think differently. humanitarian impacts of the economic crisis in europe

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www.ifrc.org

Saving lives, changing minds.

Think differentlyHumanitarianimpacts of the

economic crisisin Europe
http://www.ifrc.org/http://www.ifrc.org/http://www.ifrc.org/http://www.ifrc.org/


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International Federation of Red Cross

and Red Crescent Societies, Geneva, 2013

Copies o all or part o this study may be made or noncommercial use,

providing the source is acknowledged The IFRC would appreciate re-

ceiving details o its use. Requests or commercial reproduction should

be directed to the IFRC at [email protected].

The opinions and recommendations expressed in this study do not nec-

essarily represent the ofcial policy o the IFRC or o individual National

Red Cross or Red Crescent Societies. The designations and maps used

do not imply the expression o any opinion on the part o the International

Federation or National Societies concerning the legal status o a territory

or o its authorities. All photos used in this study are copyright o the IFRC

unless otherwise indicated. Cover photo: Belgian Red Cross.

For additional copies please contact [email protected]

P.O. Box 303

CH-1211 Geneva 19

Switzerland

Telephone: +41 22 730 4222

Teleax: +41 22 733 0395

E-mail: [email protected]

Web site: www.irc.org

Think differently, Humanitarian impacts of the economic crisis

in Europe 1260300 10/2013 E

Follow us on:

Acknowledgements

The IFRC would like to acknowledge invaluable contributions in terms o responses, stories, photos and cases rom

National Societies in the Europe zone with special thanks to Austria, Belgium, Bulgaria, France, Georgia, Greece, Italy,

Kyrgyzstan, Montenegro, Spain and Sweden.

Additional thanks to members o the National Society Advisory Group, to the Finnish Red Cross who has provided exten-sive support in drating the report and the production o the video In a Better World (included with this publication), and

to the Danish Red Cross, who has assisted obtaining the statistics.

The IFRC would also like to thank the Hungarian Government or the fnancial support to the production o this report.


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International Federation o Red Cross and Red Crescent Societies

Think differenTlyhumataa mpacts o t coomc css euop

Table of contents

Foreword 2

fv as o: fom ba to wos 5

Trend 1. The poor getting poorer 9World reduces poverty - Europe adds to it 9

Spain: down, but not out 11Italy: homelessness becoming a one way street 12

Trend 2. The new poor 19Spiralling down into poverty 19

Montenegro: when the invisible became visible 21Bulgaria: it is worst or the children 22

Trend 3. Wag at 29Cuts can be expensive 29

Georgia: helping elderly out o isolation 33Greece: a patient and a gentleman 35

Trend 4. Mgato a mobt 37Earning money at a price 37

Sweden: Red Cross deends migrants rights 38Moldova: We need ve more years in Italy 42

Trend 5. Umpomt 45Dignity and desperation 45

France: Service Civique opens new doors 46

Belgium: counting every euro 52

dag wt t css 54Iceland: switching into disaster mode 54Serbia: Food, tolerance and sel-help 55Spain: Now more than ever 56

rcommatos a commtmts 59

i a Btt Wo 61

Soucs 62


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Itratioa Fratio of R Cross a R Crsct Socitis

ThInk dIFFeRenTlyHumanitarian impacts of the economic crisis in Europe

Time to think

differently

Creating a sense o predictability and security hastraditionally been attributed to what a society o-ers to its citizens.

Today, as the economic crisis has planted its roots,millions o Europeans live with insecurity, uncer-tain about what the uture holds.

This is one o the worst psychological states omind or human beings and we now see a quietdesperation spreading among Europeans, resultingin depression, resignation and loss o hope or theiruture.

We are also seeing signs o this quiet desperationturning more vocal through demonstrations and vi-olence. We ear that increased xenophobia and the

lack o condence in society being able to providejobs and security may lead to more extreme viewsand actions, with social unrest as a consequence.

In October 2009, the International Federation oRed Cross and Red Crescent Societies (IFRC) pub-lished its rst report on the humanitarian impacto the economic crisis in Europe. At that early stagewe pointed out that while a strong ocus was di-rected towards stabilizing the macroeconomic situ-ation o the continent, too little attention was beingpaid to the humanitarian consequences or the root

causes o the crisis.

At that time, none o us imagined that our yearslater we would still be talking about an economiccrisis. Neither did we expect that this crisis wouldtake a turn or the worse, disproportionally hittingthose who were already vulnerable and also im-pacting new groups o people who had never beenaected beore.

In early 2013, we again conducted a mapping o how52 National Red Cross and Red Crescent Societies inEurope have responded to the crisis. We also asked

about their observations while assisting the peoplebehind the gures, the people most aected.

Through our network, we already knew that thesituation was only getting worse in many countries,however, some o the responses still surprised andshocked us, as they highlighted worrying trendsand challenges.

Increase in ood aid

Compared to 2009, millions more nd themselvesqueuing or ood, unable to buy medicines nor ac-

cess health care. Millions are without a job andmany o those who still have work ace dicultiesto sustain their amilies due to insucient wagesand skyrocketing prices. Many rom the middleclass have spiralled down to poverty. The amount opeople depending on Red Cross ood distributions in22 o the surveyed countries has increased by 75 percent between 2009 and 2012.

The mapping showed us that more people are get-ting poor, the poor are getting poorer and the socialdistance to climb back into mainstream society has

become arther.

We see emerging vulnerable groups o working poorcontacting the Red Cross or Red Crescent or assis-tance at the end o the month, acing the dilemmao buying ood or paying their utility bills with therisk o being cut o i they do not, or evicted i un-able to pay mortgages.

Many National Societies reported the expansion otheir domestic programmes, such as the SpanishRed Cross, who or the rst time ever, launched a na-tional appeal in 2012 to assist people in their own

country. Other National Societies reported that al-though they are trying to do their best, they are seri-ously concerned that they cannot do more to helpall those aected.

For decades to come

The long term consequences o this crisis have yetto surace. This report shows that problems causedwill be elt or decades even i the economy turnsor the better in the near uture.

Unemployment alone is a ticking time-bomb. Aquarter o the 52 countries in the IFRC Europezone are currently displaying catastrophic youth

Forwor


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International Federation of Red Cross and Red Crescent Societies

Foreword

3

unemployment statistics, starting rom one third othe young labour orce to over 60 per cent.

At the other end o the age-scale, according toEurostat, the number o unemployed people in theEuropean Union between 50 and 64 years o age hasincreased rom 2.8 million in 2008 to 4.6 millionin 2012.

Although the Red Cross Red Crescent has not so ar

been extensively involved in employment issues, thepotential personal and social consequences o highunemployment rates are very much a concern or us.

The mapping has showed that some National RedCross and Red Crescent Societies are now involvedin helping the unemployed in dierent ways, rompsychosocial support to the practicalities o lling inorms or social benets, and providing training andadvice to help them return to the labour market.

What has hit us?

The economic crisis might peak at dierent timesin dierent corners o Europe, and some countriesmight be more aected than others, but we wonderi we as a continent really understand what has hitus, and i we are prepared or the situation we ndourselves in today?

We ask this because while we are seeing some newand encouraging initiatives, ve years down the line,we are only beginning to realize that perhaps this isnot yet over, and that although some countries seemto be able to improve their nancial situation, the

humanitarian impacts o the crisis will be elt ormany years to come.

As an organization, we are committed to assistingpeople in both the short and longer term, and we arecontinually reviewing how we can adjust and adaptour assistance to the new and emerging needs, whilestill continuing to assist those who were already inneed beore the crisis.

At the same time, we see a danger in turning millionsinto passive recipients o help; we are committed to

playing a role in preventing this by involving peoplemore actively in nding solutions.

To do this, we all rst need to think in a dierentway and we then must actin a dierent way. Thereis a need or all o us to examine i our societies aregeared to the present situation or how we can adjustby implementing new initiatives, early interventions,better cooperation, and more fexible and holisticapproaches.

Naturally, the Red Cross Red Crescent does nothave all the answers. We have begun the process

o thinking dierently, and in the coming months,we will explore how models developed in someEuropean countries and other parts o the worldmight prove relevant in the ace o the economiccrisis, especially to build and oster people resilience.

We believe that irm and sustained commitmentto eective resilience strategies throughout Europeis urgently needed in order to address the conse-quences o this crisis, i we are to collectively pre-vent it rom turning into a social and moral crisiswith wide-reaching atermaths.

We thereore call on all stakeholders to work to-gether with us to urther capture the breath o thecrisis and to nd new and innovative solutions tothese challenges. There is still hope, but it will takemuch more than bailing out banks and distributingood aid to turn things around.

Anitta UnderlinDirector of Europe Zone


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4

JarkkoMikkonen/FinnishRedCross


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fv as o: fom ba to wos

fv as o:

fom ba to wosDuring the rst hal o 2013, the International Federation o Red Cross and RedCrescent Societies (IFRC) carried out a mapping exercise across the 52 NationalRed Cross and Red Crescent Societies in Europe and Central Asia (IFRC Europezone). 42 National Societies responded and this report is mainly based on theiranswers and observations.

The purpose o the mapping exercise was to get an overview o the challenges

aced now and how National Societies are responding to the crisis. This reportintends to illustrate the human aces o the crisis and highlight the conse-quences at community and grassroots level, where the Red Cross Red Crescenthas a unique insight and connection, and to portray some o the people behindthe gures. In addition we examined trends and have strived to substantiatethese through supporting statistics rom other agencies and sources.

Summary of responses

Almost ve years ater the beginning o the economic crisis, National Red Cross

and Red Crescent Societies continue to report a general rise in needs rom ex-isting as well as rom new vulnerable groups. In many cases, the assistanceto those aected by the crisis has increased, but there are also examples oNational Societies having observed needs but not being able to respond ad-equately, due to lack o resources or capacities. However, it should be noted thatwhile aid and assistance are linked to both needs and resources, they are alsoconnected to promotion/inormation. An increase in people receiving assistanceis thereore not necessarily an expression o growing needs; it may be the resulto increased unding or better inormation. Likewise, a reduction in services orin the number o people receiving help is not necessarily an expression o a de-crease in needs.

A substantial percentage o National Societies report a growing number o people

living below the poverty line and needing assistance, and also a rise in the in-tensity o poverty, whereby those who were already poor are now poorer, as wellas a widening gap between the rich and the poor. This means that those living atthe margins o mainstream society and those who are socially excluded havegrown in their numbers and the distance to re-socialize, rehabilitate, nd a joband re-join society has also increased.

Some National Societies also report the rise o a group o people living above thepoverty line but still having diculties to make ends meet (termed as workingpoor), who are becoming more vulnerable because o scal erosion infationrate (especially energy prices) rising more than salaries or having jobs with nosocial security. Many o these people turn to the Red Cross Red Crescent occa-

sionally or at the end o the month, acing the dilemma o buying ood or payingbills, with the risk o being cut o i they do not or evicted i unable to pay rentor mortgages.

At the heart o the

Italian economy150,000 small and

medium size businesseswere closed leading to

massive amounts onew poverty.

Italian Red Cross


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An additional source o vulnerability in a number o countries is the de-crease in remittances and the related increased burden on the social

welare system due to the return o labour migrants who used tosupport their amilies by working abroad and were orced to

return to their own country ater losing their jobs. Not only dothese migrants return to unemployment, they oten have

no social security either as they do not qualiy or it.

National Societies note that the number orequestsrom migrants has increased and they respond withsupport that ranges rom legal advice to healthcareprovision or undocumented migrants, to home-work support or children.

Other vulnerable groups include those who havelost their job and who are not or no longer entitled

to unemployment benets, as well as single-parentamilies, pensioners, young people neither in educa-tion nor employment, and undocumented migrants.

The consequences o cuts in public health are severelyelt with an increasing number o people coming to Red

Cross or Red Crescent clinics and social centres or treat-ment and nancial assistance to buy medicines. Likewise

the numbers o people with mental health problems andpeople in need o psychosocial support are on the increase.

Many National Societies remark that the economic crisis is

creating the conditions or a widespread social crisis, whereby agrowing gap in the distribution o resources (the rich becoming richer andthe poor becoming poorer) and the competition or shrinking resources couldbring about growing xenophobia, discrimination, social exclusion, as well asabuse and domestic problems.

Overall, many National Societies think that response mechanisms to addressvulnerabilities at country level (including their own) are not ully geared tosupport the new vulnerabilities suracing as a consequence o the crisis northe existing ones, as social benets are cut or need to be shared among morepeople. A number o National Societies have gone or are going through a pro-cess o adaptation and reprioritization, with others mentioning the crisis as aplatorm to consider and discuss their auxiliary role to public authorities in

the humanitarian feld to play an even more vital role in bridging the existinggap between actual needs and national protection systems.

Red Cross Red Crescent action

More than hal o the National Societies report that they have started new so-cial programmes (e.g. distribution o ood, clothing, medication and hygienicproduct distribution, language training or migrants, learning aid or children,nancial support or household expenditures, and support or medical care),or expanded existing programmes, adapting these to the newly identifed

needs and vulnerabilities.

Defnitions

IFRCEureze

National Red Cross and Red

Crescent Societies in 52 countries in

Europe and Central Asia.

EU

The 28 member states o the European

Union. (Most statistics do not include

Croatia, which joined in 2013).

Eurstt

The statistical ofce o the European Union

collecting statistics rom the member states

as well as FYR Macedonia, Iceland, Norway,Switzerland and Turkey. It is clearly indicated

whether the statistics used are or all states

or only or the 27 EU-countries which were

members until Croatia joined in 2013.

Eurze

The economic region ormed by those

member countries o the European

Union that have adopted the euro.

Currently 17 countries use this

currency.


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fv as o: fom ba to wos

However, more than hal also report that the dicult domestic nancial situa-tion has orced them to scale down or suspend existing programmes, and ispreventing them rom initiating new ones to meet the identied needs because oinsucient unding. The situation is sometimes worsened by the increased compe-tition or the limited resources among humanitarian actors (NGOs, charities, etc.).

Please note some National Societies appear in both categories, as they have reduced some

activities but have also started new or expanded existing activities.

There is also a vast increase in the number o people receiving ood aid.

Several National Societies have established activities aimed at tackling the socialconsequences o the crisis and ghting social exclusion by empowering peopleand providing skills or career development (e.g. second-hand shops aimed atsocial cohesion, coaching/mentoring programmes and vocational trainings orthose not in a job and not receiving unemployment benets, debt counselling

centres, application orm counselling, youth shelters).

Individual donations

and volunteering

The unding picture is very mixed. Some o the National Societies in the hardest-hit countries have managed to generate more unds rom individuals and thecorporate sector than they did previously, especially in countries with a traditiono undraising, individual donations and corporate partnerships. Others tell the

opposite story. Likewise, the picture is mixed in terms o the sense o solidarityin society and the increase/decrease o numbers o volunteers.

In addition to workingpoor and elderly with

small pensions, we haveregistered a new group o

persons in need: workingpeople who have notreceived their salaries in

months and months.

Slovenian Red Cross

The most aectedpeople are those who arealready poor: the retired,

the disabled, people livingon social welare.

Romanian Red Cross

The crisisseems to be

reducing the levelo solidarity within

the society.

Austrian RedCross

75 per cent opeople asking or

ood explain doing sobecause otherwise theycould not aord to pay

their rent.

French Red Cross


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T 1. The poor getting poorer

Trend 1: T poo

gttg poo

World reduces poverty

Europe adds to it

Five years ago it would have been unimaginable; so many millions o Europeanslining up or ood in soup kitchens, receiving ood parcels at home or being

reerred to social groceries (shops where they can buy ood at highly reducedprices ater being reerred by social authorities). Former middle class citizensliving in trailers, tents, railway stations or in shelters or the homeless, hesitatingto go to the Red Cross Red Crescent and other organizations to ask or help.

When people do ask or help, it is oten as a last resort. They are asking or oodor medicine, or money to pay or utilities or rent in order not to be evicted romtheir homes. Millions are aected by the worst economic crisis in six decades;a crisis that has seen people lose their jobs and homes, although they neverimagined it could happen; a crisis which has made the poor even poorer.

Crisis was supposed to mean something temporary, a bump on the road that

we would get over. Who would have imagined that it would last so long andhave aect so many so much? There are now more than 18 million people re-ceiving EU-unded ood aid, 43 million who do not get enough to eat each dayand 120 million at risk o poverty in the countries covered by Eurostat. Andwhile we still hope the crisis will end soon, or many it has just begun. Or is

just about to begin.

Halving global poverty by 2015 was an ambitious key component o the UnitedNations (UN) Millennium Development Goals (MDGs). The UNs denition opoverty is living on less than 1.25 US dollars per day, and this goal was alreadyreached in 2010.

In most European countries however, poverty is dened as an income level o less

than 60 per cent o the national median household income. Using this measure,poverty is widespread in Europe. O the 52 countries included in the mapping

Key Findings:

n The crisis has increased the number o people living in poverty.

n The gap between rich and poor is increasing.

n More people are asking or ood aid as well as other kinds o assistance.

n The humanitarian impact o the crisis is being elt well beyond any economic upturn.


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exercise carried out by the IFRC, 34 register double-digit gures as the proportiono poor people in their countries, whilst 9 countries have no data to show.

And it is getting worseThe European Union (EU) statistics agency, Eurostat, has released data on theamount o people at risk o poverty or social exclusion. In 2011, a quarter o EUspopulation was at risk, having increased by 6 million since 2009 to 120 millionin total. Whilst other continents successully reduce poverty, Europe adds to it.

Almost hal o Bulgarias population was at risk in 2011. Seventeen EU coun-tries record more than one-th o their population as poor or excluded. Thisincludes almost one third o the population in the most recent new memberstate, Croatia.

Only seven o the EU countries listed a decreasing percentage, mostly modest.

Romania led a decline o 2.8 per cent but still has 40.3 per cent o its popula-tion at risk.

Remarkably, none o the countries most oten associated with the crisis Spain,Italy and Greece are among the top ve o those with the largest populationat risk o poverty.

Social distance growing

Poverty is on the increase in France, Romania, Spain, Sweden and many othercountries as reported by National Red Cross and Red Crescent Societies throughthe IFRCs mapping exercise carried out in early 2013. Not only are more people

alling into poverty, but the poor are getting poorer, and the sense is that thegaps between the wealthy and the poor are growing. This means that the socialdistance required to climb back into mainstream society is growing.

We are trying toadjust to the newsituation but it isextremely hard tofnd unds.

Croatia Red Cross

100%

fgu 1. People at risk o poverty or social exclusion

Percentage o total population, 2011

49.1%

Bugaa

40.4%

latva

40.3%

romaa

33.4%

ltuaa

32.7%

Coata

Source:Eurostat


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Trend 1:The poor getting poorer

This growing social distance combined with new groups o poor emerging has spurred hal o Europes National Societies to increase their social activitiesor begin new ones. Others are in dialogue with authorities and partners aboutwhat they can and should do.

Even traditionally strong National Societies in countries not severely aectedby the crisis are adapting and changing. For example, Danish Red Cross isnow administering individual grants rom a social und, and LuxembourgRed Cross is running social groceries and considering how to respond to in-creasing youth unemployment gures.

SpaIn:Dw,uttut

Naturally it has become ar more difcult now, says Jose Javier Snchez

Espinosa, the deputy director o the social inclusion department o the SpanishRed Cross, talking about bringing the vulnerable back into mainstream society.

It has always been a big challenge, but almost 50 per cent o the people who take part in our employment

programme managed to fnd a job. That was the fgure or 2009, now we are down to around 30 per cent,

so it has obviously become more difcult. But it is not impossible, he adds.

Spanish Red Cross has maintained its holistic approach to helping people in need, although the number o

people taking part in the social inclusion programme has increased rom 900,000 people in 2008 to more

than 2.4 million in 2012.

We always strive to do more than hand-outs; we try to involve people in fnding solutions or themselves,

getting engaged in training or education or as volunteers to keep them as active citizens, not passive

recipients o aid, Jose Espinosa says.

Beore the crisis we had the

same approach assisting the

poor and the homeless. As the

number o poor has grown

together with the unemployment

fgures we do meet a lot o

scepticism when we conduct

the frst workshops or seminars

or new groups o people. That

is natural, as the situation in the

country has become so serious,

but then we also talk about whatthe options are and the possible

results in a very realistic manner.

The holistic approach or each

person or amily in need o help

is mapped out ater they fll out

a social questionnaire used by

Spanish Red Cross sta and volunteers at the initial meeting. The questionnaire considers all aspects

and issues ood, medicine, housing, schooling, fnances and makes it easier to plan which kind o

assistance that particular amily or person needs.

We also ollow up with everyone who has been assisted annually, and we use the fndings and data to

create our yearly social vulnerability report. Our 2012 report showed that the situation was worse than2011, and again this year reveals the situation continues to worsen, says Jose Espinosa.

SpanishRedCross


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From poverty to exclusion

The mapping also demonstrates that even when a country manages to over-come the worst o the crisis, the eects will be elt or many years to come.Iceland is one such example, where the Red Cross dealt with the situationin disaster mode (see box on p. 54), but is now acing the issue o lack o in-come and devaluation o the currency, while the Red Cross in Latvia, a countrywidely recognized or having overcome the crisis, is still distributing ood to140,000 people, 3.5 times more than in 2009.

French Red Cross reported that people in France are increasingly sliding roma precarious but stable nancial situation, to becoming nancially vulnerable,rom vulnerability to poverty, and rom poverty to exclusion. There seems tobe a general trend o a downhill slide in the underprivileged sectors o Frenchsociety, where 350,000 more people have allen below the poverty line in theyears rom 2008 to 2011. Unortunately, these growing needs are met with re-

duced public unding.

ITaLY:Helessesseciewystreet

We see those who were already poor becoming poorer. Families with children

and just one income fnd themselves in a precarious situation; oten almost all o

their income goes towards rent and utility bill payment, explains Giorgio Bocca,

who works or the Italian Red Cross in Milan on support and social inclusion or

vulnerable people.

I they lose their job, within a very short time they cannot make payments or even the most basic human

needs.

Although much ocus has been placed on the new poor, the Italian Red Cross has seen that ever-growing

numbers o people, who were previously on the margins o society, have been pushed over the edge by the

economic crisis. The number o homeless people is increasing and many are fnding it difcult to purchase

even basic necessities, including ood.

The Italian Red Cross has established our special units in Milan Unit di Strada to work with the

homeless. The teams are especially active during winter, operating rom 9 pm until 1 am, but also during the

warmer summer months. They work together with other organizations as well as the municipal council. All

the people they assist have one thing in common they cannot fnd work.

These Red Cross volunteers are observing that many o those they assist on a regular basis are beginning to

lose hope o returning to a normal lie.

"I came rom Ukraine because in my country, there are no jobs," says Olga, who now sleeps rough in the

centre o Milan. Olga used to work as a hospital care assistant at night, but even temporary jobs are harder

to fnd, she explains.

Cristina Mesturini, one o the long-term volunteers with the street units, has noted the changes.


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Children at risk

Children in poor households are especially vulnerable. Recent studies by Savethe Children UK show that children in poverty are missing out on holidays,school trips, warm winter coats, new shoes or clothes when grown out o oldones, and even on spending time with riends. As many as 12 per cent o parentsinvolved in these studies said that their children regularly have to go withoutone o the daily meals. One in our parents admitted that they themselves skipmeals or are making portions smaller to stretch ood urther.

Poverty can hurt children. They may even blame themselves and eel guilt i theysense that their parents are giving up something or their sake.

Children rom poor amilies are a special concern or many o the NationalSocieties in Europe. Their continued education is supported through homeworkgroups and by providing school meals, as well as trying to increase tolerance and

avoid social exclusion.

Many National Societies organize summer camps or children; due to the crisissome have had to cut down on their activities. Others have increased the numbero such camps, but are still not able to accommodate all those who have beenreerred by social authorities and other organizations.

Non-Italians, whether rom the EU or not,

fnd it difcult here. They come to work,but i they all into poverty, other homeless

people eel they are cheating them out

o work opportunities or even shelter

places, she says.

While poverty has increased, social

services have been reduced. Public

donations o ood and blankets have also

allen sharply. Italian Red Cross has been

doing its best: in Milan, 50,000 people

receive ood aid through the Red Cross

thanks to European unds rice, pasta,

cheese, biscuits, milk and grain however,there are many more also in need.

The elderly are among those worst aected, said Manuela Locatelli, a Red Cross sta worker in east Milan.

They oten cannot aord to buy groceries and are embarrassed to have to go to public canteens in their area.

We meet them in the markets late in the day, trying to buy their groceries with the ew euro they have, or even

collecting letovers rom boxes.

People are trying to reduce spending wherever possible, knowing that the urther they slide into poverty, the

harder it will be to climb back.

Since government social benefts have been cut, the support we provide is essential, says Marco Tozzi, a Red

Cross volunteer who ocuses on more complex social cases. Public services simply cannot respond to the ever-growing needs active citizenship and more social volunteering programmes are just a beginning, he adds.

MicheleNovaga/ItalianRedCross


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Families moving in together

Helping poor children is one o the activities o the Bulgarian Red Cross. In 2012,more than 7,000 children were able to return to or begin education thanksto a programme by the Red Cross providing a ree hot meal to them every day.This programme is run in partnership with a number o other organizations andcontinues to expand.

Spanish Red Cross puts a lot o ocus on maintaining contact with the peoplewho have taken part in their social programme, visiting them at least once ayear and assessing their situation. The publication o a national social vulner-ability report each year is another very useul tool or this assessment. Whatthey have observed in the past ew years is that one o the many impacts olesser known and lesser recognized poverty is amilies moving in together. On re-turn visits to elderly people, Spanish Red Cross volunteers have ound that adultchildren, who had let home, are moving back with their parents, together with

their spouses and their children to save on rent and to share whatever income orpension or benets the amily receive.

In Spain, three-quarters o the amilies assisted by the Red Cross would not beable to cope with a one-o unexpected expense o 600 euro. It has also beennoted that 26.3 per cent o assisted people have less than three protein-richmeals per week, and 43.2 per cent cannot aord heating during winter months.Hal o those assisted by the Spanish Red Cross have been unemployed or morethan two years, 20 per cent or more than our years.

The picture is similar in Greece, where a number o generations rom the sameamily are reported to be living on the reduced meagre pension o one grand-

parent or on the income o one breadwinner only.

Poverty is on the increase, and the poor are getting poorer.

Tab 1. People living below the national poverty line (20082011)

People living below the national poverty line defned as a percentage o the countrys total

population

Cutry 2008 2011

Albaa - -Aorra - -

Arma 27.6 35

Autra1 6.0 5.2

Azrbaja 13.2 7.6

Blaru 6.1 7.3

Blum 14.7 15.3

Boa a Hrzova - -

Bulara 21.4 22.3

Croata 17.3 21.1

Cpru 15.9 14.5

Czch Rpublc 9.0 9.8

We now see

young amilieswith small childrenlooking desperatelyor help.

LithuanianRed Cross


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1 Poverty line deined as 60 per cent o median income as well as 2 o 7 deprivation criteria.

2 New poverty line established rom 2013 as people who over a period o three years have had an income o 50 per cent or less o median income.

3 Break in time series

dmark2 11.8 13.0

etoa 19.5 17.5

Fla 13.6 13.7

Frac 12.7 14.0

gora 8.4 9.2

grma 15.2 15.8

grc 20.1 21.4

Huar 12.4 13.8

icla 10.1 9.2

irla 15.5 15.2

ital 18.7 19.6

Kazakhta 12.1 5.3

Krzta 31.7 36.8Latva 25.6 19.1

Lchtt - -

Lthuaa 20.0 20.0

Luxmbour 13.4 13.6

FyR Macoa 28.7 30.4

Malta 15.0 15.4

Molova 26.4 17.5

Moaco - -

Motro 4.9 9.3

nthrla3 7.5 8.7

norwa 11.4 10.5

Pola 16.9 17.7

Portual 18.5 18.0

Romaa 23.4 22.2

Rua 13.4 12.8

sa Maro - -

srba 6.1 10.0

slovaka 10.9 13.0

slova 12.3 13.6

spa 19.6 21.8

sw 12.3 14.0

swtzrla 16.2 15

Tajkta - -

Turk 17.1 -

Turkmta - -

Ukra 7.1 7.8

Ut Kom 18.7 16.2

Uzbkta - -


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Tab 2. S80/S20 index

The S80/S20 Index describes inequality in income distribution by calculating the rate between

the income o poorest and richest 20 per cent o the population. For example, a rate o 4indicates that the highest paid 20 per cent earns our times more than lowest paid 20 per cent.

Cutry S80/S20Idex.2008 S80/S20Idex.2011

Albaa - -

Aorra - -

Arma 4.5 4.6a

Autra 3.7 3.8

Azrbaja - -

Blaru 4.0 3.8

Blum 4.1 3.9

Boa a Hrzova - -

Bulara 6.5 6.5

Croata 4.5 5.4

Cpru 4.3 4.3

Czch Rpublc 3.4 3.5

dmark 3.6 4.4

etoa 5.0 5.3

Fla 3.8 3.7

Frac 4.4 4.6gora 8.9 9.5a

grma 4.8 4.5

grc 5.9 6.0

Huar 3.6 3.9

icla 3.8 3.3

irla 4.4 4.6

ital 5.1 5.6

Kazakhta 4.2 4.3

Krzta 6.9 5.4

Latva 7.3 6.6b

Lchtt - -

Lthuaa 5.9 5.8

Luxmbour 4.1 4.0

FyR Macoa 9.3 10.0a

Malta 4.2 4.1

Molova 6.0 5.3a

Moaco - -

Motro 4.0 4.2a

nthrla 4.0 3.8norwa 3.7 3.3


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a) Data point rom 2010.

b) Break in time series.

c) Data point rom 2009.

Pola 5.1 5.0

Portual 6.1 5.7

Romaa 7.0 6.2

Rua Frato 6.0 6.5c

sa Maro - -

srba 4.1 4.5a

slovaka 3.4 3.8

slova 3.4 3.5

spa 5.4 6.8

sw 3.5 3.6

swtzrla 5.3 4.5

Tajkta - -

Turk 7.1 7.0Turkmta - -

Ukra 3.9 3.6a

Ut Kom 5.6 5.3

Uzbkta - -

CesareGiana/ItalianRedCross


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T 2. The new poor

Trend 2:

T w poo

Spiralling down into poverty

It was world news and a wake-up call when in 2012, the Spanish Red Cross an-nounced that the money collected during their annual fag day would go helpthose aected by the crisis in Spain. Donations would be used to help the in-creasing number o poor, which has now reached ve million people, the sameas the population o Norway or Scotland.

It was also big news when international media described the increasing numbero Italian middle-class men now living in trailers, institutions or the homelessor on the streets ater divorces, not being able to pay or both child support totheir amilies and or a second home or themselves.

And it was disturbing news when in July 2013, the BBC showed some o the e-ects o the cutbacks in health services in Greece, leaving more work to welare

organizations, charities and volunteers, and the so-called Robin Hood doctors(see trend 3).

However, it is not only in the larger countries o southern Europe where themiddle class eel the eects o this crisis. In act, one o the most surprisingand disturbing results rom the mapping o National Society responses to theeconomic crisis is increased requency o requests rom new groups o poorand vulnerable people across Europe, and how large numbers rom among themiddle class seems to be spiralling into poverty.

Many o the new requests or assistance come rom the working poor, denedas people who work or more than hal o the year and earn less than 60 per

cent o the national median income. For example, 25 per cent o the peoplereceiving social assistance rom the French Red Cross are still in work (or pen-sioners with some income).

Key Findings:

n National Red Cross and Red Crescent Societies report a signifcant number o newpoor ordinary working people who cannot cover all their basic costs at the end o the

month, and who ace the dilemma o buying ood or pay their rent.

n The number o people in the middle-income group continues to all, and with little or

no savings, the number o people at risk o alling below the poverty line continues to

increase.

n National Red Cross and Red Crescent Societies are increasingly responding to domestic

needs, although some report it has become more difcult to raise unds.

During the 90s we didnot really have a middle

class due to the war,

sanctions and other issues.

Ater the war it emerged

and grew, but now with

the economic crisis, the

middle class is suering

and shrinking again.

Ljubomir Miladinovic,Head of InternationalDepartment,The Red Cross of Serbia


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Employment is no longer a reliable guarantee or preventing poverty. In 20118.9 per cent o people with jobs in the EU lived below the poverty line, ac-cording to Eurostat.

The new poor

Other new vulnerable groups range rom divorced and single parents to stu-dents, and amilies with young children, to people who have lost their job, theirsmall or medium-sized companies, and to amilies where only one parent isworking. All o these groups are severely aected by scal erosion infationbeing higher than salary increases.

Many National Societies in the Balkans, as well as France, Italy and Portugalare reporting that a new kind o people are asking or assistance workingamilies who cannot cover all their basic costs, and at the end o the month acea dilemma to buy ood or to pay their rent and utility bills. Even in Germany,

almost 600,000 working people had to ask or additional benets to pay theirbills in August 2012.

This scal erosion is causing serious challenges or many people. Commodityprices are increasing more than salaries, especially or ood and energy. InSpain, energy prices rose by a whopping 50 per cent in the past years.

Shrinking middle class

Although many middle class amilies are managing on a daily basis, they haveno savings, no buer. In Hungary, there are almost 350,000 people without jobsor social benets, and more than 80 per cent o the middle class has no signi-

cant savings to meet unoreseen expenses, according to a recent study on bankaccounts commissioned by PwC Hungary.

In Romania, 20 per cent o the population was classied as middle class in 2008.Today the number is about 10 per cent, the same as in Croatia and Serbia.

A Bertelsmann Foundation study published in December 2012 showed that theGerman middle class dwindled rom 65 per cent o the population in 1997 to 58per cent in 2012. As many as 5.5 million Germans lost their middle-class statusand are now classied as low-income earners. During the same period o time,hal a million new members joined the ranks o high income earners.

Middle-class households are oten vulnerable. Their economy is oten based

on two people being in employment. One or both made redundant can bring aamily to its knees in a matter o weeks, particularly i they do not have savingsat all. Associated with that are oten psychosocial problems (see chapter 3) andloss o social status. National Red Cross and Red Crescent Societies report aboutnew poor who are embarrassed to tell their riends or amilies about their situa-tion, about divorced men who are embarrassed to invite their children to spendtime with them i they live in hostels or trailers. This is a kind o sel-imposedsocial exclusion.

During the banking crisis in Cyprus in early 2013, the local Red Cross experi-enced the awkward situation o people arriving at their oces and distributionpoints in expensive cars asking or help. People who had suddenly lost every-

thing, or at least lost access to whatever was let in their bank accounts, andwere unable to buy ood or pay all o their bills.

There arenew types orequests rombenefciariesregarding payingo monthly bills,or ood aid and orsocial transportationservices or elderlypeople.

PortugueseRed Cross


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Trend 2:The new poor

monTEnEgRo:Whetheiisileeceisile

It is not that they did not exist beore, the homeless. They were there, living

in the streets, barracks, bus stations and tents, but ew knew their numbers or

their names. Montenegro Red Cross and other organizations provided relie and

blankets to them, also ood, clothes and shoes.

We cannot turn a blind eye to human suering and needs, so we provided support to the homeless and

other socially vulnerable people, says Jelena Dubak, Secretary General o Montenegro Red Cross.

However, our activities couldnt be organized or sustainable since ofcially, homelessness did not exist, and

there were no shelters or centres or homeless people. Our help was more on an ad hoc basis wheneveranybody contacted us and asked or it, she adds.

As the economic crisis took root and the homeless people grew in numbers, the government o Montenegro

decided to take action. A number o working groups were established to contribute to a new law, which would

recognize homelessness as an issue and homeless people as a special category o vulnerable people.

Montenegro Red Cross took part in one o the working groups and in May 2013 the new law on social

and child protection was passed. Through this new law, the government committed to provide systematic

support to vulnerable homeless people. There are now plans to build shelters as well as to provide other

types o support.

The role o Montenegro Red Cross has also been clarifed and they are now responsible or providing relie

as well as psychosocial support in the new shelters. Incorporating these new activities in the societys plano action means that capacities in this area will be strengthened.

Azra is one of the new homeless in Montenegro, sleeping in the bus station of the capital Podgorica until the new shelters are established.

Having worked as a teacher for 30 years and having lost her husband, a well-known and respected doctor, she lives on a pension of 160 euro

per month, not enough to rent a place to live. I had a lovely husband and family, and a job I loved. Now, when I am supposed to enjoy the fruits

of my work, I find myself on the streets, she says. Photo: Portal Vijesti.


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bULgaRIa:Itiswrstfrthechildre

My name is Maria Miteva Tenev-Tropolova and I am 47 years old. I have

three adult children from a previous marriage. I married my second husband

in 1993 and we have four children, the youngest one born in 2011.

I have been working as a kindergarten assistant for eight years, but I am currently on maternity leave.

However when I can find work, I clean houses early in the morning at around 5 am, so that I can finish

and take my children to kindergarten and school.

My husband is as an electrician and works whenever there are jobs, but we cannot manage without

my extra income.

We have really felt the crisis during the past two years as prices for rent, food and heating have gone up.

We pay 1,000 Bulgarian lev (500 euro) for our rent and utilities each month, and then there is nothing

left to l ive on. The Bulgarian Red Cross has helped us, and we are very grateful to the director of one

of the social centres, who is a unique woman. She arranged some financial help for us, but she also

gave moral and psychosocial support during a time when our youngest son was very sick and we had

no money. We really needed someone to talk to, it was a such difficult time.

Ivan, our youngest, is now two years old and attends nursery school. Nicola, who is five years old,

goes to kindergarten, Nevena will be in the second grade and Paul will be in fourth next year. Our adult

children left Bulgaria in 2010, when the situation worsened and unemployment rose. They are now in

Italy and completely independent financially. All my children are dream kids wanted and loved.

We somehow cope with the situation thanks to friends donating clothes for our children and so forth,

and I do not like to complain. However, if someone gave us a hand, we would probably leave Bulgaria

the whole fami ly, we would do it.

It is worst for the children. I want them to read books, to play sports and to follow their talents. I do not

expect a lot and I know that holidays are just a distant dream for us, but I do believe one should not

deprive children from reading a good book. There must be more to life than just surviving.

I teach my children not to divide people according to race, religion, status. They should believe in the

good and should have a positive attitude towards all. But it is difficult for them to live among other

children who are not socially weak. I try to give them self-confidence and explain to them that even if

they are socially weak, this does not make them different or worse than others.

I would really like Bulgaria to become a better country to live in. All we need is good health and a job.

I want my children to be educated. Nevena draws very well, she has talent. However, I do not have

the courage to think about the future because when I think and things do not happen as I hope, I get

disappointed.

The Bulgarian Red Cross oers a variety o social activities and social services to people in need

throughout the country. One o the possibilities or many who suer rom the impact o the economic

crisis is to apply or inancial assistance under the Bulgarian Cross charity und. For the last our years

more than 1,100 people have received small grants to support their household and daily needs.

Bulgarian Red Cross is also distributing ood to more than 300,000 people, running a number o social

centres, providing support to elderly and orphans, and organizing a hot meal programme in schools

allowing thousands o children to receive education.


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Systems out o touch?

While both unemployment and social benets can be useul or people duringtemporary crises, they also present dilemmas; in many countries benet sys-tems stem rom a time o almost ull employment and they have not beenadapted to new realities. As such, in order to qualiy or public social benets,citizens must sell whatever they own o value, oten belongings which theyhave saved up or over many years or are even still paying o.

Certain actors increase the risk o poverty or people with income and sala-ries, among them low educational levels, which increases the risk ve-oldcompared to people with higher level o education. Being employed part-time or in a job or less than a year doubles the risk. Young Europeansare more likely to be among the working poor than other age groups.Household characteristics are also very important. Single-parent house-holds are exceptionally exposed to risk, ollowed by other householdswith dependent children, sel-employed people, unpaid amily workers,and migrants.

Even a country less aected by the crisis or with some economic growthcan have pockets o poverty, usually in rural areas. While the economiccrisis has not directly caused these conditions, it has made it more dicult to

reduce the gaps between the rich and the poor.

Increase inunemployment has lednot only to economic

difculties, but also to asense o social exclusion

or many and lack oconfdence in both society

per se and the uture. Thereare growing signs

o xenophobia.

Swedish Red Cross

VasilenaKurtisheva/BulgarianRedCross


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Many countries in Central Asia as well as in central and eastern Europe havelarge rural populations, o which most are small-scale subsistence armers.Small-scale armers are not recorded as unemployed because they work theirown plots o land, however, their income is usually extremely low. In the EU,more than hal o the total population lives in regions dened as rural. Ruralareas produce less in terms o GDP per person than urban areas.

Drainage o young people and migration to cities or abroad in search o betterlie is a wide-spread phenomenon in many deprived rural regions leading todisparities in age and gender imbalances. This disparity exacerbates poverty inareas where it is already present.

Utter poverty is the predicament o many pensioners in both central andeastern Europe and Central Asia. Most o the current pensions in these

countries are paid or a lietime o work in the ormer planned econo-mies, however, they are ar rom sucient to survive.

Grassroots inormation rom National Red Cross and Red CrescentSocieties indicates that the number o borderline poor, peopleslightly above the poverty line who are just about managingtheir nances has grown signicantly in recent years. It does nottake much to push these people below the line.

Romanian

RedCross

The economic crisis has aectedover 70 per cent o the adult

population. There has been masslay-os and a decrease o the averagesalary by 24 per cent accompanied by anincrease in living costs o about 30 per

cent rom 2008 to 2012.

Romanian Red Cross


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Tab 3. Red Cross ood aid distributions in 22 European countries

ntilScieties/Red

Crssriztis2009 2012

Autra R Cro 7,500 150,000

Bla R Cro 38,500 53,000

Brth R Cro 10,000 10,000

Bulara R Cro 234,783 309,206

Cpru R Cro soct - 1,100

etoa R Cro 50,385 94,438

Frch R Cro - 250,000

Huara R Cro* 607,296 264,178itala R Cro* - 378,527

Latva R Cro 39,479 143,385

Lthuaa R Cro soct 101,000 96,000

Luxmbour R Cro - 20,000

Polh R Cro 108,693 90,000

Portuu R Cro 17,233 6,000

R Cro soct of th

Rpublc of Molova13,850 15,524

Romaa R Cro 43,314 117,246

slova R Cro 138,046 150,000spah R Cro 514,355 1,202,440

Th R Cro of srba 100,000 200,000

Th R Cro soct of Boa

a Hrzova

30,000 25,000

Th Rua R Cro 6,500 6,500

R Cro orazato

Koovo

19,540 43,925

Total 2,080,474 3,626,469

nfntilScieties/

RedCrssriztis

distriutifdid

18 22

Icresefr2009t2012 1,545,995

* Figures rom 2011


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* The surprisingly rapid wage growth was due to a combination o actors, some o which aect the statistical average even without actual wage

increases. These eects arise rom job cuts being concentrated in low-paid jobs, while higher-paid jobs remained together with a reduction in

undeclared wages.

The unemployment rate more than doubled rom about 5 per cent o the labour orce in 2008 to over 12 per cent in 2012.

During the crisis, the labour market seems to have adjusted via employment rather than wage cuts. This entails a high social cost.From: ECFIN Country Focus, Vol. 10, Issue 2, June 2013

Cutry CpI,2008

CpI,2011

avergewge,

2008

avergewge,

2011

Permonth

peryer

Currency

CpIchnge,

%,2008-11

Wgechnge,

%,2008-11

austri 107 113.1 43,226 43,555 X USD 5.7 0.8

bulri* 131 143 3,590 4,668 X EUR 9.2 30.0

Frce 106.1 110.1 36,671 38,128 X USD 3.8 4.0

geri 129.4 159.1 535 636 X GEL 23.0 18.9

greece 110.6 122.9 28,878 26,295 X USD 11.1 -8.9

Hury 119 135.1 198,741 222,990 X HUF 13.5 12.2

Itly 107.4 113 33,663 33,517 X USD 5.2 -0.4

Kyryzst 177 237.6 - - 34.2 -

Lti 128.6 145.7 8,409 8,272 X EUR 13.3 -1.6

netherlds 105.4 110.5 46,181 47,056 X USD 4.8 1.9

Russi 136.4 185.4 17,290 23,693 X RUB 35.9 37.0

Seri 100 127.5 45,674 54,532 X RSD 27.5 19.4

Si - - 32,740 34,387 X USD 8.5 5.0

Sweden 107.2 111,1 36,724 37,734 X USD 3.6 2.8

UitedKid 108.5 119.6 45,930 44,743 X USD 10.2 -2.6

Tab 4. Consumer price index and average wages, 2008-2011

Index: 2005=100

The vulnerabilityo the population

has increased due tosignifcant rise in pricesor basic commodities.

IFRC Kosovo ofce

We haveobserved a rapid

decrease in donationsand have had to

cut down on socialactivities.

Czech Red Cross


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National Societies are opening an increasing number of social grocery stores, where people referred by social authorities can buy food and other items at

reduced prices. These stores are often staffed by volunteers. Photo: Belgian Red Cross (FR).


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Trend 3: Weakening health

Trend 3:

Wag at

Cuts can be expensive

How has the economic crisis aected the humanitarian needs in your country?

was one o the questions in the mapping o National Societies responses tothe European economic crisis carried out in early 2013. On Greece, Hellenic RedCross stated:

The current economic crisis has had a serious impact on public health, since it is

connected to malnutrition and unhealthy living conditions, increase in unemploy-

ment, depression, increasing rates o suicides, health problems or children and ado-

lescents, violence, drug addiction, environmental problems, and oten inaccessibility

to health and welare agencies. The signifcant increase in poverty levels and social

exclusion, the reduction in social welare budgets and the transer o responsibility

or health and social care provision rom the state to private organizations, com-

munities and amilies, create challenges to cope with the new circumstances.

The Greek health crisis has been well documented as one o the unintentionalconsequences o the austerity measures and budget cuts. Patients are asked topay cash or their medicines and they must bring their own syringes when ad-mitted to hospitals, and the partly dysunctional public healthcare system hasbecome inaccessible to many citizens.

More than hal o unemployed Greeks no longer have health insurance and manyare now being served by organizations and underground groups o aptly namedRobin Hood doctors, eeling the humanitarian imperative to do something.

According to the Ministry o Health, suicide rates in Greece have grown drasti-cally by as much as 40 per cent between January and May 2011 compared to the

same period in 2010, a ty-year high. Suicide rates among women have morethan doubled. Beore the crisis, Greece was a country with exceptionally ewpeople taking their own lives and there is still a lot o stigma connected with

Key Findings:

n Cuts in public health during times o crisis might cost more in the long run.

n National Red Cross and Red Crescent Societies report an increased need or

psychosocial support to people suering rom depression and other mental health

problems.

n Many people change their behaviour during crisis some reduce spending on health,

some embark on unhealthy liestyles whereas there are also examples o the opposite:

some people begin to live in a healthier way.


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it in orthodox sectors o the society, meaning that it is likely that a number osuicides go unreported. Given that there can be 1520 times as many attemptsas actual suicides, the number o people crying out or help is alarming.

Many European countries aected by the crisis have also seen a rise in thenumber o suicides and suicide attempts since 2008, ater a long period o de-crease. This is a clear sign that the number o people suering rom depressionand other mental health problems is also on the rise.

Several National Societies replied that they have seen a drastic increase inpeople needing psychosocial support as they nd it dicult to cope with thecrisis. Problems arise rom sudden change in lie situation, dignity, social exclu-sion and a eeling o ailure, or uncertainty one o the worst psychologicalstates o mind or a human to be in: when we do not know what will happennext or how we can infuence our situation.

Children o the recession

The IFRC Psychosocial Support Centre has been assisting a number o NationalRed Cross and Red Crescent Societies, providing training kits on general psycho-social support and on lay-counselling. National Society psychosocial support isprovided through daily contact with people aected, during ood distribution, atsocial groceries, in social centres and through clinics and health centres.

Tab 5. Reduction in public spending on health

Countries with a reduction in per capita public spending on health (national currency units),

20082011.

2008 2009 2010 2011

Aorra Aorra Albania Aorra

France Bulgaria Arma Arma

Luxembourg Croata Croata Czch Rpublc

Malta etoa Czch Rpublc Germany

Hungary etoa grcirla Finland irla

Latva grc Netherlands

Lthuaa Iceland Portugal

FYR Macedonia irla Slovakia

Romania Latva spa

San Marino Lthuaa United Kingdom

Montenegro

Slovenia

spa

Source: Calculations based on WHO National Accounts.

Note: Countries shown in bold experienced reduced spending in more than one year.


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The Finnish National Institute or Health and Welare has systematically ol-lowed Finnish children rom the time they were born in 1987 until their 21 st

birthday in 2008. They are reerred to as the children o the recession becauseo the severe economic crisis which Finland went through in the 1990s.

According to the study, one in ve have received psychiatric treatment or con-sumed pharmaceuticals to treat mental disorders, anxiety or abnormal behav-iour. They are also displaying delayed symptoms o the distress o their parentsstruggling to cope with the crash o the Finnish economy twenty years ago.

The study reveals that certain negative actors such as lack o educationas well as problems with mental health or unemployment carry a highrisk o being transmitted rom parents to their children when amilies gothrough extreme diculties in lie.

The recession in the 90s in Finland was dealt through strict measures o

austerity. Exploding unemployment gures and crashing amily nancescollided with a set o deep cutbacks in basic public services. What is hap-pening today in some other European countries mirror Finlands approachto their economic crisis at that time.

Pushing the panic button

Although humanitarian organizations, charities and civil society eel the imper-ative to ll the gaps created when governments cut unding or health or socialwelare, their interventions are very oten ar rom enough. Furthermore, cuttingpublic health is very short-sighted as the costs will be higher in the long run.

Latvia was one o the rst countries to be hit by the crisis in late 2008, and al-though ocially out o the crisis now, the eects are still being elt.

Latvia was truly wobbling on the brink o a cli then and the governmentpushed the panic button. Costs were cut all across the board, health costs in-cluded, says Viktors Jaksons, the President o Latvia Red Cross.

Jaksons is also a ormer minister o health in his country and a long-timemember o the World Health Organisations Executive board.

In 2009 we cut our health budget by 18.9 per cent. The biggest reductions, upto a third, were made to treatment costs. Wages, as well as sta were cut andall planned new operations cancelled. Co-payments by patients shot up with

out-o-pocket payments reaching almost 40 per cent o total costs per patient.This made health services ar too expensive or many, not only the poorest, Dr

Jaksons describes.

Because o the steep salary cuts and work overload, many public health proes-sionals emigrated or joined private clinics, increasing the pressure o those whostayed. In act, so many let public service that despite rising costs to accesshealth care, queues or treatment just grew longer and longer.

With lower salaries and waiting lists fooded with patients, the medical proes-sion lost much o its prestige. Frankly, even the dedication to serve patients wassuering in the midst o all this. Many o the problems arising rom the budget

cuts will be with us or a long time. It will be more challenging to increase lieexpectancy, to decrease mortality and morbidity. Chronic diseases will continueto be an additional burden, Viktors Jaksons says.

Youth seem to be moredivided and there is a

worrying developmento a growing number o

young people with difcultiesfnding additional training or

employment ater fnishingtheir compulsory education.

Finnish Red Cross

LatvianRedCross


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Trust, once lost, is dicult to rebuild. The general publics trust towards publichealth structures was seriously damaged in Latvia. Restoring an adequate poolo medical sta or the country will also take time, eort and reconstruction o

trust between proessionals and the public health system.

Cut the at, not the rest

Latvia and Greece are not the only countries which have cut health budgets. InSpain, budgets have been cut by 14 per cent with devastating eects includingincrease in diseases. Swedish Red Cross reports that although salaries have inact increased, certain vulnerable groups are aected by regulatory changes inhealth care and unemployment insurances, with reduced compensation levelsor limiting the time they can be accessed.

The Body Politics, a book by David Stuckler and Sanjay Basu published in May 2013looks into past and present economic meltdowns and reaches a clear conclusion

based on a wide analysis o data. Economic disasters can aect public health tothe extent that people die as a consequence, but it does not have to be like this.

fgu 2. Odds ratios (OR) or risk o mental illness in people with increasing number

o debts

The data were derived rom a nationally representative sample o 8,600 people living in the United Kingdom. Key sociodemographic variables used or

adjustment were age, ethnicity, marital status, household size, household tenure, education, social class, employment status, urban or rural, and region.

Source: Jenkins et al.

Document reerence: Impact o economic crises on mental health; WHO; 2011.

ORriskofmentalillness

No. of debts

Unadjusted

Adjusted for income

Adjusted for income and key sociodemographic variables

1

1 2 3 4

2

3

4

5

6

7


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According to Stuckler and Basu, evidence rom the Great Depression whichlasted rom 1929 until deep into the 30s, rom the post-communist mortalitycrisis in Russia, and rom the Asian currency crisis in the late 1990s, right up tothe early stages o the current European crisis, all show that i social securitynets operate well and public health costs remain untouched, even the most dra-matic economic crisis will not have signicant negative health eects.

In act, they might even have positive eects. Some studies show the populationo Iceland has improved its health ater the crisis, perhaps due to the act thatast-ood chains let the country, because o soaring prices o imported items

gEoRgIa:Helielderlyutfislti

Low pensions, too little ocus on the situation o the elderly, inadequate health

care something needed to be done. And so Georgia Red Cross established its

frst social day care centre or the elderly in Kutaisi in 2005.

It quickly became a success as it not only provided medical and ood aid to some o the elderly in the

district but also engaged them in helping each other to pay utility bills, in house cleaning and gardening. In

addition, dierent social clubs were established or singing and playing, and or handicrat and other small

income generating activities.

The concept o social day care centres or the elderly soon spread, frst to the capital Tbilisi, then to other

regions o the country, and today Georgia Red Cross runs twelve centres in dierent regions. From being

a donor-unded activity in one place, it is now an activity integrated in Georgia Red Cross, and it is so

popular that local authorities have begun supporting the centres by accommodating them or supporting

activities fnancially.

There are more than 700,000 elderly people in Georgia.According to the Social Assistance and Employment State

Agency (SAESA) only two thirds o the elderly are eligible

or social assistance. However, even many o those eligible

do not have access to this assistance, due to demands or

inormal payments, high prices o medicines and denial in

provision o services or disrespectul treatment by medical

sta. In addition, elderly people meet challenges such as

social isolation due to poverty and changes o amily traditions

and patterns.

Despite the difcult situation or elderly people in Georgia, their

problems are given low priority in the local social strategies

and only ew local organizations represent, advocate or andmobilize local support or elderly people. The social day care

centres help putting more ocus on the plight and situation o

the elderly.

One day Mr Ivan Gogshelidzes neighbour told him about the social day care centre

in Tbilisi and encouraged him to come along. Mr Ivan had been working as a director

of a public school for years but had been forced to leave due to staff cuts caused

by the economic crisis. A redundancy which not only caused financial problems, but

also made him feel worthless to society.

Mr Ivan decided to give the social day care centre a try and felt comfortable from day

one. He soon began to teach young volunteers how to play Fanduri, a traditional

Georgian music instrument, and was inspired to craft by hand a number of new mu-

sical instruments. He soon became a choir leader, and a history teacher for children

from socially vulnerable families.

When he fell ill, his students would visit him regularly, and when he was ready to go back to the centre, the youths would take turns to escort himduring the harsh winter making sure he would not fall. He wanted to go there as he feels he is fulfilling a purpose in life. (Photo: Georgia Red Cross).


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such as tomatoes and onions. Instead, home cooking had a revival, especiallyeating sh, thereby also supporting local industry.

The evidence rom the same crises also shows that when social nets are slashedand public health costs cut, immediate threats to human health appear, as wellas a build-up towards long-term negative health outcomes.

The IFRC believes drastic cuts in public health and social welare should beavoided. Whereas all systems can be streamlined and made more eective, se-

rious budget cuts in health are not advisable during times when mental healthproblems are on the increase and people might consider saving on private costsor health. Public health should be exempt rom budget cuts as savings wouldcreate more problems and cost more in the long run.

Prevention is still better and cheaper than treatment and cure, and the IFRCstrongly supports the WHO call or health systems to move towards universalcoverage, dened as access to adequate healthcare or all at an aordable price.

National Red Cross and Red Crescent Societies can work as auxiliaries to thepublic authorities in the humanitarian eld and together with other organizationsto ll gaps, but this is only done ater close dialogue with authorities and whenroles and responsibilities and nances are clearly dened. The overall responsi-

bility o providing and ensuring health services still lies with the governments.

RebeccaShirinJafari


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Loss o trust in health services specically, and in authorities more generally,is one aspect o the budget cuts; the behavioural change o individual citizensis another. When we lose our jobs and money, trust and belie, we are at risk obecoming more inactive physically and eating unhealthily, more prone to drugand alcohol abuse and we tend to isolate ourselves socially.

gREECE:atietdetle

The story o Mr Konstantinos, a 60 year old Greek man, is the story o the

countrys crisis and o one person receiving the Hellenic Red Cross support in

his time o need.

Ater the hospital had diagnosed Mr Konstantinos with a severe inection on his lower let leg, he contacted

the nursing department o the Red Cross to receive ree medical treatment as he was not able to pay or

any private or even public hospital services in Athens.

His inection was severe and needed special cleaning and expensive medicine. Additionally he needed an

angiology expert to attend to him and this was made possible through the Hellenic Red Cross nursing service.

Mr Konstantinos began his visits to the nursing department in late April, and day-by-day he got to know the

Red Cross nurses and volunteers better. He also impressed them with his politeness and personality, they

described him as a true gentleman going through a difcult situation. The nurses ound out that he was a

ormerly well-known and highly respected businessman, a manuacturer o leather goods.

For weeks Mr Konstantinos declined the oer rom the nurses to come to his house to provide home

medical service, which surprised them, given his age and the condition his leg was in. However, in June

he fnally told the nurses, that he had reused their oers and sidestepped questions about his address

because he was in act homeless, and had been or the past year.

He had lost everything: income, housing, car, even his public health insurance papers, since he no longer

had the ability to pay health insurance ees.

His fnal visit to the Hellenic Red Cross nursing services was to be in July, as the recovery o his leg

inection was tremendous. However, it was only his last medical visit, because even ater his treatment was

completed, he continues to pop in at the health station or a chat with the nurses and volunteers who have

now become his good riends.

The Hellenic Red Cross is one o the

organizations now oering ree health

services to the most vulnerable at their

three health stations in various parts othe country. In 2012, the main priorities

o the nursing department were the

reduction o child mortality and the

improvement o maternal health.

Last year more than 6,300 children were

examined by Red Cross paediatricians

and almost 1,000 mothers contacted

the health stations or received home

visits. As many as 3,500 children o

vulnerable and unemployed amilies

were vaccinated against a number o

diseases and more than 3,000 studentswere tested or TB.HellenicRedCross


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Trend 4: Migration and mobility

37

Trend 4: Mgato

a mobt

Earning money at a price

Gulby Dondova smiles most o the time. Her house in the outskirts oKyrgyzstans capital Bishkek is small and crowded with three children and herdaughter-in-law also living there. Her three adult sons are migrants, living inRussia and Kazakhstan, where hundreds o thousands o Kyrgyz people try tond work to send money back home.

Gulby stays in close contact with her three sons by skyping them once a weekrom the internet ca some kilometres away. She also has enough energy tovolunteer with the Red Crescent Society o Kyrgyzstan, assisting migrants.

However, not everybody is as resourceul as Gulby and her amily. Thousands omigrants ace problems being cheated by employers or syndicates, or getting on

the wrong side o the authorities simply because they are not ully aware o therules and the laws in the country they travel to.

National Red Cross and Red Crescent Societies work closely together to assistmigrants beore they leave home, while they are abroad, and when they return.An EU-unded programme in Central Asia provides training and support to thou-sands o migrants rom Kyrgyzstan, Tajikistan and Uzbekistan taking up work inKazakhstan and Russia, and all the National Societies in the Commonwealth oIndependent States (CIS) are now cooperating to nd common approaches, advo-cate on behal o migrants and share materials and experiences.

Labour migration has become the major response to the social, demographic

and economic challenges and survival strategy or the majority o amilies inCentral Asia and Southern Caucasus region. Lack o competitive and reasonableemployment opportunities in domestic labour markets and growing poverty in

Key Findings:

n All across Europe, National Red Cross and Red Crescent Societies are involved inassisting migrants and asylum seekers, be it advocating or their rights and dignity,

helping them to integrate into host communities or providing services which are not

otherwise available.

n A number o National Societies are reporting that the public stance on migrants has

toughened during the economic crisis and that implementation o already existing laws

is problematic.

n Falling levels o overseas remittance is a serious problem, not only or individuals and

amilies but also or communities and countries.


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countries like Kyrgyzstan and Tajikistan on one side, and growing economies oKazakhstan and Russia on the other side, are the main push and pull actors oreconomically motivated migration within the region.

In Russia alone around 12 to 14 million people 10 per cent o the population are migrants, the majority o them rom neighbouring countries. Whereaspolicies and laws are in place to help migrants, it is oten the implementation othe laws that present a problem; i.e. migrants have the right to health care, butthere are numerous examples o migrants receiving insucient health care orbeing denied it entirely.

SWEDEn:RedCrssdefedsirtsrihts

When a Latin American woman holding a permanent residence permit inSweden recently visited her home country she was shocked to see the

state o her diabetic mother. Not only did she appear undernourished, she

also had ulcers on her legs; a sure sign o inadequate care. The daughter was

let with no choice but to take her mother back with her to Sweden to make sure

that she was well cared or.

This story is one example o how someone would come to Sweden and stay without a residence permit.

According to estimates, Sweden is currently hosting 35,000 undocumented migrants.

There are many other stories and reasons, some are rejected asylum seekers who have decided to go

underground. Many enter the country illicitly to escape danger, or are in search or a job and a better lie.

Lacking other options, some use human traicking networks to get there.

In most countries, undocumented migrants are outlaws without any rights. In Sweden, the Red Cross is

one o the most vocal civil society players ighting to ensure some basic humanitarian rights.

For the Red Cross, it is clear that all people must have access to healthcare on equal terms. Through our

daily work, we see how children and adults are suering unnecessarily because oten they cannot access

the treatment and care they need, says Ingela Holmertz, Swedish Red Cross National Director.

Access to healthcare cannot be a tool to control migration. Access to healthcare is a human right, she

adds.

In parallel with providing healthcare and other services, raising awareness and advocating or a change

in legislation has been a major goal or the Red Cross in Sweden. One result has been that a new law

introduced on 1 July 2013 now assures undocumented migrants the same legal rights as asylum seekers,such as access to subsidized healthcare that cannot be deerred.

The Swedish Red Cross welcomes the new law as a step in the right direction, but emphasizes that all

people in Sweden should have equal access to healthcare, Ingela Holmertz says.

Even with the change o law, Swedish Red Cross still deals with situations where undocumented migrants

have been denied the treatment they are entitled to. This illustrates another challenge concerned

authorities need to adapt their regulations and routines to provide equal and proper treatment, Ingela

Holmertz explains.

As a result o the economic crisis in Europe, in addition to the 35,000 undocumented migrants, Sweden

has received a large number o people rom across the EU looking or work. Unortunately, many o them

end up living on the streets and without means to support themselves. Large numbers o them also acethe same challenges as undocumented migrants and come to the Red Cross or help and advice.


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Trend 4: Migration and mobility

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Tougher stance

All across Europe, National Red Cross and Red Crescent Societies are involvedin assisting migrants and asylum seekers, be it advocating or their rights anddignity, helping them to integrate into host communities or providing serviceswhich are not otherwise available, such as help with homework or unaccompa-nied minors or running health clinics or undocumented migrants.

A number o National Societies are reporting that the public stance on migrantshas toughened during the economic crisis, among them the Austrian Red Cross,which states that:

The government, together with EU governments and EU agencies is strongly

supporting the tendency to externalize the EU asylum system and thereby they

are trying to keep migrants (among them potential asylum seekers) outside the

EU territory. Revisions o the asylum code usually bring tougher measures or

asylum seekers and more obstacles or amily reunions. In general terms the eco-nomic crisis seems to be reducing the level o solidarity within society.

think differently. humanitarian impacts of the economic crisis in europe

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