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.

Humanity & Inclusion provides cash transfers as part of its humanitarian assistance. This form of aid is vital for vulnerable populations living in countries suffering the disastrous social impact of Covid-19.

Who benefits from cash transfers?

This aid is provided to people in serious humanitarian and emergency situations, such as refugee families or families living in extreme poverty due to a natural disaster or food crisis. These families have often already been provided with humanitarian aid - a temporary shelter, food kits or access to medical care, for example - by Humanity & Inclusion or its partners. Recipients must meet certain conditions, called "vulnerability criteria.” These include age (an elderly, isolated person, for example), gender (a single woman with children), or an existing disability. This helps Humanity & Inclusion prioritize cash transfer recipients.

How does it work?

Cash is often transferred through a company such as Western Union. Humanity & Inclusion tells people by telephone that they can withdraw a specific amount of money at a special counter by showing a proof of identity. The money may be a one-off payment or paid in installments, depending on the seriousness of the household's situation. Amounts vary according to the cost of living in each country and the number of people in a household - $20 per person in Madagascar, for example, compared to $70 in Colombia. Humanity & Inclusion uses computer data to track withdrawals. Humanity & Inclusion is also in constant contact with beneficiaries to solve any problems they may have.

Why cash transfers?

Most people given a cash transfer have already received other kinds of assistance. Cash transfers can meet needs not generally covered by humanitarian aid, such as paying the rent. An NGO might provide temporary shelter, for example, but rarely helps pay the rent. Some refugees rent somewhere to live in a host country, such as in Lebanon, where many Syrian refugees rent houses. Cash transfers meet essential needs not already covered, such as buying food or medicine. Many people do not have health coverage or do not have access to free public health care because they do not yet have refugee status in a certain country, for example, or for other status-related reasons. 

Do we know how cash is being used?

Humanity & Inclusion always carry out assessments on samples of people. The first items people buy are always food, housing or medicine, all of which are vital needs.

Fleeing economic hardship and political unrest in their home country, 4 million Venezuelan refugees escaped to Colombia. Without jobs, housing, or support systems, the refugees have faced additional challenges caused by the Covid-19 pandemic.

Humanity & Inclusion is providing support – from financial aid to hygiene kits – to hundreds of Venezuelan refugees living in Colombia, where 1 million people have contracted the virus.

More than 200 Venezuelan refugee families are receiving regular financial assistance from Humanity & Inclusion to pay for housing, food, healthcare and other basic needs. Milagros Chacin was able to use cash provided by Humanity & Inclusion to catch up on rent payments and buy mattresses for her children so they don’t have to sleep on the floor of their makeshift home.

Humanity & Inclusion has also handed out food and hygiene kits containing items like soap and hand sanitizer. To dispel misinformation about the virus, Humanity & Inclusion has conducted awareness sessions on Covid-19. Humanity & Inclusion’s team has also translated 12 videos into Venezuelan and Colombian sign language to share prevention measures, Covid-19 symptoms, and other essential information with some of the most vulnerable people.

In addition to help Venezuelan refugees, Humanity & Inclusion is also helping indigenous people cope with the pandemic. “Many indigenous communities are still in full lockdown, or can no longer work or earn money, so our food distributions are extremely welcome,” said Debir Valdelamar, Deputy Project Officer for Humanity & Inclusion in Colombia.

Humanity & Inclusion continues to provide psychological support and rehabilitation care to mine victims in the regions of Cauca, Meta, Antioquia, Caqueta, and Nariño.

Humanity & Inclusion's response in Colombia since March

• In April 2020, Humanity & Inclusion distributed 80 food kits, one per family, to people living in the regions of Cauca and Nariño, and more than 200 hygiene kits.
• Humanity & Inclusion has trained members of national NGOs to include people with disabilities in their projects.
• Humanity & Inclusion has conducted awareness sessions on Covid-19, and translated 12 informational videos and a prevention guide into Venezuelan and Colombian sign language
• Humanity & Inclusion has provided remote psychological support to more than 150 Venezuelan refugees in the Maicao refugee centre in northern Colombia, and to people arriving in the cities of Bogota, Medellín, and Baranquilla. Humanity & Inclusion psychologists held Whatsapp sessions with those who needed them.
• Humanity & Inclusion has enabled 112 Venezuelan refugee families identified by a "vulnerability" survey to benefit from a small, one-off cash transfer.
• Humanity & Inclusion organized a series of virtual conferences on psychological first aid for caregivers and family members of people with disabilities.

Photo caption: A Venezuelan refugee sits in a wheelchair at a migrant reception center in northern Colombia.

As part of its response to the Covid-19 crisis, Humanity & Inclusion is providing support to Venezuelan refugees in Colombia, where one million people have been infected by the virus. The impact of the epidemic has been dramatic.

Covid-19 has struck more than 980,000 people in Colombia. Many older people fear starvation or serious illness in a country where little or no provision is made for social assistance, pensions, and other welfare benefits. In recent months, the lockdown has seriously impacted the four million Venezuelans living in Colombia, who can no longer earn a living from the informal economy. In Colombia, the severe economic crisis caused by the epidemic has increased the precariousness of Venezuelan refugees who have lost their jobs and homes, and are unable to access food, drinking water, electricity, and the like.
 
The security situation is also extremely tense: “Armed groups have used the lockdown to tighten their grip over certain territories where the authorities have a weak hold," says Debir Valdelamar, Deputy Project Manager for Humanity & Inclusion in Colombia. "They have cast themselves as ‘Covid crisis controllers', sowing terror, asserting their authority, imposing curfews, carrying out attacks against people who meet without authorization, and so on."

Humanity & Inclusion has assisted Venezuelan refugees since April 2019, and adapted its response to the pandemic. With support from ECHO, the organization is currently allocating financial support on a six-month basis to more than 200 Venezuelan refugee families identified as highly vulnerable. Most use the money to pay for rent, food or healthcare.

Humanity & Inclusion has also handed out food and hygiene kits containing soap, hand sanitizer, and other items to help keep the virus at bay. Teams have conducted awareness sessions on Covid-19, which included 12 videos translated into Venezuelan and Colombian sign language, and a prevention guide, to inform the most vulnerable individuals on prevention measures, and Covid symptoms.

“The first lockdown in Colombia was national. Regional authorities now decide on local prevention measures, which vary from one department to another," explains Valdelamar. "Many indigenous communities are still in full lockdown, or can no longer work or earn money, so our food distributions are extremely welcome. In November, we plan to distribute food and hygiene kits to 3,000 families."

Humanity & Inclusion also continues to provide psychological support and rehabilitation care to mine victims in the departments of Cauca, Meta, Antioquia, Caqueta, and Nariño.

Snapshot of Humanity & Inclusion's response in Colombia since March 2020

• In April 2020, Humanity & Inclusion distributed 80 food kits, one per family, to people living in the departments of Cauca and Nariño, and more than 200 hygiene kits.
• Humanity & Inclusion has trained members of national NGOs to include people with disabilities in their projects.
• Teams have conducted awareness sessions on Covid-19, which included 12 videos translated into Venezuelan and Colombian sign language and a prevention guide to inform the most vulnerable on prevention measures, Covid symptoms, and so on. (Ongoing)
• Humanity & Inclusion has also provided remote psychological support to more than 150 Venezuelan refugees in the Maicao refugee center in northern Colombia, and to people arriving in the cities of Bogota, Medellín, and Baranquilla. Humanity & Inclusion psychologists held WhatsApp sessions with those who needed them.
• Lastly, Humanity & Inclusion has also enabled 112 Venezuelan refugee families identified by a "vulnerability" survey to benefit from a small, one-off cash transfer.
• We also organized a series of virtual conferences on psychological first aid for carers and family members of people with disabilities.

Photo caption: Migrant Reception Center, Maicao, northern Colombia.
© Coalición LACRMD

Since 2013, Venezuela has been facing a severe economic, political, and social crisis. Access to health care, sanitation facilities, and food has decreased significantly, and humanitarian needs are great. At least 3.4 million Venezuelans have fled worldwide, including 2.7 million to Latin American and Caribbean countries. Among them, more than one million people now live in Colombia.

Gregory Le Blanc, Humanity & Inclusion’s director in Colombia, explains the situation facing Venezuelan refugees in Colombia and shares details about our emergency response.

Gregory Le Blanc stands in a field in Colombia wearing an old HI vest (old brand alert!).

"The serious political and economic crisis in Venezuela makes life a little harder every day while more and more people move to neighboring countries. An estimated 3.4 million Venezuelans have fled around the world, including more than 2 million to Colombia. The Colombian authorities are overwhelmed by this influx of people and the needs to assist them. Women, children, older people and people with disabilities are worst affected.

Struggling to access basic services

The fact that some no longer have ID documents or residency permits, and are unaware how to normalize their situation in the country or what their rights are, makes it more difficult for them to access basic services such as healthcare and drinking water. In large cities and at major gathering points near borders, Venezuelans receive healthcare, and the most vulnerable have access to welfare services and the like. It is less easy to access psychological support, but it is just as important.

Families uprooted

In fact, people fleeing Venezuela are very vulnerable, socially and emotionally. They have been uprooted and live in precarious conditions, and this has a serious impact on their mental health. They feel frustration, despair, anxiety and may experience depression.

Humanity & Inclusion is there

Humanity & Inclusion provides them with psychological support in Medellin and La Guajira—on the northern border—and is preparing to intervene in Bogota and Barranquilla. HI also provides support to people who need help resolving legal issues (ID documents, formalizing their situation, etc.) in Medellin, in conjunction with the local council, the university, etc., and with HI’s lawyers. Our team of rehabilitation professionals also help train health service providers, in addition to providing care directly and/or through specialized centers. We also provide mobility devices—wheelchairs, crutches, and walkers—to those who need them.

Due to the scale of the needs and the length of the humanitarian crisis, we also plan to strengthen the socio-economic inclusion of Venezuelans in Colombia from 2020, based on our extensive experience in this sector.”

Since 2013, Venezuela has been facing a severe economic, political, and social crisis. Access to health care, sanitation facilities, and food has decreased significantly, and humanitarian needs are great. At least 3.4 million Venezuelans have fled worldwide, including 2.7 million to Latin American and Caribbean countries. Among them, more than one million people now live in Colombia.

Rehabilitation care for the most vulnerable

Since April 2019, Humanity & Inclusion has been providing psychological support to migrants in the Maicao transit center on the border with Venezuela. In collaboration with the NGOs, Danish Refugee Council and Pastoral Social (Caritas Colombia), Humanity & Inclusion also provides rehabilitation care for the most vulnerable people—people with disabilities, older adults, indigenous people— technical support, including training, to local rehabilitation organizations, and runs joint social cohesion activities for Colombians and Venezuelans to promote peaceful understanding between the two communities.

Psychological support

Humanity & Inclusion has also launched an emergency response in Medellín, the second largest city in Colombia, in collaboration with the City of Medellín. Our team provides support to more than 1,000 people from Venezuela, including psychological support through individual and group sessions, and legal support to access basic services such as health care.

Sports and cultural activities

Humanity & Inclusion organizes sports and cultural activities to strengthen the social cohesion and socio-cultural inclusion of migrants in Medellín. Our team will also work on behalf of migrants in the capital Bogota and Baranquilla on the Atlantic coast.

Venezuelans in Peru

Our team recently conducted a mission to Peru to assess the humanitarian needs of Venezuelan citizens who have fled to the country. We plan to carry out the same type of work in Peru, as Colombia. More to come!

Humanity & Inclusion is committed to supporting people who are fleeing conflict and natural disaster. Whether they are sheltering within their own countries or residing in countries of first asylum as refugees, our teams are hard at work providing basic and specific aid to people with disabilities and other vulnerable groups. Read about our work with refugees and internally displaced people (IDPs) as well as our other projects in the 11 countries below.

This life-saving work is possible thanks to the generous support of our donors, as well as key funding agencies such as the U.S. Department of State, IKEA Foundation, among others.

Humanity & Inclusion is an impartial, international aid organization, and we act where needs are greatest. We do not work on refugee resettlement.  

Camille Gosselin, Handicap International’s advocacy officer for humanitarian issues

Silver Spring, MD--A new report identifies indiscriminate bombings as the overriding factor forcing millions of Syrians to flee their homes. Qasef: Escaping the bombing takes an intimate look at the worst humanitarian crisis since World War II. Based on interviews with Syrian refugees in July 2016, a document review, and expert interviews, the report identifies the large scale use of explosive weapons in populated areas as the most significant cause of the mass displacement of Syrians. More than 10.9 million Syrians have been affected, equivalent to more than half of the country’s population.

Syrians interviewed for the report said they were subject to multiple displacements within Syria—up to 25 times after successive attacks—before seeking refuge abroad. Repeated displacement causes extreme poverty and serious psychological distress.

“War does not justify everything,” says Anne Héry, head of advocacy at Handicap International. “There are international rules that must be enforced, such as the law requiring belligerent parties to protect civilians from the effects of war. Attacks using explosive weapons with a wide-area impact in populated area have indiscriminate effects. All States have a responsibility to ensure that international humanitarian law is upheld and enforced.”

The use of explosive weapons in populated areas is the main cause of civilian deaths. In 2012, according to a study released by the Integrated Regional Information Network (IRIN) and cited in the report, the use of explosive weapons in populated areas was responsible for 48% of civilian casualties. That figure rose to 83% in 2016.

Some weapons, such as barrel bombs and elephant rockets are indiscriminate by nature. Their lack of precision causes large numbers of civilian casualties. The report also underlines the seriousness of the injuries caused by these attacks: 47% of people injured by explosive weapons have complex fractures.

“Combined with the absence of appropriate medical care and psychological support in Syria, this practice has had a devastating effect on people’s lives,” Héry notes. “With more than 1.5 million casualties in Syria, an entire generation is going to suffer the sequelae [of these injuries] for many years to come.”

Syrians who were not directly affected by the attacks are also forced to flee in order to rebuild their lives: bombing destroys key infrastructure (homes, hospitals, water and electricity networks, etc.) and social and economic life.

“Weapons clearance will take decades in Syria, which is highly contaminated by explosive remnants of war,” Héry adds. “The parties to the conflict must immediately end the use of explosive weapons in populated areas, particularly weapons with a wide-area impact. The international community must take action against this practice, which has become the rule in the Syrian conflict.”

In September 2015, Handicap International launched an international campaign to end attacks on civilians. The organization is calling on States to sign a political declaration to bring an end to the use of explosive weapons in populated areas, and to recognize the suffering of civilians. To this end, the organization has co-founded the INEW (International Network on Explosive Weapons) coalition of international and national organizations.

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Methodology

Qasef: Escaping the bombing is based on interviews recorded in Jordan in July 2016, with Syrian refugees from Aleppo, Damascus and the surrounding region, Deraa and Homs, as well as a review of existing literature on the crisis, and interviews with managers of international organizations.

• Download the report here

• Download a report summary here

Handicap International and the Syrian crisis

Handicap International has helped more than 600,000 people since the launch of the organization’s Syrian crisis operations in 2012. Teams provide physical rehabilitation services and psychological support, and distribute emergency aid to meet the basic needs of casualties, people with disabilities, and vulnerable individuals, in particular. Handicap International also issues awareness-raising and safety messages targeted at local populations to prevent accidents caused by explosive remnants of war.

Previous Handicap International reports about the Syrian Crisis

• Syria, A mutilated future (June 2016)
• Kobani: a city of rubble and unexploded devices (May 2015)
• The Use of Explosive Weapons in Syria: A Time Bomb in the Making (May 2015)
• Hidden victims of the Syrian crisis: disabled, injured and older refugees (2014)

Related links

To link your audience to Handicap International’s Syrian crisis donation form, visit  http://www.handicap-international.us/helpsyria

To share the Stop Bombing Civilians petition, visit http://www.handica p-international.us/stop_bombing_civilians