Building lasting solutions for older people displaced by the conflict in Northern Uganda

The 19-year conflict between the Ugandan government and the Lord’s Resistance Army (LRA) displaced over 1.8 million people in Northern Uganda. After a ceasefire agreement was finally reached in 2006, many displaced Acholis began to return to their villages of origin. Yet data collected in early 2008 indicates that the return process is still only at its start. Long-term displacement has caused social deterioration and many internally displaced people (IDPs) are heavily reliant on food rations and NGO and UN support provided in displacement camps. Security fears related to attacks from Karamojong cattle rustlers and the possible return of the insurgency also remain high. As a result, many displaced Acholis commute between camps and transit sites, and between transit sites and their villages of origin.

Older people and the return process

UNHCR data from January 2008 indicates that 21% of the Acholi IDP population had relocated to transit sites, and another 32% had returned to their villages of origin. Around half of the remaining displaced population – 47% – remained resident in camps. According to the Inter-Agency Standing Committee (IASC) in Uganda, an estimated 31% of Acholi IDPs had moved to transit sites, but only 6% had fully returned to their villages of origin, leaving 63% still officially resident in camps. Although these figures present slightly different pictures, either way it is clear that the process of return is far from complete. Even those who have made a permanent return need both time and practical support before their livelihoods are fully re-established and social services transferred to rural parish locations.

In 2008, HelpAge International seconded an expert on ageing to the Protection Cluster Working Group (PCWG), led by UNHCR and intended to mainstream the rights and specific needs of older people into humanitarian protection responses. The secondment included an extended mission to Uganda in mid-2008, aimed at providing practical, targeted support to PCWG members in Gulu, Kitgum and Pader Districts.

HelpAge International’s own research indicates that older people (defined as those aged 60 years and above) are often disproportionately affected in emergencies, are commonly overlooked in both immediate responses and rehabilitation and are given limited if any opportunity to participate in programme planning. International humanitarian agencies often assume (incorrectly) that older people will be covered by a specialist agency, or will be supported by traditional family and community mechanisms. Even UNHCR’s own extensive Real Time Evaluation of IDPs in Northern Uganda in August 2007 failed to include reference to issues affecting older people.

Research conducted during the 2008 mission confirmed that a disproportionate number of the Acholi remaining in camps were older people. UNHCR research in eight IDP camps in Lira, Oyam and Apac districts, further substantiated this trend, confirming that the remaining camp populations were comprised exclusively older people. A brief assessment of return trends showed that between 3.5% and 5% of older IDPs were being included in the process of permanent return to villages of origin.

Focus group discussions and interviews with older people and stakeholders, including NGOs, UN agencies and local government officials, were carried out to explore the barriers to return older people were facing, and to identify recommendations as to how they could be more actively included in determining and implementing programmes.

Findings

During discussions and interviews, older people overwhelmingly expressed a desire to return to their villages of origin. However, priority needs that they felt had to be met before they could return were listed as shelter, assistance, access to social services such as healthcare and schools, caring responsibilities and psychosocial wellbeing.

Lack of shelter was identified as the main reason for not returning. A March 2008 rapid food security assessment in 11 camps in Pader District reinforced these findings, noting that nearly all older people cited shelter as the primary barrier to return, compared with just over half (56.4%) of overall respondents. Older people said that they did not have the materials needed – bricks, grass and bamboo – or the physical capability to walk long distances to collect materials, carry them back and then construct new homes. Older women cited particular difficulties due to lack of mobility and physical strength, and felt unable to ask fitter members of the community for help. Many younger people, for example, were demanding cash payment in return for their assistance.

Closely linked to this were strong feelings of uselessness among older people as a result of their physical incapacity, lack of strength and loss of traditional roles within the household and community. In many cases, communities prioritised the return of younger and more able members, rather than older relatives. The tacit expectation was that older people would eventually be assisted with return, but only when the basic needs of other returnees had been met. Feelings of social and economic uselessness also heavily impacted on older people’s wellbeing.

Access to services provided in the camps, including healthcare, water and food distributions, was also a factor in older people’s continued presence there, particularly as most act as sole carers for their grandchildren. Older people cited the lack of schools in return areas, reporting that grandchildren would simply commute back from the villages to the camp in order to attend secondary school. Camps also provide markets for goods for those older people who are economically active.

For many older people, care of the dead was another significant concern, both in terms of moving the bones of relatives who had died in the camps back to villages, and anxiety that some return sites were affected by ‘roaming spirits’. For themselves, older people were eager to return to their land before they died.

Crafting effective responses

Responding effectively to the needs of older people and including them in the planning and implementation of humanitarian responses is particularly important now, as efforts are being made to close IDP camps and phase out camp-based humanitarian assistance. If older people and the children they care for remain in decommissioned camps, they may receive reduced support, may be unable to meet their basic needs, and may be exposed to isolation and psychosocial trauma.

Seeking to ensure the participation of older people in decisions that affect the quality of their lives must be an overarching and cross-cutting element of all programme responses. Older people need to be consulted and must be encouraged to become active participants in determining solutions. One concrete method to ensure that old people’s voices are heard is to encourage the development of Older People’s Committees or Associations, which empower older people to engage in mutual social (and economic in the case of livelihoods activities) support. This could be done with little additional input, as part of regular camp monitoring and community meeting activities. However, there may be a need for support materials and direction to assist with the development of these committees. In addition, it is important to ensure that older people are represented on other community forums, such as agricultural committees or women’s groups.

Protection actors should seek to raise public awareness of older people’s rights and their contribution to the community, including their roles as mediators, educators and advisors, teachers of livelihood skills and traditional healers. By devaluing their own contributions, older people reinforce the message to their families and communities, as well as to NGOs, UN agencies and the local government, that they are useless. An information campaign directed at older people, the wider community, implementing partners and local government could help here. Hosting regional radio broadcasts where older people’s rights, needs and contributions are highlighted, debated and discussed could be another way to achieve this.

One area where public awareness needs are particularly acute regards health services for older people. Older people complained of being treated poorly by healthcare providers, who were seen as insensitive to their needs. Some older people were told that they were ‘not sick, just old’. Many also said that they were too weak to walk to healthcare centres, and that, if they did do so, when they arrived they were told that ‘medicine is for children not old people’. Meetings with World Health Organisation (WHO) staff during the mission confirmed the impression that medical staff are not trained to respond to older people’s health problems.

WHO noted that it has been unable to address the health needs of older people in its programming, focusing instead on children’s health, reproductive health and HIV/AIDS. However, it recommends that protection stakeholders could work through Village Health Teams (VHTs) to involve older people directly as team members. Working through the VHT system can support the regular monitoring of visits to older people, which could encourage community care of older people as well as feeding information on the incidence and types of older people’s health issues from the community level upwards through the health service system. Appropriate geriatric drugs should also be made more widely available, and Health Cluster members could set aside a specific time each week to receive and treat older people. This would reduce waiting times for older people as well as allowing health staff to focus specific attention on them. HelpAge International’s experience in Darfur has found this a beneficial initiative for improving older people’s access to care.

Collecting disaggregated data on older people from 60–79 and over 80 is central to effective programmatic responses. Breaking this data down further to identify active older people, who would benefit from support to return to villages of origin, and those who need specific assistance to meet basic living requirements, is vital for appropriate humanitarian intervention.

Integrated and inter-generational responses

It is vital that agencies share good practice and work together to avoid duplication or the introduction of new structures which undermine traditional clan support. Even where programming may not intimately involve older people, wherever possible it is important to consult them and engage their participation as advisors. One older man complained that, while NGOs had programmes tailored to agriculture, older people were excluded. This oversight could be easily addressed with no additional inputs, by simply inviting older people to participate as mentors, advisors and organisers. For example, involving older people in the distribution of tools and agricultural equipment reinforces their role as active participants, recognises their knowledge and experience and engages them productively with a socially and economically important duty.

Inter-generational links could also be nurtured through activities such as the inclusion of older people in child-friendly spaces, where they can act as story-tellers, or by using young people to build shelter for older relatives and neighbours. Any situation where old and young can share the work enables older people to talk about their own life experiences and increases the economic resilience of multi-generational households.

Appropriate assistance

Older people should be consulted on their specific needs, and on how assistance to meet them can best be provided. Housing, for example, needs to be age-appropriate and easy for older people to maintain. Livelihood interventions are vital in addressing older people’s protection needs. Income generation provides older people with an opportunity to contribute economically to their households through agricultural activities, small-business enterprise, handicraft work and trading, building self-esteem and increasing feelings of positive wellbeing.

Next steps

Protection Cluster Working Group members and local government have a unique opportunity to positively influence the creation of durable solutions for older displaced Acholis, whether they choose to return to their villages of origin, remain in camps or relocate elsewhere within Uganda. While the recommendations given here are specifically focused on older people, most if not all are also applicable to adults with physical disabilities and could be adopted and adapted to improve their quality of life. HelpAge International has developed checklists to help Protection Cluster members to ensure that they are including older people in both initial and ongoing needs assessments as well as in regular programming. It continues to work with PCWG member agencies so that the needs and contributions of older people are recognised and addressed by humanitarian actors.

Susan Erb is HelpAge International Policy and Programme Advisor on Ageing, seconded to the Protection Cluster Working Group in Geneva. Her email address is erb@unhcr.org or serb@helpage.org.