A community of citizens: disability rehabilitation in the Palestinian transition to statehood.
OBJECTIVE
It has been widely argued that community based programmes offer considerable advantages to the classical institutional forms of health and rehabilitation services delivery. With about 10 years of experience in operating community based rehabilitation projects (CBR) for the disabled, the Palestinian experience points to potentially serious problems relating to the conception and operationalization of such programmes in real life situations.


OBJECTIVE
Of importance is the issue of the impact of communal care on the already burdened lives of women, especially when such care is expected to be voluntary in nature. Caretaking in the Palestinian context, especially of the disabled, elderly and the sick, is a pre-defined sex linked role dictated by a patriarchal society and system of policy making that excludes women from economic and social life. The voluntary care aspect entailed in the CBR conception and practice, can and does contribute further to the exclusion of women not only from the labour force, but from most other aspects of life as well. This represents an apparent contradiction between the needs of two excluded groups, the disabled and women. The other problematic entailed in the communal model of caring for the disabled is the strategic and operational bias focusing on community, to the exclusion of the notion of social rights of all citizens, and the role and duty of state structures in the fulfilment of the disabled basic needs. Such an approach can only relegate the disabled rights back to their original place as charity. On the other hand, when CBR projects are operated holistically, in the context of social movements existing within power relation and with a broader democratic agenda engaging different groups-including a disability movement-as is currently taking place in Palestine, CBR projects can also turn into a mobilizing force for the social rights of all excluded groups.


CONCLUSIONS
Thus the question is not merely one of governmental involvement as opposed to the involvement of non-governmental organizations and charitable societies in community based projects. Rather, it is a question of the right to a decent life for all, in dignity and security, that citizenship and statehood promise, but have yet to deliver in many developing countries, especially in Palestine.
Giacaman
R
R
Institute of Community and Public Health, Birzeit University, Palestine. rita@birzeit.edu
D018912:Arabs; D001294:Attitude to Health / Q000208:ethnology*; D017028:Caregivers; D002961:Civil Rights / Q000639:trends; D003153:Community Health Services / Q000458:organization & administration*; D003256:Community Participation; D003255:Consumer Organizations; D017281:Cost of Illness; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005260:Female; D005783:Gender Identity; D018166:Health Care Reform; D006801:Humans; D007557:Israel; D008297:Male; D017063:Outcome Assessment, Health Care; D012923:Social Class; D012935:Social Justice / Q000639:trends; D014838:Volunteers; D014931:Women, Working / Q000145:classification; D000078329:Workforce