Disability Assessment

Syrian refugees
KRG-IRAQ
2014


WORLD HEALTH ORGANIZATION






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World Health Organization
Erbil Office- Iraq

Table of Content Page No

I. Preface

II. Acknowledgement

III. Executive Summary

IV. Goal & Objectives

V. Background Information

VI. Methodology

VII. General Findings

VIII.I Erbil Camp

- Kawergosek

- Dara Shakran

- Basirma

- Qushtapa

VIII.II Duhok Camps

- Gawilan

VIII.III Sulemaniya

- Arbact

IX. Conclusion

X. Limitation of the Study

XI. Recommendations

XII. Annex

3
4
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World Health Organization
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Preface

The Word Health Organization Erbil Office in Iraq is pleased to publish this
disability assessment comprehensive report on Syrian refugees in order to
develop a realistic and feasible intervention plan to mitigate the suffering
of the displaced disable Syrian refugees and improve their quality of life.

Since Syrian war started in 2011, more than 2.5 million people have fled
their homes and took shelter as refugees in the neighboring countries
Turkey, Lebanon, Jordan and Iraq. As per United Nations High
Commissioner for Refugees (UNHCR) 222,574 people registered as Syrian
refugees as of Feb 10, 2014 and among those 95,487 (42%) took shelter in
the 9 camps in 3 Governorates of Kurdistan region of Iraq.

A descriptive rapid assessment was conducted in the 6 camps of Kurdistan
regions by the WHO hired surveyors who was frequently supervised by the
WHO Technical Officer responsible for the camps. The findings of the
assessment have given an estimation of the magnitudes of the disability,
severity, types, demand and unmet need of the Syrian refugees.

The results of the disability assessment survey will pave the way to
undertake a realistic, feasible and sustainable solution related for WHO-Iraq
which will ultimately reduce the suffering and ensure positive health
among all the disable Syrian refugees residing in the camps of Kurdistan
region in Iraq.


Dr. Syed Jaffar Hussain
Representative and Head of Mission
World Health Organization, Iraq




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World Health Organization
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Acknowledgement


This document has been developed by the World Health Organization Erbil
Office in Iraq. I would like to convey my sincere gratitude to the DOH
(Directorate of Health) in Kurdistan Region to extend their support to
accomplish this disability assessment in their Governorates.

I am also equally thankful to the Camp and Sector Managers and the
interviewers who were actively involved in the registration and data
collection process throughout the disability assessment processes.
My special thanks to WHO Technical Officers and Program Assistants who
worked in this assessment for their active participation in developing
protocol, designing questionnaire, close monitoring and supervision, data
entry, analysis and prepare this evident based valuable documents to guide
WHO-Iraq to develop a realistic, feasible and timely action plan for the
Syrian disable refugees in the camps in Kurdistan region in Iraq.















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The reporting Assessment team included:

Dr. Noor Al-Alwan /Technical officer (WHO) Erbil,
Mr. Saad Al-Dahwi / (WHO) Program assistant,
Ms. Noor Sabah / (WHO) Program assistant

The Disability Assessment in Iraq-KRG is supervised by:
Eng. Mohammed Hamasha/officer in Charge for WHO Erbil Office.

Special thanks to Dr. Hussain Mustafa Manna /WHO Consultant _Polio
For his assistance in preparing this report

Special thanks are extended to the people who assist in collecting Data in
the camps:

Dr. Shokan Mohammed/Technical officer (WHO) Sulaymanniyah
Dr. Mohammed Jasim /Technical officer (WHO) Duhok,
Ms.Dalal in Kawergosek Refugee Camp.
Ms.Amina & Ms.Reem in DaraShakran Refugee Camp.
Mr.Satar in Basirma Refugee Camp.
Mr.Sabah in Qushtapa Refugee Camp.











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World Health Organization
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Executive Summary
More than 2.5 million Syrians have fled their homes since the outbreak of
civil war in March 2011, taking refuge in in the neighboring countries Iraq,
Lebanon, Turkey, and Jordan. Among the total displaced population,
222,574 IDP have taken their shelter throughout Iraq and 95,478of them are
in the camps of Kurdistan region which represent 42% of the total Syrian
refugees in Iraq. It can be said another ways that UN agencies are giving
their support to about 50% of the IDPs through establishing 9 camps in 3
Governorates in the Kurdistan region of Iraq.

As the War escalated and number IDPs gradually increased since February 2012,
there was an assumption of more casualties leading to high number of disability
among the Syrian refugees. Bearing in mind of this assumption, WHO Erbil Office
in Iraq decided to conduct a Disability assessment survey to determine the
number, categories, required assistive aids and other health care needs to
improve the quality of life and make disables self depended in the daily
activities. To accomplish this goal, Disability assessment survey was conducted in
6 camps among 473 registered disable individuals.

The study shows that highest numbers of disability are in Dara Shakran (151) and
lowest in Gawilan (47) and in the other 3 camps, the numbers are almost the
same (60-67). While analysis made based on disability versus individuals, it has
been observed that proportions of disability are higher (2.5%) in Dara Shakran
camp and lower in Kawergosk camp (0.6%). The disability further segregated by
categories which shows that significant proportion of disability is due to
movement (47%) followed by visual (19%). Among 4 categories of age groups,
15-45 years (51%) are affected more than any other age groups and male (61%)




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are affected more than female. When analysis made based on origins of
disability, it shows that disability acquired on origin are higher in Arabat (78%),
Qushtapa (77%) and Gawilan (60%). As per as Assistive Aids are concern, 50% of
the disable people have assistive aids in Arbat and 5% in Qushtapa while in the
rest 3 camps it is within the range of 15-22%.

Although estimated 20% of the registered disables couldnt be interviewed
because they might refused to register as they have feeling of disappointment
for neglected their requests and requirements for several times beside the
possibility of not being exist in the camp during the assessment ,or because
continuous influx of Syrian to KRG. however the study ended well within 80% of
the disables and gave some valuable information which will be helpful to make
a quick intervention plan for the disable people to mitigate their suffering and
make them self dependent in their daily activities and open an window of
opportunity to involve them in the income generation in his/her family.


















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Goal
To improve the quality of life and make self dependence of the Syrian disables
refugees through providing necessary assistance.


Objectives:

1. To collect descriptive data of the disable individuals in order to determine
their need;
2. To determine the disability types to procure adequate number of devices
to be distributed;
3. To find any coexisting diseases in order to treat and fulfill addition demand
and create satisfaction on health service delivery;


















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Background

Since Syrian war has started in early 2011 more than 2.5 million people fled
their homes and took shelter as refugees in the neighboring countries
Turkey, Lebanon, Jordan and Iraq. Yet the actual number of the refugees
in these countries would be much higher perhaps double than UNHCR
statistics since their statistics only based of the registration who took shelter
in the camps. As per United Nations High Commissioner for Refugees
(UNHCR) 222,574people registered as of Feb 10, 2014 and among those
95,478 (42%) have taken shelter in the 9 camps in 3 Governorates of
Kurdistan region of Iraq. More than 50% of the Syrian refugees who fled
Syria are now outside of the 9 refugees camps and have merged with the
local inhabitants in Kurdistan region and other Governorates in Iraq. Of the
total Syrian refugees residing in the camps significantly (61%) are in Domiz
camp of Duhok followed by camps in Erbil and Sulaymaniyah.

Various organizations of the United Nations, Government, Local Authority
and international community have come forward to support Syrian
refugees and to meet their basic needs to maintain a healthy life through
providing healthcare services, education, sanitation & hygiene, safe water,
foods and non-food items, shelters and psycho-social support.

World Health Organization estimates that 15% of the individual are
affected with any kind of disability within the total population; however this
rate would be significantly higher among the displaced population in the
situation of war. Due to sudden set back of their socio-cultural-economic
status most of them couldnt cope with the camps environment and take
shelter outside the camps and merge with the permanent inhabitants.




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Those who have severe form of disability and dont have a caregiver
couldnt come out from their tents to receive medical service and to get
their basic needs. These group of people are more vulnerable to get
diseases and acquire varies form of mental illnesses.

Being a technical organization on Health in the United Nations, WHO Erbil
Office has felt the necessity of doing disability assessment among the
Syrian refugees residing in the camps in order to know the magnitude of
the disability, their types, severity and assistant needed to improve their
quality of life.































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Methodology

The disability assessment was conducted through individual questioning to the
disable persons used WHO structured questionnaire. It was conducted at 6
camps in 3 Governorates of the Kurdistan region from January 14 to February 7,
2014. Among the 6 camps 4 were in Erbil namely Kawergosk, Darashakran,
Qushatapa, Basirma and Gawilan and Arbat in Duhok and Sulaymaniyah
respectively.

Before going to implementation of the disability assessment survey, the directors
of each of the DOH were communicated and verbally briefed about the
objectives and expected outcomes of the assessment in their Governorate. The
camp and sector managers were also briefed and given responsibility to
contact all the disable individuals in their respective camp to take part in the
assessment exercise.

A simplified questionnaire was developed by the WHO KRG team for the
interviewers to capture disability related information from the affected individual
without any difficulties. There were 473 disable individuals being registered in the
6 camps; the questionnaire includes personal information, disability types,




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severity, co-existing diseases and demand. Before going to implement the
questionnaire, on the job trainings were conducted by the WHO Technical
Officer in each of the Governorate for the Camp and Sectors Managers and
Nurses and or Paramedics who were later on involved in the data collection
processes.

The whole data collection process was supervised and monitored by the WHO
Technical Officer. The missing and data inconsistency was corrected through
active visit to the tents. Generally, disable individuals were called at the
assessment center close to the primary health care unit and for those who didnt
participate as per lists, physical visits were conducted to their tents to collect the
information.

At the end of the data collection, all the filled questionnaires were brought
to WHO Erbil office and entered in the excel spread sheets and analysis
were made for key variables of the disability assessment questionnaire.
















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Findings:

The result of the assessment
Varied camp to camp
depending on the size of the
population. It has been observed
that 1-2.5% people found disable
per 100 individual in all the camps
except kawergosk which was
0.6%.

While disability
segregated by 4
different age
categories, it was found
that the incidence was
higher among 15- 45
years followed by 5-15
years in almost all the
camps.








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Disability was further
distributed by gender and it
was found that male is more
affected compare to the
female in all the camps.
However the prevalence was
significantly high among
male in Qushtapa camp
than male in other camps

Prevalence of disability was
analyzed by its origin and it was
found that high number of
disability was acquired by origin
in Arbat and Qushtapa while in
the rest of the camps it shared
almost equally.







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Assistive Aids with the
disable people was analyzed
and found that almost 50%
of the disable people in
Arbat camp possessed an
assistive Aid for their disability
while it was only 5% in
Qushtapa. In other 4 camps
it was within 12-25%.
The types of disability by types were also analyzed for each camp to see the
magnitude, severity and to determine the interventions needed to improve the
quality of the life. The following are the details of the disability types by camp.















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Erbil Governorate: Disability assessment was conducted in 4 camps in Erbil
which were Kawergosk, Basirma, Qushtapa and Dara Shakran. Following
are the details in each of the Syrian Refugee camps in Erbil-

Kawergosk Camp, as of February
10, 2014 UNHCR registered 13,412
IDP in 3,696 tents which is 14.05%
and 2
nd
highest proportion after
Domiz Camp in Duhok. There were
90 disables people interviewed for
this assessment and about one
third of the disability were related
to movement followed by mental
(16%), visual (11%) and auditory
(7%). Multiple and disability due to
speech stood lowest proportion among all types of disabilities.

Basirma Camp, as of February 10
2014 UNHCR registered 2,923 IDP
in 700 tents which is 3.06 % of the
total IDP in the camps of
Kurdistan region. In this camp, 60
disable people were interviewed
for the disability assessment and
one forth of disability was related
to movement followed by visual
(22%). Mental, Auditory and multiple were shared equally (7-8%) of the
total. Speech disability found lowest which was 5% only.




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Dara Shakran Camp, as of
February 10, 2014 UNHCR
registered 7,500 IDP in 1800
tents which is 7.84 % of the total
IDP in the camps of Kurdistan
region. Of the 151 registered
disable people, one third of
them were related to
movement followed by mental
(16%). Visual and Auditory were
shared equally (7%) of the total
disability. Disability due to
speech and multiple were 3%
and 1% respectively.

Qushtapa Camp, as of February 10 2014
UNHCR registered 4,373 IDP in 976 tents
which is 4.57% of the total IDP in the camp
of the Kurdistan region. Among the 60
disable people were being interviewed,
about two third of the disability were due
to movement followed by Mental (17%)
and Visual (11%). Speech and Auditory
disability shared 2 % each while multiple
was 7%.




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Duhok Governorate: out of 2 IDP camps, assessment was conducted in one
camp. In term of density of the IDP, Duhok is the highest who
accommodate about 61% of the IDP throughout the Kurdistan region.
Gawilan Camp as of February 10,
2014 UNHCR registered 2,495 IDP in
674 tents which is 2.61% of the total
IDP in the camp of the Kurdistan
region. Of the 47 registered disable
people more than half of the
disabilities were due to movement
followed by Visual (17%). Auditory
and multiple disabilities shared 11
% each while mental and speech was 6% and 2% respectively.











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Sulemaniya Governorate: there is only one camp where assessment was being
conducted. It accommodates only
3,000 individuals in 853 tents.
Arbat Camp, of the 59 registered
disable people, disability due to
movement and visual were about
one third each followed by mental
20%. The speech disability was the
lowest (2%) while multiple and
auditory was 8% and 5% respectively.


























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Conclusion:


Disability assessment was conducted in 6 camps in the Kurdistan region. All the
camps reported high number of disability due to movement followed by mental.
In 3 camps, acquired disability were significantly higher compare to congenital
which need be ruled out whether it was due to war conflict in Syria. In all the
camps, male and 15-45 year age groups affected more. In term of density of
the disable people, Dara Shakran was the highest and the lowest was
Kawergosk. The assessment also showed that there was high number of people
in Arbat camp who using assistive aids and lower in Qushtapa camp for their
disability correction.

Limitation of the Assessment:
1. About 20% of the disable people residing in the camps didnt take part in
the disability assessment; because they might refused to register as they
have feeling of disappointment for neglected their requests and
requirements for several times beside the possibility of not being exist in
the camp during the assessment, or because of the continuous influx of
Syrian to KRG all these causes may figure as challenges during
assessment.
2. Calling disable people in the PHC might restricted the window of
information dissemination and openness to the surveyors;








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Recommendations:

1. Assistive Aids should be provided on priority basis in all the camps
2. A Health Team should be comprised with Orthopedic Surgeon,
Cardiologist, Eye & ENT specialist, Physiotherapist, Psychologist, Psychiatrist
and gynecologist and special health camp should be conducted to
accurately determine the need in term of medications, surgery as well as
assistive aids;
3. A separate areas with support worker should be established to improve
the quality of life and reduce the burden of the family member on
disables;
4. A vocational training center should be established to make them active
and as a source of income generation in their family where possible;


















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Annex


Bar Chart 1: Gradual increasing trend of the Syrian refugees in the Camps of
Kurdistan Region



Bar Chart 2: Proportion of disable people among the total Syrian refugees
in the 6 Camps





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Table 1: Number of Individuals and Households in the Camps

Camps Individual Households % Total
Domiz 58,500 10,000 61.27
Al-Obaidi 1,911 408 200
Kawergosk 13,412 3,696 14.05
Darashakran 7,500 1,800 7.86
Qushtapa 4,373 976 4.58
Basirma 2,923 700 3.06
Arbat 3,000 853 3.14
Akre 1,364 324 1.43
Gawilan 2,495 674 2.61
Total 95,478 19,431 100























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Table 2: Number of Disable Individual in the Camps by category
Camp Multiple Mental Visual Speech Auditory Movement Total
Kawergosk 1 14 10 2 6 57 90
Darashakran 2 25 10 4 10 100 151
Qushtapa 4 10 7 1 1 37 60
Basirma 4 5 13 3 5 30 60
Arbat 5 13 23 1 3 20 65
Gawilan 5 3 8 1 5 25 47
Total 21 70 71 12 30 269 473




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Photograph 1: OIC WHO Erbil Office, Iraq observing a disable child in the
Refugee Camp in Kurdistan region

Photograph 2: Technical Officer WHO Erbil Office, Iraq cross checking
disability assessment data in the Refugee Camp in Kurdistan





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Photograph 3: Technical Officer WHO Erbil Office, Iraq is interviewing a
disable individual in the Refugee Camp in Kurdistan region



Photograph 4: A disable with his self-operated wheel Chair in the Dara
Shakran Camp in Kurdistan Region