Conclusion

Drawing primarily on data collected from NSOs and to a lesser extent on data from complementary sources, this analysis has tried to shed light on the issue of disability in the Arab region. Basic demographic factors as well as socioeconomic ones have been considered.

Countries in the region have clearly made great strides towards increasing the availability and enhancing the quality of disability-related data. The most important indication of this progress is the number of countries that have adopted, or are in the process of adopting, the standards recommended by the Washington Group.

However, as this report shows, substantial limitations concerning data availability and quality remain. Consequently, the report contains no or almost no data for several ESCWA member States. Collaboration between ESCWA and the NSOs has not yet yielded any data pertaining to a number of socioeconomic indicators, including income, poverty rate and social protection coverage. 

The results also show that further standardization in terms of how data are collected is required to enable more reliable country comparisons. In particular, the striking differences between national disability prevalence rates – although in part explainable by factors such as diverging age compositions – suggest the need for continued methodological harmonization. For instance, some countries using the WGSS exclude the domain of self-care, and persons with disabilities living in institutions may be overlooked by censuses and surveys.

Other factors undermining the reliability of the data include the underreporting that may come about due to the stigma attached to disability, which may vary from context to context and depending on factors such as age and gender. Though remedying such complex problems is highly challenging, sharing experiences between NSOs and other involved actors has the potential to facilitate the identification of effective solutions.

The collaboration of NSOs and international organizations, including ESCWA, should be expanded and consolidated to further improve data quality and sharing. Producing more thoroughly disaggregated data should be a primary objective guiding such collaboration. As the analysis has shown, access to age-disaggregated data on literacy and educational attainment would have made it more feasible to draw conclusions about how much progress has been made in these areas among persons with disabilities. 

Given the limitations mentioned above, the evidence from this analysis should be seen as merely indicative. Even so, it clearly suggests that persons with disabilities in the region still face substantial disadvantages in key areas of human development. Compared to the general population, they have lower literacy, lower educational attainment and lower school attendance. Their economic participation remains weak. Preliminary results from selected national surveys show that their households must spend more on health care. 

These challenges are by no means unique to Arab societies: the existing literature has shown a strong link between disability and multiple dimensions of poverty. Disability can be both a cause and a consequence of poverty. It reduces the ability to work in traditional settings and entails direct costs which can lower standards of living. Conversely, poverty causes multiple forms of deprivation - from inadequate nutrition to lack of access to health services, to exposure to dangerous living and working conditions - all of which heighten the risk of impairments and disability.[1] However, the available data indicate minimal or no differences between persons with and without disabilities regarding access to basic services such as piped water and electricity.

Overall, disability remains one of the most overlooked yet significant sources of disadvantage and marginalization. Where it intersects with gender and location, it leaves girls and women with disabilities in rural areas particularly vulnerable. The fact that persons with disabilities are affected by gender and location as well as by disability underlines the need to implement the 2030 Agenda as an integrated package, so that efforts to overcome different types of inequalities are carried out in concert.

Importantly, the multidimensional approach should not be over-simplified, as the data presented above also indicate that the relative impact of each dimension varies. In one context, gender may be more significant than location, meaning that women with disabilities (rural and urban alike) are more vulnerable than other groups, whereas elsewhere the opposite may be true, meaning that persons with disabilities in rural areas (women and men alike) are more vulnerable. Furthermore, there are many additional potential dimensions of vulnerability, including age, ethnicity, religion and displacement,[2] though data on these are even more limited.

These issues are gaining more attention in the Arab region, where the prevalence of disability is likely to rise in the coming decades due to the ageing population as well as the impact of ongoing conflicts. Countries in the region have shown a growing commitment to advancing the rights and well-being of persons with disabilities by enacting internationally recommended legislation. The SDGs and its GFI can also be important tools for governments implementing and evaluating programmes and policies, as well as for advocacy groups pushing for disability issues to be prioritized in the development agenda. Disability must be integrated as a cross-cutting perspective involving all aspects of human life and throughout the life cycle.

The area of education is a highly promising ground for change. Progressive models of education can combat stigma, exclusion and isolation when children are in the most formative years of their lives. Education has also been shown to be a key poverty-reducing factor. It is encouraging that more countries in the region are now exploring integration and inclusion in mainstream facilities, notably through teacher training and the creation of resource rooms.[3] Investment is needed for school adaptations such as physical accessibility, accessible teaching and materials, in addition to establishing other support systems. Such adaptations have the potential to benefit all students, not just those with disabilities. The cost would be partly offset by no longer needing to provide a parallel system of special schools for children with disabilities. Allowing children with disabilities to go to school near their residence could also relieve some of the burden on their families, who would not have to provide transport to special schools or pay for their children’s accommodation at these schools.

While education for children and youth with disabilities is critical, a large number of adults with disabilities are still illiterate. More disability-specific interventions will be needed to reach this group.   

Decent work is another key area for persons with disabilities to gain autonomy and participate in society. It is the most direct way for them to fulfill their own needs and to contribute to their families and society. Quality education can facilitate their entry to the labor market by equipping them with marketable skills and a wider network for career opportunities. However, it is also necessary to overcome the environmental and attitudinal barriers that hinder persons with disabilities’ access to employment. Many countries in the region have expressed keen interest in new initiatives to break through these barriers, such as establishing disability and business networks and offering employers disability equality training that dispels misconceptions and stereotypes and encourages behavioral changes in recruitment and retention of employees with disabilities.

The concept of decent work, as defined by the ILO, encompasses among other things a fair income, workplace security and social protection coverage. In Arab countries, where most employment is informal, ensuring that these criteria are met constitutes a considerable challenge requiring comprehensive strategies. Efforts to overcome the distinct disadvantages faced by persons with disabilities in the labour market should not be undertaken in isolation, but should be an integral part of the wider strategies aiming to enhance the accessibility and decency of work overall in the region.

In the dimension of health, the exploratory analysis of the limited data available reinforces evidence pointing to the inadequacy of health care services for persons with disabilities in terms of provision and cost.[4] Persons with disabilities face several layers of disadvantages: they have greater unmet needs and a higher risk of developing secondary conditions and multiple medical issues, yet they are more at risk of exclusion from public health initiatives. They also encounter barriers to care in all aspects of access –from availability of required services, to accessibility in terms of time and distance, affordability, appropriateness of health care providers’ skills and services rendered and accommodation at health facilities.[5] Poor health can have negative downstream effects on education and work, since it can lead to impaired cognitive skills and physical conditions. Ensuring that community-wide services already in place – such as feeding, immunization, screening and sexual and reproductive health programmes – are disability-inclusive should be a priority. 

The availability of accessible infrastructure, corresponding to Article 9 of the Convention and SDG 11, is indispensable for realizing the human rights of persons with disabilities, including the right to education, work and health care. For example, ensuring that school and hospital facilities are made accessible and that the personnel have received appropriate training will not serve any purpose if persons with disabilities are not able to reach these services in the first place. Once again, this illustrates the interdependence of the Convention provisions and the SDGs and their targets.

Technological innovations, such as stair-climbing wheelchairs, digital Braille readers, communication devices controlled by eye movement and robotic prosthetics can enable persons with disabilities to overcome many of the barriers that hinder them from leading autonomous lives and participating in society on an equal basis with others. This is increasingly recognized in the Arab region. For example, in November 2017 the UAE hosted the AccessAbilities Expo, which brought together governments, private companies, NGOs, investors, medical institutions and caregivers to exhibit new technologies aiming to enhance accessibility.[6]

However, for a very large number of persons with disabilities in the region, even basic assistive devices, such as electric wheelchairs, are neither available nor affordable. Even if they were, their utility would in many contexts be limited due to the inaccessibility of streets and public transport or an unreliable supply of electricity. Governments and other stakeholders should strive to enhance the usage of existing technological solutions and encourage the development of new ones. Furthermore, the wider environment must be made accessible and adapted to make technological solutions useable. This should be remembered not least in post-conflict reconstruction processes.

As the well-known slogan of the disability movement declares “nothing about us without us”, political participation and representation is vital to the realization of equal rights and opportunities for persons with disabilities. They have the capability to decide what is best for them and to articulate their needs and preferences, and they should have the power to do so. The right to full and effective political participation is recognized in Article 29 of the Convetion and in SDG 16. Some countries, such as Egypt and Tunisia, have mandated the inclusion of persons with disabilities in candidate lists in elections at municipal or parliamentary levels. However, data on participation and representation are very limited.

Most countries in the region have established some kind of national body to coordinate disability issues and monitor the implementation of the Convention. Many of these bodies include persons with disabilities (see the country profiles). However, whether such representation does in practice lead to empowerment is difficult to gauge.

Inclusive societies benefit all groups and individuals. Strong arguments for greater inclusion of persons with disabilities have been proven in cost-benefit analyses.[7] Greater labor participation by persons with disabilities can increase earnings and productivity as well as broaden the tax and consumer base. Disability-inclusive policies can also be seen as a form of insurance, since disability can be experienced by anyone and since the burden of disability often falls on the family and the wider society. Furthermore, the whole of society benefits from inclusion principles and practices, not just persons with disabilities. Universal designs reduce barriers for people of different sizes, older persons, pregnant women and others with temporary impairments. Inclusive education facilitates better outcomes for children with different learning needs. Most fundamentally, it is a matter of human rights. What persons with disabilities demand – inclusion, equality, and non-discrimination – are universal rights that should be accorded to all in a just society.