Human Rights Watch Submission to the CRPD Committee:

Human Rights Watch welcomes the opportunity to provide input to the Committee on the Rights of Persons with Disabilities (CRPD Committee) for its General Recommendation on accessibility. This submission draws from research we have conducted in India, Nepal, Peru, Russia, Uganda, Ghana, and China.[1]

This submission focuses on the following aspects of accessibility:

1.       Access to the physical environment;

2.      Accessibility of mainstream schools;

3.      Voting and participation in the electoral process;

4.      Access to healthcare services, including gender and sexual violence services and shelters; and 

5.      Presence and effectiveness of independent monitoring of facilities and services open to the public and the involvement of people with disabilities in both the implementation and monitoring of these facilities and services.

This document does not review every accessibility issue relevant to the abovementioned topics.  Rather, it underscores several concerns that figured most prominently in our research, and that significantly influence the degree to which persons with disabilities are able to exercise other rights, such as the right to education, the right to live independently and be included in their communities, and the right to work, among others. As the CRPD Committee notes, accessibility is an essential pre-condition for the enjoyment by persons with disabilities of civil, political, economic, social and cultural rights. As such, we stress the inherent interdependence and linkages between Article 9 on accessibility and other provisions of the Convention on the Rights of Persons with Disabilities (CRPD), and the need for a holistic interpretation of the Convention.[2]

1. Access to the Physical Environment

Physical barriers often limit the degree to which persons with disabilities can exercise their rights to mobility, education, employment, and health and rehabilitation services, among other rights.

One of the most direct infrastructural barriers that people with disabilities face is inaccessible housing.  Narrow hallways in public housing, the absence of working elevators, and the absence of accessible entry ramps can make it difficult or impossible for people who use wheelchairs to move within their homes and enter and exit their homes safely. For example, in Russia, many people with physical disabilities must crawl from room to room rather than use their wheelchairs due to narrow hallways and entryways, and seldom leave their homes. The Russian federal law “On the Social Protection of the Disabled” requires that physical infrastructure be accessible to people with disabilities, and entitles people with disabilities to accessible housing accommodations designated on their government health documents, such as first-floor apartments, for example. However, in 14 of the 15 cases that Human Rights Watch documented in which people submitted written complaints to the Russian government requesting government mandated accommodations, the government failed to relocate them or retrofit their apartment buildings.

Inaccessible school buildings constitute another significant barrier for persons with disabilities. Schools often lack reasonable accommodations such as disability-friendly toilets, accessible wheelchair ramps, and desks and blackboards at appropriate heights.  For example, in Nepal, many mainstream and special schools for children with disabilities lack accessible toilets and ramps.  Nepal’s School Sector Reform Program, which aims to improve access and quality within the education system, contains little or no provisions to make schools accessible for these children.

When hospitals and health clinics lack accessible entrances, people with disabilities must either rely on family members to help them enter and exit, or forego necessary exams and treatment.  For example, in Russia, some people with physical disabilities must travel for hours to reach health clinics with accessible entrances, rather than visiting clinics in their neighborhoods. In Uganda, women with disabilities reported to Human Rights Watch that health facilities lack ramps and accessible toilets, among other accommodations. These facilities are also located far away from peoples’ homes, which can make it difficult for women with disabilities to obtain time-bound health care, such as post-exposure prophylaxis or emergency contraception after rape, and other necessary services in a timely manner. For example, two rape survivors with physical disabilities told Human Rights Watch that they could not travel the long distance to health centers to seek post-rape care.  

Inaccessible transportation systems often prevent people with disabilities from going to school, work, and to doctors’ appointments and from socializing. In Nepal, children both with and without disabilities face difficulties getting to school due to a general lack of transportation. However, the problem is exacerbated for children with disabilities, many of whom cannot walk to school on their own, particularly in rural areas.

In light of these infrastructural barriers, Human Rights Watch recommends that the General Recommendation state clearly that:

-          legislation ensuring the right to accessibility includes adequate enforcement mechanisms. The draft General Comment states that legislation should prescribe mandatory application of accessibility standards as well as sanctions for those who fail to apply them. Human Rights Watch suggests that enforcement mechanisms should include mandatory training of local government officials responsible for implementing accessible construction laws, specifically ensuring that these officials respond in a prompt and effective manner to the complaints of people with disabilities regarding lack of accessibility and requests for reasonable accommodations;

-          special priority be granted to the establishment and monitoring of accessible housing, without which the enjoyment of other facets of the physical environment such as public transportation and school attendance are often not feasible; and

-          government programs that aim to increase accessibility take into account how issues of general shortage such as lack of transportation may disproportionately affect people with disabilities. These programs might grant children with disabilities priority in access to available services, for example.

2. Accessibility of Mainstream Schools

When mainstream school curricula, teacher training, and learning materials such as textbooks lack consideration for the needs of people with disabilities, children with disabilities face the prospect of limited, substandard, or no education. This in turn affects employment opportunities, quality of life, and the extent to which people with disabilities are able to live independently and support themselves.

Both the CRPD and the Convention on the Rights of the Child (CRC) guarantee children with disabilities free education accessible to all, and the CRPD specifies that children with disabilities are entitled to inclusive education in the general education system.[3]

To facilitate their participation, states under Article 24 of the CRPD are required to provide reasonable accommodations for individuals’ requirements in mainstream schools and to facilitate the learning of Braille, sign language, and augmentative and alternative forms of communication.[4]  States are also required to employ teachers, including those with disabilities, who are qualified in sign language or Braille, disability awareness, and educational techniques and materials to support persons with disabilities.[5] However, governments do not always enforce these provisions. In China, for example, students with hearing impairments reported to Human Rights Watch that they have no written notes provided in their schools and that sign language instruction is unavailable.  According to a Chinese disability activist and an inclusive education scholar, mainstream schools in China do not readily provide visual aids, Braille, electronic materials, or enlarged texts for students with visual impairments.

In Russia, people with intellectual or developmental disabilities, their parents, and disability rights activists reported that there are no national standards for inclusive education and that teachers in both mainstream and specialized schools lack training to educate students with intellectual and developmental disabilities. Although Nepal’s 2006 National Policy and Plan of Action on Disability includes teacher training for work with students with disabilities, most teachers are not adequately trained to do so.

Mainstream schools often deny students with disabilities reasonable accommodations in the form of modified curricula and evaluation methods. For example, in China, student evaluation methods lack flexibility, and teachers do not receive needed support or training to teach students with disabilities effectively. In Nepal, children with disabilities may be required to repeat a grade because the curriculum is inflexible; because teaching and evaluation methods do not meet their needs; or because of a lack of support and accommodations.

Human Rights Watch therefore recommends that the General Recommendation include a requirement that states put in place enforcement mechanisms to ensure adherence to and application of international and national laws and standards for inclusive education for children with disabilities, and that states adopt appropriate measures to ensure adequate teacher training in inclusive education methods, modified curricula, and appropriate means of communication.

3. Accessibility of Voting and Participation in the Electoral Process

For people with disabilities to vote and participate in the electoral process, they must have access to: voting materials that are easy to use and understand; accessible voting, public hearing and campaign facilities and venues; and voting and other decision-making procedures that allow people with disabilities reasonable accommodations such as the presence of family members to assist them.  Absent these accommodations, people with disabilities may be excluded from participating in decisions that affect their lives.

People with disabilities do not always have access to information on electoral candidates and voting materials in accessible formats.  In several communities in Peru, people who were blind did not receive Braille ballots. One disability rights activist reported to Human Rights Watch that Braille ballots must be requested, and election officials are not providing information on locating and providing ballots upon request. Information about the election process and the candidates should also be produced and distributed in an easy to understand format. 

Physical access to voting polls and participation in public hearings is often lacking due to the absence of reasonable accommodations. In Peru, disability rights activists reported to Human Rights Watch that polling stations often lack ramps or are not located on the first floors of buildings, making them difficult or impossible for people who use wheelchairs to access.  In several cases, election officials were unaware that Peruvian law permits them to move polling stations to more accessible facilities, and they refused to do so under the rationale that this would facilitate electoral fraud. In addition, Peruvian candidates with disabilities raised concerns about lack of accommodations at political party events during the 2011 campaign season. Similarly, in Russia, several disability rights activists told Human Rights Watch that Moscow voting facilities are often located on the second and third floors of schools that lack elevators. A Russian disability rights activist in the city of Sochi told Human Rights Watch that public hearings in the city’s Adler district are located on the third floor of the administrative building, where the elevator goes only to the second floor.  As a result, he cannot participate in dialogues with the city administration to discuss accessibility measures currently underway in Sochi. Lack of accessibility in Sochi is particularly significant in light of Russia’s commitment to host the March 2014 Winter Paralympic Games in the city, a commitment that obligates Russia to develop accessible infrastructure and services in Sochi and elsewhere in Russia.

Human Rights Watch also found that people with disabilities are sometimes denied the right to assistance in voting and representing themselves by a person of their own choice.  For example, Peru’s legal system provides that the only way to protect the legal rights of people requiring assistance with decision-making is to install a representative to act on their behalf, through a process called interdiction, which deprives a person with a disability of the right to exercise his or her civil rights. No legal mechanisms exist for supported decision-making. When people with physical, intellectual, and psychosocial disabilities arrived at polls accompanied by someone, they found that election officials addressed questions concerning them to their companions rather than to them. In the 2011 presidential elections, the Peruvian government also did not provide people with disabilities with information on necessary accommodations to support the exercise of their voting rights, such as facilitating someone to accompany a blind person to the polling station.

Accessibility also pertains to the right to vote. In India, following a 2007 Supreme Court judgment, the government began to put facilities in place to make polling stations more accessible to people with physical and sensory disabilities, including through the use of Braille-enabled electronic voting machines. However, the Indian government continues to deny the right of people with intellectual or mental disabilities to participate in the electoral process. A federal law disqualifies a person who “is of unsound mind and stands so declared by a competent Court” from registering to vote. Indeed, many countries place such voting restrictions on people with certain disabilities.

Human Rights Watch recommends that the General Recommendation explicitly recognize that:

-          election officials be fully trained and provided necessary resources to ensure the rights of persons with disabilities to participate in voting and the electoral process;

-          people with disabilities are included among election officials; 

-          people with disabilities are fully informed of their rights and provided information on candidates, voting, and broader participation in the electoral process, in accessible and easy-to-read formats; and

-          Legal restrictions barring people with certain disabilities from voting be lifted.

4. Accessibility of Healthcare Services, Gender & Sexual Violence Services and Shelters, and Justice for Women

Although people with disabilities are entitled to the highest attainable standard of health services in or near their communities, Human Rights Watch has found that people with disabilities encounter significant obstacles to accessing care. In particular, women with disabilities face distinctive barriers to accessing reproductive health, gender and sexual violence prevention programs, and the justice system. These obstacles impede the ability of people with disabilities to realize their right to health and to enjoy freedom from violence and abuse.

Due to lack of reasonable accommodations such as sign language interpretation, accessible medical equipment, and adequately trained medical care, people with disabilities face difficulties obtaining basic health care. For example, in Uganda, women with disabilities said in interviews that health facilities lack ramps, accessible beds and toilets, and sign language interpreters. In Russia, a lack of wheelchair accessible x-ray equipment and gynecological examination chairs forces people with physical disabilities to rely on family members to accompany them to doctors’ appointments, or to forego necessary examinations and treatments.  Russians who are deaf or hard of hearing reported to Human Rights Watch that health facilities lack sign language interpreters and that the 40 hours of free government-provided interpretation is often insufficient to cover their healthcare and other interpretation needs. In addition, they reported that these interpretation services are rarely available for medical emergencies. Russians who are deaf or hard of hearing also reported to Human Rights Watch that many health clinics lack online registration systems, forcing them to rely on family members to call and make doctors’ appointments.  Another concern is the absence of emergency health, fire, and police services accessible via text message.

People with disabilities also face barriers to accessing health care specific to their disabilities.  For example, in Ghana, a doctor reported that fewer than half of the country’s districts had community psychiatric nurses as of 2003, the last year for which statistics were available; and as of 2011, there were only 3 clinical psychologists out of an estimated 80 who were needed.[6]  

Women with disabilities encounter significant obstacles to accessing sexual and reproductive health care.  For example, in the northern region of Uganda, women with disabilities who survive rape find it especially difficult to get post-exposure prophylaxis and other necessary treatment, such as emergency contraception, because of physically inaccessible transportation and healthcare facilities, as well as lack of confidentiality due to deaf women’s need to bring family members as sign language interpreters.

Women with disabilities also face attitudinal barriers to obtaining sexual and reproductive health care.  For example, in Uganda, healthcare personnel verbally mistreated women with disabilities for getting pregnant.  A parliamentarian representing women with disabilities said, “Delivery beds are extremely high and have wheels. [The nurses] tell you to get on the bed. You try to get on, but the bed is rolling. They say, ‘You get on the bed! How did you get on the bed where you got pregnant?’” In Russia, a gynecologist told a pregnant woman with a physical disability, “What right do you have to give birth?” and doctors in a maternity hospital prevented a blind woman from seeing her newborn daughter for an entire year after the birth. Human Rights Watch found that women and girls with disabilities in Argentina are infantilized in the reproductive health system, and stripped of their capacity to make decisions about available services. One woman told Human Rights Watch that some doctors thought her incapable of remembering to take her daily contraceptive pill because she is blind.

Emergency shelters for survivors of domestic violence are inaccessible to women with disabilities in many countries. In Turkey, we researched the response to domestic violence in six cities, and found that none of these locations had domestic violence shelters (state or private) that could accommodate women with physical disabilities.

Lack of access to law enforcement services and justice is another major problem for women with disabilities who are survivors of sexual and gender-based violence. Reporting crimes such as domestic violence to police is impossible for women with disabilities if police stations and services are not physically accessible, or if there is no adaptive communication technology or ability to use sign language. In Uganda, the government has not taken all necessary steps to adequately investigate and prosecute sexual and gender-based violence committed against women with disabilities. One important aspect of facilitating access to justice for women with disabilities is to make “procedural and age-appropriate accommodations in all legal proceedings, in order to enable persons with disabilities to participate fully and equally in the process, whether as complainant, defendant or witness.”[7] For example, criminal procedure law in Uganda (1909 Evidence Act) does not provide accommodations for people who cannot speak. Appropriate accommodations include meeting physical and communication needs such as ramps, accessible podiums, sign language interpretation, and Braille and large print text of court documents, as well as training of law enforcement and legal professionals in how to respectfully communicate and interact with persons with disabilities, particularly women.  

Human Rights Watch recommends that the Committee include in its General Recommendation:

-          particular emphasis on monitoring the provision of all health services, particularly services for people with intellectual or psychosocial disabilities and for women with disabilities, to determine whether these services reach people on an equitable basis. Consideration should be given to the accessibility of facilities, information and communication of health and emergency services, as stated in the draft, as well as the location of health services in or near peoples’ communities. People with disabilities should be fully included in monitoring of these services’ accessibility;

-          the need for accommodations for rape survivors to obtain immediate health care and prophylaxis and promote measures to enforce gender and sexual violence services; and

-          the need for sign language interpreters available to people with disabilities for medical and sexual violence-related emergencies, including, if necessary, these intepreters’ presence at hospitals, police stations, shelters, and rape crisis centers.

-          The need for augmentive and alternative communication capacity for hot-lines to report domestic and sexual violence.

5.  Presence and effectiveness of independent monitoring of accessibility of facilities and services open to the public and the involvement of people with disabilities in both the implementation and monitoring of these facilities and services.

Through our research in China, Ghana, Peru, Russia, and Uganda, Human Rights Watch has found that states parties to the CRPD and their international partners could do much more to ensure the independent monitoring of accessibility of facilities and services open to the public. States parties could also go farther to ensure that persons with disabilities are involved and participate fully in these monitoring processes and in the design and implementation of accessibility measures such as new construction standards.

International donors, development agencies and international organizations also often lack a system of monitoring and reporting to ensure that services that they sponsor, fund and assist are accessible to people with disabilities. For example, some development organizations in Nepal do not have specific indicators to measure whether development assistance projects are accessible for people with disabilities. In many cases, the lack of specific requirements for accessibility results in inaccessible infrastructure, such as inaccessible toilets in schools, which excludes persons with disabilities.  The International Paralympic Committee requires “continuous co-operation” with the Russian Olympic Organizing Committee, “including periodical project reviews, working groups and other means,” to ensure that the organizing committee is progressing towards an accessible and inclusive environment in host cities,[8] and the IPC indicated in a letter to Human Rights Watch that they are carrying out regular accessibility monitoring in the Olympic Park and wider Sochi.[9]  However, Human Rights Watch found that many facilities and services open to the public in Sochi remain inaccessible to people with disabilities, including public transportation, private businesses, emergency services, schools, and administrative buildings, among other facilities and services.

As we found in Nepal, China and Russia, people with disabilities are not included in the planning and implementation of projects aimed to increase accessibility of infrastructure or services. For example, China lacks formal mechanisms at all levels of education to ensure active involvement of parents and children and young people with disabilities in the implementation of inclusive education. In Russia, the Sochi 2014 Organizing Committee developed new federal construction norms to ensure accessibility, in consultation with the International Paralympic Committee. However, a local activist told Human Rights Watch that disabled persons organizations had no official role in the creation of those documents, and that they contain important flaws and omissions.

As the draft General Comment acknowledges, multiple stakeholders are involved in construction processes, and training in universal design and monitoring mechanisms should take place in relation to each of these groups. In the four regions of Russia where Human Rights Watch conducted accessibility research, disability rights activists stated that implementation of national accessible construction standards was difficult due to the many parties involved in the construction process. Architects, engineers, urban planners, and multiple construction contractors are several of the parties involved at different points throughout the construction of facilities such as schools, administrative buildings, and transport stations, among other facilities. Monitors who may provide input to architects and engineers at the start of the construction process might not ensure that builders and other stakeholders who become involved later in the process implement these standards. According to Russian disability rights activists with whom Human Rights Watch spoke, monitors also lack training in universal design. Accessibility flaws such as improperly placed tactile floor strips to guide people who are blind or low vision through an entryway, or ramps built at too sharp an angle are often not caught due to this lack of continuous monitoring and inadequate training.

Human Rights Watch recommends that

--the Committee reaffirm  that training and monitoring mechanisms be established for all groups involved in the construction process so that accessibility standards are implemented in practice; and

--the Committee include in its General Recommendation the need for concrete national mechanisms to ensure the involvement of persons with disabilities in the conception, implementation, and monitoring of infrastructure and services, including infrastructure and services available to the general public. This can be done by establishing relationships with local disabled persons’ organizations, and by creating an accessibility advisory body which should include experts with disabilities.

The five issues concerning accessibility discussed in this submission do not represent an exhaustive listof accessibility challenges that Human Rights Watch has identified in its disability rights research. These areas are nonetheless foundational to the realization of other human rights that the Committee has emphasized in the introduction to its draft General Comment, including the rights to freedom of opinion and expression, public service, and freedom of movement, among other rights.

We hope that our research findings and recommendations prove useful to the Committee as it finalizes its General Comment with its emphasis on the need for a seamlessly accessible environment and effective monitoring. We are available for additional comment as well as any questions that the Committee may have as the Committee prepares the final version of the General Comment.