'Hunger would kill us instead of COVID-19': Elders' response to the pandemic in Debre Markos Town, Ethiopia.

The COVID-19 pandemic has posed unpredictable challenges globally. Older adults are among the population groups most vulnerable to COVID-19. Poor urban elders in Ethiopia struggle to meet their basic needs due to waning traditional familial norms of providing care for elders as a result of urbanisation, poverty and migration. The aim of this study was to give voice to vulnerable elders during the COVID-19 lockdown in Ethiopia and to reveal their sources of support. Using a qualitative case study design, data were collected from 27 elders aged 60 and above in Debre Markos Town, Ethiopia via in-depth interviews conducted from March-May 2020. To determine the nature of support provided for destitute elders, data were also gathered from two local officials. Narrative data were analysed using thematic analysis. Four prominent themes were identified: 'Hunger would kill us instead of COVID-19,' 'Feeling hopeless and begging to die,' 'We prefer social support rather than food donations' and 'Gratitude.' Elders considered the practice of social distancing to fight COVID-19 as an unwelcome luxury for people whose livelihood depends on begging and petty trade. The physical distancing programme put elders in isolation, diminishing their capacity to maintain their livelihood. Due to the increasing disrespectful attitudes towards aged people, elders felt even less valued than usual. Interactions were described as undermining, embarrassing and abusive. A special emergency fund and organised social supports are needed to minimise the effect of the pandemic on vulnerable groups like destitute elders in Ethiopia. Moreover, an institutional welfare response is needed to ensure elders can live a dignified life.