ForewordFor nearly twenty five years <strong>Handicap</strong> <strong>International</strong> has been <strong>in</strong>volved <strong>in</strong> support to persons with disabilities worldwide, promot<strong>in</strong>gtheir rights and welfare, whatever the situation they are confronted by. With regards to <strong>Afghanistan</strong>, our organisation started itsactivities of rehabilitation <strong>in</strong>side the refugee camps established <strong>in</strong> Baluchistan <strong>in</strong> 1985, by produc<strong>in</strong>g wheel chairs, prosthesis andorthotic devices, and tra<strong>in</strong><strong>in</strong>g Afghan refugees <strong>in</strong> physiotherapy <strong>in</strong> Quetta, Pakistan. Follow<strong>in</strong>g this, a project was launched andcont<strong>in</strong>ued for several years on Afghan territory, <strong>in</strong> the town of Herat. It was sadly suspended follow<strong>in</strong>g the death of V<strong>in</strong>cent Gernigon,a young and dedicated physiotherapist, <strong>in</strong> a military clash between resistance and government forces <strong>in</strong> 1989. I would like to dedicatethis work to him, his family and friends.In 2001, <strong>Handicap</strong> <strong>International</strong> resumed its activities <strong>in</strong> <strong>Afghanistan</strong> by sett<strong>in</strong>g up offices and projects <strong>in</strong> different prov<strong>in</strong>ces: Kabul,Herat, Kandahar and Ghazni. Several activities have been developed s<strong>in</strong>ce then, rang<strong>in</strong>g from: physical rehabilitation services, outreachprogrammes, community based rehabilitation, awareness and sensitisation activities and tra<strong>in</strong><strong>in</strong>g of physiotherapists, to m<strong>in</strong>e riskeducation projects and sett<strong>in</strong>g up small Explosive Ordnance Demolition teams. With the NDSA, <strong>Handicap</strong> <strong>International</strong> has takena new step towards improv<strong>in</strong>g understand<strong>in</strong>g of all stakeholders and bridg<strong>in</strong>g the gap of knowledge about the situation of personswith disability <strong>in</strong> <strong>Afghanistan</strong>. The NDSA provides <strong>in</strong>sights <strong>in</strong>to the social, cultural and political mechanisms that make persons withdisability and their families one of the most vulnerable groups <strong>in</strong> the country.The NDSA was launched <strong>in</strong> 2004 to provide stakeholders with the necessary knowledge about persons with disability <strong>in</strong> order toenhance the effectiveness of their action. The overall aim was to design and def<strong>in</strong>e disability programmes <strong>in</strong> <strong>Afghanistan</strong> through abetter identification of the needs as expressed by the people themselves.It has been a challeng<strong>in</strong>g decision to launch a programme that required send<strong>in</strong>g teams of surveyors to a country where securityrema<strong>in</strong>s a constant concern.When the survey started, the Government of <strong>Afghanistan</strong> was <strong>in</strong> the process of sett<strong>in</strong>g the basis for rebuild<strong>in</strong>g public services that hadcollapsed. The ma<strong>in</strong> challenges <strong>in</strong> order to meet the population’s essential needs, were to restore access to healthcare, water supplyand sanitation, hous<strong>in</strong>g, education and employment. However, despite the general belief that “everyth<strong>in</strong>g needed to be done upfront”,our <strong>experience</strong> <strong>in</strong> the field of disability made us aware of the necessity to prioritise actions <strong>in</strong> order to def<strong>in</strong>e a susta<strong>in</strong>able strategyfor persons with disability, based on relevant knowledge and understand<strong>in</strong>g of a complex situation. Our aim was to ensure that therequirements of all persons with disabilities would be taken <strong>in</strong>to consideration and <strong>in</strong>corporated <strong>in</strong>to the proposed set of actions.I would also like to express my gratitude to Dr Frederic Tissot, who supported the project right from the very beg<strong>in</strong>n<strong>in</strong>g and understoodthe importance of such an endeavour. He has met with an unfortunate accident <strong>in</strong> Haiti, after leav<strong>in</strong>g <strong>Afghanistan</strong> and is currently <strong>in</strong>France. The entire team has appreciated his contribution to the NDSA.I hope that the present document will prove to be a relevant and <strong>in</strong>spir<strong>in</strong>g source of <strong>in</strong>formation for policy and decision makers, with<strong>in</strong>the government, the donor community as well as the humanitarian and development actors: all those who are committed to helppersons with disability ga<strong>in</strong> self respect and f<strong>in</strong>d a rightful place <strong>in</strong> the Afghan society.Jean-Baptiste RichardierExecutive Director , <strong>Handicap</strong> <strong>International</strong>, Lyon - Francexii National Disability Survey <strong>in</strong> <strong>Afghanistan</strong> 2005
IntroductionAs the process of reconstruction is currently go<strong>in</strong>g on <strong>in</strong> <strong>Afghanistan</strong>, after over two decades of conflict, the risk of the emergence andwiden<strong>in</strong>g of the gap between those who benefit <strong>in</strong> priority from peace and reconstruction and the marg<strong>in</strong>alised groups of the Afghansociety is becom<strong>in</strong>g a serious concern. Afghans with disability are one of these vulnerable groups, with specific needs and a demandfor a rightful place <strong>in</strong> the new republic.As <strong>in</strong> other countries, persons with disability <strong>in</strong> <strong>Afghanistan</strong> do not make up a homogenous group. Social perceptions of the causes ofdisability lead to social acceptance or exclusion from the community. The physically disabled, and more specifically those disabled fromwar or its consequences (landm<strong>in</strong>es and UXOs), are a fairly visible group: socially accepted and valorised, these persons with disabilityare mostly men and have a strong political voice. The picture is grimmer for women and persons with mental disability. The cause of thedisability be<strong>in</strong>g more difficult to identify, lack of knowledge and awareness lead to social exclusion and rejection. In a context whereresources are scarce and ensur<strong>in</strong>g daily survival is a constant challenge, the ‘hidden disabled’ are not the priority.The National Disability Survey <strong>in</strong> <strong>Afghanistan</strong>, or NDSA, was commissioned to better grasp the various facets of disability <strong>in</strong> thecountry: to better understand those that were visible, and to br<strong>in</strong>g to light those that were often not visible. It aimed to present acomprehensive view of the disability picture <strong>in</strong> the country, a picture that could, <strong>in</strong> turn, contribute to a better understand<strong>in</strong>g andrecognition of the social diversity of persons with disability <strong>in</strong> <strong>Afghanistan</strong>. Some f<strong>in</strong>d<strong>in</strong>gs presented <strong>in</strong> this report were <strong>in</strong> l<strong>in</strong>e withthe outlook of the various partners, others were more unexpected and forced a different approach to reality. The identification of thespecific needs and the understand<strong>in</strong>g of the exclusion mechanisms that slowly but surely marg<strong>in</strong>alise a large part of the populationwith disability, and tak<strong>in</strong>g measures to prevent these, are the first steps to ma<strong>in</strong>stream<strong>in</strong>g and empower<strong>in</strong>g all persons with disability.Knowledge of the social, cultural, physical and <strong>in</strong>stitutional barriers is crucial to fight exclusion. The NDSA attempted to answer thebasic question: why and when does impairment become disability? What are the various mechanisms that trigger exclusion and howcan this be prevented <strong>in</strong> the long run?The NDSA aims to bridge the knowledge gap regard<strong>in</strong>g the number, health, educational and employment situation, livelihoods andsocial <strong>in</strong>tegration of Afghans with disability. Such knowledge is imperative to def<strong>in</strong>e and implement a disability strategy. The results,presented briefly <strong>in</strong> the present Executive Summary Report, attempt to provide strategic planners, adm<strong>in</strong>istrators, organisations ofpersons with disability, NGOs, UN agencies and others the knowledge and tools needed to push forward the agenda of persons withdisability <strong>in</strong> <strong>Afghanistan</strong> and enable them to ga<strong>in</strong> their rightful place.The Executive Summary Report presents a brief view of the methodology and results of the NDSA. The first section looks at sampl<strong>in</strong>gmethods and field realities. The follow<strong>in</strong>g sections look at the major f<strong>in</strong>d<strong>in</strong>gs related to the ma<strong>in</strong> fields of the survey: health, education,employment, and livelihoods. The last section relates to social participation and marriage.Introductionxiii