Disability-Related Risks Among Women and Girls Who Are Forcibly Displaced from Venezuela

Abstract

Our study aimed to explore the lived experiences of Venezuelan refugee/migrant women and girls with disabilities to guide humanitarian assistance. The data analysed was part of a larger cross-sectional study whereby refugees and migrants in Ecuador, Peru, and Brazil were asked to share the migration experiences of a Venezuelan woman or girl. The sample for this analysis was drawn from one of the survey questions that asked participants whether the woman/girl in the narrative identified as a person with a disability. Thematic analysis using inductive coding was performed. A total of 126 narratives were included in the final analysis, of which four major themes were identified. Venezuelan refugees and migrants with disabilities described experiences of discrimination, violence, and physical challenges, such as exacerbation of symptoms while in transit. In host countries, refugees and migrants experienced a lack of disability-related accommodations in the workplace and long wait times when trying to obtain healthcare. Since discrimination is a cross-cutting issue, human rights awareness highlighting the dignity of persons with disabilities is imperative. Resources and support for Venezuelan refugee and migrant women and girls with disabilities should aim to create accessible employment opportunities, safe and timely access to medical care, and prioritise violence prevention.

1. Introduction

Over 7.7 million people left Venezuela between 2014 and November 2023 in one of the largest displacement crises in the world [1]. The complex socioeconomic and political climate in Venezuela since 2017, including the collapse of healthcare infrastructure, rising oil prices, shortage of basic goods, food insecurity, and significant hyperinflation, have contributed to ongoing instability [2,3,4]. Many of these factors were exacerbated between 2019 and 2021 by the additive hardships of the COVID-19 pandemic, which has led to even greater supply shortages [5].

Several Latin American countries neighbouring Venezuela serve as hosts for refugees and migrants. As of January 2023, the highest proportion of Venezuela refugees and migrants were located in Colombia (2.5 M), followed by Peru (1.5 M), the United States (545.2 K), Ecuador (502.2 K), Chile (444.4 K), Spain (438.4 K), and Brazil (414.5 K) [1]. Due to its geographic location and shared eastern border, Colombia serves as both a host country and a transit route to other regions.

Of the 25.4 million refugees in 2018, 9.3 million of them had a disability [6]. Disability has been defined as “long-term physical, mental, intellectual, or sensory impairments, which, in interaction with various barriers, hinder participation in society on an equal basis with others” [7]. Persons with disabilities are disproportionately represented among people from the poorest wealth quintile [8]. Further, 80% of people with disabilities live in low- and middle-income countries [9].

In 2021, 18% of women reported a disability compared to 14.2% of men [10]. Women are at increased risk of disability due to gender-based inequities in socioeconomic determinants of health [11]. Further, women’s experiences of disability differ from men’s due to gendered societal norms, views of the body, and expectations for cultural roles [12]. For example, women with disabilities may be viewed as less able to fulfil the role of mother [12,13], which can lead to inequitable and discriminatory experiences in healthcare [14]. Further, gender and disability status intersect such that women with disabilities are significantly more likely to experience violence compared to women without disabilities [15,16,17]. Age further complicates the intersection of gender and disability, affecting women differently across life stages. Younger women with disabilities often face exclusion from education and social stigma, hindering future opportunities, while older women may experience increased isolation, limited social support, and economic insecurity due to lifelong discrimination.

The intersection between disability and migration status also warrants consideration [18]. Notably, disability may be caused or exacerbated by the circumstances that contribute to forced displacement [19,20]. Further, there is a marked lack of social services and humanitarian assistance for individuals with these intersectional needs [18,19,20,21]. For example, the lived experiences of persons with disabilities forcibly displaced from Iraq highlight these issues and describe the impact of discrimination on the development of exclusionary policies [18,19]. Evidently, responses that consider gender, disability, and migration status are required to address these complex needs.

One study of Venezuelans in transit through Colombia estimated that 25% identified as having a disability [22]. Similarly, there is a paucity of research examining disability-related risks among Venezuelans who are forcibly displaced. It has been suggested that this population may be disproportionately affected by challenges along the migration route and lack of access to healthcare throughout the migration journey [5]. However, research to support this hypothesis is lacking. Further, one study conducted in Peru found that Venezuelan refugees and migrants with disability were disproportionately affected by food insecurity compared to those without disability [3].

In 2010, the United Nations Refugee Agency (UNRA) urged the United Nations to prioritise anti-discrimination and humanitarian support for refugees and migrants with disabilities [23]. The UNRA has also highlighted the need for accurate data collection regarding refugee and migrant access to disability-related services [24]. Having a comprehensive understanding of disability-related risks among Venezuelan refugees and migrants is critical to guide humanitarian programs and policies in the midst of this ongoing crisis. Our study aimed to address this need while maintaining the personhood of individuals with disabilities by using narrative storytelling to identify disability-related risks of women and girls during forced displacement from Venezuela.

2. Materials and Methods

This study analysed data from a larger cross-sectional, mixed methods study conducted with oversight by the International Organization for Migration from January to April 2022. The purpose of the original study was to explore the migration experiences of Venezuelan women and girls. This manuscript focuses exclusively on the migration experiences of Venezuelan women and girls with disabilities.

The larger study was conducted along the migration route and in host countries, including Ecuador (Tulcan, Manta, and Huaquillas), Peru (Tumbes, Lima, and Tacna), and Brazil (Pacaraima, Boa Vista, and Manaus). A convenience sample of male and female participants was obtained from public spaces, including transportation centres, border crossings, points of service delivery, and shelters. All shared narratives were about the migration experiences of women/girls. While men were invited to participate, they also shared the experiences of women/girls during migration. In most cases, male participants talked about the migration of their wives, daughters, sisters, aunts, and friends.

Participants aged 14 years or older who self-identified as Venezuelan refugees or migrants were invited to participate, with an effort made to include individuals from equity-deserving groups, including those with disability. Parental consent was not sought for participants under 18, as many adolescent refugees and migrants were unaccompanied by parents or guardians, and some were travelling with their own partners and children. These factors led to their classification as mature minors. Additionally, involving parents might have introduced bias, according to the American Psychology Association [25].

Local, Spanish-speaking interviewers completed a three-day training course on study methodology, ethics, psychological first aid and prevention of sexual exploitation. Some enumerators were Venezuelan refugees and migrants, while others were professionals, including social workers and psychologists.

Interviews lasting 12–15 min were conducted out of earshot from others. Data was collected on tablets using Spryng.io (Version 2.0) software. Participants were asked to respond to one of three open-ended questions regarding the migration experiences of Venezuelan women and girls (Supplementary Materials, Table S1). This design empowered participants to choose the question and experience they felt was most important. The responses, termed micronarratives, were audio-recorded or typed on the tablets. Participants then completed a multiple-choice questionnaire collecting sociodemographic information. One of the questions asked participants to identify whether the woman/girl in the story identified as having a disability. Micronarratives were initially transcribed and translated from Spanish to English using artificial intelligence. Quotes used in this article were verified by a human transcriptionist/translator.

Micronarratives for which the participant indicated that the woman/girl “had a disability” were screened by author TW for inclusion in the analysis. Micronarratives were included if the content mentioned having a disability as defined by the United Nations as “long-term physical, mental, intellectual or sensory impairments, which, in interaction with various barriers, hinder participation in society on an equal basis with others” [7].

A thematic analysis using inductive coding was performed by author TW. The process described by Braun and Clarke was followed [26] involving data familiarisation followed by open coding. The codes were then arranged into categories and included in a code book. The data was reviewed whenever new codes were identified until saturation was reached. Codes and themes were discussed with co-author SB to reduce bias, enhance validity, ensure consistency, and promote reflexivity.

Participants provided informed consent by checking a consent box on the tablet at the beginning of the survey. No identifying information was collected. No compensation was offered for participation. The Queen’s University Health Sciences and Affiliated Teaching Hospitals Research Ethics Board approved this study (protocol #6029400)

3. Results

There were 9339 participants in the parent study. Of these, 590 selected the survey response, which indicated that the narrative was related to having a disability. A total of 126 of these narratives were included in the final analysis based on our inclusion criteria. Participant demographics are included in

Table 1. Demographic data of the participants (N = 126).

	N (%)
Age
<18 years	3 (2.38)
19–30	37 (29.37)
31–45	48 (38.10)
>45	38 (30.16)
Gender
Woman	101 (80.16)
Man	23 (18.25)
Non-binary	2 (1.59)
Length of Displacement
<1 year	59 (46.83)
1–3 years	34 (26.98)
3–5 years	24 (19.05)
>5 years	7 (5.56)
Prefer not to say/not sure	2 (1.59)
* Wealth Relative to Others in the Community
Very Poor	26 (20.63)
Poor	68 (53.97)
Average	23 (18.25)
Wealthy	3 (2.38)
Prefer not to say/not sure	6 (4.76)
Location of Data Collection
Peru	16 (12.70)
Ecuador	37 (29.37)
Brazil	73 (57.94)

* ‘Community’ was left open for participants to interpret and may have been limited to the refugee community or may have included the host community.

. As shown, the majority of respondents were women (80%) over the age of 18 years. Most narratives were collected in Brazil (73%), followed by Ecuador (29%) and Peru (12%). Although data were not collected in Colombia, many participants in Ecuador and Peru spoke about experiences travelling through Colombia. Themes about disability-related risks experienced by women and girls during forced displacement from Venezuela are summarised in Figure 1.

3.1. Discrimination

Ableism is a discriminatory concept that suggests having a disability equates to inferiority [26]. It encompasses discriminatory attitudes, behaviours and structural processes such as societal values, policies or systems that disadvantage persons with disabilities [27,28,29]. Ableism was implicit in all of the themes identified. However, some narratives identified ableism during forced displacement more explicitly (N = 8). Two perpetrators were identified, including Venezuelans and individuals in the host country. For some, ableism in Venezuela was noted as a reason for leaving, while others experienced discrimination along the migration route.

[…] there was a woman who came from the east of Venezuela to the state of Táchira. She was in a wheelchair and on the road from Cúcuta to here, to Ecuador. There were a lot of leg amputees on crutches, people in wheelchairs […]. It was very sad and we heard that she had left because she could not get the medicines for her illness. There was mistreatment at the government headquarters. She knows that Venezuela is a dictatorship and no rights are respected right now.

(ID 23225—Man, aged 19–30, interviewed in Tulcán)

[…] suffered a lot of discrimination along with my daughter, a 16-year-old girl who has down syndrome. When she was on the trail she suffered a lot of harassment from the Venezuelan people themselves who saw her as a weirdo. When we got to the border they told me to go away.

(ID 18462—Women, aged 31–45, interviewed in Huaquillas)

One narrative highlighted the intersectional discrimination experienced by a person who identified as LGBTQI+ and a person with a disability.

Imagine in my case being a gay person and being a person with a disability […] you see people threatening you, they tell you to get out of here or you can’t be here.

(ID 22976—Man, aged 19–30, interviewed in Boavista)

3.2. Violence

Experiences of violence were pervasive among women and girls with disabilities during forced displacement from Venezuela (N = 12). Three types of violence were described, including intimate partner violence and physical or sexual assault from unknown assailants. Others reported experiences of physical violence from their parents. For some, intimate partner violence was the cause of a disability.

I am a Venezuelan with a disability and I have 3 children. And my partner is younger than me, well, we were always fine, but from one moment to another, the change began to consume and drink. Well, now he attacks me, mistreats me and no longer assumes the cost of the house. Well, when I complained, he hit me and dreamed of me and when he woke up, I found to my surprise that he was no longer there and that he stole from me. And he took the little baby so he could have money and keep asking for money.

(ID 19112—Women, aged 31–45, interviewed in Tumbes)

A friend was raped by her ex-partner. One day he went to see her where she was living. He wanted to have sex but she no longer wanted anything and was drunk where, in that argument and struggle, he ended up raping her and hit her so hard that she was hospitalized to where it left her so bad that she couldn’t even walk.

(ID 24259—Women, aged 31–45, interviewed in Tumbes)

Another narrative described a perpetrator who threatened the victim with ableist ideology in an attempt to prevent the victim from reporting the assault.

It was when I was in that place, he took advantage and when I told him I would report him he threatened me and told me that no one would ever believe a deaf mute. But after he found out that I got pregnant, he wanted to take my son away from me. I escaped out of fear.

(ID 24256, Women, aged <18, interviewed in Tumbes)

Several narratives described experiences of physical or sexual assault against persons with disabilities from unknown assailants. Assaults occurred both along the migration route and in host countries.

And she also went through a rape problem […] it happened to my mother also passing through the Colombian border.

(ID 23541—Man, aged 19–30, interviewed in Tulcán)

When he came through Colombia he was walking and I met a girl who came to see her daughter who said that she was here in Lima, she had problems. She was deaf mute […] They were drinking and they proposed to her for a drink and so it happened that the four of them raped and abused her.

(ID 20459—Women, aged 31–45, interviewed in Tumbes)

Finally, many narratives described experiences of fear regarding the risk of violence towards children with disabilities (N = 6). Some individuals were concerned about the risk of physical and/or sexual assault in host countries, both while living on the street or in housing.

My daughter has a mild syndrome. We were living in a room in […] and a patient made insinuations to my daughter. I couldn’t leave her alone at home, she always accompanies me to work for that reason.

(ID 24020—Women, aged 31–45, interviewed in Lima)

Some drug addicts from the street wanted to abuse her when we were sleeping on the streets because we were homeless for 3 weeks. It has been a hard process with my daughter [who has Down syndrome].

(ID 18462—Women, aged 31–45, interviewed in Huaquillas)

Others were specifically worried about the risk of child kidnapping. The risk was felt to be amplified by the additive challenges of caring for a child with a disability.

Well, first of all, I’ve heard the rumors. Plus, I’ve seen that children have been kidnapped and that I already have. I’ve been here for 15-days and I’ve been really nervous because my son is a little bit hyperactive and sometimes he lets go of my hand.

(ID 20977—Women, aged 31–45, interviewed in Boavista)

3.3. Risks Related to the Transit Phase of Migration

One theme that emerged from the narratives was disability-related risks experienced during the transit phase of migration (N = 19). Women and girls utilised many different modes of transportation when migrating from Venezuela including transport via truck, bus, car or, more commonly, by foot. For some, the journey by foot exacerbated underlying medical conditions, worsening symptoms of pain or shortness of breath.

Regarding the trip, it was complicated for her at certain points, because she had to walk a long distance and sometimes she stopped. I said ok, let’s rest a little bit. I could usually keep going like this […] but with respect to her it was a bit complicated. She has spinal difficulties and it was very difficult for her. In addition, due to the altitude, she is not very well accustomed to the altitude as such, and sometimes she breathes very little, it is difficult for her to breathe.

(ID 22479—man, aged 19–30, interviewed in Tulcán)

Getting here was very sad because she has a motor cerebral palsy […]. For her it was very difficult because she had to walk […]. From that, well, she was in a very delicate situation that hurt her a lot.

(ID 22509—woman, aged 31–45, interviewed in Tulcán)

Others had to walk and often carry children with physical disabilities. This experience presented challenges for both the children who had to navigate difficult terrain and the family members who had to assist them.

A lady with a little girl with sick legs […] we went through the trails […] it was at night, very difficult, we had to carry the girl to be able to cross. She did not have the medicine, she was in a lot of pain, her legs were not enough to walk. She was about 18 or 19 years old and the little one about nine years old. The mother was also sick, she suffered from stomach pain.

(ID 22440—man, aged 19–30, interviewed in Manaus)

And even more so with the disabled child (The authors acknowledge that correct terminology should read “child with a disability”; however, “disabled child” and “handicapped” have been used in this paragraph as direct quotations). It was also very difficult for us because imagine, with six children, there was a three-year old, the handicapped child of ten- years old. My son and 15 years old, my husband and my mother also helped me, but it was very difficult for us.

(ID 20613—woman, aged 31–45, interviewed in Boavista)

Furthermore, the migration journey, especially via foot, presented significant safety risks for individuals with visual impairment and deafness. These individuals tended to rely on friends and family members, including their own children, to guide them along footpaths and point out signs of danger.

When I came here from Venezuela, she was four years old and she was our guide […] And I also have a disability such as visual impairment, that I don’t see anything […] Mommy, watch out for a snake [..] She said no, mommy, by the trail, by the trail.

(ID 23180—woman, aged 31–45, interviewed in Boavista)

One narrative told the story of a deaf girl who was struck by a car and died along the migration route.

While on the way I met a girl who was traveling with her boyfriend. They were both very young and the girl had a problem with her ears, she was deaf. We were on the road where quite a lot of large vehicles full of cargo are moved and we were on the edge of that road and at one point the girl drops some papers from her luggage and she goes to pick them up. Her boyfriend realizes that a truck was coming at speed and yells at her but she didn’t hear […] The car killed the girl and she had been pregnant for four months. That guy wanted to die, we all tried to comfort him but it was impossible and he screamed and said God why do you take away everything I love.

(ID 23026—man, aged 31–45, interviewed in Huaquillas)

Finally, refugees and migrants who used wheelchairs tended to have insufficient support during transport.

In my case, my special chair is a little difficult because I didn’t have the help that they give here for disabled people.

(ID 23898—woman, aged 31–45, interviewed in Boavista)

3.4. Risks Related to Arrival and Integration in the Host Country

Two themes relating to arrival and stay in the host country were identified, including disability-related experiences in the workplace and in healthcare.

3.4.1. Disability-Related Experiences in the Workplace

The economic situation in Venezuela, including lack of employment, was described as a common factor contributing to forced displacement. Although some women with disabilities were able to find employment in host countries, several narratives highlighted disability-related risks in the workplace (N = 13). Specifically, narratives described experiences of verbal abuse and lack of disability-related accommodations.

I left for Colombia and looked for a job in a store but getting around was very complicated since I needed my crutches and the owner called me useless. And I begged him to continue working since I needed the money for my operation. One day while I was moving to another store I stumbled and hurt myself again causing another injury to my knee, because of that they fired me from work and with the help of a friend I came to Peru with the intention of being able to work and raise enough money and be able to have surgery so that I can work and have a normal life.

(ID 24240—woman, aged 19–30, interviewed in Tacna)

One day they left me alone attending the entire restaurant and that day I had an accident. I fell down the stairs and broke my leg and felt very strong pain in my spine. No one helped me and at work they just fired me and said it was my fault. As a result of that accident, I had ankle fractures causing complete immobility to this day since it limits me to being able to have jobs where strength or constant movement is required.

(ID 24088—woman, aged 31–45, interviewed in Tacna)

Many women with disabilities that may include mobility impairments and/or chronic diseases felt they were unable to work in the host country because of their disability (N = 7). For one person with visual impairment, the lack of disability-related workplace accommodations contributed to a significant workplace injury.

Then, on one of those days when she was going to work […] unfortunately when she was trying to get on the truck, the car started and she fell. She could not hold on and, well, because of her visual disability, which makes it difficult for her to hold on, she fell and was left alone on the road. Nobody helped her.

(ID 23219—woman, aged 19–30, interviewed in Tulcán)

Finally, some refugee and migrant women were unable to find employment due to a lack of childcare for their children with disabilities.

I need to be taken into account because they have denied me a job there because I am a single woman with a child, and I have looked for one. I have a disabled child, and I have also looked for a doctor to see him, a neurologist. I live in a shelter, and I cannot leave the children alone because I am a single mother. You cannot leave the children there.

(ID 14676—woman, aged 31–45, interviewed in Boavista)

I have had the desire to work, but I would like a collaboration to receive help in terms of childcare. I have four children. One has a disability, he is autistic. I also have a baby. I have no partner, no husband in terms of supporting them.

(ID 14892—woman, aged 19–30, interviewed in Boavista)

3.4.2. Disability-Related Experiences in Healthcare

The final theme that emerged was disability-related experiences in healthcare. Women and girls with disabilities had both positive and negative experiences obtaining healthcare in host countries. Specifically, some people were readily able to book medical appointments and obtain necessary medications and surgeries for both acute and chronic medical conditions (N = 16)

I remember we were also in the hospital, I got sick, I also had a very nice experience. I liked very much how they treated me in a hospital in Colombia, in Bogota. I felt very, very grateful to Colombia.

(ID 15760—woman, aged 31–45, interviewed in Tulcán)

Well, I came here. It was for her because she suffers from schizophrenia and I came to get her help for that. […] I came to get help for her medicine. And here I am already being taken care of. And she is in treatment. No wrong has been done to me here. I have been taken care of. I have the doctors for my daughter.

(ID 23192—woman, aged >45, interviewed in Boavista)

In contrast, several narratives (N = 11) described long wait times in host countries that precluded rapid access to necessary medical care.

I have been wanting to have surgery and I have been waiting since May 8, 2021. Every time I go to the hospital, they keep changing the date, they change the date.

(ID 21355—man, aged 19–30, interviewed in Pacaraima)

I have a health problem, and I am still waiting for the interview with the otorhinolaryngologist. I am still waiting. I have already (waited) six months. I have (been here) eight months here in Brazil and I am still waiting for the appointment for my hearing.

(ID 14775—woman, aged 31–45, interviewed in Boavista)

Finally, two narratives described poor healthcare experiences whereby discrimination limited the provision of optimal care.

One of the times my husband mistreated me, he cut off two of my fingers, and at the hospital, they treated me reluctantly. They looked at me as if I were a piece of garbage. They looked at me like I was a piece of junk. […] The doctor did not even look at me and ordered the nurse to send me away; they did not want to refer me to any other place.

(ID 15565—woman, aged 31–45, interviewed in Huaquillas)

And I went to the doctor. And he didn’t attend to me either because they didn’t understand me, and I didn’t understand. My face was smashed, and I had bruises all over.

(ID 15676—woman, aged >45, interviewed in Boavista)

4. Discussion

There is limited literature regarding the experiences of Venezuelan refugees and migrants with disabilities. Our study analysed micronarratives about women and girls to highlight disability-related risks experienced during forced displacement from Venezuela.

The first theme that emerged from our narratives was discrimination perpetuated by persons in Venezuela and host countries. Refugees and migrants with disabilities are at risk of intersectional discrimination from xenophobia and ableism, which are both pervasive globally. Xenophobia acts as a barrier to obtaining medical care and adequate social support [30]. Xenophobia has been shown to be common in shelters at the Venezuelan-Brazilian border [30] and has been linked to increased rates of violent crime in Colombia [31]. The narratives in our study highlighted the additive challenges of ableism. Ableism was encountered in Venezuela, where it was identified as a factor contributing to displacement and along the migration route. Prior experiences of Iraqi refugees with disabilities describe the outcomes of compounded discrimination, which leads to personal trauma and exclusionary policies [18,19]. Indeed, discriminatory attitudes and policies were implicitly reflected in the other themes identified in our study, which will be discussed further.

Our second theme, violence, highlights the impact of compounded xenophobia, ableism, and gender-based discrimination. Previous reports have shown that xenophobic attitudes have contributed to violent attacks among Venezuelans in Colombia, Ecuador and Peru, with women and LGBTQI+ populations being disproportionately affected [32]. Physical and psychological attacks are common in shelters housing displaced Venezuelans [30]. Further, research suggests that persons with disabilities are at higher risk of sexual and gender-based violence compared to persons without disabilities [33]. Our study confirms that violence is widespread among Venezuelan women and girls with disabilities throughout the various stages of forced displacement. Intimate partner and community violence occur in Venezuela, along the migration route, and in host countries. Our study also adds the experiences of parents who fear threats of violence against their children with disabilities and often find it more challenging to keep them safe. Violence prevention and protection for children with disabilities is crucial for the safety and well-being of this intersectional population.

The third theme we identified was risks experienced during the transit phase of migration. The Spanish term ‘caminantes’ refers to refugees and migrants who walk for some or all of their journey. Previous literature has shown that the number of caminantes significantly increased in 2020 due to the ongoing fuel crisis and hyper-inflation [34]. In response to the COVID-19 pandemic, border closings occurred across Brazil, Chile, Colombia, Ecuador, and Peru [35], leading to increased use of hidden footpaths and informal crossings, especially through Colombia [36]. Prior reports have identified road safety as a significant risk for caminantes [34], especially for refugees and migrants with disabilities who may be unable to physically move to avoid danger [9]. Our study supplements this literature by capturing the lived experiences of caminantes with disabilities. Indeed, road safety was a concern in our study, especially for refugees and migrants with visual impairment and/or deafness. In fact, a deaf person was killed along the migration route. Further, walking by foot worsened underlying medical conditions and sometimes became a threat to life. Finally, caminantes with children with disabilities had the added difficulty of navigating the paths while guiding and even carrying their children for some or all of the journey. Evidently, affordable and safe transportation should be a priority for humanitarian organisations to minimise risks experienced by caminantes with disabilities. Transportation must be accessible, as highlighted by the narratives of refugees and migrants who use wheelchairs.

The final theme that emerged was risks experienced on arrival and integration in host countries. This theme included disability-related risks experienced in the workplace and in healthcare. Literature suggests that Venezuelans’ employment and healthcare experiences vary significantly by region.

Rates of unemployment are high in host countries, especially in Colombia and Peru, resulting in many Venezuelans working in the informal sector with no standard wage or benefits [37]. Additionally, lack of access to resources has been identified as a barrier to finding employment [37]. In 2021, the International Labor Organization released a regional socio-economic integration strategy aimed at maximising the contribution of refugees and migrants to the economy in host countries [38]. Although the strategy recognises persons with disabilities as a unique population that warrants social protection, it does not include specific recommendations to integrate persons with disability into the workforce [38]. Our study found that many women and girls with disabilities felt they were unable to work in host countries due to their underlying disability. From a social lens, this suggests that there is an actual or perceived lack of disability-specific accommodations in the workplace. For others, the biggest barrier to employment was the lack of childcare services for children with disabilities. Women with disabilities who were employed in host countries experienced significant discrimination that resulted in verbal attacks and even loss of work. Safe workplaces that prioritise accommodations for persons with disabilities are needed to maintain the personhood and independence of refugees and migrants with disabilities.

The final theme included the healthcare experiences of women and girls with disabilities. Reports show that healthcare for refugees and migrants varies between Latin American countries. For instance, in Colombia, individuals need regular status to access the public health system [39]. In Peru, misinformation has been shown to limit refugees’ and migrants’ access to care, while in Ecuador, xenophobia and economic limitations have been cited as barriers to care [39]. These health inequities were further exacerbated by the COVID-19 pandemic [5]. Despite this, our study found that, on a positive note, some forcibly displaced women and girls with disabilities had positive healthcare experiences in host countries. In contrast, others report very long wait times that prevent timely access to necessary medical and surgical care for acute and chronic conditions. Prior research suggests that factors contributing to inequitable access to healthcare among refugees and migrants with disabilities may include difficulty finding information on services and challenges coordinating multiple specialists [40]. Discrimination was identified as an attitudinal barrier whereby women with injuries caused by violence were refused optimal care. Once again, gender, refugee and disability status intersect within healthcare, creating disproportionate oppression requiring directed humanitarian assistance to ensure individuals receive the care they need.

This study has several limitations. First, sensemaking micronarratives tend to have less detail and depth than traditional qualitative interviews, and as a result, important ideas and experiences may have been omitted. Second, some micronarratives were lost from the larger study as a result of real-time technical challenges when attempting to upload micronarratives with unstable internet connections. Also, the audio quality of many interviews was limited by noisy environments, which resulted in challenging transcription and translation. Third, limited funding and the large volume of data necessitated using artificial intelligence for transcription and translation, which resulted in lower-quality English texts. However, this was mitigated by having a human verify the translation of any quotes included in the final analysis. Fourth, participants were selected from a convenience sample, which may have limited the generalizability of the results. Fifth, persons with disabilities represent a heterogeneous population whereby disability type and additional social determinants of health, such as gender, age, education level, etc., may vary individual experiences. Our sample size and the method of data collection did not allow for sub-group analysis. Finally, several of the narratives in our study were told by third parties and, therefore, do not capture first-hand perspectives of people with disabilities.

Our study also has several notable strengths. The broader study used open-ended prompts that created a person-centred approach to data collection that allowed participants to share experiences that were meaningful to them. Further, participants could share a positive, negative, or neutral story, reducing reporting and social desirability bias. Finally, participants were asked whether their story was related to their disability, which allowed us to identify relevant micronarratives easily.

5. Conclusions

As humanitarian efforts continue to support Venezuelans who have been forcibly displaced, the needs of refugees and migrants with disabilities must be considered. Our research helps to inform these priorities by examining the lived experiences of this population. Based on our results, the following recommendations can be made: (1) Host countries should empower persons with disabilities and strengthen state institutions in the observation of respect for those with disabilities so that they may exercise their rights with dignity. This target should include the development of accessible employment opportunities and the promotion of timely access to medical care. (2) NGOs and governments, in their intersectional approaches, should include families of persons with disabilities. Response programs should be targeted towards identifying and appropriately addressing the individual needs of each person with a disability. (3) Specific programming required includes violence prevention and safety for women and girls with disabilities. Further, transit systems and shelters should be adapted for different types of disabilities. Future research should consider examining the unique needs of subpopulations of refugees and migrants with disabilities, given that persons with disabilities represent a broad, heterogeneous group whose individual needs may vary.