LocationsLessons from UNDP Syria’s Community-Based Disability Inclusion Model
Scaling Prosthetic Services in Crisis: The Syria Case
July 7, 2026
Providing prosthetic limbs, psychological support, and physical therapy to persons with disabilities in Aleppo.
© UNDP Syria - Adeeb Alsayed
Since 2015, UNDP Syria has supported the scale-up of prosthetic services for persons with disabilities. What began as a response to a growing number of conflict-related amputations gradually evolved into a community-based disability inclusion model combining prosthetic service delivery, local capacity development, case management, psychosocial support, livelihoods linkages, and advocacy for the rights and inclusion of persons with disabilities.
What Challenge is Being Addressed?
Providing prosthetic limbs to persons with disabilities in Damascus.
© UNDP Syria – Tahseen Saour
The conflict in Syria created a dramatic increase in traumatic injuries, including amputations and other permanent impairments. Humanitarian estimates during the crisis pointed to very high levels of conflict-related injuries, with thousands of people acquiring permanent disabilities every month. Lower-limb amputations were particularly common, especially among civilians exposed to explosive ordnance, landmines, and remnants of war.
At the same time, prosthetic service providers were unable to meet the scale of need. Public, private, and community-based facilities existed, but their capacity was constrained by shortages of raw materials, limited financial support, disrupted supply chains, weak multidisciplinary rehabilitation pathways, and a shortage of trained prosthetic professionals. Many persons with amputations were also among the poorest and most vulnerable households, making private prosthetic services unaffordable.
For many people with lower-limb amputations, lack of access to a prosthesis meant reduced mobility, dependence on family members, exclusion from work, reduced participation in community life, and increased vulnerability to poverty and isolation. In this sense, prosthetic services carried clear human rights, social protection, and socio-economic inclusion dimensions.
However, in the context of the crisis, prosthetic services were often not seen as a priority. They were costly, technically complex, and difficult to sustain. Questions were repeatedly raised about whether such interventions were sustainable, whether they should fall under health actors, and what the exit strategy would be. UNDP Syria therefore had to develop a model that was technically realistic, programmatically defensible, and adaptable to the operating constraints of the time.
Providing prosthetic limbs, psychological support, and physical therapy to persons with disabilities in Raqqa.
© UNDP Syria - Osama Almhamd
What is the Innovation or Approach?
UNDP Syria developed a community-based prosthetic service model designed for a crisis context where rapid access was needed, national service capacity was overstretched, and direct institutional support was constrained. The model was built around several core principles.
Context analysis before service design: Before launching the intervention, UNDP reviewed the prosthetic service landscape, including public, private, and community-based providers. The analysis showed that the issue was not simply the absence of workshops, but the disruption of the service delivery system: limited raw materials, insufficient financing, limited rehabilitation integration, and unequal access for people unable to afford private services.
This led UNDP to consider several possible scenarios, including support for public facilities, financial support for individuals to purchase prostheses, support for existing NGO workshops, and the establishment of new community-based workshops. The selected model combined immediate service delivery with capacity development through local NGO and community-based partners.
Cost-conscious but quality-oriented service delivery: Given that prosthetic services are expensive and recurrent, cost-efficiency was essential. UNDP conducted market research to compare the cost of prostheses produced under the project with market prices for similar levels of technology and quality. The project did not aim to provide the cheapest prostheses, nor the most technologically advanced devices. Instead, it aimed to provide prostheses that were functional, safe, affordable, and suitable for the user’s mobility potential and the crisis context. A central technical principle was “appropriate technology”: selecting the best possible prosthetic solution within the limits of the available financial resources.
UNDP worked with national technical experts to assemble equipment locally, including routers, infrared ovens, vacuum systems, workbenches, training bars, ramps, and other essential technical furniture. This reduced the cost of establishing workshops and made the model more feasible for replication in several locations.
Prioritization and transparent beneficiary selection: The model evolved from a more intuitive selection based on vulnerability and technical judgement toward a documented, and weighted selection approach. The selection approach combined technical and programmatic criteria. Priority was given to civilians, first-time prosthetic users, women, internally displaced persons, and people in age groups with greater potential for livelihoods and labour market participation.
Building technical and managerial capacity: UNDP invested not only in prosthetic production, but also in the people and systems needed to run the workshops. Technical staff received training from national experts and, at different points, from regional/international Arabic-speaking prosthetic experts. Training also covered workshop management. This included documentation, beneficiary data management, stock management, procurement, case follow-up, inclusion, gender-based violence, occupational safety, and environmental and social considerations.
This was critical because prosthetic workshops are not simple production units. They involve hazardous equipment, chemicals, and materials; direct contact with vulnerable beneficiaries, high expectation, and the need for careful technical judgement. As a result, managing safety, quality, expectations, and follow-up became integral to the service model.
Linking prosthetics to broader inclusion: Over time, UNDP increasingly framed prosthetic services as an entry point for broader disability inclusion. The intervention was linked to case management, livelihoods support, psychosocial support, peer support, and community-based activities. This approach advanced the work beyond device delivery toward a more integrated pathway for mobility, participation, and socio-economic inclusion.
Obstacles and Enabling Factors
Providing prosthetic limbs, psychological support, and physical therapy to persons with disabilities in Aleppo.
© UNDP Syria - Adeeb Alsayed
Obstacles:
One of the earliest challenges was the perception that prosthetic services were too medical for UNDP and should be led by health actors only. Internally, the project had to demonstrate that prosthetics were not only a clinical service, but also a disability inclusion, social protection, livelihoods, and recovery intervention.
A second challenge was the sustainability question. At several project appraisal stages, questions were raised about exit strategy and financial sustainability. While these questions were valid, they also required a realistic crisis lens. In an active crisis, some services are justified because they are rights-based and necessary for the survival, mobility, dignity, and participation of vulnerable people.
A third challenge was technical capacity. In Syria, the pool of trained professionals was limited, and staff retention was affected by migration, economic hardship, and better opportunities elsewhere.
A fourth challenge was cost and supply chain disruption. Prosthetic components and raw materials can be expensive and difficult to procure, particularly in a context affected by sanctions, disrupted markets, and unstable supply routes.
A fifth challenge was managing expectations. Workshop teams needed both technical and interpersonal skills to manage expectations, explain eligibility decisions, and provide safe and respectful services.
Finally, the model carried occupational safety and environmental risks. Prosthetic workshops involve machinery, dust, resins, chemicals, heat, and other hazards. This required attention to occupational safety, environmental and social safeguards, and continuous improvement of workshop management practices.
Inclusion of persons with disabilities in rubble and solid waste management project in Deir Ezzor.
© UNDP Syria - Zuhir Al-Fourati
Enabling Factors:
A major enabling factor was the availability of initial earmarked funding, which allowed UNDP to demonstrate the model in practice. Once the first services were delivered and the human impact became visible, the project generated stronger internal and donor support.
Leadership buy-in was also critical. Once senior management and colleagues from different units visited the project site and saw the service directly, support increased. Field exposure helped translate prosthetic services from a technical concept into a visible humanitarian and inclusion priority.
Communication and visibility also played an important role. The prosthetic project became one of the strongest entry points for communication and advocacy on disability inclusion within UNDP Syria. Field visits to workshops, direct exposure to the service pathway, and visible changes in mobility helped build internal and external support. It also helped in mobilizing attention and resources from multiple donors, including the European Union, Finland, Germany through KfW, Italy, Japan, and Kuwait.
How Can Others Replicate or Adapt This?
Participants at the Disability Inclusion Community of Practice bootcamp in Damascus
© UNDP Syria - Yasser Wardeh
The Syrian experience should not be replicated mechanically. It was developed for a specific crisis context where direct institutional support was constrained, needs were urgent, and community-based delivery offered a practical way to maintain access. In other contexts, especially where national institutions can be directly supported from the beginning, a different model should also be considered.
However, several principles are transferable.
Start with a realistic service mapping: Map existing public, private, and community-based service providers. Identify the main bottlenecks: infrastructure, raw materials, workforce, financing, technical quality, referrals, or affordability.
Choose technology according to context: Appropriate technology is essential. High-end components may be suitable for some users, but they are not always the best solution in crisis or low-resource settings. Technology choices should consider functional need, technical capacity, repair options, cost, and supply chains.
Build transparent selection criteria: Where resources are limited, selection must be clear, documented, and defensible. Technical criteria should be combined with vulnerability and programmatic criteria. In Syria, the focus on lower-limb amputations, first-time users, vulnerable households, women, displaced persons, and people with livelihood potential helped maximize functional and social impact.
Invest in people, not only in equipment: Workshops require trained prosthetic technicians, physiotherapists, managers, case workers, and administrative systems. Capacity development should include technical fabrication skills, but also data management, stock management, beneficiary communication, safeguarding, and occupational safety.
Link prosthetic services to inclusion pathways: The strongest impact occurs when prosthetic services are linked to rehabilitation, psychosocial support, case management, livelihoods, and community participation.
Use communication strategically: Prosthetic services are powerful tools for advocacy and resource mobilization because their impact is visible and tangible. However, communication should avoid pity-based narratives. Messaging should focus on rights, agency, inclusion, and the importance of building services that enable people to participate in society.
What’s Next?
Participants at the Disability Inclusion Community of Practice bootcamp in Damascus.
© UNDP Syria
As Syria enters a new phase, UNDP is shifting from a primarily community-based workshop model toward strengthening national prosthetic and rehabilitation services.
The earlier NGO-supported model has largely completed its crisis-response role. UNDP has exited from three earlier workshops after 10 years of continuous support. One workshop in Aleppo remains active.
Going forward, UNDP’s support will increasingly focus on strengthening national capacities. This includes support to Ministry of Health’s services through raw materials, training, and technology transfer, while continuing to promote a broader disability inclusion approach that links prosthetic services to case management and livelihoods.
Introducing a digital dimension to this work is also a priority going forward. Electronic registration of cases and a centralized dashboard to track caseloads, service delivery, and outcomes across workshops were not feasible in Syria in earlier years of the response, given operating constraints on data systems. As these constraints ease, digitizing case management will allow UNDP and its partners to monitor beneficiaries more consistently, strengthen referral pathways, and generate stronger evidence to guide the transition toward nationally led services.
Country focal point: Louay Fallouh, Programme Analyst, UNDP Syria, louay.fallouh@undp.org.