Afghanistan: Getting people with disabilities back on their feet

22 July 2016
Afghanistan: Getting people with disabilities back on their feet
Kabul, ICRC orthopaedic centre. A boy practices walking with his calipers. CC BY-NC-ND / ICRC / Kate Holt / v-p-af-e-01733

The ICRC's work with disabled people in Afghanistan helps them live an active role in society through physical rehabilitation, education, employment, micro-credit loans, vocational training and sport.

Download this article in PDF formatPhysical rehabilitation was one of the ICRC's first activities in Afghanistan, starting in Kabul in 1988. Today, almost 30 years later, there are six other ICRC orthopaedic centres, one each in Gulbahar, Herat, Jalalabad, Mazar-i-Sharif, Faizabad and Lashkar Gah. The ICRC also supports eight non-ICRC orthopaedic workshops, in Maimana, Taloqan, Ghazni, Kabul, Khost, Kunar and Kandahar, providing them with raw materials, staff training and technical assistance.

We know that the physical rehabilitation of disabled persons is only a first step towards their social reintegration, so the ICRC's physical rehabilitation programme champions the rights of people with disabilities to live an active role in society through education, employment, micro-credit loans, vocational training and sport.

The ICRC physical rehabilitation programme in Afghanistan

Over the years, the ICRC physical rehabilitation programme in Afghanistan has changed considerably. Initiated in Kabul in 1988 to provide artificial legs to people who had lost one or both in war, in 1994 it extended its work to cover anyone with a mobility handicap. Alberto Cairo, who started his work at the Kabul Orthopaedic Centre in 1990, recounts the evolution of the programme.

"So far, about 147,000 patients have been registered in the seven ICRC centres, with an average yearly increase of 9,000," he explains. "Over 19,000 artificial legs, arms and other orthopaedic devices are manufactured every year.

Despite all these efforts, we soon realised that this was not enough. A disabled person needs more than a plastic leg and the ability to walk again; he or she needs a role in society and to recover dignity and self-respect. In Afghanistan, where life is difficult enough for everybody, a disabled person needs more help than most.

But what, precisely? The same as anywhere else in the world: Education, a chance to learn a skill and thus to get a job, or a small loan to start a business, the opportunity to play, practice sport, have fun.

The orthopaedic centres therefore started to expand again in 1997, to make room for desks and blackboards, for an employment agency, and for a bank to arrange micro-loans.

In order to set an example – to prove that a disabled person can work as well as someone who is able-bodied – the physical rehabilitation programme has adopted a policy of 'positive discrimination', by employing and training only disabled people. At present, practically all the over 800 employees of the ICRC orthopaedic centres, male and female, are former patients.

The fact that the employees are themselves disabled can have a hugely positive effect on the patients, especially new arrivals. People are frequently depressed and afraid when they first come for treatment, because of their predicament and what they imagine will be their future. Being amongst disabled people who have rebuilt their lives and regained dignity gives them a huge psychological boost. At the same time, having experienced disability themselves, the staff of the centres are better equipped than anyone to understand what patients are going through, and to help them overcome their fears and concerns."

A glimpse of Nilofar's life

One evening in 2002, a bomb exploded while Nilofar was playing in the yard of her house and she suffered severe back injuries. A neighbour took her to the nearby ICRC clinic, but by the time she arrived it was too late to save her from becoming paralysed.

After several years of regular physical rehabilitation sessions, Nilofar was able to increase her mobility with the help of orthoses. In 2011, the Kabul Orthopaedic Centre needed a female data entry operator and they offered the job to Nilofar. "My life has changed. Since I started working, I've been standing on my own two feet and supporting my family," Nilofar explains.

Nilofar practices wheelchair basketball at the ICRC orthopaedic centre in Kabul.

Nilofar practices wheelchair basketball at the ICRC orthopaedic centre in Kabul. CC BY-NC-ND / ICRC

Nilofar was the first female to join the wheelchair basketball team at the ICRC orthopaedic centre, inspiring other girls to play basketball. Now there are 35 female athletes playing basketball and participating in competitions at the centre. And Nilofar has been selected for the Afghan national team.

"For someone like me it's very important to do some physical activity. Working in the ortho centre is not that easy. Every day from 7.30 am to 4.30 pm I see a lot of patients who are very depressed and of course that has a huge effect on me," says Nilofar.

However, working and empowering the patients are among the centres' main accomplishments.

"I'm like any other human being" Nilofar says. "Maybe I'm even stronger ... I won an award for my basketball team. Who would have thought that would ever happen?"

"I will continue working here and playing basketball. Even if I feel I can't carry on, I won't give up. I'll encourage and train other disabled girls to do sport, because they can make changes to their lives too. They have the same rights as any other person."

People who have suffered from a spinal cord injury and are now paraplegic or tetraplegic are especially vulnerable. The ICRC has created a special programme for them, unique to Afghanistan, called the Home Care Programme (HCP). The HCP was initiated in 1996 to provide medical, economic, social and psychological rehabilitation for people with spinal cord injuries, helping them regain their independence and integrate into society. Home care teams visit patients at home regularly and train them and their families, making the family part of the rehabilitation process.

Sport has become one of the most visible aspects of our services for people with disabilities, combining physical rehabilitation, social reintegration, fun and entertainment. The ICRC promotes wheelchair basketball, volleyball, and futsol (indoor football) and we have built courts in five of our ortho centres, with more planned. Both male and female teams compete in local and national tournaments in coordination with the Afghan Paralympic Committee and the Wheelchair Basketball Federation of Afghanistan (WBFA). Afghanistan's wheelchair basketball team has obtained international recognition, playing in Italy and in Japan.

ICRC orthopaedic centres

Ali-Abad Orthopaedic Centre opened in 1988 and assists patients from Kabul, Parwan, Paghman, Logar, Bamiyan, Paktia, Wardak, and Ghazni provinces. It has about 350 workers, practically all of them disabled former patients. Each year, in addition to making around 1,100 prostheses and 6,500 orthoses, the Centre produces 1,200 wheelchairs, 9,000 pairs of crutches and other walking aids. Over 75,000 physiotherapy sessions take place annually.

An ICRC orthopaedic technician adjusts a prosthetic leg.

An ICRC orthopaedic technician adjusts a prosthetic leg. CC BY-NC-ND / ICRC

More than 1,700 people with spinal cord injuries receive home visits and about 100 severely disabled children receive home schooling. Patients are offered vocational training and micro-loans to start small business ventures that will enable them to earn an income and support their families. Some 6,500 patients have benefited from the scheme. The Ortho Centre has an internationally recognized school for training orthopaedic technicians, run in cooperation with the Health Ministry.

This orthopaedic centre opened in 1991, and its catchment area includes the provinces of Balkh, Jawzjan, Samangan, Kunduz and Baghlan. There are 130 staff, all of whom are former patients. The work is similar to that of the Kabul Ortho Centre, with Mazar-i-Sharif producing an average of 900 prostheses and 2,300 orthoses each year. Approximately 500 paraplegics receive assistance or home visits, there are vocational training and micro-credit schemes and around 1,000 patients have received a loan. The centre also runs training courses for physiotherapists and orthopaedic technicians.

Herat and Jalalabad
Herat (130 staff) opened in 1993, Jalalabad (70 staff) in 1995. Like Kabul and Mazar, they offer rehabilitation services and a range of vocational activities to amputees and other people with disabilities. Both centres produce mobility aids, such as wheelchairs and crutches, and some 60 children are receiving home schooling. Herat delivers over 5,000 orthopaedic devices per year, making it the second busiest rehabilitation centre in the country after Kabul.

Gulbahar and Faizabad
The Gulbahar centre opened in 1999, followed in 2001 by that in Faizabad. Both centres have grown to become the referral facilities for large and remote provinces such as Parwan, Panjshir, Kapisa, Badakhshan and Takhar.

Lashkar Gah
This centre opened in 2010 and assists patients from the four southern provinces of Afghanistan. It has 44 staff, all of them disabled persons.

The ICRC has been present in Afghanistan continuously since 1987.

ICRC orthopaedic (physical rehabilitation) centres in Afghanistan

Faizabad Orthopaedic Centre

Tel: +93 799 415 805 / +93 796 329 698

Gulbahar Orthopaedic Centre

Tel: +93 799 608 754

Herat Orthopaedic Centre

Tel: +93 798 998 006 / +93 729140 663

Jalalabad Orthopaedic Centre

Tel: +93 729140 643

Kabul Orthopaedic Centre

Tel: + 93 700 297 778 / +93 729140 560

Lashkar Gah Orthopaedic Centre

Tel: +93 729140 521 / +93 729 140 61

Mazar-i-Sharif Orthopaedic Centre

Tel: + 93 700 506 852 / + 93 799 686 903

The ICRC's physical rehabilitation work in Afghanistan