The Impact of Community-Based Rehabilitation in a Post-Conflict Environment of Sri Lanka
Purpose: Conflict and disability are closely associated; it is therefore significant to examine strategies at the grassroots-level for restoring the human rights of people with disabilities living in post-conflict societies. The aim of this study is to reveal the impact of and issues with community-based rehabilitation (CBR) in the Northern Province of Sri Lanka that was ravaged by civil war from 1983 to 2009.
Methods: The research was implemented in October 2016, in collaboration with a local NGO in the Mullaitivu district. A mixed-methods approach was followed, which included quantitative analysis of the NGO’s registration database of people with disabilities in the area (n=964), group interviews with 9 community rehabilitation committees (CRCs) of people with disabilities and their family members (n=118), and semi-structured interviews with clients of the CBR programme (n=5). Thematic analysis was applied to the narrative data.
Results: The quantitative analysis on clients of the NGO revealed that 60.9% of disabilities were related to war. Livelihood assistance was the most common type of self-reported need (44.6%). The qualitative analysis revealed that in communities with inadequate local resources, CRCs that had access to livelihood assistance made a positive impact on the socioeconomic conditions of people with disabilities and their family members. Potential issues were observed, such as the expectation of and dependence on the financial aid without self-help. Some people with disabilities would not attend CRCs if there were no financial benefits. As most of the participants had war-related disabilities, it is also possible that participation of people with intellectual and psychiatric disabilities unrelated to war may not have been promoted in some CRCs.
Conclusions: The CBR programme has had positive impacts on the living conditions of participants, albeit with some potential issues such as financial expectations and aid dependency. The authors argue that empowerment of people with disabilities and addressing socioeconomic inequality should be considered simultaneously.
Bogic M, Njoku A, Priebe S (2015). Long-term mental health of war-refugees: A systematic literature review. BMC international health and human rights; 15(1). doi:10.1186/s12914-015-0064-9
Boyce W (2000). Adaptation of community-based rehabilitation in areas of armed conflict. Asia Pacific Disability Rehabilitation Journal; 11(1).
Davidson L (2005). Recovery, self-management and the expert patient: Changing the culture of mental health from a UK perspective. Journal of Mental Health; 14(1): 25-35. doi:10.1080/09638230 500047968
Department of Census and Statistics, Sri Lanka – DCS (2011). Sri Lanka census of population and housing 2011. Colombo: DCS. Available from http://www.statistics.gov.lk/pophousat/cph2011/ [Accessed on 30 October 2016]
Department of Census and Statistics, Sri Lanka – DCS (2015). The spatial distribution of poverty in Sri Lanka. Colombo: DCS.
Department of Census and Statistics, Sri Lanka – DCS (2016). District official poverty lines. Available from http://www.statistics.gov.lk/poverty/monthly_poverty/index.htm [Accessed on 30 October 2016]
Eide AH (2006). Impact of community-based rehabilitation programmes: The case of Palestine. Scandinavian Journal of Disability Research; 8(4): 199-210. doi:10.1080/15017410500466750
Eide AH (2010). Community-based rehabilitation in post-conflict and emergency situations. In E Martz (ed.) Trauma rehabilitation after war and conflict: Community and individual perspectives: 97-110. New York: Springer New York. https://doi.org/10.1007/978-1-4419-5722-1_5
Ghobarah HA, Huth P, Russett B (2004). The post-war public health effects of civil conflict. Social Science and Medicine; 59(4): 869-884. doi:10.1016/j.socscimed.2003.11.043.
Goodhand J, Lewer N (1999). Sri Lanka: NGOs and peace-building in complex political emergencies. Third World Quarterly; 20(1): 69-87. https://doi.org/10.1080/01436599913929
Guest G, MacQueen KM, Namey EE (2011). Applied thematic analysis. London: Sage.
Husain F, Anderson M, Cardozo BL, Becknell K, Blanton C, Araki D, Vithana EK (2011). Prevalence of war-related mental health conditions and association with displacement status in post-war Jaffna district, Sri Lanka. JAMA; 306(5): 522-531. https://doi.org/10.1001/jama.2011.1052, PMid:21813430
Inter-agency Working Group on Reproductive Health in Crises (2010). Inter-agency field manual on reproductive health in humanitarian settings. Available from http://www.who.int/reproductivehealth/ publications/emergencies/field_manual/en/ [Accessed on 30 October 2016]
Kandasamy N, Soldatic K, Samararatne D (2016). Peace, justice and disabled women’s advocacy: Tamil women with disabilities in rural post-conflict Sri Lanka. Medicine, Conflict and Survival; 32: 1-19. doi:10.1080/13623699.2016.1237101
Keraite A, Sumathipala A, Siriwardhana C, Morgan C, Reininghaus U (2016). Exposure to conflict and disaster: A national survey on the prevalence of psychotic experiences in Sri Lanka. Schizophrenia Research; 171(1): 79-85. https://doi.org/10.1016/j.schres.2016.01.026. PMid:26817400
Kett M, Stubbs S, Yeo R (2005). Disability in conflict and emergency situations: Focus on Tsunami-affected areas. International Disability and Development Consortium Research Report. Available from http://www.pacificdisaster.net/pdnadmin/data/original/IDCC_2005_Disability_conflict.pdf
[Accessed on 30 October 2016]
Korf B (2004). War, livelihoods and vulnerability in Sri Lanka. Development and Change; 35(2): 275-295. https://doi.org/10.1111/j.1467-7660.2004.00352.x
Mathie A, Cunningham G (2003). From clients to citizens: Asset-based community development as a strategy for community-driven development. Development in practice; 13(5): 474-486. https://doi.org/10.1080/0961452032000125857
Mertens DM, Hesse-Biber S (2012). Triangulation and mixed methods research provocative positions. Journal of Mixed Methods Research; 6(2): 75-79. doi: 0.1177/1558689812437100
Midgley J, Conley A (2010). Social work and social development: Theories and skills for developmental social work. New York: Oxford University Press. https://doi.org/10.1093/acprof:oso/9780199732326.001.0001
Moore M (2013). Disability, global conflicts and crises. Disability and Society; 28(6): 741-743. doi: 10.1080/09687599.2013.832546
Morais N, Ahmad MM (2011). NGO-led microfinance: Potentials and challenges in conflict areas. Journal of International Development; 23(5): 629-640. https://doi.org/10.1002/jid.1672
Peat M (1997). Community Based Rehabilitation. London: WB Saunders.
Rifkin SB, Kangare M (2002). What is participation? In S Hartley (ed.). Community-Based Rehabilitation (CBR) as a participatory strategy in Africa: 37-49. London: University College London.
Rohwerder B (2013). Intellectual disabilities, violent conflict and humanitarian assistance: Advocacy of the forgotten. Disability and Society; 28(6): 770-783. doi:10.1080/09687599.2013.808574
Siriwardhana C, Adikari A, Pannala G, Roberts B, Siribaddana S, Abas M, Sumathipala A, Stewart R (2015). Changes in mental disorder prevalence among conflict-affected populations: A prospective study in Sri Lanka (COMRAID-R). BMC Psychiatry; 15(1). doi:10.1186/s12888-015-0424-y
Siriwardhana C, Adikari A, Van Bortel T, McCrone P, Sumathipala A (2013). An intervention to improve mental health care for conflict-affected forced migrants in low-resource primary care settings: A WHO MhGAP-based pilot study in Sri Lanka (COM-GAP study). Trials; 14(1). Available from http://www.trialsjournal.com/content/14/1/423 [Accessed on 1 November 2016] https://doi.org/10.1186/1745-6215-14-423. PMid:24321171. PMCid:PMC3906999
Siriwardhana C, Wickramage K (2014). Conflict, forced displacement and health in Sri Lanka: A review of the research landscape. Conflict and Health; 8(1). Available from http://www.conflictand health.com/content/8/1/2 [Accessed on 1 November 2016]. https://doi.org/10.1186/1752-1505-8-22. PMid:25400692. PMCid:PMC4232712
Somasundaram D (2010). Collective trauma in the Vanni: A qualitative inquiry into the mental health of the internally displaced due to the civil war in Sri Lanka. International Journal of Mental Health Systems; 4(1). Available from http://www.ijmhs.com/content/4/1/22 [Accessed on 1 November 2016] https://doi.org/10.1186/1752-4458-4-22. PMid:20667090 PMCid:PMC2923106
Somasundaram D, Sivayokan S (2013). Rebuilding community resilience in a post-war context: Developing insight and recommendations-a qualitative study in Northern Sri Lanka. International Journal of Mental Health Systems; 7(1). Available from http://www.ijmhs.com/content/7/1/3 [Accessed on 1 November 2016]. https://doi.org/10.1186/1752-4458-7-3. PMid:23305538. PMCid:PMC3630062
Sritharan J, Sritharan A (2014). Post-conflict Sri Lanka: The lack of mental health research and resources among affected populations. International Journal of Humanities and Social Science; 4(3): 151-156.
Summerfield D (2000). War and mental health: A brief overview. British Medical Journal; 321:232-235. https://doi.org/10.1136/bmj.321.7255.232. PMid:10903662. PMCid:PMC1118225
Taira BR, Cherian MN, Yakandawala H, Kesavan R, Samarage SM, DeSilva M (2010). Survey of emergency and surgical capacity in the conflict-affected regions of Sri Lanka. World Journal of Surgery; 34(3): 428-432. doi:10.1007/s00268-009-0254-5
Thapa SB, Hauff E (2012). Perceived needs, self-reported health and disability among displaced persons during an armed conflict in Nepal. Social Psychiatry and Psychiatric Epidemiology; 47(4): 589-595. https://doi.org/10.1007/s00127-011-0359-7. PMid:21476014. PMCid:PMC3304067
Uppsala Conflict Data Programme (2016). Number of deaths: Sri Lanka. Available from http://ucdp.uu.se/#country/780 [Accessed on 4 November 2016]
Vanni Rehabilitation Organisation for the Differently-Abled – VAROD (2016). Pathivugal. Vavuniya: VAROD.
Walton O (2008). Conflict, peace building and NGO legitimacy: National NGOs in Sri Lanka 1: Analysis. Conflict, Security and Development; 8(1): 133-167. https://doi.org/10.1080/14678800801977146
World Health Organization – WHO (2014). Concept note: Opening the GATE for assistive health technology: Shifting the paradigm. Geneva: WHO. Available from http://www.who.int/phi/ implementation/assistive_technology/concept_note.pdf?ua=1 [Accessed on 8 December 2016]
World Health Organization – WHO, United Nations Educational, Scientific and Cultural Organisation – UNESCO, International Labour Organisation – ILO, International Disability and Development Consortium – IDDC (2010). Community-based rehabilitation: CBR guidelines. Geneva: WHO.
XE Currency Converter [no date]. Available from http://www.xe.com/currencyconverter/%20 convert/?Amount=1&From=GBP&To=LKR [Accessed on 1 November 2016]
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