Old Age in Exile: Health, Identity and Strained Family Care Among Elderly Afghan Refugees in Pakistan

Old age in exile is shaped less by biology alone than by poverty, legal precarity and broken social networks, according to a new mixed-methods study of elderly Afghan refugees living in urban and peri-urban areas of Pakistan. The research, published in Discover Aging, combined structured surveys with in-depth interviews to examine how aging, health and identity interact to produce vulnerability among one of the world’s largest and most persistent displaced communities. Its central finding is stark: older refugees face widespread chronic illness, poor nutrition and limited healthcare access, while the informal family care systems that keep them alive are increasingly strained by decades of displacement.

The quantitative strand included 372 Afghan refugees aged 60 and older, selected through purposive sampling stratified by age, gender and residential setting. Participants had lived in Pakistan for at least ten years, and most had resided there for more than twenty. Nearly half reported no formal education, most were unemployed or dependent on informal labor, and undocumented legal status was common, restricting access to social services and formal healthcare. Housing insecurity was evident as well, with many living in rented homes or refugee camps, often in large multigenerational households with high dependency ratios. The qualitative component drew on 30 participants chosen through maximum variation sampling, with semi-structured interviews lasting 45 to 90 minutes and conducted in participants’ preferred language.

The health picture was severe. More than three-quarters of participants reported at least one chronic medical condition, and physical disability and restricted mobility were common, particularly among those aged seventy and above. Self-rated health was predominantly poor or fair, and many respondents reported poor dietary intake and inadequate food security. Access to healthcare remained limited across the sample: most participants experienced low or moderate access to hospitals, clinics and medication services, while only a small minority had health insurance. High treatment and transportation costs restricted routine medical visits, and language barriers and experiences of discrimination further reduced satisfaction with available services.

Regression analysis quantified which resources mattered most. Income was the strongest predictor of better health outcomes (β = 5.12, p < 0.001), followed by nutrition (β = 4.27, p < 0.01) and healthcare access (β = 3.85, p < 0.01); social support also contributed significantly (β = 3.14, p < 0.05). These unstandardized coefficients indicate that economic stability, adequate food and institutional accessibility are among the most powerful determinants of wellbeing in later life for this population. The findings align with a social determinants of health perspective, which holds that health disparities emerge through unequal access to socioeconomic resources and institutional support rather than through aging alone.

Mental health told a parallel story. Logistic regression showed that social isolation significantly increased the likelihood of poor mental health outcomes, including depression, anxiety and trauma-related distress (OR = 1.35, p < 0.001). Conversely, family support functioned as a protective factor (OR = 0.72, p < 0.05), meaning that older refugees with stronger family relationships had lower odds of psychological vulnerability. Correlation analysis added another layer: identity conflict was positively associated with social isolation (r = 0.38, p < 0.01), suggesting that difficulties in negotiating belonging within the host society contribute directly to emotional insecurity.

The interviews gave these statistics a human texture. “I have diabetes and pain in my chest, but I cannot go to the hospital every month because the medicines cost too much for my family,” said a 71-year-old man. A 67-year-old woman described waiting until pain became unbearable before visiting a doctor because transport and treatment were both expensive. Others described language barriers in hospitals, where consultations in Urdu left them unable to explain their problems, and dismissive treatment that participants linked to their refugee status. “We are refugees, so people think our problems are less important,” one 74-year-old man said. “Sometimes doctors do not treat us with respect.”

Identity emerged as a double-edged force. Most participants maintained strong attachments to Afghan national, cultural and religious identities, with high cultural retention and continued use of native languages providing stability and dignity. Yet social integration into the host society remained limited: a substantial proportion reported low trust in the host community, low social participation and experiences of discrimination. “Pakistan has been our home for decades, but still we feel like temporary people who can be removed at any moment,” said a 73-year-old man. Nostalgia for Afghanistan was widespread, and intergenerational tensions surfaced repeatedly, as younger family members adapted more rapidly to Pakistani society. “Sometimes my grandchildren speak Urdu more comfortably than Pashto, and it makes me feel that our old culture is slowly disappearing,” a 75-year-old man reflected.

Family-based informal care remains the primary source of support for older refugees, with sons, daughters and spouses serving as main caregivers for emotional, financial and physical assistance in the near-absence of formal institutional systems. But that system is under strain. Community and NGO assistance were generally limited, and government support was almost entirely absent for many respondents, particularly the undocumented. Older refugees described suppressing their own needs to avoid burdening relatives facing economic hardship. “I know my family cares about me, but everyone has their own problems now. Sometimes I feel like an extra burden in the house,” said a 71-year-old woman. Statistical analysis showed that stronger family and community support significantly reduced dependency-related distress and improved satisfaction with care services (β = −0.41, p < 0.05; β = 0.39, p < 0.05), yet high caregiving burdens reduced the sustainability of family-based support.

The study’s authors frame these patterns through cumulative disadvantage theory and a structural vulnerability perspective, arguing that prolonged displacement intensifies vulnerability in later life through the interaction of aging, forced migration and marginalization. They emphasize that the findings connect directly to global development agendas, including Sustainable Development Goals on poverty, health, inequality and strong institutions, and they call for targeted interventions that address affordable healthcare, adequate nutrition, social protection, mental health services and formalized care partnerships with NGOs and host government programs.

The researchers acknowledge limitations inherent to their design. Purposive sampling without a complete sampling frame limits statistical generalizability, and the questionnaire was translated into Pashto and Dari with expert review and pilot testing rather than full back-translation due to field constraints. Data were analyzed with descriptive statistics, multiple linear regression and logistic regression in SPSS, with qualitative data coded manually through a six-phase thematic approach. Because participants did not consent to public data sharing, the datasets are available only from the corresponding author upon reasonable request. Even with these constraints, the study offers a rare empirical window into a population largely invisible in gerontological research, documenting how growing old in exile entails not just physical decline but a renegotiation of identity, belonging and care in conditions of prolonged uncertainty.

Subject of Research: Aging, health, identity and vulnerability among elderly Afghan refugees in long-term displacement in Pakistan

Article Title: Health, identity, and vulnerability among elderly Afghan refugees in Pakistan

Article References: Latif, M. A. (2026). Health, identity, and vulnerability among elderly Afghan refugees in Pakistan. Discover Aging, 1(1), Article 9. https://doi.org/10.1007/s44518-026-00009-y

Image Credits: AI Generated

DOI: 10.1007/s44518-026-00009-y

Keywords: Afghan refugees, Pakistan, elderly refugees, forced migration, chronic illness, healthcare access, social isolation, informal care, identity, mental health, structural vulnerability, aging