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UN Convention on the Human Rights of People with Disabilities Sixth Ad Hoc Committee Daily Summaries
A service brought to you by RI (Rehabilitation International)

Volume 7, #6
August 8, 2005

MORNING SESSION

ARTICLE 21 - RIGHT TO HEALTH AND REHABILITATION (cont)

Chile supported the proposal to separate the right to health and rehabilitation, to ensure that the right to health would not be couched away, and to avoid giving any impression of equating disabled people with persons of ill health. Rehabilitation is a right of PWD, belongs in a separate article, and should be defined in Article 3. It should incorporate a strengthened concept of socio-economic change as well as its other aspects such as education and work.
The chapeau should be more decisive and changed to read 'ensure'. A new subpara (b) bis should cover specialized health services, including reproductive care and sexuality. In (c) health services should be community based, also to encourage the communities' involvement. In (e) the term 'elderly' should be replaced with 'adults'. In (f) the applicable technologies should include 'biomedical, genetic and scientific'. Para (h) does not go far enough as knowledge should also be 'increased'. The Code of Ethics in (i) needs to be 'efficient, effective' and must meet 'specific goals'. Medical interventions in (k) must prohibit forced sterilization and "any form of intervention in the field of human sexuality".

Yemen reiterated its proposal from AHC 3 for a separate Article 21(bis) called the right to rehabilitation. Health care services in Article 21 should be 'free of charge'.
References to rehabilitation in Article 21 would be moved to 21(bis) including para (d). Both articles should strengthen the commitments of states to "ensure" the rights of PWD. The language of Article 21(bis) would obligate states to support PWD entitlement to physical, mental, as well as psychological rehabilitation, and only after approval has been granted by PWD. It would also ensure that PWD should participate in all stages of the rehabilitation process, including the promulgation of pertinent laws.

The Chair pointed out that several delegations had suggested separate articles on health and rehabilitation.

China expressed concern that a separate provision for medical rehabilitation could be weakened if it was not sufficiently clear what the term rehabilitation entailed. It is difficult to separate medical care from rehabilitation. If there is to be a separation, the language must ensure that international obligations with respect to medical rehabilitation for PWD is not weakened, and that PWD have the right, in addition, to other forms of rehabilitation. The discussion on involuntary interventions in (k) should be connected to the discussion on Article 12 bis on informed consent. Based on the current international standards, including the Standard Rules and the World Program of Action for PWD, the term 'secondary' should be deleted in (e).

The United Kingdom on behalf of the European Union (EU) supported the separation to ensure that rehabilitation is not just seen as a health related issue. It suggested 'habilitation and rehabilitation' as a working title for 21(bis). The close proximity to Article 21 should accommodate China's concern regarding medical rehabilitation. If agreement is reached on a separate article, all references to rehabilitation in 21 should be deleted.
The current Article 21 needs to be shortened. Because the right to health is an existing human rights obligation the term 'strive to' in the chapeau should be deleted to avoid recognizing what would be a lower standard for PWD. In para (b) 'strive to' should be replaced with 'endeavor' reflecting common treaty language with respect to the progressive nature of the provision. As (d) covers rehabilitation issues it could be deleted; (e) contains similar provisions and should therefore be deleted. The issues in (f) are referenced in a number of other articles and should be consolidated elsewhere. Following the Chair's proposal, the text in (g) should be deleted here and accommodated in Article 4 or elsewhere. Paras (h), (i) and (j) are too detailed and the EU proposed a more concise text (http://www.un.org/esa/socdev/enable/rights/ahc6eu.htm), which meets the goals of training, ethical standards and consultation of Disabled People's Organizations (DPOs) and follows language set out in the International Covenant on Economic, Social and Cultural Rights (CESCR). Following the discussion of the last AHC on Article 12, the issue of medical interventions in (k) should be placed elsewhere. The EU's proposed Article 21 bis (http://www.un.org/esa/socdev/enable/rights/ahc6eu.htm) is to cover all aspects of habilitation and rehabilitation as implementing measures with the aim of realising existing rights. The EU does not want to create a separate or new right of rehabilitation. Its proposed text ensures the assessment of personal needs in a multi-disciplinary context, not just on health but also social services, and in para (2) it ensures comprehensive training for all involved in the habilitation and rehabilitation process.

The Holy See proposed (http://www.un.org/esa/socdev/enable/rights/ahc6holysee.htm) shortening the chapeau and para (j) to increase clarity and focus, with minor adjustments to (h), (i) and (l). In (a) it proposes agreed language from the Second World Assembly on Aging: "Ensure the access of PWD to primary health care without discrimination." This will preserve the primary intention of the WG text, contribute in a manner that will allow states parties concerned with these issues to ultimately sign the convention, protect the right of PWD on an equal basis with others, and not unduly burden states. In (e) it agreed with China that given that it was not clear what a 'secondary disability' is and that 'disability' as such has not been defined, the term should be deleted. Language on the dignity of human beings and respect for human life was added to (f) in light of the recently adopted UN Declaration on Human Cloning. The essential role of families is reflected in a new (j) bis. Supplementing language on unwanted and related medical interventions and corrective surgeries has been inserted in (k). Based on the discussion on Article 15 bis - women with disabilities - as well as the issues raised by the Republic of Korea, the Holy See proposed a new (k) bis but is flexible on its ultimate placement in the convention. Finally, a paragraph on medical life-preserving treatment for PWD, addressing concerns about the protection of life is added in (k) ter.

The Chair highlighted the fact that the notion of 'secondary disability' in (e) was unclear.

Mexico strongly supported a separate article on rehabilitation, incorporating a range of issues beyond health. Limitations to the medical aspect would result in a focus on the provision of assistance and this would not be in keeping with this convention. A human rights perspective means prevention and social integration should be key components, covering, for example, actions to reduce the number of cases of new illness, both acquired and congenital / inherited disabilities; epidemiological surveillance so as to acquire greater knowledge of the nature of disability and to undertake early interventions to prevent more serious complications; support for families, and sports.
In para (a) the term 'citizens' should be replaced with 'persons' to ensure consistency of language. The issue of decentralization covered in (c) should be in an article on rehabilitation as rural areas have not received sufficient attention. The first section of (j) on the confidentiality of patient information should be included in Article 14, as the issue of free and informed consent has broader scope, and is relevant to the establishment of epidemiological surveillance systems. The second part of (j) should clarify the rights that PWD should be informed of, for example, the consequences and risks of a medical intervention. Paragraph (k) requires strict safeguards in relation to forced interventions. The list in (i) is repetitive and partly covered in (j). The wording in (m) could possibly be placed in Article 4.

The Chair noted delegations' agreement that the content of Article 21 required further work, particularly concerning the overlap with other provisions, and that there should be a separate article on rehabilitation.

Japan indicated flexibility on separating the issues of health and rehabilitation. It proposed that (e) be deleted as the prevention of disability was controversial and such a provision could send the wrong signals. In light of Article 14 paragraph (j) should be deleted. Likewise, (k) should be moved to the already discussed provision in Article 12 bis, and (l), already covered in Article 14, should be deleted or moved there.

Israel supported the separation of health and rehabilitation, as an affirmation of the social model combined with the medical model.

Australia also called for a separation, agreeing with China that health is something to which the whole community is entitled, but rehabilitation is specifically targeted towards PWD. Australia's proposed text
(http://www.un.org/esa/socdev/enable/rights/ahc6australia.htm) sets out principles rather than creating a shopping list for compliance, and is based on the proposal of the Asia Pacific Forum on National Human Rights Institutions made at AHC 4. Australia also agreed with the EU comments on habilitation and rehabilitation.

The Chair noted that the Australian text was referring to a 'right' to rehabilitation. Given the understanding that no new rights should be created, the Chair asked Australia to clarify whether it wanted rehabilitation to be a right.

Australia clarified that it did not intend to create a new right and will reconsider its draft in that context.

The Chair referred to the right to 'rehabilitation of health' in the Convention on the Rights of the Child (CRC) and read out the text of Article 24 (1) CRC. He also quoted General Comment 5 to Article 21 of the International Covenant on Economic, Social and Cultural Rights (CESCR), which emphasized social integration. There is consensus on the obligation on states to provide habilitation and rehabilitation services provided this is not cast as a right to rehabilitation.

Peru called for a more explicit statement on obligations with respect to access to comprehensive services particularly in paras. (f), (h), (i) and (j). Peru would prefer a single article but was flexible on separating health and rehabilitation. It asked for more information from specialized agencies and Disabled People's Organizations (DPOs) on the pros and cons of a separate article.

South Africa highlighted the developmental aspects of the right to health, noting that health care services should be provided within available resources and should be free for those who qualify. In the WG text (a) and (e) should be joined and (l) should be deleted as the issues are reflected in (j).
South Africa supported a separate article 21(bis) in which rehabilitation would: [1] incorporate a community based approach given the level of poverty in some countries; [2] include assistive technology and psycho-social elements; [3] be a life time process towards independence.

The Republic of Korea wanted the term 'medical' inserted before 'rehabilitation' and will consider the proposals for a separate article on rehabilitation.

Algeria supported the separation and highlighted the need to define what rehabilitation means. It embodies various measures to enable a person to adapt to her or his professional and social context. A distinction has to be made between the social-medical-psychological and the socio-professional rehabilitation. The article on rehabilitation needs to enable states parties to manage all the aspects of rehabilitation.

Colombia supported the separation, and suggested 2 proposals aimed at broadening the scope of suggestions of other delegations for the article on rehabilitation. Para (a) should be amended to read "to guarantee the right to access and coverage of rehabilitation and support services guaranteeing rehabilitation to all persons who request it, including PWD, persons with serious or multiple disabilities in order to attain the highest attainable standard of mental, physical, physiological, occupational and social level". This follows the holistic approach taken by Mexico on rehabilitation. A second provision would state "establishment of mechanisms in order to facilitate the acquisition of prostheses or other technical assistive devices, auxiliary devices that are necessary for PWD".

Thailand did not have a strong position on separation, but it did agree that rehabilitation provisions should be streamlined into other articles. However, health related aspects of rehabilitation should be retained in Article 21 to ensure that the rights-related aspects of rehabilitation were guaranteed. The concept of health nowadays has a broad meaning and does not only cover medical issues. "We must make the best use of rehabilitation within the health aspect.

Iran supported the WG text's Article 21 and was flexible on its separation. However its provisions should be integrated into the existing relevant parts of the convention text first, taking care to ensure that language used is consistent with legally binding texts. The most important aspect of Article 21 is health care, and all its aspects should be recognized equally. Care should be taken before emphasizing or exemplifying certain aspects. Iran supported the Australian proposal for (a). Like other delegations it asked for an explanation for the purpose of (e).

The Chair explained that the right protected in Article 12 of CESCR is the right to health, and health care is an important element in ensuring that right.

New Zealand stated that Article 21 should focus on health and health care and not be weakened by incorporating other elements. It endorsed Thailand's view that a separate article on rehabilitation was not necessary. The non-health related aspects of rehabilitation can be covered in the relevant articles: 15 - living independently, 17 - education, 19 - accessibility, 22 - work, 24 - leisure, sport and culture. Given the emphasis of the convention on inclusion the goal should be to ensure that PWD can lead an ordinary life with the necessary support. one should therefore be careful not to professionalize specific services. It endorsed Thailand's stance on including a reference to "health-related rehabilitation" in Article 21, particularly in the chapeau and (a). It preferred that term to 'medical rehabilitation' as suggested by the Republic of Korea as that may be interpreted more narrowly. With regard to the concerns of some of the Non-Governmental Organizations (NGOs), NZ supported the inclusion of "life skills and mobility" in Article 17 bis as proposed by Australia.
NZ subscribes to the amendments made by the EU, particularly to delete paragraphs such as (d), (e), (f), (h), (i), (j), (k), (l), (m) and (n), which are overly prescriptive or covered elsewhere. However, it was important to retain (g) and New Zealand endorsed the EU's (g) bis. In 2 (a) and (b) it is important to ensure access to health related services, particularly with a view to ongoing services required by PWD. As PWD often miss out on 'population based public health programs' it is important to include those in (a). In (b) 'early identification and intervention as appropriate' should be included.

The Chair asked for an explanation of the term 'population based health program'.

New Zealand responded that this includes any program aimed at the health and fitness of the whole population, e.g. immunization, clean water. Furthermore the chapeau should clearly state that health includes both physical and mental health, firstly because this reflects the language in Article 12 (1) CESCR and secondly because not everyone understands the term health to include both.

Kenya supported the separation of health and rehabilitation and endorsed the proposal to delete all references to rehabilitation in Article 21 accordingly. It endorsed the EU proposal to strengthen the language and therefore replace 'strive to' with 'ensure' and the term 'and effective' should be inserted after 'appropriate' in the chapeau. To ensure accessibility, health services should be 'free or affordable'; an insertion should therefore be made in the chapeau. In (b) 'strive to provide' should be replaced with 'ensure' to strengthen the provision. Para (e) could be deleted and the language moved to (b). Kenya endorsed New Zealand's proposal to include 'early detection, assessment and identification' in (b). Para (d) could be deleted as the issues will be covered in Article 21 bis. Likewise (f) could be deleted as the issues are covered elsewhere. In (g) 'undertake' should be included at the beginning to strengthen the provision. In (h) the final phrase 'in line with the principles of this convention' should be deleted. In (k) special emphasis should be given to the fate of children and the phrase 'including forced sterilization of children with disabilities' should be added. In (m) 'delivery' should be replaced with 'monitoring' to ensure the involvement of PWD in the implementation of the convention. Kenya proposed a new draft text for Article 21 bis (http://www.un.org/esa/socdev/enable/rights/ahc6kenya.htm) on habilitation and rehabilitation. Peer support, new technologies, training and continued training for professionals involved in habilitation and rehabilitation dealing with ethics and human rights for PWD, as well as the involvement of PWD in the provision of services are some of the issues and principles included in this new Article.

The Chair summarized the two recurring issues. Firstly, with regard to footnote 75 of the WG text, he noted that under existing human rights law there is no requirement to provide free health care services, rather they have to be affordable. The Chair made a reference to General Comment 14 on Article 12 CESCR, which referred to 'affordability". He asked whether states parties were intending to possibly establish a higher standard - i.e. provide free health care services - or not. Secondly, in light of a possible stand-alone article on rehabilitation some delegations had proposed the deletion of all references to rehabilitation in the article on the right to health. The Chair asked for clarification as to what 'medical rehabilitation' or 'health related rehabilitation' meant and how it was different from other forms of rehabilitation in the social and economic sense. If there were a separate article on rehabilitation, would it still be necessary to refer to medical rehabilitation in the article on the right to health.

Brazil was flexible on separating the Article provided that, as suggested by NZ, references to the health related aspects of rehabilitation should remain in the article on the right to health. It endorsed the proposal to strengthen the chapeau by replacing 'strive to' with 'ensure'. The reference to 'sexual and reproductive health' in (a) should be maintained.

Costa Rica asserted that it is impossible to separate the concepts of health and rehabilitation because rehabilitation is a necessary component of the right to health. In support of this assertion it brought the attention of the Committee to documents of the International Labor Organization (ILO), United Nations Educational, Scientific and Cultural Organization (UNESCO) as well as the World Health Organization (WHO), which make reference to 'community based rehabilitation'. There may be some confusion in terminology used in those proposals that oppose retaining references to rehabilitation in an article on the right to health because this would imply an endorsement of a medical model approach towards rehabilitation. Costa Rica asked for an explanation for this reasoning, given that the definition of 'health', as put forward by WHO in 1946 is very broad. Health is a "state of complete physical, mental and social well being and not merely the absence of disease or infirmity." (Basic Principles, in: Preamble of the WHO Constitution). Article 12 CESCR, which the Chair had quoted previously, also supports this broad concept, referring to the "highest attainable standard of physical and mental health," which goes far beyond medical treatment. The Alma-Ata Declaration also stipulates prevention, support and rehabilitation as measures to ensure that the right to health is fulfilled.
Costa Rica emphasized that the right to health as outlined in these documents is one that all persons are entitled to, and this convention must guarantee that PWD are able to enjoy this right on an equal basis with others. States therefore should commit to taking specific actions and measures that will ensure this highest attainable standard of health for PWD, their physical, mental and social wellbeing not defined by the absence of infirmity. The existing Article 21 on the right to health and rehabilitation is in fact an article on the right to health, emphasizing one of its components; it does not include the right to rehabilitation. To avoid the risk of establishing a new right, Costa Rica supports Thailand and New Zealand. on including rehabilitation in the article on the right to health.
Costa Rica supports community based rehabilitation, which allows PWD to optimize their capacities, as laid out in the documents cited earlier. There should not be a medical perspective of rehabilitation.
Costa Rica had several additional comments: 'strive to' should be replaced with 'ensure'; it endorsed the position of the Holy See on (a) and particularly (f); family care and motherhood are crucial to the implementation of the convention; the particular problems of rural areas in relation to health should be recognised.

The Chair thanked Costa Rica for the explanations given on the meaning of 'health'.

Jordan was open to the idea of separation because it would allow for a wider view of rehabilitation, to include resources and services in the community, and to avoid the dominance of a medical perspective. It should be possible to find a balance between the various proposals without creating new rights. The definition of health provided by Costa Rica indicates that the term is all-encompassing, not restricted to the medical, and both issues should be mentioned in the same article. The article is too detailed and the more concise Australian proposal is appreciated in this regard. Strong language such as 'ensure' should be used. The issue of free health services is a cross cutting issue which should be dealt with in the provision on general obligations, Article 4, in keeping with established international standards.

India believed that health and rehabilitation should be dealt with separately, with a separate article addressing access to rehabilitation as proposed by India, both in a new 21(bis) and elsewhere in the relevant clauses of the convention. Para (d) is too prescriptive and should be deleted; (f) is covered in 20 (c) and should be deleted; (g) should be moved to the article on rehabilitation; (m) is covered in 4 (2) and should be deleted; (h) (i) and (j) should be merged as proposed by the EU.

Russian Federation called for a separate article on rehabilitation, reflecting the UN Standard Rules on the Equalisation of Opportunities, which was adopted by the General Assembly and should be mentioned here. Medical assistance and rehabilitation should not be confused. Like the Article on 'mobility', rehabilitation applies to many articles and it would be useful to reinforce it in the appropriate articles. In addition there should be a right to rehabilitation, which should be moved further up in the text following the approach taken in the Australian proposal. The delegation is flexible on using the term "ensure" in the chapeau of Article 21. It welcomed the inclusion of the concept of 'affordability' in line with the CESCR. The New Zealand proposal to include early detection of disability deserves further attention. Also, the EU proposal for (h), (i), (j) was welcomed. It noted that "health" as defined in the Russian translation means "a selection of individual qualities" and as such, this cannot be subject to a state's guarantees. It is more appropriate to reformulate the title of the article to "the right to health protection and medical care", which is something the state can guarantee.

The Chair acknowledged possible problems due to translation and restated that CESCR Article 12 and its General Comment 14 clarify the meaning of the 'right to health'. He agreed with the Russian delegate that states cannot guarantee a right to be healthy. He proposed to use the language used in Article 12 CESCR as the safest way forward. The current text does not use the exact language of the CESCR and it would probably be good to change the language accordingly.

Jamaica was flexible on a separation of health and rehabilitation. The latter should be understood broadly beyond medical treatment to include training, entrepreneurship and social skills, and these elements should be incorporated into this Article or the relevant provisions as suggested by NZ. It endorsed the replacement of 'strive' with 'ensure' in the chapeau. The purpose of para (a) is to ensure there is no discrimination, that PWD have access to the same range of services, of the same standard and quality, as other people. Therefore this para should end with as 'other citizens.' However if there is to be a delineation Jamaica would prefer the language from the Chair, "including physical and mental health services,' which is general enough to cover the full range of health services. It prefers to avoid any listing, as is the case in the Australian proposal, because this risks emphasizing one aspect to the detriment of others, and causes undue complications in terms of specific, controversial issues.
It endorsed the New Zealand proposal on early detection stating that while it did not want the provision to be overly prescriptive, this was an area of particular importance. In (f) it is important to ensure that there will be no experimentation with PWD. There is merit in the Holy See proposal to include 'respect for human dignity and the protection of human life' as it strengthens the provision. It endorsed the merger of (h) (i) and (j) proposed by the EU.

Nigeria endorsed the separation of health and rehabilitation as well as the strengthening of the chapeau to replace 'strive' with 'ensure'. The delegation endorsed the Jamaican proposal to end (a) after 'citizens'. It endorsed the Holy See's proposals to include a qualification on 'dignity' in (f). Given the role of families in taking care of PWD in Nigeria it also endorsed (j) bis proposed by the Holy See. The same goes for the suggested (k) bis on motherhood, and (k) ter on nutrition.

Morocco endorsed the separation of health and rehabilitation. There is a need to define rehabilitation and the medically related aspects of rehabilitation have to go under the health article. Prevention of disabilities should be included in (e), particularly maternal and child health care aiming at the prevention of infectious diseases. Should (e) be deleted, the issue should be covered in Article 21. It endorsed South Africa's proposal to include confidentiality, currently in (l), in (j).

Uganda supported the separation of health and rehabilitation. The concept of rehabilitation is more easily connected to the broader range of services, like sexual health. It endorsed South Africa's statement concerning community based rehabilitation. It agreed that the chapeau should be strengthened to read 'ensure' rather than 'strive to'. Additionally, Uganda stressed the importance of 'public health' in Article 21 and proposed language: 'States Parties shall ensure that PWD are included in all public health outreach efforts intended to ensure good health for everyone recognizing that as members of the general population the individuals with disabilities are equally entitled to equal and adequate assistance of health needs; the development of policies aimed at controlling priorities, health problems and the assurance that services capable of realizing policy goals do not discriminate on the basis of disability'.

Ukraine supported the separation of this article and a broad concept of rehabilitation that includes its social and occupational aspects. It proposed inserting "or their legal representatives" in (j) because this provision affects both children and adults, and children cannot give informed consent on the dissemination of information on their own due to their psychological state. For the same reason it also proposed adding a new para (n) on an obligation to provide diagnostic tools and training to PWD who cannot describe their own problems or seek necessary prescriptions.

Canada submitted a detailed statement of its proposed amendments to strengthen Article 21, and its rationale for integrating aspects of rehabilitation into existing articles of the convention. http://www.un.org/esa/socdev/enable/rights/ahc6canada.htm.

Argentina called for rehabilitation to be broadly and comprehensively addressed in a separate article going beyond health related reference, and dealing specifically with access to rehabilitation in rural communities and community based rehabilitation, as proposed by Costa Rica. It endorsed the position of Brazil in para (a), supporting the principle of nondiscriminatory access to health services, including sexual and reproductive services. Para (c) needs to be strengthened by replacing "strive to" with "ensure". Para (f) should include a reference to the respect for the dignity of persons. Following the proposal of Mexico and others, para (j) should provide for exceptional cases in certain circumstances. Para (m) belongs in Article 4 and should be deleted.

The session was adjourned.

AFTERNOON SESSION

ARTICLE 21 - RIGHT TO HEALTH (cont)

The EU reiterated that there should not be a separate right to rehabilitation. The text of Article 24 of the CRC cited by the Chair previously and which provides for the "rehabilitation of health" is viewed in the narrow context of the right to health, and is a component of that right. It also pointed out that General Comment #14 on Article 12 CESCR as also cited by the Chair is not legally binding, and not a statement of international law. Rehabilitation at best is currently recognized in international law as a narrow implied component of the right to health. The EU believes that rehabilitation should enable PWD to enjoy all human rights, including education and work, and it is in this context that the EU would accept a separate article on rehabilitation.

The Chair noted that while a couple of delegations had called for recognition of a separate right, it is generally understood that no separate right should be created.

Sudan stated that a definition for rehabilitation, and how it fits in with the right to health, would be helpful in the process of separating this article and in deciding on the relevance of its various elements in other articles. In (a) Sudan proposed to add at the end "and when possible shall be obliged to provide treatment to curable disabilities in all different stages by PWD due to poverty", emphasizing that in countries plagued by severe poverty some disabilities can be cured with early detection. Health services provided to PWD in para (b) because of their disability should be free of charge. Para (h) should also call on professionals to "observe subtleties toward persons with disabilities and give them priority in their work." http://www.un.org/esa/socdev/enable/rights/ahc6sudan.htm

Israel commented on the placement of rehabilitation in an article on health while also noting its support for a separate article on rehabilitation. "Medical and paramedical rehabilitation", dealing with the functioning of the body, have an important placement in the Article on health. These elements should be distinguished from "psycho-social rehabilitation" dealing with the wider functioning in the community, and which belongs in a separate article on rehabilitation. It agreed to the proposals of other delegations streamlining the provisions of this article elsewhere in the convention, provided that the substance was not compromised. Paras (b) and (c) should be strengthened, by replacing "strive to with "ensure" and by removing the reference to "endeavour to". It proposed replacing "appropriate" with "culturally sensitive" measures in the chapeau. In para (g) the phrase "covering the various sectors of the population" should be inserted before "and ensure they have adequate specialised training". If (m) is maintained, "monitoring" should be added before "evaluation".

Norway noted that its delegation had concluded after consideration of the NZ position that a separate article on rehabilitation would be of sufficient added value to justify separation from health, while noting also that the article on health would deal with medical rehabilitation. A separate article on habilitation and rehabiltiation would clarify this concept as a series of interdependent issues leading to a good quality of life and independent living, highlight an important concept that is covered in many other parts of the convention, and stress its cross-cutting nature. It endorsed both the EU and Australian amendments to this article, with the following exceptions: in paras (b) and (c) of the EU text references to "endeavour to" should be deleted and the Australian proposal should be reworded so that a right to rehabilitation is not created.

Qatar called for the deletion of "sexual and reproductive" in para (a) because this could be construed as recognizing the right to an abortion. Such an amendment would not deny the right of disabled people to marry and reproduce. The reference to "health services" in the same sentence should however be retained so that PWD would have access to all health services. It supported the separation of health and rehabilitation.

Singapore called for a separation of health from rehabilitation and all references to rehabilitation should be removed from this article. It reserved comments on the new Article 21(bis) but proposed several amendments to the content of the current Article 21 based on the EU proposals, with the addition of "equal access" and "affordable health services" in the second sentence of the chapeau.

The USA proposed inserting "to be progressively realized," in the chapeau after "the highest attainable standard of health". While the US recognizes that the progressive realization of ESC rights require government action, these rights are not an immediate entitlement. Sovereign states should determine through participatory debate and democratic processes the combination of policies and programs they consider most effective in progressively realizing the needs of their citizens, including healthcare. As noted in Footnote 19, this issue was raised by several delegations at the WG, as well as in Footnote 98, and in the Chair's own statements on ESC rights. Progressive realization is particularly relevant to the right to health because, except for its nondiscrimination clause which is immediately realizable, Article 21 is not a hybrid of ESC and CPR rights as is the case in other articles. Instead it focuses on the ESC right to health that will require substantial resources. As a practical and theoretical matter such an insertion is appropriate in this convention.
In (a) the term 'services' should be replaced with 'care' which is linked more firmly to a therapeutic approach that is essential in the context of this convention. Sexual and reproductive health care as well as maternal healthcare for PWD should at all times be predicated on respect for individual desires and health needs. For too long PWD have been subjected to reproductive health procedures that have not been based on the health and wellbeing of the patient.
The Holy See's proposal, in particular on respect for the inherent dignity and worth of the individual, deserves careful consideration.

Yemen reiterated that "health services" as mentioned in this convention should be free particularly in developing countries where the PWD suffer from poverty more than others. Other international documents may not provide for this; however this is a new convention which should contain new elements, and its own specificities that recognize the special needs of PWD and their circumstances. Habilitation and rehabilitation are rights of PWD, and they should both be recognized in the title of the new Article: Right to Habilitation and Rehabilitation.

Mali supported a separate right to rehabilitation and habilitation and stressed the need of PWD to be enabled to practice professions, raise revenues and be a part of society.

Statements from NGOs and NHRIs

The World Blind Union, speaking on behalf of the International Disability Caucus (IDC), supported separating health and rehabilitation. Health care is as important for PWD as for all other people yet their healthcare is often ignored by health authorities and is marked by official neglect. Healthcare is a temporary intervention for PWD, unlike rehabilitation which is lifelong. A PWD can be perfectly healthy. The healthcare of PWD should be governed by the same principles of ethics as applied to other people in national legislation, and in this regard forced sterilization of women and children due to disability must be prohibited. An overriding goal of the IDC is that rehabilitation is no longer seen only in the context of health or in the medical model. Habilitation and rehabilitation bring new skills and knowledge that allow the individuals to cope with disability in their daily lives. They also cover the concepts of CBR, particularly in the rural areas of developing countries. The IDC reiterated the necessity to move away from the medical model of disability. Rehabilitation has more to do with education than health.

The WNUSP also spoke on behalf of the IDC, representing 47 national, regional and international organizations and led by DPOs with allied NGOs. WNUSP highlighted the necessity to retain the informed consent provision in this article. Except for Peru, so far no delegation has supported this. In fact there seems to be a great deal of support for deleting it. WNUSP emphasized that it is recognized as an aspect of the right to health, is referred to in General Comment (GC) 14 on Article 12 CESCR, and is critical to the right of PWD to control their own bodies and health in other ways. Informed consent relates to interventions imposed on PWD when their disability is treated as a medical rather than social issue. It also relates to any kind of medical treatment or intervention that might be offered to PWD, but where they are seen as not having the right or the legal capacity to make a decision for themselves because of their disability. Sometimes this relates to the need for accessible information, or the need to require health care professionals to respect PWD's rights to decide for themselves. Respect for the right to informed consent therefore entails a recognition of the full legal capacity of PWD as WNUSP advocates for Article 9. It is not enough to have language on supporting autonomy and dignity because the right to informed consent is per se an aspect of the right to health. Informed consent is the positive aspect of the requirement to prohibit forced interventions against PWD. Not only are acts against a person's will prohibited but informed consent affirmatively, and much more broadly, requires that PWD be provided with full and accurate information needed to make a decision or for supported decision-making.
Therefore there needs to be both a strong prohibition on forced intervention aimed at correcting impairments in Article 11 as well as a strong and unequivocal provision on informed consent in Article 21. This is vital to PWD who are often treated in paternalistic ways by healthcare professionals.
The provision on the privacy of records is also very important to PWD. Some delegations had proposed this issue could be dealt with in Article 14. However it should be noted that in the AHC4 discussion on Article 14 delegations had agreed to deleting this reference to privacy of records. Medical records are of particular importance to PWD, so their confidentiality, the right of PWD to have access to complete unedited versions of these records, and the requirement of PWD consent before disclosure to third parties, must be protected in Article 21.
The IDC opposes separate references to mental health. This leads to segregation and inferior standards and practice, particularly in relation to issues such as informed consent and the right to services that are acceptable to the cultures, communities and minorities concerned, as also specified in GC 14.
The IDC supports the inclusion of the requirement that healthcare be affordable, and that it should be available to all persons, not just citizens.
As with the right to health, the upcoming Article 22 on the right to work, also an economic and social right, should be firmly based on the principles of equality, accessibility, the application of equal standards and the elimination of segregation that would amount to institutionalization.

The Chair responded that no delegation had argued against the principle of informed consent, only taking the position that it was duplicative to mention this in Article 21 as well as Article 11. Therefore this was a question of placement. The Chair noted the difference in the way this is referred to in Article 11, and the need for a positive counterweight to its negative statement. With regard to privacy, the reference to this in Article 14 remains, as noted in para 93 of the AHC4 Report. However it is not as nuanced as that in 21(l).

The German Disability Council, also speaking on behalf of the IDC, welcomed the statements of the USA and Canada to take women's needs principally into account in 21(a). Stating that men get better access health care, it highlighted the need to ensure equal access to health care for women and girls with disabilities. Secondly, the article should ensure the self determination of women with disabilities, the informed self control of their own bodies especially with regard to reproduction and related issues. It stressed the need to prohibit forced sterilization and forced abortion. Thirdly, the needs of women and girls with disabilities need to be taken into account in public health programs on pregnancy, childbirth, post-maternal care, family planning and childhood, regardless of their disability but with awareness of it, and in particular in programs on breast screening, HIV/AIDS prevention and treatment, access to clean water and sanitation. The feminization of HIV/AIDS is growing.

Rehabilitation International (RI), also speaking on behalf of the IDC underscored the need for a separate article on the right to habilitation and rehabilitation. PWD, particularly in developing countries, continue to be deprived of the right to take part in society and develop of their own capacity because of missed opportunities for education, social counseling, and training on how to cope with daily life activities and assistive technologies. Mortality is high, and many children with disabilities do not reach adulthood. The lifespan of people with Spinal Cord Injury in Africa are sometimes only months, or a few years. This is not because of the injury itself but because of the lack of rehabilitation. RI highlighted the fate of persons with epilepsy who are not represented at this meeting, who form part of the large group of PWD often referred to as people with chronic illness, chronic disease or medical disability. 85% of the 50 million people with epilepsy do not have access to rehabilitation. Yet, as demonstrated by people with epilepsy in the industrialised world, those who have rehabilitation can live a fulfilled life. Habilitation describes measures to support persons who are born with a disability, rehabilitation describes measures for persons who become disabled in the course of their life. Both will allow a PWD to acquire the competence to lead a fulfilling life, to overcome barriers, stigma and discrimination. The placement of both in proximity to health risks reinforcing the medical model of disability and is a violation of the rights and dignity of PWD. Both must be gender sensitive.
IDC appreciates comments by delegations that rehabilitation as defined in the Alma Ata Declaration incorporates a comprehensive and holistic approach. However the practical experience of PWD in most countries in the world is that rehabilitation remains strongly oriented towards its medical aspects. The WHO, UNESCO and the ILO have issued a joint position paper on CBR, which underlines the different elements of rehabilitation ( http://www.ilo.org/public/english/employment/skills/download/jointpaper.pdf). This underscores the importance of a stand-alone article not related to healthcare. The CBR concept was developed so that high quality rehabilitation can be implemented in poorer communities. While well-trained professionals play a vital role in the referral system of CBR, studies have shown that 2/3 of rehabilitation can take place at community level without the direct involvement of trained staff.
The IDC text underlines the principle that no one should be forced to participate in a habilitation or rehabilitation program against their will. The IDC also calls for greater consistency in references to "assistive technology" or some other agreed upon term.
Several international and regional instruments draw a distinction between health and rehabilitation: Rules 2 & 3 of the UN Standard Rules (http://www.un.org/esa/socdev/enable/dissre00.htm); Article 23 (3) CRC; ILO Convention 159; and Articles 11 & 15 of the European Social Charter.

The WHO restated its comments during AHC4 on 11 of the Articles of the convention, on health as a fundamental right, a multi-sectoral concept, and one in which medical care forms a component. (http://www.un.org/esa/socdev/enable/rights/ahc4reporte.htm). These principles were established in WHO's constitution in 1946, and reaffirmed in the subsequent Declaration of Alma-Ata (http://www.who.int/hpr/NPH/docs/declaration_almaata.pdf), and more recently the CESCR. Irrespective of a possible separation, an article on health has to include a reference to the provision of rehabilitation services. WHO has recognized 4 inseparable components to health care: promotion, prevention, treatment and rehabilitation. Since this was established in 1978 rehabilitation has been the most neglected component. As the weakest link in health services, it has caused irreparable consequences for PWD around the world. As stated in the UNSR there must be awareness raising and training in the medical establishment to ensure that PWD are treated on an equal basis in this regard. States have an obligation to provide rehabilitation as part of their health services to PWD and people with other impediments, and it is essential this obligation is included in the article.

The ILO highlighted the various dimensions of habilitation and rehabilitation, as identified by RI, and would like to see these reflected in the text. It supported the position of the WHO with regard to incorporating these dimensions in the relevant articles, eg. vocational rehabilitation for article 22 on the right to work, medical rehabilitation for article 21 on the right to health, etc.

National Human Rights Institutions expressed concern on proposed formulations on access to health services in Article 21 that draw on Article 12 CESCR. The recognition of mere formal equality in access to health services may not go far enough in ensuring that PWD have "equal and effective access to the full range of services." In this regard the WG draft contains some useful elements that should be retained.
Rehabilitation is not an end in itself but a means. For this reason references to social and economic rehabilitation are more appropriately addressed in the relevant articles than through expression in a separate article 21(bis). Central to rehabilitation is the learning of life skills, and this issue is placed in Article 15 - independent living and being part of the community.

Korea Solidarity for International Disability Convention called for a careful approach to the concept of "rehabilitation" given the paradigm shift from the individual to the social model and from the rehabilitation to the independent living model. This evolution should be reflected in this article. The relationship between references in Article 17 and 22 to so-called occupational, vocational and educational rehabilitation is unclear. The possibility that the rehabilitation approach would be applied to every disability issue is a cause for concern because this approach is likely to see PWD as subjects of change.

Latin American Region Disabled Confederation drew a distinction between the various components of the right to health as outlined by WHO that applies to all people, and as they apply to PWD whose healthcare may be linked to their disability. Governments must be mandated to provide health coverage for PWD and this should be a part of their budgets. In addition, there is a difference between the rehabilitation of of nondisabled people who are temporarily affected in the treatment of disease, and the system of rehabilitation for PWD which, in addition to health extends to their employment, their daily life and their interaction with their environment. For this reason a separate article on rehabilitation is needed in this convention.
In a world where the gulf between the rich and poor is widening, governments must in addition recognise that PWD in their large majority live in communities that do not have economic resources. Government resources should therefore be focused on reaching these PWD to ensure their access rehabilitation in their communities.

Mental Disability Rights International supported the position of NZ, Canada, Costa Rica and Jamaica that the chapeau of Article 21 should track language from Article 12.1 CESCR on the 'highest attainable standard of physical and mental health" ie by inserting "physical and mental" before "health." This addition is important because mental health issues are often overlooked in the right to health or misunderstood as a disability issue.
As stressed by South Africa, Argentina, Costa Rica, Chile, Uganda, health care services must be community based. There is an essential link between the right to health / rehabilitation and the right to community integration. Health care and rehab services are the means towards implementation of the right to integration. Without such a link, so called treatment programs may actually keep people segregated from society. What is called "rehabilitation" is often "busy-work" imposed on people in place of real opportunities for building the skills necessary for full social participation. In this sense para (c) is not sufficient, because it focuses only on the geographic aspect of the problem. Para (c) misses the fundamental element on full social integration as stated in the Montreal Declaration on Intellectual Disability, adopted in 2004 by the Pan American Health Organization (http:// www.aamr.org/pdf/DeclarationMTL.pdf). This principle was reinforced by Paul Hunt, Special Rapporteur on the right to health in his 2005 Report to the Commission on Human Rights particularly in paragraphs 84 & 86. (http://daccessdds.un.org/doc/UNDOC/GEN/G05/108/93/PDF/G0510893.pdf?OpenElement) Para (c) should therefore provide for a right to health and rehab services, to promote maximum possible social inclusion and individual independence and integrated into mainstream health and rehab services.
Whether or not Article 21(bis) is created, Article 23 (3) CRC's references requiring PWD access to "education, training, healthcare, habilitation and rehabilitation services, preparation for employment and cultural opportunities.... " provides a useful guideline to governments for inclusion this Convention.
As noted by the ESCR Committee and the Special Rapporteur, the right to health encompasses both negative and positive obligations. The negative obligations are freedoms which take immediate effect, not subject to progressive realization or resource availability, and includes the right to be free from nonconsensual treatment. Given the long and accepted history of nonconsensual / forced treatment for PWD around the world, this issue goes beyond the right to personal integrity, the prohibition of cruel and unusual treatment, or the right to privacy, and should therefore also be highlighted in Article 21. An article on the right to health should make explicit the right of every person to an individually prescribed plan developed in collaboration with that person, to be reviewed regularly and revised as necessary when the person's condition changes and when the individual so chooses.

Landmine Survivor's Network (LSN), on behalf of the IDC, highlighted three factors that emerged from the previous discussion on Article 20 on mobility: firstly, access in the broader sense; secondly, access in the personal sense; and thirdly, freedom of movement. While some of these elements can be moved to other articles, the IDC is concerned that the concept of 'personal mobility' might be lost. Personal mobility is individual and must be seen in the broadest sense: assistive technologies, augmentative devices, mobility aids etc. In order to ensure that this concept is retained in the convention the IDC supports New Zealand's proposal for Article 15 (d) bis, amended such that it clearly establishes that the right to live in the community is for everyone, and not just for people who the government decides ought to live in the community. This is a right that should "have no strings attached."
The IDC also supported the substance of Kenya's proposed Article 20 bis and suggests that its content also include a reference protecting PWD who are refugees and asylum seekers from discrimination, as stated in para 20(e). As noted by Liechtenstein, if the concept if personal mobility is not retained then the PWD will not actually be able to get to the accessible building.

The WBU on behalf of the IDC introduced a new element not yet reflected in the convention: indigenous people with disabilities who face multiple discrimination. PWD are as diverse as the world's population and these groups must be specifically recognized so that their needs are also protected from the cradle to the grave.

The WNUSP clarified that the reference to medical records in Article 14 on the right to privacy was not specific enough, given the paternalism that governs the way PWD are treated in this context. Informed consent should be dealt with in an unequivocal way in Article 21 as a right that applies to all PWD, in addition to the recognition of their full legal capacity without exceptions in Article 9.

The Society for the Protection of Unborn Children voiced concern over a possible codification of abortion and euthanasia, because 'sexual and reproductive health services' in 20(a) are not part of any international legally binding document, and therefore should be deleted. There is no reason to single out one type of service, especially since it is not clear what sexual health services constitute. The right of persons to marry and found a family should be emphasized, as per the UDHR and CCPR. Language in regard to medical treatment needs to be clarified given that PWD are often vulnerable to denial of treatment and food and water because of their perceived quality of life. The term "worth" should be added to "dignity" in this Article and throughout the document as stated in the UN Charter. The term "dignity" has been corrupted to justify assisted suicide.

The Chair brought the attention of the Committee to para. 94 of the Report of AHC 4 (http://www.un.org/esa/socdev/enable/rights/ahc4reporte.htm), emphasizing the general agreement that this Convention does not interfere with individual states domestic policies with regard to family size, reproduction etc. It only seeks to ensure that PWD are not treated any differently from other people in relation to such issues.

National Right to Life proposed 2 new paras to ensure that PWD are treated on an equal basis with others because they are often perceived as having a lower quality of life: (k) ter to "ensure that PWD will not be denied nutrition and hydration necessary to preserve or sustain a person's life regardless of method of administration or perceived quality of life"; and k(quat) to "ensure that PWD will not be denied life preserving treatment with the intent of ending the disabled person's life". In a time of limited medical resources, the "right to die" could evolve into "the duty to die" when applied to PWD.

Thailand supported a separate Article on rehabilitation and habilitation, and noted in this regard that the EU proposal for 21(bis) could be improved with an additional reference to the employment of rehabilitation professionals. Other rehabilitation related services should be streamlined into their relevant articles. It stressed that references to health services, including any health related aspects of rehabilitation, being provided on an equal basis with others, must be retained in Article 21.

The Chair highlighted the overwhelming support for a separation of health and rehabilitation. Those delegations supporting a single article indicated flexibility. He underscored that no issues should be lost due to the split especially the health-related aspects of rehabilitation. The broad definition of health - particularly adopted by the WHO - should be kept in mind. The chapeau and other paragraphs using qualifying language need to be strengthened in the context of the existing right to health. The language of Article 12 CESCR should be followed, particularly to include mental and physical health. Some paras are duplicated elsewhere, particularly (f), (g), (k), (l), (m); if they are streamlined into the relevant articles no elements should be lost and the same terminology should be used. Questions were raised on "secondary disabilities", which were partly clarified by General Comment #5, para 34. Suggestions to delete the last phrase in para (a) were based on a fear of creating new rights. The Chair reassured that no new rights were being created and that no laws on reproductive health and related issues would have to be adopted by States Parties as a result of this provision. The AHC6 report may need to reiterate this point, already made in previous sessions. There were also references to the situation of PWD in rural areas, and the importance of CBR, public health outreach to PWD, and the early detection of disability. The EU proposal to combine (h) (i) and (j) in a streamlined formula was supported. Proposals by Australia and the Holy See found support. There was discussion on the affordability of health care and free health care. On progressive realization one delegation pointed out that Article 4 - general obligations - was not a hybrid article on civil/political and economic/social rights and that therefore, reference to the progressive nature of Article 21 should be made. This remains an open issue. No one has argued that ESCR should not be progressively realized.
The proposed Article 21 bis would cover both habilitation and rehabilitation. Most delegations agreed that there was no right to rehabilitation as such. The article would deal with social, professional, psycho-social issues. The EU proposal for Article 21 bis received support.

The Chair thanked the Facilitator from Jordan. Article 23 - social security - would be discussed next, followed by Article 22 - right to work.

ARTICLE 23 - SOCIAL SECURITY AND ADEQUATE STANDARD OF LIVING

The Chair highlighted the need for consistency with the CESCR, particularly Article 9 on social security. There has been some discussion of whether the committee should address 'social security' first followed by 'standard of living'. The WG text is quite prescriptive and there are also some linguistic and technical issues. With regard to footnote 97 of the WG text (http://www.un.org/esa/socdev/enable/rights/ahcwg.htm), the Chair noted that the CESCR does refer to social security. The issue of progressive realization recurred, however, it will have to be taken up as a general issue elsewhere. The term 'severe' in (c) raised concern because it was difficult to define or could be prejudicial. Also, the question of how to deal with families of PWD recurs in this paragraph. In (d) there was some discussion on 'earmarking percentages'. In (2) the reference to 'clean water' should be reconsidered since this is not recognized in the CESCR. The Chair pointed to the various footnotes of the WG text and invited statements on the article as a whole.

New Zealand supported South Africa's comment at AHC3 that this article is a means to address the extremely poor living conditions of PWD. Therefore, and as suggested also by Jordan, NZ suggests that para 2 on an adequate standard of living should be moved up to become para 1. The reference to 'access to clean water' in what would become para 1 could be moved to a provision in Article 21 on public health programs to circumvent the discussion on creating a right. (http://www.un.org/esa/socdev/enable/rights/ahc6nz.htm), NZ also proposes a new 1(bis) on access of PWD to states' development programs and poverty reduction strategies including international aid on an equal basis with others. With regard to the subparas (a) is covered in Article 15 - living independently or in a possible Article 21 bis - rehabilitation. Paras (b) and part of (c) are covered in the chapeau. The other part of (c) is too prescriptive as is the second part of (d) and all of (e). It proposed a new (d) bis to provide assistance to PWD and their families to meet the extra cost incurred because of disability. In (f) 'ensure' should be replaced with 'encouraged' due to national provisions in New Zealand where the state cannot intervene in the decisions of insurance companies to read: "encourage insurance providers to consider applications for insurance from PWD in a fair and reasonable manner..."

Japan welcomed New Zealand's proposal and agreed that the article should prioritise the issue of standard of living; accordingly current para 2 should be moved up. The reference to 'clean water' should be removed to ensure conformity as 11 (1) CESCR does not cover this aspect. In (c) 'severe' should be deleted because this is a relative term, like "multiple". As a matter of principle any reference to 'families' should be deleted as PWD are the focus of the convention and families are often the cause of PWD isolation. The second part of (d) on earmarking should be removed as Japanese law does not provide for this even for its general population. Para (e) should be removed entirely as this has no reference in existing human rights legislation, and there are rich PWD who do not need tax exemptions. In (f) it preferred NZ language of 'in a fair and reasonable manner' which should replace the reference to "without discrimination". Private insurance companies determine premiums based on risk. However PWD should not be denied coverage entirely so Japan supports retaining this para with NZ's amended language.

Thailand highlighted that in countries where there are strong anti-discrimination laws, private insurance companies do not discriminate against PWD. Yet when conducting business in other countries that have weak anti-discrimination laws, these very same companies reject applications or withhold information that lessens the opportunities for PWD to have health or life insurance on a basis of equality with others. The substance of para (f) should therefore be retained and its language improved to read "ensure access by PWD to life and health insurance .. " This would follow the pattern of previous subparas by focusing on access. Thailand asked for "empathy and understanding" from the Committee with regards to people with severe and multiple disabilities in para (c), because they need special attention. There are ways in which they can be defined, and this can be incorporated into Article 3.

Serbia & Montenegro endorsed the position of NZ, Japan and others to reverse the order to deal with adequate standard of living before social security as a better reflection of this Article's priorities. It proposed that Costa Rica's amendments from AHC3 to amend the original para 1 so that "adequate standard of living" is mentioned with the reference to social security as well. It welcomed New Zealand's proposals for (1) bis and 1(d) bis. Para (c) should be deleted because there are alternate ways of dealing with issue as proposed by NZ. As stated by Japan and the EU, the last sentence in (d) and para (e) should be deleted. The EU's AHC3 proposal provides preferred alternative language for para (f) (http://www.un.org/esa/socdev/enable/rights/ahc3reporte.htm), including an equality clause. 'Clean water' may not need to be spelled out explicitly as references to food in the CESCR could be interpreted to already cover this. Given the focus of this article, references to families and poverty reduction strategies should be included.

Jordan agreed that adequate standard of living should be mentioned first followed by social security. Para (d) is already covered in the chapeau and should be deleted. 'Social safety nets" as a means to fight poverty may be less ambiguous than references to "social security" which may not be recognized in some countries.

Israel emphasized the centrality of this article given that PWD the world over are the poorest of the poor. This should be recognized at the outset with an overall statement of purpose in Article 2. Israel made a number of additional proposals: http://www.un.org/esa/socdev/enable/rights/ahc6israel.htm. The order of WG text paras 1 and 2 should be reversed. As noted also by NZ the issue of compensation for additional costs incurred should be incorporated in (1) (a) and Israel provided alternative text. It reiterated its proposal from AHC3 to replace 'access' with 'entitlement' in (a), (b) and (c) as this is clearly the intended meaning of the paras. In (b) 'members of minority groups with disabilities' should be added. In (c) ''persons with severe and multiple disabilities' is too prescriptive and should be deleted, with new language recognizing the link between the degree of disability and the extent of the entitlement. The IDC's proposal on shelter is a preferred alternative for (d). Para (e) should be deleted as it is too prescriptive. In (f) a distinction should be drawn between health and life insurance. The former is part of social security provided by governments and should be retained. The latter is part of the private sector and can therefore be dealt with using the language from NZ, to be provided "in a fair and reasonable manner."

The session was adjourned.


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