It’s truly heartbreaking to contemplate the challenges individuals with diabetes face in regions ravaged by conflict. These communities are already grappling with immense adversity, and the addition of managing a chronic illness like diabetes only compounds their struggles. It’s crucial to shed light on these issues and explore how we can support those navigating diabetes amidst conflict. As Dr Tedros, Director-General of the World Health Organization, aptly stated,

“There cannot be health without peace, and there cannot be peace without health.”

Wars and acts of terrorism wreak havoc on healthcare infrastructure, pushing many regions to the brink of collapse. Basic medical supplies and facilities become scarce, leaving countless individuals without access to essential healthcare. The destruction and disruption caused by conflict make it challenging to obtain crucial medications, including insulin, further exacerbating the plight of those managing diabetes.

Individuals with diabetes in conflict zones often face limited access to life-saving medications like insulin. The scarcity of humanitarian aid and the need to constantly relocate to avoid danger make it difficult to maintain a stable supply of medication. Additionally, inadequate storage conditions, exacerbated by erratic access to electricity, pose significant challenges for insulin storage and efficacy. This dire situation underscores the urgent need for sustained efforts to ensure uninterrupted access to essential medications for those in conflict-affected areas.

Access to insulin is crucial for people with diabetes to survive, maintain health, and build immunity against diseases.

The displacement of millions of individuals due to conflict adds another layer of complexity to managing diabetes. Forced to flee their homes, many find themselves in precarious situations. The continuous movement inherent in conflict zones makes it challenging for individuals to maintain consistent diabetes management practices. With limited access to healthcare and essential resources, an increase in health risks and complications can arise.

As of the 12th December 2023, according to UNRWA, almost 1.9 million people in Gaza, or nearly 85 per cent of the population, are estimated to be internally displaced with many of them being displaced multiple times. In Ukraine, as of December 2023, 3.7 persons were internally displaced. And in South Sudan, there were 2.3 million internally displaced people as of July 2023.

For an individual with diabetes, not being able to have their insulin doses on time or as often as needed can be a major concern. Food and water insecurity further complicates the situation by affecting blood glucose levels, leading to hyperglycaemia (high blood glucose levels) and hypoglycemia (low blood glucose levels).

A limited supply of insulin means individuals with diabetes also face many health concerns. Uncontrolled blood glucose levels will increase the prevalence of other diabetes-related conditions. Everything from cardiovascular conditions, nerve damage, eye conditions, and even amputations. More imminently, Diabetic Ketoacidosis (DKA), which can occur due to consistently high blood glucose levels.

Displacement and overcrowded living conditions, compromise healthcare infrastructures. With limited access to clean water and sanitation facilities, the prevalence and spread of viral diseases are further exacerbated. Some of the viral diseases commonly observed in such contexts include:

1. Respiratory Infections: Viral respiratory infections like influenza, respiratory syncytial virus (RSV), and adenovirus are often prevalent in overcrowded refugee camps and makeshift shelters. Poor ventilation and close quarters facilitate the transmission of respiratory viruses, leading to outbreaks among displaced populations.
2. Dengue Fever: Mosquito-borne viral diseases like dengue fever can proliferate in war-torn areas with stagnant water sources and inadequate vector control measures. Displacement and disruption of public health services may further exacerbate the risk of dengue outbreaks in affected communities.
3. Hepatitis A: Viral hepatitis, particularly hepatitis A, can spread rapidly in poor sanitation and hygiene practices. Contaminated water sources and inadequate sanitation infrastructure increase the risk of hepatitis A transmission among displaced populations living in crowded and unsanitary conditions.
4. Measles: Measles outbreaks can occur in conflict-affected areas with low vaccination coverage and disrupted healthcare services. Displacement, malnutrition, and limited access to healthcare facilities contribute to the vulnerability of children and adults to measles infection and its complications.
5. Polio: While efforts to eradicate polio globally have made significant progress, conflict-affected areas with weak health systems and population displacement remain at risk of polio outbreaks. Insecurity and access constraints may hinder vaccination campaigns and surveillance efforts, allowing the virus to circulate undetected.
6. COVID-19: The COVID-19 pandemic has posed unprecedented challenges in conflict zones, where overcrowded living conditions, limited healthcare capacity, and disrupted supply chains exacerbate the spread of the virus. Inadequate access to testing, treatment, and vaccination further compounds the impact of COVID-19 on vulnerable populations in war-torn areas.

Diabetics are at a greater risk of contracting viral diseases in these regions due to their already compromised immune systems, leaving them vulnerable to death.

According to a study published in the Public Health Journal, the impact of displacement and trauma endured by individuals in war-torn areas can lead to an increased level of inflammation in the body. Resulting in an early presentation of diabetes in Individuals who had no history of the condition.

Living with diabetes in a war-torn region takes a toll on mental health, amplifying stress, depression, anxiety, trauma and post-traumatic stress. The constant threat of violence, displacement, and uncertainty about the future contribute to heightened psychological distress among individuals and their families.

When someone experiences stress, their body releases hormones such as cortisol and adrenaline as part of the natural “fight or flight” response. These hormones can interfere with insulin’s ability to regulate blood sugar effectively, leading to insulin resistance. Insulin resistance means that the body’s cells are less responsive to insulin, resulting again in higher blood glucose levels.

In everyday life, stress can significantly impact eating habits, leading individuals to opt for less nutritious foods or to overindulge, thereby exacerbating fluctuations in blood sugar levels. Moreover, individuals with diabetes commonly experience heightened anxiety about hypoglycemia or low blood sugar, and stress tends to exacerbate these concerns. However, for those enduring such challenging conditions in war-torn regions, where access to healthy and regular meals becomes a luxury, the fear is compounded by the hostile environment and the added pressure of managing their condition. As a result, the inevitable consequence is a disruption in blood glucose levels, further complicating the already daunting task of diabetes management.

As we reflect on the challenges faced by these individuals, it is imperative, that we take action to provide support and assistance to those in need. Whether through humanitarian aid efforts, advocacy for improved healthcare infrastructure, or raising awareness about the plight of these communities, each of us has a role to play in making a difference.

We must recognise the interdependence of health and peace, as so eloquently stated by Dr Tedros Director-General of the World Health Organisation. ”Without peace, there can be no health, and without health, there can be no peace’. It is only by addressing the underlying causes of conflict and striving towards a more fair and just world that we can truly ensure the well-being of all individuals, including those who live with diabetes in the most difficult of circumstances.

Thanks for stopping by

Amina xx