Understanding the Barriers of a Disability-inclusive humanitarian response in mixed migration crisis:

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Understanding the Barriers of a Disability-inclusive

humanitarian response in mixed migration crisis:

A case study of the humanitarian response to the mixed migration

flows from Venezuela in Colombia.

By

Constanzza Sermeño Rosales

S3856143

December 2020

Supervised by Dr. Adhemar Mercado Auf der Maur

Faculty of Arts

University of Groningen

Netherlands

This thesis is submitted for obtaining the Master’s Degree in International Humanitarian Action. By submitting the thesis, the author certifies that the text is from his/her hand, does not include the work of someone else unless clearly indicated, and that the thesis has been produced in accordance with proper academic practices.

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1 Abstract

Persons with disabilities have been historically neglected and marginalized in contexts of conflict and displacement. The rising awareness of disability among academics and professionals is visible with an increase in publications, practitioners' guidelines, institutional policies in the past few years. Additionally, humanitarian actors have committed to focusing aid on those who need it most, determining that people with disabilities must be at the center of the response, eliminating the barriers to achieve full participation, and ensure equal access to humanitarian assistance. Nevertheless, there is a gap between theory and practice, visible in the lack of effective implementation of these strategies and systematically respond inclusively.

This research aims to understand the disability approach of humanitarians in the context of mixed migration to identify the challenges and barriers that contribute to this gap. To answer this, the case study of the Venezuelan mixed migration flux in Colombia is analyzed considering the migratory and sociopolitical complexity that the country is suffering, as well as the strong existing coordination mechanisms from the humanitarian organizations that are responding to the severe and varied health and protection needs of the Venezuelan population displaced in Colombia.

For this process, a mixed-method analysis was used, consisting of a quantitative part with 31 surveys applied to humanitarian professionals working on Colombia's migration response. The qualitative analysis was carried out through a desk review and ten semi-structured interviews with key informants.

This study stressed that one of the most significant difficulties that prevent an inclusive response is the perception of humanitarian actors about what disability entails. Although there is an awareness among the interviewed professionals in Colombia about the importance of prioritizing persons with disabilities, processes have not yet been adapted to include their perspective and ensure full access to the services. In other words, people with disabilities are systematically excluded from access to assistance and from having their specific needs met. To reduce this void between theory and practice, the research presents starting points of action, including the necessary training of teams at all levels to create awareness on the understanding of disability, as well as the importance of improving the standardization of processes and reliable, comparable information to generate awareness of the situation and needs of these individuals.

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2 Finally, the active participation and inclusion of organizations of people with disabilities and local organizations of migrants and refugees is necessary and may reduce inclusion barriers such as access and acceptance.

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Before 2015 and due to the armed conflict, Colombia was a country of mostly emigrants, mainly fleeing to Venezuela. However, from 2015 onwards, due to the worsening of the Venezuelan crisis, a change in the dynamics was generated between both countries, with the arrival of millions of Venezuelans in search of protection, economic, and health alternatives. Among those more marginalized and with higher protection risks are persons with disabilities, their families, and caregivers, as explained in this chapter.

Moreover, this chapter provides details of the background situation of persons with disabilities from the international framework to the contextual information of migrants and refugees from Venezuela in Colombia. This chapter also provides a short explanation of essential concepts for this work, such as migration, disability, and migration.

1.1. Background

As a part of the Agenda 2030 for Sustainable Development, in 2015, 193 United Nations (UN) Member States committed themselves to take action to reduce inequalities, eliminate extreme poverty and “leave no one behind.” And not only that, but the undertaking included reaching first those ¨furthest behind¨ (UN 2015, 6, IFRC 2018, 9). Likewise, international aid community attendees to the World Humanitarian Summit in Istanbul in 2016 presented the determination to continue with this commitment of reaching those most at risk of being left behind in the humanitarian aid collective response, being incorporated as one of the five core responsibilities of the Agenda for Humanity 1_{(Ki-moon 2016, 4, UN 2016, ALNAP 2018, 76). Remarkable}

progress has been attained worldwide, reaching, and improving the lives of those who need it the most in the last decades2_.

Notwithstanding these significant steps, accomplishing this commitment of leaving no one behind is not a simple task. Evidence demonstrates that this development has not been equally

1_{The World Humanitarian Summit intended to identify and agree on key commitments for the humanitarian} system's reform. It resulted in 32 major commitments, framed under five priority responsibilities, forming the Agenda for Humanity, the Secretary-General's policy framework for improving humanitarian action globally (ALNAP 2018, 76).

2_{Among the most significant achievements, about one billion people managed to escape from extreme poverty,} together with an increase of access to drinking water by 2,6 billion people, and the reduction of mortality rates of children under five years old was achieved (UNDP 2018, 6)

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8 achieved (Lenhardt and Samman 2015, 9), and millions of people are currently being left out in humanitarian interventions (IFRC 2018, 9). The United Nations Office for the Coordination of Humanitarian Affairs (OCHA) reported that in 2020, around 168 million people would need assistance or protection, representing one in every 45 persons worldwide (OCHA 2020, 4,22). However, due to several reasons -including, but not limited to, financial restrictions- humanitarian organizations estimated to assist only around 65% of these people of concern in 2020 (OCHA 2020, 4,22). This gap in the possibility to assist has increased from 27% in 2018 (IFRC 2018, 4) to 35% today, a trend that is likely to continue, considering that allocated international funds are not moving at the same rate as conflicts or disasters are. The Secretary-General of the International Federation of the Red Cross (IFRC) warns that the situation is even more alarming, as their analysis of several 2017 operations determined that less than half of the estimated number of people in need actually received humanitarian assistance with international support (IFRC 2018, 4).

Moreover, when different characteristics intersect, these gaps are more significant, resulting in further discrimination and exclusion. This is the case of people with disabilities who are considered one of the most marginalized and affected population groups in emergency settings (WHO and World Bank 2011) facing higher protection risks linked directly to their impairment3_.

When the disability condition interacts with other individual, socioeconomic characteristics4_{, it}

can lead to situations where their specific needs are neglected or "invisible" for humanitarian responders, causing a decrease of opportunities for participation, as well as unmet needs (Berghs, 2015, 445; Berghs and Kabbara, 2016, 274; Mirza 2014, 1; ALNAP, 2018, 125, 141) —in other

3_{These risks range from physical or emotional abuse to denial of access to food and health and neglect of care and} response to basic needs (UNHCR 2019c, 19). People with disabilities are 1,5 times more likely to suffer violence in contrast to people without disabilities (Dowse, Frohmader and Didi 2016, 326, UN 2018, 251). This ratio increases to four times when referring to those with cognitive disabilities (UN 2018, 251) and children with disabilities (Dowse, Frohmader and Didi 2016, 326). Women with disabilities have almost three times higher possibilities of being victims of violence compared to their peers without disabilities (Dowse, Frohmader and Didi 2016, 326). Even though it is well known that the cases of gender-based violence are underreported, evidence suggest that the prevalence of this situation is aggravated in the case of girls and women with cognitive and sensory disabilities due to further communication obstacles (UN 2018, 115, Dowse, Frohmader and Didi 2016, 324). Regarding health disparities, the World Report on Disability informed that from 51 countries surveyed, people with disabilities reported being almost three times more likely to be denied receiving treatment, as well as four times higher than people without disabilities to declare to be mistreated during health care (WHO and World Bank 2011, 9). Finally, people with disabilities’ mortality rate are twice to four times higher than people without disabilities (OCHA 2020, 75).

4_{As the legal and documentation situation, dependents under their responsibilities -or their caregivers’-, social} network during transit and in their host country, high levels of discrimination and stigma.

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words, creating conditions of greater inequality and vulnerability. Consequently, acknowledging the importance of understanding how these experiences and characteristics interact and the value of considering the more complex and multi-layered social relations, this research applies an intersectionality approach as an analytical tool to achieve a critical perspective in a humanitarian migration response. Intersectionality in this study refers to "the interaction between gender, race, class and other categories of difference in individual lives, social practices, institutional arrangements, and cultural ideologies and the outcomes of these interactions in terms of power." (Davis 2008, 68). This approach will be further detailed in section 2.1.

1.2 Persons with disability and inclusive response

Although the conceptualization of disability is central for this research and will be further discussed in chapter 2, this work assumes a disability approach reflected in the United Nations Convention of the Rights of Persons with Disabilities (henceforth “the convention” or CRPD). Thus, in this work, “persons with disabilities” include “those who have long-term physical, mental, intellectual, or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others” (UN 2006, art. 1). This concept bolsters the understanding that persons with disabilities are firstly right holders and that the disability condition is not inherent to the individual, rather on the interaction between the individual, societal and contextual aspects (UNHCR 2019c, 5). In this regard, disability studies provide an essential framework of analysis for this research, presenting a change of perspective from the "medical model" to the "social model" of disability, allowing to examine stakeholders' actions and perception of disability. Often, humanitarian responses still apply the medical model, which considers disability a problem-focused on the individual, that must be treated, rehabilitated, or cured, considering that the impairment leads to exclusion and it is a problem of the person (Degener 2017, 42).

On the other hand, the social model of disability, framework applied in this work, in the words of Degener (2017, 42) allows differentiating between impairment, being just a component of disability, which relates to “the condition of the body or mind”5_{, and disability resulting from}

how “environment and society respond to the impairment”. According to the social model of disability, the exclusion is not a consequence of individuals' impairment but rather the

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10 discrimination instituted through the social level. Therefore, the social model of disability constitutes a tool that enables the analysis of the barriers of exclusion, discrimination, and oppression structures that people with disabilities face, preventing them from achieving full integration and participation in society.

1.2.1 Disability-inclusive humanitarian response

The adoption of the CRPD in 2006 is one of the most important steps forwards for putting persons with disabilities at the center, being ratified by 182 countries (UNDESA 2019, UN 2015). It is the first human rights instrument of the 21st century to propose a "paradigm shift" in attitudes and approaches to persons with disabilities, promoting the rights and respect for the dignity of persons with impairments, in other words, recognizing them as subjects of rights (WHO and World Bank 2011, 7). More specifically, Article 11 sets out the obligation to ensure the safety and protection of persons with disabilities in humanitarian emergencies, calling for a more disability-inclusive humanitarian response (UN 2006).

As elucidated by Sien Andries, Inclusive Humanitarian Action Specialist from the organization Humanity & Inclusion (HI), in the webinar “Persons with disabilities in humanitarian response” a disability-inclusive humanitarian response can be explained in three sections:First, by defining ‘inclusion,’ which is the process and the concept to systematically ensure meaningful participation of all persons and groups in all aspects of life without discrimination (Andriens in ICVA, PHAP and IASC 2020). Secondly, an inclusive-humanitarian action is about promoting and respecting the lives of all individuals in situation of humanitarian crisis, looking after their right to equal protection and access to assistance without any form of discrimination, including age, gender, ability, religious backgrounds, amongst others and their respective intersections (ICVA, PHAP and IASC 2020). Finally, the inclusion of people with disabilities in humanitarian aid, is placing the rights of persons with disabilities at the center, ensuring their protection, safety, and equal access to assistance by incorporating those rights into every part of the work of the Organization (ICVA, PHAP and IASC 2020).

The UN (2019,6) adds that this promotion of the rights should also be included through disability-specific programs, with the active participation and perceptions of these population groups. UNHCR (2019c, 8) recognizes that to achieve inclusion, the removal of barriers linked to physical, communication, legal frameworks and policies, and behaviors or attitudes should be

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11 addressed. Thus, it highlights the responsibility that humanitarian actors must create and adjust programming to make accessible, equal opportunities and full participation of persons with disabilities (UNHCR 2019c, 8).

1.3 Disability in Mixed Migration Context

The World Health Organization (WHO) estimated that people with disabilities represented 15% of the world population in 2010 (WHO and World Bank 2011). Due to the lack of specific data regarding disability, and assuming that this percentage can be extrapolated, the number of forcibly displaced persons with disabilities amounts to almost twelve million in 20196_{. However,}

according to different authors, this ratio could be heightened during displacement processes given the escalation of situations that may cause impairments, such as injuries, violence, and the unavailability or limited access to health services aggravating the effects of chronic diseases (UNHCR 2019b, 4; Mirza 2014, 2; Smith-Khan, et al. 2014; Berghs 2015,445’; WHO and World Bank 2011, 5, 8). Therefore, people with disabilities embody an essencial subgroup within the displaced population, facing higher protection risks during transit, as well as in host countries (Mirza, 2014, 3; UNHCR 2019c, 4).

1.3.1 Context of the Study Area

This research aims to analyze the humanitarian stakeholders’ actions and perceptions of a disability-inclusive response in a forced displacement context from a disability studies perspective, focusing on the case study of the mixed migration flows from the Bolivarian Republic of Venezuela (from now on Venezuela) in Colombia.

Venezuela is going through a “complex political emergency”7_{where the economic crisis and the}

collapse of public services have entailed that people in Venezuela struggle to access essential goods and services such as food, health care, and education. The increase of widespread violence, insecurity, and systematic violation of human rights has caused more than 4,5 million people to leave Venezuela by the end of 2019 (UNHCR 2019b, 3). In 2019, the United Nations High

6_{According to UNHCR, by the end of 2019, there were “79,5 million people forcibly displace worldwide as a result} of persecution, conflict, violence, human rights violations or events seriously disturbing public order” (UNHCR 2019a, 2).

7_{As defined by ANALP and presented in (Tellier, et al. 2018, 231), a complex political emergency is ‘[a] situation} with complex social, political and economic origins which involves the breakdown of states structures, the disputed legitimacy of host authorities, the abuse of human rights and possibly armed conflict that creates humanitarian needs.

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12 Commissioner for Refugees (UNHCR) informed that more than 68% of refugees from all over the world and Venezuelan displaced abroad came from five countries, being Venezuela the second spelling country after the Syrian Arab Republic (UNHCR 2019b, 3). According to UNHCR (2019b,3), “It is the largest exodus in the region’s recent history and one of the biggest displacement crises in the world”.

This forced displacement situation has affected the already vulnerable social systems in the Latin American region, especially the neighboring countries. However, Colombia has a particular condition, since in addition to being a country of transit and destination of migrants; due to the internal armed conflict, it is also a country of return for those Colombians returnees from Venezuela; and a country that hosts some eight million internally displaced persons (CONPES 3950 2018, 4). It, therefore, has a complex institutional challenge in dealing with this mixed migration flows context.

Regarding persons of Venezuelan origin in Colombia, there are approximately 1.8 million migrants and refugees in 2019, is the country with the highest reception of Venezuelan migrants. Moreover, Colombia is the second country worldwide to host refugees after Turkey (UNHCR 2019b, 3). According to the World Bank (2018), the massive arrival of the Venezuelan population to Colombia in the last five years affects mostly urban areas, especially the border cities, such as Norte de Santander, Arauca, and La Guajira. Venezuelan displaced abroad also arrive in cities with Venezuelan diaspora, which can provide support networks and large metropolises where public service institutions respond to this situation, such as Bogotá8_{and the Atlantic region.}

The mobility situation of this population makes it difficult to identify and locate them, so a coordinated response is required to guarantee their access to social services that facilitate their settlement and local integration (CONPES 3950 2018, 4). In this sense, the regional inter-institutional coordination platform, the R4V (Response for Venezuelans), has been established in 2018 to coordinate efforts at a regional level to achieve coherence consistency in the response9_.

This Regional Platform is replicated by local coordination mechanisms, which work closely with

8_{Representing 22% of Venezuelans in Colombia as of March 31, 2019, according to Colombian Migration reports} (2019).

9_{IOM & UNHCR are co-leading and coordinating the response for migrants and refugees from Venezuela in 17} Latin American and Caribbean countries (R4V 2020).

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13 host governments and are responsible for operational coordination and implementation of the Refugees and Migrants Response Plan (RMRP). In Colombia specifically, this coordination platform is called Interagency Group on Mixed Migration Flows10_{(GIFMM for its acronym in}

Spanish) and considers their situational context, the governments, and the RMRP partners' operational capacities, as well as existing coordination structures. The humanitarian response to Venezuelan refugees and migrants in Colombia includes activities in the sectors of health, protection, food security, water and sanitation, monetary transfers, coordination, integration, protection of children and adolescents, education, shelter, distribution of non-food items, information management, gender-based violence, communication, humanitarian transport, human trafficking, and protection against sexual exploitation and abuse (R4V 2020).

This case study entails a contribution to disability and migrations studies due to a high level of coordination and information management in the humanitarian response of Venezuelan migrants and refugees in Colombia, which can provide a more accurate understanding of the perception and barriers humanitarian actors face in responding inclusively in a migration context. Moreover, as the Situation of Humanitarian System report (SOHS) indicates, some crises are disregarded since they do not correspond to what humanitarian action is frequently understood. This is the case of Venezuela and the persons migrating to the neighboring countries from 2015. This crisis was only acknowledged by humanitarian responders in 2018 while fundamental and basic needs were identified from 2015, where local Colombian organizations and Venezuelans in Colombia were already responding (Interview 3). This situation of not being considered within the range of humanitarian responsibility represents one of the barriers humanitarian stakeholders must respond to, which will be further analyzed.

1.3.1.1 Persons of concern

According to the Humanitarian Response Plan 2020 (HRP), there are around 8.5 million people in Colombia who require humanitarian assistance, from which are 5.1 million persons related to internal situations such as armed conflict, the new dynamics of violence, and the effects of natural events. Around 1.8 million correspond to the migratory flows from Venezuela (OCHA

10_{The GIFMM is co-led by IOM and UNHCR and coordinates the response to the needs of refugees, migrants,} returnees, and host populations, both at the national level and through a local presence in 14 departments in a complementary manner to Government's response in Colombia. It has 71 members, including UN agencies, international and local NGOs, and the Red Cross Movement (R4V 2020)

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14 2020, 6). The GIFMM affirms that “all those who arrive in Colombia have humanitarian needs” (GIFMM 2019). However, irregular migrants are in the most unfavorable situations regarding access to fundamental rights such as social integration, health, education, and employment, as they are freestanding without access to public services. According to the World Bank report "Migration from Venezuela to Colombia", about half of the Colombian returnees are affiliated to some health regime, either subsidized or contributory (World Bank 2018). However, this situation is reduced to 16% in the case of migrants of Venezuelan origin (including irregular and regular migrants). For irregular migrants, however, this possibility is almost null, with only 1% affiliated. Likewise, in terms of access to education, children in an irregular situation showed a non-assistance rate to school of 1,7 times higher compared to Venezuelan migrants in a regular or irregular situation. This rate increases to 2,5 times higher compared to Colombian returnees.

1.4 Problem Statement

Mirza (2011,1) points out that to address the previously explained, historically neglect and marginalization that persons with disabilities experience in contexts of displacement, there has been a rising awareness of disability among academics and professionals, with an increase in publications, practitioners’ guidelines, policies. The year 2019 has been critical for placing people with disabilities at the center of humanitarian action owing to undertaken guidelines, commitments, and strategies (OCHA 2020, 75)11_.

However, despite the evidence and tools confirming that these persons of concern should be among the most prioritized in assistance programs, effective implementation of these strategies and systematically inclusion of disability perspective is still a challenge in humanitarian settings, presenting a void between theory and practice (UNHCR 2019b, 4; Mirza 2014, 2; Berghs and Kabbara, 2016, 270; Spurway and Griffiths 2016, 477; IFRC 2918, 5). Exemplifying this issue,

11_{Among the more important, the UN, has embedded in its country teams and entities the UN Disability and} Inclusion Strategy assuring improvement in their accountability actions by being able to monitor and evaluate these inclusive programs (OCHA 2020, 75, UN 2019, 3). Likewise, there are other three essential guidelines for humanitarian agencies in order to include persons with disabilities in humanitarian responses, providing practical and concrete recommendations: the Sphere Humanitarian inclusion standards for older people and people with disabilities, the Inter-Agency Standing Committee (IASC) Guidelines for Inclusion of Persons with Disabilities in Humanitarian Action, and The European Commission’s humanitarian affairs department operational guidelines for the Inclusion of Persons with Disabilities in EU-funded Humanitarian Aid Operations.

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15 in the report12_{made by the organization Humanity & Inclusion}13_{(HI), 85% of the 167}

practitioners surveyed consider persons with disabilities to be more vulnerable in crises context (Handicap International 2015, 18). Nevertheless, only 8% of the 167 surveyed answered that persons with disabilities are indeed properly taken into account in current humanitarian responses (Handicap International 2015, 18).

In this sense, the literature review shows that the approach towards the inclusion of persons with disabilities is focused on a medical approach, provoking to only considered their needs once the emergency has passed or once the funds are available, oftentimes leaving this population unattended after the essential needs are covered (ICVA, PHAP and IASC 2020). This continues to be a problem of not being able to operationalize the theory, knowledge, and principles that the needs of these persons of concern are, in fact essential, should be at the center of the response and that it is a matter of human rights. And not only that, but as Berghs (2015a, p. 448; 2015b, p.445) sustains, humanitarian response concerning people with disabilities in emergencies still mainly focus on reducing and preventing mortality and impairment (whether it is direct or indirect) focusing on the person, leaving aside a void of social aspects such as the short-term impact of the crises on people with disabilities, the creation of new barriers, the reproduction of power relation structures and inequalities. Also, the preparation of transformative, sustainable actions to access essential services is barely included in action plans. Therefore, if the different individual characteristics that could increase the risk of protection on migration contexts, such as disability, are not proactively considered during the identification process, it could lead to the invisibility of the problem.

Finally, the inability to operationally reach those most in need contravenes the guiding principles of humanitarian aid, highlighted by the compliance of the humanitarian principles of ‘humanity’ and ‘impartiality’, principles that are categorized by Jean Pictet14_{as substantive, considering both}

are fundamental to achieve the main objective of humanitarian response, which, according to the UNHCR (2018) is to ‘save lives and alleviate suffering in a manner that respects and restores

12_{This report was done as a collaboration for the World Humanitarian Summit to understand the needed changes} for an inclusive humanitarian. Seven hundred sixty-nine persons were surveyed for this report, among them 118 Disabled People’s Organization, 167 humanitarian actors, and 484 persons with disabilities.

13_{Before Handicap International}

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16 personal dignity’ (Gibbons, et al. 2020, 504). Appropriately, the principle of humanity considers that "human suffering must be addressed wherever it is found" being this the main objective in humanitarian crisis response (OCHA 2012). On the other hand, impartiality is based on the fact that humanitarian action should consider those who need it most, without discrimination on other characteristics such as race, gender, religion, or political opinion (OCHA 2012).

1.5 Objective & Research Question

Drawing upon this research material, this study's general objective is to explore and understand how the disability approach that is being applied by aid providers in Colombia limits or facilitates an inclusive response in the Venezuelan mixed migration emergency setting. By focusing on this specific case study, this research intends to identify the actions humanitarian responders are taking to proactively search for those most marginalized, considering the intersectionality between migration and disability.

This study’s specific objective is to analyze the perception of humanitarian actors on disability, being this the foundation to understand the approach on disability that aid providers are applying in Colombia, allowing to recognize what are the limitations and challenges preventing them (or facilitating) from ensuring a disability-inclusive response during the mixed migration emergency response. Finally, the research will identify the actions humanitarian responders are taking to proactively reach persons with disabilities, considering the humanitarian principles and intersectionality between migration and disability.

In this respect, the research seeks to answer the question: How does the disability approach used by humanitarian aid providers in Colombia facilitate or limit a disability-inclusive response in the Venezuelan mixed-migration crisis?

Considering the following sub-questions:

- How is disability perceived by the different actors responding to the Venezuelan mixed migration crisis in Colombia?

- What are the existing mechanisms applied by aid providers to provide an inclusive-disability response in a humanitarian mixed migration setting?

- What barriers and challenges do actors face to ensure an inclusive response during a migration setting?

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17 1.6 Justification and Relevance of the Study

This exploratory research tries to understand the myriad of barriers that prevent humanitarians from putting into practice a disability-inclusive perspective. Considering the vast information void regarding disability, with the collected information, the researcher aims to provide practical recommendations to improve the level of engagement of disability inclusion in the humanitarian migration response to promote equality in power relations dynamics, hoping to bring theory and practice closer together.

Bearing in mind the scarce existing literature regarding people with disabilities specifically in migrations studies in the global south, this research aims to provide a perspective from a complex and varied migration setting such as Colombia, leading to further investigations topics on the heterogeneous subject of migrant people with disabilities.

1.7 Outline and Structure of the Research

This research is structured in seven chapters as follows. This introductory chapter provides insight into the problem and research question, as well as a summary of the context and relevance of the study, and a brief explanation of the diverse disability models to contextualize the relevance of the disability-inclusion approach. Chapter 2 includes the theoretical framework that serves as guiding structure of the research and explains in detail how disability is understood and used in this research through the social model of disability, as well as an approach to the concept of intersectionality as a fundamental basis for this analysis. Chapter 3 explains the methodology applied in this research to respond to the research question, and the found limitations. Followed by the empirical results analysis reflecting on the theoretical framework in Chapter 4, the case study of the disability migration context in Colombia, with the findings of the interviews and questionnaires from an intersectional perspective. In chapter 5, the limitations obtained from the field research, with both interviews and surveys, as well as the information analyzed in secondary sources. Finally, in Chapter 7, the author summarizes the key conclusions of the research.

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18 2. Theoretical Framework

The framework of analysis used is two-fold and consists of an intersectional approach of disability and migration to understand the complexity of the heterogeneous nature of disability through the social model of disability.

The first section explains the intersectional framework of analysis, considering both disability and migration characteristics. This part of the section presents contextual information regarding the situation of persons displaced from Venezuela in Colombia, and a first approach to the debate within the different terms in migration studies and what this entails.

The second part of this chapter, the framework allows understanding disability and its barriers through the Social Model, incorporating the discussion on what disability refers to, opposing what is understood by vulnerability.

Applying both analytical frameworks to the institutions and actors responding to a migratory humanitarian, allows the researcher and reader to understand the heterogenous vulnerability conditions of disability in the context of migration.

2.1 Intersectionality: Disability and Migration

According to Pisani and Grech (2015, 421), most displaced persons reside in highly impoverished countries, as do people with disabilities. The situation of poverty, coupled with a complex humanitarian crisis, such as the one being experienced by Venezuelans, may force people to migrate in search of protection. However, in the host countries, the vulnerability and marginalization risks can exacerbate due to social and economic limitations, xenophobia, lack of access to essential services, among others. This being said, several contextual, individual experiences and identities may affect the vulnerability of migrants and refugees with disabilities in different ways (HI 2020, 15). In this sense, in the following paragraphs, the feminist approach of intersectionality will be explained as it will be applied in this research as an analytical tool to understand disability from the plurality that it entails.

Guided by black feminism structural analysis on the systematical disadvantage of women in capitalist societies, a first approximation to the concept of intersectional considered that there were further complexities, marginalization, and oppression of gender if two other main characteristics -race and class- were added (Davis 2008, 71, Bürkner 2012, 182, Lenhardt and

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19 Samman 2015, 9). These three factors -race, class, and gender- were identified as the “triple oppression” approach, and it was criticized in the late ‘80s since these categories were being considered in a separate, lineal, and additive way; rather than on how their convergence results in greater vulnerability than if we look at them separately (Bürkner 2012, 182, Davis 2008). Therefore, in the ‘90s, the legal scholar, Kimberlé Crenshaw, coined the term “intersectionality,” arguing that the struggles of black women were not considered either under the feminist or under the anti-racist discourse. Thus, she created an image of this concept, presenting it as different axes of discrimination, explaining that the intersecting categories and the structural variables could diverge according to particular situations and social context (Bürkner 2012, 182, Davis 2008, 68). How different axes influence and interact with each other can shape a person’s sociopolitical advantages or drawbacks, and the multiple forms of discrimination and segregation (Slim 2018, HI 2018).

Hence, for the present research, intersectionality will be understood as ¨the interaction between gender, race, class, and other categories of difference in individual lives, social practices, institutional arrangements, and cultural ideologies and the outcomes of these interactions in terms of power¨ (Davis 2008, 68).

Humanity & Inclusion (HI) identifies nine inequality categories, including disability, age, sexual orientation, gender, religion, political opinion, socioeconomic status, geographical location, and ethnic origin (HI 2018, 6). The research held by HelpAge as presented by Berghs indicates that there is a higher risk when these categories correlate with impairment and its different levels (HelpAge in Berghs 2015a, 446). Regarding the context of migration, Figure 1 represents graphically the identified characteristics that may exacerbate vulnerabilities and exclusion. Exemplifying this, an irregular migrant, older woman, head of household, in charge of her grandsons, will have more significant protection risks since she may be discriminated against in her search for work due to her legal status, gender, age.

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Figure 1- Intersectional vulnerable characteristics of migration

Regarding the previously explained analytical tool of intersectionality, the following subsection details the situation of migrants and refugees in Colombia, providing information on how the legal status represents situations of greater exclusion or discrimination.

2.2 Migrant, refugee or Venezuelan displaced?

In recent years, Colombia has experienced an exponential increase in mixed migratory flows from Venezuela, rising from 39,000 migrants and refugees at the end of 2015 to 1,630,903 by October 31, 2019 (a 3,000% increase). Of these, 44% have regular migratory status and 56% have irregular status, with a significant percentage in the Caribbean coast's strategic corridor with an important border crossing (La Guajira 9.55%, Atlántico 9.59%, Magdalena 5.22%, and Bolívar 4.58%). In this context, there are three forms of migration: (i) pendulum migration, those living in border cities who have numerous short-term entries and exits to Colombia; for these groups of people, there is a Border Mobility Card (TMF for its Spanish acronym) and 4. 3 million have been issued; (ii) transit migration, by those who cross Colombia to reach another country (PIP temporary transit permits - PTT 354. 124); (iii) migrants with the intention to stay, those who arrive expecting to be able to stay in the medium term, some have irregular legal status and asylum seekers.

Regarding the humanitarian response in forced migration, IOM (2019, iii) explains that coordination is one of the most critical and complex elements for effective assistance. This coordination can be even further affected in migration contexts by the diverse use and understanding of main concepts to define displaced populations, leading to divergences in the interpretation of responsibilities and actions, not only at the State level but also between actors

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21 and researchers working with these groups (Reiffers 2018, 372, IOM 2019, iii). These differences can also influence the rights and protection needs they are entitled to, affecting the intervention programming as well (Reiffers 2018). One clear example is how migration and refugees are understood by the international community.

In this regard, international law provides some common thread thanks to the definitions contained in binding international instruments, being this the case of “refugee”, which is clearly defined in the 1951 Geneva Convention and its 1967 Protocol as:

[…] a person who, owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality and is unable or, owing to such fear, is unwilling to avail himself of the protection of that country; or who, not having a nationality and being outside the country of his former habitual residence as a result of such events, is unable or, owing to such fear, is unwilling to return to it. (UNHCR 1951, art.1)

However, although migrants and refugees have the same universal rights and, in some cases, face similar vulnerabilities, they constitute two different groups with separate legal frameworks (UN 2016, par. 6). The definition of “migrant” is not included under international law, and there is no universally accepted definition; instead, the interpretations of this term abound (IOM 2019, 1, 132). According to Carling, two main approaches define the term “migrant”, the residualist and the inclusivist (Carling 2017, 2). The first one, the residualist view mainly promoted by UNHCR, excludes migrants from refugees, basically based on agency and protection needs, differentiating migrants as those who voluntarily decided to migrate to those forced to do so, and as such search for international protection (Carling 2017, 2). Contrariwise, the inclusivist view recognizes “migrant” as a general term that includes all kinds of movements from the habitual place of residence, inside the same country, or crossing an international border (IOM 2019, 132). This is the definition used by the United Nations International Organization for Migration (IOM), and it is applied regardless of the reason for mobility, legal status, the length of stay, or whether it is voluntary or not (Carling 2017, 2). Therefore, in this definition, all refugees can be migrants but not the other way around. In other words, refugees are a subgroup of migrants (Carling 2017, 2).

Furthermore, and regarding the Venezuelan displaced abroad, the circumstances suffered in the Latin American region in the seventies forced governments to rethink their asylum policies.

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22 While refugees from South American dictatorships met the requirements of the 1951 Geneva Convention, the civil wars in Central America led to asylum protection instruments adapted to the region’s reality. Therefore, the Cartagena Declaration on Refugees was adopted in 1984 at the 'Colloquium on the International Protection of Refugees in Central America, Mexico and Panama: Legal

and Humanitarian Problems' as a regional complement to the 1951 Geneva Convention. Its

international relevance lies in the broadening of the definition of a refugee, including “persons who have fled their country because their lives, safety or freedom have been threatened by generalized violence, foreign aggression, internal conflicts, massive violation of human rights or other circumstances which have seriously disturbed public order" (UNHCR 1984, 36, par. 3). The Cartagena Declaration includes the principle of non-refoulment and calls on countries to seek durable solutions such as local integration, as well as to make efforts to eradicate the root causes of the refugee problem. Although the Cartagena Declaration is not a treaty and therefore not binding, its provisions are respected and included in national legislations and constitute the basis for refugee policy in the region. Notwithstanding the gradual protection expansion for refugees, many persons are forced to leave their homes for reasons that do not fit this definition of refugee, such as food insecurity and the deterioration of livelihoods (Ki-Moon 2016, 6). This is the case of Venezuelan displaced, where the definition of migrant does not necessarily cover their reality and protection needs.

In this regard, from 2019, UNHCR incorporates the concept “Venezuelan displaced abroad” and differentiates it from refugees. UNHCR considers that even if people of Venezuelan origin need international protection under the Cartagena Declaration, they will most likely not apply for asylum once in the host countries. However, despite their status, UNHCR considers that they require access to basic needs and protection, especially against forced returns. (UNHCR, 2019, 65). In the case of Venezuelan displaced in Colombia, the migrant flows are mixed. This means that the same routes and destinations are traveled by economic migrants, refugees, and asylum seekers (Churruca-Muguruza 2018, 10). For this research, the author will use the terms migrant and refugee, with the residualist view.

This first part of the chapter has allowed understanding the analytical framework of intersectionality, considering the characteristics of migration, to further understand the

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23 complexity of the Colombian context. In the following part of the section, the debate of how disability is understood.

2.3 Disability though the Social Model

The starting point of the social model of disability was initially conceived as a critical reflection of the medical model. It started as a social movement, led in 1974 by union activists with physical disabilities in the United Kingdom (Mirza 2014, 2; Victoria Maldonado 2013, 3). They challenged the idea that the obstacles people with disabilities faced were there because the world was organized around people without disabilities (Aramayo, Burton and Kagan 2016, 517, Victoria Maldonado 2013, 1095). This not only failed to serve people with disabilities but created permanents oppression and normalized their segregation (Pisani and Grech 2015, 426). This generated a new understanding of disability, not by negating the existence of impairments, but understanding it as a social and cultural construction that leads to power relations and marginalization (Aramayo, Burton and Kagan 2016, 518, Victoria Maldonado 2013, 1095). Up to this moment, disability was considered inherent to the person, as something to be treated or overcome to adapt as much as possible to the existing society. Disability studies distinguish three models of disability, the model of dispensing, the medical model, and the social model of disability. The dispensing model, was characteristic of the Middle Ages, considers people with disabilities as victims, who had nothing to contribute to society, persons with disabilities are perceived as unproductive and therefore ended up becoming a burden for their family and community (Velarde Lizama 2011, 115).

The medical or rehabilitation model, typical of the first half of the 20th century, considers that discrimination barriers for people with disabilities lie on the individual. As such, responses are focused on treating and improving the impairment or physical condition, by medical means or through economic subsidies, which is still predominant and used by some humanitarian responders.

The social model, which emerged from the 1960s onwards, applies a rights-based approach, which refers to the recognition of people with disabilities are right holders, ensuring their rights and putting them at the center of the response. Therefore, this model allows abandoning the

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24 preconception that people with disabilities must overcome their impairments in order to adapt to the existing society. Moreover, this model acknowledges that the root causes of disability are linked to society and institutions that fail to recognize the rights, capabilities, and dignity of people with disabilities, as well as the non-accessible facilities creating barriers and provoking further marginalization (Joyce, Brendan 2010, 44).

To further understand the concept of disability through the social model approach, it is necessary to grasp the difference between disability and vulnerability, since both factors intersecting with other characteristics can lead to situations of exclusion but in different ways. Stephen Hawking illustrates it as follows:

Humanity has always been vulnerable to different challenges. And there can be no doubt that great scientific discoveries […] have helped us to understand our world, reduce our vulnerability, and build more resilient societies.

But, despite great and varied progress, vulnerable people and vulnerable groups of people remain—none more so than the disabled […] However, disability need not be an obstacle to success […] People with disabilities are vulnerable because of the many barriers we face attitudinal, physical, and financial […] But most important, addressing these barriers will unlock the potential of so many people with so much to contribute to the world. (Hawkins in UNDP 2014, 77)

This distinction, explained by Hawking, encompasses, and summarizes how the social model understands disability, considering that people with disabilities are not vulnerable intrinsically, but instead is a situation enforced by the obstacles and failure to support (IASC 2019). Therefore, vulnerability will be considered as “the characteristics of a person or group and their situation that influence their capacity to anticipate, cope with, resist and recover from the impact of a major event.” (Handicap International 2015, 7). At the same time, disability is related to the discrimination that a person can find in their participation provoked by the negative relations between the person with impairment and their environment (HI 2018).

Degener (2017, 43) suggests that this model has been designed to analyze the existing repressive structures of society, to understand the marginalization of persons with disabilities in society. In this sense, Michael Oliver, one of the authors of the social model, defines disability, from this model´s point of view as:

“All the things that impose restrictions on disabled people, ranging from individual prejudice to institutional discrimination, from inaccessible public buildings to unusable transport systems, from segregated education to excluding work arrangements, and so

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25 on. Further, the consequences of this failure do not simply and randomly fall on individuals but systematically upon disabled people as a group who experience this failure to discrimination institutionalized throughout society.” (Oliver 1996 in Degener 2017, 43).

Therefore, considering the words of one of the founders of the model, these exclusions are owed to limitations that hinder people with disabilities active participation and inclusion in society derive from the adverse interaction between structural (or institutional), environmental and attitudinal barriers embedded in the person-environment (HI 2018, IFRC 2018, 87, Cutajar and Adjoe 2016, 510, IASC 2019, 8). Hence, the importance of this method to emphasize the barriers of inclusion. In this research, these three barriers are considered as outlined below.

Attitudinal barriers are considered those negative mindsets that may be based, among others, on religious beliefs, unequal power relations, lack of information, that may generate exclusion and marginalization (IASC 2019, 9). Translating it into the humanitarian field, one can identify attitudinal barriers from both aid receivers and aid providers, including the conception of disability, the perception of ability, and agency from persons with impairment, among others. Environmental barriers include, on the one hand, natural or constructed physical obstacles that do not allow access (or affect it) to opportunities for equal participation (IASC 2019, 9). On the other hand, environmental barriers also include communicational barriers that prevent people from accessing information or knowledge, limiting their abilities to participate. In the case of humanitarian assistance, the non-existence of the service for a specific population group or the non-adapted form of delivery of aid, among others- is considered an environmental obstacle (IASC 2019, 9).

Finally, the institutional barriers are “laws, policies, strategies or institutionalized practices that discriminate against persons with disabilities or prevent them from participating in society” (IASC 2019, 9).

Barrier Social Model

Attitudinal Negative attitudes that may be based, among others, on religious beliefs, unequal power relations, ignorance that may generate exclusion and marginalization.

Environmental Physical or communication limitations that impede people with disabilities to access to opportunities for fully participating in the society.

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26 Institutional Includes “laws, policies, strategies or institutionalized practices that

discriminate against persons with disabilities or prevent them from participating in society” (IASC 2019, 9)

Table 1-Summary of the Social Model of Disability Barriers (Source: IASC 2019)

Considering the mentioned in this section, the concept of disability that will be referred to during this work will be the one established in the United Nations Convention of the Rights of Persons with Disabilities (henceforth “the convention” or CRPD). It states: “Persons with disabilities include those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others.” (UN 2006, art. 1). This conception of disability adopted in 2006 by the CRPD presents a development to a rights-based approach by highlighting that one of the critical elements of disability is the restriction of equal participation. Moreover, acknowledging that disability is not based only on the person’s impairment but rather understanding it as a social construction, resulting in the interrelation between a person with impairments and attitudinal, structural, and environmental obstacles that deter full and active participation in society on an equal basis with others. Finally, the CRPD does not limit the definition of disabilities to certain types of impairments; instead, it recognizes an open and evolutive concept, not limited to categories.

Furthermore, since this research is focused on the humanitarian actor's perception, mechanisms, and actions and its intention is to bring together theory and practice; the following section uses the social model of disability to analyze these three barriers from the humanitarian agencies view to be able to understand the gaps and straights for an inclusive response.

2.4 Limitation on Humanitarian Aid inclusive response

This chapter began by discussing migrant and refugee concepts, signaling their differences, and appointing its major debate arguments. It analyzed the understanding of disability through the limitations that society imposes on persons with impairments. Both aspects allowed an in-depth comprehension of the factors that may hinder an inclusive response in a humanitarian migration crisis. In the present section, the social model's barriers of disability will be compared with specific contextual variables that will give a structure of the analysis to determine whether these variables influence or hinder the organization’s ability to respond inclusively in a mixed migration context.

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27 Considering that the research focuses on practical aspects of humanitarian action, information from practitioners and aid receivers is essential for understanding their challenges. Therefore, three reports from recognized organizations providing empirical results from different humanitarian stakeholders’ in varied countries and situations of crises, including forced displacement, have been included in the literature review process. The three reports (IFRC 2018, ALNAP 2018, Handicap International 2015) present perceptions and information on the difficulties for aid providers in reaching and covering the needs of those in a situation of greater vulnerability. In this sense, the author has identified the most frequent obstacles and set a structure of analysis, allowing categorizing them into two variables that impact the development of an inclusive-humanitarian response from a social model of disability perspective. These variables are i) visibility, information, and data; ii) (in)voluntary exclusion, further discussed below and summarized in Table 3 and Table 4.

2.4.1 Visibility, Information, and data

As rightly pointed out by the IFRC, “The humanitarian sector cannot help people if it fails to see them” (IFRC 2018, 10). In this research, this quote represents the important gap in statistical data and reliable information being one of the main situations found in the literature review that limits disability-inclusive response in migration and refugee crisis.

In this regard, valid information regarding disability prevalence in a specific context, such as the access to their fundamental rights; their living conditions in migration and refugee context, is fundamental to include a disability-inclusive perspective in advocacy processes, in programming, request of funds, as well as for monitoring, evaluating, and compare vulnerable situations between this and other priority groups (Eide and Loeb 2016, 51). However, the authors assert that statistical data on disability, especially from the global south, is limited and non-reliable since in most of the cases, this information comes from the national census considering physical and visible disabilities, therefore a limited portion of persons and, as such, underreporting it (Eide and Loeb 2016, 51). The authors exemplify this problem of statistical data comparing the prevalence in low-income countries, which rounds about 4%, were in high-income countries stands in 15%.

Moreover, different authors indicate that the scanty data in disability issues are related to the existing attitudinal barriers of those collecting the data, and on the individuals in situations of

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28 disability (IFRC 2018, Eide and Loeb 2016, 52). Information regarding disability is often focused on the medical model, from an individualistic and person-oriented perspective, with epidemiological indicators, considering disability as a burden, a charity, rather than promoting protection, preventing, and adapting responses to include the needs of persons with disabilities, to have equal participation and integration in the society (Eide and Loeb 2016, 53; Berghs and Kabbara 2016, 270).

Additionally, the situation of underrepresentation of the disability does not necessarily change if data collectors asked to self-identify as a person of disability or not. This is also a matter of the individual understanding of the concept, but also, depending on the cultural and social construction of disabilities, identifying as an individual with disability can lead to other situations of discrimination and marginalization (Eide and Loeb 2016, 52). According to Eide and Loeb (2016, 51), for more than 30 years, efforts through international initiatives and policy papers have been made to define disability and improve ways to measure disability. However, in 2001 the Washington City Group on Disability Statistics (WG) was formed, with the objective to create a group of general disability indicators which could be applied in different circumstances such as national census and surveys. The WG presented the short set of questions on disability15

(see Table 2) in 2006, constructed considering the foundation of the disability inclusion approach aiming to determine the limitations of persons to conduct everyday activities that may lead to marginalization (Eide and Loeb 2016, 58). The WG set of questions contribute improving the comparable data in intersectoral and international contexts. Considering the ease with which these questions can be incorporated, it can be developed in contexts with reduced means.

Table 2- WG Short Set of Disability Questions. Source (Eide and Loeb 2016)

15_{The possible answers for the questions presented in Table 2 are: No, no difficulty; Yes, some difficulty; Yes,} much difficulty; Cannot do it at all.

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29 The WG has created other versions of questionnaires. One adapted for children, and another one extended to collect additional information on functionality considering aspects such as the ability to develop the mentioned functions with assistive technologies (Eide and Loeb 2016, 58). As previously mentioned, a change of paradigm has been achieved with the social model of disability and through the CRPD, which, in article 31, calls for the collection of disaggregated statistical data to identify and solve the barriers encountered by persons with disabilities, with a change of perspective, from an economic or epidemiological perspective to a human rights approach by considering a more in-depth analysis of disability measure (UN 2016 in Eide and Loeb 2016).

On the procedural barriers, as there are different conceptions on disability, these can lead to different processes to approach and measure it, making the possibility of obtaining comparable data more complex (Eide and Loeb 2016, 52). Furthermore, the lack of resources, including human and capital, can aggravate the problems linked to the lack of information, including enumerators making the identification of persons in need who have not received training and thus, a possible absence of awareness and sensibility that can hinder results of the questionnaires, leading to underrepresentation (Eide and Loeb 2016, 52).

Table 3 below summarized this variable, linked to the social model of disability, from an institutional point of view.

Variable

Institutional

Barriers Description Information & Data Description Source

Procedures, Laws, Policies

Existing organizational procedures that can lead to discrimination (intended or unintended) against certain groups. These may marginalize people from participating in activities and receiving aid distribution.

Sub-registrations of Persons with disabilities: Identification based on self-understanding of what disability entails instead of clear procedures, indicators

Due to the lack of information, people most in need are not reached

(Eide and Loeb 2016)

Not consistent data, not measurable or

comparable

(Pisani and Grech 2015)

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30

Attitudinal

Attitudes from the humanitarian aid providers that can create further marginalization, power relations among the

community or even between the humanitarian actor and the community. It may include prejudices and misconceptions on capacity and agency of persons in need (PiN)

Identification of persons with disabilities

according to the perception of

humanitarian actors (i.e., only identifying physical disability)

Under-representation of the needs and

identification of PiN due to lack of information (WHO and World Bank 2011; Smith-Khan, et al. 2014; Mirza, 2011) Identification based on self-understanding of what disability entails

(Smith-Khan, et al. 2014)

Environmental Physical

Obstacles created (or that remain) during the

humanitarian response due to the non-adaptation of the response to physical barriers.

Out of reach or outside the geographical zone of intervention: When making the

identifications, no areas of difficult access were included

(IFRC 2018)

Table 3-Data & Information variable impacting institutional barriers according to the social model of disability.

2.4.2 (In)voluntary exclusion

The second variable refers to those constraints that arise from unadapted interventions as they are considered, for the reasons described below, not to be within the humanitarian actor's scope of competence.

The SOHS report bolsters the statement that most vulnerable populations such as elder adults and persons with disabilities are often overlooked or not systematically addressed in humanitarian responses. One of the possibilities presented in the report for this neglect is the impossibility for persons with disabilities to reach distribution areas, to be aware of the available assistance (ALNAP 2018, 125). Despite this being a well-known aspect, far from improving, people affected during displacements have increased over their annual reports from 2015- 2018, specially for those irregular migrants who are not located in shelters (ALNAP 2018, 123). Moreover, when humanitarians reach these populations, often, the response is not adapted to their specific needs (ALNAP 2018, 125). The organization Ground Truth Solution analyzed open-ended questions of surveys carried out during the period 2015-2017, in seven countries, finding out that the major challenges identified by aid beneficiaries were: the lack of information; their needs were not being met; and that aid was not reaching those who need it the most. Aid receivers accordingly described that in their perception, those with further vulnerabilities are persons with disabilities, women, older adults, those with chronic illness, and those who do not receive or have access to information of aid services (Ground Truth Solutions in ALNAP 2018,

Understanding the Barriers of a Disability-inclusive humanitarian response in mixed migration crisis: