Mohammed Ndoye: From Senegal to Morocco

I came across Mr. Ndoye on Mohammed V Avenue on the way back from shopping in the Medina. He was walking across the sidewalk on his hands, with his legs tucked under his body. He explained to me that he was born in Senegal and ran a small cosmetics and clothing business back home to support his wife and daughter. He went to public school in Senegal for eight years. He decided to come to Morocco to try to make more money to bring back to his family in Senegal. Presently, he begs on the streets of Rabat and lives in a hotel (Hotel Ajari, near the Medina) for 80 dirhams a night (approximately $10). Because Mohammed doesn't have Moroccan citizenship, he is unable to get the RAMED health insurance card that would give him access to public healthcare. While we talked to him, a woman approached him to strike up conversation, and a man greeted him and explained to us that life is very difficult for him in Morocco. Ndoye is just one of many who would benefit from equal employment laws and increased access to basic mobility devices like wheelchairs.    

Life in the Margins: Physical Disability in Morocco

 Today I took a taxi to Sale, a city across the river from Rabat where the "Centre National Mohammed VI Des Handicapes" is located. This center was contributed by the Royal Family and are located near the palace of the King. Unfortunately, the center director was not present when I made my visit and I had to fill out a formal request explaining what information I needed. I intended to ask questions concerning the current healthcare system, accessibility in infrastructure, and the education and employment of disabled Moroccans. While I waited (and I continue to wait) for a response to my request, I decided to do a little independent research online to preclude the center's response. I found a number of statistics and multiple studies done on Moroccan attitudes towards disability, and included them in a small essay discussing Morocco's problematic approach to disability and how cultural and religious context, as well as lacking healthcare and benefits, put disabled Moroccans at risk of being uneducated and unemployed.

"Disability is defined by Merriam-Webster as a condition such as an illness or an injury that damages or limits a person’s physical or mental abilities. In the United States, disabled individuals’ situations are recognized by the law and handled by the government through the social security system and the Americans with Disabilities Act. Citizens with disabilities are protected from discrimination by employers and have the ability to apply for Supplemental Security Income (SSI) to offset their compromised ability to work.

Morocco, however, has no such system in place, despite having 1,530,000 disabled citizens, making up 5.12% of the population. Disabled individuals are not recognized in the Moroccan constitution nor in any codified law. There is a very limited welfare state to act as a safety net for citizens with limited mobility, rather, they rely on the generosity of average Moroccans and hopelessly corrupt “charity associations.” Additionally, there is no way for wheelchair users to access public transportation and public buildings, as there is no accessible infrastructure. Lifts onto busses and trains are nonexistent. Elevators (outside of hotels) are also absent, even in large urban centers. When ramps are present, they are in tourist-frequented areas, and even these areas often have uneven terrain that would be difficult to travel through by wheelchair.

In order to uncover practical solutions for the marginalization of physically disabled Moroccans, we must ask questions dealing with the origins of the problem. What is the understanding of disability in Morocco and how does it affect the education and employment of disabled Moroccans? How is the healthcare system structured in Morocco? Lastly, what are the next steps to constructing an inclusive, accessible Moroccan society?

Religion plays an integral role in the understanding of disability in Morocco. There exists is a sympathetic attitude towards the physically disabled but also a set of limited expectations that inhibit their ability to lead fulfilling lives. Because Morocco is an Islamic society, many Moroccans respect Islamic concepts of generosity. Zakat, one of the five pillars of Islam, asks Muslims to give 2.5% of their savings to the poor and needy (this is not strictly adhered to, but donating to the poor in general is practiced). Thus, a culture of begging “networks,” consisting of the sick, elderly, young children and disabled, is engrained in Moroccan society. Beggardom is the expected rung on the societal ladder for the physically disabled Moroccan. 

Religion also contributes to a limited understanding of disability—In Perceptions of Child’s Disability in the Moroccan Context: Religious Perspectives Lydia Bakker asserts “religious beliefs in general have been associated with the idea that an agent has given the handicap to a particular person…49.5% of informants with disability in the Moroccan National Survey of 2004 mentioned the divine will as the cause of the handicap.” Additionally, the Maliki school of Islamic thought believes that human beings should not keep themselves busy with the question what the cause is of suffering and pain, but rather “how they should deal with it.” Surely this failure to diagnose or search for any physiological explanation for a child’s handicap makes treatment virtually impossible.

There are also cultural stigmas that prevent disabled Moroccans from developing socially at a young age. Mousa Karayanni’s essay in the International Journal for the Advancement of Counseling asserts that “overprotection -the denial process that ‘stems from refusal to see the situation as it is’- is typical to Arab families…‘The disabled child brings shame not only for the couple (nuclear family), but for the whole family (extended family).” Bakker theorizes in rural areas, the National Survey reported less disabled individuals than in urban areas (41.6% rather that 58.4%) because of denial and a high mortality rate.

Because disability is seen as divine work rather than a medically treatable physical condition or obstacle to be overcome, it widely expected that the physically disabled are dependent on a caretaker. Although physical disability does not indicate mental impairment, many physically disabled individuals find that their competency is questioned. 

These assumptions are especially problematic in the realm of seeking education or employment. Both issues came up when I interviewed handicapped individuals in Rabat Centreville and the Rabat Medina. For instance, I met a 26-year-old man named Al-Araby with what appeared to be cerebral palsy affecting his ability to coordinate his movements. Al-Araby attended a school for the handicapped for his first year of schooling and then was kicked out because he had nobody to take care of him at school (his father worked all day and his mother was at home). I also met a man named Khaled, who had been beaten blind as child, who was unable to find work despite graduating from law school. Often, the inability to complete one’s education or find work leads to poverty for the physically disabled. The National Survey from 2004-2006 determined that 67.6% of disabled Moroccan children are non-educated. “Lack of an adapted school-environment” was cited as the reason that over 50% of these absent children do not attend. Other reasons included financial means and family action. This quickly leads to problems with finding work. According to sociologist Jamil Tahri’s research, 55% of disabled people working age are unemployed.

Given the financial situation of many disabled Moroccans, what healthcare options are available to them? Like many second-world and first-world countries, healthcare in Morocco is divided into private and public care, and public care is divided into what is known as the AMO and RAMED schemes. The basic medical scheme (AMO) is required for Moroccan citizens since 2005. Employees enrolled in AMO are covered as well as their spouses and unmarried children under 21. However, public clinics are generally poorly maintained and less satisfactory than private clinics. Although the Moroccan government spends over $5 billion annually on healthcare, public hospitals are “decrepit and lack doctors [and] equipment” according to insurance informational website April International.

Citizens can also apply for a Medical Assistance Scheme (RAMED card), a form of social welfare that gives individuals not paying into AMO access to public medical care. April International asserts that “the social protection system covers all employees for sickness, maternity, invalidity and retirement.” For a higher price, Moroccans can pay into Social Security and a top-up plan, or contribute to a private insurer that allows them to go to any doctor in any clinic. The private sector is well-developed and private care is of better quality.

            How does this healthcare framework affect disabled Moroccans? Many disabled Moroccans are unemployed and therefore the AMO option through an employer is unrealistic, and an expensive private healthcare plan is out of reach. Therefore those who have the means to ability for a RAMED card and are confirmed are able to access public medical centers only. This means that the majority of disabled Moroccans are receiving limited or no care. In fact, fewer than 30% of the total population of Morocco has health insurance (New York Times, 2013). For the disabled population, only one in one hundred receive state help for dealing with the negative impact of their disability (Touahri, 2008). Given Morocco’s considerable disabled population, problematic religious and cultural attitudes towards disability, and inaccessible infrastructure, there are a number of difficult steps that must be taken before Moroccan society is inclusive to citizens regardless of ability. Primarily, families with disabled children need to have access to clinics where they can be diagnosed, treated, and educated on their disability. Having doctors who are able to explain a child’s condition will go a long way towards changing attitudes towards physical handicaps. A government-run disability education campaign that corrects misconceptions and has the flexibility to be compatible with the Maliki Islam would dramatically improve the situation of the one in four Moroccan households that are “lodging” a disabled person. Childhood education is also critical to the social integration of disabled Moroccans. According to the “reasons for non-attendance” section of the National Survey, making schools accessible would allow nearly 71,000 Moroccan children to pursue an education. Perhaps an influx of disabled children in schools would change the way the next generation of Moroccans, and employers, see their handicapped counterparts. Lastly, improving access to and the quality of public healthcare would change the lives of disabled Moroccans for the better, whether they live with a family, independently, or on the streets. An AMO plan that covers accidents at work would make sure that those who were previously employed are also afforded proper coverage. Once some of these steps are taken, Moroccans of all ability can enjoy the fruits of education and the fulfillment of a career. Perhaps in the years to come, more progressive attitudes and an accessible infrastructure with quality care will help nearly 1.5 million Moroccans realize their dreams."

Mohammed

As I was talking to Al-Araby a man riding a contraption that could only be described as a wheelchair-bicycle hybrid parked himself right next to me and introduced himself as Mohammed. He explained that his problems with growth and the formation of his hands began at birth. When I asked him what it is like being disabled in Morocco, he answered with "Al-Hamdullillah" or "thanks be to God," meaning he is grateful for the health that God has afforded him. 

Mohammed went to school until the end of college, or junior high, when his father who lived in the countryside informed him that he had run out of money for his schooling. Now thirty-nine years old, Mohammed doesn't work, but the donations he receives allow him to rent a home in the Karia neighborhood of Sale and provide for his wife and three children.  

Al-Araby

I met Al-Araby sitting in his old wheelchair near the end of the souq in the medina. Al-Araby is 26 years old but appears younger. Although he refers to himself as "handicapped" without specific knowledge of his disability, his muscle movements and speech suggest cerebral palsy. As a child he attended a primary school for the handicapped in the Khamisat area, south of Rabat. The school was founded by a Frenchman and taken over by his daughter and then Moroccans after his death. It was in this period after his death that the school experienced a decline. Previously, the children received niceties like a pair of free shoes every school year. Under the new regime, schoolchildren had to pay to receive shoes. After completing the first grade, Al-Araby was kicked out of school because he "had no one to take care of him at school." His father, who worked, came to the school to demand an answer from the administration. They offered the same answer.

Al-Araby also acknowledges the existence of charity organizations. When he approached an association for help they asked him that he write them a letter, of which he has yet to receive a reply. His old chair, he says, is cumbersome and inhibits his ability to get around the city. He has contacted the disability center in Sale about applying for a new chair but has waited four months so far for a response.

Khaled

I met Khaled on Avenue Al-Mohamed VI, crouched up against a wall with a large folder of papers spread out in front of him. Among these papers were his diplomas from law school, his various forms of identification, and a number of letters and photographs. Khaled was blind and sang as people rushed past. Unlike many of the visionless beggars in Rabat, he was dressed in jeans and a dress shirt and covered his eyes with a pair of sunglasses. Khaled was beaten blind in 1985 by his father. First his injury was to his left eye (presumably nerve damage or retinal hemorrhaging) and then complications spread to his right eye. However, he was able to continue his schooling and he graduated from law school in 2000.

In 2009 Khaled paid a man to take him illegally to Spain where he could continue his education. Shortly after his graduation, he was confronted in the street by Spanish authorities and failed to present proper documentation, resulting in his arrest and deportation back to Morocco, where it was impossible to find work. He saved 800 dirham (approximately $100) to apply for a Visa to France but was denied on the basis that his bank account balance was too low.

As for the role of government and philanthropy in his life, Khaled acknowledges that charity associations exist for the purpose of helping the less fortunate but many of them are hopelessly corrupt. King Mohammed VI has made no specific statements regarding the disabled but can be solicited for assistance in person.

One of the letters Khaled showed me was a letter to the Wali, or Mayor, of the territory of Rabat that Khaled had written on his own behalf to help him find employment.