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Disability and povertyA global challenge$

Arne H. Eide and Benedicte Ingstad

Print publication date: 2011

Print ISBN-13: 9781847428851

Published to Policy Press Scholarship Online: March 2012

DOI: 10.1332/policypress/9781847428851.001.0001

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Where culture really matters: disability and well-being in Yemen

Where culture really matters: disability and well-being in Yemen

Chapter:
(p.137) Seven Where culture really matters: disability and well-being in Yemen
Source:
Disability and poverty
Author(s):

Benedicte Ingstad

Arwa Baider

Lisbet Grut

Publisher:
Policy Press
DOI:10.1332/policypress/9781847428851.003.0008

Abstract and Keywords

This chapter shows a situation in which culture makes the difference in the life situation of poor disabled women and men. It concentrates on data from Yemen, mainly qualitative interviews with 35 individuals and one group interview with young physically disabled girls in an orphanage. The chapter confirms that poverty gives people less access to healthcare and preventive measures, education, and money to buy nutritious food and medicines. Thus poor people are more at risk than others of developing impairments. Similarly, education, social services, and employment are less accessible to a disabled person in Yemen than to those who have full use of their limbs, senses, and intellectual ability. The gender issues of segregation and male dominance play an important role in making girls/women with an impairment more disadvantaged in many ways than boys/men.

Keywords:   Yemen, disability studies, poverty, disabled women, male dominance

Introduction

Since the early 1970s so-called ‘disability studies’ has been a growing field of interest in anthropology. There are several reasons for this. First, a focus on the disabled body links up to themes of interest in mainstream anthropology such as ‘the body’, ‘normality and deviance’, ‘stigma’ etc. Second, it has to do with the medically or mentally impaired body, and as such, with the growing field of medical anthropology as a sub-discipline. Third, a group of scholars have recently come together and made an interesting anthology on the fruitful use of Foucault's theoretical perspective on the topic of disability (Tremain, 2005). This brings it right into the mainstream of professional interest. And finally, ‘disability studies’ links up to traditions of activism by groups of disadvantaged people that – especially in the USA – has had a major influence on the field of anthropology.

Lately, in the field of disability studies and activism there has been a strong move towards substituting a medical model – with a focus on impairment and its consequences – with a social model – focusing on the disabling environment. The concept of ‘disabling environment’ implies an emphasis on how structural, sociocultural and physical conditions constrain people and make it difficult for them to function to the extent that is considered ‘normal’ in a given society. This change of focus – from the individual body to the surrounding society – links up to recent interests in mainstream and medical anthropology in social suffering and structural violence (Farmer, 1999, 2003; Kleinman, 2000; Daas, 2006). This also links to applied perspectives in anthropology such as community development, empowerment of disadvantaged groups and so on.

In academic writing about people with disabilities in poor countries it has often been claimed, by academics as well as aid workers, that these people are hidden, neglected and sometimes even killed by their families, and that such behaviour has to do with ‘attitudes’ and ‘culture’ (Helander, 1993). Ingstad has, however, on several occasions and through research argued for the fact that ‘attitudes’ towards people with disabilities is as much – and often more – the result of social circumstances of which poverty is an important factor. She has also demonstrated that circumstances which, seen from the outside, may look like hiding and neglect most often may (p.138) be explained by the life situation of the family who are responsible for the care of the child/person with a disability (Ingstad, 1991; Ingstad and Whyte, 1995, 2007).

The study from Yemen, on which this chapter is based, shows a situation in which culture does make a real difference – the difference in the life situation of poor disabled women and men.

Methodology

This chapter is based on a multi-country study on ‘disability and poverty’ which so far includes two countries1 – Kenya and Yemen2 (Grut and Ingstad, 2006, 2007). This chapter concentrates on the data from Yemen, mainly qualitative interviews with 35 individuals and one group interview with young physically disabled girls in an orphanage.3 The interviews were conducted in a variety of different sites, all from poverty-stricken areas, rural as well as urban. The interviews followed a checklist of key words, but were flexible to the extent that the person being interviewed was free to take the lead in the conversation. The informants were primarily people with disabilities, but they were substituted by close kin if the person with a disability was too young or too impaired to speak for him/herself. The interview sessions were of one to two hours' duration, and were conducted by two teams consisting of one researcher, together with one local counterpart. The two counterparts served both as translator(s) and partner(s) for discussion of the findings.4 One of them is a co-author of this chapter.

Disability and poverty: a theoretical approach

Several academics have pointed out that disability and poverty are linked together in a ‘vicious circle’ (Yeo, 2001; Yeo and Moore, 2003; Grut and Ingstad, 2006, 2007). Disability creates – or contributes to – poverty by people with disabilities not being able to get an education, to participate in the labour market and so on. Similarly, poverty increases the risk of becoming disabled through malnutrition in pregnancy, increased exposure to hazardous work situations, unavailability of health services, lack of money to buy medicines etc. In a clinically controlled study from Haiti it was shown that of those tuberculosis patients who received free medicine, home-based follow-up, food and vitamin supplements plus money to cover travel expenses, as much as 100% of all patients were cured. However, in the group receiving free medicine only, the recovery rate was barely half that of the other group (Farmer, 2003, pp 149–50). Thus we see that compliance to a treatment regime, or rehabilitation, is not only a question of availability but also about ability to – or a barrier against – utilising it. For instance, the availability of a clinic for delivery is not enough if a woman in difficult labour does not have the means of transport or money to pay for it.

Kleinman (2000) talks about ‘the violence of everyday life’, and this is precisely what is present in the link between disability and poverty. The violence is structural and comes from the individual's surroundings, from the local community, state (p.139) legislation and even the international policies and economic forces that contribute to creating wealth in some places, and for some people, and poverty for others. This leads to suffering that is not primarily linked to impairments and individual shortcomings, but that is social in its character and generated by forces outside the individual. While all people in a community may be victims of such suffering, people with disabilities are hit the hardest, because of their problems in reaching even the small resources that are available, and having to turn to unsatisfactory – even degrading – solutions to survive. For instance, in Ghana, Dennis found that a significant number of children who work on the streets in the city of Tamale were supporting disabled adults at home (Dennis, 1997, quoted in Yeo and Moore, 2003).

Structural violence – or barriers – is also to be found in the environment, in the houses that are constructed that are inaccessible to wheelchair users, elevators without Braille writing, or schools without facilities for children with hearing difficulties. It is also to be found in the constraints given by nature – sand that is too deep for wheelchairs, mountains that are too steep to climb for a person with an impairment to get to the field etc. Such natural barriers do not represent structural violence in themselves, but become so when nothing is done to overcome them and to give people with disability equal opportunities (or alternatives) to participation.

Farmer (2003) argues that if problems are caused by structural violence, then the solutions also have to be structural and sustainable. Our task as (critical) medical anthropologists is to identify the structural forces as well as the social and cultural barriers that create and sustain ‘the evil circle of disability and poverty’. This brings us to a revival of Fredrik Barth's (1960) ‘generative model’ from the early 1960s, which seems like a suitable analytic tool for this purpose. Barth looks at social forms. These are the aggregated results of people's choices, made under specific constraints and possibilities in a given situation. The issue in the model is to understand how social forms are generated by identifying the constraints and possibilities under which choices are made.

Such a perspective brings anthropology and disability activism close to each other. The new emphasis on a ‘social model’ focusing on barriers to integration and participation – instead of a definition of disability based on individual shortcomings (impairment) – in many ways resembles a generative model put into practice.

“This is my life”: barriers to integration in Yemen

Background

The Republic of Yemen was established with the merging of former North and South Yemen in 1990. Previously South Yemen was a socialist country. Yemen is located on the tip of the Arabian Peninsula, bordering on Oman to the East, Saudi Arabia to the North and surrounded by the Gulf of Aden to the South and the Red Sea to the West. The ocean route across to Somalia on the Horn (p.140) of Africa is short, and the influx of boat refugees is an increasing social problem. The language spoken is Arabic and the religion is Islam, but there are also small communities of Jewish people.

The main income comes from agriculture. Small farms in terraces cling to the steep mountainsides, requiring hand-held tools, harvesting by hand and carrying products on people's backs. In the fertile bottoms of the valleys more advanced machinery may be used, but this is often limited by lack of money to buy them. The main agricultural products are grain, vegetables and fruit. The climate is warm, and while the temperature is bearable on the mountain plateaus at about 2,000m, it becomes desert-like and very hot towards the South. Other ways of getting an income are fishing and small industries. Yemen is facing rapid urbanisation and a growing economy, but is still rated as the poorest country in the Arab world. The United Nations Development Programme (UNDP) World Development Report ranks Yemen as 151 out of 177 countries in the world (UNDP, 2005).

Islam is practised strictly according to the Qurʼan, and religion plays a large part in most people's lives. This had an implication for gender roles and relationships. Women, for the most part, are completely covered in foot-long black cloaks and black veils that cover everything but the eyes. Such a way of dressing is said to be voluntary, and some younger women are seen with only a headscarf above their long dress, which may also come in other colours than black. The extended family is the centre of social life. Girls live in their father's house until they marry – most often with their cousin or another close relative – after which they move to the husband's family's home, often to live in the same house as his parents, married brothers and unmarried siblings. For the well-off families this necessitates building very large mansions; for the poorer families it often leads to very crowded quarters. For a nuclear family to live on their own may be a sign of poverty, of having had to move out because of lack of space. The man is the head of the household, and women are not supposed to travel or walk the streets alone without being escorted by one of the male family members – even a young boy may do. If a woman breaks the rules of behaviour or clothing it may be seen as bringing a great shame on the family, and thus damaging the family's honour. Women and men occupy separate spaces within the home (if big enough), celebrate weddings and other festive occasions separately, and in some restaurants there are even separate rooms for men and women. Thus men and women move in separate spheres: the women's sphere is one of public seclusion and close individual relations, and unveiled companionship only with other women and at home. The men's sphere is the public arena, with an emphasis on strength and manliness. Ideally, during his lifetime a man should not see the face of any other women than his mother, his sisters, his wife (or wives) and nieces, and a woman should only see the men with whom she is prohibited from marrying (father, brothers, nephews).

(p.141) Gender and disability

Against this background of religiously prescribed gender segregation, it is interesting to see how this cultural trait, which permeates all areas of life, influences the lives of people with disabilities. Consider the difference between these two cases:

It would be wrong from this to deduct that the woman is ‘hidden’ in the house. Obviously her existence is known by neighbours and relatives outside the immediate household. The same is the case with her more mobile sister who gets to go to the day care centre. Thus ‘hiding’ as such is not an issue. However, the custom of gender segregation combined with the constraints of the physical surroundings and a somewhat unconcerned father makes her situation far worse than that of the man with a much more extensive impairment.

Another cultural trait that is important for the lives of people with disabilities is the strong emphasis on beauty and bodily fitness for both men and women. Thus an impairment which affects the beauty and working ability of a woman is seen as an impediment to marriage. Similarly, men with an impairment may risk being considered ‘less manly’. Two men, one blind and one a wheelchair user who had moved to a city, stated that they preferred not to go to their home village because there they were treated as inferior by other men. This was in spite of the fact that the man in the wheelchair had succeeded in getting an academic degree.

It was striking among our informants that several of the men were married, and the others hoped to get married, while the women did not even consider the possibility of marrying. When we asked about marriage in the group interview with physically impaired young women, it created spontaneous laughter and they (p.142) said that this was something they had not considered as a possibility at all. Another young woman, in a wheelchair as a result of polio, said jokingly that she would marry if she found a rich man who could afford to keep a maid. A young man, also a polio victim, had proposed to her father to marry her. She had refused, however, and said: “He is even more disabled than I am and does not have a job. What would we live on? It is not enough just to like each other.”

Divorce is relatively easy to obtain in Yemen for both men and women, provided the bride price dowry is returned to the man's family. Separated women usually move back to their father's household. We did, however, encounter a few examples of divorced women staying alone with a disabled child, if possible with the help of a younger sister or older sibling, on the grounds that she was afraid her family would not accept the disabled child. The group interview with young girls in the orphanage showed that many of them came from broken homes. Thus in a situation of divorce the disabled child, and in particular the girls, seem to be vulnerable, especially if the mother remarries. As said by one girl in the orphanage: “First I was kicked out by my father, then by my mother and then told to go to my grandmother.” She felt unwanted by her family and preferred to live in an institution with her disabled friends.

To acquire a disability as an adult is especially painful for a woman who thereafter is no longer able to fulfil her duties as a woman and as a housewife.

We see that although Khort's household duties are taken care of and she still has small children who depend on her love, it is not enough for her to feel accepted and worthy as a woman. The fact that she feels that her husband has rejected her because of her damaged body, and the co-wife is unsupportive, is an added pain to the physical phantom pains she has to live with daily.

(p.143) Disability in the household

The occurrence of a disability tends to make a poor household even more crowded than it would normally have been. The reasons for this are that a disabled girl does not marry but remains in her parents', and later her eldest brother's, household for the rest of her life. In addition, such families often keep another non-disabled sibling from marrying in order to stay at home to take care of a disabled brother or sister, and if the brother eventually marries it is usually too late for the sister to have any ‘value’ on the marriage market:

It is useful to analyse the situation of the household with a disabled member in Yemen from the perspective of the ‘disabled household’ (Ingstad, 1997). When an impairment occurs in a family, whether from birth or by accident later in life, the family has to reorganise their resources of labour, time and capital in order to meet the new needs. Thus in this way we may also say that the family becomes disabled, and therefore rehabilitation of the disabled individual should also be concerned with the family unit. In some cases, the best help a ‘disabled family’ may get could be for a non-disabled household member to get a job. There seems to be a tendency for non-disabled sons in such families to leave school early to get a job in order to contribute to the family's income. We see from the case above how poor Yemeni families with no money to hire help have few other ways of meeting the demands on their time and working capacity but to keep adult daughters from continuing school and/or getting married and involve them as lifetime caretakers for disabled family members.

(p.144) We also met people with disabilities who did not live in large family households. In these cases breakdown or physical distance to the supportive family network was part of the reason for living in poverty. The forced return of Yemeni families from Gulf countries after the first Gulf war was one example. Some of these families had only weak family networks remaining in Yemen, and with a person with a disability to care for it was easy for them to end up alone. In other cases families choose to live alone for various reasons. In one case a blind man chose to live in a small town with his wife and children because he had been to school for the blind there and had friends. They lived under poor conditions, in a very small rented house. Neither he nor his wife had a job, but they did get some support from his family in the village. This was the same man who felt that he was seen as inferior by other men when returning to his home village. In another case an elderly woman, bound to a wheelchair, lived alone with a son in the poor areas of Sanaʼa. The son was married but his wife refused to come to the city. It seemed that the old lady spent the day begging, an activity which could only be profitable in the city, and probably the main reason why they were there.

Religion and the meaning of disability

Religious activities in Yemen organise the day into five prayer times and give meaning to everything that happens in life – such as having a disabled child or becoming disabled oneself. People strongly believe that everything that happens to them or their loved ones comes from God, that he will help them and give them the strength to cope with any problem, and that they will be rewarded for being patient with what they got. The Qurʼan has a verse that says ‘great and good things will happen to enduring people’.

Disabled people are considered to be vulnerable, and looking after them and being kind to them is a religious duty which people will also be rewarded for. There is a story in the Qurʼan about a blind man who called on the Prophet, but the Prophet was busy and did not give him much attention. The blind man went away unhappy, and that made God angry. There is also a saying that ‘one is blind when his heart is blind, not his eyes’. We saw many examples of how religion played a role in giving meaning to a life with a disability/disabled child:

While this seemed to be the most prevalent attitude within families with disabled members there was, however, as in many areas of life, often a gap between learning and practice, especially when it came to people outside the family. It was said to (p.145) be common occurrence for people with disabilities to be teased and even have thrown stones at them. Several parents therefore chose to keep their disabled children at home and away from school. One mother had complained to one of the teachers, but was told that “they are just children and nothing can be done about it.”

Fear of ridicule or mistreatment may also keep disabled individuals and their families from seeking help from family members outside the immediate family. Such is the case of a teenage girl who is deaf in one ear, and her divorced mother. They live under very poor conditions, but the mother is afraid of moving back to her own family because she thinks they may mistreat the child. Other parents kept their disabled children from meeting strangers in order to protect them from negative reactions. The girls in the orphanage preferred to spend most of the day inside the house because strangers would call them names and shout at them in the streets.

Adults may also prefer to spend most of the time at home because of their disability:

In some respects it seems that the village life, in close-knit communities where everybody knows each other, may be easier for a person with a disability then life in the city. But on the other hand, if villagers reject them and discriminate against them, life in the village becomes very hard.

Employment

The majority of the people in Yemen live in villages that are scattered around the mountains. Village life is based on employment in the agricultural sector that produces both cash crops such as quat and crops for home consumption. Some families have their own piece of farmland; poorer families are employed by others and sometimes paid only in kind. In rugged terrain farming is obviously almost impossible for people with a physical impairment and the only place they can make themselves useful – if at all – is around the house.

(p.146) Self-employment based on special skills is another option. Some centres for people with disabilities give training in special skills such as sewing, basket making, leatherwork etc. But this requires a market to be profitable and capital to get started on their own. The market is rarely sufficient in rural areas, thus this requires a move to the town or city, and micro-finance or similar loans are hard to obtain for people with disabilities:

But even a small capital may make a lot of difference:

We learn from this example that (self)employment is difficult but not impossible for people with physical impairments in Yemen, especially men. There are some employers who are willing to take them on if they can perform the necessary tasks, and even a small capital opens up opportunities to be self-employed.

Education

Basic education is not yet compulsory in Yemen, but there is a major effort going on to increase the enrolment rate. Girls go to school, but at a lower rate and for fewer years than boys. Not every village has a school and many children have to walk long distances in rugged and hilly terrain to get to one. This of course makes it difficult for children with disabilities to attend if they are not able to get there on their own. Transport facilities exist in some places, but these cost money, and if poor people can afford it at all they are likely to make priorities among their children – with non-disabled boys most likely to come first.

Training of teachers in special education is still at an early stage in Yemen, and ordinary schools rarely have staff who are able to give extra help to children with hearing, visual or intellectual impairments. Parents tend to be aware of this and see little point in spending money on transport and uniforms if it is considered to be of no use. Facilities for special education tend to be found in cities, and (p.147) many parents are hesitant to send their children off on their own. In some cases they choose to move the whole family:

Although it seems that the parents are particularly worried about the education of their disabled boys, the fact that disabled girls are not considered likely to be married gives them a chance of education that they probably would not have had if they were not disabled. Some caring fathers of disabled girls paid particular attention to the education of their disabled daughters on the grounds that they should have a different chance in life, and be able to develop their intellectual skills.

Gender issues may also become relevant in other ways. A 15-year-old boy, Mahmud, with an intellectual impairment, was brought by his mother to a centre that teaches illiterate adults. But after a short while the female teacher refused to teach him on the grounds that she did not teach male students. The mother was very sad about this because he was beginning to learn for the first time in his life: “He is a child inside and a man on the outside” she argued.

Healthcare and rehabilitation services

In most rural areas people do not have access to healthcare and schools, and since transport costs money, these services are in any case inaccessible for the poor. Consequently disability-causing conditions, such as difficult child labour and severe infections, are, to a large extent, dealt with outside the professional healthcare system. Yemen has had one of the worst epidemics of polio worldwide, with around 485 cases in 2005–06. The epidemic has been stopped now and there have been no more new cases of polio for more than a year (WHO, 2004, 2006). There is a widespread rumour that the vaccination shot in itself causes the disease, thus making parents hesitant to accept such services.

Similarly, existing possibilities for (minor) economic support for disabled people5 can only be applied for at an office in Sanaʼa and is thus unavailable for many poor people in remote areas.

(p.148) To apply for financial support people have to go to the office in Sanaʼa, fill out a form (which of course requires writing skills) and get the necessary signatures. They have to appear at the office several times during the application process, which may take up to two years. This means long and costly travel for poor people in remote areas:

We see from this example that although there are possibilities for (very limited) social support for people with disabilities, the process for obtaining it disfavours the ones who need it most – poor people who are often illiterate and without the means to pay repeatedly for transport to get to the right office(s).

Environment

A rugged and hilly environment, like that to be found in (parts of) Yemen, does, as we have already seen, in itself represent an obstacle for people with disabilities, especially those who are physically impaired or even blind. However, the environment as such only becomes part of a picture of ‘structural violence’ when nothing is done to overcome it for people with physical limitations. When nothing is done to make buildings accessible, when transport to school or education close to home is not provided for, thus leaving disabled children and adults disadvantaged compared to others, when alternative income opportunities to agriculture on steep hills does not exist, then we may talk about ‘social suffering’.

Conclusions

The ‘evil circle of poverty and disability’ is in many ways confirmed in this study from Yemen. Poverty gives people less access to healthcare and preventive measures, education (knowledge) and money to buy nutritious food and medicines. Thus poor people are more at risk than others to develop impairments. Similarly, education, social services and employment are less accessible to a disabled person in Yemen than those who have full use of their limbs, senses and intellectual ability. In addition to this, the gender issues of segregation and male dominance play an important role in making girls/women with an impairment more disadvantaged in many ways than boys/men. Poor girls with a disability, even more than other girls, are stuck in a traditional family pattern. There is, however, an exception to this, in that the presence of an impairment and thus few chances of getting married (p.149) may give the girl a chance of being educated if she has a caring and ‘enlightened’ father. Economy is a critical factor here, thus girls from poor families are very unlikely to get such a chance, unless they are lucky and find a sponsor.

Speaking in terms of Barth's generative model, we may say that we have in this study identified some important factors that generate the ‘social form’ of inequality and lack of integration for poor people with disability in Yemen. The constraints under which people make their choices are those of poverty in general, but made worse by limitations in the ability to utilise natural resources, or obtain the services of healthcare, education and social security. The options they have are those provided for by a (more or less) caring family, non-governmental organisations (NGOs) providing for special education and skills training – and in some cases the luck of finding a sponsor.

The life situations faced by many of the poor people we interviewed in Yemen demonstrates what Kleinman (2000) called ‘the violence of everyday life’ creating a situation of ‘social suffering’ (Farmer, 1999, 2003). These concepts are useful in that they remind us of the fact that discrimination and lack of integration is not so much a question of personal shortcomings or bad will, but a result of political, social and cultural constraint imposed on the suffering individual. Thus when a poor ‘disabled family’ is not providing the optimal opportunities for their disabled family member, it is not so much because they do not want to, but because they are not able to and/or have not been given the necessary information and options. In Yemen, however, we have seen that cultural factors, especially religion and its impact on gender segregation, play a strong role in making the life situation for disabled women and men very different from each other. While the culturally constructed role of men allows for participation in social life, work and even marriage and fatherhood, the traditional role of women adds an extra constraint to the life of those who have a disability and may easily leave them isolated, unemployed and unmarried. Thus Yemen differs strongly from several other studies in which it has been shown that ‘culture’ and ‘traditional beliefs’ play a fairly minor role in determining the life situation of people with disabilities compared to the influence of social and political factors (Ingstad and Whyte, 1995).

Turning to the ‘social’ and ‘rights-based’ model of the disability activist, we can clearly see how this may feed from the analytical approaches indicated above. A generative analysis may help identify the barriers to integration that need to be overcome in order for the rights of people with disabilities to be fulfilled. There are, however, aspects of ‘equal rights’ to be considered. One is that of comparing the life situation of people with disabilities with that of people without disabilities. Another is the more difficult issue of achieving equal rights for disabled girls/women and disabled boys/men. In Yemen this is probably a very slow process since it is linked to the religious and cultural values that generate the situation of Yemenite women and men in general. Equality in the Western sense of the word may, at least for the time being, have to be replaced by a more culturally appropriate way of thinking of equality within the separate gendered spheres of life.

References

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Daas, V. (2006) ‘Review essay. Poverty, marginality, and illness’, American Ethnologist, vol 33, no 1, pp 27–32.

Dennis, C. (1997) ‘Truck pushers, grain pickers and grandmothers: street-children and some gender and age aspects of vulnerability in Tamale, northern Ghana’, In Gender aspects and ageing (http://www.un-instraw.org/view-documentdetails/461-truck-pushers-grain-pickers-and-grandmothers-street-childrenand-some-gender-and-age-aspects-of-vulnerability-in-tamale-northern-ghana.html).

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Notes:

(1) We are in the process of applying for funding for similar studies in South Africa, India and China.

(2) Two studies on ‘disability and poverty’ were carried out in 2006 by Grut and Ingstad in Yemen and Kenya, commissioned by the World Bank (Grut and Ingstad, 2006, 2007).

(3) They were in their teens and early twenties. They were all physically impaired, but not all were true orphans. Some had been abandoned and some had just left home.

(4) We thus made two teams consisting of one Norwegian and one Yemenite. After each day we would change partners. The Norwegians are both female, one anthropologist (BI) and one qualitatively oriented sociologist (LG). Our counterparts, Dr Arwa Bader and Dr Mahdi Nasser, are both medical doctors. Arwa is a pediatrician. We thank both of them for having contributed to this study. The responsibility for the content of this chapter rests solely on us as the authors, however.

(5) The Social Welfare Fund and The Disability Foundation Fund.