In rebel-controlled areas of Syria, the acute risks of living with diabetes have been exacerbated by irregular access to food and medicine. For those who depend on daily doses of insulin, the problem can be a daily struggle to manage given the severe scarcity of the medicine in these areas. The problem is magnified by the fact that just six months ago, most diabetic were able to get their medicine nearly for free through a discontinued aid program.

Doctor Firas Abu Abdou, an endocrionaly and diabetes specialist in southern Idlib, told the Syrian Voice explained the acute dangers diabetics face. “There are several complications related to diabetes resulting from insufficient medicine of the proper type and patients not being able to keep their blood sugar where it should be. This can cause nerve damage and chronic renal damage. Untreated conditions could lead to gangrene which starts in the foot and leads to it needing to be amputated.”

Mara’i Abu Osam, a pharmacist from southern Idlib, explained to the Syrian Voice that “insulin has disappeared from the market,” adding that “when it is available, the price of one vial can be as much as 3,000 SP ($13.95), whereas it used to not cost more than 600 SP ($2.79).”

“The Asian Company for Medicine Production used to be the only producer of insulin and hormone medications in Syria. With the onset of the revolution and the expansion of the war, the company began shipping a lot of its medicine to Iraq, looking for higher prices. In Iraq, prices are five times more than what they are inside Syrian. Recently, the company stopped producing insulin because they didn’t have the primary ingredients and because of the bad security condition in Aleppo, where its headquarters is located. This has led to a scarcity of insulin over the last six months, and the problem has spread throughout Idlib.”

Things were not always this way. Beginning in November 2014, the opposition Syrian Interim Government began providing insulin in Idlib via the Syrian American Medical Society through clinics in Saraqb, Kasanfara, and KafrTakharim, but due to funding issues the SIG stopped its work semi-permanently several months ago, including the work of the Ministry of Health which was overseeing the project of distributing insulin.

Abu Ahmad Khutab, a diabetic “I need 10,000 SP ($46.70) a month to pay for my dosages of insulin, after the clinic in our village stopped providing it for free, and sometimes I have to travel as far as 40km in order to buy it. This has saddled me with new burdens on top of providing for my family of seven.

Zaher al-Bukour, the director of the KafrNabel Health Clinic told the Syrian Voice the story of a diabetic girl who came to the clinic.

“She was 14 when she came and had Type 1 diabetes, and hadn’t been able to get a dose of mixed insulin for more than a month, so her father was giving her rapid-acting insulin, which resulted in her going into a diabetic coma. She was taken to a hospital where she was treated, but now she suffers from weak retinasand continuous bleeding if she gets her menstrual cycle.

“In our clinic there are more than 200 patients diabetics who need insulin, and in another center there are 100, we have them documented by name. Despite our pleas on social media for help saving what remains of our patients, who suffer on the levels of both a health and quality of life, things remain the same.”

One diabetic told the Syrian Voice his views on the issue, saying “people with diabetes and other chronic conditions are the invisible victims of the Syrian war who are not portray in the media. They hope local and international organizations will help helping to provide them with these basic medicines, before it begins to threaten their lives.”