition, roughly 15% ofall patients belonged to minoritygroups. During the year, the YRCreported three new landmine casual-ties. The YRC-managed centre pro-vided 44 prostheses (25%) out of atotal of 176 to landmine survivors,including four survivors who hadnever had access to services.

To improve the quality of services, arefresher course on lower-limb pros-thetic alignment was conducted atthe beginning of year. The four tech-nicians trained at the China TrainingCentre for Orthopaedic Technologistsare now fully engaged in providingservices. The ICRC promoteed the

long-term functioning of services bystrengthening the capacity of theYRC to manage physical rehabilita-tion activities.


ensure the quality of servicesthrough support from ICRCregional ortho-prosthetists facilitate access to services by donating the necessary components, wheelchairs andwalking aids to the centre inKunming and its two repair workshopspromote the long-term functioningof services by developing thecapacity of the YRC to manage all activities relating to physicalrehabilitation

CHINANational partnerRed Cross Society of China (Yunnan branch)Location of projectsKunming, Malipo and KaiyuanPatient services in 2008Patients attending the centres 503New patients fitted with prostheses 44Prostheses 176Crutches (pairs) 3.5Beginning of assistance: 2003

39


DPRK

The Korean Federation for theProtection of the Disabled (KFPD),the Ministry of Public Health and theMilitary Medical Bureau of theMinistry of People’s Armed Forceswere the sole providers of physicalrehabilitation activities. They were incharge of the centres in Hamhung,Songrim and Rakrang, respectively.The Ministry of Public Health also runsthree repair workshops in Pyongyang,Chong Jin (North Hamgyongprovince) and Sunchon (NorthPyongyang province), where mainlyleather prostheses, manufactured atthe Hamhung Factory, are repairedor maintained. Since 2002, the ICRChas been providing assistance to theMinistry of Public Health for thedevelopment of physical rehabilita-tion services at its centre in Songrim(30 km from Pyongyang). Since2005, the ICRC has been providingassistance to the Military MedicalBureau to develop services at its centrein Rakrang. There is still no nationalpolicy regarding physical rehabilita-tion services. In November 2008, theKFPD organized a joint informationseminar with the Military MedicalBureau, the Ministry of Public Health,the Ministry of Labour, and the DPRKRed Cross Society. Management representatives from the three physi-cal rehabilitation centres and repairworkshops were present, as was theICRC. All participants expressedtheir interest in working to develop anational structure that would stan-dardize regulations and methods.The ICRC will support this initiative.

To improve access to services, theICRC donated the raw materials,equipment and components neededto ensure that services were providedin both centres. With ICRC support,the Ministry of Public Health, in col-laboration with the DPRK Red CrossSociety, conducted four outreach vis-its with the aim of following up onthose who had received services and,when needed, repairing devices onthe spot. Some 300 persons wereexamined during the visits and 236 devices were repaired. Some1,508 persons benefited from variousservices provided at ICRC-assistedcentres. These services included theprovision of 1,204 prostheses (0.17%of them for mine survivors) and 13 orthoses, and 49 wheelchairs and1,859 pairs of crutches. In addition,most of those who received deviceswere also given the appropriate phys-iotherapy treatment. Children andwomen represented 1% and 12%,respectively, of all those benefitingfrom services.

The quality of services at ICRC-assisted centres was improved throughin-house training and mentoring ofnational personnel by ICRC ortho-prosthetists and physiotherapists.Clinical personnel were coachedalmost daily, and short-term trainingcourses were provided on such sub-jects as trans-tibial and trans-femoralamputations, pre/post-fitting physi-cal therapy, and gait deviation analy-ses. In addition, a 10-day trainingsession on wheelchair prescription,adaptation and training for users was

conducted in both centres. Duringthe year, five students returned toDPRK after successfully graduatingfrom the CSPO in Phnom Penh.They had received financial supportfrom the ICRC. All of them are nowworking within the centres. In addi-tion, the ICRC sponsored the train-ing of five persons at the CSPO.


enhance the quality of services by providing mentoring by ICRC ortho-prosthetists and physiotherapists, sponsoring persons for formal training inP&O and in physiotherapy, andconducting a short course inupper-limb prostheses and ankle-foot orthoticsfacilitate access to services by supporting the Songrim andRakrang physical rehabilitationcentres, and assisting the Ministryof Public Health and the DPRKRed Cross Society in conductingthe outreach programmepromote the long-term functioningof services by building the nationalcapacity to provide and managephysical rehabilitation services and supporting any national initiatives to develop a nationalpolicy for physical rehabilitation

National partnersRed Cross Society of the DPRK, Ministry of Public Health, Ministry of DefenceLocation of projectsSongrim and PyongyangPatient services in 2008Patients attending the centres 1,508New patients fitted with prostheses 640New patients fitted with orthoses 4Prostheses 1,204Orthoses 13Wheelchairs 49Crutches (pairs) 930Beginning of assistance: 2002

DEMOCRATIC PEOPLE’S REPUBLIC OF KOREA

40


In 2008, the ICRC continued to backthe efforts of the Indian Red CrossSociety to improve accessibility ofservices in Jammu and Kashmir by providing support for the P&O departments at the JammuGovernmental Medical College andthe Bone and Joint Hospital inSrinagar. The strategically locatedJammu and Kashmir State is boundedby Pakistan, Afghanistan and China.One-fifth of the State’s population ofnearly nine million live in urbanareas. Partly because of the land-scape, it is difficult for those in needof physical rehabilitation services totravel either to Srinagar or in Jammu.Public transportation is available, butin some cases, it takes up to threedays to reach the cities. Given thatmany people live in poverty, theyoften cannot afford the cost of trans-port and accommodation whenunder treatment are so cannot accessservices. The Republic of India hasnot acceded to the Mine Ban Treaty.A Landmine Monitor field visit toJammu and Kashmir in October andNovember 2007 noted that minescontinue to pose a threat for civiliansliving near the Line of Control andthat casualties occur while people arecarrying out livelihood activities,such as collecting firewood, shep-herding and farming.

The ICRC donated P&O materials,equipment and components, physio-therapy equipment, and wheelchairsand walking aids during 2008. Inaddition, the ICRC covered the costof accommodation for beneficiariescoming to the Bone and Joint

Hospital in Srinagar. With supportfrom the ICRC, the assisted centreproduced 76 prostheses (17% of themfor mine survivors) and 95 orthoses(17% of them for mine survivors)and distributed 20 pairs of crutchesand 19 wheelchairs. Children andwomen represented 11% and 21%,respectively, of the 540 persons bene-fiting from services.

The quality of the services providedin the centres was ensured by contin-ued on-the-job training and mentor-ing by ICRC expatriate and nationalortho-prosthetists and an expatriatephysiotherapist. The ICRC alsosponsored two candidates from theBone and Joint Hospital in Srinagarto attend formal training in P&O atthe Mobility India centre inBangalore.

The ICRC continued to promote thelong-term functioning of services bystrengthening the capacity of itspartners, including the Indian Red Cross Society, the JammuGovernmental Medical College andthe Bone and Joint Hospital inSrinagar.


enhance the quality of servicesthrough continued on-the-jobtraining and mentoring by ICRCexpatriate and national ortho-prosthetists, by sponsoringcandidates for P&O training atMobility India, and by organizingshort-term refresher courses intopics related to physical rehabilitationfacilitate access to services by supporting the Indian Red Crossin providing assistance to the P&Odepartments at the JammuGovernmental Medical Collegeand the Bone and Joint Hospitalin Srinagar, by covering the cost oftransport for some beneficiaries,and by assisting the Indian RedCross Assam State Branch inopening a centre in Guwahatipromote the long-term functioningof services by strengthening thecapacity of the Indian Red Cross,and that of the managerial staffin the two centres, to providephysical rehabilitation services

INDIANational partnerIndian Red Cross Society

Location of projectsJammu and SrinagarPatient services in 2008Patients attending the centres 540New patients fitted with prostheses 58New patients fitted with orthoses 89Prostheses 76Orthoses 95Wheelchairs 19Crutches (pairs) 20Beginning of assistance: 2004

41


MYANMAR

In Myanmar, government restric-tions imposed on the ICRC contin-ued to prevent the organization fromfulfilling its mandate in accordancewith its standard working procedures– procedures that are internationallyrecognized and which the Myanmarauthorities had accepted in previousyears. In June 2007, the ICRC was leftwith no choice but to publiclydenounce significant and repeatedviolations of international humanitar-ian law committed against civilians,and against detainees who were beingused as porters, in some conflict-affected border areas. Since then, thedelegation has adapted its overallactivities, including its physical reha-bilitation activities, to the situation.Only the Hpa-an OrthopaedicRehabilitation Centre (HORC), runjointly by the Myanmar Red CrossSociety and the ICRC, continued toreceive direct support from the ICRC.However, centres that were formerlyassisted by the ICRC and managedeither by the Ministry of Health (3)or the Ministry of Defence (3) weregiven enough materials to ensure thatthey could continue to provide serv-ices. In 2008, a total of 5,419 peoplebenefited from various services at theHORC (1,194) and within the centresrun by the two ministries (4,225).These services included productionof 1,867 prostheses and 1,204 orthoses,and provision of 26 wheelchairs and1,155 pairs of crutches. Children andwomen represented 4% and 9%,respectively, of all those benefitingfrom services.

On 2 May 2008, a cyclone (Nargis)struck Myanmar. The ICRC physicalrehabilitation project provided asmall generator for the DefenceServices Rehabilitation Hospital inYangon, managed by the Ministry ofDefence, to supply water to theamputee wards and 80 hygiene kits,consisting of soap, laundry deter-gent, towel, toothpaste, toothbrush,napkin, T-shirt, longyi, plastic cupand plastic back-bag, for hospitalizedamputees. Raw materials needed toproduce spinal-cord orthoses andwheelchairs for 30 patients withspinal-cord injuries were provided tothe National Rehabilitation Hospitalin Yangon, managed by the Ministryof Health.

The Outreach Prosthetic Programmeat the HORC was expanded toanother eight townships in easternBago Division in 2008, and now covers Mon State, Kayin State,Thanintheryi Division and eighttownships in eastern Bago Division.During the year, 223 amputeesreceived services from the HORCthrough the programme. Some 98 ofthose patients had never been fittedbefore.

In 2008, 67% of the prostheses weredelivered to landmine survivors (inwhich 93% were for men, 6% forwomen and 1% for children). Mostof those injured by landmines camefrom eastern Bago Division (157),Kayin State (109), Mon State (57),and Thanintheryi Division (41).

Throughout the year, an ICRC expatriate specialist conducted regularin-house theoretical and on-the-jobtraining for P&O technicians andassistant-physiotherapists in theHORC. The ICRC also sponsoredtwo candidates to attend a one-month training course in clinicalmethods for lower-limb prostheticsfitting at the ICRC Special Fund forthe Disabled training unit in AddisAbaba, Ethiopia.


facilitate access to services by supporting the activities ofthe Hpa-an OrthopaedicRehabilitation Centre and theMyanmar Red Cross’s OutreachProsthetic Programmeconduct quarterly technical visitsto centres managed by theMinistry of Health to follow up onthe continuity of servicespromote long-term functioning ofservices by strengthening thecapacities of partners to deliverrehabilitation services

National partnersMyanmar Red Cross SocietyLocation of projectsHpa-anPatient services in 2008Patients attending the centres 5,419New patients fitted with prostheses 1,031New patients fitted with orthoses 672Prostheses 1,867Orthoses 1,204Wheelchairs 1,155Crutches (pairs) 26Beginning of assistance: 1986

42


In 2008, the first government-runrehabilitation centre, the AerahitiNational Rehabilitation Centre,opened in Kathmandu. Managed bythe Army, the centre started provid-ing services in June for persons withspinal-cord injuries. Under a cooper-ation agreement, the ICRC providesassistance to establish a prostheticsand orthotics department within thecentre. While ongoing support wasprovided in 2008, direct assistancewill begin in early 2009. Most physi-cal rehabilitation services were pro-vided through such organizations asthe International Nepal Fellowship(assisted by the ICRC), and otherinternational and national NGOs.Although in charge of the rehabilita-tion of persons suffering impairedmobility, the Ministry of SocialWelfare did not directly providethose services.

Most potential beneficiaries live inremote, mountainous regions wherethere is often no transport. Poorroads, lack of or irregular publictransport and high travel fares, whichincreased by 60% in 2008, oftenmake it impossible to access services.The ICRC increased its financial sup-port by 70% over the previous yearso that more beneficiaries would bereimbursed for their transportationcosts. The ICRC continued to helporganize outreach visits in close collaboration with the Green PastureHospital and the Nepalese Red CrossSociety. With ICRC support (reim-bursement for treatment), the P&Odepartment of the Green PastureHospital provided services for more

than 1,098 people and produced 97 prostheses and 174 orthoses in 2008.Children and women represented14% and 27%, respectively, of the1,098 persons benefiting from services.

Nepal is not a signatory to the anti-personnel mine-ban treaty and is nota signatory to the Convention onCertain Conventional Weapons.According to the Informal SectorService Centre, representativesreported 37 incidents with 68 casual-ties in 2008. All five regions (24 dis-tricts out of 75) had incidents ofvictim-activated explosions, with thecentral region having the highestnumber of accidents. Some 63.88%of victims were children. Most of theincidents (89%) resulting in civilianinjuries were caused by IEDs. Withthe ICRC’s assistance, the GreenPasture Hospital delivered four pros-theses and one orthosis to mine/ERWsurvivors. In addition, the ICRC’sMicro-Economic Initiative pro-gramme, implemented through theNepal Red Cross Society, providedfinancial assistance (cash for kind) tosurvivors to start small businesses.

The quality of the services providedwas supported by regular visits by anICRC ortho-prosthetist. In addition,two groups of two P&O techniciansand two occupational therapists weresent to the ICRC-assisted centres inCambodia for two months, duringwhich they received training in pros-thetics and orthotics and in wheel-chair prescription/modifications/adaptations and user-training.One candidate started formal train-

ing in P&O at the Cambodian Schoolof Prosthetics & Orthotics with finan-cial support from the ICRC.


enhance the quality of servicesthrough continued support froman ICRC ortho-prosthetist andphysiotherapist, by sending P&Otechnicians and physiotherapistsfor clinical practice in Cambodia,sponsoring one person for formalP&O training (ISPO Cat. II) at theCambodian School of Prostheticsand Orthotics, and conducting in-house training in wheelchairservices facilitate access to services bydonating the necessary equipment,tools and materials to establish a P&O department at the Aerahiti National RehabilitationCentre, supporting the P&Odepartment of the Green PastureHospital, covering the costs oftreatment transportation andaccommodation for a certainnumber of beneficiaries, and supporting field follow-up visitsby hospital personnelpromote long-term functioning ofservices by supporting initiativesto develop a national physicalrehabilitation structure

NEPALNational partnersGreen Pasture Hospital, Nepal Army

Location of projectPokhara and KathmanduPatient services in 2008Patients attending the centre 1,098New patients fitted with prostheses 91New patients fitted with orthoses 144Prostheses 97Orthoses 174Crutches (pairs) 132Wheelchair 1Beginning of assistance: 2004

43


PAKISTAN

In Pakistan, political turmoil contin-ued to hamper access to services inmost regions where the ICRC pro-vides assistance for physical rehabili-tation services. Since the 2005 earth-quake, physical rehabilitation inPakistan has received more attentionand support from both the authori-ties and international organizations.However, the network of centres pro-viding physical rehabilitation servicesremained inadequate to meet exist-ing needs. The 1998 census foundthat the disability rate per 1,000 mem-bers of the population was 25.4 inrural areas and 25.9 in urban areas.In absolute terms, however, the num-ber of disabled persons in rural areaswas twice that in urban areas. TheIslamic Republic of Pakistan has notacceded to the Mine Ban Treaty, andwhile there are no reliable data onmine casualties, the LandmineMonitor Report 2008 noted that therewere at least 271 new casualties in2007. Most of the casualties occurredin Balochistan, the FederallyAdministered Tribal Areas and theNorth-West Frontier Province.

In 2008, the ICRC maintained itssupport for the Pakistan Institute ofProsthetic and Orthotic Sciences inPeshawar, for the Quetta ChristianHospital Rehabilitation Centre, andfor the Muzaffarabad PhysicalRehabilitation Centre (MPRC), man-aged by the ICRC. In addition,the ICRC began collaborating withthe Hayatabad Paraplegic Centre(Peshawar) within the framework ofthe Home Care Project. To enhanceaccessibility to services, the organization

donated material and components,reimbursed transportation andaccommodation costs, covering thecost of treatment for patientsreferred by the ICRC to the PakistanInstitute of Prosthetic and OrthoticSciences, and conducted two out-reach visits in collaboration with thePakistan Red Crescent Society. Morethan 5,200 people benefited from var-ious services at ICRC-assisted centresduring the year. These servicesincluded production of 758 prosthe-ses (39% of them for mine survivors)and 1,078 orthoses (8% of them formine survivors), and provision of118 wheelchairs and 309 pairs ofcrutches. Children and women rep-resented 19% and 14%, respectively,of the 5,277 persons benefiting fromservices.

The Home Care Project, implementedin collaboration with the Ministry ofHealth for the North-West FrontierProvince and the HayatabadParaplegic Centre, provided directassistance to 224 persons and con-ducted 527 home visits. In addition,221 Afghan refugees were referred tothe ICRC centre in Jalalabad,Afghanistan. Transportation costswere covered by ICRC Pakistan andtreatment costs were covered by ICRCAfghanistan. Through the ICRCMicro-Economic Initiative (MEI)programme, 104 grants were issued tophysically disabled persons registeredat the MPRC who live in Muzaffarabaddistrict. This joint collaboration rein-tegrated MPRC beneficiaries intomainstream society by improvingtheir socio-economic conditions.

The quality of the services providedat the centres was improved throughmentoring and on-the job trainingprovided by ICRC ortho-prosthetistsand physiotherapists. In addition, theICRC sponsored three persons forformal P&O training at the PakistanInstitute of Prosthetic and OrthoticScience in Peshawar.

Throughout the year, the ICRC heldbi-monthly meetings with theMinistry of Health in Pakistan-administrated Kashmir to develop astrategy to hand over the MPRC,which is managed by the ICRC, tothe authorities. The ICRC alsoworked to build the managementcapacities of all assisted centres.

National partnersMinistry of Health, Quetta Christian Hospital, Pakistan Institute of Prosthetic and Orthotic Sciences, Hayatabad Paraplegic Centre Location of projectsPeshawar (2), Muzaffarabad and Quetta Patient services in 2008Patients attending the centres 5,277New patients fitted with prostheses 732New patients fitted with orthoses 692Prostheses 758Orthoses 1,078Wheelchairs 118Crutches (pairs) 309Beginning of assistance: 2004

44



enhance the quality of servicesthrough continued support from ICRC ortho-prosthetistsand an ICRC physiotherapist, by providing sponsorship to the fourpersons undergoing training inP&O at the Institute in Peshawar,and by improving the professionalexpertise of those involved in theHome Care Project

facilitate access to services bycovering the cost of treatment forpatients at the Pakistan Instituteof Prosthetic and OrthoticScience in Peshawar, donatingmaterials and components to the Balochistan CommunityRehabilitation Centre, supportingthe Home Care Project,supporting the centre inMuzaffarabad, working with theMinistry of Health’s Lady HealthWorkers Programme to help disseminate services, workingwith the ICRC MEI programme,and assisting Afghan refugees in gaining access to services in Jalalabad

promote long-term functioningof services by maintaining closecontact with the Ministry ofHealth in Pakistan-administeredKashmir to ensure a smooth handover of the MPRC, and by building the managementcapacities of the assisted centres

© C

ICR

45


45

Hostilities between the Governmentand the Moro Islamic LiberationFront resumed in August. As a result,some 400,000 persons were displacedwithin the Mindanao peninsula andthe ICRC launched a large-scaleassistance programme for them.

In February, the functions and orga-nizational structure of the NationalCouncil for the Welfare of DisabledPersons were redefined and the bodywas renamed the National Councilon Disability Affairs (NCDA). It isnow the national government agencymandated to formulate policies andcoordinate the activities of all agencies,whether public or private, concerningdisability issues. The NCDA is alsotasked with monitoring the imple-mentation of several laws to ensurethat the civil and political rights ofpersons with disabilities are protected.Physical rehabilitation services aremainly provided by national NGOs.In Mindanao, five were registered bythe NCDA, including the DavaoJubilee Centre, managed by the DavaoJubilee Foundation. The ICRC refersbeneficiaries to the centre and coversthe cost of their treatment.

Since 2000, the ICRC has providedfinancial support and facilitatedmedical treatment for thousands ofpersons, including over 230 personswho were fitted with prostheses.The ICRC is not directly involved in managing the centre but it sharesits experience through regional support missions. The ICRC spon-sors formal training courses, clinicalplacements abroad, and short-termin-house coaching.

In 2008, the Davao Jubilee Centre,supported by the ICRC, providedservices to 45 persons, including the provision of 43 prostheses and 34 pairs of crutches. The ICRC metthe patients’ expenses for transporta-tion, lodging, food, and treatment.Women represented 16% of all thosebenefiting from services. While theICRC and the Philippines Red CrossSociety planned to conduct follow-up visits to those who had receivedservices, these visits were postponeddue to the hostilities.

To enhance the quality of the servicesprovided at the Davao Jubilee Centre,the ICRC sponsored one person forformal training in prosthetics andorthotics at the Cambodian Schoolof Prosthetics and Orthotics inPhnom Penh (second year). In addi-tion, the ICRC ortho-prosthetist

conducted short-term, in-housetraining sessions.


facilitate access to services for victims of the internal conflict bysubsidizing services, including firstfittings, replacements and repairs,and covering users’ expenses fortransportation, lodging and foodenhance the quality of services by providing support from an ICRC ortho-prosthetist,sponsoring clinical placement forone physiotherapist in Cambodia,and sponsoring the trainee at theCambodian School of Prosthetics& Orthotics in Phnom Penh

PHILIPPINESNational partnerDavao Jubilee Foundation

Location of collaborating centreDavaoPatient services in 2008Patients referred by the ICRC 45New patients fitted with prostheses 28Prostheses 43Crutches (pairs) 34Beginning of assistance: 2000

© C

ICR

46


SRI LANKA

In Sri Lanka, physical rehabilitationwas the responsibility of theDirectorate of Rehabilitation forYouth, Elderly, Disabled and Displacedin the Ministry of Health; however,the Ministry of Social Services andSocial Welfare was also involved. It isunclear how responsibilities weredivided between the two, but in gen-eral, the Ministry of Health wasresponsible for establishing guide-lines and providing hospital-basedphysiotherapy services, while theMinistry of Social Services and SocialWelfare was responsible for providingassistive devices and financial sup-port for disabled persons. As a resultof the political situation, disabled per-sons in the Jaffna district of Sri Lankafaced many obstacles in getting thephysical rehabilitation that theyneeded. Although distances in theJaffna peninsula are small, highprices and irregular bus transportcould make a trip of just a few kilo-metres very difficult and time-consuming. The Democratic SocialistRepublic of Sri Lanka has not acced-ed to the Mine Ban Treaty. Accordingto the Landmine Monitor Report2008, the northern Jaffna peninsulais the most severely affected area.About half of all mines laid in Sri Lankaare estimated to be in the peninsula.However, northern districts ofKilinochchi, Mullaittivu, Mannar,and Vavuniya, and eastern districts ofAmpara, Batticaloa, and Trincomaleehave also been affected by theresumed conflict. Landmine Monitoridentified at least 34 new mine/ERWcasualties in 2007, and at least 39 casualties between January and

August 2008. In 2008, the ICRCmaintained its support to the activi-ties of the Jaffna Jaipur Centre forDisability Rehabilitation (JJCDR),the only physical rehabilitation service-provider in the Jaffna penisnsula.

To make services more accessible, theICRC continued to cover the costs oftransportation for persons going tothe centre, when needed. The ICRCalso donated all the necessary materi-als and components and assumedresponsibility for clearing and trans-porting goods into Jaffna. More than842 persons benefited from variousservices provided, which includedthe provision of 265 prostheses (55%of them for mine survivors) and 126 orthoses (1.6% of them for minesurvivors), 67 wheelchairs and 35 pairsof crutches. Children and womenrepresented 4% and 25%, respectively,of the 842 persons benefiting fromservices.

The quality of the services providedat the centres was improved by thementoring and on-the job trainingprovided by an ICRC ortho-prosthetistand an ICRC physiotherapist. Topromote the long-term functioningof services, the ICRC intervened withthe Social Services to encourage themto reinforce their support, and workedwith the Management Board of theJJCDR to develop funding proposals.


enhance the quality of services bymaintaining the support providedby an expatriate ortho-prosthetistand a physiotherapist, conductingshort training courses in severalareas of P&O and physiotherapy,and donating equipment toupdate the physiotherapy departmentfacilitate access to services byreimbursing patients for theirtransportation expenses, as needed,organizing outreach visits, anddonating raw materials and componentspromote the long-term functioningof services by supporting its partner organization in improvingworking procedures and methodsof generating income

National partnerJaffna Jaipur Centre for Disability RehabilitationLocation of projectJaffnaPatient services in 2008Patients attending the centre 842New patients fitted with prostheses 35New patients fitted with orthoses 103Prostheses 265Orthoses 126Wheelchairs 67Crutches (pairs) 35Beginning of assistance: August 2007

48

PHYSICAL REHABILITATION PROGRAMME EUROPE AND THE AMERICAS

ICRC SUPPORT IN EUROPE AND THE AMERICAS AT A GLANCEIn 2008, the ICRC provided support for 10 projects in five countries:Azerbaijan (1 project), Colombia (5), Georgia (2), Russian Federation (1), and Tajikistan (1).Services providedPatients attending the centres 18,399New patients fitted with prostheses 746New patients fitted with orthoses 3,412Prostheses delivered 2,052Orthoses delivered 6,668Wheelchairs distributed 25Walking aids distributed (pairs) 396Children and women represented 44% and 22%, respectively, of all those benefiting from services.Developing national capacities12 candidates sponsored to attend formal training in P&OPromoting long-term functioning of servicesPromoted the establishment of a coordinating body in ColombiaSupported the Ministry of Social Protection in Colombia in developing and drafting a resolution on standards for P&O servicesSupported the Ministry of Social Protection and other institutions in Colombia in establishing a training programme for P&O personnelContinued to support the Ministry of Labour, Health and Social Affairs in Georgia in its efforts to develop a national physical rehabilitation policy

49


In Azerbaijan, the Ministry of Labour and SocialProtection is in charge of providing physical rehabilitationservices. It does so through a network of three centres: anational centre in Baku (the Ahmedly ProstheticOrthopaedic Rehabilitation Centre – PORC) and twodecentralized centres, in Ganja and Nakhichevan. Whiledirect assistance was ended, the ICRC delegation hasmaintained close contact with the management team ofthese facilities and has been able to sign a contract ofservices with the PORC as service provider for the ben-efit of nine Chechen refugees. Under the supervision ofan ICRC expert, these services were delivered on timeand were of good quality.

In Colombia, the Ministry of Social Protection isresponsible for physical rehabilitation and for the healthsector. The main responsibilities of the Ministry are todefine standards and guidelines regulating the sector.In 2006, the ICRC resumed its physical rehabilitation support under the umbrella of the comprehensive mine-action programme, implemented by the ICRC’sWeapons Contamination Department in collaborationwith the Norwegian Red Cross. In 2008, the ICRC continued to provide direct assistance to five existingrehabilitation facilities in Bogotá, Cúcuta, Cartagena,Cali and Medellín in the form of management support,training, material and equipment. The ICRC providedtechnical advice to the Hospital Universitario deSantander in Bucarmanga (Santander) and to theGobernación del Meta in Villavicencio (Meta). In 2008,more than 14,300 people benefited from various servicesat ICRC-assisted centres. These services included production of 1,108 prostheses (14% of them for minesurvivors) and 5,052 orthoses (0.4% of them for minesurvivors), 23 wheelchairs and 35 pairs of crutches.Children and women represented 44% and 25%, respec-tively, of the 14,370 persons benefiting from services.

In Georgia, the Ministry of Labour, Health and SocialAffairs is responsible for physical rehabilitation services.The ICRC’s physical rehabilitation project consisted of three major components: support for the GeorgianFoundation for Prosthetic and OrthopaedicRehabilitation in Tbilisi, support for the Gagra centre inAbkhazia, and a referral service for patients from SouthOssetia (the ICRC covered the cost of devices for them).In both Tbilisi and Gagra, different activities were initi-ated and/or implemented for gradually transferring allresponsibilities (managerial, technical and financial) tolocal partners. In total, more than 1,100 people benefitedfrom various services at ICRC-assisted centres. Theseservices included production of 336 prostheses (12% ofthem for mine survivors) and 692 orthoses, and provi-sion of 242 pairs of crutches. Children and women rep-resented 32% and 12%, respectively, of the 1,121 per-sons benefiting from services.

In the Russian Federation, disability issues were handledby the Federal Agency for Health and Social Development,which was attached to the Ministry of Health and SocialDevelopment. The Ministry allocated the funds for providing rehabilitation services in the Federation.

Since 2002, the ICRC has been providing support to theGrozny Prosthetics and Orthotics Centre (GPOC).From the beginning, the ICRC focused on developingcapacity to provide appropriate physical rehabilitationservices by: providing scholarships to candidates toattend formal P&O training (eight candidates), providingthe services of ICRC specialists (ortho-prosthetist andphysiotherapist), donating equipment and tools, andupgrading the GPOC infrastructure. In 2008, more than1,800 persons benefited from various services at theGrozny Prosthetics and Orthotics Centre. These servicesincluded production of 377 prostheses (9% of them formine survivors) and 787 orthoses. Children and womenrepresented 60% and 13%, respectively, of the 1,840 personsbenefiting from services. In addition, and with the aimof promoting social inclusion for persons with disabili-ties, 39 people applied for the ICRC Micro-EconomicInitiative programme. Eleven of them were approved andreceived ICRC support.

In Tajikistan, physical rehabilitation services were avail-able at the Dushanbe Physical Rehabilitation Centre,managed by the Ministry of Labour and SocialProtection (MoLSP). To improve access to services, theDushanbe centre ran three satellite workshops in Kulob,Khorog and Khujand to repair devices belonging tothose living in neighbouring areas. In 2009, the ICRCintends to end its support in Tajikistan. However, fol-lowing a request from the MoLSP, the ICRC SpecialFund for the Disabled will provide limited support tofacilitate the handover process.

50


AZERBAIJAN

The Ministry of Labour and SocialProtection is in charge of providingphysical rehabilitation services inAzerbaijan. It does so through a net-work of three centres: a national centre in Baku (the Ahmedly ProstheticOrthopaedic Rehabilitation Centre –PORC) and two decentralized centres,in Ganja and Nakhichevan. TheDirector of the Ahmedly PORC andits administration manage the net-work from Baku. Azerbaijan has notacceded to the Mine Ban Treaty; andmines and ERW continue to pose athreat to the civilian population livingin conflict-affected areas. The part-nership established through the safeplay areas project has a positiveimpact on both the ICRC and theAzerbaijan Red Crescent Society(AzRCS). Nine local branches regularly

visit and work with the affected com-munities, thus positioning the AzRCSas an important actor in mine issues.The AzRCS has been encouraged toinclude mine action in its StrategicWork Plan 2008–2010.

Following repeated attempts by theICRC to raise concern about weakpoints in the physical rehabilitationsector, which were met with indiffer-ence, ICRC assistance in this fieldended in 2007. However, the ICRCdelegation has maintained close contactwith the team managing these facili-ties. The management style used inAzeri physical rehabilitation facilitiesdoes not allow the ICRC to developtraining programmes and, conse-quently, the ICRC does not have ameaningful impact on the services

delivered. Nevertheless, the ICRCsigned a contract of services with thePORC as service provider for thebenefit of nine Chechen refugees.Under the supervision of an ICRCexpert, these services were deliveredon time and were of good quality.


maintain regular contact with theMinistry of Labour and SocialProtectionmonitor accessibility of services,in collaboration with the AzCRSensure access to appropriate physical rehabilitation services forsome foreign detainees

National partnerMinistry of Labour and Social ProtectionLocation of projectsBakuPatient services in 2008 No statistics availableBeginning of assistance: 1994

51

COLOMBIA

The Ministry of Social Protection isresponsible for physical rehabilita-tion and the health sector inColombia. The main responsibilitiesof the Ministry are to define stan-dards and guidelines regulating thesector. Two bodies within theMinistry cover the cost of services:the FIDUFOSYGA (FIDUciaria delFOndo de Solidaridad Y GArantia)and Acción Social. In recent years,laws and regulations have beenadopted enabling more people withdisabilities to have better access toeducation, public spaces, and thehealth and social security systems.Although these laws exist, complexadministrative procedures often hin-der, rather than improve, access toservices. In the latest NationalStatistics Department housing andpopulation survey (2005), some6.3% of the population were foundto have some kind of disability.

Colombia signed the Mine BanTreaty on 3 December 1997, ratifiedit on 6 September 2000, and becamea State Party on 1 March 2001. Minescontinue to be planted in many ruralareas and in areas previously unaffectedor marginally affected by them.Colombia is one of the top three mine-affected countries (along withAfghanistan and Cambodia) whenmeasured by the number of casualties.

In 2006, the ICRC resumed its physi-cal rehabilitation support under theumbrella of the comprehensive mine-action programme implemented by

the ICRC’s Weapons ContaminationDepartment in collaboration withthe Norwegian Red Cross. In 2008,the ICRC continued to provide directassistance to five existing rehabilita-tion facilities in Bogotá, Cúcuta,Cartagena, Cali and Medellín withmanagement support, training,material and equipment. The ICRCprovided technical advice to theHospital Universitario de Santanderin Bucarmanga (Santander) and tothe Gobernación del Meta inVillavicencio (Meta). During theyear, the ICRC completed the reno-vation of charity-run hostels inMedellín, Cartagena, and Cali.

In 2008, the ICRC contributed to the rehabilitation of 14,370 persons.Children and women represented44% and 25%, respectively, of the14,370 persons benefiting from serv-ices. These persons benefited fromservices delivered by five assisted centres, including the provision of1,108 prostheses (152 of which werefor mine/UXO/IED victims) and5,042 orthoses (including 18 for mine/UXO/IED victims). Among theseusers, the ICRC directly assisted 205persons (153 amputees and 52 non-amputees), including 37 women and 25children, and covered the full costsfor their 155 prostheses (including 96 for mine/UXO/IED victims) and57 orthoses (including seven for mine/UXO/IED victims). Most of thepatients benefited from additionaldirect economic assistance in theform of transport, food and accom-

modation. The organization also cov-ered the full costs of wheelchairs andcrutches for 75 beneficiaries.

To enhance the quality of services,the ICRC provided ongoing supportthrough ICRC specialists, by con-ducting several refresher courses, andproviding scholarships to eight can-didates to attend formal training inP&O (two candidates enrolled in adistance-learning programme at theUniversity of Don Bosco in ElSalvador and six candidates enrolledin a three-year training course in thesame institution).

Throughout the year, the ICRCworked closely with national institu-tions with the aim of promotinglong-term functioning of services.With input from the ICRC and otherinvolved institutions, in 2008 theMinistry published a draft resolutionon standards for P&O services.The ICRC also supports nationalauthorities in establishing a training programme for orthopaedic technol-ogists (through the State traininginstitution, SENA), and supports anapprenticeship programme for ortho-paedic technicians at the technicalcollege, Centro Don Bosco.

National partnersMinistry of Social Protection and State Training Institute, two local NGOs (CIREC in Bogota and Foundation REI in Cartagena), two private providers (Orthopraxis in Medellín and Ortopédica American in Cali), one governmental centre (Cúcuta)Location of projectsBogotá, Carthagena, Cúcuta, Medellín and Cali Patient services in 2008Patients attending the centres 14,370New patients fitted with prostheses 461New patients fitted with orthoses 2,676Prostheses 1,108Orthoses 5,052Wheelchairs 23Crutches (pairs) 35Beginning of assistance: 2006




cooperate with the NorwegianRed Cross in a comprehensivemine-action project in Colombiainvolving physical rehabilitation,data gathering, support for the social and economic reintegration of survivors intosociety, mine-risk reduction and public education

facilitate access to services bymaintaining its support for thefive physical rehabilitation centres it supported in 2008,covering the costs of transportationand accommodation for disabled persons undergoingtreatment, and strengthening theexisting referral networkenhance the quality of services byproviding scholarships for formalP&O training at the University of Don Bosco and through continued support from ICRCortho-prosthetists

promote the long-term functioning of services by providing support in managingphysical rehabilitation activitiesfor national authorities and for the managerial staff oflocal centres

52

© C

ICR

53

In Georgia, the Ministry of Labour,Health and Social Affairs is developinga comprehensive National PhysicalRehabilitation Policy with an appro-priate legislative and institutionalframework to protect the rights ofthe disabled. A concept paper on theSocial Integration of People withDisabilities was drawn up by theCoalition for Independent Living, acoalition of NGOs, in cooperationwith the Ministry. At the beginningof December, the Ministry announcedthat a parliamentary commissionhad been established to develop a National Disability Policy. InAbkhazia, the Ministry of Healthprovided services at the GagraPhysical Rehabilitation Centre and at its repair workshop in Gali.The ICRC’s physical rehabilitation project in Georgia consisted ofthree components: support for theGeorgian Foundation for Prostheticand Orthopaedic Rehabilitation(GEFPOR) in Tbilisi, support for theGagra centre in Abkhazia, and areferral service for patients fromSouth Ossetia (the ICRC covered thecost of devices for them). In bothTbilisi and Gagra, different activitieswere initiated and/or implementedto gradually transfer all managerial,technical and financial responsibili-ties to local partners.

In 2008, the GEFPOR centre inTbilisi provided 258 prostheses and592 orthoses. In all, 752 persons ben-efited from services provided at thecentre. Through its Patient ServiceSupport programme (PSS), the ICRCcovered the cost of 278 devices (33%of the total production of the centre).

With the support of the ICRC theGagra centre in Abkhazia provided78 prostheses and 100 orthoses. Inall, 369 persons benefited from servic-es provided at the centre. In addition,four persons from South Ossetiareceived services with ICRC support:two at the GEFPOR centre and two atthe Vladikavkaz Orthopaedic Centre inthe Russian Federation. In total, morethan 1,100 people benefited fromvarious services at ICRC-assistedcentres. These services included production of 336 prostheses (12% ofthem for mine survivors) and 692orthoses, and provision of 242 pairsof crutches. Children and womenrepresented 32% and 12%, respec-tively, of the 1,121 persons benefitingfrom services.

The quality of services was enhancedthrough ongoing support from ICRCortho-prosthetists and physiothera-pists. In addition, seminars on a mul-tidisciplinary team approach and onthe psychological approach to patientswere held in both centres.

While the managerial staff at GEFPORstruggled to raise funds, there weresome positive signals from newdonors. In 2008, the ICRC, throughits PSS programme, represented 37%of the total income of GEFPOR,while contributions from the Staterepresented 22%, support from otherorganizations 18% and direct sale of devices 23%. Despite a difficulteconomic situation, the authoritiesin Abkhazia increased support forphysical rehabilitation services.In 2008, they covered all the centre’sexpenses.


enhance the quality of services byproviding continued support fromICRC specialistsfacilitate access to services by covering the treatment costs ofsome patients at the GEFPOR centre, and covering the cost oftreatment at the Vladikavkaz centre or the GEFPOR centre forpatients from South Ossetiapromote the long-term functioning of services by supporting the consolidation ofGEFPOR, providing continuedsupport for the Ministry ofLabour, Health and Social Affairsin its efforts to develop a nationalphysical rehabilitation policy, andassisting the Abkhaz authorities indeveloping and implementing along-term strategy to ensure thesustainability of the Gagra centre organize a regional seminar onmanaging physical rehabilitationactivities


GEORGIANational partners Georgian Foundation for Prosthetic and Orthopaedic Rehabilitation, Ministry of Health of AbkhaziaLocation of projectsTbilisi and GagraPatient services in 2008Patients attending the centres 1,121New patients fitted with prostheses 124New patients fitted with orthoses 300Prostheses 336Orthoses 692Crutches (pairs) 242Beginning of assistance: 1994

54


RUSSIAN FEDERATION

In the Russian Federation, disabilityissues were handled by the FederalAgency for Health and SocialDevelopment, which was attached tothe Ministry of Health and SocialDevelopment. The Ministry allocatedfunds to provide rehabilitation serv-ices in the Federation. Since 2002, theICRC has been supporting theGrozny Prosthetics and OrthoticsCentre. The ICRC provided scholar-ships to candidates to attend formalP&O training (eight candidates) andsupport from ICRC specialists(ortho-prosthetist and physiothera-pist), donated equipment and tools,and improved the Centre’s infra-structure. Between 2002 and 2008,thousands of persons benefited fromvarious services at the Centre. Theseservices included production of1,258 prostheses (67% of them formine survivors) and 1,328 orthoses,and provision of 103 wheelchairs and688 pairs of crutches. The ICRCended its support to the Centre inNovember 2008.

The Grozny Centre depended largelyon timely allocations from the SocialInsurance Fund, the main govern-ment body responsible for fundingthe Centre’s activities. In 2008, morethan 1,800 persons benefited fromvarious services at the GroznyProsthetics and Orthotics Centre.These services included productionof 288 prostheses (43% of them formine survivors) and 787 orthoses.Children and women represented60% and 13%, respectively, of the1,840 persons benefiting from services.In addition, 39 people applied for

the ICRC Micro-Economic Initiativeprogramme; 11 of them were approvedand received ICRC support.

In 2008, a group of students com-pleted their training at the StPetersburg Social College. Earlier,they developed their clinical skills atthe Albrecht Scientific and PracticalProsthetic Centre in St Petersburg. Inaddition, an ICRC ortho-prosthetistprovided ongoing support to thetechnicians, while an ICRC physio-therapist provided a two-monthcourse on gait training. In January,the ICRC organized a seminar onP&O prescription for more than 30 doctors working in different hospitals around the country. A two-week seminar on trans-femoralprostheses was organized at theVladikavkaz Prosthetics and OrthoticsCentre.


monitor and evaluate the servicesprovided at the Grozny Centre andwill invite two officials fromChechnya to attend the regionalseminar on physical rehabilitation,which will be held in Tbilisi

National partnerMinistry of Health and Social DevelopmentLocation of projectGroznyPatient services in 2008Patients attending the centre 1,840New patients fitted with prostheses 62New patients fitted with orthoses 377Prostheses 288Orthoses 787Beginning of assistance: 2002

55

TAJIKISTAN

Tajikistan has legislation protectingthe rights of persons with disabilitiesand providing them with medicalcare, physical rehabilitation, socio-economic reintegration and pen-sions. Physical rehabilitation serviceswere available at the DushanbePhysical Rehabilitation Centre man-aged by the Ministry of Labour andSocial Protection. To ease access toservices, the Dushanbe centre ranthree satellite workshops in Kulob,Khorog and Khujand, whose aim wasto repair devices belonging to thoseliving in neighbouring areas. TheRepublic of Tajikistan acceded to theMine Ban Treaty on 12 October 1999,becoming a State Party on 1 April 2000.The Tajikistan Mine Action Centre is responsible for coordinating allactivities related to mine action,including demining and victim assis-tance.

Since 1999, the ICRC has assisted theMinistry of Labour and SocialProtection in developing nationalcapacities to provide physical reha-bilitation services. Over the years,more than 2,200 persons benefitedfrom various services at theDushanbe Physical RehabilitationCentre. These services included pro-duction of 3,488 prostheses (11% of them for mine survivors) and1,062 orthoses, and provision of70 wheelchairs and 1,039 pairs ofcrutches. The scope of ICRC supportranged from donating material andcomponents, to providing direct support to service users, includingcovering transportation and accom-modation costs.

Besides donating raw materials andcomponents, in 2008 the ICRC sup-ported several activities that were under-taken to enhance access to services.In 2008, more than 1,000 personsbenefited from various services at theDushanbe Physical RehabilitationCentre. These services included production of 320 prostheses (9% of them for mine survivors) and 137 orthoses, and provision oftwo wheelchairs and 119 pairs ofcrutches. Children and women rep-resented 17% and 21%, respectively,of the 1,068 persons benefiting fromservices.

The quality of services was main-tained and enhanced by regular mentoring provided by an ICRCortho-prosthetist and physiothera-pist. The ICRC physiotherapist spenttwo months in the centre and partiallyre-organized the services with thetwo assistant physiotherapists. TheICRC ortho-prosthetist spent onemonth reorganizing P&O servicesand revising the guidelines for producing prostheses.

Throughout 2008, the ICRC sup-ported the Ministry of Labour andSocial Protection in implementing itsstrategy to ensure the long-termfunctioning of the centre. It contin-ued to mobilize other actors, such asthe Tajikistan Mine Action Centre,to assist the Ministry in managingphysical rehabilitation activities. Thecentre’s managerial staff receivedongoing support.

The ICRC intends to end its supportin Tajikistan in 2009. However, fol-lowing a request from the Ministry,the ICRC Special Fund for theDisabled will provide limited sup-port to facilitate the handover.

National partnerMinistry of Labour and Social Protection, Red Crescent Society of TajikistanLocation of projectDushanbePatient services in 2008Patients attending the centre 1,068New patients fitted with prostheses 99New patients fitted with orthoses 59Prostheses 320Orthoses 137Wheelchairs 2Crutches (pairs) 119Beginning of assistance: 1999


57


ICRC SUPPORT IN THE MIDDLE EAST AND NORTH AFRICA AT A GLANCEIn 2008, the ICRC provided support for 18 projects in three countries and one territory:Algeria (2 projects), Iraq (12), Gaza (1), and Yemen (3).Services providedPatients attending the centres 38,639New patients fitted with prostheses 3,044New patients fitted with orthoses 12,089Prostheses delivered 4,172Orthoses delivered 14,199Wheelchairs distributed 85Walking aids distributed (pairs) 1,524Children and women represented 38% and 18%, respectively, of all those benefiting from services.Developing national capacities14 candidates sponsored to attend formal training in P&O Promoting long-term functioning of servicesMentored the director of the Martyr Chereïf Centre in Rabouni to develop his capacity to manage physical rehabilitation activitiesSupported the Iraqi Ministry of Health, the Ministry of Higher Education and the Iraqi Red Crescent in managing physical rehabilitation activities

Algeria had a nationwide network of facilities providingphysical rehabilitation services. However, services wereavailable only to those registered with the national socialsecurity system. Physically disabled persons not coveredby the system could not afford the cost of services. InJune 2001, the ICRC signed a cooperation agreementwith the Algerian Ministry of Health and with theAlgerian Red Crescent. This agreement defined the roleand responsibilities of each partner in implementing anew P&O department within the rehabilitation unit ofthe Ben Aknoun hospital in Algiers. Initially, the projecthad two main objectives: ensuring access to services forSaharawi amputees living in the refugee camp in south-west Algeria, and ensuring access to Algerian amputeeswho are not covered by the social security system. Theproject in favour of the Saharawi lasted 18 months andended in 2003. However, the centre continues to offerservices to those who are not covered by the social secu-rity system. In 2008, the ICRC maintained its supportfor the Ben Aknoun P&O department. More than 40 people benefited from various services at the ICRC-assisted centre. These services included production offour prostheses and 53 orthoses. Children and womenrepresented 29% and 17%, respectively, of the 41 per-sons benefiting from services. The centre was largelyclosed between July and December.

An armed conflict between the Government of Moroccoand the Polisario Front (PF) raged from 1975 to 1991,when a ceasefire went into effect. As a consequence ofthe conflict, thousands of Saharawis became refugees. Alarge number of these refugees were living in five campslocated in the region of Tindouf, in south-west Algeria.Between 2002 and 2003, the ICRC supported accessibil-ity to services for Saharawis living in this area. Duringthat period, 64 Saharawis were fitted with prostheses inthe Ben Aknoun centre in Algiers. In 2006, the ICRCsigned a cooperation agreement with the PF publichealth authorities to open a small physical rehabilitationcentre in Rabouni, aimed at ensuring that serviceswould be provided over the long term. In early 2008,installation of the centre was completed and the firstservice was provided in May. Since then, 50 people havebenefited from various services at the ICRC-assistedcentre. These services included production of 18 pros-theses (94% of them for mine survivors) and twoorthoses, and provision of one wheelchair and two pairsof crutches.

The Gaza Strip is one of two Palestinian territories; theother is the West Bank. Until the end of 2008, there wasno physical rehabilitation coordinating body active in the Gaza Strip. However, the Ministry of Health’sPhysiotherapy and Rehabilitation Unit became active atthe end of the year, a few months after it was created.The only operational physical rehabilitation centre inthe Gaza Strip is the Artificial Limb and Polio Centre(ALPC) located in Gaza City. Created nearly 25 yearsago, the centre has been managed by the Municipality ofGaza since 1998. The ICRC has supported the activities ofthe ALPC and the activities of the Al Shifa Hospital since2007 with the aim of ensuring access to appropriatephysical rehabilitation services and appropriate

post-surgical rehabilitation focused on physiotherapy.In 2008, more than 1,400 people benefited from variousservices at ICRC-assisted centres. These services includedproduction of 71 prostheses and 313 orthoses, and pro-vision of eight wheelchairs and four pairs of crutches.No statistics were compiled on the number of personswho were given physiotherapy, but such treatment wasavailable for most of them, and the majority did receivethose services. Children and women represented 50%and 9%, respectively, of the 1,474 persons benefitingfrom services.

In Iraq, the Ministry of Health was solely responsible forall physical rehabilitation activities through a dedicateddepartment, the Higher Committee for PhysicalRehabilitation. The low number of services providednationwide does not mean that the national capacitywas overwhelmed, but rather that patients were notcoming to existing structures. There are many reasonsfor this, including the risk of travel, given the currentsecurity situation, travel costs, ethnic considerations andlack of information about available services. In theKurdistan region, seven physical rehabilitation centreswere functioning, including the ICRC-managed centrein Erbil. In the other parts of the country, 10 centreswere providing services. Among them, eight were man-aged by the Ministry of Health (and supported by theICRC), one was managed by the Ministry of Defence,and one was managed by the Iraqi Red Crescent Society,with support from the ICRC. In addition, the ICRC supported the Ministry of Health’s Al-Salam crutch production unit and the P&O school, run by theMinistry of Higher Education. In 2008, more than29,400 people benefited from various services at ICRC-assisted centres. These services included production of2,863 prostheses (16% of them for mine survivors) and9,864 orthoses (0.8% of them for mine survivors), andprovision of 70 wheelchairs and 1,316 pairs of crutches.Children and women represented 35% and 17%, respec-tively, of the 29,422 persons benefiting from services.

In Yemen, the Ministry of Public Health and Populationand the Ministry of Labour and Social Affairs were themain ministries in charge of the physical rehabilitationsector. Existing centres were located in big cities (Sana’a,Mukalla, and Aden), making access difficult for peoplefrom remote areas. People who receive orthopaedicappliances had difficulty maintaining the devices, giventhe distance to the nearest centre. Many people remainwithout services, especially in rural areas where there isa near total absence of disability support services,including health education and rehabilitation. In 2008,the ICRC continued to provide support for the NationalArtificial Limbs and Physiotherapy Centre in Sana’a, forthe Al-Mukalla Centre in Mukalla, and for the AdenPhysical Rehabilitation Centre. In 2008, more than 7,652 people benefited from various services at ICRC-assisted centres. These services included production of1,216 prostheses (33% of them for mine survivors) and3,967 orthoses (2% of them for mine survivors), andprovision of six wheelchairs and 201 pairs of crutches.Children and women represented 48% and 23%, respec-tively, of the 7,652 persons benefiting from services.

58

PHYSICAL REHABILITATION PROGRAMME MIDDLE EAST AND NORTH AFRICA

59


In 2008, Algeria had a nationwidenetwork of facilities providing physi-cal rehabilitation services. However,services were available only to thoseregistered with the national socialsecurity system. Physically disabledpersons not covered by the systemcould not afford the cost of services.In June 2001, the ICRC signed acooperation agreement with theMinistry of Health and with theAlgerian Red Crescent. This agreementdefined the role and responsibilitiesof each partner in implementing anew P&O department within therehabilitation unit of the BenAknoun hospital in Algiers. Initially,the project had two main objectives:ensuring access to services forSaharawi amputees living in therefugee camp in south-west Algeria,and ensuring access to amputees notcovered by the social security system.The project in favour of the Saharawilasted 18 months and ended in 2003,during which 64 persons had accessto services (see the section Algeria – Saharawi Refugee Camp for moredetails). However, the centre contin-ues to offer services to Algerians notcovered by the social security system.

The ICRC maintained its support forthe Ben Aknoun P&O departmentduring 2008. More than 40 peoplebenefited from various services therethat year. These services includedproduction of four prostheses and 53 orthoses. Children and womenrepresented 29% and 17%, respec-tively, of the 41 persons benefitingfrom services. The centre was largelyclosed between July and December.

Since 2007, the ICRC has been tryingto find ways to increase the impact ofthe Ben Aknoun P&O department.Late in 2006, a proposition was madeto move the production unit from the rehabilitation unit of the BenAknoun hospital to the paramedicprofessional school (INPFP), whichwill promote and increase practicaltraining within the school andincrease the referral system for desti-tute patients. This proposition wasrejected. In 2007, a convention proj-ect was proposed by the school ofparamedics in which the BenAknoun P&O department wouldbecome a place to train students ofthe INPFP and would ensure thatthose who were not covered by thesocial security system had access toservices. A draft of the conventionwas also sent to the AlgerianFederation of the Disabled (FAHM),which was responsible for identifyingand referring destitute persons withdisabilities to Ben Aknoun. Eventhough the convention was neversigned, in 2008, the Ben AknounP&O department received studentsfor clinical placement, and theFAHM identified 20 destituteamputees and three individuals werereferred.

For more than two years, theMinistry of Health has not shownany interest in the ICRC-assisted centre, and has never answered anyproposals made by ICRC.

In 2009, the ICRC intends to end itssupport to the Ben Aknoun P&Odepartment by the beginning of July,

given the low impact of ICRC assistance and lack of strong com-mitment from the implementingpartners.


donate the necessary material andcomponents to ensure a smoothhandovermaintain contact with variousactors (Ben Aknoun, INPFP and FAMH) to facilitate theimplementation of the proposedconvention

ALGERIANational partnerMinistry of HealthLocation of projectAlgiersPatient services in 2008Patients attending the centres 41New patients fitted with prostheses 3New patients fitted with orthoses 37Prostheses 4Orthoses 53Beginning of assistance: 2002

60


An armed conflict between theGovernment of Morocco and thePolisario Front (PF) raged from 1975to 1991, when a ceasefire went intoeffect. As a consequence of the con-flict, thousands of Saharawis becamerefugees. A large number of theserefugees were living in five campslocated in the region of Tindouf, insouth-west Algeria.

In June 2001, the ICRC signed acooperation agreement with thePolisario Front and the Algerian RedCrescent Society, with the aim ofensuring access to services forSaharawi refugees living in theTindouf region. The ICRC set up aP&O department at the Ben Aknounhospital (Algiers). Between 2002 and2003, 64 individuals were fitted withprostheses there. In 2006, the ICRCsigned a cooperation agreement withthe public health authorities of thePolisario Front to open a small phys-ical rehabilitation centre in Rabounithat would provide services to about100 persons a year and ensure newfittings, repairs, follow-up and phys-iotherapy over the long term. In early2008, installation of the centre wascompleted and the first service wasprovided in May. Since then, 50 peoplehave benefited from various servicesat the ICRC-assisted centre. Theseservices included production of18 prostheses (94% of them for minesurvivors) and two orthoses, andprovision of one wheelchair and twopairs of crutches. No statistics werecompiled on the number of persons

who were given physiotherapy, butsuch treatment was available formost of them, and most receivedthose services.

Throughout the year, the ICRCortho-prosthetist and physiothera-pist provided ongoing mentoringand on-the-job training to the fiveassistant ortho-prosthetists and tothe four assistant physiotherapists. Inaddition, the director of the MartyrChereïf Centre was mentored to helpdevelop his capacity to manage phys-ical rehabilitation activities.


support the activities of theMartyr Chereïf Centre by donatingmaterials and components,widening the types of services provided, and conducting visits to the different camps to identifythose in needenhance the quality of services byproviding ongoing support fromICRC ortho-prosthetists and physiotherapists, and providingon-the-job training to techniciansand physiotherapists working atthe Martyr Chereïf Centrepromote long-term functioning of services by providing ongoingsupport to the director of the centre in managing physical rehabilitation activities

ALGERIA (SAHARAWI REFUGEES LIVING IN SOUTH-WEST ALGERIA)

PartnerPublic Health Authority of the Polisario Location of projectRabouniPatient services in 2008 (statistics May – December)Patients attending the centres 50New patients fitted with prostheses 41New patients fitted with orthoses 2Prostheses 18Orthoses 2Wheelchairs 1Crutches (pairs) 2Beginning of assistance: 2007

61


GAZA

The Gaza Strip is one of twoPalestinian territories; the other isthe West Bank. The Gaza Strip hasborders with the Mediterranean Sea,Egypt and Israel, and has one of thehighest densities of population in theworld. According to the WorldHealth Organization, the populationof physically disabled in need of P&Oservices averages 0.5% of the popula-tion. That means that there are anestimated 7,000 persons in need inthe Gaza Strip. Persons with disabili-ties, who are among the most vulner-able and usually over-representedamong those living in poverty, areseverely affected by the current crisis.Until the end of 2008, there was nophysical rehabilitation coordinatingbody active in the Gaza Strip.However, the Ministry of Health’sPhysiotherapy and RehabilitationUnit became active at the end of thatyear, several months after it was cre-ated. The only operational physicalrehabilitation centre in the GazaStrip is the Artificial Limb and PolioCentre (ALPC), located in Gaza City.Created nearly 25 years ago, the centre has been managed by theMunicipality of Gaza (MoG) since1998. Following a needs assessment,and after the signing of a cooperationagreement, the ICRC began to pro-vide support for the centre inOctober 2007 with the aim of ensur-ing access to appropriate physicalrehabilitation services and appropriatepost-surgical rehabilitation focusedon physiotherapy.

To ensure access to appropriate phys-ical rehabilitation services, the ICRCimplemented several activitiesthroughout the year, includingdonating needed materials, compo-nents, physiotherapy equipment, andwheelchairs, renovating the centres,and providing on-the-job trainingand ongoing support and mentoringby ICRC ortho-prosthetists andphysiotherapists. In 2008, more than1,400 people benefited from variousservices at ICRC-assisted centres.These services included productionof 71 prostheses and 313 orthoses,and provision of eight wheelchairsand four pairs of crutches. No statis-tics were compiled on the number ofpersons who were given physiothera-py, but such treatment was availablefor most of them, and the majoritydid receive those services. Childrenand women represented 50% and9%, respectively, of the 1,474 personsbenefiting from services.

At the same time, the ICRC supportedthe Al Shifa Hospital to ensure accessto appropriate post-surgical rehabili-tation. The support included donation of equipment, on-the-jobtraining and mentoring by an ICRCphysiotherapist, and organizing awar-surgery seminar in March 2008that focused on a multidisciplinaryteam approach, correct amputationtechniques, and post-surgical physio-therapy services. It was attended by50 persons, including surgeons,physiotherapists, anaesthetists, andnurses from 15 medical facilities inthe Gaza strip.


ensure access to appropriate physical rehabilitation services forthose in need by donating materials, components and wheelchairs to the ALPC, andfinancially supporting the construction of a dormitoryensure access to post-surgicalrehabilitation by supporting theactivities of the Al Shifa Hospital(South Gaza Strip) and initiatingthe same kind of support at theEuropean Gaza Hospital (NorthGaza Strip)improve the quality of services by providing ongoing support and mentoring by ICRC ortho-prosthetists and physiotherapists,proving sponsorships to two candidates to attend formal P&Otraining, and organizing a physiotherapy seminar

National partnerMunicipality of GazaLocation of projectGazaPatient services in 2008Patients attending the centre 1,474New patients fitted with prostheses 63New patients fitted with orthoses 289Prostheses 71Orthoses 313Wheelchairs 8Crutches (pairs) 4Beginning of assistance: 2007

62

IRAQ

Although the security environmentimproved throughout 2008, theinternationalized internal armedconflict in Iraq continued on manyfronts. The series of conflicts thaterupt result in an ever-growing num-ber of persons disabled by war. TheWorld Health Organization in Ammanreported that statistics from emer-gency rooms in Iraq show that 80%of the patients are admitted forinjuries; 60% of them are war-related,10% are due to traffic accidents and 10% to domestic accidents.The Republic of Iraq acceded to theMine Ban Treaty in mid-August 2007and the treaty entered into force on 1 February 2008. There is no reliableinformation available on mine/ERWvictims in most of the country.A Landmine Monitor report identi-fied 216 mine/ERW/IED casualties in2007 and 111 casualties betweenJanuary and August 2008.

While disability issues were handledby several ministries, including theMinistry of Health, the latter wassolely responsible for all physicalrehabilitation activities through adedicated department, the HigherCommittee for Physical Rehabilitation.This body, responsible for coordinat-ing the provision of services acrossthe nation, does not meet regularly.The low number of services provideddoes not mean that the nationalcapacity is overwhelmed, but ratherthat patients are not coming to existing structures. There are manyreasons for this, including the risk oftravel, given the current security situation, travel costs, ethnic considerations and lack of informa-

tion about available services. In theKurdistan region, seven physicalrehabilitation centres were function-ing, including the ICRC-managedcentre in Erbil. In the other parts ofthe country, 10 centres were provid-ing services. Among them, eight weremanaged by the Ministry of Health(and supported by the ICRC), onewas managed by the Ministry ofDefence, and one was managed bythe Iraqi Red Crescent Society (withsupport from the ICRC). In addition,the ICRC supported the MoH Al-Salam crutch production unit andthe P&O school, run by the Ministryof Higher Education.

With the aim of improving services,the ICRC worked to ensure that thecentres had enough raw materialsand components, and that the net-work of assisted centres covered mostof the country so that most patientswould not have to travel long distances for treatment. The newly-constructed centre in Fallujah, finan-cially supported by the ICRC, wasinaugurated in October and beganproviding services in December. InErbil, the ICRC covered the trans-portation costs of those seekingtreatment at the centre. In coopera-tion with the Higher Committee forPhysical Rehabilitation, a leaflet wasproduced showing the location ofcentres nationwide. In addition,several patients at the Erbil centrebenefited from the ICRC’s Micro-Economic Initiative programme andset up an income-generating scheme.In 2008, more than 29,400 peoplebenefited from various services atICRC-assisted centres. These services

included production of 2,863 pros-theses (16% of them for mine sur-vivors) and 9,864 orthoses (0.8% ofthem for mine survivors), and provi-sion of 70 wheelchairs and 1,316 pairsof crutches. Children and womenrepresented 35% and 17%, respec-tively, of the 29,422 persons benefit-ing from services.

In addition, the ICRC enhanced thequality of the services provided byorganizing four training sessions inP&O and physiotherapy. The topicsincluded: gait analysis, lower-limbdeformities in children, cosmeticcover of prostheses, and wheelchairmanagement. In addition, ICRC spe-cialists, both expatriates and nation-als, provided ongoing mentoring.Finally, the ICRC sponsored sevenpersons for formal training at theCambodian School for Prosthetics &Orthotics (CSPO) in Phnom Penh.

National partnersMinistry of Health, Ministry of Higher Education, Iraqi Red Crescent SocietyLocation of projectsBaghdad (5), Najef, Hilla, Tikrit, Basrah, Falluja, Mosul and ErbilPatient services in 2008Patients attending the centres 29,422New patients fitted with prostheses 1,845New patients fitted with orthoses 8,267Prostheses 2,863Orthoses 9,864Wheelchairs 70Crutches (pairs) 1,316Beginning of assistance: 1993



enhance the quality of services by organizing training sessions in P&O, physiotherapy andwheelchair services, through continued support from ICRCexpatriates and national personnel, and by continuing toprovide scholarships for personsto continue or to begin formaltraining in prosthetics andorthotics

facilitate access to services bydonating raw materials and components to the 12 assistedcentres, covering transportationcosts for those undergoing treatment at the centres, andclosely monitoring the situationin the country with the aimof determining the extent towhich available services are meeting needs

promote the long-term functioning of services throughcontinued support to theMinistry of Health, the Ministryof Higher Education, and theIraqi Red Crescent in managingphysical rehabilitation activities

63


© C

ICR/

VII/D

OM

ANIC

ZKY,

Tiva

dar

64

Yemen’s cohesion was increasinglyjeopardized by a deteriorating securitysituation in the south and in thenorth. The country was largelydependent on external aid fromPersian Gulf countries, Westerndonors, and international financialinstitutions, and it was the poorestnation in the Arab region, ranking151 out of 177 countries on the UnitedNations Development Programme’sHuman Development Index. TheRepublic of Yemen signed the MineBan Treaty on 4 December 1997 andratified it on 1 September 1998. Thetreaty entered into force on 1 March1999. A Landmine Monitor reportidentified at least 26 new mine/ERW casualties in Yemen in 2007 andat least 18 casualties from January toAugust 2008.

The Ministry of Public Health andPopulation and the Ministry ofLabour and Social Affairs were themain ministries in charge of thephysical rehabilitation sector. TheSocial Fund for Development, whichis an independent body under thePrime Minister, and the RehabilitationFund and Care of HandicappedPersons, which is under the Ministryof Labour and Social Affairs, provid-ed funding and support directly toindividuals and to the physical reha-bilitation centres. Existing centreswere located in big cities (Sana’a,Mukalla, and Aden), making accessdifficult for people from remoteareas. People who receive orthopaedicappliances had difficulty maintainingthem, given the distances to the nearest

centre. Many people remain withoutservices, especially in rural areaswhere there is a near total absence ofdisability support services, includinghealth education and rehabilitation.In 2008, the ICRC continued to pro-vide support for the NationalArtificial Limbs and PhysiotherapyCentre in Sana’a, for the Al-MukallaCentre in Mukalla, and for the AdenPhysical Rehabilitation Centre.

The ICRC promoted access to servicesby donating raw materials and com-ponents to all assisted centres. Inaddition, the ICRC gave final supportto set up a mobile clinic, located inSa’ada, with the aim of improvingaccessibility of services in the gover-norate. In 2008, more than 7,652 peoplebenefited from various services atICRC-assisted centres. These servicesincluded production of 1,216 pros-theses (33% of them for mine sur-vivors) and 3,967 orthoses (2% ofthem for mine survivors), and provi-sion of six wheelchairs and 201 pairsof crutches. Children and womenrepresented 48% and 23%, respec-tively, of the 7,652 persons benefitingfrom services.

The quality of services provided atthe Sana’a, Mukalla and Aden centreswas maintained through continuedsupport from an ICRC ortho-prosthetist, who provided on-the-jobtraining and monitoring. In 2008, theICRC provided scholarships to sevencandidates to attend formal P&Otraining at Mobility India inBangalore.


facilitate access to services bydonating raw materials and components so that the Sana’a,Mukalla and Aden centres canprovide services, supporting theimplementation of a unit to manufacture crutches at the Sana’acentre, and supporting the activitiesof the Sa’ada mobile clinicenhance the quality of services byproviding regular support to all centres from an ICRC ortho-prosthetist and physiotherapist,and sponsoring trainees atMobility India promote more coordinationamong stakeholders through continuous meetings and networking


YEMENNational partnersMinistry of Public Health and Population, Ministry of Labour and Social AffairsLocation of projectsSana’a, Mukalla and AdenPatient services in 2008Patients attending the centres 7,652New patients fitted with prostheses 1,118New patients fitted with orthoses 3,494Prostheses 1,216Orthoses 3,967Wheelchairs 6Crutches (pairs) 201Beginning of assistance: 2002

6565

ANNEX – ICRC PUBLICATIONS

The following documents are available through theICRC website and in most cases can be downloadeddirectly from the ICRC website.

P&O manufacturing guidelines

In 2007, manufacturing guidelines for trans-tibial,trans-femoral, partial-foot, trans-humeral and trans-radial prostheses and ankle-foot, knee-ankle andpatellar-tendon-bearing orthoses, and for using thealignment jig in the manufacture of lower-limb prostheses,were published and widely distributed among all ICRC-assisted projects and NGOs and among stakeholdersinvolved in providing P&O services in developing coun-tries. Each manual contains material that should be ofhelp in transferring know-how in projects.

Polypropylene technology

To mark the ICRC’s role in developingand promoting appropriate technology,such as the polypropylene technology,a brochure on the subject was pub-lished in 2007. It provides the neces-sary information about the advantagesand appropriateness of using thistechnology for producing prostheticand orthotic devices in developingcountries.

Physiotherapy

This booklet/CD-ROM provides examples of basic post-prosthetic exercises for use by physiotherapists, physio-therapy assistants, ortho-prosthetists and othersinvolved in the gait training of lower-limb amputees.The aim of these exercises is to help amputees regaintheir self-confidence and to walk as well as possible.

MISSION

The International Committee of the Red Cross (ICRC) is an impartial,neutral and independent organization whose exclusively humanitarian mission is to protect the lives and dignity of victims of armed conflict and other situations of violence and to provide them with assistance.The ICRC also endeavours to prevent suffering by promoting and strengthening humanitarian law and universal humanitarian principles.Established in 1863, the ICRC is at the origin of the Geneva Conventionsand the International Red Cross and Red Crescent Movement.It directs and coordinates the international activities conducted by the Movement in armed conflicts and other situations of violence.

0988

/002

05

.200

9

physical rehabilitation programme - icrc.org · first step towards enjoying such basic rights as...

Documents