WHO helps diabetes patients in Syria

March 2016

A shortage of insulin in Syria is threatening the health of thousands of people with diabetes. WHO is working hard to fill the gap created by the disrupted health system and lack of local production but many challenges remain.

Hussam Hidaoui prepares an insulin shot.
WHO/T. Jašarević

Hussam Hidaoui, 27 years of age, was diagnosed with type 1 diabetes as a child and is 1 of an estimated 400 000 Syrians whose survival depends on insulin. He gets only 1 insulin shot once a day, and even that is not always an easy task in Syria, a country that has been in conflict for 5 years.

“I have learned how to live with the disease, it has become my friend,” he says with a smile, as he shows his insulin kit at the Syrian Association for Diabetes Care in the capital city, Damascus.

Before the conflict, there were around 200 specialized diabetes clinics across Syria. Many are no longer functioning howver, or lack adequate staff or supplies, especially those in areas the conflict makes hard to reach.

Based on the new WHO diabetes Syria country profile, the prevalence of diabetes amongst the population has almost tripled since 1980, with more than 1 in 10 Syrians (12.6% of females and 11.2% of males) today living with diabetes.

Learning about diabetes

Diabetes is a noncommunicable disease (NCD) that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar.

Type 1 diabetes is mostly diagnosed in childhood and is characterized by a lack of insulin production leading to insulin-dependency. The type 2 form of diabetes is caused by the body’s ineffective use of insulin, often resulting from excess body weight and physical inactivity. Many people with diabetes lack crucial information about how to control their blood sugar levels and use insulin properly.

“I have serious issues with my eyes and my kidneys as I was not using insulin properly,” says Hussam, who now visits the diabetes centres regularly for advice and free blood sugar tests.

Insulin shortages

More than half (60%) of insulin-dependent Syrians are at risk due to limited supplies. Prior to the conflict, insulin was provided free of charge to all registered users with the National Diabetes Programme. But today, shortages are common. Syria’s only facility producing insulin has been damaged and has stopped production.

Lack of insulin for insulin-dependent patients leads to hyperglycaemia, or raised blood sugar, which can cause serious damage to many of the body's systems, especially the nerves and blood vessels.

WHO is now the main supplier of insulin in the country with over 500 000 vials delivered in 2015. “We are trying to fill the gap created by the lack of local production, either by supplying diabetes centres directly or through nongovernmental organizations,” says Ms Elizabeth Hoff, WHO Representative in Syria.

But it is not always possible to have all types of insulin readily available in the diabetes centres. Shortages are frequent. This leads diabetes patients to sometimes use a different type of insulin or be forced to buy it from the private sector.

“Recently a patient fell into a coma because he could not find his usual medication and used the only available type of insulin he could find in a nearby pharmacy”' explains Dr Bilal Hammad, a diabetes specialist and director of the Syrian Association for Diabetes Care.

Distribution to areas not controlled by the government is an additional challenge. Maintaining the cold chain from the warehouse to the final destination is difficult, while access to many parts of Syria is hampered by insecurity. “We include insulin in the shipments only if we know that the cold chain can be maintained,” says Ms Hoff.

According to WHO, around 9% of adults worldwide had diabetes in 2014. In 2012, diabetes was the direct cause of 1.5 million deaths globally.