Submission to UN on Rights of Disabled in Palestine

Introduction

This memorandum, submitted to the United Nations Committee on the Rights of Persons with Disabilities ("the Committee") ahead of its upcoming adoption of list of issues on Palestine, highlights areas of concern that Human Rights Watch hopes will inform the Committee's consideration of the compliance by Palestinian and Israeli authorities with the Convention on the Rights of Persons with Disabilities ("CRPD"). This submission focuses on violations of the rights of people with disabilities, in particular articles 5, 6, 9, 10, 11, 18, 19, 20, 24, and 25.

This submission draws from research conducted between 2018 and 2020 in Gaza, including 37 interviews with Gaza residents with physical, visual, and hearing disabilities, and family members of six children and one 18-year-old with disabilities. Human Rights Watch also interviewed 31 representatives of international and local organizations operating in Gaza, a representative of a company that imports assistive devices, and local government officials.

This document does not review every 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 life, the right to personal mobility, accessible environment, education, and health care, among others.

Much of the submission focuses on Israel's treatment of Palestinians with disabilities, given the repression they face as Palestinians by the Israeli government. In April 2021, Human Rights Watch concluded in a 213-page report that Israeli authorities are committing the crimes against humanity of apartheid and persecution against millions of Palestinians.[1] Human Rights Watch reached this determination based on a finding of an overarching Israeli government policy to maintain the domination by Jewish Israelis over Palestinians across Israel and the Occupied Palestinian Territory (OPT), as well as grave abuses committed against Palestinians living in the OPT, including East Jerusalem.

Major Israeli,[2] Palestinian,[3] and other international human rights groups have also found that Israeli authorities are committing apartheid against Palestinians,[4] as has the UN Special Rapporteur for the Occupied Palestinian Territory and other UN experts,[5] as well as the Harvard Law School International Human Rights Clinic,[6] among others.

Many of the grave human rights abuses carried out by Israeli authorities as part of their crimes of apartheid and persecution against Palestinians significantly impact people with disabilities, including sweeping restrictions on the movement of people and goods, as this submission lays out.

The Convention applies to Israel's conduct towards Palestinians in the Occupied Palestinian Territory (OPT), alongside international humanitarian law governing occupation. While Israel maintains that its human rights obligations do not extend to the OPT, UN treaty bodies have repeatedly found that states are bound to respect the human rights treaties they have ratified outside their state borders, including to occupied territory. By virtue of the significant control that Israel exercises over the lives and welfare of Palestinians in Gaza, Israeli authorities are obliged under the law of occupation and international human rights law to ensure the welfare of the population there.

The State of Palestine also acceded to the Convention on the Rights of Persons with Disabilities in 2014 without reservations. Hamas authorities exercise internal control in Gaza, and therefore also have a direct responsibility to protect people's rights, including those with disabilities.

Liberty of Movement, Personal Mobility, Right to Health, and Right to Assistive Devices (articles 20 and 14)

Human Rights Watch found that sweeping Israeli restrictions on the movement of people and goods, at times exacerbated by restrictive policies by Palestinian authorities, curb access to assistive devices, health care, and electricity essential to many people with disabilities.

For more than 15 years, Israeli authorities have blocked most of Gaza's population from traveling through the Erez Crossing, the only passenger crossing from Gaza into Israel through which Palestinians can travel to the West Bank and abroad. Israeli authorities often justify the closure, which came after Hamas seized political control over Gaza from the Fatah-led Palestinian Authority in June 2007, on security grounds. The closure policy, though, is not based on an individualized assessment of security risk; a generalized travel ban applies to all, except those whom Israeli authorities deem as presenting "exceptional humanitarian circumstances," mostly people needing vital medical treatment and their companions, as well as prominent businesspeople.

Israeli authorities also significantly restrict the entry and exit of goods into Gaza. While there are no restrictions on the import of assistive devices, policies regarding "dual-use" items have restricted the entry of spare parts and batteries for hearing aids and other devices, according to the Israeli human rights group Gisha.[7] Medical Aid for Palestinians has documented that Israel has restricted as "dual-use" items carbon fiber components used to stabilize and treat limb injuries, and carbon fiber and epoxy resins used to produce artificial limbs, resulting in patients being fitted with heavier, more uncomfortable alternatives.

Human Rights Watch documented how the lack of prosthetics affected the mobility, emotional well-being, and independence of people with disabilities, including their ability to flee armed attacks and to participate in the community.[8] Alaa al-Ayadi, 43, said that his leg was amputated in 2018 after Israeli forces shot him as he protested along the fences with Israel. He said he received a prosthetic leg that did not fit him well and causes him significant pain.[9] Inappropriate prosthetics have hindered also the independence and development of children. According to UNICEF, children whose limbs have been amputated have difficulty getting prosthetic and assistive devices as they grow and require replacements.[10]

Several people described a lack of expertise in Gaza to repair damaged devices, in part due to Israeli movement restrictions. This stems in part from the sweeping Israeli movement restrictions, which, according to the Italian aid organization EducAid, block people from getting training to repair devices outside Gaza and necessary parts from entering Gaza.[11] Dr. Hassan Ramadan, from the Gaza-based Atfalona Society for Deaf Children, said that Israeli authorities did not respond to requests for permits for him and another staff member to attend a workshop in Jordan in 2019 for treating children who undergo Cochlear Implant Surgery, a procedure to implant electronic devices to stimulate hearing. The Israeli authorities denied permits to four staff members to attend a similar workshop in the West Bank in 2018.

He felt the group had lost the opportunity for hands-on training on the latest methods of evaluation, maintenance of devices, and rehabilitation; and that this diminished the services they can provide to children with hearing disabilities.[12] Other people expressed concern about the possibility of damage to their assistive devices and the inability to have it repaired. "My scooter is as precious as a family member or part of my body," said Zahra al-Mahoun. "I feel imprisoned without it."[13]

Hamas authorities in Gaza and humanitarian organizations have sought to provide assistive devices to those in need of them, but their efforts often fall short. Gaza's Social Development Ministry reported on its website in September 2017 that it had allocated US $500,000 in its 2018-2020 plan for assistive devices, but it is unclear what devices it secured and distributed, and what standards it relies on to assess need.[14]

Several people with disabilities interviewed in Gaza highlighted difficulties in obtaining free or subsidized assistive devices from local authorities, including long waits. Others said the devices they received were low quality or ill-fitting. No single system exists in Gaza to compile information about community needs or to coordinate efforts among non-government organizations and local authorities, making some necessary items, such as mobility scooters, unavailable for long periods, while other items were available in excess.

Assistive devices positively contribute to a person's independence and development by promoting social inclusion and facilitating access to other rights.[15] They can greatly improve a person's health, access to education, community services, and facilitate participation in the community. As an example, a child who is equipped with a prosthetic and can use it, even for a limited time, is ostensibly healthier and better able to take steps to access a replacement, including by travel, than one who never receives one at all.

Under the CRPD, States Parties should take effective measures to ensure personal mobility, including by facilitating access to assistive technology and by promoting the availability, knowledge, and use of assistive devices and technologies.[16] International humanitarian law obliges occupying powers to ensure the safety and welfare of civilians living in the occupied territory.[17]

Israel's sweeping restrictions on the movement of people and goods, at times exacerbated by restrictive policies by Palestinian authorities, restrict the right of people with disabilities to freedom of movement and access to assistive devices, as set out under articles 20 and 14 of the CPRD.

In the upcoming adoption of list of issues on the state of Palestine, Human Rights Watch urges the Committee to question the Palestinian and the Israeli authorities, as the occupying power, regarding the steps they have taken to implement article 20, including:

• What mechanisms are in place to ensure people with disabilities have access to assistive devices, spare parts, and batteries?
• How do Israeli authorities justify significantly restricting travel for Palestinians, including people with disabilities and NGOs working with them, between the West Bank and the Gaza Strip, which Israel recognized in the Oslo Accords as a single territorial entity?

Electricity

Chronic power outages, in part stemming from the Israeli closure, jeopardize the rights of many people with disabilities who need light to communicate using sign language, or need equipment powered by electricity to move, including elevators and electric mobility scooters.

Israeli policies sharply limit Gaza's access to electricity. Gaza's sole electric power plant has operated at only partial capacity since 2006, in part as a result of Israeli aerial attacks.[18] Israel's restrictions on the entry of goods, including spare parts and equipment deemed "dual-use," have hampered efforts to repair the plant.[19]

Israeli authorities have also restricted, sometimes punitively and other times as a result of disputes over payments, the amount of industrial fuel it allows to be purchased for the plant.[20] Fuel restrictions further reduce the already-limited supply of electricity, at times for weeks, by more than 50 percent, according to Gisha, the Israeli rights group.[21] Israeli restrictions on the entry of solar panels and batteries also hamper the development of alternate energy sources.[22]

These restrictions force Palestinians in Gaza to rely primarily on buying electricity from Israel. The state-owned Israel Electric Corporation, though, sells only a limited quantity of electricity to Gaza, 120 Megawatts (MW) annually in recent years, outside of a six-month period in 2017 when it cut supply to 70 MW following a request from the Palestinian Authority[23], linked to the factional rivalry between Fatah and Hamas. The 120 MW is insufficient to meet the demand, which the World Bank said in November 2017 was 450 MW.[24]

According to UN OCHA, the monthly average of electricity available per household per day since 2017 has fluctuated between five and 15 hours, depending on a range of factors, including demand and availability of fuel for Gaza's power plant.[25] Those who can afford it use alternate energy sources, including generators and solar energy, to supply electricity during power outages.

The extremely limited availability of electricity over long periods affects nearly all aspects of everyday life for Gaza residents, but particularly jeopardizes the rights of people with disabilities. Fadwa Salha, the mother of an 11-year-old girl with cerebral palsy and an intellectual disability, said that her daughter uses a nebulizer when she has trouble breathing, which she cannot operate without electricity, putting her child's health at risk.[26]

When the power cuts out while her daughter is using the ventilator, Salha said, her daughter's "chest starts going up and down, she breathes quickly, her heart beats quickly and her eyes move really fast and she has phlegm. Sometimes I cry when electricity is cut off, wishing I could do anything not to see her in that condition."

Many people with disabilities also need a regular electricity supply to move or communicate. For those with physical disabilities living in a heavily urban context, the electricity schedule dictates when elevators work, and therefore, when they can leave their apartments.

A 25-year-old woman with a physical disability who lives on the eighth floor of a high-rise building, said that she is able to leave her home only when electricity is available to use the elevator. Electricity sometimes comes only at odd hours, she said, and is often unavailable when she needs to go out, including for appointments or to run errands, sometimes for days or weeks at a time. She said she missed a friend's wedding in March because of a power outage that evening. "I don't know how to describe my feeling," she said. "I felt so sad."

A 26-year-old woman with a physical disability described having to cancel outings due to her inability to charge her mobility scooter. "Electricity shortages control my life," she said. "It makes me feel more aware of my disability."

Ahmed Abu Salama, 27, who acquired a disability after being wounded during a 2008 Israeli airstrike, also said electricity outages make it difficult to charge his mobility scooter.[27] Mobility scooters require daily charging, which can take up to 14 hours, more than Gaza residents get most days.[28]

He said the electricity sometimes comes on in the middle of the night, but since residents often avoid leaving devices plugged in overnight for fear that the change in voltage would damage them, he would miss that narrow window to charge it. "Because of this, my scooter sometimes suddenly runs out of charge while I am out, forcing me to call my father to take me home," he said.

Light in the evenings is crucial for people with disabilities who use visual communication, such as sign language. Human Rights Watch interviewed five women with hearing disabilities who said that they cannot use sign language with family and friends during electrical blackouts.

By undermining the ability of people with disabilities to use elevators and electric mobility scooters, the Israeli restrictions that contribute to electricity shortages negatively impact the rights of Palestinians in Gaza under article 20 of the CPRD.

In the upcoming adoption of list of issues on the state of Palestine, Human Rights Watch urges the Committee to question the Israeli authorities regarding the steps they have taken to ensure people with disabilities have access to electricity to fulfil their right to health, personal mobility, and participation in the community. Concretely:

• Why have Israeli authorities not increased the amount of electricity it provides to Palestinians in Gaza?

Right to an Accessible Environment (article 9); Rights to Living Independently and Being Included in the Community (article 19)

Many public institutions and other buildings across Gaza are inaccessible to people with disabilities. Palestinian law applicable in Gaza forbids discrimination based on disability and guarantees people with disabilities the rights to health care, work, inclusive education, and access to public institutions. However, these laws are largely not implemented in practice and Hamas authorities in Gaza have largely failed to adequately ensure accessibility. This failure leaves many people with disabilities unable to participate in society on an equal basis with others and may also put them at a possible serious risk of injury.

Many parts of Gaza, in particular the overcrowded refugee camps, have poor infrastructure, including narrow, bumpy, and uneven roads. Several people with physical disabilities told Human Rights Watch that they felt the poor condition of roads put them at risk, and that they avoid leaving their homes in rainy weather for fear of accidents on muddy streets. In 2019 and 2020, two people with a visual disability told Human Rights Watch that walking in inaccessible roads made them feel insecure. A 16-year-old girl with a physical disability told Human Rights Watch in 2020 that the toilets in her school are inaccessible to people like her who use a wheelchair. As a result, she has to go home every time she needs to use the bathroom and sometimes needs her teacher to call her father to take her home for this purpose.

Doa Qashlan and her sister Abeer, 24, both said they fell off their mobility scooters several times, with Doa once injuring her face and Abeer bruising her body, as a result of the poor condition of the streets where they live in the Nuseirat refugee camp. Mohammad Qanona, 37, said he fell several times, once injuring his head while using his mobility scooter near his home in Deir al-Balah in central Gaza.[29]

In 2012, Gaza's Local Government ministry set regulations requiring public buildings to guarantee accessibility, but the regulations did not specifically mandate providing ramps or elevators or address other accessibility requirements. They also lacked clear standards for enforcement and did not address the needs of people with visual or other disabilities. Building regulations issued by the ministry in January 2020 include more robust physical accessibility requirements, including mandating ramps and elevators for new public buildings, but do not address the accessibility needs of those with visual and other disabilities. In addition, a ministry official said that the regulations apply to government facilities, gas stations, and other public institutions, but not private businesses, malls, and mosques.

Our research also revealed that the Gaza City Municipality has no specific plans in ensuring accessibility for people with disabilities. A municipal official explained they instead prioritize initiatives such as paving roads that serve that serve the entire population.

Abdelkareem al-Qernawi, 30, said that the Social Development Ministry office in al-Nuseirat refugee camp where he often needs to go has no elevator. He either needs to bring someone with him to help, or he waits downstairs until a staff person can come down to see him, which usually takes about an hour. A 30-year-old woman had similar experiences at two Labor Ministry offices in central Gaza Strip.

Gaza residents said that several organizations providing services to people with disabilities in Gaza are themselves not fully accessible to people with disabilities. Siham Abu Oweida, 37, said she attended a training session by a Gaza-based organization that provides services to people with disabilities on the third floor of a private university that had no elevator. She had to crawl up six flights of stairs to participate.

Human Rights Watch observed several organizations that work with people with disabilities that did not provide signs in Braille for those with visual disabilities. Three women with hearing disabilities told Human Rights Watch in 2019 and 2020 that public hospitals do not provide sign language services. "Whenever I go to a hospital without someone to interpret for me, they write on a piece of paper that I should come back and bring someone with me," one of the women said. "This experience made me feel less of a person."

By allowing many places, including health and community services centers, to be inaccessible for people with disabilities, Hamas authorities restrict the right of people with disabilities to live independently and to be included in the community, under articles 9 and 19 of the CPRD.

In the upcoming adoption of list of issues on the state of Palestine, Human Rights Watch urges the Committee to question the Hamas authorities regarding the steps it has taken to implement articles 9 and 19, including:

• What steps have been taken to ensure accessibility is assessed across the Gaza Strip, including with respect to the physical environment, transportation, information and communications and other services open or provided to the public?
• Have the authorities updated the 2020 building regulations so as to include a more accessible environment for people with hearing and visual disabilities?
• What steps have the authorities in Gaza taken to ensure that all community services and facilities are available on an equal basis to people with disabilities and are responsive to their needs?

Right to Equality and Non-Discrimination (article 5); Rights of Women with Disabilities to Full and Equal Enjoyment of All Human Rights and Fundamental Freedom (article 6)

People with disabilities in Gaza face widespread discrimination and social stigma, and are perceived as being helpless, unable to care for themselves, or to make their own decisions.

Women with disabilities face discrimination both as women and as people with disabilities. A 26-year-old woman who has a physical disability told Human Rights Watch: "I hope people see me the same way they see other people. They consider us patients who need treatment, look at us with pity, they don't think of us as humans."[30]

Three other women with disabilities also spoke of a widespread perception in Gaza that women with disabilities are unsuitable for marriage, while a man with a physical disability said the family of the woman he hoped to marry told him that they refused to consider him on account of his disability.

The mother of a girl with a physical disability told Human Rights Watch that her former husband regarded the child as "something that should not have happened," would not allow her to leave the house so she would not be seen in public, and ultimately left her and the family because he could not accept that his child had a disability.[31]

The mother of an 18-year-old woman said that when her daughter started displaying signs of a mental health condition as a child, the family despaired and felt they had no access to quality mental health care and psychosocial support for her.[32] She said they decided, when she was 5 years old, to chain her hands and one of her feet during the day to prevent her from smashing things or fleeing the house, only unchaining her at night when she slept with her mother inside a locked room.

The woman's older sister said that they feel their only option, given scarce mental health services, is to chain the young woman. Human Rights Watch documented shackling of men, women, and children with psychosocial disabilities in 60 countries and found that the inhumane practice exists due to inadequate support and mental health services as well as widespread beliefs that stigmatize people with psychosocial disabilities.[33]

The UN Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment has noted that shackling "unequivocally amount[s] to torture even if committed by non-State actors under conditions in which the State knows or ought to know about them."[34]

The authorities have made little effort to combat stigma, such as through initiatives to raise awareness about the rights of people with disabilities, including mental health conditions. One woman with a hearing disability said: "People don't understand the meaning of disability, they think that we have no ability to do anything. I have a disability and I am proud of my disability."

Failures to combat widespread stigma and address inhumane practices, such as shackling, restrict people with disabilities from fully exercising their basic rights and fall afoul of the guarantees of equality and non-discrimination under articles 5 and 6 of the CPRD.

In the upcoming adoption of list of issues on the state of Palestine, Human Rights Watch urges the Committee to question the Hamas authorities regarding the steps it has taken to implement articles 5 and 6, including:

• What steps and initiatives have the authorities in Gaza taken to reduce stigma and discrimination against people with disabilities, and train and sensitize health workers and mental health professionals on the rights and needs of people with psychosocial disabilities?
• What measures are being taken to prevent the use of physical restraints, including shackling, by families and in institutions?
• What measures have been taken to ensure people with psychosocial disabilities have access to adequate, quality, and voluntary community-based support and mental health services on the basis of free and informed consent?
• Is shackling a practice used at government-run institutions in Gaza? If so, how many people have been subjected to it?

Right to Life and Situations of Risks and Humanitarian Emergencies (articles 10 and 11)

A June 2015 United Nations Commission of Inquiry found that nearly 10 percent of the more than 11,000 Palestinians wounded during 2014 hostilities between Israel and Palestinian armed groups, acquired a physical disability as a result.[35] Physicians for Human Rights Israel said that they include about 100 people who have had a limb amputated.[36] In 2018 and 2019, according to UN OCHA, 156 Palestinians had limbs amputated after being wounded by Israeli fire during demonstrations along the fences separating Gaza and Israel.[37] According to UNICEF, 14 of them were children. According to the UK-based Medical Aid for Palestinians, 15 people lost their vision and 24 people "were paralyzed due to spinal cord injuries" after being shot by Israeli forces during the demonstrations in 2018.[38] In addition, the group estimated that at least 1,200 people required "expensive limb reconstruction treatment."

Israeli forces have also carried out attacks against people with disabilities. A March 2019 UN Commission of Inquiry report found that Israeli forces fired on people with disabilities, among other identifiable groups, "knowing who they are," although protesters, including those with disabilities, did not pose an imminent threat in the vast majority of cases they investigated, making those killings unlawful.[39] The Gaza-based Nusierat Rehabilitation and Social Training Association told Human Rights Watch that the fence protest casualties have "exhausted the consumption of assistive devices."

Many people with disabilities interviewed by Human Rights Watch highlighted traumatic experiences during armed hostilities and their difficulty or inability to flee danger in the event of a future attack.[40]

Five people with disabilities described their severe difficulties fleeing civilian buildings that came under attack during Israeli offensives between 2009-2014, and their need for help to reach safety. Israeli forces sometimes provided warnings only minutes before striking-not enough time for people with disabilities to flee. The Geneva Academy in a 2019 report documented a 2014 airstrike that killed two people with disabilities, who could not evacuate a civilian building in the two minutes between receiving a "roof-knock warning" and the strike itself.[41]

A 26-year-old woman with a physical disability interviewed by Human Rights Watch said that, when a missile struck her house during the 2014 war, she tried to flee with the rest of her family but was wounded by shrapnel in her leg and remained stuck in the house for another 15 minutes, until a relative helped her out. She said the attack damaged her mobility scooter, which she said felt like "losing a member of a family." Six years later, she said, she still hears the "sound of explosions in my head," gets frightened whenever she hears ambulances, and avoids "looking at the sky."

Ahmed Abu Salama, 27, said that, during the 2014 hostilities, an Israeli drone struck a mosque while he was praying there. Everyone fled but he froze, unsure if he could flee in his wheelchair. He waited a few minutes until some people returned and carried him out. In the 2008-2009 hostilities, he said, a bullet struck the wall above his head in the hospital room where he laid, and he managed to escape only with another person's help. Abu Salama said that the incidents stayed with him and to this day he is startled every time he hears a loud sound.[42]

Article 11 of the CRPD calls on state parties to "take, in accordance with their obligations under international law, including international humanitarian law and international human rights law, all necessary measures to ensure the protection and safety of persons with disabilities in situations of risk." International humanitarian law provides general protection for people with disabilities as members of the civilian population, including the basic principle of humane treatment, respect for life and physical and moral integrity, and prohibition of coercion, corporal punishment, torture, collective penalties and reprisals.[43] Under the principle of distinction, parties to the conflict must at all times distinguish between military and civilian targets, and civilians may never be the deliberate target of attack.[44]

International humanitarian law also requires parties to the conflict to give effective advance warning prior to an attack that may affect a civilian population.[45] The Office of the United Nations High Commissioner for Human Rights (OHCHR) said: "the failure to comply with this obligation in an accessible and inclusive manner amounts to discrimination on the basis of disability."[46]

Consequently, advance warnings should, for example, use different forms of communication to increase their accessibility.[47] To be effective, a warning should, where possible, allow sufficient time to maximize the opportunity for civilians, especially those with disabilities, to act between the warning and the attack.[48]

The lack of measures to ensure protection to people with disabilities during armed conflict falls afoul of obligations in articles 10 and 11 of the CPRD to safeguard the right to life and protection in situations of risk.

In the upcoming adoption of list of issues on the state of Palestine, Human Rights Watch urges the Committee to question the Israeli authorities, as the occupying power, regarding the steps it has taken to implement articles 10 and 11, including:

• What measures, if any, have been taken to ensure safety and protection of people with disabilities in line with article 11 of the CRPD and international humanitarian law?
• What measures have been taken to ensure that the warning system is accessible to and inclusive of the rights and needs of people with disabilities?
• What plans do Israeli authorities have to address the root causes of the current humanitarian crisis, including the sweeping movement restrictions and lack of accountability for serious abuses, that impact the daily life of people with disabilities?

We hope you will find the comments in this letter useful and would welcome an opportunity to discuss them further with you. Thank you for your attention to our concerns, and with best wishes for a productive session.