30/03/2022
Seham’s trip to the disability training center usually takes around ten minutes. Seham’s father helps her get there every morning. ٍOne day, Seham had to make the trip alone, since her daily companion was unavailable. The trip usually entails going in her wheelchair on the road as the sidewalks are not accessible. At one point, Seham’s wheelchair started rolling faster as she was going downhill. She tried to brake. The brakes didn’t work. She fell and injured her hands and legs.
Seham is 39. She was born with muscle atrophy and has had to use a wheelchair all her life. The one she uses breaks down frequently and is not suitable for her condition.
This report documents how wheelchairs available to disabled persons in Gaza are of low-quality. They mostly are without labels to show information on country of origin and manufacturer. Users, along with local and international specialists, agree that available wheelchairs are not suitable for daily use and break down frequently. In addition, they are being distributed to users without fittings, manuals or instructions on how to use them.
The report also shows how Palestine is in violation of a number of articles in the UN Convention on the Rights of Persons with Disability which it is a signatory of.
There are four thousand wheelchair users in Gaza, according to the social development ministry’s statistics. The disability rate in Gaza is at 2.5% of the two million population.Zahra al MadhounMohammed BahloulNehad Garbou
A tour of eight of the importing companies in Gaza revealed that the wheelchairs available at all of them, except for one, had no labels with company name or country of origin information and no catalog with specs, tests and instructions on use. Out of 61 wheelchair users interviewed, 23 said they had no information about their wheelchairs.
Abdel Karim al Qiranawy, director of the middle governorate office of the Palestinian Union for the Disabled Persons, suffers partial paralysis in the spinal cord. He uses a wheelchair with unknown origin that he received from the center for prosthetics of the municipality of Gaza.
“The problem is the quality. It’s not good. Rust appeared after only three months. The brakes broke after just one month.” Al Qiranawy adds that he also had repeated problems with the wheels, which put him in danger.
Ahmed al Nagar is the director of the Physical Therapists Union. He recalls a wheelchair user complaining after his wheelchair broke down days after he started using it. Al Nagar says they investigated but the wheelchairs didn’t even come in boxes with company names. “We couldn’t find any information.” He describes the wheelchairs distributed by the disability rehabilitation organizations as being of “very bad quality” and they don’t last long.
Bill Amer, Chairman of Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) Standards Committee on Wheelchairs, looked at pictures of the wheelchairs without labels available in Gaza. Ammer, who has over 20 years experience in testing wheelchairs, commented: “They were made for transporting a person to and from different places but not to spend all day in these.”
“These are very typical, very low cost products that are used in most countries, we call them depot or hospital style wheelchairs. They are specifically designed for indoor use and it’s been known for years and years and years that they fail prematurely in any kind of demanding environment,” says Dr. John Pearlman, director of the International Society of Wheelchair Professionals (ISWP) when he reviewed the pictures of the Gaza wheelchairs.
Dr. Ziyad Youssef, owner of al Shams company for medical and assistive devices, admits that the companies think of wheelchairs from a purely profit perspective, which he says is the reason these low-quality wheelchairs, whose origin is unknown, are available on the market.
“Unfortunately, organizations are looking for cheap prices regardless of quality,” says Ahmed al Ashhab, director of al Ashhab for Import of Medicalُ Equipment in Palestine. He says quality wheelchairs would always have a label with a clear trademark and a manual with instructions and other relevant information.
The average price of manual wheelchairs that have no label is $155- $200, while the price of wheelchairs with a label and known manufacturer ranges between $170-$280.
getting a permit to import from the ministry
Shipping the product from the country where it was manufactured
Products arrive at Asdud port in Israel
Products are transported to the Karam Abu Salem crossing
Products enter Gaza
Ministry of Economy spokesperson in Gaza Abdel Fattah Moussa says traders are smuggling goods through the Karam Abu Salem trade crossing south of Gaza.
“You wouldn’t let an automobile to your country to be sold to people, that hasn’t been safety tested and that no one knows the manufacturer or the history. You wanna be safe and it’s the same with the wheelchairs,” says Kara Koplin, Chair of the RESNA Standards Committee for Wheelchairs and Related Seating.
Dr. Ayman Kardeyah, director of the Drug Control Department at the Ministry of Health in Gaza confirms that it is a requirement for wheelchairs to have a clear manufacturer’s name and instructions manual in order to enter Gaza.
The International Standards Organization (ISO) through TC173 for assistive products specifies the wheelchair tests that need to be carried out to ensure their quality. Some countries require companies to show that these tests were carried out and passed as a condition to import its products. In Gaza, companies are not required to do so. The World Health Organization in its Guidelines on the Provision of Manual Wheelchairs in Less Resources Settings says, “Governments are encouraged to develop and adopt national wheelchair standards to ensure a reasonable level of quality.”
“I think an important consideration is that these are medical devices. I think sometimes people think that it’s something lesser, that it’s just a wheelchair. Yes, but the person’s safety and transportation is dependent on that,” says Koplin. She suggests countries should require companies to do ISO testing as a condition to sell their wheelchairs.
Ibrahim Erhayem received an electric wheelchair from the Balsam Association for Disabilities in 2017. It broke down the day he got it, so he exchanged it. The wheelchair was not tested before it was given to him and Erhayem did not receive any instructions on how to use it, how to sit in it and for how long. Soon, his skin got infected.
Many of the associations distributing wheelchairs in Gaza don’t have physical or occupational therapists. The director of the physical therapy union Ahmed al Najjar and head of physical therapy at Doctors without Borders in Gaza Abdel Hamid Qaradaya, and director of the physical therapy department at al Azhar University Adnan Nasr agree that absence of physical therapists is one of the reasons why disabled persons are not fitted with an appropriate wheelchair and unable to use them effectively and safely. Al Najjar explains that it is the physical therapist’s responsibility to ensure the wheelchair fits the condition of the disabled person and is up to the standards.
Four physical therapy specialists said distributing wheelchairs without conducting the appropriate examinations and not giving users instructions on how to use them causes medical complications.
Bill Ammer points out that the wheelchair seats he’s seen in the pictures is what’s called “a sling seat.” “It’s basically a piece of fabric that’s stretched across the two seat rails. Number one, there is no support, number two the curve of that seat will compress your hips and it can be painful. If there is no cushion you can cause pressure sores.”
Alaa Abu Hajjaj, Secretary of the Palestiian Union for the Disabled in the Northern Governorate, criticizes the process of wheelchair distribution, noting that his union has recorded a number of cases in which users received wheelchairs that did not fit their condition.
Adding to the problem is the fact that the associations depend primarily on a medical report by the attending physician without doing their own examination to determine the wheelchair specifications needed for each case.
This takes place even though the Ministry of Health requires that the disabled person is evaluated through its guidelines for wheelchair distribution, a form that contains basic information about the user’s condition. Meanwhile, the Ministry of Social Development requires that a physical therapist is present during an examination of any disabled persons applying to get a wheelchair. This is rarely implemented.
Most of the wheelchair users interviewed for this report did not receive instructions on how to use their chairs. “There has to be a follow up in their homes,” says Nasr. He adds that users and a family member need to be given specific and clear instructions and there has to be regular follow up by the party providing the wheelchair. Over 35 users interviewed for this report had not received instructions.
Palestine ratified the UN Convention on Rights of Persons with Disabilities and all of its protocols in 2014. This report shows how Palestine is in violation of three of the convention’s articles.
By not providing quality wheelchairs that allow the free movement of persons with disabilities in Gaza, Palestine is in violation of Article 20 which states that states should facilitate “access by persons with disabilities to quality mobility aids, devices, assistive technologies and forms of live assistance and intermediaries, including by making them available at affordable cost.”
Palestine is also in violation of Article 9 which relates to accessibility and enabling “persons with disabilities to live independently and participate fully in all aspects of life.”
“The primary obligations would rest on the state, and I guess in this instance it’s the state of Palestine, to ensure regulatory oversight, to make sure that the products being imported are actually serviceable to the end user,” notes Gerard Quinn, UN Special Rapporteur on the rights of persons with disabilities.
Article 33 of the convention is also not being followed. “Unlike most other treaties, the disability treaty requires governments to have a key focal point so there is no passing of the buck from one department to the other. It also requires that there be a coordinating mechanism between different entities within government,” says Quinn.
Zarif al Ghorra, a member of the shadow report to the UN, confirms that Palestine is in violation of Article 33 since Palestine does not have a focal person to communicate with the UN regarding issues related to disabled persons.
Al Ghotta adds that the Palestinian law regarding the disabled persons is from 1999 and not aligned with the UN Convention. Palestinian President Mahmoud Abbas had ordered for a new disability law, but it was never finalized.
It depends on who you ask. The ministries of economic affairs, health and social development throw the blame at each other and the importing companies.
The Health Ministry claims the Ministry of Economic Affairs is responsible since it oversees the Karam Abu Salem crossing and is in charge of products entering through crossings. The Health Ministry also says the Social Development Ministry is in charge of supervising the associations and thereby distribution process.
The Ministry of Economic Affairs in turn blamed the Health Ministry, since wheelchairs are considered medical devices and importing companies require a health ministry permit.
Meanwhile, the Ministry of Social Development blamed the health and economic affairs ministries. It claimed it had no supervising role when it comes to medical supply companies.
Interviews with owners of four companies showed confusion and dysfunction in the oversight and supervisory role played by government bodies and the absence of clear rules and specifications for imported wheelchairs.
Dr. Pearlman says there are ways for government authorities to set standards for products that come into the country. He notes that while the governments don’t have to carry the quality tests themselves, they could request test reports and have a clinical review of the product so “you can set expectations and hold manufacturers accountable.”
◉ According to an amendment of the consumer law in 2017, the Ministry of Health should confiscate and stop the import of any products that show signs of being dangerous for consumers. The amendments state that the ministry is responsible for inspecting wheelchairs and ensuring their quality and has the authority to stop importing them and to refer violators to prosecution.
Mr. Quinn points out that having a focal point to coordinate with the relevant UN departments is a critical step to ensure the UN convention is effective and ensure the quality of the products and its serviceability to the end users. He added that his office is ready to communicate with the relevant authorities in Gaza if they are interested in having a focal point and creating a coordinating mechanism.
The International Society of Wheelchair Professionals (ISWP) aims to improve the quality of wheelchairs and related services around the world. Dr. Pearlman, its director, says it offers numerous services to help governmental and non-governmental organizations improve the quality of wheelchairs.
The organization also offers virtual and in-person training workshops and a certificate for technicians and those working in organizations providing services Dr. Pearlman explains that they have helped different organizations in the past and are happy to connect with parties interested in improving wheelchairs in and its related services in Gaza.This investigation was conducted with the support of ARIJ.
