Disability Definition and Determination

In large part as a consequence of the global disability movement’s achievements during recent decades, it is increasingly recognized that disability should be understood as an effect of the interaction between individuals and their environment. To enable the adoption of such an interactive model, the World Health Assembly in 2001 approved the International Classification of Functioning, Disability and Health (ICF). The ICF “provides a standard language and a conceptual basis for the definition and measurement of health and disability” incorporating components relating to body function; body structure; activities and participation; and environmental factors. It thus facilitates the transition from the medical model, which focuses solely on impairment at the individual level, towards an interactive understanding of disability, which should inform the implementation of both the CRPD and the 2030 Agenda.

The legislative frameworks of Arab countries increasingly incorporate definitions of disability which are not based solely on the medical model, but which are more aligned with the interactive approach of the CRPD and the ICF. For instance, according to Kuwait's law no. 8 of 2010, a person with a disability is “[o]ne who suffers from permanent, total, or partial disorders…that may prevent him/her from securing the requirements of life to work or participate fully and effectively in society on an equal basis with others.”[1]

Tunisia’s law 2005-83, like the ICF, mentions ability to perform daily activities: “A person with a disability is any person who has a permanent impairment…that limits his ability to perform one or more basic daily, personal or social activities and that reduces the chances of his/her integration into society.”[2] Morocco’s law 97-13, following Article 1 of the CRPD, quite explicitly points to the causal link between the environment and the impairment, defining a person with a disability as “[a]ny person presenting, in a permanent way, a limitation or restriction…whose interaction with various barriers may impede his/her full and effective participation in society on an equal basis with others”.[3]

In the regulations of social insurance schemes, disability is typically coupled with work inability. According to the disability pension eligibility criteria in Egypt, for instance, a worker “[m]ust be assessed with a total or partial disability and permanent incapacity for any gainful employment”.[4] The work inability requirement is also common in social assistance and health insurance programmes. Algeria’s La Pension Handicapée à 100%, for example, is restricted to those who have a disability “entailing a total incapacity to work”.[5] In Morocco, SHI coverage extends to family members, including adult children with disabilities “who are totally, permanently and definitively unable to engage in gainful employment”.[6] RAMED includes an almost identical provision.[7]

The identification of disability with inability to work may be problematic if environmental factors are not sufficiently taken into account. Persons with disabilities may be perfectly able to work in productive employment if the workplace is accommodated to their needs. For example, screen readers and similar equipment may enable blind people to perform office functions, and barrier-free buildings can facilitate the participation of wheelchair users. New technological inventions and innovations continuously enhance the possibility to make the working environment more accessible, but they may not be harnessed towards this end if persons with disabilities are from the outset presumed to be inherently incapable of working. It is therefore important that disability assessments are conducted taking into account environmental as well as medical factors.

Typically, a person applying for a social protection benefit on the basis of having a disability needs to submit a medical certificate (and, in most cases, a number of other documents) to a designated body. In Jordan, for instance, the Central Medical Committee determines disability status for the purpose of the country’s main social insurance scheme.[8] In Egypt, the Medical Commission evaluates the disability status of Karama applicants.[9] To the extent that information is available regarding the nature of these medical certificates and how the bodies in question evaluate them, there seems to be some variation concerning the degree to which social and environmental factors, in addition to strictly medical ones, are taken into account.

In Tunisia, the medical form to be handed in by disability card applicants to the Regional Commission for Persons with Disabilities, which evaluates such applications, incorporates the ICF factors related to activities and participation. For instance, under the category of “domestic life”, the doctor submits with how much difficulty (if at all) the applicant can perform the daily tasks of shopping, cooking, and undertaking housework.[10] In the State of Palestine, for comparison, applications for disability pensions and the disability status of PNCTP applicants are evaluated by committees which seem to adhere more closely to the traditional medical model.[11]

Overall, countries seem to be slow in adapting their assessment mechanisms to the ICF. This is understandable considering the complexity of the issue, the problems related to obtaining sufficient information about the individual’s environment, and the fact that no standard guidelines for managing the transition are currently available. ESCWA has worked with the National Council for Persons with Disabilities of Sudan to review the current assessment mechanism in the light of the ICF, and some Arab countries such as Morocco and Jordan are currently working with the WHO on finding solutions.

It appears, as mentioned above, that definitions of disability frequently differ not only between countries, but within them as well. In Iraq, for instance, different ministries reportedly use different definitions.[12] In Egypt, “[t]here is no consistency between the eligibility criteria used in the various social protection programs due to the multiplicity of definitions of disability. For example, there is a definition according to the Rehabilitation Act and there is a definition according to the Social Security Act in addition to the multiple medical assessments and classifications used.”[13] In those cases where social protection programmes are targeted on the basis of disability, these shortcomings in terms of how disability is defined and determined can make the difference between inclusion and exclusion.