This letter comes urgently from a unified network of diabetes associations and public health advocates, in a heartfelt, humanitarian request for prompt medical aid in Gaza. There is a dire need for an immediate and permanent ceasefire, an emergency medical envoy and a refunding of UNRWA to provide critical medical aid to the people in Gaza immediately.

In line with the appeals from the United Nations, the World Health Organisation (WHO), Unicef, and others, we appeal for the United States to use its role to demand a humanitarian crossing to allow crucial life-saving supplies into Gaza.

The United Nations Refugee and Work Agency (UNRWA) has played a significant role in healthcare provision in Gaza. Before October, UNRWA served as the lifeline by which people with diabetes received their supplies, providing 70-80% of primary healthcare services for noncommunicable disease in Gaza.

As a consequence of the ongoing massacre with frequent airstrikes occurring, reports state that 1.7M people have been displaced. As of March 25, 2024, over 114,000 people in Gaza have been killed, injured or are reported missing or under the rubble. Gaza’s health system was already under-resourced before October 2023 and now only 10 out of 36 hospitals are partially functioning. Additionally, 27 children have died of malnutrition. Imposing a blockade to Gaza for humanitarian aid is against International Law and is a crime against humanity and a war crime per the Geneva Convention.

For a person living with a serious chronic condition such as insulin dependent diabetes, lack of access to life-saving medication will and has resulted in the death of people living with diabetes in Gaza. Due to the current conditions, it is impossible for people in Palestine with diabetes to obtain critical supplies.

Access to Pharmacies and Medical essentials

• Medical facilities have been bombed; pharmacies are closed. A person with a serious medical condition currently has no means by which to collect critical medications.
• One full 250 units/ml pen of the most common rapid acting insulin lasts an average of 5-6 days, depending on physiological needs and total daily doses. Those who have a higher insulin resistance in their body require higher doses of insulin and may use a full pen of insulin within 3-4 days.
• In the absence of insulin, people with diabetes will first suffer from DKA, then a diabetic coma, and then death.
• To make this insulin last for a longer duration, people will ration their supplies by taking less insulin than required resulting in consistently higher blood glucose levels and risk of high ketones / Diabetic Ketoacidosis (DKA) and potential of a diabetic coma; long term organ damage / complications.

Insulin Storage

• Unused insulin vials, cartridges or pens should be stored in a refrigerator between 36-46 Fahrenheit. If stored properly these will remain ‘good’ until the expiration date. Opened vials of insulin should be maintained at room temperature between 56-80 Fahrenheit. Insulin that is not maintained at this temperatures does not work efficiently, leading to elevated blood sugars. The present temperatures at day within the Gaza strip are averaging 78–84 Fahrenheit.

Insight from the Palestinian Ministry of Health:

According to the Palestinian Ministry of Health the statistics in Gaza taken in 2018 shared there are approximately 68,000 people with diabetes living in the Gaza strip.

Call for Action (to sign onto below):

• Demand an immediate ceasefire and a medical envoy to provide critical medical aid immediately.
• Allow the organisations providing humanitarian aid including UNICEF, UNRWA, WHO, Anera, PCRF, Red Crescent, and MedGlobal, along with other CBOs to provide medical and humanitarian aid including food and water to the people of Gaza.
• Work with internal health institutes / organisations in the aftermath of the damage caused by these attacks, to assess and support access to medical care for people living with diabetes in Gaza.

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Diabetes Humanitarian Aid Coalition