Old, Poor and Alone in Palestine

by F Zanoon, A Findlay and Gabriella Lazaridis
University of Leicester

Sociological Research Online, Volume 11, Issue 4,
<http://www.socresonline.org.uk/11/4/lazaridis.html>.

Received: 20 Jan 2006     Accepted: 21 Sep 2006    Published: 31 Dec 2006


Abstract

In most societies there has been a progressive transfer of responsibility for caring for the older people from the family to the state. The political context of the Palestinian population of the occupied territories has made this impossible. The paper reports on a large scale survey of the problems of caring for older people in Palestine. It shows significant variations in the problems faced by older people, with those living alone outside refugee camps who are unable to access family support networks more vulnerable than others. The greatest need for intervention is for older people living alone in urban areas. Following a classification of older people, policy options for social care for the most vulnerable groups are explored.


Keywords: Older People, Demographic Ageing, Single Person Households, Residential Environment, Social Care, Refugees, Palestine

Introduction

1.1 Care for older people is a complex issue in all societies, but nowhere more so than in places where territorial conflict combines with poverty to inhibit the organisation of any state support. Older people in Palestine face exactly this context. This paper explores the plight of older people in Palestine as revealed by a large scale household survey carried out in early summer 2000 with the objectives both of extending understanding of exactly how the old are cared for by family and community in the absence of any significant state support, and also of exploring what policy options exist in this situation that can ameliorate the circumstances of the most vulnerable old people.

1.2 Since the beginning of the twentieth century, the history of Palestinians living in the West Bank and Gaza has been marked by prolonged conflict, dispossession, military occupation, land and resource confiscation, mass population displacement and, perhaps most critical of all, the lack of an independent state (Rowley, 1984; Falah, 2003, Zureik, 2003). The lack of stability reached its peak in the 1948 Arab-Israeli war, which deprived the Palestinian people of the ability to establish an independent state and led to the flight of nearly a million Palestinians. The 1967 war and the Israeli occupation of the West Bank & Gaza Strip, led to further emigration of Palestinians to the Arab countries (Findlay, 1994; Gilbert, 2005; Al Qudsi, 2000; Dumper, 2005). Since 1967 the Palestinians within Palestine have neither had the luxury of enjoying the right to self-determination nor of controlling their own human and natural resources in such a way as to put in place an effective strategy for developing policies which would enable them to respond effectively to, or alleviate, poverty (Alzaroo, 2003; Falah, 2003; Massad, 2006).

1.3 The first (1987) and second (2000) Palestinian Intifadas "uprisings", the Israeli military government's response to these (especially curfews, closures of areas which blocked access to labour markets for thousands of Palestinian workers[1] and hampered trade) and to the subsequent conflicts in Gaza (2005-6), have had a considerable impact on limiting employment opportunities and increasing unemployment (Farsakh, 2002; Falah, 2003). They have also seen poverty rates rise as well as a deterioration of Palestinian living standards (PCBS, 2003). The transfer of some powers following the Oslo accord of the early 1990s (including the provision of services such as health care and social services) from the Israeli Civil Administration to the Palestinian National Authority was not unproblematic (Hamdon and Denfer et al 2003) and the subsequent failure of the 'peace process' following the election of the Hamas-led government have had profound consequences for the vulnerable populations of Palestine. It is within this context of political and economic uncertainty, limited resource availability and mismanagement and corruption that this study of older people in Palestine is located. It is a context in which some cohorts of the population have been able to access resources more effectively than others (National Poverty Eradication Committee, 1999, 17-18) and in which poverty amongst the most vulnerable old people has increased significantly.

1.4 In this paper, we examine the ways in which conditions of poverty amongst older people varies between different contexts. In particular, attention is given to differences between those living in Palestinian villages and those living in internationally recognised refugee camps or in urban areas. Not surprisingly the provision of social care for older people living alone is shown to be more problematic than for those living within a family setting, but the intricate social care networks that exist mean that even this group is vulnerable in different ways in different contexts. The research examines why older people who have no children suffer more than those with children even if they do not live with them.

Perspectives on care for older people

2.1 Almost all developing countries in the 21st century are experiencing demographic ageing. The Palestinian population of the West Bank and Gaza is unusual in that while the number of older people has increased very markedly in recent decades due to improved health care and other factors promoting higher life expectancies, the proportion of the population that is old has not changed much simply because of the very high level of fertility. This demographic situation, amongst many other features that shape the very unusual demographic and political regimes in Palestine, makes research on older Palestinians particularly interesting.

2.2 Recent reviews of old age and poverty across the developing world (Lloyd-Sherlock, 2000a and 2000b) note that most policy concern has focused on pension programmes, yet these have little relevance for the poor in developing countries who receive financial support and social care in very different ways from in western economies (UNECE, 2003). In developing countries most support for those in older cohorts comes from the family with tremendous emphasis placed on intergenerational exchanges (National Research Council, 1999). Indeed recognition of these exchanges is not new with Caldwell (1982) identifying in his Theory of Fertility Decline the importance of intergenerational wealth flows as one of the key mechanisms responsible for accounting for differentials in fertility between one country and another. Thus in poorer countries the net wealth flow from children to parents was one of the main reasons posited by Caldwell for the logic of couples in these countries maintaining high fertility levels much longer than in the west. But also important in maintaining high fertility has been the perceived need to have family support in old age in the absence of any state financial or social support (World Bank, 1995; Casterline, 2001). It is not therefore surprising that livelihood patterns and social support systems in developing countries revolve around the family and that policy statements about poverty and older people in developing countries require to be framed in quite a different fashion (Al Essa, 1995).

2.3 The well-being of older people in developing countries depends on a complicated and intricate set of intergenerational transfers that have been built up during the course of their life history and which in old age become the key mechanisms by which they survive (Committee on Population, 2000). In Islamic countries these patterns are particularly intricate (Nasir, 1997) as a result of the very specific cultural practices that determine the relations not only between men and women, but also between mothers and sons, and fathers and daughters and daughters in law (Fikri, 1975; Hussein, 1992). These practices influence a wide range of household behaviour (Findlay, 1990). Critically from the perspective of this paper, reliance on these relationships in old age is not a supplement to public tier support for this group, as in most western societies, but forms the fundamental social care network on which the old depend (Lloyd-Sherlock, 2000a). In such a situation, for most of those without sons or daughters, or without access to them because they do not live close by, the prospects for a high quality of life in old age are very limited. Social relations therefore become a fundamental determinant of the conditions of poverty or well-being experienced by older people in quite a different way from in developing countries.

2.4 It is in this context that it is particularly interesting to consider the concepts proposed by the gerentologist, Clare Wenger (1994). Over a period of twenty years she researched the nature of support networks for older people in the UK, producing a now well-respected typology of five different types of support network based on the availability of kin, levels of interaction with family , friends and neighbours and the level of involvement with religious and community groups (Wenger, 1989; Wenger, 1995). While inevitably the details of the typology are specific to the UK, attempts have been made to apply the concept to other cultures and societies (Liu and Wenger, 1998). In the research reported in this paper, special attention is paid to the different types of social relations accessed by older Palestinians. Although the nature of the resultant social networks is inevitably very different from anything that might be identified in a UK typology, the importance of social care networks is obviously much, much greater in Palestine. This is true not only because of the constraints on economic development of this dominantly Islamic society (Lang, 1990), but especially because of the long history of political conflict that has disrupted family structures and inhibited personal mobility.

The context of poverty in Palestine and systems of provision of care

3.1 Prior to turning to the survey work undertaken by the authors it is necessary to provide a little contextual information both about the nature of poverty in Palestine and about social care systems as they operate in this context. Poverty is widespread in the Palestinian territories; the overall poverty rate among households in the West Bank (excluding East Jerusalem) was 16% and in the Gaza Strip 38% in the late 1990s (NPEC, 1999, 34). But these figures beg the questions 'what is poverty and how can it be measured'? In the context of Palestine there are in fact two different poverty lines that are widely referred to: the so called 'deep' or absolute poverty line (NPEC, 2000) has been calculated by the Palestinian authorities to reflect the budget for clothing, shelter and food; the second line, 'average poverty line', includes also spending on health care, personal care, education, transportation, housekeeping supplies.

3.2 While much time might be spent evaluating the quality of the statistics or relative merits of one means of measuring poverty relative to another, the main purpose here in referring to the NPEC survey of 'Poverty in Palestine' is to enable comparative statements to be made using their metrics. Their work suggests that absolute poverty in the Central West Bank, the region where the survey was conducted on which this paper reports, affects a lower percentage of the population (8%) than in the Southern (24%) and Northern (18%) parts of the West Bank. In turn poverty was much worse in both Northern Gaza (with an incidence of poverty of 31%) and Southern Gaza, (51%). These regional differences in part reflect the history of settlement and refugee flows in these occupied territories. Initial efforts to tackle the poverty in Palestine were launched shortly after the 1948 war through organisations such as UNRWA (United Nations Relief and Works Agency). Their early aims were to alleviate severe poverty rather than to eradicate it, because it was widely believed that the fundamental cause of poverty was the lack of a Palestinian state and hence that any long term solution lay in the realm of larger scale political strategies rather than in short term measures (Shalbi, 1999). Few could have anticipated that the plight of the Palestinians as a stateless nation was to persist for more than fifty years (Rowley, 1984). Over time a range of programmes for social support for the poorest in Palestine have emerged including some that directly focus on the needs of older people (Samsur and Keroukian, 1993). We distinguish below between official provisions by the Palestinian Ministry for Social Welfare, care funded by non-Palestinian organisations and support from national international agencies.

(i) The Programme of the Ministry of Social Welfare

3.3 The offices of the department of Social Welfare in the West Bank & Gaza Strip were set up in the early-1950's. The aim was to secure material aid for those who, for a number of reasons including old age, had lost the ability to obtain sufficient income.

3.4 There are five main offices of the Ministry of Social Welfare in the Gaza Strip and six in the West Bank. The administration of the departments of social welfare was transferred from the Israeli Civil Administration to the Palestinian National Authority in the Gaza Strip & the Jericho area in May 1994. The Ministry of Social Welfare seeks to adopt a policy for social welfare that differs from the one which was operating under the Israeli Civil Administration, apart from the cancellation in 1995 of a 15 per cent reduction of the scale which was introduced by the Israeli authorities in 1994. Its programmes nowadays involve the families of Palestinians killed in action and prisoners as well as the rehabilitation of prisoners and ex-prisoners. However, no change has taken place with regard to the value of assistance provided to poor households.

3.5 Families are eligible for assistance if they have lost a large proportion or all of their income because of the inability of the breadwinner to work[2]. So the criteria depend not on the standard of living or on being below a povery line, but on total or partial lack of income. The threshold is based on an assistance scale adopted by the ministry under the Israeli Civil Administration in 1987. It deals with families from a relief perspective. The two largest categories of households receiving assistance (48.6% in 1996) are older people and widows (NPEC, 1999, 67).

(ii) Al Zakat Committees' Programme

3.6 The Al zakat committees of the mosques in Palestine represent one of the most important channels for providing social welfare to older people. They work as a link between the local donors and the needs of poor people in surrounding areas. The criteria of eligibility for receiving aid include the loss of the male head of household (women are not considered as breadwinners irrespective of whether or not they work) and temporary or permanent partial or total inability of the male breadwinner to earn an income. These committees are pro-active in that they cooperate with local committees, recommendations of clergymen, and their own field investigations to get access to needy families who fail to apply for assistance. Religion is not a necessary condition for entitlement of aid.

3.7 In 1996, the Al zakat committees offered aid to nearly 27,585 families in the areas of the Palestinian National Authority (PNA). This included health and education services for individuals as well as financial aid for orphans. These committees do not apply a standardised assistance scale; each committee applies a different scale depending on its financial resources. And the assistance provided in general is lower than that provided by UNRWA and the Ministry of Social Affairs (NPEC, 1999, 75). The committees are less active in villages than in the towns of Palestine.

(iii) UNRWA's Programme

3.8 UNRWA's social assistance programme is providing assistance to families and individuals classified as 'special hardship cases', that is cases who have lost their income because of death, chronic illness or disability of the head of the household or the head of the household being old. Its eligibility criteria are restricted to the ones of the Ministry of Social Affairs in that the refugee family must not include an adult male member between 18-60 years old who is physically fit to work and the family's total sum of income from all sources must not exceed two-thirds of the lowest employee's salary appointed by UNRWA itself in the area of the family's residence. The majority of the assistance is in kind rather than cash. The procedure followed by UNRWA does not differ a great deal from the Ministry of Social Welfare. It mainly concentrates on groups living in the camps. UNRWA offers aid mostly to 'official' refugees. It restricts its aids to "cases of special distress". The complex bureaucratic procedures followed to determine elegibility act as a discouraging mechanism together with the negative image or stigma culturally associated with asking for this type of assistance.

3.9 In 1996 widows and older people constituted 45.7% of individuals and 69.2% of households receiving special hardship assistance (NPEC, 1999, 69). A higher proportion of aid goes to the Gaza Strip than to the West Bank due to the higher number of refugees in the Gaza Strip. The opposite is true for the Al Zakat committees who provide more support to more families in the West Bank

3.10 To summarise, it has been shown that social care in Palestine (especially with regard to older people with poor social networks) is highly fragmented. Most aid offered is ameliorative in nature. There appears to be a lack of strategic programmes tackling the root causes of poverty amongst older people. Appreciation of this context helps to explain why the family (Rosenfeld, 2002), therefore is a key support mechanism for many aspects of social care and why when this form of support is not available, older people can be an extremely vulnerable group.

Methodology

4.1 In order to investigate some of the issues introduced above the authors organised a large scale household survey in the early summer of 2000. The survey was funded by the British Council and co-ordinated by a research team from Al Najah University, Nablus.

4.2 A three fold geographical division of city, villages and refugee camps was selected as the main population groups that would be surveyed, with questionnaires being distributed in each type of area. We chose these three different settings because they pose different challenges for older people. For example, those in villages lived in traditional houses and had some opportunities to form close social networks of support, whereas those living in the city by and large lived in residential multi-storey flats which post various problems regarding mobility. Older people living in camps suffered from problems of overcrowding. On the other hand, those living in cities had better opportunities of receiving better health and publicly organised social care than those living in villages.

4.3 Because of the restrictions on research work imposed by the Israeli military occupation of the West Bank, work was restricted to the functional region around Nablus (the third largest city of the West Bank). Survey work in the refugee camp was particularly tightly constrained. Some 940 households with older residents were identified. From these households 893 questionnaire responses were achieved, with university students calling to collect the completed forms.

4.4 Some 483 of our respondents were married, 35 were single, 398 widowed and 22 divorced. The majority (53%) were illiterate and more than a third (37%) had only elementary schooling. The latter were mainly those who had studied the Katatib[3] for about four years to acquire the fundamentals of reading and writing. There were of course differences in the levels of learning according to the place of residence with most formal schools being situated in the cities; hence the majority of old people with levels of learning beyond the elementary level had acquired this in the city, and most illiterate people lived in villages and camps (Table 1). In general the Palestinian population is thought of in the Arab world as one of the most educated peoples, yet Table 1 shows that for older people outside the cities the vast majority are illiterate or have only had elementary schooling (94% of those in villages and 97% of those in camps). There is also a gender difference with women twice as likely to be illiterate as men. In these circumstances the potential for self-help is clearly much more limited than would be the case for older people in more developed economies.

4.5 In terms of income, 20 per cent of the families of the older people we interviewed lived in dire penury with incomes which did not exceed fifty Jordanian dinars (around US$75) per month[4]. Some 23 per cent survived in relative poverty with incomes ranging between US$75 and US$140. And one third of families lived on an income between US$140 and 280.

4.6 Following the questionnaire survey, we conducted 31 in-depth interviews with older people and their carers. The selection of cases for in-depth interviews were based on a number of factors, such as the place of residence (15 living in villages, 11 in the city and 5 in camps), age, gender, number of children, social status, and type of care needed and received. This paper draws mainly on the questionnaire survey, but insights from the interviews have been used to inform our interpretation of our dataset.

4.7 The fieldwork was affected by the political situation and especially by the Israeli curfews and checkpoints restricting access to many places. Clearly there are immense problems with field work in these circumstances and the authors would be the first to note that the survey was unable to fulfil all the conditions expected of a statistically controlled sample designed to represent the population in a normal fashion. Nevertheless the size of the sample and its fundamental partitioning into three types of geographical environments should permit some useful insights to be achieved as long as proportional rather than absolute statistics are used. Consequently in the remainder of this article most statistics are provided as percentages, either of the three geographical sub-samples or in relation to household type (older people living alone or living with others). This facilitates comparison and the search for wider understanding of the forces defining and shaping poverty amongst older Palestinians. We estimate that our sample covers approximately 10 per cent of the estimated 9,000 old people who live in the Nablus area.

Old, poor and living alone in Palestine

5.1 Only 11.6 per cent of the older people surveyed in the study claimed to receive any support from government sources. This underscores the basic premise of this research project that most older Palestinians are dependent on family and informal social networks as the dominant source of support.

5.2 Given the importance of inter-generational transfers in the care of people in the older cohorts of the population, it is not surprising that the survey revealed that the vast majority of people lived with their sons, daughters or other relatives. Only some 17.4 per cent (155 persons) lived alone. As Table 2 indicates most of these were women living in rural villages (nearly three quarters of all elderly living alone resided in the villages covered by the survey). Very few older people lived alone in towns or refugee camps.

5.3 The geography of older single person households is not difficult to understand, given the high rates of out-migration of young people from the villages of the West Bank in search of work combined with the greater cost of accommodation in the cities and the virtual lack of single person housing in the camps. In addition social and psychological factors contribute to this group feeling more secure living in the villages that they have inhabited for most of their lives than living on their own in other types of environment.

5.4 Of course most of those who lived alone had little or no control over the circumstances that had shaped their residential environment. Some 78 per cent of those living alone had been widowed (Table 3) or were divorcees (7%). And about a third of those living alone had no children (Table 4) and therefore could not move to live with the next generation. Since cultural forces in the Arab world in general inhibit people living with their married daughters, it is not surprising to find some older people who only had female offspring living alone, but as Table 4 indicates there were very few who had more than four children that did not live with a son or daughter.

5.5 Those people who did live alone were, as a result of their isolation from family support systems, much more likely to be living in households with incomes below the absolute poverty line (defined as 175 JD by the NCPE, 1999). Table 5 shows the distribution of household income for the two types of household. Some 53 per cent of those living alone had less than 100JD per month compared with only 25 per cent of other households. Of course measuring income is thoroughly complex, but other dimensions of the survey showed that older single person households were also very poor on other measures (eg 15 per cent reported their household expenditure to be less than their income).

5.6 Given the particular plight of the old who live alone, it is useful to note a few other descriptive statistics from the survey that highlight specific dimensions of vulnerability amongst the population. First, many of them had done so for many years. Some 57 per cent of those living alone at the time of the survey had resided in the same accommodation for more than 40 years. Women in particular, once widowed or divorced, found remarriage difficult (a feature common across the Arab world Fargues, 1988), while men in their sixties often remarried. This phenomenon, combined with the lower life expectancy of men, contributes to the much lower percentage of men living alone. The plight of those living alone was also not a short-run phenomenon. As Table 6 shows, 65% of those on their own, had lived as a single person household for more than a decade. Living alone for a long time span was more common amongst women with 31 per cent of them living alone twenty years or more. In turn this situation, occurring as it does in a strongly patriarchal society, may help to explain why 44 per cent of women living alone claimed that they were in urgent need of economic support compared with less than a third of older men living alone (Table 7).

5.7 The poorer housing of older people living alone (19 per cent without running water, 50 per cent without hot water, 26 per cent without access to a toilet in their home) may have affected the physical health of this group, but it would appear from the survey that depressive illness and feelings of stress, anxiety and introversion were the main ways in which living conditions impacted most negatively in a differential fashion on this group.

5.8 Much more detail could be reported on the health aspects of the survey, but for the purposes of this paper, what is significant is that on virtually every socio-economic and health indicator the survey showed that older people living alone were much more vulnerable than those living with others. Where this vulnerable group did not therefore have access to some form of formal social support, they therefore were exposed to conditions of dire poverty affecting their health and well-being. Given the difficulty of providing such formal social care in the context of a population living outside the framework of a normal state with social services, it is not therefore surprising that the older Palestinian population who live alone suffer some of the worst conditions of deprivation and poverty that have been recorded anywhere in the world.

A Typology of Social Support Systems for Older People on the West Bank

6.1 Although it is evident from the data presented above that older people who live alone in a Palestinian context are an extremely vulnerable population, it is equally clear that they are not the only old people living in poverty. Some of those living alone choose to do so because they have established alternative informal social care. Older couples without children and indeed old people living in extended families which themselves are impoverished also face poor prospects of achieving either an adequate diet, health care or other measures of well-being. The boundaries of social exclusion are not therefore uniquely demarcated by those living alone.

6.2 Of older people living with others (Table 5), 57 per cent were in households with incomes below 200JD per month. These households were unevenly distributed with the poorest being in the villages where 60 per cent were recorded as being below the poverty line. Older women living with their children were particularly likely to be found in the villages. To those unfamiliar with the Palestinian context it may come as a surprise that the official UNRWA refugee camps had a higher average household income. It was equally true that provision of health care to old people in the camps was better than elsewhere.

6.3 The survey showed that not all of those living alone were necessarily cut off from informal support. Respondents to the authors' survey were asked to report on a five point Lichert scale the strength of family and other social relations (Table 8). The first row in each part of the table indicates those who had no one in the category (eg no married sons) rather than no social relation with people in the group.



6.4 It can be seen that some older people living alone had daily contact especially with married sons and daughters. In villages this was often because they lived next door or in the same street, but such contacts were much less likely for urban residents. Contact with unmarried sons and daughters appears weak, but in reality reflects the very high percentage of the Palestinian population who marry. Discussing in detail the contact between parents and their children or nearest relatives would go well beyond the scope of this paper, but an interesting pattern is evident in Table 8 that maps the intricate pattern of social relations that exist in the West Bank. For example, unlike in western societies, the proportion of those in very strong contact with neighbours is very striking, providing an essential support especially to older people living alone.

6.5 The data discussed above points to the need to go beyond simply equating living alone with older people experiencing poverty. To this end the researchers decided to construct a typology of the social relations of old people, adapting Wenger's (1994) typology to the Palestinian context. Some 60.8 per cent of the older people in the sample lived with their children or another relative (Group A). This group was far from homogeneous, with some being entirely dependent on their kin and hence the poverty or other wise of their family, while others still had some financial independence (about a quarter of this category). A second group (Group B) further 17.7 per cent lived separately from their children but were close enough to see them daily and therefore enjoyed significant family support. A third group (group C) did not live with their family, nor had local family support, but saw other relatives on a very regular basis and might be thought of as enjoying a locally integrated support network. This group was represented most strongly in the villages. Others were locally self-contained having weak family links but receiving social and psychological support from local friends and neighbours (Group D). Finally, there were some with only the most restricted support network having neither local family nor links with a local social network (Group E). Groups C, D and E together accounted for some 21.5 per cent of the households included in the survey.

6.6 The significant features of the typology outlined above include first the immense importance relative to equivalent typolgies in western society (Werner, 1985) of family support. Second, living alone is a key criteria of exclusion as discussed above, but it is geographically specific in its significance. Not only is living alone more probable in rural areas, but its impact in terms of weakened support systems is less, because of the greater likelihood of having daily contact with sons, daughters or other relatives (Groups B and C). Thirdly, being old and suffering from poor social support is less of a problem in the geographical context of the refugee camps than it is in the urban environment where health care provision is less effective and where therefore having a local self-contained social network or having only restricted social support (Group E) is thoroughly problematic. It therefore emerges that not only does a typology of social support for the old reveal significant differences, as one would expect, between a Palestinian situation and that of research in other countries (especially those of the west), but also that the boundaries of exclusion and vulnerability have a strong geographical dimension. Although many older people in our survey risked facing very difficult conditions on account of the high proportion of the rural population living at or below the absolute poverty line, those without family support systems living in urban areas were the ones whose situation was potentially most critical.

Policy Challenges

7.1 To some extent the policy conclusions arising from this research are rather depressing since the research has identified public care systems that only tackle the consequences of poverty rather the root causes of deprivation in old age. As a result, reflection on the analysis of our research leads to identification of at least three types of policy recommendation that to some extent address the causes as well as the consequences of poverty among older people in Palestine. Of course the underlying instability caused by the continued military occupation of Palestine remains the most serious cause of under-development, but addressing this issue lies well beyond the scope of the research focus of this paper.

7.2 The first policy concern should be to change public attitudes in relation to issues associated with ageing. Given that many of those identified by the survey as amongst the most vulnerable also appeared to have made little or no preparation for old age, it is clear that there is scope for some policy interventions to raise awareness amongst younger people of the importance of planning for old age. This is an issue identified as problematic in other Arab societies (Al Shati, 1990). There are several reasons why policies aimed at younger generations are needed. First, they need to be made aware of the increased life expectancies now being achieved in Palestine compared with the past. In 2003 the Population Reference Bureau put Palestinian life expectancy at birth at 71 for men and 74 for women, placing the current younger generation in a very different position from their parents in terms of the prospects of surviving to old age. Secondly, the younger generation needs to be made more aware that social relations are changing with family support weakening over time and with the prospect that in future older people will not be able to rely to the same extent on their children for support. Both these factors point to the urgent need to implement policies appraising the population at large of the need to prepare in new ways for slef-support in old age.

7.3 Balancing the need to increase awareness amongst the young of the issues surrounding ageing is the need to change attitudes amongst older people to receiving public assistance (Al Badaynii, 2001). The current cultural context has meant that a stigma appears to be associated with receiving formal assistance, yet there is a need to counter this view as the numbers of older people without access to informal support networks increases. Cultural and social mores continue to hamper the vulnerable from seeking aid from formal sources.

7.4 Second, it is evident that the vulnerability of the poorest old people varies from location to location. Equally social care provision varies geographically between towns, refugee camps and villages. These socio-geographic differences reflect not only the expected variations that might arise from living in areas of low or high population density, but stem from the very specific immobilities experienced by the Palestinian population living in territories under military occupation where road blocks and military curfews significantly restrict the ability of people to move and to fulfil social familial obligations (Findlay, 1994; Gilbert, 2005; Massad, 2006). Our research therefore points to the desirability of a greater targeting of policies to address first the uneven causes of hardship that relate directly to the military occupation of Palestine and second the location-specific needs of older people that stem from the implications of the occupation for personal mobility. The tables reporting the conditions of poverty amongst older people highlighted the significance of the greater social support available in villages and refugee camps compared with urban areas and pointed to the specific need for stronger formal provision of care to isolated old people living in the urban environment.

7.5 Third, it is worth advocating policies that would encourage a switch in the balance of resources allocated to funding the formal provision of care from young people in favour of the older population. Although the Palestinian situation is an extreme example, other societies in the developing world, such as the Islamic Republics of the Former Soviet Union, have in recent decades been forced to tackle similar problems (Falkingham and Hussain, 2000; McKee et al 2002). Much private finance in Palestine is currently channelled by families into schooling and university support in an attempt to shape the educational environment of young Palestinians at school and university level. This flow of capital is a natural response by families to invest in the young as the future generation that will be lifeblood of Palestinian society. But no equivalent imperative seems to exist with regard to supporting older people. The international community as well as the state needs to recognise this imbalance and to target resources on vulnerable sections of the older population as part of their commitment to upholding human rights in what has proved to be a particularly harsh political and economic environment.

Conclusion

8.1 This article is one of a very small number that has opened up to an Anglo-American readership the problematic issues surrounding ageing in a developing country facing military occupation. This challenging situation is worth consideration even if just in terms of reviewing existing patterns of social care provision, but this paper has gone further in providing primary research results from a large questionnaire survey amongst older people in Palestine at the beginning of the 21st century.

8.2 The analysis of this survey focused on the issues associated with poverty amongst the most vulnerable in this group and resulted in the establishment of a typology of social care networks for older peoples of Palestine. Building on the work of Wenger (1994), typologies of this kind highlight the variable nature of social support netwroks for older people. This is a feature that is particularly important in analysing the difficulties faced by old people living at some distance from their family in situations where military curfews and political tensions make travel even more difficult than it would be for older people in other contexts.

8.3 It was no surprise to find that old people living alone and in particular those without a supportive local family network faced the greatest hardships in West Bank of Palestine. The 21 per cent of older persons living in Groups C, D and E of our typology are those that we have identified as in greatest need. Those in Group E (living alone with no local support network even from friends or neighbours) were most vulnerable if residing in an urban context. Given the prospect that this group is likely to grow in size in the future as a result of the combined influence of demographic ageing, the social decline in family support and the increasing shift from rural to urban residence, this makes consideration of our policy recommendations all the more urgent. Not only do attitudes to ageing need to change in Palestine, but in the absence of adequate formal care for older people, this needs to feed through to policies to encourage individuals and families to participate in the active redistribution of family resources from younger to older generations.


Notes

1It is estimated that the Israeli labour market absorbed around 150,000 Palestinian workers. In addition to this, tens of thousands of Palestinian workers were expelled from Kuwait after its occupation, who returned to the Palestinian areas after suffering loss of income as well as savings.

2The procedures which need to be followed for receiving aid from the Ministry of Social Welfare are long and complicated. The applicant must submit of a written application form which needs to be checked by a social worker who pays a visit to the concerned family and fills a special form about its situation and opens a file of "case"; the aid is paid after the approval of the director in charge. The latter submits a monthly report called a "concentration" including the number of new applicants and the number of cases already approved. The registered 'cases' are reviewed annually by the directorates of the Ministry of Social Welfare..

3These were at pre-school level concentrating on the teaching of reading, writing and arithmetic.

4At the time of the survey one Jordanian Dinar was worth approximatgely 1.5 US dollars.


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