New Guidelines to Save Older People's Lives in Emergencies

Older people constitute a significant proportion of those at risk in humanitarian crises. They are often ignored, left behind or isolated in dangerous and life-threatening situations. While most aid agencies recognise them as a vulnerable group, they are rarely assigned the priority given, for example, to children. Humanitarian organisations frequently lack the expertise and capacity to address older people’s needs, resulting in unnecessary hardship.

New guidelines published by HelpAge International suggest practical ways to meet older people’s needs, and to recognise their potential in emergency situations. The guidelines cover basics like shelter and appropriate food, accessible services, including healthcare and psychosocial support, protection from abuse, and ways to consult older people and involve them in decisions about the kind of assistance they need.

The guidelines also address the structural problems that face older people in developing countries. Even before disaster strikes, many are poor and marginalised. Their numbers are growing; the number of older people in developing countries will more than double over the next 25 years, reaching 850m by 2025 – 12 per cent of the developing world’s total population.

Concern for older people’s frailty can obscure the fact that by no means all are passive and unable to look after themselves. HelpAge International’s guidelines thus urge that their responsibilities, and the knowledge and skills they bring, should be recognised and built upon. The guidelines encourage aid workers to use older people’s knowledge of the community and local conditions to decide on the distribution of assistance. Elders’ ability to pick up the pieces after an emergency stems from their past experience, and aid agencies can learn valuable lessons from them.

Older people’s priorities

The guidelines developed by HelpAge International are based on research conducted during 1999 in the aftermath of emergencies in Bangladesh, Bosnia-Herzegovina (BiH), the Dominican Republic and Rwanda. They conclude that: ‘If invisibility, exclusion and powerlessness are common themes emerging from the experience of older people, then consultation, inclusion and empowerment through partnership have emerged as the primary indicators for good practice. Older people have consistently asked:

• to be seen, heard and understood
• to have equal access to essential support services
• to have their potential and contributions recognised, valued and supported’.

The research revealed marked differences between the perceptions of older people interviewed about their experience of emergencies, and those of aid-agency workers. Older people assessed their most important problem in emergencies as lack of income, followed by poor access to health services. Aid agencies considered food, nutrition and isolation as key, with income not included in the top six problems they identified. This difference in priorities seems to reflect older people’s concern to re-establish coping mechanisms, whereas aid workers concentrate on the more immediate problems of relief.

Older people’s needs

The guidelines insist that older people should have equal rights to support and protection in emergencies as other vulnerable groups. They do not call for separate services or facilities, but rather aim to ensure that access to services is available to all, while taking into account the particular needs of older people.

When regular healthcare facilities are disrupted, older people often have to rely on clinics located at a central point in the camp or service centre, and therefore hard to reach from outlying areas. The guidelines suggest home-visiting programmes to reach those who cannot get to medical facilities.

At clinics themselves, systems can be developed to prioritise the most vulnerable, including older people. Staff tend to focus on the very young and on acute cases, and clinics geared to emergencies do not necessarily stock medication for chronic disorders common among older people, or disorders that will become acute without regular treatment. The guidelines advocate that, where feasible, simple age-related clinics should be established to deal with issues such as joint pain, and that appropriate drugs should be available to deal with chronic disorders. Treating older people in a group in this way can reduce pressure on limited aid-agency resources.

Older people’s restricted mobility is a key consideration in planning the delivery of services. Outreach services are particularly important in supporting those who are left isolated and vulnerable, in damaged homes and without basic services, when younger people have fled. In Eastern Slavonia, an area handed to Croatia after the Dayton Peace Accords of 1995, Serb families departed for the Federal Republic of Yugoslavia, in some cases leaving their elders behind to care for their property. Many had health needs that were not met due to their isolation and fear, and because of discrimination by service providers.

Where there is competition for food, fuel and water supplies at distribution points, younger and stronger people tend to take the lion’s share. Aid workers need to ensure that queuing arrangements for distributing basic goods do not allow older people to be pushed aside. Another problem often ignored by aid agencies is the type of food provided as basic rations, which is often unsuitable for teeth and digestive systems compromised by age. In the February 2000 floods in Mozambique, for example, some older people reported that the food provided aggravated diarrhoea.

Neither age nor frailty is any protection against abuse, and safeguarding older people from robbery, intimidation, rape and violence is a necessity. In arranging shelter for refugees and displaced people, the guidelines suggest not mixing older women and men to make up the numbers for shelters without the informed permission of the women. In late 1999, the Organisation for Security and Cooperation in Europe (OSCE) reported ‘a deplorable pattern of violence and harassment’ against older people in Kosovo, both during the Serb attacks on the Albanian majority, and after the refugees returned. Vulnerable older Serbs face reprisals and harassment on the streets, at World Food Programme (WFP) distribution points and at medical centres. In coordination with other agencies, HelpAge International set up a home-visiting programme in Pristina to ensure that vulnerable older people from ethnic minorities receive warm clothing, meals and medical attention in their homes.

Older people and the family

It is a common misconception that older people in developing countries have their families to look after them. In some circumstances this is still the case, but societies are changing. Even where older people are still accorded respect and care, there are many pressures that drive families apart. In India, for example, over 75 per cent of older people remain in the countryside, while many of their younger relatives live in the cities. Chronic health problems, functional impairment and a 73 per cent illiteracy rate already put older people at a disadvantage. Older people, especially older widows, are among the worst affected because they rely on the informal economic sector and small-scale subsistence agriculture for their survival. An estimated 55 per cent of rural women in India over the age of 60 are widows, who are traditionally discriminated against.

In emergencies, older people are often separated from their families. In the Mozambique floods, HelpAge International staff reported that the young and the elderly were most frequently separated from more able adults, or abandoned in the rush for survival. Some older people still do not know where their family members are. They were the last group of people to reach the relief camps, and the last to know about the recession of waters and resettlement. The guidelines emphasise the importance of providing psychosocial support to older people, and extending family-tracing services to include them.

When the immediate crisis is past, older people need to rebuild their livelihoods. In most developing countries, only a small minority have pensions of any kind. They therefore need to work in order to survive if their families cannot provide for them. In some cases, they have to support other family members. In the aftermath of the Rwandan genocide, for example, 70-year-old widow Joyce Mukankundiye is supporting her three grandchildren because her daughter has suffered from psychological trauma since the war. The guidelines highlight the need to support older people by including them in skills training, access to credit and support for income generation. Older people caring for children also need longer-term help with costs such as school fees, and links with other carers for mutual support.

Lesley-Anne Knight is Emergencies Manager, HelpAge International, London.

‘Older People in Disasters and Humanitarian Crises: Guidelines for Best Practice’ is available free of charge in English, French, Portuguese and Spanish. It is also available in English at http://www.helpage.org. For copies, or further information, contact Sarah Graham-Brown, Communications Department, HelpAge International, 67–74 Saffron Hill, London EC1N 8QX, UK. Tel: +44 020 7404 7201 Fax: +44 020 7404 7203 Email:press@helpage.org