We have all grown accustomed to the gradual decline in funding for the disabled in our own part of the world. Small residential programs are growing into group homes. People with obvious mental illnesses (who are not, by definition anyways, disabled at all) panhandle on the streets. Large and presumably obsolete institutions are shut down without replacement programs in place....

All of this, however, is almost inconsequential beside the extremely difficult life situations of most of the disabled outside of the wealthiest countries. The remainder of this article is an attempt to describe at least some of these difficulties.

Worldwide, approximately one person in ten has a disability. In all likelihood, the incidence rates in the "developing world" are considerably higher than in the more affluent industrialized nations. And, as we will see, life can be extremely difficult for those with significant impairments born into less affluent societies.

(For further discussion of terminology and statistics, see the end of this article.)

One of the most obvious reasons for the higher incidences of disability in the "developing world" is a general lack of thoroughgoing medical care, especially away from the major urban centres, and for the vast, poor majorities. Down's Syndrome, for example, can be diagnosed in utero, but only with the use of fairly sophisticated techniques. Iodine deficiency is a common cause of mental handicap in populations where poor nutrition is common. Often, complications in childbirth that could be dealt with routinely under the kinds of medical conditions that we all take for granted in the "developed world" lead to brain damage for the newborn, as well as (of course) terrible consequences for the mother. Alcohol abuse on the part of pregnant mothers who may not even be aware of the outcome of their actions may lead to individuals with FAS or FAE.

Traffic accidents in the developing world are a major cause of physical and mental disability. Mexico, for example, has a fatality rate that is approximately 700% higher than the Canadian equivalent, and injury rates would reflect this. Industrial safety standards and environmental regulations are practically nonexistent or completely unenforced in many parts of the world, leading to poorly documented but certainly high levels of injury and work-caused disability.

Warfare and protracted civil strife are a major cause of physical disability. Worse still, the damage caused by armed conflict to a region's social, physical and economic infrastructure contributes negatively to the resources available for care and rehabilitation of any individuals with any sort of need whatsoever. For example, several years ago, during the fighting in the former Yugoslavia, Canadian troops encountered a psychiatric hospital with most of its residents and absolutely no staff whatsoever! The nurses, mainly women, had fled out of fear for their own safety.

Mass migrations, of the sort recently witnessed from Rwanda, are especially difficult to cope with for those who cannot fend properly for themselves under extremely difficult and demanding conditions. Populations of refugee camps have been noted to be extremely underrepresented by persons with disabilities. There have even been reports of refugee families killing their disabled children to enable the rest of the family to emigrate to another country; "point systems" do not favor those who do not meet their age, health, and educational criteria.

In the former "East Bloc" and in other parts of the world that have also seen recent precipitous declines in income and standards of living, there can be little doubt that the disabled are not at the front of the line for scant, diminishing, and unevenly allocated resources. Russia, apparently, affords standards of living at or below the poverty level for 50-80% of its citizens!

According to semi-official estimates, only about 1% of the disabled individuals in the developing world receive rehabilitation services of any kind! Most must depend on their families, charity, begging, or the meagre forms of employment available to them. Physical abuse, sexual abuse, and neglect are routinely inflicted on the disabled without consequence.

To some extent, traditional and grass roots non governmental organizations and self-help groups attempt to expose the vast problems and to at least begin to find ways to improve the lot of the disabled in the developing world. The United Nations through the World Health Organization is also beginning to pay heed to the magnitude of the situation. Obviously, however, these are only vague beginnings.

It would be nice, as the planetary population explodes, the environment degrades, and neoconservative economic thought prevails, to be able to outline a potential future that would hold greater hope for the disabled of the world. Nice, but unrealistic. Unless some real changes occur in the basic assumptions that we all live our lives by, and unless this is translated into profound changes in the world order and the way that we all carry out our duties and responsibilities as global citizens, then the plight of the disabled will in all likelihood worsen.

Statistics concerning worldwide incidences should be taken with a grain of salt. The terms "disability" or "handicap" are difficult to define precisely, as it is easy to delineate their mid ranges and the extremes, but much harder to define their thresholds. In a good many cases in the literature, the term "disability" is left gloriously ambiguous, and allowed to cover absolutely everything. Also, the sheer enormity of the problems make precise study and measurement extremely difficult. In parts of the world where medical and scientific resources are already taxed to the limit, it would be difficult to justify large studies that seek only to gather vast reams of statistics.

However, a general lack of precise terminology or research is no excuse whatsoever for assuming that a problem is unimportant.

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