‘The Highest Attainable Standard’: The Right to Health for Refugees with Disabilities
1. New Paradigms for the Right to Health
1.1. Changing Global Approaches to Disability
Persons with disabilities include those who have long-term physical, mental, intellectual or sensory impairments, which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others.
1.2. Current Approaches to Disability in Displacement
2. The International Legal Framework for Health Rights 1
2.1. The International Human Right to Health
Take, in accordance with their obligations under international law, including international humanitarian law and international human rights law, all necessary measures to ensure the protection and safety of persons with disabilities in situations of risk, including situations of armed conflict, humanitarian emergencies and the occurrence of natural disasters.
The rights to food, housing, work, education, human dignity, life, non-discrimination, equality, the prohibition against torture, privacy, access to information, and the freedoms of association, assembly and movement .(para 3)
The right to health embraces a wide range of socio-economic factors that promote conditions in which people can lead a healthy life, and extends to the underlying determinants of health, such as food and nutrition, housing, access to safe and potable water and adequate sanitation, safe and healthy working conditions and a healthy environment .(para 4. See also para 11. See also , article 11, which draws links between health and safe working environments)
attain and maintain maximum independence, full physical, mental, social and vocational ability, and full inclusion and participation in all aspects of life.(CRPD, art 26(1))
2.2. Human Rights Legal Frameworks in Six Refugee-Hosting Countries
3. Rights in Reality: Disability and the Enjoyment of Health in Displacement Settings
3.1. The Protection of Refugees with Disabilities Project
3.2. Displacement Contexts
4. Access to Health Services: Country Comparisons
4.1. Malaysia and Indonesia
4.1.1. Health and Disability Overview
4.2.1. Health and Disability Overview
4.3.1. Health and Disability Overview
4.4. Jordan and Turkey
4.4.1. Health and Disability Overview
5. Beyond Medical Assistance: Disability and Wellbeing in Displacement
6. The Highest Attainable Standard? Concluding Reflections on Promoting Article 25 and Beyond
Conflicts of Interest
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This section of the paper draws on our work in Chapter 2. See 5. Crock, M.; Smith-Khan, L.; McCallum, R.; Saul, B. The Legal Protection of Refugees with Disabilities: Forgotten and Invisible?; Edward Elgar: Cheltenham, UK; Northampton, USA, 2017.
More information about the group and the questions they developed is available on their website: http://www.washingtongroup-disability.com/washington-group-question-sets/short-set-of-disability-questions/.
See for example the extensive work in this area by Uganda National Action on Physical Disability https://unapd.org/about-us/.
For an extended discussion of the combined impact of migration status and other personal attributes, see Chapter 6, 5. Crock, M.; Smith-Khan, L.; McCallum, R.; Saul, B. The Legal Protection of Refugees with Disabilities: Forgotten and Invisible?; Edward Elgar: Cheltenham, UK; Northampton, USA, 2017.
For a depiction of the connections between stressors, needs and experiences among Syrians in Jordan, see ref .
|Treaty and Article||Description|
|Convention relating to the status of Refugees 1951|
|Article 1A(2)||Defines who is a refugee|
|Articles 20–24||Basic welfare provisions covering refugees’ access to rations, housing, public relief, and social security, etc.|
|Article 33||Prohibits parties from returning refugees from the country they are fleeing|
|International Covenant on Economic, Social and Cultural Rights 1966|
|Article 11||Sets out rights to adequate standard of living (food, clothing and housing)|
|Article 12||Sets out right to the ‘highest attainable standard of health’|
|Convention on the Rights of Persons with Disabilities 2006|
|Article 1||Describes persons with disabilities|
|Article 5||Requires parties to take measures to ensure equality and overcome discrimination|
|Article 9||Sets out duties related to accessibility to ensure participation and full enjoyment of rights|
|Article 11||Provides that Convention on the Rights of Persons with Disabilities (CRPD) applies in conflict/emergency situations|
|Article 25||Echoes International Covenant on Economic, Social and Cultural Rights (ICESCR) article 12 right to health|
|Article 26||Sets out right to habilitation and rehabilitation|
|Refugee Convention and Protocol||No||No||No||27 September 1976||No||30 March 1962|
31 July 1968
(with geographic limitations)
|CRPD||19 July 2010||30 November 2011||5 July 2011||25 September 2008||31 March 2008||28 September 2009|
|ICESCR||No||23 February 2006||17 April 2008||21 January 1987||28 May 1975||23 September 2003|
|Barrier||Overall Challenges||Additional Barriers|
|Affordability||Most commonly identified barrier. Refugee incomes are often well below national poverty lines. In some locations, compounded by limited access to public health services due to non-citizen status, or the unavailability of free specialist care.||Persons with disabilities commonly have less household disposable income.|
Costs compounded by limited transport options.
Assistive devices are not provided, even where diagnosis is available (e.g., glasses).
Specialist services are less likely to be free.
|Bureaucratic||Prioritization of ‘urgent’ treatable needs over long-term care.|
Difficult to obtain travel clearance or access services outside assigned area based on registered address.
Age-based inclusion criteria problematic in forced migration.
|Persons with disabilities that are not ‘curable’ or who need ongoing support, e.g., with pain management, may quickly exhaust their allocated assistance.|
Fear around the impact of disclosing disability to refugee agency on refugee status determination and resettlement outcomes.
|Demand/resources||Public/NGO services are overburdened and cannot meet demand.||Persons with disabilities pushed to the back of queues, experience distress or discomfort over waiting times. Overreliance on private/high fee services.|
Competition/limited places available for specialist/secondary services.
|Geographic/physical||Affordable and/or specialist services are located far from refugee housing.||Limited accessible transport options.|
Requiring the assistance of a friend/family member to navigate to/access the service.
Physical accessibility of buildings: e.g., stairs, inaccessible toilets, etc.
|Communication||Language barriers between refugees and service providers may impede access to, or limit information about, available services.||Information for refugees may not be shared in accessible formats, and appropriate interpreting assistance is less likely to be available in non-local sign languages|
Increased risk of social isolation decreases access to information.
|Social/cultural||Stigma attached to certain conditions or experiences: e.g., accessing reproductive services for pregnancy/birth or injury resulting from sexual violence.|
Ethnic, religious, age- or nationality-based discrimination.
|Specific impairments/disabilities attract direct discrimination from the community, family or health service providers and deter disclosure/encourage social isolation.|
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Smith-Khan, L.; Crock, M. ‘The Highest Attainable Standard’: The Right to Health for Refugees with Disabilities. Societies 2019, 9, 33. https://doi.org/10.3390/soc9020033
Smith-Khan L, Crock M. ‘The Highest Attainable Standard’: The Right to Health for Refugees with Disabilities. Societies. 2019; 9(2):33. https://doi.org/10.3390/soc9020033Chicago/Turabian Style
Smith-Khan, Laura, and Mary Crock. 2019. "‘The Highest Attainable Standard’: The Right to Health for Refugees with Disabilities" Societies 9, no. 2: 33. https://doi.org/10.3390/soc9020033