A World Living Longer: Global aging is one of the greatest challenges of the century. And this is not just a “Western” problem. Politicians and policy makers around the world are rethinking healthcare networks, urban design, nursing care, and pension systems to prepare for it. The elderly themselves are key players to help turn this from challenge to opportunity.
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War and its problems are never far from Jafar Ghazi’s family.
One recent night, two bodies were found on a street near the Iraqi family’s Baghdad home; just days before, two children from the neighborhood were kidnapped.
But such violence isn’t Mr. Ghazi’s only concern: Living at home is his ailing mother-in-law, whose high medical costs and ever-increasing need of care are a heavy extra burden.
Yet Rasmiya Mohammed, who is 85, is beaming from her bed in the living room, with her 7-year-old grandson Fadl happily sitting by her side. It is a rare harmonious arrangement for older people who are often left behind as they age in war zones in Syria, Iraq, Yemen, and Afghanistan.
Aging can be tough anywhere. But the process is far more complicated in crucibles of conflict where traditional values and support networks are often corrupted by violence, dislocation, hunger, failing economies, and the daily effort to survive.
“Thank God, everyone here loves me and takes care of me,” says Mrs. Mohammed, wiping away a tear. “Many people, when they become very old, become humiliated or insulted by their family, who don’t care. I am lucky.… Even the small boys take care, and kiss me.”
“She is a good omen for us,” says Ghazi, adding that Mohammed reminds him of his own mother, who was killed in a 2010 explosion. “When I see her, it is like a blessing for the house, and good things come to us.”
The Quran explicitly requires wholehearted care of parents as they age, and in Iraq and many other countries in the Middle East such support is a cultural norm as well as a religious obligation, with three generations often living under one roof.
In nations torn apart by war, though, the aged often drop to the bottom of the priority list. Among the million refugees who migrated to Europe in 2015, for example, there were few elderly able to make the perilous journeys. Or, in the case of many Syrian families interviewed by the Monitor, the oldest family members refused to leave their homes, preferring to take their chances in a war zone rather than leave everything behind for an unfamiliar country and uncertain future.
The impact of crisis can be found among the few statistics that exist about those who age in wartime. The Global AgeWatch Index of 2015, for example, which says it “ranks countries according to the social and economic well-being of older people,” places Afghanistan last among 96 countries analyzed. After decades of war, male life expectancy there is just 59.
In the AgeWatch ranking, which is put together by London-based HelpAge International, Iraq does slightly better at 87th, but largely because some 56 percent of the elderly receive a pension, much higher than the regional average.
Social fabric torn
Yet three decades of perennial crisis have ruptured Iraq's social fabric. Professional caregivers say today there are some signs of it mending, but the damage has been acute.
“Because of the wars, people have not thrown out their values, but there is a storm of dust covering all these values,” says Ena’am al-Badri, a sociologist and director of Al-Selaikh Elderly Home, one of only two such state-run homes in Baghdad.
“Many years ago it was a source of pride to care for old people,” says Ms. Badri. “Most Iraqis feel shame if they don’t care about their parents.”
War helped change that. Iraq under former dictator Saddam Hussein suffered war with Iran in the 1980s, and war in 1990 with the US over Kuwait; it weathered more than 20 years of Western sanctions. Then the 2003 American invasion ignited an insurgency; years of sectarian ethnic cleansing; endless suicide attacks; eventually the so-called Islamic State’s occupation of one-third of the country; and today the fight to push IS out.
That chain of events crushed what remained of Iraq’s social cohesion, especially after 2003, says Badri.
“It’s like a knock-out – it affected humanitarian relations between people,” she says. “It makes families kill each other. This was not the case before. These are the ruins of war.”
There are as many different reactions as there are families, however, and not all stories are grim tales of neglect of older Iraqis, as their sons fight and die on Iraq’s battlefields, or struggle with two jobs to support extended families.
'He never said goodbye'
But many stories reflect relentless and monumental social changes.
“The sanctions, the wars, and the violence don’t give us time to educate our sons in good ways,” says Leila Abdul-Hossein Hamza, director of the private Mercy Home for the Elderly. It is a charitable organization with an adjacent orphanage run by Shiite cleric Ayatollah Hussein Ismail al-Sadr.
“The Quran says, ‘With your parents, you have to treat them well,’ because they raised you from a child,” says Ms. Hamza. “But we feel sorry now for what we see. A lot of sons and daughters do not take care of them. Many die, with no one to bury them.”
Elderly homes see many troubled cases, like that of Kadriya Saleh, who at 75 wears the all-black shroud favored by devout Shiite Iraqis and has two daughters and a son.
“I feel shame when I mention my son,” says Ms. Saleh, recounting how he was a translator for US forces, and then left for America in 2005.
“I never heard from him again,” says Saleh. “He never said goodbye. He could have come.” Her daughters do not visit, either.
“They know that Heaven is under the feet of mothers, and should not say, ‘Ooof, I don’t want to care for her,’” adds Saleh. “This [duty] does not exist anymore for my son and daughters.”
She says she now feels cared for and doesn’t “feel like a stranger here – thank God for that.” And if there was no Mercy Home, which provides free care and a bed? Her answer is emphatic: “I would be on the street.”
Low occupancy in state homes
Beyond war, traditional care structures have also been compromised by a change in expectations, caused partly by the overnight arrival in 2003 of the Internet and satellite television – and with them materialistic Western values, says Badri.
“That makes stagnation in the family; it was not step-by-step,” she says. “Social relations 30 years ago were much better than now… Before, there were few people in places like this. Now, it has become a phenomenon.”
But there are other, far more recent improvements to the home, where rooms hold one or two residents and are decorated with everything from plastic flowers to religious sayings.
Prime Minister Hayder al-Abadi has twice visited the home, and there are more visits by school children to learn “how to care for people,” adds Badri. Even graduation parties have been held at the elderly home “to support us. This is a big message for everyone.”
“There are signs of hope. There is a kind of uprising inside people,” says Badri. “There are still many people trying to recover from their wounds, and people started thinking of how to heal society again. So people are rising up to face this.”
Despite the changes brought by war, the number of residents of elderly homes is tiny for a city of 5 million. This state-run home has 38 people but a capacity of 100 – numbers now limited because of a roof leak on the second floor. At Mercy Home, the 16 cameras that deliver a constant split-screen view to the director’s office monitor fewer than 100 residents, despite a capacity for 400.
'We will not let her down'
The bottom line is that, despite all the challenges, most families still care for their elderly members at home, ashamed to send their aging members away, even if there is family friction.
When families do get along, the challenges can still be enormous, as in the case of Jafar Ghazi and his wife, Hanaa. Half her salary as a medical service worker, for example, pays for medicine for her mother.
They are also raising three children – one of whom, Fadl, receives monthly medical care. And Ghazi hurt his shoulder and back five years ago when his mother-in-law was immobile and he had to lift her.
“Even with all the difficulties, we will not let her down,” says Hanaa, nodding toward her mother. “She is above everything; she is our top priority.”
War prevented the family from sending her to a decent doctor, years ago. And sanctions kept them from sending her abroad for treatment.
But the family acknowledges the benefits of her presence as well.
“Despite all the suffering," says Hanaa, "when we just hear her breathing, we feel happy.”