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Archive for September 20th, 2013

“Urgent” needs widely ignored

Posted by African Press International on September 20, 2013

TAALABAYA, 6 September 2013 (IRIN) – 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.”

Khadijeh Sayyid Ahmad tells of family members killed in Syria.

Limited mobility

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.

“Urgent” needs

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 wishes he could go fight in Syria, even at his age.

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

tq/ha/cb/rz  source

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Newly built latrines in Myanmar – but will they be working in 12 months?

Posted by African Press International on September 20, 2013

Newly built latrines in Myanmar – but will they be working in 12 months?

STOCKHOLM,  – The success in achieving the Millennium Development Goals’ (MDGs) water target and massive growth in water, sanitation and hygiene (WASH) programmes have masked a little-discussed secret: WASH interventions frequently fail.

Rather than focusing on what is almost literally pouring money down the drain, donor reports and NGO websites prefer instead to boast of the numbers of water pumps drilled or toilets installed.

“You don’t take photos at a funeral,” said Dutch water expert George De Gooijer, who is based at the Netherlands’ embassy in Benin. “The lack of a link between results on the ground and the proposals is the one that needs to be solved.”

In 2012, an audit by the European Union (EU) sought to make that link between its officially completed WASH projects in sub-Saharan Africa and the reality on the ground – but found that more than half of the drinking water schemes surveyed had failed to deliver.

“Negligible positive outcomes” 

A key failure was in the management of the projects rather than the installation of the equipment.

Overall EU spending on water and sanitation projects in sub-Saharan Africa, from 2001 to 2010, amounted to more than one billion euros – and much of it is likely to have failed to produce the intended outcomes.

Hundreds of short-term WASH projects were implemented in the aftermath of the 2010 earthquake in Haiti – rapid construction schemes that have had little long-term impact, says Sasha Kramer, an ecologist and co-founder of the sanitation NGO Sustainable Organic Integrated Livelihoods.

“This approach to sanitation interventions results in massive spending in the sector, impressive implementation statistics for NGOs and negligible positive outcomes for community beneficiaries,” Kramer said.

The UN in Haiti is actually blamed by many analysts for causing the world’s worst recent outbreak of cholera, which killed more than 8,000 people and infected at least 600,000.

This year, the UK’s Independent Commission for Aid Impact found that a government water project in Sudan’s Darfur region had created “aid dependency” with little focus on creating a durable solution.

The long list of failures is all the more painful because water and sanitation are universally recognized as critically important.

Low-quality water and sanitation systems create acute vulnerabilities during natural disasters. When earthquakes and floods strike, it is frequently the subsequent population movements, water-source contamination and unsanitary conditions that create the most dangers to human life.

Sixty percent of the world’s population has dysfunctional or non-existent sanitation, says Arno Rosemarin, a researcher at the Stockholm Environment Institute. There is “no other global statistic leading to high risk that comes close to this one,” he said.

Speaking at this month’s World Water Week in Sweden, he said WASH – particularly sanitation – was “a failing chapter in human development.”

Humanitarian accounting

Donors like concrete, measurable targets. In a WASH sector looking to reduce open defecation and control human waste, this has often meant building toilets – what some analysts call a “vending machine” approach.

Rosemarin says, “There’s a big difference between having a toilet and having a toilet that works.”

In India, which has some of the highest rates of open defecation in the world, the government has embarked on a vast programme of toilet building. The results are so far extremely mixed, says Prakash Jumar from the WASH Institute in India.

Jumar says communities have often been completely left out of the implementation process; sometimes to the extent that they do not use the new toilets because they fail to realize the toilets were built for them.

Poor construction quality has meant that 30-40 percent of toilets have been abandoned, repairs are nearly impossible because of nonexistent supply chains for spare parts, and even when still standing, many are used for storage rooms rather than for defecation.

“We have a lot of lessons learned, but we are not implementing [them] in national and major sanitation programmes. We need to integrate these failures,” Jumar said.

He says the key is community engagement.

“When the community is [involved, they] often don’t then need support from the government. That was one of the major lessons learned from 10 years in the region.”

Global water sector figures say half of water projects end up failing because of a lack of community involvement.

Emergency aid 

Many WASH projects are implemented during humanitarian emergencies, when broken water and sanitation systems can create massive health risks.

“There’s a big difference between having a toilet and having a toilet that works”

But in the rush to intervene in places like refugee camps, basic steps are often not taken – like building adequate drains in areas with high rainfall and not installing flush toilets where water is scarce, according to Katarina Runeberg, an environmental advisor with the Swedish Civil Contingencies Agency (MSB).

There are often multiple actors seeking to respond in a crisis, with no one looking holistically at the whole WASH cycle.

And in many cases, humanitarian actors are trying to implement adequate water and sanitation systems where none existed even before the crisis.

Even before its earthquake, Haiti had the lowest sanitation coverage in the northern hemisphere and the world’s highest incidence rates of diarrhoea, for example.

Long-term perspective 

But even in the world of development, donor deadlines are frequently tight, adequate measurables can be difficult to find, and construction continues to be favoured over operation and maintenance.

“WASH systems inherently require long-term operations and maintenance. And to ensure the ongoing maintenance of a WASH system, community engagement and long-term planning are critical,” said Kramer.

But projects implemented from outside rarely have the sort of long-term funding needed for maintenance and regular assessment. One rare example is the Netherlands, which is attempting to make sure implementing partners aim for 10-year sustainability, says De Gooijer, but this can be difficult to implement.

“We are very frequently limited through time-framing that we need to complete by a certain date, and spend money by a certain date,” said Patrick Fox, an advisor to the disaster unit at the Swedish Red Cross.

They have begun using “Look Back” studies to check up on WASH projects two to five years later. In the case of their work in North Korea, they initially found 80 percent of projects were no longer functional. Problems included a lack of local familiarity with the materials used (like PVC piping), and the use of sewage as fertilizer before it was safe to do so – issues they were able to correct.

“If you think you’ve discovered something good, leave it alone in the field for two years and then see if it is working,” said Peter Morgan, an award-winning WASH inventor and scientist who has been implementing projects in Zimbabwe for decades.

A Syrian refugee in Iraq tries to unblock a ‘grey’ water channel at his camp

But donors have yet to establish concrete funding mechanisms for these kinds of long-term assessments.

This leads to the broader question of just how practical it is for outside humanitarian and development actors to be even trying to implement large-scale WASH systems.

Morgan says the success of a mass-deployment of specially designed ventilated improved pit (VIP) latrines could be attributed largely to the fact that it was approved and implemented by the Zimbabwean government itself. He says governments and users need to be strongly associated with any projects if they are to avoid failure.

“Local people are incredibly innovative, and if you are a humble character you need to open your eyes and look at that,” he said. “People live there. They don’t drive off in a fancy 4×4 vehicle and vanish in the dust. They actually live there.”

Few, if any, countries can claim to have a large-scale WASH system thanks to international NGOs, which Kramer says frequently lack “cultural fluency” and have an “inability or unwillingness to engage with local communities.”

Donor pressure 

Canada’s Engineers Without Borders produces an annual “Failure Report”. The organization found that around half of all failures were not related to conditions in recipient countries, but rather derived from internal planning, communication, decision-making and personal leadership.

Yet it remains extremely difficult for UN agencies, international NGOs and local actors to say that their WASH projects were failures. Donors want to see successful track records, and no one wants to fund a fiasco.

“It’s not fashionable enough to talk about failure,” said Rosemarin

For communities receiving water and sanitation projects, the lack of honest engagement can create barriers.

“The walls of fear, distrust and misperception affect international interventions in all sectors, but are particularly disruptive to WASH interventions, where quick fixes are not possible and successful projects are completely dependent on community engagement,” said Kramer.

Otherwise, as one aid worker from Uzbekistan reported, villages may be successively visited by different NGOs installing the same sanitation project one year after the next.

“Getting negative feedback could be more valuable than the opposite,” said Morgan. “If you have failures, then the very least you can do is to find out what went wrong.”

jj/rz  source

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