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War in Syria

Diabetes is manageable–unless you live in Syria

A health system broken by war leaves Syrians like 65-year-old Miriam to cope with unchecked chronic disease.

Miriam*, 65, spends her days sitting on a floor mat in her brother’s home, massaging her swollen arms and legs. She lives in a village set among sweeping green fields in northeast Syria. When war descended over two years ago and armed fighters closed in, her family fled. They returned late last year after local authorities secured the area, but at that point, Miriam could barely walk.

“For two years, we moved between villages. We stayed in one place until fighting started. Then we left again.” Miriam sighs and rubs her tingling foot. “I tried to take care of my diabetes. Sometimes I even got free medicine. But it just got worse.”

Diabetes shouldn’t have become a disability for Miriam.

Diabetes can be managed. It’s a chronic disease, marked by the body’s inability to either produce or effectively use insulin to control blood sugar levels. The key to staying healthy? Maintaining consistent blood sugar over time with regular monitoring and medication. But forced from her home and moving for two years, Miriam’s routine was shattered.

An IRC nurse checks a patient’s blood pressure during a mobile clinic day in northeast Syria. IRC mobile medical units provide some of the first health care and medicines that communities have had in two years. Teams use mosques, schools and even abandoned buildings as makeshift clinic spaces.

Photo: IRC

“When the gun battles started, we went to another town and lived in an old school,” explains Abdullah, Miriam’s brother. “Life there was very bad. Miriam’s health deteriorated a lot. Medications were sort of available, but not all the time. We never had enough money.”

Left unchecked, diabetes can lead to blindness, damage to extremities requiring amputation, and kidney failure. Miriam’s illness and the war also cause incredible stress on the family as Abdullah struggles to provide her with round-the-clock care. He and his 10-year-old daughter Amal are Miriam’s primary caregivers.

In the morning, Amal helps Miriam use the bathroom,” Abdullah says. “We give her breakfast and medicine. We are with her day and night, helping her eat, move, take her medication.” He runs his hands through his thinning hair and over his face. “Amal had to leave school to help my sister.”

According to the World Health Organisation, 1 out of every 10 Syrians has diabetes. That’s 1.8 million people forced to manage their condition in a war zone.

Before conflict erupted, Syria had a network of clinics specialising in diabetes care. Today, most health infrastructure is in ruins, including the few facilities serving rural areas. Oral medication and insulin, once free, can now cost $25 a month or more. Unreliable electricity and refrigeration have rendered much of the insulin supply useless. International Rescue Committee staff say that some families bury insulin in the ground to keep it cool.

Mobile clinics restore health for rural Syrians

A health system broken by war leaves Syrians desperate for care.

  • Syria’s public health system, once a strong network of primary and specialty care facilities, has been decimated by years of war. Clinics and hospitals are in ruins, and pharmaceutical production has stopped. Over 70 percent of the health workforce has fled the country. 

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  • Families move from village to village seeking safety, work and schooling for their children. Many have gone for years without access to health care or medication. Parents have had to deal with their children’s fevers, diarrhoea and infections with no safety net if their health deteriorates. Once-healthy adults now face severe disability from unchecked disease, stress and trauma.

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  • IRC mobile health teams are providing lifesaving care and medication twice a month to remote villages and tent cities across Syria. “The destruction is massive, and so is the damage to people’s health,” says one doctor. “Our mobile clinics are providing some of the first health care and medication people have had in over two years, free of charge.”

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  • Each mobile clinic comprises a doctor, nurse, midwife and pharmacist to provide primary and reproductive care. Teams use a room in a mosque, a school, or even someone’s home to conduct exams and dispense medication—in the most damaged villages, they turn abandoned buildings into makeshift clinic space. Two mobile clinics cover about 20 villages across the rural northeast and have reached over 8,000 patients since early 2017. 

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  • A mother gets medicine and instructions from an IRC pharmacist during a clinic day. Syria once produced 90 percent of its own pharmaceuticals; today, there is a shortage of essential medicines, and what is available in the market comes at a high price. “For two years, we moved between villages to avoid fighting,” says one patient. “Medications were sort of available, but not all the time. We never had enough money.” 

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  • As the battle for ISIS-controlled Raqqa intensifies, families are fleeing to roadside camps and settlements. Many need emergency care. An IRC mobile unit recently treated 500 people from Raqqa for diarrhoea, respiratory infections and skin conditions like leishmaniasis (above). Caused by sand flies, leishmaniasis often afflicts people suffering from malnutrition and weak immunity. Left untreated, the condition can affect internal organs.

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  • The IRC is training a network of community health workers to carry out regular visits to households in remote villages where displaced people are returning to their homes. Community health workers build trust among clients and provide health education and referrals to IRC mobile clinics. Patients such as Miriam (above), a 65-year-old homebound woman in northeastern Syria, now have access to vital medication—for Miriam, drugs to control her diabetes—and can get regular checkups. The IRC also provided Miriam with a wheelchair. 

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  • Abdulrahman, a farmer, gently places a breathing mask on his son Jamil’s face. The IRC mobile clinic provided the mask and special medication to help Abdulrahman manage Jamil’s asthma. “If the clinic did not come to us, it would be very hard,” he says. “What if we needed a doctor? We would have to go at least 100 kilometers [60 miles] to the nearest city just to get help.”

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  • Restoring health is a slow process, but the IRC is filling a critical gap in care for Syrians who no longer have access to their country’s once-strong public health system. Our mobile clinics are responding to acute emergencies in the south, north and northeast regions while establishing regular primary, reproductive and chronic-disease care in communities trying to rebuild. For families who’ve lived for years with little safety or stability, mobile services provide new connection—and new hope.

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“The destruction in these villages is massive, and so is the damage to people’s health,” says one IRC doctor. “Try managing a chronic disease when you’ve lost your home, your job, and are struggling to find safe shelter and food—it’s impossible. Our mobile clinics are providing some of the first health care and medication people have had in over two years, free of charge.” 

Funded by EU humanitarian aid, the IRC deploys mobile teams—each with a doctor, nurse, midwife and pharmacist—to provide primary and reproductive care to Syrian villages. One team comes to Miriam’s village twice a month, using classrooms in a crumbling school to conduct exams and dispense medications. Miriam is one of 265 patients with diabetes in this rural area who receive medication, blood sugar monitoring and home visits from the IRC.

“The clinic has been coming here for four months,” says Miriam. “They give me my pills and visit me at home.” To build trust with families and improve their care, IRC community health workers make regular home visits to provide health education and psychological support. They monitor Miriam’s blood sugar, and help her family track her medication. And they listen to Miriam talk about the “nightmare”—returning after two years to find her house completely destroyed.

“I tried to take care of my diabetes, but it just got worse.” For two years, Miriam, 65, was displaced by fighting between armed groups in northeast Syria. Unable to get care or medication, her blood sugar went unchecked, with dire consequences.

Photo: IRC

Restoring health is a slow process, especially for a patient like Miriam who has such advanced diabetes. She needs more than just medication to weather her disease and the aftermath of war. But with EU aid, the IRC is filling a critical gap in care for Syrians with diabetes, as well as those with heart disease, asthma and other chronic conditions. Mobile services provide new connections and new hope for villagers.

“I dream about doing all of the activities I love to do,” says Miriam. “But at least people come to visit me. I am so grateful for what you are doing.” She smiles at the IRC community health worker who’s come to see her this morning.

“I hope I can get stronger. I hope the village gets stronger, too.”

The International Rescue Committee works across Syria, providing services that improve family health and economic wellbeing, civilian safety, and children’s education and stability. Supported by European Union Civil Protection and Humanitarian Aid, the IRC reaches thousands of patients via clinics and mobile teams with primary and reproductive care, essential medicines and health education.