A/HRC/57/47 21. Racism affects the socioeconomic status of Indigenous Peoples, which determines their access to education, housing and health care; these social indicators result in an increased likelihood of experiencing a physical or intellectual impairment. 15 Racial discrimination in health-care services can lead to the failure to provide early diagnosis and intervention for Indigenous children with impairments and to adults experiencing disproportionally higher rates of impairments.16 22. The lack of accessible, available, acceptable and quality reproductive health services and the distance to health facilities makes it almost impossible for Indigenous women to give birth in a health facility, which has implications for impairment prevention. A study examining the availability of emergency, non-emergency and preventive care in rural First Nations communities in Canada found that the delivery of all of these types of care was severely limited. A lack of qualified health-care staff located within a reasonable distance rendered people with urgent health emergencies much more likely to experience problematic complications, including those that may lead to impairments. 17 23. The Inter-American Commission on Human Rights has drawn attention to the disproportionate rates of maternal mortality and morbidity among Indigenous women, who mostly reside in rural areas. The lack of maternal health services for Indigenous Peoples causes preventable impairments because premature births, infections and complications related to childbirth are not properly attended to.18 24. Conflicts and the militarization of Indigenous lands are directly linked to the high numbers of persons with disabilities among Indigenous Peoples. Physical violence in the form of forced recruitment, bombing, harassment by the military, torture and the installation of anti-personnel mines all cause disabilities among Indigenous persons. IV. Main barriers faced by Indigenous persons with disabilities in the realization of their rights 25. Indigenous persons with disabilities face a unique and compounded set of challenges that are deeply intertwined with their identity, culture and historical context. Addressing their needs requires a nuanced understanding of the intersectionality of their identities and a commitment to upholding their rights as both Indigenous Peoples and persons with disabilities. This includes respecting their collective rights to self-determination, lands, territories and resources, consultation and free, prior and informed consent before adopting any legislation or policy that addresses their unique circumstances. 26. In many States, there is a significant funding and infrastructure gap that continues to have an impact on access to health-care services, education, adequate and accessible housing, employment and economic opportunities for Indigenous persons with disabilities. Indigenous persons with disabilities are overrepresented among persons living in poverty and are rarely consulted in matters affecting them. They face greater risk of violence, systemic discrimination, ableism and racism from States and other actors. 19 Below, the Special Rapporteur analyses the most frequently encountered barriers, as conveyed to him by Indigenous persons with disabilities. 15 16 17 18 19 6 Richard Matthews, “The cultural erosion of Indigenous people in health care”, Canadian Medical Association Journal, vol. 189, No. 2 (January 2017). Submission from Australia. Tim Michiel Oosterveer and T. Kue Young, “Primary health care accessibility challenges in remote Indigenous communities in Canada’s North”, International Journal of Circumpolar Health, vol. 74, No. 1 (2015). Inter-American Commission on Human Rights, Indigenous Women and Their Human Rights in the Americas (2017). Submission from the International Disability Alliance, the National Indigenous Disabled Women Association Nepal and the Indigenous Persons with Disabilities Global Network. GE.24-12379