One August morning, Khadijeh Sayyid Ahmad, 65, sits in a rooftop room of a half-constructed building in Lebanon while she waits for her husband to return from prayers. The sun filters through the pink tarpaulin that serves as a ceiling, creating a glow over her wizened face.
She shifts from side to side on a mattress as her relatives try to console her. Reports of an alleged chemical attack in her Syrian hometown of Muadhamiya have just spread to her refugee gathering, and she is barely able to control her tears.
“The problem is that when she gets distressed, her blood pressure starts to rise. This makes us very afraid for her heart condition,” says her son Ahmad.
Khadijeh is one of thousands of Syrian refugees in Lebanon who are over 60 and quietly suffering from a host of health and psychological problems. Elderly Syrian refugees elsewhere in the region face similar challenges. The humanitarian community has struggled to cater for the special needs of the age group, which is disproportionately affected by the violence and displacement.
"Older refugees have so many needs, which are not yet a priority to the humanitarian aid actors responding to this crisis," the Caritas Lebanon Migrant Center (CLMC) wrote in a 27 August report, which described the elderly as an "often forgotten population of refugees… whose needs have been widely ignored in this crisis…
"We know from experience," the report went on, "that older persons suffer in silence, quietly stepping aside so that younger members of their families can access services and aid."
While according to the UN Population Fund (UNFPA), 6 percent of the Syrian population was above the age of 60 before the conflict, only 2.5 percent of refugees in Lebanon are that age. Elderly people struggle to register with the UN Refugee Agency (UNHCR) because they cannot reach the registration centres easily.
That was one of the findings of a quick assessment of 70 elderly refugees in May by Claire Catherinet, an inclusion advisor with HelpAge, on secondment to Handicap International in Lebanon. It echoed the findings of CMLC: Many elderly cannot afford their medication, and most are dependent on humanitarian assistance for things as basic as food because they have no livelihood opportunities, said Catherinet
“They benefit from all the humanitarian assistance, but there is no special attention [given to elderly people], as there is for women and children,” she told IRIN. “As among the most vulnerable people in times of emergencies, older persons are neglected.”
In a statement to IRIN, UNHCR said it would like to “do more than we currently do” for refugees with special needs, “but because of lack of funds and capacity, we are not able to meet all the needs and give the assistance they would deserve."
In its study, conducted in coordination with Johns Hopkins University, CLMC interviewed 175 elderly Syrian refugees (in addition to 45 elderly Palestinian refugees from Syria) and drew on 10 years of experience working with older people at Palestinian refugee camps.
The impetus of the study came during a visit to one of the tented settlements in eastern Lebanon. One of CLMC’s staff members was shocked to find an elderly woman staring at him from under a blanket in the mud. Her family said they had grown tired of moving her frail body from her mattress to the home-made latrine outside. So they decided to leave her lying next to her toilet, to answer calls of nature without their help.
CLMC has since purchased a wheelchair for the family and secured a tent for them near a concrete toilet, but there are many other families with elderly people that do not receive this kind of assistance.
Akram al-Kilani, 63, who sought refuge in Lebanon's eastern Beka'a Valley, said the biggest problem he has faced since arriving in Taalabaya several weeks ago is the public bathroom. He must walk for nearly five minutes to reach it.
“We’re very grateful to the people providing for us here. But tap water in the tents and nearby toilets are absolute necessities for us,” said al-Kilani.
According to CLMC’s findings, the elderly’s needs are widespread and urgent. Sixty-six percent of the elderly surveyed described their overall health status as bad or very bad, with most respondents having multiple chronic illnesses.
|Of the elderly refugees surveyed by Caritas:|
|87 percent could not afford the medication they require|
|74 percent depended on humanitarian assistance to meet their basic needs|
|60 percent had hypertension|
|47 percent had diabetes|
|30 percent had some form of heart disease|
|10 percent were physically unable to leave their homes|
|4 percent were bedridden|
|"Significant proportions" sensed they were a burden to their families|
Catherinet said the inability to afford their medication had resulted in swollen limbs, difficulty breathing and walking, and in some cases, an inability to leave their beds. Many people resorted to returning to Syria to get medication for elderly members of their family, she said.
The health status of the elderly is often linked to their state of mind, said Hessen Sayah, coordinator for Syrian refugee projects at CLMC, who has extensive experience with elderly Palestinian refugees in Lebanon. When CLMC’s psychosocial programmes in the Palestinian camps had run their course, she said, the elderly community saw a sharp increase in diabetes.
Prioritizing younger people
Undergirding the issues faced by elderly refugees is an expectation that they must suffer in silence so that younger people may fulfil their needs first.
The CLMC survey found that malnutrition among the elderly was prevalent due to reductions in meal sizes and insufficient intake of fruit, vegetables and meat, with the intention of leaving more to younger people.
Khadijeh serves as a case in point. She refuses to seek treatment for her heart palpitations, preferring to use the family’s limited money on healthcare for her son, who recently broke his arm.
“There’s just no point in me going to the hospital,” she told IRIN. “There is nothing left for me but death.”
Um Lateef*, 63, is unsure about whether to replenish her dwindling medical supplies because she does not want to endure “the humiliation” of asking humanitarian groups for help.
Elderly can play a role
But CLMC is now hard at work to prove that there is indeed a point to keeping the elderly healthy. CLMC espouses alleviating the problem by changing the way we view the elderly, who tend to be more effective negotiators with host communities because of the respect garnered by their age. They can also offer stability to a household overwrought by the stress of displacement.
“When we give the elderly their value, they are able to intervene in problems, domestic or otherwise... and this in turn improves their health,” Sayah said.
With over 722,000 refugees in Lebanon, there are widespread reports of growing resentment between the refugees and their Lebanese hosts. The presence of refugees in some 1,400 localities around the country has chipped away at government-funded pharmaceutical stocks, as well as increased competition in the job market and raised housing prices.
CLMC says older people can provide a calm and sagacious face for the refugee community, helping to soothe tensions with their hosts. However, refugees and humanitarian workers must recognize the elderly’s capacity to fill this role.
“We try as much as possible to involve [the] elderly in [the] community center’s activities, also to use their advisory role with youth and other community members,” UNHCR said in its statement. “The challenge is sometimes the fact that [the] elderly need special logistics assistance for transportation to the centers and unfortunately we do not have enough funds and capacity to transport many of them.”
Ahmad Dattouf, 63, breaks into sobs as he talks about the alleged chemical attacks on eastern Damascus suburbs that morning. “What is happening these days has never been seen before. The situation is still very bad,” he says.
He is racked with guilt about whiling away his days between four grey concrete walls in Lebanon.
“Even at this age, my body urges me to go fight with those heroes [in Syria].”
HelpAge and Handicap International will be conducting a more detailed assessment of elderly Syrian refugees in Lebanon, Jordan and Turkey in the coming weeks, with findings to be ready in the fall.
*not a real name