Tag Archives: DRR

‘At the heart’ of humanitarian decision-making

“Together we launched a ground-breaking charter that places people with disabilities at the heart of humanitarian decision-making”

When Ban Ki-moon makes a statement like that, of course it does not mean we have achieved all our goals yet but it does show a hugely positive shift in the understanding of disability in situations of crisis, conflict and disaster. Gone are the stereotypical phrases that generally lead us back to a ‘charity’ model. Instead, there is the recognition of the necessity to have us at the table where plans are made; this is the first step towards real inclusion.

This is what I was writing about before the World Humanitarian Summit opened, so it was with great pleasure that I heard Secretary-General of the United Nations close the summit in such a way.

So it is a first step, but no time to relax. Now the real work begins: ensuring the the Charter, already endorsed by more than 80 stakeholders, is used, promoted and further endorsed;  ensuring that persons with disabilities and disabled people’s organisations are really part of discussions as equal partners and not only consulted in a check-box style approval process; and increasing the exchange of skills and knowledge between the humanitarian and disability communities.

I’m flying shortly, but will add to this blog soon, with more details on events over the last couple of days and opinion/comments from participants, so do check back. In the meantime, if you weren’t following live, you can catch up here:


And now updated, 26th May

During the events I sought the opinions of several people. Here are two that struck me as particularly relevant.

Two men at a booth in a conference. The booth has branding 'CBM HHoT, Humanitarian Hands-on Tool'

Nazmul Bari at the CBM HHoT booth in the World Humanitarian Summit Innovation Fair. HHoT is a prototype application to provide humanitarian field workers with practical guidance on accessibility

Nazmul Bari, Director, Centre for Disability in Development (CDD):

“There are many barriers that cause persons with disabilities to be left behind during humanitarian crises. These begin to take effect immediately post-disaster, with a lack of data and info meaning that rescuers don’t know specifics about who lives where. Then, the sudden change in environment means that difficult decisions must be made, like who to prioritise during evacuation; persons with disabilities are often seen as least important.

“Transportation to safe shelter may not be accessible and once reaching there we have examples where people are turned away on the grounds of their disability. Even if the shelter is reached and the person is accepted, there are considerations like safety, security and accessibility of latrines.

“As time moves on, the next priorities include ensuring that relief efforts are inclusive. Commonly, information about and location of distribution points are not accessible to everyone. As well as directly excluding some people this indirectly puts an extra burden on family members who may then have to collect and transport multiple relief items. A further consequence is that normal support systems – e.g. caring for children – may be disrupted. There are then more challenges once early recovery is underway: Are livelihood and longer-term rebuilding/reconstruction efforts taking the needs of everyone into account?”

Two women at a booth during a conference. The booth has branding 'Inclusion of Persons with Disabilities'

Nelly Caleb, co-Chair of Pacific Disability Forum (PDF) at the Disability Group booth

Nelly Caleb, National Coordinator of Disability Promotion and Advocacy Association in Vanuatu, Board Member International Disability Alliance (IDA) and co-Chair of Pacific Disability Forum (PDF):

Persons with disabilities are excluded from projects and policies, even if, on paper, they are ‘included’. We must be able to actively participate. In the South Pacific we see disaster affects persons with disabilities a lot, so PDF helped different countries such as Vanuatu to developed a toolkit to help NGOs, civil societies and these countries to facilitate inclusion in their Disaster Risk Reduction (DRR) and disaster response work.


Mental Health is the centre of attention at the World Bank this year: “Out of the shadows; making mental health a global priority”

Momenta's Project Sierra Leone 2015

The human toll of mental illness has started to be widely recognised for its impact on individuals and families. There is now much more awareness of, for example depression, due to stories in the media about famous people who are talking openly about their problems. Even the once taboo subject of suicide is now more openly acknowledged in society.  When someone like the comedian Robin Williams dies by suicide, it has the effect of reminding us that at least 1,000,000 people die in this way every year around the world. In many countries suicide is one of the top three causes of death in young people, but is often ignored or even denied as an issue.

CBM, along with many other partners in global development have long pointed out that mental illness and psychosocial disability also has an important impact on communities and broader society. Mental illness does not only cause personal suffering, but often results in social exclusion and lack of opportunity for large sectors of the population to contribute to the economy and community development. Since 85% of the people with mental conditions live in the poorest countries in the world, the impact is particularly marked on these fragile economies.

By 2030, depression is expected to become the single largest contributor to disease burden globally, and even today, 350 million people around the world are affected by depression. The sheer scale of this issue, and the well documented impact on people’s ability to work and actively engage in the economic life of a country has led the World Bank to focus on mental illness at their annual Spring Meeting in Washington in April. At last year’s World Economic Forum, careful analysis in a report by a Harvard group resulted in an estimate that the annual global costs of mental illness to the economy was 2.5 trillion dollars in 2010, a staggering number that was expected to rise to 6 trillion dollars by 2030.

The joint meeting, called ‘Out of the shadows, making mental health a global priority’ will be run by the World Bank and WHO, from April 13th to 15th in Washington. It will be a forum to examine how the major financial actors in global development can address this issue. These key funders and politically powerful groups can hopefully start to play their role, joining development organisations like CBM, and other groups like service user organisations and activists, so make more resources available and raise prioritisation of mental health.

CBM will be well represented at the meeting. Carmen Valle will be sharing our experiences of working in Sierra Leone with partners to build resilience and reduce the psychological impact of the Ebola epidemic. This is a part of Disaster Risk Reduction that is often not sufficiently recognised. Information about this project with our partners in Sierra Leone is here. She will also be talking about how our partners ensured that access to important public health messages, for example during an epidemic like the 2014/15 Ebola outbreak, can be accessible to all people, including people with disabilities.

I will be speaking during a panel discussion on the topic of mental health and people with sensory impairments. The main points are that

  • Mental ill health is much more common in people with sensory impairments, but is often not recognised.
  • Mental health components should be integrated into services for people with sensory impairments, for example ensuring that service users themselves, and health and education personnel, are made sensitive to these needs and are aware of how to address them
  • The barriers that people with sensory impairments face should be specifically addressed in messaging relating to mental health by paying attention to accessible formats (as in any other awareness and public health work).

Carmen and Julian will be Tweeting and Blogging from the meeting. Follow our our blog, Twitter and Facebook to get all the latest news about the WHO meetings in Washington DC (the hashtag for this event is #mentalhealthnow). You can also follow Dr. Julian Eaton and Dr. Carmen Valle on Twitter who will be tweeting live from the events.

Additional information on the Innovation Fair can be found here.


Julian Eaton

Mental Health Advisor, CBM

Dhaka, disability and disaster risk reduction

As I sit here amidst the honking of horns of the Dhaka rush hour, I take the chance to reflect on some of what I’ve seen over the last few days…

Sandwiched between the Himalayas and the Bay of Bengal, Bangladesh is a disaster-prone land. Glacial and rain-induced flooding, cyclones and earthquakes are some of the hazards that it’s exposed to, so maybe it’s no surprise that the country is taking a leading role on the global disaster risk reduction stage. Specifically, the Dhaka Declaration, adopted last week at the Dhaka Conference on Disability and Disaster, is a two-year plan with strategic action points that will help shape governments’ Disaster Risk Management (DRM) policy in line with the Sendai Framework.

But enough jargon – what does all this mean in practice?

After the conference, I had the good fortune to escape the motorised jam of the capital city and visit some project work being done by our partner Centre for Disability in Development with Gana Unnayan Kendra in Gaibandha, in the north of the country.

yellow fields

Mustard fields in winter (dry season)

Deceptively tranquil, with fields of bright yellow mustard and rice paddies at all stages of growth (apparently the fertile ground can provide up to four harvests per year), this region is often affected by severe flooding. To avoid significant loss of their harvests, livestock and indeed their own lives, the local people need to be prepared.

The measures that are being taken are impressive, providing a seamless framework that starts at the local communities and links with government bodies. They reflect the ‘people-centred’ approach called for by Sendai, but also, in line with the Dhaka Declaration, they revolve around the inclusion of persons with disabilities in leadership roles, and have had some stunning results so far.

From exclusion to respect

The highlight for me was probably meeting what is known as the ‘Apex’ body, a group of disability leaders from local self-help groups who come together (I think they said bi-weekly) to plan their advocacy towards inclusion.

Led by Kazol Rekha, some of their greatest successes to date include:

  • increasing access to disability allowance by influencing the ‘open budget’ procedure (this action also allowed other more marginalised people to participate, proof if it is needed of the value of disability inclusion to the wider community)
  • creating an increase in the provision of assistive devices (including mobility tricycles and white canes)
  • and, on a practical level, having the local social services office moved from the (inaccessible) second floor to the ground floor
A young woman wearing traditional Bengali dress

Shirin – “I work to make sure other children do not miss their schooling as I did”

Shirin, one of the many female members of the group, has a learning disability and had very limited opportunity to attend school, but captured the mood of the moment perfectly:

“I was excluded, people did not give me respect; but now they are curious and want to know where I’m going and what I’m doing. I work to make sure other children do not miss their schooling as I did”.

Badsha Mia, another member of the group said “​I cannot imagine the changes over last two months: trainings, meetings… when people stop to talk they talk with us first; previously I felt limited as someone with a disability, but now no longer.”

So how does this link to DRR for all?

People, including a wheelchair user, seated cross-legged in a group in a public event

Kazol Rekha (in red) leading disaster management discussions during mock drill event. Kazol is also receiving training, to allow her to support people to learn their legal rights.

These people are not only personally empowered, but are positively affecting their community approach to resilience. We met the sub-district executive officer, who – with sincerity and a real understanding of inclusion – opined that “good human society brings marginalised people into the mainstream”, while highlighting the need for data on disability and access in infrastructure.

We attended a ‘mock drill’ organised by a school. This theatrical event drew hundreds of local people and depicted the process of community preparedness and response to flooding.

Early warning messages were given in various formats (ensuring they can be seen, heard, understood by all) and similarly, persons with disabilities, women and older people – often forgotten – were active throughout the decision-making and evacuation procedures.

It was impressive to see, and what sticks in the mind is that children (including children with disabilities) were centre-stage, providing invaluable foundations for future resilience.

The ‘last mile’

A man holding a red flag

A Ward Disaster Management Committee member explains their accessible early warning system

Back to real life, we met with the Union (Council) and Ward (more local level) Disaster Management Committees. These meetings were brief but powerful. The Apex body of persons with disabilities have representation with strong influence here, showing how the last mile between government and community can be covered.

This ‘last mile’ concept is easily exemplified by the community planning and preparing their own (accessible) early warning system, which includes coloured flags and audible messages.

And it was clear to us that the other committee members appreciate the value of inclusion – the secretary of the Union committee chairperson closed by saying that she is “waiting for the day when someone like Kazol is in her position“.

The way forward from Sendai

Schoolchildren (including wheelchair user)

Children learning about inclusive DRR during mock drill

There was much more, including visits to examples of income generating activities and accessible flood-prone housing, but the final message that is worth sharing, which was echoed by several of the groups we met, is that they know their work is changing their world but they want it to change THE world.

Following their example and implementing the Sendai Framework using government-endorsed papers like the Dhaka Declaration will do just this.


Dhaka Declaration – Disability-inclusive Sendai implementation


Six months after Nepal earthquake

Six months have passed. Looking back, it feels like just a short time ago that I was waiting to board a flight to Kathmandu – four days after a 7.8-magnitude earthquake rocked Nepal on 25th April. With its epicenter barely 100 kilometres from Kathmandu and first reports of the collapse of a nine-storey tower, I thought there’s nothing much left of the capital city. As I sat in the departure lounge, I could see the toll of dead and injured on the TV screen mounting every few minutes.

An aeroplane on the ground

First emergency assignment

As such, it was pouring and lightning outside, very unusual for an April spring, tourist season in Nepal. My heart went out to those who had lost their shelter and their loved ones, and were stranded in the hills amid ongoing aftershocks and unfathomable destruction.

In the next few hours, as I embarked upon my first emergency assignment, I was going to travel to some of the most affected areas and witness first-hand the scale of the destruction.

People with leg casts etc sitting eating

Outreach camp

On 1st May, I was part of a relief medical camp conducted by our partner HRDC (Hospital and Rehabilitation Centre for Disabled Children) in the yard of a partially-damaged house in Sipaghat in Sindhupalchowk district. Of the 133 clients, there were mostly people who had sustained severe head and spinal injuries, broken arms and ribs, and many had deep cuts all over their bodies. With minimum surgical equipment, the team sutured cuts and wounds, provided assistive devices such as cervical collars, splints and slings, and transported critical cases to Kathmandu for further treatment.

Meeting room with about 25 people

Cluster meeting Nepal earthquake 2015

The next two weeks were very crucial. As CBM joined forces with a string of partners, including local DPOs (Disabled People’s Organisations), to conduct a Rapid Need Assessment (RNA) of the overall situation, I had to travel to seven of the 14 worst-affected districts. The RNA team held long discussions with CBM partners on how they could scale-up their capacities to meet the sudden rise in patient count and related demands. I was also part of several UN Cluster meetings where CBM not just represented but played a crucial role in creating an advocacy alliance that voiced for ‘inclusive humanitarian response’.

As life was slowly getting back to normal, a second major quake measuring 7.3 on the Richter scale jolted Nepal on 12th May. What I saw at HRDC hospital that day will remain unforgettable. Fortunately, the 20 tents provided by CBM were useful, to shift all 72 in-patients from the wards into safer, open spaces. While the children stayed in the tents for a month, the medical team at HRDC continued to reach out to some of the remotest villages in Sindhupalchowk, Kavre, Dhading, Makwanpur and Chitwan districts, and provided much-needed medical services to the people.

A man presenting to a group of adults

Koshish PFA session

Over the next few months, I continued reporting about the efforts of CBM and its partners on the ground. As I travelled, I experienced and engaged in a range of activities conducted by CBM partners for people and communities impacted by the earthquake. Of all, the work of our partner ‘Koshish’ at providing psychological first aid (PFA) is of the utmost importance. I almost cried during a PFA session for schoolchildren in Bhaktapur district, as the little ones narrated their tales of trauma. Bhaktapur, with over 300 deaths and 12,000 injured, is one of the worst-hit districts. As schools reopened about two months after the earthquake, children were extremely happy to be sitting again in the classroom, but had a deep sense of fear and anxiety.

“Given the impact of disaster on the mental health of growing children, it’s important that we conduct psychological first aid sessions with schoolchildren…We have been doing such sessions in schools across Bhaktapur district after the Nepal earthquake,” explained Savitra Neupane, psychologist with Koshish. Furthrmore, with the support of CBM, Koshish went a step ahead to train teachers and social workers from other organisations on PFA and psychosocial counseling. “Sadly, there aren’t many organisations working to address the psychosocial needs of people affected by the earthquake… We’re happy to be working with CBM,” Savitra added.

A young mother with baby

Ganga’s newborn baby

Another memorable moment was meeting Ganga at the field hospital of our partner ‘The Leprosy Mission Nepal (TLMN)’ in Lalitpur district. “Ganga was heavily pregnant during the second quake on 12th May. As we were living in a tent, we were really worried about Ganga’s health. Yesterday morning we brought Ganga to Anandaban (TLMN) Hospital at around 7 am. We didn’t want to take any risks of post-partum complications. But even here everything was out in the tents… Ganga delivered a boy at 7.25 am. It was a smooth delivery and everything went well,” exclaimed Ganga’s caretaker Subhadra. Amid tents filled with injured patients, Ganga was beaming with joy. “Every now and then there’re people coming to our tent to see the newborn. I think they’re surprised to see a baby born in the tents…” said Ganga looking her baby.

Both TLMN and HRDC continued with their medical outreach camps in the affected districts. Sharing his experience, Dr Bibek Banskota, medical director at HRDC, says: “Initially, we saw a lot of clients with serious injuries at the outreach camps. But over a period of weeks to months, the flow of patients started changing into more chronic type of problems coming out of lack of proper sanitation, living in open shelters, and not having access to food and clean drinking water.”

In the meantime, CBM set up a dedicated emergency response team (ERT) in Nepal, and continued to roll out a full-fledged emergency response program with nine partners working mainly in central, and parts of eastern and western Nepal. In its first phase of eight months, the ERT was directed to work with a ‘twin-track approach’ – to empower persons with disabilities to access relief and participate in response initiatives, and to ensure mainstream relief is disability inclusive.

To me, the most strategic of interventions was what CBM borrowed from its experience of working in Haiti and Philippines – called the ADFP mapping system. ADFPs, or the Ageing and Disability Focal Points, were specialized hubs set up in three most affected districts in partnership with ‘National Federation of the Disabled Nepal (NFDN)’. These focal points were tasked with mapping all service providers in a particular area, and linking them with people or families that are in need of a particular service.

A man holding a pocket radio to his ear

Communication is essential

During a visit to Sindhupalchowk district in early July, I met Tul Bahadur (who has visual impairment) and his family at their temporary hut. Asked what support has he received from the ADFPs, a joyous Tul Bahadur explains: “I’m receiving their help since I got my disability identity card… After earthquake, they have provided me with a temporary shelter. In addition, I got 20 kg rice, two liters oil and two packets of salt. I’m happy that they provided me a radio. Now, I get all important information to cope with the post-quake situation. I even listen to music to heal my pain.”

Six months on, CBM has touched the lives of over 21,000 people from across all 14 affected districts in Nepal. Through outreach camps in remote, inaccessible villages, our partners have provided medical services to 14,800 people. Thanks to our partner Koshish, more than 2,700 people including schoolchildren have received psychosocial counseling through classroom sessions and psychiatric clinics. Through the focal points, more than 3000 people and 70 organisations have been ‘mapped’, and more than 900 referrals made. Besides, CBM has also held workshops with government officials, NGO and civil society members on accessibility and building inclusive structures. We’re also working with the Ministry of Health and Population in Nepal to provide injury management training to community health workers in 14 quake-hit districts. A campaign on accessible media information on relief and recovery work is underway; and CBM together with ‘HelpAge International’ is carrying out an operational research to analyse the impact of disasters on people with disabilities and older people, among other long-term initiatives.

However, this month as I visited Sindhupalchowk, on the way I could see children studying in an open, makeshift classroom right next to the highway – with just a tarpaulin sheet as a roof over their heads and shield from the noise of vehicles passing just inches away. I felt extremely sorry for the little ones. Indeed there’s so much to do. We have a long, long way to go… People continue to live in temporary shacks and struggle for basic needs and healthcare. October end marks the onset of winter in Nepal and temperature in the remote hills of Sindhupalchowk can drop to –5 degrees Celsius.

This week as I return to my hometown in the plains, the first time after the April 25 earthquake, my thoughts and prayers are with the hapless survivors battling winter chills up in the hills. While the rest of the country is celebrating the ten-day Dashain festival, the survivors must be missing their loved ones, must be remembering how things were during Dashain last year. But I know the tides will turn, and I look forward to being part of it, to doing more together!

Read about CBM and partners’ response

Download six month report (PDF, ~ 1.1MB)