Livelihoods & caregiving  

Providing care to injured and impaired survivors of gun violence often falls to family, friends and other community members, particularly women and girls. Caregiving includes emotional, physical, logistical and economic support. This essential support is usually unpaid as well as unrecognised from a social and policy perspective. Caregivers may be forced to give up or significantly reduce their paid work hours in order to take on caregiving duties.

  • Caregiving can increase psychological problems and decrease health and mental wellbeing of the caregivers.[1]
  • Caregivers are in short supply. One study found that in the past decade, adults with injuries and impairments aged 30-65 were the fastest-growing population in US nursing homes.[2] This is because some young people find the only accessible and safe care setting to be a nursing home, which is neither socially- nor age- appropriate.

In the long term, survivors of gun violence may face difficulties getting a job or otherwise being a part of  society. Some survivors are so impaired that they cannot engage in any kind of paid employment, some are not given a fair chance to do so. More often, the obstacles are in the minds of employers and the physical arrangements of workplaces and transport systems that do not accommodate people with mobility or cognition issues

  • People living with impairments are twice as likely to be unemployed and are at greater risk of living in or on the verge of poverty.[3]In some countries, unemployment among people with impairments is as high as 80[4]
  • A 2006 survey of patients at a rehabilitation clinic in El Salvador revealed that their primary concern was economic survival, not long-term health.[5]

In such instances, survivors may have to depend on social protection schemes. This refers to policies and programmes that provide individuals with a degree of income security and other support. However coverage is not universal. Where eligibility for social security depends on having made payments in the course of formal employment, large numbers of survivors do not qualify. Where social assistance is offered for survivors of conflict-related violence, eligibility can be contingent on political criteria or being a part of fighting forces.

  • An estimated 5.1 billion people lack adequate social security or social protection worldwide.[6]
  • Coverage decreases in middle- and low-income countries, and is as low as 10% across sub-Saharan Africa.[7]
  • In India, Kashmiri families of those killed or injured by security forces are not eligible for government social security assistance.[8]
Providing care to injured and impaired survivors of gun violence often falls to family, friends and other community members, particularly women and girls.

Weak or non-existent social security is particularly problematic given the health costs incurred by people with impairments.

  • People with severe impairments in India spend 1.3 times more on healthcare than their able-bodied counterparts.[9]

Gun violence increases the number of female-headed households, because so many men are killed or impaired in ways that make paid employment difficult. Since women generally earn less than men, financial pressure on the household is likely to increase.  This affects the education of children and young people, who may drop out of school or engage in risk-taking behaviour to contribute to household income. Male unemployment can also exacerbate violence against women.[10]  

Resources and References

International Social Security Association

World Bank Disability & Development webpage

International Labour Organisation Disability & Work webpage

UN Enable


More resources: Click here for a document with more website suggestions, articles and reports


[1] J. Brodsky, J. Habib, and M. Hirschfield (Eds), Long-term care in developing countries: ten case studies (Geneva: WHO, 2003).

[2] J. Shapiro, “A new nursing home population: The young,” National Public Radio, December 9, 2010. Includes data from the US Centers for Medicare and Medicaid Services. Accessed 14 August 2012.

[3] Organisation for Economic Cooperation and Development, Sickness, Disability and Work: Breaking the Barriers (Paris: OECD, 2010), p.10.

[4] UN Enable fact sheet on persons with disabilities. Accessed 13 August 2012.

[5] Centre for Humanitarian Dialogue, Surviving gun violence in El Salvador: A tax on firearms for health Background paper No. 3 (Geneva: HD Centre, 2007); J. S. Krause and C. A. Anson, “Adjustment after spinal cord injury: relationship to participation in employment or educational activities,” Rehabilitation Counseling Bulletin 40/3 (1997), pp. 202-214.

[6] International Labour Organization, Social protection floors for social justice and a fair globalization (Geneva, ILO: 2011).

[7] International Social Security Association, Dynamic Social Security for Africa: An Agenda for Development (Geneva: ISSA, 2008), p.1.

[8] R. Singh Nandal, “State data refutes claim of 1 lakh killed in Kashmir,” Times of India (June 20, 2011). Accessed 9 February 2012.

[9] The World Bank, “Disability and Poverty in Developing Countries: A Snapshot from the World Health Survey,” Social Protection Discussion Paper No. 1109 (2011), p. 14.

[10] C. O. Moser and D. Rodgers, Change, violence and insecurity in non-conflict situations Overseas Development Institute Working Paper 245 (London: ODI, 2005).


Image: 38-year-old Protais Mbonimumpa on his tricycle at his fruit and vegetable shop in Bujumbura, Burundi. Protais lost his leg after being shot by a burglar; this meant he struggled to support his wife and six children because he could no longer travel to the rural areas to buy stock for his shop. After five years he received a tricycle from Handicap International, which enabled him to be mobile again. (Dieter Telemans/Panos 2009)