Recommendations

Based on its findings and guided by the provisions of Article 19, the report makes the following recommendations.

Deinstitutionalization plans with concrete timelines, budgets and sources of alternative should be adopted. The guidance of the UN Committee on the Rights of Persons with Disabilities recognizes that while the implementation of Article 19 is an urgent human rights priority, its full realization requires structural shifts that may need to be taken in stages.[1] This concept of progressive achievement is particularly relevant to countries in the Arab region, in which the immediate and complete closure of all institutions may not be feasible for reasons related to war and conflict, poverty, inaccessible infrastructure and weak social protection systems. However, to meet the requirements of Article 19, even states facing these challenges must actively plan for deinstitutionalization through increasing the accessibility of community services and creating new systems of local personal assistance, with the end goal of ending the use of residential institutions. The exact pathways taken by States to achieve this final result may differ, but according to the CRPD maintaining the status quo of institutionalized care is not an option. At every stage of the deinstitutionalization planning process, States should actively consult with civil society, seeking the opinions of persons with disabilities and their representative organizations. Especially countries coming out of violent conflict should design reconstruction in a way that facilitates the inclusion of persons with disabilities in their local communities.

Our understanding of the extent and scope of institutionalization needs to improve. Further in-depth research and data collection are needed to concretely identify the numbers and types of residential institutions in the Arab world, as well the profiles of institutionalized persons with disabilities and the quality of care they receive. In many cases, the available data does not allow for a solid understanding on which strategies can be built. The available information on Lebanon indicates that almost half of the children receiving free education or vocational training at the residential schools are formally registered as “residential” although they return to their families in the evening.[2] Robust and reliable statistics on institutionalization are needed to fully evaluate progress made by Arab States in their implementation of Article 19, and to inform deinstitutionalization plans and policies.

Throughout transitions to community-based services, improved monitoring and regulation are necessary to ensure existing residential institutions provide high quality care. While states plan for and implement alternatives to residential institutions, steps must be taken to ensure persons with disabilities currently living in institutions are protected, supported, and listened to. Governments must actively monitor and regulate all operational institutions, identifying barriers to residents’ autonomy and facilitating necessary improvements in the provision of care and services while keeping larger goals of independent living in mind.

More inclusive, better-quality and individualized support services for persons with disabilities are needed at the local level. In addition to ensuring hospitals, schools, recreational and commercial spaces, transport, employment support, etc. are accessible to people with disabilities, home and community-based support services can make caring for individuals with disabilities less costly and lessen the pressure on families to send family members to institutions, which are often located in bigger cities. This can include subsidized personal assistance and assisted living programs, medical equipment, adaptation of the home environment and individualized rehabilitative care.

Governments should redirect state resources away from institutions to directly supporting persons with disabilities and their families. Currently, many Arab countries provide financial support to public and non-profit institutions, and some subsidize care in private residential centers. Individuals with disabilities from disadvantaged socioeconomic backgrounds are more likely to end up spending their lives in residential institutions since support services maybe be expensive, difficult to obtain or far from home. This study recommends that as part of deinstitutionalization plans, governments redirect their financial support away from residential institutions and to persons with disabilities and their families or caregivers, in addition to improving the provision of necessary facilities and services within communities. Additionally, making the provision of community-based services for persons with disabilities an identifiable budget item also contributes to the coordination of Article 19’s implementation.

Education and employment are two essential means to ensure the inclusion of individuals with disabilities in society. Inclusion in the mainstream education system and workforce are important ingredients for inclusion in the community. Investing in inclusive education and implementing/upholding inclusive labour laws, policies and programmes will boost the intellectual and financial independence of persons with disabilities, thus reducing isolation and promoting independent living and participation in society. The existing numbers in the case of Lebanon suggest that most of the children holding a Personal Disability Card do not attend integrated public schools. [3]This raises serious concerns about the whereabouts of children who hold a Personal Disability Card and their access to education and their future participation in the labour market.

Accessible transportation can help individuals remain in their communities. Even when institutions offer non-residential programs, inaccessible transport services, high transportation costs and logistical difficulties force many families to place their relatives in institutions full time. In addition to establishing more facilities and services at the local level, ensuring access to accessible, affordable and efficient transportation will allow individuals to seek specialized care, education and employment outside of their communities while maintaining their residence of choice.

Mitigating stigma surrounding disability will help support social inclusion. Negative depictions of individuals with disabilities in public culture reinforces the separation and exclusion of persons with disabilities from society. Public education campaigns can help fight stereotypes and portray positive images that fight the stigma and shame surrounding disability. Governments can enlist the help of civil society organizations and media groups to identify discriminatory stereotypes and reinforce more equitable norms that advance social inclusion.

Finally, the study found that the majority of public officials were pro-deinstitutionalization while directors of institutions often maintained that their role was to protect persons with disabilities from society. Further dialogue is needed between government officials and institutions on how institutions can support the transition away from segregated residential care and become establishments that continue to provide specialized services while fostering independent and community living. In many instances, residential institutions are the only entities available to persons with disabilities that have the capacity to provide specialized services, so rather than simply shuttering them, they could be redesigned in a way which replaces institutionalized care with day-service facilities that support the principles outlined in Article 19.

This report comprises five chapters. The first chapter presents an introduction to the study in addition to some recommendations. The second chapter describes the methodology deployed in this study and its limitations. The third chapter presents the empirical findings of the interviews with public officials and heads of institutions. The fourth chapter presents the findings of the case studies. Finally, the fifth chapter presents a conclusion of the study and recommendations for the way forward.