Just days after an earthquake hit Haiti, Humanity & Inclusion is providing assistance in hospitals in the country’s worst-affected region. A team of physical therapists trained to care for people with earthquake-related injuries will begin work this week.

The current economic crisis in Lebanon, which was aggravated by the deadly explosions in Beirut on August 4, 2020, is having a serious impact on communities living in vulnerable circumstances, including Syrian refugees and people with disabilities.

A young man and a teenager who receive care from the Mousawat Center, supported by Humanity & Inclusion, share their stories.

Mohammed Ali Raja, 26

Mohammed Ali Raja fled Syria to Lebanon in 2017 after a rocket attack left him with a spinal cord injury, causing him to experience paralysis from the waist down. His left leg had to be amputated. Humanity & Inclusion’s partner in Lebanon, the Mousawat Center, provided Mohammed with crutches and psychological support. They also referred Mohammed to the World Rehabilitation Fund (WRF), where he received a prosthetic leg and medical boots. Mohammad continues to receive for other health issues caused by his spinal injury.

On August 4, 2020, the Beirut blast killed more than 200 people and injured 7,500. For Mohammed, it triggered psychological trauma from his memories of the conflict in Syria.

“I was afraid to go to the bathroom after the blast because I was scared,” he says. “The feeling of fear got worse because I can’t escape if there is a problem.”

Due to the current economic collapse in Lebanon, Mohammed is in need of financial support. For example, the incontinence pads that he has to wear cost 100,000 pounds—more than $66—for a pack of 24. That is unaffordable at local salary rates, especially when Mohammed’s brother is the sole income provider for his family.

Mohammed’s hope for the future is to pursue education outside Lebanon, in a place where he can “work and be productive enough to cover my needs.” He would like to use his interest in biology to become a doctor or school teacher.

Mohammed Abboud al-Saleh, 14

Mohammed Abboud al-Saleh and his family fled from Syria to Lebanon several years ago. Unfortunately, he was struck by a car while crossing the street in Beirut. He suffered a spinal cord injury causing his legs to be paralyzed.

After 15 sessions at the Mousawat Center, Mohammed has made great progress. He can now stand with assistance and transfer himself from his wheelchair to a bed.

“There were movements I couldn’t do before, but now I can,” he says. “I am so happy.”

Being a wheelchair user is a day-to-day challenge for Mohammed. One time, his father was late to pick up him from school, so he was stuck on the third floor. His teacher was unable to move Mohammed by herself, so they had to wait for his dad to arrive and to call people from the street to help get Mohammed back down. It made Mohammed very upset and he said that he “felt lonely.” Like many places, schools often don’t have elevators or facilities for persons with disabilities. Even if they did, the current frequent electricity blackouts in Lebanon would likely cause a major issue.

Mohammed has big plans for the future. He would like to continue his studies and become a doctor or pharmacist. But his real passion is in acting! He posts challenges, pranks and sight-seeing videos to his thousands of subscribers on Youtube and TikTok.

When asked if he could go anywhere, Mohammed suggests a few places, all within miles of his home.

“I’d like to play with my friends and go for walks around the building and around these areas,” he says. “My biggest dream is to walk again.”

Covid-19 has presented numerous challenges, changing the way Humanity & Inclusion teams around the world work with the communities we serve. One of those challenges was figuring out how to safely continue providing rehabilitation to people with disabilities. The answer in many places? Telehealth.

For instance, take Priti, a 3-year-old girl living with cerebral palsy in Nepal. Doctors suggest she do regular physical therapy sessions to improve her condition, but her parents find it difficult to afford treatment on top of other living expenses.

A community member and former patient referred Priti to Community Based Rehabilitation Biratnagar (CBRB), a local partner organization of Humanity & Inclusion, for physical therapy and assistive devices.

Priti completed three physical therapy sessions at the center and received a specialized chair that helps stabilize her body and maintain upright sitting posture. She can also use the chair during daily activities like playing and eating.

Then, as the second wave of Covid -19 swept through Nepal reinstating travel restrictions, Priti completed four telerehabilitation sessions by video. Physical therapists gave Priti’s family advice on continuing home exercise to help Priti grow stronger and checked on the condition of her chair.

“It was difficult for me to continue regular exercises on my own during this pandemic as I could not remember techniques taught by the physical therapist,” says Priti’s mother. “With regular video calls, I am satisfied and happy with the services that helped me to continue exercises."

After three months of regular rehabilitation services, specialists have noticed that Priti’s neck is growing stronger and that her arms and legs are more flexible.

Many people living with disabilities, like Priti, lack access to regular follow-up services that they need because of Covid-19 safety measures and travel restrictions.  

“Through the provision of telerehabilitation, another easy way of reaching out to the individuals who need such services, we tried better at our level,” explains Rinki Adhikari, CBRB physical therapist. She added that telerehabilitation can be an alternative way of making rehabilitation services accessible for people in the future.

Humanity & Inclusion’s Covid-19 response in Nepal

These physical rehabilitation activities are supported by USAID and managed by Humanity & Inclusion. The program supports the establishment of a sustainable, integrated, public-private rehabilitation system in order to improve the mobility and functional independence of victims of conflict as well as other adults and children in need of rehabilitation services in Nepal.

With Covid-19, the program has adapted to offer telehealth services and distribute information to prevent the spread of coronavirus. So far:

• 922 audio messages have been broadcast in four different languages on the radio
• 257 accessible video messages have been broadcast in four different languages on television
• 10,726 posters and leaflets have been delivered to government and rehabilitation stakeholders
• Health workers have received 275 sets of personal protective equipment; 16,750 pairs of gloves; 32,500 masks; 62 gallons of disinfectant; and 19 gallons of hand sanitizer
• 7,067 physical therapy sessions have been conducted, including 3,390 telerehabilitation sessions
• 483 assistive devices have been provided to people with disabilities or injuries
• 678 people received essential medical items
• Specialists have offered guidance to government officials related to inclusive health and rehabilitation and to rehabilitation care for people with Covid-19

Header images: Priti sits in her special chair to help her posture while eating and playing. At center, her mother helps her with exercises during a telerehabilitation session. Inline image: A CBRB Prosthetist and Orthotist teaches a woman to re-learn to walk, gain balance, strength and mobility with their new prosthetic device in a parallel bar at the rehabilitation center. Copyright: CBRB/HI

Saisa’s leg was amputated after an unknown critter stung or bit her foot, causing a serious infection. With help from Humanity & Inclusion, she is learning to get back on her feet and has already returned to school.

Saisa, 10, lives with her parents and seven brothers and sisters in Kenya’s Kakuma refugee camp. At a birthday party near her home, Saisa was bitten or stung on her left foot. After the injury, her leg became gangrenous and required a life-saving amputation.

"Saisa was 2 years old when we arrived in Kakuma,” says her mother, Rihad. “My daughter was in good health. And then this happened. One day she went to play with her friends and the next morning she told us she’d been bitten or stung by something. We don't know what. At first, I thought she’d had a nightmare, but then things got worse.

“We took her to hospital, but we were under lockdown because of Covid-19, so we were sent away before she could be treated. Back home, her leg started to swell up and got worse, so we returned to hospital."

The doctors spotted the first signs of gangrene and, to save her life, amputated her leg below the knee.

A support network

Humanity & Inclusion’s physical therapists immediately began providing Saisa with the care she needed. She was also given psychological support to cope with the distress of losing her leg. Saisa continues to visit Humanity & Inclusion’s rehabilitation center, where she is supported by a multidisciplinary team.

“I first met Saisa just two days after her amputation,” explains Stella Mwende, a physical therapist. “We initially focused on treating her stump and giving her emergency psychological support. She was then referred to the rehabilitation center, where she was given rehabilitation care once a week. We started by doing exercises with her to increase her flexibility and strengthen her muscles. We also gave her a pair of crutches.”

Saisa has already learned to keep her balance and get around using the crutches. Humanity & Inclusion also built parallel bars at her home to help in her recovery.

“Saisa can go out and play with her friends at last without me running after her all the time,” her mother says.

Humanity & Inclusion teams also supported Saisa’s family through this tough time, explaining the different stages of grief that Saisa was experiencing. Her family learned how to reassure her and encourage her to learn new skills and become more independent.

“I found the hospital really stressful because I thought I was going to lose her,” Saisa’s mother explains. “Once we got home, some people from Humanity & Inclusion came and now my daughter feels more hopeful about the future.”

Back to school

Humanity & Inclusion’s inclusive education team also helped find a place for Saisa at an inclusive school near her home.

“We’ve put a plan in place so Saisa can return to school under the right conditions,” explains Caleb Omollo, an occupational therapist. “The first decision, which we took with Saisa and her family, was to transfer her to a school closer to home, where the teachers are trained in inclusive education and are used to assisting children with disabilities. We have assigned an educational assistant to monitor her progress at school and to look after her welfare both inside and outside the classroom.”

Saisa walks to school each day with a classmate named Ana.

"We’ve also put in place a system to make sure Saisa feels safe on the way to school,” adds Caleb. “We want Saisa to feel she belongs to her school and her community as soon as possible, so she can play a full role in every aspect of society.”

She also attends psychotherapy sessions to help her rebuild her confidence and reconnect with others.

“We work on her interaction with other children, and we help them learn from each other,” Caleb says.

Saisa is now waiting to be fitted with a prosthetic leg from another service provider, which should happen soon. Humanity & Inclusion will continue to support Saisa with the services she needs to move forward.

“It’ll be good to play with my friends again when I get my prosthesis,” Saisa says. "I'm really glad to be back at school again now. I want to be a businesswoman when I grow up and sell a lot of things!”

Header image: Saisa completes classwork at school. Inline image: Saisa with her mother. Copyright: A. Patient/HI

After Riad, 20, lost his leg in a shooting, he feared that he could not care for his family. Today, with the help of Humanity & Inclusion’s psychosocial support, physical therapy and a new prosthetic leg, he can’t wait to show his family what he can do.

On February 15, Riad and his family heard gunfire outside of their house in the Central African Republic. The shooting continued for hours, so they fled in search of safety. Like many others, they sought refuge in a mosque in Bambari. But their safety was short-lived, as gunmen soon entered and opened fire on the families inside, taking several innocent lives. Riad was shot twice, once in his left ankle and once in his right leg. He lay wounded on the ground until the next day, too afraid to seek help until then. By the time he was taken to the hospital, his injury had become so severe that his right leg was amputated 21 days later.

The operation was a success, but Riad worried about the future. He lives with his mother, his siblings and their children in Bambari. His greatest fear after losing his leg was that he would not be able to take care of his family. After the amputation, Humanity & Inclusion psychosocial specialists helped him overcome his fears, cope with the pain, and start adjusting to life with a disability.

Always accompanied by his older brother, Riad has been attending physical therapy with Humanity & Inclusion specialists twice a week in Bambari. Ready for an artificial leg, Humanity & Inclusion recently paid for the brothers to visit the Central African Republic’s only fitting center in Bangui.

“I can’t wait to receive my prosthesis,” Riad said during his fittings. “I hope to be able to walk again and take care of my mother. I’ll be able to go get food and spend my day working outside of the house. I think I’ll feel brave again.”

After a week of casts and learning to walk again, Riad received his new prosthetic leg.

“I used to look at my leg and cry, but now I feel stronger,” he says. “I feel that I will have less to worry about from now on and I’m so grateful for the support I’ve received from HI, from my amputation until now. I can stand up and walk again. I can’t wait to show my family!”

Header image: Riad practices walking with his new artificial leg at a fitting center in Bangui. Inline image: Riad and his brother at a rehabilitation center in Bambari. Copyright: A. Servant/HI

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