2. Background:
   
   Pakistan is located in South Asia, bordering the Arabian Sea, between India on the east, Iran and Afghanistan to the west and China to the north.
   
   The population is approximately 165.803,560, with 24% of people –around 38 million –living below the national poverty line and a population growth rate of 2.09%.
   
   The most recent census statistics on disability, from 1998, show that there were 3,286,630 people with disabilities comprising 2.49 % of the total population. This is probably an underestimate.
   
   The Disabled Person (Empowerment and Rehabilitation) Ordinance of 1981 protects the employment, welfare and rehabilitation rights of disabled people and is implemented through the ‘National Council for the Rehabilitation of Disabled Persons’.
   
   Most disabled children do not attend school. Overall at primary level, 50% of girls and 28% of boys are out of school.
   
   According to the World Health Organization, health investment is low and more than 75% of health financing is out-of-pocket. The Pakistan Ministry of Health estimates that 80% of the population has access to local health services in rural areas and 100% in cities but reports significant regional differences.
   
   Nursing is not considered a prestigious healthcare profession, which is reflected by lower number of nurses (48,000) compared to physicians (116,000). There are no specific statistics for rehabilitation professionals, but combined, there are approximately 19,000 occupational therapists, physical therapists, Speech Language Pathologists, psychologists, medical interns and dietitians. The Pakistani physiotherapists are well educated university graduates; but lack the hands-on skills required by trained physical and occupational therapists. In Pakistan, there is little opportunity for professional development and continuing education courses are almost unheard of.
   
   In October 2005 an earthquake devastated the Kashmir region of Pakistan. As a result, an estimated 95,000 people were killed while another 100,000 people sustained injuries that were mostly orthopedic and neurological in nature. It was estimated that there were up to 1500 people living with a spinal cord injury as a result of the disaster. Most of the people injured were young adults, women, and children who were in their homes and schools at the time of the earthquake. Additionally, according to official figures, over 200,000 people have fled from their home, mainly in Bajaur, to Lower Dir Mardan, Charsadda, Nowshera and Peshawar since August 2008. Civilians in Swat fled within the district to Mingora and beyond – to Lower Dir, Malakand and Peshawar. Since October, fighting has intensified in Mohmand Agency, forcing people to flee, mainly to the plains around Peshawar, including the twin cities of Islamabad and Rawalpindi. Not only do these people not have homes but they also have injuries secondary to the fighting. They have difficulties feeding their families, let alone seeking rehabilitative care.
   
   Every nation has to face the challenges of disability but these are particularly marked among the world’s poorer nations. In recent years many new insights have been gained on assisting children and adults with disabilities to live fuller lives in community settings inclusive community services are often the most effective in ensuring holistic and accessible support that enables greater freedom of lifestyle choices. They provide person-centered care and support services within the individual’s home and community.
   
   Three themes re-echo throughout modern policy statements:

• People with disabilities have many needs in common with their fellow citizens who are ‘non-disabled’ and they are entitled to the same rights and responsibilities as anyone else.
• The lives of people with disabilities are richer if they remain connected with their families and have access to community resources and amenities.
• A key role of staff specializing in disability work is for them to share their knowledge and expertise so that many more people can be supported in their local communities.

These services nurture the skills and resources available within communities and help them cope with the demands of poverty as well as disability. They mobilize the supports available in society and work in partnership with other agencies to provide a better quality of life for everyone in the family. They seek to remove the attitudinal and as well as physical barriers many people with disabilities face in their daily lives. Their goal is to encourage the social inclusion of people with disabilities in education, in employment and community life.