Older people and political instability
Authors: None The Lancet Healthy Longevity
Journal: The Lancet Healthy Longevity (2021)

On Aug 16th, 2021 the Taliban entered Afghanistan's capital city Kabul and claimed victory to the nearly 20-year war that has engulfed the country. As of writing, the Taliban are in the process of forming a government while world powers send military planes to evacuate their citizens. The world has been shocked by the brutal images of hordes of Afghani citizens clinging to planes in desperate efforts to leave. Since the start of 2021, abnout 400 000 Afghans have been internally displaced, fleeing their homes in pursuit of safety, and this number will continue to rise in response to Taliban rule. Although these numbers are appalling, there is at least the possibility that those seeking asylum will be able to rebuild their lives elsewhere. By contrast, older people are less likely to be able to flee situations of oppression. Older people are more likely to be left behind both because of strong bonds to their homes and land, and because they are affected by higher levels of frailty and limited mobility, encumbering travel. Those who remain in volatile regions are at risk of violence and abuse, and a loss of access to basic needs, such as water, food, medical care, and electricity. When violence erupted in April, 2014, in eastern Ukraine, many young adults fled the Luhansk and Donetsk Donbas regions, leaving these conflict-stricken areas largely inhabited by older people, with UN estimates suggesting 31% of the population in the area is older than age 60 years, compared with the national average of 23%. With infrastructure strained and many young health professionals gone, older adults with chronic conditions were left isolated and stripped of access to health care; a 2021 WHO report indicated that 30% of those needing humanitarian assistance in eastern Ukraine were aged 60 years and older. A 2018 survey by HelpAge International of older people living in close proximity to the contact line revealed that 97% of those surveyed had a chronic condition, making access to medical care a key priority. Economic autonomy has been impeded by restricted access to pensions; older people living in eastern Ukraine are required to cross the contact line to government-controlled areas to receive their pensions and other social benefits. Limitations in mobility have resulted in an estimated 1·2 million older people not receiving their pensions. The plight of older people living in the conflict-ridden regions of Ukraine is not unique. Older people living in conflict zones in Venezuela report having disrupted access to food and safe drinking water, and older refugees from South Sudan displaced to camps in Ethiopia report an inadequate supply of food and safe access to toilets. Faced with these inhumane conditions, some older people choose to make the harrowing journey to seek safety despite the difficulties. However, the sought asylum is often devoid of the promised protection and older refugees often fall through the cracks in their host countries. In many cases, refugees arrive without documentation, having lost these in the journey or left them behind, and older people face difficulties in obtaining identity documents, due in part to an increase in technology-based services, limited physical mobility, and difficulties in navigating foreign registration policies and systems. Without documentation, access to health care, housing, and financial autonomy, such as pensions and paid work, is restricted. The lack of identifying documents is a reflection of the invisibility of older refugees. They face the challenging transition from having strong community ties, often with revered social status, to separation from families and an erosion of social networks. Compounded by language barriers, older refugees face the challenge of adapting to and integrating within a new culture and are largely relegated to the fringes of society. Unsurprisingly, older refugees experience heightened loneliness and high rates of mental health problems, exacerbating existing health conditions. The circumstances of refugees and those who stayed behind are strikingly similar: they are deprived of agency. With a rich repertoire of knowledge and experience rooted in the culture and history of their homelands, older people play a unique and crucial role in protecting the cultures of displaced people and enriching host communities. Humanitarian efforts must recognise the distinct challenges of older internally displaced people and refugees to ensure secure access to basic needs, including documentation, housing, health care, and food security, to protect their integral role in displaced communities worldwide. And there must be provision for those who are forced to remain in politically and climatically unstable regions, unable to leave. For more on health outcomes in older refugees https://www.euro.who.int/__data/assets/pdf_file/0003/386562/elderly-eng.pdf For more on health outcomes in older refugees https://www.euro.who.int/__data/assets/pdf_file/0003/386562/elderly-eng.pdf