An evangelist by trade, Zoumatchi was unable to work after a gunshot wound caused him to lose his left leg.

Zoumatchi is a 48-year-old father of four children. He was shot while working in Bangui during the 2014 crisis in the Central African Republic. After his leg was amputated at a community hospital, he returned home to his family in Bambari.

“I was in a very difficult position,” Zoumatchi says. “I was in a lot of pain, and I had difficulty getting around. For years I felt that I was useless.”

In September 2020, he started treatment with Humanity & Inclusion teams in Bambari. By November, he was ready to receive an artificial leg.

Zoumatchi went to Bangui to be fitted at the rehabilitation center (ANRAC), a project supported by Humanity & Inclusion. In December, he began rehabilitation with Humanity & Inclusion physical therapy assistants William and Peggy. As the sessions progressed, Zoumatchi regained his walking ability and experienced less pain. With his crutches, he is finally able to walk in neighborhoods all over Bambari.

“Over the past few days, I’m proud to say that I can even walk short distances without my crutches,” Zoumatchi says. “I’m so happy. Now that I can walk again, I can continue my work spreading messages of peace and love.”

A violent incident cost Hervé his right leg, but with support from Humanity & Inclusion, the 26-year-old proudly stands on two feet again.

One day in late June marked the start of a new beginning for Hervé, who took his first steps with his freshly fitted prosthetic leg. In the months since his right foot was seriously injured in an armed attack in Bambari in February, Hervé’s life—and outlook—have changed dramatically.  

After the incident, Hervé was taken to the hospital where doctors said they needed to amputate the lower part of his leg. At first, Hervé refused.

“I was so afraid of losing my leg and of the consequences it would have on my life,” Hervé explains. “I thought I would become a burden to my family and I didn’t want that.”

With Hervé refusing surgery, the hospital was prepared to discharge him despite the life-threatening risks of his injury. But his leg had become infected and the need to amputate was increasingly urgent. It was then that Humanity & Inclusion’s team learned of Hervé’s case and intervened.

Over the course of a week, Humanity & Inclusion’s mental health specialists counseled Hervé and helped him to overcome his fears, while educating him on the severity of his situation. With his newfound understanding and psychosocial support, he made the life-saving decision to undergo the operation.

After his amputation, Humanity & Inclusion’s team provided Hervé with a wound dressing kit and he regularly received care from physical therapists and mental health specialists to aid in a smooth recovery. His transportation costs to and from therapy were also covered by Humanity & Inclusion to ensure access to the care he needed.

When the time finally came for Hervé to take the next step in his recovery, Humanity & Inclusion took him to Bangui to be fitted for an artificial limb at ANRAC, the only fitting center in the Central African Republic. One week in June, Hervé spent every morning testing models and having molds made at the center, all leading up to the moment where he can finally begin to walk with his new prosthetic.

“I’m so happy,” Hervé says. “It has been so difficult to get around without a prosthetic. I hope, for myself and my family, that I will be able to walk normally again soon so that I can go back to living the way I used to. I see that little by little, I’m becoming mobile again and for that I thank HI.”

After his injury, Hervé’s job opportunities were limited. For now, he's shining shoes along the main road in the city for very little income. But with his newfound mobility, Hervé is eager to start a new job as a mobile pharmaceutical vendor, walking tall around the neighborhoods of Bambari.

Kotime and her mother are the definition of resilient. They have braved disability, war, exodus and rejection by their family to fight for a better life.

When Kotime was 9, she suddenly lost the use of her legs. At the same time, her family was forced to flee their home to escape violence. Kotime and her family have received support from Humanity & Inclusion’s teams in Burkina Faso.

Before her village in the Sahel became the target of increasingly frequent jihadist attacks, Kotime's family enjoyed a peaceful life. Then, in 2019, fate took a turn for the worse. Just as Kotime's condition suddenly deteriorated, the village came under renewed attack. Only weeks before her family fled and took refuge in the north central region of Burkina Faso, she found herself unable to walk.

Mariam, Kotime's mother, has fought for her daughter against all the odds.

“I stayed in the hospital for about three months while my daughter was being treated,” Mariam recalls. “My in-laws were threatening to disown me because I’d left my home to treat a child who might never walk again. They also said Kotime was not my only child. So, I had to bring her back again. Then one night, armed groups entered our village, killed people, and stole our animals, so we had to leave. It was extremely hard for me because I was pregnant, and I fled with Kotime and her sister in my arms."

In seeking safety, the family now faces new challenges.

“When we got here, to feed ourselves, we sold all the animals we had left,” Mariam explains. “We've been here for a long time. My husband doesn’t work. Now and again, I collect sand to sell, or I go to town to wash clothes to feed my children and buy soap. Sometimes we get help from the government and NGOs. That's how I met the Humanity & Inclusion team, at a disability awareness event. They spotted Kotime. I’d just given birth. I was carrying my baby on my back and Kotime in my arms. I would take her to places of worship and pray, hoping she might walk again.”

Kotime, 11, has never been to school.

“Kotime has never attended classes. When my daughter was 7 years old, the age children start school, the schools in our village were already closed because it wasn’t safe. Two years later, she fell ill, and her lower limbs were paralyzed," Mariam explains.

Working alongside Kotime and her family

Humanity & Inclusion’s Inclusive Humanitarian Action project team has supported Kotime and her mother in helping their family understand Kotime’s disability and the importance of rehabilitation.

“To start with, HI’s awareness-raising officer came to talk to us to learn more about Kotime's situation. She referred us to the functional rehabilitation center, but my in-laws were against the idea,” Mariam says. “HI did everything they could to convince them and offered to mediate between us. The officer came back to meet my husband’s brothers, but my father-in-law wasn’t there. When he heard the news, he set his mind firmly against it. It took more meetings with my family and a visit from the director of the rehabilitation center and a religious figure to convince my in-laws! But today everything has changed, at last!”

Kotime couldn’t wait to start her twice-weekly rehabilitation sessions. Humanity & Inclusion also equipped her with a wheelchair, walking frame and leg braces. Now, she can join in everyday family activities again and can even take a few steps on her own. Mariam no longer has to carry Kotime from place to place and is able to spend more time with her other children.

"The wheelchair’s changed Kotime's life - and mine too! It means I can take her everywhere without feeling worn out, and thanks to her rehabilitation sessions Kotime has begun to walk again, although she can’t go far. Life is returning to normal,” Mariam says. “She can help me with the dishes, and best of all she can go out and play with her friends again. They bring her home after they’ve finished playing. I’m really proud of her!”

This testimony was collected by Pascaline Nongbzanga Tapsoba, who is responsible for Humanity & Inclusion’s community campaigning and inclusion work in Burkina Faso.

Header image: Kotime and her mother, Mariam, fist bump each other. Copyright: Olivier Czar Katona/HI
Inline image: Kotime plays with other children from her community. Copyright: Olivier Czar Katona/HI

On her path to recovery after stepping on an explosive device, Alima, 16, participates in rehabilitation sessions with Humanity & Inclusion specialists.

After finishing up a trip to the market in Bambari one Sunday in May, Alima was ready to embark on the six-mile walk home. With each step, she was careful to avoid the dangers she had heard about: active explosive devices hiding silently in the rocks and dirt beneath her feet, left behind from intense conflict in the Central African Republic.

Knowing the risks, Alima’s brother had taught her a safe route to the market through the grass. Following his instructions, she arrived safely to the market. But on her way home, Alima forgot the way and veered off the path. She stepped on an explosive weapon.

The blast severely damaged both of Alima’s legs, making it difficult to get out of her bed or perform routine activities. Today, Alima is in the Bambari hospital, where she is visited daily by Humanity & Inclusion’s physical therapists.

“Since I spend most of my time lying down or sitting after the accident, the HI physical therapists come every day to do exercises on my legs and feet,” Alima explains. “They keep my muscles working, so that when my wounds heal I can recover more quickly and be independent again.” 

With the help of these regular rehabilitation visits and proper medical treatment, Alima will soon leave the hospital and return to living her life at home. Humanity & inclusion teams will continue to work with Alima through the healing process and beyond.

Image: Alima sits on her bed at the Bambari hospital. Copyright: A. Servant/HI, 2021

As food insecurity in Madagascar worsens, Humanity & Inclusion uses stimulation therapy and food aid to prevent long-term disabilities in malnourished children.

As the south of Madagascar—an island country off the east coast of continental Africa—faces its worst drought in 40 years, its people continue to face the brutal consequences of starvation and malnutrition. Years of insufficient rainfall and the added impact of climate change have ravaged the land and devastated the agricultural production that much of the population depends on. Today, more than 1.35 million people in the Atsimo Andrefana region face acute food insecurity, and are experiencing dangerous levels of hunger. Death rates are soaring and local health and social services are unable to meet such high demand. These challenges are worsened by the Covid-19 pandemic.

“Accessing food has become a real challenge for many families,” says Emilie Sauvanet, Humanity & Inclusion’s Country Director for Madagascar. "In this already very difficult context, the situation is made even worse for people with disabilities. They experience discrimination and socio-economic inequalities, high levels of insecurity, poor access to drinking water and sanitation facilities, difficulties in moving around and, above all, a lack of consideration for their specific needs. As in any crisis situation, people with disabilities, children and women are most affected.”

Long-term risks of malnutrition

The increasingly high levels of malnutrition and undernutrition in children under the age of 5 put them at heightened risk of delaying their growth or developing long-term disabilities.

Severe acute malnutrition (SAM) affects approximately 20 million children worldwide and is the estimated cause for 400,000 child deaths each year. In Madagascar, nearly half of all children under the age of 5 experience SAM, which is only worsening amid the current crisis. SAM can lead to difficulties in developing motor skills such as crawling, sitting and grasping, or to Hypotonia, a disorder that affects motor nerve control by the brain. If not properly managed, these developmental delays can transform into lifelong disabilities. 

Humanity & Inclusion teams in the region have already identified more than 800 children in need of nutrition support and physical therapy to facilitate normal growth and development. Physical therapists use functional exercises, early childhood stimulation therapy and physical therapy to enable children with SAM to maintain normal weight gain, growth patterns and cognitive development. Through individual therapy sessions with trained professionals, children gain skills through interactive play. Techniques are also taught to their caregivers so they can continue therapy at home. 

HI's TIALONGO project

After an assessment, Humanity & Inclusion launched the “TIALONGO” project in the Madagascar program. Teams provide urgent food support to people with disabilities and their households and are working to reduce the development of disabilities linked to malnutrition and undernutrition in children. Among others, the key outcomes include: 

• Providing quality and sufficient food to people disproportionately affected by the crisis
• Improving the nutritional situation of children below the age of 5 and reducing the development of disabilities linked to malnutrition
• Educating local health professionals on early identification and management of disabilities
• Training physical therapists and occupational therapists in stimulation therapy

The project is expected to reach nearly 115,000 people in need of support. 

Image: A mother and her children from Humanity & Inclusion’s early childhood project in Tana, Madagascar. Copyright: S. Bonnet/HI Archives, 2007

Despite a daunting economic crisis caused by restrictive measures to combat the spread of Covid-19 in Cambodia, Humanity & Inclusion continues providing in-person and virtual rehabilitation care.  

While many regions around the globe may be seeing a drop in Covid-19 cases, Cambodia is experiencing its first wave of infections. Largely spared by the pandemic in 2020, the country began seeing a rise in positive cases in February 2021. Numbers steadily rose until May, and have remained mostly stagnant since. 

“We have hundreds of new cases a day, and now it’s spreading to the provinces,” says Edith Van Wijngaarden, Humanity & Inclusion’s country manager for Cambodia. “The rates haven’t decreased over the past few weeks, and the real numbers may be even higher than the official figures.” 

Economic deterioration 

Strict government restrictions were put in place to prevent more infections, but efforts to stifle one crisis have fueled another. Following the mandatory closure of businesses, travel and social gatherings, people found themselves in the midst of a serious economic crisis, with no means to make a living. 

“The situation has been really difficult,” Van Wijngaarden explains. “People in the high-risk, or ‘red’ zones could not even access food. Many people have lost their jobs. There is no more tourism, so everyone in that industry is struggling. There were outbreaks in the garment factories. The entire economic situation is degrading.”

While the pandemic situation appears hopeful with a promising vaccination plan in place, the government opted to prematurely lift restrictions to provide some economic relief, renewing risks posed by the current wave of cases. 

Work continues despite challenges

Despite the difficulties imposed by both the pandemic and economic crises, Humanity & Inclusion’s teams have continued to support the population’s most vulnerable people. 

In addition to providing Personal Protective Equipment to reduce Covid-19 infection risk, staff members are distributing food kits to those affected by loss of income. Teams continue to provide rehabilitation services to people living with disabilities. Since February, staff have implemented in-person care as well as tele-rehabilitation to ensure accessibility. Using dolls as demonstration tools, parents are learning how to practice physical therapy exercises and continue care for children with disabilities at home. 

“Our rehabilitation center is still up and running,” Van Wijngaarden says. “It has had to open and close a little, but it hasn’t impacted our ability to support the community. When we have no other option, we follow up and support them remotely. We are currently training five other centers to do remote rehabilitation as well.”

Global response to Covid-19

Amid the health crisis, Humanity & Inclusion specialists continue to provide vital rehabilitation care for people with disabilities in physical therapy units and alongside local partners. This is increasingly important, as overworked medical facilities and government restrictions limit access to other care services. Teams are also providing mental health and psychosocial support to assist frontline healthcare workers, people with disabilities, vulnerable people and their families.

Humanity & Inclusion teams around the world have been responding to the Covid-19 pandemic since March 2020. Donors helped launch more than 170 Covid-19 projects in dozens of countries to protect and care for the people that others overlook. Between March and August 2020, staff have reached 2.2 million people with care and aid to keep Covid-19 at bay.

Image: A Humanity & Inclusion physical therapist uses a doll to demonstrate rehabilitation exercises a mother can practice at home with her son who has cerebral palsy. Copyright: HI

Persons with disabilities often encounter significant barriers to accessing health information and services, including physical, communication, attitudinal and financial barriers. Persons with disabilities are two times more likely to find health care providers’ skills and facilities inadequate, three times more likely to be denied health care, and four times more likely to be treated poorly in health care facilities.

While the general health needs of persons with disabilities are the same as everyone else and can often be met by primary healthcare services, they may also have additional specific health needs, including access to rehabilitation and assistive devices such as wheelchairs, artificial limbs and visual supports. Despite greater needs, 50% of persons with disabilities cannot afford healthcare, facing a 50% higher risk, compared to persons without disabilities, of facing catastrophic healthcare costs.

During the Covid-19 pandemic, persons with disabilities were significantly affected by the disruption of health services, and experienced greater difficulties in getting information on and implementing preventive measures such as accessing clean water and sinks and practicing social distancing. In addition, they might have been disqualified from receiving care due to the prioritization of treating Covid-19 patients.

In Jordan, 88% of those who responded to a survey conducted by Humanity & Inclusion in 2020 reported that they could not go to the hospital for their regular checks or additional medical needs.

WHA adopts crucial resolution

Recognizing the huge unmet health needs and the persistent exclusion of persons with disabilities from health care information and services, the resolution recently adopted by the World Health Assembly builds on the Convention on the Rights of Persons with Disabilities and reaffirms the right of persons with disabilities to enjoy the highest attainable standard of health, with no discrimination and on the basis of free and informed consent.

Organizations of persons with disabilities and other civil society organizations were consulted during the drafting process and provided critical input to the resolution. Humanity & Inclusion’s contribution was provided through the International Disability & Development Consortium and in partnership with the International Disability Alliance.

The resolution provides a set of important commitments for Member States to move toward more disability-inclusive health systems, including:

• consulting with, and actively involving persons with disabilities and their representative organizations, in decision making and designing programs;
• identifying and eliminating attitudinal, environmental and institutional obstacles and barriers that prevent persons with disabilities from accessing health;
• collecting health-related data, disaggregated by disability, age and sex, education level and household income to inform relevant policies and programs;
• developing and implementing policies and programs to improve access to rehabilitation, as well as affordable and quality assistive technology within universal health and/or social services coverage and to ensure their sustainability.

The resolution requests the World Health Organization (WHO) to produce, in close consultation with Member States and relevant stakeholders, a global report on the highest attainable standard of health for persons with disabilities by the end of 2022. WHO is also called to ensure the implementation of the United Nations Disability Inclusion Strategy, and the creation of an inclusive global research agenda.

Translating political commitment to action

As an organization with extensive experience in disability inclusion in health as well as in rehabilitation, Humanity & Inclusion believes this resolution can help make significant steps in both fields. However, Humanity & Inclusion recognizes that rehabilitation is an essential health strategy not only for some persons with disabilities, but also for many other people who experience limitations in their everyday functioning. Therefore, while Humanity & Inclusion welcomes the integration of rehabilitation in this resolution, the organization also highlights that the need for rehabilitation is bigger—estimated at 2.4 billion people globally—and requires additional, specific political commitment to ensure that health systems integrate rehabilitation and make it accessible to everyone in need.

The resolution comes at a crucial time, as the WHO global disability action plan expires and when Covid-19 has exacerbated existing inequities in accessing and receiving health care.

As the WHO, Member States and community organizations are paying efforts to “build back better,” they should look into building back more inclusively. This resolution provides a solid roadmap to advance in this direction, but it will remain an empty text if it is not followed by concrete and immediate actions.

Humanity & Inclusion is marking World Clubfoot Day on June 3 by highlighting the importance of early treatment. Providing care for clubfoot in the weeks immediately after a child’s birth can prevent them from growing up with a disability.

Clubfoot is the malformation of one or both feet and is visible at birth. If left untreated the foot never regains its normal position, with serious consequences for the child. They can never wear shoes, risk injury, and find it difficult to walk, especially over long distances. Because the child cannot take part in activities with other children, they also risk being excluded and stigmatized. 

“We can prevent this bleak outcome," says Uta Prehl, one of Humanity & Inclusion’s rehabilitation specialists. “But we must detect this malformation as soon as possible after birth. It’s one of the keys to successful treatment. The child can then be treated effectively, and the malformation corrected, and within months they can walk normally. Social workers also play an important role in the care cycle by working with parents to ensure they continue the treatment. If children are not followed up correctly and regularly, the malformation may not be properly corrected. So, it’s crucial to give caregivers as much information as possible.”

Treatment involves placing a cast—which is replaced every week for six weeks—on the child’s leg to steadily correct the foot. The tendons are sometimes operated on before the final cast. Humanity & Inclusion’s partner organizations then fit the child with an orthopedic brace made of a bar connecting two small shoes, which is worn for the first four months and regularly adjusted to appropriately correct the malformation. The child’s feet are checked until they are able to walk, and an X-ray is performed to check healing. The brace and shoes are normally removed between the ages of 3 and 4. The child continues to attend regularly follow-up consultations until they stop growing to prevent the malformation from returning.

For several years, Humanity & Inclusion has trained physical therapists in a number of countries to promote the early detection and appropriate care management of clubfoot. Teams continue to run these projects today, particularly in Burkina Faso and Sri Lanka, so children born with these malformations grow up without disabilities. 

Image: An adult's hands hold the out-turned feet of a small child in Cambodia who has clubfoot. Copyright: Lucas Veuve/HI

Srey Nuch has been living with paraplegia since she was 13. Humanity & Inclusion has helped her set up her own sewing business, but she doesn’t plan to stop there!

Srey was picking pods for a family meal from the top of a tamarind tree—a common fruit tree in Cambodia— when she fell to the ground.  The accident  left Srey unable to walk, and her family went into debt paying for her treatment. Her parents sold their belongings and borrowed money from village moneylenders. Srey's two older brothers dropped out school to find work. Since Srey was unable to stand, she also had to stop attending classes.

Unable to climb the seven steps into her family’s stilt house, Srey moved into a small outbuilding nearby. During rainy season, it was almost impossible for her to move around on the muddy floor.

“It was an awful experience, and it left me disabled, and with my family we went through a lot of pain and some really tough times," Srey explains. “It was hard. I couldn't move around, and that made me feel sad. But since I’ve been able to access rehabilitation services, I feel a lot more hopeful about the future.

A budding entrepreneur

Srey lives in a village near Humanity & Inclusion’s rehabilitation center in Kampong Cham, where she has received rehabilitation care since 2015. The team also gave Srey a wheelchair and leg braces.

"Srey Nuch's condition has really improved,” says Vimean Srun, a physical therapist for Humanity & Inclusion. “To begin with, she couldn't move her legs at all. So I began by doing physical therapy exercises with her and showed her mother so they could do them at home. We also gave her with a wheelchair. Initially she found it hard to move from the chair to her bed or the toilet. But she put in a lot of practice and now she moves around with her crutches and braces.”

Staff from Humanity & Inclusion’s socio-economic inclusion project also helped Srey put her plans to become a seamstress into action. She was given a sewing machine and material to get her business up and running. She also joined an inclusive community investment program, which taught her how to sew. Today, Srey’s an accomplished entrepreneur who makes beautiful clothes.

“I earn an income from my sewing skills, which helps my family,” Srey says. “I’m really grateful to Humanity & Inclusion and everyone who wants me to be part of the community."

When she’s not working, Srey is active in her village, does chores, and enjoys hobbies.

“With my braces, crutches and wheelchair I can move around the house, go out, and visit my neighbors” she says. “I can do a lot of things without help, like washing myself and my clothes, and cooking. I love cooking! I can even go into the garden and pick lemongrass to make my favorite dish!”

Srey ’s aspirations don’t end there: “As well as sewing, I am going to start raising chickens to earn more and help my younger brother go to school,” she says.

Top image: Srey sits in her wheelchair at her sewing machine in Cambodia. Copyright: Stephen Rae/HI
Inline image: Srey sits at a table while preparing one of her favorite meals at her home in Cambodia. Copyright: Stephen Rae/HI

Ceasefire between Gaza and Israel enables local teams in Gaza to launch rehabilitation services for more than 500 people.

Twelve days after the most recent escalation of violence in Gaza, the parties involved have announced a ceasefire. 

This long-awaited break comes after nearly eight days of constant bombings resulted in 242 lives lost between Gaza and Israel, including 67 children and 43 women. More than 1,700 people are injured.

“We’ve been waiting for a ceasefire,” says Laurent Palustran, Humanity & Inclusion’s country manager for the region. “We can now start responding to humanitarian needs with more ease and be able to intensify the distribution of a lot more aid than what we’ve done so far.”

According to a recent report by the UNWRA, approximately 91,000 people have been internally displaced, over 66,000 of whom have sought refuge in 58 UNWRA schools opened as emergency shelters. Humanity & Inclusion teams have conducted needs assessments of those displaced people to determine next steps. 

“We’re starting to get clearer data thanks to these evaluations,” Palustran explains. “We have identified over 500 people in these shelters that have disabilities and are in need.” 

Reham Shaheen, Humanity & Inclusion’s Rehabilitation Task Force Coordinator in Gaza, explains the needs of the vulnerable populations the organization serves in areas of conflict.

“Psychosocial support is one of the greatest needs,” Shaheen says. “Many will lose a limb or an organ and will have psychological needs afterwards. People really need mental health and counseling to cope with the current situation. Then there is great need for multidisciplinary rehabilitation services, like physical therapy and wound dressing sessions to prevent disabilities after injury.

“Usually the needs of injured people change after a few weeks. There is either deterioration or improvement in their condition, so there is dire need for assistive devices and rehabilitation support as well.” 

Humanity & Inclusion is prepared to distribute mobility aids such as crutches, walkers and wheelchairs, along with Infection Prevention and Control kits to keep wounds clean and prevent infection that could lead to long-term ailments. 

The Covid-19 pandemic has not let up in Gaza, with Johns Hopkins reporting a total of 304,532 confirmed cases since the start of the pandemic, and 3,448 deaths between Gaza and the West Bank.

“This escalation occurred while we’re being hit with a second wave of Covid-19,” Shaheen explains. “We have two emergencies, so there is a need for hygiene kits. People need to have clean environments to be able to avoid illness, and in terms of injuries, to keep their wounds clean to avoid any infections.” 

Image: A Humanity & Inclusion physical therapist assists an injured civilian in a rehabilitation session in Gaza in 2018. Copyright: Hardy Skills/HI