Disability Assessment_WHO April 2014

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Disability Assessment

Syrian refugees

KRG-IRAQ2014

WORLD HEALTH ORGANIZATION



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World Health Organization Erbil Office- Iraq

Table of Content Page No

I. Preface

II. Acknowledgement

III. Executive Summary

IV. Goal & Objectives

V. Background Information

VI. Methodology

VII. General Findings

VIII.I Erbil Camp

- Kawergosek

- Dara Shakran

- Basirma

- Qushtapa

VIII.II Duhok Camps

- Gawilan

VIII.III Sulemaniya

- Arbact

IX. Conclusion

X. Limitation of the Study

XI. Recommendations

XII. Annex

3

4

6

8

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13

16

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Preface

The Word Health Organization Erbil Office in Iraq is pleased to publish this

disability assessment comprehensive report on Syrian refugees in order todevelop a realistic and feasible intervention plan to mitigate the suffering

of the displaced disable Syrian refugees and improve their quality of life.

Since Syrian war started in 2011, more than 2.5 million people have fled

their homes and took shelter as refugees in the neighboring countries

Turkey, Lebanon, Jordan and Iraq. As per United Nations High

Commissioner for Refugees (UNHCR) 222,574 people registered as Syrian

refugees as of Feb 10, 2014 and among those 95,487 (42%) took shelter in

the 9 camps in 3 Governorates of Kurdistan region of Iraq.

A descriptive rapid assessment was conducted in the 6 camps of Kurdistan

regions by the WHO hired surveyors who was frequently supervised by the

WHO Technical Officer responsible for the camps. The findings of the

assessment have given an estimation of the magnitudes of the disability,

severity, types, demand and unmet need of the Syrian refugees.

The results of the disability assessment survey will pave the way to

undertake a realistic, feasible and sustainable solution related for WHO-Iraq

which will ultimately reduce the suffering and ensure positive health

among all the disable Syrian refugees residing in the camps of Kurdistan

region in Iraq.

Dr. Syed Jaffar Hussain

Representative and Head of MissionWorld Health Organization, Iraq



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Acknowledgement

This document has been developed by the World Health Organization Erbil

Office in Iraq. I would like to convey my sincere gratitude to the DOH

(Directorate of Health) in Kurdistan Region to extend their support to

accomplish this disability assessment in their Governorates.

I am also equally thankful to the Camp and Sector Managers and the

interviewers who were actively involved in the registration and data

collection process throughout the disability assessment processes.

My special thanks to WHO Technical Officers and Program Assistants who

worked in this assessment for their active participation in developing

protocol, designing questionnaire, close monitoring and supervision, data

entry, analysis and prepare this evident based valuable documents to guide

WHO-Iraq to develop a realistic, feasible and timely action plan for the

Syrian disable refugees in the camps in Kurdistan region in Iraq.



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The reporting Assessment team included:

Dr. Noor Al-Alwan /Technical officer (WHO) Erbil,

Mr. Saad Al-Dahwi / (WHO) Program assistant,Ms. Noor Sabah / (WHO) Program assistant

The Disability Assessment in Iraq-KRG is supervised by:

Eng. Mohammed Hamasha/officer in Charge for WHO Erbil Office.

Special thanks to Dr. Hussain Mustafa Manna /WHO Consultant _Polio

For his assistance in preparing this report

Special thanks are extended to the people who assist in collecting Data in

the camps:

Dr. Shokan Mohammed/Technical officer (WHO) Sulaymanniyah

Dr. Mohammed Jasim /Technical officer (WHO) Duhok,

Ms.Dalal in Kawergosek Refugee Camp.Ms.Amina & Ms.Reem in DaraShakran Refugee Camp.

Mr.Satar in Basirma Refugee Camp.

Mr.Sabah in Qushtapa Refugee Camp.



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Executive Summary

More than 2.5 million Syrians have fled their homes since the outbreak of

civil war in March 2011, taking refuge in in the neighboring countries Iraq,

Lebanon, Turkey, and Jordan. Among the total displaced population,

222,574 IDP have taken their shelter throughout Iraq and 95,478of them are

in the camps of Kurdistan region which represent 42% of the total Syrian

refugees in Iraq. It can be said another ways that UN agencies are giving

their support to about 50% of the IDPs through establishing 9 camps in 3

Governorates in the Kurdistan region of Iraq.

As the War escalated and number IDPs gradually increased since February 2012,

there was an assumption of more casualties leading to high number of disability

among the Syrian refugees. Bearing in mind of this assumption, WHO Erbil Office

in Iraq decided to conduct a Disability assessment survey to determine the

number, categories, required assistive aids and other health care needs to

improve the quality of life and make disables self depended in the daily

activities. To accomplish this goal, Disability assessment survey was conducted in

6 camps among 473 registered disable individuals.

The study shows that highest numbers of disability are in Dara Shakran (151) and

lowest in Gawilan (47) and in the other 3 camps, the numbers are almost the

same (60-67). While analysis made based on disability versus individuals, it has

been observed that proportions of disability are higher (2.5%) in Dara Shakran

camp and lower in Kawergosk camp (0.6%). The disability further segregated by

categories which shows that significant proportion of disability is due to

movement (47%) followed by visual (19%). Among 4 categories of age groups,

15-45 years (51%) are affected more than any other age groups and male (61%)



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are affected more than female. When analysis made based on origins of

disability, it shows that disability acquired on origin are higher in Arabat (78%),

Qushtapa (77%) and Gawilan (60%). As per as Assistive Aids are concern, 50% of

the disable people have assistive aids in Arbat and 5% in Qushtapa while in therest 3 camps it is within the range of 15-22%.

Although estimated 20% of the registered disables couldn’t be interviewed

because they might refused to register as they have feeling of disappointment

for neglected their requests and requirements for several times beside the

possibility of not being exist in the camp during the assessment ,or because

continuous influx of Syrian to KRG. however the study ended well within 80% ofthe disables and gave some valuable information which will be helpful to make

a quick intervention plan for the disable people to mitigate their suffering and

make them self dependent in their daily activities and open an window of

opportunity to involve them in the income generation in his/her family.



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Goal

To improve the quality of life and make self dependence of the Syrian disables

refugees through providing necessary assistance.

Objectives:

1. To collect descriptive data of the disable individuals in order to determine

their need;

2. To determine the disability types to procure adequate number of devices

to be distributed;

3. To find any coexisting diseases in order to treat and fulfill addition demand

and create satisfaction on health service delivery;



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Background

Since Syrian war has started in early 2011 more than 2.5 million people fled

their homes and took shelter as refugees in the neighboring countriesTurkey, Lebanon, Jordan and Iraq. Yet the actual number of the refugees

in these countries would be much higher perhaps double than UNHCR

statistics since their statistics only based of the registration who took shelter

in the camps. As per United Nations High Commissioner for Refugees

(UNHCR) 222,574people registered as of Feb 10, 2014 and among those

95,478 (42%) have taken shelter in the 9 camps in 3 Governorates of

Kurdistan region of Iraq. More than 50% of the Syrian refugees who fled

Syria are now outside of the 9 refugees’ camps and have merged w ith the

local inhabitants in Kurdistan region and other Governorates in Iraq. Of the

total Syrian refugees residing in the camps significantly (61%) are in Domiz

camp of Duhok followed by camps in Erbil and Sulaymaniyah.

Various organizations of the United Nations, Government, Local Authority

and international community have come forward to support Syrian

refugees and to meet their basic needs to maintain a healthy life through

providing healthcare services, education, sanitation & hygiene, safe water,

foods and non-food items, shelters and psycho-social support.

World Health Organization estimates that 15% of the individual are

affected with any kind of disability within the total population; however this

rate would be significantly higher among the displaced population in the

situation of war. Due to sudden set back of their socio-cultural-economic

status most of them couldn’t cope with the camps environment and take

shelter outside the camps and merge with the permanent inhabitants.



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Those who have severe form of disability and don’t have a caregiver

couldn’t come out from their tents to receive medical service and to get

their basic needs. These group of people are more vulnerable to get

diseases and acquire varies form of mental illnesses.

Being a technical organization on Health in the United Nations, WHO Erbil

Office has felt the necessity of doing disability assessment among the

Syrian refugees residing in the camps in order to know the magnitude of

the disability, their types, severity and assistant needed to improve their

quality of life.



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Methodology

The disability assessment was conducted through individual questioning to the

disable persons used WHO structured questionnaire. It was conducted at 6

camps in 3 Governorates of the Kurdistan region from January 14 to February 7,

2014. Among the 6 camps 4 were in Erbil namely Kawergosk, Darashakran,

Qushatapa, Basirma and Gawilan and Arbat in Duhok and Sulaymaniyah

respectively.

Before going to implementation of the disability assessment survey, the directors

of each of the DOH were communicated and verbally briefed about the

objectives and expected outcomes of the assessment in their Governorate. The

camp and sector managers were also briefed and given responsibility to

contact all the disable individuals in their respective camp to take part in the

assessment exercise.

A simplified questionnaire was developed by the WHO KRG team for the

interviewers to capture disability related information from the affected individual

without any difficulties. There were 473 disable individuals being registered in the

6 camps; the questionnaire includes personal information, disability types,



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severity, co-existing diseases and demand. Before going to implement the

questionnaire, on the job trainings were conducted by the WHO Technical

Officer in each of the Governorate for the Camp and Sectors Managers and

Nurses and or Paramedics who were later on involved in the data collectionprocesses.

The whole data collection process was supervised and monitored by the WHO

Technical Officer. The missing and data inconsistency was corrected through

active visit to the tents. Generally, disable individuals were called at the

assessment center close to the primary health care unit and for those who didn’t

participate as per lists, physical visits were conducted to their tents to collect theinformation.

At the end of the data collection, all the filled questionnaires were brought

to WHO Erbil office and entered in the excel spread sheets and analysis

were made for key variables of the disability assessment questionnaire.



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Findings:

The result of the assessment

Varied camp to camp

depending on the size of the

population. It has been observed

that 1-2.5% people found disable

per 100 individual in all the camps

except kawergosk which was

0.6%.

While disability

segregated by 4

different age

categories, it was foundthat the incidence was

higher among 15- 45

years followed by 5-15

years in almost all the

camps.



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Disability was further

distributed by gender and it

was found that male is more

affected compare to the

female in all the camps.

However the prevalence was

significantly high among

male in Qushtapa camp

than male in other camps

Prevalence of disability was

analyzed by its origin and it was

found that high number of

disability was acquired by origin

in Arbat and Qushtapa while in

the rest of the camps it shared

almost equally.



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Assistive Aids with the

disable people was analyzed

and found that almost 50%

of the disable people in

Arbat camp possessed an

assistive Aid for their disability

while it was only 5% in

Qushtapa. In other 4 camps

it was within 12-25%.

The types of disability by types were also analyzed for each camp to see the

magnitude, severity and to determine the interventions needed to improve the

quality of the life. The following are the details of the disability types by camp.



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Erbil Governorate: Disability assessment was conducted in 4 camps in Erbil

which were Kawergosk, Basirma, Qushtapa and Dara Shakran. Following

are the details in each of the Syrian Refugee camps in Erbil-

Kawergosk Camp, as of February

10, 2014 UNHCR registered 13,412

IDP in 3,696 tents which is 14.05%

and 2nd highest proportion after

Domiz Camp in Duhok. There were

90 disables people interviewed for

this assessment and about onethird of the disability were related

to movement followed by mental

(16%), visual (11%) and auditory

(7%). Multiple and disability due to

speech stood lowest proportion among all types of disabilities.

Basirma Camp, as of February 102014 UNHCR registered 2,923 IDP

in 700 tents which is 3.06 % of the

total IDP in the camps of

Kurdistan region. In this camp, 60

disable people were interviewed

for the disability assessment and

one forth of disability was related

to movement followed by visual

(22%). Mental, Auditory and multiple were shared equally (7-8%) of the

total. Speech disability found lowest which was 5% only.



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Dara Shakran Camp, as of

February 10, 2014 UNHCR

registered 7,500 IDP in 1800

tents which is 7.84 % of the totalIDP in the camps of Kurdistan

region. Of the 151 registered

disable people, one third of

them were related to

movement followed by mental

(16%). Visual and Auditory were

shared equally (7%) of the totaldisability. Disability due to

speech and multiple were 3%

and 1% respectively.

Qushtapa Camp, as of February 10 2014

UNHCR registered 4,373 IDP in 976 tents

which is 4.57% of the total IDP in the camp

of the Kurdistan region. Among the 60

disable people were being interviewed,

about two third of the disability were due

to movement followed by Mental (17%)

and Visual (11%). Speech and Auditory

disability shared 2 % each while multiple

was 7%.



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Duhok Governorate: out of 2 IDP camps, assessment was conducted in one

camp. In term of density of the IDP, Duhok is the highest who

accommodate about 61% of the IDP throughout the Kurdistan region.

Gawilan Camp as of February 10,

2014 UNHCR registered 2,495 IDP in

674 tents which is 2.61% of the total

IDP in the camp of the Kurdistan

region. Of the 47 registered disable

people more than half of the

disabilities were due to movement

followed by Visual (17%). Auditory

and multiple disabilities shared 11

% each while mental and speech was 6% and 2% respectively.



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Sulemaniya Governorate: there is only one camp where assessment was being

conducted. It accommodates only

3,000 individuals in 853 tents.

Arbat Camp, of the 59 registered

disable people, disability due to

movement and visual were about

one third each followed by mental

20%. The speech disability was the

lowest (2%) while multiple and

auditory was 8% and 5% respectively.



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Conclusion:

Disability assessment was conducted in 6 camps in the Kurdistan region. All thecamps reported high number of disability due to movement followed by mental.

In 3 camps, acquired disability were significantly higher compare to congenital

which need be ruled out whether it was due to war conflict in Syria. In all the

camps, male and 15-45 year age groups affected more. In term of density of

the disable people, Dara Shakran was the highest and the lowest was

Kawergosk. The assessment also showed that there was high number of people

in Arbat camp who using assistive aids and lower in Qushtapa camp for theirdisability correction.

Limitation of the Assessment:

1. About 20% of the disable people residing in the camps didn’t take part in

the disability assessment; because they might refused to register as they

have feeling of disappointment for neglected their requests and

requirements for several times beside the possibility of not being exist inthe camp during the assessment, or because of the continuous influx of

Syrian to KRG all these causes may figure as challenges during

assessment.

2. Calling disable people in the PHC might restricted the window of

information dissemination and openness to the surveyors;



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Recommendations:

1. Assistive Aids should be provided on priority basis in all the camps

2. A Health Team should be comprised with Orthopedic Surgeon,

Cardiologist, Eye & ENT specialist, Physiotherapist, Psychologist, Psychiatrist

and gynecologist and special health camp should be conducted to

accurately determine the need in term of medications, surgery as well as

assistive aids;

3. A separate areas with support worker should be established to improve

the quality of life and reduce the burden of the family member on

disables;

4. A vocational training center should be established to make them active

and as a source of income generation in their family where possible;



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Annex

Bar Chart 1: Gradual increasing trend of the Syrian refugees in the Camps of

Kurdistan Region

Bar Chart 2: Proportion of disable people among the total Syrian refugeesin the 6 Camps



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Table 1: Number of Individuals and Households in the Camps

Camps Individual Households % Total

Domiz 58,500 10,000 61.27

Al-Obaidi 1,911 408 200

Kawergosk 13,412 3,696 14.05

Darashakran 7,500 1,800 7.86

Qushtapa 4,373 976 4.58

Basirma 2,923 700 3.06

Arbat 3,000 853 3.14

Akre 1,364 324 1.43

Gawilan 2,495 674 2.61

Total 95,478 19,431 100



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Table 2: Number of Disable Individual in the Camps by category

Camp Multiple Mental Visual Speech Auditory Movement Total

Kawergosk 1 14 10 2 6 57 90

Darashakran 2 25 10 4 10 100 151

Qushtapa 4 10 7 1 1 37 60

Basirma 4 5 13 3 5 30 60

Arbat 5 13 23 1 3 20 65

Gawilan 5 3 8 1 5 25 47

Total 21 70 71 12 30 269 473



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Photograph 1: OIC WHO Erbil Office, Iraq observing a disable child in the

Refugee Camp in Kurdistan region

Photograph 2: Technical Officer WHO Erbil Office, Iraq cross checking

disability assessment data in the Refugee Camp in Kurdistan



World Health Organization E bil Offi I

Photograph 3: Technical Officer WHO Erbil Office, Iraq is interviewing a

disable individual in the Refugee Camp in Kurdistan region

Photograph 4: A disable with his self-operated wheel Chair in the Dara

Shakran Camp in Kurdistan Region

Disability Assessment_WHO April 2014

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