# FOREWORD
The International Committee of the Red Cross (ICRC) is an impartial, neutral and independent organization whose exclusively humanitarian mission is to protect the lives and dignity of victims of war and other violence and to provide them with assistance. Established in 1863, the ICRC is at the origin of the International Red Cross and Red Crescent Movement. It strives through its delegations and missions around the world to fulfil its mandate to protect and assist the millions of people affected by armed conflict and other violence.
The UN Convention on the Rights of Persons with Disabilities, which seeks to promote, protect and ensure full and equal enjoyment of all human rights and fundamental freedoms, requires States Parties to take effective measures to ensure that people with disabilities have access to rehabilitation services (Article 26) and to mobility devices (Article 20). Ensuring access to physical rehabilitation, which involves providing physiotherapy and mobility devices (prostheses, orthoses, walking aids and wheelchairs), is the core objective of the ICRC's Physical Rehabilitation Programme (PRP). The term "rehabilitation" refers to a process aimed at removing -or reducing as far as possible -restrictions on the activities of people with disabilities and at enabling them to become more independent and enjoy the highest possible quality of life in physical, psychological, social and professional terms. Different measures, such as medical care, therapy, psychological support and vocational training, may be needed. Physical rehabilitation is an important part of the rehabilitation process. It is not an objective in itself but an essential part of fully integrating people with disabilities in society. Restoring mobility, which is the backbone of ICRC physical rehabilitation projects, is the first step towards enjoying such basic rights as access to food, shelter and education, finding a job and earning an income and generally having the same opportunities as other members of society.
Since 1979 the ICRC's physical rehabilitation activities have diversified and expanded throughout the world as the organization has worked to remove barriers hindering access to appropriate physical rehabilitation services. ICRC physical rehabilitation projects are planned and implemented in such a way as to strengthen the physical rehabilitation services available in the country concerned, the primary aims being to improve access to services for people with disabilities, to upgrade the quality of those services and to ensure their long-term availability. Enabling a person with physical disabilities to gain or regain mobility is an important step toward inclusion. However, the ICRC acknowledges that physical rehabilitation alone is often not enough to ensure full participation. It thus strives to provide more comprehensive assistance for disabled people by addressing their rehabilitative needs and by helping them to reintegrate socially and economically.
Over time, the ICRC has acquired a leadership position in physical rehabilitation, mainly because of the scope of its activities, the development of its in-house technology, its acknowledged expertise and its long-term commitment to assisted projects. In most countries where the ICRC has provided physical rehabilitation support, such services were previously either minimal or non-existent. In most cases, ICRC support has served as a basis for establishing a national rehabilitation service that cares for those in need. Between 1979 and 2014 the ICRC's Physical Rehabilitation Programme provided support for more than 190 projects (centres) in 50 countries and one territory. Large numbers of individuals have benefited from physical rehabilitation services, which have included the provision of 437,910 prostheses, 595,897 orthoses, 47,638 wheelchairs, 455,876 pairs of crutches, physiotherapy and follow-up (repair and maintenance of devices) with the assistance of the ICRC.
In 2014 the Physical Rehabilitation Programme provided assistance in 113 projects in 28 countries and one territory; more than 318,000 people (an increase of 13% on the 2013 figure) benefited from various services at ICRC-assisted centres. The services included the provision of 20,101 prostheses, 74,102 orthoses, 4,495 wheelchairs and 19,118 pairs of crutches as well as appropriate physiotherapy treatment for 153,461 people. Children represented 28% and women 20% of the beneficiaries.
In addition to its operational Physical Rehabilitation Programme, the ICRC provides support for physical rehabilitation through its Special Fund for the Disabled (SFD). Created by the ICRC in 1983, the SFD provides support similar to that provided through the Physical Rehabilitation Programme. It is primarily the political context and the specific needs that decide which channel the ICRC uses in a given situation. The SFD's mission is to provide support for physical rehabilitation in low-income countries that are not covered by the Physical Rehabilitation Programme, with priority being given to projects formerly implemented by the ICRC. In 2014 the SFD provided assistance in 45 projects in 20 countries. The services provided by SFD-supported centres included the production of 5,109 prostheses and 17,759 orthoses and the distribution of 274 wheelchairs and 2,187 pairs of crutches. Of the total number of prostheses supplied, 1,679 (33%) were for mine survivors. This report describes the worldwide activities of the ICRC's Physical Rehabilitation Programme in 2014. Information on the activities of the Special Fund for the Disabled may be obtained from its 2014 Annual Report (www.icrc.org/fund-disabled).
T. Leblanc/ICRC

# -INTRODUCTION
The UN Convention on the Rights of Persons with Disabilities (UNCRPD) seeks to protect, promote and ensure full and equal enjoyment of all human rights and fundamental freedoms. It requires States Parties to take effective measures to ensure that people with disabilities have access to mobility devices (Article 20) and rehabilitation services (Article 26) and enjoy full inclusion and participation in the community (Articles 19 and 26).
People with disabilities generally have poorer health, lower levels of educational attainment and fewer economic opportunities than other members of society. As a result, many of them are forced into poverty and excluded from day-to-day activities. Health-care services, education, employment, transportation, information and technology are today still inaccessible to large numbers of people with disabilities. The 2011 World Report on Disability, published by the World Health Organization and the World Bank, gives a list of barriers faced by people with disabilities wishing to access appropriate physical rehabilitation services. These include the absence of a national plan or strategy, non-existent or inadequate services (where services exist, they are often located in major cities only), the lack of trained professionals, and insufficient finances to cover the cost of services, including transport to places providing them. Conflicts and other situations of violence exacerbate the constraints faced by people with disabilities in relation to meeting their basic and specific needs. Some have difficulty fleeing to safety, while those who are able to do so struggle with the change in terrain, lose their mobility aids/equipment in the process and/or cannot access rehabilitative care. Detainees with disabilities also have to contend with several challenges while they are in held in temporary or permanent places of detention.
Rehabilitation is a process that aims to remove restrictions on the activities of people with disabilities, or to reduce those restrictions as much as possible, and to enable them to become more independent, participate fully in society and enjoy the highest possible quality of life. Depending on the type of disability, various measures may be needed to achieve this end. They range from medical care and physical rehabilitation to social support, vocational training and other help in attaining economic self-reliance. Physical rehabilitation is an integral part of the process required to ensure the full participation and inclusion in society of people with disabilities. It includes providing people with physical disabilities with mobility devices, such as prostheses, orthoses, walking aids and wheelchairs, as well as with therapy that will enable them to make the fullest use of those devices. Physical rehabilitation must also include services for maintaining, adjusting, repairing and renewing the devices as needed.
Access to physical rehabilitation is important from both human rights and human development perspectives. Personal mobility and the availability of assistive devices is a precondition for equal participation in and being a productive member of society. The use of assistive devices is a means of gaining mobility, opportunities for education and work, and improved health and quality of life. These outcomes are important indicators of human development. Assistive devices may also prevent falls, injuries and other impairments. Consequently, investment in the provision of assistive devices can reduce health-care costs and economic vulnerability and increase productivity and quality of life.
Although the ICRC had undertaken some physical rehabilitation activities before 1979, the establishment of the Physical Rehabilitation Unit that year marked the beginning of a serious commitment in this field. Two operational projects were implemented in 1979 under the newly established Physical Rehabilitation Programme (PRP). Since 1979 the ICRC's worldwide physical rehabilitation activities have diversified and expanded. It has now acquired a leadership position in this context, partly because of its development of the polypropylene technology now also used by several other organizations as part of standard practice in the production of prostheses and orthoses in many low-income countries. Between 1979 and 2014 the ICRC's Physical Rehabilitation Programme provided support for more than 190 projects in 50 countries and one territory. Over half the centres were newly built, frequently with substantial ICRC co-funding of construction and equipment. The programme's operational activities have expanded from two centres in two countries in 1979 to a total of 113 assisted projects in 28 countries and one territory in 2014. A direct result of this steady growth in the number of assisted centres is the rise in the number of people receiving services. People with disabilities who have received services continue to benefit from the infrastructure and expertise developed by the ICRC, not only during the period of assistance but afterwards, too. Thus, the true number of beneficiaries is higher than indicated by the statistics, which do not include those treated after the ICRC's withdrawal from assisted centres.

# APPROACH
In its work to enable people with physical disabilities to gain or regain mobility, the ICRC acknowledges that physical rehabilitation alone is often not enough to ensure their full participation in society. As a pendant to the provision of a wide range of services providing direct assistance for people with disabilities, the ICRC therefore also seeks to strengthen national capacities as a means of overcoming the different barriers to accessing services faced by people with disabilities. This is done by:  working closely with local partners;  supporting national authorities in the management, development, implementation and monitoring of national physical rehabilitation services;  supporting service providers to ensure that they have the means to provide services;  increasing and strengthening human resources for physical rehabilitation;  strengthening national and regional professional associations;  providing direct support for potential service users to ensure that they have access to services by subsidizing the cost of travel to the services, the cost of accommodation and food while receiving services and the cost of services provided at centres; and  working closely with people with disabilities organizations.
The ICRC endeavours to respond to physical rehabilitation needs at the individual, structural and societal levels, notably by helping to improve the accessibility, quality and sustainability of services along the rehabilitation chain (emergency and continuing medical care; physical rehabilitation and psychological support). It directly assists people injured during armed conflicts and other situations of violence as well as other people with physical disabilities, with a view to reducing, as much as possible, the impact of their injuries and/or disabilities on the quality of their lives.
In the conflict-racked countries where the ICRC carries out its mandate, it is not only people directly affected by the conflict (those injured by landmines, bombs and other ordnance) who need physical rehabilitation but also people indirectly affected -people who become physically disabled because the breakdown of normal health services prevents them from receiving proper care and/or vaccinations. The projects assisted by the ICRC provide services for all those in need.
The ICRC's PRP projects are designed to strengthen the overall physical rehabilitation services in a given country. They are planned, implemented and monitored in a manner that takes account of the life-long needs of people with disabilities. People who have been provided with a first device have the right to expect services whenever repairs/new devices are needed. To optimize impact, various modes of action are implemented in combination: persuasion, support, substitution and mobilization. The mode of action and the level and type of assistance used to respond to the needs of people with disabilities depend on the urgency and magnitude of the needs, the possibility of working with a local partner and the ICRC's overall analysis of the situation.
ICRC projects are implemented with the following aims:
 Improving accessibility: The ICRC takes all possible measures to ensure that everyone in need of physical rehabilitation services has access to them on an equalopportunity basis, regardless of social, religious, ethnic or other considerations. Special attention is given to vulnerable groups, such as women and children.  Improving quality: The ICRC promotes the application of internally developed guidelines based on international norms. The organization also promotes a multidisciplinary patient-management approach that includes physiotherapy and ensures that the ICRC technology used to produce appliances and aids for people with disabilities remains appropriate and up to date.  Ensuring sustainability: The ICRC works with and helps to strengthen the capacity of local partners from the outset. In addition, whenever necessary, the ICRC ensures project continuity through its Special Fund for the Disabled (SFD). This long-term approach not only takes account of the ICRC's residual responsibility, but also reduces the risk of any loss of investment in human resources, capital and materials.  Promoting full inclusion and participation: The ICRC facilitates the social and economic reintegration of people with disabilities through various assistance and advocacy activities implemented directly or with partners. It also lobbies with the national authorities for the implementation of related treaties or legislation.
In order to achieve these aims, the ICRC pursues a twin-track approach: assistance is given to both the national system and to users of its services. Assistance to the national system aims to ensure that the system has the means to provide services. It includes support at centre level to ensure that centres have the capacity to provide and manage services. This support may include constructing/renovating facilities, donating machines, tools, other equipment, raw materials and components, developing local human resources and supporting the development of a national strategy for physical rehabilitation. Assistance is also provided for the pertinent national authorities to manage and supervise activities related to physical rehabilitation. Assistance for users is intended to ensure that they have access to the services. That includes covering travel, accommodation and food expenses, the cost of treatment at the centres and, when needed, the cost of implementing specific activities to overcome inequality among vulnerable groups in accessing services.

# DEVELOPING NATIONAL CAPACITY
The Physical Rehabilitation Programme strives to develop national capacities so as to enable the national sector to overcome the different barriers faced by people with disabilities and to meet their basic physical rehabilitation needs, and to do this in the most prompt, humane and professional way possible. For that reason, the ICRC supports local partners (governments, NGOs, etc.) in providing these services. The level of support varies from one country to another but the aim is always to develop national capacity, technical and managerial. However, in certain circumstances the ICRC may take over the role of the authorities entirely in this field. Ninety per cent of the ICRC's projects have been, and continue to be, managed in close cooperation with local partners, primarily government authorities. Few centres have been or are run by the ICRC alone, but there are two situations in which this may happen: when there is no suitable partner at the outset and when a centre is established to treat people from a neighbouring country. In 2014, apart from one centre in Iraq (Erbil) and all eight projects in Afghanistan, assisted centres were either government-run or managed by NGOs, National Red Cross/Red Crescent Societies or private entrepreneurs.
The ICRC's withdrawal from functioning rehabilitation projects has been successful in a number of instances; on some occasions, however, the result after a year or so has been an empty centre without materials, trained personnel or service users. In countries with limited financial resources, the needs of people with disabilities, including rehabilitation, are seldom given priority. The result is a poorly funded and poorly supported sector, including centres. Besides the impact on people with physical disabilities and personnel, this represents a significant loss in terms of investment of human capital and materials. As noted above, people with disabilities need access to functioning rehabilitation services for the rest of their lives. In order to improve the chances of services continuing to function, the ICRC pursues a long-term approach when setting up and managing its projects. While assistance is given in order to increase access to and improve the quality of the services, the ICRC is always attentive to fostering its partners' managerial and technical capacity from the outset. It does this by training and mentoring, by improving facilities and by promoting an effective physical rehabilitation policy within the government.
Besides developing the capacities of the service providers, the ICRC also works closely with national authorities responsible for the physical rehabilitation sector in their roles of overseeing, managing and regulating the sector. Since 1979 the ICRC has developed several tools (stock management, patient management, treatment protocols, etc.) to support managers of assisted centres. These management tools have also been distributed to other organizations working in the same area.
Since the quality and the long-term availability of services depend largely on a ready supply of trained professionals, the training component of ICRC-assisted projects has gained in importance over the years. The presence of trained professionals also increases the chances of rehabilitation facilities continuing to function in the long term. In 2003 an in-house training package for orthotic/prosthetic technicians (Certificate of Professional Competency -CPC) was developed by the ICRC and recognized by the International Society for Prosthetics and Orthotics (ISPO). Since 1979 the ICRC has run formal prosthetic and orthotic (P&O) programmes leading to a diploma in more than 12 countries, as well as formal training in physiotherapy in one country. It has also provided scholarships enabling a number of candidates to be trained in P&O or physiotherapy at recognized schools. Over the years, support from the ICRC through scholarships or formal training programmes has led to nearly 595 people becoming P&O professionals and to more than 200 becoming physiotherapy professionals. Besides working toward increasing the number of professionals, the ICRC provides support to either establish national P&O schools or to strengthen existing P&O and PT schools.

# BEYOND PHYSICAL REHABILITATION
The aim of ICRC projects is to help to fully integrate and ensure the participation of people with disabilities in society, both during and after the period of assistance. Although its focus is on physical rehabilitation itself, the ICRC's Physical Rehabilitation Programme recognizes the need to go beyond physical rehabilitation to ensure that people with physical disabilities have access to other services that give them equal opportunities, allow them to enjoy human rights and enable them to live in dignity.
Several initiatives have been launched as part of the ICRC's physical rehabilitation projects to promote inclusion and participation, sometimes with or in support of organizations specializing in this field. For example, people with physical disabilities are directed to microeconomic assistance programmes run by the ICRC or local organizations or enabled to access education and vocational training and to participate in sporting events. In addition, the ICRC provides support for awareness campaigns and advocacy and seeks to deepen the national authorities' commitment to assisting people with disabilities, notably in relation to the UN Convention on the Rights of Persons with Disabilities.

# POLYPROPYLENE TECHNOLOGY
The ICRC initially used raw materials and machinery imported from established Western suppliers to produce prosthetic and orthotic components. However, it soon started developing a new technology using polypropylene as the basic material, thus bringing down the cost of rehabilitation services. Recognition for the vital role played by the ICRC in making rehabilitative devices more widely available -by introducing low-cost, high-quality technology -came in 2004 in the form of the Brian Blatchford Prize awarded by ISPO. It is now standard practice to use the technology developed by the ICRC in the production of prostheses and orthoses; the technology has also been adopted by a significant number of organizations involved in physical rehabilitation.
To highlight the ICRC's role in developing and promoting better technology, such as that using polypropylene, a brochure on the subject was published in 2007. It contains information about the suitability of this technology for developing countries and the advantages to be gained from its use.

# SPECIALIST SUPPORT
Apart from developing technologies and training professionals, the ICRC uses its specialists to promote high-quality services. Its pool of experts, drawn from more than 25 countries, is by far the largest among the international organizations working in the same area.
Over time, the average number of expatriates per project has dropped from seven (in 1979) to approximately 0.8 in 2013, mainly because of the ICRC's greater experience and the growing number of locally trained professionals working at assisted centres.

# L. Merlo/ICRC
In 2014 the ICRC continued its efforts to remove the barriers faced by people with disabilities in accessing appropriate physical rehabilitation services, to enhance the quality of those services and to promote their longterm availability.
The information contained in this section provides a summary of activities carried out by the ICRC in 2014. More detailed information is provided in Chapter 4 of this report, "Project activities. "

# IMPROVING ACCESS TO SERVICES
Throughout the year, the ICRC continued to improve access to services by applying its twin-track approach, that is, by providing assistance for both the national system and users of its services. Assistance for the national system aims to ensure that the system has the means to provide services, while the goal of providing assistance for users is to overcome barriers faced by them when seeking to access services.  ), which opened in 2011 with the financial support of the ICRC and which serves as the national referral centre. Since its reopening, the CRM has increased its activities in terms of the number of service users and services/programmes provided and it is well on the way to regaining some of its former good reputation. The number of people with physical disabilities receiving services at the CRM increased by 31% compared to 2013.

# Support for service provision and users of services
In Libya, ICRC operations were challenged by the increasingly insecure working environment and renewed armed fighting, compounded by the existence of a general political and security vacuum. In June the head of the ICRC sub-delegation in Misrata was killed by unidentified armed men in Sirte. This led to a temporary reduction of ICRC international staff and in July, following the severe inter-militia clashes in Tripoli and the destruction of the airport, the decision was taken to temporarily relocate the remaining international staff to Tunis, from where they have been operating since then. Despite these setbacks, the ICRC continued to operate in Libya through its 140 national staff and its four offices in Benghazi, Misrata, Sabha and Tripoli. Nonetheless, the events forced the ICRC to completely review, if not reset, its operational priorities and objectives in Libya for the rest of 2014 as well as to change its operating model in the country. The physical rehabilitation department at the University of Misrata was about to be inaugurated when the serious security incident took place in Sirte on 4 June.
In Mali, the ICRC continued for the second year to work closely with the Pere Bernard Verspieren physical rehabilitation centre (CPBV), which had been established by the PROPHET association. While not providing direct support, the ICRC reimbursed the cost of physical rehabilitation services for people with physical disabilities who were victims of the conflict in the north of the country. The ICRC Special Fund for the Disabled provided technical support until the end of 2014. In Niger, the ICRC continued to support the physical rehabilitation department at Niamey National Hospital (HNN). In 2014, after the refurbishment of the physical rehabilitation department at HNN and the establisment of a vast network linking the disabled associations in the country, the project entered a new phase. Most of the ICRC's activities in 2014 focused on improving services for the large number of people seeking them at HNN (an increase of 27% compared to 2013), building up the service provision and logistical capacities of the department and managing the services.
In South Sudan, the conflict that started in December 2013 and the ensuing insecurity in Juba led to the project being put on hold. National staff employed at the assisted centres returned to work in January but were not confident that security was sufficient to permit the facilities to reopen. Following a request from the President's office to provide crutches for the wounded at three hospitals, the centre in Juba slowly resumed operations in order to meet the need. In April 2014 the project was again fully operational and people with physical disabilities steadily began to return to the centre despite the extremely high transport costs, the insecurity, the poor road infrastructure and the devaluation of the South Sudanese pound. In Sudan, the Humanitarian Aid Commission, the government body in charge of relations with humanitarian organizations, asked the ICRC to suspend its activities, citing technical issues. In September the ICRC received a letter from the Sudanese authorities informing it that the suspension has been lifted and after nine months of absence, the ICRC therefore relaunched its activities. During the suspension of ICRC activities, the National Authority for Prosthetics and Orthotics (NAPO) continued to provide physical rehabilitation services at reduced capacity until its operations came to a standstill in late May. The NAPO was able to resume its services in October after the ICRC had provided new supplies of raw materials.
In Asia, the ICRC provided support for 45 projects in 11 countries. The ICRC's physical rehabilitation project in Afghanistan combines physical rehabilitation with activities aimed at social inclusion and participation of people with disabilities in society. Besides physical rehabilitation activities, the centre offers medical consultations, psychological counselling and community-based rehabilitation services. In conjunction with national and international partners, the Foundation also facilitates the social and economic inclusion of people with disabilities by sponsoring scholarships for children and by integrating economically vulnerable adults into the workplace.
In Sri Lanka, the ICRC continued supporting the Jaffna Jaipur Centre for Disability Rehabilitation (JJCDR) until end of June. As planned, the JJCDR eased out of ICRC technical and financial support by mid-year, receiving a last shipment of ICRC-donated materials and components to cover its production needs up to the end of 2015.
The JJCDR has been able to cope with the gradual reduction of support without adverse consequences for the provision of services.
In the Americas, the ICRC provided support for 15 projects in four countries. The ICRC's projects in Mexico, Honduras and Guatemala were part of a regional effort by the organization to ensure access to suitable rehabilitation services for migrants. Many of these migrants suffer serious injuries while travelling north in dangerous conditions, with little chance of gaining access to physical rehabilitation. The strategy and approach employed in Guatemala complement those used in El Salvador, Honduras, Mexico and Nicaragua. In all those countries, after identifying migrants in need of physical rehabilitation services, the ICRC refers them to one of the assisted centres, where it then covers the cost of treatment, transport and accommodation. Before they are returned to their countries of origin, migrants fitted with devices in, say, Mexico, are informed of how they may continue to receive services through the network of ICRC-partnered centres in the various countries. In addition to ensuring that migrants have access to services, the project in Guatemala provided similar support for mine survivors. In the Near and Middle East, the ICRC supported 18 projects in two countries and one territory. In Gaza, the ICRC, with the support of the Norwegian Red Cross, continued to provide assistance for the Artificial Limb and Polio Centre in Gaza City, which is managed by the Municipality of Gaza, the aim being to ensure access to appropriate physical rehabilitation services in the Gaza Strip. In addition, in March the ICRC completed its project on post-surgical physiotherapy for inpatients, which was developed to reduce the risk to these service users of becoming physically disabled during hospitalization. 

# Services provided
In 2014 more than 318,000 people with physical disabilities benefited from various services at ICRC-assisted centres. The services included the provision of 20,145 prostheses, 74,104 orthoses, 4,495 wheelchairs and 19,118 pairs of crutches, as well as physiotherapy for nearly 154,000 people. In addition, to the services mentioned above, several people attended the centres for follow-up and maintenance and repair of their devices. Thirteen per cent more people received services at ICRC-assisted centres in 2014 than in the previous year. Children represented 28% and women 20% of the beneficiaries.

# Ensuring equal access to services
The ICRC takes all possible measures to ensure that everyone in need of physical rehabilitation has equal access to it, regardless of social, religious, ethnic or other considerations. Throughout the year, specific activities were implemented in projects to overcome inequality in accessing services for specific groups such as women, children and minority groups. This included supporting outreach and mobile clinic visits for those living in remote areas (Cambodia, Guinea-Bissau, Mali, Myanmar, Nepal, the Philippines and Sudan), supporting the opening of small repair workshops and/or referral sites (China, South Sudan and Sudan), supporting the implementation and functioning of separate clinical areas for women when needed, providing scholarships to increase the number of women professionals (Yemen), and so on.

# Services for mine/ERW survivors
In 2014 the ICRC provided assistance for 12 of the 28 States party to the Anti-Personnel Mine Ban Convention that had acknowledged their responsibility for landmine survivors: Afghanistan, Burundi, Cambodia, Chad, Colombia, the Democratic Republic of the Congo, Ethiopia, Guinea-Bissau, Iraq, South Sudan, Sudan and Yemen. In all those countries, survivors' access to services was facilitated by the ICRC. This was also the case for survivors from the Sahrawi population living in refugee camps in southwestern Algeria and for survivors in China, Guatemala, India, Myanmar, Nepal, Niger, Pakistan and Sri Lanka.
In 2014 the ICRC-assisted network of centres provided 6,543 prostheses and 279 orthoses specifically for mine survivors (of the total number of prostheses and orthoses provided, 20,145 and 74,104 respectively); it also ensured access to physiotherapy treatment for 11,563 survivors (of a total of 153,478 people receiving physiotherapy treatment). In addition, many survivors were provided with wheelchairs and walking aids. Children accounted for 3% and women for 8% of the total number of survivors who received prostheses and orthoses. In Afghanistan, Cambodia, Chad, Colombia, the Democratic Republic of the Congo, Ethiopia, Iraq, Myanmar, South Sudan, Sudan and Yemen, the ICRC continued to be the main international organization providing physical rehabilitation and assisting in its provision.

# Improving access to appropriate clubfoot services
In 2014 the ICRC continued its efforts to enhance clubfoot services as part of its assisted physical rehabilitation projects. Activities were therefore reinforced in countries where the ICRC had already conducted clubfoot projects (Afghanistan, Cambodia, Ethiopia, Nepal and Pakistan). Contacts were maintained with the Global Clubfoot Initiative, an international consortium whose aim is to mitigate the consequences of clubfoot throughout the world; the ICRC is a member of the board of trustees.
Guidelines have been produced internally to standardize the ICRC's approach for children affected by clubfoot; the Ponseti method has been recognized as the best approach to implement in ICRC-assisted projects.

# IMPROVING THE QUALITY OF THE SERVICES PROVIDED
A number of factors helped to improve services: enhancing local technical and clinical capacity and the skills contributed by expatriate specialists, improving the ICRC-developed polypropylene technology, developing treatment guidelines, promoting a multidisciplinary patient-management approach and emphasizing the quality rather than the quantity of the services provided. The ICRC's approach to improving the quality of appropriate physical rehabilitation services encompasses numerous activities; the key activities are listed below and three of them are then discussed in greater detail. 

# PROMOTING THE LONG-TERM AVAILABILITY OF SERVICES
The ICRC endeavoured throughout the year to ensure long-term services, not only by providing support for training but also by implementing projects in close cooperation with local partners, by continuing to develop management tools, by supporting the work of bodies coordinating local rehabilitation and by promoting the development of national policies for the provision of physical rehabilitation services.

# Local partners
To help services to continue functioning after it has withdrawn, the ICRC has adopted a long-term approach to implementing and managing its rehabilitation projects. Implementing projects with local partners is the cornerstone of this strategy. Of the 99 projects assisted by the ICRC in 2014, 55 had been undertaken in conjunction with governments (ministries of health or of social affairs), 42 with local NGOs, three with private entities and three with National Societies. Ten other projects were implemented directly by the ICRC.
The ICRC conducted several activities to ensure the longterm sustainability of services, for example: 

# Supporting management at centres
The ICRC also helped management staff at assisted centres to improve their management skills and their knowledge of physical rehabilitation. In most of its assisted projects, it introduced an ISPO cost-calculation system, which enabled managers to draw up budgets for their centres. In addition, managers were given close support to develop and implement standard working procedures (human resources management, stock management, service user management, etc.).
Throughout the year, ICRC specialists helped managers of assisted centres to improve management of stock and orders, administration of the annual budget and fund allocation, organization of machinery and equipment maintenance, service user management (by means of a database) and wheelchair services. In Cambodia, the ICRC continued to provide financial support, enabling one centre manager to enrol in a three-year management training course.
Over the year, the deployment of the ICRC-developed computerized user management system (Patient Management System -PMS) was extended. The PMS was developed by the ICRC as a tool to manage user records and services at physical rehabilitation centres. It is now in use in 16 countries (61 centres).

# BEYOND PHYSICAL REHABILITATION
In the course of the year, the ICRC supported several activities that went beyond physical rehabilitation services and set out to promote the inclusion and participation in their societies of people with disabilities. In 2014 the ICRC maintained and, in some cases, provided support for people with disabilities organizations in most countries where it was providing assistance. Support in celebrating the International Day of People with Disability was provided in most countries. In addition, socioeconomic reintegration and sports activities continued to receive support from the ICRC, as shown in the following examples.

# Socio-economic reintegration
The ICRC's physical rehabilitation project in Afghanistan combines physical rehabilitation with activities aimed at social inclusion and participation of people with disabilities in society. In 2014 over 3,000 people with disabilities were offered social inclusion opportunities such as education (around 1,400), vocational training (250), microcredit (540), employment (54) and sport (400). Special home teaching was provided for 230 children with severe physical disabilities who were unable to attend schools, while transport was provided for those with problems in reaching school or university. Home adaptations were made and accessible toilets and baths built to improve home mobility of people with spinal cord injuries.
In Pakistan, besides some activities organized in conjunction with partners for the International Day of People with Disability, the ICRC continued to support social integration activities run by the Children Amputees Rehabilitation Programme (C-ARP) such as socio-psychological development sessions to help provide psychological needs for 15 children. Sports equipment was distributed to 20 children to enable them to participate in healthy activities at school and in their home environment. In Cambodia, to ensure access to economic reintegration programmes, social workers from the MoSVY employed at assisted centres facilitated the enrolment of 58 people with disabilities in socio-economic programmes. In Colombia, at the end of the year the ICRC initiated a social and reintegration project under the management of the Economic Security Department for those receiving physical rehabilitation services with the assistance of the ICRC. In Honduras, 20 returned migrants received training and funds for microeconomic initiatives that would ease their reintegration in their communities. The funds provided by the ICRC enabled the returned migrants to create small income-generation projects (barber shop, selling shoes, etc.).
In the Philippines, with ICRC support, the Davao Jubilee Foundation celebrated the importance of technology in empowering the lives of people with disabilities in Mindanao and called for efforts to ensure that modern technology is accessible to people with disabilities. Several advocacy campaigns on empowering people with disability groups from various areas in Mindanao were launched through different activities. For instance, the Davao Jubilee Foundation, in cooperation with the Surallah local government (South Cotabato) conducted a two-day resource mobilization training workshop for people with disabilities leaders; it was attended by 18 people with disabilities. This workshop specifically stressed the fact that through adaptive and assistive technology, people with disabilities can make the most of their potential in their communities; resource mobilization activities such as the development of small group websites showcasing the products of their livelihood projects play a key role.
In Ethiopia, there was a strong focus on the International Day of People with Disability on 3 December 2014, with the ICRC supporting a number of different programmes in connection with that event. In the Oromia region, support was provided for the Oromia Agency of Labour and Social Affairs for an awareness-raising activity in Bishoftu highlighting issues relevant to people with disabilities. The centre in Nekemte ran a programme in the town with ICRC support, introducing its activities and services for people with disabilities. In partnership with the Ethiopian Basketball Federation (EBF), the ICRC held an exhibition of different sports for people with disabilities at the EBF headquarters.
In Iraq, the ICRC-run Erbil physical rehabilitation centre had four employees with disabilities and the ICRC continued to stress the importance of employing people with disabilities at partner institutions. Moreover, the ICRC's economic security activities provided economic support for socio-economic reintegration for 50 households in which there was a family member with a disability.
In Yemen, isolation and stigmatization are challenges experienced by people with disabilities that will require both political and social willpower if they are to be overcome. The ICRC continued to network with local NGOs and others, with a view to increasing the inclusion of people with disabilities in their communities.  18), Bangalore (38), Chennai ( 140), the CMC in Vellore( 12), the Indian Spinal Injuries Centre (ISIC) in New Delhi ( 44), Kochi ( 43) and the PRC in Pune ( 22). Two round-table discussions on developing disability sports and social inclusion also took place in New Delhi and Chennai.  In Ethiopia, 24 basketball wheelchairs were donated to the Ethiopian Basketball Federation (EBF) as an additional step to support wheelchair basketball in Ethiopia and, by doing so, to increase social participation/inclusion opportunities for people with disabilities. This donation was channelled to four Regional Basketball Federations (in Addis Ababa, Dire Dawa, Southern Nation and Oromia), and will be followed in 2015 by support for training and capacity building for coaches, referees and players. In 2014 the EBF officially ratified wheelchair basketball in its constitution and is now the "owner" of the sport in Ethiopia. With support from the ICRC, this will have a significant impact on the sustainability of the sport in that country. The inclusion of wheelchair basketball (a "para" sport) within the EBF, an able-bodied sports organization, is the first in Ethiopia and is important in facilitating social change with regard to people with disabilities.  In Gaza, a wheelchair basketball tournament to promote social inclusion through sports was organized by the ICRC in cooperation with the Paralympic Committee and the Wheelchair Basketball Federation of Gaza. The tournament consisted of 4 teams of 20 players each, making a total of 80 participants. The event was widely appreciated by the ICRC's main contacts and the local media.

# COOPERATION WITH OTHER BODIES
In order to set technology standards, draw up guidelines for training professionals and further develop the field of physical rehabilitation, the ICRC continued interacting with various bodies involved in physical rehabilitation and disability issues: the International Society for Prosthetics and Orthotics, the World Confederation for Physical Therapy, the World Health Organization and the International Society of Physical and Rehabilitation Medicine.
International Society for Prosthetics and Orthotics (ISPO)
The Physical Rehabilitation Programme maintained close contact with ISPO throughout the year. This included participation in the open board meetings, educational committee meetings, inspections and evaluations of schools and several other activities conducted by ISPO.

# World Confederation for Physical Therapy (WCPT)
The Physical Rehabilitation Programme maintained close contact with the WCPT throughout the year and participated in different working groups and/or network discussions such as the WCPT Network for Physical Therapist Educators.

# International Society of Wheelchair Professionals (ISWP)
The ICRC is a member of the Advisory Board.

# World Health Organization (WHO)
The Physical Rehabilitation Programme (PRP) maintained close contact with WHO throughout the year. The PRP is a member of the Guidelines on Health-Related Rehabilitation Development Group and supports the GATE Initiative.

# International non-governmental organizations
Besides the regular and ongoing contacts at field level between the ICRC and other organizations, the Physical Rehabilitation Programme held regular meetings at headquarters and in the field with organizations such as Handicap International, EXCEED, Johanniter-Unfall-Hilfe, the Christoffel-Blindenmission (CBM) and Motivation UK in order to share information and to coordinate activities.

# Global Clubfoot Initiative (GCI)
The Global Clubfoot Initiative was launched by a group of international non-governmental organizations to support the development of clubfoot projects, with the aim of increasing access to appropriate treatment and methods of prevention in low and middle-income countries. The GCI's vision is that the enormous burden of disability caused by untreated (or wrongly treated) clubfoot could be lifted if more and more people gained the skills to recognize and treat clubfoot effectively, primarily using the Ponseti method. The ICRC is actively participating in the work of the GCI through field projects and as a member of the board of trustees.

# Academic institutions in developed and developing countries
In 2014 the ICRC continued to interact with various training institutions to improve the polypropylene technology that it had developed and to provide support for the professional development of people working in the field of physical rehabilitation. The institutions and support activities included: 

# African Federation of Orthopaedic Technicians (FATO)
The ICRC's Physical Rehabilitation Programme (PRP) and the ICRC Special Fund for the Disabled signed an agreement with the FATO, under which both organizations would work to improve and promote access to appropriate rehabilitation services in Africa. Under this agreement, the PRP actively supported various activities organized by the FATO and actively supported the work of several FATO committees such as the Scientific Committee, the Education Committee and the Advisory Board.
Organisation Africaine pour le Developpement des Centres pour Personnes Handicapees (OADCPH)
The OADCPH was created to promote access to physical rehabilitation services in Africa through several activities, including the implementation of a central purchasing outlet based in Lome (Togo). As the ICRC considers this an excellent way of facilitating access to materials and components for assisted projects, several activities were implemented in 2014 in support of the initiative. 

# GUINEA-BISSAU

# ICRC SUPPORT IN AFRICA AT A GLANCE
In 2014 the ICRC provided support for 36 projects in 11 countries: Algeria (1), Burundi (1), Chad (2), the Democratic Republic of the Congo (5), Ethiopia (10), Guinea-Bissau (1), Libya (1), Mali (1), Niger (1), South Sudan (3) and Sudan (10).  In Guinea-Bissau, the number of people with physical disabilities receiving services at the CRM increased by 31% compared to 2013.  In Niger, the number of people with physical disabilities receiving services at the CRM increased by 27% compared to 2013.

# Services provided
Service users attending the centres 22,915
New service users fitted with prostheses 1,783
New service users fitted with orthoses 1,706
Prostheses supplied 3,923
Orthoses supplied 4,774

# Wheelchairs supplied 752
Walking aids supplied (pairs) 5, 209Service users receiving appropriate physiotherapy services 11,899 Children represented 33% and women 19% of those benefiting from services. In Mali, 52 people with physical disabilities had access to physical rehabilitation services owing to financial support from the ICRC. In the Democratic Republic of the Congo, the ICRC developed accessibility to psychosocial support for beneficiaries in its Kivu-based projects. In the Democratic Republic of the Congo, the ICRC organized a workshop on the national situation of physical rehabilitation and supported national professional P&O and PT associations (ATOC and UKC) to develop their structure and organize national events.

# Developing national capacities

# Promoting inclusion and participation
In most countries where the ICRC provided assistance, support was given to either government bodies and/or people with disabilities organizations to organize activities to mark the International Day of People with Disability. In the Democratic Republic of the Congo, the ICRC built a basketball ground in Bukavu and furnished teams in three provinces with sports wheelchairs. In addition, the ICRC converted a hotel in Goma to make it accessible for wheelchair users. In Ethiopia, the ICRC donated basketball wheelchairs to the Ethiopian Basketball Federation (EBF) as an additional step to support wheelchair basketball in Ethiopia and, by doing so, to increase social participation/inclusion opportunities for people with disabilities. In Guinea-Bissau, the ICRC supported the Federacoa de Desportos para Deficientes da Guinee-Bissau in the organization of a wheelchair basketball tournament to mark the International Day of People with Disability. In 2014 the ICRC continued to provide support for the activities of the Centre Martyr Chereif, managed by the Polisario Front's Public Health Authority. The centre was originally located in Noukhaila but had been moved to Rabouni, within the hospital compound. It offers physical rehabilitation for the Sahrawi population living in refugee camps. There are five camps -four of them within a radius of 35 km from Rabouni (Auserd, Bujdoor, El Ayun and Smara); the fifth, Dakhla, is situated 150 km from Rabouni. The Ministry of Public Health (MoPH) is the main body responsible for disability issues and physical rehabilitation services.
It remains unclear how many people were living in the camps (estimates range from 45,000 to 165,000) and how many people with disabilities were in need of access to physical rehabilitation services. As of August 2014 the Saharawi Association of Landmine Victims (ASAVIM) had collected detailed information on 1,006 victims of mines, cluster munitions and other ERW who were living in and around the Rabouni refugee camps on the Algerian border with Western Sahara. The Polisario authorities reported a total of 1,413 people killed and injured by mines/ERW in April 2014. Action on Armed Violence (AOAV) carried out a survey in 2012 and located 300 amputees who had been landmine victims. There are 700 people with disabilities registered on the ICRC's database of beneficiaries. With regard to weapon contamination, in 2005 the Polisario Front, through the Geneva Call Deed of Commitment, pledged to unilaterally ban the stockpiling of anti-personnel mines and to cooperate in mine action.
The physical rehabilitation sector is the responsibility of the MoPH and the Ministry of Social Affairs (MoSA). The MoPH has a physiotherapy department at the "national" hospital in Rabouni and basic services at each of the wilaya hospitals covering the Auserd, Bujdoor, El Ayun and Smara camps. Through its network, the MoSA is responsible for registering people with disabilities in the camps and for providing supplementary assistance for children with cerebral palsy. Before ICRC assistance was provided, obtaining access to physical rehabilitation was virtually impossible as no services were available other than those provided by NGOs during their sporadic missions. Transport and financial resources remains major obstacles to accessing rehabilitation services. Within the camps, which are spread over a fairly large area of desert, there is little public transport and, especially for individuals who have mobility impairments, it is difficult to access the local facilities.
In 2014 several activities were implemented by the ICRC to increase access to services. They included donating materials and components to enable the centre to provide services, establishing a referral network with the hospitals and conducting outreach visits in the different camps. The objectives of this outreach programme were the same as in the past, i.e. to identify potential beneficiaries, to provide follow-up for those who had already received services, to perform basic repairs and to disseminate information on the services provided by the centre. Two outreach visits were conducted in two camps in 2014. In 2014 a total of 436 people with physical disabilities received various services at the ICRC-assisted centre (this number does not include people receiving services during outreach visits). Services included the provision of 22 prostheses (73% for mine survivors), 40 orthoses (15% for mine survivors), 2 wheelchairs and 14 pairs of crutches as well as physiotherapy for 424 people (34% for mine survivors). Children represented 29% and women 19% of the beneficiaries. Throughout the year, the ICRC ortho-prosthetist and physiotherapist provided mentoring and on-the-job training.
To mark the International Day of People with Disability in 2014, a two-day ceremony was organized by the MoSA, with support from the ICRC and other organizations. The event took place at El Ayun camp. On the first day, the various organizations and associations active in the camps, including the MoSA, gave presentations; the second day was given over to festivities and dancing and singing competitions; most people with disabilities in the camps participated.
In 2015 the ICRC intends to:  support the Centre Martyr Chereif by donating materials and components and by broadening the types of service provided (i.e. wheelchair services, clubfoot services, etc.);  continue to support outreach visits to the camps to identify those in needs, to perform basic repairs and to train/educate families with children affected by cerebral palsy;
 enhance quality by continuing to provide ICRC ortho-prosthetists and physiotherapists, by providing on-the-job training for technicians and physiotherapy assistants working at the centre and by cooperating with international NGOs and associations that could sponsor the visit of international experts;  promote the long-term functioning of services by continuing to support the MoPH and MoSA in managing physical rehabilitation services and facilitating the social integration of people with disabilities. In 2014 the ICRC continued to work closely with the Saint Kizito Institute in Bujumbura, which is managed by the Archdiocese of Bujumbura, the aim being to provide physical rehabilitation services for people from the centre's catchment areas -Bubanza, Bujumbura Mairie, Bujumbura Rural, Cibitoke and Muramvya Provincesfour of which were the areas in Burundi most severely contaminated by weapons.
Burundi signed the UN Convention on the Rights of Persons with Disabilities (and its Optional Protocol) on 27 April 2007 and ratified it in March 2014. There are no current national statistics on the prevalence and incidence of disabilities and handicap in Burundi. A General Census of Population and Housing in 2008 revealed the prevalence of a major handicap in Burundi of 4.5%, with provincial variations ranging from 3% to 7.1%, increasing sharply with age.
The physical rehabilitation sector of Burundi was the responsibility of the Ministry of National Solidarity, Human Rights and Gender (MNSHRG), which was also responsible for numerous vulnerable groups (refugees, women/children, indigent citizens, etc.). In 2014 the MNSHRG covered the costs of physical rehabilitation services for indigent people with impaired mobility through the Solidarity Fund. For the Saint Kizito Institute, that represented only about 5% of its total income from treatment. Following implementation of the Strategic Plan for the Development of Medical Rehabilitation 2011-2015, the Ministry of Public Health (MoPH) now also deals with rehabilitation. The MoPH continued to cover the cost of physical rehabilitation for children under five years of age; for the Saint Kizito Institute that represented only about 30% of the total income from treatment.
The network of providers of physical rehabilitation services in the country includes two government-run centres, three centres managed by religious communities (such as the Saint Kizito Institute) and one private establishment in the capital. All centres providing services for people with disabilities are members of the Reseau des Centres pour Personnes Handicapees du Burundi (RCPHB). Access to suitable rehabilitation services remains difficult for most of those in need. The main causes remained the same: lack of facilities and professionals and the cost of treatment (users have to pay for the services). Burundi is one of the 30 States party to the Anti-Personnel Mine Ban Convention that have acknowledged their responsibility for landmine survivors. As in 2010, the estimated number of survivors was approximately 5,000. In 2014 the head of Victim Assistance in the General Directorate for Civil Protection participated in a joint ICRC/African Union workshop on victim assistance in Addis Ababa.
In order to increase the accessibility of services, the ICRC continued to cover the cost of treatment for 26 poor people with physical disabilities. In all, 2,808 people with physical disabilities benefited from the various services provided by the ICRC-assisted centre. Services included the provision of 12 prostheses, 452 orthoses and 46 pairs of crutches as well as physiotherapy for 988 people. Children represented 85.5% and women 7% of the 2,808 beneficiaries.
The quality of the services provided was enhanced by technical and clinical mentoring by an ICRC orthoprosthetist and an ICRC physiotherapist. ICRC specialists provided on-the-job training and mentoring for the entire staff of the assisted centre. The clinical personnel continued improving the quality of physical rehabilitation services and a multidisciplinary approach was routinely applied when prescribing mobility aids and/or physical therapy. The ICRC continued to provide two scholarships to enable two candidates to attend formal physiotherapy training (three years) at the Faculty of Health Science in Benin; it also continued to provide scholarships to enable two candidates to receive formal training in P&O (three years) at TATCOT in Tanzania.
To promote the long-term functioning of services, the ICRC continued to support the directorate of the Saint Kizito Institute in managing the centre and in its efforts to mobilize the relevant authorities. Throughout the year, the ICRC continued helping the directorate to reorganize the services, to implement new treatment protocols and to develop an organization chart. Following the revised calculation of the cost of producing assistive devices in 2012, the Saint Kizito physical rehabilitation centre continued to systematically apply the prices set. Service users are now asked to pay the full or a partial amount, depending on their social condition. In 2014 the Saint Kizito Institute continued to assume full financial responsibility for covering all running costs associated with its physical rehabilitation services and covered all costs related to the purchase of components and materials. In addition, the ICRC actively participated in several national workshops addressing national coordination and the development of the national plan of action.
In 2015 the ICRC intends to:
 improve access to services by continuing to support the activities of the Saint Kizito Institute and by covering the cost of treatment for 50 poor people with disabilities;
 enhance the quality of services through support and mentoring by an ortho-prosthetist and a physiotherapist, both from the ICRC, and by providing scholarships for four candidates to attend formal training courses in P&O and in physiotherapy;  promote the long-term functioning of services by continuing to support the Institute in its efforts to further improve its management and by supporting the directorate of the Institute in its work to obtain the support of the relevant authorities and to mobilize potential donors in order to increase the financial contributions;  promote the inclusion in society of the Institute's students by developing the concept of inclusive education through sport and games with the Institute's pedagogical team. The ICRC continued supporting the two centres providing physical rehabilitation services in the country, the Centre d' Appareillage et de Reeducation de Kabalaye (CARK) in N'Djamena (central Chad) and the Maison Notre Dame de la Paix in Moundou (southern Chad), both managed by local NGOs. The ICRC also continued supporting a referral system for people with disabilities from eastern and northern Chad and financed their transportation to N'Djamena. In addition, it covered the cost of accommodation for those without family support in N'Djamena while they received treatment.
The Ministry of Social Affairs, National Solidarity and Women was responsible for protecting the rights of people with disabilities, while the Ministry of Public Health was responsible for physical rehabilitation. However, there was no direct involvement by the government in physical rehabilitation and those seeking services had to pay for them. Rehabilitation services were available in only six of the country's twenty-three regions. The sector included the two centres assisted by the ICRC, which were the only centres providing full physical rehabilitation services, and eight centres providing only physiotherapy services. The Centre National d' Appareillage et de Reeducation (CNAR), managed by the Ministry of Health, opened in November 2014 but is not operational, despite an appropriate budget and newly recruited administrative staff and physiotherapy assistants.
Chad signed the UN Convention on the Rights of Persons with Disabilities (UNCRPD) in September 2012, but the application decree for the domestic law protecting the rights of people with disabilities, adopted in 2007, has remained inoperative, pending the President's signature to render it law. Chad is among the 30 States party to the Anti-Personnel Mine Ban Convention that have acknowledged their responsibility for landmine survivors. Landmines and explosive remnants of war continue to be a threat for many rural communities, particularly in the north and, to a lesser extent, in the east. With ICRC financial support, a Foreign Affairs Ministry staff member participated in a workshop on victim assistance, jointly organized in Ethiopia by the African Union and the ICRC.
Access to physical rehabilitation remained difficult for most of those in need. The main causes remained the same: lack of financial support from the social system to cover the cost of treatment (people with disabilities therefore being obliged to pay for the services), lack of facilities and professionals, and the cost of transport (when available). While the exact number of people with disabilities in need of physical rehabilitation services is unknown, it is obvious that the two functioning centres do not have the capacity, in terms of infrastructure and human resources, to meet the needs.
In the course of the year, several activities were implemented by the ICRC to improve accessibility to services. Assisted centres were supplied with raw materials and components to ensure that they could provide services. The cost of services for 157 people at the CARK was covered. Through the referral systems implemented in eastern and northern Chad, 36 people with disabilities from those regions received treatment at the CARK, with ICRC support. In those regions, the ICRC conducted a campaign to disseminate information about the possibility of accessing services with the support of the ICRC. In total, over 5,932 people with physical disabilities benefited from various services at ICRC-assisted centres in 2014. Services included the provision of 390 prostheses (39% for mine survivors), 630 orthoses (1% for mine survivors), 42 wheelchairs and 466 pairs of crutches as well as physiotherapy for 4,150 people (4% for mine survivors). Children represented 41% and women 19% of the 5'932 beneficiaries.
The quality of the services provided by the two centres was enhanced by technical and clinical mentoring by ICRC specialists (a physiotherapist and an ortho-prosthetist). ICRC specialists also provided on-the-job training and mentoring for the entire staff of both centres. The ICRC also continued sponsoring four people to enable them to attend P&O training at the Ecole Nationale des Auxiliaires Medicaux (ENAM) in Lome (Togo) and one physiotherapist at the ESK (Ecole Superieure de Kinesitherapie) in Cotonou (Benin). Three of them completed their training in 2014 and commenced work at the centres.
To ensure the long-term sustainability of services, the ICRC continued supporting both centres in their efforts to locate additional sources of income and in their determination to improve their management. To promote and increase access to services, the ICRC gave both directors support to submit project proposals to authorities and international NGOs. With the ICRC's help, the CARK acquired financial support from the European Union in August 2013 for a three-year project, "Agir en faveur de la personne handicapee. " In parallel to such support, the ICRC continued to encourage the Ministry of Public Health to increase its investment in physical rehabilitation services. Work also continued with the Ministry of Public Health and other stakeholders, including the Association des Professionnels de l'Orthopedie et de la Reeducation du Tchad (APORT), to draft a national plan to address physical rehabilitation needs in Chad. An agreement was signed between the Minister of Public Health and the ICRC to support the process of drafting the national plan, in which the ICRC agreed to cover the cost of recruiting an international expert for that purpose. Throughout the year, the ICRC maintained close contact with -and in some cases provided support for -several government institutions, including the National Mine Action Centre, APORT, the National Network of Rehabilitation Actors, and several organizations for people with disabilities in their activities to support the sector. In 2014 the ICRC continued to cooperate with Shirika La Umoja in Goma and Heri Kwetu in Bukavu. In Kinshasa, the ICRC signed an agreement with a new partner, the Centre de Reeducation pour Handicapes Physiques (CRHP). Direct support was provided to improve infrastructure, and equipment and tools were donated. The ICRC also covered transportation and treatment costs for people directly affected by the conflict and other people with physical disabilities, as well as expenses for food and accommodation. After having identified and assessed beneficiaries, the ICRC referred them to centres that had signed cooperation agreements. A workshop run by disabled former soldiers was supported by the ICRC to enable it to provide crutches in Kinshasa.
Although the UN Convention on the Rights of Persons with Disabilities (UNCRPD) was signed in July 2013, the DRC is not yet on the official list of the countries having ratified it. Apparently, the required documents have not yet all been sent to New York. The country is still working on specific legislation for people with disabilities but the 2016 polls are focusing government members' attention on remaining in power. Furthermore, the document submitted to the Assembly was not the one approved by the Ministry of Social Affairs and drafted together with the sub-cluster on disability. Although officially in charge of physical rehabilitation, the Ministry of Health (MoH) does not manage any centres and its involvement in rehabilitation remains modest, consisting mainly of paying bonuses to staff from recognized and registered centres. The MoH is also organizing training courses on clubfoot for physiotherapists through the National Community-Based Rehabilitation Programme (PNRBC), its coordinating body for physical rehabilitation and the PRP's main interlocutor. The Ministry of Social Affairs, National Solidarity and Humanitarian Action was closed down during the last change of government, and social affairs now depend on one of the Vice Prime Ministers. In the area of rehabilitation and disabilities, the national subcluster on disability, which is subject to supervision by the WHO health cluster, is the most active body. Human resources are still poor in quantity and quality in the rehabilitation sector and services are provided through a network of centres managed by the government (in Kinshasa), religious organizations or local NGOs. The DRC is among the 30 States party to the Anti-Personnel Mine Ban Convention that have acknowledged their responsibility for landmine survivors. The ICRC maintained close contact with the Congolese Mine Action Centre and the United Nations Mine Action Service throughout the year and participated actively in quarterly coordination meetings on victim assistance.
The total number of people with disabilities in need of physical rehabilitation services remains unknown and access to services is difficult. People with disabilities face numerous barriers such as poverty, insecurity and poor and dangerous traffic conditions. Service users have to deal with the lack or low capacities of service providers and high prices. There is no financial participation by the State. Throughout the year, the ICRC worked on enhancing access to services by rehabilitating and developing partner centres' facilities and by providing materials and components for assisted and non-assisted centres to ensure continuity and quality of services. For beneficiaries, the ICRC covered the cost of transport and accommodation for most of the civilians whom it referred to the centres and strengthened its referral network, working closely with several international NGOs. The cost of treatment was subsidized for 915 people with physical disabilities, both civilians and weaponbearers, who needed physical rehabilitation services (an increase of 5% since 2013 and 21% since 2012). Among other services, the ICRC, which works with only three centres, achieved a record of 320 prostheses (6% for mine survivors) and 87 orthoses produced. 331 pairs of crutches and 49 wheelchairs (including 28 sports wheelchairs) were also provided; 370 of the beneficiaries had access to suitable physiotherapy services. Children represented 9% of the beneficiaries, women 25% and mine victims less than 1%.
The quality of devices is improving in the Kivu centres since three ortho-prosthetists (two in Bukavu and one in Goma) completed their studies, which were sponsored by CBM, and returned to their workshops in September with a diploma. The ICRC began supporting Heri Kwetu in Bukavu in December by covering the cost of one additional P&O salary for 12 months. The ICRC ortho-prosthetists and physiotherapists have been closely supervising the quality of services in the partner centres, providing on-the-job mentoring and support. ICRC sponsorship enabled two candidates from Kinshasa and Goma to start a threeyear training course on prosthetics and orthotics at the National School of Medical Auxiliaries (ENAM) in Lome, Togo. The ICRC also sponsored attendance at an ISPO congress in South Africa for the president of the well-developing Congolese P&O association (ATOC). A new physiotherapy room is currently being built on the partner's premises in Goma.
To ensure the long-term functioning of services and good coordination with the authorities, the ICRC maintained regular contact with the PNRBC. In Kinshasa, the ICRC led and housed three sessions of the Committee on Physical Rehabilitation and attended monthly sessions of the sub-cluster on disability. The ICRC organized a workshop on the national situation of physical rehabilitation and supported national professional P&O and PT associations (ATOC and UKC) to develop their structure and organize national events. The ICRC's has provided assistance for UKC in its application for membership of the World Confederation for Physical Therapy (WCPT).
In 2014 the ICRC developed accessibility to psychosocial support for beneficiaries in its Kivu-based projects, sought to raise awareness of disability by advocating and providing financial assistance for local NGOs to organize inclusive cultural and sport events on various international days. The ICRC mentored the National Congolese Paralympic Committee in the creation of a provincial league in South Kivu, built a basketball ground in Bukavu and furnished teams in three provinces with sports wheelchairs. For the civil society, ICRC transformed a hotel in Goma to make it accessible for wheelchair users and improved accessibility of its own premises. The ICRC continued providing support for seven physical rehabilitation centres in Arba Minch, Assela, Bahir Dar, Dessie, Dire Dawa, Mekele and Menegesha. Support was also given to establish three new physical rehabilitation centres in the remote western border regions of the country -in Assosa, Gambella and Nekemte. The rehabilitation centre in Nekemte is already providing regular services for people with disabilities living in the western parts of Oromia Region, while Assosa and Gambela are still struggling to obtain the required human resources and government operational budgets. The ICRC-assisted physical rehabilitation centres are managed by regional governments through their Bureau of Labour and Social Affairs or by local NGOs such as the Tigray Disabled Veterans Association in Mekele or Cheshire Services Ethiopia in Dire Dawa and Menagesha. In conjunction with the Ministry of Labour and Social Affairs (MoLSA), the Ministry of Health, the Ministry of Education and the Medical Faculty of Addis Ababa University, the ICRC also conducts training courses in prosthetics and orthotics at the National Rehabilitation Centre at the Black Lion Hospital.
The number of people with disabilities in Ethiopia remains uncertain; estimates vary from 0.8 million, according to a census conducted in 2007, to nearly 15 million, the figure reported by the 2011 World Report on Disability. Most people with disabilities live in rural areas where basic services are limited and often inaccessible, and most of them lack opportunities to earn a living. In response, the government of Ethiopia has adopted and implemented a number of laws, policies and standards: it included a disability clause in the constitution, ratified the UN Convention on the Rights of Persons with Disabilities (UNCRPD) in 2010, developed a physical rehabilitation strategy, adopted laws on accessibility and, more recently, approved a national plan of action for people with disabilities. The MoLSA is the main government body responsible for the socio-economic rehabilitation of people with disabilities. Activities to address disability issues are coordinated at the federal level by the MoLSA's Social Welfare Development Promotion Directorate. At the regional level, disabilityrelated issues are handled by the Bureau of Labour and Social Affairs within the policy framework established by the MoLSA.
The availability of physical rehabilitation services is still limited and concentrated in urban areas. Awareness of such services is low and formal or informal referral systems have not yet been implemented or strengthened. Access to rehabilitation services is hindered by the lack of services and by the absence of information about those services that are available. In addition, most people with disabilities may not be able to cover the transport, food and accommodation costs associated with travelling to the nearest rehabilitation centre. To help overcome these barriers and to improve access to services, the ICRC continued to cover the costs of transport, food and accommodation for people with disabilities receiving physical rehabilitation services; it also continue to donate the imported materials and equipment needed by assisted rehabilitation centres. As a result, more than 6,000 people with physical disabilities had access to free rehabilitation services. For approximately half of them, namely those who were more economically vulnerable, registration fees and the costs of transport and food were covered. Services included the provision of 1,977 prostheses (18% for mine survivors), 2,203 orthoses, 431 wheelchairs and 2,505 pairs of crutches as well as physiotherapy services for 3,252 people (5% for mine survivors). Children accounted for 21% and women for 20% of the beneficiaries.
The quality of the rehabilitation services provided at ICRC-assisted centres was enhanced through close professional coaching and mentoring by ICRC specialists. First, the service provision and its impact on the beneficiaries were closely monitored through systematic assessments performed on sample selections of beneficiaries. Apart from looking into technical and clinical issues that needed to be addressed in order to improve quality, these assessments also looked into the beneficiaries' perception of accessibility, quality and the socio-economic impact of the rehabilitation services received. It is worth mentioning the significant socio-economic impact as 54% of the people with disabilities assessed stated that they had not been able to perform any activity before being given access to rehabilitation services, while 61% of them stated that they were now working to earn their own living or contributing/providing to the household income. Second, the physiotherapy support was aimed at better framing the numerous thematic issues in the multidisciplinary team approach at assisted centres. A prosthetic gait analysis training course was completed by 15 physiotherapists from the 10 supported PRCs and other PRCs working in prosthetic services in Ethiopia. The physiotherapy and multidisciplinary staff were given ongoing clinical support, including a focus on referral to existing social inclusion services. Close cooperation was initiated with the Physiotherapy School at the University of Gondar to support clinical placements at supported centres for fourth-year students on the prosthetic, orthotic and mobility aids course. During 2014, 24 basketball wheelchairs were donated to the Ethiopian Basketball Federation (EBF) as an additional step to support wheelchair basketball in Ethiopia and, by doing so, to increase social participation/inclusion opportunities for people with disabilities. This donation was channelled to four Regional Basketball Federations (Addis Ababa, Dire Dawa, Oromia and Southern Nation), and will be followed in 2015 by support for training and capacity building for coaches, referees and players. In 2014 the EBF officially ratified wheelchair basketball in its constitution and is now the "owner" of the sport in Ethiopia. This will have a significant impact on the sustainability of the sport in Ethiopia with support from the ICRC. The inclusion of wheelchair basketball (a "para" sport) within the EBF, an able-bodied sporting organization, is the first in Ethiopia and is important in facilitating social change with regard to people with disabilities.
There was a strong focus on the International Day of People with Disability on 3 December 2014, with the ICRC supporting a number of different programmes linked to the celebrations. In the Oromia region, support was provided to the Oromia Agency of Labour and Social Affairs for an awareness-raising activity in Bishoftu highlighting issues relevant to people with disabilities. The centre in Nekemte ran a programme in the town with ICRC support, introducing its activities and services for people with disabilities. In partnership with the Ethiopian Basketball Federation, the ICRC held an exhibition of different sports for people with disabilities at the EBF headquarters.
In 2015 the ICRC intends to:  continue supporting accessibility to rehabilitation services by (1) providing assisted rehabilitation centres with imported materials and equipment; and (2) by implementing a service user support system policy -covering travel, food and accommodation costsspecifically targeting the more economically vulnerable people with disabilities living in rural areas;  continue to improve the quality of services ( 1 In 2014 the ICRC continued supporting the Ministry of Public Health (MoPH) in the management of the Centro de Reabilitacao Motora (CRM), which opened in 2011 with the financial support of the ICRC and serves as the national referral centre. Since its reopening, the CRM has increased its activities in terms of the number of service users and services/programmes provided and it is well on the way to regaining some of its former good reputation. The number of people with physical disabilities receiving services at the CRM increased by 31% compared to 2013.
The country has no specific disability legislation. The MoPH is responsible for the management of the CRM, the only rehabilitation facility in the country. The Ministry of Defence and the Ministry of Social Affairs are responsible for subsidizing the cost of services for war veterans and disabled civilians respectively. In 2014 Guinea-Bissau ratified the UN Convention on the Rights of Persons with Disabilities (UNCRPD). The key actor in achieving this was the Guinea-Bissau Federation of the Disabled, the umbrella organization for 13 national associations. The Federation organized the first national conference on the rights of people with disability on 1 and 2 December 2014. According to a census conducted in 2009, there are around 5,200 people with musculoskeletal disabilities in the country; a sizeable percentage of them would be eligible for some kind of rehabilitation services. The real number of physically disabled is probably higher. Diagnostic facilities and hospital/medical services are poor or non-existent and payment for treatment poses a major problem. Networking/referral between the existing facilities is inadequate.
Access to physical rehabilitation services remains difficult, mainly owing to the lack of rehabilitation facilities/ professionals and of financial resources to cover the cost of services. In 2014 the ICRC conducted several activities to improve accessibility, including by donating materials and components (for both P&O and physiotherapy), by reimbursing the cost of treatment and transport for service users attending the CRM and by supporting the centre's outreach activities. The outreach activities, which began in 2013, have raised awareness and facilitated access for regional service users. The programme is currently being consolidated; four out of seven regions have been covered to date. Networking with regional partners is in process. The implementation of a wheelchair project in conjunction with the German Embassy has resulted in the provision of appropriate wheelchair services for 30 people living in the regions. In all, 1,595 people with disabilities benefited from services provided by the ICRC-assisted centre (including 137 people assessed during outreach activities). The services included the provision of 46 prostheses (18% for mine victims), 53 orthoses, 66 wheelchairs and 61 pairs of crutches as well as physiotherapy treatment for 1,423 people (1.4% for mine victims). Women represented 25.5% and children 19.2% of the beneficiaries.
In-house training and supervision/support by an ICRC ortho-prosthetist and an ICRC physiotherapist continued in 2014. The technical skills of CRM staff have improved and progress has been made in the development/implementation of treatment protocols. The multidisciplinary team approach and cooperation with external partners has been strengthened. The set-up of treatment facilities and the workshop has been optimized. Although there is room for improvement, the centre's P&O services are developing positively, in terms of both technical skills and organization and staff commitment. For further capacity building, the ICRC continued sponsoring P&O students from Guinea-Bissau. Since September 2014, three P&O graduates from ENAM in Togo have started working at the CRM. One more student is expected to finish his studies in mid-2015. To secure a stable supply of water at the CRM, a solar pump has been installed with financial assistance from the ICRC.
To promote the long-term functioning of services, the ICRC continued to work closely with the MoPH to strengthen its capacity to implement, coordinate and lead-manage physical rehabilitation activities, as well as with the centre directorate. In addition, the ICRC maintained close working relations with the Ministry of Defence (Secretariat for War Veterans) and the Ministry of Social Affairs.
On 3 December, the International Day of People with Disability, the ICRC supported the Federacoa de Desportos para Deficientes da Guinee-Bissau in the organization of a wheelchair basketball tournament for men and women. The ICRC supported the poster campaign as well as the printing of T-shirt and banners. The ICRC also funded the logistics involved in organizing the event.
In 2015, the ICRC intends to:  further improve access to services by reimbursing the cost of services (transport) for those in need and by supporting the extension of the outreach programmes and other information activities in close cooperation with the associations working on behalf of people with disabilities; Throughout 2014, ICRC operations in Libya were challenged by the increasingly insecure working environment and renewed armed fighting, compounded by the existence of a general political and security vacuum.
In June the head of the ICRC sub-delegation in Misrata was killed by unidentified armed men in Sirte. This led to a temporary reduction of ICRC international staff and in July, following the severe inter-militia clashes in Tripoli and the destruction of the airport, the decision was taken to temporarily relocate the remaining international staff to Tunis, from where they have been operating since then. Despite these setbacks, the ICRC continued to operate in Libya through its 140 national staff and its four offices in Benghazi, Misrata, Sabha and Tripoli. The ICRC's existing set-up and stocks have allowed it to be the first and the main international organization to respond to the emerging humanitarian needs. Nonetheless, the events forced the ICRC to completely review, if not reset, its operational priorities and objectives in Libya for the rest of 2014 as well as to change its operating model in the country. In 2014 the ICRC continued for the second year to work closely with the Pere Bernard Verspieren physical rehabilitation centre (CPBV), which was run by the PROPHET association. While not providing direct support, the ICRC reimbursed the cost of physical rehabilitation services for people with physical disabilities who were victims of the conflict in the north of the country. The ICRC Special Fund for the Disabled provided technical support until the end of 2014.
Mali is a vast, landlocked country. It is the second largest country in West Africa and the fifth poorest country in the world. Over 90% of Malians live on less than USD 2 a day. Mali ratified the UN Convention on the Rights of Persons with Disabilities in 2008. Disability issues are the responsibility of the Ministere de la Solidarite, de l' Action Humanitaire et de la Reconstruction du Nord (MSAHRN). Technical services such as the provision of prostheses and orthoses were the responsibility of MSAHRN, while physiotherapy services were dealt with by the Ministere de la Sante et de l'Hygiene Publique. The total number of people with disabilities is not known but was estimated at over one million. People with physical disabilities face several barriers in accessing services, including, for example, the cost of services, the cost of transport to access the centres and the lack of functioning centres.
The physical rehabilitation sector included governmentmanaged centres and NGO-managed centres, such as the Centre Pere Bernard Verspieren. The governmentmanaged centres included the national centre located in Bamako; the Centre National d' Appareillage Orthopedique du Mali (CNAOM), and regional centres located in Gao, Kayes, Mopti, Segou, Sikasso and Timbuktu. Many of these centres are equipped but not functional owing to the lack of materials and components, qualified human resources and financial resources.
In 2014 the ICRC reimbursed the cost of services for 52 people with physical disabilities from the conflict area in the north of the country. The ICRC also provided financial support so that two visits (one in Gao and one in Timbuktu) of the CPBV's mobile clinic could be organized, which gave 35 people with physical disabilities access to services. These services included the provision of 44 prostheses, 2 orthoses, and 1 pair of crutches. In addition, 17 people had access to appropriate physiotherapy treatment at the CPBV in Bamako.
In 2015 the ICRC intends to:
 improve access to services by starting to provide support for the CNAOM in Bamako and its regional centres, by donating material and components for the CPBV centre, by raising awareness of the services available at ICRC-assisted centres, by supporting information campaigns (radio broadcasts and leaflets) and by cooperating closely with the associations working for the well-being of people with disabilities;  There are no reliable data on the incidence of disability in Niger; the exact number of people seeking access to physical rehabilitation services is unknown. The Ministry of Health has a five-year national health development plan (Plan du Developpement Sanitaire 2011-2015 but it makes no reference to physical rehabilitation. The physical rehabilitation sector had three service providers, but HNN's physical rehabilitation department was the only one that had a significant impact. Access to physical rehabilitation services remained difficult for several reasons: the lack of service providers and qualified P&O professionals (only five professionals for the whole country), the lack of financial resources to cover the costs of services and the lack of transportation for potential beneficiaries.
In 2014 the ICRC implemented several activities aimed at increasing accessibility: improving the existing facilities at HNN and subsidizing the cost of treatment, transport and accommodation for those arriving from the northern region. The ICRC also provided financial support to enable HNN to purchase materials and components from the Organisation Africaine pour le Developpement des Centres pour Personnes Handicapees (OADCPH). In all, 475 people with physical disabilities benefited from various services at the ICRC-assisted centre (an increase of 27% compared to 2013). The services included the provision of 108 prostheses (30% for mine survivors), 163 orthoses, 3 wheelchairs and 88 pairs of crutches as well as physiotherapy for 154 people (21% for mine survivors).
To improve the quality of services, ICRC specialists continued their support and mentoring. The ICRC also continued to sponsor, for a third year, one person to attend formal training in P&O at the Ecole Nationale des Auxiliaires Medicaux (ENAM) in Lome (Togo).
To promote long-term functioning, the ICRC worked closely with the hospital's directorate to strengthen the latter's capacity to implement, coordinate and lead-manage physical rehabilitation activities and with the centre manager to strengthen supervision and administrative capacities. The project was put on hold as a result of the conflict that started in December 2013, the ensuing insecurity in Juba and the resultant need to reduce the number of expatriate staff on site. National staff employed at the assisted centres returned to work in January but were not confident that security was sufficient to permit the facilities to reopen. Following a request from the President's office to provide crutches for the wounded at three hospitals, the centre in Juba slowly resumed operations in order to meet the need. In April 2014 the project was again fully operational and people with disabilities steadily began to return to the centre despite the extremely high transport costs, the insecurity, the poor road infrastructure and the devaluation of the South Sudanese pound. Since the start of the conflict in December 2013, the Nuer ethnic group has had great difficult in accessing physical rehabilitation services.
Despite the many constraints experienced in 2014, the ICRC continued supporting the Ministry of Gender, Child and Social Welfare (MoGCSW) in the management and operation of the only two operational physical rehabilitation centres in South Sudan, the Physical Rehabilitation Reference Centre (PRRC) in Juba, which served as the referral centre for the whole of South Sudan, and the Rumbek Rehabilitation Centre (RRC) in Lake State. In addition, the ICRC upgraded the ICRC Physical Rehabilitation Referral Unit in Wau to a centre providing a wider range of services.  . The ICRC supported the MoGCSW in its efforts to develop a national disability policy and participated in meetings of the Victim Assistance/Disability Working Group. The mandate of the South Sudan War Disabled, Widows and Orphans Commission, created in November 2006, is to formulate and promote policies and legislation for the protection, care and welfare of people with war-related disabilities, war widows and war orphans and to advise the Government of South Sudan on the most effective procedures for implementing such policies and programmes.
The ICRC conducted several activities aimed at improving accessibility, i.e. helping with the cost of transport and accommodation for those attending both supported centres, developing a referral system, conducting some outreach visits, supporting information campaigns (radio broadcasts and information leaflets) and donating materials and components to ensure that the PRRC and the RRC had the means to provide services. Almost 2,000 people with physical disabilities benefited from various services at ICRC-assisted centres; children represented 6% (1% in 2013) and women 23% of them. The services included the provision of 324 prostheses (8% for mine survivors), 118 orthoses, 159 wheelchairs and more than 1,500 pairs of crutches as well as physiotherapy services for 556 people.
To improve quality, ICRC specialists (ortho-prosthetists and physiotherapists) continued their support and mentoring activities. The ICRC continued to provide scholarships for three candidates to attend formal training in P&O at TATCOT and at Tumaini University (both in Tanzania). In addition, the ICRC organized a module on physical rehabilitation for beneficiaries in need of devices or mobility aid for physiotherapy students at St Mary's University. All those activities were undertaken in order to build local capacity to provide high-quality services, which is essential to ensure longterm functioning.
To promote the long-term functioning of services, the ICRC continued to work closely with the MoGCSW to strengthen its capacity to implement, coordinate and lead-manage physical rehabilitation activities. The ICRC started to discuss increased support for the centre management and to establish a national board in charge of supervising the quality and quantity of physical rehabilitation services.
The ICRC was the only partner assisting the MoGCSW with the celebrations for the International Day of People with Disability, which took place on the premises of the PRC in Juba.
In 2015 the ICRC intends to: In February the Humanitarian Aid Commission, the government body in charge of relations with humanitarian organizations, asked the ICRC to suspend its activities, citing technical issues. In September the ICRC received a letter from the Sudanese authorities informing it that the suspension had been lifted and after nine months of absence, the ICRC therefore relaunched its activities. During the suspension of ICRC activities, the National Authority for Prosthetics and Orthotics (NAPO) continued to provide physical rehabilitation services at reduced capacity until its operations came to a standstill in late May. The NAPO was able to resume its services in October after the ICRC had provided new supplies of raw materials. The ICRC was unable to monitor the services provided by the NAPO for most of the year.
In 2014 the ICRC maintained its partnership with the Federal Ministry of Welfare and Social Security (MoWSS) and the National Authority for Prosthetics and Orthotics (NAPO) in order to support and strengthen physical rehabilitation services in Sudan. The ICRC provided materials and technical expertise for the NAPO's national referral centre in Khartoum and its regional physical rehabilitation centres in Damazin, Dongola, Gedaref, Kadugli, Kassala and Nyala. The mobile workshop, also supported by the ICRC, conducted only two field visits. Support for the Cheshire Home for Disabled Children in Khartoum (KCH) continued, as did the support for the Al Fashir repair workshop managed by the Al Fashir Disabled Society.
The MoWSS continued to be the main body responsible for disabilities issues in in Sudan. The Government of Sudan ratified the UN Convention on the Rights of Persons with Disabilities (UNCRPD) in 2009. Following ratification of the UNCRPD, the MoWSS established the National Council for Persons with Disabilities (NCPD), which is responsible for developing disability policy, advocacy and raising awareness about the rights of people with disabilities in different federal ministries and among the general public. A national census carried out in 2008 put the population at approximately 32 million. There are an estimated 1.3 million people with disabilities in Sudan, of whom approximately 450,000 are in need of physical rehabilitation services and assistive devices such as prostheses and orthoses. Sudan is among the 30 States party to the Anti-Personnel Mine Ban Convention that have acknowledged their responsibility for landmine survivors.
The National Authority for Prosthetics and Orthotics (NAPO) was established in 1975 to provide prosthetic and orthotic services. In 2013 the NAPO became an authority in Sudan by Presidential Decree; its recognition by the Government of Sudan allows for greater financial and managerial autonomy. A Board of Directors was established, of which the ICRC continued to be a member in an advisory capacity. The NAPO supports the State physical rehabilitation centres by providing professional clinical staff from the NAPO pool of human resources and materials and components donated by the ICRC. The NAPO is the advisory body and reference point for all matters related to physical rehabilitation for the Government of Sudan; it is also a member of the National Council for Persons with Disabilities.
People with physical disabilities still faced several barriers in accessing services, including long distances to reach centres, the lack of a transportation system and money to cover the cost of transport, and securitylinked constraints. As a result of the suspension of ICRC activities, access to services for people with physical disabilities was reduced. Despite the ICRC's suspension of activities, 2,683 people with physical disabilities had access to services at the different assisted centres following the donation of materials and components by the ICRC. Services provided included the provision of 672 prostheses (0.7% for mine survivors), 1,026 orthoses and 179 pairs of crutches as well as appropriate physiotherapy services for 565 people. Children represented 31% and women 21% of the beneficiaries.
In 2014 the technical and clinical support provided by ICRC specialists (ortho-prosthetists and physiotherapists) was limited. However, the ICRC continued to sponsor candidates to enable them to attend formal training in P&O at Mobility India (one to continue his studies for a BSc and the other for diploma-level studies). 11,934 Children represented 28% and women 18% of the beneficiaries. In Afghanistan, over 3,000 people with disabilities were aided by the various activities in the social inclusion programme. In Afghanistan, the ICRC-managed component factory continued to provide components for seven non-ICRC centres free of charge. In Cambodia, the ICRC-supported component factory in Phnom Penh continued producing components for all the centres, ensuring proper care throughout the country.

# Developing local capacities
Thirty-seven candidates were sponsored for P&O courses and one candidate was sponsored for a physiotherapy course. In Afghanistan, the ICRC sponsored 26 physiotherapy assistants to continue their studies leading to a BSc in Physiotherapy. Eighteen people (including six women) entered the second year of the P&O training course conducted by the ICRC in Afghanistan. In Bangladesh, the ICRC continued to support the P&O Training Programme of the Bangladesh Health Professions Institute and provided scholarships for 10 candidates to start the training. Promoting the long-term functioning of services In Afghanistan, the ICRC maintained close working relations and coordination activities with the relevant authorities and participated in the making of guidelines. It also attended the Disability Stakeholder Commission Group of the MOLSAMD, a working group set up to promote social reintegration. In India, the ICRC continued to promote the long-term functioning of services by strengthening the capacity of its various partners. It also established close links with organizations such as Cure India, Jiv Daya Foundation, Motivation India and the Indian chapter of ISPO to ensure the smooth functioning of various physical rehabilitation organizations and activities. In Cambodia, besides promoting access to the centres and improving the quality of the services provided at the centres, the ICRC continued implementing its strategy for strengthening the capacity of the MoSVY at central and provincial levels to manage all activities at the centres and at the component factory.

# Promoting inclusion and participation
In Afghanistan, over 3,000 people with disabilities were offered social inclusion opportunities such as education (around 1,400), vocational training (250), microcredit (540), employment (54) and sport (400). Special home teaching was provided for 230 children with severe physical disabilities who were unable to attend schools, while transport was provided for those with problems in reaching school or university. In Cambodia, to ensure access to economic reintegration programmes, social workers from the MoSVY employed at assisted centres facilitated the enrolment of 58 people with disabilities in socio-economic programmes. In Pakistan, the ICRC supported the social integration activities of the Children Amputees Rehabilitation Programme (C-ARP), such as sociopsychological development sessions to help provide psychological needs for 15 children. Sports equipment was distributed to 20 children to enable them to participate in healthy activities at school and in their home environment. In most countries the ICRC supported the events organized during the International Day of People with Disability. In Afghanistan, Bangladesh, Cambodia and India, the ICRC continued to support sports activities for people with disabilities.  (MoE). The MoPH has a dedicated unit for disability issues, the Disability Rehabilitation Department (DRD), which has the task of developing guidelines for the implementation of services, quality assurance monitoring standards and reporting tools. The DRD is struggling to find an effective role and is often in conflict with the organizations working in the field of disability. The MOLSAMD has a deputy minister who is supposed to be the focal point for any disability issue and who is in the process of drafting a new national policy for people with disability. The ministry is faced with a huge task and is criticized for making slow progress and for its charity approach. The MoE is implementing a policy of inclusive education which, although it is undoubtedly good in theory, is encountering obstacles in practice. The Mine Action Coordination Centre of Afghanistan (MACCA) is supposed to be responsible for coordination in the area of disability. Afghanistan is one of the 30 States party to the Anti-Personnel Mine Ban Convention that have acknowledged their responsibility for landmine survivors. The number of national and international organizations working in the field of disability has decreased due to financial constraints and security issues. There are few that are able to work effectively in the countryside; most of them are operating in the main towns.
The number of people with disabilities in Afghanistan is uncertain, as is its population, which is estimated to be between 29 and 31 million. According to the authorities, people with disabilities account for 2-3% of the total population, meaning that they number between 600,000 and 900,000. Roughly 450,000 to 650,000 of these people need access to physical rehabilitation services. The current annual production of mobility devices in the country indicates that demand has outstripped the capacities of the existing centres. In 2014 physical rehabilitation services were available through a network of 17 centres, seven of which managed by the ICRC, the others by non-governmental organizations, apart from two that are managed by the MoPH (in Kabul and Khost, with negligible impact on needs and questionable performance). As these centres are concentrated in only some of 34 provinces, people with disabilities are forced to travel long distances to access services. There are numerous obstacles to rehabilitation (and to health services in general): ignorance; the lack of compassion, dedication, accountability and professionalism among medical personnel; a shortage of physiotherapists and orthopaedic technicians; prejudices against disability; poverty; distances and transport difficulties; violence; and ethnic and political divisions.
The ICRC has been contributing to the removal of such The treatment protocols for the most common pathologies seen in the centres were reviewed and updated.
Because of the difficulties presently faced by Afghanistan and the large number of people with disabilities in the country, it is unrealistic to expect the government to be able to provide the services needed. The ICRC is aware that it will be many years before the authorities are able to take over and ensure the long-term functioning of services. Nevertheless, the process started several years ago to ensure that a progressive handover can take place at some point in the future has continued, with the aim of empowering the Afghan employees. Additional management responsibilities were transferred to them, and courses and training were provided. The ICRC maintained close working relations and coordination activities with the relevant authorities and participated in the drafting of guidelines, in particular those relating to the treatment of service users with spinal cord injuries (SCI). It also attended the Disability Stakeholder Commission Group of the MOLSAMD, a working group set up to promote social reintegration. The ICRC also continued to cooperate with most organizations working in the field of disability as well as with the Afghan Association of Physiotherapists and the Afghan National Society for Orthotics and Prosthetics.
Convinced that physical rehabilitation is just one step towards inclusion and participation of people with disabilities in society, the PRP in Afghanistan has been promoting social inclusion since 1997. In 2014 over 3,000 people with disabilities were offered social inclusion opportunities such as education (about 1,400), vocational training (250), microcredit (540), employment (54) and sport (400). Special home teaching was provided for 230 children with severe physical disabilities who were unable to attend schools, while transport was provided for those with problems in reaching school or university. Home adaptations were carried out and accessible toilets and baths built to improve home mobility of people with spinal cord injuries. The ICRC continued to promote sport activities, football, volleyball, badminton and wheelchair basketball. The latter currently has over 300 players, with six men's and three women's teams in six different locations. National tournaments were organized for male and female players, with the aim of raising awareness of disability and of supporting the Afghan Paralympic Committee. Men's and women's national teams were selected. The men's team participated in international competitions in Europe. The Wheelchair Basketball Federation of Afghanistan (WBFA) is in the process of obtaining recognition by the International Wheelchair Basketball Federation (IWBF).
In 2015 the ICRC intends to:
 facilitate access to services by continuing support for the seven centres, by conducting outreach visits, by continuing its home care programme and the special programme for children with cerebral palsy and for those with clubfoot, by maintaining a good working relationship with health-care facilities and other organizations, by supporting the development of referral networks (especially in areas where no service is available) and by continuing to donate components to non-ICRC centres and giving them training and technical support;  enhance the quality of services by continuing to train P&O personnel and physiotherapists with the support of expatriate specialists, improve the quality of the components and wheelchairs produced at the Kabul factory, and monitor and supervise physiotherapy services and the production of mobility devices;  promote long-term services by developing local capacities, by participating in forums on disability issues and by supporting government action to promote physical rehabilitation and social reintegration;  continue the social inclusion programme and the promotion of participation in sport among people with disabilities as a mean of rehabilitation and recreation, support the Afghan Paralympic Committee and build a basketball court in Gulbahar (originally scheduled for 2014 but postponed). Access to rehabilitation services remained difficult for most of those in need because of the barriers, such as the high cost of transport, treatment and accommodation, the lack of service providers and qualified staff, lack of awareness about the existence of rehabilitation services, and frequent strikes (hartals) in 2014 (albeit far fewer than in 2013). The ICRC conducted several activities aimed at improving accessibility, i.e. assisting with the cost of transport, food and accommodation for poor service users attending the CRP in Savar and Chittagong, and donating raw material, machinery, tools and components to ensure that all assisted centres had the means to provide services. In addition, the ICRC and the Bangladesh Red Crescent Society (BDRCS) introduced a referral mechanism. Since the start of the activity in October 2014, volunteers from the Chittagong Division of the BDRCS registered over 60 people with physical disabilities and referred them to the CRP in Chittagong. In all, 818 people with physical disabilities benefited from various services at the ICRC-assisted centres (an increase of 30% compared to 2013). The services included the provision of 199 prostheses and 1,160 orthoses. Children accounted for 74% and women for 4% of the beneficiaries. In 2014 the ICRC continued its cooperation with the Ministry of Social Affairs, Veterans and Youth Rehabilitation (MoSVY) in support of the Battambang Regional Physical Rehabilitation Centre, the Kompong Speu Regional Physical Rehabilitation Centre and the Phnom Penh Orthopaedic Component Factory. Since 2004 the ICRC has progressively reduced its role in managing the assisted projects and focused on strengthening the MoSVY's capacity (at national and centre level), gradually transferring all responsibilities to it. ICRC staff continued to act as advisers for MoSVY personnel in managing service provision at centre level and the physical rehabilitation sector at the national level. In all, 10,183 people benefited from various services provided at ICRCassisted centres.
Cambodia has signed a considerable number of agreements and international programmes concerning people with disabilities, such as the UN Convention on the Rights of Persons with Disabilities, signed in 2007, and the World Programme of Action concerning Disabled Persons (1982) The MoSVY has primary responsibility for providing rehabilitation services and training in vocational skills for people with disabilities. There were 11 physical rehabilitation centres spread throughout the country, two of which are supported by the ICRC (Battambang and Kompong Speu). Apart from the 11 centres, the physical rehabilitation sector consists of the Phnom Penh Orthopaedic Component Factory (supported by the ICRC), the Cambodian School for Prosthetics and Orthotics, the Technical School for Medical Care, which provides training for physiotherapists, and two professional associations, the Cambodian Association of Prosthetists and Orthotists and the Cambodian Physiotherapy Association. The Disability Action Council, a semi-autonomous body attached to the MoSVY, was also part of the sector; it provided technical, coordinating and advisory services for the MoSVY. At the beginning of 2013, a new institution, the Persons with Disabilities Foundation (PWDF), has been created under the MoSVY. Its mandate is to provide rehabilitation services for people with disabilities, manage the rehabilitation funds for implementing various projects such as support for education and vocational training, manage job placement services and prepare policies for assisting and supporting people with disabilities.
Cambodia is among the 30 States party to the Anti-Personnel Mine Ban Convention that have acknowledged their responsibility for landmine survivors. Landmines and explosive remnants of war (ERW), including cluster munitions, continue to pose a threat in many rural communities despite mine/ERW clearance and longstanding mine-risk education activities. From January to December 2014, 154 mine/ERW casualties were provisionally recorded by the Cambodian Mine/ERW Victim Information System. This figure represents an increase of 39% compared to 2013. As in previous years, most of the accidents occurred in the five northern and western provinces, Banteay Meanchey, Battambang, Oddar Meanchey, Pailin and Pursat. Five of these provinces were covered by the Battambang Regional Physical Rehabilitation Centre.
In 2014, to enhance the accessibility of services, the ICRC continued to provide direct support for beneficiaries (covering, together with the MoSVY, the cost of transport and of accommodation at the centres), maintained its support for the centres' outreach programmes and provided support for the development of a comprehensive network of potential partners within the centres' catchment areas. In all, 10,183 people benefited from various services provided at ICRC-assisted centres. The services included the provision of 1,647 prostheses (81% for mine survivors), 1,174 orthoses, 497 wheelchairs and 679 pairs of crutches as well as physiotherapy for 2,993 people (57% for mine survivors). Children represented 10% and women 15% of the beneficiaries. In addition, the Phnom Penh Orthopaedic Component Factory continued to provide components for all physical rehabilitation centres in Cambodia, thus ensuring proper care for all people receiving services at centres throughout the country. Both ICRC-assisted centres continued their outreach programmes: 8,261 people were assessed and 6,058 P&O devices and 518 wheelchairs repaired during the visits.
To improve the quality of services, the ICRC continued developing the skills of local personnel. In addition to ongoing mentoring for all personnel, the ICRC continued to provide a scholarship for one candidate to attend formal P&O training (ISPO Cat. II level) at the Cambodian School of Prosthetics and Orthotics (CSPO).
Besides promoting access to the centres and improving the quality of the services provided at the centres, the ICRC continued implementing its strategy for strengthening the capacity of the MoSVY at central and provincial levels to manage all activities at the centres and at the component factory. Throughout the year, the ICRC supported MoSVY efforts to strengthen management of the sector. In 2014, with the financial and technical support of the ICRC, the MoSVY continued to monitor the implementation of a stock management system at all centres and tried to implement a common centre management tool, the Patient Management System. Both systems were developed by the ICRC. In addition, the ICRC continued to promote the long-term functioning of services by actively participating in the work of various committees addressing disability issues, by providing some financial support for the Cambodian ortho-prosthetists and professional physiotherapists associations, and by providing a scholarship for one deputy manager, enabling him to study for a Bachelor's degree in business.
To ensure access to economic reintegration programmes, social workers from the MoSVY employed at assisted centres facilitated the enrolment of 58 people with disabilities in socio-economic programmes. With the financial support of the ICRC and the International Olympic Committee, the Cambodian National Volleyball League for the Disabled (CNVLD) expanded the women's wheelchair basketball programme in Battambang and in Kampong Speu. All athletes undergo regular weekend training under the supervision of CNVLD staff/coaches, and all of them also took part in two 10-day basketball training sessions conducted by an ICRC-sponsored international trainer. In 2014 the ICRC continued to provide support for the Yunnan branch of the Red Cross Society of China in running its Orthopaedic Rehabilitation Centre in Kunming and its repair workshop in Malipo. The objectives of ICRC assistance are to develop the capacity of the Kunming and Malipo centres, which are managed by the Yunnan branch, to ensure that the most destitute among people with disabilities have access to appropriate services.
The Ministry of Civil Affairs, the China Disabled Persons' Federation and the Ministry of Health are mandated to address issues associated with disability. In the province of Yunnan, their resources -in terms of the money, knowledge, human resources and infrastructure required to cover the needs of disabled people -appear to be limited. To improve conditions for people with disabilities, the government has set specific targets for the coming years, notably in the areas of rehabilitation, education, employment, protection of rights, and sports and leisure activities. The State Council published the first draft of the Regulation governing the Construction of a No-obstacle Environment to promote social participation for people with disabilities and to make daily life easier for them as well as for the elderly. The China Disabled Persons' Federation decided to pursue the government's objectives mainly through community-based rehabilitation activities. The second National Sampling Survey on Disabilities conducted in 2006 estimates that there are 83 million people (6.34% of the total population) in China who are living with some form of disability. More than 75% of them live in rural areas, where they are the most vulnerable groups, with limited access to health services, education, job opportunities and social activities. People with disabilities encounter difficulties every day in a society whose economy is undergoing a massive market-oriented transition. The China Disabled Persons' Federation estimates that nearly 10 million of them are living in poverty. Throughout the year, the ICRC continued supporting the Yunnan Orthopaedic Rehabilitation Centre and its repair workshop, thus allowing services to be brought closer to beneficiaries living far from Kunming. In all, 378 people with physical disabilities benefited from various services at the ICRC-assisted centres. The services included the provision of 214 prostheses (8% for mine survivors) and 1 orthosis as well as physiotherapy for 209 people (7% for mine survivors). Children accounted for 4% and women for 21% of the beneficiaries.
In 2015 the ICRC intends to:  continue supporting the Yunnan Orthopaedic Rehabilitation Centre and its repair workshop by donating materials and orthopaedic components necessary to ensure service provision, the aim being to ensure access to services for 500 people with physical disabilities, and by developing partnerships with various actors;  enhance the quality of services provided through regular support and mentoring for local personnel (technical, clinical and managerial staff) through regular visits by an ICRC specialist.  To improve the accessibility of services, the ICRC continued to donate essential materials and components to the Rakrang centre. In all, 491 people with physical disabilities benefited from various services at the ICRCassisted centre. The services included the provision of 474 prostheses (1% for mine survivors), 18 orthoses, 22 wheelchairs and 240 pairs of crutches as well as physiotherapy for 439 people. Children represented 3% and women 11% of the beneficiaries.
To improve the quality of services, an ortho-prosthetist and a physiotherapist, both from the ICRC, continued to conduct several courses for P&O technicians, physiotherapy assistants and other personnel at the centre. The ICRC continued sponsoring two people to attend formal P&O training at the Cambodian School of Prosthetics and Orthotics. In 2014 the ICRC continued to provide managerial support for the centre's manager and to promote clinical, technical and managerial standards.
On the International Day of People with Disability (3 December), Rakrang PRC and the ICRC held a half-day sports event for all service users and staff at the centre. The ICRC introduced various sports activities specially designed for people with various types of amputations as an example of encouragement for service users to actively participate in their community and, as their skills and confidence increase, to take part in national and international sports competitions.
In 2015 the ICRC intends to:  enhance access to physical rehabilitation by donating materials and components needed to ensure the provision of services;  enhance the quality of services by providing regular support and mentoring for centre personnel (technical, clinical and managerial), by organizing refresher/ upgrading courses in these areas, which will be conducted by an ICRC ortho-prosthetist and an ICRC physiotherapist, and by continuing to provide scholarships for the two candidates to attend formal P&O training at the Cambodian School of Prosthetics and Orthotics;  strengthen understanding of physical rehabilitation among personnel at the Red Cross Society of the Democratic People's Republic of Korea, and provide financial and technical support for management of the Rakrang centre. In 2014 the ICRC continued to provide support for four centres, three of which were in the state of Jammu and Kashmir: the Artificial Limb Centre at the Bone and Joint Hospital in Srinagar, the Artificial Limb Centre at the Government Medical College in Jammu and the P&O department of the Voluntary Medicare Society (VMS) in Srinagar. The fourth centre, the Physical Rehabilitation Reference Centre in Raipur, is in the state of Chhattisgarh. In addition, the ICRC started to provide support for two additional centres, the Christian Medical College (CMC) in Vellore and Mobility India (MI) in Bangalore. For a number of reasons access to rehabilitation nevertheless remained difficult for the poorest people. For example, some facilities were not fully operational owing to insufficient funds for equipment, materials and professional staff. Access to rehabilitation was made more difficult by the lack of facilities, particularly in rural areas, the lack of awareness of existing services, inadequate legislation, and the absence of schemes to cover costs during treatment (accommodation, food, etc.).
Throughout the year, the ICRC implemented several activities to increase accessibility to services. These activities included donating materials and components, covering the cost of transportation and accommodation for service users at assisted centres, and supporting campaigns to disseminate information about the activities of the assisted centres. In 2014, 31,256 people with disabilities benefited from various services at ICRC-assisted centres. The services included the provision of 650 prostheses (4% for mine survivors), 3,592 orthoses, 304 wheelchairs and 1655 pairs of crutches as well as appropriate physiotherapy for 5,786 people. Children accounted for 10% and women for 35% of the beneficiaries.
Quality was ensured by continued on-the-job training and mentoring by the ICRC team of ortho-prosthetists and physiotherapists. The ICRC sponsored the participation of one staff member from a national training institute, SVNIRTAR in Orissa, to attend the global educators meeting in Kobe, Japan. It also sponsored three members of staff from assisted centres to attend training on foot orthoses, seven staff members to attend a conference organized by the Orthotics & Prosthetics Association of India (OPAI), and three staff members from the assisted-centre to attend the South Asian Association for Regional Cooperation (SAARC) conference on Best Practice in Rehabilitation Therapy at Mobility India, Bangalore.
The ICRC continued to promote the long-term functioning of services by strengthening the capacity of its various partners. It also established close links with organizations such as Cure India, the Jiv Daya Foundation, Motivation India and the Indian chapter of ISPO to ensure the smooth functioning of various physical rehabilitation organizational structures and activities.
In order to promote the inclusion of people with disabilities through sports, the ICRC worked in partnership with the newly established Wheelchair Basketball Federation and Choice International UK as well as with other organizations. In this framework, a country-wide wheelchair basketball event was organized in six Indian cities, including the first national wheelchairs basketball tournament in Chennai. Overall, 177 people with disabilities from Amar Jyoti (18), Bangalore (38), Chennai (140), the CMC in Vellore( 12), the Indian Spinal Injuries Centre (ISIC) in New Delhi (44), Kochi (43 and the PRC in Pune ( 22) took part in the training sessions. Two round-table discussions on developing disability sports and social inclusion also took place in New Delhi and Chennai. In 2014 the ICRC sponsored the celebration of the International Day of People with Disability in Jammu and Kashmir.
In 2015 the ICRC intends to:  improve accessibility of services by continuing to support the various assisted-centres by donating materials and components, by supporting referral networks in the various states, and by continuing to subsidize the cost of transport, accommodation and food for service users at the centres;  Improve the quality of services by strengthening the skills and knowledge of national rehabilitation professionals (P&O and PT) through mentoring and support by ICRC specialists, by sponsoring candidates for attend formal training and/or seminars in P&O, physiotherapy and wheelchair services, by enhancing treatment protocols, the multidisciplinary team approach and technical guidelines, and by developing the capacity of faculty members in the P&O national institutions;  promote the long term-functioning of services by strengthening the skills of assisted-centre managers and by continuing to support organizations for people with disabilities;  promote the inclusion and participation in society of people with disabilities by promoting education, livelihood, employment and sports. 

# MYANMAR
In 2014 the ICRC continued to support the Hpa-an Orthopaedic Rehabilitation Centre (HORC), which is run jointly by the Myanmar Red Cross Society (MRCS) and the ICRC, as well as the Yenanthar Leprosy Hospital and Mandalay General Hospital, both managed by the Ministry of Health. However, the ICRC terminated its support for Mandalay General Hospital at the end of 2014. The ICRC also continued to support the prosthetic foot and crutches manufacturing unit at the National Rehabilitation Hospital, which is managed by the Ministry of Health and located in Yangon. Following the Ministry of Health's acceptance of the ICRC's proposal to establish two physical rehabilitation centres (PRCs) in Myitkyina (Kachin State) and in Kyaing Tong (Eastern Shan State) in order to respond to the high demand from services users in those conflict-affected regions, the Ministry gave its approval for the Myitkyina PRC to be constructed in 2015 and for the Kyaing Tong PRC to be constructed in 2016. The Ministry of Health and the ICRC signed the project agreements for the two PRCs on 26 November 2014.
Myanmar ratified the UN Convention on the Rights of Persons with Disabilities in 2011. The Department of Social Welfare at the Ministry for Social Welfare, Relief and Resettlement is the government coordinating body for disability issues. Various legal provisions for people with disabilities exist in current Myanmar legislation. The disability law that was initially drafted in 2011 was still being studied by the Parliament in 2014. In June 2014 the first Myanmar National Disability Conference took place with the participation of over 500 people. The conference objectives were (1) to discuss the main barriers that people with disabilities experience and to issue a statement that highlights the rights of people with disabilities to enjoy full access and inclusion in society; (2) to advocate for the adoption of the National Draft Disability Law; and (3) to establish the Myanmar Council of Persons with Disabilities. The 2010 Myanmar National Disability Survey, endorsed by the Ministry of Social Welfare, Relief and Resettlement, indicated that 1,276,000 people in Myanmar (2.32% of the population) have some form of disability -11.22% of all households are affected. The survey gave further proof of the fact that people with disabilities are disproportionately represented in the poorest sections of society: 85% of all people with disabilities in Myanmar did not have a job and their academic achievements were considerably below the national average, with only 10% attending high school. People with disabilities in Myanmar suffer from a traditional belief (also found in other countries in the region) that their condition is somehow a "moral punishment, " either because the person has bad karma from a previous existence or as a religious or spiritually based punishment for some wrongdoing in their current life. People with disabilities in Myanmar, especially those living in rural areas, often have to overcome tremendous difficulties to access services as most of the centres are located in major cities and travel costs are high.
Several government ministries, including the Ministry of Health (MoH) and Ministry of Defence (MoD), were involved in the provision of physical rehabilitation services. In addition, services were also available through centres managed by the Myanmar Red Cross Society (MRCS) and/or by national organizations. The Department of Social Welfare at the Ministry of Social Welfare, Relief and Resettlement remained responsible for community-based rehabilitation and for providing social welfare services through preventive, protective and rehabilitative measures.
Throughout the year, the ICRC implemented several activities to improve accessibility to services. These activities included supporting the MRCS's Outreach Prosthetic Programme (OPP) for areas covered by the Hpa-an Orthopaedic Rehabilitation Centre (HORC) as well as for Upper and Central Myanmar, covered by Yenanthar Leprosy Hospital. In addition, the ICRC supported the launch by the HORC in July 2014 of the Mobile Repair Workshop, which has successfully complemented the OPP activities.
The importance of these programmes cannot be emphasized enough: they enable people living in remote areas to access the closest service providers. In 2014, 250 people benefited from the services provided through the HORC outreach programme, while 144 people were referred from the northern state to the Yenanthar Leprosy Hospital. The HORC Mobile Repair Workshop, which started operating in July 2014, has provided services for 1,046 people. Through a children's summer programme launched at the HORC in 2009 that earmarked the summer school holiday season (April-May) to prioritize admission for children, 54 children benefited from services in 2014. A similar programme at Yenanthar Leprosy Hospital also fitted 14 children during the summer season in 2014. In all, 3,251 people benefited from various services at the ICRC-assisted centres. The services included the provision of 1.207 prostheses (49% for mine survivors), 23 orthoses (4% for mine survivors), 25 wheelchairs and 945 pairs of crutches as well as appropriate physiotherapy for 689 people (62% for mine survivors). . Children represented 4% and women 9% of the beneficiaries.
The quality of services was enhanced through several activities in 2014. In addition to regular in-house and on-the-job training, the ICRC sponsored four candidates to attend P&O training, three of them at the CSPO in Phnom Penh, (Cambodia) and one who attended a twoyear ISPO Cat. I upgrading course at the Siridorn School of Prosthetics and Orthotics in Bangkok (Thailand). In addition, the ICRC sponsored one candidate for a12-month certificate course in physical rehabilitation therapy at Mobility India. The ICRC also sponsored two candidates to enable them to attend a two-week ischial containment socket (ISC) seminar in Tanzania. The ICRC also funded the third amputation surgery seminar for 27 junior surgeons working at remote stations in southeastern Myanmar. The training made it possible to focus on the most appropriate surgical techniques to ensure optimal use of the prosthetic device.
Apart from promoting access to the centres and improving the quality of the services provided there, the ICRC continued supporting the directorate of the Hpa-an centre and the directorates of the MoH-managed centres.
In 2015 the ICRC intends to:  facilitate access to services by continuing to support the activities of the assisted centres, by strengthening the referral programme and mobile repair workshop, by covering the cost of transport and accommodation for those attending the centres, by informing the public about services available and by starting the construction of the Myitkina Physical Rehabilitation Centre (Kachin State);  enhance the quality of services by providing ongoing support through ICRC specialists, by providing scholarships and continuing training for P&O specialists as well as for physiotherapists, surgeons and administrative personal and by offering organizational support;  promote the long-term functioning of services by strengthening its partners' capacities and by supporting the implementation of a national coordination body;  promote the inclusion of people with disabilities in society through sports activities programmes. The ICRC continued supporting the provision of physical rehabilitation services at Green Pastures Hospital in Pokhara and at the Yerahity Rehabilitation Centre (YRC) in Kathmandu. Since 2009 the YRC has been the sole government-run facility in Nepal providing physical rehabilitation services for military personnel and civilians.
Nepal ratified the UN Convention on the Rights of Persons with Disabilities and its Optional Protocols at the end of 2009. Several government ministries are involved in disability, the main ones being the Ministry of Women, Children and Social Welfare (MoWCSW), the Ministry of Health and Population and the Ministry of Peace and Reconstruction (MoPR). The MoWCSW is responsible for implementing programmes related to disability, including the registration of people with disabilities. The MoPR works as a government conduit, financing mine action and assisting conflict-related victims. However, its ability to fulfil this role has been constrained by a lack of capacity. The Nepal National Federation of the Disabled is an umbrella organization that represents organizations working for people with disabilities throughout the country. It has been leading the disability movement in Nepal since 1993, drawing the attention of public officials and civil society to the rights and dignity of people with disabilities by emphasizing social inclusion, mainstreaming and equality of opportunity.
There are no accurate data on the prevalence of disability in Nepal and the available statistics do not reflect the range of disabilities. Physical disability is still considered by many Nepalese to be a punishment for sins committed in a previous life. Children with disabilities particularly suffer the consequences of this belief. Most people with disabilities are also excluded from primary-level education and health care, mainly because of the high cost of treatment.
Access to physical rehabilitation services remains a challenge for the rural population. Potential beneficiaries living in mountainous areas hesitate to travel long distances because of limited (unreliable) public transport and the expense involved. The ICRC covers these expenses for some people with physical disabilities but most people with disabilities cannot afford to travel to a physical rehabilitation centre. In addition, complex administrative procedures prevent many people with disabilities from registering for and obtaining government support.
To enhance access to rehabilitation services, the ICRC and the Nepal Red Cross Society worked together to disseminate essential information to people with physical disabilities through a network of local organizations, authorities and service providers. The ICRC provided financial support for Green Pastures Hospital and Partnership for New Life to enable them to organize a users' follow-up camp in Butwal. In 2014, 2,023 people with physical disabilities benefited from various services at ICRC-assisted centres (an increase of 47% compared to 2013). These services included the provision of 151 prostheses (7% for mine survivors), 169 orthoses, 189 wheelchairs and 159 pairs of crutches as well as physiotherapy for 666 people (2% for mine survivors). Children represented 8% and women 31% of the beneficiaries. Support and mentoring were provided regularly for personnel at the two ICRC-supported centres. The aim was to enhance the quality of service provision. The ICRC also continued to develop its partners '   Several government ministries, including the Ministry of Health and the Ministry of Social Welfare, were involved in disability issues. In 2012 Pakistan adopted its National Policy for Persons with Disabilities "to provide by 2025 an environment that would allow full realization of the potential of persons with disabilities through their inclusive main-streaming and providing them full support of the government, private sector and civil society. " Many people with physical disabilities faced barriers in accessing physical rehabilitation services, including the lack of financial means to travel to service providers and to cover the cost of services, ongoing disturbances, etc. There is also an increased prevalence of poliomyelitis cases as a result of active militant operations against vaccination workers and programmes.
In 2014 the ICRC strove to enhance access to the centres that it assisted by covering the cost of transport, food and accommodation and the cost of services for people with physical disabilities attending the ICRC-assisted centres, and by donating equipment and necessary materials/components to all assisted centres. In all, 19,845 people with physical disabilities benefited from various services at the ICRC-assisted centres (an increase of 18% compared to 2013). The services included the provision of 2,355 prostheses (22% for mine survivors), 7,403 orthoses (2% for mine/ERW survivors), 353 wheelchairs and 1,054 pairs of crutches as well as physiotherapy for 3,525 people (15% for mine survivors). Children represented 46% and women 10% of the beneficiaries. In 2014, the PCH, with financial support from the ICRC, completed 24 home modifications and 294 home visits to follow up beneficiaries within their communities. The MPRC, CHAL and the PRSP continued their clubfoot programmes, through which 890 children were treated using the Ponseti method. Over the year, wheelchair services were enhanced through close cooperation with Motivation UK. The ICRC supported training for the centres' personnel and supervised the provision of wheelchair services at the assisted centres.
Besides mentoring and support by ICRC specialists, several activities were undertaken to enhance service quality. Several short courses were conducted on various aspects relating to P&O, physiotherapy and wheelchair services. The ICRC supported three wheelchair training sessions, which were attended by 26 participants, and continued sponsoring candidates to attend formal P&O training at different institutions (two at the CSPO in Cambodia, four at Strathclyde University in Scotland and three at PIPOS in Pakistan).
Throughout the year, the ICRC provided support for authorities and partners to manage services, develop and implement the national strategy/plan and to develop and implement national standards, working procedures and coordination mechanisms. In particular, the ICRC continued to support the Pakistani branch of the International Society for Prosthetics and Orthotics (ISPO). Emphasis was also placed on capacity building and support for PIPOS -the only internationally recognized P&O training facility in Pakistan. To further enhance the long-term functioning of physical rehabilitation services in Pakistan, a concept to establish a supply-chain offering a wider range of raw materials and components was developed with the support of the ICRC. The ICRC is also supporting one of CHAL Foundation's management staff to attend a two-year training programme in project management.
Besides some activities organized in conjunction with partners for the celebration of the International Day of People with Disability, in 2014 the ICRC continued supported social integration activities conducted by the Children Amputees Rehabilitation Programme (C-ARP), such as: socio-psychological development sessions to help provide psychological needs for 15 children. Sports equipment was distributed to 20 children to enable them to participate in healthy activities at school and in their home environment. 

# PHILIPPINES
In 2014 the ICRC continued to cooperate with the Davao Jubilee Foundation by providing support for its physical rehabilitation centre, the Davao Jubilee Rehabilitation Centre. The Foundation assures access to its services for everyone who needs them, irrespective of his or her financial means or affiliation to opposition groups. Besides physical rehabilitation activities, the centre offers medical consultations, psychological counselling and community-based rehabilitation services. In conjunction with national and international partners, the Foundation also facilitates the socio-economic inclusion of people with disabilities by sponsoring scholarships for children and integrating economically vulnerable adults into the workplace. As in the past, in 2014 the ICRC strove to meet -more comprehensively -the needs of conflict-affected victims. The ICRC enhanced access to physical rehabilitation services for conflict-related victims by providing financial support. It completely subsidized service costs, including expenses for transport and accommodation, for 99 victims of the conflict (as opposed to 63 in 2013).
Created in 2008, the National Council on Disability Affairs (NCDA) is the national government agency mandated to formulate policies and to coordinate the activities of all agencies, both public and private, relating to disability issues and concerns. The NCDA is also mandated to monitor the implementation of various laws to ensure that the civil rights of people with disabilities are protected. It is also required to strengthen the database on disability for policy formulation and programme development, conduct policy reviews and engage different interested parties in dialogue. The government recognizes that the provision of assistive devices and equipment is an important measure in ensuring that people with disabilities have the same opportunities as everyone else, in the workplace and elsewhere. The Department of Social Welfare and Development, the Department of National Defence, the NCDA and local government units have funds to subsidize, to a limited extent, the provision of assistive devices and rehabilitative care for those who cannot afford them. However, because of the shortage of funds, only a few people are assisted every year, usually on a first-come-first-served basis. There are not many institutions providing physical rehabilitation services in the country and very few trained P&O professionals. As a result, people with disabilities usually have to rely on the support of a limited number of charitable organizations.
For many years the Davao Jubilee Foundation has been the only professional, non-profit service provider of physical rehabilitation services on the island of Mindanao. In the Philippines, the most commonly used form of land transport is the bus as it is relatively cheap (1 Philippine peso per kilometre). However, the average return fare to the Davao Jubilee Centre is 500 pesos. This is prohibitively expensive as one-third of the population lives on less than 90 pesos a day. To improve access to services, the Davao Jubilee Rehabilitation Centre established a referral and follow-up system for amputees registered with the local authorities in two provinces. In early 2014 the ICRC proposed that our partner increased its catchment areas so as to reach beneficiaries in conflict areas. In May 2014, with the support of MNLF, the Davao Jubilee Foundation conducted its first medical mission in Sultan Kudarat.
In 2014, 534 people with physical disabilities benefited from various physical rehabilitation services at the ICRC-assisted centre (an increase of 30% compared to 2013). The number of people receiving services at the centre has increased significantly since the beginning of ICRC assistance (from 45 in 2008 to 534 in 2014). The services included the provision of 91 prostheses (2% for mine survivors), 22 orthoses, 62 wheelchairs and 53 pairs of crutches as well as physiotherapy for 368 people (1% for mine survivors). Children represented 40% and women 16% of the beneficiaries.
In 2014 the ICRC continued to enhance the quality of services provided at the Davao Jubilee Foundation. Clinical and technical support and mentoring were provided by an ICRC ortho-prosthetist. During the year, the candidate sponsored by the ICRC for three years to attend P&O training at the Cambodian School of Prosthetics and Orthotics in Phnom Penh graduated and started to work at the centre.
Throughout the year, the ICRC continued to support the directorate of the Davao Jubilee Foundation in its efforts to strengthen the capacity of the centre.
"Sustainable Development: The Promise of Technology" was the theme of the International Day of People with Disability in 2014. With ICRC support, the Davao Jubilee Foundation celebrated the importance of technology in empowering the lives of people with disabilities in Mindanao and called for efforts to ensure that they have access to modern technology. Several advocacy campaigns on empowering people with disability groups from various areas in Mindanao were launched through different activities. For instance, the Davao Jubilee Foundation, in cooperation with the local government of Surallah, in the province of South Cotabato, conducted a two-day resource mobilization training workshop for people with disabilities leaders; it was attended by 18 people with disabilities. The workshop specifically stressed the fact that through adaptive and assistive technology, people with disabilities can make the most of their potential in their communities; resource mobilization activities such as the development of small group websites showcasing the products of their livelihood projects play a key role.
In 2015 the ICRC intends to:  enhance access to services for victims of the internal conflict by continuing to subsidize the cost of services (first fittings, replacements, repairs, etc.) and by covering the cost of transport, accommodation and food for 100 beneficiaries, by setting up a crutch manufacture unit, by supporting the establishment of a wheelchair service provision, by providing financial support for the Davao Jubilee Foundation to construct a new dormitory for service users including one kitchen, one dining room and a training centre and by continuing to support the development of new services;  enhance the quality of service provision through technical and managerial support from an ICRC prosthetist-orthotist;  continue promoting the long-term functioning of services by developing tools to ensure the technical, managerial and financial independence of the centre. 

# SRI LANKA
Between January and June 2014 the ICRC continued supporting the Jaffna Jaipur Centre for Disability Rehabilitation (JJCDR), which offered a broad range of services, including the provision of prosthetics, orthotics, various mobility aids (wheelchairs, tricycles, crutches, etc.), physiotherapy, microcredit and financial support for disabled students. It was the only centre providing physical rehabilitation on the Jaffna peninsula. As planned, the JJCDR eased out of ICRC technical and financial support by mid-year, receiving a last shipment of ICRC-donated materials and components to cover its production needs up to the end of 2015. The JJCDR has been able to cope with the gradual reduction of support without adverse consequences for the provision of services.
With the support of the ICRC, 649 people with physical disabilities benefited from various services provided by the JJCDR. Services included the provision of 173 prostheses (40% for mine survivors), 95 orthoses, 12 wheelchairs and 16 pairs of crutches as well as physiotherapy for 360 people. Children represented 7% and women 29% of the beneficiaries.

# MEXICO

# COLOMBIA

# HONDURAS

# GUATEMALA

# ICRC SUPPORT IN THE AMERICAS AT A GLANCE
In 2014 the ICRC supported 15 projects in 4 countries: Colombia (8), Guatemala (3), Honduras (2) and Mexico (2).  ICRC projects in Guatemala, Honduras and Mexico were part of a regional effort by the ICRC to ensure access to suitable physical rehabilitation services for migrants. The strategy and approach employed in these countries complement those implemented in El Salvador and Nicaragua through the ICRC Special Fund for the Disabled. In addition to ensuring access to physical rehabilitation services for migrants in Mexico and returned migrants in Guatemala and in Honduras, the ICRC covered the cost of treatment for 23 Salvadorians at the centre assisted (Don Bosco University) by the ICRC Special Fund for the Disabled.

# Developing local capacities
In Colombia, the ICRC organized six short-term training courses for P&O professionals, conducted two seminars on physiotherapy for lower-limb amputees, and provided an introductory course in physiotherapy. In Guatemala, Honduras and Mexico, the ICRC sponsored attendance by several candidates at a two-week training course, conducted by Don Bosco University (El Salvador), on the production of prostheses for amputees with hip disarticulation and attendance by several candidates at a two-week seminar (in Cartagena, Colombia) on the management of lower limb amputees for physiotherapists. Promoting the long-term functioning of services In Colombia, several activities were implemented at national and centre levels. At the national level, they included mobilization and cooperation with other interested parties, support for the Ministry of Health and Social Protection in regulating the provision of physical rehabilitation services, and support for national training institutions that conducted training in P&O or physiotherapy.

# Promoting inclusion and participation
In Colombia, at the end of the year the ICRC initiated a social reintegration project under the management of the Economic Security Department for people receiving physical rehabilitation services with the assistance of the ICRC. In Honduras, 20 returned migrants received training and funds for microeconomic initiatives that would ease their reintegration in their communities. The funds provided by the ICRC enabled the returned migrants to create small income-generation projects (barber shop, selling shoes, etc.). In Colombia, the ICRC resumed its physical rehabilitation support in 2006 under the umbrella of the comprehensive mine action programme implemented in conjunction with the Norwegian Red Cross Society (integrated partnership). In order to strengthen the national rehabilitation sector, the ICRC concentrated on cooperating with public institutions at national level. However, owing to the limited availability of public services, the ICRC decided to work with a wide range of service providers, including private centres, public hospitals and local non-governmental foundations, as well as training institutions (public and private facilities). Each working relationship was established and managed in an individual manner, depending on the capacity of the institutions and their possibilities to address the needs of victims of the armed conflict.
In 2014 the ICRC continued working closely with the Ministry of Health and Social Protection (MSPS) in drafting standards and guidelines for regulating the physical rehabilitation sector. In addition, the ICRC continued to work with the two existing training institutions for P&O professionals, the Servicio Nacional de Aprendizaje (SENA) in Bogota and the Instituto de Tecnicas Integradas Multiples del Occidente (TIMDO) in Cali. In terms of service provision, the ICRC's principal partners were still the Hospital Universitario del Valle and Ortopedica Americana in Cali. Because of the recurrent lack of involvement from the provincial authority, the ICRC decided to suspend its support for the Centro Cardio-neuromuscular in Cucuta in September 2014. The ICRC also provided material support for the Centro Integral de Rehabilitacion de Colombia (CIREC) in Bogota and the Fundacion REI para la Rehabilitacion Integral in Cartagena.
Colombia ratified the UN Convention on the Rights of Persons with Disabilities in 2011. In 2007, the Colombian government established the Sistema Nacional de Discapacidad. This entity, which is still active today, is managed by the Ministry of Health and Social Protection (MSPH) and consists of (1) the National Council on Disabilities and (2) departmental and municipal disabilities committees. Their activities consist mainly of disseminating information about disability issues, training government staff and implementing the Registro para la Localizacion y Caracterizacion de Personas con Discapacidad (RLCPD). In parallel, the MSPS had set up a national database called SISPRO which compiled information on the population of people with disabilities. Colombia is among the 30 States party to the Anti-Personnel Mine Ban Convention that have acknowledged their responsibility for landmine survivors. Colombia is endowed with a powerful legal arsenal to assist and integrate people with disabilities and there were notable advances over the years but many of the policies are not fully put into practice owing to the lack of resources. Health and physical rehabilitation services today remain inaccessible for the poorest people living in areas affected by the armed conflict.
The Ministry of Health and Social Protection (MSPS) was responsible for the physical rehabilitation sector. While not directly involved in service provision (which comes mainly from private providers and local nongovernmental organizations), its main responsibility was to regulate the sector. In that regard, the MSPS developed (with the support of the ICRC) and published, in 2010, Resolution 1319 on good manufacturing practice for developing and adapting made-to-measure medical prosthetic and orthotic devices, with the aim of regulating the sector. In 2013 the MSPS decided to update the document and in 2014, the ICRC participated in finalizing the first revision of Resolution 1319. The revised resolution (scheduled for 2015) should facilitate the implementation of the national standards of good practices in the country.
Through donations of materials as well as technical and managerial assistance and on-the-job mentoring, the ICRC contributed during the year to improving access to physical rehabilitation for 12,062 people with physical disabilities, who received various services from the network of assisted centres. The services included the provision of 748 prostheses (8% for victims of explosive devices), 3,330 orthoses (0.2% for victims of explosive devices), 285 wheelchairs and 43 pairs of crutches as well as appropriate physiotherapy for 8,101 people. The ICRC made a special effort to reach people with physical disabilities in remote rural zones. Through this activity, 338 people received assistance, including the provision of a comprehensive interdisciplinary service in Cucuta and in Cali (138 people) and the provision of transport, food and accommodation enabling 251 people to access the services.
The quality of services continued to be enhanced through various activities supported by the ICRC. The ICRC organized six short-term training courses for P&O professionals; they were attended by 25 people from various services providers. It also conducted two seminars on physiotherapy for lower-limb amputees, which were attended by 22 people from Colombia and six other Latin American countries. In addition, 20 P&O students from the SENA were given an introductory course in physiotherapy by the ICRC. The team from the Physical Rehabilitation Programme participated in three war surgery seminars, with a view to improving the quality of amputations and promoting interdisciplinary rehabilitation services.
The ICRC continued working closely with national institutions and with the management of the assisted centres to promote the long-term functioning of services. Throughout the year, several activities were implemented at national and centre levels. At the national level, they included mobilization and cooperation with other interested parties, support for the Ministry of Health and Social Protection in regulating the provision of physical rehabilitation services, and support for national training institutions that conducted training in P&O or physiotherapy. The ICRC works with universities which have a PT curriculum and promote the inclusion of the "management of amputees" in their curriculum. At the end of 2014 eight universities had included this subject in their curriculum.
In Colombia, there were many initiatives to promote the inclusion and participation of people with disabilities but most were located in major urban centers. The most frequently cited local organizations working in this field were Fundir, Arcangeles, Corona Foundation and CIREC. In recent years one of the most important initiatives was the Pacto de Programa Productividad which brings together several organizations to provide support for people with disabilities seeking to obtain professional training and employment. In 2014 the Colombian Red Cross employed one person with reduced mobility to work on the implementation of the disability inclusion resolution adopted at the 2013 Council of Delegates of the International Red Cross and Red Crescent Movement. At the end of the year the ICRC initiated a social reintegration project under the management of the Economic Security Department for those receiving physical rehabilitation services with the assistance of the ICRC. 

# GUATEMALA
ICRC projects in Mexico, Honduras and Guatemala were part of a regional effort by the organization to ensure access to suitable rehabilitation services for migrants. Many of these migrants suffer serious injury while travelling north in dangerous conditions, with little chance of gaining access to physical rehabilitation. In El Salvador, Honduras, Guatemala, Mexico and Nicaragua, after identifying migrants in need of physical rehabilitation services, the ICRC refers them to one of the assisted centres, where it then covers the cost of treatment, transport and accommodation. Before they are returned to their countries of origin, migrants fitted with devices in, say, Mexico, are informed of how they may continue to receive services through the network of centres partnering with the ICRC in the various countries. In addition, the project in Guatemala provided support to ensure that migrants, mine survivors and children had access to services.
In Guatemala, the ICRC continued to work with the Centro de Atencion a Discapacitados del Ejercito de Guatemala (CADEG), the Hospital Infantil de Infectologia y Rehabilitacion (HIIR) and a private service provider, Clinica Ortopedica y Rehabilitacion CLOR S.A.
In Guatemala, the ICRC's support for improving access to services for all people with physical disabilities focused on three specific groups, victims of former conflict, children and returned migrants with physical disabilities.
Guatemala ratified the UN Convention on the Rights of Persons with Disabilities in 2009. The protection of the rights of people with disabilities is inscribed in Guatemala's constitution and in specific laws. The National Council for the Assistance of Persons with Disabilities (Consejo Nacional para la Atencion a las Personas con Discapacidad, CONADI) is the national agency responsible for promoting disability policy. The Law on Care for Persons with Disabilities requires the Ministry of Health (MoH) and the Guatemalan Social Security Institute (IGSS) to provide comprehensive rehabilitation services for people with disabilities. In fact, the MoH has two specific hospitals for physical rehabilitation, one for adults and one for children (the HIIR). The MoH is also in charge of the issue of health rehabilitation, promoting joint actions to restore disabled people's quality of life, to develop their normal activities and to participate actively in society.
The physical rehabilitation sector included several service providers managed by the government, by a foundation, by the Ministry of Defence (including the CADEG) and private providers (including CLOR). However, only a few of these service providers provide P&O services and most of them are located in Guatemala City. Because the vast majority of P&O service providers are located in the capital, people with physical disabilities in need of P&O services have to travel long distances and often incur high transportation costs (outside and within the capital) in reaching the services.
Through donations from the ICRC, all those centres were equipped, when needed, with specific tools to ensure that migrants, mine survivors and children had access to appropriate physical rehabilitation. In all, 7,285 people with physical disabilities benefited from services of the ICRC-assisted centres. The services included the provision of 90 prostheses (32% for mine victims), 680 orthoses, and 1 pair of crutches. Women represented 0.6% and children 6% of the beneficiaries. Of the total number of prostheses and orthoses provided by the assisted centres, 53 prostheses and 654 orthoses were provided for the groups specifically targeted by the ICRC: victims of former conflict, children and returned migrants with physical disabilities.
To improve the quality of P&O services, the ICRC invited two ortho-prosthetists from the assisted-centres to attend a two-week training course conducted by Don Bosco University (El Salvador) on the production of prostheses for amputees with hip disarticulation. Multidisciplinary team work has been implemented at CLOR S.A. and in order to strengthen the quality of physiotherapy services, the ICRC sponsored the physiotherapist from CLOR to attend a two-week seminar (in Cartagena, Colombia) on the management of lower limb amputees for physiotherapists. ICRC projects in Mexico, Honduras and Guatemala were part of a regional effort by the organization to ensure access to suitable rehabilitation services for migrants. Many of these migrants suffer serious injury while travelling north in dangerous conditions, with little chance of gaining access to physical rehabilitation. In Honduras, Guatemala, Mexico, El Salvador and Nicaragua, after identifying migrants in need of physical rehabilitation services, the ICRC refers them to one of the assisted centres, where it then covers the cost of treatment, transport and accommodation. Before they are returned to their countries of origin, migrants fitted with devices in, say, Mexico, are informed of how they may continue to receive services through the network of centres partnering with the ICRC in the various countries.
In Honduras, the ICRC continued to work with the TELETON integral physical rehabilitation centre in San Pedro Sula and the Vida Nueva physical rehabilitation centre in Choluteca to ensure that returned migrants had access to adequate physical rehabilitation services. While its area of focus was ensuring that migrants with physical disabilities had access to services, all those attending the two assisted centres benefited from the support given by the ICRC.  (impairment, mental problems, blindness, etc.). Of those 14%, 95% were without employment and 80% lived below poverty line.
Together with organizations in the civil sector, the MoH and DIGEDEPDI have prepared a document leading to the implementation of a policy to meet the needs of people with physical disabilities. This document calls for substantial contribution by the civilian and private sector (churches, NGOs, foundations, private service providers, etc.). Private initiatives, such as the TELETON organization and a few smaller NGOs/foundations are, in fact, providing services. Although there were rehabilitation centres in most part of the country, only few of them were providing P&O services. They were only three centres with qualified ISPO trained technicians in the country, e.g. Hospital San Felipe in Tegucigalpa and the two ICRC assisted-centres, TELETON in San Pedro Sula and Vida Nueva in Choluteca. It is therefore difficult for people with disabilities who need P&O services to access services as the centres are located only in the major cities, often requiring people to travel long distances to reach them. In all, 1,106 people with physical disabilities benefited from services of the ICRC-assisted centres. The services included the provision of 129 prostheses, 348 orthoses, 13 wheelchairs and 1 pair of crutches as well as appropriate physiotherapy for 3,614 people. Women represented 15% and children 40% of the beneficiaries. Of the total number of people with physical disabilities who accessed services at the ICRC-assisted centres, 132 were returned migrants with physical disabilities (124 men and 8 women) who had access to services with financial support from the ICRC. The services included the provision of 56 prostheses, 5 orthoses, 4 wheelchairs and 13 crutches as well as physiotherapy and medical treatment.
To improve the quality of P&O services, the ICRC invited two ortho-prosthetists from the assisted centres to attend a two-week training course conducted by Don Bosco University (El Salvador) on the production of prostheses for amputees with hip disarticulation. Multidisciplinary team work improved with the introduction of physiotherapy services at the Vida Nueva centre and in order to further strengthen physiotherapy services, the ICRC sponsored the physiotherapist working at the centre to attend a two-week seminar (in Cartagena, Colombia) on the management of lower limb amputees for a physiotherapists.
Twenty returned migrants received training and funds for microeconomic initiatives that would ease their reintegration in their communities. The funds provided by the ICRC enabled the returned migrants to set up small income-generation projects (barber shop, selling shoes, etc.).
In 2015 the ICRC intends to:  continue supporting accessibility to rehabilitation services by continuing to work closely with TELETON and Vida Nueva, by donating materials and components, by covering the cost of treatment for its target groups and by covering part or all the cost of transportation and accommodation;  continue to improve the quality of services by providing continuous support and mentoring through its specialists, by promoting multidisciplinary team work and by strengthening the skills and knowledge of physiotherapists;  continue supporting the long-term sustainability of the rehabilitation services by supporting the management of the assisted centres through the introduction and implementation of ICRC management tools.
In 2015 the ICRC intends to:
 continue supporting accessibility to rehabilitation services by continuing to work closely with Orthimex and the National Rehabilitation Institute, by donating materials and components, by covering the cost of treatment for its target groups and by covering part or all the cost of transportation and accommodation;  continue to improve the quality of services by providing continuous support and mentoring through its specialists, by promoting multidisciplinary team work and by strengthening the skills and knowledge of physiotherapists;  continue supporting the long-term sustainability of the rehabilitation services by supporting the management at the assisted centres through the introduction and implementation of ICRC management tools. 

# ICRC SUPPORT IN THE NEAR AND MIDDLE EAST AT A GLANCE
The ICRC supported 19 projects in 4 countries and 1 territory: Gaza (1), Iraq (13), Lebanon, Syria (1) and Yemen (4).  In Syria, the ICRC started to provide physical rehabilitation assistance in mid-2014.  In Lebanon, the ICRC started to provide physical rehabilitation assistance in October. ICRC-managed microeconomic initiatives enabled 50 households with a person with disabilities to set up an income-generating scheme in Iraq, while 86 people with disabilities received loans to start businesses in Yemen. In Iraq, 318 Syrian refugees were given access to physical rehabilitation at the Erbil centre; in Lebanon, 51 Syrian refugees had access to physical rehabilitation services with the financial support of the ICRC. Developing local capacities A total of 18 candidates, seven of whom were women from Yemen, were sponsored to attend P&O courses at various training institutions, with the aim of increasing access to services for women when these candidates returned. In Yemen, the ICRC signed an agreement with the High Institute of Health Sciences (HIHS) to establish a P&O training programme. Promoting the long-term functioning of services In Gaza, the ICRC provided managerial support for the board of directors of the assisted centre. In Iraq, the ICRC participated actively in meetings of the Higher Committee for Physical Rehabilitation; conducted, in close cooperation with the Ministry of Health (MoH), an assessment of all assisted centres; and organized, in close cooperation with the MoH and the MoH of the Iraqi Kurdistan Region, a two-day national workshop. Several issues were discussed at the national workshop, including the link between national policies and strategies and physical rehabilitation. In Yemen, the ICRC continued working closely with national institutions and with the management of the assisted centres to promote the long-term functioning of services.

# Services provided

# Promoting inclusion and participation
In Gaza, a wheelchair basketball tournament to promote social inclusion through sports was organized by the ICRC in cooperation with the Paralympic Committee and the Wheelchair Federation of Gaza. In Iraq, the ICRC, in conjunction with the Iraqi National Paralympic Committee, hosted sports events on the International Day of People with Disability. In Yemen, the ICRC continued to network with local NGOs and others, with a view to increasing the inclusion of people with disabilities in their communities. In 2014 the ICRC, in partnership with the Norwegian Red Cross, continued to provide material and technical assistance for the Artificial Limb and Polio Centre (ALPC) in Gaza City, which is managed by the Municipality of Gaza, the aim being to ensure access to appropriate physical rehabilitation services in the Gaza Strip. In addition, the ICRC team were effective during the recent armed conflict, reactively responding to immediate rehabilitation needs at major referral hospitals in the Gaza Strip. The hospital projects once supported by the ICRC were revisited to assess the physiotherapy response during the conflict. Assistive and mobility devices were donated and they were highly appreciated by the hospital. A review on post-surgical inpatient physiotherapy services in 2014 was conducted, highlighting the effective role of physiotherapists during an emergency.

# GAZA
The Ministry of Health (MoH) continues to be responsible for the rehabilitation sector in the Gaza Strip and a large number of local and international non-governmental organizations continue to work in the field of physical rehabilitation. The International Coordination Department (ICD) coordinates the rehabilitation-related activities of the MoH and of international organizations in the Gaza Strip. After the 2012 survey, there have been no specific disability prevalence studies. However, after the recent armed conflict in 2014, preliminary findings from the MoH indicate that approximately 1,134 injured individuals (833 individuals aged 18 years and over, and 301 individuals under 18 years) are expected to have to deal with permanent disabilities.
The ICRC conducted several activities to improve accessibility, including the donation of prosthetic and orthotic materials and components needed to produce mobility devices and the provision of financial support for 38 people with disabilities to cover the cost of transport. The ALPC, in cooperation with the ICRC, conducted 6 dissemination sessions for 89 participants from the MoH and from national and international organizations working in the rehabilitation sector in order to help strengthen referral mechanisms and disseminate information about ALPC services . In 2014, despite the closure of the ALPC for nearly two months, 2,587 people with disabilities (approximately 3% more than in 2013) received various services at the ALPC. The services included the provision of 182 prostheses, 337 orthoses, 21 wheelchairs and 158 pairs of crutches as well as appropriate physiotherapy for 781 people. Children represented 40% and women 10% of the beneficiaries. During the last armed conflict in July 2014, all referral hospitals in the Gaza Strip suffered from a severe shortage of devices. As a result, assistive and mobility devices were donated to six major referral hospitals; materials for two burns units in the Gaza Strip were also provided. In total, 287 wheelchairs, 2,320 crutches (elbow and axillary), 555 walking frames and 30 air mattresses were donated.
ICRC specialists (ortho-prosthetists and physiotherapists) continued to provide on-the-job training and mentoring for ALPC P&O technicians, benchworkers and physiotherapists. Closer multidisciplinary cooperation between P&O technicians, physiotherapists and orthopaedic surgeons was established but is still a "work in progress, " with efforts ongoing to ensure good quality services. Particular emphasis was placed on clinical reasoning, fitting and training, and efficient use of available resources. Three P&O technicians were sponsored to attend an orthotic training co-organized by TATCOT and the ICRC Special Fund for the Disabled in Tanzania; additionally, the clinical coordinator of the ALPC visited Battambang Physical Rehabilitation Centre (PRC) in Cambodia to learn about PRC centre management and proficiency in service provision. In conjunction with the ICRC Mental Health and Psychological Support (MHPSS) team, sessions were conducted for ALPC staff in general and specifically for technical staff to help improve the quality of rehabilitation interventions provided for service users who had experienced traumatic situations during the recent conflict.
The ICRC continued to provide managerial support for the ALPC directorate; the Fundraising Strategy for the ALPC was completed and recommendations such as job descriptions, an organizational chart and cost calculations were drafted and later finalized. The ICRC continues to promote the use of polypropylene technology to help provide alternative cost-effective options. The ALPC now has contracts for its 33 staff members, although the matter of permanent contracts for the technical (P&O and PT) and support staff (12 in total) continues to require attention. The accreditation process has resulted in recognition of the ISPO Cat. II qualifications for all five technicians by the MoH authorities in the Gaza Strip.
A wheelchair basketball tournament to promote social inclusion through sports was organized by the ICRC in cooperation with the Paralympic Committee and the Wheelchair Federation of Gaza. The tournament consisted of 4 teams of 20 participants from each team, total of 80 participants. The event was widely appreciated by our main contacts and local media.  The entitlement to basic health care and rehabilitative services from the MoH as well as cash transfer benefits and specified services from the Ministry of Labor and Social Affairs (MoLSA) are protected under laws passed in 2013 on the Care of Persons with Disabilities and Special Needs and the Social Protection Law of February 2014. In the Iraqi Kurdistan Region, a law providing stipends for people with disabilities and special needs was passed in 2011, and in 2012 a law mandated a 3% quota for employment in the public sector. The physical rehabilitation sector was mainly the responsibility of the MoH, although the Ministry of Environment also had a victim-assistance component through its Directorate of Mine Action, in line with its formal responsibility for all matters relating to ERW. The Higher Committee for Physical Rehabilitation and Prosthetics & Orthotics (HCPRPO), a MoH body, dealt with all issues related to the provision of mobility aids nationwide, except for areas under the jurisdiction of the Kurdistan Regional Government (KRG). With the exception of the country's Kurdish region, physical rehabilitation services were provided through a network of centres run by the MoH ( 14), the Ministry of Defence (1), the Ministry of Higher Education (MoHE) (1), the Iraqi Red Crescent Society in Mosul (1) and private service providers. In the Iraqi Kurdistan Region, nine rehabilitation centres were functioning; eight were government-managed facilities and one was managed by the ICRC.
In Iraq, the provision of health and rehabilitation services has been negatively affected by the decades of conflict, violence and international sanctions, with severe consequences for more than 3.5 million Iraqis with disabilities. Rehabilitation services are free of charge and the MoH provides free accommodation in general hospitals; however, the services are often based in centralized areas and with limited accessibility. Because of the shortage of qualified human resources, some of the physical rehabilitation centres have waiting lists and there are very few female ortho-prosthetists with the exception of Baghdad, which among other things, had limited access for women to some facilities.
Throughout the year, the ICRC implemented several activities to increase accessibility to services; including donating raw materials and components to all assisted centres, supporting the most vulnerable with transport costs and providing dormitory facilities in Erbil PRC. In 2014 a total of 33,155 people with disabilities received services within the network of ICRC assisted-centres. The services included the provision 3,098 prostheses (28% for mine survivors), 16,962 orthoses (0.1% for mine survivors), 365 wheelchairs and 790 pairs of crutches as well as physiotherapy for 7,627 people (10% for mine survivors). Children represented 35% and women 13% of the beneficiaries. As the security situation deteriorated in June, there was a high influx of internally displaced people, in particular in the Iraqi Kurdistan Region, adding to the increase in demand for physical rehabilitation services caused by the arrival of Syrian refugees. To meet this demand, the ICRC established assessment visits in four refugee camps within the region, ensuring access to services for 318 Syrian refugees.
Apart from ongoing mentoring and support by ICRC specialists, 7 out of 11 planned national training modules intended to enhance the quality of services were conducted (four were cancelled because of the security situation) at the ICRC-managed centre in Erbil; 54 people took part. With ICRC support, Iraq's only prosthetic/orthotic school continued to work towards meeting internationally recognized standards and the development of the physiotherapy curriculum at Hawler Medical University (Iraqi Kurdistan Region) was initiated with the support of Slippery Rock University. During the year, 27 physiotherapy students completed internships at the PRC in Erbil.
To promote the long-term functioning of services, the ICRC worked closely with government ministries involved in rehabilitation, actively participated in meetings of the HCPRPO, organized a national workshop on physical rehabilitation in Erbil, and continuously assessed supported centres with the MoH. The ICRC continued to sponsor three P&O students pursuing postgraduate studies at Strathclyde University in Scotland with the aim of strengthening the capacity of the P&O Institute in Baghdad.
To promote the social inclusion of people with disabilities, the ICRC, in conjunction with the Iraqi National Paralympic Committee, hosted sports events on the International Day of People with Disability. The ICRC-run Erbil physical rehabilitation centre had four employees with disabilities and the ICRC continued to place emphasis on the importance of employing people with disabilities among partner institutions. Moreover, 50 households with a family member with a disability received economic support for socio-economic reintegration through the ICRC's economic security activities.
In 2015 the ICRC intends to:
 facilitate access to services by donating raw materials, components, tools and physiotherapy equipment, by continuing to support the cost of transport for destitute beneficiaries living in remote areas of the Iraqi Kurdistan Region, by improving dissemination to local entities and authorities of information on services available for people with disabilities, by further developing an integrated approach with the Economic Security and Protection departments, including the socio-economic reintegration of people with disabilities, and by continuing to support Syrian refugees and internally displaced people with disabilities by providing assistive devices, including wheelchairs;
 enhance quality by monitoring physical rehabilitation activities at assisted centres through ICRC specialists in conjunction with the HCPRPO, by organizing 10 national training modules, by continuing to provide scholarships for those enrolled in postgraduate education, by upgrading the practical skills of the present P&O and physiotherapy teachers, and by working with the HCPRPO to implement quality control tools and treatment protocols;  promote the long-term functioning of services by assisting and strengthening the HCPRPO at the MoH of Iraq and at the MoH in the Iraqi Kurdistan Region as well as at the Higher Committee for Physiotherapy in order to develop a comprehensive national rehabilitation strategy, by strengthening the close working relations with Directorates of Health so as to increase the focus on physical rehabilitation, by systematically mapping rehabilitation services, by assisting the MoHE of Iraq and MoHE in the Iraqi Kurdistan Region to upgrade training and education in prosthetics and orthotics as well as in physiotherapy so that they are more in line with international standards, and by continuing to support Erbil Governorate in the planning of a new physical rehabilitation centre in Erbil;  encourage the social inclusion of people with disabilities by working with disabled people's organizations to promote implementation of the UNCRPD, by making it easier for people with disabilities to take part in sports events by donating wheelchairs to the Iraqi National Paralympic Committee and marking the International Day for People with Disability, by creating awareness about physical infrastructure at health facilities, and by enhancing the employability of people with disabilities at the supported physical rehabilitation centres. In 2014, with the influx of Syrian refugees, the ICRC decided to conduct a physical rehabilitation needs assessment mission. The ICRC then decided to start being active in physical rehabilitation in Lebanon and in October, the ICRC Physical Rehabilitation Project Manager started his mission. Between October and December 2014, the PRP manager invested time and effort to understand and integrate into the Lebanese physical rehabilitation sector. Out the 23 P&O service providers in the country, 6 have been visited and their services were assessed as good. One in Tripoli and one in the Bekaa Valley became the referral points for PRP beneficiaries in need of mobility devices. Discussions about possible collaboration with P&O and PT syndicates and their needs were started. At the end of 2014, the ICRC provided financial assistance for 51 people in need of physical rehabilitation services.
Lebanon signed the UN Convention on the Rights of Persons with Disabilities in 2007, but has not yet ratified the Optional Protocols. The National Council on Disability (NCOD) is the key mechanism for policy-making with regard to people with disabilities in Lebanon. Its mission, which is defined in Law 220/2000, is mainly to prepare the general policy on disability or to adopt norms and standards for public institutions. From 1994 until now, the National Council made a number of achievements. It played a key role in preparing and lobbying for the passing of Law 220/2000 and the adoption of the disability card programme, including the classification of different forms of disability. The Ministry of Public Health, while responsible for regulating the sector, is not directly involved in physical rehabilitation service provision but reimburses the cost of assistive devices for economically vulnerable service users. Services are provided through a network of private providers across the country. The Ministry of Public Health and the Lebanese Syndicate of Prosthetists/Orthotists agreed on a national price list for P&O devices. Currently, the Ministry of Public Health lacks funds and has reduced its aid. Previously, people needing assistive appliances could have them replaced after two years. Today, those devices are replaced only after four years. Additionally, the Ministry allocates only USD 16,000 per annum to each private and accredited prosthetic/orthotic clinic. With this sum, an average of 10 people per clinic can be fitted with complex braces or artificial limbs.
In 2015 the ICRC intends to:  continue assessing the situation for Syrian refuges in need of physical rehabilitation services and when needed, provide financial assistance to access appropriate physical rehabilitation services;  maintain close contact with the Lebanese authorities and with professional associations to further enhance working relations;  support the opening, in conjunction with the Iranian Red Crescent Society, of a physical rehabilitation department at Nabatiyeh Hospital. 

# YEMEN
As in the past, the prevailing security situation had an impact on the implementation of activities. Nevertheless, the ICRC's support for the physical rehabilitation sector in Yemen continued to increase from one centre in 2002 to four centres in 2014. In 2014 the ICRC continued assisting four physical rehabilitation centres in Aden, Mukalla, Sana'a and Taiz, all managed by the Ministry of Public Health and Population (MoPHP) and the only functioning centres in the country. Discussions with the authorities -about opening a new centre in Sa'ada to ensure access to services for people with disabilities from Sa'ada governorate and its surroundings -were successful and at the end of the year, an agreement was signed between the ICRC and the local Directorate of Health (and endorsed by MoPHP) to construct a fifth centre in Sa'ada, which should start operating in early 2015. In addition to the material and technical assistance, gait training area at the PRC in Taiz was renovated.
Yemen ratified the UN Convention of the Rights of the Persons with Disabilities in 2009 and it is one of the 30 States party to the Anti-Personnel Mine Ban Convention that have acknowledged their responsibility for landmine survivors. The MoPHP continued to be in charge of the physical rehabilitation sector, which consisted of four physical rehabilitation centres (all assisted by the ICRC), four training institutions for physiotherapy and three funds created to alleviate the living conditions of people with disabilities. The Ministry of Social Affairs and Labour (MoSAL) was responsible for welfare and for coordinating the provision of services for people with disabilities. In February 2014 the MoSAL published the National Disability Strategy and its Plan of Action for the period from 2014 to 2018. The National Disability Strategy outlines the vision, objectives and principles of a "rightsbased" approach to disability for Yemen. The National Disability Strategy also proposes a time frame within which the Strategy will be implemented, including the establishment of the Care and Rehabilitation Fund for Handicapped Persons (CRFHP), which will assume responsibility for overseeing the implementation, monitoring and evaluation.
Insecurity remains a major stumbling block for many people with disabilities in accessing physical rehabilitation services. The services are centralized in major cities and there are no outreach programmes. According to the National Disability Strategy document, health services are widely inaccessible by the rural population, which constitutes 75% of total population in Yemen. The shortage of female professionals, especially for P&O services, remains a hindrance for access to PRCs services by women. To improve accessibility for women, the ICRC sponsored two additional women to attend formal P&O training, thus taking the total of Yemen women on ICRC scholarship at Mobility India to seven. The ICRC also promoted general service accessibility by supporting the MoPHP to construct a physical rehabilitation centre in Sa'ada.
In 2014 the ICRC promoted accessibility to services by donating raw materials and components to all assisted centres. In all, 65,131 people benefited from various services at ICRC-assisted centres. The services included the provision of 826 prostheses (7% for mine survivors), 20,839 orthoses, 348 wheelchairs and 941 pairs of crutches as well as physiotherapy for 33,236 people. Children represented 42% and women 26% of the beneficiaries. The total number of women receiving services showed a small increase compared to 2013 (+ 2%); however, it is expected that this figure will increase with the return of women students from Mobility India.
The quality of the services provided at the assisted centres was maintained through continued support from ICRC ortho-prosthetists and physiotherapists, who provided on-the-job mentoring, short training courses and monitoring. In 2014 the ICRC provided scholarships for six more candidates to study P&O at Mobility India; this is in addition to the nine Yemeni students already enrolled there. Of these 15 students, 7 are women; they were given scholarships in the hope that when they return, access to services for women will increase. A training course for trainers (ToT) on dynamic alignment and gait training for lower limb prosthetic users was conducted at the High Institute of Health Sciences (HIHS) for 10 participants from the Aden and Sana'a institutes of physiotherapy assistants. In addition, the ICRC signed an agreement with the HIHS in Sana'a to open a P&O department and launch P&O training programme to curb the shortage of trained personnel in the country. Renovation of the P&O department was started and completed in 2014. A booklet on hygiene and stump and prosthesis care was produced and distributed to the four main PRCs so as to educate beneficiaries.
The ICRC continued working closely with national institutions and with the management of the assisted centres to promote the long-term functioning of services. In 2014, 42 participants took part in a national coordination seminar organized by the ICRC. Participants came from the four assisted PRCs, MoPHP Directorates and other stakeholders and a sub-committee with representation from the centres was constituted to follow up the recommendations of the seminar. Despite budgetary constraints, the MoPHP realizes and appreciates the importance of having qualified personnel in their institutions and therefore sponsored two physiotherapists to study for an MSc degree in Turkey.
Isolation and stigmatization are challenges experienced by people with disabilities that will require both political and social willpower if they are to be overcome. The ICRC continued to network with local NGOs and others, with a view to increasing the inclusion of people with disabilities in their communities. In 2014 ICRC-managed microeconomic initiatives provided loans for 86 people with disabilities to start businesses. The International Day of People with Disability (3 December) and the Arabic Day of Persons with Disabilities (13 December) were celebrated in different cities in Yemen in 2014. The ICRC distributed 1,500 T-shirts bearing a special message about equality and donated 16 wheelchairs to the General Union for Sports for Disabled. A marathon was organized for eight women and eight men as part of the Arabic Day of Persons with Disabilities celebrations in Sana'a. 

# ANNEX 1 -ICRC PUBLICATIONS
The following documents are available through the ICRC website and, in most cases, can be downloaded directly from there.

# PHYSICAL REHABILITATION

# Towards Social Inclusion -Physical Rehabilitation Programme
This brochure promotes the ICRC's physical rehabilitation work, describing the benefits of these services for people with disabilities -from recovering their mobility to being integrated back into society. It also explains what the ICRC does to ensure that people have access to physical rehabilitation and describes some of the situations in which it provides those services.

# P&O Manufacturing Guidelines
Manufacturing guidelines for trans-tibial, trans-femoral, partial-foot, trans-humeral and trans-radial prostheses and ankle-foot, knee-ankle and patellar-tendon-bearing orthoses and for using the alignment jig in the manufacture of lower-limb prostheses were published in 2007 and widely distributed among all ICRC-assisted projects and NGOs and among stakeholders involved in providing P&O services in developing countries. Each manual contained material that should be of help in transferring skills in projects.

# Polypropylene Technology
To mark the ICRC's role in developing and promoting appropriate technology, such as the polypropylene technology, a brochure on the subject was published in 2007. It provides the necessary information about the advantages and appropriateness of using this technology for producing prosthetic and orthotic devices in developing countries.

# Physiotherapy
The "Physiotherapy" leaflet is a concise introduction to the work of the ICRC's physiotherapists. It explains the role that these professionals play in physical rehabilitation and hospital projects as well as the ICRC's approach in this field

# Exercises for Lower-Limb Amputees
This booklet/CD-ROM provides examples of basic post-prosthetic exercises for use by physiotherapists, physiotherapy assistants, ortho-prosthetists and others involved in gait training for lower-limb amputees. The aim of these exercises is to help amputees to regain their self-confidence and to walk as well as possible.
In 2015 the ICRC intends to:  enhance access to services at Green Pastures Hospital and the YRC by continuing to provide support for planning and implementing an outreach programme with the aim of reaching people living in remote areas and by donating raw materials and components to Yerahity Rebilitation Centre;  enhance the quality of services provided at ICRCsupported centres through technical and managerial support;  promote the long-term functioning of services by providing managerial support for the YRC, and strengthen synergies between ICRC-supported centres, government actors and coordination bodies working in the physical rehabilitation sector. ICRC projects in Mexico, Honduras and Guatemala were part of a regional effort by the organization to ensure access to suitable rehabilitation services for migrants. Many of these migrants suffer serious injury while travelling north in dangerous conditions, with little chance of gaining access to physical rehabilitation. The strategy and approach employed in Mexico complement those implemented in Honduras, Guatemala, El Salvador and Nicaragua. In all these countries, after identifying migrants in need of physical rehabilitation services, the ICRC refers them to one of the assisted centres, where it then covers the cost of treatment, transport and accommodation.
In Mexico, the ICRC continued to work with the Orthimex Prosthetics and Orthotics Centre in Tapachula (Chiapas state) and with the National Rehabilitation Institute in Mexico City to ensure access to adequate physical rehabilitation for migrants injured when falling off trains on the way to the United States.
Mexico ratified the UN Convention on the Rights of Persons with Disabilities in 2007. The Mexican government designated the National Human Rights Commission and the 32 public human rights agencies in each state and the Federal District as the bodies responsible for overseeing implementation of that Convention. Recent disability-related data were available from the 13th National Census of Population and Housing, which was conducted in 2010. Disability assessment followed the recommendations of the Washington Group on Disability Statistics and identified 5,739,270 (5.1%) people with disabilities, 51.1% of whom were women. Policies and legislation endorse the rights of people with disabilities.
The public and private network of rehabilitation centres covered a large part of the country, even if they are still far from covering all needs. Physical rehabilitation services provided by public institutions such as the National System for the Integral Development of the Family (DIF), the Mexican Social Security Institute (IMSS) and the National Rehabilitation Institute (INR) focus on physical, occupational and/or speech therapy, while the provision of P&O services in the public sector is limited to some DIF and IMSS centres, mainly in Mexico City. As for the others, in the 31 states of Mexico services are mainly subcontracted to the private sector.
In 2014, 36 migrants with physical disabilities benefited from various services at the assisted centres with the financial support of the ICRC. These services included the provision of 12 prostheses, 1 wheelchair and 3 pairs of crutches. Women represented 6% and children 6% of the beneficiaries. In addition, to ensure access to physical rehabilitation services, the ICRC covered the cost of treatment for 23 returned migrants with physical disabilities in El Salvador (directly covered by the regional delegation in Mexico).
Multidisciplinary team work has improved with the creation of a provisional working relationship between the private Orthimex centre (does not employ any physiotherapists) and the DIF centre in Tapachula. To improve the quality of P&O services, the ICRC invited one ortho-prosthetist from Orthimex to attend a two-week training course conducted by Don Bosco University (El Salvador) on the production of prostheses for amputees with hip disarticulation and the ICRC sponsored candidates from the DIF to attend a two-week seminar (in Cartagena, Colombia) on the management of lower limb amputees for physiotherapists. In 2014 the ICRC decided to start physical rehabilitation assistance following a needs assessment mission conducted in 2013. Although the original plan was to have ICRC specialists in Syria at the beginning of the 2014, their arrival was postponed until mid-2014 for several reasons. From mid-2014 until the end of year, ICRC specialists laid the foundations for a project that will ensure access to appropriate physical rehabilitation services in two cities, Damascus and Aleppo.
The conflict and the economic sanctions imposed by other countries seriously affected the possibilities for people with physical disabilities to access physical rehabilitation services. While the needs are increasing, existing rehabilitation centres have been destroyed, have closed down, are not accessible, and/or lack staff, funding and/or material. Among other services, the Syrian Red Crescent Society (SRCS) was managing a temporary centre in Damascus as security issues rendered their main centre inaccessible. The ICRC donated materials and components to the SRCS, enabling it to provide services. In addition, the ICRC established contact with the Ibn Nafis hospital, where the Ministry of Health is managing a physical rehabilitation centre.
In 2015 the ICRC intends to:
 improve access to services by continuing to support the physical rehabilitation services provided by the SRCS, by opening a centre in Aleppo and by continuing to assess possibilities to decentralize the provision of services in other regions;  improve the quality of the services by providing support and mentoring by ICRC specialists and by supporting the establishment of a physiotherapy department at the SRCS-managed centre in Damascus.

# MISSION
The International Committee of the Red Cross (ICRC) is an impartial, neutral and independent organization whose exclusively humanitarian mission is to protect the lives and dignity of victims of armed conflict and other situations of violence and to provide them with assistance. The ICRC also endeavours to prevent suffering by promoting and strengthening humanitarian law and universal humanitarian principles. Established in 1863, the ICRC is at the origin of the Geneva Conventions and the International Red Cross and Red Crescent Movement. It directs and coordinates the international activities conducted by the Movement in armed conflicts and other situations of violence.