(source: www.dailystar.com.lb)  Medical and social centers have long catered to the needs of the socially isolated elderly, most of whom have no contact with relatives. At times the onus to take care of them falls on the goodwill of nonprofit organizations, raising the question of whether Lebanese society has lost touch with values that once held the elderly in high esteem. "So, we are going to talk about loneliness, then?" asks Gharabet, a man in his 70s, when informed The Daily Star is profiling the elderly demographic. Having lost both parents in the Civil War, Gharabet, who refused to provide his last name, has been living by himself in a small Burj Hammoud flat ever since. "Up there is God," he says, pointing his finger toward the ceiling, "and down here it's me, alone." He takes comfort in his faith, and expresses thanks to the church and social centers in his neighborhood for catering to his needs. Without this support, he says, he would not manage. There were eight in his immediate family, he recalls. Those that did not perish in the war moved to Canada, and were never heard from again. "They feel dignified here, because they receive attention and are invited to various events and activities," explains Seta Pamboukian, director of Jinishian, a social center in the area that provides services to 120 elderly people, all of whom are impoverished and living alone. "There is some materialism in society, if [an] elderly [person] has money, or property, then they are valued, because they [members of society] expect to inherit. If the elderly [person] is poor, it's a burden for them. We are seeing it, in the society. When people come and ask for assistance and tell their stories, then we see this side of the story." Social isolation within the elderly population is not limited to Burj Hammoud, it is a problem in most urban centers. All the social workers who deal with the elderly that The Daily Star spoke to described similar living conditions among their clients. Without the existence of comprehensive surveys, however, social workers are reluctant to generalize the condition of their clients. Typically, they say, their clients fall under two categories: Either they are isolated in old age because they never had children and are widowed, or they receive no assistance from their children, most of whom have emigrated. The onus to take care of them, then, often falls on these nonprofit centers that try to meet their medical, nutritional and social needs. These organizations, unable to financially sustain a full-fledged program, usually help the elderly on an ad hoc basis. Social workers report that they usually learn their clients have died from people who become accustomed to seeing them on a day-to-day basis, and become concerned when they don't. "It's a complicated issue," says George Massoud Khoury, director of Caritas in Lebanon. Caritas was one of the first organizations to recognize that social isolation among the elderly population was becoming a problem. From his perspective, rural exodus, resulting from poor economic conditions and a transitioning economy, paired with rising living costs are to blame for the plight of the elderly, as their children are effectively forced to move away to earn a living. "They [the children] want to support them, but they are unable to support themselves and their families," he continues. "For those who emigrate, most live making a minimum wage wherever they live." Ten percent of University of Balamand psychiatrist Dr. Georges E. Karam's patients are impoverished elderly citizens living alone, and he says they are the most difficult to treat. These patients in particular exhibit higher rates of mental illnesses such as depression, anxiety and schizophrenia. "The fact that they are socially isolated explains the rates of depression and anxiety, because isolation makes these conditions worse," he says, adding he tends to see more severe illnesses among those elderly people who are isolated. Karam also points out that the risk of suicide is higher among elderly males who live alone. Because people tend to normalize mental diseases as a feature of old age, most - erroneously - don't think it's a problem. "These people are just sitting at home and withering away and there is nothing geared to take care of them at a national level" he says, adding their plight would worsen as the demographic increases. Sister Gioia Sawrma finds the neediest of the elderly on the streets with her organization Mission de Vie's program that also administers a home in Antelias. "We find them under the bridge, sleeping in gas stations, on the streets. There are so many in Lebanon, and we know all of them," she said. The home currently houses 35 people, but many homeless elderly found on the streets simply don't want to live there, Sawrma says. "Some prefer to stay outside," she laughs, "They say they are happy, but I think they are worried to change places. Old people don't like to change their lifestyles." These elderly people have become so dependent on the kindness of strangers, such as local shopkeepers, restaurant owners and neighbors, that they prefer the street lifestyle over a more regimented one indoors: "They don't want to leave because they have gotten used to the people around who help them regularly." During the winter, many old people come to the mission's house just to sleep, but with the coming of warmer months, they leave because "they've come to love the streets." "Some had conflicts with their families and left, some were abandoned by their children," Sawrma explains. She continues that she typically encounters widows, many of whom become poor and neglect their own needs after their spouses pass away. Others who never married find that they reach old age alone and without proper resources. Usually, the mission tries to contact the relatives of the elderly who pass away, "but they don't come." Often, the missionaries are the sole witnesses to the burial. "Once, an old man at home used to be a benediction," says Sawrma, who believes these values are steadily being lost in urban centers. Back in Burj Hammoud, Gharabet, too, feels less respected now that he is an old man. "There is something in the way people communicate with me, I feel it all the time." "It was different when I was a boy. We grew up respecting the elderly, because we were more obedient back then."