Pakistan + 1 more

7th Report - The Humanitarian Response to the Pakistan Floods - Volume II

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Evaluation and Lessons Learned
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Written evidence submitted by Age UK

ABOUT HELPAGE INTERNATIONAL

  1. HelpAge International is an international NGO established in 1983 by Age UK (formerly Help the Aged) with the vision of a world in which older people fulfil their potential to lead secure, healthy and dignified lives. It leads an international network of 75 affiliate organisations and over 400 partner organisations in over 50 countries; a major donor and partner is Age UK.

  2. HelpAge, with Age UK is the only organisation working specifically to meet the needs, uphold the rights and recognise the capacities of older people in humanitarian crises. It is recognised in the international humanitarian community as an expert practitioner ensuring appropriate assistance to older people in emergencies and as a leading advocate for the recognition of the rights of older people. HelpAge is the Focal Point for the issue of ageing within the Global Clusters (UN-led forums for coordination and collaboration in the international humanitarian system) and it was tasked with insuring the inclusion of age in the recent revision of the Sphere Standards for disaster response. Following a progress report last month to the IASC (the Inter-Agency Standing Committee, the primary mechanism for inter-agency coordination of humanitarian assistance involving key UN and non-UN humanitarian partners), HelpAge has been tasked by the IASC Working Group to assist IASC agencies and Cluster Lead Agencies to mainstream appropriate assistance for older people in humanitarian needs assessments, best practice guidelines and training.

ABOUT AGE UK

  1. Age UK is the new force combining Age Concern and Help the Aged. We work closely with our sister organisation HelpAge International and our aim is a better later life for people across the world today and tomorrow. Through our partners we deliver and support services in every part of the UK and support HelpAge International to reach over 1.5 million people in low-income countries with development programmes and emergency relief. Age UK is a member of the DEC and works in partnership with HelpAge International to increase the inclusion of older people in humanitarian aid and in the UK to increase the UK public's understanding of older people's needs in times of emergency. Our influencing work is based on evidence of what works, on the views of people in later life and on our experience of direct service delivery.

EXECUTIVE SUMMARY

  1. HelpAge and Age UK estimate that there are at least 1.2 million older people out of the 20 million people affected by the Pakistan floods. Evidence from disasters around the world shows that older people are particularly vulnerable in emergencies. They have specific needs in terms of healthcare and nutrition, shelter and protection and, as a vulnerable group, they need targeted support. During the course of its emergency response to the floods in Pakistan, HelpAge has found that whilst some steps were taken by UN agencies to ensure the needs of older people are included in response plans and actions in general, the necessary steps were not taken to properly assess and respond to older people's needs. This is a failure to uphold the fundamental principle of impartiality, ensuring humanitarian response is undertaken according to need. Specific measures, such as including disaggregated data by sex and age in assessments, distribution mechanisms that recognise mobility impairment and relief supplies that are age-appropriate, will enable humanitarian responses to better meet the needs of this vulnerable group.

The performance of the "cluster system" and other donor coordination mechanisms

  1. About 6% of the disaster-affected population in Pakistan are older people.[1] They are particularly vulnerable and have specific needs in disaster situations due to factors which are often age related, like for example health needs. The cluster system is designed to ensure a coherent and coordinated response to needs in accordance with humanitarian principles. In the Pakistan flood response, HelpAge found that some agencies endeavoured to ensure proper inclusion of vulnerable groups such as older people (in particular, the Protection Cluster). In general, however, the Clusters failed to take essential steps to ensure that older people's needs were properly understood, assessed and responded to.

  2. Through commitments made by the Inter-Agency Standing Committee (IASC),[2] the Cluster lead agencies are expected to ensure the collection of age disaggregated data in sector and multi-sector assessments and to use this information to inform and guide programming to ensure it addresses the needs of all age groups appropriately. Without disaggregated data, it is difficult to identify the needs of older people without additional targeted assessments and it makes it easy to ignore the fact that they have specific needs. In many cases this information was not collected in Pakistan.

  3. The Health Cluster (led by WHO) continues to use age 49 as its cut-off point for data collection. This makes it impossible to assess properly the health situation of older age groups and to identify and address age-specific health concerns. The lack of health data documenting the specific health needs of older people is of particular concern in light of HelpAge International's assessments in Sindh (one of the worst affected flood areas). HelpAge conducted interviews with 358 beneficiaries 58% of whom said their health had deteriorated and that they were increasingly physically weak and immobile; 72% had lost their assistive devices such as mobility aids, hearing aids, glasses and dentures; 46% had lost their medicines and had no money to replace them.[3]

  4. In the initial Flash Appeal for the Pakistan floods (11 August 2010), the response plan of the Protection Cluster (led by UNHCR) notes that the collection of sex- and age-disaggregated data will be a prerequisite in the response (p 28). However, in protection rapid assessments, reference to older persons and persons with disability was inconsistent and often absent. Questions to elicit important information on the situation of older people following the floods were not included in the assessments.

  5. Under an agreement with UNHCR, HelpAge seconded an age and disability specialist into the Protection Cluster to provide technical support to the cluster and other disaster response actors. The impact of advocacy to include older people's needs in assessments and programmes is reflected in the revised Flash Appeal (5 November 2010). In the revised Flash Appeal, 20% of the projects submitted mention older people as a vulnerable group; 6.2% of all the projects submitted included an activity that addressed older people's needs (eg registration, building age and disability appropriate latrines, psychosocial activity, protection). This contrasts with the first Flash appeal in Pakistan in which 12.8% of projects mentioned older people as a vulnerable group, and 1.2% had a specific activity that addressed their needs.

Whether the provision of humanitarian assistance to those displaced by the recent floods and longer term internally displaced persons is sufficient, efficient, effective and cost effective

  1. The scale of the disaster and displacement in Pakistan means the general response is not sufficient. More specifically, there were and continue to be serious gaps in the response in relation to the needs of vulnerable groups such as older people. These are undermining the effectiveness and principled and equitable nature of the humanitarian response.

  2. The fundamental principle of impartiality requires humanitarian actors to ensure they undertake an analysis of the needs of all vulnerable groups in an affected population and that levels of assistance provided to them is commensurate with this analysis. The relationship between assessment and response to the most vulnerable should be at the centre of analysis of cost effectiveness and efficiency.

  3. Relief distribution methods in Pakistan limited older people's access to essential supplies, thereby undermining the effectiveness of the response. HelpAge International's assessments in Nowshera, Muzzafargarh and Sakhar indicate the extent of the problem.[4] Older people report the demeaning nature of distributions, with food being thrown from helicopters. These modes of distribution affected older people, especially older women who do not have the strength to carry the relief supplies or get to the front of crowds. Data from the Multi-cluster Rapid Assessment Mechanism (McRAM) further shows that three-quarters of older people found distribution points for non-food items inaccessible. Experience from other emergencies shows the importance of age-appropriate distribution methods to ensure the most vulnerable are supported. These include specific distribution points or times for older people, identifying and targeting the most vulnerable for instance by direct delivery of relief goods to immobile beneficiaries.

  4. HelpAge International's assessments in Khyber Pakhtunkhwa found that almost 73% of older people were at risk of malnutrition,[5] yet systems for measuring and responding to malnutrition in older people were inadequate because data was not disaggregated for older age groups. Emergency food rations, where available, were generally the same as for younger adults, with no allowance made for the difficulty older people might have in chewing, digesting and absorbing sufficient micronutrients. Furthermore, agencies often do not give sufficient thought to the ability of older people to collect water and fuel to prepare the food. Such access issues can be addressed by providing support to older people who are unable to carry relief assets, or ensuring direct delivery of goods where necessary.

  5. While general distributions to families will in some cases ensure the delivery of relief items to older people, this does not address the needs of older people living alone who can represent a significant proportion of the population. HelpAge International's assessments in Sindh, for example, found that older people living alone accounted for 26% of the population.[6] In such cases special arrangements are needed ensure equitable access for the most vulnerable through direct delivery of relief assets or support to ensure older people are able to collect and transport goods.

How quickly livelihoods can be restored, assets protected and food security provided

  1. Long term food security must be achieved through restoration of agricultural livelihoods. Food security for older people will only be achieved by ensuring those still capable of working are included in livelihoods programmes. Early recovery programmes often exclude older people from agriculture recovery activities, overlooking the contribution they can make to household subsistence through small-scale agriculture. Furthermore, older people's experience and understanding of traditional coping mechanisms and agricultural techniques should be harnessed to support recovery through inclusion of older people in consultation processes surrounding livelihoods recovery programming.