the plight and prospects of elderly exiles in developed nations

The Plight and Prospects of Elderly Exiles in Developed Nations

by Barry Robinson*

An earthquake somewhere you never heard of and the. Red Cross moved the inhabitants, primitive people, from their land and resettled them. And very soon they began to die, one by one, for no apparent reason at all. They're still dying. The Red Cross thinks they're dying o f broken hearts, leaving their ancestral places. Their souls rebel and they die.

from the novel Jack Gance by Ward Just I

"Of all the persons affected by the rigors of involuntary displacement, it is perhaps the elderly refugee who suffers the greatest hardship," declares Elzbieta Gozdziak in a 1988 Refugee Policy Group report on Older Refugees in the United States: From Dignity to Despair. "Torn from familiar surroundings and lifestyles, and thrust into uncertain circumstances at a time of life when continuity and habit are especially prized, the aged refugee endures a particularly intense sense of desolation, and encounters special difficulties in adapting to the hardships of resettlement."

Not only do they face what are considered the normal range of refugee hardships, but they are also beset by the entire plethora of problems usually associated with aging, thereby multiplying their troubles almost exponentially and making them that much more difficult to resolve.

"In more developed countries," notes a February 1989 statement from the United Nations High Commissioner for Refugees, "problems such as loneliness and isolation seem to be more severe among the elderly in the refugee population, cut off from friends, family and society . . . Even those who arrived at a young enough age to master a new language have a tendency to forget it and have more and more difficulty speaking their new language as they grow older. When such problems are combined with the loss of family, and traumas such as the reliving of experiences leading to flight from the home country, the severe depression that often results is easily understandable"--if not as easily treatable.

Old age is, of course, relative and this can have personal economic implications. "Since life expectancy is often much shorter in developing countries, refugees considered elderly in their country of origin may not even have reached retiremen t age in the asylum country," points out the UN statement. Although still too young to qualify for public pension or other old age benefits, their age may add to their difficulty in finding much-needed employment. Thus, the end result for many elderly exiles is still further

*Barry Robinson is associate editor of Ageing International.

intensification of the loss of status, purpose and self-esteem that to some degree afflicts almost all refugees.

Add to this the tendency of programs which provide services and assistance to older people in most nations to usually be designed with each country's majority population in mind. This, of course, makes them particularly inaccessible for older refugees who may not speak the predominant language or understand the process involved--especially when the program providers neither speak the refugees' language nor understand their needs. Under such circumstances, life for many older refugees is little more than living in limbo while waiting to die.

The Who, What and Where of Life in Transit

Just as there may be some disagreements over the definition of a refugee, as Ken Tout points out elsewhere in this issue, there also appears to be no general agreement about how long a person continues to be considered a refugee. Each country uses its own criteria and, in compiling its statistics, the UNHCR relies on individual governments' estimates and definitions without delineating between the various shades of meaning which may influence their figures. In some countries, refugees retain that status until they become naturalized citizens, while other countries lump them together with all other immigrants. Most of today's estimated 15 million "refugees" are still in the countries of first asylum to which they had fled directly from their homelands, and will remain there awaiting resettlement or repatriation, a transitional status which may last for many years.

There is also no indication of whether those who are considered elderly are recent arrivals or have become so in their country of refuge, and no reliable age breakdown for adult refugees. Some insight may be gathered, however, from the UNHCR, which has pointed out that:

�9 "the elderly make up a much smaller proportion of the total refugee population than that of the national population," and

�9 "the percentage of men among elderly refugees also tends to be somewhat higher than in national populations. As a consequence, the number of men and women among them are reported as almost equal."

With this in mind, the estimated figures in the following list from U.S. News and World Report, based on UNHCR and U.S. Committee for Refugees data, offers at least a selective and superficial overview of who (and how many) the world's refugees are in terms of original nationality and numbers, and where they are now. (The numbers, which are

Ageing International June 1990 11

Photo: UNHCR/I I ISO/A. Eg&er A number of elderly refugees are depressed or mentally disturbed because of their physical condition or social isolation.

not necessarily complete, do not always add up to 15 million, nor to 100% due to unstated categories of "other.")

Afghans, 5.98 million Pakistan, 60% Iran, 39%

Palestinians, 2.34M Jordan, 38% Gaza Strip, 20% West Bank, 17% Lebanon, 13% Syria, 12%

Mozambieans, 1.25M Malawi, 58% South Africa, 16oi0 Zimbabwe, 14%

Ethiopians, 1.04M Sudan, 64% Somalia, 35%

Haitians, nearly 1M United States, 45%0 Dominican Republic, 38%

Sudanese, 355,000 Ethiopia, 99%

Cambodians, 346,221 Thailand, 93%

Bulgarians, 300,000 Turkey, 100%

Salvadorans, 151,600 Mexico, 79%

Vietnamese, 127,587 Hong Kong, 43%

Soviets, 73,000 West Germany, 65% United States, 28%

Niearaguans, 57,600 Costa Rica, 57% Honduras, 40%

As can be seen, the large majority of refugees have moved from one developing country to another. Less than 5%o are located in the more developed nations.

Arousing Awareness and Attention

It is much easier, explains one UNHCR official, to gather data about refugees located in camps especially established to house them than it is to keep track of refugees dispersed throughout the country, perhaps occasionally clustered in local ethnic communities in which they often become less visible.

This might explain why the United States, Canada, Australia, Great Britain and some other European nations do not appear more frequently in the above list although

there are indeed many refugees in their rnidsts, along with considerable concern about their presence and problems. Interestingly, it is in these seemingly overlooked countries (most of which probably fall into the list's "other" category) that much of the global concern about the problems of elderly refugees is being generated, and from which much of what is being learned about this issue--and what is being done to deal with it--is emanating.

While much has been written about the general refugee situation in recent years (enough, in fact, to necessitate the publication of an International Thesaurus of Refugee Terminology in 1989), developments regarding elderly exiles have been somewhat more limited in both scope and number. This may be a reflection perhaps of their relatively small representation within most refugee populations and/or some societies' habitual devaluation of the old. There has, however, been some movement, as reflected in the convening of two conferences on two different continents in 1988--Age in Exile 2 in the Netherlands and New Branches... Distant Roots s in the United States. These meetings and their follow-up activities are helping to shed light on the troubling situations of elderly and aging refugees and what might be done to improve them.

Needs in Search of Responses

"Providers of mainstream services for the elderly usually are unaware of the special needs of this population," declares the New Branches conference report which calls for "sensitizing American medical personnel to the culture of the refugees." The Age in Exile report recommends that "health care professionals should be taught about the effects of refugee experiences, the best teachers being the refugees themselves . . . Basic education in all relevant disciplines should include reference to refugees and cultural variables."

"Next to language, theusual customs and conventions of the host country should be explained to the refugee. He or she may then be spared at least some anguish, some misunderstanding. It works on both sides," advises Inka Nowotna, a Polish exile living in England, who provides this personal illustration in her background paper for Age in Exile:

I remember very well when I started visiting elderly and sick refugees, I was often told that patients were religious maniacs o r sexual maniacs because they always insisted on kissing ladies" hands and crossing themselves at "'inconvenient" moments. I had to explain that in Poland every woman, either married or at least o f a certain age, expected to have her hand kissed and it was the custom to make the sign o f the cross when starting a journey, seeing a church or a roadside shrine. What I considered a remnant o f consciousness and old tradition was taken by the doctors as a sign o f illness/

In general, the two conferences (identified parenthetically after each item quoted from their reports) concurred on the need for:

12 Ageing International June 1990

�9 greater communication, understanding and cooperation between aging organizations and those serving refugees.. .

"Agencies serving refugee elders should work in conjunction with those serving children to develop a holistic strategy for strengthening the family system. Programs that address the needs of elders as vital members of a larger unit help alleviate the intergenerational tension that exists in many refugee families." (NB) "Agencies involved in tracing family members must reinforce their efforts to reunite separated families and enable elderly refugees to complete their lives together with their family." (AE)

�9 refugees having more input in decisions affecting their well-being...

"Those lobbying on behalf of older refugees should urge more consultation with ethnic leaders, refugee service providers and refugee elders themselves in order to determine priority needs, and to insure the adequate level of funding for this growing population." (NB)

�9 making service providers sensitive to refugees" ethnic traditions and preferences, including appropriate use o f native languages in communicating with those not fluent in English. . .

"Meal programs that offer traditional and familiar foods, health services that incorporate traditional herbal treatments within modern clinical settings, and availability of bilingual staff are among the possibilities for preparing mainstream institutions to better deal with growing cultural diversity." (NB) "In health care especially, methods of diagnosis and classification should be in the language of the refugees concerned.. .

"Special care should be taken of elderly refugees who are not likely to learn the language of the host country in their lifetime by: (a) offering courses, events and written material in [the refugees'] mother tongue, and (b) increasing the number of courses for refugee children (third generation) in the mother tongue in order to prevent the isolation and alienation of elderly refugees from their own family members." (AE)

�9 developing innovative approaches to language learning for the use of older refugees and those who would tutor t hem . . .

"Very little is known about what kinds of language skills are really needed by elders or how language is used in refugee households. Those who are illiterate in their native language have yet another obstacle to language learning...because of literacy- based teaching methods." (NB) "The availability of language courses, the length and methods of teaching the language of the host country should be adapted to the individual disposition, cultural and intellectual background of the elderly refugees." (AE)

�9 helping refugees to help themselves... "Self-help groups should always be encouraged

Photo: UNHCR/9202/A. Diamond Some elderly refugees are provided with loans and other assistance for their integration.

and supported. The resources, experience and skills of elderly refugees and exiles must be used effectively." (AE)

Implementing New Initiatives

For elderly refugees and those who assist them, there are always far more problems than there are workable solutions. Approaches which work in one locale with a particular group of refugees might not necessarily be transferable to a different population in another setting.

In many European countries, as well as in England, the United States and Canada, there are loose networks of traditional ethnic immigrant/emigre societies which came into being in the years following World War II or during earlier waves of immigration. Where appropriate, some of these have attempted to respond to the needs of current refugees, but their limited resources are already committed to helping earlier refugees who have now grown old. While it is often difficult for them to obtain additional government funding for efforts involving more recent older refugees, some of the more successful projects tend to involve collaborative undertakings between a host country's aging network and local refugee/ethnic assistance groups.

Acting on the premise that "information is power," the Canadian Cross Cultural Learning Centre in London, Ontario, has developed a series of videos on topics which foreign-born seniors (whether refugees or immigrants) said they need to know about in order to cope with their new lives in Canada. Older members of local Vietnamese, Portuguese, Italian, Laotian and Spanish ethnic communities were surveyed to determine their needs, interests and general quality of life. The resulting videos are available to the local ethnic senior communities in several languages. While the Centre was not originally established with seniors in mind, its staff has become increasingly aware of their needs and of the compounding effect of ethnicity upon aging problems. (Contact: Dr. Jack Lee, Adult and Seniors Health Policy Group, Department of Public Health, Toronto, Canada)

Ageing International June 1990 13

In a similar collaboration in the United States, the Asian Association of Utah was able to nearly triple the number of Asian elders using senior services between 1986 and 1988 while creating a body of bilingual Asian volunteers to carry the project's outreach activities into the future. The project involved Cambodian, Chinese-Cantonese, Chinese- Mandarin, Japanese, Korean, Filipino, Laotian and Vietnamese elderly, and was funded by the federal Administration on Aging. The project hired eight bilingual outreach workers to survey the target populations' needs, established support groups for six of the eight ethnic groups, and trained service providers. (Contact: Mr. Shu H. Cheng, Asian Association of Utah, 28 East 2100 South #102, Salt Lake City, Utah 84115, USA)

Originally founded in 1981 to forge links between Hmong, Lao and American women in Central Minnesota, the Women's Association of Hmong and Lan (WAHL) has since broadened its scope to serve entire refugee families through literacy classes, ethnic meals, support groups, socialization activities and information and referral services. It also provides eiders with an opportunity to share feelings with others who have had similar experiences. (Contact: WAHL, 1544 Tomberlake Road, St. Paul, MN 55117, USA)

Concentrating its efforts on older people with limited knowledge of English, the Respected Elders Program in Tacoma, Washington, stresses the use of bilingual individuals as professional workers, not just as translators. The program also offers cross-cultural training to local service agencies and produces informational brochures in many languages. (Contact: Respected Elders Program, 3817 South M Street, Tacoma, WA 98408, USA)

Sometimes seemingly small strategies can make an immense difference for individuals, especially where language is concerned. For instance, "talking books are much appreciated by people with fading sight, but for [an older person] living in exile these can be of a very special value," explains Velta King, a Latvian exile living in England. "Their grasp of the so-called host country's language is sometimes poor, therefore they cannot follow the radio programmes which for most isolated people means company." Talking books in Latvian are produced in Germany via the Latvian Red Cross, and are available in both Germany and Great Britain. (Contact: Velta King, c/o British Refugee Council, Bondway House, 3/9 Bondway, London SW81SJ, U.K.)

Combining language learning with socialization, Project LEIF (Learning English through Intergenerational Friendship) recruits and trains college students in the Philadelphia area to teach English to older refugees and immigrants from China, Southeast Asia and Latin America on a one-to-one basis. In addition to helping elders avoid becoming socially isolated, the program enables the young students to gain understanding through communication with older people from other cultures. (Contact: Project LEIF, Temple University Institute on Aging, 1601 North Broad Street, Philadelphia, PA 19122, USA)

A major focus of American refugee assistance programs has always been to help the recipients help themselves, and thus become independent. An excellent example is the Older Women's Weaving Program created by the United Cambodian Community in Long Beach, California, with assistance from the American Association for International Aging and funding from the federal government. In addition to utilizing the traditional silk weaving skills of the community's elders to generate income and activities for the elders and the agency, the project also encourages participants to learn English and participate in other community activities. While the elders weave silk fabric of traditional and modem designs, others in the local Cambodian community are responsible for designing and marketing the products. (Contact: Than Pok, Executive Director, United Cambodian Community, Inc., 1432 Atlantic Avenue, Long Beach, CA 90813, USA)

Under the auspices of the New York State Refugee/Entrant Assistance Program (R/EAP), an umbrella project called "Networking Vocational Services for the Older Refugee" has been stimulating the state's aging, refugee and employment organizations to find jobs for older refugees.

Two such R/EAP-funded projects involved efforts by the Rochester Regional Council on Aging and the New York Association for New Americans (NYANA) to train older refugee workers and place them in suitable positions. Both projects found on-the-job training the most promising approach for older refugees. (Contact: Jane Bloom, 12 West Bayberry Road, Glenmont, NY 12077, USA)

Another R/EAP project which has borne a double harvest is New York City's Training Program in Human Services Counseling for Emigr~s which prepares refugees with some proficiency in English for jobs with city social service and government agencies where they act as interpreters and intermediaries, helping their fellow refugees. (Contact: Katherine Schuchman, Director, Training Program in Human Services for Emigr6s, Institute for Child Mental Health, 75 Varick St., 2nd Floor, New York, NY 10013, USA)

Lives Forever Lost In Limbo

For some of yesterday's refugees, the ordeal of exile has become a never-ending one with unexpected ramifications and unsettling implications for those who work at helping today's new refugees adjust and cope.

One example of this may be found in the story of Cambodian refugees who, years ago in their homeland, had watched their husbands and families being slain before their eyes. Now middle-aged and living in the United States, they are "functionally blind," unable to see more than shadows, even though there is no physiological reason for their condition. As a psychologist who is studying the phenomenon told New York Times reporter Alexandra Smith, the worse the horror witnessed or experienced by

14 Ageing International June 1990

these women, "the worse their psychological condition in terms of psychosomatic blindness. It's almost like a see-no- evil kind of thing."

Then, there are the survivors of the Nazi holocaust, living in England, the United States and Israel since the 1940s, who have long been pointed to with justifiable pride as prime examples of how refugees can overcome the horrors of their past and, with appropriate assistance, begin successful new lives in adopted homelands. Once old age is reached, however, problems may arise whose connection to their earlier displacement is not entirely clear. It now appears that Polish members of this cohort presently residing in England are four times more likely to suffer from dementias (including Aizheimer's Disease) than their British peers.

"Particularly tragic," observes Ken Tout (HelpAge International, U.K.), "are the cases where such persons, after apparently happy assimilation into the life of the new nation, regress in their old age to their childhood and even return to speaking only their childhood language in a community where that language may be totally incomprehensible."

At the same time, there are indications that many of the Holocaust survivors who adapted best to life in Israel after World War II did so by essentially "sealing off" their memories of their ordeals. This runs somewhat counter to most conventional psychological theory and practice which maintains that such memories need to be unearthed and purged by recalling traumatic experiences and reliving the emotions generated by them.

According to psychologist Peretz Lavie (Technion-Israel Institute of Technology, Haifa), survivors spent little time thinking about their wartime ordeals and were not interested in discussing them even though, when requested, they could recall those experiences in detail. Thus, the most well- adjusted survivors turned out to be those who had coped best by avoiding unpleasant memories.

"They sealed it off," comments Lavie, "and this enabled them to go on with their lives. This was the mechanism that allowed them to survive and adapt and adjust. It's better to forget it than to year after year expose them to the trauma through therapy."

How this can be applied to the problems of today's younger refugees who are also fleeing from brutal situations in their homelands remains to be seen. It is possible that Lavie has uncovered something that will change the way modern psychology deals with trauma, or it may be a unique response, applicable only to this one group.

At the other extreme, there is Oum Mustapha who has been living in a refugee camp near Beirut, Lebanon since fleeing with her family from her home in Palestine.

"We barely had time to grab the children as we escaped," she told Edward Yeranian of U.S. News & World Report. "I don't remember if we locked the door to the house or not. My husband fetched several donkeys and we headed north to Lebanon. I remember thinking we would be back soon after things quieted down."

That was 40 years ago when she was 40 years old. "Our house was surrounded by orange orchards and a

grove of olive trees," she recalls. "I still remember the taste of the oranges. They were sweet with just a slight sour taste."

Oum Mustapha knows she will probably never see her home again, but she still longs to.

"No one," she says, "ever thought we would spend 40 years as refugees."

Notes

1Just, Ward, Jack Gance: Boston, Houghton Mifflin 1989. ~Convened by the British Refugee Council, Age in Exile was co-sponsored by Help the Aged, the British Red Cross Society, the European Consultation on Refugees and Exiles (ECRE) and Age Concern England. SSponsored by the Refugee Policy Group and the Center for Intergenerational Learning of Temple University's Institute on Aging, New Branches was co-sponsored by the American Association for International Aging, American Association of Retired Persons, National Association of State Units on Aging, New York Association for New Americans, and the University of Maryland in Baltimore's School of Social Work.

Continued from page 10 General relief is often quickly and effectively delivered

by major agencies, including the UNHCR, the U.S. Air Force, and others. However, as many more older people will now live on to a greater age (and UN forecasts clearly indicate that both percentage and gross increases in such numbers will be higher in developing countries than in industrialized countries through and into the new millennium), there are likely to be proportionately many more elderly persons and fewer children within refugee populations.

Opinion leaders such as the International Federation on Ageing and HelpAge International face an uphill struggle in raising elderly refugees' requirements to a priority concern.

More generic organizations must be persuaded to become aware of older persons' needs. Above all, international collaboration is essential for no one organization can handle such emergencies alone.

Such collaboration is feasible. For example, with many refugee camps to service in Sudan, the equally numerous international agencies operating there wisely decided not to operate on the basis of each agency having a presence in each and every camp. Instead, individual agencies and small groups of agencies took the entire responsibility for voluntary action in a particular camp.

The system appeared to work reasonably well. In the course of the discussions it was agreed that the services in the

Continued on page 22

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