This blog reflects on COVID-19 related risks that elderly people face in South Sudan and provides recommendations on how to protect them in more conflict sensitive ways. Unlike many Western countries, where some elderly people reside in care homes or on their own, in South Sudan older people usually live within their family households. As such they are looked after by their children, usually their sons and daughters-in-law, and sometimes daughters. Being with the family has advantages that come with living in closer proximity to loved ones, children and grandchildren, but, in the current context, particularly in large households, regular contact with the rest of family members can put elderly people at risk of contracting the virus.

Elderly people are more vulnerable

The recent substantial increase in the number of deaths has been noted by many, with anecdotal evidence suggests that this is at an unprecedented scale, especially amongst elderly people in Juba. Although many of the deaths are likely to be as a direct consequence of contracting COVID-19, as the elderly are among the most vulnerable, particularly those with pre-existing conditions, some deaths may occur due to the secondary implications of the pandemic. For example, some ailing elderly who suffer from different chronic diseases have been unable to travel abroad to seek treatments due to the border closure; thus compounding their vulnerability to existing health conditions. As the virus continues to spread across the country, overwhelming the existing weak health systems, the likelihood of an increased mortality rate of older people also increases according to global trajectories. So, the question is how can elderly people be protected against not only the spread, but also the secondary impacts, of COVID-19?

In other countries, shielding of vulnerable people has formed a key part of a national COVID-19 response. However, in South Sudan there has been poor uptake of shielding and other social distancing measures meant to restrict disease transmission, alongside poor public understanding of the risks due to misinformation and inadequately targeted communications. Aid agencies need to ensure that their responses are informed by a good understanding of the cultural context, in this case specifically with regards to the experience of elderly people in society.

Care of the elderly and conflict

How elderly people ought to be treated and looked after has frequently been a cause of conflict between their children, well before the outbreak of COVID-19 in South Sudan. These conflicts are partly brought about by societal expectations that oblige children to take good care of their elderly relatives, particularly parents. Children who fail to do so are regarded as social outcasts. In some cases, if an elderly person dies when in the care of one of their children, this can lead to tension as they are accused of negligence – the risk of this may be heightened due to COVID-19. The elderly are said to possess spiritual power, either to bless or curse those who don’t look after them well. These factors create competition between children, with some elderly people being moved from one child’s house to another. This competition can occur because every child wants to fulfill their societal obligations, but also to receive their relative’s blessing. In some instances, this competition can lead to open conflict between children and with their families.

Aid actors can be unintentionally implicated in these conflicts. For instance, when an agency is targeting elderly beneficiaries, this can create additional incentives for some children to ensure that elderly relatives remain in their care, so as to enable them to access additional assistance from those agencies. Additionally, after the delivery of food or cash, there is the possibility that some children may accuse those who are receiving assistance on behalf of their older people of mismanagement of this assistance, as observed in prior incidents.

The elderly play a key role in tying the family and the society together as a whole. They occupy core positions as heads of households with power to make major decisions that affect every member of society, from marital issues to assets keeping and the like. They are also often regarded as the custodians of culture and knowledge for the family and clans on conflict resolution, with chiefs falling into this demographic bracket, as expanded upon in Dr Martina Santschi’s blog ‘Crucial, but vulnerable: The role of Chiefs in COVID response and conflict resolution’. With the low literacy rate in the country, they serve as “living archives” whose views and experiences are regularly sought and consulted. As such, their demise is likely be a big loss not only to their families, but also society because of their expertise in conflict resolution as well as because of their archival knowledge.

Recommendations

Since 2013, South Sudan has remained unstable because of the recurrent conflict in the country, putting the lives of many people in danger. Specifically, the elderly and people with disabilities face disproportionate risks. Being unable to move swiftly during conflict, the elderly and people with disabilities can face violence and death. Also, during displacement, the elderly face a range of challenges compared to the rest of the population, including limited access to health services. Lastly, since COVID-19 will likely hit the elderly and those with existing health conditions the hardest, so it becomes only more essential that their views and experiences should strongly inform COVID-19 response strategies. Recommendations are as follows:

1. As individuals vested with expertise in conflict resolutions whose words are highly trusted, elderly people should be prioritised by agencies designing COVID-19 response. However, and in spite of their reliance on aid, historically the elderly are often not consulted in programme design, project feedback or greater relief objectives. Messaging should be inclusive, accessible and tailored to the needs of specific groups, including the elderly and those with disabilities – this includes the messages themselves and how they are disseminated. With the onset of COVID-19, a guide has been developed to ensure information dissemination is inclusive. South Sudanese NGOs and CSOs (including those listed in the guide) can play a key role in ensuring that responses are based on an in depth understanding of context.
2. Although some agencies target them in their selection criteria, some elderly people might be missed out because they’re not physically present, less able to move around and less visible in society. Also, given the strong societal obligations for individuals to look after their elderly people, they might not be mentioned by their caretakers as needing assistance. As such, agencies should ensure that their support to households take into consideration the needs and conditions of the elderly.
3. To avoid inadvertent interference in family relationships, agencies should understand the context and ensure that they don’t exacerbate the tensions over the care of the elderly. For example, it will normally be better to not take a position on where they should live, especially during the delivery of humanitarian responses. Rather agencies should find ways to enhance social relationships between individuals or groups responsible for looking after the elderly people. Thus, agencies should be guided by conflict-sensitivity during COVID-19 response.
4. As delivery of humanitarian assistance requires people to come in person, this may mean forcing elderly from shielding to line up to receive much-needed assistance. Although agencies have developed a guide to ensure social distancing during relief distribution, they should provide extra protection to the elderly through ensuring that they are not exposed to risk of contracting COVID-19 in the process of consultations or during delivery of humanitarian assistance. To avoid the spread of the disease, agencies, for example, are asked to follow COVID-19 food distribution standards.