Aged and Disabled in UkraineThe elderly population is the fastest growing age group worldwide, and two-thirds of its population lives in low-income and middle-income countries. Such geographic locations have greater likelihoods of humanitarian crises, and the impacts of humanitarian disasters in these countries are more severe. Research shows the aged and disabled in Ukraine also have higher rates of poverty than younger, non-disabled people, making them more vulnerable during disasters. More than one-fifth of Ukraine’s population (more than 9.5 million people) were over the age of 60 in 2018. The country also is facing one of the world’s most acute global crises today.

Increased Vulnerability and Disproportionate Effects

According to HelpAge International (HAI), marginalization is having greater effects on older individuals, especially older women and the disabled. Since 2014, older persons have constituted more than one-third of the conflict-affected population — equivalent to more than one million people. Many of them have fled their homes due to violence along the contact line — a line dividing government-controlled areas (GCA) from non-government-controlled areas (NGCA). The number of affected people continues to rise as the ceaseless fighting impacts the mental health of the aged and disabled in Ukraine. These populations must contend with widespread landmines and restricted access to nutrition, healthcare, housing, pensions, fuel and public transportation.

Residents living along either side of the contact line and in NGCA are among the most vulnerable in Ukraine because humanitarian access is severely restricted in these areas.

The majority of individuals residing in and displaced from NGCA collect pensions. However, they can claim their pensions only if they are registered as internally displaced persons (IDPs) in GCA. They must also undergo complex and discriminatory vetting for pension verification, including home visits, physical identification in banks and additional safeguards. This approach is riddled with liabilities and creates serious humanitarian consequences because pensions are the sole source of income for most pensioners in NGCA. If approved, administrative requirements demand the aged and disabled travel through five checkpoints along the contact line every few months to avoid pension suspension. These individuals spend 50 to 80 percent of their monthly pension on travel expenses. Consequently, many seniors are cut off from their pensions because they either are physically unable to travel to GCA or cannot afford the trip.

Pensions are not the only reason seniors cross the contact line. They also cross to visit with family, obtain documentation and access medical services. The many restrictions imposed on crossing result in older and disabled persons waiting at entry and exit checkpoints for extended periods of time without adequate facilities like toilets, drinking water or shelter. Red tape often prohibits them from crossing with necessary items like medications and food as these may not be permitted goods. People also must renew their electronic passes on regular basis if they plan to cross — a near impossibility for much of the senior population who has no computer or internet access. These conditions are detrimental to the well-being of the aged and disabled, creating a dire need for mental health services, psychosocial support and life-saving aid.

Forgotten in the Midst of Crises

Marginalizing the older and disabled during disasters is not unique to Ukraine. In 2015, HAI interviewed hundreds of seniors across Ukraine, Lebanon and South Sudan. In all three countries, there was evidence of neglect. Most interviewees said they had never met with anyone to discuss their needs nor did they have sufficient information about available assistance. Almost 50 percent complained that health services were not equipped to treat their age-related conditions, and nearly half said they suffered from anxiety or depression.

Humanitarian Relief for the Aged and Disabled in Ukraine

HAI has worked with the elderly in Ukraine for more than 10 years and has provided them with community safe spaces. The organization has also directed advocacy and coordination efforts with NGOs and UN agencies to ensure that seniors are not excluded from receiving services and psychosocial support. HAI has established support groups and provided home-based care activities, assistive devices and hygiene kits to those of advanced age. However, despite the organization’s humanitarian assistance, a survey they conducted in 2018 showed that those aged 60 and older are still suffering.

The findings were echoed at a 2018 conference organized by the European Commission and the UN Office for the Coordination of Humanitarian Affairs in Brussels. The conference highlighted the support that the WHO and partners have given Ukraine to help combat the devastating effects of the country’s ongoing crisis. During the conference, it also was noted that despite the efforts of the WHO and its health partners, Ukrainian health needs still are on the rise. Speakers attributed the lack of improvement to a weak health system, limited disease prevention and insufficient treatment for chronic illnesses.

The conference also confirmed that the European Union (EU) will provide an additional €24 million to conflict-affected persons in eastern Ukraine, bringing their aid total for Ukraine to more than €677 million. The money will be used to fulfill the essential needs of the most vulnerable populations along the contact line, including IDPs and those in NGCA.

With coordinated efforts and increased humanitarian funding, permanent change for Ukraine is on the horizon.

– Julianne Russo
Photo: Pixabay

Elderly Care in Iran
The Iranian government recently turned an eye towards aiding development and putting the nation back on track after the Iraq war. There is still a great deal of room for social reform in this improved state of development, especially in the area of elderly care in Iran.

Aid for the elderly population in Iran is projected to become a large issue, as the country experienced a baby boom in the years of the Iraq-Iran war (1980 to 1988) which will lead to an increased elderly population in the future. The rising rate of unemployment in Iran has made it difficult for the elderly to find and hold jobs, and most elderly people are unable to provide for themselves in their old age.

Elderly People in Iran

One-third of the Iranian elderly population is not covered by any health insurance; meanwhile, the Iranian government diminished the elderly retirement pension — only one-third of the elderly population receives a pension — while 20 percent of families are economically dependent on the senior householder. The elderly demographic has a very low socioeconomic status and basic insurance policies fail to cover most elderly care costs. Without the money to afford the extra costs, older people often fail to receive the help they need.

There are currently five main governmental organizations taxed with elderly care in Iran:

  • The Social Security Organization
  • The State Welfare Organization
  • The Red Crescent
  • The Imam Khumeini Relief Foundation
  • The Martyrs Foundation

However, there are no clear developed policies on elderly care, and no single organization responsible for addressing this crucial societal need. As a result, ambiguity and uncertainty surround specific organizational responsibility.

Challenges of Elderly Care in Iran

Policy-making is one identified challenge of the elderly care process in addition to access, technical infrastructure, integrity and coordination and lastly, health-based care services. In regards to access, there are no transportation facilities and many of the elderly are entirely stuck at home due to physical reasons or an inability to pay for transportation costs.

Also, 70 percent of elderly people in Iran are illiterate, which impacts their awareness of access to resources. Currently, Iran does not have the physical, human and informational resources to implement an elderly care policy. This is concerning as the country is projected to experience fast demographic changes and a huge increase in the elderly population in the near future.

The country does have community-based services for the elderly such as nursing homes, adult daycare centers, cultural centers and meals on wheels; unfortunately, the distribution is sparse and these services are intended for mainly elderly people with disabilities. However, on a more positive note, the fact that this issue is being qualitatively and quantitatively studied is considered progress.

Need for Action

Historically, little attention has been paid to elderly care in Iran, but new studies and scenario exercises will thankfully aid the government in creating a sturdy policy framework for addressing elderly care in Iran.

The country is still developing and many other issues surrounding poverty are the main focus of the government right now. There is still time to address the problem of elderly care in Iran before it becomes too big to handle, but the Iranian government will need to start taking action immediately.

– Mary Spindler

Photo: Pixabay

Elderly Care in Bosnia and Herzegovina
Bosnia and Herzegovina has been slowly recovering from the conflict that took place in the country during the late 1990s. The war took a toll on the country economically, politically, socially and physically. On top of its high levels of poverty, the country is also becoming a victim of the aging population epidemic and elderly care in Bosnia and Herzegovina is a huge concern. The country is facing issues of a dip in fertility rate and an increase in the rate of the elderly people, leaving a large number of older population with a small population of working-age people to support them. This issue coming from the uneven age distribution grew due to a fall in birth rates, a decrease in population from deaths during the war years and an increase in life expectancy.

The Increase of Elderly Population

Currently, people over the age of 65 make up 17 percent of the total population. Moreover, the United Nations Department of Economic and Social Affairs estimated that the number of persons aged 65 and more than 65 will reach 30 percent of the population in 2060, comparative with the 15 percent it sat at in 2010. With a population of only 3.5 million, this is a daunting number.

The older population in Bosnia and Herzegovina is extremely vulnerable for many reasons. Some of the issues they face include low income and increased living expenses. Obtaining employment is difficult as well. Due to the high unemployment rate the country faces, many employers prefer younger workers. This means that many of the elderly face poverty and have been unemployed since before retirement age, leaving them with subsequently less to provide for themselves as they age.

The situation for elderly women is worse than it is for men, as women lose rights with the loss of a husband. They also face higher rates of poverty as they are usually unable to economically provide for themselves alone. The elderly are ailed by illnesses such as cardiovascular and malignant diseases, neurological and mental disorders like Alzheimer’s, as well as sensory and physical disabilities. Many of these diseases and the lack of care for them result in a higher rate of depression amongst the elderly.

The Exodus of Medical Workers

On top of all this, Bosnia and Herzegovina is facing an exodus of its medical workers. Many young doctors and medical professionals are leaving the country after their schooling is complete and migrating toward Germany and other Western countries because these countries offer better job opportunities and more competitive salaries. More than 10,000 nurses, doctors, caregivers have gone to Germany alone. Only about 6,000 doctors work in Bosnia, meaning for every six doctors, one works in Germany. Not only is this leading to a lack of medical professionals, but the country is also losing money as they put millions into medical training facilities that students use and then leave behind as they migrate their services.

Bosnia is being forced to send patients abroad for care, so in the last two years, the country has spent around $37 million on patients that were sent outwards. Not only is this epidemic draining the country’s money, leaving it with less available funding to put towards elderly care in Bosnia and Herzegovina, it also means there are not enough doctors to perform geriatric care. It’s a negative feedback loop that hinders the country’s ability to care for its citizens, especially the elderly ones.

The Solutions for the Problems

The growing number of the elderly population in combination with the exodus of medical workers leaves the country with many people suffering and few resources to help them. Thankfully though, Bosnia and Herzegovina has not turned a blind eye towards these issues and instead has begun to search for solutions. Members of the United Nations adopted the Madrid International Plan of Action on Ageing that aims to address the issues of aging in the 21st century. The plan focuses on three main aspects: older persons and development, advancing health and well-being into old age and ensuring enabling and supportive environments.

With support from the United Nations Population Fund, United Nations Department for Economic and Social Affairs and the Swiss Cooperation in Bosnia and Herzegovina, the country has developed its own strategies, inspired by the structure of the Madrid International Plan of Action on Ageing. It plans to improve social and health protections, promote activism and volunteerism in local communities, as well as inter-generational support. The country aims to improve access to public services, especially for those in rural areas and prevent violence, neglect and abuse against older persons. The execution of this initiative will require a great deal of money and resources, but the government is dedicated to the improvement of elderly care in Bosnia and Herzegovina.

This plan of action shows that the government is making this issue a focal point in national policy and beginning to address the problems that will address the aging population. Elderly care in Bosnia and Herzegovina has a long way to go before the older population is secure and comfortable. With initiative from the government to care for the elderly, social attention will be turned towards this problem that will encourage the younger generation to aid the older and make room for various organizations to provide help and resources to the country’s older population.

– Mary Spindler
Photo: Flickr