Today, HelpAge International and Handicap International have released a report highlighting the precarious lives of some of the most vulnerable people on earth right now - older and disabled refugees from Syria.
The report makes for uncomfortable reading, detailing the everyday problems faced by refugees struggling to cope with their displacement, away from their families and from their home country's healthcare system. In addition, they are neglected by much of the humanitarian system which barely takes them into account into aid operations on the gorund. These groups of refugees are, as the authors of the report write, "hidden casualties" of the world's most visible conflict.
The Syrian crisis is ubiquitous: UNHCR announced on 3rd April that the conflict had generated its millionth refugee in Lebanon alone, and confirms the movement of 2.5m Syrians outside their country as the largest since the Rwandan genocide twenty years ago this week. Media coverage has been constant, often shocking. But political solutions to the conflict have remained out of reach.
Despite the fact that the conflict represents the UN's largest ever humanitarian appeal, targeted and appropriate humanitarian response for older people has not been achieved, despite their vulnerability in this crisis. Of particular concern to us are the 77% of refugees aged 60 plus who are affected by impairment, injury or chronic disease.
Injury is widespread in the Syrian refugee population - an unsurprising but alarming indicator of the dangers for civilians inside the country they are fleeing - with one in 20 surveyed suffering from injury and nearly 80% of injuries resulting directly from the conflict. They now face significant difficulties in accessing aid and are disproportionately affected by the huge psychological toll of the disaster.
Psychological distress, estimated to affect 65% of older refugees, is substantial. The lack of psychosocial or mental health care is a major challenge, affecting the well-being of older people but placing an additional burden on their families. Aid needs to be tailored specifically so that older, disabled and injured refugees from Syria are provided with appropriate treatment, so that this in turn may help to reduce the trauma of displacement.
How is it possible or acceptable that, three years into a major humanitarian operation, that such an important segment of the population has not been reached with appropriate services? Above all, why does this keep happening?
Firstly, needs assessments must take sex, age and disability into account. We have a plethora of studies showing that the exclusion starts with the way initial assessments are made on arrival. The system can't help what it doesn't see. An accurate picture of the overall demographic profile of a refugee population at the beginning of a crisis is the only way to start, along with a commitment on behalf of those responsible for the overall aid operation to ensure that appropriate services are planned and delivered for all age groups.
If you start with an accurate picture of the population to be assisted, plan a response programme designed to meet humanitarian needs in their totality, and regularly monitor and assess progress towards that goal, then there is no excuse for not translating these plans into concrete programmes on the ground.
In our joint report, HelpAge International and Handicap International make eight recommendations to prevent the almost systematic exclusion of older and disabled people from mainstream humanitarian programmes.
• Collect, analyse and use sex, age and disability disaggregated data (SADDD) to create appropriate services
• Train staff to identify and include people with specific needs to address everyday challenges
• Ensure appropriate services are available and accessible for all age groups
• Develop strategies to strengthen existing family and community support
• Address gaps in primary healthcare services for people with chronic or non-communicable diseases
• Ensure medical assistance and longer term rehabilitation is available for post-operative patients
• Ensure these projects receive the necessary funding
• Support governments and local authorities to adapt strategies, services, infrastructure and regulatory frameworks to ensure accessibility by older, disabled and injured refugees and support recognition of their rights
There is nothing here that can't be done. The Syria conflict is complex, deep-rooted, and incredibly difficult to solve politically.
But none of that is any kind of excuse for some of the most vulnerable categories of refugees to be so poorly served by the overall response.
Humanitarian organisations providing assistance to Syrian refugees need to be accountable for the situation facing older, injured and disabled Syrians. There is no need for this continuing exclusion.
Unfortunately, there is every indication the conflict and displacement will continue for some time to come, so this can and must be fixed. We need to change the way aid is delivered in Lebanon, Jordan and other countries hosting the refugees from Syria.
More precise targeting and registration, better training of staff, and above all a genuine and powerful commitment to inclusion can ensure humanitarian assistance is accessible, appropriate and effective for all age groups.