A/HRC/42/43 5. Rights to food and to health 62. Older persons face numerous challenges to the enjoyment of their right to health during emergency situations. Existing health conditions, chronic illnesses and disability are a frequent risk for older persons, and even those who are autonomous in daily life may be at significant risk in emergency situations due to lack of access to medical care, the unavailability of relevant medical records necessary for establishing appropriate treatment of an older person during an emergency situation or during evacuation, or as a result of the suspension of therapy or treatment, or even a disruption to daily routines relating to health care and nourishment. 63. The dietary needs of not only older persons are often overlooked; because if they care for orphaned children, that additional food support is not necessarily taken into account. Older persons with mobility issues may moreover be prevented them from collecting food.19 Likewise, older persons with health conditions or disabilities may have difficulty reaching health-care facilities centres, especially when displaced populations are dispersed in remote locations. 64. Health programming in emergency situations may overlook the needs of older persons. Vaccination and nutrition programmes often prioritize children, while older persons continue to face significant risks. They also have special needs, such as access to adequate food that satisfies their health and nutritional requirements, and may need access to medical personnel trained in geriatric issues. The care most often needed by older persons, such as to prevent and treat non-communicable diseases, and access to assistive devices may also not be prioritized during an emergency. 65. Mental health in emergencies is a significant concern. Conditions may be brought on by the emergency, by pre-existing conditions and/or by the humanitarian response, such as an overcrowded shelter or the lack of privacy. Assessment tools are virtually never designed to recognize depression or the early stages of dementia in older persons, even when they are designed to identify the psychosocial needs of older persons. Ensuring free and informed consent to treatment is another challenge that may be compounded during an emergency situation, when additional strain is placed on the administration of health-care services. 66. The loss of and breakdown in social networks associated with forced displacement may create a situation whereby the significant mental health and psychosocial support needs of many older persons are no longer met. Funding for mental health and psychosocial support is often limited, and where such services are in place, younger age groups are usually prioritized. 6. Violence, maltreatment and abuse 67. The most frequent forms of elder abuse during or in the aftermath of a crisis are financial abuse, abandonment and systemic abuse, as well as physical abuse. Financial abuse often takes the form of contractor fraud in the recovery phase and theft in shelter. Older persons with diminished cognitive functions and physical strength and those alone in the shelter context, that is, without an accompanying member of the family, are exposed to a greater risk of theft. 68. Older persons in situations of forced displacement, particularly older women, are at heightened risk of violence, exploitation and abuse. Violence may be encountered inside or outside the home (such as when collecting firewood). 69. Systemic abuse refers to disregarding older persons and their specific needs during a response to an emergency, distribution of relief aid or provision of services. Older persons are often less visible to humanitarian actors delivering programmes for prevention, mitigation and response to violence, exploitation and abuse. It would be incorrect to assume that older women are not subject to sexual and gender-based violence, or that older persons 19 12 Hutton, Older people in emergencies, p. 8.