Health needs of older adults displaced to Sudan by war and famine: questioning current targeting practices in health relief.

The high rates of death, disability and illness and the scarcity of resources associated with relief operations for victims of oppression, war and famine have led to some support systems of triage for health and nutritional care in relief. Two vulnerable groups have often been given priority for targeting in health relief--young children and their mothers. This paper reports the findings of a study of the health needs of another vulnerable group, older adults, among those who had been recently displaced to Sudan in 1984-1985 by the war and famine in Tigray region of Ethiopia. The study attempted to determine the extent to which morbidity events and migration affected the life-style of older adults and the socio-economic support mechanisms which were available to them. The findings indicate that older adults (those over 45 years of age) were a very small proportion of the population and that over half of those aged 60 years and over (defined as 'elderly' in this paper) had been left behind in Tigray. This may well indicate that disability, illness or both, forced many older adults, particularly those most in need, to remain in Tigray. Among older adults living in Sudan, high levels of minor disability, social isolation and total economic dependency indicated vulnerability, but older adults had not been specifically considered in health policies and plans. Their primary needs were basic--for cloth, food, shelter, transport, seeds, oxen and farming tools. We conclude that priority in relief should be to support individuals, families and entire communities by adequately providing for basic needs. Furthermore, international relief agencies should give equal consideration to those who remain in their homes and those who migrate for assistance. This approach would take into consideration quality of life, not just the number of lives saved among those who reach the camps and shelters, and would assume responsibility for 'Health for All', not just for selected 'vulnerable groups'.