COURTLAND ROBINSON, PHDCENTER FOR REFUGEE AND DISASTER RESPONSE

DEPT OF INTERNATIONAL HEALTHHEALTH SYSTEMS PROGRAM

JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH

Health Care for Refugees, Internally Displaced Persons and

Other Vulnerable Groups in Georgia

Triple Transition…Multiple Health Burdens

Since becoming independent in the 1990s following the disintegration of the Soviet Union, Georgia was one of a number of countries in the region that underwent what has been called a “triple transition…Their economies and their populations have suffered not only from the impacts of conflict (their own and those of their neighbors), but also from the disruptions accompanying the birth pangs of transitions from large, multi-ethnic states to the formation and consolidation of independent states, as well as economic transitions from different varieties of state socialism to greater reliance on a free market economy” (Holtzman & Nezam, 2006).

A series of political and economic crises in Georgia—including disruptions in production and trade, hyperinflation, massive unemployment, political instability, civil war and forced migration—led to a dramatic decline in national output and a rise in poverty both in relative and absolute terms (Sumbadze and Tarkhan-Mouravi, 2003).

Age is a striking factor in Georgia’s poverty profile. According to recent data from the Social Assistance and Employment State Agency (SAESA), pensioners living alone and older couples are the sub-population most likely to live in poverty, accounting for the largest proportion of eligible welfare beneficiaries (Office of the UN Resident Coordinator in Georgia, 2006).

Triple Transition…Multiple Health Burdens

In gerontological lore, the Caucasus, and Georgia in particular, are famed as a region of extraordinary longevity. Indeed, there are over 700 centenarians reportedly living in Georgia (out of a total population of 4.6 million). The proportion of older (60+) people in the population is estimated at 18-20% and current demographic data indicates a life expectancy of 69 years for men and 77 for women (HelpAge International, 2004).

Population aging in Georgia is propelled not only by longevity but also by declining fertility rates and increasing levels of out-migration for economic purposes (Zoidze and Djibuti, 2004; UNFPA, 2005).

These trends are even more pronounced among IDPs in Georgia, where dramatically low birth rates have undercut the population pyramid and, together with higher migration rates, have yielded a population where approximately 25% are 60 and over (Zoidze and Djibuti, 2004). These individuals thus have double burdens of vulnerability—due to their age and their IDP status.

Age Structure of IDPs (UNDP, 2004)

Internally Displaced Persons in Georgia

In the Republic of Georgia approximately 230,000 people have been displaced in Georgia for over 16 years; of these, nearly 30% are aged 60 or older (Ministry of Refugees and Accommodation, 2010). Nearly three-quarters of these “protracted” IDPs live in urban areas such as Tbilisi, Zugdidi, Gori, and Kutaisi. Renewed political and ethnic conflict in August 2008 displaced another 135,000, of whom around 26,000 are still displaced.

The government has been resettling many of the more recent IDPs into newly constructed settlements throughout Georgia, particularly in Shida Kartli, and as part of the IDP National Strategy and Action Plan (developed with UNHCR assistance), the government has announced plans to permanently resettle all IDPs from the 1992/1993 conflicts by 2011 (MRA, 2010). Among its settlement solutions, the government has initiated the use of Housing Purchase Vouchers and has plans to hand over ownership of some “collective centers” to IDPs as a way of promoting their integration into Georgian society (Golda, 2009; Mooney, 2009).

230,000 people displaced in Republic of Georgia for more than 16 years; 30% of whom are 60 or over; 75% live in urban areas. 26,000 more people were displaced by renewed conflict in August 2008. Small population (<1000) of Chechen refugees remaining in Georgia since 1999.

Assessing Health Status of Displaced Older Adults in the Republic of Georgia

Grant from the Dept of State, Bureau for Population, Refugees and Migration (PRM); three aims: To develop and validate an instrument to measure physical

and mental health status of displaced older adults (60+). To conduct a prevalence study of physical and mental health

problems among older adults (n=950), comparing “protracted” IDP populations with “shorter-term” displaced populations, comparing urban with non-urban displaced, and comparing IDP and refugee experiences.

To develop guidelines for measuring physical and mental health status of older adults displaced by natural and human-made disasters and promote improved program and policy interventions for healthier aging in displacement.