Collaborative Critical Appraisal of Vulnerable Populations in Disaster

Question: Describe about collaborative critical appraisal of vulnerable populations in disasters. Answer: Vulnerable populations refer to a wide range of individuals such as the homeless, the ethnic and racial minorities, the low-income children who are uninsured, chronically ill individuals, the economically disadvantaged and the elderly. These populations are highly vulnerable in their day-to-day lives and more so, when they are faced with emergencies or particular disasters. Dadaab, Kenya is the largest refugee camp in the world. More than 400,000 people fled from their countries in times of disaster, to settle there. The place is hot, sandy and windy and it stays for long before receiving rains. Among the residents of the camp, are 13,000 elderly people. This article critically appraises the vulnerability of the elderly (people above 50 years old) by assessing their immediate nutritional needs. In order to assess these nutritional needs, the article identifies nutritional status indicators that would be used, provides a description of how the vulnerability would be investigated, how the elderly would be involved and the particular challenges that would be faced in the process. Several guiding principles have been created to help the older people to deal with situations of emergencies and/or disasters. The International Plan of Action on Ageing was endorsed by the United Nations General Assembly in 1982. The action plan was created to act as a guide for the thinking as well as for formulating programmes and policies for the aged. Nine years later after the plan was endorsed, the UN principles for Older Persons was adopted (Hokenstad and Restorick Roberts, A 2013). These principles addressed the issues of dignity, care, participation, self-fulfillment and independence. The Madrid International Plan of Action on Ageing (MIPAA) was the first global agreement to recognize older population as contributors to societal development. The plan committed governments to include ageing in all policies on economic and social development as well as programmes that reduce poverty. It also urged governments to ensure that old people are included in programmes and policies to achieve Millennium Development Goals of reducing people who were living in extreme poverty. According to Sidorenko and Walker (2004), 159 countries were in agreement with this action plan, but the problem is that it was not binding legally because its implementation is voluntary. In the Madrid plan, the core issues that can improve the lives of old people, which were recommended were as follows. On decision making and discrimination issues, governments were obliged to implement and promote human rights conventions as well as any other human rights instruments; on the issue of pensions and work, it was recommended that older people be allowed to work for as long as they would like; on health issue, governments agreed to ensure that old people gained access to curative and preventive care and rehabilitation like all other groups; and finally on the supportive environment issue, governments promised to ensure that old people had access to housing that is decent and that they would be free from violence, abuse and neglect (Sidorenko, Mikhailova and Anisimov, 2007). Even though the International plan and the UN Principles provide an action framework, more nutritional approaches and principles are required. HelpAge International (HAI), an international non-governmental organization which helps the elderly to claim their rights, recommended several principles to be used. The principles are specific to nutrition and food interventions in times when there are disasters and they assist in reinforcing the plan of action on ageing of 1982. They are six principles in total. First, older people are supposed to easily access the adequate general ration which is appropriate in terms of quality and quantity and that which is culturally acceptable and easily digestible. Second, the physiological changes which are related to ageing as well as consequences for special needs and nutrition should be reflected in the design of the programmes. Thirdly the elderly should be involved during the assessments, designs and programme implementation. Fourth, the chronic nature of the old peoples needs should be represented in the programme design. Fifth, the support structures that exist within the community should be strengthened and rebuilt as the most essential strategies for nutrition and food assistance programmes for the aged. Lastly, it is important the malnourished old persons be provided equal access to the selective feeding programmes for purposes of nutritional rehabilitation (HelpAge International, 2013). Identification of Nutritional Status Indicators According to Cdc.gov (2016), Nutritional status indicators which are used with CDC growth Charts include short stature, underweight, overweight and obesity. In addition, a group or an individual is ranked on growth chart using percentiles so that they can be referenced where they fit within the population. Anthropometric evaluation would be an important for the geriatric nutritional evaluation of the old people in this population to determine their condition. Anthropometric evaluation would help to find out the individuals who are malnutritioned, underweights, obese, overweight, those who have lost muscular mass, the redistribution of adipose tissue and individuals who have gained fat mass (Snchez-Garca et al., 2007). Anthropometric indicators would be essential in the evaluating the prognosis of acute and chronic conditions in this vulnerable population and aid in coming up with the right intervention. Nutritional status and anthropometric measurements would be evaluated as they relate to gender and age of the healthy elderly individuals. These nutritional status indicators that would be used are closely related to the environment characteristics, genetic makeup, health, lifestyle. Cultural conditions and the functional status of the individuals. Snchez-Garca et al. (2007) points out that anthropometric evaluations that are conducted by trained health professionals are non-invasive, inexpensive and they provide detailed information of body structure components, especially the fat and muscular components and they also assist to assess old peoples nutritional status. The process of ageing involves nutritional and physiological changes which are manifested by the loss of weight and height, loss of muscular mass and the increase of fat mass. The measures used would held indicate the nutritional status as they differ in both women and men. The anthropometric measurements that would be taken for nutritional status indicators will include weight, height, body mass circumferences, knee-heel length, body-mass index (BMI) and Waist to hip ratio (WHR). After the collection of these measures, the data would be validated and stored in the Statistical Package for the Social Sciences (SPSS) software (Xiaoxin et al., 2014). This would make it easier to analyze data and assess the nutritional needs of this vulnerable population. How Vulnerability would be investigated Old people are nutritionally vulnerable in emergency situations. For instance, in this case study, Abdullahi, aged 70 years, flees from Somalia for insecurity reasons. He is a lucky individual who reached Dadaab Refugee camp in Kenya after travelling for fifteen days (Fritsh, 2011). Abdullahi is nutritionally vulnerable because he is issued with food for three weeks before he gets registered as a refugee. The process is expected to be complete in two months. Meanwhile, Abdullahi might be surviving from borrowing small rations from the other refugees within the camp. According to Runkle, Brock-Martin, Karmaus and Svendsen, (2012), vulnerability does not only happen in the camps, it also happens in other emergency situations. The causes of malnutrition in different situations results from food insecurities within households; inadequate care (social care and health care); and lack of healthcare services and household environments that are inadequate. In Dadaab camp, I would assess vulne rability of the elderly by relating it to either inadequate care or unhealthy environments. The common vulnerabilities that magnify the malnutrition of the elderly include their lack of understanding, disability levels, difficulties to access services and absence of family support. These make older people to be the most vulnerable group in the community. In old age, the quantity and quality of food matter in order to meet the nutrient needs (HelpAge International, 2013). The nutrient density of food should be increased so as to compensate the low energy intakes that exist in the elderly. Just like the other groups within the population, older people require balanced diet. As human body ages, muscle and fat composition changes according to the modifications caused by hormonal activities. Fat stores increase as muscles are lost progressively. This affects an individuals ability to maintain balance as they make movements. The individuals are likely to fall often and their abilities to fight or flee when there is danger are limited. When psychosocial stress, disability or illness leads to loss of appetite in the elderly, there are high chances that they would face nutritional risks which would be worsened further by emergency cases or disasters. Such situations might lead the individuals to have inadequate energy when their bodies require it. How the Old People would be involved in the Assessment In order to conduct the exercise of assessing the nutritional needs as well as vulnerability of the old people in Dadaab camp, I will have to involve them so that the assessment is efficient. The immediate nutrient needs of these individuals vary depending on the different factors that affect the individuals differently. For instance, old people often have different health complications that affect their food consumption. In this refugee camp, some elderly people might be suffering from gum disease or loss of teeth which makes it difficult for them to chew and swallow food. These will be limited to certain types of foods. Others will have physical problems and loss of senses, problems that interfere with the individuals ability to access food or sunlight which is essential for vitamin D. It is also common for individuals to be separated from their immediate family members during disasters if they were suffering from reduced eyesight or mobility. This leads to their inability to successfully find foods or cook. Social isolation occurs to individuals who have lost vision or hearing senses. Such individuals eat alone and this causes poor appetites. Such individuals are undernourished since they dont get the necessary diets (HelpAge International, 2013). In this case study it is necessary to work with the older people during the assessment in order to identify the problems that each one of them faces. This would ensure that every old person is heard and considered in any design that would later be planned. As the assessor, the best way to ensure that I engage every individual would be to move around the camp collecting the information so that even the bedridden ones and those with less mobility can be reached in their tents. Studies indicate that Dadaab Camp is located in a place where the weather is often hot. Though old people are vulnerable to dehydration, the situation may be worsened by the hot weather in the area or outbreaks such as cholera and diarrhea. While assessing the immediate nutritional needs in this area, it is important to determine how accessible safe water is. Such information would best be achieved only if the residents of the camp are engaged. The immune system of human body declines with age. Nutrient deficiencies also compromise immunity levels. When malnutrition combines with age, the older population becomes highly vulnerable to diseases that are infectious. The level of infections would help in assessing the immediate nutritional needs of elderly people in the Camp. Expected Challenges during the Assessment Like in other different cases, the common challenge I would face would be informing communities that there are laws, rules and policies which protect the rights of old people and that they need to be implemented. It is the sovereign obligation of states to protect the vulnerable populations according to the UN resolutions, different intergovernmental organizations and the international law. The international human rights law (IHRL) prohibits any kind of discrimination including discrimination on age basis (Olson, 2009). The law asserts that every individual has fundamental rights and states must protect them at all times even during emergencies. The international humanitarian law (IHL) protects all people during armed conflicts so long as they dont take part in those hostilities. The 1949 Geneva Conventions as well as other 1977 Protocols enshrine this right (Geneva Conventions, 2006). IHL does not represent certain individual groups; however, it considers certain vulnerabilities that are experienced by particular categories in the populations that are conflict-affected (Lanz, Max and Hoehne, 2014). Fourth Geneva Convention has two provisions that request for the attention and protection of groups such as the older individuals: The 14th article, first paragraph mentions aged persons among the the sick, children below fifteen years, mothers with children of less than seven, expectant mothers and the wounded, as the groups that should be specially protected. The seventeenth article of the convention also seeks to protect the infirm, sick, wounded, maternity cases, children and the aged people from conflicting parties (Geneva Conventions, 2006). Even though these conventions offer protection, it would be challenging for them to be implemented. In relation to this case study, where refugees free from their countries and settle in Dadaab, Kenya, the old people are still offered protection by certain rules, laws and policies. It will be challenging to convince the local communities that the refugees have a right to be there and must be protected. The 1951 convention that relates to Refugees status along with different regional and international treaties offer protection to populations that seek security and safety in other territories or countries. The protection also applies to individuals who have been internally displaced according to the international human rights laws. The 1998 Internal Displacement Guiding Principles protect the internally displaced individuals (Ache and Majinge, 2010). The Kampala convention came into being on December 2012. Some of these conventions are not legally binding and this provides challenges in terms of implementation (UNHCR, 2016). The governments in the affected regions are sometimes ignor ant arguing that more of their resources would be wasted. Some of the other important principles for the aged that are lightly considered and easily ignored include: The UN Principles for Older Persons that insist on the care, independence, dignity, self-fulfillment and participation of older persons; the MIPAA that was endorsed in 2002 by the UN General assembly; and the Humanitarian Charter Sphere as well as Minimum Standards of the Humanitarian Response that established assistance and protection as the main pillars in Humanitarian action (Sidorenko, 2004). The vulnerable individuals including the older people in the population are protected in a large manner internationally, regionally and locally. The main challenge remains implementation of the created rules, laws, policies and principles. This remains to be a problem for all aid agencies. In conclusion, when disasters strike, the elderly find it difficult to access food. For instance, when Abdullahi flees from his country, it becomes difficult for him to register for food immediately. For others, it becomes challenging for them to access food distribution points and even transport the food from one point to another. These challenges undermine equal access to nutritional needs. Sometimes it is difficult for them elderly to consume food that has been provided because of the various reasons such as difficulties in cooking or chewing. Like in every population with old people, Dadaab faces these challenges and the vulnerability of the elderly exacerbates due to other additional factors (Fritsh, 2011). Immediate nutritional needs of the elderly can best be assessed by taking every facto into consideration and ensuring that the elderly are involved in the assessment. References Ache, C. and Majinge, C. (2010). 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