We are currently facing a global pandemic that is particularly fatal for older people. But how well has the humanitarian response in Ukraine been tailored to protect this group?
Covid-19 predominantly affects older people, with more than 95 per cent of fatalities registered among people aged over 60. Older people are also distinctly vulnerable during complex emergencies, be it armed conflict or natural disaster. In eastern Ukraine, the covid-19 crisis is compounded by an ongoing conflict.
Humanitarian actors have identified older people as being disproportionately affected by both in eastern Ukraine. Yet in the absence of disaggregated data on age in the midst of the covid-19 crisis, this assumption has been built largely on anecdotal evidence coming from various international NGOs and health practitioners. Humanitarians are struggling to deliver assistance that is tailored and which takes into account the specific needs of the older people. These data could guide humanitarians that are designing elements of aid programmes that would accommodate the specific physical, medical, social and psychological needs of older people.
The response to the covid-19 crisis has illustrated how spectacularly unprepared the humanitarian system in Ukraine is to deliver age-sensitive assistance and care for a group with different physical, social and psychological needs and capabilities.
Caught between covid and conflict
Older people are distinctly vulnerable during complex emergencies because their limited mobility and physical capacity makes it harder for them to flee or find refuge. They may also struggle to adapt to different environments. Between 2015 and 2019, MSF ran 28 mobile clinics in Donetsk oblast, along the shifting frontline of the conflict. Our clinics treated over 3,000 patients, 88 per cent of whom were above the age of 50 and suffered from non-communicable chronic conditions, such as hypertension and diabetes. The conflict has left eastern Ukraine’s health infrastructure in ruins. Patients suffering from chronic conditions are barely able to access healthcare and many have seen their treatments interrupted.
MSF is not the only humanitarian organisation that has spoken out about the vulnerability of older people living along the contact line in eastern Ukraine. The Humanitarian Response Plan has consistently highlighted the demographic erosion in eastern Ukraine. While the younger generation have fled to safety and to find employment, healthcare and education for their children, older people have stayed. Humanitarians agree that older people people have been disproportionately affected by the armed conflict and that we ought to find ways to design age-sensitive programmes when developing future medical humanitarian interventions.
We are now facing a global pandemic that is particularly fatal for older people and those with chronic conditions. So far, it is difficult to quantify if and how age has been factored in the design of humanitarian programmes given competing institutional and donor interests. Today’s covid-19 crisis should serve as a wake-up call for humanitarians, as adapted assistance for older people does not stop now. The UN Department of Economic and Social Affairs records that the number of older people worldwide is projected to more than double, reaching more than 1.5 billion in 2050.
One size doesn’t fit all
In mid-March, with the worsening covid-19 crisis spreading across Europe, nationwide lockdown measures were put in place in Ukraine to restrict movement. Rural communities in eastern Ukraine on the frontlines of the conflict had to adapt to the same measures as the rest of their country. However, this one-size-fits-all approach may cause a great deal of harm to older members of these communities, who are heavily reliant on communal support and locally-rooted coping mechanisms. The broad-stroke lockdown measures will also have an impact on the continuity of care for patients with chronic conditions. In rural communities, the absence of transport, combined with health activists being in lockdown, means access to healthcare for older patients with chronic conditions is further constrained. HelpAge advice on covid-19 specifically highlights assistance needed from others and issues of disability, which, translated into the context of eastern Ukraine, would hardly be compatible with the lockdown measures. For example, 82 year-old MSF patient Hannah has to walk 5 km from Vodiane to Pervomaiske to see her family doctor for a consultation and must then travel another 20 km to refill her prescription for chronic disease medicine at a pharmacy in Selidove. If she contracts covid-19, she will need to travel 44 km to reach to nearest covid-19 designated hospital, in Volnovakha.
Adjusting humanitarian response beyond covid-19
The need to have age and gender disaggregated data is not new. Year after year, the humanitarian community in Ukraine singles out vulnerabilities among the elderly in eastern Ukraine. Dyan Mazurana, at the Feinstein International Center, made the case in 2013 to draw attention to the need for this data. Yet, in 2020, we are on the frontline of the covid-19 crisis with an empty arsenal. Success of our work cannot and shall not be measured by reducing mortality and morbidity alone. Sensitivity to the age-specific needs of older people within humanitarian programming extends our humanitarian mission to encompass actions that are not only the life-saving, but also dignity-giving.
Grigor Simonyan, MSF Head of Mission in Ukraine
Grigor Simonyan has worked in the humanitarian field for over 15 years with Caritas, Catholic Relief Services, Mercy Corps, and MSF. Since 2012, he has been country director with MSF in Kyrgyzstan, South Sudan, India, and presently Ukraine (since 2018).
Competing interests: None declared