I. THE SITUATION OF OLDER PERSONS IN THE ARAB REGION
A. DEMOGRAPHIC BACKGROUND
14. With the beginning of the twenty-first century and the dawn of the era of globalization and the breaking-down of inter-State barriers, the Arab countries have become aware of the urgent need to modernize their socio-economic and political infrastructure. They are faced with new challenges, in parallel with huge demographic development that will have a long-term impact on Arab societies if no attention is paid thereto, no preparations are made to cope or work effectively with that development and none of the necessary arrangements are made or measures taken with a view to limiting its effects.
15. The characteristics of these changes are clear in the achievements of Arab countries in the last quarter of the twentieth century, including the reduction by half of death rates and the increase in life expectancy at birth from 55 in 1975 to 67 in 2000, a figure which is expected to increase yet further, namely, to more than 73 by 2025 and 76 by 2050. Fertility rates have decreased considerably, from 6.8 in 1975 to 3.7 in 2000, and are expected to reach 3.2 by 2025. The natural population increase fell from 3.1 per cent in 1975 to 2.3 per cent in 2000, and is expected to fall to 1.4 per cent by 2025.
16. Arab countries have therefore witnessed fundamental changes in the age structure of the population: there has been a sharp decrease in the percentage of children aged under 15 years old, namely, from 42 per cent in 1975 to 38 per cent in 2000. It is expected that this percentage will have fallen to less than 29 per cent by 2025. In tandem with that decrease, there has been a slow rise in the proportion of persons aged 60 and above, from 5.4 per cent in 1975 to 5.6 per cent in 2000. However, this figure is expected to rise rapidly, to reach 8.9 per cent by 2025. In terms of actual numbers, this percentage represents an absolute increase in the number of older persons from 8.7 million in 1975 to 15.8 million in 2000, a number which is expected to rise to 41.6 million by 2025. The expected increase in the percentage of older persons will therefore outstrip the increase in the total population, rising to 3.9 per cent during the period 2000-2025 as compared with an increase of 2 per cent in the total population.
B. ANALYTICAL INDICATORS ON THE SITUATION OF OLDER PERSONS
17. The fundamental changes in the economic and political frameworks of Arab countries are attributable to a number of internal factors, including urbanization, technology transfer, the upsurge in education and various patterns of migration, and to such external factors as globalization in all its economic, technological and cultural dimensions, the lack of political stability caused by internal and external conflicts, demographic challenges, the changes in the situation of women and related ideologies and, in particular, with respect to social equality and equity and human and reproductive rights. The traditional role of the family in caring for older persons has contracted as a result of such factors and in view of an increase in internal and crossboundary labour movements. Those factors have also exacerbated many of the psychological, health and social problems which have limited the capacity of older persons and prevented them from adapting to the latest developments. The various roles which older people were able to continue to perform within and outside the family have diminished. Those factors have also had an impact on the effectiveness of social policies and programmes related to social and family care for older persons.
18. The aforementioned factors have created a society which has had a tangible impact on the nature of family-related problems and, in consequence, on care for older persons. Family-provided care for such persons is no longer as common as it was in the past, and the psychological suffering and social isolation of older persons has increased. Families have a dwindling economic capacity to meet the needs of older persons and family cohesion has suffered as a result of the exigencies of the new social and economic reality. Extended families have given way to nuclear families and the mutual respect between generations has diminished as the values of society have changed, living spaces in cities have shrunk and youth and older persons no longer share the same values.
19. Older women suffer from additional problems, attributable largely to Arab women¡¯s limited access to equal opportunities for paid employment. This has a negative impact because it also denies them access to social and health benefits as they age. They are also affected by the worsening social and economic situations of their families caused by structural changes in society. In some countries, social reform policies and structural adjustment have hampered the provision of education, social and health services for older women, which has impaired their educational and health situation and prevented them, even when unpaid, from engaging in such productive work as caring for their grandchildren or doing housework. The information revolution has affected their role in transmitting culture to their grandchildren. Such internal and external factors have also affected older rural women. Their participation in the informal sector, in family income and in caring for grandchildren has diminished and as a result, older women are more socially and economically marginalized than older men. Older widowed, divorced and never-married women have neither received any awareness training nor the necessary economic support. The economic changes have forced poor older women in towns to depend on the performance of poorly-paid activities in the non-formal sector, including selling textiles and vegetables, collecting refuse and working as cleaners and in the agricultural sector in rural areas, such women depend on animal husbandry. In some cases, economic factors have forced older women to raise loans or to buy commodities on instalment, both of which represent heavy material burdens. They must also resort to bartering their services in order to satisfy their needs.
20. In addition to the foregoing, total and functional illiteracy is still widespread amongst older Arab women. Its prevalence reflects their poor preparation for any work that is sufficiently well paid to alleviate the burden of poverty. Older women¡¯s lack of independence is exacerbated by lack of awareness of employment opportunities, either because they are functionally illiterate or because such opportunities are not well advertised.
21. The abovementioned changes have, in some cases, led to many of the social problems from which older persons suffer within their families, including, inter alia, loss of social status, psychological and health problems, social difficulties caused by domestic abuse, lack of mutual respect, economic distress caused by the lack or inadequacy of health and social security services, and the inability to meet the demands of life and children. A very small percentage of older persons are financially independent; the vast majority have difficulty in acquiring sufficient money and live in extremely difficult circumstances because of the inadequacy of their financial resources. Older persons also lack personal, family and social protection because of their social isolation and low level of interaction with others, either within or outside the family. It has become increasingly difficult for older persons to adapt to the new, nuclear family with its limited financial resources and capabilities.
22. In addition to the aforementioned problems, social welfare systems are either non-existent or inadequate when it comes to providing protection and financial support for older women who are left as the heads of their households when their sole breadwinner migrates or is a casualty of one of the wars or armed conflicts which plague the region. Widowed and divorced women very commonly receive only minimal financial assistance because of the failure of Arab legislation to ensure provision for them.
23. Older persons of both sexes in rural, remote and desert areas may suffer from neglect because of the number of burdens borne by those who care for them, lack of awareness and limited financial resources.
C. REVIEW AND ASSESSMENT OF PROGRESS ACHIEVED IN THE IMPLEMENTATION OF THE VIENNA INTERNATIONAL PLAN OF ACTION ON AGEING (1982) AND THE REGIONAL PLAN OF ACTION ON AGEING (CAIRO, 1993)
24. This section is devoted to an evaluation of the achievements of the Arab countries with regard to the international and regional plans of action. For this purpose, use was made of the responses to the two questionnaires circulated to Arab Governments by DESA and ESCWA respectively in order to review national progress in implementation of those two plans, identify obstacles and formulate the necessary policies and measures. The aim was to assess the regional dimensions of the situation of older persons in Arab countries, in order to take them into account when discussing the International Plan of Action on Ageing 2002 that will be adopted by the Second World Assembly on Ageing in Madrid in April 2002.
25. The responses to the questionnaires indicated that certain Arab countries had formulated national plans on ageing, pursuant to the recommendations of the Vienna Plan. Some countries had begun to incorporate ageing-related issues into their social policies and to implement the six priorities identified in the Vienna Plan, namely, social, income and employment security, training, education and media, health, housing, the family and social welfare, as detailed below.
(a) With respect to the social, income and employment security systems, it was observed that, while the majority of countries provide pensions, some do not offer age-related disability benefits. It should be noted that some Arab countries did not mention any type of benefit for female workers or the wives of those working in the public, private or any other sector. If proper welfare services are to be provided for older persons, guarantees must be given of an income sufficient to ensure that they may live a life of dignity. Appropriate activities, sources of income and pensions must all be provided. In many countries, the focus was on the provision to older persons of material assistance, with a view to strengthening their productive capacities, putting in place a sophisticated system for retirement and the provision of material assistance to poor older persons not covered by the social security system. Both the cooperative and the private sectors took part in such work. Some countries gave priority to guaranteeing pension coverage to young migrant workers, while others offered loans and security facilities for older persons with no other coverage. In most countries, women do not enjoy the same guarantees and pension benefits as men do and are therefore, in most cases, deprived of the right to protection as they grow older. The Gulf States pioneered the provision of social welfare services for older persons, albeit the voluntary sector plays a very small role in such services and the private sector none whatsoever. Very few countries have cooperatives that can provide social welfare services for older persons or offer any incentives to encourage youth to take part in caring for such persons. There is also a lack of emergency hotlines for older persons, geriatric wards in hospitals and specialized emergency services and programmes to promote voluntary work and self-help.
(b) With regard to training, education and media, it was observed that most Arab countries gave priority to the eradication of illiteracy in older persons, self-reliance and training in self-help techniques. Only the Gulf States offer programmes which enable older persons to pursue studies and gain modern information and computer skills. They are also alone in providing older persons with training for productive work and in producing a database on their situation. Some countries indicated that they had research centres on ageing, and others that geriatrics had become a specialization in medical faculties. In some countries, information on ageing had been included in educational curricula. In all these activities, the Government bears most of the burden, while the contribution of the voluntary sector is limited and that of the private sector merely token.
(c) The responses to the questionnaires indicated that, in cooperation with the public and private sectors, all countries were carrying out campaigns to raise public awareness and knowledge of ageing-related issues, and that some were publishing special magazines for older persons.
(d) Most Arab countries provide free health services or free medical insurance for older persons, early diagnosis of geriatric illnesses and subsidized audio-visual appliances. In most Arab countries, campaigns to raise awareness of good nutrition have received substantial support from all sectors. Some countries have imposed health specifications and standards on food stuffs and domestic utensils and supplied older persons with nutritious meals and other basic needs. There are clinics for older persons in most Arab countries, which provide them with medication and diagnostic services. In some countries, services are also provided outside such clinics as part of the health service.
(e) The housing, urbanization and living environment for older persons sector is not accorded sufficient attention to meet the needs of such persons. Certain countries that can afford to do so provide older persons with financial assistance in order to enable them to continue living in their own homes or with relatives and subsidize heads of households who support ageing parents. Other countries have provided special housing units for older persons. However, buildings have not been designed with the capabilities of older persons in mind, nor are material facilities made available for their own homes to be adapted to their needs. No provision is made for transportation facilities to health and social centres.
(f) It appears from the countries¡¯ responses and their national reports that most do provide support for the family and older men. However, the same level of support is not provided for older women. The voluntary sector plays an outstanding role in providing support and services for older persons. In general, the position of older persons in the Arab family remains more secure than in other societies, and Arab NGOs continue to direct their activities towards caring for older persons by, inter alia, establishing old persons¡¯ homes and leagues, while believing that the family must take most of the responsibility for caring for older persons.
(g) In some countries, particular attention has been paid to certain social welfare services, including cooperatives, which have either been given material support or benefited from exemption from taxes and other constraints. Older persons have been given the opportunity to be involved in their local communities and are provided with guidance, advice and emergency services. With respect to the role of institutions in the welfare of older persons, some countries have established special departments for them in hospitals, and nursing homes. Some such institutions have been established with support from the voluntary or private sectors.
26. Some of the highest priorities of the Arab Maghreb countries include the protection of and provision of the necessary care for older persons and the expansion of the range and delivery of social services. The majority of Gulf States have emphasized the importance of strengthening partnership and synergy between the Government and private sectors. They have adopted a policy of not expanding provision of social welfare homes, preferring to apply programmes for family care in the home and assure older persons¡¯ health needs. Some have focused on formulating a plan of action for improving the situation of older persons, and have reviewed provision of psychological and health care, establishing mobile health units for continuous care. Attempts are being made to ensure that older persons are connected to their communities and to train them to become self-reliant. Most of the Arab Mashreq countries have indicated that they are pursuing policies to support the families of older persons and safeguard family cohesion. They also support the establishment of care facilities for displaced persons, the provision of free medicines and the creation of awareness of the situation and needs of older persons. Some have focused on renovating homes for older persons, improving the capacities of those who work with such persons, training a body of technical specialists in geriatrics, running media awareness campaigns, formulating emergency plans, carrying out studies and research, arranging for surrogate families and providing day-care centres and homes for older persons, while perfectly well aware that in implementing such plans, many legal and other obstacles will arise, caused by the paucity of financial support and the security situation which prevails in a number of those countries and the fact that priority is not being given to implementation of the Vienna Plan.
27. Some Gulf States have not formulated separate work plans or special programmes on ageing, but have incorporated such plans into national development plans or the programmes of Government departments. Certain other countries have given no indication of how they deal with the issue of ageing. The various Arab countries also have differing priorities, reflecting the discrepancy between the needs of older persons and countries¡¯ intentions to improve care provision for such persons. This discrepancy is clear in international cooperation measures in important areas and the ranking in importance of areas for cooperation. It appears that the majority of Arab countries attach importance to mutual cooperation and coordination, the preparation of studies in support of development programmes, the establishment of income-generation projects and specialized training in social and health issues.
28. All the Arab countries emphasized that international cooperation was a fundamental dimension of their future work with older persons. Some have chosen multilateral cooperation, while others prefer bilateral cooperation and yet others opt for cooperation with all parties, entities and partners. Most Arab countries declared themselves satisfied with their cooperation with NGOs in their capacity as partners, and with intergovernmental organizations and private sector institutions. The majority of countries also attached great value to international cooperation with respect to research and training, income-generation projects, data collection and analysis and the design of policies and programmes on ageing and for follow-up and evaluation. Some Maghreb countries, for example, have focused on establishing the numbers of older persons, adopting health insurance systems, amending the compulsory retirement age and promoting care for ageing persons in their own communities. Some Gulf countries have sought to rehabilitate older persons, integrate them into society, exploit their expertise and meet their basic needs. Most Mashreq countries have aimed to develop specific policies and sound assistance programmes for older persons and provide them with health care schemes and social and economic welfare services. The disparities between the strategies of the Arab countries arise from their different needs and capabilities, and the services needed in order to care for older persons.
29. Evaluation of the current level of responsibility undertaken by the various parties concerned with ageing-related issues, including the public and private sectors, civil society institutions, voluntary organizations and NGOs and the family, showed that in certain Gulf States, the Government sector assumes the heaviest responsibility, followed by the family and the other sectors. In the Arab Maghreb the burden is shared by civil society institutions, NGOs, the public sector and the family. The situation is different in the countries of the Arab Mashreq, where the responsibilities of Governments vary and the family remains the principal support, assisted to some extent by civil society and the religious sector. In the Gulf States, therefore, ageing-related issues are largely dealt with by the Government and the family, while in the remaining Arab countries, responsibility is more widely dispersed. In general, it may be noted that Arab countries are, to a certain degree, aware of their responsibility to care for older persons and endeavour, to the extent their capacities permit, to carry out that responsibility. However, the requirements are extensive and exceed current potential.
30. It is also clear that the ways in which older persons are integrated into public life vary from one country to another. They are not mere receivers of care, but are actively involved in their local communities as trainers and tutors of youth, volunteers and advisers. They participate in cultural and artistic life and work in small, multi-generational enterprises, although these are not common.
31. With regard to policies concerning older women, some Arab countries indicated that they had taken this issue into consideration when formulating comprehensive policies. However, priorities varied. Family care was of primary concern, followed by health, financial security, the protection of human rights and the role of women in the local community.
32. The statutory age of retirement ranges from 50 to 68 years. In the majority of the countries of the Arab Maghreb, the Arab Mashreq and certain Gulf States, no differentiation is made in this respect between men and women working in the public or private sectors. In some countries where men and women retire at the same age in the public sector, women retire earlier than men in the private sector. Certain Gulf States make no reference to the retirement age of women in their legislation.
33. There is wide variation in the achievements of Arab countries with respect to ageing-related policies since the first World Assembly on Ageing was held in Vienna in 1982. Some Arab countries have formulated national plans and enacted appropriate ageing-related legislation, while others have established national committees on ageing. Some have amended their national plans, adjusted systems for social care and creating awareness of the phenomenon of ageing and related problems, strengthened activities designed to protect older persons, introduced pilot programmes for care in the home and developed systems concerned with the role of older persons and their future aspirations. Some Arab countries are beginning to involve the private sector and NGOs in caring for older persons and to encourage volunteerism to play a leading part in this field. The Arab countries are unanimous in believing that NGOs play a pioneering role in formulating programmes to involve older persons in their communities. Such work is matched by the efforts of religious organizations and those that defend women¡¯s human rights. Few Arab countries referred to the limited role played in this field by academic institutions, professional associations and trade unions and federations.
34. The results certainly show that certain Arab countries have made progress in the field of caring for older persons by, inter alia, formulating national work plans, adopting policies and measures and implementing programmes of work, providing health, financial, housing, education and other necessary services for such persons and acknowledging the importance of their participation in the community. Certain shortcomings in implementing the recommendations of the Vienna Plan are attributable to the disparities in the economic, political, security, demographic and geographical situations of the various countries. However, there are many other causes, the most significant of which is the deteriorating economic situation in the majority of countries and dwindling financial resources, from which, contrary to general expectation, certain Arab Gulf States also suffer. Further obstacles to implementation of the Vienna Plan and ageing specific policies in some Arab countries include a lack of trained human resources; poor security situations; instability and occupation, especially the Israeli occupation; and the economic sanctions imposed on occupied Palestine and Iraq. Certain countries also cited legislative and planning obstacles to implementation of the recommendations. Some countries stated that their Governments had not given the Plan due priority or lacked the experience necessary to implement it. There was also a lack of coordination between Government institutions and of policies specifically addressing older women¡¯s issues, despite the fact that the great concern that Governments have for older persons is evident in the number and quality of services that they provide for such persons, albeit varying in comprehensiveness and variety. In short, many countries continue to face severe difficulties, especially with respect to ensuring the provision of the necessary health care, the protection of elderly consumers and guaranteeing an income that allows older persons to live a life of dignity.
35. In implementing plans and strategies, some countries face difficulties caused by a plethora of priorities, which mean that little attention is given to the concerns of older persons or to improving their situation. Other countries come up against complex bureaucratic procedures and administrative and technical complications in the decision-making process which delay project implementation, a conflict between limited financial resources and human capabilities and increasing demands for services, and little effective participation or financial support from the voluntary and private sectors in bearing the burden of caring for older persons, which throws all the responsibility on the Government sector.
36. With respect to joint Arab action in the field of care for older persons, the General Secretariat of the League of Arab States has accorded great importance to this sector of the population since the beginning of the 1970s, and has incorporated ageing-related issues into conventions and social work strategies. The Arab Charter for Social Work adopted by the League in 1970 and amended in 2001 affirms the need for older persons to be cared for within their natural environment, namely, the family, and for needy families to be provided with the assistance necessary for them to continue to provide such care. Similarly, the Strategy for Social Work in the Arab Countries adopted in 1979 and amended in 2001 confirmed what had been stated in the Charter, and urged Arab Governments to establish homes for older persons whose circumstances compelled them to live in such institutions. Ever since it was established in 1980, the Council of Arab Social Affairs Ministers has given form to this concern, and has arranged many activities, including conferences, seminars, workshops and field trips to inform those working with older persons of pioneering experiments in this domain. A series of studies and research papers has been prepared in order to identify the needs of older persons and care for and integrate them into society. The Council supports the endeavours of the voluntary organizations and associations working with older persons in order to enable them to carry out their role of upholding the family and providing day care in day centres, clubs and homes. The Council¡¯s involvement has expanded to include coordination with the other Arab councils concerned with, inter alia, health, education, youth and sport.
37. With regard to their preparations for the Second World Assembly on Ageing, to be held in Madrid in April 2002, most Arab countries stated that they had adopted the slogan ¡°Building a Society for All Ages¡± and the United Nations Principles for Older Persons and incorporated them into their ageing-related policies. Some countries had established national committees to deal with the issue, and held national workshops in order to review national reports and achievements in the field. All the Arab countries have issued updated national reports for submission in Beirut and Madrid. Most are ready to adopt the International Plan of Action on Ageing 2002 in its current form, provided amendments are introduced in some sensitive areas, in order to comply with Arab value systems and give traditions and religious convictions due priority.
