Healthcare rights and needs of older people in humanitarian crises

Abstract

Humanitarian crises caused by conflict, environmental disaster, food insecurity, severe malnutrition, and disease outbreaks are projected to become more complex and protracted. These crises disproportionately affect older adults, who may have pre-existing health issues, limited physical functioning, and reduced access to services. The limited understanding of healthcare needs of older adults (50 years and older) in humanitarian crises negatively impacts the appropriateness of the healthcare services available to them. This thesis aims to contribute to a better understanding of these healthcare needs and to identify clear recommendations towards age-inclusive humanitarian health responses. This thesis highlights efforts to raise awareness of this exclusion through published opinion pieces and proposes a framework illustrating how ageism and intersecting forms of oppression contribute to the marginalization of older adults in humanitarian planning, response, and recovery. A systematic review revealed critical knowledge gaps related to the healthcare needs of older people, in areas such as communicable diseases, cancer, neurocognitive disorders, sexual and reproductive health, and nutrition. The empirical evidence presented in this thesis includes routine data collected by Médecins sans Frontières Operational Center Amsterdam (MSF) between 2019 and 2025 across hospitals, mental health services and sexual violence services in humanitarian crises. First, we present data from MSF-supported hospitals from 10 countries (n=149,483), which revealed that older adults were more frequently admitted for chronic respiratory diseases, cardiovascular events, and respiratory tract infections, with notable gender disparities, e.g. older women had higher odds of being admitted for complications of noncommunicable diseases. Second, we present data from MSF-supported mental health services in 20 countries. Among 21,926 older adults, anxiety, mood-related symptoms, and physical complaints were the most reported. Displaced older adults and older women were disproportionately affected by trauma-related precipitating events. Comparative analysis with 177,228 younger adults found that older adults reported more ageing- and functioning-related symptoms and were less likely to present with anxiety or mood symptoms. Third, we present data from MSF-supported sexual violence services in 11 countries (n=35,248), revealing older women who sought care at MSF-supported sexual violence services more frequently reported assaults by multiple unknown perpetrators during essential survival tasks, in contrast to younger women who more often reported intimate partner violence. These findings underscore the urgent need for age- and gender-sensitive health interventions in humanitarian crises. The thesis concludes with the following key recommendations: 1. Consult older adults and co-create solutions and approaches with them to ensure that their specific needs are not overlooked 2. Secure dedicated funding and accountability mechanisms for age-inclusive healthcare and research within humanitarian responses 3. Prioritize research into urgent research questions related to the healthcare needs of older adults in humanitarian settings, using adaptive research methodologies to ensure inclusion of older adults 4. Strengthen Sex-, Age-, Disability Disaggregated (SADD) data collection, analysis and reporting using five-year cohorts where possible, and 10-year cohorts at a minimum 5. Train healthcare staff, health policy makers and health authorities on ageism and age-sensitive approaches to care