Bags of ice and wet towels have become the emergency lifelines for Sudanese diabetics struggling to keep their insulin cool while waiting in extreme heat as they try to escape the recent violence.
A vital medication for many diabetics, insulin must be kept cool to remain effective, But since fighting broke out between the Sudanese army and paramilitary Rapid Support Forces last month, hospitals and pharmacies have forced to close and there has been damage to cold-storage facilities.
Now, alongside the challenge of procuring insulin, those on the country’s borders are being left in chaotic queues for days as they try to escape, with no way to refrigerate their medicine and with scant medical care.
“It was very stressful because me and my sister are insulin dependent. I’m a type 1 diabetic and having working insulin is really a must for me. My entire body was shutting down because we didn’t have enough food for the kids and had to ration,” said Arwa Zaki Mustafa, 32.
After the RSF had surrounded her neighbourhood, Mustafa and her family headed for the Egyptian border but faced several long waits to get out of Khartoum and then again at the border.
She was fortunate enough to have replenished her insulin supplies before the fighting broke out, but had to protect it from the 40C heat. When they left, she took a freezable gel pack and kept her insulin pens in her nephew’s lunchbox. Along the way she would buy bags of ice wherever she could.
“[At the border] we were stuck outside for 12 hours and that was when I realised my gel was starting to melt. We stayed there for 27 hours and there wasn’t much water but what I found I used to wet some towels to wrap the insulin in and tried to keep it out of the sun,” she said.
Injected insulin helps those whose bodies do not produce enough, or cannot effectively use it, to convert sugar in the blood into fuel for the body. In some cases, a lack of insulin can lead to potentially fatal diabetic ketoacidosis, when dangerous substances called ketones are released in the blood as a result of the body converting fat for fuel because it cannot process the sugar.
Mustafa said she reduced her insulin intake because of the uncertainty of supply and that many other diabetics were doing the same. In some cases, people hadn’t eaten for days for fear of raising their blood sugar level.
Afnan Hassab, a Sudanese doctor who worked at a Khartoum hospital until it was forced to close by the fighting, said insulin access has been a concern since the conflict began and is a problem for those fleeing.
“Some of the older women with me on the bus were taking insulin and they were carrying bags of ice to put their insulin in. The trip was so long and so hot the plastic handles on my bag stretched out. You can only imagine what is happening to the insulin people are trying to preserve,” she said.
Hassab said that with many pharmacies damaged, closed or out of reach for people near the fighting, there has been a desperate search for medication. Social media has become a vital resource for those in search of insulin, allowing them to make requests or get information on which pharmacies have stock. Some who have access to it have also offered to help those in need.
“It’s very concerning and scary. I’ve seen people looking for insulin, epilepsy drugs, hypertension medication, for pain medication. People have been looking everywhere,” said Hassab. “I think a lot people are going to die. It’s a very sad and gruesome thing to say but it’s true. I’ve already seen cases of diabetic ketoacidosis, where people were not able to reach hospital so they died.”
Unicef, the UN children’s agency, said power cuts have damaged cold-storage facilities used to stock insulin for children. The Wad Medani teaching hospital has warned that 1,400 children are at risk of dying because of a lack of insulin.
Dr Nahreen Ahmed, medical director for MedGlobal, a charity that provides primary healthcare in crisis-hit areas, said treatment for long-term conditions such as diabetes or heart disease are often not prioritised in humanitarian situations but can very quickly prove fatal. “When somebody is dependent on insulin [they] will become critically ill and it happens very fast,” she said. “Within a day, somebody who is without insulin can become so sick that they’re potentially in a diabetic coma or become severely anaemic in certain situations.”.
Ahmed added that greater priority needed to be given to people with chronic illnesses to receive medication as they crossed borders and also to allow them to enter the health systems in neighbouring countries, as many Ukrainian refugees were able to do in the past year.
“It made a huge difference that people could get out and were inserted immediately into the health system in Poland. It was almost unheard of, it’s not what happened with refugees from Syria, Palestine or Sudan.
“If things like that are in place in neighbouring countries and borders are allowing people to cross and seek asylum, it’s absolutely better for patients with chronic medical problems, because it just allows immediate access to some version of healthcare.”