Diabetes in Gaza

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This is Beta Cell, a show about people living with type one diabetes. I'm Craig Stubing.

Have you ever thought about what it would be like managing type one diabetes in the zombie apocalypse? Of course you have. You've considered how much insulin you have in your fridge right now? How you'd find ways to keep it cold. What pharmacy you'd break into to get more insulin. Deep down. You know, you probably couldn't last more than a few months. But we like to think we could maybe push that to a year. Maybe two, if we had to.

As fun of a game as this is, there are many diabetics who live this reality. Not the zombie part, of course. But they live in a place where they have to grab their insulin and evacuate with no warning. Where they don't have access to refrigerators to keep a little insulin they have cold. And we're the pharmacies often don't have any insulin left.

And one of those places is Gaza.

On October 7th, Hamas fighters entered Israel and massacred 1400 people. Including children, and took over 200 hostages. In response, Israel vowed to destroy Hamas and started a bombing campaign that, as of recording this, has killed over 5,000 people, including over 2000 children. A group of independent United Nations experts has called this violence against civilians quote, collective punishment.

And right in the middle of this, are, you guessed it, diabetics. Regular people trying to manage an extremely complicated disease. But with all the additional mental stress, lack of access to supplies, and physical danger, that is present in an armed conflict.

But the access to insulin for diabetics and Gaza didn't start two weeks ago.

It's important for anyone who cares about diabetics to understand what life is like for Palestinians trying to live with type one diabetes in places like Gaza. Not just for the extreme hardships they face now, but the hardships they face all the time.

Mohammed: There's always an attack. There's always a siege. There's always a problem that would affect them and affect everything around them and make them start from the beginning all over again. How would I live, especially under those circumstances?

This is Muhammad, who talked to me from London where he's pursuing his master's degree. He's had type one diabetes for almost 13 years, including when he was living in Gaza City, where he was born and raised.

Mohammed: I love Gaza City, and I love how I grew up in Gaza, and how I was able to see my friends, go to school, go to uni, and enjoy my day with my friends, with my families. Enjoy my mom cooking the best meals I could ever had.

But it's definitely tough. It's like you always have some kind of limitation, especially when it comes to movement. For example, you were invited to a conference, it would be really hard for you to go to that conference because there's almost no way out of the Gaza Strip. And it takes months of preparations of, again, maybe visa denies, to be able to travel out of the Gaza City.

Gazans are resilient people and Palestinians in general are resilient people, and they enjoy life. They want to live. They want the normal life. They want to experience how amazing life is. But of course, every time they want to do this, they've been denied from their freedom of thinking, the freedom of talking, the freedom to dream about their future, because there's always a war against them.

And of course, living with a chronic condition makes it even harder because you don't usually get everything that you need. And sometimes the very basics could sound kind of something like a, like it's a luxury thing to have.

Craig: What does living with type one diabetes look like for Palestinians?

Mohammed: Generally for Palestinians at the Gaza Strip, people living with diabetes would have to get only insulin vials from the healthcare providers, the main healthcare providers in the Gaza Strip. And those are the Ministry of Health and UNRWA, and UNRWA stands for the United Nations Relief and Works Agency. Sometimes children under the age of 18 in UNRWA clinics could get insulin pens, but after that they would just be back on insulin vials. If you want to, for example, test strips, you'd also need to buy those out of your own pocket.

You don't have any access to CGMs, to pumps, any sort of technology that you could think of at the moment, is not available in the Gaza Strip. So even the very basics of insulin, test strips, and education were not available for everyone in the Gaza Strip.

So living with diabetes in the Gaza Strip gets you uncertainty about your future, whether I'll be able to get that for that sort of medication that I need next month or not, whether my family would be able to afford my medication if they can't get it from the Ministry of Health or any healthcare provider there. Sometimes families, and I know personally, people, kind of jeopardize getting food for their own family or getting insulin for the children because they can't afford both.

And on top of all of that, putting attacks and escalations, wars against those people, of course, would make it even much harder for them to live with their condition. Because the constant stress, the constant fear, the lack of sleep, all those things would affect your ability to manage your condition. It would be almost impossible for you to be able to manage your diabetes.

And I've been there. In May 2021 attack, I had to evacuate with my family from my home. And the only thing I was worried about, in my backpack, because I was not able to take anything else, was my insulin. And will this insulin be enough for me throughout the upcoming days, because I don't know whether I'll be back to my home or not.

And during this attack as well, a lot of my friends that I tried to get in touch with, which is hard, very hard because they have no internet connection and very limited access to cellular connection as well, they keep asking me, how can I get my insulin? Where would I be able to get my insulin today?

Imagine that you are in a situation like the current situation in the Gaza Strip. What would you do?

And people with diabetes in the Gaza Strip are currently insulin rationing. they're reducing the amount of insulin they take, or they try to find any type of insulin they could get their hands on, to use it instead of the insulin they used to use, because they don't have access to their regular insulin.

In fact, a mother of two children with diabetes asked me, how will I be able to get insulin for my two children because I cannot go anywhere. And the insulin that I have is only enough for the upcoming two days. Where will I be able to get insulin? So it is again, the fear, the stress, the uncertainty that makes it impossible for those people to manage their condition.

Noor: I never thought that I would be in a point in my life where I am talking to friends, them calling to say goodbye. Because they don't know if they're going to wake up next day. Keep staring at our phones, waiting to see if we hear back from them or not. And then other friends just casually texting you and saying, Hey, I'm alive, I'm fine, but 20 of my family members got killed.

Noor has had type one diabetes for 26 years and currently lives in the Bay Area. She grew up in Abu Dhabi after her family was forcibly displaced, first in 1948, and again, in 1967, that forced them to flee Palestine, where they haven't been able to return since.

Noor: I think a lot of people don't realize or, can't comprehend the fact that I am Palestinian and I don't even have the right to visit and see my own land. Imagine you as an American being like told you're not allowed to come into America. That pain in itself is something that we carry very heavily. And on top of that, you have the generational trauma and just living in diaspora and exile.

And it's been especially hard for me since moving to the U. S. where not only do I have to face all the reality of that, but then I have to justify my existence, as simple as me existing as a Palestinian can be a threatening statement to some people. And that in itself is very scary. And dehumanizing. Just the fact that I have to continuously explain to people, educate them on the very basics of why we deserve human rights, the same as everybody else. Like we're talking about basic human rights at this point. We're not asking for more.

People keep talking about how this has been a 15 day war, but it's not a 15 day war. This has been ongoing for 75 years. The occupation has been there. The oppression has been there. The dehumanization.

For the past two weeks, Israel has not allowed any humanitarian aid into Gaza. And has only recently allowed very few aid trucks into the region. This is how all the clean water, food, and medication, including insulin, gets into Gaza. The UN. humanitarian office says that Israel is allowing just 4% of the daily average from before the conflict, which is just a fraction of what is needed right now.

Noor: A lot of people in the Western world don't realize that although Rafah crossing is on Egypt's side, Egypt doesn't really have much say. Ultimately, the end say comes from Israel. We've had trucks, thousands of trucks waiting at Rafah border with humanitarian aid, but Israel is not giving them the green light to go through.

How much did they let in, Mohammad?

Mohammed: It was only 20. And I think today they had another 15, but to put it into context. During regular times, quote unquote regular times, every day, gaza had 550 trucks getting into it. Of business or kind of food and supplies, fuel. But now imagine yourself getting from 550 to 20. That would be not enough.

When it comes to such circumstances, a lot of people think about emergencies. A lot of people think, oh, how will this hospital keep running? How would this hospital treat casualties?

But they mostly neglect the fact that people living with chronic conditions, such as diabetes, are in actual need of the supplies to be able to live. Because without insulin, people would die.

Noor: When they're thinking about, okay, what's the most important thing that whole population needs right now? They're going to send in the essentials, which is water, foods, canned goods. I'm pretty sure insulin is going to be at the very bottom of their list, because they're thinking, oh, it's a small portion of the population. But still, a life is a life. And we're asking for the very basic needs again, like we're not asking for anything outrageous.

Craig: Whenever there's a natural disaster or Ukraine, there was always this outpouring from the diabetes community for other diabetics, right? Do you guys feel like there's that same support for Palestinians?

Noor: No. Sorry. I'm just going to say it straight up. I'm not going to say everybody in the community, there's definitely been individuals who have been speaking up, fighting for Palestinian rights, standing alongside us, and have been amazing allies and comrades. But organizations? Straight up no.

Our whole life has been this just wanting someone to listen and acknowledge our humanity and our existence. But we are not given the same privileges or the same benefit of doubt that are given to other people in other community. And that in itself is also extremely dehumanizing.

Seeing the way people responded to other war or even natural crisis. But when it comes to the Palestinian cause, it's always complicated. Or it's always both sides. And the media is always so biased. And we can't have the time to mourn and just be sad about the situation because we need to continue doing the heavy work of educating people. Of explaining why we have the right to exist. That in itself is a heavy load.

I've lost a lot of people during this war, and that's not even mentioning the past years. I haven't had the time to just stop and mourn in peace and just be sad about it. You just gotta keep going and fighting because you know that your people on the ground are experiencing a hundred times worse than what you're going through.

These are humans. These are human lives. You can't pick and choose which lives are worthy of living and which are not.

Mohammed: The moment the Ukrainian Russian war started, Spare A Rose campaign was just declared and everybody was just supporting, and I'm not again talking about individuals, I'm talking about organizations and pharma companies that literally run the insulin world. And how everyone was running to support and, oh yeah, we stand with that and we stand with that but again, this is not happening at the moment in the Gaza Strip. This is not happening for diabetics in the Gaza Strip.

We've tried to contact them and they're not responding. And they say that, oh, our hands are tied. We can't do anything. Because they look at it as a political issue. We're talking about human rights. We're talking about access to health. And we're talking about something that is mentioned in the international law, in Geneva conventions. Access to healthcare is a human right. And every civilian, every person, should or must have access to that human right.

I'm not even talking about food and water, because Gazans at the moment don't have access to food and water. My family, my own family, my own parents, don't have access to food and water.

I'm in constant stress. I'm in constant worry about my family, about how they'll turn up. I wake up every day, every morning and spend two or three hours trying to contact them. My phone is never on silent mode because any moment, you could just hear a notification with something happening across the Gaza Strip, for example. Something close to your family. And that happens to me almost every night.

My family, my own family had to evacuate four times during the past 15 days. Four different places they had to go through, they had to live because they can't stay at that same place because there is no safe place in Gaza at the moment.

And we keep going around, humanitarian, people with diabetes, civilians, because everybody is affected. And everybody is in stress. Everybody is not safe.

And that's, again, of course, something that would trigger me, that would trigger any person with diabetes across the globe who would want to ensure that every person with diabetes must have access to the basic needs.

Noor: Yeah. And unfortunately there's this very strong notion that standing up for Palestinian rights means you're anti Israel and being anti Israel, they associate it with being antisemitic, which is completely a very dangerous and false narrative.

Every time me and Mohammed and other people in the T1D community talked about resources for Palestinians, it's always, Oh, why not for Israel? Do you guys not realize that they have universal health care? They have one of the most advanced health care systems in the world when we don't even have that in the U.S. And this is our tax money.

The U.S. tax money, billions every year go to Israel when they have universal health care. And we don't have access to, like most people don't have access to basic health care in the U.S. One in four people are rationing their insulin in the U.S. So just because we're saying we need to get together and help the people with type one diabetes in Palestine or in Gaza does not mean that we don't think that the people with type one diabetes in Israel are not worthy of insulin access or getting insulin. They have their insulin. So it's like, standing up for Palestinian rights does not mean that you're anti Semitic or anti Israel. And that's just creating a lot of confusion and hate and impacting the access of basic needs and health care to the people who really need it.

Craig: You can't have insulin for all if it's not for all.

Noor: Yeah and unfortunately as disheartening as it is, it's not something that's new to us. Even just the simple things as saying we have freedom of speech in America, every single Palestinian that lives in America knows that does not apply to us. Even me, being on this podcast with you, I am risking possibly my livelihood.

But again, Palestinian people are super resilient. We have lost enough and you know what? We're ready to lose a lot more to fight for what is right. And that's a risk that I'm willing to take and so many Palestinians are willing to take, but this is how we're trying to be silenced and we won't let them silence us.

These are our basic human rights.

Mohammed: That's why it is important to talk. That's why it's important to express. That's why it is important to advocate. And that's something that we've been doing as people living with diabetes.

For me personally, advocating for the rights of people with diabetes got us into the Gaza Strip to get insulin analogs, even if it's not sustainable, but at least it's something that we've been having for the past couple of years in Gaza. And me advocating about diabetes has allowed me to educate others living with diabetes in the Gaza Strip and maybe across other countries as well. And it gave me the point to be able to sit with policy makers and decision makers to actually change how the healthcare system works. And that's why it is important, because you could change things with your voice and you have the ability to do it. So you have to be loud. You have to keep fighting for your rights, for your life, for your health, because otherwise no one would just listen to you.

Because we're living in, sorry to say it this way, in a world full of greed. And if you're not actually doing things for yourself and for the people that you support and for the people you feel for, then no one else would.

Craig: If someone's listening to this and they come away thinking, I want people in Gaza to have access to insulin, to test strips, to CGMs, to water and food. What can they do?

Noor: People in the U.S. have a lot more power than they realize. Your votes matter and who you vote for matters a lot. UNRWA is an arm, a branch from the United Nations. They get majority of their funding from the U.S. And over the past decade, the U.S. has been drastically cutting the funding to UNRWA. And UNRWA is specifically for Palestinians and refugees.

And they've been significantly cutting the funding for that and funneling fundings into wars. So voting, contacting your rep, your congresspeople, speaking up, protesting. I know sometimes it feels performative. I know sometimes you feel like it's not doing much, but it does. If we just keep applying pressure hopefully we'll be able to make a change.

Mohammed: You need to humanize everyone. Look into every human being with the same eye. Understand their needs. Put yourself in their shoe. Just to know how do they feel, or how do they spend their days in such circumstances.

And by then you definitely understand and feel. And in doing so, of course, you'll be educating yourself. You'll be raising awareness for yourself, for the people around you. And you'll be able to use your voice to support those who can't use their voice at the moment. To give them maybe some hope that the world is equal and that the world is standing with your needs, with the humanitarian needs, with your right to live a happy, fulfilling, healthy life.

PCRF a non-profit on the ground is collecting diabetes supplies to help children in Gaza.

If you have long or short acting, insulin vials or pens, syringes, test strips, or meters, that don't expire for at least six months, there's a group of diabetics in the U S collecting them to donate. For info on where to send supplies, email aid@betacellfoundation.org.

Beta cell is produced, recorded, and edited by me, Craig Stubing. And our theme music is by Purple Glitter.

Special thanks to my good friend Saira for putting me in touch with Noor and Muhammad.

I know it's been a while since our last episode, but that doesn't mean I haven't been doing anything. If you're interested in free diabetes meetups, including all inclusive camping trips to National Parks, check out the Beta Cell Foundation at betacellfoundation.org. Or if pressuring U.S. Congresspeople into lowering the cost of insulin for everyone in the United States is more up your alley, check out what we've been building at Beta Cell Action at betacellaction.org.

And if you appreciate podcast episodes like this one, we still have a Patreon that you can support. Find that in the show notes too.

I'm Craig Stubing, and this is Beta Cell.