latest the blog Children with disabilities: accessing healthcare in Pakistan The 7th in a series of posts that portray the complex journeys of individual asylum seekers who come to Asylos, this edition of our asylum stories brings you the journey of Qudrah*, whose asylum claim rested on the treatment her family experienced in Pakistan and because of her children's disabilities and their inability to access adequate healthcare to treat them. by Julia Z. Pohl and Olivia Baskerville The Story When Qudrah, a wife and mother of three, arrived in Belgium from Karachi in 2011, she had a story to tell: Life had not been easy for Qudrah and her family in Karachi. Having married outside her husband’s baradari, or familial patrilineage, she and her husband were already ostracised by his family, and struggling to bring up their three children. When their son and eldest daughter developed physical and mental illnesses requiring intensive medical care, they did their best to provide. Her husband’s family blamed the marriage to Qudrah for the children’s disabilities, and repeatedly urged him to leave her and marry within his baradari. When he would not, they refused all familial support and actively rejected Qudrah’s family. As any parent knows bringing up children without a social support system is no easy feat, but bringing them up in Pakistan, where family groups often play the role of social support, was virtually impossible. Unfortunately, Qudrah told her lawyer, their family’s views were not exceptional within Pakistan. Other people in the village patronised her and her children, ignored their presence, and made efforts to socially exclude and discriminate against them. Qudrah and her husband did everything in their power to give their children the care they needed to go to school and integrate into their social environments. But time and again Pakistan’s health care system proved to be inaccessible to them. Qudrah felt that the government hospitals were either unable or unwilling to provide for their children’s needs, resulting in a total lack of treatment. She and her husband sank large amounts of money into private care with the hope that they could help their son to walk again and to battle their daughter's severe depression. But they soon realised that private sector healthcare was just as incapable of delivering what they were paying for, including physiotherapy essential to their son’s mobility. But time and again Pakistan’s health care system proved to be inaccessible to Qudrah and her family. As far as Qudrah and her husband were concerned, this was an impossible environment for their children to survive in, especially for their oldest daughter and their son, who are in urgent need of continuous care and medical treatment. In spite of their parents’ strongest efforts, their ostracisation from a wider society prevented them from accessing adequate care. So Qudrah and her husband made a decision that they hoped would change their lives and their children’s future for the better: they fled Karachi for Belgium and filed an application for asylum. For the next five years while she waited on a decision, Qudrah worked to ensure that her children received medical care and education, enabling them to fully participate in social life, make friends and plan their futures in Belgium. She and her husband were devastated when in 2016 the authorities dismissed their application for asylum on the grounds that the required care was allegedly available and affordable in Pakistan. With only thirty days to appeal the decision, their lawyer turned to Asylos for help to investigate whether treatment was indeed available and affordable and whether the children would face potential dangers such as physical violence and discrimination in a city like Karachi. The Research Qudrah’s lawyer asked Asylos’ researchers to look into the availability and accessibility of mental and physical healthcare in Pakistan, and whether there were any barriers on the basis of physical and mental disabilities. We found indicators that despite the availability of healthcare in Karachi, it was limited to those who can afford it. Sources suggested that public health care was limited, with restricted capacities for primary care, leaving a gap between the poorest and those who could afford private healthcare. The Ministry of Health was dissolved in 2011 and only one province in Pakistan had since developed an ‘essential package of health services’ for its citizens, while the private sector suffered from a lack of regulation, according to USAID Health and other sources. Services for children with disabilities and rehabilitation centres available in Karachi had a similar lack of capacity. Our report also cited evidence of aborted attempts in Karachi to implement a law requiring free treatment at public hospitals for the rehabilitation of persons with disabilities. Our research found indications that although by law there were equal rights for children and adults with mental and physical disabilities, the reality in Pakistan was very different. There were instances in which health care staff caring for families like Qudrah’s were subject to violent attacks and children with disabilities were socially excluded. We uncovered information that most children with mental and physical disabilities cannot attend school, as they often suffer severe social, political and economic discrimination. There were instances in which health care staff caring for families like Qudrah’s were subject to violent attacks and children with disabilities were socially excluded. Qudrah’s lawyer included sources that we found in the appeal to show that if Qudrah and her family were to return to Pakistan it could expose the whole family to a life of social and economic exclusion and potentially violence. After a long battle to safeguard her family and build a new and better life for them in Belgium, Qudrah and her children were granted protection on medical and humanitarian grounds, which allowed the whole family to stay together in Belgium. Qudrah’s story is just one example of a humanitarian situation in which the existence of legislation and infrastructure does not necessarily lead to a quality of life with adequate access to medical care, protection, or security. Asylos works every day with lawyers like Qudrah’s to make sure that asylum and protection claims are based in factual evidence and that asylum-seekers have access to high-quality information.