Diabetes in the Shadow of Conflict Understanding and Addressing the Crisis in Gaza

Authors

  • Abdel Rahman Feras AlSamhori School of Medicine, The University of Jordan, Amman, 11942, Jordan
  • Jehad Feras AlSamhori School of Medicine, The University of Jordan, Amman, 11942, Jordan
  • Abdullah Firas Al-Deffaie School of Medicine, The University of Jordan, Amman, 11942, Jordan
  • Leen Anwer Saleh Alhadidi School of Medicine, The University of Jordan, Amman, 11942, Jordan
  • Michael Khoury School of Medicine, The University of Jordan, Amman, 11942, Jordan
  • Noor S. Bader Department of Basic Medical Sciences, Yarmouk University, Irbid 21163, Jordan
  • Ahmad Feras AlSamhori AlSamhori School of Medicine, The University of Jordan, Amman, 11942, Jordan
  • Mohammad Al-Jafari Mutah university

Abstract

The conflict in Gaza has inflicted severe damage on an already fragile healthcare system, leading to significant challenges in providing adequate care for individuals, particularly those with chronic diseases like diabetes. The conflict has caused immense strain on healthcare facilities, resulting in shortages of essential supplies and medications, including insulin, and disrupting the provision of proper nutrition and medical care. This situation has led to an increase in communicable diseases and a significant impact on individuals with chronic conditions, such as diabetes.

Patients with diabetes in Gaza face numerous challenges, including the inability to access necessary medications, adhere to specialized diets, and receive proper surveillance and care for their condition. The lack of appropriate management can lead to a deterioration in quality of life and an acceleration of disease processes, increasing the risk of complications such as cardiovascular disease, nephropathy, retinopathy, and neuropathy.

To address these challenges, short-term strategies must focus on promptly identifying diabetic patients and ensuring their continuous access to essential medications, particularly insulin. Long-term strategies should include strengthening health information systems, ensuring continuous access to medication and adequate supplies, and providing comprehensive healthcare services targeting diabetes within primary health centers. Additionally, training healthcare professionals in diabetes care, developing national emergency response plans, and fostering effective communication between governments are crucial steps in managing diabetes during crises like the conflict in Gaza.

References

Khunti K, Chudasama YV, Gregg EW, Kamkuemah M, Misra S, Suls J, et al. Diabetes and Multiple Long-term Conditions: A Review of Our Current Global Health Challenge. Diabetes Care. 2023 Dec 1;46(12):2092–101.

Ali MK, Pearson-Stuttard J, Selvin E, Gregg EW. Interpreting global trends in type 2 diabetes complications and mortality. Diabetologia. 2022 Jan;65(1):3–13.

Di Maio M, Leone Sciabolazza V. Conflict exposure and health: Evidence from the Gaza Strip. Health Econ. 2021 Sep;30(9):2287–95.

Jebril M, Liu X, Shi Z, Mazidi M, Altaher A, Wang Y. Prevalence of Type 2 Diabetes and Its Association with Added Sugar Intake in Citizens and Refugees Aged 40 or Older in the Gaza Strip, Palestine. Int J Environ Res Public Health. 2020 Nov 19;17(22):8594.

Abidi SH. Humanitarian Concerns in Conflict Zones: Case Study of Gaza Strip and West Bank. Int J Res Appl Sci Eng Technol. 2024 Mar 31;12(3):946–52.

Keelan E. Medical Care in Palestine: Working in a Conflict Zone. Ulster Med J. 2016 Jan;85(1):3–7.

Ogurtsova K, Guariguata L, Barengo NC, Ruiz PLD, Sacre JW, Karuranga S, et al. IDF diabetes Atlas: Global estimates of undiagnosed diabetes in adults for 2021. Diabetes Res Clin Pract. 2022 Jan;183:109118.

Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022 Jan;183:109119.

Bommer C, Sagalova V, Heesemann E, Manne-Goehler J, Atun R, Bärnighausen T, et al. Global Economic Burden of Diabetes in Adults: Projections From 2015 to 2030. Diabetes Care. 2018 May 1;41(5):963–70.

Khan MAB, Hashim MJ, King JK, Govender RD, Mustafa H, Al Kaabi J. Epidemiology of Type 2 Diabetes – Global Burden of Disease and Forecasted Trends: J Epidemiol Glob Health. 2019;10(1):107.

United Nations. United Nations Western Europe. 2023 [cited 2024 Mar 24]. The UN and the crisis in Gaza: What you need to know. Available from: https://unric.org/en/the-un-and-the-crisis-in-the-middle-east-gaza/

United Nations Office for the Coordination of Humanitarian Affairs. United Nations Office for the Coordination of Humanitarian Affairs - occupied Palestinian territory. 2024 [cited 2024 Mar 28]. United Nations Office for the Coordination of Humanitarian Affairs - occupied Palestinian territory | Hostilities in the Gaza Strip and Israel - reported impact | Day 173. Available from: http://www.ochaopt.org/content/hostilities-gaza-strip-and-israel-reported-impact-day-173

WHO. World Health Organization - Regional Office for the Eastern Mediterranean. 2023 [cited 2024 Mar 24]. Occupied Palestinian territory health crisis 2023. Available from: http://www.emro.who.int/opt/priority-areas/occupied-palestinian-territory-health-crisis-2023.html

WHO. Patients under siege in Gaza (Published 31st October 2023) - occupied Palestinian territory | ReliefWeb [Internet]. 2023 [cited 2024 Mar 24]. Available from: https://reliefweb.int/report/occupied-palestinian-territory/patients-under-siege-gaza-published-31st-october-2023

WHO. World Health Organization - Regional Office for the Eastern Mediterranean. 2024 [cited 2024 Mar 24]. Gaza Hostilities 2023 / 2024 - Emergency Situation Reports. Available from: http://www.emro.who.int/opt/information-resources/emergency-situation-reports.html

IPC. IPC Global Initiative - Special Brief IPC ACUTE FOOD INSECURITY ANALYSIS 15 FEBRUARY - 15 JULY 2024 [Internet]. 2024 Mar. Available from: https://www.ipcinfo.org/fileadmin/user_upload/ipcinfo/docs/IPC_Gaza_Strip_Acute_Food_Insecurity_Feb_July2024_Special_Brief.pdf

Saydah SH. Medication Use and Self-Care Practices in Persons With Diabetes. In: Cowie CC, Casagrande SS, Menke A, Cissell MA, Eberhardt MS, Meigs JB, et al., editors. Diabetes in America [Internet]. 3rd ed. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases (US); 2018 [cited 2024 Mar 24]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK567996/

Khanyk N, Hromovyk B, Levytska O, Agh T, Wettermark B, Kardas P. The impact of the war on maintenance of long-term therapies in Ukraine. Front Pharmacol. 2022 Nov 24;13:1024046.

WHO. Ukraine crisis strategic response plan for June – December 2022 [Internet]. 2022 [cited 2024 Mar 24]. Available from: https://www.who.int/europe/publications/i/item/WHO-EURO-2022-5778-45543-65230

Currie CJ, Peyrot M, Morgan CLl, Poole CD, Jenkins-Jones S, Rubin RR, et al. The Impact of Treatment Noncompliance on Mortality in People With Type 2 Diabetes. Diabetes Care. 2012 Jun 1;35(6):1279–84.

Currie CJ, Peyrot M, Morgan CLl, Poole CD, Jenkins-Jones S, Rubin RR, et al. The impact of treatment non-compliance on mortality in people with type 1 diabetes. J Diabetes Complications. 2013 May;27(3):219–23.

Jimmy B, Jose J. Patient Medication Adherence: Measures in Daily Practice. Oman Med J. 2011 May;26(3):155–9.

Saran R, Li Y, Robinson B, Ayanian J, Balkrishnan R, Bragg-Gresham J, et al. US Renal Data System 2014 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis Off J Natl Kidney Found. 2015 Jul;66(1 Suppl 1):Svii, S1-305.

Bourne RRA, Stevens GA, White RA, Smith JL, Flaxman SR, Price H, et al. Causes of vision loss worldwide, 1990–2010: a systematic analysis. Lancet Glob Health. 2013 Dec;1(6):e339–49.

Moxey PW, Gogalniceanu P, Hinchliffe RJ, Loftus IM, Jones KJ, Thompson MM, et al. Lower extremity amputations--a review of global variability in incidence. Diabet Med J Br Diabet Assoc. 2011 Oct;28(10):1144–53.

Koopmanschap M. Coping with Type II diabetes: the patient’s perspective. Diabetologia. 2002 Jul;45(S1):S21–2.

Lustman PJ, Anderson RJ, Freedland KE, De Groot M, Carney RM, Clouse RE. Depression and poor glycemic control: a meta-analytic review of the literature. Diabetes Care. 2000 Jul 1;23(7):934–42.

Osborn CY, Mayberry LS, Wagner JA, Welch GW. Stressors May Compromise Medication Adherence Among Adults With Diabetes and Low Socioeconomic Status. West J Nurs Res. 2014 Oct;36(9):1091–110.

Roohafza H, Kabir A, Sadeghi M, Shokouh P, Ahmadzad-Asl M, Khadem-Maboudi AA, et al. Stress as a risk factor for noncompliance with treatment regimens in patients with diabetes and hypertension. ARYA Atheroscler. 2016 Jul;12(4):166–71.

Garfield RM. War-related changes in health and health services in Nicaragua. Soc Sci Med. 1989 Jan;28(7):669–76.

Al-Sharafi BA, Al-Tahami BA. The effect of war on the control of diabetes in patients with type 2 diabetes mellitus in Yemen: a cross-sectional study. Endocrinol Metab Syndr. 2017;6(270):2161–1017.

Richter B, Bongaerts B, Metzendorf MI. Thermal stability and storage of human insulin. Cochrane Metabolic and Endocrine Disorders Group, editor. Cochrane Database Syst Rev [Internet]. 2022 Jan 3 [cited 2024 Mar 24];2022(1). Available from: http://doi.wiley.com/10.1002/14651858.CD015385

Levy BS, Sidel VW. Documenting the Effects of Armed Conflict on Population Health. Annu Rev Public Health. 2016 Mar 18;37(1):205–18.

Garry S, Checchi F, Cislaghi B. What influenced provision of non-communicable disease healthcare in the Syrian conflict, from policy to implementation? A qualitative study. Confl Health. 2018 Dec;12(1):45.

Aebischer Perone S, Martinez E, Du Mortier S, Rossi R, Pahud M, Urbaniak V, et al. Non-communicable diseases in humanitarian settings: ten essential questions. Confl Health. 2017 Dec;11(1):17.

Rezaeian M. A review on the most important consequences of wars and armed conflicts. Middle East J Bus. 2009 Jan 1;4:7–9.

Kulenovic I. Health care in wartime conditions. The impact of war on Sarajevans with non-insulin-dependent diabetes mellitus. Eur J Public Health. 1996 Dec 1;6(4):252–6.

Williamson RT. Remarks ON THE ETIOLOGY OF DIABETES MELLITUS AND THE DIET AND CONDITIONS OF LIFE DURING THE WAR. BMJ. 1918 Feb 2;1(2979):139–41.

Jain N, Prasad S, Czárth ZC, Chodnekar SY, Mohan S, Savchenko E, et al. War Psychiatry: Identifying and Managing the Neuropsychiatric Consequences of Armed Conflicts. J Prim Care Community Health. 2022 Jan;13:215013192211066.

Khan Y, Albache N, Almasri I, Gabbay RA. The Management of Diabetes in Conflict Settings: Focus on the Syrian Crisis. Diabetes Spectr Publ Am Diabetes Assoc. 2019 Aug;32(3):264–9.

Kehlenbrink S, Smith J, Ansbro É, Fuhr DC, Cheung A, Ratnayake R, et al. The burden of diabetes and use of diabetes care in humanitarian crises in low-income and middle-income countries. Lancet Diabetes Endocrinol. 2019 Aug 1;7(8):638–47.

Kehlenbrink S, Jaacks LM, Boston Declaration signatories. Diabetes in humanitarian crises: the Boston Declaration. Lancet Diabetes Endocrinol. 2019 Aug;7(8):590–2.

Besançon S, Fall IS, Doré M, Sidibé A, Hagon O, Chappuis F, et al. Diabetes in an emergency context: the Malian case study. Confl Health. 2015 May 1;9(1):15.

Mikityuk MR, Karachentsev YuI. Management of type 1 type 2 diabetes mellitus in conditions of armed conflict. Int J Endocrinol Ukr. 2022 Jun 27;18(4):203–7.

Stacey M, Gifford R, Pye A. Diabetes care in times of armed conflict. Br J Diabetes. 2022 Jun 29;22(1):1–4.

Li R, Zhang P, Barker LE, Chowdhury FM, Zhang X. Cost-Effectiveness of Interventions to Prevent and Control Diabetes Mellitus: A Systematic Review. Diabetes Care. 2010 Aug;33(8):1872–94.

Hii MSY, Courtney P, Royall PG. An Evaluation of the Delivery of Medicines Using Drones. Drones. 2019 Sep;3(3):52.

Zaferani S, Sams M, Ghomashchi R, Chen ZG. Thermoelectric Coolers as Thermal Management Systems for Medical Applications: Design, Optimization, and Advancement. Nano Energy. 2021 Sep 1;90:106572.

Tonelli M, Wiebe N, Nadler B, Darzi A, Rasheed S. Modifying the Interagency Emergency Health Kit to include treatment for non-communicable diseases in natural disasters and complex emergencies. BMJ Glob Health. 2016 Oct 1;1(3):e000128.

Downloads

Published

2024-10-11

How to Cite

AlSamhori, A. R. F., AlSamhori , J. F., Al-Deffaie, A. F., Alhadidi, L. A. S., Khoury, M., Bader, N. S., … Al-Jafari, M. (2024). Diabetes in the Shadow of Conflict Understanding and Addressing the Crisis in Gaza. JAP Academy Journal. Retrieved from https://journal.japacademy.org/index.php/Home/article/view/183

Issue

Section

Review Articles

Most read articles by the same author(s)