Disabilities in Syria: A 'hidden' crisis

The al-Hassan family have been victims of Russian-launched cluster bombs twice in Syria now, both times with horrific consequences.

The first time, Abd al-Hadi Miteb al-Hassan told DW, his father was killed during an aerial attack on a camp for displaced people in opposition-controlled Idlib. The family is originally from countryside near the central Syrian city of Hama but moved to the opposition-held north during the civil war. The second time, al-Hassan's two little sisters were playing just outside the camp when the remnants of a cluster bomb exploded.

"Rua lost an eye and Doaa lost her hand," the 23-year-old says. "We took them to hospital in Idlib and I stayed there with them for a month."

That was around 16 months ago. Now the two girls, aged 9 and 10, are trying to live a more normal life despite their injuries. But it's terribly difficult, al-Hassan says.

"In addition to the amputation of her hand, Doaa has problems with her leg," the girls' brother explains. "They both need special care but there's nothing for them here. It's just all on me and their mother. So many days are so hard, especially because we live in tents and it's so hot."

How many Syrians are disabled?

According to numbers collected by the United Nations in 2021, over a decade of civil war means that around 28% of the Syrian population, aged over 2, now suffers from a disability of some kind.

The numbers are even higher in parts of northern Syria. The region, where the al-Hassan sisters live and which are controlled by opposition fighters, is heavily dependent on humanitarian aid and short of medical facilities. The UN says that around 37% of the population in northeastern Syria suffers from some kind of disability.

That percentage is more than double the world average, which sits at around 15%.

"The statistic is not only so high because of the war," says Emina Cerimovic, a senior researcher on disability rights at Human Rights Watch, who helped author a 2022 report on the topic. "It's not just that somebody was shot or injured in shelling but also because of a lack of healthcare and other services. All of that has resulted in many children and adults acquiring a disability they wouldn't have otherwise."

Aid organizations DW spoke with believe that the real number of disabled people is even higher than the UN's 2021 survey suggests. "Not everyone was counted then. The methodology that was used doesn't include mental health problems or psychosocial disabilities," Cerimovic continued. "So we fear the numbers are even higher."

Numbers have also gone up after a devastating earthquake hit Turkey and northern Syria in February this year, confirms Myriam Abord-Hugon, head of the Syria response team and aid organization Handicap International.

"In Syria after that week [of the earthquake], it was difficult to access medical care. The hospitals were completely overloaded," she recalls. "They were not able to take care of everybody properly. So although I can't tell you what the percentage is now [in northern Syria], it will definitely be much more than what we had at the beginning of the year."

"We have seen many new cases after the earthquake," confirmed Mohamed al-Mahmoud, director of the Idlib-based Syrian Network for Disability, or SND. "Especially the phenomenon of crushing, which has led to amputations. That includes children and women as well."

But at the same time as Syria has such high rates of disability, the topic is also often described by those working in the sector as an "invisible" or "hidden" one. 

"Armed conflicts, in particular, generate new disabilities, exacerbate the existing barriers faced by persons with disabilities and expose the whole community to greater harm. Yet the experiences of persons with disabilities in armed conflict and the effects of armed conflict on this population are sorely understudied," the journal International Review of the Red Cross explained in the introduction to its November 2022 issue focusing specifically on "persons with disabilities in armed conflict."

Why is disability described as 'hidden'?

The "hidden" nature of the problem can be partially explained because of how it manifests, suggested Abord-Hugon. 

A disability is defined as any impairment that limits a person's abilities and "if you see a wheelchair on the street, then that is fairly obvious," she told DW. "But this also applies to somebody who can't walk properly — they may have been shot or have broken their leg and it has not healed properly. Or it could be somebody who has difficulty hearing or seeing. So that's the kind of thing you cannot see."

Cerimovic also thinks that there hasn't been as much focus on Syria's disabled recently because, despite the worryingly high numbers, the conflict has been going on for so long now that there's no solution in sight and many other issues coming up continuously — such as the fight over cross-border aid deliveries and political issues around the authoritarian Syrian government headed by Bashar Assad.

The topic may be sidelined but it obviously has significant repercussions on the country's social and economic landscape, both Cerimovic and Abord-Hugon said.

Researchers at the UK's Institute of Development Studies say it's difficult to know how many disabled people there were in Syria before the war started in 2011 due to "a lack of systematic surveying, the persistence of negative social stigmas that prevent disclosure of disability and the general difficulty linked to assessing disability." It could have been anywhere between 8% of the population and closer to the 15% that is considered the world average, they concluded.

A different future for a third of Syrians

Today's much higher numbers "mean that a third of the population has a very different perspective on the future and on work," Handicap International's Abord-Hugon says. "It's also a question of self-esteem. These people fear they are useless, that they are dependent on their families or they cannot support their families. So there's a high psychological cost and also a high economic cost."

"We've noticed some cases of persons with disabilities who withdraw into themselves because of things like negative reactions from their parents or inappropriate social reactions," says the SND's Mahmoud. His organization tries to counter that with education, he notes.

Other research in Syria indicates that having disabled family members increases the likelihood of unemployment and dropping out of school, which generally means households are less able to meet their basic needs.

For example, Fatima al-Abdullah's relatives are increasingly worried about what to do with the her. Her father and brother died in February's earthquake and her mother and other siblings were injured.  Al-Abdullah, 15, is now a quadriplegic and has undergone spinal surgery for free at the Idlib hospital run by the Syrian American Medical Society.

"But there are lots of other costs that we have to cover," says the teenager's aunt, Munira Um-Mohammed. "She needs more operations and she needs psychological care too. She has lost her home and her family and there is nobody to help cover these costs. We just don't know how we're going to manage."

"There's a whole generation of children growing up without the right care and it will most likely be more difficult for them to succeed later in life," adds Cerimovic.

More social inclusion for the disabled

There is perhaps one surprising aspect that's come out of having such a high percentage of disabled people in one community.

As Raya al-Jadir. an Iraqi-born researcher and disabled rights advocate, has argued: "To be born with a disability in an Arab culture you are often cast as a 'failure' in the eyes of society. As a woman, you are also seen as a 'burden'," al-Jadir wrote in a 2022 op-ed on disabled rights in the Middle East.

Activists like al-Jadir have argued there is much to do when it comes to the rights of, and respect for, disabled people in the region and further afield. It's about reframing perceptions, going from caring for the disabled to respecting their rights, they say. 

In some parts of Syria now, every family knows somebody with some kind of disability, Abord-Hugon points out.

"So, for better or worse, in terms of perceptions about disabilities, things are maybe a little different here," she notes. "People see that a disability isn't about God's will or fate. In that way, it potentially improves social inclusion for persons with a disability and empowers them to see things differently."

This story was updated on July 28, 2023, with extra comments from the SND in Idlib.