Since the massive earthquake in China's Sichuan province, much of the media focus has understandably been on the school children who lost their lives under collapsed buildings and others who were left orphaned.

But as is often the case in disasters, little attention has been paid to the plight of the elderly who are often as vulnerable as children. Likewise, the fate of the tens of thousands left severely injured by the quake has gone largely ignored. On top of dealing with permanent disability, many have now lost the means to earn a living.

Exact figures on disability as a result of the earthquake are hard to find, partly because many of the injured were transferred to hospitals outside Sichuan for treatment.

But aid agency Handicap International China, which has been working in the country for over a decade, estimates around 13 percent of the nearly 400,000 people hurt in the quake suffered significant injury - that's about 50,000 people.

In Mianzhu city alone, over 2,000 people need rehabilitation, says Jean Van Wetter, Handicap's country director. They will need long-term support to rebuild their lives including artificial limbs and counselling.

LIFE-LONG PROCESS

"It's not like you install a false limb or have a prosthetics treatment once and it lasts forever," says Wilson Wong, secretary general of the Hong Kong Red Cross which is running a rehabilitation and prosthetics centre in Deyang Prefecture in the quake zone.

Prosthetics will need to be adjusted and maintained and patients need regular therapeutic treatments. In addition, artificial limbs will suffer wear and tear and need to be changed over the years. But there's a big question mark over how people will afford to pay for this.

Similarly, many people who have received internal fixators - devices to hold fractured bones in place - will need expensive follow-up surgery, according to Wetter.

But active rehabilitation with exercise and regular follow-up is a new phenomenon in China which can make it difficult to persuade people of its importance, says Wetter.

With many survivors preoccupied with trying to get a permanent roof over their heads before winter, aid agencies are finding it hard to convince them to attend check-up and therapy sessions. The vast and difficult geography of the area is another problem.

"Our centre already provides free accommodation and meals during their stay and free transportation for severe cases," said Wong. "But because of the geographical distance, it creates certain difficulties and motivation for them to come back again."

Wetter agreed, saying Handicap has seen a significant decrease in people attending appointments at Chengdu hospital.

Aid agencies are starting outreach programmes, but they say it may take some work to change people's attitude to rehabilitation - especially as a high percentage of those with disabilities are older people.

Wong said of over 500 patients they have treated so far, about 90 percent are aged over 56.

ELDERLY FORGOTTEN

In earthquakes, the elderly usually account for a fifth of those affected, according to Francis Markus, spokesperson for the International Federation of Red Cross and Red Crescent Societies.

Yet, little is written about them and aid workers say older people normally do not receive the assistance they need in times of emergency.

"The tradition of families looking after their elderly parents is already coming under economic and social pressure (in China) and the earthquake has further intensified this pressure," Markus says. "There is a growing need for provisions to look after those elderly."

Aid agency Help Age International says by the middle of the century one in three people in China will be over 60.

With a rapidly aging population and a growing pattern of young people migrating to big cities, older people are often forced to carry on working in rural areas like Sichuan.

Livelihoods are a major problem for all survivors of the quake with many people having lost crops, farmland and animals. But for the elderly, picking up the pieces again can be particularly hard.

"Many older people are, out of necessity, still economically active. A lot of these activities were disrupted heavily during the earthquake," said Peter Morrison, Help Age International's regional programme manager. "The earthquake has left many of these people to fend for themselves."

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