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222 Human Rights Watch correspondence with Arun Tiwari, Deputy Director, Department of Education, and Chief of the Inclusive Education Section, Ministry of Education, June 8, 2011. 223 Human Rights Watch interview with Lakshmi Joshi, Resource Teacher, Mahendranagar Secondary School, Kanchanpur district, April 4, 2011. Human Rights Watch interview with Prem Raj Pathak, Principal Teacher, Balmandir School, Tuphandada, Dhadeldhura, April 5, 2011. 224 Human Rights Watch interview with Arun Tiwari, Deputy Director, Department of Education, and Chief of the Inclusive Education Section, Ministry of Education, Kathmandu, April 2, 2011. 225 Human Rights Watch interview with Jagat Bahadi Chandar, Assistant Head Teacher, Mahendranagar Secondary School, Mahendranagar, April 4, 2011. We want him in mainstream school because there he can integrate with other children. If we isolate [him] now, he’ll be isolated from society.226 However, given the lack of awareness among parents about the right to education, and limited access to and lack of specialized instruction and care in general schools, local organizations of people with developmental disabilities and their families in Nepal question whether an inclusive education system is viable in Nepal.227 Parents expressed a desire for special schools and vocational training, where their children could learn skills to live independently.228 In fact, the Disabled Welfare and Protection Act requires that government-run vocational training programs include people with disabilities.229 However, young people with disabilities are not integrated into these programs. As a result, many parents were concerned about how their children with intellectual or developmental disabilities will be cared for in the future. Resource classes are intended as a transition to mainstream schools, but children in classes designated for “mentally retarded children” often stay in the same resource class for years.230 Children in these classes range in age from 6 to 17, some are even in their 20s. In effect, these resource classes perpetuate segregation. Resource classes and special schools for deaf and blind students are only up to Class 5, at which point these students must join a mainstream school, often with teachers who have little or no training on how to adapt teaching methodologies.231 While deaf children and their parents in Nepal, in principle, support an inclusive approach to education, they have concerns about how this will work in practice. Sumitra, a young deaf woman studying at Sirjana Deaf School, said: “I would like to go to school with hearing kids but I can’t. We don’t share a common language.”232 Organizations of deaf people in Nepal support separate schools for deaf children. Birendra Pokharel, the President of the National Federation of the Disabled Nepal explained, “The Deaf Federation believes in special education. They are
afraid of sending children to general stream schools because their drop-out rate is higher.”233 There is no official data on the drop-out rate disaggregated by type of disability.234 Ineffective Social Support According to the Interim Constitution, children with intellectual or developmental disabilities, among other marginalized groups, are entitled to “special privileges from the State to ensure their secure future.”235 The National Planning Commission has developed a comprehensive social protection policy, which includes social protection mechanisms for children with disabilities, women and other marginalized groups. Programs are carried out at the village level and include cash transfers, employment, income-generating activities, community-based rehabilitation and the distribution of assistive devices (such as wheelchairs, canes and prosthetic limbs).236 The Nepalese government issues identity cards on the basis of four classifications of disability, which entitle children to free education, discounted bus fares, monthly allowances and other services provided by the state. Individuals with a “profound disability” receive a red identity card, those with a “severe disability” receive a blue card, those with a “moderate disability” receive a yellow card, and those with a “mild disability” receive a white card.237 Based on the classification, children with disabilities receive monthly allowances (ranging from 50 rupees to 1000 rupees per month), as part of the government’s social security scheme.238
Many children with disabilities, particularly in rural areas, are not benefitting from these allowances because of long distances to the District Administration Office (where the cards are 2  33 Human Rights Watch interview with Birendra Pokharel, President, National Federation for the Disabled Nepal, Kathmandu, April 2, 2011.
234 Human Rights Watch interview with Ganesh Paudel, Department of Education, Kathmandu, April 7, 2011. 235 United Nations Development Programme, “The Interim Constitution of Nepal, 2063 (2007),” 2008, http://www.ccd.org.np/new/resources/interim.pdf (accessed May 31, 2011), section 18, 22(4), 35(9). 236 Human Rights Watch interview with Surya Prasad Shrestha, Undersecretary and CRPD Art 33 Focal Point, Social Protection Section, Ministry for Women, Children and Social Welfare, Kathmandu, April 7, 2011. 237 Asia Pacific Network for Independent Living Centres, “Activity Report from Nepal,” April 13, 2010, http://apnil.org/category/nepal/ (accessed May 12, 2011). 238 Parents and disability advocates have argued that the monthly allowances are too low and have not been updated since they were set some 14-15 years ago. The Ministry of Education is currently reviewing the allocations. Human Rights Watch interview with Ganesh Paudel, Department of Education, Kathmandu, April 7, 2011. Human Rights Watch telephone interview with Suryabhakta Prajapathi, Director, Resource Center for Rehabilitation and Development, June 3, 2011. distributed), high transportation costs, parental attitudes that such cards will further marginalize and thus foster discrimination against their children and wrong or no diagnoses.239 As noted by the CRC Committee, “[t]he question of children with disabilities living in poverty should be addressed by allocating adequate budgetary resources as well as by ensuring that children with disabilities have access to social protection and poverty reduction programmes.”240 The CRPD requires that education and health services should be provided in or near the communities in which people live.241 The CRC Committee has urged governments “to make public transportation safe, easily accessible to children with disabilities, and free of charge, whenever possible, taking into account the financial resources of the parents or others caring for the child.”242 An official in the Ministry of Women, Children and Social Welfare admitted, however, that there is no proper planning for the significant amount of money budgeted for these programs.243 In Dadeldhura district, for example, where there is a quota of 70 children with disabilities in schools, only 47 students were getting allowances and attending residential schools. The other 23 children were not getting benefits and thus not attending school.244 While financial support can facilitate education for children from families with limited resources, the distribution of allowances to children with disabilities does not address other underlying causes of exclusion and discrimination.245 The government and international donors have acknowledged that, while scholarships and other incentives to encourage the participation of marginalized children, including children with disabilities, has generally been positive, the quotas and amount distributed to individual students is inadequate.246
Some parents told Human Rights Watch about a range of problems they encountered while trying to register for the identity cards, including refusal to register and misclassification. Subarna, the mother of a young woman with an intellectual disability and autism, said that when she asked for the appropriate card for her daughter, the government officials at the District Administration Office told her, “She has ears, eyes. Why does she need a red card?” They were told to go to the doctor first and come back. Subarna explained that it is difficult for her to take her daughter to the doctor because she is very active. Sometimes they have waited for hours only for the doctor to ask them to come another day.247 Mayakuna, the mother of a six-year-old girl who does not have full control of her limbs on her right side, told us that she was issued an identity card indicating that she has Down’s syndrome.248 Another child who is autistic was issued an identity card stating that he is deaf. “[The officials] said a person who can’t talk is deaf,” his mother told Human Rights Watch.249 Some parents did not want to register for the identity cards because of concerns of added stigma in the community. The mother of an eight-year-old with possible hearing impairments and learning disability told Human Rights Watch that she hoped her son would improve his hearing, so she did not apply for a card: If I get the identity card, people will say “this is a disabled child,” so there may be more teasing. There is another woman in the community who has deaf/dumb children and people say “latto.” It’s a disgusting word. If I get the card, then it’s a license for people to use such words.250 To address these challenges, District Administration Offices should distribute the identity cards closer to village communities and have a doctor present when the identity cards are being issued. 2  47 Human Rights Watch interview with Subarna Chitrakar, mother of 30-year-old woman with intellectual disability and autism and founder of SUNGAVA, a vocational training program for young women and girls with intellectual disabilities, Kathmandu, March 30, 2011.
248 Human Rights Watch interview with Mayakuna, mother to a six-year-old girl with physical disability and possible developmental disability, Kanchanpur district, April 4, 2011. 249 Human Rights Watch interview with Seema Oja, mother to Akash, a 9-year-old boy with an intellectual disability, Dhangadi, April 6, 2011. 250 Human Rights Watch interview with Srijana, mother to Sameet, an 8-year-old boy with a possible hearing impairment and/or learning disability, Dadeldhura, April 5, 2011. School Fees The cost of education can be a significant barrier for children with disabilities, some of whom face significant economic burdens because of their disabilities. According to both international law and national policy, children with disabilities are entitled to free primary education.251 However, Human Rights Watch found that, in some instances, families are requested to pay fees for admission, exams or uniforms for government-run schools, leading some parents not to enroll their children in school.252 For example, in a resource class for the blind in Dhangadi, the children are required to pay as much as 300 rupees (about US$4) per year for exam fees.253 Mayakuna, the mother of a six-year-old girl with a physical disability and possible developmental disability, said: I want to get the allowance from the government. Then I can add more money from the family and pay for school. There are admission fees. Also fees for exams. I know the ID card is there but I don’t know what it is. I have no information about the benefits. The Disability Human Rights Centre, a disability advocacy and litigation organization, is still receiving complaints from parents who are paying school fees for their children.254 The CRC Committee and the UN Special Rapporteur on Education, among others, affirm that free basic education should be provided to all children, including children with disabilities.255 Indeed, this is the decision of the Supreme Court, in the case of Shudarson 2  51 Disabled Welfare and Protection Act of Nepal 2039 (1982), Special Education Policy (2053/1997), provisions in the Education Act (2028/1971), Education Regulations (2049/1992), 1994 Disabled Protection and Welfare Regulation, Paragraph 15 (1) and (2). The 1994 Protection and Welfare of Disabled Persons Act states that the government should give
assistance to institutions providing education and training to people with disabilities and that free education up to a specific level will be provided to up to two children of a person with disability. 252 Human Rights Watch interview with M.M. Wara, Inclusion Project Coordinator, Handicap International, Kathmandu, March 29, 2011. Human Rights Watch interview with Prabha (not real name), mother of 20-year-old man with mild intellectual disabilities, Kathmandu, April 3, 2011. Human Rights Watch interview with Mayakuna, mother of a 6-year-old girl with physical disability and possible developmental disability, Kanchanpur district, April 4, 2011. Human Rights Watch interview with Manju, 17-year-old girl with a physical disability, Pokhara, March 31, 2011. Human Rights Watch interview with Indra, 10 year old boy with a physical disability, Dhadeldhura district, April 5, 2011. 253 Human Rights Watch interview with Roopa Rai, teacher for the blind resource class, Dhangadi, April 6, 2011. The exam fees are 100 rupees for exam for 3 exams. Per capita income in Nepal is $440. Asian Development Bank, “Factsheet on Nepal,” December 31, 2010, http://www.adb.org/Documents/Fact_Sheets/NEP.pdf (accessed June 6, 2011). 254 Human Rights Watch interview with Shudarson Subedi, Advocate, Disability Human Rights Centre, Kathmandu, March 29, 2011. 255 UN Committee on the Rights of the Child, “ General Comment No. 9 (2006): The rights of children with disabilities,” February 27, 2007, CRC/C/GC/9, http://www.unhcr.org/refworld/docid/461b93f72.html (accessed 17 June 2011), para. 39. Subedi & Ors. v. Govt of Nepal, Council of Ministers & Ors.256 The court issued a directive order for free education to students with physical, sensory or intellectual disabilities at all levels in public schools, universities and training centers, finding that the 1990 Constitution itself has provisions for the special treatment of persons with disabilities.257 While the Court case was significant in promoting the right to education for the disability community, the government has been slow in addressing the problems.258 Impact of Lack of Access to Health Care International law requires that all children, including children with disabilities, have a right to health care services that are accessible, available, acceptable, and of good quality.259 In addition, children with disabilities are entitled to access to health care without discrimination on the basis of disability as well as early identification and intervention programs, and “services designed to minimize or prevent further disabilities.”260 Failure to ensure appropriate, available, accessible and quality medical care has direct and indirect consequences on schooling and access to education. Thus, the CRC Committee has called on governments to establish links “between early intervention services, pre-schools and schools to facilitate the smooth transition of the child.”261 U human rights instruments, including the Universal Declaration of Human Rights, the ICESCR, the CRC, and the CRPD. The ICESCR, which Nepal has ratified, specifies that everyone has a right “to the enjoyment of the highest attainable standard of physical and mental health,” and the CRPD further clarifies that this right must be upheld “without discrimination on the basis of disability.” CRPD, Article 25. Physical accessibility requires that health facilities, goods, and services be within safe physical reach for all sections of the population, especially vulnerable and marginalized groups such as children with disabilities. Physical accessibility requires equitable distribution of health facilities and personnel within the country. Likewise, the CRPD also requires that states provide health facilities close to communities, even in rural areas. CRPD, Article 25(c). Equal access may require the government to take extra measures to ensure that facilities and services are accessible for all. The CRPD further requires that accessible information be provided to people with disabilities about assistance, support services, and facilities. 260 CRPD, art. 5, 25(b). UN Committee on the Rights of the Child, “ General Comment No. 9 (2006): The rights of children with disabilities,” February 27, 2007, CRC/C/GC/9, http://www.unhcr.org/refworld/docid/461b93f72.html (accessed 17 June 2011). One of the core principles of international law on accessibility to health services is that of non-discrimination, especially for “the most vulnerable or marginalized sections of the population.” Committee on Economic, Social and Cultural Rights, “General Comment No. 14: The Right to the Highest Attainable Standard of Health,” December 4, 2000, http://www.unhchr.ch/tbs/doc.nsf/(symbol)/E.C.12.2000.4.En (accessed June 18, 2011), para. 12(b). 261 UN Committee on the Rights of the Child, “ General comment no. 9 (2006): The rights of children with disabilities,” February 27, 2007, CRC/C/GC/9, http://www.unhcr.org/refworld/docid/461b93f72.html (accessed 17 June 2011), para. 56. Children with disabilities face a number of difficulties in accessing health care including: discrimination, physical barriers, lack of accessible information about available services, and/or limited financial resources for doctor’s fees, medicines and transport, and for some children with intellectual, developmental or physical disabilities, difficulty waiting in doctors’ offices for long periods of time.262 As a result, they often do not get proper diagnoses or treatment and are not put into the appropriate school program. Community disability workers, who provide community-based rehabilitation services and raise awareness about disability at the district level, are given three months of training so they do not have the skills to diagnose many disabilities.263 In some instances, for example, deaf children are diagnosed as having intellectual disabilities. These misdiagnoses can have a serious impact on their education. For example, Human Rights Watch learned of cases where children with physical disabilities were sent to a class for “mentally retarded” children or placed in a day care center because general schools would not admit them.264 These children did not see a doctor for a proper diagnosis but were placed in such classes by the parents or the school. The brother of a nine-year-old boy with physical disability told us: [Suraj] can speak; he can understand. He can’t walk or use his left hand and arm, and lower legs since birth. We haven’t taken him to the doctor because of the cost. He didn’t go to school. My parents thought that no school would admit him. Before, he would just stay at home, but now he comes here [to the day care center].265 Lack of regular access to health care services is a particular challenge for children with disabilities. Parents of children with intellectual or developmental disabilities told us about the challenges of taking their children to visit the doctor.266 Mukunda, the father of a 13-year-old girl with autism, said:
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26 Human Rights Watch interview with Rajeev Singh, father of an 11-year-old boy 
nited Nations Human Rights Council, “The Right to Education of persons with disabilities: Report by the UN Special Rapporteur on the Right to Education Vernor Muñoz,” February 19, 2007, A/HRC/4/29, http://daccess-ddsny.un.org/doc/UNDOC/GEN/G07/108/92/PDF/G0710892.pdf?OpenElement (accessed June 17, 2011).