Protecting the Vulnerable in Disasters and Conflicts

Original Editors - Naomi O'Reilly

Top Contributors - Naomi O'Reilly, Ewa Jaraczewska, Kim Jackson and Jess Bell      

Introduction[edit | edit source]

Conflict and disasters often place people at an increased risk of discrimination and/or abuse, especially vulnerable groups such as children, women, older people and those with existing disabilities or chronic health conditions. In some contexts, this may also include particular ethnic or religious minorities, who face disproportionate risk during disasters and conflicts.[1] [2] While some contributing factors to this vulnerability may be intrinsic, most commonly they are due to environmental or societal factors that pre-date the disaster and conflict. Medical and rehabilitation professionals need to be aware of and act upon any factors that can make certain groups of people more vulnerable. They need to recognise that healthcare priorities cannot be adequately assessed without taking into account the specific vulnerabilities of these groups in disasters and conflicts, while acknowledging that these groups are not homogenous, and the risks they face vary from individual to individual, depending on the interaction of both personal and environmental factors.[2] Rehabilitation professionals are likely to come into contact with these groups as part of their role. They have the knowledge to understand the challenges these groups face and have a key role to play in protecting vulnerable people. As such, they should engage with all humanitarian protection mechanisms that are in place in raising any concerns they have encountered.[3]

Children[edit | edit source]

As the frequency and intensity of disaster events increase around the globe, children are among those most at risk for the negative effects of a disaster. They represent a significant portion of those who endure the devastating long-lasting consequences of disasters.[2] Children are a highly vulnerable group, particularly infants and young children, who are partially or totally dependent on adults. Older children and adolescents are psychologically and physically vulnerable and may develop post-traumatic stress disorder or related symptoms. They experience death, injury, illness, and abuse and often must cope with disruptions or delays in their educational progress in the aftermath of a disaster. Systems that protect children and young people, including family and community structures, are often impacted during disasters and conflicts. Children may be separated from their families and this situation places them at increased risk of injury, abuse and exploitation, including trafficking or being recruited by armed groups.[4]

As rehabilitation professionals, we need to recognise the different forms of physical and emotional vulnerability and consider the different forms of physical, social, mental, and emotional support that infants, children and adolescents may require when compared to adults.[5] Moreover, in post-disaster and conflict settings, the voices of children are often not heard[6] and, as a result, children’s rights and needs are frequently under-addressed. This creates adverse long-term consequences for them and their communities.[7] The negative effects of disaster and conflict include a decline in children’s physical health and emotional and intellectual well-being in both the short- and long-term. Table 1 outlines the types of vulnerabilities that children and young people experience in a disaster and conflict setting including factors that influence them.

Table 1. Types of Vulnerability Children Experience in Disasters and Conflict, and Factors that Influence Vulnerability[5]
Physical Vulnerability Psychological Vulnerability Educational Vulnerability
Types of Vulnerability Children Experience in Disaster
  • Death
  • Injury
  • Illness and disease
  • Malnutrition
  • Heat stress
  • Physical abuse
  • Sexual abuse
  • Post-traumatic stress disorder
  • Depression
  • Anxiety
  • Emotional distress
  • Sleep disorders
  • Somatic complaints
  • Behavioural problems
  • Missed school
  • Poor academic performance
  • Delayed progress
  • Failure to complete education
Factors Influencing Children’s Vulnerability in Disaster
  • Living in poor communities in hazard-prone regions
  • Living in/going to school in substandard structures
  • Loss of a parent
  • Family separation
  • Child characteristics (race, age, gender etc.)
  • Size, strength, stage of development
  • Poor diet
  • Parental distress
  • Unsafe/unsanitary shelter environments
  • Life threat
  • Family separation
  • Death of a loved one
  • Material loss
  • Home/school damage
  • Direct exposure or media exposure to disaster
  • Child characteristics (race, age, gender etc.)
  • Poor functioning pre-disaster
  • Parental distress
  • Low levels of social support
  • Additional life stressors
  • Negative coping skills
  • Lack of coping assistance
  • Displacement
Destruction of school buildings

Displacement of students and teachers

Loss of vital records

Delayed enrollment

Multiple school changes

Family instability

Unwelcoming/unsupportive school environments

Poor academic performance pre-disaster

Loss of a parent / caregiver

Increased work demands

The United Nations Convention on the Rights of the Child (UNCRC), which is ratified by all countries apart from the USA, provides a comprehensive code of rights that offers the highest standards of protection and assistance for children. The UNCRC is a legally-binding international agreement setting out the civil, political, economic, social and cultural rights of every child, regardless of their race, religion or abilities and is applicable to all children within the jurisdiction of each state, regardless of whether they are a national or not. Organisations working in humanitarian response should have child safeguarding policies in place, and it is vital that rehabilitation professionals become familiar with and adhere to these child protection guidelines.

Healthcare in Danger - The Responsibilities of Health-Care Personnel Working in Armed Conflicts and Other Emergencies highlights the following questions, which rehabilitation professionals can use to guide their thinking around supporting children and young people following disasters and conflicts.[8]

  • Do children have unimpeded access to health care? If not, what is the reason? Prevailing insecurity? Financial or cultural constraints?
  • Do children become especially vulnerable to, for example, abduction for trafficking, sexual violence or coercion to join armed forces or armed groups when trying to reach health care?
  • Am I clear about what I should do with unaccompanied children regarding, for example, consent for treatment and discharge from the hospital? [8]

Women[edit | edit source]

Cultural and social practices regarding gender provide some of the most fundamental sources of inequality and exclusion around the world for women. They frequently manifest themselves through economic and political consequences, including gender inequalities in areas such as school and university enrolment, labour force participation, control over assets combined with lower social visibility, and less freedom and mobility. Given this status of women pre-disaster and conflict, it is not surprising that women are generally more likely than men to suffer injuries or to be killed during disasters and that violence against women and girls may be exacerbated during emergencies. Women also face an increased burden of care tasks, such as the provision of food and water, and caring for the sick and injured following disasters and conflicts, which further impacts their participation.

The 1979 Convention on the Elimination of All Forms of Discrimination Against Women and the 1999 Optional Protocol to the Convention on the Elimination of All Forms of Discrimination Against Women protect the rights of women during disasters. The new Minimum standards for Protection, Gender and Inclusion in Emergencies, developed by the International Committee for the Red Cross provides rehabilitation professionals with a set of minimum standards for protection, gender and inclusion limiting people’s exposure to the risks of violence and abuse and ensuring that emergency programmes “do no harm”. As rehabilitation professionals, we can advocate for the inclusion of women in disaster planning at all stages, including recovery. It will help build resilience and empower women, and reduce stereotypes and discrimination of woman's roles not only in disasters and conflicts, but in their community as a whole.

Healthcare in Danger - The Responsibilities of Health-care Personnel Working in Armed Conflicts and Other Emergencies highlights the following questions, which rehabilitation professionals can use to guide their thinking around supporting women and girls following disasters and conflicts.[8]

  • Do women have unimpeded access to health care? If not, what is the reason? Prevailing insecurity? Financial or cultural constraints?
  • Does local custom stipulate that women should be treated only by female healthcare personnel?
  • Do women become especially vulnerable to, for example, trafficking or sexual violence when trying to reach or benefit from health care?
  • What can I do to curb practices such as female genital mutilation and mitigate their effects?
  • What child-care facilities are available for women seeking health care?
  • Can I direct women to health education programmes, including family planning?
  • Are women who have to pay for their health care or the health care of their families, vulnerable to sexual exploitation?[8]

Older Persons[edit | edit source]

The success of industrialisation and advances in modern medicine and technology has resulted in an increase in average life expectancy and with that an increase in the percentage of people living beyond 60 years. The United Nations defines the older person as anyone 60 years and above. According to the World Health Organization (WHO), there were 600 million persons aged 60+ years in 2000, with that number expected to rise to 1.2 billion by 2025 and 2 billion by 2050, with a significant and growing number of those affected by humanitarian crises.[9] Pre-existing conditions and positions exacerbated by a crisis and specific issues and risks created by the emergency itself are the main challenges and protective factors that impact on the older person in humanitarian crises. These can be found at the individual, community and structural levels. Older age often compounds other forms of vulnerabilities or inequality, such as gender, race, education level, income, health status, or access to justice, that accumulate during a lifetime. When older persons do not enjoy their rights fully in regular times, their vulnerability to emergencies is likely to increase: [10]

Figure 1. Proportion of People Aged 60+
  • Older persons who had pre-existing conditions including mobility, sensory and communication difficulties have been shown to have an increased likelihood to be severely injured or killed as a result of disasters and conflicts
  • Older persons are neglected in both disaster risk reduction strategies and emergency responses, and are not prioritised to receive medical and rehabilitation services
  • Social isolation and reduced access to care support can result in greater difficulty accessing basic needs, including food, water, shelter, latrines and can mean older adults face higher risks associated with safety, protection and dignity and vulnerable to violence and exploitation. These factors can also contribute to deteriorating health during disasters and conflicts.[11][12]
  • Older people may also face a range of protection issues that arise from the disaster and conflict directly including human rights violations perpetrated by states, armed groups, or other international or national actors, or may result from problems at individual, family or community levels.


Table 2. Protection Issues faced by Older Persons in Disasters and Conflicts
At the level of the state, armed groups and international actors At individual, family and community level
  • Safety and security:
    • Physical risk or harm - reduced regenerative capacity and mobility challenges place older persons at greater risk of injury and make them more vulnerable to the longer-term impacts of an injury.
  • Violence:
    • The act or threat of physical, sexual or psychological abuse. Cycles of dependency, discrimination and isolation may place older people at risk of abuse within the family. Within the community, older people may become victims of the attack as a result of perceived vulnerability.
  • Housing, land and property rights:
    • Interference or discrimination in relation to housing, land, property, and possessions, with challenges in proving ownership as a result of lost ownership documents and high rates of eviction.
  • Neglect and deprivation:
    • Older people may be prevented from accessing the goods and services they need. This can be unintended or may be the result of deliberate discrimination.
  • Documentation:
    • Loss or destruction of personal documentation (such as ID, birth certificate or marriage certificate) and difficulty replacing it.
  • Isolation and dependency:
    • Lack of access to support and social relationships compounds the isolation felt by older people, as does the high level of help required in daily activities.
  • Freedom of movement:
    • Restriction on the rights to travel, reside in or work in any part of the state, as well as to leave that state and return at any time.
Family structures and family separation:
  • Family structures, for example, older people headed households, female or widow headed households, and households with large numbers of dependent children create specific protection risks for older people and their families.
  • Involuntary family separation affecting older people increases their levels of social isolation and reduces levels of support, making it harder for older people to access the goods and services they require.
  • Humanitarian principle of impartiality:
    • Humanitarian assistance is not provided according to need and without discrimination.
    • The failure to ensure access and accessibility of services for older people poses a major violation of the central principle of impartiality.

Currently, there is no United Nations Convention on the Rights of Older People or universally applicable standards, which could serve as a reference for developing legislation to protect such rights. This situation is unchanged despite frequent calls for enhanced actions to promote the full enjoyment of all human rights by older persons, and as such, older persons often remain invisible within current international legal frameworks. The 1991 United Nations Principles for Older Persons[13] provides an authoritative framework for the rights of older people including independence, participation, care, self-fulfillment and dignity, that can be applied during emergencies and humanitarian settings. The Madrid Plan of Action on Ageing,[14] is a practical tool endorsed by the UN General Assembly in 2002 to assist governments in addressing issues associated with population ageing, including social protection, health, nutrition, urbanisation, infrastructure, housing, and training of carers, which also prioritises humanitarian disasters as one of eight key areas for action, with a focus on equal access and inclusion.[2]

Figure 1. Checklist for Older Person Involvement in Disaster Management

The humanitarian needs and requirements of older persons should be included across all stages of emergency and humanitarian responses including engagement with older persons to ensure their involvement in decision making. This helps reduce their vulnerability to further hazards by enabling more equitable access to community-based risk-reduction activities, to early warning systems and evacuation mechanisms. Rehabilitation professionals can play a role in this and can support this process by assessing the protection issues faced by older persons, including older persons in all decision-making, and by advocating for the older person during disasters and conflicts. Figure 1 outlines key elements to include older persons in each phase of the disaster management process.

Healthcare in Danger - The Responsibilities of Health-care Personnel Working in Armed Conflicts and Other Emergencies highlights the following questions, which you can use to guide your thinking around supporting older persons following disasters and conflicts.[8]

  • Do the elderly have difficulty reaching health care? Are they confined to their homes?
  • Is there any information as to how health care for elderly people has been affected by the armed conflict or other emergencies?
  • Can the elderly claim their pensions, so that they can pay for their health care?[8]

Persons with a Disability[edit | edit source]

Over a billion people in the world today are estimated to live with some form of disability, which corresponds to about 15% of the world's population, or one in seven people. Between 110 million (2.2%) and 190 million (3.8%) people 15 years and older have significant difficulties in functioning, while some 93 million children or one in 20 of those under 15 years of age live with moderate or severe disability. Since the adoption of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), disability has been firmly established as a human rights and development issue. There is an increasing body of evidence highlighting that people with a disability experience worse socioeconomic outcomes and poverty than persons without disabilities. Article 11, on “Situations of Risk and Humanitarian Emergencies” pays particular attention to the obligation of states to undertake “all necessary measures to ensure the protection and safety of persons with disabilities in situations of risk, including situations of armed conflict, humanitarian emergencies and the occurrence of natural disasters”,[15] while Article 32 recognises the importance of international cooperation to address the limited capacities of some states to respond to situations of risk and humanitarian crises, both highlighting that emergency and humanitarian operations must be inclusive of people with disabilities.[15]

People with disabilities may be disproportionately affected by disasters and conflicts, with evidence suggesting that mortality rates for people with disabilities (2.06%)[16] are double, or even up to four times that seen for the general population (1.03%)[16] in disaster settings.[2][17] In emergency responses, people with disabilities may also be more likely to be left behind, lose essential assistive devices such as spectacles, hearing and mobility aids and/or medications or fail to benefit from humanitarian services due to a range of environmental, physical and social barriers .[18][17] They may also have greater difficulty accessing basic needs, including food, water, shelter, latrines and health-care services and can also face higher risks associated with safety, protection and dignity and may be particularly vulnerable to violence, exploitation and sexual abuse.[17] Traditional caring mechanisms within the community are also interrupted and the capacity of caregivers and care settings to provide for and support people with disabilities are often reduced, further increasing vulnerabilities and risks for people with a disability.[8]

There is growing recognition that disability inclusion is crucial to effective humanitarian action and numerous policy tools and guidelines have been produced at the global level to support the inclusion of persons with disabilities in humanitarian action including the Charter on Inclusion of Persons with Disabilities in Humanitarian Action (2016), the Humanitarian Inclusion Standards for Older People and People with Disabilities (2018) and the Inter-Agency Standing Committee (IASC) Guidelines on Inclusion of Persons with Disabilities in Humanitarian Actions (2019). Despite these guidelines, there still remains a substantial gap in the engagement of persons with a disability in humanitarian action at the field level. Thus, further actions need to be taken to strengthen disability-inclusive humanitarian action strengthened including:[19]

  • Recognition of persons with disabilities, not only as beneficiaries of humanitarian assistance but also as key actors in the response.
  • Capacity-building of humanitarian actors at field level to ensure they are equipped, not only with the knowledge of ‘what’ disability inclusion entails, but also the resources to address the ‘how’ to ensure inclusion in humanitarian responses.
  • Systematically integrate disability inclusion into key global agendas and ensure that it does not remain a separate stand-alone workstream, but rather is recognised as being closely interlinked to other marginalised issues such as gender equality, age-sensitive programming and mainstreaming of mental health and psychosocial support.[19]


The following webinar recording, organised by ICVA, PHAP, and the Inter-Agency Standing Committee (IASC), introduces the guidelines for the inclusion of persons with disabilities in humanitarian action and discusses how the guidelines can be implemented in practice.

The humanitarian needs and requirements of persons with a disability, paying attention to the diversity of disabilities, should be included across all stages of emergency and humanitarian responses. This includes engagement with disabled person organisations, where they exist, to ensure the involvement of people with disabilities in decision-making. This helps reduce their vulnerability to further hazards by enabling more equitable access to community-based risk-reduction activities, early warning systems and evacuation mechanisms. Rehabilitation professionals can support this process by including persons with a disability in all decision-making, and by ensuring that planning does not just focus on those injured during the disaster, but also incorporates all those with a disability.

Healthcare in Danger - The Responsibilities of Health-care Personnel Working in Armed Conflicts and Other Emergencies highlights the following questions, which you can use to guide your thinking around supporting persons with a disability following disasters and conflicts.[8]

  • Do people with disabilities have difficulty reaching health care or rehabilitation services? Are they confined to their homes? What means of transport are available for them?
  • Are people with disabilities discriminated against in terms of access to health-care services, education etc?
  • What institutions provide services for people with disabilities? Is there any information about how facilities upon which people with disabilities depend, including health-care facilities, have been affected by the conflict?
  • Is there any danger of people with disabilities being taken advantage of as a result of the insecurity created by the armed conflict or other emergencies?
  • Are people with disabilities able to pay for their health care? [8]

Resources[edit | edit source]

Children[edit | edit source]

Women[edit | edit source]

Older Person[edit | edit source]

Persons with a Disability[edit | edit source]

References [edit | edit source]

  1. World Health Organization and UNICEF. Guidance Note on Disability and Emergency Risk Management for Health. World Health Organization, UNICEF, Geneva, Switzerland. 2013. Available at: http://www.who.int/hac/techguidance/preparedness/disability/en/ [Accessed 09 March 2022].
  2. 2.0 2.1 2.2 2.3 2.4 World Confederation for Physical Therapy. WCPT Report: The Role of Physical Therapists in Disaster Management. London, UK: WCPT; 2016
  3. Skelton P, Foo W. Responding Internationally to Disasters: A Do's and Don'ts Guide for Rehabilitation Professionals. London, United Kingdom: Handicap International. 2016.
  4. Lathia C, Skelton P, Clift Z. Early rehabilitation in conflicts and disasters, 2020.
  5. 5.0 5.1 Peek L. Children and Disasters: Understanding Vulnerability, Developing Capacities, and Promoting Resilience - An Introduction. Children Youth and Environments. 2008 Jan 1;18(1):1-29.
  6. A. Jabry, After the Cameras Have Gone – Children in Disasters (2nd ed, 2005) Plan International.
  7. J. Todres, ‘Mainstreaming Children’s Rights in Post-Disaster Settings’ (2011) Emory International Law Review 25: 1233-1261.
  8. 8.0 8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8 International Committee of the Red Cross. Health Care in Danger: The Responsibilities of Health-care Personnel Working in Armed Conflicts and Other Emergencies. International Committee of the Red Cross; 2012.
  9. Office for National Statistics. Interim Life Tables, 2008–2010. http://www.ons.gov.uk/ons/rel/lifetables/interim-life-tables/2008-2010/index.html?format=hi-vis (accessed 28 Jan 2012)
  10. UNECE. Policy Brief on Ageing - Older Persons in Emergency. No. 25 November 2020
  11. Zhang L, Li H, Carlton JR, Ursano R. The injury profile after the 2008 earthquakes in China. Injury[Internet]. 2009 Jan [cited 2014 Jul 22];40(1):84 - 6. Available from: www.ncbi.nlm.nih.gov/pubmed/19117564 [Accessed on 05 March 2022]
  12. Allaire A. Protection interventions for older people in emergencies. HelpAge International; 2013.
  13. United Nations General Assembly. 46/91 Implementation of the international plan of action on ageing and related activities. [Internet]. 1991. p. A/Res/46/91. Available from: www.un.org/documents/ga/res/46/a46r091.htm [Accessed on 05 March 2022]
  14. United Nations. Political Declaration and Madrid International Plan of Action on Ageing. 2002. Available from: www.un.org/en/events/pastevents/pdfs/Madrid_plan.pdf [Accessed on 03 March 2022]
  15. 15.0 15.1 United Nations, Division for Social Policy and Development Disability. Convention on the rights of persons with disabilities and optional protocol. [last accessed 22.03. 2022].
  16. 16.0 16.1 NHK Fukushi Network Shuzaihan. Higashi nihon daishinsai ni okeru shogaisha no shiboritsu [Death rate among persons with disabilities in the eastern Japan earthquake]. Normalization, November 2011:61–63 (in Japanese) (http://www8.cao.+go.jp/shougai/suishin/kaikaku/s_kaigi/k_37/pdf/ref4–1.pdf, accessed 1 February 2013).
  17. 17.0 17.1 17.2 World Health Organization, UNICEF. Guidance Note on Disability and Emergency Risk Management for Health. World Health Organization, UNICEF, Geneva, Switzerland. 2013.
  18. Disability-tsunami emergency response summary for ACFID, January 2005. Deakin, Australian Council for International Development, 2005.
  19. 19.0 19.1 Inter-Agency Standing Committee. Inclusion of Persons with Disabilities in Humanitarian Action. 2019 Available from: https://interagencystandingcommittee.org/iasc-task-team-inclusion-persons-disabilities-humanitarian-action/documents/iasc-guidelines [Accessed on 03 March 2022]
  20. PHAPassociation. An introduction to the new Physiopedia Plus. Available from: https://youtu.be/0bJgGcyJylo[last accessed 12/03/22]