Editorial
Ukraine: diabetes on the front line
The crisis in Ukraine is evolving rapidly, with 2 million
people estimated to have fled the country as of
March 8 and many more facing unimaginable danger and
uncertainty. Despite some advances made in Ukraine’s
attempts to transform and modernise its health system,
Ukrainian citizens still face large inequalities in health-
care services, inadequate access to medical supplies
and equipment, and have the lowest life expectancy
compared to all other European countries. In a country still
struggling with the burden of the COVID-19 pandemic,
the Russian invasion of Ukraine has further disrupted
medical services, including diabetes care.
7∙1% of the Ukrainian adult population lives with
diabetes and non-communicable diseases are the
leading case of premature death. With the number of
refugees increasing daily and insulin supplies already
running low, how long will it be until the situation in
Ukraine causes catastrophic problems in diabetes care as
other humanitarian crises have done before?
The latest UN figures show that an unprecedented
82∙4 million people were displaced by conflict or disaster
at the end of 2020. In the Lancet Diabetes & Endocrinology,
Kehlenbrink and colleagues examined diabetes care in
refugee camps, rural and urban non-camp sites, and
internally displaced people camps, and found that the
majority lacked diabetes training for health-care workers
and lacked access to diabetes medications, with 34% not
providing insulin. Access can also be difficult for refugees
in non-camp settings. A 2018 health survey by the UN
Refugee Agency found that of the 80% of Syrian refugees
living outside of camps in Jordan, 19% had diabetes and
74% of those with chronic conditions could not obtain
medicines mainly due to cost.
Those who remain in areas of conflict face hospitals
and pharmacies running out of supplies, being attacked,
or closing. In Ukraine, reports have emerged of hospitals
being destroyed through missile strikes, and many
paediatric and maternity units have been forced to go
underground for safety while stocks of critical supplies,
including insulin, are running dangerously low. Lack of
timely intervention and access to diabetes care causes
serious long-term health consequences, which can be
fatal. The protracted conflict in Yemen, for example, has
resulted in approximately half the county’s health facilities
being out of service and a quarter of limb amputations at
www.thelancet.com/diabetes-endocrinology Vol 10 April 2022
International Committee of the Red Cross centres are due
to diabetes.
However, diabetes management is so much more
than access to medications. Controlling diet and lifestyle
factors is often not only impractical but unfeasible
in emergency settings where the cost of daily staples
increases exponentially, food aid (focussed on providing
Shutterstock
sufficient caloric intake) is primarily composed of
carbohydrate-heavy food groups, and large, open, safe
spaces to exercise are hard to come by. Published Online
March 9, 2022
Despite improved diabetes care in humanitarian settings, https://doi.org/10.1016/
getting essential supplies to people in need during S2213-8587(22)00084-5
emergency situations is still fraught with difficulty. WHO, For more on European health
and life expectancy see https://
includes insulin, glucometers, and urine tests strips in gateway.euro.who.int/en/
their interagency emergency health kits and international indicators/hfa_43-1010-life-
expectancy-at-birth-years/
food agencies are implementing schemes to manage visualizations/#id=19363
more complex long-term nutritional require­ments, but For more stats on diabetes in
Ukraine see https://idf.org/our-
such advancements have limited impact if they are unable network/regions-members/
to reach the populations in need. Logistic experts from europe/members/164-ukraine.
html
WHO, Médecins Sans Frontières, and other humanitarian
For more on the WHO
organisations are setting up opera­tional hubs and trying Emergency in Ukraine –
to secure land corridors to facilitate rapid movement of Situation Report see https://
www.who.int/publications/m/
supplies in Ukraine, but considerable barriers, including item/emergency-in-ukraine---
active combat, damage to roads and transportation, situation-report-1
For more on diabetes care in
and martial law, remain. Novo Nordisk recently stated refugee camps see
that although their warehouses storing insulin are still in Correspondence
Lancet Diabetes Endocrinol 2022;
operation within Ukraine, deliveries have been affected 10: 159-62
due to shortages in driving staff. Further­more, at the time For more on access to
of writing, WHO has announced that their prepositioned healthcare services among
Syrian refugees in Jordan see
supplies in Kyiv are currently inaccessible due to ongoing https://reliefweb.int/sites/
military operations, high­ lighting the stark reality and reliefweb.int/files/
resources/68539.pdf
arduous practicality of delivering health-care aid.
For more on the International
The impact of humanitarian crises is often measured Committee of The Red Cross
aid in Yemen see https://www.
in terms of crude mortality rates. However, although a icrc.org/en/where-we-work/
useful indicator of excess avoidable deaths, this does middle-east/yemen/health-
crisis-yemen
not portray the possible consequences a disruption
For more on Novo Nordisk’s
to chronic disease management might have. The update on the invasion of
humanitarian disaster in Ukraine is unfolding at a Ukraine see https://www.
novonordisk.com/news-and-
rapid rate. Although the more robust health-care media/critical-updates.html
systems of the countries hosting Ukrainian refugees
might currently reduce the risk of diabetes care
mismanagement, there will be a greater cost to human
life than predicted if diabetes and chronic conditions are
not adequately managed in acute emergency settings.
■ The Lancet Diabetes & Endocrinology
231