Latest news feedUNHCR Assistance to Older Refugees
SCOPE OF THE STUDY
This study seeks to examine the processes that can increase the isolation and dependency of older refugees and displaced persons of concern to UNHCR, to analyze the issues involved in seeking durable solutions for them and to survey the measures that may help in the rehabilitation of the young elderly, and in the provision of care for the very old. Particular attention is given to identifying optimal implementing arrangements and phase out strategies for social assistance projects which address these needs.
The findings of the study are based on the results of a field survey on elderly refugees undertaken by the Community Development Unit of PTSS in early 1997 as well as on observations made during field visits to Bosnia, Croatia, Egypt, Russia, Sudan and Yemen which took place between mid-September and mid-November 1997. Some 200 elderly refugees were interviewed during the mission and meetings were held with staff from UNHCR, governments, local and international NGOs and UN agencies. Extensive consultations were conducted with community development staff both at headquarters and in the field.
The study is in two parts. The first is a review of key issues which results in a number of general recommendations aimed at consolidating and improving UNHCR’s response to the elderly. The second part consists of case studies each one of which dwells upon a different constellation of problems. They show that adequate measures on behalf of the elderly require an integrated policy involving several, if not all, programme sectors in a given country. The case studies include a number of specific recommendations discussed and agreed with UNHCR staff in the countries concerned.
The field work in Bosnia, Croatia, and Russia was undertaken jointly by Constantin Sokoloff, Senior Officer, Inspection and Evaluation Service and Stefan Sperl, a former UNHCR staff member who now lectures at the School of Oriental and African Studies in London. Mr Sperl also undertook the field work in Egypt, Sudan and Yemen and prepared this report. Field research in Armenia was conducted by Ms. W. van Bemmel, who also wrote the corresponding case study.
OVERVIEW
The elderly are among the most invisible groups of refugees
and displaced persons. I hope to change that.
Mrs. Sadako Ogata[1]
1. When official refugee emergencies are over and aid agencies are beginning to scale down their programmes, a different but no less insidious emergency can begin for older people, especially those who have been parted from their families. They may find themselves increasingly marginalised and often face enormous difficulties in trying to rebuild what remains of their lives. The consequences involved have been closely witnessed during the field visits undertaken to prepare this study which included interviews with some 200 individuals.
2. The elderly are, however, by no means a homogeneous group. How greatly the problems and situations can differ is illustrated by the countries visited which fall into two sets: Bosnia, Croatia and Russia on the one hand, and Egypt, Sudan and Yemen on the other. In the Eastern European countries the elderly persons of concern to UNHCR are normally entitled to state pensions, were forced to flee in their old age and form a well known part of the refugee population which has often benefited from special UNHCR programmes.
3. In the other three countries, the refugees are not entitled to any form of state aid and must rely on the traditional family-based safety net. Most of them fled as young or middle aged persons and have grown old in exile, particularly the Eritreans in the Sudan and the Armenians in Egypt which are among UNHCR’s oldest caseloads. Their presence has been little noticed and they have not attracted any special community services programmes; those in Egypt, however, have benefited from regular allowances.
4. Considering the many differences between these groups and the countries in which they reside it is remarkable that there are a number of basic features which these situations have in common. In all countries, the elderly have been the population group most affected by three crucial factors: social disintegration, negative social selection and chronic dependency. The implications for UNHCR are also broadly similar. What is required is: better integration of the elderly into all aspects of programme planning and implementation; more emphasis on targeted community services projects with competent linkage partners; and greater advocacy on behalf of the elderly during the crucial phase-out stages. To document this with reference to concrete situations and discuss options based on lessons learnt is the purpose of this review.
Social Disintegration
5. In the countries visited, the two main factors behind the erosion of social support systems, whether formal or informal, are: economic decline, resulting in a drastic reduction of living standards for the poorest, with refugees among the hardest hit; and the separation and dispersal of families as a result of war, flight and economic or security pressures, resulting in a rise in the number of unaccompanied elderly persons in need.
6. In Eastern Europe, the comprehensive pension, health care and social welfare systems of the socialist era have not survived the transition to a market economy which has lead to a catastrophic drop in the standard of living of all those who had to depend on welfare provided by the state, principally, of course, the elderly. Hardest hit of all are the victims of forced displacement such as those in the former Yugoslavia and in the Caucasus region who lost not only the value of their former entitlements but also their homes and with it all their economic assets.
7. While the problems in Eastern Europe have been more frequently reported, the gradual but no less painful erosion of traditional support networks in developing countries and its impact on refugees is much less well known. In the Sudan, for instance, everyone interviewed paid lip service to traditional community values but admitted in the same breath that economic decline, social mobility and the pace of social change meant that the elderly no longer enjoyed the same authority, care and attention they had in the past. Also, the degree of support and respect the elderly receive is by no means uniform but depends very much on their social status within the community: not all elderly are elders.
8. As a result, unaccompanied elderly refugees in developing countries may face situations of utmost misery and destitution. In both Sudan and Yemen, the poorest among them live a totally marginalized existence as beggars and may never even come to the notice of UNHCR and aid agencies. Due to bad nutrition, appalling living conditions and lack of medical attention, they are invariably prone to illness and their life expectancy is severely curtailed.
Negative Social Selection
9. This term is used in the former Yugoslavia to describe the manner in which camps and collective centres have been observed to empty over time. Those who are young, healthy and able bodied are the first to depart, leaving behind the more vulnerable members of the group: the sick, the handicapped, single mothers with young children and the elderly. At the end there remains a hard core of mostly elderly persons who have nowhere to go and no one to take care of them. In this way, some collective centres in Bosnia, Croatia and Serbia have become geriatric wards in all but name.
10. This phenomenon is not limited to the former Yugoslavia but is, to a greater or lesser extent, a spontaneous process characteristic of camps and collective centres everywhere. In the Sudan, for instance, negative social selection has been an important factor in nullifying UNHCR’s 20 year efforts to help wage-earning settlements become self-sustaining. As shown in a recent report, these settlements now comprise a disproportionate number of small children, single-headed households and elderly who live in extremely poor conditions and remain wholly dependent on the continuation of assistance provided by UNHCR and WFP.
11. Government resettlement policies can contribute to the negative selection process by discriminating against elderly applicants who may not pass medical screenings and be left behind in countries of first asylum, painfully separated from the rest of their kin. Reports received from UNHCR Branch Offices in different parts of the world indicate that this is a common problem. There is a clearly a need to raise the issue with resettlement countries as a matter of principle instead of dealing with it on a case-by-case basis.
Chronic Dependency : Primarily a Protection Challenge?
12. Avoiding chronic dependency on the part the elderly must be UNHCR’s first objective, which is primarily a protection challenge. Wherever possible, the Office must ensure that elderly victims of forced migration are able to regularise their status and obtain access to all possible benefits, entitlements and rights. Where elderly people with mobility problems are involved, legal counselling sessions should be made available to them in their places of residence such as old people’s homes, collective centres or private accommodation.
13. Despite such efforts, many refugee situations produce over time a residual caseload of solitary older persons who have not found a durable solution, are unable to secure state benefits or family support, and may become dependent on UNHCR for long periods of time. This has been the case with many Russians and Armenians who became refugees in the 1920s. UNHCR has been providing the destitute elderly among them with allowances in countries as far afield as, Argentina, Egypt, Morocco and Venezuela.
14. The Office should continue to assume its responsibilities in this regard by ensuring that the experience of exile is not compounded by an old age marked by poverty and destitution. General criteria to determine the adequacy of such allowances have, however, never been established and there is evidence that standards vary markedly from one country to another, in some cases the allowances do not even cover minimum subsistence needs. A more comprehensive approach is needed because the problem of residual elderly caseloads may well increase in severity as the ageing of populations and global trends towards social disintegration may lead to a rise in the number of unaccompanied older refugees.
Integrating the elderly in all aspects of programme planning and implementation
15. While the elderly clearly have special problems there is little to be gained from establishing yet another separate refugee category with a distinct set of guidelines and interventions such as those devised for refugee women and children. What is clearly required, however, is a more targeted inclusion of the elderly in all aspects of programme planning and implementation, with the aim of helping young elderly to be more self-supporting and promoting better community care initiatives for the very old.
16. Outside Eastern Europe where the elderly have attracted more attention, the social assistance policies adopted by UNHCR and its implementing partners are often focused primarily on children and women of child-bearing age for whom elaborate strategies are being devised. Rarely have training programmes, income-generation schemes, micro-loan projects or even community development projects been designed so as to deliberately include older refugees, tap their potential and ensure that their voices are heard.
17. The reason for this is partly a question of attitude which perceives preoccupation with the elderly as a low priority, since their needs are supposedly met by the community as a whole and they appear to have little of substance to offer. The topical focus on women and children as preferential beneficiaries of assistance tends to breed oblivion of the fact that the well-being of the old has a profound impact on the entire family, especially the very young.
18. Moreover, in many cases where the middle generation is absent for some usually tragic reason, grand parents can find themselves in sole charge of their grandchildren. Families such as these are often without a breadwinner and constitute the neediest and most unfortunate cases witnessed during this mission. Their existence which appears to be widespread in refugee situations, is eloquent testimony of the need to adopt a more family-centred concept of care rather than one in which certain groups are singled out for special treatment.
19. The attitude problem is compounded by a shortage of community services staff with a background in geriatric care. There are none in UNHCR, and the situation among NGOs is little better, with the notable exception of Help Age International. There is a need for UNHCR’s staff and its implementing partners to participate in training and awareness-raising sessions to discuss ways in which their activities can be made more deliberately inclusive of the elderly. A survey of different types of relevant approaches and programmes is included in this review.
Community Services’ Input is Vital
20. The field visits have shown that an adequate response to the needs of the elderly depends primarily on the quality and competence of the community services’ input provided by UNHCR. The neediest among the elderly are often the least visible, and a proper assessment leading to a well designed programme requires a targeted effort under the supervision of qualified staff. One example is the network of refugee monitors established through a local NGO in Vladikavkaz which proved indispensable in identifying beneficiaries who might otherwise never have come to the notice of the Office. Comparable successes were also noticed in Bosnia and Croatia where UNHCR’s community services input is strong.
21. At the other extreme is the situation in the refugee camps and settlements of the Sudan where there has been no community service structure of any kind. This is one of the main reasons why UNHCR has for a long time been insufficiently aware of the disastrous consequences brought about by negative social selection in the camps. Personnel policy is partly to blame as the community services dossier in the country has for long been entrusted to very junior staff who could hardly be expected to make an impact on the management of one of UNHCR’s largest and most intractable programmes. In Yemen and Egypt the lack of a qualified community services presence was evident in the work of local NGOs who are clearly in need of more guidance on the part of UNHCR so as to develop more effective and creative counselling and outreach initiatives, not only concerning the elderly.
22. Securing accurate information on the socio-economic circumstances of the refugees and their quality of life is a vital by-product of well-managed community service programmes. Such information is notoriously difficult to come by but is essential for the proper design of assistance activities in all other sectors, including the enhancement of community participation and self-help initiatives. For this reason, a close interface must be maintained between community service projects and those in other sectors, particularly health and education. They are not a luxury but a necessity upon which much else can depend.
Phasing Out Responsibility
23. Phasing out programmes that benefit the elderly is likely to be problematic, particularly if a residual caseload of abandoned older persons is involved who have no alternative means of support. Thought must be given to the long-term implications of such programmes even before they begin and their phase-out should never be sudden but subject to a multi-year planning horizon.
24. The main problem areas identified in this context are three : service delivery through local NGOs which are unlikely to survive the withdrawal of UNHCR funding; lack of sufficient involvement of competent government departments such as the ministries of social affairs; and insufficient co-ordination with fellow UN agencies able to provide relevant support and advice, in particular WHO, UNDP and the World Bank.
25. Experience with local NGOs has shown that they may not become independently viable unless UNHCR engages early on in a concerted capacity-building effort which goes much beyond the occasional briefing workshop. They need to be thoroughly trained in project design and fund-raising techniques and helped in setting up a sound administration and in identifying and liaising with potential donors. To further this, UNHCR should also take a leading part in system-wide efforts to consolidate the legal position and technical competence of local NGOs in a given country. All this takes time to be effective, and competent NGOs should be granted a two- or three-year period of assured support prior to the withdrawal of UNHCR support.
26. Concerning government implementing partners, it was remarkable to note that in all the countries visited UNHCR’s co-operation with social affairs ministries was at best tenuous and often non-existent. In Eastern Europe, preference for implementation through NGOs has meant that existing government service outlets, such as social welfare centres which could have played a useful role in outreach services for the elderly, were often ignored. If UNHCR wishes to phase out responsibly it must ensure that residual caseloads of needy elderly persons become the responsibility of competent government departments. This should not be initiated at the last moment; rather, any government capacity in this field should be tapped and enhanced already at the emergency stage.
27. As part of its phase-out strategy, UNHCR should also seek to ensure a successful transition from relief to development also in the social assistance sector. For the elderly, whether refugees, returnees or displaced persons, this means that they should have access to the same services which are available to locals and that relevant welfare structures should be helped to develop the capacity necessary to cope with any added demands. However, in countries affected by war, economic decline or structural adjustment welfare provision is gravely under-resourced and usually occupies a very low priority. In these circumstances, UNHCR can only hope to influence government policy on welfare provision and funding if its interventions are closely co-ordinated with sister agencies that are habitually engaged in offering support and advice in this field, particularly the World Bank, but also WHO and UNDP.
28. These and other agencies have in recent years become closely involved in assisting governments to manage health care and welfare reforms and to set up major poverty alleviation programmes. The difficulties of integrating refugee concerns into such national development plans are notorious, but in certain situations UNHCR itself seems to be part of the problem. Locked into the often stifling embrace of a local government bureaucracy, it pursues its own programmes with little consultation and is not sufficiently proactive in seeking the involvement of other agencies despite the fact that the latter will have a vital role to play during the phase-out stage.
29. In large, complex programmes, UNHCR’s phase-out strategy should be subject to a multi-year plan in which the gradual withdrawal of its services in the social assistance sector is linked to the implementation of government welfare reforms and poverty alleviation programmes supported by the World Bank and other bilateral and multilateral donors. This requires complex negotiations that need to be engaged well in advance.
1999 is an opportunity not to be missed
30. UNHCR should see the forthcoming International Year of the Older Persons not only as a public relations exercise but as an opportunity to put older refugees more decisively on the map, both within the organisation and among its partners. A programme of activities could be devised with the objective of raising more awareness about the subject among UNHCR staff, giving implementing partners the opportunity to acquire more relevant training and expertise, and securing a greater measure of co-operation and support on the part of donor governments and fellow UN agencies. The review includes some specific proposals to this effect.
RECOMMENDATIONS
Recommendation 1
In seeking durable solutions for elderly refugees, UNHCR must ensure that the tragedy of their exile is not compounded by an old age marked by poverty and neglect; it must draw the attention of the international community to their plight and make every effort to ensure that they have access to a basic level of safety, mental and physical welfare and continuity of care.
Recommendation 2
In seeking durable solutions for refugees, UNHCR should be mindful of the situation of their elderly dependants, including those in the country of origin; it should seek to facilitate family reunion by intervening with countries of asylum, origin or resettlement and should, if appropriate, seek the support of other competent agencies in mitigating threats to their security and well-being.
Recommendation 3
Organised efforts should be made to seek out and identify elderly refugees in need of legal advice to regularise their status and secure access to benefits and entitlements; to this effect legal counselling sessions should be held in collective places of residence such as old people’s homes, and home visitors should monitor the legal needs of clients for liaison with protection staff.
Recommendation 4
Elderly refugees who have not found a durable solution in their country of asylum and have no other means of income or support should be assisted by UNHCR even on a long-term basis if necessary; allowances paid to them should be calculated to cover at least minimum subsistence needs.
Recommendation 5
UNHCR should promote the position that family reunification between adult refugees and their dependent parents should be treated as a basic right; on the occasion of the International Year of Older Persons, the Office should prepare documentation on pending cases for presentation to governments of resettlement countries.
Recommendation 6
During voluntary repatriations operations, UNHCR should ensure that its legitimate concern for the consequences of return fully extends to elderly returnees and covers not only their transportation and reception arrangements but also their long-term reintegration prospects; to this effect a strong community service presence should be established in the country of origin and maintained for an extended period if necessary.
Recommendation 7
In order to ensure the effective integration of older refugees into all relevant assistance sectors, UNHCR’s community development activities need to be strengthened and refocused ;
This requires :
- the assignment of staff of sufficient seniority and experience, especially to large programmes;
- appropriate training of local staff and implementing partners;
- mechanisms to locate and identify older persons in need;
- better supervision and guidance of counselling services;
- an effective interface between community development activities and other sectors, in particular health, nutrition, education and training;
- the assignment of a role for the elderly in all community services initiatives; and
- the appointment in the Community Development Unit (within PTSS) at Headquarters of one staff member with a specialist background in gerontology to give appropriate guidance and training.
Recommendation 8
To optimise health and nutritional care for older refugees, UNHCR should:
- develop standard mechanisms and reporting formats to identify the health and nutritional situation of older age groups;
- design supplementary feeding programmes to meet the specific needs of older persons;
- develop a policy on preventive health measures for older persons;
- develop a policy on the treatment of chronic diseases, including supportive measures for the chronically ill; and
- ensure an effective interface between health and community services at field level.
Recommendation 9
Efforts should be made to include older persons in education, training and income-generation activities both as recipients and providers; to this effect their interests and abilities should be more systematically assessed and projects designed accordingly; whenever appropriate, older people should be brought together with younger people and children.
Recommendation 10
In large refugee situations, relief substitution projects should be introduced with the aim of training local craftsmen to manufacture good quality walking aids, including shoes, sticks, crutches, wheel chairs and prostheses, for use by elderly and handicapped people.Recommendation 11
Wherever possible, UNHCR should seek to implement social assistance programmes, in particular those likely to involve recurrent costs, from the beginning through the competent line ministry and, in doing so, strengthen the capacity of its dependent institutions in preparation for eventual phase-out.
Recommendation 12
Local NGOs, in particular those involved in longer-term social assistance programmes, should be provided with a two- or three-year period of assured support to allow for financial and administrative consolidation prior to the withdrawal of external funding; they should also be helped with developing fund-raising approaches and given opportunities for specialised training in geriatric care.
Recommendation 13
Wherever possible, UNHCR should attempt to integrate its social assistance activities into social development programmes adopted by other UN agencies and the local government; to make this effective, the phase-out stage should be subject to a multi-year strategy negotiated jointly with linkage partners and donors and based upon clear objectives and realistic time frames; if necessary, field offices should be strengthened to help with establishment of such a strategy.
Recommendation 14
In the light of the recommendations of this review, UNHCR should use the forthcoming International Year of Older Persons as an opportunity to draw donors and implementing partners into a dialogue on ways to improve awareness, policy planning and projects for older beneficiaries; an overall training and information strategy should be developed to this effect.
I. BACKGROUND
31. Speaking on the occasion of the International Day of Older Persons in October 1997, the High Commissioner expressed her belief that UNHCR needed to increase its efforts “at improving awareness, policy planning and projects for older refugees”. An initiative in that direction had already been undertaken earlier in the year when the Community Development Unit of PTTS conducted a survey of field offices to produce a summary assessment of older refugees under the care of the Office.
32. Geographical differences abound in the data obtained. Definitions of the term “older” range from the age of 46 in Ethiopia to the age of 73 in Venezuela and the proportionate number of elderly as well as the nature of their problems vary from one situation to another. The overall trends, however, justify the High Commissioner’s concern. Older refugees everywhere tend to have diminished access to training and employment opportunities, often lack information about rights, services and facilities available to them and are at risk of neglect or abandonment by family members who are not able to provide care.
33. The present review which makes extensive use of the PTSS data was sparked off by mounting concern over the long term dependency of elderly refugees in urban situations. To elicit first hand information, field visits were undertaken to selected countries which can be divided into two groups: Bosnia, Croatia, and Russia on the one hand, and Egypt, Sudan and Yemen on the other. The Eastern European countries were an evident choice as they harbour large proportions of elderly refugees and displaced persons. Armenians in Egypt and Eritreans in Sudan are among UNHCR’s oldest caseloads and provided interesting case studies of long-term dependency among the elderly. Yemen was included on account of BO Sana’a’s response to the field survey which indicated concern for the situation of elderly urban refugees.
34. Already during the first field visit to Croatia it became clear, however, that a distinction between elderly in urban and non-urban settings could not be meaningfully upheld and that the dynamics of displacement in any given country could only be understood if the entire caseload was taken into account. In the end, elderly refugees and displaced persons were visited without discrimination as to residence. In total, some 200 interviews were conducted in collective centres, old people’s homes, refugee camps and private accommodation in rural and urban areas. All had been arranged with the help of UNHCR Community Development staff and implementing partners who provided invaluable support throughout. Meetings were also held with relevant UNHCR, NGO and government staff as well as fellow UN agencies, in particular the World Bank, UNDP, WHO and WFP.
35. The High Commissioner’s concern for the elderly must be seen in the larger global context where changing demographic patterns in developed countries have led to an intense debate on all aspects of ageing, with inevitably implications also for UNHCR. In 1991, the General Assembly adopted the 18 United Nations Principles for Older Persons several of which are so relevant to refugees that they can be used as guidelines for UNHCR’s policy planning and are cited as such in this review. The following year, the General Assembly declared 1999 as the International Year of Older Persons. This may represent an important opportunity for UNHCR to draw more attention to the special difficulties faced by older refugees and develop new policy, programme and fund-raising strategies on their behalf. The findings and recommendations of this review are intended to contribute to this process.
II. OLDER REFUGEES: SOME BASIC CONSIDERATIONS
Older persons are more likely to be givers than receivers of aid
36. Abdi Omar is 69 and lives in al-Basatin, a slum on the outskirts of Aden. He lost an arm during the fighting in Somalia and his two sons were killed in the Yemen civil war. He now supports his daughter-in-law and a grandchild with the minimal income he derives from reading the Qur’an in people’s houses. When asked why the family does not move to the refugee camp where food and shelter are available for free, his answer is clear : there is no future for the children in the camp, no education beyond primary level; for the sake of his grandchild, he will make any sacrifice and struggle to survive in town for as long as he can.
37. Another scene: a transit centre run by the Federal Migration Service in Stavropol Kray, Southern Russia. Olga Gatieva lives there, a frail old lady from Grozny. Her injured son is still in Grozny, destitute and unable to get away. Olga sends him whatever she can save from her minuscule pension and is left penniless herself. She is not alone. In many displaced families in the CIS, pensioners are the only ones who have any regular income and share the little they receive with their children and grandchildren.
38. These case histories, and many others like them, contradict the widely-held assumption that older persons, and older refugees in particular, are synonymous with passivity and dependency and therefore somehow socially redundant. Most older persons are highly motivated to make an active contribution to the well-being of their next-of-kin and become dependent in a full sense only in the final stages of disability or illness. The tragedy of older people who have been forcibly displaced is not so much that they become dependent on others but that they have been robbed of the means to provide for others in the manner they would wish.
39. For this reason alone, assistance programmes must be designed in such a way as to include the elderly as much as possible in all activities and provide them with the means and the opportunities to restore and realise their potential. Such initiatives, targeted at the young or active elderly are quite different from measures designed to ensure proper care and medical attention for frail elderly who have become incapacitated due to sickness or old age.
40. The neediest cases witnessed during the field visits concerned what may be termed elderly-headed households where a grandparent was in charge of grandchildren following the death or forcible departure of the middle generation. Whether in North Ossetia, Sudan, Bosnia or Yemen, such families live in desperate poverty due to the lack of an employable breadwinner. The physical and mental strains are enormous as the grandparent struggles to cope, often neglecting his or her own needs in the process.[2]
41. Any measures designed to support elderly people in this position will help not only them but, by extension, the entire family. Currently this is happening very much on an ad hoc basis and there appears to be no adequate prioritisation on the part of UNHCR. The well-publicised focus on Refugee Women and Refugee Children is not sufficiently family centred and encourages staff members to take the elderly for granted. One colleague recounted the story of an old man carrying a child during the Rwanda exodus. On arrival in the camp the child was immediately examined and provided with emergency food but nobody paid attention to the old man.
42. That this manifestation of ageism in action[3] is not an isolated incident is indicated by the 1995 Joint Evaluation of the Agreement Between Redda Barnen and UNHCR which concluded that prioritisation of refugee children was leading to “relative and unavoidable neglect of other vulnerable groups, notably elderly and disabled people who do not feature prominently in ... mission reports” (p.26). The evaluation recommends that corrective steps should be taken, “consciously and not by default” (Recommendation 23, p.39). Conscious steps will more readily be taken once the role of the elderly as givers and providers is more widely recognised. Mistaken assumptions about their role as givers can lead to them being ranked lowly as receivers.
Older refugees: a chronic emergency?
43. For the elderly most affected by the circumstances of displacement - those who have lost both their material assets and their families - a serious problem of dependency can build up over time. When the official emergency is over and aid agencies withdraw, as able-bodied refugees and those with assets and connections begin to rebuild, a new emergency begins. Left behind in camps, collective centres or dingy dwellings, the elderly find themselves supplied with ever-diminishing resources and facing a most uncertain future. This situation has become familiar in the former Yugoslavia where negative social selection has turned many collective centres into veritable geriatric wards.
44. The refugee camps in the Sudan show that the same negative social processes can also be at work over a much longer period of time. As revealed by a recent study, wage earning settlements and reception centres that have existed now for well over a decade have been gradually abandoned by younger, economically active refugees and come to be populated by a disproportionate number of vulnerable individuals, especially elderly, single-headed households and children, many of whom live below the poverty line. Conditions are so bad that full WFP cereal rations are having to be reintroduced.
45. A related phenomenon, though on a lesser scale, is observable in Pakistan where BO Peshawar has identified some 1,000 elderly Afghan refugees without family or community support. Repatriation for them is no longer an option as “the most affluent and enterprising individuals of the community who were most likely to support older persons were among the first to return” (BO Islamabad) and many elderly have now become too frail to face the harsh journey into Afghanistan alone. As assistance resources diminish, their situation and that of other extremely vulnerable groups in Pakistan poses a serious dilemma.
46. More examples could be found to show that the gradual emergence of a residual caseload of frail elderly refugees without family or community support tends be a characteristic of most refugee situations. If no durable solutions have been secured, UNHCR may find itself in the position of being the last remaining lifeline of support. Having understood the social processes at work, the challenge for the Office is, on the one hand, to design programmes in such a way as to discourage the emergence of such residual caseloads from the outset and, on the other hand, to assume totally its humanitarian responsibilities in cases where long-term dependency is indeed unavoidable. Both options require a range of measures some of which are taken up in the recommendations of this review.
Patterns of family separation and dispersal
47. Family separations invariably put the elderly at risk and are often at the root of long-term dependency. They can occur at all stages during flight for a multiplicity of reasons but certain characteristic patterns arise which can be summarised as follows:
Pre-flight
- Genocidal crimes: younger people are killed, leaving the elderly as IDPs or refugees without support; and
- Younger people flee, leaving the elderly behind as “remainees” in the country of origin.
Local Integration
- Negative social selection : elderly left behind in camps, or collective centres, while younger people depart in search of greater security or employment; and
- Long-staying refugees face old age in country of asylum without family support.
Resettlement
- Younger people resettle while elderly are left behind, either because they are excluded under discriminatory criteria or because they do not want to leave.
Repatriation
- Isolated long-staying refugees have lost touch with their country of origin and do not wish to return or are not able to return; and
- The elderly repatriate alone, leaving the younger generation behind in exile.
48. These different types of family separation or dispersal have major implications for the protection and assistance requirements of older refugees, particularly in the context of the search for durable solutions. This is the subject of the next chapter.
III. OLDER REFUGEES AND DURABLE SOLUTIONS
A fundamental principle
49. “We must make sure that the unbearable tragedy of living through the Holocaust is not compounded by an old age marked by the fear and sadness of poverty. We must let them know that the international community is not indifferent to their plight”. These remarkable words, recently spoken by the British Foreign Secretary[4], apply with equal force to all innocent survivors of comparable crimes. No one who has witnessed the pain of abandoned older persons grieving for children and relatives lost in such circumstances can come away without the feeling that humanity owes them some compensation for what they have suffered.
50. The decimation of families during genocide often has long-term consequences in contributing to the isolation later in life of people who were children at the time of the crime. Many of the elderly Armenians in Cairo attribute their isolation in old age to the fact that their extended family was wiped out seventy years ago. Inevitably, the long term consequences of the Rwandan genocide will be felt for generations, with children and elderly people having to bear the brunt.
51. The notion that the international community has an obligation to be mindful of the needs of genocide survivors in their old age has a convincing moral force which should be taken into account by UNHCR and adopted as a guiding principle in approaching the issue of elderly refugees as a whole.
Recommendation 1 : In seeking durable solutions for elderly refugees UNHCR should ensure that the tragedy of their exile is not compounded by an old age marked by poverty and neglect; it must draw the attention of the international community to their plight and make every effort to ensure that they have access to a basic level of safety, mental and physical welfare and continuity of care.
Elderly remainees also need solutions
52. When the Croatian military stormed the UN Protected Zones on 4 August 1995, most of the population fled instantly, leaving behind several thousand elderly persons who were “in all aspects dysfunctional”; scattered in villages over a wide area they were “in poor, even critical health condition, in destroyed homes and in communities with no transportation, services or even food supply” (Lang, 1997, p.269). A large emergency operation had to be mounted with the help of LRCS and UNHCR, and the Office has ever since attempted to promote the accelerated repatriation of their relatives, so far with little success.
53. This situation which has been termed “social collapse” (Lang, 1997, p.270), is a particularly extreme example of a phenomenon which is widespread in refugee situations: the fact that many elderly relatives of refugees remain behind in the country of origin because they are unable or unwilling to depart. In certain cases this may lead to tragic consequences as elderly remainees are exposed not only to destitution but to reprisals, abduction and murder. Refugees often worry desperately about their elderly dependants at home and may be powerless to help them in any way. Recently reported cases of this kind concern elderly Russian remainees in Chechnya[5] and Yazidi remainees in Turkey[6].
54. The problems of elderly remainees are normally outside the competence of UNHCR. In situations of large-scale displacement, however, where the Office assumes a regional lead agency function which includes the country of origin it should follow the precedent established in Croatia and give close attention to this issue. In pertinent cases, durable solutions for refugees should be planned taking into consideration the needs of elderly dependants in the country of origin, and family reunification through repatriation or resettlement should be promoted wherever possible. In cases where UNHCR cannot intervene directly, it should seek the support of other competent agencies such as ICRC, IFRS or the UN High Commissioner for Human Rights to provide protection and support.
Recommendation 2 : In seeking durable solutions for refugees, UNHCR should be mindful of the situation of their elderly dependants, including those in the country of origin; it should try to facilitate family reunion by intervening with countries asylum, origin or resettlement and should, if appropriate, seek the support of other competent agencies in mitigating threats to their security and well-being.
Local integration of older refugee : primarily a protection a challenge
Older persons should have access to social and legal services to enhance their autonomy, protection and care. United Nations Principles for Older Persons, (No 12) (Annex to General Assembly Resolution 46/91, 16 December 1991).
55. In many countries, the most effective manner to help elderly refugees and displaced persons and reduce their dependency on humanitarian aid consists of securing their access to legally prescribed entitlements and benefits. This means, first and foremost, access to a recognised legal status which is usually a precondition for all other rights, including pensions, welfare benefits, right of abode (e.g. the Russian propiska), compensation for loss of property etc.
56. In highly bureaucratised societies such as those in Eastern Europe, the paperwork in such transactions involves complex procedures that are often subject to obstruction and delay. Scarcity of resources and discriminatory practices by officials can act as a further disincentive to the speedy resolution of claims. It is here that UNHCR has an important role to play in setting up networks designed to help the elderly find their way through the legal maze. Typical problems that have been observed during the mission are:
- lack of information about rights, entitlements and claims procedures to be followed;
- need for expert legal advice or representation to deal with specific issues; and
- lack of access to important documentation, especially documents left behind in places of pre-flight residence.57. The mere presence of protection officers, legal support agencies or UNHCR-sponsored local lawyers is not enough. Often, the elderly are not even aware of such services and even if they are, may not be mobile or confident enough to go and ask for help. Where legal problems are known to exist, elderly people concerned need to be actively sought out and identified. For this purpose, legal counselling sessions should be organised on a regular basis in places such as old people’s homes, collective centres and geriatric wards to provide expert advice and to follow up on pending cases.
58. Community workers should be encouraged to bring legal problems of those resident in private accommodation to the notice of legal staff so that similar meetings or visits can be arranged. All this can be done by local personnel at relatively little cost; the benefits it brings to the elderly, however, are immeasurable in terms of giving them a clearer understanding of their situation and making them realise that someone cares about their rights and tries to protect them.
Recommendation 3 : Organised efforts should be made to seek out and identify elderly refugees in need of legal advice to regularise their status and secure access to benefits and entitlements; to this effect, legal counselling sessions should be held in collective places of residence such as old people’s homes, and home visitors should monitor the legal needs of clients for liaison with protection staff.
59. Where refugees have no access to legal rights, cannot obtain entitlements to pensions or government welfare and have no family or community support, situations of long-term dependency on the part of some elderly inevitably arise which may actually worsen with the passage of time. Problems of this nature also occur with elderly refugees who are left behind in countries of first asylum because they are unable (or, in some cases, unwilling) to resettle or repatriate. Such cases are always likely to be small in number but thought needs to be given to their circumstances, particularly if UNHCR is due to phase out of the country programme concerned.
Recommendation 4 : Elderly refugees who have not found a durable solution in their country of asylum and have no other means of income or support should be assisted by UNHCR even on a long-term basis if necessary; allowances paid to them should be calculated to cover at least minimum subsistence needs.
Resettlement: family reunion for the elderly?
Older Persons should benefit from family and community care and protection in accordance with each society’s system of cultural values. United Nations Principles for Older Persons (No 10)
60. The UNHCR Resettlement Handbook states that “resettlement of the elderly should only be considered in the context of family reunification and elderly dependants should be included in resettlement submissions”. In practice, the resettlement of elderly dependants has often met with considerable obstacles. Under governmental criteria, family reunion as an entitlement only extends to the members of the nuclear family (spouse and minor unmarried children) and does not include elderly parents of adult refugees. 61. Reports with case studies to illustrate the types of problems encountered have been prepared for the purpose of this review by a number of field offices, including Croatia, Germany and India. From the data provided, it appears that traditional resettlement countries such as Australia, Canada, and the USA tend to judge such cases on the basis of health status, employability and general integration potential while ignoring the primary goal of reuniting elderly refugees with their immediate relatives. As a result a number of cases that are highly deserving from a humanitarian point of view have been rejected. No consistent pattern is observable, however, and the exact reason for accepting or rejecting such applicants often remains unclear.
62. The situation with respect to European countries is even more problematic. The right to family reunion cannot be invoked in favour of elderly dependants on any account and there are usually no alternative criteria under which older refugees might hope to join their younger relatives. BO Bonn even cites a case where elderly parents and their children have found refuge in different European countries and still were not permitted to live together.
63. Elderly refugees who are rejected and have family members abroad may face enormous personal difficulties on account of “the lack of psychological and in some cases financial support from family members, and the limited assistance which can be provided by UNHCR” (BO Delhi).
64. The Office should take the year of the elderly in 1999 as an opportunity to address the issue of family reunion for elderly dependants as a matter of principle and raise it as such with resettlement countries.
Recommendation 5 : UNHCR should publicly promote the position that family reunion between adult refugees and their dependent parents should be treated as a basic right; on the occasion of the International Year of Older Persons the Office should prepare a documentation on pending cases for presentation to governments of resettlement countries at a specially convened meeting.
65. Another related problem concerns elderly refugees who purposefully choose not to join their children in countries of resettlement. This may lead to difficulties in the long run as shown by the example of several very old Armenians in Cairo whose children left for Australia up to thirty years ago. In several cases, contacts between them and their children have ceased altogether and they have become entirely dependent on annuities paid by UNHCR.
Voluntary Repatriation : long-term needs require attention
66. It has become standard practice for UNHCR to give special attention to vulnerable individuals in preparing the movement stage of voluntary repatriations and general guidelines have been established to this effect (see Refugee Emergencies, A Community-Based Approach, p.93). A good example of practical implementation is the Report on Special Needs for Repatriation Status of Elderly and Disabled Refugees commissioned from a local NGO by the UNHCR Office in Bratislava.
67. The purpose of the report was to make an assessment of the mental and physical health of the persons concerned, prepare a registry of special needs and disabilities, and establish a transportation plan. The precautions taken as a result proved to be vital as the journey back to Bosnia was subject to extensive delays at border crossings which could otherwise have been a source of even greater discomfort. The information obtained was also communicated in advance to the country of origin to help with reception arrangements.
68. From discussions with staff members it became clear that comparable measures have been undertaken in many other repatriation operations but it proved difficult to locate any of the relevant reports. It would be useful if such information could be centrally compiled by the Community Development Unit (PTSS) to provide a record of the experience gained by the Office in the transportation and reception of elderly and vulnerable persons during voluntary repatriation operations. This is a problem which UNHCR encounters very frequently and more easily accessible information on the measures taken in specific situations may provide a helpful resource for staff training purposes.
69. Transportation problems are insignificant compared to the challenge which vulnerable elderly persons may face when trying to rebuild their lives in war-torn countries. This is perhaps nowhere more evident than in the former Yugoslavia where older refugees and displaced persons have proved to be more willing to return to their former homes than younger people who are often kept at bay by fears about security and poor economic prospects. Elderly persons who return face immense difficulties, including the task of having to rebuild their destroyed homes. The long-term assistance measures their rehabilitation will require are both a challenge and an opportunity for all the actors involved.
70. The repatriation of older refugees is also an issue in other countries, particularly when they have been in exile for long periods and have lost contact with their home communities. Several Laotian families in Ban Napho camp in Thailand, for instance, have been split between resettlement and repatriation, leaving the elderly to return “with no family support and no relatives in Laos” (BO Vientiane). Unaccompanied elderly Ethiopian returnees from the Sudan are also likely to face severe difficulties as resources in Ethiopia are known to be more than scarce.
Recommendation 6 : During voluntary repatriation operations, UNHCR should ensure that its legitimate concern for the consequences of return fully extends to elderly returnees and covers not only their transportation and reception arrangements but also their long-term reintegration prospects; to this effect a strong community services component should be established in the country of origin and maintained for an extended period if required.
71. In such situations a more sustained UNHCR involvement in the country of origin may be required and phase out strategies should be subject to longer term planning (see also below recommendations 11-13). Such an approach has been adopted with success in Kampuchea where community services staff where retained for a period of two and a half years after the repatriation was completed in order to help in the reintegration of vulnerable groups.
IV. ASSISTANCE MEASURES THAT MAY BENEFIT THE ELDERLY
Older persons should remain integrated in society, participate actively in the formulation and implementation of policies that directly affect their well-being and share their knowledge and skills with younger generations. United Nations Principles for Older Persons (No 7).
72. It would be counterproductive to view older refugees as a separate category of persons requiring a distinct set of assistance measures destined only for them; this may only be necessary in exceptional circumstances. What is required is the opposite: instead of being segregated or, as is sometimes the case, ignored, they should be more deliberately included in all aspects of ongoing programmes. This requires more awareness of their needs and their potential as well as more understanding of the range of measures that may be taken.
73. The survey given below focuses on certain key issues that have come up repeatedly in different programmes and are equally applicable to refugees, returnees and internally displaced persons. It is no more than a beginning and there may be a case for a thorough study which could provide material for a training module on the subject.
74. A major consideration with all these measures is their sustainability in the longer term. This depends largely on the implementing arrangements and the phase-out strategy adopted, topics that are addressed in the next chapter.
Community Services: a basis for all other sectors?
75. For the rehabilitation and long-term welfare of the elderly, community development projects run by competent and experienced staff are without doubt among the most important. The reasons are as follows:
76. Community development projects can play a key role in mobilising self-help initiatives. Their importance is widely recognised and UNHCR has on many occasions provided the necessary support for the establishment and functioning of community centres. The problem is that in many instances activities tend to be organised principally for the benefit of younger persons. This was observed during field visits to Sudan (Port Sudan) and Yemen (Sana’a) and appears also to apply to other programmes. Clearly, it is not the result of a deliberate policy but springs from a staff mentality long conditioned to give priority attention to women and children. When the inclusion of older persons in centre activities was proposed, staff immediately agreed and began to think of ways this could be achieved.
77. The neediest elderly are often the least likely to come forward and may have to be actively sought out. This may involve extensive and time consuming efforts and requires community service projects designed for the purpose. Two particularly impressive examples may be given. The first concerns the Bosnian NGO Zena 21 which runs a psycho-social programme in Sarajevo with UNHCR funding. Their activities began with a thorough house to house search in selected districts during which they “discovered” many older people who had been completely isolated and had lost all contact with family and friend; Zena 21 enabled them to become part of a supportive social network once again.78. In Vladikavkaz, the Children’s Fund, a UNHCR-supported local NGO, engages in similar work. It employs social monitors and medical information assistants, most of whom are themselves refugees, to identify persons in need and put them in touch with relevant local institutions for support. They have made an enormous difference to the most vulnerable people, including many elderly. One particularly tragic elderly-headed household living in a remote rural area would never have come to anyone’s notice without their efforts.
79. It is more than likely that there are other UNHCR programmes where similar efforts to search for elderly or immobile beneficiaries are lacking. Part of UNHCR’s Community Services role should, as a matter of policy, be to make such surveys a routine procedure. By employing refugee monitors, costs can be kept to a minimum.
80. Keeping in touch through outreach services and home visits can be life saving. For immobile older persons without family or friends, the mere fact of having regular contact with a sympathetic home visitor may be worth more than material benefits. Research in Canada has shown that the mortality rate of older persons actually increased with the cancellation of such projects[7]. There is a need for them at all stages of a refugee programme but their role becomes particularly important in the post-emergency phase when isolated older people are at risk of being gradually forgotten and abandoned. This also applies to long term refugees in residual caseloads who have become old in their country of asylum.
81. Visiting services are often difficult to provide as they require continuity and a substantial input of time on the part of sensitive and trained staff. In Venezuela, for instance, the dispersal of beneficiaries and the limited capacity of the implementing partner mean “that regular follow up visits are difficult to make” (BO Caracas). In Moscow it was observed that home visits when they occur tend to be investigative rather than pastoral : the prime objective is to verify the beneficiary’s continued eligibility for assistance. Visits undertaken in this spirit are more likely to cause offence than succour.
82. Counselling services require supervision and guidance from staff experienced in community development. If this is not available, they may become mere mechanisms for the hand-over of material assistance, without proper follow up or thought given to ways in which the refugees’ self-help attempts might be better supported. The Refugee Counselling Service in Khartoum may be cited as an example, but CARITAS in Cairo and Partners in Action (PAD) in Yemen could also benefit from more training and advice, particularly concerning activities aimed at involving the elderly. The chances are that this applies to other programmes as well.
83. More professional guidance is also required when it comes to the level of living allowances which UNHCR-supported counselling services provide to elderly refugees in a variety of countries. Criteria to determine their adequacy have never been established and levels vary considerably from one country to another. While elderly Armenians in Cairo receive US$60 per month, a modest but adequate sum, an elderly Ethiopian or Eritrean in Khartoum obtains no more than US$6 even though the cost of living in Sudan is higher than in Egypt and rents are considerably more expensive than the peppercorn rents paid by the beneficiaries in Cairo. There are many reasons that mitigate against a significantly higher allowance in the Sudan (including the need to avoid disincentives to repatriation) but the disparity between the two figures is excessive and shows the lack of a consistent approach to the issue on the part of UNHCR.
84. The Community Development Unit at headquarters should draw up basic criteria for the level of allowances, taking into account local salaries and pensions; they should not be permitted to fall below minimum subsistence needs (see also recommendation 4 above).
85. Community development projects are an important monitoring tool, providing insights into the living conditions of the refugees in general. This is a welcome by-product of projects based principally on close and regular communication with the refugees themselves. The Social Monitors in Vladikavkaz, for instance, provide the UNHCR office there with valuable firsthand information on the quality of life of the refugees. Where such projects do not exist, this information is often absent. The most striking example of the kind is the Sudan where the absence of a community service structure in the camps is one of the main reasons why UNHCR has for a long time been insufficiently aware of the negative social trends which were taking place.
86. By stimulating self-help initiatives, community development projects can make a major contribution to the proper implementation of assistance measures in other sectors. The most telling example seen with respect to the elderly in particular, concerns a project implemented for Help Age International by the Sudanese Red Crescent. The beneficiaries, internally displaced persons in a deprived suburb of Khartoum, were helped to put their own plans and priorities into effect. This meant the running of health and social centres, home visiting programmes, a micro-credit scheme and fund-raising by levying charges on younger patients in the health centre. All activities are open to the community as a whole but using the elderly as a target group ensures that they are fully integrated despite the fact that many are living on their own. There appears to be no UNHCR project of similar scope, certainly not in the Sudan. The project (which has just received renewed funding from ECHO) certainly shows what community organisation with focus on the elderly may be able to achieve.
87. The reasons given above sufficiently illustrate the pivotal role of community services in ensuring that the elderly are integrated in assistance activities. This fact has been recognised by UNHCR in theory and appropriate guidelines are included in the Community Services Information Kit. In practice, however, it is undeniable that older refugees tend to be marginalised in UNHCR programmes, especially outside Eastern Europe. The results of the PTSS survey show that in many African programmes, community service activities involving the elderly are either lacking (specifically in Rwanda, Uganda, Zambia, and in Tabou in Ivory Coast) or merely at the planning stage (Ghana, Senegal). Reasons given include lack of staffing, funding or suitable technical advice. The observations made during the field visits to the Sudan and Yemen more than confirm these data.
88. If UNHCR wishes to ensure that, in the words of the High Commissioner, “mechanisms are put in place allowing older persons to express themselves, raise their voices and contribute their knowledge and skills”[8] then community development activities in many programmes need to be strengthened and their priorities refocused.
Recommendation 7 : In order to ensure the effective integration of older refugees into all relevant assistance sectors, UNHCR community development activities need to be strengthened and refocused; this requires
- the assignment of staff of sufficient seniority and experience, especially to large programmes;
- appropriate training of local staff and implementing partners;
- mechanisms to locate and identify older persons in need;
- better supervision and guidance of counselling services;
- an effective interface between community development activities and other sectors, in particular health, nutrition, education and training;
- the assignment of a role for the elderly in all community services initiatives; and
- the appointment in the Community Development Unit in Headquarters of one staff member with a specialist background in gerontology to provide appropriate guidance and training.
Shelter : institutions or community care?
89. The lack of somewhere to live is often the greatest and costliest problem faced by elderly refugees, especially in countries with inclement weather. The solution to be adopted depends to a considerable extent on government policies and resources, and, for the frail elderly, may involve the much debated choice between institutional placement and community care.
90. UNHCR’s policy on this is clear: “only when there is no other possibility should institutional care be considered” (see UNHCR Community Services Information Kit). Institutions such as old people’s homes have, in fact, come to acquire a bad name as costly, artificial environments which breed despondency and depression. In some countries they are culturally inappropriate, and there may be local traditions which are more effective in providing shelter for the elderly; in Kampuchea, for instance, homeless older persons can live and work in Pagodas.
91. In other countries, however, these institutions may have a very important role to play as was shown by two well run homes visited in Stavropol Krai (Southern Russia). The elderly accommodated there, most of them ethnic Russians from Chechnya and Georgia, were clearly far happier than those in transit centres and rented private accommodation. The mere fact of having an assured roof over their heads clearly made a vital difference to their state of mind and removed some of their anxieties. In return for having accepted the refugees UNHCR provided the homes with a renovation grant as the premises had partly fallen into disrepair. After having seen so much misery the positive impact of this project was truly striking.
92. In many other countries UNHCR has made similar contributions to the construction, renovation or furnishing of homes for the elderly, the oldest being perhaps the Russian Old Age Home in Cairo which goes back to the 1960s. Recent examples include the construction of a cluster house for elderly in Armenia as well as several projects in the former Yugoslavia where shelter needs are by far the greatest. For the sake of institutional memory and staff training, it may be of interest to the Office to maintain a central record of elderly home construction projects in which the Office has participated, with particular emphasis on innovative or culture-specific approaches.[9]
Health and nutrition: more policy considerations needed
Older persons should have access to health care to help them to maintain or regain the optimum level of physical, mental and emotional well-being and to prevent the onset of illness. United Nations Principles for Older Persons (No 11).
93. Health problems are inevitably a major concern for older persons, and many respondents to the PTSS survey on the elderly listed a range of ailments common in their regions. Those mentioned most frequently included TB, diabetes, hypertension, rheumatism and cataract, the latter most prevalent in Africa.
94. The vulnerability of older persons to war-related stress has been documented in a recent study of displaced persons in Croatia which showed that they are far more susceptible to traumatic disorder than younger people. Symptoms such as persistent recall of stressful events, depression, insomnia, nightmares, emotional numbness and fear were markedly more common among the older persons (Havelka 1995). The psycho-trauma of war and exile can weaken the immunological system and has been shown even to accelerate the onset of senile dementia in certain cases (Fornegovic-Smalc, 1997).
95. Considering the risk of increased morbidity among the old in refugee situations it is surprising that UNHCR has not as yet developed a standard mechanism for the identification and monitoring of health problems among this group. While such data exist for refugee children, they are difficult to come by for the elderly. There are no standard reporting categories for the older age groups and each Office appears to establish its own criteria. A typical case is Pakistan where all refugees above the age of 35 were reported as one group during the 1996 census and the number of persons above 60 could only be estimated. The absence of such data makes reliable reporting on elderly health very difficult.
96. Another point is the absence in UNHCR of a policy on preventive measures commonly recommended for the elderly (e.g. cervical smears) and the treatment of longer-term illnesses, in particular diabetes and TB which have been found to be a scourge among elderly refugees in many countries. Local conditions will inevitably influence the degree to which medical services can be provided and there is an understandable tendency not to intervene when sustainability of the drug supply cannot be assured. Nevertheless there are regional differences which are hard to explain. Why should TB patients in Yemen receive treatment whereas in North Ossetia they do not? A systematic identification of the health situation of the elderly might yield the necessary data for a more consistent approach, including measures UNHCR may take to improve the quality of life of those suffering from chronic ailments.
97. The lack of interface between the terms of reference of health workers and those of community workers in many programmes adds to the incomplete picture of elderly health and welfare. Health workers often focus only on the collection of quantitative health related data which reveal little about the respondents’ quality of life and the extraneous circumstances that may have an impact on their mental and physical health. Community workers, on the other hand, are concerned with the latter but lack the technical capacity to deal with health issues. There is a strong case for training health visitors to act as community workers and vice versa, and design terms of reference and monitoring formats accordingly. This is particularly important for the immobile elderly who may depend on home visitors for contact with the outside world; where this is the case, health visitors should also be provided with training in geriatric care.
98. The relative neglect of the elderly in the health sector is more than matched when it comes to nutrition. It is symptomatic that WFP has so far never undertaken a study to determine the nutritional requirements of older persons, let alone established any projects targeted at this group[10]. Supplementary feeding programmes run by UNHCR are primarily designed for children under five and pregnant or lactating mothers and rarely cater for the specific needs of the elderly.
99. Recognising the wide-spread lack of information on the nutritional status of older persons in developing countries Help Age International and the London School of Hygiene & Tropical Medicine engaged in a research programme in 1992 which has now resulted in a field handbook on assessing nutritional vulnerability. This document may assist UNHCR staff in designing more targeted responses to the nutritional needs of older persons in emergencies and camp.
Recommendation 8 : To optimise health and nutritional care for older refugees, UNHCR should
- develop standard mechanisms and reporting formats to identify the health and nutritional situation of older age groups;
- design supplementary feeding programme to meet the specific needs of older persons;
- develop a policy on preventive health measures for older persons;
- develop a policy on the treatment of chronic diseases, including supportive measures for the chronically ill; and
- ensure an effective interface between health and community services at field level
Education, Training and Income-Generation - also for the elderly
Older persons should have the opportunity to work or to have access to other income-generating opportunities. United Nations Principles for Older Persons (No 2).
100. Available data indicate that the approaches adopted by UNHCR Offices concerning education, training and income-generation projects for older refugees vary considerably and much depend on the personal initiative of staff members in the field. Not surprisingly, the bulk of resources under these sectors goes to the benefit of younger people; it is a fact, however, that older people have greater difficulty of reinsertion into the labour market and that their skills are often unrecognised and under-utilised. Moreover, the income situation of many elderly-headed households is often particularly desperate. The need for language classes for elderly refugees has also been noted in several instances.
101. It has to be more widely recognised that older persons should be systematically included as a target group for education, training and income-generation activities in keeping with their interests, abilities and needs. This requires an assessment of the caseload which may best be done by community service staff using proven techniques such as those described in the forthcoming UNHCR publication entitled Self-reliance, Employment and Microfinance Assistance. While the draft version of this excellent document mentions elderly as potential beneficiaries of self-reliance strategies, it was interesting to note that they do not figure in any of the numerous examples given.
102. Another very different topic to be treated under this heading concerns the production of suitable mobility aids such as walking sticks, crutches and wheelchairs for use by elderly and handicapped persons. The poor quality of such utensils in the Sudanese camps was evident, and in large refugee situations there may be a rationale in favour of training craftsmen to produce such goods to a high standard for sale to aid agencies and interested local people. Relief substitution projects of this kind have already been tried with some success. They may include the production of shoes and clothes suitable for older persons since in-kind donations of these goods are frequently destined for younger recipients.
Older persons should have access to appropriate educational and training programmes. United Nations Principles for Older Persons (No 4)
103. It is clear that older persons may themselves have a role to play in the education and training process, both formally and informally. It has often been mentioned that they are, in the words of the High Commissioner, “the fundamental link between the past and the future, transmitting norms and values from one generation to the next”. To enhance their role in this respect, community development projects may be designed in such a way as to bring older people more regularly into contact with children and to organise storytelling sessions, thus perpetuating the oral tradition which many older people are still part of. Primary school classes might be set aside for that ; also visits to old people’s homes could be organised. In this respect, it is worth pointing out that the mutual benefits of bringing the very old and the very young together has been the subject of much recent experimentation and research, evidence of a healthy new trend which mitigates against the segregation of old age (e.g. in Armenia).
Recommendation 9: Efforts should be made to include older persons in education, training and income-generation activities both as recipients and providers; to this effect their interests and abilities should be more systematically assessed and projects designed accordingly; whenever appropriate, older people should be brought together with younger people and, in particular, children.
Recommendation 10: In large refugee situations, relief substitution projects should be introduced with the aim of training local craftsmen to manufacture good quality walking aids, including shoes, sticks, crutches, wheelchairs and prostheses, for use by elderly and handicapped people.
V. IMPLEMENTATION AND PHASE-OUT
Basic patterns
104. The implementing arrangements set up at the beginning of a programme determine the ease or difficulty of phasing out of it at the end. This is illustrated in the Case Studies in the second part of this review, particularly those on Bosnia and Sudan. As a rule, the more the implementing arrangements are set up as separate structures and the more limited the number or capacity of the partners involved, the more difficult UNHCR’s withdrawal is likely to be; on the other hand, the more the implementing arrangements are integrated into existing structures and the wider and stronger the partnership base, the easier it will be for UNHCR to hand over residual responsibilities.
105. While this rule applies to all programme sectors, it is nowhere more important than in projects involving recurrent costs catering for chronic needs such as those of frail older persons with little prospect of rehabilitation. They will require some form of care for the remainder of their lives and phasing-out of projects on their behalf may be traumatic or humanly indefensible. To prevent open-ended commitments while effectively addressing their needs requires careful long-term planning from the start of the operation. The following basic principles can be said to apply to an equal extent to programmes involving older refugees, IDPs or returnees:
- involve competent government departments and line ministries from the beginning;
- mobilise a multiplicity of actors and resources in the local community (not only local NGOs but religious organisations, schools, universities, volunteer groups etc.);
- assist communities in forming effective self-help groups by providing premises, training, equipment etc;
- design programmes that also bring benefit local people and thus lend themselves to integration into national development plans;
- involve fellow UN agencies from the beginning;
- engage early on in sustained capacity-building campaigns to strengthen local partners financially and administratively;
- advise local partners on fund-raising techniques and approach funding agencies and donors on their behalf; and
- in consultation with all partners, establish a multi-year planning horizon for phase-out and stick to agreed deadlines.
106. Perhaps the best example to illustrate some of the principles listed above is the approach adopted by UNHCR in Armenia. The beneficiaries of the programme were some 3,000 extremely vulnerable older persons, including both refugees and nationals; the key government partner was the relevant line ministry; many other local actors were involved as part of a well co-ordinated plan; and initial funding was provided by both UNHCR and the World Bank. Here, the Office was clearly instrumental in bringing together different actors and setting a process in motion which is most likely to remain functional well after it has withdrawn from the scene.
107. The Armenian programme has benefited from a favourable political climate rooted partly in the fact that all the beneficiaries are ethnic Armenians. In many other programmes, the implementation of similar strategies is fraught with a host of obstacles; in some cases, however, UNHCR may not have been proactive enough in broadening its support base and in seeking the timely involvement of other competent partners. The Case Studies in this report contain some pertinent examples, and the lessons that can be learnt from them are summarised below.
Involving competent government counterparts
108. It was remarkable to observe that virtually all the country programmes visited had the following features in common:
- many projects benefiting older people were implemented by local NGOs entirely dependent on external funding for the continuation of their work;
- UNHCR’s contacts with line ministries concerned with social welfare were often tenuous or non-existent; and
- UNHCR’s government implementing partners had neither the resources nor the facilities to cope with the long term needs of the elderly.
It goes without saying that such factors are a recipe for difficulties at the phase out stage.
109. The circumstances that lead to this are usually established already at the time of the emergency: preference for implementation of social services programmes is given to NGOs as they are cheaper, more flexible and easier to control; and the central government establishes a separate refugee or migration office to act as UNHCR counterpart. This means that existing government social welfare structures which could have played a useful role may be ignored or even duplicated. Bosnia and North Ossetia could be cited as examples in Eastern Europe, but the problem also exists in developing countries. Provincial offices of the Sudanese Ministry of Social Affairs, for instance, are said to have the facilities and expertise to run effective social programmes; if they have not so far been involved in any implementing arrangements this is largely because of the stranglehold of the local refugee bureaucracy (COR) which seeks to monopolise all UNHCR input in the country.
110. In discussing the sustainability of social assistance programmes, a recent World Bank publication points out that “public agencies are better equipped to meet recurrent costs through the national budget process than are NGOs and community groups” (Subbarao, 1997, p.107). Mindful of this UNHCR should, as a rule, seek to implement social welfare programmes from the beginning through competent government institutions despite the fact that it might be simpler to work through NGOs. Drawing the Ministry of Social Affairs (or its equivalent) into the picture from the start is at any rate likely to be easier than attempting to do this later on when institutional rivalries may become insurmountable.
111. In implementing such programmes through the competent government organ, UNHCR should aim to strengthen its capacity sufficiently so it will be able to assume responsibility for providing welfare services for residual caseloads of persons with long term needs and meeting the recurrent costs involved. Clearly, this is already being done in a number of instances; there is, however, a case for the practice to become far more widespread.
Recommendation 11: Wherever possible UNHCR should seek to implement social assistance programmes, in particular those likely to involve recurrent costs, from the beginning through the competent line ministry and, in doing so, trengthen the capacity of its dependent institutions in preparation for eventual phase-out.
Strengthening local NGOs and community organisations
112. Even if first preference is given to government networks, NGOs will always have a vital part to play in providing welfare for the elderly, both for those in need of rehabilitation and those in need of continuing care. The excellent work undertaken in this field by many local and international NGOs in the former Yugoslavia is ample testimony of the contribution they are able to make.
113. The main problem that may arise, however, is one of short-term approaches to long-term needs. International NGOs tend to pull out soon after the emergency, local NGOs may lack the capacity to become independently viable, and funding cycles are short and unpredictable, allowing little time for the creation of locally sustainable entities. The Bosnia Case Study dwells on this in some detail, but the phenomenon as such is attested in many situations.
114. The difficulties inherent in this are perhaps best addressed within the framework of a multi-year phase-out strategy which aims on the one hand at a sustained capacity building effort targeted at selected local NGOs and, on the other, at seeking to ensure that such NGOs may become eligible as government implementing partners in the long run. Both objectives require a considerable input of time and effort, and their viability will depend on local circumstances. There is, however, a world-wide trend for welfare services to be contracted out to NGOs and private firms as part of the “care in the community” approach increasingly adopted by numerous governments. A pre-condition for this to work, however, is that the services delivered by UNHCR funded NGOs should not be haphazard but closely interlinked and co-ordinated with the existing (or evolving) government system. This is another reason why close co-operation between UNHCR and the competent line ministry is crucial.
115. How such an approach works in practice can be seen from the example of the United Kingdom where the government in the guise of the local authority provides funding for refugee community organisations which in turn assume responsibility for the welfare of their poorer members, including the frail elderly.
116. An additional word must be said about capacity-building for local NGOs. For it to work, it must go much beyond the occasional seminar and should ideally involve a longer period of assured support during which financial and administrative consolidation can really take root. This very much confirms the findings of a recent study of post-repatriation phase-out strategies undertaken by the Inspection and Evaluation Service which notes that “unrealistic time frames put all the emphasis on providing services at the expense of capacity-building. Expectations of a two or three year involvement, as opposed to one year, can help NGOs make reasonable plans for developing the capacity of local staff” (Review of UNHCR’s Phase out Strategies: Case Studies in Selected Countries of Origin, 1997, p. 13).
117. In the social assistance field, capacity-building should also include training on work with the elderly. Such expertise is generally rare and many UNHCR implementing partners (such as some witnessed in Sudan and Yemen) would undoubtedly benefit from training and awareness-raising in this regard. Help Age International has local and international staff-members with extensive training experience who might be contracted to organise workshops for UNHCR’s implementing partners in the field.
Recommendation 12: In preparation for phase-out, local NGOs, in particular those involved in longer term social assistance programmes, should be provided with a two- or three-year period of assured support to allow for financial and administrative consolidation; they should also be helped with developing fund raising approaches and given opportunities for specialised training in geriatric care.
Seeking partnership with other UN agencies
118. Close co-operation with other UN agencies is a requirement governing all aspects of UNHCR’s work and is no less important when it comes to the well-being of the old. This is particularly clear when the issue is viewed from a wider perspective. What has most affected the elderly world-wide is the spread of poverty caused by economic transition in the former Eastern block and structural adjustment in many developing countries. The tragedy of forced displacement is often no more than an additional element in an already bleak picture.
119. The challenge of providing effective long-term relief in these circumstances is a developmental one which goes much beyond anything UNHCR can achieve on its own. To be effective its strategy should be closely integrated with social development programmes adopted by other UN agencies. Their activities in this field have been given a new direction by the 1995 World Summit on Social Development which recognised the urgent need for national poverty alleviation programmes with focus on employment creation and access to health, education and basic social services for all.
120. Evidence of this new approach could be witnessed in Yemen where UNDP is currently engaging in a large poverty alleviation project with the World Bank and interagency support. One of the target areas for the UNDP project happens to be a refugee-affected suburb of Aden which also figures high on UNHCR’s priority list. The potential for convergence is clear but the regrettable absence of consultation between the two Offices during the design stage illustrates once more the difficulty of integrating refugee assistance projects into national development plans. There is a need for UNHCR field staff to be vigilant and take advantage of such opportunities as soon as they arise.
121. A partner with a major role to play in the field of elderly welfare in particular is WHO. Its 1996 report entitled Health and Social Situation of Elderly People in Sarajevo appears to be one of the first studies of elderly people in man-made disasters ever undertaken and contains numerous practical recommendations. It was used as a starting point for an international WHO-sponsored seminar on Multidisciplinary Aspects of Ageing held later that year which was intended to promote the formulation of a comprehensive health policy for older citizens on the part of the Bosnian Government. This shows that the expertise of WHO is a significant resource which may be called upon, both to assess the situation of the elderly persons of concern to UNHCR and to stimulate the adoption of national programmes that are responsive to their needs.
122. Perhaps the most important partner when it comes to long-term planning in the social assistance sector is the World Bank. It is able to make reliable assessments of the viability of social safety nets and can provide technical and financial resources to assist in developing government strategies in this field. A pertinent example is Bosnia where the World Bank has taken a leading role. Its analyses of social protection programmes such as the one published in the 1997 Bosnia Country Study (World Bank 1997, pp.75-84) are important sources of information which can be used as a basis for the formulation of phase-out strategies by UNHCR and as an argument for enlisting continued donor support. In the Bosnian case the macroeconomic data clearly indicate that in the shorter term continued donor involvement in the social assistance sector is vital “to provide a floor of protection”.
123. If UNHCR wishes to make the best use of what other UN agencies have to offer in the field of social development (or any other specialisation for that matter), it is first and foremost essential that, in the words of the recent study on phase-out strategies, it “should make a conscious effort to understand their organisational objectives and programme expectations” (para. 18). The lack of such understanding appears to be at the root of some instances of negative thinking and poor inter-agency communication witnessed in the field. To help prevent this, headquarters should keep field staff regularly informed about the evolving policies and objectives of other agencies and give them the opportunity to become closely acquainted with different types of co-operation and programme interface; staff exchanges and secondments should be strongly encouraged.
Long-term planning is a necessity
124. Generally, the conclusion is inescapable that in situations involving residual social assistance needs of a longer-term nature, UNHCR should be realistic enough to adopt multi-year phase out plans jointly negotiated with donors, development agencies and the local government; they should contain a clear statement of objectives linked to a timetable indicating when and under what conditions other partners will assume responsibilities for specified programme sectors, in keeping with the implementation of an overall government plan. Such an initiative may also stimulate the government into giving sufficient priority to social assistance programmes in budgeting resources.
125. It is interesting to note that the need for a longer-term planning perspective is also very much emphasised in the recent study on phase-out strategies. It states that UNHCR should overcome its “emergency mind-set” and be prepared to engage in comprehensive programme planning which is more likely to generate long-term stability; a period of two or three years is repeatedly mentioned as a realistic time frame for this purpose (see paras. 9, 19, 34, 41, 45, 58, 59).
126. Planning exercises of this kind and the negotiations and contacts that they involve require a considerable amount of time which is often not available as regular staff are more often than not fully occupied in running day-to-day programmes. This should be recognised and headquarters should be prepared to strengthen field offices with the secondment of additional staff to assist in the formulation and implementation of phase-out plans.
Recommendation 13: Wherever possible, UNHCR should attempt to integrate its social assistance activities into social development programmes adopted by other UN agencies and the local government; to make this effective, the phase-out stage should be subject to a multi-year strategy negotiated jointly with linkage partners and donors and based upon clear objectives and realistic time-frames; if necessary, field offices should be strengthened to help with establishment of such a strategy.
1999 : an opportunity not to be missed
127. The findings of this review confirm the High Commissioner’s belief that UNHCR needs to make further efforts at “improving awareness, policy planning and projects for older refugees”. The forthcoming International Year of Older Persons would seem to be an excellent opportunity to draw UNHCR’s partners into a dialogue on this topic and take concrete action. To this effect UNHCR might wish to:
- develop a strategy for the implementation of the recommendations of this report, to be submitted to the Executive Committee for discussion and approval in October 1998;
- develop a training module on ways to optimise the inclusion and participation of older refugees in assistance activities, with particular attention to community development, health, nutrition, shelter, education, training and income-generation;
- assess the geriatric care training needs of implementing partners and organise training seminars with the help of outside expertise;
- upgrade in-house POP training materials by including case studies on older refugees (at present there are virtually none); and
- organise an inter-agency seminar to discuss ways in which inter-agency co-operation in the field of social development can be strengthened for the benefit of vulnerable groups of refugees, returnees and displaced persons; the findings should be used to brief UNHCR field staff and assist them in the formulation of appropriate inter-agency approaches.
Public Information campaigns planned for the year, such as the special issue of Refugees magazine, should be integrated into this overall plan and designed to give it maximum effect.
Recommendation 14: In the light of the recommendations provided in this review, UNHCR should use the forthcoming International Year of Older Persons as an opportunity to draw donors and implementing partners into a dialogue on ways to improve awareness, policy planning and projects for older beneficiaries; an overall training and information strategy should be developed to this effect.
BOSNIA-HERZEGOVINA :
A LONG-TERM PHASE-OUT STRATEGY REQUIRED
128. As lead agency in the former Yugoslavia, UNHCR continues to have the largest programme of the UN system in Bosnia-Herzegovina. From the beginning, its activities have dominated every aspect of the international relief operation and benefited not only the displaced but also many persons in need who did not have to leave their homes. In fact, it can be said that UNHCR did much to maintain the semblance of a social safety net at a time when government institutions were no longer in a position to do so.
129. This was confirmed by interviews with elderly refugees that were conducted during the mission in various localities, including Banja Luka, Bihac, Mostar, Zenica and Sarajevo. UNHCR-funded projects have enabled both local and international NGOs to conduct numerous programmes which provide medical and psycho-social care and essentially needed supplies to destitute elderly. Their number includes many single, abandoned or immobile persons who are still resident in their own homes but are unable to cope on their own. This was the result of a deliberate policy which did not wish to make a distinction between different categories of beneficiaries, and there is no doubt that many lives have been, and continue to be, saved as a result.
130. Two years after the signature of the Dayton Agreement, however, the continuation of such programmes is a matter of debate. UNHCR is under donor pressure to scale down its activities and the question is being asked to what extent the most urgent needs have now been met and whether local NGOs and government services are in a position to assume the bulk of social welfare responsibilities for the remaining vulnerable persons, including the elderly. The impression gained by this mission is otherwise: needs remain extremely high while local institutions have as yet neither the resources nor the structure to be able to respond without substantial external support. This must have implications for the phase-out strategy to be adopted by UNHCR.
Why are needs still so high?
131. In pre-war Bosnia there were very few residential homes for elderly persons. Care for them was assured by a patriarchal family network bolstered by state pensions, free health care and selected cash benefits for the poorest. Since 1992 this entire system has collapsed. According to the recent World Bank Country Study, pensions have fallen “below any reasonable poverty line”, the health-care systems in both entities “are experiencing severe financial crisis”, and “neither entity has the resources to finance a programme of cash transfers to the poor” (1997, p.78-83). Perhaps worst of all, the old patriarchal system, the main guarantor of security and support, has been largely destroyed as families were dispersed and lost their economic base. Often, younger family members who would normally have been expected to provide for their elders have become victims of the war.
132. The consequences of this chain of misfortune are profound and cannot be remedied quickly. For a start, the re-establishment of a functioning government system is not only a question of raising sufficient tax revenue which in turn must depend on the pace of economic recovery. As in other countries of the old socialist block, the former social protection programmes are unsustainable and cannot simply be reintroduced. While the melt-down of the old system might be seen as providing “a unique opportunity for fundamental reform” (p.75) the decision-making process on the design and implementation of such reforms is slow because of the continued political and administrative fragmentation of the country.
133. What we see to-day is a disturbing picture. While the Bosnia emergency is officially over, for many elderly it is continuing unabated and in some cases even worsening as aid programmes are being reduced. Those who have to depend exclusively on their pensions are barely able to survive even if they have not been directly affected by the fighting. In the collective centres, negative social selection has meant that those who remain include a disproportionate number of elderly persons who have nowhere to go and no-one to take care of them. Some centres have become veritable geriatric wards despite the fact that their premises and facilities are unsuitable for this purpose. Their long term financing and staffing is far from assured and those accommodated there are distressed and deeply worried about the future.
134. For many persons in temporary accommodation and collective centres, the most burning question concerns return to their places of former residence. Because of their attachment to the land, the elderly are more willing to contemplate return even to minority areas from where they were expelled but many lack the means and strength to reconstruct their homes and resume a rural life in areas that are often quite isolated, especially if the younger generation is not with them. While repatriation is the solution they most desire, a lot of material help and aftercare is needed for them to achieve it, quite apart from overcoming the persistent political obstacles that impede return to minority areas.
135. Altogether, the mission observed that the psychological trauma incurred by many elderly victims of the war, particularly those who lost close relatives and children, remains like an open wound. Elderly interviewees broke into tears at the mention of what they had experienced. As shown by recent research undertaken in Croatia, older persons are indeed more susceptible to psychosomatic symptoms and disorders resulting from war trauma, and suffer from a much higher rate of depression, insomnia and persistent recall of traumatic events than younger people (Havelka, 1995). Their resulting state of mind clearly has a bearing upon their general health condition and life expectancy. As shown by another Croatian study, war trauma can even speed up the onset of senile dementia.
136. Psycho-social programmes can do much to bring elderly trauma victims out of their isolation and give the more able-bodied ones the energy and hope to rebuild what remains of their lives. This, however, is a process which takes not months but years. Yet, already with the end of the official emergency, donor priorities began to shift away from such programmes despite the fact that “actual needs remain extremely high, and, in many cases, the possibility of doing real psycho-social healing is only just beginning” (Smillie, 1996). While it is clear, that outside funding for such programmes cannot be made available indefinitely, their withdrawal should normally be commensurate with the development of a local capacity to cater for the remaining needs. It seems, however, that the local structures are as yet ill equipped to take over the responsibility for running such programmes.
Local NGO capacity remains weak
137. According to a study undertaken on behalf of CARE in late 1996 (Smillie, 1996), implementing arrangements adopted by UN agencies and international NGOs may be partly to blame for the slow consolidation of independently-viable welfare mechanisms in Bosnia, both in the government and the non-government sectors. International preference for NGOs has meant that “government departments and social service centres have received very little donor attention” (p.5), and this despite the fact that many welfare offices continued to operate throughout the war, relying on staff who worked without salaries and provided “services to the extent possible” (World Bank, 1997, p.83). If the international community had used this network more extensively for service delivery during the emergency, the government might now be in a better position to assume its welfare responsibilities. Instead, the overriding preference given to NGOs “who are, in many cases viewed as having been over-funded” (Smillie, 1996, p.5) has meant that existing government welfare offices have in some instances been marginalized and their ability and effectiveness may have been undermined .
138. Moreover, generously-funded implementing arrangements with local NGOs do not necessarily make the organisations concerned sustainable in the long term. Many of them were hurriedly set up by external donors and international NGOs for the purpose of cheap service delivery and were not provided with sufficient resources, training and expertise to help them become financially viable institutions. Their fragility was compounded by the short time frames of agreements which impose very limited planning horizons and create a climate of unpredictability and insecurity. Smillie evaluates UNHCR’s role in this process as follows:
Despite its good intentions in channelling funding through local NGOs, UNHCR is perhaps one of the most prominent culprits is setting up organisations for a fall. Its rigid adherence to “implementation costs” and its avoidance of “organisational costs”, combined with the fact that it has been the biggest source of NGO funding for the past three years, has created a community of organisations that live an almost completely unsustainable hand-to-mouth existence. Many other donors are no better.
139. While this criticism was made a year ago, discussions with staff members in the UNHCR Office in Sarajevo have shown that the inherent weakness of many local NGO partners remains very much a live issue. The uncertainty about their future has potentially grave implications for the elderly in need. Government services will remain under-resourced for some time to come and if the continuing reduction of external funding leads to the collapse of vitally needed NGOs, they may find themselves without any source of support. Inevitably, the poorest and weakest among them will suffer most. UNHCR’s phase-out strategy must include measures to avoid such a scenario.
Phasing Out Responsibility
140. Sarajevo based staff of the World Bank, ECHO, WHO and UNDP met during the mission, stated unequivocally that it would require an economic recovery period of at least two more years before the government would be able to run sufficient social protection programmes to meet the vast demands. The conclusion is inescapable that until that time, the continued involvement of UNHCR is very much needed, especially in view of the country-wide role assumed by the Office during the emergency which carries with it an added element of responsibility for the post-emergency period. With the well-being of so many people still depending on the input of UNHCR, a phase out strategy is required which is not sudden and unilateral but long-term and mindful of the inevitably slow recovery process of a society so thoroughly devastated.
141. Devising such a strategy is far from simple, however, because of the fragmentation of the country, the magnitude of the problems and the multiplicity of actors involved. As far as the elderly are concerned, a needs assessment should be conducted as a first step so as to elicit more detailed information on the number, status and location of those who are most in need. Various approaches will then have to be adopted to take account of the local circumstances which differ not only between the two entities but also between cantons and municipalities. The result should be a plan with a three-year time-frame which should be discussed with all relevant parties, well-publicised and strictly adhered to.
142. The plan should aim to prepare the ground for a phased hand-over of responsibility for different groups of beneficiaries by:
- enhancing the capacity of government welfare offices and geriatric institutions while ensuring as a counter-measure that welfare needs receive adequate priority in the government’s long-term spending plans at federal, cantonal and municipal levels;
- strengthening the most competent local NGOs and facilitating arrangements between them and funding organisations, including bilateral aid agencies;
- closer co-operation with UNDP, particularly in regions covered by their Area Based Development Programmes which should also include support for social protection measures;
- co-operation with WHO and the World Bank in their efforts to advise the authorities on the current reforms in the pensions, health care and welfare systems;
- UNHCR phase-out should to the extent possible be linked to the time-frame and progressive implementation of these reforms; and
- seeking donor support for the concept of a three-year phase-out plan which in turn may allow local implementing partners the necessary time to become more financially viable and self-supporting.
143. When deciding on budgetary cuts, it should be accepted as a matter of principle that items of expenditure which directly benefit the poorest and most vulnerable beneficiaries should be the last to be affected. This must include the community services sector which is at any rate one of the least costly parts of the country budget as detailed in the Country Operations Plan: with US$4.1 million it amounts to only 3% of the total needs of US$122 million during 1997.
144. From a fund-raising point of view, the lynch pin of this entire strategy must be the focus on elderly returns. Donors are supportive of repatriation programmes and the willingness of many elderly to return to their former homes provides opportunities for the reconciliation of divided communities. However, the success and sustainability of elderly returns depends on the availability of functioning health and welfare services in the areas concerned. One of the key aims of the phase-out plan is to provide time, resources and inter-agency advocacy to allow for the consolidation of such sources of support while passing a clear cut message on agreed deadlines for UNHCR involvement. Couched in such terms donors may be willing to provide for the staffing and material resources needed for its implementation.
CROATIA :
RESTRICTED ACCESS TO A WELFARE SYSTEM UNDER STRAIN
145. By international standards Croatia’s population is ageing rapidly. The birth-rate is low and the number of persons over the age of 65 has risen from 7% in 1953 to 13.1% in 1991. Welfare provision for the elderly, already under growing pressure as a result of this demographic change, has been stretched beyond capacity by the catastrophic consequences of the recent war which has led to a drastic increase in the number of older persons requiring support. To the Croatian elderly in need must be added some 68,000 refugees from Bosnia who live in private accommodation and various collective centres run by the Office for Displaced Persons and Refugees (ODPR). No less than 20,000 of them are over the age of 60 and the majority have no direct family support.
146. During its brief visit to Croatia, the mission interviewed elderly refugees in collective centres in Varazdin and Gasinci and met with ODPR staff and several NGOs involved in providing services for the elderly. Home visits were conducted in Zagreb, Varazdin and Okucani (Western Slavonia) where the mission met with elderly Serbian returnees.
Assistance entitlements depend on legal status
147. Access to government services for the elderly is first and foremost a question of legal status and a distinction must be made between three groups: Croatian citizens in possession of an ID card, Bosnian Croats who have access to a Croatian residence permit (domovnica) if they can prove their Croatian identity but are not considered full citizens, and Bosniaks who can make no claim to Croatian nationality.
148. Croatian citizens are legally entitled to state pensions and services provided by the Ministry of Labour and Welfare which may include institutional placement, financial support, and home care. In practice, access to such services is anything but straightforward. There is a drastic shortage of beds in institutions where the waiting list now tops 9,000 persons while in-home care remains to be developed and is only available in a few localities.
149. Bosnian Croats, the second group, form the majority of the refugee population. Holders of the domovnica have indefinite residence rights in Croatia as well as other privileges such as access to free education but they are not entitled to state pensions. Access to government welfare may be granted on a case-by-case basis but is not systematic. Institutional placement for the elderly is very difficult to obtain and subject to a partial subsidy by ODPR at the rate of DM6.- per person per day. In recognition of the urgent need to increase the number of available places, the IFRC has recently reconstructed four residential homes on the understanding that the added capacity will be used to accommodate refugees and displaced persons. Most of these can be expected to be Croatian.
150. The third group, Bosniak refugees, currently number some 17,000 of whom 30% are over the age of 60. They are in the weakest position, both legally and materially. Most of them are from minority areas which means that their repatriation prospects are as slim as their chances of local integration in Croatia. Their attempts at securing access to their Bosnian government pensions have mostly met with failure and they tend to find themselves at the end of the ODPR queue for placement in Croatian residential homes. Unless solutions are secured for them in their country of origin they may turn into a long term residual caseload with increasing rather than diminishing needs. Both from a protection and an assistance point of view, their situation must remain a priority for UNHCR.
151. A major difficulty shared by both Croat and Bosniak refugees concerns access to health services. As refugees they may obtain primary health care free of charge while secondary health care is only available for emergencies and tertiary care is not provided. The chronic ailments usually suffered by older people are therefore not covered and those without support from family or friends find themselves unable to secure the treatment and medication they require.
Voluntary Repatriation : obstacles and opportunities
152. The elderly represent a key element in the voluntary repatriation process for different and contrasting reasons. The returnees, most of whom are ethnic Serbs, fall into two groups: those who left during the height of the Serbo-Croat war in 1992-93 and those who departed from the former sectors South and North following the Croatian military offensive against the so-called Krajina Republic in 1995. Among the former group the elderly tend to be the first to return, while many of the elderly of the second group never departed but were left behind as remainees because of the suddenness of the exodus. What is vital for the latter is the repatriation of their younger relatives who alone can ensure their long-term care. The two situations are problematic in different ways.
153. The repatriation of elderly Serbs to regions such as Western Slavonia was observed firsthand by the mission. They have less reason to fear for their safety than their children who often prefer to remain as refugees in FRY. They are also more prepared to resume ties with their Croat neighbours but their main motivation for returning is their wish to die in their ancestral land to which they are deeply attached. It was indeed remarkable to see how happy the returnees were to be back home but it was equally clear that they are facing enormous problems in trying to rebuild their frequently devastated homes and work the land without the help of their children.
154. The assistance available to the returnees appears to be very limited considering their age and the fact that many have lost all their possessions. Those who return in an organised manner receive help from ODPR for a six month period but until very recently there was no government support for the many who return spontaneously to avoid the official procedure which is very slow, particularly for ethnic Serbs. Moreover, returnees cannot apply for social welfare from local funds because beneficiaries must have been resident in the area for the previous two years. The government’s evident unwillingness to encourage a rapid spontaneous return is due to political and security factors, not least the highly sensitive problem that many Serb houses have, with government approval, been taken over by Croat refugee settlers who are now facing the prospect of being displaced yet again as the rightful owners return.
155. For UNHCR, the willingness of the elderly to repatriate must be seen as a valuable opportunity to set in motion a process of reconciliation and social reconstruction of neighbourhoods affected by the war. In view of the underlying tension that persists in many regions and the restricted availability of government support, the continued presence of UNHCR-sponsored NGOs in areas of return is highly desirable. Community development projects and aid in shelter reconstruction for the elderly is and must remain a priority. However, beyond that UNHCR should attempt to ensure that discrimination between spontaneous and organised returns should be minimised and that all returnees should have access to social care both from lo