Physiotherapy without borders: case of the international committee of the red cross (ICRC) supported project in Tindouf, Western Sahara

Abstract

Background: Tindouf is situated in the South West of Algeria where around 160,000 Sahrawi refugees live in five camps, all victims of a conflict dating from 1973. No clear population census available, but the 0.5% given by theWorld Disability report (WHO, 2011) we conclude that 3000 people with physical disabilities (PwD) are living in this remote place suffering both from acquired and congenital disabilities. The ICRC is supporting the only rehabilitation facility depending on the Sahrawi Ministry of Health. Purpose: The aim of this review is to present a rehabilitation structure in a very challenging context but able to provide physiotherapy and comprehensive rehabilitation services. It will also discuss its achievements and constraints. Indeed, the limited care of PwD (e.g. victims of war or children with cerebral palsy) in this very special geo political and security context is unique but representative of other places in low resourced countries. Methods:Themain objectives of the ICRC physical rehabilitation are fourfold: assuring access, quality and long-term quality of services and social integration. In this context, the third objective will not be achieved, but the ICRC project is supporting the three others both at the physical rehabilitation centre and through its outreach programme. This presentation is a review of the project 7 years after its start. Results: Since 2007, a total of 759 persons received services through this programme, with 30 PwD receive physiotherapy services monthly. Uniquely in the region, physiotherapist helpers work in a multidisciplinary approach with the ortho-prosthetists assistants under supervision of Algerian staff. The treatments provided are basic but centred on the optimal use of the assistive devices and aiming at assuring independence in daily living activities. Within the camps, the identification of PwD is a priority and parents’ education on the care for their child with cerebral palsy is an essential part of the activities. The provision of rehabilitation is a unique way of improving the mobility and quality of life of this destitute population. Nevertheless, the daily challenges are immense, ranging from human resources, logistics to just environmental (climate). Conclusion(s): Such a project shows the importance to invest adequate resources on a medium-long term instead of just bringing sporadic support. It also of importance to try to get a clear picture of a context before initiating services, to include preventive measure in limiting further disabilities and to find, in collaboration with the partner, ways for the PwD to be re-integrated into society. Implications: Physiotherapy in Tindouf might not follow latest international guidelines, thus assures minimal care to gain mobility independence and hope for social integration through basic equipment and services adapted to the context. Training of national staff and support to the government in developing health services is important to assure quality of care for PwD.