COVID-19 pandemic and its impact on persons with disabilities in Nepal

COVID-19 pandemic has a huge negative impact in the lives of persons with disabilities in Nepal. The weeks longer countrywide lockdown has worsened the lives of those persons with disabilities who used to depend upon daily basis wages. Since disability and poverty has a vicious cycle as they reinforce each other contributing to increased vulnerability and exclusion, the COVID-19 pandemic has also negatively impacted to create the vulnerability of persons with disabilities in Nepal. Nepal Government including various development actors has taken several control measures of COVID-19 pandemic. However, there is no meaningful participation of persons with disabilities and Organisations of Persons with Disabilities (OPD). This has consequently excluded persons with disabilities from addressing their special needs in COVID-19 pandemic. 

Persons with disabilities are being at most risk of COVID-19 pandemic, Nepal Government including other international humanitarian actors should primarily include them at all cycles of planning, implementation and monitoring process of COVID-19 pandemic control, response and recovery phases. All the information related with COVID-19 pandemic should be accessible to all including persons with disabilities. And, they should be equally provided all the basic necessities of health services, immediate relief materials, health and hygiene kits and psychosocial support on an equal basis with others. The government should take data disaggregation based on age, disability and sex systematically to ensure that no one is left behind from the government’s initiatives addressing COVID-19 pandemic in its all phases. 

Context

Over the last few months, the whole world is collectively fighting against the corona virus 2019 (COVID-19) pandemic to keep us all safe. The COVID-19 was first identified in December 2019 in Wuhan, the capital city of China’s Hubei province, and has since spread globally, resulting in the ongoing pandemic. According to the World Health Organisation (WHO) COVID-19 situation report – 94 as of April 23, 2020, total 2,544,792 people have been tested positive and 175,694 have already lost their lives. The COVID-19 outbreak has already reached more than 210 countries. Comparatively, the European region is found to be badly affected with 1,251,458 people infected and 113,336 people who have died.

However, the latest updates by the CNN says that the United States is now reporting more coronavirus deaths than any other country in the world. The situation shows higher risks to be further continued in all other regions as well. In recent days, the cases in South Asia have gradually increased with deaths now recorded in Pakistan, India and Bangladesh. In Nepal, the Ministry of Health and Population confirmed that 9 people tested were found to be COVID-19 positive as of April 11, 2020. WHO has already formally announced its alert to the South Asia region to be conscious by taking all the possible measurers in order to stop the virus from spreading. Almost all South Asian Association of the Regional Cooperation (SAARC) countries are under the countrywide lockdown for 2/3 weeks. And, this seems to be prolonged for even more weeks. 

Purpose of this report

The major purpose of this situation report is to document the current situation of persons with disabilities caused by COVID-19 pandemic in Nepal. And, share it with wider concerned actors to draw their serious attention to make COVID-19 pandemic’s control, response and recovery actions disability inclusive and gender specific. 

Scope and Limitation of this Report

This report is voluntarily prepared in an individual initiation. All the information, facts and figures used here in this report are completely based on secondary source of information which are already published or broadcasted in both – electronic cum print media. No financial support from any agencies or persons is taken to prepare this report. This report gives overview of current situation of persons with disabilities as how they are impacted from COVID-19 pandemic in Nepal. 

Methodology 

This report is prepared based on the secondary sources of information which are already published in different sources. Based on these information, the current situation of COVID-19 pandemic and its effect to the lives of persons with disabilities is analysed and interpreted qualitatively. 

COVID-19 Pandemic in Nepal

Despite of COVID-19 cases spreading over many countries, the Nepal Government did not immediately take such serious control measures. However, the first appeal was issued by Office of Tribhuwan International Airport Civil Aviation of Civil Aviation Authority of Nepal on February 4, 2020 announcing that Tribhuwan International Airport health desk was stepped up with thermal scanner against coronavirus. But, the first COVID-19 case was formally identified in Nepal on January 25, 2020 with a 32-year Nepali student who used to study in Wuhan city of China, was tested positive.

With this identified case in Nepal, the COVID-19 outbreak created a kind of threat to all general public. And, therefore, the Nepal Government took immediate actions with the formal restrictions on Chinese tourists, followed by the postponement of international flights. The Nepal Government temporarily suspended visas on arrival for Chinese, Iranian, Italian, Korean and Japanese visitors to restrict the spread of COVID-19 within its borders on March 10, 2020. Similarly, the Nepal Government formally suspended “Visit Nepal 2020” tourist campaign amid escalation of COVID-19 along with the Sagarmatha Dialogue. On March 11, 2020, the WHO Director–General declared COVID-19 as a pandemic with more than 118,000 cases in 114 countries and 4,291 deaths. The Nepal   Government suddenly announced countrywide lockdown initially for a week commencing from March 24 to 31st, 2020. But, it was again prolonged till April 5, 2020 for a second time and, then again to April 15, 2020 for its third time. Analysing the current effect of this COVID-19 pandemic, there is no other alternative than prolonged lockdown in Nepal.  

As of April 23, 2020, the Ministry of Health and Population (MoHP) has done Rapid Diagnostic Test (RDT) to 34,523 people and Polymerase Chain Reaction (PCR) to 9,200 people. Out of these tests, 48 people are found with COVID-19 positive till the date where 9 of them have already recovered and back to their home. There is no death case reported yet in Nepal due to COVID-19 pandemic. 

COVID-19 pandemic and its effect on general public lives

The COVID-19 has led to lockdowns all over the world. The only positive development of the lockdown has been growth in the environmental quality. It has unprecedented affects in general people’s lives indiscriminately. Since the lockdown has been identified and introduced as only the one best alternative to control its transmission, the unplanned and chaotic lockdown has worsened the general public’s lives. Therefore, COVID-19 is not just a health pandemic but it is also socio-economic and cultural pandemic as people’s lives have been put into crisis. 

Although the pandemic affects people across all walks of life, certain groups are more impacted than others. Many people from lower class who used to work in the informal sector were badly affected from COVID-19 pandemic in Nepal. The people with long term diseases are facing a great challenge of accessing medicines and regular health checkups easily. Many small and micro entrepreneurs in Nepal are losing their businesses due to a prolong countrywide lockdowns. The excluded and marginalised castes and ethnic communities like Dalit, indigenous and Madhesi people are compelled to lose their labor and daily wages. And, this has resulted in hardship for their daily existence. Similarly, high numbers of youths from Sudurpaschim province along with other provinces used to go to India as seasonal migrant workers for their livelihoods. They are now forced to return to their home country due to COVID-19 pandemic. While returning, they faced lots of challenges at Nepal-India boarders and forced to stay under open sky without proper foods and safe quarantines. 

COVID-19 pandemic and its effect on persons with disabilities’ lives

Although COVID-19 spreads indiscriminately, certain groups are disproportionately impacted. These include those already marginalised by structural barriers and gender inequalities: among them, older persons, women (including pregnant women) and girls, persons living with disabilities, caregivers and migrant and informal sectors workers. Globally, more than one billion people which is roughly 15% of the world’s total population – live with some form of disability. 80% of them live in developing and underdeveloped countries like Nepal. Persons with disabilities are among the world’s most marginalised and stigmatised even under the normal circumstances. They do often have underlying health conditions which make them more vulnerable to get infected by COVID-19. According to the Central Bureau Statistics (CBS) of 2011 of Nepal Government, there are about 2% (1.94% i.e. 513,321) people who are living with some forms of disability.

Persons with disabilities in Nepal are adversely affected by this COVID-19 pandemic and their lives have been put at risk due to the abrupt and unsystematic nationwide lockdown by the Nepal Government. Persons with disabilities are not a homogenous group and, therefore, their needs or requirements differ based on their individual identity and condition. However, the Nepal   Government’s blanket approach to address the needs or requirements of people in such humanitarian crises always seem ignorant of these facts. Hence, the current challenges faced by persons with disabilities due to this COVID-19 pandemic is categorised below: 

Lack of access to information on an equal basis with others

Access to information is a fundamental human rights of every individual. Therefore, the Convention on the Rights of Persons with Disabilities 2006 (CRPD) article 21 – freedom of expression and opinion, and access to information mandates all state parties to make sure that all persons with disabilities have equal access to information on an equal basis to others. This provision is further reiterated in CRPD with the article 8 on awareness raisins and article -9 on accessibility. Despite of these provisions, there are many challenges faced by persons with disabilities in Nepal for the COVID-19 pandemic despite of being a state party of this convention. One of the major challenges faced by persons with disabilities is that none of the communication and mass awareness raising informative materials developed and disseminated were in accessible formats and easy-to-read versions. There were no sign language interpretations and appropriate captioning in the COVID-19 pandemic media briefing organised by the MoHP of Nepal Government. Due to these limitations, persons who are deaf and hard of hearing were completely left behind in awareness about the pandemic. Many governmental and nongovernmental national and international development agencies collaborating with MoHP has designed, published and disseminated various mass awareness raising informative materials on COVID-19 pandemic control. 

Despite of these attempts, such informative materials could not address the especial requirements of those people who are with autism, developmental disabilities, deaf, blind, hard of hearing and others could not access this information on an equal basis with others. According to the CBS 2011, Nepal has 121 caste and ethnic communities with 123 lingual people. Therefore, persons with disabilities from particular ethnic communities who need the information on their own native languages to know about the COVID-19 pandemic controls are not considered at all at this crisis. Many articles are written in this regard in print media. 

Some media especially FM, Radio and televisions are frequently messaging on COVID-19 pandemic control measures through different audio and visual materials. These information materials also lack accessible formats, easy-to-read versions, multi-lingual messages and disability inclusive perspectives. For example, the Nepal Government abruptly called for countrywide lockdown which was not well known by many persons with disabilities. Consequently, they could not get adequate time for their personal survival needs arrangement and, thereby, facing various challenges for right to live. 

Lack of access to sanitation and hygiene kits on an equal basis with others

Persons with disabilities like others want to get safe from COVID-19 pandemic. However, they do not have access to sanitation and hygiene kits on an equal basis with others. For instance – hand sanitisers, face masks, hand gloves, hand washing soaps, adequate clean water. Due to abruptly created shortage in the markets, they could not have access to these kits. Now, they are more at risk. 

For instance, Mr. Suman Palikhel is a self-advocate for disability rights from Bhaktapur district of Nepal. Mr. Palikhel is a person who has severe type of cerebral palsy. He does door-to-door education program for those children with severe types of health conditions who cannot go to formal education programs. In addition, he is also running a day care program as part of inclusive education programs. Mr. Palikhel shared that he is not able to continue his day care program due to the lack of sanitation and hygiene kits. He said that he made requests but he could not obtain them for the children, placing them at greater risk. 

Lack of access to medical kits and clinical apparatus

As mentioned above, persons with disabilities are heterogeneous groups. Some persons with severe disabilities or who have chronic health conditions require continual medical checkups, medical kits and clinical apparatus. But, they are completely forgotten by the Nepal Government. There was one formal decision made by the MoHP to postpone all Outpatient Department (OPD) services in all Government hospitals and convert them to COVID-19 related services. This decision, created some policy barriers from getting an access to regular health checkups and other medicinal access. 

Persons who have haemophilia need factor VIII (8) and plasma regularly. But, the government’s abrupt decision has created a big threat to their lives. Pushpalal Tamang is 44 years old with haemophilia from Dhankuta district, Nepal. He belongs to the indigenous community. He has bleeding at least four times a month with severe pain. He has to use factor VIII (8) and plasma CRYO every time to stop this. His supply has been used up during this lockdown. He has been bleeding for the last four days and he has no option but to give up his life if the bleeding does not stop itself. Though the Nepal Government lacks accurate and reliable data of with haemophilia, it is roughly estimated that there are about 700 persons with haemophilia throughout the country according to Nepal Haemophilia Society (NHS). They all are facing the same challenges at the moment.  

Devi Acharya, a woman with spinal cord injury and wheelchair user shares that she is facing a great health challenge due to the unavailability of diaper, urine bag, gloves, and Clean Intermittent Catheterisation (CIC) pipes during these lockdown period. She used to be supported by her personnel assistant before this COVID-19 pandemic. But her personnel assistant is not coming because of the lockdown. She further reported that there are about 300 women and girls with spinal cord injuries like her in Kathmandu. All facing the same challenges. This COVID-19 response and lockdown is creating new and large health challenges for many persons with disabilities. 

Lack of accessible and gender specific quarantines

Nepal Government has built 34,394 quarantine beds and 3,126 isolation beds throughout the country to support with COVID-19. For instance, the Nepal Army set up a quarantine zone at their headquarters in Tripureshwor, in preparation for a COVID-19 outbreak. The camp can accommodate 108 patients with 2 in each tent. There are  isolation rooms, regular check-up rooms and a tap water system has also been established. Accessibility and gender specific requirements are not adequately addressed. There are no accessible toilets. These newly established areas have similar conditions. Therefore, accessible and gender specific quarantines are must for persons with disabilities. Women and girls with disabilities need reasonable accommodation to address their needs.  

Lack of appropriate disability and gender specific data disaggregation

Data is very crucial as it helps to have appropriate and realistic plan immediately in such humanitarian crisis. To date, the data of persons with disabilities who have been with COVID-19 is not available even globally. Data lacks disability and gender specific disaggregation e.g. infected and mortality rates among specific populations. Data disaggregation is also closely related with the poverty and exclusion. Therefore, data disaggregation can help Nepal Government to make its response and control measures plan more effective and inclusive reducing barriers to COVID-19 and other health services. 

Lack of access to government’s relief packages on an equal basis with others

Nepal Government decided to prolong lockdown weeks more long. Therefore, it announced a slew of decisions, measures and relief packages. Since the lockdown halted businesses, it also created problems for the poor. The local government is authorised to provide food mainly based on the data of those working in informal sectors. There are many evidences shared by local level that persons with disabilities who do not have adequate foods at their houses could not access these relief packages on an equal basis with others as published in news media. 

In Kathmandu, many persons who are visually impaired used to manage their daily foods through the singing on the food paths are completely halted. And, they are now in big crisis of accessing these relief packages since local governments asks for various legal documents at this crisis.  Some rehabilitation centres run by OPD has faced a similar kinds of challenge to purchase food materials for survival. Similarly, persons who are at with severe health conditions and who are deaf or visually impaired are not getting information in appropriate way. These are causing big challenges leaving them behind from accessing these relief packages. The local government has not set up the appropriate measures as how they can reach to those needy people at this crisis. 

Lack of meaningful participation and consultations of persons with disabilities and their representative organisations

Analysing the COVID-19 pandemic, WHO has announced that the ageing population, people with chronic health conditions, persons with disabilities, pregnant women and children are at most risk. Different international human rights frameworks mandate states to ensure their equal participation and consultations in COVID-19 pandemic control and response action. 

Nepal Government current structures and mechanism from federal-to-provincial-to-local levels has not ensured the meaningful participation and consultations of Organisations of Persons with Disabilities (OPDs). Due to the absence of OPDs, there are many gaps in terms of addressing the needs or requirements of persons with disabilities in their actions. As CRPD says – Nothing About Us Without Us is meant persons with disabilities and OPDs are the expert of their needs or requirements to tell or ask what they actually need.  

Lack of personnel attendance and individual support system

Though ‘social distancing’ is considered one of the most important measures to control the COVID-19 outbreak, this is not easy option for persons with disabilities who rely on personnel attendant for their daily lives. Thus, persons with disabilities and their care takers are at higher risks and more likely to die due to extreme contagious COVID-19. The government support system lacks the trained sign language interpreters’ availability, trained human resources to deal with persons with disabilities in order to provide reasonable accommodation. The government has set up of online free call centres as help desk at this crisis. However, it lacks alternative measures to provide support to those who with intellectual disability, hard of hearing and deaf people. 

Lack of psychosocial support for mental health wellbeing

When WHO announced as COVID-19 could be characterised as pandemic in March, 2020, it generated stress throughout the population. As time passes, the COVID-19 pandemic’s affected and death rates rapidly increased throughout the world. There are two aspects of direct effect on the lives of persons with disabilities – one is being more anxious of life threatening and another is hardship created by extended countrywide lockdown. 

The persons who are with psychosocial disabilities and are with mental illness have been facing a great challenge and doubling their stresses and anxiety. The girls and women with disabilities who are with poor health conditions from Dalits, indigenous and Madhesi communities have been adversely affected. Similarly, those people who have psychosocial condition and mental illness might be deteriorated their health conditions. Nepal Government lacks adequate psychosocial support mechanism for supporting people’s mental health wellbeing.  

Nepali OPDs Initiatives for Disability Inclusive COVID-19 Pandemic Control and Response Actions

The Government did not consult Nepali OPDs at the initial stage despite being state party of CRPD. Therefore, the Nepal Government created huge gap in terms of addressing persons with disabilities needs and requirements. Realising these gaps, Nepali OPDs immediately took some measures to draw the serious attention of Nepal Government and other concerned stakeholders to make sure that the COVID-19 pandemic control and response actions are disability inclusive. The National Federation of the Disabled-Nepal (NFDN) – national umbrella organisation of all persons with disabilities and their representations organisations of Nepal, made its first appeal to  Nepal   Government and all concerned stakeholders on COVID-19 pandemic control mass awareness materials accessible for all including persons with disabilities dated March 21, 2020. After this, NFDN also developed a short informative video with sign language interpretation about COVID-19 pandemic followed by some additional appeals and precautionary information on it. On March 31, 2020, NFDN developed A General Guidelines for Persons with Disabilities and All Stakeholders on Disability Inclusive Response Against COVID-19 Pandemic and shared to its wider stakeholders through different electronic media. 

Then after, Nepal Disabled Women Association (NDWA) also made their public appeal to make COVID-19 response disability inclusive and gender specific on March 29, 2020. Following these initial initiatives by NFDN and NDWA, other OPDs made their public appeal to leave no persons with disabilities behind. The National Federation of the Deaf Nepal (NFDN) and the National Indigenous Disabled Women Association Nepal (NIDWAN) produced and disseminated COVID-19 pandemic videos with sign language interpretations. KOSHISH is providing free online psychosocial services. Some of the OPDs and disability leaders organised Facebook Live to broadly discuss and disseminate the advocacy strategies and its response actions. The advocacy efforts were also made at federal level with sectoral line ministries. Consequently, the Ministry of Women, Children and Senior Citizen (MoWCSS) influenced the MoHP. The policy level advocacy and influence to the government at all levels by OPDs is gradually increasing. 

Nepal Government’s initiatives for disability inclusive COVID-19 pandemic control and response actions

After the continual lobby and advocacy made by Nepali OPDs at federal and provincial levels, the MoHP began to disseminate COVID-19 media briefing by providing sign language interpretation too since April 9, 2020. Similarly, the Right Honourable Prime Minister KP Sharma Oli did address to the Nation on control and prevention of COVID-19 pandemic accompanied by sign language interpretation, for the first time in history on March 20, 2020. 

Following these good deeds, some of other provincial governments like Sudurpaschim and Gandaki Province of Nepal also has started to provide sign language interpretation in its COVID-19 media briefing. Nepal Television has started to provide sign language interpretation on COVID-19 pandemic related news. These are some good deeds, in fact, undertaken by Nepal Government. However, these are made possible with the frequent lobby and advocacy being undertaken by various Nepali OPDs. Despite of these good deeds, there are many areas to make COVID-19 pandemic control and response actions disability inclusive.

Conclusion

There are many areas of gaps where the Nepal Government can take immediate actions closely consulting and ensuring the participation of Nepali OPDs. The prolonged countrywide lockdown for more than a month has already created adverse situation to the poor and most excluded communities who used to work in informal sectors. The migrant workers, people from ethnic and cultural minorities, poorest people have been more affected with this action without taking anything into considerations. 

Nepali OPDs have taken some proactive actions to provide support to the Nepal   Government. These OPDs are supporting Nepal Governmentbyproviding all the necessary ideas and some sample works to control and response to the COVID-19 pandemic.  The Nepal   Government has also started to listen OPDs voices and therefore, has begun to practice some good deeds like ensuring sign language interpretations in its media briefing. But, there seems still a huge space to work for ensuring disability inclusion in COVID-19 pandemic. 

Recommendations

Based on the current situation of persons with disabilities during this COVID-19 pandemic in Nepal, following points are identified to take into consideration to make COVID-19 pandemic control and response actions disability inclusive: 

•  Nepal Government should immediately make sure that persons with disabilities and their OPDs have equal access to the information on an equal basis with others and they receive these mass awareness raising information of COVID-19 pandemic in an accessible format, easy to read versions and audio and visual materials. 
• Nepal Government should ensure that persons with disabilities have access to the sanitation and hygiene kits on an equal basis to the others. 
• Nepal Government should take immediate actions to make available of medical kits and clinical apparatus to persons with disabilities who needs these. 
• Nepal Government should make quarantines accessible to all and gender specific requirements are available. The relevant OPDs shall provide certain models on it to Nepal Government for the facilitation. 
• Data is very crucial for having most reliable and justifiable programs and policies. Therefore, Nepal Government should establish such system or mechanism to have detail data disaggregation based on age, disability and gender from local levels to provincial and to federal levels. 
• Nepal Government should establish appropriate mechanism to address all structural barriers including institutional or other kinds of barriers to access to the local governments relief packages on an equal basis with others. 
• Nepal Government should include persons with disabilities and OPDs into their mechanism and structures to better address the needs and requirements during these lockdown period of COVID-19 pandemic. 
• Nepal Government should establish a personnel attendance and individual support system during this COVID-19 pandemic.
• Nepal Government should make availability of psychosocial support to the greater population with easy access at this crisis.
• Nepal Government should come up with better social protection schemes to ensure that persons with disabilities including women with disabilities headed households are compensated through support packages and cash based transfers at this lockdown.
• Persons with disability rights advocates and OPDs should support in government’s initiatives providing required technical support and advices continuing their advocacy efforts.