Since settling in Armenia 17 years ago, Sonya Sargsian can only recall losses, hardships and heartbreaks.

“When we escaped Azerbaijan in 1988, the state gave us temporary asylum here with assurances we would receive an apartment later,” said the 80-year-old widow. “But they forgot about us,” she continued, repeatedly pressing her face into her open hands.

A “refugee,” Mrs. Sargsian is among the thousands of Armenians who fled their homes in neighboring Azerbaijan in the late 1980’s and early 1990’s.

“Who needs a life like this? I don’t want to live in these inhumane conditions,” she added, gesturing at her run-down studio apartment.

Sonya Sargsian resides in a dilapidated government-owned building housing impoverished pensioners and the homeless — one of three clustered in a forgotten suburb of Yerevan, the Armenian capital. Built as a student dormitory after World War II, the building has not been renovated since its construction. Residents share a common bathroom, which barely functions. Decrepit plumbing supplies water at irregular intervals.

“We can’t take a bath for months. We walk a district away to get water. Those unable to make the trip try to forget they have basic human needs,” Mrs. Sargsian said, pointing to the sewage leaking through the ceiling.

Complicating matters is the disappearance of her son and his family. “When the war began,” she said, “I sent my son and his children to his in-laws’ home in Chechnya. I had no idea they would escape one war only to find themselves in another.”

She has received no news of their whereabouts; attempts to contact them have not yielded any leads. “Their home has been shelled and ruined. Nobody lives there,” she concluded.

For many elderly Armenians such as Sonya Sargsian, a normal life is but a memory.

A small landlocked nation of 2.9 million people, Armenia has paid a high price for its independence from the Soviet Union in 1991. Once part of a mammoth state-controlled centralized economy, Armenia has had to go it alone. Soviet-organized trading patterns collapsed and state-subsidized industries decayed.

Exacerbating Armenia’s economic turmoil, the conflict over Nagorno-Karabakh — an Armenian enclave seeking independence in neighboring Azerbaijan — soon escalated into war. Azerbaijan imposed a blockade that cut off Armenia from the outside world, crippling its economy further. By the mid-1990’s, the blockade had worsened living conditions in Armenia, leading hundreds of thousands of people to emigrate. Many of those who remained until the Russian-brokered cease-fire in 1994 endured years of economic warfare without electricity, heat and other basic amenities.

Armenia’s economy began its slow but steady recovery once fighting stopped and the state implemented wide-ranging reforms. According to government statistics, Armenia’s economy has grown at a double-digit rate for the past seven years. Official figures also indicate the poverty rate dropped from 56 percent to 35 percent between 1999 and 2005.

While Armenia’s current economic success may be a source of jubilation for some, for many it has translated into little if any improvement in their lives. The income gap in Armenia has widened and poverty remains widespread. Armenia’s most vulnerable citizens, children, the disabled and the elderly, have experienced a decline — at times dramatic — in the quality of their lives.

Most senior citizens depend on pensions to survive. And though the average pension has increased by $10 over the last five years, the cost of living has risen, mitigating the effectiveness of any increase. Today a typical pension pays a third of what is considered necessary for the average person to maintain the minimum standard of living in Armenia.

“The problem with raising pensions is quite difficult,” said Anahit Gevorgian, who heads the Elderly Issues Division in the Ministry of Labor and Social Issues. “Paying higher pensions is impossible in a country with widespread unemployment.

“Today there is just 0.9 worker for every pensioner, when there should be at least two workers to pay for one person’s pension.” About 11 percent of Armenia’s citizens are 65 or older.

In addition to the high unemployment rate, many Armenians work in the country’s substantial but informal economy. These “black market” jobs undermine the national pension system since neither the employee nor the employer pays taxes on salaries. Tax evasion of this kind plagues Armenia’s economy; the World Bank and the International Monetary Fund recently urged Yerevan to address the problem swiftly, which poses a principal hurdle to the country’s economic health.

Though pensions continue to fall short, the government is taking measures to make primary medical care freely available to pensioners in need; but those requiring specialized care must register in the hospital system. Generally, patients in Armenia pay for at least a portion of their medical costs. Under a special state-issued order, however, hospitals are required to waive their fees for pensioners, including those associated with specialized examinations and procedures.

Unfortunately, the order, signed into effect by the health minister, has had little success in compelling profit-driven hospitals to waive fees for pensioners.

“Each time we take an elderly person to the hospital using the state-issued order, they simply refuse the patient. In cases where we manage to have them admitted, we are forced to pay for everything,” said Karine Hayrapetian, a social worker with Mission Armenia, a social service agency serving the needs of elderly Armenians.

All too aware of these and other gaps in the health care system, Ms. Gevorgian says the breadth of the problem reaches farther than anything the Elderly Issues Division can tackle alone. A solution demands an overhaul of the entire national health care system.

For generations, Armenia’s seniors lived out their golden years in the company and loving care of their children. Their plight today comes as an alarming wake-up call to many in a society deeply rooted in traditional family values. A crisis that cannot be chalked up to inadequate pensions alone, it reveals a fundamental change of the family’s role in contemporary Armenian society.

Prior to independence, Armenia had only one nursing home and it operated at 50 to 60 percent capacity. Today, seven nursing homes are scattered throughout the country. Overcrowded, these facilities have long waiting lists with as many as 100 or 200 persons waiting for a room.

“Attitudes about bringing elderly family members to nursing homes have changed,” said Artur Markosian, deputy director of a government-run nursing home in Yerevan. “It used to be shameful to do so; no child would bring a parent to such a place. But today, everything is seen from a different point of view.”

The growing demand for nursing homes is not the sole indicator that Armenia’s traditional family-centered values are deteriorating. The children of aging Armenians are not only admitting their parents into nursing facilities in record numbers, they are also in large part abandoning them in the process. According to Anahit Gevorgian of the state’s Elderly Issues Division, about 80 percent of the patients at nursing homes have children. However, she said, less than 10 percent of these patients ever receive visitors.

“It often happens that children bring their parents to the nursing home without telling them where they are going and why,” said Mr. Markosian, and “many children don’t even attend their funerals when they die.”

Bedridden, Astghik Sirekanian rarely leaves her small room at a state-supported home near the capital.

“They forgot I raised them,” the 83-year-old widow said of her three children.

“I have two diplomas, one in law and the other in economics. I gave higher education to all my three children. I don’t deserve to die alone.”

In the absence of family and without regular visits by their children, many nursing home residents rely on the staff and one another for emotional support.

“In homes for children, workers try to replace parents, here we replace children,” said Laura Hayrapetian, a nurse at one of the state-run nursing homes.

“The work is hard, physically and morally.”Dressed in a neatly pressed shirt, 77-year-old Hovhannes Minasian sits with Tamara Hakobian, a fellow resident he married four years ago. Discussing their marriage, the gray-haired man said with a smile, “Overcoming hardships together is easier.

“Outside, there are people who do worse than me,” he continued. “Struggle is a normal thing in life. You struggle at every stage: We struggled against hunger during the war years. After independence, we struggled against cold and hunger. And now, we have to overcome being deserted, and we will win.”

In lieu of comprehensive state-sponsored initiatives or the traditional means of caring for pensioners — the family — grassroots efforts have filled the void.

Mission Armenia, the single largest initiative serving the elderly community, provides services to nearly 8,000 needy persons. Established as a volunteer group soon after an earthquake struck northern Armenia, today the agency employs some 500 people in 100 offices throughout the country.

“Over time, we’ve expanded our work,” said Mission Armenia’s founder, Hripsime Kirakosian, of the group’s outreach to pensioners. “We began with only in-home care and now we have two 24-hour full-service medical centers and a program for house cleaning and home repairs.

“We also have opened 40 medical clinics with outpatient services in several regions and, of course, we run the soup kitchens. All services are offered according to need and availability,” she continued.

By far its most well-known program, Mission Armenia’s soup kitchens provide hot meals each day to 5,000 individuals at 32 locations in nine regions across the country.

The Armenian government contributes to Mission Armenia’s budget; last year alone, state funds accounted for approximately 20 percent of the agency’s budget. Mission Armenia also receives support from a number of international organizations, including Caritas, Oxfam, the United Nations World Food Program and the United States Agency for International Development.

In cooperation with the Armenian General Benevolent Union, the Armenian Apostolic Church — perhaps the most dominant force in Armenia — provides daily meals to needy elderly people and orphaned children in six locations in Yerevan and three other towns, feeding an estimated 1,200 people per day.

“Before the soup kitchens, there were days my wife and I didn’t even have bread so we just drank water for dinner,” said 75-year-old Grisha Ohanjanian. “About four years ago, our pension was very small, just $8, which isn’t even enough to sustain a dog.

“Both of us lost 22 pounds.”

Despite suffering from Parkinson’s disease, Mr. Ohanjanian travels nine miles each way to the soup kitchen, where he eats then picks up prepackaged meals for his bedridden wife.

The Ohanjanians have a son, but he does not live in Armenia. Mr. Ohanjanian does not complain and contents himself with the annual letters he receives from his grandchildren. “They hardly make a living,” he said. “How can they help us?”

Soup kitchens offer more than just a meal for the hundreds of needy pensioners who gather at each location every night. Once there, these mostly solitary individuals have the chance to socialize, participate in a variety of hobby groups, sing in a choir or obtain legal, medical and psychological services.

“This is a restaurant for us,” said 76-year-old Emma Navasardian. “People here serve us with smiles on their faces. Those who have difficulties eating get assistance.

“And,” she pointed out with a smile, “I haven’t even mentioned how clean and fresh the food is.”

Reporter Gayane Abrahamyan is based in Armenia. Photojournalist Armineh Johannes has contributed to these pages for more than a decade.