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‘We will see patients dying and falling in the street’: Tigray could run out of insulin within days

  • The war in Ethiopia caused catastrophe in the country’s northern Tigray region, where fighting between rebels and the government broke out in late 2020.
  • A truce halted the hostilities in May, which allowed humanitarian groups to provide people in Tigray with food and medicine. But by August, the ceasefire broke down, cutting the region off from help once again.
  • Now, hospitals in Tigray are running out of insulin, a medicine that helps people with diabetes to control their blood sugar levels. The shortage could be fatal, especially for those with type 1 diabetes who require a daily dose of the drug. Health workers predict that patients will die in the streets if nothing is done.

Doctors at the biggest hospital in Tigray say they have just days’ supply left of insulin, as the resumption of fighting between rebels and Ethiopian government troops once again cuts off supplies to the region.

In what the head of the International Diabetes Federation (IDF) has branded “a humanitarian crime,” medics at Ayder specialist referral hospital warn they have already run out of one kind of the life-saving medicine and have only a week’s supply of another.

Earlier this year, a cessation of hostilities in the bitter conflict between the Tigray People’s Liberation Front (TPLF) and federal troops allowed for the delivery of emergency supplies into the northern region, which until then had been languishing under what the United Nations termed a de-facto blockade.

Now, with fighting once again raging and both sides blaming the other for breaking the truce, humanitarian officials say they have been unable to get fresh supplies of either food or medicines into Tigray for a month. The region remains largely cut off from the rest of Ethiopia, without basic services such as electricity, communications and banking.

‘When we tell them there is no insulin, they are heartbroken’

“What we had at the hospital we were distributing to the patients, but especially this week, patients are coming and we tell them we don’t have insulin medications,” said a senior doctor, who did not want to be named for security reasons. “They are coming from very far places. Transport is not easy … So when they reach here and we tell them there is no insulin, they are heartbroken. They cry.”

The doctor said he was scared that Ayder hospital would see a repeat of last year, when supplies into Tigray were stopped for months. “We will see patients dying and falling in the street,” he said.

Andrew Boulton, president of the IDF and professor of medicine at the University of Manchester, called on Abiy Ahmed’s government to take urgent action so that insulin and other essential supplies could get to Tigray.

“This is really a sort of humanitarian crime,” he said. “Even at times of war, there are agreements that essential medications should get through to the population. And this appears not to be occurring at the moment, in the best evidence that I have.”

A second doctor at Ayder hospital said doctors in Tigray generally used two types of insulin: fast-acting, or regular, insulin and an intermediate-acting insulin known as NPH.

“What we have is a very [small] amount of the regular; we reserved that to manage acute complications of diabetes,” the doctor said. “Otherwise, the main insulin preparation for the patient is the intermediate-acting, which mimics physiologic insulin. We don’t have that one. It’s almost more than a month since we have finished the insulin.”

People with type 1 diabetes require daily insulin to control their blood glucose levels. Without this, their condition can rapidly prove fatal.

Thousands in Tigray may be thrust back to the 19th century

Boulton has written to the Ethiopian Health Minister, Lia Tadesse Gebremedhin, urging her to end the “ongoing regulatory and security obstacles” that are “endangering the lives of the many thousands of people living with chronic and noncommunicable conditions, including diabetes”.

More than 6 000 people were being treated for type 1 diabetes throughout the region before the war began, about 2 500 of them at Ayder.

In the letter, seen by the Guardian, Boulton urges the government to “fully comply with international law and ensure the necessary humanitarian access” to support vulnerable populations in Tigray.

He said the outlook for type 1 diabetes patients in Tigray was “terrible, as we used to see in the 19th century [before the discovery of insulin]”.

“I’m not involved politically [in the conflict] on either side,” he told the Guardian. “But as president of IDF, especially at this time – it is 100 years, this year, since the first successful insulin injection was given in Toronto – our aim is that nobody, anywhere in the world, should die because they cannot get the treatments they need.”

The rebels or the Ethiopian government – who’s to blame?

The government denies placing Tigray under blockade, blaming the TPLF for making aid delivery too dangerous. The UN’s World Food Programme (WFP), which has delivered all humanitarian cargo into the region on behalf of the World Health Organisation, Médecins Sans Frontières and others, has also in the past accused the rebels of seizing its fuel, and for a long time refusing to return its aid trucks.

The International Committee of the Red Cross (ICRC) was able to start airlifting in some supplies of insulin and other medicines, with the support of the ministry of health, in January, after the IDF and others raised concerns about pharmaceutical stocks.

On Thursday, a spokesperson for the ICRC said that all its flights and humanitarian convoys to Tigray had been suspended “until further notice” since the resumption of hostilities. WFP has not been able to lead a convoy into Tigray since 22 August.

Fighting erupted between the TPLF and government forces in late August. The TPLF said federal troops and their allies had launched a big offensive towards southern Tigray. The government, however, accused the TPLF of striking first.

This feature was originally published by The Guardian’s global development project part of Guardian News & Media Ltd.

Lizzy Davies writes about global development for The Guardian. Previously she was The Observer's head of news.