Handicap International experience in Afghanistan - CBM

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Comparing the situation between males and females concerning the symptoms of anxiety and depression, wefind even sharper disparity than for violent behaviour. This is in line with the findings of other surveys 21 . Whilethe highest proportion of men with disability is 38.9% for “feeling suffocated”, the proportion of the same is70.1% for women with disability. Similarly, for four of the parameters, the proportion for men is about 30%,whereas for women these figures are above 50% : “feel sad/cry” (59.8% for women as compared to 30.2%for men), “sit and think” (50.4% compared to 34.9%), “feeling of oppression” (54.5% compared to 36%),“feeling of suffocation” (70.1% compared to 38.9%). These signs are particularly characteristic of depressionand show the distressing mental health situation of women with disability in the country. These results aresimilar to those found by the CDC survey held in the Nangarhar province of Afghanistan in 2002, which showthat all the trauma exposures were translated into significant scores for anxiety and depression 22 .Figure 15. Distribution of Persons with Disability above 14 ShowingDepression or Anxiety Signs and by Gender80• Females • Males706050403020100Want to StayLocked UpFeel Sad/CryNot FeelHungryFeel AfraidSit and ThinkWant to LiveElsewhereRapid MoodChangesFeelOppressedFeelSuffocatedFeel Angry/ResentfulThe statusof women inAfghan society ischanging. Due toa breakdown offamily structuresand migration tocities, the role ofmen as providersand protectors isno longer a givenThe higher proportion of women with depression and anxiety signs results from a combination of factors.First of all, because of disability, their social status, valorised by the ability to get married and become amother might be suddenly jeopardised by a disabling event, thus resulting in lowered self-esteem 23 .The status of women in Afghan society is changing. Due to a breakdown of family structures and migration tocities, the role of men as providers and protectors is no longer a given. As a result, a number of women haveto earn a living and step out of the houses in a context, which can be hostile and challenging.Last but not least, they have also suffered the war and its consequences. Among displaced persons due to war,women and children represent three quarters of the massive exodus of millions of people 24 . They were alsovictims of violence, experiencing and witnessing loss and mistreatment as well as lack of security and basiccommodities: all this can have resulted in psychological trauma and distress.21RASEKH Z. et al. (1998), JAMA, op. cit.22SCHOLTE W.F., et al. (2004) JAMA op. cit.23MEEKOSHA H. (2004),“Gender and Disability”, Encyclopedia of Disability, Sage.24BHUTTA Z. A. (2002),“Children of War: the real casualties of the Afghan Conflict”, British Medical Journal, 324: 350.26 Understanding the Challenge Ahead
Health ServicesThis section presents the findings with regard to the access and use of health services. Questions were askedregarding the access, expenditure and barriers faced within the existing facilities. Figure 16 reports theresponses of persons with disability and the non-disabled according to the two main types of health servicesavailable. The results show that the persons with disability and non-disabled have similar responses:• 51% persons with disability and 54.3% non-disabled report having a health centre available;• 68.3% and 67.1% respectively report having a private clinic or doctor available;• 32.4% and 30.5% respectively report having a hospital available.Figure 16. Types of Health Services Available According toPersons with and without Disability60• Persons with Disability • Non-Disabled50403020100Health Centre Hospital Pharmacy/ChemistPhysiotherapy and/orOrthopaedic CentreFemale HealthProfessional AvailableIf we consider the frequency of use of services in the year preceding the survey, a high percentage of nondisabledpersons (31.2%) have been to health facilities only once. The majority (52.5%) of persons withdisability went to the health facility at least twice during the one year period considered. There are threemain hypotheses explaining this result, the first being that persons with disabilities undergo ailments morefrequently than the non-disabled, requiring that they go to a health facility for treatment more often. Thesecond is that they hope to find some new treatment for their impairment. Thirdly, persons with disabilitiesreturn to the facilities multiple times due to the need to repeat treatment. Regardless of the reasons, personswith disabilities visit facilities more frequently than those without disability.Lastly, the NDSA analysis shows that persons with mental disability and those having epilepsy/seizureproblems use traditional cures (bone-setter, mullah, religious persons…) more often, hoping to find a curefor their problems. 26.1% persons with disability used traditional and religious cure in the past year. Of thosewho used a traditional or religious cure, 65.7% visited a mullah, while 25.7% went on a pilgrimage or dida special prayer.Barriers to Accessing Health Care and ServicesThe health system is under reconstruction in Afghanistan. Considerable efforts have been made since 2002to provide access to facilities in the entire territory. Nevertheless, many gaps remain, especially for treatmentof disability: lack of trained medical staff is a major challenge for public planners. This section gives a quickoverview of difficulties linked to health services. For a more in-depth analysis, one can refer to the surveycarried out by the Ministry of Public Health and Johns Hopkins University Third Party Evaluation Team 25 .Persons withdisabilitiesundergo ailmentsmore frequentlythan the nondisabled,requiring thatthey go to ahealth facility fortreatment moreoften25See MINISTRY OF PUBLIC HEALTH and JOHNS HOPKINS UNIVERSITY (2005), Report on Health Seeking Behaviour, HealthExpenditures, and Cost Sharing Practices in Afghanistan, Kabul, 60 pp.The Health Picture27
Page 3 and 4: Islamic Republic of AfghanistanUNDE
Page 5 and 6: ContentsAcknowledgementsAbbreviatio
Page 8: Figure 25 : Retention, Transition a
Page 11 and 12: AbbreviationsAFAs : AfghanisBPHS :
Page 13 and 14: PrefaceThe National Disability Surv
Page 15: IntroductionAs the process of recon
Page 18 and 19: Figure 1. Sampling Stages of NDSA1s
Page 20 and 21: A variety of subjects and fields ad
Page 22 and 23: • Beliefs and expectations of wha
Page 24 and 25: Prevalence Threshold with Regard to
Page 26 and 27: The proportion of persons with disa
Page 28 and 29: Mental disability shows a much more
Page 30 and 31: The effectiveprevalencerate of seve
Page 32 and 33: to a maximum of 37.4% unable to coo
Page 34 and 35: Table 3. Proportion of Persons with
Page 36 and 37: Table 4: Proportion of Persons with
Page 38 and 39: Figure 9. Distribution of Persons w
Page 40 and 41: Figure 12: Distribution of Persons
Page 44 and 45: Figure 17. Number of Visits to Heal
Page 46 and 47: Table 5: Yearly Average Expenses (A
Page 48 and 49: 32 Understanding the Challenge Ahea
Page 50 and 51: A crucial aspect that influences ac
Page 52 and 53: Table 6 highlights the advantage th
Page 54 and 55: Figure 26: Retention, Transition an
Page 56 and 57: to take this into consideration whe
Page 58 and 59: • Boys with physical disability a
Page 64 and 65: to others: usually they benefit fro
Page 66 and 67: Figure 37: Distribution of Active P
Page 70 and 71: According to NRVA 2003, poverty is
Page 72 and 73: means that the average living space
Page 76 and 77: Figure 46: Distribution of Househol
Page 80 and 81: The inability tobear children is am
Page 82 and 83: The situation is somewhat different
Page 86 and 87: 706050• Landmine/UXO Survivors•
Page 88 and 89: ConclusionInclusion is a major fact
Page 90 and 91: of persons with disability 48 . Thi
Page 92 and 93:
GHOSH N., MOHIT A., MURTHY R.S. (20
Page 95:
The National Disability Survey in A
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Handicap International experience in Afghanistan - CBM

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