14 November, World Diabetes Day – according to the Gazan Ministry of Health, 71,000 people are living with diabetes and a further 225,000 with high blood pressure in the war-stricken territory.
While the baseline prevalence of non-communicable diseases in Gaza – including diabetes – was already high before the start of the recent conflict, medical care was still widely accessible. The outbreak of war, however, placed enormous strain on the pharmaceutical supply chain as key medicines such as insulin became increasingly difficult to import. Coupled with the destruction of hospitals and primary health care centres, and the dismantling of Gaza’s health infrastructure, tens of thousands of people in Gaza are at risk of life-threatening complications from diabetes.
The challenges of managing diabetes in the Gaza Strip
Amal, 31, was diagnosed with diabetes as a teenager. A week ago, she arrived at the UK-Med emergency department in Al Mawasi, Khan Younis, after an injury on her foot became infected.
‘I was out collecting food when a nail went through my sandals. Because I’m diabetic I couldn’t feel it, and I only noticed the wound after four days, at which point my whole leg was red and infected. I was admitted to the UK-Med hospital for IV antibiotics, but the doctors said I needed to stay under observation on the inpatient ward.’
‘My illness is very severe, so I was committed to doing everything I could to control it before the war. I made sure I took my medication; I went for check-ups. I was taking good care of my health.
‘But since the war began, insulin has been difficult to find. It’s not always available in the clinics and I can’t afford to buy it on the market. Because we are staying in tents and it is very hot, there is nowhere I can safely store the insulin. It expires very quickly because of the heat. At home, before the war, I had a fridge for my medication, but now the insulin is expired and makes me ill when I take it.’
Hind, a pharmacist at the UK-Med field hospital explained: ‘At room temperature, insulin will last a couple of weeks. But everyone has been displaced – we are living in tents which are like furnaces in the sun, so the medication expires much quicker.
Stress: the hidden cause of diabetes complications
Lack of supply, expired medication, and restricted access to healthcare has resulted in an alarming increase in diabetes complications in Gaza. But there is another, hidden contributor – stress. Hind explained:
‘Stress can affect the hormones that help manage diabetes in the body. Your body releases hormones like cortisol and adrenaline when you’re feeling stressed, which can lessen the efficacy of insulin, resulting in increased blood sugar levels. If the stress doesn’t dissipate, it can keep your blood sugar levels high and put you at higher risk of complications.’
Living under the shadow of relentless bombing, displacement, hunger, and disease, stress is a constant companion for people in Gaza. For Amal, her stress will continue even after the is treated and discharged.
‘I can’t lie and say I’m in a good mental state,’ she said.
‘Psychologically it is very difficult. I’m very worried about being discharged and going back to my tent because my wound will get infected again. The sand is dirty, and while I will try my best to keep my feet clean so that they don’t get infected again, these conditions can cause all sorts of complications.’
