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Vulnerable populations and fragile settings

Name of documentReference to older peopleLast updated
Public health and social measures for COVID-19 preparedness and response in low capacity and humanitarian settings- Link the community heath workforce with trained and engaged community level social service and protection actors to help identify and address risks to vulnerable populations (including single parent households, children, older people, homeless people, those affected by violence etc.) and support referral pathways for multi-sectoral support.
- Existing collective accommodations for older people should be monitored closely for potential cases and staff working in these accommodations need to fully comply with the required IPC measures. Additional placement of individuals at high risk of poor outcomes in a separate facility or location should be avoided. The risk of introduction of the virus into such facilities is most likely unmanageable, as shown by experience in high resource settings. This measure is also most likely unsustainable in the long run given available resources, which should be prioritized for critical measures that are known to be working
- Modalities of isolation and treatment should be voluntary to minimize avoidance and consider greater protections or alternative measures for those who are at highest risk of poor outcomes if infected, including older caregivers or individuals with underlying health conditions
Key special considerations for inclusion in national and local COVID-19 readiness and response operations:
- Make provisions so that essential informal services such as food selling, provision of water, hygienic articles, care for children, persons with disabilities, older persons, and those with illnesses, can be sustained in the safest possible way, including during lock down
- Monitor the protection needs of pregnant women, gender-based violence survivors, indigenous people, refugees, migrants, internally displaced persons, people with disabilities and older people
7 May 2020
Preparedness, prevention and control of coronavirus disease (COVID-19) for refugees and migrants in non-camp settingsGuiding principles
- Health systems should aim to deliver culturally, linguistically and child-, gender- and age-responsive COVID-19 services that are accessible to all populations. Refugees and migrants are particularly vulnerable to public health risks and some of them may need special service provisions. These include provisions for people with underlying conditions and/or disabilities, the elderly, people experiencing sexual violence, abuse and exploitation and other forms of gender-based violence, as well as unaccompanied or separated children, as well as people in detention
Surveillance, case investigation and management, and infection control
- Include refugees and migrants in COVID-19 surveillance and health information systems. New cases of COVID-19 infection should be rapidly detected and reported, and the resulting data should be disaggregated by age and gender.
17 Apr 2020
Scaling up COVID-19 Outbreak Readiness and Response in Camps and Camp Based Settings (jointly developed by IASC / IFRC / IOM / UNHCR / WHO)No specific reference to older people17 Mar 2020
COVID-19: How to include marginalized and vulnerable people in risk communication and community engagementWhy include a protection, gender, and inclusion lens in risk communication and community engagement?
- Women, the elderly, adolescents, youth, and children, persons with disabilities, indigenous populations, refugees, migrants, and minorities experience the highest degree of socio-economic marginalization. Marginalized people become even more vulnerable in emergencies. This is due to factors such as their lack of access to effective surveillance and early-warning systems, and health services. The COVID-19 outbreak is predicted to have significant impacts on various sectors. The populations most at risk are those that:
• depend heavily on the informal economy;
• occupy areas prone to shocks;
• have inadequate access to social services or political influence;
• have limited capacities and opportunities to cope and adapt and;
• limited or no access to technologies.
- By understanding these issues, we can support the capacity of vulnerable populations in emergencies. We can give them priority assistance, and engage them in decision-making processes for response, recovery, preparedness, and risk reduction.
What have we learned about protection, gender, inclusion, and risk communication and community engagement in other epidemics?
- As primary caregivers to children, the elderly, and the ill, we must recognize and engage women in risk communication and community engagement.
Populations at disproportionate risk in public health emergencies, and key implications for risk communication and community engagement
- Women and girls
• Women make up large parts of the health workforce.
• Most primary caregivers to the ill are women.
• Women are more likely to be engaged in the informal sector and be hardest hit economically by COVID-19.
• Women experience increased risks of gender-based violence, including sexual exploitation.
• Cultural factors may exclude women from decision-making spaces and restrict their access to information on outbreaks and availability of services.
• In some cultural contexts, gender roles may dictate women cannot obtain health services independently or from male service providers.
• RCCE actions to include this group:
• Ensure that community engagement teams are gender-balanced and promote women’s leadership within these.
• Provide specific advice for people - usually women - who care for children, the elderly and other vulnerable groups in quarantine, and who may not be able to avoid close contact.
• Design online and in-person surveys and other engagement activities so that women in unpaid care work can participate.
• Take into account provisions for childcare, transport, and safety for any in-person community engagement activities.
• Ensure frontline medical personnel are gender-balanced and health facilities are culturally and gender sensitive.
- The elderly
• The evidence for COVID-19 shows they are the most vulnerable group with higher fatality rate.
• Not always able to go to the health services or the services provided are not adequate for elderly.
• May have difficulty caring for themselves and depend on family or caregivers. This can become more challenging in emergencies.
• May not understand the information/ messages provided or be unable to follow the instructions.
• Elderly in assisted-living facilities live close to each other and social distancing can be difficult.
• RCCE actions to include this group:
• Tailor messages and make them actionable for particular living conditions (including assisted living facilities), and health status.
• Engage the elderly to address their specific feedback. Develop specific messages to explain the risk for elderly and how to care for them, especially in homecare
• Target family members, health care providers and caregivers.
Q&A: Older people and COVID-19 May 2020
COVID-19 and Violence Against Older People- Violence against older people – which includes physical, psychological, and sexual violence, financial abuse, and neglect – can have devastating physical and mental health consequences for older people and can even lead to death.
- Violence against older people, who are already bearing the brunt of this pandemic, has risen sharply since the beginning of the COVID-19 pandemic and imposition of lockdown measures.
- Violence is occurring in homes, in institutions such as long-term care facilities, and online, with a surge in scams directed at older people.
- Lockdown and “stay-at-home” orders, likely to last longer for older people, exacerbate those factors which put older people at particular risk of violence – social isolation and loneliness, mental health problems (depression and anxiety), financial dependency of caregivers on older people, dependency of older people on caregivers, and alcohol and substance use in caregivers. COVID-19 has led to staff reductions in longterm care facilities, due to illness or selfisolation, and the suspension of family visits, increasing the isolation of residents and the already high risk of violence.
- Ageism - the stereotyping, prejudice and discrimination towards people because of their age - pervasive before the pandemic and a risk factor for violence against older people, has worsened during this pandemic. For those women already in abusive situations, gender inequalities and prolonged exposure to their abusers increases the risks of genderbased violence against older women.
What can be done to address violence against older people during the COVID-19 response
- Governments and policy makers should:
• Create awareness of increased risk of violence against older people in the public and provide information via radio, TV, print media, and the internet on how victims can seek help and receive support safely.
• Work with essential services such as grocery stores or pharmacies to display information about violence, existing services, and reporting mechanisms.
• Maintain national helplines for violence against older people or, where they don’t exist, seek to extend helplines for violence against women and/or against children to cover violence against older people.
• Where movement is restricted, allow older people to leave their place of residence in the case of violence.
• Alert older people and trusted others to the main types of financial scams being perpetrated and provide information on how to avoid them and what to do if targeted e.g. putting phone down/deleting emails or seeking advice from a trusted other before responding.
• Collaborate with other sectors to address violence against older people, such as criminal justice, health, and social services by setting up virtual multidisciplinary teams that can provide coordinated consistent support.
• Increase awareness of violence against older people among community workers and volunteers dealing with COVID-19 and train them to identify and respond to it.
- Health care and COVID-19 testing facilities should:
• Provide information about local services (e.g. helplines, counselling services, adult protective services) for victims of violence against older people, including opening hours, contact details, whether available remotely, and referral pathways.
- Health providers and social services should:
• Watch for/be alert to objective signs of elder abuse.
• Provide information, support and, if possible, respite care to caregivers, particularly those caring for older people with dementia, including about how to manage stress, to reduce the likelihood of violence.
• Be aware of the risks and health consequences of violence against older people and offer support and medical treatment to those who disclose violence.
- Residential and nursing facilities for older people should:
• Be more closely monitored by relevant authorities; facilitate residents’ contact with family and friends by phone, internet, or via written messages if access is restricted; review staffing procedures (e.g. flexible schedules, work breaks) to better manage the burden of care; and seek to prevent the use of physical restraints.
• Provide guidance and a checklist to help family members and older adults to make decisions about whether to leave residential and nursing facilities.
- Community members should:
• Keep in touch and encourage others (family members, friends, neighbours) to keep in touch with older people online or by ‘phone to reduce social isolation and to provide support safely to those subjected to violence.
- Older people experiencing violence may:
• Find it helpful to reach out to supportive family and friends, obtain support from a helpline (including how to access emergency services), or seek out local services for victims.
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