Where still no health and psychosocial care for older people is available

To continue to ignore older men and women in humanitarian crises is to deny our shared humanity

Von Justin Derbyshire

Humanitarian assistance is guided by core principles, underpinned by international humanitarian law. This gives everyone affected by a crisis the right to humanitarian assistance. Crucially, the code of impartiality means help must be provided to the most urgent cases first, without discrimination. The vulnerability of older men and women during emergencies underlines this urgency, yet they are being ignored.

To continue to ignore older men and women in humanitarian crises is to deny our shared humanity

Photo: Warda, 85, Tyre Libanon / Sandra Kastoun - HelpAge International

 

“I know that humanitarian aid might be helping, but only for those who can go and get it. How am I supposed to get this help if I can’t leave the room?”

These are the words of Warda, an 85-year-old woman who fled Syria for Lebanon. She is widowed and all but one of her children has abandoned her. She cannot walk. Her low bone density means she needs knee implants but, even if she could afford the surgery, she says it is unlikely she would survive.

Warda was told she could get humanitarian aid. The caveat? It wouldn’t be delivered to her. She would need a car and someone to take her to collect it. Stranded in her house, Warda must get by without any support.

Her story is not unusual. Older people are consistently overlooked and misunderstood in disaster responses, with little targeted relief from national governments and aid organisations.

HelpAge International interviewed 300 women and men aged 60 and over affected by humanitarian crises in Lebanon, South Sudan and Ukraine. Eighty-five per cent of them said no one other than HelpAge had consulted them about their needs. Two-thirds said they did not have enough information about the humanitarian assistance available to them, and almost half said health services did not provide care for their “age-related” conditions.

Older people feel discriminated against because of their age. Close to half (43%) of those we spoke to in Ukraine said they had to wait longer than younger people for assistance, while more than half (55%) believed they had been turned away when seeking help due to their age.

Humanitarian principles oblige the sector to help the most vulnerable

Humanitarian assistance is guided by core principles, underpinned by international humanitarian law. This gives everyone affected by a crisis the right to humanitarian assistance. Crucially, the code of impartiality means help must be provided to the most urgent cases first, without discrimination. The vulnerability of older men and women during emergencies underlines this urgency, yet they are being ignored.

Older people are disproportionately affected in emergencies. When Hurricane Katrina struck New Orleans in 2005, 75% of those who died were over 60, even though older people made up only 16% of the population. When the tsunami hit Japan in 2011, 56% of deaths were people aged 65 and over when 23% of the population is in this age range. Most recently, 29% of mortalities caused by the 2015 Nepal earthquake were people aged over 60, but they number only 4.5% of the population.

Older people are often separated from their families and cut off from services in emergencies, while symptoms of physical and psychological distress are common. Older women in particular are vulnerable to abuse and neglect.

Despite this evidence, less than 1% of humanitarian financing targets older people, according to a recent HelpAge report analysing 16,000 projects between 2010 and 2014.

It paints a picture of an ageist humanitarian sector that discriminates against older people and denies them their rights. On 1 October – International Day of Older Persons – the UN asked us all to “take a stand against ageism”. The humanitarian sector must heed this call and end the widespread neglect of older people.


Photo: Angelina, 64, Juba, Sudan/ Samir Bol - HelpAge International

 

Older people face a multitude of health challenges in a crisis

Existing health challenges can exacerbate older men and women’s struggles during an emergency.

One in three of the older people we spoke to in Lebanon, South Sudan and Ukraine had a physical disability, while two-thirds had more than one chronic health condition, such as diabetes, hypertension, tuberculosis or respiratory problems.

Yet only 28% of people across the three countries accessed health services regularly, and more than half of respondents in South Sudan had never visited a health centre. The cost of care, accessibility and, particularly in South Sudan, lack of medication at clinics were cited as reasons for not attending health facilities.

Interruption of treatment and support for conditions such as hypertension or diabetes can be debilitating. It can lead to the onset or progression of disabilities and cause complications such as stroke, blindness, amputation and even death.

Overwhelmed by distress

Just as older people are rarely asked what they need or want, they are rarely given the opportunity to express how they feel. We asked older people how often they felt hopeless, depressed or anxious, and their responses showed how insecurity, poverty, poor healthcare and limited access to basic services impacts psychosocial wellbeing.

“Because of my health I’m confined to one place,” said a 68-year-old man from South Sudan. “I just stay in and eat, like a child. I’m always sick and unable to treat myself as there’s no medication.”

In Lebanon, a 90-year-old man said he felt hopeless because of “not being able to move” and a feeling of “closeness to death”.

“I’ve had to take sedatives for the last two years because of the sound of the explosions at night,” said Tatiana, a 67-year-old woman in Ukraine.

Psychosocial care has been increasingly on the radar in the humanitarian community in recent years, especially concerning the impact of gender-based violence on women’s mental health. However, the anguish caused to older people, and ways such distress might be alleviated, remain a policy and practice blind spot.

Photo: James, 68, Juba, Sudan/ Samir Bol - HelpAge International

 

Neglect of older people is not a new trend

The neglect of older people during humanitarian emergencies is by no means a new development. Seventeen years ago we conducted research in Bangladesh, Bosnia, the Dominican Republic and Rwanda and found then that older people believed if they were consulted their problems would be better addressed.

Almost all those we spoke to said they were not cared for and pushed out of sight, and around a third said they received no help at all – findings that today remain all too familiar.

Then, like now, older people rely on themselves, neighbours and the wider community in the wake of a disaster. And despite investment in humanitarian reform since then and improvements across the sector, not much has changed.

How to address the neglect

Engagement with older people at risk of crises is crucial to ensure they are no longer invisible. Properly disaggregated data must be collected and utilised, and the views and needs of older men and women must be heard in order for agencies and governments to design, deliver and evaluate effective humanitarian responses.

There must be more focus on addressing gaps in healthcare services and medication provision for people with chronic diseases in humanitarian crises. Counselling and support must be made be available to older men and women to address psychological distress.

Services must be physically accessible for older people and outreach services should be provided for those who are unable to make it to the point of delivery.

For these initiatives to be possible, humanitarian donors must be aware of older people’s particular needs and provide funding that is impartial and based on data that is fully disaggregated by sex, age and disability.

The whole humanitarian community has a role to play. It has a responsibility to develop the skills and understanding to identify older people’s needs and deliver the appropriate response.

Without this, older men and women will continue to be excluded in humanitarian relief efforts. To ignore their voices and needs would be to deny our shared humanity.

 

References:

Justin Derbyshire

Justin Derbyshire
Chief Executive Officer, HelpAge International.