The physical rehabilitation services of the ICRC had been present in the country since 2007 following the civil war which broke out in 1991 and ended in 1997. Years of conflict had weakened the country economically and politically and its economy was largely dependent on foreign aid. Another fateful legacy of the civil war was landmines and explosive remnants of war (ERW), which have killed hundreds of men, women and children.
In 2004, victim assistance was included in the national mine action strategy; including the recruitment of the Victim Assistance officer in 2006 and the subsequent development and implementation of a national victim assistance programme through the coordination of the Tajikistan National Mine Action Center (TNMAC) and the integration of victim assistance in line with the Mine Ban Treaty. The mine action center gathered detailed information on mine/ERW casualties and service provision in cooperation the Tajik Red Crescent Society through a needs assessment survey initiated in 2013. By December 2015, more than 600 people had been surveyed.
The number of communicable and non-communicable diseases continues to increase, such as the polio outbreak in 2010 which resulted in a rise of people with disabilities. The vast majority of people with disabilities cannot afford to access appropriate health services. Although basic rehabilitation services are free of charge for registered persons with disabilities, they are inadequate in both quality and quantity. The qualifications of personnel are low, wages are substandard and the overall effectiveness of the social welfare system is inadequate.
In 2010, the adoption of the National Health Strategy for 2010–2020, providing the framework for the most recent round of health reforms, coincided with the hand-over from ICRC to MoveAbility, to ensure continuation of the physical rehabilitation services. New disability legislation was adopted at the end of 2010. In 2013, the Tajik Victim Assistance Program was “rebranded” as the Disability Support Unit (DSU) to reinforce the understanding that efforts to assist landmine/ERW survivors are part of broader disability and development frameworks.
Between 2005 and 2009, the government gradually took on more responsibility for the State Enterprise Orthopedic Plant (SEOP); it was handed over to full government management at the beginning of 2009. By 2012, there was a gradual deterioration of the quality of prosthetics and orthotic services at the SEOP caused by a low level of expertise following the departure of all the formally trained technicians and caused by the departure of all the formally trained technicians.
Although the SEOP had introduced better salaries, there was still a high turnover. MoveAbility assisted with planned improvements to the rehabilitation structure and seconded two physical rehabilitation professionals on site. This full-time presence greatly improved the service delivery and the collaboration with other actors. In 2017 the SEOP upgraded its branch in Khujand with MoveAbility’s support. This center will meet the needs of people in remote areas through a multidisciplinary approach.
Efforts are continuing to improve the quality of information on the needs of survivors and to integrate assistance into programs and strategies that also address the rights of persons with disabilities. So far Tajikistan has not signed the Convention on the Rights of Persons with Disabilities (CRPD), but is likely to do so in 2018.