At the beginning of 2020, the world was taken by surprise by the Covid-19 pandemic: in Morocco, as in most countries, priority was given to slowing down the circulation of the virus on the territory. Drastic measures were thus multiplied: declaration of a state of health emergency, implementation of a national lockdown, stopping all non-essential economic activities, introduction of a curfew, etc.
These restrictions were unprecedented in scope and aimed to protect the population as a whole and to buy time to prepare the health system to face the pandemic (massive production of masks and other protective equipment, increase in the number of intensive care beds in hospitals, development of diagnostic capacities, etc.). In time of emergency, these decisions had a global objective but did not take into account certain specific needs of the population, and in particular the most vulnerable. While in the short term they did limit the circulation of Covid-19, their economic and social cost quickly proved to be considerable. Subsequently, the resumption of activities in a weakened economic and health context left little room for differentiated consideration of needs: for all citizens, it was therefore necessary to learn to live with the virus and adapt to a ‘new normality’.
One year after the start of the pandemic, we are now able to to take a step back from the onset of the crisis and analyse its impact on the population in order to draw the first lessons. That is why the AMH Group, with the financial support of the British Embassy in Morocco, has undertaken a study on the impact of the crisis on the paramedical care of people with disabilities in Morocco. A reference in the field of disability since its creation in 1992, the organisation seeks to better understand the needs of people living with disability in order to adapt its activity accordingly and offer concrete solutions.
The support offered by the AMH Group is based on the “life project” approach. This project, which aims to meet the needs of people with disabilities at each stage of their journey, also had to adapt to face the new difficulties encountered by the beneficiaries during the pandemic while complying with health restrictions and new measures.
Disability in Morocco: a multidimensional vulnerability exacerbated by the Covid-19 crisis
In times of crisis, people with disabilities, who represent 6.8% of the Moroccan population (i.e. 2.3 million people), are already among the most vulnerable groups in the country. It is estimated that two thirds of them do not have access to any social protection and that of those who do, a large majority are affiliated to RAMED (Moroccan Medical Assistance Scheme for the most vulnerable families). Similarly, their access to technical aids (crutches, walking frames, wheelchairs, etc.) remains extremely limited, as only one in three people with disabilities has the technical support that their state of health requires.
The majority of people with disabilities therefore face major difficulties in accessing the care they need, even though this access is a prerequisite for social participation. Indeed, the lack of appropriate care severely restricts mobility and independence. Moreover, almost two thirds of children with disabilities do not go to school, even though schooling is compulsory up to the age of thirteen in Morocco, while the unemployment rate of people with disabilities is six times higher than the national rate.
This particularly worrying situation was further aggravated by the Covid-19 crisis: people with disabilities were confronted with the same difficulties as the Moroccan population as a whole, but also had to face obstacles that affected them more specifically such as temporary closure of reception and orientation centres, interruption of medical follow-up and of non-urgent paramedical procedures.
They were thankfully able to benefit from the Special Fund for the management of the pandemic, State aid and, most of all, from solidarity actions carried out by civil society. For instance, the AMH Group, among other groups and organisations, carried out several distributions of basic necessities (Ramadan baskets, rent assistance, personal care products, etc.). As part of an emergency approach, these activities made it possible, in the very short term, to alleviate the human and financial distress of many beneficiaries, but this support, which was necessarily limited, was not enough to meet all the needs.
In fact, the economic difficulties of people with disabilities have been strongly reinforced by the crisis, since many of them were in precarious jobs or working in the informal sector, and were therefore among the first to be affected. Their state of health has deteriorated considerably, both physically, with the interruption of rehabilitation care, and psychologically, with the fear of illness and the frustration of losing the progress made. Access to transport, already limited by a lack of accessibility, was also almost impossible during lockdown and has remained difficult since (notably due to an increase in prices). Similarly, the schooling of children and young people with disabilities has been strongly impacted by the generalisation of distance learning (lack of space and specific equipment to follow lessons at home, absence of a professional accompanier, impossibility of access to an Internet connection for children from vulnerable families).
The syndemic approach as a means to fight pandemics
The Covid-19 crisis therefore revealed and exacerbated the inequalities present in Moroccan society as well as in most societies. Alarming in itself, this observation is even more so if we consider that this increased vulnerability weakens society as a whole. Indeed, the current pandemic has given renewed visibility to the concept of syndemics, developed by medical anthropologist Merrill Singer in the 1990s and combining the terms “epidemic” and “synergy”. According to this approach, the existence of vulnerability factors (biological and environmental) can strongly amplify the impact of an epidemic: instead of combining into one, the two diseases reinforce each other and their effects are more significant than their simple sum.
The multidimensional vulnerability of people with disabilities in Morocco therefore exposes them to the risk of developing more severe forms of the disease, which is an important issue for the Moroccan health system – one of the main challenges of the current pandemic being precisely to combat hospital overcrowding and limit the number of severe cases. The fight against inequality is therefore no longer just a social challenge, but a real public health issue, and a means of making society more resilient to pandemics.
The key role of civil society
In this perspective, the role of civil society as a whole, and of non-profit organisations such as the AMH Group, which analyses the various risk factors in order to act on the structural causes of these vulnerabilities, appears all the more fundamental. Indeed, the organisation was founded in 1992 by people with disabilities to try to find a concerted solution to the difficulties they encountered in their daily lives and it has since been working to develop a more holistic support system.
AMH therefore works in several complementary areas: in the field of health, it seeks to facilitate access to health care services and has created two rehabilitation centres operating according to a solidarity-based economic model. The Noor Hospital Centre (CHN), founded in 2001, aimed to respond to the lack of specialised centres for the treatment of disabilities. It is the first structure of its kind in North Africa and has since developed a wide range of care (physiotherapy, occupational therapy, orthopaedics, speech therapy, etc.). Their goal is also to support the most vulnerable people through a redistributive system : on average, the fees paid by five patients through their health insurance are used to cover the care of a patient without social security. Since 2019, the opening of a new medical centre in Khouribga allows this expertise to be disseminated in a more marginalised area of the country. Several development projects are also strengthening and diversifying the services offered. For instance, comprehensive sexual and reproductive health support is now developed within the CHN to assist women with disabilities in an area that is still taboo in Morocco. Moreover, the group is also implementing an adapted and innovative flat to facilitate the re-learning of everyday gestures before the patient returns home. This recent pilot project in Morocco will enable people with disabilities to move around in an adapted environment (kitchen, sanitary facilities, doors and other openings that meet accessibility standards) and to take part in therapeutic rehabilitation workshops (cooking, gardening, IT, pottery, etc.) during their treatment at the Noor Hospital.
The AMH Group is also active in the field of autonomy, and encourages the social participation of people with disabilities by providing them with the various support they need such as administrative support, assistance towards professional integration, technical aids, etc. To do this, the organisation’s social workers have adopted the “life project” approach, which allows for personalised support that is co-constructed with the disabled person according to his or her pathway, needs and aspirations, and enables the person to be accompanied at each stage of his or her life.
The AMH Group is also committed to access to education, in particular through the Institution Tahar Sebti (ITS), a school with an inclusive and innovative pedagogy in Morocco. The ITS offers an educational programme from kindergarten to primary school centred on the development and fulfilment of the child in all areas (i.e. physical, psychological, intellectual, emotional etc.) and accessible to all. In addition to teaching the fundamentals, it organises numerous extracurricular activities from art to sports or philosophy to strengthen the child’s social skills while developing his or her abilities beyond the purely academic framework, and thus fostering future social participation.
Lastly, the AMH Group carries out numerous advocacy activities to ensure that the rights of people with disabilities are recognised and respected. In this effort, it relies on its many non-profit and institutional partners to develop concerted and relevant solutions to the difficulties identified. Given the cross-cutting nature of the disability issue, it is essential to mobilise the many stakeholders concerned, from the health, education and employment sectors, to ensure their support and benefit from their different expertise.
The above-mentioned study also emphasised the crucial nature of such work: the Covid-19 crisis has highlighted the need for reliable data and statistics in order to offer support adapted to various needs in a population, a major task that must also be carried out by the State.
In this way, the AMH Group contributes to the reduction of inequalities and the promotion of the inclusion of people with disabilities in Moroccan society. While the needs remain considerable, and have been further reinforced by the pandemic, the work of non-profit organisations remind us that a more equal society is a more resilient society in the face of all crises. The exclusion and marginalisation of vulnerable populations is a risk to society as a whole, and it is more necessary than ever to fight it.
In order to pursue these efforts and continue to diversify their offer, the AMH Group is now planning to embark on a vast development project. This will involve creating a new coworking and training space specifically dedicated to people with disabilities. Accessible, functional and user-friendly, this space will enable members to work on their professional skills to facilitate their integration into the working world, to benefit from advice and personalised support to launch their own business, and to participate in discussion groups to strengthen their self-esteem and share their experience. In doing so, the project will contribute to the long-term empowerment of people with disabilities and encourage their full social engagement.
Co-authors: AZICKIA & AMH Group / GROUPE SOS Pulse
 SINGER Merrill, Introduction to Syndemics: A Critical Systems Approach to Public and Community Health, John Wiley & Sons, 2009
 Since 2018, the activities of the AMH Group have benefited from the project on “Improving the care in re-education and functional rehabilitation of people with disabilities in Morocco”, carried by GROUPE SOS Pulse, an association supporting social entrepreneurship, with the financial support of the French Development Agency (AFD).
Through these Stories, Azickia aims to highlight social impact initiatives, in France and around the world, while not necessarily adhering to all the opinions and actions implemented by them. It is and will remain in Azickia’s DNA to fight against all forms of discrimination and to promote equality for all.
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