The effectiveness of community and family-based approaches to disability awareness and support in Afghanistan
Chris Fitzgerald & Jahanzeb Daudzai
Disability in Afghanistan
The development sector has failed to acknowledge disability as an important issue for decades, only recently being recognised in the United Nations Sustainable Development Goals (SDGs). For this reason, people with disability, particularly children, are often the last group to benefit from development programmes.
This has meant that children with disability continue to face significant barriers in their day-to-day lives, including high levels of poverty, low literacy rates, social isolation and often without basic services and supports. Children with disabilities and their families are rarely allowed platforms to explain to donors and service-providers what support they require and how they believe their quality of life can be improved.
Afghanistan has one of the highest proportions of people with disability globally. At least one in five households contain an adult or child with a physical, sensory or psychosocial disability. More than one million Afghans also have amputated limbs, or experience mobility, visual or hearing disabilities. The prevalence of disability in Afghanistan is due to a myriad of problems caused by decades of conflict and instability. This includes buried land mines, and artillery shelling, disease, poor healthcare and acute poverty.
In Afghanistan, children with disability face significant challenges that act as barriers to their active participation in society. These include abuse and exploitation, stigma, harmful stereotypes, discrimination and a lack of accessibility. This is the result of prevailing and persistent beliefs, norms and cultural myths. Disability is often treated as a burden, shameful, a curse or seen as divine punishment, particularly mental illness and severe intellectual disabilities. This prevents people with disability from accessing healthcare or education because they are often excluded from their communities.
The solution to this issue needs to address the challenges children with disability face in their daily lives, starting from within their home, and it needs to put family’s voices at its core. Supporting children with disability from a young age and within their homes and communities increases their chances of full participation and access to services and their rights throughout their lifetime. This also helps to break down stigma and discrimination within their communities.
The Enabled Children Initiative’s (ECI) community-based disability awareness and support program, across six provinces of Afghanistan, meets these challenges and achieves positive outcomes for children with disability by taking a family-focused approach.
The program works with the family to create an action plan for each child, placing the family and child’s unique situation and needs at the core of each plan. It also connects children with disability and their families to nearby services, and provides emergency support for children and their families. Awareness-raising and information-sharing about disability to families of children with disability and their wider communities, particularly the view that disability is not inability, is also a key component of the program geared toward breaking down stigma.
The program began in December 2021 and operates in Nangarhar, Kabul, Herat, Kandahar, Bamiyan, and Balkh provinces of Afghanistan. The success of this program has provided the organisation with an insight into how to effectively support children with disability in Afghanistan, taking a family and community-based approach. However, it has also highlighted the challenges faced in raising awareness and accessing services in often remote and poor communities.
These challenges became clear when assessing children, speaking with families, and conducting enrolment surveys. While families wanted to support their child with disability, all families were struggling to make ends meet, many of them living in acute poverty. They did not have access to services or information about available services. For example, in Nangarhar province, the families of children currently enrolled in the program didn’t know how to support their child in receiving an education. Families and their communities also had a limited understanding, or misunderstanding, about their child’s disability.
Staff also found that children often experienced mental health problems, including depression and anxiety, due to the day-to-day challenges they faced, on top of their disability. This was either a result of exclusion by their family, stigma, abuse, or harassment from community members or with the children themselves avoiding play or attending school due to the real or perceived threat of embarrassment or abuse, or that they would hold other children back.
These findings are consistent with a recent report (August 2022) produced by Save the Children about the effects of the humanitarian crisis in Afghanistan on children over the past year. Political instability and the dire humanitarian crisis in Afghanistan have caused severe mental health issues for children with disability. Children with disability are three times more likely than those without disability to show daily signs of anxiety and depression. This becomes more acute when it is intersected with gender and poverty. Girls with disability experience mental health issues to a higher degree than boys and this increases further in poorer households. This has meant that one in seven children with disability do not attend school due to “depression, anxiety and sadness.” The occurrence of children with disabilities staying out of school increased over the past year, with 1 out of 7 children reporting that they don't attend school due to disability. Families with disability in their household were found to be most likely to have children resorting to hard labor to make ends meet and were four times more likely to have lost their income over the past year.
ECI has been able to meet these challenges through a multi-staged approach that has provided an effective support system for children with disability and their families. Staff visit identified children with disability and their families and conduct a thorough enrollment survey. This enables staff to adequately determine the individual, personalized support needs of children but also the educational or disability awareness needs of their families and wider communities.
Second, based on the enrollment survey, staff provide tailored services and support depending on the needs of the child and the severity of disability. Together, families and ECI staff create an action plan for each child. Where possible, families are referred to other organizations in ECI’s network to address healthcare, therapy, or housing needs. The families are also provided with a cash stipend to help them make ends meet and provide for their child with disability.
The third component of this approach is to raise awareness about disability within the family and within the wider community. In the case of Habiba, a girl with an intellectual disability, staff held information sessions on important topics related to children with disability with the parents, family members and other people in the village. This allowed people in Habiba’s community to gain a better understanding and acceptance about Habiba’s disability, her human rights and disability more broadly.
The results of this approach have been promising. ECI staff have reported that children with disability have experienced better treatment from their families and communities and are accessing some of their basic rights. These children have also experienced less mental health issues due to more autonomy, increased mobility, participation in family and social life and access to education through other ECI programs.
Due to the high prevalence of disability in Afghanistan and the humanitarian crisis, it is vital that children with disability get the support they need, particularly in rural or remote areas. ECI has been able to create and undertake an effective community-based disability awareness and support program that supports children with disability based on the specific needs of each child, their families, and communities. Crucially, the organisation has also successfully addressed the need to raise awareness amongst families and communities to break down stigma. This has not only helped to achieve better health, social and educational outcomes, but it has also ensured that these children are treated according to their human rights.
Founded in 2010, Enabled Children Initiative, is an independent not-for-profit organisation that works toward a more inclusive Afghanistan, where people with disability are embraced and respected by their families and communities and have equal access to education, healthcare and employment. The organisation delivers six programs across six provinces and has fifty employees. More information can be found at www.enabledchildren.org
Chris Fitzgerald is a freelance journalist based in Australia, writing for a number of publications on human rights and international law, with a particular focus on Afghanistan. Chris holds Masters Degrees in Public Policy and Law from Flinders University.
Jahanzeb Daudzai is Programs Director of Enabled Children Initiative in Afghanistan. He has years of experience working at the community level with children, young people and persons with disabilities in Afghanistan in the areas of humanitarian assistance, awareness-raising and social protection.
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1 Save the Children (2022). Household with disability in Afghanistan: Multi Sectoral Needs Assessment, https://resourcecentre.savethechildren.net/pdf/child_household_disability_afghanistan_2022.pdf/
2 Save the Children (2022). Household with disability in Afghanistan: Multi Sectoral Needs Assessment, https://resourcecentre.savethechildren.net/pdf/child_household_disability_afghanistan_2022.pdf/
3 Human Rights Watch (2021) Afghanistan: Women with Disabilities Face Systemic Abuse: Barriers, Discrimination in Healthcare, Education https://www.hrw.org/news/2020/04/27/afghanistan-women-disabilities-face-systemic-abuse.
4 Jennifer Heath and Ashraf Zahedi, Land of the Unconquerable: The Lives of Contemporary Afghan Women (University of California Press, 2011) p. 156.
5 Jonckheere, Steven (2020) Disability in Rural Areas: A Matter of Perception (International Fund for Agricultural Development https://www.ifad.org/en/web/latest/-/blog/disability-in-rural-areas-a-matter-of-perception.
6 Save the Children (2022) Breaking Point: Children’s Lives One Year Under Taliban Rule, https://resourcecentre.savethechildren.net/pdf/Breaking-Point-Childrens-lives-one-year-under-Taliban-rule_Aug-2022.pdf/.
7 Name has been changed.