Rehabilitation Literature Review | Medical rehabilitation of spinal cord injury following earthquakes (2013)
This literature review examined spinal cord injury survivors of the 2005 Kashmir earthquake in Pakistan, the 2008 Sichuan earthquake in China, and the 2010 Haiti earthquake.
The effects of an earthquake in an urban area can be devastating. Often much is destroyed, including signiﬁcant materials and human public health infrastructures, communication and transportation networks, as well as medical facilities. There are also vast individual risk factors to be conscious of, including pre-existing disabilities, extremes of age, chronic illness, and lack of mobility.
Proper care and knowledge regarding spinal cord injuries is critical in any emergency response, such as an earthquake; on-scene spinal immobilization, intravenous access and maintenance of cervical alignment are critical. In addition, rapid referral to a multidisciplinary care facility with appropriate rehabilitation services is essential.
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More than a billion people, or about 15% of the world’s population, live with a disability. The rates of disability are expected to grow due to an aging population and the growing prevalence of chronic health conditions like heart disease and diabetes.
People with disabilities are among the world’s most marginalized and vulnerable groups:
- 80% of people with disabilities live in low income countries, and people with disabilities are among the most poverty-stricken citizens of those states.
- Worldwide, people with disabilities are less likely to have access to quality healthcare, education, and employment.
- When natural disasters, disease epidemics, or conflict strike, people with disabilities are more likely to become victims, but less likely than others to receive humanitarian
- In many low-income countries, where disability is treated as a stigma, people with disabilities can face discrimination in all aspects of life. They are also disproportionately affected by physical and sexual violence.
For 36 years, Humanity and Inclusion (HI) has fought to improve the living conditions of people with disabilities and ensure that their fundamental rights—including their rights to healthcare, rehabilitation, education, employment, accessibility and security—are met. Last year we supported 500,000 people with disabilities in 63 countries:
- 277,000 people received rehabilitation, including physical therapy and the provision of assistive devices like wheelchairs and prostheses.
- 42,600 children went to school through our inclusive education programs.
- 37,500 people gained employment as a result of skills training and assistance in starting small businesses.
- Hundreds of thousands of people with disabilities and other vulnerable populations received humanitarian aid following natural disasters and human conflicts.
HI also advocates for the rights of people with disabilities on global, national, and local levels and supports inclusion programs in more than 50 countries. HI participated in the drafting of the UN’s Convention on the Rights of Persons with Disabilities (CRPD), and now works with local organizations in a number of countries to ratify or implement the CRPD.
The earthquake and tsunami that hit Indonesia on September 28, killed more than 2,000 people and injured 4,000 others. Some 68,000 homes were destroyed or damaged, displacing more than 200,000 people. Humanity & Inclusion is assisting victims of the disaster, in partnership with Ikatan Fisioterapis Indonesia (IFI), a local physical therapy association.
"Two months after the earthquake, the situation is still very difficult for many victims,” says Cheria Noezar, HI operational coordinator in Indonesia. “Thousands of people who have lost their homes are still living in temporary shelters or sleeping in tents. Hundreds of thousands of people are in urgent need of shelter, healthcare, rehabilitation, and sanitation facilities. Many amputees and people who have spinal cord or head injuries have not yet received appropriate treatment. HI's priority is to provide rehabilitation care to victims in order to avoid the onset of long-term disabilities.
"Many people with disabilities are not aware of their rights in Palu. Their needs are too often ignored. We meet many people who have serious injuries as a result of the earthquake, but who did not seek help because the people around them did not think helping them was important. Thus, making sure their needs are taken into consideration is one of HI's priorities."
HI organized a training course in conjunction with IFI in Makassar City on November 24 and 25. Sudan Rimal, one of HI’s rehabilitation experts from Nepal, taught ten IFI physical therapists how to provide victims with post-emergency care. Following the training, the physical therapists traveled to ten areas in the regions of Sigi, Palu, and Donggala. They are going to provide rehabilitative care to at least 900 injured people and will teach their patients' families important exercises to perform with them. HI and IFI are also identifying the most vulnerable people in the community and referring them to other organizations that offer education, health care, and other services.
Another day of demonstrations rocked Gaza on Friday June 8, resulting in more than 500 new injuries, according to early estimates. Since demonstrations began last March on the border between Gaza and Israel, at least 128 people have been killed, and more than 13,900 people injured, half of whom required hospitalization, according to the World Health Organisation’s data through June 3. Among the people injured, 3,778 have live ammunition gunshot injuries, 1,191 are children, and 2,604 had lower limb injuries.
Present in Gaza since 1996, Humanity & Inclusion has mobilized its local, 40-person emergency team to help injured people who are discharged early from overcrowded hospitals. These rehabilitation teams will case manage more than 1,500 casualties in the coming months. They benefit from access to medical equipment that HI pre-positioned in Gaza.
"The patients we visit at home have suffered massive tibial destruction, torn tissue and pulverized bone that are comparable to war injuries," says Bruno Leclercq, Head of HI's operations in Palestine. Recovery is long and requires months or years of surgery, physical therapy and rehabilitation.
HI is alarmed by the increasingly precarious situation experienced by the most vulnerable people—women, children, older people and people with disabilities. These individuals are suffering the direct consequences of recurring conflicts, travel restrictions and run-down medical facilities. Problems accessing healthcare, medicine, drinking water and electricity—available for less than two hours a day—weigh more heavily on the most vulnerable families when the situation takes a turn for the worse.
“Restricted access to specialized services outside Gaza can lead to a deterioration in the health of many patients, with a high risk of decline or amputation in the weeks and months ahead," explains Leclercq. In recent months, out of 40 requests for medical evacuation from Gaza, only a handful have been granted.
For years, a blockade has stifled Gaza's economy, leaving the Palestinian population largely dependent on humanitarian aid. Three years ago, HI and a coalition of humanitarian organizations published a report on the incomplete reconstruction of Gaza and called on the international community to live up to its promises. The most vulnerable families are no longer able to cope with these additional medical, financial and psychological pressures.
With these new episodes of violence, Humanity & Inclusion is urging all parties and the international community to ensure the effective protection of civilians, medical staff and humanitarian workers. The organization has also stressed that the parties are accountable for violations of international humanitarian law, and invites them to work towards a lasting political solution.
On August 31st, 2016, Handicap International and the United States Department of State's Bureau of Population, Refugees and Migration (PRM) completed a year-long partnership, during which the organization was able to provide assistance to thousands of Syrian refugees in Lebanon, thanks to funding provided by PRM.
Beginning Sept. 1, 2015, Handicap International began implementing a yearlong project in the Beqaa Valley, Lebanon. The goal of this project was to address the essential needs of the most vulnerable Syrian crisis affected persons in the country. This project included the implementation of various services such as rehabilitation sessions, caregivers’ support, and the delivery of assistive devices, prosthetic limbs and orthotic braces to injured and/or Syrian refugees with disabilities.
The results of this cooperation exceeded Handicap International’s expectations. While Handicap International and PRM had planned for 1,250 refugees to benefit from rehabilitation services throughout the year, teams reached almost 1,500 Syrians with physical and functional limitations. Ninety percent of these people showed a measurable improvement in their autonomy, mobility and quality of life. Beneficiaries included people with injuries, temporary impairments and disabilities, older people with functional limitations, and people living with disabling chronic conditions.
Handicap International expected to deliver assistive devices, customized or pre-made orthotic braces and prosthetic limbs to about 600 Syrian refugees throughout the year. Yet by Aug. 31, 2016, more than 900 people had benefited from these services.
Moreover, PRM and Handicap International’s cooperation allowed more than 750 caregivers to improve their capacity to provide quality care to people with physical and functional limitations. When surveyed, 90% of caregivers said they’d noted an improvement in their capacity to provide assistance to their relatives.
Handicap International identified and now supports four local partners in the Beqaa Valley. This operational strategy, which will be reinforced through a follow-up PRM grant, promotes local ownership and sustainability of services, in line with the priorities established by the humanitarian community and national authorities.
These encouraging results convinced PRM and Handicap International of the strength of their partnership and the two entities will start a new project in Lebanon together in September 2016.
Seven-year-old Chetra is one of the youngest patients at the Handicap International rehabilitation center in Kompong Cham, Cambodia.Read more