Dar Al-Shifa hospital after bombing, Aleppo, Syria,2012 ( AFP/Getty Images)
Two and a half years after the uprising that has escalated into a full-blown civil conflict, Syria is suffering from one of the worst displacement crises in the world. According to the head of the UN refugee agency, 7 million Syrians, or almost one-third of its population, have been displaced by the ongoing armed conflict. Among these, five million are still in Syria, and about two million have taken refuge in neighboring countries.
The civil war has created a complex humanitarian emergency, and poses an imminent threat to the health of those displaced by conflict. Aside from many infectious diseases thriving under these circumstances, those suffering from chronic non-communicable diseases have also felt the effects of Syria’s ongoing violence.
Prior to the conflict, non-communicable diseases were already the leading cause of morbidity and mortality in Syria, and with its escalation, the condition of many patients with chronic diseases such as diabetes has worsened. In 2011, there were more than 430,000 registered diabetic patients in Syria, of which 40,000 were children with T1DM.
Rada Hallabi, 4, a diabetes patient in a refugee camp near Azaz village, Syria, 2012. (Manu Brabo/AP)
One of many challenges that displaced people with diabetes face is the limited availability of and access to insulin and other anti-diabetic drugs. In Syria, 57% of public hospitals have been damaged and 36% are no longer functional, and in some governorates, up to 70% of the health practitioners have fled, resulting in limited access to health care for those in need. Pharmaceutical plants, which used to produce more than 90 percent of the country’s drug needs, have dropped their production capacity by 75 percent, resulting in an acute scarcity of medication for chronic conditions. According to WHO, insulin is no longer available in some of the areas affected by the conflict. Even when available, diabetes medicine is sold at an exorbitant price, making it unaffordable for the displaced population.
Aside from this, substandard living conditions, improper nutrition and stressful life events further aggravate the health condition of the displaced population with diabetes. Left uncontrolled, diabetes can lead to severe complications such as kidney failure, blindness, stroke, renal failure, limb amputation, diabetic foot ulcers, cardiovascular diseases, poor pregnancy outcomes, or eventually lead to death.
As the conflict in Syria continues to escalate, it is important to recognize the issue of controlling diabetes in conflict situations. Diabetes and other non-communicable diseases should be thus taken into account when assessing and preparing for interventions in conflict settings.