Volume 3, #6
January 12, 2004

Morning Session

Commenced: 10:19 AM
Adjourned: 1:03 PM

Canada reported that the small group made good progress on the issue of self-determination and the right to be different and made some recommendations on text that should be inserted to the corresponding articles. 1) Add to text on right to be different "dignity, individual autonomy, including the freedom to make one's own choices, and independence of persons". Also add footnote stating the opinion of one delegation that this concept of individual autonomy includes the freedom to determine one's own life. 2) Add to text on self-determination ? "respect for difference and acceptance of disability as part of human diversity and humanity". Canada noted that some delegations requested that a new fundamental principle on equality of opportunity for disabled persons be added to Article 2 and that text on this will be circulated later in the day.

ACCESSIBILITY, RIGHT TO MOBILITY, RIGHT TO UNIVERSAL/INCLUSIVE DESIGN

InterAmerican Institute on Disability - Articles 21, 22, 28 are linked but should not be combined into a single article. On accessibility, the world is not fully accessible to people with disabilities and this inhibits the rights to free movement and other rights. For example, the delegate's hotel is accessible, but only through a side entrance which is not always open. Thus, his freedom of movement is restricted and is dependent on other people to provide assistance when this door is not open. Lack of physical accessibility and transportation services not only inhibit civil rights but also limit the exercise of social rights such as health, education and employment. Decision-makers who affect the built environment and transportation services need to be made aware of accessibility needs. They must consult PWD and their organizations on this. Buildings and transportation services need to be completely accessible according to international standards or norms, which States would have to incorporate in national legislation. Another concept that must be included in these international standards is that of universal design, applying to equipment, services, software and hardware. Universal design will benefit not only PWD but others as well. Convention should also include a point on technical assistance, which is especially important in developing world. IID suggested adding the following text: "the provision of technical assistance for mobilization and communication for those who cannot acquire it by their own means."

The Coordinator noted that he perceived, from previous discussions, a general view that the three articles should be separate, though they are linked thematically.

Thailand noted that accessibility is a means to fulfil existing rights. For example, accessibility of the built environment is necessary to fulfil the right of freedom of movement and accessible communications is necessary to fulfil the right to freedom of information. However, these issues sometimes cross over: for some impairment groups, access to information is necessary also for freedom of movement. Therefore, we should first look at the overlap between accessibility and the rights it affects. This is addressed somewhat in article 15 (freedom of expression), but needs to be elaborated upon. Then, we have to make the link between access to the built environment in the provision on freedom of movement. These concepts should be considered State obligations.

Canada stated that it is comfortable having three separate articles for the three subjects. Regarding accessibility, Canada is comfortable with the text as written as basis for further discussion, but offered a caveat about listing items as such lists can never be exhaustive and the list itself often becomes the focus instead of the right. The delegate suggested adding language to indicate that the list is not intended to be exhaustive. Canada supports the suggestion by Thailand regarding framing the right to mobility as the right to freedom of movement. Canada expressed concern about the language in the chapeau of Article 22 requiring States to take "all necessary measures", because of the later requirement that States provide mobility aids, etc. at "no or low cost". There is a need to adjust the level of prescriptiveness when dealing with cost issues. This could be done either by generalizing sub-item b., regarding how States are to make these aids available, or adjusting the text in chapeau to make it less obligatory. Regarding universal design as it relates to obligations in the private sector, it seems more appropriate to frame this in terms of encouragement and awareness raising [by governments] than as a requirement for compliance by the private sector.

Jamaica stated that it would like to see accessibility, mobility, and universal design linked to the concept of international cooperation. To achieve these goals in developing countries there will need to be outside support and, indeed, outside support is already involved. For example, in Jamaica, the EU is currently involved in road building, which should be done accessibly. Therefore, international cooperation is intimately linked to accessibility, mobility and universal design and should be considered in negotiations for this kind of development aid.

World Federation of the Deaf suggested that, given this discussion, there may be a need to revisit some other issues already covered as they relate to accessibility. In the article on accessibility, it is important to mention interpretive services in 21(f). The current narrow view of accessibility needs to be broadened as accessibility does relate to other issues such as participation in political life, legal issues, etc. Regarding universal design, WFD is satisfied with the text except that it would like to see accessibility in the area of information society included as well.

Uganda noted that Article 21 should mention the goal of a barrier free environment, which is an important objective in this convention. The requirement for only for public buildings to be access Article 1(c), is limiting and the requirement for the private sector to achieve a barrier free environment should be strengthened. Regarding accessibility in the broader sense, the concept of access to opportunity, especially in terms of business opportunity (access to bank loans and financial credit) should be incorporated. There could even be a new article providing for states to ensure that PWD are afforded opportunity for economic empowerment. On the question of provision of mobility aids, the requirement should be at "no cost or affordable" instead of "no or low cost". "Low cost" is too subjective internationally. With respect to rehabilitation and health, sensitizing health care workers/givers to the needs of PWD should also be included. The Convention should also include a provision on interventions to prevent or minimize disability in children.

South Africa stated that it feels very strongly about the right to accessibility but that items included in Chairs draft referring mobility would be more appropriate in article 23 on health and rehabilitiation and certain other items should be moved to the section on right to information and communication. The right to mobility as stated cannot be provided as a right. The State can provide mobility aids, but not mobility, per se. Regarding Article 22 on the built environment, this should be addressed under an article on the right to live independently or under the auspices of universal design. The provision of assistive devices, such as wheelchairs and hearing aids, belongs in the domain of health and rehabilitation. However, Braille, computer aids, etc. belongs under access to information and communication. South Africa would support article 21 if it is extended to include other forms of access (personal assistants, interpretive services). South Africa noted that the principle of universal design is a means to an end, and should thus be dealt with in article on general provisions. Finally, the issue of reduction of tariff taxes should be included as these create major barriers to access.

DPI noted that accessibility has not been addressed in other human rights treaties. It is not clear from Chair's text how the right to accessibility is linked to other rights such as freedom of movement and the right to educational opportunities. The article on accessibility should ensure access to both the built environment and information.

The Republic of Korea supported the separation of access and mobility into two separate articles. This section should also address issue of the extra costs created by disability, which create hardships for PWD. Article 22 has some wording issues, related to financial costs that need to be solved.

The World Federation of the Deaf-Blind noted that universal design is the key starting place for ensuring accessibility. Even with all of the new technological developments, deaf-blind persons do not have access to most devices from computers to kitchen appliances. With this in mind, universal design should be mentioned before accessibility. WFDB concurred with WFD that interpretive services should added to 21(f) and also called for the addition of the concept of guide services in Article 22 on mobility. The delegate articulated the unique struggle of the deaf-blind who are living in a society built for seeing and hearing people. Besides being inaccessible, it is often also unsafe and, as a result, leads to deaf-blind persons being isolated in their homes.

The European Disability Forum noted that accessibility can not be enforced through a voluntary approach and that the chapeau of article 21 is too weak to ensure compliance. There is a need not only for international standards on accessibility, but also legislation on to enforce those standards. Although we cannot change existing problems overnight we can prevent the establishment of new barriers - which is also more cost-effective than retrofitting poorly designed and inaccessible structures. This needs to apply to both public and the private sector. In addition, there should be a provision for ensuring that States eliminate existing barriers in a reasonable time frame. Building on Canada's point regarding Article 28 that States should encourage the private sector to promote universal design, EDF noted that the Canadian and American models on public authorities' use of procurement policies is a helpful model for promoting accessible design. The article on accessibility should also be linked to the concept of international cooperation in order to end the practice of using international development/corporation funds for inaccessible structures and programs.

Landmine Survivors Network proposed that "with the greatest independence" be added after "necessary measures" in the chapeau of article 22 in order to reinforce the concept of autonomy. LSN proposed that 22(c) be transferred to the section on access to facilities because it pertains to the outside environment, while mobility issues should be person-centered. Regarding the South African comment, the right to freedom of movement is generally considered a negative right (as reflected in Article 12 of the ICCPR which relates to the obligation of a State to not interfere with a person's free movement within a country or outside a country). The right to mobility, as in the Chair's text, is a positive right in the sense that it requires States to take action to guarantee a person's right to mobility.

Lebanon noted that encouraging the private sector is not enough to ensure accessibility and, to this end, proposed the addition to 21(c) of "and given specific incentives" after the word "encouraged". Because society tends to think only of physically disabled people with regard to accessibility, the chapeau of Article 21 should directly acknowledge diversity of disability by incorporating after the phrase "in all aspects of life" the words "and addressing all kinds of disabilities" or other language to guarantee non-discrimination between disabled people themselves. Lebanon supported Ireland's view that the Article 21 be clarified as a non-exhaustive list and also supported EDF that the issue of cost had to be addressed in Article 22, and to this end, suggested retaining "low or no cost".

Thailand noted that the matter of accessibility is not addressed in existing human rights instruments and should be addressed as a disability-specific issue. Thailand proposed that the following new paragraph 3 be added to Article 21: "States shall promulgate legislation to ensure and promote accessibility through the use of universal design, assistive technologies, and all other necessary means."

The World Blind Union affirmed the need to widen the text to accommodate more groups of PWD than is reflected in the Chair's text. The issue of access to information for the blind, deaf, deaf-blind and should be reflected in the text. WBU proposed merging Articles 22 and 28 here. Universal design should be included before accessibility in the structure of the Convention. The WBU stated its support for the proposals to add the words "all kinds of disability" and to retain the words "no or low cost".

Serbia and Montenegro supported Canada and Thailand regarding accessibility as a means and not a right. Accessibility is a means to fulfil the rights to freedom of expression and movement. Reference to mobility aids would be more appropriate in article on health and rehabilitation than in the article on mobility. Paragrapsh 1(c) of article 21 should be broadened to allow that all buildings meant for public use, not just public buildings, should be accessible, which would be enforced through legislative measures. Interpretive and guide services should be included in article 21 and 22, respectively.

Slovenia commented that Articles 15, 21, 22, 28 were different sides of the same issue of accessibility and referenced the need for centers of excellence to support efforts to provide accessibility.

Morocco noted that accessibility is in the same area as non-discrimination, with a goal to ensuring that PWD are afforded the same opportunities of access to all services. The principle of sign language should be included in Article 21 by encouraging States Parties to work together to make sign language universal. Some work has already been done on this by the League of Arab States but more needs to be done to develop a universal sign language.

Inclusion International emphasized the need for access to information in an easy to read/understand format for people with intellectual disabilities and indicated its support for the WBU, WFD, and WFDB with regard to the need for the article on accessibility to address the specific needs of people with sensory disabilities. Forms of sign language used by people with intellectual disabilities should also be encouraged.

The Republic of Korea emphasized the need to accelerate research and development in accessible technology and proposed the addition of wording to Article 21 encouraging governments to give preference to accessible items and technologies and thus encourage their development.

The World Network of Users and Survivors of Psychiatry supported Inclusion International on the point that universal design means that services should be provided in easy to understand and easy to read formats. A similar kind of accessibility would also benefit people with psycho-social disabilities as well as the general population, this wide impact being one of the great benefits of universal design. WNUSP supported Uganda's point of accessibility perhaps going beyond the physical and information environments and encompassing economic opportunities for PWD. This may not seem like the appropriate place to discuss that but it does not clearly fit in the right to work or any of the other articles. For people with psycho-social disabilities, the right to have economic opportunities is very important in both developed and developing countries. With regard to freedom of mobility and movement, both the positive and negative components need to be addressed: the positive component of providing aides, assistive devices, etc. as well as the negative component of preventing States from interfering with the right of PWD to go where they choose, to leave their homes, etc. which touches on right of liberty and freedom of movement. States also have the obligation to ensure that private actors, such as families, do not interfere with these rights.

The World Federation of the Deaf supported the Inclusion Internationa point regarding the use of signs by people with intellectual disabilities as a method of support to communication. The need for access to information cannot be overstated. Even in this situation here, there is a need for sign language interpretation, real time captioning, etc. and there is no system to do this without using interpreters. Morocco's point regarding the idea of universal sign language is appreciated, but this has never been successful and will not work. The convention should guarantee the right to use one's own national language by using the term "national sign languages" (in the plural to cover countries that may have more than one sign language just as many have more than one spoken language.)

The Coordinator noted the number of comments on structure of the convention and on specific articles and recommended that substance and content are a higher priority for the moment. There may, in fact, not be adequate time to address the structural issues, especially in terms of shifting topics from one article to another, although there will be some opportunity to discuss structure at the end of week. WNUSP and Uganda had referred to economic opportunity which is not dealt with in the Chair's draft. It might be best to look at that topic in through a broadening of the article on the right to work to encompass elements beyond simply the right for people to work for someone else.

RIGHT TO EDUCATION

Ireland commented that this article is very focused on the right to education of children with disabilities and may be more appropriately dealt with under the other heading of children with disabilities. It is only the last paragraph that deals with more general issue of people with disabilities who are not children. This should be looked at further. There seems to be slight terminology problem in the last paragraph where it talks about "right to equal access.. on the basis of equality". The difference between these two ideas is not defined and the reason for including of both in the same sentence is unclear. Regarding the first paragraph of the article, note the inconsistency of language in the definition of right to education from article 13 (ICESR). The Chair's draft refers to the full development of the human potential while the ICESR refers to the development of the human personality. This kind of difference tends to lead to endless discussion regarding the meaning and content of the right. If it is our intention to re-define rights, we should know what we are doing.

Japan said that the general exchange between PWD and persons without disabilities should be promoted in the article. It is important to give children maximum opportunities to education, to provide children with disabilities the opportunity to develop their full potential. If all children are required to study in a general education setting, this can be counterproductive to fully meet their needs. What is most important is to guarantee compulsory education for all children with disabilities. We should address the need for flexibility and variety in curriculum and character of schools to ensure this maximum access. A general school system is not necessarily the only answer. Japan therefore called for the deletion of the clause "aimed at preparing students in general education system" in paragraph 2.

The Coordinator reminded the group of the relevance of Article 29 of the CRC, in particular, 1(a), which states that "States Parties agree that the education of the child shall be directed to the development of the child's personality, talents and mental and physical abilities to their fullest potential."

Thailand said that the paragraph 3 in the Chair's draft favored one model of education over another and proposed that the sentence which included the phrase "general school system" should be deleted. The paragraph should be rewritten so that PWD have the right to choose a general education school or a specialized school to meet their educational needs. The article should address quality and choice of education in this context.

Jamaica said that the article should reflect a developmental approach in a human rights context. If PWD are to be empowered, they need social and economic mobility which depends on education. We must ensure, ultimately, that all schools are so designed and constructed so that they accommodate all disabilities.

The World Blind Union said that, while the ultimate goal should be that all forms of education be in a format to provide equally good education for all children in a class, it is our experience that UNESCO's promotion of inclusive education has harmed blind children enormously. Blind children find themselves mainstreamed in a class without support, with teachers who can't read Braille and lack the ability to communicate effectively with blind children. Beyond Braille, fundamental habilitation and mobility training must be available to blind children and cannot be taught in inclusive education. Braille skills have declined worldwide and illiteracy among blind children increased as a result. The WBU called for the addition of the words "special and inclusive education" in paragraph 2 as well as a reference to lifelong learning, as many people are not born blind but lose their sight over time and need to learn new skills as an adult. Paragraph 3 should be re-written, as previously noted by Thailand, and paragraph 5 should address the needs of blind persons on an equal level as it addresses the needs of deaf people.

The World Federation of the Deaf-Blind pointed out that most deaf blind children and adults receive no or very little education and it rarely geared toward their potential. Paragraph 3 should be re-written. Inclusive education does not mean putting everyone in the same classroom, which is wrong for the deaf-blind because of the communications issues. Being included in the classroom is not the same as being included in the actual education. Braille and large print should be added to paragraph 5 and the idea of lifelong learning should also be incorporated, as most deaf-blind people lose their vision and hearing during their adult lives.

Disability Australia Limited supported eliminating any bias toward one particular type of education service delivery and endorsed the concept that this treaty must widen the educational choices for children and their parents. The push for inclusive education had its place and time when there was a need to eliminate the historic restriction of people with disabilities to special schools. But, in attempting to undo this historical mistake, we must not impose another system that is also not universally appropriate. Choice in education must be available to PWD.

Canada agreed with many delegations that paragraph 3 is overly prescriptive, as is the wording in brackets in paragraph 2. One model of education does not fit all people. Individual circumstances and the severity of the disability must be considered when making educational choices for PWD. We need to ensure that we do not create a model that provides an excuse for authorities to ignore their responsibility to provide appropriate services (e.g. special schools, when required) by claiming that the standard calls for inclusive education. On a more general note, delegations should consider using the word "should" instead of "shall" in all articulations and proposals. The overuse of the word "shall" has the effect of weakening it.

The World Federation of the Deaf noted that 80% PWD do not have access to education and that the article should cover all levels and forms of education and not prescribe only one option. In developing countries, for example, some deaf schools are being closed in the name of inclusive education, resulting in high illiteracy among deaf children. Inclusive education cannot meet certain specific need and special education is not the same as segregated education. Paragraph 5 should encourage education of deaf children to become bi-lingual or multi-lingual in terms of knowing national sign language, the national spoken language in written form, as well as foreign languages in written form. There is also a need to address the issue of the need of interpretation in higher education.

The Coordinator commented that while inclusiveness is a fundamental principle in the Convention, it also needs to be tempered with reality. Communication skills for deaf, blind, for example, cannot be taught in general school. In this regard, there is a need to find a balance so that special skills can be taught in a specialist environment and other elements of education more appropriate for inclusive setting can also be made available.

The European Disability Forum stated that it is clear the article needs to ensure that all disabled children have access to education and should also cover the area of lifelong learning. What is more complicated is striking the balance between special versus inclusive education. In some cases, special supports can facilitate integration in general classrooms. In other cases, special schools are the better choice. It is unacceptable in any case to send children with physical disabilities to special schools due solely to issues of physical accessibility. The fundamental principle at the core of this article is the issue of choice. The article should not allow for reliance on special schools as excuse for States to not make general schools accessible.

The World Network of Users and Survivors of Psychiatry noted that in the case of psycho-social disabilities, it would not support segregation in the educational context. In this, the article needs to take into account different disabilities. The inclusion of the word personality in the article is good because it is also contained in the International Declaration on Human Rights. The inclusion of the word potential is also appropriate. If specific supports are to be listed in paragraph 2, then psycho-social support should added to the list. WNUSP also called for some mention, either in this context or in the context of torture, of the right to be protected from medical intervention as a means to control behavior, which is often justified in educational settings as well as prisons and other institutional settings.

Rehabilitation International said that the problem is that PWD either receive no education or receive it in such a segregated environment, without choice, that they face discrimination in other spheres of life. Regarding the right itself, there are interconnecting rationales that explain the right: the rationale of economic independence, by providing marketable skills; social independence, that is, preparing the person for an interactive life; and, finally, civic responsibility, not only to exercise rights but also assume responsibilities. In addition to Article 29 of the CRC, members should be aware of the language in the Council of Europe recommendation of 1992, which provides for the right to appropriate free education, adapted to meet their needs and wishes. It is important for the international community to voice support for an exceptionally strong principle of mainstreaming to reverse the exceptionally strong principle of separate but equal, which is so embedded in national laws in policies all over the world. This is not only important for the peers of disabled children who then grow to expect the presence of diversity. At the same time we must be careful that support and reasonable accommodation be available in the educational setting and that the educational plan be individualized for the needs of the student. So, in paragraph 2, we should begin desegregating these things: adequate support, reasonable accommodation, etc. and then individualize the education plan. The paragraph should also refer to teacher training during initial training. Overall, the provision should reflect the priority of mainstreaming first, segregating if you must but only if proved that it is objectively necessary as opposed to subjectively convenient. Paragraphs 4 and 5 should carve out space for the deaf and deaf-blind, but in a way that preserves a strong presumption in favor of mainstreaming. Finally, some link in the text should be made between rehabilitation and education. Helpful language on this can be found in the1992 Council of Europe recommendation.

Serbia and Montenegro supported the idea that education should bear in mind the future employment of children with disabilities. The article should emphasize the best interest of child when choosing a form of education to be pursued. Education should provide options and a right to choice. The point made several times regarding lifelong learning is well taken and should be included.

InterAmerican Institute on Disability said that the article should cover all ages and access to all levels of education - from early education to higher education. It should promote measures towards inclusion and against unjustified segregation and should refer to options in education. Illiteracy rates in developing countries prevent access to work. To this end, access to technical training to create additional opportunities for work should be reflected in the text.

Mexico said that Article 12 of the Mexican proposal could serve as guide for drafting as it incorporates idea of lifelong education, development of personality, and reasonable accommodation. This article also includes statements that the State should guarantee any right to education that is conducive to equal social and economic inclusion. It should also include measures for inclusion, ensure access to other educational institutions, consider those who are especially vulnerable and ensure training and sensitization for public and private school teachers. The article should include a reference to education technology and the facilitation of technical assistance. It should also mention access to financial resources, the need to exercise the right to choose the educational method and ensure that PWD receive information on educational options in a timely manner.

Inclusion International noted that children with learning and intellectual disabilities are usually the lowest priority, which is many times linked to problem of poverty and lack of access. For these children, segregation leads to exclusion and stigmatization. The article therefore must ensure support to these children in the class (teacher training, aides). Many UNESCO documents support the concept of inclusive education, but those who have a need for special education should the right of choice. It is important to understand that once children with intellectual disabilities are segregated in a special school, they almost always end up in sheltered workshops instead of independent employment. Segragated schools promote a pattern of moving from one segregated environment to the next and away from the community.

The Coordinator noted that it was clear that one size does not fit all with regard to educational options.

Uganda supported the need for choice between inclusive and special education. Where inclusive education is appropriate it should be available. This should be the emphasized priority. However, where special schools are needed, they should be available. It is also necessary for the government to define accessibility in the educational environment as this may differ from accessibility in other situations. Lack of access often causes disabled students to leave school in frustration. The article should have a provision on Braille facilities and should address the need to train a reasonable number of teachers in sign language.

South Africa requested the addition of an introductory note to elaborate on the quality of education for PWD. Paragraph 6 is useful as it takes into account the ongoing problem of finances, but the three items listed (tertiary education, vocational training and adult education) should be broken into three separate provisions since different laws may guide them each domestically. South Africa supported the restructuring most of article 24 to be more specific and to emphasize the right to education of children and adults with disabilities rather than to prescribe specifically what should be done. The issue of a right to choice and an informed process to decision making for parents is important and should be strengthened. Finally, the government of South Africa is a proponent of inclusive education as a priority, as this form allowed for inclusion in the community and family environments.

Germany referred the members to Standard Rule 6 and General Comment 5 and 13 of the ICESR ,which favor the issue of mainstreaming as a matter of non-discrimination in education, and commented that it would be odd for a disability convention not to reflect this standard developed under international law. At the same time, the article should reflect the need to accommodate individual needs and to provide choice. The article should refrain from mentioning specifically deaf and blind children as it could be misinterpreted as representing the medical model of disability. Finally, attention to the needs girls with disabilities should be mentioned because they are frequently denied access to education.

China said that on the basis of existing Conventions, specifically article 28 of CRC, the emphasis should be on right to access of education for children with disabilities. The article should include the obligation of States to take measures to progressively realize these rights and should not suggest partiality towards any one model of education.

Afternoon Session

Commenced: 3.25 pm
Adjourned: 6:05 pm

RIGHT TO HEALTH AND REHABILITATION

India objected to the first paragraph on PWD right to enjoyment of services of the "highest attainable standards" pointing out that rights must correspond to the ability of states to fulfill them. "While the range of health services in the private and public sector can vary from the state of the art to the basic, the commitment on the part of the state for provision of services can only be of the basic level for all citizens." However India is committed to the obligation to ensure that PWD have access to services on the same level as that of the general population. Rehabilitation must be decentralized and should not be confined to a few centers of excellence. The draft Convention text from India provides useful language in Article 9, highlighting the need for trained health care workers. Along with early detection, prevention is included in this context, because "so much of disability is related to malnutrition, infectious diseases, poor sanitation, poor delivery practices." Since institutionalization is a common practice and will continue to be so in many countries the Indian draft also suggests language that subject public and private healthcare institutions, particularly psychiatric ones, to regular monitoring.

Ireland supported the approach taken in the EU text Article 5 (e) which corresponded with Paragraph 1 of the Chair's text ensuring PWD the same level of care as others as well as services required as a result of disability. The meaning behind "acceptable" services as stated in this paragraph needed clarification. The participation of PWD in decisionmaking should be in the form of ensuring they enjoy equal rights in matters that affect their lives; however the responsibility for the "formulation of legislation and policy" rests with the government, with appropriate consultation from PWD.

Japan concurred with Ireland's position regarding both paragraphs calling for "flexibility" in relation to how it deals with legislation and policymaking.

WBU drew a distinction between rehabilitation and "habilitation" both of which should be addressed in this convention. Rehabilitation for children is actually habilitation. Prevention remains a "strong objection" for the purposes of this process, while this issue is important it should be addressed by other UN Agencies with a health specific mandate. Rehabilitation is not a closely connected sector to prevention.

Disability Australia Limited drew attention to Rules 1 to 4 of the Standard Rules, keeping in mind that this convention must not fall below existing standards. The principle of participation is very well developed here. In addition, Paragraph 1 recognising the right to the enjoyment the highest attainable standards of health, is in fact directly from the Alma Ata Declaration of 1978 that also deals with PWD. This sentence has already been accepted by states in this Declaration and therefore there should be no problem with its restatement in this Article.

The origin of the word "acceptable" was clarified by the Coordinator as emerging out of General Comment 14 from the Committee on Economic, Cultural and Social Rights, in the context of cultural acceptability in relation to private facilities for women, and tied to the concept of dignity.

South African Human Rights Institution (SAHRI) sought to expand Article 23 so that the CBR concept could be built into the second provision as well as inclusion of the importance of reproductive health care services, given the text's recognition of gender based discrimination.

Canada suggested a definition of "acceptability" that most delegations would be comfortable with be footnoted in the proposed text. The provision on specific forms of health care that PWD may require as a result of their disability is very broad covering any number of issues; perhaps what is meant here is the provision of "essential" forms of health care as a result of disability. Finally, in the last paragraph on the role of PWD in the formulation of policy, "leading" could be replaced by "integral."

DPI highlighted the fact that the provision of rehabilitation services are often left by governments to local NGOs with no resources. These organisations operate at a very small scale on "pilot projects" that are never up scaled. These initiatives are too far between to make any impact on the lives of PWD. However, as discussed at this meeting, international cooperation measures can be used to support such initiatives. These measures do not have to be in the form of funds, but also technical assistance and sharing of experiences. The involvement of PWD in the provision of rehabilitation services has been inadequately recognised. Neither the Mexican nor BKK documents address the rights of PWD to have equal access to and benefit from, public health programs such as those aimed at preventing diseases like HIV AIDs or polio, or to those related to sanitation and safe drinking water. Many such programs are not designed to include PWD; failing to target PWD in this is a form of discrimination.

RI emphasized that the vast bulk of PWD are not sick, so the right to health that they enjoy is the same right to health that everyone else enjoys, except that they are not delivered appropriately. There are 3 aspects to this article: 1. the right to health; 2. an action orientation, the right to rehabilitation, that makes real this right to health in a disability context;, 3. participation in decisionmaking. This is supported amply in ESCR General Comment 5, especially Paragraph 14, and the Council of Europe's Malaga Declaration of May 2002. The question of participation in decisionmaking could perhaps be more generally dealt with in an overall context under General Obligations rather than repeating this point right by right. The key point in the General Comment that dealt with "acceptability" is its stress on the importance of health to lead an independent life. There is furthermore simple and straightforward language in the UN SR that is key to the concepts of health and rehabilitation being addressed here: "states should ensure the provision of rehabilitation services to PWD in order for them to reach and sustain their optimum level of independence and functioning." (Rule 3). This underlies the approach to rehabilitation, not for its own sake, not to be imposed upon people, but to serve "an instrumental purpose" ? to live a life of independence.

South Africa proposed that the title of this article be amended to reflect that it does not deal with all aspects of rehabilitation, only medical rehabilitation, or that it address other forms of rehabilitation. It further noted that unless there are trained health care providers who are aware of the rights of PWD, they will continue to be undermined. The Mexican draft Article 13 provides useful language both on the training of health care providers in particular, and for its general applicability as well. Awareness raising is very important in particular in the area of sexuality and reproductive rights, where perceptions that are humiliating to PWD, remain, that they either should be, or are, asexual, and that they do not need to avail themselves of reproductive health care.

WNUSP cautioned that access to rehabilitation as dealt with in other drafts seem to assume people with certain kinds of disabilities. The two paragraphs of Article 23 in the Chair's draft are therefore acceptable. Everything that PWD need should be included in this convention's language, but there should not be language that assumes that all PWD need a particular type of service. For people with psycho social disabilities, separating this article into the right to health and the right to rehabilitation and supportive services, may be useful since they don't need ongoing long term supportive services or medical care. Peer support should also be specifically included here as a type of service. PWD should have access without discrimination to the full range of health care services that should not be exclusive to the person's disability. In relation to the "acceptability" of the services, this gets to the issue of participation. One way of making sure that services are acceptable to PWD is by giving them a lead role in the formulation, delivery and evaluation of these services. The language in the Standard Rules calls for PWD to have an "influential" role. The Coordinator cited UNSR 3(7) and Rule 17 dealing with the functions of national coordinating committees.

World Federation of the DeafBlind highlighted the problems deafblind people have in communicating about their health or in understanding diagnoses. In their interactions with the medical services "much goes wrong here." They cannot sometimes communicate with their own family. It is strange to deal with rehabilitation and health in one article. As RI said, in many cases rehabilitation is connected with education. There is also social rehabilitation ? the concern of deafblind people. All these aspects of rehabilitation should be mentioned in some way, and the article should not focus on wheelchairs etc.

Thailand concurred that rehabilitation should cover more than the medical aspects and the difference from medical care needs to be drawn in this article. The spirit of Paragraph 2 should be retained with modification reflecting the role of PWD. The "prime movers" for getting legislation in place should be PWD, even though the passage of laws is of course the domain of government. As the SAHRI suggested, CBR should be mentioned, but without any prevention aspects, which is "out of the range" here.

Mali called for further elaboration on what is meant by "highest attainable standards" in Paragraph 1. If this refers to developed country standards this language cannot remain. In addition what is the word "acceptable" measured against ? is it international standards, the state or the PWD. The right to health is a universal right and the paragraph should reflect this: "the right to enjoyment of good physical, psychological and mental health is granted to all citizens including disabled persons. In that respect health and rehabilitation services should available, accessible and affordable. Paragraph 2 on the "leading" role of PWD goes "too far."

Landmine Survivors Network suggested a reformulation of this Article using the BKK (pg 119 Compilation) and Mexico (pg 102 Compilation) texts to develop the elements of rehabilitation, which was a complex issue. These elements would include support groups as stated in BKK Article 26 (2) (3) reflecting the importance of "reciprocal assistance," of PWD helping each other. With regard to the training of health care workers as South Africa has called for, there is as the EU pointed out a need to focus on measures of implementation, and Article 13 (a) of the Mexico text provides useful language here that also supports the principle of autonomy. With regard to promoting the participation of PWD, Article 13 (e) 4 of the Mexico test suggests how countries can strengthen the capacity of PWD to facilitate their participation in the implementation of the Convention. Finally, as the WBU has said, prevention should remain outside of the scope of this Convention.

Inclusion International took issue with the concept of rehabilitation overall, preferring the term "participation" so as to avoid the medical model. Should the word remain, the text of Article 23 should recognize the different dimensions, including medical, vocational and social.

Disability Australia Limited raised a concern that the obligation to ensure "affordability and accessibility" may not extend to health insurance policies where discrimination on the basis of disability is common. If these obligations do not shield the PWD from such discrimination they should be reworded. Also perhaps health and rehabilitation could be dealt with in 2 separate articles. Rehabilitation has wider implications in terms of state obligations. Regarding prevention, the problems related to malnourishment etc as raised by India, demonstrate why this should be incorporated into this convention making it "truly progressive." This could be addressed in 2 sections, on ESCR and an adequate standard of health, and in relation to international cooperation. In the latter case, a new standard could be established to address these larger issues with which disability has an important concern.

World Federation of the Deaf highlighted the importance of health care workers with adequate knowhow. All PWD also deserve full information about all aspects of their care. As has been mentioned by previous delegates, the article should be separated into its health and rehabilitation aspects. As WBU has said habilitation as well as rehabilitation should both be dealt with in this convention, for people who are born with disabilities. CBR should also be included. PWD have the right to act within their own governments as they are citizens too.

New Zealand highlighted situations where PWD are denied essential services because they are not deemed capable of providing consent for them. Dental care as part of medical care should be considered as well as access to seeing / hearing devices perhaps as part of the right to mobility ? both connected to the ability of the PWD to lead an independent life. Early identification and intervention for PWD and families is very important as they help both parties understand their capabilities. The training of professionals is needed here because they can "set the tone" at this early stage, and often they have outdated ideas of PWD full capacity. Doctors themselves do not understand the progression of developing disability nor do they know how to reliably get information from PWD, as a result producing diagnoses based on misinterpretation from other sources. The risk of overmedication is another area of concern, with research indicating that PWD are left on drugs for too long, or given outdated drugs when improved ones are on the market. Pharmaceutical actors need to be monitored for this reason. Habilitation is appropriately used in this context; but it also should be noted that while rehabilitation is seen as something short term, it is often a long term need that includes the PWD not losing a physical function rather than getting back what he has lost. Support and training should be kept distinct from that which is more therapeutic in nature. Finally, there remains the danger that providers see PWD as more costly than others.

China highlighted the language in its draft text (pg 96 of the Compilation) in Article 7 (1), (3), and (7) as necessary components of rehabilitation. The same article also asserts the importance of PWD involvement in decisionmaking.

Korea supports Article 23 because it incorporates the right to health. While it needs to be used with caution and in a limited fashion prevention is critical to an understanding of secondary disabilities and ageing. These issues have not yet been discussed, but can be found in BKK Article 26 2 (a).

Serbia Montenegro raised concerns of India, Canada, Ireland, Japan, on economic obligations in this Article, and suggested qualifying the language with "progressive realization" and the "availability of resources." The training of health care workers was important. "Acceptable" as explained by the Coordinator can remain in this text, and "leading" in relation to participation of PWD could be replaced with "integral" to address state concerns. "Prevention is not a human rights issue" and therefore better placed elsewhere. The wording of UNSR 2- 4 should be cited. Support services and technical aids merit discussion in a separate article.

WNUSP asserted that the principle of informed consent on the individual level with respect to each treatment should be included, and this has been addressed in the BKK draft. PWD are often deprived of autonomy by the way services are bundled, or when some services are made contingent on the acceptance of others.

RIGHT TO WORK

The Inter-American Institute on Disability (IAID) stressed the extreme importance of the right to work for adults with disabilities. Autonomy is fantasy for an individual with a disability, if he or she wants to work and is not able to. The individual becomes dependant on family and is deprived of the right to be productive. Unemployment is a serious problem with respect to PWDs. In Latin America, 75% of adults with disabilities are unemployed. Greater effort on the part of states is needed to deal with this. In spite of an individual's best efforts, the attitude of society is oftentimes that the individual is unable to work, or that the PWD will be sick more often than a non-disabled worker. Furthermore, if the PWD has no opportunity to train, opportunities for work are limited. In many cases, experience cannot be gained. There may also be physical and ergonomic barriers, such as the inability to travel to the factories or offices, as well as economic demands placed in the workplace. With respect to access to transportation, if a PWD has to use a high-cost manner to commute to the workplace, this may contribute to unemployment. States must take action specifically related to the work environment, regarding reasonable accommodation or adaptation, ramps, access to bathrooms, and adequate lighting. The individual with a disability should be able to do his or her work safely and efficiently without excessive costs placed on the individual. States must ensure that this is applied to public institutions, and that there be incentives for private institutions to do likewise. Some countries already have experience with quota systems and incentives that we may draw from. The individual with a disability must have opportunities for employment in the public and private sectors, as well as for self-employment, to feel productive and active.

India favored the more prescriptive approach to the right to work stipulated in Article 28 of the Bangkok draft and Article 12 of its own text. The delegate underscored the importance of ensuring the opportunity for self-employment, especially with regard to women with disabilities. Moreover, as many PWD live in destitution, governments need to include PWD in their programs to eliminate poverty. Workplace training, and in-place training is also essential, so that absorption in the workplace is made easier.

Japan asserted that the term "reasonable accommodation" in Article 25 of the Chair's draft needed further qualification. This term is now in the General Obligations of States Parties section of the treaty, in close connection with the definition of discrimination. When we consider it we hope to take into account the various programs in each country as well as employers' responsibilities.

Ireland asserted that the EU text contains many elements that are not in the Chair's draft. Article 6 (c) stipulates that States are to "take measures to promote employment opportunities including free vocational choice for persons with disabilities so as to enable them to exercise the right to work and enjoy equal conditions of work." Ireland would like to see the promotion of employment opportunities for PWD and the emphasis on equal conditions of work reflected in this article. Both the original meaning of the concept of reasonable accommodation and its reference in EU legislation is related to the context of employment. The WG needs to address it more specifically in this article, than in the general convention. A right to reasonable accommodation would present some difficulty but a provision on this would be acceptable. In this context the concept of training, as described in the EU's legislation on the subject, may be relevant. EU Article 6 (b) provides useful language on vocational training that is relevant to the right to work. Some of the measures in other drafts do not go far enough, such as Article 14 of the Mexican draft on the right to work cited by the Indian delegation. The issues addressed in article 14 (a) are issues that need to be dealt with in legislation, and not simply in individual or collective labor agreements. Article 14 (c) of the Mexican draft addresses the issue of equal salary for equal pay; this should also be clearly set out in legislation.

Columbia concurred with Ireland that Article 25 needs to be strengthened and its scope broadened. Several important elements, included in other drafts, had been left out, such as professional rehabilitation, as proposed by Ecuador. A person who has suffered a disability or illness should be entitled to re-inclusion or transfer within the workplace. Professional rehabilitation entails rehabilitation because an individual often cannot continue to work after the disability and may need to be re-included in the company. If the person does have a pension, the individual may be more likely to be denied the right to return to the work place. In Columbia, there has been some success in relocating people with disabilities. Columbia stressed the importance for PWDs of the right to elect freely one's career or employment, as well as of establishing national policies that need to be periodically reviewed. Furthermore, the stigma in accommodating working professionals needs to be erased so that an individual who has suffered a disability can continue to work. Awareness campaigns are an essential aspect of this.

Thailand stated that Article 28 (2) of the Bangkok draft on the right to work should be considered here, because this article offers more detail concerning the ways in which states need to guarantee this right than does the Chair's Article 25. The Bangkok draft, for example, covers self-employment. The representative underlined the importance of requiring the same practices of the private sector, as of the public sector. Some countries, including Thailand, have developed laws and legislation that are only aimed at the private sector.

Canada asserted that there are two aspects contained in this Article. One is the establishment of the right to work as stipulated in the ICESCR. Regarding this first aspect Canada pointed to the phrase "productive resources and services" in the Chair's Article 25, as it was not sure as to the meaning. The second aspect in this article, as indicated by Canada, is the provision of equal services in the workplace. PWD should have the opportunity to obtain skills through training, as mentioned by Ireland. Awareness raising was mentioned by several delegates, but encouraging employers to hire people with disabilities constitutes a more proactive approach. Thailand proposed providing opportunities for self-employment, however the establishment of business by PWD should also be covered. Lastly, a return to work provision is essential for PWD, because quite often PWD must take absence from their work more often than others. This needs to be recognized so that PWD may return to the workplace after an absence.

WNUSP concurred with much in the Indian draft as well as with the Mexican text. The issue of non-discrimination in the workplace has to be recognized. Language "prohibiting and abolishing any discriminatory practices" is not the same as recognizing the issue of discrimination in the sense of structural systematic barriers, such as the failure to provide reasonable accommodation. People with psychosocial disabilities are significantly represented in the unemployed, even as compared with other categories of PWD. WNUSP stressed the importance for PWD of the right to equal pay for equal work. Exploitation happens when people are in segregated projects. PWD are paid token sums for actual productive work. The issue of free choice is an integral issue, which entails economic opportunities beyond working for someone else. The Bangkok draft reference to self-employment of PWD, in its Article 28 (d) is limited to PWD in rural and remote areas. Though WNUSP respects the particular needs these groups might have, it is essential to address self-employment with respect to PWD in general.

Rehabilitation International (RI) drew a distinction between the 2 components of this Article, the substantive right to work and the concept of reasonable accommodation, and proposed they be addressed in two subparagraphs. On the former, "active labor market policies in favor of PWD including skills enhancement" as well as emphasizing "the insertion of PWD into the open labor market" need to be addressed, "which leaves open the difficult question of sheltered employment." On the latter, the search for RA should be a "voluntary and interactive process", with sensitivity to the public / private divide, and "great care will be needed to set out the ingredients of RA", what is required of employers, and in this respect documents from the EU and the ILO will be useful. While reasonable accommodation might not be a right, it is a corollary to a right, namely the right to non-discrimination. Like Canada, some emphasis should be placed on right to self ?employment in the context of disability. The interaction between Article 25 and the General Obligation of states to engage in positive action measures, namely quotas, in the context of employment is a controversial and difficult issue that will not be resolved here but needs to kept in mind for the future.

Germany concurred with Ireland's statements on equal work conditions and the promotion of employment opportunity. Germany supported India with respect to including wording on the situation of women with disabilities, who often suffer double discrimination.

Regarding barriers to employment, World Federation for the Deaf (WFD) noted that legislation or even the issue of security in the workplace may constitute difficulties for PWD to exercise their right to work. In many states there is strict guidance on job security issues. On a site to repair streets, deaf people may not allowed to be hired, yet the hearing workers have to wear hearing protection devices. Security issues must be bases on real issues and not just assumptions.

World Blind Union (WBU) noted that blind people, deaf people and people with intellectual disabilities have a particularly high rate of unemployment. The reason behind this is discrimination. PWDs are among the poorest of poor. They have lower incomes, less education and fewer job opportunities. Legislation in many countries forbids blind people from certain professions and duties, such as being a witness. Countries should to take a look at their legislation to ensure that the market is open. WBU asserted that the section of the convention on employment must be more specific. Moreover, though it is indispensable to change peoples' attitudes and perceptions towards disabilities, concrete issues such as transportation and vocational training must be addressed in order to get not only society and but also the committee who will eventually implement the treaty to understand the extent of exclusion experienced by PWD. The WBU supported comments make by Canada and Columbia.

China asserted that the WG should look at this problem from two angles. The first is to guarantee equal participation and equal pay for equal work. There is a need to make sure that PWD have protection in the workplace such as leave with pay and vocational training. Secondly, it is essential to make sure that Sates Parties take active measures to promote job opportunities for PWD. Article 8 paragraphs (2) (3) (4) and (5) of China's text on page 96 of the Compilation includes proposals to that effect, including support for self-employed PWDs.

Uganda explored what was meant by the term "productive resources and services" in the Chair's draft. Uganda offered that what was meant by this language was that PWD establish their own business and participate in the economic sector of their societies. The delegate specified that there was a need for that aspect to be properly covered. Uganda agreed that PWD must be provided with technical vocational skills to enable them to be competitive. There is also a need also for career guidance for PWDs to enable them to make the right choices. In situations with high unemployment, there is temptation to exploit PWDs. Hence the need to have measures in place so that they are protected from working longer hours for less pay for example. States Parties should have clear policies on employment, outlined in consultation with PWDs. These policies should be clear and well disseminated.

DPI noted that often when PWD do have access to work, it is for lower wages. In addition, PWD are often stereotyped for a certain type of work. The Mexican and Bangkok drafts clearly guarantee PWDs employment on their own terms. The Chair's draft is less comprehensive. Article 28 (c) of the Bangkok draft, for example, specifically mentions the issue equal wages.

WFDB asserted that employment amongst deaf-blind people hardly exists. In some countries deaf-blind people have something like a job, for example shelving shoes. Most deaf-blind people work as volunteers. There is still a lot to do with respect to deaf-blind people exercising the right to work.

Lebanon concurred that Article 25 of the Chair's draft is not comprehensive. It does not include positive actions such as quotas or vocational training, as contained in other texts, notably the ILO proposal. Lebanon is facing the particular problem of employers who are requesting the redefinition of the capacity of PWDs to ensure productivity. If this issue is not addressed, implementation of the right to work will be in danger.

The Coordinator noted the general agreement among members of the Working Group that this article needs to be expanded.

RIGHT TO SOCIAL SECURITY AND TO AN ADEQUATE STANDARD OF LIVING

Jamaica asserted that paragraph 1 of Article 26 needs to be broadened either to introduce social protection or to note that it includes social protection and insurance. As it is now phrased, the whole range of provisions of social protection are not covered. Regarding the issue of self-employment, in most developing counties there is a coverage gap for people with their own business. We need to introduce special measures so that persons, who do not enjoy formal employment, are covered under the social security provision.

Ireland noted that the article as it is in the Chair's text appears to conflate 2 separate rights. Article 9 of the ICESCR does not give much guidance. Article 13 (a) of the Mexican text constitutes a more fruitful approach as compared with Article 26.1 of the Chair's text.

WFDB noted that many deaf-blind people do not have any security. Often their only protection is through the family.

With respect to Article 26 (2) of the Chair's draft, the WBU proposed inserting a reference to clean water. Clean water plays a role in prevention as all human beings need water. Advocating the right to clean water in the convention would entail prevention, without specifically naming it as such.

Sweden pointed to Article 26 (4) which implies that families of PWD have "rights." The representative emphasized that this is a convention on the human rights of PWD and not the family members of PWD families. Addressing the adequate standard of living of PWDs might entail addressing PWD families, but it is important to avoid referring to the "rights" of family members.

India proposed that Article 26 (2) of the Chair's draft be qualified, at the end of the paragraph, with the language "not below standards prevailing in the country." Article 26 (3) does not seem relevant and might even be eliminated, as it relates to questions of access, mobility and non-discrimination. India urged that this article be elaborated by referring to paragraphs (a) (b) (c) and (d) of Article 13 of its own text. The representative concurred with previous comments that in developing countries the family is often the PWD's only support.

With respect to the right of PWD to found their own families, the WNUSP noted that if one is the head of the household, there are children and family members to provide for. This is one way of addressing this issue; another is in the context of children with disabilities, which has already been raised. Regarding the expression "to look after" in Article 13 (c) of the Indian draft, WNUSP noted that this term, in English, has a paternalistic connotation. Regarding the reference in Article 13 (d) of the Indian draft to "access to legal guardianship," the representative recalled comments by Inclusion International advocated that those paternalistic forms of guardianship be done away with.

The Disability Negotiations Daily Summaries are published by the Landmine Survivors Network, a US based international organization with amputee support networks in six mine affected / developing countries. They cover the intergovernmental proceedings of the Ad Hoc Committee on the human rights of people with disabilities. Reporters covering the Working Group meetings are Elizabeth Kissam, Jennifer Perry and Zahabia Adamaly and Joelle Balfe (editors). The Summaries are posted on line by noon the following day at www.worldenable.net and www.rightsforall.org They are translated into Japanese by the Japanese Society for Rehabilitation of Persons with Disabilities (dinf-j@dinf.ne.jp) and Spanish by the Inter American Institute on Disability (iidisab@aol.com) If you are interested in translating and disseminating the Summaries over the course of the Working Group meetings, and would like your contact information to be distributed, or have comments / questions, please write to Zahabia@landminesurvivors.org