After War and Displacement, Accessibility Knows No Limits

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As the conflict in Artsakh (Nagorno-Karabakh) reached its peak in September 2023, Vardan Tadevosyan, director of the Lady Cox Rehabilitation Center, was appointed Health Minister. He was called to evacuate patients injured in the largescale attack against the territory and the explosion of a fuel depot outside Stepanakert days later. When he returned to the clinic, it was almost empty. In the space of a day, around 80 staff members and essentially all his patients had fled.   

“For 24 hours, I was involved in organizing the first-aid treatment [and evacuation] for these people [in the explosion],” he said, recalling the pivotal moment in the conflict, followed by the mass displacement of over 100,000 Artsakh-Armenians. “So, when I finished this duty, I came back to the rehab center. I found that 90% of my employees are gone. Wow,” he paused, “My patients are gone, and only the [patients with severe disabilities] are waiting with their family.” 

And so it went: Tadevosyan and his remaining staff and patients filled six of the clinic’s seven minibuses, normally used for summer camp excursions, and made the grief-stricken, several-day journey through the Lachin Corridor to Armenia. They left everything behind, including over two decades of hard work building what had become a life-saving mission. 

Tadevosyan arrived in Yerevan on October 1, met his newborn grandson and felt empty. He remembers quickly looking at himself in the mirror: “You have everything here. You have a family, you have friends, you can easily get a job… But who will take care of them?” He recounts this over an iced coffee, sipping through a twisty straw as he looks out toward the mountains beyond the newly established clinic in Yeghvard. That same bittersweetness permeates the center, where beauty, warmth and humor coexist with the daily struggle of rebuilding what was lost.

About 10 days after the displacement, he sat down with his bookkeeper and one of the doctors and decided to launch a new NGO under the same name. This would make it easy for his patients to find them, he said. They were now scattered throughout Armenia, living in difficult circumstances without the community they had relied on. 

With funding from the Humanitarian Aid Relief Trust (HART) and Christian Solidarity International (CSI), the team also found a new home: an acquaintance of Vardan’s arranged for an unfinished hotel in Yeghvard to be donated to the center. It proved an almost perfect fit, with indoor and outdoor pools, a garden, rooms for inpatient care and rehabilitation, spaces for different therapies, offices for workshops, and a kitchen that gets plenty of use, especially during events like the summer party in June. The building is still being renovated, and the team plans to fully resume operations within the next two years, while some programs are already back up and running.

Since March 2026, nurses have been conducting regular home visits across Armenia, and the youth program for children with autism and disabilities from the region meets twice a week. On those days, the sound of drilling and hammering mixes with laughter and kids splashing in the pool, along with the smell of Armenian coffee and home-cooked staff lunches. Guests never leave bored or hungry, and they’re encouraged to bring a bathing suit.  

The youth come for a variety of therapies, from art and speech to psychology and hydrotherapy in the pool, while parents have access to a wealth of resources. After a positive parenting workshop in August led by guest social worker Lousine Karapetian, the mothers took part in a candle-making session and bonded over their shared experiences. 

Liana Hovhannisyan sends her son to the youth program and attends all the workshops. She said they especially help her learn to parent with affection. “When [my son] is close to being uncontrollable, he can’t explain what he wants… And at that moment, I give him a hug and never get angry.” Arevik Harutyunyan, the in-house social worker, said Hovhannisyan also helps other mothers stay positive. “The workshops help a lot, and it’s relaxing for me to be here,” Hovhannisyan said. “I don’t remember what is going on in the world, I am in my world and [the workshops] give me so much.” 

At their core, these workshops are informative. Some incorporate art therapy, while others provide practical resources, such as helping parents register to vote in the June 2026 parliamentary elections. They also help mothers find ways to navigate parenting a child with special needs and teach communication tactics. “I do not criticize or judge… I see you, you’re angry/sad, and I’m here for you,” reads one handout from the positive parenting session with Karapetian. The group also discussed coping mechanisms, such as daily check-ins and reminders to keep up physical activities and hobbies. “Where did I direct my energy today?…Did I make time for a hobby or inner peace?” reads another handout. 

Harutyunyan, who holds a master’s degree from Yerevan State University and has been part of the Cox team since 2023, also helps parents with bureaucracy and applying for funding, which can often be intimidating. “Displaced people trust the Cox Rehabilitation Center because the specialists speak their dialect and are from their native land,” she said. “Our role is to socialize. We are a bridge for them, a bridge to the community, the government and NGOs, because they are spread all over Armenia.” She added that the team also organizes excursions for children, works with mothers, and offers therapy, including art therapy and psychological training.  

Some parents initially reject their child’s diagnosis and find it hard to manage the day-to-day moving forward. But Harutunyan has seen many success stories: one patient on the autism spectrum started singing in an orchestra, one mother opened her own baklava business, and Hovhannisyan started a blog with her autistic son. 

Harutyunyan is currently working especially hard to integrate fathers and siblings, since the burden traditionally falls on mothers alone. In a recent grant application to GIZ (Deutsche Gesellschaft für Internationale Zusammenarbeit, a German organization), for example, the beneficiaries are not the children but the families, and the grant will only be awarded if fathers participate in the program. Fathers’ understanding of their child’s condition is crucial to creating a safe environment at home, while siblings can help integrate children with autism or disabilities, who are often isolated and excluded from social settings. “Unfortunately, we have situations where brothers and sisters are ashamed of their autistic [sibling],” she said. Yet with socialization and therapy from a young age, many children with disabilities or autism can grow into independent or partially independent adults. 

Harutyunyan’s work is essential to the Cox Clinic. The parent workshops especially offer a space to come together, vent, and be vulnerable. When one mother was brought to tears during the positive parenting workshop while opening up about the challenges she faces, Hovhannisyan extended her hand and offered advice from her own experience. After all, professional help can only go so far without a sense of trust and community, and the clinic has stayed true to that principle since its founding. 

At its peak, the Cox Clinic, founded in 1998 in Stepanakert was one of a kind, not only in Artsakh, but in Armenia. The clinic was officially launched by Caroline Cox, Baroness and Deputy Speaker of the United Kingdom’s House of Lords. In 1999, she invited Tadevosyan, then a therapist and lecturer in Armenia, to take over the center. Lady Cox was especially taken by his approach, which went far beyond basic medical attention and rehabilitation for people with disabilities. It was about creating a sustainable operation that continuously trained nurses, educated family members, broke down stigmas, encouraged social integration, and offered a loving safe haven. 

Aside from the home visits and youth programs they have since resumed in Armenia, the clinic hosted annual summer camps and excursions and provided inpatient care, physical therapy, and rehabilitation. It also offered occupational therapy for adults, teaching them skills to enroll in classes or enter the workforce. In 2007, it opened the first inclusive rehabilitation kindergarten in Armenia and Artsakh, and in 2017 it constructed a new department for children with autism. Tadevosyan also proudly shared that Cox Clinic members were consecutive boccia champions in Armenia and Artsakh. He started with 12 nurses, training them to work across different disciplines. “Because of the lack of specialists, these nurses were doing three jobs working with patients,” he said, emphasizing how rare this multidisciplinary approach is, even now, in Armenia. 

“When you have a very small budget, you can’t afford to have all these [different] specialists. My background is in training people from a medical background to become rehabilitation therapists, which means combining the roles of occupational and physical therapy. So our center developed, and in 2020, before the Artsakh War, it was quite well known,” he said. 

The clinic was known not only for its wide range of services but also for their quality. When staff attended workshops in Armenia held by international organizations, other participants “were surprised that the specialists from Karabakh had such a strong professional background. We always pursued continuing education and welcomed specialists from different countries to come train us,” said Tadevosyan. “Before we were displaced from Artsakh, we had 87 employees, half of them medical. Each year, we treated 2,000 people with different kinds of disabilities [between home visits and inpatient care].”

People came in as patients with little prospects of working, studying, or living independently, some having barely been outside the house, he said. They left not only in better physical and mental health, but with a network of friends, a range of new skills, and maybe even a few souvenirs and a new favorite song, movie, or ice cream. 

Armenia’s institutions and culture surrounding people with disabilities have a controversial reputation. The Cox team said the culture has improved. “It was shameful and they used to hide,” said Harutyunyan. Since the team began working in Armenia after the mass displacement, “it has become more acceptable, and it’s more common to see people with autism out and about.” 

It is also important to note that after the Artsakh Wars, institutional challenges received more attention as soldiers returned with both physical disabilities and psychological struggles. Over the decades, the government has also implemented some measures, such as the Law on Social Protection of Persons with Disabilities and the ratification of the UN Convention of Rights of Persons with Disabilities. Still, much of Armenia remains inaccessible because of both physical and social barriers. A 2026 Human Rights Watch report cites ongoing issues: “With poor physical infrastructure, social care and mental health institutions lack rights-respecting psychosocial and therapeutic services that could support people to live independently, trapping many people in prolonged, often lifelong, institutionalization and facilitating detention on the basis of disability.” A 2017 report by Human Rights Watch also detailed the abusive treatment of children with disabilities in Armenia. 

Understanding the sociopolitical landscape surrounding disability in Armenia puts the Cox Clinic in perspective. Not only does Cox lead with community-based multidisciplinary approaches, but Tadevosyan reports that many patients have not wanted to leave and often tried everything to stay after their inpatient care ended. The staff called this phenomenon “discharge syndrome.” With a slight smile, Tadevosyan explained that patients often “didn’t want to be discharged. They were happy to stay as long as they could and found excuses to stay longer.”

But being discharged from Cox isn’t necessarily the end of the road. Arsen Aghajanyan first set foot in the clinic when he was three years old and remained involved until 2023, when he was 25. Thanks to intensive rehabilitation and various therapies, he learned to walk with crutches and to swim. He later attended Mesrop Mashtots University, where he studied Russian literature and English, graduating in 2019. Now 28, he is a journalist for step1.am. 

“People with disabilities need to adapt and integrate so that they meet people, go out, and see things. There needs to be a workplace for them, and that’s also important. In all my articles I talk about it: the country needs to create workplaces for people with disabilities,” he said in an interview in Yerevan. He added that although he has managed to adapt to life in Armenia after being displaced with his family, many of his friends in the same situation have struggled immensely. 

During the nine-month blockade leading up to the mass displacement, the clinic kept operating because Tadevosyan had secured a generator, enough diesel and supplies. The clinic also became a refuge for patients, including Aghajanyan and his family, who spent their final days in Artsakh by the clinic’s pool. “We lived in the hydrotherapy rooms near the swimming pool because it was safe. Our home was near the conflict area,” he said. 

Aghajanyan said he has found ways to cope with the displacement and the stresses of living in a big city. He enjoys listening to a peculiar mix of Rammstein and Chopin, watches old films on his computer, and stays as busy as he can: “I don’t like to be lazy,” he said mid-laugh. Back in Stepanakert, he learned to use Adobe Photoshop at the clinic as part of their occupational therapy and worked to digitize the clinic’s analog photo archive. He said he also taught swimming lessons, helped organize excursions and movie nights, and attended the clinic’s summer camps.

Throughout Aghajanyan’s life, the clinic ran at full capacity, drawing on its full range of resources. Nurse home visits therefore became an essential part of the operation. The clinic had 500 home-visit patients in Artsakh, a number that has since gone down to around 200 in Armenia. 

“All of them are from Karabakh, and about 98% were our former patients. I think these changes, [the displacement] weren’t good for their mental state or their health,” said Tadevosyan, which is why so many reconnected with Cox. “We lost quite a number of young people,” he added. Recently, a patient died of an infection because the Cox team was called in too late. 

Given the current living conditions many patients are in, an issue that can be treated with proper disinfection has become a major health risk. When someone is sedentary for long periods without being repositioned regularly or given minor exercises, such as massaging and moving the limbs, fluid builds up or pressure sores can form. After the fluid is drained or the sores are surgically removed, the wounds must be kept sterile. If they are not, sepsis can kill the patient. 

Back in Artsakh, Tadevosyan said, the team had essentially eradicated the problem by 2002. “I never say that rehabilitation can save lives. But in these cases, we really saved many people’s lives.”  

In the most recent case, hospitals turned the patient away, saying they treat only registered patients. The Cox team said it was likely due to discrimination against people from Artsakh, which they acknowledged remains a barrier for many of their patients. 

Keeping infections from untreated, disability-related wounds is central to Narine Avanesyan’s job. As the nurse and manager of the home-visits program, she also works to teach families how to keep wounds clean in her absence. This takes the necessary supplies, but also a certain level of expertise, education, and household hygiene. 

Avanesyan said that since the mass displacement, the patients’ living conditions have become a key contributing factor. In Artsakh, families had adjusted their homes and practices over time to accommodate their loved ones with disabilities, “But now, people are living in terrible conditions. Their living standard has significantly dropped, and because of that, the sores have gotten worse,” she said. “The main thing is to deal with all the pressure sores, to provide them with psychological support. We also teach them to be independent.” But since most of the energy goes into treating and cleaning wounds, there is often no time for additional therapy, said Avanesyan. 

With patients dispersed around Armenia and with Avanesyan being the only available nurse, it isn’t always simple. While some families learn the hygiene steps quickly and create conditions where wounds heal well, others struggle to maintain an environment that keeps wounds from becoming infected. In the recent death, for example, Avanesyan said the bed sheets hadn’t been changed in several years. 

As with Harutyunian’s efforts as a social worker, “the family’s participation is the most crucial,” Avanesyan emphasized. Without it, the work she does is almost void once she leaves. Cox’s services are free of charge, but Avanesyan cannot visit all 200 patients around the country every week. Hiring a nurse to visit more regularly is expensive, which often leaves the responsibility with families who may already have limited resources and who have faced trauma from the wars and financial insecurity after displacement. 

While Avanesyan is mostly able to focus on Yerevan and the surrounding regions, she remains on call for all the families 24/7. For those in further regions, the team organizes trips. Depending on capacity and needs, she might, for example, visit all the patients in Lori and Tavush in one go every couple of months. Avanesyan has worked at Cox since 2017, after graduating from nursing school in 2016. Specializing in patients with disabilities was not initially in the cards, “but now, I cannot imagine doing anything else,” she said.

With more and more donors and charities showing interest in the Cox Clinic, Tadevosyan hopes to get government support from Armenia’s Ministry of Social Affairs. Despite the constant uphill battle, whether from the mass displacement, lack of infrastructure, sociopolitical barriers, or a small staff, spirits remain high. Aghajanyan, who regularly reports on the Cox Clinic for Step1.am, represents the insistent optimism the clinic embodies. “What we can do is write about it and hope that one day it will make a difference,” he said. “I mean, it’s the best thing you can do. I’m working, and I hope to change something in the world.” 

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