The vulnerabilities and specific needs many people have in older age can become a serious challenge to survival and wellbeing in a humanitarian crisis.
When conflict or disaster shatters communities and public services, older people’s health is at risk because they are unable to get the care they need.
Chronic non-communicable disease
In older age, many people have one or more chronic non-communicable disease (NCD), and in low and middle-income countries people are especially at risk. Conditions such as cardiovascular disease, stroke, diabetes and dementia are common.
In a crisis situation, chronic health conditions can be exacerbated and may become life-threatening as the risk of complications grows. With medication in short supply and health facilities inaccessible or their services disrupted, managing NCDs can be a huge challenge.
Older people can be at increased risk from infectious diseases too. HIV, tuberculosis, diarrhoea and pneumonia, for example, present differently in older people. Both malaria and cholera are likely to be more severe in older men and women, and mortality rates are higher than among younger adults.
Psychological and mental health
The psychological toll of conflict, disaster and insecurity on older people can be severe. Our research reveals high levels of anxiety, depression and post-traumatic stress disorder among older people affected by humanitarian crises in Syria, Ukraine, South Sudan and Darfur, Sudan.
In humanitarian crises, older people vulnerable to poor nutrition. Markets or food distribution points can be difficult for them to reach and food aid packages do not cater for older people’s particular nutritional requirements. However, the biggest challenge is that older men and women are rarely included in nutrition needs assessments and programmes. This is despite a growing body of evidence on older people’s nutritional needs in emergencies.
Income and livelihoods
Our research shows that in low-income countries where the human impact of disasters and conflict is usually greatest, at least half of people in their 60s are economically active. One in five are still working in their 70s. This income can be disrupted in humanitarian crises as older people may lose access to their land or other property and be prevented from carrying on their usual work.
In low and middle-income countries, only one in four older people who are unable to work receives a pension. Where they exist, pension systems are rarely robust enough to continue uninterrupted during an emergency.
Yet older people are frequently excluded from programmes that would help them to sustain or recover their livelihoods, such as "cash for work", income-generation projects and micro-credit support. These schemes are generally targeted at younger adults and planned without considering older people’s roles and capabilities. In cases where older people are primary carers, for example, when parents are absent due to factors such as HIV/AIDS or urban migration, this also impacts on the children and other dependants they care for.
Older people in humanitarian crises face particular threats to their safety, security and ability to survive.
Violence and harm
Older people are among those at highest risk in humanitarian crises. When the earthquake and tsunami struck Japan in 2011, 56% of those who died were 65 and over, although only 23% of the population is in this age group. In the Philippines, 38% of the fatalities in Typhoon Haiyan in 2013 were aged over 60 years, although older people are just 7% of the population. And in Nepal, 29% of those who died in the earthquake in 2015 were aged over 60, yet older people are only 8.1% of the population.
Mobility challenges and other disabilities put older people at greater risk of injury and harm. They are less likely to flee in times of conflict due to hardships associated with travel and a reluctance to leave home, land and possessions. Injuries too can impact older men and women disproportionately as they take longer to heal due to their age.
Furthermore, in conflict and disasters, older people can be more vulnerable to physical, sexual and psychological abuse. Cycles of dependency, discrimination and isolation can put them at risk of ill-treatment at the hands of family members. In the community, older people may become victims of attack as a result of perceived vulnerability.
Families often become separated from one another in crises. Older people who are physically unable to flee are left behind. The disruption and breakdown of normal family and community support structures can leave older people isolated. This makes it hard for them to access the services and assistance they need.
Lack of age-friendly assistance
Assistance and services provided to people affected by conflict and disaster seldom take account of older people’s limited mobility and other disabilities. Shelter, water supplies and latrines are rarely designed to take account of the disabilities and limited strength and mobility of many older people. Health facilities may not be physically accessible, while relief distributions require strength and stamina to get to.
Visual and other sensory disabilities can prevent older people from accessing or understanding information about available assistance and services. Similarly poverty can prevent access to services. When fees are charged for health consultations and medication, for example, they may become inaccessible for older people with no source of income.
Data is rarely collected on older men and women. This means their situation and needs are not assessed or understood, and they are invisible to those providing assistance.
(c) Peter Caton/HelpAge International
Property rights and personal documentation
In the chaos and destruction that follows conflicts, disasters and population displacement, important documents can be lost. This includes those that demonstrate personal identity and ownership of homes, land and other property.
Older people who have lost or never had ownership documentation, and older women and widows who are not always recognised in inheritance law, find it difficult to prove ownership of land or homes. This puts them at high risk of eviction.
Loss of personal records such as official identity documentation, birth certificates or marriage certificates can prevent people from being able to register for assistance and claim rights and entitlements. This leaves them in a vulnerable position.
In conflict and displacement situations it can be extremely difficult or impossible to replace such documents, while older people may never have possessed relevant documentation in the first place.
Ensuring humanitarian aid reaches the most vulnerable
The failure to provide appropriate, accessible assistance and services for older people represents a violation of the fundamental humanitarian principles of humanity and impartiality. HelpAge International is the only international organisation working specifically to meet the needs, uphold the rights and recognise the capacities of older people in humanitarian crises.