Aisha Bibi* lives in the Edhi Old Age Home in Karachi. She says she was abandoned by her children after her husband died. “I have grown-up sons but they left me saying I have mental issues. Do I have mental issues?” she asks plaintively.

“My daughter asks me to come back but not my sons,” says Aisha Bibi. “When they last visited I asked to go home but since then they have not returned. Maybe they have forgotten about me. I only ask my sons to take me home so I can spend whatever remaining life with them. I wish my husband had not died. If he were alive, I would have a home today.”

The problem of abandonment and ill-treatment of the elderly in Pakistan is compounded by several factors that emerge in a changing society, including the decline of the joint family system and immigration trends. A simple online search reveals a list of old homes, many of which started operations only a few years back. And it is not just the number of organisations that is growing but the occupancy numbers are increasing as well.

According to Saad Edhi, spokesperson for the Edhi Foundation, Edhi homes for the elderly were set up in the early 1970s and, since then, the foundation has taken care of thousands of senior citizens. Media reports indicate that just within Edhi Homes, the number of elderly persons has gone up manifold.

In 1975, Afiyat old age home was set up by the Punjab Social Welfare Department in Lahore and now has many branches across Punjab.

Pakistan is one of only 15 countries worldwide with over 10 million older people. Despite cultural traditions of caring for the elderly, the number of cases of parent abandonment is increasing. What has changed in society?

Dar-ul-Sukun, a charity-run organisation in Karachi, started operations in 1969, as a care home for children with disabilities who were abandoned by their families, with a mixed group of housemates that included the elderly. In 1983, the organisation established a centre exclusively for elderly people. According to Anna Danial, branch manager at Dar-ul-Sukoon Centre for Older Citizens, the number of residents have rapidly gone up in the past few years. “It’s not just economic problems, the Western model of life is also a problem,” says Danial. “Once children are established, they care only about their own lives and do not even bother to spend 5,000 rupees for their parents’ medicine.”

Like Aisha Bibi, Mohammad Raheel* has experienced loss in his old age. He lives at the Dar-ul-Sukoon Old Age Home in Catholic Colony, M.A Jinnah Road in Karachi. “I have lost everything, my home, my possessions and my family but now at least I have a roof, a place to pray and I get three meals a day in peace and quiet,” he says. He shares a long, narrow room with other housemates. A bed and a small side table mark his personal living area. The sparsely furnished but clean space gives him a sense of belonging within a community. He may not be around family but he feels cared for.

After a career in Saudi Arabia, Raheel returned to Pakistan to enjoy his retirement but things did not work out as expected. First, his son persuaded him to purchase a new home because his wife did not want to live in a joint family. Then, he pressured Raheel to sell his own home and move in with his son’s family. But once Raheel sold the house and transferred the money to his son’s account, the latter moved to Rawalpindi and refused to take in Raheel. He said his wife was still unhappy about living together.

Raheel blames only his son for his current predicament. “When my own flesh and blood does not care for an old father who gave him everything, why blame someone married into the family?” he says.

Negligence, loneliness and health issues are the major troubles that the elderly suffer from, some without any support from their families. As their children become adults, they move away from their parents’ homes for jobs or they move out after getting married and live separately with their own family units. In Pakistan, industrialisation in the 1960s sparked off the trend of the nuclear family households, as did immigration abroad. For the parents left behind to manage on their own, government support or infrastructure for senior citizens is lamentable.

Last year, the government passed the ‘Islamabad Capital Territory Senior Citizens Welfare Bill 2019’ to ensure that the neglected elderly are looked after by the state. Earlier, similar bills were passed in Sindh, Punjab, Khyber Pakhtunkhwa and Balochistan in the last few years. The government of Khyber Pakhtunkhwa approved the Senior Citizens Act in 2014, followed by Sindh and Balochistan in 2016 and 2017, respectively.

Yet so far, it remains to be seen how the ‘Sindh Senior Citizens Welfare Act’ will be implemented. The ‘senior citizens council’ that the bill proposes is yet to be established.

Pakistan is not the only country facing the issue of providing care for its ageing population. Asian countries have a high regard for family values and the elderly but one does not have to look hard for cases that indicate how far things have slipped on that front and why governments had to intervene.

In 2007, India passed the Welfare of Parents and Senior Citizens Act that makes caring for elderly people a legal obligation for their children, the contravention of which is a criminal offence. In 2015, the Madras High Court ruled, “A son’s or daughter’s liability to pay maintenance amount to his or her parents is not just a duty but a dharma.” It directed the errant son to follow the law and provide financial support to his mother. Bangladesh passed the Parents’ Care Act in 2013, which compels children to take good care of their parents. China takes a hardline stance by enforcing the “Elderly Rights Law” which ensures that adult children in China visit their parents or potentially face fines or jail.

Why is it that the younger generation fails to take care of their elders?

Maryah Omar, a mother of two daughters, has worked in the corporate sector. She believes that balancing a career and proper care for parents is difficult. “If there are physical, financial or time constraints, then I understand if one cannot take care of their parents’ needs while living abroad, but there are no excuses for people living in the same cities as their parents and still being aloof,” she says. “Distances and work schedules are so hectic that I can understand if people don’t see their parents regularly, but at least an effort can be made on a weekly basis and they should take care of their [parents’] needs, especially emotional.”

Husna Khatoon* lives in a sprawling house in a posh area in Karachi. Her husband passed away years ago. Her companions are a couple of trusted servants and some cats. All her children live in Canada.

“I cannot stand the cold and when I visit [Canada], I always feel that I am a guest,” says Husna Khatoon. Her sons refuse to live in Pakistan and the cost of healthcare abroad is expensive, she says.

“Eventually I know I will die alone here. I am resigned to that, but I do wish I could see my children and grandkids at my time of passing.”

Life can end in such loneliness for the underprivileged and affluent alike. For those who can afford to live in their own homes, domestic staff is hired for help to replace children’s support.

“I know a lot of parents whose children are abroad,” says Dr Imran Afzal, a family physician who has patients ranging from newborns to nonagenarians. Their children fly them over to the US or Canada, he says, when a grandchild is born, for example. The parents will take a 20-hour flight, work as a nurse or helper and then return to Pakistan when their help is no longer needed.

Sometimes, even when a parent wants to live abroad with their family, the children respond that it is better for them to stay in Pakistan because insurance cost in the US is difficult to bear, he relates from cases he has seen.

Often, such senior people will visit the doctor, accompanied by their servants. “The servant will dial the number of their employer’s child abroad and have me speak to them when the parent is over for a check-up,” Dr Afzal says.

“You don’t leave your child and shift to Canada, so why is it so easy to leave parents behind?”

With emotional or physical distance, it is the youngest generation of a family that loses out on having a complete and wholesome sense of family. Grandparents are instrumental in imparting values and the breakdown of the family unit does not give children that opportunity to learn from them. With busy lifestyles and both partners working, the role of grandparents in imparting love and values to children is more significant than ever. Omar understands this well. “My husband is based in Dubai but we decided that the kids and I move back to Pakistan so that our daughters can gain the most from both sets of grandparents’ love and values. My husband shuttles back and forth, but we did not want to compromise on this,” she says.

A practical factor that breaks up the old family structure is lack of living space. After marriage, the sons get a home for their wives and children. Long work hours and long commutes make it difficult to sustain a physical connection with parents. The rising cost of healthcare is also an issue not only in the West but in Pakistan too. In fact, most organisations do not consider parents as an employee’s dependents and only count the nuclear family members worthy of health cover.

Should children be burdened with taking care of parents in tough economic times and is caring for children an investment that should be returned in the old age?

Masood Mukhtar, a retired barrister, argues that it is unfair to expect too much from children. “I raised my daughters, I gave them an education and put them on the path to success for their benefit, not mine,” he says. “I am providing for my wife and myself and have no expectation from any of my girls to take care of me in my old age, in the same way that I owe nothing to my parents.”

On the other hand, there are exceptions who feel different. Farwa Hussain, a recent graduate of Habib University, gave up her job in Karachi and moved to Lahore for her father’s health. “Yes, it certainly gets overwhelming but I never see it as a burden. My father, who now has Parkinson’s disease, has struggled so much to give everything to us four siblings. Life is difficult but does that mean we pick and choose relationships we are born into with a lens of convenience?”

Whether it is financial constraints or Western influence that has made us comfortable with the idea of separating our parents from our lives, or even moving them into old homes, it is not easy to do so in Pakistan. There is nothing available in Pakistan in terms of quality of community living that one sees in the developed countries. In Western culture, parents have expectations of the children to become financially independent; young adults are expected to leave home at the age of 18 so that their parents can start saving for their retirement plan. The community centres for the aged in the West are often better than their own homes because of 24-hour medical care facilities, options for socialising with people of their own age, meal plans suitable for their health and other amenities.

As Pakistan’s population ages, and the cost of healthcare and other amenities rises, it seems we must pay attention to the rising cases of parent abandonment. Pakistan is one of only 15 countries worldwide with over 10 million older people. It is estimated that currently seven percent of the population (about 14 million) is over 60 years old, according to a paper Moving from the Margins: Promoting and Protecting The Rights of Older Persons in Pakistan, published by British Council and HelpAge International.

One of the key findings of the research concerns the right to social protection for the elderly. It stresses the need for financial support for senior citizens who are unable to engage in work. “Most believe that families should support older people emotionally and financially when they are not able to work. Recognising the difficulties that families can have in providing financial support to their older members, many would like to see regular financial support provided by the government especially to poor older people. Allowances for poor older people today are limited especially in rural areas and their allocation is often affected by corruption.”

As a signatory to the Madrid Plan of Action on Ageing 2002, the state must focus on safeguarding a demographic which is overlooked in the fast pace of modern life. Both state and society can work towards the aims of the plan which calls for older persons to have secure income, access to healthcare, a safe place to live and an opportunity for community participation.

“A parent’s love is the only one that is unconditional,” says Dr Afzal. “A child’s love may be conditional, a wife’s love too, but parents want nothing from their children except time and company.

The writer is a CEO of Dublu 11, a communications enterprise.

He tweets @Sibtain_n

Published in Dawn, EOS, March 8th, 2020