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Community based rehabilitation: a strategy for peace-building

William Boyce1*, Michael Koros2 and Jennifer Hodgson3

Author affiliations

1 Community Health and Epidemiology and Education, Queen's University, Kingston Ontario Canada, K7L 3N6

2 Canadian International Development Agency, Central & Eastern European Branch, Hull Ouebec, Canada, K1A 0G4

3 International Programs, Faculty of Arts & Science, Queen's University, Kingston Ontario Canada, K7L 3N6

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Citation and License

BMC International Health and Human Rights 2002, 2:6  doi:10.1186/1472-698X-2-6


The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1472-698X/2/6


Received:19 April 2002
Accepted:4 November 2002
Published:4 November 2002

© 2002 Boyce et al; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.

Abstract

Background

Certain features of peace-building distinguish it from peacekeeping, and make it an appropriate strategy in dealing with vertical conflict and low intensity conflict. However, some theorists suggest that attempts, through peace-building, to impose liberal values upon non-democratic cultures are misguided and lack an ethical basis.

Discussion

We have been investigating the peace-building properties of community based approaches to disability in a number of countries. This paper describes the practice and impact of peace-building through Community Based Rehabilitation (CBR) strategies in the context of armed conflict. The ethical basis for peace-building through practical community initiatives is explored. A number of benefits and challenges to using CBR strategies for peace-building purposes are identified.

Summary

During post-conflict reconstruction, disability is a powerful emotive lever that can be used to mobilize cooperation between factions. We suggest that civil society, in contrast to state-level intervention, has a valuable role in reducing the risks of conflict through community initiatives.

Background

Role of Civil Society in Peace-building

In the 1992 report

    Agenda For Peace
, the Secretary General of the United Nations defines peace-building as "action to identify and support structures which will tend to strengthen and solidify peace in order to avoid a relapse into conflict" [1]. Because this definition is extremely general, it has provoked tremendous interest and considerable discussion. For example, the Canadian Department of Foreign Affairs now defines peace-building as "a set of measures that create a sustainable infrastructure for human security". Furthermore, Foreign Affairs notes that "the concept of human security recognizes that human rights and fundamental freedoms, the rule of law, good governance, sustainable development, and social equity" are important elements of sustaining global peace [2].

However, these general definitions of peace-building require refinement, especially in relation to various forms of conflict that are endemic in the early twenty-first century. In the search for a term describing conflict which encompasses such diverse conditions as full-scale armed conflict, military occupation, and popular rebellion, it is helpful to use 'political violence', as described in the epidemiological work of Zwi and Ugalde [3][4]. These authors identify four major forms of political violence: structural, repressive, reactive, and combative. These forms of conflict describe situations of political violence varying from imposed societal inequities in resources and power (structural political violence), to the processes of militarization and war (combative political violence). The framework also includes informal forms of political violence by the state such as political assassinations, torture, disappearances, detention, and harassment (repressive political violence), as well as violence against the state in the form of coups d'etat, guerrilla warfare, and revolutionary force (reactive political violence).

With respect to these various forms of conflict, R. J. Fisher distinguishes peace-keeping from peace-building but does so in relation to another typology of conflict, either horizontal or vertical [5]. Fisher defines peace-keeping as "a dissociative approach in which a third party intervenes simply to keep the warring parties apart and maintain the absence of direct violence. This approach is appropriate in a horizontal conflict such as combative or reactive political violence, between equals who are relatively weak (because strong parties can be their own peace-keepers), but is not appropriate to vertical conflicts between un-equals because it freezes the status quo in a biased manner [6].

Thus, peace-keeping is not an appropriate strategy in vertical conflicts, structural or repressive political violence which "are highly resistant to de-escalation, in part because of a host of social-psychological processes, including cognitive rigidities and distortions, self-fulfilling prophecies, and irrational commitment mechanisms....Due to the complexities of such conflicts ... [there is] a set of interlocking ethnic, political, and economic factors in which no one issue can be resolved by itself" [7]. By far, the most common type of conflict in the world today is vertical in nature, involving 'low intensity conflict', which is "based in deep-seated racial, ethnic, and religious hatreds combined with structural cleavages and political oppression that result in the victimization of one or more groups through a denial of their fundamental needs" [8].

Fisher describes features of peace-building which distinguish it from peace-keeping, and suggests the appropriateness of peace-building strategies in dealing with vertical conflict and with the very nature of low intensity conflict. He states that peace-building is "an associative approach that attempts to create a structure of peace both within and among nations – a structure that removes the causes of war and provides alternatives to war. This structure involves relations among a large domain of several parties that are equitable, interdependent, include a variety of people and types of exchange, and have a supportive superstructure.... Peace-building thus requires a process of nonviolent social change toward equality" [9]. Therefore, in Fisher's view, peace-keeping keeps relatively balanced parties apart, while peace-building brings unbalanced parties together.

Multi-track diplomacy is a practice that includes peace-building and implies that, in addition to formal diplomatic efforts to resolve conflict, other methods are of value. The relevant external actors in peacekeeping activities are usually other national governments and multilateral agencies. External actors in peace-building efforts, on the other hand, may be from a broader base. The phrase 'Track Two diplomacy' was coined in 1982 by Montville [10] to describe activities occurring outside formal state-to-state, or Track One relations. The main objectives of Track Two diplomacy efforts are:

X to reduce or resolve conflict between groups or nations by improving communication, understanding, and relationships;

X to decrease tension, anger, fear, or misunderstanding by humanizing the 'face of the enemy' and giving people direct personal experience of one another; and

X to affect the thinking and action of Track One diplomacy by addressing root causes, feelings, and needs and by exploring diplomatic options without prejudice, thereby laying the groundwork for more formal negotiations, or for re-framing policies.

Indeed, the basic premise of Track Two diplomacy "is that the expertise for dealing successfully with conflict does not reside solely within government personnel or procedures" [11].

The importance of multi-track efforts to the success of formal peace agreements has been recognized by scholars such as Crocker & Hampson [12] whose study of five peace settlements (Cyprus, Namibia, Angola, El Salvador, and Cambodia), led to the distillation of several operational and strategic rules of the road, one of which is of particular relevance here. They assert that civil society is a key player in peace-building:

"Economic and social reconstruction is crucial to the success of the peace process. In addition to advancing human rights, third parties have a crucial role to play in rebuilding and reconstructing civil society for long-term peace and stability. There is a vital link between sturdy civic institutions, including the norms and networks of civic engagement, and the performance of representative government. Not only is civil society important to democracy, but it also has a significant role to play in consolidating the peace process in countries making the transition from war to peace. Because third parties often provide the necessary foundations for democratic institutions, international development agencies and non-governmental organizations have a pivotal contribution to make to the task of post-conflict rebuilding" [13].

Ball and Halevy [14] have suggested several peace-building activities that can be undertaken in support of a peace agreement:

X provide a sufficient level of internal security to enable economic activity to recover, to encourage refugees and internally displaced persons to re-establish themselves, and to persuade the business community to invest;

X strengthen the government's capacity to carry out key activities;

X assist the return of refugees and internally displaced persons;

X support the rejuvenation of household economies, especially by strengthening the smallholder agricultural sector;

X assist the recovery of communities, in part through projects that address social and economic infrastructure;

X rehabilitate physical infrastructure of crucial importance for economic revival, such as roads, and communication systems;

X remove land mines from major transport arteries, fields and other critical sites;

X stabilize the national currency and rehabilitate financial institutions; and

X promote national reconciliation.

Of course, these activities are part of traditional reconstruction efforts in many post-conflict countries. However, to achieve peace-building dividends, certain dynamics must be understood which can be illustrated by examining this strategy through an ethical perspective.

Discussion

The Ethics of Peace-building

There are a number of social relationships involved in the process of peace-building. The obvious relationship, which is the primary focus of peace-building, is the one between the opposing groups during periods of conflict. However, the peace-building process introduces a new set of relationships between the specific groups recovering from conflict situations, and the external observers of the conflict who participate in the peace-building process. It is commonly assumed that peace-building reflects humanitarian, honourable intentions in seeking to stop the violence and human rights abuses that occur during conflicts. But given the compromised state of post-conflict groups, there is significant risk that external intervention can have unforeseen, negative consequences. Two types of negative consequences from the efforts of peacemakers, -keepers, and -builders, as well as international development assistance agencies and their staff, have been identified in recent years through the development of peace and conflict impact assessment (PCIA) approaches. One set of negative consequences arises from the actions and approaches of individuals and organizations. The other set arises from the political instrumentalization of external resources and interventions by domestic political actors intent on resolving conflict through violence. The work of Mary Anderson and the Collaborative for Development Action Inc., has examined the former in considerable detail and at a micro-level in the "Local Capacities for Peace" project. Donor approaches to assessing the latter have been summarized in "Conflict Impact Assessment of EU Development Cooperation with ACP Countries: A Review of Literature and Practice", by Manuela Leonhardt. [15]. These potentially negative consequences provide the rationale for examining the ethics of peace-building interventions.

Canada's foreign policy objectives include the projection of Canadian values and culture. These values, which can be generally characterized as liberalistic, have also led Canadians to embrace multicultural ideals. The 1996 recommendations on Canadian Foreign Policy and International Peace-Building include a directive that:

The Canadian government should ensure that any peacekeeping/peace building interventions are based on promoting, protecting and reflecting Canadian values, including human rights, rule of law, and multicultural tolerance [16]. (emphasis ours)

Although this directive is intended to stress the importance of promoting respect for human rights and tolerance of multiculturalism in other societies, it also implies that Canadians highly value cultural integrity when engaging in international relationships.

Canada is not alone in this view. Liberal values that underpin human rights are reflected in international law, and have been espoused by a large number of countries, representing a large sector of the human population. Although liberal values may be largely Western in origin, they are assumed to rest on a fundamental respect for individual persons, a respect which is not only prevalent within a diversity of cultures, but also requires attention to multicultural rights. Thus, widespread acceptance of human rights policies should serve to discourage violent conflict and should provide a stable foundation for lasting peace. From an ethical perspective, it therefore becomes acceptable and beneficial to introduce and promote liberal values within post-conflict societies. Indeed, the 1996 'Policy Options for Post-Conflict Reconstruction' suggest that:

the democratic ideals of respect for human rights and free elections should be conceived of as a core component of Canadian reconstruction efforts and promoted regardless of a lack of local democratic traditions [17].

However, some liberal theorists suggest that attempts to impose liberal values upon non-democratic cultures are misguided. In cases where such cultures oppress their members,

the initial moral judgment is clear enough. From a liberal point of view, someone's rights are being unjustly denied by their own government. But what is not clear is the proper remedy, that is, what third party (if any) has the authority to intervene in order to force the government to respect those rights? [18]

International mechanisms for protecting human rights are not always acted upon (e.g., Srebrenica or Rwanda), and provide the basis for intervention to end those forms of conflict which rely upon human rights abuses. But this does not justify the imposition of liberal values on non-democratic cultures which refrain from blatant abuses. If the imposition of liberal values on stable, non-democratic cultures is unjustifiable, then the imposition of such values upon compromised groups involved in low intensity conflict may be viewed as equally unacceptable, as follows.

Low intensity conflicts not only destroy property and societies, but also result in immense human costs. People are wounded, disabled, or killed in violent conflict. Among the survivors, the psychological costs are immeasurable. The loss of loved ones, home, security, and a normal context for everyday living disables individuals, inhibiting their ability to interact with others. The strategic infliction of terror upon innocents further deprives them of their humanity. Rape, torture, and particularly the targeting of children, all serve to strip individuals of their confidence and their sense of self. The impact of low intensity conflict is long-term. Once an individual's own secure identity has been displaced, the process of rediscovering the self is necessarily long and difficult.

However, despite the degradation of human beings that occurs during low intensity conflict, these occurrences cannot be viewed as tragedies that fully obliterate societies. Many authors have criticised the fatalist 'apocalyptic view' of conflict, which mistakenly assumes that post-conflict development means rebuilding a society from nothing:

This approach has been criticised by those who maintain that armed violence is in practice continuous with normal social experience, suggesting that conflict does not necessarily correspond with social breakdown ... many communities are extremely practised at coping with adversity.... A lack of curiosity about sociological and cultural causality invites operational responses which are insensitive to local social and cultural conditions. Indeed, to intervene in an emergency by ignoring indigenous coping strategies is to increase civilian jeopardy. A prime aim of humanitarian operations should be to identify patterns of social resilience and vulnerability and reinforce local capacities rather than introduce foreign perceptions and foreign responses [19].

Respect for social and cultural integrity, then, is of the utmost importance in dealing with low intensity conflict situations, when cultural identity is perhaps all that is left to persons who are compromised by violent conflict.

Furthermore, Kymlicka suggests that the coercive imposition of alien liberal values is likely to fail: "Attempts to impose liberal principles by force are often perceived ... as a form of aggression or paternalistic colonialism" [20]. When attempts at liberalisation are perceived this way, members of non-democratic cultures are more likely to reject such values. Kymlicka suggests that liberal values can only take hold in a society when those values are internally embraced by members of that society. The key to the promotion of lasting values is to introduce those ideas gradually and to support internally-driven movements for liberalisation: "Since the most enduring forms of liberalization are those that result from internal reform, the primary focus for liberals outside the group should be to provide this sort of support" [21].

Thus, although Canadian foreign policy objectives include the projection of Canadian liberal values, these must be promoted with caution in post-conflict situations. The imposition of alien values upon individuals struggling to regain their own identity, independence, and confidence may cause unintended harm by inhibiting authentic cultural identities. Peace-building strategies should provide compromised individuals and groups with an opportunity to rediscover their identities and situate themselves in a context of peace. The opportunity for rediscovery of self is essential if any peace is to be lasting. Individuals who are compromised and threatened cannot enter into the process of building healthy, trusting relationships that are necessary for a society to engage in sustainable, peaceful relations.

Given these reflections on the morality of promoting Canadian liberal values abroad, it is not surprising that the 1996 Canadian Foreign Policy and International Peace Building consultations yielded the following recommendation:

Democratization should be the primary goal of Canadian peace-building initiatives. At the centre of this lies the importance of the reconstruction of civil society as a means of fostering indigenous democratic elements. Strengthening the social/economic sphere can create a political space for civil society to develop, and can help democratic development that reflects local values and history [22] (emphasis ours).

This recommendation recognises the need to respect the cultural integrity of post-conflict groups, while at the same time supporting internal liberalisation. The question, then, is how to promote liberal values in post-conflict situations, without taking advantage of the compromised position of those individuals and groups who are trying to rebuild their lives.

The successful promotion of such values requires an approach which is both respectful of other cultures, and which allows others to appreciate the benefits of incorporating liberal practices within their society. J.P. Lederach [23] suggests that a dialectical approach to the practice of mediation, which he terms an 'elicitive model', may be useful. Rather than imposing alien standards in resolving conflict, the elicitive model seeks to discover and solidify the resources that exist in a specific post-conflict context. There are several reasons to recommend this elicitive model as a peace-building approach. By empowering individuals to speak for their own cultural traditions, it allows a voice to under-represented or oppressed groups. And in seeking resources within the specific contexts in which it is applied, it also demonstrates respect for the value and integrity of the culture.

However, mediation alone is not sufficient to achieve sustainable peace. The elicitive model of mediation necessarily focuses on past conflict and recalls the essential differences that initially triggered unrest. Peace-building strategies should also incorporate approaches that are forward thinking, and that demonstrate the common values shared by those affected by conflict. Some key perspectives must be shared by both sides, yet each group needs to comprehend the unique perspectives of the other in their own cultural context. This expansion of self is what philosopher and political theorist Charles Taylor refers to as a 'fusion of horizons':

we learn to move in a broader horizon, within which what we have formerly taken for granted as the background to valuation can be situated as one possibility alongside the different background of the formerly unfamiliar culture. The 'fusion of horizons' operates through our developing new vocabularies of comparison, by means of which we can articulate these contrasts [24].

It is only through such a fusion that we can truly begin to appreciate the value of other perspectives. The ideal peace-building approach will enable this fusion of horizons to occur between opposed groups, as well as between the victims of conflict and peace-builders.

There are a number of frameworks, methods, tools and processes being used by a variety of development actors to achieve and monitor such peace-building strategies [25,26]. These tools are used at the formulation, monitoring and evaluation stages in the programme cycle of humanitarian, reconstruction, and traditional development interventions [15]. Following upon the path-breaking work of Kenneth Bush [27] in this area, donors and other development actors recognize that their interventions are not conflict neutral and are seeking ways of increasing the conflict-sensitivity of their activities in operationally feasible ways.

Community Based Rehabilitation Approaches to Peace-building

We now turn to an examination of the particular strategies and benefits that community based approaches to peace-building can entail. Perhaps the most common human security concern during conflict is that of basic health, upon which life depends. Many practical examples of peace-building can be found in the health sector [28]. 'Days of Tranquility' and 'Corridors of Peace' agreements have been negotiated by UNICEF (United Nations Children's Fund) and other agencies, including the International Committee of the Red Cross, the World Health Organization, and various ministries of health, churches and non-governmental organizations. These agreements are designed to allow activities such as immunization programs and the distribution of relief supplies during special ceasefires, demonstrating the common concern of belligerents for the health of children. Strategies that channel such assistance through community based health organizations have been used in Afghanistan, El Salvador, Lebanon, Sudan and Iraq. Interestingly, the focus of many efforts has been on prevention of childhood disability caused by polio. Disability is a powerful emotive lever that can be used to mobilize cooperation between factions. Consequently, we have been investigating the peace-building properties of community based approaches to disability in a number of countries.

We use the general term disablement to include impairment, disability, and handicap, which vary during different stages of conflict - from instability to conflict to reconstruction. For example, impairments incurred during overt conflict may include peripheral nerve injuries caused by bullet or shrapnel wounds; hand, foot, facial injuries, or blindness caused by explosions or torture; and head, chest, and orthopaedic injuries caused by collapse of buildings. After hostilities cease, civilians may continue to suffer impairments, such as amputations and blindness due to land mines. These impairment problems result in needs for specific clinical programs such as surgery and prosthetics.

Disabilities, or functional problems, which can occur during overt conflict may include being weak, unable to see, and unable to protect oneself during armed attack. At later post-conflict stages, being unable to rapidly respond to curfew, and being unable to look after basic hygiene and self-care may become problems. These functional problems result in needs for specific rehabilitation programs such as muscle strengthening, mobility training, vocational retraining, and provision of adaptive devices.

Handicaps, or social responses to disablement, that are experienced by persons with disabilities during times of active conflict often include being unable to safely earn a living. In post-conflict situations, one may also be stigmatized as a disabled veteran. These social problems result in needs for specific community based programs such as public education, income generation projects, accessibility modifications, and peer support programs.

Community Based Rehabilitation (CBR) is a response, in both developed and developing countries, to the need for adequate and appropriate rehabilitation services to be available to a greater proportion of the population with disabilities. The World Health Organization Expert Committee on Rehabilitation has defined CBR as an approach that involves, utilizes, and builds on existing resources in disabled persons themselves, their families, and communities [29].

CBR can be contrasted with institutionally-based and outreach rehabilitation services. In CBR, there is a large-scale transfer of knowledge about disabilities and rehabilitation skills to people with disabilities, their families, and members of the community, such that resources become available at the community level and rehabilitation is 'democratized' [30]. Such democratization and access to the resource provided by technical rehabilitation knowledge and skills are important principles, with obvious links to the peace-building process.

On a practical level, CBR programs aim to rehabilitate and train individuals with disabilities, as well as to find ways to integrate them into their communities. In effective CBR programs, persons with disabilities, their families, the community, and health professionals collaborate to provide non-institutional services in an environment where services for persons with disabilities are seriously limited or totally absent. The essential feature of CBR is its focus on the processes supporting partnership of diverse groups and community participation. CBR programs assist local people to develop sustainable processes and systems that: deliver clinical services in remote areas; train personnel; promote Disabled Peoples' Organizations; plan, manage and coordinate local services; and provide appropriate technology. In areas of armed conflict, CBR programs typically aim to work with other agencies that are active in emergency aid and re-construction, which are often the only functioning organizations in the area.

Introducing rehabilitation services at a local or community level removes many obstacles to care that are associated with traditional institutional care. The difficulty of travel for persons with disabilities, and its expense, are eliminated or reduced to a minimum. The individual is not isolated from the community. Family members and community volunteers are part of the rehabilitative process. Community members can see what the person with a disability is achieving. This transparency to rehabilitation can help integrate the person into the community, a community that can then value the unique contribution that the person is able to make.

It has often been stated that there is no blueprint for a CBR project [31]. Approaches to the implementation of CBR are context-specific, and are determined by the diversity of social and demographic factors that are present in the community [32]. This is because countries, regions, and communities vary enormously with respect to their administrative structures, economic and cultural conditions, population distribution, and financial and workforce resources. Each of these factors must direct the nature of the approach to rehabilitation, if the program is to be indeed 'community-based'. Nonetheless, drawing upon an emerging consensus in this field, a useful framework has been formed of what can be considered 'key elements' of CBR [33].

In many countries, circumstances of conflict complicate the development of these key elements [35-37]. Experience in a number of situations of armed conflict (Central America, Bosnia, Afghanistan, Sri Lanka) suggests that CBR has a constructive role to play in peace-building. As a preventive and post-conflict peace-building strategy, CBR operates in several of the areas mentioned by Ball and Halevy as important for civil society initiatives and it can make important contributions to economic and social reconstruction [38]. However, adapting CBR programs so that these contribute to the process of peace-building, and do not have unintended negative consequences, is crucial [39]. The following describes some common ways of adapting the key elements of CBR programs to increase their peace-building impact.

The 'Promotion of Positive Community Attitudes and Behaviours towards Disability' usually involves de-stigmatizing persons with disabilities, often through promoting positive role models. CBR approaches have facilitated the integration into schools of disabled refugee children and supported alternatives to institutions for disabled, displaced, and orphaned children in Sri Lanka. In Palestine, program personnel from a variety of health and social development agencies have been encouraged to avoid preferential treatment of persons injured in the Intifada. This strategy has helped to reduce inequities between injured combatants and civilians and has led to gains for all persons with disabilities that previously had been difficult to achieve. Legislative and bureaucratic measures that include persons with disabilities in public services have also become symbols of equality in Palestine [40,41].

The 'Empowerment of Persons with Disabilities enabling Integration within Society' can be achieved directly by disabled persons' organizations, but preferably by those with experience in politically dynamic situations. In Cambodia, Afghanistan, Mozambique, and Lebanon, members of Disabled Peoples' International consult to national disability organizations to improve their abilities to develop self-help programs and also conduct advocacy with their governments to improve local rehabilitation efforts. Fora have been organized in these post-conflict societies for persons with disabilities and the public to discuss the needs of disabled persons. Organizations from different political factions in Afghanistan and El Salvador have been linked by disability organizations in common causes, such as International Disability Day on December 3. In contrast to the Palestinian example above that had to contend with traditionally negative attitudes towards disability, this strategy has utilized conflict-injured persons' status and visibility as victims of war to achieve benefits for all other disabled persons.

'Knowledge and Skills Transfer to Promote Self-help Skills' is a fundamental principle of CBR. Standard CBR training focuses on problems such as child developmental disabilities, polio, blindness, and stroke. CBR training modules for low intensity conflict areas must instead focus on major traumatic musculo-skeletal impairments from head injuries, multiple fractures, peripheral nerve injuries caused by projectiles, traumatic amputations from landmines, and torture injuries. In Sri Lanka, joint training in CBR skills for both Sinhalese military and Tamil community groups exposed these different factions to commonalities of the disability experience and promoted mutual assistance between the groups. Such cooperative training can be only achieved during specific windows of opportunity and must be acted upon quickly before separate rehabilitation services are established for different groups, which then become difficult to reconcile.

'Development of Rehabilitation Services/Resources Based upon Needs Identified by Persons with Disabilities and their Families' often involves conducting a disability prevalence survey and detailed needs assessment. However, CBR programs in conflict areas must prioritize action over lengthy planning processes if they are to have a peace-building impact. Rapid community-based assessment and evaluation methods for physical disability and psychosocial trauma have been developed to assess needs as well as local response capacities [42]. Such rapid disability assessment teams are necessary for responding quickly in emerging war zones such as Central Africa, as well as in large-scale disasters such as earthquakes.

'Community Decision-making, Implementation, and Accountability to the Community' are routine in CBR. However, in post-conflict societies, communities are often divided. In Sri Lanka, community reconstruction in conflict areas has addressed disability access problems, but has also occasionally required relocation of valued public services such as transportation and recreation facilities. Such relocation has to be done with particular sensitivity or there is a risk of increasing tensions within communities that are still suspicious of each other [43].

'Partnership and Cooperation among Persons with Disabilities, their Families, the Community, and Rehabilitation Personnel' is a core practice in CBR and involves training local rehabilitation workers (using a 'Training of Trainers' model), developing appropriate technology, and building peer support networks. This type of cooperation has been extended to include national groups that were previously in conflict. For example, in southern Africa inter-country disability programmes have brought together former political adversaries for policy, sports, and cultural exchanges and have demonstrated possibilities for reconciliation [44].

'Development of Rehabilitation Technology Utilizing Local Skills and Materials' ensures long term CBR sustainability. In areas of low intensity conflict, local technical support persons (e.g., carpenters, welders) can be sought out for assistance prior to training new technicians or developing new orthopaedic workshops that may exclude local capacities. This approach has been used to reinforce support for local community economic development by disability organizations in Angola. Emigrants from countries in conflict can also be mobilized in their new homes to donate rehabilitation equipment, prosthetics, and orthotic supplies.

'Co-ordination with, and Referral to, a Network of Specialized Interventions, Including Institutions, to Provide Professional and Technical Support and Training which may be Unavailable within the Community' ensures that disabled persons in the community are supported by other technical agencies. In areas of conflict, national development programs (for example, primary health care, food and agriculture, rural and urban re-construction) can be integrated with CBR programs so that the needs of persons with disabilities, including ex-combatants, are considered and there is less chance of exclusion. In Afghanistan, disabled persons' organizations have been linked to such national reconstruction planning [45]. Finally, organizing national and regional conferences for CBR information dissemination, networking, and strategic planning can demonstrate the benefits of a multi-sectoral approach to national planners as they gain insight into the complex interaction between disability, education, and employment.

Those who choose to wage war have only one remaining relation of interdependence, and that is the objective of mutual destruction – in a sense, the very negation of that remaining relation. To achieve peace, this one negative relation of interdependence must be transformed into several positive relations of interdependence on the cultural, economic, social and productive planes. While a focus only on CBR for developing such relations of interdependence is clearly insufficient, it is a remarkably useful starting point.

CBR, because of its focus on supportive community processes, on the value of diversity, and on universal access to the means needed to lead a fulfilling life, is a very positive means of re-founding relations of interdependence on a basis that can promote peaceful conflict mediation and resolution. Where disability is the consequence of violent armed conflict, CBR strategies that highlight persons with disabilities provide the traumatized society with an opportunity to perceive the actual human result of the conflict. A tangible and direct consequence of doing this is to create the means whereby those who were engaged in, or affected by, violent conflict as combatants or as civilians come to grips with the need to (re-)integrate persons with disabilities as part of the psychological healing of the population at large. Rather than focusing on divisive issues, CBR is a positive, forward-thinking approach that may contribute to peace-building.

In terms of foreign policy agendas of donor countries, a CBR focus on integration of persons with disabilities promotes liberal values and human rights. Since low intensity conflicts cause disability in individuals, and in seeking to move forward from periods of conflict, the need to redress the harm done to individuals and families during this conflict is clear. Rather than imposing liberal values in a vacuum, CBR introduces them by example in a clear, accessible, and tangible manner. Persons from non-democratic cultures are more likely to internalize liberal values when they are embodied in social phenomena and processes to which they are exposed every day [46].

While CBR focuses on the needs of individual persons with disabilities, it also recognises the need for integration within a broad, stable social context. This social context casts a wide net: persons with disabilities live in family and neighbourhood contexts, work in professional contexts, and belong to religious or spiritual groups. In providing greater visibility of persons with disabilities, CBR touches people in all of these contexts and promotes liberal values in a non-invasive manner. Although CBR appears to have a limited focus, its arena for the promotion of liberal values is great because it highlights what can be done by those who have suffered the greatest losses.

CBR promotes liberal values and contributes to peace-building because it works toward the 'fusion of horizons' prescribed by Taylor [47]. In identifying and making use of local resources and capacities, CBR enters post-conflict situations with an implicit assumption of the value and abilities of other cultures, and a fundamental respect for persons and their cultural integrity. In working to establish self-sufficient programmes, CBR brings expertise and humanitarian values to a context where they are wanted and welcomed. It can lend confidence to groups whose self-assurance and identity have been critically compromised during periods of violent conflict. In building effective local programmes, CBR efforts must engage in the inter-cultural dialogue that leads to Taylor's fusion of horizons. Thus, CBR offers the additional benefits of establishing open and trusting dialogue that can aid in resolving conflicts and discourage future violence.

Summary

In summary, several key benefits result from the integration of disability issues and CBR strategies into the peace-building process:

1. The immediate impact of CBR intervention with a critical vulnerable group, whose immediate human security is in jeopardy, is significant. This early humanitarian response demonstrates compassion and may be viewed as both symbolic and tangible catharses to warring factions, to donor agencies, and to civilian victims of conflict. Local visibility is achieved in the early stages of CBR intervention because local capacity and domestic resources must, by the very nature of the intervention, be employed to a significant degree. Furthermore, CBR can alleviate poverty in families in which a member is disabled, as well as minimize the social costs that accrue to long term disability.

2. The process of implementing a CBR focus on disability, a strategy which by definition attempts to transcend gender, cultural, social class, religious, and political divisions, contributes to de-legitimizing politics and conflict which draw their legitimacy from the exclusion of human beings on the basis of these characteristics. CBR, addressing an emotive issue held in common, can diminish perceived barriers between disparate groups, thereby decreasing the legitimacy of exclusionist political rhetoric.

3. CBR, as one element of humanitarian intervention and multi-track peace building, diplomacy and conflict resolution, can provide examples of solutions to the problems which complex emergencies present in organizational and management terms. CBR promotes a multi-sectoral approach to problems that require interaction and negotiations. This interaction can alter the disposition of key managers who control the health and social service infrastructure, by increasing their propensity to view local cooperative non-hierarchical action as effective and worthwhile to support.

4. Conflict can create opportunities to re-establish the philosophy and basis for social service and economic reconstruction. CBR, due to its focus on both personal change and social adaptation through community based strategies, demonstrates opportunities for health, social, and economic reform in a non-contentious arena. This opportunity can create community capacity and awareness of the organizational forms and relationships required to address the interacting causes of poverty and disability. It can also heighten the expectation in local communities that they be consulted in the design of longer term social reconstruction and development projects [48].

CBR addresses an extreme form of vulnerability. If public services and support can reach the most vulnerable in society, especially in difficult circumstances such as low intensity conflict, then processes, systems and relationships are established whereby lesser forms of vulnerability and their social impacts may also be addressed. The impact of CBR may be enhanced as a peace-building activity if it works in a complementary manner with other community based initiatives. For example, community based delivery of rehabilitation services in conflict zones can have a major influence on the reconstruction and further development of the health care sector, and often with significant economic benefits through increased local employment. CBR may also be a basis for extension of community based service delivery because of its multi-disciplinary nature. More research is required about the benefits to peace-building associated with various types of community level public health and social development interventions. These interventions may include water, sanitation, agriculture, and income-generating projects such as extension of credit and appropriate technology to excluded groups. All these types of projects can have community based approaches and this knowledge base needs to be tapped so that peace-building as a process, and as a Canadian foreign policy initiative, is robust and multi-sectoral, drawing on the extensive experience of our development and humanitarian assistance agencies.

To this end, it would be extremely helpful if peace and conflict impact assessments (PCIA) of CBR interventions could be conducted as part of ongoing research and development of both CBR and PCIA. It is clear from early research on PCIA that, like CBR, it is context specific, and while some broad guidelines and indicators regarding conflict and peace impacts can be elaborated, tailoring these to specific settings is essential [15]. Above, we have discussed CBR and peace-building in general terms, and related specific CBR experiences familiar to the authors to ethical thinking about liberalism and to current Canadian foreign policy. Further cumulative reflection on, and distillation of, lessons learned from CBR interventions in relation to peace and conflict impacts is necessary. This could provide the basis for eventually understanding the relative impacts on peace-building of CBR and other interventions aimed at providing community based social support services in a non-discriminatory manner in countries characterised by latent or overt low-intensity vertical conflict, and accompanied by structural and repressive political violence.

Competing interests

None declared.

Authors' Contributions

WB conceptualized the paper and drafted the manuscript, particularly regarding the application of CBR to peace-building. MK conceptualized the paper and drafted the section on the role of civil society in peace-building. JH drafted the section on ethics of peace-building. All authors read and approved the final manuscript.

Acknowledgements

The authors acknowledge the assistance of Emily Boyce and Diane Davies in the preparation of this manuscript.

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Pre-publication history

The pre-publication history for this paper can be accessed here:

http://www.biomedcentral.com/1472-698X/2/6/prepub