The situation in Ukraine has been called the world’s ‘oldest’ humanitarian crisis, with more people over 60 affected by conflict and displacement than any other country. Since the escalation of the war in February 2022, gas, electricity and water infrastructure has been damaged and large swathes of civilian infrastructure destroyed. Access to pensions, health care and other basic services has been severely curtailed. With the demographics of Ukraine skewed towards older people, and particularly older women, the impact on this group has been devastating.
Older people make up a disproportionate number of civilians remaining in areas of active hostilities and face a greater likelihood of being killed or injured. Older people who have remained in conflict areas face disruptions to supplies of food, water, medicine and electricity. For those who are displaced, the collective centres and other informal, unvetted sources of shelter that provide emergency accommodation are often unsuitable to meet their needs. Many older Ukrainians are also in a financially precarious position as they rely on the small State pension to survive.
Despite the high proportion of older people among the conflict-affected population, humanitarian support generally follows a one-size-fits-all model that fails to uphold older people’s rights. Recent research by HelpAge International reveals the varied experiences of older people, including how specific sections of the older population, namely older women, people over 70 and older people with disabilities face disproportionate risks.
Assumptions that older people are passive recipients of care and aid ignores the diversity and complexity of their lives and overlooks their active participation in responding to the needs of their communities. Many older people are performing crucial roles in the current crisis, whether as social care workers or as care givers for other older adults and/or children.
This article explores some of the key needs identified through research and from supporting older people in the Ukraine humanitarian response. HelpAge’s trained social care workers deliver essential services to older people in their own homes and in shelters. These services include psychosocial support, home help and assessment for the provision of multi-purpose cash, assistive devices, and hygiene products to support those living with bowel and urinary incontinence.
Displaced and remaining
Displacement poses many challenges to older people. Packing belongings, carrying cases and getting on public transport can be difficult. The facilities at shelters or the homes of friends and relatives may not be designed with the needs of older people and people with disabilities in mind. Access problems can include the absence of ramps, shower facilities without handrails, and corridors that are not wide enough to accommodate wheelchairs. Many older people are turned away by shelters because they cannot cater for people with incontinence. Other issues include the inability to access cash assistance when identity documents and pension books have been lost.
Those that remain in their own homes face specific challenges. There is the physical danger of being close to the conflict. There is also the reduction in services: health facilities may have been relocated, power supplies and other utilities may be cut or reduced, shops and businesses may have closed down. In addition, many older people lack the financial resources to repair or improve their damaged homes. Finally, friends, relatives and neighbours might have left. However, after a lifetime in their own homes, many older people are still reluctant to leave and would rather stay and face these challenges. Nina, 84, from a village in the east of Kharkivska Oblast that saw intense fighting in May 2022, reflected this feeling: “I’m never leaving, even the Russian shell that blew a hole in my roof couldn’t force me out.”
In a recent survey that explored a number of issues including the psychosocial support needs of older people because of the war, over 50% of respondents reported a negative impact on their mental health. Many reported experiencing nightmares, isolation, fear of the future and feeling unable to cope. The support of HelpAge trained social care workers, many of whom are older people themselves, can help reduce the psychological stress experienced by older people. Social care workers visit older people in their homes once or twice a week and are a vital lifeline, they are also instrumental in collecting data and conducting needs assessments to determine whether additional services are required.
Hygiene and incontinence
Maintaining good personal hygiene is an important factor for the physical health, mental health and dignity of all people. In contexts of conflict and displacement, these needs are amplified and increasingly difficult to maintain. In Ukraine, a lack of income or inability to access funds, the reduced availability of hygiene products, and limited public transport or support networks to help purchase these products present huge barriers to good hygiene, especially in shelters and areas closest to the front line. For older people living with bowel and urinary incontinence, regular access to incontinence products is crucial to living a dignified life. Lyubov, 62, displaced from the East and currently living in a shelter in Lviv, explains the importance of such products:
“I have low mobility from arthritis and a stroke I recently suffered. This is a large shelter with many people, and the bathrooms are quite far away. The incontinence pads are essential for me and my husband with disabilities.”
Devices that enable functioning and independence
The timely provision of assistive devices, such as wheelchairs, walking frames, sticks, adapted toilet seats and bathroom chairs, needs to be a key component of humanitarian assistance for older people in Ukraine. Assistive devices can have a positive impact on independence, reducing vulnerability and building older peoples’ resilience. Out of 400 older people interviewed by HelpAge in Ukraine in December 2022, 43% faced barriers to accessing assistive devices. Although older people are in theory able to obtain government support for such items, the registration process is slow, bureaucratic and not adapted to catering for displaced people, people who have lost their documentation and those unable to easily access local health services for assessment.
Multi-purpose cash assistance
Multi-purpose cash assistance (MPCA) has been a critical part of the overall humanitarian response in Ukraine and has been identified by older people, and the affected population more broadly, as their number one need. However, our experience shows that older people’s additional needs are not always factored in. The Cash Working Group in Ukraine (comprising national and international NGOs and UN agencies that provide cash voucher assistance) aims to promote the development of inclusive quality cash assistance; it has recommended the monthly amount of 2,220 UAH per person. For older people who frequently need to spend more on medicines and personal hygiene items, and often spend more time at home, which increases heating and lighting costs, this is not enough.
In addition, the most at-risk older people might not be able to access MPCA. Most older people receive monthly pension payments through the Ukrainian postal service – Ukrposhta. Due to its reach, HelpAge uses the same system to deliver MPCA, though there are challenges. The service offers two options for payment – collection in person from a post office or cash delivery to a residence. However, opening and operating a post office account is contingent upon being able to provide identity documentation. For displaced people who have lost their documents this is impossible. The service is also address dependent and there are often delays updating addresses in the post office systems. Additionally, in many remote villages near the frontline, the postal system no longer operates. This means MPCA providers using this method often have to seek riskier alternatives such as distributing physical cash or providing transfers through the friends and relatives of the recipients in order to ensure no-one is left out.
The targeting of Ukraine’s energy infrastructure has left millions of people without power for heating, lighting and cooking for extended periods, which creates particular challenges in winter. Older people face greater health risks associated with the onset of cold weather and winter in wartime greatly amplifies those risks. Humanitarian winterisation programmes are often centred on providing warm clothing, but whilst displaced older people often need additional winter clothing, those remaining in their own homes generally do not.
What they do need is access to cash to pay utility bills and carry out essential repairs for improved domestic insulation. They also need the ability to stay in contact with friends and relatives, lighting and a way of cooking and staying warm during power-cuts. The most important winterisation interventions are the provision of low-energy rechargeable lighting, power banks for charging mobile phones and servicing traditional coal or wood burning stoves.
Insights and recommendations
Older people face specific challenges in situations of humanitarian crises and displacement. When there is a failure to consider older people and identify their particular requirements, they will continue to face barriers to accessing protection and assistance. In Ukraine, a far greater focus is needed on providing targeted support to this disproportionately large and increasingly at-risk group.
This can be achieved by all responding organisations promoting the engagement and participation of older people to incorporate their perspectives into the design, implementation and monitoring of programmes and policies. Collecting, analysing, using and reporting on sex, age and disability disaggregated data is critical to understanding the complexity of experience of all affected people and designing appropriate interventions.
Befriending, mentoring and counselling services could be added to existing protection programmes. The development of new shelters or rehabilitation of existing shelters should consider the needs of older people so that their use is ‘universal’, and access to assistive devices should be a part of every agency’s programming through partnership with experienced organisations, such as HelpAge.
Finally, it is critical that humanitarian actors expand programmes that focus on delivering assistance to older people close to where they are living through community-based services and support, such as assisted living arrangements and home-based health and care services, to empower them to live safely, with dignity, and as actively and independently as possible.
Luciana Caffarelli email@example.com
Humanitarian Age Inclusion Adviser
Hester Clark firstname.lastname@example.org @hester_c
Humanitarian Advocacy Advisor,
Simon Harris email@example.com
Former Area Manager (East Ukraine)