Everybody needs a toilet

29 Apr 2021

“It’s very basic, but it’s the first step,” says Paul Cabrera, MSF Construction and Shelter Advisor, who created MSF’s first accessibility guidelines for people working in construction. In the future, he hopes to see more accessible latrines – and more accessible health care facilities in general in MSF.

When asked, what prompted him to create the guidelines, the answer comes quickly:

“MSF is a medical humanitarian organization. One of our core principles is to assist populations in distress regardless of their religion, political belief, or country of origin. It is a natural next step to make sure that everyone can access our care. As an architect, I can help make a change.”

Before starting as a Construction and Shelter Advisor in 2009, Cabrera had already been aid worker since 2004. He had worked with MSF in DRC, Ethiopia, Haiti, Liberia, and Pakistan in construction and logistics.

His prior experiences from those projects helped to make sure that the guidelines are practical.

“Most of the time, we do not have architects present in our projects. The guidelines had to be basic, so anyone working in the construction could follow them. At the same time, the guidelines are serving another purpose as well – they help raise awareness about accessibility and people with disabilities.”

The process started by mapping what kind of accessibility documents already were in use in MSF and comparing them with the documents used by ICRC and Architects Without Borders.

Because much of the guidelines had to do with building accessible restrooms and showers, Cabrera worked closely with Water and Sanitation advisors who could provide expertise in this field.

The covid pandemic gave a last boost to the project as one of the canvassers who was a trained architect, and couldn’t work due to the lockdown, could help finish the manual.

In the last phase of the process, Cabrera consulted his colleagues in the other operational centers. After their feedback, the manual was ready to be handed out in the briefings to the people working in construction.

MSF often works under challenging circumstances, which might mean some extra difficulties in building facilities.

Sometimes the biggest barriers for accessible construction are attitudinal. If people with disabilities are invisible in society, it might be difficult to argue why we need to build ramps for people who seem to be non-existent.

“It becomes a vicious cycle. When facilities are not accessible, the patients with disabilities are not showing up. And when they don’t show up, it gives the impression that there aren't any people with disabilities and no changes that would make the facilities more accessible are made.”

Sometimes the physical and attitudinal barriers exist at the same time. That was the case in a project in CAR that Cabrera was visiting.

“The project was in a very remote area, and there was a lack of building materials and we had to improvise with what was available to build a ramp to our clinic. Originally the ramp was built for stretchers, but immediately after it was ready, people with wheelchairs, children, and pregnant women started using it as well. It was a rewarding experience for the staff.”

People with disabilities became visible.

In the future, Cabrera hopes to see that all our health care facilities are checked regularly together with the patients. The patients help with recognizing potential barriers to care and help to find solutions to work around them. Another goal is that all healthcare facilities would have a certain ratio with accessible toilets and showers.

The Project on Inclusion of People with Disabilities recommends contacting and collaborating with Disabled People’s Organizations. They can give great insights to how MSF supported facilities and services can be made more accessible for persons with disabilities.

This year Cabrera is also collecting data on how many projects are making sure that patients with disabilities have access to our health care facilities by implementing the standard measures for accessibility.

“I’m super happy that we’re finally giving more importance to this topic. When we were making these guidelines, we realized that we were already late. We could have done this a long time ago.”

Do you know someone working in construction in humanitarian settings? Please find the accessibility guidelines in ENGLISH, FRENCH, SPANISH, and ARABIC.