When she was 2, Aminata contracted a disease in her left hand, the cause of which remains unknown. Despite numerous consultations in health centers and with traditional healers, her hand had to be amputated. Now 10, Aminata is enrolled in school and has a new artificial limb with support from Humanity & Inclusion.
"In 2014, my daughter was left with a missing upper limb,” says Youma, Aminata’s mother. “It was a terrible shock for the whole family, totally darkening our future.”
In 2019, a community agent referred Aminata’s family to Humanity & Inclusion. Teams encouraged Aminata's parents to enroll their daughter in an inclusive school that welcomes children with and without disabilities, where the teachers are trained to use adapted teaching methods and tools.
"Shortly after Aminata enrolled in school, her father died,” Youma explains. “We lost all hope for a while. Fortunately, together we had the strength to overcome this painful ordeal.”
With Humanity & Inclusion’s support, Aminata received an artificial arm. The organization accompanied her family throughout the medical process and paid related expenses.
"When Aminata received her prosthesis, we were very relieved that she had been fitted,” Youma remembers. “It was as if she had a 'new arm'. My daughter was really happy to have this prosthesis.”
As part of the project, Aminata also received a complete school kit, including a school bag, pens and notebooks. This was a relief for her family, who could not afford to pay for the young girl's supplies.
In December 2021, Aminata's family moved more than a mile away from the school she attends in Mali.
"I was worried because I thought she would drop out of school because of the distance to our new home," Youma explains. "But Aminata was never discouraged, and she continues to go to school."
Since her enrollment, Aminata has been attending school regularly. Currently in fifth grade, she dreams of becoming a police officer.
"Today, Aminata is my greatest hope," Youma adds.
Andrew Mwangi is a Prosthetics and Orthotics Officer at Humanity & Inclusion in Kenya. In the Kakuma refugee camp and the Kalobeyei settlement, he helps people with disabilities access artificial limbs.
When Andrew was younger, he saw someone wearing an artificial limb for the first time.
“I was captivated,” he recalls. “I wanted to know how it was made.”
He turned his fascination into a career, learning how to fabricate and fit artificial limbs, braces and other assistance devices. In December 2021, he joined Humanity & Inclusion to work with refugees and host communities in Kakuma.
“I had not done humanitarian work before, but I was interested in working in that context,” he explains.
Daily life in the field
Andrew is one of 36 full-time Kenyan staff who live at Humanity & Inclusion’s compound near the refugee camp. Staff rotate through 8-week cycles at Kakuma, with 2-week breaks to visit home and decompress, before returning for another two months.
Andrew is the only full-time prosthetics and orthotics officer working at the camp, which has a population of more than 240,000 people. He spends each day of the week visiting one of Humanity & Inclusion’s three rehabilitation centers that are spread throughout the refugee camp, as well as its facility in the nearby Kalobeyei settlement.
“The demand for our services is quite high,” Andrew explains. “I’m covering the four camps and host community. In a given week, I will only visit each place once.”
Andrew does have the support of six technical aid workers—refugees who have been trained in basic fabrication and repair of mobility devices—who staff the workshop at each rehabilitation center. Each workshop includes a cabinet stocked with basic tools and supplies. Crutches of all sizes line the walls. Walkers, wheelchairs, orthopedic shoes, toilet seats, wooden scooters and other mobility devices can also be found.
Journey to fitting
Once someone in need of an artificial limb is identified and assessed—either at the reception center or by staff in the community, the person’s amputated limb is routinely measured and shaped, to ensure proper fitting. The individual also participates in rehabilitation sessions to strengthen their muscles, and learns how to care for their stump and mobility device. Once a person receives their artificial limb, they complete training so they can walk, balance, climb stairs and complete other movements.
Andrew and his team see people who have required amputations for a number of reasons: gunshot wounds, explosions, snake bites, road traffic accidents, diabetes.
The waiting list for artificial limbs and braces is long, and funding is limited. In an average year, Andrew explains that Humanity & Inclusion's program at Kakuma has the budget to provide new artificial limbs for 20 to 25 people, and orthotics—such as special shoes or leg braces—for around 85 people. The waiting process can take more than a year because artificial limbs must travel over 125 miles to reach people who are being fitted with them.
Gatkuoth, 17, pictured with Andrew in the lead image, is on the waiting list for an artificial limb.
The boy’s leg was recently amputated after he sustained a gunshot wound in September 2021. Initially identified at the reception center when he arrived in Kakuma from South Sudan, Gatkuoth is undergoing three months of stump-shaping. Andrew and his team measure the circumference at different points along Gatkuoth’s residual stump, taking note of changes over time.
“Once it stabilizes, we will know it won’t shrink any further, and then he can be fitted,” Andrew explains, showing Gatkuoth how to wrap a bandage around his leg. Andrew undoes the bandage so Gatkuoth can give it a try himself. Gatkuoth is expected to receive his artificial limb in September 2022.
Provision of artificial limbs, braces and other assistive devices is based on a selection with emphasis on disability, gender and age.
“If fitting someone with an artificial limb will help them enroll in school, we will make them a priority,” Andrew explains.
These actions are supported by the U.S. Department of State Bureau of Population, Refugees and Migration.
Tok, 27, lost his leg in a work accident. Over the last two years, Humanity & Inclusion has provided him with an artificial limb and rehabilitation care in Laos.
Five years ago, Tok was hired to cut down a tree that was touching a power line. When the tree fell, it crushed his left leg. Tok managed to call his brother, who rushed him to hospital, but his leg was too badly damaged and had to be amputated. Tok’s acquired disability presented challenges and prevented him from performing certain everyday tasks.
In 2020, Humanity & Inclusion referred Tok to its rehabilitation center, where he received physical therapy and an artificial limb. Since then, Tok has regained independence.
Today, Tok’s living conditions have improved significantly. He can work again and has started to raise livestock. He is also employed by the Lao electricity board, collecting data on electricity consumption, distributing bills and collecting dues.
Tok has also joined a group of red mushroom producers and received training in the bamboo value chain, which has helped boost his income. In the future, he hopes to expand his farm and keep goats.
Advocating for disability rights
Tok has also received training from Humanity & Inclusion and Group for Research and Technology Exchanges (GRET) on disability rights and inclusion.
Now a community volunteer, he advocates against discrimination and promotes understanding, acceptance and awareness of the rights of people with disabilities and the importance of their inclusion. He also provides peer support.
His goal is to remove the physical barriers encountered by people with disabilities.
"People with disabilities need support to access public services and opportunities to improve their lives," Tok explains. "I have received a lot of support and it has changed my life."
Amina, 7, was seriously injured in a missile attack during heavy fighting in Afghanistan in July 2021. She’s learned to walk again, with rehabilitation care and an artificial limb from Humanity & Inclusion.
Amina was walking to school with her parents and sisters when the missiles struck. Her mother and two of her sisters were killed in the attack.
Her father was also injured, causing paralysis of his right arm. He lost his job. To survive, he now sells chewing gum and cookies from a cart outside his house and is supported by relatives and neighbors. (Amina and her father are pictured above.)
Amina is close with her father, who is now a single parent after his wife’s untimely death. He promises to be there for his daughter, to play with her and to help her overcome the trauma of losing her mother and sisters.
Learning to walk again
Amina’s right leg was so severely injured that she required a surgical amputation. Since January 2022, Humanity & Inclusion’s physical therapy specialists have been teaching her to walk again.
The team measured her leg to make a customized artificial limb, and gave her mobility exercises to do at home. She was also given a walking frame to help her get around on her own until her artificial leg was ready.
After a few weeks, Amina received her artificial limb and began rehabilitation sessions at Humanity & Inclusion’s rehabilitation center in Kandahar to help her adapt to it.
When she started her rehabilitation, Amina was sad and frustrated. She found it challenging to walk with her artificial limb without the help of a walking frame. But the many exercises paid off, and today she can walk on her own.
Amina’s most recent visit to the rehabilitation center was in March for a consultation and some minor repairs to her artificial limb. She will continue to visit the center regularly to replace and repair her artificial leg.
Humanity & Inclusion’s physical rehabilitation center in Kandahar is the only facility in the area where people with disabilities are provided with services free of charge.
HI's rehabilitation center
Located in Kandahar, Humanity & Inclusion's rehabilitation center treats people with conflict-related injuries, often caused by explosive devices. Survivors of serious accidents, patients with diabetes-related amputations and people with polio are also among those receive physical therapy services. The center is staffed by 52 professionals specializing in physical therapy or psychosocial support work. It is the only rehabilitation center in southern Afghanistan.
For 18 months, Longini was unable to walk; he had outgrown his artificial limbs and Covid-19 lockdowns prevented him from getting new ones. If he was going to get back on track, Longini needed replacements as soon as possible.
Longini, now 9, was born with lower limb deformities. When he was 3 months old, his mother, Elisabeth, took him to the nearest hospital, and he was referred to an orthopedic hospital in Ririma. As other children took their first steps, Longini was still unable to walk. When he was 3 years old, doctors performed a double amputation so he could wear artificial limbs later in life.
In between working odd jobs to support Longini and his younger brother, Elisabeth sought out educational opportunities for Longini. After years of searching, she found HVP-Gatagara—a leading center for the rehabilitation and education of people with disabilities in Rwanda. More than 30 miles from their home, the center includes an inclusive boarding school. At 6 years old, Longini was finally enrolled in school.
But Longini’s greatest dream was to learn to walk.
At nearly $900 each, artificial limbs are particularly expensive in Rwanda. Few patients can afford the assistance devices, including Longini’s family. Humanity & Inclusion stepped up to help. The complex housing Longini’s school also includes a rehabilitation center and orthopedic-fitting workshop supported by Humanity & Inclusion. For families unable to afford care, Humanity & Inclusion provides financial assistance.
Fitted with two custom-made artificial limbs, Longini took his first ever steps as a 7-year-old. In no time, he was running around and playing enthusiastically with his friends. His life changed completely.
As a growing boy, Longini regularly needs new artificial limbs. Unfortunately, the Covid-19 pandemic and the strict measures taken by the government to protect the population meant the orthopedic center had to close its doors. Longini outgrew his worn devices, and it was 18 months before he could be fitted with new ones in November 2021. Longini will need rehabilitation care and artificial limbs for the rest of his life.
‘A joy to watch him now’
Longini is in his second year of primary school, where he lives most of the time.
“When he comes home for the holidays, he can do small jobs around the house, like the dishes or sweeping the courtyard,” Elisabeth adds. “He loves being with other people, going out and running about the local streets with them. All children like him.”
A hard-working student, Longini repeatedly tells his mother he wants to finish his studies so he can get a good job, earn money and support his family.
“My son’s life hasn’t always been easy but it’s a joy to watch him now,” Elisabeth says. “It’s wonderful he’s included with other children. It’s so uplifting.”
After losing his leg in a road accident, Sandip was fitted with an artificial limb by Humanity & Inclusion and its partners.
In Nepal, road accidents are the second most common cause of injury. When he was 14, the truck Sandip was riding in was involved in a traffic crash in Chitwan. He was seriously injured.
“Doctors had to amputate his leg above the knee immediately to prevent further infection,” his mother Sukumaya explains.
Trials of isolation
The accident caused Sandip to have limited mobility. A sixth grader, he ultimately dropped out of school.
“Having lost my leg, I was ashamed to go out or to school,” Sandip says. “I did not see myself going anywhere as I could not walk. As a result, I started staying home, playing games on my phone, and cutting myself off from the outside world.”
Fortunately, Sandip’s family heard about an upcoming health screening camp in their community, providing different services for children with disabilities. These services were implemented by Humanity & Inclusion and its local partners, including Autism Care Chitwan Society, as part of the UK-funded Inclusive Futures Program.
The power of rehabilitation
After the health screening camp, Sandip was referred to the National Disabled Fund, Humanity & Inclusion’s partner, which provides rehabilitation services. The teenager was fitted with an artificial limb, but he didn’t believe he would ever walk again.
“Initially when we met Sandip, he wasn’t convinced by the idea of having rehabilitation care,” says Ramesh Baral, an inclusion officer working with Humanity & Inclusion. “He didn’t trust anyone. He didn’t even believe that an artificial limb and exercises would help him walk.”
“During counseling, we showed him some videos of people with disabilities who have achieved milestones in their lives through rehabilitation care, like walking, going to school, working and dreaming big,” Baral adds.
The counseling helped Sandip understand the power of rehabilitation and realize his own potential. Sandip is determined and making massive improvements. After just four days with his new artificial limb, he found it easy to walk by himself with the parallel bar. Through a 15-day process, Sandip learned how to use his artificial limb through. He completed gait training and learned to balance, stand, shift weight, sit and stand from a chair, and go up and down stairs.
“Training to walk with my new limb is hard work and sometimes painful, but I am confident that when it is over, it will be okay,” he told us.
Sandip’s parents now see a positive future for him. They have seen a change in their son’s attitude, and now Sandip smiles and shares his ambitions and his love of learning.
“Now, I want to read and get help to improve my mobility,” Sandip explains. “Education is my new ambition! I need to study hard so I can get a job and become independent. I have to turn my dreams into reality. I plan to open a mobile repair shop or start working after I complete my education.”
Prabin, 5, lives in southeastern Nepal with his parents. He was born without the lower part of his right leg.
“Because of the disability of our child we were worried about his future,” says Sunita, Prabin’s mother.
A community mobilizer from Community Based Rehabilitation-Biratnagar (CBRB), a local partner organization of Humanity & Inclusion, met Prabin and referred the family to seek services at a rehabilitation center.
At first, Prabin was hesitant to be fitted with an artificial limb. Specialists worked with the boy and his parents to better understand how the device would work, and how it would help him. A month later, he was eager to have a new leg.
“This was a wonderful change for our little boy, as he quickly accepted the prosthesis and began playing, running, and even jumping like any other child of his age,” Sunita explains.
Prabin attends school and loves to play with his toys.
Ambika Sharma, a specialist in artificial limbs and orthopedic braces at CBRB, worked with the family.
“Initially, it was challenging to fit Prabin with an artificial limb because he was not accepting,” Sharma says. “But his parents made it possible with their supervision and guidance. It was an amazing experience for us to see him happy with prosthesis.”
As Prabin gets older, he will need to be fitted with new devices.
“Growth is an important aspect of a child's life,” Sharma continues. “As their bodies change, prostheses have to be adapted or changed in the similar manner to accommodate them. Just as they outgrow shirts, pants, and shoes, they will outgrow their prostheses."
These rehabilitation services are supported by USAID.
Khadidja is a 27-year-old entrepreneur living in Chad. With a boost from Humanity & Inclusion’s economic inclusion initiative, she opened her own business.
When she was 2, Khadidja fell off of a donkey in her village and was seriously injured. Ever since, her right leg muscles have been weak, requiring her to wear an orthopedic brace for support.
“As they could not treat me there, my family took me to N'Djamena,” she recalls. “The doctors here told me that I had to be treated in France but we couldn't afford it. Later, my family was able to buy a prosthesis.”
When Khadidja’s brace broke, an acquaintance suggested she reach out to Humanity & Inclusion. Since 2018, she’s been participating in Humanity & Inclusion activities in Chad. Teams repaired her brace and she received an income-generating activities grant. The single mother of two was able to launch her own business.
“Thanks to HI’s help, I set up my small business selling cereals. Now I have enough food every day,” Khadidja explains. “I make numerous orders, which helps me to live and pay for my health care and my children's school.”
With money she saved from her work, Khadidja was also able to purchase a sewing machine to start a small sewing workshop for extra income.
Khadidja's newfound autonomy is helping her plan for the future.
"Since my business is doing well, I would like to expand my activities and buy a motorized tricycle to make it easier for me to get around and collect the goods I sell,” she says. “I would also like to build an extra room to better accommodate my children.”
When creating artificial limbs and braces, Humanity & Inclusion uses alternative, innovative solutions to limit negative environmental impacts.
Artificial limbs and braces can be life changing for many people. They open the door to countless opportunities and contribute to the invaluable autonomy and independence of their users. However, making these devices often requires an incredible amount of energy and materials.
“To make an orthopedic device, we need a lot of plastic, metals, water, plaster, carbon, resin, and more,” says Abder Banoune, rehabilitation specialist for Humanity & Inclusion.
“It takes a lot of energy, and a lot of people to make one simple device,” Banoune continues. “Each one is custom-made for the user, and new ones must be made as people grow or their bodies change. For example, many adults change prosthetics every five years, but amputation is for life. So you can imagine how many devices one person would have in their closet after 40 or 60 years. Children need to change even more frequently (every six months or a year) since they grow more. This results in a lot of waste.”
Humanity & Inclusion is committed to making quality rehabilitation care accessible to people all around the world, while remaining conscious of its ecological impact. Low-income countries, where Humanity & Inclusion primarily operates, are disproportionately affected by the negative consequences of waste, climate change and environmental neglect, all of which magnify humanitarian needs. As part of Humanity & Inclusion’s commitment to the communities it serves and to their environments, the organization takes a three-prong approach to limit waste and energy use in creating assistive devices: reuse, reduce, recycle.
After seeing old assistive devices going to waste, Humanity & Inclusion’s Rehabilitation Director Isabelle Urseau had the idea to reuse second-hand artificial limbs and braces. Banoune has seen the same thing.
“When I was working in Africa, the centers all had huge piles and containers full of destroyed or rusted devices that could not be re-used,” Banoune explains. “They are just dumped in the backyard where they would stay forever.”
In Lyon, France, Humanity & Inclusion operates a second-hand prosthetics workshop called “La Poudrette.” It’s run by retired prosthetics and orthotics professionals. The workshop receives used devices and dismantles them, conserving all of the re-usable components that can help construct new devices.
“About 50-60% of the device can be re-used,” Banoune explains. “Sometimes, if you need to repair a device, you only need one part. Instead of buying new components or having to make an entirely new prosthetic, we can still use the parts that are good quality from the old ones.”
La Poudrette has grown significantly since its creation and is now dismantling as many as 1,500 prosthetics each year, with plans to double or triple their actions in the near future.
In 2016, Humanity & Inclusion became the first NGO to use 3D printing to make braces in low-resource settings. In Uganda, the organization uses the innovative technology in refugee camps to scan individuals in need of orthopedic devices, and send the digital files off to be 3D printed in a separate location, without the recipient needing to travel to a rehabilitation center. By doing so, Humanity & Inclusion can reach more people in isolated areas while using less energy and fewer materials than the traditional method of making these devices.
When making devices the traditional way, a cast of the body is first made out of plaster, which is difficult to recycle. Plastic is then heated to 392 degrees Fahrenheit to be shaped onto the plaster cast, before later adding components such as metal joints, foam, resin laminate and others. The process requires thousands of gallons of fuel, a powerful generator, and a large center to house the equipment.
“3D printing is a unique approach to making orthopedic devices without needing huge equipment, lots of energy, or a lot of materials,” Banoune says. “It’s all virtual, so instead of using plaster, we can just scan the limbs. We don’t need a huge space and the printer only uses a small amount of energy—about three or four times less than the traditional method. In the future, I think we can power them by solar panels, which would not be possible traditionally. It’s ecological, and it is inexpensive.”
Though 3D printing is emerging as a possible solution, plaster-based creation is still the norm for most devices. The plaster required to make artificial limbs and braces is often shipped internationally and can only be used once before being thrown in the trash. Gypsum, from which plaster is made, makes up 400,000 tons of waste worldwide. Humanity & Inclusion alone creates 5 to 10 tons of gypsum waste per year through prosthetic creation, and is determined to find a solution.
Humanity & Inclusion has partnered with the National Institute of Applied Sciences, an engineering school in France, to conduct research to solve this problem. A program at the institute is performing experiments and studying efficient ways to re-use and recycle the plaster needed for the prosthetics process.
Another research program is looking at ways to locally source and recycle materials such as plastic bottles or vegetable fibers to create the filament used in 3D printing.
“It’s important to find adapted, local solutions,” explains Magdalena Szynkowska, Humanity & Inclusion’s Innovation Development Officer. “Every context might have different materials available, different vegetable fibers, and variety of types of plastic used in plastic bottles, so there may not be one single answer. It is complicated work, but I am confident that we will find solutions.”
GREEN Initiative: Humanity & Inclusion is committed to reducing the adverse effects of climate change on populations worldwide. We help communities prepare for and adapt to climate shocks and stresses, and we respond to crises magnified by environmental factors. Applying a disability, gender and age (DGA) inclusion lens across all our actions, we advocate for practitioners and policy-makers to embed DGA in their climate work as well. Humanity & Inclusion is also determined to reduce its own ecological footprint by adapting and implementing environmentally conscious approaches to humanitarian action.
Thanks to an innovative 3D-printing project, 5-year-old Kennedy can walk on his own and play with other children for the first time.
Displaced by fighting in South Sudan, Kennedy’s family arrived in Uganda in December 2016, when he was just 9 months old. Now, he lives with his mother and two siblings in the Arua district.
Kennedy has Cerebral Palsy. And though he can eat, drink and hear easily, he is unable to speak. He also has limited dexterity and finds it difficult to hold objects.
“My wonderful, brilliant, cheerful little boy has had from Cerebral Palsy since birth,” says his mother. “Two days after he was born, he had a high fever; I took him to hospital in South Sudan where they diagnosed him with severe malaria. The doctors treated him straightaway, but it left him with consequences that have affected his mobility and communication skills: he can’t switch sides when he is lying down and he can’t sit, kneel or stand. He couldn’t walk without a walking frame. He depends on adults to do almost everything other children take for granted, including dressing himself or going to the bathroom.”
Kennedy began physical therapy with Humanity & Inclusion’s specialists in February 2020, after meeting with community volunteers. Despite challenges, Kennedy is growing stronger with each rehabilitation session. He’s already learned to stand and move around with the support of a walker.
In November 2020, Kennedy was enrolled in Humanity & Inclusion’s 3D PETRA project—an initiative that equips people with custom, 3D-printed braces and artificial limbs. After a consultation with a technician, Kennedy was prescribed braces for his feet. The team scanned his lower limbs, then printed braces to fit him perfectly.
As Kennedy continues his physical therapy exercises, he’ll soon be able to walk on his own with his braces. His mother is extremely grateful and delighted her son can finally play with other children in their neighborhood. Next, he’ll conquer school for the first time!