Chapter 1: Introduction

States Parties to the present Convention recognize the equal right of all persons with disabilities to live in the community, with choices equal to others, and shall take effective and appropriate measures to facilitate full enjoyment by persons with disabilities of this right and their full inclusion and participation in the community, including by ensuring that:

1. Persons with disabilities have the opportunity to choose their place of residence and where and with whom they live on an equal basis with others and are not obliged to live in a particular living arrangement; 
2. Persons with disabilities have access to a range of in-home residential and other community support services, including personal assistance necessary to support living and inclusion in the community, and to prevent isolation or segregation from the community;
3. Community services and facilities for the general population are available on an equal basis to persons with disabilities and are responsive to their needs.

—UN Convention on the Rights of Persons with Disabilities (Article 19)

There is no single set definition for disability, though recent years have seen a confluence of several analytic models that have informed how disability is understood in society. For a long time, a dominant model was the medical model of disability, which assumes that disabilities and impairments must be “fixed” through rehabilitation and medical treatment .[1] By presenting disability as an ailment to be cured, the medical model positions life with disability as outside the norms of human functioning, ultimately dividing persons with disabilities from persons without disabilities.

Today, a transition away from the medical model of disability has opened the door for reflection on the practice of institutionalization. In general, institutions for people with disabilities often operate by restricting residents from participating in the outside community and giving them little to no choice about their activities and how they are treated.[2] Even institutions that are well-monitored and regulated can lead to exclusion and deprive people with disabilities of their freedom and ability to interact with society an equal basis with others.

The institutionalization and the time people with disabilities spend in institutions are often strong indicators of negative psychosocial impact.  If persons with disabilities must conform with a pre-planned, non-individualized schedule, and are subjected to prolonged periods of isolation, they may suffer psychosocial distress and deterioration: institutionalization can diminish autonomy and self-confidence, worsen mental health conditions, provoke negative and self-damaging behaviors, and cause attachment problems and distorted relationships, making it more difficult to live in society.[3]

Deinstitutionalization movements globally have stemmed from negative perceptions of the effects of institutions on the physical and psychosocial condition of persons with disabilities, as well as from baseline objections to the practice of excluding persons with disabilities from society. Within the deinstitutionalization movement, two main camps have emerged. Some countries, such as the United States, have chosen to transform existing residential institutions into community health centers.[4] Civil society has long been critical of this strategy, calling instead for the complete closure of institutions and the creation of new structures for providing personal assistance and services.

Regardless of the chosen approach, many countries have advanced in supporting community-based models of individualized care. Yet only modest progress has been made on this front in many Arab countries, despite 21 out of 22 having signed and/or ratified the Convention on the Rights of Persons with Disabilities.[5] [6] Much more needs to be done to integrate persons with disabilities into society, challenge cultural stigmas surrounding disability, and expand the services needed to allow persons with disabilities to live and actively participate in their communities.

Persons with disabilities in the Arab region face substantial disadvantages in key areas of human development, creating further barriers to integration and inclusion. They have lower rates of literacy, educational attainment, school attendance and economic participation and continue to be marginalized from the education system and the labour market.[7] For example, most schools in Lebanon still exclude children with disabilities, including through inaccessible school premises, and inappropriate school curricula and teaching methods.[8] Some progress, however has been achieved by including children with learning difficulties in about 30 schools in Lebanon.

When considering the issue of deinstitutionalization in the Arab region, it is important to note that the social inclusion of persons with disabilities has not been mainstreamed in most Arab countries – cities are not accessible, schools are not inclusive and specialized services for persons with disabilities are often available only in institutions. Without options available at the local level, persons with disabilities and their families often have no other choice but to turn to institutions to meet their needs.