Children with disabilities often face increased risk of harm during armed conflict and crises, Human Rights Watch said today. The United Nations and governments around the world need to urgently ensure protection and assistance for children with disabilities in these circumstances.
"Armed conflict takes a devastating toll on children with disabilities, yet governments and the UN have not done nearly enough to protect them," said Jane Buchanan, deputy disability rights director at Human Rights Watch. "Governments, the UN Security Council, UN agencies, and aid groups should urgently step up efforts to protect and assist children with disabilities as part of their commitments toward children affected by hostilities."
Since 2015, Human Rights Watch has documented the impact of armed conflict and crises on children with disabilities in Afghanistan, Cameroon, the Central African Republic, the Gaza Strip in the Occupied Palestinian Territory, South Sudan, Syria, and Yemen.
Children with disabilities are often at greater risk during attacks, including risk of abandonment. Their families can face a split-second decision, either to flee only with family members who can flee easily, or to remain behind to provide support. Children with physical disabilities can struggle to flee without assistance and assistive devices such as wheelchairs, prostheses, crutches, or hearing aids. Children who have visual, hearing, developmental, or intellectual disabilities may not hear, know about, or understand what is happening.
Children with disabilities can also experience disruptions to education, lack access to services and humanitarian assistance, and face lasting psychological harm. Conflict can worsen poverty for them and their families, affecting their ability to meet basic needs, let alone get assistive devices or rehabilitation.
The disruption of education during conflict and crises places a high burden on children with disabilities. Government forces and armed groups may attack, occupy, and destroy schools. Remaining options for schooling may be inaccessible or difficult to flee in case of attack. Children with disabilities are more likely to be out of school and without access to education provided by humanitarian organizations, which may have limited options for inclusive programs and lack trained staff.
A former student in Cameroon's Anglophone regions, where civilians have been caught in attacks by armed separatists and government forces, and whose leg had been amputated said: "Education for [students with disabilities] was already a luxury prior to the crisis and has just become impossible now. Nowadays, only those who can run go to school."
For children with disabilities, lack of access to support and services and education exacerbates conflict's impact on mental health. Trauma caused by armed conflict and a lack of subsequent mental health support can harm a child's development and life trajectory.
In 2019, the UN Security Council adopted a landmark resolution on protecting civilians with disabilities during armed conflict, focusing on the duty to protect, assist, consult, and end impunity for crimes. The report said the UN secretary-general should include relevant information and recommendations regarding people with disabilities in his briefings and thematic and geographic reports to the Security Council.
However, there has been little mention of children with disabilities in these reports. A January 2022 study by the special representative of the secretary-general for children and armed conflict, Virginia Gamba de Potgieter, found that children with disabilities have overwhelmingly been left out of 25 years of UN action to help children caught in armed conflict.
In a July 2021 report, the UN special rapporteur on disability said that governments and militaries should "develop specific protections for persons with disabilities during the conduct of hostilities" and undertake "disability-inclusive programming" in humanitarian action.
Governments, the UN Security Council, and United Nations agencies and bodies should ensure that existing efforts to monitor, report, and respond to child rights violations in armed conflict include children with disabilities. Together with humanitarian organizations, they should also improve humanitarian coordination and assistance so that children with disabilities have access to nutrition, health care, education, assistive devices, and psychosocial support.
"Bold commitments and targeted action are needed to protect and include children with disabilities, who have largely been forgotten," Buchanan said. "After 25 years of action on children in armed conflict, the UN, including the secretary-general, and member states should immediately make sure that children with disabilities are included fully in all UN efforts on children in armed conflict, and that children with disabilities receive equal protection and assistance."
People interviewed are identified without their surname or with a pseudonym to protect their privacy.
Children with disabilities can be at a higher risk during armed attacks without assistance or assistive devices or because they can't hear or don't know that an attack is happening.
Ahmed, who lives in Idlib governorate in Syria with his six children, including an 11-year-old girl who is deaf, said he and his wife fear for their daughter's safety because she cannot hear airstrikes or shelling. "My wife and I keep our eye on her all the time, and if we hear an attack, we have to physically go and grab her to bring her with us to the shelter," he said.
Osman, whose 12-year-old daughter has a physical disability, struggled to flee an airstrike on their community in northeast Syria in 2019 because his daughter did not have a wheelchair. He carried her at first but quickly became exhausted. His brother found a wheelbarrow to push the girl in, and they managed to escape. "That's how we were able to flee," he said. "I pushed the wheelbarrow for nine kilometers. It was very difficult."
The family eventually obtained a broken wheelchair that had belonged to someone who had died. "The [wheel]chair she is using now … it's hard to use this chair, and I have no tools to work on it," he said. "It's very expensive to buy a new one."
Children who are unable to flee independently and do not have someone to support them can be left behind.
In Cameroon, a 5-year-old blind child was left in his house in the South-West region when soldiers arrived in the village in January 2019. His father said:
That morning my wife and I went to the farm and left the child with his elder brother, who is only 11. The military invaded the community, and my 11-year-old boy ran away, leaving the child alone. The child attempted to run, but he fell in a pit toilet. Luckily, he was still alive when we found him.
In 2015, Human Rights Watch interviewed Hamamatou, then 13, from southwestern Central African Republic, who had polio and could not walk independently. When armed fighters attacked Hamamatou's community, her brother carried her on his back until he became too tired to continue. "I told him, 'Souleymane, put me down and save yourself,'" she said. "He said he would come back for me if they didn't kill him." He never came back.
In 2015, Human Rights Watch interviewed "Hamamatou," then 13, from southwestern Central African Republic, who had polio and could not walk independently. When armed fighters attacked Hamamatou's community, her brother carried her on his back until he became too tired to continue. "I told him, 'Souleymane, put me down and save yourself,'" she said. "He said he would come back for me if they didn't kill him." He never came back.
Children with disabilities are at a higher risk of being unable to reach a school and being left out of formal education and educational services provided by humanitarian organizations. For children with physical disabilities, barriers can include inaccessible roads, inaccessible school facilities, and lack of assistive devices. One student in Afghanistan who uses a wheelchair said: "Unfortunately, I cannot go to school by myself, I need someone to take me to school and pick me up. The school has no ramp, so it's hard for me to get in and out of the classroom, and sometimes even that's impossible."
In 2015, in the Central African Republic, Human Rights Watch found very few children with disabilities enrolled in schools in camps for internally displaced people. The school in the M'Poko camp had 3,797 children enrolled, of whom only 14 had disabilities. School staff reported that some parents hesitated to send their children with physical disabilities to school out of fear that they would be unable to flee an attack.
Attacks on schools interfere with access to school for all children, including children with disabilities. According to the United Nations Children's Fund (UNICEF), since the Syria conflict began in 2011, more than 7,000 schools have been damaged and destroyed. The 2021 UN Humanitarian Needs Overview on Syria estimates that there is one functioning classroom for every 53 school-age children, and that children with disabilities are less likely to be included. The report highlighted that existing schools are characterized by unsafe infrastructure, including absent walls, roofs, staircases, windows, or heating, as well as severe overcrowding. In Cameroon, armed separatists have attacked at least 70 schools since 2017.
Osman said his 12-year-old daughter has never gone to school. "Most of the schools we had before the war were completely destroyed during the war," he said.
In 2018, UNICEF reported that attacks on schools "can reverse progress on inclusion, pushing previously included children with disabilities into domestic isolation or exploitative work." An October 2021 UN Security Council resolution strongly condemned attacks on schools and said that governments should ensure education for children with disabilities "on an equal basis provided in the context of armed conflict."
Many children and families Human Rights Watch interviewed said they couldn't afford basic necessities, such as food and health care, and especially struggled to provide items such as assistive devices or diapers for older children, as well as rehabilitation or other therapies.
Lack of access to nutrition and health care can exacerbate existing disabilities. When Human Rights Watch interviewed Mamadou, a 14-year-old with physical disabilities in the Central African Republic, in 2015, he weighed less than 8 kilograms and had an acute pulmonary infection. Dozens of people in the same camp, including children with disabilities, had died from malnutrition, respiratory illnesses, and other diseases.
In Afghanistan, a lack of female health workers and female trained professionals has limited access to rehabilitative services for girls with disabilities.
In 2020, Humanity & Inclusion reported that conflict-related deterioration of infrastructure, health care, and other services in Yemen, including because of the use of explosive weapons in areas with civilian populations, had a disproportionate impact on children and adults with disabilities. They found that 86 percent of people with disabilities surveyed had experienced problems in getting services due to physical barriers, lack of security, and economic and social discrimination. Increased prices of medications and denial of humanitarian assistance are also serious concerns.
Hanan, a 4-year-old girl with cerebral palsy and epilepsy in Yemen, needed medications that became unaffordable. In 2015, her father said: "Her medication is important for her health because when she takes it regularly, she only experiences an epileptic seizure once every two weeks. But when she does not take the medicine, she experiences a seizure twice a day…. It's hard to feel useless."
In a June 2020 address to the UN Security Council, Raja Abdullah Almasabi, a disability rights activist from Yemen, said: "Denial of humanitarian access has created chronic health conditions, especially among children, such as malnutrition. This is one of the primary reasons why many children in Yemen have acquired a disability."
Ahmed A., an 18-year-old man from Syria, requires adult diapers because his disability affects his bladder and bowel control. Because adult diapers are more expensive, he wears children's diapers that do not meet his needs. "It's hard emotionally," he said. "That I am in this situation because we cannot afford the right diapers. I cannot go out with my friends. I just sit at home."
Sites for internally displaced people or refugees are often not accessible. Children may need to crawl or drag themselves in unsanitary conditions to reach a latrine. Uneven terrain in camps for displaced people in the Central African Republic made navigation dangerous or impossible for children who are blind or who use assistive devices to move around.
Israeli restrictions that limit access to electricity in Gaza impact people with disabilities in particular ways. A mother of an 11-year-old girl with cerebral palsy and an intellectual disability said that without electricity she cannot operate a nebulizer her daughter needs when she was trouble breathing, putting her health at risk. She said that her daughter's "chest starts going up and down, she breathes quickly, her heart beats quickly and her eyes move really fast … Sometimes I cry when electricity is cut off, wishing I could do anything not to see her in that condition."
Children with physical and sensory disabilities in many cases cannot get adequate prosthetic or assistive devices. A 16-year-old boy who lost a leg after stepping on a landmine in northwest Syria said: "A prosthetic leg would help a lot... It will help me to come and go without having to ask other people for help. It will help me emotionally. Today, I cannot go, I cannot do anything alone. I need to have my father there to help me, even to walk."
If children have access to assistive devices, they are often not tailored or appropriate for their needs. Alaa, a 5-year-old girl with a developmental disability who lives with her family in a camp for internally placed persons north of Aleppo governorate in Syria, cannot walk without support. Her mother said that a humanitarian organization provided her with a wheelchair, but photos shared by her mother show Alaa in an adult wheelchair not appropriate for her age and her disability.
Research in Cameroon in 2019 found that security forces had destroyed and looted hundreds of homes across the Anglophone regions. People with disabilities often lost everything, including their assistive devices, accessible homes, and livelihoods.
A UNICEF representative interviewed in 2019 said that children in Gaza whose limbs have been amputated have difficulty getting prosthetic and assistive devices as they grow and require replacements. Israeli import restrictions, shortfalls in local authorities' and aid groups' provision of necessary devices, and lack of expertise in Gaza to repair damaged devices all limit the availability of assistive devices.
Research indicates that all children living in conflict and crises zones are at high risk of depression, anxiety, and other mental health conditions. Children and families interviewed in multiple countries reported signs of psychological distress in children such as anxiety, sadness, extreme agitation, or frequent trouble sleeping. Lack of access to support and services and education exacerbates conflict's impact on mental health.
A teacher at the secondary school in Mendankwe, a village in Cameroon's North-West region that was attacked by armed separatists in June and September 2020, said:
They [children with disabilities] suffered more than others… They were particularly traumatized by the violence they witnessed.
Many of the deaf children we have in school have been internally displaced. They told me that even if they could not hear the gunshots when their communities were under attack, they felt them, they felt the panic, they saw the terror in the eyes of their families trying to escape to safety. Some of these children have trouble sleeping, and they cannot concentrate or do their homework.
Ahmed, father of an 11-year-old girl with a hearing disability, said sudden attacks and fleeing in Syria had a more profound impact on his daughter, Shahid, than on his other five children:
Shahid was psychologically affected. Whenever there was airstrike, the children became terrified, and we started yelling and trying to run to the shelters, and when she saw us in that situation, she started to cry. Now whenever there is something unexpected, even if someone rushes into the house, she starts to cry.
In the Central African Republic, a 17-year-old-boy with an intellectual and physical disability, Suleiman, was fleeing when he saw his uncle being brutally killed. Suleiman appeared to be traumatized by what he saw. He had not received psychosocial support. He said: "My uncle's death in front of my eyes continues to scare me. … When I sleep, I have nightmares that bring back the images of the events I lived. I haven't spoken to anyone about it."
In 2019, a father of three in South Sudan said that one of his daughters became traumatized after seeing the dead bodies of her aunt and cousins in December 2013 as they fled an attack:
Before the war, she was OK. But then, she started to insult everyone and run away from home for many days at a time. At the hospital, they didn't know what she has but they gave her Phenorbitone (used to treat anxiety symptoms). Now, she can't even go to school here. Otherwise, she gets into fights with other children or just runs away, and there is no fence around the school to keep her in there.
In 2020, Save the Children reported that over half of the children they surveyed in Yemen reported feelings of sadness and depression, "with more than 1 in 10 saying they feel that way constantly."
UN Resolution 2475 (2019) on people with disabilities in armed conflict asks the secretary-general to include information and data on people with disabilities in his reporting. The secretary-general is mandated to bring to the Security Council's attention any matter that may threaten the maintenance of international peace and security. However, the secretary-general has not included consistent, substantive reporting on abuses against and the experiences of people with disabilities in country-specific reports and briefings.
The secretary-general's reports on some of the countries included in this and previous Human Rights Watch's research (Afghanistan, Central African Republic, Palestine, South Sudan, and Syria) either did not mention the conflict's impact on people with disabilities at all or made only brief reference. Only one of the nine reports on the humanitarian situation in Syria since 2019 mentions the specific needs of people with disabilities and two mention people with disabilities who had been killed.
The secretary-general's annual reports on protection of civilians have been more inclusive. All such reports since 2019 have included information on the impact of armed conflict on people with disabilities.
For reporting specifically about children with disabilities, a January 2022 report by the secretary-general's special representative for children and armed conflict found that children with disabilities have overwhelmingly been left out of 25 years of UN action on children in armed conflict and recommended greater attention going forward.
Some of these gaps include the secretary-general's 2020 annual report to the Security Council on children in armed conflict, which mentions children with disabilities only in relation to reintegration programs for child soldiers. While all of the secretary-general's annual reports about children in armed conflict include data on children who have been "maimed," or acquired a permanent injury, the reports do not elaborate on their rights as children with disabilities, or include other information on the conflict's impact on children with disabilities. Five country-specific reports on children in armed conflict since Resolution 2475 similarly only included information on "maiming."
The secretary-general's 2022 report on children and armed conflict should recognize the specific abuses and exclusion experienced by children with disabilities, including those who have acquired a disability, are out of school, and lack access to humanitarian assistance, and provide recommendations to the Security Council and governments to guarantee their rights. In addition, in all its reporting, the UN should consider using another term to refer to violations against children that result in serious injury other than "maiming." Although "maiming" is a term used in international humanitarian law, it is not consistent with the Convention on the Rights of Persons with Disabilities (CRPD), and can be stigmatizing to people with disabilities. Consultation with organizations of people with disabilities is crucial in identifying alternative language.
Resolution 2475 called for "sustainable, timely, appropriate, inclusive and accessible assistance to civilians with disabilities affected by armed conflict, including reintegration, rehabilitation and psychosocial support," including for children. The UN, governments, and humanitarian organizations should improve humanitarian coordination and assistance to guarantee children with disabilities access to basic services, including health care, education, assistive devices, and psychosocial support.
Resolution 2475 also emphasized the importance of including people with disabilities across United Nations peacekeeping and peacebuilding efforts. Specific progress remains limited. Recent resolutions renewing mandates for UN peacekeeping missions in the Central African Republic and South Sudan fail to call for specific protection and assistance for people with disabilities and deployment of disability protection advisers. The mandate did include other specialized advisers for children and women. Future resolutions and all child protection programs in UN peace operations and political missions should be inclusive of children with disabilities.
